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<1>
Accession Number
618863087
Author
Saad M.; Nairooz R.; Pothineni N.V.K.; Almomani A.; Kovelamudi S.; Sardar
P.; Katz M.; Abdel-Wahab M.; Bangalore S.; Kleiman N.S.; Block P.C.;
Abbott J.D.
Institution
(Saad, Pothineni, Almomani, Kovelamudi) Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas, United States
(Nairooz) Division of Cardiology, University of Southern California, Los
Angeles, California, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, Utah, United States
(Katz) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Abdel-Wahab) Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, New York, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, Texas, United States
(Block) Division of Cardiovascular Medicine, Emory University School of
Medicine, Atlanta, Georgia
(Abbott) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, Rhode Island, United States
Title
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women
Compared With Men: Evidence From a Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 24-35), 2018. Date of
Publication: 08 Jan 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to examine long-term outcomes with
transcatheter aortic valve replacement (TAVR) in women versus men.
Background TAVR is commonly performed in women. Previous studies have
shown conflicting results with respect to sex differences in outcomes with
TAVR. In addition, short-term outcomes have primarily been reported.
Methods Electronic search was performed until March 2017 for studies
reporting outcomes with TAVR in women versus men. Random effects
DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause
mortality and major cardiovascular events at short- (30 days) and
long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR
registries; 47,188 patients; 49.4% women) were analyzed. Women were older
but exhibited fewer comorbidities. At 30 days, women had more bleeding (p
< 0.001), vascular complications (p < 0.001), and stroke/transient
ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or
cardiovascular mortality (p = 0.91) compared with men. However, female sex
was associated with lower all-cause mortality at 1 year (risk ratio: 0.85;
95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available
follow-up (mean 3.28 +/- 1.04 years; risk ratio: 0.86; 95% confidence
interval: 0.81 to 0.92; p < 0.001), potentially caused by less
moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular
mortality (p = 0.009). The female survival advantage remained consistent
across multiple secondary analyses. The risk of stroke, moderate/severe
aortic insufficiency, and all-cause mortality seemed to vary based on the
type of valve used; however, without significant subgroup interactions.
Conclusions Despite a higher upfront risk of complications, women derive a
better long-term survival after TAVR compared with men.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<2>
Accession Number
617911834
Author
Bilchick K.C.; Mejia-Lopez E.; McCullough P.; Breathett K.; Kennedy J.L.;
Tallaj J.; Bergin J.; Pamboukian S.; Abuannadi M.; Mazimba S.
Institution
(Bilchick, Mejia-Lopez, Kennedy, Bergin, Abuannadi, Mazimba) University of
Virginia Health System, Charlottesville, Virginia, United States
(McCullough) Baylor Heart and Vascular Institute, Dallas, Texas, United
States
(Breathett) University of Colorado, Denver, Colorado, United States
(Tallaj, Pamboukian) University of Alabama, Birmingham, Alabama, United
States
Title
Clinical Impact of Changes in Hemodynamic Indices of Contractile Function
During Treatment of Acute Decompensated Heart Failure.
Source
Journal of Cardiac Failure. 24 (1) (pp 43-50), 2018. Date of Publication:
January 2018.
Publisher
Churchill Livingstone Inc.
Abstract
Background The objective of this work was to determine the impact of
improving right ventricular versus left ventricular stroke work indexes
(RVSWI vs LVSWI) during therapy for acute decompensated heart failure
(ADHF). Methods and Results Cox proportional hazards regression and
logistic regression were used to analyze key factors associated with
outcomes in 175 patients (mean age 56.7 +/- 13.6 years, 29.1% female) with
hemodynamic data from the Evaluation Study of Congestive Heart Failure and
Pulmonary Artery Catheterization Effectiveness trial. In this cohort,
28.6% and 69.7%, respectively, experienced the outcomes of death,
transplantation, or ventricular assist device implantatation (DVADTX) and
DVADTX or HF rehospitalization (DVADTXHF) during 6 months of follow-up.
Increasing RVSWI (DELTARVSWI) from baseline to discharge was associated
with a decrease in DVADTXHF (hazard ratio [HR] 0.923, 95% confidence
interval [CI] 0.871-0.979) per 0.1 mm HgLm^-2 increase);
however, increasing LVSWI (DELTALVSWI) had only a nonsignificant
association with decreased DVADTXHF (P =.11) In a multivariable model,
patients with DELTARVSWI <=1.07 mm HgLm^-2 and DELTALVSWI <=4.57
mm HgLm^-2 had a >2-fold risk of DVADTXHF (HR 2.05, 95% CI
1.23-3.41; P =.006). Conclusion Compared with left ventricular stroke
work, increasing right ventricular stroke work during treatment of ADHF
was associated with better outcomes. The results promise to inform optimal
hemodynamic targets for ADHF.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<3>
Accession Number
620027237
Author
Montero S.; Aissaoui N.; Tadie J.-M.; Bizouarn P.; Scherrer V.; Persichini
R.; Delmas C.; Rolle F.; Besnier E.; Le Guyader A.; Combes A.; Schmidt M.
Institution
(Montero, Combes, Schmidt) Medical Intensive Care Unit, iCAN, Institute of
Cardiometabolism and Nutrition, Hopital de la Pitie-Salpetriere,
Assistance Publique-Hopitaux de Paris, Paris, France
(Aissaoui) Intensive Care Unit, U970, European Georges-Pompidou Hospital,
Paris Descartes University, Paris, France
(Tadie) Infectious Diseases and Intensive Care Unit, Pontchaillou
University Hospital, Rennes, France
(Bizouarn) Cardiac Intensive Care Department, CHU Nantes, Nantes, France
(Scherrer, Besnier) Rouen University Hospital, Department of
Anaesthesiology and Critical Care, Rouen, France
(Persichini) Medical-Surgical Intensive Care Unit, CHU de La Reunion,
Felix-Guyon Hospital, Saint Denis, La Reunion, France
(Delmas) Medical Intensive Care Unit, Rangueil Hospital, Toulouse, France
(Rolle, Le Guyader) Thoracic and Cardiac Surgery Department, CHU Limoges,
Limoges, France
(Montero) Acute and Intensive Cardiovascular Care Unit, Department of
Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research
Institute IIB-Sant Pau, Barcelona, Spain
Title
Fulminant giant-cell myocarditis on mechanical circulatory support:
Management and outcomes of a French multicentre cohort.
Source
International Journal of Cardiology. 253 (pp 105-112), 2018. Date of
Publication: 15 Feb 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Giant-cell myocarditis (GCM) is a rare and often fatal form of
myocarditis. Only a few reports have focused on fulminant forms. We
describe the clinical characteristics, management and outcomes of GCM
patients rescued by mechanical circulatory support (MCS). Methods and
results The clinical features, diagnoses, treatments and outcomes of
MCS-treated patients in refractory cardiogenic shock secondary to
fulminant GCM admitted to eight French intensive care units (2002-2016)
were analysed. We also conducted a systematic review of this topic.
Thirteen patients (median age 44 [range 21-76] years, Simplified Acute
Physiology Score II 55 [40-79]) in severe cardiogenic shock (median
[range] left ventricular ejection fraction 15% [15-35%] and blood lactate
4 mmol/L) were placed on MCS 4 [0-28] days after hospital admission.
Severe arrhythmic disturbances were frequent (77%), with six (46%)
patients experiencing an electrical storm prior to MCS. Venoarterial
extracorporeal membrane oxygenation was the first MCS option for 11 (85%)
patients. GCM was diagnosed in five (38%) patients before transplant or
death and treated with immunosuppressants; infections were the main
complication (80%). Four patients died on MCS and no patient presented
long-term survival free from heart transplant (nine patients, 69%). All
transplanted patients were alive 1 year later and no GCM recurrence was
reported after median follow-up of 42 [12-145] months. Conclusion Outcomes
of fulminant GCMs may differ from those of milder forms. In this context,
heart transplant might likely be the only long-term survival
option.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<4>
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Accession Number
620046382
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, United States
(Columbo, Sundling, Chauhan, Bessen, Kang, Riblet, Goodney) Dartmouth
Institute for Health Policy and Clinical Practice, Hanover, NH, United
States
(Columbo, Kang, Goodney) VA Outcomes Group, Veterans Health
Administration, White River Junction, VT, United States
(Columbo, Kang) VA Quality Scholars, Veterans Health Administration, White
River Junction, VT, United States
(Lambour, Linshaw, Kang) Department of General Surgery,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
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.<br/>Copyright &#xa9; 2017 Wolters
Kluwer Health, Inc.

<5>
Accession Number
620004534
Author
Bjornnes A.K.; Parry M.; Lie I.; Falk R.; Leegaard M.; Rustoen T.
Institution
(Bjornnes, Rustoen) Oslo University Hospital, Ulleval, Department of
Research and Development, Division of Emergencies and Critical Care,
Nydalen, P.O Box 4956, Oslo 0424, Norway
(Bjornnes, Parry) University of Toronto, Lawrence S. Bloomberg Faculty of
Nursing, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada
(Lie) Oslo University Hospital, Ulleval, Center for patient centered
heart- and lung research, Department of Cardiothoracic Surgery, Division
of Cardiovascular and Pulmonary Diseases, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Falk) Oslo University Hospital, Ulleval, Oslo Centre for Biostatistics
and Epidemiology, Research Support Services, Nydalen, P.O Box 4956, Oslo
0424, Norway
(Leegaard) Oslo and Akershus University College of Applied Sciences,
Faculty of Health Sciences, Institute of Nursing, St. Olavs Plass, P.O Box
4, Oslo N-0130, Norway
(Rustoen) Oslo University Hospital, Ulleval, Institute of Health and
Society, Nydalen, P.O Box 4956, Oslo 0424, Norway
Title
The association between hope, marital status, depression and persistent
pain in men and women following cardiac surgery.
Source
BMC Women's Health. 18 (1) (no pagination), 2018. Article Number: 2. Date
of Publication: 02 Jan 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgery is a major life event, and outcomes after
surgery are associated with men's and women's ability to self-manage and
cope with their cardiac condition in everyday life. Hope is suggested to
impact cardiac health by having a positive effect on how adults cope with
and adapt to illness and recommended lifestyle changes. Methods: We did a
secondary analysis of 416 individuals (23% women) undergoing elective
coronary artery bypass graft and/or valve surgery between March 2012 and
September 2013 enrolled in randomized controlled trial. Hope was assessed
using The Herth Hope Index (HHI) at three, six and 12 months following
cardiac surgery. Linear mixed model analyses were performed to explore
associations after cardiac surgery between hope, marital status,
depression, persistent pain, and surgical procedure. Results: For the
total sample, no statistically significant difference between global hope
scores from 3 to 12 months was observed (ranging from 38.3 +/- 5.1 at 3
months to 38.7 +/- 5.1 at 12 months), and no differences between men and
women were observed at any time points. However, 3 out of 12 individual
items on the HHI were associated with significantly lower scores in women:
#1) I have a positive outlook toward life, #3) I feel all alone, and #6) I
feel scared about my future. Over the study period, diminished hope was
associated with older age, lower education, depression prior to surgery,
and persistent pain at all measurement points. Isolated valve surgery was
positively associated with hope. While neither sex nor marital status, as
main effects, demonstrated significant associations with hope, women who
were divorced/widowed/single were significantly more likely to have lower
hope scores over the study period. Conclusion: Addressing pain and
depression, and promoting hope, particularly for women living alone may be
important targets for interventions to improve outcomes following cardiac
surgery. Trial registration: Clinical Trials gov Identifier: NCT01976403.
Date of registration: November 28, 2011.<br/>Copyright &#xa9; 2017 The
Author(s).

<6>
Accession Number
620021259
Author
Paratz E.D.; Kao C.; MacIsaac A.I.; Somaratne J.; Whitbourn R.
Institution
(Paratz, Kao, MacIsaac, Somaratne, Whitbourn) Department of Cardiology, St
Vincent's Hospital, Melbourne, Australia
Title
Evolving management and improving outcomes of pregnancy-associated
spontaneous coronary artery dissection (P-SCAD): a systematic review.
Source
IJC Heart and Vasculature. 18 (pp 1-6), 2018. Date of Publication: March
2018.
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background Pregnancy-associated spontaneous coronary artery dissection
(P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months
post-partum. Earlier systematic reviews have suggested a high maternal and
foetal mortality rate. We undertook a structured systematic review of
P-SCAD demographics, management and maternal and foetal outcomes. Methods
Case study identification was conducted according to PRISMA guidelines,
with screening of all published P-SCAD cases not meeting pre-defined
exclusion criteria. Of two hundred and seventy-three publications
screened, one hundred and thirty-eight cases met inclusion criteria. Cases
were allocated to one of three time periods; 1960-85 (twenty cases)
reflecting early management of P-SCAD, 1986-2005 (forty-two cases)
reflecting recent management, and 2006-16 (seventy-six cases), reflecting
contemporary management. Results The only significant demographic change
in women experiencing P-SCAD over the last 50 years was an increasing
proportion of primigravidas (p = 0.02). Management and outcomes, however,
have altered significantly. Emergent angiography (p < 0.0001), reduced
thrombolysis (p = 0.006) and increasingly conservative or percutaneous
management (p < 0.0001) are associated with dramatic reductions in
maternal mortality (85% in earliest reports to 4% in the last decade, p <
0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last
decade, p = 0.023). Conclusion This systematic review of temporal changes
in presentation, management and outcomes of P-SCAD represents the widest
range of variables analysed in the largest cohort of P-SCAD patients to
date. In the setting of earlier coronary angiography and increasingly
conservative management, maternal and foetal survival rates continue to
improve.<br/>Copyright &#xa9; 2017 The Authors

<7>
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Accession Number
620029560
Author
Jiang L.-C.; Cao J.-Y.; Chen M.
Institution
(Jiang, Cao, Chen) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Coronary artery aneurysm combined with other multiple aneurysms at
multiple locations: A case report and systematic review.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9230. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Coronary artery aneurysm (CAA) with concomitant aneurysms at
multiple sites is quite unusual and rare. The characteristics and the
etiology of this phenomenon are unknown. Methods: Herein, we present a
case with right coronary aneurysm with concomitant abdominal aorta as well
as right renal artery aneurysm. A systematic review of the literatures
regarding CAA with other coexisting aneurysms at multiple locations was
also conducted on Medline and Embase databases. Results: A total of 76
patients (male gender: 58; age: 37.4 +/- 26.5) including the present case
were included in the final study. The most common etiology of CAA with
multiple aneurysms was Kawasaki (43.3%) and atherosclerotic disease
(16.4%). CAA was the most frequently found at the right coronary artery
(62.7%), following, left anterior descending (51%), left main (43.1%), and
left circumflex (35.3%). The most common concomitant aneurysms were
abdominal aorta (52.6%) and iliac artery (50%). In addition, 60.5% of the
patients had an involved bilateral peripheral artery. Conclusion: CAA with
coexisting systemic aneurysms in multiple sites is quite rare. And it
usually involves multiple aneurysms at the coronary and bilateral
peripheral arteries simultaneously. Currently, there are no general
consensus regarding the clinical characteristics, diagnostic method, and
treatment of these cases.<br/>Copyright &#xa9; 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<8>
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Accession Number
620029352
Author
Han D.; Liu Y.G.; Pan S.; Luo Y.; Li J.; Ou-Yang C.
Institution
(Han, Pan) Anesthesia Department, Capital Institute of Pediatrics
Affiliated Children's Hospital, China
(Liu, Ou-Yang) Anesthesia Center, Capital Medical University Affiliated
Beijing Anzhen Hospital, 2 Anzhen Street, Chaoyang District, Beijing
100029, China
(Luo) Cardiac Surgery Division, Capital Institute of Pediatrics Affiliated
Children's Hospital, China
(Li) Clinical Physiology Laboratory, Capital Institute of Pediatrics,
Beijing, China
Title
Comparison of hemodynamic effects of sevoflurane and ketamine as basal
anesthesia by a new and direct monitoring during induction in children
with ventricular septal defect: A prospective, randomized research.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9039. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Sevoflurane and ketamine are commonly used to obtain sedation
and facilitate intravenous anesthetic induction in children undergoing
cardiac surgery who are uncooperative. We used a new and direct systemic
hemodynamic monitoring technique pressure recording analytical method and
compared the hemodynamic effects of sevoflurane and ketamine to facilitate
intravenous anesthetic induction. Methods: Forty-four children with
ventricular septal defect (2.2 +/- 1.2 years) were enrolled and randomized
to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for
sedation, followed by intravenous midazolam-sufentanil induction and
tracheal intubation. Recorded parameters included heart rate (HR),
arterial pressures, stroke volume index (SVI), cardiac index (CI),
systemic vascular resistance index (SVRI), the maximal slope of systolic
upstroke (dp/dt<inf>max</inf>) after sedation obtained with sevoflurane or
ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10
minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac
power output (CPO) were calculated. Results: As compared with Group S,
Group K had faster decreases during intravenous anesthetic induction in
arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI,
dp/dt<inf>max</inf>, RPP, lower SVI, CI, CPO (P < .05 for all) during the
study period. Conclusion: As compared with sevoflurane, ketamine
facilitated intravenous anesthetic induction exerts unfavorable effects on
systemic hemodynamic and myocardial energetic in children with ventricular
septal defect.<br/>Copyright &#xa9; 2017 the Author(s). Published by
Wolters Kluwer Health, Inc.

<9>
[Use Link to view the full text]
Accession Number
620029131
Author
Brandao S.M.G.; Hueb W.; Ju Y.T.; De Lima A.C.P.; Polanczyk C.A.; Cruz
L.N.; Garcia R.M.R.; Takiuti M.E.; Bocchi E.A.
Institution
(Brandao, Hueb, Garcia, Bocchi) Instituto Do Coracao (InCor), Hospital das
Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP,
Brazil
(Ju, De Lima) Institute of Mathematics and Statistics, Department of
Statistics, University of Sao Paulo, Sao Paulo, SP, Brazil
(Polanczyk) Post Graduate Program in Cardiology and Cardiovascular
Disease, Federal University of Rio Grande Do sul, Brazil
(Polanczyk, Cruz) Instituto Nacional para Avaliacao de Tecnologia em
Saude, IATS/CNPq, Porto Alegre, RS, Brazil
Title
Utility and quality-adjusted life-years in coronary artery disease:
Five-year follow-up of the MASS II trial.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9113. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study evaluated the utility and quality-of-life year
measurements for patients with coronary artery disease who underwent any
of 3 therapeutic strategies with a 5-year follow-up. Methods:
Quality-of-life data were obtained from the Medicine, Angioplasty, or
Surgery Study II trial. To obtain utilities, the 36-Item Short-Form
questionnaire was converted to a 6-Dimensional Health State Classification
System. Results: Of the 611 initial patients, 579 completed the
questionnaire. In all, 188 patients received the surgical treatment-194
the percutaneous, and the remaining 197 the medical. The median utility
scores for the 5 years analyzed were 0.809 (95% confidence interval [CI]
0.794-0.842) for patients assigned to percutaneous coronary intervention,
0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI
0.761-0.809) for coronary artery bypass graft surgery. The difference
between percutaneous coronary intervention and medical treatment was
statistically significant (P < .05, Dunn test). The median cumulative
quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936)
for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95%
CI 3.638-3.890) for surgery. Additionally, the median quality-of-life
years between percutaneous and medical treatment was 0.262 (95% CI
0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI
0.036-0.413), and between surgery and percutaneous coronary intervention
it was -0.038 (95% CI -0.221 to -0.146). Conclusion: Coronary artery
bypass surgery and percutaneous coronary intervention were similar
regarding cumulative quality-of-life years; however, they were both
superior to that of medical treatment. The results presented are valuable
data for further cost-utility studies.<br/>Copyright &#xa9; 2017 the
Author(s). Published by Wolters Kluwer Health, Inc.

<10>
Accession Number
616115547
Author
Robertson J.M.; Dias R.D.; Yule S.; Smink D.S.
Institution
(Robertson, Dias, Yule, Smink) STRATUS Center for Medical Simulation,
Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA
02115, United States
(Robertson) Department of Emergency Medicine, Harvard Medical School,
Boston, MA, United States
(Yule, Smink) Department of Surgery, Harvard Medical School, Boston, MA,
United States
(Yule, Smink) Center for Surgery and Public Health, Brigham and Women's
Hospital, Boston, MA, United States
Title
Operating room team training with simulation: A systematic review.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 27 (5) (pp
475-480), 2017. Date of Publication: May 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Introduction: Nontechnical skills (NTS) such as teamwork and communication
play an important role in preventing adverse outcomes in the operating
room (OR). Simulation-based OR team training focused on these skills
provides an environment where team members can learn with and from one
another. We sought to conduct a systematic review to identify
simulation-based approaches to NTS training for surgical teams. Materials
and Methods: We conducted a systematic search of PubMed, ERIC, and the
Cochrane Database using keywords and MeSH terms for studies describing
simulation-based training for OR teams, including members from surgery,
anesthesia, and nursing in September 2016. Information on the simulations,
participants, and NTS assessments were abstracted from the articles
meeting our search criteria. Results: We identified 10 published articles
describing simulation-based OR team-training programs focused on NTS. The
primary focus of these programs was on communication, teamwork,
leadership, and situation awareness. Only four of the programs used a
validated instrument to assess the NTS of the individuals or teams
participating in the simulations. Discussion: Simulation-based OR
team-training programs provide opportunities for NTS development and
reflection by participants. Future programs could benefit from involving
the full range of disciplines and professions that compose an OR team, as
well as increased use of validated assessment instruments.<br/>&#xa9;
Copyright 2017, Mary Ann Liebert, Inc. 2017.

<11>
Accession Number
620053316
Author
Kemp S.V.; Slebos D.-J.; Kirk A.; Kornaszewska M.; Carron K.; Ek L.;
Broman G.; Hillerdal G.; Mal H.; Pison C.; Briault A.; Downer N.; Darwiche
K.; Rao J.; Hubner R.-H.; Ruwwe-Glosenkamp C.; Trosini-Desert V.;
Eberhardt R.; Herth F.J.; Derom E.; Malfait T.; Shah P.L.; Garner J.L.;
Ten Hacken N.H.; Fallouh H.; Leroy S.; Marquette C.H.
Institution
(Kemp, Shah, Garner) Royal Brompton Hospital, Imperial College London,
London, United Kingdom
(Kemp, Downer) Sherwood Forest Hospitals, NHS Foundation Trust,
Nottinghamshire, United Kingdom
(Slebos, Ten Hacken) Department of Pulmonary Diseases, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(Kirk) Department of Thoracic Surgery, West of Scotland Regional Heart and
Lung Centre, Golden Jubilee National Hospital, West Dunbartonshire,
Scotland, United Kingdom
(Kornaszewska, Fallouh) Department of Cardiothoracic Surgery, University
Hospital of Wales, Cardiff, United Kingdom
(Carron) Department of Pulmonology, AZ Delta, Menen, Belgium
(Ek) Department of Pulmonary Diseases, Skane University Hospital, Lund,
Sweden
(Broman, Hillerdal) Department of Pulmonary Diseases, Uppsala University
Hospital, Uppsala, Sweden
(Mal) Service de Pneumologie A, Hopital Bichat, Paris, France
(Pison, Briault) Clinique Universitaire de Pneumologie, Pole Thorax et
Vaisseaux, CHU Grenoble Alpes, Grenoble, France
(Darwiche) Department of Interventional Pneumology, Ruhrlandklinik, West
German Lung Center, University Clinic Essen, Essen, Germany
(Rao) Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield,
United Kingdom
(Hubner, Ruwwe-Glosenkamp) Charite Universitatsmedizin Berlin,
Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus
Virchow, Berlin, Germany
(Trosini-Desert) Service de Pneumologie et Reanimation, Unite d'Endoscopie
Bronchique, Groupe Hospitalier Pitie Salpetriere, Paris, France
(Eberhardt, Herth) Department of Pneumology and Critical Care Medicine,
Thoraxklinik, University of Heidelberg and, Translational Lung Research
Center Heidelberg, Heidelberg, Germany
(Derom, Malfait) Department of Pulmonary Diseases, Ghent University
Hospital, Ghent, Belgium
(Leroy, Marquette) Universite Cote d'Azur, Centre Hospitalier
Universitaire de Nice, FHU OncoAge, Service de Pneumologie, Nice, France
Title
A multicenter randomized controlled trial of zephyr endobronchial valve
treatment in heterogeneous emphysema (Transform).
Source
American Journal of Respiratory and Critical Care Medicine. 196 (12) (pp
1535-1543), 2017. Date of Publication: 15 Dec 2017.
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: Single-center randomized controlled trials of the Zephyr
endobronchial valve (EBV) treatment have demonstrated benefit in severe
heterogeneous emphysema. This is the first multicenter study evaluating
this treatment approach. Objectives: To evaluate the efficacy and safety
of Zephyr EBVs in patients with heterogeneous emphysema and absence of
collateral ventilation. Methods: This was a prospective, multicenter 2:1
randomized controlled trial of EBVs plus standard of care or standard of
care alone (SoC). Primary outcome at 3 months post-procedure was the
percentage of subjects with FEV<inf>1</inf> improvement from baseline of
12% or greater. Changes in FEV<inf>1</inf>, residual volume, 6-minute-walk
distance, St. George's Respiratory Questionnaire score, and modified
Medical Research Council score were assessed at 3 and 6 months, and target
lobe volume reduction on chest computed tomography at 3 months.
Measurements and Main Results: Ninety seven subjects were randomized to
EBV (n = 65) or SoC (n = 32). At 3 months, 55.4% of EBV and 6.5% of SoC
subjects had an FEV<inf>1</inf> improvement of 12% or more (P, 0.001).
Improvements were maintained at 6 months: EBV 56.3% versus SoC 3.2% (P,
0.001), with a mean 6 SD change in FEV<inf>1</inf> at 6 months of 20.7 6
29.6% and 28.6 6 13.0%, respectively. A total of 89.8% of EBV subjects had
target lobe volume reduction greater than or equal to 350 ml, mean 1.09 6
0.62 L (P, 0.001). Between-group differences for changes at 6 months were
statistically and clinically significant: DEBV-SoC for residual volume,
2700 ml; 6-minute-walk distance, 178.7 m; St. George's Respiratory
Questionnaire score, 26.5 points; modified Medical Research Council
dyspnea score, 20.6 points; and BODE (body mass index, airflow
obstruction, dyspnea, and exercise capacity) index, 21.8 points (all P,
0.05). Pneumothorax was the most common adverse event, occurring in 19 of
65 (29.2%) of EBV subjects. Conclusions: EBV treatment in hyperinflated
patients with heterogeneous emphysema without collateral ventilation
resulted in clinically meaningful benefits in lung function, dyspnea,
exercise tolerance, and quality of life, with an acceptable safety
profile.<br/>Copyright &#xa9; 2017 by the American Thoracic Society

<12>
[Use Link to view the full text]
Accession Number
620048572
Author
Ferrero-De-Loma-Osorio A.; Garcia-Fernandez A.; Castillo-Castillo J.;
Izquierdo-De-Francisco M.; Ibanez-Criado A.; Moreno-Arribas J.; Martinez
A.; Bertomeu-Gonzalez V.; Lopez-Mases P.; Ajo-Ferrer M.; Nunez C.;
Bondanza-Saavedra L.; Sanchez-Gomez J.M.; Martinez-Martinez J.G.;
Chorro-Gasco F.J.; Ruiz-Granell R.
Institution
(Ferrero-De-Loma-Osorio, Izquierdo-De-Francisco, Lopez-Mases, Ajo-Ferrer,
Nunez, Bondanza-Saavedra, Sanchez-Gomez, Chorro-Gasco, Ruiz-Granell)
Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital
Clinico Universitario, Valencia, Spain
(Garcia-Fernandez, Ibanez-Criado, Moreno-Arribas, Martinez-Martinez)
Department of Cardiology, Arrhythmia Unit, Hospital General Universitario,
Valencia, Spain
(Castillo-Castillo, Martinez, Bertomeu-Gonzalez) Department of Cardiology,
Arrhythmia Unit, Hospital Universitariod de San Juan, Avenida Blasco
Ibanez 17, Alicante 46010, Spain
Title
Time-to-Effect-Based Dosing Strategy for Cryoballoon Ablation in Patients
with Paroxysmal Atrial Fibrillation: Results of the plusONE Multicenter
Randomized Controlled Noninferiority Trial.
Source
Circulation: Arrhythmia and Electrophysiology. 10 (12) (no pagination),
2017. Article Number: e005318. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background The optimal dosage of cryotherapy during cryoballoon ablation
of pulmonary veins is still unclear. This trial tested the noninferiority
of a novel, individualized, cryotherapy-dosing strategy for each vein.
Methods and Results This prospective, randomized, multicenter,
noninferiority study included 140 patients with paroxysmal atrial
fibrillation, which was refractory to antiarrhythmic drugs. Patients were
randomly assigned to a conventional strategy of 180-second cryoballoon
applications per vein with a bonus freeze (control group, n=70) or to a
shorter-time application protocol, with 1 application that lasted the time
required for electric block time to effect plus 60- A nd a 120-second
freeze bonus (study group, n=70). Patients were followed with a long-term
monitoring system of 30 days. At 1-year follow-up, no difference was
observed in terms of free atrial fibrillation-recurrence rates: 79.4% in
control versus 78.3% in study group (DELTA=1.15%; 90% confidence
interval,-10.33% to 12.63%; P=0.869). Time to effect was detected in 72.1%
of veins. The control and study groups had similar mean number of
applications per patient (9.6+/-2 versus 9.9+/-2.4; P=0.76). Compared with
controls, the study group had a significantly shorter cryotherapy time
(28.3+/-7 versus 19.4+/-4.3 minutes; P<0.001), left atrium time (104+/-25
versus 92+/-23 minutes; P<0.01), and total procedure time (135+/-35 versus
119+/-31 minutes; P<0.01). No differences were observed in complications
or acute reconnections. Conclusions The new time-to-effect-based
cryotherapy dosage protocol led to shorter cryotherapy and procedure
times, with equal safety, and similar acute and 1-year follow-up results,
compared with the conventional approach. Clinical Trial Registration URL:
Https://clinicaltrials.gov. Unique identifier: NCT02789358.<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

<13>
Accession Number
614075930
Author
Xiu J.; Cui K.; Wang Y.; Zheng H.; Chen G.; Feng Q.; Bin J.; Wu J.; Porter
T.R.
Institution
(Xiu, Cui, Wang, Zheng, Chen, Feng, Bin, Wu) Department of Cardiology,
Nanfang Hospital Southern Medical University, Guangzhou, China
(Porter) Division of Cardiology Internal Medicine, University of Nebraska
Medical Center, Omaha, Nebraska, United States
Title
Prognostic Value of Myocardial Perfusion Analysis in Patients with
Coronary Artery Disease: A Meta-Analysis.
Source
Journal of the American Society of Echocardiography. 30 (3) (pp 270-281),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Myocardial perfusion (MP) imaging during stress myocardial
contrast echocardiography (MCE) improves the detection of coronary artery
disease (CAD). However, its prognostic value to predict cardiac events in
patients with known or suspected CAD is still undefined. Methods A search
was conducted for single- or multicenter prospective studies that
evaluated the prognostic value of stress MCE in patients with known or
suspected CAD. A database search was performed through June 2015. Effect
sizes of relative risk ratios (RRs) with their corresponding 95% CIs were
used to evaluate the association between the occurrence of total cardiac
events (cardiac death, nonfatal myocardial infarction, coronary
revascularization) and hard cardiac events (cardiac death and nonfatal
myocardial infarction) in subjects with normal and abnormal MP measured by
MCE. The Cochran Q statistic and the I² statistic were used to
assess heterogeneity. Results A comprehensive literature search of the
MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11
studies enrolling a total of 4,045 patients. The overall analysis of RRs
revealed that patients with abnormal MP were at higher risk for total
cardiac events compared with patients with normal MP (RR, 5.58; 95% CI,
3.64-8.57; P < .001), with low heterogeneity among trials (I² =
48.15%, Q = 7.71, P = .103). Similarly, patients with abnormal MP were at
higher risk for hard cardiac events compared with patients with normal MP
(RR, 4.99; 95% CI, 1.75-14.32; P = .003), with significant heterogeneity
among trials (I² = 81.48%, Q = 21.59, P < .001). Conclusions
The results of this meta-analysis suggest that MP assessment using stress
MCE is an effective prognostic tool for predicting the occurrence of
cardiac events in patients with known or suspected CAD.<br/>Copyright
&#xa9; 2016 American Society of Echocardiography

<14>
Accession Number
620066744
Author
Ziyaeifard M.; Azarfarin R.; Faritous Z.; Dehdashtian E.; Baghestani A.;
Ziyaeifard P.; Yousefi Z.
Institution
(Ziyaeifard, Faritous) Rajaie Cardiovascular, Medical, and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Azarfarin) Echocardiography Research Center, Rajaie Cardiovascular,
Medical, and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Dehdashtian, Baghestani, Ziyaeifard) Faculty of Medicine, Iran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Yousefi) Dezful University of Medical Sciences, Iran, Islamic Republic of
Title
Evaluation of lavender oil inhalation effects on blood pressure and heart
rate in patients undergoing coronary angiography.
Source
Iranian Heart Journal. 18 (4) (pp 29-33), 2017. Date of Publication: 2017.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Hemodynamic changes are among the side effects of diagnostic
cardiovascular procedures. Hypothesizing that the anxiolytic effects of
lavender oil inhalation could alleviate anxiety among patients undergoing
diagnostic cardiovascular modalities, we conducted the present study on
patients undergoing coronary angiography with the aim of assessing the
effects of lavender oil inhalation on hemodynamic changes. Method: This
clinical trial enrolled 80 patients hospitalized for coronary angiography.
The patients were randomly divided into 2 groups: the lavender group (n =
40), who inhaled lavender oil during angiography, and the control group (n
= 40), who received only 1 mg of lorazepam on the night before the
procedure (similar to the lavender group). Demographic data and
hemodynamic variables (blood pressure and heart rate) were recorded in all
the patients before and after lavender oil aromatherapy. Results:
Demographic parameters had no statistically significant differences
between the 2 groups (P > 0.05). After lavender oil aromatherapy,
hemodynamic parameters such as systolic and diastolic blood pressures and
heart rate were significantly reduced (within normal ranges) in the
intervention group by comparison with the control group (P = 0.05).
Conclusions: By reducing the stress response, lavender oil inhalation had
efficacy in controlling blood pressure and heart rate in our patients
undergoing coronary angiography.<br/>Copyright &#xa9; 2017, Iranian Heart
Association. All rights reserved.

<15>
Accession Number
620066711
Author
Onk D.; Onk O.A.; Degirmenci H.; Kucuksu Z.; Bedir Z.; Kuyrukluyildiz U.;
Ayazoglu T.A.
Institution
(Onk, Kuyrukluyildiz) Department of Anesthesiology, Erzincan University,
Erzincan, Turkey
(Onk) Department of Cardiovascular Surgery, Erzincan University, Erzincan,
Turkey
(Degirmenci) Department of Cardiology, Erzincan University, Erzincan,
Turkey
(Kucuksu) Department of Cardiology, Erzincan Mengucek Gazi Education and
Research Hospital, Erzincan, Turkey
(Bedir) Department of Anesthesiology, Erzincan Mengucek Gazi Education and
Research Hospital, Erzincan, Turkey
(Ayazoglu) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Title
Comparison of the effects of propofol plus fentanyl with midazolam plus
fentanyl on pr, qtc interval and qt dispersion in patients undergoing
coronary artery surgery.
Source
Journal of Clinical and Analytical Medicine. 8 (6) (pp 461-465), 2017.
Date of Publication: November 2017.
Publisher
Derman Medical Publishing (E-mail: secretary@jcam.com.tr )
Abstract
Aim: To compare the effects of propofol and midazolam on markers of
myocardial homogeneity when used during anesthesia induction in patients
undergoing coronary artery bypass grafting. Material and Method: A total
of 50 patients with normal left ventricular systolic function and normal
electrocardiogram were randomized into two groups as to receive propofol
Group 1 (n=25, mean age: 68.28+/-10.44) or midazolam (n=25, mean age:
67.88+/-8.90) during induction of anesthesia. Standard 12-lead
electrocardiograms were obtained just before induction of anesthesia to
ensure baseline compara-bility of two groups. Patients were monitored with
an ambulatory electrocardiogram before and after surgery, and individual
average QT duration, QTc duration, P dispersion and QT dispersion were
calculated. Results: Dis-tribution of baseline characteristics were
similar between two groups. Two groups were also similar regarding
preoperative QT duration, QTc duration, QT dispersion and p-wave
dispersion. Mean of individual average QT duration, QTc duration, and P
dispersion did not differ significantly between two groups whereas mean of
individual average QT dispersion was significantly higher in propofol
group than that in midazolam group in the postoperative period
(32.80+/-13.07 vs. 24.60+/-9.34, in Group 1 and 2, respectively, p=0.01).
Discussion: Midazolam seems to have minimal effect on the electrical
stabil-ity of the myocardium, whereas propofol is likely to limit recovery
of myocardial homogeneity after CABG to some extent when used during
induction of anesthesia.<br/>Copyright &#xa9; 2017, Derman Medical
Publishing. All rights reserved.

