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<1>
Accession Number
618962345
Author
Fu N.; Yang S.; Zhang J.; Zhang P.; Liang M.; Cong H.; Lin W.; Tian F.; Lu
C.
Institution
(Fu, Yang, Zhang, Zhang, Cong) Department of Cardiology, Tianjin Chest
Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin
300222, China
(Liang) Tianjin Medical University, Tianjin, China
(Lin) Department of Cardiology, Teda International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Title
The efficacy of probucol combined with hydration in preventing
contrast-induced nephropathy in patients with coronary heart disease
undergoing percutaneous coronary intervention: a multicenter, prospective,
randomized controlled study.
Source
International Urology and Nephrology. 50 (1) (pp 105-112), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Springer Netherlands
Abstract
Purpose: To investigate the preventive effect of probucol combined with
hydration on contrast-induced nephropathy (CIN) in patients with coronary
heart disease undergoing percutaneous coronary intervention (PCI).
Methods: A total of 641 patients undergoing PCI were randomly assigned to
either a probucol group (probucol 500 mg twice daily and hydration; n =
321) or a control group (hydration only; n = 320). The primary endpoint
was the incidence of CIN, defined as an increase in serum creatinine (Scr)
by >= 44.2 mumol/L or >= 25% within 72 h after the administration of
contrast agent. Secondary endpoints were changes in Scr, cystatin-C
(Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP),
superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major
adverse events during hospitalization or the 14-day follow-up period.
Results: The incidence of CIN was 4.0% (13/321) in the probucol group and
10.9% (35/320) in the control group. The probucol group had lower Cys-C
and higher Ccr at 48 and 72 h after PCI compared with the control group.
At 48 and 72 h following the operation, Cys-C and CRP were lower in the
probucol group compared with the control group, but Ccr, SOD, and GSH were
higher. There were no differences in the incidence of major adverse events
during hospitalization or the 14-day follow-up between the groups.
Multivariate logistic regression analysis showed that probucol was an
independent protective factor for CIN. Conclusions: Probucol combined with
hydration more effectively decreased the incidence of CIN in patients with
coronary heart disease undergoing PCI compared with hydration
alone.<br/>Copyright &#xa9; 2017, Springer Science+Business Media B.V.

<2>
Accession Number
620083185
Author
Hellhammer K.; Afzal S.; Tigges R.; Spieker M.; Rassaf T.; Zeus T.;
Westenfeld R.; Kelm M.; Horn P.
Institution
(Hellhammer, Afzal, Tigges, Spieker, Zeus, Westenfeld, Kelm, Horn)
University Hospital Dusseldorf, Medical Faculty, Dept. of Medicine,
Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf,
Germany
(Rassaf) University Hospital Essen, Medical Faculty, Dept. of Medicine,
Division of Cardiology and Vascular Medicine, Essen, Germany
Title
High body mass index is a risk factor for difficult deep sedation in
percutaneous mitral valve repair.
Source
PLoS ONE. 13 (1) (no pagination), 2018. Article Number: e0190590. Date of
Publication: January 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The safety and efficacy of deep sedation (DS) in
MitraClip procedures have been shown previously. However,
clinical experience demonstrates that in some patients DS is difficult to
achieve. We hypothesize that some patient characteristics can predict
difficult DS. Methods We prospectively analysed 69 patients undergoing
MitraClip procedures using DS. Application of DS was graded as
simple (group 1) or difficult (group 2) depending on a cumulative score
based on one point for each of the following criteria: decrease in oxygen
saturation, retention of carbon dioxide, disruptive body movements, and
the need for catecholamines. Patients with one point or less were
classified as group 1, and patients with two or more points were
classified as group 2. Results In 58 of 69 patients (84.1%), the
performance of DS was simple, while in 11 patients (15.9%), DS was
difficult to achieve. Patients with difficult DS were characterized by a
higher body mass index (33.7 +/- 6.0 kg/m² vs. 26.1 +/- 4.1; p
= 0.001), younger age (67 +/- 13 years vs. 75 +/- 13 years; p = 0.044),
and reduced left ventricular ejection fraction (36% +/- 10 vs. 45% +/- 14;
p = 0.051) and presented more often with an obstructive sleep apnoea
syndrome (6.9% vs. 45.5%; p = 0.003). In the multivariate analysis, body
mass index was an independent predictor of difficult DS. Using a body mass
index of 31 kg/m² as a cut-off value, the sensitivity of
predicting difficult DS was 73%, and the specificity was 88%. Using a body
mass index of 35 kg/m² as a cut-off value, the specificity
increased to 97%, with a sensitivity of 36%. Conclusion In patients with a
higher body mass index who undergo MitraClip procedures, DS
might be difficult to perform.<br/>Copyright &#xa9; 2018 Hellhammer et al.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source
are credited.

<3>
Accession Number
618224017
Author
Amiet V.; Perez M.-H.; Longchamp D.; Boulos Ksontini T.; Natterer J.;
Plaza Wuthrich S.; Cotting J.; Di Bernardo S.
Institution
(Amiet, Perez, Longchamp, Natterer, Cotting) Pediatric Intensive Care
Unit, University Hospital and Medicine and Biology Faculty of Lausanne,
Lausanne, Switzerland
(Boulos Ksontini, Plaza Wuthrich, Di Bernardo) Pediatric cardiology Unit,
University Hospital and Medicine and Biology Faculty of Lausanne, CHUV,
rue du Bugnon 46, Lausanne 1011, Switzerland
Title
Use of Levosimendan in Postoperative Setting After Surgical Repair of
Congenital Heart Disease in Children.
Source
Pediatric Cardiology. 39 (1) (pp 19-25), 2018. Date of Publication: 01 Jan
2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Low cardiac output is one of the most common complications after cardiac
surgery. Levosimendan, a new inotrope agent, has been demonstrated in
adult patient to be an effective treatment for this purpose when classical
therapy is not effective. The aim of this study was to evaluate the effect
of Levosimendan on cardiac output parameters in cardiac children with low
cardiac output syndrome (LCOS.). We carried out a retrospective analysis
on 62 children hospitalized in our pediatric intensive care unit (PICU)
after cardiac surgery, which demonstrated LCOS not responding to classical
catecholamine therapy and who received levosimendan as rescue therapy.
LCOS parameters like diuresis, central venous oxygen saturation
(SvO<inf>2</inf>), venous-to-arterial CO<inf>2</inf> difference
(avCO<inf>2</inf>), and plasmatic lactate were compared before therapy and
at 3, 6, 12, and 24 h after the beginning of the levosimendan infusion. We
also analyzed the effect on the Vasoactive-inotropic score (VIS), adverse
events, and mortality. After the beginning of levosimendan infusion,
diuresis (1.1 vs. 3.5 ml/kg/h, p = 0.001) and SvO<inf>2</inf> (59.5 vs.
63.3%, p = 0.026) increased significantly during the 24 h of infusion, and
at the same time, plasmatic lactate (2.3 vs. 1.3 mmol/l, p < 0.001)
decreased. avCO<inf>2</inf> (10.8 vs. 9.4 mmHg, p = 0.21) and the VIS
(44.5 vs. 22.5, p = 0.143) also decreased, but not significantly. No side
effects were noted. The mortality in this patient group was 16%.
Levosimendan is an effective treatment in children presenting LCOS after
congenital heart surgery. Our study confirms the improvement of cardiac
output already shown in other pediatric studies, with no undesirable side
effects.<br/>Copyright &#xa9; 2017, Springer Science+Business Media, LLC.

<4>
Accession Number
620194240
Author
Ragg C.
Institution
(Ragg) Angioclinic Vein Centers, Berlin, Germany
Title
Updates on percutaneous valvuloplasty.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 23), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: If vein dilatation is the major component of
a valve insufficiency, long-term diameter reduction by external
compression may be a solution. Percutaneous valvuloplasty (PVP) using
cross-linked hyaluronan to achieve diameter reduction has been recently
introduced. Now, a first evaluation of an approved commercial product was
performed. Method: In this prospective controlled study, 22 patients with
proximal GSV valve incompetence but preserved and mobile valve structures
according to 8 -16MHz ultrasound analysis were included (8 f, 4m, 32 -54
yr/o): Vein diameter was 7.0 -12.0, mean 8.6mm). PVP was performed by use
of a cross-linked hyaluronan acid (Princess Volume, Croma) and a safety
cannula (Sterimedix). Results: Orthograde flow was established in 20/22
cases (90.9%). Gel volumina varied from 4 -13 ml (mean: 8.2 ml. There were
no adverse reactions. At one year follow-up, orthograde flow was present
in 14/20 cases (70.0%). 5/6 cases (83,3%) with recurring reflux
successfully received supplementary hyaluronan injections of 2 -6 ml. At
one year follow-up, the assisted success rate was 95%. Conclusions:
Percutaneous valvuloplasty is the first minimal-invasive method to
eliminate venous reflux while fully preserving the target vein. It is
effective and safe. Early detection of vein disease is mandatory to
fulfill eligibility. Maintenance injections will be required in few year's
intervals, like known from esthetic hyaluronan applications.

<5>
Accession Number
620194239
Author
Lohr J.; Wright E.; Leuenberger K.; Jiang J.
Institution
(Lohr) Lohr Surgical Specialists LLC, Cincinnati, OH, United States
(Wright) University of Cincinnati, School of Medicine, Cincinnati, OH,
United States
(Leuenberger) US Oncology, Cincinnati, OH, United States
(Jiang) Mercy Health West, Cincinnati, OH, United States
Title
Is a Negative ELISA for Heparin-Induced Thrombocytopenia Really Negative?.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 61), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: To increase awareness that a negative
enzyme-linked immunosorbent assay (ELISA) test may represent a false
negative result. Serotonin assays are confirmatory but are no longer being
routinely done in order to contain costs. This practice needs to be
carefully considered especially when platelet counts remain low. We
describe a case of heparin induced thrombocytopenia in a patient with a
negative ELISA test. Method: Case report and retrospective review of
literature of heparin and heparin-induced thrombocytopenia (HIT)
antibodies and testing. Results: The patient is a 58 year old male who
underwent aortic prosthetic valve replacement and aortic reconstruction.
His hospital course was complicated by bowel perforation and subtotal
colectomy seven days post-op. All labs were consistent with his hospital
course at that time. Ten days later while the patient was on a heparin
drip, he developed a persistent decline in platelet count. At this point,
an ELISA test was negative. Further testing, four days later included a
serotonin release assay, which came back positive for HIT. He was treated
with Argatroban. Conclusions: In a patient population where
anticoagulation is imperative, when should we be suspicious of false
negatives? The multitude of tests for HIT has varying degrees of
sensitivity and specificity. Providers must be aware that false negatives
can and do occur with both platelet aggregation studies and ELISA antibody
tests. In a patient who is not recovering as expected, there must be
suspicion for HIT and the most definitive test, the serotonin release
assay, must be performed. In some circumstances, where there is a high
degree of suspicion for HIT, it may be beneficial to bypass initial ELISA
or platelet aggregation screening tests in favor of the serotonin release
assay which will have the best chance of catching patients who may
otherwise not be discovered. Treatment and testing should be tailored to
the clinical situation.

<6>
Accession Number
620194204
Author
Kumar K.; Qualls E.; Thakur A.; Thakur V.
Institution
(Kumar) Affiliated with Medical Practice of Dr. Anjani Thakur, Turlock,
CA, United States
(Qualls) California State University, Stanislaus, Turlock, CA, United
States
(Thakur, Thakur) Valley Vein Health Center, Turlock, CA, United States
Title
Paradigm shifts in surgery and what we can expect for the future.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 50-51), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: Innovations in health care have shifted
standards of surgical treatment throughout history. The purpose of this
systematic review is to reflect on the paradigm shift of endovenous
ablation in the treatment of venous insufficiency and the circumstances in
which it arose, as well as conduct a comparative historical analysis of
similar paradigm shifts for other surgical interventions. Through this
comparison, we can begin to predict trends for future paradigm shifts and
how they will improve the surgical management of disease. Method: The
PubMed database was used to identify scholarly articles that allowed a
historical overview of changes in surgery paradigms. This analysis
occurred between December of 2016 and February of 2017. The articles
identified ranged from the 1920's to present. The data was analyzed to
determine changes in case volume, treatment efficacy, doctor and patient
responses to the new treatment at the time of implementation, and economic
factors in healthcare diffusion that allowed the novel treatment to become
the new treatment paradigm. Results: Specifically, the paradigm shift of
endovenous ablation modeled that of previous shifts such as peptic ulcer
disease, pulmonary tuberculosis, coronary artery bypass grafting versus
coronary angioplasty, abdominoperineal resection versus chemoradiation
therapy, and open versus laparoscopic cholecystectomy. These surgeries had
previously utilized a more invasive and often less effective treatment
modality than the newly introduced paradigm. Endovenous radiofrequency
ablation and endovenous laser ablation, compared to sclerotherapy and
ligation, have become the first-line treatments of chronic venous
insufficiency due to the lesser degree of invasiveness. Ligation alone
demonstrated a 43-71% failure rate at 5 years and ligation in conjunction
with stripping had a 25-60% failure rate. This ranged from 5 to 34 years
within the available literature.64-68 Niedzwiecki68 identified a host of
research relating risk factors associated with vein stripping and ligation
-an aggregate 0.5% average incidence of pulmonary embolism, an average 1%
incidence of deep venous thrombosis (DVT), an 8% incidence of infection,
and an approximately 0.5% incidence of lymphedema. 69-76 Paresthesia
occurred in nearly 1 in 4 patients treated by stripping from the
saphenofemoral junction, while an average of 1 in 10 patients noted
paresthesia limited to above the knee saphenous stripping66,77-80.
Endovenous laser ablation studies demonstrated high success rates
initially (ranging from 97-100%), as did early trials of laparoscopy in
treatment of acute cholecystectomy. Regarding peptic ulcer disease, we
found that the introduction of a surgical alternative, cimetidine and
proton pump inhibitors, decreased surgical management through partial
vagotomy in the U.S. by 50% between 1966 and 1978. This study also found a
significant decrease in peptic ulcer complications in the mid-eighties
that coincided with the discovery of H pylori as a causative agent for
peptic ulcer disease. 10 Rates of surgery declined from 8 to 3.3 per
100,000 individuals between 1988 and 2003 in men, and 5.5 to 2.7 in women.
Its rapid implementation was attributed to a nearly 20% savings in
treatment cost and reduced invasiveness. In pulmonary tuberculosis
management, several papers were found after the mid-1950's to address
surgical management of the disease as only secondary to administration of
isoniazid (and later) rifampicin, pyrazinamide and ethambutol.
Antimycobacterial therapy was significantly less invasive and led to a
much better quality of life outlook than earlier induced pneumothorax.
Bypass grafting was once a staple procedure in the treatment of stable
coronary artery disease, but between 2001 and 2011, the volume of CABG
operations in the U.S. decreased by nearly 46% -from 395,000 to 213,700.33
This trend was also demonstrated across the majority of OECD (Organization
for Economic Cooperation and Development) countries between 2000 and 2012.
Among European countries, Spain and France show angioplasty rates at
nearly 90%. A study conducted by the London School of Economics analyzing
healthcare diffusion found that nearly 30% of angioplasty procedures are a
direct substitutes for CABG, demonstrating a cost savings of nearly 60;
however, this shift occurred much more rapidly in wealthier nations. The
treatment of anal carcinoma saw a large shift after the publication of the
Nigro protocol of chemoradiative therapy. As of 2001, abdominoperineal
resection is performed in only 20% to 30% of rectal cancer patients across
OECD countries. Knab et al argued that there is little downside to an
attempt at laparoscopy in a patient without previous upper abdominal
surgery and that 100% of operations for acute cholecystitis should be
initiated laparoscopically. Studies also showed similar morbidity and
mortality between laparoscopic and open surgery and decreased length of
hospital stay -sometimes less than 24 hours -and decreased postoperative
pain. Several contributing factors to a successful shift were identified,
such as increased efficacy and shorter recovery period; however, some
procedures showed a shift even with resistance from physicians, like
laparoscopy initially, given significant benefits. Conclusions: Today, the
primary treatment of venous insufficiency no longer involves stripping or
ligation procedures, and demonstrated a safe and effective modality that
led to the wide availability of endovenous ablation therapy. The most
common characteristics of a successful paradigm shift were found to be
increased efficacy, minimal invasiveness, a short recovery period, cost
savings, decreased retreatment necessity, and safety. These criteria may
help us to predict which new technological advances will become future
first-line treatments, and even which treatments -such as tuberculosis
amid multidrug resistance -may regress to pre-paradigm protocols.

