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<1>
Accession Number
619004332
Author
Jonokuchi A.J.; Knopman J.; Radwanski R.E.; Martinez M.A.; Taylor B.E.S.;
Rothbaum M.; Sullivan S.; Robison T.R.; Lo E.; Christophe B.R.; Bruce
E.M.; Khan S.; Kellner C.P.; Sigounas D.; Youngerman B.; Bagiella E.;
Angevine P.D.; Lowy F.D.; Sander Connolly E.
Institution
(Jonokuchi, Radwanski, Martinez, Taylor, Robison, Lo, Christophe, Bruce,
Kellner, Youngerman, Angevine, Sander Connolly) Department of Neurological
Surgery, Columbia University College of Physicians and Surgeons, 710 W
168th Street, New York, NY 10032, United States
(Knopman, Rothbaum, Sigounas) Department of Neurological Surgery, Weill
Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065,
United States
(Sullivan, Khan, Lowy) Department of Pathology and Cell Biology, Columbia
University College of Physicians and Surgeons, 630 W 168th Street, New
York, NY 10032, United States
(Bagiella) Center for Biostatistics, Department of Population Health
Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place,
New York, NY 10029, United States
Title
Topical vancomycin to reduce surgical-site infections in neurosurgery:
Study protocol for a multi-center, randomized controlled trial.
Source
Contemporary Clinical Trials. 64 (pp 195-200), 2018. Date of Publication:
January 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical-site infections (SSIs) account for 20% of all
healthcare-associated infections, are the most common nosocomial infection
among surgical patients, and are a focus of quality improvement
initiatives. Despite implementation of many quality care measures (e.g.
prophylactic antibiotics), SSIs remain a significant cause of morbidity,
mortality, and economic burden, particularly in the field of neurosurgery.
Topical vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. However, a randomized controlled trial assessing its efficacy in the
general neurosurgical population has yet to be done. The principle aim of
"Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is
to determine whether prophylactic, topical vancomycin reduces the risk of
SSIs in the adult neurosurgical population. This prospective, multicenter,
patient-blinded, randomized controlled trial will enroll patients to
receive the standard of care plus topical vancomycin, or the standard of
care alone. The primary endpoint of this study is a SSI by postoperative
day (POD) 30. Patients must be over 18 years of age. Patients are excluded
for renal insufficiency, vancomycin allergy, and some ineligible
procedures. Univariate analysis and logistic regression will determine the
effect of topical vancomycin on SSIs at 30 days. A randomized controlled
trial is needed to determine the efficacy of this treatment. Results of
this trial are expected to directly influence the standard of care and
prevention of SSIs in neurosurgical patients.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<2>
Accession Number
619925093
Author
Baystrukov V.I.; Kretov E.I.; Boukhris M.; Osiev A.G.; Grazhdankin I.O.;
Biryukov A.V.; Najjar H.; Verin V.V.; Zubarev D.D.; Naryshkin I.A.;
Bogachev-Prokophiev A.V.; Mashayekhi K.; Galassi A.R.; Prokhorikhin A.A.
Institution
(Baystrukov, Kretov, Grazhdankin, Zubarev, Naryshkin, Bogachev-Prokophiev,
Prokhorikhin) E.N. Meshalkin Siberian Federal Biomedical Research Center,
Novosibirsk 630090, Russian Federation
(Osiev) Moscow Regional Research and Clinical Institute ('Moniki'),
Moscow, Russian Federation
(Biryukov) Pavlov First Saint Petersburg State Medical University, Saint
Petersburg, United States
(Verin) Primorskiy Regional Hospital No. 1, Vladivostok, Russian
Federation
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
(Galassi) Department of Clinical and Experimental Medicine, University of
Catania, Catania, Italy
(Galassi) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Boukhris, Najjar) Department of Cardiology, Abderrahmen Mami Hospital,
Ariana, Tunisia
(Boukhris, Najjar) Faculty of Medicine of Tunis, University Tunis El
Manar, Tunis, Tunisia
Title
A randomized trial of bifurcation stenting technique in chronic total
occlusions percutaneous coronary intervention.
Source
Coronary Artery Disease. 29 (1) (pp 30-38), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The optimal strategy to treat bifurcation lesions (BFLs) in a
percutaneous coronary intervention (PCI) for chronic total occlusions
(CTOs) remains unknown. Aims We sought to assess whether T-provisional or
mini-crush is appropriate for BFLs within CTO vessels. Patients and
methods From January 2011 to December 2013, patients who underwent
successful CTO guidewire crossing and with a BFL within the CTO target
vessel were enrolled prospectively and assigned randomly to either
T-provisional stenting or the mini-crush technique for BFL treatment.
One-year clinical follow-up was performed. Major adverse cardiac and
cerebrovascular events (MACCE) were defined as the composite of
cardiovascular death, myocardial infarction, target vessel
revascularization, and stroke. Results The prevalence of BFLs was 54.3%. A
total of 146 patients with BFLs within CTO vessel were enrolled
prospectively and assigned randomly to either T-provisional stenting
(N=73) or the mini-crush technique (N=73). Angiographic and clinical
success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27)
and 91.8 versus 94.5% (P=0.67), respectively. Although T-provisional
stenting was associated with a nonsignificantly lower incidence of MACCE
in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the
mini-crush technique resulted in higher MACCE-free survival at 1 year in
the presence of BFLs within the CTO body or close to the proximal or the
distal cap (89.1 vs. 64.9%; P=0.007). Conclusion The mini-crush technique
appeared to be associated with improved 1-year clinical and angiographic
outcomes, particularly when used to treat BFLs located within the CTO body
or close to the proximal or the distal cap.<br/>Copyright &#xa9; 2017
Wolters Kluwer Health, Inc. All rights reserved.

<3>
Accession Number
619534264
Author
Fender A.C.; Rauch B.H.; Geisler T.; Schror K.
Institution
(Fender, Schror) Institut for Pharmakologie and Klinische Pharmakologie,
Klinikum der Heinrich-Heine-Universitat Dosseldorf, Mendelstr. 11, Monster
48149, Germany
(Fender) Experimentelle Hamostaseologie, Klinik for Anasthesiologie,
Universitatsklinikum Monster, Monster, Germany
(Rauch) Center of Drug Absorption and Transport (C-DAT), Institut for
Pharmakologie, Universitatsmedizin Greifswald, Greifswald, Germany
(Geisler) Medizinische Klinik III, Kardiologie Klinikum der
Eberhard-Karls-Universitat Tobingen, Tobingen, Germany
Title
Protease-Activated receptor PAR-4: An inducible switch between thrombosis
and vascular inflammation?.
Source
Thrombosis and Haemostasis. 117 (11) (pp 2013-2025), 2017. Date of
Publication: 2017.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Thrombin triggers activation of platelets through protease-Activated
receptor 1 (PAR-1) and PAR-4. Both receptors are widely expressed and
exert multiple platelet-independent functions. PAR signalling contributes
to healing responses after injury, by promoting cytokine activity and
cellular growth and mobility. Uncontrolled PAR activation, however, can
prevent timely resolution of inflammation, enhance thrombogenic
endothelial function and drive adverse remodelling. The specific role of
PAR-4 in thromboinflammatory vascular disease has been largely
underestimated, given the relatively limited expression of PAR-4 in
non-platelet cells under healthy conditions. However, unlike PAR-1, PAR-4
expression adapts dynamically to numerous stimuli associated with
thromboinflammation, including thrombin, angiotensin II,
sphingosine-1-phosphate (S1P), high glucose and redox stress, suggesting
expression is switched on 'at need'. Prostacyclin negatively regulates
PAR-4 expression at the post-Transcriptional level, which may serve to
fine-Tune thrombin responses and limit these to the injury site. PAR-4
elicits inflammatory, mitogenic and proliferative actions not only in
response to thrombin but also to numerous other inflammatory proteases,
and can cross-Talk with other receptor systems such as S1P and adenosine
receptors. Accordingly, PAR-4 has emerged as a candidate player in vessel
disease and cardiac post-infarction remodelling. Currently, PAR-4 is a
particularly promising target for safer anti-Thrombotic therapies. Recent
studies with the PAR-4 antagonist BMS-986120 lend support to the concept
that selective antagonism of PAR-4 may offer both an effective and safe
anti-Thrombotic therapy in the acute thrombotic setting as well as an
anti-inflammatory strategy to prevent long-Term progressive
atherosclerotic disease in high-risk cardiovascular
patients.<br/>Copyright &#xa9; 2017 Schattauer.

<4>
Accession Number
619949956
Author
Zhang Z.J.; Zheng M.L.; Nie Y.; Niu Z.Q.
Institution
(Zhang, Zheng, Nie, Niu) Department of Anesthesiology, The Cangzhou
Central Hospital, Cangzhou, Hebei, China
Title
Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with
left-sided double-lumen endobronchial tube in one-lung ventilation in
thoracic surgery in the morbidly obese.
Source
Brazilian Journal of Medical and Biological Research. 51 (2) (no
pagination), 2018. Article Number: e6825. Date of Publication: 2018.
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
This study aimed to evaluate the feasibility and performance of
Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway
(LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in
morbidly obese patients in one-lung ventilation (OLV). In a prospective,
randomized double-blind controlled clinical trial, 80 morbidly obese
patients (ASA I-III, aged 20-70) undergoing general anesthesia for
elective thoracic surgeries were randomly allocated into groups Arndt
(n=40) and L-DLT (n=40). In group Arndt, a LMATM Proseal was placed
followed by an Arndt-endobronchial blocker. In group L-DLT, patients were
intubated with a left-sided double-lumen endotracheal tube. Primary
endpoints were the airway establishment, ease of insertion, oxygenation,
lung collapse and surgical field exposure. Results showed similar ease of
airway establishment and tube/device insertion between the two groups.
Oxygen arterial pressure (PaO<inf>2</inf>) of patients in the Arndt group
was significantly higher than L-DLT (154+/-46 vs 105+/-52 mmHg; P<0.05).
Quality of lung collapse and surgical field exposure in the Arndt group
was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05).
Duration of surgery and anesthesia were significantly shorter in the Arndt
group (2.4+/-1.7 vs 3.1+/-1.8 and 2.8+/-1.9 vs 3.8+/-1.8 h, respectively;
P<0.05). Incidence of hoarseness of voice and incidence and severity of
throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h
after surgery were significantly lower in the Arndt group (P<0.05).
Findings suggested that Arndt-endobronchial blocker combined with LMA can
serve as a promising alternative for morbidly obese patients in OLV in
thoracic surgery.<br/>Copyright &#xa9; 2018, Associacao Brasileira de
Divulgacao Cientifica. All rights reserved.

<5>
Accession Number
620017091
Author
Lee J.E.; Kim H.Y.; Kim J.
Institution
(Kim, Lee) Department of Anesthesiology and Pain Medicine, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Kim) Biostatistics Collaboration Unit, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro,
Seodaemun-gu, Seoul 03722, South Korea
Title
Volatile sedation in the intensive care unit: A systematic review and
meta-analysis.
Source
Medicine (United States). 96 (49) (no pagination), 2017. Article Number:
e8976. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Volatile sedation in the intensive care unit (ICU) may reduce
the number of adverse events and improve patient outcomes compared with
intravenous (IV) sedation. We performed a systematic review and
meta-analysis comparing the effects of volatile and IV sedation in adult
ICU patients. Methods: We searched the PubMed, Embase, Cochrane Central
Register, and Web of Science databases for all randomized trials comparing
volatile sedation using an anesthetic-conserving device (ACD) with IV
sedation in terms of awakening and extubation times, lengths of ICU and
hospital stay, and pharmacologic end-organ effects. Results: Thirteen
trials with a total of 1027 patients were included. Volatile sedation
(sevoflurane or isoflurane) administered through an ACD shortened the
awakening time [mean difference (MD), -80.0-minutes; 95% confidence
intervals (95% CIs), -134.5 to -25.6; P = .004] and extubation time (MD,
-196.0-minutes; 95% CIs, -305.2 to -86.8; P < .001) compared with IV
sedation (midazolam or propofol). No differences in the lengths of ICU and
hospital stay were noted between the 2 groups. In the analysis of cardiac
effects of sedation from 5 studies, patients who received volatile
sedation showed lower serum troponin levels 6-hours after ICU admission
than patients who received IV sedation (P < .05). The effect size of
troponin was largest between 12 and 24-hours after ICU admission (MD,
-0.27-mug/L; 95% CIs, -0.44 to -0.09; P = .003). Conclusion: Compared with
IV sedation, volatile sedation administered through an ACD in the ICU
shortened the awakening and extubation times. Considering the difference
in serum troponin levels between both arms, volatile anesthetics might
have a myocardial protective effect after cardiac surgery even at a
subanesthetic dose. Because the included studies used small sample sizes
with high heterogeneity, further large, high-quality prospective clinical
trials are needed to confirm our findings.<br/>Copyright &#xa9; 2017 the
Author(s). Published by Wolters Kluwer Health, Inc.

<6>
Accession Number
619949738
Author
Pilmore H.; Webster M.; Sidhu K.; Srikumar G.
Institution
(Pilmore) Department of Renal Medicine, University of Auckland, Auckland,
New Zealand
(Webster) AucklandNew Zealand
(Sidhu) Auckland City Hospital, Auckland, New Zealand
(Srikumar) University of Auckland, Auckland, New Zealand
Title
Management of coronary artery disease in patients on dialysis.
Source
New Zealand Medical Journal. 130 (1467) (pp 11-22), 2017. Date of
Publication: 15 Dec 2017.
Publisher
New Zealand Medical Association (26 The Terrace, P.O. Box 156, Wellington
6140, New Zealand)
Abstract
AIMS: Coronary artery disease is common in patients with end-stage renal
failure (ESRF). However, there is little evidence that revascularisation
improves outcomes, compared with medical management. This study assessed
survival and cardiovascular outcomes in patients with ESRF undergoing
coronary angiography and then having coronary artery bypass gra (CABG)
surgery, percutaneous coronary intervention (PCI) or medical management.
METHODS: Survival and major adverse cardiac events (MACE) were examined in
all patients with ESRF who underwent coronary angiography at Auckland City
Hospital between 2003 and 2012. Outcomes of patients who underwent
revascularisation (CABG or PCI) were compared with those managed
medically. RESULTS: Two hundred and eighty-eight patients with ESRF had a
total of 382 diagnostic coronary angiograms. Ninety-one (32%) patients
underwent revascularisation (61 PCI, 30 CABG), with the other 197 (68%)
treated medically or requiring no specific cardiac treatment. The median
survival was 3.3 (IQR 2.1-5.3) years in patients undergoing CABG, 2.9 (IQR
1.5-5.4) years in patients treated with PCI and 2.9 (IQR 1.3-5.5) years in
patients managed medically. There was no significant di- erence in
survival between treatment modalities in the entire cohort, nor in the 108
patients with triple vessel disease. Similarly, there was no di- erence in
the incidence of major adverse cardiac events, comparing medical
management with revascularisation. CONCLUSION: There was no apparent
survival advantage with revascularisation by either CABG or PCI, compared
with medical management, in patients with ESRF undergoing coronary
angiography. This study confirms the poor prognosis of patients with ESRF
and coronary disease. Observational studies cannot control for all
potential confounders; randomised trial data are needed to guide optimal
management of this high-risk patient cohort.<br/>Copyright &#xa9; NZMA.

<7>
Accession Number
619949348
Author
Wang H.-J.; Li S.-Q.
Institution
(Wang) Department of Thoracic Surgery, Eastern Medical District of Linyi
People's Hospital, Linyi City, Shandong Province 276034, China
(Li) The Third Ward of Internal Medicine, Eastern Medical District of
Linyi People's Hospital, Linyi City, Shandong Province 276034, China
Title
Application of NRS 2002 in nutritional screening of patients underwent
thoracic surgery and study on nutritional nursing intervention.
Source
Biomedical Research (India). 28 (20) (pp 8933-8938), 2017. Date of
Publication: 2017.
Publisher
Scientific Publishers of India (E-mail: qayyum@del3.vsnl.net.in)
Abstract
Objective: To explore application of Nutritional Risk Screening 2002
(NRS2002) scale in nutritional screening for thoracic surgery, and to
analyze the nutritional nursing methods. Methods: Totally 98 patients with
thoracic surgery in our hospital from March 2013 to March 2017 were
randomly divided into control group and observation group, 49 cases in
each group. The control group received routine nutrition nursing, the
observation group evaluated by NRS 2002 scale were given specific
nutritional nursing by regulating diets according to different nutritional
status, until two groups were discharged from hospital. The conditions of
nutritional risk were analyzed after 2 weeks of intervention, the changes
of transferrin (TRF) and hemoglobin (Hb), prealbumin (PA), albumin (ALB)
level and physical status were compared, the incidences of complications
were compared. Results: The incidence of nutritional risk in the
observation group was significantly lower than that of the control group
(6.12% vs. 20.41%; chi²=4.346, P<0.05); there were significant
differences in the ALB, PA, Hb, TRF of the observation group before and
after intervention (P<0.05); the ALB, PA and TRF of the observation group
after intervention were significantly higher than those of the control
group (P<0.05); the upper arm muscle circumference, upper arm
circumference and triceps skinfold thickness of two groups were higher
than those before intervention, and the observation group after
intervention were significantly higher than those of the control group
(P<0.05); the hypoxemia and pulmonary infection in the observation group
were significantly lower than those in the control group (4.08%, 2.04% vs.
16.33%, 12.24%; chi²=4.009, 4.405, P<0.05). Conclusion: NRS
2002 scale can identify the nutritional status of patients with open chest
surgery and give targeted nursing guidance, it is worthy of clinical
promotion.<br/>Copyright &#xa9; 2017, Scientific Publishers of India, All
rights reserved.

<8>
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.

<9>
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.

<10>
Accession Number
619552674
Author
Tornyos A.; Aradi D.; Horvath I.G.; Konyi A.; Magyari B.; Pinter T.;
Vorobcsuk A.; Tornyos D.; Komocsi A.
Institution
(Tornyos, Horvath, Konyi, Magyari, Pinter, Vorobcsuk, Tornyos, Komocsi)
Department of Interventional Cardiology, Heart Institute, University of
Pecs, Pecs, Hungary
(Aradi) Heart Centre Balatonfured and Heart and Vascular Centre,
Semmelweis University, Budapest, Hungary
Title
Clinical outcomes in patients treated for coronary in-stent restenosis
with drug-eluting balloons: Impact of high platelet reactivity.
Source
PLoS ONE. 12 (12) (no pagination), 2017. Article Number: e0188493. Date of
Publication: December 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: The impact of high platelet reactivity (HPR) on clinical
outcomes after elective percutaneous coronary interventions (PCI) with
drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown.
Objective: We sought to evaluate the prognostic importance of HPR together
with conventional risk factors in patients treated with DEB. Methods:
Patients treated with DEB due to ISR were enrolled in a single-centre,
prospective registry between October 2009 and March 2015. Only patients
with recent myocardial infarction (MI) received prasugrel, others were
treated with clopidogrel. HPR was defined as an ADP-test >46U with the
Multiplate assay and no adjustments were done based on results. The
primary endpoint of the study was a composite of cardiovascular mortality,
MI, any revascularization or stroke during one-year follow-up. Results:
194 stable angina patients were recruited of whom 90% were treated with
clopidogrel. Clinical characteristics and procedural data were available
for all patients; while platelet function testing was performed in 152
subjects of whom 32 (21%) had HPR. Patients with HPR had a higher risk for
the primary endpoint (HR: 2.45; CI: 1.01-5.92; p = 0.03). The difference
was primarily driven by a higher risk for revascularization and MI.
According to the multivariate analysis, HPR remained a significant,
independent predictor of the primary endpoint (HR: 2.88; CI: 1.02-8.14; p
= 0.04), while total DEB length and statin treatment were other
independent correlates of the primary outcome. Conclusion: HPR was found
to be an independent predictor of repeat revascularization and MI among
elective patients with ISR undergoing PCI with DEB.<br/>Copyright &#xa9;
2017 Tornyos et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<11>
Accession Number
606679132
Author
Moglia A.; Ferrari V.; Morelli L.; Ferrari M.; Mosca F.; Cuschieri A.
Institution
(Moglia, Ferrari, Morelli, Ferrari) EndoCAS, Center for Computer Assisted
Surgery, University of Pisa, Edificio 102, via Paradisa 2, Pisa 56124,
Italy
(Ferrari) Information Engineering Department, University of Pisa, Pisa,
Italy
(Morelli) Multidisciplinary Center for Robotic Surgery, University
Hospital of Pisa, Pisa, Italy
(Mosca) Cisanello Teaching Hospital, Pisa, Italy
(Cuschieri) Scuola Superiore sant'Anna, Pisa, Italy
(Cuschieri) Institute for Medical Science and Technology, University of
Dundee, Dundee, United Kingdom
Title
A Systematic Review of Virtual Reality Simulators for Robot-assisted
Surgery.
Source
European Urology. 69 (6) (pp 1065-1080), 2016. Date of Publication: 01 Jun
2016.
Publisher
Elsevier B.V.
Abstract
Context No single large published randomized controlled trial (RCT) has
confirmed the efficacy of virtual simulators in the acquisition of skills
to the standard required for safe clinical robotic surgery. This remains
the main obstacle for the adoption of these virtual simulators in surgical
residency curricula. Objective To evaluate the level of evidence in
published studies on the efficacy of training on virtual simulators for
robotic surgery. Evidence acquisition In April 2015 a literature search
was conducted on PubMed, Web of Science, Scopus, Cochrane Library, the
Clinical Trials Database (US) and the Meta Register of Controlled Trials.
All publications were scrutinized for relevance to the review and for
assessment of the levels of evidence provided using the classification
developed by the Oxford Centre for Evidence-Based Medicine. Evidence
synthesis The publications included in the review consisted of one RCT and
28 cohort studies on validity, and seven RCTs and two cohort studies on
skills transfer from virtual simulators to robot-assisted surgery.
Simulators were rated good for realism (face validity) and for usefulness
as a training tool (content validity). However, the studies included used
various simulation training methodologies, limiting the assessment of
construct validity. The review confirms the absence of any consensus on
which tasks and metrics are the most effective for the da Vinci Skills
Simulator and dV-Trainer, the most widely investigated systems. Although
there is consensus for the RoSS simulator, this is based on only two
studies on construct validity involving four exercises. One study on
initial evaluation of an augmented reality module for partial nephrectomy
using the dV-Trainer reported high correlation (r = 0.8) between in vivo
porcine nephrectomy and a virtual renorrhaphy task according to the
overall Global Evaluation Assessment of Robotic Surgery (GEARS) score. In
one RCT on skills transfer, the experimental group outperformed the
control group, with a significant difference in overall GEARS score (p =
0.012) during performance of urethrovesical anastomosis on an inanimate
model. Only one study included assessment of a surgical procedure on real
patients: subjects trained on a virtual simulator outperformed the control
group following traditional training. However, besides the small numbers,
this study was not randomized. Conclusions There is an urgent need for a
large, well-designed, preferably multicenter RCT to study the efficacy of
virtual simulation for acquisition competence in and safe execution of
clinical robotic-assisted surgery. Patient summary We reviewed the
literature on virtual simulators for robot-assisted surgery. Validity
studies used various simulation training methodologies. It is not clear
which exercises and metrics are the most effective in distinguishing
different levels of experience on the da Vinci robot. There is no reported
evidence of skills transfer from simulation to clinical surgery on real
patients.<br/>Copyright &#xa9; 2015 European Association of Urology.

<12>
Accession Number
610789624
Author
Hartman J.E.; Klooster K.; Slebos D.-J.; Ten Hacken N.H.T.
Institution
(Hartman, Klooster, Slebos, Ten Hacken) Department of Pulmonary Diseases,
University of Groningen, University Medical Center Groningen, PO Box
30001, Groningen 9700 RB, Netherlands
(Hartman, Klooster, Slebos, Ten Hacken) Groningen Research Institute for
Asthma and COPD, University of Groningen, University Medical Center
Groningen, PO Box 30001, Groningen 9700 RB, Netherlands
Title
Improvement of physical activity after endobronchial valve treatment in
emphysema patients.
Source
Respiratory Medicine. 117 (pp 116-121), 2016. Date of Publication: 01 Aug
2016.
Publisher
W.B. Saunders Ltd
Abstract
Rationale Bronchoscopic lung volume reduction using endobronchial valves
is a promising treatment for severe emphysema patients without collateral
ventilation. Physical activity is an important contributing factor for the
autonomy, morbidity and mortality of these patients. Objective We
investigated the impact of endobronchial valve treatment on physical
activity in severe emphysema patients. Methods Physical activity was
measured for 7 days by a triaxial accelerometer at baseline and 6 months
follow-up after EBV treatment, and compared with standard medical care in
a randomized controlled trial. Results Forty-three patients (77%female,
age 59 +/- 9years, FEV<inf>1</inf> 30 +/- 7%pred, steps 3563 +/-
2213per/day) wore the accelerometer and were included in the analysis.
Nineteen patients received EBV treatment and 24 standard medical care. At
baseline, physical activity level was comparable between groups. After 6
months, the endobronchial valve group significantly improved compared to
the controls in steps/day (+1252vs-148) and locomotion time (+17vs-2
min/day). Change in sit duration (0vs + 27 min/day) did not significantly
differ. Conclusions Physical activity significantly improved after
endobronchial valve treatment in severe emphysema patients. This
improvement was without any specific encouragement on physical activity.
Clinical trial number Dutch trial register: NTR2876.<br/>Copyright &#xa9;
2016 Elsevier Ltd. All rights reserved.