<16>
Accession Number
620034557
Author
Hendrickx S.; Van Vlimmeren K.; Baar I.; Verbrugghe W.; Dams K.; Van
Cromphaut S.; Roelant E.; Embrecht B.; Wittock A.; Mertens P.; Hendriks
J.M.; Lauwers P.; Van Schil P.E.; Van Craenenbroeck A.H.; Van Den Wyngaert
T.; Jorens P.G.; Van Regenmortel N.
Institution
(Hendrickx, Van Vlimmeren, Baar, Verbrugghe, Dams, Van Cromphaut, Jorens,
Van Regenmortel) Department of Intensive Care Medicine, Antwerp University
Hospital, Wilrijkstraat 10, Edegem B2640, Belgium
(Hendrickx, Van Vlimmeren, Embrecht, Wittock, Mertens) Department of
Anesthesiology, Antwerp University Hospital, Antwerp, Belgium
(Roelant) Clinical Trial Center (CTC), Antwerp University Hospital,
University of Antwerp, Antwerp, Belgium
(Hendriks, Lauwers, Van Schil) Department of Thoracic and Vascular
Surgery, Antwerp University Hospital, Antwerp, Belgium
(Van Craenenbroeck) Department of Nephrology, Antwerp University Hospital,
Antwerp, Belgium
(Van Den Wyngaert) Department of Nuclear Medicine, Antwerp University
Hospital, Antwerp, Belgium
(Van Den Wyngaert, Jorens) Faculty of Medicine and Health Sciences,
University of Antwerp, Antwerp, Belgium
(Van Regenmortel) Department of Intensive Care Medicine, Ziekenhuis
Netwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium
Title
Introducing TOPMAST, the first double-blind randomized clinical trial
specifically dedicated to perioperative maintenance fluid therapy in
adults.
Source
Anaesthesiology Intensive Therapy. 49 (5) (pp 366-372), 2017. Date of
Publication: 28 Dec 2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Although prescribed to every patient undergoing surgery,
maintenance fluid therapy is a poorly researched part of perioperative
fluid therapy. The tonicity of the chosen solutions, could be an important
cause of morbidity, with hyponatremia being a potential side effect of
hypotonic solutions, where isotonic solution could lead to fluid overload.
Methods: The TOPMAST-trial is an ongoing prospective single-center
double-blind randomized trial comparing an isotonic and a hypotonic
maintenance fluid strategy during and after surgery in patients undergoing
different types of major thoracic surgery. Patients receive NaCl 0.9% in
glucose 5% with an added 40 mmol L^-1 of potassium chloride or a
premixed solution containing 54 mmol L^-1 sodium, 55 mmol
L^-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg
of body weight per day. The primary hypothesis is that isotonic
maintenance solutions cause a more positive perioperative fluid balance
than hypotonic fluids. Different secondary safety endpoints will be
explored, especially the effect of the study treatments on the occurrence
electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of
clinical endpoints. Efficacy endpoints include the need for resuscitation
fluids and assessment of renal and hormonal adaptive mechanisms. An
anticipated 68 patients will be included between March 2017 and January
2018. Discussion: The study will provide the most comprehensive evaluation
of clinically important outcomes associated with the choice of
perioperative maintenance fluid therapy.

<17>
[Use Link to view the full text]
Accession Number
612361864
Author
Phan K.; Haswell J.M.; Xu J.; Assem Y.; Mick S.L.; Kapadia S.R.; Cheung
A.; Ling F.S.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan, Yan, Tchantchaleishvili) Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
(Phan, Xu) Faculty of Medicine, University of Sydney, Sydney, NSW,
Australia
(Phan, Assem) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Haswell, Ling) Division of Cardiovascular Diseases, University of
Rochester Medical Center, Rochester, NY, United States
(Mick) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Cheung) Division of Cardiothoracic Surgery, St. Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW, Australia
(Tchantchaleishvili) Division of Cardiac Surgery, University of Rochester
Medical Center, Rochester, NY, United States
(Tchantchaleishvili) Division of Cardiac Surgery, Mayo Clinic, 200 First
Street, Rochester, MN, United States
Title
Percutaneous Transcatheter Interventions for Aortic Insufficiency in
Continuous-Flow Left Ventricular Assist Device Patients: A Systematic
Review and Meta-Analysis.
Source
ASAIO Journal. 63 (2) (pp 117-122), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
De novo progressive aortic insufficiency (AI) is a side effect frequently
related to prolonged support with continuous-flow left ventricular assist
devices (CF-LVAD). Its progression can result in recurrent clinical heart
failure symptoms and significantly increased mortality. Recently,
percutaneous intervention methods, such as transcatheter aortic valve
replacement (TAVR) and percutaneous occluder devices, have emerged.
However, given the very scarce global experience with these approaches,
evidence in the literature is lacking. We sought to assess the outcomes of
CF-LVAD patients who had undergone percutaneous intervention for AI. A
systematic search of six databases from inception to April 2016 was
performed by two independent reviewers. Eligible studies were those that
included series or cases where patients had percutaneous transcatheter
interventions for AI in CF-LVAD patients. Data were extracted and
meta-analyzed from the identified studies. A total of 29 patients from 15
published studies and 3 unpublished records were included in the analysis.
Mean patient age was 56.6 +/- 13.7 years, and 72.4% were male. The
etiology of heart failure resulting in LVAD placement was ischemic
cardiomyopathy in 17.2%. The two intervention groups were TAVR (27.6%) and
occluder devices (72.4%). A transfemoral approach (69%), apical approach
(10%), brachial approach (7%), subclavian approach (3%), and
mini-sternotomy (3%) were used. The preintervention AI grade was severe
with a median grade of 4 (interquartile range, 4-4). Postoperatively, the
AI grade improved significantly to a median grade of 0 (0-2). At long-term
follow-up AI grade was still trivial with a median AI grade of 1 (0-1).
Subgrouping the treatments into the occluder device and TAVR, it was found
that both interventional techniques were similarly effective in reducing
the AI grade from severe to trivial. In terms of complications, from the
occluder group, two patients were complicated with device migration and
another two with transient hemolysis. In the TAVR cohort, two patients
experienced device migration and another had significant postimplant
perivalvular leakage. Our results indicate that percutaneous interventions
for AI in CF-LVAD patients with TAVR, and closure devices demonstrate
similar efficacy in significantly reducing severe AI. Current results are
encouraging, potentiating viability as a treatment option, particularly in
nonsurgical candidates. Future research with larger patient cohorts and
comparative controls is required to sufficiently evaluate the efficacy of
this technique and promote its widespread acceptance as a mainstay
treatment.<br/>Copyright &#xa9; 2016 by the ASAIO.

<18>
Accession Number
613784579
Author
Luo Z.; Li X.; Zhu M.; Tang J.; Li Z.; Zhou X.; Song G.; Liu Z.; Zhou H.;
Zhang W.
Institution
(Luo, Li, Tang, Li, Liu, Zhou, Zhang) Department of Clinical Pharmacology,
Xiangya Hospital, Central South University, Changsha, China
(Luo, Tang, Li, Liu, Zhou, Zhang) Hunan Key Laboratory of
Pharmacogenetics, Institute of Clinical Pharmacology, Central South
University, Changsha, China
(Zhu) School of Mathematics and Statistics, Central South University,
Changsha, China
(Zhou, Song) Department of Cardio-Thoracic Surgery, the Second Xiangya
Hospital Hospital of Central South University, Changsha, China
Title
Identification of novel variants associated with warfarin stable dosage by
use of a two-stage extreme phenotype strategy.
Source
Journal of Thrombosis and Haemostasis. 15 (1) (pp 28-37), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials Required warfarin doses for mechanical heart valves vary
greatly. A two-stage extreme phenotype design was used to identify novel
warfarin dose associated mutation. We identified a group of variants
significantly associated with extreme warfarin dose. Four novel identified
mutations account for 2.2% of warfarin dose discrepancies. Summary:
Background The variation among patients in warfarin response complicates
the management of warfarin therapy, and an improper therapeutic dose
usually results in serious adverse events. Objective To use a two-stage
extreme phenotype strategy in order to discover novel warfarin
dose-associated mutations in heart valve replacement patients.
Patients/method A total of 1617 stable-dose patients were enrolled and
divided randomly into two cohorts. Stage I patients were genotyped into
three groups on the basis of VKORC1-1639G>A and CYP2C9*3 polymorphisms;
only patients with the therapeutic dose at the upper or lower 5% of each
genotype group were selected as extreme-dose patients for resequencing of
the targeted regions. Evaluation of the accuracy of the sequence data and
the potential value of the stage I-identified significant mutations were
conducted in a validation cohort of 420 subjects. Results A group of
mutations were found to be significantly associated with the extreme
warfarin dose. The validation work finally identified four novel
mutations, i.e. DNMT3A rs2304429 (24.74%), CYP1A1 rs3826041 (47.35%),
STX1B rs72800847 (7.01%), and NQO1 rs10517 (36.11%), which independently
and significantly contributed to the overall variability in the warfarin
dose. After addition of these four mutations, the estimated regression
equation was able to account for 56.2% (R² <inf>Adj</inf> =
0.562) of the overall variability in the warfarin maintenance dose, with a
predictive accuracy of 62.4%. Conclusion Our study provides evidence
linking genetic variations in STX1B, DNMT3A and CYP1A1 to warfarin
maintenance dose. The newly identified mutations together account for 2.2%
of warfarin dose discrepancy.<br/>Copyright &#xa9; 2016 The Authors.
Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc.
on behalf of International Society on Thrombosis and Haemostasis.

<19>
Accession Number
611124677
Author
Bagur R.; Kwok C.S.; Nombela-Franco L.; Ludman P.F.; de Belder M.A.;
Sponga S.; Gunning M.; Nolan J.; Diamantouros P.; Teefy P.J.; Kiaii B.;
Chu M.W.A.; Mamas M.A.
Institution
(Bagur, Diamantouros, Teefy) Division of Cardiology, Department of
Medicine, London Health Sciences Centre, London, ON, Canada
(Bagur) Department of Epidemiology and Biostatistics, London, ON, Canada
(Chu) Department of Surgery, London, ON, Canada
(Gunning, Nolan, Chu, Mamas) Department of Western University, London, ON,
Canada
(Kwok, Mamas) Department of Royal Stoke University Hospital,
Stoke-on-Trent, Staffordshire, United Kingdom
(Kwok) Department of Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine and Primary Care, Keele University,
Stoke-on-Trent, Staffordshire, United Kingdom
(Nombela-Franco) Division of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(de Belder) James Cook University Hospital, Middlesbrough, North
Yorkshire, United Kingdom
(Sponga) Cardiothoracic Department, University Hospital of Udine, Italy
(Kiaii) Division of Cardiac Surgery, London Health Sciences Centre,
University Hospital, London, ON, Canada
Title
Transcatheter aortic valve implantation with or without preimplantation
balloon aortic valvuloplasty: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003191. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Preimplantation balloon aortic valvuloplasty (BAV) is
considered a routine procedure during transcatheter aortic valve
implantation (TAVI) to facilitate prosthesis implantation and expansion;
however, it has been speculated that fewer embolic events and/or less
hemodynamic instability may occur if TAVI is performed without
preimplantation BAV. The aim of this study was to systematically review
the clinical outcomes associated with TAVI undertaken without
preimplantation BAV. Methods and Results--We conducted a search of Medline
and Embase to identify studies that evaluated patients who underwent TAVI
with or without preimplantation BAV for predilation. Pooled analysis and
random-effects meta-analyses were used to estimate the rate and risk of
adverse outcomes. Sixteen studies involving 1395 patients (674 with and
721 without preimplantation BAV) fulfilled the inclusion criteria. Crude
device success was achieved in 94% (1311 of 1395), and 30-day all-cause
mortality occurred in 6% (72 of 1282) of patients. Meta-analyses
evaluating outcomes of strategies with and without preimplantation BAV
showed no statistically significant differences in terms of mortality
(relative risk [RR] 0.61, 95% CI 0.32-1.14, P=0.12), safety composite end
point (RR 0.85, 95% CI 0.62-1.18, P=0.34), moderate to severe paravalvular
leaks (RR 0.68, 95% CI 0.23-1.99, P=0.48), need for postdilation (RR 0.86,
95% CI 0.66-1.13, P=0.58), stroke and/or transient ischemic attack (RR
0.72, 95% CI 0.30-1.71, P=0.45), and permanent pacemaker implantation (RR
0.80, 95% CI 0.49-1.30, P=0.37). Conclusions--Our analysis suggests that
TAVI procedures with or without preimplantation BAV were associated with
similar outcomes for a number of clinically relevant end points. Further
studies including a large number of patients are needed to ascertain the
impact of TAVI without preimplantation BAV as a standard
practice.<br/>Copyright &#xa9; 2016 The Authors.

<20>
Accession Number
611124672
Author
Khan J.N.; Greenwood J.P.; Nazir S.A.; Lai F.Y.; Dalby M.; Curzen N.;
Hetherington S.; Kelly D.J.; Blackman D.; Peebles C.; Wong J.; Flather M.;
Swanton H.; Gershlick A.H.; McCann G.P.
Institution
(Khan, Nazir, Lai, Gershlick, McCann) Department of Cardiovascular
Sciences, University of Leicester, United Kingdom
(Khan, Nazir, Lai, Gershlick, McCann) NIHR Leicester Cardiovascular
Biomedical Research Unit, University Hospitals of Leicester NHS Trust,
Glenfield Hospital, Leicester, United Kingdom
(Greenwood, Blackman) Multidisciplinary Cardiovascular Research Centre,
The Division of Cardiovascular and Diabetes Research, University of Leeds,
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
(Dalby, Wong) Royal Brompton and Harefield Foundation Trust, Harefield
Hospital, Middlesex, United Kingdom
(Curzen, Peebles) University Hospital Southampton NHS Foundation Trust,
University of Southampton, United Kingdom
(Hetherington) Kettering General Hospital, Kettering, United Kingdom
(Kelly) Royal Derby Hospital, Derby, United Kingdom
(Flather) Norfolk and Norwich University Hospitals NHS Foundation Trust,
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
(Swanton) The Heart Hospital, University College London Hospitals, London,
United Kingdom
Title
Infarct size following treatment with second-versus third-generation
P2Y<inf>12</inf> antagonists in patients with multivessel coronary disease
at ST-segment elevation myocardial infarction in the CvLPRIT study.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003403. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Third-generation P2Y<inf>12</inf> antagonists (prasugrel and
ticagrelor) are recommended in guidelines on ST-segment elevation
myocardial infarction. Mechanisms translating their more potent
antiplatelet activity into improved clinical outcomes versus the
second-generation P2Y<inf>12</inf> antagonist clopidogrel are unclear. The
aim of this post hoc analysis of the Complete Versus Lesion-Only PRImary
PCI Trial-CMR (CvLPRIT-CMR) substudy was to assess whether prasugrel and
ticagrelor were associated with reduced infarct size compared with
clopidogrel in patients undergoing primary percutaneous coronary
intervention. Methods and Results-CvLPRIT-CMR was a multicenter,
prospective, randomized, open-label, blinded end point trial in 203
STsegment elevation myocardial infarction patients with multivessel
disease undergoing primary percutaneous coronary intervention with either
infarct-related artery-only or complete revascularization.
P2Y<inf>12</inf> inhibitors were administered according to local
guidelines. The primary end point of infarct size on cardiovascular
magnetic resonance was not significantly different between the randomized
groups. P2Y<inf>12</inf> antagonist administration was not randomized.
Patients receiving clopidogrel (n=70) compared with those treated with
either prasugrel or ticagrelor (n=133) were older (67.8+/-12 versus
61.5+/-10 years, P < 0.001), more frequently had hypertension (49% versus
29%, P=0.007), and tended to have longer symptom-to-revascularization time
(234 versus 177 minutes, P=0.05). Infarct size (median 16.1% [quartiles
1-3, 10.5-27.7%] versus 12.1% [quartiles 1-3, 4.8-20.7%] of left
ventricular mass, P=0.013) and microvascular obstruction incidence (65.7%
versus 48.9%, P=0.022) were significantly greater in patients receiving
clopidogrel. Infarct size remained significantly different after
adjustment for important covariates using both generalized linear models
(P=0.048) and propensity score matching (P=0.025). Conclusions-In this
analysis of CvLPRIT-CMR, third-generation P2Y<inf>12</inf> antagonists
were associated with smaller infarct size and lower microvascular
obstruction incidence versus the second-generation P2Y<inf>12</inf>
antagonist clopidogrel for ST-segment elevation myocardial
infarction.<br/>Copyright &#xa9; 2016 The Authors.

<21>
Accession Number
611124576
Author
Wallentin L.; Held C.; Armstrong P.W.; Cannon C.P.; Davies R.Y.; Granger
C.B.; Hagstrom E.; Harrington R.A.; Hochman J.S.; Koenig W.; Krug-Gourley
S.; Mohler E.R.; Siegbahn A.; Tarka E.; Steg P.G.; Stewart R.A.H.; Weiss
R.; Ostlund O.; White H.D.; Budaj A.; Ardissino D.; Avezum A.; Aylward
P.E.; Bryce A.; Chen H.; Chen M.-F.; Corbalan R.; Dalby A.J.; Danchin N.;
De Winter R.J.; Denchev S.; Diaz R.; Elisaf M.; Flather M.D.; Goudev A.R.;
Grinfeld L.; Husted S.; Kim H.-S.; Linhart A.; Lonn E.; Lopez-Sendon J.;
Manolis A.J.; Nicolau J.C.; Pais P.; Parkhomenko A.; Pedersen T.R.; Pella
D.; Ramos-Corrales M.A.; Ruda M.; Sereg M.; Siddique S.; Sinnaeve P.;
Sritara P.; Swart H.P.; Sy R.G.; Teramoto T.; Tse H.-F.; Douglas Weaver
W.; Viigimaa M.; Vinereanu D.; Zhu J.
Institution
(Wallentin, Held, Hagstrom) Department of Medical Sciences, Cardiology,
Uppsala University, Uppsala, Sweden
(Wallentin, Held, Hagstrom, Siegbahn, Ostlund) Uppsala Clinical Research
Center (UCR), Uppsala University, Uppsala, Sweden
(Siegbahn) Department of Medical Sciences, Clinical Chemistry, Uppsala
University, Uppsala, Sweden
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Cannon) Harvard Clinical Research Institute, Boston, MA, United States
(Davies, Krug-Gourley) Metabolic Pathways and Cardiovascular Therapeutic
Area, GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) Former Employee of Metabolic Pathways and Cardiovascular
Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, United States
(Granger) Medical Center, Duke University, Durham, NC, United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, 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
(Mohler) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), Paris, France
(Steg) DHU FIRE, Universite Paris-Diderot, Sorbonne Paris-Cite, Paris,
France
(Steg) Hopital Bichat, INSERUM U-1148, Paris, France
(Steg) NHLI, ICMS, Imperial College, Royal Brompton Hospital, London,
United Kingdom
(Stewart, White) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Stewart, White) University of Auckland, New Zealand
(Weiss) Maine Research Associates, Auburn, ME, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Wallentin) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Budaj) Grochowski Hospital, Warsaw, Poland
(Cannon) TIMI Study Group, Brigham and Women's Hospital, Boston, MA,
United States
(Harrington) Stanford University, Stanford, CA, United States
(Steg) INSERM-Unite, APHP, Hopital Bichat and Universite Paris-Diderot,
Paris, France
(Davies) GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) GlaxoSmithKline, King of Prussia, PA, United States
(Ardissino) Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
(Armstrong) University of Alberta, Edmonton, CA, United States
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, SA, Australia
(Bryce) Cardiogolf/Clinica El Golf, Lima, Peru
(Chen) Peking University People's Hospital, Beijing, China
(Chen) National Taiwan University Hospital, Taipei, Taiwan (Republic of
China)
(Corbalan) Pontificia Universidad Catolica de Chile, Santiago, Chile
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Danchin) AP-HP and Universite Paris Descartes, Paris, France
(De Winter) University of Amsterdam, Amsterdam, Netherlands
(Denchev) University Hospital Alexandrovska, Sofia, Bangladesh
(Diaz) ECLA Estudios Cardiologicos, Latinoamerica, Rosario, Argentina
(Elisaf) University of Ioannina, Ioannina, Greece
(Flather) University of East Anglia and Norfolk, Norwich University
Hospital, United Kingdom
(Goudev) Queen Giovanna University Hospital, Sofia, Bangladesh
(Granger) Duke University, Medical Center, Durham, NC, United States
(Grinfeld) University of Buenos Aires, School of Medicine, Buenos Aires,
Argentina
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Hochman) NYU Langone Medical Center, New York, NY, United States
(Husted) Hospital Unit West, Herning/Holstebro, Denmark
(Kim) Seoul National University Hospital, Seoul, South Korea
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Linhart) Charles University in Prague, Prague, Czech Republic
(Lonn) McMaster University, Hamilton, ON, Canada
(Lopez-Sendon) Hospital Universitario La Paz, Madrid, Spain
(Manolis) Asklepeion Hospital, Athens, Greece
(Mohler) University of Pennsylvania, Philadelphia, PA, United States
(Nicolau) University of Sao Paulo Medical School, Sao Paulo, Brazil
(Pais) St. John's Medical Collage, Bangalore, India
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Pedersen) University of Oslo, Oslo University Hospital, Oslo, Norway
(Pella) PJ Safarik University, Kosice, Slovakia
(Ramos-Corrales) San Jose Satelite Hospital, Naucalpan, Mexico
(Ruda) Russian Cardiologic Research and Production Complex of
Rosmedtechnology, Moscow, Russian Federation
(Sereg) St. George Hospital, Szekesfehervar, Hungary
(Siddique) Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
(Sinnaeve) University Hospitals Leuven, Leuven, Belgium
(Sritara) Mahidol University, Bangkok, Thailand
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Swart) Antonius Hospital Sneek, Netherlands
(Sy) University of the Philippines, Manila, Philippines
(Teramoto) Teikyo Academic Research Center, Itabashi-ku, Tokyo, Japan
(Tse) University of Hong Kong, Hong Kong
(Douglas Weaver) Henry Ford Heart and Vascular Institute, Wayne State
University, Detroit, MI, United States
(Weiss) Maine Research Associates, Auburn, ME, United States
(Viigimaa) Tallinn University of Technology, Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy, University and Emergency
Hospital, Bucharest, Romania
(Zhu) Fudan University, Shanghai, China
(Steg) Royal Brompton Hospital, London, United Kingdom
Title
Lipoprotein-associated phospholipase A<inf>2</inf> activity is a marker of
risk but not a useful target for treatment in patients with stable
coronary heart disease.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003407. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--We evaluated lipoprotein-associated phospholipase
A<inf>2</inf> (Lp-PLA<inf>2</inf>) activity in patients with stable
coronary heart disease before and during treatment with darapladib, a
selective Lp-PLA<inf>2</inf> inhibitor, in relation to outcomes and the
effects of darapladib in the STABILITY trial. Methods and Results--Plasma
Lp-PLA<inf>2</inf> activity was determined at baseline (n=14 500); at 1
month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end
of treatment. Adjusted Cox regression models evaluated associations
between Lp-PLA<inf>2</inf> activity levels and outcomes. At baseline, the
median Lp-PLA<inf>2</inf> level was 172.4 lmol/min per liter
(interquartile range 143.1-204.2 lmol/min per liter). Comparing the
highest and lowest Lp-PLA<inf>2</inf> quartile groups, the hazard ratios
were 1.50 (95% CI 1.23-1.82) for the primary composite end point
(cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI
1.29-2.93) for hospitalization for heart failure, 1.42 (1.07-1.89) for
cardiovascular death, and 1.37 (1.03-1.81) for myocardial infarction after
adjustment for baseline characteristics, standard laboratory variables,
and other prognostic biomarkers. Treatment with darapladib led to a =65%
persistent reduction in median Lp-PLA<inf>2</inf> activity. There were no
associations between on-treatment Lp-PLA<inf>2</inf> activity or changes
of Lp-PLA<inf>2</inf> activity and outcomes, and there were no significant
interactions between baseline and on-treatment Lp- PLA<inf>2</inf>
activity or changes in Lp-PLA<inf>2</inf> activity levels and the effects
of darapladib on outcomes. Conclusions--Although high Lp-PLA<inf>2</inf>
activity was associated with increased risk of cardiovascular events,
pharmacological lowering of Lp-PLA<inf>2</inf> activity by =65% did not
significantly reduce cardiovascular events in patients with stable
coronary heart disease, regardless of the baseline level or the magnitude
of change of Lp-PLA<inf>2</inf> activity.<br/>Copyright &#xa9; 2016 The
Authors.

<22>
Accession Number
51637224
Author
Krzych L.J.; Lees B.; Nugara F.; Banya W.; Bochenek A.; Cook J.; Taggart
D.; Flather M.D.
Institution
(Krzych, Lees, Nugara, Banya, Flather) Clinical Trials and Evaluation
Unit, Royal Brompton and Harefield NHS, Foundation Trust, London, United
Kingdom
(Bochenek) Department of Cardiac Surgery, Medical University of Silesia,
47 Ziolowa Street, Katowice 40635, Poland
(Cook, Taggart) JohnRadcliffe Hospital, University of Oxford, Oxford,
United Kingdom
Title
Assessment of Data Quality in an International Multi-centre Randomised
Trial of Coronary Artery Surgery.
Source
Trials. 12 (1) (no pagination), 2011. Article Number: 212. Date of
Publication: 26 Sep 2011.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
evaluate the data from a large number of centres from a variety of
countries. We attempted to assess data quality, including recruitment
rates, timeliness and completeness of the data obtained from the centres
in different socioeconomic strata. Methods: The analysis was based on the
2-page CRF completed at the 6 week follow-up. CRF pages were categorised
into "clean" (no edit query) and "dirty" (any incomplete, inconsistent or
illegible data). The timelines were assessed on the basis of the time
interval from the visit and receipt of complete CRF. Data quality was
defined as the number of data queries (in percent) and time delay (in
days) between visit and receipt of correct data. Analyses were stratified
according to the World Bank definitions into: "Developing" countries
(Poland, Brazil and India) and "Developed" (Italy, UK, Austria and
Australia). Results: There were 18 centres in the "Developed" and 10
centres in the "Developing" countries. The rate of enrolment did not
differ significantly by economic level ("Developing":4.1 persons/month,
"Developed":3.7 persons/ month). The time interval for the receipt of data
was longer for data queries was 23% in "Developed" countries compared to
19% in "Developing" ones (p = ns). Conclusions: In this study we showed
that data quality was comparable between centres from "Developed"
and"Developing" countries. Data was received in a less timely fashion from
Developing countries and appropriate systems should be instigated to
minimize any delays. Close attention should be paid to the training of
centres and to the central management of data quality<br/>Copyright &#xa9;
2011 Krzych et al; licensee BioMed Central Ltd.

<23>
Accession Number
620059693
Author
Czarny M.J.; Miller J.M.; Naiman D.Q.; Hwang C.-W.; Hasan R.K.; Lemmon
C.C.; Aversano T.
Institution
(Czarny, Miller, Hwang, Hasan, Lemmon, Aversano) School of Medicine, Johns
Hopkins University, Baltimore, MD, United States
(Naiman) Department of Applied Mathematics and Statistics, Johns Hopkins
University, Baltimore, MD, United States
Title
Nonprimary PCI at hospitals without cardiac surgery on-site: Consistent
outcomes for all?.
Source
American Heart Journal. 197 (pp 18-26), 2018. Date of Publication: March
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The CPORT-E trial showed the noninferiority of nonprimary
percutaneous coronary intervention (PCI) at hospitals without cardiac
surgery on-site (SoS) compared with hospitals with SoS for 6-week
mortality and 9-month major adverse cardiac events (MACE). However, target
vessel revascularization (TVR) was increased at non-SoS hospitals.
Therefore, we aimed to determine the consistency of the CPORT-E trial
findings across the spectrum of enrolled patients. Methods Post hoc
subgroup analyses of 6-week mortality and 9-month MACE, defined as the
composite of death, Q-wave myocardial infarction, or TVR, were performed.
Patients with and without 9-month TVR and rates of related outcomes were
compared. Results There was no interaction between SoS status and
clinically relevant subgroups for 6-week mortality or 9-month MACE (P for
any interaction =.421 and.062, respectively). In addition to increased
9-month rates of TVR and diagnostic catheterization at hospitals without
SoS, non-TVR was also increased (2.7% vs 1.9%, P =.002); there was no
difference in myocardial infarction-driven TVR, non-TVR, or diagnostic
catheterization. Predictors of 9-month TVR included intra-aortic balloon
pump use, any index PCI complication, and 3-vessel PCI, whereas predictors
of freedom from TVR included SoS, discharge on a P2Y<inf>12</inf>
inhibitor, and stent implantation. Conclusions The noninferiority of
nonprimary PCI at non-SoS hospitals was consistent across clinically
relevant subgroups. Elective PCI at an SoS hospital conferred a TVR
benefit which may be related to a lower rate of referral for diagnostic
catheterization for reasons other than myocardial
infarction.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<24>
Accession Number
620070026
Author
Hwang D.; Park K.W.; Lee J.M.; Rhee T.-M.; Hong M.-K.; Jang Y.; Valgimigli
M.; Colombo A.; Gilard M.; Palmerini T.; Stone G.W.; Kim H.-S.
Institution
(Hwang, Park, Rhee, Kim) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
(Lee) Department of Internal Medicine and Cardiovascular Center, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Hong, Jang) Severance Cardiovascular Hospital, Yonsei University Health
System, Seoul, South Korea
(Valgimigli) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Gilard) Departement de cardiologie, CHU de la Cavale Blanche, Boulevard
Tanguy Prigent, Brest Cedex, France
(Palmerini) Dipartimento Cardiovascolare, Policlinico S. Orsola,
University of Bologna, Bologna, Italy
(Stone) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, NY, United States
Title
Efficacy and safety of dual antiplatelet therapy after coronary stenting
in patients with chronic kidney disease.
Source
American Heart Journal. 197 (pp 103-112), 2018. Date of Publication: March
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background We compared efficacy and safety of short- (3 or 6 months)
versus long-term (>=12 months) dual antiplatelet therapy (DAPT) after
drug-eluting stent (DES) implantation, according to the presence of
chronic kidney disease (CKD). Methods Patient-level pooled analysis was
performed with 7242 patients (87.2% with 2nd generation DES) from 5
randomized controlled trials. Results In both CKD (1273 patients) and
non-CKD (5969 patients) population, the rates of patient-oriented
composite outcomes at 1-year (POCO, all-cause death, any myocardial
infarction [MI], stroke and TIMI major bleeding) were not different
between the short- and long-term DAPT (hazard ratio [HR] 1.19, 95%
confidence interval [CI] 0.76-1.86, P =.449 in CKD population; HR 1.14,
95% CI 0.83-1.56, P =.434 in non-CKD population). The rates of coronary
thrombotic events (any MI and definite/probable stent thrombosis) also did
not differ between short- and long-term DAPT in either CKD or non-CKD
population. As for bleeding events, long-term DAPT increased the TIMI
major bleeding (HR 2.91, 95% CI 1.31-6.48, P =.009) in non-CKD population.
The similar trend was observed with long-term DAPT in CKD population. But
it did not reach statistical significance (HR 3.15, 95% CI 0.64-15.63, P
=.160). Conclusions The rates of POCO and coronary thrombotic events were
significantly higher in patients with CKD compared with those without CKD,
which were not affected by short- or long-term DAPT. Higher bleeding
incidence by long-term DAPT was only observed in non-CKD patients but not
in CKD patients. Further large scale studies are warranted to confirm our
findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<25>
Accession Number
620128456
Author
Rampersad P.P.; Udell J.A.; Zawi R.; Ouzounian M.; Overgaard C.B.; Sharma
V.; Rao V.; Farkouh M.E.; Dzavik V.
Institution
(Rampersad, Udell, Overgaard, Sharma, Farkouh, Dzavik) Division of
Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University
Health Network, 6-246 en Toronto General Hospital, 200 Elizabeth Street,
Toronto, ON M5G 2C4, Canada
(Udell, Zawi) Women's College Research Institution, Cardiovascular
Division, Department of Medicine, Women's College Hospital, Peter Munk
Cardiac Centre, Toronto General Hospital, University of Toronto, 76
Grenville Street, Toronto, ON M5S 1B1, Canada
(Ouzounian, Rao) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University Health Network, Toronto, ON, Canada
(Farkouh) Heart and Stroke Richard Lewar Centre of Excellence in
Cardiovascular Research, Toronto, ON, Canada
(Udell, Zawi, Ouzounian, Overgaard, Sharma, Rao, Farkouh, Dzavik)
University of Toronto, Toronto, ON, Canada
Title
Preoperative Intraaortic Balloon Pump Improves Early Outcomes Following
High-Risk Coronary Artery Bypass Graft Surgery: A Meta-Analysis of
Randomized Trials and Prospective Study Design.
Source
Journal of Invasive Cardiology. 30 (1) (pp 2-9), 2018. Date of
Publication: January 2018.
Publisher
HMP Communications
Abstract
BACKGROUND: Despite widespread use, evidence to support preemptive
intraaortic balloon pump (IABP) insertion for patients undergoing
high-risk coronary artery bypass graft (CABG) surgery remains sparse, and
in need of a well-defined clinical trial. To inform the design of a
prospective trial, we sought to review outcomes in randomized controlled
trials (RCTs) of anticipatory IABP use vs control in patients undergoing
high-risk CABG through meta-analysis. The primary endpoint was all-cause
mortality within 30 days of surgery. The secondary endpoint was major
adverse cardiac and cerebrovascular event (MACCE), a composite of death,
myocardial infarction, stroke, or repeat revascularization. METHODS: Using
Ovid MEDLINE, we systematically reviewed all RCTs comparing preoperative
IABP with control in patients undergoing high-risk CABG, defined as: left
ventricular ejection fraction (LVEF) <=40%, left main stenosis >=70%,
unstable angina, recent myocardial infarction, or prior myocardial
revascularization undergoing elective or emergent CABG on or off pump.
RESULTS: Of 950 articles assessed for eligibility, 10 RCTs of 1261
subjects (mean age, 65.0 years; 21.8% women; mean LVEF, 35%) were
included. Mortality was significantly lower in patients receiving IABP
compared with control (relative risk [RR], 0.48; 95% confidence interval
[CI], 0.30-0.76; P<.01). The risk of MACCE was also lower with IABP (RR,
0.67; 95% CI, 0.54-0.84; P<.001). No significant differences in major
bleeding events (RR, 1.27; 95% CI, 0.44-3.72) or vascular complications
(RR, 1.13; 95% CI, 0.42-3.06) were detected. CONCLUSIONS: A strategy of
routine prophylactic IABP use may reduce short-term mortality and MACCE in
high-risk CABG patients. A definitive, adequately powered, prospective,
randomized trial is warranted to confirm these results.

<26>
Accession Number
620124575
Author
Xu J.-J.; Zhang Y.; Jiang L.; Tian J.; Song L.; Gao Z.; Feng X.-X.; Zhao
X.-Y.; Zhao Y.-Y.; Wang D.; Sun K.; Xu L.-J.; Liu R.; Gao R.-L.; Xu B.;
Yuan J.-Q.
Institution
(Xu, Zhang, Jiang, Tian, Song, Gao, Zhao, Wang, Xu, Liu, Gao, Xu, Yuan)
Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing 100037, China
(Feng) Department of Endocrinology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing 100037, China
(Zhao) Medical Research and Biometrics Center, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Science and
Peking Union Medical College, Beijing 100037, China
(Song, Sun) Department of State Key Laboratory of Cardiovascular Disease,
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Science and
Peking Union Medical College, Beijing 100037, China
(Song) Department of Hypertension, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing 100037, China
Title
Comparison of Long-term Outcomes in Patients with Premature Triple-vessel
Coronary Disease Undergoing Three Different Treatment Strategies: A
Prospective Cohort Study.
Source
Chinese Medical Journal. 131 (1) (pp 1-9), 2018. Date of Publication: 05
Jan 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Patients with premature triple-vessel disease (PTVD) have a
higher risk of recurrent coronary events and repeat revascularization;
however, the long-term outcome of coronary artery bypass grafting (CABG),
percutaneous coronary intervention (PCI), and medical therapy (MT) alone
for PTVD patients is controversial. The aim of this study is to evaluate
the long-term outcome of PTVD patients among these three treatment
strategies, to find out the most appropriate treatment methods for these
patients. Methods: One thousand seven hundred and ninety-two patients with
PTVD (age: men <=50 years and women <=60 years) were enrolled between 2004
and 2011. The primary end point was all-cause death. The secondary end
points were cardiac death, myocardial infarction, stroke, or repeat
revascularization. Results: PCI, CABG, and MT alone were performed in 933
(52.1%), 459 (25.6%), and 400 (22.3%) patients. Both PCI and CABG were
associated with lower all-cause death (4.6% vs. 4.1% vs. 15.5%,
respectively, P < 0.01) and cardiac death (2.8% vs. 2.0% vs. 9.8%,
respectively, P < 0.01) versus MT alone. The rate of repeat
revascularization in the CABG group was significantly lower than those in
the PCI and MT groups. After adjusting for baseline factors, PCI and CABG
were still associated with similar lower risk of all-cause death and
cardiac death versus MT alone (all-cause death: hazard ratio [HR]: 0.35,
95% confidence interval [CI]: 0.23-0.53, P < 0.01 and HR: 0.35, 95% CI:
0.18-0.70, P = 0.003, respectively, and cardiac death: HR: 0.32, 95% CI:
0.19-0.54, P < 0.01 and HR: 0.36, 95% CI: 0.14-0.93, P = 0.03,
respectively). Conclusions: PCI and CABG provided equal long-term benefits
for all-cause death and cardiac death for PTVD patients. Patients
undergoing MT alone had the worst long-term clinical outcomes. Trial
Registration: ClinicalTrials.gov; Identifier: NCT02634086.
https://www.clinicaltrials.gov/ct2/show/record/NCT02634086?term=NCT0263408
6&rank=1.