<7>
Accession Number
619331470
Author
Goldstein D.J.; Mehra M.R.; Naka Y.; Salerno C.; Uriel N.; Dean D.; Itoh
A.; Pagani F.D.; Skipper E.R.; Bhat G.; Raval N.; Bruckner B.A.; Estep
J.D.; Cogswell R.; Milano C.; Fendelander L.; O'Connell J.B.; Cleveland J.
Institution
(Goldstein) Department of Cardiothoracic Surgery, Montefiore Medical
Center, Bronx, New York, United States
(Mehra) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
(Naka) Division of Cardiothoracic Surgery, Columbia University College of
Physicians & Surgeons, New York, New York, United States
(Salerno) Department of Cardiothoracic Surgery, St. Vincent Heart Center,
Indianapolis, Indiana, United States
(Uriel) Section of Cardiology, University of Chicago School of Medicine
and Medical Center, Chicago, Illinois, United States
(Dean) Division of Cardiothoracic Surgery, Piedmont Heart Institute,
Atlanta, Georgia, United States
(Itoh) Division of Cardiothoracic Surgery, Washington University School of
Medicine, St. Louis, Missouri, United States
(Pagani) Department of Cardiac Surgery, University of Michigan Health
System, Ann Arbor, Michigan, United States
(Skipper) Department of Thoracic and Cardiovascular Surgery, Danger Heart
and Vascular Institute, Carolinas Medical Center, Charlotte, North
Carolina, United States
(Bhat) Division of Cardiology, Advocate Christ Medical Center, Oak Lawn,
Illinois, United States
(Raval) Cardiology Department, Florida Hospital, Orlando, Florida, United
States
(Bruckner, Estep) Department of Cardiology, Houston Methodist Hospital,
Houston, Texas, United States
(Cogswell) Division of Cardiology, University of Minnesota, Minneapolis,
Minnesota, United States
(Milano) Department of Surgery, Duke Heart Center, Duke University,
Durham, North Carolina, United States
(Fendelander, O'Connell) Abbott, Chicago, Illinois, United States
(Cleveland) Division of Cardiothoracic Surgery, University of Colorado
School of Medicine, Aurora, Colorado, United States
Title
Impact of age, sex, therapeutic intent, race and severity of advanced
heart failure on short-term principal outcomes in the MOMENTUM 3 trial.
Source
Journal of Heart and Lung Transplantation. 37 (1) (pp 7-14), 2018. Date of
Publication: January 2018.
Publisher
Elsevier USA
Abstract
Background Primary outcomes analysis of the Multicenter Study of MagLev
Technology in Patients Undergoing MCS Therapy With HeartMate 3 (MOMENTUM
3) trial short-term cohort demonstrated a higher survival rate free of
debilitating stroke and reoperation to replace/remove the device (primary
end-point) in patients receiving the HeartMate 3 (HM3) compared with the
HeartMate (HMII). In this study we sought to evaluate the individual and
interactive effects of pre-specified patient subgroups (age, sex, race,
therapeutic intent [bridge to transplant/bridge to candidacy/destination
therapy] and severity of illness) on primary end-point outcomes in
MOMENTUM 3 patients implanted with HM3 and HMII devices. Methods Cox
proportional hazard models were used to analyze patients enrolled in the
"as-treated cohort" (n = 289) of the MOMENTUM 3 trial to: (1) determine
interaction of various subgroups on primary end-point outcomes; and (2)
identify independent variables associated with primary end-point success.
Results Baseline characteristics were well balanced among HM3 (n = 151)
and HMII (n = 138) cohorts. No significant interaction between the
sub-groups on primary end-point outcomes was observed. Cox multivariable
modeling identified age (<=65 years vs >65 years, hazard ratio 0.42 [95%
confidence interval 0.22 to 0.78], p = 0.006]) and pump type (HM3 vs HMII,
hazard ratio 0.53 [95% confidence interval 0.30 to 0.96], p = 0.034) to be
independent predictors of primary outcomes success. After adjusting for
age, no significant impact of sex, race, therapeutic intent and INTERMACS
profiles on primary outcomes were observed. Conclusions This analysis of
MOMENTUM 3 suggests that younger age (<=65 years) at implant and pump
choice are associated with a greater likelihood of primary end-point
success. These findings further suggest that characterization of
therapeutic intent into discrete bridge-to-transplant and destination
therapy categories offers no clear clinical advantage, and should ideally
be abandoned.<br/>Copyright &#xa9; 2018 The Authors

<8>
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)

<9>
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)

<10>
Accession Number
620142123
Author
Swaminathan M.; Stafford-Smith M.; Chertow G.M.; Warnock D.G.; Paragamian
V.; Brenner R.M.; Lellouche F.; Fox-Robichaud A.; Atta M.G.; Melby S.;
Mehta R.L.; Wald R.; Verma S.; Mazer C.D.; Lombard F.W.; Schroder J.;
Kurtzberg J.; Bisnar T.; Conte J.; Dodd-O J.; Rabb H.; Katz N.; Shah A.;
Huyette-Arrizza E.; Bellot C.; Kramer R.; Tolson B.; Solomon R.; Brooks
C.; Mora-Mangano C.; Wong J.; Kashani K.; Naka Y.; Umanath K.; Yee J.;
Kilic A.; Lecker S.; Frendl G.; MacKensen B.; Simon M.; Dagenais F.;
Ferland M.-C.; Bouchard P.-A.; Whitlock R.; Ainsworth C.; McDonald E.;
Curley G.; Yagnik S.; Crescini C.; Ferland A.; Maier K.; Denault A.; Ly
H.; Bainbridge D.; Bentall T.; Legare J.-F.; Grocott H.
Institution
(Swaminathan, Stafford-Smith) Division of Cardiothoracic Anesthesiology,
Department of Anesthesiology, Duke University School of Medicine, Durham,
NC, United States
(Chertow) Department of Medicine (Nephrology), Stanford University,
Stanford, CA, United States
(Warnock) Division of Nephrology, Department of Medicine, Birmingham, AB,
United States
(Paragamian, Brenner) Division of Cardiothoracic Surgery, Department of
Surgery, University of Alabama at Birmingham, Birmingham, AB, United
States
(Lellouche) AlloCure Inc., Burlington, MA, United States
(Fox-Robichaud) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Quebec City, QC, Canada
(Atta) Division of Critical Care, Department of Medicine and Thrombosis,
Atherosclerosis Research Institute, McMaster University and Hamilton
Health Sciences, Hamilton, ON, Canada
(Melby) Division of Nephrology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Mehta) Division of Nephrology, Department of Medicine, University of
California, San Diego, CA, United States
(Wald) Division of Nephrology, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer) Department of Anesthesia, Keenan Research Centre for Biomedical
Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON
M5B 1W8, Canada
(Lombard, Schroder, Kurtzberg, Bisnar) Duke University, United States
(Conte, Dodd-O, Rabb, Katz, Shah, Huyette-Arrizza) Johns Hopkins
University, United States
(Bellot) University of Alabama, Birmingham, United States
(Kramer, Tolson) Maine Medical Center, United States
(Solomon) Fletcher Allen Health Care, United States
(Brooks) University of Virginia, United States
(Mora-Mangano, Wong) Stanford University, United States
(Kashani) Mayo Clinic, United States
(Naka) Columbia University, United States
(Umanath, Yee) Henry Ford Hospital, United States
(Kilic) Ohio State University, United States
(Lecker) Beth Israel Deaconess, Medical Center, United States
(Frendl) Brigham and Women's Hospital, United States
(MacKensen) University of Washington, United States
(Simon, Dagenais, Ferland, Bouchard) Institut Universitaire de Cardiologie
et de Pneumologie, Quebec, Canada
(Whitlock, Ainsworth, McDonald) McMaster-Hamilton General Hospital,
Thrombosis and Atherosclerosis Research Institute, Canada
(Curley, Yagnik, Crescini) St. Michael's Hospital, Canada
(Ferland, Maier) Libin Cardiovascular Institute of Alberta Foothills
Hospital, Canada
(Denault, Ly) Montreal Heart Institute, Canada
(Bainbridge, Bentall) London Health Sciences Centre, University Hospital,
Canada
(Legare) Capital District Health Authority, Queen Elizabeth II Health
Sciences Centre, Canada
(Grocott) St. Boniface Hospital, University of Manitoba, Canada
Title
Allogeneic mesenchymal stem cells for treatment of AKI after cardiac
surgery.
Source
Journal of the American Society of Nephrology. 29 (1) (pp 260-267), 2017.
Date of Publication: January 2018.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
AKI after cardiac surgery remains strongly associated with mortality and
lacks effective treatment or prevention. Preclinical studies suggest that
cell-based interventions may influence functional recovery. We conducted a
phase 2, randomized, double-blind, placebo-controlled trial in 27 centers
across North America to determine the safety and efficacy of allogeneic
human mesenchymal stem cells (MSCs) in reducing the time to recovery from
AKI after cardiac surgery. We randomized 156 adult subjects undergoing
cardiac surgery with evidence of early AKI to receive intra-aortic MSCs
(AC607; n=67) or placebo (n=68). The primary outcome was the time to
recovery of kidney function defined as return of postintervention
creatinine level to baseline. The median time to recovery of kidney
function was 15 days with AC607 and 12 days with placebo (25th, 75th
percentile range, 10-29 versus 6-21, respectively; hazard ratio, 0.81; 95%
confidence interval, 0.53 to 1.24; P=0.32). We did not detect a
significant difference between groups in 30-day all-cause mortality (16.7%
with AC607; 11.8% with placebo) or dialysis (10.6% with AC607; 7.4% with
placebo). At follow-up, 12 patients who received AC607 and six patients
who received placebo had died. Rates of other adverse events did not
differ between groups. In these patients with AKI after cardiac surgery,
administration of allogeneic MSCs did not decrease the time to recovery of
kidney function. Our results contrast with those in preclinical studies
and provide important information regarding the potential effects of MSCs
in this setting.<br/>Copyright &#xa9; 2018 by the American Society of
Nephrology.

<11>
Accession Number
620124669
Author
Giugliano R.P.; Keech A.; Murphy S.A.; Huber K.; Tokgozoglu S.L.; Lewis
B.S.; Ferreira J.; Pineda A.L.; Somaratne R.; Sever P.S.; Pedersen T.R.;
Sabatine M.S.
Institution
(Giugliano, Murphy, Sabatine) TIMI (Thrombolysis in Myocardial Infarction)
Study Office, Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, 60 Fenwood Rd, Ste 7122, Boston, MA 02115, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, Australia
(Huber) Third Department of Medicine, Cardiology, and Intensive Care
Medicine, Faculty of Medicine, Sigmund Freud University, Vienna, Austria
(Tokgozoglu) Department of Cardiology, Hacettepe University Faculty of
Medicine, Ankara, Turkey
(Lewis) Cardiovascular Clinical Research Institute, Lady Davis Carmel
Medical Center, Haifa, Israel
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Lisbon,
Portugal
(Pineda, Somaratne) Amgen, Inc, Thousand Oaks, CA, United States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Ulleval and Medical Faculty, Oslo University Hospital,
University of Oslo, Oslo, Norway
(Sabatine) JAMA Cardiology, United States
Title
Clinical efficacy and safety of evolocumab in high-risk patients receiving
a statin: Secondary analysis of patients with low LDL cholesterol levels
and in those already receiving a maximal-potency statin in a randomized
clinical trial.
Source
JAMA Cardiology. 2 (12) (pp 1385-1391), 2017. Date of Publication:
December 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Current guidelines for atherosclerotic cardiovascular disease
focus on high-intensity statins and targeting or using a threshold
low-density lipoprotein cholesterol (LDL-C) level of less than 70mg/dL for
the highest-risk patients. Whether further reduction of LDL-C beyond these
boundaries would be beneficial is unknown. OBJECTIVE To compare outcomes
of evolocumab vs placebo in patients with stable atherosclerotic
cardiovascular disease and a baseline LDL-C of less than 70mg/dL and in
those receiving background treatment with a maximal-potency statin.
DESIGN, SETTING, AND PARTICIPANTS This secondary ad hoc analysis of the
Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects
With Elevated Risk (FOURIER) trial compared randomized treatments in 2
subgroups of patients with stable atherosclerotic cardiovascular disease
currently receiving statin. Patientswere classified by a baseline LDL-C of
less than 70 or at least 70mg/dL and by statin intensity (maximal:
atorvastatin calcium, 80mg/d, or rosuvastatin, 40mg/d; submaximal: all
other dosages). Patients with baseline LDL of less than 70mg/dL either had
a final screening LDL-C of at least 70mg/dL or a final screening
non-high-density lipoprotein cholesterol level of at least 100 mg/dL.
Datawere retrieved from 2013 to 2016 and analyzed in 2017 based on
intention to treat. MAIN OUTCOMES AND MEASURES The primary efficacy
endpointwas the composite of cardiovascular death,myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization. The secondary efficacy endpoint was the composite of
cardiovascular death,myocardial infarction, or stroke. Safety outcomes
included adverse events and events of interest identified in the FOURIER
trial. Interaction testing was used to assess the consistency of results
in patients who did vs did not satisfy the above criteria. RESULTS A total
of 27 564 patients (75.4%men and 24.6%women; mean [SD] age, 62.5 [9.0]
years) were included in the analysis. Of 2034 patients (7.4%) who had a
baseline LDL-C of less than 70mg/dL, evolocumab reduced the risk for the
primary endpoint (hazard ratio [HR], 0.80; 95%CI, 0.60-1.07) to a similar
degree as in the 25 529 patients who had baseline LDL-C of at least
70mg/dL (HR 0.86; 95%CI, 0.79-0.92; P = .65 for interaction; 1 patient was
missing baseline LDL-C data). Of 7533 patients (27.3%) receiving
maximal-potency statins, evolocumab significantly reduced the primary
endpoint (HR, 0.86; 95%CI, 0.75-0.98) to a similar degree as in the 20 031
patients not receiving a maximal-potency statin (HR, 0.85; 95%CI,
0.78-0.93; P = .88 for interaction). The key secondary endpoint was
reduced to a similar degree in both analyses. No major safety concerns
were identified. CONCLUSIONS AND RELEVANCE Evolocumabwas equally effective
in reducing cardiovascular events in patients with stable atherosclerotic
cardiovascular disease regardless of whether the baseline LDL-C was less
than 70 or at least 70mg/dL and whether the background statin was of
maximal or submaximal potency.<br/>Copyright &#xa9; 2017 American Medical
Association. All rights reserved.