<13>
Accession Number
610819058
Author
Poggio P.; Cavallotti L.; Songia P.; Di Minno A.; Ambrosino P.; Mammana
L.; Parolari A.; Alamanni F.; Tremoli E.; Di Minno M.N.D.
Institution
(Poggio, Cavallotti, Songia, Di Minno, Mammana, Alamanni, Tremoli, Di
Minno) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Cavallotti, Mammana, Alamanni) Dipartimento di Medicina e Chirurgia,
University of Milan, Italy
(Songia, Tremoli) Department of Pharmacological and Biomolecular Sciences,
University of Milan, Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Italy
(Ambrosino, Di Minno) Division of Cardiology, Department of Advanced
Biomedical Sciences, Federico II University, Naples, Italy
(Parolari) Unita Operativa di Cardiochirurgia e Ricerca Traslazionale, San
Donato IRCCS, San Donato Milanese, Italy
Title
Impact of valve morphology on the prevalence of coronary artery disease: A
systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003200. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Literature studies suggested a lower prevalence of coronary
artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid
aortic valve (TAV) patients. However, this finding has been challenged. We
performed a meta-analysis to assess whether aortic valve morphology has a
different association with CAD, concomitant coronary artery bypass
grafting (CABG), and postoperative mortality. Methods and Results-Detailed
search was conducted according to the PRISMA (Preferred Reporting Items
for Systematic reviews and Meta-Analyses) guideline to identify all
patients with BAV or TAV and presence of CAD, concomitant myocardial
surgical revascularization, and the postoperative mortality. Thirty-one
studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery
were included. BAV patients showed a lower prevalence of CAD (odds ratio
[OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35,
0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than
TAV. However, BAV subjects were significantly younger than TAV (mean
difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR,
1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension
(OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54,
0.93). Interestingly, a metaregression analysis showed that younger age
and lower prevalence of diabetes were associated with lower prevalence of
CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively)
and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001,
respectively) documented in BAV patients. Conclusions-Analysis of raw data
suggested an association of aortic valve morphology with prevalence of
CAD, concomitant CABG, and postoperative mortality. Interestingly, the
differences in age and diabetes have a profound impact on prevalence of
CAD between BAV and TAV. In conclusion, our meta-analysis suggests that
the presence of CAD is independent of aortic valve
morphology.<br/>Copyright &#xa9; 2016 The Authors.

<14>
Accession Number
619950441
Author
Campbell N.G.; Allen E.; Sanders J.; Swinson R.; Birch S.; Sturgess J.;
Al-Subaie N.; Elbourne D.; Montgomery H.; O'Brien B.
Institution
(Campbell) Manchester University Foundation NHS Trust, Department of
Cardiology, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT,
United Kingdom
(Allen, Swinson, Sturgess, Elbourne) London School of Hygiene and Tropical
Medicine, Clinical Trials Unit, Keppel Street, London WC1E 7HT, United
Kingdom
(Sanders, Birch, O'Brien) St Bartholomew's Hospital, Barts Health NHS
Trust, Barts Heart Centre, West Smithfield, London EC1A 7BE, United
Kingdom
(Al-Subaie) St George's Hospital, Cardiothoracic Intensive Care Unit,
Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
(Montgomery) UCL Division of Medicine, and Institute for Sport, Exercise
and Health, 1st floor, 170 Tottenham Court Road, London W1T 7HA, United
Kingdom
(Sanders, O'Brien) Queen Mary University of London, William Harvey
Research Institute, Charterhouse Square, London EC1M 6BQ, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland, OH, United States
Title
The impact of maintaining serum potassium >=3.6 mEq/L vs >=4.5 mEq/L on
the incidence of new-onset atrial fibrillation in the first 120 hours
after isolated elective coronary artery bypass grafting - study protocol
for a randomised feasibility trial for the proposed Tight K randomized
non-inferiority trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 618. Date of
Publication: 28 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF) occurs in approximately one in three
patients after cardiac surgery, and is associated with increased
short-term and long-term mortality, intensive care unit (ICU) and hospital
stay, and increased cost of care. In an attempt to reduce AF incidence in
these patients, serum potassium (K+) levels are commonly maintained at the
high end of normal (4.5-5.5 mEq/L). However, such potassium
supplementation is without proven benefit, and is not without negative
consequences. It carries clinical risk, negatively impacts patient
experience and is both time-consuming and costly. This protocol describes
a randomised controlled pilot trial to assess the feasibility of a
proposed randomised non-inferiority trial to investigate the impact of
maintaining serum potassium >= 3.6 mEq/L vs >= 4.5 mEq/L on the incidence
of new-onset atrial fibrillation in the first 120 hours after isolated
elective coronary artery bypass grafting. Methods: Design: this is a
randomized feasibility trial as a pilot for a randomized non-inferiority
trial. Participants: are 160 patients undergoing isolated coronary artery
bypass grafting at two centres. Allocation: patients will be randomized
(1:1) to protocols aiming to maintain serum potassium at either >= 3.6
mEq/L ("relaxed control") or >= 4.5 mEq/L ("tight control"). Primary
analytic aim: was to assess the feasibility and acceptability of planning
and delivering the intervention and trial methods to inform a full-scale
non-inferiority trial. Outcome: the primary indicative efficacy outcome
measures being field-tested are feasibility of participant recruitment and
randomization, maintaining a protocol violation rate < 10%, and retaining
90% patient follow up 28 days after surgery. The primary clinical outcome
measure of the future full "Tight K Study" will be incidence of AF after
cardiac surgery. Discussion: The Tight K Pilot will assess the feasibility
of conducting the full trial, which is intended to confirm or refute the
efficacy of current potassium management in preventing AF after cardiac
surgery. Trial registration: ClinicalTrials.gov, NCT03195647. Registered
on 23 May 2017. Last updated 19June 2017.<br/>Copyright &#xa9; 2017 The
Author(s).

<15>
Accession Number
620002863
Author
Ruzicic D.; Dobric M.; Vukovic M.; Hrncic D.; Dordevic S.; Ruzicic M.;
Aleksandric S.; Dordevic-Dikic A.; Beleslin B.
Institution
(Ruzicic, Vukovic, Ruzicic) General Hospital Valjevo, Department of
Cardiology and Invasive Cardiology, Street Sindeliceva 62, 14000 Valjevo,
Serbia
(Dobric, Aleksandric, Dordevic-Dikic, Beleslin) Cardiology Clinic,
Clinical Center of Serbia, Faculty of Medicine, University of Belgrade,
Street Pasterova 2, 11000 Belgrade, Serbia
(Hrncic) Institute of Medical Physiology Richard Burian, Faculty of
Medicine, University of Belgrade, Street Visegradska 26, 11000, Belgrade,
Serbia
(Dordevic) General Hospital Valjevo, Department of Radiology, Street
Sindeliceva 62, 14000 Valjevo, Serbia
Title
The correlation of SYNTAX score by coronary angiography with breast
arterial calcification by digital mammography.
Source
Clinical Radiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
W.B. Saunders Ltd
Abstract
Aim: To evaluate the hypothesis that breast arterial calcification (BAC)
may predict coronary artery disease (CAD) severity. Materials and methods:
The study comprised 102 women >45 years (mean age 62+/-8 years) referred
for digital mammography after coronary angiography. BAC was assessed using
the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy
between percutaneous coronary intervention with TAXus and cardiac surgery
trial) score. Results: In comparison to the low SYNTAX score group (<=22)
patients with a intermediate-to-high SYNTAX score (>22) were older
(p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes
(p=0.021), and a history of smoking (p=0.048). They also had a
statistically higher level of fasting blood glucose (p<0.001), glycated
haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen
(p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the
group with a SYNTAX score <=22 (p=0.005). BAC was significantly higher in
patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC
(odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7,
p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001)
and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent
predictive factors for patients with intermediate-to-high SYNTAX score.
Conclusions: In women >45 years, there was a significant correlation
between the severity of CAD as evaluated by the SYNTAX score and BAC as
evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen
may be used as an additional diagnostic tool to predict the presence and
severity of CAD.<br/>Copyright &#xa9; 2017 The Royal College of
Radiologists.

<16>
Accession Number
620001638
Author
Hou X.; Chen Z.; Sun C.; Zhang G.; Wu S.; Liu Z.
Institution
(Hou, Zhang, Wu, Liu) Department of Orthopaedics, Peking University
Shougang Hospital, Beijing, China
(Chen, Sun) Department of Orthopaedics, Peking University Third Hospital,
Beijing, China
Title
A systematic review of complications in thoracic spine surgery for
ossification of ligamentum flavum.
Source
Spinal Cord. (pp 1-7), 2017. Date of Publication: 28 Dec 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Study design: Systematic review. Objectives: The aim of this systematic
review is to summarize the incidence of complications, to relate
complication incidence to procedures performed, to assess the impact of
the year of study publication and follow-up duration on complication
incidence. Methods: The authors conducted the Cochrane Central Register of
Controlled Trials, PubMed, and EMBASE searches for relevant literatures.
The incidence of complications was summarized. Correlation of the
incidence with year of study publications, follow-up duration, and the
surgical outcome was statistically evaluated. Results: A total of 16
studies met our inclusion criteria, including 475 patients. All of these
studies were retrospective case series. The mean age of patients ranged
from 55 to 64 years. Average follow-up duration ranged from 26 to 65
months. Partial patients in four studies underwent surgeries and reserved
posterior structure of the spinal canal. The others underwent operations
removing posterior structure of spinal canal. The mean recovery rate from
each individual study varied between 31 and 68% and the pooled neurologic
function recovery rate was 53% (95% CI: 43-62%). The mean complication
rate was 24%. Cerebrospinal fluid leakage was the most reported
postoperative complication (19%), then neurologic deterioration (5%).
Other complications included local infections, wound dehiscence, increased
kyphotic deformity, an hematoma. Conclusions: Operations removing
posterior structure of spinal canal are the main technique to decompress
spinal cord. Cerebrospinal fluid leakage and postoperative neurologic
deterioration were the most reported complications.<br/>Copyright &#xa9;
2017 The Author(s) 2017, under exclusive licence to the International
Spinal Cord Society

<17>
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

<18>
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

<19>
Accession Number
619869963
Author
de Araujo-Filho A.A.; de Cerqueira-Neto M.L.; de Assis Pereira Cacau L.;
Oliveira G.U.; Cerqueira T.C.F.; de Santana-Filho V.J.
Institution
(de Araujo-Filho) Nucleo de Pos Graduacao em Ciencias da Saude,
Universidade Federal de Sergipe, Aracaju, SE, BR
(de Araujo-Filho, de Assis Pereira Cacau) Departamento de Fisioterapia,
Universidade Tiradentes - UNIT, Aracaju, SE, BR
(de Cerqueira-Neto, Oliveira, de Santana-Filho) Departamento de
Fisioterapia, Universidade Federal de Sergipe - UFS, Aracaju, SE, BR
(de Cerqueira-Neto, Cerqueira) Departamento de Fisioterapia, Universidade
Federal de Sergipe - UFS, Lagarto, SE, BR
Title
Effect of prophylactic non-invasive mechanical ventilation on functional
capacity after heart valve replacement: a clinical trial.
Source
Clinics (Sao Paulo, Brazil). 72 (10) (pp 618-623), 2017. Date of
Publication: 01 Oct 2017.
Abstract
OBJECTIVE: During cardiac surgery, several factors contribute to the
development of postoperative pulmonary complications. Non-invasive
ventilation is a promising therapeutic tool for improving the
functionality of this type of patient. The aim of this study is to
evaluate the functional capacity and length of stay of patients in a
nosocomial intensive care unit who underwent prophylactic non-invasive
ventilation after heart valve replacement.
METHOD: The study was a controlled clinical trial, comprising 50
individuals of both sexes who were allocated by randomization into two
groups with 25 patients in each group: the control group and experimental
group. After surgery, the patients were transferred to the intensive care
unit and then participated in standard physical therapy, which was
provided to the experimental group after 3 applications of non-invasive
ventilation within the first 26 hours after extubation. For non-invasive
ventilation, the positive pressure was 10 cm H2O, with a duration of 1
hour. The evaluation was performed on the 7th postoperative day/discharge
and included a 6-minute walk test. The intensive care unit and
hospitalization times were monitored in both groups. Brazilian Registry of
Clinical Trials (REBeC): RBR number 8bxdd3.
RESULTS: Analysis of the 6-minute walk test showed that the control group
walked an average distance of 264.34+/-76 meters and the experimental
group walked an average distance of 334.07+/-71 meters (p=0.002). The
intensive care unit and hospitalization times did not differ between the
groups.
CONCLUSION: Non-invasive ventilation as a therapeutic resource was
effective toward improving functionality; however, non-invasive
ventilation did not influence the intensive care unit or hospitalization
times of the studied cardiac patients.

<20>
Accession Number
619979679
Author
Vafaey H.R.; Omran M.T.S.; Abbaspour S.; Banihashem N.; Ganji G.F.
Institution
(Vafaey, Ganji) Department of Cardiac Surgery, Ayatollah Rouhani Hospital,
Babol University of Medical Sciences, Babol, Iran, Islamic Republic of
(Omran) Department of Cardiology, Ayatollah Rouhani hospital, Babol
University of Medical Sciences, Babol, Iran, Islamic Republic of
(Abbaspour) Babol University of Medical Sciences, Babol, Iran, Islamic
Republic of
(Banihashem) Department of Anesthesiology, Babol University of Medical
Sciences, Babol, Iran, Islamic Republic of
Title
Anti-coagulation therapy following coronary endarterectomy in patient with
coronary artery bypass graft.
Source
Caspian Journal of Internal Medicine. 9 (1) (pp 27-31), 2018. Date of
Publication: 2018.
Publisher
Babol University of Medical Sciences (Journal office,Ganj Afrooz Avenue,
Babol 4717641367, Iran, Islamic Republic of)
Abstract
Background: Since there is a lack of research on postoperative
anticoagulation protocol in patients undergoing coronary artery bypass
graft (CABG) / coronary endarterectomy (CE), we recommend a new protocol
for anticoagulation in these patients. Methods: In this double-blind
randomized clinical trial study, 52 patients undergoing CABG / CE entered
the study and were divided into two groups. In group 1, the patients were
given warfarin(international normalized ratio (INR) between 2-3) together
with 80 mg aspirin daily for 3 months. In group 2, the patients were given
75 mg plavix daily together with 80 mg aspirin daily for 3 months. We
evaluated patients with electrocardiography, echocardiography and checking
ceratin phosphokinase MB and troponin I in the several stages. The data
were analysed SPSS Version18 software. Results: There was no significant
difference between pre and post-operative Ejection fraction in patients
with plavix (P=0.21) and warfarin (P=0.316) regimen. However, wall mrotion
score was significantly better in clopidogrel - aspirin patients in late
(3 months) post operation (p < 0.001). Conclusions: Since warfarin has
serious hemorrhagic complications and requires closed monitoring of serum
drug activity by serial INR checking, it is recommended that clopidogrel -
aspirin can be the preferred alternative anticoagulation therapy in CABG /
CE patients.

<21>
Accession Number
620000215
Author
Yang C.F.J.; McSherry F.; Mayne N.R.; Wang X.; Berry M.F.; Tong B.;
Harpole D.H.; D'Amico T.A.; Christensen J.D.; Ready N.E.; Klapper J.A.
Institution
(Yang, McSherry, Mayne, Wang, Tong, Harpole, D'Amico, Christensen, Ready,
Klapper) Duke University Medical Center, Durham, North Carolina
(Berry) Department of Cardiothoracic Surgery, Stanford University,
Stanford, California
Title
Surgical Outcomes After Neoadjuvant Chemotherapy and Ipilimumab for
Non-Small-Cell Lung Cancer.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: The objective of this study was to evaluate the safety and
feasibility of using neoadjuvant chemotherapy plus ipilimumab followed by
surgery as a treatment strategy for stage II-IIIA non-small-cell lung
cancer. Methods: From 2013 to 2017, postoperative data from patients who
underwent surgery after neoadjuvant chemotherapy plus ipilimumab in the
TOP1201 trial, an open label phase II trial (NCT01820754), were
prospectively collected. The surgical outcomes from TOP1201 were compared
with outcomes in a historical cohort of patients receiving standard
preoperative chemotherapy followed by surgery identified from our
institution's prospectively collected thoracic surgery database. Results:
In the TOP1201 trial, 13 patients were treated with preoperative
chemotherapy and ipilimumab followed by surgery. In the historical cohort,
42 patients received preoperative chemotherapy by a platinum doublet
regimen preoperative chemotherapy by a platinum doublet regimen without
ipilimumab followed by lobectomy or pneumonectomy. The 30-day mortality in
both groups was 0%. The most frequently occurring perioperative
complications in the TOP1201 group were prolonged air leak (n = 2, 15%)
and urinary tract infection (n = 2, 15%). The most common perioperative
complication in the preoperative chemotherapy alone group was atrial
fibrillation (n = 6, 14%). One patient (8%) had atrial fibrillation in the
TOP1201 group. There was no apparent increased occurrence of adverse
surgical outcomes for patients in the TOP1201 group compared with patients
receiving standard of care neoadjuvant chemotherapy alone before surgery
for stage II-IIIA non-small cell lung cancer. Conclusions: This report is
the first to demonstrate the safety and feasibility of surgical resection
after treatment with ipilimumab and chemotherapy in stage II-IIIA
non-small-cell lung cancer.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons.

<22>
Accession Number
619999875
Author
Chivasso P.; Bruno V.D.; Farid S.; Malvindi P.G.; Modi A.; Benedetto U.;
Ciulli F.; Abu-Omar Y.; Caputo M.; Angelini G.D.; Livesey S.; Vohra H.A.
Institution
(Chivasso, Bruno, Benedetto, Ciulli, Caputo, Angelini, Vohra) University
Hospitals Bristol, Bristol Heart Institute, Bristol, United Kingdom
(Farid, Abu-Omar) University Hospitals Cambridge, Papworth Hospital,
Cambridge, United Kingdom
(Malvindi, Modi, Livesey) University Hospitals Southampton, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
Title
Predictors of survival in octogenarians after mitral valve surgery for
degenerative disease: The Mitral Surgery in Octogenarians study.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: An increasing number of octogenarians are referred to undergo
mitral valve surgery for degenerative disease, and percutaneous approaches
are being increasingly used in this subgroup of patients. We sought to
determine the survival and its predictors after Mitral valve Surgery in
Octogenarians (MiSO) in a multicenter UK study of high-volume specialized
centers. Methods: Pooled data from 3 centers were collected
retrospectively. To identify the predictors of short-term composite
outcome of 30 days mortality, acute kidney injury, and cerebrovascular
accident, a multivariable logistic regression model was developed.
Multiple Cox regression analysis was performed for late mortality.
Kaplan-Meier curves were generated for long-term survival in various
subsets of patients. Receiver operating characteristic analysis was done
to determine the predictive power of the logistic European System for
Cardiac Operative Risk Evaluation. Results: A total of 247 patients were
included in the study. The median follow-up was 2.9 years (minimum 0,
maximum 14 years). A total of 150 patients (60.7%) underwent mitral valve
repair, and 97 patients (39.3%) underwent mitral valve replacement. Apart
from redo cardiac surgery (mitral valve repair 6 [4%] vs mitral valve
replacement 11 [11.3%], P = .04) and preoperative atrial fibrillation
(mitral valve repair 79 [52.6%] vs mitral valve replacement 34 [35.1%], P
< .01), there was no significant difference in terms of any other
preoperative characteristics between the 2 groups. Patient operative risk,
as estimated by logistic European System for Cardiac Operative Risk
Evaluation, was lower in the mitral valve repair group (10.2 +/- 11.8 vs
13.7 +/- 15.2 in mitral valve replacement; P = .07). No difference was
found between groups for duration of cardiopulmonary bypass and aortic
crossclamp times. The 30-day mortality for the whole cohort was 13.8%
(mitral valve repair 4.7% vs mitral valve replacement 18.6%; P < .01). No
differences were found in terms of postoperative cerebrovascular accident
(2% vs 3.1%; P = .9), acute kidney injury requiring dialysis (6.7% vs
13.4%; P = .12), and superficial or deep sternal wound infection (10% vs
16.5%, P = .17; 2% vs 3.1%, P = .67, respectively). The final multiple
regression model for short-term composite outcome included previous
cardiac surgery (odds ratio [OR], 4.47; 95% confidence interval [CI],
1.37-17.46; P = .02), intra-aortic balloon pump use (OR, 4.77; 95% CI,
1.67-15.79; P < .01), and mitral valve replacement (OR, 7.7; 95% CI,
4.04-14.9; P < .01). Overall survival for the entire cohort at 1, 5, and
10 years was 82.4%, 63.7%, and 45.5% (mitral valve repair vs mitral valve
replacement: 89.9% vs 70.7% at 1 year, 69.6% vs 54% at 5 years, and 51.8%
vs 35.5% at 10 years; P = .0005). Cox proportional hazard model results
showed mitral valve replacement (hazard ratio, 1.88; 95% CI, 1.22-2.89; P
< .01) and intra-aortic balloon pump use (hazard ratio, 2.54; 95% CI,
1.26-5.13; P < .01) to be independent predictor factors affecting
long-term survival. Logistic European System for Cardiac Operative Risk
Evaluation did not perform well in predicting early mortality (area under
the curve, 0.57%).: Conclusions: In octogenarians, mitral valve repair for
degenerative disease is associated with good survival and remains the gold
standard, whereas mitral valve replacement is still associated with
significant mortality. Logistic European System for Cardiac Operative Risk
Evaluation was unable to predict early mortality in our cohort of
patients. Larger international multicenter registries are required to
optimize the decision-making process in such a high-risk
subgroup.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery.

<23>
Accession Number
619998937
Author
Lu Y.; Dai W.; Zong Z.; Xiao Y.; Wu D.; Liu X.; Chun Wong G.T.
Institution
(Lu, Dai, Zong, Xiao, Liu) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, China
(Wu) Department of Anesthesiology, Affiliated Fuyang Hospital of Anhui
Medical University, Hefei, China
(Chun Wong) Department of Anesthesiology, University of Hong Kong, Hong
Kong SAR, China
Title
Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung
Ventilation in Right Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the quality of lung
deflation of a left-sided double-lumen endotracheal tube (DLT) with a
bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic
surgery (VATS). Design: A prospective, randomized, clinical study.
Setting: A university-affiliated teaching hospital. Participants:
Forty-five adult patients undergoing esophageal tumor surgery using VATS
with right lung deflation. Interventions: Patients were assigned by a
computer-generated randomization sequence to either the left-sided DLT or
BB group. The correct positioning of the airway device was confirmed using
fiberoptic bronchoscopy. Measurements and Main Results: The variables
assessed included: (1) time required to correctly place the devices and to
achieve lung collapse; (2) the number of times the device malpositioned;
(3) the quality of lung deflation as rated by the surgeon; (4) blood
pressure and heart rate at baseline (T<inf>1</inf>), immediately before
(T<inf>2</inf>) and after (T<inf>3</inf>) and 1 minute (T<inf>4</inf>)
after intubation; (5) the number of patients with hypoxemia
(SpO<inf>2</inf> < 90%) during the one-lung ventilation (OLV) period; and
(6) postoperative hoarseness of voice, sore throat, or pulmonary
infection. Of the 45 patients approached for the study, 21 patients in the
DLT group and 19 patients in the BB group were analyzed. The time required
to place the device in the correct position was similar between the 2
groups. The time to achieve right lung collapse in the BB group was
significantly longer (mean difference: 3.232, 95% confidence interval
[CI]: 1.993-4.471; p = 0.003). The quality of lung collapse, OLV duration,
number of patients with device malposition, and hypoxemia in both groups
were similar. There were more patients suffering hoarseness (odds ratio
[OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore throat (OR: 4.29, 95%
CI: 1.14-16.18; p = 0.030) in the DLT group, while no patients developed
postoperative lung infection in either group. Compared to T<inf>1</inf>,
systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR) at
T<inf>2</inf> in both groups were higher (p < 0.05) in the DLT group.
Then, compared to T<inf>2</inf>, sBP and dBP at T<inf>3</inf> and
T<inf>4</inf> and HR at T<inf>3</inf> in the DLT group were higher (p <
0.05). Conclusions: The results of this study showed that BB is an
effective alternative for left one-lung ventilation in right VATS, but
requires a longer time to achieve complete lung collapse. Moreover, the
use of BB caused less hemodynamic perturbation and can reduce
postoperative hoarseness and sore throat.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<24>
Accession Number
617315797
Author
Benedetto U.; Caputo M.; Guida G.; Bucciarelli-Ducci C.; Thai J.; Bryan
A.; Angelini G.D.
Institution
(Benedetto, Caputo, Guida, Bucciarelli-Ducci, Thai, Bryan, Angelini)
Bristol Heart Institute, University of Bristol, School of Clinical
Sciences, Bristol, United Kingdom
Title
Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of
Randomized Controlled Trials.
Source
Seminars in Thoracic and Cardiovascular Surgery. 29 (3) (pp 301-310),
2017. Date of Publication: 03 Feb 2017.
Publisher
W.B. Saunders
Abstract
Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac
surgery, there is still paucity of evidence to prove its benefit in terms
of neurologic protection. Therefore, we conducted a meta-analysis of
available randomized controlled trials comparing CDI vs standard de-airing
maneuvers. Electronic searches were performed to identify relevant
randomized controlled trials. Primary outcomes investigated were
postoperative stroke, neurocognitive deterioration, and in-hospital
mortality. Risk difference (RD) was used as summary statistic. Pooled
estimates were obtained by means of random-effects model to account for
possible clinical diversity and methodological variation between studies.
Eight studies were identified with 668 patients randomized to CDI (n =
332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was
2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95%
confidence interval [CI] -2% to 2%; P = 0.87; I² = 0%).
Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the
CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62;
I² = 0%). Neurocognitive deterioration rate was 12% vs 21% in
the CDI and control group, respectively, but this difference was not
statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35;
I² = 0%). The present meta-analysis did not find any
significant protective effect from the use of CDI when compared with
manual de-airing maneuvers in terms of clinical outcomes, including
postoperative neurocognitive decline.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<25>
Accession Number
613203890
Author
Rauch B.; Davos C.H.; Doherty P.; Saure D.; Metzendorf M.-I.; Salzwedel
A.; Voller H.; Jensen K.; Schmid J.-P.
Institution
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Bremserstr. 79,
Haus M, Ludwigshafen am Rhein D-67063, Germany
(Davos) Cardiovascular Research Laboratory, Biomedical Research
Foundation, Academy of Athens, Greece
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Saure, Jensen) Institute of Medical Biometry and Informatics (IMBI),
University of Heidelberg, Germany
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Institute
of General Practice, University of Dusseldorf, Germany
(Salzwedel, Voller) Centre of Rehabilitation Research, University of
Potsdam, Germany
(Schmid) Department of Cardiology Spital Tiefenau, Switzerland
Title
The prognostic effect of cardiac rehabilitation in the era of acute
revascularisation and statin therapy: A systematic review and
meta-analysis of randomized and non-randomized studies - The Cardiac
Rehabilitation Outcome Study (CROS).
Source
European Journal of Preventive Cardiology. 23 (18) (pp 1914-1939), 2016.
Date of Publication: 01 Dec 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The prognostic effect of multi-component cardiac rehabilitation
(CR) in the modern era of statins and acute revascularisation remains
controversial. Focusing on actual clinical practice, the aim was to
evaluate the effect of CR on total mortality and other clinical endpoints
after an acute coronary event. Design Structured review and meta-analysis.
Methods Randomised controlled trials (RCTs), retrospective controlled
cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs)
evaluating patients after acute coronary syndrome (ACS), coronary artery
bypass grafting (CABG) or mixed populations with coronary artery disease
(CAD) were included, provided the index event was in 1995 or later.
Results Out of n = 18,534 abstracts, 25 studies were identified for final
evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702
patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed
populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in
design, biometrical assessment of results and potential confounders was
evident. CCSs evaluating ACS patients showed a significantly reduced
mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95%
confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds
ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac
Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral
results. CR participation was also associated with reduced mortality after
CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations.
Conclusions CR participation after ACS and CABG is associated with reduced
mortality even in the modern era of CAD treatment. However, the
heterogeneity of study designs and CR programmes highlights the need for
defining internationally accepted standards in CR delivery and scientific
evaluation.<br/>Copyright &#xa9; European Society of Cardiology.