<27>
Accession Number
620134307
Author
Ngo A.; Hassager C.; Thyregod H.G.Ho.; Sondergaard L.; Olsen P.S.;
Steinbruchel D.; Hansen P.B.; Kjaergaard J.; Winther-Jensen M.; Ihlemann
N.
Institution
(Ngo) Department of Cardiology, Zealand University Hospital, Roskilde
4000, Denmark
(Hassager, Sondergaard, Kjaergaard, Winther-Jensen, Ihlemann) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen
2100, Denmark
(Thyregod, Olsen) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen 2100, Denmark
(Steinbruchel) Emergency Department, Nykobing Falster Hospital, Nykobing
Falster 4800, Denmark
(Hansen) Department of Cardiac Anesthesia, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
Title
Differences in left ventricular remodelling in patients with aortic
stenosis treated with transcatheter aortic valve replacement with
corevalve prostheses compared to surgery with porcine or bovine biological
prostheses.
Source
European Heart Journal Cardiovascular Imaging. 19 (1) (pp 39-46), 2018.
Date of Publication: 01 Jan 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Patients with severe aortic stenosis (AS) can be considered for
treatment with either transcatheter (TAVR) or surgical aortic valve
replacement (SAVR). The purpose of this study was to compare left
ventricular (LV) remodeling in patients with AS after treatment with TAVR
or SAVR. Methods and results This is an echocardiographic substudy of the
NOTION trial, a randomized all-comers trial comparing TAVR with SAVR in
patients above 70 years of age. Transthoracic echocardiograms were
performed at baseline, 3 and 12 months after TAVR and SAVR. About 232
patients were included in the study, 120 were randomized to TAVR and 112
to SAVR. From baseline to 12 months post-procedure, aortic valve area
(AVA) increased in both groups, but with a larger increase in the TAVR
group (0.65 +/- 0.04 cm 2 vs. 1.02 +/- 0.05 cm 2 for SAVR and TAVR group,
P < 0.0001). At 12 months, LV mass regression was more pronounced in the
SAVR group as compared with TAVR (17.5% vs. 7.2%, P < 0.001). In the TAVR
group at 12 months, end diastolic volume (EDV) increased by 10.2 +/- 2.5
ml and, in the SAVR group, EDV decreased by 15.4 +/- 2.6 ml with a
statistically significant difference between the two groups (P < 0.0001).
Paravalvular leakage (PVL) and pacemaker implantations were more common in
patients treated with TAVR, which was associated with an increase in EDV
(P < 0.01). Conclusion Patients undergoing SAVR had a larger LV mass
regression at 1 year compared with patients undergoing TAVR, which may be
due to increasing amounts of PVL and pacemakers in the TAVR group.
Published on behalf of the European Society of Cardiology. All rights
reserved.<br/>Copyright &#xa9; The Author 2017. For permissions, please
email: journals.permissions@oup.com.

<28>
Accession Number
620079096
Author
Szerlip M.; Gualano S.; Holper E.; Squiers J.J.; White J.M.; Doshi D.;
Williams M.R.; Hahn R.T.; Webb J.G.; Svensson L.G.; Kirtane A.J.; Cohen
D.J.; Douglas P.S.; Alu M.C.; Crowley A.; Tuzcu E.M.; Makkar R.R.;
Herrmann H.C.; Babaliaros V.; Thourani V.H.; Leon M.B.; Kodali S.K.; Mack
M.J.
Institution
(Szerlip, Gualano, Holper, Squiers, Mack) Department of Cardiology, The
Heart Hospital Baylor Plano, Plano, Texas, United States
(White, Svensson, Tuzcu) Cleveland Clinic, Cleveland, Ohio, United States
(Doshi, Hahn, Kirtane, Alu, Leon, Kodali) Columbia University Medical
Center, New York, New York, United States
(Williams) NYU Langone Medical Center, New York, New York, United States
(Webb) St. Paul's Hospital, Vancouver, Canada
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, Missouri,
United States
(Douglas) Duke Clinical Research Institute/Duke University Medical Center,
Durham, North Carolina, United States
(Crowley) Cardiovascular Research Foundation, New York, New York, United
States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California, United
States
(Herrmann) University of Pennsylvania, Philadelphia, Pennsylvania, United
States
(Babaliaros, Thourani) Emory University, Atlanta, Georgia
Title
Sex-Specific Outcomes of Transcatheter Aortic Valve Replacement With the
SAPIEN 3 Valve: Insights From the PARTNER II S3 High-Risk and
Intermediate-Risk Cohorts.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 13-20), 2018. Date of
Publication: 08 Jan 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to identify sex-specific outcomes
of intermediate risk patients undergoing transcatheter aortic valve
replacement with the SAPIEN 3 valve. Background A survival difference has
been observed in women as compared with men in inoperable and high-risk
patients receiving early-generation balloon-expandable valves for
transcatheter aortic valve replacement (TAVR). Whether a sex-specific
outcome difference persists with newer-generation valves and in lower-risk
patients is unknown. Methods The PARTNER (Placement of Aortic
Transcatheter Valves) II S3 trial included high-risk (HR) (Society of
Thoracic Surgeons risk score >8% or heart team determination) and
intermediate-risk (IR) (Society of Thoracic Surgeons risk score 4% to 8%
or heart team determination) patients with severe symptomatic aortic
stenosis who were treated with TAVR with the SAPIEN 3 valve. Patient
characteristics and clinical outcomes at 30 days and 1 year were compared
by sex. Results Between October 2013 and December 2014, 1,661 patients
were enrolled: 583 were HR (338 men, 245 women) and 1,078 were IR (666
men, 412 women). In both cohorts, women were more likely than men to be
frail (22% vs. 13%; p < 0.001), but less likely to have comorbid
conditions of renal insufficiency, coronary artery disease, atrial
fibrillation, or chronic obstructive pulmonary disease. Women were more
likely to receive <=23-mm valves (74.1% vs. 11.1%; p < 0.001) and were
less likely to receive 29-mm valves (1.4% vs. 35.1%; p < 0.001). In the
combined cohorts, there was no difference in mortality for women compared
with men at 30 days (2.0% vs. 1.2%; p = 0.20) or 1 year (9.3% vs. 10.2%; p
= 0.59). There were no differences in disabling stroke or any stroke at 30
days or 1 year; however, women had an increased rate of minor stroke at 30
days (2.1% vs. 0.7%; p = 0.01). Female sex was associated with increased
major vascular complications (7.9% vs. 4.4%; p = 0.003), but not with
moderate or severe paravalvular regurgitation. Notably, similar outcomes
regarding sex-specific outcomes were obtained within stratified analyses
of the HR and IR cohorts. Conclusions The study found no apparent
sex-specific differences in survival or stroke in this trial of TAVR. This
may reflect the changing demographic of patients enrolled, use of
newer-generation valves with more sizes available, and more accurate valve
sizing techniques.<br/>Copyright &#xa9; 2018 American College of
Cardiology Foundation

<29>
Accession Number
620078857
Author
Deharo P.; Quilici J.; Camoin-Jau L.; Johnson T.W.; Bassez C.; Bonnet G.;
Fernandez M.; Ibrahim M.; Suchon P.; Verdier V.; Fourcade L.; Morange
P.E.; Bonnet J.L.; Alessi M.C.; Cuisset T.
Institution
(Deharo, Bassez, Bonnet, Bonnet, Cuisset) Departement de Cardiologie, CHU
Timone, Marseille, France
(Deharo, Morange, Bonnet, Alessi, Cuisset) "Nutrition, Obesity and Risk of
Thrombosis," UMR1062, INSERM, Marseille, France
(Deharo, Bassez, Bonnet, Ibrahim, Suchon, Morange, Bonnet, Alessi,
Cuisset) Faculte de Medecine, Aix-Marseille Universite, Marseille, France
(Quilici, Fernandez) Departement de Cardiologie, Centre Hospitalier de
GAP, France
(Camoin-Jau, Morange, Alessi) Laboratoire d'Hematologie, CHU Timone,
Marseille, France
(Johnson) Interventional Cardiology Department, Bristol Heart Institute,
Bristol, United Kingdom
(Ibrahim, Fourcade) Cardiologie, Hopital Laveran, Marseille, France
(Suchon, Verdier) Research Unit, asistance publique des hopitaux de
Marseille, Unite Medicale des Maladies Auto-Inflammatoires, Marseille,
France
(Morange, Alessi) Department of Hematology, CHU Timone, asistance publique
des hopitaux de Marseille, Marseille, France
Title
Benefit of Switching Dual Antiplatelet Therapy After Acute Coronary
Syndrome According to On-Treatment Platelet Reactivity: The TOPIC-VASP
Pre-Specified Analysis of the TOPIC Randomized Study.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2560-2570), 2017. Date of
Publication: 26 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the impact of initial platelet
reactivity on the benefit of switched strategy. Background TOPIC (Timing
Of Platelet Inhibition after acute Coronary Syndrome) study suggested that
switched dual antiplatelet therapy (DAPT) could improve net clinical
benefit after acute coronary syndrome by preventing bleeding. Methods
Acute coronary syndrome patients, 1 month after coronary stenting and
event free, were randomly assigned to aspirin and clopidogrel (switched
DAPT) or continuation of drug regimen (unchanged DAPT). All patients
underwent platelet function testing at this time and were classified as
low on-treatment platelet reactivity (LTPR) (platelet reactivity index
vasodilator-stimulated phosphoprotein <=20%) or non-LTPR (platelet
reactivity index vasodilator-stimulated phosphoprotein >20%). The primary
endpoint aimed to evaluate the impact of platelet reactivity on clinical
outcomes and benefit of switched DAPT strategy. Results A total of 645
patients were included, 305 (47%) of whom were classified as LTPR. LTPR
patients were less often diabetic (p = 0.01), had lower body mass index (p
< 0.01), and were more often on ticagrelor (p < 0.01). Patients defined as
LTPR and randomized to unchanged DAPT were at the highest risk of primary
endpoint occurrence (31%; p < 0.01). Conversely, in the switched arm, LTPR
patients had no significant difference in primary outcome incidence
compared with non-LTPR patients (hazard ratio [HR]: 0.78; 95% confidence
interval [CI]: 0.40 to 1.49; p = 0.45). The switched strategy was
associated with important reduction in primary endpoint incidence in LTPR
patients (HR: 0.29; 95% CI: 0.17 to 0.51; p < 0.01) and only numerically
lower incidence in non-LTPR patients (HR: 0.79; 95% CI: 0.46 to 1.35; p =
0.39). Conclusions Switched DAPT was superior regardless of initial
platelet reactivity but the benefit was greater in LTPR patients. Indeed,
the switched strategy was highly effective in this group, which had
impaired prognosis with unchanged DAPT but similar prognosis after
switching.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<30>
Accession Number
620134617
Author
Athanasopoulos L.V.; Casula R.P.; Punjabi P.P.; Abdullahi Y.S.; Athanasiou
T.
Institution
(Athanasopoulos) Department of Cardiovascular Surgery, Texas Heart
Institute, Houston, TX, United States
(Casula, Punjabi, Abdullahi, Athanasiou) Department of Cardiothoracic
Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
Title
A technical review of subvalvular techniques for repair of ischaemic
mitral regurgitation and their associated echocardiographic and survival
outcomes.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 975-982),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Subvalvular techniques are gaining ground as adjunct procedures for
addressing ischaemic mitral regurgitation. The aim of this study was to
describe the different techniques and assess their results. A systematic
review of the literature was performed. The end points of interest were
recurrence of mitral regurgitation, cardiac events and early and late
echocardiographic measurements. After initial screening, 450 articles were
identified, of which 24 provided the best available evidence on the topic.
The different subvalvular techniques had similar mortality rates when
compared with the standard restrictive annuloplasty. Recurrence of mitral
regurgitation was of lower degree and the remodelling process was better
for these techniques. Reoperation rates were also quite low. The
subvalvular techniques showed superiority, addressing more successfully
the leaflet tethering. However, larger randomized studies are needed to
confirm these early positive results.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<31>
Accession Number
620134607
Author
Benstoem C.; Goetzenich A.; Stoppe C.
Institution
(Benstoem, Goetzenich, Stoppe) AachenGermany
Title
The role of propofol for remote ischaemic preconditioning in the setting
of cardiac surgery-a Cochrane systematic review⁺.
Source
British Journal of Anaesthesia. 119 (6) (pp 1234-1235), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)

<32>
Accession Number
620134596
Author
Geng J.; Qian J.; Si W.; Cheng H.; Ji F.; Shen Z.
Institution
(Geng, Qian, Si, Cheng, Ji) Department of Anesthesiology, First Affiliated
Hospital of Soochow University, 899 Pinghai Rd, Gusu District, Suzhou
215000, China
(Shen) Jiangsu Province's Key Medical Center for Cardiovascular Surgery,
Suzhou, Jiangsu, China
Title
The clinical benefits of perioperative antioxidant vitamin therapy in
patients undergoing cardiac surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 966-974),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
The clinical benefits of perioperative antioxidant vitamin therapy in
cardiac patients remain controversial. Here, we conducted a meta-analysis
to determine the strength of the evidence supporting the perioperative use
of antioxidant vitamins in patients undergoing cardiac surgery. We
searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane
Library) for randomized controlled trials that reported the effects of
antioxidant vitamin therapy on patients undergoing cardiac surgery until 6
June 2016. Risk ratio (RR) or mean difference (MD) and its 95% confidence
interval (95% CI) served as the summarized results. Heterogeneity among
included studies was evaluated using the I 2 statistic, which help
determine which effect model to apply. We constructed a funnel plot to
assess the existence of publication bias. Sensitivity analyses were also
conducted to evaluate the robustness of the outcomes. Twelve trials with
1584 cardiac patients were included. Compared with placebo or no
antioxidant vitamin therapy, administration of antioxidant vitamin therapy
resulted in a reduction in postoperative atrial fibrillation (POAF) (RR
0.55, 95% CI 0.42, 0.73, P < 0.0001), duration of hospital stay (MD -0.68,
95% CI -0.98, -0.39, P < 0.00001), intensive care unit length of stay (MD
-0.21, 95% CI -0.30, -0.12, P < 0.00001) and intubation time (MD -2.41,
95% CI -3.83, -0.98, P = 0.001). Our results also showed a trend towards a
decrease in postoperative complications (RR 0.72, 95% CI 0.48, 1.08, P =
0.11) and duration of POAF (MD -1.950, 95% CI -3.28, 0.29, P = 0.10). This
meta-analysis demonstrated that perioperative antioxidant vitamin therapy
in patients undergoing cardiac surgery can reduce the incidence of POAF,
duration of hospital stay, intensive care unit length of stay and
intubation time.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<33>
Accession Number
620134566
Author
An J.; Shi F.; Liu S.; Ma J.; Ma Q.
Institution
(An, Shi, Liu, Ma, Ma) Department of Cardiac Surgery, Second Hospital of
Hebei Medical University, Shi Jiazhuang 050000, China
Title
Preoperative statins as modifiers of cardiac and inflammatory outcomes
following coronary artery bypass graft surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 958-965),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Early postoperative cardiac complications of coronary artery bypass graft
surgery, such as atrial fibrillation (AF) or myocardial infarction (MI),
may be beneficially modulated by preoperative statins, involving their
anti-inflammatory effects. There is uncertainty on the clinical merit of
statin pretreatment. Addressing this, we conducted a meta-analysis of
early cardiac complications and inflammatory markers following statin
pretreatment in coronary artery bypass graft surgery. A search of Medline
and Cochrane databases was undertaken to identify suitable studies. A
meta-analysis was carried out for early cardiac (AF, MI, myocardial injury
markers) and inflammatory (cytokines, C-reactive protein) outcomes. We
identified 17 suitable studies that featured data from the total of 2796
patients. Twelve studies (1260 treated and 1263 untreated patients)
reported AF incidence. Statin pretreatment was associated with a
significant decrease of AF incidence: odds ratio 0.44 (95% confidence
interval: 0.27-0.70; P = 0.003). Seven studies (381 treated and 277
untreated patients) reported useful data on MI. Unlike in AF, no
significant modulation of postoperative MI in association with statin
pretreatment could be observed: odds ratio 0.62 (95% confidence interval:
0.21-1.81; P = 0.62). Five studies (248 treated and 245 untreated
patients) provided data on postoperative rise of C-reactive protein. This
rise was significantly downregulated in statin-pretreated patients:
standardized mean difference -0.44 (95% confidence interval: -0.78 to
-0.11; P = 0.02). Thus, postoperative AF incidence is the biggest
beneficiary of statin pretreatment in coronary artery bypass graft
surgery. This effect is associated with beneficial modulation of systemic
inflammatory markers.<br/>Copyright &#xa9; The Author 2017. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<34>
Accession Number
620134481
Author
Anonymous
Title
Corrigendum: Predicting delirium: Are we there yet? (British Journal of
Anaesthesia (2017) 119:2 (281-283) DOI: 10.1093/bja/aex082).
Source
British Journal of Anaesthesia. 119 (6) (pp 1246), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Reference 9 was incorrectly cited in the above paper. The correct
reference is: Lee A, Mu JL, Joynt GM, Chiu CH, Lai VKW, Gin T,Underwood
MJ. Risk prediction models for delirium in the intensive care unit after
cardiac surgery: a systematic review and independent external validation.
Br J Anaesth. 2017 Mar 1;118(3):391-399. doi: 10.1093/bja/aew476. This has
now been corrected online.<br/>Copyright &#xa9; The Author 2017.

<35>
Accession Number
620134765
Author
Xu Y.; Chen N.; Ma A.; Wang Z.; Zhang Y.; Liu C.; Liu L.
Institution
(Xu, Chen, Liu, Liu) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Xu, Chen, Liu, Liu) W. China Collab. Innovation Center for Early
Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan
University, Chengdu, Sichuan, China
(Ma, Wang, Zhang) West China School of Medicine, Sichuan University,
Chengdu, Sichuan, China
Title
Three-dimensional versus two-dimensional video-assisted thoracic surgery
for thoracic disease: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 862-871),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES It remains unclear whether 3D systems are manoeuvrable in
video-assisted thoracic surgery (VATS) for patients with thoracic
diseases. The objective of this systematic review and meta-analysis was to
evaluate the efficacy and safety of 3D VATS compared with 2D VATS. METHODS
A systemic research of the literature was performed using the PubMed,
Embase, the Cochrane library, China National Knowledge Infrastructure,
Wanfang and CQVIP databases through December 2016. Studies investigating
the efficacy and safety of 3D VATS compared with 2D VATS were eligible for
our meta-analysis. Odds ratios and mean differences or standard mean
differences with 95% confidence intervals (95% CI) as well as a P-value
were applied to compare continuous and dichotomous variables,
respectively. RESULTS Seven studies with 1080 patients (525 patients for
3D VATS and 555 patients for 2D VATS) were included. There were
significant differences in the 3D group with regard to shorter operation
times (standard mean difference = -0.66, 95% CI: -0.98 to - 0.34; P <
0.001), less blood loss (mean difference = -12.12, 95% CI: -19.07 to -
5.16; P < 0.001) and shorter postoperative drainage times (standard mean
difference = -0.53, 95% CI: -0.92 to - 0.14; P = 0.008) compared with the
2D group. However, no statistical difference was found for postoperative
hospital stay, total postoperative drainage volume, postoperative drainage
volume in 24 h, number of lymph nodes dissected and postoperative
complications. CONCLUSIONS The results of this systematic review and
meta-analysis suggest that 3D VATS might be an acceptable method for
treating thoracic diseases in the future.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<36>
Accession Number
620124276
Author
Choi H.N.; Park K.-H.; Park S.; Kim J.-M.; Kang H.J.; Park J.H.; Lee M.S.
Institution
(Choi, Park, Park, Kim, Kang, Park, Lee) Department of Internal Medicine,
Kyung Hee University Hospital, Kyung Hee University School of Medicine,
Seoul, South Korea
Title
Prosthetic valve endocarditis caused by HACEK organisms: A case report and
systematic review of the literature.
Source
Infection and Chemotherapy. 49 (4) (pp 282-285), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Korean Society for Chemotherapy (E-mail: ksinfect@naver.com)
Abstract
HACEK is a rare cause of prosthetic valve endocarditis (PVE). We describe
42-year-old male patient who presented with Aggregatibacter aphrophilus
PVE and cerebral infarct. A. aphrophilus was isolated from his blood
cultures as the sole pathogen, which was confirmed by subsequent 16S rRNA
sequencing. He was treated with valve replacement surgery and an 8 week
course of pathogen- directed antibiotic therapy and followed for 20 months
without recurrence.<br/>Copyright &#xa9; 2017 by The Korean Society of
Infectious Diseases.

<37>
Accession Number
620038608
Author
Manolis A.S.
Institution
(Manolis) Third Department of Cardiology, Athens University School of
Medicine, Athens, Greece
Title
Transseptal access to the left atrium: Tips and tricks to keep it safe
derived from single operator experience and review of the literature.
Source
Current Cardiology Reviews. 13 (4) (pp 305-318), 2017. Date of
Publication: 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transseptal puncture (TSP) remains a demanding procedural step
in accessing the left atrium with inherent risks and safety concerns,
mostly related to cardiac tamponade. Objective: Based on our own
experience with 249 TSP procedures and in-depth literature review, we
present our results and offer several tips and tricks that may render TSP
successful and safe. Methods: This prospective study comprised 249
consecutive patients (146 men), aged 41.6+/-17.4 years, undergoing TSP by
a single operator for ablation of a variety of arrhythmias, mostly related
to left accessory pathways (n=145) or left atrial tachycardias (n=33) and
more recently, atrial fibrillation (n=70). TSP was guided by fluoroscopy
alone in all patients without the use of echocardiography imaging. In
addition, an extensive literature review of TSP-related topics was carried
out in PubMed, Scopus and Google Scholar. Results: Among 249 patients, 33
patients were children or young adolescents (aged 7-18 years); 14 patients
were undergoing a repeat procedure. Patients with a manifest accessory
pathway were the youngest (mean age 33.7+/-15.9) and patients with atrial
fibrillation the oldest (mean age 56.0+/-10.8 years). A successful TSP was
accomplished in 247 patients (99.2%). Two (0.8%) procedures were
complicated by cardiac tamponade managed successfully with
pericardiocentesis or surgical drainage. Review of the literature revealed
no systematic reviews and meta-analyses of TSP studies; however, several
patient series have documented that fluoroscopy-guided TSP, with various
modifications in the technique employed in the present series, have been
effective in 95-100% of the cases with a complication rate ranging from
0.0% to 6.7%, albeit with a mortality rate of 0.018%-0.2%. Echo imaging
techniques were employed in cases with difficult TSP. Conclusion:
Employing a standardized protocol with use of fluoroscopy alone minimized
serious complications to 0.8% (2 patients) among 249 consecutive patients
undergoing TSP for ablation of a variety of cardiac arrhythmias. Based on
this single-operator experience and review of the literature, a list of
practical tips and tricks is provided for a successful and safe procedure,
reserving the more expensive and patient inconveniencing echo-imaging
techniques for difficult or failed cases.<br/>Copyright &#xa9; 2017
Bentham Science Publishers.

<38>
Accession Number
620038369
Author
Ifedili I.A.; Bolorunduro O.; Bob-Manuel T.; Heckle M.R.; Christian E.;
Kar S.; Ibebuogu U.N.
Institution
(Ifedili, Bolorunduro, Bob-Manuel, Heckle, Christian, Ibebuogu) Division
of Cardiovascular Diseases, Department of Medicine, University of
Tennessee Health Science Center/Methodist University Hospital, Memphis,
TN, United States
(Kar) Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048,
United States
Title
Impact of pre-existing kidney dysfunction on outcomes following
transcatheter aortic valve replacement.
Source
Current Cardiology Reviews. 13 (4) (pp 283-292), 2017. Date of
Publication: 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Pre-existing chronic kidney disease (CKD) portends adverse
outcomes following heart valve surgery. However, only limited and
conflicting evidence is available on the impact of CKD on outcomes
following transcatheter aortic valve replacement (TAVR). The objective of
this review was to evaluate the effect of pre-existing CKD on TAVR
outcomes. Methods: We performed a systematic electronic search using the
PRISMA statement to identify all randomized controlled trials and
observational studies investigating the effect of pre-existing CKD on
outcomes following TAVR. 30-day and long-term outcomes were measured
comparing patients with Glomerular filtration rate (GFR) >=60 to those
with GFR <60. Results: Ten studies were analyzed comprising of 8688
patients. Compared to patients with GFR >=60, those with GFR < 60 had
worse 30-day all cause mortality (OR 1.40, 95% CI: 1.13-1.73),
cardiovascular mortality (OR 1.66, 95% CI: 1.04-2.67), strokes (OR 1.39,
95% CI: 1.05-1.85), acute kidney injury (OR 1.42, 95% CI: 1.21-1.66) and
the risk for dialysis (OR 2.13, 95% CI: 1.07-4.22). There was no
difference in device success (p=0.873), major or life threatening bleeds
(p = 0.302), major vascular complications (p=0.525), need for pacemaker
implantation (p = 0.393) or paravalvular leaks (p = 0.630). All-cause
mortality at 1 year was also significantly higher in patients with GFR <60
(OR 1.80, 95% CI: 1.26-2.56). Conclusion: Pre-existing CKD defined as GFR
<60 is a strong predictor of worse short and longterm outcomes following
TAVR. Active measures should be taken to mitigate the postprocedure risk
in these group of patients.<br/>Copyright &#xa9; 2017 Bentham Science
Publishers.

<39>
Accession Number
620129627
Author
Genereux P.; Pibarot P.; Redfors B.; Mack M.J.; Makkar R.R.; Jaber W.A.;
Svensson L.G.; Kapadia S.; Tuzcu E.M.; Thourani V.H.; Babaliaros V.;
Herrmann H.C.; Szeto W.Y.; Cohen D.J.; Lindman B.R.; McAndrew T.; Alu
M.C.; Douglas P.S.; Hahn R.T.; Kodali S.K.; Smith C.R.; Miller D.C.; Webb
J.G.; Leon M.B.
Institution
(Genereux, Redfors, McAndrew, Hahn, Kodali, Leon) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Pibarot) Pulmonary Hypertension and Vascular Biology Research Group,
Laval University, Quebec, Canada
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Makkar) Interventional Technologies in the Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(Jaber, Svensson, Kapadia, Tuzcu) Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, United States
(Thourani, Babaliaros) Emory University School of Medicine, Atlanta, GA,
United States
(Herrmann, Szeto) Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Lindman) Vanderbilt University Medical Center, Nashville, TN, United
States
(Alu, Hahn, Kodali, Smith, Leon) Columbia University Medical Center, 161
Ft. Washington Avenue, New York, NY 10032, United States
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Miller) Stanford University, Stanford, CA, United States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
Title
Staging classification of aortic stenosis based on the extent of cardiac
damage.
Source
European Heart Journal. 38 (45) (pp 3351-3358), 2017. Date of Publication:
2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In patients with aortic stenosis (AS), risk stratification for aortic
valve replacement (AVR) relies mainly on valverelated factors, symptoms
and co-morbidities. We sought to evaluate the prognostic impact of a
newly-defined staging classification characterizing the extent of
extravalvular (extra-aortic valve) cardiac damage among patients with
severe AS undergoing AVR. Methods and results Patients with severe AS from
the PARTNER 2 trials were pooled and classified according to the presence
or absence of cardiac damage as detected by echocardiography prior to AVR:
no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage
1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or
tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4).
One-year outcomes were compared using Kaplan- Meier techniques and
multivariable Cox proportional hazards models were used to identify 1-year
predictors of mortality. In 1661 patients with sufficient
echocardiographic data to allow staging, 47 (2.8%) patients were
classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413
(24.9%) as Stage 3, and 145 (8.7%) as Stage 4. Oneyear mortality was 4.4%
in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5%
in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was
independently associated with increased mortality after AVR (HR 1.46 per
each increment in stage, 95% confidence interval 1.27-1.67, P < 0.0001).
Conclusion This newly described staging classification objectively
characterizes the extent of cardiac damage associated with AS and has
important prognostic implications for clinical outcomes after
AVR.<br/>Copyright &#xa9; 2017 The Author.

<40>
Accession Number
620129078
Author
Korteland N.M.; Etnel J.R.G.; Arabkhani B.; Mokhles M.M.; Mohamad A.;
Roos-Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Etnel, Arabkhani, Mokhles, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus MC, PO Box 2040, Rotterdam 3000 CA,
Netherlands
(Mohamad) Department of Radiology, Erasmus MC, PO Box 2040, Rotterdam 3000
CA, Netherlands
(Roos-Hesselink) Department of Cardiothoracic Cardiology, Erasmus MC, PO
Box 2040, Rotterdam 3000 CA, Netherlands
Title
Mechanical aortic valve replacement in non-elderly adults: Meta-analysis
and microsimulation.
Source
European Heart Journal. 38 (45) (pp 3370-3377), 2017. Date of Publication:
2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To support decision-making regarding prosthetic valve selection in
non-elderly adults, we aim to provide a detailed overview of outcome after
contemporary mechanical aortic valve replacement (AVR). Methods and
results A systematic review was conducted for papers reporting clinical
outcome after AVR with bileaflet mechanical valves with a mean patient age
>=18 and <=55 years, published between 1 January 1995 and 31 December
2015. Through meta-analysis outcomes were pooled and entered into a
microsimulation model to calculate (event-free) life expectancy and
lifetime event risk. Twenty-nine publications, encompassing a total of
5728 patients with 32 515 patient-years of follow-up (pooled mean
follow-up: 5.7 years), were included. Pooled mean age at surgery was 48.0
years. Pooled early mortality risk was 3.15% (95% confidence interval
(CI):2.37-4.23), late mortality rate was 1.55%/year (95%CI:1.25-1.92);
38.7% of late deaths were valve-related. Pooled thromboembolism rate was
0.90%/year (95%CI:0.68-1.21), major bleeding 0.85%/year (95%CI:0.65-1.12),
nonstructural valve dysfunction 0.39%/year (95%CI:0.21-0.76), endocarditis
0.41%/year (95%CI:0.29-0.57), valve thrombosis 0.14%/year
(95%CI:0.08-0.25), structural valve deterioration 0.00%/year (zero events
observed), and reintervention 0.51%/year (95%CI:0.37-0.71), mostly due to
nonstructural valve dysfunction and endocarditis. For a 45-year-old, for
example, this translated to an estimated life expectancy of 19 years
(general population: 34 years) and lifetime risks of thromboembolism,
bleeding and reintervention of 18%, 15%, and 10%, respectively. Conclusion
This study demonstrates that outcome after mechanical AVR in non-elderly
adults is characterized by suboptimal survival and considerable lifetime
risk of anticoagulation-related complications, but also reoperation.
Non-elderly adult patients who are facing prosthetic valve selection are
entitled to conveyance of evidence-based estimates of the risks and
benefits of both mechanical and biological valve options in a shared
decision-making process.<br/>Copyright &#xa9; 2017 The Author.

<41>
Accession Number
620118711
Author
She X.-W.; Gu Y.-B.; Xu C.; Li C.; Ding C.; Chen J.; Zhao J.
Institution
(She, Xu, Li, Ding, Chen, Zhao) Department of Thoracic Surgery The First
Affiliated Hospital of Soochow University Suzhou China
(She) Department of Thoracic Surgery, Suzhou Municipal Hospital North
District Nanjing Medical University Suzhou China
(Gu) Department of Radiology The First Affiliated Hospital of Soochow
University Suzhou China
Title
Three-dimensional (3D)- computed tomography bronchography and angiography
combined with 3D-video-assisted thoracic surgery (VATS) versus
conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of
non-small cell lung cancer.
Source
Thoracic Cancer. (no pagination), 2018. Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Compared to the pulmonary lobe, the anatomical structure of
the pulmonary segment is relatively complex and prone to variation, thus
the risk and difficulty of segmentectomy is increased. We compared
three-dimensional computed tomography bronchography and angiography
(3D-CTBA) combined with 3D video-assisted thoracic surgery (3D-VATS) to
perform segmentectomy to conventional two-dimensional (2D)-VATS for the
treatment of non-small cell lung cancer (NSCLC). Methods: We
retrospectively reviewed the data of randomly selected patients who
underwent 3D-CTBA combined with 3D-VATS (3D-CTBA-VATS) or 2D-VATS at the
Department of Thoracic Surgery, The First Affiliated Hospital of Soochow
University Hospital, from January 2014 to May 2017. Results: The operative
duration of 3D group was significantly shorter than the 2D group (P <
0.05). There was no significant difference in the number of dissected
lymph nodes between the two groups (P > 0.05). The extent of
intraoperative bleeding and postoperative drainage in the 3D group was
significantly lower than in the 2D group (P < 0.05). Chest tube duration
in the 3D group was shorter than in the 2D group (P < 0.05). Incidences of
pulmonary infection, atelectasis, and arrhythmia were not statistically
different between the two groups (P > 0.05). However, hemoptysis and
pulmonary air leakage (>3d) occurred significantly less frequently in the
3D than in the 2D group (P < 0.05). Conclusion: 3D-CTBA-VATS is a more
accurate and smooth technique and leads to reduced intraoperative and
postoperative complications.<br/>Copyright &#xa9; 2018 China Lung Oncology
Group and Wiley Publishing Asia Pty Ltd.

<42>
Accession Number
620115798
Author
Shatila M.; Arab W.A.; Fasih N.; Karara K.; Ramadan A.-M.
Institution
(Shatila, Arab, Karara, Ramadan) Cardiothoracic Surgery Department,
University of Alexandria, Egypt
(Fasih) Pediatric Department, University of Alexandria, Egypt
Title
Comparative study between outcome of intercostal tube drainage and video
assisted thoracoscopic surgery in management of complicated parapneumonic
effusion in children.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Intercostal tube drainage (ICTD) has been known for the
management of complicated parapneumonic effusion (PPE) since the early
1870s. Video assisted thoracoscopic surgery (VATS) has been applied since
the early 1990s. The aim of this study was to compare between both
surgical procedures in children. Methods: This randomized clinical study
included 75 children for drainage of complicated PPE in the Cardiothoracic
Surgery Department of Alexandria University hospital, Egypt. They were
classified into two groups. Group I included 35 children managed by ICTD
while group II included 40 children managed by VATS. Results: The mean age
in group I was 7.81 +/- 4.04 years and 8.93 +/- 1.73 years in group II.
Mean duration on medical therapy before and after intervention was 0.74
+/- 2.83 days in group I and 4.80 +/- 0.94 days in group II, and 11.06 +/-
5.31 days in group I, and 2.88 +/- 1.52 days in group II respectively.
Success rate following primary intervention was 17.1% in group I and 90%
in group II. Average amount of pleural fluid drained was 291.14 +/- 94.86
ml in group I and 156.50 +/- 76.28 ml in group II.The mean hospital stay
following primary intervention was 11.06 days in the first group and 2.43
days in group II. The mean hospital stay after secondary intervention in
group I was 3.74 +/- 2.79. In contrast, it was 1.38 days in group II which
was significantly shorter than that of the group I. Moreover, the mean
total hospital stay was 14.77 +/- 7.12 days in the first group and 7.68
+/- 2.07 days in the second group. Conclusions: VATS is a safe and
effective procedure with low rates of complications. Early VATS should be
the first treatment of choice in children with PPE.<br/>Copyright &#xa9;
2017 The Egyptian Society of Cardio-thoracic Surgery.

