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<1>
Accession Number
619847431
Author
Canty D.J.; Heiberg J.; Yang Y.; Royse A.G.; Margale S.; Nanjappa N.;
Scott D.; Maier A.; Sessler D.I.; Chuan A.; Palmer A.; Bucknill A.; French
C.; Royse C.F.
Institution
(Canty, Yang, Royse, Bucknill) Department of Surgery, University of
Melbourne, Australia
(Canty) Royal Melbourne and Monash Hospitals, Melbourne, Australia
(Heiberg, Royse) Department of Anesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, Australia
(Heiberg) Department of Anesthesia and Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
(Yang, French, Royse) Department of Intensive Care, Western Health,
Melbourne, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Australia
(Margale) Northside Clinical School, University of Queensland, Brisbane,
Australia
(Margale) Department of Anaesthesia and Perfusion services, Prince Charles
Hospital, Brisbane, Australia
(Nanjappa) University of Adelaide, Australia
(Nanjappa) Queen Elizabeth Hospital, Adelaide, Australia
(Scott) School of Medicine, University of Melbourne, Australia
(Scott) St. Vincent's Hospital Melbourne, Australia
(Maier) Department of Medicine and Aged Care, Royal Melbourne Hospital,
University of Melbourne, Australia
(Maier) Department of Human Movement Sciences, MOVE Research Institute
Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
(Sessler) Anesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
(Chuan) University of New South Wales, Sydney, Australia
(Chuan) Liverpool Hospital, Sydney, Australia
(Palmer) Health Economics Research Unit, Menzies Institute for Medical
Research, University of Tasmania, Hobart, Australia
(Bucknill) Royal Melbourne Hospital, Melbourne, Australia
Title
Pilot multi-centre randomised trial of the impact of pre-operative focused
cardiac ultrasound on mortality and morbidity in patients having surgery
for femoral neck fractures (ECHONOF-2 pilot).
Source
Anaesthesia. 73 (4) (pp 428-437), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Hip fracture surgery is common, usually occurs in elderly patients who
have multiple comorbidities, and is associated with high morbidity and
mortality. Pre-operative focused cardiac ultrasound can alter diagnosis
and management, but its impact on outcome remains uncertain. This pilot
study assessed feasibility and group separation for a proposed large
randomised clinical trial of the impact of pre-operative focused cardiac
ultrasound on patient outcome after hip fracture surgery. Adult patients
requiring hip fracture surgery in four teaching hospitals in Australia
were randomly allocated to receive focused cardiac ultrasound before
surgery or not. The primary composite outcome was any death, acute kidney
injury, non-fatal myocardial infarction, cerebrovascular accident,
pulmonary embolism or cardiopulmonary arrest within 30 days of surgery. Of
the 175 patients screened, 100 were included as trial participants
(screening:recruitment ratio 1.7:1), 49 in the ultrasound group and 51 as
controls. There was one protocol failure among those recruited. The
primary composite outcome occurred in seven of the ultrasound group
patients and 12 of the control group patients (relative group separation
39%). Death, acute kidney injury and cerebrovascular accident were
recorded, but no cases of myocardial infarction, pulmonary embolism or
cardiopulmonary arrest ocurred. Focused cardiac ultrasound altered the
management of 17 participants, suggesting an effect mechanism. This pilot
study demonstrated that enrolment and the protocol are feasible, that the
primary composite outcome is appropriate, and that there is a treatment
effect favouring focused cardiac ultrasound - and therefore supports a
large randomised clinical trial. Copyright © 2017 The Association
of Anaesthetists of Great Britain and Ireland

<2>
Accession Number
619127124
Author
Chebbout R.; Heywood E.G.; Drake T.M.; Wild J.R.L.; Lee J.; Wilson M.; Lee
M.J.
Institution
(Chebbout) Department of General Surgery, Wishaw General Hospital, Wishaw,
United Kingdom
(Heywood) Department of General Surgery, University of Edinburgh, United
Kingdom
(Drake) Department of Clinical Surgery, University of Edinburgh, United
Kingdom
(Wild) Leeds Teaching Hospitals NHS FT, FT, Leeds, United Kingdom
(Lee) Department of Cardiology, Sheffield Teaching Hospitals NHS FT,
Sheffield, United Kingdom
(Wilson) School of Health and Related Research (ScHARR) University of
Sheffield, Sheffield, United Kingdom
(Lee) Department of General Surgery, Sheffield Teaching Hospitals,
Sheffield, United Kingdom
Title
A systematic review of the incidence of and risk factors for postoperative
atrial fibrillation following general surgery.
Source
Anaesthesia. 73 (4) (pp 490-498), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Atrial fibrillation is a common cardiac arrhythmia and can occur de novo
following a surgical procedure. It is associated with increased inpatient
and long-term mortality. There is limited evidence concerning new-onset
atrial fibrillation following abdominal surgery. This study aimed to
identify the prevalence of and risk factors for postoperative atrial
fibrillation in the general surgical population. A systematic search of
the Embase, MEDLINE and Cochrane (CENTRAL) databases was conducted.
Studies were included in the review if they reported cases of new-onset
atrial fibrillation within 30 days of the index operation. Results were
evaluated qualitatively due to substantial clinical heterogeneity.
Incidence rates were pooled using a weighted random-effects meta-analysis
model. A total of 835 records were initially identified, from which 32
full texts were retrieved. Following review, 13 studies were included that
involved 52,959 patients, of whom 10.94% (95%CI 7.22-15.33) developed
atrial fibrillation. Five studies of patients undergoing oesophagectomy (n
= 376/1923) had a weighted average rate of 17.66% (95%CI 12.16-21.47),
compared with 7.63% (95%CI 4.39-11.98) from eight studies of
non-oesophageal surgery (n = 2927/51,036). Identified risk factors
included: increasing age; history of cardiac disease; postoperative
complications, particularly, sepsis, pneumonia and pleural effusions.
New-onset postoperative atrial fibrillation is common, and is more
frequent after surgery involving the thorax. Future work should focus on
stratifying risk to allow targeted prophylaxis of atrial fibrillation and
other peri-operative complications. Copyright © 2017 The
Association of Anaesthetists of Great Britain and Ireland

<3>
Accession Number
2000513205
Author
Gargiulo G.; Carrara G.; Frigoli E.; Vranckx P.; Leonardi S.; Ciociano N.;
Campo G.; Varbella F.; Calabro P.; Garducci S.; Iannone A.; Briguori C.;
Ando G.; Crimi G.; Limbruno U.; Garbo R.; Sganzerla P.; Russo F.; Lupi A.;
Cortese B.; Ausiello A.; Ierna S.; Esposito G.; Zavalloni D.; Santarelli
A.; Sardella G.; Tresoldi S.; de Cesare N.; Sciahbasi A.; Zingarelli A.;
Tosi P.; van 't Hof A.; Omerovic E.; Brugaletta S.; Windecker S.;
Valgimigli M.
Institution
(Gargiulo, Frigoli, Windecker, Valgimigli) Department of Cardiology, Bern
University Hospital, Bern, Switzerland
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(Carrara) Advice Pharma Group S.r.l., Milan, Italy
(Vranckx, Crimi) Department of Cardiology and Critical Care Medicine,
Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life
Sciences Hasselt University, Hasselt, Belgium
(Leonardi) SC Terapia Intensiva Cardiologica, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(Ciociano) EUSTRATEGY Association, Forli', Italy
(Campo) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di
Ferrara, Cona (FE), Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA),
Italy
(Varbella) 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, Italy
(Iannone) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Interventional Cardiology Unit, Clinica Mediterranea, Naples,
Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino",
University of Messina, Messina, Italy
(Crimi) SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Limbruno) UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
(Garbo) Interventional Cardiology Unit, Ospedale San Giovanni Bosco,
Turin, Italy
(Sganzerla) ASST Bergamo ovest, Ospedale di Treviglio (BG), Italy
(Russo) Cardiovascular Interventional Unit, Cardiology Department, S.Anna
Hospital, Como, Italy
(Lupi) University Hospital "Maggiore della Carita", Novara, Italy
(Cortese) ASST Fatebenefratelli-Sacco, Milan, Italy
(Cortese) Fondazione Monasterio-CNR-Regione Toscana, Toscana, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Ierna) Simple Departmental Emodynamic Structure, Ospedale Sirai-Carbonia,
Carbonia, Italy
(Zavalloni) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Sardella) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza",
University of Rome, Rome, Italy
(Tresoldi) Struttura complessa di Emodinamica, ASST Monza, Ospedale di
Desio, Italy
(de Cesare) Policlinico San Marco, Zingonia, Italy
(Sciahbasi) Interventional Cardiology, Sandro Pertini Hospital, Rome,
Italy
(Zingarelli) Clinic of Cardiovascular Disease, IRCCS Policlinico San
Martino, Genoa, Italy
(Tosi) Mater Salutis Hospital-Legnago, Verona, Italy
(van 't Hof) Maastricht University Medical Center, Zuyderland MC,
Maastricht, Netherlands
(Omerovic) Sahlgrenska University Hospital, Goteborg, Sweden
(Brugaletta) Clinic Cardiovascular Institute, University Hospital Clinic,
IDIBAPS (Institut d'Investigacions Biomediques August Pi i Sunyer),
Barcelona, Spain
Title
Bivalirudin or Heparin in Patients Undergoing Invasive Management of Acute
Coronary Syndromes.
Source
Journal of the American College of Cardiology. 71 (11) (pp 1231-1242),
2018. Date of Publication: 20 March 2018.
Publisher
Elsevier USA
Abstract
Background: Contrasting evidence exists on the comparative efficacy and
safety of bivalirudin and unfractionated heparin (UFH) in relation to the
planned use of glycoprotein IIb/IIIa inhibitors (GPIs). Objectives: This
study assessed the efficacy and safety of bivalirudin compared with UFH
with or without GPIs in patients with acute coronary syndrome (ACS) who
underwent invasive management. Methods: In the MATRIX (Minimizing Adverse
Haemorrhagic Events by Transradial Access Site and Systemic Implementation
of AngioX) program, 7,213 patients were randomly assigned to receive
either bivalirudin or UFH with or without GPIs at discretion of the
operator. The 30-day coprimary outcomes were major adverse cardiovascular
events (MACEs) (a composite of death, myocardial infarction, or stroke),
and net adverse clinical events (NACEs) (a composite of MACEs or major
bleeding). Results: Among 3,603 patients assigned to receive UFH, 781
(21.7%) underwent planned treatment with GPI before coronary intervention.
Bailout use of GPIs was similar between the bivalirudin and UFH groups
(4.5% and 5.4%) (p = 0.11). At 30 days, the 2 coprimary endpoints of MACEs
and NACEs, as well as individual endpoints of mortality, myocardial
infarction, stent thrombosis or stroke did not differ among the 3 groups
after adjustment. Compared with the UFH and UFH+GPI groups, bivalirudin
reduced bleeding, mainly the most severe bleeds, including fatal and
nonaccess site-related events, as well as transfusion rates and the need
for surgical access site repair. These findings were not influenced by the
administered intraprocedural dose of UFH and were confirmed at multiple
sensitivity analyses, including the randomly allocated access site.
Conclusions: In patients with ACS, the rates of MACEs and NACEs were not
significantly lower with bivalirudin than with UFH, irrespective of
planned GPI use. However, bivalirudin significantly reduced bleeding
complications, mainly those not related to access site, irrespective of
planned use of GPIs. (Minimizing Adverse Haemorrhagic Events by
Transradial Access Site and Systemic Implementation of AngioX [MATRIX];
NCT01433627) Copyright © 2018 American College of Cardiology
Foundation

<4>
Accession Number
2000533589
Author
Saxena A.; Virk S.A.; Bowman S.; Chan L.; Jeremy R.; Bannon P.G.
Institution
(Saxena, Chan, Bannon) Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, Sydney, Australia
(Jeremy) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia
(Saxena, Virk, Bannon) The Baird Institute, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon) Institute of Academic Surgery, The University of Sydney, Sydney,
Australia
Title
Preoperative atrial fibrillation portends poor outcomes after coronary
bypass graft surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp 1524-1533.e2),
2018. Date of Publication: April 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<5>
Accession Number
621206174
Author
Foik J.; Brzek A.; Gierlotka M.J.; Zembala M.O.; Gasior M.; Zembala M.
Institution
(Foik) Department of Rehabilitation, Silesian Center for Heart Diseases,
Zabrze, Poland
(Brzek) Department of Kinesiology, Department of Physiotherapy, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Gierlotka, Gasior) 3rd Department of Cardiology, Medical University of
Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
(Zembala, Zembala) Department of Cardiac Surgery and Transplantation,
Medical University of Silesia, Katowice, Silesian Center for Heart
Diseases, Zabrze, Poland
(Brzek) Wydzial Nauk O Zdrowiu W Katowicach, Zaklad Kinezjologii Katedry
Fizjoterapii, Slaski Uniwersytet Medyczny W Katowicach, ul. Medykow 12,
Katowice 40-754, Poland
Title
Effect of hybrid treatment on rehabilitation and clinical condition of
patients with multivessel coronary artery disease.
Source
Polish Archives of Internal Medicine. 128 (2) (pp 77-88), 2018. Date of
Publication: 2018.
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
Introduction: Rehabilitation after coronary revascularization procedures
is an intrinsic part of treatment during the in-hospital period.
Objectives: We aimed to compare the course and effects of rehabilitation
in patients receiving hybrid treatment (minimally invasive direct coronary
artery bypass / percutaneous coronary intervention) or classic treatment
(coronary artery bypass grafting / off-pump coronary artery bypass) during
hospitalization. Patient s and methods: The study included 200 patients
participating in a prospective randomized clinical trial (POLMIDES) that
assessed the effect of hybrid treatment on in-hospital outcomes and
long-term results in patients with multivessel coronary artery disease.
Patients were divided into the classic and hybrid groups. Result s: The
classic group showed a higher perioperative risk than the hybrid group
(mean [SD] EuroSCORE, 3.54 [2.12] and 2.89 [1.97], respectively). During
all the rehabilitation cycles, lower arterial oxygen saturation
(SaO<inf>2</inf>) was reported in the hybrid group (P = 0.002). The
classic group showed lower systolic blood pressure (P <0.001), lower
diastolic blood pressure (P = 0.029), and a higher rate of blood pressure
drops during rehabilitation (P = 0.02). Patients from the classic group
were able to sit (P <0.001), assume a vertical position (P <0.001), and
walk (P = 0.01) earlier than those from the hybrid group. In the hybrid
group, earlier completion of rehabilitation and discharge from the
hospital were noted (P = 0.001). Conclusions: Patients receiving hybrid
coronary revascularization less often suffer from hypotonia events but
show lower SaO<inf>2</inf> values than patients receiving classic
treatment. Mobilization of patients receiving the hybrid treatment is
slower during the initial days and cycles of rehabilitation, but they
achieve full self-reliance earlier, which enables a shorter
hospitalization period. Copyright by Medycyna Praktyczna, Krakow
2018. Copyright © 2018 Medycyna Praktyczna. All rights reserved.

<6>
Accession Number
617805238
Author
Hebra A.; Kelly R.E.; Ferro M.M.; Yuksel M.; Campos J.R.M.; Nuss D.
Institution
(Hebra, Kelly, Ferro, Yuksel, Campos, Nuss) Nemours Children's Hospital,
Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk,
VA, USA; Fundacion Hospitalaria Children's Hospital, Buenos Aires,
Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara
University, Istanbul, Turkey
Title
Life-threatening complications and mortality of minimally invasive pectus
surgery.
Source
Journal of Pediatric Surgery. 53 (4) (pp 728-732), 2018. Date of
Publication: April 2018.
Publisher
W.B. Saunders
Abstract
The prevalence and type of life-threatening complications related to the
minimally invasive repair of pectus excavatum (MIRPE) and bar removal are
unknown and underreported. The purpose of this communication is to make
surgeons aware of the risk of these life threatening complications as well
as the modifications which have been developed to prevent them. Methods:
Data related to life-threatening complications of Pectus Excavatum (PE)
patients was obtained from four sources: 1. A survey of Chest Wall
International Group (CWIG) surgeons who specialize in repairing congenital
chest wall malformations, 2. Papers and case reports presented at CWIG
meetings, 3. Review of medico-legal cases from the USA and 4. A systematic
review of the literature related to major complications post MIRPE.
Results: From 1998 to 2016, we identified 27 published cases and 32
unreported life-threatening complications including: cardiac perforation,
hemothorax, major vessel injury, lung injury, liver injury,
gastrointestinal problems, and diaphragm injury. There were seven cases of
major complications with bar removal (reported and non-reported) with two
lethal outcomes. Mortality data with bar placement surgery: Four published
death cases and seven unpublished death cases. The overall incidence of
minor & major complications post MIRPE has been reported in the literature
to be 2-20%. The true incidence of life-threatening complications and
mortality is not known as we do not know the overall number of procedures
performed worldwide. However, based on data extrapolated from survey
information, the pectus bar manufacturer in the USA, literature reports,
and data presented at CWIG meetings as to the number of cases performed we
estimated that approximately fifty thousand cases have been performed and
that the incidence of life-threatening complications is less than 0.1%
with many occurring during the learning curve. Analysis of the cases
identified in our survey revealed that previous chest surgery, pectus
severity and inexperience were noted to be significant risk factors for
mortality. Conclusions: Published reports support the safety and efficacy
of MIRPE; however major adverse outcomes are underreported. Although major
complications with MIRPE and pectus bar removal surgery are very rare,
awareness of the risk and mortality of life-threatening complications is
essential to ensure optimal safety. Factors such as operative technique,
patient age, pectus severity and asymmetry, previous chest surgery, and
the surgeon's experience play a role in the overall incidence of such
events. These preventable events can be avoided with proper training,
mentoring, and the use of sternal elevation techniques. Type of study:
Treatment Study. Level of evidence: Level IV. Copyright © 2017
Elsevier Inc.

<7>
Accession Number
615847496
Author
Almond C.S.; Hoen H.; Rossano J.W.; Castleberry C.; Auerbach S.R.; Yang
L.; Lal A.K.; Everitt M.D.; Fenton M.; Hollander S.A.; Pahl E.; Pruitt E.;
Rosenthal D.N.; McElhinney D.B.; Daly K.P.; Desai M.
Institution
(Almond, Hollander, Rosenthal, McElhinney) Department of Pediatrics
(Cardiology), Stanford University, Palo Alto, California, United States
(Hoen, Yang, Desai) Department of Medicine - Quantitative Sciences Unit,
Stanford University, Palo Alto, California, United States
(Rossano) Department of Cardiology Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania, United States
(Castleberry) Division of Pediatric Cardiology, St. Louis Children's
Hospital, St. Louis, Missouri, United States
(Auerbach, Everitt) Division of Pediatric Cardiology, The Children's
Hospital Colorado, Aurora, Colorado, United States
(Lal) Division of Pediatric Cardiology, Primary Children's Hospital, Salt
Lake City, Utah, United States
(Fenton) Great Ormond Street Hospital, London, United Kingdom
(Pahl) Pediatric Heart Transplant Study Group, University of Alabama at
Birmingham, Birmingham, Alabama, United States
(Pruitt) Lurie Children's Hospital, Chicago, Illinois, United States
(Daly, Desai) Department of Cardiology, Boston Children, 's Hospital,
Boston, Massachusetts, United States
Title
Development and validation of a major adverse transplant event (MATE)
score to predict late graft loss in pediatric heart transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 441-450), 2018. Date
of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Background: There is inadequate power to perform a valid clinical trial in
pediatric heart transplantation (HT) using a conventional end-point,
because the disease is rare and hard end-points, such as death or graft
loss, are infrequent. We sought to develop and validate a surrogate
end-point involving the cumulative burden of post-transplant complications
to predict death/graft loss to power a randomized clinical trial of
maintenance immunosuppression in pediatric HT. Methods: Pediatric Heart
Transplant Study (PHTS) data were used to identify all children who
underwent an isolated orthotopic HT between 2005 and 2014 who survived to
6 months post-HT. A time-varying Cox model was used to develop and
evaluate a surrogate end-point comprised of 6 major adverse transplant
events (MATEs) (acute cellular rejection [ACR], antibody-mediated
rejection [AMR], infection, cardiac allograft vasculopathy [CAV],
post-transplant lymphoproliferative disease [PTLD] and chronic kidney
disease [CKD]) occurring between 6 and 36 months, where individual events
were defined according to international guidelines. Two thirds of the
study cohort was used for score development, and one third of the cohort
was used to test the score. Results: Among 2,118 children, 6.4% underwent
graft loss between 6 and 36 months post-HT, whereas 39% developed CKD, 34%
ACR, 34% infection, 9% AMR, 4% CAV and 2% PTLD. The best predictive score
involved a simple MATE score sum, yielding a concordance probability
estimate (CPE) statistic of 0.74. Whereas the power to detect
non-inferiority (NI), assuming the NI hazard ratio of 1.45 in graft
survival was 10% (assuming 200 subjects and 6% graft loss rate), the power
to detect NI assuming a 2-point non-inferiority margin was >85% using the
MATE score. Conclusion: The MATE score reflects the cumulative burden of
MATEs and has acceptable prediction characteristics for death/graft loss
post-HT. The MATE score may be useful as a surrogate end-point to power a
clinical trial in pediatric HT. Copyright © 2018

<8>
Accession Number
619623382
Author
de Jesus L.E.; Martins A.B.; Oliveira P.B.; Gomes F.; Leve T.; Dekermacher
S.
Institution
(de Jesus, Martins, Oliveira, Gomes, Leve, Dekermacher) Pediatric Surgery
and Urology Department, Servidores do Estado Federal Hospital, Ministry of
Health, Rio de Janeiro, Brazil
Title
Negative pressure wound therapy in pediatric surgery: How and when to use.
Source
Journal of Pediatric Surgery. 53 (4) (pp 585-591), 2018. Date of
Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Introduction: Negative pressure wound therapy (NPWT) has been widely
adopted to treat laparostomy, abdominal compartment syndrome (ACS) and
complicated wounds associated with tissue loss. The method presents
specific aspects, advantages and indications in Pediatrics. Our aim is to
review the evidence available about NPWT in children. Methods: Active
search for papers about NPWT in Pediatric patients. Papers referring to
orthopedic problems, wound complications after Cardiac Surgery or burns
were excluded. Results: The method shows good results to treat ACS,
complicated wounds and abdominal wall malformations in neonates, including
prematures. Periwound skin protection, monitoring of fluid losses and fine
tuning of negative pressure levels according to age are necessary. Less
pain, quicker recovery, less frequent dressing changes, possible recovery
of exposed surgical hardware, granulation and shrinkage of the wound are
advantages of the method over other kinds of dressing. NPWT is
contraindicated over blood vessels and exposed nerves. Debridement is
needed before usage over necrotic areas. Enteric fistulae are not
contraindications. Complications are rare, mainly foam retention and
dermatitis/skin maceration. The possibility of fistulae being caused by
NPWT remains debatable. Conclusion: NPWT is widely used in Pediatrics,
including neonates and premature, but the evidence available about the
method is scarce and low quality. Complications are uncommon and mostly
manageable. A possible causal relationship between NPWY and enteric
fistula remains unclear. Adult devices and parameters have been adapted to
children's use. Extra care is needed to protect the delicate tissues of
Pediatric patients. Comparative research to define differential costs,
indications and advantages of the method, specific indications and limits
of NWTP in Pediatrics is needed. Type of study: Review. Evidence level:
IV Copyright © 2017 Elsevier Inc.

<9>
Accession Number
621290969
Author
Karkouti K.
Institution
(Karkouti) Department of Anesthesia, Toronto General Hospital, Toronto,
ON, Canada
Title
The fibres study: A phase 3, non-inferiority, randomized comparison of a
new fibrinogen concentrate vs. cryoprecipitate for treating acquired
hypofibrinogenemia in bleeding cardiac surgical patients.
Source
Haemophilia. Conference: 11th Annual Congress of the European Association
for Haemophilia and Allied Disorders 2018. Spain. 24 (Supplement 1) (pp
96), 2018. Date of Publication: February 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Cardiac surgery involving cardiopulmonary bypass (CPB) is
associated with coagulopathy and excess bleeding. Acquired
hypofibrinogenemia (plasma fibrinogen <1.5-2.0 g/L) is a primary causative
factor. Randomized trials evaluating the use of fibrinogen supplementation
with cryoprecipitate vs. fibrinogen concentrate in this setting are
needed. Methods: FIBrinogen REplenishment in Surgery (FIBRES) is a
prospective, multi-centre, randomized (1:1), active-control,
single-blinded, non-inferiority phase 3 trial in adult cardiac surgical
patients with clinically significant bleeding due to acquired
hypofibrinogenemia (NCT03037424). The primary objective is to determine if
the efficacy of a new fibrinogen concentrate (Octafibrin/ Fibryga,
Octapharma) is non-inferior to cryoprecipitate. Patients will receive 4 g
fibrinogen concentrate or 10 units of cryoprecipitate (dose-equivalent to
4 g) each time fibrinogen supplementation is ordered within 24 hours after
CPB; all randomized patients will receive fibrinogen supplementation as
clinically indicated. The primary outcome is total allogeneic blood
products (ABPs; red blood cells, pooled/apheresis platelets, plasma)
administered within 24 hours. Secondary outcomes include ABPs administered
within 7 days, major bleeding within 24 hours, fibrinogen levels, and
adverse events (AEs) and serious AEs within 28 days. Patient consent prior
to treatment is waived, and the study will include 1200 patients; using a
20% non-inferiority margin and assuming a drop-out rate of ~10% after
randomization, >=550 patients/group will provide >80% power. Interim
analysis will include 600 patients. The pragmatic study design and
treatment algorithm align with standard practice, aiding adherence and
clinical relevance. Results: FIBRES is expected to complete in late 2018,
with results available in early 2019. Discussion/Conclusion: FIBRES is the
largest randomized comparison of fibrinogen concentrate and
cryoprecipitate in cardiac surgery patients undergoing CPB, an
under-studied, high-risk population. Non-inferiority of the new, highly
purified fibrinogen concentrate would support its use in acquired
hypofibrinogenemia. The results from FIBRES are likely to improve care for
cardiac surgical patients experiencing significant bleeding.

<10>
Accession Number
621291954
Author
Akinseye O.; Nwagbara C.; Jha S.; Ibebuogu U.N.
Institution
(Akinseye, Nwagbara, Jha, Ibebuogu) University of Tennessee Health Science
Centre, Memphis, TN, United States
Title
Outcomes of coronary artery occlusion following transcatheter aortic valve
replacement.
Source
Journal of Investigative Medicine. Conference: 2018 Southern Regional
Meeting, SRM 2018. United States. 66 (2) (pp 389), 2018. Date of
Publication: February 2018.
Publisher
BMJ Publishing Group
Abstract
Purpose of study Coronary Occlusion (CO) is a rare but serious
complication following transcatheter aortic valve replacement (TAVR) with
limited published data. We sought to evaluate the immediate and short-term
outcomes of CO complicating TAVR. Methods used Studies, including case
reports, case series and original articles published from 2002 to 2016
describing CO following TAVR were identified with a systematic electronic
search using the PRISMA Statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analysed. Summary of results A total of 40 publications
describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean
age was 83+/-7 years and most (81%) were females. The mean logistic
EuroSCORE and STS score was 23.5%+/-14.6% and 9.1%+/-3.2% respectively.
TAVR access site was transfemoral in 73% and a balloon expandable valve
was used in 78%. Among those with LCA occlusion, the mean LCA ostium
height was 10.1+/-1.8 mm while the mean RCA ostium height was 10.4+/-2.0
mm among those with RCA occlusion. CO frequently involved the left main
coronary artery (80%) and the most common mechanism was displacement of
native valve leaflet (60%), and most cases occurred within 1 hour
postimplantation (88%). Percutaneous coronary intervention was attempted
in 82 patients and successful in 89%. Procedural death was 10.4%. CO
following TAVR in native aortic valve stenosis was associated with a 30
day mortality rate of 35.3%. Conclusions CO following TAVR is associated
with a high procedural and 30 day mortality rate despite aggressive
resuscitative measures including percutaneous coronary intervention.

<11>
Accession Number
621286877
Author
Goel S.; Raheja H.; Shani J.
Institution
(Goel, Raheja, Shani) Cardiology, Maimonides Medical Centre, Brooklyn, NY,
United States
Title
Dual versus single anti-platelet therapy after trans catheter aortic valve
replacement.
Source
Journal of Investigative Medicine. Conference: 2018 Eastern Regional
Meeting. United States. 66 (3) (pp 709-710), 2018. Date of Publication:
March 2018.
Publisher
BMJ Publishing Group
Abstract
Purpose of study Methods used We searched PubMed, EMBASE, the Cochrane
Central Register of Controlled trials, and the clinical trial registry
maintained at clinicaltrials.gov for randomised control trials (RCT) and
observational studies comparing DAPT with SAPT post TAVR. Event rates were
compared using a Forest plot of relative risk using a random-effects model
assuming interstudy heterogeneity. Summary of results A total of 6 studies
(3 RCTs and 3 observational studies, n=840) were included in the final
analysis. Compared to SAPT, DAPT was associated with increased risk of
significant bleeding (life threatening and major) [RR=2.49 (95% CI: 1.58
to 3.94, Z=3.91, p<0.0001)] with the number needed to harm for major or
life threatening bleeding calculated to be 10.4. There was no significant
difference in the incidence of stroke [RR=1.06 (95% CI: 0.43 to 2.60,
Z=0.13, p=0.90)], spontaneous myocardial infarction [RR=2.08 (95% CI: 0.56
to 7.70, Z=1.10, p=0.27)] and All-cause mortality [RR=1.18 (95% CI: 0.68
to 2.05, Z=0.58, p=0.56] in the DAPT and SAPT groups. [Figure showing the
analysis results.] Conclusions In our meta-analysis, use of DAPT after
TAVR was associated with the increased risk of major and life threatening
bleed as compared to SAPT. No difference in stroke, myocardial infarction
and All-cause mortality was noted between two groups. Post TAVR treatment
with aspirin alone might be an acceptable strategy. (Figure pasented).

<12>
Accession Number
621287340
Author
MacKenzie R.M.; Pinel K.; Carrick E.J.; Nather K.; Husi H.; Graham D.;
Mullen W.; Nicklin S.A.; Delles C.
Institution
(MacKenzie, Pinel, Carrick, Nather, Husi, Graham, Mullen, Nicklin, Delles)
Univ of Glasgow, Glasgow, United Kingdom
Title
Vascular tissue proteomics enables detection of cell type-specific changes
in target expression.
Source
Hypertension. Conference: American Heart Association's Council on
Hypertension 2017 Scientific Sessions. United States. 70 (Supplement 1)
(no pagination), 2017. Date of Publication: September 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Identification of robust targets from proteomic studies in
cardiovascular tissue may prove challenging. Using an angiotensin II (Ang
II)-infusion mouse model, we performed a proteomics study in isolated
thoracic aortas. Changes in proteins related to cardiovascular
pathophysiology were identified and candidate targets selected for
validation via traditional techniques. Methods and Results: C57 black/6
mice were infused with ANG II (24 mug/kg/hour) via osmotic minipump for 6
weeks. Elastic Van Gieson staining demonstrated significantly increased
medial area in aortas from ANG II-infused mice compared to water-infused
control mice (P<0.005), indicating ANG II-induced remodelling. Nanoscale
liquid chromatography coupled to tandem mass spectrometry (nano LC-MS/MS)
revealed a 1.28 fold increase in galectin-3 (LGALS3) expression in vessels
from ANG II-infused mice as compared to controls. LGALS3, a
beta-galactoside binding lectin, is a well known marker of cardiovascular
disease reported to play a role in ANG II-induced cardiac remodelling.
Immunohistochemical (IHC) staining showed increased LGALS3 expression
throughout the vessel wall and particularly in the endothelial layer
(quantification using Image J Fiji software: 110.4 +/- 1.37 vs 120.5 +/-
2.6 arbitrary units; P=0.005) in ANG II-infused mice compared to controls.
Human primary endothelial cells (ECs) were isolated from saphenous veins
of patients undergoing coronary artery bypass graft surgery and
translational studies performed. LGALS3/LGALS3 expression was detected at
both mRNA and protein level by qRT-PCR and immunoblotting respectively.
Acute stimulation of ECs with ANG II (200nM for 24 hours) failed to
upregulate LGALS3/LGALS3 expression suggesting that the increased
endothelial expression observed in vivo is due to chronic infusion of ANG
II. Conclusions: We have successfully validated the ANG II-induced
increase in LGALS3 identified via vascular tissue proteomics. Despite the
use of homogenised whole aortic tissue, nano LC-MS/MS proved sensitive
enough to detect elevated expression of a candidate protein that is
predominantly expressed in the endothelium. Tissue proteomics can detect
changes in expression specific to a single cell type.

<13>
Accession Number
621290402
Author
Yu P.; Mattia A.M.; Cassiere H.; Manetta F.; Hartman A.
Institution
(Yu, Mattia, Cassiere, Manetta, Hartman) Northwell Health, Great Neck, NY,
United States
Title
Impact of chronic opioid and benzodiazepine use on postoperative outcomes
in patients undergoing coronary artery bypass grafting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 54th Annual Meeting of the Eastern Cardiothoracic
Surgical Society, ECTSS 2016. United States. 12 (Supplement 2) (pp S39),
2017. Date of Publication: September 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Increased use of opioids and benzodiazepines in the outpatient
setting has resulted in increased prevalence of their chronic use in
patients undergoing cardiac surgery. The purpose of this study was to
determine the impact of the preoperative use of such medications on
postoperative outcomes in cardiac surgery patients. Methods: A
retrospective study was performed on patients who underwent isolated
coronary artery bypass grafting. Patients were grouped based on
preoperative outpatient use of opioids and/or benzodiazepines.
Postoperative outcomes were compared within each group. The Mann-Whitney
test was used to compare continuous factors, and the X2 test
was used to compare categorical factors. Results: Of the 556 patients
undergoing isolated coronary artery bypass grafting during the study
period, 49 (8.8%) were taking preoperative opioids and/or benzodiazepines.
No significant differences were found in composite rates of postoperative
morbidity and mortality, time on the ventilator, or length of intensive
care unit or hospital stay between the 2 cohorts. Patients taking
preoperative opioids and/or benzodiazepines were at increased risk for
readmission. Of the patients at risk for readmission, 18.7% (9/48) of the
patients taking preoperative opioids and/or benzodiazepines had nonsternal
wound infection-related readmissions compared to 7.8% (38/488) of those
patients not taking preoperative opioids or benzodiazepines (P=0.01).
Conclusions: Patients taking chronic preoperative opioids and/or
benzodiazepines are at a significantly higher risk for readmission after
coronary artery bypass surgery. Efforts to reduce readmission rates should
therefore be directed at such patient populations.

<14>
Accession Number
621289401
Author
Ziankou A.; Zhyhalkovich A.; Laiko M.; Vykhrystsenka K.; Chuyashou V.;
Ostrovsky Y.
Institution
(Ziankou, Laiko, Vykhrystsenka, Chuyashou) Vitebsk StateMedical
University, Regional Clinical Hospital, Vitebsk, Belarus
(Zhyhalkovich, Ostrovsky) Republic Research- Practical Center
'Cardiology', Minsk, Belarus
Title
Hospital and 1-year results of a randomized trial: Minimally invasive
cardiac surgery revascularization strategy.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S152-S153), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: We evaluated hospital and 1-year results of the prospective
randomized controlled trial (RCT)Minimally Invasive Cardiac Surgery
Revascularization Strategy (MICSREVS), which compared the effectiveness of
multivessel small thoracotomy coronary artery bypass grafting (MVS.T-CABG)
versus off-pump coronary artery bypass grafting (OPCABG) and on-pump
coronary artery bypass grafting (ONCABG). Methods: The RCT MICSREVS was
started in January 2014 (http:// www.clinicaltrials.gov/show/NCT02047266).
In accordance with the trial design, 150 patients were included, divided
into 3 groups of 50 people each. In group I, the MVS.T-CABG strategy was
to perform multivessel arterial revascularization via a left
minithoracotomy on the beating heart, using the aortic no-touch technique.
In control groups II (OPCABG) and III (ONCABG), conventional surgery was
performed via a median sternotomy. Randomization was carried out by the
blind method ("envelopes"). Primary outcome measures were accepted death
from any cause and major adverse cardiac and cerebrovascular events. The
follow-up times were during the hospitalization period and 12 and 36
months after primary myocardial revascularization. Results: MVS.T-CABG was
associated with less perioperative blood loss, a lower number of blood
transfusions, shorter hospital length of stay and time to return to full
physical activity, greater improvement in the 30-day physical health
component of quality of life, compared with the other groups and less
postoperative ventilation time compared with the ONCAB group. The patients
who hadMVS.T-CABG demonstrated an associative trend toward shorter
intensive care unit stays, less newonset atrial fibrillation versus that
in patients having ONCABG, and fewer deep wound infections versus those in
patients having OPCABG. The mean follow-up period was 21.6 +/- 8.3 months.
A total of 139 (92.7%) patients have passed the 1-year control point.
During the 1-year follow-up period, 1 patient died of a cardiovascular
cause in the ONCABG group, and 1 patient in the MVS.T-CABG group received
coronary angioplasty. Cumulative midterm survival and freedom from major
adverse cardiac and cerebrovascular events did not differ significantly
between the treatment groups (Table P42-1). Conclusions: The full arterial
aortic no-touch MVS.T-CABG demonstrated good results at the in-hospital
and midterm follow-up examinations of patients participating in the
MICSREVS. RCT and can be applied to most patients with multivessel
coronary heart disease (Table Presented).

<15>
Accession Number
621289399
Author
Klvacek A.; Konecny J.; Lonsky V.; Santavy P.
Institution
(Klvacek, Konecny, Lonsky, Santavy) University Hospital Olomouc, Olomouc,
Czech Republic
Title
Efficacy of wound analgesia for postoperative pain control.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S196), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Continuous wound infusion of local anesthetics has been
successfully applied for postoperative pain control in several procedures
but, surprisingly, it is underused in cardiothoracic surgery. Our goal was
to investigate the effects of wound analgesia associated with systemic
patient-controlled analgesia in patients undergoing myocardial
revascularization from a left anterior small thoracotomy. Methods:
Forty-two consecutive patients who had myocardial revascularization via a
left anterior small thoracotomy were randomized into 2 groups (wound
analgesia and systemic patient-controlled analgesia). In thewound group,
bupivacaine was injected using a multiholed catheter connected to an
elastomeric pump inserted at the end of the operation above the
intercostal muscles and removed 48 h later. The intergroup differences
were assessed using the following criteria: pain on a visual analogue
scale at rest and consumption of narcotic and nonsteroidal
antiinflammatory medications at different time points postoperatively.
Results: All 42 patients were included into the analysis. Thus, the wound
and systemic analgesia groups comprised 22 and 20 patients, respectively.
The wound analgesia group had a significant decrease in pain scores at
rest (P < 0.001) and a reduction in the amounts of piritramide (P < 0.002)
and metamizole (P < 0.003) taken during the entire postoperative course
compared with the systemic analgesia group. Conclusions: Our data show
that wound analgesia is an effective, easy, and safe procedure. It
significantly reduces pain scores and the intake of analgesic medications.
Catheter placement does not require particular maneuvers by the surgeon
nor does the elastomeric pump need any adjustment or care by physicians or
nurses.

<16>
Accession Number
621289387
Author
Tamim M.; Al Kadi Y.; Hassan D.A.L.
Institution
(Tamim, Al Kadi, Hassan) King Fahd Military Medical Complex, Dhahran,
Saudi Arabia
Title
Mid-term results in endoscopic versus open radial artery harvesting
technique a randomized trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S109), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: An endoscopically harvested radial artery as a graft for
coronary revascularization has become a standard of care in many centers.
Four years ago, we introduced an endoscopic harvesting technique. The aim
of this randomized study was to assess graft quality 1 year after the
operation. Methods:We followed 30 patients who underwent nonemergent
onpump coronary artery bypass grafting prospectively randomized to either
endoscopic radial artery (ERA) harvest or open radial artery (ORA)
harvest. As a follow-up procedure, 64-slice cardiac computed tomography
and echocardiography were used to assess graft patency and left ventricle
function at 6 months and 1 year. In addition, the factors influencing
radial artery graft patency were evaluated. One interventional
cardiologist and 1 consultant radiologist assigned graft patency and
disease grades independently. Results: Any patency of endoscopically
harvested radial artery grafts was 93% (28/30) and perfect patency was 83%
(25/30) 1 year after coronary revascularization. The implanting surgeon
and graft harvester, patient factors, graft properties, medication, and
target territory did not influence the patency rates of the radial artery
graft. The only significant, strong parameter to predict perfect graft
patency was the severity of the target vessel stenosis (P < .001). Patency
rates of endoscopically (82%) and conventionally (80%) harvested radial
arteries did not differ (P = 0.822). Conclusions: Patency rates 1 year
after endoscopic radial artery harvesting are comparable to those with the
open technique. Based on our results, we attempted to use the radial
artery as a bypass graft only for target coronary arteries with 90% or
greater stenosis. We recommend endoscopic harvesting as the technique of
choice to harvest the radial artery.

<17>
Accession Number
621289385
Author
Toeg H.; Glineur D.; Dick A.; LeMay M.; Labinaz M.; Ruel M.
Institution
(Toeg, Glineur, Dick, LeMay, Labinaz, Ruel) University of Ottawa Heart
Institute, Ottawa, ON, Canada
Title
Hybrid coronary revascularization in patients with diabetes: Pilot
randomized controlled trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S151-S152), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The objective of this trial, which focuses on patients with
diabetes who have multivessel coronary artery disease (CAD), is to
evaluate whether minimally invasive coronary artery bypass grafting
(MI-CABG) with the left internal thoracic artery (LITA) to the left
anterior descending (LAD) coronary artery followed by placement of
drug-eluting stents (DES) in other affected coronary arteries (hybrid
coronary artery revascularization [HCAR]) is more or less effective than
CABG alone. Methods: Enrollment began in December 2015 (ClinicalTrials.gov
Identifier: NCT02504762). Adult patients with diabetes, multivessel
coronary artery disease (with involvement of the LAD coronary artery), and
angiographic lesion characteristics amenable to either percutaneous
coronary intervention (PCI) or CABG were screened and enrolled in the
study. Patients were randomized to either conventional off-pump CABG or
MI-CABG with the LITA grafted to the LAD coronary artery followed by PCI
within 3 days. The main objective of this study was to determine the
number of consenting patients after 1 year of enrollment, protocol
adherence, crossovers, and follow-up rates. After completion of this
feasibility trial, patients will be enrolled in the main trial, the aim of
which is to measure major adverse cardiac and cerebrovascular events at 5
years. Results: After 12 months of enrollment, 60 patients were screened
and a total of 11 patients were enrolled. The potential reason for
nonenrollment was perceived suboptimal PCI in non-LAD coronary arteries.
Patients underwent either off-pump CABG (n = 6) or HCAR (n = 5). All
patients had hypertension and diabetes and were on maximalmedical therapy
(aspirin, beta blocker, statin, ACE inhibitor). HCAR patients underwent
PCI after 1.2 +/- 0.4 days following MI-CABG with placement of 2.2 +/- 1.1
DES per patient. Angiography demonstrated Thrombolysis in Myocardial
Infarction grade 3 flow in all LITA to LAD coronary artery grafts. Length
of hospital stay was shorter in the HCAR group (5 days) compared to the
CABG group (7 days) (P = 0.04). Protocol adherence and follow-up rates at
a median of 6.3 months were 100%. No crossover/ conversion to sternotomy,
major adverse cardiac and cerebrovascular events, or blood transfusions
occurred in either group. Conclusions: This study is the first randomized
controlled trial comparing conventional CABG to HCAR in patients with
diabetes who have multivessel CAD. This feasibility study demonstrates
that enrollment, crossover, and adherence to protocol rates are
acceptable. The potential reason for nonenrollment is diffuse CAD felt to
preclude PCI. HCAR patients demonstrated early discharge from the
hospital; moreover, neither group had any major adverse cardiac and
cerebrovascular events. Results of analysis of midterm outcome data and
myocardial perfusion imaging are underway.

<18>
Accession Number
621289346
Author
Schulte K.; Attia R.
Institution
(Schulte) St. Hedwig Hospital, Charite University Berlin, Berlin, Germany
(Attia) St. Bartholomew's Hospital, London, United Kingdom
Title
Do enhanced recovery programs improve outcomes in adult cardiac surgery?.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S150), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Enhanced recovery programs (ERP) are a major innovation in the
care of general surgical patients, reducing perioperative complications,
shortening length of stay (LOS), and reducing costs. It is unclear how
these results relate to the postcardiac surgery population. Methods: We
analyzed all databases for studies that evaluated ERP after cardiac
surgery from 1999 to 2016. A total of 5 studies were identified: 3 studies
(2 prospective, 1 retrospective) compared a fast-track recovery vs. a
control group; 2 studies (1 prospective, 1 retrospective) assessed the
reasons for failure of fast-track recovery programs. Results: A total of
368 patients were included. The retrospective study (n = 74) showed a
significant reduction of the total LOS in the ERP group (4.05 +/- 1.43 vs.
5.4 +/- 1.17, P = 0.003). The prospective study (n = 272) showed a
reduction in the LOS in the intensive care unit (ICU) (14.38 hours, range,
2.83-202.00, SD 31.27 vs. 26.79 +/- 11.58 hours, range, 14.42-50.00, P <
0.001) in the ERP group. There was an additional reduction in the duration
of intubation (3.36 +/- 2.54 hours, range, 0.25-18.57 vs. 5.11 +/- 2.87
hours, range, 1.17-13.17, P < 0.001) and in the cost effectiveness
compared to conventional recovery [4182 +/- 2284 vs. 4553 +/- 1355, mean
difference 371(166- 1324), P < 0.001]. There was a significant reduction
in the number of postoperative complications (1 or more complications:
50.9% vs. 19.2%, P < 0.01) and an improvement in postoperative pain scores
(P < 0.01) in the ERP cohorts. A total of 346 complications occurred in
3317 patients (1704 patients, 11.6% in-hospital complications, 5.6%
complications post discharge; and 1613 patients with 3.53% readmission
rate for complications). In case of readmission, there was an association
with a longer second ICU stay (105 +/- 180 hours vs. 19.2 +/- 2.4 hours in
the ICU during the initial hospitalization). The mortality rate associated
with readmissions was significant (6 of 53, 11.3%) in the ERP group.
Independent risk factors for ERP failure were age (inhospital OR 1.406, P
< 0.01; post discharge OR 1.386, P <0.01), female sex (in-hospital OR
1.509, P < 0.01), and prolonged operating time (in-hospital OR 1.382, P <
0.01, postdischarge OR 1.672, P < 0.01). Conclusions: Small retrospective
and prospective studies demonstrate fast-track recovery after cardiac
operations as an important management strategy in carefully preselected
patients for decreasing the LOS in the ICU, total duration of intubation,
and LOS in the hospital. Fast-track recovery is a cost- effective strategy
compared to conventional recovery. There is a lack of randomized trial
data assessing which components of the fast-track system contribute most
to the outcomes.

<19>
Accession Number
621289253
Author
Di Giammarco G.; Marinelli D.; Di Mauro M.; Foschi M.; Omar A.
Institution
(Di Giammarco, Marinelli, Di Mauro, Foschi, Omar) Department of Cardiac
Surgery, University G.D'Annunzio Chieti-Pescara, Chieti, Italy
Title
A sutureless versus a sutured bioprosthesis: A prospective randomized
evaluation of surgical times.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S167-S168), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The introduction of the sutureless valve represents one of the
most important innovations in cardiac surgery. Many retrospective studies
demonstrated that the use of these prostheses reduced the cardiopulmonary
bypass (CPB) and cross-clamp times. To date, no randomized studies have
analyzed these aspects. Our aim was to evaluate whether the use of a
sutureless prosthesis reduces CPB and X-clamp times during isolated aortic
valve replacement. Methods: The primary end points were CPB and
cross-clamp times. Secondary end points were mortality rates, lengths of
stay in the intensive care unit and on the ward, intubation time, and rate
of pacemaker implantation. The inclusion criteria were patients who had
aortic valve replacement for predominant aortic valve stenosis with
anatomical characteristics suitable for both a sutured prosthesis and a
sutureless valve implantation (sinotubular junction/annulus diameter ratio
<= 1.3) and a single surgeon as the first operator. The power of the study
was calculated from retrospective data. For the primary end points of CPB
and cross-clamp time with a type I alpha error of .01, a type II beta
error of .02, and a power of the study of 80%, the sample size was 12
patients for each arm of the study. The patients were randomized
intraoperatively before cross-clamping of the aorta. The data are reported
as mean and standard deviation (SD) or median and 25th-75th percentile
based on a normality test analysis (D'Agostino-Pearson test). The results
were analyzed using the intention to treat analysis. A diagram of the
study is shown in Figure P75-1A. Results: There were no differences in
patient characteristics. The duration of CPB was 53.83 +/- 6.14 minutes
and 69.75 +/- 15.6 minutes (P = 0.0028); the duration of the cross-clamp
was 37.17 +/- 5.18 and 50.58 +/- 11.6 (P = 0.0014), respectively, for the
sutureless and the sutured valve groups. An analysis of the detail of the
surgical procedure indicated that the only significantly shorter time in
the Perceval group was the valve implant time (13.17 +/- 2.79 vs. 24.42
+/- 8.7; P = 0.0003) (Fig. P75-1B). There were no differences among the
secondary end points. Conclusions: We confirm that the use of a sutureless
bioprosthesis reduces the CPB and cross-clamp times, mainly because of a
reduction in prosthesis implantation time. A multicenter trial is ongoing
and will provide more information about clinical outcomes. (Table
Presented).

<20>
Accession Number
621289246
Author
Malhotra R.; Mehta T.; Mehta C.; Singh P.K.; Kumar R.M.; Singh R.K.;
Krishan K.
Institution
(Malhotra, Mehta, Mehta, Singh, Kumar, Singh, Krishan) Max Super
Speciality Hospital, Saket, New Delhi, India
Title
Minimally invasive mitral approach: The way ahead.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S208-S209), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Mitral valve disease is a tremendous burden in developing
countries like India. The conventional midsternotomy approach to the
mitral valve has been traditionally well accepted. Lately, the minimally
invasive approach to the mitral valve through a right minithoracotomy is
evolving as the standard of care for mitral access as a safe and effective
way with minimum surgical trauma and multiple additional advantages.
Methods: We performed a randomized prospective observational study in 90
patients with mitral valve stenosis undergoing mitral valve replacement
from December 2013 to December 2016 who met the inclusion criteria of
being 18 to 75 years of age and of having an isolated mitral valve
procedure. The study population was divided into 2 groups based on
approach: group 1 had minimally invasive cardiac procedures and group 2
had conventional midsternotomies. The primary end points studied were
deaths, length of hospital stay, and blood product usage the secondary end
points were risk factors for mortality and morbidity. Results: The primary
end point of death was not significantly different statistically (2.22%
vs. 6.67%, P = 0.616) between the 2 groups. The mean blood product usage
was not significantly different between the 2 groups (394.7 ml in those
having minimally invasive procedures vs. 460.4 ml in those having the
conventional surgical procedure, P = 0.60). The mean hospital stay in the
minimally invasive group was 6.1 days and 8.2 days in the conventional
group, which was statistically significant (P = 0.04). Statistically
significant differences were observed in total bypass time (145.4 vs. 97.4
minutes, P = 0.00009), cross-clamp time (102.1 vs. 71.8 minutes, P =
0.000003), and early return to work (31.3% vs. 36.6%, P = 0.000008) in the
minimally invasive compared to the conventional approach, respectively. No
statistically significant difference was found for other risk factors like
incidence of AF, stroke rate, ventilation time, reintubation, ejection
fraction, mean pulmonary arterial pressure, pleural effusion, renal
dysfunction, reexploration, wound infection, paravalvular leak, pain
score, New York Heart Association class readmission, and need for
reoperation. Conclusions: Minimally invasive mitral valve replacement is
as safe and as effective as the standard conventional midsternotomy
approach and has various advantages over the conventional approach, such
as better cosmesis, shorter hospital stay, faster return to work, and
complete avoidance of complications like sternal wound dehiscence.