<26>
Accession Number
613101748
Author
Gripari P.; Tamborini G.; Bottari V.; Maffessanti F.; Carminati M.C.;
Muratori M.; Vignati C.; Bartorelli A.L.; Alamanni F.; Pepi M.
Institution
(Gripari, Tamborini, Bottari, Carminati, Muratori, Vignati, Bartorelli,
Alamanni, Pepi) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Maffessanti) Department of Medicine, Section of Cardiology, University of
Chicago, Chicago, Illinois, United States
(Maffessanti) Center for Computational Medicine in Cardiology, Institute
of Computational Sciences, Universita della Svizzera Italiana, Lugano,
Switzerland
(Bartorelli, Alamanni) Department of Clinical Sciences and Community
Health, Cardiovascular Section, University of Milan, Milan, Italy
Title
Three-Dimensional Transthoracic Echocardiography in the Comprehensive
Evaluation of Right and Left Heart Chamber Remodeling Following
Percutaneous Mitral Valve Repair.
Source
Journal of the American Society of Echocardiography. 29 (10) (pp 946-954),
2016. Date of Publication: 01 Oct 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Percutaneous mitral valve repair (PMVR) is an alternative
treatment in patients with significant mitral regurgitation (MR) who are
denied surgery. Although in surgical patients, outcomes have been related
both to acute hemodynamic favorable results and to positive cardiac
remodeling in the midterm, in the case of PMVR the effect on cardiac
chamber remodeling has never been extensively studied. The aims of this
study were (1) to evaluate the short- and mid-term remodeling induced by
PMVR on cardiac chamber volume using two- and three-dimensional (3D)
transthoracic echocardiographic (TTE) imaging and (2) to assess changes in
left ventricular (LV) shape on the basis of 3D TTE data. Methods Patients
undergoing PMVR were prospectively enrolled. Two-dimensional and 3D TTE
data sets acquired at baseline, and at 30 days and 6 months after PMVR
were analyzed to assess LV and right ventricular (RV) volumes and ejection
fraction and left atrial and right atrial volumes. Moreover, 3D
endocardial surfaces were extracted to compute 3D shape indexes of LV
sphericity and conicity at end-diastole and end-systole. Results Six of
the 64 enrolled patients did not reach follow-up and were excluded. The
analysis was feasible in all 58 patients considered (26 with functional MR
and 32 [55%] with degenerative MR). PMVR resulted in significant reduction
of MR and in favorable remodeling: (1) effective PMVR was mainly
associated with decreased LV loading, (2) PMVR-related reverse remodeling
was observed in patients with degenerative MR and those with functional MR
at 30 days and continued at 6-month follow-up, (3) favorable remodeling in
LV shape from abnormally spherical to more normal conical took place in
both groups after PMVR, and (4) RV volumes and systolic function were
preserved after PMVR. Conclusions A comprehensive two-dimensional and 3D
TTE analysis allows investigation from a double perspective (volume and
morphology) of the entity and modality of changes following PMVR. In
high-risk patients undergoing PMVR, postprocedural heart remodeling
involves all cardiac chambers, occurs in the short term, and further
improves at midterm follow-up.<br/>Copyright &#xa9; 2016 American Society
of Echocardiography

<27>
Accession Number
613782202
Author
Albers J.J.; Slee A.; Fleg J.L.; O'Brien K.D.; Marcovina S.M.
Institution
(Albers, Marcovina) University of Washington, Northwest Lipid Metabolism
and Diabetes Research Laboratories, 401 Queen Anne Ave N, Seattle, WA
98109, United States
(Slee) AIM-HIGH Coordinating Center, Axio Research, 2601 Fourth Ave, Ste
200, Seattle, WA 98121, United States
(Fleg) National Heart, Lung, and Blood Institute, Division of
Cardiovascular Diseases, 6701 Rockledge Dr, Rm 8150, Bethesda, MD 20892,
United States
(O'Brien) University of Washington, Division of Cardiology, Department of
Medicine, 1959 NE Pacific Ave, Box 356422, Seattle, WA 98195-6422, United
States
Title
Relationship of baseline HDL subclasses, small dense LDL and LDL
triglyceride to cardiovascular events in the AIM-HIGH clinical trial.
Source
Atherosclerosis. 251 (pp 454-459), 2016. Date of Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims Previous results of the AIM-HIGH trial showed that
baseline levels of the conventional lipid parameters were not predictive
of future cardiovascular (CV) outcomes. The aims of this secondary
analysis were to examine the levels of cholesterol in high density
lipoprotein (HDL) subclasses (HDL2-C and HDL3-C), small dense low density
lipoprotein (sdLDL-C), and LDL triglyceride (LDL-TG) at baseline, as well
as the relationship between these levels and CV outcomes. Methods
Individuals with CV disease and low baseline HDL-C levels were randomized
to simvastatin plus placebo or simvastatin plus extended release niacin
(ERN), 1500 to 2000 mg/day, with ezetimibe added as needed in both groups
to maintain an on-treatment LDL-C in the range of 40-80 mg/dL. The primary
composite endpoint was death from coronary disease, nonfatal myocardial
infarction, ischemic stroke, hospitalization for acute coronary syndrome,
or symptom-driven coronary or cerebrovascular revascularization. HDL-C,
HDL3-C, sdLDL-C and LDL-TG were measured at baseline by detergent-based
homogeneous assays. HDL2-C was computed by the difference between HDL-C
and HDL3-C. Analyses were performed on 3094 study participants who were
already on statin therapy prior to enrollment in the trial. Independent
contributions of lipoprotein fractions to CV events were determined by Cox
proportional hazards modeling. Results Baseline HDL3-C was protective
against CV events (HR: 0.84, p = 0.043) while HDL-C, HDL2-C, sdLDL-C and
LDL-TG were not event-related (HR: 0.96, p = 0.369; HR: 1.07, p = 0.373;
HR: 1.05, p = 0.492; HR: 1.03, p = 0.554, respectively). Conclusions The
results of this secondary analysis of the AIM-HIGH Study indicate that
levels of HDL3-C, but not other lipoprotein fractions, are predictive of
CV events, suggesting that the HDL3 subclass may be primarily responsible
for the inverse association of HDL-C and CV disease.<br/>Copyright &#xa9;
2016 Elsevier Ireland Ltd

<28>
Accession Number
604475007
Author
Ansari M.T.; Ahmadzai N.; Coyle K.; Coyle D.; Moher D.
Institution
(Ansari, Ahmadzai, Moher) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
(Coyle) Brunel University London, Uxbridge, Middlesex, United Kingdom
(Coyle) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Mitral valve clip for treatment of mitral regurgitation: An evidence-based
analysis.
Source
Ontario Health Technology Assessment Series. 15 (12) (pp 1-104), 2015.
Date of Publication: 2015.
Publisher
Medical Advisory Secretariat (E-mail: HTA@HQOntario.ca)
Abstract
Background: Many of the 500,000 North American patients with chronic
mitral regurgitation may be poor candidates for mitral valve surgery.
Objective: The objective of this study was to investigate the comparative
effectiveness, harms, and cost-effectiveness of percutaneous mitral valve
repair using mitral valve clips in candidates at prohibitive risk for
surgery. Data Sources: We searched articles in MEDLINE, Embase, and the
Cochrane Library published from 1994 to February 2014 for evidence of
effectiveness and harms; for economic literature we also searched NHS EED
and Tufts CEA registry. Grey literature was also searched. Review Methods:
Primary studies were sought from existing systematic reviews that had
employed reliable search and screening methods. Newer studies were sought
by searching the period subsequent to the last search date of the review.
Two reviewers screened records and assessed study validity. We used the
Cochrane risk of bias tool for randomized, generic assessment for
non-randomized studies, and the Phillips checklist for economic studies.
Results: Ten studies including 1 randomized trial were included. The
majority of the direct comparative evidence compared the mitral valve clip
repair with surgery in patients not particularly at prohibitive surgical
risk. Irrespective of degenerative or functional chronic mitral
regurgitation etiology, evidence of effectiveness and harms is
inconclusive and of very low quality. Very-low-quality evidence indicates
that percutaneous mitral valve clip repair may provide a survival
advantage, at least during the first 1 to 2 years, particularly in
medically managed chronic functional mitral regurgitation. Because of
limitations in the design of studies, the cost-effectiveness of mitral
valve clips in patients at prohibitive risk for surgery also could not be
established. Limitations: Because of serious concerns of risk of bias,
indirectness, and imprecision, evidence is of very low quality.
Conclusions: No meaningful conclusions can be drawn about the comparative
effectiveness, harms, and cost-effectiveness of mitral valve clips in the
population with chronic mitral regurgitation who are at prohibitive risk
for surgery.<br/>Copyright &#xa9; 2015 Medical Advisory Secretariat. All
rights reserved.

<29>
Accession Number
617597157
Author
Harky A.; Balmforth D.; Shipolini A.; Uppal R.
Institution
(Harky, Balmforth, Shipolini, Uppal) Department of Cardiothoracic Surgery,
Barts Heart Centre, St. Bartholomew's Hospital, London EC1A7BE, United
Kingdom
Title
Is endoscopic long saphenous vein harvesting equivalent to open harvesting
technique in terms of graft patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (2) (pp 323-326),
2017. Date of Publication: 01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether endoscopic vein harvesting (EVH) is
equivalent to open vein harvesting in terms of graft patency for patients
undergoing coronary artery bypass surgery. A total of 417 articles were
found using the reported search, of which 4 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these articles are tabulated. Reported outcomes were vein graft
failure or patency on coronary angiography or computed tomography
angiography at early, mid and long-term follow-up. Of the non-randomized
studies reviewed, those with greater patient numbers and longer follow-up
periods showed reduced patency rates in the EVH group. Two small early
randomized controlled trials demonstrated equivalent patency rates at up
to 6 months follow-up. However, a more recent randomized controlled trial
showed reduced patency with EVH in 63 patients at a median follow-up of
6.3 years. We conclude that high-quality evidence for the effects of
harvesting method on vein graft patency is lacking, with no large
randomized trials performed to date. The current evidence suggests that
although rates of vein graft failure seem to be similar within the first 6
months following surgery, EVH is associated with reduced graft patency
from 12 months onwards.<br/>Copyright &#xa9; VC The Author 2017.

<30>
Accession Number
613799386
Author
Nagaraja V.; Ooi S.-Y.; Nolan J.; Large A.; De Belder M.; Ludman P.; Bagur
R.; Curzen N.; Matsukage T.; Yoshimachi F.; Kwok C.S.; Berry C.; Mamas
M.A.
Institution
(Nagaraja, Ooi) Department of Cardiology, Prince of Wales Hospital,
Sydney, NSW, Australia
(Nolan, Large, Kwok, Mamas) Royal Stoke University Hospital, University
Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nolan, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine, University of Keele, Stoke-on-Trent,
United Kingdom
(De Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Bagur) Division of Cardiology, Department of Medicine and Department of
Epidemiology and Biostatistics, London Health Sciences Centre, Western
University, London, ON, Canada
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, United Kingdom
(Matsukage, Yoshimachi) Division of Cardiology, Tokai University School of
Medicine, Isehara, Japan
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
Title
Impact of incomplete percutaneous revascularization in patients with
multivessel coronary artery disease: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 5 (12) (no pagination), 2016.
Article Number: e004598. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Up to half of patients undergoing percutaneous coronary
intervention have multivessel coronary artery disease (MVD) with
conflicting data regarding optimal revascularization strategy in such
patients. This paper assesses the evidence for complete revascularization
(CR) versus incomplete revascularization in patients undergoing
percutaneous coronary intervention, and its prognostic impact using
meta-analysis. Methods and Results-A search of PubMed, EMBASE, MEDLINE,
Current Contents Connect, Google Scholar, Cochrane library, Science
Direct, and Web of Science was conducted to identify the association of CR
in patients with multivessel coronary artery disease undergoing
percutaneous coronary intervention with major adverse cardiac events and
mortality. Random-effects metaanalysis was used to estimate the odds of
adverse outcomes. Meta-regression analysis was conducted to assess the
relationship with continuous variables and outcomes. Thirty-eight
publications that included 156 240 patients were identified. Odds of death
(OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI
0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50- 0.81), and major
adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly
lower in the patients who underwent CR. These outcomes were unchanged on
subgroup analysis regardless of the definition of CR. Similar findings
were recorded when CR was studied in the chronic total occlusion (CTO)
subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed
a negative relationship between the OR for mortality and the percentage of
CR. Conclusion-CR is associated with reduced risk of mortality and major
adverse cardiac events, irrespective of whether an anatomical or a
score-based definition of incomplete revascularization is used, and this
magnitude of risk relates to degree of CR. These results have important
implications for the interventional management of patients with
multivessel coronary artery disease.<br/>Copyright &#xa9; 2016 The
Authors.

<31>
Accession Number
610172560
Author
Vedin O.; Hagstrom E.; Budaj A.; Denchev S.; Harrington R.A.; Koenig W.;
Soffer J.; Sritara P.; Stebbins A.; Stewart R.H.A.; Swart H.P.; Viigimaa
M.; Vinereanu D.; Wallentin L.; White H.D.; Held C.
Institution
(Vedin, Hagstrom, Wallentin, White, Held) Department of Medical Sciences,
Cardiology, Uppsala University, Uppsala, Sweden
(Vedin, Hagstrom, Wallentin) Uppsala Clinical Research Center, Uppsala
University, Uppsala, Sweden
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Denchev) Clinic of Cardiology, Medical Institute of Ministry of Interior,
Sofia, Bulgaria
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Soffer) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, PA, United States
(Sritara) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Stebbins) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
University of Auckland, Auckland, New Zealand
(Swart) Department of Cardioresearch, Antonius Ziekenhuis Sneek,
Netherlands
(Viigimaa) Tallinn University of Technology, North Estonia Medical Centre,
Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital, Bucharest, Romania
Title
Tooth loss is independently associated with poor outcomes in stable
coronary heart disease.
Source
European Journal of Preventive Cardiology. 23 (8) (pp 839-846), 2015. Date
of Publication: 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective We investigated associations between self-reported tooth loss
and cardiovascular outcomes in a global stable coronary heart disease
cohort. Methods We examined 15,456 patients from 39 countries with stable
coronary heart disease (prior myocardial infarction, prior
revascularisation or multivessel coronary heart disease) in the STABILITY
trial. At baseline, patients reported number of teeth (26-32 (all), 20-25,
15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression
models adjusted for cardiovascular risk factors and socioeconomic status,
determined associations between tooth loss level (26-32 teeth: lowest
level; no teeth: highest level) and cardiovascular outcomes. Results After
adjustment, every increase in tooth loss level was associated with an
increased risk of the primary outcome, the composite of cardiovascular
death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio
1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17;
1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal
stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial
infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth,
entailed a significantly higher risk of the primary outcome (1.27 (1.08,
1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81
(1.50, 2.20)) and stroke (1.67 (1.15, 2.39)). Conclusions In this large
global cohort of patients with coronary heart disease, self-reported tooth
loss predicted adverse cardiovascular outcomes and all-cause death
independent of cardiovascular risk factors and socioeconomic
status.<br/>Copyright &#xa9; 2015 European Society of Cardiology.

<32>
Accession Number
619986905
Author
Lemor A.; Hernandez G.A.; Patel N.; Cohen M.G.; Alfonso C.E.; De Marchena
E.
Institution
(Lemor) Internal Medicine, Mount Sinai St Lukes- West Hosp, New York, NY,
United States
(Hernandez) Div of Cardiology, Univ of Miami Miller Sch of Medicine,
Miami, FL, United States
(Patel, Cohen, Alfonso, De Marchena) Cardiology, Univ of Miami, Miller Sch
of Medicine, Miami, FL, United States
Title
Volume of coronary artery bypass surgery and risk of 30-day readmissions
(analysis from the nationwide readmissions database).
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The rate of coronary artery bypass graft (CABG) surgery has
decreased in the past years as a consequence of an increase in
percutaneous coronary interventions (PCI). The association between CABG
surgery volume and outcome remains a quality metric, as well as a
parameter to decrease operative complications and mortality. Methods:
Using the National Readmission Database of 2013 and 2014 we identify adult
patients that underwent CABG and grouped them in quartiles based on the
hospital annual CABG volume, in low (<25th percentile), medium (25-50th),
high (5075th), and very high (>75th) volume hospitals. Rates of
readmission, in-hospital outcomes and mortality were compared between
quartiles. Results: Of 1,026 hospitals included, 534 (52.1.0%) were
categorized as low volume, 239 (23.3%) as medium volume, 156 (15.2%) as
high volume, and 92 (9.0%) as very high-volume. Of 269,177 CABG
procedures, 66,079 (24.5%) were performed in low-volume, 67,799 (25.2%) in
medium-volume, 67,112 (24.9%) in high-volume, and 68,187 (25.3%) in
very-high volume hospitals. Thirty-day readmission rates were
significantly higher in low-volume (11.1%) compared with medium-volume
(10.6%, OR:1.07, 95%CI:1.01-1.12, p=0.02), high-volume (10.4%, OR:1.10,
95%CI: 1.04-1.17, p=0.01), and very high-volume (10.5%, OR:1.10, 95%CI:
1.04-1.17, p=0.01) hospitals. Mortality was also significantly higher in
low-volume hospitals (3.1%) when compared with medium-volume (2.5%,
OR:1.25, p<0.01), high-volume (OR: 1.48, p<0.01), and very high-volume
(2.0%, p<0.01) hospitals. Hospital costs were significantly higher in the
low-volume hospitals (p<0.01). There was no significant difference in
length of stay and major bleeding rates among the 4 groups. Conclusions:
There is an inverse association between hospital CABG volume and 30-day
readmissions. Readmission carries a high inpatient mortality risk
independent of the hospital volume, nonetheless in higher volume centers
there is a statistically significant decrease in mortality. Hospital costs
were significantly higher in low-volume hospitals when compared to medium,
high, and very high-volume hospitals. This should be taken into
consideration when comparing outcomes of CABG and PCI in large clinical
trials.

<33>
Accession Number
619986776
Author
Hill K.D.; O'Brien S.; Baldwin H.S.; Bichel D.; Hornik C.; Jacobs J.;
Jacobs M.; Jaquiss R.; Kannankeril P.; Torok R.; Li J.S.
Institution
(Hill, Hornik, Torok, Li) Pediatrics, Duke Clinical Rsch Institute,
Durham, NC, United States
(O'Brien) Outcomes, Duke Clinical Rsch Institute, Durham, NC, United
States
(Baldwin, Kannankeril) Pediatrics, Vanderbilt Univ Med Cntr, Nashville,
TN, United States
(Bichel) Cardiothoracic Surgery, Vanderbilt Univ Med Cntr, Nashville, TN,
United States
(Jacobs) Cardiothoracic Surgery, Johns Hopkins All Childrens Hosp, St
Petersburg, FL, United States
(Jacobs) Cardiothoracic Surgery, Johns Hopkins Univ, Baltimore, MD, United
States
(Jaquiss) Pediatrics, Univ of Texas Southwestern, Dallas, TX, United
States
Title
Overcoming underpowering: Simulation study to evaluate an STS global rank
endpoint for trials in congenital heart surgery.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Global rank scores are increasingly used in clinical trials.
The approach permits combinations of binary, surrogate or continuous
outcomes in a composite endpoint with components ranked by clinical
relevance. We sought to develop a global rank endpoint reflecting
post-cardiopulmonary bypass (CPB) outcomes in neonates, and evaluated
power gains when using this approach in simulated trials. Methods:
Endpoints for the global rank composite were selected from variables in
the STS Congenital Heart Surgery Database (STS-CHSD). Monte Carlo trial
simulations (n=50,000) were performed using STS-CHSD data for neonates
undergoing CPB surgery (2010-2016, 11,408 surgeries, 127 centers).
Neonates (1200 per simulation) were randomly selected from the STS-CHSD
and assigned 1:1 to placebo vs treatment. Rank outcomes were allocated
based on prevalence in the study population with odds = 0.7 for treatment
vs placebo. We evaluated power based on the proportion of trial datasets
with a significant outcome (p<0.05), and evaluated the impact of covariate
adjustment using the STS-CHSD risk model (including patient factors, preop
risk factors and surgical complexity score). Results: Overall discharge
mortality was 9.1% and the unranked composite mortality / morbidity
endpoint occurred in 35.7% (Table). Prevalence of the composite increased
with surgical complexity (22.9% for STAT <= 3; 29.8% for STAT 4; 50.3% for
STAT 5 operations). In trial simulations, study power was 38% for a
mortality only endpoint, 74% for the unranked composite, and increased to
77% when endpoint components were ranked. With addition of post-op length
of stay, power increased to 89% with a further increase to 94% with
covariate adjustment. Conclusions: Our simulations demonstrate that the
global rank endpoint, as well as covariate adjustment increase study
power, improving trial feasibility. With prospective validation, our rank
measure could be applied to trials focused on post-CPB outcomes.

<34>
Accession Number
619986663
Author
Tummala R.; Banerjee K.; Mick S.; Krishnaswamy A.; White J.; Fares M.;
Mehta A.; Popovic Z.; Kapadia S.
Institution
(Tummala) Internal Medicine, St. Vincent Charity Med Cntr, Cleveland, OH,
United States
(Banerjee, Mick, Krishnaswamy, White, Fares, Mehta, Popovic, Kapadia)
Cardiology, Cleveland Clinic, Cleveland, OH, United States
Title
Clinical and procedural outcomes with the sapien 3 versus the sapien XT
prosthetic valves in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The SAPIEN 3 valve (S3V) was designed to overcome the
shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a
meta-analysis to compare their clinical outcomes and procedural
characteristics. Methods: PUBMED, EMBASE and Cochrane CENTRAL were
searched by two independent reviewers. The clinical outcomes of interest
were paravalvular leak (PVL), major vascular complications (MVC),
bleeding, acute kidney injury (AKI), device success, need for
post-dilation, all-cause mortality and procedural details. Results:
Fifteen observational cohort studies were included in the analysis
involving a total of 4,496 patients. Of these, 1,700 were S3V recipients
and 2,796 were SXT recipients. The S3V group showed fewer complications
compared to the SXT group with respect to PVL (5.58% vs. 19.35%, OR: 0.27,
P: 0.000), MVC (4.07% vs. 9.13%, OR: 0.44, P: 0.002), bleeding (6.40% vs.
12.03%, OR: 0.50, P: 0.003), 30-day mortality (3.29% vs. 5.68%, OR: 0.51,
P: 0.000) and stroke (1.48% vs. 2.86%, OR: 0.49, P: 0.014). Device success
was higher in the S3V (98.18% vs. 93.76%, OR: 3.14, P: 0.000).
Cardiovascular mortality, myocardial infarction, AKI and post-dilatation
were not significantly different. Permanent pacemaker implantation (PPI)
was higher in S3V recipients (13.29% vs. 9.23%, OR: 1.58, P: 0.000).
Procedure time was shorter for the S3V (71.94 vs. 86.85, P: 0.016) and
used less contrast volume (129.36 vs. 161.18, P: 0.049). Conclusions:
Patients receiving the S3V had lower risk of PVL, MVC, bleeding, mortality
and stroke. PPI was somewhat higher in the S3V group. S3V implantation was
faster and used less contrast. (Figure Presented).

<35>
Accession Number
619986471
Author
Perry A.; Chung M.; Novak E.; Krone R.; Brown D.
Institution
(Perry, Chung, Novak, Krone, Brown) Internal Medicine, Cardiovascular Div,
Washington Univ in St Louis, Saint Louis, MO, United States
Title
Risk score identifies patient with diabetes and multivessel coronary
artery disease who can safely defer coronary artery bypass surgery: An
analysis of the bypass angioplasty revascularization investigation 2
diabetes (BARI 2D) study.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Current ACC/AHA guidelines provide a Class I recommendation
that patients with diabetes and symptomatic multivessel coronary artery
disease be treated with coronary artery bypass surgery (CABG). However,
these patients are heterogeneous in terms of the risk and benefit
associated with CABG. We hypothesized that a risk score can be developed
from the CABG arm of BARI 2D to identify low-risk patients with diabetes
and multivessel CAD in whom CABG can be safely deferred. Methods: A risk
score for the composite outcome of death, myocardial infarction (MI) and
stroke was developed using age, history of CHF, history of
hypercholesterolemia, history of CVA/TIA, serum creatinine, insulin use,
myocardial jeopardy index, and HbA1c data from the OMT group then
validated in the CABG group. Event-free survival curves were compared
among three groups: CABG, patients who crossed over from OMT to CABG/PCI
within 12 months of randomization and OMT alone. Results: Among the 763
patients in the CABG strata of BARI 2D, 385 were randomized to OMT and 378
to CABG. Among the 385 patients randomized to OMT, 72 crossed over to
CABG/PCI within 12 months of randomization. Patients randomized to OMT,
CABG and those who crossed over with a risk score less than the median
experienced similar rates of event-free survival at 5 years from death,
MI, or stroke (77%, 83%, 80%, respectively; p=0.51). Patients who crossed
over with a high risk score suffered worse rates of event-free survival
than the OMT alone or CABG groups (41%, 65%, 73%, respectively; p<0.0001).
Conclusion: Low-risk patients with diabetes and multivessel CAD in whom
CABG can be safely deferred can be identified by a novel risk score. Among
those with high risk scores, patients who cross over from OMT to
revascularization suffered worse outcomes indicating that all high-risk
patients should continue to undergo CABG.