<43>
Accession Number
620069745
Author
Hosny H.; Ibrahim M.; El-Siory W.; Abdel-Monem A.
Institution
(Hosny, Ibrahim, El-Siory, Abdel-Monem) Department of Anesthesia and
Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University
(Hosny) Department of Cardiothoracic Anaesthesia, Royal Brompton Hospital,
London, United Kingdom
Title
Comparative Study Between Conventional Fasting Versus Overnight Infusion
of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients
Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative insulin resistance represents a major component
of postoperative metabolic disorder. The authors compared the effects of
preoperative infusion of lipid emulsion or carbohydrate to conventional
preoperative fasting on postoperative insulin and free fatty acid (FFA)
levels. Design: A prospective randomized double-blinded study. Settings:
Tertiary university hospital. Participants: Sixty-three patients
undergoing coronary artery bypass grafting. Intervention: Participants
were randomized into 3 equal groups. Group G received 500 mL of glucose
10% (50 g glucose). Group L received 100 mL of 2% lipid emulsion (soybean
30%, medium chain triglycerides (TG) 30%, olive oil 25%, fish oil 15%, and
20 mg vitamin E). Group C fasted overnight except for clear fluids allowed
until 4 hours preoperatively. Serum insulin at the start of infusion
(T<inf>1</inf>), 1-hour preinduction (T<inf>2</inf>), on admission to the
intensive care unit (T<inf>3</inf>), after 24 hours of admission
(T<inf>4</inf>), and after 48 hours of admission (T<inf>5</inf>), and FFA
at T<inf>1</inf> and T<inf>2</inf> were measured. Serum very-low-density
lipoprotein (VLDL), serum TG, and blood sugar were all measured
(T<inf>1</inf>-T<inf>4</inf>). Bypass time, ischemic time, need for
inotropic support, and length of intensive care unit stay also were
measured. Measurements and Main Results: At the end of infusion FFAs were
significantly lower in the L group (1.1 +/- 0.76 mg/dL) compared with G
(1.64 +/- 0.85 mg/dL) and C groups (1.48 +/- 0.76 mg/dL). Insulin levels
were significantly lower in the L group compared with levels in the G and
C groups at T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf>. Also, TG,
VLDL, and random blood sugar levels decreased significantly at
T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf> in the L group compared
with the other 2 groups and compared with baseline value within the same
group. Conclusion: Preoperative lipid infusion lowered postoperative FFA,
insulin, TG, VLDL, and random blood sugar in obese patients undergoing
coronary artery bypass grafting surgeries.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<44>
Accession Number
620127219
Author
Tan W.; Zhang C.; Liu J.; Li X.; Chen Y.; Miao Q.
Institution
(Tan, Zhang, Liu, Li, Chen, Miao) Department of Cardiac Surgery, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing 100730, China
Title
Remote Ischemic Preconditioning has a Cardioprotective Effect in Children
in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled
Trials.
Source
Pediatric Cardiology. (pp 1-10), 2018. Date of Publication: 04 Jan 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
In this updated meta-analysis, we assessed the cardioprotective effect of
remote ischemic preconditioning (RIPC) in pediatric patients undergoing
congenital heart surgery. A total of 9 randomized controlled trials (RCTs)
involving 793 pediatric patients under 18 years old were identified. RIPC
obviously reduced the release of troponin I at 6 h after surgery [standard
mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04;
p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI
-0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to
-0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95%
CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care
unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our
meta-analysis determined that RIPC had cardioprotective effects in the
early postoperative phase. Additional RCTs focused on the cardiac benefits
from RIPC in pediatric patients are warranted.<br/>Copyright &#xa9; 2018
Springer Science+Business Media, LLC, part of Springer Nature

<45>
Accession Number
620125977
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Szlapka M.; Scharpenberg M.;
Eberle T.; Hasenkam J.M.
Institution
(Bauer, Schaarschmidt) Department of Cardiovascular Perfusion, MediClin
Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
(Bauer, Hasenkam) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Bauer, Hasenkam) Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
(Hausmann, Szlapka) Department of Cardiothoracic and Vascular Surgery,
MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) Competence Center for Clinical Trials Bremen, University of
Bremen, Bremen, Germany
(Eberle) Department of Anesthesia and Intensive Care Medicine, MediClin
Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
Title
Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2017. Date of
Publication: 31 Dec 2017.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Introduction The recommended minimum activated clotting time (ACT) level
for cardiopulmonary bypass (CPB) of 480 seconds originated from
investigations with bubble oxygenators and uncoated extracorporeal
circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are
completely closed circuits containing a membrane oxygenator and a
tip-to-tip surface coating. We hypothesized that surface coating and the
"closed-loop" design allow the MiECC to safely run with lower ACT levels
and that an ACT level of 300 seconds can be safely applied without
thromboembolic complications. The aim of this study was to investigate the
potential risks during application of reduced heparin levels in patients
undergoing coronary surgery. Methods In this study, 68 patients undergoing
coronary artery bypass grafting with MiECC were randomized to either the
study group with an ACT target of 300 seconds or the control group with an
ACT of 450 seconds. All other factors of MiECC remained unchanged. Results
The study group received significantly less heparin and protamine (heparin
[international units] median [min-max], Red_AC: 32,800 [23,000-51,500] vs.
Full_AC: 50,000 [35,000-65,000] p < 0.001; protamine [international
units], Red_AC: 18,000 [10,000-35,000] vs. Full_AC: 30,000 [20,000-45,000]
p < 0.001). The ACT in the study group was significantly lower at the
start of MiECC (mean +/- standard deviation: study group 400 +/- 112 vs.
control group 633 +/- 177; p < 0.0001). Before termination of CPB the ACT
levels were: study group 344 +/- 60 versus control group 506 +/- 80. In
both groups, the values of the endogenous thrombin potential (ETP)
decreased simultaneously. None of the study participants experienced
thromboembolic complications. Conclusion Since no evidence of increased
thrombin formation (ETP) was found from a laboratory standpoint, we
concluded that the use of MiECC with a reduced anticoagulation strategy
seems possible. This alternative anticoagulation strategy leads to
significant reduction in dosages of both heparin and protamine. We can
confidently move forward with investigating this anticoagulation concept.
However, to establish clinical safety of ACT below 300 seconds, we need
larger clinical studies. <br/>Copyright &#xa9; 2017, Georg Thieme Verlag
KG. All rights reserved.

<46>
Accession Number
618879798
Author
Velagapudi P.; Turagam M.; Kolte D.; Khera S.; Parikh P.; Hyder O.; Aronow
H.; Abbott J.D.
Institution
(Velagapudi, Kolte, Parikh, Hyder, Aronow, Abbott) Division of
Cardiovascular Medicine, Brown University Warren Alpert Medical School,
Providence, RI, United States
(Turagam) Division of Cardiovascular Medicine, University of Missouri
Health Care, Columbia, MO, United States
(Khera) Division of Cardiovascular Medicine, New York Medical College,
Valhalla, NY, United States
Title
Less than two versus greater than two hour invasive strategy in non-ST
elevation myocardial infarction: a meta-analysis of randomized controlled
trials.
Source
Expert Review of Cardiovascular Therapy. 16 (1) (pp 67-72), 2018. Date of
Publication: 02 Jan 2018.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Background: Optimal timing for an invasive strategy in non-ST elevation
myocardial infarction (NSTEMI) is unclear. Whether clinical outcomes are
improved with a less than two (LT2) compared with greater than two hour
(GT2) invasive strategy remains to be determined. We performed a
meta-analysis of randomized controlled trials (RCTs) comparing LT2 vs GT2
for NSTEMI. Methods: A comprehensive literature search for RCTs comparing
LT2 vs. GT2 in NSTEMI patients was performed. Three eligible studies
consisting of 1,075 patients (LT2: 537, GT2: 538) with NSTEMI were
identified. Follow-up ranged from 1 to 12 months. Results: Time from
randomization to sheath insertion ranged from 0.5-2.2 and 14.0-85.0 hours
in the LT2 and GT2 groups. More percutaneous coronary interventions and
fewer coronary artery bypass grafting were performed in the LT2 vs. GT2
group. There was no significant difference in all-cause mortality,
myocardial infarction (MI), and major bleeding between the two groups. LT2
was numerically, but not statistically superior to GT2 at preventing
recurrent ischemia/urgent revascularization/refractory ischemia.
Conclusion: Our meta-analysis found no significant difference in outcomes
between less than two versus greater than two hours invasive strategy for
NSTEMI. The differences observed in the mode of revascularization
according to timing of catheterization deserve further
study.<br/>Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor &
Francis Group.

<47>
Accession Number
620122649
Author
Karady J.; Apor A.; Kolossvary M.; Szilveszter B.; Panajotu A.; Suhai
F.I.; Jermendy A.L.; Orosz P.; Milanovich D.; Nagy A.I.; Molnar A.A.;
Molnar L.; Rajani R.; Merkely B.; Maurovich-Horvat P.
Institution
(Karady, Apor, Kolossvary, Szilveszter, Panajotu, Suhai, Jermendy, Nagy,
Molnar, Molnar, Merkely, Maurovich-Horvat) Semmelweis University Heart
Center, MTA-SE Lendulet Cardiovascular Imaging Research Group, Budapest,
Hungary
(Orosz, Milanovich) Semmelweis University, Department of Neurology,
Budapest, Hungary
(Rajani) St Thomas' Hospital, Cardiology Department, London, United
Kingdom
Title
Retoric study: Initial results.
Source
European Heart Journal Cardiovascular Imaging. Conference: 21st Annual
Meeting of the European Association of Echocardiography, EUROECHO 2017.
Portugal. 18 (Supplement 3) (pp iii334), 2017. Date of Publication:
December 2017.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an
alternative to surgical valve replacement in high-risk patients with
aortic stenosis. The appearance of subclinical hypo-attenuated leaflet
thickening (HALT) of the prosthetic valve on contrast-enhanced computed
tomography (CT) images is a recently described phenomenon. The RETORIC
(Rule Out Transcatheter Aortic Valve Thrombosis with Post Implantation
Computed Tomography) study aims to define the incidence, predictors and
clinical relevance of HALT following TAVI. Methods: The predominant
inclusion criterion is patients who have previously undergone or are
scheduled to undergo a TAVI. The predominant inclusion criterion is
patients who have previously undergone or are scheduled to undergo a TAVI
procedure with selfexpandable valve system. The study is comprised of two
cohorts. Cohort A includes those patients who have previously undergone a
TAVI and Cohort B includes those patients who are scheduled to undergo a
TAVI. All patients undergo comprehensive cardiac CT, transthoracic
echocardiography (TTE), brain magnetic resonance imaging (MRI) and
comprehensive neurological evaluation. In Cohort A, all HALT positive
patients receive oral anticoagulant therapy (OAC), while in Cohort B
patients are randomized to standard therapy and OAC therapy or standard
therapy alone. After 4 months, HALT positive patients from both Cohort A
and B undergo repeat cardiac CT, TTE and brain MRI to determine the
effects of anticoagulation based on the presence and volume of HALT.
Results: As of May 2017, the RETORIC study has enrolled 116 patients to
Cohort A arm (78.2 6 11.5 years, 55% females) and 53 to Cohort B arm (79,8
6 6,3 years, 50% females). The average time between TAVI and CT was 16.2 6
10.4 months in Cohort A. The current prevalence of HALT in Cohort A is
4.3%, whereas in Cohort B further follow-up data is awaited. Conclusion:
The RECTORIC study may provide valuable information on the relevance of
subclinical HALT appearance and OAC therapy in TAVI patients.

<48>
Accession Number
620122627
Author
Nagy A.I.; Turani M.; Apor A.; Karady J.; Suhai F.; Panajotu A.;
Kolossvary M.; Varga A.; Jermendy A.; Milanovich D.; Orosz P.K.; Kovats
T.; Rajani R.; Merkely B.; Maurovich Horvat P.
Institution
(Nagy, Turani, Apor, Kovats, Merkely) Semmelweis University, Heart and
Vascular Centre, Budapest, Hungary
(Karady, Suhai, Panajotu, Kolossvary, Jermendy, Maurovich Horvat)
Semmelweis University, MTA-SE Cardiovascular Imaging, Research Group Heart
and Vascular Center, Budapest, Hungary
(Varga) Semmelweis University, Heart and Vascular Centre, Department of
Diagnostic Radiology, Budapest, Hungary
(Milanovich, Orosz) Semmelweis University, Department of Neurology,
Budapest, Hungary
(Rajani) Guy's Hospital, London, United Kingdom
Title
Improved cognitive performance following transcatheter aortic valve
implantation despite the presence of lacunar cerebral lesions-a RETORIC
substudy.
Source
European Heart Journal Cardiovascular Imaging. Conference: 21st Annual
Meeting of the European Association of Echocardiography, EUROECHO 2017.
Portugal. 18 (Supplement 3) (pp iii55), 2017. Date of Publication:
December 2017.
Publisher
Oxford University Press
Abstract
Background: Data regarding the cognitive trajectory of patients undergoing
transcatheter aortic valve implantation (TAVI) are scarce and
contradictory. With the indication area of TAVI expanding towards younger
generations, understanding the effects of TAVI on cognitive function is
attaining crucial importance. Purpose: The primary aim of the present
study was 1) to assess the evolution of global cognitive function and
specific cognitive domains after TAVI 2) to identify any correlation
between periprocedural lacunar brain lesions and potential cognitive
changes Methods:-Patients were included from the prospective arm of the
Rule out Transcatheter Aortic Valve Thrombosis with Post-implantation
Computed Tomography (RETORIC), NCT02826200. Global cognitive function was
assessed using the Mini Mental State Examination (MMSE); specific
cognitive domains were investigated using the Addenbrooke's cognitive
examination (ACE). Tests were performed before (within 2 days) and after
(within 3 days) the procedure. Following intervention, all patients
underwent brain MRI including diffusion tensior imaging (DTI) before
hospital discharge to identify potential new ischemic lesions. Results:-As
of May 2017, 34 patients with full datasets of pre-and postoperative
cognitive tests and brain MRI examinations have been included in the study
(mean age: 79 years; range: 63-92). Global cognitive performance of the
patients was similar pre-and post-operatively (mean MMSE score 24.7 vs
25.6 p=0,13). However, when the analysis was confined to those patients
whose baseline score was under the study population's average (n=8), a
significant improvement was observed (20.7 vs 23.0 p=0.019). Regarding
specific cognitive domains, the short term memory of the patients improved
significantly following intervention (1,03 60,97 vs 0,6360,81, p=0,001).
No statistically significant change was observed in case of the other
domains. Novel lacunar cerebral lesions were detected in 63% of the
subjects. When classifying the patients according to the presence or
absence of cerebral lesions, similar perioperative cognitive trajectory
was observed in the two groups (MMSE: 23.863.8 vs 2663 with and 24.463.1
vs 27.062.5, without lesions, respectively; p>0.05 in all cases).
Conclusion:-The initial results of this RETORIC substudy indicate no short
term cognitive decline following TAVI, despite the presence of
peri-operatively developed novel lacunar cerebral lesions. Furthermore,
patients with slightly reduced intellectual capacities at baseline showed
improvement in global cognitive function after valve replacement.

<49>
Accession Number
620121882
Author
Dorobantu D.M.; Enache R.; Ghiorghiu I.; Badea R.; Ginghina C.; Popescu
B.A.
Institution
(Dorobantu, Enache, Badea, Ginghina, Popescu) Institute of Cardiovascular
Diseases Prof. C.C. Iliescu, Bucharest, Romania
(Ghiorghiu) "prof. Dr. Victor Gomoiu" Children's Hospital, Bucharest,
Romania
Title
Pulmonary artery dilation parallels ascending aorta dilation in children
with bicuspid aortic valve.
Source
European Heart Journal Cardiovascular Imaging. Conference: 21st Annual
Meeting of the European Association of Echocardiography, EUROECHO 2017.
Portugal. 18 (Supplement 3) (pp iii153), 2017. Date of Publication:
December 2017.
Publisher
Oxford University Press
Abstract
Background: Bicuspid aortic valve (BAV) is associated with dilated
ascending aorta (AAO) and main pulmonary artery (MPA) in adults. It is not
clear if this is true in children. Purpose: We aim to identify the
presence and pattern of MPA dilation in children with BAV. Methods: We
retrospectively identified 27 pediatric patients with BAV and aortic and
pulmonary artery measurements at one visit. We randomly selected 27
children with similar gender and age as controls. There were 5 patients
with aortic coarctation in the BAV group and they were paired with
children having isolated coarctation and normal aortic valve. We
calculated the following ratios: AAO/aortic annulus, MPA/ pulmonary
annulus, AAO/MPA and aortic/pulmonary annulus. Previous studies have shown
that the AAO/aortic annulus ratio remains constant irrespective of age,
weight or height in normal children, and we assumed that the MPA/pulmonary
annulus follows the same pattern. Results: The mean age was 14.6 years.
From the BAV group 7 patients (26%) had moderate or severe stenosis and 10
(37%) moderate or severe regurgitation. The main results are summarized in
Table. We found that AAO and MPA diameters are larger in the BAV group,
but not annulus sizes. Both the AAO/ aortic annulus and MPA/pulmonary
annulus ratios were higher in the BAV group. Aortic/pulmonary annulus
ratio was slightly higher in the BAV group, with AAO/MPA ratio being
comparable among the two groups. The analysis was repeated excluding the
patients with aortic coarctation, obtaining similar results. Conclusions:
In our study, using both absolute values and age-independent ratios, we
showed MPA diameters in children with BAV are larger when compared to
controls, following a pattern of dilation similar to that of the AOO.
Further studies are warranted to prospectively determine the rate of MPA
dilation, and whether it can have clinical implications, especially in
cases of autograft aortic valve replacements (Table presented).

<50>
Accession Number
620121853
Author
Ishiwata J.; Kawata T.; Daimon M.; Kimura K.; Nakao T.; Hirokawa M.;
Sawada N.; Xu B.; Watanabe M.; Yatomi Y.; Komuro I.
Institution
(Ishiwata, Kawata, Kimura, Hirokawa, Sawada, Watanabe, Komuro) University
of Tokyo Hospital, Department of Cardiovascular Medicine, Tokyo, Japan
(Daimon, Nakao, Xu, Yatomi) University of Tokyo Hospital, Department of
Clinical Laboratory, Tokyo, Japan
Title
Clinical manifestations of non-ischemic dilated cardiomyopathy with right
ventricular dysfunction.
Source
European Heart Journal Cardiovascular Imaging. Conference: 21st Annual
Meeting of the European Association of Echocardiography, EUROECHO 2017.
Portugal. 18 (Supplement 3) (pp iii202-iii203), 2017. Date of Publication:
December 2017.
Publisher
Oxford University Press
Abstract
Background: Right ventricular (RV) function has recently gained attention
as a prognostic predictor of outcome in patients with non-ischemic dilated
cardiomyopathy (DCM). Therefore, not only the left-sided evaluation, but
also the evaluation of RV function is important to manage DCM patients.
However, the clinical manifestations of DCM with RV dysfunction are
uncertain. Purpose: To clarify the clinical manifestations of DCM with RV
dysfunction assessed by transthoracic echocardiography. Methods: We
retrospectively analyzed 54 non-ischemic DCM patients (41 6 15 years, 38
male) with left ventricular (LV) ejection fraction < 35% from December
2012 to November 2014. All patients were undergoing evaluation for heart
transplantation or management of heart failure. RV dysfunction was defined
as RV fractional area change < 35% based on the guideline. We divided our
subjects into 2 groups according to RV function, and we compared general
characteristics, laboratory data and echocardiographic data between 2
groups. Primary outcomes were defined as LV assist device implantation or
cardiac death within one year. Results: Forty-one patients had RV
dysfunction (75.9%). Compared with patients with preserved RV function,
they showed significantly lower pulse pressure (31 6 8 vs 40 6 9mmHg, p <
0.01), higher heart rate (87 6 20 vs 69 6 12/min, p < 0.01), lower sodium
(136 6 4 vs 139 6 3mEq/L, p < 0.01) and higher total bilirubin (1.6 +/-
1.1 vs 1.1 +/- 0.5mg/dl, p < 0.05). Patients with RV dysfunction also had
significantly larger LV (end systolic volume index, 144 6 55 vs 99 6
25ml/m2, p < 0.01), lower LV ejection fraction (17 6 4 vs 24 6 5%, p <
0.01) and distended inferior vena cava (20 6 5 vs 16 6 5mm, p < 0.01).
During the first year, 28 events (4 deaths, 24 left ventricular assist
devices) occurred. Kaplan-Meier analysis revealed that the event rate was
significantly higher (log rank, p < 0.05) in patients with RV dysfunction.
In multivariate analysis, RV dysfunction was independently associated with
low LV ejection fraction (odds ratio 0.72, 95% confidence interval,
0.56-0.86, p < 0.01) and inferior vena cava expansion (odds ratio 1.19,
95% confidence interval, 1.004-1.46, p < 0.05). Conclusion: DCM with RV
dysfunction assessed by transthoracic echocardiography showed low pulse
pressure and elevated heart rate as clinical manifestations, indicating
that they are at high risk of hemodynamic collapse. Those manifestations
seemed to be caused by lower cardiac output due to severe biventricular
dysfunction. Therefore, evaluation of RV function is useful for extracting
high risk cases of hemodynamic collapse in DCM.

<51>
Accession Number
620121219
Author
Nisa C.; Lobo M.F.; Resnic F.; Freitas A.; Azevedo L.F.; Azzone V.;
Nicolau L.B.; Teixeira-Pinto A.; Normand S.-L.; Costa-Pereira A.
Institution
(Nisa, Lobo, Freitas, Azevedo, Teixeira-Pinto, Costa-Pereira) Faculdade de
Medicina, Universidade Do Porto, Portugal
(Resnic, Azzone, Normand) Harvard Medical School United States, United
States
(Nicolau) Faculdade de Medicina, Universidade de Lisboa, Portugal
Title
Treating coronary heart disease in diabetic patients: A systematic review
of systematic reviews.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 60-61), 2016.
Date of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: Diabetes mellitus (DM) is a frequent comorbidity in patients
with coronary heart disease (CHD). CHD prevalence rises from 2% to 4% in
the general population to as high as 55% among adult diabetic patients.
The concurrence of these conditions increases the overall risk of
mortality and morbidity, particularly following invasive treatment. The
evidence base for treatment of patients with DM and CHD has been primarily
derived from cohort studies and registries. Less effort has been dedicated
to systematizing evidence from randomized controlled trials (RCTs).
Evidence synthesized from meta-analyses of randomized controlled trials
could provide information regarding effective treatments in high risk
subgroups. This issue has important implications for the selection of the
most effective treatment in these high risk patients. Objectives: To
characterize the effectiveness for treatment of CHD in DM patients.
Methods: We conducted a review of all systematic reviews and meta-analyses
of randomized controlled trials related to the treatment of CHD in DM
patients-including medical devices, drugs or a combination of the two.
Electronic searches were performed from 1980 to December 2015 combining a
variety of strategies in MEDLINE, PUBMED, EMBASE and Cochrane Database of
Systematic Reviews. Only randomized controlled trials were included in the
analysis. Two authors independently screened the titles and abstracts and
standardized data collection forms were used to extract characteristics of
included reviews and outcome data. The methodological quality of the
included reviews was assessed using the Revised Assessment of Multiple
Systematic Reviews (R-AMSTAR). Results: From initial 102 systematic
reviews identiied, 33 were included in the inal analysis. Four reviews
examined drug therapy (aIIbb3 inhibitors, ACE inhibitors, lipid lowering
drugs and b-blockers) vs placebo; another 4 reviews compared drugs (aIIbb3
inhibitors, abciximab, thienopyridines and fibrinolysis) to PCI. More
recent reviews (from 2008) focused on revascularization: CABG vs
angioplasty (8 studies) and speciic reviews for coronary stenting (15
studies), including comparative analysis between bare-metal, sirolimus,
paxlitaxel, everolimus stents and biodegradable polymer vs durable polymer
stents. Results for drug therapies were consistent. However, we observed
conlicting results between different reviews focusing on
revascularization. We will present our reassessment of the clinical
evidence for the discrepancies found.

<52>
Accession Number
620121212
Author
Rodrigues J.D.; Vasconcelos M.; Rodrigues R.A.; Amorim M.; Campelo M.;
Silva J.C.; Pinho P.; Maciel M.J.
Institution
(Rodrigues, Vasconcelos, Rodrigues, Amorim, Campelo, Silva, Pinho, Maciel)
Centro Hospitalar de S. Joao, EPE, Portugal
Title
Hybrid coronary revascularization in 100 patients with multivessel
disease: What can we expect?.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 55), 2016. Date
of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: Hybrid coronary revascularization (HCR) arises as a
combination of surgical and percutaneous intervention approach. This
strategy joins the best of two traditionally isolated treatment options in
multivessel coronary artery disease (CAD). We aim to assess procedural
feasibility the safety and clinical outcomes of patients submitted to HCR
in our institution. Methods: Since May 2008 up to December 2014, 100
consecutive patients underwent two-staged revascularization process. After
Heart Team evaluation, coronary artery bypass grafting (CABG) was
performed in the irst staged followed by percutaneous coronary
intervention (PCI). Major adverse cardiac and cerebrovascular events and
repeated target vessels revascularization (MACCE) rate were eventuated
in-hospital and at follow-up. Results: Mean age was 67 +/- 10 years and
66% of patients were males. HCR was performed after an acute coronary
syndrome in 47% of the population and the remaining had stable coronary
disease. Two-thirds of the patients had preserved left ventricular
ejection fraction. In all patients an arterial graft to the left main was
performed. Forty-nine patients also underwent other arterial or veins
grafts. CABG was carried out off-pump in 76%. PCI was performed in all
patients after surgery (interval 5 +/- 3 days) with 100% of angiographic
success using drug-eluting (67%), bare-metal stents (32%) or both (1%). No
intra-operative or in-hospital deaths were reported. Eighty three patients
had 22 +/- 14 months of follow-up. Overall population freedom from MACCE
was 97%. No cardiac death occurred. Conclusions: Hybrid coronary
revascularization may be considered a viable option in patients with
multivessel CAD. In our experience HCR has a good outcome at short and
mid-term follow-up. In spite of the lack of large randomized controlled
trials with long term follow-up, it seems reasonable to consider than HCR
can have an important role in CAD treatment.

<53>
Accession Number
620121211
Author
Caetano F.; Ledot S.; Simon A.; Kaul S.
Institution
(Caetano, Ledot, Simon, Kaul) Royal Brompton and Hareield Hospital NHS,
London, United Kingdom
Title
The role of sildenafil in the treatment of right ventricular dysfunction
and pulmonary hypertension after heart transplant and LVAD implantation.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 131-132), 2016.
Date of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: Superimposed acute right ventricular (RV) failure in the
setting of preexisting pulmonary hypertension (PH) is a nearly fatal
complication after heart transplant (HT). Despite inhaled nitric oxide
(iNO) being the "milestone" in the treatment of PH, the debate regarding
the role of new selective pulmonary vasodilators is still open.
Objectives: Evaluate the safety and eficacy of sildenail (SLD) in patients
(P) with RV dysfunction and PH, detected by echocardiography (Echo) and/or
pulmonary artery catheter, after HT and left ventricular assist device
(LVAD) implantation. Methods: Retrospective study of 33 patients (P) (85%
male; age 45.5 +/- 13.1 years) who received SLD to facilitate weaning of
IV and inhaled pulmonary vasodilators after HT or LVAD implantation.
Hemodynamic data were analyzed and Echo was performed in different moments
in time. A follow-up (FU) (9.5 +/- 6.5 months) regarding readmission and
mortality was done. Results: 39.4% of P underwent HT; 21% had a redo
surgery; LVAD P had 89 +/- 30 minutes of bypass time. 75.8% of cases were
urgent procedure. SLD was started 4.7 +/- 5.3 days after surgery, as an
infusion in 72.7% of P (cumulative dose: 156 +/- 195 mg), converted to
oral (77 +/- 17 mg/day) after 3.3 +/- 3.6 days. Remaining therapy:
adrenaline in all patients, milrinone in 97%, iNO in 94%, nitrates in 64%
and right VAD in 9.1%. Table 1 shows hemodynamic parameters evolution
during SLD administration. The duration of ventilation was 8.1 +/- 6.8
days and ITU length of stay was 19.6 +/- 19.0 days. SLD therapy was
completely stopped after 53 +/- 47 days. RV function was assessed by
TAPSE: before SLD-8.0 +/- 4.8 mm; at hospital discharge-9.8 +/- 3.7 mm and
at FU-9.7 +/- 3.4 mm. In hospital mortality was 6.1%. During FU: 87% were
classiied NYHA <= 2; 55% were re-admitted in the hospital and 6.5% died.
(Figure presented) (Table presented) Conclusions: In this study SLD
allowed a gradual weaning from inotropic and pulmonary vasodilator drugs
in P suffering from RV failure and PH after HT and LVAD implantation. Its
low cost and possible oral administration are two important advantages in
comparison with other therapies currently available.

<54>
Accession Number
620121206
Author
Moura-Ferreira S.; Silva M.; Dias T.; Guerreiro C.; Caeiro D.; Dias A.;
Ponte M.; Braga P.; Rodrigues A.; Pelicano N.; Vouga L.; Gama V.
Institution
(Moura-Ferreira, Pelicano) Hospital Do Divino Espirito Santo, Ponta
Delgada, Portugal
(Silva, Dias, Guerreiro, Caeiro, Dias, Ponte, Braga, Rodrigues, Vouga,
Gama) Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Title
Predictors of all-cause mortality during follow-up after non-emergent
coronary artery bypass graft surgery or percutaneous coronary intervention
due to left main coronary artery disease.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 54-55), 2016.
Date of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Objectives: The aim of this study was to report long-term all-cause
mortality after non-emergent coronary artery bypass graft (CABG) surgery
or percutaneous coronary intervention (PCI) due to left main coronary
artery (LMCA) disease. Methods: Retrospective, observational study
including all patients submitted to non-emergent CABG Surgery or PCI in
our centre, due to signiicant unprotected LMCA disease detected
angiographically, between January 2008 and September 2015. Information
regarding baseline characteristics, past and present medical history,
motive for CABG or PCI, type of procedure performed and localization of
the lesion in LMCA (distal vs non-distal lesion) was retrospectively
collected. All patients were followed-up and all-cause mortality was
assessed. Results: 289 patients [81.7% male; mean age 65.6 +/- 11.2 years
old; mean EuroSCORE II (ESII) 3.6 +/- 5.8], including those with stable
angina (22.8%), unstable angina (43.8%), acute non-ST-segment elevation
myocardial infarction (33%) were analysed. Of these, 226 (78.2%) patients
were submitted to CABG Surgery and 204 patients (70.6%) had signiicant
distal LMCA disease. At a median follow-up period of 1095 days, follow-up
all-cause mortality rate was 11.8%. The prevalence of most cardiovascular
risk factors was not statistically different between the group of patients
that died and the group of patients that survived during the follow-up
period. However, PCI procedure, non-distal LMCA and ESII was signiicantly
associated with the primary end-point (p < 0.01). However, after
preforming a multivariate regression analysis, only ESII remained
associated with the primary end-point (95%CI 0.80-0.94 p < 0.01). After
preforming a receiver operating characteristics (ROC) curve, we found that
AUC for ESII was 0.823 (95%CI 0.73-0.92 p < 0.01), which yield a good
discriminate power. The best cut off point for ESII was 5.97 (sensitivity
86.4% and speciicity 76.9%). In a binary logistic regression model, an
ESII equal or above 5.97 was associated with 18 times increase in the
probability of dying during follow-up. Conclusions: Our study demonstrated
that, in this population, ESII is a strong and independent predictor of
all-cause mortality during follow-up after non-emergent CABG Surgery or
PCI due to unprotected LMCA disease. Randomized controlled clinical trials
including a larger number of patients are needed to validate ESII as a
predictor of all-cause mortality in these patients.

<55>
Accession Number
620121203
Author
Moura-Ferreira S.; Silva M.; Dias T.; Guerreiro C.; Caeiro D.; Dias A.;
Ponte M.; Braga P.; Rodrigues A.; Pelicano N.; Vouga L.; Gama V.
Institution
(Moura-Ferreira, Pelicano) Hospital Do Divino Espirito Santo, Ponta
Delgada, Portugal
(Silva, Dias, Guerreiro, Caeiro, Dias, Ponte, Braga, Rodrigues, Vouga,
Gama) Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Title
Euroscore II strongly predicts all-cause mortality during follow-up in
patients with significant left main coronary artery disease undergoing
percutaneous coronary intervention or coronary artery bypass.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 54), 2016. Date
of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: EuroSCORE II (ESII) is used to predict surgical risk in
patients undergoing cardiac surgery. It is unknown whether ESII accurately
predicts all-cause mortality during follow-up in patients with signiicant
left main coronary artery (LMCA) disease undergoing percutaneous coronary
intervention (PCI) or Coronary artery bypass graft (CABG). Methods:
Retrospective, observational study, including all patients undergoing
unprotected LMCA PCI or CABG due to signiicant ULMCA disease detected
angiographically between january 2008 and december 2015. ESII was
calculated and all-cause mortality during follow-up was collected for all
patients. We used a Mann Whitney U test to compare ESII between patients
that survived and patients that died during follow after being submitted
to LMCA stenting or CABG. A receiver operating characteristics (ROC) curve
was used to obtain the best cut-off value of ESII to predict all-cause
mortality in each group. Then ESII was transformed into a categorical
variable with 2 groups and a binary logistic regression analysis was
conducted to test the strength of prediction of the projected value of
ESII to assess follow-up mortality. Results: Between January 2008 and
September 2015, 84 patients undergoing PCI and 248 patients undergoing
CABG Surgery due to signiicant ULMCA disease, were consecutively enrolled.
At a median follow-up of 690 days, all-cause mortality rate for patients
undergoing PCI was 29.7%. ESII mean values were signiicantly different
between patients that survived (6.0 +/- 1.1) and patients that died during
follow-up (16.4 +/- 3.1) (p < 0.01). Area under the curve (AUC) for ESII
was 0.823 (95%CI 0.72-0.92 p < 0,01), which yield a good discriminate
power. We considered the best cut off point for ESII to be 5.97
(sensitivity 86.4%, speciicity 76.9%). In a binary logistic regression
model, an ESII equal or above 5.97 was associated with a 21 times increase
in the probability of dying during follow-up after ULMCA stenting. In what
concerns patients undergoing CABG, at a median follow-up of 1170 days,
all-cause mortality rate was 8%. ESII mean values were also signiicantly
different between patients that survived and died during follow-up (5.5
+/- 2.4 vs 2.1 +/- 4.8, p < 0.01). AUC for ESII was 0.73 (95%CI 0.61-0.86
p < 0.01), which yield a good discriminate power. We found that the best
cut off point for ESII was 1.37 (sensitivity 84.2% and speciicity 55.6%).
In a binary logistic regression model, an ESII equal or above 1.37 was
associated with a 7 times increase in the probability of dying during
follow-up after CABG. Conclusions: In our study, we concluded that ESII
accurately predicts all-cause mortality during follow-up in patients with
signiicant LMCA disease undergoing PCI or CABG. Randomized controlled
clinical trials including a larger number of patients are needed to
validate ESII as a predictor of all-cause mortality in these patients.

<56>
Accession Number
620121171
Author
Mendes S.L.; Oliveira-Santos M.; Leite L.; Alves P.M.; Ferreira J.M.;
Marques J.; Ferreira M.J.; Ramos D.; Macario F.; Ferreira C.A.B.; Mota A.;
Pego M.
Institution
(Mendes, Oliveira-Santos, Leite, Alves, Ferreira, Marques, Ferreira,
Ramos, Macario, Ferreira, Mota, Pego) Centro Hospitalar e Universitario de
Coimbra, Hospitais da Universidade de Coimbra, Portugal
Title
Who is the population of patients with end-stage renal disease undergoing
renal transplantation?.
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (pp 197), 2016. Date
of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction: The inextricable link between the heart and the kidneys
predestines that signiicant cardiovascular disease (CVD) ensues in the
face of end-stage renal disease (ESRD). Despite the enormous
cardiovascular burden that ESRD poses, few randomized control studies have
included these patients. In this study we sought to evaluate the
prevalence and the types of CVD in patients with ESRD undergoing renal
transplantation. Methods: The data of 226 consecutive patients who
underwent renal transplantation from January 2009 to December 2010 were
evaluated. Data regarding demographic, clinical, blood test and
echocardiographic parameters as well as myocardial perfusion scintigraphy
and cardiac angiogram results were collected. Continuous data are
presented as the mean +/- standard deviation (SD) or median (interquartile
range), as appropriate. Categoric data are given as group percentages.
Results: The median age of patients was 57 (52-61) years, of whom 65.5%
were male. The prevalence of major atherosclerotic risk factors was as
follows: arterial hypertension 90.9%, dyslipidemia 68.3%, diabetes
mellitus 32.1% and smoking 21.3%. Heart failure occurred in 4.4%, 5.5% had
a history of peripheral arterial disease, 8.8% had prior stroke and 4.9%
patients had previous myocardial infarction. Regarding to medication, the
percentage of patients treated with antiplatelet drug was 56.5%,
angiotensin-converting enzyme inhibitors 28.1%, beta blocker 28.6%, and
statin 26.1%. According to American Society of Transplantation and the
European Renal Association-European Dialyses and Transplant Association,
198 patients (87.6%) were considered as intermediate to high risk
probability of coronary artery disease (CAD). Electrocardiogram was
performed on all patients and myocardial perfusion scintigraphy on 136
(60.2%). CAD was identiied in 15 of 34 patients (44.1%) who had undergone
angiography. Seven patients underwent percutaneous coronary intervention,
and coronary bypass surgery was performed on four cases prior to renal
transplantation. On echocardiography examination median ejection fraction
was 64.5% (60-68%) and left ventricular hypertrophy was detected in 81
patients (41.8%). Conclusions: The indings of this study indicate that CVD
and atherosclerotic risk factors are common in patients with ESRD
undergoing renal transplantation. As a result risk stratiication is a
dificult task, prospective randomized, controlled trials with long-term
follow-up are needed to reach more concrete conclusions about the impact
of preoperative cardiovascular disease and the best strategy able to
minimize cardiovascular events in these patients.