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

<13>
Accession Number
620117342
Author
Szymanski F.M.; Galazka Z.; Platek A.E.; Gorko D.; Ostrowski T.;
Adamkiewicz K.; Legosz P.; Rys A.; Semczuk-Kaczmarek K.; Celejewski K.;
Filipiak K.J.
Institution
(Szymanski, Platek, Adamkiewicz, Rys, Semczuk-Kaczmarek, Filipiak) 1st
Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A,
Warszawa 02-097, Poland
(Galazka, Gorko, Ostrowski, Celejewski) Department of General and
Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland
(Platek) Department of General and Experimental Pathology, Centre for
Preclinical Research and Technology (CEPT), Medical University of Warsaw,
Warsaw, Poland
(Gorko) Cardiology Department, Regional Hospital, Kolobrzeg, Poland
(Legosz) Department of Orthopaedics and Traumatology, Medical University
of Warsaw, Warsaw, Poland
Title
Peripheral A Rtery Atherosclerotic DIsease and Sleep disordered breathing
(PARADISE) trial-protocol for an observational cohort study.
Source
Kardiologia Polska. 75 (12) (pp 1332-1338), 2017. Date of Publication: 15
Dec 2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Peripheral arterial disease (PAD) is in fact a group of
disease entities with different symptoms and course but a common
underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be
aggravated by several cardiovascular risk factors, including obstructive
sleep apnoea (OSA). Aim: Following paper is a protocol for the Peripheral
ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE)
trial, which aims to describe the prevalence of OSA in PAD patients
scheduled for revascularisation, and to determine the effect of OSA on the
procedure outcomes. Methods: The PARADISE study is an observational cohort
trial. It plans to include 200 consecutive patients hospitalised for
revascularisation due to PAD. In every patient an overnight sleep study
will be performed to diagnose sleep disorders. According to the results of
the test, patients will be divided into two groups: Group A - patients
with OSA, and group B - patients without OSA (control group). All patients
will also be screened for classical and non-classical cardiovascular risk
factors. In some of the patients, during surgery, a fragment of
atherosclerotic plaque will be collected for further testing. Patients
will be followed for one year for adverse events and end-points. Primary
end-point of the study will be the failure of revascularisation defined as
recurrence or new onset of the symptoms of ischaemia from the treated
region, a need for re-operation or procedure revision, or recurrence of
ischaemia signs on the imaging tests. Discussion: The data obtained will
help determine the incidence of OSA in the population of patients with
PAD. The authors expect to show that, as with other cardiovascular
diseases associated with atherosclerosis, also in patients with PAD the
incidence of undiagnosed OSA is high and its presence is associated with
elevated cholesterol, inflammatory markers, and higher prevalence of
arterial hypertension and poor control of other cardiovascular risk
factors. In addition, due to increased oxidative stress and vascular
endothelial injury associated with OSA, patients afflicted with this
condition will not only have more advanced atherosclerotic lesions, but
also in their histopathological examination their atherosclerotic plaque
will exhibit evidence of greater instability and adverse morphology. We
also expect to show that in patients with OSA, achieving correct control
of cardiovascular risk factors will be more difficult. The study may
improve PAD control through assuring better multispecialty care in PAD
patients.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<14>
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.

<15>
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.

<16>
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.

<17>
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.

<18>
Accession Number
620193774
Author
Roeleveld P.P.; de Klerk J.C.A.
Institution
(Roeleveld) Department of Pediatric Intensive Care, Leiden University
Medical center, Leiden, Netherlands
(de Klerk) Department of Neonatal Intensive Care, Erasmus MC-Sophia
Children's Hospital, Rotterdam, Netherlands
Title
The Perspective of the Intensivist on Inotropes and Postoperative Care
Following Pediatric Heart Surgery: An International Survey and Systematic
Review of the Literature.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (1) (pp
10-21), 2018. Date of Publication: 01 Jan 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Inotropes are frequently being used in children undergoing
heart surgery to prevent or treat low cardiac output syndrome (LCOS).
There is only limited evidence that inotropes actually positively
influence postoperative outcome. Our aim was to describe the current
international practice variation in the use of inotropes following
congenital heart surgery. Methods: We developed an online survey regarding
the postoperative use of inotropes. We sent an invitation to all 197
registered members of the Pediatric Cardiac Intensive Care Society (PCICS)
to participate in the survey. We also performed a systematic review of the
literature. Results: Ninety-eight people (50%) responded, representing 62
international centers. Milrinone is routinely used perioperatively by 90
respondents (97%). Adrenaline/epinephrine is routinely used by 43%,
dopamine by 36%, dobutamine by 11%, and levosimendan by 6%. Steroids are
used routinely by 54% before initiating cardiopulmonary bypass.
Vasopressin is used by 44% of respondents. The development of LCOS is
monitored with lactate in 99% of respondents, physical examination (98%),
intermittent mixed venous saturation (76%), continuous mixed venous
saturation (13%), echocardiography (53%), core-peripheral temperature gap
(29%), near-infrared spectrometry (25%), and 4% use cardiac output
monitors (PiCCO, USCOM). To improve cardiac output, 42% add/increase
milrinone, 37% add adrenaline, and 15% add dopamine. Rescue therapy is
titrated individually, based on the patients' pathophysiology. A
systematic review of the literature failed to show compelling evidence
with regard to the benefit of inotropes. Conclusions: Despite the lack of
sufficient evidence, milrinone is used by the vast majority of caregivers
following congenital heart surgery.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<19>
Accession Number
620195767
Author
Zamani M.M.; Najafi A.; Sehat S.; Janforooz Z.; Derakhshan P.; Rokhtabnak
F.; Kiaee M.M.; Kholdebarin A.; Ghorbanlo M.; Hemadi M.H.; Ghodraty M.R.
Institution
(Zamani, Sehat, Rokhtabnak, Kholdebarin, Hemadi, Ghodraty) Department of
Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Najafi) Department of Anesthesiology and Critical Care, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Janforooz, Kiaee, Ghorbanlo) Department of Anesthesiology and Pain
Medicine, Moheb Hospital, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Derakhshan) Department of Anesthesiology and Pain Medicine, Rasoul Akram
Hospital, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
The effect of intraoperative lung protective ventilation vs conventional
ventilation, on postoperative pulmonary complications after
cardiopulmonary bypass.
Source
Journal of Cardiovascular and Thoracic Research. 9 (4) (pp 221-228), 2017.
Date of Publication: 2017.
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: This study aimed to evaluate the effects of high
positive-end expiratory pressure (PEEP) and low tidal volume (TV) and
recruitment maneuver, on postoperative pulmonary complications (PPCs)
after coronary artery bypass grafting (CABG) surgery. Methods: This study
is a randomized double blind clinical trial on 64 patients who were
undergoing CABG surgery, and were randomly divided into two groups of
conventional ventilation (C-Vent) with TV of 9 mL/kg and PEEP=0 cm H2O,
and lung protective ventilation (P-Vent), with 6 mL/ kg TV and PEEP=10 cm
H2O with recruitment maneuver every 30 minutes. Measures of PPCs and
modified clinical pulmonary infection score (mCPIS), were assessed for the
first 24 hours of postoperative time in order to evaluate the pulmonary
complications. Results: P-Vent with 31 patients and C-Vent with 30
patients, participated in the stage of data analysis. Demographic, and
preoperative laboratory results showed no significant difference between
two groups. During surgery, cardiovascular complications were higher in
P-Vent group (P = 0.61) but pulmonary complications were higher in C-Vent
group (P = 0.26). Extubation time was not significantly different between
two groups, and also components of arterial blood gases (ABG) of 24 hours
after surgery showed no significant difference between the two groups.
Pathologic changes in the chest X-ray (CXR) of 24 hours after surgery,
were lower in P-Vent group, but the difference was not significant (P =
0.22). The PPC criteria was less positive in P-Vent (2 patients) vs 9
patients in C-Vent group (P = 0.02) and mCPIS score was significantly
lower in P-Vent group (1.2 +/- 1.4) than C-Vent group (2 +/- 1.6) (P =
0.048). Conclusion: Lung protective strategy during and after cardiac
surgery, reduces the postoperative mCPIS in patients undergoing open heart
surgery for CABG.<br/>Copyright &#xa9; 2017 The Author (s).

<20>
Accession Number
620175480
Author
de Geus H.R.H.; Meersch M.; Zarbock A.
Institution
(de Geus) Department of Intensive Care, Erasmus University Medical Center,
Rotterdam, Netherlands
(Meersch, Zarbock) Department of Anesthesiology, Intensive Care and Pain
Medicine, University Hospital Munster, Albert-Schweitzer-Campus 1 Geb. A1,
Munster 48149, Germany
Title
Discussion on "Prevention of cardiac surgery-associated AKI by
implementing the KDIGO guidelines in high risk patients identified by
biomarkers: the PrevAKI randomized controlled trial".
Source
Intensive Care Medicine. (pp 1-2), 2018. Date of Publication: 09 Jan 2018.
Publisher
Springer Verlag (E-mail: service@springer.de)

<21>
Accession Number
613800714
Author
Gong M.; Zhang Z.; Fragakis N.; Korantzopoulos P.; Letsas K.P.; Li G.; Yan
G.-X.; Liu T.
Institution
(Gong, Zhang, Li, Liu) Tianjin Key Laboratory of Ionic-Molecular Function
of Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Fragakis) Third Cardiology Department, Hippokrateion Hospital, Aristotle
University, Medical School, Thessaloniki, Greece
(Korantzopoulos) First Department of Cardiology, University of Ioannina
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, "Evangelismos" General Hospital of Athens, Athens,
Greece
(Yan) Lankenau Institute for Medical Research and Lankenau Medical Center,
Wynnewood, Pennsylvania, United States
(Yan) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Title
Role of ranolazine in the prevention and treatment of atrial fibrillation:
A meta-analysis of randomized clinical trials.
Source
Heart Rhythm. 14 (1) (pp 3-11), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Background Randomized controlled trials (RCTs) on the use of ranolazine
(RN) for prevention and cardioversion of atrial fibrillation (AF) have
yielded conflicting results. Objective The purpose of this study was to
conduct a meta-analysis of RCTs to examine the potential role of RN in the
prevention and cardioversion of AF. Methods PubMed and EMBASE were
searched until June 2016. Of 484 initially identified studies, 8 RCTs were
finally analyzed. Results The analysis of RCTs showed that RN
significantly reduced the incidence of AF compared to the control group in
various clinical settings, such as after cardiac surgery, in acute
coronary syndromes, and post-electrical cardioversion of AF (relative risk
[RR] 0.67, 95% confidence interval [CI] 0.52-0.87, Z = 3.06, P =.002).
Furthermore, a higher conversion rate of AF from the combined use of RN
and amiodarone compared to amiodarone alone (RR 1.23, 95% CI 1.08-1.40, Z
= 3.07, P =.002) was clear, with conversion time significantly shorter in
RN plus amiodarone compared to the amiodarone group (weighted mean
difference [WMD] = -10.38 hours, 95% CI -18.18 to -2.57, Z = 2.61, P
=.009). Conclusion Our meta-analysis suggests that RN may be effective in
AF prevention, whereas it potentiates and accelerates the conversion
effect of amiodarone of recent-onset AF. Larger RCTs with long-term
follow-up in diverse clinical settings are needed to further clarify the
impact of RN on AF therapy.<br/>Copyright &#xa9; 2016 Heart Rhythm Society

<22>
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.

<23>
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.