<36>
Accession Number
619986461
Author
Balasubramanian S.S.; Vij A.; Siddamsetti S.; Sethi A.; Kodumuri V.
Institution
(Balasubramanian, Vij, Siddamsetti, Kodumuri) Dept of Cardiology, John H.
Stroger Jr. Hosp of Cook County, Chicago, IL, United States
(Sethi) Internal Medicine, Alexian Brothers Med Cntr, Elk Grove Village,
IL, United States
Title
Percutaneous coronary intervention with drug eluting stents is as
efficacious as coronary artery bypass grafting in unprotected left main
disease: A meta analysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: CABG is the preferred revascularization strategy for
unprotected left main disease. Multiple small scale trials and registry
data showed that PCI with Drug Eluting Stents is a non-inferior strategy
and is a Class IIa ACC/AHA recommendation in a high surgical risk patient
with favorable anatomy. However, two recent large scale randomized trials
have shown conflicting evidence. We conducted a meta-analysis of the
existing data to compare the long term outcomes of PCI with DES vs CABG
for left main stenosis. Methods: 4 randomized and 8 non-randomized studies
involving 10,284 patients were included. The primary endpoint was a
composite of death, stroke or MI at three years or longer. Secondary end
points were MACCE (death, stroke, MI or repeat revascularization) and it's
individual components. Heterogeneity of the studies was analyzed by
Cochran's Q statistics. The Mantel-Haenszel random effects model was used
to calculate the combined odds ratio for outcomes. An independent analysis
was performed for the randomized data only. Results: There was no
significant difference in the primary composite outcome between PCI and
CABG at long term follow up. However the MACCE was significantly higher in
PCI, primarily driven by significantly high repeat revascularization. The
stroke rate was lower in PCI, although not significant. Analysis of
randomized data also yielded similar results. A subgroup analysis
stratified by SYNTAX score showed that MACCE and repeat revascularization
were not significantly different between PCI and CABG in low to
intermediate SYNTAX score (<33) while they were significantly higher in
PCI in high SYNTAX score. Conclusion: There was no significant difference
in the primary composite outcome between PCI with DES and CABG at long
term follow up. Repeat Revascularization in PCI was also not different
from CABG in left main stenosis with low SYNTAX score. PCI with DES can be
considered as a reasonable alternate strategy in isolated left main
stenosis.

<37>
Accession Number
619986430
Author
Lamour J.M.; Mason K.L.; Hsu D.T.; Feingold B.; Blume B.D.; Canter C.E.;
Dipchand A.I.; Shaddy R.E.; Mahle W.T.; Zuckerman W.A.; Bentlejewski C.;
Armstrong B.D.; Morrison Y.; Diop H.; Ikle D.N.; Odim J.; Zeevi A.; Webber
S.A.
Institution
(Lamour, Hsu) Pediatrics, Childrens Hosp at Montefiore, Bronx, NY, United
States
(Mason, Armstrong, Ikle) Clinical Trials, Rho Inc, Chapel Hill, NC, United
States
(Feingold) Pediatrics, Children's Hosp of Pittsurgh, Pittsburgh, PA,
United States
(Blume) Pediatrics, Boston Children's Hosp, Boston, MA, United States
(Canter) Pediatrics, St Louis Children's Hosp, Saint Louis, MO, United
States
(Dipchand) Pediatrics, SickKids, Toronto, Canada
(Shaddy) Pediatrics, Children's Hosp of Philadelphia, Philadelphia, PA,
United States
(Mahle) Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, United
States
(Zuckerman) Pediatrics, Children's Hosp of New YorkColumbia, Presbyterian,
New York, NY, United States
(Bentlejewski) Pathology, Univ of Pittsburgh Med Cntr, Pittsburgh, PA,
United States
(Morrison, Diop, Odim) Clinical Transplantation, National Institute of
Health Allergy and Infectious Diseases, Bethesda, MD, United States
(Zeevi) Pathology, Univ of Pittsburgh Med Cntr, Bronx, NY, United States
(Webber) Pediatrics, Monroe Carell Jr Children's Hosp at Vanderbuilt,
Nashville, TN, United States
Title
First year outcomes for low immunologic risk pediatric heart transplant
recipients managed with a steroid avoidance protocol: Results from a
multicenter prospective cohort study (CTOTC-04).
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Immunosuppression (ISx) strategies have changed over the yrs in pediatric
heart transplantation (HT). Thus, comorbidity profiles may have evolved.
CTOTC-04 is a multicenter, prospective, cohort study assessing the impact
of pre-HT sensitization on HT outcomes using a standard ISx regimen. In
this sub study, we report contemporary outcomes among recipients without
pre-HT donor specific HLA antibodies (DSA). Methods: We prospectively
recruited consecutive candidates (<21 yr) at 8 centers. Pts were deemed
sensitized if positive Luminex LABScreen Mixed for class I and/or class II
was associated with >1 HLA Ab at >1000 median fluorescence intensity
determined by core lab single antigen bead testing. ISx was standardized:
Thymoglobulin induction, tacrolimus/MMF maintenance, and steroid avoidance
beyond 1 week. Rejection surveillance was by serial EMB. Results: There
were 317 screened subjects, 290 enrolled and 240 received HT. Subjects for
this sub study (n=186) were non-sensitized (n=115) or had Ab without DSA
(n=71). Median age was 5 yr, 87% were UNOS status 1A, 48% male, and 38%
congenital heart disease. Survival at 1 yr was 94.5% (95% CI: 90.1- 97.0).
Sixty-seven (36.0%) had > 1 acute rejection. Freedom from rejection at 1
year was: cellular 78.6%, antibody mediated 94.4%, hemodynamic compromise
97.1%. Freedom from infection requiring hospitalization/IV antimicrobials
at 1 yr was 75.4%. Freedom from documented infection was: bacterial 71.4%,
viral 65.8%, fungal 99.4%. CMV disease occurred in 4 (2.2%). Freedom from
rehospitalization was 40.3% (226 hospitalizations; 56.4% subjects). New
onset diabetes mellitus (NOD) and PTLD occurred in 2.2% and 1.1% of
subjects respectively. Mean GFR was 109.4 +/-40.9
mls/min/1.73m² at 1 year vs. 101.5 +/-46.3 at HT.
Corticosteroids were used in 14.5% at 1 yr visit. Conclusion: HT
recipients without DSA at HT and managed with steroid avoidance regimen
have excellent short term survival and low risk of first yr NOD, PTLD,
CMV, and fungal infection. Renal function remains stable during first yr.
Rehospitalization remains common driven by rejection/infection. These
contemporary observations allow for improved caregiver/patient counseling
and provide necessary outcomes to help design future randomized controlled
trials.

<38>
Accession Number
619986243
Author
Lipshultz S.E.; Rossano J.W.; Shi L.; Jefferies J.L.; Colan S.D.; Pahl E.;
Everitt M.D.; Webber S.A.; Canter C.E.; Towbin J.A.; Kantor P.F.; Feingold
B.; Addonizio L.J.; Lamour J.M.; Ware S.M.; Lee T.M.; Czachor J.D.; Razoky
H.; Wilkinson J.D.
Institution
(Lipshultz) Pediatrics, Wayne State Univ, Detroit, MI, United States
(Rossano) Pediatrics, Children's Hosp of Philadelphia, Philadelphia, PA,
United States
(Shi) Rsch, New England Rsch Institute, Watertown, MA, United States
(Jefferies) Pediatrics, Heart Institute, Cincinnati's Children's Hosp Med
Cntr, Cincinnati, OH, United States
(Colan) Pediatrics, Boston Children's Hosp, Boston, MA, United States
(Pahl) Pediatrics, Ann and Robert H. Lurie Children's Hosp of Chicago,
Chicago, IL, United States
(Everitt) Pediatrics, Children's Hosp Colorado, Univ of Colorado, Aurora,
CO, United States
(Webber) Pediatrics, Vanderbilt Univ, Monroe Carell Jr. Children's Hosp at
Vanderbilt, Nashville, TN, United States
(Canter) Pediatrics, Washington Univ, Sch of Medicine, St. Louis, MO,
United States
(Towbin) Pediatrics, Heart Institute, Le Bonheur Children's Hosp, Memphis,
TN, United States
(Kantor) Pediatrics, Stollery Children's Hosp, Univ of Alberta, Edmonton,
Canada
(Feingold) Pediatrics, Univ of Pittsburgh, Children's Hosp of Pittsburgh,
Pittsburgh, PA, United States
(Addonizio, Lee) Pediatrics, Columbia Univ Med Cntr, New York, NY, United
States
(Lamour) Pediatrics, Albert Einstein College of Medicine, Children's Hosp
at Montefiore, Bronx, NY, United States
(Ware) Pediatrics, Indiana Univ, Sch of Medicine, Indianapolis, IN, United
States
(Czachor, Razoky, Wilkinson) Pediatrics, Wayne State Univ, Children's Hosp
of Michigan, Detroit, MI, United States
Title
Cardiac biomarkers are associated with death and listing for heart
transplantation in pediatric patients with newly diagnosed dilated
cardiomyopathy: A multi-center study from the pediatric cardiomyopathy
registry.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Children with dilated cardiomyopathy (DCM) are at high risk
for morbidity and death. There are no validated serum biomarkers
associated with clinical events. Objective: To evaluate cardiac biomarkers
as predictors of clinical endpoints (heart failure, death, or transplant
listing, heart transplant). Design / Methods: Patients (<21 years of age
at DCM diagnosis) were enrolled at 15 North American pediatric
cardiomyopathy centers within one year of diagnosis with collection of
serum, echocardiograms and clinical data at enrollment and at intervals
for up to 2 years. The main hypothesis was that heart failure, myocyte
injury, and inflammatory biomarkers are associated with the primary study
endpoint (heart failure, death, or transplant listing, or heart
transplant) <90 days of enrollment. Results: Data from 74 subjects were
analyzed, median age 2.1 years at enrollment [interquartile range (IQR
0.7-12.8)], 44 (55%) female, and 61 (76%) enrolled within 90 days of
diagnosis. The primary endpoint was met in 14 subjects (18%). Patients
that met the primary endpoint < 90 days were more likely to be on VAD or
ECMO at enrollment (n=5, 36% vs. n=7, 11%; p=0.02) compared to those who
did not meet the primary endpoint but the groups were similar in age,
presence of heart failure and hospitalization status. Several cardiac
biomarkers of heart failure, (NT-proBNP, Growth Differentiation Factor-15)
and inflammation (IL-6, C-Reactive Protein) were significantly associated
with the primary endpoint (Table; all Ps <0.05). ST-2 and Galectin- 3 were
borderline significantly associated with the primary endpoint (p=0.06 and
0.05, respectively). Conclusion: Several biomarkers of heart failure and
inflammation were associated with death, transplant or listing for heart
transplantation in children with a recent diagnosis of DCM. Validation of
the clinical utility and predictive performance of these biomarkers should
be studied in randomized clinical trials.

<39>
Accession Number
619985972
Author
Kleinbongard P.; Gedik N.; Stoian L.; Frey U.; Zandi A.; Thielmann M.;
Jakob H.; Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Stoian, Heusch) Institut fuer Pathophysiologie UKE,
Universitatsklinikum Essen, Westdeutsches Herz- und Gefafczentrum Essen,
Essen, Germany
(Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Zandi, Kamler) Herzzentrum Essen-Huttrop, Universitatsklinikum Essen,
Westdeutsches Herz- und Gefafczentrum Essen, Essen, Germany
(Thielmann, Jakob) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Westdeutsches Herz- und Gefafczentrum Essen,
Essen, Germany
Title
Cardioprotection by remote ischemic conditioning in humans: Improved
contractile function and mitochondrial respiration of atrial trabeculae.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Remote ischemic preconditioning (RIPC), i.e. repeated cycles
of brief limb ischemia/reperfusion by blood pressure cuff
inflation/deflation, attenuates postoperative troponin release in patients
undergoing surgical coronary revascularization and improves clinical
outcome in some, but not all studies. Better understanding of the
underlying signal transduction will permit avoidance of confounding
variables and more successful clinical use of RIPC. We therefore developed
a bioassay reflecting the RIPC-induced protection in isolated human atrial
trabeculae. Hypothesis: RIPC improves contractile function along with
mitochondrial respiration in human atrial trabeculae. Methods: Patients
undergoing elective surgical coronary revascularization under isoflurane
anesthesia were randomized to RIPC by 3x 5 min/5 min upper arm blood
pressure cuff inflation/deflation or placebo (n=35/39), and their right
atrial appendages were harvested prior to cardioplegic arrest.
Cardioprotection by RIPC was reflected by a 14% decrease vs. placebo in
the area under the curve of serum troponin I/T concentrations over 72h
after surgery. Atrial trabeculae (>= 3 mm length, < 1 mm diameter) were
isolated, and their developed force of contraction was measured under
electrical stimulation (1 Hz). Mitochondria were isolated from the atrial
tissue (n=5/5). ADP-stimulated respiration at complex I and ATP production
were measured and normalized to mitochondrial protein concentration.
Results: With RIPC vs. placebo, contractile function of human atrial
trabeculae was 7.8+/-0.2 vs. 6.5+/-0.3 mN/mm² (p<0.05).
ADP-stimulated respiration (158+/-6 vs. 127+/-4 nmolO<inf>2</inf>/min/mg)
and ATP production (264+/-16 vs. 161+/-21 jmol/100 mug) were also
increased with RIPC vs. placebo (both p<0.05). Conclusions: RIPC improves
contractile function of human atrial trabeculae along with mitochondrial
respiration and ATP production. This in vitro assay will allow further
elucidation of underlying signal transduction and potential confounding
variables of RIPC in human myocardium.

<40>
Accession Number
619985875
Author
Kang S.; Verma S.; Teng G.; Belke D.D.; Svystonyuk D.A.; Guzzardi D.G.;
Park D.S.; Turnbull J.D.; Dundas J.A.; Fedak P.W.
Institution
(Kang, Teng, Belke, Svystonyuk, Guzzardi, Park, Turnbull, Dundas, Fedak)
Cardiac Sciences, Univ of Calgary, Calgary, Canada
(Verma) Div of Cardiac Surgery, Univ of Toronto, Toronto, Canada
Title
Empagliflozin attenuates extracellular matrix remodeling by human cardiac
fibroblasts: Novel translational clues to EMPA-REG outcome.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2)
inhibitor that reduced cardiovascular mortality and heart failure related
events (EMPA-REG OUTCOME study). The mechanism(s) underlying the heart
failure protective effects of empagliflozin remain unclear. Cardiac
fibroblasts play an essential role in progression of structural remodeling
and heart failure, in part, by regulating extracellular matrix (ECM)
homeostasis. In this study, we hypothesized that the therapeutic benefits
of empagliflozin may be explained by a direct effect on human cardiac
fibroblast-mediated collagen remodeling. Methods: Cardiac fibroblasts were
isolated via explant culture from human myocardial tissue obtained at
open-heart surgery. Collagen gel contraction assay was used to assess
myofibroblast activity (n=11). Cell morphology and cell-mediated ECM
remodeling was examined by embedding cells in a thin non-contractile 3D
collagen gel matrix supported by a nylon scaffold, stimulated with TGFp1
to induce myofibroblast activation and local collagen remodeling. These
were visualized by confocal microscopy and quantified (n=3). Pro-fibrotic
gene expression was assessed using RT-qPCR (n=5). Results: Empagliflozin
significantly attenuated TGFp1-induced fibroblast activation after 72-hour
exposure with escalating concentrations (0.5u.M, 1u.M, and 5u.M) resulting
in greater attenuation (P<0.0001). Cells exposed to empagliflozin (5u.M)
were smaller in size (P=0.04) with reduced cell extension length (P=0.03)
and total number of extensions (P=0.0009), indicative of a more quiescent
phenotype. Moreover, empagliflozin significantly attenuated cell-mediated
ECM remodeling as measured by collagen fiber alignment index (P=0.006).
Empagliflozin (5u.M) also suppressed expression of critical pro-fibrotic
markers including COL1A1 (P=0.001), ACTA2 (P<0.0001), CTGF (P=0.0004), and
MMP2 (P<0.0001). Conclusions: We provide novel data that show a direct
effect of empagliflozin on human cardiac fibroblast phenotype and
function, particularly by attenuation of myofibroblast activity and
cell-mediated collagen remodeling. We provide critical insights into the
profound effects of empagliflozin as noted in the EMPAREG OUTCOME study.

<41>
Accession Number
619985731
Author
Graham E.M.; Martin R.H.; Atz A.M.; Hamlin-Smith K.; Alsoufi B.; Mahle
W.T.; Everett A.D.
Institution
(Graham, Atz) Pediatric Cardiology, Med Univ of South Carolina,
Charleston, SC, United States
(Martin) Public Health Sciences, Med Univ of South Carolina, Charleston,
SC, United States
(Hamlin-Smith) Pediatrics, Med Univ of South Carolina, Charleston, SC,
United States
(Alsoufi) Cardiothoracic Surgery, Emory Univ, Atlanta, GA, United States
(Mahle) Pediatric Cardiology, Emory Univ, Atlanta, GA, United States
(Everett) Pediatric Cardiology, Johns Hopkins Univ, Baltimore, MD, United
States
Title
Intraoperative circulating-brain biomarker is associated with
neurodevelopmental outcomes at 1 year in neonates undergoing cardiac
surgery.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Neurodevelopmental disability is the most significant
complication for survivors of surgery for congenital heart disease. The
ability to detect brain injury in real time remains elusive. This study
sought to determine if perioperative circulatingbrain injury biomarker
levels are associated with neurodevelopmental outcomes at 12 months of
age. Methods: A secondary analysis of a multicenter randomized controlled
trial of neonates undergoing cardiac surgery with cardiopulmonary bypass
(CPB) was performed. The brain injury biomarker glial fibrillary acidic
protein (GFAP) was measured in blood at 4 time points: 1) prior to skin
incision, 2) immediately after CPB, 3) 4 and 4) 24 hours post-operatively.
Univariate and multivariable analysis was used to determine an association
with peak levels of GFAP and Bayley Scale of Infant Development III (BSID)
composite scores. Results: There were 97 subjects who had cardiac surgery
at a mean age of 9 +/- 6 days and completed a BSID at 12.5 +/- 0.6 months
of age. BSID mean scores were cognitive 105 +/- 15, language 101 +/- 13,
and motor 92 +/-17. GFAP levels are shown in Fig 1A. In univariate
analysis peak GFAP was inversely associated with cognitive (p=0.02),
language (p=0.03) and motor (p<0.01) composite scores. Upon multivariable
regression analysis adjusting for STAT category, CPB duration, aortic
crossclamp time, use of deep hypothermic circulatory arrest, and site peak
GFAP was independently associated with BSID motor (t value = -2.13,
p=0.04). There was a significant difference between peak GFAP levels
between institutions (Fig 1B, p=0.01). Conclusions: Higher GFAP levels
were independently associated with decreased BSID motor composite scores
at 12 months. GFAP may serve as a diagnostic means to acutely identify
perioperative brain-specific injury and serve as a benchmark of
therapeutic efficacy for investigational treatments, discriminate center
specific effects and early prognostic information for intervention.
(Figure presented).

<42>
Accession Number
619985683
Author
Asleh R.; Briasoulis A.; Barry B.A.; Edwards B.S.; Pereira N.L.; Adigun
R.; Maltais S.; Daly R.C.; Lerman A.; Kushwaha S.S.
Institution
(Asleh, Briasoulis, Barry, Edwards, Pereira, Adigun, Maltais, Daly,
Lerman, Kushwaha) Cardiovascular Diseases, Mayo Clinic Rochester,
Rochester, MN, United States
Title
The impact of HMGCOA reductase inhibitors on allograft vasculopathy
progression and outcomes in heart transplant recipients.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Early studies from the 1990's have shown that statins improve
survival and attenuate cardiac allograft vasculopathy (CAV) after heart
transplantation (HT). However, contemporary data on the impact of statins
on CAV progression and clinical outcomes with the current use of
newgeneration immunosuppressive agents and coronary intravascular
ultrasound (IVUS) for accurate assessment of CAV are lacking. Objectives:
To examine the effect of early compared with late initiation of statins
after HT on longterm progression of CAV and clinical outcomes in a large
HT cohort. Methods: We retrospectively analyzed a longterm followup cohort
of 409 HT recipients. CAV progression was assessed by serial coronary IVUS
volumetric measurements of the difference between baseline and last
followup plaque volume (PV), normalized to the examined segment length
(SL), and plaque index (PI%) (PV/vessel volume ratio). CAV progression and
clinical outcomes were compared between early statin (ES) (<2 years post
HT) and late statin (LS) (>2 years post HT) groups. Results: We identified
342 patients in the ES group (median time to statin therapy: 29 days post
HT) and 67 patients in the LS group (median time: 3 years, range: 2.4 to
5.2 years). At baseline, patients in the ES group were older (52.8 vs.
46.3 years, p=0.004), had higher rates of conversion to sirolimus (69% vs
53.7%, p=0.02), and higher total cholesterol and HDL cholesterol levels.
During a median followup time of 8.2 years, ES resulted in significantly
lower change (DELTA) of PI% (+3.8+/-1.7 vs +8.2+/-3.6; p=0.0008) and PV/SL
(+0.8+/-0.3 vs +1.9+/-1.2; p=0.04) compared with LS group. After adjusting
for patient characteristics, ES was associated with significantly lower
CAVassociated events and the composite endpoint of allcause mortality and
CAVassociated events (Figure). Conclusions: Early initiation of statin
therapy after HT results in attenuated CAV progression as well as in
decreased CAVrelated events and mortality.

<43>
Accession Number
619985664
Author
Scudeler T.L.; Hueb W.; De Soarez P.C.; Campolina A.G.; Rezende P.C.;
Garzillo C.L.; Lima E.G.; Azevedo D.F.; Hueb A.C.; Filho J.P.L.; Ramires
J.A.; Filho R.K.
Institution
(Scudeler, Hueb, Rezende, Garzillo, Lima, Azevedo, Hueb, Filho, Ramires,
Filho) Cardiology, Heart Institute (InCor), Univ of Sao Paulo, Sao Paulo,
Brazil
(De Soarez) Cardiology, Univ of Sao Paulo, Sao Paulo, Brazil
(Campolina) Cardiology, Cancer Institute of the State of Sao Paulo, Sao
Paulo, Brazil
Title
Cost-effectiveness of on-pump and off-pump stable multivessel coronary
artery bypass grafting - MASS III trial 5-year follow-up.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Long-term cost-effectiveness of on-pump and off-pump
coronary artery bypass graft surgery (CABG) is under debate. Hypotheses:
Off-pump CABG was introduced with the aim of minimizing the
non-physiological effects of extracorporeal circulation. Thus contributing
to increase the cost-effectiveness. Methods: Between 2001 and 2006, 308
patients were randomized to on-pump CABG (n=153) or off-pump CABG (n=155).
The 2 groups were well matched for baseline characteristics. Costs of all
cardiovascular events and hospitalizations, medical consultations,
diagnostic tests and medications were adjusted to inflation rates from
2001 to 2016. Costs were standardized to 2016 dollars. Patient QoL was
assessed using the Short Form 36. Health state utilities were assessed
using the SF-6D questionnaire. Results: Off-pump CABG patients had more
incomplete revascularization (52.9% vs 42.5%; p=0.052). QoL improved
significantly, but similarly, in the on-pump and off-pump CABG,
respectively, from baseline (0.781 vs 0.768, p=0.381) to 6 mo (0.817 vs
0.809, p=0.175), 12 mo (0.832 vs 0.831, p=0.696), 24 mo (0.837 vs 0.827,
p=0.349) and 60 mo (0.829 vs 0.820, p=0.300).The cumulative QALY adjusted
by baseline over 5-year follow-up was higher with on-pump CABG (3.707 vs
3.556), but not significantly. Although hospital stay (9 vs 6 days,
p<0.001) and length of ICU (43 vs 19.5h, p<0.001) of on-pump CABG group
were higher than the off-pump CABG group, total costs for the index
hospitalization per patient were higher in the offpump CABG group
($2966.72 vs $3046.39, p=0.293). Over the 5-year follow-up, costs were
similar between the treatment groups. Nonetheless, 5-year cumulative cost
remained only $180.64 higher per patient with on-pump CABG. Conclusion:
Despite incomplete revascularization following off-pump CABG, there was no
difference in QoL and cost-analysis between the procedures. QoL markedly
improved in both treatment groups over 5-year follow-up.