<57>
Accession Number
620121072
Author
Anonymous
Source
Revista Portuguesa de Cardiologia. Conference: Congresso Portugues de
Cardiologia, CPC 2016. Portugal. 35 (1 Supplement 1) (no pagination),
2016. Date of Publication: April 2016.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
The proceedings contain 510 papers. The topics discussed include: safety
and long-term outcomes of catheter ablation of atrial fibrillation using
magnetic navigation vs manual conventional ablation - a propensity score
analysis; ICD and prevention of sudden cardiac death in hypertrophic
cardiomyopathy: what has changed in the new guidelines?; the role of
galectine-3 levels in the early diagnosis of hypertrophic cardiomyopthy
mutation carriers; predictors of all-cause mortality during follow-up
after non-emergent coronary artery bypass graft surgery or percutaneous
coronary intervention due to left main coronary artery disease; EUROSCORE
II strongly predicts all-cause mortality during follow-up in patients with
significant left main coronary artery disease undergoing percutaneous
coronary intervention or coronary artery bypass; hybrid coronary
revascularization in 100 patients with multivessel disease: what can we
expect?; procedures for left main coronary artery disease in the real
world clinical practice - sents, CABG, or hybrid procedures - a single
centre experience; feasibility and safety of right coronary artery
revascularization strategies: percutaneous intervention versus saphenous
vein graft; risk of major gastrointestinal bleeding with non-vitamin k
antagonist oral anticoagulants: systematic review with meta-analysis;
infective endocarditis: analysis of in-hospital outcomes and predictors of
major complications; sex differences in presenting symptoms of acute
coronary syndrome; and arrhythmic risk and genetic variations in dilated
cardiomyopathy patients.

<58>
Accession Number
619897437
Author
Savonitto S.; Morici N.; Nozza A.; Cosentino F.; Perrone Filardi P.;
Murena E.; Morocutti G.; Ferri M.; Cavallini C.; Eijkemans M.J.C.; Stahli
B.E.; Schrieks I.C.; Toyama T.; Lambers Heerspink H.J.; Malmberg K.;
Schwartz G.G.; Lincoff A.M.; Ryden L.; Tardif J.C.; Grobbee D.E.
Institution
(Savonitto) Division of Cardiology, Ospedale Alessandro Manzoni, Lecco,
Italy
(Morici) Cardiovascular Department, Ospedale Niguarda Ca' Granda, Milano,
Italy
(Nozza, Tardif) Montreal Health Innovations Coordinating Center (MHICC),
Montreal, QC, Canada
(Cosentino, Malmberg, Ryden) Cardiology Unit, Department of Medicine,
Karolinska University Hospital, Stockholm, Sweden
(Perrone Filardi) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(Murena) Division of Cardiology, Ospedale Santa Maria delle Grazie,
Pozzuoli, Italy
(Morocutti) Cardiothoracic Department, University Hospital 'Santa Maria
della Misericordia', Udine, Italy
(Ferri) Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio
Emilia, Italy
(Cavallini) Division of Cardiology, Ospedale Santa Maria della
Misericordia, Perugia, Italy
(Eijkemans, Schrieks, Grobbee) Julius Center for Health Sciences and
Primary Care and Julius Clinical, University Medical Center Utrecht,
Utrecht, Netherlands
(Stahli, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, QC, Canada
(Toyama) The George Institute for Global Health, Camperdown, NSW,
Australia
(Lambers Heerspink) Department of Clinical Pharmacy and Pharmacology,
University Medical Center Groningen, Groningen, Netherlands
(Schwartz) Veterans Affairs Medical Center, School of Medicine, University
of Colorado, Denver, CO, United States
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
Title
Predictors of mortality in hospital survivors with type 2 diabetes
mellitus and acute coronary syndromes.
Source
Diabetes and Vascular Disease Research. 15 (1) (pp 14-23), 2018. Date of
Publication: 01 Jan 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Aim: To define the predictors of long-term mortality in patients with type
2 diabetes mellitus and recent acute coronary syndrome. Methods and
results: A total of 7226 patients from a randomized trial, testing the
effect on cardiovascular outcomes of the dual peroxisome
proliferator-activated receptor agonist aleglitazar in patients with type
2 diabetes mellitus and recent acute coronary syndrome (AleCardio trial),
were analysed. Median follow-up was 2 years. The independent mortality
predictors were defined using Cox regression analysis. The predictive
information provided by each variable was calculated as percent of total
chi-square of the model. All-cause mortality was 4.0%, with cardiovascular
death contributing for 73% of mortality. The mortality prediction model
included N-terminal proB-type natriuretic peptide (adjusted hazard ratio =
1.68; 95% confidence interval = 1.51-1.88; 27% of prediction), lack of
coronary revascularization (hazard ratio = 2.28; 95% confidence interval =
1.77-2.93; 18% of prediction), age (hazard ratio = 1.04; 95% confidence
interval = 1.02-1.05; 15% of prediction), heart rate (hazard ratio = 1.02;
95% confidence interval = 1.01-1.03; 10% of prediction), glycated
haemoglobin (hazard ratio = 1.11; 95% confidence interval = 1.03-1.19; 8%
of prediction), haemoglobin (hazard ratio = 1.01; 95% confidence interval
= 1.00-1.02; 8% of prediction), prior coronary artery bypass (hazard ratio
= 1.61; 95% confidence interval = 1.11-2.32; 7% of prediction) and prior
myocardial infarction (hazard ratio = 1.40; 95% confidence interval =
1.05-1.87; 6% of prediction). Conclusion: In patients with type 2 diabetes
mellitus and recent acute coronary syndrome, mortality prediction is
largely dominated by markers of cardiac, rather than metabolic,
dysfunction.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<59>
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.

<60>
Accession Number
619331514
Author
Phan K.; Abi-Hanna D.; Kerferd J.; Lu V.M.; Dmytriw A.A.; Ho Y.-T.;
Fairhall J.; Reddy R.; Wilson P.
Institution
(Phan, Abi-Hanna, Kerferd) NeuroSpine Surgery Research Group, Prince of
Wales Private Hospital, Sydney, Australia
(Phan, Lu, Ho) Sydney Medical School, University of Sydney, Sydney,
Australia
(Dmytriw) Department of Medical Imaging, University of Toronto, Toronto,
Canada
(Fairhall, Reddy, Wilson) Department of Neurosurgery, Prince of Wales
Hospital, Randwick, Sydney, Australia
Title
Resumption of Antithrombotic Agents in Chronic Subdural Hematoma: A
Systematic Review and Meta-analysis.
Source
World Neurosurgery. 109 (pp e792-e799), 2018. Date of Publication: January
2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The clinical decision whether and when to resume
antithrombotics in patients with chronic subdural hematomas (CSDH)
postoperatively is limited by a lack of quality evidence exploring this
topic. Our study aims to assess the available evidence of patient
complication outcomes, specifically hemorrhagic and thromboembolic events,
following the resumption or non-resumption of antithrombotic agents
postoperatively in CSDH patients already on these agents before CSDH.
Methods We followed recommended PRISMA guidelines for systematic reviews.
Electronic database searches were performed to identify included studies.
Data were extracted and analyzed using meta-analysis. Results Eight
studies were included for analysis. The most common indication for
antithrombotic treatment before onset of CSDH was atrial fibrillation
(29.6%), followed by prosthetic heart valve (16.6%), recent myocardial
infarction (14.1%), prior stroke or transient ischemic attack (11.6%), and
finally venous thromboembolism (8.3%). The overall hemorrhagic
complication rate was 14.8% in the resumption group versus 18.6% in the no
resumption group (P = 0.591). This did not differ between early (<2 weeks)
versus late (>1 month) resumption (15% vs. 18.6%, P = 0.97). The rate of
thromboembolism however was statistically lower in those who resumed
antithrombotics (2.9% vs. 6.8%, P<0.001). There was a non-significant
trend towards higher thromboembolic rates with early resumption (5.3% vs.
2.1%, P = 0.23). Conclusions The decision to resume antithrombotics
postoperatively in the clinical management of CSDH patients is a complex
one and should therefore be a highly individualized process. Our
meta-analysis demonstrates that in selected cases, it is feasible to
resume early antithrombotic treatment without additional hemorrhagic or
thromboembolic risk.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<61>
Accession Number
619724580
Author
Okrainec K.; Lau D.; Abrams H.B.; Hahn-Goldberg S.; Brahmbhatt R.; Huynh
T.; Lam K.; Bell C.M.
Institution
(Okrainec, Abrams) University Health Network, Toronto, ON, Canada
(Okrainec, Abrams, Lam, Bell) Department of Medicine, University of
Toronto, ON, Canada
(Okrainec, Abrams, Hahn-Goldberg, Brahmbhatt, Huynh) OpenLab, University
Health Network, Toronto, ON, Canada
(Lau, Bell) Samuel Lunenfeld Research Institute, Mount Sinai Hospital,
Toronto, ON, Canada
(Bell) University of Toronto Institute of Health Policy, Management and
Evaluation, ON, Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
Title
Impact of patient-centered discharge tools: A systematic review.
Source
Journal of Hospital Medicine. 12 (2) (pp 110-117), 2017. Date of
Publication: February 2017.
Publisher
Society of hospital medicine (E-mail: jhospitalmedicine@jjeditorial.com)
Abstract
BACKGROUND: Patient-centered discharge tools provide an opportunity to
engage patients, enhance patient understanding, and improve capacity for
self-care and postdischarge outcomes. PURPOSE: To review studies that
engaged patients in the design or delivery of discharge instruction tools
and that tested their effect among hospitalized patients. DATA SOURCES: We
conducted a search of 12 databases and journals from January 1994 through
May 2014, and references of retrieved studies. STUDY SELECTION:
English-language studies that tested discharge tools meant to engage
patients were selected. Studies that measured outcomes after 3 months or
without a control group or period were excluded. DATA EXTRACTION: Two
independent reviewers assessed the full-text papers and extracted data on
features of patient engagement. DATA SYNTHESIS: Thirty articles met
inclusion criteria, 28 of which examined educational tools. Of these, 13
articles involved patients in content creation or tool delivery, with only
6 studies involving patients in both. While many of these studies (10
studies) demonstrated an improvement in patient comprehension, few studies
found improvement in patient adherence despite their engagement. A few
studies demonstrated an improvement in self-efficacy (2 studies) and a
reduction in unplanned visits (3 studies). CONCLUSIONS: Improving patient
engagement through the use of media, visual aids, or by involving patients
when creating or delivering a discharge tool improves comprehension.
However, further studies are needed to clarify the effect on patient
experience, adherence, and healthcare utilization postdischarge. Better
characterization of the level of patient engagement when designing
discharge tools is needed given the heterogeneity found in current
studies.<br/>Copyright &#xa9; 2017 Society of Hospital Medicine.

<62>
Accession Number
612903022
Author
Eisenberger M.; Bulava A.; Kautzner J.; Neuzil P.; Mokracek A.; Hanis J.;
Dusek L.
Institution
(Eisenberger, Mokracek, Hanis) South Bohemia Cardiac Centre, Budweis
Hospital, B. Nemcove 54, Budweis, Czech Republic
(Eisenberger) South Bohemia University, Faculty of Health and Social
Studies, J. Boreckeho 27, Budweis, Czech Republic
(Kautzner) Institute for Clinical and Experimental Medicine, Department of
Cardiology, Videnska 1958/9, Prague, Czech Republic
(Neuzil) Department of Cardiology, Na Homolce Hospital, Roentgenova 2,
Prague, Czech Republic
(Dusek) The Institute of Biostatistics and Analyses, Masaryk University,
Kamenice 5, Brno, Czech Republic
(Bulava) Palacky University Olomouc, Faculty of Medicine and Dentistry,
Olomouc, Czech Republic
Title
Sequential Hybrid CryoMaze Ablation versus Surgical CryoMaze Alone for the
Treatment of Atrial Fibrillation (SurHyb): Study protocol for a randomized
controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 518. Date of
Publication: 24 Oct 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation is common in patients with structural
heart disease who are undergoing cardiac surgery. Surgical CryoMaze has
been shown to be an effective treatment in several trials, but success
rates have varied considerably, between 47-95 %. The sequential hybrid
approach, combining surgical CryoMaze followed by radiofrequency catheter
ablation, can achieve high freedom from atrial arrhythmias, even when
rigorous methods to detect arrhythmias after the procedure are used.
However, data from randomized trials comparing hybrid ablations to
surgical ablations alone are lacking. Methods/Design: The SurHyb study is
a prospective, multicenter, randomized study. Patients with persistent or
long-standing persistent atrial fibrillation will be randomized to either
surgical CryoMaze alone or surgical CryoMaze followed by catheter ablation
3 months post-surgery. The primary outcome measure is arrhythmia-free
survival without class I or III antiarrhythmic drugs, which will be
evaluated using 7-day ECG Holter monitoring at 24 months. A total of 260
patients will be investigated from three medical centers in the Czech
Republic to obtain the relevant information. Discussion: This is the first
randomized study that compares surgical CryoMaze alone with the staged
hybrid surgical CryoMaze followed by catheter ablation in patients with
persistent or long-standing persistent atrial fibrillation. These results
will contribute to the optimization of the treatment for these patients.
Trial registration: Czech Clinical Trials Registry, cz-301020151253.
Registered on 30 October 2015.<br/>Copyright &#xa9; 2016 The Author(s).

<63>
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.

<64>
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.

<65>
Accession Number
619909836
Author
Verhamme P.; Herregods M.-C.; Van Dewerf F.
Institution
(Verhamme, Herregods, Van Dewerf) Division of Cardiovascular Diseases,
University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
Title
Anticoagulation of pregnant women with mechanical heart valves: Protecting
mother or child?.
Source
European Heart Journal. 38 (19) (pp 1517-1519), 2017. Date of Publication:
14 May 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)

<66>
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).

<67>
Accession Number
620002983
Author
Thiele H.; Akin I.; Sandri M.; Fuernau G.; De Waha S.; Meyer-Saraei R.;
Nordbeck P.; Geisler T.; Landmesser U.; Skurk C.; Fach A.; Lapp H.; Piek
J.J.; Noc M.; Goslar T.; Felix S.B.; Maier L.S.; Stepinska J.; Oldroyd K.;
Serpytis P.; Montalescot G.; Barthelemy O.; Huber K.; Windecker S.;
Savonitto S.; Torremante P.; Vrints C.; Schneider S.; Desch S.; Zeymer U.
Institution
(Thiele, Sandri, Desch) Heart Center Leipzig, University Hospital,
Department of Internal Medicine-Cardiology, Strumpellstr. 39, Leipzig
04289, Germany
(Akin) Universitatsmedizin Mannheim, Mannheim, Germany
(Fuernau, De Waha, Meyer-Saraei) University Heart Center Lubeck, Lubeck,
Germany
(Fuernau, De Waha, Meyer-Saraei, Landmesser, Skurk, Felix, Desch) German
Center for Cardiovascular Research (DZHK), Campus Benjamin Franklin,
Berlin, Germany
(Landmesser, Skurk) Universitatsklinikum Charite, Campus Benjamin
Franklin, Berlin, Germany
(Nordbeck) Universitatsklinikum Wurzburg, Wurzburg, Germany
(Geisler) Klinikum der Eberhard-Karls-Universitat Tubingen, Tubingen,
Germany
(Fach) Klinikum Links der Weser, Bremen, Germany
(Lapp) Helios Klinik Erfurt, Erfurt, Germany
(Felix) Ernst-Moritz-Arndt-Universitat, Greifswald, Germany
(Maier) Universitares Herzzentrum Regensburg, Regensburg, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Zeymer) Klinikum Ludwigshafen, Ludwigshafen, Germany
(Piek) Academic Medical Center, Amsterdam, Netherlands
(Noc, Goslar) University Medical Center Ljubljana, Ljubljana, Slovenia
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Serpytis) Vilnius University Hospital Santaros Klinikos, Faculty of
Medicine, Vilnius University, Vilnius, Lithuania
(Montalescot, Barthelemy) Sorbonne Universite Paris 6, ACTION Study Group,
Centre Hospitalier Universitaire Pitie-Salpetriere, United Kingdom
(Torremante) Applied Research, Technology Transfer, Industrial
Collaboration, SocietePar Actions Simplifiee, Paris, France
(Huber) Wilhelminenspital, Department of Cardiology, Sigmund Freud
University, Medical School, Vienna, Austria
(Windecker) University of Bern, Inselspital, Bern, Switzerland
(Savonitto) Manzoni Hospital, Lecco, Italy
(Vrints) Universitair Ziekenhuis Antwerp, Antwerp, Belgium
Title
PCI strategies in patients with acute myocardial infarction and
cardiogenic shock.
Source
New England Journal of Medicine. 377 (25) (pp 2419-2432), 2017. Date of
Publication: 21 Dec 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In patients who have acute myocardial infarction with
cardiogenic shock, early revascularization of the culprit artery by means
of percutaneous coronary intervention (PCI) improves outcomes. However,
the majority of patients with cardiogenic shock have multivessel disease,
and whether PCI should be performed immediately for stenoses in nonculprit
arteries is controversial. METHODS In this multicenter trial, we randomly
assigned 706 patients who had multivessel disease, acute myocardial
infarction, and cardiogenic shock to one of two initial revascularization
strategies: either PCI of the culprit lesion only, with the option of
staged revascularization of nonculprit lesions, or immediate multivessel
PCI. The primary end point was a composite of death or severe renal
failure leading to renal-replacement therapy within 30 days after
randomization. Safety end points included bleeding and stroke. RESULTS At
30 days, the composite primary end point of death or renal-replacement
therapy had occurred in 158 of the 344 patients (45.9%) in the
culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in
the multivessel PCI group (relative risk, 0.83; 95% confidence interval
[CI], 0.71 to 0.96; P=0.01). The relative risk of death in the
culprit-lesion-only PCI group as compared with the multivessel PCI group
was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of
renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The
time to hemodynamic stabilization, the risk of catecholamine therapy and
the duration of such therapy, the levels of troponin T and creatine
kinase, and the rates of bleeding and stroke did not differ significantly
between the two groups. CONCLUSIONS Among patients who had multivessel
coronary artery disease and acute myocardial infarction with cardiogenic
shock, the 30-day risk of a composite of death or severe renal failure
leading to renal-replacement therapy was lower among those who initially
underwent PCI of the culprit lesion only than among those who underwent
immediate multivessel PCI.<br/>Copyright &#xa9; 2017 Massachusetts Medical
Society.

<68>
Accession Number
618198288
Author
Khan S.U.; Rahman H.; Arshad A.; Khan M.U.; Lekkala M.; Yang T.; Mishra
A.; Kaluski E.
Institution
(Khan, Rahman, Lekkala, Yang, Mishra, Kaluski) Guthrie Health
System/Robert Packer Hospital, Sayre, PA, United States
(Arshad) Unity Hospital/Rochester Regional Health System, Rochester, NY,
United States
(Khan) West Virginia University School of Medicine, Morgantown, WV, United
States
(Kaluski) Rutgers Medical School, Newark, NY, United States
(Kaluski) Geisinger Commonwealth School of Medicine, Scranton, PA, United
States
Title
Percutaneous Coronary Intervention Versus Surgery in Left Main Stenosis-A
Meta-Analysis and Systematic Review of Randomised Controlled Trials.
Source
Heart Lung and Circulation. 27 (2) (pp 138-146), 2018. Date of
Publication: February 2018.
Publisher
Elsevier Ltd
Abstract
Objective To investigate the safety and efficacy of percutaneous coronary
interventions (PCI) versus coronary artery bypass graft (CABG) surgery for
left main coronary artery (LMCA) disease. Methods Six randomised
controlled trials (RCTs) were reviewed by searching PubMed/Medline, Embase
and the Cochrane Library. Estimates were pooled according to random
effects model. Binary outcomes were reported as risk ratio (RR) and
continuous outcomes were reported as mean difference (MD) with 95%
confidence interval (CI). Results 3794 patients were randomised into PCI
and CABG arms. Mean age of the total population was 64.7 years, 74.4% were
male and mean Logistic EURO score (LES) was 2.9. When compared with CABG,
patients treated with PCI had reduced risk of major adverse cardiovascular
events (MACE) at 30 days: (RR: 0.55; 95% CI, 0.41-0.75; p < 0.001;
I² = 0) but similar risk at 1 year (RR: 1.15; 95% CI,
0.92-1.45; p = 0.22; I² = 0). Five years MACE rates favoured
CABG (RR: 1.32; 95% CI, 1.13-1.53; p < 0.001; I² = 0) driven by
a higher rate of target vessel revascularisation (TVR) (RR: 1.71; 95%CI,
1.38-2.12; p < 0.001; I² = 0) and myocardial infarction (MI)
(RR: 1.97; 95%CI, 1.28-3.04; p < 0.001; I² = 22). Percutaneous
coronary intervention was comparatively a safer procedure with lower rates
of periprocedural adverse events including MI, stroke, bleeding events and
need for blood transfusions. Conclusion Percutaneous coronary intervention
reduced MACE at 30 days with comparable MACE at 1 year. However, CABG was
a more effective modality when considering mid- to long-term outcomes. PCI
is a safer procedure with regards to periprocedural adverse
events.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<69>
Accession Number
615868858
Author
Singh K.; Carson K.; Rashid M.K.; Jayasinghe R.; AlQahtani A.; Dick A.;
Glover C.; Labinaz M.
Institution
(Singh, Carson, Jayasinghe) Griffith University, Brisbane, Qld, Australia
(Singh) Gold Coast University Hospital, Brisbane, Qld, Australia
(Rashid, AlQahtani, Dick, Glover, Labinaz) University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
Title
Transcatheter Aortic Valve Implantation in Intermediate Surgical Risk
Patients With Severe Aortic Stenosis: A Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. 27 (2) (pp 227-234), 2018. Date of
Publication: February 2018.
Publisher
Elsevier Ltd
Abstract
Background Recent data from randomised and observational studies have
reported non-inferior outcomes for transcatheter aortic valve implantation
(TAVI) compared to surgical aortic valve replacement (SAVR) in
intermediate-risk patients. We performed a systematic review to evaluate
the mortality of TAVI compared to SAVR in intermediate-risk patients.
Methods A comprehensive search of four major databases (Embase, Ovid
MEDLINE, PubMed, and Google Scholar) was performed from their inception to
29 April 2016. We included original research studies reporting data on
TAVI and SAVR in intermediate-risk patients. We compared the outcomes of
TAVI to SAVR. Results A total of 2,375 and 2,377 intermediate-risk
patients underwent TAVI and SAVR respectively. The 30-day all-cause (p =
0.07), 30-day cardiac (p = 0.53), and 12-month all-cause mortality (p =
0.34) was similar between the two groups. However, TAVI through
transfemoral access had a significantly lower mortality than SAVR (OR
0.58, p = 0.006). The incidence of >=moderate aortic incompetence (p <
0.00001) and pacemaker implantation (p < 0.0001) was higher in the TAVI
group. Conclusions In the intermediate-risk patients, the 30-day and
12-month mortality are similar between TAVI and SAVR. Increased operator
experience and improved device technology have led to a significant
reduction in mortality in intermediate-risk patients undergoing
TAVI.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<70>
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Accession Number
620080368
Author
Browder K.; Thomas C.; Valentine K.; Moser E.; Brown J.
Institution
(Browder, Thomas, Valentine, Moser, Brown) N/A 2Riley Hospital for
Children at IU Health, Indianapolis, IN, 3Riley Hospital for Children,
Indiana University School of Medicine, N/A, 4Indiana University Health,
Indianapolis, United States, 5Riley Hospital for Children, Indianapolis,
IN
Title
The opioid-and sedative-sparing effects of chlorpromazine in pediatric cv
surgery patients.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
108), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Chlorpromazine studies in pediatric patients are
limited to the setting of procedural sedation. Despite the lack of safety
and efficacy data for other indications, our institution uses
chlorpromazine as an adjunct to sedation after cardiovascular (CV)
surgery. The objective of this study was to determine the opioid-and
sedative-sparing effects of chlorpromazine. We hypothesized that
chlorpromazine use would decrease opioid requirements. Methods: In this
retrospective cohort control study, patients aged one month to three years
who received chlorpromazine within 72 hours of CV surgery between January
1, 2010 and August 1, 2016 were included. Patients who received
chlorpromazine were matched with patients who did not receive
chlorpromazine in a 1:1 ratio based on age, disease severity, and
post-operative day. Patients with trisomy 21 were included in the study
and analyzed separately. The primary endpoint was the cumulative daily
dose of opioids in the 72 hours following chlorpromazine initiation and
secondary endpoints included the cumulative dose of sedatives, mechanical
ventilation duration, and mortality. Results: Fourty-eight patients who
received chlorpromazine were matched with 48 patients who did not. There
was no significant difference in the median opioid dose (in fentanyl
equivalents) between groups at 24 hours (5.7 [3.7-29.3] vs. 5.0 [3.6-21.7]
mcg/kg; p = 0.58) and 72 hours (10.6 [6.9-54.8] vs. 11.7 [8.5-42.1]
mcg/kg; p = 0.93) post-operatively. Dexmedetomidine was identified as the
primary sedative utilized. Patients who received chlorpromazine had higher
baseline dexmedetomidine requirements compared to controls (5.15 [2.1-9.6]
vs. 2.73 [0-6.21] mcg/kg; p = 0.002). Following chlorpromazine
administration, dexmedetomidine requirements decreased, and were
significantly less than dexmedetomidine requirements of control patients
matched for post-operative day (1.63 [0-14.83] vs. 10.42 [4.52-18.54]
mcg/kg; p = 0.045). Conclusions: Chlorpromazine use was not associated
with a reduction in opioid requirements but did result in a lower
cumulative dexmedetomidine dose compared to controls.

<71>
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Accession Number
620080264
Author
Hawn J.; Wanek M.; Bauer S.; Ammar M.; Insler S.; Adi A.; Torbic H.
Institution
(Hawn, Wanek, Bauer, Ammar, Insler, Adi, Torbic) N/A, N/A, 2Cleveland
Clinic Foundation, Cleveland, OH, 3N/A, Cleveland, OH, 4N/A, New Haven,
CT, 5Cleveland Clinic, Cleveland, OH
Title
Evaluation of inhaled flolan versus inhaled veletri in a cardiothoracic
surgery patient population.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
62), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Flolan and Veletri are two brand products of
epoprostenol which have been administered via the inhalation route in
cardiac surgery patients to correct hypoxemia, decrease pulmonary arterial
pressure, and improve right ventricular function. Flolan and Veletri vary
in stability, diluent, and inactive ingredients and it is unknown if these
variances lead to differences in effectiveness and safety via the
inhalation route. The aim of this project was to evaluate a formulary
conversion from inhaled Flolan (iFLO) to inhaled Veletri (iVEL) to
determine the impact on effectiveness, safety, or cost in cardiothoracic
surgery patients. Methods: This was a retrospective, non-inferiority study
performed at a large academic medical center comparing iFLO and iVEL in
cardiothoracic surgery patients. Included subjects were >=18 years old,
who were admitted to the cardiothoracic intensive care unit, and received
iFLO or iVEL therapy for >= 1 hour while being mechanically ventilated
between January 1, 2015 and December 1, 2016. Results: A total of 244
patients were included in the primary outcome analysis. There were no
significant differences in baseline characteristics between the iFLO and
iVEL groups. The primary outcome, change in the
PaO<inf>2</inf>/FiO<inf>2</inf> ratio one hour after administration of
iFLO or iVEL, did not cross the lower limit of the noninferiority margin
of-20 mm Hg (95% CI =-14.8 to 65.4 mm Hg). Significant differences in
secondary outcomes included duration of mechanical ventilation (iFLO 4.4
vs iVEL 2.6 days; p < 0.01), number of patients requiring tracheostomy
(iFLO 19.7% vs iVEL 7.4%; p = 0.01), number of patients initiated on
dialysis (iFLO 20.5% vs iVEL 9.8%; p = 0.02), and cost per median duration
of therapy (iFLO $257.08 vs iVEL $183.30; p = 0.02). Conclusions: Inhaled
Veletri is non-inferior to inhaled Flolan when comparing change in
PaO<inf>2</inf>/FiO<inf>2</inf> ratio one hour after therapy initiation.
The conversion from inhaled Flolan to inhaled Veletri was likely
justified.

<72>
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Accession Number
620080259
Author
Cervantes C.E.; Lee C.C.; Wulff L.; Shaharyar S.; Iguina M.
Institution
(Cervantes, Lee, Wulff, Shaharyar, Iguina) N/A, Aventura, FL, 2Aventura
Medical Center, Aventura, FL, 3N/A, Weston, FL, 4Aventura Hospital Medical
Center, Aventura, FL, 5Aventura Hospital and Medi461 cal Center, Aventura,
FL
Title
Effect of dexmedetomidine on perioperative kidney function during
cardiovascular surgery.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
666), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Dexmedetomidine is a highly selective alpha 2
adrenoreceptor agonist possessing sedative as well as analgesic effects.
Initial data has suggested a clinic benefit in patients undergoing
cardiovascular surgery. However, the role of dexmedetomidine in improving
kidney function and preventing acute kidney injury is controversial. The
present review aims to collect and summarize published data on the
dexmedetomidine use, either perioperative or postoperative, to evaluate if
it affects kidney function in patients receiving cardiovascular surgery.
Methods: Studies reviewed were selected based on relevance from a
systematic literature search conducted in Medline and EMBASE to include
all published original research through July 2016. Ten prospective studies
matched the inclusion criteria. Results: When kidney function was
evaluated with conventional makers (creatinine and creatinine clearance),
majority of studies showed no benefit with periprocedural dexmedetomidine
administration in preventing postoperative renal injury. 4 of 5 studies
demonstrated no statistically significant difference in creatinine
clearance 24 hours post-operatively. 5 of 6 studies failed to demonstrate
a significant difference in serum creatinine. 4 studies reported incidence
of acute kidney injury, determined variously by AKIN or RIFLE criteria.
Among them, 3 of 4 studies failed to detect statistically difference
between dexmedetomidine and placebo group. Interestingly, 3 of 6 included
studies demonstrated an increase in urine output 24 hours post-operatively
in patients receiving perioperative dexmedetomidine infusion. Only one
study reported and demonstrated lower concentration of kidneyspecific
urinary proteins, proinflammatory cytokines and lower cystatin C in
patients who received dexmedetomidine. One study used neutrophil
gelatinase-associated lipocalin (NGAL) to assess early development of
acute kidney injury and it showed significantly lower NGAL level in
patients receiving perioperative dexmedetomidine infusion. Conclusions:
The present review failed to demonstrate a benefit in prevention of acute
kidney injury with perioperative dexmedetomidine administration. Although
no clinical benefit was demonstrated in our review, studies which measured
subclinical markers of renal injury as well as urine output demonstrated a
protective effect of dexmedetomidine. However, these data are only
available from single studies for inflammatory markers and NGAL. Urine
output results were equivocal across studies. The present.

<73>
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Accession Number
620080752
Author
Fox M.; Perry M.; Liu-DeRyke X.
Institution
(Fox, Perry, Liu-DeRyke) N/A, Orlando, FL, 2N/A, Ocoee, FL
Title
Insulin glargine in critically ill patients: Once-daily compared to
twice-daily dosing.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
195), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Critically ill patients frequently develop
hyperglycemia and long acting insulin glargine, traditionally dosed
once-daily (daily), is often used for glucose management. However,
twice-daily insulin (BID) glargine dosing has been used due to concern for
pharmacokinetic changes in critically ill patients. Data evaluating BID
glargine use is limited to outpatients with type 1 diabetes mellitus (DM).
This study evaluated the safety and efficacy of BID compared to daily
insulin glargine in the critically ill. Methods: This was a retrospective
chart review of adult patients admitted to ICUs at Orlando Regional
Medical Center between February 2013 and June 2017. Patients who received
BID or >=40 units daily of insulin glargine for >=48 hours were included.
Post cardiovascular surgery patients were excluded. Demographics,
concomitant therapies, point-of-care blood glucoses (BG), and insulin
usage were collected. Efficacy was assessed by overall hyperglycemia (BG>
180 mg/dL), predose hyperglycemia (BG> 180 mg/dL within 4 hours before the
dose) which was normalized for the number of insulin glargine doses, and
BG variability (standard deviation). Safety was assessed by the incidence
of hypoglycemia (BG< 70 mg/dL) and severe hypoglycemia (BG< 40 mg/dL).
Data was analyzed using SPSS and a p-value of < 0.05 was considered
statistically significant. Results: Fifty-eight patients were included for
data analysis (daily n = 35 vs BID n = 23). Demographics were similar
including DM history, home insulin use, and BG at study entry. There was
no difference in daily correctional insulin required, but the BID group
received a higher total daily insulin glargine dose compared to the daily
group (58 vs 45 units, p = 0.04). Hyperglycemia occurred in > 95% patients
in both groups and the BID group had a higher incidence per patient (8 vs
6; p = 0.02). However, the BID group also had more BG measurements than
the daily group (28 vs 17; p < 0.01). Interestingly, the BID group had a
lower predose hyperglycemia rate (27 vs 43%; p = 0.02). No differences in
the incidence of hypoglycemia, severe hypoglycemia, or hypoglycemia while
NPO were observed. Additionally, there was no difference in the mean BG or
BG variability. Conclusions: To our knowledge, this is the first study
demonstrating that BID insulin glargine dosing reduced predose
hyperglycemia without excessive hypoglycemia in critically ill patients. A
larger, randomized study is needed to confirm the safety and efficacy of
BID glargine in the critically ill.

<74>
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Accession Number
620080704
Author
Sato K.; Taniguchi T.; Okajima M.
Institution
(Sato, Taniguchi, Okajima) Intensive Care Unit, Kanazawa university
hospital, Kanazawa Ishikawa, Japan, 2Department of Anesthesiology and
Intensive Care Medicine,Kanazawa University, Kanazawa, Ishikawa, Japan,
3Intensive Care Unit, Kanazawa University Hospital, Kanazawa, Ishikawa,
Japan
Title
Dexmedetomidine for delirium prevention in nonsurgical cardiac patients on
mechanical life support.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
348), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Mechanical life support is essential to provide high
quality care in modern intensive cardiac care unit. Since those devices
often impose patients a lot of stress, elderly patients on mechanical
devices might be at a high risk of developing delirium and often need
sedation. Dexmedetomidine has been reported as an attractive option both
to prevent and treat delirium in intensive care unit (ICU). This study was
conducted to examine the effect of dexmedetomidine on delirium prevention
in non-surgical cardiovascular patients supported mechanically. Methods:
This is a single center, retrospective cohort study of nonsurgical
cardiovascular patients admitted to the ICU at Kanazawa university
hospital and administered dexmedetomidine from January 1, 2014 to May 31,
2017. We evaluated delirium with the Intensive Care Delirium Screening
Checklist (ICDSC) and defined as a score of 4 or more. Demographics,
comorbidities and APACHE II scores were abstracted from the medical record
along with the use of mechanical life support including intra-aortic
balloon pump (IABP), extracorporeal membrane oxygenation, mechanical
ventilation (MV), non-invasive ventilation, and continuous renal
replacement therapy. Binary and proportional-odds logistic regression
analyses were used to evaluate the association between delirium, maximal
ICDSC score, delirium duration, and mechanical devices. Results: A total
of 108 patients (Acute coronary syndrome 35%, Acute decompensated heart
failure 30%, Arrhythmia 15%, Others 20%) were included, of which 21
(19.4%) developed delirium. Patients with delirium indicated higher APACHE
II score (median 23 vs 13) and lower systolic blood pressure (109 +/- 32
vs 130 +/- 32) than patients without delirium. In multivariate analysis
adjusted for age, APACHE 2 score and dementia, IABP (OR 5.4; 95%CI
1.7-17.4) and MV (OR 7.3; 95%CI 1.4-36.6) were significantly associated
with delirium development. In addition, IABP was also related to higher
ICDSC score (OR 3.2; 95%CI 1.3-7.8) and longer delirium duration (OR 6.4;
95%CI 1.9-21.5). There were not significant relations with other
mechanical devices. Conclusions: Regardless of dexmedetomidine
administration, patients supported by IABP have a significant risk of
delirium.