<24>
Accession Number
618785012
Author
de Barros Araujo Junior R.; Gonzaga I.C.A.; Fernandes G.A.; Lima A.C.G.;
Cortelazzi P.S.T.; de Oliveira R.A.; Nicolau R.A.
Institution
(de Barros Araujo Junior) Department of Cardiac Surgery, Santa Maria
Hospital, University of Piaui State (UESPI), Rua Olavo Bilac 2335,
Teresina, Piaui 64001-280, Brazil
(Gonzaga, Fernandes, Lima, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Avenida Shishima Hifumi, 2911, Sao Jose dos Campos, Sao Paulo
12244-000, Brazil
(Gonzaga, Fernandes, de Oliveira) Uninovafapi College, Rua Vitorino
Orthigues Fernandes 6123, Teresina, Piaui 64003-505, Brazil
(Lima) University of Piaui State (UESPI), Rua Olavo Bilac 2335, Teresina,
Piaui 64001-280, Brazil
(Cortelazzi) Department of Cardiac Surgery, Sao Paulo Hospital, Rua
Lindolfo Monteiro, 1551, Bairro de Fatima, Teresina, PI 64049-440, Brazil
(de Oliveira) Department of Health Sciences, University of Piaui State
(UESPI), Rua Olavo Bilac 2335, Teresina, Piaui 64001-280, Brazil
Title
Low-intensity LED therapy (lambda 640 +/- 20 nm) on saphenectomy healing
in patients who underwent coronary artery bypass graft: a randomized,
double-blind study.
Source
Lasers in Medical Science. 33 (1) (pp 103-109), 2018. Date of Publication:
01 Jan 2018.
Publisher
Springer London
Abstract
Myocardial revascularization surgery (CABG) is the most appropriate
treatment for coronary artery disease. Currently, the great challenge is
to reduce postoperative complications, such as wound infections,
dehiscence, pain, and patients' quality of life. The saphenectomy is the
target of complications in 10% of cases, which can cause greater
morbidity, time, and cost of hospitalization. Studies show that
low-intensity laser or light-emitted diode (LED) therapy promotes positive
biomodulation of the tissue repair process, culminating in a lower
incidence of dehiscence, pain reduction, and improvement in quality of
life. The objective of the present study was to evaluate clinically the
saphenous tissue repair after LED therapy. Forty subjects of both genders
who underwent CABG with extracorporeal circulation were randomly divided
into two groups: the placebo (PG) and experimental (EG). The experimental
group underwent low-intensity LED therapy (lambda 640 +/- 20 nm, 6
J/cm²) on saphenectomy. The tissue repair was analyzed by
digital photogrammetry on the first and fifth postoperative day. The
border closure was blindly evaluated by three researchers. The hematoma
and hyperemia area was quantitatively analyzed using ImageJ&#xa9;
software. The results showed that in the experimental group, there were
less bleeding points and no dehiscence in saphenectomy, as compared to the
placebo group. There was also a smaller area of hematoma and hyperemia in
the experimental group (p < 0.0009). These data lead to the conclusion
that the type of phototherapy protocol employed can assist in tissue
repair.<br/>Copyright &#xa9; 2017, Springer-Verlag London Ltd.

<25>
Accession Number
620089896
Author
Chavez-Tostado M.; Carrillo-Llamas F.; Martinez-Gutierrez P.E.;
Alvarado-Ramirez A.; Lopez-Taylor J.G.; Vasquez-Jimenez J.C.;
Fuentes-Orozco C.; Rendon-Felix J.; Irusteta-Jimenez L.; Calil-Romero
V.C.; Ramirez-Jimenez J.A.; Michel-Espinoza L.R.; Contreras-Lopez C.K.;
Cuesta-Marquez L.A.; Gonzalez-Ojeda A.
Institution
(Chavez-Tostado) Biomedical Research Unit 02. Specialties Hospital -
Western National Medical Center. Mexican Institute of Social Security.
Guadalajara, Jalisco. Mexico
Title
Oral glutamine reduces myocardial damage after coronary revascularization
under cardiopulmonary bypass. A randomized clinical trial.
Source
Nutricion hospitalaria. 34 (2) (pp 277-283), 2017. Date of Publication: 30
Mar 2017.
Abstract
BACKGROUND: Glutamine is the most abundant free amino acid in the body. It
modulates immune cell function and is an important energy substrate for
cells in critically ill patients. Reduction of injury cardiac markers had
been observed in patients receiving intravenous glutamine and in a pilot
study with oral glutamine. The aim of this study was to analyze the effect
of preoperative oral supplementation of glutamine on postoperative serum
levels of cardiac injury markers.
METHODS: A randomized clinical trial was performed in 28 Mexican patients
with ischemic heart disease who underwent cardiopulmonary bypass with
extracorporeal circulation. Patients were randomly assigned to receive
oral glutamine (0.5 g/kg/day) or maltodextrin 3 days before surgery.
Cardiac injury markers as troponin-I, creatine phosphokinase, and creatine
phosphokinase-Mb were measured at 1, 12, and 24 hours postoperatively.
RESULTS: At 12 and 24 hours serum markers levels were significantly lower
in the glutamine group compared with controls (p = 0.01 and p = 0.001,
respectively) (p = 0.004 and p < 0.001, respectively). Overall,
complications were significantly lower in the glutamine group (p = 0.01,
RR = 0.54, 95% CI 0.31-0.93). Mortality was observed with 2 cases of
multiple organ failure in control group and 1 case of pulmonary embolism
in glutamine group (p = 0.50).
CONCLUSION: Preoperative oral glutamine standardized at a dose of 0.5
g/kg/day in our study group showed a significant reduction in
postoperative myocardial damage. Lower cardiac injury markers levels,
morbidity and mortality were observed in patients receiving glutamine.

<26>
Accession Number
620171111
Author
McCullough P.A.; Bennett-Guerrero E.; Chawla L.S.; Beaver T.; Mehta R.L.;
Molitoris B.A.; Eldred A.; Ball G.; Lee H.-J.; Houser M.T.; Khan S.
Institution
(McCullough) Texas A&M, Department of Internal Medicine Baylor University
Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane
Hamilton Heart and Vascular Hospital, Dallas, TX The Heart Hospital,
Plano, TX
(Bennett-Guerrero) Stony Brook Medicine Health Science Center, Stony
Brook, NY
(Chawla) George Washington School of Medicine, Department of Internal
Medicine, Veterans Affairs Medical Center, Washington, DC
(Beaver) Department of Thoracic and Cardiovascular Surgery, University of
Florida, Gainesville, FL
(Mehta) Department of Internal Medicine, University of California San
Diego Medical Center, San Diego, CA
(Molitoris) Department of Internal Medicine, Indiana University,
Indianapolis, IN
(Eldred, Houser, Khan) Renal Clinical Development, AbbVie Inc., North
Chicago, IL
(Ball, Lee) Statistics, AbbVie Inc., North Chicago, IL
Title
ABT-719 for the Prevention of Acute Kidney Injury in Patients Undergoing
High-Risk Cardiac Surgery: A Randomized Phase 2b Clinical Trial.
Source
Journal of the American Heart Association. 5 (8) (no pagination), 2016.
Date of Publication: 20 Aug 2016.
Abstract
BACKGROUND: Patients undergoing cardiac surgeries with cardiopulmonary
bypass (on-pump) have a high risk for acute kidney injury (AKI). We tested
ABT-719, a novel alpha-melanocyte-stimulating hormone analog, for
prevention of AKI in postoperative cardiac surgery patients.
METHODS AND RESULTS: This phase 2b randomized, double-blind,
placebo-controlled trial included adult patients with stable renal
function undergoing high-risk on-pump cardiac surgery in the United States
and Denmark. Participants received placebo (n=61) or cumulative ABT-719
doses of 800 (n=59), 1600 (n=61), or 2100 mug/kg (n=59). Primary outcome
was development of AKI based on Acute Kidney Injury Network (AKIN)
criteria, measured utilizing preoperative creatinine value and maximum
value within 48 hours and urine output within the first 42 hours
postsurgery. Secondary outcomes included incidence of AKI based on maximal
changes from baseline in novel AKI biomarkers over a 72-hour period after
clamp release and length of intensive care unit stays through 90 days
postsurgery. A total of 65.5%, 62.7%, and 69.6% of patients in the 800-,
1600-, and 2100-mug/kg groups, respectively, developed AKI (stages 1, 2,
and 3 combined) versus 65.5% in the placebo group (for each pair-wise
comparison with placebo, P=0.966, 0.815, and 0.605, respectively). Adverse
events occurred at a similar rate in all treatment groups.
CONCLUSIONS: ABT-719 treatment did not lower AKI incidence using AKIN
criteria, influence the elevations of novel biomarkers, or change 90-day
outcomes in patients after cardiac surgery.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique
Identifier: NCT01777165.<br/>Copyright &#xa9; 2016 The Authors. Published
on behalf of the American Heart Association, Inc., by Wiley Blackwell.

<27>
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.

<28>
Accession Number
618159359
Author
De Rosa S.; Polimeni A.; Sabatino J.; Indolfi C.
Institution
(De Rosa, Polimeni, Sabatino, Indolfi) Magna Graecia University, Division
of Cardiology, Department of Medical and Surgical Sciences, Catanzaro
88100, Italy
(Indolfi) Consiglio Nazionale delle Ricerche (CNR), URT-CNR, Department of
Medicine, Catanzaro 88100, Italy
Title
Long-term outcomes of coronary artery bypass grafting versus stent-PCI for
unprotected left main disease: A meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 240. Date of Publication: 06 Sep 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery bypass graft (CABG) surgery has traditionally
represented the standard of care for left main coronary artery (LMCA)
disease. However, percutaneous coronary intervention with stent
implantation (PCI) has more recently emerged as a valuable alternative.
The long-time awaited results of the largest randomized trials on the
long-term impact of PCI versus CABG in LMCA disease, the newly published
NOBLE and EXCEL studies, revealed contrasting results. Thus, aim of the
present meta-analysis was to review the most robust evidence from
randomized comparisons of CABG versus PCI for revascularization of LMCA.
Methods: Randomized studies comparing long-term clinical outcomes of CABG
or Stent-PCI for the treatment of LMCA disease were searched for in
PubMed, the Chochrane Library and Scopus electronic databases. A total of
5 randomized studies were selected, including 4499 patients. Results: No
significant difference between CABG and PCI was found in the primary
analysis on the composite endpoint of death, stroke and myocardial
infarction (OR=106 95% CI 080-140; p=070). Similarly, no differences were
observed between CABG and PCI for all-cause death (OR=103 95% CI 081-132;
p=081). Although not statistically significant, a lower rate of stroke was
registered in the PCI arm (OR=086; p=067), while a lower rate of
myocardial infarction was found in the CABG arm (OR=143; p=017). On the
contrary, a significantly higher rate of repeat revascularization was
registered in the PCI arm (OR=176 95% CI 145-213; p<0001). Conclusions:
The present meta-analysis, the most comprehensive and updated to date,
including 5 randomized studies and 4499 patients, demonstrates no
difference between Stent-PCI and CABG for the treatment of LMCA disease in
the composite endpoint of death, stroke and myocardial infarction. Hence,
a large part of patients with unprotected left main coronary artery
disease can be managed equally well by means of both these
revascularization strategies.<br/>Copyright &#xa9; 2017 The Author(s).

<29>
Accession Number
610546332
Author
Phibbs C.S.; Love S.R.; Jacobson A.K.; Edson R.; Su P.; Uyeda L.; Matchar
D.B.; writing for the THINRS Executive Committee and Site Investigators
Institution
(Phibbs, Su) Health Economics Resource Center, VA Palo Alto Health Care
System, Palo Alto, CA, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, Stanford, CA, United
States
(Phibbs) Health Economist, VA Health Economics Resource Center, 795 Willow
Road (152MPD), Menlo Park, CA 94025, United States
(Love, Matchar) Health Services and Systems Research Program,
Duke-National University of Singapore Graduate Medical School, Singapore,
Singapore
(Love) Warren Alpert Medical School of Brown University, Providence, RI,
United States
(Jacobson) Jerry L. Pettis VA Medical Center, Research and Development
Service (151), Loma Linda, CA, United States
(Jacobson) Department of Internal Medicine, Loma Linda University, Loma
Linda, CA, United States
(Edson, Uyeda) VA Palo Alto Health Care System, Cooperative Studies
Program Coordinating Center (151 K), Palo Alto, CA, United States
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar) Division of General Medicine, Department of Medicine, and Center
for Clinical Health Policy Research, Duke University Medical Center,
Durham, NC, United States
Title
At-Home Versus In-Clinic INR Monitoring: A Cost-Utility Analysis from The
Home INR Study (THINRS).
Source
Journal of General Internal Medicine. 31 (9) (pp 1061-1067), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Effective management of patients using warfarin is
resource-intensive, requiring frequent in-clinic testing of the
international normalized ratio (INR). Patient self-testing (PST) using
portable at-home INR monitoring devices has emerged as a convenient
alternative. As revealed by The Home INR Study (THINRS), event rates for
PST were not significantly different from those for in-clinic high-quality
anticoagulation management (HQACM), and a cumulative gain in quality of
life was observed for patients undergoing PST. Objective: To perform a
cost-utility analysis of weekly PST versus monthly HQACM and to examine
the sensitivity of these results to testing frequency.
Patients/Interventions: In this study, 2922 patients taking warfarin for
atrial fibrillation or mechanical heart valve, and who demonstrated PST
competence, were randomized to either weekly PST (n = 1465) or monthly
in-clinic testing (n = 1457). In a sub-study, 234 additional patients were
randomized to PST once every 4 weeks (n = 116) or PST twice weekly (n =
118). The endpoints were quality of life (measured by the Health Utilities
Index), health care utilization, and costs over 2 years of follow-up.
Results: PST and HQACM participants were similar with regard to gender,
age, and CHADS<inf>2</inf>score. The total cost per patient over 2 years
of follow-up was $32,484 for HQACM and $33,460 for weekly PST,
representing a difference of $976. The incremental cost per
quality-adjusted life year gained with PST once weekly was $5566 (95 % CI,
-$11,490 to $25,142). The incremental cost-effectiveness ratio (ICER) was
sensitive to testing frequency: weekly PST dominated PST twice weekly and
once every 4 weeks. Compared to HQACM, weekly PST was associated with
statistically significant and clinically meaningful improvements in
quality of life. The ICER for weekly PST versus HQACM was well within
accepted standards for cost-effectiveness, and was preferred over more or
less frequent PST. These results were robust to sensitivity analyses of
key assumptions. Conclusion: Weekly PST is a cost-effective alternative to
monthly HQACM and a preferred testing frequency compared to twice weekly
or monthly PST.<br/>Copyright &#xa9; 2016, Society of General Internal
Medicine.