<44>
Accession Number
619985595
Author
Raheja H.; Kumar V.; Namana V.; Chopra K.; Hollander G.; Moskovits N.;
Malik B.; Frankel R.; Shani J.
Institution
(Raheja) Cardiology, Cleveland Clinic, Cleveland, OH, United States
(Kumar) Internal Medicine, Maimonides Med Cntr, Brooklyn, NY, United
States
(Namana, Hollander, Moskovits, Malik, Frankel, Shani) Cardiology,
Maimonides Med Cntr, Brooklyn, NY, United States
(Chopra) Dentistry, Indiana Univ, Indianapolis, IN, United States
Title
Dual versus single antiplatelet therapy after trans catheter aortic valve
replacement: A meta-analysis of randomized controlled trials.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel
is a commonly practiced strategy after transcatheter aortic valve
replacement (TAVR). However there is lack of sufficient evidence
supporting this approach. Objective: We sought to assess the current
evidence for DAPT (aspirin plus clopidogrel) versus single anti-platelet
therapy (SAPT) with aspirin alone post TAVR. Methods: A systematic search
of RCTs in databases comparing DAPT and SAPT post TAVR was performed.
Random effects meta-analysis was conducted to estimate the relative risk
with 95% confidence intervals (CI) for several end-points. Results: A
total of 3 RCTs with 421 patients were included in the final analysis.
Major stroke occurred in 3 (1.4%) of DAPT and 4 (1.9%) of SAPT, RR = 0.74
(95% CI, 0.16-3.35, P = 0.7); minor stroke occurred in 2 (0.94%) of DAPT
and 1 (0.47%) of SAPT , RR = 1.35 (95% CI, 0.09-19.27, P= 0.82);
significant bleeding (major and life threatening bleeding) occurred in 19
(9%) of DAPT and 8 (3.8%) of SAPT, RR = 2.29 (95% CI, 1.01-5.16, P =
0.04). Number needed to harm for major or life threatening bleeding was
19. Death occurred in 12 (5.68%) of DAPT and 11 (5.23%) of SAPT, RR= 1.07
(95% CI, 0.47-2.4, P = 0.86). Spontaneous myocardial infarction occurred
in 5 (3.3%) of DAPT and 1 (0.66%) of SAPT, RR=3.61 (95% CI, 0.60-21.76, P=
0.16). Conclusion: In our meta-analysis, no significant differences were
found between DAPT versus SAPT after TAVR in terms of major or minor
stroke and all cause death. The risk of major and life threatening bleed
seems to be significantly higher with DAPT. This suggests that treatment
with aspirin alone might be an acceptable strategy. (Figure Presented).

<45>
Accession Number
619985580
Author
Torella M.; Torella D.; Chiodini P.; Amarelli C.; De Feo M.; Della Corte
A.; Romano G.; De Santo L.S.
Institution
(Torella) DPT of Cardio-thoracic Sciences, Universita della Campania Luigi
Vanvitelli, Caserta, Italy
(Torella) Dipartimento di Scienze Mediche e Chirurgiche, Universita Degli
Studi Magna Graecia di Catanzaro, Catanzaro, Italy
(Chiodini) Dipartimento di Salute Mentale e Fisica e Medicina Preventiva,
Universita della Campania, Caserta, Italy
(Amarelli, Romano) DPT of Cardiac Surgery, Monaldi Hosp, Napoli, Italy
(De Feo, Della Corte) DPT of Cardio-thoracic Sciences, Universita della
Campania, Caserta, Italy
(De Santo) Dept of Med and Surgical Sciences, Casa di Cura Montevergine
and Universita di Foggia, Avellino, Italy
Title
Low dose anticoagulation is safe and feasible after isolated mechanical
aortic valve replacement with livanova prosthesis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Thrombotic complications are due to a complex interplay
between patients' features, device characteristics, and anticoagulation
intensity. Low-dose anticoagulation is safe and feasible in selected
recipients. Subtle design and material differences in available prostheses
imply different susceptibility to thrombosis. LivaNova Bicarbon
bi-leaflets valve is the only featuring a titanium housing, a carbon layer
coating the entire device and an innovative rolling hinge mechanism.
Hypothesis: This post hoc sub analysis of the LOWERING-IT database tested
the safety and feasibility of a low-level oral anticoagulant regime with
an INR range between 1.5 and 2.5 compared to a higher level of
anticoagulant therapy with the recommended INR range of 2.0 to 3.0 in
low-risk patients with aortic LivaNova prosthetic valve replacement.
Methods: Study population included 148 patients randomized to LOW-INR
group, and 144 patients randomized CONVENTIONAL-INR group. The primary
outcomes were the thromboembolic and bleeding events. The non inferiority
of thromboembolic events between LOW-INR and CONVENTIONAL-INR groups was
tested. This analysis has a 70% power, with a significance level of 0.025
(1-sided) considering the assumption of the LOWERING-IT trial.
Specifically, a non inferiority margin delta of 0.036 (corresponding to
0.90%/year) were considered. Results: The two groups were well matched.
Follow-up reached 1,545 patient/years. The mean INR in the LOW-INR group
was 1.91 +/- 0.23, whereas in the CONVENTIONAL-INR group, it was 2.59 +/-
0.26 (P<0.001). There were 3 thromboembolic event: all in the
CONVENTIONAL-INR group (3.96 per 1,000 patient/year, 95% CI 0.82-11.58).
Comparison of thromboembolic events was not significant (P = 0.119, RR
0.00, 95% CI 0.00-1.45). The 1-sided 97.5% exact CI for the difference in
primary event proportion was 0.54%, satisfying criteria for non
inferiority. The incidence of bleeding events was significantly different
(P = 0.045, RR 0.37, 95% CI 0.14-0.98): 6.61 per 1,000 patient/year, 95%
CI 2.14-15.41 in LOW-INR group vs 18.65 per 1,000 patient/year, 95% CI
9.93-31.89 in CONVENTIONAL-INR group. Conclusions: Low-dose
anticoagulation is safe in selected patients after aortic LivaNova
prosthesis implantation.

<46>
Accession Number
619985432
Author
Armstrong A.K.; Batra A.S.; Benson L.N.; Berger F.; Cheatham J.P.; Eicken
A.; Jones T.K.; Moore J.; Rhodes J.F.; Turner D.R.; Vincent J.A.; Zellers
T.; McElhinney D.B.
Institution
(Armstrong, Cheatham) Heart Cntr, Nationwide Children's Hosp, Columbus,
OH, United States
(Batra) Pediatrics, Children's Hosp of Orange County, Orange, CA, United
States
(Benson) Pediatrics, Hosp for Sick Children, Toronto, Canada
(Berger) Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
(Eicken) Klinik fur Kinderkardiologie und angeborene Herzfehler, Deutsches
Herzzentrum Munchen, Munich, Germany
(Jones) Cardiology, Seattle Children's Hosp, Seattle, WA, United States
(Moore) Cardiology, Rady Children's Hosp, San Diego, CA, United States
(Rhodes) Cardiology, Nicklaus Children's Hosp, Miami, FL, United States
(Turner) Pediatric Cardiology, Detroit Med Cntr, Children's Hosp of
Michigan, Detroit, MI, United States
(Vincent) Pediatric Cardiology, Morgan Stanley Children's Hosp of New
York, Columbia Univ Med Cntr, New York, NY, United States
(Zellers) Div of Cardiology Dept of Pediatrics, Univ of Texas,
Southwestern Med Cntr, Dallas, TX, United States
(McElhinney) Cardiothoracic Surgery, Lucille Packard Children's Hosp
Stanford, Palo Alto, CA, United States
Title
Association between patient age at implant and outcomes after
transcatheter pulmonary valve replacement in the multicenter Melody valve
trials.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Patient (pt) age and valve size at implant contribute to
longevity of surgical pulmonary valves. Hypothesis : Age and valve size at
implant contribute to outcomes after Melody Transcatheter Pulmonary Valve
Replacement (TPVR). Methods : Data from 3 prospective Melody valve
multicenter studies were pooled and analyzed. All pts with successful
Melody valve implant in a dysfunctional conduit and had the valve present
at hospital discharge comprised the study cohort. Acute and time-related
outcomes were analyzed according to age: children (<=12 yrs), adolescents
(13-18 yrs), young adults (19-29 yrs), and older adults (>=30 yrs).
Results : Successful Melody valve implantation occurred in 49 children,
107 adolescents, 96 young adults, and 57 older adults. Pediatric pts (<=18
yrs) were more likely to have TPVR for conduit stenosis than adults ( 61 %
vs. 43%), who were more likely to have conduit regurgitation ( 39% vs.
57%) (p=0.005). After TPVR, pediatric and adult pts had similar decreases
in right ventricular (RV) size and no significant change in RV ejection
fraction by MRI, but adults had an improvement in the % predicted peak
VO<inf>2</inf> ( 57% pre to 63% post, p=0.02) and FEV1 (68% pre to 71 %
post, p=0.005), while pediatric pts did not. Pediatric pts did have higher
FEV1 at baseline ( 83% vs 68%, p<0.001). In conduits protected with a
stent, smaller Melody size was associated with both RVOT re-intervention
and explant, and pre-implant peak gradient was associated with RVOT
re-intervention. Children had the highest incidence of endocarditis
(Figure 1) and of explant (Figure 2), as well as the smallest initial
conduit and Melody size. Conclusions : Smaller Melody size was associated
with RVOT re-intervention and explant of protected conduits. Pts >=13 yrs
of age were at low risk for endocarditis and explant, even out to 5 years.
Adult pts experienced an exercise benefit with Melody TPVR. Time-related
outcomes by age will aid in the comparison of therapeutic options for TPVR
candidates.

<47>
Accession Number
619985316
Author
Gasparovic H.; Kopjar T.; Anticevic A.; Rados M.; Malojcic B.; Ivancan V.;
Fabijanic T.; Cikes M.; Milicic D.; Gasparovic V.; Biocina B.
Institution
(Gasparovic, Kopjar, Ivancan, Biocina) Cardiac Surgery, Univ Hosp Rebro
Zagreb, Zagreb, Croatia
(Rados) Radiology, Croatian Institute for Brain Rsch, Zagreb, Croatia
(Anticevic) Dept of Psychiatry and Psychology, Yale Univ Sch of Medicine,
New Haven, CT, United States
(Rados) Radiology, Univ Hosp Rebro Zagreb, Zagreb, Croatia
(Malojcic) Neurology, Univ Hosp Rebro Zagreb, Zagreb, Croatia
(Fabijanic) Cardiac Surgery, Sch Od Medicine, Univ of Zagreb, Zagreb,
Croatia
(Cikes, Milicic) Cardiology, Univ Hosp Rebro Zagreb, Zagreb, Croatia
(Gasparovic) Cardiology, Sch of Medicine, Univ of Zagreb, Zagreb, Croatia
Title
Remote ischemic preconditioning preceding coronary artery bypass grafting
reduces the volume of ischemic brain lesions.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Neurological sequelae following cardiac surgery impact
quality of life, mortality and health resource utilization. We
hypothesized that remote ischemic preconditioning (RIPC) prior to CABG
harbors a neuroprotective effect. Methods: In this randomized trial 70
CABG patients were assigned to undergo RIPC or a sham procedure.
Structural brain MRI was complemented with resting state functional MRI to
gain a whole-brain data-driven global connectivity analysis. A
postoperative decrease of one standard deviation in neurocognitive tests
was considered abnormal. Paired neurocognitive and MRI data were acquired
pre-and postoperatively. Results: Two patients in each group didn't have
postoperative MRIs and were excluded. There were a total of 11 new brain
ischemic lesions in 8 patients in the RIPC group, and 25 new lesions in 7
patients in the control group (8/33 (24%) vs. 7/33 (21%) P=1.0, mean
ischemic volume 191+/-92 vs. 2588+/-5105 mm , P=0.004). A total of 99
individual neurocognitive tests were performed in each group. The
reduction in abnormal test results in the RIPC group was below the
threshold of statistical significance (8/99 (8%) vs. 17/99 (17%);
P=0.085). There were no major adverse cardiac and cerebrovascular events
in either group. Thirty-three patients had resting state functional MRI
datasets of sufficient quality to undergo analysis. Interaction effects in
bilateral primary visual cortex regions, driven by both the effects of
surgery and RIPC, were noted (Figure 1). RIPC was associated with
postoperative global brain connectivity elevations. Contrariwise,
attenuation of connectivity was noted in the control group. Conclusions:
New, clinically silent, ischemic brain lesions after CABG are frequently
detected on brain MRI. While the overall incidence of new ischemic brain
lesions did not differ between the groups, RIPC significantly reduced
their mean volume. RIPC also impacted global brain connectivity within
primary visual regions.

<48>
Accession Number
619985308
Author
Yamaguchi K.; Wakatsuki T.; Kawabata Y.; Ito H.; Matsuura T.; Ise T.;
Kusunose K.; Tobiume T.; Yagi S.; Yamada H.; Soeki T.; Sata M.
Institution
(Yamaguchi, Wakatsuki, Kawabata, Ito, Matsuura, Ise, Kusunose, Tobiume,
Yagi, Yamada, Soeki, Sata) Cardiovascular medecine, Tokushima Univ Hosp,
Tokushima, Japan
Title
Preserved endothelial function and suppressed local coagulative and
inflammatory response after biodegradable polymer SES implantation
compared to durable polymer SES.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We have previously demonstrated local persistent
hypercoagulation after durable polymer (DP)-sirolimus-eluting stent (SES)
implantation by measuring plasma prothrombin fragment 1+2 (F1+2) levels.
The aim of this study is to examine endothelial function and local
coagulative and inflammatory response after biodegradable polymer
(BP)-SES. Method: Fifty patients who were treated about eight months
earlier with coronary stenting for isolated proximal left anterior
descending (LAD) stenosis, with no evidence of restenosis, were studied
[bare metal stent (BMS): 12pts, DP-SES: 26pts, and BP-SES: 12pts. We
measured plasma levels of F1+2 and pentraxin3 (PTX3) sampled in coronary
sinus (CS) and sinus of Valsalva (V). The transcardiac gradient (DELTA)
were defined as CS levels minus V levels. We additionally examined
coronary vasoreactivity to intracoronary acetylcholine (ACh) by
quantitative coronary angiography. Results: The percent diameter
restenosis were greater in the BMS groups than in the DP-SES and BP-SES
groups (25.1+/-15.6 vs 7.1+/-16.5 and 11.2+/-10.5%, p<0.05, respectively).
The DELTAF1+2 was lower in the BMS and BP-SES groups than in the DP-SES
groups (5.2 +/- 14.4 and 7.5 +/- 18.1 vs 23.4 +/- 21.1 pmol/l, p<0.05,
respectively). The DELTAPTX3 was lower in the BMS and BP-SES groups than
in the DP-SES groups (1.0 +/- 5.0 and 6.1 +/- 6.0 vs 13.0 +/- 5.0 x10
ng/ml, p<0.05, p=0.08, respectively). Coronary vasoconstricting responses
to ACh were significantly suppressed at the distal lesion in the BMS and
BP-SES groups compared with the DP-SES group (-19.4+/-6.5 and -18.8+/-12.7
vs -34.9+/-13.2 %, p<0.05, respectively) Conclusion: Preserved endothelial
function and suppressed local coagulative and inflammatory response after
BP-SES implantation were observed compared to DP-SES. These findings
indicate that more biocompatibility owing to abluminal coating and early
disappearance of the polymer is one of the most important factors in the
vascular response and endothelial function.

<49>
Accession Number
619985296
Author
Choi J.H.; Hwang K.W.; Jung S.M.; Kim Y.S.; Lee S.Y.; Chon M.K.; Lee S.H.;
Kim J.S.; Park Y.-H.; Kim J.H.; Chun K.J.; Je H.G.; Lee S.K.
Institution
(Choi, Hwang, Jung, Kim, Lee, Chon, Lee, Kim, Park, Kim, Chun) Div of
Cardiology, Dept of Internal Medicine, Pusan National Univ Yangsan Hosp,
Yangsan-si, Gyeongsangnam-do, South Korea
(Je, Lee) Dept of Cardiovascular and Thoracic Surgery, Pusan National Univ
Yangsan Hosp, Yangsan-si, Gyeongsangnam-do, South Korea
Title
Redefining the blanking period after the maze procedure for atrial
fibrillation.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction & Hypothesis: Early recurrence (ER) of atrial tachyarrhythmia
(ATA) is common after atrial fibrillation ablation. There is well unknown
about current guidelines of blanking period after maze procedure. We aimed
to investigate the significance of ER after maze procedure is a predictor
of late recurrence (LR) and determine whether it varies according to
timing. Methods: From 2009 to 2016, a total of 290 patients underwent the
open heart surgery with concomitant maze procedure were analyzed. Data
were obtained from 12-lead electrocardiograms and Holter monitoring during
follow-up. Patients with atrial ATA >=30 seconds within post procedure 3
month were stratified according to the timing of ER. Results: A total of
146 patients (50.3%) experienced their last episode of ER during the first
the first (n=82), second (n=15), or third (n=49) month of the 3-month
blanking period. One-year freedom from ATAs was 97.7% in patients without
ER compared with 96.9%, 76.9%, and 10.4% in patients with ER 1, 2, and 3
months after index procedure, respectively (P<0.001). Receiver operating
curve analyses showed a strong correlation between the timing of ER and
late recurrence (area under the curve, 0.84, p<0.001, cut-off value: 58
days). Hazard ratios about LR according to timing of the last episode of
ER 1, 2, and 3 months were 1.45, 13.7, and 89.86, respectively (figure).
Conclusions: Our study validates the blanking period after maze procedure
for AF. As about 90% of patients with ER during the last 3 months post
maze procedure experience late recurrence by 1 year, we put into question
the 90-day cut-off value. Randomized trials required to assess the shorter
blanking period on clinical outcomes after ablation of AF. (Figure
Presented).

<50>
Accession Number
619984926
Author
Jeong H.S.; Lim J.W.; Hong S.J.; Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.;
Yu C.W.
Institution
(Jeong, Lim, Hong, Cho, Lee, Joo, Park, Yu) Dept of Cardiology, Korea Univ
Anam Hosp, Seoul, South Korea
Title
Effects of lowest-dose vs. highest-dose pitavastatin on coronary
neointimal hyperplasia at 12 months follow-up in type 2 diabetic patients
with non-ST elevation acute coronary syndrome: An optical coherence
tomography analysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Current ACC/AHA guidelines recommend high-dose statin
therapy after coronary stenting, especially in diabetic patients; however,
pitavastatin 4mg or pitavastatin 1mg are frequently used after coronary
stenting in Asia, even in patients with acute coronary syndrome.
Hypothesis: Data regarding the adequate dose of statin to effectively
reduce the overgrowth of neointimal hyperplasia and improve the clinical
outcomes in Koreans are lacking. Therefore, we compared the effects of
highest-dose and lowest-dose pitavastatin therapy on coronary neointimal
hyperplasia at 12-month follow-up in diabetic patients with
non-ST-elevation acute coronary syndrome(NSTE-ACS) using optical coherence
tomography. Methods: A total of 72 diabetic patients with NSTE-ACS were
randomized to lowest-dose pitavastatin(1mg[n=36]) or highestdose
pitavastatin(4mg[n=36]) after everolimus-eluting stent implantation. The
primary endpoint was to compare the neointimal volume at 12-month
follow-up. Secondary endpoints were to compare the changes in the brachial
artery flow-mediated dilation(baFMD), lipid profiles, and inflammatory
markers, such as interleukin-6, tumor necrosis factor-alpha,
high-sensitive Creactive protein, and adiponectin. Results: Neointimal
volume was significantly lower in the pitavastatin 4mg group(0.41+/-0.28mm
/1 mm vs. 0.74+/-0.23mm /1 mm, p<0.01) at 12-month follow-up. Improvement
of baFMD was significantly higher in the pitavastatin 4mg group than in
pitavastatin 1mg group(0.15+/-0.15mm vs. -0.03+/-0.19mm, p<0.001).
Additionally, the improvement of adiponectin levels was significantly
greater in the pitavastatin 4mg group than in the pitavastatin 1mg
group(2.97+/-3.98mug/mL vs. 0.59+/-2.80mug/mL, p<0.05). Conclusions:
Pitavastatin 4mg significantly improved inflammatory cytokines and lipid
profiles compared to pitavastatin 1 mg during the 12-month follow-up,
contributing to the reduction of neointimal hyperplasia and to the
improvement of baFMD in diabetic patients with NSTE-ACS requiring coronary
stenting. Thus, the administration of pitavastatin 4mg can be safely and
effectively used in high-risk patients requiring coronary stenting.

<51>
Accession Number
619984752
Author
Boralkar K.A.; Kobayashi Y.; Pargaonkar V.S.; Moneghetti K.J.; Tuzovic M.;
Krishnan G.; Bouajila S.; Wheeler M.; Banerjee D.; Horne B.D.; Knowlton
K.U.; Heidenreich P.A.; Haddad F.
Institution
(Boralkar, Kobayashi, Pargaonkar, Moneghetti, Tuzovic, Krishnan, Bouajila,
Wheeler, Banerjee, Heidenreich, Haddad) Cardiovascular Institute, Stanford
Univ Med Cntr, Stanford, CA, United States
(Horne, Knowlton) Cardiovascular Institute, Intermountain Med Cntr Heart
Institute, Salt Lake City, UT, United States
Title
Complementary value of heart failure risk scores on longterm mortality in
patients hospitalized with acute heart failure preserved ejection
fraction.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Heart Failure preserved Ejection Fraction (HFpEF) is a major
burden on the healthcare system and better understanding risk prediction
in this population may help guide management. Our objective was to assess
the complementary value of existing heart failure risk scores, Get with
The Guidelines (GWTG), Intermountain Mortality Risk Score (IMRS) and the
MetaAnalysis Global Group in Chronic Heart Failure (MAGGIC) Scores in an
independent cohort of patients hospitalized with acute HFpEF. Methods:
Using Stanford Translational Research Integrated Database Environment and
individual chart review, we identified 580 adult patients hospitalized
with acute heart failure and left ventricular ejection fraction >= 50%. We
excluded patients with advanced liver/kidney disease, valve replacement,
transplantation, active malignancy, pulmonary arterial hypertension and
hypertrophic cardiomyopathy. A subgroup of 341 patients had NTproBNP
levels available. Mortality status was determined using United States
Social Security Death Index and chart review. Cox proportional hazard
analysis was used to determine the heart failure risk scores predictive of
allcause mortality in HFpEF. Results: The mean age was 76 +/- 15 years
with 334 (57.6%) females. Median length of hospital stay was 4 (IQR 2 9)
days and follow up of 2.0 (IQR 0.2 4.6) years with a total of 139 (24%)
deaths. On multivariate analysis, the GWTG, IMRS and MAGGIC scores were
independent correlates of allcause mortality with normalized hazard ratios
of 1.48 (1.17 1.86), 1.41 (1.15 1.76) and 1.31 (1.04 1.70) respectively
(Figure). In patients with NTproBNP collected, NTproBNP remained
significantly associated with mortality with normalized hazard ratio of
1.52 (1.22 1.91) even after adjustment for the risk scores. Conclusion: In
patients hospitalized with acute HFpEF, established heart failure Risk
scores together with NTproBNP can play a complementary role in outcome
prediction.

<52>
Accession Number
619984511
Author
Crystal A.; Labos C.; Freitas C.; Ha A.; Lee D.
Institution
(Crystal, Labos, Freitas, Ha, Lee) Cardiology, Univ of Toronto, Toronto,
Canada
Title
Stroke and death in patients with atrial fibrillation after cardiac
surgery - A meta-analysis of recent literature.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation is a known risk factor for stroke and
death. Post-operative atrial fibrillation (POAF) occurs in 20- 40% of
patients undergoing cardiac bypass surgery. The optimal management of POAF
remains unclear. Furthermore, the risk of adverse outcomes amongst
patients with POAF has not been fully delineated. In this study, we
assessed the effect of POAF on mortality and stroke events after coronary
artery bypass graft (CABG) surgery. Methods: We conducted a meta-analysis
of POAF mortality and stroke outcome studies published in the last decade.
POAF was defined as new onset AF in patients without history of AF with at
least 30 minute episode of AF occurring during the postoperative hospital
stay. A search of OVID Medline, Pubmed, EMBASE databases was performed.
All articles were reviewed and abstracted for rates of stroke and death
events occurring within the post-operative period. We also abstracted
information about rates of use of anticoagulation at hospital discharge. A
random effects meta-analysis using the Der-Simonian and Laird method was
used to pool the results. Results: We included eleven trials in the
analysis. Nine trials including a total of 88207 patients reported stroke
outcomes. Eight trials including a total of 85589 patients reported on
mortality outcomes. POAF was reported in an average of 26% of patients
during the post-operative period. We found that POAF patients are at a
significantly increased risk of stroke [pooled RR 2.39 (95% confidence
interval (CI) 2.12-2.70)]. Patients with POAF demonstrated a significantly
increased risk of mortality [HR 1.72 (95% CI 1.67-1.99)]. Seven trials
reported percentage of patients discharged on anticoagulation. Average
rate of anticoagulation at discharge was 15% (range 3.6-27.4%).
Conclusion: New onset POAF after cardiac surgery occurs commonly and is
associated with increased risk of death and stroke. On the other hand, the
rate of the anticoagulation is quite low in this high-risk population.
Prospective trials are needed to better define the impact of broader use
of oral anticoagulation for cardiac surgical patients with POAF.

<53>
Accession Number
619984474
Author
Krakowski G.A.; Foy A.J.
Institution
(Krakowski) Dept of Internal Medicine, Penn State Hershey Med Cntr,
Hershey, PA, United States
(Foy) Dept of Internal Cardiology, Penn State Hershey Med Cntr, Hershey,
PA, United States
Title
A systematic review on the risk of mortality related to the timing of
coronary artery bypass grafting following myocardial infarction.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The optimal timing for coronary artery bypass grafting
(CABG) following an acute myocardial infarction (MI) is a topic of
controversy among cardiologists and cardiothoracic surgeons. We sought to
perform a systematic review of the evidence. Methods: PubMed was searched
for studies that compared mortality between patients who underwent CABG,
at different time points, following an acute MI. The quality of evidence
was assessed using the National Institute of Health (NIH) quality
assessment tool for observational cohort and cross-sectional studies.
Mortality was compared between groups who had CABG performed <24 hours
(acute), 24-72 hours (sub-acute), and >72 hours (delayed) following MI.
Results: Sixteen observational studies were identified (1 prospective, 15
retrospective) which included 94,841 patients. There were no randomized
controlled trials (RCT). Five studies used data from official registries
while 11 relied upon data from a single site. Two studies specified the MI
type as NSTEMI, 2 as STEMI, and it was unspecified in 12. Mortality was
assessed as 'inhospital' in 10 studies, 'perioperative' in 5, and 'one
month' in 1. Using the NIH quality assessment tool, we scored 12 domains
on a dichotomous scale of 'yes', 'no', or 'other' and found the average
number of 'yes' answers was 6.5/12 with a range of 4 to 8/12. A
quantitative comparison of mortality risk between timing groups could not
be performed due to heterogeneity between recorded baseline covariates
across studies as well as heterogeneity between MI-type, timing cut-offs,
and specific mortality endpoints across studies. Only 1 study used
propensity-matching, most used some logistic regression but 4 did not
adjust at all for baseline cofounders. Most studies found that mortality
was increased when patients underwent CABG <24 hours following MI but
there was no consistent difference in mortality between sub-acute versus
delayed groups. Conclusions: The current evidence base for timing of CABG
post-MI is poor, being composed of low to fair quality observational
studies and expert opinion. Selection bias is a major concern for all
studies that were reviewed. Well-conducted RCTs are urgently needed to
better inform this important clinical question.