<75>
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Accession Number
620080697
Author
Allen L.; Gunn J.; Jones K.; Virtue J.; Derenski K.
Institution
(Allen, Gunn, Jones, Virtue, Derenski) CoxHealth, Springfield, MO, 2Cox
Health, Springfield, MO
Title
Evaluation of clevidipine versus nicardipine for acute blood pressure
management.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
466), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Clevidipine has become a popular alternative to
nicardipine for acute blood pressure management in ICU patients. Due to a
more rapid onset of action and a shorter halflife, when compared to
nicardipine, clevidipine may be associated with improved blood pressure
(BP) control. Unfortunately, literature comparing the two agents is
limited. The purpose of this evaluation was to compare the effectiveness
of clevidipine versus nicardipine through mean time to goal systolic blood
pressure (SBP) and mean duration of therapy in patients at a community
hospital. Methods: This single center, retrospective review evaluated ICU
patients who received clevidipine or nicardipine infusions between April
9th, 2016 and August 8th, 2016. Goal SBP was determined based on
parameters set in medical record by a provider. If no goal was specified,
a goal of 160mmHg was used for analysis. Patients were excluded if
cardiology, cardiovascular surgery, or vascular surgery had ordered
infusion, patient received other BP altering infusion(s) while on either
agent, or patient was at goal when infusion was started. Primary endpoints
were time to goal SBP in minutes and mean duration of therapy in hours.
Results: Forty-nine patients were included in the final analysis, 32 in
the clevidipine group and 17 in the nicardipine group. Four patients had
unspecified SBP goals and all were in the clevidipine group. Mean time to
goal SBP in the clevidipine group was 130.8 minutes versus 60.1 minutes in
the nicardipine group (p = 0.0138, 95%CI 15-126). Mean duration of therapy
in clevidipine group was 40.2 hours versus 26.1 hours in nicardipine group
(p = 0.1199, 95%CI-3.8-32). Conclusions: Nicardipine was associated with a
statistically significant shorter time to goal SBP compared to
clevidipine. However, there was not a statistically significant difference
in mean duration of therapy between the two agents.

<76>
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Accession Number
620080605
Author
Connor-Schuler R.; Hrabec D.; Uduman A.K.; Corrales J.P.
Institution
(Connor-Schuler, Hrabec, Uduman, Corrales) Henry Ford Hospital, Detroit,
MI, 2N/A, Detroit, MI
Title
Cardiac arrest from massive pe in nephrotic syndrome successfully treated
with embolectomy and ecmo.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
524), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Pulmonary emboli (PE) are commonly encountered events
with presentations ranging from benign incidental findings to obstructive
shock. We present a case of a 20 year old male with nephrotic syndrome who
suffered complete cardiovascular collapse with cardiac arrest in the
setting of a massive PE, requiring open surgical embolectomy and ECMO
support. We reviewed the literature on massive PE's focusing on the use of
ECMO and success of the rarely performed open embolectomy for the
treatment of obstructive shock from a massive PE. Methods: 20 year old
male with a history of nephrotic syndrome presented to the emergency
department (ED) with complaints of abdominal discomfort and fatigue. The
patient had a syncopal episode in the ED and became tachycardic,
hypotensive, tachypneic, hypoxic and cool to touch. He was admitted to the
MICU where troponin increased from 0.06 to 2.87ng/mL, BNP was 150 pg/mL,
EKG demonstrated RBBB with right heart strain pattern, bedside US showed a
massive RV with bowing septum and CT PE demonstrated a massive saddle PE
with RV strain. The patient became increasingly unstable requiring maximal
vasopressor support and intubation, and ultimately had a PEA arrest en
route to the OR for emergent open embolectomy. He received 30 minutes of
open cardiac massage with surgical removal of large clot burden. Patient
was placed on VA ECMO due to RV failure and cor pulmonale. He was
stabilized and able to be decannulated from ECMO 7 days later. He was
discharged to subacute rehab with all of his faculties. Results: The
presentation of a pulmonary embolus (PE) can range from benign to complete
cardiovascular collapse. With the increasing frequency of diagnosed PE's,
treatment modalities have also been evolving. For massive PE's with
hemodynamic instability patients can be treated with systemic tPA or by
surgical embolectomy. Although uncommonly seen in medical practice,
several case reviews of massive PE's demonstrated overall positive
outcomes following surgery. Open embolectomies are rarely performed,
however, as patients are often either too ill to survive to the operating
table or are well-enough for less invasive therapies such as
catheter-directed lysis. ECMO is occasionally performed in cases of
massive PE as a temporizing measure to embolectomy but has also been used
successfully for ongoing RV failure following embolectomy, such as in our
patient.

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Accession Number
620079230
Author
Burns V.; Peitz G.
Institution
(Burns, Peitz) Nebraska Medicine, Omaha, NE, United States
Title
Dexmedetomidine vs. propofol: Incidence of cardiovascular compromise in
cardiovascular ICU patients.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
432), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Dexmedetomidine and propofol are both preferred
agents for sedation in patients who are mechanically ventilated. However,
both drugs have been shown to induce cardiovascular compromise, including
bradycardia and hypotension. There remains a paucity of evidence
evaluating the safety of dexmedetomidine and propofol specifically in a
cardiovascular-ICU (CVICU) patient population. We hypothesize that
dexmedetomidine is associated with an increased incidence of
cardiovascular compromise in CVICU patients. Methods: This retrospective
chart review included adult patients who received dexmedetomidine or
propofol for mechanical ventilation within an academic medical center's
CVICU. Patients who were receiving extracorporeal membrane oxygenation
(ECMO), were pregnant, had a history of heart block, or received
concomitant or previous doses of dexmedetomidine or propofol during the
encounter were excluded. Cardiovascular compromise was defined as a mean
arterial pressure (MAP) < 60 mmHg or heart rate (HR) < 50 beats per minute
after the initiation of either sedative. Secondary outcomes included
escalation or addition of vasoactive medications following sedative
initiation, duration of mechanical ventilation, hospital and ICU length of
stay (LOS), and costs associated with each drug. Results: A total of 113
patients were included in both the propofol and dexmedetomidine groups,
with 39 and 43 patients undergoing cardiac surgery, respectively. No
differences existed between the groups at baseline regarding age, severity
of illness, or baseline HR or MAP. In an unadjusted analysis, patients
receiving dexmedetomidine had a higher incidence of hypotension than
propofol in both the aggregate (44.2% vs. 17.6%, p < 0.001) and cardiac
surgery patient population (39.5% vs. 17.9%, p = 0.037). Patients
receiving dexmedetomidine required escalation of their vasoactive
medications more frequently than patients receiving propofol (13.2% vs
1.7%, p = 0.001). No difference in bradycardia, duration of mechanical
ventilation, or LOS was observed between the two groups. Dexmedetomidine
use resulted in higher sedative costs than propofol ($1721 vs. $112, p <
0.001). Conclusions: This study found that there was an increase in
hypotension with dexmedetomidine compared to propofol in a CVICU
population. There were no observed differences in time of mechanical
ventilation, or ICU or hospital LOS. There was a significantly higher cost
associated with dexmedetomidine compared to propofol in this patient
population.

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Accession Number
620079626
Author
Olson L.; Nei S.; Nei A.; Joyce D.; Dierkhising R.
Institution
(Olson, Nei, Nei, Joyce, Dierkhising) N/A, Columbus, OH, 2Mayo Clinic,
Rochester, MN, 3N/A, Rochester, MN, 4Mayo Clinic, Rochester
Title
Surgical bleeding risk associated with rapid rise in inr post-cardiac
surgery.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
79), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Warfarin is the most common oral agent used for
post-cardiac surgery anticoagulation, yet it is used with caution as the
bleeding rate in this population has been reported to vary from 3% to 29%.
Sensitivity factors inherent within this population can potentiate the
effects of warfarin and cause an unexpected rapid rise in the level of
anticoagulation, as measured by international normalized ratio (INR). A
high variability in the INR post-cardiac surgery has been previously shown
to be an independent predictor of mortality, but it is unknown if a rapid
INR rise confers a similar risk in the immediate post-operative period.
The objective of this study was to determine the impact of a rapid rise in
INR due to warfarin therapy on post-cardiac surgery bleeding. Methods:
Retrospective chart review of post-cardiac surgery patients initiated on
the pharmacy-to-dose warfarin protocol within 5 days of cardiac surgery at
Mayo Clinic Hospital, Rochester from January 1st, 2013-October 31st, 2016.
Patients were identified as having a rapid rise if the INR increased >= 1
within a 24-hour period. Time to event analysis will be used to assess the
primary outcome, which was a composite of intracranial bleeding,
reoperation after closure to control bleeding, transfusion of >= 5 units
whole blood or packed red blood cells within a 48 hour period, chest tube
output of >= 2L within a 24-hour period, or cardiac tamponade. Risk
factors for bleeding will be adjusted for with a multivariate cox model.
Results: A total of 2, 342 post-cardiac surgery patients were included in
the study, of which 752 (32.1%) had a rapid rise in INR, with 425 (56.5%)
of those resulting in a supratherapeutic INR. The majority (58.2%) of
rapid rises occurred on day 3 of warfarin therapy. The most common
procedures were aortic valve replacement (n = 1069) and mitral valve
repair (n = 785). Overall, 56 bleeding events occurred after initiation of
warfarin. No significant difference was found between rapid rise vs. no
rapid rise [HR=1.99; 95% CI (0.89-4.47), P = 0.094]. Additionally, no
significant difference was observed between the two groups with regard to
length of stay [HR=1.03; 95% CI (0.94-1.13), P = 0.48]. Conclusions:
Despite the relatively common incidence (32.1%) of a rapid rise in INR, it
was not associated with increased bleeding complications during the
immediate post-operative period. This is the first study to our knowledge
to evaluate bleeding risk associated with rapid rise INR in a large
post-cardiac surgery patient population.

<79>
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Accession Number
620079612
Author
Lafever M.; Kopp B.; Patanwala A.; Cosgrove R.
Institution
(Lafever, Kopp, Patanwala, Cosgrove) University of Arizona College of
Pharmacy, Tucson, AZ, 2N/A, Tucson, AZ, 3Banner University Medical
Center-Tucson, Tucson, AZ
Title
Aminocaproic acid versus aminocaproic acid/prothrombin complex concentrate
in cardiac surgery.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
435), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: The use of aminocaproic acid (ACA) is a common
intervention to manage uncontrolled hemorrhage during cardiac surgery. In
some cases, prothrombin complex concentrate (PCC) is combined with ACA
despite limited data in this setting and potential for harm due thrombotic
complications. The objective of this study was to compare postoperative
chest tube output, transfusion requirements, and thromboembolic
complications in patients who were given ACA alone versus those given ACA
combined with PCC. Methods: This was a retrospective cohort study
conducted at an academic medical center in the United States. Consecutive
adult cardiac surgery patients who received either ACA or ACA/PCC between
February 2015 and October 2016 were included. The primary outcome of this
study was chest tube output during the first 12 hours postoperatively.
Secondary outcomes included total chest tube output during
hospitalization, transfusion requirements, and thromboembolic
complications. Results: A total of 101 patients were included in the study
cohort (ACA=50, ACA/PCC=51). Median chest tube output in the first 12
hours postoperatively was lower in the ACA group compared to the ACA/PCC
group (580 ml versus 760 mL, p = 0.011). Median total chest tube output
was also lower in the ACA group (1480 ml versus 2639 ml, p = 0.007). Fresh
frozen plasma use was lower in the ACA group (619 ml versus 1078 ml, p =
0.030). There was a trend of lower packed red blood cell volume was in the
ACA group (503 ml versus 875 ml, p = 0.094). Three patients in the ACA/PCC
group had a postoperative ischemic stroke. No other postoperative
thrombotic complications were recorded. Conclusions: The combination of
ACA/PCC during cardiac surgery procedures did not reduce chest tube output
or transfusion requirements in our study. There is the potential for
thromboembolic complications when this combination is used.

<80>
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Accession Number
620080862
Author
Fuchita M.; Perkins A.; Khan S.; Kesler K.; Khan B.
Institution
(Fuchita, Perkins, Khan, Kesler, Khan) Indiana University School of
Medicine, Indianapolis, IN, 2Center for Health Innovation and
Implementation Science, Indianapolis, IN, 3Indiana University School of
Medical, Indianapolis, IN
Title
Perioperative risk factors for postoperative delirium in patients
undergoing esophagectomy.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
369), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Postoperative delirium (POD) affects 50% of patients
undergoing major thoracic surgery such as esophagectomy with associated
negative outcomes. At present, there is no consensus on strategies to
predict and prevent POD. Previous studies have suggested multiple risk
factors for POD including lower postoperative hemoglobin. However, this
has not been investigated in esophagectomy patients. We conducted the
current study to assess perioperative risk factors for POD among
esophagectomy patients; specifically examining the effect of hemoglobin
concentrations on development of POD. Methods: We conducted a secondary
data analysis of patients enrolled in a randomized controlled trial
evaluating the efficacy of haloperidol prophylaxis postoperatively in
reducing delirium among esophagectomy patients. POD was assessed twice
daily by trained research assistants. Variables of interest included age,
Charlson Comorbidity Index, APACHE II score, estimated blood loss,
perioperative hemoglobin, transfusion, postoperative sedation and
analgesics, ICU length of stay, and duration of mechanical ventilation.
Univariate and logistic regression analyses were performed to examine the
association between perioperative variables and development of POD.
Results: Of 84 consecutive esophagectomy patients, 27 (32%) developed POD.
No differences were observed between those who developed POD and those who
did not in regards to preoperative hemoglobin [12.9 (1.9) g/dL versus 13.3
(1.7) g/dL; p = 0.413], estimated blood loss [277 (162) ml versus 245
(161) ml; p = 0.409], immediate postoperative hemoglobin [11.5 (1.7) g/dL
versus 11.6 (1.6) g/dL; p = 0.443], lowest postoperative hemoglobin [9.7
(1.5) g/dL versus 9.8 (1.5) g/dL; p = 0.649], and transfusion rate [11.1%
versus 3.5%; p = 0.322]. Patient who developed POD had higher APACHE II
scores [22.1 (6.5) versus 17.4 (6.8); p = 0.003], longer ICU days [5.1
(2.6) days versus 2.6 (1.6) days; p < 0.001], and longer duration of
mechanical ventilation [1.7 (1.4) days versus 1.0 (1.1) days; p = 0.001].
In a logistic regression model adjusting for APACHE II score, ICU length
of stay, and duration of mechanical ventilation, only ICU length of stay
was found to have significant association with POD [OR 1.65; 95% CI
1.21-2.25]. Conclusions: Perioperative hemoglobin was not found to be
associated with development of POD. Esophagectomy patients who developed
POD had longer ICU length of stay.

<81>
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Accession Number
620080015
Author
Holmes A.; Hoth L.; Kimmons L.; Jones M.; Parish T.; Swiggart B.
Institution
(Holmes, Hoth, Kimmons, Jones, Parish, Swiggart) Saint Luke's Hospital of
Kansas City, Kansas City, MO, 2Barnes-Jewish Hospital, Saint Louis, MO,
3Methodist University Hospital, Memphis, TN, 4Methodist LeBonheur
Germantown Hospital, Germantown, TN
Title
Predictors of dexmedetomidineassociated hypotension in cardiovascular
intensive care unit patients.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
59), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Dexmedetomidine is often used in cardiac surgery
patients for sedation as it has been associated with a decrease in
duration of mechanical ventilation and reduced intensive care unit (ICU)
and hospital length of stay (LOS); however, it has been shown to lead to
higher rates of hypotension and bradycardia when compared to other
sedative agents. No study has previously sought to determine the incidence
of dexmedetomidine-associated hypotension in cardiovascular intensive care
unit (CVICU) patients or identified independent predictors for the
development of hypotension in this population. Methods: A retrospective
cohort study of patients with a primary cardiac diagnosis who received
dexmedetomidine in the CVICU between September 2013 and August 2016 was
completed. The primary objective was to determine the incidence of
hypotension (MAP < 60 mmHg). Secondary outcomes included incidence of
bradycardia (HR < 50 bpm), interventions made for hemodynamic
disturbances, duration of mechanical ventilation, ICU and hospital LOS,
and mortality. A multivariable logistic regression was completed to
identify independent predictors of hypotension. Results: Of the 276
patients included in the analysis, 40.2% developed hypotension. Univariate
analysis showed that patients with a ST-elevation myocardial infarction (p
= 0.04), longer duration of dexmedetomidine infusion (p = 0.02), or an
increased number of rate changes (p = 0.02) were more likely to develop
hypotension. Only concomitant bradycardia (odds ratio [OR] 3.5) was
independently associated with the development of hypotension, while
concomitant administration of dihydropyridine calcium channel blockers (OR
0.44) and ordering of dexmedetomidine per our hospital protocol (OR 0.58)
were protective against the development of hypotension. Patients who
experienced hypotension had a longer duration of mechanical ventilation
and longer ICU LOS than those who did not; however, there was no
difference in hospital LOS or mortality between the groups. Conclusions:
Dexmedetomidine use in CVICU patients is associated with a significant
incidence of hypotension. Bradycardia was found to be an independent
predictor of hypotension.

<82>
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Accession Number
620079987
Author
Evans D.; Metayer J.; Lin H.; Newman K.; Rozen G.
Institution
(Evans, Metayer, Lin, Newman, Rozen) Massachusetts General Hospital,
Boston, MA, 2University of Illinois at Chicago, Chicago, IL
Title
Amiodarone dose for rhythm control in the sicu for new-onset postoperative
atrial fibrillation.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
437), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Amiodarone is utilized as a rhythm control strategy
for postoperative atrial fibrillation (POAF); however, an optimal dosage
regimen has not been elucidated in the critically ill population. The
objective of this study was to investigate an association between
cumulative doses of IV amiodarone and the probability of achieving rhythm
control in SICU patients with new onset POAF. Methods: A retrospective
chart review was conducted for patients admitted to the SICU between
2014-2016 who received IV amiodarone for new onset POAF occurring within 7
days of a procedure. The diagnosis of POAF was confirmed by an
electrophysiologist. Patients who underwent cardiac surgery were excluded.
The primary outcome was the proportion of patients achieving rhythm
control with 24 hour IV amiodarone cumulative doses < 1050mg (low dose)
versus >=1050mg (high dose). This dose was selected to coincide with
current guideline recommendations. Secondary outcomes included ventricular
rate control, hypotension, bradycardia and hepatotoxicity. Results:
Seventy three patients were included for primary analysis, 35 received 24
hour amiodarone doses < 1050mg and 38 received >=1050mg. Baseline
characteristics were similar between the groups including weight,
APACHEII, LVEF, beta blocker administration, concomitant vasopressors, and
the presence of structural heart disease. Significantly more patients
receiving amiodarone >=1050mg were mechanically ventilated. In the overall
cohort, the median (IQR) dose and time to rhythm control were 368mg
(164-605) and 3.4 hours (0.8-8.9), respectively. Rhythm control occurred
in 94.3% of subjects who received low doses of amiodarone at 24 hours
versus 73.7% of patients who received high doses (p < 0.05). Rate control
at 6, 12, 24 and 48 hours after amiodarone initiation did not
significantly differ between groups. There was no difference in any of the
safety endpoints. Conclusions: Based on the results of this small
retrospective cohort, more patients who received doses < 1,050 mg within
24 hours of amiodarone initiation achieved rhythm control compared to
patients who received higher doses. Because such a high proportion of
patients in our study achieved rhythm control within 48 hours, additional
data is needed to determine if there is a correlation between amiodarone
dose and probability of achieving rhythm control.

<83>
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Accession Number
620079475
Author
Migally K.; Rettiganti M.R.; Gossett J.; Gupta P.
Institution
(Migally, Rettiganti, Gossett, Gupta) Arkansas Children's Hospital, Little
Rock, AR, 2Arkansas Children's Hospital Researcher Institute, Little Rock,
AR
Title
Impact of regional cerebral perfusion on outcomes among children
undergoing the norwood operation.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
102), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: To evaluate the impact of regional cerebral perfusion
(RCP) during heart operation on outcomes in infants undergoing Norwood
operation. Methods: We performed a retrospective cohort study using data
from the Pediatric Heart Network Single Ventricle Reconstruction trial
public use dataset. Elastic net regularized logistic regression models
were fitted to evaluate the association of RCP with study outcomes. We
adjusted for baseline characteristics, preoperative risk factors,
operative factors related to Norwood procedure, complications after
Norwood operation, and center volume. The outcomes evaluated included
in-hospital transplant-free survival, transplant-free survival at 12
months, and composite poor outcome (in-hospital transplant free survival
or prolonged mechanical ventilation or prolonged hospital length of stay).
Results: In total, 549 patients from 15 North American centers qualified
for inclusion. Of these, 252 patients (45.9%) received RCP during their
heart operation. In the RCP group, the in-hospital transplant free
survival was noted among 207 patients (82.1%), and the transplant-free
survival at 12 months was noted among 172 patients (68.2%). In contrast,
in the no RCP group, the inhospital transplant free survival was noted
among 249 patients (83.8%), and the transplant-free survival at 12 months
was noted among 207 patients (69.6%). In univariate comparisons, majority
of the baseline characteristics and preoperative risk factors were similar
in the two groups. The total cardiopulmonary bypass (CPB) time and the
total cross clamp (CC) time were longer in the RCP group (RCP vs. No RCP,
Median CPB time: 161 minutes vs. 109 minutes; Median CC time: 63 minutes
vs. 43 minutes). Lower proportion of patients in the RCP group underwent
classic aortic arch repair (82.7% vs. 92.2%), and higher proportion of
patients in the RCP group left operating room with open sternum (91.2% vs.
67.2%). In adjusted models, we did not find any association between
operation with RCP and any of the study outcomes (in-hospital transplant
free survival, OR: 1.26, 95% CI: 0.74-2.17; transplant-free survival at 12
months, OR: 1.12, 95% CI: 0.74-1.69; composite poor outcome, OR: 1.05, 95%
CI: 0.69-1.61). Conclusions: This multi-center study did not demonstrate
any impact of RCP on mortality among infants undergoing Norwood operation.
Further analysis is needed to understand the impact of RCP on neurological
outcomes in this select patient population.

<84>
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Accession Number
620079289
Author
Gupta P.; Chakraborty A.; Gossett J.; Rettiganti M.R.
Institution
(Gupta, Chakraborty, Gossett, Rettiganti) Arkansas Children's Hospital,
Little Rock, AR, 2University of Arkansas, Fayetteville, AR, 3Arkansas
Children's Hospital Researcher Institute, Little Rock, AR
Title
A prognostic tool to predict outcomes in children undergoing the norwood
operation.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
27), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: To create and validate a prediction model to assess
outcomes associated with the Norwood operation. Methods: The public-use
dataset from a multicenter, prospective, randomized single-ventricle
reconstruction trial was used to create this novel prediction tool. A
Bayesian lasso logistic regression model was used for variable selection.
We employed a hierarchical framework by representing discrete probability
models with continuous latent variables that depended on the risk factors
for a particular patient. Bayesian conditional probit regression and
Markov chain Monte Carlo simulations were then used to estimate the
effects of the predictors on the means of these latent variables to create
a score function for each of the study outcomes. We also devised a method
to calculate the risk of outcomes associated with the Norwood operation
before the actual heart operation. The two study outcomes evaluated were
in-hospital mortality and composite poor outcome (defined as mortality or
heart transplantation or need for cardiopulmonary resuscitation or use of
ECMO outside the operating room or prolonged mechanical ventilation or
prolonged hospital length of stay). Results: The training dataset used 524
patients to generate the prediction model. The model included patient
demographics, baseline characteristics, cardiac diagnosis, operation
details, site volume, and surgeon experience. An online calculator for the
tool can be accessed at https://soipredictiontool.shinyapps.io/
NorwoodScoreApp/. We then validated the model with a 10-fold, internal
cross-validation approach. Model validation was done on 520 observations.
Our model predicted 92 deaths in our internal validation sample when the
observed number of deaths was 88, and it predicted 240 patients with
composite poor outcome when the observed number of patients with composite
poor outcomes was 238. The prediction model had an AUC of 0.77 for
mortality and 0.72 for composite poor outcome on the validation dataset.
Conclusions: Our new prognostic tool is a promising first step in creating
real-time risk stratification in children undergoing a Norwood operation;
this tool will be beneficial for the purposes of benchmarking, family
counseling, and research. Future studies should seek external validation
and improved discrimination for this prediction tool.

<85>
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Accession Number
620081385
Author
Crowley K.; Urben L.; Hacobian G.; Geiger K.
Institution
(Crowley, Urben, Hacobian, Geiger) Brigham and Women's Hospital, Boston,
MA, Brigham and Women's Hospital, Boston, MA
Title
Valproic acid for the management of agitation and delirium in the
intensive care setting.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
430), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Agitation and delirium are highly prevalent in
critically ill patients and have been associated with poor clinical
outcomes. Current management of these conditions includes opioid, sedative
and antipsychotic agents. Valproic acid (VPA) has been proposed as an
alternative and/or adjunctive agent for treatment of both agitation and
delirium in the intensive care unit (ICU). The objective of this study was
to assess the efficacy and safety associated with the use of VPA for the
management of agitation and delirium in the ICU. Methods: This
retrospective observational analysis included patients who were prescribed
VPA for a minimum of three days for the treatment of agitation and/or
delirium in the cardiac, surgical or medical ICU from May 31, 2015 to
January 31, 2017. Agitation and delirium were defined by a Richmond
Agitation Sedation Score greater than or equal to positive two and a
positive Confusion Assessment Method for the ICU, respectively. Patients
were followed until VPA discontinuation or day seven of therapy, whichever
came first. Additional data collected included opioid, sedative and
antipsychotic requirements, VPA dosing, duration of therapy, and safety
data. Results: A total of 17 patients met inclusion criteria. On day one
of VPA, 76.5% of patients met criteria for agitation and 52.9% of patients
screened positive for delirium, which decreased to 70% and 20%
respectively by day seven. Additionally, the proportion of patients
requiring sedative, opioid, and antipsychotic agents was reduced. VPA
dosing ranged from a median dose of 5.8 mg/kg on day one up to 17.4 mg/kg
on day six. The duration of VPA therapy ranged from three days to
continuation at discharge, and no adverse effects due to VPA were noted.
Conclusions: There was an observed downtrend in the prevalence of
agitation and delirium while on VPA therapy, thus suggesting a role for
VPA in the management of agitation and delirium in critically ill
patients. Prospective randomized controlled trials are needed to validate
the results of this observational cohort analysis.

<86>
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Accession Number
620081179
Author
Sun H.; Peng Z.
Institution
(Sun, Peng) Zhongnan Hospital of Wuhan University, Wuhan, China, 2N/A,
Pittsburgh, PA
Title
Fenoldopam and acute kidney injury in cardiovascular surgery: A
metaanalysis of rcts.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
18), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Acute kidney injury (AKI) is a common and threatening
complication in patients undergoing cardiovascular surgery. Fenoldopam is
a selective dopamine-1 receptor agonist with renoprotective properties.
The aim of this meta-analysis of randomized trials was to evaluate the
role of fenoldopam in patients undergoing cardiovascular surgery with or
at risk of AKI. Methods: A systematic search of the Pubmed, Embase, and
CENTRAL databases, up to March 30, 2017.Two reviewers independently
selected randomized controlled trials that compared fenoldopam with
placebo or any pharmacological comparator in patients undergoing
cardiovascular surgery. Summary statistics, odds ratios (ORs), and CIs
were calculated using randomeffects modeling. Study quality was assessed
using Jadad score and Cochrane collaboration's tool for assessing risk of
bias, and publication bias using funnel plots and Egger's test. The
primary endpoint of the present analysis was to determine the effect of
fenoldopam on AKI (as per author definition). The coprimary endpoints was
the number of patients requiring RRT. The secondary endpoints included the
incidence of mortality, and hypotension, and/or the use of
vasoconstrictors (as per author definition). Results: Final analysis
included 10 trials and 1408 patients (705 fenoldopam and 703 control). The
overall analysis showed that the use of fenoldopam was associated with a
reduction in the risk of AKI (36 of 272 [13.2%] in the fenoldopam group
versus 62 of 227 [27.3%] in the control group, OR = 0.51, [0.27, 0.96], p
for effect =0.04) and with a higher rate of hypotensive episodes or use of
vasopressors (117/427 [27.4%] v 56/419 [13.4%], OR = 3.69 [1.35; 10.13], p
for effect = 0.01), and no effect on renal replacement therapy, hospital
mortality. Conclusions: This meta-analysis suggests that the use of
fenoldopam is associated with a reduction of AKI in Cardiovascular Surgery
patients at risk for acute renal failure, but with higher rate of
hypotension.

<87>
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Accession Number
620081792
Author
Lee S.; De Leon N.; Thompson A.; Baumgartner C.; Fang M.; Prasad P.
Institution
(Lee, De Leon, Thompson, Baumgartner, Fang, Prasad) University of
California San Francisco Medical Center, San Francisco, CA, 2UCSF Medical
Center, San Francisco, United States, 3UCSF Medical Center, San Francisco,
CA
Title
Use of 4-factor prothrombin complex concentrate in cardiothoracic surgery.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
608), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Major bleeding in the setting of cardiothoracic (CT)
surgery is associated with increased morbidity and mortality. Management
of refractory bleeding with 4-factor prothrombin complex concentrate
(4PCC) is growing in the setting of potential advantages over blood
products, including smaller volume(s) of administration and faster onset
of action. However, in the absence of literature to guide optimal dosing,
4PCC dosing in CT surgery patients is variable. To standardize dosing, an
electronic order set for 4PCC in CT surgery patients was implemented at
our institution. The recommended dose is 1000 units if < 100 kg and 1500
units if >=100 kg. The purpose of this study is to evaluate the impact of
4PCC dose standardization via order set implementation on blood product
use in CT surgery patients. Methods: A retrospective chart review was
conducted for any patient older than the age of 18 years undergoing any
type of CT surgery and receiving 4PCC intra-operatively. Intra-operative
records were utilized to document 4PCC dose, blood product usage, and
administration of vitamin K and/or recombinant factor VII. Additional data
collected include preoperative anticoagulation and post-operative
incidence of thromboembolic events. Results: A total of 47 patients were
included in the preliminary analysis. For the primary outcome, there was a
trend toward lower mean dose of 4PCC (units/kg) following the
implementation of an electronic order set, though not statistically
significant (16.0 units/kg vs 13.3 units/kg; p = 0.15). There was no
difference in median volume of red blood cells (RBCs) administered
intraoperatively when comparing pre-and post-order set groups, and no
difference in median dose of 4PCC when measured per unit of RBC given
intra-operatively (8.51 units/kg vs 5.20 units/kg; p = 0.26). Conclusions:
The preliminary results of this study demonstrate a lower mean dose of
intra-operative 4PCC administered following standardized dosing
recommendations with no associated increase in blood product usage. This
study is ongoing and will continue to evaluate the impact of standardized
4PCC dosing on blood product usage.

<88>
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Accession Number
620081566
Author
Walker P.; Gormley L.; Reulbach L.; Davis B.; Wu J.
Institution
(Walker, Gormley, Reulbach, Davis, Wu) Greenville Health System,
Greenville, SC, 2Presbyterian College School of Pharmacy, Clinton, SC
Title
Impact of postoperative protamine infusion on blood transfusions following
cardiopulmonary bypass.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
76), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Cardiac procedures utilizing cardiopulmonary bypass
(CPB) require anticoagulation to maintain vascular and circuit patency.
Heparin is most frequently used to provide anticoagulation during the
procedure and is reversed with protamine upon CPB discontinuation. Current
literature describes a phenomenon called heparin rebound and suggests this
increases the patient's risk of postoperative bleeding. The optimal method
to combat this phenomenon remains unknown. The purpose of this study was
to evaluate the addition of a 5-hour protamine infusion in addition to
protamine boluses for the reversal of heparin after CPB procedures.
Methods: This retrospective, observational cohort study was conducted at a
single-center, acute care hospital comparing patients receiving a
protamine infusion as a new standard of care to a historical cohort. The
primary outcome of this study was the volume of packed red blood cells
(pRBCs) transfused postoperatively at 24 hours. Results: Interventional (n
= 64) and historical cohorts (n = 65) were similar in baseline
characteristics. A total of 10 (15.6%) in the intervention and 13 (20%) in
the historical cohort required pRBCs at 24 hours postoperative (P = 0.51).
For patients requiring pRBCs, the interventional cohort received 808.3
mL/patient and the historical cohort received 1, 310 mL/patient. No
statistically significant differences were noted for secondary outcomes
including blood loss, blood product use, prothrombin complex concentrate
use, nor lengths of stay. Postoperative bleeding and thromboembolic events
were similar between cohorts at 30 days. Conclusions: The use of a 100 mg
protamine infusion over 5 hours as an adjunct to protamine boluses for
heparin reversal in CPB patients did not reduce the volume of blood
transfusions required in the postoperative period.

<89>
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Accession Number
620081081
Author
Schneider J.; Bakar A.; Meyer D.; Parnell V.; Silver P.; Sethna C.
Institution
(Schneider, Bakar, Meyer, Parnell, Silver, Sethna) Cohen Children's
Medical Center, New Hyde Park, NY, 2Cohen Children's Hos461 pital, New
Hyde Park, NY
Title
Urine alkalization does not prevent acute kidney injury in children
undergoing cardiac surgery.
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
679), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Acute kidney injury (AKI) is common in children after
cardiopulmonary bypass (CPB) for surgical correction of congenital heart
disease (CHD), and is independently associated with increased length of
mechanical ventilation (LMV) and PICU length of stay (LOS). Currently,
data is limited on specific strategies to prevent AKI in this setting.
Methods: We conducted a randomized, double-blinded, placebocontrolled
clinical trial in children <=18 years old scheduled for surgical
correction of CHD requiring CPB to investigate the impact of urine
alkalization on the development of AKI. Subjects randomized to
alkalization received intravenous fluids (IVF) consisting of D5 0.3% NaCl
+ 100 mEq/L NaHCO3 + 20mEq/L KCl at 1x maintenance during the operation
and for the following 24 hours. The control group received IVF consisting
of D5 0.9% NaCl + 20mEq/L KCl in a similar manner. Serum creatinine, urine
pH and serum pH were monitored serially for 48 hours beginning from the
initiation of CPB. AKI was determined by Kidney Disease: Improving Global
Outcomes criteria. Results: Of 51 subjects, 26 were randomized to urine
alkalization (median age 4.5 months). There were no demographic
differences between groups, including baseline GFR or cardiac lesion (p>
0.05). Both groups underwent similar CPB and aortic cross clamp durations
(p> 0.05). Serum pH (median 7.45 vs 7.40, p = 0.001) and urine pH (8.5 vs
5.8, p < 0.0001) of the intervention group were greater than the controls
at 24 hours post-op. The incidence of any AKI in the control group was 80%
(20/25) vs 73% (19/26) in the intervention group (p = 0.73). Intervention
subjects had a greater daily fluid balance on post-op day 2 compared to
the control group (+147.9 vs-89.8 mL, p = 0.003), but similar
subsequently. Both groups had similar LMV (3.8 vs 1.2 days, p = 0.38), and
duration of PICU (6.1 vs 5.2 days, p = 0.91) and hospital LOS (7.5 vs 7.3
days, p = 0.35). The trial was stopped early due to futility. Conclusions:
Urine alkalization does not prevent the development of AKI in children
undergoing CPB.

<90>
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Accession Number
620081065
Author
Bansal V.; Agarwal A.; Guru P.
Institution
(Bansal, Agarwal, Guru) Mayo Clinic Florida, Jacksonville, FL, United
States
Title
Ecmo as a bailout procedure in patients undergoing transcatheter aortic
valve replacement (TAVR).
Source
Critical Care Medicine. Conference: 47th Society of Critical Care Medicine
Critical Care Congress, SCCM 2018. United States. 46 (Supplement 1) (pp
582), 2018. Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Trans-catheter aortic valve replacement (TAVR) has
been accepted as a safe and effective method for treating severe aortic
stenosis in high risk patients. However, patients are at risk for severe
hemodynamic instability during the perioperative period. Extracorporeal
membrane oxygenation (ECMO) has been used as a bailout procedure to
improve the overall success rate. This meta-analysis aimed to describe the
experience and outcome of patients requiring ECMO support during TAVR.
Methods: We performed a comprehensive literature search from January 1st,
1966, through April 1st, 2017, using PubMed, Medline, CENTRAL, EMBASE,
Scopus, ISI, Regulatory Documents, and Web of Science with the filters
using multiple search terms with no language restrictions. We included all
studies that included patients 18 years of age and older and who underwent
TAVR procedure and in whom ECMO used as emergently or electively. Our
primary outcome of interest were patient mortality, and procedural success
rate in elective supports, and secondary outcome was incidence of
postoperative complication including major bleeding complication, acute
renal failure, myocardial infarction, vascular complication, and stroke.
Results: We identified seven observational cohort studies including total
of 586 participants (52 ECMO and 534 non-ECMO). The unadjusted risk of
mortality in ECMO supported patient was higher compared to non-ECMO
patients (OR 6.07; 95% CI 2.06-17.93 P = 0.001, I2=0%). In patients with
elective ECMO (4 out of 7 studies) the unadjusted risk of mortality was
remain high (OR 1.79; 95% CI 0.30-10.85 P = 0.53, I2=0%;). The procedural
success rate according to Valve Academic Research Consortium-2 (VARC-2)
criteria was lower in ECMO supported patient (OR 0.15; 95% CI 0.02-1.10 P
= 0.06, I2=22%). In subgroup analysis, we found significant increased risk
of renal failure and stroke in ECMO group with summed OR 4.98; 95% CI
1.92-12-.94, P = 0.0010,I2=0% and OR 5.17; 95% CI 1.05-25.49, P =
0.04,I2=0% respectively. Conclusions: The use of ECMO in high-risk
patients undergoing TAVR is not associated with improved clinical
outcomes. However, we are unable to draw comparison between emergency and
prophylactic use of ECMO use in TAVR due to small number of studies. It
may possible prophylactic use of ECMO in selected high-risk patients may
decrease procedural mortality in TAVR. A large prospective cohort or
randomized control trial needed to explore our result.

