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<1>
Accession Number
620606953
Author
Kooiman J.; De Vries J.-P.P.M.; Der Heyden J.V.; Sijpkens Y.W.J.; van
Dijkman P.R.M.; Wever J.J.; van Overhagen H.; Vahl A.C.; Aarts N.;
Verberk-Jonkers I.J.A.M.; Brulez H.F.H.; Hamming J.F.; van der Molen A.J.;
Cannegieter S.C.; Putter H.; van den Hout W.B.; Kilicsoy I.; Rabelink
T.J.; Huisman M.V.
Institution
(Kooiman, Kilicsoy, Huisman) Department of Thrombosis and Hemostasis,
Leiden University Medical Center, Leiden, Netherlands
(Kooiman, Rabelink) Department of Nephrology, Leiden University Medical
Center, Leiden, Netherlands
(De Vries) Department of Vascular Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Der Heyden) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Sijpkens) Department of Internal Medicine, Bronovo Hospital, The Hague,
Netherlands
(van Dijkman) Department of Cardiology, Bronovo Hospital, the Hague,
Netherlands
(Wever) Department of Vascular Surgery, Haga Teaching Hospital, The Hague,
Netherlands
(van Overhagen) Department of Radiology, Haga Teaching Hospital, The
Hague, Netherlands
(Vahl) Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Aarts) Department of Radiology, Bronovo Hospital, The Hague, Netherlands
(Verberk-Jonkers) Department of Nephrology, Maasstad Hospital, Rotterdam,
Netherlands
(Brulez) Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam,
Netherlands
(Hamming) Department of Vascular Surgery, Leiden University Medical
Center, Leiden, Netherlands
(van der Molen) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Putter) Department of Medical Statistics, Leiden University Medical
Center, Leiden, Netherlands
(van den Hout) Department of Medical Decision Making, Leiden University
Medical Center, Leiden, Netherlands
Title
Randomized trial of one-hour sodium bicarbonate vs standard periprocedural
saline hydration in chronic kidney disease patients undergoing
cardiovascular contrast procedures.
Source
PLoS ONE. 13 (2) (no pagination), 2018. Article Number: e0189372. Date of
Publication: February 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Guidelines advise periprocedural saline hydration for
prevention of contrast induced-acute kidney injury (CI-AKI). We analysed
whether 1-hour sodium bicarbonate hydration administered solely prior to
intra-arterial contrast exposure is non-inferior to standard
periprocedural saline hydration in chronic kidney disease (CKD) patients
undergoing elective cardiovascular diagnostic or interventional contrast
procedures. Methods We performed an open-label multicentre non-inferiority
trial between 2011-2014. Patients were randomized to 1 hour pre-procedure
sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline
hydration (1000 ml 0.9%, N = 165) prior to and following contrast
administration (2000 ml of saline total). Primary outcome was the relative
serum creatinine increase (%) 48-96 hours post contrast exposure.
Secondary outcomes were: incidence of CI-AKI (serum creatinine
increase>25% or >44?mol/L), recovery of renal function, the need for
dialysis, and hospital costs within two months follow-up. Results Mean
relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the
bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean
difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI
occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12
(7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0%
and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required
dialysis. Mean costs for preventive hydration and clinical preparation for
the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for
saline (p < 0.001). Conclusion Short hydration with sodium bicarbonate
prior to elective cardiovascular diagnostic or therapeutic contrast
procedures is non-inferior to standard periprocedural saline hydration in
CKD patients with respect to renal safety and results in considerable
healthcare savings.<br/>Copyright &#xa9; 2018 Kooiman et al. This is an
open

<2>
Accession Number
616113042
Author
Siddiqu N.U.R.; Merchant Q.; Hasan B.S.; Rizvi A.; Amanullah M.; Rehmat
A.; Haq A.U.
Institution
(Siddiqu, Merchant, Hasan, Rizvi, Haq) Department of Pediatrics and Child
Health, Aga Khan University Hospital, Karachi, Pakistan
(Amanullah) Department of Surgery, Aga Khan University, Karachi, Pakistan
(Rehmat) Aga Khan University, Karachi, Pakistan
Title
Comparison of enteral versus intravenous potassium supplementation in
hypokalaemia in paediatric patients in intensive care post cardiac
surgery: Open-label randomised equivalence trial (EIPS).
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e011179. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The primary objective was to compare the efficacy of enteral
potassium replacement (EPR) and intravenous potassium replacement (IVPR)
as first-line therapy. Secondary objectives included comparison of adverse
effects and number of doses required to resolve the episode of
hypokalaemia. Trial design The EIPS trial is designed as a randomised,
equivalence trial between two treatment arms. Study setting The study was
conducted at the paediatric cardiac intensive care unit (PCICU) at Aga
Khan University Hospital, Karachi. Participants 41 patients (aged 1 month
to 15 years) who were admitted to PCICU post cardiac surgery were
recruited (23 IVPR arm and 18 EPR arm). Intervention Intervention arms
were block randomised on alternate weeks for IVPR and EPR. Outcome measure
Change in serum potassium levels in (mmol/L) and percentage change after
each event of potassium replacement by the intravenous or enteral route.
Results Both groups (41 patients) had similar baseline characteristics.
Mean age was 4.7 (SD+/-4) years while the most common surgical procedure
was ventricular septal defect repair (12 patients, 29.3%). No mortality
was observed in either arm. Four episodes of vomiting and one arrhythmia
were seen in the EPR group. After adjusting for age, potassium level at
the beginning of the episode, average urine output, inotropic score and
diuretic dose, it was found that there was no statistically significant
difference in change in potassium levels after EPR and IVPR: 0.86 mmol/L
(+/-0.8) and 0.82 mmol/L (+/-0.7) respectively (p=0.86, 95% CI-0.08 to
1.10), or percentage change in potassium level after enteral and
intravenous replacement: 26% (+/-30) and 24% (+/-20) (95% CI-3.42 to 4.03,
p=0.87). Conclusion EPR may be an equally efficacious alternative
first-line therapy in treating hypokalaemia after surgery in selective
patients with congenital heart disease. Ethics and dissemination This
study has been approved by Ethics Review Committee at AKU.<br/>Copyright
&#xa9; 2017 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2017. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.

<3>
Accession Number
617118597
Author
Roehrborn F.; Dohle D.-S.; Waack I.N.; Tsagakis K.; Jakob H.; Teloh J.K.
Institution
(Roehrborn, Waack, Teloh) Institute of Physiological Chemistry, University
Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen,
North Rhine-Westphalia 45147, Germany
(Dohle, Tsagakis, Jakob) Department of Thoracic and Cardiovascular
Surgery, West German Heart Center, University Hospital Essen,
Hufelandstrasse 55, Essen, North Rhine-Westphalia 45147, Germany
Title
Postoperative Compensatory Ammonium Excretion Subsequent to Systemic
Acidosis in Cardiac Patients.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
5383574. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Postoperative acid-base imbalances, usually acidosis,
frequently occur after cardiac surgery. In most cases, the human body, not
suffering from any severe preexisting illnesses regarding lung, liver, and
kidney, is capable of transient compensation and final correction. The aim
of this study was to correlate the appearance of postoperatively occurring
acidosis with renal ammonium excretion. Materials and Methods. Between
07/2014 and 10/2014, a total of 25 consecutive patients scheduled for
elective isolated coronary artery bypass grafting with cardiopulmonary
bypass were enrolled in this prospective observational study. During the
operative procedure and the first two postoperative days, blood gas
analyses were carried out and urine samples collected. Urine samples were
analyzed for the absolute amount of ammonium. Results. Of all patients,
thirteen patients developed acidosis as an initial disturbance in the
postoperative period: five of respiratory and eight of metabolic origin.
Four patients with respiratory acidosis but none of those with metabolic
acidosis subsequently developed a base excess > +2 mEq/L. Conclusion.
Ammonium excretion correlated with the increase in base excess. The
acidosis origin seems to have a large influence on renal compensation in
terms of ammonium excretion and the possibility of an
overcorrection.<br/>Copyright &#xa9; 2017 Friederike Roehrborn et al.

<4>
Accession Number
616332470
Author
Milojevic M.; Head S.J.; Andrinopoulou E.-R.; Serruys P.W.; Mohr F.W.;
Tijssen J.G.; Kappetein A.P.
Institution
(Milojevic, Head, Andrinopoulou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230,
Rotterdam 3015 CE, Netherlands
(Andrinopoulou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Mohr) Department of Cardiovascular Surgery, Herzzentrum Universitat
Leipzig, Leipzig, Germany
(Tijssen) Academic Medical Center, Amsterdam, Netherlands
Title
Hierarchical testing of composite endpoints: Applying the win ratio to
percutaneous coronary intervention versus coronary artery bypass grafting
in the SYNTAX trial.
Source
EuroIntervention. 13 (1) (pp 106-114), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: The goal of the study was to compare long-term outcomes of
percutaneous coronary intervention (PCI) versus coronary artery bypass
grafting (CABG), accounting for the clinical impact of individual
components in the composite endpoints and prioritising these using the win
ratio (Rw). Methods and results: The win ratio was compared with
conventional methods of analyses (hazard ratio [HR] and relative risk) in
the SYNTAX trial (n=1, 800). For the composite of death/stroke/myocardial
infarction (MI), the win ratio favoured CABG and was 1.37 (95% CI:
1.10-1.77) for matched analysis, 1.28 (95% CI: 1.11-1.53) for unmatched
analysis, while the conventional HR was 1.29 (95% CI: 1.11-1.53). The
largest number of winners in favour of CABG over PCI were based on MI
(n=39 vs. n=19, respectively). Death was significantly reduced with CABG
in matched (Rw=1.39, 95% CI: 1.04-1.86) and unmatched win ratio analyses
(Rw=1.27, 95% CI: 1.01-1.42) as compared with non-significant conventional
analysis (HR 1.19, 95% CI: 0.92-1.56). In subgroups, matched win ratio
analyses had a larger treatment effect in favour of CABG compared with
conventional analyses, especially in patients with three-vessel disease
and intermediate SYNTAX scores, while unmatched win ratios had a smaller
point estimate, but with narrower confidence intervals than matched
analyses findings. Conclusions: This re-analysis of the SYNTAX trial using
the win ratio shows that the most important benefit of CABG treatment is
the reduction of hard clinical endpoints such as mortality and MI. Future
trials using this approach can expect to maintain similar statistical
power with smaller sample sizes, and thereby reduce the cost of a trial.
ClinicalTrials.gov Identifier: NCT00114972.<br/>Copyright &#xa9; Europa
Digital & Publishing 2017. All rights reserved.

<5>
Accession Number
616332431
Author
Urena M.; Del Trigo M.; Altisent O.A.-J.; Campelo-Prada F.; Regueiro A.;
DeLarochelliere R.; Doyle D.; Mohammadi S.; Paradis J.-M.; Dagenais F.;
Dumont E.; Puri R.; Laroche V.; Rodes-Cabau J.
Institution
(Urena, Del Trigo, Altisent, Campelo-Prada, Regueiro, DeLarochelliere,
Paradis, Puri, Rodes-Cabau) Department of Cardiology, Quebec Heart and
Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, QC G1V
4G5, Canada
(Doyle, Mohammadi, Dagenais, Dumont) Department of Cardiac Surgery, Quebec
Heart and Lung Institute, Laval University, Quebec City, QC, Canada
(Laroche) Department of Hematology, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
Title
Combined erythropoietin and iron therapy for anaemic patients undergoing
transcatheter aortic valve implantation: The EPICURE randomised clinical
trial.
Source
EuroIntervention. 13 (1) (pp 44-52), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this study was to evaluate, in anaemic patients, the
efficacy of erythropoietin (EPO) in reducing red cell (RC) transfusion
rates post TAVI. Methods and results: This was a randomised double-blind
trial. Patients with severe symptomatic aortic stenosis and concomitant
anaemia with an indication for TAVI were randomised (1:1) to receive two
weight-based doses of EPO (darbepoetin alfa)+iron or placebo at days 10
(+/-4 days) and 1 (+/-1 day) pre TAVI. The primary outcome was the rate of
RC transfusions at 30 days. A total of 100 patients (mean age 81+/-7
years, male 49%) were included: 48 patients received EPO (+iron) and 52
patients received placebo. Baseline characteristics and procedural
findings were well balanced between groups except for baseline haemoglobin
levels, which were lower in those patients receiving EPO (10.7+/-1.2 vs.
11.3+/-1.1 g/dl, p=0.01). The rate of 30-day RC transfusion was similar in
both groups (27.1 vs. 25.0% in the EPO and placebo groups, respectively;
adjusted odds ratio 1.05, 95% CI: 0.42-2.64, p=0.92), and no differences
were observed in the number of RC units per transfused patient (1 [1-3]
vs. 2 [1-2] in the EPO and placebo groups, respectively, adjusted p=0.99).
Rates of 30-day mortality, stroke, new-onset atrial fibrillation, acute
kidney injury, and troponin peak were also similar between groups (p>0.20
for all). Conclusions: EPO (+iron) administration failed to reduce RC
transfusion rates or the per-patient number of transfusion units in
anaemic patients undergoing TAVI. ClinicalTrials.gov Identifier:
NCT02390102.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All
rights reserved.

<6>
Accession Number
611757300
Author
Dery J.-P.; Mahaffey K.W.; Tricoci P.; White H.D.; Podder M.; Westerhout
C.M.; Moliterno D.J.; Harrington R.A.; Chen E.; Strony J.; Van de Werf F.;
Ziada K.M.; Held C.; Aylward P.E.; Armstrong P.W.; Rao S.V.
Institution
(Dery) Department of Cardiology and Cardiovascular Surgery, Institut
Universitaire De Cardiologie Et De Pneumologie De Quebec, Laval
University, Quebec City, Canada
(Mahaffey, Harrington) Department of Medicine, Department of Medicine,
Stanford University, Stanford, CA, United States
(Tricoci, Rao) Department of Medicine, Duke Clinical Research Institute,
Durham, NC, United States
(White) Department of Cardiology, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Podder, Westerhout, Armstrong) Department of Economics, Canadian VIGOUR
Centre, University of Alberta, Edmonton, AB, Canada
(Moliterno, Ziada) Department of Internal Medicine, Gill Heart Institute
and Division of Cardiovascular Medicine, University of Kentucky,
Lexington, KY, United States
(Chen) Bayer HealthCare Pharmaceuticals, Department of Internal Medicine,
Bayer HealthCare Pharmaceuticals, Whippany, NJ, United States
(Strony) Merck, Whitehouse Station, NJ, United States
(Van de Werf) Department of Cardiovascular Sciences, University Hospitals
Leuven, Belgium
(Held) Department of Medical Sciences, Uppsala Clinical Research Center,
Uppsala University, Sweden
(Aylward) Division of Medicine, SAHMRI, Flinders University and Medical
Center, Adelaide, Australia
Title
Arterial access site and outcomes in patients undergoing percutaneous
coronary intervention with and without vorapaxar.
Source
Catheterization and Cardiovascular Interventions. 88 (2) (pp 163-173),
2016. Date of Publication: 01 Aug 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We evaluated outcomes associated with transradial vs.
transfemoral approaches and vorapaxar in acute coronary syndrome (ACS)
patients undergoing percutaneous coronary intervention (PCI) in the TRACER
trial. Background: Vorapaxar reduces ischemic events but increases the
risk of major bleeding. Methods: We compared 30-day and 2-year major
adverse cardiac events (MACE: cardiovascular death, myocardial infarction,
stroke, recurrent ischemia with rehospitalization, and urgent coronary
revascularization) and noncoronary artery bypass graft (CABG)-related
bleedings in 2,192 transradial and 4,880 transfemoral patients undergoing
PCI after adjusting for confounding variables, including propensity for
transradial access. Results: Overall, 30-day GUSTO moderate/severe and
non-CABG TIMI major/minor bleeding occurred less frequently in transradial
(0.9% vs. 2.0%, P = 0.001) vs. transfemoral (1.1% vs. 2.5%, P = 0.005)
patients. A similar reduction was seen at 2 years (3.3% vs. 4.7%, P =
0.008; 3.3% vs. 4.9%, P < 0.001, respectively). Transradial was associated
with an increased risk of ischemic events at 30 days (OR 1.38, 95% CI
1.11-1.72; P = 0.004), driven primarily by increased periprocedural
myocardial infarctions. At 2 years, rates of MACE were comparable (HR
1.14, 95% CI 0.98-1.33; P = 0.096). Although bleeding rates were higher
with vorapaxar in transfemoral vs. transradial patients, there was no
significant treatment interaction. Also, the access site did not modulate
the association between vorapaxar and MACE. Conclusions: Transradial
access was associated with lower bleeding rates and similar long-term
ischemic outcomes, suggesting transradial access is safer than
transfemoral access among ACS patients receiving potent antiplatelet
therapies. Because of the nonrandomized allocation of arterial access,
these results should be considered exploratory. &#xa9; 2015 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<7>
Accession Number
611757285
Author
Ndrepepa G.; Groha P.; Lahmann A.L.; Lohaus R.; Cassese S.; Schulz-Schupke
S.; Kufner S.; Mayer K.; Bernlochner I.; Byrne R.A.; Fusaro M.; Laugwitz
K.-L.; Schunkert H.; Kastrati A.
Institution
(Ndrepepa, Groha, Lahmann, Lohaus, Cassese, Schulz-Schupke, Kufner, Mayer,
Byrne, Fusaro, Schunkert, Kastrati) Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Bernlochner, Laugwitz) 1.Medizinische Klinik, Klinikum rechts der Isar,
Technische Universitat, Munich, Germany
(Laugwitz, Schunkert, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
Title
Increased bleeding risk during percutaneous coronary interventions by
arterial hypertension.
Source
Catheterization and Cardiovascular Interventions. 88 (2) (pp 184-190),
2016. Date of Publication: 01 Aug 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to assess the association between arterial
hypertension and bleeding in patients undergoing percutaneous coronary
intervention (PCI). Background: The impact of arterial hypertension on
bleeding risk of patients with coronary artery disease undergoing PCI is
unknown. Methods: This study included 14,180 patients who underwent PCI.
Bleeding was defined using the Bleeding Academic Research Consortium
(BARC) criteria. Arterial hypertension was defined as treatment with
antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or
diastolic blood pressure value >90 mm Hg documented on at least 2
occasions. The primary outcome was bleeding rate within 30 days of PCI.
Results: Overall, 11,066 patients (78.0%) had arterial hypertension.
Bleeding events occurred in 1,232 patients with arterial hypertension and
278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR]
= 1.28, 95% confidence interval [CI] 1.11-1.46, P < 0.001). Access-site
bleeding occurred in 730 patients with arterial hypertension and 175
patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19
[1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients
with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR =
1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was
significantly associated with any bleeding (adjusted OR = 1.41
[1.19-1.67], P < 0.001), access-site bleeding (adjusted OR = 1.36
[1.10-1.68], P = 0.005) and non-access-site bleeding (adjusted OR = 1.42
[1.09-1.83], P = 0.008). A history of arterial hypertension increased the
risk of non-access-site bleeding (P = 0.002), whereas systolic blood
pressure at the time of PCI increased the risk of access site bleeding (P
= 0.018). Conclusions: Arterial hypertension is associated with increased
risk of bleeding during PCI procedures. &#xa9; 2015 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<8>
[Use Link to view the full text]
Accession Number
613375878
Author
Zong Z.J.; Shen Q.Y.; Lu Y.; Li Y.H.
Institution
(Zong, Shen, Lu, Li) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
Title
A simple blind placement of the left-sided double-lumen tubes.
Source
Medicine (United States). 95 (45) (no pagination), 2016. Article Number:
e5376. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
One-lung ventilation (OLV) has been commonly provided by using a
double-lumen tube (DLT). Previous reports have indicated the high
incidence of inappropriate DLT positioning in conventional maneuvers.
After obtaining approval from the medical ethics committee of First
Affiliated Hospital of Anhui Medical University and written consent from
patients, 88 adult patients belonging to American society of
anesthesiologists (ASA) physical status grade I or II, and undergoing
elective thoracic surgery requiring a left-side DLT for OLV were enrolled
in this prospective, single-blind, randomized controlled study. Patients
were randomly allocated to 1 of 2 groups: simple maneuver group or
conventional maneuver group. The simple maneuver is a method that relies
on partially inflating the bronchial balloon and recreating the effect of
a carinal hook on the DLTs to give an idea of orientation and depth. After
the induction of anesthesia the patients were intubated with a left-sided
Robertshaw DLT using one of the 2 intubation techniques. After intubation
of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate
the patient while the patient lay in a supine position. The number of
optimal position and the time required to place DLT in correct position
were recorded. Time for the intubation of DLT took 100+/-16.2seconds
(mean+/-SD) in simple maneuver group and 95.1+/-20.8seconds in
conventional maneuver group. The difference was not statistically
significant (P=0.221). Time for fiberoptic bronchoscope (FOB) took
22+/-4.8seconds in simple maneuver group and was statistically faster than
that in conventional maneuver group (43.6+/-23.7seconds, P<0.001). Nearly
98% of the 44 intubations in simple maneuver group were considered as in
optimal position while only 52% of the 44 intubations in conventional
maneuver group were in optimal position, and the difference was
statistically significant (P<0.001). This simple maneuver is more rapid
and more accurate to position left-sided DLTs, it may be substituted for
FOB during positioning of a left-sided DLT in condition that FOB is
unavailable or inapplicable.<br/>Copyright &#xa9; 2016 the Author(s).
Published by Wolters Kluwer Health, Inc. All rights reserved.

<9>
Accession Number
611616765
Author
Vasques F.; Kinnunen E.-M.; Pol M.; Mariscalco G.; Onorati F.; Biancari F.
Institution
(Vasques) Department of Medicine, Anesthesia and Intensive Care Unit,
Padua University Hospital, Padua, Italy
(Kinnunen, Biancari) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Pol) Institute of Anatomy, First Faculty of Medicine, Charles University
in Prague, Prague, Czech Republic
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
Title
Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic
review and meta-analysis of comparative studies.
Source
Transfusion. 56 (8) (pp 2146-2153), 2016. Date of Publication: 01 Aug
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: The objective was to evaluate the early outcome after adult
cardiac surgery in Jehovah's Witnesses (JWs) compared with controls not
refusing blood transfusions. STUDY DESIGN AND METHODS: A literature review
was performed through PubMed, Scopus, and Google Scholar to identify any
comparative study evaluating the outcome of JWs and patients not refusing
blood transfusion after adult cardiac surgery. RESULTS: Six studies
comparing the outcome of 564 JWs and 903 controls fulfilled the inclusion
criteria of this study. All series included a matched control cohort.
Baseline characteristics of these two cohorts were similar, but JWs had
higher hemoglobin (Hb) levels as reported in three studies. Pooled
analysis of postoperative outcomes showed that JWs had higher
postoperative levels of Hb (data from four studies: mean, 11.5 g/L vs. 9.8
g/L; p < 0.001) and significantly less postoperative blood loss (mean, 402
mL vs. 826 mL; p < 0.001) compared to controls. JWs and controls had
similar early outcome. However, JWs had a nonsignificant trend toward
decreased early mortality (2.6% vs. 3.6%; p = 0.318), reoperation for
bleeding (3.2% vs. 4.7%; p = 0.070), atrial fibrillation (9.9% vs. 14.3%;
p = 0.056), stroke (2.2% vs. 3.1%; p = 0.439), myocardial infarction (0.4%
vs. 1.4%; p = 0.203), and length of stay in the intensive care unit (1.5
days vs. 2.0 days; p = 0.081). CONCLUSION: JWs undergoing adult cardiac
surgery have a nonsignificant trend toward better early outcome than
controls receiving or not blood transfusions. The suboptimal quality of
available studies prevents conclusive results on the possible benefits of
a transfusion-free strategy in patients not refusing blood
transfusion.<br/>Copyright &#xa9; 2016 AABB

<10>
Accession Number
612628124
Author
Moerman A.; Van Eeckhout C.; Vanderstraeten K.; De Somer F.; Van Belleghem
Y.; De Hert S.
Institution
(Moerman, Van Eeckhout, De Hert) Department of Anaesthesiology, Ghent
University Hospital, Gent, Belgium
(De Somer, Van Belleghem) Department of Cardiac Surgery, Ghent University
Hospital, Gent, Belgium
(Vanderstraeten) Ghent University, Gent, Belgium
Title
The effect of hydroxyethyl starch 6% 130/0.4 compared with gelatin on
microvascular reactivity.
Source
Anaesthesia. 71 (7) (pp 798-805), 2016. Date of Publication: 01 Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We compared the effects on microvascular reactivity of hydroxyethylstarch
(Volulyte) and gelatin (Geloplasma) during acute
haemodilution. The hypothesis was that Volulyte would provide better
microvascular reactivity than Geloplasma. Forty patients undergoing
elective cardiac surgery were randomly assigned to receive either Volulyte
or Geloplasma as the exclusive priming solution of the cardiopulmonary
bypass. To evaluate microvascular reactivity, postocclusive reactive
hyperaemia was examined before and after cardiopulmonary bypass.
Microvascular reactivity assessments included the rate of the occlusion
and reperfusion slopes and reperfusion times. After cardiopulmonary
bypass, increases in reperfusion time were significantly smaller in the
Volulyte group (3 (-27 to 9 [-35 to 33]%) vs 29 (-17 to 76 [-34 to 137]%)
in the Geloplasma group, p = 0.02 between groups). Rate of reperfusion
increased in the Volulyte group (26 (-17 to 43 [-59 to 357])%), whereas it
decreased in the Geloplasma group (-22 (-47 to 16 [-84 to 113])%), p =
0.02 between groups. The shorter reperfusion times and increased
reperfusion rate suggest that Volulyte maintains better microvascular
reactivity than Geloplasma.<br/>Copyright &#xa9; 2016 The Association of
Anaesthetists of Great Britain and Ireland

<11>
Accession Number
612627021
Author
Ma L.; Xiang J.
Institution
(Ma, Xiang) Department of Thoracic Surgery, Fudan University Shanghai
Cancer Center, Shanghai, China
(Ma, Xiang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
Title
Clinical outcomes of video-assisted thoracic surgery and stereotactic body
radiation therapy for early-stage non-small cell lung cancer: A
meta-analysis.
Source
Thoracic Cancer. 7 (4) (pp 442-451), 2016. Date of Publication: 01 Jul
2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: We compared video-assisted thoracoscopic surgery (VATS)
lobectomy and stereotactic body radiation therapy (SABR) to explore
clinical outcomes in the treatment of patients with early stage NSCLC.
Methods: Major medical databases were systematically searched to identify
studies on VATS and SBRT published between January 2010 and October 2015.
English publications of stage I and II NSCLC with adequate patients and
SBRT doses were included. A multivariate random effects model was used to
perform meta-analysis to compare overall survival (OS) and disease-free
survival (DFS) between VATS and SBRT, adjusting for median age and
operable patient numbers. Results: Thirteen VATS (3436 patients) and 24
SBRT (4433) studies were eligible. The median age and follow-up duration
was 68 years and 42 months for VATS and 74 years and 29.4 months for SBRT
patients. After adjusting for the proportion of operable patients and
median age, the estimated OS rates at one, two, three, and five years with
VATS were 94%, 89%, 84%, and 69% compared with 96%, 94%, 89%, and 82% for
SBRT. The estimated DFS rates at one, two, three, and five years with VATS
were 97%, 93%, 87%, and 77% compared with 86%, 80%, 73%, and 58% for SBRT.
Conclusion: Before adjustment, patients treated with SBRT had poorer
clinical outcomes compared to those treated with VATS. A substantial
difference between median age and operability exists between patients
treated with SBRT and VATS. After adjusting for these differences, OS and
DFS did not differ significantly between the two techniques.<br/>Copyright
&#xa9; 2016 The Authors. Thoracic Cancer published by China Lung Oncology
Group and John Wiley & Sons Australia, Ltd

<12>
Accession Number
611515898
Author
Bruch L.; Zadura M.; Waliszewski M.; Platonic Z.; Eranen J.; Scheller B.;
Gotting B.; Herberger D.; Palmieri C.; Sinicropi G.; Motz W.
Institution
(Bruch) Unfallkrankenhaus Berlin, Berlin, Germany
(Zadura, Motz) Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH and Co.
KG, Karlsburg, Germany
(Waliszewski, Herberger) Medical Scientific Affairs B.Braun Vascular
Systems, Berlin, Germany
(Platonic) Clinical Hospital Center Rijeka, Rijeka, Croatia
(Eranen) Pohjois-Karjalan Keskussairaala 1, Kokkola, Finland
(Scheller) Universitatsklinikum des Saarlandes, Homburg/Saar, Germany
(Gotting) Christliches Krankenhaus Quakenbruck gGmbH, Quakenbruck, Germany
(Palmieri) Ospedale del Cuore G. Pasquinucci, Massa, Italy
(Sinicropi) Policlinico Le Scotte Siena, Italy
Title
Results From the International Drug Coated Balloon Registry for the
Treatment of Bifurcations. Can a Bifurcation Be Treated Without Stents?.
Source
Journal of Interventional Cardiology. 29 (4) (pp 348-356), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This observational study assessed the 9-month clinical
outcomes in patients with coronary bifurcation lesions suitable for
drug-coated balloon (DCB) angioplasty. It was the intention to use DCB's
without additional stenting (DCB-only strategy) in selected patients for
this chosen strategy. Bail-out main branch (MB) and/or side branch (SB)
stenting, however, were permissible when flow limiting dissections or
excessive recoil occurred. Background: A multitude of interventional
strategies have been studied to treat bifurcation lesions. With the
availability of DCB angioplasty, investigators have been using this
interventional tool with the optional implantation of bare metal stents
(BMS). Methods: This study is an international, prospective, multicenter
registry enrolling patients with coronary bifurcation lesions including a
side branch >=2 mm in diameter. Patients with stable angina and documented
ischemia or selected forms of unstable angina due to a culprit bifurcation
lesion of any Medina classification type were recruited. The primary
endpoint was clinically driven target-lesion revascularization (TLR) at 9
months. Secondary endpoints included 9-month major adverse cardiac events
(death, myocardial infarction, or TLR), technical success, in-hospital
outcomes and vessel thrombosis rates. Results: A total 127 patients 66.1
+/- 10.1 years of age were enrolled. Demographic characteristics were
80.3% (102/127) male gender, 31.5% (40/127) diabetes, 91.3% (116/127)
hypertension, 7.1% (9/127) ST-elevation myocardial infarction (STEMI), and
9.4% (12/127) non ST-elevation myocardial infarction (NSTEMI). The 130
lesions were treated with 184 DCB's and 64 BMS. In 53.8% (70/130) of all
lesions the DCB-only strategy could be used while 34.6% (45/130) of
lesions had at least 1 stent (BMS) in the main branch, 8.5% (11/130) had
at least 1 stent in the side branch and 3.1% (4/130) needed at least 1
stent in the main and side branch. 94.5% patients (121/127) were available
for follow-up after 9.8 +/- 2.0 months. The TLR rate was 4.6% in the
absence of any thrombotic events in the treated vessels whereas the
9-month MACE rate was 6.2%. Conclusion: This observational study suggests
that the DCB-only strategy is safe and effective to treat selected
bifurcations while benefiting from a shortened dual antiplatelet therapy
(DAPT).<br/>Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<13>
Accession Number
611515886
Author
Moon J.; Kang W.C.; Kim S.; Kim M.G.; Oh P.C.; Park Y.M.; Chung W.-J.;
Choi D.Y.; Lee J.Y.; Lee Y.-B.; Hwang H.Y.; Ahn T.
Institution
(Moon, Kang, Kim, Kim, Oh, Park, Chung) Cardiology Division, Department of
Internal Medicine, Gachon Cardiovascular Research Institute, Gachon
University Gil Medical Center, Incheon, South Korea
(Choi) Department of Pediatrics, Gachon University Gil Medical Center,
Incheon, South Korea
(Lee, Ahn) Department of Anesthesiology, Gachon University Gil Medical
Center, Incheon, South Korea
(Lee) Department of Neurology, Gachon University Gil Medical Center,
Incheon, South Korea
(Hwang) Department of Radiology, Gachon University Gil Medical Center,
Incheon, South Korea
Title
Comparison of Outcomes after Device Closure with Transseptal Puncture and
Standard Technique in Patients with Patent Foramen Ovale and Ischemic
Events.
Source
Journal of Interventional Cardiology. 29 (4) (pp 400-405), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The purpose of this study was to compare the effectiveness of
device closure with the transseptal puncture and standard technique in
patients with patent foramen ovale (PFO) and ischemic events. Methods:
Eighty-two consecutive patients (men: 60 patients, mean age: 45.2 years)
who underwent PFO closure with the Amplatzer PFO Occluder were enrolled.
PFO closure with the transseptal puncture was performed in 22 patients
(transseptal puncture technique, group I). In the remaining patients (n =
60), PFO closure was performed with the standard technique (group II). The
co-primary end points were the incidence of significant residual shunt on
follow-up transesophageal echocardiography (TEE) and a composite of death,
stroke, transient ischemic attack (TIA), and peripheral embolism. Results:
Baseline characteristics were similar between the two groups. On TEE,
despite similar grade of interatrial right-to-left shunt, shunt at
rest/septal hypermobility was less common in group I than in group II
(40.9% vs. 72.9%, P < 0.010). The device was successfully implanted in all
patients. On follow-up TEE, significant residual shunt was more common in
group I than in group II (28.6% vs. 4.3%, P = 0.021). In addition,
composite of death, stroke, TIA, or peripheral embolism was more common in
group I than in group II (13.6% vs. 0%, P = 0.017) during the follow-up
period (mean 25.4 months). Conclusion: Compared to the standard technique,
PFO closure with the transseptal puncture technique showed higher
incidence of residual shunt and ischemic events. Therefore, this technique
might be considered in only highly selected patients as the last
option.<br/>Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<14>
Accession Number
611515878
Author
Cruz-Gonzalez I.; Rama-Merchan J.C.; Calvert P.A.; Rodriguez-Collado J.;
Barreiro-Perez M.; Martin-Moreiras J.; Diego-Nieto A.; Hildick-Smith D.;
Sanchez P.L.
Institution
(Cruz-Gonzalez, Rama-Merchan, Rodriguez-Collado, Barreiro-Perez,
Martin-Moreiras, Diego-Nieto, Sanchez) University Hospital of Salamanca,
IBSAL, Salamanca, Spain
(Calvert) Queen Elizabeth Hospital, University Hospitals Birmingham and
Institute of Translational Medicine, University of Birmingham, United
Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, United Kingdom
Title
Percutaneous Closure of Paravalvular Leaks: A Systematic Review.
Source
Journal of Interventional Cardiology. 29 (4) (pp 382-392), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Paravalvular leak (PVL) is an uncommon yet serious complication associated
with the implantation of mechanical or bioprosthetic surgical valves and
more recently recognized with transcatheter aortic valves implantation
(TAVI). A significant number of patients will present with symptoms of
congestive heart failure or haemolytic anaemia due to PVL and need further
surgical or percutaneous treatment. Until recently, surgery has been the
only available therapy for the treatment of clinically significant PVLs
despite the significant morbidity and mortality associated with
re-operation. Percutaneous treatment of PVLs has emerged as a safe and
less invasive alternative, with low complication rates and high technical
and clinical success rates. However, it is a complex procedure, which
needs to be performed by an experienced team of interventional
cardiologists and echocardiographers. This review discusses the current
understanding of PVLs, including the utility of imaging techniques in PVL
diagnosis and treatment, and the principles, outcomes and complications of
transcatheter therapy of PVLs.<br/>Copyright &#xa9; 2016, Wiley
Periodicals, Inc.

<15>
Accession Number
611515588
Author
Altarabsheh S.E.; Deo S.V.; Dunlay S.M.; Obeidat Y.M.; Erwin P.J.;
Rababa'h A.; Sarabhu N.; Navale S.; Cho Y.H.; Lamba H.K.; Markowitz A.H.;
Park S.J.
Institution
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, Harrington
Heart and Vascular Institute, University Hospitals, Cleveland, OH, United
States
(Dunlay) Division of Cardiology, Mayo Clinic, Rochester, MN, United States
(Obeidat) Department of Cardiac Surgery, Al-Mouwasat Hospital, Al-Dammam,
Saudi Arabia
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Rababa'h) Department of Clinical Pharmacy, Jordan University of Science
and Technology, Irbid, Jordan
(Sarabhu) Division of Nephrology, University Hospitals, Cleveland, OH,
United States
(Navale) Department of Epidemiology and Biostatistics, Case Western
Reserve University, Cleveland, OH, United States
(Cho) Division of Cardiovascular Surgery, Samsung Hospitals, Sungkyunkwang
School of Medicine, Seoul, South Korea
(Lamba) Department of Cardiothoracic Surgery, Louis Stokes Veterans
Affairs, Cleveland, OH, United States
Title
Tissue valves are preferable for patients with end-stage renal disease: an
aggregate meta-analysis.
Source
Journal of Cardiac Surgery. 31 (8) (pp 507-514), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Valve selection in patients with end-stage renal disease
(ESRD) is uncertain. We performed a systematic review and meta-analysis to
compare clinical outcome in ESRD patients undergoing valve replacement.
METHODS: We systematically searched multiple databases (2000-October 2015)
to identify original studies comparing adverse events between mechanical
and biological valve replacement in ESRD patients. End-points studied
were: postoperative mortality, bleeding events, need for re-operation, and
late survival. A random-effect inverse-variance weighted analysis was
performed; event rates are compared as odds ratio (OR and 95% confidence
interval) and hazard ratios (HR) for time-to-event data. Mechanical valve
and tissue valve replacement were considered as study and control cohorts,
respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and
1600 tissue valve) were included in our meta-analysis. Early mortality was
comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among
studies ranged from 1.6-15 years. Bleeding was significantly higher after
mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003).
Structural valve degeneration was present in only 0.6% patients after a
tissue valve replacement. Overall survival after valve replacement was
poor (median 2.61 years); valve choice did not influence this outcome
(pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality
in ESRD patients is comparable between mechanical and tissue valve
replacement. Major bleeding episodes are significantly higher after
mechanical valve replacement but structural degeneration in tissue valves
during the follow-up period is low. Based on the findings from this
meta-analysis, we would recommend using tissue valves in patients with
ESRD.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<16>
Accession Number
611568134
Author
Paredes S.; Cortinez L.; Contreras V.; Silbert B.
Institution
(Paredes, Cortinez, Contreras) Anesthesiology Division, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Silbert) Centre for Anaesthesia and Cognitive Function, Department of
Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Vic., Australia
(Silbert) Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, Melbourne, Vic., Australia
Title
Post-operative cognitive dysfunction at 3 months in adults after
non-cardiac surgery: a qualitative systematic review.
Source
Acta Anaesthesiologica Scandinavica. 60 (8) (pp 1043-1058), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Post-operative cognitive dysfunction is defined as a decline
in cognitive functions that occurs after surgery, but different diagnostic
criteria and incidences have been reported in medical literature. Our aim
was to determine incidence of post-operative cognitive dysfunction 3
months after non-cardiac surgery in adults. Methods: A systematic review
of available evidence was performed by PRISMA guidelines. A search was
done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical
Trials, and Grey Literature Reports. Inclusion criteria were prospective
design studies with patients over 18 years old, surgery under general or
regional anesthesia, follow-up for 3 months, and use of a neurocognitive
battery for diagnosis. We excluded studies made on cardiac or brain
surgery patients. Risk of bias was assessed using tools from National
Heart Lung and Blood Institute. Results: We selected 24 studies. Average
age was 68 years. Only five studies reported incidence of cognitive
decline for a non-surgical control group. Median number of tests used was
5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction
at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological
differences between studies. Increasing age was the most consistent risk
factor identified (seven studies). Conclusions: Post-operative cognitive
dysfunction in patients is frequent, especially in patients over 60 years
old. Limitations include methodological differences in studies. Efforts
must be made to reach a consensus in definition and diagnosis for future
research.<br/>Copyright &#xa9; 2016 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<17>
Accession Number
611254373
Author
Singh K.; Qutub M.; Carson K.; Hibbert B.; Glover C.
Institution
(Singh, Qutub, Hibbert, Glover) Department of Cardiology, University of
Ottawa Heart Institute, Ottawa, ON K1Y 1J7, Canada
(Singh, Carson) Department of Cardiology, Basil Hetzel Institution,
University of Adelaide, SA 5000, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
Title
A meta analysis of current status of alcohol septal ablation and surgical
myectomy for obstructive hypertrophic cardiomyopathy.
Source
Catheterization and Cardiovascular Interventions. 88 (1) (pp 107-115),
2016. Date of Publication: 01 Jul 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Our objective was to perform an updated systematic review to
compare the efficacy and short- and long-term mortality of surgical
myectomy (SM) and alcohol septal ablation (ASA) by including most recent
and largest cohort studies published in last few years. Background: SM and
ASA are the two invasive strategies used to relieve left ventricular
outflow tract obstruction (LVOTO) in patients with drug refractory
symptomatic hypertrophic cardiomyopathy (HCM). In the absence of a
randomized trial, we tried to compare the pros and cons of the two
procedures using a systematic review and meta-analysis. Method: A
comprehensive search of three major databases was performed. We included
original research studies comparing data on ASA and SM. Of 1,143
citations, 10 studies were included in the analysis. Results: A total of
805 patients underwent ASA and 1,019 underwent SM. Patients undergoing SM
were younger (MD 6.3, P = 0.0001) and had higher reduction in the LVOT
gradient (MD -9.56, P = 0.05). However, there was similar resolution of
class III and IV symptoms between the two groups (P = 0.56). There was no
difference in sudden cardiac death (SCD) (P = 0.93), short-term (P =
0.36), long-term all cause (P = 0.27), and long-term cardiac mortality (P
= 0.58). Patients undergoing ASA had higher incidence of post procedure
device implantation (OR 3.09, P < 0.00001). Conclusion: No significant
difference in symptom relief was noted between the two approaches. ASA was
as safe a myectomy with regards to SCD, short-term, and long-term
mortality. &#xa9; 2015 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<18>
Accession Number
611254147
Author
Scheller B.; Fontaine T.; Mangner N.; Hoffmann S.; Bonaventura K.; Clever
Y.P.; Chamie D.; Costa R.; Gershony G.; Kelsch B.; Kutschera M.; Genereux
P.; Cremers B.; Bohm M.; Speck U.; Abizaid A.
Institution
(Scheller, Fontaine, Clever, Cremers, Bohm) Universitatsklinikum des
Saarlandes, Homburg, Saar, Germany
(Mangner) Herzzentrum Leipzig, Germany
(Hoffmann) Werner Forsmann Krankenhaus, Eberswalde, Germany
(Bonaventura) Ernst Von Bergmann Klinikum, Potsdam, Germany
(Chamie, Costa, Abizaid) Instituto Dante Pazzanese De Cardiologia, Sao
Paulo, Brazil
(Gershony) John Muir Cardiovascular Institute, Concord, CA, United States
(Kelsch, Kutschera, Speck) Experimentelle Radiologie, Charite, Berlin,
Germany
(Genereux) Columbia University and Cardiovascular Research Foundation, New
York, NY, United States
Title
A novel drug-coated scoring balloon for the treatment of coronary in-stent
restenosis: Results from the multi-center randomized controlled PATENT-C
first in human trial.
Source
Catheterization and Cardiovascular Interventions. 88 (1) (pp 51-59), 2016.
Date of Publication: 01 Jul 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Scoring balloons produce excellent acute results in the
treatment of in-stent restenosis (ISR), fibro-calcific and bifurcation
lesions but have not been shown to affect the restenosis rate. A novel
paclitaxel-coated scoring balloon (SB) was developed and tested to
overcome this limitation. Methods and Results: SB were coated with
paclitaxel admixed with a specific excipient. Patients at four clinical
sites in Germany and one in Brazil with ISR of coronary bare metal stent
(BMS) were randomized 1:1 to treatment with either a drug-coated or
uncoated SB. Baseline and 6-month follow-up quantitative coronary
angiography was performed by an independent blinded core lab and all
patients will be evaluated clinically for up to one year. The primary
endpoint was angiographic in-segment late lumen loss (LLL). Secondary
endpoints included the rate of clinically driven target lesion
revascularization (TLR), composite of major adverse cardiovascular events
(MACE), stent thrombosis and other variables. Sixty-one patients were
randomized (28 uncoated and 33 drug-coated SB); mean age 65 years, males
72%, and presence of diabetes 39%. At 6-month angiography, in-segment LLL
was 0.48 +/- 0.51 mm in the uncoated SB group versus 0.17 +/- 0.40 mm in
the drug-coated SB group (P = 0.01; ITT analysis). The rate of binary
restenosis was 41% in the uncoated SB group versus 7% in the drug-coated
SB group (P = 0.004). The MACE rate was 32% with the uncoated SB vs. 6% in
the drug-coated SB group (P = 0.016). This difference was primarily due to
the reduced need for clinically driven TLR in the coated SB group (3% vs.
32% P = 0.004). Conclusions: A novel paclitaxel-coated coronary SB has
been developed and successfully used in a first-in-human randomized
controlled trial [ClinicalTrials.gov Identifier: NCT01495533]. &#xa9; 2015
Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<19>
Accession Number
611153187
Author
Siddik-Sayyid S.M.; Aouad M.T.; Ibrahim M.H.; Taha S.K.; Nawfal M.F.;
Tfaili Y.J.; Kaddoum R.N.
Institution
(Siddik-Sayyid, Aouad, Ibrahim, Taha, Nawfal, Tfaili, Kaddoum) Department
of Anesthesiology, American University of Beirut - Medical Center, Beirut,
Lebanon
Title
Femoral arterial cannulation performed by residents: a comparison between
ultrasound-guided and palpation technique in infants and children
undergoing cardiac surgery.
Source
Paediatric Anaesthesia. 26 (8) (pp 823-830), 2016. Date of Publication: 01
Aug 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Percutaneous cannulation of the femoral artery in the
pediatric age group can be technically challenging, especially when
performed by residents in training. Objective: We examined whether the use
of real-time ultrasound guidance is superior to a palpation landmark
technique for femoral artery catheterization in children undergoing heart
surgery. Methods: Patients were prospectively randomized into two groups.
In the palpation group, the femoral artery was cannulated using the
traditional landmark method of palpation of arterial pulse. In the
ultrasound group, cannulation was guided by real-time scanning with an
ultrasound probe. Ten minutes were set as time limit for the resident's
trials during which the time taken for attempted cannulation (primary
outcome), number of attempts, number of successful cannulations on first
attempt, and success rate were compared between the two groups. Adverse
events were monitored on postoperative days 1 and 3. Results: A total of
106 patients were included in the study. The time taken for attempted
femoral artery cannulation was shorter (301 +/- 234 vs 420 +/- 248 s;
difference in mean: 119; 95% confidence interval (CI) of difference:
26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2
(1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P =
0.003] in the ultrasound group compared with the palpation group. The
number of successful cannulations on first attempt was higher in the
ultrasound group compared with palpation group [24/53 (45%) vs 13/53
(25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of
patients who had successful cannulation was 31 of 55 (58%) in the
palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95%
CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days
1 and 3. Conclusions: Ultrasound-guided femoral arterial cannulation in
children when performed by anesthesia residents is superior to the
palpation technique based on the reduction of the time taken for attempted
cannulation and the number of attempts, and improvement in first attempt
success.<br/>Copyright &#xa9; 2016 John Wiley & Sons Ltd