<54>
Accession Number
619984467
Author
Karhausen J.; Smeltz A.M.; Qi W.; Li Y.-J.; Shah S.H.; Kraus W.E.; Mathew
J.P.; Podgoreanu M.V.; Kertai M.D.
Institution
(Karhausen, Qi, Li, Mathew, Podgoreanu, Kertai) Anesthesiology, Duke Univ
Med Cntr, Durham, NC, United States
(Smeltz) Anesthesiology, Univ of North Carolina Med Cntr, Chapel Hill, NC,
United States
(Shah, Kraus) Medicine, Duke Univ Med Cntr, Durham, NC, United States
Title
Genome-wide association study links receptor tyrosine kinase inhibitor
sprouty2 to thrombocytopenia after coronary artery bypass surgery.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Thrombocytopenia after cardiac surgery is an independent
predictor of stroke, acute kidney injury, and death (Kertai et al. 2016,
Karhausen et al. 2017) but is inadequately explained by baseline and
clinical patient characteristics. Hypothesis: We hypothesized that
identification of genetic variations provides insights into the risk and
mechanism of developing thrombocytopenia after cardiac surgery. Methods:
Study subjects underwent isolated coronary artery bypass grafting with
cardiopulmonary bypass at Duke University Medical Center. Postoperative
thrombocytopenia was defined as platelet count < 100 x 109/L. A
genome-wide association study was performed in a discovery cohort of 860
patients using a logistic regression model adjusted for clinical risk
factors. Single-nucleotide polymorphisms (SNPs) that met a P < 1 x 10-4
were further tested using a validation dataset of 296 patients. Protein
expression was examined by immunoplot from platelets isolated from healthy
donors. Results: 61 SNPs met the a priori discovery threshold for
replication, but only 2 (rs9574547, rs7727559) met nominal significance in
the validation cohort. Importantly, rs9574547 in the intergenic region of
sprouty 2 (SPRY2), showed the same direction of effect for
thrombocytopenia (OR 0.45, 95% CI 0.30-0.67, P = 9.37 x 10-5 ) and a
strong overall association by meta-analysis (meta-P = 8.14 x 10-6 ).
Immunoblotting demonstrated that platelets express SPRY2 and that
expression changed significantly following in vitro activation (Figure).
Conclusions: We found a genetic polymorphism in SPRY2 associated with a
decreased risk of postoperative thrombocytopenia. SPRY2 acts as a tyrosine
kinase inhibitor, a class of molecules known to affect platelet
activation. Together with its regulation during platelet activation, this
identifies SPRY2 as a potential novel modulator of platelet function with
significance to postoperative outcomes after cardiac surgery.

<55>
Accession Number
619984354
Author
Berve P.-O.; Skalhegg T.; Hardig B.M.; Carlson J.; Kramer-Johansen J.; Wik
L.
Institution
(Berve) Air Ambulance Department, Norwegian National Advisory Unit on
Prehospital Emergency Medicine (NAKOS), Oslo Univ Hosp, Ullevaal, Oslo,
Norway
(Skalhegg, Kramer-Johansen, Wik) Air Ambulance Department, Norwegian
National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo
Univ Hosp, Oslo, Norway
(Hardig) Air Ambulance Department, Norwegian National Advisory Unit on
Prehospital Emergency Medicine (NAKOS), Bjarne Madsen Hardig, Lund, Sweden
(Carlson) Dept of Cardiology, Lund Univ Hosp, Lund, Sweden
Title
Mechanical active compression-decompression with LUCAS2AD provide
equivocal P<inf>ET</inf>co<inf>2</inf>values to the standard LUCAS2 during
out-of-hospital cardiopulmonary resuscitation.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Studies comparing manual active compression-decompression
CPR (ACD-CPR) to manual CPR have shown similar survival rates. Recently a
new mechanical ACD-CPR device (LUCAS2AD, Jolife AB/Physio-Control, Lund,
Sweden) was compared to the standard LUCAS2 device in pigs, documenting
improved hemodynamics. In this first clinical study on mechanical ACD-CPR
we hypothesized that it would produce better hemodynamic variables than
the standard LUCAS2 device (ClinicalTrials.gov NCT02479152). Methods: The
trial is a prospective block-randomized unblinded study of out-of-hospital
cardiac arrest patients >18 years old with anterior-posterior (AP) chest
diameter 185-280mm, treated by the physician manned vehicle in Oslo.
Inclusion criteria: simultaneous minimum 5 minutes of LUCAS2/LUCAS2AD
chest compressions, intubated and side stream pCO measurements. Exclusion
criteria: traumatic arrest, pregnancy, imprisonment and previous chest
surgery. LIFEPAK 15 data was exported via CodeStat 10 (both PhysioControl,
Redmond, WA, USA) to Excel and analyzed by automatic algorithms in MatLab.
The primary end-point p<inf>ET</inf>CO<inf>2</inf>was collected as the
averaged top readings from two consecutive 3-12 seconds long ventilations
every 30-second period. Generalized linear mixed model (GLMM) was used.
Results: Of 221 patients enrolled, 211 were analyzed (excluded n=10,
(denied consent n=6, various n=4)). Eligible patients for per protocol
final inclusion were 133 (LUCAS2 n=64, LUCAS2AD n=69). Intention-to-treat
group had AP-diameter (<185mm n=53, >280mm n=2), too short observation
period and technical issues (n=23). So far 90% of patient data is
analyzed. Averaged p<inf>ET</inf>CO<inf>2</inf>: LUCAS2 32.5mmHg (n=61)
and LUCAS2AD 31.0mmHg (n=65). GLMM did not reveal significant differences
between the devices at any time-point (difference for LUCAS2AD:-1.2mmHg,
standard error 2.40, CI-5.94 to 3.54, p=0.62). Calculation with ITT group
did not change the result (difference for LUCAS2AD-1.05mmHg, standard
error 2.57, CI-6.1 to 4.0, p=0.68). Overall survival was 6.3% (14)
patients, all CPC 1 and 44.7% (99) patients had ROSC on arrival to
hospital. Conclusion: Preliminary analysis of
p<inf>ET</inf>CO<inf>2</inf>data in the LUCAS2AD trial did not find
statistical differences between the two groups.

<56>
Accession Number
619984258
Author
Ubels J.; Sahlen K.-G.; Beaton A.Z.; Do Carmo Nunes M.P.; Diamantino A.C.;
Oliveira C.M.; Teixeira I.M.; Lauriano K.C.; Santos J.P.; Costa A.L.M.;
Ribeiro A.L.P.; Sable C.; Nascimento B.R.
Institution
(Ubels, Sahlen) Epidemiology and Public Health, Umea Univ, Umea, Sweden
(Beaton, Sable) Children's National Heart Institute, Children's National
Health System, Washington, DC, United States
(Do Carmo Nunes, Diamantino, Oliveira, Teixeira, Lauriano, Santos, Costa,
Ribeiro, Nascimento) Servico de Cardiologia e Cirurgia Cardiovascular,
Hosp das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte,
Brazil
Title
Cost-effectiveness of rheumatic heart disease echocardiographic screening
in Brazil: Data from the PROVAR study.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In recent years, new technologies have emerged that make it
possible to screen for Rheumatic Heart Disease (RHD) with portable
echocardiographic machines. We performed a cost-utility analysis of
screening with handheld echocardiographic machines in the Brazilian
context. Methods: A Markov model was created to compare the
cost-effectiveness from a public perspective of one-time school-based
screening for RHD in a hypothetical cohort of 11 years-old socioeconomic
disadvantaged children to standard care with a time horizon of 10 years.
The model consisted of 8 states: No RHD, Undiagnosed Borderline RHD,
Diagnosed Borderline RHD, Untreated Definite RHD, Treated Definite RHD,
Heart Failure, Post Surgery and Death. The initial distribution of the
population over the different states was derived from primary data of
echocardiographic screening in the target population, extracted from 5,996
children enrolled in the PROVAR screening program. Costs of the different
states were also derived from primary data of the Brazilian public health
system (DataSUS). Transition probabilities and utilities were derived from
published studies, through systematic review of literature. A discount
rate of 3% per year was used. Sensitivity analysis was conducted to
identify key transition probabilities. A cost-effectiveness threshold of
$8,000 per Disability Adjusted Life Year (DALY) averted is used (the lower
bound of the implicit cost-effectiveness threshold used in Brazil is
$8,000 per life year saved). Results: The prevalence observed for the
target age range was 5.0% (4.3% borderline RHD and 0.7% definite RHD). The
result of the analysis was that screening is cost-effective with an
Incremental Cost-Effectiveness ratio of $6,586.62 per DALY averted. The
most sensitive transition probability was the effect of secondary
prophylaxis with penicillin. As long as secondary prophylaxis reduces the
amount of progression from definite RHD to heart failure by 50%, the
screening could be considered cost-effective. Conclusion: Screening for
RHD with handheld echocardiographic machines in 11 years-old
schoolchildren in the target population is cost-effective in the Brazilian
context within 10 years.

<57>
Accession Number
619984238
Author
Beohar N.; Panchal H.
Institution
(Beohar) Cardiology, Columbia Univ Div, Miami Beach, FL, United States
(Panchal) Cardiology, East Tennessee State Univ, Johnson City, TN, United
States
Title
Transcatheter versus surgical aortic valve replacement in patients with
moderate to severe chronic kidney disease: A systematic review with
meta-analysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Patients with chronic kidney disease (CKD) and aortic
stenosis (AS) have poor prognosis after both transcatheter aortic valve
replacement (TAVR) and surgical aortic valve replacement (SAVR) compared
with patients without CKD. Hypothesis: To assess the clinical and
qualitative outcomes of TAVR versus SAVR for severe AS among patients with
moderate to severe CKD (stage >=3). Methods: PubMed, Cochrane Center
Register of Controlled Trials and clinical trial registry were searched
through April 2017. Seven studies comparing TAVR (n=878) and SAVR
(n=2,531) in patients with CKD stage >=3 were included. End points were
clinical outcomes and qualitative outcomes. The odds ratio (OR) or mean
difference (MD) with 95% confidence interval (CI) was computed and p<0.05
was considered for significance. Results: There was no difference in
all-cause mortality (p=0.7), cerebrovascular accidents (p=0.28) and acute
myocardial infarction (p=0.55) or the need for new permanent pacemaker
placement (p=0.06) between TAVR as compared with SAVR. Post-procedural
worsening renal failure or acute kidney injury and new dialysis were
significantly lower with TAVR compared with SAVR (OR: 0.47, CI: 0.33-0.68,
p<0.0001 and OR: 0.44, CI: 0.25-0.74, p=0.002 respectively) as was length
of intensive care unit stay (MD:-68.32 hours, CI:-86.35-50.28 hours,
p<0.00001). Major vascular complications were significantly higher with
TAVR compared with SAVR (OR: 8.84, CI: 1.6-49, p=0.01). There was no
difference in bleeding events (p=0.14), but red blood cell transfusion was
significantly lower with TAVR compared with SAVR (OR: 0.39, CI: 0.18-0.82,
p=0.01). Conclusions: The results of our meta-analysis comparing TAVR with
SAVR in patients with severe AS who have moderate to severe CKD suggest
that TAVR is comparable to SAVR but with the advantage of a decreased
incidence of post-procedural worsening of renal failure or acute kidney
injury, need for new dialysis and intensive care unit stay.

<58>
Accession Number
619984226
Author
Jazayeri M.-A.; Vuddanda V.; Lavu M.; Jain R.; Parikh V.; Turagam M.K.;
Bommana S.; Atkins D.; Dendi R.; Emert M.P.; Pimentel R.; Sheldon S.H.;
Berenbom L.; Reddy M.; Lakkireddy D.R.
Institution
(Jazayeri, Vuddanda, Lavu, Jain, Parikh, Bommana, Atkins, Dendi, Emert,
Pimentel, Sheldon, Berenbom, Reddy, Lakkireddy) Cardiovascular Diseases,
Univ of Kansas Hosp and Med Cntr, Kansas City, KS, United States
(Turagam) Cardiovascular Disease, Univ of Missouri Hosps and Clinics,
Columbia, MO, United States
Title
Comparison of AQUACEL ag silver dressing with micro-contour technology to
traditional Silverlon silverimpregnated dressing for prevention of cardiac
implantable electronic device infection: A randomized open label study.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Silver-impregnated dressings have shown utility for wound
healing and infection prevention in a variety of procedures, including
cardiac implantable electronic device (CIED) implantation. We evaluated a
new silver-based dressing with purported micro-contour technology (AQUACEL
Ag) to achieve better wound contact and, thus, improved infection
prevention. Hypothesis: We hypothesized AQUACEL Ag use following CIED
implantation would result in a reduction in infectious complications, as
compared to a standard Silverlon silver-based dressing. Methods:
Prospectively enrolled patients undergoing CIED implantation, upgrade, or
generator change from June 2016-June 2017 were randomized to receive one
of the two dressings at the end of the procedure. Immunocompromised
patients and those on non-standard antibiotic regimens were excluded.
Follow-up with a nurse visit, pocket examination, and templated
documentation took place at 7-10 days post-implant. Outcomes assessed
included skin erythema, rash, wound drainage, dehiscence, hematoma, and
itching/burning. Outcomes were compared among groups by Chi-Square and
Fisher's exact tests. Results: In total, 147 patients met criteria for
inclusion. Mean age was 69 +/- 14 years, 69% were male, and 80% were
white. Other baseline characteristics are shown in the table. At
follow-up, skin erythema was noted in 3 (5.3%) Aquacel patients and 4
(5.7%) Silverlon patients (p = 1.0). Wound drainage was noted in 1 patient
from each group (1.8% vs. 1.4%; p = 1.0), and dehiscence was observed in 1
(1.4%) Silverlon and no Aquacel patients (p = 1.0). There were no
significant differences in rashes or subjective itching/burning.
Conclusions: In a prospective, randomized study examining Aquacel
silver-based dressing with micro-contour technology, no significant
difference was observed in infectious complications, skin discomfort, or
rash, in comparison to a more traditional Silverlon dressing after CIED
implant. (Table Presented).

<59>
Accession Number
619984224
Author
Nicewarner H.C.; Kalesan B.; Intwala S.S.; Leung C.K.; Balady G.J.
Institution
(Nicewarner) Section of Cardiology, Everett Clinic, Everett, WA, United
States
(Kalesan, Intwala, Leung, Balady) Section of Cardiology, Boston Univ., Sch
of Medicine, Boston, MA, United States
Title
A meta analysis of pre-operative stress testing in the evaluation of
patients undergoing non-cardiac surgery.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Pre-operative stress testing prior to non-cardiac surgery is
widely used, but its value in predicting peri-operative mortality is
uncertain. A comprehensive meta-analysis was performed to assess the value
of pre-operative stress testing among patients undergoing non-cardiac
surgery in predicting 30-day post-operative mortality. Methods: A
systematic search of Medline, EMBASE and PubMed Central databases through
January 27, 2016 was conducted. A total of 1807 abstracts were
independently reviewed by 2 physicians from which 79 eligible studies
consisting of 297,534 patients were included in the analysis. Subjects
were enrolled from 1976-2010 and the mean subject age range was 32-75
years. The primary outcome of 30-day mortality was reported in 40 studies;
random effects meta-analysis using Freeman-Tukey Arcsine Transformation
was used to pool risk estimates. Only 6 studies compared patients who
received a pre-operative stress test to those who did not; risk ratios
(RR) were calculated for these studies. Results: Patients were most
frequently awaiting vascular (52%), lung (22%) or abdominal (19%) surgery.
Cardiopulmonary stress (27 studies), pharmacological nuclear (19 studies),
and dobutamine echo (17 studies) were most commonly used, while only 3%
were exercise-ECG tests. The 30-day mortality among patients who received
a stress test was 1.98% (95% CI, 1.25- 2.85; I2=77.4%, p<0.0001; Figure).
Among the 6 studies comparing stress testing vs. no stress testing, there
was no significant difference in 30-day mortality (RR= 0.79, 95% CI,
0.35-1.80; I2=53.8%, p=0.09). Conclusions: Despite substantial research
over the past 40 years to predict risk among patients undergoing
non-cardiac surgery, the current body of evidence is insufficient to
derive a conclusion as to whether pre-operative stress testing leads to
reduced post-operative mortality. A large multicenter randomized study to
evaluate this question in the current era is needed.

<60>
Accession Number
619984081
Author
Fernandes G.C.; Nasi G.; Rivera M.; Cardoso R.; De Marchena E.; Cohen
M.G.; Alfonso C.E.
Institution
(Fernandes, Nasi, Rivera, Cardoso) Internal Medicine, Univ of Miami Miller
Sch of Medicine, Miami, FL, United States
(De Marchena, Cohen, Alfonso) Cardiology, Univ of Miami Miller Sch of
Medicine, Miami, FL, United States
Title
Antithrombotic therapy after TAVR: An updated meta-analysis of single
versus dual-antiplatelet therapy of randomized and propensity-matched
studies.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Since the initial trials, dual-antiplatelet therapy (DAPT)
for 6 months is the recommended antiplatelet regimen after Transcatheter
Aortic Valve Replacement (TAVR). The goal of this meta-analysis was to
compare the safety and efficacy of single-antiplatelet therapy (SAPT)
versus DAPT after TAVR. Methods: PubMed was searched for randomized and
propensity-matched studies comparing SAPT versus DAPT after TAVR. Outcomes
were described based on the VARC definitions and stratified into
short-term (30 days) and long-term (3 to 12 months). Odds-ratios (OR) were
calculated using fixed-effects (FE) or random-effects (RE) models based on
I statistics. Results: Five studies, 3 randomized and 2 propensity-matched
studies, and 691 patients were included, of whom 345 received SAPT and 346
received DAPT following TAVR. Short-term outcomes were available for 603
patients and long-term for 571. The combined efficacy endpoint of
all-cause death, myocardial infarction (MI) and major stroke was not
significantly different between SAPT and DAPT at both 30-day [FE OR 0.88
(0.49-1.58); p=0.67] and 3 to 12-month [FE OR 0.79 (0.45-1.38); p=0.41]
follow-up (Fig 1A). There was no significant difference in all-cause death
[FE OR 0.95 (0.47-1.89); p=0.87/FE OR 0.89 (0.44-1.78); p=0.74], MI [FE OR
0.59 (0.14-2.52); p=0.48/FE OR 0.33 (0.08-1.38); p=0.13] or major stroke
[FE OR 1.01 (0.27-3.77); p=0.99/FE OR 1.16 (0.41-3.29); p=0.78] short-term
and long-term, respectively, between groups. Life-threatening and major
bleeding were significantly lower in the SAPT group compared to DAPT (Fig
1B), both short-term [17 vs 46; RE OR 0.37 (0.16-0.88); p=0.02] and
long-term [15 vs 30; FE OR 0.47 (0.25-0.90); p=0.02]. Conclusion: Our
meta-analysis demonstrates that DAPT offered no benefit when compared to
SAPT in preventing all-cause death, MI and major stroke. SAPT had a better
safety profile than DAPT while associated with significantly less
life-threatening and major bleeding.

<61>
Accession Number
619984078
Author
Panoulas V.; Khan H.; Chaubey S.; Cummings I.; Ilsley C.J.; Raja S.G.
Institution
(Panoulas, Ilsley) Cardiology, Harefield Hosp, London, United Kingdom
(Khan, Chaubey, Cummings, Raja) Cardiac Surgery, Harefield Hosp, London,
United Kingdom
Title
Propensity-matched comparison of outcomes of coronary artery bypass
grafting versus percutaneous coronary intervention using second generation
drug eluting stents for multivessel coronary artery disease.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There is limited data comparing percutaneous coronary
intervention (PCI) using second generation drug eluting stents (DES) with
coronary artery bypass grafting (CABG) for treatment of multivessel
coronary artery disease. The purpose of this study was to compare the
clinical outcomes of PCI with second generation DES and CABG for patients
with multivessel coronary artery disease. Methods: The study comprised of
1415 CABG patients propensity matched with 1415 patients who had PCI with
second generation DES. In-hospital major adverse cardiac events (MACE),
stroke rate as well as 1-, 3-, and 5-year survival, were retrospectively
compared. Median follow-up duration was 933 days (interquartile range 414
to 1845). Results: In hospital re-intervention (p=0.118), mortality
(p=0.780) and overall MACE (p=0.220) were similar for the two groups.
There was a significantly higher incidence of in-hospital stroke for CABG
patients (p=0.002). At median follow-up crude all-cause mortality was
significantly higher for patients undergoing PCI (OR 1.63, 95%CI 1.31 to
2.04, p<0.001) (Figure). After adjustment for unadjusted confounders
(previous PCI, left ventricular function, smoking, hypertension, renal
disease and significant left main disease) there was still a significantly
higher all-cause mortality for patients undergoing PCI (OR 1.68, 95% CI
1.2 to 2.35, p=0.002). Conclusions: In patients with multivessel coronary
artery disease, CABG offers superior survival advantage compared with PCI
using second generation DES. Longer follow-up with evaluation in a
randomized setting will further substantiate the results of this study.

<62>
Accession Number
619984017
Author
Mahle W.T.; Hu C.; Trachtenberg F.; Menteer J.; Kindel S.; Dipchand A.I.;
Richmond M.E.; Daly K.; Henderson H.; Lin K.; McCulloch M.; Lal A.;
Schumacher K.; Jacobs J.; Atz A.M.; Villa C.; Burns K.M.; Newburger J.W.
Institution
(Mahle) Pediatrics, Emory Univ, Atlanta, GA, United States
(Hu, Trachtenberg) Biostatistics, New England Rsch Institutes, Watertown,
MA, United States
(Menteer) Pediatric Cardiology, Children's Hosp Los Angeles, Los Angeles,
CA, United States
(Kindel) Pediatric Cardiology, Children's Hosp of Wisconsin, Milwaukee,
WI, United States
(Dipchand) Pediatric Cardiology, Hosp for Sick Children, Toronto, Canada
(Richmond) Pediatric Cardiology, Children's Hosp of New York, New York,
NY, United States
(Daly, Newburger) Pediatric Cardiology, Boston Children's Hosp, Boston,
MA, United States
(Henderson) Pediatric Cardiology, Duke Univ Hosp, Durham, NC, United
States
(Lin) Pediatric Cardiology, Children's Hosp of Philadelphia, Philadelphia,
PA, United States
(McCulloch) Pediatric Cardiology, Alfred I. DuPont Hosp for Children,
Wilmington, DE, United States
(Lal) Pediatric Cardiology, Primary Children's Med Cntr, Salt Lake City,
UT, United States
(Schumacher) Pediatric Cardiology, Univ of Michigan Health System, Ann
Arbor, MI, United States
(Jacobs) Pediatric Cardiology, Johns Hopkins All Children's Heart
Institute, St. Petersburg, FL, United States
(Atz) Pediatric Cardiology, Med Univ of South Carolina, Charleston, SC,
United States
(Villa) Pediatrics, Cincinnati Children's Hosp Med Cntr, Cincinnati, OH,
United States
(Burns) Biostatistics, National Heart, Lung, and Blood Institute,
Bethesda, MD, United States
Title
Heart failure following the norwood procedure.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Some young children with hypoplastic left heart syndrome
(HLHS) and its variants develop heart failure (HF) following the Norwood
procedure (NP). We report the incidence of and risk factors for HF by age
6 years in children who were prospectively followed after randomization to
the modified Blalock-Taussig shunt (MBTS) or right ventricle to pulmonary
artery shunt (RVPAS) in the Single Ventricle Reconstruction (SVR) trial.
Hypothesis: Following the NP, HF is relatively common, and factors other
than shunt type impact its risk. Methods: Study subjects were enrolled in
the SVR trial, survived to hospital discharge after the NP, and were
followed up to age 6 years. HF was defined as heart transplant listing
after NP hospitalization, death attributable to HF, or NYHA class IV HF.
Cox regression methodology was used to identify variables associated with
early and late HF. Results: Of the 461 subjects discharged home following
NP, 66 (14%) met criteria for HF. Among these, 15 died from HF with no
transplant listing, 39 were listed for transplant (22 had transplants, 12
died after listing without receiving a transplant and 5 were alive and not
yet transplanted), and 12 had NYHA Class IV HF but were never listed. Risk
factors for development of early HF (<1 year) included fractional area
change <35% at NP post-operative study (p=.02), need for ECMO in operating
room (p=.004), non-Hispanic ethnicity (p=.04), greater use of regional
cerebral perfusion compared to circulatory arrest (P<.001) and shorter
total bypass time (p<.001). The only predictor of late HF (>=1 yr) was not
using alpha-blockade at NP. HF was not associated with shunt type
(Figure). Conclusions: HF develops in ~ 1 in every 7 children discharged
after NP. Whereas almost half are listed for transplant, many die from HF
before receiving a transplant or without being listed. Several NP
perioperative variables, including perfusion strategies, are associated
with development of HF, whereas shunt type is not.