<91>
Accession Number
620075028
Author
Kolcz J.; Karnas E.; Stycula W.; Borowka M.; Madeja Z.; Zuba-Surma E.;
Skalski J.
Institution
(Kolcz, Stycula, Borowka, Skalski) Jagiellonian University, Pediatric
Cardiac Surgery, Krakow, Poland
(Karnas, Madeja, Zuba-Surma) Jagiellonian University, Cell Biology,
Krakow, Poland
Title
Anti inflammatory and cardioprotective effect of nitric oxide during
pediatric cardiopulmonary by pass-clinical randomised study.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S543-S544), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Objective: Cardio-plulmonary bypass (CPB) used for open heart surgery,
induces systemic inflammatory response (SIRS) and contributes to
ischemia-reperfusion injury of the cardioplegiaarrested heart. Multiple
strategies have been elaborated to mitigate effects of CPB on
perioperative stress response. We carried out a randomised clinical study
to investigate an effect of nitric oxide (NO) inhalation into the
oxygenator during CPB, in children. Methods: Blood samples were taken from
24 patients (aged 8 days- 13 years) during open heart surgery. CPB was
managed according to previously reported, standard approach. Repeated
measures were carried out before surgery, during the procedure, and 4, 8
12 and 24 hours after the operation. During the procedure nitric oxide
(NO) was inhaled into the oxygenator according to the separate protocol in
12 patients. Relevant panel of cytokins and angiogenic factors was
profiled by human proteome profiler Array Kits and quantitively analyzed
by milliplex map kit assay. Based on screening, following analytes were
selected for high-sensitivity quantative analysis: IL-10, IL-1b, TNF-a,
GM-CSF, IL-6, IL-8, SDF-1, VEGF, IL-1ra, MMP-8, pentraxin-3, NT-proBNP,
CK-MB, troponin I, TIMP-4, angiopoietin-2, insulin, lectin. Glucose and
lactates were additionally measured. Repeated measures Friedman ANOVA was
used for statistic evaluation of data. Results: Inhalation of NO decreased
concentration of TnI and CK-MB and reduced level of IL-6, IL-8 and
Pentraxin-3. Antiinflammatory IL1-ra and TIMP 4 was significantly
increased in NO group. SDF 1 and GM-CSF were also significantly increased
in particular time points. NO-patients had lower post-bypass concentration
of lactates and glucose and higher levels of Insulin, leptin and
angiopoetin 1 in postoperative period. All above mentioned effects were
significant at p <0.05 in post hoc tests. Conclusions: Intraoperative NO
inhalation into the oxygenator during pediatric cardiopulmonary by-pass
can have anti-inflammatory, cardioprotective and reliving-metabolic-stress
effects. (Figure Presented).

<92>
Accession Number
620075780
Author
Alkon J.; Scholl F.; Niu J.; Tayon K.; Bibevsky S.
Institution
(Alkon) Joe Dimaggio Children's Hospital, Pediatric Cardiology, Hollywood,
United States
(Scholl, Bibevsky) Joe Dimaggio Children's Hospital, Pediatric Cardiac
Surgery, FL, United States
(Niu) JDCH, Pediatric Cardiac Surgery, FL, United States
(Tayon) JDCH, Pediatrics, FL, United States
Title
Custodiol single dose is comparable to blood cardioplegia for myocardial
protection in congenital cardiac surgery.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S490-S491), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Custodiol used for myocardial protection due to single dose
administration. We investigated single dose Custodiol myocardial
protection versus intermittent blood cardioplegia in congenital cardiac
surgery. Methods: single-center retrospective review of prospectively
collected data. One hundred twenty-seven patients <12 months undergoing
biventricular congenital cardiac repair under cardiopulmonary bypass (CPB)
were randomized to single dose Custodiol (n=101) or blood cardioplegia (n=
26). Demographic, preoperative variables and postoperative (24 hours and
discharge) echocardiography cardiac function were compared. Results: same
baseline patient's STAT mortality categories and score. Average CPB time
(Custodiol: 90.7+/-51.3 minutes vs blood cardioplegia: 82.6 +/-45.1
minutes, P =0.46) and aortic crossclamp time (Custodiol: 57.5 +/-33.1
minutes vs blood cardioplegia: 53.8+/- 34.3 minutes, P=0.62) were similar.
Patients on Custodiol were younger (101.3+/- 56.6 days), lower weight
(4.8+/-1.3 kg), compared with 143.6 +/-81.4 days and 5.4 +/-1.6 kg blood
cardioplegia (p< 0.05). Left ventricle Ejection Fraction preoperative
(blood cardioplegia: 69.6+/-14.6% vs. Custodiol: 73+/- 9.5%, p= 0.15),
post-operative at 24 hrs (blood cardioplegia: 64.7+/- 10.6% vs. Custodiol:
65.1+/- 13.7%, p= 0.89), and postoperative at discharge (blood
cardioplegia: 66.3+/- 8.5% vs. Custodiol: 67.7 +/-10.7% p= 0.54) were
similar. The pre-operative right ventricle (RV) function by fractional
area change (FAC) was lower in blood cardioplegia than Custodiol (blood
cardioplegia: 43.4+/- 12.9% vs. Custodiol: 49.1+/-8.2%, p <0.05) although
both normal (>40%). The FAC (24 hours and discharge) was 41.4+/- 12.7% and
41.9+/-9.9% for blood cardioplegia, compared with 50.1+/-9.1% and
50.9+/-8.5% for Custodiol (P< 0.001). Conclusions: Single dose Custodiol
is convenient and as safe as blood cardioplegia for myocardial protection
in congenital cardiac surgery with better RV function preservation.

<93>
Accession Number
620075555
Author
Alsaied T.; Bokma J.; Engel M.; Kuijpers J.; Hanke S.; Zuhlke L.; Zhang
B.; Veldtman G.
Institution
(Alsaied, Hanke, Veldtman) Cincinnati Children's Hospital, Pediatric
Cardiology, Cincinnati, United States
(Bokma) Academic Medical Center, Department of Cardiology, Amsterdam,
Netherlands
(Engel) Groote Schuur Hospital, Department of Medicine, Cape Town, South
Africa
(Kuijpers) Academic Medical Center, Depatment of Cardiology, Amsterdam,
Netherlands
(Zuhlke) Red Cross War Memorial Children's Hospital, University of Cape
Town, Department of Paediatrics, Cape Town, South Africa
(Zhang) Cincinnati Children's Hospital, Department of Statistics,
Cincinnati, United States
Title
Factors associated with long term mortality after Fontan procedures. Risk
score creatioin based on sytematic review of 6707 patients from 28
studies.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S2-S3), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Despite an aging Fontan population, data on late outcomes is
still scarce. Reported outcome measures and determinants vary greatly
between studies making comprehensive appraisal of mortality hazard
challenging. Methods: We conducted a systematic review to evaluate causes
and factors associated with late mortality in patients with Fontan
circulation. Late mortality was defined as mortality beyond the first
postoperative year. Studies were included if they had >90 patients or >20
late mortalities and/or transplants. Studies with overlapping patients
were rationalized to include only the most recent studies to avoid
duplication. The pooled hazard ratios were used to create the initial
components and weighting of a clinical score for Fontan patients. Results:
From 28 studies, a total of 6707 patients with an average follow-up time
of 8.23+/-5.42years were identified. There were 1000 deaths. Causes of
late death were reported in 697 cases. The five most common causes were
heart/Fontan failure (22%), arrhythmia (16%), respiratory failure (15%),
renal disease (12%), and thrombosis/bleeding (10%). Factors associated
with late mortality were evaluated and classified into 9 categories and
their relative hazards were used to derive the initial components of a
weighted, practical and clinically based Fontan risk score (ranging from
0-100). Nine risk factors including anatomic risk factors, elevated
preoperative pulmonary artery pressure, age >7 at the time of the
operation, atriopulmonary Fontan, heart failure symptoms, arrhythmia,
moderate/ severe ventricular dysfunction or atrioventricular valve
regurgitation, protein losing enteropathy and end organ disease (cirrhosis
or renal insufficiency) were identified as the most significant.
Conclusion: Factors associated with late mortality after the Fontan
operation are summarized in this study, and the components of a new
mortality risk score, that is weighted, and potentially usable in an
outpatient setting are presented. Prospective validation and refinement of
this risk score will be undertaken.

<94>
Accession Number
620076261
Author
Mandal C.K.; Chand R.; Roychowdhury S.; Narayan P.; Rupert E.
Institution
(Mandal, Chand, Roychowdhury, Rupert) R.N. Tagore International Institute
of Cardiac Sciences, Anaesthesia, Kolkata, India
(Narayan) R.N. tagore International Institute of Cardiac Sciences, Cardiac
Surgery, Kolkata, India
Title
Benefits of using microcuffed tracheal tube in patients undergoing
congenital cardiac surgeries evidence from a prospective randomized study.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S192-S193), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: It has been suggested that compared to conventional uncuffed
tubes, high volume-low pressure microcuffed tracheal tubes in smaller
children are beneficial. However, there is paucity of evidence of its
usage in children undergoing congenital cardiac surgery. Aim of this study
was to assess if microcuffed tracheal tubes in neonates and younger
children undergoing congenital cardiac surgery is associated with better
outcomes than uncuffed tubes. Methods: We carried out this single centre,
prospective, double blinded randomized study between June and November
2016. 80 patients were randomized into those receiving microcuffed
tracheal tubes and conventional uncuffed tubes. Primary outcome was
post-extubation stridor. Secondary outcomes measured included number of
tube changes, volume of anaesthetic gases required and cost incurred.
Results: The 2 groups were comparable in terms of baseline characteristics
and duration of intubation. Incidence of stridor was significantly higher
in conventional uncuffed tubes (12(30%) vs 4 (10%), p= 0.04) and so was
the the number of tube changes required (17/40 (42.5%) vs. 2/40(5%);
p=<0.001). Tube change was associated with more than three-fold risk of
stridor (odds ratio 3.92 (95% CI 1.23-12.43). Isoflurane (29.14 +/-7.01 ml
vs 19.2+/- 4.81 ml; p value <0.0001) and Oxygen flow requirement (p value
<0.0001) and the resultant cost (p value <0.0001) were all significantly
higher in the conventional uncuffed group. Conclusion: Microcuffed
paediatric tracheal tube is associated with significantly lower incidence
of stridor, tube changes and anaesthetic gas requirement. This leads to
significant cost-reduction that offsets the higher costs associated with
usage of microcuffed tracheal tube.

<95>
Accession Number
620076243
Author
Rato J.; Sousa A.; Martins D.; Abecasis M.; Neves J.; Anjos R.; Nogueira
G.
Institution
(Rato, Sousa, Martins, Anjos, Nogueira) Hospital Santa Cruz - Centro
Hospitalar Lisboa Ocidental, Pediatric Cardiology, Lisbon, Portugal
(Abecasis, Neves) Hospital Santa Cruz - Centro Hospitalar Lisboa
Ocidental, Cardiothoracic Surgery, Lisbon, Portugal
Title
Milrinone and arrhythmia following pediatric heart surgery is there an
association.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S375), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Milrinone is an inotrope and vasodilator used after pediatric
heart surgery. Arrhythmia is considered to be one of its most frequent
side effects, but with scarse evidence in pediatric age. In our study, we
evaluated the incidence of arrhythmia and its potential association to
milrinone following pediatric heart surgery. Materials and Methods: We
performed a retrospective study in a Pediatric Cardiac Intensive Care
Unit. Patients with <=1 year of age submitted to heart surgery with
extracorporeal circulation during the last 4 years were randomly selected.
The data was analyzed by SPSS, using the Chi-square or Fisher's exact test
for categorical variables and the T-test for ordinal variables. Results:
Our sample consisted of 104 patients, median of age 4 months. Diagnosis
included: transposition of the great arteries (29), ventricular septal
defect (25), tetralogy of Fallot (18), complete atrioventricular septal
defect (14), others (25). Arrhythmia was documented in 36.5% of the
patients (38): junctional tachycardia (19), atrioventricular block (5),
ventricular extrasystole (5), others (9). The following factors were
significantly associated with arrhythmia: coronary manipulation (p=0.019),
RACHS1>=4 (p=0.017), use of milrinone (p=0.003) or epinephrine (p=0.008),
and with lower significance, with the occurrence of low cardiac output
syndrome (p=0.041) or acute kidney injury (p=0.028). Patients with
arrhythmia were significantly younger (3.1 vs 5.4months, p=0.004) and
presented higher lactate levels (5.4 vs 3.0mmol/L, p=0.011). Conclusion:
In our study we found a statistical association between the occurrence of
arrhythmia and the use of milrinone after pediatric heart surgery. This
may result from a pure side effect of milrinone or a cluster of factors
that configure situations of higher arrhythmia risk.

<96>
Accession Number
620076145
Author
Kirk C.C.J.; Radman M.; Di Gennaro J.; Mazor R.; Chan T.
Institution
(Kirk) Seattle Children's Hospital, Pharmacy, Seattle, United States
(Radman, Di Gennaro, Mazor, Chan) Seattle Children'sHospital, Division of
PediatricCritical Care, Seattle, United States
Title
Targeted prophylactic heparin infusions significantly reduce catheter
associated thromboses in infants after cardiac surgery.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S336), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Infants with central venous catheters (CVC) after cardiac
surgery are at an increased risk of venous thrombosis. Previous studies of
fixed untargeted heparin infusions (10units/ kg/hr) or other
anticoagulants have not decreased the incidence of thromboses. We
hypothesized that a targeted prophylactic heparin infusion (TPHI) protocol
would reduce the incidence of catheterassociated thromboses in infants
after cardiac surgery. Materials and Methods: Beginning in September of
2010, all infants (age less than 6 months or weight less than 5 kg) with
an upper extremity CVC received a TPHI for the duration of CVC usage.
Heparin infusions were titrated to achieve slightly subtherapeutic
unfractionated heparin levels between 0.2-0.3units/mL. All venous
ultrasounds obtained between CVC insertion and one week after CVC removal
were reviewed for presence of thromboses. Rates of venous thromboses were
compared to historical controls receiving untargeted heparin infusions or
no anticoagulation. Results: Of 526 patients (TPHI: n =397, control: n=
129), 544 CVC were analyzed. The median duration of CVC usage (TPHI=4.9
days vs. control=4.0 days, p= 0.06) was similar between cohorts; however,
there were fewer venous ultrasounds (22% vs. 33%) in the TPHI cohort. TPHI
was associated with a significantly decreased incidence of thromboses per
CVC (8.6% vs. 19.1%, p <0.01) as well as a significant reduction in
thromboses per 1000 line days (8.0 vs. 19.2). Further analysis of
ultrasound data also showed that, among identified thrombotic events,
there were fewer occlusive thrombi after implementation of the TPHI
protocol (3.5% vs. 12.2%, p <0.01). Conclusions: Targeted prophylactic
heparin infusions significantly decreased catheter-associated thromboses
in infants with congenital heart disease.

<97>
Accession Number
620078076
Author
Jung J.W.; Cha M.J.; Kim C.S.; Jung S.Y.; Choi J.Y.; Shin Y.R.; Park H.K.;
Park Y.H.
Institution
(Jung, Cha, Kim, Jung, Choi) Severance Cardiovascular Hospital, Yonsei
University, Pediatric Cardiology, Seoul, South Korea
(Shin, Park, Park) Severance Cardiovascular Hospital, Yonsei University,
Pediatric Cardiovascular Surgery, Seoul, South Korea
Title
Retrospective study of optional treatment strategy using pulmonary
vasoreactivity in borderline eigenmenger syndrome.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S640), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: This study aimed to evaluate the feasibility, clinical
application of pulmonary vasoreactivity testing with inhaled iloprost and
to determine the treatment strategy in patients with pulmonary arterial
hypertension (PAH) associated with congenital heart diseases (CHD).
Method: This retrospective study was done in single center for 139 cases
with CHD diagnosed as PAH through the right heart catheterization from
Jan. 2011 to Jul.2016. Inhaled iloprost was delivered during cardiac
catheterization by ultrasonic nebulizer via a flow-inflating bag with 0.02
or 0.04 mg. The hemodynamic results and post-catheterization treatment
results were reviewed. Results: The median age of the patients was 32.48
years. The average numbers of systolic pulmonary artery pressure (sPAP)
and mean pulmonary artery pressure (mPAP) were 67.39 +/- 35.77mmHg and
44.39 +/-26.30 mmHg. The median pulmonary vascular resistance index was
7.42 Wood units. Among those patients, 58 patients had underwent the
pulmonary vasoreactivity test with inhaled iloprost plus oxygen during
catheterization (testing group). The average numbers of sPAP and mPAP were
88.32 +/-22.77mmHg and 57.34+/- 18.37mmHg in testing group. The median
pulmonary vascular resistance index (PVRi) was 10.8 Wood units. 32 (55%)
patients were regarded as responder group. The mean PVRi was also
significantly decreased in responder group (9.6 to 5.6 vs 12.3 to 11.0
Wood units). After pulmonary vasoreactivity testing, 8 patients had
undertaken complete corrective procedure, 19 had received corrective
procedure with either fenestration or banding, 4 had undertaken one more
procedure/ operation followed initial procedure after catheterization, and
in only 1 patient, palliative coronary stenting was done. The others were
treated with single or combined pulmonary vasodilators without any
procedure/operation. Conclusion: We suggest that even in patients with PAH
associated with CHD, pulmonary vasoreactivity test in RHC is essential to
determine the treatment strategy of closure or not for borderline
Eigenmenger syndrome.

<98>
Accession Number
620078073
Author
Jung J.W.; Cha M.J.; Kim C.S.; Jung S.Y.; Choi J.Y.; Shin Y.R.; Park H.K.;
Park Y.H.
Institution
(Jung, Cha, Kim, Jung, Choi) Severance Cardiovascular Hospital, Yonsei
University, Pediatric Cardiology, Seoul, South Korea
(Shin, Park, Park) Severance Cardiovascular Hospital, Yonsei University,
Pediatric Cardiovascular Surgery, Seoul, South Korea
Title
Retrospective study of optional treatment strategy using pulmonary
vasoreactivity in borderline eigenmenger syndrome using pulmonary
vasoreactivity.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S639-S640), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: This study aimed to evaluate the feasibility, clinical
application of pulmonary vasoreactivity testing with inhaled iloprost and
to determine the treatment strategy in patients with pulmonary arterial
hypertension (PAH) associated with congenital heart diseases (CHD).
Method: This retrospective study was done in single center for 139 cases
with CHD diagnosed as PAH through the right heart catheterization from
Jan. 2011 to Jul.2016. Inhaled iloprost was delivered during cardiac
catheterization by ultrasonic nebulizer via a flow-inflating bag with 0.02
or 0.04 mg. The hemodynamic results and post-catheterization treatment
results were reviewed. Results: The median age of the patients was 32.48
years. The average numbers of systolic pulmonary artery pressure (sPAP)
and mean pulmonary artery pressure (mPAP) were 67.39 +/- 35.77mmHg and
44.39 +/-26.30 mmHg. The median pulmonary vascular resistance index was
7.42 Wood units. Among those patients, 58 patients had underwent the
pulmonary vasoreactivity test with inhaled iloprost plus oxygen during
catheterization (testing group). The average numbers of sPAP and mPAP were
88.32 +/-22.77mmHg and 57.34+/- 18.37mmHg in testing group. The median
pulmonary vascular resistance index (PVRi) was 10.8 Wood units. 32 (55%)
patients were regarded as responder group. The mean PVRi was also
significantly decreased in responder group (9.6 to 5.6 vs 12.3 to 11.0
Wood units). After pulmonary vasoreactivity testing, 27 patients had
undertaken complete/partial corrective procedure, 4 patients had
undertaken one more procedure/ operation followed initial procedure after
catheterization, and in only 1 patient, palliative coronary stenting was
done. The others were treated with single or combined pulmonary
vasodilators without any procedure/operation. Conclusion: We suggest that
even in patients with PAH associated with CHD, pulmonary vasoreactivity
test in RHC is essential to determine the treatment strategy of closure or
not for borderline Eigenmenger syndrome.

<99>
Accession Number
620077994
Author
Scholl R.; Benkwitz C.; Fontes M.L.; Shah N.; Jaquiss R.D.B.; Lodge A.J.;
Ames W.A.; Homi M.; Machovec K.A.; Jooste E.H.
Institution
(Scholl, Ames, Homi, Machovec, Jooste) Duke University Hospital, Pediatric
Anesthesiology, Durham, United States
(Benkwitz) Vanderbilt University, Pediatric Anesthesiology, Nashville,
United States
(Fontes) Yale, Pediatric Anesthesiology, New Haven, United States
(Shah) Duke University Hospital, Medicine, Durham, United States
(Jaquiss, Lodge) Duke University Hospital, Congenital Cardiac Surgery,
Durham, United States
Title
Double blind randomized placebo controlled trial comparing the effects of
anti thrombin vs placebo on the coagulation system in infants with anti
thrombin deficiency undergoing congenital cardiac surgery.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S24), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Introduction: Anti-thrombin (AT) is crucial for heparin to be effective
and for the prevention of thrombosis. We tested the hypothesis that pre
cardiopulmonary bypass (CPB) normalization of AT levels to 100% would
improve anticoagulation during CPB, attenuate activation of the
coagulation cascade, as measured by fibrin degradation products- D-Dimers,
and mitigate microthrombosis in the post-operative period. Methods: This
is a randomized, double blinded, placebo controlled study in infants with
AT levels less than 70% undergoing CPB at 2 academic centers. Half were
given AT (Thrombate) to normalize to 100% functional assay and the other
half received placebo. We recorded demographics, laboratory values,
hemostatic agents, blood products administered, operating room times,
24-hour chest tube output, and occurrence of post-operative thrombosis.
Summary statistics, pooled T-test, Fisher exact test and Wilcoxon Rank-Sum
test were performed. Results: Over 24 month period 223 patients were
screened, 68 met inclusion criteria, 40 were randomized, and 1 (in Placebo
group) was withdrawn during the study due to ECMO initiation in the
operating room. Thirty percent of screened patients had AT levels <70%.
Table 1 shows demographic and peri-operative variables. Notable
differences were observed between the two groups including higher first
post-heparin activated clotting time (ACT) and AT levels in the treatment
group. Table 2 shows Laboratory results. Significantly, 24 hours
post-operative chest tube output, overall blood product transfusions and
D-Dimer production were all lower in the AT group. No difference in major
adverse events was noted. Conclusion: Replacement of AT improves
anticoagulation during CPB without increased rates of bleeding or adverse
events. Furthermore our results suggest extension of these beneficial
effects into the postoperative period, reflected by significantly less
postoperative bleeding and transfusions, and generation of D-Dimers. We
conclude that treatment of low AT levels with exogenous AT is helpful in
infants undergoing cardiac surgery. (Table presented).

<100>
Accession Number
620077980
Author
Burch M.; Nallagangula T.; Lochlainn E.N.; Severin T.; Thakur L.; Jaecklin
T.; George A.; Solar-Yohay S.; Rossano J.; Shaddy R.
Institution
(Burch) Great Ormond Street Hospital for Children, Cardiorespiratory
Division, London, United Kingdom
(Nallagangula, Thakur, George) Novartis Healthcare Pvt. Ltd., Patient
Access Services, Hyderabad, India
(Lochlainn) Novartis Pharma Ag, Basel, Switzerland
(Severin) Novartis Pharma Ags, Basel, Switzerland
(Jaecklin) Shire International Gmbh, Global Clinical Development, Zug,
Switzerland
(Solar-Yohay) Novartis Pharmaceuticals Corporation, Cardiometabolic, East
Hanover, United States
(Rossano, Shaddy) Children's Hospital of Philadelphia, Pediatric
Cardiology, Philadelphia, United States
Title
Systematic literature review on the clinical economic humanistic and
societal burden of heart failure in children and adolescents.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S627), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Pediatric heart failure (HF) is associated with substantial
morbidity and mortality. However, to date, there has been no systematic
assessment of pediatric HF burden. Methods: This narrative systematic
review used Cochrane methodology to assess the evidence on the HF burden
in children and adolescents (<18 years) over the past 10 years
(2006-2016). Sources searched included Embase, Medline; selected
congresses; and WHO, NHSEED, and HTA databases. Results: 18 observational
studies were included. Six studies reported mortality rates. In a
UK/Ireland study, the 1-year mortality rate for patients admitted with a
first HF episode was 18.3%, while a US study reported 71% mortality over
10 years for inhospital HF following cardiac arrest. Based on three
studies, 16.4%-82% of end-stage HF patients underwent heart
transplantation. Four studies reported HF-related hospitalization rates of
18.2%-63.9% in infants (<1 year) and 18.7%-45.7% in children aged 1-12
years. Across six studies, mean length of hospital stay was 15 days
overall, but was up to 26 days for infants. Five studies reported cost
data. US studies reported mean hospital charges/year that were higher for
infants (US$176,000) than for children aged 1-10 years (US$132,000) and
total hospitalization costs for all US pediatric HF admissions in 2006 of
US$753,149,082 (mean hospital cost per patient: US$49,354). In Germany,
DRG-based hospital allowances per HF case were 3,498 in 1995 and 4,250 in
2009. In a Nigerian study, out-of-pocket expenses for HF treatment were
0.7%-122% of family income (mean US $17.6+/-10.6/month); indirect costs
(transportation/man hours) were 0.1%-57.1% of monthly income; and mean
man-hour loss was 85.2 hours/year. No study reporting on patient quality
of life fulfilled the selection criteria. Conclusions: This review
demonstrates the substantial burden of pediatric HF. However, the small
number of studies, heterogeneity, and limited geographical coverage
indicates the need for further research.

<101>
Accession Number
620077681
Author
Vener D.; Gaies M.; Jacobs J.; Pasquali S.
Institution
(Vener) Baylor Com/Texas Childrens Hospital, Anesthesiology, Houston,
United States
(Gaies, Pasquali) U Michigan/Cs Mott Childrens Hospital, Cardiology, Ann
Arbor, United States
(Jacobs) Johns Hopkins/All Childrens Hospital, Cardiac Surgery, St
Petersburg, United States
Title
Multi center congenital heart disease databases active worldwide.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S83-S85), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
There are at least 39 known multi-center efforts collecting information on
patients with congenital heart disease that we have identified worldwide.
Some of these are geographically limited while others are very disease or
specialty specific. We have collated and present here all of the currently
active databases and registries. These were identified by personal
involvement, word of mouth, PubMed searches and Google(TM) searches
utilizing terms such as "cardiac, congenital, surgery, intensive care,
critical care, cardiology, databases, and registries" in various
combinations. Hospitals in developed countries may spend millions of
dollars in participation fees and indirect expenses (salaries, travel).
There needs to be better coordination between existing registries and
databases and mechanisms for cross-linking data between them. Access to
these databases also needs to be made more usable for resourcepoor
countries and for "mission" trips. Prior to starting more databases or
registries it would be useful for planners to see if existing ones might
suit their purposes. (Figure Presented).

<102>
Accession Number
620077235
Author
Khawaja T.; Asghar A.; Amanullah M.
Institution
(Khawaja, Asghar) Aga Khan University, Medical College, Karachi, Pakistan
(Amanullah) Aga Khan University, Surgery, Karachi, Pakistan
Title
Systematic review comparison between figure of eight and simple wire
technique for sternal closure in preventing sternal dehiscence after open
heart surgeries.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S518), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Introduction: Multiple techniques have been employed for sternal closure
following cardiothoracic surgery. These include the figure of eight method
and the simple wire technique. This study aims to investigate the
advantages of employing the figure of eight technique over the simple wire
method. Objective: To assess whether the figure of eight technique is
superior to the traditional technique of sternal closure in reducing the
chance of sternal dehiscence in patients undergoing open heart surgeries.
Methods: In this systematic review we searched through Pubmed, Cochrane
Library (Wiley) and Scopus for articles relevant to our study. We narrowed
down our search to Randomized Control Trials, Clinical Trials,
Retrospective Cohort Studies, Journal Analyses, Systematic Reviews and
Meta-analyses published since 2000. We excluded any animal studies and
articles published in any other language but English. Results: A total of
394 articles were retrieved. Upon excluding duplications, protocols only
papers, case reports, case series and reviews, 121 papers were finally
selected and reviewed independently by two critics. Of the 7 articles that
were finally included in the study, 4 articles stated that the figure of
eight method reduced the chances of sternal dehiscence in patients
undergoing open heart surgeries. 3 articles, however, showed that there
was no significant difference between the incidences of sternal dehiscence
with each technique of sternal closure. None of the articles showed an
increase in the risk of sternal dehiscence with the figure of eight
technique. Conclusion: Majority of articles showed a decreased risk of
developing sternal dehiscence with the figure of eight technique. Hence,
we can conclude that the figure of eight technique is superior to the
traditional wire technique since it lessens the risk of sternal dehiscence
in patients undergoing open heart surgeries.

<103>
Accession Number
620077127
Author
Anonymous
Title
7th World Congress of Pediatric Cardiology and Cardiac Surgery Abstracts.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (no pagination), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
The proceedings contain 1631 papers. The topics discussed include:
improving timely discharge by using goal oriented rounding and team based
communication; a clinical effectiveness program leveraging aggregate
patient data at the point of care improves value in patients undergoing
congenital heart surgery; how hard do cardiologists work the patient
encounter index (PEI) a novel method to assess the clinical workload of a
pediatric cardiology service; performance of pediatric cardiac surgery
centers a national effort to reduce the gaps of burden of congenital heart
disease in Colombia; and factors associated with long term mortality after
FONTAN procedures. Risk score creatioin based on systematic review of 6707
patients from 28 studies.

<104>
Accession Number
620077050
Author
Almond C.; Jaquiss J.; Massicotte P.; Ichord R.; Kaltman J.; Stylianou M.;
Siami S.; Dasse K.; Egan D.; Zak V.; Baldwin T.; Mahle W.
Institution
(Almond) Stanford University, Pediatrics, Palo Alto, United States
(Jaquiss) University of Texas Southwestern, Surgery, Dallas, United States
(Massicotte) Stollery Children, Pediatrics, Edmonton, Canada
(Ichord) Children's Hospital of Philadelphia, Pediatrics, Philadelphia,
United States
(Kaltman, Stylianou, Egan, Baldwin) NIH, NHLBI, Bethesda, United States
(Siami) New England Research Institute, Regulatory Affairs, Watertown,
United States
(Dasse) Geno Llc, Medical Devices, Cocoa, United States
(Zak) New England Research Institute, Biostatistics, Watertown, United
States
(Mahle) Children's Healthcare of Atlanta, Pediatrics, Atlanta, United
States
Title
The pumpkin trial study design and rationale.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S78-S79), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Severe heart failure in children carries high mortality.
Durable ventricular assist device (VAD) options for smaller children are
currently limited to pulsatile devices that carry a high risk of stroke
and lack portability. The Jarvik 2015, a fully implantable axial flow
pump, similar in design to contemporary adult devices, has emerged as a
promising treatment alternative for bridge-to-transplant support in
smaller children. Methods: The PumpKIN trial is an Investigational Device
Exemption (IDE) study designed to evaluate the Jarvik 2015 VAD in children
to support regulatory review of the device under the HDE regulation. The
IDE study, which was conditionally approved by the FDA in 2016, is set to
begin enrollment in 2017. Results: The PumpKIN trial is a randomized
clinical trial comparing the safety and probable benefit of the Jarvik
2015 VAD to the Berlin Heart EXCOR Pediatric VAD. Children between 8 and
20 kilograms with 2-ventricle circulations and class IV heart failure
(INTERMACS profile 1 or 2) despite optimal medical therapy and candidates
for heart transplant will be enrolled. The primary probable benefit
endpoint is the survival to transplant or 180 days of support without
severe neurological dysfunction or randomized device failure. The primary
safety endpoint is the incidence of protocol-defined adverse events using
PEDIMACS criteria (version 5.0). The study is powered to show
noninferiority of the primary safety endpoint and will enroll a total of
88 subjects randomly assigned in a one-to-one ratio to each study arm.
Conclusions: The PumpKIN trial will be the first randomized clinical trial
of a pediatric ventricular assist device. It is anticipated that data
generated from the study will provide critical safety and effectiveness
information for the first axial flow pump designed specifically for
children with advanced heart failure.

<105>
Accession Number
620077048
Author
Lozada M.A.; Balderas J.; Bunyi M.I.; Suarez C.
Institution
(Lozada, Balderas, Bunyi) Philippine Heart Center, Pediatric Cardiology,
Quezon City, Philippines
(Suarez) Philippine Heart Center, Rehabilitation Medicine, Quezon City,
Philippines
Title
Comparison of the effectiveness of four(4) session play module versus the
conventional cardiovascular rehabilitation therapy among post operative
congenital heart disease pediatric patients ages 5 12 years old.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S144), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Play is primarily a way for a child to communicate, especially
when under stress. However, the efficacy of therapeutic play is not widely
accepted by the scientific community due to lack of evidence-based
studies. The objective of this study was to determine the effectiveness of
the four-session play module as cardiovascular post-operative
rehabilitation therapy. Methodology: A randomized controlled clinical
trial among pediatric patients ages 5-12 years old diagnosed of Congenital
Heart Disease, who underwent elective open heart surgery. The patients
were divided into two groups: play module or conventional rehabilitation
therapy. Quality of life (QoL) was assessed through PedsQL cardiac module.
Result: There was a total of 56 subjects, with a mean age of 7.3 years. On
the 2nd post-operative day, there was a significant difference on the QoL
of patients who had the play module with regards to heart problem (2.4
+/-0.77 vs 1.4 +/-0.74, p <0.001), treatment problem (1.2+/- 1.12 vs
0.5+/- 0.74, p= 0.019), perceived physical appearance (2.2 +/- 1.09 vs 1.4
+/-1.1, p = 0.007), treatment anxiety (2.6 +/-0.99 vs 1.4 +/-1.14, p
<0.001), cognitive (1.7+/-0.94 vs 0.8 +/- 0.69, p <0.001), and
communication (2.4+/-1.15 vs 1.3 +/-1.1, p< 0.001). The QoL was also
significant on the 5th post-operative day, except for treatment problem.
Comparing the treatment group, there was a significant improvement on the
QoL as the sessions progressed. Conclusion: The structured play module is
an effective therapeutic tool for cardiovascular rehabilitation of
post-operative pediatric patients. It helped improved the quality of their
lives postoperatively.

<106>
Accession Number
620076944
Author
Phillips A.; Berndsen N.; Hartmann R.; Shane R.; Lubin L.; Wong R.;
Nawathe P.; Olshove V.
Institution
(Phillips, Berndsen, Olshove) Cedars,Sinai Medical Center, Surgery, Los
Angeles, United States
(Hartmann, Shane) Cedars,Sinai Medical Center, Pharmacy, Los Angeles,
United States
(Lubin, Wong) Cedars,sinai Medical Center, Anesthesia, Los Angeles, United
States
(Nawathe) Cedars,Sinai Medical Center, Pediatrics, Los Angeles, United
States
Title
Decreased opiate usage by incorporating ofirimev in post operative pain
management in congenital heart surgery.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S342-S343), 2017. Date
of Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: Opioids and benzodiazepines are frequently used to manage
post-operative pain and sedation in patients undergoing congenital heart
surgery. In recent years, Ofirmev has been incorporated into the
post-operative pain management plan. Methods: We reviewed the use of
opioids and benzodiazepines in two cohorts from our congenital cardiac
surgery program. Group 1 consisted of congenital heart cases performed
between 2012- 2014. Group 2 were cases performed between 2014-2016. Data
was extracted from Vizient, which comes from UHC institutions, and
specifically looked at the type of medication used, percent of cases
requiring the use of opiates, benzodiazepines and Ofirimev and number of
treatment days each case required. A comparison of overall opiate,
benzodiazepine and Ofirimev utilization between the two cohorts was
completed. Results: 37 congenital heart surgeries occurred between 2012-
2014. Between 2014-2016, 173 heart surgeries were performed. 92% of cases
from both cohorts received opiates post-operatively while 68% of Group 1
received benzodiazepines, compared to 69% of Group 2. Ofirimev was not
used in post-operative management for cases performed between 2012-2014,
whereas, 51% of cases from 2014-2016 received Ofirimev. With the addition
of Ofirimev in post-operative pain management, there was an overall
decrease in length of opiate treatment with the current cohort receiving
3.8 days of opiates compared to the historical group at 7.7 days.
Benzodiazepine use was 3.2 days in the recent cohort compared to 3.8 days
in the previous cohort. Conclusions: When compared to the historical
cohort, patients undergoing heart surgery between 2014-2016 received fewer
days of opiates and more Ofirimev. Overall use of benzodiazepines was
similar for each group. Although early results suggest that Ofirimev
decreases opiate and benzodiazepine usage in post-operative pain
management, further studies are needed.