<20>
Accession Number
611149747
Author
Zhao Y.; He Y.H.; Liu W.X.; Sun L.; Han J.C.; Man T.T.; Gu X.Y.; Chen Z.;
Wen Z.Y.; Henein M.Y.
Institution
(Zhao, He, Liu, Sun, Han, Man, Gu, Chen) Ultrasound Department, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
(Wen) Radiology Department, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Henein) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
Title
Intramyocardial Dissecting Hematoma after Acute Myocardial
Infarction-Echocardiographic Features and Clinical Outcome.
Source
Echocardiography. 33 (7) (pp 962-969), 2016. Date of Publication: 01 Jul
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Intramyocardial dissecting hematoma (IDH) after acute
myocardial infarction (MI) is a rare form of subacute cardiac rupture and
hence management uncertainties. The objective of this study was to
describe the clinical course of a small series of IDH patients and to
review the available evidence for managing similar cases. Methods: Eight
IDH patients from our center had echocardiographic, coronary angiographic
and clinical outcome data reviewed. PubMed was also searched for IDH
following MI. Cases were divided into three groups and compared according
to the dissection location. Results: In our 8 patients, 3 had septal, 1
right ventricular (RV), and 4 left ventricular (LV) dissection. Five were
medically treated and 3 surgically repaired. Reviewing the literature
revealed 68 IDH patients, of mean age 66 +/- 10 years, 43 males. The
percentage of IDH involving the LV free wall, septal, and RV free wall
were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole,
mortality was not different between surgically and medically treated
patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P
= 0.49). While surgical and medical treatment of the LV free wall (20.0%
vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not
different, surgical repair of RV free wall had significantly better
survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral
regurgitation (P = 0.49) failed to predict mortality. Conclusion: While
survival following medical and surgical treatment of LV IDH is not
different, patients with RV free wall dissection benefit significantly
from surgical repair.<br/>Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<21>
Accession Number
611306113
Author
Bignami E.; Cattaneo M.; Crescenzi G.; Ranucci M.; Guarracino F.; Cariello
C.; Baldassarri R.; Isgro G.; Baryshnikova E.; Fano G.; Franco A.; Gerli
C.; Crivellari M.; Zangrillo A.; Landoni G.
Institution
(Bignami, Crescenzi, Fano, Franco, Gerli, Crivellari, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Cattaneo) ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute,
Universita degli Studi di Milano, Italy
(Ranucci, Isgro, Baryshnikova) Department of Cardiothoracic and Vascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
(Guarracino, Cariello, Baldassarri) Department of Anesthesia and Intensive
Care, University Hospital of Pisa, Pisa, Italy
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Desmopressin after cardiac surgery in bleeding patients. A multicenter
randomized trial.
Source
Acta Anaesthesiologica Scandinavica. 60 (7) (pp 892-900), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Previous studies showed that desmopressin decreases
post-operative blood loss in patients undergoing cardiac surgery. These
studies were small and never studied the effect of desmopressin in
patients with active bleeding. Objective of the study was to determine
whether desmopressin reduces red blood cells transfusion requirements in
patients with active bleeding after cardiac surgery who had been
pre-treated with tranexamic acid. Methods: This multicenter, randomized,
double-blind, placebo-controlled, parallel-group study randomized elective
patients with bleeding after cardiac surgery despite pre-treatment with
tranexamic acid, to receive placebo (saline solution) or a single
administration of desmopressin (0.3 mug/kg in saline solution). The
primary endpoint was the number of patients requiring red blood cells
transfusion after randomization and during hospital stay. Secondary end
points were: blood loss from chest tubes during the first 24 h after study
drug administration, hours of mechanical ventilation, intensive care unit
stay, and in-hospital mortality. Results: The study was interrupted after
inclusion of 67% of the planned patients for futility. The number of
patients requiring red blood cells transfusion after randomization was
37/68 (54%) in desmopressin group and 33/67 (49%) in placebo group (P =
0.34) with no difference in blood loss: 575 (interquartile 422-770) ml in
desmopressin group and 590 (476-1013) ml in placebo group (P = 0.42),
mechanical ventilation, intensive care unit stay or mortality.
Conclusions: This multicenter randomized trial demonstrated that, in
patients pre-treated with tranexamic acid, desmopressin should not be
expected to improve treatment of patients who experience bleeding after
cardiac surgery.<br/>Copyright &#xa9; 2016 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<22>
Accession Number
613198600
Author
Doumouras B.S.; Alba A.C.; Foroutan F.; Burchill L.J.; Dipchand A.I.; Ross
H.J.
Institution
(Doumouras, Alba, Foroutan, Ross) Heart Failure and Transplant Program,
Toronto General Hospital, University Health Network, University of
Toronto, Toronto, Ontario, Canada
(Burchill) Adult Congenital Heart Disease Program, Knight Cardiovascular
Institute, Oregon Health Science University, Portland, Oregon, United
States
(Dipchand) Labatt Family Heart Centre, The Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
Title
Outcomes in adult congenital heart disease patients undergoing heart
transplantation: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 35 (11) (pp 1337-1347), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Studies assessing mortality and morbidity in adult transplant
recipients with congenital heart disease (CHD) are limited. We conducted a
systematic review and meta-analysis comparing post-transplant outcomes in
these 2 populations. Methods After conducting an electronic database
search, we selected studies evaluating mortality, cause-specific
mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD
patients. We used random-effects models for the meta-analysis. Results
Thirty-day mortality was significantly higher in CHD vs non-CHD patients
(risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62-2.93;
I² = 41%). This was influenced by increased mortality in
Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI,
1.89-5.77; I² = 0%). Mortality at 1 and 5 years was higher in
the CHD population, although neither achieved statistical significance.
Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95%
CI, 0.60-0.95, I² = 42%). Deaths caused by malignancy,
infection, rejection, and cardiac allograft vasculopathy were decreased in
CHD patients, although only death from malignancy achieved significance.
Death secondary to primary graft failure, stroke, and hemorrhage was
significantly higher in CHD patients. Risk of reoperation and dialysis
were not statistically different between the 2 groups. Conclusions
Although adult CHD patients have higher early mortality,
post-transplantation long-term survival is superior to non-CHD recipients.
The challenge is to identify the CHD patients who will benefit from
transplantation vs those who are higher risk.<br/>Copyright &#xa9; 2016
International Society for Heart and Lung Transplantation

<23>
Accession Number
610887861
Author
Dominguez A.C.; Bittl J.A.; El-Hayek G.; Contreras E.; Tamis-Holland J.E.
Institution
(Dominguez, El-Hayek, Tamis-Holland) Mount Sinai Saint Luke's-Roosevelt
Hospital, New York, NY, United States
(Bittl) Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL,
United States
(Contreras) Instituto Tecnologico De Santo Domingo, Santo Domingo,
Dominican Republic
Title
Meta-analysis of randomized controlled trials comparing percutaneous
coronary intervention with aspiration thrombectomy Vs. Conventional
percutaneous coronary intervention during ST-segment elevation myocardial
infarction.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1203-1210),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Evaluate the impact of aspiration thrombectomy (AT) during
primary coronary intervention (PCI) for ST-segment elevation myocardial
infarction (STEMI) on clinical outcomes. Background: AT during PCI for
STEMI may improve microvascular reperfusion, but its impact on clinical
outcomes has remained controversial. Methods: We searched Pubmed, EMBASE,
Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31,
2015 for randomized controlled trials that evaluated the use of AT with
PCI compared with PCI alone for STEMI. The primary end point was all-cause
mortality. Secondary end points included major adverse cardiac events
(MACE, consisting of death, myocardial infarction, and target-vessel
revascularization), recurrent myocardial infarction (MI), target-vessel
revascularization (TVR), stent thrombosis and stroke. Results: Eighteen
randomized controlled trials (n = 21,501) fulfilled the inclusion
criteria. A total of 10,544 patients were treated with AT and PCI,
compared to 10,957 control patients. The use of AT was not associated with
a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01;
P = 0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P = 0.06), recurrent MI (RR
0.97: 95% CI 0.81-1.17; P = 0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P =
0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P = 0.17), or stroke
(RR 1.35; 95% CI 0.86-2.11; P = 0.19). Conclusions: Using the totality of
evidence available through 2015, this meta-analysis failed to show that
the routine use of aspiration thrombectomy in patients with ST-elevation
myocardial infarction significantly reduces all-cause mortality, MACE,
recurrent MI, TVR, or stent thrombosis. The role of aspiration
thrombectomy in selected patients with angiographic evidence of large
thrombus burden requires further clinical investigation. &#xa9; 2015 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<24>
Accession Number
610887762
Author
Vos N.S.; van der Schaaf R.J.; Amoroso G.; Herrman J.-P.R.; Patterson
M.S.; Slagboom T.; Vink M.A.
Institution
(Vos, van der Schaaf, Amoroso, Herrman, Patterson, Slagboom, Vink)
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam,
Netherlands
Title
REVascularization with paclitaxEL-coated balloon angioplasty versus
drug-eluting stenting in acute myocardial infarcTION-A randomized
controlled trial: Rationale and design of the REVELATION trial.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1213-1221),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: In primary percutaneous coronary intervention (PPCI) for ST-elevation
myocardial infarction (STEMI), stenting has proved to reduce the need for
repeat revascularization compared with balloon angioplasty alone. The
incidence of cardiac death or recurrent myocardial infarction, though, is
not reduced by stenting. This is in part attributable to stent-related
complications like stent thrombosis which may occur even years after
implantation. A strategy of drug coated balloon (DCB) angioplasty without
stenting would abolish the potential disadvantages of stent implantation
while reducing the probability of restenosis observed in plain old balloon
angioplasty. Our aim is to evaluate the efficacy and safety of a DCB only
strategy versus drug-eluting stents (DES) in PPCI for STEMI. Study design:
The REVELATION trial is a prospective, single center, randomized study, in
which 120 patients presenting with STEMI will be allocated to treatment
with a DCB versus DES. Appertaining to the established prognostic value of
fractional flow reserve (FFR) rather than angiographic lesion severity,
the functional assessment of the infarct-related lesion by FFR at 9 months
after initial treatment is the primary end point. Assuming an FFR value of
0.90 after stenting and an increased risk of adverse events if post-PCI
FFR <0.85, we decided to accept an FFR value of >=0.85 after DCB only at
follow-up as noninferiority margin. Secondary end points include major
adverse cardiac events up to 5-year follow-up. Conclusion: Our trial will
address the efficacy and safety of DCB angioplasty versus DES in the
setting of PPCI for STEMI. The REVELATION trial will introduce the
recognized prognostic significance of physiologic assessment of the
infarct-related lesion by FFR at 9 months follow-up as primary end point.
&#xa9; 2015 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<25>
Accession Number
610887746
Author
Genereux P.; Kini A.; Lesiak M.; Kumsars I.; Fontos G.; Slagboom T.; Ungi
I.; Metzger D.C.; Wykrzykowska J.J.; Stella P.R.; Bartorelli A.L.; Fearon
W.F.; Lefevre T.; Feldman R.L.; Tarantini G.; Bettinger N.; Minalu Ayele
G.; LaSalle L.; Francese D.P.; Onuma Y.; Grundeken M.J.; Garcia-Garcia
H.M.; Laak L.L.; Cutlip D.E.; Kaplan A.V.; Serruys P.W.; Leon M.B.
Institution
(Genereux, Bettinger, Leon) Columbia University Medical Center/NewYork
Presbyterian Hospital, New York, NY, United States
(Genereux, Bettinger, Minalu Ayele, LaSalle, Francese, Leon)
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Hopital Du Sacre-Coeur De Montreal, Universite De Montreal,
Montreal, QC, Canada
(Kini) Mount Sinai Medical Center, New York, NY, United States
(Lesiak) 1st Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Kumsars) Latvian Center of Cardiology, Paul Stradins Clinical University
Hospital, Riga, Latvia
(Fontos) Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
(Slagboom) Department of Cardiology, OLVG, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Ungi) 2nd Department of Medicine and Cardiology Center Medical Faculty,
Albert Szent-Gyorgyi Clinical Center, University of Szeged- Department of
Cardiology, Szeged, Hungary
(Metzger) Wellmont CVA Heart Institute, Kingsport, TN, United States
(Wykrzykowska, Grundeken) Department of Cardiology, Academic Medical
Center, Amsterdam, Netherlands
(Stella) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Bartorelli) Centro Cardiologico Monzino, University of Milan, Milan,
Italy
(Fearon) Division of Cardiovascular Medicine, Stanford University Medical
Center, Stanford, CA, United States
(Lefevre) Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
(Feldman) MediQuest Research Group, Ocala, FL, United States
(Tarantini) Azienda Ospedaliera Di Padova, Padova, Italy
(Onuma, Garcia-Garcia, Serruys) Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Laak, Kaplan) Tryton Medical Inc., Durham, NC, United States
(Cutlip) Harvard Clinical Research Institute, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Kaplan) Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
Title
Outcomes of a dedicated stent in coronary bifurcations with large side
branches: A subanalysis of the randomized TRYTON bifurcation study.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1231-1241),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To examine the benefit of the Tryton dedicated side branch
(SB) stent compared with provisional stenting in the treatment of complex
bifurcation lesions involving large SBs. Background: The TRYTON Trial was
designed to evaluate the utility of a dedicated SB stent to treat true
bifurcation lesions involving large (>=2.5 mm by visual estimation) SBs.
Patient enrolled in the trial had smaller SB diameters than intended (59%
SB <=2.25 mm by Core Lab QCA). The TRYTON Trial did not meet its primary
endpoint due to an increased rate of peri-procedural myocardial
infarctions (MIs). Methods: The TRYTON Trial randomized 704 patients to
the Tryton SB stent with main vessel DES versus provisional SB treatment
with main vessel DES. The rates of the primary end point of target vessel
failure and the secondary powered end point of angiographic percent
diameter stenosis in the SB at 9 months were assessed and compared between
the two treatment strategies among patients with a SB >=2.25 mm diameter
at baseline determined by Core Lab QCA. Results: Among the 704 patients
enrolled in the TRYTON Trial, 289 patients (143 provisional and 146 Tryton
stent; 41% of entire cohort) had a SB >=2.25 mm. The primary end point of
TVF was numerically lower in the Tryton group compared with the
provisional group (11.3% vs. 15.6%, P = 0.38), and was within the
non-inferiority margin. No difference among the rates of clinically driven
target vessel revascularization (3.5% vs. 4.3% P = 0.77) or cardiac death
(0% both groups) were seen. In-segment percent diameter stenosis of the SB
was significantly lower in the Tryton group compared with the provisional
group (30.4% vs. 40.6%, P = 0.004). Conclusions: Analysis of the TRYTON
Trial cohort of SB >=2.25 mm supports the safety and efficacy of the
Tryton SB stent compared with a provisional stenting strategy in the
treatment of bifurcation lesions involving large SBs. &#xa9; 2015 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<26>
Accession Number
612022859
Author
Liu P.; Qiao W.-H.; Sun F.-Q.; Ruan X.-L.; Al Shirbini M.; Hu D.; Chen S.;
Dong N.-G.
Institution
(Liu, Qiao, Sun, Ruan, Al Shirbini, Hu, Chen, Dong) Department of
Cardiovascular Surgery, Union Hospital, Huazhong University of Science and
Technology, Wuhan, China
Title
Should a Mechanical or Biological Prosthesis Be Used for a Tricuspid Valve
Replacement? A Meta-Analysis.
Source
Journal of Cardiac Surgery. 31 (5) (pp 294-302), 2016. Date of
Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: The prosthesis of choice for a tricuspid
valve replacement is still unkown. This meta-analysis was undertaken to
review the results of mechanical and bioprosthetic valves in the tricuspid
position. Methods: We identified all relevant studies published in the
past 20 years (from January 1, 1995 to December 31, 2014) through the
Embase, Current Contents, and PubMed databases. The hazard ratio and its
95% confidence limits were utilized to evaluate time-to-event related
effects of surgical procedures. The Q-statistic, Index of Inconsistency
test, funnel plots, and Egger's test were used to assess the degree of
heterogeneity and publication bias. Random effects models were used, and
study quality was also assessed. Results: In our meta-analysis, 22 studies
published from 1995 to 2014 were reviewed and 2630 patients and 14,694
follow-up years were analyzed. No statistically significant difference was
identified between mechanical and biological valves in terms of survival,
reoperation, and prosthetic valve failure. The respective pooled hazard
ratio estimates were 0.95 (0.79 to 1.16, p = 0.62, I² = 29%),
1.20 (0.84 to 1.71, p = 0.33, I² = 0%), and 0.35 (0.06 to 2.01,
p = 0.24, I² = 0%). A higher risk of thrombosis was found in
mechanical tricuspid valve prostheses (3.86, 1.38 to 10.82, p = 0.01,
I² = 0%). Conclusions: No statistically significant difference
was identified between mechanical and biological valves in terms of
survival, reoperation, or prosthetic valve failure, but mechanical
tricuspid valve prostheses had a higher risk of thrombosis. doi:
10.1111/jocs.12730 (J Card Surg 2016;31:294-302).<br/>Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<27>
Accession Number
610799349
Author
Levin D.N.; Taras J.; Taylor K.
Institution
(Levin) London School of Hygiene and Tropical Medicine and London School
of Economics, London, United Kingdom
(Levin) Department of Anesthesia, University of Toronto, Toronto, ON,
Canada
(Taras) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Taylor) Department of Anesthesia, Hospital for Sick Children, Toronto,
ON, Canada
Title
The cost effectiveness of transesophageal echocardiography for pediatric
cardiac surgery: a systematic review.
Source
Paediatric Anaesthesia. 26 (7) (pp 682-693), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Intraoperative transesophageal echocardiography (ITEE) for
pediatric cardiac surgery has been described as clinically efficacious and
cost-effective. There are a small number of publications supporting these
claims. Aims: The objectives were to assess the quality of the research,
the variability of results across studies and, if possible, to make a
consensus statement based on the results. Methods: In March 2015, a
systematic search of MEDLINE and MEDLINE In-Process, EMBASE, and the
National Health Service Economic Evaluation Database was performed. The
search was supplemented with a review of Health Technology Assessment
reports through the Centre for Reviews and Dissemination database. English
language articles including any quantitative economic evaluation were
included. The quality of each study was assessed using the British Medical
Journal economic evaluation quality checklist. Data extracted included the
main outcomes from each study, study methodologies, itemized costs,
sensitivity ranges, biases, and delayed reoperation prevented with ITEE.
When possible, a cost-savings per ITEE was calculated to facilitate
comparison across studies and used to create a synthesis of the results.
Results: Seven studies met the inclusion criteria; of these, five were
included in the synthesis of results. The cost-savings per ITEE ranged
from $194 to $4910 with a mean of $1930 (95%CI: $845 to $3015) (2015 USD).
Prevented delayed reoperation rates using ITEE ranged from 2.8% to 10%.
Earlier studies were of poorer quality (scores 8-17) and more recent
studies were of higher quality (scores 22-25). Methodologies used were
either retrospective chart reviews (57%) or prospective observational
studies (43%) with a range of approaches to estimate costs. Conclusion:
ITEE for pediatric cardiac surgery is effective and cost-saving. This is a
validation of the current practice patterns. These finding may influence
the expansion of the use of this technology.<br/>Copyright &#xa9; 2016
John Wiley & Sons Ltd

<28>
Accession Number
610799347
Author
Mattila I.; Patila T.; Rautiainen P.; Korpela R.; Nikander S.; Puntila J.;
Salminen J.; Suominen P.K.; Tynkkynen P.; Hiller A.
Institution
(Mattila, Patila, Puntila, Salminen) Division of Pediatric Surgery,
Hospital for Children and Adolescents, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Rautiainen, Korpela, Nikander, Suominen, Tynkkynen, Hiller) Division of
Anesthesiology, Hospital for Children and Adolescents, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Title
The effect of continuous wound infusion of ropivacaine on postoperative
pain after median sternotomy and mediastinal drain in children.
Source
Paediatric Anaesthesia. 26 (7) (pp 727-733), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Postoperative pain after median sternotomy is usually treated
with i.v. opioids. We hypothesized that continuous wound infusion of
ropivacaine decreases postoperative morphine consumption and improves
analgesia in children who undergo cardiac surgery. Methods: This
randomized, double-blind study comprised 49 children aged 1-9 years who
underwent atrial septal defect (ASD) closure. Patients received continuous
local anesthetic wound infiltration either with 0.2% ropivacaine, 0.3-0.4
mg.kg^-1.h^-1 (Group R) or with saline (Group C).
Rescue morphine consumption, Objective Pain Scale (OPS), time to
mobilization, time to enteral food intake, and time to discharge were
recorded. Results: There were no statistically significant differences in
morphine consumption at 24, 48, and 72 h postsurgery between R and C
groups. There was a weak evidence for a difference in the time to the
first morphine administration after tracheal extubation to be longer for
Group R than Group C (186.2 vs 81.0 min; 95% CI (-236.5, 26.2), P =
0.114). The incidence of nausea and vomiting were comparable between the
groups. No signs or symptoms of local anesthetic toxicity were registered.
Conclusions: Contrary to our hypothesis, continuous ropivacaine wound
infusion did not reduce morphine consumption, pain score values, or nausea
and vomiting in children who underwent ASD closure with median sternotomy
and mediastinal drain.<br/>Copyright &#xa9; 2016 John Wiley & Sons Ltd

<29>
Accession Number
611062446
Author
Gullestad L.; Eiskjaer H.; Gustafsson F.; Riise G.C.; Karason K.; Dellgren
G.; Radegran G.; Hansson L.; Gude E.; Bjortuft O.; Jansson K.; Schultz
H.H.; Solbu D.; Iversen M.
Institution
(Gullestad, Gude) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Gullestad, Gude) Faculty of Medicine, K.G. Jebsen Cardiac Research Centre
and Center for Heart Failure Research, University of Oslo, Oslo, Norway
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Riise) Department of Respiratory Medicine, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Karason, Dellgren) Department of Cardiology and Transplant Institute,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Radegran) Department of Clinical Sciences Lund, Cardiology, Lund
University and the Section for Heart Failure and Valvular Disease, Skane
University Hospital, Lund, Sweden
(Hansson) Department of Respiratory Medicine, Lund University Hospital and
Skane University Hospital, Lund, Sweden
(Bjortuft) Department of Respiratory Medicine, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Jansson) Department of Cardiology, Heart Center, University Hospital,
Linkoping, Sweden
(Schultz, Iversen) Division of Lung Transplantation, Department of
Cardiology, Rigshospitalet, Copenhagen, Denmark
(Solbu) Novartis Norge AS, Oslo, Norway
Title
Long-term outcomes of thoracic transplant recipients following conversion
to everolimus with reduced calcineurin inhibitor in a multicenter,
open-label, randomized trial.
Source
Transplant International. 29 (7) (pp 819-829), 2016. Date of Publication:
01 Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The NOCTET study randomized 282 patients >=1 year after heart or lung
transplantation to continue conventional calcineurin inhibitor (CNI)
therapy or to start everolimus with reduced-exposure CNI. Last follow-up,
at >=5 years postrandomization (mean: 5.6 years) was attended by 72/140
everolimus patients (51.4%) and 91/142 controls (64.1%). Mean measured GFR
remained stable in the everolimus group from randomization (51.3 ml/min)
to last visit (51.4 ml/min) but decreased in controls (from 50.5 ml/min to
45.3 ml/min) and was significantly higher with everolimus at last
follow-up (P = 0.004). The least squares mean (SE) change from
randomization was -1.5 (1.7)ml/min with everolimus versus -7.2 (1.7)ml/min
for controls (difference: 5.7 [95% CI 1.7; 9.6]ml/min; P = 0.006). The
difference was accounted for by heart transplant patients (difference: 6.9
[95% 2.3; 11.5]ml/min; P = 0.004). Lung transplant patients showed no
between-group difference at last follow-up. Rates of rejection, death, and
major cardiac events were similar between groups, as was graft function.
Pneumonia was more frequent with everolimus (18.3% vs. 6.4%). In
conclusion, introducing everolimus in maintenance heart transplant
patients, with reduced CNI, achieves a significant improvement in renal
function which is maintained for at least 5 years, but an early renal
benefit in lung transplant patients was lost. Long-term immunosuppressive
efficacy was maintained.<br/>Copyright &#xa9; 2016 Steunstichting ESOT

<30>
Accession Number
610915332
Author
Patel H.C.; Rosen S.D.; Hayward C.; Vassiliou V.; Smith G.C.; Wage R.R.;
Bailey J.; Rajani R.; Lindsay A.C.; Pennell D.J.; Underwood S.R.; Prasad
S.K.; Mohiaddin R.; Gibbs J.S.R.; Lyon A.R.; Di Mario C.
Institution
(Patel, Hayward, Vassiliou, Smith, Wage, Bailey, Lindsay, Pennell,
Underwood, Prasad, Mohiaddin, Lyon, Di Mario) Royal Brompton Hospital,
London, United Kingdom
(Rosen) Ealing Hospital, Southall, London, United Kingdom
(Rajani) Guys and St Thomas' Hospital, London, United Kingdom
(Gibbs) Hammersmith Hospital, London, United Kingdom
Title
Renal denervation in heart failure with preserved ejection fraction
(RDT-PEF): a randomized controlled trial.
Source
European Journal of Heart Failure. 18 (6) (pp 703-712), 2016. Date of
Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aim: Heart failure with preserved ejection fraction (HFpEF) is associated
with increased sympathetic nervous system (SNS) tone. Attenuating the SNS
with renal denervation (RDT) might be helpful and there are no data
currently in humans with HFpEF. Methods and results: In this
single-centre, randomized, open-controlled study we included 25 patients
with HFpEF [preserved left ventricular (LV) ejection fraction, left atrial
(LA) dilatation or LV hypertrophy and raised B-type natriuretic peptide
(BNP) or echocardiographic assessment of filling pressures]. Patients were
randomized (2:1) to RDT with the SymplicityTM catheter or continuing
medical therapy. The primary success criterion was not met in that there
were no differences between groups at 12 months for Minnesota Living with
Heart Failure Questionnaire score, peak oxygen uptake (VO<inf>2</inf>) on
exercise, BNP, E/e', LA volume index or LV mass index. A greater
proportion of patients improved at 3 months in the RDT group with respect
to VO<inf>2</inf> peak (56% vs. 13%, P = 0.025) and E/e' (31% vs. 13%, P =
0.04). Change in estimated glomerular filtration rate was comparable
between groups. Two patients required plain balloon angioplasty during the
RDT procedure to treat renal artery wall oedema. Conclusion: This study
was terminated early because of difficulties in recruitment and was
underpowered to detect whether RD improved the endpoints of quality of
life, exercise function, biomarkers, and left heart remodelling. The
procedure was safe in patients with HFpEF, although two patients did
require intraprocedure renal artery dilatation.<br/>Copyright &#xa9; 2016
The Authors European Journal of Heart Failure &#xa9; 2016 European Society
of Cardiology

<31>
Accession Number
610739246
Author
Vandenberghe W.; Gevaert S.; Kellum J.A.; Bagshaw S.M.; Peperstraete H.;
Herck I.; Decruyenaere J.; Hoste E.A.J.
Institution
(Vandenberghe, Peperstraete, Herck, Decruyenaere, Hoste) Departments of
Intensive Care Medicine, ICU, University Hospital Ghent, Ghent University,
Ghent BE 9000, Belgium
(Gevaert) Cardiology, Ghent University Hospital, Ghent University, Ghent,
Belgium
(Hoste) Research Foundation-Flanders (FWO), Brussels, Belgium
(Kellum) Centre for Critical Care Nephrology, University of Pittsburgh,
United States
(Kellum, Hoste) Clinical Research, Investigation, and Systems Modelling of
Acute Illness (CRISMA) Centre, Department of Critical Care Medicine,
University of Pittsburgh, School of Medicine, Pittsburgh, PA, United
States
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AL, Canada
Title
Acute kidney injury in cardiorenal syndrome type 1 patients: A systematic
review and meta-analysis.
Source
CardioRenal Medicine. 6 (2) (pp 116-128), 2015. Date of Publication: 2015.
Publisher
S. Karger AG
Abstract
Background: We evaluated the epidemiology and outcome of acute kidney
injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its
subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and
after cardiac surgery (CS). Summary: We performed a systematic review and
meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO),
worsening renal failure (WRF) and renal replacement therapy (RRT). We
investigated the three most common clinical causes of CRS-1: AHF, ACS and
CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41
studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by
AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had
a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI:
47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types
of acute cardiac disease. AKI was associated with an increased mortality
rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227
patients), a longer length of stay in the intensive care unit
[LOS<inf>ICU</inf>] (median duration = 1.37 days, 95% CI 0.41-2.33; 9
studies and 10,758 patients) and a longer LOS in hospital
[LOS<inf>hosp</inf>] (median duration = 3.94 days, 95% CI 1.74-6.15; 8
studies and 35,227 patients). Increasing AKI severity was associated with
worse outcomes. The impact of CRS-1 defined by AKI on mortality was
greatest in CS patients. RRT had an even greater impact compared to AKI
(mortality risk ratio = 9.2, median duration of LOS<inf>ICU</inf> = 10.6
days and that of LOS<inf>hosp</inf> = 20.2 days). Key Messages: Of all
included patients, almost one quarter developed AKI and approximately 3%
needed RRT. AHF patients experienced the highest occurrence rate of AKI,
but the impact on mortality was greatest in CS patients.<br/>Copyright
&#xa9; 2015 S. Karger AG, Basel.

<32>
Accession Number
611183716
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Coexisting Mitral Regurgitation Impairs Survival After Transcatheter
Aortic Valve Implantation.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2270-2276), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background It remains unclear whether coexisting and untreated mitral
regurgitation (MR) affects survival after transcatheter aortic valve
implantation (TAVI) for aortic stenosis (AS). To summarize contemporary
evidence, we performed the first metaanalysis of adjusted observational
studies reporting post-TAVI mortality in patients with various grades of
MR. Methods MEDLINE and EMBASE were searched until February 2015, with a
bibliographic review of secondary sources. Eligible studies were
observational studies enrolling patients undergoing TAVI for AS and
reporting adjusted odds ratios (ORs), hazard ratios (HRs), or both for
early (30-day or in-hospital) all-cause mortality, overall all-cause
mortality, or both in patients with apparent (significant) versus
unapparent (nonsignificant) MR as outcomes. Results Sixteen eligible
studies enrolling a total of 13,672 patients undergoing TAVI for AS were
identified and included. Pooled analyses of eight studies (representing
9,356 patients) and 14 studies (representing 7,405 patients) respectively
demonstrated a statistically significant increase in early (OR 2.17; 95%
confidence interval [CI] 1.50 to 3.14; p < 0.0001) and overall all-cause
mortality (HR 1.81; 95% CI 1.37 to 2.40; p < 0.0001) in patients with
apparent relative to unapparent MR. The exclusion of any single study from
the analyses did not substantively alter the overall results of our
analyses, and there was no evidence of significant publication bias.
Conclusions Coexisting and untreated apparent (usually moderate or severe)
MR appears to be associated with an increase in both early and overall
mortality after TAVI for AS.<br/>Copyright &#xa9; 2015 The Society of
Thoracic Surgeons

<33>
Accession Number
611183705
Author
Kara I.; Koksal C.; Erkin A.; Sacli H.; Demirtas M.; Percin B.; Diler
M.S.; Kirali K.
Institution
(Kara, Erkin, Sacli, Percin, Diler, Kirali) Department of Cardiovascular
Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
(Koksal) Department of Cardiovascular Surgery, Kartal Kosuyolu Research
and Training Hospital, Kartal, Istanbul, Turkey
(Demirtas) Department of Cardiovascular Surgery, State Hospital of
Beyhekim, Konya, Turkey
Title
Outcomes of Mild to Moderate Functional Tricuspid Regurgitation in
Patients Undergoing Mitral Valve Operations: A Meta-Analysis of 2,488
Patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2398-2407), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
This meta-analysis examined the prognosis of patients who were found to
have mild to moderate functional tricuspid regurgitation during mitral
valve operations. Overall, this meta-analysis included 2,488 patients in
10 studies. Compared with the group without tricuspid valve annuloplasty,
the probability of not progressing to moderate to severe functional
tricuspid regurgitation was significantly higher in the tricuspid valve
annuloplasty group. A more aggressive surgical approach involving
concomitant tricuspid repair with mitral valve operations may be
considered to avoid the development of moderate to severe functional
tricuspid regurgitation in the follow-up.<br/>Copyright &#xa9; 2015 The
Society of Thoracic Surgeons

<34>
Accession Number
611183701
Author
Luthra S.; Leiva-Juarez M.M.; Taggart D.P.
Institution
(Luthra, Leiva-Juarez) Division of Cardiac Surgery, Corrigan Minehan Heart
Center, Massachusetts General Hospital, Boston, Massachusetts, United
States
(Taggart) Oxford Heart Center, John Radcliffe Hospital, Headley Way,
Oxford, United Kingdom
Title
Systematic Review of Therapies for Stable Coronary Artery Disease in
Diabetic Patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2383-2397), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Diabetes mellitus is a significant risk modifier for stable coronary
artery disease, causing patients to have more extensive and diffuse
lesions. Opposing treatment strategies remain a matter of debate. A
multiple database search was conducted and outcomes, lesion, and patient
characteristics were compared. Overall mortality, cardiac death, major
adverse cardiovascular and cerebrovascular events, and need for
revascularization were higher with percutaneous coronary intervention than
with coronary artery bypass graft surgery. Multivessel disease and high
Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac
Surgery (SYNTAX) scores were associated with better outcomes for coronary
artery bypass graft surgery.<br/>Copyright &#xa9; 2015 The Society of
Thoracic Surgeons

<35>
Accession Number
611183688
Author
Chaudhry U.A.R.; Harling L.; Sepehripour A.H.; Stavridis G.; Kokotsakis
J.; Ashrafian H.; Athanasiou T.
Institution
(Chaudhry, Harling, Sepehripour, Ashrafian, Athanasiou) Imperial College
London, London, United Kingdom
(Stavridis) Onassis Cardiac Surgery Centre, Athens, Greece
(Kokotsakis) Evangelismos General Hospital, Athens, Greece
Title
Beating-Heart Versus Conventional On-Pump Coronary Artery Bypass Grafting:
A Meta-Analysis of Clinical Outcomes.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2251-2260), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Beating-heart on-pump coronary artery bypass grafting
(BH-ONCAB) offers a hybrid coronary revascularization technique that may
confer the benefits of an "off-pump" operation while maintaining the
hemodynamic stability and mechanical support of conventional on-pump CABG
(C-ONCAB). This study aimed to identify whether BH-ONCAB confers a
morbidity or mortality benefit over C-ONCAB in the immediate and midterm
postoperative period. Methods A systematic literature review identified 13
studies incorporating 3,930 patients (937 BH-ONCAB; 2,993 C-ONCAB)
fulfilling our inclusion criteria. Outcomes were meta-analyzed using
random-effects modelling. Between-study heterogeneity was investigated
through quality assessment, subgroup, and risk of bias analysis. Results
No difference was seen in overall 30-day mortality (13 studies; odds
ratio, 0.60; 95% confidence interval, 0.32 to 1.14; p = 0.12), or midterm
survival (5 studies; hazard ratio, 0.65; 95% confidence interval, 0.22 to
1.88; p = 0.43) between BH-ONCAB and C-ONCAB. BH-ONCAB was associated with
significantly fewer postoperative myocardial infarction events (odds
ratio, 0.32; 95% confidence interval, 0.11 to 0.92; p = 0.03); however, no
significant difference was observed in other postoperative morbidity
outcomes. Intraoperatively, BH-ONCAB resulted in significantly less
intraaortic balloon pump use, shorter cardiopulmonary bypass time, and
less blood loss. The number of anastomoses and vessels grafted were not
significantly different between BH-ONCAB and C-ONCAB. Conclusions BH-ONCAB
is a safe and comparable alternative to C-ONCAB in terms of early
mortality and late survival. Furthermore, BH-ONCAB may confer a particular
advantage in preventing perioperative myocardial infarction and reducing
overall blood loss. Future work should focus on larger matched studies and
multicenter randomized controlled trials that risk-stratify patients
according to preoperative ventricular function and renal insufficiency to
allow us to optimize our surgical revascularization strategy in these
high-risk patients.<br/>Copyright &#xa9; 2015 The Society of Thoracic
Surgeons

<36>
Accession Number
619243123
Author
Carvalho A.C.; Sebold F.J.G.; Calegari P.M.G.; Oliveira B.H.D.;
Schuelter-Trevisol F.
Institution
(Carvalho) Universidade do Sul de Santa Catarina (Unisul), Curso de
Medicina, Campus Tubarao, Tubarao, SC, Brazil
(Sebold, Calegari, Oliveira) Hospital Nossa Senhora da Conceicao (HNSC),
Anestesiologia, Tubarao, SC, Brazil
(Schuelter-Trevisol) Universidade do Sul de Santa Catarina (Unisul),
Programa de Pos-Graduacao em Ciencias da Saude, Tubarao, SC, Brazil
(Schuelter-Trevisol) Hospital Nossa Senhora da Conceicao (HNSC), Centro de
Pesquisas Clinicas, Tubarao, SC, Brazil
Title
Comparison of postoperative analgesia with methadone versus morphine in
cardiac surgery.
Source
Brazilian Journal of Anesthesiology. 68 (2) (pp 122-127), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Editora Ltda
Abstract
Background and objectives: Pain is an aggravating factor of postoperative
morbidity and mortality. The aim of this study was to compare the effects
of methadone versus morphine using the numerical rating scale of pain and
postoperative on-demand analgesia in patients undergoing myocardial
revascularization. Method: A randomized, double-blind, parallel clinical
trial was performed with patients undergoing coronary artery bypass
grafting. The subjects were randomly divided into two groups: Morphine
Group (MoG) and Methadone Group (MeG). At the end of cardiac surgery, 0.1
mg.kg^-1 adjusted body weight of methadone or morphine was
administered intravenously. Patients were referred to the ICU, where the
following was assessed: extubation time, time to first analgesic request,
number of analgesic and antiemetic drug doses within 36 hours, numerical
pain scale at 12, 24, and 36 hours postoperatively, and occurrence of
adverse effects. Results: Each group comprised 50 patients. Methadone
showed 22% higher efficacy than morphine as it yielded a
number-needed-to-treat (NNT) score of 6 and number-needed-to-harm (NNH)
score of 16. The MeG showed a mean score of 1.9 +/- 2.2 according to the
numerical pain scale at 24 hours after surgery, whereas as the MoG showed
a mean score of 2.9 +/- 2.6 (p = 0.029). The MeG required less morphine
(29%) than the MoG (43%) (p = 0.002). However, the time to first analgesic
request in the postoperative period was 145.9 +/- 178.5 minutes in the
MeG, and 269.4 +/- 252.9 in the MoG (p = 0.005). Conclusions: Methadone
was effective for analgesia in patients undergoing coronary artery bypass
grafting without extracorporeal circulation.<br/>Copyright &#xa9; 2017
Sociedade Brasileira de Anestesiologia

<37>
Accession Number
620707401
Author
Lee S.-Y.; Hong M.-K.; Palmerini T.; Kim H.-S.; Valgimigli M.; Feres F.;
Colombo A.; Gilard M.; Shin D.-H.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Stone G.W.
Institution
(Lee) Sanbon Hospital, Wonkwang University College of Medicine, Gunpo,
South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seoul, South Korea
(Hong, Jang) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Kim) Department of Internal Medicine, Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Valgimigli) Department of Cardiology, Bern University Hospital,
University of Bern, Switzerland
(Feres) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Gilard) Department of Cardiology, CHU de la Cavale Blanche, Brest, France
(Stone) Columbia University Medical Center/New York-Presbyterian Hospital
and the Cardiovascular Research Foundation, New York, New York, United
States
Title
Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting
Stent Implantation in Elderly Patients: A Meta-Analysis of Individual
Participant Data From 6 Randomized Trials.
Source
JACC: Cardiovascular Interventions. 11 (5) (pp 435-443), 2018. Date of
Publication: 12 Mar 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the optimal duration of dual
antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent
(DES) in elderly patients. Background: Qualified studies to evaluate the
optimal duration of DAPT in elderly patients have been very limited.
Methods: Using 6 randomized trials that compared short-term (<=6 months)
and long-term (12 months) DAPT, individual participant data meta-analysis
was performed in elderly patients (>=65 years of age). The primary study
outcome was the 12-month risk of a composite of myocardial infarction,
definite or probable stent thrombosis, or stroke. The major secondary
outcome was the 12-month risk of major bleeding. Results: The primary
outcome risk did not significantly differ between patients receiving
short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence
interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study
participants. In subgroup analysis, a significant interaction between age
and DAPT duration was observed for primary outcome risk (p for interaction
= 0.0384). In the subset of younger patients (<65 years of age, n =
6,152), short-term DAPT was associated with higher risk of primary outcome
(HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n =
5,319), however, the risk of primary outcome did not significantly differ
between patients receiving short-term and long-term DAPT (HR: 0.84; 95%
CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a
significant reduction in major bleeding compared with long-term DAPT (HR:
0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and
particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p =
0.0196). Conclusions: Short-term DAPT after new-generation DES
implantation may be more beneficial in elderly patients than in younger
patients.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<38>
Accession Number
615488249
Author
Qu H.; Guo M.; Zhang Y.; Shi D.-Z.
Institution
(Qu, Guo, Zhang, Shi) China Heart Institute of Chinese Medicine, China
Academy of Chinese Medical Sciences, Beijing, China
(Qu) Graduate School of Beijing University of Traditional Chinese
Medicine, Beijing, China
(Qu, Guo, Zhang, Shi) Xiyuan Hospital, China Academy of Traditional
Chinese, Beijing, China
(Guo) Graduate School of China Academy of Chinese Medical Sciences,
Beijing, China
Title
Obstructive sleep apnea increases the risk of cardiac events after
percutaneous coronary intervention: a meta-analysis of prospective cohort
studies.
Source
Sleep and Breathing. 22 (1) (pp 33-40), 2018. Date of Publication: 01 Mar
2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Recent studies have shown an association between obstructive
sleep apnea (OSA) and coronary artery disease; however, the association
between OSA and cardiac outcomes in patients after percutaneous coronary
intervention (PCI) remains undetermined. Methods: PubMed, EMBASE, and
CENTRAL were searched from inception to July 2016 for cohort studies that
followed up with patients after PCI, and evaluated their overnight sleep
patterns within 1 month for major adverse cardiac events (MACEs) as
primary outcomes including cardiac death, non-fatal myocardial infarction
(MI), and coronary revascularization and secondary outcomes including
re-admission for heart failure and stroke. Outcomes data were pooled using
fixed-effect meta-analysis, and heterogeneity was assessed with the
I² statistics. The methodological quality of the studies was
assessed using the Newcastle-Ottawa Scale checklist, and publication bias
was evaluated by a visual investigation of funnel plots. Results: We
identified seven pertinent studies including 2465 patients from 178
related articles. OSA was associated with MACEs (odds ratio [OR], 1.52,
95% confidence interval [CI], 1.20-1.93, I² = 29%), which
included cardiac death (OR 2.05, 95% CI, 1.15-3.65, I² = 0%),
non-fatal MI (OR 1.59, 95% CI, 1.14-2.23, I² = 15%), and
coronary revascularization (OR 1.69, 95% CI, 1.28-2.23, I² =
0%). However, OSA was not associated with re-admission for heart failure
(OR 1.71, 95% CI, 0.99-2.96, I² = 0%) and/or stroke (OR 1.68,
95% CI, 0.91-3.11, I² = 0%) according to the pooled results.
Conclusions: In patients after PCI, OSA appears to increase the risk of
cardiac death, non-fatal MI, and coronary revascularization.<br/>Copyright
&#xa9; 2017, Springer-Verlag Berlin Heidelberg.