<30>
Accession Number
612988954
Author
Gentile F.; Lundberg G.; Hultgren R.
Institution
(Gentile, Lundberg, Hultgren) Department of Vascular Surgery A2:01,
Karolinska University Hospital, Stockholm 171 76, Sweden
(Lundberg, Hultgren) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Gentile) Royal London Hospital, Whitechapel Road, London E1 1BB, United
Kingdom
Title
Outcome for Endovascular and Open Procedures in Infrapopliteal Lesions for
Critical Limb Ischemia: Registry Based Single Center Study.
Source
European Journal of Vascular and Endovascular Surgery. 52 (5) (pp
643-649), 2016. Date of Publication: 01 Nov 2016.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background To describe the risk factor distribution and outcome
for patients with critical limb ischemia (CLI) due to infrapopliteal
arterial lesions treated by endovascular or open procedures, with special
consideration of diabetic patients. Methods Data were collected from the
Swedish Vascular Registry, Swedvasc, covering all procedures performed on
549 consecutive patients between May 2008 and January 2014 at the
Karolinska University Hospital. Diagnosis of ischemic rest pain and/or
tissue loss and treatment of infrapopliteal arterial occlusive disease
were considered. Analysis was performed on the first procedure during the
observation period, "endo" or "open". Amputation rate and death from any
cause were recorded as the primary outcome measures. Subgroup analysis was
performed on diabetic patients. Results Patient demographics did not
differ between the endo (n = 430) and open (n = 114) cohorts. Wound
complications requiring treatment within 30 days were more common in
patients treated with open procedures (32% vs. 1% for endo; p < .001), as
well as stroke and myocardial infarction. Amputation rates were higher at
30 days in the open group (7% vs. 2%; p = .012) but similar at 1 year (10%
vs. 7%; p = .206). Mortality was similar at 30 days (p = .400) and 1 year
(p = .860). Median survival at the end of the observation period was 43
months for endo and 56 months for open patients (p = .055). Patients with
diabetes treated with open procedures had more complications at 30 days
and a higher rate of transfemoral amputations at 1 year compared with
non-diabetic patients. Conclusion This non-randomized registry based study
shows similar outcomes regarding amputation and survival rate in a large
group of patients treated for infrapopliteal CLI with endovascular or open
procedures, although more post-operative complications were reported in
the open group. These findings support the continued use of both
treatments while stressing the importance of minimizing surgical trauma to
reduce wound complications.<br/>Copyright &#xa9; 2016 European Society for
Vascular Surgery

<31>
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.

<32>
Accession Number
620085906
Author
Chaikof E.L.; Dalman R.L.; Eskandari M.K.; Jackson B.M.; Lee W.A.; Mansour
M.A.; Mastracci T.M.; Mell M.; Murad M.H.; Nguyen L.L.; Oderich G.S.;
Patel M.S.; Schermerhorn M.L.; Starnes B.W.
Institution
(Chaikof, Patel, Schermerhorn) Department of Surgery, Beth Israel
Deaconess Medical Center, Boston, Mass, United States
(Dalman, Mell) Department of Surgery, Stanford University, Palo Alto,
Calif, United States
(Eskandari) Department of Surgery, Northwestern University, Chicago, Ill,
United States
(Jackson) Department of Surgery, University of Pennsylvania, Philadelphia,
Pa, United States
(Lee) Christine E. Lynn Heart & Vascular Institute, Boca Raton Regional
Hospital, Boca Raton, Fla, United States
(Mansour) Department of Surgery, Spectrum Health Medical Group, Grand
Rapids, Mich, United States
(Mastracci) The Royal Free Hospital, London, United Kingdom
(Murad) Evidence-based Practice Center, Mayo Clinic, Rochester, Minn,
United States
(Nguyen) Department of Surgery, Brigham and Women's Hospital, Boston,
Mass, United States
(Oderich) Department of Surgery, Mayo Clinic, Rochester, Minn, United
States
(Patel) Department of Surgery, Massachusetts General Hospital, Boston,
Mass, United States
(Starnes) Department of Surgery, University of Washington, Seattle, Wash,
United States
Title
The Society for Vascular Surgery practice guidelines on the care of
patients with an abdominal aortic aneurysm.
Source
Journal of Vascular Surgery. 67 (1) (pp 2-77.e2), 2018. Date of
Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Decision-making related to the care of patients with an
abdominal aortic aneurysm (AAA) is complex. Aneurysms present with varying
risks of rupture, and patient-specific factors influence anticipated life
expectancy, operative risk, and need to intervene. Careful attention to
the choice of operative strategy along with optimal treatment of medical
comorbidities is critical to achieving excellent outcomes. Moreover,
appropriate postoperative surveillance is necessary to minimize subsequent
aneurysm-related death or morbidity. Methods The committee made specific
practice recommendations using the Grading of Recommendations Assessment,
Development, and Evaluation system. Three systematic reviews were
conducted to support this guideline. Two focused on evaluating the best
modalities and optimal frequency for surveillance after endovascular
aneurysm repair (EVAR). A third focused on identifying the best available
evidence on the diagnosis and management of AAA. Specific areas of focus
included (1) general approach to the patient, (2) treatment of the patient
with an AAA, (3) anesthetic considerations and perioperative management,
(4) postoperative and long-term management, and (5) cost and economic
considerations. Results Along with providing guidance regarding the
management of patients throughout the continuum of care, we have revised a
number of prior recommendations and addressed a number of new areas of
significance. New guidelines are provided for the surveillance of patients
with an AAA, including recommended surveillance imaging at 12-month
intervals for patients with an AAA of 4.0 to 4.9 cm in diameter. We
recommend endovascular repair as the preferred method of treatment for
ruptured aneurysms. Incorporating knowledge gained through the Vascular
Quality Initiative and other regional quality collaboratives, we suggest
that the Vascular Quality Initiative mortality risk score be used for
mutual decision-making with patients considering aneurysm repair. We also
suggest that elective EVAR be limited to hospitals with a documented
mortality and conversion rate to open surgical repair of 2% or less and
that perform at least 10 EVAR cases each year. We also suggest that
elective open aneurysm repair be limited to hospitals with a documented
mortality of 5% or less and that perform at least 10 open aortic
operations of any type each year. To encourage the development of
effective systems of care that would lead to improved outcomes for those
patients undergoing emergent repair, we suggest a door-to-intervention
time of <90 minutes, based on a framework of 30-30-30 minutes, for the
management of the patient with a ruptured aneurysm. We recommend treatment
of type I and III endoleaks as well as of type II endoleaks with aneurysm
expansion but recommend continued surveillance of type II endoleaks not
associated with aneurysm expansion. Whereas antibiotic prophylaxis is
recommended for patients with an aortic prosthesis before any dental
procedure involving the manipulation of the gingival or periapical region
of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not
recommended before respiratory tract procedures, gastrointestinal or
genitourinary procedures, and dermatologic or musculoskeletal procedures
unless the potential for infection exists or the patient is
immunocompromised. Increased utilization of color duplex ultrasound is
suggested for postoperative surveillance after EVAR in the absence of
endoleak or aneurysm expansion. Conclusions Important new recommendations
are provided for the care of patients with an AAA, including suggestions
to improve mutual decision-making between the treating physician and the
patients and their families as well as a number of new strategies to
enhance perioperative outcomes for patients undergoing elective and
emergent repair. Areas of uncertainty are highlighted that would benefit
from further investigation in addition to existing limitations in
diagnostic tests, pharmacologic agents, intraoperative tools, and
devices.<br/>Copyright &#xa9; 2017 Society for Vascular Surgery

<33>
Accession Number
620079079
Author
Gargiulo G.; Ariotti S.; Vranckx P.; Leonardi S.; Frigoli E.; Ciociano N.;
Tumscitz C.; Tomassini F.; Calabro P.; Garducci S.; Crimi G.; Ando G.;
Ferrario M.; Limbruno U.; Cortese B.; Sganzerla P.; Lupi A.; Russo F.;
Garbo R.; Ausiello A.; Zavalloni D.; Sardella G.; Esposito G.; Santarelli
A.; Tresoldi S.; Nazzaro M.S.; Zingarelli A.; Petronio A.S.; Windecker S.;
da Costa B.R.; Valgimigli M.
Institution
(Gargiulo, Ariotti, Frigoli, Windecker, da Costa, Valgimigli) Department
of Cardiology, Bern University Hospital, Bern, Switzerland
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Leonardi, Crimi, Ferrario) UOC Cardiologia, Dipartimento
CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Ciociano) EUSTRATEGY Association, Forli, Italy
(Tumscitz) Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara,
Cona, Italy
(Tomassini) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Cardiology, Department of Cardiothoracic Sciences,
University of Campania "Luigi Vanvitelli," Naples, Italy
(Garducci) Struttura complessa di Cardiologia ASST di Vimercate, Desio,
Italy
(Crimi) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino, "
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
(Cortese) ASST Fatebenefratelli-Sacco, Milan, Italy
(Cortese) Fondazione Toscana Gabriele Monasterio, Pisa, Italy
(Sganzerla) ASST Bergamo Ovest, Ospedale di Treviglio, Bergamo, Italy
(Lupi) Cardiology Unit, University Hospital "Maggiore della Carita,"
Novara, Italy
(Russo) Cardiovascular Interventional Unit, Cardiology Department, S.Anna
Hospital, Como, Italy
(Garbo) Interventional Cardiology Unit, Ospedale San Giovanni Bosco,
Turin, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Zavalloni) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Sardella) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza"
University of Rome, Rome, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Tresoldi) Cardiology Unit, A.O. Ospedale di Desio, Desio, Italy
(Nazzaro) Interventional Cardiology Unit, San Camillo-Forlanini, Rome,
Italy
(Zingarelli) Interventional Cardiology Unit, IRCCS AOU San Martino, Genoa,
Italy
(Petronio) Catheterisation Laboratory, Cardiothoracic and Vascular
Department, University of Pisa, Pisa, Italy
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
Title
Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in
Patients With Acute Coronary Syndromes Undergoing Invasive Management:
Data From the Randomized MATRIX-Access Trial.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 36-50), 2018. Date of
Publication: 08 Jan 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to assess whether transradial access (TRA)
compared with transfemoral access (TFA) is associated with consistent
outcomes in male and female patients with acute coronary syndrome
undergoing invasive management. Background There are limited and
contrasting data about sex disparities for the safety and efficacy of TRA
versus TFA for coronary intervention. Methods In the MATRIX (Minimizing
Adverse Haemorrhagic Events by TRansradial Access Site and Systemic
Implementation of angioX) program, 8,404 patients were randomized to TRA
or TFA. The 30-day coprimary outcomes were major adverse cardiovascular
and cerebrovascular events (MACCE), defined as death, myocardial
infarction, or stroke, and net adverse clinical events (NACE), defined as
MACCE or major bleeding. Results Among 8,404 patients, 2,232 (26.6%) were
women and 6,172 (73.4%) were men. MACCE and NACE were not significantly
different between men and women after adjustment, but women had higher
risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p =
0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR:
0.56; p = 0.0089). When comparing radial versus femoral, there was no
significant interaction for MACCE and NACE stratified by sex
(p<inf>int</inf> = 0.15 and 0.18, respectively), although for both
coprimary endpoints the benefit with TRA was relatively greater in women
(RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly,
there was no significant interaction between male and female patients for
the individual endpoints of all-cause death (p<inf>int</inf> = 0.79),
myocardial infarction (p<inf>int</inf> = 0.25), stroke (p<inf>int</inf> =
0.18), and Bleeding Academic Research Consortium type 3 or 5
(p<inf>int</inf> = 0.45). Conclusions Women showed a higher risk of severe
bleeding and access site complications, and radial access was an effective
method to reduce these complications as well as composite ischemic and
ischemic or bleeding endpoints.<br/>Copyright &#xa9; 2018 American College
of Cardiology Foundation

<34>
Accession Number
617808606
Author
Cornell J.E.; Liao J.M.; Stack C.B.; Mulrow C.D.
Institution
(Cornell, Mulrow) University of Texas Health Science Center at San
Antonio, 7703 Merton Minter Boulevard, San Antonio, TX 78299, United
States
(Liao) Department of Medicine, University of Pennsylvania, 3400 Spruce
Street, Philadelphia, PA 19104, United States
(Stack) American College of Physicians, 190 N. Independence Mall West,
Philadelphia, PA 19106, United States
Title
Annals understanding clinical research: Evaluating the meaning of a
summary estimate in a meta-analysis.
Source
Annals of Internal Medicine. 167 (4) (pp 275-277), 2017. Date of
Publication: 15 Aug 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<35>
Accession Number
617795506
Author
Zhou Y.; Wang Y.; Wu Y.; Huang C.; Yan H.; Zhu W.; Xu W.; Zhang L.; Zhu J.
Institution
(Zhou, Wu, Huang, Yan, Zhu, Zhang, Zhu) Department of Cardiology, The
First Affiliated Hospital, Zhejiang University, School of Medicine, 79
Qingchun Road, Zhejiang, Hangzhou 310003, China
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo 315000, China
(Xu) Department of Endocrinology, The First Affiliated Hospital, Zhejiang
University, School of Medicine, 79 Qingchun Road, Hangzhou 310003, China
Title
Individualized dual antiplatelet therapy based on platelet function
testing in patients undergoing percutaneous coronary intervention: A
meta-analysis of randomized controlled trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 157. Date of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: High on-treatment platelet reactivity (HPR) represents a
strong risk factor for thrombotic events after PCI. We aim to evaluate the
efficacy and safety of individualizing intensified dual antiplatelet
therapy (DAPT) in PCI-treated patients with HPR based on platelet function
testing (PFT). Methods: Electronic databases were searched for randomized
control trials that reported the clinical outcomes of using an intensified
antiplatelet protocol with P2Y12 receptor inhibitor comparing with
standard maintenance dose of clopidogrel on the basis of platelet function
testing. Clinical endpoints were assessed. Results: From 2005 to 2016,
thirteen clinical studies comprising 7290 patients were included for
analysis. Compared with standard antiplatelet therapy with clopidogrel,
the intensified protocol based on platelet function testing was associated
with a significant reduction in major adverse cardiovascular events
(RR:0.55, 95% CI: 0.36-0.84, p = 0.005), cardiovascular death (RR:0.60,
95% CI: 0.38-0.96, p = 0.03), stent thrombosis (RR:0.58, 95% CI:
0.36-0.93, p = 0.02) and target vessel revascularization (RR:0.33, 95% CI:
0.14-0.76, p = 0.009). No significant difference was found in the rate of
bleeding events between intensified and standard protocol. Conclusions:
Compared with standard clopidogrel therapy, individualized intensified
antiplatelet therapy on the basis of platelet reactivity testing reduces
the incidence of cardiovascular events in patient undergoing PCI, without
increasing the risk of bleeding.<br/>Copyright &#xa9; The Author(s). 2017.