<21>
Accession Number
621289239
Author
Subramanian S.; Hall J.; McRae A.T.
Institution
(Subramanian, Hall, McRae) Tri Star Centennial Medical Center, Nashville,
TN, United States
Title
Minimally invasive transmitral septal myectomy, concomitant mitral repair
without annuloplasty, and left-sided cryo maze procedure.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S208), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Various minimally invasive surgical approaches to hypertrophic
cardiomyopathy have been described. However, the combination of septal
myectomy and surgical atrial fibrillation (AF) ablation have typically
been performed via a sternotomy. Our goal was to report a case of
minimally invasive transmitral septal myectomy, concomitant mitral valve
repair without annuloplasty, and a left-sided cryoMaze procedure to
highlight the decision-making and technical aspects. Patient: The chart of
a patient referred for surgical myectomy and concomitant atrial
fibrillation ablation was reviewed. In addition, a MEDLINE search was
performed to obtain articles on minimally invasive approaches to septal
myectomy. The patient was a 70-year-old woman who had severe systolic
anterior motion-related mitral regurgitation, peak and mean left
ventricular outflow tract gradients of 86 and 43 mmHg, respectively, and
paroxysmal AF. She underwent femoral cannulation, a right minithoracotomy,
and transmitral septal myectomy with a left atrial cryoMaze procedure
including left atrial appendage ligation. The augmentation of the anterior
mitral leaflet was achieved with glutaraldehyde-fixed autologous
pericardium. No annuloplasty was performed to avoid altering the mitral
geometry and creating postoperative systolic anterior motion.
Transesophageal echocardiography immediately after the operation showed no
residual systolic anterior motion the mean left ventricular outflow tract
gradient was 11 to 14 mmHg, and she exhibited mild-moderate mitral
regurgitation under hypovolemic conditions. She was discharged on
postoperative day 7after an uneventful hospital stay. An echocardiogram at
2 months postoperatively showed mild mitral regurgitation, no dynamic left
ventricular outflow tract obstruction, and a mean transaortic gradient of
12 mmHg. The patient remains in New York Heart Association class I at 3
months. A literature review identified 6 papers including 58 patients
treated with minimally invasive approaches to septal myectomy. Robotic
transmitral, partial upper sternotomy, right minithoracotomy transmitral,
and right minithoracotomy transaortic approaches have been reported.
Excellent relief of left ventricular outflow tract obstruction and
systolic anterior motion-related mitral regurgitation was documented.
Conclusions: Right minithoracotomy transmitral septal myectomy and
concomitant mitral valve repair without annuloplasty and the leftsided
cryoMaze procedure comprise a useful therapeutic strategy. The addition of
surgical ablation for atrial fibrillation would warrant selection of a
minimally invasive transmitral versus transaortic approach. As experience
accumulates with the lateral approaches for septal myectomy, we believe
that, similar to degenerative mitral valve repair, sternotomy will be used
less frequently, perhaps only when there are anatomical contraindications
to the lateral approach.

<22>
Accession Number
621289230
Author
Danesi T.H.; Cresce G.D.; Sella M.; Rasovic O.; Favaro A.; Piccin C.;
Lamascese N.; Salvador L.
Institution
(Danesi, Cresce, Sella, Rasovic, Favaro, Piccin, Lamascese, Salvador)
Ospedale San Bortolo Vicenza, Vicenza, Italy
Title
Endoscopic cardiac surgery: Early results from aortic valve replacement in
a completely thoracoscopic fashion.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S101-S102), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:Minimally invasive aortic valve replacement (AVR) through a
right anterior minithoracotomy has become widespread. A full endoscopic
minimally invasive AVR procedure, named endoscopic cardiac surgery, has
been adopted by a few centers. The goal of this study was to evaluate
early outcomes of minimally invasive AVR performed in a completely
thoracoscopic fashion regardless of the type of prosthetic valve
implanted. Methods: From April 2013 to September 2016, 54 consecutive
patients without any selection underwent full thoracoscopic minimally
invasive AVR. The mean age was 69.9 +/- 10.8 years, and the median
EuroSCORE (logistic) was 5 (1.51-15). Baseline characteristics and
intraoperative and in-hospital outcomes were collected and analyzed.
Results: In this study, 2 patients had redo procedures. In 12 patients, a
Sorin Perceval S sutureless bioprosthesis was implanted; 7 received an
Edwards Lifesciences rapid-deployment INTUITY Elite bioprosthesis; and 34
patients received a stented standard bioprosthesis (17Medtronic Mosaic
Ultra porcine valves and 17 other types). The associated procedures were 1
mitral valve repair and 2 tricuspid valvuloplasties. The mean CPB and
aortic cross-clamp times were 136 +/- 37.4 and 96 +/- 23.9 minutes,
respectively; in sutureless and rapid deployment bioprostheses, the times
were, respectively, 136 +/- 55.3 and 88.9 +/- 29.3 minutes. The mean
ventilation time and the stay in the intensive care unit stay were 15.9
+/- 40 and 60.6 +/- 70.7 hours (median 4.5 and 42 h, respectively). The
30-day mortality rate was 3.7% (2/54); there was no permanent stroke, no
conversion to full sternotomy, and no aortic dissection. Conclusions: Full
endoscopic minimally invasive AVR is safe and feasible with favorable
early outcomes. The choice of the prosthesis does not influence the
operating time. In the future, it could serve as a benchmark for
interventional methods. Randomized studies are needed to compare the
long-term outcomes of these approaches.

<23>
Accession Number
621289219
Author
Wong J.K.; Kadiyala V.; Forrest A.; DeSelms H.; Joshi D.J.; Melvin A.L.;
Siordia J.A.; Hicks G.L.; Prasad S.M.; Knight P.A.
Institution
(Wong, Kadiyala, Forrest, DeSelms, Joshi, Melvin, Siordia, Hicks, Prasad,
Knight) University of Rochester Medical Center, Rochester, NY, United
States
Title
Titanium fasteners during aortic valve replacements: Assessment of safety
and efficacy.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S101), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The use of titanium fasteners (TF) in lieu of hand-tied (HT)
knots during aortic valve replacement (AVR) is increasing worldwide.
Nevertheless, limited data are available on the outcomes of patients who
have their prosthetic aortic valves secured using this technology.
Methods: A review of AVR (n = 1035) procedures performed at an academic
medical center from January 2008 to October 2014 was performed to allow a
minimum 2-year follow-up period for all patients. Patients inwhom TF were
used to secure the prosthetic valvewere identified (TF group, n = 153),
and their outcomes were compared to those of a control group in whom
conventional HT knots were used (HT group, n = 882). Outcome variables
considered relevant to the use of TF included cardiopulmonary bypass (CPB)
and cross-clamp times, cerebrovascular accidents, renal failure, acute
limb ischemia, perivalvular leaks (PVL), and >=2+ aortic insufficiency. A
subanalysis in patients undergoing isolated AVRs was also performed.
Results: There were no significant differences between TF and HT groups in
the incidence of redo sternotomies (14% vs. 15%, P = 0.71), concomitant
procedures (42% vs. 49%, P = 0.19), endocarditis (4% vs. 5%, P = 0.69),
and other relevant co-morbidities. However, TF use was associated with a
significant reduction in mean CPB (110 vs. 126 minutes, P = 0.01) and
cross-clamp times (87 vs. 96 minutes, P = 0.01) compared to the controls.
Additionally, no differences were noted between groups for postoperative
cerebrovascular accidents, renal failure, acute limb ischemia, and
in-hospital mortality rates (P > 0.05). In the subset of isolated AVRs,
CPB (88 vs. 103 minutes, P < 0.01) and cross-clamp (67 vs. 76 min, P <
0.01) times also remained shorter in TF patients. During follow-up, >=2+
aortic insufficiency was present in 1% of TF patients vs. 2% in the HT
group (P = 0.51), whereas a significantly lower incidence of detected PVLs
was noted in the TF vs. the HT group, most notably in patients undergoing
isolated AVRs (1% vs. 7%, P = 0.05). Conclusions: In the largest reported
cohort to date of patients undergoing AVR with TF, this study provides
evidence that the use of TFs does not lead to increased complications but
instead could lead to a reduction in critical operative times and PVL
rates.

<24>
Accession Number
621289103
Author
Muneretto C.; Di Bacco L.; Rosati F.; Di Bartolomeo R.; Rambaldini M.;
Laborde F.; Tespili M.; Repossini A.; Folliguet T.; Metras A.; Labrousse
L.; Bisleri G.
Institution
(Muneretto, Di Bacco, Rosati, Repossini) Division of Cardiac Surgery,
University of Brescia Medical School, Brescia, Italy
(Di Bartolomeo) Division of Cardiac Surgery, University of Bologna Medical
School, Bologna, Italy
(Rambaldini) Division of Cardiac Surgery, Azienda Ospedaliera Carlo Poma,
Mantova, Italy
(Laborde) Division of Cardiac Surgery, Institut Mutualiste Montsouris,
Paris, France
(Tespili) Division of Cardiology, Ospedale Bolognini, Seriate, Bergamo,
Italy
(Folliguet) Division of Cardiac Surgery, CHU De Nancy, Nancy, France
(Metras, Labrousse) Division of Cardiac Surgery, CHU Bordeaux, Hopital
Haut-Leveque, Pessac - Bordeaux, France
(Bisleri) Division of Cardiac Surgery, Queen's University, Kingston, ON,
Canada
Title
Transcatheter versus rapid deployment sutureless bioprosthesis: Real-world
outcomes in octogenarians at intermediate risk.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S117), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The use of transcatheter aortic valve replacement (TAVR) has
been validated in patients at extremely high risk or contraindicated for
conventional cardiac surgery. Recently there has been a trend to extend
TAVR to patients with an intermediate risk profile. In this specific
subset of patients, rapid deployment sutureless valves (RDSV) are becoming
a valuable tool for surgeons. The aim of this study was to investigate the
clinical outcomes of octogenarians with severe aortic stenosis and
intermediate to high risk treated either by RDSV or TAVR in multiple
centers. Methods: Among 397 consecutive patients with severe aortic
stenosis and an intermediate- to high-risk profile (Society of Thoracic
Surgeons 30-Day Predicted Risk of Mortality Score 4%-10% and logistic
EuroSCORE I 10%-20%), a propensity score analysis was performed based on
the following therapeutic strategy: RDSV [group 1 (G1), n = 112] and TAVR
[group 2 (G2), n = 112]. Primary end points were short-term (30-day)
mortality as well as overall survival at the 24 month follow-up
examination; the secondary end point was survival free from a composite
end point of major adverse cardiac and cerebral events (defined as
cardiac-related death, myocardial infarction, cerebrovascular accidents,
and major hemorrhagic events) and periprosthetic regurgitation >2.
Results: The reported 30-day mortality rate was significantly higher in
the TAVR group (G1 = 2.7% vs. G2 = 9.8 %; P = 0.050) as were
postprocedural pacemaker implantation (G1 = 5.4% vs. G2 = 16.1%; P =
0.016) and peripheral vascular complications (G1 = 0% vs. G2 = 10.7%; P <
0.001). No significant difference was noted in early reoperation for early
device failure (G1 = 1.8% vs. G2 = 2.6%; P = 0836). At the 24-month
follow-up examination, the overall survival (G1 = 86.6 +/- 6.1%vs. G2 =
66.6 +/- 6.8%; P = 0.032) rate and being survival free fromthe composite
end point of major adverse cardiac and cerebral events and periprosthetic
regurgitation (G1 = 71.4 +/- 8.1% vs. G2 = 49.8 +/- 9.1%; P < 0.001) were
significantly better in patients undergoing RDSV than in those undergoing
TAVR. Multivariate Cox regression analysis identified TAVR as an
independent risk factor for overall mortality (HR = 2.7, CI = 1.2-7.1; P =
0.044). Conclusions: The use of TAVR in elderly patients with intermediate
risk profileswas associated with a significantly higher incidence of
perioperative complications (e.g., postoperative pacemaker implantation
and peripheral vessel complications). TAVR significantly decreased
survival at mid-term compared to RDSV. The TAVR approach in this subset of
patients should be carefully evaluated in further independent prospective
randomized trials.

<25>
Accession Number
621289076
Author
Nawalaniec J.T.; Elson M.; Reznik S.I.; Wait M.; Peltz M.; Jessen M.; Yuan
C.; Madrigales A.; Lysikowski J.; Kernstine K.H.
Institution
(Nawalaniec, Elson, Reznik, Wait, Peltz, Jessen, Yuan, Madrigales,
Lysikowski, Kernstine) University of Texas, Southwestern Medical Center at
Dallas, Dallas, TX, United States
Title
Robotic pulmonary lobectomy comparedwith thoracotomy and video-assisted
lobectomy in a cardiothoracic training program: A 6-year analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S158-S159), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Our understanding of robotic lobectomy comes largely from
established thoracic surgical programs with experienced teams without
trainee involvement. Our objective was to assess the effect of robotic
lobectomy on patient care, cardiothoracic training, and the health care
system. Methods: Clinical data were obtained from a prospectively
maintained database of anatomic lung resections performed from 1 January
2006 to 30 June 2016. Cost and oncological data were collected from the
analytics department and the tumor registry, respectively. Based on age,
sex, and 5 comorbidities, propensity scores were assigned. Differences
were confirmed using multiple regression analysis. Survival was analyzed
by the Kaplan-Meier method and compared to the SEER database. Our robotic
cardiothoracic training method consists of a 6-month programover 3 years;
the first 3months focus on simulation and bedside assist and the last 3
months, on complete case set-up and console training. Results: A total of
523 consecutive cases were identified; 91 cases were excluded. The query
identified 212 robotic [179 non-small-cell lung cancer (NSCLC)], 160
thoracotomy (117 NSCLC), and 60 video-assisted (44 NSCLC) cases. Multiple
surgeons performed each approach. Operative results and clinical and
oncological outcomes favored robotic surgery compared to thoracotomy and
showed little difference with video-assisted cases (Table P53-1). A
cardiothoracic resident served as the console surgeon in 35% of all cases:
0% in the first 2 years, increasing to 79% in the latest year. Minimally
invasive procedures increased from 32% of all cases in the first year of
using robotics to 89% in the latest year. The total volume of lung cancer
cases increased by 51%, surgical cases by 92%, and clinical trial accrual
by 70%. Conclusions: In the setting of a cardiothoracic training program,
robotic lobectomy can be performed without sacrificing quality. Robotic
surgery in this setting offers similar or better clinical results, is
costeffective, and is oncologically sound. Additionally, a robotic program
may increase an institution's volume of lung cancer cases, enhancing
resident training and clinical research. Finally, this analysis has
identified opportunities to improve efficiency and reduce costs. (Table
Presented).

<26>
Accession Number
621289065
Author
Siordia J.A.; Knight P.A.
Institution
(Siordia, Knight) University of Rochester Medical Center, Rochester, NY,
United States
Title
Surgical aortic valve replacement wins the hearts of intermediate-and
low-risk patients for the transcatheter approach in a 3-year outcome
study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 20th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2017. Italy. 12
(Supplement 4) (pp S180), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Transcatheter aortic valve replacement (TAVR) is a novel
therapy for inoperable and high-risk patients with severe aortic stenosis.
Long-term data comparing the operative procedure and TAVR in
intermediate-risk patients continue to undergo investigation. We sought to
present a compilation of data addressing 3-year outcomes between the 2
interventions in intermediate and low-risk patients. Methods: We performed
a literature search to identify randomized or observational,
propensity-matched studies comparing the survival of intermediate- and
low-risk patients undergoing TAVR or surgical aortic valve replacement
(SAVR) for severe aortic stenosis. Intermediate risk and low risk were
defined by either a Society of Thoracic Surgeons score <=8%, a EuroSCORE
<=20%, or a EuroSCORE II <=10%. Primary end points included 1-, 2-, and
3-year survival rates. Secondary end points included strokes, transient
ischemic attacks, major vascular complications, permanent pacemaker
implantations, life-threatening bleeding, acute kidney injury, and atrial
fibrillation. Results: After exclusions were identified, 5 studies were
used to present 1- and 2-year data, and 2 studies were used for 3-year
data. One-year and 2-year survival rates were similar for the 2 therapies
[OR (95% CI): 0.84 (0.70, 1.02) for 1 year and 0.79 (0.52, 1.21) for 2
years]. The 3-year survival rate was statistically significant in favor of
SAVR compared to TAVR [OR (95% CI): 0.56 (0.42-0.76)] (Fig. P101-1). TAVR
presented with more major vascular complications [OR (95% CI): 7.50
(1.81-31.03)], permanent pacemaker implantation [OR (95% CI): 3.49
(1.65-7.38)], and moderate-severe aortic regurgitation [OR (95% CI): 8.15
(4.04-16.42)]. SAVR presented with more lifethreatening bleeds [OR (95%
CI): 0.36 (0.17-0.78)], acute kidney injury [OR (95% CI): 0.51
(0.33-0.79)], and atrial fibrillation [OR (95% CI): 0.35 (0.20-0.60)].
Stroke and transient ischemic attacks were similar between the 2 groups.
Conclusions: SAVR is associated with a better long-term survival rate than
TAVR for intermediate- and low-risk patients. One- and 2-year survival
rates are similar between the 2 interventions, but SAVR has a
statistically significant increased survival rate. Improvements in factors
affecting transcatheter longevity are necessary to meet the standards of
the surgical approach.

<27>
Accession Number
621288637
Author
Nishimura M.; Kishimoto Y.; Nakamura Y.
Institution
(Nishimura, Kishimoto, Nakamura) Cardiovascular Surgery, Tottori
University Hospital, Yonago, Japan
Title
Effect of tolvaptan on renal function in the early postoperative period
after cardiac surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: Winter Workshop 2016 of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2016. Japan. 12
(Supplement 3) (pp S68), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Tolvaptan (TV), a vasopressin V2 inhibitor, has a strong
diuretic effect that is beneficial for the management of body fluids in
patients with acute heart failure. Several studies have reported that TV
significantly reduces transient worsening renal function, which has
recently been highlighted as a factor exacerbating the treatment of acute
heart failure. We prospectively randomized the patients into the TV group,
in which TV was administered in addition to conventional diuretics, and
the control group, in which the patients received conventional diuretics
only. Our primary end point was the incidence of worsening renal function;
the secondary end point was body fluid management in the early
postoperative period. Methods: One hundred and ninety consecutive patients
who underwent cardiac surgery at Tottori University Hospital between July
2013 and February 2015 were enrolled. Patients who were on hemodialysis or
who could not take oral medication within postoperative day (POD) 1 for
any reason were excluded. A total of 176 patients were included in the
study and divided into 2 groups: the TV group (TV, TV + furosemide with or
without spironolactone, 90 patients) and the conventional diuretic
treatment group (control [C], furosemide with or without spironolactone,
86 patients). Results: The mean daily urine output from POD1 to POD 3 of
the TV group (2672 +/- 769 mL/day) was higher than that of the C group
(2240 +/- 529 mL/day) (P = 0.001). The time required to restore
preoperative body weight was shorter in the TV group (3.8 +/- 1.4 days)
than in the C group (4.8 +/- 2.0 days) (P = 0.003). Although the highest
postoperative creatinine level of the TV group (1.01 +/- 0.50 mg/dL) was
the same as that of the C group (1.16 +/- 0.91 mg/dL) (P = 0.25), the
incidence of worsening renal function in the TV group (9 patients, 10%)
was significantly lower than in the C group (24 patients, 28%) (P =
0.007), which might indicate the protective effect of TV against worsening
renal function in the patients undergoing cardiac surgery. Conclusions:
Administration of TV with conventional diuretics in the early
postoperative period after cardiac surgery could be beneficial in
maintaining urine output without affecting renal function, which may help
to avoid worsening renal function after cardiac surgery.

<28>
Accession Number
621211160
Author
He S.-J.; Liu Q.; Li H.-Q.; Tian F.; Chen S.-Y.; Weng J.-X.
Institution
(He, Liu, Li, Tian, Chen, Weng) Department of Cardiology, Shenzhen Sun
Yat-sen Cardiovascular Hospital, Shenzhen, China
Title
Role of statins in preventing cardiac surgery-associated acute kidney
injury: An updated meta-analysis of randomized controlled trials.
Source
Therapeutics and Clinical Risk Management. 14 (pp 475-482), 2018. Date of
Publication: 05 Mar 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: The prevention of cardiac surgery-associated acute kidney
injury (CSA-AKI) by statins remains controversial. Therefore, the present
meta-analysis including randomized controlled trials (RCTs) was performed
to assess the effect of perioperative statin on CSA-AKI. Methods: Two
reviewers independently searched for RCTs about perioperative statin for
prevention of CSA-AKI. The primary endpoint was CSA-AKI. Relative risk was
calculated between statin and placebo for preventing CSA-AKI using the
random-effect model or fixed-effect model according to different
heterogeneity. Results: Eight RCTs met inclusion criteria, including five
studies with atorvastatin, two with rosuvastatin, and one with
simvastatin. There were 1,603 patients receiving statin treatment and
1,601 with placebo. Perioperative statin therapy did not reduce the
incidence of CSA-AKI (relative risk =1.17, 95% CI: 0.98-1.39, p=0.076).
Furthermore, perioperative statin increased the risk of CSA-AKI in the
subgroup analysis with clear definition of CSA-AKI and those with JADAD
score >3. Perioperative rosuvastatin produced slightly significantly
higher risk of AKI than atorvastatin therapy (p=0.070). Statin
intervention both pre and post surgery slightly increased the risk of
CSA-AKI versus preoperative statin therapy alone (p=0.040). Conclusions:
Perioperative statin therapy might increase the risk of CSA-AKI after
cardiac surgery. Copyright © 2018 He et al.

<29>
Accession Number
2000546852
Author
Joseph C.; Garrubba M.; Smith J.A.; Melder A.
Institution
(Joseph, Garrubba, Smith, Melder) Monash Health, Melbourne, Vic, Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Vic, Australia
Title
Does the use of a pulmonary artery catheter make a difference during or
after cardiac surgery?.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
Pulmonary artery catheters (PACs) were introduced in 1970. Since then,
their use has steadily increased. However, there have been questions
raised regarding their efficacy for multiple clinical scenarios. The
purpose of this systematic review was to determine the safety and
effectiveness of routine use of PACs post cardiac surgery on mortality,
complications, days in intensive care unit, days in hospital, and costs in
patients undergoing cardiac surgery, or patients who end up in an
intensive care unit. Methods: Medline, All EBM, Embase and Cumulative
Index to Nursing and Allied Health Literature (CINAHL) databases were
searched using predetermined search terms. Google, British Medical Journal
(BMJ) Best Practice, and the National Institute for Clinical Excellence
(NICE) were also searched. All searches were from 2012 to current to
update a previous review from 2013. Studies were included if they involved
adult cardiac surgery patients, or intensive care unit (ICU) patients
requiring haemodynamic monitoring. All other surgical patients were
excluded. Results: Six articles were included in this review. Of the six
articles, five were randomised or observational studies, and one was an
expert recommendation. For all cardiac surgery patients and patients
having coronary artery bypass grafting, there was no difference in
mortality. There was an increase in mortality in high-risk cardiac surgery
patients, who had a PAC. For patients following coronary artery bypass
grafting, there was no difference in ICU length of stay (LOS) but for
patients following cardiac surgery total length of hospital stay >30 days
was greater in patients with a PAC. For patients following coronary artery
bypass grafting, in-hospital costs for the entire hospitalisation were
higher in patients with a PAC and, there was no difference in
complications between PAC and a central venous catheter use. Overall, PACs
were not a predictor of worse outcomes. Conclusion: This review revealed
that PAC use was associated with a poorer outcome in a small subset of
cardiac surgical patients but in the majority of patients PAC use made no
difference to outcome. Further studies are required to confirm the true
safety and efficacy of PAC use in cardiac surgery. Copyright ©
2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<30>
Accession Number
615590996
Author
Mellouk Aid K.; Tchala Vignon Zomahoun H.; Soulaymani A.; Lebascle K.;
Silvera S.; Astagneau P.; Misset B.
Institution
(Mellouk Aid, Soulaymani) Ibn Tofail University, Laboratory of Genetics
and Biometrics, Faculty of Sciences, Kenitra, Morocco
(Mellouk Aid) Clinical Research Centre, Foundation Hospital Saint-Joseph,
185 Rue Raymond Losserand, Paris 75014, France
(Tchala Vignon Zomahoun) Universite Laval, Quebec SPOR-SUPPORT Unit
Research Centre of CHU de Quebec, Quebec City, QC, Canada
(Lebascle) Centre for Control of Healthcare-Associated Infections, Paris,
France
(Silvera) Foundation Hospital Saint-Joseph, 185 Rue Raymond Losserand,
Paris 75014, France
(Astagneau) Sorbonne Universities, Centre for Control of Healthcare,
Associated Infections and Pierre and Marie Curie Faculty of Medicine,
Paris, France
(Misset) Foundation Hospital Saint-Joseph, Department of Intensive Care
and Clinical Research Centre, 185 Rue Raymond Losserand, Paris 75014,
France
(Misset) Paris Descartes University, Paris, France
(Misset) Department of Intensive Care, Rouen, France
(Misset) University of Rouen, Rouen University Hospital, Rouen, France
Title
Mortality and infectious complications of therapeutic endovascular
interventional radiology: A systematic and meta-analysis protocol.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 89. Date
of Publication: 24 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Endovascular interventional radiology (EIR) is an increasingly
popular, mini invasive treatment option for patient with symptomatic
vascular disease. The EIR practiced by qualified hands is an effective,
well-tolerated procedure that offers relief of patient's symptoms with a
low risk of complications. During acute post procedural period, immediate
complications may relate to vascular access, restenosis, thromboembolic
events, uterine ischemia, infection, necrosis, sepsis, ICU stay, surgical
recovery, pain management, treatment failure, and death. Moreover,
additional non-life-threatening complications exist, but they are not well
described and represent disparate information. Methods/design: A range of
databases will be screened consulted to identify the relevant studies:
PubMed, EMBASE, The Cochrane Library, NosoBase, and Google Scholar (to
identify articles not yet indexed). Scientist librarian used Medical
Subject Headings (MeSH) and free terms to construct the search strategy in
PubMed. This search strategy will be adapted in other databases. Two
coauthors will independently select the relevant studies, extract the
relevant data, and assess the risk of bias in the included studies. Any
disagreements between the two authors will be solved by a third author.
Discussion: This systematic review will provide a synthesis of EIR
complications. The spotlighted results will be analyzed in order to
provide a state-of-knowledge synopsis of the current evidence base in
relation to the epidemiology of the infectious complications after EIR. In
the event of conclusive results, our findings will serve as a reference
background to assess guidelines on reality of the problem of the
infections linked to endovascular interventional radiology and to
formulate of assumptions and propose preventive measures, based on the
results of our investigations. These propositions will aim to reduce the
risk and/or the severity of these complications in the concerned
population in favor a positive medical economics report. It will also aim
to decrease the antibio-resistance and in fine will improve health status
and security of patients. Systematic review registration: PROSPERO
CRD42015025594 Copyright © 2017 The Author(s).

<31>
Accession Number
604986623
Author
Toller W.; Heringlake M.; Guarracino F.; Algotsson L.; Alvarez J.;
Argyriadou H.; Ben-Gal T.; Cerny V.; Cholley B.; Eremenko A.;
Guerrero-Orriach J.L.; Jarvela K.; Karanovic N.; Kivikko M.; Lahtinen P.;
Lomivorotov V.; Mehta R.H.; Music S.; Pollesello P.; Rex S.; Riha H.;
Rudiger A.; Salmenpera M.; Szudi L.; Tritapepe L.; Wyncoll D.; Owall A.
Institution
(Toller) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital of Graz, Auenbruggerplatz 29, Graz 8036, Austria
(Heringlake) Department of Anaesthesiology, University of Lubeck, Lubeck,
Germany
(Guarracino) Department of Anaesthesia and Critical Care Medicine, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Algotsson) Department of Cardiothoracic Surgery, Skanes University
Hospital Lund, Lund, Sweden
(Alvarez) Department of Anaesthesiology and Intensive Care, University
Hospital of Santiago de Compostela, Santiago de Compostela, Spain
(Argyriadou) Department of Anaesthesiology and Intensive Care Unit,
Aristotle University of Thessaloniki, AHEPA Teaching Hospital,
Thessaloniki, Greece
(Ben-Gal) Rabin Medical Centre, Heart Failure Unit, Petach Tikva, Israel
(Cerny) Department of Anaesthesiology and Intensive Care, University
Hospital Hradec Kralove, Hradec Kralove, Czech Republic
(Cholley) Department of Anaesthesiology and Intensive Care, Hopital
Europeen Georges Pompidou, Paris, France
(Cholley) Universite Paris Descartes, Paris, France
(Eremenko) B. v. Petrovsky Russian National Centre of Surgery, Moscow,
Russian Federation
(Guerrero-Orriach) Department of Cardio-Anaesthesiology, University
Hospital Virgen de la Victoria de Malaga, Malaga, Spain
(Jarvela) Heart Centre and Intensive Care Unit, Tampere University
Hospital, Tampere, Finland
(Karanovic) Department of Anaesthesiology and Intensive Care, University
Hospital Split, Split, Croatia
(Kivikko, Pollesello) Orion Pharma, Critical Care, Espoo, Finland
(Lahtinen) Department of Anaesthesiology and Intensive Care, Kuopio
University Hospital, Kuopio, Finland
(Lomivorotov) E. N. Meshalkin State Novosibirsk Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Mehta) Duke University Medical Center and Duke Clinical Research
Institute, Department of Internal Medicine and Cardiology, Durham, NC,
United States
(Music) Department of Cardio-Anaesthesiology, University Clinical Centre
Ljubljana, Ljubljana, Slovenia
(Rex) Department of Anaesthesiology, Campus Gasthuisberg, UZ Leuven,
Leuven, Belgium
(Riha) Cardiothoracic Anaesthesiology and Intensive Care, Department of
Anaesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Rudiger) Institute of Anaesthesiology, University Hospital of Zurich,
Zurich, Switzerland
(Salmenpera) Department of Anaesthesiology Intensive Care, Emergency and
Pain Medicine, Helsinki University Hospital, Helsinki, Finland
(Szudi) Department of Anaesthesiology and Intensive Care, Gottsegen Gyorgy
National Institute of Cardiology, Budapest, Hungary
(Tritapepe) Department of Anaesthesiology and Intensive Care Policlinico
Umberto I, La Sapienza University of Rome, Rome, Italy
(Wyncoll) Department of Critical Care, St. Thomas' Hospital, London,
United Kingdom
(Owall) Department of Cardiothoracic Surgery, Karolinska University
Hospital Solna, Stockholm, Sweden
Title
Preoperative and perioperative use of levosimendan in cardiac surgery:
European expert opinion.
Source
International Journal of Cardiology. 184 (1) (pp 323-336), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ireland Ltd
Abstract
In cardiac surgery, postoperative low cardiac output has been shown to
correlate with increased rates of organ failure and mortality.
Catecholamines have been the standard therapy for many years, although
they carry substantial risk for adverse cardiac and systemic effects, and
have been reported to be associated with increased mortality. On the other
hand, the calcium sensitiser and potassium channel opener levosimendan has
been shown to improve cardiac function with no imbalance in oxygen
consumption, and to have protective effects in other organs. Numerous
clinical trials have indicated favourable cardiac and non-cardiac effects
of preoperative and perioperative administration of levosimendan. A panel
of 27 experts from 18 countries has now reviewed the literature on the use
of levosimendan in on-pump and off-pump coronary artery bypass grafting
and in heart valve surgery. This panel discussed the published evidence in
these various settings, and agreed to vote on a set of questions related
to the cardioprotective effects of levosimendan when administered
preoperatively, with the purpose of reaching a consensus on which patients
could benefit from the preoperative use of levosimendan and in which kind
of procedures, and at which doses and timing should levosimendan be
administered. Here,we present a systematic reviewof the literature to
report on the completed and ongoing studies on levosimendan, including the
newly commenced LEVO-CTS phase III study (NCT02025621), and on the
consensus reached on the recommendations proposed for the use of
preoperative levosimendan. Copyright © 2015 The Authors.
Published by Elsevier Ireland Ltd.

<32>
Accession Number
604986270
Author
Liu Y.; Gao L.; Song Y.; Chen L.; Xue Q.; Tian J.; Wang Y.; Chen Y.
Institution
(Liu, Gao, Chen, Xue, Tian, Wang, Chen) Cardiology Department, Institute
of Geriatric Cardiology, General Hospital of People's Liberation Army, No.
28 Fuxing Road, Hai dian District, Beijing 100853, China
(Song) Tianjin Chest Hospital, Tianjin, China
Title
Efficacy and safety of limus-eluting versus paclitaxel-eluting coronary
artery stents in patients with diabetes mellitus: A meta-analysis.
Source
International Journal of Cardiology. 184 (1) (pp 680-691), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives: The relative efficacy and safety of limus-eluting
stent (LES) versus paclitaxel-eluting stent (PES) in DM patients remain
unclear. Methods: The PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials electronic databases were searched from January 2001 to
December 2013. Clinical trials that performed head-to-head comparisons of
LES versus PES implantation in patients with DM were considered for
inclusion. Results: This meta-analysis included 28 clinical trials
involving 23,678 patients: 9953 who underwent sirolimuseluting stent (SES)
implantation, 4209 underwent everolimus-eluting stent (EES) or
zotarolimus-eluting stent (ZES) implantation, and 9516 underwent PES
implantation. The short-term target lesion revascularization (TLR) rate
was significantly lower after SES implantation than after PES implantation
(3.6% vs 6.3%; odds ratio (OR): 0.659; P = 0.014), but there were no
significant differences in the rates of target vesel revascularization
(TVR), stent thrombosis (ST), myocardial infarction (MI), all-cause
mortality, or major adverse cardiac events (MACE). There were no
differences in the longer-termrates of TLR, TVR, ST,MI, all-cause
mortality, orMACE between SES versus PES. Second-generation LES (EES or
ZES) implantation resulted in lower rates of ST (2.1% vs 3.3%; OR: 0.586;
P < 0.001), MI (2.3% vs 4.1%; OR: 0.527; P = 0.001), and MACE (8.0% vs
10.3%; OR: 0.796; P = 0.007) than PES implantation. Conclusions: In
patients with DM, short- And longer-termMACE rates were similar after
first-generation LES and PES implantation. The second-generation LES may
be better than PES implantation in rates of ST,MI, and MACE. Copyright
© 2015 Elsevier Ireland Ltd. All rights reserved.

<33>
Accession Number
604986262
Author
Naganuma T.; Latib A.; Sgueglia G.A.; Menozzi A.; Castriota F.; Micari A.;
Cremonesi A.; De Felice F.; Marchese A.; Tespili M.; Presbitero P.;
Panoulas V.F.; Buffoli F.; Tamburino C.; Varbella F.; Colombo A.
Institution
(Naganuma, Latib, Colombo) EMO-GVM Centro Cuore Columbus, Interventional
Cardiology Unit, 48 Via M. Buonarroti, Milan 20145, Italy
(Naganuma, Latib, Colombo) Interventional Cardiology Unit, San Raffaele
Scientific Institute, Milan, Italy
(Castriota) GVM Care and Research, Interventional Cardiology Unit, Citta
di Lecce Hospital, Lecce, Italy
(Micari) GVM Care and Research, Interventional Cardiology Unit, Maria
Eleonora Hospital, Palermo, Italy
(Cremonesi) GVM Care and Research, Interventional Cardiology Unit, Maria
Cecilia Hospital, Cotignola, Italy
(De Felice) Interventional Cardiology Unit, Ospedale San Camillo, Rome,
Italy
(Marchese) GVM Care and Research, Interventional Cardiology Unit, Anthea
Hospital, Bari, Italy
(Tespili) Interventional Cardiology Unit, Ospedale Bolognini, Seriate,
Bergamo, Italy
(Presbitero) Istituto Clinico Humanitas, Interventional Cardiology Unit,
Rozzano, Milan, Italy
(Sgueglia) Interventional Cardiology Unit, Ospedale Santa Maria Goretti,
Latina, Italy
(Buffoli) Interventional Cardiology Unit, Ospedale di Mantova, Mantova,
Italy
(Panoulas, Tamburino) Division of Cardiology, University of Catania,
Ferrarotto Hospital, Catania, Italy
(Varbella) Interventional Cardiology Unit, Ospedale di Rivoli, Torino,
Italy
(Menozzi) Cardiology Department, Interventional Cardiology Unit, Ospedale
di Parma, Parma, Italy
Title
A 2-year follow-up of a randomized multicenter study comparing a
paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small
coronary vessels the BELLO study.
Source
International Journal of Cardiology. 184 (1) (pp 17-21), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives: A prospective, multi-center, randomized trial,
BELLO (Balloon Elution and Late Loss Optimization), showed that the
primary endpoint of in-stent (in-balloon) late loss was significantly less
with drug-eluting balloons (DEB) as compared with paclitaxel-eluting
stents (PES). At 6 months, DEB and PES were associated with similar rates
of angiographic restenosis, target lesion revascularization (TLR), and
major adverse cardiac events (MACE) defined as death, myocardial
infarction and target vessel revascularization. The aim of this study was
to report 2-year clinical outcomes after treatment of de novo small vessel
disease with DEB as compared with PES. Methods: A total of 182 patients
were enrolled and randomized to treatment with DEB (n=90) in 94 lesions or
PES (n= 92) in 98 lesions. The study endpoint was the incidence of MACE at
2-year follow-up. Results: Two-year follow-up was achieved in almost all
cases (97.8% in DEB group vs. 98.9% in PES group). There was a trend
towards a lower incidence of MACE in the DEB group as compared with the
PES group (14.8% vs. 25.3%; p= 0.08). TLR rates in the DEB group were
acceptable at 6 months, 1 year and 2 years and did not differ
significantly from the PES group (4.4% vs. 7.6%, p =0.37; 6.7% vs. 12.1%,
p =0.23; 6.8% vs. 12.1%, p =0.25, respectively). Conclusions: Our results
suggest that treatment of small vessel disease with a paclitaxel DEB is
associated with a trend for improved clinical outcomes as compared with
PES up to 2 years. Late catch-up phenomenon requiring repeat intervention
after treatment with DEB was not evident in this study. Copyright
© 2015 Elsevier Ireland Ltd. All rights reserved.

<34>
[Use Link to view the full text]
Accession Number
620564259
Author
Hu W.; Tong J.; Kuang X.; Chen W.; Liu Z.
Institution
(Hu, Kuang, Chen, Liu) Department of Cardiology, Second Clinical
Institute, Chongqing Medical University, Chongqing 400010, China
(Tong) Department of Respirology, Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
Title
Influence of proton pump inhibitors on clinical outcomes in coronary heart
disease patients receiving aspirin and clopidogrel.
Source
Medicine (United States). 97 (3) (no pagination), 2018. Article Number:
e9638. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Proton pump inhibitors (PPIs) are usually prescribed to protect
against gastrointestinal bleeding in patients on dual antiplatelet
therapy. This meta-Analysis reviewed clinical outcomes in patients taking
aspirin and clopidogrel, with and without concomitant PPIs to address
concerns of adverse reactions.Methods:We searched PubMed, Embase, and the
Cochrane Library for articles published between January 1, 2010 and April
11, 2017. The primary end points were major adverse cardiovascular events
and gastrointestinal bleeding. Secondary end points were myocardial
infarction, stent thrombosis, revascularization, cardiogenic death, and
all-cause mortality.Results:The meta-Analysis included 33,492 patients in
4 randomized controlled trials and 8 controlled observational studies.
Overall, patients taking PPIs had statistical differences in major adverse
cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI]
1.07-1.28); P = .001; I2 = 28.3%], gastrointestinal bleeding
[OR 0.58 (95% CI 0.36-0.92); P = .022; I2 = 80.6%], stent
thrombosis [OR 1.30 (95% CI 1.01-1.68); P = .041; I2 = 0%], and
revascularization [OR 1.20 (95% CI 1.04-1.38); P = .011; I2 =
5.1%], compared those not taking PPIs. There were no significant
differences in myocardial infarction [OR 1.03 (95% CI 0.87-1.22); P =
.742; I2 = 0%], cardiogenic death [OR 1.09 (95% CI 0.83-1.43);
P = .526; I2 = 0%], or all-cause mortality [OR 1.08 (95% CI
0.93-1.25); P = .329; I2 = 0%).Conclusions:Among the patients
taking aspirin and clopidogrel, the results indicated that the combined
use of PPIs increased the rates of major adverse cardiovascular events,
stent thrombosis, and revascularization. Copyright © 2018 the
Author(s).

<35>
[Use Link to view the full text]
Accession Number
620564128
Author
Tong J.; Yu Q.; Li C.; Shao X.; Xia Y.
Institution
(Tong, Yu, Li, Shao, Xia) Affiliated Hospital of Xuzhou Medical
University, Xuzhou, Jiangsu 221000, China
Title
Successful revascularization of noninfarct related artery with chronic
total occlusion among acute myocardial infarction patients.
Source
Medicine (United States). 97 (3) (no pagination), 2018. Article Number:
e9655. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Randomized trials and meta-Analyses demonstrated that chronic
total occlusion (CTO) in noninfarct related artery (n-IRA) was associated
with increased all-cause mortality. Recently, several observational
studies suggested that the successful revascularization of n-IRA with CTO
decreased all-cause mortality.Methods:A systematic search was performed in
Cochrane Controlled Trials Registry, PubMed, MEDLINE, and EMBASE databases
for relevant studies. Article assessing the prognostic role of
revascularization of n-IRA with CTO was enrolled in this meta-Analysis.
Data and characteristics of each study were extracted. A meta-Analysis was
performed to generate pooled odds ratio (OR) and 95% confidence intervals
(95% CIs) for outcomes. The primary outcome was major adverse cardiac
events (MACE). Beg funnel plot was used to evaluate publication
bias.Results:Four observational studies and one randomized controlled
trial involving 1083 patients were enrolled for analysis. Compared with
nonreperfusion, the successful percutaneous coronary intervention (PCI) of
n-IRA with CTO was related to decreased all-cause mortality (OR was 0.34,
and 95% CI was 0.2-0.59; P = .0001).Conclusions:Successful PCI of n-IRA
with CTO could significantly decrease all-cause mortality, cardiac
mortality, MACE, and stroke in acute myocardial infarction patients. In
addition, it was not associated with the increased risk of repeat
revascularization and myocardial infarction. Copyright © 2018 the
Author(s).

<36>
Accession Number
620929212
Author
Ma Q.-Q.; Fan X.-D.; Li T.; Hao Y.-Y.; Ma F.
Institution
(Ma, Li, Hao, Ma) Department of Cardiology, Xi'an Central Hospital, Xi'an,
Shaanxi Province, China
(Fan) Department of Infectious Diseases, First Affiliated Hospital of
Xi'an Jiao Tong University, Xi'an, Shaanxi Province, China
Title
Short- and long-term prognostic value of hyponatremia in patients with
acute coronary syndrome: A systematic review and metaanalysis.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0193857. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Hyponatremia is relevant to heart failure, liver cirrhosis and stroke, but
the prognostic value of serum sodium levels in patients with acute
coronary syndrome are still unclear. So we did a systematic review and
meta-analysis to assess the prognostic value of hyponatremia on adverse
events in patients after ACS. We systematically searched PubMed, Embase
and Cochrane Library to find literatures which studied the prognostic
value of hyponatremia in patients with ACS. Our main endpoints were the
all-cause mortality and heart failure in the short- and long-term. Of 369
identified studies, 20 studies were included in our analysis. Compared
with the normal natrium, hyponatremia was significantly associated with
the increased risks of all-cause mortality within 30 days (RR: 2.18;
95%CI: 1.96-2.42) and during the follow-ups (HR: 1.74; 95%CI: 1.56-1.942).
For the second endpoint of short- and long-term heart failure, the pooled
effect sizes in hyponatremia patients were 1.72(95%CI: 1.38-2.14) and
1.69(95%CI: 1.12-2.55) respectively. In conclusion, hyponatremia has a
significant prognostic value for short- and long-term adverse event in
patients after ACS, the dynamic monitoring of serum sodium levels may
could help physicians to identify high risk ACS patients and to stratify
risk for optimal management. Copyright © 2018 Ma 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.

<37>
Accession Number
620719429
Author
Jia X.; Alam M.; Ye Y.; Bajaj M.; Birnbaum Y.
Institution
(Jia, Alam, Birnbaum) The Section of Cardiology, Department of Medicine,
Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United
States
(Ye) The Department of Biochemistry and Molecular Biology, University of
Texas Medical Branch, Galveston, TX, United States
(Bajaj) Endocrinology and Diabetes Division, Department of Medicine,
Baylor College of Medicine, Houston, TX, United States
Title
GLP-1 Receptor Agonists and Cardiovascular Disease: a Meta-Analysis of
Recent Cardiac Outcome Trials.
Source
Cardiovascular Drugs and Therapy. 32 (1) (pp 65-72), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The aim of this study is to examine the cardioprotective
properties of Glucagon-like peptide-1 receptor agonist, a class of
antihyperglycemic therapy, via meta-analysis of four recently published
cardiovascular outcomes trials. Methods: Meta-analysis was performed
pooling data from the ELIXA, LEADER, SUSTAIN-6 and EXSCEL trials. A random
effects model was used to generate risk ratio with 95% confidence interval
for cardiovascular and safety outcomes. Results: A total of 33,457
patients were included in the meta-analysis. Based on the study, GLP-1R
agonists significantly reduced all-cause mortality (RR 0.89; 95% CI 0.82
to 0.96) and cardiovascular mortality (RR 0.88; 95% CI 0.80 to 0.97) when
compared to placebo. When long-acting agents were analyzed alone,
reduction in major adverse cardiac events (RR 0.88; 95% CI 0.81 to 0.97)
and non-fatal strokes (RR 0.87; 95% CI 0.76 to 0.99) also showed
significance. Conclusion: Overall, GLP-1R agonists appear to have
cardioprotective properties likely via modification of metabolic
parameters such as glycemic control, weight loss, and improvement in blood
pressure. Additional studies are warranted to compare cardiovascular
outcomes among the different agents. Copyright © 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<38>
Accession Number
621265327
Author
Ghanem M.; Meyer F.; Schoeder V.; Ignatov A.; Fadel M.; Halloul Z.
Institution
(Ghanem) University Hospital at Magdeburg, Division of Vascular Surgery,
Dept. of General,Abdominal,Vascular and Transplant Surgery, Magdeburg,
Germany
(Meyer) Universitatsklinikum Magdeburg A.O.R.,Gefas- und
Schlaganfallzentrum, Arbeitsbereich Gefaschirurgie, Klinik fur
Allgemein-,Viszeral- and Gefaschirurgie, Magdeburg, Germany
(Schoeder) University Hospital at Magdeburg, Inst. of Pathology,
Magdeburg, Germany
(Ignatov) University Hospital at Magdeburg, Dept. of Gynecology and
Obstetrics, Magdeburg, Germany
(Fadel) Mohammad, Fadel, Magdeburg, Germany
(Halloul) Uniklinik Magdeburg, Magdeburg, Germany
Title
Intravascular (post-hyterectomy) leiomyoma (IVL) as late tumor thrombus
within the inferior vena cava (IVC) - A rare case primarily imposing as
IVC thrombus'originating from left renal vein after former left
nephrectomy Status (case report & review of literature).
Source
Oncology Research and Treatment. Conference: 33. Deutscher Krebskongress,
DKK. Germany. 41 (Supplement 1) (pp 171-172), 2018. Date of Publication:
February 2018.
Publisher
S. Karger AG
Abstract
Introduction: Intravascular leiomyoma is a rare type of myoma. It was
firstly described by Birch-Hirschfeld in 1896, however, its intracardiac
subtype was firstly reported by Durck in 1907. Most patients are
asymptomatic. The tumor invades mostly the tributaries of the inferior
vena cava (IVC) with upward extension that may approach the intracardiac
space. Aim & Method: By means of a scientific case report, a patient with
the very rare diagnosis of an endocaval leiomyoma thrombus post
hysterectomy is described based on the clinical experiences obtained in
the specific case management and selective references from the literature.
Case presentation: A 48-years old female was diagnosed with intravascular
tumor growth within the IVC with intracardiac extension using chest and
abdominal CT scan, ECG and echocardiography which was approached by an
interdisciplinary (vascular and cardiothoracic) surgical intervention
including heart-lung machine with favorable postoperative result (R0
resection status with mid-term outcome, no recurrent tumor growth).
Histopathological investigation diagnosed leiomyoma origin already from
ovarian vein most likely in context to the former hysterectomy (3 years
ago). Discussion & conclusion: Intravascular leiomyoma is a benign tumor
with invasive tendency, which can be considered a diagnostic and
therapeutic challenge. It should be thoroughly investigated to be planned
for a radical surgical removal. By possible adherence to the
intraabdominal or -thoracic organs, an interdisciplinary and eventually
step-wise surgical approach (combining vascular, abdominal, thoracic and
heart surgery as well as gynecology and urology), which can be demanding,
is recom mended to be seriously considered to i) reliably achieve R0
resection status and, thus, ii) provide best outcome and prognosis.

<39>
Accession Number
621227668
Author
Lira R.; Akerman S.; Klinge B.; Bostrom E.A.; Gustafsson A.
Institution
(Lira, Klinge, Bostrom, Gustafsson) Karolinska Institutet, Department of
Dental Medicine, Division of Oral Diseases, Stockholm, Sweden
(Lira) Rio de Janeiro State University, Faculty of Odontology, Department
of Periodontology, Rio de Janeiro, Brazil
(Akerman) Malmo University, Faculty of Odontology, Department of Orofacial
Pain and Jaw Function, Malmo, Sweden
(Klinge) Malmo University, Faculty of Odontology, Department of
Periodontology, Malmo, Sweden
Title
Salivary microbial profiles in relation to age, periodontal, and systemic
diseases.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0189374. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Analysis of saliva is emerging as a promising tool to diagnose
and monitor diseases which makes determination of the salivary microbial
profile in different scenarios essential. Objective: To evaluate the
effects of age, periodontal disease, sex, smoking, and medical conditions
on the salivary microbial profile. Design: A randomly selected sample of
441 individuals was enrolled (51% women; mean age 48.5 +/-16.8).
Participants answered a health questionnaire and underwent an oral
examination. Stimulated saliva was collected and the counts of 41 bacteria
were determined by checkerboard DNA-DNA hybridization. Results: Elderly
participants (> 64 years old) presented a significant increase in 24 out
of 41 bacterial species compared to adults (<= 64 years old). Eubacterium
nodatum, Porphyromonas gingi-valis, and Tannerella forsythia were
significantly higher in participants with generalized bone loss compared
to without. Males and non-smokers had higher bacteria counts in saliva.
Individuals having mental disorders or muscle and joint diseases showed
significantly altered microbial profiles whereas small or no differences
were found for subjects with high blood pressure, heart disease, previous
heart surgery, bowel disease, tumors, or diabetes. Conclusion: Age,
periodontal status, sex, smoking, and certain medical conditions namely,
mental disorders and muscle and joint diseases, might affect the microbial
profile in saliva. Copyright © 2018 Lira-Junior 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.

<40>
Accession Number
621226796
Author
Hueb T.; Rocha M.S.; Siqueira S.F.; Nishioka S.A.D.; Peixoto G.L.; Saccab
M.M.; Lima E.G.; Garcia R.M.R.; Ramires J.A.F.; Kalil Filho R.; Filho M.M.
Institution
(Hueb, Rocha, Siqueira, Nishioka, Peixoto, Saccab, Lima, Garcia, Ramires,
Kalil Filho, Filho) Clinical Division, Heart Institute (InCor) of the
University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, Sao Paulo,
SP 05403-000, Brazil
Title
Impact of diabetes mellitus on ischemic cardiomyopathy. Five-year
follow-up. REVISION-DM trial.
Source
Diabetology and Metabolic Syndrome. 10 (1) (no pagination), 2018. Article
Number: 19. Date of Publication: 15 Mar 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients with ischemic cardiomyopathy and severe left
ventricular dysfunction have a worse survival prognosis than patients with
preserved ventricular function. The role of diabetes in the long-term
prognosis of this patient group is unknown. This study investigated
whether the presence of diabetes has a long-term impact on left
ventricular function. Methods: Patients with coronary artery disease who
underwent coronary artery bypass graft surgery, percutaneous coronary
intervention, or medical therapy alone were included. All patients had
multivessel disease and left ventricular ejection fraction measurements.
Overall mortality, nonfatal myocardial infarction, stroke, and additional
interventions were investigated. Results: From January 2009 to January
2010, 918 consecutive patients were selected and followed until May 2015.
They were separated into 4 groups: G1, 266 patients with diabetes and
ventricular dysfunction; G2, 213 patients with diabetes without
ventricular dysfunction; G3, 213 patients without diabetes and ventricular
dysfunction; and G4, 226 patients without diabetes but with ventricular
dysfunction. Groups 1, 2, 3, and 4, respectively, had a mortality rate of
21.6, 6.1, 4.2, and 10.6% (P <.001); nonfatal myocardial infarction of
5.3,.5, 7.0, and 2.6% (P <.001); stroke of.40,.45,.90, and.90% (P = NS);
and additional intervention of 3.8, 11.7, 10.3, and 2.6% (P <.001).
Conclusion: In this sample, regardless of the treatment previously
received patients with or without diabetes and preserved ventricular
function experienced similar outcomes. However, patients with ventricular
dysfunction had a worse prognosis compared with those with normal
ventricular function; patients with diabetes had greater mortality than
patients without diabetes. Trial registration
http://www.controlled-trials.com. Registration Number:
ISRCTN66068876. Copyright © 2018 The Author(s).