<39>
Accession Number
615000456
Author
Pierce B.; Bole I.; Patel V.; Brown D.L.
Institution
(Pierce, Bole, Patel) Hospitalist Division, Washington University School
of Medicine, St. Louis, MO, United States
(Brown) Cardiovascular Division, Washington University School of Medicine,
St. Louis, MO, United States
Title
Clinical outcomes of remote ischemic preconditioning prior to cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004666. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Multiple randomized controlled trials of remote ischemic
preconditioning (RIPC) prior to cardiac surgery have failed to demonstrate
clinical benefit. The aim of this updated meta-analysis was to evaluate
the effect of RIPC on outcomes following cardiac surgery. Methods and
Results-Searches of PubMed, Cochrane, EMBASE, and Web of Science databases
were performed for 1970 to December 13, 2015. Randomized controlled trials
comparing RIPC with a sham procedure prior to cardiac surgery performed
with cardiopulmonary bypass were assessed. All-cause mortality, acute
kidney injury (AKI), and myocardial infarction were the primary outcomes
of interest. We identified 21 trials that randomized 5262 patients to RIPC
or a sham procedure prior to undergoing cardiac surgery. The majority of
patients were men (72.6%) and the mean or median age ranged from 42.3 to
76.3 years. Of the 9 trials that evaluated mortality, 188 deaths occurred
out of a total of 4210 randomized patients, with 96 deaths occurring in
2098 patients (4.6%) randomized to RIPC and 92 deaths occurring in 2112
patients (4.4%) randomized to a sham control procedure, demonstrating no
significant reduction in all-cause mortality (risk ratio [RR], 0.987; 95%
CI, 0.653-1.492, P=0.95). Twelve studies evaluated AKI in 4209 randomized
patients. In these studies, AKI was observed in 516 of 2091 patients
(24.7%) undergoing RIPC and in 577 of 2118 patients (27.2%) randomized to
a sham procedure. RIPC did not result in a significant reduction in AKI
(RR, 0.839; 95% CI, 0.703-1.001 [P=0.052]). In 6 studies consisting of
3799 randomized participants, myocardial infarction occurred in 237 of
1891 patients (12.5%) randomized to RIPC and in 282 of 1908 patients
(14.8%) randomized to a sham procedure, resulting in no significant
reduction in postoperative myocardial infarction (RR, 0.809; 95% CI,
0.615-1.064 [P=0.13]). A subgroup analysis was performed a priori based on
previous studies suggesting that propofol may mitigate the protective
benefits of RIPC. Three studies randomized patients undergoing cardiac
surgery to RIPC or sham procedure in the absence of propofol anesthesia.
Most of these patients were men (60.3%) and the mean or median age ranged
from 57.0 to 70.6 years. In this propofol-free subgroup of 434 randomized
patients, 71 of 217 patients (32.7%) who underwent RIPC developed AKI
compared with 103 of 217 patients (47.5%) treated with a sham procedure.
In this cohort, RIPC resulted in a significant reduction in AKI (RR,
0.700; 95% CI, 0.527-0.930 [P=0.014]). In studies of patients who received
propofol anesthesia, 445 of 1874 (23.7%) patients randomized to RIPC
developed AKI compared with 474 of 1901 (24.9%) who underwent a sham
procedure. The RR for AKI was 0.928 (95% CI, 0.781-1.102; P=0.39) for RIPC
versus sham. There was no significant interaction between the two
subgroups (P=0.098). Conclusions-RIPC does not reduce morbidity or
mortality in patients undergoing cardiac surgery with cardiopulmonary
bypass. In the subgroup of studies in which propofol was not used, a
reduction in AKI was seen, suggesting that propofol may interact with the
protective effects of RIPC. Future studies should evaluate RIPC in the
absence of propofol anesthesia.<br/>Copyright &#xa9; 2017 The Authors.

<40>
Accession Number
621105463
Author
Guo Z.; Yuan X.; Ju W.; Wang D.; He X.
Institution
(Guo, Yuan, Ju, Wang, He) First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
Title
Changes in patient/graft survival and causes of death in liver, kidney,
and heart transplantation over time, according to age, sex, and geographic
region: A meta-analysis.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 832), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background The efficacy of solid organ transplantation (SOT) has been
improved over time. We aimed to assess the patient/graft survivals and
causes of death in SOT recipients in relation to age, sex, geographic
region, and time period. Methods A search of PubMed and Embase with
predefined inclusion criteria identified eligible prospective studies.
Trends in patient/graft survivals and causes of death over time and the
effect of age, sex, and geographic region on these trends were assessed
with weighted linear regression analysis. Findings 66 studies with 12589
liver transplant recipients, 35 studies with 10296 renal transplant
recipients, and 39 studies with 14831 cardiac transplant recipients were
included. Patient/graft survivals in all three SOTs had increasing trends
per year. The annual increase of long-term patient survivals were with
yearly increases by 0.5%, 1.2%, and 2.3%, respectively, at 1, 3, and 5
years after liver transplantation; by 0.5% and 0.6% at 3 and 5 years after
kidney transplantation; and by 0.2%, 0.8%, and 0.8% at 1, 3, and 5 years
after heart transplantation. The 5-year kidney transplant recipient
survival rates (94%, 89-98) were higher in Asia than Europe (82%, 75-88).
No regional survival disparities were found in both liver and heart
transplantation. While the incidences of infection/sepsis and
cardiovascular factors as causes of death have decreased yearly, the
incidence of malignancy as a cause of death has been on the rise.
Furthermore, the role of graft rejection as a cause of death has been
decreasing overtime in liver and heart transplantation. Interpretation
Post-transplant patient/graft survivals have shown improving trends in the
past three decades, and these trends are not affected by patient age, sex,
or geographic region. (Figure Presented).

<41>
Accession Number
621105280
Author
Sun H.; Liu W.; Su Y.; Ho C.; Hu R.; Chou N.; Wang S.; Hsu H.; Hung C.;
Chang S.
Institution
(Sun, Liu, Su, Hung, Chang) Department of Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan (Republic of China)
(Sun) Institute of Epidemiology and Preventive Medicine, National Taiwan
University, Taipei, Taiwan (Republic of China)
(Ho, Hu, Chou, Wang, Hsu) Department of Surgery, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
Title
Immunogenicity and safety of 13-valent pneumococcal conjugate vaccine
(PCV13) in solid organ transplant (SOT) candidates and recipients.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 770-771), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose:The United States Advisory Committee on Immunization Practices
recommends that PCV13 be given in addition to 23-valent pneumococcal
polysaccharide vaccine to immunocompromised adults, such as chronic renal
failure and SOT. However, data regarding this is sparse. The present study
aimed to assess the immunogenicity and safety of PCV13 in SOT candidates
and recipients. Methods: Consecutive patients receiving pre-SOT evaluation
and SOT receipts with stable clinical conditions 6 months post transplant
were enrolled. Symptoms developed within 7 days after one dose PCV13 and
anti-capsular antibody responses against 4 serotypes (6B, 14, 19F and 23F)
at baseline and 1 month following vaccination were recorded. Significant
antibody responses were defined as 2-fold or greater increase of antibody
levels at 1 month compared with the baseline Results:From 2013/10/1 to
2013/12/30, a total of 21 study patients were enrolled. PCV13 was given to
19 (90.5%) SOT candidates and 2 (9.5%) heart recipients; the two heart
recipients received PCV13 60 months and 1320 months after transplantation.
Two SOT candidates received liver transplantation after PCV13
administration; the durations from PCV13 vaccination to transplantation
were 44 and 23 days, respectively. Only 2 (9.5%) study patients felt pain
at PCV13 injection site, and 1 (4.8%) had fever after PCV13
administration; all symptoms subsided spontaneously. Of 19 study patients
receiving PCV13 before transplantation, 13 (68.4%) were liver transplant
candidates, 5 (26.3%) were heart transplant candidates, and 1 (5.3%) was
lung transplant candidate. The geometric mean titer of baseline antibody
titer for 6B, 14, 19F, and 23F of the 21 study patients were 2719.04
ng/mL, 15259.20 ng/mL, 3828.42 ng/mL, and 1897.98 ng/mL, respectively.
Thirteen (61.9%) patients had 1-month follow-up. At 1 month, 58.3%, 58.3%,
70.0%, and 75.0% of the study patients had significant antibody responses
against 6B, 14, 19F and 23F, respectively. None of them developed
pneumonia at the time of the abstract drafting. Conclusion: The use of
PCV13 appeared safe and immunogenic in SOT candidates and recipients
during a short-term follow-up.

<42>
Accession Number
621104484
Author
Zhang X.; Liu Y.; Jiang J.; Zheng X.; Siu K.; Johnston N.; Chen R.; Quan
D.; Min W.
Institution
(Zhang, Zheng, Siu, Johnston, Chen, Quan, Min) Surgery, Pathology and
Oncology, Western University, London, ON, Canada
(Zhang, Jiang, Quan, Min) Multi-Organ Transplant Program, London Health
Sciences Centre, London, ON, Canada
(Liu, Min) Jiangxi Academy of Medical Sciences, Institute of
Immunotherapy, Nanchang University, Nanchang, China
Title
Prolong allograft survival by silencing mTOR gene using mannose liposome
in heart transplantation.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 679), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: The mammalian target of rapamycin (mTOR) is one of the most
critical signaling kinases that controls dendritic cells (DCs) and T cells
function. RNA interference based therapy is a novel strategy for
prolonging allograft survival. DCs abundantly express mannose receptor. We
hypothesized that blocking the mTOR pathway using mannose liposome with
small interference RNA (siRNA) target mTOR gene, can specifically deliver
siRNA to DCs block mTOR pathway and may prolong allogeneic heart graft
survival. Method: Mannose liposome with mTOR siRNA (Man-mTOR) was
prepared. Recipients (BALB/c mice) were treated with Man-mTOR, 3 and 7
days prior to heart transplantation and 7, 14, 21 days after
transplantation. Control groups were injected with mannose liposome with
scramble siRNA (Man-Gl2) and liposome without mannose (without Man-mTOR).
After siRNA treatment, a fully MHC-mismatched (C57/BL6 to BALB/c) heart
transplantation was performed. Result: Mannose liposome can specific
deliver mTOR siRNA to the spleen APCs, the fluorescence of Cy3-labeled
siRNA and gene silencing efficiency can be confirmed by western blot.
Man-mTOR treatment significantly prolonged allogeneic heart graft survival
(mean survival time MST=56.2 days). In contrast, MST of allogenic hearts
in recipients treated with Man-Gl2 and without Man-mTOR was 6.3 days and
17.5 days respectively. Flow cytometric analysis showed an upregulation of
FoxP3 expression in spleen lymphocytes and a concurrent downregulation of
CD40 and CD86 expression in splenic DCs of Man-mTOR treated mice. An MLR,
using splenic DCs isolated from Man-mTOR treated recipients, showed lower
T cell proliferation capacity and lower level of INF-gamma, IL1-beta and
higher level of IL-10 and IL-6, compared to control groups. Finally,
tissue histopathology demonstrated an overall reduction in lymphocyte
interstitium infiltration, vascular obstruction, and edema in mice treated
with Man-mTOR. Conclusion: This study demonstrated that use mannose
liposome specifically deliver siRNA to the spleen DCs silencing of mTOR
gene can prolong allograft survival, and may provide a novel and more
effective RNAi based anti-rejection regimen in heart transplantation.

<43>
Accession Number
621104356
Author
Gombos P.; Suesal C.; Opelz G.; Scherer S.; Tran H.; Doesch A.
Institution
(Gombos, Suesal, Opelz, Scherer, Tran) Transplantation Immunology,
University of Heidelberg, Heidelberg, Germany
(Doesch) Cardiology, University of Heidelberg, Heidelberg, Germany
Title
Association of pre-and post-transplant HLA antibodies in heart
transplantation with acute rejection and death.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 424), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
We investigated whether pre- and post-transplant HLA antibodies detected
by the Single Antigen Bead (SAB) assay are associated with acute rejection
episodes (ARE) and/or death in heart transplantation (Tx). Sera of 60
heart transplant recipients on whom we had a serum before and one year
after Tx were tested in ELISA for the presence of HLA antibodies and in
parallel in SAB for antibody reactivity against donor HLA class I and II
antigen mismatches. While 97% of the patients were negative in ELISA
before and after Tx, the SAB assay showed HLA antibodies before Tx in 85%
and at one year in 78% of the patients. The rate of ARE (ISHLT >=2R)
during the first two years in 36 patients who had pre-Tx HLA antibodies
against class II was 53%, significantly higher than the 21% rate in 24
patients who had no pre-Tx class II antibodies (p=0.013). No association
was observed with pre-Tx class I antibodies. Similarly, in 34 patients
positive for class II HLA antibodies at year 1, the rate of ARE during the
second year was 15%, as compared to 0% in 26 patients who had no class II
HLA antibodies (p=0.041). 50% of patients whose pre-Tx class I
donor-specific antibodies (DSA) persisted at year one experienced ARE
between the second and fifth year, as compared to 11% who were negative
for persistent class I DSA (p=0.026) and 0% who had lost their pre-Tx
class I DSA at one year (p=0.029). In 4 patients positive for persistent
class II DSA and in 6 patients with loss of class II DSA during year 1,
the ARE rate between the second and fifth year was 0%. Beyond the first
year after Tx, 13% of the patients died. The rate of death in 12 patients
who had class II DSA one year post-Tx was 33%, as compared to 8% in 48
patients who had no class II DSA (p=0.023). The rate of death in 4
patients who had post-Tx class I DSA was 0%. Only 11 patients developed De
novo (dn) DSA during the first post-Tx year. 37% (n=3) of the 8 patients
who developed class II dnDSA died after the first year post-Tx, whereas
the death rate was only 10% in 52 patients without class II dnDSA
(p=0.031). None of the patients with class I dnDSA died during the
observation period. Our preliminary data indicate that even in
ELISA-negative heart transplant patients, the SAB assay should be utilized
for identifying patients who are at increased risk of ARE or death.

<44>
Accession Number
621104309
Author
Du C.; Guan Q.; Gao S.; Chafeeva I.; Brooks D.; Nguan C.; Kizhakkedathu J.
Institution
(Du, Guan, Nguan) Department of Urologic Sciences, University of British
Columbia, Vancouver, BC, Canada
(Gao) Department of Thoracic and Cardiovascular Surgery, Huazhong
University of Science and Technology, Wuhan, China
(Chafeeva, Brooks, Kizhakkedathu) Centre for Blood Research, University of
British Columbia Vancouve, Vancouver, BC, Canada
Title
A novel hyperbranched polyglycerol-based solution for donor organ
preservation: A comparison with university of wisconsin solution in
hypothermic preservation of mouse donor hearts.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 369), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Donor organ injury during hypothermic preservation has
negatively impacts on transplant function recovery and survival.
Hyperbranched polyglycerol (HPG) is a novel, biocompatible polymer. This
study was to compare HPG-based solution with University of Wisconsin (UW)
solution in the hypothermic preservation of donor hearts. Methods. Human
endothelial cell cultures were used as an in vitro model. Heart
transplantation in mice was used as an in vivo model. Cell death was
indicated by lactate dehydrogenase (LDH) release. Results: Preservation of
mouse hearts with HPG solution at 4oC reduced tissue damage compared to
those with UW solution. In isotransplantation, transplanted hearts
pre-preserved in HPG solution had a better functional recovery than those
in UW solution, which was associated with lower degrees of tissue injury
and neutrophil infiltration. In allotransplantation, HPG
solution-preserved donor hearts survived longer than those in UW solution,
indicated by the fact of that nine out of ten transplants from UW solution
group failed within 24 h, while only four of nine transplants in HPG group
were rejected, and three of them survived with function for 20 days in
cyclosporine-treated recipients (P = 0.0175). In cultured cells, more
cells survived during preservation with cold HPG solution than those with
UW solution, which was correlated with the maintenance of cell membrane
fluidity and intracellular adenosine triphosphate. Conclusion:
Preservation with HPG solution significantly enhances the prevention of
cold ischemic injury in donor organs, suggesting that HPG solution is a
promising alternative to UW solution for hypothermic storage of donor
organs for transplantation.

<45>
Accession Number
621104076
Author
Esmailian F.; Kobashigawa J.; Thottam M.; Yu Z.; Liou F.; Patel J.;
Kittleson M.; Czer L.; Trento A.
Institution
(Esmailian, Kobashigawa, Thottam, Yu, Liou, Patel, Kittleson, Czer,
Trento) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
Title
Heart in the box with good 1-year outcome post heart transplantation.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 58-59), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: The use of the heart in the box, otherwise known as the organ
care system (OCS), has been found to have comparable 30 day mortality
compared to standard of care (SOC) therapy for the donor heart. It is not
known whether OCS has any effects on 1-year outcome in terms of rejection,
antibody development and survival. Therefore, from a single center
experience, we assessed 1-year outcome on patients (pts) randomized to the
OCS versus SOC as intent to treat. Methods: Between 2011 and 2013, we
randomized 38 heart transplant (HTx) pts to either OCS or SOC. Pts were
assessed for total ischemic time (TIT), cold ischemic time (CIT),
development of de novo antibodies (abs) and donor specific antbodies (DSA)
within 1 year post-HTx, 1-year survival, 1-year freedom from cardiac
allograft vasculopathy (CAV), 1-year freedom from non-fatal major cardiac
events (NF-MACE: Myocardial Infarction, Heart Failure, angioplasty,
pacemaker/ICD, stroke), 1-year freedom from any-treated rejection, biopsy
(bx) proven cellular rejection (>2R), bx proven antibody-mediated
rejection (AMR1, 2, or 3). Results: OCS group had significant longer TIT
but significantly shorter CIT compared to SOC. There was no significant
difference between the OCS and SOC in development of de novo abs or DSA
within 1 year post-HTx, 1-year survival, freedom from CAV, freedom from
NF-MACE, freedom from any treated rejection, and freedom from bx proven
cellular or AMR. OCS group had numerically better freedom from bx proven
AMR which might be due to numerically less sensitized patients pre-HTx
(see table). Two patients who were randomized to OCS did not undergo OCS
treatment due to administrative obstacles. Conclusion: OCS appears to be a
valid tool to extend donor ischemic time without compromising first year
outcome. (Table Presented).

<46>
Accession Number
621103955
Author
Chen J.; Young J.; Vu V.; Ying D.; Wang Q.; Chong A.
Institution
(Chen, Young, Vu, Ying, Wang, Chong) University of Chicago, Chicago,
United States
Title
Efficacy of CTLA4-IG in preventing acute rejection of fully allogeneic
heart allografts in sensitized recipients.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 325), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Belatacept, a high-affinity variant of CTLA4-Ig, is a recently approved
immunosuppressive agent for the prevention of acute rejection. It
functions as a potent antagonist of the CD28^-B7 interactions,
thereby inhibiting T cell co-stimulation and activation. Experimental data
involving the transient use of CTLA4-Ig to induce allograft tolerance have
shaped the current paradigm that CTLA-4Ig is ineffective at inhibiting
memory T cell responses, and by extension T-dependent alloantibody
responses. This resistance is explained by the acquisition of additional
activationinduced costimulatory molecules by memory T cells. We noted that
the efficacy of CTLA4-Ig as a continuously administered drug for
controlling rejection in sensitized recipients has not been investigated.
Here we report on the efficacy of CTLA4-Ig in preventing acute rejection
in sensitized C57BL/6 recipients that had received BALB/c spleen cell
transfusion 3-6 months previously. We set up four experimental groups.
Group 1 (N=5): sensitized mice with HTX and CTLA4-Ig treated (Day -2, Day
0, Day2, then weekly (1 mg/dose) Group 2 (N=3): sensitized mice with HTX
and no CTLA4-Ig, Group 3: (N=10) naive mice with HTX and CTLA4-Ig treated,
Group 4 (N=10): naive mice with HTX and no CTLA4-Ig. In the untreated
Groups 2 & 4, allografts were rejected within 7 days post-transplantation,
whereas in Group 3 of naive mice receiving CTLA4-Ig, all the grafts
survived long-term (>90 days). In Group 1 of sensitized recipients
receiving CTLA4-Ig, the allografts survived for 42, 42, 49, >90, >90 days.
The pre-transplant donor-specific antibody (DSA) titers in the recipients
that went on to reject their graft was significantly higher compared to
those that accepted their grafts. Furthermore, DSA titers increased
post-transplantation in the recipients that went on to reject their
allografts, whereas DSA titers decreased in those that accepted their
grafts. In conclusion, these observations illustrate the efficacy of
CTLA-4Ig treatment at controlling rejection in sensitized recipients, and
underscore the barrier pre-transplantation DSA poses to long-term graft
acceptance. This experimental model also provides a unique opportunity for
testing if DSA promotes antibody-mediated rejection or alloreactive memory
T cell priming and T cell-mediated rejection in CTLA4-Ig treated
recipients, and for identifying therapies that promote long-term graft
survival in sensitized recipients.

<47>
Accession Number
621103938
Author
Coleman B.; Phililps A.; Mirocha J.; Patel J.; Kobashgawa J.
Institution
(Coleman) Heart Institute, Nursing Research and Development, Cedars Sinai
Medical Center, Los Angeles, CA, United States
(Phililps) Department of Surgery, Division of Cardiothoracic Surgery,
Cedars Sinai Medical Center, Los Angeles, CA, United States
(Mirocha) Biostatistics Core, Research Institute, Cedars Sinai Medical
Center, Los Angeles, CA, United States
(Patel, Kobashgawa) Heart Institute, Cedars Sinai Medical Center, Los
Angeles, CA, United States
Title
Induction therapy in pediatric heart transplantation: Is there a benefit?.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 57), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Outcomes in pediatric heart transplant (pedHTx) when comparing
African American (AA) to Caucasian American (CA) recipients are disparate.
Genetic differences in metabolism of immunosuppression in AA have been
attributed to these differences. Controversy persists in the use of
induction therapy in pedHTx. Aim: We explored whether the use of induction
therapy improved outcomes in AA and CA pedHTx patients (pts), using the
UNOS database. Methods: 1,243 consecutive pedHTx pts (age 11 to 20)(393 AA
and 850 CA) from the UNOS database between 5/1999-3/2011 were included.
Data were analyzed comparing 4 groups (grps); AA with (n=215) or without
(n=178) induction to CA with (n=419) or without (n=431) induction. CA with
induction was the reference grp. Ten-year survival was estimated by
Kaplan-Meier method. Survival was compared across grps by Log-Rank. Cox
proportional hazards models were used to assess factors related to 10-year
survival, hazard ratios and their 95% conference intervals. Results:
Univariable analysis demonstrated AA pedHTx had worse survival at 10 years
compared to CA (Log- Rank P = <0.0001). AA pedHTx with (P = <0.0001, HR
2.09) or without induction (P = 0.0005, HR = 1.71) had worse survival
compared to CA with induction; Survival among CA without induction (P =
0.62, HR = 0.934) was similar to CA with induction. No specific induction
agent conferred a survival benefit in either grp. Multivariable Cox models
were adjusted for serum Cr>= 1.5mg/dL, ischemic time >4hours, gender,
donor sex, donor age, and recipient diagnosis (congenital and other
compared with dilated cardiomyopathy. (reference group). Contributors to
worse survival were serum Cr>= 1.5mg/dl (P = 0.006, HR 1.68), Congenital
diagnosis (P = 0.028, HR = 1.36) and AA with (P =< 0.0001, HR = 2.23) or
without induction (P < 0.0001, HR = 1.89).Conclusion: AA pedHTx have worse
survival than CA pedHtx and serum creatinine level >1.5d/L effects long
term survival. Induction therapy conferred no benefit in either group but
weak evidence of harm in AA. Randomized trials to assess efficacy of
induction in pediatric HTx are indicated.

<48>
Accession Number
621103810
Author
Jamero G.; Kittleson M.; Patel J.; Liou F.; Yu Z.; Dilibergo D.; Perry N.;
Chang D.; Czer L.; Hage A.; Esmailian F.; Kobashigawa J.
Institution
(Jamero, Kittleson, Patel, Liou, Yu, Dilibergo, Perry, Chang, Czer, Hage,
Esmailian, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
Title
Are first year mycophenolate trough levels associated with the subsequent
outcomes after heart transplant?.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 432), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac allograft vasculopathy (CAV) is one of the major
factors limiting long-term survival after heart transplantation (HTx). In
the multi-center mycophenolate trial published in 1998 (Transplantation.
1998 Aug27;66(4):507- 15), mycophenolate was found to decrease first year
intimal thickening compared to azathioprine, both in combination with CSA
and corticosteroids. Thus, it appears that mycophenolate has
anti-proliferative properties to slow the development of CAV. It is not
known whether the trough level ofmycophenolate, known as mycophenolic acid
(MPA), is critical in affecting the progression of CAV. Therefore, we
performed a study assessing different levels of first year trough MPA
levels and the subsequent development of CAV at 3-years. Methods: Between
2002 and 2011 we assessed 237 HTx patients. First year MPA levels were
drawn at 1, 3, 6, and 12 months after transplant and were averaged. These
values were then divided into 4 groups, which include MPA < 1 ug/ml, MPA
1-1.9 ug/ml, MPA 2-2.9 ug/ml, and MPA > 3 ug/ml. All patients were on
tacrolimus and corticosteroids at the time of transplant. There was no
difference in the amount of patients receiving ATG induction therapy
between the three groups. Results: Among the 4 levels of MPA trough
results there was no significant difference in 3-year freedom from CAV or
1-year freedom from any rejection, acute cellular rejection or
antibody-mediated rejection (see table). Conclusion: First year MPA trough
levels do not appear to correlate to 3 year outcome after heart
transplant, but longer follow-up time may be needed. (Table Presented).

<49>
Accession Number
621103772
Author
Torrealba J.; Roenneburg D.; Djamali A.
Institution
(Torrealba) Pathology, University of Texas Southwestern, Dallas, TX,
United States
(Roenneburg) Surgery, University of Wisconsin, Madison, WI, United States
(Djamali) Medicine, University of Wisconsin, Madison, WI, United States
Title
Chronic allograft vasculopathy: An entity related to the downregulation of
selenium binding protein 1.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 271), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Selenium binding protein-1 (SBP-1) has been implicated in
intracellular protein trafficking and secretion. In a rhesus monkey kidney
transplant model we previously demonstrated that SBP-1 is significantly
downregulated in the smooth muscle cells (SMC) of arteries with chronic
allograft vasculopathy (CAV). Objective: The purpose of this study were
multiple: 1- to investigate the expression of SBP-1 in human and murine
allografts with chronic vasculopathy; 2- to explore factors that influence
the expression of SBP-1 in vitro; and 3-to asses the influence of selenium
supplementation in SBP-1 levels in mice. Methods: 21 biopsies from human
kidney allografts and mouse heart transplant -B10.A/B10.BR model- were
immunolabeled with antibodies that recognize SBP-1 in paraffin tissue.
CRL-1999 SMC cell cultures were incubated and assess for the expression of
SBP-1 in the presence of PDGF, INF-g, TNF-a and TGF-b. Selenium (Se)
supplementation (sodium selenite) was given for 3 months to nude mice that
were evaluated for the effect of Se in the expression of SBP-1 in kidneys.
Results: Using a semiquantitative scale (0-3 for SBP-1 signal) the average
staining for SBP-1 in control biopsies with normal vessels was 2.89,
whereas for biopsies with any degree of CAV was 1.33 (p<0.001). SBP-1 was
significantly decreased in each study group when compared to controls:
humans p<0.02 and mice p<0.03. A significant negative correlation between
the degree of CAV and the SBP-1 staining was found (r= -0.97). After 48
hours of incubation at 37C of the SMC cell line, only TGF-b induced
downregulation of SBP-1. Whereas the supplementation of Se in the diet
increased the levels of anti-oxidant selenoproteins GPX-1, 2 and 3; it had
no effect on the levels of SBP-1 on Western blots of kidneys from nude
mice. Conclusions: SBP-1 is significantly downregulated in the vascular
smooth muscle of vessels with CAV, an effect that seems to be induced by
TGFb in vitro. These findings implicate SBP-1 in the pathogenesis of CAV.

<50>
Accession Number
621103532
Author
Moriguchi J.; Arabia F.; Kittleson M.; Patel J.; Yu Z.; Liou F.; Ernst W.;
Huie N.; Hage A.; Chang D.; Czer L.; Kobashigawa J.
Institution
(Moriguchi, Arabia, Kittleson, Patel, Yu, Liou, Ernst, Huie, Hage, Chang,
Czer, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA, United
States
Title
Heart transplantation vs. ventricular assist device as destination therapy
in older patients: Are they comparable?.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 52), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: As the aging population begins to expand, older patients (> 65
years old) may require therapy with either heart transplant (HTx) or
ventricular assist devices as destination therapy (DTVAD). Older patients
from the ISHLT registry are known to have increased mortality after
transplant. Many of these older patients are given older donor hearts as
an "alternate list" patient, whereby post-transplant survival may be
impaired. Now, with the advent of DTVAD, it is not clear whether HTx in
the elderly has clear benefit over DTVAD. Methods: Between 2010 and 2012,
we assessed 48 HTx patients greater than the age of 65 years old and
compared them to 7 patients who underwent DTVAD in the same age group. One
year survival was compared between the older age HTx recipient group vs.
the older age DTVAD group. Complications and the number of
rehospitalizations were also assessed between the two groups. Results: DT
VAD patients had comparable 1 year survival to HTx patients (100% in DTVAD
vs. 93.6% in HTx group). One year freedom from rehospitalization was also
comparable. (57.1% in DTVAD vs. 41.7% in HTx group). 3 patients
(representing 8 episodes) in the DTVAD group developed complications
compared to 20 patients (representing 25 episodes) in the HTx group (see
table) within 1 year. Conclusion: Older HTx patients may not have
significant benefit over older patients who undergo DTVAD in our single
center experience. Various complications are present in both groups. A
randomized trial is warranted. (Table Presented).

<51>
Accession Number
621103280
Author
Javaheri A.; Zamani P.; Molina M.; Rodriguez A.; Chambers S.; Stutman P.;
Williams M.; Lukmanova D.; Picataggi A.; Woo J.; Lilly S.; Christie J.;
Goldberg L.; Billheimer J.; Rader D.
Institution
(Javaheri, Rodriguez, Lukmanova, Picataggi, Billheimer, Rader) Human
Genetics and Translational Research, University of Pennsylvania,
Philadelphia, PA, United States
(Javaheri, Zamani, Molina, Chambers, Stutman, Williams, Goldberg)
Medicine, Division of Cardiology, University of Pennsylvania,
Philadelphia, PA, United States
(Woo) Cardiothoracic Surgery, Stanford, Palo Alto, CA, United States
(Lilly) Medicine, Division of Cardiology, Ohio State University, Columbus,
OH, United States
(Christie) Medicine, Division of Pulmonary and Critical Care Medicine,
University of Pennsylvania, Philadelphia, PA, United States
Title
Inverse correlation of cholesterol efflux capacity of high density
lipoprotein with survival after cardiac transplantation.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 426-427), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Statin therapy, which inhibits intracellular cholesterol
synthesis, has improved survival after cardiac transplantation. We
hypothesized that pathways enhancing removal of cholesterol from cells may
impact survival. In cardiac transplant recipients, high density
lipoprotein (HDL) exhibits impaired ability to promote cholesterol efflux
from macrophages. We tested whether reduced cholesterol efflux associates
with mortality in cardiac transplant recipients. Methods and Results: We
used a case-control design to evaluate mortality risk associated with
cholesterol efflux capacity. From a cohort of patients enrolled from our
echocardiography and cardiac catheterization laboratories, we enrolled
cardiac transplant recipients who died between 2009-2013 (n=33). Controls
(n=59) were identified as cardiac transplant patients alive on October
1st, 2013. Baseline demographics, clinical characteristics, serum lipids
and apolipoproteins, and cholesterol efflux capacity were compared between
groups. Efflux capacity was measured by incubating apolipoprotein
B-depleted serum with macrophages in a validated ex vivo system.
Multivariable Cox proportional hazard ratios demonstrated that
post-transplant chronic kidney disease and smoking were associated with
increased mortality, while higher levels of cholesterol efflux capacity of
HDL (HR 0.64, 95% CI 0.42-0.96), but not HDL-C levels, had an inverse
relationship with mortality. This relationship was particularly notable
amongst those subjects with allograft vasculopathy. Importantly, efflux
capacity was also lower amongst patients with a history of rejection
compared to those with no history of rejection. Conclusion: Improved
cholesterol efflux is associated with long-term survival after cardiac
transplantation. This study suggests that cholesterol efflux capacity
improving therapies may provide benefit in cardiac transplant recipients.

<52>
Accession Number
621103228
Author
Carbone J.; Diez P.; Arraya M.; Palomo J.; Navarro J.; Jaramillo M.;
Sarmiento E.
Institution
(Carbone, Arraya, Navarro, Jaramillo, Sarmiento) Clinical Immunology,
Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Diez, Palomo) Cardiology, Hospital General Universitario Gregorio
Maranon, Madrid, Spain
Title
Efficacy and safety of intravenous immunoglobulin as prophylactic
treatment for severe infection in heart recipients with IgG
hypogammaglobulinemia.
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 426), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Severe infections are frequent in patients with post heart transplant IgG
hypogammaglobulinemia. The present clinical trial was set up to evaluate
the efficacy and safety of intravenous immunoglobulin (IVIG) in the
prophylaxis of infection in heart transplant recipients with
post-transplant IgG hypogammaglobulinemia. Nine adult heart recipients who
developed IgG hypogammaglobulinemia (defined as a serum IgG concentration
<500 mg/dL) were included in this phase-II, openlabel pilot study (Eudract
2009-011165-85, February 2011 to December 2013). Hypogammaglobulinemia was
detected during a screening that was done as part of the trial protocol at
days 7, 14, 30, 60 and 90 after transplantation. Patients without
exclusion criteria received intravenous immunoglobulin (IVIG) (Flebogamma
5%) 2 doses of 200 mg/kg (day 0 and day 14 of the trial) followed by up to
5 additional doses of 300 mg/kg (days 30, 60, 90, 120 and 150) if IgG was
below 750 mg/dL in samples obtained in previous visits. The primary
end-point was development of infections that required IV antimicrobial
therapy during the first 6 months after transplantation. Data were matched
with nine patients with IgG hypogammaglobulinemia that were not included
in the clinical trial during the same study period. Severe infection was
detected in 2 of 9 recipients with IVIG and in 8 of 9 recipients without
IVIG prophylaxis (2-sided Fisher's exact test, p = 0.015). Cytomegalovirus
infection that required antiviral treatment developed in 1 recipient with
IVIG vs in 6 non-IVIG recipients (p = 0.05). A trend for reduction in the
incidence of severe bacterial infections was observed (22.2% with vs 66.6%
without IVIG prophylaxis, p = 0.15). We found no significant difference
between the groups in the incidence of deadly infections 11.1% with vs
22.2% without IVIG, p = 0.53). The survival rate during the first 6 months
post-transplant did not differ between the groups. No severe IVIG-related
side effects occurred. Even if our analysis was limited to only 9 cases,
the data of this pilot study suggest that prophylactic use of IVIG
replacement therapy decreases the incidence of severe infections in heart
transplant recipients with IgG hypogammaglobulinemia. A larger randomized
study is needed to confirm these results.

<53>
Accession Number
621103163
Author
Sigurdardottir V.; Andreassen A.; Gustafsson F.; Eiskjaer H.; Radegran G.;
Gude E.; Larsson K.; Solbu D.; Andersson B.; Dellgren G.; Gullestad L.
Institution
(Sigurdardottir, Dellgren) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Andreassen, Gude, Gullestad) Department of Cardiology, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Skejby University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital and Lund University, Lund, Sweden
(Larsson) Heart Center University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Early calcineurin inhibitors elimination improves renal function in de
novo heart transplant recipients: The results of a randomized controlled
trial (schedule trial).
Source
American Journal of Transplantation. Conference: 2014 World Transplant
Congress. United States. 14 (Supplement 3) (pp 3), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Calcineurin inhibitors remain the mainstay of immunosuppression
following heart transplantation, but are associated with significant long
term complications. We conducted a randomized, open-label, parallel group
clinical trial to assess whether early introduction of everolimus followed
by withdrawal of cyclosporine would lead to superior renal function in de
novo heart transplant (HTx) recipients, compared to a standard
cyclosporine-based immunosuppression. Methods: 115 patients were randomly
assigned within 5 days postoperatively to everolimus and reduced dose
cyclosporine (CsA) followed by CsA withdrawal after 7-11 weeks (n=56) or
standard cyclosporine dosage (n=59). All received mycophenolate mofetil
and corticosteroids. The primary efficacy endpoint was renal function
assessed by measured glomerular filtration rate (mGFR) after 12 months.
Secondary objectives included progression of cardiac-allograft
vasculopathy (by intravascular ultrasound (IVUS)), left ventricular
function and rejections. Results: At 12 months, mGFR was significantly
higher in the everolimus group compared to those receiving standard
cyclosporine-based immunosuppression (80 mL/minvs.62 mL/min; p<0.0001;
Intention To Treat population). A significantly higher incidence of acute
cellular rejection was observed in the everolimus group, while left
ventricular function and NT-proBNP were similar between the two groups.
there were similar rates of bacterial infection but less cytomegalovirus
infection in everolimus treated patients (5.4% vs 30.5%; p<0.001). IVUS
data, not yet ready, will be presented. Conclusions: Early introduction of
everolimus followed by withdrawal of cyclosporine was associated with
significant and clinically relevant improvement in renal function in HTx
patients. DISCLOSURE: Solbu, D.: Employee, Novartis.