<36>
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

<37>
Accession Number
619331991
Author
Buccheri S.; Franchina G.; Romano S.; Puglisi S.; Venuti G.; D'Arrigo P.;
Francaviglia B.; Scalia M.; Condorelli A.; Barbanti M.; Capranzano P.;
Tamburino C.; Capodanno D.
Institution
(Buccheri, Franchina, Romano, Puglisi, Venuti, D'Arrigo, Francaviglia,
Scalia, Condorelli, Barbanti, Capranzano, Tamburino, Capodanno) Division
of Cardiology, Cardio-Thoracic-Vascular Department, Azienda
Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of
Catania, Catania, Italy
Title
Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary
Angiography-Guided Percutaneous Coronary Intervention With Stent
Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31
Studies and 17,882 Patients.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2488-2498), 2017. Date of
Publication: 26 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to explore the comparative clinical efficacy
of different imaging modalities for guiding percutaneous coronary
interventions (PCI). Background Coronary angiography (CA) is the standard
imaging modality for intraprocedural guidance of PCI. Intracoronary
imaging techniques, including intravascular ultrasound (IVUS) and optical
coherence tomography (OCT), can overcome some limitations of CA. Methods
Comprehensive hierarchical Bayesian network meta-analysis of randomized
clinical trials and adjusted observational studies comparing clinical
outcomes of PCI with stent implantation guided by CA, IVUS, or OCT.
Results A total of 31 studies encompassing 17,882 patients were included.
Compared with CA guidance, the risks of all-cause death (odds ratio [OR]:
0.74; 95% credible interval [CrI]: 0.58 to 0.98), myocardial infarction
(OR: 0.72; 95% CrI: 0.52 to 0.93), target lesion revascularization (OR:
0.74, 95% CrI: 0.58 to 0.90) and stent thrombosis (OR: 0.42; 95% CrI: 0.20
to 0.72) were significantly reduced by IVUS guidance. PCI guidance using
either IVUS or OCT was associated with a significant reduction of major
adverse cardiovascular events (OR: 0.79; 95% CrI: 0.67 to 0.91 and OR:
0.68; 95% CrI: 0.49 to 0.97, respectively) and cardiovascular death (OR:
0.47; 95% CrI: 0.32 to 0.66 and OR: 0.31; 95% CrI: 0.13 to 0.66,
respectively). No differences in terms of comparative clinical efficacy
were found between IVUS and OCT for all the investigated outcomes. Pooled
estimates were consistent across several sensitivity analyses. However,
the treatment effect of IVUS on all-cause death was neutralized in the
analysis restricted to randomized clinical trials (OR: 1.03; 95% CrI: 0.41
to 2.14). Conclusions Compared with CA, the use of intravascular imaging
techniques for PCI guidance reduces the risk of cardiovascular death and
adverse events.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<38>
Accession Number
617490472
Author
Shi Y.-J.; Lv J.; Han X.-T.; Luo G.-G.
Institution
(Shi) Department of Neurology, Xi'an Jiaotong University, Xi'an, China
(Lv, Luo) Department of Neurology, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi 710061, China
(Han) Department of Stomatology, Xi'an Jiaotong University, Xi'an, China
Title
Migraine and percutaneous patent foramen ovale closure: A systematic
review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 203. Date of Publication: 26 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The association between patent foramen ovale (PFO) and
migraine with aura (MA) is well established. However, the benefits of PFO
closure are less certain in patients with migraine without aura (MwoA).
Methods: We systematically searched Pubmed for pertinent clinical studies
published from January 2000 to July 2015. The primary end-point was the
elimination or significant improvement of migraine symptoms after PFO
closure. Results: Upon screening an initial list of 315 publications, we
identified eight studies that included 546 patients. Overall, our analysis
indicated a significant improvement of migraine in 81% of MA cases
compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95%
confidence interval 1.09-5.73), and the benefits of PFO closure were
significantly greater for patients with MA compared to patients with MwoA
(P = 0.03). Conclusions: The presence of aura provides a reference
standard for the clinical selection of patients with migraine for PFO
closure intervention.<br/>Copyright &#xa9; 2017 The Author(s).

<39>
Accession Number
617327302
Author
Bundhun P.K.; Gupta C.; Xu G.M.
Institution
(Bundhun) the First Affiliated Hospital of Guangxi Medical University,
Institute of Cardiovascular Diseases, Nanning, Guangxi 530027, China
(Gupta) Guangxi Medical University, Nanning, Guangxi 530027, China
(Xu) The People's Hospital of Guangxi Zhuang Autonomous Region, Department
of Cardiology, Nanning, Guangxi 530021, China
Title
Major adverse cardiac events and mortality in chronic obstructive
pulmonary disease following percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 191. Date of Publication: 17 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: We aimed to systematically compare Major Adverse Cardiac
Events (MACEs) and mortality following Percutaneous Coronary Intervention
(PCI) in patients with and without Chronic Obstructive Pulmonary Diseases
(COPD) through a meta-analysis. Methods: Electronic databases (Cochrane
library, EMBASE and Medline/PubMed) were searched for English publications
comparing in-hospital and long-term MACEs and mortality following PCI in
patients with a past medical history of COPD. Statistical analysis was
carried out by Revman 5.3 whereby Odds Ratio (OR) and 95% Confidence
Intervals (CI) were considered the relevant parameters. Results: A total
number of 72,969 patients were included (7518 patients with COPD and
65,451 patients without COPD). Results of this analysis showed that
in-hospital MACEs were significantly higher in the COPD group with OR:
1.40, 95% CI: 1.19-1.65; P = 0.0001, I² = 0%. Long-term MACEs
were still significantly higher in the COPD group with OR: 1.58, 95% CI:
1.38-1.81; P = 0.00001, I² = 29%. Similarly, in-hospital and
long-term mortality were significantly higher in patients with COPD, with
OR: 2.25, 95% CI: 1.78-2.85; P = 0.00001, I² = 0% and OR: 2.22,
95% CI: 1.33-3.71; P = 0.002, I² = 97% respectively. However,
the result for the long-term death was highly heterogeneous. Conclusion:
Since in-hospital and long-term MACEs and mortality were significantly
higher following PCI in patients with versus without COPD, COPD should be
considered a risk factor for the development of adverse clinical outcomes
following PCI. However, the result for the long-term mortality was highly
heterogeneous warranting further analysis.<br/>Copyright &#xa9; 2017 The
Author(s).

<40>
Accession Number
617956058
Author
Elmaraezy A.; Ismail A.; Abushouk A.I.; Eltoomy M.; Saad S.; Negida A.;
Abdelaty O.M.; Abdallah A.R.; Aboelfotoh A.M.; Hassan H.M.; Elmaraezy
A.G.; Morsi M.; Althaher F.; Althaher M.; AlSafadi A.M.
Institution
(Elmaraezy, Ismail) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Elmaraezy, Ismail, Abushouk) NovaMed Medical Research Association, Cairo,
Egypt
(Abushouk) Ain Shams University, Faculty of Medicine, Cairo, Egypt
(Eltoomy) University of Sadat City, Genetic Engineering and Biotechnology
Research Institute (GEBRI), Sadat City, Egypt
(Saad) Tanta University, Faculty of Medicine, Tanta, Egypt
(Negida) Zagazig University, Faculty of Medicine, Zagazig, Egypt
(Abdelaty) Ahmed Maher Teaching Hospital, Cairo, Egypt
(Abdallah, Aboelfotoh) Benha University, Faculty of Medicine, Benha, Egypt
(Hassan) Beni Suef University, Faculty of Medicine, Beni suef, Egypt
(Elmaraezy, Morsi) Minoufia University, Faculty of Medicine, Shebin
El-Kom, Egypt
(Althaher, Althaher) Misr University for science and technology (MUST),
6th of October City, Faculty of Medicine, Giza, Egypt
(AlSafadi) Damascus University, Faculty of Medicine, Damascus, Syrian Arab
Republic
Title
Efficacy and safety of transcatheter aortic valve replacement in aortic
stenosis patients at low to moderate surgical risk: A comprehensive
meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 234. Date of Publication: 24 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, transcatheter aortic valve replacement (TAVR) has
become the procedure of choice in high surgical risk patients with aortic
stenosis (AS). However, its value is still debated in operable AS cases.
We performed this meta-analysis to compare the safety and efficacy of TAVR
to surgical aortic valve replacement (SAVR) in low-to-moderate surgical
risk patients with AS. Methods: A systematic search of five authentic
databases retrieved 11 eligible studies (20,056 patients). Relevant Data
were pooled as risk ratios (RRs) or standardized mean differences (SMD),
with their 95% confidence interval, using Comprehensive Meta-Analysis and
RevMan software for windows. Results: At one-year of follow-up, the pooled
effect-estimates showed no significant difference between TAVR and SAVR
groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26],
stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95%
CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34,
0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and
acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower
in the TAVR group, compared to the SAVR group. However, TAVR was
associated with a higher risk of permanent pacemaker implantation (RR
2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR
1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30
days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. Conclusions: Due
to the comparable mortality rates in SAVR and TAVR groups and the lower
risk of life-threatening complications in the TAVR group, TAVR can be an
acceptable alternative to SAVR in low-to-moderate risk patients with AS.
However, larger trials with longer follow-up periods are required to
compare the long-term outcomes of both techniques.<br/>Copyright &#xa9;
2017 The Author(s).

<41>
Accession Number
616492247
Author
Bahlmann E.; Cramariuc D.; Minners J.; Lonnebakken M.T.; Ray S.;
Gohlke-Baerwolf C.; Nienaber C.A.; Jander N.; Seifert R.; Chambers J.B.;
Kuck K.H.; Gerdts E.
Institution
(Bahlmann, Kuck) Department of Cardiology, Asklepios Clinic St. Georg, II.
Medical Clinic, Lohmuhlenstrasse 5, Hamburg 20099, Germany
(Cramariuc, Seifert) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Minners, Gohlke-Baerwolf, Jander) Department of Cardiology, Herz-Zentrum
Bad Krozingen, Bad Krozingen, Germany
(Lonnebakken, Gerdts) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Ray) Manchester Academic Health Sciences Centre, Manchester, United
Kingdom
(Nienaber) Imperial College, Royal Brompton and Harefield Trust,
Cardiology and Aortic Centre, London, United Kingdom
(Chambers) Cardiothoracic Centre, Guys and St. Thomas Hospitals, London,
United Kingdom
Title
Small aortic root in aortic valve stenosis: Clinical characteristics and
prognostic implications.
Source
European Heart Journal Cardiovascular Imaging. 18 (4) (pp 404-412), 2017.
Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In aortic valve stenosis (AS), having a small aortic root may
influence both the assessment of AS severity and the treatment strategy.
The aim was to test the prognostic implications of having a small aortic
root in AS within a large prospective study. Methods and results We used
data from 4.3-year follow-up of 1560 patients with asymptomatic, initially
mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic
Stenosis study. A small aortic root was defined as inner aortic
sinotubular junction diameter indexed for body height <1.4 cm/m in women
and <1.5 cm/m in men. A small aortic root was found in 270 patients
(17.3%) at baseline. Having a small aortic root was associated with larger
aortic root wall thickness, higher pressure recovery, lower systemic
arterial compliance, left ventricular mass index, and female sex in a
multivariable logistic regression analysis (all P < 0.05). In the Cox
regression analysis, having a small aortic root at baseline was associated
with higher hazard rates of ischaemic cardiovascular events (n = 268; HR
1.55, 95% CI 1.16-2.06), non-haemorrhagic stroke (n = 55; HR 1.88, 95% CI
1.04-3.41), and cardiovascular death (n = 81; HR 2.08, 95% CI 1.28-3.39)
(all P < 0.05) after adjusting for confounders, including randomized study
treatment, sex, hypertension, AS severity, and aortic valve replacement.
Conclusion In AS patients without known cardiovascular disease or
diabetes, having a small aortic root was associated with increased
ischaemic cardiovascular events and mortality. The results suggest a
relation between the presence of a small aortic root and that of
subclinical atherosclerosis. All rights reserved.<br/>Copyright &#xa9; The
Author 2016.

<42>
Accession Number
620148202
Author
Aisner J.; Langenfeld J.; Nemoyer R.; Crystal J.; Mellender S.; Chiricolo
A.; Jongco R.; Anton E.
Institution
(Aisner, Crystal, Chiricolo, Jongco) Medical Oncology, Rutgers Cancer
Institute of New Jersey, New Brunswick, NJ, United States
(Langenfeld) Surgery, Rutgers Cancer Institute of New Jersey, New
Brunswick, NJ, United States
(Nemoyer) Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Mellender) Anesthesia, Robert Wood Johnson Medical School, New Brunswick,
NJ, United States
(Anton) Nursing, Robert Wood Johnson University Hospital, New Brunswick,
NJ, United States
Title
Liposomal bupivacaine (Exparel) reduces thoracic surgery post-operative
pain and reduces length of stay, a retrospetive study.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S2189), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Background: Intercostal nerve blocks with a liposomal Marcaine formulation
(Exparel) was reported to provide pain relief equivalent to an epidural in
the immediate post-operative period following a thoracotomy. We compared
pain relief of thoracotomies that received an Exparel block to minimally
invasive procedures in the immediate and extended post-operative period.
Method: We reviewed the records of 166 patients who underwent thoracic
surgery procedures with a thoracotomy or a video-assisted thoracoscopic
surgery (VATS) and who received multilevel paravertebral nerve blocks with
either Exparel or 1 % Marcaine with epinephrine. Pain scores and opiate
use were routinely recorded by nurses for the first 48 hours as well as
opiate use in the postoperative days (POD) 5 to 13 (by patients). Clinical
variables, atrial fibrillation, pulmonary complications, and hospital
length of stay (LOS) were also examined. Statistics included t-test for
means, and Fisher exact for proportions. Result: Fifty patients underwent
a VATS wedge resection with a paravertebral block with Exparel (VATS-E)
and 53 patients underwent a VATS wedge resection with a paravertebral
block with Marcaine (VATS-M). The pain score were lower for the VATS-E vs.
the VATS-M patients (p<0.001). 32 patients underwent a thoracotomy with an
Exparel block (Thor-E) (30 lobectomies) and 15 patients had a VATS
lobectomy with a Marcaine block (VATS-lobe-M). Thor-E patients expressed
lower pain scores compared to VATS-M and VATS-lobe-M in the first 48 hours
after surgery (p<0.001). Opiate use was also lower in the Thor-E patients
compared to VATS-lobe-M patients, with 25% of the Thor-E patients not
taking opiates by POD 5. Opiate use was not significantly different
between Thor-E and VATS-E patients from POD5 to POD 13. The LOS was 3.2
days for Thor-E and 5.7 days for historic control thoracotomy lobectomy
patients who received a Marcaine nerve block. Conclusion: Our study
suggests that the pain relief provided by an Exparel block in thoracotomy
patients compares favorably to that of VATS procedures in the immediate
and extended postoperative period, and that Exparel paravertebral nerve
blocks may also improve hospital length of stay.