<41>
[Use Link to view the full text]
Accession Number
621052369
Author
Potena L.; Pellegrini C.; Grigioni F.; Amarelli C.; Livi U.; MacCherini
M.; Masciocco G.; Faggian G.; Lilla Della Monica P.; Gerosa G.; Marraudino
N.; Corda M.; Boffini M.; De Santo L.S.; Tona F.; Poggio D.; Savini C.;
Ambrogi F.; Bernazzali S.; D'Armini A.M.; Mattiucci G.; Rinaldi M.;
Ribezzo M.; Porcu M.; Musumeci F.; Gambino A.; Maiello C.; Frigerio M.;
Guzzi G.; Forni A.; Capone G.
Institution
(Potena, Grigioni, Savini) Heart and Lung Transplant Program,
Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, Building
21, via Massarenti, 9, Bologna 40138, Italy
(Pellegrini, D'Armini, Mattiucci) Cardiac Surgery Department, University
of Pavia-Hospital Policlinico, San Matteo, Pavia, Italy
(Amarelli, Maiello) Transplant Surgery Department, Hospitals
Colli-Monaldi, Naples, Italy
(Livi, Guzzi) Cardiothoracic Surgery Department, Academic Hospital S.
Maria della Misericordia, Udine, Italy
(MacCherini, Bernazzali) Heart Transplant Surgery Unit, Academic Hospital
Senese, Siena, Italy
(Masciocco, Frigerio) Cardiology 2-Cardiac Insufficiency and
Transplantation Department, Academic Hospital Niguarda, Milan, Italy
(Faggian, Forni) Cardiac Surgery Unit, Academic Hospital Civile Maggiore,
Verona, Italy
(Lilla Della Monica, Musumeci) Cardiac Surgery Unit, Hospital San Camillo
Forlanini, Rome, Italy
(Gerosa, Poggio, Gambino) Cardiac Surgery Unit, Academic Hospital of
Padova, Padua, Italy
(Marraudino, Capone) Cardiac Surgery Unit, Hospital of Bari, Bari, Italy
(Corda, Porcu) Cardiology Unit, Hospital G. Brotzu, San Michele, Cagliari,
Italy
(Boffini, Rinaldi, Ribezzo) Cardiac Surgery Unit, Hospital Molinette,
Turin, Italy
(De Santo) Hospital Monaldi, Naples, Italy
(Tona) Hospital of Monza, Monza, Italy
(Ambrogi) University of Milan, Milan, Italy
Title
Optimizing the Safety Profile of Everolimus by Delayed Initiation in de
Novo Heart Transplant Recipients: Results of the Prospective Randomized
Study EVERHEART.
Source
Transplantation. 102 (3) (pp 493-501), 2018. Date of Publication: 01 Mar
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Although everolimus potentially improves long-term heart
transplantation (HTx) outcomes, its early postoperative safety profile had
raised concerns and needs optimization. Methods This 6-month, open-label,
multicenter randomized trial was designed to compare the cumulative
incidence of a primary composite safety endpoint comprising wound healing
delays, pericardial effusion, pleural effusion needing drainage, and renal
insufficiency events (estimated glomerular filtration rate <=30/mL/min per
1.73 m2) in de novo HTx recipients receiving immediate
everolimus (EVR-I) (<=144 hours post-HTx) or delayed everolimus (EVR-D)
(4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with
reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven
rejection >= 2R, rejection with hemodynamic compromise, graft loss, or
death was the secondary composite efficacy endpoint. Results Overall, 181
patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms.
Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm
(44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial
effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal
insufficiency events, and pleural effusion occurred at similar frequencies
in the study arms. Efficacy failure was not significantly different in
EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in
the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically
significant adverse events leading to discontinuation was higher in EVR-I
arm versus EVR-D arm (P = 0.02). Conclusions Compared with immediate
initiation, delayed everolimus initiation appeared to provide a clinically
relevant early safety benefit in de novo HTx recipients, without
compromising efficacy. Copyright © 2017 The Author(s). Published
by Wolters Kluwer Health, Inc.

<42>
Accession Number
605198320
Author
Xu N.; Yu M.; Liu X.; Sun C.; Chen Z.; Liu Z.
Institution
(Xu, Liu, Sun, Chen, Liu) Department of Orthopaedics, Peking University
Third Hospital, 49 Huayuan North Road, Beijing 100191, China
(Yu) Peking University Spine Institute, 38 Xueyuan Road, Beijing 100191,
China
Title
A systematic review of complications in thoracic spine surgery for
ossification of the posterior longitudinal ligament.
Source
European Spine Journal. 26 (7) (pp 1803-1809), 2017. Date of Publication:
01 Jul 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: To answer two questions: (1) what are the common complications
associated with surgery for thoracic myelopathy caused by ossification of
the posterior longitudinal ligament, and (2) which surgical approach is
safer with regard to the incidence of post-operative complications.
Methods: Relevant literature searches were performed using the Cochrane
Central Register of Controlled Trials, PubMed, EMBASE, the Chinese
Biomedical Literature Database, the China National Knowledge
Infrastructure, KoreaMed, and the Japan CentraRevuoMedicina. Results: 15
studies met the inclusion criteria and were retrieved. They included a
total of 595 patients, 39 % of whom were male and 61 % female. The mean
patient age ranged from 52.6 to 60.9 years. The mean recovery rate from
each individual study varied between 24.7 and 77.6 % and the pooled
neurologic function recovery rate was 50.4 %. From these 15 studies, the
mean complication rate was 39.4 %. By far, two complications were more
common than the others: cerebrospinal fluid leakage (incidence rate 22.5
%) and post-operative neurologic deficit (incidence rate 13.9 %). 7.7 % of
patients from the indirect decompression group experienced cerebrospinal
fluid leakage, while it was reported in 25.6 % of those in the direct
decompression group. Neurologic deficit was reported in 8.4 % of patients
undergoing indirect decompression and 19.8 % of those undergoing direct
decompression. Conclusions: Cerebrospinal fluid leakage and neurologic
deficit were the two most common complications following surgical
decompression of the thoracic spine with ossification of the posterior
longitudinal ligament. Patients undergoing indirect decompression
surgeries had significantly lower complication rates compared with those
undergoing direct decompression surgeries. Copyright © 2015,
Springer-Verlag Berlin Heidelberg.

<43>
[Use Link to view the full text]
Accession Number
612823614
Author
Pollmann A.G.E.; Frederiksen M.; Prescott E.
Institution
(Pollmann, Frederiksen, Prescott) Department of Cardiology, Bispebjerg
Hospital, University of Copenhagen, Bldg 67, Bispebjerg Bakke 23,
Copenhagen DK-2400, Denmark
Title
Cardiac Rehabilitation after Heart Valve Surgery: IMPROVEMENT in EXERCISE
CAPACITY and MORBIDITY.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 37 (3) (pp
191-198), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart
valve surgery is scarce, but nevertheless CR is recommended for this group
of patients. Therefore, this study assessed the effect of CR on exercise
capacity, cardiovascular risk factors, and long-term mortality and
morbidity, as well as predictors for enrolment in or failing to complete
CR. METHODS: A review of medical records identified 250 patients who
underwent heart valve surgery between January 2009 and August 2013. Of
these, 211 patients eligible for CR were identified. Effect of CR was
assessed by peak oxygen uptake (o<inf>2</inf> <inf>peak</inf>) or 6-minute
walk test (6MWT). A composite endpoint of all-cause mortality and hospital
admission due to myocardial infarction, stroke, heart failure,
endocarditis, revascularization, or reoperation was used to assess the
hazard ratio between CR attenders and nonattenders. Multivariable logistic
regression was used to find predictors for CR attendance and CR
completion. RESULTS: A total of 146 patients completed CR. o<inf>2</inf>
<inf>peak</inf> improved by 16% from 21.6 to 24.8 mL/kg/min (P <.0001) and
6MWT distance by 13% from 349 to 393 m (P =.0016). Rate of clinical events
was higher among nonattenders with an adjusted hazard ratio of 2.46 (95%
CI, 1.26-4.80). Age >75 years was predictive for not attending (adjusted
OR, 2.99; 95% CI,.37-6.53), whereas ethnic minorities were less likely to
complete CR (adjusted OR, 4.88; 95% CI, 1.58-15.06). CONCLUSIONS: CR after
heart valve surgery improved exercise capacity and was associated with
reduced morbidity. Elderly and ethnic minorities were less likely to
attend or complete CR and deserve special attention. Copyright ©
2017 Wolters Kluwer Health, Inc. All rights reserved.

<44>
Accession Number
620537856
Author
Mingxing F.; Landoni G.; Zangrillo A.; Monaco F.; Lomivorotov V.V.; Hui
C.; Novikov M.; Nepomniashchikh V.; Fominskiy E.
Institution
(Mingxing, Hui) Department of Intensive Care, The Third Hospital, Hebei
Medical University, Shijiazhuang, Hebei Province, China
(Landoni, Zangrillo, Monaco, Fominskiy) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Milan,
Italy
(Lomivorotov, Nepomniashchikh, Fominskiy) Department of Anesthesia and
Intensive Care, Siberian Biomedical Research Center of the Ministry of
Health, Novosibirsk, Russian Federation
(Novikov) Department of Anesthesia and Intensive Care, Medical Center of
Saint-Petersburg State University, Saint-Petersburg, Russian Federation
Title
Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 762-770),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: There is experimental evidence that phosphocreatine (PCr) can
decrease ischemia/reperfusion injury of the heart. The authors
investigated if PCr would improve heart performance as compared with
standard treatment in cardiac surgery. Design: Meta-analysis of randomized
controlled trials. Setting: Hospitals. Participants: Adult and pediatric
patients undergoing cardiac surgery. Interventions: The ability of PCr to
improve cardiac outcomes as compared with standard treatment was
investigated. Measurements and Main Results: PubMed/Medline, Embase,
Scopus, Cochrane Library, China National Knowledge Infrastructure,
WANGFANG DATA, and VIP Paper Check System were searched to March 1 2017.
The authors included 26 randomized controlled trials comprising 1,948
patients. Random and fixed-effects models were used to estimate odds ratio
(OR) and mean difference (MD) with 95% confidence interval (CI). PCr use
was associated with reduced rates of intraoperative inotropic support (27%
v 44%; OR 0.47, 95% CI 0.35-0.61; p < 0.001), major arrhythmias (16% v
28%; OR 0.44, 95% CI 0.27-0.69; p < 0.001), as well as increased
spontaneous recovery of the cardiac rhythm immediately after aortic
declamping (50% v 34%; OR 2.45, 95% CI 1.82-3.30; p < 0.001) as compared
with standard treatment. The use of PCr decreased myocardial damage and
augmented left ventricular ejection fraction in the postoperative period;
however, MD for these outcomes were small and do not seem to be clinically
significant. Conclusions: In randomized trials, PCr administration was
associated with reduced rates of intraoperative inotropic support and
major arrhythmias, and increased spontaneous recovery of the cardiac
rhythm after aortic declamping. Large multicenter evidence is needed to
validate these findings. Copyright © 2017 Elsevier Inc.

<45>
Accession Number
619185339
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Title
Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 731-738),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: Adjustment in the doses of opioids has been a focus of interest
for achieving better fast-track conditions in cardiac anesthesia, but
relatively sparse information exists on the potential effect of
psychologic and behavioral factors, such as stress, anxiety, and type of
personality, on anesthesia requirements and patient turnover in the
cardiac recovery unit (CRU); to the authors' knowledge, this particular
focus has not been systematically investigated. In this randomized study,
the authors tested the hypothesis that low-dose sufentanil, compared with
a standard dose, can improve fast-track parameters and the overall quality
of recovery. Opioid requirements related to personality type, pain
sensitivity, and preoperative stress and anxiety also were assessed.
Design: A randomized, prospective study. Participants: The study comprised
60 patients scheduled for elective coronary artery bypass grafting with or
without aortic valve replacement. Setting: A university hospital.
Interventions: Patients were randomly assigned to receive either a
standard dose (bolus 0.5 micro g/kg) or low dose (bolus 0.25
micro g/kg) of sufentanil combined with propofol. Measurements and
Main Results: The primary outcome variables were ventilation time and
eligible time to discharge from the CRU. The secondary objective was to
evaluate the relationship between opioid requirements and personality
type, pain sensitivity, and preoperative stress and anxiety. The groups
were comparable in selected demographics and perioperative parameters.
There was no difference between groups in ventilation time (low dose: 191
[163-257] v standard dose: 205 [139-279] min; p = 0.405); eligible CRU
discharge time (10.3 +/- 5.0 v 10.3 +/- 4.2 h; p = 0.978); or
administration of postoperative morphine (25 [11-34) v 27 [10-39] g; p =
0.790). There was no difference between groups in total sufentanil
administration and various preoperative psychologic and behavioral test
levels nor in the time to reach bispectral index <50 during induction,
except that personality type A demonstrated a longer induction time of 10
(8-12) minutes versus 6 (4-8) minutes in low-score patients. Conclusion: A
lower dose of sufentanil, compared with a standard dose, does not enhance
fast-track conditions significantly. Copyright © 2017 Elsevier
Inc.

<46>
Accession Number
619361263
Author
D'Ercole F.; Arora H.; Kumar P.A.
Institution
(D'Ercole, Arora, Kumar) Department of Anesthesiology, University of North
Carolina School of Medicine, Chapel Hill, NC, United States
(Arora, Kumar) Outcomes Research Consortium, Cleveland, OH, United States
Title
Paravertebral Block for Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 915-927),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Local anesthetic injected into a wedge-shaped space lateral to the spinal
nerves as they emerge from the intervertebral foramina produces
somatosensory and sympathetic nerve blockade effective for anesthesia and
for managing pain of unilateral origin from the chest and abdomen.
Paravertebral blockade (PVB) is versatile and may be applied unilaterally
or bilaterally. Unlike thoracic epidural, the PVB technique may be used to
avoid contralateral sympathectomy, thereby minimizing hypotension and
leading to better preservation of blood pressure. There are no reports on
systemic toxicity associated with bilateral PVB despite the need for
relatively large doses of local anesthetics. This review includes an
important historic background and captures the resurgence of PVB-an almost
lost technique. Thoracic PVB provides post-thoracotomy pain relief
comparable with thoracic epidural analgesia (TEA) with lower side effects
supported by moderate-quality evidence. The feasibility and potential of
bilateral thoracic PVB for bilateral thoracic surgery appear practical.
However, there is existing controversy in the assumption that thoracic PVB
is a satisfactory, safer alternative when anticoagulation status is a
contraindication to thoracic epidural placement. During the last 2 decades
of systematic reviews and meta-analyses, both TEA and PVB have been deemed
appropriate in the management of thoracic surgery. A multimodal approach
to analgesia includes regional techniques for thoracic surgery that may
reduce the likelihood of the development of postoperative complications
and chronic pain. Purpose of This Review: The authors evaluated current
opinion, clinical practice, new multimodal adjuvants, regional anesthesia,
and innovation and technology related PVB in the thoracic surgery patient
population. The review focuses on history, techniques, application, ease
of placement, and relative safety of this regional technique. For this
review, studies and reference lists were retrieved from the Cochrane
library, Embase, and Medline from January 1995 through January 2017.
Existing evidence demonstrates noninferiority of thoracic PVB compared
with TEA for postoperative analgesia, with fewer side effects for
unilateral and bilateral thoracic surgery, including video-assisted
thoracoscopy. The determining factors in selecting the regional technique
of choice include the following: (1) tolerance of side effects associated
with TEA, (2) consensus on best practice or technique, and (3) operator
experience. There is no consensus on the optimal approach for thoracic PVB
technique or any standardization when comparing the landmark,
ultrasound-guided, or stimulation-based PVB approaches. Moreover, the
efficacy of TEA compared with PVB in preventing post-thoracotomy chronic
pain syndrome has not been investigated thoroughly and requires future
clinical trials. Copyright © 2017 Elsevier Inc.

<47>
Accession Number
618953020
Author
Arora S.; Vaidya S.R.; Strassle P.D.; Misenheimer J.A.; Rhodes J.A.; Ramm
C.J.; Wheeler E.N.; Caranasos T.G.; Cavender M.A.; Vavalle J.P.
Institution
(Arora, Misenheimer, Ramm, Cavender, Vavalle) Division of Cardiology,
University of North Carolina, Chapel Hill, NC 27599-7075, United States
(Vaidya) Division of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC 28304, United States
(Strassle) Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC 27599-7400, United
States
(Strassle, Caranasos) Department of Surgery, UNC School of Medicine,
Chapel Hill, NC 27599-7050, United States
(Misenheimer) Division of Cardiology, The Medical College of Georgia at
Augusta University, Augusta, GA 30912, United States
(Rhodes, Wheeler) Campbell University School of Osteopathic Medicine,
Lillington, NC 27546, United States
Title
Meta-analysis of transfemoral TAVR versus surgical aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. 91 (4) (pp 806-812),
2018. Date of Publication: 01 Mar 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was
shown to have lower risks of death or disabling strokes as compared to
SAVR, whereas the outcomes with transthoracic TAVR were comparable with
SAVR. Methods: We searched PubMed, EMBASE, Web of Science, and Google
Scholar for all comparison studies between TAVR and SAVR and mortality as
an outcome, irrespective of surgical risk. Randomized controlled trials
and propensity-score-matched cohort studies that used a transfemoral
approach exclusively or stratified results by route of access and reported
data for TF-TAVR patients were eligible for inclusion. Outcomes of
interest included 30-day and 1-year mortality, and 30-day complications.
If significant heterogeneity was found in the random effects
meta-analyses, a sensitivity analysis which individually removed each
study was conducted. Results: Seven studies reported results on TF-TAVR.
Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95%
CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day
risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was
associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI
0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and
myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher
incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and
pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions: TF-TAVR
is associated with lower 30-day risks of myocardial infarction compared to
SAVR. Further studies are required to investigate the role of myocardial
injury on overall TF-TAVR outcomes. Copyright © 2017 Wiley
Periodicals, Inc.

<48>
Accession Number
620559205
Author
Ikram A.; Mohiuddin H.; Zia A.; Siddiqui H.U.; Javadikasgari H.;
Koprivanac M.; Raza S.; Zafar A.
Institution
(Ikram, Zafar) Department of Neurology, University of New Mexico,
Albuquerque, NM, United States
(Mohiuddin, Zia) Department of Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Siddiqui, Javadikasgari) Department of Thoracic & Cardiovascular Surgery,
Cleveland Clinic, Cleveland, OH, United States
(Koprivanac) Department of Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Raza) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
Title
Does epiaortic ultrasound screening reduce perioperative stroke in
patients undergoing coronary surgery? A topical review.
Source
Journal of Clinical Neuroscience. 50 (pp 30-34), 2018. Date of
Publication: April 2018.
Publisher
Churchill Livingstone
Abstract
Although the occurrence of stroke in patients undergoing coronary artery
bypass grafting (CABG) is decreasing, it remains an important concern.
Therefore, it is important to identify and adopt strategies that can
decrease the incidence of stroke in these patients. One of the strategies
that have demonstrated the potential to decrease the rate of post-CABG
stroke is an assessment of aorta for atherosclerosis before surgery and
changing the surgical plan accordingly to minimize the stroke risk. This
assessment can be done through palpation of the aorta, transesophageal
echocardiography (TEE), and epiaortic ultrasound scanning (EAS). EAS has
shown superiority over both palpation and TEE for intraoperative
evaluation of aorta. However, despite the evidence demonstrating reduced
stroke rates with the EAS-guided approach, EAS is not yet the standard of
care procedure in patients undergoing CABG. Therefore, we have reviewed
the literature for evidence that supports the routine use of EAS in
patients undergoing coronary surgery and have presented solutions to
overcome the barriers to its routine use. Copyright © 2018
Elsevier Ltd

<49>
Accession Number
621246821
Author
Alrifai A.; Soud M.; Kabach A.; Jobanputra Y.; Alraies M.C.; Fanari Z.
Institution
(Alrifai, Jobanputra) University of Miami, JFK Medical Center, Atlantis,
FL, United States
(Soud) MedStar Heart and Vascular Institute, Washington, DC, United States
(Kabach) Creighton University, School of medicine, Omaha, NE, United
States
(Alraies) MedStar Heart and Vascular Institute, MedStar Washington
Hospital Center, Washington, DC, United States
(Fanari) Heartland Cardiology, Wesley Medical Center, University of Kansas
School of Medicine, Wichita, KS, United States
Title
Dual antiplatelet therapy versus single antiplatlet therapy after
transaortic valve replacement: Meta-analysis.
Source
JACC: Cardiovascular Interventions. Conference: 21st Annual Conference on
Cardiovascular Research Technologies, CRT 2018. United States. 11 (4
Supplement 1) (pp S58), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc.
Abstract
BACKGROUND The current American College of Cardiology/American Heart
Association (ACC/AHA) recommends empirical therapy with dual antiplatelet
(DAPT) regimen of ASA and clopidogrel for six months after aortic valve
replacement (TAVR). This recommendation is based on the expert consensus
rather than clear clinical evidence. Given the lack of clear consensus on
treatment strategy for ischemic events prevention following TAVR, we
performed a meta-analysis of studies comparing aspirin based
mono-antiplatelet therapy (MAPT) with DAPT in patients who have undergone
TAVR. METHODS We performed a systematic review and meta-analysis from
randomized clinical trials (RCTs) and prospective studies that tested DAPT
vs. MAPT for all-cause mortality and major bleeding. The primary efficacy
outcomes were 30-days mortality and stroke. The primary safety outcomes
were major bleeding and major vascular complications. Secondary safety
outcomes included minor bleeding and minor vascular complications. RESULTS
The meta-analysis included 603 patients with 301 receiving MAPT and 302
receiving DAPT. The use of MAPT was associated with similar mortality
(MAPT 5.9% vs. the DAPT 6.6%; RR= 0.92; = 95% CI 0.49 to 1.71; P= 0.68) or
in major strokes (1.3% vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P=0.81).
MAPT was associated with significantly less risk of major bleeding (4.9%
vs. 14.5%; RR 0.37; 95% CI 0.20 to 0.70; P<0.01). However there was no
difference in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI
0.23 to 1.18; P=0.17), minor bleeding (4.2% vs. 3.6%; RR 1.16; 95% CI 0.43
to 3.10; P= 0.85) or minor vascular complication (4.2% vs. 7.3%; RR 0.58;
95% CI 0.25 to 1.34; P=0.14). CONCLUSION MAPT use post TAVR is associated
with lower risk of major bleeding comparing to DAPT with no significant
difference in mortality, stroke or vascular complications risk. (Figure
Presented).

<50>
Accession Number
621246816
Author
Wang T.-Y.; Gruberg L.; Kort S.; Butler J.; Jeremias A.; Chikwe J.; Parikh
P.B.
Institution
(Wang, Gruberg, Kort, Butler, Jeremias, Chikwe, Parikh) Stony Brook
University Medical Center, Stony Brook, NY, United States
Title
Impact of gender on mortality in adults undergoing transcatheter or
surgical aortic valve replacement: A systematic review and meta-analysis.
Source
JACC: Cardiovascular Interventions. Conference: 21st Annual Conference on
Cardiovascular Research Technologies, CRT 2018. United States. 11 (4
Supplement 1) (pp S57-S58), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc.
Abstract
BACKGROUND Limited data exists regarding gender differences in outcomes
following transcatheter (TAVR) and surgical aortic valve replacement
(SAVR). We sought to review the published data and perform a systematic
review to investigate differences in mortality between men and women
following TAVR and SAVR. METHODS We systematically searched Medline from
1972 to May 2017 for randomized trials and observational studies examining
the relationship between gender and mortality outcomes in patients
following TAVR or SAVR. Two authors selected studies and extracted data
independently. Studies were excluded if data regarding 30-day all-cause
mortality were not provided for both men and women. RESULTS There were 34
articles, a total of 41,089 patients, enrolled in our systematic review
and meta-analysis, including 22,894 men and 18,195 women. Of these 34
articles, 19 involved TAVR, 13 involved SAVR, and 2 involved both TAVR and
SAVR. Rates of 30-day all-cause mortality following TAVR was noted to be
similar in men and women [odds ratio (OR) 0.99, 95% confidence interval
(CI), 0.87 to 1.11]. Men had lower rates of 30-day all-cause mortality
following SAVR compared to women (OR 0.72, 95% CI, 0.62 to 0.83) (Figure).
CONCLUSIONS Female gender is associated with higher rates of mortality
following SAVR. No significant differences in mortality were noted in men
versus women following TAVR. (Figure Presented).

<51>
Accession Number
621246813
Author
Schmidt T.
Institution
(Schmidt) Asklepios Klinik St. Georg, Hamburg, Germany
Title
Debris heterogeneity across different valve types captured by a cerebral
protection system during TAVR.
Source
JACC: Cardiovascular Interventions. Conference: 21st Annual Conference on
Cardiovascular Research Technologies, CRT 2018. United States. 11 (4
Supplement 1) (pp S57), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc.
Abstract
BACKGROUND Differences of transcatheter heart valve (THV) types and
cerebral injury after TAVR are not well understood; therefore, this study
investigated differences between THV types and debris captured by a
cerebral embolic protection system (Claret Medical Sentinel, Santa Rosa,
CA). METHODS 246 patients pooled from two prospective studies (SENTINEL
IDE Trial n=100, SENTINEL-H trial n=146) were included in the analysis.
Histopathologic assessment and histomorphometric analyses of debris were
compared with THV types. Analyses were differentiated by particle size
(>=150mum, >=500mum, >=1000 mm), particle count (PC), total particle area
(TPA) and maximum of largest dimension (MOLD). Only commercially available
THVs were included: 16% Evolut R (EvR), 15% Lotus, 59% SAPIEN 3 (S3) and
10% SAPIEN XT (XT). RESULTS Particles were captured in 99% of patients.
There was a significantly higher debris related to the vascular bed (valve
tissue, arterial wall, calcification) in EvR patients compared to S3 pts.
53% of all patients irrespective of valve type had at least one particle
>=1mum. Larger particles (>=500mum and >=1000mum) were significantly more
frequent in EvR than XT and S3 patients. Lotus patients with particles
>=1000mum were significantly more frequent than in S3 patients. PC, TPA
and MOLD were significantly higher in both Lotus and EvR patients compared
to S3 and XT. CONCLUSIONS Debris was captured in 99% of patients, of whom
53% had at least one particle of debris >1mum. Embolic debris is universal
across valve types and supports the potential benefit of using cerebral
embolic protection in all TAVR procedures.

<52>
Accession Number
621246810
Author
Testa L.
Institution
(Testa) IRCCS Pol. S. Donato, Milan, Italy
Title
Cerebral protection during transcatheter aortic valve implantation: An
updated systematic review and meta-analysis.
Source
JACC: Cardiovascular Interventions. Conference: 21st Annual Conference on
Cardiovascular Research Technologies, CRT 2018. United States. 11 (4
Supplement 1) (pp S56), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc.
Abstract
BACKGROUND AND PURPOSE The use of embolic protection devices (EPD) may
theoretically reduce the occurrence of cerebral embolic lesions during
transcatheter aortic valve implantation (TAVI). Available evidence from
single studies is quite inconclusive. The aim of the present meta-analysis
was to assess the safety and efficacy profile of current EPD. METHODS
EMBASE, PubMed, Web of Science Core Collection, and the Cochrane Library
were searched up to October 2017 for studies that evaluated patients
undergoing TAVI with or without EPD. Endpoints of interest were 30-day
mortality, 30-day stroke, the total number of new lesions, the ischemic
volume per lesion, and the total volume of lesions. RESULTS Seven studies
involving 725 patients were included. The EPD delivery success rate was
reported in all studies and was achieved in 94.5% of patients. The use of
EPD was not associated with significant differences in terms of 30-day
mortality [OR 0.57 (0.19, 1.66), p=0.3] or stroke [OR 0.67 (0.35-1.29),
p=0.23]. Moreover, no differences were detected with respect to the number
of new lesions: [standardized mean difference -0.19; (-0.71 to 0.34);
P=0.49]. The use of EPD was associated with a significantly smaller
ischemic volume per lesion [standardized mean difference, -0.52; (-0.85 to
-0.20); P=0.002] and smaller total volume of lesions [standardized mean
difference, -0.23 (-0.42 to -0.03), P=0.02]. CONCLUSIONS The use of EPD is
not associated with a reduced rate of stroke, mortality and new ischemic
cerebral lesions. The use of EPD during TAVI is associated with smaller
volume of ischemic lesions and smaller total volume of ischemic lesions.
(Figure Presented).

<53>
Accession Number
621246718
Author
Erinne I.; Maheshwari V.; Parikh R.; Srivastava M.; Gupta A.
Institution
(Erinne, Maheshwari, Parikh, Srivastava, Gupta) University of Maryland
Medical Center, Baltimore, MD, United States
Title
Impact of spironolactone on heart failure readmission after transcatheter
aortic valve replacement.
Source
JACC: Cardiovascular Interventions. Conference: 21st Annual Conference on
Cardiovascular Research Technologies, CRT 2018. United States. 11 (4
Supplement 1) (pp S47), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc.
Abstract
BACKGROUND Thirty-day readmission rates are a performance benchmark in
contemporary evaluation of cardiovascular procedures. Trans-catheter
aortic valve replacement (TAVR) has been widely adopted since initial Food
and Drug Administration approval in 2011; however, re-admission rate
following TAVR remains high. Amongst cardiac etiologies for re-admission
post-TAVR, heart failure is the most common precipitant. In randomized
controlled trials, spironolactone has been shown to reduce heart failure
readmissions in patients with heart failure with reduced ejection fraction
(HFrEF) as well as with preserved EF (HFpEF). We sought to examine the
impact of spironolactone therapy on the rate of heart failure readmissions
in patients discharged after TAVR at our institution. METHODS We analyzed
all TAVR patients receiving balloon-expandable Sapien (Edwards
Lifesciences, Irvine, California) or self-expanding CoreValve (Medtronic,
Minneapolis, Minnesota) valves from March 2012 to April 2017 at the
University of Maryland Medical Center, Baltimore, MD. Patients discharged
from the hospital following the TAVR procedure were grouped into two
categories: those who received spironolactone (either prescribed prior to
the procedure and continued upon discharge or newly initiated on
spironolactone) and those who did not, based on physician discretion. The
primary outcome evaluated was 30-day readmission for heart failure.
RESULTS 270 patients who underwent TAVR (132 Sapien, 138 CoreValve) were
included for analysis. The mean age was 80.7 +/- 9.5 years, 52% were men,
89% were Caucasian race, and 24% were on spironolactone at time of
hospital discharge. A total of 52 (19%) patients were re-admitted within
30 days of discharge and among those, 21 (8%) were re-admissions for
decompensated heart failure. Of those re-admitted to the hospital with
heart failure, 9% were on spironolactone compared to 7% who were not
(p=0.65). CONCLUSION Our retrospective analysis did not demonstrate an
impact of spironolactone on the likelihood of readmission for heart
failure (both HFpEF and HFrEF sub-types) following TAVR. Further
prospective studies are required in order to assess clinical benefits of
adding post-procedure spironolactone.

<54>
Accession Number
621233036
Author
Virk S.; Bowman S.; Bannon P.; Saxena A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon, Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
(Bannon, Saxena) Discipline of Surgery, Sydney Medical School, Sydney,
Australia
Title
Aortic and mitral valve surgery performed by trainee surgeons: A
meta-analysis of clinical outcomes.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S310), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Cardiac surgical units must balance trainee education with
their duty to provide optimal patient care. This is particularly
challenging with valvular surgery, given the lower volume and increased
complexity of these procedures. The present meta-analysis was thus
conducted to assess the impact of trainee operator status on clinical
outcomes following valvular surgery. Methods: Medline, Embase and CENTRAL
databases were systematically searched for studies reporting clinical
outcomes according to the training status of the primary operator
(consultant or trainee). Data were extracted and meta-analysed according
to pre-defined endpoints. Results: Eleven observational studies met the
criteria for inclusion, reporting on five patient cohorts undergoing
mitral valve (MV) surgery (n = 3975), six undergoing aortic valve
replacement (AVR) (n = 6236) and three undergoing com-bined AVR and
coronary artery bypass grafting (CABG) (n = 3495). Perioperative mortality
was not significantly different between trainee and consultant cases for
MV surgery (odds ratio [OR] 0.92; 95% confidence interval [CI],
0.62-1.37), AVR (OR 0.67; 95% CI, 0.37-1.24), or combined AVR and CABG (OR
1.07; 95% CI, 0.40-2.85). The incidences of perioperative stroke,
myocardial infarction, arrhythmias, acute renal failure, reoperation or
wound infection were not signif-icantly different between trainee and
consultant cases. There was a paucity of mid-term survival data.
Conclusions: In the present meta-analysis, valvular surgery cases
performed primarily by trainees were not associated with adverse
perioperative outcomes. These findings suggest the rigorous design of
cardiac surgical trainee programs can sufficiently mitigate trainee
deficiencies. However, studies with longer follow-up duration are required
to assess long-term durability and safety.

<55>
Accession Number
621232876
Author
Wang T.; Wang M.; Glenie T.; El-Jack S.; Khan A.
Institution
(Wang) Auckland City Hospital, Auckland, New Zealand
(Wang, Glenie, El-Jack, Khan) North Shore Hospital, Auckland, New Zealand
(Wang, Wang) University of Auckland, Auckland, New Zealand
Title
Meta-analysis of randomised trials comparing percutaneous coronary
intervention versus coronary artery bypass grafting for severe left main
disease.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S217-S218), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: Coronary artery bypass (CABG) grafting is traditionally the
gold standard treatment for severe unprotected left main (LMS) coronary
artery disease, however percutaneous coronary intervention (PCI) for LMS
disease has gained popularity in recent years. This meta-analysis pooled
the outcomes of randomised trials comparing PCI and CABG for severe LMS
disease. Methods: We searched Medline, Embase and Cochrane from 1980 to 31
October 2016 for randomised trials of PCI versus CABG for severe LMS
disease for data extraction and subsequent pooled analyses using random
effects models. Results: Amongst 2,275 articles searched, 53 full-texts
were reviewed and 6 randomised trials totaling 4,706 patients were
included. Composite of death, myocardial infarction (MI) and stroke was
similar between PCI and CABG odds ratio 0.98 (95% confidence interval
0.81-1.20, P = 0.86), with no differ-ence in all-cause mortality (p =
0.91), myocardial infarction (p = 0.17) or stroke (p = 0.65). PCI did have
higher rates of repeat revascularisation 1.76 (1.02-1.53) and if this is
included also higher MACE 1.33 (1.15-1.54, p< 0.001). There were no
differences in all of the above individual endpoints at 30 days. Subgroup
analyses found no differences in MACE rates between the two treatment
modalities for elderlies >65 years of age, either sex, diabetics or all
tertiles of syntax scores. Conclusions: PCI had similar rates of death,
myocardial infarction, stroke and their composite during follow-up
compared to CABG, except for more repeat revascularisation required. PCI
therefore provides a viable alternative intervention for severe LMS
traditionally treated by CABG.

<56>
Accession Number
621232809
Author
White H.; Goodman S.; Schwartz G.; Bhatt D.; Bittner V.; Diaz R.; Hanotin
C.; Harrington R.; Jukema J.; Moryusef A.; Pordy R.; Roe M.; Sasiela W.;
Szarek M.; Tamby J.; Zeiher A.; Steg P.
Institution
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
(Goodman) University of Toronto, Toronto, Canada
(Schwartz) University of Colorado School of Medicine, Denver, United
States
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
(Bittner) University of Alabama at Birmingham, Birmingham, United States
(Diaz) Estudios Cardiologicos Latinoamerica, Rosario, Argentina
(Hanotin) Sanofi-Aventis Recherche et Developpement S.A, Paris, France
(Harrington) Stanford University, Stanford, United States
(Jukema) Leiden University Medical Centre, Leiden, Netherlands
(Moryusef, Tamby) Sanofi-Aventis Recherche et Developpement S.A,
Bridgewater, United States
(Pordy, Sasiela) Regeneron Pharmaceuticals, Tarrytown, United States
(Roe) Duke Clinical Research Institute, Durham, United States
(Szarek) State University, New York Downstate Medical Centre, Brooklyn,
United States
(Zeiher) Johann Wolfgang Goethe University, Frankfurt, Germany
(Steg) Assistance Publique-Hopitaux de Paris, INSERM U-1148, Universite
Paris Diderot, Paris, France
Title
Use of high-intensity statin therapy post-acute coronary syndrome in the
ongoing odyssey outcomes trial of alirocumab, a proprotein convertase
subtilisin/kexin type 9 monoclonal antibody, versus placebo: Interim
baseline data.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S304), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Despite intensive statin therapy after acute coronary
syndromes (ACS), the risk for recurrent cardiovascular (CV) events remains
high and related to low-density lipoprotein cholesterol (LDL-C) levels.
The ODYSSEY OUTCOMES trial tests the hypothesis that alirocumab, a fully
human monoclonal antibody to proprotein convertase sub-tilisin/kexin type
9 (PCSK9) that produces substantial and sustained LDL-C reductions,
improves CV outcomes after ACS. Methods: At 1,297 participating sites in
57 countries, 18,536 patients with recent ACS and not at optimal lipid
levels (LDL-C > 70 mg/dL [>1.81 mmol/L] or Non-HDL-C>100 mg/dL [>2.59
mmol/L] or ApoB>80 mg/dL >0.8g/L]) despite high-intensity (or maximally
tolerated) statin +/- other lipid modifying therapy have been randomised
to receive alirocumab or matching placebo. The interim baseline
characteristics of patients at randomisation (which is ongoing in China)
are described. Results: Patients (13,873 [75%] male; median [interquartile
range; IQR] age 58 [52-65]); median BMI 28 (25-31) kg/m2;
11,877 [64%] prior history of hypertension; 4,501 [24%] prior history of
diabetes mellitus; 4,449 [24%] current smokers) were randomised a median
(IQR) 2.6 (1.7-4.3) months after myocardial infarction (MI; 15,356, 83%)
or unstable angina (3,152, 17%). Prior to the index event, CV history
included MI (3,652, 20%) and coronary revascularisation (3,719,20%).
High-intensity statin (atorvastatin 40-80 mg, rosuvastatin 20-40 mg daily)
was used in 16,565 (89%) patients at randomisation and ~85% at 12 months.
Median (IQR) baseline LDL-C was 87(73-104) mg/dL [2.25 (1.89-2.69)
mmol/L]. Conclusions: ODYSSEY OUTCOMES has randomised a high-risk
population on intensive statin and guideline-based therapy and will
determine whether adding the PCSK9 antibody alirocumab reduces CV events
after ACS.

<57>
Accession Number
621232782
Author
Akbar Ladak L.; Gullick J.; Hasan B.; Gallagher R.
Institution
(Akbar Ladak, Gullick, Gallagher) University of Sydney, Sydney, Australia
(Hasan) Aga Khan University, Karachi, Pakistan
Title
Health related quality of life in children and young adults following
congenital heart disease surgery: A meta-analysis.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S323), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Health related quality of life (HRQOL) issues have become an
increasing focus in the congenital heart disease (CHD) population but the
findings are inconsistent. We aimed to conduct a meta-analysis to explore
HRQOL in CHD surgical children and young adults from both patients and
parental report and to identify its predictors. Method: Medline, CINAHL
and Embase were searched. Quantitative designs with samples of at least
80% surgical patients, mean age < 24 years and had their HRQOL assessed at
> 1 year following CHD surgery were included in the analysis. Gill and
Feinstein's 10 criteria were used for evaluating the studies. Data was
analysed in RevMan 5.3 using random model. Result: 21 studies were
included in the review which had utilised a generic and/or disease
specific questionnaire (DSQ) with 4033 patients (median = 113) and 3070
parents (median = 60). The quality appraisal score ranged from 0 to 6
(median 1). This meta-analysis revealed that the HRQOL was lower in CHD
compared to the healthy controls in all the domains for both self and
parental reports. Physical functioning had the largest standard mean
difference of-0.60 (CI-0.83,-0.36). DSQ highlighted better HRQOL in simple
compared to complex CHDs. Factors predictive of HRQOL postoperatively
included clinical, operative and socio-demographic factors. Only one study
reviewed was conducted in low-middle income countries (LMIC). Conclusion:
HRQOL in CHD surgical patients was substantially lower than age matched
controls, identifying that support from health care professionals is
needed. HRQOL research needs to be conducted in LMICs.

<58>
Accession Number
621232502
Author
Wang T.; Liao Y.; Wang M.; Wheeler M.
Institution
(Wang, Liao, Wheeler) Auckland City Hospital, Auckland, New Zealand
(Wang, Wang) University of Auckland, Auckland, New Zealand
Title
Rheumatic mitral valve surgery: Meta-analysis of repair versus
replacement.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S335), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Rheumatic heart disease remains one of the leading causes of
valvular heart disease worldwide despite being a preventable condition.
Valve repair is superior to replacement in degenerative mitral valve
disease, however their relative efficacies are controversial in rheumatic
heart disease, in part because of differing and mixed lesions and
pathologies, technical challenges, and recurrent events. This
meta-analysis compared mitral valve repair and replacement surgery for
rheumatic mitral valve disease. Methods: We searched Medline, Embase,
Cochrane and Scopus databases from January 1980 to June 2016 for original
studies reporting outcomes of both mitral valve repair and replacement in
rheumatic heart disease. Two authors independently assessed studies for
inclusion, followed by data extraction and analysis. Results: The search
yielded 933 articles, with 100 full-texts reviewed after initial screening
and 17 studies were included for analysis, totaling 1982 mitral valve
repairs and 3426 replacements. Pooled rates and odds ratio (95% confidence
interval) for operative mortality of repair versus replacement was 3.2% vs
4.3%, 0.68 (0.50-0.92; P = 0.01). Pooled odds ratios (95% confidence
interval) were for long-term mortality 0.41 (0.30-0.56; p< 0.001); valve
related mortality 0.23 (0.14-0.37; p< 0.001); re-operation 3.02
(1.72-5.31; p< 0.001); and bleed-ing 0.26 (0.11-0.63; P = 0.003). There
was a trend towards lower thrombo-embolism 0.42 (0.17-1.03; P = 0.06) and
no significant difference in endocarditis (p = 0.76) rates during
follow-up. Conclusion: Mitral valve repair is associated with reduction in
operative and long-term mortality and bleeding, so is recommended to be
performed in rheumatic mitral valve disease where feasible, although it
does have higher rates of re-operations during follow-up.

<59>
Accession Number
621232501
Author
Wang N.; Fulcher J.; Abeysuriya N.; Adams M.; Lal S.
Institution
(Wang, Fulcher, Abeysuriya, Adams, Lal) University of Sydney, Sydney,
Australia
(Wang, Fulcher, Abeysuriya, Adams, Lal) Royal Prince Alfred Hospital,
Sydney, Australia
Title
Predictors of successful chronic total occlusion percutaneous coronary
interventions: A systematic review and meta-analysis.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S228), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Chronic total occlusion (CTO) is found in 18-30% of patients
undergoing coronary angiography. Suc-cessful percutaneous coronary
intervention (PCI) of CTO lesions relieves symptoms, improves ventricular
function and increases patient survival. The aim of this study was to
identify predictors of technical success (restoration of flow) and
clinical success (technical success without major complications) for CTO
PCI. Methods: We conducted a systematic review and metaanalysis of 61
studies, totalling 69,886 patients. Rates of PCI success for demographic
and angiographic factors were analysed using crude odds ratios (OR) and
95% confidence intervals. Results: The demographic characteristics
associated with lower technical and clinical success were a history of
myocardial infarction (OR 0.74; 0.67-0.81), PCI (OR 0.79; 0.69-0.91),
coronary artery bypass grafting (OR: 0.61; 0.53-0.70), prior stroke (OR:
0.80; 0.74-0.86) and peripheral vascular disease (OR: 0.73; 0.64-0.83).
The angiographic factors had even greater predictive ability, and included
tortuous vessels (OR 0.56; 0.40-0.77), >45-degree bending (OR: 0.61;
0.28-0.92), moderate-severe calcification (OR 0.58; 0.49-0.68) and blunt
stump (OR: 0.51; 0.42-0.60). Conclusion: We have identified several
negative predictors of successful CTO PCI that will help guide patient
selection for this procedure. [Table Presented].

<60>
Accession Number
621232453
Author
Virk S.; Bowman S.; Bannon P.; Saxena A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon, Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
(Bannon, Saxena) Discipline of Surgery, Sydney Medical School, University
of Sydney, Sydney, Australia
Title
Impact of preoperative atrial fibrillation on short-and long-term outcomes
after mitral valve surgery.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S313), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Objective: This systematic review and meta-analysis was performed to
evaluate the impact of preoperative atrial fibrillation (preAF) on early
and late outcomes after mitral valve surgery (MVS). Methods: Medline,
EMBASE, and CENTRAL were systematically searched for studies that reported
MVS outcomes according to the presence or absence of preAF. Data were
independently extracted by two investigators; a metaanalysis was conducted
according to predefined clinical endpoints. Studies including patients
undergoing concomitant atrial fibrillation surgery were excluded. Results:
Ten observational studies met the criteria for inclusion, including a
total of 4279 patients. Of these, 1896 (44.3%) presented with preAF. There
was a non-significant trend towards increased perioperative mortality in
patients with preAF (odds ratio [OR] 1.61; 95% Confidence Interval [CI],
0.97-2.67; P = 0.07). Pre-AF was associated with stroke on follow-up
(hazard ratio [HR] 3.70; 95% CI, 1.36-10.09; P = 0.003) and cardiac death
(HR 4.29; 95%, CI, 1.28-14.37; P = 0.02). Analysis of pooled data from
these studies also indicated that preoperative AF was independently
associated with late mortality (HR 1.84; 95% CI, 1.40-2.42; p< 0.001).
There was no association of preAF with NYHA III/IV at follow-up (HR 1.21;
95% CI, 0.56-2.63; P = 0.63). Conclusions: PreAF is associated with an
increased risk of late mortality after MVS, in part due to the increased
risk of cardioembolic complications.

<61>
Accession Number
621232437
Author
Virk S.; Bowman S.; Bannon P.; Saxena A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon, Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
(Bannon, Saxena) Institute of Academic Surgery, University of Sydney,
Sydney, Australia
Title
Impact of preoperative atrial fibrillation on short-and long-term outcomes
after aortic valve surgery.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S312), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Objective: This systematic review and meta-analysis was performed to
evaluate the impact of preoperative atrial fibrillation (PreAF) on early
and late outcomes after aortic valve replacement (AVR). Methods: Medline,
EMBASE, and the Cochrane Library were systematically searched for studies
that reported AVR outcomes according to the presence or absence of preAF
Data were independently extracted by two investigators; a meta-analysis
was conducted according to predefined clinical endpoints. Studies
including patients undergoing concomitant atrial fibrillation surgery were
excluded. Results: Six observational studies with eight distinct AVR
cohorts (AVR +/- concomitant surgery) met the criteria for inclusion with
a total of 6693 patients. Of these, 1014(15%) presented with preAF
In-hospital mortality was higher overall in patients with preAF (Odds
Ratio [OR] 2.33; 95% CI, 1.48-3.67; P < 0.001). Subgroup analysis of
patients undergoing isolated AVR also showed that preAF was a risk factor
for in-hospital mortality (OR 2.49; 95% CI, 1.57-3.95; p<0.001). PreAF was
also associated with acute renal failure (OR 1.42; 95% CI, 1.07-1.89; P =
0.02) but not stroke (OR 1.11; 95% CI, 0.59-2.12; P = 0.74). Late
mortality was significantly higher in patients with preAF (HR 1.75; 95%
CI, 1.33-2.30; P < 0.001). This association remained significant when only
patients who underwent isolated AVR were analysed (HR 1.94; 95% CI,
1.27-2.96; P = 0.002). Conclusions: PreAF is associated with an increased
risk of early-and late-mortality after AVR.

<62>
Accession Number
621232422
Author
Virk S.; Bowman S.; Bannon P.; Saxena A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon, Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
(Bannon, Saxena) Discipline of Surgery, Sydney Medical School, Sydney,
Australia
Title
Impact of preoperative atrial fibrillation on outcomes following isolated
coronary artery bypass graft surgery.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S312), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Objective: The present meta-analysis was conducted to assess the impact of
preoperative atrial fibrillation (AF) on clinical outcomes following
isolated coronary artery bypass graft (CABG) surgery. Methods: Medline,
EMBASE and CENTRAL databases were systematically searched for studies
reporting CABG out-comes according to the absence or presence of
preoperative AF. Data were independently extracted by two reviewers and
meta-analysed according to pre-defined clinical endpoints. Results: Twelve
studies, including a total of 389 998 patients, met the inclusion
criteria. Preoperative AF was associated with adverse perioperative
outcomes-mortality (odds ratio [OR] 1.56; 95% confidence intervals
1.21-2.03), stroke (OR 1.18; 1.07-1.31), acute renal failure (OR 1.43;
1.13-1.82), prolonged ventilation (OR 1.34; 1.09-1.65) and need for
reoperation (OR 1.24; 1.09-1.42). Preoperative AF was also associated with
increased mortality at long-term follow-up (hazards ratio 1.47;
1.32-1.63). Subgroup analysis of off-pump CABG cases yielded similar
results for perioperative and late mortality. Conclusions: Preoperative AF
is an independent predictor of adverse peri-operative outcomes and
increased long-term mortality following isolated CABG.

<63>
Accession Number
621232399
Author
Virk S.; Bowman S.; Bannon P.; Saxena A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Bannon, Saxena) Discipline of Surgery, Sydney Medical School, Sydney,
Australia
(Bannon, Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
Title
Equivalent outcomes after coronary artery bypass graft surgery performed
by consultant and trainee surgeons: A systematic review and meta-analysis.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S311), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Objective: In recent years, concerns have been raised about the learning
opportunities available to cardiac surgical trainees. This meta-analysis
was conducted to assess the impact of trainee operator status on clinical
outcomes following coronary artery bypass graft (CABG) surgery. Methods:
Medline, Embase and Cochrane Library were systematically searched for
studies reporting CABG outcomes according to the training status of the
primary operator (consultant or trainee). Data were independently
extracted by two reviewers and meta-analysed according to pre-defined
clinical endpoints. Results: Sixteen observational studies (n = 52 966)
met criteria for inclusion, with eight studies (n = 36 479) reporting
propensity-adjusted analyses. Trainee cases were associated with increased
aortic cross-clamp (mean difference [MD] 4.80; 95% confidence interval
[CI], 0.76-8.83) and cardiopulmonary bypass (MD 4.24; 95% CI, 0.00-8.47)
duration. Perioperative mortality was similar whether CABG was primarily
performed by trainees or consultants (odds ratio 0.98; 95% CI, 0.81-1.18).
There was no significant difference in the incidence of perioperative
stroke, myocardial infarction, acute renal failure, reoperation for
bleeding or wound infection. Trainee operator status was not associated
with increased mid-term mortality (hazards ratio 1.00; 95% CI, 0.90-1.11).
In subgroup analysis including five studies and 8 025 patients, off-pump
CABG trainee cases were not associated with increased peri-operative
mortality or morbidity. Conclusions: With appropriate supervision,
conventional CABG can be performed by trainee surgeons without an adverse
impact on perioperative outcomes or mid-term survival. Data regarding
OPCABG is currently limited, and further research is warranted to
ascertain the impact of trainee operator status on long-term outcomes
following OPCABG.

<64>
Accession Number
621232393
Author
Ha F.; Nerlekar N.; Verma K.; Cameron J.; Meredith I.; Own A.
Institution
(Ha, Nerlekar, Verma, Cameron, Meredith, Own) Monashheart and Monash
University, Melbourne, Australia
Title
Percutaneous coronary intervention using drug-eluting stents versus
coronary artery bypass grafting for unprotected left main coronary artery
stenosis: A meta-analysis of randomised trials.
Source
Heart Lung and Circulation. Conference: 65th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting.
Australia. 26 (Supplement 2) (pp S225), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Current guidelines suggest that coronary artery bypass
grafting (CABG) should be the preferred revascularisation method for
unprotected left main coronary artery (ULMCA) stenosis. In light of
evidence from recent randomised trials, we assessed whether percutaneous
coronary intervention (PCI) using drug-eluting stents (DES) is as safe and
effective as CABG for treatment of ULMCA disease. Methods and Results:
Digital databases and manual searches were performed for randomised trials
comparing PCI and CABG for ULMCA stenosis. Among 3,887 potentially
relevant studies, 5 met inclusion criteria. The primary safety endpoint
was defined as the composite of all-cause death, myocardial infarction
(MI) or stroke. Secondary end-points included a clinical effectiveness
composite, which was defined as all-cause death, MI, stroke or repeat
revascularisa-tion. Summary estimates were obtained using random-effect
modelling. In total, 4,594 patients were included in the analysis. There
was no significant difference in the primary safety endpoint between the
revascularisation strategies (OR 0.97, 95%CI 0.79-1.17, P = 0.73).
However, when compared with CABG, PCI was less effective (OR 1.36, 95% CI
1.18-1.58, P < 0.001), due to significantly higher rates of repeat
revascularisation (OR 1.85,95%CI 1.53-2.23, P < 0.001). The incidence of
all-cause death (OR 1.03,95%CI 0.78-1.35, P = 0.61), MI (OR 1.46, 95%CI
0.88-2.45, P = 0.08) and stroke (OR 0.88, 95%CI 0.39-1.97, P = 0.53) did
not differ between PCI and CABG. Conclusions: PCI using DES and CABG are
equally safe methods of revascularisation for patients at low surgical
risk with significant ULMCA stenosis. However, CABG is associated with
significantly lower rates of repeat revascularisation.