<54>
Accession Number
620999367
Author
Piciche M.; Dato G.A.; Lorusso R.; Musumeci F.
Institution
(Piciche) Cardiac Surgery Department, San Bortolo Hospital, Vicenza, Italy
(Dato) Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy
(Lorusso) Cardio-Thoracic Surgery Unit, Heart & Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
(Musumeci) Cardiac Surgery Department, San Camillo-Forlanini Hospital,
Rome, Italy
Title
A review of evolutionary and cyclical changes in the surgical approach to
aortic valve disease.
Source
Reviews on Recent Clinical Trials. 13 (1) (pp 45-51), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Introduction: Aortic valve surgery is no exception to the general rule
that history is a cycle in many fields. This manuscript aims to assist
readers in transitioning from past to present and on into the future
within the field of aortic valve surgery. Methods: The existing literature
has been examined, including old and modern articles published on pubmed,
old articles non visible on pubmed, old and recent books on the history of
medicine, looking for similarities and repetitions in techniques and
surgical approaches to the aortic valve in the past and the current times.
Results: Steps of evolution included a blind approach, plasty procedures
under direct visualization of the valve without the aid of cardiopulmonary
bypass, prosthetic valve replacements via sternotomies with
cardiopulmonary bypass, minimally-invasive access routes, trans-catheter
aortic valve implants (TAVI), suture-less prostheses, mini-thoracotomies
incorporating suture-less prostheses, and finally, totally-endoscopic
aortic valve replacements. Conclusion: After the advent of CPB and several
decades of open-heart surgery with full sternotomies, the
minimally-invasive approach has re-emerged. Supported by a commitment to
smaller incisions and shorter bypass times, the concept is now being
aggressively developed. The cycling of science, including the field of
aortic valve surgery, means that ingenious theories and concepts that have
fallen by the wayside can be brought back and explored again with current
tools and enhanced knowledge.<br/>Copyright &#xa9; 2018 Bentham Science
Publishers.

<55>
Accession Number
620990707
Author
Duncan D.; Sankar A.; Beattie W.S.; Wijeysundera D.N.
Institution
(Duncan, Sankar) University of Toronto, Department of Anesthesia, 123
Edward Street, 12th Floor, Toronto, ON M5G 1E2, Canada
(Beattie) Toronto General Hospital, University Health Network, Department
of Anaesthesia, EN 3-453 Toronto General Hospital, University Health
Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Wijeysundera) St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30
Bond Street, Toronto, ON M5B 1W8, Canada
Title
Alpha-2 adrenergic agonists for the prevention of cardiac complications
among adults undergoing surgery.
Source
Cochrane Database of Systematic Reviews. 2018 (3) (no pagination), 2018.
Article Number: CD004126. Date of Publication: 06 Mar 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The surgical stress response plays an important role on the
pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic
agonists attenuate this response and may help prevent postoperative
cardiac complications. Objectives: To determine the efficacy and safety of
alpha-2 adrenergic agonists for reducing mortality and cardiac
complications in adults undergoing cardiac surgery and non-cardiac
surgery. Search methods: We searched CENTRAL (2017, Issue 4), MEDLINE
(1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science
Citation Index, clinical trial registries, and reference lists of included
articles. Selection criteria: We included randomized controlled trials
that compared alpha-2 adrenergic agonists (i.e. clonidine, dexmedetomidine
or mivazerol) against placebo or non-alpha-2 adrenergic agonists. Included
trials had to evaluate the efficacy and safety of alpha-2 adrenergic
agonists for preventing perioperative mortality or cardiac complications
(or both), or measure one or more relevant outcomes (i.e. death,
myocardial infarction, heart failure, acute stroke, supraventricular
tachyarrhythmia and myocardial ischaemia). Data collection and analysis:
Two authors independently assessed trial quality, extracted data and
independently performed computer entry of abstracted data. We contacted
study authors for additional information. Adverse event data were gathered
from the trials. We evaluated included studies using the Cochrane 'Risk of
bias' tool, and the quality of the evidence underlying pooled treatment
effects using GRADE methodology. Given the clinical heterogeneity between
cardiac and non-cardiac surgery, we analysed these subgroups separately.
We expressed treatment effects as pooled risk ratios (RR) with 95%
confidence intervals (CI). Main results: We included 47 trials with 17,039
participants. Of these studies, 24 trials only included participants
undergoing cardiac surgery, 23 only included participants undergoing
non-cardiac surgery and eight only included participants undergoing
vascular surgery. The alpha-2 adrenergic agonist studied was clonidine in
21 trials, dexmedetomidine in 24 trials and mivazerol in two trials. In
non-cardiac surgery, there was high quality evidence that alpha-2
adrenergic agonists led to a similar risk of all-cause mortality compared
with control groups (1.3% with alpha-2 adrenergic agonists versus 1.7%
with control; RR 0.80, 95% CI 0.61 to 1.04; participants = 14,081; studies
= 16). Additionally, the risk of cardiac mortality was similar between
treatment groups (0.8% with alpha-2 adrenergic agonists versus 1.0% with
control; RR 0.86, 95% CI 0.60 to 1.23; participants = 12,525; studies = 5,
high quality evidence). The risk of myocardial infarction was probably
similar between treatment groups (RR 0.94, 95% CI 0.69 to 1.27;
participants = 13,907; studies = 12, moderate quality evidence). There was
no associated effect on the risk of stroke (RR 0.93, 95% CI 0.55 to 1.56;
participants = 11,542; studies = 7; high quality evidence). Conversely,
alpha-2 adrenergic agonists probably increase the risks of clinically
significant bradycardia (RR 1.59, 95% CI 1.18 to 2.13; participants =
14,035; studies = 16) and hypotension (RR 1.24, 95% CI 1.03 to 1.48;
participants = 13,738; studies = 15), based on moderate quality evidence.
There was insufficient evidence to determine the effect of alpha-2
adrenergic agonists on all-cause mortality in cardiac surgery (RR 0.52,
95% CI 0.26 to 1.04; participants = 1947; studies = 16) and myocardial
infarction (RR 1.01, 95% CI 0.43 to 2.40; participants = 782; studies =
8), based on moderate quality evidence. There was one cardiac death in the
clonidine arm of a study of 22 participants. Based on very limited data,
alpha-2 adrenergic agonists may have reduced the risk of stroke (RR 0.37,
95% CI 0.15 to 0.93; participants = 1175; studies = 7; outcome events =
18; low quality evidence). Conversely, alpha-2 adrenergic agonists
increased the risk of bradycardia from 6.4% to 12.0% (RR 1.88, 95% CI 1.35
to 2.62; participants = 1477; studies = 10; moderate quality evidence),
but their effect on hypotension was uncertain (RR 1.19, 95% CI 0.87 to
1.64; participants = 1413; studies = 9; low quality evidence). These
results were qualitatively unchanged in subgroup analyses and sensitivity
analyses. Authors' conclusions: Our review concludes that prophylactic
alpha-2 adrenergic agonists generally do not prevent perioperative death
or major cardiac complications. For non-cardiac surgery, there is
moderate-to-high quality evidence that these agents do not prevent death,
myocardial infarction or stroke. Conversely, there is moderate quality
evidence that these agents have important adverse effects, namely
increased risks of hypotension and bradycardia. For cardiac surgery, there
is moderate quality evidence that alpha-2 adrenergic agonists have no
effect on the risk of mortality or myocardial infarction, and that they
increase the risk of bradycardia. The quality of evidence was inadequate
to draw conclusions regarding the effects of alpha-2 agonists on stroke or
hypotension during cardiac surgery.<br/>Copyright &#xa9; 2018 The Cochrane
Collaboration.

<56>
Accession Number
621164192
Author
Doering B.K.; Glombiewski J.A.; Rief W.
Institution
(Doering) Catholic University Eichstatt-Ingolstadt, Eichstatt, Germany
(Glombiewski) University of Koblenz-Landau, Landau, Germany
(Rief) Philipps-University Marburg, Marburg, Germany
Title
Expectation-Focused Psychotherapy to Improve Clinical Outcomes.
Source
International Review of Neurobiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Placebo research has shown that patients' expectations are among the
strongest predictors of treatment outcome regarding various medical
conditions. Therefore, interventions focusing on the change of such
expectations might be most effective. This could be of relevance not only
for outcome expectations but also for disease-specific, problem-specific,
and treatment-specific expectations.A theoretical model is introduced to
illustrate the conditions for expectation change and persistence.
Strategies for patients regarding how to devalue learning effects in
expectation violation situations are exemplified, and ways to optimize
expectation-violating effects are highlighted.Data from a large randomized
controlled trial serve as a practical example and demonstrate the effect
of a presurgery optimization of expectations in patients scheduled for
heart surgery (coronary artery bypass grafting). Disability scores that
were obtained 6 months postsurgery confirmed that patients who
participated in preoperative psychological interventions, which aimed at
optimizing expectations, demonstrate the best outcome after heart surgery.
Practical aspects of the intervention are presented, and suggestions on
implementing these procedures to optimize outcome in medical interventions
are discussed.Psychotherapy is conceptualized as an intervention that
should target expectation violation of disorder- and treatment-specific
expectations.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<57>
Accession Number
608591529
Author
Lee J.Z.; Singh N.; Howe C.L.; Low S.-W.; Huang J.J.; Ortega G.; Lee K.S.;
Pandit A.
Institution
(Lee, Singh, Low, Huang) Department of Internal Medicine, University of
Arizona, Tucson, AZ, United States
(Howe) Arizona Health Sciences Library, University of Arizona, Tucson, AZ,
United States
(Ortega) College of Medicine, University of Arizona, Tucson, AZ, United
States
(Lee) Department of Cardiovascular Diseases, University of Arizona, 3950
S. Country Club Road, Tucson, AZ 85714, United States
(Pandit) DeBakey Heart Institute, Hays, KS, United States
Title
Colchicine for prevention of post-operative atrial fibrillation: A
meta-analysis.
Source
JACC: Clinical Electrophysiology. 2 (1) (pp 78-85), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier Inc
Abstract
Objectives This study sought to investigate the efficacy and safety of
colchicine for prevention of post-operative atrial fibrillation.
Background Proinflammatory processes induced during cardiac surgery may
contribute toward post-operative atrial fibrillation (AF). Colchicine is a
potent anti-inflammatory agent, which may have a role in post-operative AF
prevention. Methods We searched PubMed, EMBASE, Web of Science, CINAHL,
ClinicalTrials.gov, and the Cochrane Library databases for randomized
controlled trials (RCT) comparing colchicine versus placebo for prevention
of post-operative AF. The main outcome measure of interest was the
development of AF within 12 months after cardiac surgery. The overall risk
ratio (RR) for the development of post-operative AF was computed using a
random-effects model. Results Data analyzed from 3 randomized studies with
a total of 912 patients, where 457 patients received colchicine and 455
patients received placebo, showed that perioperative colchicine therapy
was associated with a reduced incidence of post-operative AF (RR: 0.65;
95% confidence interval [CI]: 0.46 to 0.91; p < 0.01). Although colchicine
therapy was associated with increased incidence of gastrointestinal
intolerance (RR: 2.20; 95% CI: 1.31 to 3.70; p = 0.003), it was not
associated with early treatment discontinuation (RR: 1.37; 95% CI: 0.95 to
1.96; p = 0.09). Conclusions In conclusion, current evidence suggests that
colchicine therapy is efficacious for the prevention of post-operative AF,
and may be considered as adjunctive prophylaxis. Further studies may be
required to determine the optimal treatment protocol to reduce the
incidence of gastrointestinal intolerance.<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation. Published by Elsevier.

<58>
Accession Number
604272500
Author
Fiorentino F.; Angelini G.D.; Suleiman M.-S.; Rahman A.; Anderson J.;
Bryan A.J.; Culliford L.A.; Moscarelli M.; Punjabi P.P.; Reeves B.C.
Institution
(Fiorentino, Angelini, Rahman, Anderson, Moscarelli, Punjabi) Imperial
College London, National Heart and Lung Institute, Cardiothoracic Surgery
Department, Du Cane Road, London W12 0NN, United Kingdom
(Angelini, Suleiman, Bryan, Culliford, Reeves) Bristol Heart Institute,
University of Bristol, Bristol Royal Infirmary, Marlborough Street,
Bristol BS2 8HW, United Kingdom
Title
Investigating the effect of remote ischaemic preconditioning on biomarkers
of stress and injury-related signalling in patients having isolated
coronary artery bypass grafting or aortic valve replacement using
cardiopulmonary bypass: Study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 181. Date of
Publication: April 23, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Ischaemia-reperfusion injury occurs during heart surgery that
uses cardiopulmonary bypass (CPB) and cardioplegic arrest. It is
hypothesised that remote ischaemic preconditioning (RIPC) protects the
heart against such injury. Despite the numerous studies investigating the
protective effects of RIPC, there is still uncertainty about the
interpretation of the findings as well as conflicting results between
studies. The objective of this trial is to investigate the
cardioprotective effect of RIPC in patients having coronary artery bypass
grafting (CABG) or aortic valve replacement surgery. This will be achieved
by estimating the effect of the intervention in the two groups of
pathologies and by investigating the signalling mechanisms that may
underpin the cardioprotective effect. Methods/Design: A two-centre
randomised controlled trial will be used to investigate the effects of
RIPC in two pathologies: patients having isolated CABG and those having
aortic valve replacement surgery (AVR) with CPB. Participants will be
randomised to RIPC or control (sham RIPC), stratified by surgical stratum.
The intervention will be delivered by a research nurse. Data will be
collected by a research nurse blinded to the intervention. The patient and
the theatre staff are also blinded to the allocation. Markers of
myocardial injury and inflammation will be measured in myocardial biopsies
and in blood samples at different times. Discussion: This trial is
designed to investigate whether RIPC will reduce myocardial injury and
inflammation following heart surgery and whether there is a difference in
effect between participants having CABG or AVR. This trial is a unique
opportunity to study the mechanisms associated with RIPC using human
myocardial tissue and blood, and to relate these to the extent of
myocardial injury/protection.<br/>Copyright &#xa9; 2015 Fiorentino et al.

<59>
Accession Number
607484474
Author
Smelt J.; Corredor C.; Edsell M.; Fletcher N.; Jahangiri M.; Sharma V.
Institution
(Smelt, Jahangiri) Department of Cardiothoracic Surgery, St George's
Hospital, Blackshaw Rd, London SW17 0QT, United Kingdom
(Corredor, Edsell, Fletcher, Sharma) Cardiothoracic Anesthesia, St
George's Hospital, London, United Kingdom
Title
Simulation-based learning of transesophageal echocardiography in
cardiothoracic surgical trainees: A prospective, randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (1) (pp 22-25), 2015.
Date of Publication: 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The Intercollegiate Surgical Curriculum now recommends that
cardiac surgical trainees should be able to understand and interpret
transesophageal echocardiography images. However, cardiac surgical
trainees receive limited formal transesophageal echocardiography training.
The objective of this study was to assess the impact of simulation-based
teaching versus more traditional operating room teaching on
transesophageal echocardiography knowledge in cardiac surgical trainees.
Methods A total of 25 cardiac surgical trainees with no formal
transesophageal echocardiography learning experience were randomly
assigned by computer to a study group receiving simulation-based
transesophageal echocardiography teaching via the Heartworks (Inventive
Medical, London, UK) simulator (n = 12) or a control group receiving
transesophageal echocardiography teaching during elective cardiac surgery
(n = 13). Each subject undertook a video-based test composed of 20
multiple choice questions on standard transesophageal echocardiography
views before and after teaching. Results There was no significant
difference in the pretest scores between the 2 groups (P =.89). After
transesophageal echocardiography teaching, subjects within each group
demonstrated a statistically significant improvement in transesophageal
echocardiography knowledge. Although the subjects within the simulation
group outperformed their counterparts in the operating room teaching group
in the post-test scores, this difference was not significant (P =.14).
Conclusions Despite the familiarity with transesophageal echocardiography
images during surgery, subjects in the simulation group performed at least
as well as those in the operating room group. Surgical trainees will
benefit from formal transesophageal echocardiography teaching incorporated
into their training via either learning method.<br/>Copyright &#xa9; 2015
The American Association for Thoracic Surgery.

<60>
Accession Number
606164574
Author
Mittnacht J.; Choukair D.; Kneppo C.; Brunner R.; Parzer P.; Gorenflo M.;
Bettendorf M.
Institution
(Mittnacht, Choukair, Kneppo, Bettendorf) Division of Paediatric
Endocrinology and Diabetes, Department of Paediatrics, University Hospital
Heidelberg, Im Neuenheimer Feld 430, Heidelberg DE-69120, Germany
(Brunner, Parzer) Department of Child and Adolescent Psychiatry, Centre of
Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
(Gorenflo) Department of Paediatric and Congenital Cardiology, University
Hospital Heidelberg, Heidelberg, Germany
Title
Long-term neurodevelopmental outcome of children treated with
tri-iodothyronine after cardiac surgery: Follow-up of a double-blind,
randomized, placebo-controlled study.
Source
Hormone Research in Paediatrics. 84 (2) (pp 130-136), 2015. Date of
Publication: 27 Aug 2015.
Publisher
S. Karger AG
Abstract
Background: Transient thyroid dysfunction occurs in children after
cardiopulmonary bypass (CPB). We demonstrated significant benefits of
acute postoperative tri-iodothyronine (T3) treatment for recovery and
myocardial function. Now we report the long-term neurodevelopment of these
children. Methods: Twenty-eight children (70% of the original study
population) could be recruited for a follow-up examination (median age
10.7 years, range 10-19.6 years) retaining the double-blind, randomized,
placebo-controlled protocol. Cognitive function and motor development were
tested, as were growth and thyroid and cardiac functions. Results: The
median full-scale intelligence quotient of all children was within the
reference range and similar in the placebo and T3 groups. Tests for motor
and cognitive functions, growth, and thyroid and cardiac functions
revealed concurrent results. Conclusions: Overall intellectual development
is preserved in adolescents treated with CPB in infancy irrespectively of
low postoperative thyroid hormone concentrations. While acute
postoperative T3 treatment in children after CPB improves recovery, no
significant long-term effects on neurodevelopment could be detected. We
therefore speculate that transient postoperative thyroid dysfunction by
means of nonthyroidal illness syndrome is predominantly mediated by
extranuclear, nongenomic mechanisms and thus acutely affects the
cardiovascular system but not the development of the central nervous
system mediated by genomic mechanisms.<br/>Copyright &#xa9; 2015 S. Karger
AG, Basel.

<61>
Accession Number
604015725
Author
Iglar P.J.; Hogan K.J.
Institution
(Iglar) University of Wisconsin School of Medicine and Public Health,
Department of Population Health Sciences, 707 WARF Building, 610 North
Walnut Street, Madison, WI 53726, United States
(Hogan) University of Wisconsin School of Medicine and Public Health,
Department of Anesthesiology, 600 Highland Avenue, B/6 319 Clinical
Sciences Center, Madison, WI 53792-3272, United States
Title
Vitamin D status and surgical outcomes: A systematic review.
Source
Patient Safety in Surgery. 9 (1) (no pagination), 2015. Article Number:
14. Date of Publication: April 30, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
The importance of vitamin D for musculoskeletal health has long been
recognized, and awareness of significant extra-skeletal effects in health
and disease is rapidly emerging. Although it has been possible for many
decades to quantify serum markers of vitamin D deficiency, and to correct
deficiency at low cost and with high safety, the influence of vitamin D
status on post-surgical outcomes has only recently been identified as a
research topic of interest. To the present, these data have not been the
subject matter of formal review. Accordingly, we conducted a systematic
review to assess the association between perioperative vitamin D status
and outcomes after surgery. The databases of PubMed, Ovid MEDLINE, EMBASE,
AMED, CINAHL (EBSCOHost), The Cochrane Databases of Systematic Review, and
PROSPERO were searched through December, 2014 for studies relating to
vitamin D and surgery. The initial search yielded 90 manuscripts. After
applying exclusion criteria, 31 studies were eligible for inclusion.
Fifteen studies employed prospective observational designs, 3 used
prospective randomized protocols, and 13 report retrospective database
interrogations. The main finding of the present review is that 26 of 31
studies (84%) report at least one statistically significant worse outcome
in patients with low vitamin D status. Five of 31 studies (16%) found no
association. In conclusion, this review supports the hypothesis that
hypovitaminosis D is associated with adverse outcomes after diverse
surgical procedures. Future studies should focus on additional surgeries
and outcomes, and on the role of vitamin D supplementation in the
improvement of patient safety in participants with low vitamin D status at
the time of surgery.<br/>Copyright &#xa9; Iglar and Hogan; licensee BioMed
Central.

<62>
Accession Number
605985038
Author
Rana B.S.; Calvert P.A.; Punjabi P.P.; Hildick-Smith D.
Institution
(Rana) Department of Cardiology, Papworth Hospital NHS Foundation Trust,
Cambridge CB23 3RE, United Kingdom
(Calvert) Queen Elizabeth Hospital, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, United Kingdom
(Calvert) University of Birmingham, Birmingham, United Kingdom
(Punjabi) Cardiothoracic Department, Hammersmith Hospital, Imperial
College London, London, United Kingdom
(Hildick-Smith) Brighton University Hospital, United Kingdom
Title
Role of percutaneous mitral valve repair in the contemporary management of
mitral regurgitation.
Source
Heart. 101 (19) (pp 1531-1539), 2015. Date of Publication: 01 Oct 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Percutaneous mitral valve (MV) repair has been performed in over 20 000
patients worldwide. As clinical experience in this technique grows
indications for its use are being defined. Mitral regurgitation (MR)
encompasses a complex heterogeneous group and its treatment is governed by
determining a clear understanding of the underlying aetiology. Surgical MV
repair remains the gold standard therapy for severe MR. However in select
groups of high-risk surgical patients, a percutaneous approach to MV
repair is establishing its role. This review gives an overview of the
published data in percutaneous MV repair and its impact on the
contemporary management of MR.

<63>
Accession Number
605985012
Author
Wu J.; Xie F.; Lof J.; Sayyed S.; Porter T.R.
Institution
(Wu) Department of Cardiology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
(Xie, Lof, Sayyed, Porter) Division of Cardiology, University of Nebraska,
Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198-2265,
United States
Title
Utilization of modified diagnostic ultrasound and microbubbles to reduce
myocardial infarct size.
Source
Heart. 101 (18) (pp 1468-1474), 2015. Date of Publication: 01 Sep 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: We sought to determine whether guided high mechanical index
(MI) impulses from a diagnostic ultrasound transducer during an
intravenous microbubble infusion could augment low-dose fibrinolytic
therapy in treating acute myocardial infarction (ST segment elevation
myocardial infarction, STEMI). Methods: Acute thrombotic occlusions of the
left anterior descending were created in 32 atherosclerotic pigs. Fourteen
historical control pigs received half dose of tissue plasminogen activator
alone (half tPA), while the subsequent 18 were randomised to (a) 1.0 mg/kg
tPA (full-dose tPA); (b) low-dose tPA (0.5 mg/kg) and an intravenous
microbubble infusion where guided transthoracic high MI impulses were
applied intermittently to the risk area (guided high MI/half tPA) or (c)
guided high MI impulses and microbubbles alone (guided high MI alone).
Angiographic recanalisation, ST segment resolution and wall thickening
(WT) at 60 min were compared between all pigs, while indexed infarct size
at 48 h was compared in the 18 randomised pigs. Results: Recanalisation
rates improved from 36% for half dose tPA alone to 83% with the addition
of guided high MI impulses, while it was 50% for full-dose tPA and guided
high MI alone. WT recovery within the risk area following treatment was
highest for guided high MI/half tPA (p=0.007 compared with full-dose tPA;
ANOVA), and indexed infarct size was lowest (p<0.05 compared to full-dose
tPA). Conclusions: Guided high MI-induced microbubble cavitation from a
diagnostic transducer added to lowdose tPA can immediately improve
regional function and reduce infarct size in acute STEMI. Trial
registration number: Clinical Trials.gov NCT02170103.

<64>
[Use Link to view the full text]
Accession Number
606105878
Author
Watanabe G.; Yamaguchi S.; Tomita S.; Nishida Y.
Institution
(Watanabe, Yamaguchi, Tomita, Nishida) Department of General and
Cardiothoracic Surgery, Kanazawa University Graduate School of Medical
Science, Kanazawa, Japan
Title
Fasudil is an effective graft vasodilator for gastroepiploic artery in
coronary artery bypass grafting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (4) (pp 268-272), 2015. Date of Publication: 01 Sep 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The gastroepiploic artery (GEA) has been used as an alternative
arterial in situ graft for coronary artery bypass grafting (CABG).
However, because of the large individual differences and the spastic
nature of the GEA, caution has to be exercised during harvesting. We
evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a
vasodilator for rightGEA(RGEA) graft after harvesting, compared with the
conventional agents papaverine and verapamil-nitroglycerin. Methods:
Between June 2009 and January 2013, 30 patients with ischemic heart
disease who underwent isolated CABG using RGEA graft were randomly
assigned to fasudil (n = 10), papaverine (n = 10), or
verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine
(1.0 mmol/L) mixed with heparinized blood, or verapamilnitroglycerin (30
Kmol/L each) was injected intraluminally into the RGEA graft after
harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and
histopathology of RGEA were evaluated. Results: Intraluminal injection of
fasudil increased GFF significantly (PG 0.001) andmarkedly from41.5 T
31.5mL/min at baseline to 149.3 T 46.7mL/min after injection. Papaverine
increasedGFF (P G 0.001) from 40.0 T 35.8 to 64.9 T 33.7 mL/min, and
verapamil-nitroglycerin also increasedGFF (P G 0.001) from38.8 T 32.1 to
79.0 T 35.2 mL/min. The GFF was significantly higher (P = 0.001) in the
fasudil group than in the other two groups. Histopathologically, fasudil
treatment markedly increased the diameter of RGEA graft, while maintaining
integrity of the multiple elastic lamellae. Blood pressure did not change
significantly after drug injection in all groups. Conclusions: Fasudil is
more potent than papaverine or verapamilnitroglycerin in increasing GFF of
RGEA graft for CABG.

<65>
[Use Link to view the full text]
Accession Number
606105807
Author
Puskas J.D.; Martin J.; Cheng D.C.H.; Benussi S.; Bonatti J.O.; Diegeler
A.; Ferdinand F.D.; Kieser T.M.; Lamy A.; Mack M.J.; Patel N.C.; Ruel M.;
Sabik J.F.; Yanagawa B.; Zamvar V.
Institution
(Puskas, Yanagawa) Department of Cardiovascular Surgery, Icahn School of
Medicine, Mount Sinai Beth Israel, New York, NY, United States
(Martin, Cheng) Centre for Medical Evidence, Decision Integrity, Clinical
Impact (MEDICI), Department of Anesthesia and Perioperative Medicine,
Department of Epidemiology and Biostatistics, Western University, London,
ON, Canada
(Benussi) Division of Cardiovascular Surgery, University Hospital Zurich,
Zurich, Switzerland
(Bonatti) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
(Diegeler) Herz-Und Gefasse Klinik Bad Neustadt, University of Leipzig,
Bad Neustadt, Germany
(Ferdinand) Division of Cardiovascular and Thoracic Surgery, Lankenau
Medical Center, Wynnewood, PA, United States
(Kieser) Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB, Canada
(Lamy) Division of Cardiac Surgery and Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON, Canada
(Mack) Baylor Health System, Heart Hospital Baylor Plano, Dallas, TX,
United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill, New York, NY,
United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Sabik) Heart Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Zamvar) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
ISMICS consensus conference and statements of randomized controlled trials
of off-pump versus conventional coronary artery bypass surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (4) (pp 219-229), 2015. Date of Publication: 01 Sep 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: At this consensus conference, we developed evidenceinformed
consensus statements and recommendations on the practice of off-pump
coronary artery bypass graft (OPCAB) by systematically reviewing and
performing meta-analysis of the randomized controlled trials (RCTs)
comparing OPCAB and conventional coronary artery bypass (CCAB). Methods:
All RCTs of OPCAB versus CCAB through April 2013 were screened, and 102
relevant RCTs (19, 101 patients) were included in a systematic review and
meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs of 9550
low-risk patients) in accordance with the Cochrane Collaboration and
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) methodology. Consensus statements for the risks and
benefits of OPCAB surgery in mortality, morbidity, and resource use were
developed based on best available evidence. Results: Compared to CCAB, it
is reasonable to perform OPCAB to reduce risks of stroke [class IIa, level
of evidence (LOE) A], renal dysfunction/failure (class IIa, LOE A), blood
transfusion (class I, LOE A), respiratory failure (class I, LOE A), atrial
fibrillation (class I, LOE A), wound infection (class I, LOE A),
ventilation time, and ICU and hospital length of stay (class I, LOE A).
However, OPCAB may be associated with a reduced number of grafts performed
(class I, LOE A) and with diminished graft patency (class IIa, LOE A, with
increased coronary reintervention at 1 year and beyond (class IIa, LOE A),
aswell as increased mortality at a median follow-up of 5 years (class IIb,
LOE A). Conclusions: OPCAB compared with CCAB may improve outcomes in the
short-term (stroke, renal dysfunction, blood transfusion, respiratory
failure, atrial fibrillation, wound infection, ventilation time, and
length of stay). However, over the longer-term, OPCAB may be associated
with reduced graft patency, and increased risk of cardiac re-intervention
and death.

<66>
Accession Number
605001250
Author
Du Q.; Zhou X.; Wang X.; Chen S.; Yang X.; Chen N.; Liang J.; Deng W.; Sun
K.
Institution
(Du, Zhou, Yang, Chen, Deng) Department of Rehabilitation Medicine, Xin
Hua Hospital Affiliated to Shanghai Jiao Tong University School of
Medicine, Shanghai, China
(Wang) Sport Medicine and Rehabilitation Centre, Shanghai University of
Sport, Shanghai, China
(Chen, Sun) Department of Pediatric Cardiology, Xin Hua Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665
Kongjiang Road, Shanghai, China
(Liang) Department of Kinesiology, Shanghai University of Sport, Shanghai,
China
Title
Passive movement and active exercise for very young infants with
congenital heart disease: A study protocol for a randomized controlled
trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 288. Date of
Publication: June 30, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delayed motor development is reported in patients with
congenital heart disease (CHD). Exercise is widely used to facilitate
motor development and improve motor ability. Exercise for adolescents and
adults with CHD has been extensively studied. However, the evidence of
exercise for infants with CHD is sparse. This study aims to identify the
effect of passive movement and active exercise on motor development within
very young CHD infants with cardiac catheterization. Methods/Design: A
prospective and randomized controlled trial will be conducted in very
young CHD infants with cardiac catheterization. A total of 147 infants
with CHD will be randomized by a 1:1:1 allocation ratio by computer to an
exercise intervention group, a home-based intervention group and a control
group. The exercise intervention group will receive passive movement and
active exercise from experienced physiotherapists in pediatrics three
times a week for 12 weeks. The home-based intervention group will receive
passive movement and active exercise from their parents or caregivers at
home three times a week for 12 weeks. The control group will receive
follow up only. The follow-up duration is 20 months. The primary outcome
measures are the motor quotient measured by the Peabody Developmental
Motor Scales-II. The secondary outcome measures are the Ross score,
ventricular function, bone quality, body length, weight, head
circumference, upper arm circumference, and adverse events. Discussion:
This study has several important features, including the randomization
process, the long follow-up duration, the control group, and the large
sample size. The aim of this study is to determine whether 12-week passive
movement and active exercise promotes motor development and produces other
beneficial effects for very young CHD infants with cardiac
catheterization. Therefore, this study will contribute new knowledge
regarding the rehabilitation program in very young CHD infants with
cardiac catheterization. Trial registration: Current Controlled Trials
ChiCTR-IOR-15005909 (January 31, 2015).<br/>Copyright &#xa9; 2015 Du et
al.

<67>
Accession Number
607483154
Author
Phan K.; Ha H.; Phan S.; Misfeld M.; Di Eusanio M.; Yan T.D.
Institution
(Phan, Phan, Di Eusanio, Yan) Collaborative Research (CORE) Group,
Macquarie University Hospital, Macquarie University, 2 Technology Pl,
Sydney, NSW 2109, Australia
(Phan) Westmead Clinical School, Sydney Medical School, University of
Sydney, Sydney, Australia
(Phan, Ha) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Misfeld) University of Leipzig, Heart Center, Leipzig, Germany
(Di Eusanio) Cardiovascular Surgery Department, Sant'Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Early hemodynamic performance of the third generation St Jude Trifecta
aortic prosthesis: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (6) (pp 1567-1575e2),
2015. Date of Publication: 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The Trifecta aortic prosthesis is a latest-generation trileaflet
stented pericardial valve designed for supra-annular placement in the
aortic position. Robust clinical evidence and long-term follow-up data for
this new prosthesis are lacking; a systematic review was conducted to
assess current evidence. Methods A comprehensive search from 6 electronic
databases was performed, with time period parameters dating from database
inception to January 2014. Results utilizing Trifecta prosthesis for
aortic valve replacement (AVR) were identified. Results A total of 13
studies with 2549 patients undergoing AVR with this prosthesis were
included in this review. The mean proportion of patients with aortic
stenosis was 82.4%, with a mean gradient of 47.4 mm Hg, and a pooled
effective orifice area (EOA) of 0.74 cm². Valve sizes of 21 mm
and 23 mm were implanted in 71.3% of patients. The pooled rates of 30-day
mortality, cerebrovascular accidents, and acute kidney injuries were 2.7%,
1.9%, and 2.6%, respectively. After implantation, the pooled mean gradient
decreased to 9.2 mm Hg, whereas discharge EOA increased to 1.8
cm², compared with preoperative parameters. Among included
studies with significant heterogeneity detected, most patients had
satisfactory patient-prosthesis mismatch, with 2.7% having severe
mismatch. Conclusions The present systematic review demonstrated that
short-term AVR with this prosthesis provided excellent early safety and
hemodynamic outcomes with acceptable mean gradients and EOA. Long-term
follow-up and randomized controlled trials are warranted to confirm the
early results.<br/>Copyright &#xa9; 2015 The American Association for
Thoracic Surgery.

<68>
Accession Number
605006431
Author
Jang J.-S.; Jin H.-Y.; Seo J.-S.; Yang T.-H.; Kim D.-K.; Kim D.-S.; Cho
K.-I.; Kim B.-H.; Park Y.H.; Je H.-G.
Institution
(Jang, Jin, Seo, Yang, Kim, Kim) Department of Cardiology, Busan Paik
Hospital, University of Inje College of Medicine, Busan, South Korea
(Cho) Department of Cardiology, Kosin University, Medical Center, Busan,
South Korea
(Kim) Department of Internal Medicine, Pusan National University Hospital,
Busan, South Korea
(Park, Je) Department of Cardiovascular and Thoracic Surgery, Research
Institute for Convergence of Biomedical Science and Technology, Pusan
National University, Yangsan, South Korea
Title
Meta-analysis of multivessel versus culprit-only percutaneous coronary
intervention in patients with non-ST-segment elevation acute coronary
syndrome and multivessel coronary disease.
Source
American Journal of Cardiology. 115 (8) (pp 1027-1032), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Even in the era of contemporary drug-eluting stents, it is not clear
whether percutaneous coronary intervention (PCI) for nonculprit lesions
can improve long-term outcomes in patients with noneST-segment elevation
acute coronary syndrome (NSTE-ACS) with multivessel coronary disease.
Relevant studies published through August 2014 were searched and
identified in the electronic databases. Summary estimates were obtained
using a randomeffects model. From 368 initial citations, 8 observational
studies with 8,425 patients (3,227 multivessel and 5,198 culprit-only PCI)
were included. Mean follow-up duration was 18 months. There were no
significant differences in all-cause mortality (odds ratios [ORs] 0.85,
95% confidence interval [CI] 0.70 to 1.04) and myocardial infarction (OR
0.86, 95% CI 0.55 to 1.35). However, multivessel PCI was associated with a
significantly lower rate of repeat revascularization (OR 0.75, 95% CI 0.56
to 1.00). Comparison of multivessel versus culprit-only PCI disclosed OR
for major adverse cardiac events of 0.74 (95% CI 0.57 to 0.97). In
conclusion, multivessel PCI reduced repeat revascularization without
significant benefits in terms of mortality or myocardial infarction at the
long-term follow-up in patients with NSTE-ACS and multivessel coronary
disease. Future randomized studies that examine the safety and efficacy of
multivessel PCI in NSTE-ACS are warranted.<br/>Copyright &#xa9; 2015
Elsevier Inc. All rights reserved.

<69>
Accession Number
604437982
Author
Hermans M.P.; Bouenizabila E.; Amoussou-guenou D.K.; Ahn S.A.; Rousseau
M.F.
Institution
(Hermans) Universite catholique de Louvain, Division of Endocrinology and
Nutrition, Cliniques universitaires St-Luc, Institut de Recherche
Experimentale et Clinique (IREC), Brussels, Belgium
(Bouenizabila) Centre Hospitalier et Universitaire de Brazzaville, Service
de Maladies Metaboliques et Endocriniennes, Brazzaville, Congo
(Amoussou-guenou) CNHU HKM Cotonou, Universite d'Abomey-Calavi, Service
d'Endocrinologie et Metabolisme, Abomey-Calavi, Benin
(Ahn, Rousseau) Cliniques universitaires St-Luc and Pole de Recherche
Cardiovasculaire, Institut de Recherche Experimentale et Clinique (IREC),
Universite catholique de Louvain, Division of Cardiology, Brussels,
Belgium
Title
Baseline diabetes as a way to predict CV outcomes in a lipid-modifying
trial: A meta-analysis of 330,376 patients from 47 landmark studies.
Source
Cardiovascular Diabetology. 14 (1) (no pagination), 2015. Article Number:
60. Date of Publication: May 21, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Diabetes is a major cardiovascular risk factor. However, its
influence on the rate of occurrence of cardiovascular (CV) events during a
clinical trial that included a diabetes subgroup has not yet been
quantified. Aims: To establish equations relating baseline diabetes
prevalence and incident CV events, based on comparator arms data of major
lipid-modifying trials. Methods: Meta-analysis of primary outcomes (PO)
rates of key prospective trials, for which the baseline proportion of
diabetics was reported, including studies having specifically reported CV
outcomes within their diabetic subgroups. Results: 47 studies,
representing 330,376 patients (among whom 124,115 diabetics), were
analyzed as regards the relationship between CV outcomes rates (including
CHD) and the number of diabetics enrolled. Altogether, a total of 18,445
and 16,156 events occurred in the comparator and treatment arms,
respectively. There were significant linear relationships between diabetes
prevalence and both PO and CHD rates (%/year): y = 0.0299*x + 3.12 [PO] (p
= 0.0128); and y = 0.0531*x + 1.54 [CHD] (p = 0.0094), baseline diabetes
predicting PO rates between 3.12 %/year (no diabetic included) and 6.11
%/year (all patients diabetic); and CHD rates between 1.54 %/year (no
diabetic) and 6.85 %/year (all patients diabetic). The slopes of the
equations did not differ according to whether they were derived from
primary or secondary prevention trials. Conclusions: Absolute and relative
CV risk associated with diabetes at inclusion can be readily predicted
using linear equations relating diabetes prevalence to primary outcomes or
CHD rates.<br/>Copyright &#xa9; 2015 Hermans et al.; licensee BioMed
Central.

<70>
Accession Number
604884032
Author
Pike K.; Nash R.L.; Murphy G.J.; Reeves B.C.; Rogers C.A.
Institution
(Pike, Nash, Reeves, Rogers) University of Bristol, Clinical Trials and
Evaluation Unit, School of Clinical Sciences, Bristol, United Kingdom
(Murphy) University of Leicester, Department of Cardiovascular Sciences,
Leicester, United Kingdom
Title
Transfusion Indication Threshold Reduction (TITRe2) randomized controlled
trial in cardiac surgery: Statistical analysis plan.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 54. Date of
Publication: February 22, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The Transfusion Indication Threshold Reduction (TITRe2) trial
is the largest randomized controlled trial to date to compare red blood
cell transfusion strategies following cardiac surgery. This update
presents the statistical analysis plan, detailing how the study will be
analyzed and presented. The statistical analysis plan has been written
following recommendations from the International Conference on
Harmonisation of Technical Requirements for Registration of
Pharmaceuticals for Human Use, prior to database lock and the final
analysis of trial data. Outlined analyses are in line with the
Consolidated Standards of Reporting Trials (CONSORT). Methods and design:
The study aims to randomize 2000 patients from 17 UK centres. Patients are
randomized to either a restrictive (transfuse if haemoglobin concentration
<7.5 g/dl) or liberal (transfuse if haemoglobin concentration <9 g/dl)
transfusion strategy. The primary outcome is a binary composite outcome of
any serious infectious or ischaemic event in the first 3 months following
randomization. Trial registration: ISRCTN70923932.<br/>Copyright &#xa9;
2015 Pike et al.; licensee BioMed Central.

<71>
Accession Number
607362980
Author
Finsterer J.; Stollberger C.
Institution
(Finsterer) Krankenanstalt Rudolfstiftung, Vienna, Austria
(Stollberger) 2^nd Medical Department with Cardiology and
Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
Title
Review of Cardiac Disease in Nemaline Myopathy.
Source
Pediatric Neurology. 53 (6) (pp 473-477), 2015. Date of Publication: 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives Little is known about the type, frequency, severity, treatment,
and outcome of cardiac disease in nemaline myopathy. This review
summarizes and discusses findings concerning the type, prevalence,
diagnosis, treatment, and outcome of cardiac involvement in nemaline
myopathy. Methods Review of publications about nemaline myopathy and
cardiac disease. Results Altogether, 35 patients with nemaline myopathy
with cardiac disease were identified. Age at presentation ranged from 0 to
62 years. In 30 individuals whose gender was described, 22 were male and
eight were female. Onset was congenital in 16 patients, infantile in five,
and adult in four. Nine patients presented with dilated cardiomyopathy,
six with hypertrophic cardiomyopathy, and one with nonspecific
cardiomyopathy. Among those with cardiomyopathy, four developed heart
failure. One patient experienced sudden cardiac death. A ventricular
septal defect was described in two patients. Cardiac treatment included
drugs for heart failure (eight patients), implantable
cardioverter-defibrillator implantation (one patient), and heart
transplant (three patients). Four patients received noninvasive
positive-pressure ventilation and two continuous positive-pressure
ventilation. The outcome was fatal in 11 patients. Conclusions Cardiac
disease in nemaline myopathy manifests as cardiomyopathy leading to heart
failure. If respiratory muscles are affected, the right side of the heart
may be secondarily involved. Early detection of cardiac involvement is
essential since effective treatment for cardiac disease in nemaline
myopathy may be available.<br/>Copyright &#xa9; 2015 Elsevier Inc.