<43>
Accession Number
620147604
Author
Einhorn L.
Institution
(Einhorn) Department of Medicine, Indiana University, Indianapolis, IN,
United States
Title
Mediastinal germ cell tumor.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S1652-S1653), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Extragonadal germ cell tumors (EGCTs) are among the most perplexing and
embryologically intriguing entities in clinical oncology. They represent
only 2-5% of adult germ cell malignancies. Their histology is identical to
germ cell tumors (GCTs) derived from primary gonadal sites. However, their
biology, especially primary mediastinal nonseminomatous GCT (PMNSGCT), is
substantially different. PMNSGCT represents a clinically and biologically
distinct subset of EGCT. It carries a poor prognosis with 40-50% overall
survival after platinumbased chemotherapy and surgery.1-3 The cure rate is
even worse if there is metastatic disease of the lung, liver, or
supraclavicular lymph nodes with only 25% overall survival. In contrast,
mediastinal seminomas have a good prognosis with 88-90% overall
survival.4,5 Survival outcome for PMNSGCT is dependent on successful
chemotherapy and expert thoracic surgery to remove residual disease when
feasible. Patients presenting with anterior mediastinal tumor do not have
a testis primary and there is no need to evaluate with testis ultrasound.
The significant elevation in tumor markers including human chorionic
gonadotrophin (hCG) > 1,000 U/1 and/or any elevation in alphafetoprotein
(AFP) confirms the diagnosis of NSGCT and no biopsy is needed. The patient
should be treated with 4 courses of platinum-based triple chemotherapy. We
recommend using etoposide (VP-16), ifosfamide and cisplatin (VIP x 4) as
the standard chemotherapy for PMNSGCT followed by surgical resection.2
Patients with normal tumor markers or mild elevation in hCG require a
biopsy to establish the diagnosis of pure seminoma vs. NSGCT vs. other
etiology such as thymic malignancy or lymphoma. Between 1980 and 2013, 221
patients with PMNSGCT who underwent postchemotherapy surgery at Indiana
University were retrospectively reviewed. Our initial experience was
entirely with BEP x 4. Because of our clinical observation of unacceptable
pulmonary toxicity, we subsequently substituted ifosfamide for bleomycin.
One hundred sixty-six patients received BEP and 55 received VIP. There
were 11perioperative deaths when bleomycin was part of the preoperative
chemotherapy (6.6%). By contrast, we saw no perioperative deaths on the
VIP arm. Furthermore, 30 patients (18.1%) had prolonged ventilator use for
greater than 48 hours. Only 2 patients (3.6%) had this complication on the
VIP arm.6 A phase III intergroup study of 181 patients with poor-risk germ
cell tumors, including patients with PMNSGCT, demonstrated equivalent
survival in patients with VIP compared to BEP. Given the high rate of
postoperative pulmonary failure and mortality after BEP, we feel these
results strongly support our present policy of preferring to use VIP
chemotherapy in patients with PMNSGCT before major thoracic surgical
procedure. Surgical resection of residual disease after chemotherapy is an
integral part of the management of patients with PMNSGCT. Surgical
resection after chemotherapy serves to assess response, remove
chemotherapyresistant disease and direct additional chemotherapy. Viable
teratoma or germ cell cancer is present in 30-47% of patients who undergo
resection post-chemotherapy.7,8 Chest CT scan every 4 months for 2 years,
then every 6 months for years 3-5 is recommended if teratoma or malignant
transformation of teratoma is present in the surgical specimen. However,
if there is persistent germ cell cancer in the surgical specimen, then
patients should receive 2 post-operative courses of etoposide and
cisplatin (EP). Surgical treatment for relapsed PMNSGCT in the presence of
rising tumor markers after chemotherapy is controversial. Our preferred
treatment option is surgery, if feasible, especially if carried out by
experienced thoracic surgical oncologists. We recently reported our
results with surgery alone in 35 patients with relapsed PMNSGCTs with
rising serum AFP (32 patients) or hCG (3 patients). Seven (20%) of 35
patients remained continuously diseasefree, with median followup of 64
months (range, 25-220 months).10 If surgery is not feasible, then high
dose chemotherapy in an experienced center is a reasonable approach.
Mature teratoma is the most common GCT in the mediastinum. Patients
present with large circumscribed anterior mediastinal mass with normal
serum hCG and AFP. The treatment of mature teratoma is surgical resection
and there is no role for chemotherapy unless elevated tumor markers are
present. Mediastinal pure seminomas comprise 30-40% of malignant
mediastinal GCT. Mediastinal seminoma carries an excellent prognosis and
should be treated with good-risk chemotherapy regimen (3 cycles of
bleomycin, etoposide, and platinum or 4 cycles of EP) with no surgical
resection needed.

<44>
Accession Number
620147570
Author
Kerr A.; Oswald N.; Webb J.; Kadiri S.; Bancroft H.; Taylor J.; Rajesh P.;
Steyn R.; Kalkat M.; Bishay E.; Naidu B.
Institution
(Kerr, Oswald, Webb, Kadiri, Bancroft, Taylor, Rajesh, Steyn, Kalkat,
Bishay, Naidu) Thoracic Surgery, Heart of England NHS Foundation Trust,
Birmingham, United Kingdom
Title
Outcome of pilot RCT in lung cancer surgery patients receiving either
PREOP carbohydrate & POSTOP nutritional drinks or water.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S2023), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Background: In recent thoracic surgical studies, malnutrition and/or
weight loss are important risk factors for complications after surgery.
However, it is uncertain whether modifying or optimizing perioperative
nutritional state with oral supplements results in a reduction in
complications or malnutrition. Enhanced Recovery After Surgery (ERAS)
programs in non-lung surgery include pre-surgery optimization with
carbohydrate loading drinks and post-surgery nutritional supplements.
These interventions have proven highly effective in reducing postoperative
complications. No trials have been performed in thoracic surgery to assess
the impact. Method: Single center mixed method open label Randomized
Controlled Trial (RCT) was conducted to assess the feasibility of carrying
out a large multicenter RCT in patients undergoing lung resection. A
nutritional intervention regime of preoperative carbohydrate-loading
drinks 4x200mls evening before surgery and 2X200mls the morning of
surgery, and early postoperative nutritional protein supplement drinks
twice a week for 2 weeks was compared to the control group receiving an
equivalent volume of water. Trial feasibility measures were collected as
primary outcome. Postoperative pulmonary complications were measured using
the Melbourne group scale along with additional surgical complications.
Visual analogue scores of symptoms, Quality of Recovery score 40, quality
of life (EQ-5D-5L) and satisfaction questionnaires were collected at
baseline, in hospital, 3-4 weeks and 3 month post-surgery along with hand
grip and peak flow. Qualitative semi structured interviews post-surgery
were undertaken to assess patient experience of the trial and
interventions. Result: Feasibility criteria's were met and the study
completed recruitment 5 months ahead of target. All elective lung cancer
surgery patients were screened of which 41% (n=64) were randomized over 6
month period. The 2 groups were well balanced and tools used to measure
outcome robust. 97% of patients were compliant with nutritional drinks
scheduled pre-surgery, 89% of 3 month questionnaires were returned
completed. Importantly, qualitative interviews demonstrated that the trial
and the intervention were acceptable to patients. Patients felt the
questionnaires used captured their experience of recovery from surgery
well. Conclusion: Current international guidelines for enhanced recovery
following thoracic surgery cannot recommend pre or post-operative
nutrition because of lack of evidence. We have shown an intervention and a
trial design of pre-op carbohydrate-loading and post-surgery
supplementation is highly acceptable to patients' with good compliance to
both intervention and trial measures. A large multi-center clinical trial
is required to test clinical efficacy in improving outcomes after surgery.

<45>
Accession Number
620147474
Author
Filosso P.L.; Guerrera F.; Lyberis P.; Committee E.L.N.S.
Institution
(Filosso, Guerrera, Lyberis) Sugical Sciences, University of Torino Italy,
Torino, Italy
(Committee) University Torino, Torino, Italy
Title
ESTS registration for neuroendocrine tumors.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S1685-S1686), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Lung Neuroendocrine Tumors (NETs) are rare neoplasms derived from the
neuroendocrine cells of the bronchopulmonary epithelium. They represent
about 25% of all the neuroendocrine tumors, and no more than 2%-3% of all
the primary tumors of the lung. Their incidence has recently increased by
approximately 6% per year, probably due to the improved awareness as well
as for the diffusion of lung cancer screening programs worldwide. NETs'
incidence now ranges from 0.2 to 2 per 100,000 individuals per year in the
United States. Their rarity, along with the lack of randomized clinical
trials, make lung NETs' global management still questioned, especially in
case of advanced diseases, and only few clinical recommendations currently
exist. In 2012, during the Annual Meeting in Essen (Germany), the European
Society for Thoracic Surgeons (ESTS) created a new Working Group (WG)
specifically dedicated to the Lung NETs. The Steering Committees was
composed by the following Thoracic Surgeons: Pier Luigi Filosso (Torino,
Italy-Chair), Pascal Alexandre Thomas (Marseille, France), Mariano
Garcia-Yuste (Valladolid, Spain), Eric Lim (London, UK), Federico Venuta
(Rome, Italy), Alessandro Brunelli and Konstantinos Papagiannopoulos
(Leeds, UK), Hisao Asamura (Tokyo, Japan). The aim of this WG was to
create a group of physicians expert on Lung NETs in order to improve
scientific knowledge on such rare neoplasms, and disseminate it among the
scientific community. A specific database was rapidly designed, to
retrospectively collect data of patients operated for lung NETs, and it
was sent to all the ESTS Members who expressed their interest to this
project. Moreover, a survey concerning lung NETs'clinical management was
prepared and its results were recently published (Future Oncol.
2016;12:1985-1999). Up to now, 2040 operated NETs patients have been
collected amongst 17 high-volume International Thoracic Surgery
Institution worldwide. This retrospective database was used for several
studies about lung NETs clinical behavior and outcome. In particular, the
outcome and prognostic factors of two aggressive lung NETs: atypical
carcinoids (ACs) and largecell neuroendocrine carcinomas (LCNCs) were the
object of the first publication (Eur.J. Cardiothorac Surg. 2015;48:55-64).
For ACs, age (P<0.001), tumor size (P=.015) and sub-lobar resections
(P=0.005) were independent negative prognostic factors; for LCNCs, only
pTNM stage III tumors (P=0.016) negatively affected outcome in the
multivariate analysis. Local recurrences and distant metastases were
statistically more frequent in LCNCs (P=0.02), as expected. A prognostic
model of survival for typical carcinoids (TCs) was the matter of the
second publication (Eur.J.Cardiothorac Surg. 2015;48:441-447): an analysis
of 1109 TC patients was performed. A prediction model for mortality,
evaluating age, gender, previous malignancies, peripheral tumor location,
TNM stage and ECOG PS was elaborated, and the final model showed a good
discrimination ability with a C-statistic equal to 0.836 (bootstrap
optimism-corrected 0.806). Moreover, this model has been recently
validated by Cattoni and Coll. The treatment of biologically
aggressive/advanced lung NETs was recently investigated in a paper
published by the Journal of Thoracic Disease (J.Thorac. Dis.
2015;7:S163-S171). Surgery, whenever feasible, remains the mainstay of
treatment, and chemo/radiotherapy should be reserved to progressive
diseases. In case of resected N1-N2 carcinoids, a "watch and see" policy
and a close clinical/radiological follow-up is also recommended. Surgery
alone is not sufficient to treat high-grade NETs (e.g.: LCNC): adjuvant CT
is suggested even in early stages. Platinum- Etoposide regimen
demonstrated to be the most effective; Irinotecan and other biological
drugs are also regarded to be very promising. The management of advanced
lung NETs should be tailored by multidisciplinary teams including Medical
and Radiation Oncologists, Surgeons, Pathologists, Pulmonologists,
Endocrinologists, Interventional Radiologists; patients' prognosis is
mainly dependent on tumor grade and its anatomical extent. Large-cell
neuroendocrine carcinoma (LCNC) is a rare tumor characterized by an
aggressive biological behavior and poor prognosis; its optimal treatment
is still under debate. Some recent reports indicate that adjuvant
chemotherapy (CT) may have a beneficial effect on survival. Data from 400
patients with resected LCNC were analyzed. The 3- and 5-year survival
rates were 54.1% and 45%, respectively. With the multivariable model,
increasing age, ECOG >=2 and advanced TNM stage were indicators of poor
prognosis. Weak evidence of a higher overall survival in patients
receiving adjuvant CT (adjusted hazard ratio 0.73; 95% confidence
interval: 0.56-0.96, P =0.022) was also observed
(Eur.J.Cardio-Thorac.Surg. 2017;52:339- 345). In Stage I TCs (SITCs)
non-anatomical resections (wedge) are sometimes advocated because of their
indolent behavior. An analysis on effect of surgical procedure on SITC
patients' survival was therefore done (Eur.J.Cardiothorac.Surg. 2017
submitted paper). Eight-hundred seventy-six SITC patients (569
females,65%) were included in this study; the 5-year OS rate was 94.3%
(95%CI:92.2 -95.9). At univariable analysis, wedge resection resulted to
be associated with a poor prognosis (5-year OS 82%,95%CI:0.71-0.89,
P<.001) compared to other anatomical resections. At multivariable
score-adjusted analysis, wedge resection confirmed to be an independent
predictor of poor prognosis (HR2.17,95%CI: 1.19-3.96, P=.012). Since 2106,
a lung NETs prospective database is active through the official ESTS
European Database, and up to now, more than 150 new cases have been
collected. Through this new platform, very easy to be used, we are
confident to collect, in few years, more data especially on possible tumor
recurrences and their treatment, as well as on the role of emerging
biological drugs used in the adjuvant setting in advanced diseases. An
active participation of Medical/Radiation Oncologists to this scientific
project would be also desirable. The active role of the most important
Scientific Societies could strongly support the success of this scientific
project.