<65>
Accession Number
621245710
Author
Kankam H.; Kirk N.; Fitzsimons S.; Pettit S.
Institution
(Kankam) University of Cambridge, United Kingdom
(Kirk, Fitzsimons, Pettit) Papworth Hospital NHS Foundation Trust, United
Kingdom
Title
ST2 levels are elevated in patients with advanced heart failure but are
not consistently associated with other markers of adverse prognosis.
Source
Heart. Conference: British Cardiovascular Society Annual Conference, BCS
2017. United Kingdom. 103 (Supplement 5) (pp A10-A11), 2017. Date of
Publication: June 2017.
Publisher
BMJ Publishing Group
Abstract
Introduction Heart transplantation and mechanical circulatory support
(MCS) improve survival in selected patients with advanced heart failure
and an adverse prognosis. Soluble ST2 is a protein belonging to the
interleukin-1 receptor family. ST2 is released in response to
cardiomyocyte stess and thought to be a marker of adverse prognosis. We
examined the association between ST2 levels and currently accepted markers
of adverse prognosis in patients with advanced heart failure. Methods We
included 20 consecutive outpatients who were assessed for heart
transplantation at Papworth Hospital over ten weeks. All patients
underwent echocardiography, six minute walk testing, cardiopulmonary
exercise testing and right heart catheterisation, in addition to blood
tests including serum ST2 measurement using a commercial assay. Prognosis
was estimated using the Seattle Heart Failure Model (SHFM) and the
Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores. A
multi-disciplinary team decided whether listing for heart transplantation
was indicated. We examined the association between ST2 levels and other
markers of adverse prognosis. Results Ten patients were too well to be
listed for heart transplantation (group A) and ten patients were
sufficiently unwell to be listed for heart transplantation (group B).
There was no difference in age, gender or body mass index. Key prognostic
variables are presented in table 1. Compared with patients in group A,
patients in group B had higher ST2 levels, lower peak VO<inf>2</inf>,
shorter six minute walk distance and higher SHFM predicted one-year
mortality. However, there was no difference in LVEF, serum Creatinine,
NTproBNP, cardiac index or predicted one-year mortality by MAGGIC score.
Previous studies have found that an ST2 level of >35 ng/ml is indicative
of adverse prognosis. At this cut-off, there was frequent disagreement
between ST2 level and other markers of adverse prognosis. Patients
identified as high risk by ST2 level were identified as low risk by peak
VO<inf>2</inf> (n=5) and six minute walk distance (n=6). In addition,
eight patients identified as low risk by ST2 level were identified as high
risk by NTproBNP (figure 1). Conclusions ST2 levels are higher in patients
who are sufficiently unwell to be listed for heart transplantation,
compared with those who are too well to be listed for heart
transplantation. However, there is frequent disagreement between ST2
levels and other markers of adverse prognosis such as six minute walk
distance, peak VO<inf>2</inf> and NTproBNP. Larger studies with assessment
of real world outcomes, such as death, urgent heart transplantation or
MCS, are required to determine whether ST2 measurement can improve
assessment of prognosis in patients with advanced heart failure.

<66>
Accession Number
621238221
Author
Novak J.; Machackova T.; Sana J.; Kafunkova T.; Godava J.; Hude P.;
Zampachova V.; Nemec P.; Bedanova H.; Slaby O.; Bienertova-Vasku J.;
Krejci J.; Spinarova L.
Institution
(Novak, Bienertova-Vasku) Masaryk University, Department of Pathological
Physiology, Brno, Czech Republic
(Machackova, Sana, Slaby) Masaryk University, Central European Institute
of Technology, Brno, Czech Republic
(Kafunkova, Godava, Hude, Krejci, Spinarova) St. Anne's University
Hospital, Department of Cardiovascular Diseases, Brno, Czech Republic
(Zampachova) St. Anne's University Hospital, Department of Pathology,
Brno, Czech Republic
(Nemec, Bedanova) Centre of Cardiovascular Surgery and Organ
Transplantation, Brno, Czech Republic
Title
Levels of various microRNAs are altered in endomyocardial biopsies during
acute cellular rejection in patients after heart transplantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1267), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Heart failure (HF) represents one of the leading causes of
death in the developed countries. Despite the successes of
(non-)pharmacological therapies, heart transplantation (HT) remains the
only solution for some patients' groups. Among other factors, prognosis of
patients after HT is significantly affected by acute cellular rejection
(ACR). Diagnostics of ACR is currently based on histopathologic evaluation
of endomyocardial biopsies (EMB). Better understanding of molecular
changes occurring prior to histological changes may results in
identification of novel markers that would enable sooner identification of
patients at risk of ACR. Purpose: The purpose of the study was to identify
the microRNAs (miRNAs, miRs) whose levels are altered in the EMB samples
in patients with histologically proven ACR. Methods: Retrospective study.
78 patients with confirmed ACR were identified in the archives of our
hospital. Complete "trios" of paraffin embedded EMB samples (i.e. sample
prior to rejection, with ongoing rejection and after the rejection from
the same patient) were collected from 40 individuals. 16 trios were
randomly selected for the miRNA profiling using next generation
sequencing. Results: 488 individual miRNAs were identified in the EMBs.
Out of these, 14 miRNAs were statistically significantly dysregulated
among the samples with and without ACR. Six miRNAs (miR-31-5p,
miR-146a-5p, miR-589-5p, miR-1273c, miR-3135b, miR-3605-5p) showed to be
upregulated during ACR and their levels returned to normal after the
adjustment of immunosuppressive therapy. Another five miRNAs (miR-17-5p,
miR-182-5p, miR-190b, miR-4506, miR-4492) showed the opposite trend, i.e.
to be downregulated during ACR. Due to these specific trends, i.e.
normal-higher-normal or normal-lower-normal, respectively, these miRNAs
are highly likely connected with the ACR process. Conclusion: We have
identified 11 miRNAs whose levels are altered in EMB samples from patients
after HT that are either increased or decreased during ACR. These findings
may improve diagnostics of ACR and potentially lead to timely adjust of
immunosuppressive therapy in indicated individuals. Moreover, since miRNAs
are also present in bodily fluids, determining their levels may also
provide rationale for further search and development of blood-based ACR
biomarkers that would reduce the need of EMB.

<67>
Accession Number
621238207
Author
Bellemain-Appaix A.; Begue C.; Bhatt D.L.; Ducci K.; Harrington R.A.; Roe
M.T.; Wiviott S.D.; Cucherat M.; Silvain J.; Collet J.P.; Bernasconi F.;
Montalescot G.
Institution
(Bellemain-Appaix, Bernasconi) Hospital La Fontonne, Antibes, France
(Begue, Silvain, Collet, Montalescot) AP-HP - Hospital Pitie-Salpetriere,
Paris, France
(Bhatt, Wiviott) Brigham and Women's Hospital, Boston, United States
(Ducci) San Donato Hospital of Arezzo, Cardiovascular and Neurologic
Department, Arezzo, Italy
(Harrington) Stanford University Medical Center, Stanford, United States
(Roe) Duke University Medical Center, Division of Cardiology, Durham,
United States
(Cucherat) University Hospital of Lyon, Hospital Louis Pradel, Lyon,
France
Title
The efficacy of early versus delayed P2Y12 inhibition in percutaneous
coronary intervention for ST-elevation myocardial infarction: A systematic
review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1263-1264), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Benefit of "Early" vs "Delayed" P2Y12 inhibition in patients
undergoing Percutaneous Coronary intervention (PCI) for ST-Elevation
Myocardial Infarction (STEMI) has not been well investigated. Objectives:
To conduct a meta-analysis of randomized controlled trials (RCTs)
comparing a strategy of P2Y12 inhibition before versus after (or during)
PCI for STEMI. Methods: We pooled datas from seven RCTs which compared
early vs delayed P2Y12 inhibition in STEMI patients scheduled for PCI,
providing data on Major Adverse Cardiac Events (MACE), all cause death,
and major bleeding. The primary endpoint was MACE. Secondary endpoints
included stent thrombosis and the use of GpIIbIIIa inhibitors. All
endpoints were analysed at shortest follow-up available. Results: 9648
patients were included ("Early" = 4792, "Delayed" = 4856). "Early" P2Y12
inhibition was associated with a significant reduction in MACE rate
(OR=0.73, CI95% (0.61-0.88), p=0.0008), Myocardial Infarction (OR=0.71,
CI95% (0.57-0.90), p=0.004), bailout GPI use (OR=0.87, CI95% (0.75-1.00),
p=0.04) and coronary reperfusion before PCI (Odd Ratio for Thrombolysis in
Myocardial Infarction flow grade 2-3 = 1.12, CI95% (1.00-1.26), p=0.04).
Major bleeding was not increased (OR=0.87; CI95% (0.62-1.21), p=0.41).
Conclusion: A strategy of early effective P2Y12 inhibition in PCI of STEMI
appears to improve coronary reperfusion before PCI, and reduce MACE, MI
and bailout GPI use without increase of major bleeding.

<68>
Accession Number
621238158
Author
Santiago De Araujo Pio C.; Marzolini S.; Pakosh M.; Grace S.L.
Institution
(Santiago De Araujo Pio, Grace) York University, Department of Kinesiology
and Rehabilitation Sciences, Toronto, Canada
(Marzolini, Pakosh) University Health Network, Cardiovascular Prevention
and Rehabilitation Program, Toronto, Canada
Title
Effect of cardiac rehabilitation dose on mortality and morbidity: How low
can we go-a systematic review and meta-regression.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1258), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Cardiac rehabilitation (CR) is a Class I, Level A
recommendation, given its proven benefits. However, there is wide
variability in CR dose delivered, and there are no evidence-based
recommendations regarding dose to prescribe. Purpose: To ascertain the
effect of CR dose (i.e., prescribed duration in weeks x frequency/week;
categorized as low [<12 sessions], medium [12-35], or high [>=36]) on
mortality and morbidity. Methods: Six electronic databases (Cochrane
Database [CCTR, CDSR], CINAHL, EMBASE, PsycINFO and MEDLINE) were
systematically searched through November 2015. Inclusion criteria included
randomized or nonrandomized studies, in adults with CR-qualifying
conditions, with a minimum comprehensive CR dose >=4 sessions, presence of
a control/comparison group and reporting dose, as well as mortality or
morbidity outcomes. Citations were considered for inclusion, and data were
extracted in included studies as well as quality assessed, independently
by 2 investigators. Studies were pooled using randomeffects meta-analysis,
and meta-regression was conducted where warranted. Results: Of 4630 unique
citations identified, 33 trials were included comparing CR to usual care
(i.e., no dose), reporting on 15,133 participants (27.1% female). In
subgroup meta-analyses, high (relative risk [RR]=0.56, 95% confidence
interval [CI]=0.41-0.78), and medium dose (RR=0.58, 95% CI=0.37-0.91), but
not low dose CR were associated with lower all-cause mortality (overall
p=0.61). High dose CR (RR=0.61, 95% CI 0.40-0.95) only was associated with
lower cardiovascular-related hospitalization (overall p=0.77). Dose was
significantly associated with percutaneous coronary intervention (PCI;
high: RR=0.65, 95% CI 0.50-0.84, and medium/low: RR=1.04, 95% CI. 74-1.4,
overall p=0.03). No doseresponse association was found for cardiovascular
mortality, all-cause hospitalization, coronary artery bypass graft surgery
(trend observed), or myocardial infarction. Meta-regression covariates
included study quality, country, publication year, and diagnosis. The
effect of CR dose on all-cause mortality sustained adjustment (high:
coefficient=-0.77, Standard Error [SE]=0.22, p>0.001; medium:
coefficient=-0.80, SE=0.22, p>0.001, when compared to low dose).
Similarly, the impact of CR dose sustained adjustment for PCI (high vs.
low-medium dose: coefficient=-0.73, SE=0.20, p>0.001), but not for
cardiovascular-related hospitalization. Publication bias may impact the
effects for all-cause mortality and cardiovascular-related
hospitalization. Conclusion: A minimum of 36 CR sessions may be needed to
reduce PCI. Future studies should examine the effect of actual dose of CR,
and trials are needed comparing different doses. (Figure Presented).

<69>
Accession Number
621237904
Author
Carrero M.C.; Vera Janavel G.; Diaz Babio G.; Pipikin M.; Masson Juarez
G.; Mezzadra M.; Altamirano C.; Stutzbach P.
Institution
(Carrero, Vera Janavel, Diaz Babio, Pipikin, Masson Juarez, Mezzadra,
Altamirano, Stutzbach) Cardiovascular Institute of San Isidro-Sanatorio
Las Lomas, Buenos Aires, Argentina
Title
Variability of thoracic aortic diameters according to gender, age and body
surface area: Nomograms should replace absolute cut-off values?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1097), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Thoracic aortic (TA) dilatation requires accurate and timely
detection to prevent progression to aneurysm or dissection, and 2-D
transthoracic echocardiography remains the screening tool. Differences in
TA diameters (TAD) according to gender, age and body surface area (BSA)
have been previously reported. However, the reported ranges of TAD are
limited by small sample size, different measurement sites and
heterogeneous cohorts. Moreover, surgery indication for aneurysms is still
based mainly on absolute diameters with no reference to gender, age or
BSA. Purpose: We aimed to assess the full spectrum of TAD in both gender
and their correlations with age and BSA to obtain reference normograms in
healthy adolescents and adults. Methods: Medical examination and complete
color flow/spectral Doppler transthoracic echocardiograms were performed
to exclude cardiovascular risk factors, thoracic aorta aneurysm, aortic
regurgitation, bicuspid valve, past history of cardiac surgery or
personal/familial Marfan/Ehlers-Danlos syndromes. TAD (cm) were assessed
according to last recommendations in healthy, >=14 y/o volunteers at:
annulus (TAD1), sinuses of Valsalva (TAD2), sinotubular junction (TAD3),
proximal ascending (TAD4), isthmus (TAD5) and proximal descending (TAD6).
We used parasternal long axis (TAD1-4) and suprasternal (TAD5&6) views.
TAD1 was measured at mid-systole (inner edge method). All other TAD were
measured at end-diastole (leading edge method). Data was stratified by G
and A (A1: 14-24 y/o, A2: 24-40 y/o, A3: >40 y/o) and indexed to BSA
(TADi). Linear regression analyses between dependent (TAD, TADi) and
independent (G, A and BSA) variables were conducted with Pearson's least
squares method to obtain coefficients of determination (R2) and 95%
prediction intervals. Group data was compared with unequal variance T-test
for independent samples or Fisher's z transformation for independent
correlations, and results are reported as mean+/-SEM. Significance was set
at P<0.05. Results: Pooled data from all patients (n=520; 39% women;
32.8+/-0.7 y/o; 1.82+/-0.23 m2) showed that all TAD increased with age and
BSA (p<0.001). All TADi were negatively correlated with BSA (p<0.001).
Every TADi was positively correlated with age (p<0.001) except for the
annulus diamters (R2=0.0005; p=NS). Gender comparisons showed differences
between men and women and TAD, TADi, age and BSA (p<0.001), but strongly
similar correlations (p=NS). Normograms were obtained for A1, A2 and A3 to
predict TAD from BSA with no need of G distinction. Conclusions: BSA is
the strongest predictor of TAD. Similarly, TAD increase with age, except
for the aortic annulus which depends more on BSA. Women have smaller TAD
due to their lower BSA, but they correlate strongly similar to men.
Therefore, we propose nomograms of TAD for different A groups without G
distinction. BSA and A must be taken into account when assessing an
individual patient.

<70>
Accession Number
621237757
Author
Van Stipdonk A.M.W.; Ter Horst I.A.H.; Kloosterman M.; Rienstra M.; Meine
M.; Prinzen F.W.; Maass A.; Vernooy K.
Institution
(Van Stipdonk, Vernooy) Maastricht University Medical Centre (MUMC),
Cardiology, Maastricht, Netherlands
(Ter Horst, Meine) University Medical Center Utrecht, Cardiology, Utrecht,
Netherlands
(Kloosterman, Rienstra, Maass) University Medical Center Groningen,
Cardiology, Groningen, Netherlands
(Prinzen) Cardiovascular Research Institute Maastricht (CARIM),
Physiology, Maastricht, Netherlands
Title
QRS area as superior electrocardiographic marker in patient selection for
CRT.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1112), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Patient selection in cardiac resynchronisation therapy (CRT)
currently relies on QRS duration and left bundle branch block (LBBB)
morphology. Significant non-response rates imply suboptimal patient
selection. Small studies have suggested that vectorcardiographically
determined QRSAREA improves identification of CRT responders. Purpose: To
compare the value of QRSAREA to that of QRS duration and morphology in
prediction of the occurrence of LV assist device (AD) implantation/
cardiac transplantation/all-cause mortality (primary endpoint), heart
failure hospitalisation within the first year after implantation and
echocardiographic response at 6 to 12 months after implantation (secondary
endpoints). Methods: In a multicentre cohort of patients implanted with a
CRT device between 2001 and 2015, patient electronic databases were
assessed for clinical and echocardiographical outcomes data. QRSAREA was
calculated by converting the digital 12-lead ECG and taking the root of
the sum of squared QRSAREA in X-, Y-, and Z-direction. Data on the primary
endpoint was available in 1.486 patients. Heart failure hospitalisation
data was available in 1.269 patients. Baseline and follow-up
echocardiograms (relative reduction in LV end-systolic volume) were
available for 928 patients. Results:. In a mean follow-up time of
3.4+/-2.4 years, 474 patients (32%) experienced the primary endpoint.
Patients with LBBB (with QRS duration above and below 150ms) showed
significantly lower probability of experiencing the primary event than
patients with non-LBBB and a QRS below 150ms. This was the same for
patients within the two highest QRSAREA quartiles compared to patients
within the lowest QRSAREA quartiles (Figure 1.) 85 (6%) Patients were
hospitalised within the first year after CRT implantation. Patients above
the median of QRSAREA had significantly lower risk of heart failure
hospitalization, as did the patients above the median of QRS duration.
LBBB morphology however was not significantly associated with
hospitalization. Mean reduction of LVESV was 19+/-32%. Both LBBB patient
groups (QRS above and below 150ms) showed significantly higher reductions
than non-LBBB patient groups. Patients in the two upper QRSAREA quartiles
also experienced significantly more reduction. Multivariable cox
regression analyses proved higher QRSAREA to be the only independent
electrocardiographic predictor of lower incidence of the primary endpoint
(HR 0.52; 0.37-0.75) as well as for the risk of heart failure
hospitalisation (HR 0.56; 0.33-0.95) Conclusion: Baseline QRSAREA predicts
clinical and echocardiographic outcome to CRT. Moreover its distinctive
character seems better than that of traditional QRS duration and
morphology.

<71>
Accession Number
621237719
Author
Chan A.Q.; Chan E.L.; Chan M.P.; Candic M.; Antonio N.; Wei D.
Institution
(Chan, Chan, Chan, Candic, Antonio) Chanwell Clinic, Instritute for Heart
and Sleep Disorders, Henderson, NV, United States
(Wei) University of California Davis, Molecular and Cell Biology, Davis,
CA, United States
Title
Rapid carotid plaques reversal of PCSK9 inhibitors when added to statins
and eicosapentaenoic acid in high risk cardiovascular patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1331), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Statins are the most widely prescribed lipid-lowering
medications, have been shown to lower the relative risk for cardiovascular
event (CVE) by 20-50%. Substantial residual cardiovascular risk persists
in some patients while on statins, in those patients with combined mixed
dyslipidemia, i.e., high triglycerides (TG) and low HDL. Research data
suggests that pure eicosapentaenoic acid (EPA) could reduce residual risk
in statin-treated population especially those with TG >150mg/dL. Purpose:
We attempt to determine whether triple combination of statins, EPA, PCSK9
inhibitors (PCSK9i) evolocumab henceforth known as Trio Combo could
promote faster and larger carotid plaque regression. Method: 57 patients
with high risk cardio-cerebrovascular diseases were entered into the
study. Age between 55 to 88 years old, average age 72 years, male/female
ratio 30/27. 57/57 (100%) have treated obstructive sleep apnea, 55/57
(96%) have diabetes mellitus, 12/57 (21%) had previous myocardial
infarction, 20/57 (35%) had percutaneous coronary stenting, 12/57 (21%)
had transient ischemic attacks, 22/57 (39%) have congestive heart failure.
All were treated atorvastatin 40 mg and EPA 4 grams daily for more than
one year that served as Control. CIMT measurements using high-resolution
2-D ultrasound systems with a 5- to 13-MHz linear array transducer were
done on Control subjects; and repeat CIMT measurements at 3 to 6 months
after initiation of Trio Combo. CIMT was measured as the distance between
the leading edge of the lumen intima boundary and the leading edge of the
media-adventitia of the carotid artery with the patient in the supine
position. Results: Average LDL-C was 75, TG 102 in the Control group, and
LDL-C 22, TG 92 in the Trio Combo group 3 months after therapy. 20%% to
65% plaque reversal occurred after 6 months of Trio Combo therapy in 37
patients (65%), - 28% (progression) to 0% reversals in 10 patients who
took evolocumab for only 3 months. - 6% (progression) to 10% reversal in 3
patients elected to receive evolocumab once a month instead of once every
2 weeks. 1 patient had 50% left common carotid stenosis that was reversed
down to 2.5 mm CIMT plaques after only 3 months of evolocumab. 2 patients
with active chronic periodontitis (P) have 0% to 10% CIMT plaque
reversals. 4 patients took EPA 2 grams a day instead of the usual 4 grams
a day resulted in CIMT plaque reversals of -3% to 12%. Conclusion: Trio
Combo therapy of atorvastatin, EPA, evolocumab resulted in rapid and
significant CIMT plaque reversal within 6 months compared to the Control
group of EPA, atorvastatin in high risk elderly CV patients. The added
cost of evolocumab as part of Trio Combo therapy in high risk patients
could more than offset the lesser occurrence of CVE and its associated
economic cost to healthcare.

<72>
Accession Number
621237675
Author
Burup Kristensen C.; Kofoed K.F.; De Knegt M.; Host N.; Hassager C.; De
Backer O.; Sondergaard L.; Mogelvang R.
Institution
(Burup Kristensen, Kofoed, De Knegt, Hassager, De Backer, Sondergaard,
Mogelvang) Rigshospitalet - Copenhagen University Hospital, Department of
Cardiology, Copenhagen, Denmark
(Host) Bispebjerg University Hospital, Department of Cardiology,
Copenhagen, Denmark
Title
Transthoracic echocardiography may rule-out leaflet dysfunction after
transcatheter aortic valve replacement, a novel algorithm based on leaflet
morphology and color doppler flow characteristics.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1094), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: 4D computed tomography (4DCT) is considered the gold standard
for evaluation of bioprosthesis leaflet function after transcatheter
aortic valve replacement (TAVR), because traditional gradients measured by
Doppler are usu-ally not elevated. Radiation, high costs and dependency of
intravenous contrast makes this modality, however, less suitable for
screening. Echocardiographic methods are improving fast and the
possibility of adequate evaluation of leaflet function by echocardiography
has not yet been investigated. Purpose: To compare transthoracic
echocardiographic and 4DCT evaluation of bioprosthesis leaflet function
after TAVR. Methods: Single-center prospective follow-up with 4DCT and
echocardiography after TAVR. 4DCT was performed as part of the SAVORY
registry using a 320- detector-row CT-scanner (Aquilion One Vision
Edition, Toshiba Medical systems) and additional echocardiography was
performed in 33 randomly selected patients using GE Healthcare Vivid E95.
Both modalities were evaluated separately by different readers blinded to
the results of the other reader. Bioprosthesis status by 4DCT was analysed
for hypoattenuating leaflet thickening (HALT) or hypoattenuation affecting
motion (HAM) and reported as either normal or abnormal. An algorithm for
echocardiographic interpretation of leaflet dysfunction was designed based
on visual interpretation of leaflet morphology, presence of eccentric flow
and flow acceleration within the valve (Figure 1). Results: The 33
patients had a wide range of TAVR bioprosthesis types implanted, mean age
82+/-6 years, mean time interval between implantation and imaging was
9+/-5 months. 4DCT identified 11 (33%) valves with leaflet dysfunction
whereas echocardiography identified 12 (36%). No patient with 4DCT-leaflet
dysfunction was missed by echocardiography (sensitivity 100%, specificity
95%). The individual components of the algorithm performed well
(sensitivity/specificity): leaflet morphology (91%/95%), eccentric flow
(70%/100%), and flow acceleration (91%/82%). Conclusions: Transthoracic
echocardiographic evaluation appears to rule-out TAVR leaflet dysfunction
safely. (Figure Presented).

<73>
Accession Number
621237603
Author
Tarun A.; Psarros C.; Sanna F.; Herdman L.; Akoumianakis I.; Antonopoulos
A.; Sayeed R.; Krasopoulos G.; Chuaiphichai S.; Channon K.M.; Antoniades
C.
Institution
(Tarun, Psarros, Sanna, Herdman, Akoumianakis, Antonopoulos, Sayeed,
Krasopoulos, Chuaiphichai, Channon, Antoniades) University of Oxford,
Division of Cardiovascular Medicine, Oxford, United Kingdom
Title
Redox-sensitive regulation of cystathionine gamma-lyase (CSE) and the
potential protective role of hydrogen sulfide (H2S) in the human heart.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1141), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The human heart has self-regulatory mechanisms that influence
myocardial redox state, but the mechanisms underlying these processes are
still largely unknown. Cystathionine gamma-Lyase (CSE) and its generation
of hydrogen sulfide (H2S) are increasingly being recognized as important
players in the regulation of myocardial redox signaling. Purpose: We
explore whether CSE itself is a redox-sensitive enzyme and whether its
expression relates to human myocardial redox state. We further examine the
effects of H2S on the regulation of human myocardial redox state. Methods:
In study 1, biopsies of right atrial appendage (RAA) obtained from 179
patients undergoing cardiac surgery were used to quantify the expression
of CSE and its transcription factor specificity protein 1 (SP1) using
qRTPCR, as well as myocardial O2.- (using lucigenin chemiluminescence). In
study 2, H9C2 cardiomyocytes were exposed to NADPH (1mM, 18h), to study
the acute effects of oxidative stress on CSE expression. In study 3, RAA
biopsies from 20 additional CABG patients were exposed to H2S donor NaHS
(30muM, 1h) in an ex vivo system, and O2.- was measured in the presence
and absence of NOS inhibitor L-NAME. Peroxynitrite (ONOO-) was measured
using urate-inhibitable luminol chemiluminescence. Results: In study 1,
myocardial CSE expression was positively related with O2.- generation
(P=0.01, n=75; A) and SP1 expression (P=0.0003, n=179; B) in the human
heart. In study 2, CSE expression is reduced after short-term exposure of
H9C2 cardiomyocytes (P=0.03, n=5-6; C). In study 3, fast-releasing donor
NaHS significantly increased myocardial LNAME delta O2.-, suggesting
improved NOS coupling (P=0.02, n=11; D), and reduced ONOO- (P=0.03, n=6;
D). These effects were not mediated by changes in the levels or oxidation
status of tetrahydrobiopterin in this tissue. Conclusions: We demonstrate
the presence of CSE, the source of H2S, in the human heart, and show for
the first time that myocardial CSE is downregulated after acute exposure
to oxidative stress but may be upregulated with chronic exposure to
oxidative stress via an SP1-mediated mechanism. This suggests that CSE is
part of the defense mechanisms of the human heart against myocardial
oxidative injury. (Figure Presented).

<74>
Accession Number
621237270
Author
Lima E.G.; Hueb W.; Garzillo C.L.; Favarato D.; Segre C.A.W.; Azevedo
D.F.C.; Hueb A.C.; Rezende P.C.; Silva E.E.R.; Garcia R.M.R.; Scudeler
T.L.; Ramires J.A.F.; Kalil Filho R.
Institution
(Lima, Hueb, Garzillo, Favarato, Segre, Azevedo, Hueb, Rezende, Silva,
Garcia, Scudeler, Ramires, Kalil Filho) Heart Institute (InCor),
University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
Title
Impact of chronic kidney dysfunction among patients with stable coronary
artery disease: Ten-year follow-up of mass II trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1402), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Chronic kidney disease (CKD) has poor prognosis among
patients with stable coronary artery disease (CAD), but there is a lack of
evidence regarding long term follow-up. Purpose: Our objective was to
evaluate the CKD in patients with multivessel CAD preserved ventricular
function, and the interaction between received treatment and mortality in
a 10-year follow-up. Methods: The glomerular filtration rate was
determined at baseline on 611 patients who were randomized into three
treatment groups: medical treatment (MT), percutaneous coronary
intervention (PCI), and coronary artery bypass surgery (CABG). Endpoint
considered was overall death. Survival was estimated by the Kaplan-Meier
method and hazard ratio (HR) using Cox proportional hazard. Results: Of
611 patients, 112 (18%) had normal renal function, 349 (57%) mild
dysfunction, and 150 (25%) moderate dysfunction. Treatment assigned and
baseline characteristics were similar among renal function (RF) groups,
except by age, smoking, body mass index, number of diseased vessels,
triglycerides, and HDL cholesterol levels. There were significant
differences among cumulative overall mortality curves among the three
renal function groups. Survival rates were 81.3%, 76,2% and 60,7% for
normal renal function, mild CKD, and moderate CKD respectively
(log-rank=0.001; HR: 0.43: 0.26-0.70 for normal RF versus moderate CKD;
and HR: 0.64; 0.46-0.90 for mild versus moderate CKD). Comparing treatment
strategies in RF groups we observed a higher survival in CABG group (81%)
compared to those in PCI (75.9%) and MT (71.4%) groups among mild CKD
subjects (log-rank:0.015; HR: 0.44; 0.25-0.77 for CABG versus MT; HR:
0.59; 0.33-1.03 for CABG versus PCI) Conclusions: CAD associated to
chronic kidney dysfunction has a worse prognosis, regardless of the
therapeutic strategy option. Additionally, our data suggest that CABG is
related to higher survival when compared to MT among mild CKD subjects.

<75>
Accession Number
621237112
Author
Ladak L.A.; Hasan B.S.; Gullick J.; Gallagher R.
Institution
(Ladak, Gallagher) University of Sydney, Charles Perkins Center, Sydney
Nursing School, Sydney, Australia
(Hasan) Aga Khan University, Pediatrics and Child Health, Karachi,
Pakistan
(Gullick) University of Sydney, Sydney Nursing School, Sydney, Australia
Title
Health related quality of life in children and young adults following
congenital heart disease surgery: A systematic literature review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1354), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Morbidity and health related quality of life (HRQOL) issues
have become an increasing focus in the congenital heart disease (CHD)
surviving population; however the results have been inconsistent. Purpose:
To conduct systematic literature review and meta-analysis to explore HRQOL
in CHD surgical children and young adults compared to their age matched
healthy controls. Methods: Medline, CINAHL and EMBASE databases were
searched. Quantitative observational studies with samples of at least 80%
surgical patients, mean age <=18 years and HRQOL assessed at >=1 year
following CHD surgery were included in the review. Data extraction was
conducted by two persons independently and Gill and Feinstein's 10
criteria was used for evaluating the studies. Results: 23 studies
prospective cross sectional were included in the review and the studies
met 6/10 criteria for quality assessment (median = 0, range 0-6). Patients
(n=3870) were representative of different CHD severity along with their
parents (n=4077). Meta-analysis was conducted on 8 studies that had used
PedsQL Generic 4.0 for self and parental report. Random effects model was
used for meta-analysis and I2 for assessing the heterogeneity. HRQOL was
significantly lower in both self and parental report in CHD surgical
patients compared to healthy cohorts in all the domains (see table 1).
Similar results were found in the studies reviewed but were not part of
metaanalysis. Factors predictive of lower HRQOL post-operatively included
clinical, operative and socio-demographic factors. No study reviewed was
conducted in low-middle income countries (LMIC). Conclusions: HRQOL in CHD
surgical children and young adults was substantially lower than age
matched controls identifying that support from health care professionals
is urgently needed. HRQOL research needs to be conducted in LMICs.

<76>
Accession Number
621236943
Author
Mandel I.A.; Mikheev S.L.; Podoksenov Y.K.; Svirko Y.S.; Suhodolo I.V.;
Shipulin V.M.
Institution
(Mandel) Federal Scientific Clinical Center of Specialized Methods Medical
Care and Medical Technology, Anesthesiology and Intensive Care, Moscow,
Russian Federation
(Mikheev, Shipulin) Cardiology Research Institute, Cardiovascular Surgery,
Tomsk, Russian Federation
(Podoksenov, Svirko) Cardiology Research Institute, Anesthesiology and
Intensive Care, Tomsk, Russian Federation
(Suhodolo) Siberian State Medical University, Morphology and General
Pathology, Tomsk, Russian Federation
Title
Hypoxic-hyperoxic preconditioning: A novel technique for myocardial
protection against ischemia-reperfusion injury in coronary surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1226), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Preconditioning by moderate hypoxia, as well as hyperoxia,
constitute an effective drug-free method to amplify adaptive response to
various negative influences of cardiac surgery. Normobaric interval
hypoxic-hyperoxic training has been demonstrated to be effective in
rehabilitation of coronary artery disease (CAD) patients by improving
stress resistance and oxygen delivery. Purpose: To assess the impact of
combined hypoxic-hyperoxic preconditioning (HHP) on myocardial function
and postoperative recovery in patients with CAD undergoing coronary
surgery with cardiopulmonary bypass (CPB). Methods: The study included 77
patients randomly assigned to two groups: 41 patients received
hypoxic-hyperoxic preconditioning in the beginning of surgery before the
CPB (HHP group) and 36 patients were not preconditioned (control group).
Coronary artery bypass grafting with CPB for multivessel coronary artery
disease was performed in all cases (2014-2016). The anaerobic threshold
were measured before operation to establish the optimal oxygen level for
hypoxic preconditioning phase. HHP was conducted as follows: 10 min of
hypoxemia (10- 14% oxygen in breathing gas mixture) followed by 30 min
hyperoxia (75-80% oxygen in breathing gas mixture), then mechanical
ventilation was carried out with room air until CPB started. Safety
control of the procedure included ECG monitoring, invasive arterial and
venous blood pressure control, cardiac output, pulse oximetry,
capnography, cerebral oximetry. To monitor acid-base status and metabolic
state we measured saturation of arterial and mixed venous blood, lactate
and glucose level, pH every 10 min during the HHP procedure; calculated
oxygen consumption and delivery indices, ratio between venous-to-arterial
carbon dioxide difference to arteriovenous oxygen content difference
(PCO2/C(av) O2). Results: The operation time, CPB time and cross-clamping
time did not differ significantly in HHP group and control group. The
(PCO2/C(a-v)O2) ratio, an additional indicator of anaerobic metabolism and
tissue hypoperfusion, did not reach critical point in all cases.
Spontaneous sinus rhythm recovery after CPB was registered more often in
HHP group - 30 (73,17%) comparing to controls - 14 (38.89%),
chi2 =8.38, p=0.015. The length of inotropic support in early
postoperative period was significantly lower in HHP group comparing to
control (13 [11; 16] vs 23 [16,5; 36,75] h, U=1,281,000, p<0.001).
Mechanical ventilation time in HHP group was 9 [8; 12] hours comparing to
15 [8; 24] hours in control group, (U=1,025,500, p=0.003). In HHP group
complication-free rate in early postoperative period was higher comparing
to control group (33 (80%) vs 21 (58%), U=569,000, p=0.033). Conclusion:
Hypoxic-hyperoxic preconditioning adjusted by anaerobic threshold enhances
adaptive response to the surgical stress, facilitates sinus rhythm
recovery and provides a faster recovery after surgery in patients with
CAD.

<77>
Accession Number
621236942
Author
McClure G.R.; Belley-Cote E.P.; Harlock J.; Lamy A.; Stacey M.; Devereaux
P.J.; Whitlock R.P.
Institution
(McClure) McMaster University, Undergraduate Medicine, Hamilton, Canada
(Belley-Cote) McMaster University, Medicine, Hamilton, Canada
(Harlock, Stacey) McMaster University, Vascular Surgery, Hamilton, Canada
(Lamy, Whitlock) McMaster University, Cardiac Surgery, Hamilton, Canada
(Devereaux) Population Health Research Institute, Hamilton, Canada
Title
Steroids in cardiac surgery (SIRS): Infection substudy.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 1276), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Infections following cardiac surgery result in significant
morbidity, mortality and healthcare cost. To target populations for
prophylactic interventions, clinicians are interested in predictors of
post-operative infections. Methods: Steroids in Cardiac Surgery (SIRS) was
a multi-centre randomized controlled trial assessing the intraoperative
use of methylprednisone during cardiac surgery. 7507 patients were
enrolled in 80 centers and 18 countries. Using the participants as a
cohort, we aimed to identify independent risk factors for postoperative
wound infections. We excluded those who did not undergo surgery, died
intraoperatively or within 48 hours of operation. Patients were identified
as having developed "surgical site infection" or not by postoperative day
30. Using hypothesized and known risk factors, we created a binary
logistic regression model using a forward step-wise entry model. Results:
Follow-up at 30 days was complete for all patients; 7406 were included in
the cohort. Risk factors significant at the p<0.05 level include: diabetes
managed with insulin (aOR: 1.53, 95% CI: 1.12-2.10), oral hypoglycemics
(1.58, 1.16-2.13), or diet (1.66, 1.05-2.62), female gender (1.32,
1.04-1.70), renal failure with (2.05, 1.07-3.95), and without (1.52,
1.06-2.17) dialysis, >96 minutes cardiopulmonary bypass (CPB) time (1.86,
1.45-2.38), BMI >30.49 (1.56, 1.22- 1.99), peak ICU blood-sugar (mmol/L)
(1.02, 1.00-1.04), dual-antiplatelet therapy (1.44, 1.01-2.05), CABG
operation type (2.55, 1.84-3.54). Discussion: Being at higher risk of
surgical site infection, diabetic patients, those requiring longer CPB,
with higher BMI or undergoing CABG (likely due to saphenous vein harvest)
may benefit from additional prophylactic interventions. Intensive
postoperative glucose control may reduce surgical site infections.

<78>
Accession Number
621236792
Author
Espada Guerreiro C.; Almeida J.; Dias T.; Barbosa A.; Silva M.; Teixeira
P.; Caeiro D.; Sampaio F.; Ribeiro J.; Fontes-Carvalho R.; Rodrigues A.;
Braga P.; Melica B.; Gama-Ribeiro V.
Institution
(Espada Guerreiro, Almeida, Dias, Barbosa, Silva, Teixeira, Caeiro,
Sampaio, Ribeiro, Fontes-Carvalho, Rodrigues, Braga, Melica, Gama-Ribeiro)
Hospital Center of Vila Nova De Gaia/Espinho, Cardiology, Vila Nova De
Gaia, Portugal
Title
Aortic valve hemodynamic deterioration after transcatheter aortic valve
implantation (TAVI) and its association with anti-thrombotic therapy.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 873-874), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The balance between ischemic and bleeding risk in TAVI
patients is difficult to achieve. There seems to be a mild increase in
transvalvular gradients over time after TAVI and it is unknown if
antithrombotic therapy can reduce the risk of hemodynamic deterioration.
Purpose: This study aimed to evaluate the modification of transvalvular
aortic valve gradients after TAVI, and the association with
anti-thrombotic therapy at discharge. Methods: Retrospective single-centre
study including patients with severe aortic stenosis consecutively
referred for TAVI, from 2007 and 2016. We evaluated transaortic gradients
by transthoracic echocardiography at discharge and in a mean follow up
(FUP) of 8+/-4 months. We defined aortic valve hemodynamic deterioration
(VHD) as an increase of >=10 mmHg in mean transaortic gradients during
FUP. Patients were grouped according to the specific anti-thrombotic
therapy at discharge (single anti-platelet therapy with aspirin - SAPT vs.
dual anti-platelet therapy - DAPT with aspirin plus clopidogrel vs. oral
anti-coagulation - OAC with warfarin). Results: We included 232 patients,
mean age 78.6+/-8.1 anos, 51% female, STS mortality risk score 4.8% (IQR
3.1-7.0). At discharge, 50% (n=116) were medicated with DAPT, 18.1% (n=42)
with SAPT, 31.9% (n=74) with OAC. The main reason to begin or maintain OAC
was atrial fibrillation (80.3%). In our cohort, there wasn't a significant
maximum and mean gradients change between discharge and FUP (mean gradient
11.6+/-6.2 mmHg vs. 11.5+/-7.2 mmHg; p=NS). At FUP, patients under OAC had
lower aortic mean gradients (9.9+/-4.5 for OAC vs. 11.7+/-7.4 DAPT vs.
13.3+/-9.8 mmHg SAPT; p=0.044). Aortic valve hemodynamic deterioration
occurred less frequently in patients under OAC (1.4% vs. 9.5% SAPT+DAPT;
p=0.023). In univariate analysis, factors associated with VHD were:
absence of OAC (p<0.05), need for repositioning the aortic prosthesis
during the procedure (p<0.05), valve-in-valve procedure (p=0.006) and
smaller prosthesis (p=0.024). The smaller valve size implanted was the
only independent predictor of VHD (OR 1.44; IC 95% 1.07-1.94; p=0.017).
Conclusions: One third of patients that undergone TAVI procedure were
discharged under OAC. Those patients had lower mean aortic gradients at
FUP and lower incidence of VHD. Technical aspects of the procedure were
also relevant, and specifically smaller prosthesis was an independent
predictor of VHD, possibly because of suboptimal valve sizing.

<79>
Accession Number
621236740
Author
Higgins J.; Bashir J.; Abel J.; Humphries K.H.; Daniele P.R.; Lee M.K.
Institution
(Higgins) St. Mary's Hospital, Cardiac Surgery, Kitchener, Canada
(Bashir, Abel) St Paul's Hospital, Cardiac Surgery, Vancouver, Canada
(Humphries, Daniele, Lee) BC Centre for Improved Cardiovascular Health,
Vancouver, Canada
Title
Does dual-antiplatelet therapy decrease the risk of stroke following
coronary artery bypass grafting?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 823), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Stroke can be a devastating complication following coronary
artery bypass grafting (CABG). Recent trials suggest increased rates of
stroke in CABG vs percutaneous coronary intervention (PCI), even beyond
the first 30 days. There are suggestions that differences in medical
management between these 2 groups, including increased use of dual
antiplatelet therapy (DAPT) post-PCI, may contribute to differences in
mid-term rates of stroke. Purpose: To determine whether the use of DAPT
post-operatively, compared to ASA alone, decreases the risk of stroke
after discharge, following isolated CABG. Methods: Prospectively
maintained provincial registry accessed to identify all residents, >=20
years of age, undergoing primary isolated CABG between April 2007-December
2012, and discharged home on either (1)ASA or (2)ASA & clopidogrel (DAPT).
Baseline characteristics compared using Chi-square and Wilcoxon rank sum
tests. Fisher's exact test used to compare 30-day mortality and combined
30-day stroke/death. Cumulative mortality and cumulative stroke/death
curves calculated up to 5 years. Five year cumulative event rates
estimated using Kaplan-Meier method. Cox proportional hazards model used
to determine unadjusted and adjusted hazard ratios for DAPT use on 5-year
stroke/death outcome. Results: 8197 adults meeting inclusion criteria
underwent primary isolated CABG. Among this cohort, 12.9% were discharged
on DAPT. Prior myocardial infarction, prior cerebrovascular accident,
peripheral vascular disease, chronic obstructive pulmonary disease, and
prior PCI were all more common in patients discharged on DAPT (p<0.05).
Within 30 days of discharge, 12 patients died, and 29 patients either had
a stroke or died. There were no significant differences between the 2
groups. Over the 5-year follow up, 319 patients died and 484 patients
either had a stroke or died. Again, there were no significant differences
in rates of death (log-rank p=0.81) or combined stroke/death (log-rank
p=0.48). At 5 years, rate of stroke/death was 7.3% (95% CI 6.7, 8.1) among
ASA group and 8.3% (95% CI 6.5, 10.5) among DAPT group. DAPT vs ASA was
not a significant predictor of 5-year stroke/death following isolated
CABG. Even after adjusting for 12 pre-operative and intra-operative
factors, DAPT vs ASA still was not a significant predictor of 5-year
stroke/death following isolated CABG. Conclusion: Following isolated CABG,
discharge on DAPT with ASA and clopidogrel does not decrease risk of
stroke or death, up to 5 years, compared to ASA alone. However, a
randomized trial is necessary to account for selection bias and provide
further information regarding which patients may benefit from DAPT.

<80>
Accession Number
621236622
Author
Simopoulos V.; Gionga P.; Raptis D.; Hatziefthimiou A.; Skoularigis I.;
Tsanaxidis N.; Tsilimingas N.; Aidonidis I.
Institution
(Simopoulos, Gionga, Raptis, Tsilimingas) Univ. of Thessaly, Dept. of
Thoracic and Cardiovascular Surgery, Univ. Hospital of Larissa, Larissa,
Greece
(Hatziefthimiou, Aidonidis) Univ. of Thessaly, Dept. of Physiology, School
of Medicine, Larissa, Greece
(Skoularigis, Tsanaxidis) University General Hospital of Larissa,
Cardiology, Larissa, Greece
Title
Postoperative atrial fibrillation in patients with reduced ejection
fraction heart failure undergoing cardiac surgery: Ranolazine shortens
time to conversion when added to amiodarone.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 575), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Postoperative atrial fibrillation (POAF) in patients with systolic heart
failure constitutes an emerging situation, particularly when occurring
after cardiac surgery. Amiodarone (A) alone is generally insufficient in
achieving a fast termination of AF independently from left ventricular
systolic function and atrial size. Recent investigations showed faster
restoration of sinus rhythm (SR) by the combination of A and ranolazine
(R) in patients with preserved systolic function. In this prospective,
randomized, allocation-concealed, single-blind, single-site clinical
trial, we enrolled 511 consecutive eligible patients with reduced ejection
fraction (<40%) heart failure (HF-REF) who developed POAF after elective
on-pump CABG surgery. A 35% of these patients reported at least one
episode of paroxysmal AF within the last 6 months. Preoperatively, none
patient had episodes of AF. All participants were randomized to receive
either 500 mg oral R given once at the time of randomization plus
intravenous standard dosing regimen of A (256 patients, 65+/-9 years, 86%
male) or A alone at the same dosage (255 patients, 66+/-10 years, 88%
male). Preoperative left ventricular EF values were well balanced in both
groups (36.5+/-4.7% in the A+R treated patients vs 36.4+/-4.6% in the
A-only treated patients). Left atrial diameter did not significantly
differ between the two groups (4.7+/-0.2 vs 4.8+/-0.3 cm in the A+R vs A
group, respectively). Mean time to conversion of POAF was significantly
shorter in the A+R vs A group (9.1+/-0.8 vs 14.4+/-3.9 hours,
respectively; P<.0001). Arrhythmia conversion rate during 24 hours post
intervention was 91.8% in the A+R treated patients and 14.5% in the A
group (p<.0001). Post conversion heart rate was significantly lower in the
drug-combination group vs the A-only group (77+/-8 vs 93+/-10 bpm,
P<0.0001). QTc intervals were shorter in the A+R group vs A-only group
(409+/-19 vs 428+/-24 ms, P<0.0001). No considerable cardiac or noncardiac
clinically evident adverse effects were noted especially in patients
receiving R as add-on therapy. In conclusion, A+R treatment for conversion
of POAF after cardiac surgery in patients with HF-REF was safe and more
efficacious than A monotherapy, as indicated by significantly faster SR
restoration.

<81>
Accession Number
621236453
Author
Capoulade R.; Overbey J.; Mihos C.; Acker M.; Ailawadi G.; Alexander J.;
Bowdish M.; Gammie J.; Grayburn P.; Melnitchouk S.; Michler R.; Gara P.O.;
Smith P.; Taub C.; Hung J.
Institution
(Capoulade, Mihos, Melnitchouk, Hung) Massachusetts General Hospital,
Boston, United States
(Overbey) Mount Sinai School of Medicine, New York, United States
(Acker) University of Pennsylvania, Philadelphia, United States
(Ailawadi) University of Virginia, Charlottesville, United States
(Alexander, Smith) Duke Clinical Research Institute, Durham, United States
(Bowdish) University of Southern California, Los Angeles, United States
(Gammie) University of Maryland, Baltimore, United States
(Grayburn) Baylor University Medical Center, Dallas, United States
(Michler, Taub) Albert Einstein College of Medicine, Bronx, United States
(Gara) Brigham and Women's Hospital, Boston, United States
Title
Mitral valve geometry and left ventricular to mitral ring size mismatch in
patients with ischemic mitral regurgitation post mitral annuloplasty
repair.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 754-755), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: In patients with ischemic mitral regurgitation (IMR), ring
annuloplasty is associated with a significant rate of recurrent MR. We
recently showed that the ratio of left ventricular (LV) end-systolic
dimension (LVESd)/mitral valve (MV) ring size which is a measure of the
mismatch between LV to MV ring size, is an independent predictor of
recurrent IMR (Figure). However, the mechanism underlying this association
was not directly studied. We aimed to compare MV geometry in IMR patients
with low vs high LV-MV ring ratio. Methods: Patients from two
cardiothoracic surgical network IMR trials (NCT- 00806988 and 00807040)
who underwent ring annuloplasty were eligible. Patients with low versus
high LVESd/MV ring ratio (defined as patients in the 1st and 4th quartiles
of LVESd/MV ring ratio [i.e. <1.45 and >1.81, respectively]) were
examined. Baseline pre-operative and 1 year post annuloplasty MV geometry
parameters were measured at mid-systole from the apical 3 chamber view and
included MV annulus dimension, tenting height and area, and posterior and
anterior leaflet angles. Results: At pre-operative baseline, patients in
the highest quartile of LVESd/MV ring ratio (n=41) had significantly more
MV tethering compared to those in the lowest quartile of LVESd/MV ring
ratios (n=37) (tenting height: 12.1+/-2.6 vs 9.8+/-3.3 mm, p=0.001;
tenting area: 2.79+/-0.76 vs 2.09+/-1.37cm2, p=0.001; posterior
angle: 55+/-8 vs 49+/-13degree, p=0.06; anterior angle: 41+/-10 vs
37+/-9degree, p=0.12; Table). A similar reduction in mitral annular size
was observed in both groups (21% vs 21%, p=0.91). However at 1 year post
procedure, the MV remained more tethered in patients in the highest
quartile of LVESd/MV ring ratio compared to those in the lowest quartile
of LVESd/MV ring ratio (tenting height: 10.3+/-2.9 vs 8.2+/-2.7 mm,
p=0.002; tenting area: 1.90+/-0.70 vs 1.37+/-0.89cm2, p=0.02;
posterior angle: 59+/-13 vs 53+/-13degree, p=0.03; anterior angle: 43+/-10
vs 36+/-10degree, p=0.001; Table). The relative changes in MV tethering
parameters between baseline and 1 year were not statistically different
between highest and lowest quartiles of LVESd/MV ring ratio (all p>0.05).
Conclusion: We found that patients in the highest LV-MV ring mismatch
group had more MV tethering at baseline, which persisted at 1 year
following restrictive annuloplasty for IMR. These findings highlight
persistent tethering as the main mechanism to explain the association
between LV-MV ring mismatch and recurrent IMR post annuloplasty. LVESD-MV
ring mismatch may help identify patients at higher risk of persistent MV
tethering and recurrent MR post annuloplasty (Figure Presented).