<72>
Accession Number
604117753
Author
Yi J.; Gong Y.; Quan X.; Huang Y.
Institution
(Yi, Gong, Quan, Huang) Peking Union Medical College Hospital, Department
of Anesthesiology, Chinese Academy of Medical Science, No.1 Shuaifuyuan
Wangfujing Street, Beijing 100730, China
Title
Comparison of the Airtraq laryngoscope and the GlideScope for double-lumen
tube intubation in patients with predicted normal airways: A prospective
randomized trial.
Source
BMC Anesthesiology. 15 (1) (no pagination), 2015. Article Number: 58. Date
of Publication: April 28, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The Airtraq laryngoscope and the GlideScope are commonly used
in many airway scenarios. However, their features have not been fully
described for double-lumen tube intubation. A prospective randomized study
was designed to compare their intubation performances in thoracic surgery
patients. Methods: Seventy ASA physical status I and II patients with
predicted normal airway were scheduled for thoracic surgeries with
double-lumen tube intubation. They were randomly assigned to one of two
groups and intubated with either the Airtraq laryngoscope (group A, n =
35) or the GlideScope (group G, n = 35). Airway assessments were performed
prior to anesthesia, and all patients were induced with a standard
anesthetic regimen. The Cormack-Lehane grades were initially evaluated
with a Macintosh laryngoscope and subsequently with the group-specific
laryngoscope before intubation. Intubation time was recorded as the
primary outcome. The Cormack-Lehane grade, the success of the first
intubation attempt, the intubation difficulty scales and ease of tube
advancement were noted. Hemodynamic variables during intubation and
incidence of post-operative sore throat were documented as well. Results:
The intubation time of group A was shorter than that of group G (36.6 +/-
20.2 s vs. 54.6 +/- 25.7 s, p = 0.002). The Cormack-Lehane grade
(I/II/III/IV) was significantly better in group A (33/2/0/0 vs. 28/7/0/0,
p = 0.042). The mean arterial pressure and heart rate rose to higher
levels during intubation with the GlideScope than with the Airtraq
laryngoscope. The success of the first intubation attempt and the
intubation difficulty scales were comparable between the two groups. The
numbers of patients who experienced postoperative sore throat were similar
(6 vs. 8) in the two groups. Conclusions: Compared with the GlideScope,
the specially designed Airtraq laryngoscope might be more suitable for
double-lumen tube intubations in patients with predicted normal airway.
Trial registration: www.chictr.org Identifier:
ChiCTR-TRC-11001628.<br/>Copyright &#xa9; 2015 Yi et al.; licensee BioMed
Central.

<73>
Accession Number
605985088
Author
Nombela-Franco L.; Eltchaninoff H.; Zahn R.; Testa L.; Leon M.B.;
Trillo-Nouche R.; Donofrio A.; Smith C.R.; Webb J.; Bleiziffer S.; De
Chiara B.; Gilard M.; Tamburino C.; Bedogni F.; Barbanti M.; Salizzoni S.;
Del Blanco B.G.; Sabate M.; Moreo A.; Fernandez C.; Ribeiro H.B.;
Amat-Santos I.; Urena M.; Allende R.; Garcia E.; Macaya C.; Dumont E.;
Pibarot P.; Rodes-Cabau J.
Institution
(Nombela-Franco, Ribeiro, Amat-Santos, Urena, Allende, Dumont, Pibarot,
Rodes-Cabau) Quebec Heart and Lung Institute, 2725 cheminSte-Foy, Quebec
City, QC G1V 4G5, Canada
(Nombela-Franco, Fernandez, Garcia, Macaya) Cardiovascular Institute,
Hospital Clinico San Carlos, Madrid, Spain
(Eltchaninoff) Cardiology Department, Charles Nicolle Hospital, University
of Rouen, Rouen, France
(Zahn) Abteilung fur Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen,
Germany
(Testa, Bedogni) Cardiology Department, Instituto Clinico S. Ambrogio,
Milan, Italy
(Leon, Smith) Columbia University, Medical Center, New York-Presbyterian
Hospital, New York, United States
(Trillo-Nouche) Hospital Universitario de Santiago Compostela, A Coruna,
Spain
(Donofrio) Division of Cardiac Surgery, University of Padova, Padova,
Italy
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Bleiziffer) German Heart Center, Munich, Germany
(De Chiara, Moreo) Cardiology Department, Niguarda Ca' Granda Hospital,
Milan, Italy
(Gilard) Department of Cardiology, La Cavale Blanche Hospital, Brest,
France
(Tamburino, Barbanti) Ferrarotto Hospital, Catania, Italy
(Salizzoni) Department of Surgical Sciences Torino, Citta della Salute e
della Scienza Hospital, Molinette, Torino, Italy
(Del Blanco) Department of Cardiology, Vall d'Hebron University Hospital,
Barcelona, Spain
(Sabate) Cardiology Department, Hospital Clinic de Barcelona, IDIBAPS,
Barcelona, Spain
Title
Clinical impact and evolution of mitral regurgitation following
transcatheter aortic valve replacement: A meta-analysis.
Source
Heart. 101 (17) (pp 1395-1405), 2015. Date of Publication: 01 Sep 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Mitral regurgitation (MR) is a common entity in patients with
aortic stenosis undergoing transcatheter aortic valve replacement (TAVR),
but its influence on outcomes remains controversial. The purpose of this
metaanalysis was to assess the clinical impact of and changes in
significant (moderate-severe) MR in patients undergoing TAVR, overall and
according to valve design (self-expandable (SEV) vs balloon-expandable
(BEV)). Methods: All national registries and randomised trials were pooled
using meta-analytical guidelines to establish the impact of
moderate-severe MR on mortality after TAVR. Studies reporting changes in
MR after TAVR on an individual level were electronically searched and used
for the analysis. Results: Eight studies including 8015 patients (SEV:
3474 patients; BEV: 4492 patients) were included in the analysis. The
overall 30-day and 1-year mortality was increased in patients with
significant MR (OR 1.49, 95% CI 1.16 to 1.92; HR 1.32, 95% CI 1.12 to
1.55, respectively), but a significant heterogeneity across studies was
observed (p<0.05). The impact of MR on mortality was not different between
SEV and BEV in meta-regression analysis for 30-day (p=0.360) and 1-year
(p=0.388) mortality. Changes in MR over time were evaluated in nine
studies including 1278 patients. Moderate-severe MR (SEV: 326 patients;
BEV: 192 patients) improved in 50.5% of the patients at a median follow-up
of 180 (30-360) days after TAVR, and the degree of improvement was greater
in patients who had received a BEV (66.7% vs 40.8% in the SEV group,
p=0.001). Conclusions: Concomitant moderate-severe MR was associated with
increased early and late mortality following TAVR. A significant
improvement in MR severity was detected in half of the patients following
TAVR, and the degree of improvement was greater in those patients who had
received a BEV.

<74>
Accession Number
605985060
Author
Kowalewski M.; Schulze V.; Berti S.; Waksman R.; Kubica J.; Kolodziejczak
M.; Buffon A.; Suryapranata H.; Gurbel P.A.; Kelm M.; Pawliszak W.;
Anisimowicz L.; Navarese E.P.
Institution
(Kowalewski, Pawliszak, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland
(Kowalewski, Schulze, Berti, Kubica, Kolodziejczak, Kelm, Navarese)
Systematic Investigation and Research on Interventions and Outcomes
(SIRIO), MEDICINE Research Network, Dusseldorf, Germany
(Schulze, Kelm, Navarese) Department of Internal Medicine, Division of
Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University,
Moorenstr. 5, Dusseldorf 40225, Germany
(Berti) Department of Invasive Cardiology, Institute of Clinical
Physiology, National Research Council, Pisa, Italy
(Waksman) MedStar Washington Hospital Center, Washington, DC, United
States
(Kubica, Kolodziejczak) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz,
Bydgoszcz, Poland
(Buffon) Department of Cardiovascular Sciences, Catholic University of the
Sacred Heart, Rome, Italy
(Suryapranata) Department of Cardiology, Radboud University, Nijmegen
Medical Center, Nijmegen, Netherlands
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, MD, United States
Title
Complete revascularisation in ST-elevation myocardial infarction and
multivessel disease: Meta-analysis of randomised controlled trials.
Source
Heart. 101 (16) (pp 1309-1317), 2015. Date of Publication: 01 Aug 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Current guidelines recommend culpritonly revascularisation
(COR) in haemodynamically stable patients with ST-segment elevation
myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily,
growing body of evidence available from recent randomised controlled
trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous
coronary intervention (PCI). Methods and results: We performed a
meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI
in STEMI and MV disease. Complete MV-PCI was defined as revascularisation
to non-infarct-related artery lesions during index procedure, non-complete
MVPCI-encompassed COR and staged approaches. Multiple databases and
congress proceedings from major cardiovascular societies' meetings were
screened for relevant studies. Primary endpoint was the composite of major
adverse cardiac events (MACE) typically defined as death, recurrent
myocardial infarction (MI) and repeat revascularisation. Secondary
endpoints were cardiovascular mortality, recurrent MI and repeat
revascularisation. Outcomes were analysed at longest available follow-up
with differences accounted for with adjusted models by person-years. Seven
RCTs (N=1303) were included. The median follow-up was 12 months. Complete
MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95%
CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI
(0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to
0.84), p=0.008). Complete MV-PCI was associated with a non-significant
trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10),
p=0.09) as well. In a sensitivity analysis, none of the baseline clinical
variables significantly influenced overall estimates. Conclusions: In
STEMI and MV disease, complete MVPCI as compared with non-complete
strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI
and 49% reduction in repeat revascularisation.

<75>
Accession Number
604712192
Author
Tian L.; Zhang J.; Xiao S.; Huang J.; Zhang Y.; Shen J.
Institution
(Zhang) Department of Pharmacy, Fujian Medical University Union Hospital,
Fuzhou 350001, China
(Tian, Xiao, Huang, Zhang, Shen) Fujian Insitute of Hematology, Fujian
Provincial Key Laboratory on Hematology, Fujian Medical University Union
Hospital, Fuzhou 350001, China
Title
Impact of polymorphisms of the GGCX gene on maintenance warfarin dose in
Chinese populations: Systematic review and meta-analysis.
Source
Meta Gene. 5 (pp 43-54), 2015. Date of Publication: September 01, 2015.
Publisher
Elsevier B.V.
Abstract
The meta-analysis was conducted to investigate the impact of
gamma-glutamyl carboxylase (GGCX) on maintenance warfarin dose. 8 studies
were included, focusing on the impact of GGCX single nucleotide
polymorphisms (SNPs) on mean daily warfarin dose (MDWD). GGCX (rs699664;
AA versus GG, GA versus GG, A versus GG) and GGCX (rs12714145; GA versus
GG, AA versus GG, A versus GG) showed no significant differences on mean
daily warfarin dose (MDWD). This meta-analysis was the first to report the
relationship between GGCX SNPs and MDWD in Chinese populations. No
evidence could be found in the relationship between SNPs of GGCX (rs699664
and rs12714145) and maintenance warfarin dose.<br/>Copyright &#xa9; 2015
Elsevier Ltd.

<76>
[Use Link to view the full text]
Accession Number
605233268
Author
Zhu F.; Gomersall C.D.; Ng S.K.; Underwood M.J.; Lee A.
Institution
(Zhu, Gomersall, Ng, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing
Street, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong
Title
A randomized controlled trial of adaptive support ventilation mode to wean
patients after fast-track cardiac valvular surgery.
Source
Anesthesiology. 122 (4) (pp 832-840), 2015. Date of Publication: 20 Apr
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Adaptive support ventilation can speed weaning after coronary
artery surgery compared with protocolized weaning using other modes. There
are no data to support this mode of weaning after cardiac valvular
surgery. Furthermore, control group weaning times have been long,
suggesting that the results may reflect control group protocols that delay
weaning rather than a real advantage of adaptive support ventilation.
Methods: Randomized (computer-generated sequence and sealed opaque
envelopes), parallel-arm, unblinded trial of adaptive support ventilation
versus physician-directed weaning after adult fast-track cardiac valvular
surgery. The primary outcome was duration of mechanical ventilation.
Patients aged 18 to 80 yr without significant renal, liver, or lung
disease or severe impairment of left ventricular function undergoing
uncomplicated elective valve surgery were eligible. Care was standardized,
except postoperative ventilation. In the adaptive support ventilation
group, target minute ventilation and inspired oxygen concentration were
adjusted according to blood gases. A spontaneous breathing trial was
carried out when the total inspiratory pressure of 15 cm H<inf>2</inf>O or
less with positive end-expiratory pressure of 5 cm H<inf>2</inf>O. In the
control group, the duty physician made all ventilatory decisions. Results:
Median duration of ventilation was statistically significantly shorter (P
= 0.013) in the adaptive support ventilation group (205 [141 to 295] min,
n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual
ventilator changes and alarms were less common in the adaptive support
ventilation group, and arterial blood gas estimations were more common.
Conclusion: Adaptive support ventilation reduces ventilation time by more
than 2 h in patients who have undergone fast-track cardiac valvular
surgery while reducing the number of manual ventilator changes and
alarms.<br/>Copyright &#xa9; 2015 The American Society of
Anesthesiologists, Inc.

<77>
Accession Number
607137650
Author
Ke J.-D.; Hou H.-J.; Wang M.; Zhang Y.-J.
Institution
(Ke, Hou, Wang, Zhang) Department of Anesthesiology, Friendship Hospital,
Capital Medical University, Beijing 100050, China
Title
The comparison of anesthesia effect of lung surgery through video-assisted
thoracic surgery: A meta-analysis.
Source
Journal of Cancer Research and Therapeutics. 11 (2015) (pp C265-C270),
2015. Date of Publication: 01 Dec 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The epidural anesthesia and general anesthesia are the most
commonly used in lung surgery through video-assisted thoracic surgery
(VATS). Each of these methods has their advantages and disadvantages, so
the aim of this meta-analysis is to identify which anesthesia is more
conducive to lung surgery under VATS and rehabilitation of patients.
Materials and Methods: The Cochrane Library Database (Issue 12, 2013),
PubMed (1966-2015), and China National Knowledge Infrastructure
(1950-2015) were searched without language restrictions. Meta-analyses
were conducted using Review Manager 5.2 software (The Cochrane
Collaboration, Software Update, Oxford). We calculated odds ratio (OR) and
its confidence interval (95% CI) to estimate the difference between
epidural anesthesia and general anesthesia through finishing of the
collected data. Results: Due to our search results, 7 studies were
included in our study. Studies among them show that different contents of
these articles are not all the same about research direction. Our findings
suggested that epidural anesthesia had more advantages than general
anesthesia for operative time (mean difference = - 23.85, 95% CI: - 29.67
- 18.03, P = 0.0001). More than that, epidural anesthesia showed a good
surgical outcome on postoperative hospital stay (mean difference = - 0.43,
95% CI: - 0.85 - 0.01, P = 0.04) than general anesthesia. But we found
that there were no different on numbers of people with complications (OR =
0.45, 95% CI: 0.23-0.89, P = 0.97) and headache occurrence (OR = 2.69, 95%
CI: 0.62-11.70, P = 0.91) between epidural anesthesia and general
anesthesia. Conclusion: These results indicated that epidural anesthesia
can save operating time and postoperative hospital stay time. But epidural
anesthesia and general anesthesia have the same effect on
complications.<br/>Copyright &#xa9; 2015 Journal of Cancer Research and
Therapeutics <br/> Published by Wolters Kluwer - Medknow.

<78>
Accession Number
600590850
Author
Alexander S.; Doukky R.
Institution
(Alexander, Doukky) Division of Cardiology, Rush University Medical
Center, Chicago, IL, United States
(Doukky) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, 1901 W. Harrison St., Chicago, IL 60612, United States
Title
Effective Risk Stratification of Patients on the Basis of Myocardial
Perfusion SPECT Is Dependent on Appropriate Patient Selection.
Source
Current Cardiology Reports. 17 (1) (no pagination), 2015. Date of
Publication: 2015.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Myocardial perfusion imaging (MPI) with single-photon emission computed
tomography (SPECT) is commonly used in risk assessment, as an abnormal
scan predicts a multifold increase in cardiac risk. Recent studies have
showed that application of the appropriate use criteria (AUC) sharpens the
prognostic value of SPECT-MPI, while inappropriate use is clinically
ineffective and may lead to unnecessary downstream invasive testing and
revascularization procedures. In this review, we will discuss recent
literature examining the impact of appropriate use on the prognostic value
of SPECT-MPI and downstream decision-making. We will also discuss the
implications of appropriate use on cost-effectiveness of
MPI.<br/>Copyright &#xa9; 2014, Springer Science+Business Media New York.

<79>
Accession Number
604611486
Author
Uebing A.; Rigby M.L.
Institution
(Uebing) Adult Congenital Heart Centre, National Centre for Pulmonary
Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP,
United Kingdom
(Uebing, Rigby) National Heart and Lung Institute, Imperial College School
of Medicine, London, United Kingdom
(Rigby) Department of Paediatric Cardiology, Royal Brompton Hospital,
London, United Kingdom
Title
The problem of infective endocarditis after transcatheter pulmonary valve
implantation.
Source
Heart. 101 (10) (pp 749-751), 2015. Date of Publication: 01 May 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<80>
[Use Link to view the full text]
Accession Number
600686586
Author
Akeju O.; Westover M.B.; Pavone K.J.; Sampson A.L.; Hartnack K.E.; Brown
E.N.; Purdon P.L.
Institution
(Akeju, Pavone, Sampson, Hartnack, Brown, Purdon) Department of
Anesthesia, Critical Care, and Pain Medicine, Massachusetts General
Hospital, 149 13th Street, Rm 4005, Boston, MS 02129, United States
(Westover) Department of Neurology, Massachusetts General Hospital,
Boston, MS, United States
(Akeju, Brown, Purdon) Harvard Medical School, Boston, MS, United States
(Westover, Brown, Purdon) Department of Brain and Cognitive Science,
Massachusetts Institute of Technology, Cambridge, MS, United States
(Brown) Harvard-Massachusetts Institute of Technology Division of Health
Sciences and Technology, Massachusetts Institute of Technology, Cambridge,
MS, United States
(Brown) Institute for Medical Engineering and Sciences, Massachusetts
Institute of Technology, Cambridge, United States
Title
Effects of sevoflurane and propofol on frontal electroencephalogram power
and coherence.
Source
Anesthesiology. 121 (5) (pp 990-998), 2014. Date of Publication: 04 Nov
2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The neural mechanisms of anesthetic vapors have not been
studied in depth. However, modeling and experimental studies on the
intravenous anesthetic propofol indicate that potentiation of
?-Aminobutyric acid receptors leads to a state of thalamocortical
synchrony, observed as coherent frontal alpha oscillations, associated
with unconsciousness. Sevoflurane, an ether derivative, also potentiates
?-Aminobutyric acid receptors. However, in humans, sevoflurane-induced
coherent frontal alpha oscillations have not been well detailed.
Methods: To study the electroencephalogram dynamics induced by
sevoflurane, the authors identified age- and sex-matched patients in which
sevoflurane (n = 30) or propofol (n = 30) was used as the sole agent for
maintenance of general anesthesia during routine surgery. The authors
compared the electroencephalogram signatures of sevoflurane with that of
propofol using time-varying spectral and coherence methods.
Results: Sevoflurane general anesthesia is characterized by alpha
oscillations with maximum power and coherence at approximately 10 Hz,
(mean +/- SD; peak power, 4.3 +/- 3.5 dB; peak coherence, 0.73 +/- 0.1).
These alpha oscillations are similar to those observed during propofol
general anesthesia, which also has maximum power and coherence at
approximately 10 Hz (peak power, 2.1 +/- 4.3 dB; peak coherence, 0.71 +/-
0.1). However, sevoflurane also exhibited a distinct theta coherence
signature (peak frequency, 4.9 +/- 0.6 Hz; peak coherence, 0.58 +/- 0.1).
Slow oscillations were observed in both cases, with no significant
difference in power or coherence.
Conclusions: The study results indicate that sevoflurane, like propofol,
induces coherent frontal alpha oscillations and slow oscillations in
humans to sustain the anesthesia-induced unconscious state. These results
suggest a shared molecular and systems-level mechanism for the unconscious
state induced by these drugs. &#xa9; 2014, the American Society of
Anesthesiologists, Inc.

<81>
[Use Link to view the full text]
Accession Number
606426495
Author
Une D.; Al-Atassi T.; Kulik A.; Voisine P.; Le May M.; Ruel M.
Institution
(Une, Al-Atassi, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, 40 Ruskin St., Ottawa, ON, Canada
(Le May) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Kulik) Lynn Heart and Vascular Institute, Boca Raton, FL, United States
(Voisine) Division of Cardiac Surgery, Hopital Laval, Quebec City, QC,
Canada
(Ruel) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Impact of Clopidogrel plus aspirin versus aspirin alone on the progression
of native coronary artery disease after bypass surgery analysis from the
Clopidogrel after surgery for coronary artery DiseasE (CASCADE) randomized
trial.
Source
Circulation. 130 (11) (pp S12-S18), 2014. Date of Publication: 09 Sep
2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-The effects of dual antiplatelet therapy with aspirin and
clopidogrel on the progression of native coronary artery disease after
coronary artery bypass grafting are unknown. Methods and Results-In the
Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a
total of 113 patients were randomized to receive aspirin plus clopidogrel
or aspirin plus placebo for 1 year after coronary artery bypass grafting.
In this secondary analysis, the 92 patients who underwent preoperative and
1-year postoperative angiograms at 2 centers had each of their coronary
stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1
[25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and
grade 5 [99%-100%]). We compared the incidence and degree of evolving
coronary artery disease between the 2 treatment groups. A total of 543
preoperative stenoses and occlusions were quantified and followed. At
1-year postoperatively, there were 103 evolving (94 worsened, 9 improved)
and 22 new lesions. The right coronary artery territory and sites proximal
to a graft were more commonly associated with worsening coronary artery
disease (P<=0.02). There were no differences in clinical events between
treatment groups, and the proportion of patients with evolving or new
lesions was also similar (70% versus 74%, aspirin-clopidogrel versus
aspirin-placebo, respectively; P=0.8). However, in evolving or new
lesions, the mean grade change (1.1+/-1.0 versus 1.6+/-1.1, respectively;
P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were
lower in the aspirin-clopidogrel group. Conclusions-The addition of
clopidogrel to aspirin correlates with less worsening of native coronary
artery disease 1 year after coronary artery bypass grafting. These
findings may help guide post-coronary artery bypass grafting antiplatelet
therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.
Unique identifier: NCT00228423.<br/>Copyright &#xa9; 2014 American Heart
Association, Inc.

<82>
Accession Number
53226786
Author
Shahzad A.; Kemp I.; Mars C.; Wilson K.; Roome C.; Cooper R.; Andron M.;
Appleby C.; Fisher M.; Khand A.; Kunadian B.; Mills J.D.; Morris J.L.;
Morrison W.L.; Munir S.; Palmer N.D.; Perry R.A.; Ramsdale D.R.; Velavan
P.; Stables R.H.
Institution
(Shahzad, Kemp, Mars, Wilson, Roome, Cooper, Andron, Appleby, Fisher,
Khand, Kunadian, Mills, Morris, Morrison, Munir, Palmer, Perry, Ramsdale,
Velavan, Stables) Institute of Cardiovascular Medicine and Science,
Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool L14
3PE, United Kingdom
Title
Unfractionated heparin versus Bivalirudin in primary percutaneous coronary
intervention (HEAT-PPCI): An open-label, single centre, randomised
controlled trial.
Source
The Lancet. 384 (9957) (pp 1849-1858), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Bivalirudin, with selective use of glycoprotein (GP) IIb/IIIa
inhibitor agents, is an accepted standard of care in primary percutaneous
coronary intervention (PPCI). We aimed to compare antithrombotic therapy
with bivalirudin or unfractionated heparin during this procedure. Methods:
In our open-label, randomised controlled trial, we enrolled consecutive
adults scheduled for angiography in the context of a PPCI presentation at
Liverpool Heart and Chest Hospital (Liverpool, UK) with a strategy of
delayed consent. Before angiography, we randomly allocated patients (1:1;
stratified by age [<75 years vs >=75 years] and presence of cardiogenic
shock [yes vs no]) to heparin (70 U/kg) or bivalirudin (bolus 0.75 mg/kg;
infusion 1.75 mg/kg per h). Patients were followed up for 28 days. The
primary efficacy outcome was a composite of all-cause mortality,
cerebrovascular accident, reinfarction, or unplanned target lesion
revascularisation. The primary safety outcome was incidence of major
bleeding (type 3-5 as per Bleeding Academic Research Consortium
definitions). This study is registered with ClinicalTrials.gov, number
NCT01519518. Findings: Between Feb 7, 2012, and Nov 20, 2013, 1829 of 1917
patients undergoing emergency angiography at our centre (representing 97%
of trial-naive presentations) were randomly allocated treatment, with 1812
included in the final analyses. 751 (83%) of 905 patients in the
bivalirudin group and 740 (82%) of 907 patients in the heparin group had a
percutaneous coronary intervention. The rate of GP IIb/IIIa inhibitor use
was much the same between groups (122 patients [13%] in the bivalirudin
group and 140 patients [15%] in the heparin group). The primary efficacy
outcome occurred in 79 (8.7%) of 905 patients in the bivalirudin group and
52 (5.7%) of 907 patients in the heparin group (absolute risk difference
3.0%; relative risk [RR] 1.52, 95% CI 1.09-2.13, p=0.01). The primary
safety outcome occurred in 32 (3.5%) of 905 patients in the bivalirudin
group and 28 (3.1%) of 907 patients in the heparin group (0.4%; 1.15,
0.70-1.89, p=0.59). Interpretation: Compared with bivalirudin, heparin
reduces the incidence of major adverse ischaemic events in the setting of
PPCI, with no increase in bleeding complications. Systematic use of
heparin rather than bivalirudin would reduce drug costs substantially.
Funding: Liverpool Heart and Chest Hospital, UK National Institute of
Health Research, The Medicines Company, AstraZeneca, The Bentley Drivers
Club (UK).

<83>
Accession Number
604462641
Author
Villella M.; Villella A.
Institution
(Villella) Cardiac Rehabilitation Unit, IRCCS 'Casa Sollievo della
Sofferenza', Head of Cardiac Rehabilitation Unit, Italy
(Villella) ASL FG Cardiology-CCU Department, 'Masselli Mascia' Hospital,
San Severo, Italy
Title
Exercise and cardiovascular diseases.
Source
Kidney and Blood Pressure Research. 39 (2-3) (pp 147-153), 2014. Date of
Publication: 22 May 2014.
Publisher
S. Karger AG
Abstract
Exercise is a physiologic stressor that has multiple beneficial effects on
cardiovascular system. Currently exercise training is a class I
intervention as part of a multifactorial long-term process that includes:
clinical assistance, assessment of global cardiovascular risk,
identification of specific objective for each cardiovascular risk factor,
formulation of an individual treatment plan with multiple intervention
aimed at reduction of the risk, educational programs, planning of long
term follow-up. This paper reviews the evidences of benefit of exercise in
the most common heart diseases and describes the role of exercise training
in the cardiac rehabilitation programs.<br/>Copyright &#xa9; 2014 S.
Karger AG, Basel.

<84>
Accession Number
605028700
Author
de Hoogd S.; Ahlers S.J.G.M.; van Dongen E.P.A.; Tibboel D.; Dahan A.;
Knibbe C.A.J.
Institution
(de Hoogd, Ahlers, Knibbe) St Antonius Hospital, Department of Clinical
Pharmacy, Koekoeklaan 1, Nieuwegein 3435 CM, Netherlands
(van Dongen) St Antonius Hospital, Department of Anesthesiology and
Intensive Care, Koekoeklaan 1, Nieuwegein 3435 CM, Netherlands
(Tibboel, Knibbe) Erasmus MC - Sophia Children's Hospital, Intensive Care
and Department of Pediatric surgery, Wytemaweg 80, Rotterdam 3015 CN,
Netherlands
(Dahan) Leiden University Medical Center, Department of Anesthesiology,
Albinusdreef 2, Leiden 2333 ZA, Netherlands
(Knibbe) Leiden University, Division of Pharmacology, Leiden Academic
Center for Drug Research, Einsteinweg 55, Leiden, Netherlands
Title
Remifentanil versus fentanyl during cardiac surgery on the incidence of
chronic thoracic pain (REFLECT): Study protocol for a randomized
controlled trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 466. Date of
Publication: November 27, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Chronic thoracic pain after cardiac surgery is prevalent (11
to 56%) and may affect patients' physical and mental health status.
Despite its favorable pharmacokinetic and pharmacodynamic properties, high
doses of remifentanil administered during surgery are reported to cause
acute postoperative pain and increased requirements for analgesics.
Recently, an association between remifentanil use and the incidence of
chronic thoracic pain in the long term was also reported. Our objective is
to investigate the influence of the intraoperative remifentanil on chronic
postoperative pain in a prospective randomized controlled trial.
Methods/design: In this prospective, randomized, single-blind clinical
trial, all patients (N =126) between 18 and 85 years undergoing cardiac
surgery via sternotomy receive a continuous infusion of propofol together
with intermittent intravenous fentanyl at predetermined times
perioperatively. Patients are randomized to receive either an additional
continuous infusion of remifentanil (0.15
mug^-1kgIBW^-1 min^-1) or additional
fentanyl (200 to 500 mug) as needed during surgery. The primary end point
is the prevalence of chronic thoracic pain 12 months after surgery.
Secondary end points include acute postoperative pain; postoperative
analgesic use; chronic thoracic pain 3 and 6 months after surgery; quality
of life (SF-12) at 3, 6 and 12 months after surgery; work productivity;
and use of health care. In addition, thermal detection and pain thresholds
are measured preoperatively, 3 days after surgery and 12 months after
surgery using quantitative sensory testing (QST). Finally, the influence
of several genetic variances on the different outcomes will be measured.
Discussion: Chronic thoracic pain is prevalent after cardiac surgery, and
research is needed to minimize the risk of chronic persistent
postoperative pain, which is an invalidating, long-term complication of
surgery. The objective of this trial is to determine the influence of
perioperative remifentanil on long-term pain outcomes for cardiac patients
in a prospective randomized trial. The results may be used to optimize
perioperative analgesia techniques and, thereby, improve quality of life
after cardiac surgery. Trial registration: Clinicaltrials.gov NCT02031016
on 13 December 2013.<br/>Copyright &#xa9; 2014 de Hoogd et al.; licensee
BioMed Central Ltd.

<85>
Accession Number
53240928
Author
Collet J.-P.; Silvain J.; Barthelemy O.; Range G.; Cayla G.; Van Belle E.;
Cuisset T.; Elhadad S.; Schiele F.; Lhoest N.; Ohlmann P.; Carrie D.;
Rousseau H.; Aubry P.; Monsegu J.; Sabouret P.; O'connor S.A.; Abtan J.;
Kerneis M.; Saint-Etienne C.; Beygui F.; Vicaut E.; Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Sabouret, O'connor, Abtan, Kerneis,
Montalescot) Institut de Cardiologie, Bureau 2-236, Centre Hospitalier
Universitaire Pitie-Salpetriere, 47 Boulevard de l'Hopital, Paris 75013,
France
(Range) Les Hopitaux de Chartres, Le Coudray, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Nimes, France
(Van Belle, Rousseau) CHRU de Lille, Lille, France
(Cuisset) Departement de Cardiologie, CHU La Timone, Marseille, France
(Elhadad) Cardiologie, CH de Lagny-Marne-la-Vallee, Lagny-sur-Marne,
France
(Schiele) CHU Jean Minjoz, Besancon, France
(Lhoest) GH du Centre Alsace, France
(Ohlmann) CHR, Strasbourg, France
(Carrie) CHU Rangueil, Toulouse, France
(Rousseau, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), Universite Denis Diderot, Paris, France
(Aubry) Centre Hospitalier Bichat, APHP, Paris, France
(Monsegu) Institut Mutualiste Montsouris, Paris, France
(Saint-Etienne) CHU Trousseau, Tours, France
(Beygui) ACTION Study Group, CHU, Caen, France
Title
Dual-antiplatelet treatment beyond 1 year after drug-eluting stent
implantation (ARCTIC-interruption): A randomised trial.
Source
The Lancet. 384 (9954) (pp 1577-1585), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Optimum duration of dual antiplatelet treatment (DAPT) after
coronary stenting remains uncertain, with an unknown efficacy to safety
ratio of extended treatment leading to discrepancies between international
guidelines and clinical practice. We assessed whether DAPT continuation
beyond 1 year after coronary stenting is beneficial. Methods: This
analysis was a planned extension of the previously published
ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a
strategy of platelet function testing with antiplatelet treatment
adjustment or a conventional strategy after coronary stenting with
drug-eluting stent (DES). We recruited patients (aged 18 years or older)
scheduled for planned DES implantation at 38 centres in France. After 1
year of follow-up, patients without contraindication to interruption of
DAPT were eligible for a second randomisation to this second phase of the
study (ARCTIC-Interruption). Using a computer-generated randomisation
sequence (1:1; stratified by centre), we allocated patients to a strategy
of interruption of DAPT where the thienopyridine was interrupted and
single aspirin antiplatelet treatment was maintained (interruption group)
or a strategy of DAPT continuation for 6-18 months (continuation group).
The primary endpoint was the composite of death, myocardial infarction,
stent thrombosis, stroke, or urgent revascularisation, analysed by
intention to treat. This trial is registered with ClinicalTrials.gov,
number NCT00827411. Findings: Between Jan 4, 2011, and March 3, 2012, 1259
eligible patients were randomly allocated to treatment in
ARCTIC-Interruption: 624 to the interruption group and 635 to the
continuation group. After a median follow-up of 17 months (IQR 15-18), the
primary endpoint occurred in 27 (4%) patients in the interruption group
and 24 (4%) patients in the continuation group (hazard ratio [HR] 1.17
[95% CI 0.68-2.03]; p=0.58). STEEPLE major bleeding events occurred more
often in the continuation group (seven [1%] patients) compared with the
interruption group (one [<0.5%] patient; HR 0.15 [0.02-1.20]; p=0.073).
Major or minor bleedings were also more common in the continuation group
compared with the interruption group (12 [2%] patients vs three [1%]
patients; HR 0.26 [0.07-0.91]; p=0.04). Interpretation: Our finding
suggests no apparent benefit but instead harm with extension of DAPT
beyond 1 year after stenting with DES when no event has occurred within
the first year after stenting. No conclusion can be drawn for high-risk
patients who could not be randomised. The consistency between findings
from all trials of such interruption suggests the need for a reappraisal
of guidelines for DAPT after coronary stenting towards shorter duration of
treatment. Funding: Allies in Cardiovascular Trials Initiatives and
Organized Networks (ACTION Study Group), Fondation de France,
Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM.

<86>
Accession Number
602896003
Author
Zarea K.; Maghsoudi S.; Dashtebozorgi B.; Hghighizadeh M.H.; Javadi M.
Institution
(Zarea, Dashtebozorgi) Chronic Disease Care Research Center, Nursing and
Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Maghsoudi) Alzahra Heart Charity Hospital, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Hghighizadeh) School of Health, Ahvaz Jundishapur University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Javadi) Research Center for Nursing and Midwifery Care in Family Health,
School of Nursing and Midwifery, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
Title
The impact of Peplau's therapeutic communication model on anxiety and
depression in patients candidate for coronary artery bypass.
Source
Clinical Practice and Epidemiology in Mental Health. 10 (1) (pp 159-165),
2014. Date of Publication: 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background and Objective: Anxiety and depression are among the
psychological disorders in heart surgeries. Establishing a simple
communication is essential to reduce anxiety and depression. Hence, the
objective of the present studywas to examine the impact of Peplau
therapeutic communication model on anxiety and depression in patients, who
were candidate for coronary artery bypass in Al-Zahra Heart Hospital,
Shiraz during 2012-2013. Methods: This is a clinical trial in which 74
patients were randomly divided into intervention and control groups, each
consisted of 37 patients. Anxiety and depression levels were assessed
before, and two and four months after intervention using the Hospital
Anxiety and Depression Scale (HADS). Seven therapeutic communication
sessions were held in four stages. Data were analyzed with the SPSS
(version 16) using analysis of covariance. Results: The mean anxiety and
depression levels decreased in the intervention group after the
therapeutic communication (p<0.01). Anxiety scores in the intervention
group before and after intervention were 10.23 and 9.38, respectively.
While the corresponding scores in the control group were 10.26 and 11.62,
respectively. Depression scores in the intervention group before and after
intervention were 11 and 9.13, respectively. The corresponding scores in
the control group were 11.30 and 12.08, respectively. Conclusion: The
results demonstrated the positive role of therapeutic communication in
reducing anxiety and depression of the patients. Therefore, the
therapeutic communication is recommended as a simple, cost effective and
efficient method in this area.<br/>Copyright &#xa9; Zarea et al.; Licensee
Bentham Open.

<87>
Accession Number
605028722
Author
Buggeskov K.B.; Jakobsen J.C.; Secher N.H.; Jonassen T.; Andersen L.W.;
Steinbruchel D.A.; Wetterslev J.
Institution
(Buggeskov, Andersen) The Heart Centre, Rigshospitalet, Department of
Cardiothoracic Anaesthesiology, 4142, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Jakobsen, Wetterslev) Centre for Clinical Intervention Research,
Rigshospitalet, The Copenhagen Trial Unit, 7812, Blegdamsvej 9, Copenhagen
DK-2100, Denmark
(Secher) Rigshospitalet, Department of Anaesthesiology, 2041, Blegdamsvej
9, Copenhagen DK-2100, Denmark
(Jonassen) University of Copenhagen, Department of Biomedical Sciences,
The Panum Institute, Blegdamsvej 3, Copenhagen DK-2200, Denmark
(Steinbruchel) The Heart Centre, Rigshospitalet, Department of
Cardiothoracic Surgery, 2152, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Detailed statistical analysis plan for the pulmonary protection trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 510. Date of
Publication: December 23, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Pulmonary dysfunction complicates cardiac surgery that
includes cardiopulmonary bypass. The pulmonary protection trial evaluates
effect of pulmonary perfusion on pulmonary function in patients suffering
from chronic obstructive pulmonary disease. This paper presents the
statistical plan for the main publication to avoid risk of outcome
reporting bias, selective reporting, and data-driven results as an update
to the published design and method for the trial. Results: The pulmonary
protection trial is a randomized, parallel group clinical trial that
assesses the effect of pulmonary perfusion with oxygenated blood or
CustodiolTM HTK (histidine-tryptophan-ketoglutarate) solution versus no
pulmonary perfusion in 90 chronic obstructive pulmonary disease patients.
Patients, the statistician, and the conclusion drawers are blinded to
intervention allocation. The primary outcome is the oxygenation index from
10 to 15minutes after the end of cardiopulmonary bypass until 24hours
thereafter. Secondary outcome measures are oral tracheal intubation time,
days alive outside the intensive care unit, days alive outside the
hospital, and 30- and 90-day mortality, and one or more of the following
selected serious adverse events: pneumothorax or pleural effusion
requiring drainage, major bleeding, reoperation, severe infection,
cerebral event, hyperkaliemia, acute myocardial infarction, cardiac
arrhythmia, renal replacement therapy, and readmission for a
respiratory-related problem. Conclusions: The pulmonary protection trial
investigates the effect of pulmonary perfusion during cardiopulmonary
bypass in chronic obstructive pulmonary disease patients. A preserved
oxygenation index following pulmonary perfusion may indicate an effect and
inspire to a multicenter confirmatory trial to assess a more clinically
relevant outcome. Trial registration: ClinicalTrials.gov identifier:
NCT01614951, registered on 6 June 2012<br/>Copyright &#xa9; 2014 Buggeskov
et al.

<88>
Accession Number
605028653
Author
Gasparovic H.; Kopjar T.; Anticevic A.; Rados M.; Malojcic B.; Ivancan V.;
Fabijanic T.; Cikes M.; Milicic D.; Gasparovic V.; Biocina B.
Institution
(Gasparovic, Kopjar, Ivancan, Fabijanic, Biocina) University of Zagreb,
Department of Cardiac Surgery, University Hospital Center Zagreb,
Kispaticeva 12, Zagreb 10 000, Croatia
(Rados) School of Medicine University of Zagreb, Croatian Institute for
Brain Research, Zagreb, Croatia
(Anticevic) Yale University School of Medicine, Departments of Psychiatry
and Psychology, New Haven, United States
(Rados) University of Zagreb, Department of Radiology, University Hospital
Center Zagreb, Zagreb, Croatia
(Malojcic) University of Zagreb, Department of Neurology, University
Hospital Center Zagreb, Zagreb, Croatia
(Cikes, Milicic, Gasparovic) University of Zagreb, Departments of
Cardiology and Internal Medicine, University Hospital Center Zagreb,
Zagreb, Croatia
Title
Impact of remote ischemic preconditioning preceding coronary artery bypass
grafting on inducing neuroprotection (RIPCAGE): Study protocol for a
randomized controlled trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 414. Date of
Publication: October 27, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Neurological complications after cardiac surgery have a
profound impact on postoperative survival and quality of life. The
increasing importance of strategies designed to improve neurological
outcomes mirrors the growing risk burden of the contemporary cardiac
surgical population. Remote ischemic preconditioning (RIPC) reduces
adverse sequelae of ischemia in vulnerable organs by subjecting tissues
with high ischemic tolerance to brief periods of hypoperfusion. This trial
will evaluate the neuroprotective effect of RIPC in the cardiac surgical
arena, by employing magnetic resonance imaging (MRI) and neurocognitive
testing. Methods: Patients scheduled for elective coronary artery bypass
grafting with the use of cardiopulmonary bypass will be screened for the
study. Eligible patients will be randomized to undergo either a validated
RIPC protocol or a sham procedure. The RIPC will be induced by inflation
of a blood pressure cuff to 200mmHg for 5minutes, followed by a 5-minute
reperfusion period. Three sequences of interchanging cuff inflations and
deflations will be employed. Neurocognitive testing and MRI imaging will
be performed preoperatively and on postoperative day 7. Paired pre- and
postoperative neurocognitive and neuroimaging data will then be compared.
The primary composite outcome measure will consist of new ischemic lesions
on brain MRI, postprocedural impairment in brain connectivity on
resting-state functional MRI (rs-fMRI), and significant new declines in
neurocognitive performance. The secondary endpoint measures will be the
individual components of the primary endpoint measures, expressed as
continuous variables, troponin T release on postoperative day 1 and the
incidence of major adverse cardiovascular events at 3months
postoperatively. Major adverse cardiovascular events, including
accumulating cardiovascular mortality, stroke, nonfatal myocardial
infarction, and rehospitalization for ischemia, will form a composite
endpoint measure. Discussion: This trial will aim to assess whether RIPC
in patients subjected to surgical myocardial revascularization employing
cardiopulmonary bypass initiates a neuroprotective response. Should the
results of this trial indicate that RIPC is effective in reducing the
incidence of adverse neurological events in patients undergoing coronary
artery bypass grafting, it could impact on the current standard of care.
Trial registration: ClinicalTrials.gov NCT02177981.<br/>Copyright &#xa9;
2014 Gasparovic et al.; licensee BioMed Central Ltd.