<63>
Accession Number
619983810
Author
Rao P.; Schipper D.; Hallmark B.; Fisher J.; Avery R.; Marsh K.; Pilikian
T.; Johnson K.; Duncker D.; Billheimer D.; Runyan R.; Konhilas J.; Khalpey
Z.
Institution
(Rao) Dept of Cardiovascular Diseases, Sarver Heart Cntr, Univ of Arizona,
Tucson, AZ, United States
(Schipper, Marsh, Pilikian, Johnson, Duncker, Khalpey) Dept of
Cardiothoracic Surgery, Univ of Arizona, Tucson, AZ, United States
(Hallmark, Fisher) Dept of Biomedical Informatics and Biostatistics, Univ
of Arizona, Tucson, AZ, United States
(Avery) Dept of Radiology, Univ of Arizona, Tucson, AZ, United States
(Billheimer) College of Public Health, Univ of Arizona, Tucson, AZ, United
States
(Runyan) Dept of Cell Biology and Anatomy, Univ of Arizona, Tucson, AZ,
United States
(Konhilas) Dept of Physiology, Univ of Arizona, Tucson, AZ, United States
Title
Human amniotic patch placement during cardiac surgery reduces
post-operative atrial fibrillation.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation after cardiac surgery occurs in
approximately one third of patients and is associated with increased
morbidity and mortality. Inflammation and oxidative stress may play a key
role in the pathophysiology of new onset post-operative atrial
fibrillation (POAF). Acellular human amniotic matrix is known to be
anti-inflammatory, and therefore may have anti-arrhythmic effects in
patients undergoing cardiac surgery. Hypothesis: To determine whether the
application of an amniotic membrane patch (AMP) during cardiac surgery
reduces the rate of POAF. Methods: During a three-year period, AMPs were
placed in patients undergoing cardiac surgery (CABG, Valve Replacement,
CABG+Valve Replacement). Three patches (5x8cm) were topically placed onto
the anterior epicardium prior to partial pericardial and chest closure. We
identified controls from the Society of Thoracic Surgeons (STS) database
at the University of Arizona. Propensity score matching was performed
based on 18 risk variables. POAF was defined using the STS criteria.
Results: After exclusions, 51 AMP patients and 798 controls were analyzed
to include 45 AMP patients and 172 propensity matched controls. 4.4% of
the AMP patients developed POAF compared to 21.5% in the propensity
matched control group (odds ratio: 0.17, 95% CI:0.03-0.59) (Figure 1). Of
those undergoing CABG surgery, none of the 29 AMP patients developed POAF,
compared to 17% of the matched controls (odds ratio: 0, 95% CI:0-0.81).
Conclusions: Human amniotic membrane patch placement during cardiac
surgery reduces the incidence of POAF. This may lead to a reduction in
thromboembolic complications, prolonged hospitalizations and repeat
admissions. We will use this preliminary data to perform a multi-center
double-blinded randomized controlled trial to further delineate the
benefit of AMP placement in the prevention of POAF and the downstream
impact on clinical outcomes.

<64>
Accession Number
619983581
Author
Merkle J.; Liakopoulos O.; Siskos D.; Kuhn E.; Choi Y.-H.; Kuhr K.;
Hellmich M.; Wahlers T.
Institution
(Merkle, Liakopoulos, Siskos, Kuhn, Choi, Wahlers) Cardiothoracic Surgery,
Univ Hosp of Cologne, Cologne 50937, Germany
(Kuhr, Hellmich) Institute of Med Statistics, Informatics and
Epidemiology, Univ Hosp of Cologne, Cologne 50937, Germany
Title
High-sensitive c-reactive protein does not predict early and 1-year
outcomes after coronary artery bypass.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: High-sensitive C-reactive protein (hsCRP) is an inflammtory
marker of patients with coronary heart disease but there is still
conflicting data on its impact on early and midterm outcomes after
isolated coronary artery bypass grafting (CABG). Hypothesis: Preoperative
elevated hsCRP is not an independent predictor of cardiovascular events
after CABG surgery. Methods: We prospectively analysed data of consecutive
400 patients that underwent elective, isolated CABG between 2012 to 2016
within the randomized-controlled StaRT-CABG trial. Patients were
subdivided into a low (2.5mg/l) versus high hsCRP group (>2.5mg/l) as
assessed at hospital admission. The primary endpoint was a composite
including all-cause mortality, myocardial infarction and cerebrovascular
events (MACCE) at 30 days and 1-year survival was assessed. Results: After
CABG surgery through postoperative day 30, 5 patients (1.3%) died and 102
patients (25.5%) suffered major morbidity. One-year survival was 96.5% (14
deaths). Univariable and multivariable model revealed a statistically not
significant predictive effect of elevated preoperative values of hsCRP for
30-day mortality (odds ratio = 2.31, p = 0.36 versus odds ratio = 2.36, p
= 0.36), myocardial infarction (odds ratio = 1.16, p = 0.64 versus odds
ratio = 1.22, p = 0.57), MACCE (odds ratio = 1.17, p = 0.60 versus odds
ratio = 1.17, p = 0.61), and of 1-year all cause mortality (hazard ratio =
2.64, p = 0.08 versus hazard ratio = 2.82, p = 0.08). Multivariable model
indicated that elevated hsCRP is not an independent predictor of CABG
setting. Kaplan- Meier plot of 1-year survival stratified according to
preoperative low and high levels of hsCRP was not significant (logrank =
3.27, p = 0.07). Receiver operating characteristic curves (ROC) could not
identify a cut-off point for hsCRP with respect to all analyzed outcomes.
Conclusions: Preoperative hsCRP does not predict early and one-year
outcomes after CABG.

<65>
Accession Number
619983499
Author
Croix G.R.S.; Ibrahim M.; Alfonso C.
Institution
(Croix, Ibrahim) Medicine, Jackson Memorial Hosp, Miami, FL, United States
(Alfonso) Medicine, Univ of Miami Hosp, Miami, FL, United States
Title
3 to 5 years outcomes of TAVR vs SAVR for high surgical risk patients, a
systematic review and metanalysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The comparative benefits and harms of transcatheter aortic
valve intervention and surgical aortic valve replacement for high surgical
risk patients with aortic stenosis haven't shown any significant
statistical and clinical difference up to 2 years. However, the comparison
has not been well characterized beyond 3 years. This meta-analysis aims to
assess the differential outcomes of TAVR and SAVR in high surgical risk
patients enrolled in randomized controlled trials with at least 3 years of
follow up.METHODS We performed a systematic literature review to identify
randomized and nonrandomized clinical studies that reported at least 3
years outcomes of transcatheter aortic valve replacement vs surgical
aortic valve replacement for high surgical risk patients with aortic
stenosis. A total of 8 databases including Pubmed (Medline), Embase,
Cochrane Library, ACP Journal Club, Scopus, DARE and Ovid containing
articles from January 2000 to March 2017 were analyzed. Results: We were
able to identify and screen 748 potential eligible publications through
the databases and we found 3 relevant randomized controlled trials for a
total of 6321 participants. 2 evaluated the incidence of all-cause
mortality at 3 years and one at 5 years. Analysis of the TAVR and SAVR
cohorts revealed no significant differences in the outcomes beyond 3 years
in term of all-cause mortality [OR (95% CI): 1.29 (0.82, 2.03)]. The
incidence of stroke was not statistically significant in both groups [OR
(95% CI): 0.92 (0.67, 1.27)].Nevertheless, there were a higher rate of
pacemaker implantations for the TAVR group [ OR (95% CI): 2.73 (2.05,
3.64)]. Conclusion: This study confirms that all-cause mortality beyond 3
and up to 5 years in TAVR vs SAVR is not statistically significant. There
is no difference in incidence of stroke either. However, there appears to
have an increased risk of pacemaker placement in high risk patients
undergoing TAVR compared to SAVR. (Figure Presented).

<66>
Accession Number
619983497
Author
Esper R.B.; Ribeiro E.E.; Hueb W.; Domanski M.; Hamza T.; Siami S.;
Farkouh M.E.; Fuster V.
Institution
(Esper, Ribeiro, Hueb) Interventional Cardiology, Heart Institute Sao
Paulo-Brazil, Sao Paulo, Brazil
(Domanski) Cardiology, Mount Sinai Med Cntr, NewYork, NY, United States
(Hamza) Rsch, New England Rsch Institute, Boston, MA, United States
(Siami, Farkouh) Interventional Cardiology, Univ of Toronto, Toronto,
Canada
(Fuster) Interventional Cardiology, Mount Sinai Hosp, New York, NY, United
States
Title
The role of the syntax score in predicting clinical outcome in diabetic
patients after percutaneous coronary intervention and coronary artery
bypass graft: A freedom trial sub-analysis.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Diabetes mellitus (DM) associates with complex coronary artery
disease (CAD), what in turn translates into increased morbidity from
cardiovascular disease. The SYNTAX Score (SS) is an anatomical based tool
for objectively determining the complexity of CAD and guiding
decision-making between CABG and PCI. Nonetheless, few studies have
evaluated the SS in DM patients for choosing between CABG and PCI
revascularization strategy, and its role in predicting future
cardiovascular events. Objectives: To evaluate the role of SS in
predicting major adverse cardiovascular events (MACCE) in PCI and CABG
groups in DM with multivessel CAD in FREEDOM. Methods: FREEDOM was a
randomized trial that assigned patients with DM and multivessel CAD to
undergo either PCI with drug-eluting stents or CABG. The SS for each
patient was calculated retrospectively by a core laboratory. MACCE was
defined by death from any cause, myocardial infarction, stroke and need
for repeat revascularization. Multivariate analysis was conducted using
Cox regression modelling. Results: FREEDOM included 1900 patients
randomized to PCI (953) or CABG (947). The mean Syntax Score were similar
in PCI (26.2+/-8.4) and CABG (26.11+/-8.8) groups (p=0.67). In
multivariate analysis of the PCI cohort, left ventricular ejection
fraction (LVEF) < 40%, insulin dependent DM, Creatinine Clearance
<60ml/min, and SS (HR=1.02, CI 95% 1.00 to 1.03, p=0.014) were independent
predictors of MACCE at 5-years. In the CABG group, age > 70 years, left
ventricular ejection fraction (LVEF) < 40%, insulin dependent DM,
Creatinine Clearance < 60 ml/min but not SS were independent predictors of
MACCE at 5-years. LDL cholesterol <= 100 mg/dL was considered a protective
factor for MACCE in the CABG group. There was a higher incidence of MACCE
in PCI patients with low, intermediate and high SS compared to those who
underwent CABG (36.6% vs 25.9% with low SS category , p=0.02 ; 43.9% vs
26.8% with intermediate SS category, p<0.001; 48.7% vs 29.7% with high SS,
p=0.003). Conclusions: In DM patients the complexity of CAD evaluated by
the SS is a modest independent risk factor for MACCE only in patients
undergoing PCI. In DM with multivessel CAD, the incidence of MACCE is
higher for the PCI treatment strategy in all Syntax scores categories.

<67>
Accession Number
619983414
Author
Blumer V.; Arcay L.; Khalafi M.; Mendirichaga R.; Zablah G.; Hernandez
G.A.; Macon C.; Chaparro S.
Institution
(Blumer, Khalafi, Mendirichaga, Zablah) Internal Medicine, Univ of Miami,
Jackson Memorial Hosp, Miami, FL, United States
(Arcay) Internal Medicine, Univ of Miami, Miami, FL, United States
(Hernandez, Macon, Chaparro) Div of Cardiology, Univ of Miami, Jackson
Memorial Hosp, Miami, FL, United States
Title
Impact of sexmismatch on heart transplantation: A meta-analysis and
systematic review.
Source
Circulation. Conference: Resuscitation Science Symposium, ReSS 2017.
United States. 136 (Supplement 1) (no pagination), 2017. Date of
Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Limited research has explored heart transplantation (HT)
outcomes in patients with sexmismatched organ donors and recipients.
Findings on which type of sexmismatch has worse posttransplant outcomes
have been contradictory. Methods: We searched Medline, Embase, Scopus and
Cochrane for publications reporting HT outcomes according to
donor/recipient sex mismatch through May 2017. Sex mismatched HT male
recipients were compared to nonmismatched male recipients, and sex
mismatched HT female recipients were compared to nonmismatched female
recipients. Outcomes were compared under the randomeffects model and
heterogeneity examined via Chi and I statistics. Sensitivity analyses were
performed. Results: A total of 8 studies including 110211 patients were
included in the analysis. Of these, 80% were male recipients and 29% had
sexmismatched transplants. In male recipients, sex mismatch was associated
with a higher rate of rejection (OR 1.25; 95% CI 1.191.32; p<0.00001). In
female recipients, sex mismatch was associated with less rejection (OR
0.72; 95% CI 0.530.97; p=0.03). Sex mismatch was not associated with early
mortality in either sex. Mortality at 10 years had a tendency of being
greater in both male and female mismatched patients; however, the
heterogeneity was high and it did not achieve statistical significance
(Figure 1). Conclusions: Our analysis suggests that sexmismatch in HT may
affect the incidence of rejection without necessarily having clear impact
on mortality. Sexmismatch in HT remains an area in need of investigation
and further studies are needed to determine if sexmismatch truly
influences HT outcomes.

<68>
Accession Number
619997011
Author
Giacoppo D.; Colleran R.; Cassese S.; Frangieh A.H.; Wiebe J.; Joner M.;
Schunkert H.; Kastrati A.; Byrne R.A.
Institution
(Giacoppo, Colleran, Cassese, Frangieh, Wiebe, Joner, Schunkert, Kastrati,
Byrne) Deutsches Herzzentrum Munchen, Munich, Germany
Title
Percutaneous coronary intervention with drugeluting stent versus coronary
artery bypass grafting for left main coronary artery disease: A
meta-analysis of long-term safety outcomes complemented with individual
patient data reconstruction.
Source
Giornale Italiano di Cardiologia. Conference: 38. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica - GISE. Italy. 18
(10 Supplement 1) (pp e4-e5), 2017. Date of Publication: October 2017.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. As compared with other anatomic sites, left main coronary
artery (LMCA) disease is associated with the highest risk of mortality and
myocardial injury. Coronary artery bypass grafting (CABG) has been the
standard of care for LMCA disease for a long time, but due to significant
advances in device technology, increased operators' expertise, and
development of a modern adjuvant medical therapy, percutaneous coronary
intervention (PCI) has emerged as valid alternative. We aimed to assess
safety PCI with drug-eluting stent (DES) and CABG at very longterm
follow-up. Methods. We searched main PubMed, ScienceDirect, Scopus, EMBASE
and Web of Knowledge electronic databases from December 18th, 2001 to
December 1st, 2016. No filters or language restrictions were applied. We
included trials fulfilling all the following criteria: (i) randomised
clinical trial; (ii) PCI versus CABG; (iii) exclusive use of DES; iv.
clinical follow-up >=3 years. The primary endpoint was defined as a
composite of all-cause death, myocardial infarction, or stroke. Secondary
endpoints were individual components of the primary endpoint. We digitised
Kaplan-Meier curves for each trials by using high-quality figures with
extreme magnification. Retrieved spatial information of curves was pooled
across trials according to the treatment, either PCI or CABG. Combined
data, number at risk, and number of events for each time interval (year of
follow up) were used to estimate survival function and time-to-first event
cumulative incidence by validated algorithm. According to a one-stage
individual patient data meta-analysis, risk between PCI and CABG was
computed shared frailty model accounting for clustering of patients across
trials with semi-parametric penalized likelihood estimation of the hazard
function. Cross-validation of results was performed according to standard
trial-level fixed- and random-effects meta-analysis of log hazard ratio
(HR) and corresponding standard error. Risk measures were expressed as HR
and 95% confidence interval (CI). Heterogeneity across trials was assessed
with between-trial variance tau² and I² statistic.
Influence of individual trials on pooled estimate and I2 was inspected by
one-leave-out analysis. Results. After removal of duplicate records and
data merging from independent searches, we identified of a total of 6,569
reports. After screening at title and abstract level, 14 potentially
eligible trials were identified. After full-text assessment, a total of 4
randomized clinical trials (4394 patients: 2197 PCI vs. 2197 CABG) were
included in the primary analysis. With respect to the primary endpoint,
PCI and CABG showed comparable safety (HR 1.05, 95% CI 0.90-1.23, p=0.532)
at long term follow-up. Kaplan-Meier analysis did not show significant
differences between treatments over time, with a cumulative incidence of
18.3% (319 events) in PCI group and 16.9% (292 events) in CABG group at
5-year follow-up; within the first 2 years PCI group exhibited a numerical
advantage over CABG group, while from 3 to 5 years CABG group gained a
non-significant advantage over PCI. Standard meta-analysis confirmed these
findings both by fixed- (HR 1.06, 95% CI 0.90-1.24, p=0.476) and
random-effects model (HR 1.06, 95% CI 0.85-1.32, p=597). The EXCEL trial
had the highest relative weight (35.9%). A moderate degree of
heterogeneity was detected (I2=42.5%, p=0.154). At one-leave-out analysis
this finding resulted to be mainly due to the NOBLE trial (omitting NOBLE:
HR 0.96, 95% CI 0.80-1.15, p=0.660; I2=0%). With respect to allcause
death, PCI was associated with a comparable risk of death (random-effects:
HR 1.04, 95% CI 0.81-1.33, p=0.772) as compared with CABG. A numerical
excess in myocardial infarction was observed in patients assigned to PCI
as compared with those assigned to CABG (random-effects: HR 1.48, 95% CI
0.85-2.58, p=0.170); moreover, a high degree of heterogeneity was detected
(I²=67.4%, p=0.027) as a result of the significant risk
increase in the PCI arm of the NOBLE trial (omitting NOBLE: HR 1.13, 95%
CI 0.76-1.67. p=0.543, p=0.543; I²=27.3%) and the comparable
incidence between treatments observed in the EXCEL trial (omitting EXCEL:
HR 1.95, 95% CI 1.26-3.02, p=0.003; I²=0.6%). Risk of stroke
was comparable between treatments (random-effects: HR 0.87, 95% CI
0.39-1.92, p=0.722) but a high degree of heterogeneity was observed
(I²=62.7%, p=0.045) mainly as a consequence of the increased
incidence observed after PCI in the NOBLE trial (omitting NOBLE: HR 0.63,
95% CI 0.37-1.09, p=0.097; I²=9.1%). Conclusions. PCI and CABG
are associated with a quite comparable risk of a composite of all-cause
death, myocardial infarction, or stroke at longterm follow-up. Differences
between treatments in individual components of the composite endpoints
were not significant. However, a numerical excess in the risk of
myocardial infarction after PCI at long-term follow-up and high
between-trial heterogeneity were observed, mainly as a result of the
diverging effect of the NOBLE trial. (Figure Presented).

<69>
Accession Number
619996940
Author
Khadka R.; Paudel B.H.
Institution
(Khadka) Department of Basic and Clinical Physiology, Nepal
(Paudel) Department of Internal Medicine, B. P. Koirala Institute of
Health Sciences, Nepal
Title
Effect of yoga on cardiovascular autonomic activity and reactivity in
essential hypertensive patients.
Source
Indian Journal of Physiology and Pharmacology. Conference: 63rd Annual
Conference of Physiologists and Pharmacologists of India. India. 61 (5
Supplement 1) (pp 195-196), 2017. Date of Publication: 2017.
Publisher
Association of Physiologists and Pharmacologists of India
Abstract
Background: Despite, long-term normalization of blood pressure by
anti-hypertensive drugs in essential hypertensive (EH) patients, there
exist autonomic dysfunction. Yoga is known to decrease BP in EH patients,
however, it is not much clear whether combined yogic practices improve
cardiovascular autonomic regulation in EH patients. Objectives: To study
the effect of yoga on cardiovascular activity and reactivity in EH
patients. Methods: The study included 40 essential hypertensive patients.
They were randomized into yoga (n=20, age 46.71+/-8.79 years) and control
(n=20, age 44.8+/-7.47 years) groups. Yoga group practiced meditation,
pranayama and few easy asanas for 40 min/day for one month. Control group
did not practice yoga or any relaxation procedures. Cardiac autonomic
activity was assessed using short-term heart rate variability (HRV) and
reactivity using deep breathing (DBT), Valsalva Maneuver (VM), Handgrip
(HGT) and Lying to standing (LST) tests in both groups at zero and after
one month. Institutional Ethical Committee approved the study. Results:
Both groups had comparable age, height, weight, BMI, SBP, DBP, HR, and
respiratory rate. SBP, DBP, HR, and BMI decreased in yoga group, time
domain measures of HRV, which are markers of cardiac parasympathetic
activity [SDNN: 29.8.9(18-33.9) vs 35.2(26.87-38.8) ms, p=0.013; rMSSD:
13.5(11.5-21.86) vs 37.4(30.9-43.3) ms, p=0.001] increased in yoga group
as compared to control group after yoga. E: I ratio and Valsalva ratio,
which are indicators of parasympathetic reactivity also increased in yoga
group. Conclusion: Both parasympathetic activity and reactivity increased
in EH patients after a month of yoga practice. It indicates that yoga
increases cardiac autonomic modulation by increasing cardiac
parasympathetic activity.

<70>
Accession Number
619997230
Author
Attisano T.; Silverio A.; Di Lorenzo E.; Tesorio T.; Di Girolamo D.;
Golino P.; Giordano A.; Valva G.; Esposito G.; Bigazzi M.C.; Briguori C.;
Monteforte I.; Dialetto G.; Rubino P.; Vigorito F.; Giudice P.; Mauro C.
Institution
(Attisano, Silverio, Vigorito, Giudice) Cardiologia Interventistica,
A.O.U. San Giovanni Di Dio E Ruggi d'Aragona, Salerno, Italy
(Di Lorenzo) UO Cardiologia Interventistica, AORN G. Moscati, Salerno,
Italy
(Tesorio) Servizio Di Emodinamica, Casa Di Cura Montevergine, Mercogliano
(AV), Italy
(Di Girolamo) Cardiologia Interventistica, A.O. Sant'Anna San Sebastiano,
Caserta, Italy
(Golino) Cattedra Di Cardiologia, Seconda Universita Di Napoli E A.O. San
Sebastiano, Caserta, Italy
(Giordano) Reparto Di Interventistica Cardiovascolare, Clinica Pineta
Grande, Castelvolturno (CE), Italy
(Valva) Laboratorio Di Emodinamica, Casa Di Cura San Michele, Maddaloni
(CE), Italy
(Esposito) Dipartimento Di Scienze Biomediche Avanzate, Universita
Federico II, Napoli, Italy
(Bigazzi) Dipartimento Di Scienze Toraciche, Seconda Universita Di Napoli,
Napoli, Italy
(Briguori) Laboratorio Di Cardiologia Interventistica, Clinica
Mediterranea, Napoli, Italy
(Monteforte) Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli, Italy
(Dialetto) Cardiochirurgia, A.O. dei Colli, Ospedale Monaldi, Napoli,
Italy
(Rubino) Emodinamica-UTIC, Presidio Ospedaliero IOS Pomigliano d'Arco,
Pomigliano d'Arco (NA), Italy
(Mauro) Dipartimento Cardiovascolare, AORN A. Cardarelli, Napoli, Italy
Title
Sici-gise community campania survey donna TAVI (incanta). Acute, short-and
long-term outcome in women after TAVI.
Source
Giornale Italiano di Cardiologia. Conference: 38. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica - GISE. Italy. 18
(10 Supplement 1) (pp e73-e74), 2017. Date of Publication: October 2017.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Currently women represent more than 50% of patients undergoing
transcatheter aortic valve implantation (TAVI). Furthermore, given to the
natural longer life expectancy, TAVI is bound to become an increasingly
used treatment in women in the next years. However, the role of gender on
the outcome of TAVI patients is not well understood and the data available
in literature are few and not univocal. Objectives. To survey the
in-hospital, 30-days and 1-year safety and efficacy clinical outcome of
TAVI women at high and intermediate-risk treated with new generation
devices. Methods. An online multiple-choice questionnaire concerning pre-,
periand post-procedural management of TAVI female patients treated between
January and December 2016, was distributed in all medium and high-volume
Campania centers (listed below). Results. In 2016, 331 women (mean age
83+/-7 years) underwent TAVI in Campania. Of note, pre-procedural
EuroSCORE was <10, 10-20 and > 20 in 21%, 46% and 33% respectively; STS
score was <4, 4-8 and >8 in 13%, 40% and in 47% of patients respectively.
Heart Team meetings were routinely performed in the majority of centers
(95%) in order to evaluate surgical risk score and frailty index of
patients. Key reasons for surgical exclusion were: age >80 (72%), high
surgical risk (63%) and frailty (55%). All patients treated with
transfemoral approach (95%) underwent TAVI with local anesthesia.
Transapical and transaortic access were performed in only 5% of cases with
general anesthesia. Edward Sapien 3 (Edwards Lifesciences, Irvine,
California) and Medtronic Evolut R (Medtronic Inc, Minneapolis, Minnesota)
were the most frequent devices implanted (44% and 43% respectively); only
6% of patients were treated with 31 Medtronic Corevalve, and 7% with
Portico, Simetys and Lotus valve. In 78% of cases a prosthetic size <= 26
mm was chosen. The questioned centers reported a mean length of hospital
stay of 5.5+/-1.1 days, with cardiac care unit stay of 1.6+/-0.37 days.
The most prevalent in-hospital complication was pacemaker implantation
(15%), followed by life-threatening vascular complication in 3%. Despite
the heterogeneity in the antithrombotic therapy at discharge, dual
anti-platelet therapy represents the most frequent used medical approach
(56%). The 30- day VARC -2 composite endpoint occurred in 7%, all-cause
death in 4%, and stroke in 1%. One year follow-up data were available for
206 patients. Of them, 53 (25.7%) were still in dual anti-platelet
therapy. Echocardiography showed a mean aortic gradient of 10+/-4.5 mmHg
and moderate to severe paravalvular leaks in only 10 (4.8%) patients.
Death occurred in 13 patients (6.3%), in all cases for non-cardiac causes.
Rehospitalization for any cause was reported in 51 patients (24.7%), major
vascular complication in 3 (1.5%) and new TAVI implantation in only 3
patients (1.5%). No patients experienced myocardial infarction at 1 year.
From discharge, other 15 patients (7.3%) underwent pacemaker implantation.
Conclusion. This study represents the first survey on women undergoing
TAVI in Campania. TAVI confirms a good safety and efficacy profile at 30
days and 1 year also in this peculiar setting, probably due to the large
use of new-generation device and to the lower surgical risk of patients.
Randomized assessment of TAVI versus surgical aortic valve replacement is
warranted to determine the optimal therapeutic strategy of symptomatic
severe aortic stenosis in women at lower risk.