<82>
Accession Number
621236411
Author
Wolff G.; Navarese E.P.; Brockmeyer M.; Lin Y.F.; Karathanos A.;
Kolodziejczak M.; Kubica J.; Zeus T.; Westenfeld R.; Andreotti F.; Kelm
M.; Schulze V.
Institution
(Wolff, Navarese, Brockmeyer, Lin, Karathanos, Zeus, Westenfeld, Kelm,
Schulze) University Hospital Dusseldorf, Cardiology,Pulmonology and
Angiology, Dusseldorf, Germany
(Kolodziejczak, Kubica) Nicolaus Copernicus University (NCU), Bydgoszcz,
Poland
(Andreotti) Catholic University of the Sacred Heart, Rome, Italy
Title
Efficacy and safety of perioperative aspirin therapy in non-cardiac
surgery: A systematic review and comprehensive meta-analysis of randomized
controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 837), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Aspirin is a key element of prevention therapy in
cardiovascular disease (CVD) and thromboembolism. In the setting of
non-cardiac surgery however, continuation of aspirin therapy remains
questionable, with clinical trials providing inconclusive evidence about
cardiovascular benefits in comparison to bleeding risks. Purpose and
methods: To assess the value of aspirin therapy in this setting, we
performed a systematic review and comprehensive meta-analysis of all
available randomized controlled clinical trials (RCTs) on aspirin vs. no
aspirin therapy in non-cardiac surgery. Seven RCTs involving 28,302
patients were included, and perioperative clinical outcomes of all-cause
mortality, cardiovascular events, thromboembolism and major bleeding were
separately evaluated. Results: All-cause mortality was not significantly
different in aspirin vs. no aspirin groups (3.7% vs. 3.8%; odds ratio (OR)
0.97, 95% confidence interval (CI) 0.86- 1.10). The same was true for
cardiovascular mortality (2.0 (aspirin) vs. 2.1% (no aspirin)), myocardial
infarction (2.5% (aspirin) vs. 2.5% (no aspirin)), cerebrovascular events
(0.6% (aspirin) vs. 0.6% (no aspirin)) and peripheral arterial events
(0.2% (aspirin) vs. 0.3% (no aspirin)). Aspirin significantly reduced the
risk for venous thromboembolic events (1.5% (aspirin) vs. 2.0% (no
aspirin); OR 0.74 with CI 0.59-0.94. Perioperative major bleeding was
significantly more frequent in aspirin groups (4.4% vs. 3.7%; OR 1.18 with
CI 1.05-1.33, p=0.007). Aspirin's number needed to harm through major
bleeding was lower (161) than its number needed to treat for prevention of
thromboembolism (185). Conclusion: The present analysis found no influence
of aspirin therapy on survival and cardiovascular events, and a benefit in
prevention of thromboembolism came at the expense of major bleedings. The
available data do currently not support a routine perioperative
continuation of long-term aspirin therapy in CVD patients. Identification
of cardiovascular high-risk patients possibly profiting from aspirin
continuation remains challenging and needs to be further evaluated in
clinical trials.

<83>
Accession Number
621236276
Author
Fischer-Rasokat U.; Kim W.K.; Liebetrau C.; Van Linden A.; Arsalan M.;
Renker M.; Rolf A.; Moellmann H.; Walther T.; Hamm C.W.
Institution
(Fischer-Rasokat, Kim, Liebetrau, Renker, Rolf, Hamm) Kerckhoff Clinic,
Department of Cardiology, Bad Nauheim, Germany
(Van Linden, Arsalan, Walther) Kerckhoff Clinic, Department of Cardiac
Surgery, Bad Nauheim, Germany
(Moellmann) St. Johannes Hospital, Dortmund, Germany
Title
Impact of left ventricular and aortic valve characteristics on one-year
mortality of patients with low-flow low-gradient aortic valve stenosis
after transcatheter aortic valve implantation (TAVI).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 354), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Patients with severe aortic valve stenosis (AS), low
transvalvular gradients (Pmean) and depressed left ventricular (LV)
systolic function are characterised by higher overall morbidity than other
patients with AS. Purpose: We aimed to analyse the impact of parameters of
LV function and characteristics of aortic valve disease before TAVI on the
mid-term outcome after TAVI. In particular, we examined whether latent LV
functional capacity, unmasked by LV contractile reserve, can predict the
survival of these patients. Methods: This study was designed as a
retrospective landmark analysis of TAVI patients from the day of discharge
to the time point of completion of the oneyear follow-up. 34 patients (79%
male) with low-flow low-gradient AS [aortic valve area <0.6
cm2/m2, Pmean <40 mmHg, stroke volume (SV) <35
ml/m2, ejection fraction (EF) <50%] received a comprehensive
echocardiographic examination before TAVI, including low-dose dobutamine
stress testing. Results: Mortality one year after TAVI was 32% (n=11, 100%
male). Age (79.7+/-4.0 vs. 77.5+/-7.3 years; p=0.36), glomerular
filtration rate (54+/-23 vs. 59+/-21 ml/min/1.73m2; p=0.53), the incidence
of diabetes (p=0.41), coronary artery disease (p=0.47), prior myocardial
infarction (p=0.61), and prior cardiac surgery (p=0.52) or stroke (p=0.35)
were not different between non-survivors and survivors. Non-survivors
tended to have a higher EUROscore II (14.0+/-11.4 vs. 8.0+/-6.7%; p=0.07).
LV mass (131+/-24 vs. 138+/-44 g/m2; p=0.70), Pmean (18.5+/-5.6
vs. 19.4+/-4.8 mmHg; p=0.64), and aortic valve area (0.48+/-0.08 vs.
0.47+/-0.10 cm2/m2; p=0.69) were not different between groups.
While the EF tended to be lower in non-survivors (27.5+/-8.6 vs.
34.5+/-9.7%; p=0.05), SV was similar between groups (24.7+/-5.6 vs.
25.2+/-5.3 ml/m2; p=0.79). The LV contractile reserve did not
differ between non-survivors and survivors (26.7+/-15.7 vs. 31.5+/-20.5;
p=0.50), but the stress-induced increase in transvalvular flow tended to
be higher in survivors (46.5+/-22.2 vs. 68.0+/-37.2 ml/s; p=0.09). The
Agatston mean calcium score was slightly higher in non-survivors than in
survivors (1942+/-841 vs. 1396+/-605; p=0.05). We determined the area
under the curve (AUC) of the receiver-operating characteristic (ROC) curve
to evaluate the test performance of parameters with borderline
significance as a predictor of mortality after TAVI. Only the Agatston
score (AUC of 0.72, 95% CI 0.52 - 0.92; p=0.048) emerged as a useful
predictor of one-year mortality, whereas EF (AUC of 0.32) and the increase
in transvalvular flow (AUC of 0.28) did not. Conclusions: In our patients
with low-flow low-gradient AS, parameters of LV function or LV contractile
reserve or hemodynamic characteristics of AS had no predictive value for
one-year mortality after successful TAVI. Only the degree of aortic valve
calcification emerged as a marker, which may potentially be useful to
estimate the mid-term risk in these patients.

<84>
Accession Number
621236164
Author
Wang T.K.M.; Liao Y.W.; Wang M.T.M.; Wheeler M.
Institution
(Wang, Liao, Wheeler) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) University of Auckland, Department of Medicine, Auckland, New
Zealand
Title
Meta-analysis of surgical repair or replacement for rheumatic mitral valve
disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 958-959), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Rheumatic heart disease remains one of the leading causes of
valvular heart disease worldwide despite being a preventable condition.
Valve repair is superior to replacement in degenerative mitral valve
disease, however their relative efficacies is controversial in rheumatic
heart disease, in part because of differing and mixed lesions and
pathologies, technical challenges, and recurrent events. This
meta-analysis compared mitral valve repair and replacement surgery for
rheumatic mitral valve disease. Methods: We searched Medline, Embase,
Cochrane and Scopus databases from January 1980 to June 2016 for original
studies reporting outcomes of both mitral valve repair and replacement in
rheumatic heart disease. Two authors independently assessed studies for
inclusion, followed by data extraction and analysis. Results: The search
yielded 933 articles, with 100 full-texts reviewed after initial screening
and 17 studies were included for analysis, totaling 1982 mitral valve
repairs and 3426 replacements. Pooled rates and odds ratio (95% confidence
interval) for operative mortality of repair versus replacement was 3.2% vs
4.3%, 0.68 (0.50-0.92; p=0.01). Pooled odds ratios (95% confidence
interval) were for longterm mortality 0.41 (0.30-0.56; p<0.001); valve
related mortality 0.23 (0.14-0.37; p<0.001); re-operation 3.02 (1.72-5.31;
p<0.001); and bleeding 0.26 (0.11-0.63; p=0.003). There was a trend
towards lower thrombo-embolism 0.42 (0.17-1.03; p=0.06) and no significant
difference in endocarditis (p=0.76) rates during followup. Conclusion:
Mitral valve repair is associated with reduction in operative and longterm
mortality and bleeding, so is recommended to be performed in rheumatic
mitral valve disease where feasible, although it does have higher rates of
reoperations during follow-up.

<85>
Accession Number
621236019
Author
Sano T.; Ishigami S.; Ousaka D.; Hirai K.; Goto T.; Kasahara S.; Ohtsuki
S.; Sano S.; Oh H.
Institution
(Sano, Ishigami, Ousaka, Hirai, Goto, Kasahara, Sano) Okayama University
Hospital, Cardiovascular Surgery, Okayama, Japan
(Ohtsuki) Okayama University Hospital, Pediatrics, Okayama, Japan
(Oh) Okayama University Hospital, Regenerative Medicine, Okayama, Japan
Title
Transcoronary cardiac progenitors in patients with functional single
ventricle: Two-year follow-up of the phase 1/2 clinical trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 865), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Single ventricle physiology is a fatal congenital heart
disease. Patients who have undergone a series of staged palliation remain
at risk for the development of late-onset heart failure.
Cardiosphere-derived cells (CDCs) have shown to reduce myocardial fibrosis
and increase ventricular function in preclinical studies. Purpose: We
aimed to assess safety and efficacy of intracoronary infusion of
autologous CDCs in patients with single ventricle physiology. Methods: In
the prospective, randomized phase 1/2 clinical trials, we enrolled 48
children (2.8+/-1.4 yr) with single ventricle physiology 4 weeks after
surgical palliation between January, 2011, and March, 2015. For 24
patients assigned to receive CDCs, autologous CDCs (3.0x105 cells per
kilogram of the body weight) were isolated from atrial tissue harvested
during cardiac surgery and selectively infused into coronary arteries 4
weeks after staged palliation. Treatment arm was compared with 24 controls
who received cardiac reconstruction alone. Among the control subjects, 17
participants received late CDC infusion upon request as an ethical
consideration. The primary endpoint was to assess the safety and
feasibility of such an approach in children and the efficacy endpoints
were determined by the cardiac function improvement on MRI and reduction
of heart failure status. Multiple linear regression analysis was performed
to investigate the prognostic factors that may impact on cardiac function
improvement. Results: There were no 30-day treatment-emergent serious
adverse events and no patients had died or developed cardiac tumors by
2-year observation. Forty-one patients have received CDC infusion at final
analysis. Compared with controls, CDC-treated patients showed
significantly improved cardiac function (P<0.01) and regional
contractility as well as reduced myocardial fibrosis (P<0.01) measured by
MRI. These clinical outcomes could be addressed by marked decrease in BNP
levels (P<0.001) and reduction of ventricular stiffness (P<0.001) and
heart failure status (P<0.001), resulting in reduced parenting stress at
2-year compared with baseline. Although the therapeutic effects had
specifically impact on patients with heart failure with reduced ejection
fraction rather than those with preserved ejection function, CDC infusion
substantially produced a marked improvement in regional contractile and
diastolic functions in both types of heart failure. In multivariate
prediction analysis, the ventricular function and weight for age z score
at CDC infusion were identified as dominant variables to predict the
functional improvement (P=0.001). Conclusion: In the phase 1/2 clinical
trials, intracoronary infusion of autologous CDCs in 41 patients with
functional single ventricle was feasible and safe and demonstrated a
durable effect at 2-year, manifested by significant improvement in
ventricular function, heart failure status, and concordant outcomes of
healthrelated quality of life.

<86>
Accession Number
621235885
Author
Chen C.Y.; Hsieh C.F.; Yeh H.I.
Institution
(Chen, Yeh) Mackay Memorial Hospital, Cardiovascular, Taipei, Taiwan
(Republic of China)
(Hsieh) E-Da univeristy, Medicine department, Kaosiung, Taiwan (Republic
of China)
Title
Effects of Clopidogrel and proton pump inhibitors on cardiovascular events
in patients with type 2 diabetes mellitus after bare metal stent
implantation: A nationwide cohort study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 879-880), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Objective: To investigate whether there is an increased risk of cardiac
events in diabetic patients with a combined therapy of clopidogrel (CLO)
and proton pump inhibitors (PPIs) after bare metal stent (BMS) deployment.
Methods: Using the National Health Insurance Research Database (NHIRD),
all patients undergoing deployment of BMS received a therapy of CLO
with/without PPIs for 90 days. The end points were acute coronary syndrome
(ACS) and readmission for revascularization (percutaneous coronary
intervention or coronary artery bypass graft surgery) after 3, 6, and 12
months. Results: There were 6,757 patients with diabetes who received BMS
(6,243 in the CLO subgroup and 514 in the CLO plus PPIs subgroup). The
patients who received CLO plus PPIs showed no increase in adverse
cardiovascular events compared with those who received CLO within one year
after BMS deployment (3-month hazard ratio (HR) = 0.87, 95% confidence
interval (CI), 0.65-1.15; 6 months HR = 0.95, 95% CI, 0.78-1.15; 1 year HR
= 0.60, 95% CI, 0.81-1.12). Conclusion: In diabetic patients with BMS
deployment, there was no evidence of an increased risk of CV events among
concomitant users of CLO and PPIs. Our study indicated that the use of
PPIs as a class may not modify the protective effect of CLO after BMS
implantation. (Figure Presented).

<87>
Accession Number
621235870
Author
Makkiya M.; Algodi M.; Villablanca P.; Bulcha N.; Briceno D.; Kargoli F.;
Garcia M.
Institution
(Makkiya, Villablanca, Bulcha, Briceno, Kargoli, Garcia) Albert Einstein
College of Medicine, New York, United States
(Algodi) St. Barnabas Hospital, New York, United States
Title
Prophylactic antiplatelet therapy is superior to anticoagulation after
surgical bioprosthetic aortic valve replacement: A meta-analysis and
meta-regression.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 633), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The use of anticoagulation (AC) or antiplatelet therapy (APLT)
after surgical bioprosthetic aortic valve (SAVR) replacement remains
controversial and still debated. Purpose: Our objective was to evaluate
the efficacy and safety of AC therapy with vitamin K agonists (VKA)
compared with APLT in patients who underwent SAVR. Methods: A
comprehensive search of PubMed, EMBASE, Cochrane Central Register of
Controlled Trials, conference proceedings, and relevant Web sites from
inception through February 2017. The primary endpoint was thromboembolism.
Secondary endpoints included major bleeding, all-cause mortality, repeat
surgery and heart failure New York Association Class III-IV. Odds ratios
(OR) and 95% confidence intervals (CI) were computed using the
Mantel-Haenszel (MH) method. Fixed-effect model was used; if heterogeneity
(I2)>25, effects were obtained using a random model. Meta-regression was
performed with unrestricted maximum-likelihood method (inverse
variance-weighted regression) on the OR log-transformed before being used
as independent variables in linear meta-regression analyses. Results: Ten
studies enrolling 19,958 patients met the inclusion criteria. The mean
duration of follow-up was 12 months. There was a significant difference
favoring APLT with a lower incidence of thromboembolism (OR, 0.59; 95% CI
0.39-0.90) and major bleeding (OR, 0.42; 95% CI 0.21-0.83) events; see
figure 1 for overall results. No differences were found for all-cause
mortality (OR, 0.69; 95% CI 0.37-1.27), repeat valve surgery (OR, 0.42;
95% CI 0.04-4.70) or heart failure (OR, 0.77; 95% CI 0.42-1.40).
Meta-regression analysis showed that male sex was an independent predictor
of thromboembolism in patients receiving A APLT after SAVR (p<0.05). No
statistically significant associations were found for age, hypertension,
diabetes mellitus, or heart failure. Conclusion: Our meta-analysis showed
that the use of APLT compared to AC therapy with VKA after a surgical
bioprosthetic valve replacement resulted in lower rates of thromboembolism
and major bleeding. Male gender was associated with increased risk of
thromboembolism. (Figure presented).

<88>
Accession Number
621235851
Author
McClure G.R.; Belley-Cote E.P.; Tong W.; Jaffer I.H.; Healey J.; Singal
R.K.; Lamy A.; Whitlock R.P.
Institution
(McClure) McMaster University, Undergraduate Medicine, Hamilton, Canada
(Belley-Cote) McMaster University, Medicine, Hamilton, Canada
(Tong, Healey) Population Health Research Institute, Hamilton, Canada
(Jaffer, Lamy, Whitlock) McMaster University, Cardiac Surgery, Hamilton,
Canada
(Singal) University of Manitoba, Cardiac Surgery, Winnipeg, Canada
Title
Surgical ablation of atrial fibrillation evaluation (SAFE): A cost
analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 667), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: International guidelines currently recommend concomitant
surgical ablation of atrial fibrillation (AF) in patients with known AF
undergoing cardiac surgery. However, recent meta-analyses of randomized
controlled trials (RCTs) show no significant difference in clinically
meaningful outcomes including mortality and stroke in patients who undergo
surgical ablation of AF compared to those who do not. Surgically forced
maintenance of sinus rhythm, of dubious clinical relevance, is the only
observable benefit; and is not achieved in all patients. Based on LAAOS II
data, 10 percent of patients undergoing cardiac surgery have a history of
AF. Purpose: Given the absence of clear clinical benefit, we aimed to
assess the incremental costs associated with current practice patterns of
surgical ablation of AF. Methods: We describe the additional cost incurred
at hospital discharge by performing surgical AF ablation per 1000 cardiac
surgeries in patients with known AF. To estimate clinical outcomes, we
used results from a recent systematic review of 23 RCTs which demonstrated
no difference in mortality or stroke with surgical AF ablation, but an
increase in hospital length of stay (LOS) of 1.67 days. We used data from
the ongoing LAAOS III trial to assess the proportion of cardiac surgery
patients with AF who undergo concomitant AF ablation (33%) and the
breakdown of technique used (69% radiofrequency, 19% cryoablation, 10%
cut-and-sew). Incremental costs incurred included the ablation device
costs, professional fees, increase in LOS, and increased requirement for
pacemaker implantation. Institutional costs were based on average costs
for large academic centers in Ontario, professional fees based on Ontario
fee schedule and device costs based on Canadian industry data. Results:
The estimated average extra cost of surgical ablation of AF is $4269.05
CAD (95% CI 4096.91 to 4598.19) per patient ablated. Given observed rates
of ablation, the gross cost associated with these procedures per thousand
AF patients undergoing cardiac surgery is therefore $1,408,786.78 CAD (95%
CI 1,351,981.28 to 1,517,401.97). The majority of this is contributed by
initial procedure costs (82.3%), while a smaller portion is related to the
increased need for pacemaker (3.9%) and increased hospital LOS (13.8%).
Conclusion: With ever increasing health care costs and the need for fiscal
responsibility in health care systems, a $4250 CAD procedure with no
proven clinical benefit such as surgical ablation of AF is difficult to
justify until research demonstrates its impact on clinically meaningful
outcomes.

<89>
Accession Number
621235787
Author
Hsieh W.C.H.; Lindner J.L.; Chen P.L.C.; Henry B.M.H.
Institution
(Hsieh, Lindner) First Faculty of Medicine, Charles University in Prague,
2nd Department of Cardiovascular Surgery, Prague, Czech Republic
(Chen) Division of Cardiovascular Surgery, Department of Surgery, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Henry) Jagiellonian University Medical College, Faculty of Medicine,
Krakow, Poland
Title
Incidence, predictors, and prognostic values of periprocedural myocardial
injury in patients undergoing transcatheter aortic valve implementation
for aortic stenosis: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 666), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implementation (TAVI) is the
procedure of choice for patients with severe aortic stenosis who are at
high risk for conventional surgery. Myocardial injury is a common
complication after TAVI, but its occurrence and clinical relevance remain
unclear. Purpose: This meta-analysis aimed to evaluate the incidence,
predictors, and prognostic values of periprocedural myocardial injury
after TAVI. Methods: Medline, EMBASE, Web of Science, Cochrane Database,
and CNKI database were searched, supplemented by a manual search of
bibliographies. Relevant studies were assessed for methodological quality
and their reported incidence rates of myocardial injury extracted. Pooled
incidence rates were calculated using a random effects model. Information
on the predictors and prognostic values of myocardial injury were also
extracted and assessed. Results: Our search returned 283 records, with 22
studies from 7 countries meeting the selection criteria. The calculated
pooled myocardial injury incidence rate was 2.0% (95% CI: 1.4%-2.5%).
Periprocedural myocardial injury was independently predicted by procedural
duration, peripheral arterial disease, major bleeding, the use of a
self-expandable valve, preprocedural beta-blocker use, and renal
insufficiency (all P's<0.05). The occurrence of myocardial injury was
associated with poorer clinical outcomes, including preprocedural
hospitalization, left ventricular ejection fraction (LVEF), and short- and
mid-term mortality (P<0.05). Conclusions: Periprocedural myocardial injury
occurs in about one in fifty patients undergoing TAVR. As this injury was
found to be significantly associated with poorer clinical outcomes,
clinicians should aim to minimize the observed risk factors when possible.

<90>
Accession Number
621235756
Author
Chang W.T.; Wu N.C.; Liao C.T.; Chang C.L.; Ho C.H.; Chen Z.C.
Institution
(Chang, Liao, Chen) Chi-Mei Medical Center, Cardiology, Tainan, Taiwan
(Republic of China)
(Wu) Chi-Mei Medical Center, Cardiovascular Surgery, Tainan, Taiwan
(Republic of China)
(Chang, Ho) Chi-Mei Medical Center, Medical Research, Tainan, Taiwan
(Republic of China)
Title
The impact of warfarin on the long term survivals of patients undergoing
bioprosthetic aortic valve replacement.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 666), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The need for anticoagulation after surgical aortic valve
replacement (AVR) with bioprosthetic valves is not well examined. In this
study, we aimed to investigate the associations of warfarin treatment with
the risk of major adverse cardiovascular events (MACEs), bleeding
incidents and the requirement of reoperation after bioprosthetic AVR
surgery. Methods: We identified 1007 patients who received the first
bioprosthetic AVR from Taiwan's National Health Insurance Database between
2001 and 2010, excluding those with prior use of Warfarin, dual valve
procedures, prior valve surgeries or concomitant with other surgeries.
These patients were divided to two groups according to free from Warfarin
use (N=298) and less than three month use of Warfarin (N=718). The median
follow up duration were 36 months. Results: Compared with non-Warfarin
user, patients received Warfarin were at their younger age (68.4+/-14.0
vs. 66.1+/-13.2, p=0.01) and free from kidney disease. Interestingly,
despite a decrease of MACE in patients receivedWarfarin, the risk of MACE
rebounded in patients under Warfarin for a longer duration (31-90 days)
had non-significantly higher risk than those for a less than 30 day use
(adjusted HR: 1.07 and 0.53, respectively). In contrast, no significant
differences of bleeding and the risk of reoperation were observed in
between non-Warfarin user and patients receiving various durations of
Warfarin. Older patients suffered from higher risks of post-operative
MACEs and bleeding. Also, patients with comorbidities including
hyperlipidmeia and renal diseases encountered an increased incidence of
bleeding. Conclusions: The short term use of postoperative warfarin (less
than 30 days) following bioprosthetic AVR reduces the incidence of MACEs
compared with those of non-users. However, the benefit diminished in the
prolonged use (31- 90 days). Conversely, the risks of bleeding and
reoperation were not insignificant between groups.

<91>
Accession Number
621235614
Author
Gomez Polo J.C.; Vilacosta I.; Martin-Garcia A.C.; Fortuny E.;
Fernandez-Perez C.; Garcia-Bouza M.; Carnero M.; Vivas D.; Higueras J.;
Cobiella J.; Ferrera C.; Martin-Benitez J.C.; Acedo Diaz-Pache M.V.; Olmos
C.; Maroto L.
Institution
(Gomez Polo, Vilacosta, Vivas, Higueras, Ferrera, Olmos) Hospital Clinic
San Carlos, Cardiovascular Institute., Madrid, Spain
(Martin-Garcia) Hospital Clinico Universitario, Department of Cardiology,
Salamanca, Spain
(Fortuny) University Hospital Son Espases, Department of Cardiology, Palma
De Mallorca, Spain
(Fernandez-Perez) Hospital Clinic San Carlos, Madrid, Spain
(Garcia-Bouza, Carnero, Cobiella, Maroto) Hospital Clinic San Carlos,
Department of Cardiovascular Surgery, Madrid, Spain
(Martin-Benitez) Hospital Clinic San Carlos, Intensive Care Unit, Madrid,
Spain
(Acedo Diaz-Pache) Hospital Clinic San Carlos, Department of
Anesthesiology, Madrid, Spain
Title
Use of corticosteroids in the prophylaxis of atrial fibrillation after
cardiac surgery (ECOFA study).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 580-581), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is a frequent complication after
cardiac surgery, associated with hemodynamic deterioration, prolonged
hospital stay, increased risk of stroke and mortality. Although the
pathogenesis of postoperative AF is multifactorial, inflammation may play
a key role as a transient trigger mechanism. Purpose: To assess the
effects of corticosteroids on the occurrence of postoperative AF. Methods:
A prospective, randomized, double-blind, placebo-controlled clinical trial
(ECOFA study) was designed. Patients without prior history of AF or atrial
flutter and scheduled to undergo cardiac surgery (coronary artery bypass
graft surgery, valve replacement or combined surgery) were randomized to
receive either corticoids or placebo as follows: 500 mg of
methylprednisolone or an equal volume of normal saline after induction of
anesthesia and 4 mg of dexamethasone or placebo every 8 hours during 24
hours after surgery. All patients were treated with oral carvedilol before
and after surgery. Patient rhythm was monitored by continuous telemetry
during the immediate postoperative period and with a Holter recording
throughout the patients' hospital stay. Results: A total of 104
consecutive patients were randomized to either of the two strategies (52
patients each arm), with similar distribution of cardiovascular risk
factors and baseline characteristics. AF developed in 18,4% (9 patients)
in the treatment group in contrast to 28,6% (14 patients) in the control
group. In patients receiving corticosteroids, a relative decrease of 44%
in the incidence of postoperative AF was documented [OR 0,56 CI 95%
(0,33-0,96, p=0,035)]. No difference in the incidence of postoperative
complications and adverse effects due to corticosteroid therapy were
observed. Conclusion: Prophylactic short-term use of corticosteroids
during and after cardiac surgery proved to be safe and effective in
reducing the incidence of postoperative AF. (Table Presented).

<92>
Accession Number
621235569
Author
Belley-Cote E.P.; Whitlock R.P.; Ulic D.V.; Honarmand K.; Khalifa A.;
McClure G.R.; Alshamsi F.; D'Aragon F.; Rochwerg B.; Duan E.; Savija N.;
Karachi T.; Lamontagne F.; Devereaux P.J.; Cook D.J.
Institution
(Belley-Cote, Whitlock, Ulic, Khalifa, McClure, Rochwerg, Duan, Savija,
Karachi, Devereaux, Cook) McMaster University, Hamilton, Canada
(Honarmand) University of Western Ontario, London, Canada
(Alshamsi) United Arab Emirates University, Al Ain, United Arab Emirates
(D'Aragon, Lamontagne) Sherbrooke University, Sherbrooke, Canada
Title
The PROTROPICS feasibility: Prognostic value of elevated troponins in
critical illness.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 595), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Troponins are sensitive and specific markers of cardiac
injury, most commonly used in clinical practice for the diagnosis of
myocardial infarction (MI). Critically ill patients frequently have
elevated troponins. Whether fulfilling criteria for MI or not,
observational evidence to date shows that elevated troponins in critical
illness are associated with an increased risk of death when adjusted for
other confounding factors. Purpose: We aimed to assess the feasibility of
a large study to ascertain the prognostic value of troponin elevations on
hospital mortality in critically ill patients. Methods: We recruited
patients in 4 academic medical and surgical intensive care units (ICUs) in
Canada. All patients admitted to participating ICUs during the 1 month
enrolment period were eligible. We excluded cardiac surgical patients and
patients who were admitted and either died or were discharged within 12
hours. Using a deferred consent model, while the patients were in the ICU,
we obtained high sensitivity troponin T and ECGs daily for 1 week, every
other day for 3 weeks and then weekly for 2 months. Clinicians were
blinded to the study troponins and ECGs. Data on the patients' symptoms,
medications, laboratory results, and clinical events were also collected.
We defined MI using the third universal definition. ECG adjudicators were
blinded to the troponin measurements. Patients were followed until
hospital discharge, death or for a maximum of 3 months. Results: We
screened 304 admissions; 282 patients were eligible. Full consent was
provided by 81% of patients/substitute decision makers and 12% consented
to the use of collected data but declined further participation. Overall,
99 (38%) suffered an MI, 31 (12%) had an isolated troponin elevation, and
132 (50%) had no troponin elevation. The crude hospital mortality rate was
9% in those without a troponin elevation, but 29% with an isolated
troponin elevation (RR 3.0, 95% confidence interval [CI] 1.1 to 7.6) and
29% with an MI (RR 3.1, 95% CI 1.5 to 6.3). In a logistic regression model
that adjusted for APACHE II score and vasopressor use, MI was not
associated with an increase in hospital mortality (aOR 2.1, 95% CI 0.9 to
5.1, p=0.09); isolated troponin elevation also was not associated with
hospital mortality (aOR 2.3, 95% CI 0.7 to 7.9, p=0.2). Conclusion:
Troponin elevations and troponin elevations meeting MI criteria are
frequent during critical illness and these patients are at higher risk of
mortality compared to patients who do not have a troponin elevation.
Whether the association of troponin elevation with death in the ICU is
independent of other prognostic factors remains uncertain. This pilot
study has established the feasibility of conducting a large-scale
investigation addressing this issue.

<93>
Accession Number
621235507
Author
Talasaz A.H.; Daei M.D.; Karimi A.K.
Institution
(Talasaz, Daei, Karimi) Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Potential role of vitamin D supplementation in the prevention of atrial
fibrillation after coronary artery bypass grafting in vitamin D deficient
patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 579-580), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Post operative atrial fibrillation (POAF) is the most common
complication after cardiac surgery. with an incidence of 15 to 40 percent
following coronary artery bypass graft surgery (CABG).Its mechanism is
multi-factorial including an increase in the sympathetic tone and release
of pro-inflammatory cytokines. Purpose: Vitamin D may have
anti-inflammatory effects by reducing the levels of pro-inflammatory
biomarkers and inhibition of renin-angiotensin-aldosterone system. The aim
of this study is to assess the potential role of vitamin D supplementation
in patients with vitamin D deficiency preoperatively. Methods: In this
open-label randomized clinical trial (IRCT201212288698N6), a total of 196
patients with 25 hydroxy vitamin D [25(OH) vit D] levels of less than
30ng/ml, candidates for CABG in a university affiliated hospital were
included. Among them, 93 (47.4%) patients received 600000IU vitamin D3
three days before surgery (Group A) and 103 (52.6%) patients did not
receive any supplementation (Group B).The 25(OH) vit D level was assessed
48 hours after surgery and ECG was monitored until 120 hours after
surgery.Any AF rhythm lasting for more than 5 minutes was recorded.
Results: Both groups had similar baseline characteristics. Baseline levels
of 25(OH) vit D in Groups A and B were 14.7+/-7.7 and 16.2+/-7.9ng/ml,
respectively (p=0.194). In Group A, POAF was observed in 9 (9.7%) patients
compared to 21 (20.4%) patients in Group B (p=0.038). Serum creatinine
change after surgery was 0.07 (0.03-0.17) in group A and 0.12 (0-0.3) in
group B (p=0.2). Mean ICU stay was 2.2+/-0.12 in Group A and 3.86+/-0.67
in Group B (p<0.0001). Conclusion(s): Vitamin D3 supplementation can
decrease the rate of POAF after CABG. This can be helpful because vitamin
D has no prevalent side effect. Considering the higher prevalence of POAF
in valvular patients, vitamin D supplementation in deficient patients can
be the next step. (Table Presented).

<94>
Accession Number
621235481
Author
Singh S.; Ismail I.; Dhillon A.S.; Arora R.
Institution
(Singh, Ismail, Dhillon, Arora) Rosalind Franklin University,
Cardiovascular Medicine, North Chicago, United States
Title
Successful PCI of chronic total occlusion of coronary arteries with drug
eluting stents improves outcomes: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 859-860), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: There are limited data on outcomes of coronary Chronic Total
Occlusion (CTO) intervention with Drug Eluting Stents (DES). Methods: We
conducted a meta-analysis to evaluate clinical outcomes of CTO (>3 Month
duration) Percutaneous Coronary Intervention (PCI) with DES among patients
with successful vs failed procedures. Failed procedures group was
considered control. PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials were searched for studies comparing successful vs failed
CTO-PCIs. Pooled estimates were calculated using Der-Simonian and Laird
random-effects models. Results: Nine studies comprising of 4, 840 patients
and weighted mean follow up of 2.8 years (range 2-7) met inclusion
criteria. Median success rate was 75.4% (range 53.9-86.4). Successful
CTO-PCI was associated with significantly lower risk of all-cause
mortality [Relative Risk (RR): 0.51; 95% Confidence Interval (CI):
0.38-0.66], major adverse cardiovascular events (MACE) (RR: 0.58; CI:
0.39- 0.86), myocardial infarction (RR: 0.51; CI: 0.28-0.92) and incidence
of coronary artery bypass graft (CABG) (RR: 0.18; CI: 0.09-0.36) [Fig. 1].
Statistical heterogeneity (I2) was low except in case of MACE. Conclusion:
Successful PCI of CTO with DES significantly reduces all-cause mortality,
MACE, myocardial infarction, incidence of CABG. Therefore, PCI should be
attempted in selected patients with CTOs to improve long term outcomes.

<95>
Accession Number
621235431
Author
Spinarova L.; Spinar J.; Parenica J.; Ludka O.; Spinarova M.; Labr K.;
Malek F.; Ostadal P.; Vondrakova D.; Jarkovsky J.
Institution
(Spinarova, Spinarova, Labr) Masaryk University, St. Anne's Faculty
Hospital, 1st Department of Internal Medicine-Cardioangiology, Brno, Czech
Republic
(Spinar, Parenica, Ludka) University Hospital and Masaryk university,
Internal Cardiologic Dpt, Brno, Czech Republic
(Malek, Ostadal) Homolka Hospital, Cardiologic Dpt, Praha, Czech Republic
(Vondrakova, Jarkovsky) Masaryk University, Faculty of Medicine, Institute
for Biostatistics and Analysis, Brno, Czech Republic
Title
Prognostic impact of new humoral substances in chronic heart failure.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 907), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Aim: To evaluate the impact of new humoral substances on one year survival
of patients with stable systolic chronic heart failure (CHF). Methods: The
FAR NHL (FARmacology and NeuroHumoraL activation) registry is a database
of patients treated in departments with specialized HF care in three
University hospitals. Anamnestic data were prospectivelly collected from
November 2014 till November 2015. The patients should be treated for
systolic heart failure (EF <50%) and stable for at least one month, follow
up was one year. Copeptin, mid regional-proadrenomedullin (MR-pADM),
galectin3, NGAL, soluble lectin-like oxidized LDL receptor-1 (sLOX-1),
pentraxin 3 ((PTX3) and 3-Nitrotyrosine (3-NT) were measured. Primary
endpoint after 1 year follow-up was: death or hospitalization for
decompensation of HF or heart transplantation or LVAD implantation.
Results: 1050 patients were included, mean age 65 years, 80.8% were male.
The etiology of CHF was ischemic heart disease in 49.4%, dilated
cardiomyopathy in 42.3% and 8.3% were classified as other. Mean EF was
30%, median of blood pressure was 128/80 mmHg, median of heart rate 72
13.0% were classified as NYHA I, 61.3% NYHA II and 24.7% as NYHA III and
IV. Patients without primary endpoint (death or hospitalization for
decompensation of HF or heart transplantation or LVAD implantation) were
assigned as group A (906 pts), those with the primary endpoint group B
(144 pts). There were statistically significant differences between the
groups in the levels of copeptin: group A median 15.9 pmol/l (3.4-50.9) vs
group B 23.7 pmol/l (5.0-89.44) (p<0.001), MR-pADM: group A median 0.63
nmol/l (0.32-1.34) vs group B 0.74 nmol/l (0.4-1.94) (p<0.001) and PTX3
group A median 0.7ng/ml (0.24-2.79) and group B 0.9 ng/ml (0.37- 44.07)
(p<0.001). There were no differences between the groups in other
substances: galectin3, NGAL, sLOX-1 and 3-NT. Copeptin had sensitivity
50.6% and specificity 73.4%, MR-pADM 78.3% and 43.5%, PTX3 93.9% and 35.2%
respectively. Summary: Higher levels of new humoral substances: copeptin,
MR-pADM and PTX3 might identify HF patients with higher risk of adverse
outcome, while galectin3, NGAL, sLOX-1 and 3-NT were not predictive for
further prognosis of stable HF patients.

<96>
Accession Number
621235274
Author
Feldman T.; Kar S.; Lim D.S.; Smalling R.; Whisenant B.; Rammohan C.; Fail
P.; Rinaldi M.; Hermiller J.; Herrmann H.; Kipperman R.; Slater J.; Foster
E.; Weissman N.J.; Glower D.
Institution
(Feldman) Evanston Hospital Northshore, Evanston, United States
(Kar) Cedars-Sinai Medical Center, Los Angeles, United States
(Lim) University of Virginia, Charlottesville, United States
(Smalling) Memorial Hermann Hospital, Houston, United States
(Whisenant) Intermountain Heart Institute, Murray, United States
(Rammohan) El Camino Hospital, Mountain View, United States
(Fail) Terrebonne General Medical Center, Houma, United States
(Rinaldi) Sanger Heart and Vascular Institute, Charlotte, United States
(Hermiller) St Vincent's Medical Center of Indiana, Indianapolis, United
States
(Herrmann) University of Pennsylvania, Philadelphia, United States
(Kipperman) Morristown Medical Center, Morristown, United States
(Slater) New York University, Langone Medical Center, New York, United
States
(Foster) University of California San Francisco, San Francisco, United
States
(Weissman) Medstar Research Institute, Washington, United States
(Glower) Duke University Medical Center, Durham, United States
Title
The EVEREST II REALISM continued access non-high risk study: Midand
long-term follow-up in surgical candidates.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 858), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background/Introduction: The EVEREST II REALISM Continued Access study
(REALISM) is a prospective, multi-center, continued access study to
collect data on the "real world" use of the MitraClip device in both high
and non-high surgical risk patients. Enrollment in REALISM was initiated
in January 2009 at the conclusion of the EVEREST II Randomized Controlled
Trial (RCT) to allow patients continued access to the therapy. Enrollment
in the non-high risk arm was completed in April 2011, and subjects have
reached 5-year follow-up. Purpose: Mid- and long-term outcomes through 5
years will be presented to evaluate durability of transcatheter mitral
valve (MV) repair with the MitraClip device and long-term safety in
standard risk patients. Methods: Patients with 3+/4+ mitral regurgitation
(MR) were enrolled. Pre- and post-procedure and follow-up echocardiograms
for all patients were evaluated by an independent core lab. Safety
outcomes include acute procedural results at 30 days and survival.
Clinical outcomes at 5 years include MR severity, change in left
ventricular (LV) volumes and dimensions and NYHA Functional Class.
Results: A total of 271 non-high risk patients were enrolled. The mean age
was 74+/-11 years. MR etiology was degenerative in 68% and functional in
32%. At baseline, 54% of patients were in NYHA Class III/IV and mean
ejection fraction was 56+/-11% (61+/-7% degenerative MR; 45+/-12%
functional MR). Kaplan-Meier estimated survival rates were 91%, 78%, and
61% at 1, 3, and 5 years, respectively. Similarly, freedom from MV surgery
was 90%, 87%, and 84% at 1, 3, and 5 years, respectively. In surviving
patients with paired data available at baseline and 3 years (n=140), MR
severity was <=2+ in 87% and <=1+ in 43%. This was accompanied by a
significant reduction in LV end diastolic volumes from 134+/-42 ml at
baseline to 124+/-53 ml (p=0.03, n=127 with paired data; 128+/-39 ml to
118+/-53 ml degenerative MR, p=0.077 (n=95); 149+/-46 ml to 140+/-52 ml
functional MR, p=0.12 (n=32)) and improvement in NYHA Functional Class
I/II from 56% at baseline to 92% at 3 years (p<0.0001, n=154 with paired
data). Conclusions: The mid-term data from the EVEREST II REALISM non-high
risk arm confirmed the efficacy and stability of repair over 3 and 5
years. The low rates of MV surgery beyond the first year was consistent
with the results of the EVEREST II RCT, reconfirming the stability of
repair using the MitraClip device. In the EVEREST II RCT freedom from MV
surgery was 79%, 78%, and 74% at 1, 3 and, 5 years respectively. The lower
rates of MV surgery observed in the REALISM non-high risk study reflect
the learning curve associated with the MitraClip procedure and are a
result of improved case selection and better procedural outcomes. Final
5-year results of the EVEREST II REALISM non-high risk arm will be
presented to evaluate long-term durability of outcomes post-treatment with
the MitraClip device.

<97>
Accession Number
621235256
Author
Laerum Sibilitz K.; Berg S.K.; Tang L.H.; Thygesen L.C.; Hansen T.B.;
Risom S.S.; Lindschou J.; Schmid J.P.; Hassager C.; Koeber L.; Taylor
R.S.; Zwisler A.D.
Institution
(Laerum Sibilitz, Berg, Risom, Hassager, Koeber) Rigshospitalet,
Department of Cardiology, Copenhagen, Denmark
(Tang, Zwisler) University of Southern Denmark, Knowledge Centre for
Rehabilitation and Palliative Care, Nyborg, Odense, Denmark
(Thygesen) National Institute of Public Health, Copenhagen, Denmark
(Hansen) Roskilde Hospital, Department of Cardiology, Roskilde, Denmark
(Lindschou) Rigshospitalet - Copenhagen University Hospital, Copenhagen
Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
(Schmid) Clinic Barmelweid, Department of Cardiology, Barmelweid,
Switzerland
(Taylor) University of Exeter, Health Services Research, Exeter, United
Kingdom
Title
Is cardiac rehabilitation after heart valve surgery redundant? Long-term
results from the randomized CopenHeartVR trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 517), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Cardiac rehabilitation is recommended in patients after heart
valve surgery despite limited evidence. The CopenHeartVR trial found a
positive effect on physical capacity after 4 months weeks, but no effect
on mental health. However, the long term effects of cardiac rehabilitation
is yet unknown. Purpose: To assess the long term effect of comprehensive
cardiac rehabilitation versus usual care for patients after heart valve
surgery on physical capacity and mental health. Methods: 147 participants
were included in the CopenHeartVR trial. After valve surgery, the
participants were randomly allocated 1:1 to either cardiac rehabilitation
(intervention group) or "usual care" without physical exercise (control
group). In this follow-up study, we assessed the outcomes: peak oxygen
uptake measured by cardiopulmonary exercise testing at 12 months, and
self-assessed mental and physical health using the Short Form-36
questionnaire, Mental Component Scale (MSC) and Physical Component Scale
(PCS) 24 months after inclusion, respectively. Groups were compared using
mixed model analysis. Results: Participants were mainly men (76%), mean
age 66.0 years with aortic valve surgery (65%). We found no effect in VO2
peak at 12 months follow-up (intervention group vs control group: 24.5
(standard deviation (SD)+/-1.7) vs. 25.8 (SD+/-1.2) ml/kg/min, p<.85).
Further, we found no significant difference between groups in
self-assessed mean mental or physical health at 24 months (MCS: 55.5 (SD
+/-1.2) vs. 54.0 (SD +/-1.3), p=0.78; PCS: 50.1 (SD +/-1.0) vs. 50.7
(SD+/-1.1), p=0.93). Conclusions: Undertaking exercise-based cardiac
rehabilitation after heart valve surgery positively impacts VO2 peak short
term, but no long term benefit was found, indicating that successful
cardiac rehabilitation requires long follow-up. Further, guidelines should
consider including an individualised approach after surgery with needs
assessment as part of follow up in a heart valve clinic.

<98>
Accession Number
621235160
Author
Gupta S.; Belley-Cote E.; Sarkaria A.; Pandey A.; McClure G.; Jaffer I.;
Spence J.; An K.; Panchal P.; Devereaux K.; Willingstorfer J.; Eikelboom
J.; Whitlock R.
Institution
(Gupta, Jaffer) McMaster University, Department of Cardiac Surgery,
Hamilton, Canada
(Belley-Cote) McMaster University, Department of Medicine, Hamilton,
Canada
(Sarkaria) Queen's University, School of Medicine, Kingston, Canada
(Pandey, Spence, Devereaux, Whitlock) Population Health Research
Institute, Hamilton, Canada
(McClure) McMaster University, Department of Clinical Epidemiology and
Biostatistics, Hamilton, Canada
(An) McMaster University, Michael G. DeGroote School of Medicine,
Hamilton, Canada
(Panchal) McMaster University, Hamilton, Canada
(Willingstorfer) University Julius Maximilian of Wurzburg, Wurzburg,
Germany
(Eikelboom) McMaster University, Hamilton Health Sciences, Hamilton,
Canada
Title
A meta-analysis of INR targets for mechanical heart valves: We need new
evidence.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 417), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Mechanical heart valves are more durable than tissue valves
but require life-long anticoagulation. Guidelines recommend higher INR
target ranges for valves in the mitral position compared with other
positions and for patients deemed to be at higher risk for
thromboembolism. Higher INR targets ranges are likely associated with
increased bleeding risk. We performed a systematic review and
meta-analysis of randomized control trials (RCTs) assessing the effect of
high and low INR target ranges on thromboembolic and bleeding risk in
adult patients with bi-leaflet mechanical heart valve replacement.
Methods: We searched Cochrane CENTRAL, MEDLINE and EMBASE from 1975 to
July 2016 as well as related reference lists and conference proceedings
for RCTs evaluating low versus high INR target ranges for adults with
bi-leaflet mechanical mitral and/or aortic valve(s). We performed title
and abstract screening, full-text review, risk of bias evaluation, and
data collection independently and in duplicate. We evaluated risk of bias
for individual studies with the modified Cochrane (RCT) tool, overall
quality of evidence with the GRADE framework, and pooled data using a
random effects model in Revman 5.3. Event definitions were based on the
definitions used in individual studies. We separated the data two
different ways - 1) studies comparing lower versus higher INR target
ranges and 2) studies comparing INR ranges with a median <3 versus >=3.
Results:We identified 6 RCTs (n=5497) comparing INR target ranges in
predominantly (>80%) bi-leaflet mechanical valves. When pooling RCTs that
compared lower versus higher INR ranges, lower INR ranges were associated
with a significantly lower risk of bleeding (RR 0.54, 95% CI [0.31 to
0.93], p=0.03, I2=87%, very low quality). Thromboembolic events and
mortality did not differ significantly between the two groups
(respectively, RR 1.28, 95% CI [0.88 to 1.85], p=0.20, I2=0%, very low
quality and RR 1.23, 95% CI [0.69 to 2.22], p=0.48, I2=0%, very low
quality). We found no significant difference in major thromboembolic (RR
1.09, 95% CI [0.63 to 1.87], p=0.77, I2=0%, low quality) and major
bleeding events (RR 0.78, 95% CI [0.46 to 1.33], p=0.36, I2=58%, very low
quality). Pooling studies that compared INR target ranges with a median <3
versus >=3 yielded consistent results. Conclusions: Based on low and very
low quality of evidence, in patients with aortic and/or mitral mechanical
valve replacement, lower INR target ranges offer a significantly lower
bleeding risk when compared to higher INR target ranges with no
significant difference in thromboembolic or mortality risk.

<99>
Accession Number
621235073
Author
Elias J.; Van Dongen I.M.; Hoebers L.P.C.; Ramunddal T.; Laanmets P.;
Eriksen E.; Claessen B.E.P.M.; Hirsch A.; Tijssen J.G.; Van Der Schaaf
R.J.; Henriques J.P.S.
Institution
(Elias, Van Dongen, Hoebers, Claessen, Hirsch, Tijssen, Henriques)
Academic Medical Center of Amsterdam, Amsterdam, Netherlands
(Ramunddal) Sahlgrenska,Cardiology, Goteborg, Sweden
(Laanmets) North Estonia Medical Centre, Cardiology, Tallinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Van Der Schaaf) Hospital Onze Lieve Vrouwe Gasthuis, Amsterdam,
Netherlands
Title
Mid-and long-term outcome of the EXPLORE trial: Investigating the impact
of CTO PCI versus no-CTO PCI in STEMI patients with a concurrent CTO.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 415), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: At 4 month follow-up (FU) the EXPLORE trial showed no
difference on the primary endpoint left ventricular (LV) function
comparing early percutaneous coronary intervention of the chronic total
occlusion (CTO PCI) to standard medical treatment (no-CTO PCI) in
ST-elevation myocardial infarction (STEMI) patients. However, the
long-term effects of CTO PCI versus no-CTO PCI are currently unknown.
Purpose: To investigate the effect of CTO PCI versus no-CTO PCI in STEMI
patients on mid- and long-term LV function and clinical outcome. Methods:
At 1, 2, 3, 4, and 5 years, clinical follow up was obtained on: angina
status, dyspnoea status, all events and major adverse cardiac events
(MACE); composite of cardiac death, myocardial infarction and coronary
artery bypass graft surgery. Moreover, patients underwent cardiac magnetic
resonance imaging (CMR) at 1 year. An independent corelab analysed all CMR
data. All events underwent independent monitoring and were adjudicated by
an independent critical events committee. For the incidence of MACE,
Kaplan-Meier curves were constructed and compared using the log-rank test.
Results: In the EXPLORE Trial there were 148 patients randomized to CTO
PCI within 7 days and 154 patients to no-CTO PCI. There were no
differences in baseline characteristics between both arms. One year LV
function was comparable between CTO PCI patients (n=45) and no-CTO PCI
patients (n=49) (LVEF 45.5+/-9.1% versus 44.6+/-10.7%, p=0.66, LVEDV
198.0+/-44.8ml versus 208.1+/-50.9ml, p=0.31). One year clinical follow-up
was complete for all patients. MACE rates were comparable between CTO PCI
and no-CTO PCI (6.8% versus 5.3%, p=0.56). In the no-CTO PCI group 27
patients (17.6%) underwent an additional CTO PCI after obtaining the
primary endpoints. The median longterm follow-up of all patients is 3.9
(IQR 2.9) years. Conclusion: The EXPLORE trial is the first randomized
clinical trial investigating the impact of revascularization of a CTO. The
primary outcome (LVEF and LVEDV) of the EXPLORE Trial was not met at four
months. Furthermore no benefit of CTO PCI on 1 year LV function was seen.
There was no significant difference in MACE between the 2 treatment
groups. Long-term follow-up is currently being analyzed and we will be
able to present the long-term clinical outcome at ESC 2017. (Figure
Presented).

<100>
Accession Number
621234936
Author
Scudeler T.L.; Hueb W.; De Soarez P.C.; Campolina A.G.; Rezende P.C.; Lima
E.G.; Garzillo C.L.; Azevedo D.F.C.; Costa L.M.A.; Oikawa F.T.C.; Ramires
J.A.F.; Kalil Filho R.
Institution
(Scudeler, Hueb, Rezende, Lima, Garzillo, Azevedo, Costa, Oikawa, Ramires,
Kalil Filho) Heart Institute (InCor), University of Sao Paulo Clinics
Hospital, Sao Paulo, Brazil
(De Soarez, Campolina) University of Sao Paulo, Sao Paulo, Brazil
Title
Quality of life and economic outcomes of on-pump and off-pump stable
multivessel coronary artery bypass grafting-MASS III trial 5-year
follow-up.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 446), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the long-term cost-effectiveness of on-pump and
off-pump coronary artery bypass grafting. Methods: Between 2001 and 2006,
308 patients with stable multivessel coronary artery disease and preserved
ventricular function were randomized to on-pump CABG (n=153) or off-pump
CABG (n=155). The 2 groups were well matched for baseline characteristics.
Costs for hospitalizations, physician services, outpatient care, and
medications were assigned using 2016 US dollars. Health state utilities
were assessed using the SF-6D questionnaire. Results: On-pump CABG
patients received a greater number of grafts per patient (2.97 versus
2.49; P<0.001) and had less incomplete revascularization (42.5% versus
52.9%; P=0.052). QoL improved similarly in both groups from baseline
(0.781 vs 0.768, p=0.381) to 6 months (0.817 vs 0.809, p=0.175), 12 months
(0.832 vs 0.831, p=0.696), 24 months (0.837 vs 0.827, p=0.349) and 60
months (0.829 vs 0.820, p=0.300). The cumulative QALY adjusted by baseline
over 5-year follow-up was higher in on-pump group (3.707; IC 95%
3.678-3.736 and 3.556; IC 95% 3.528-3.585), but not statistically
significant. Total costs for the index hospitalization per patient was
higher in the off-pump CABG group ($2966.72+/-381.45 vs $3046.39+/-890.81,
p=0.293). Over the 5-year follow-up, costs were similar between the two
treatment groups. Nonetheless, 5-year cumulative cost remained only
$180.64 higher per patient with on-pump CABG. Conclusion: Despite
incomplete revascularization following off-pump CABG, there was no
difference in QoL and cost-analysis between off-pump and on-pump
procedures. QoL markedly improved in both treatment groups over 5-year
followup. (Figure Presented).