<89>
Accession Number
620550659
Author
Ren B.; Spitzer E.; Geleijnse M.L.; Zijlstra F.; de Jaegere P.P.T.; Van
Mieghem N.M.; Tijssen J.G.
Institution
(Ren, Spitzer, Geleijnse, Zijlstra, de Jaegere, Van Mieghem) Department of
Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Right ventricular systolic function in patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 257 (pp 40-45), 2018. Date of
Publication: 15 Apr 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Right ventricular (RV) systolic dysfunction is associated with
worse survival in patients undergoing surgical aortic valve replacement
(SAVR), yet it is not included in traditional risk scores of transcatheter
aortic valve implantation (TAVI) candidates. We aimed to evaluate the
prognostic value of RV systolic function on clinical outcomes in patients
undergoing TAVI at one year follow-up; and, echocardiographic changes of
RV systolic function up to 12 months after TAVI and compared with SAVR
when possible. Methods and results: This systematic review and
meta-analysis is registered in PROSPERO (CRD42017065761). Studies
investigating RV systolic function with echocardiography in TAVI cohorts
were identified from Medline, Embase and Cochrane databases. We used
random-effects models to assess differences in primary outcomes.
Twenty-one studies were identified, where RV systolic function and
clinical outcomes were assessed in eight (4016 patients) and RV systolic
function changes were evaluated in 14 (1709 patients). For the primary
outcome of all-cause death at one year, RV systolic dysfunction was
associated with a significant 78% relative risk increase (risk ratio[95%
confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit
significant heterogeneity (I² = 64%, P < 0.01). RV systolic
function was unchanged after TAVI throughout follow-up as shown with
tricuspid annular plane systolic excursion (TAPSE)(mean difference[95%
CI]pre-discharge = 0.03 [-0.92,0.99]mm,1-3 months =
-0.09[-0.89,0.71]mm,6-12 months = 0.52 [-0.29,1.32] mm, all P = NS), while
TAPSE was significantly reduced after SAVR (pre-discharge =
-10.17[-13.11,-7.24]mm, P < 0.01;1-3 months = -7.3[-8.17,-6.44]mm, P <
0.01;6-12 months = -5.99[-7.95,-4.03]mm, P < 0.01). Conclusions: RV
systolic dysfunction was associated with a significant increase in
all-cause mortality at one year after TAVI. RV systolic function was
unchanged after TAVI up to 12 months, whereas deteriorated significantly
after SAVR.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<90>
Accession Number
620565773
Author
Li Q.; Chen C.; Li T.; Xiong J.-Y.; Qin Z.; Luo M.; Tan Z.-X.; Liu T.; Yin
X.-R.; Yu H.; Zhou R.-H.
Institution
(Yu, Li, Chen, Li, Xiong, Qin, Luo, Tan, Liu, Yin, Yu, Zhou) Department of
Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan,
China
(Yu) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Effect of intralipid on myocardial injury during valve replacement surgery
with concomitant radiofrequency ablation.
Source
Medicine (United States). 97 (1) (no pagination), 2018. Article Number:
9603. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: This study aimed to evaluate the effect of intralipid
postconditioning (ILPC) on myocardial damage in patients undergoing valve
replacement surgery with concomitant radiofrequency ablation (RFA) for
atrial fibrillation (AF). Methods: Randomized patient and assessor-blind
controlled trial conducted in adult patients undergoing valve replacement
surgery with concomitant RFA. Sixty-nine patients were randomly assigned
to ILPC group (n = 34) or control group (n = 35): ILPC group received an
intravenous infusion of 20% intralipid (2 mL/kg) just 10 minutes before
aortic cross-unclamping, and control group received an equivalent volume
of normal saline. Serum cardiac troponin-T (cTnT) and creatine kinase-MB
(CK-MB) was measured before surgery and at 4, 12, 24, 48, and 72 hours
after surgery. The primary endpoints were the 72-hour area under the curve
(AUC) for cTnT and CK-MB. Results: The total 72-hour AUC of cTnT (P = .33)
and CK-MB (P = .52) were comparable between 2 groups. The left ventricle
ejection fraction at discharge (P = .011) was higher in the ILPC group
than that in the control group, while the AF recurrence did not differ
significantly between 2 groups. Conclusions: There was no observed
beneficial effect of ILPC on myocardial injury documented by the cardiac
biomarkers in patients undergoing valve replacement surgery with
concomitant RFA, and the effect of intralipid against myocardial I/R
injury is undetectable within the background of massive biomarker release
following ablation owing to localized myocardial necrosis. Besides, there
are no other published data about the cardioprotective role of intralipid
in patients undergoing this procedure and benefits of this protection need
further studies to validate.<br/>Copyright &#xa9; 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<91>
Accession Number
620804174
Author
Smit B.; Smulders Y.M.; van der Wouden J.C.; Oudemans-van Straaten H.M.;
Spoelstra-de Man A.M.E.
Institution
(Smit, Oudemans-van Straaten, Spoelstra-de Man) VU University Medical
Center, Department of Intensive Care, De Boelelaan 1117, Amsterdam MB
1007, Netherlands
(Smulders) VU University Medical Center, Department of Internal Medicine,
Amsterdam, Netherlands
(van der Wouden) VU University Medical Center, Department of General
Practice and Elderly Care Medicine, Amsterdam Public Health research
institute, Amsterdam, Netherlands
Title
Hemodynamic effects of acute hyperoxia: Systematic review and
meta-analysis.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 45. Date of
Publication: 25 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In clinical practice, oxygen is generally administered to
patients with the intention of increasing oxygen delivery. Supplemental
oxygen may, however, cause arterial hyperoxia, which is associated with
hemodynamic alterations. We performed a systematic review and
meta-analysis of the literature to determine the effect of hyperoxia on
central hemodynamics and oxygen delivery in healthy volunteers and
cardiovascular-compromised patients. Methods: PubMed and EMBASE were
searched up to March 2017. Studies with adult humans investigating changes
in central hemodynamics or oxygen delivery induced by acute normobaric
hyperoxia were included. Studies focusing on lung, retinal, or brain
parameters were not included. We extracted subject and oxygen exposure
characteristics, indexed and unindexed values for heart rate, stroke
volume, cardiac output, mean arterial pressure (MAP), systemic vascular
resistance, and oxygen delivery during normoxia and hyperoxia. For
quantitative synthesis of the data, a random-effects ratio of means (RoM)
model was used. Results: We identified 33 studies with 42 datasets. Study
categories included healthy volunteers (n = 22 datasets), patients with
coronary artery disease (CAD; n = 6), heart failure (HF; n = 6), coronary
artery bypass graft (CABG; n = 3) and sepsis (n = 5). Hyperoxia (arterial
oxygen tension of 234-617 mmHg) reduced cardiac output (CO) by 10-15% in
both healthy volunteers (-10.2%, 95% confidence interval (CI) -12.9% to
-7.3%) and CAD (-9.6%, 95% CI -12.3% to -6.9%) or HF patients (-15.2%, 95%
CI -21.7% to -8.2%). No significant changes in cardiac output were seen in
CABG or septic patients (-3%). Systemic vascular resistance increased
remarkably in patients with heart failure (24.6%, 95% CI 19.3% to 30.1%).
In healthy volunteers, and those with CAD and CABG, the effect was smaller
(11-16%) and was virtually absent in patients with sepsis (4.3%, 95% CI
-3.2% to 12.3%). No notable effect on MAP was found in any group (2-3%).
Oxygen delivery was not altered by hyperoxia. Considerable heterogeneity
existed between study results, likely due to methodological differences.
Conclusions: Hyperoxia may considerably decrease cardiac output and
increase systemic vascular resistance, but effects differ between patient
categories. Heart failure patients were the most sensitive while no
hemodynamic effects were seen in septic patients. There is currently no
evidence supporting the notion that oxygen supplementation increases
oxygen delivery.<br/>Copyright &#xa9; 2018 The Author(s).

<92>
Accession Number
621005723
Author
Wald D.S.; Bestwick J.P.
Institution
(Wald, Bestwick) Queen Mary University of London, Wolfson Institute of
Preventive Medicine, Barts, The London School of Medicine and Dentistry,
United Kingdom
Title
Association between serum calcium, serum phosphate and aortic stenosis
with implications for prevention.
Source
European Journal of Preventive Cardiology. 25 (5) (pp 551-556), 2018. Date
of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aortic stenosis is the most common cause of valvular heart
disease with no means of prevention. Lowering serum levels of calcium or
phosphate are potential preventive strategies but observational studies on
the associations with aortic stenosis are inconsistent. Design and
methods: A case-control study was conducted in 132 individuals undergoing
echocardiography (63 with aortic stenosis and 69 without) and the results
combined with three other comparable studies (914 individuals overall) to
provide a summary odds ratio of aortic stenosis for a 0.1 mmol/L increase
(approximately one standard deviation) in calcium and phosphate
respectively. The relationship between calcium and phosphate and the
severity of aortic stenosis, according to peak trans-aortic velocity, was
also examined in the case-control study using linear regression. Results:
Both calcium and phosphate were positively associated with aortic
stenosis. The summary odds ratio for a 0.1 mmol/L increase in calcium was
1.79 (95% confidence interval 1.07-2.99), p = 0.027 and for phosphate it
was 1.47 (1.08-2.01), p = 0.015. Peak trans-aortic velocity increased with
phosphate levels, 9% (4%-14%) per 0.1 mmol/L, p = 0.001, but not with
calcium, p = 0.089. Conclusions: If the associations are causal and
reversible, these results indicate that a small reduction in calcium or
phosphate levels, within the physiological rage, would translate into a
clinically significant reduction in the risk of aortic stenosis.
Randomised trials of calcium and phosphate lowering therapies in aortic
stenosis are needed.<br/>Copyright &#xa9; 2018, &#xa9; The European
Society of Cardiology 2018.

<93>
Accession Number
620888939
Author
Cantoni V.; Sollini M.; Green R.; Berchiolli R.; Lazzeri E.; Mannarino T.;
Acampa W.; Erba P.A.
Institution
(Cantoni, Green, Mannarino, Acampa) Department of Advanced Biomedical
Sciences, University Federico II, Naples, Italy
(Sollini) Department of Biomedical Sciences, Humanitas University, Pieve
Emanuele, Milan, Italy
(Berchiolli) Vascular Surgery, Department of Translational Research and
Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
(Lazzeri, Erba) Department of Translational Research and Advanced
Technologies in Medicine, Regional Center of Nuclear Medicine, University
of Pisa, Pisa, Italy
(Acampa) Institute of Biostructure and Bioimaging, National Council of
Research, Naples, Italy
Title
Comprehensive meta-analysis on [¹⁸F] FDG PET/CT and
radiolabelled leukocyte SPECT-SPECT/CT imaging in infectious endocarditis
and cardiovascular implantable electronic device infections.
Source
Clinical and Translational Imaging. 6 (1) (pp 3-18), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Background: The use of medical imaging has significantly increased over
the past decade in all fields of medicine according to the advances in
imaging technology. Cardiac infection represents an emblematic example
where the use of nuclear molecular techniques is evolving as an important
supplementary method for patients with suspected infection and diagnostic
difficulties. Positron emission computed tomography (PET/CT) using
fluor-18-fluorodeoxyglucose ([18F]FDG) and single-photon emission computed
tomography (SPECT) using radiolabeled leukocyte (WBC) have been widely
used in the diagnosis of infections. The aim of the present work is to
provide a systematic review and meta-analysis of the published data on the
use of hybrid nuclear medicine imaging [18F]FDG PET/CT and radiolabeled
leukocyte SPECT in the diagnostic workup of patients with IE and CIED
infection. Materials and methods: An English literature search was
performed using the PubMed, Cochrane and Web of Science databases to
identify articles. Studies were included if they assessed the diagnostic
accuracy of [18F]FDG PET/CT and SPECT or SPECT/CT WBC in the diagnosis of
possible infection, provided detailed criteria of a reference standard for
diagnosis of infection, and provided sufficient data to determine
sensitivity and specificity of [18F]FDG PET/CT and WBC SPECT-SPECT/CT. A
first analysis was performed considering IE as endpoint and compared
[18F]FDG PET/CT and WBC SPECT-SPECT/CT imaging. A second analysis
considered CIED as endpoint was performed only on [18F]FDG PET imaging
without a comparison with SPECT-SPECT/CT. Two additional analysis were
performed, including (i) the sub-analysis of the manuscripts dealing with
IE that were evaluated considering separately the ones dealing with NVE
and PVE, (ii) the sub-analysis of the manuscripts for IE and CIED where
patients underwent a specific preparation before undergoing [18F]FDG
PET/CT scan. Results: The IE group included 14 [18F]FDG PET/CT and 3
SPECT/CT studies, while the CIED infection set comprised 13 [18F]FDG
PET/CT and 1 SPECT/CT. For the subsequent sub-analysis within the group of
IE studies, we included seven studies for NVE (all the ones with < 50%
patients with native valve) and 11 studies for PVE (all patients with
prosthetic valve or with > 50% patients with prosthetic valve). The
sub-analysis, considering preparation protocols before [18F]FDG PET/CT
scan, included 17 studies. [18F]FDG PET/CT had good specificity (89%) and
lower sensitivity (71%), with high heterogeneity amongst studies. In the
sub-analysis of 18 manuscripts dealing with NVE and PVE, sensitivity and
specificity for NVE are 71 and 97%, respectively, while for PVE
sensitivity and specificity were 83 and 92%. For WBC SPECT/CT, we found an
overall sensitivity of 80% and specificity of 100%, even in the early
post-intervention phase. When proper patients' preparation is performed,
sensitivity increased from 72 to 76% and specificity from 86 to 90%.
Conclusions: [18F]FDG PET/CT and WBC SPECT/CT are useful for the diagnosis
of IE and CIED infection. WBC SPECT-SPECT/CT appears to be slightly more
specific than [18F]FDG PET/CT. On the other hand, [18F]FDG PET/CT has the
advantage of being faster and very sensitive, with the great potential to
allow an overall evaluation of the burden of the disease including
clinically relevant extra-cardiac foci of infection, leading to timely and
appropriate patients' management.<br/>Copyright &#xa9; 2018, Italian
Association of Nuclear Medicine and Molecular Imaging.

<94>
Accession Number
620843382
Author
Riegger H.; Hollinger A.; Seifert B.; Toft K.; Blum A.; Zehnder T.;
Siegemund M.
Institution
(Riegger, Hollinger, Blum, Zehnder, Siegemund) University Hospital Basel,
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency
Medicine and Pain Therapy, Basel, Switzerland
(Seifert) University of Zurich, Epidemiology, Biostatistics and Prevention
Institute, Zurich, Switzerland
(Toft) See-Spital, Horgen and Kilchberg branches, Department for
Anesthesia, Intensive Care and Emergency Medicine, Horgen and Kilchberg,
Switzerland
Title
Baden Prevention and Reduction of Incidence of Postoperative Delirium
Trial (PRIDe): A phase IV multicenter, randomized, placebo-controlled,
double-blind clinical trial of ketamine versus haloperidol for prevention
of postoperative delirium.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 142. Date of
Publication: 26 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is a neurobehavioural syndrome that frequently
develops in the postoperative setting. The incidence of elderly patients
who develop delirium during hospital stay ranges from 10 to 80% (Schonauer
et al., J Pept Sci. 2017). Delirium was first described more than half a
century ago in the cardiac surgery population (Blachy and Starr, Am J
Psychiatry 121:371-5, 1964), where it was already discovered as a state
that might be accompanied by serious complications such as prolonged ICU
and hospital stay, reduced quality of life and increased mortality.
Furthermore, the duration of delirium is associated with worse long-term
cognitive function in the general ICU population (Sessler et al., Am J
Respir Crit Care Med 166:1338-44, 2002). This long-term experience with
delirium suggests a high socioeconomic burden and has been a focus of many
studies (Nishio et al., Crit Care Med 5:953-7, 1997; Ehlenbach et al.,
JAMA 303:763-70, 2010; Jahangir et al., World J Cardiol 3:383-7, 2011;
Abegunde et al., Lancet 370:1929-1938, 2007; Darmon et al., Intensive Care
Med 43:829-840, 2017; Marino et al., J Nephrol 28:717-24, 2015; Ng LL et
al., J Am Coll Cardiol 69:56-69, 2017; Sezen et al., J Pharmacol Exp Ther
287:238-45, 1998; Kim et al., Ann Lab Med 37:388-97, 2017). Due to the
multifactorial origin of delirium, we have several but no incontestable
options for prevention and symptomatic treatment. Overall, delirium
represents a high burden not only for patient and family members, but also
for the medical care team that aims to prevent postoperative delirium to
avoid serious consequences associated with it. The purpose of this study
is to determine whether postoperative delirium can be prevented by the
combination of established preventive agents. In addition, measured levels
of pre- and postoperative cortisol, neuron specific enolase (NSE) and
S-100beta will be used to investigate dynamics of these parameters in
delirious and non-delirious patients after surgery. Methods/design: The
Baden PRIDe Trial is an investigator-initiated, phase IV, two-centre,
randomised, placebo-controlled, double-blind clinical trial for the
prevention of delirium with haloperidol, ketamine, and the combination of
both vs. placebo in 200 patients scheduled for surgery. We would like to
investigate superiority of one of the three treatment arms (i.e.,
haloperidol, ketamine, combined treatment) to placebo. Discussion: There
is limited but promising evidence that haloperidol and ketamine can be
used to prevent delirium. Clinical care for patients might improve as the
results of this study may lead to better algorithms for the prevention of
delirium.<br/>Copyright &#xa9; 2018 The Author(s).

<95>
[Use Link to view the full text]
Accession Number
620924588
Author
Hopkins M.K.; Goldstein S.A.; Ward C.C.; Kuller J.A.
Institution
(Hopkins, Kuller) Division of Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Duke University, Durham, NC, United States
(Goldstein, Ward) Division of Cardiology, Department of Internal Medicine,
Duke University, Durham, NC, United States
Title
Evaluation and Management of Maternal Congenital Heart Disease: A Review.
Source
Obstetrical and Gynecological Survey. 73 (2) (pp 116-124), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective Congenital heart defects represent the most common major
congenital anomalies. The objective of this review was to define the most
common forms of congenital heart disease (CHD) in pregnancy, outline
preconception counseling, discuss the associated morbidity and mortality
of each lesion, and review current recommendations for management of CHD
in pregnancy. Evidence Acquisition A MEDLINE search of "congenital heart
disease in pregnancy" and specific conditions in pregnancy including
"ventricular septal defect," "atrial septal defect," "left outflow
obstruction," "right outflow obstruction," "tetralogy of Fallot," and
"transposition of the great vessels" was performed. Results The evidence
included in the review contains 18 retrospective studies, 8 meta-analyses
or systematic reviews or expert opinions, 5 case reports including
surgical case reports, 2 prospective studies, and 2 clinical texts.
Conclusions Given advances in surgical and medical management, women with
a history of congenital cardiac defects are more frequently reaching
childbearing age and requiring obstetric care. Many women with CHD can
have successful pregnancies, although there are a few conditions that
confer significant maternal risk, and pregnancy may even be
contraindicated. Appropriate care for women with CHD requires a knowledge
of cardiac physiology in pregnancy, the common lesions of CHD, and
coordinated care from cardiology and maternal-fetal medicine specialists.
Target Audience Obstetricians and gynecologists, family physicians.
Learning Objectives After completing this activity, the learner should be
better able to compare pregnancy risks among varying types of the most
common maternal CHD; apply criteria of relative and absolute
contraindications to pregnancy when performing preconception counseling to
women with CHD; interpret for patients and other health providers the
prognosis, management, and expectations of pregnancies with women with the
most common types of CHD; and select relevant imaging studies, tests, and
appropriate consultations and referrals when caring for women with
maternal CHD.<br/>Copyright &#xa9; Wolters Kluwer Health, Inc. All rights
reserved.

<96>
Accession Number
614297390
Author
Dobbels F.; De Bleser L.; Berben L.; Kristanto P.; Dupont L.; Nevens F.;
Vanhaecke J.; Verleden G.; De Geest S.
Institution
(Dobbels, De Bleser, De Geest) Academic Centre for Nursing and Midwifery,
KU Leuven, Leuven, Belgium
(Dobbels, Berben, De Geest) Institute of Nursing Science, University of
Basel, Basel, Switzerland
(Kristanto) AARDEX Group, a WestRock Healthcare Company, Vise, Belgium
(Dupont, Verleden) Lung Transplant Program, University Hospitals of
Leuven, Leuven, Belgium
(Nevens) Liver Transplant Program, University Hospitals of Leuven, Leuven,
Belgium
(Vanhaecke) Heart Transplant Program, University Hospitals of Leuven,
Leuven, Belgium
Title
Efficacy of a medication adherence enhancing intervention in
transplantation: The MAESTRO-Tx trial.
Source
Journal of Heart and Lung Transplantation. 36 (5) (pp 499-508), 2017. Date
of Publication: May 2017.
Publisher
Elsevier USA
Abstract
Background Well-designed randomized controlled trials (RCTs) testing
efficacy of post-transplant medication adherence enhancing interventions
and clinical outcomes are scarce. Methods This randomized controlled trial
enrolled adult heart, liver, and lung transplant recipients who were >1
year post-transplant and on tacrolimus twice daily (convenience sample)
(visit 1). After a 3-month run-in period, patients were randomly assigned
1:1 to intervention group (IG) or control group (CG) (visit 2), followed
by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up
period (visit 5). All patients used electronic monitoring for 15 months
for adherence measurement, generating a daily binary adherence score per
patient. Post-intervention 5-year clinical event-free survival (mortality
or retransplantation) was evaluated. The IG received staged multicomponent
tailored behavioral interventions (visits 2-4) building on social
cognitive theory and trans-theoretical model (e.g., electronic monitoring
feedback, motivational interviewing). The CG received usual care and
attended visits 1-5 only. Intention-to-treat analysis used generalized
estimating equation modeling and Kaplan-Meier survival analysis. Results
Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline,
average daily proportions of patients with correct dosing (82.6% IG, 78.4%
CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had
a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p <
0.001), resulting in odds of adherence being 5 times higher in the IG than
in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This
effect was sustained at end of follow-up (similar results for timing
adherence). In the IG, 5-year clinical event-free survival was 82.5% vs
72.5% in the CG (p = 0.18). Conclusion Our intervention was efficacious in
improving adherence and sustainable. Further research should investigate
clinical impact, cost-effectiveness, and scalability.<br/>Copyright &#xa9;
2017 International Society for Heart and Lung Transplantation

<97>
Accession Number
616161456
Author
Sharma S.P.; Dahal K.; Khatra J.; Rosenfeld A.; Lee J.
Institution
(Sharma, Khatra) University of New England, LRGHealthcare, Laconia, NH,
United States
(Dahal) Division of Cardiology, Louisiana State University Health Science
Center, Shreveport, LA, United States
(Rosenfeld) Concord Cardiac Associates, Concord, NH, United States
(Lee) Division of Interventional Cardiology, Section of Cardiology,
University of Connecticut, Farmington, CT, United States
Title
Percutaneous coronary intervention vs coronary artery bypass grafting for
left main coronary artery disease? A systematic review and meta-analysis
of randomized controlled trials.
Source
Cardiovascular Therapeutics. 35 (3) (no pagination), 2017. Article Number:
e12260. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: It is not clear whether percutaneous coronary intervention
(PCI) is as effective and safe as coronary artery bypass grafting (CABG)
for left main coronary artery disease. We aimed to perform a systematic
review and meta-analysis of all randomized controlled trials (RCTs) that
compared PCI and CABG in left main coronary disease. Methods: We searched
PubMed, EMBASE, Cochrane, Scopus and relevant references for RCTs
(inception through, November 20, 2016 without language restrictions) and
performed meta-analysis using random-effects model. All-cause mortality,
myocardial infarction, revascularization rate, stroke, and major adverse
cardiac and cerebrovascular events (MACCE) were the measured outcomes.
Results: Six RCTs with a total population of 4700 were analyzed. There was
no difference in all-cause mortality at 30-day, one-year, and five-year
(1.8% vs 1.1%; OR 0.60; 95% CI: 0.26-1.39; P=.23; I²=9%)
follow-up between PCI and CABG. CABG group had less myocardial infarction
(MI) at five-year follow-up than PCI (5% vs 2.5%; OR 2.04; CI: 1.30-3.19;
P=.002; I²=1%). Revascularization rate favored CABG in one-year
(8.6% vs 4.5%; OR 2; CI: 1.46-2.73; P<.0001; I²=45%) and
five-year (15.9% vs 9.9%; OR 1.73; CI: 1.36-2.20; P<.0001;
I²=0%) follow-up. Although stroke rate was lower in PCI group
at 1 year, there was no difference in longer follow-up. MACCE at 5 years
favored CABG (24% vs 18%; OR 1.45; CI: 1.19-1.76; P=.0001;
I²=0%). On subgroup analysis, MACCE were not different between
two groups in low-to-intermediate SYNTAX group while it was higher for PCI
group with high SYNTAX group. Conclusion: Percutaneous coronary
intervention could be as safe and effective as CABG in a select group of
left main coronary artery disease patients.<br/>Copyright &#xa9; 2017 John
Wiley & Sons Ltd

<98>
Accession Number
613210196
Author
Chan J.L.; Kobashigawa J.A.; Reich H.J.; Ramzy D.; Thottam M.M.; Yu Z.;
Aintablian T.L.; Liou F.; Patel J.K.; Kittleson M.M.; Czer L.S.; Trento
A.; Esmailian F.
Institution
(Chan, Kobashigawa, Reich, Ramzy, Thottam, Yu, Aintablian, Liou, Patel,
Kittleson, Czer, Trento, Esmailian) Cedars-Sinai Heart Institute, Los
Angeles, California, United States
(Chan, Reich, Ramzy, Trento, Esmailian) Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, California, United States
Title
Intermediate outcomes with ex-vivo allograft perfusion for heart
transplantation.
Source
Journal of Heart and Lung Transplantation. 36 (3) (pp 258-263), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background The Organ Care System, an ex-vivo heart perfusion platform,
represents an alternative to the current standard of cold organ storage
that sustains the donor heart in a near-physiologic state. It is unknown
whether using the Organ Care System influences 2-year outcomes after heart
transplantation. We reviewed our institutional experience to compare
2-year outcomes for patients randomized to the Organ Care System or
standard cold storage. Methods Between 2011 and 2013, heart transplant
candidates from a single tertiary-care medical center enrolled within the
PROCEED II trial were randomized to either standard cold storage or the
Organ Care System. Outcomes assessed included 2-year survival, freedom
from cardiac allograft vasculopathy (CAV), non-fatal major cardiac events
(NF-MACE), biopsy-proven cellular rejection (CMR) and biopsy-proven
antibody-mediated rejection (AMR). Results Thirty-eight patients were
randomized to the Organ Care System (n = 19) or cold storage group (n =
19). There was no significant difference in 2-year patient survival (Organ
Care System: 72.2%; cold storage: 81.6%; p = 0.38). Similarly, there were
no differences in freedom from CAV, NF-MACE, CMR or AMR. The Organ Care
System group had significantly longer total ischemia time (361 +/- 96
minutes vs 207 +/- 50 minutes; p < 0.001) and shorter cold ischemia time
(134 +/- 45 minutes vs 207 +/- 50 minutes; p < 0.001) compared with the
cold storage group. Conclusion The Organ Care System did not appear to be
associated with significant differences in intermediate results compared
with conventional strategies. These results suggest that this ex-vivo
allograft perfusion system is a promising and valid platform for donor
heart transportation.<br/>Copyright &#xa9; 2017 International Society for
Heart and Lung Transplantation

<99>
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.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<100>
Accession Number
621116505
Author
Delanoe F.; Catargi B.
Institution
(Delanoe) CHU Rennes, Endocrinologie, Rennes, France
(Catargi) CHU Bordeaux, Endocrinologie-diabetologie, Bordeaux, France
Title
Randomised control trial of 2 groups of diabetes patients comparing
glucose control after coronary bypass by glucose monitoring alone or
associated with continuous glucose monitoring.
Source
Diabetes Technology and Therapeutics. Conference: 11th International
Conference on Advanced Technologies and Treatments for Diabetes, ATTD
2018. Austria. 20 (Supplement 1) (pp A66-A67), 2018. Date of Publication:
2018.
Publisher
Mary Ann Liebert Inc.
Abstract
Background and Aims: In intensive care, stress is a hyperglycemic factor
regardless of whether a patient is diabetic or not. Strict glucose control
has resulted in decreased mortality. Seeing as capillary blood glucose
measurement (CBGM) is imprecise and intermittent, we decided to compare
the efficiency of glycemic control under CBGM alone or associated with
real-time continuous glucose monitoring (RT-CGMS), in diabetic patients
following coronary bypass surgery. Method: Randomised control prospective
trial of 2 groups of patients; group 1: CBGM alone and group 2: CBGM
associated with RT-CGMS (Glucoday, Menarini), a sensor implanted in the
interstitial fluid directly following surgery for a period of 48h. The
main criterion was time spent in normoglycemia (0.8-1.1 g/L). Results: 45
patients (24 in group 1, 21 in group 2) were included: 37 men and 8 women
of 67.1+/-9.3 years old; 8 of type 1 diabetes and 37 of type 2. HbA1C
7.14+/-0.87% and upon entry glycemia 1.45+/-0.47 g/L.(<0.5 g/L) was
significantly bettered in group 2 (2.7 vs. 7.5%) as well as for time spent
in normoglycemia (9.2 vs. 6.4%). (Figure presented). Conclusion: This
study enabled us to see that RT-GMS allowed for an improvement of times
spent in hypoglycemia and normoglycemia for patients in surgical intensive
care. Larger randomised control trials along with insulin therapy
adaptation algorithm are necessary to properly establish the efficiency of
CGMS in intensive care.

<101>
Accession Number
621111924
Author
Anonymous
Title
Society of Surgical Oncology 71st Annual Cancer Symposium.
Source
Annals of Surgical Oncology. Conference: 71st Annual Cancer Symposium of
the Society of Surgical Oncology, SSO 2018. United States. 25 (1
Supplement 1) (no pagination), 2018. Date of Publication: February 2018.
Publisher
Springer New York LLC
Abstract
The proceedings contain 552 papers. The topics discussed include:
microscopic surgical margins and outcome in localized GIST treated within
the Eortc Stbsg, Agitg, unicancer, Fsg, Isg and Geis randomized trial on
adjuvant imatinib; molecular subtypes predict therapy response in
pancreatic cancer; nodal downstaging in gastric cancer: promising survival
if ypN0 is achieved; outcomes of patients with metastatic melanoma
selected for surgery after immunotherapy; FOLFIRINOX versus
gemcitabine/nab-paclitaxel for neoadjuvant treatment of resectable and
borderline resectable pancreatic adenocarcinoma: a propensity matched
analysis; changing practice patterns of adjuvant radiation among elderly
women with early stage breast cancer in the United States from 2004-2014;
chemoprevention uptake for breast cancer risk reduction varies by risk
factors; black-white breast cancer mortality disparities in Atlanta: an
update (2004-2014); radiation therapy associated sarcoma after breast
cancer treatment: a population-based study; the influence of anatomic
stage and receptor status on first recurrence for breast cancer within
five years (AFT-01); colon cancer quality measure adherence within
hospitals; detailed outcomes analysis of over 1500 patients determines the
safety and efficacy of enhanced recovery (ER) protocols in major oncologic
surgery; and defining volume thresholds for high-risk low-volume
gastrointestinal and thoracic operations: a pragmatic approach to
regionalization.

<102>
Accession Number
621081424
Author
Guest K.; Smith T.; Cynk M.
Institution
(Guest, Smith, Cynk) Maidstone and Tunbridge Wells NHS Trust, United
Kingdom
Title
Outcome and complications of holmium laser enucleation of the prostate in
patients on anticoagulation.
Source
Journal of Endourology. Conference: 35th World Congress of Endourology,
WCE 2017. Canada. 31 (Supplement 2) (pp A361), 2017. Date of Publication:
September 2017.
Publisher
Mary Ann Liebert Inc.
Abstract
Introduction & Objective: Holmium Laser Enucleation of the Prostate
(HoLEP) has emerged as an alternative to Transurethral Resection of the
Prostate (TURP) for the surgical management of bladder outflow obstruction
secondary to benign prostatic enlargement. A key advantage over TURP is
the reduced risk of significant bleeding complications. Patients on
anticoagulation pose a difficult challenge in this type of surgery. The
objective of this study was to evaluate the outcomes of HoLEP in patients
on anticoagulation in a large single centre UK series. Materials and
Methods: We retrospectively analysed a prospective database of all HoLEP
procedures performed under the care of a single consultant urological
surgeon between December 2003 and March 2017. We identified patients who
remained on anticoagulation in the peri-operative period. Those included
were either on anti-platelet therapy or anticoagulants such as warfarin
bridged with low molecular weight heparin (LMWH) or heparin infusion.
Outcome measures including post-operative flow rate (FR), post-void
residual volume (PVR) and international prostate symptom score (IPSS) were
compared between anticoagulated and non-anticoagulated patients using the
Mann-Whitney U test. Complications were listed in accordance with the
Clavien-Dindo classification system. Results: 1034 HoLEP procedures were
performed over a 13-year period. Of these, 57 patients remained on
anticoagulants perioperatively (age range 63-95 years). 29 were bridged
with prophylactic-dose LMWH, 11 with treatment-dose LMWH and 5 with
heparin infusion. Of those on anti-platelets, 7 remained on clopidogrel, 3
on aspirin and 2 on dual anti-platelets. Median FR of 19.3ml/s (range
7.9-40.1), PVR of 46ml (range 0-465) and IPSS of 0 (range 0-32) were found
in the anticoagulated group. There was no statistically significant
difference in FR (p = 0.77), PVR (p = 0.13) or IPSS (p = 0.72) between the
2 groups. Secondary haemorrhage and need for blood transfusion were
slightly more prominent in the anticoagulated group (7% and 1.8%,
respectively) than the non-anticoagulated group (0.9% and 0.3%,
respectively), although the number of these remains very low. Only one
anticoagulated patient had significant bleeding requiring return to
theatre. Other complications appeared comparable across both groups.
Conclusions: HoLEP is safe and effective in patients on anticoagulants.
Aspirin and clopidogrel do not need to be stopped prior to surgery. Our
practice is to temporarily stop warfarin in patients with atrial
fibrillation, and bridge with LMWH in those with prosthetic heart valves.
There is an increased risk of secondary bleeding in anticoagulated
patients, but overall the complication rate is low.

<103>
Accession Number
621102238
Author
Urja P.; Gujjula N.R.; Anugula D.; Parekh J.; Kumar M.; Walters R.W.;
Anantanarayan M.; Vivekanandan R.
Institution
(Urja, Gujjula, Anugula, Parekh, Walters, Vivekanandan) Creighton Univ Med
Cntr, Omaha, NE, United States
(Kumar) Nepal Med Association, Kathmandu, Nepal
(Anantanarayan) Univ of Minnesota, Minneapolis, MN, United States
Title
A retrospective study on heart-lung transplantation patient utilizing
united network for organ sharing database to identify the effect of CMV
donor recipient serostatus, age, sex, or anti-thymocyte immunoglobulin
therapy on mortality.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Heart-lung transplant is the treatment of choice for the
end-stage disease to improve the survival and the overall quality of life.
One of the major causes of the morbidity and hospitalization after the
heart-lung transplant is cytomegalovirus (CMV) infection. The major
determinant of CMV infection includes the donor (D) and recipient (R)
serological status present (+) or absent (-) at the time of transplant.
Different category of serostatus include high risk (D+/R-), intermediate
risk (D+/R+, D-/R+) and low risk (D-/R). The risk of CMV infection is also
related to the immunosuppressive protocol. Our aim was to identify if age,
sex, or anti-thymocyte immunoglobulin (ATG) immunosuppressive therapy are
associated with mortality in heart-lung transplant patients. Methods: We
retrospectively analyzed heart-lung transplant patients identified within
the United Network for Organ Sharing (UNOS) database. For mortality data,
differences in donor-recipient CMV serostatus were evaluated using
unadjusted and adjusted logistic regression models. SAS v. 9.4 was used
for statistical analysis with p < .05 used to indicate statistical
significance. Results: Of the 79,015 patients who had a heart and/or lung
transplant, CMV serostatus data was available for 49,294 patients (62%).
All 49,294 patients had gender and age data; however, only 3,080 (6%) had
ATG induction data. The overall mortality rate was 39%, with statistically
significant differences in mortality rate observed between the low and
intermediate risk groups (36% vs. 40%; p < 0.001) and between the low and
high risk groups (36% vs. 39%; p < 0.001). After adjusting for age, sex,
and ATG induction at discharge, low risk patients had 21% lower odds of
dying compared to high risk patients (95% CI = 1% to 37%; p = 0.040). The
effect of serostatus on mortality was not moderated by age, biological
sex, or ATG induction at discharge. Finally, a 1% increase in the odds of
dying was observed between patients who were one-year older at transplant
(p = 0.006), and patients who received ATG induction at discharge had 54%
lower odds of dying relative to patients who did not receive ATG induction
(p < 0.001). Conclusion: Serostatus had the exclusive effect on mortality
with higher mortality rate in high risk group compared to low risk
serostatus group. Young population group had lower mortality rate and ATG
induction therapy tends to lower the mortality rate.

<104>
Accession Number
621102180
Author
Goins A.; Strassle P.; Ramm C.; Teeter E.; Smeltz A.; Caranansos T.;
Vavalle J.; Kolarczyk L.
Institution
(Goins) Univ of North Carolina, Sch of Medicine, Chapel Hill, NC, United
States
(Strassle) Univ of North Carolina, Dept of Epidemiology, Chapel Hill, NC,
United States
(Ramm, Vavalle) Univ of North Carolina, Dept of Cardiology, Chapel Hill,
NC, United States
(Teeter, Smeltz, Kolarczyk) Univ of North Carolina, Dept of Anesthesia,
Chapel Hill, NC, United States
(Caranansos) Univ of North Carolina, Dept of Cardiothoracic Surgery,
Chapel Hill, NC, United States
Title
Total intravenous anesthesia as compared to volatile anesthesia is
associated with reduced length of stay after transcatheter aortic valve
replacement: Results from two-year program at major academic medical
center.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic valve replacement in patients with severe,
symptomatic aortic stenosis who are at least intermediate risk for
surgery. As TAVR has evolved, more emphasis has been placed on reducing
hospital length of stay (LOS) following the procedure. Therefore, we
sought to identify whether changes in the general anesthetic technique,
specifically using total intravenous anesthesia (TIVA) versus volatile
anesthesia (VA), would lead to reductions in hospital LOS. Methods: A
retrospective review was conducted of 67 consecutive patients at a single
institution who underwent TAVR under general anesthesia (GA) with either
TIVA or VA between November 2014 and July 2016. Hospital LOS, as well as
patient demographics, intraoperative, and postoperative risk factors for
prolonged hospital LOS were analyzed. Descriptive statistics were
conducted using Fisher's exact and Student's t-test. Risk factors for LOS
were assessed using unadjusted linear regression. Results: Data were
analyzed from 67 TAVR patients with a mean age of 78 +/- 9 years. The
patient population was 43% female (29/67), 88% Caucasian (59/67), with a
mean +/- SD aortic valve gradient of 42 +/- 17 mmHg with an ejection
fraction of 53 +/- 13 %. Of the 67 patients, 35 received TIVA (52%) and 32
received VA (48%). The majority of patients in both the TIVA and VA group
underwent TAVR with a transfemoral approach (29/35, 83% vs. 24/32, 75%,
p=0.55). Patients receiving TIVA had a shorter hospital LOS (3.7 +/- 2.6
days vs. 5.9 +/- 3.3 days, p=0.003) and shorter ICU LOS (1.5 +/- 0.8 days
vs. 2.7 +/- 2.0 days, p=0.004) as compared to patients receiving VA. For
every hour increase in anesthesia time, hospital LOS was increased by 0.92
days (p=0.02). Patients receiving GA with propofol infusion had a
reduction in hospital LOS by 1.9 days (p=0.02) and a reduction in ICU LOS
by 1 day (p=0.009) as compared to patients who received VA with
desflurane. Conclusions: Reducing hospital LOS following TAVR is a complex
and multifactorial problem. Our study suggests that anesthetic technique,
the particular mix of drugs used for GA, and the time under GA all play a
role in determining the hospital LOS. This finding can influence
refinements in the techniques used to care for patients undergoing TAVR
and may help us continue to reduce hospital LOS following TAVR.