<71>
Accession Number
619972838
Author
Columbo J.A.; Lambour A.J.; Sundling R.A.; Chauhan N.B.; Bessen S.Y.;
Linshaw D.L.; Kang R.; Riblet N.B.V.; Goodney P.P.; Stone D.H.
Institution
(Columbo, Goodney, Stone) Section of Vascular Surgery, Dartmouth-Hitchcock
Medical Center, Lebanon, NH
(Columbo, Sundling, Chauhan, Bessen, Kang, Riblet, Goodney) The Dartmouth
Institute for Health Policy and Clinical Practice, Hanover, NH
(Columbo, Kang, Goodney) VA Outcomes Group, Veterans Health
Administration, White River Junction, VT
(Columbo, Kang) VA Quality Scholars, Veterans Health Administration, White
River Junction, VT
(Lambour, Linshaw, Kang) Department of General Surgery,
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Title
A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual
Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery.
Source
Annals of surgery. 267 (1) (pp 1-10), 2018. Date of Publication: 01 Jan
2018.
Abstract
OBJECTIVE: The aim of this study was to determine the bleeding risks
associated with single (aspirin) and dual (aspirin + clopidogrel)
antiplatelet therapy (DAPT) versus placebo or no treatment in adults
undergoing noncardiac surgery.
SUMMARY OF BACKGROUND DATA: The impact of antiplatelet therapy on bleeding
during noncardiac surgery remains controversial. A meta-analysis was
performed to examine the risk associated with single and DAPT.
METHODS: A systematic review of antiplatelet therapy, noncardiac surgery,
and perioperative bleeding was performed. Peer-reviewed sources and
meeting abstracts from relevant societies were queried. Studies without a
control group, or those that only examined patients with coronary stents,
were excluded. Primary endpoints were transfusion and reintervention for
bleeding.
RESULTS: Of 11,592 references, 46 studies met inclusion criteria. In a
meta-analysis of >30,000 patients, the relative risk (RR) of transfusion
versus control was 1.14 [95% confidence interval (CI) 1.03-1.26, P =
0.009] for aspirin, and 1.33 (1.15-1.55, P = 0.001) for DAPT. Clopidogrel
had an elevated risk, but data were too heterogeneous to analyze. The RR
of bleeding requiring reintervention was not significantly higher for any
agent compared to control [RR 0.96 (0.76-1.22, P = 0.76) for aspirin, 1.84
(0.87-3.87, P = 0.11) for clopidogrel, and 1.51 (0.92-2.49, P = 0.1) for
DAPT]. Subanalysis of thoracic and abdominal procedures was similar. There
was no difference in RR for myocardial infarction [1.06 (0.79-1.43)],
stroke [0.97 (0.71-1.33)], or mortality [0.97 (0.87-1.1)].
CONCLUSIONS: Antiplatelet therapy at the time of noncardiac surgery
confers minimal bleeding risk with no difference in thrombotic
complications. In many cases, it is safe to continue antiplatelet therapy
in patients with important indications for their use.

<72>
Accession Number
619926361
Author
Zheng Y.; Gu Q.; Chen H.-W.; Peng H.-M.; Jia D.-Y.; Zhou Y.; Xiang M.-X.
Institution
(Zheng, Zhou, Xiang) Department of Cardiology, the Second Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
(Zheng, Zhou, Xiang) Cardiovascular Key Lab of Zhejiang Province, the
Second Affiliated Hospital, School of Medicine, Zhejiang University,
Hangzhou 310009, China
(Gu) Department of Anesthesiology, the First Affiliated Hospital, School
of Medicine, Zhejiang University, Hangzhou 310003, China
(Chen) Cardiology Division, the First Affiliated Hospital of Nanjing
Medical University, Nanjing 210029, China
(Peng) Department of Respiratory, Tinhu People's Hospital, Yancheng
224001, China
(Jia) Department of Biology, Georgia Southern University, Statesboro
30460, United States
Title
Efficacy of amiodarone and lidocaine for preventing ventricular
fibrillation after aortic cross-clamp release in open heart surgery: a
meta-analysis of randomized controlled trials.
Source
Journal of Zhejiang University: Science B. 18 (12) (pp 1113-1122), 2017.
Date of Publication: 01 Dec 2017.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Objective: The relative preventative efficacy of amiodarone and lidocaine
for ventricular fibrillation (VF) after release of an aortic cross-clamp
(ACC) during open heart surgery has not been determined. This
meta-analysis was designed to systematically evaluate the influence of
amiodarone, lidocaine, or placebo on the incidence of VF after ACC.
Methods: Prospective randomized controlled trials (RCTs) that compared the
VF-preventative effects of amiodarone with lidocaine, or amiodarone or
lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane
Library were searched for relevant RCTs. Fixed or randomized effect models
were applied according to the heterogeneity of the data from the selected
studies. Results: We included eight RCTs in the analysis. Pooled results
suggested that the preventative effects of amiodarone and lidocaine were
comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to
1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71,
95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88,
P=0.006). The percentage of patients requiring electric defibrillation
counter shocks (DCSs) did not differ significantly among patients
administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine
(RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI:
0.25 to 1.25, P=0.16). Conclusions: Amiodarone and lidocaine are
comparably effective in preventing VF after ACC, but the percentage of
patients who subsequently require DCSs does not differ among those
administered amiodarone, lidocaine, or placebo.<br/>Copyright &#xa9; 2017,
Zhejiang University and Springer-Verlag GmbH Germany, part of Springer
Nature.

<73>
Accession Number
619909843
Author
Head S.J.; Celik M.; Kappetein A.P.
Institution
(Head, Celik, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Dr Molewaterplein 40, Rotterdam 3015GE,
Netherlands
Title
Mechanical versus bioprosthetic aortic valve replacement.
Source
European Heart Journal. 38 (28) (pp 2183-2191), 2017. Date of Publication:
21 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Mechanical valves used for aortic valve replacement (AVR) continue to be
associated with bleeding risks because of anticoagulation therapy, while
bioprosthetic valves are at risk of structural valve deterioration
requiring reoperation. This risk/benefit ratio of mechanical and
bioprosthetic valves has led American and European guidelines on valvular
heart disease to be consistent in recommending the use of mechanical
prostheses in patients younger than 60 years of age. Despite these
recommendations, the use of bioprosthetic valves has significantly
increased over the last decades in all age groups. A systematic review of
manuscripts applying propensity-matching or multivariable analysis to
compare the usage of mechanical vs. bioprosthetic valves found either
similar outcomes between the two types of valves or favourable outcomes
with mechanical prostheses, particularly in younger patients. The
risk/benefit ratio and choice of valves will be impacted by developments
in valve designs, anticoagulation therapy, reducing the required
international normalized ratio, and transcatheter and minimally invasive
procedures. However, there is currently no evidence to support lowering
the age threshold for implanting a bioprosthesis. Physicians in the Heart
Team and patients should be cautious in pursuing more bioprosthetic valve
use until its benefit is clearly proven in middle-Aged
patients.<br/>Copyright &#xa9; The Author 2017.

<74>
Accession Number
619957180
Author
Halle T.R.; Oh M.S.; Collop N.A.; Quyyumi A.A.; Bliwise D.L.; Dedhia R.C.
Institution
(Halle, Oh, Dedhia) Department of Otolaryngology, Emory University School
of Medicine, Atlanta, GA, United States
(Collop, Bliwise, Dedhia) Department of Neurology, Division of Sleep
Medicine, Emory University School of Medicine, Atlanta, GA, United States
(Quyyumi) Department of Medicine, Division of Cardiology, Emory University
School of Medicine, Atlanta, GA, United States
Title
Surgical Treatment of OSA on Cardiovascular Outcomes: A Systematic Review.
Source
Chest. 152 (6) (pp 1214-1229), 2017. Date of Publication: December 2017.
Publisher
Elsevier Inc
Abstract
Background OSA is an increasingly prevalent clinical problem with
significant effects on quality of life and cardiovascular risk. Surgical
therapy represents an important treatment for those unable to use positive
airway pressure. This systematic review examines the available
cardiovascular risk reduction data for the surgical treatment of OSA.
Methods A comprehensive literature search was performed. Articles were
included if they met the following criteria: (1) the sample population
consisted of adults (age >= 18 years); (2) OSA was diagnosed according to
a sleep study; (3) surgical intervention was performed for OSA; and (4)
one or more physical or biochemical cardiovascular and/or cerebrovascular
variables was measured preoperatively and at >= 14 days postoperatively.
Results Thirty-three articles were included. The majority of studies were
case series and cohort studies (42% and 44%, respectively), with
wide-ranging follow-up periods (4 weeks-9 years) and sample sizes (range,
6-10,339; median, 34). The following classes of surgical intervention were
examined: pharyngeal surgery (n = 23), tracheostomy (n = 6),
maxillomandibular advancement (n = 3), and hypoglossal nerve stimulation
(n = 1). In total, 19 outcome measures were assessed. Tracheostomy was
most consistently associated with improvement in cardiovascular end
points. Pharyngeal surgeries (eg, uvulopalatopharyngoplasty) were variably
associated with improvement in cardiovascular end points. Conclusions The
published literature examining cardiovascular end points following
surgical treatment of OSA is limited and generally of poor quality.
However, available data from mainly small and observational studies
suggest that surgical treatment of OSA may provide improvement in some
cardiovascular end points. Larger, randomized, and prospective trials with
more rigorous study designs are needed. Trial Registry PROSPERO
International Prospective Register of Systemic Reviews (PROSPERO
42016040120).<br/>Copyright &#xa9; 2017 American College of Chest
Physicians

<75>
Accession Number
619956880
Author
White K.; Macfarlane H.; Hoffmann B.; Sirvas-Brown H.; Hines K.; Rolley
J.X.; Graham S.
Institution
(White) MonashHeart, Clayton, Vic, Australia
(Macfarlane) Frankston Hospital, Frankston, Vic, Australia
(Hoffmann) Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
(Sirvas-Brown) St John of God Subiaco Hospital, Subiaco, WA, Australia
(Hines) Calvary Wakefield Hospital, Adelaide, SA, Australia
(Rolley) University of Canberra, Bruce, ACT, Australia
(Graham) Middlemore Hospital, Auckland, New Zealand
Title
Consensus Statement of Standards for Interventional Cardiovascular Nursing
Practice.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Interventional cardiovascular nursing is a critical care nursing specialty
providing complex nursing interventions to patients prone to clinical
deterioration, through the combined risks of the pathophysiology of their
illness and undergoing technically complex interventional cardiovascular
procedures. No guidelines were identified worldwide to assist health care
providers and educational institutions in workforce development and
education guidelines to minimise patients' risk of adverse events.The
Interventional Nurses Council (INC) developed a definition and scope of
practice for interventional cardiac nursing (ICN's) in 2013. The INC
executive committee established a working party of seven representatives
from Australia and New Zealand. Selection was based on expertise in
interventional cardiovascular nursing and experience providing education
and mentoring in the clinical and postgraduate environment. A literature
search of the electronic databases Science Direct, Cumulative Index to
Nursing and Allied Health Literature (CINAHL), Medline and Health Source
was performed, using the search terms: clinical deterioration, ST
elevation myocardial infarction, vital signs, primary percutaneous
coronary intervention, PCI, AMI, STEMI, acute coronary syndrome,
peri-procedural care, unstable angina, PCI complications, structural heart
disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology
studies, vascular access, procedural sedation. Articles were limited to
the cardiac catheterisation laboratory and relevance to nursing based
outcomes. Reference lists were examined to identify relevant articles
missed in the initial search. The literature was compared with national
competency standards, quality and safety documents and the INC definition
and scope of practice. Consensus of common themes, a taxonomy of education
and seven competency domains were achieved via frequent teleconferences
and two face-to-face meetings.The working party finalised the standards on
14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm
Council, CSANZ Quality Standards Committee and the Australian College of
Critical Care Nurses (ACCCN). The resulting document provides clinical
practice and education standards for interventional cardiac nursing
practice.<br/>Copyright &#xa9; 2017.

<76>
Accession Number
619850569
Author
Shen T.; Picard M.H.; Hua L.; Burns S.M.; Andrawes M.N.
Institution
(Shen, Burns, Andrawes) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Harvard Medical School, White
437, 55 Fruit St, Boston, MA 02114, United States
(Picard, Hua) Cardiac Ultrasound Laboratory, Division of Cardiology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
Title
Assessment of Tricuspid Annular Motion by Speckle Tracking in Anesthetized
Patients Using Transesophageal Echocardiography.
Source
Anesthesia and Analgesia. 126 (1) (pp 62-67), 2018. Date of Publication:
01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The perioperative assessment of right ventricular (RV)
function remains a challenge. Tricuspid annular plane systolic excursion
(TAPSE) using M-mode is a widely used measure of RV function. However,
accurate alignment of the ultrasound beam with the direction of annular
movement can be difficult with transesophageal echocardiography (TEE) to
measure TAPSE, precluding effective use of M-mode to measure annular
excursion. Tracking of specular reflectors in the myocardium may provide
an angle-independent method to assess annular motion with TEE. We
hypothesized that TEE speckle tracking of the lateral tricuspid annular
motion represents a comparable measurement to the well-validated M-mode
TAPSE on transthoracic echocardiogram (TTE), and may be considered as a
reasonable alternative to TAPSE. METHODS: This is a prospective,
observational cohort study. We included all patients, who were in sinus
rhythm, with a preoperative TTE within 3 months of scheduled cardiac
surgery that required intraoperative TEE. Tissue motion annular
displacements (TMAD) of the lateral (L), septal (S), and midpoint (M)
tricuspid annulus were measured (QLAB Cardiac Motion Quantification;
Philips Medical, Andover, MA) after induction of general anesthesia. This
was compared to the preoperative M-mode TAPSE on TTE. RESULTS: Seventy-two
consecutive patients who met eligibility requirements were enrolled from
September to November 2016. Twelve were excluded due to poor image
quality, allowing TMAD to be analyzed in 60 patients. TMAD was analyzed
offline and TMAD analysis was able to track tricuspid annular motion in
all patients. The mean TMAD (L), TMAD (S), and TMAD (M) were 17.4 +/- 5.2,
10.2 +/- 4.8, and 14.2 +/- 4.8 mm, respectively. TMAD (L) showed close
correlation with M-mode TAPSE on TTE (r = 0.87, 95% confidence interval,
0.79-0.92; P <.01). All patients with a preoperative TAPSE <17 mm had a
TMAD (L) <17 mm, while 71% of those with a TAPSE >= 17 mm had a TMAD (L)
>= 17 mm. There was strong positive correlation between TMAD (L) and
intraoperative RV fractional area change (r = 0.86, 95% confidence
interval, 0.77-0.91; P <.01). Reproducibility analysis of TMAD within and
across observers showed excellent correlation. CONCLUSIONS: TMAD is a
quick and angle-independent method to quantitatively assess RV
longitudinal function by TEE. It correlates strongly with M-mode TAPSE on
TTE. Because TMAD and TAPSE were not simultaneously measured in this
study, their correlation is subject to differences in loading conditions,
general anesthesia, and changes in the disease process. TMAD may be easily
applied in routine clinical settings and its role in the perioperative
environment deserves to be further explored.<br/>Copyright &#xa9; 2017
International Anesthesia Research Society.

<77>
Accession Number
619883515
Author
Goldstein B.H.; Goldstein S.L.; Devarajan P.; Zafar F.; Kwiatkowski D.M.;
Marino B.S.; Morales D.L.S.; Krawczeski C.D.; Cooper D.S.
Institution
(Goldstein, Goldstein, Zafar, Morales, Cooper) Heart Institute, Cincinnati
Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003,
Cincinnati, OH 45229, United States
(Goldstein, Devarajan, Cooper) Center for Acute Care Nephrology,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United
States
(Kwiatkowski, Krawczeski) Division of Cardiology, Stanford University
School of Medicine, Palo Alto, California, United States
(Marino) Division of Cardiology, Northwestern University Feinberg School
of Medicine and Lurie Children's Hospital, Chicago, Illinois, United
States
Title
First-stage palliation strategy for univentricular heart disease may
impact risk for acute kidney injury.
Source
Cardiology in the Young. 28 (1) (pp 93-100), 2018. Date of Publication: 01
Jan 2018.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective Norwood palliation for patients with single ventricle heart
disease is associated with a significant risk for acute kidney injury,
which portends a worse prognosis. We sought to investigate the impact of
hybrid stage I palliation (Hybrid) on acute kidney injury risk. Design
This study is a single-centre prospective case-control study of seven
consecutive neonates with single ventricle undergoing Hybrid palliation.
Levels of serum creatinine and four novel urinary biomarkers, namely
neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty
acid-binding protein, and kidney injury molecule-1, were obtained before
and after palliation. Acute kidney injury was defined as a 50% increase in
serum creatinine within 48 hours after the procedure. Data were compared
with a contemporary cohort of 12 neonates with single ventricle who
underwent Norwood palliation. Results Patients who underwent Hybrid were
more likely to be high-risk candidates (86 versus 25%, p=0.01) compared
with those who underwent Norwood. Despite similar preoperative serum
creatinine levels, there was a trend towards higher levels of
postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47,
0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in
the Norwood cohort. Preoperative neutrophil gelatinase-associated
lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and
interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels
were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect
models demonstrated Hybrid palliation to be a protective factor against
increased postoperative levels of neutrophil gelatinase-associated
lipocalin (estimate -1.8 [-3.0, -9.0], p<0.001) and liver fatty
acid-binding protein (-49.3 [-89.7, -8.8], p=0.018). Conclusions In this
single-centre case-control study, postoperative acute kidney injury risk
did not differ significantly by single ventricle stage I treatment
strategy; however, postoperative elevation in novel urinary biomarkers,
consistent with subclinical kidney injury, was encountered in the Norwood
cohort but not in the Hybrid cohort.<br/>Copyright &#xa9; Cambridge
University Press 2017.

<78>
Accession Number
619721330
Author
Peker Y.; Thunstrom E.; Glantz H.; Wegscheider K.; Eulenburg C.
Institution
(Peker) Dept of Pulmonary Medicine, Faculty of Medicine, Marmara
University, Pendik Education and Research Hospital, Sleep Medicine Center,
Pendik, Istanbul 34899, Turkey
(Peker, Thunstrom) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Thunstrom) Dept of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Glantz) Dept of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Wegscheider) Dept of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Eulenburg) Medical Statistics and Decision Making, Dept of Epidemiology,
University Medical Center Groningen, Groningen, Netherlands
Title
Outcomes in Coronary artery disease patients with sleepy obstructive sleep
apnoea on CPAP.
Source
European Respiratory Journal. 50 (6) (no pagination), 2017. Article
Number: 1700749. Date of Publication: 01 Dec 2017.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA)
have increased risk for major adverse cardiovascular and cerebrovascular
events (MACCEs) compared with CAD patients without OSA. We aimed to
address if the risk is similar in both groups when OSA patients are
treated. This study was a parallel observational arm of the RICCADSA
randomised controlled trial, conducted in Sweden between 2005 and 2013.
Patients with revascularised CAD and OSA (apnoea-hypopnoea index (AHI)
>=15 events.h-1) with daytime sleepiness (Epworth Sleepiness Scale score
>=10) were offered continuous positive airway pressure (CPAP) (n=155); CAD
patients with no OSA (AHI <5 events.h-1) acted as controls (n=112), as a
randomisation of sleepy OSA patients to no treatment would not be
ethically feasible. The primary end-point was the first event of MACCEs.
Median follow-up was 57 months. The incidence of MACCEs was 23.2% in OSA
patients versus 16.1% in those with no OSA (adjusted hazard ratio 0.96,
95% CI 0.40-2.31; p=0.923). Age and previous revascularisation were
associated with increased risk for MACCEs, whereas coronary artery bypass
grafting at baseline was associated with reduced risk. We conclude that
the risk for MACCEs was not increased in CAD patients with sleepy OSA on
CPAP compared with patients without OSA.<br/>Copyright &#xa9; ERS 2017.

<79>
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).

<80>
Accession Number
619849460
Author
Lee M.-C.; Shen Y.-C.; Wang J.-H.; Li Y.-Y.; Li T.-H.; Chang E.-T.; Wang
H.-M.
Institution
(Lee, Li) Department of Human Development and Psychology, College of
Humanities and Social Sciences, Tzu Chi University, Hualien, Taiwan
(Republic of China)
(Shen, Li) Department of Psychiatry, Buddhist Tzu Chi General Hospital,
Hualien, Taiwan (Republic of China)
(Shen, Wang, Chang) School of Medicine, Tzu Chi University, Hualien,
Taiwan (Republic of China)
(Wang) Department of Cardiology, Buddhist Tzu Chi General Hospital,
Hualien, Taiwan (Republic of China)
(Li) Department of Psychiatry, Pingtung Branch of Kaohsiung Armed Forces
General Hospital, Pingtung, Taiwan (Republic of China)
(Chang, Wang) Department of Chest, Buddhist Tzu Chi General Hospital, 707,
Section 3, Chung-Yang Road, Hualien, Taiwan (Republic of China)
Title
Effects of continuous positive airway pressure on anxiety, depression, and
major cardiac and cerebro-vascular events in obstructive sleep apnea
patients with and without coronary artery disease.
Source
Tzu Chi Medical Journal. 29 (4) (pp 218-222), 2017. Date of Publication:
October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Obstructive sleep apnea (OSA) is associated with bad
cardiovascular outcomes and a high prevalence of anxiety and depression.
This study investigated the effects of continuous positive airway pressure
(CPAP) on the severity of anxiety and depression in OSA patients with or
without coronary artery disease (CAD) and on the rate of cardio-and
cerebro-vascular events in those with OSA and CAD. Materials and Methods:
This prospective study included patients with moderate-To-severe OSA, with
or without a recent diagnosis of CAD; all were started on CPAP therapy.
Patients completed the Chinese versions of the Beck Anxiety Inventory
(BAI) and Beck Depression Inventory-II (BDI-II) at baseline and after
6-month follow-up. The occurrence of major adverse cardiac and
cerebrovascular events (MACCE) was assessed every 3 months up to 1 year.
Results: BAI scores decreased from 8.5 +/- 8.4 at baseline to 5.4 +/- 6.9
at 6 months in CPAP-compliant OSA patients without CAD (P < 0.05). BAI
scores also decreased from 20.7 +/- 14.9 to 16.1 +/- 14.5 in
CPAP-compliant OSA patients with CAD. BDI-II scores decreased in
CPAP-compliant OSA patients without CAD (from 11.1 +/- 10.7 at baseline to
6.6 +/- 9.5 at 6 months) and in CPAP-compliant OSA patients with CAD (from
20.4 +/- 14.3 to 15.9 +/- 7.3). In addition, there was a large effect size
(ES) of BAI and BDI in 6-month CPAP treatment of OSA patients with CAD and
a large ES in those with OSA under CPAP treatment. In OSA patients with
CAD, the occurrence of MACCE was significantly lower in CPAP-compliant
patients than that in CPAP noncompliant patients (11% in CPAP compliant
and 50% in noncompliant; P < 0.05). Conclusions: CPAP improved anxiety and
depression in OSA patients regardless of CAD. In OSA patients with CAD,
CPAP-compliant patients had a lower 1-year rate of MACCE than
CPAP-noncompliant patients.

<81>
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.

<82>
Accession Number
619944059
Author
Sakusic A.; O'Horo J.C.; Dziadzko M.; Volha D.; Ali R.; Singh T.D.;
Kashyap R.; Farrell A.M.; Fryer J.D.; Petersen R.; Gajic O.; Rabinstein
A.A.
Institution
(Sakusic) Department of Physiology, Faculty of Medicine, University of
Tuzla, Tuzla, Bosnia and Herzegovina
(Sakusic) University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
(Sakusic, O'Horo, Volha, Ali, Singh, Kashyap, Gajic, Rabinstein)
Multidisciplinary Epidemiology and Translational Research in Intensive
Care (METRIC), Emergency and Perioperative Medicine, Mayo Clinic,
Rochester, MN, United States
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
(Gajic) Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Mayo Clinic, Rochester, MN, United States
(Dziadzko, Kashyap) Department of Anesthesiology, Mayo Clinic, Rochester,
MN, United States
(Singh, Petersen, Rabinstein) Department of Neurology, Mayo Clinic,
Rochester, MN, United States
(Dziadzko) Department of Anesthesiology, CHU Croix Rousse, Lyon, France
(Fryer) Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United
States
(Farrell) Mayo Clinic Libraries, Rochester, MN, United States
Title
Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment
After Critical Illness: A Systematic Review.
Source
Mayo Clinic Proceedings. 93 (1) (pp 68-82), 2018. Date of Publication:
January 2018.
Publisher
Elsevier Ltd
Abstract
Long-term cognitive impairment is common in survivors of critical illness.
Little is known about the etiology of this serious complication. We sought
to summarize current scientific knowledge about potentially modifiable
risk factors during intensive care unit (ICU) treatment that may play a
substantial role in the development of long-term cognitive impairment. All
searches were run on October 1, 2017. The search strategy included Ovid
MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled
Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of
Science, and included MeSH headings and keywords related to intensive
care, critical care, and cognitive disorders. Searches were restricted to
adult subjects. Inclusion required follow-up cognitive evaluation at least
2 months after ICU discharge. Studies assessing patients with cardiac
arrest, traumatic brain injury, and cardiac surgery history were excluded.
The search strategy resulted in 3180 studies. Of these, 28 studies (.88%)
met our inclusion criteria and were analyzed. Delirium and duration of
delirium were associated with long-term cognitive impairment after ICU
admission in 6 of 9 studies in which this factor was analyzed. Weaker and
more inconsistent associations have been reported with hypoglycemia,
hyperglycemia, fluctuations in serum glucose levels, and in-hospital acute
stress symptoms. Instead, most of the studies did not find significant
associations between long-term cognitive impairment and mechanical
ventilation; use of sedatives, vasopressors, or analgesic medications;
enteral feeding; hypoxia; extracorporeal membrane oxygenation; systolic
blood pressure; pulse rate; or length of ICU stay. Prolonged delirium may
be a risk factor for long-term cognitive impairment after critical
illness, though this association has not been entirely consistent across
studies. Other potentially preventable factors have not been shown to have
strong or consistent associations with long-term cognitive dysfunction in
survivors of critical illness.<br/>Copyright &#xa9; 2017 Mayo Foundation
for Medical Education and Research