<101>
Accession Number
621234884
Author
Spence J.; Bosch J.; Sharma M.; Cukierman-Yaffe T.; Canavan M.;
Belley-Cote E.; Whitlock R.; Devereaux P.J.; Lamy A.
Institution
(Spence, Belley-Cote, Whitlock, Devereaux, Lamy) Population Health
Research Institute, Perioperative Medicine and Surgical Research Group,
Hamilton, Canada
(Bosch, Sharma, Cukierman-Yaffe, Canavan) Population Health Research
Institute, Hamilton, Canada
Title
Predictors of cognitive decline after cardiac surgery: An evaluation of
the CABG off or on pump revascularization study (CORONARY) cohort.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 445-446), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Postoperative cognitive dysfunction (POCD) is the most common
adverse neurological outcome after cardiac surgery. POCD impacts patients
and their families, and is associated with both short- and long-term costs
to health care systems. Little is known as to how to predict this outcome
in patients undergoing cardiac surgery. Physicians remain unable to
confidently identify those at risk of POCD, which has subsequent
implications for patient decision-making, preoperative risk stratification
and perioperative resource allocation. CORONARY is the largest trial
comparing on- to off-pump coronary surgery, and evaluated cognitive
outcomes in a subset of patients representing the largest cohort studied
to date. This trial found no difference in cognitive outcomes between on-
and off-pump cardiac surgery. Purpose: We used this large dataset of
prospectively assessed patients to identify predictors of POCD after
cardiac surgery; Methods: Our primary, binary, outcome was a decline in
MoCA score that was >=1 standard deviation (SD) below the preoperative
value at 3 follow-up timepoints. We used logistic regression, including
center as a random effect, to evaluate our primary outcome at discharge,
30-days, and 1-year after surgery. We evaluated potential independent
variables, including age, sex, euroSCORE, on- vs off-pump cardiac surgery,
postoperative delirium, diabetes, baseline cognitive impairment (defined
as a baseline MoCA <=24), and non-English speaking status. Results: We
included 1424 (707 On-pump, 717 Off-pump) patients in this analysis. For
every increase of 5 years in age above the mean, the odds of POCD at
discharge increased 50% (OR 1.5, 95% CI 1.1-1.9, P=0.003), though age had
no impact at 30-days or 1-year. Baseline cognitive impairment was
associated with decreased odds of POCD at discharge (OR 0.4, 95% CI
0.2-0.6, P=0.0001), 30- days (OR 0.4, 95% CI 0.2-0.7, P=0.0006), and
1-year (OR 0.5, 95% CI 0.3-0.8, P=0.003). Patients with diabetes did not
have an increased odd of POCD at discharge or 30-days that was
statistically significant, but were more likely to have POCD at 1-year (OR
1.8, 95% CI 1.1-3.0, P=0.03). Conclusions: Contrary to previous reports,
baseline cognitive impairment was protective at all time-points when a
defined baseline MoCA cut-point was used. The association of diabetes with
POCD at 1-year suggests that cognitive changes in this population are more
related to the natural history of the disease, but more study including a
control group is required.

<102>
Accession Number
621234616
Author
Martins J.L.; Afreixo V.; Santos L.; Viana J.; Santos J.
Institution
(Martins, Afreixo, Santos, Viana, Santos) Centro Hospitalar do Baixo
Vouga, Cardiology, Aveiro, Portugal
Title
Spontaneous coronary artery dissection-"To stent or not to stent that is
the question".
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 396-397), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Spontaneous coronary artery dissection (SCAD) is defined as
a non-traumatic and non-iatrogenic separation of the coronary arterial
walls, creating a false lumen. While the incidence and prevalence of the
disease is not well determined due to underdiagnosis of this condition, it
is known that the incidence of SCAD is common in young women presenting
with acute coronary syndrome. Although several small reports have
demonstrated favorable outcomes with conservative management, as well as
with percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG), there is still a lack of consensus with respect to the
best treatment approach in patients presenting with SCAD. Objectives: We
sought to determine if outcomes differ between the first line approaches
(conservative vs revascularization) in patients with SCAD. Methods: We
searched Medline, EMBASE, and the Cochrane library from January 1990 to
November 2016 for studies comparing the first line treatment approach of
patients with SCAD. A pooled risk-ratio meta-analysis has been conducted
for four main outcomes: mortality, myocardial infarction (MI), SCAD
recurrence and target lesion revascularization (TVR). Results: Eleven
non-randomized studies, including 631 patients were identified. Pooled
meta-analysis showed no significant differences between conservative
management and the revascularization approach in mortality, MI and SCAD
recurrence (RD 0.01; 95% CI -0.01-0.04; I2=0%; p=1); (RD =-0.01; 95% CI
-0.04- 0.03; I2=0%; p=0.5); (RD = -0.01; 95% CI -0.06-0.05; I2=0%; p=0.74)
respectively (Fig 1). Revascularization as initial first line approach was
associated with an estimated additional risk of TVR (PCI or CABG) of 6.3%
(RD =0.06; 95% CI 0.01-0.11; I2=0%; p=0.96) (Fig. 1). Conclusion: The
results of this meta-analysis demonstrated an increased risk of TVR when
the strategy of revascularization is used as initial first line approach
in patients presenting with spontaneous coronary artery dissection. The
decision to treat medically or perform percutaneous intervention or
surgery must be individ- ualized based on both clinical and angiographic
factors, but conservative therapy should prevail in most cases.

<103>
Accession Number
621234552
Author
Ongen Z.; Erturk E.; Kilickiran Avci B.; Kucur M.; Karadag B.
Institution
(Ongen, Erturk, Kilickiran Avci, Karadag) Istanbul University (1453),
Cardiology, Istanbul, Turkey
(Kucur) Istanbul University, Pediatrics, Istanbul, Turkey
Title
Evaluation of pre and post-procedure high sensitive cardiac troponin T
values in patients undergoing elective coronary angiography.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 203-204), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: High troponin (cTn) levels indicate a poor prognosis of
cardiac diseases even in non-acute setting. Purpose: By measuring pre and
post procedural high sensitive (hs) cTnT we aimed to investigate whether
diagnostic angiography cause any myocardial injury and also to search the
relationship between pre and post angiographic hs cTnT levels and clinical
adverse events in patients (pts) with stable coronary artery disease
(SCAD) who underwent diagnostic angiography. Methods: This prospective
single blinded study included 253 pts with SCAD in whom myocardial
ischemia was shown by noninvasive tests, except in 6%. None of the pts had
any disorder that may elevate pre-procedural cTn levels. Coronary
angiographies were mainly performed via femoral route. Pre and
postangiographic 4th hour venous blood samples were driven for hs cTnT
measurement. A hs cTnT level >14 ng/L (over 99th pecentile) was accepted
as elevated. For all pts demographic, clinical and laboratory findings,
risk factors and medications were recorded to a data base. Death, acute
coronary syndromes, revascularization and hospitalization were specified
as clinical adverse events and all pts were followed at least for 3
months. For statistical analysis Khi square, Fisher, Mann-Whitney and
Kruskal-Wallis tests were used, accordingly. Results: Advanced age
(r=0.157; p=0.012), lower EF (r=-0.212, p=0.002) and higher blood urea
levels (r=0.190, p=0.002) were related with pre and post angiographic
higher hs cTnT levels. Compared to baseline there was a mean 0.14 ng/L
increase in post angiographic cTnT levels. The amount of dye was the only
significant parameter related with the post-angiographic elevation of hs
cTnT (r=0.127, p=0.044). Although there was a trend of elevation in hs
cTnT levels in pts with higher diastolic blood pressure, it did not reach
to a significant level (p=0.068). The pts were followed for mean 223+/-149
days. Clinical adverse events were significantly higher in pts whose pre
and post angiographic hs cTnT levels were elevated (p<0.001 for both pre
and post procedural levels). By 17.4% coronary re-vascularization was the
most common clinical event, followed by hospitalization for cardiac
reasons (7,1%) and acute coronary syndromes (1.2%). There was no deaths.
Conclusion: Since the amount of the dye found to be related with the rise
of hs cTnT, in order to prevent myocardial injury during diagnostic
angiography unnecessary shots should be avoided. Otherwise the procedure
is safe in terms of myocardial injury. As shown in other studies in a
non-acute clinical setting the high cTn levels predict adverse clinical
events.

<104>
Accession Number
621234532
Author
Spinthakis N.; Farag M.; Gorog D.A.; Mahmood H.; Prasad A.; Srinivasan M.
Institution
(Spinthakis, Farag) University of Hertfordshire, Postgraduate Medical
School, Hertfordshire, United Kingdom
(Gorog) Imperial College London, London, United Kingdom
(Mahmood, Srinivasan) East and North Hertfordshire NHS Trust, Department
of Cardiology, Hertfordshire, United Kingdom
(Prasad) Mayo Clinic, Division of Cardiovascular Diseases, Department of
Internal Medicine, Rochester, United States
Title
Percutaneous coronary intervention with drug-eluting stent versus coronary
artery bypass grafting: A meta-analysis of patients with left main
coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 271), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The relative efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES), in comparison to
coronary artery bypass grafting (CABG) for left main coronary artery
disease (LMCAD) remains controversial. Methods: We performed a
meta-analysis of randomsied studies comparing patients with LMCAD treated
with PCI with DES, with those treated with CABG, with respect to clinical
outcomes at 1 year, 3 years and maximum follow-up duration (median of 5
years). A secondary analysis was performed according to low (<32), or high
(>=33) SYNTAX score. Overall estimates of treatment effect were calculated
with random-effects model. Results: Five studies comprising 4595 patients
were included in the analysis. There was no significant difference in
death or non-fatal myocardial infarction between PCI and CABG at all time
points or when stratified with respect to SYNTAX score. The need for
repeat revascularization was significantly higher with PCI at all time
points, and regardless of SYNTAX score. There was no association between
need for repeat revascularization with PCI and the occurrence of non-fatal
myocardial infarction (p=0.23). CABG increased the risk of stroke at 1
year (OR 0.21; CI 0.07-0.63; p=0.005), but not beyond this at later
follow-up, nor according to SYNTAX score. Conclusions: PCI with DES or
CABG appear equivalent management strategies for LMCAD for up to 5 years,
regardless of SYNTAX score. CABG avoids the need for repeat
revascularization, but this benefit is offset by a higher rate of stroke
in the first year of follow up, that is likely procedure-driven.

<105>
Accession Number
621234530
Author
Taborsky M.; Fedorco M.; Klimes D.; Rohanek P.; Grofkova H.; Novak M.;
Kozak M.; Gloger V.
Institution
(Taborsky, Fedorco, Klimes, Rohanek, Grofkova) Palacky University, Faculty
of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology,
Olomouc, Czech Republic
(Novak) St. Anne's University Hospital, Ist Internal Cardiology Angiology
Clinic, Brno, Czech Republic
(Kozak) University Hospital Brno, Ist Internal Cardiology Clinic, Brno,
Czech Republic
(Gloger) Bata Regional Hospital Zlin, Cardiology Clinic, Zlin, Czech
Republic
Title
Safety and effectiveness of endovasal lead extraction in patients with
bacterial endocarditis: The olomouc lead extraction study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 367-368), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: The increased number of implantable devices along with
expanding indications has produced the subsequent need for removal of
these devices and leads. Aim of the study: Removal of the chronically
implanted transvenous lead system can be a significantly complex
procedure. The aim of Olomouc Lead Extraction Study was to compare the
safety and effectiveness of endovasal lead extraction in patients with a
bacterial endocarditis (Class IA indication) using only the excimer laser
(Excimer Laser System, Spectranetics) or combined technique - laser plus
mechanical extraction (Evolution, Needle's Eye Snare, Dotter helical
Baskett, Amplatz gooseneck snare, Cook Vascular, and others). Methods and
results: 471 patients with ICD and evidence of bacterial endocarditis
(TEE) with a clear indication for endovasal lead extraction were
randomized to one of the above defined techniques. Average time from ICD
implantation was 8.3+/-5.7 years, average number of electrodes was
2.3+/-1.8, 229 patients had a dual coil ICD electrode (48.6%), 187
patients had CRT-D (39.7%) 77 (16.3%) it was fully dependent on pacing.
The procedures were carried out on the hybrid OR using direct monitoring
of blood pressure, in all cases under control of intracardiac ultrasound
(ICE), and the stand-by cardiac surgery. The results are summarized in
Table 1. Conclusions: The combination technique involving the excimer
laser and mechanical extraction had the same number of serious
complications but significantly higher efficiency in terms of complete
lead extraction as the primary goal of effective bacterial endocarditis
treatment. On the other hand, it is necessary to accentuate that
combination technique had more small complications and a increased need
for blood transfusion. (Table Presented).

<106>
Accession Number
621234451
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Tasic I.; Saric S.; Andonov
S.; Petrovic D.; Marinkovic D.; Stojanovic S.; Mitic S.
Institution
(Stoickov, Deljanin Ilic, Tasic, Petrovic) University of Nis, Medical
Faculty, Institute of Cardiology Niska Banja, Nis, Serbia
(Stoickov, Saric, Andonov, Marinkovic, Stojanovic, Mitic) Institute of
Cardiology, Niska Banja, Serbia
Title
Impact of short-term exercise training and residual ischemia on QT
dispersion and double product in patients after bypass graft surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 123), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background/Introduction: Patients after coronary artery bypass graft
surgery (CABG) are at high risk of cardiovascular and arrhythmic events.
QT dispersion (QTd) is a measure of inhomogeneous repolarization of
myocardium. Abnormally high QTd has been correlated with risk of cardiac
death in coronary patients. Purpose: The aim of this study was to
establish the influence of short-term exercise training and residual
ischemia (RI) on QT dispersion and double product (DP) as well, in
patients after CABG. Methods: The study involved 172 patients after CABG,
in the sinus rhythm without AV blocks or branch blocks. Average age of
patients was 57.3 years. Patients were randomly divided into the physical
training group (TG: 133 patients) and non-training group (39 patients).
Patients were of similar age and baseline stress test duration. In all
subjects clinical examination, standard ECG and exercise test on treadmill
according to Bruce protocol, were performed and after that TG patients
were included in rehabilitation treatment for three weeks. TG of patients
were instructed to follow a training program using the bicycle ergometer
(10 min, 2 times a day). The patients continued to take the same
medicaments in same doses. From standard ECG corrected QT dispersion
(QTdc) was calculated. Results: RI was present in 29 (21.8%) patients in
the TG and in 9 (23.1%) patients in the control group. In the TG, before
starting with the program of physical training, patients with RI had
significantly higher values of QTdc (55.6+/-13.4 vs 47.2+/-16.8 ms;
p<0.005), while the values of DP did not significantly vary
(11752.6+/-653.8 vs 11505.3+/-724.4 beat/min x mmHg; p-NS) in comparison
to those without RI. After three weeks, in the TG, significant reduction
of QTdc was found (from 55.6+/-13.4 to 48.8+/-12.5 ms; p<0.05 in patients
with RI and from 47.2+/-16.8 to 39.6+/-15.9 ms; p<0.001 in patients
without RI). In the TG, significant reduction of DP was found (from
11752.6+/-653.8 to 11390.5+/-492.7 beat/min x mmHg; p<0.02 in patients
with RI and from 11505.3+/-724.4 to 10124.5+/-529.6 beat/min x mmHg;
p<0.001 in patients without RI). In contrast, the non-training group
showed no significant changes. Conclusions: The study showed that
short-term exercise training has favourable effects on QT dispersion and
double product in patients after CABG. In patients without RI physical
training had more favourable effects on the followed parameters. Physical
training led to the significant decrease of myocardial oxygen uptake at
rest and probably decreased the possibility of arrhythmia events,
especially in patients without RI.

<107>
Accession Number
621234328
Author
Pap Z.; Sax B.; Assabiny A.; Racz K.; Nemeth E.; Kiraly A.; Becker D.;
Monostory K.; Merkely B.
Institution
(Pap, Sax, Assabiny, Kiraly, Becker, Merkely) Semmelweis University Heart
Center, Budapest, Hungary
(Racz, Nemeth) Semmelweis University, Department of Anestesiolgy and
Intensiv Care, Budapest, Hungary
(Monostory) Hungarian Academy of Sciences, Budapest, Hungary
Title
Investigation of tacrolimus metabolism through CYP3A enzymes after cardiac
transplantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 424), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction: Immunosuppressive regime, especially tacrolimus (TAC) dosing
after cardiac transplantation (HTX) should be carefully tailored to avoid
rejection, side effects and infection. TAC is metabolized by the CYP3A
enzyme family. Polymorphism of these genes may lead to greatly differing
TAC doses. Purpose: Our aim was to investigate the correlation between
CYP3A5 genotype and CYP3A4 mRNS expression and of the TAC dose required to
achieve stable trough levels. Methods: We included 54 consecutive
transplanted patients, all treated with the same immunosuppressive regime
(pharmacogenetic study performed: CYP1, n=35; not performed: CYP0, n=19).
Results: According to our results, 17% of the investigated patients showed
CYP3A5*1/*3 heterozygous genotype which results in active CYP3A5 enzyme.
The CYP3A5*3/*3 homozygous patients metabolize TAC solely through the
CYP3A4 enzyme. In the latter group, 55% had low and 45% had normal CYP3A4
mRNS expression. The CYP3A5 heterozygous patients had a significantly
higher TAC dose requirement to achieve therapeutic TAC trough level as
compared to the CYP3A5*3/*3 homozygous patients (0.17+/-0.06 vs.
0.11+/-0.05 mg/kg, p=0.03), independently of their CYP3A4 mRNS expression.
While the clinical application of these pharmacogenetic results were not
obligatory for the treating physician, the CYP1 group had a significantly
better renal function after HTX (worst post-HTX GFR: 52+/-24 vs. 37+/-24
ml/min/1.73m2, p=0.04) and significantly lower need for dialysis (11% vs.
37%, p<0.05). Conclusions: We may conclude, that the analysis of TAC
metabolism, especially identifying CYP3A5*1/*3 heterozygous HTX patients
may be an effective tool in optimizing TAC dosing. Application of the
pharmacogenetic results may improve post-HTX renal function and may help
in avoiding dialysis treatment.

<108>
Accession Number
621234274
Author
Fiorelli F.; Giannini C.; Petronio A.S.; Liga R.; Spontoni P.; De Carlo
M.; Marraccini E.; Pieroni A.; Guarracino F.
Institution
(Fiorelli, Giannini, Petronio, Liga, Spontoni, De Carlo, Marraccini,
Pieroni) University of Pisa, Cardiac Thoracic and Vascular Department,
Pisa, Italy
(Guarracino) University of Pisa, Department of Anesthesia and Intensive
Care, Pisa, Italy
Title
Effects of levosimendan therapy in patients with severe functional mitral
regurgitation and chronic heart failure undergoing mitraclip implantation:
A single-centre experience.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 267-268), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background and purpose: Percutaneous mitral valve repair (PMVR) has been
introduced as a valuable therapy in high surgical risk patients with
functional mitral regurgitation (FMR) who are not responding to medical
treatments. Our aim was to assess clinical, functional and prognostic
impact of peri-procedural levosimendan administration in patients with FMR
undergoing PMVR Methods: Between December 2009 and August 2016, 94
consecutive patients with FMR who underwent PMVR at our centre were
enrolled in a prospective registry. In order to identify two comparable
groups of patients, 27 patients not receiving levosimendan (No-L-group)
were selected for the analysis matching by propensity score with those
treated with levosimendan (L-group). Propensity score was calculated by
using a logistic regression model including age, gender, Log EuroSCORE and
EuroSCORE II values, history of diabetes mellitus, coronary artery disease
and cardiac surgery, values of glomerular filtration rate, left ventricle
(LV) ejection fraction and systolic pulmonary artery pressure (sPAP)
(Cstatistic0.76) Results: Baseline demographics and echocardiographic
variables were similar between the two groups (No-L-group vs L-group).
Surgical risk was comparable: EuroSCORE II and STS PROM (6.3 (3-17.1) vs
4.9 (2.9-12.1), p=0.89; 4.4 (2.3-6.6) vs 4.2 (2.1-8.1), p=0.59).79% of
patients were in NYHA classes III to IV with high BNP values (median
1022.4 pg/ml). The overall study population showed enlarged left chambers
with severely reduced LV systolic function (mean LV ejection fraction 31%)
without significant differences between groups. Right chambers dimensions
and RV (right ventricle) systolic function were also similar in both
groups. Acute procedural success was similarly high with no differences in
procedural time and hospital and long-term outcome. Survival at 1 year
(84.0+/-7.3% vs 77.9+/-8.1%; HR0.56, 95% CI: 0.16-1.94, p=0.36), 1-year
survival free from cardiovascular death (87.3+/-6.8% vs 83.7+/-7.4%;
HR0.60, 95% CI: 0.14- 2.68, p=0.51) and free from readmission due to
cardiac disease (76.6+/-8.4% vs 76.6+/-8.4%; HR0.69, 95% CI: 0.24-2.00,
p=0.46) were comparable. Interestingly, patients treated with levosimendan
showed higher value of RV TDI peak Swave velocity at discharge (10.7+/-3.0
vs 13.0+/-4.1 cm/sec, p=0.03; respectively). None other echo parameters
differed among groups after PMVR. Compared with baseline measurements, LV
end diastolic volume decreased significantly after PMVR in both groups
(p=0.04 and p=0.004, respectively in No-L-group and Lgroup) whereas, LV
end diastolic diameter, sPAP and RV TDI peak S-wave velocity showed a
significant improvement after PMVR only in the L-group (p=0.05, p=0.0004
and p=0.03; respectively) Conclusion: The present study shows that
peri-procedural administration of levosimendan in patients with end-stage
heart failure undergoing Mitraclip implantation for severe FMR is safe and
might be associated with significant RV functional improvement
representing a valid therapeutic strategy.

<109>
Accession Number
621234175
Author
Leonardi S.L.; Musumeci G.; De Luca L.; Varbella F.; Lettino M.; Tarantini
G.; Tarelli G.; Trabattoni D.; Crimi G.; Rizzotti D.; Lettieri C.; Marino
M.; Maiorana F.; Bettari L.; De Servi S.
Institution
(Leonardi, Crimi, Rizzotti, Maiorana) Foundation IRCCS Polyclinic San
Matteo, University of Pavia, Pavia, Italy
(Musumeci) Santa Croce E Carle Hospital, Cuneo, Italy
(De Luca) S.Giovanni Evangelista Hospital-Tivoli, Rome, Italy
(Varbella) Degli Infermi Hospital, Rivoli, Italy
(Lettino, Tarelli) Clinical Institute Humanitas IRCCS, Rozzano, Italy
(Tarantini) University Hospital of Padova, Padua, Italy
(Trabattoni) Centro Cardiologico Monzino-IRCCS, Monzino, Italy
(Lettieri) Hospital Carlo Poma, Mantova, Italy
(Marino) Maggiore Hospital of Crema, Crema, Italy
(Bettari) Hospital of Cremona, Cremona, Italy
(De Servi) IRCCS Multimedica of Milan, Milan, Italy
Title
Appropriateness of percutaneous coronary interventions in patients with
ischemic heart disease in Italy: The APACHE Pilot study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 183), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Real world data on appropriateness of indication, adherence to
guideline recommendations, and mode of selection for coronary
revascularization in Europe are scarce. Purpose:We designed the
APpropriAteness of percutaneous Coronary interventions in patients with
ischemic HEart disease - APACHE Pilot study to first explore the degree of
appropriateness of indication of PCI, multi-disciplinary decisionmaking
processes, and implementation of key guideline recommendations in patients
undergoing coronary revascularization in Italy. Methods: We analyzed data
from twenty-two Italian hospitals (20 patients/site), thirteen (59%) with
on-site cardiac surgery. 440 patients who received percutaneous coronary
intervention (PCI) for stable coronary artery disease (CAD) or non-ST
elevation acute coronary syndrome were independently selected in a 4:1
ratio with half diabetics without site personnel involvement in the
selection of the cases identified to minimize selection bias.
Appropriateness of PCI indication was evaluated using validated
appropriate use scores (AUS). An angiographic core laboratory verified
site-reported coronary anatomy and identified borderline coronary
stenoses. In patients with stable CAD adherence to the following ESC
recommendations was examined: a) % of patients with complex coronary
anatomy (including lesions of the left main, proximal LAD and/or
three-vessel CAD) treated after heart-team discussion; b) % of fractional
flow reserve-guided PCI for borderline stenoses in patients without
documented ischemia; c) % of patients receiving guideline-directed medical
therapy at the time of PCI. Finally, pre-test probability (PTP) of CAD in
stable CAD patients without known coronary anatomy and its association
with test of ischemia use was examined. The study is registered on
ClinicalTrial.Gov ID: NCT02748603. Results: Of all PCIs, 35.2% were
classified as appropriate, 43.4% as uncertain, and 12.5% as inappropriate.
Median (25th, 75th) AUS was 6 (5,7). Median PTP of CAD in stable CAD
patients was 69% (78% intermediate PTP, 22% high PTP, no patient with low
PTP). The use of provocative tests of ischemia was similar (p=0.71) in
patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In
patients with stable CAD (n=352) guideline adherence to the 3
recommendations explored was: a) 11%; b) 25%; c) 23%. AUS was higher in
patients evaluated by the heart team as compared to patients who were not
[7 (6,8) vs 5 (4,7); P=0.001] (Figure). Most hospitals (n=12, 54%) did not
have either a heart-team institutional protocol or regularly planned
heart-team meetings. (Figure Presented) Conclusions: Use of heart-teams
approaches and adherence to guideline recommendations on coronary
revascularization in a real world setting is limited. This pilot study
documents the feasibility of measuring appropriateness and guideline
adherence in clinical practice and identifies substantial opportunities
for quality improvement.

<110>
Accession Number
621234071
Author
Thomas C.; Schaefer U.; Von Bardeleben S.; Zuern C.; Bekeredjian R.;
Ouarrak T.; Sievert H.; Nickenig G.; Boekstegers P.; Senges J.;
Schillinger W.; Lubos E.
Institution
(Thomas, Schaefer, Lubos) University Heart Center Hamburg, General and
Interventional Cardiology, Hamburg, Germany
(Von Bardeleben) University Medical Center of Mainz, Department of
cardiology, Mainz, Germany
(Zuern) University Hospital of Tubingen, Department of cardiology,
Tubingen, Germany
(Bekeredjian) University Hospital of Heidelberg, Department of
cardiology,angiology and pneumology, Heidelberg, Germany
(Ouarrak, Senges) Heart Attack Research Center, Ludwigshafen am Rhein,
Germany
(Sievert) CardioVascular Center Frankfurt, Frankfurt am Main, Germany
(Nickenig) University Hospital Bonn, Department of cardiology and
pneumology, Bonn, Germany
(Boekstegers) Helios Hospital Siegburg-Bonn, Cardiology and Angiology,
Siegburg, Germany
(Schillinger) Helios Albert-Schweitzer-Klinik, Department of cardiology,
Northeim, Germany
Title
Risk assessment in patients undergoing MitraClip therapy: the usefulness
of NT-proBNP.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 24), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Introduction/Purpose: NT-proBNP is a widely used biomarker in heart
failure, including therapy as well as prognosis, and is also helpful in
decision making process in patients (pts) with mitral regurgitation (MR).
Since risk assessment in pts undergoing percutaneous mitral valve repair -
usually a heterogeneous group of pts with multiple comorbidities - is
challenging, but essential, we thought to evaluate the usefulness of
preprocedural NT-proBNP levels. Methods: Using the data of 432 pts
undergoing MitraClip (MC) implantation of the German transcatheter mitral
valve registry (TRAMI), ROC-analysis and Youden Index were applied to
identify the overall NT-proBNP cut-off of 2329 pg/ml for the prediction of
death. Results: The majority of pts (64.6%) was scheduled to the high
NT-proBNP group. Mean age (75.3+/-8.6 years vs. 75.7+/-8.6 years; p=0.54)
and sex did not differ significantly between both groups. Patients in the
high NT-proBNP group suffered from higher NYHA classes (NYHA II/ III/ IV
in 9.0%/ 71.0%/ 19.4% vs. 14.4%/ 74.5%/ 9.8%; p<0.01), worse LV ejection
fraction (LVEF <30% in 41.9 vs. 18.0%; p<0.0001), more severe tricuspid
regurgitation, and a higher rate of renal failure with a serum-creatinine
above 1.5 mg/dl in 51.6% vs. 26.8% (p<0.0001). Comorbidities were more
common in the high NT-proBNP group, leading to a higher logEUROScore of
26.0% vs. 17.7% (p<0.0001). MC procedure could be conducted safely, with a
need for slightly more clips in pts with a high NT-proBNP (1.5 vs. 1.4;
p<0.05), but with high success rates (97.5% vs. 97.4%; p=0.95) leading to
comparable severity of residual MR in both groups. Nevertheless, duration
of hospital stay and severe intrahospital complications other than major
cardiac events were higher in pts with a NT-proBNP above 2329 pg/ml (9 vs.
7 days; p<0.0001 and 15.8% vs. 8.5%; p<0.05). NYHA-classes after 30 days
were still higher in the high NT-proBNP group (NYHA I/ II/ III/ IV in
32.5%/ 33.1%/ 24.8%/ 9.6% vs. 42.5%/ 38.7%/ 11.3%/ 7.5%), coming along
with more problems in daily life, whereas this effect could not be shown
any longer after 1 year (NYHA I/ II/ III/ IV in 29.2%/ 36.4%/ 19.5%/ 14.9%
vs. 25.9%/ 40.2%/ 23.2%/ 10.7%; p=0.74). After 30 days and 1 year,
mortality was substantial and significantly higher in those pts above the
cut-off (6.6% vs. 2.0%; p<0.05 and 26.3% vs. 9.4%; p<0.0001), with a
Hazard ratio of 2.42 (95%-CI 1.35-4.35; p=0.031) in the complete cox
regression. Conclusion: NT-proBNP is capable to identify pts at a high
risk of death in midand longterm follow up after percutaneous mitral valve
repair. Nevertheless, several patient-characteristics, such as severe
LV-dysfunction, renal failure and age, should be taken into account to use
the optimal cut-off for risk prediction.

<111>
Accession Number
621234063
Author
Spieker M.; Hellhammer K.; Horn P.; Kelm M.; Westenfeld R.
Institution
(Spieker, Hellhammer, Horn, Kelm, Westenfeld) Heinrich-Heine University,
Department of Cardiology, Pneumology and Angiology, Duesseldorf, Germany
Title
MitraClip implantation as effective symptomatic therapy of dynamic mitral
regurgitation unraveled by handgrip echocardiography.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 265), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The dynamic nature of mitral regurgitation (MR) has become a
recognized entity. Handgrip exercise may be an alternative approach to
bicycle exercise especially in patients who are unfit to cycle.
Percutaneous mitral valve repair using the MitraClip (Abbott Vascular,
Santa Clara, California) is a promising technique to treat symptomatic
severe mitral regurgitation in patients at high or prohibitive surgical
risk. There are currently no data which evaluated the benefit of MitraClip
in patients with exercise-induced increase in MR severity. Purpose: To
investigate whether patients with symptomatic heart failure and
exercise-induced changes in MR severity benefit from MitraClip. Methods:
We retrospectively included 306 patients who underwent MitraClip
implantation between 2011 and 2016 at our institution in an all-comers
observational study. Our final patient group consisted of 92 patients who
initially presented with moderate to severe MR thus receiving exercise
echocardiography on top of comprehensive echocardiography examination at
rest prior MitraClip implantation. One-year outcome was monitored by
follow-up examination or by telephone. The combined endpoint of the study
was a composite of all-cause mortality and hospitalization for heart
failure. Median follow-up period was 11 months. Results: Thirty-five
patients (38%) had degenerative MR and 57 patients (62%) presented with
functional MR. During handgrip exercise, regurgitation volume and
effective regurgitation orifice area calculated by the PISA method
increased from 34+/-14 ml at rest to 45+/-14 ml during exercise and from
21+/-10 mm2 to 25+/-9 mm2, respectively (all
p<0.01). According to current recommendations, 15 patients (43%) with
moderate degenerative MR at rest and 25 patients (44%) with moderate
functional MR at rest showed progression of MR severity during handgrip.
There was no difference in post procedural MR severity between patients
with marked exercise-induced changes in echocardiographic parameters and
those without. During follow-up 36 patients (39%) experienced at least one
event. By univariate and multivariate analysis, clinical outcome of
patients with marked exercise-induced changes of MR severity was similar
to those without (combined endpoint: no exercise induced increase in MR
severity n=20 (35%) vs. exercise-induced increase in MR severity n=16
(46%), p=0.32). Conclusion: Handgrip exercise echocardiography serves as a
valuable tool to unmask dynamic MR. Furthermore, these data provide first
clinical evidence of the benefit of MitraClip in patients with
marked-exercise induced increases in MR severity. These patients equally
benefit from MitraClip as patients without exercise-induced changes in MR
severity do. The current data are relevant in the anticipation of large
prospective trials investigating the clinical potential of percutaneous
mitral valve repair therapy in intermediate MR at rest.

<112>
Accession Number
621234046
Author
Reichart D.; Kalbacher D.; Tigges E.; Thomas C.H.; Schofer N.; Deuschl F.;
Schirmer J.; Blankenberg S.; Reichenspurner H.; Schaefer U.; Conradi L.;
Lubos E.
Institution
(Reichart, Kalbacher, Tigges, Thomas, Schofer, Deuschl, Schirmer,
Blankenberg, Reichenspurner, Schaefer, Conradi, Lubos) University Heart
Center Hamburg, Hamburg, Germany
Title
MitraClip therapy in ideal patients with a post-interventional mitral
regurgitation equal or below grade 1.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 23), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Objective: MitraClip therapy is an approved option for high-risk surgical
patients with relevant mitral regurgitation (MR). The aim of this study
was to assess midterm clinical and hemodynamic results after MitraClip
therapy in patients with optimal acute results (MR <= Idegreeat
discharge). Methods: We analyzed retrospectively our MitraClip database
(n=560) and included 270 patients (age 74.8+/-8.3 years, logistic
EuroSCORE I 25.1+/-16.5%), who had MR <= Idegreeat discharge from
hospital. Results: Out of 270 patients, all patients were in New York
Heart Association (NYHA) functional class III/IV before treatment and
74.8% of the patients had functional MR. 65.9% of the successfully treated
patients received one clip, 34.1% received >= two clips. Thirty-day
mortality was 3.0%; cumulative survival at 12 and 24 months was 83.7 and
66.9%. Clinical and echocardiographic 12-months follow-up was available in
165 patients. At 12 months, MR <= Idegreewas still present in 56.4%, MR
IIdegree in 40.0% and MR III/IVdegree in 3.6% of the patients. 64.6% of
the patients were in NYHA functional class I/II. Six-minute walk distance
improved significantly (baseline 212.0+/-142.7 meters vs 280.0+/-158.0
meters at 12 months, p<0.01). However, LV remodeling or improvement of LV
ejection fraction did not occur: LVEDD-baseline 62.8+/-11.0 mm vs. -at 12
months 62.5+/-11.8 mm (p>0.05); LV ejection fraction-baseline 40.8+/-15.9%
vs. -at 12 months 39.6+/-16.2% (p>0.05). During 12 months follow-up, 3.6%
of the patients needed repeat MitraClip procedures due to recurrence of
MR. An additional 1.8% of the patients had surgical mitral valve
replacement. In comparison to the total MitraClip database, patients with
MR <= Idegreeat discharge showed a significantly superior survival rate
(p<0.05). Significant pre-implant predictors for success (MR <= Idegree at
discharge) are functional MR (Odds radio (OD) 1.02), male gender (OD
1.17), history of myocardial infarction (OD 1.24) and CRT therapy (OD
1.41). Significant pre-implant predictors for MR > Idegreeat discharge are
LVEDD (OD 0.74), ejection fraction (OD 0.80), MR IVdegreevs IIIdegree(OD
0.82) and mean mitral gradient (OD 0.87). Conclusion: The majority of
MitraClip patients with ideal functional results (MR <= Idegree at
discharge) show a clinical improvement. However, a recurrence of MR is
detectable in 43.6% of the patients after 12 months. The survival of
patients with MR <= Idegreeat discharge is significantly superior to
patients with MR > Idegreeat discharge. Trials comparing mitral valve
surgery and MitraClip therapy are strongly needed to compare long-time
durability in these patients.

<113>
Accession Number
621234016
Author
Abdelghani M.; Nassif M.; Blom N.; Van Mourik M.; Straver B.; Koolbergen
D.; Kluin J.; Tijssen J.; Mulder B.; Bouma B.; De Winter R.
Institution
(Abdelghani, Nassif, Blom, Van Mourik, Straver, Koolbergen, Kluin,
Tijssen, Mulder, Bouma, De Winter) Academic Medical Center of Amsterdam,
Cardiology, Amsterdam, Netherlands
Title
Infective endocarditis after Melody valve implantation in the pulmonary
position: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 55-56), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Transcatheter pulmonary valve implantation (TPVI) is an
effective therapy for dysfunctioning right ventricular outflow tract
(RVOT) conduits. Functional deterioration of the Melody valve overtime due
to infective endocarditis (IE) has evoked growing concerns. Purpose: We
aimed to delineate the actual incidence and the natural history of IE
after Melody valve implantation through a systematic review and
meta-analysis of published data. Methods: PubMed, EMBASE, and Web of
Science databases were systematically searched for articles published
until August 2016 reporting on IE after Melody valve implantation.
Results: Eleven studies (including 1037 patients and a total of 2516
patient-years of follow-up) were included in the analysis of the incidence
of IE. The pooled annualized incidence rate was 1.44% (95% CI, 0.97-1.91%)
per patient-year. The median time from TPVI to the onset of IE was 18
months (IQR, 9.0-30.0; range, 1.0-72 months) with 35% of cases occurring
within the first year. Patients with Melody valve IE (average age, 22
[range: 4-56] years) were predominantly males (89%). The majority had a
homograft (59%) or a bioprosthetic valve (27%) as an RVOT conduit
implanted in the setting of correction of tetralogy of Fallot (48%),
aortic stenosis treated by a Ross procedure (20%), truncus arteriosus
(14%), or transposition of the great arteries (12%). Fever was the most
common presenting symptom of IE (87%), while vegetations were visualized
by transthoracic/transesophageal echocardiography in only one third of
patients (34%). New/worsening RVOT obstruction occurred in 81% of IE
patients and pressure gradient rise averaged 17+/-8 mmHg. New significant
PR was documented in a single case (severe paravalvular leakage). The
majority of cases involved Gram positive cocci (staphylococci in 42% and
streptococci in 33%). This microbiologic profile was similar between early
(within 12 months post-TPVI) and late IE (staphylococci, 50% vs. 46%; and
streptococci, 33% vs. 30%; p>0.5). Bacterial culture was negative in 4
cases, of which serology and/or polymerase chain reaction of excised valve
revealed Bartonella henselae in 3 cases. Out of 60 patients with IE after
TPVI, 5 patients died (8.3%) and 30 (50%) underwent surgical and/or
transcatheter re-intervention, while the remainder were successfully
treated with antibiotics only. Death or re-intervention tended to occur
more in those with significant/new RVOT obstruction (65% vs. 33%; p=0.07)
and in those with documented vegetations on echocardiography (75% vs. 44%;
p=0.09). On multivariate regression analysis, non-streptococcal IE was an
independent predictor of death/re-intervention (HR, 12.0 [95% CI:
1.9-76.4]; p=0.009). Conclusions: The risk of IE after Melody valve
implantation, albeit considerable, is lower than previously reported.
Surgical/percutaneous re-intervention is a common consequence of IE,
although many patients can be managed medically.

<114>
Accession Number
621233990
Author
Benito Gonzalez T.; Estevez-Loureiro R.; Garrote-Coloma C.; Gualis Cardona
J.; Iglesias Garriz I.; Alonso-Rodriguez D.; Lopez-Benito M.; Cuellas C.;
Alvarez-Roy L.; Romero-Roche L.; Rodriguez-Santamarta M.; Minguito M.; Del
Castillo S.; Castano-Ruiz M.; Fernandez-Vazquez F.
Institution
(Benito Gonzalez, Estevez-Loureiro, Garrote-Coloma, Gualis Cardona,
Iglesias Garriz, Alonso-Rodriguez, Lopez-Benito, Cuellas, Alvarez-Roy,
Romero-Roche, Rodriguez-Santamarta, Minguito, Del Castillo, Castano-Ruiz,
Fernandez-Vazquez) Hospital of Leon, Cardiology, Leon, Spain
Title
Survival advantage of percutaneous mitral valve repair over medical
treatment in patients with mitral regurgitation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 23), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background and aims: MitraClip has shown promising results for
percutaneous mitral valve repair in patients at highrisk for surgery. AIM:
to assess the effect of MitraClip on survival in patients with significant
mitral regurgitation compared to medical therapy alone. Methods and
results: A metaanalysis on percutaneous mitral valve repair with MitraClip
device versus standalone medical therapy in patients with symptomatic
mitral regurgitation was carried out. The MOOSE statement for reporting
systematic reviews and metaanalyses of observational studies was applied.
We conducted a literature search of common electronic databases for
studies published from January 2005 to October 2016. Search keywords
included a combination of ?MitraClip?, ?mitral clip?, ?percutaneous
edgetoedge repair?, ?percutaneous mitral valve repair?, ?transcatheter
mitral valve repair? and ?medical therapy alone?. Reviewers independently
examined publications identified by the described search strategy to
determine inclusion or exclusion, and extract data for the analysis. The
search strategy identified a total of 658 potential articles. Duplicate
reports, abstracts, studies that did not compare survival after PMVR with
medical treatment alone, and narrative or systematic reviews were removed.
Primary outcome was 30 day and 1 year mortality. The collected data were
summarized across treatment arms using Mantel- Hansel odds ratio (OR)
fixed effects model when I2 was below 25% and heterogeneity p value over
0.05. Otherwise we used randomeffect analysis. No randomized controlled
trial was reported. We included 5 observational reports that enrolled a
total of 1271 patients: 720 underwent percutaneous mitral valve repair and
551 were managed conservatively. A total of 49 allcause mortality events
were reported at 30 days: 3.05% (22/720) in the MitraClip arm and 4.90%
(27/510) in the conservative group, with no significant differences in
allcause mortality (OR 0.64, 95% CI 0.361.14, p=0.13; heterogeneity: I2 =
14%, p 0.33). A total of 269 allcause mortality events at one year were
reported: 15.14% (109/720) in the MitraClip arm and 29.04% (160/551) in
the conservative group. A significant difference favoring percutaneous
edgetoedge repair over medical therapy alone was observed at one year
followup (OR 0.44, 95% CI 0.30-0.64, p<0.0001; heterogeneity: I2 = 37%, p
0.18). Neither significant between study heterogeneity using the
onestudyout method (p=0.18) nor publication bias estimated by funnel plots
and the Egger's linear regression test (p=0.3) were detected. Conclusions:
Percutaneous mitral valve repair with MitraClip system may be associated
with an improvement in oneyear survival compared to standalone medical
management. (Figure Presented).

<115>
Accession Number
621233953
Author
Calvino Santos R.A.; Estevez-Loureiro R.; Bouzas-Mosquera A.;
Peteiro-Vazquez J.; Rodriguez-Fernandez J.A.; Rodriguez-Vilela A.; Franco
Gutierrez R.; Salgado Fernandez J.; Aldama-Lopez G.; Pinon-Esteban P.;
Flores Rios X.; Vazquez-Gonzalez N.; Mesias-Prego A.; Gonzalez Juanatey
C.; Vazquez Rodriguez J.M.
Institution
(Calvino Santos, Bouzas-Mosquera, Peteiro-Vazquez, Rodriguez-Fernandez,
Salgado Fernandez, Aldama-Lopez, Pinon-Esteban, Flores Rios,
Vazquez-Gonzalez, Vazquez Rodriguez) Complexo Hospitalario Universitario A
Coruna, A Coruna, Spain
(Estevez-Loureiro) Hospital of Leon, Complejo Asistencial Universitario De
Leon (CAULE), Leon, Spain
(Rodriguez-Vilela, Mesias-Prego) Hospital Arquitecto Marcide, Ferrol,
Spain
(Franco Gutierrez, Gonzalez Juanatey) University Hospital Lucus Augusti,
Lugo, Spain
Title
Complete revascularisation versus stress echocardiography-guided
revascularisation in patients with ST-segment elevation myocardial
infarction and multivessel disease (CROSS-AMI): A clinical trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 436), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Recent clinical trials have shown that revascularisation of
all significant coronary lesions may be beneficial in patients with ST
elevation acute myocardial infarction (STEMI) compared to treatment of
infarct-related artery (IRA) only. However patients in the conservative
branch of these trials did not undergo any systematic test to rule out
myocardial ischemia. Stress echocardiography is a validated test that has
been exhaustively studied in patients with ischaemic heart disease and
provides additional prognostic information compared to conventional
exercise test. Purpose: We sought to compare the outcome of two treatment
strategies for non-IRA lesions in patients with AMI and multivessel
disease: 1) complete percutaneous revascularization of all
angiographically significant lesions (CR) versus 2) stress
echocardiography-guided revascularisation (SEGR). Methods: Randomised,
open-label, multicenter study comprising 306 patients with multivessel
coronary artery disease and STEMI in whom IRA had been successfully
treated with percutaneous coronary intervention (PCI): 154 patients in the
CR group and 152 in the SEGR group. All elective revascularisation were
performed in a staged procedure before hospital discharge. Primary
endpoint was the composite of cardiovascular death, acute myocardial
infarction, coronary revascularisation and hospital readmission for heart
failure. Results: Patient clinical data, cardiovascular risk factors,
medical treatment and location and number of coronary lesions were not
significantly different between both groups. Two patients in the CR group
refused the PCI. 45 patients in the SEGR group underwent a PCI of non-ARI
lesions, 3 due to recurrent myocardial ischaemia, 2 due to patient or
doctor preference and 40 due to a positive stress echo. CR did not reduce
the incidence of the primary end-point at 12 months follow-up (14.3% CR vs
13.8% SEGR; Hazard Ratio (HR) 1.06, 95% CI: 0.58- 1.92). There were no
differences in the four components of the primary outcome: cardiovascular
death (1.3% CR vs 0.7% SEGR; HR 1.97, 95% CI: 0.18-21.71); acute
myocardial infarction (9.7% CR vs 4.6% SEGR, HR 2.22, 95% CI: 0.90- 5.43);
any coronary revascularisation (10.4% CR vs 11.8% SEGR, HR 0.88, 95% CI:
0.45-1.72); hospital readmission for heart failure (0.6% CR vs 1.3% SEGR,
HR 0.50, 95% CI: 0.05-5.48). The need for revascularisation of non-ARI
lesion was not significantly different between groups (5.8% CR vs 9.9%
SEGR, HR 0.58, 95% CI: 0.25-1.31). Conclusions: A SEGR strategy seems to
be equivalent to a CR strategy in patients with AMI and multivessel
coronary artery disease. (Figure Presented).

<116>
Accession Number
621233952
Author
Berger J.; Heizer G.; Baumgartner I.; Fowkes F.G.R.; Held P.; Katona B.G.;
Norgren L.; Jones W.S.; Lopes R.D.; Abramson B.L.; Millegard M.; Blomster
J.; Hiatt W.R.; Patel M.R.; Mahaffey K.W.
Institution
(Berger) New York University, School of Medicine, Departments of Medicine
and Surgery, New York, United States
(Heizer, Jones, Lopes, Patel) Duke Clinical Research Institute, Duke
University, School of Medicine, Durham, United States
(Baumgartner) Bern University Hospital, University of Bern, Bern,
Switzerland
(Fowkes) University of Edinburgh, Edinburgh, United Kingdom
(Held, Millegard, Blomster) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, United States
(Norgren) Orebro University, Orebro, Sweden
(Abramson) University of Toronto, Toronto, Canada
(Hiatt) University of Colorado, School of Medicine and CPC Clinical
Research, Aurora, United States
(Mahaffey) Stanford University, School of Medicine, Stanford, United
States
Title
Ticagrelor in patients wtih symptomatic peripheral artery disease and
prior coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 452), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The optimal long-term antithrombotic regimen in patients with
symptomatic peripheral artery disease (PAD) and a history of coronary
artery disease (CAD) is uncertain. Methods: The EUCLID trial randomized
13,885 patients with symptomatic PAD to antithrombotic monotherapy with
ticagrelor 90 mg twice daily or clopidogrel 75 mg daily (NCT01732822).
Patients were enrolled based on an abnormal anklebrachial index <=0.80 or
prior lower extremity revascularization. We identified those enrolled with
prior CAD (prior myocardial infarction [MI], percutaneous coronary
intervention [PCI], or coronary artery bypass graft surgery [CABG]). The
primary efficacy endpoint was a composite of cardiovascular death, MI, or
ischemic stroke. The primary safety endpoint was TIMI major bleeding.
Median follow-up was =30 months. Results: Of 4032 patients with PAD and
prior CAD, 63% had a prior MI, 49% prior PCI, and 38% prior CABG. After
adjustment for baseline characteristics, PAD patients with prior CAD had
significantly higher rates of the composite primary endpoint (15.3% vs.
8.9%, HR 1.50, 95% CI 1.13-1.99, p=0.005), but no increase in acute limb
ischemia (ALI) (1.6% vs. 1.7%, HR 1.28, 95% CI 0.57-2.85, p=0.55) or major
bleeding (1.8% vs. 1.5%, HR 1.10, 95% CI 0.49-2.48, p=0.81), as compared
with PAD patients without CAD. Among patients with PAD and prior CAD,
there were no differences between ticagrelor vs. clopidogrel for the
primary efficacy endpoint (15.4% vs. 15.3%; HR 1.02, 95% CI 0.87-1.19;
p=0.84), ALI (1.6% vs. 1.5%; HR 1.03, 95% CI 0.63-1.69; p=0.89), or major
bleeding (1.7% vs. 1.8%; HR 1.06, 95% CI 0.66-1.69; p=0.81). There was a
significant interaction between prior stent placement and study treatment
(p=0.03) with a numeric trend towards a reduction in the primary efficacy
endpoint with ticagrelor (13.8% vs. 16.8%, HR 0.82, 95% CI 0.65-1.03,
p=0.09). Conclusions: Patients with PAD and prior CAD had higher composite
rates of cardiovascular death, MI, and ischemic stroke compared with PAD
patients without CAD. There were no significant differences between
ticagrelor and clopidogrel for reduction of cardiovascular or acute limb
ischemia events. Major bleeding was not significantly different between
groups.

<117>
Accession Number
621233947
Author
Moumneh T.; Malledan Y.; Calmes A.; Lacour E.; Roy P.M.
Institution
(Moumneh, Malledan, Calmes, Lacour, Roy) University Hospital of Angers,
Emergency Department, Angers, France
Title
Anti-Xa concentration better than activated partial thromboplastin time
for the monitoring of unfractionated heparin treatment.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 360-361), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: Suboptimal anticoagulation with Unfractionated Heparin (UFH)
is correlated with poor outcome. UFH monitoring is thus critical. Although
activated Partial Thromboplastin Time (aPTT) is widely use to do that,
Anti-Xa concentration was shown to be more reliable to reflect the
biological efficacy of UFH. Only low-level evidences are available to
support Anti-Xa monitoring in clinical practice Purpose: To assess the
efficacy of Anti-Xa concentration and aPTT to reach a stable level of
anticoagulation into clinical practice. Method: Retrospective monocentric
study. Patients above 18 receiving therapeutic dose of UHF, regardless of
the indication, for more than 48-hours were eligible. Exclusion criteria
were the monitoring with both aPTT and Anti-Xa concentration, no
monitoring in the first 48-hours, patients with mechanical heart valves or
the need for extrarenal purification or heart-lung bypass. The main
criterion was the time to reach anticoagulant stability, defined as two
consecutive assays in therapeutic range, defined as an aPTT ratio from 1.5
to 2.5 or an Anti-Xa concentration from 0.3 to 0.7 UI/mL. The percent time
in therapeutic range (TTR) was also calculated supposing linear evolution
for anticoagulation level between two assays. 71 patients estimated
necessary in each group. Agreement of the ethic committee. Results: The
median duration of treatment was 164 hours (Inter Quartile Range 112-243),
not different between the two groups (p=0.198). Anticoagulant stability
was reached in 58/71 (81.7%) patients in the Anti-Xa group versus 49/71
(69.0%) in the aPTT group (p=0.08). Time to reach stability was
significantly longer in the aPTT group (median time 58.6h) than in the
Anti-Xa group (median time 42.8h, Hazard Ratio 1.47 [1.08-1.85], Figure).
The percent TTR was no significantly different between the two groups:
49.8% [46.3-53.3] in the Anti-Xa group, 45.6% [42.0-49.2] in the group
aPTT, p=0.103. The need for dose adjustment was lower in the Anti-Xa
group: 5.6 vs 6.7 adjusments, p<0.001. Conclusion: UFH stability was
reached more often, and faster using Anti-Xa concentration. However, the
TTR seems less influenced by the type of assay. A prospective randomized
study in needed to support these observations. (Figure Presented).