<105>
Accession Number
621102074
Author
Barrett A.M.; DiBenedetti D.B.; Rane P.; Wade S.; Qian Y.
Institution
(Barrett, DiBenedetti) RTI Health Solutions, Rsch Triangle Park, NC,
United States
(Rane, Qian) Amgen, Thousand Oaks, CA, United States
(Wade) Wade Outcomes Rsch and Consulting, Salt Lake City, UT, United
States
Title
Assessing attitudes and treatment preferences among patients with
hyperlipidemia: Patient focus groups.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To better understand current and recent statin users'
perceptions, attitudes, experiences, and preferences related to
hyperlipidemia (HLD) and its treatment. Methods: Four focus groups were
conducted in 2 cities in the US with individuals (N = 28) >= 18 years old
self-reporting a clinician diagnosis of HLD for >= 6 months and current or
previous statin use for >= 3 months in the past year. Two of the focus
groups included a total of 13 participants reporting a cardiovascular
event or surgery (e.g., heart attack, stroke, stent placement) in the past
10 years (CV group). The other two groups included a total of 15
participants who had not had a CV event or surgery (non-CV group). Concern
about HLD and treatment motivation, adherence, and preferences were
explored. Results: Among the 28 participants, 15 (53.6%) were male. The
mean age was 57.3 +/- 10.1 years. At screening, 6 (21.4%) participants
were not using a statin, and 3 of these 6 reported statin intolerance. The
majority of the 28 participants (17; 60.7%) had switched statins.
Including their current statin, 10 (35.7%) participants had used 2
statins, and 7 (25.0%) had used 3 statins. Twelve (42.9%) participants had
experienced statin-related muscle aches. Participants reported high levels
of statin adherence, but reasons for dissatisfaction were noted: adverse
events (primarily muscle aches and gastrointestinal symptoms),
insufficient lowering of cholesterol levels, and worry about potential
liver damage with long-term use. All participants identified having no/few
side effects, lowering cholesterol levels, and preventing CV events as
important attributes of cholesterol-lowering drugs (CLDs). Avoidance of
drug-drug interactions was important for all 13 CV group participants but
for only 4 of the 15 (26.7%) non-CV group participants. Although
participants believed statins reduced cholesterol levels, they generally
considered lifestyle changes, such as eating a healthy diet and
exercising, to be more or as effective. Overall, 60.7% (17 of 28) said
they would be willing to try an injectable CLD in addition to their
current treatment if cholesterol levels were not sufficiently lowered.
Given the choice of a prefilled syringe, autoinjector, or on-body infusor
(with no limit on the number of selections), the autoinjector was
acceptable to the largest percentage of participants (22 of 28; 78.6%),
followed by the on-body infusor (13 of 28; 46.4%). More participants in
the CV group than the non-CV group were willing to try each type of
injection. Discussion: The frequent switching and side effects highlight
significant unmet need in patients with HLD and dissatisfaction with
statins among current and recent users, with and without a history of CV
events. Results also suggest that a sizeable portion of patients with HLD
may be willing to try an injectable CLD.

<106>
Accession Number
621102037
Author
Majeed M.U.; Green K.D.; Fudim M.; Robbins M.A.; Zhao D.X.
Title
Endovascular management of major vascular access site complications during
transcatheter aortic valve implantation (TAVI).
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Major vascular access site complications remain a challenge in
the field of TAVI and are associated with higher 30 day mortality.
However, outcomes following endovascular management with covered stents
for such complications are not well established. Methods: We reviewed the
one year data of patients who underwent TAVI at our institution with a
Sapien valve by percutaneous femoral approach. Identified were patients
who suffered major vascular complications according to the definitions set
forth by the Valve Academic Research Consortium. We then compared the
outcome of patients managed by an endovascular approach with a population
whose femoral access site complications were managed
surgically/endovascularly (85.7% surgically), as reported from the Partner
trial. Results: A total of 16 patients experienced Major Vascular
complications. TAVI was aborted on 2 patients due to access site
complication. Excluded were 3 patients who had benign small ascending
aortic dissections after successful valve deployment and 3 patients who
were managed surgically. Ten remaining patients were managed by a pure
endovascular approach with covered stents. Four of these patients suffered
ilio-femoral dissection, 4 had perforation and 2 had both perforation and
dissection. No significant difference was observed in pre and post
procedure creatinine (1.01 vs 1.14, p=0.16) and none required dialysis
within 30 days, as compared with 8.1% in Partner trial. We observed no
statistically significant difference between the Partner trial cohort and
our patients in 30 day all cause mortality (14.1% vs 10%, p=1), stroke
rate (4.8% vs 0%, p=1), access site hematoma (22.9% vs 0%, p=0.1),
retroperitoneal bleed (9.5% vs 0%, p=0.6), pseudoaneurysm (3.4% vs 0%,
p=1), and gastrointestinal ischemia (1.6% vs 0%). No access site
infection, stent thrombosis, or stenosis leading to limb ischemia were
noted clinically at 30 day follow-up. Conclusion: Many patients with major
vascular complications during TAVI can be treated with a pure endovascular
approach. In our small series we observed no difference in concurrent
complications when an endovascular repair can be rapidly initiated as
compared to a primary surgical approach.

<107>
Accession Number
621102034
Author
Atreya A.R.; Priya A.; Stefan M.S.; Pack Q.R.; Lagu T.; Lotfi A.S.;
Lindenauer P.K.
Title
Outcomes associated with perioperative amiodarone in cardiac surgery
patients receiving metoprolol.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Post-operative atrial fibrillation (POAF) after cardiac
surgery occurs frequently and the guidelines make a Class I recommendation
for peri-operative betablocker use and a Class IIa recommendation for
amiodarone use in high risk patients to reduce length of stay and
mortality. Our aim was to study the association between perioperative
amiodarone use and clinical outcomes in patients already receiving
metoprolol, in a real-world cohort. Methods: Using the PREMIER, Inc. data
warehouse, we identified patients >=18 years without atrial fibrillation
at baseline, who underwent elective cardiac surgery during years
2013-2014. We included patients with conditions replicating prior
randomized controlled studies. We then excluded all patients not receiving
metoprolol. Perioperative amiodarone use was defined as administered on
the day of surgery or prior to surgery within the same hospitalization.
After propensity matching, we compared outcomes for patients receiving
perioperative amiodarone + metoprolol vs. those who received only
metoprolol. The primary outcome was POAF and secondary outcomes were
in-hospital mortality, length of stay and 1 month readmission among
survivors. Results: Among 4351 patients who underwent cardiac surgery and
received metoprolol at 212 hospitals, 997 (23%) were treated with
perioperative amiodarone. We matched 928 (94%) of perioperative amiodarone
treated group based on the propensity score. Table 1 shows baseline
characteristics and outcomes of interest in the propensity matched cohort.
Median age was 66 years and 74% were male. The propensity matched cohort
was well balanced on type of surgery and comorbidities and some imbalances
remained in demographic variables. After adjusting for unbalanced factors
in the matched cohort, perioperative amiodarone+ metoprolol was associated
with reduction in POAF (ARR 5.1%; RR 0.81, 95% CI 0.69-0.95). There were
no differences in in-hospital mortality, length of stay, 1 month
readmission or cost of hospitalization. Conclusions: In this large cohort
of propensity matched patients undergoing elective cardiac surgery,
perioperative amiodarone use was associated with a modestly significant
reduction in POAF rates, but there were no significant relationships with
mortality, length of stay, 1 month readmission or costs. (Table
Presented).

<108>
Accession Number
621102028
Author
Atreya A.R.; Priya A.; Stefan M.S.; Pack Q.R.; Lagu T.; Lotfi A.S.;
Lindenauer P.K.
Institution
(Atreya, Priya, Stefan, Pack, Lagu, Lotfi, Lindenauer) Univ of
Massachusetts Med Sch-Baystate, Springfield, MA, United States
Title
Association between perioperative amiodarone and postoperative atrial
fibrillation following cardiac surgery.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: American
Heart Association's Quality of Care and Outcomes Research 2017 Scientific
Sessions, AHA QCOR 2017. United States. 10 (Supplement 3) (no pagination),
2017. Date of Publication: March 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Amiodarone effectively reduces the incidence of postoperative
atrial fibrillation (POAF) in randomized trials and guidelines give a
Class IIa recommendation for its use in high risk patients to improve
outcomes; but little is known about its effectiveness to prevent POAF in
routine clinical practice. Our aim was to determine the association
between perioperative amiodarone use and clinical outcomes in a real-world
cohort. Methods: We identified patients aged >=18 years without atrial
fibrillation at baseline, who underwent elective coronary artery bypass
surgery +/- heart valve surgery in a hospital that contributed to PREMIER,
Inc. data warehouse during 2013-2014. We excluded patients to replicate
patients enrolled in prior randomized controlled studies. Perioperative
amiodarone use was defined as receipt of amiodarone on the day of surgery
or prior to surgery within the same hospitalization. We used propensity
scores to match patients who received perioperative amiodarone to patients
who did not, and compared outcomes. Our primary outcome was POAF (not
present on admission). Secondary outcomes included in-hospital mortality,
1 month-readmission among survivors, length of stay and cost. Results: We
examined 12,758 patients free of AF admitted at 235 hospitals, of which
2191 (17%) were treated with perioperative amiodarone. Baseline
characteristics were well matched after propensity scoring. (Table 1)
After adjustment, receipt of amiodarone was associated with reduction in
POAF in the matched cohort (ARR 5.6%; RR 0.83, 95% CI 0.75-0.92) but was
associated with greater risk of ventricular arrhythmias (OR: 1.66, 95% CI:
1.20 - 2.29), cardiogenic shock (OR: 1.66, 95% CI: 1.13 - 2.42) and higher
hospitalization costs ($1,159, 95% CI: $373 - $1,946). There were no
differences in in-hospital mortality, length of stay, 1 month readmission.
Conclusions: In this large cohort of propensity matched patients
undergoing elective cardiac surgery, perioperative amiodarone use was
associated with a modest reduction in POAF, but there was no significant
relationship with mortality, length of stay, or 1 month readmission.
However, we found a small increase in risk of ventricular arrhythmias,
cardiogenic shock and costs; findings that have not previously been
described and require further evaluation. (Table Presented).

<109>
Accession Number
621112964
Author
Wenczel J.; Santer D.; Mach M.; Hoti G.; Koschutnik M.; Oliva S.; Polat
E.; Pisarik H.; Boswart F.; Koller U.; Haumer H.; Weiss G.; Grabenwoger M.
Institution
(Wenczel, Santer, Mach, Hoti, Koschutnik, Oliva, Polat, Pisarik, Boswart,
Koller, Haumer, Weiss, Grabenwoger) LBC F. Kardiovaskulare Forsch., Bes.
Einrichtung F. Biomed. Forsch. Karl Landsteiner Gesell. for Cardiosurgical
Res. Dept. of Cardiovasc. Surg., Inst. F. Labormedizin, Abt. F. Anasthesie
und Intensivmedizin, Hosp. Hietzing, Vienna, Austria
Title
Does CytoSorb adsorber therapy during extracorporeal circulation reduce
postoperative inflammatory response?.
Source
Wiener Klinische Wochenschrift. Conference: 2016 Jahrestagung der
Osterreichischen Kardiologischen Gesellschaft. Austria. 128 (3 Supplement
1) (pp S234-S235), 2016. Date of Publication: 2016.
Publisher
Springer-Verlag Wien
Abstract
Background: Systemic inflammatory response syndrome (SIRS) after
extracorporal circulation is a serious risk factor in cardiac surgery. The
CytoSorb adsorber is integrated in the cardiopulmonary bypass (CPB) in
order to extract inflammatory mediators such as IL-6 and therefore reduce
the severity of postoperative inflammation. The aim of this retrospective
study was to analyze whether CytoSorb application reduces SIRS during CPB
in cardiac surgery. Methods: From January to February 2016 seven patients
(29 % females, 60 +/- 6a) underwent cardiac surgery with Cyto-Sorb (Valve
+ CABG: n = 3, CABG only: n = 1, valve + aortic procedure: n = 3). After
propensity score matching 11 patients (18 % females, 63 +/- 3a) of the
same observation period were included into the control group.
Interleukin-6 (IL-6), c-reactive protein, fibrinogen and leukocytes were
compared at three time points: preoperatively, one hour after surgery and
on postoperative day one. Both groups were compared by student's t-test
and ANOVA for repeated measurements. Data are given as means +/-SEM.
Results: In total, 18 patients were included into the study. CPB time
(CytoSorb vs. control: 152 +/- 19 min vs. 120 +/- 7 mins, n. s.), as well
as aortic cross clamp time (CytoSorb vs. control: 86 +/- 5 min vs. 107 +/-
13 min, n. s.) were comparable in both groups. Postoperative ventilation
time and ICU stay did not differ between the groups. The total volume
demand during CPB was significantly higher in the CytoSorb group (6714 +/-
535 ml vs. control group 4334 +/- 382 ml; p < 0.01). Leukocytes were
significantly increased in the CytoSorb group on the first postoperative
day (19 +/- 2 vs. 13 +/- 1 G/L; p < 0.05). No statistical difference was
observed for IL-6, c-reactive protein and fibrinogen. Conclusions: No
beneficial effects of the CytoSorb adsorber could be documented within the
first 24 h postoperatively. Moreover, intraoperative volume demand and
leucocytes were even significantly increased in the CytoSorb group. IL-6
did not differ from the control group. Next step is a prospective
randomized trial to confirm these preliminary results and to analyze
further relevant inflammatory parameters.

<110>
Accession Number
621112959
Author
Wagner G.; Steiner S.; Wildner B.; Mayr H.; Moertl D.
Institution
(Wagner, Steiner, Wildner, Mayr, Moertl) Clin. Dept. of Int. Med. 2, Univ.
Hosp. St. Poelten, St. Poelten, Austria Dept. of Interventional Angiol.,
Univ. Hosp. Leipzig, Leipzig, Germany Univ. Lib.-Info. Retr. Off., Med.
Univ. of Vienna, Vienna, Austria
Title
One-year mortality after transcatheter aortic valve implantation (TAVI)
compared to surgical aortic valve replacement (SAVR): A systematic
literature review and meta-analysis.
Source
Wiener Klinische Wochenschrift. Conference: 2016 Jahrestagung der
Osterreichischen Kardiologischen Gesellschaft. Austria. 128 (3 Supplement
1) (pp S328-S329), 2016. Date of Publication: 2016.
Publisher
Springer-Verlag Wien
Abstract
Background: Transcatheter aortic valve replacement (TAVI) has become an
alternative treatment option also in patients eligible for surgical aortic
valve replacement (SAVR), but with an increased peri-operative risk.
Supplementary to data from randomized controlled trials (RCTs) comparing
TAVI with SAVR, the body of evidence from non-randomized trials is
constantly growing. While these real-world cohorts better reflect clinical
reality, they are often small-sized and significant effects might only be
visible upon pooling in a meta-analysis. Therefore, we performed a
systematic review and meta-analysis to compare the effects of TAVI and
SAVR on one-year mortality including both randomized and non-randomized
studies. Methods: A systematic literature search was performed to identify
studies comparing TAVI in at least 20 patients to alternative treatment
strategies and reporting mortality as outcome. For the purpose of this
presentation, only comparisons of oneyear mortality between TAVI and SAVR
are reported. Six electronic databases were searched between 1st of
January 2002 and 15th of January 2015, updates were screened until 15th of
June 2015. In addition, hand searching was performed. Two reviewers
independently performed eligibility assessment, study selection, data
extraction and quality assessment. Metaanalysis of relative risks and 95 %
confidence intervals were calculated using fixed (Mantel-Haenszel) or
random-effects (Figure Presented) models (DerSimonian and Laird, in case
of high heterogeneity [I2 >50 %]). Results: After screening of 5747
abstracts data were extracted from 65 publications, of which 32 reported
one-year mortality of TAVI versus SAVR. These comprised 3 randomized
controlled trials and 29 cohort studies (9 with propensity score matching)
comparing TAVI with SAVR. Pooled analysis showed no difference in one-year
mortality between TAVI and SAVR in both the complete study sample (32
studies, 21152 patients, RR 1.09, 95 % CI 0.84-1.41, p = 0.523, I2 = 88.1
%) and in a subgroup including only RCTs and propensity score matched
studies (12 studies, 3718 patients, RR 0.95, 95 % CI 0.83-1.09, p = 0.414,
I2 = 3.1 %, Fig. 1). Conclusions: Our meta-analysis showed no difference
for one-year mortality between TAVI and SAVR. This not only confirms
previous data from randomized controlled trials but also supports the
establishment of heart teams in order to make recommendations for either
approach on an individual basis.

<111>
Accession Number
621112916
Author
Distelmaier K.; Roth C.; Schrutka L.; Steinlechner B.; Heinz G.; Lang I.;
Maurer G.; Koinig H.; Wiedemann D.; Niessner A.; Hulsmann M.; Speidl W.;
Goliasch G.
Institution
(Distelmaier, Roth, Schrutka, Steinlechner, Heinz, Lang, Maurer, Koinig,
Wiedemann, Niessner, Hulsmann, Speidl, Goliasch) Univ. Klin. F. Inn. Med.
II, Kardiol., Med. Univ. Wien, Vienna, Austria Landesklinikum Krems,
Krems, Austria
Title
Beneficial effects of levosimendan on survival in patients undergoing
extracorporeal membrane oxygenation following cardiovascular surgery.
Source
Wiener Klinische Wochenschrift. Conference: 2016 Jahrestagung der
Osterreichischen Kardiologischen Gesellschaft. Austria. 128 (3 Supplement
1) (pp S322-S323), 2016. Date of Publication: 2016.
Publisher
Springer-Verlag Wien
Abstract
Background: The impact of levosimendan treatment on clinical outcome in
patients undergoing extracorporeal membrane oxygenation (ECMO) support
following cardiovascular surgery is unknown. It is tempting to speculate
that the benefical effects of levosimendan are more efficiently translated
into improved survival, when adequate end-organ perfusion is ensured by
concomitant ECMO therapy. We therefore analyzed the impact of levosimendan
treatment on survival and ECMO weaning failure in ECMO patients following
cardiovascular surgery. Methods: We enrolled a total of 240 patients
undergoing veno-arterial ECMO therapy following cardiovascular surgery at
a university-affiliated tertiary care center in our registry. Results: The
median SAPS-3 score and median EuroSCORE of the study population were 43
(IQR 36-51) and 10 (IQR 8-13), respectively. ECMO support was initiated in
59 patients after valve surgery, in 24 after coronary artery bypass graft
(CABG) surgery, in 56 after combined CABG-valve surgery, in 51 patients
after cardiac transplantation, in 21 patients after ventricular assist
device implantation, in 17 after aortic reconstruction and in 12 after
other cardiovascular surgeries. Indications for ECMO implantation were
weaning failure from cardiopulmonary bypass (60 %), postoperative
cardiogenic shock (20 %), immediate post-transplant cardiac graft failure
(6 %), postoperative respiratory failure (4 %), postoperative
bleeding/tamponade with cardiogenic shock (4 %), and miscellaneous
conditions (6 %). In total 75 % of patients received levosimendan during
the first 24 hours following ECMO implantation. In brief, ECMO patients
treated with levosimendan had a higher EuroSCORE (P < 0.001) and SAPS III
score (P = 0.02), had a lower left ventricular ejection fraction (P =
0.04), and required higher doses of noradrenaline (P < 0.001) and
dobutamine (P = 0.014). Over a median follow-up of 37 months (IQR 19 to 67
months), 65 % of patients died. Seventy-five percent of patients received
levosimendan treatment within the first 24 hours after initiation of ECMO
therapy. Cox regression analysis revealed a beneficial association between
levosimendan treatment and successful ECMO weaning (adj. HR 0.41; 95 %CI
0.22-0.80; p = 0.008 Fig. 1a), 30-day mortality (adj. HR 0.52; 95 %CI
0.30-0.89; P = 0.016; Fig. 1b), and long-term mortality (adj. HR 0.64; 95
%CI 0.42-0.98; P = 0.04; figure 1C). Conclusions: The present data suggest
that an association between levosimendan treatment and improved short- and
long-term survival in patients undergoing ECMO support following
cardiovascular surgery. The current study advances the limited knowledge
on the effects of levosimendan treatment in this specific patient
population enabling a more individualized treatment decision-making.
(Figure Presented).

<112>
Accession Number
621119885
Author
Deng B.; Qian K.; Zhou J.-H.; Tan Q.-Y.; Wang R.-W.
Institution
(Deng, Qian, Zhou, Tan, Wang) Department of Thoracic Surgery, Institute of
Surgery Research, Daping Hospital, Third Military Medical University,
Chongqing, 400042, People's Republic of China
Title
Optimization of Chest Tube Management to Expedite Rehabilitation of Lung
Cancer Patients After Video-Assisted Thoracic Surgery: A Meta-Analysis and
Systematic Review.
Source
World journal of surgery. 41 (8) (pp 2039-2045), 2017. Date of
Publication: 01 Aug 2017.
Abstract
BACKGROUND: The aim of this meta-analysis and systematic review of
published evidence was to optimize chest tube management for fast-track
rehabilitation of lung cancer patients after video-assisted thoracic
surgery (VATS).
METHODS: The PubMed, Web of Science, and EMBASE databases were searched to
identify all studies that addressed the issue of chest tube management
after VATS for lung cancer. Finally, 35 articles were included for
analysis, i.e., 29 randomized controlled trials and 6 clinical trials.
RESULTS: After synthesis of the published evidence, the following protocol
for chest tube drainage was formulated: (1) after VATS lung wedge
resection, chest tube drainage can be omitted in selected cases; (2)
normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use
of a digital monitoring system is recommended; (4) in case of increasing
pneumothorax or severe air leakage supported by digital recording system,
the tube should be placed with active suction; and (5) the chest tube can
be removed within 48 h postoperatively when air leakage is resolved and
fluid drainage is <400 mL/day.
CONCLUSIONS: Further multicenter studies are warranted based on the
variations of body sizes among different ethnicities.

<113>
Accession Number
621102330
Author
Tu R.; Peng Y.; Wang Y.; Tang X.; Wang S.
Institution
(Tu, Peng, Wang, Tang, Wang) Department of Anesthesiology, Children's
Hospital of Chongqing Medical University, Ministry of Education Key
Laboratory of Child Development and Disorders, China Intl. Science and
Technology Cooperation Base of Child Development and Critical Disorders,
Chongqing Key Laboratory of Pediatrics, No. 136, 2nd Zhongshan Road,
Yuzhong District, Chongqing, China
Title
The stromal cell-derived factor 1/C-X-C chemokine receptor type 4 axis is
important in neutrophil migration caused by cardiopulmonary bypass in
children.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 431-437),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Acute lung injury caused by cardiopulmonary bypass (CPB) is
characterized by massive neutrophil migration to the lungs. Neutrophil
migration may be closely related to stromal cell-derived factor 1
(SDF-1)/C-X-C chemokine receptor Type 4 (CXCR4) axis activation, which
plays an essential role in modulating the trafficking of neutrophils. We
investigated the changes in the expression of SDF-1/ CXCR4 axis components
before and after CPB as well as the role of the axis in driving the
migration of neutrophils in patients with congenital heart disease.
METHODS: Fifteen children undergoing elective open-heart surgery under CPB
(CPB group) and 15 children undergoing minimally invasive
ultrasound-guided closure of a ventricular septal defect (control group)
were enrolled in this non-randomized clinical trial. Neutrophil CXCR4
expression was evaluated using quantitative reverse transcription
polymerase chain reaction and flow cytometry. An enzymelinked
immunosorbent assay was used to measure plasma SDF-1 levels. The migration
characteristics of neutrophils under 8 different combinations designated
A-H were assayed with and without a specific CXCR4 antagonist, AMD3100, to
evaluate the functional significance of the SDF-1/CXCR4 axis. RESULTS:
Both CXCR4 gene and protein expressions were elevated in the CPB group
compared with the control group after CPB (0.81 +/- 0.55 vs 1.76 +/- 1.32;
P < 0.05, 1.96 +/- 0.86 vs 2.65 +/- 0.79; P < 0.05), and plasma SDF-1
levels were also increased in the former compared with the latter (197.84
+/- 19.96 pg/ml vs 539.13 +/- 99.83 pg/ml; P < 0.05). The in vitro
experiments showed that plasma isolated post-CPB exhibited the strongest
chemotactic effect on neutrophils. The CPB group showed a higher
chemotaxis index, which serves as a marker for the effects of plasma on
neutrophils, than that for the control group after CPB (37.38 +/- 9.39 vs
13.61 +/- 2.59; P < 0.05). In addition, the CXCR4 antagonist AMD3100
significantly abrogated the increase in neutrophil migration in the CPB
group. ONCLUSIONS: Exposure to CPB, which activates the SDF-1/CXCR4 axis,
using an antagonist to prevent neutrophil trafficking, may be a beneficial
therapy for the related complications.<br/>Copyright &#xa9; The Author
2017.

<114>
Accession Number
621066190
Author
Ilangkovan N.; Mogensen C.B.; Mickley H.; Lassen A.T.; Lambrechtsen J.;
Sand N.P.R.; Albiniussen R.; Byg J.; Hald F.; Gronhoj M.H.; Diederichsen
A.
Institution
(Ilangkovan, Albiniussen, Byg) Cardiology Department, Hospital of Southern
Denmark, Aabenraa, Denmark
(Mogensen) Emergency Department, Hospital of Southern Denmark, Aabenraa,
Denmark
(Mickley, Gronhoj, Diederichsen) Cardiology Department, Odense University
Hospital, Odense, Denmark
(Lassen) Emergency Department, Odense University Hospital, Odense, Denmark
(Lambrechtsen) Medical Department, Svendborg Hospital, Svendborg, Denmark
(Sand) Cardiology Department, Esbjerg Hospital, Esbjerg, Denmark
(Hald) Cardiology Department, Vejle Hospital, Vejle, Denmark
Title
Prevalence of coronary artery calcification in a non-specific chest pain
population in emergency and cardiology departments compared with the
background population: A prospective cohort study in Southern Denmark with
12-month follow-up of cardiac endpoints.
Source
BMJ Open. 8 (3) (no pagination), 2018. Article Number: e018391. Date of
Publication: 01 Mar 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To examine and compare the prevalence of coronary artery
calcification (CAC) and the frequency of cardiac events in a background
population and a cohort of patients with non-specific chest pain (NSCP)
who present to an emergency or cardiology department and are discharged
without an obvious reason for their symptom. Design: A double-blinded,
prospective, observational cohort study that measures both CT-determined
CAC scores and cardiac events after 1 year of follow-up. Setting:
Emergency and cardiology departments in the Region of Southern Denmark.
Subjects: In total, 229 patients with NSCP were compared with 722 patients
from a background comparator population. Main outcomes measures:
Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial
infarction (MI), ventricular tachycardia (VT), coronary revascularisation
and cardiac-related mortality 1 year after index contact. Results: There
was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6
to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between
the studied groups. When compared with the background population, the OR
for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI
0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with
NSCP underwent cardiac revascularisation, while none experienced UAP, MI,
VT or death. In the background population, four (0.6%) participants
experienced a clinical cardiac endpoint; two had an MI, one had VT and one
had a cardiac-related death. Conclusion: The prevalence of CAC (CAC >0 AU)
among patients with NSCP is comparable to a background population and
there is a low risk of a cardiac event in the first year after discharge.
A CAC study does not provide notable clinical utility for risk-stratifying
patients with NSCP.<br/>Copyright &#xa9; 2018 Article author(s). All
rights reserved.

<115>
Accession Number
621048151
Author
Agrawal H.; Teleb M.; Lahsaei S.; Carbajal L.; Montanez R.; Carrozza J.P.
Institution
(Agrawal, Lahsaei, Carrozza) Division of Interventional Cardiology,
Department of Internal Medicine, St. Elizabeth's Medical Center, Tufts
School of Medicine, Boston, MA, United States
(Agrawal) Interventional Cardiology Fellow, St. Elizabeth's Medical
Center, Tufts School of Medicine, 736 Cambridge Street, Boston, MA 02135,
United States
(Teleb, Carbajal, Montanez) Division of Cardiovascular Medicine,
Department of Medicine, Texas Tech University, Paul L. Foster School of
Medicine, El Paso, TX, United States
Title
Routine Angiographic Follow-Up After Coronary Artery Disease
Revascularization: Is Seeing Believing?.
Source
Current Cardiology Reports. 20 (3) (no pagination), 2018. Article Number:
17. Date of Publication: 01 Mar 2018.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of the Review: Coronary artery disease is a major cause of
mortality and morbidity in the world, and PCI and CABG account for over a
million procedures performed annually in the USA. The goal of percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) is
to achieve complete revascularization (CR) if at all possible. However,
restenosis and stent thrombosis (ST) remain the Achilles heel of
contemporary PCI with restenosis rates between 10 and 30% with bare metal
stents to 5-15% after drug-eluting stents and ST rates of around 0.8 vs
1.2%, respectively. Routine angiography after revascularization seems
theoretically attractive as this may allow intervention before clinical
events occur. In this manuscript, we review the literature regarding
routine angiography after PCI or CABG and its outcomes. Recent Findings:
According to the 2016 update from the American Heart Association (AHA),
15.5 million people above the age of 20 have coronary heart disease (CHD)
in the USA. The prevalence of CHD is now almost similar in both men and
women, and one American suffers from a myocardial infarction (MI) every 42
s. Recent data from randomized clinical trials and observational studies
does not support the use of routine coronary angiography after
revascularization in asymptomatic patients. There are some studies which
show that routine angiography may have a role in left main or complex
coronary interventions; however, these findings are exploratory and were
not seen in randomized trials. Summary: After reviewing the data on
routine angiography after coronary revascularization, we came to the
conclusion that current data does not support the use of routine
angiography for asymptomatic patients. However, there is a lack of
randomized controlled trial in this field with only one recent trial
reporting negative outcomes.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<116>
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.<br/>Copyright &#xa9; 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.

<117>
Accession Number
621085223
Author
Blichfeldt-Eckhardt M.R.
Institution
(Blichfeldt-Eckhardt) Department, Anaesthesiology and Intensive Care,
Denmark
Title
From acute to chronic postsurgical pain: The significance of the acute
pain response.
Source
Danish Medical Journal. 65 (3) (no pagination), 2018. Article Number:
B5326. Date of Publication: March 2018.
Publisher
Danish Medical Association (E-mail: lwe@dadl.dk)
Abstract
The thesis comprises an overview and four papers, all published or
submitted for publication in international peer-reviewed scientific
journals. Background Chronic pain after surgery is a common and
debilitating complication after many types of surgery. The cause and
pathology behind is still mainly uncovered, though several risk factors
have been proposed. One of the strongest risk factors for persistent
postsurgical pain is the intensity of the acute pain response though the
mechanisms involved remains unsettled. The acute pain response consists of
several different types of pain (ie. somatic pain, visceral pain, referred
pain, neuropathic pain). Its uncovered whether some components of the
acute pain response are closer correlated to chronic pain than others and
whether treatment of acute pain can change the risk of developing chronic
pain. Aim The aim of the thesis was to investigate which components of the
acute pain response, was correlated to chronic postsurgical pain in
patients for cholecystectomy and lobectomy. Furthermore, to study the type
and time course of ipsilateral shoulder pain after lobectomy and whether
an ultrasoundguided supraclavicular phrenic nerve block was effective in
preventing acute and chronic shoulder pain after major thoracic surgery.
Methods Paper I is based on a prospective, observational, multicenter,
cohort study, in which 100 patients for cholecystectomy was examined
preoperatively, 1 week postoperatively and 3, 6, and 12 months
postoperatively for pain, psychological factors and signs of
hypersensitivity. Paper II and III is based on a prospective,
observational, cohort study, in which 60 patients for lobectomy was
examined preoperatively, 4 days postoperatively and 12 months
postoperatively for pain, psychological factors and signs of
hypersensitivity. Paper IV is based on a prospective, randomized,
double-blind and placebo-controlled trial, where 76 patients were
randomized to receive ultrasound guided supraclavicular phrenic nerve
block with a blinded study solution (ropivacaine or saline). The primary
endpoint was pain within the first 6 hours after surgery. Secondary
endpoints included pain the following days and after 3 months. Results
Paper I: Nine patients developed chronic unexplained pain 12 months
postoperatively. In a multivariate analysis, cumulated visceral pain
during the first week and number of preoperative biliary pain attacks were
identified as independent risk factors for unexplained pain 12 months
after surgery. There were no consistent signs of increased
hypersensitivity in the referred pain area before or after the operation
in patients with chronic pain. Paper II: Sixteen patients developed
chronic pain 12 months postoperatively. In a multivariate analysis
thoracic pain during activity was the only significant predictor of
chronic pain 12 months after surgery. Shoulder pain, referred pain and
overall pain was not significant predictors. There were no signs of
general hypersensitivity 12 months after surgery. Paper III: Forty-seven
(78 %) of patients experienced postoperative shoulder pain, but only 25
patients (42 %) experienced clinically relevant pain (NRS > 3). On
postoperative day 4, 19 (32 %) of patients suffered shoulder pain, but
only 4 (7 %) suffered clinically relevant pain. Only 4 patients (8%)
suffered chronic shoulder pain. Ipsilateral shoulder pain of the
musculoskeletal type is more intense than referred ipsilateral shoulder
pain, though referred shoulder pain is more common. Surgical approach was
not related to incidence of shoulder pain or type of pain.Paper IV:
Shoulder pain within 6 hours of the operation was reported in 9 patients
(24%) in the treatment group versus 26 (68%) in the placebo group
(p<0.0001). Absolute and relative risk reductions were 44% (95% CI 22-67%)
and 65% (95% CI 41-80%), respectively. No major complications, including
respiratory compromise, were observed. Subsequent treatment with a nerve
catheter was effective during the first 36 hours after surgery, but
because of loss of nerve catheter or early submission of patients, data
concerning pain the following days and after 3 months were inconclusive.
Conclusion The intensity of the cumulated visceral pain response in the
first postoperative week after cholecystectomy is predictive for
post-cholecystectomy syndrome 12 months postoperatively. No consistent,
statistically significant signs of hyperalgesia could be demonstrated in
the referred pain area before or 6 and 12 months after cholecystectomy in
patients who developed post-cholecystectomy syndrome. Only cumulated chest
pain during the first four days after lobectomy was predictive for
post-thoracotomy pain syndrome 12 months after surgery. Ipsilateral
shoulder pain is major clinical pain problem after lobectomy but usually
declines in intensity after day 3 and only a small subset of patients
experience chronic shoulder pain. Shoulder pain of the musculoskeletal
type is less common, but more intense than referred shoulder pain.
Ultrasound guided supraclavicular phrenic nerve block is a safe and
effective treatment for ipsilateral shoulder pain after major thoracic
surgery.<br/>Copyright &#xa9; 2018, Danish Medical Association. All rights
reserved.

<118>
Accession Number
621085186
Author
Karanfil E.O.T.; Moller A.M.
Title
Preoperative inspiratory muscle training prevents pulmonary complications
after cardiac surgery - a systematic review.
Source
Danish Medical Journal. 65 (3) (no pagination), 2018. Article Number:
A5450. Date of Publication: March 2018.
Publisher
Danish Medical Association (E-mail: lwe@dadl.dk)
Abstract
INTRODUCTION: Post-operative pulmonary complications are a common cause of
morbidity and mortality in patients undergoing heart surgery. The aim of
this systematic review was to determine if preoperative inspiratory muscle
training could prevent the development of pneumonia and atelectasis in
patients undergoing coronary artery bypass grafting (CABG) or heart valve
surgery. METHODS:Systematic searches were performed in MED-LINE, Embase
and the Cochrane Library. The included studies compared the development of
pneumonia and atelectasis in CABG patients or heart valve surgery patients
who were prescribed either preoperative inspiratory muscle training or
usual care. The quality of the studies was assessed using the Cochrane
Risk of Bias Tool. RESULTS: The search yielded 2,479 records. The
inclusion criteria were fulfilled by five studies. All the studies were
randomised controlled trials. We found that the development of both
pneumonia and atelectasis was significantly reduced among patients who
received inspiratory muscle training preoperatively compared with patients
treated with usual care. CONCLUSIONS: Preoperative inspiratory muscle
training may reduce the risk of developing pneumonia and atelectasis.
However, more trials are needed to support and strengthen the evidence
found in this systematic review before routine implementation of this kind
of training preoperatively.<br/>Copyright &#xa9; 2018, Danish Medical
Association. All rights reserved.

<119>
Accession Number
621085258
Author
Buggeskov K.B.
Institution
(Buggeskov) Department of Thoracic Anaesthesiology, Rigshospitalet,
Copenha-gen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
Title
Pulmonary artery perfusion versus no pulmonary perfusion during
cardiopulmonary bypass.
Source
Danish Medical Journal. 65 (3) (no pagination), 2018. Article Number:
B5473. Date of Publication: March 2018.
Publisher
Danish Medical Association (E-mail: lwe@dadl.dk)
Abstract
BACKGROUND During conventional cardiopulmonary bypass (CPB) there is no
active perfusion of the pulmonary circulation and the mechanical
ventilation is ceased leaving the lungs exposed to warm ischemia.
Pulmonary dysfunction is seen in varying degrees after major surgery, but
more severe in cardiac surgery patients probably due to the effects of
CPB. The evidence for effect and safety are limited, but active pulmonary
artery perfusion during CPB could be beneficial for the patients'
postoperative oxygenation. Our aim was in a randomised clinical trial to
assess primarily the effect of pulmonary artery perfusion during CPB on
postoperative oxygenation in patients diagnosed with chronic obstructive
pulmonary disease (COPD), secondarily to assess other possible benefits
and harms. Furthermore, we wanted in a systematic review with
meta-analyses of all randomised clinical trials to investigate the pooled
effects of pulmonary artery perfu-sion during CPB. METHODS We planned and
conducted a randomised, partly blinded, clinical trial assigning cardiac
surgery patients diagnosed with COPD to receive pulmonary artery perfusion
with oxygenated blood or histidine-tryptophan-ketoglutarate (HTK) solution
compared to no pulmonary perfusion during CPB. The primary outcome was the
oxygenation index measured during and after surgery. Secondary outcomes
were intubation time, serious adverse events, days alive outside the
intensive care unit and outside the hospital, 30- and 90-days mortality.
Secondly, we conducted a systematic review of randomised clinical trials
comparing benefits and harms of using pulmonary artery perfusion versus no
pulmonary perfusion during CPB pooling results in meta-analyses and trial
sequential analyses (TSA). RESULTS Of the 90 randomised patients 89 were
included in analysis of the primary outcome, the inverse oxygenation
index, measured at a single time point 21 hours after CPB start and
longitudinally 1, 3, 5, 7, and 21 hours after CPB start. At 21 hours,
patients random-ised to pulmonary artery perfusion with oxygenated blood
had a higher inverse oxygenation index compared to patients random-ised to
no pulmonary perfusion during CPB (mean difference (MD) 0.94; 95%
confidence interval (CI), 0.05 to 1.83; P=0.04). The inverse oxygenation
index was also significantly higher at 21 hours after CPB start (MD 0.99;
CI, 0.29 to 1.69; P=0.007), and longitudinally (P=0.009), for patients
receiving pulmonary artery perfusion with oxygenated blood compared to
pulmonary artery perfusion with HTK solution. This corresponds to a PaO2
difference of 23 mmHg with a median FiO2 of 0.32. We found no additional
significant differences for the remaining comparisons of the inverse
oxygenation index neither for any of the secondary outcomes. The
systematic review identified 4 trials with a total of 210 patients. In
meta-analyses pulmonary artery perfusion with blood versus no pulmonary
perfusion during CPB was not associ-ated with relative risk of death (1.7;
95% CI, 0.4 to 6.9; 210 patients in three trials with high and one trial
with low risk of bias), serious adverse events (1.2; 95% CI, 0.8 to 1.8;
180 patients in two trials with high and one trial with low risk of bias)
or intubation time (-0.4 hours; 95% CI, -1.1 to 0.4; 176 patients in three
trials with high and one trial with low risk of bias). TSA on mortality,
serious adverse events, and PaO<inf>2</inf>/FiO<inf>2</inf> ratio showed
that required information sizes have not been reached, but pulmonary
artery perfusion with blood was associated with a higher
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (27.8 mmHg; 95% CI, 5.7 to 50.0
mmHg; 119 patients in two trials with high and one trial with low risk of
bias). TSA on intubation time showed that the boundary for lack of
superiority (futility) was crossed refuting a shorten intubation time of
1.5 hours or more. CONCLUSION Our trial provided additional knowledge
about the use of pulmonary artery perfusion during CPB in cardiac surgery
patients with COPD, and improved oxygenation for patients receiving
pulmonary artery perfusion with oxygenated blood. Pulmonary artery
perfusion with HTK solution did not result in an improved oxygenation. In
line with this, the systematic review including data from additional
trials showed a possible association between pulmonary artery perfusion
with blood and improved oxygenation, but no significant associations with
mortality, serious adverse events or intubation time. However, all data
are too sparse to be conclusive.<br/>Copyright &#xa9; 2018, Danish Medical
Association. All rights reserved.

<120>
Accession Number
621102322
Author
Caldas J.R.; Haunton V.J.; Panerai R.B.; Hajjar L.A.; Robinson T.G.
Institution
(Caldas, Hajjar) Department of Anesthesia, Heart Institute, University of
Sao Paulo, Surgical Intensive Care, Av. Dr. Eneas de Carvalho Aguiar 44,
Sao Paulo 05403-000, Brazil
(Caldas) Hospital Sao Rafael, Salvador, Bahia, Brazil
(Haunton, Panerai, Robinson) Department of Cardiovascular Sciences,
University of Leicester, Leicester, United Kingdom
(Panerai, Robinson) NIHR Leicester Biomedical Research Centre, University
of Leicester, Leicester, United Kingdom
(Hajjar) Department of Cardiopneumology, Heart Institute, University of
Sao Paulo, Brazil
Title
Cerebral autoregulation in cardiopulmonary bypass surgery: A systematic
review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 494-503),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Cardiopulmonary bypass surgery is associated with a high incidence of
neurological complications, including stroke, delirium and cognitive
impairment. The development of strategies to reduce the incidence of such
neurological events has been hampered by the lack of a clear understanding
of their pathophysiology. Cerebral autoregulation (CA), which describes
the ability of the brain to maintain a stable cerebral blood flow over a
wide range of cerebral perfusion pressures despite changes in blood
pressure, is known to be impaired in various neurological disorders.
Therefore, we aimed to systematically review studies reporting indices of
CA in cardiopulmonary bypass surgery. Databases such as MEDLINE, Web of
Science, Cochrane Database of Systematic Reviews and EMBASE were searched
for relevant articles. Titles, abstracts and full texts of articles were
scrutinized according to predefined selection criteria. Two independent
reviewers undertook the methodological quality screening nd data
extraction of the included studies. Twenty of 2566 identified studies were
relevant. Studies showed marked heterogeneity and weaknesses in key
methodological criteria (e.g. population size and discussion of
limitations). All but 3 of the 20 studies described impairments of CA with
cardiac surgery. Eleven studies investigated clinical outcomes, and 9 of
these found a significant relationship between these and impaired CA.
There is a general agreement that cardiac surgery is associated with
changes in CA and that clinical outcomes appear to be significantly
related to impaired CA. Further studies are now needed to determine
prognostic significance and to inform future therapeutic
strategies.<br/>Copyright &#xa9; The Author 2017.