<46>
Accession Number
620147433
Author
Hoffmann H.
Institution
(Hoffmann) Thoracic Surgery,Thoraxklinik, University of Heidelberg,
Heidelberg, Germany
Title
Salvage surgery.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S1622), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Salvage thoracic surgery has become an increasingly common indication in
patients with lung cancer.1 In principle, three different indicative
fields of salvage surgery in patients with lung cancer can be
distinguished: a) the surgical resection of a persistent or recurring
primary lung tumor after stereotactic radiotherapy, b) salvage lung
resection after definitive chemoradiation therapy for Stage III nonsmall-
cell lung cancer, or c) palliative surgery in cases with e.g. massive
hemoptysis or bronchial obstruction with treatment-resistant retention
pneumonia. Common to all indications is that they are always individual
case decisions. The published series are all retrospective, comprise only
a small number of patients and refer to a long period at a single
institution. All studies show that these operations are often surgically
challenging and demanding and require careful consideration of individual
patient related factors. The presentation will provide an overview of the
current literature, and will discuss own clinical experiences from
selected cases. SBRT is an increasingly used modality in patients with
stage I lung cancer. Whereas in the past SBRT was typically considered an
alternative to surgery for patients unfit or at high risk for surgery, the
modality is now being used more often also for healthier, potentially
operable patients. In a recent study from MD Anderson Cancer Center,
Antonoff and colleagues presented a retrospective analysis of the largest
series of pulmonary resections after local SBRT failure reported to date,
along with a cumulative review that incorporates all patients who have
been previously reported.2 They demonstrated that resection after local
failure of SBRT in highly select individuals is feasible and safe, and has
an overall acceptable morbidity and mortality, albeit higher than what is
typically observed in nonirradiated patients. It is of note that in their
series the majority (73%) of patients underwent lobectomy, and only 24% of
patients underwent sublobar resections. In considering salvage resection,
the authors recommend careful consideration of the patient's performance
status and the likely extent of required resection, to be discussed
thoughtfully both with the patient and in a multidisciplinary tumor board
setting. Local recurrence is observed in 20-35% of patients after
definitive chemoradiation therapy for Stage III non-small-cell lung
cancer. In selected cases salvage surgery may be considered. A recent
study from Italy identified 35 cases that underwent salvage surgery after
definitive chemoradiation therapy for locally advanced nonesmall cell lung
cancer over a period of 10 years, representing 1.2% of all lung resections
for lung cancer performed at their institution.3 The authors showed
acceptable postoperative survival (2- and 3-year OS was 39% and 33%,
respectively) and complication rates (25.7% of both minor and major
complications). Another recent study from the Netherlands reported on 15
patients that underwent salvage surgery for locoregional recurrence or
persistent tumor after high dose chemoradiation therapy for locally
advanced non-small cell lung cancer. The authors concluded that selected
patients with locoregional recurrence or persistent tumor after high dose
chemoradiation therapy can undergo salvage surgery with acceptable
morbidity and mortality, even when a pneumonectomy is required.4 Factors
that might have contributed to their favorable results included adequate
pre-operative staging, ability to obtain an R0 resection and a good
performance status. Based on the favorable results, the authors emphasized
that medically operable patients presenting with locoregional recurrence
or persistent tumor after definitive chemoradiation therapy for NSCLC,
should have all treatment options reviewed in an experienced
multidisciplinary tumor board. In conclusion, salvage surgery after
stereotactic radiotherapy or after definitive chemoradiation therapy for
Stage III non-small-cell lung cancer has become a new challenge for
thoracic surgeons.

<47>
Accession Number
620147414
Author
Guerrera F.; Lococo F.; Evangelista A.; Rena O.; Ampollini L.; Vannucci
J.; Ventura L.; Marchese V.; Paci M.; Filosso P.L.; Oliaro A.; Casadio C.;
Puma F.; Ardissone F.; Ruffini E.
Institution
(Guerrera, Marchese, Filosso, Oliaro, Ruffini) Thoracic Surgery,
University of Torino, Torino, Italy
(Lococo, Paci) Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria
Nuova, Reggio Emilia, Italy
(Evangelista) Unit of Cancer Epidemiology and Cpo Piedmont, CittA Della
Salute E Della Scienza University Hospital, Torino, Italy
(Rena, Casadio) Amedeo Avogadro' University of Eastern Piedmont, Novara,
Italy
(Ampollini) Department of Surgical Sciences, Thoracic Surgery, University
Hospital of Parma, Parma, Italy
(Vannucci, Puma) University of Perugia, Perugia, Italy
(Ventura) Thoracic Surgery, University Hospital of Parma, Parma, Italy
(Ardissone) Oncology, University of Torino, Torino, Italy
Title
Risk of recurrence in stage I adenocarcinoma of the lung: A
multi-institutional study on interaction with type of surgery and type of
nodal staging.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S1788), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Background: In last years, an increasing interest emerges on the role of
sub-lobar resection and lobe-specific lymph node dissection in the
treatment of early stage lung cancer. The aim of our study was to define
impact on Cumulative incidence of recurrence (CIR) of type of surgical
resection and type of nodal staging. Furthermore, we evaluated the effect
of interactions between the different kinds of procedure. Method: An
analysis of 969 consecutive stage I pulmonary adenocarcinoma patients,
operated in six Thoracic Surgery Institutions between 2001 and 2013, was
conducted. Type of surgical resection included lobectomy and sub-lobar
resection; pneumonectomy and bilobectomy were excluded from the analysis.
Nodal staging procedures were classified in nodal sampling (NS),
lobe-specific lymph node dissection (LS-ND) and systematic lymph node
dissection (SND). Multivariableadjusted comparisons for CIR was performed
using Fine and Grey model, taking into account death by any cause as
competing event. Test of interaction between type of surgical resection
and type of nodal staging was carried out and results presented in a
stratified way. Missing data were multiple-imputed, combined estimates
were obtained from 5 imputed datasets. Result: Median follow-up was 63
months. Eight-hundred forty-six (87%) patients were submitted to
lobectomy, while 123(13%) to sub-lobar resection. Four-hundred fiftyfive
(47%) patients received SND, 98(10%) LS-ND and 416(43%) NS. Two-hundred
forty-seven (26%) patients developed a local/distant recurrence with a
5-year CIR of 24%. Multivariable-adjusted comparisons showed an
independent negative effect of sub-lobar resection(HR
1.52;95%CI:1.07-2.17), LS-ND(HR 1.74;95%CI:1.16-2.6) and NS(HR
1.49;95%CI:1.12-1.98) on CIR(Table). Test of interaction showed an
homogeneity of results among subgroups. Conclusion: In our series,
lobectomy and systematic lymph node dissection confirmed to be the optimal
strategy to achieve a favorable prognosis in stage I adenocarcinoma of the
lung. The real value of sub-lobar resection and less aggressive nodal
staging should be assessed by randomized clinical trial before being
integrated in clinical practice. (Table presented).

<48>
Accession Number
620146830
Author
Van Schil P.
Institution
(Van Schil) Thoracic and Vascular Surgery, Antwerp University Hospital,
Edegem (Antwerp), Belgium
Title
Limited vs. Standard surgical resection: European experience.
Source
Journal of Thoracic Oncology. Conference: 18th World Conference on Lung
Cancer of the International Association for the Study of Lung Cancer,
IASLC 2017. Japan. 12 (11 Supplement 2) (pp S1671-S1672), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Until the beginning of the new century limited resection for
pathologically proven, early-stage lung cancer was not frequently applied
in Europe. The main reason for this practice were the results of the
randomized phase III trial of the Lung Cancer Study Group published in
1995, showing that for peripheral, clinical T1N0 tumors, lobectomy yields
better locoregional control with less recurrences compared to sublobar
resection.1 This study was very influential in Europe. A majority of
thoracic surgeons adopted the principle that lobectomy was the minimally
acceptable lung volume to be resected for patients with an early-stage
bronchogenic carcinoma and a low cardiopulmonary risk. Limited resection
for lung cancer was only considered for elderly persons, patients with
severe chronic obstructive pulmonary disease precluding lobectomy,
patients with a high comorbidity score and limited life expectancy due to
debilitating disease. Quite a substantial variation in practice is
observed, not only within countries but also when comparing North America
and Europe. In an interesting analysis of the thoracic surgical databases
of the Society of Thoracic Surgeons (STS) and European Society of Thoracic
Surgeons (ESTS), some important differences were discovered regarding the
daily practice of lung resections performed during the period 2010-2013.2
Patients in the STS database were more frequently operated by
video-assisted thoracic surgery (VATS) compared to the ESTS dataset (63%
versus 22%), and were more likely to undergo sublobar resection (43%
versus 31%). However, most of the sublobar resections were wedge
resections. Anatomical segmentectomies were more frequently performed in
the ESTS database than in the STS dataset (7.4% versus 3.9%). For the ESTS
patients 30-day mortality of wedge resections was lower compared to the
STS data (0.1% versus 1.9%); however, mortality for lobectomy was higher
(2.6% versus 1.4%).2 With the start of European screening studies,
although not at the scale of the National Lung Screening Trial, a new
clinical problem arose for thoracic surgeons, namely how to deal with
small pulmonary nodules and how to limit the false-positive rate? Thoracic
surgical issues of screening were addressed in a recent paper by a task
force of the ESTS.3 Recommendations were made for implementation of CT
screening in Europe focusing on the training of thoracic surgeons, their
clinical profile and the use of minimally invasive thoracic surgery. In
general, it has been clearly demonstrated that the main goal of surgery
for an invasive lung cancer is to obtain a complete resection which is a
major prognostic factor. This mostly implies a lobectomy for tumors > 2cm,
and at least a lobe-specific systematic nodal dissection as defined in
2005 by a working group of the International Association for the Study of
Lung Cancer (IASLC).4 Unfortunately, quite a lot of resections have to be
considered uncertain due to the fact that the required number of lymph
nodes, especially mediastinal, have not been removed for further
pathological analysis.5 The new adenocarcinoma classification published in
2011 by a common task force of the IASLC, American Thoracic Society (ATS)
and European Respiratory Society (ERS) and accumulating phase II data
mainly coming from Japan, had important surgical implications.6 As new
entities, adenocarcinoma in situ (AIS) and minimally invasive
adenocarcinoma (MIA) were introduced and the confusing term
bronchioloalveolar cell carcinoma (BAC) is not used anymore. This clearly
resulted in a paradigm shift and the concept of sublobar resection was
reconsidered for smaller, early-stage lung cancers < 2cm. Anatomical
segmentectomy is generally preferred to wide wedge resection because of
concerns of local recurrence.7 Regarding the overall oncological results
several meta-analyses have been performed. Their results are somewhat
conflicting but overall, good long-term results are described for tumors
until 2 cm treated by segmentectomy when no lymph node invasion is
present. However, for small, early-stage lung cancer no high-level
evidence is currently available and the reported evidence should be
interpreted with caution. As most studies were not randomized, there was
probably a clear selection bias regarding comorbidity, histology and tumor
size. Recent guidelines and evidence from a randomized trial indicate that
small nodules of <=10 mm or <=500 mm3 that are clearly 100% pure
groundglass opacities (GGO) on chest CT may be considered as AIS or MIA,
and hence may be suitable for close follow-up or sublobar resection rather
than a formal lobectomy.8 Subcentimeter lung cancers, currently T1a
disease, represent a specific subgroup as they comprise the smallest
lesions. It should also be emphasized that for subsolid lesions the
current tumor size is determined by the solid or invasive part only which
represents a major change in the 8th TNM (tumor, node, metastasis)
classification.9 For thoracic surgeons another important topic is the
accuracy of intraoperative frozen section analysis to determine the
intraoperative extent of resection. Recent studies show that a concordance
rate of more than 80% can be reached between the frozen section and
definitive pathological report.10 However, AIS and MIA are more difficult
to diagnose on frozen section and accuracy becomes less for lesions below
10 mm, which represent the main category to be considered for sublobar
resection. This implies that a second intervention to perform a completion
lobectomy may be indicated in patients with poor prognostic histological
features who initially underwent a limited resection for a presumably
low-malignant lesion. In conclusion, sublobar resection is currently more
often applied in European countries but more high-level evidence on
longterm oncological results is required to refine its indications and
make this procedure a generally accepted intervention, not only by
thoracic surgeons but also by thoracic oncologists and pulmonary
physicians.

<49>
Accession Number
620155944
Author
Hill G.D.; Ginde S.; Rios R.; Frommelt P.C.; Hill K.D.
Institution
(Hill, Ginde, Rios, Frommelt) Division of Cardiology, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, WI
(Hill) Division of Cardiology, Department of Pediatrics, Duke University,
Durham, NC
Title
Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic
Valve Stenosis: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 5 (8) (no pagination), 2016.
Date of Publication: 08 Aug 2016.
Abstract
BACKGROUND: Optimal initial treatment for congenital aortic valve stenosis
in children remains unclear between balloon aortic valvuloplasty (BAV) and
surgical aortic valvotomy (SAV).
METHODS AND RESULTS: We performed a contemporary systematic review and
meta-analysis to compare survival in children with congenital aortic valve
stenosis. Secondary outcomes included frequency of at least moderate
regurgitation at hospital discharge as well as rates of aortic valve
replacement and reintervention. Single- and dual-arm studies were
identified by a search of PubMed (Medline), Embase, and the Cochrane
database. Overall 2368 patients from 20 studies were included in the
analysis, including 1835 (77%) in the BAV group and 533 (23%) in the SAV
group. There was no difference between SAV and BAV in hospital mortality
(OR=0.98, 95% CI 0.5-2.0, P=0.27, I(2)=22%) or frequency of at least
moderate aortic regurgitation at discharge (OR=0.58, 95% CI 0.3-1.3,
P=0.09, I(2)=54%). Kaplan-Meier analysis showed no difference in long-term
survival or freedom from aortic valve replacement but significantly more
reintervention in the BAV group (10-year freedom from reintervention of
46% [95% CI 40-52] for BAV versus 73% [95% CI 68-77] for SAV, P<0.001).
Results were unchanged in a sensitivity analysis restricted to infants (<1
year of age).
CONCLUSIONS: Although higher rates of reintervention suggest improved
outcomes with SAV, indications for reintervention may vary depending on
initial intervention. When considering the benefits of a less-invasive
approach, and clinical equipoise with respect to more clinically relevant
outcomes, these findings support the need for a randomized controlled
trial.<br/>Copyright &#xa9; 2016 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley Blackwell.