<118>
Accession Number
621233814
Author
Iliadis C.; Lee S.; Kuhr K.; Metze C.; Matzik S.; Michels G.; Rudolph V.;
Baldus S.; Pfister R.
Institution
(Iliadis, Lee, Metze, Matzik, Michels, Rudolph, Baldus, Pfister) Cologne
University Hospital - Heart Center, Department III of Internal Medicine,
University of Cologne, Cologne, Germany
(Kuhr) University of Cologne, Institute of Medical Statistics,Informatics
and Epidemiology, Cologne, Germany
Title
Functional status and quality of life after transcatheter mitral valve
repair: A prospective cohort study and systematic review.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2017. Spain. 38 (Supplement 1) (pp 70), 2017. Date of
Publication: August 2017.
Publisher
Oxford University Press
Abstract
Background: The effect of transcatheter mitral valve repair using the
MitraClip system on functional and quality-of-life parameters is weakly
quantified. Methods: We combined data from a prospective monocentric
cohort study (N=215) with data from a systematic literature review (pubmed
search term ?mitraclip?, till 30.04.2016) on patients undergoing MitraClip
with at least mortality after discharge reported as an outcome, and
analysed effects on available functional parameters (range of mean change
indicated). Results: 36 observational studies and 1 randomised controlled
trial were identified. Substantial heterogeneity of effects on all
functional parameters was observed across studies. Quality of studies was
judged poor regarding selection of comparison groups (97.4% inadequate)
and assessment of outcomes (86.8% inadequate). All studies reported
improvements in mean New York Heart Association (NYHA) class (0.5 to 1.9
classes), Short-Form (SF)-12/36 scores (4.4 to 9.2 for physical component
score, 2.6 to 8.9 for mental component score), 6-minute walk distance
([6MWD] 2 to 336 meters) and Minnesota Living with Heart failure
questionnaire (MLWHFQ) score (-7 to -18 points), with clinically relevant
improvements in NYHA class in 20 of 29 studies, in SF12/36 in all of 7
studies, in 6MWD in 9 of 15 studies and in MLWHFQ in all of 8 studies.
Conclusion: MitraClip therapy provides clinically relevant improvements in
physical capacity, physical and mental functioning and disease-specific
quality of life. However, more comparative and high quality studies are
required for understanding the heterogeneity of results and individual
treatment decision-making.

<119>
Accession Number
621246948
Author
Needleman J.S.; Yeh D.D.; Belcher D.M.; Quraishi S.A.
Institution
(Needleman) Penn State College of Medicine, Hershey, PA, United States
(Needleman, Quraishi) Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Yeh) Surgery, Massachusetts General Hospital, Boston, MA, United States
(Belcher) Nutrition and Food Services, Massachusetts General Hospital,
Boston, MA, United States
Title
Vitamin D status is associated with new-onset atrial fibrillation in
critically ill surgical patients.
Source
Journal of Parenteral and Enteral Nutrition. Conference: Clinical
Nutrition Week , CNW 2017. United States. 41 (2) (pp 279-280), 2017. Date
of Publication: February 2017.
Publisher
SAGE Publications Inc.
Abstract
Purpose: New-onset atrial fibrillation (NOAF) is a common complication in
the intensive care unit (ICU), which is associated with increased
morbidity and mortality. Although there are several treatment options once
the arrhythmia develops, to date, strategies to prevent the onset of NOAF
are limited. A growing body of evidence suggests that systemic
inflammation plays an important role in the pathogenesis of NOAF; however,
the use of traditional anti-inflammatory agents has been shown to be
ineffective or is contraindicated in critically ill patients. Recent data
suggest that vitamin D has potent anti-inflammatory properties and that
low vitamin D status is very common in ICU patients. Therefore, our goal
was to investigate whether admission vitamin D status is associated with
NOAF in critically ill surgical patients. Methods: We performed a
retrospective analysis of data from a prospective, observational study of
nutrition status in critically ill surgical patients. Patients were
recruited from 2 surgical ICUs of a single teaching hospital in Boston,
Massachusetts. All patients had 25-hydroxyvitamin D (25OHD) levels
measured within 24 hours of ICU admission. NOAF was defined as the
occurrence of sustained atrial fibrillation within 72 hours of ICU
admission, which required medical intervention (either pharmacological or
cardioversion). To limit confounding, we excluded patients with a known
history of arrhythmias or those who were found to be in atrial
fibrillation at the time of ICU admission. To investigate the association
of 25OHD levels with NOAF, we first performed a logistic regression
analysis, controlling for body mass index (BMI), Acute Physiology and
Chronic Health Evaluation (APACHE) II score, and the type of surgical
patient (ie, general, thoracic, vascular, emergency/trauma, and
neurosurgery), while considering vitamin D status as a continuous
variable. Since vitamin D adequacy has been defined conservatively as
25OHD levels >=20 ng/mL, we therefore repeated the regression analysis,
while considering vitamin D status as a dichotomous variable (ie, 25OHD
levels <20 ng/mL vs >=20 ng/mL). Results: In total, 500 patients comprised
the analytic cohort. Mean (SD) 25OHD level was 18 (8), ng/mL and 36
patients (7.2%) developed NOAF. In our primary analysis, when vitamin D
status was considered as a continuous variable, regression analysis
demonstrated that each unit increment in 25OHD level was associated with a
15% reduced risk of NOAF (odds ratio [OR], 0.85; 95% confidence interval
[CI], 0.78-0.93). In our secondary analysis, when vitamin D status was
considered as a dichotomous variable, regression analysis demonstrated
that patients with 25OHD levels <20 ng/mL were almost 4 times more likely
to develop NOAF (OR, 3.59; 95% CI, 1.01-12.70) compared with those with
levels >=20 ng/mL. In these models, both BMI and APACHE II scores were
also independently associated with NOAF. Compared with general surgery
patients, thoracic (OR, 5.02; 95% CI, 1.63-15.39) and vascular surgery
(OR, 3.75; 95% CI, 1.18-11.94) patients were more likely to develop NOAF.
Conclusions: Our results suggest that vitamin D status may be a modifiable
risk factor for NOAF in critically ill surgical patients. Future
randomized controlled trials are needed to determine whether vitamin D
supplementation and/or optimization early in the course of critical
illness can reduce the risk of NOAF and its related complications.

<120>
Accession Number
621248179
Author
Anonymous
Title
Abstracts of CardioRisk2016, the Conference of the Egyptian Association of
Vascular Biology and Atherosclerosis, EAVA 2016.
Source
Atherosclerosis Supplements. Conference: CardioRisk2016, the Conference of
the Egyptian Association of Vascular Biology and Atherosclerosis, EAVA
2016. Egypt. 25 (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
The proceedings contain 18 papers. The topics discussed include: a
retrospective study to assess the presence of association between vitamin
D levels and ejection fraction in KAMCHC patients; assessment of IL-10
levels and LV global longitudinal strain by speckle tracking
echocardiography in acute myocardial infarction; characteristics of
coronary artery ectasia and its association with carotid intima-media
thickness and high sensitivity C-reactive protein; atorvastatin for
reduction of postoperative atrial fibrillation in patients undergoing
cardiac surgery; comparison between bolus intracoronary versus bolus
intravenous injection regimens of eptifibatide during primary PCI in
patients with anterior STEMI; and comparison of the effect of warm versus
cold cardioplegia during and after surgery on patients with rheumatic left
sided lesions associated with preoperative impaired right ventricular
function.

<121>
Accession Number
621248136
Author
Mansour H.; Ghaleb R.
Institution
(Mansour) October 6th University, Cairo, Egypt
(Ghaleb) Aswan University, Aswan, Egypt
Title
Atorvastatin for reduction of postoperative atrial fibrillation in
patients undergoing cardiac surgery.
Source
Atherosclerosis Supplements. Conference: CardioRisk2016, the Conference of
the Egyptian Association of Vascular Biology and Atherosclerosis, EAVA
2016. Egypt. 25 (pp e2), 2017. Date of Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Post-operative atrial fibrillation (POAF) is the most common
complication encountered after cardiac surgery. Atrial fibrillation (AF)
after cardiac surgery is associated with increased risk of complications,
length of stay, and cost of care. Observational evidence suggests that
patients who have undergone previous statin therapy have a lower incidence
of postoperative AF. We tested this observation in a randomized,
controlled trial. Methods: Patients undergoing elective cardiac surgery,
without previous statin treatment or history of AF, were enrolled.
Patients were randomized to atorvastatin (40 mg/d, n: 25) or placebo (n:
25) starting 7 days before operation. The primary end point was incidence
of postoperative AF; secondary end points were length of stay, major
adverse cardiac and cerebrovascular events, and postoperative C-reactive
protein (CRP) variations. Results: Atorvastatin significantly reduced the
incidence of AF versus placebo (36% versus 64%, p = 0.048). Accordingly,
length of stay was longer in the placebo versus atorvastatin arm (7.5 +/-
1.5) versus (5.5 +/- 1.5) days, p = 0.04). Multivariable analysis showed
that atorvastatin treatment conferred a 61% reduction in risk of AF,
whereas high postoperative CRP levels were associated with increased risk
(p = 0.04). The incidence of major adverse cardiac and cerebrovascular
events at 30 days was similar in the two arms. Conclusion: Treatment with
atorvastatin 40 mg/d, initiated 7 days before surgery, significantly
reduces the incidence of postoperative AF after elective cardiac surgery
and shortens hospital stay. These results may influence pharmacological
therapy before cardiac surgery.

<122>
Accession Number
621245439
Author
Erdoes G.; Basciani R.; Kroninger F.; Gygax E.; Jenni H.; Reineke D.;
Stucki M.; Hagenbuch N.; Carrel T.; Eberle B.
Institution
(Erdoes, Basciani, Kroninger, Gygax, Jenni, Reineke, Stucki, Hagenbuch,
Carrel, Eberle) Department of Anesthesiology and Pain Therapy, Bern
University Hospital, University of Bern, Switzerland
Title
Cerebral microembolization in patients undergoing surgical aortic valve
replacementon minimal invasive or conventional extracorporeal circulation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 2nd
International Symposium on Minimal Invasive Extracorporeal Technologies,
MiECT. Greece. 23 (4) (pp i3), 2016. Date of Publication: October 2016.
Publisher
Oxford University Press
Abstract
Background: Evidence about the incidence of cerebral microembolization
(CME) on minimal invasive extracorporeal circulation (MiECC) when compared
to conventional ECC (cCPB), is not conclusive. Theoretically, less CME may
be expected with MiECC, since numerous factors promoting CME are avoided.
Methods: The primary outcome was the procedural phase-related rate of
highintensity transient signals (HITS) on transcranial Doppler ultrasound.
HITS rate was used as a surrogate of CME in defined procedural phases
during surgical aortic valve replacement (SAVR) using MiECC or cCPB with
(+F) or without (-F) an oxygenator with integrated arterial filter.
Results: Forty-eight patients were randomized in a 1:1 ratio to MiECC or
cCPB. Due to intraprocedural Doppler signal loss (n = 3), 45 patients were
included in the final analysis. MiECC perfusion regimen showed a
significantly increased HITS rate compared to cCPB (by a factor of 1.75;
95% CI: 1.19 to 2.56). This was due to different HITS rates in procedural
phases from aortic cross-clamping until de-clamping [phase 4 (P = 0.01),
and from aortic de-clamping until discontinuation of extracorporeal
perfusion [phase 5] (P = 0.05). Post-hoc analysis revealed that MiECC-F
generated a higher HITS rate than cCPB + F (P = 0.005), cCPB-F (P = 0.05)
in phase 4, and cCPB-F (P = 0.03) in phase 5, respectively. Conclusions:
In open-heart surgery, MiECC is not superior to cCPB with regard to
gaseous cerebral microembolism. When using MiECC for SAVR, the use of
oxygenators with an integrated arterial line filter appears highly
advisable. Only with this precaution does MiECC confer a cerebral
microembolic load comparable to cCPB during this type of open heart
surgery.

<123>
Accession Number
621245436
Author
Antonitsis P.; Kostarellou G.; Argiriadou H.; Kleontas A.; Deliopoulos A.;
Grosomanidis V.; Anastasiadis K.
Institution
(Antonitsis, Kostarellou, Argiriadou, Kleontas, Deliopoulos, Grosomanidis,
Anastasiadis) Cardiothoracic Department, AHEPA University Hospital,
Thessaloniki, Greece
Title
Minimal invasive extracorporeal circulation improves quality of life after
coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 2nd
International Symposium on Minimal Invasive Extracorporeal Technologies,
MiECT. Greece. 23 (4) (pp i2-i3), 2016. Date of Publication: October 2016.
Publisher
Oxford University Press
Abstract
Background: The effect on postoperative health related quality of life
(HRQoL) after coronary artery bypass grafting (CABG) surgery with
conventional cardiopulmonary bypass (cCPB) and off-pump surgery has been
investigated extensively; however, there are no studies focusing on HRQoL
after surgery with minimal invasive extracorporeal circulation (MiECC).
Therefore, we sought to prospectively investigate the effect of MiECC on
postoperative HRQoL as compared to cCPB in patients undergoing CABG over a
short-term (3-month) follow-up period. Methods: Sixty patients scheduled
for elective CABG surgery were randomly assigned into two groups: those
who had surgery on MiECC system (n = 30) and those who underwent CABG
using cCPB (n = 30). Quality of life assessment was performed
preoperatively (baseline-T0), at first postoperative month (T1) and at
3-month follow-up (T3). The RAND SF-36 scale was used for data collection,
which included both sociodemographic and clinical characteristics of
patients. The primary outcome of the study was quantitative measurement of
postoperative HRQoL at 3-month follow-up. Results: Both groups were
balanced in terms of demographic, socioeconomic and operative
characteristics. At 3-month follow-up mean SF-36 component and summary
scores in each group were higher in absolute values than the respective
mean baseline scores, apart from the role physical score in patients
operated with cCPB. Patients operated on MiECC showed uniformly
significantly higher values in all individual and summary domains, while
patients operated on cCPB showed significant improvement in 6/8 individual
domains. Patients operated on MiECC showed a more pronounced increase in
SF-36 individual domains scores from the first to the third postoperative
month as compared to cCPB, which was statistically significant regarding
physical functioning (P = 0.001), physical role (P < 0.001), vitality (P =
0.01) and emotional role (P = 0.004). This resulted in a significant
improvement in physical (P = 0.002) and mental (P= 0.01) summary scores.
Conclusions: The current study proves that MiECC significantly improves
HRQoL after coronary surgery compared with cCPB. This finding, combined
with results from large-scale studies showing superior clinical outcomes
from its use, enhances the role of MiECC as a dominant technique in
coronary revascularization surgery.

<124>
Accession Number
621245435
Author
Glendza D.; Dedieu F.; Crispin V.; Aunac S.; Guennaoui T.; Van Ruyssevelt
P.
Institution
(Glendza, Dedieu) Perfusion Service, Jolimont Hospital, Belgium
(Crispin, Aunac) Department of Anesthesia, Jolimont Hospital, Belgium
(Guennaoui, Van Ruyssevelt) Department of Cardiovascular Surgery, Jolimont
Hospital, Belgium
Title
Coronary artery bypass grafting on beating heart, on cardiopulmonary
bypass or on minimal extracorporeal circulation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 2nd
International Symposium on Minimal Invasive Extracorporeal Technologies,
MiECT. Greece. 23 (4) (pp i2), 2016. Date of Publication: October 2016.
Publisher
Oxford University Press
Abstract
Background: The aim of this study was to compare three methods of coronary
bypass grafting, using a beating heart (OPCAB), or a conventional
cardiopulmonary bypass (cCPB) or a mini-extracorporeal circulation (MECC)
technique. Simple parameters routinely used in cardiac surgery were
recorded and analysed. Substantial advantages of MECC expected to be
highlighted. Methods: At our institution, from September 2012 and June
2014, sixty patients divided in three cohorts (n = 20) underwent
myocardial revascularization on beating or arrested heart. A prospective
single-blind study was carried out. We mainly analysed simple biological
and clinical parameters (e.g. haemodilution, transfusion rate,
haemoglobin, haematocrit, blood platelets, lactates, urea, creatinine
levels, intensive care stay and hospital stay). Results: At 24 hours
postoperatively, the MECC group showed a higher haemoglobin level (11.17
+/- 1.26 g/dl vs 9.85 +/- 1.53 g/dl, P = <0.005 on cCPB and 10.13 +/-
0.56, P = <0.026 on OPCAB). Red blood cells transfusion rate was higher in
the cCPB group (10 patients (50%), P = <0.041 vs 3 (15%) in the MECC and
OPCAB groups. Patients in the cCPB group had a longer mechanical assisted
ventilation time (9 patients (45%), P = <0.031, while only 2 patients
(10%) in MECC group and 4 patients (20%), P = <0.088 in OPCAB group).
Blood losses at 48 hours postoperatively were respectively 844 +/- 440 ml
in MECC vs 845 +/- 415 ml in cCPB, P = <0.988 and 1222 +/- 639 ml, P =
<0.035 in OPCAB group. Conclusions: Despite the limitation of this study
(small cohorts), the results showed that surgical multivessel
revascularization can be performed with a mini-extracorporeal circulation
avoiding haemodynamic instability, and with reduced transfusion needs.
Compared to the other cohorts, patients of the MECC group were extubated
earlier but without any reduction of the length of hospital stay. However,
this interesting observation and few encountered problems lead us to go
further on our survey. Larger studies are warranted for more significant
results.

<125>
Accession Number
621239586
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Drug-eluting stents versus coronary artery bypass grafting for left-main
coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 91 (4) (pp 697-709),
2018. Date of Publication: 01 Mar 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To compare follow-up outcomes after percutaneous coronary
intervention with drug-eluting stents (DES-PCI) versus coronary artery
bypass grafting (CABG) for left-main coronary artery disease (LMCAD), we
performed a meta-analysis of randomized controlled trials (RCTs) and
observational studies with propensity-score analysis. Methods: MEDLINE,
EMBASE, and the Cochrane Central Register of Controlled Trials were
searched through November 2016. Eligible studies were RCTs or
observational studies with propensity-score analysis of DES-PCI versus
CABG enrolling patients with LMCAD and reporting >= 6-month mortality,
myocardial infarction (MI), stroke, or repeat revascularization (RRV).
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic hazard ratios (HRs) in the random-effects model.
Results: We identified 5 RCTs and 17 observational studies with
propensity-score analysis enrolling a total of 12,387 patients. Pooled
analysis demonstrated a significant increase in a composite of death, MI,
and RRV (with/without stroke) after DES-PCI (HR, 1.42; P < 0.00001); no
significant difference in a composite of death and MI (with/without
stroke); no significant differences in mortality and stroke; a strong
trend toward an increase in MI after DES-PCI (HR, 1.44; P = 0.05); and
significant increases in any (HR, 1.86; P < 0.00001), target-vessel (HR,
3.28; P < 0.00001), and target-lesion RRV (HR, 2.26; P = 0.003) after
DES-PCI. Conclusions: When compared with CABG, DES-PCI for LMCAD was
associated with increases in RRV and the composite of death, MI, and RRV
(with/without stroke), despite no differences in mortality, MI, stroke,
and the composite of death and MI (with/without stroke). Copyright
© 2017 Wiley Periodicals, Inc.

<126>
Accession Number
621231977
Author
Liu Z.; Zhao L.; Jia Q.; Yang X.; Liang S.J.; He W.
Institution
(Liu, Jia, Yang, Liang, He) Department of Anesthesiology, First Hospital
of Qinhuangdao, Qinhuangdao, Hebei, China
(Zhao) Department of Emergency, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei, China
Title
Chest Computed Tomography Image for Accurately Predicting the Optimal
Insertion Depth of Left-Sided Double-Lumen Tube.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 855-859),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: The main objective of this study was to assess the feasibility
and accuracy of measuring the distance between the vocal cord and carina
using chest computer tomography (CT) as a guide for the intubation of a
left-sided double-lumen tube (LDLT). Design: Single-center, prospective,
randomized study. Setting: Local hospital in China. Participants: Sixty
adult patients undergoing elective thoracic surgery requiring an LDLT for
one lung ventilation were enrolled in this study. Interventions: Patients
were randomly allocated to the following 2 groups: blind intubation group
(B group, n = 30) or chest computed tomography-guided group (C group, n =
30). The placement of the LDLT was accomplished using 1 of the 2
intubation methods. After intubation, an independent anesthesiologist
evaluated the position of the LDLT and carina and bronchial injuries using
fiber optic bronchoscopy. The number of optimal positions, the time for
LDLT intubation, the time for fiber optic bronchoscope confirmation, and
carina and bronchial injuries were recorded. Results: Sixteen of 30
intubations in the B group were in optimal position, whereas 27 of 30
intubations in the C group were in optimal position; the difference was
statistically significant (p < 0.01). The time for intubation of the LDLT
took 118.0 +/- 26.2 seconds in the B group and 71.5 +/- 8.7 seconds in the
C group (p < 0.01). The time for position confirmation using fiber optic
bronchoscope took 40.8 +/- 15.8 seconds in the B group and 18.7 +/- 7.9
seconds in the C group (p < 0.05). The incidences of carina and bronchial
injuries were obviously lower in the C group (occurred in 3 of 30 cases)
than in the B group (11 of 30 cases) p < 0.05. The incidences of
postoperative sore throat and hoarseness showed no significant differences
between the 2 groups (p > 0.05). Conclusion: This study demonstrated that
the method of measuring the distance between the vocal cord and carina
according to the chest CT as a guide for the intubation of LDLT is more
effective and more accurate than the blind intubation
method. Copyright © 2017 Elsevier Inc.

<127>
Accession Number
621231973
Author
Wang Y.-C.; Huang C.-H.; Tu Y.-K.
Institution
(Wang, Huang) Department of Anaesthesiology, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Tu) Institute of Epidemiology & Preventive Medicine, College of Public
Health, National Taiwan University, Taipei, Taiwan (Republic of China)
Title
Effects of Positive Airway Pressure and Mechanical Ventilation of the
Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 748-759),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether different ventilation strategies during
cardiopulmonary bypass (CPB) can improve outcomes in adult cardiac surgery
patients. Design: Systematic review of randomized controlled trials with
meta-analyses. Setting: Clinical trials for human studies up to July 2016
were obtained from electronic databases (Medline, Embase, PubMed, and the
Cochrane Central Register of Controlled Trials) and reference lists of
relevant randomized trials and review articles. Participants: Adult
patients undergoing cardiac surgery. Interventions: Patients who underwent
cardiac surgery with CPB and ventilation or continuous positive airway
pressure (CPAP). Measurements and Main Results: Fifteen randomized
controlled trials with 748 patients were analyzed. In cardiac surgery,
CPAP use during CPB was associated with an improved alveolar-arterial
oxygen gradient difference compared with no CPAP (weighted mean difference
[WMD] = 4.11 kPa; 95% confidence interval [CI] = 0.85-7.37; I2
= 28.8%). Ventilation during CPB did not improve the postoperative
hypoxemia score (WMD = 30.94; 95% CI = -20.76 to 82.63; I2 =
61%) or diffusion capacity compared with the apnea group (WMD = 2.59 kPa;
95% CI = -2.49 to 7.67; I2 = 81.3%). Neither CPAP nor
ventilation during CPB was associated with a shorter mechanical
ventilation time or hospital stay. Conclusions: CPAP during CPB improved
the alveolar-arterial oxygen gradient difference compared with apnea, but
ventilation during CPB did not. Neither CPAP nor ventilation during CPB
demonstrated evidence of improving clinical outcomes in low- or
intermediate-risk patients for elective cardiac surgery. The findings are
inconclusive because of heterogeneity and small sample
sizes. Copyright © 2017 Elsevier Inc.

<128>
Accession Number
621179874
Author
Romano R.; Cristescu S.M.; Risby T.H.; Marczin N.
Institution
(Romano, Marczin) Section of Anaesthetics, Pain Medicine and Intensive
Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London, London, United Kingdom
(Cristescu) Department of Molecular and Laser Physics, Institute of
Molecules and Materials, Radboud University, Nijmegen, Netherlands
(Risby) Department of Environmental Health Sciences, Bloomberg School of
Public Health, Johns Hopkins University, Baltimore, United States
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
Title
Lipid peroxidation in cardiac surgery: Towards consensus on biomonitoring,
diagnostic tools and therapeutic implementation.
Source
Journal of Breath Research. 12 (2) (no pagination), 2018. Article Number:
027109. Date of Publication: April 2018.
Publisher
Institute of Physics Publishing (E-mail: helen.craven@iop.org)
Abstract
This review focuses on oxidative stress and more specifically lipid
peroxidation in cardiac surgery, one of the fundamental theories of
perioperative complications. We present the molecular pathways leading to
lipid peroxidation and integrate analytical methods that allow detection
of lipid peroxidation markers in the fluid phase with those focusing on
volatile compounds in exhaled breath. In order to explore the accumulated
data in the literature, we present a systematic review of quantitative
analysis of malondialdehyde, a widely used lipid peroxidation product at
various stages of cardiac surgery. This exploration reveals major
limitations of existing studies in terms of variability of reported values
and significant gaps due to discrete and variable sampling times during
surgery. We also appraise methodologies that allow real-time and
continuous monitoring of oxidative stress. Complimentary techniques
highlight that beyond the widely acclaimed contribution of the
cardiopulmonary bypass technology and myocardial reperfusion injury, the
use of diathermy contributes significantly to intraoperative lipid
peroxidation. We conclude that there is an urgent need to implement the
theory of oxidative stress towards a paradigm change in the clinical
practice. Firstly, we need to acquire definite and irrefutable information
on the link between lipid peroxidation and post-operative complications by
building international consensus on best analytical approaches towards
generating qualitatively and quantitatively comparable datasets in
coordinated multicentre studies. Secondly, we should move away from
routine low-risk surgeries towards higher risk interventions where there
is major unmet clinical need for improving patient journey and outcomes.
There is also need for consensus on best therapeutic interventions which
could be tested in convincing large scale clinical trials. As future
directions, we propose combination of fluid phase platforms and
'metabography', an extended form of capnography - including real-time
analysis of lipid peroxidation and volatile footprints of metabolism - for
better patient phenotyping prior to and during high risk surgery towards
molecular prediction, stratification and monitoring of the patient's
journey. Copyright © 2018 IOP Publishing Ltd.

<129>
Accession Number
621250003
Author
Grundmann F.; Muller R.-U.; Reppenhorst A.; Hulswitt L.; Spath M.R.;
Kubacki T.; Scherner M.; Faust M.; Becker I.; Wahlers T.; Schermer B.;
Benzing T.; Burst V.
Institution
(Grundmann, Muller, Reppenhorst, Hulswitt, Spath, Kubacki, Schermer,
Benzing, Burst) Department II of Internal Medicine, Center for Molecular
Medicine Cologne, University of Cologne, Germany
(Muller, Schermer, Benzing) Cologne Excellence Cluster on Cellular Stress
Responses in Aging-Associated Diseases (CECAD), University of Cologne,
Germany
(Scherner, Faust, Wahlers) Department of Cardiothoracic Surgery,
University of Cologne, Germany
(Faust) Center for Endocrinology, Diabetes and Preventive Medicine,
University of Cologne, Germany
(Becker) Institute of Medical Statistics and Computational Biology,
University of Cologne, Germany
Title
Preoperative short-term calorie restriction for prevention of acute kidney
injury after cardiac surgery: A randomized, controlled, open-label, pilot
trial.
Source
Journal of the American Heart Association. 7 (6) (no pagination), 2018.
Article Number: e008181. Date of Publication: 20 Mar 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury is a frequent complication after cardiac
surgery and is associated with adverse outcomes. Although short-term
calorie restriction (CR) has proven protective in rodent models of acute
kidney injury, similar effects have not yet been demonstrated in humans.
Methods and Results--CR_KCH (Effect of a Preoperative Calorie Restriction
on Renal Function After Cardiac Surgery) is a randomized controlled trial
in patients scheduled for cardiac surgery. Patients were randomly assigned
to receive either a formula diet containing 60% of the daily energy
requirement (CR group) or ad libitum food (control group) for 7 days
before surgery. In total, 82 patients were enrolled between April 16,
2012, and February 5, 2015. There was no between-group difference in the
primary end point of median serum creatinine increment after 24 hours
(control group: 0.0 mg/dL [-0.1 - (+0.2) mg/dL]; CR group: 0.0 mg/dL [-0.2
- (+0.2) mg/dL]; P=0.39). CR prevented a rise in median creatinine at 48
hours (control group: +0.1 mg/dL [0.0 - 0.3 mg/dL]; CR group: -0.1 mg/dL
[-0.2 - (+0.1) mg/dL]; P=0.03), with most pronounced effects observed in
male patients and patients with a body mass index > 25. This benefit
persisted until discharge: Median creatinine decreased by 0.1 mg/dL (-0.2
- 0.0 mg/dL) in the CR group, whereas it increased by 0.1 mg/dL (0.0 - 0.3
mg/dL; P=0.0006) in the control group. Incidence of acute kidney injury
was reduced by 5.8% (41.7% in the CR group compared with 47.5% in the
control group). Safety-related events did not differ between groups.
Conclusions--Despite disappointing results with respect to creatinine rise
within the first 24 hours, the benefits observed at later time points and
the subgroup analyses suggest the protective potential of short-term CR in
patients at risk for acute kidney injury, warranting further
investigation. Copyright © 2018 The Authors.

<130>
Accession Number
621249873
Author
Junejo F.; Akhtar M.I.; Hamid M.; Ahmed S.S.; Minai F.; Amanullah M.
Institution
(Junejo, Akhtar, Hamid, Ahmed, Minai, Amanullah) Department of
Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan
Title
Comparison between intravenous boluses versus infusion of tranexamic acid
(TXA) to reduce bleeding in paediatric cyanotic congenital heart disease
(CHD) surgeries.
Source
Journal of the College of Physicians and Surgeons Pakistan. 28 (3) (pp
180-183), 2018. Date of Publication: 01 Mar 2018.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare the intravenous boluses and intravenous continuous
infusion of tranexamic acid (TXA) to reduce postoperative bleeding in
cyanotic congenital heart disease surgeries. Study Design: Single-blinded
randomised clinical trial. Place and Duration of Study: Anaesthesia
Department, The Aga Khan University Hospital, Karachi, from July 2016 to
April 2017. Methodology: Sixty patients of cyanotic congenital heart
disease, undergoing either palliative or corrective surgery involving
cardiopulmonary bypass (CPB), were recruited. These 60 patients were
divided randomly into two groups. The infusion group received intravenous
infusion of TXA at 5 mg/kg/hour while the bolus group received three
intravenous boluses of 10 mg/kg after induction, after going to bypass and
after protamine reversal. Data was collected through predesigned proforma.
There were two primary outcomes: postoperative bleeding in the first 24
hours, and chest closure time. Results: Postoperative bleeding was 13.94
(10.27-20.18) ml/kg in the first 24 hours in infusion group and 15.05
(9.04- 23.50) ml/kg in the bolus group. Chest closure time was 38.5
(25-45) in infusion group and 30 (20-46.25) minutes in the bolus group.
There was no statistically significant and clinical difference between
both groups regarding postoperative bleeding in the first 24 hours and
chest closure time. Conclusion: These infusion and bolus groups had
comparable postoperative bleeding and chest closure time. Copyright
© Journal of the College of Physicians and Surgeons Pakistan 2018.

<131>
Accession Number
621243862
Author
Beaupre L.A.; Wai E.K.; Hoover D.R.; Noveck H.; Roffey D.M.; Cook D.R.;
Magaziner J.S.; Carson J.L.
Institution
(Beaupre) Department of Physical Therapy, University of Alberta, Edmonton,
AB, Canada
(Wai, Roffey) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada
(Wai) Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa,
ON K1H 8M5, Canada
(Wai) Division of Orthopaedic Surgery, Department of Surgery, The Ottawa
Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
(Hoover) Department of Statistics and Biostatistics, Rutgers University,
The State University of New Jersey, 473 Hill Center, Campus Rutgers Univ.
110 Frelinghuysen Rd, Piscataway, NJ 08854-8019, United States
(Noveck, Carson) Division of General Internal Medicine, Rutgers Robert
Wood Johnson Medical School, Rutgers Biomedical and Health Sciences,
Rutgers, The State University of New Jersey, 125 Paterson St, New
Brunswick, NJ 08901, United States
(Cook) Division of General Internal Medicine, Cumming School of Medicine,
University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, AB
T2N 2T9, Canada
(Magaziner) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood
Street, Baltimore, MD 21201, United States
Title
A comparison of outcomes between Canada and the United States in patients
recovering from hip fracture repair: Secondary analysis of the FOCUS
trial.
Source
International Journal for Quality in Health Care. 30 (2) (pp 97-103),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
Objective: To determine if adjusted mortality, walking ability or return
home differed after hip fracture surgery between Canada and the USA.
Design: Secondary analysis of the Functional Outcomes in Cardiovascular
Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data.
Setting: Data were collected from 47 American and Canadian hospitals.
Participants: Overall, 2016 subjects with a hip fracture (USA = 1222
(60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive
transfusion strategy. Subjects were 50 years and older, with
cardiovascular disease and/or risk factors and hemoglobin <100 g/L within
3 days post-surgery. The average age was 82 years and 1527(76%) subjects
were females. Intervention: Demographics, health status and health
services data were collected up to 60 days post-surgery and mortality to a
median of 3 years post-surgery. Main outcomes: Mortality, inability to
walk and return home. Results: US subjects had higher adjusted mortality
than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval:
1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio =
1.25; 1.07-1.45). There were no differences in adjusted outcomes for
walking ability or return home at 30 or 60 days post-surgery. Median
hospital length of stay was longer (P < 0.0001) in Canada (9 days;
interquartile range: 5-18 days) than the US (3 days; 2-5 days). US
subjects (52.9%) were more likely than Canadians (16.8%) to be discharged
to nursing homes for rehabilitation (P < 0.001). Conclusions: Adjusted
survival favored Canadians post hip fracture while walking ability and
return home were not different between countries. The reason(s) for
mortality differences warrant further investigation. Copyright ©
The Author(s) 2018. Published by Oxford University Press in association
with the International Society for Quality in Health Care. All rights
reserved.

<132>
Accession Number
2000543371
Author
Wang A.; Wu A.; Wojdyla D.; Lopes R.D.; Newby L.K.; Newman M.F.; Smith
P.K.; Alexander J.H.
Institution
(Wang) Department of Surgery, Duke University Medical Center, Durham, NC,
United States
(Wu, Wojdyla) Department of Statistics, Duke Clinical Research Institute,
2400 Pratt St, Durham, NC, United States
(Lopes, Newby, Alexander) Division of Cardiology, Department of Medicine,
Duke University Medical Center, Durham, NC, United States
(Newman) Division of Cardiothoracic, Department of Anesthesiology, Duke
University Medical Center, Durham, NC, United States
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
Title
Dual antiplatelet therapy for perioperative myocardial infarction
following CABG surgery.
Source
American Heart Journal. 199 (pp 150-155), 2018. Date of Publication: May
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Perioperative myocardial infarction (MI) after coronary artery
bypass graft surgery (CABG) has been associated with adverse outcome.
Whether perioperative MI should be treated with dual antiplatelet therapy
(DAPT) is unknown. We compared the effect of DAPT versus aspirin alone on
short-term outcomes among patients with perioperative MI following CABG.
Methods: We used data from 3 clinical trials that enrolled patients
undergoing isolated CABG: PREVENT IV (2002-2003), MEND-CABG II
(2004-2005), and RED-CABG (2009-2010) (n = 9117). Perioperative MI was
defined as CK-MB >5 times the upper limit of normal within 24 h of surgery
(n = 2052). DAPT was defined as DAPT given after surgery and prior to
discharge. A Cox regression model was used to assess the association
between DAPT and 30-day nonfatal MI, stroke, or mortality after adjustment
for baseline covariates. Results: DAPT (n = 527) and aspirin alone (n =
1525) cohorts were similar in baseline comorbidities. Off pump bypass was
used in 5.2% (n = 106) of patients. There was no difference in the 30-day
composite of death, MI or stroke between patients receiving DAPT versus
aspirin alone, nor in any of the individual components. There were fewer
all-cause re-hospitalizations at 30 days following surgery among patients
in the DAPT group (adjusted HR 0.71, CI 0.52-0.97, P =.033). Conclusion:
One-quarter of CABG patients who had perioperative MI were treated with
DAPT. DAPT was not associated with a difference in MI, stroke, or
mortality at 30 days, but was associated with fewer re-hospitalizations.
Further studies are needed to determine the optimal antiplatelet regimen
following perioperative MI. What is already known about this subject?
Perioperative myocardial infarction portends poor outcome but optimal
management is currently unclear. While dual antiplatelet therapy is
standard of care for acute coronary syndrome, its role in perioperative
myocardial infarction is unknown. What does this study add? Dual
antiplatelet therapy use during perioperative myocardial infarction was
not associated with a difference in myocardial infarction, stroke or
mortality at 30 days. It was, however, associated with fewer
re-hospitalizations at 30 days. How might this impact on clinical
practice? Dual antiplatelet therapy may be a potential treatment option
for perioperative myocardial infarction after CABG surgery. Further
studies are needed to better understand treatment for this disease
process. Copyright © 2018

<133>
[Use Link to view the full text]
Accession Number
621248423
Author
Nagappa M.; Ho G.; Patra J.; Wong J.; Singh M.; Kaw R.; Cheng D.; Chung F.
Institution
(Nagappa) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre and St Joseph Health Care, Western University,
London, ON, Canada
(Ho, Patra, Wong, Singh, Chung) Department of Anesthesiology and Pain
Medicine, Toronto Western Hospital, University of Toronto, 399 Bathurst
St, Toronto, ON M5T 2S8, Canada
(Kaw) Departments of Hospital Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Kaw) Departments of Outcomes Research (Anesthesiology), Cleveland Clinic,
Cleveland, OH, United States
(Cheng) Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(Cheng) Department of Anesthesia and Perioperative Medicine, Western
University, London, ON, Canada
Title
Postoperative outcomes in obstructive sleep apnea patients undergoing
cardiac surgery: A systematic review and meta-analysis of comparative
studies.
Source
Anesthesia and Analgesia. 125 (6) (pp 2030-2037), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in
patients undergoing cardiac surgery and may predispose patients to
postoperative complications. The purpose of this meta-analysis is to
determine the evidence of postoperative complications associated with OSA
patients undergoing cardiac surgery. METHODS: A literature search of
Cochrane Database of Systematic Reviews, Medline, Medline In-process, Web
of Science, Scopus, EMBASE, Cochrane Central Register of Controlled
Trials, and CINAHL until October 2016 was performed. The search was
constrained to studies in adult cardiac surgical patients with diagnosed
or suspected OSA. All included studies must report at least 1
postoperative complication. The primary outcome is major adverse cardiac
or cerebrovascular events (MACCEs) up to 30 days after surgery, which
includes death from all-cause mortality, myocardial infarction, myocardial
injury, nonfatal cardiac arrest, revascularization process, pulmonary
embolism, deep venous thrombosis, newly documented postoperative atrial
fibrillation (POAF), stroke, and congestive heart failure. Secondary
outcome is newly documented POAF. The other exploratory outcomes include
the following: (1) postoperative tracheal intubation and mechanical
ventilation; (2) infection and/or sepsis; (3) unplanned intensive care
unit (ICU) admission; and (4) duration of stay in hospital and ICU.
Meta-analysis and meta-regression were conducted using Cochrane Review
Manager 5.3 (Cochrane, London, UK) and OpenBUGS v3.0, respectively.
RESULTS: Eleven comparative studies were included (n = 1801 patients; OSA
versus non-OSA: 688 vs 1113, respectively). MACCEs were 33.3% higher odds
in OSA versus non-OSA patients (OSA versus non-OSA: 31% vs 10.6%; odds
ratio [OR], 2.4; 95% confidence interval [CI], 1.38-4.2; P = .002). The
odds of newly documented POAF (OSA versus non-OSA: 31% vs 21%; OR, 1.94;
95% CI, 1.13-3.33; P = .02) was higher in OSA compared to non-OSA. Even
though the postoperative tracheal intubation and mechanical ventilation
(OSA versus non-OSA: 13% vs 5.4%; OR, 2.67; 95% CI, 1.03-6.89; P = .04)
were significantly higher in OSA patients, the length of ICU stay and
hospital stay were not significantly prolonged in patients with OSA
compared to non-OSA. The majority of OSA patients were not treated with
continuous positive airway pressure therapy. Meta-regression and
sensitivity analysis of the subgroups did not impact the OR of
postoperative complications for OSA versus non-OSA groups. CONCLUSIONS:
Our meta-analysis demonstrates that after cardiac surgery, MACCEs and
newly documented POAF were 33.3% and 18.1% higher odds in OSA versus
non-OSA patients, respectively. Copyright © 2017 International
Anesthesia Research Society.

<134>
[Use Link to view the full text]
Accession Number
621248371
Author
Spence J.; Long S.; Tidy A.; Raymer K.; Devereaux P.J.; Lamy A.; Whitlock
R.; Syed S.
Institution
(Spence, Tidy, Raymer, Syed) Department of Anesthesia, McMaster
University, Hamilton, ON, Canada
(Spence, Devereaux, Lamy, Whitlock) Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON, Canada
(Spence, Devereaux, Lamy, Whitlock) Population Research Health Institute
(PHRI), Hamilton, ON, Canada
(Long) Michael G DeGroote School of Medicine, Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Devereaux) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Lamy, Whitlock) Division of Cardiac Surgery, Department of Surgery,
McMaster University, Hamilton, ON, Canada
Title
Tranexamic acid administration during on-pump cardiac surgery: A survey of
current practices among Canadian Anesthetists Working in Academic Centers.
Source
Anesthesia and Analgesia. 125 (6) (pp 1863-1870), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Tranexamic acid (TXA) is commonly administered during on-pump
cardiac surgery to minimize bleeding. However, an optimal dosing regimen
has not been described, and recent studies suggest that higher doses may
be associated with seizure. Little is known about current practice among
cardiac anesthetists. METHODS: We contacted all academic anesthesia
departments in Canada to identify cardiac anesthetists, who represent the
majority of practitioners. This group constituted our sampling frame.
Information regarding participant demographics, TXA dose, and
administration details were obtained by electronic survey. Responses were
analyzed descriptively. To compare dose, we assumed an 80-kg patient and 3
hours of infusion time. The Kruskal-Wallis test was used to compare
average dose across provinces. RESULTS: Among 341 Canadian academic
cardiac anesthetists, 234 completed the survey (68.2% response rate).
Among respondents, 86.3% administer TXA to all patients; 13.7% administer
it to some. Most (68.4%) administer an infusion after a bolus; other modes
included infusion (4.7%), single bolus (13.2%), 2 or more boluses (12.0%),
or another regimen (1.7%). The mean (standard deviation) dose given was 49
mg/kg (24), with a range from 10 to 100 mg/kg. The mean dose varied across
provinces from 23 to 55 mg/kg (P = .001). CONCLUSIONS: TXA is given to
nearly all patients undergoing on-pump cardiac surgery at academic
hospitals in Canada. However, there is significant heterogeneity in
practice between individuals and across provinces. Further research is
needed to determine the TXA dose that maximizes efficacy and minimizes
side effects. Copyright © 2017 International Anesthesia Research
Society.

<135>
Accession Number
621249026
Author
Briasoulis A.; Inampudi C.; Pala M.; Asleh R.; Alvarez P.; Bhama J.
Institution
(Briasoulis, Inampudi, Pala, Alvarez, Bhama) Division of Cardiovascular
Diseases, Section of Heart Failure and Transplant, University of Iowa
Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Asleh) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Title
Induction immunosuppressive therapy in cardiac transplantation: a
systematic review and meta-analysis.
Source
Heart Failure Reviews. (pp 1-9), 2018. Date of Publication: 13 Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Approximately 50% of heart transplant programs currently employ a strategy
of induction therapy (IT) with either interleukin-2 receptor antagonists
(IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early
postoperative period. However, the overall utility of such therapy is
uncertain and data comparing induction protocols are limited. The authors
searched PubMed, the Cochrane Central Register of Controlled Trials, and
ClinicalTrials.govthrough January 2018 for randomized controlled trials
(RCTs) or observational controlled studies of IT vs no IT and IL2RA vs
ATG. Inverse variance fixed effects models with odds ratio (OR) as the
effect measure were used for primary analyses. Main outcomes include
moderate and severe rejection, all-cause mortality, infection, and cancer.
The authors' search retrieved 2449 studies, of which 11 met criteria for
inclusion (8 RCTs and 3 observational case-control studies). Quality of
evidence for RCTs was moderate to high. Overall, patients receiving IT had
similar risk of moderate-to-severe rejection, all-cause death, infection,
and cancer with patients who did not receive IT. The use of IL2RA was
associated with significantly higher risk of moderate-to-severe rejection
than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death,
infections, and cancer. The use of IT was not associated with any benefits
or harms compared with no IT. Moderate-to-severe rejection may be reduced
by ATG compared with IL2RA. Copyright © 2018 Springer
Science+Business Media, LLC, part of Springer Nature

<136>
Accession Number
619859984
Author
Shaddy R.E.; George A.T.; Jaecklin T.; Lochlainn E.N.; Thakur L.; Agrawal
R.; Solar-Yohay S.; Chen F.; Rossano J.W.; Severin T.; Burch M.
Institution
(Shaddy) Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#126, Los
Angeles, CA 90027, United States
(George, Thakur, Agrawal) Novartis Healthcare Pvt. Ltd., Hyderabad, India
(Jaecklin) Shire International GmbH, Global Clinical Development,
Zahlerweg 10, Zug 6300, Switzerland
(Lochlainn, Severin) Novartis Pharma AG, Basel, Switzerland
(Solar-Yohay, Chen) Novartis Pharmaceuticals Corporation, East Hanover,
NJ, United States
(Rossano) Children's Hospital of Philadelphia, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, United States
(Burch) Cardiorespiratory Division, Great Ormond Street Hospital for
Children, London, United Kingdom
Title
Systematic Literature Review on the Incidence and Prevalence of Heart
Failure in Children and Adolescents.
Source
Pediatric Cardiology. 39 (3) (pp 415-436), 2018. Date of Publication: 01
Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
While the epidemiology of adult heart failure has been extensively
researched, this systematic review addresses the less well characterized
incidence and prevalence of pediatric HF. The search strategy used
Cochrane methodology and identified 83 unique studies for inclusion.
Studies were categorized according to whether the HF diagnosis was
reported as primary (n = 10); associated with other cardiovascular
diseases (CVDs) (n = 49); or associated with non-CVDs (n = 24). A
narrative synthesis of the evidence is presented. For primary HF, the
incidence ranged from 0.87/100,000 (UK and Ireland) to 7.4/100,000
(Taiwan). A prevalence of 83.3/100,000 was reported in one large
population-based study from Spain. HF etiology varied across regions with
lower respiratory tract infections and severe anemia predominating in
lower income countries, and cardiomyopathies and congenital heart disease
major causes in higher income countries. Key findings for the other
categories included a prevalence of HF associated with cardiomyopathies
ranging from 36.1% (Japan) to 79% (US); associated with congenital heart
disease from 8% (Norway) to 82.2% (Nigeria); associated with rheumatic
heart diseases from 1.5% (Turkey) to 74% (Zimbabwe); associated with renal
disorders from 3.8% (India) to 24.1% (Nigeria); and associated with HIV
from 1% (US) to 29.3% (Brazil). To our knowledge, this is the first
systematic review of the topic and strengthens current knowledge of
pediatric HF epidemiology. Although a large body of research was
identified, heterogeneity in study design and diagnostic criteria limited
the ability to compare regional data. Standardized definitions of
pediatric HF are required to facilitate cross-regional comparisons of
epidemiological data. Copyright © 2017, The Author(s).