<107>
Accession Number
620076660
Author
Makarapong P.; Namchaisiri J.; Vithessonthi K.
Institution
(Makarapong) Rajavithi Hospital, Cardiovascularthoracic, Bangkok, Thailand
(Namchaisiri) King Chulalongkorn Memorial Hospital,
Cardiovascularthoracic, Bangkok, Thailand
(Vithessonthi) Pediatric Cardiac Surgery Foundation, Pediatric Cardiology,
Bangkok, Thailand
Title
Custodiol versus conventional cardioplegia in tetralogy of fallot surgery.
Source
Cardiology in the Young. Conference: 7th World Congress of Pediatric
Cardiology and Cardiac Surgery. Spain. 27 (4) (pp S513), 2017. Date of
Publication: July 2017.
Publisher
Cambridge University Press
Abstract
Background: We examine whether Custodiol and conventional cardioplegia
have differential effects on patients' perioperative and postoperative
conditions. Materials and Methods: The initial sample consists of 90
pediatric patients with Tetralogy of Fallot (TOF) who underwent a total
correction surgery from March 2014 to November 2016. The patients were
randomly allocated to receive Custodiol or conventional cardioplegia. Both
groups of patients' perioperative and postoperative conditions were
collected. We employed ordinary least square (OLS) regressions and probit
models to test our hypotheses. Perioperative conditions include
cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC) time.
Postoperative conditions consist of right and left ventricular ejection
fraction (RVEF and LVEF), mechanical ventilation time, ICU stays, overall
stays, arrhythmia, complications and Vasoactive Inotropic Score (VIS).
Results: Based on the final sample of 78 patients, we find that Custodiol
and conventional cardioplegia have the differential effects on CPB time,
ACC time and post-operative outcome for patients undergoing TOF surgery.
The results indicate that patients who received conventional cardioplegia
tend to have shorter CPB time than those receiving Custodiol. In addition,
patients who received conventional cardioplegia tend to have shorter ACC
time than those receiving Custodiol. These results remain evident after
controlling for operation procedure (i.e. transannular patch vs.
nontransannular patch), other lesions (e.g., PDA, ASD), and the presence
of previous shunt. In addition, there is evidence to suggest that CPB time
had a positive effect on VIS during the first 24 hours after surgery and
had a negative effect on RVEF. Overall, there is no evidence to support
the notion that CPB time had any effect on postoperative mechanical
ventilation time, ICU stays, overall stays, arrhythmia, and complications.
Conclusions: Relative to the use of conventional cardioplegia, the use of
Custodiol results in longer CPB time, longer ACC time and higher VIS
during the first 24 hours after surgery.

<108>
Accession Number
619550532
Author
Gnanenthiran S.R.; Kritharides L.; D'Souza M.; Lowe H.C.; Brieger D.B.
Institution
(Gnanenthiran, Kritharides, Lowe, Brieger) Cardiology Department, Concord
Repatriation General Hospital, hospital Rd, Concord, NSW 2139, Australia
(Gnanenthiran, Kritharides, D'Souza, Lowe, Brieger) University of Sydney,
Sydney, NSW, Australia
Title
Revascularisation compared with initial medical therapy for
non-ST-elevation acute coronary syndromes in the elderly: A meta-analysis.
Source
Heart. 103 (24) (pp 1962-1969), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Whether revascularisation is superior to medical therapy in
older populations presenting with non-ST-elevation acute coronary
syndromes (NSTEACS) remains contentious, with inconclusive evidence from
randomised trials. We aimed to compare routine invasive therapy with
initial medical management in the elderly presenting with NSTEACS. Methods
MEDLINE, EMBASE and Cochrane Controlled Trial Register were searched for
studies comparing routine invasive therapy with initial medical management
in patients >=75 years old presenting with NSTEACS. Endpoints included
long-term mortality, myocardial infarction (MI), revascularisation,
rehospitalisation, stroke and major bleeding reported as ORs. Results Four
randomised trials and three observational studies met inclusion criteria,
enrolling a total of 20 540 patients followed up from 6 months to 5 years.
Routine invasive therapy reduced mortality (OR 0.67, CI 0.61 to 0.74), MI
(OR 0.56, CI 0.45 to 0.70) and stroke (OR 0.53, CI 0.30 to 0.95). Analyses
restricted to randomised controlled trials (RCTs) confirmed a reduction in
MI (OR 0.51, CI 0.40 to 0.66), revascularisation (OR 0.27, CI 0.13 to
0.56) and a trend to reduced mortality (OR 0.84, CI 0.66 to 1.06) at the
expense of major bleeding (OR 2.19, CI 1.12 to 4.28). Differences in major
bleeding were unapparent in more recent studies. Conclusion Routine
invasive therapy reduces MI and repeat revascularisation and may reduce
mortality at the expense of major bleeding in elderly patients with
NSTEACS. Our findings highlight the need for further RCTs to better
determine the effect on mortality and contemporary bleeding
risk.<br/>Copyright &#xa9; 2017 Article author(s) (or their employer(s)
unless otherwise stated in the text of the article). All rights reserved.

<109>
Accession Number
619550521
Author
Foroutan F.; Guyatt G.H.; Otto C.M.; Siemieniuk R.A.; Schandelmaier S.;
Agoritsas T.; Vandvik P.O.; Bhagra S.; Bagur R.
Institution
(Foroutan, Guyatt, Siemieniuk, Schandelmaier, Agoritsas) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON L8S 4L8, Canada
(Foroutan, Bhagra) Heart Failure/Transplant Program, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Otto) Division of Cardiology, Department of Medicine, University of
Washington School of Medicine, Seattle, WA, United States
(Siemieniuk) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Agoritsas) Division of General Internal Medicine, Division of Clinical
Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
(Vandvik) Department of Internal Medicine, Innlandet Hospital
Trust-division Gjovik, Gjovik, Norway
(Vandvik) Institute of Health and Society, University of Oslo, Faculty of
Medicine, Gjovik, Norway
(Bagur) Division of Cardiology, Departments of Medicine and Epidemiology
and Biostatistics, London Health Sciences Centre, Western University,
London, ON, Canada
(Bagur) Keele Cardiovascular Research Group, Institute of Applied Clinical
Science, Centre for Prognosis Research, Keele University, Stoke-on-Trent,
United Kingdom
Title
Structural valve deterioration after transcatheter aortic valve
implantation.
Source
Heart. 103 (23) (pp 1899-1905), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Transcatheter aortic valve implantation (TAVI), widely used to
treat high-risk patients with severe symptomatic aortic stenosis, has
recently been extended to younger patients at lower operative risk in whom
long-term durability of TAVI devices is an important concern. Therefore,
we conducted a systematic review and meta-analysis of observational
studies addressing the frequency of structural valve deterioration (SVD)
after TAVI. Methods We searched Medline, Embase, Cochrane Database of
Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We
included observational studies following patients with TAVI for at least 2
years. Independently and in duplicate, we evaluated study eligibility,
extracted data, and assessed risk of bias for SVD post-TAVI. Our review
used the GRADE system to assess quality of evidence. We pooled incidence
rates using a random effects model. Results Thirteen studies including
8914 patients, with a median follow-up between 1.6 and 5 years, reported
an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The
pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to
73.44 per 100 patient years). Of those who developed SVD, 12% underwent
valve re-intervention. Confidence in the evidence was moderate due to
inconsistency among studies. Conclusion Structural valve deterioration is
probably an infrequent event within the first 5 years after TAVI.
Ascertaining the impact of SVD and the need for valve-related
re-interventions to inform recommendations for patients with a longer
life-expectancy will require studies including a large number of patients
with longer follow-up (>10 years).<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<110>
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.

<111>
Accession Number
619159216
Author
Agarwal N.; Mahmoud A.N.; Patel N.K.; Jain A.; Garg J.; Mojadidi M.K.;
Agrawal S.; Qamar A.; Golwala H.; Gupta T.; Bhatia N.; Anderson R.D.;
Bhatt D.L.
Institution
(Agarwal, Mahmoud, Jain, Mojadidi, Anderson) Department of Medicine,
University of Florida, Gainesville, Florida, United States
(Patel) Department of Medicine, Virginia Commonwealth University Health
System, Richmond, Virginia, United States
(Garg) Department of Medicine, Lehigh Valley, Allentown, Pennsylvania,
United States
(Agrawal) Department of Medicine, St Lukes University Health Network,
Bethlehem, Pennsylvania, United States
(Qamar, Golwala, Bhatt) Department of Medicine, Brigham and Women's
Hospital, Boston, Massachusetts, United States
(Gupta) Department of Medicine, Montefiore Medical Centre, Albert Einstein
College of Medicine, Bronx, New York, United States
(Bhatia) Department of Medicine, Vanderbilt University Medical Center,
Nashville, Tennessee, United States
Title
Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following
Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 121 (1) (pp 32-40), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although aspirin monotherapy is considered the standard of care after
coronary artery bypass grafting (CABG), more recent evidence has suggested
a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a
meta-analysis of observational studies and randomized controlled trials
comparing outcomes of aspirin monotherapy with DAPT in patients after
CABG. Subgroup analyses were conducted according to surgical technique
(i.e., on vs off pump) and clinical presentation (acute coronary syndrome
vs no acute coronary syndrome). Random effects overall risk ratios (RR)
were calculated using the DerSimonian and Laird model. Eight randomized
control trials and 9 observational studies with a total of 11,135 patients
were included. At a mean follow-up of 23 months, major adverse cardiac
events (10.3% vs 12.1%, RR 0.84, confidence interval [CI] 0.71 to 0.99),
all-cause mortality (5.7% vs 7.0%, RR 0.67, CI 0.48 to 0.94), and graft
occlusion (11.3% vs 14.2%, RR 0.79, CI 0.63 to 0.98) were less with DAPT
than with aspirin monotherapy. There was no difference in myocardial
infarction, stroke, or major bleeding between the 2 groups. In conclusion,
DAPT appears to be associated with a reduction in graft occlusion, major
adverse cardiac events, and all-cause mortality, without significantly
increasing major bleeding compared with aspirin monotherapy in patients
undergoing CABG.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<112>
Accession Number
619235004
Author
Hirata Y.; Hirahara N.; Murakami A.; Motomura N.; Miyata H.; Takamoto S.
Institution
(Hirata, Hirahara, Murakami, Motomura, Miyata, Takamoto) Japan
Cardiovascular Surgery Database, 2-26-9 Hongo, Bunkyo-ku, Tokyo 113-0033,
Japan
(Hirata) Department of Cardiac Surgery, The University of Tokyo School of
Medicine, Tokyo, Japan
(Hirahara, Miyata) Department of Health Policy and Management, Keio
University, Tokyo, Japan
(Murakami) Kanazawa Cardiovascular Hospital, Kanazawa, Japan
(Motomura) Department of Cardiovascular Surgery, Toho University Sakura
Medical Center, Tokyo, Japan
(Takamoto) Mitsui Memorial Hospital, Tokyo, Japan
Title
Current status of cardiovascular surgery in Japan 2013 and 2014: A report
based on the Japan Cardiovascular Surgery Database. 2: Congenital heart
surgery.
Source
General Thoracic and Cardiovascular Surgery. 66 (1) (pp 4-7), 2018. Date
of Publication: 01 Jan 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: We analyzed the mortality and morbidity of congenital heart
surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD).
Methods: Data regarding congenital heart surgery performed between January
2013 and December 2014 were obtained from JCVSD. The 20 most frequent
procedures were selected and the mortality rates and major morbidities
were analyzed. Results: The mortality rates of atrial septal defect repair
and ventricular septal defect repair were less than 1%, and the mortality
rates of tetralogy of Fallot repair, complete atrioventricular septal
defect repair, bidirectional Glenn, and total cavopulmonary connection
were less than 2%. The mortality rates of the Norwood procedure and total
anomalous pulmonary venous connection repair were more than 10%. The rates
of unplanned reoperation, pacemaker implantation, chylothorax, deep
sternal infection, phrenic nerve injury, and neurological deficit were
shown for each procedure. Conclusion: Using JCVSD, the national data for
congenital heart surgery, including postoperative complications, were
analyzed. Further improvements of the database and feedback for clinical
practice are required.<br/>Copyright &#xa9; 2017, The Japanese Association
for Thoracic Surgery.

<113>
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

<114>
Accession Number
619583227
Author
Shahbazi S.; Alishahi P.; Asadpour E.
Institution
(Shahbazi, Alishahi, Asadpour) Anesthesiology and Critical Care Research
Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Title
Evaluation of the effect of aminophylline in reducing the incidence of
acute kidney injury after cardiac surgery.
Source
Anesthesiology and Pain Medicine. 7 (4) (no pagination), 2017. Article
Number: e21740. Date of Publication: August 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Objectives: Acute renal failure is a common complication of major
cardiovascular surgeries (One-third of patients). Adenosine release as a
vascular vasodilator increases after cardiac surgery, which reduces renal
and glomerular blood flow and subsequently causes kidney ischemic damage.
The present study aimed at evaluating the impact of aminophylline as an
adenosine receptor antagonist on renal function after cardiac surgery
hoping to find an appropriate method to reduce acute kidney injury.
Methods: The patients in the intervention group received 5 mg/kg
aminophylline bolus after induction of anesthesia; then, 0.25 mg/kg/hr of
the drug was administered intraoperatively and up to 48 hours after
surgery in the ICU cardiac surgery. Similar volume of normal saline was
injected to the patients of the second group. Serum BUN, Cr, and GFR were
measured pre- and postoperatively and 3 days postsurgery. Patients' 24-
hour urine output and RIFLE were also calculated. Results: Those patients
who received medication were extubated earlier (P = 0.018) and received
lower amount of inotropic drugs (P < 0001). According to the RIFLE
criteria, most of the patients experienced no change or even improved GFR
and Cr amounts compared to the control group (p < 0.05). GFR and Cr value
of all the patients with Cleveland score, less and more than 6, showed a
significant difference between the 2 groups (P = 0.001 and P = 0.01,
respectively). According to the RIFLE criteria, most of the patients
experienced no change or even improved GFR. Conclusions: Aminophylline in
cardiac surgery can reduce the frequency of acute kidney injury according
to RIFLE criteria and could be used in the prevention of AKI as a safe and
efficient modality in high-risk patients. Also, the use of this drug may
reduce the need for inotropic medication at the time of surgery, intensive
care unit stay length, and extubation time.<br/>Copyright &#xa9; 2017,
Anesthesiology and Pain Medicine.

<115>
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

<116>
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.

<117>
Accession Number
615611016
Author
Auer C.J.; Laferton J.A.C.; Shedden-Mora M.C.; Salzmann S.; Moosdorf R.;
Rief W.
Institution
(Auer, Laferton, Salzmann, Rief) Department of Clinical Psychology and
Psychotherapy, Philipps University of Marburg, Marburg, Germany
(Laferton) Department of Clinical Psychology and Psychotherapy,
Psychologische Hochschule Berlin, Berlin, Germany
(Shedden-Mora) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Philipps University of Marburg, Marburg, Germany
Title
Optimizing preoperative expectations leads to a shorter length of hospital
stay in CABG patients: Further results of the randomized controlled
PSY-HEART trial.
Source
Journal of Psychosomatic Research. 97 (pp 82-89), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To examine the effect of a preoperative expectation-optimizing
psychological intervention on length of stay in the hospital and time
spent in the Intensive Care Unit (ICU) in patients undergoing elective
cardiac surgery. Methods In a randomized controlled trial, 124 patients
prior to undergoing coronary artery bypass grafting (CABG) or CABG
combined with heart valve surgery were randomized to either a) standard
medical care alone (SMC) or an additional preoperative intervention, b) an
additional expectation manipulation intervention (EXPECT) to optimize
patients' expectations, or c) an additional supportive therapy (SUPPORT),
containing the same amount of therapeutic attention but without a specific
focus. Participants were followed-up post-operatively to assess their
length of hospital stay and the time spent in the ICU. Results Patients in
both psychological intervention groups spent significantly less days in
the hospital then patients in the SMC group (M(EXPECT) = 12.62, M(SUPPORT)
= 14.13, M(SMC) = 17.27, p = 0.028). There was a significant linear trend
(F(1112) = 7.68, p = 0.009) showing that the more specific the
intervention patients received the shorter they stayed in the hospital.
The effect of the intervention on time spent in the ICU was only
marginally significant (M(EXPECT) = 103.76, M(SUPPORT) = 103.10, M(SMC) =
158.45, p = 0.066). Conclusion Changing patients' preoperative
expectations via a psychological intervention leads to less days spent in
the hospital. The psychological interventions are associated with positive
cost-benefit ratios. Specific psychological mechanisms underlying the
effect of our intervention remain unclear and need to be investigated
further. Trial Registration: www.clinicaltrials.gov
(NCT01407055).<br/>Copyright &#xa9; 2017

<118>
Accession Number
619934429
Author
Smith L.E.; Smith D.K.; Blume J.D.; Linton M.F.; Billings F.T.
Institution
(Smith, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Smith, Blume) Department of Biostatistics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Linton, Billings) Department of Biostatistics and Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
Title
High-density lipoprotein cholesterol concentration and acute kidney injury
after cardiac surgery.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006975. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury (AKI) after cardiac surgery is associated
with increased short- and long-term mortality. Inflammation, oxidative
stress, and endothelial dysfunction and damage play important roles in the
development of AKI. Highdensity lipoproteins (HDLs) have anti-inflammatory
and antioxidant properties and improve endothelial function and repair.
Statins enhance HDL's anti-inflammatory and antioxidant capacities. We
hypothesized that a higher preoperative HDL cholesterol concentration is
associated with decreased AKI after cardiac surgery and that perioperative
statin exposure potentiates this association. Methods and Results--We
tested our hypothesis in 391 subjects from a randomized clinical trial of
perioperative atorvastatin to reduce AKI after cardiac surgery. A
2-component latent variable mixture model was used to assess the
association between preoperative HDL cholesterol concentration and
postoperative change in serum creatinine, adjusted for known AKI risk
factors and suspected confounders. Interaction terms were used to examine
the effects of preoperative statin use, preoperative statin dose, and
perioperative atorvastatin treatment on the association between
preoperative HDL and AKI. A higher preoperative HDL cholesterol
concentration was independently associated with a decreased postoperative
serum creatinine change (P=0.02). The association between a high HDL
concentration and an attenuated increase in serum creatinine was strongest
in long-term statinusing patients (P=0.008) and was further enhanced with
perioperative atorvastatin treatment (P=0.004) and increasing long-term
statin dose (P=0.003). Conclusions--A higher preoperative HDL cholesterol
concentration was associated with decreased AKI after cardiac surgery.
Preoperative and perioperative statin treatment enhanced this association,
demonstrating that pharmacological potentiation is possible during the
perioperative period.<br/>Copyright &#xa9; 2017 The Authors.

<119>
Accession Number
619934422
Author
Karatasakis A.; Danek B.A.; Karacsonyi J.; Rangan B.V.; Roesle M.K.;
Knickelbine T.; Miedema M.D.; Khalili H.; Ahmad Z.; Abdullah S.; Banerjee
S.; Brilakis E.S.
Institution
(Karatasakis, Danek, Karacsonyi, Rangan, Roesle, Khalili, Ahmad, Abdullah,
Banerjee, Brilakis) VA North Texas Health Care System, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Karatasakis, Danek) Rutgers New Jersey Medical School, Newark, NJ, United
States
(Knickelbine, Miedema, Brilakis) Minneapolis Heart Institute, Minneapolis,
MN, United States
Title
Effect of PCSK9 inhibitors on clinical outcomes in patients with
hypercholesterolemia: A meta-analysis of 35 randomized controlled trials.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006910. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--We sought to examine the efficacy and safety of 2 PCSK9
(proprotein convertase subtilisin/kexin type 9) inhibitors: alirocumab and
evolocumab. Methods and Results--We performed a systematic review and
meta-analysis of randomized controlled trials comparing treatment with and
without PCSK9 inhibitors; 35 randomized controlled trials comprising 45
539 patients (mean follow-up: 85.5 weeks) were included. Mean age was
61.0+/-2.8 years, and mean baseline low-density lipoprotein cholesterol
was 106+/-22 mg/dL. Compared with no PCSK9 inhibitor therapy, treatment
with a PCSK9 inhibitor was associated with a lower rate of myocardial
infarction (2.3% versus 3.6%; odds ratio [OR]: 0.72 [95% confidence
interval (CI), 0.64-0.81]; P < 0.001), stroke (1.0% versus 1.4%; OR: 0.80
[95% CI, 0.67-0.96]; P=0.02), and coronary revascularization (4.2% versus
5.8%; OR: 0.78 [95% CI, 0.71-0.86]; P < 0.001). Overall, no significant
change was observed in all-cause mortality (OR: 0.71 [95% CI, 0.47- 1.09];
P=0.12) or cardiovascular mortality (OR: 1.01 [95% CI, 0.85-1.19];
P=0.95). A significant association was observed between higher baseline
low-density lipoprotein cholesterol and benefit in all-cause mortality
(P=0.038). No significant change was observed in neurocognitive adverse
events (OR: 1.12 [95% CI, 0.88-1.42]; P=0.37), myalgia (OR: 0.95 [95% CI,
0.75-1.20]; P=0.65), new onset or worsening of preexisting diabetes
mellitus (OR: 1.05 [95% CI, 0.95-1.17]; P=0.32), and increase in levels of
creatine kinase (OR: 0.84 [95% CI, 0.70-1.01]; P=0.06) or alanine or
aspartate aminotransferase (OR: 0.96 [95% CI, 0.82- 1.12]; P=0.61).
Conclusions--Treatment with a PCSK9 inhibitor is well tolerated and
improves cardiovascular outcomes. Although no overall benefit was noted in
all-cause or cardiovascular mortality, such benefit may be achievable in
patients with higher baseline lowdensity lipoprotein
cholesterol.<br/>Copyright &#xa9; 2017 The Authors.

<120>
Accession Number
619934401
Author
Bang C.N.; Greve A.M.; Rossebo A.B.; Ray S.; Egstrup K.; Boman K.;
Nienaber C.; Okin P.M.; Devereux R.B.; Wachtell K.
Institution
(Bang) Department of Cardiology, Zealand University Hospital Roskilde,
Roskilde, Denmark
(Bang, Okin, Devereux, Wachtell) Department of Medicine, Weill Cornell
Medicine, New York, NY, United States
(Greve) Department of Clinical Biochemistry, Rigshospitalet, Copenhagen,
Denmark
(Rossebo) Department of Cardiology, Oslo University Hospital Ulleval,
Oslo, Norway
(Ray) Department of Cardiology, Manchester Academic Health Sciences
Centre, Manchester, United Kingdom
(Egstrup) Department of Cardiology, Odense University Hospital, Svendborg,
Denmark
(Boman) Institution of Public Health and Clinical Medicine, Medicine
Skelleftea, Umea University, Skelleftea, Sweden
(Nienaber) Department of Cardiology, University Hospital, Rostock, Germany
(Wachtell) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Title
Antihypertensive treatment with beta-blockade in patients with
asymptomatic aortic stenosis and association with cardiovascular events.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006709. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--Patients with aortic stenosis (AS) often have concomitant
hypertension. Antihypertensive treatment with a beta-blocker (Bbl) is
frequently avoided because of fear of depression of left ventricular
function. However, it remains unclear whether antihypertensive treatment
with a Bbl is associated with increased risk of cardiovascular events in
patients with asymptomatic mild to moderate AS. Methods and Results--We
did a post hoc analysis of 1873 asymptomatic patients with mild to
moderate AS and preserved left ventricular ejection fraction in the SEAS
(Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity-matched
Cox regression and competing risk analyses were used to assess risk ratios
for all-cause mortality, sudden cardiac death, and cardiovascular death. A
total of 932 (50%) patients received Bbl at baseline. During a median
follow-up of 4.3+/-0.9 years, 545 underwent aortic valve replacement, and
205 died; of those, 101 were cardiovascular deaths, including 40 sudden
cardiovascular deaths. In adjusted analyses, Bbl use was associated with
lower risk of all-cause mortality (hazard ratio 0.5, 95% confidence
interval 0.3-0.7, P < 0.001), cardiovascular death (hazard ratio 0.4, 95%
confidence interval 0.2-0.7, P < 0.001), and sudden cardiac death (hazard
ratio 0.2, 95% confidence interval 0.1-0.6, P=0.004). This was confirmed
in competing risk analyses (all P < 0.004). No interaction was detected
with AS severity (all P > 0.1). Conclusions--In post hoc analyses Bbl
therapy did not increase the risk of all-cause mortality, sudden cardiac
death, or cardiovascular death in patients with asymptomatic mild to
moderate AS. A prospective study may be warranted to determine if Bbl
therapy is in fact beneficial.<br/>Copyright &#xa9; 2017 The Authors.

<121>
Accession Number
618107545
Author
Solomon D.H.; Husni M.E.; Libby P.A.; Yeomans N.D.; Lincoff A.M.;
Lupsilonscher T.F.; Menon V.; Brennan D.M.; Wisniewski L.M.; Nissen S.E.;
Borer J.S.
Institution
(Solomon, Libby) Brigham and Women's Hospital, Boston, Mass, United States
(Husni, Lincoff, Menon, Brennan, Wisniewski, Nissen) Cleveland Clinic,
Cleveland, Ohio, United States
(Yeomans) Western Sydney University, Sydney, NSW, Australia
(Yeomans) University of Melbourne, Melbourne, Australia
(Luscher) University of Zurich, Zurich, Switzerland
(Borer) SUNY Downstate Medical Center, Brooklyn, NY, United States
Title
The Risk of Major NSAID Toxicity with Celecoxib, Ibuprofen, or Naproxen: A
Secondary Analysis of the PRECISION Trial.
Source
American Journal of Medicine. 130 (12) (pp 1415-1422.e4), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The relative safety of long-term use of nonsteroidal
anti-inflammatory drugs is unclear. Patients and providers are interested
in an integrated view of risk. We examined the risk of major nonsteroidal
anti-inflammatory drug toxicity in the PRECISION trial. Methods We
conducted a post hoc analysis of a double-blind, randomized, controlled,
multicenter trial enrolling 24,081 patients with osteoarthritis or
rheumatoid arthritis at moderate or high cardiovascular risk. Patients
were randomized to receive celecoxib 100 to 200 mg twice daily, ibuprofen
600 to 800 mg thrice daily, or naproxen 375 to 500 mg twice daily. All
patients were provided with a proton pump inhibitor. The outcome was major
nonsteroidal anti-inflammatory drug toxicity, including time to first
occurrence of major adverse cardiovascular events, important
gastrointestinal events, renal events, and all-cause mortality. Results
During follow-up, 4.1% of subjects sustained any major toxicity in the
celecoxib arm, 4.8% in the naproxen arm, and 5.3% in the ibuprofen arm.
Analyses adjusted for aspirin use and geographic region found that
subjects in the naproxen arm had a 20% (95% CI 4-39) higher risk of major
toxicity than celecoxib users and that 38% (95% CI 19-59) higher risk.
These risks translate into numbers needed to harm of 135 (95% CI, 72-971)
for naproxen and 82 (95% CI, 53-173) for ibuprofen, both compared with
celecoxib. Conclusions Among patients with symptomatic arthritis who had
moderate to high risk of cardiovascular events, approximately 1 in 20
experienced a major toxicity over 1 to 2 years. Patients using naproxen or
ibuprofen experienced significantly higher risk of major toxicity than
those using celecoxib.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<122>
Accession Number
613772248
Author
Ederoth P.; Grins E.; Dardashti A.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Grins, Dardashti, Bronden, Metzsch, Erdling, Algotsson)
Department of Anesthesiology and Intensive Care, Lund University, Skane
University Hospital, Lund, Sweden
(Nozohoor, Mokhtari, Bjursten) Department of Cardiothoracic Surgery, Lund
University, Skane University Hospital, Lund, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine, Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Fredrik Meijer Heart and Vascular Institute Spectrum Health, MI
US Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Title
Ciclosporin to Protect Renal function In Cardiac Surgery (CiPRICS): A
study protocol for a double-blind, randomised, placebo-controlled,
proof-of-concept study.
Source
BMJ Open. 6 (12) (no pagination), 2016. Article Number:
bmjopen-2016-012299. Date of Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Acute kidney injury (AKI) after cardiac surgery is common
and results in increased morbidity and mortality. One possible mechanism
for AKI is ischaemia-reperfusion injury caused by the extracorporeal
circulation (ECC), resulting in an opening of the mitochondrial
permeability transition pore (mPTP) in the kidneys, which can lead to cell
injury or cell death. Ciclosporin may block the opening of mPTP if
administered before the ischaemia- reperfusion injury. We hypothesised
that ciclosporin given before the start of ECC in cardiac surgery can
decrease the degree of AKI. Methods and analysis: Ciclosporin to Protect
Renal function In Cardiac Surgery (CiPRICS) study is an
investigator-initiated double-blind, randomised, placebo-controlled,
parallel design, single-centre study performed at a tertiary university
hospital. The primary objective is to assess the safety and efficacy of
ciclosporin to limit the degree of AKI in patients undergoing coronary
artery bypass grafting surgery. We aim to evaluate 150 patients with a
preoperative estimated glomerular filtration rate of 15-90 mL/min/ 1.73
m2. Study patients are randomised in a 1:1 ratio to receive study drug 2.5
mg/kg ciclosporin or placebo as an intravenous injection after anaesthesia
induction but before start of surgery. The primary end point consists of
relative P-cystatin C changes from the preoperative day to postoperative
day 3. The primary variable will be tested using an analysis of covariance
method. Secondary end points include evaluation of P-creatinine and
biomarkers of kidney, heart and brain injury. Ethics and dissemination:
The trial is conducted in compliance with the current version of the
Declaration of Helsinki and the International Council for Harmonisation
(ICH) Good Clinical Practice guidelines E6 (R1) and was approved by the
Regional Ethical Review Board, Lund and the Swedish Medical Products
Agency (MPA). Written and oral informed consent is obtained before
enrolment into the study.

<123>
Accession Number
619980647
Author
Lima M.L.; Fiorelli A.I.; Vassallo D.V.; Batista P.R.; Simoes F.V.; Fiorim
J.; Stefanon I.; Pinheiro B.B.; Stolf N.A.G.; Gomes O.M.
Institution
(Lima, Fiorelli, Pinheiro, Gomes) Laboratory of Experimental
Cardiovascular Research, Sao Francisco de Assis Research Foundation, Belo
Horizonte, Minas Gerais, Brazil
(Fiorelli, Stolf) Heart Institute of Sao Paulo University, Sao Paulo,
Brazil
(Vassallo, Batista, Simoes, Fiorim, Stefanon) Department of Physiological
Sciences, Biomedical Center, Federal University of Espirito Santo,
Vitoria, Brazil
Title
Deleterious Effect of Hypothermia in Myocardial Protection Against Cold
Ischemia: A Comparative Study in Isolated Rat Hearts.
Source
Transplantation Proceedings. 44 (8) (pp 2326-2332), 2012. Date of
Publication: October 2012.
Publisher
Elsevier USA
Abstract
Background There is a growing need to improve heart preservation benefit
the performance of cardiac operations, decrease morbidity, and more
important, increase the donor pool. Therefore, the objective of this study
was to evaluate the cardioprotective effects of Krebs-Henseleit buffer
(KHB), Bretschneider-HTK (HTK), St. Thomas No. 1 (STH-1), and Celsior
(CEL) solutions infused at 10degreeC and 20degreeC. Methods Hearts
isolated from male albino Wistar rats and prepared according to
Langendorff were randomly divided equally into 8 groups according to the
temperature of infusion (10degreeC or 20degreeC) and cardioprotective
solutions (KHB, HTK, STH-1, and CEL). After stabilization with KHB at
37degreeC, baseline values were collected (control) for heart rate (HR),
left ventricle systolic pressure (LVSP), coronary flow (CF), maximum rate
of rise of left ventricular pressure during ventricular contraction
(+dP/dt) and maximum rate of fall of left ventricular pressure during left
ventricular relaxation (-dP/dt). The hearts were then perfused with
cardioprotective solutions for 5 minutes and kept for 2 hours in static
ischemia at 20degreeC. Data evaluation used analysis of variance (ANOVA)
in all together randomized 2 way ANOVA and Tukey's test for multiple
comparisons. The level of significance chosen was P <.05. Results We
observed that all 4 solutions were able to recover HR, independent of
temperature. Interestingly, STH-1 solution at 20degreeC showed HR above
baseline throughout the experiment. An evaluation of the corresponding
hemodynamic values (LVSP, +dP/dt, and -dP/dt) indicated that treatment
with CEL solution was superior at both temperatures compared with the
other solutions, and had better performance at 20degreeC. When analyzing
performance on CF maintenance, we observed that it was temperature
dependent. However, when applying both HTK and CEL, at 10degreeC and
20degreeC respectively, indicated better protection against development of
tissue edema. Multiple comparisons between treatments and hemodynamic
variable outcomes showed that using CEL solution resulted in significant
improvement compared with the other solutions at both temperatures.
Conclusion The solutions investigated were not able to fully suppress the
deleterious effects of ischemia and reperfusion of the heart. However,
these results allow us to conclude that temperature and the
cardioprotective solution are interdependent as far as myocardial
protection. Although CEL solution is the best for in myocardial
protection, more studies are needed to understand the interaction between
temperature and perfusion solution used. This will lead to development of
better and more efficient cardioprotective methods.<br/>Copyright &#xa9;
2012 Elsevier Inc.

<124>
[Use Link to view the full text]
Accession Number
610495409
Author
De Hert S.
Institution
(De Hert) Department of Anaesthesiology, Ghent University, Hospital Ghent
University, De Pintelaan 185, Ghent B-9000, Belgium
Title
Cardiac troponins and volatile anaesthetics in on-pump coronary surgery:
How much longer do we need to state the obvious?.
Source
European Journal of Anaesthesiology. 33 (6) (pp 393-395), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)

<125>
Accession Number
620030232
Author
Ruf T.F.; Heidrich F.M.; Sveric K.M.; Pfluecke C.; Stephan A.-M.; Strasser
R.H.; Wiedemann S.
Institution
(Ruf, Heidrich, Sveric, Pfluecke, Strasser, Wiedemann) Department of
Medicine and Cardiology, Technische Universitat Dresden, Heart Centre
Dresden, University Hospital Dresden, Dresden, Germany
(Stephan) Medical Department i, Technische Universitat Dresden, University
Hospital Dresden, Dresden, Germany
Title
ELMSTREET (Esophageal Lesions during MitraClip uSing TRansEsophageal
Echocardiography Trial).
Source
EuroIntervention. 13 (12) (pp e1444-e1451), 2017. Date of Publication:
December 2017.
Publisher
EuroPCR
Abstract
Aims: We aimed to evaluate possible detrimental effects of
transoesophageal echocardiography (TEE) on the oesophageal tissue during
percutaneous mitral valve repair (PMVR). Methods and results: From March
2014 to July 2015, 186 patients were treated for severe mitral
regurgitation with PMVR using the MitraClip system. In 40 patients,
oesophago-gastro-duodenoscopy was performed due to symptoms related to the
gastrointestinal tract. Based on the procedure duration, patients were
classified into group 1 (>60 minutes, n=23) or into group 2 (<60 minutes,
n=17), respectively. Oesophageal lesions (OL) were found in 19 patients
(group 1: n=17 vs. group 2: n=2, p<0.0001). We observed a change in
leucocyte count after the procedure (group 1: +2.00 Gpt/L [SEM+/-0.48] vs.
group 2: +0.54 Gpt/L [SEM+/-0.36], p=0.028). This change was more apparent
when comparing patients with OL vs. those without (lesions: +2.65 Gpt/L
[SEM+/-0.56] vs. no lesions: +0.23 Gpt/L [SEM+/-0.12], p<0.0001).
Conclusions: Prolonged use of TEE during PMVR with a procedure time of
longer than 60 minutes increases the risk of oesophageal damage. An
exceptional rise of leucocyte count after PMVR may raise suspicion of new
oesophageal damage.<br/>Copyright &#xa9; 2017 Europa Digital & Publishing.
All rights reserved.