<137>
Accession Number
2000461742
Author
Head S.J.; Milojevic M.; Daemen J.; Ahn J.-M.; Boersma E.; Christiansen
E.H.; Domanski M.J.; Farkouh M.E.; Flather M.; Fuster V.; Hlatky M.A.;
Holm N.R.; Hueb W.A.; Kamalesh M.; Kim Y.-H.; Makikallio T.; Mohr F.W.;
Papageorgiou G.; Park S.-J.; Rodriguez A.E.; Sabik J.F.; Stables R.H.;
Stone G.W.; Serruys P.W.; Kappetein A.P.
Institution
(Head, Milojevic, Papageorgiou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
(Daemen, Boersma) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Ahn, Kim, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Domanski, Farkouh, Fuster) Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Domanski, Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
(Flather) Norwich Medical School University of East Anglia and Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kamalesh) Richard L Roudebush VA Medical Center, Indianapolis, IN, United
States
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Mohr) Department of Cardiac Surgery, Herzzentrum Universitat Leipzig,
Leipzig, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Sabik) Department Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Stone) Columbia University Medical Center and the Center for Clinical
Trials, Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
Title
Mortality after coronary artery bypass grafting versus percutaneous
coronary intervention with stenting for coronary artery disease: a pooled
analysis of individual patient data.
Source
The Lancet. 391 (10124) (pp 939-948), 2018. Date of Publication: 10 - 16
March 2018.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Numerous randomised trials have compared coronary artery
bypass grafting (CABG) with percutaneous coronary intervention (PCI) for
patients with coronary artery disease. However, no studies have been
powered to detect a difference in mortality between the revascularisation
strategies. Methods: We did a systematic review up to July 19, 2017, to
identify randomised clinical trials comparing CABG with PCI using stents.
Eligible studies included patients with multivessel or left main coronary
artery disease who did not present with acute myocardial infarction, did
PCI with stents (bare-metal or drug-eluting), and had more than 1 year of
follow-up for all-cause mortality. In a collaborative, pooled analysis of
individual patient data from the identified trials, we estimated all-cause
mortality up to 5 years using Kaplan-Meier analyses and compared PCI with
CABG using a random-effects Cox proportional-hazards model stratified by
trial. Consistency of treatment effect was explored in subgroup analyses,
with subgroups defined according to baseline clinical and anatomical
characteristics. Findings: We included 11 randomised trials involving 11
518 patients selected by heart teams who were assigned to PCI (n=5753) or
to CABG (n=5765). 976 patients died over a mean follow-up of 3.8 years (SD
1.4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
score was 26.0 (SD 9.5), with 1798 (22.1%) of 8138 patients having a
SYNTAX score of 33 or higher. 5 year all-cause mortality was 11.2% after
PCI and 9.2% after CABG (hazard ratio [HR] 1.20, 95% CI 1.06-1.37;
p=0.0038). 5 year all-cause mortality was significantly different between
the interventions in patients with multivessel disease (11.5% after PCI vs
8.9% after CABG; HR 1.28, 95% CI 1.09-1.49; p=0.0019), including in those
with diabetes (15.5% vs 10.0%; 1.48, 1.19-1.84; p=0.0004), but not in
those without diabetes (8.7% vs 8.0%; 1.08, 0.86-1.36; p=0.49). SYNTAX
score had a significant effect on the difference between the interventions
in multivessel disease. 5 year all-cause mortality was similar between the
interventions in patients with left main disease (10.7% after PCI vs 10.5%
after CABG; 1.07, 0.87-1.33; p=0.52), regardless of diabetes status and
SYNTAX score. Interpretation: CABG had a mortality benefit over PCI in
patients with multivessel disease, particularly those with diabetes and
higher coronary complexity. No benefit for CABG over PCI was seen in
patients with left main disease. Longer follow-up is needed to better
define mortality differences between the revascularisation strategies.
Funding: None. Copyright © 2018 Elsevier Ltd

<138>
Accession Number
620867060
Author
Moller M.H.; Granholm A.; Junttila E.; Haney M.; Oscarsson-Tibblin A.;
Haavind A.; Laake J.H.; Wilkman E.; Sverrisson K.O.; Perner A.
Institution
(Moller, Granholm, Perner) Department of Intensive Care 4131, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
(Junttila) Department of Anaesthesiology, Tampere University Hospital,
Tampere, Finland
(Haney) Anaesthesiology and Intensive Care Medicine, Umea University,
Umea, Sweden
(Oscarsson-Tibblin) Department of Anaesthesiology and Intensive Care,
Department of Medicine and Health, Linkoping University, Linkoping, Sweden
(Haavind) Department of Anaesthesiology and Intensive Care, University
Hospital Northern Norway, Tromso, Norway
(Laake) Division of Critical Care, Oslo University Hospital, Oslo, Norway
(Wilkman) Division of Intensive Care Medicine, Department of
Perioperative, Intensive Care and Pain Medicine, Helsinki University
Hospital, University of Helsinki, Helsinki, Finland
(Sverrisson) Department of Anesthesia & Critical Care, Landspitali
University Hospital of Iceland, Reykjavik, Iceland
Title
Scandinavian SSAI clinical practice guideline on choice of inotropic agent
for patients with acute circulatory failure.
Source
Acta Anaesthesiologica Scandinavica. 62 (4) (pp 420-450), 2018. Date of
Publication: April 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Adult critically ill patients often suffer from acute
circulatory failure and those with low cardiac output may be treated with
inotropic agents. The aim of this Scandinavian Society of Anaesthesiology
and Intensive Care Medicine guideline was to present patient-important
treatment recommendations on this topic. Methods: This guideline was
developed according to GRADE. We assessed the following subpopulations of
patients with shock: (1) shock in general, (2) septic shock, (3)
cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery,
and (6) other types of shock, including vasodilatory shock. We assessed
patient-important outcome measures, including mortality and serious
adverse reactions. Results: For all patients, we suggest against the
routine use of any inotropic agent, including dobutamine, as compared to
placebo/no treatment (very low quality of evidence). For patients with
shock in general, and in those with septic and other types of shock, we
suggest using dobutamine rather than levosimendan or epinephrine (very low
quality of evidence). For patients with cardiogenic shock and in those
with shock after cardiac surgery, we suggest using dobutamine rather than
milrinone (very low quality of evidence). For the other clinical
questions, we refrained from giving any recommendations or suggestions.
Conclusions: We suggest against the routine use of any inotropic agent in
adult patients with shock. If used, we suggest using dobutamine rather
than other inotropic agents for the majority of patients, however, the
quality of evidence was very low, implying high uncertainty on the balance
between the benefits and harms of inotropic agents. Copyright ©
2018 The Authors. Acta Anaesthesiologica Scandinavica published by John
Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation

<139>
Accession Number
620964248
Author
Wang N.; Fulcher J.; Abeysuriya N.; Adams M.; Lal S.
Institution
(Wang, Fulcher, Adams, Lal) University of Sydney, Sydney, Camperdown, NSW
2006, Australia
(Wang, Fulcher, Adams, Lal) Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Abeysuriya) University of Queensland, Brisbane, Australia
Title
Predictors of successful chronic total occlusion percutaneous coronary
interventions: A systematic review and meta-analysis.
Source
Heart. 104 (6) (pp 517-524), 2018. Date of Publication: March 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The aim of this study was to identify positive and negative
predictors of technical and clinical success for percutaneous coronary
intervention (PCI) of chronic total occlusions (CTO). Methods We conducted
a systematic review and meta-analysis of studies published between 2000
and 2016 analysing rates of CTO PCI success with respect to demographic
and angiographic characteristics. Crude ORs and 95% CIs for each predictor
were calculated using a random effects model. Predictors of technical and
clinical success were assessed among 28 demographic and 31 angiographic
variables. Clinical success was defined as technical success without major
adverse cardiac events. Results A total of 61 studies, totalling 69 886
patients were included in this analysis. The major demographic
characteristics associated with a 20% or greater reduction in the odds of
technical and clinical success were a history of myocardial infarction,
PCI, coronary artery bypass grafting, stroke/transient ischaemic attack
and peripheral vascular disease. Angiographic factors were generally
stronger predictors of reduced technical and clinical success. Those
associated with >20% odds reduction included non-left anterior descending
CTOs, multivessel disease, presence of bridging collaterals,
moderate-to-severe calcification, >45 degree vessel bending, tortuous
vessel, blunt stump and ostial lesions. Of these, novel predictors
included prior PCI, prior stroke, peripheral vascular disease, presence of
multivessel disease and bridging collaterals. Conclusion The present study
has identified strong negative predictors for clinical success for CTO
PCI, which will aid in patient selection for this procedure. Copyright
© Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<140>
Accession Number
620908706
Author
Ling X.; Zhou H.; Ni Y.; Wu C.; Zhang C.; Zhu Z.
Institution
(Ling) Outpatient Nursing Department, Second Affiliated Hospital of
Jiaxing University, Jiaxing City, Zhejiang Province, China
(Zhou, Ni, Wu, Zhang, Zhu) Department of Anesthesiology, Second Affiliated
Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
Title
Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A
meta-analysis of randomized controlled trials.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0193303. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiac surgery patients often experience several types of
tachyarrhythmias after admission to the intensive care unit (ICU), which
increases mortality and morbidity. Dexmedetomidine (DEX) is a popular
medicine used for sedation in the ICU, and its other pharmacological
characteristics are gradually being uncovered. Purpose To determine
whether DEX has an antiarrhythmic effect after cardiac surgery. Methods
The three primary databases MEDLINE, Embase (OVID SP) and the Cochrane
Central Register of Controlled Trials (CENTRAL) were searched, and all
English-language and randomized control-designed clinical publications
comparing DEX to control medicines for sedation after elective cardiac
surgery were included. Two colleagues independently extracted the data and
performed other quality assessments. A subgroup analysis was performed
according to the different medicines used and whether cardiopulmonary
bypass (CPB) was applied. All tachyarrhythmias that occurred in the atria
and ventricles were analyzed. Results A total of 1295 patients in 9
studies met the selection criteria among 2587 studies that were screened.
After quantitative synthesis, our results revealed that the DEX group was
associated with a lower incidence of ventricular arrhythmia (VA, OR 0.24,
95% CI 0.09-0.64, I2 = 0%, P = 0.005) than the control group.
Subgroup analysis did not reveal a significant difference between the DEX
and propofol subgroups (OR 0.13, 95% CI 0.03-0.56, I2 = 0%, P =
0.007). Additionally, no difference in the incidence of atrial
fibrillation (AF) was observed regardless of the different control
medicines (OR 0.82, 95% CI 0.60-1.10, I2 = 25%, P = 0.19) or
whether CPB was applied. Conclusions This meta-analysis revealed that DEX
has an antiarrhythmic effect that decreases the incidence of VA compared
to other drugs used for sedation following cardiac surgery. DEX May not
have an effect on AF, but cautious interpretation should be exercised due
to high heterogeneity. Copyright © 2018 Ling 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.

<141>
Accession Number
620127219
Author
Tan W.; Zhang C.; Liu J.; Li X.; Chen Y.; Miao Q.
Institution
(Tan, Zhang, Liu, Li, Chen, Miao) Department of Cardiac Surgery, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing 100730, China
Title
Remote Ischemic Preconditioning has a Cardioprotective Effect in Children
in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled
Trials.
Source
Pediatric Cardiology. 39 (3) (pp 617-626), 2018. Date of Publication: 01
Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
In this updated meta-analysis, we assessed the cardioprotective effect of
remote ischemic preconditioning (RIPC) in pediatric patients undergoing
congenital heart surgery. A total of 9 randomized controlled trials (RCTs)
involving 793 pediatric patients under 18 years old were identified. RIPC
obviously reduced the release of troponin I at 6 h after surgery [standard
mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04;
p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI
-0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to
-0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95%
CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care
unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our
meta-analysis determined that RIPC had cardioprotective effects in the
early postoperative phase. Additional RCTs focused on the cardiac benefits
from RIPC in pediatric patients are warranted. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<142>
Accession Number
620921809
Author
Qayyum A.A.; Mathiasen A.B.; Mygind N.D.; Kuhl Jo.T.; Jorgensen E.;
Helqvist S.; Elberg J.Jo.; Kofoed K.F.; Vejlstrup N.G.; Fischer-Nielsen
A.; Haack-Sorensen M.; Ekblond A.; Kastrup J.
Institution
(Qayyum, Mathiasen, Mygind, Kuhl, Jorgensen, Helqvist, Kofoed, Vejlstrup,
Kastrup) Department of Cardiology, Cardiac Catheterization Laboratory
2014, Heart Centre Rigshospitalet, University of Copenhagen, Blegdamsvej
9, Copenhagen 2100, Denmark
(Elberg) Department of Plastic Surgery, Rigshospitalet University of
Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Kofoed) Department of Radiology, Diagnostic Center, Rigshospitalet
University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Fischer-Nielsen) Department of Clinical Immunology, Rigshospitalet
University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Haack-Sorensen, Ekblond, Kastrup) Cardiology Stem Cell Centre, Heart
Centre, Rigshospitalet University of Copenhagen, Blegdamsvej 9, Copenhagen
2100, Denmark
Title
Adipose-Derived Stromal Cells for Treatment of Patients with Chronic
Ischemic Heart Disease (MyStromalCell Trial): A Randomized
Placebo-Controlled Study.
Source
Stem Cells International. 2017 (no pagination), 2017. Article Number:
5237063. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
We aimed to evaluate the effect of intramyocardial injections of
autologous VEGF-A 165 -stimulated adipose-derived stromal cells (ASCs) in
patients with refractory angina. MyStromalCell trial is a randomized
double-blind placebo-controlled study including sixty patients with
CCS/NYHA class II-III, left ventricular ejection fraction > 40%, and at
least one significant coronary artery stenosis. Patients were treated with
ASC or placebo in a 2: 1 ratio. ASCs from the abdomen were culture
expanded and stimulated with VEGF-A 165 . At 6 months follow-up, bicycle
exercise tolerance increased significantly in time duration 22 s (95%CI
-164 to 208 s) (P=0.034), in watt 4 (95%CI -33 to 41, 0.048), and in METs
0.2 (95%CI -1.4 to 1.8) (P=0.048) in the ASC group while there was a
nonsignificant increase in the placebo group in time duration 9 s (95%CI
-203 to 221 s) (P=0.053), in watt 7 (95%CI -40 to 54) (P=0.41), and in
METs 0.1 (95%CI -1.7 to 1.9) (P=0.757). The difference between the groups
was not significant (P=0.680, P=0.608, and P=0.720 for time duration,
watt, and METs, resp.). Intramyocardial delivered VEGF-A 165 -stimulated
ASC treatment was safe but did not improve exercise capacity compared to
placebo. However, exercise capacity increased in the ASC but not in the
placebo group. This trial is registered with ClinicalTrials.gov
NCT01449032. Copyright © 2017 Abbas Ali Qayyum et al.

<143>
Accession Number
621219927
Author
Albisinni R.; Morra S.; Pafundi P.C.; Utili R.
Institution
(Albisinni) A.O.R.N. Azienda Ospedaliera Dei Colli-Monaldi, Napoli, Italy
(Morra, Pafundi, Utili) Internal Medicine, Second University of Naples and
AA.O.R.N. Azienda Ospedaliera Dei Colli-Monaldi, Naples, Italy
Title
Responsiveness to aspirin in heart-transplanted recipients: A
retrospective "pilot" cohort study.
Source
Blood Transfusion. Conference: 24th National Congress of the Italian
Society for Thrombosis and Hemostasis - SISET 2016. Italy. 14 (Supplement
5) (pp s803-s804), 2016. Date of Publication: October 2016.
Publisher
SIMTI Servizi Sri
Abstract
Background: Heart transplant is the gold-standard for patients with
end-stage heart failure. Nowadays limiting factor to A long-term survival,
in heart transplant recipients, is graft vasculopathy (CAV), burdened by
an estimated mortality of 30% 5 years after transplant. Because of
hyperaggregability state typical of the heart transplant recipients as
well as the reduction of major cardiovascular events in high risk
patients, the use of cardioaspirin in primary prevention is consolidated.
However, in literature, there are few studies showing its real utility in
heart transplanted subjects. Aim of this pilot study was the assessment,
by the Multiplate Aspitest method, of aspirin efficiency in an arm of 61
heart transplanted patients under treatment, as well as the clinical and
retrospective evaluation of the real impact of aspirin administration on
the reduction of cardiovascular mortality, by comparing the arm of treated
patients with another subgroup of heart transplanted subjects not taking
aspirin. Methods: This is A pilot retrospective study on A cohort of 112
heart transplanted subjects enrolled in A four-month period (Jan-May 2016)
at the Neapolitan Heart Transplant Center at "V. Monaldi" hospital. The
cohort was divided into two arms, "treated" (n=61), subjected to Aspitest,
and "no treated" (n=51). results The 61 patients from the treatment arm,
predominantly males (median age=61 yrs), with median age at transplant
equal to 52 years, were divided into 3 groups based on Aspitest
responsiveness: high (34; 55.8%), moderate (16; 26.2%) or resistant to the
drug (11; 18%). There were no statistically significant differences
neither in terms of general features nor of risk factors/laboratory
parameters, except for A trend (p=0.076) for dyslipidemia, whose
prevalence was higher in moderately responsive/resistant patients (11/16;
68.8% and 6; 54.5%, respectively) compared to the highly responsive group
(12; 35.3%). The "no treated" arm (n=51) was homogeneous with respect to
the arm "treated" with aspirin by age, sex and time after transplantation.
The comparison between the two arms of the cohort highlighted A
statistically significant reduction in both cardiovascular and
non-cardiovascular mortality (p=0.002 and p=0.022, respectively) and total
mortality (p=0.0001), whose reliability is supported by Kaplan-Meier
survival analysis (log-rank p=0.003). Conclusions: The major evidence from
the analysis of the treatment arm was an effective ability of aspirin to
antiaggregate even the platelets of this specific population. However, no
significant associations were found between level of antiaggregation and
main environmental risk factors/haematochemical parameters. Moreover, in
agreement with the literature, aspirin reduces cardiovascular mortality of
one third, as underlined by the higher long-term survival of treated
subjects. This is A pilot study and Multiplate has been adopted since A
few years and, in any case, not on heart transplanted populations. Thus,
it renders necessary A deepening of such issues on A larger population.

<144>
Accession Number
621182080
Author
Blessberger H.; Kammler J.; Domanovits H.; Schlager O.; Wildner B.; Azar
D.; Schillinger M.; Wiesbauer F.; Steinwender C.
Institution
(Blessberger, Kammler, Steinwender) Kepler University Hospital, Medical
Faculty of the Johannes Kepler University Linz, Department of Cardiology,
Krankenhausstrase 9, Med Campus III, Linz 4020, Austria
(Domanovits) Vienna General Hospital, Medical University of Vienna,
Department of Emergency Medicine, Wahringer Gurtel 18-20, Vienna 1090,
Austria
(Schlager, Schillinger) Vienna General Hospital, Medical University of
Vienna, Department of Internal Medicine II, Division of Angiology,
Wahringer Gurtel 18-20, Vienna 1090, Austria
(Wildner) University Library of the Medical University of Vienna,
Information Retrieval Office, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Azar) Landesklinikum Thermenregion Baden, Department of General Surgery,
Wimmergasse 19, Baden 2500, Austria
(Wiesbauer) Division of Cardiology, Vienna General Hospital, Medical
University of Vienna, Department of Internal Medicine II, Wahringerstrasse
18-20, Vienna 1090, Austria
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
Cochrane Database of Systematic Reviews. 2018 (3) (no pagination), 2018.
Article Number: CD004476. Date of Publication: 13 Mar 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Randomized controlled trials have yielded conflicting results
regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue. Objectives:
The objective of this review was to systematically analyse the effects of
perioperatively administered beta-blockers for prevention of
surgery-related mortality and morbidity in patients undergoing any type of
surgery while under general anaesthesia. Search methods: We identified
trials by searching the following databases from the date of their
inception until June 2013: MEDLINE, Embase , the Cochrane Central Register
of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative
Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File,
Science Citation Index Expanded, Life Sciences Collection, Global Health
and PASCAL. In addition, we searched online resources to identify grey
literature. Selection criteria: We included randomized controlled trials
if participants were randomly assigned to a beta-blocker group or a
control group (standard care or placebo). Surgery (any type) had to be
performed with all or at least a significant proportion of participants
under general anaesthesia. Data collection and analysis: Two review
authors independently extracted data from all studies. In cases of
disagreement, we reassessed the respective studies to reach consensus. We
computed summary estimates in the absence of significant clinical
heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and
mean differences (MDs) were used for continuous outcomes. We performed
subgroup analyses for various potential effect modifiers. Main results: We
included 88 randomized controlled trials with 19,161 participants. Six
studies (7%) met the highest methodological quality criteria (studies with
overall low risk of bias: adequate sequence generation, adequate
allocation concealment, double/triple-blinded design with a placebo group,
intention-to-treat analysis), whereas in the remaining trials, some form
of bias was present or could not be definitively excluded (studies with
overall unclear or high risk of bias). Outcomes were evaluated separately
for cardiac and non-cardiac surgery. CARDIAC SURGERY (53 trials) We found
no clear evidence of an effect of beta-blockers on the following outcomes.
* All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants,
moderate quality evidence. * Acute myocardial infarction (AMI): RR 1.04,
95% CI 0.71 to 1.51, 3553 participants, moderate quality evidence. *
Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166 participants, low
quality evidence. * Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02,
1400 participants, low quality evidence. * Hypotension: RR 1.54, 95% CI
0.67 to 3.51, 558 participants, low quality evidence. * Bradycardia: RR
1.61, 95% CI 0.97 to 2.66, 660 participants, low quality evidence. *
Congestive heart failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants,
low quality evidence. Beta-blockers significantly reduced the occurrence
of the following endpoints. * Ventricular arrhythmias: RR 0.37, 95% CI
0.24 to 0.58, number needed to treat for an additional beneficial outcome
(NNTB) 29, 2292 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB five,
6420 participants, high quality evidence. * On average, beta-blockers
reduced length of hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450
participants, low quality evidence). NON-CARDIAC SURGERY (35 trials)
Beta-blockers significantly increased the occurrence of the following
adverse events. * All-cause mortality: RR 1.25, 95% CI 1.00 to 1.57,
11,413 participants, low quality of evidence, number needed to treat for
an additional harmful outcome (NNTH) 167. * Hypotension: RR 1.50, 95% CI
1.38 to 1.64, NNTH 16, 10,947 participants, high quality evidence. *
Bradycardia: RR 2.23, 95% CI 1.48 to 3.36, NNTH 21, 11,033 participants,
moderate quality evidence. We found a potential increase in the occurrence
of the following outcomes with the use of beta-blockers. * Cerebrovascular
events: RR 1.59, 95% CI 0.93 to 2.71, 9150 participants, low quality
evidence. Whereas no clear evidence of an effect was found when all
studies were analysed, restricting the meta-analysis to low risk of bias
studies revealed a significant increase in cerebrovascular events with the
use of beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 265, 8648
participants. Beta-blockers significantly reduced the occurrence of the
following endpoints. * AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 76, 10,958
participants, high quality evidence. * Myocardial ischaemia: RR 0.51, 95%
CI 0.34 to 0.77, NNTB nine, 978 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.73, 95% CI 0.57 to 0.94, NNTB 112, 8744
participants, high quality evidence. We found no clear evidence of an
effect of beta-blockers on the following outcomes. * Ventricular
arrhythmias: RR 0.68, 95% CI 0.31 to 1.49, 476 participants, moderate
quality evidence. * Congestive heart failure: RR 1.18, 95% CI 0.94 to
1.48, 9173 participants, moderate quality evidence. * Length of hospital
stay: mean difference -0.45 days, 95% CI -1.75 to 0.84, 551 participants,
low quality evidence. Authors' conclusions: According to our findings,
perioperative application of beta-blockers still plays a pivotal role in
cardiac surgery, as they can substantially reduce the high burden of
supraventricular and ventricular arrhythmias in the aftermath of surgery.
Their influence on mortality, AMI, stroke, congestive heart failure,
hypotension and bradycardia in this setting remains unclear. In
non-cardiac surgery, evidence shows an association of beta-blockers with
increased all-cause mortality. Data from low risk of bias trials further
suggests an increase in stroke rate with the use of beta-blockers. As the
quality of evidence is still low to moderate, more evidence is needed
before a definitive conclusion can be drawn. The substantial reduction in
supraventricular arrhythmias and AMI in this setting seems to be offset by
the potential increase in mortality and stroke. Copyright © 2018
The Cochrane Collaboration.

<145>
Accession Number
621132571
Author
Kosmac N.; Vidmar G.; Virag M.; Osredkar J.; Knezevic I.
Institution
(Kosmac, Osredkar, Knezevic) University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Vidmar) University Rehabilitation Institute, Ljubljana, Slovenia
(Virag) University of Ljubljana, Faculty of Economics, Ljubljana, Slovenia
Title
Comparison of sevoflurane and propofol anaesthetic regimes in respect to
the release of troponin I and cystatin C in off-pump myocardial
revascularisation: A randomised controlled trial.
Source
Signa Vitae. 12 (1) (pp 36-42), 2016. Date of Publication: 05 Oct 2016.
Publisher
Pharmamed Mado Ltd. (Zatisje 8 g, Zagreb 10000, Croatia. E-mail:
marija.karamarko@pharmamed.com)
Abstract
Objective. Sevoflurane has been used in cardiac surgery because of its
protective effects on the myocardium from ischaemic injury. We wanted to
test the hypothesis that sevoflurane has beneficial effects on the heart
and kidneys in comparison to propofol. Methods. We conducted a randomised
controlled study, with balanced randomization blocked by sex. The
participants were 62 patients undergoing off-pump myocardial
revascularization (44 men and 18 women), who did not have a myocardial
infarction less than 24 hours before the start of the operation and who
had normal serum values of troponin I preoperatively. The surgery and the
measurements were conducted according to the same protocol for both
groups. Propofol was used for the induction of anaesthesia in both groups;
anaesthesia was continued with either propofol or sevoflurane. Troponin I
and cystatin C plasma concentrations were determined in eight consecutive
blood samples, starting before induction of anaesthesia and ending 48
hours after admission to the intensive care unit (ICU). The data were
log-transformed and analysed using analysis of variance. Results. We
observed a clear and highly statistically significant effect of time for
troponin I (p<0.001) without statistically significant differences between
the groups (either main or interaction effects). For the majority of
patients, the measurements rose quickly upon reperfusion and reached a
peak 12 hours after admission to the ICU, descending approximately back to
the reperfusion level 48 hours after admission to the ICU. Similar
inferences were reached for cystatin C, for which the time-course was
approximately bath-shaped. Conclusion. We observed no clear superiority of
either sevoflurane or propofol anaesthetic regime in off-pump myocardial
revascularisation. Copyright © 2016, Pharmamed Mado Ltd. All
rights reserved.

<146>
Accession Number
621206984
Author
Nezafati P.; Shomali A.; Kahrom M.; Omidvar Tehrani S.; Dianatkhah M.;
Nezafati M.H.
Institution
(Nezafati) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
(Shomali) Javad Al Aemeh Hospital, Mashhad, Iran
(Kahrom, Nezafati) Cardiac Surgery, Ghaem Hospital, Mashhad University of
Medical Sciences, Mashhad, Iran
(Omidvar Tehrani) Student Research Committee, Mashhad University of
Medical Sciences, Mashhad, Iran
(Dianatkhah) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Title
ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
Background: The present study aimed to compare postoperative complications
commonly revealed after sternotomy closure by new sternal ZipFixTM
(Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire.
Methods: Among the initial 360 subjects, 326 patients enrolled in this
randomised control trial who were candidates for cardiac surgery from
April 2014 to March 2015. After the surgery, the sternal closure was
randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix
(ZF) on the sternal body (n = 168) or with conventional wires (CWs) (n =
158). Patients were followed postoperatively as well as 1, 3, 6, and 12.
months after discharge regarding postoperative complications such as pain
severity, dehiscence, and infection including incisional infections
(superficial or deep), and organ/space infection (mediastinitis or
osteomyelitis). Results: The mean age of the ZF and CW groups were 63.58.
+/-. 10.9 and 62.42. +/-. 7.1. years, respectively (p = 0.262). In
addition, there was no significant difference between the two groups'
baseline characteristics (p. >. 0.05). Our study showed higher mean pain
severity score in the conventional closure group compared with ZipFix
closure group at all study time points (p. <. 0.001). Infection was seen
in 2.76% of the overall participants with no significant difference of
incisional and organ infection between the two groups throughout the
study. After 1-month follow-up, five patients in the CW group had sternal
dehiscence whereas no patients in ZF had dehiscence (p. <. 0.001).
Conclusions: Our trial demonstrates greater clinical advantages in terms
of pain and sternal dehiscence post surgery by using sternal ZipFix
compared to conventional steel wire. Copyright © 2018 Australian
and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<147>
Accession Number
2000533314
Author
Sohn S.H.; Jang M.-J.; Hwang H.Y.; Kim K.H.
Institution
(Sohn, Hwang, Kim) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Title
Rapid deployment or sutureless versus conventional bioprosthetic aortic
valve replacement: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: This meta-analysis was conducted to compare the early and
follow-up outcomes of aortic valve replacement using rapid deployment or
sutureless (RD) valves (RDAVR group) with aortic valve replacement using
conventional bioprostheses (CAVR group). Methods: A literature search of 5
online databases was conducted. The primary outcomes were postoperative
complications and the secondary outcomes included the aortic cross-clamp
(ACC) and cardiopulmonary bypass (CPB) times and early mortality and
all-cause mortality during follow-up. Results: Twenty-one articles (RDAVR
group = 1297 patients; CAVR group = 1488 patients) were selected. The
pooled analyses showed that the ACC and CPB times were significantly
shorter in the RDAVR group than in the CAVR group (mean difference,
-26.34; 95% confidence interval [CI], -31.86 to -20.82 and mean
difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The pooled
risk ratios (RRs) of any paravalvular leak and permanent pacemaker (PPM)
insertion were significantly higher in the RDAVR group than in the CAVR
group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90,
respectively). The pooled analysis showed that the risk of a paravalvular
leak grade >=2 in the RDAVR group did not significantly differ between the
RDAVR and CAVR groups (RR, 2.05; 95% CI, 0.71-5.93). The risk of PPM
insertion remained significant when only studies reporting adjusted
outcomes were pooled. The risks of other postoperative complications,
early mortality, and all-cause mortality during follow-up were not
significantly different between the RDAVR and CAVR groups. Conclusions:
RDAVR is associated with significantly shorter ACC and CPB times than
CAVR, although this difference did not translate into improved
postoperative outcomes, early mortality, and all-cause mortality during
follow-up. Care might be needed when implanting RD valves because they are
associated with a higher incidence of PPM insertion, regardless of the RD
valve type. Copyright © 2018 The American Association for
Thoracic Surgery

<148>
Accession Number
616395848
Author
Blair J.E.A.; Atri P.; Friedman J.L.; Thomas J.D.; Brummel K.; Sweis R.N.;
Mikati I.; Malaisrie S.C.; Davidson C.J.; Flaherty J.D.
Institution
(Blair) Section of Cardiology, Department of Medicine, University of
Chicago Medicine, Chicago, Illinois, United States
(Atri) Scripps Clinic, La Jolla, California, United States
(Friedman, Thomas, Brummel, Sweis, Mikati, Malaisrie, Davidson, Flaherty)
Division of Cardiology, Department of Medicine, Feinberg School of
Medicine, Bluhm Cardiovascular Institute of Northwestern University,
Chicago, Illinois, United States
Title
Diastolic Function and Transcatheter Aortic Valve Replacement.
Source
Journal of the American Society of Echocardiography. 30 (6) (pp 541-551),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Little is known about baseline diastolic dysfunction and
changes in diastolic dysfunction grade after transcatheter aortic valve
replacement (TAVR) for aortic stenosis (AS) and its impact on overall
outcomes. The aim of this study was to describe baseline diastolic
dysfunction and changes in diastolic dysfunction grade that occur with
TAVR and their relationship to mortality and rehospitalization. Methods
This was a single-center study evaluating all TAVRs from January 2012 to
June 2014. We compared parameters of diastolic dysfunction grade on
pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing
the procedure. Descriptive statistics, Kaplan-Meier time-to-event
analysis, and multivariate logistic regression were used. Results Of a
sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90
were included in the final analysis after excluding significant mitral
valve disease. There were improvements in individual parameters of
diastolic dysfunction grade such as lateral e' velocity, E/lateral e', and
left atrial volume index (nonsignificant trend) in the setting of
improvement in aortic valve area and gradients and functional class pre-
and post-TAVR. Multivariate analysis revealed that baseline diastolic
dysfunction grade, but not post-TAVR or changes in diastolic dysfunction
grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI,
1.049-1.277, P =.005) and combined death/cardiovascular hospitalization
(hazard ratio, 1.174; 95% CI, 1.032-1.318; P =.018). Conclusions In this
single-center retrospective study of patients with symptomatic severe AS
who underwent TAVR, several diastolic function parameters improved on
echocardiography, but baseline diastolic dysfunction grade remained the
most important echocardiographic factor associated with adverse 1-year
outcomes. Copyright © 2017 American Society of Echocardiography

<149>
[Use Link to view the full text]
Accession Number
616277624
Author
Santos E.; Cardoso D.; Neves H.; Cunha M.; Rodrigues M.; Apostolo J.
Institution
(Santos, Cardoso, Neves, Rodrigues, Apostolo) Health Sciences Research
Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence
Based Practice, Joanna Briggs Institute Centre of Excellence, Australia
(Santos) Emergency Department, Centro Hospitalar e Universitario de
Coimbra (CHUC), Coimbra, Portugal
(Cunha) Research and Development Unit, Centre of Studies in Education,
Health and Technology, Viseu, Portugal
Title
Effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (5) (pp
1440-1472), 2017. Date of Publication: 01 May 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
EXECUTIVE SUMMARYBackground Delirium is associated with increased
intensive care unit and hospital length of stay, prolonged duration of
mechanical ventilation, unplanned removal of tubes and catheters, and
increased morbidity and mortality. Prophylactic treatment with low-dose
haloperidol may have beneficial effects for critically ill patients with a
high risk of delirium. Objectives To identify the effectiveness of
haloperidol prophylaxis in critically ill patients with a high risk for
delirium. Inclusion criteria Types of participants Patients with a
predicted high risk of delirium, aged 18 years or over, and in intensive
care units. Patients with a history of concurrent antipsychotic medication
use were excluded. Types of intervention(s)/phenomena of interest
Haloperidol prophylaxis for preventing delirium. Types of studies
Experimental and epidemiological study designs. Outcomes Primary outcome
is the incidence of delirium. Secondary outcomes are duration of
mechanical ventilation, incidence of re-intubation, incidence of
unplanned/accidental removal of tubes/lines and catheters, intensive care
unit and hospital length of stay, and re-admissions to both settings.
Search strategy An initial search of MEDLINE and CINAHL was undertaken,
followed by a second search for published and unpublished studies from
January 1967 to September 2015 in major healthcare-related electronic
databases. Studies in English, Spanish and Portuguese were included.
Methodological quality Two independent reviewers assessed the
methodological quality of five studies using the standardized critical
appraisal instrument from the Joanna Briggs Institute Meta-Analysis of
Statistics Assessment and Review Instrument. There was general agreement
among the reviewers to exclude one relevant study due to methodological
quality. Data extraction Data were extracted using the JBI data extraction
form for experimental studies and included details about the
interventions, populations, study methods and outcomes of significance to
the review questions. Data synthesis Significant differences were found
between participants, interventions, outcome measures (clinical
heterogeneity) and designs (methodological heterogeneity). For these
reasons, we were unable to perform a meta-analysis. Therefore, the results
have been described in a narrative format. Results Five studies met the
inclusion criteria. One of these studies was excluded due to poor
methodological quality. The remaining four original studies (total of 1142
patients) were included in this review. Three studies were randomized
controlled trials and one was a cohort study. Two studies confirmed the
effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium. These studies showed that short-term prophylactic
administration of low-dose intravenous haloperidol significantly decreased
the incidence of delirium in elderly patients admitted to intensive care
units after non-cardiac surgery and in general intensive care unit
patients with a high risk of delirium. However, the two remaining studies
showed contradictory results in mechanically ventilated critically ill
adults, revealing that the administration of haloperidol reduced delirium
prevalence, delayed its occurrence, and/or shorten its duration.
Conclusions The evidence related to the effectiveness of haloperidol
prophylaxis in critically ill patients with a high risk of delirium is
contradictory. However, balancing the benefits and low side effects
associated with haloperidol prophylaxis, this preventive intervention may
be useful to reduce the incidence of delirium in critically ill adults in
intensive care units. Copyright © 2017 THE JOANNA BRIGGS
INSTITUTE.

<150>
Accession Number
613201906
Author
Cao Z.; Shen R.; Zhang X.; Cheng G.; Yan Z.
Institution
(Cao, Shen, Zhang, Cheng, Yan) Department of Cardiac Surgery, Affiliated
Province Hospital of Anhui Medical University, Hefei 230001, China
Title
Effects of remote ischemic preconditioning on acute myocardial injury in
patients undergoing valve replacement.
Source
Irish Journal of Medical Science. 186 (4) (pp 889-893), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer London
Abstract
Background: This study investigated the effects of remote ischemic
preconditioning (RIPC) on acute myocardial injury and clinical outcome in
adult patients undergoing valve replacement surgery. Methods: Sixty-three
adult patients scheduled for elective valve replacement undergoing
cardiopulmonary bypass (CPB) were randomly assigned to control or remote
ischemic preconditioning treatment. RIPC was applied beginning with the
first surgical incision by three times of inflating the cuff to 200 mmHg
for 5 min, followed by 5 min of deflation. The plasma creatine kinase-MB
(CK-MB) and cardiac troponin I (cTnI) were determined. The preoperative,
intraoperative, and postoperative characteristics, and hemodynamics values
were recorded during the study. Results: There were no significant
differences in patient preoperative, intraoperative, and postoperative
characteristics and hemodynamics values between groups. The activity of
CK-MB and cTnI was significantly lower in RIPC group than CON group at 4
and 48 h after aortic unclamping. Conclusions: The present study
demonstrated that remote ischemic preconditioning might reduce release of
CK-MB and cTnI in patients undergoing valve replacement. However, RIPC
does not improve the clinical outcome of these patients. Copyright
© 2016, Royal Academy of Medicine in Ireland.

<151>
Accession Number
611509928
Author
Li M.; Zou H.; Xu G.
Institution
(Li) Jiangxi Medical College, Nanchang University, China
(Zou) Medical Center of the Graduate School, Nanchang University, China
(Xu) Department of Nephrology, Second Affiliated Hospital, Nanchang
University, Jiangxi 330006, China
Title
The prevention of statins against AKI and mortality following cardiac
surgery: A meta-analysis.
Source
International Journal of Cardiology. 222 (pp 260-266), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective It is universally acknowledged that acute kidney injury (AKI)
often comes following cardiac surgery with severe morbidity and mortality.
The impact of statins on the incidence of AKI and mortality after cardiac
surgery are controversial, therefore, it is urgent to explore the source
of heterogeneity via the subgroup analysis. Methods We searched PubMed,
ISI and Elsevier to May 31st 2016 for studies which investigated the
effects of statins relevant to this theme. Statistical analysis was using
RevMan5.2 and Stata12.0. The outcomes were the occurrence of AKI and the
mortality after cardiac surgery. For the first time, we discussed the
source of heterogeneity on the basis of the characters of patients in the
following subgroup analysis. Results A total of 17 studies with 18,684
statins and 24,033 non-statin users were included. The meta-analysis
suggested that statins not only reduced the occurrence of AKI [Odds Ratio
(OR) 0.72, 95% Confidence Interval (CI) 0.55-0.94)] in the subjects
without high risk factors, also decreased the mortality of the patients
suffering AKI (OR 0.40, 95% CI 0.22-0.72). Conclusion Patients undergoing
cardiac surgery might benefit from statins by reducing the occurrence of
AKI and the mortality of the patients suffering AKI. Copyright ©
2016 Elsevier Ireland Ltd

<152>
Accession Number
621062672
Author
Busro P.W.; Romolo H.; Sastroasmoro S.; Rachmat J.; Sadikin M.; Santoso
A.; Boom C.E.; Suwarto S.; Jusuf A.A.
Institution
(Busro, Romolo) Department of Pediatric Cardiac Surgery, Rumah Sakit
Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
(Sastroasmoro) Department of Pediatrics, Rumah Sakit Cipto Mangunkusumo,
Jakarta, Indonesia
(Rachmat) Department of Pediatric Cardiac Surgery, Rumah Sakit Cipto
Mangunkusumo, Jakarta, Indonesia
(Sadikin) Department of Biochemistry, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Santoso) Department of Cardiology, Rumah Sakit Jantung dan Pembuluh Darah
Nasional Harapan Kita, Jakarta, Indonesia
(Boom) Department of Anesthesiology, Rumah Sakit Jantung dan Pembuluh
Darah Nasional Harapan Kita, Jakarta, Indonesia
(Suwarto) Department of Internal Medicine, Rumah Sakit Cipto Mangunkusumo,
Jakarta, Indonesia
(Jusuf) Department of Histology, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
Title
Role of terminal warm blood cardioplegia in complex congenital heart
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 26 (3) (pp 196-202), 2018. Date
of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Myocardial protection is vital to ensure successful open
heart surgery. Cardioplegic solution is one method to achieve good
myocardial protection. Inevitably, ischemia-reperfusion injury occurs with
aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a
frequently used cardioplegia for complex congenital heart surgery. We
postulated that addition of terminal warm blood cardioplegia before
removal of the aortic crossclamp might improve myocardial protection.
Method: A randomized controlled trial was conducted on 109 cyanotic
patients aged, 1 to 5 years who underwent complex biventricular repair.
They were divided into a control group of 55 patients who had
histidine-tryptophan-ketoglutarate only and a treatment group of 54 who
had histidine-tryptophan-ketoglutarate with terminal warm blood
cardioplegia. Endpoints were clinical parameters, troponin I levels, and
caspase-3 as an apoptosis marker. Results: The incidence of low cardiac
output syndrome was 34%, with no significant difference between groups
(35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment
group was lower compared to the control group (36% vs. 12%, p = 0.005).
Troponin I and caspase-3 results did not show any significant differences
between groups. For cases with Aristotle score >= 10, weak expression of
caspase-3 in the treatment group post-cardiopulmonary bypass was lower
compared to the control group. Conclusion: For complex congenital cardiac
surgery, the addition of terminal warm blood cardioplegia does not
significantly improve postoperative clinical or metabolic
markers. Copyright © 2018, © The Author(s) 2018.

<153>
Accession Number
620395143
Author
Wang H.; Chen J.; Zhao L.
Institution
(Wang, Chen, Zhao) Department of Cardiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, China
Title
N-3 polyunsaturated fatty acids for prevention of postoperative atrial
fibrillation: updated meta-analysis and systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 51 (2) (pp 105-115),
2018. Date of Publication: 01 Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background or purpose: N-3 polyunsaturated fatty acids (PUFA) have been
postulated to have an anti-arrhythmic effect on postoperative atrial
fibrillation (POAF), with conflicting results among studies. This study on
pooled data evaluated the effect of PUFA on POAF among patients undergoing
cardiac surgery. Methods: The Pubmed, EMBASE, and CENTRAL databases were
searched without restriction on language for randomized controlled trials
on the effect of PUFA on POAF that were published before August 31, 2017.
The incidence of POAF was extracted as primary endpoint. Pooled data were
assessed by using a random-effects model. Results: Out of 269 articles
identified, 14 studies with 3570 patients were eligible and included in
the meta-analysis. PUFA reduced incidence of POAF (RR 0.84 [95% CI
0.73-0.98], P = 0.03). The funnel plot and fail-safe number suggested
insignificant publication bias. In sensitivity and subgroup analyses, (1)
PUFA was effective in preventing POAF for eicosapentaenoic acid (EPA)/DHA
OpenSPiltSPi 1 (0.51 [0.36-0.73], P = 0.0003) but not EPA/DHA
CloseSPigtSPi 1 or unknown; (2) the efficacy in reducing POAF was apparent
when placebo was usual care (0.59 [0.44-0.80], P = 0.0005), but not when
placebo was non-fish oils; and (3) PUFA reduced POAF after CABG (0.68
[0.47-0.97], P = 0.03), but not other cardiac surgery. Conclusions: PUFA
appears to reduce the incidence of POAF. However, the said protective
effect may be influenced by EPA/DHA ratio, with OpenSPiltSPi 1 appearing
preferable. PUFA efficacy on POAF prevention appeared insignificant when
compared with non-fish oils and only apparent in the setting of CABG
alone. Further studies are needed to confirm the effect of PUFA on POAF
and to assess the proper use of PUFA against POAF. Copyright ©
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<154>
Accession Number
614302509
Author
Ando T.; Takagi H.
Institution
(Ando) Detroit Medical Center, Department of Cardiology, Detroit, MI,
United States
(Takagi) Shizuoka Medical Center, Department of Cardiovascular Surgery,
Shizuoka, Japan
Title
Comparison of late mortality after transcatheter aortic valve implantation
versus surgical aortic valve replacement: Insights from a meta-analysis.
Source
European Journal of Internal Medicine. 40 (pp 43-49), 2017. Date of
Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has shown
non-inferior late mortality in severe aortic stenosis (AS) patients in
intermediate to inoperable risk for surgery compared to surgical aortic
valve replacement (SAVR). Late outcome of TAVI compared to SAVR is crucial
as the number of TAVI continues to increase over the last few years.
Methods A comprehensive literature search of PUBMED and EMBASE were
conducted. Inclusion criteria were that [1] study design was a randomized
controlled trial (RCT) or a propensity-score matched (PSM) study: [2]
outcomes included > 2-year all-cause mortality in both TAVI and SAVR. The
random-effects model was utilized to calculate an overall effect size of
TAVI compared to SAVR in all-cause mortality. Publication bias was
assessed quantitatively with Egger's test. Results A total of 14 studies
with 6503 (3292 TAVI and 3211 SAVR, respectively) were included in the
meta-analysis. There was no difference in late all-cause mortality between
TAVI and SAVR (HR 1.17, 95%CI 0.98-1.41, p = 0.08, I2 = 61%).
The sub-group analysis of all-cause mortality of RCT (HR 0.93 95%CI
0.78-1.10, p = 0.38, I2 = 40%) and PSM studies (HR 1.44 95%CI
1.15-1.80, p = 0.02, I2 = 35%) differed significantly (p for
subgroup differences = 0.002). Meta-regression implicated that increased
age and co-existing CAD may be associated with more advantageous effects
of TAVI relative to SAVR on reducing late mortality. There was no evidence
of significant publication bias (p = 0.19 for Egger's test). Conclusions
TAVI conferred similar late all-cause mortality compared to SAVR in a
meta-analysis of RCT but had worse outcomes in a meta-analysis of
PSM. Copyright © 2017 European Federation of Internal Medicine

<155>
Accession Number
620273996
Author
Benedetto U.; Altman D.G.; Gerry S.; Gray A.; Lees B.; Flather M.; Taggart
D.P.
Institution
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Oxford, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Norwich, United Kingdom
Title
Off-pump versus on-pump coronary artery bypass grafting: Insights from the
Arterial Revascularization Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp 1545-1553.e7),
2018. Date of Publication: April 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The long-term effects of off-pump coronary artery bypass
continue to be controversial because some studies have reported increased
adverse event rates with off-pump coronary artery bypass when compared
with on-pump coronary artery bypass. The Arterial Revascularization Trial
compared survival after bilateral versus single internal thoracic artery
grafting. The choice of off-pump coronary artery bypass versus on-pump
coronary artery bypass was based on the surgeon's discretion. We performed
a post hoc analysis of the Arterial Revascularization Trial to compare
5-year outcomes with 2 strategies. Methods: Among 3102 patients enrolled
in the Arterial Revascularization Trial, we selected 1260 patients who
underwent off-pump coronary artery bypass versus 1700 patients who
underwent on-pump coronary artery bypass with cardioplegic arrest for the
present comparison. Primary outcomes were 5-year mortality and incidence
of major cardiac and cerebrovascular events, including cardiovascular
death, myocardial infarction, cerebrovascular accident, and
revascularization after index procedure. Propensity score matching
selected 1260 pairs for final comparison. Stratified Cox models were used
for treatment effect estimate. Results: Hospital mortality was comparable
between off-pump coronary artery bypass and on-pump coronary artery bypass
groups (12 [1.0%] vs 15 [1.2%]; P =.7). Conversion rate to on-pump during
off-pump coronary artery bypass was 29 of 1260 (2.3%). When compared with
off-pump coronary artery bypass not converted, off-pump coronary artery
bypass converted to on-pump presented a remarkably higher hospital
mortality (10.3% vs 0.7%; P <.001). At 5 years, the mortality rate was 110
(8.9%) versus 102 (8.3%) in the off-pump coronary artery bypass and
on-pump coronary artery bypass groups, respectively, with no significant
difference (hazard ratio, 1.14; 95% confidence interval, 0.86-1.52; P
=.35). Incidence of major cardiac and cerebrovascular events was 175
(14.3) versus 169 (13.8) in the off-pump coronary artery bypass and
on-pump coronary artery bypass groups, respectively, with no significant
difference (hazard ratio, 1.05; 95% confidence interval, 0.84-1.31; P
=.65). Conclusions: The present post hoc Arterial Revascularization Trial
analysis supports the hypothesis that both off-pump coronary artery bypass
and on-pump coronary artery bypass are equally effective and
safe. Copyright © 2017 The American Association for Thoracic
Surgery

<156>
Accession Number
621215218
Author
Varaei S.; Shamsizadeh M.; Cheraghi M.A.; Talebi M.; Dehghani A.; Abbasi
A.
Institution
(Varaei, Cheraghi, Dehghani) School of Nursing and Midwifery, Tehran
University of Medical Sciences, Tehran, Iran
(Shamsizadeh, Talebi, Abbasi) School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Shahroud, Iran
Title
Effects of a peer education on cardiac self-efficacy and readmissions in
patients undergoing coronary artery bypass graft surgery: a
randomized-controlled trial.
Source
Nursing in critical care. 22 (1) (pp 19-28), 2017. Date of Publication: 01
Jan 2017.
Abstract
AIM: This study aimed to investigate the effects of a peer education on
cardiac self-efficacy (CSE) and readmission of the patients undergoing
bypass surgery.
BACKGROUND: Self-efficacy is an antecedent vital factor in both initiating
and maintaining healthy behaviours. It significantly improves after
effects of heart attacks, anxiety and diminishes the possibility of
readmission.
DESIGN: This study is a randomized-controlled trial.
METHOD: Sixty patients undergoing bypass surgery were chosen and assigned
equally into the control and intervention groups. While routine education
was presented to the patients in the control group, intervention group
were taught using the peer education in two sessions. CSE of all the
selected patients was assessed orderly in 5 days, 4 weeks and 8 months
after surgery. Moreover, their readmission was investigated after 8 months
from surgery. Data was collected using demographic and the CSE scale. Data
were also analysed by using chi2 , Kolmogorov-Smirnov and repeated
measures analysis of variance tests.
RESULTS: The mean score of CSE in the intervention group was significantly
different from the corresponding number in the control group in all three
stages of data collecting (p < 0.001). Compared to the control group, a
smaller number of the patients in the intervention group were readmitted
to the hospitals after 8 months (p = 0.011).
CONCLUSIONS: Implementation of peer education has positive effects on CSE
in patients who have bypass surgery and reduces their hospital
readmission. It can be beneficial to apply this method as an
educative-supportive approach in cardiac surgery fields.
RELEVANCE TO CLINICAL PRACTICE: Implementation of peer education has
positive effects on CSE in these patients and reduces their hospital
readmission. Copyright © 2014 British Association of Critical
Care Nurses.

<157>
Accession Number
621200847
Author
Kimose H.-H.; Randsbaek F.; Christensen T.D.; Valen G.; Botkerc H.E.;
Vaage J.
Institution
(Kimose, Randsbaek, Christensen) Department of Cardiothoracic and Vascular
Surgery, Institute of Clinical Medicine, Aarhus University Hospital,
Aarhus, Denmark
(Valen) Division of Physiology, Department of Molecular Medicine,
Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
(Botkerc) Department of Cardiology, Institute of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
(Vaage) Department of Emergency and Intensive Care, Institute of Clinical
Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
(Vaage) Radiation Medicine Laboratory, ITMO University, St Petersburg,
Russian Federation
Title
A dose-response study of glutamate supplementation in isolated, perfused
rat hearts undergoing ischaemia and cold cardioplegia.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 664-671), 2018.
Date of Publication: 01 Mar 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Several studies have reported superior post-cardioplegic
recovery after glutamate supplementation. The optimum dose of glutamate
supplementation is unknown. The purpose of this study was to find the
optimal protective concentration of glutamate supplementation in a model
of ischaemia/cardioplegia and reperfusion. METHODS: Isolated rat hearts (n
= 77) were perfused with the Krebs-Henseleit buffer. After stabilization,
the hearts were subjected to 25 min of normothermic ischaemia followed by
a single 3-min infusion of cold (4-6 degreeC) St. Thomas' Hospital II
cardioplegia and 87 min of cardioplegic ischaemic arrest and 60 min of
reperfusion. Sodium-L-glutamate was added to the perfusate (control group
had zero glutamate) in increasing concentrations (0.01, 0.1, 1, 10, 20, 30
and 100mM) and given throughout perfusion. Corresponding concentrations
were added to the cardioplegic solution. A balloon in the left ventricle
inserted via the left atrium measured left ventricular pressures
isometrically. Left ventricular developed pressure was calculated.
Myocardial exchange of glucose and lactate was measured prior to ischaemia
and during reperfusion. Myocardial content of glycogen and glutamate was
measured at the end of reperfusion. RESULTS: During reperfusion left
ventricular developed pressure increased (P < 0.0001) in groups
supplemented with 0.1, 1.0, 10, 20 and 30mM glutamate, whereas left
ventricular end-diastolic pressure was attenuated (P = 0.008) when
compared with the controls. No additional benefit on the continuous data
left ventricular developed pressure and left ventricular end-diastolic
pressure was observed with glutamate concentrations above 1 mM. Onset of
LV pressure rise during the period of ischaemia was delayed by 100mM of
glutamate (P = 0.02). Myocardial content of glutamate was increased in a
dose-related manner in Groups 10, 20, 30 and 100 compared with the control
hearts (P < 0.0001). Glycogen was increased in the hearts supplemented
with 100mM of glutamate (P = 0.02). CONCLUSIONS: Even low concentrations
of L-glutamate improved postischaemic and post-cardioplegic heart function
and 1mM seems to be optimal. Copyright © The Author 2017.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<158>
Accession Number
621200759
Author
Gozdek M.; Raffa G.M.; Suwalski P.; Kolodziejczak M.; Anisimowicz L.;
Kubica J.; Navarese E.P.; Kowalewski M.
Institution
(Gozdek, Anisimowicz, Kowalewski) Department of Cardiac Surgery,
Cardiovascular Institute, Dr Antoni Jurasz Memorial University Hospital,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, Poland
(Kolodziejczak) Cardiovascular Institute, Collegium Medicum in Bydgoszcz,
University of Nicolaus Copernicus, Torun, Poland
(Kubica) Department of Cardiology and Internal Medicine, Cardiovascular
Institute, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Navarese) Inova Center for Thrombosis Research and Drug Development,
Inova Heart and Vascular Institute, Fairfax, VA, United States
Title
Comparative performance of transcatheter aortic valve-in-valve
implantation versus conventional surgical redo aortic valve replacement in
patients with degenerated aortic valve bioprostheses: Systematic review
and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 495-504), 2018.
Date of Publication: 01 Mar 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The objective of this report was to directly compare, by means of a
systematic review and meta-analysis, redo surgical aortic valve
replacement (re-sAVR) with valve-in-valve transcatheter aortic valve
implantation (ViV TAVI) for patients with failed degenerated aortic
bioprostheses. Multiple databases were screened for all available reports
comparing ViV TAVI with re-sAVR in patients with failing degenerated
aortic bioprostheses. The primary outcome was all-cause mortality
determined from the longest available survival data. Five observational
studies (n = 342) were included in the meta-analysis; patients in the ViV
TAVI group were older and had a higher baseline risk compared to those in
the re-sAVR group. Although there was no statistical difference in
procedural mortality [risk ratio (RR) 0.74, 95% confidence interval (CI)
0.18-2.97; P = 0.67], 30-day mortality (RR 1.29, 95% CI 0.44-3.78; P =
0.64) and cardiovascular mortality (RR 0.91, 95% CI 0.30-2.70; P = 0.86)
at a mean follow-up period of 18 months, cumulative survival analysis
favoured surgery with borderline statistical significance (ViV TAVI versus
re-sAVR: hazard ratio 1.91, 95% CI 1.03-3.57; P = 0.039). ViV TAVI was
associated with a significantly lower rate of permanent pacemaker
implantations (RR 0.37, 95% CI 0.20-0.68; P = 0.002) and shorter intensive
care unit (P < 0.001) and hospital stays (P = 0.020). In contrast, re-sAVR
offered superior echocardiographic outcomes: lower incidence of
patient-prosthesis mismatch (P = 0.008), fewer paravalvular leaks (P =
0.023) and lower mean postoperative aortic valve gradients in the
prespecified analysis (P = 0.017). The ViV TAVI approach is a safe and
feasible alternative to re-sAVR that may offer an effective, less invasive
treatment for patients with failed surgical aortic valve bioprostheses who
are inoperable or at high risk. Re-sAVR should remain the standard of
care, particularly in the low-risk population, because it offers superior
haemodynamic outcomes with low mortality rates. Copyright © The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

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