<121>
Accession Number
621102293
Author
Lowres N.; Mulcahy G.; Jin K.; Gallagher R.; Neubeck L.; Freedman B.
Institution
(Lowres, Freedman) Heart Research Institute, University of Sydney,
Building D17, Sydney, NSW 2006, Australia
(Lowres, Mulcahy, Freedman) Charles Perkins Centre, University of Sydney,
Sydney, Australia
(Jin, Gallagher, Neubeck) Sydney Nursing School, University of Sydney,
Sydney, Australia
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
Edinburgh, United Kingdom
(Neubeck) School of Nursing and Midwifery, Faculty of Medicine, Nursing,
and Health Sciences, Flinders University, Adelaide, Australia
Title
Incidence of postoperative atrial fibrillation recurrence in patients
discharged in sinus rhythm after cardiac surgery: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 504-511),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Postoperative atrial fibrillation (POAF) is associated with increased
stroke risk and mortality post-discharge. POAF is often considered
transient; however, recurrence is likely under-recognized as symptoms are
an unreliable guide. Surveillance post-discharge may identify asymptomatic
POAF recurrences in patients discharged in sinus rhythm. Therefore, we
performed a systematic review and meta-analysis of studies investigating
POAF recurrence post-discharge, in patients with new-onset POAF following
cardiac surgery who reverted to sinus rhythm prior to discharge. Two
independent reviewers searched medical databases, clinical trial
registries, reference lists and the Internet. After screening from 6525
studies, 8 studies were identified (n = 1157 participants, mean age 66 +/-
10 years and 73% men). Monitoring methods included the following:
telemetry during twice-daily exercise sessions (n = 2), continuous
telemetry for 3 weeks (n = 1), daily 20-s electrocardiography (ECG) using
wearable event recorder (n = 1), 30-s single-lead ECG, 4 times/day (n = 1)
and implanted continuous monitoring (n = 2). The incidence rate of POAF
recurrence identified through non-invasive monitoring in the first 4 weeks
post-discharge was 28.3% [confidence interval (CI) 23.0-33.6%]; recurring
12 +/- 5 days (mean +/- SD) post-surgery. The incidence rate identified
through implanted continuous monitoring was 61-100% within 2 years.
Between 40% and 93% of episodes were asymptomatic. In one small study
reporting stroke risk, 8 of 10 patients with recurrence were
guideline-indicated (CHA2DS2-VASc score >2) for oral anticoagulation for
stroke prevention. Monitoring for POAF recurrence post-hospital discharge
identifies significant numbers of early asymptomatic recurrences in
patients at high risk of stroke who may benefit from anticoagulation for
stroke prevention. More intense monitoring is more likely to identify POAF
recurrence. Future research is required to investigate the prognostic
significance of POAF recurrence, especially stroke and mortality
risk.<br/>Copyright &#xa9; The Author 2017.

<122>
[Use Link to view the full text]
Accession Number
620970795
Author
Pearce A.; Lockwood C.; Van Den Heuvel C.; Pearce J.
Institution
(Pearce, Lockwood, Pearce) Joanna Briggs Institute, Faculty of Health and
Medical Sciences, University of Adelaide, Adelaide, Australia
(Van Den Heuvel) School of Medical Sciences, Faculty of Health and Medical
Sciences, University of Adelaide, Adelaide, Australia
(Pearce) School of Nursing, Midwifery and Paramedicine, Australian
Catholic University, Canberra, Australia
Title
The use of therapeutic magnesium for neuroprotection during global
cerebral ischemia associated with cardiac arrest and cardiac surgery in
adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (1) (pp
86-118), 2017. Date of Publication: 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background: Global cerebral ischemia occurs due to reduced blood supply to
the brain. This is commonly caused by a cessation of myocardial activity
associated with cardiac arrest and cardiac surgery. Survival is not the
only important outcome because neurological dysfunction impacts on quality
of life, reducing independent living. Magnesium has been identified as a
potential neuroprotective agent; however, its role in this context is not
yet clear. Objectives: The objective of this review was to present the
best currently available evidence related to the neuroprotective effects
of magnesium during a period of global cerebral ischemia in adults with
cardiac arrest or cardiac surgery. Inclusion criteria Types of
participants: The current review considered adults aged over 18 years who
were at risk of global cerebral ischemia associated with cardiac arrest or
cardiac surgery. Studies of patients with existing neurological deficits
or under the age of 18 years were excluded from the review. Types of
intervention(s)/phenomena of interest: The intervention of interest was
magnesium administered in doses of at least of 2 g compared to placebo to
adult patients within 24 hours of cardiac arrest or cardiac surgery. Types
of studies: The current review considered experimental designs including
randomized controlled trials, non-randomized controlled trials and
quasi-experimental designs. Outcomes: The outcome of interest were
neurological recovery post-cardiac arrest or cardiac surgery, as measured
by objective scales, such as but not limited to, cerebral performance
category, brain stem reflexes, Glasgow Coma Score and independent living
or dependent living status. To enable assessment of the available data,
neuroprotection was examined by breaking down neurological outcomes into
three domains - functional neurological outcomes, neurophysiological
outcomes and neuropsychological outcomes. Search strategy: The search
strategy aimed to find both published and unpublished studies between
January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI)
three-step search strategy. Databases searched included PubMed, Embase,
CINAHL, Cochrane Central Register of Controlled Trials, Australian
Clinical Trials Register, Australian and New Zealand Clinical Trials
Register, Clinical Trials, European Clinical Trials Register and ISRCTN
Registry.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS INSTITUTE.

<123>
Accession Number
620970547
Author
Anonymous
Title
Erratum: A simple blind placement of the left-sided double-lumen tubes
(Medicine 95: 45 (e5376) DOI: 10.1097/MD.0000000000005376).
Source
Medicine (United States). 96 (7) (no pagination), 2017. Article Number:
6196. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article "A simple blind placement of the left-sided double-lumen
tubes",[1] which appeared in Volume 95, Issue 45 of Medicine, the Methods
section incorrectly stated the numbers of men and women who participated
in the study. The statement should have read as follows: Among the
patients enrolled in the study, 70 were men and 18 were
women.<br/>Copyright &#xa9; 2017 the Author(s).

<124>
Accession Number
621079995
Author
Gottlieb M.; Long B.; Koyfman A.
Institution
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, Illinois
(Long) Department of Emergency Medicine, San Antonio Military Medical
Center, Fort Sam Houston, Texas
(Koyfman) Department of Emergency Medicine, The University of Texas
Southwestern Medical Center, Dallas, Texas
Title
Evaluation and Management of Aortic Stenosis for the Emergency Clinician:
An Evidence-Based Review of the Literature.
Source
Journal of Emergency Medicine. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Introduction: Aortic stenosis is a common condition among older adults
that can be associated with dangerous outcomes, due to both the disease
itself and its influence on other conditions. Objective: This review
provides an evidence-based summary of the current emergency department
(ED) evaluation and management of aortic stenosis. Discussion: Aortic
stenosis refers to significant narrowing of the aortic valve and can be
caused by calcific disease, congenital causes, or rheumatic valvular
disease. Symptoms of advanced disease include angina, dyspnea, and
syncope. Patients with these symptoms have a much higher mortality rate
than asymptomatic patients. Initial evaluation should include an
electrocardiogram, complete blood count, basic metabolic profile,
coagulation studies, troponin, brain natriuretic peptide, type and screen,
and a chest radiograph. Transthoracic echocardiogram is the test of
choice, but point-of-care ultrasound has been found to have good accuracy
when a formal echocardiogram is not feasible. Initial management should
begin with restoring preload and ensuring a normal heart rate, as both
bradycardia and tachycardia can lead to clinical decompensation. For
patients with high blood pressure and heart failure symptoms, nitrate
agents may be reasonable, but hypotension should be avoided. Dobutamine
can increase inotropy. For hypotensive patients, vasopressors should be
used at the lowest effective dose. The treatment of choice is valve
replacement, but extracorporeal membrane oxygenation and percutaneous
balloon dilatation of the aortic valve have been described as temporizing
measures. Conclusion: Aortic stenosis is an important condition that can
lead to dangerous outcomes and requires prompt recognition and
disease-specific management in the ED.<br/>Copyright &#xa9; 2018.

<125>
Accession Number
2000518728
Author
Cassao B.D.; Herbella F.A.M.; Schlottmann F.; Patti M.G.
Institution
(Cassao, Herbella) Department of Surgery, Escola Paulista de Medicina,
Federal University of Sao Paulo, Sao Paulo, Brazil
(Schlottmann, Patti) Department of Medicine and Surgery, University of
North Carolina, Chapel Hill, North Carolina, United States
Title
Retracted articles in surgery journals. What are surgeons doing wrong?.
Source
Surgery (United States). (no pagination), 2018. Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Retraction of previously published scientific articles is an
important mechanism to preserve the integrity of scientific work. This
study analyzed retractions of previously published articles from surgery
journals. Methods: We searched for retracted articles in the 100 surgery
journals with the highest SJR2 indicator grades. Results: We found 130
retracted articles in 49 journals (49%). Five or more retracted articles
were published in 8 journals (8%). The mean time between publication and
retraction was 26 months (range 1 to 158 months). The United States,
China, Germany, Japan, and the United Kingdom accounted for more than 3
out of 4 of the retracted articles. The greatest number of retractions
came from manuscripts about orthopedics and traumatology, general surgery,
anesthesiology, cardiothoracic surgery, and plastic surgery. Nonsurgeons
were responsible for 16% of retractions in these surgery journals. The
main reasons for retraction were duplicate publication (42%), plagiarism
(16%), absence of proven integrity of the study (14%), incorrect data
(13%), data published without authorization (12%), violation of research
ethics (11%), documented fraud (11%), request of an author(s) (5%), and
unknown (3%). In 25% of the retracted articles, other publications by the
same authors also had been retracted. Conclusion: Retraction of published
articles does not occur frequently in surgery journals. Some form of
scientific misconduct was present in the majority of retractions,
especially duplication of publication and plagiarism. Retractions of
previously published articles were most frequent from countries with the
greatest number of publications; some authors showed
recidivism.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<126>
Accession Number
614039898
Author
Myles P.S.; Smith J.A.; Forbes A.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Byrne
K.; Chan M.T.V.; Landoni G.; Wallace S.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Commercial Rd., Melbourne, VIC
3004, Australia
(Myles, Smith, Forbes, Jayarajah, Cooper, Marasco, Wallace) Monash
University, Melbourne, VIC, Australia
(Silbert) St. Vincent's Hospital, Fitzroy, VIC, Australia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(McNeil) South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(McGuinness) Auckland Hospital, Auckland, New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Chan) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Landoni) Istituto di Ricovero e Cura A Carattere Scientifico San Raffaele
and Vita-Salute, San Raffaele University, Milan, Italy
Title
Tranexamic acid in patients undergoing coronary-artery surgery.
Source
New England Journal of Medicine. 376 (2) (pp 136-148), 2017. Date of
Publication: 12 Jan 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Tranexamic acid reduces the risk of bleeding among patients
undergoing cardiac surgery, but it is unclear whether this leads to
improved outcomes. Furthermore, there are concerns that tranexamic acid
may have prothrombotic and proconvulsant effects. METHODS In a trial with
a 2-by-2 factorial design, we randomly assigned patients who were
scheduled to undergo coronary-artery surgery and were at risk for
perioperative complications to receive aspirin or placebo and tranexamic
acid or placebo. The results of the tranexamic acid comparison are
reported here. The primary outcome was a composite of death and thrombotic
complications (nonfatal myocardial infarction, stroke, pulmonary embolism,
renal failure, or bowel infarction) within 30 days after surgery. RESULTS
Of the 4662 patients who were enrolled and provided consent, 4631
underwent surgery and had available outcomes data; 2311 were assigned to
the tranexamic acid group and 2320 to the placebo group. A primary outcome
event occurred in 386 patients (16.7%) in the tranexamic acid group and in
420 patients (18.1%) in the placebo group (relative risk, 0.92; 95%
confidence interval, 0.81 to 1.05; P = 0.22). The total number of units of
blood products that were transfused during hospitalization was 4331 in the
tranexamic acid group and 7994 in the placebo group (P<0.001). Major
hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of
the patients in the tranexamic acid group and in 2.8% of the patients in
the placebo group (P = 0.001), and seizures occurred in 0.7% and 0.1%,
respectively (P = 0.002 by Fisher's exact test). CONCLUSIONS Among
patients undergoing coronary-artery surgery, tranexamic acid was
associated with a lower risk of bleeding than was placebo, without a
higher risk of death or thrombotic complications within 30 days after
surgery. Tranexamic acid was associated with a higher risk of
postoperative seizures. (Funded by the Australian National Health and
Medical Research Council and others; ATACAS Australia New Zealand Clinical
Trials Registry number, ACTRN12605000557639.).<br/>Copyright &#xa9; 2017
Massachusetts Medical Society.

<127>
Accession Number
620867720
Author
Gasser S.; Reichenspurner H.; Girdauskas E.
Institution
(Gasser, Reichenspurner, Girdauskas) Department of Cardiovascular Surgery,
University Heart Centre Hamburg, Martinistrasse 52, Hamburg 20251, Germany
Title
Genomic analysis in patients with myxomatous mitral valve prolapse:
Current state of knowledge.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 41. Date of Publication: 27 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myxomatous mitral valve prolapse is a common cardiac
abnormality. Morbus Barlow is characterized by excess myxomatous leaflet
tissue, bileaflet prolapse or billowing, chordae elongation and annular
dilatation with or without calcification. Extensive myxoid degeneration
with destruction of the normal three-layered leaflet tissue architecture
is observed histologically in such patients. Autosomal dominant
inheritance with an age and sex-dependent expression has long been
recognised. This review explores the current understanding of the genetics
of bileaflet prolapse, with a focus on genetic analysis and the role for
echocardiographical screening of the first degree relatives of affected
patients. Methods: Systematic literature searches were performed using
PubMed and Embase up to September 2017. In Disse et al.'s study (study
one) first degree relatives of 25 patients with Morbus Barlow who
underwent mitral valve repair were screened for bileaflet valve prolapse.
In Nesta et al.'s study one family with three living generations of 43
individuals with 9 confirmed cases of MVP was screened. Genotyping was
performed in four families for 344 microsatellite markers from Chromosome
1 to 16. Results: In study one, autosomal dominant inheritance was shown
in four pedigrees. Genome-wide linkage analysis of the most informative
pedigree (24 individuals, three generations) showed a significant linkage
for markers mapping to chromosome 16p. Linkage to this locus was confirmed
in a second family within the same study, but was excluded in the
remaining two pedigrees. In study two an autosomal dominant locus was
mapped to chromosome 13. 8 of the 9 individuals affected were found to
suffer from bileaflet prolapse. Conclusions: Barlow's disease is a
heritable trait but the genetic causes remain largely elusive.
Ch16p11.2-p12.1 is the only locus proven to be associated with bileaflet
prolapse. Locus 13.q31.3-q32.1 was shown to cause bileaflet as well as
posterior leaflet prolapse. This review intends to make physicians aware
of genetic causes of myxomatous mitral valve prolapse, thereby emphasising
the importance of cardiological examination of first-degree relatives of
patients with Morbus Barlow. Integrated and more comprehensive studies are
needed for identification of genes involved in this heterogenic disease.
Further genomic studies may facilitate more individualised and accurate
risk assessment and may help to develop possible preventive stategies for
patients in the future.<br/>Copyright &#xa9; 2018 The Author(s).

<128>
Accession Number
620955530
Author
Chiang M.-H.; Wu S.-C.; Hsu S.-W.; Chin J.-C.
Institution
(Chiang, Wu, Chin) Department of Anesthesiology, Kaohsiung Chang Gung
Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei
Road, Niao-Song District, Kaohsiung 833, Taiwan (Republic of China)
(Hsu) Department of Radiology, Kaohsiung Chang Gung Memorial Hospital,
Chang Gung University College of Medicine, Kaohsiung, Taiwan (Republic of
China)
(Chin) Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
(Republic of China)
Title
Bispectral index and non-bispectral index anesthetic protocols on
postoperative recovery outcomes.
Source
Minerva Anestesiologica. 84 (2) (pp 216-228), 2018. Date of Publication:
February 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The study aimed to compare Bispectral Index (BIS) and
non-BISanesthetic protocols on postoperative recovery outcomes.
EVIDENCEACQUISITION: Medline, PubMed, Cochrane, EMBASE, and Google Scholar
databases were searched until January 21, 2016. EVIDENCESYNTHESIS:
Twenty-six studies were included with a total of 9537 patients.
BISmonitoring was significantly associated with shorter time to eye
opening (P=0.001), time to extubation (P<0.001), and time to orientation
(P=0.002) compared with non-BIS monitoring. No difference between groups
was seen with respect to hypoxemia, postoperative nausea and vomiting
(PONV), time to oral fluid intake, and length of Postanesthesia Care Unit
(PACU) stay (P values =0.185). CONCLUSIONS: The use of BIS-monitoring is
superior to non-BISmonitored anesthesia in terms of shorter time to
eye-opening, extubation, and orientation. BISmonitor may be considered a
safe and effective method for monitoring depth of anesthesia during
surgery.<br/>Copyright &#xa9; 2017 Edizioni Minerva Inervainerva Medica.

<129>
Accession Number
613692212
Author
Conrotto F.; D'Ascenzo F.; D'Amico M.; Moretti C.; Pavani M.; Scacciatella
P.; Omede P.; Montefusco A.; Biondi-Zoccai G.; Gaita F.; Maisano F.;
Nietlispach F.
Institution
(Conrotto, D'Ascenzo, D'Amico, Moretti, Pavani, Scacciatella, Omede,
Montefusco, Gaita) Division of Cardiology, Citta della Salute e della
Scienza Hospital, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Maisano, Nietlispach) Heart Surgery and Cardiology, University Heart
Center, Zurich, Switzerland
Title
Outcomes of patients with low-pressure aortic gradient undergoing
transcatheter aortic valve implantation: A Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (6) (pp 1100-1106),
2017. Date of Publication: May 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The risk/benefit balance of transcatheter aortic valve
implantation (TAVI) in patients with low-gradient aortic stenosis (LGAS)
remains to be well defined. Aim of the study was to investigate the impact
of LGAS in patients undergoing TAVI. Methods: Medline, Cochrane Library,
and Scopus were searched for articles reporting outcome of patients with
LGAS undergoing TAVI. The primary endpoint was 12-months all-cause
mortality and the secondary endpoint was 30-day all-cause mortality. Using
event-rates as dependent variable, a meta-regression was performed to test
for interaction between baseline clinical features (age, gender, diabetes
mellitus, coronary artery disease, left ventricular ejection fraction
(LVEF) and type of implanted valve) and transaortic gradient for the
primary endpoint. Results: Eight studies with a total of 12,589 patients
were included. Almost one-third of the patients presented with LGAS
(27.3%: 24.4-29.2). Median LVEF was 48% in patients with LGAS and 56% in
patients with high-gradient AS. Patients with LGAS were more likely to
have diabetes mellitus, previous coronary artery disease, higher mean
Logistic EuroSCORE, and lower EF. At 12 (12-16.6) months, low transaortic
gradient emerged as independently associated with all-cause death, both if
evaluated as a dichotomous and continuous value (respectively OR 1.17;
1.11-1.23 and OR 1.02; 1-1.04, all CI 95%). Clinical variables, including
EF did not affect this result. Conclusions: In a population of TAVI
patients, LGAS appears to be independently related to dismal prognosis.
&#xa9; 2016 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<130>
Accession Number
616209733
Author
Asher E.; Frydman S.; Katz M.; Regev E.; Sabbag A.; Mazin I.; Abu-Much A.;
Kukuy A.; Mazo A.; Erez A.; Berkovitch A.; Narodistky M.; Barbash I.;
Segev A.; Beigel R.; Matetzky S.
Institution
(Asher, Frydman, Katz, Regev, Sabbag, Mazin, Abu-Much, Kukuy, Mazo, Erez,
Berkovitch, Narodistky, Barbash, Segev, Beigel, Matetzky) Leviev Heart
Center, Sheba Medical Center Tel Hashomer, Israel
Title
Chewing versus swallowing ticagrelor to accelerate platelet inhibition in
acute coronary syndrome - the CHEERS study: For the PLATIS (Platelets and
Thrombosis in Sheba) study group.
Source
Thrombosis and Haemostasis. 117 (4) (pp 727-733), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
It was the study objective to evaluate whether chewing a 180 mg loading
dose of ticagrelor versus an equal dose of traditional oral
administration, enhances inhibition of platelet aggregation 1 hour (h)
after administering a ticagrelor loading dose in non-ST elevation
myocardial infarction (NSTEMI) patients. Dual anti-platelet therapy
represents standard care for treating NSTEMI patients. Ticagrelor is a
direct acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does
not require metabolic activation. Fifty NSTEMI patients were randomised to
receive either a chewing loading dose of 180 mg ticagrelor or an equal
standard oral dose of ticagrelor. Platelet reactivity was evaluated by
VerifyNow at baseline, 1 and 4 h post-loading dose. Results are reported
in P2Y12 reaction units. Patients then continued to receive standard 90 mg
oral ticagrelor twice daily. Baseline characteristics did not differ
between the two groups. P2Y12 reaction units in the chewing group compared
with the standard group at 0, 1 and 4 h after ticagrelor loading dose
were: 245 vs 239 (p=0.59), 45 vs 130 (p=0.001) and 39 vs 60 (p=0.12),
respectively, corresponding to a relative inhibition of platelet
aggregation of 83 % vs only 47 % at 1 h (p< 0.001), and 84 % vs 77 %
(p=0.59) at 4 h. Major adverse cardiac and cardiovascular events at 30
days were low (2 %), occurring in only one patient in the standard group.
In conclusion, chewing a 180 mg ticagrelor loading dose is feasible and
facilitates both faster and improved early inhibition of platelet
aggregation in NSTEMI patients, compared with a standard oral-loading
dose.<br/>Copyright &#xa9; Schattauer 2017.

<131>
Accession Number
613133657
Author
Luni F.K.; Riaz H.; Khan A.R.; Riaz T.; Husnain M.; Riaz I.B.; Khan M.S.;
Taleb M.; Kanjwal Y.; Cooper C.J.; Khuder S.A.
Institution
(Luni, Taleb, Kanjwal) Mercy Saint Vincent Medical Center, Toledo, OH,
United States
(Riaz) Cleveland Clinic, Cleveland, OH, United States
(Khan) University of Louisville, Louisville, KY, United States
(Riaz) Bronx Lebanon Hospital, New York, NY, United States
(Husnain, Riaz) University of Arizona, Tucson, AZ, United States
(Khan) Dow University of Health Sciences, Karachi, Pakistan
(Cooper, Khuder) University of Toledo Medical Center, Toledo, OH, United
States
Title
Clinical outcomes associated with per-operative discontinuation of aspirin
in patients with coronary artery disease: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (7) (pp 1168-1175),
2017. Date of Publication: 01 Jun 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Postoperative state is characterized by increased thrombotic
risk by virtue of platelet activation. Whether aspirin ameliorates this
risk in patients with established coronary artery disease undergoing
cardiac or noncardiac surgery is unknown. We conducted a systematic review
and meta-analysis to compare the risk of major adverse cardiac events
(MACE) and the risk of bleeding in patients with early (3-5 or more days
before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of
aspirin. Methods: Multiple databases were searched from inception of these
databases until March 2015 to identify studies that reported
discontinuation of aspirin in patients undergoing surgery. The outcomes
measured were all cause mortality, nonfatal myocardial infarction and
other relevant thrombotic events (MACE) which also may include, fatal and
nonfatal MI, stent thrombosis and restenosis, stroke, perioperative
cardiovascular complications (heart failure, MI, VTE, acute stroke) and
perioperative bleeding during the perioperative period to up to 30 days
after surgery. Results: A total of 1,018 titles were screened, after which
six observational studies met the inclusion criteria. Our analysis
suggests that there is no difference in MACE with planned discontinuation
of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I² = 55%).
Early discontinuation of aspirin showed a decreased risk of peri-operative
bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I² = 42%).
Conclusion: Our analysis suggests that planned short-term discontinuation
in the appropriate clinical setting appears to be safe in the correct
clinical setting with no increased risk of thrombotic events and with a
decreased risk of bleeding. &#xa9; 2016 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<132>
Accession Number
614212199
Author
Pourdjabbar A.; Hibbert B.; Chong A.-Y.; Le May M.R.; Labinaz M.; Simard
T.; Daniel Ramirez F.; Lugomirski P.; Maze R.; Froeschl M.; Glove C.; Dick
A.; Marquis J.-F.; Bernick J.; Wells G.; So D.Y.F.
Institution
(Pourdjabbar, Hibbert, Chong, Le May, Labinaz, Simard, Daniel Ramirez,
Lugomirski, Maze, Froeschl, Glove, Dick, Marquis, So) Division of
Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
(Bernick, Wells) Cardiovascular Methods Centre, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Title
A randomised study for optimising crossover from ticagrelor to clopidogrel
in patients with acute coronary syndrome.
Source
Thrombosis and Haemostasis. 117 (2) (pp 303-310), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Ticagrelor has been endorsed by guidelines as the P2Y<inf>12</inf>
inhibitor of choice in patients with acute coronary syndrome. Clinically,
some patients on ticagrelor will require a switch to clopidogrel; however,
the optimal strategy and pharmacodynamics effects of switching remain
unknown. Patients with an indication to switch were randomly assigned to
either a bolus arm (Clopidogrel 600 mg bolus followed by 75 mg daily,
n=30) or a no-bolus arm (Clopidogrel 75 mg daily, n=30). Blood samples
were collected at baseline, 12, 24, 48, 54, 60 and 72 hours (h) for
assessment of platelet reactivity. The primary outcome was
P2Y<inf>12</inf> reactivity units (PRU) at 72 h. Secondary outcomes
included: PRUs at each time point, incidence of high on-treatment platelet
reactivity (HPR), major adverse cardiac events (MACE) and TIMI bleeding at
30 days. Serial PRUs increased after switching to clopidogrel in both
groups. At 72 h, no difference in PRU was observed (165.8 +/- 71.0 vs
184.1 +/- 67.7, bolus vs no bolus, respectively, p=0.19). At 48 h the PRUs
were significantly lower in the bolus arm (114 +/- 73.1 vs 165.1 +/- 70.5,
respectively; p=0.0076) and at 72 h, there was a significant reduction in
incidence of HPR (26.7% vs 56.7%, p=0.02). No differences in MACE or TIMI
bleeding were observed. Although a bolus strategy was not associated with
improved platelet inhibition at 72 h; at 48 h, platelet inhibition was
superior with reduced incidence of HPR. Larger studies will be required to
determine its clinical significance. Until then, decision for giving a
bolus of clopidogrel at the time of a switch may in part be dependent on
the indication for switching, especially if there are concerns for
bleeding risk.<br/>Copyright &#xa9; Schattauer 2017.

<133>
Accession Number
616161404
Author
Wang H.; Liang Z.; Li Y.; Li B.; Liu J.; Hong X.; Lu X.; Wu J.; Zhao W.;
Liu Q.; An J.; Li L.; Pu F.; Ming Q.; Han Y.
Institution
(Wang, Liang, Li, Han) General Hospital of Shenyang Military Region,
Shenyang, China
(Li) Hainan General Hospital, Haikou, China
(Liu) Xinjiang Corps General Hospital, Urumchi, China
(Hong) Beijing Shijingshan Hospital, Beijing, China
(Lu) Fujian Medical University Affiliated First Quanzhou Hospital,
Quanzhou, China
(Wu) Shenzhen Forth Hospital, Shenzhen, China
(Zhao) Tianjin Chest Hospital, Tianjin, China
(Liu) Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
(An) Shanxi Cardiovascular Hospital, Taiyuan, China
(Li) Jiangxi Province People's Hospital, Nanchang, China
(Pu) Dongying People's Hospital, Dongying, China
(Ming) Shanghai Tenth People's Hospital, Shanghai, China
Title
Effect of postprocedural full-dose infusion of bivalirudin on acute stent
thrombosis in patients with ST-elevation myocardial infarction undergoing
primary percutaneous coronary intervention: Outcomes in a large real-world
population.
Source
Cardiovascular Therapeutics. 35 (3) (no pagination), 2017. Article Number:
e12251. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: This study aimed to evaluate the effect of prolonged full-dose
bivalirudin infusion in real-world population with ST-elevation myocardial
infarction (STEMI). Background: Subgroup data as well as meta-analysis
from randomized clinical trials have shown the potency of postprocedural
full-dose infusion (1.75 mg/kg/h) of bivalirudin on attenuating acute
stent thrombosis (ST) after primary percutaneous coronary intervention
(PCI). Methods: In this multicenter retrospective observational study,
2047 consecutive STEMI patients treated with bivalirudin during primary
PCI were enrolled in 65 Chinese centers between July 2013 and May 2016.
The primary outcome was acute ST defined as ARC definite/probable within
24 hours after the index procedure, and the secondary endpoints included
total ST, major adverse cardiac or cerebral events (MACCE, defined as
death, reinfarction, stroke, and target vessel revascularization), and any
bleeding at 30 days. Results: Among 2047 STEMI patients, 1123 (54.9%) were
treated with postprocedural bivalirudin full-dose infusion (median 120
minutes) while the other 924 (45.1%) received low-dose (0.25 mg/kg/h) or
null postprocedural infusion. A total of three acute ST (0.3%) occurred in
STEMI patients with none or low-dose prolonged infusion of bivalirudin,
but none was observed in those treated with post-PCI full-dose infusion
(0.3% vs 0.0%, P=.092). Outcomes on MACCE (2.1% vs 2.7%, P=.402) and total
bleeding (2.1% vs 1.4%, P=.217) at 30 days showed no significant
difference between the two groups, and no subacute ST was observed.
Conclusion: Post-PCI full-dose bivalirudin infusion is safe and has a
trend to protect against acute ST in STEMI patients undergoing primary PCI
in real-world settings.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<134>
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.<br/>Copyright &#xa9;
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<135>
Accession Number
620835116
Author
Anonymous
Title
Correction: Tranexamic acid in patients undergoing coronary-artery surgery
(New England Journal of Medicine (2017) 376 (136-148) DOI:
10.1056/NEJMoa1606424).
Source
New England Journal of Medicine. 378 (8) (pp 782), 2018. Date of
Publication: 22 Feb 2018.
Publisher
Massachussetts Medical Society
Abstract
Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery (N Engl J
Med 2017;376:136-48). In the final sentence of the Trial Drug subsection
of Methods (page 137), the number of patients should have been 1526,
rather than 1392. In the Preoperative medications list in Table 1 (page
141), the aspirin entry should have specified within 4 days, rather than 3
days, and in the final row, the data for assignment to the aspirin group
should have been 521 (22.5) in the tranexamic acid group and 526 (22.7) in
the placebo group, rather than 529 (22.9) and 533 (22.9). In Table 2 (page
142), in the "Surgery type" list, "Nonelective" should have been
"Elective." In the same table, footnotes regarding missing data have been
added, the footnote symbols have been reordered to reflect the changes,
and the data in those rows have been updated as follows: In the "Combined
CABG and cardiac-valve replacement" row, the values for the placebo group
should have been 436 (18.8), rather than 484 (20.9). In the "Received
internal thoracic-artery graft" row, the percentages for the tranexamic
acid and placebo groups should have been 90.3 and 90.6, rather than 90.1
and 90.5. In the "Postoperative aspirin within 24 hr" row, the percentages
for the tranexamic acid and placebo groups should have been 84.9 and 81.0,
rather than 83.7 and 79.8. In the first paragraph of the Bleeding-Related
Outcomes subsection of Results (page 143), the final parenthetical P value
should have been P = 0.003, rather than P <0.001. In the Postoperative
Seizures and Other Adverse Events subsection of Results (page 143), the
first sentence should have begun, "Postoperative seizures occurred in 15
patients who received tranexamic acid and in 2 patients who received
placebo (0.7% vs. 0.1%; relative risk, . . . ," rather than ". . . in 15
patients (0.7%) in the tranexamic acid group and in 2 patients (0.1%) in
the placebo group (relative risk, . . . ." In the final sentence of the
same subsection, the parenthetical should have read, "8 hours [95% CI, 5
to 14] vs. 9 hours [95% CI, 6 to 16]," rather than "5.0 hours [95% CI, 8.0
to 14.0] vs. 6.0 hours [95% CI, 9.0 to 16.0]." In the second paragraph of
the Subgroup Analyses subsection of Results (page 143), the expression "in
the tranexamic group than in the placebo group" should have read, "in
those who received tranexamic acid than in those who received placebo." In
the same subsection, all three instances of "Fisher's exact test" should
have been "exact logistic regression." In Table 3 (page 144), in the
Reoperation list, the values for "Due to major hemorrhage" should have
been 50/2320 (2.2) in the Placebo Group column, rather than 48/2320 (2.1),
and the values for "Due to cardiac tamponade" should have been 14/2310
(0.6) in the Tranexamic Acid Group column, rather than 16/2310 (0.7), and
0.61 (0.32-1.19) in the Risk Ratio column, rather than 0.61 (0.32-1.18).
The article is correct at NEJM.org.<br/>Copyright &#xa9; 2018
Massachusetts Medical Society. All rights reserved.

<136>
[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.<br/>Copyright &#xa9; 2017 The Author(s). Published
by Wolters Kluwer Health, Inc.

<137>
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.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<138>
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.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<139>
Accession Number
611164411
Author
Blot S.I.; Rello J.; Koulenti D.
Institution
(Blot) Ghent University, Department of Internal Medicine, Campus UZ Gent,
De Pintelaan 185, Ghent 9000, Belgium
(Rello) CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain
(Koulenti) Burns Trauma and Critical Care Research Centre, The University
of Queensland, Brisbane, Australia
(Koulenti) Attikon University Hospital, 2nd Critical Care Department,
Athens, Greece
Title
The value of polyurethane-cuffed endotracheal tubes to reduce
microaspiration and intubation-related pneumonia: A systematic review of
laboratory and clinical studies.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 203. Date of
Publication: 24 Jun 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: When conventional high-volume, low-pressure cuffs of
endotracheal tubes (ETTs) are inflated, channel formation due to folds in
the cuff wall can occur. These channels facilitate microaspiration of
subglottic secretions, which is the main pathogenic mechanism leading to
intubation-related pneumonia. Ultrathin polyurethane (PU)-cuffed ETTs are
developed to minimize channel formation in the cuff wall and therefore the
risk of microaspiration and respiratory infections. Methods: We
systematically reviewed the available literature for laboratory and
clinical studies comparing fluid leakage or microaspiration and/or rates
of respiratory infections between ETTs with polyvinyl chloride (PVC) cuffs
and ETTs with PU cuffs. Results: The literature search revealed nine in
vitro experiments, one in vivo (animal) experiment, and five clinical
studies. Among the 9 in vitro studies, 10 types of PU-cuffed ETTs were
compared with 17 types of PVC-cuffed tubes, accounting for 67 vs. 108
experiments with 36 PU-cuffed tubes and 42 PVC-cuffed tubes, respectively.
Among the clinical studies, three randomized controlled trials (RCTs) were
identified that involved 708 patients. In this review, we provide evidence
that PU cuffs protect more efficiently than PVC cuffs against fluid
leakage or microaspiration. All studies with leakage and/or
microaspiration as the primary outcome demonstrated significantly less
leakage (eight in vitro and two clinical studies) or at least a tendency
toward more efficient sealing (one in vivo animal experiment). In
particular, high-risk patients intubated for shorter periods may benefit
from the more effective sealing capacity afforded by PU cuffs. For
example, cardiac surgery patients experienced a lower risk of early
postoperative pneumonia in one RCT. The evidence that PU-cuffed tubes
prevent ventilator-associated pneumonia (VAP) is less robust, probably
because microaspiration is postponed rather than eliminated. One RCT
demonstrated no difference in VAP risk between patients intubated with
either PU-cuffed or PVC-cuffed tubes, and one before-after trial
demonstrated a favorable reduction in VAP rates following the introduction
of PU-cuffed tubes. Conclusions: Current evidence can support the use of
PU-cuffed ETTs in high-risk surgical patients, while there is only very
limited evidence that PU cuffs prevent pneumonia in patients ventilated
for prolonged periods.<br/>Copyright &#xa9; 2016 The Author(s).

<140>
Accession Number
620753805
Author
Hua P.; Liu J.; Tao J.; Lin X.; Zou R.; Zhang D.; Yang S.
Institution
(Hua, Tao, Lin, Zou, Zhang) Department of Cardiovascular Surgery, Sun
Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
(Liu) Department of Vascular Surgery, Henan Provincial People's Hospital,
Zhengzhou, China
(Yang) The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Yang) Guangdong Province Key Laboratory of Brain Function and Disease,
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
Title
Safety and efficacy of the perioperative administration of recombinant
human brain natriuretic peptide (rhBNP): A systematic review and
meta-analysis.
Source
Therapeutics and Clinical Risk Management. 14 (pp 313-321), 2018. Date of
Publication: 20 Feb 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objective: Retrospective studies and a meta-analysis were performed to
evaluate the safety and effectiveness of the perioperative administration
of recombinant human brain natriuretic peptide (rhBNP) during cardiac
surgery under extracorporeal circulation. Methods: Computerized literature
searches were performed in Medline, Embase, The Cochrane Library, CNKI,
CBM, and WANFANG to find randomized controlled trials (RCTs) related to
the perioperative administration of rhBNP during cardiac surgery starting
from the database inception until December 2016. Two researchers
independently performed study screening, information extraction, and
quality evaluation according to the inclusion/exclusion criteria, and a
meta-analysis was performed using RevMan 5.2 software. Results: A total of
12 studies were analyzed, including 12 RCTs and 727 patients. The
meta-analysis results indicated that the perioperative administration of
rhBNP could reduce the occurrence rate of postoperative complications,
length of intensive care unit (ICU) stay, length of hospital stay, and
serum creatinine (Scr) levels, and increase the 24-hour urine volume;
however, it did not affect the postoperative mortality rate. Conclusion:
The perioperative administration of rhBNP during cardiac surgery was safe
and effective, and could improve the prognosis of the
patients.<br/>Copyright &#xa9; 2018 Hua et al.

<141>
Accession Number
620892214
Author
Yousef A.; MacDonald Z.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Latib A.; Rodes-Cabau J.; Labinaz M.;
Hibbert B.
Institution
(Yousef, MacDonald, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Latib, Labinaz, Hibbert) CAPITAL Research Group, Division of Cardiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and
San Raffaele Scientific Institute, Milan, Italy
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Simard, Hibbert) Department of Cellular and Molecular Medicine,
University of Ottawa, Ottawa, ON, Canada
Title
Transcatheter aortic valve implantation (TAVI) for native aortic valve
regurgitation - A systematic review -.
Source
Circulation Journal. 82 (3) (pp 895-902), 2018. Date of Publication: 2018.
Publisher
Japanese Circulation Society
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
standard of care for management of high-risk patients with aortic
stenosis. Limited data is available regarding the performance of TAVI in
patients with native aortic valve regurgitation (NAVR). Methods and
Results: We performed a systematic review from 2002 to 2016. The primary
outcome was device success as per VARC-2 criteria. Secondary endpoints
included procedural complications, and 30-day and 1-year mortality rates.
A total of 175 patients were included from 31 studies. Device success was
reported in 86.3% of patients - with device failure driven by moderate
aortic regurgitation (AR >=3+) and/or need for a second device. Procedural
complications were rare, with no procedural deaths, myocardial infarctions
or annular ruptures reported. Procedural safety was acceptable with a low
30-day incidence of stroke (1.5%). The 30-day and 1-year overall mortality
rates were 9.6% and 20.0% (cardiovascular death, 3.8% and 10.1%,
respectively). Patients receiving 2nd-generation valves demonstrated
similar safety profiles with greater device success compared with
1st-generation valves (96.2% vs. 78.4%). This was driven by the higher
incidence of second-valve implantation (23.4% vs. 1.7%) and significant
paravalvular leak (8.3% vs. 0.0%). Conclusions: TAVI demonstrates
acceptable safety and efficacy in high-risk patients with severe NAVR.
Second-generation valves may afford a similar safety profile with improved
device success. Dedicated studies are needed to definitively establish the
efficacy of TAVI in this population.<br/>Copyright &#xa9; 2018, Japanese
Circulation Society. All rights reserved.

<142>
Accession Number
615137717
Author
Da Silva Guimaraes S.; De Souza Cruz W.; Da Silva L.; MacIel G.; Huguenin
A.B.; De Carvalho M.; Costa B.; Da Silva G.; Da Costa C.; D'Ippolito J.A.;
Colafranceschi A.; Scalco F.; Boaventura G.
Institution
(Da Silva Guimaraes, De Souza Cruz, MacIel, Huguenin, De Carvalho, Costa,
Da Silva, Da Costa, Boaventura) Experimental Nutrition Laboratory, College
of Nutrition, Fluminense Federal University, Rio de Janeiro 24020-140,
Brazil
(Colafranceschi) National Institute of Cardiology, Department of Surgical
Procedures, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz, Scalco) Laboratory of Inborn Errors of Metabolism
(LABEIM), Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz) College of Medicine, Rio de Janeiro Federal University,
Rio de Janeiro, Brazil
(Da Silva) Istitute of Mathematics, Fluminense Federal University, Rio de
Janeiro, Brazil
(D'Ippolito) Clinical Pathology Service, Fluminense Federal University,
Rio de Janeiro, Brazil
Title
Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients
with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A
Randomized, Placebo-Controlled Trial.
Source
Annals of Nutrition and Metabolism. 70 (2) (pp 106-110), 2017. Date of
Publication: 01 Apr 2017.
Publisher
S. Karger AG
Abstract
During cardiac failure, cardiomyocytes have difficulty in using the
substrates to produce energy. L-carnitine is a necessary nutrient for the
transport of fatty acids that are required for generating energy. Coronary
artery graft surgery reduces the plasma levels of L-carnitine and
increases the oxidative stress. This study demonstrates the effect of
L-carnitine supplementation on the reverse remodeling of patients
undergoing coronary artery bypass graft. Patients with ischemic heart
failure who underwent coronary graft surgery were randomized to group A -
supplemented with L-carnitine or group B controls. Left ventricular
ejection fraction, left ventricular systolic and diastolic diameters were
assessed preoperatively, 60 and 180 days after surgery. Our study included
28 patients (26 [93.0%] males) with a mean age +/- SD of 58.1 +/- 10.5
years. The parameters for the evaluation of reverse remodeling did not
improve after 60 and 180 days of coronary artery bypass grafting in
comparison between groups (p > 0.05). Evaluation within the L-carnitine
group showed a 37.1% increase in left ventricle ejection fraction (p =
0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and
diastolic diameters, respectively. L-carnitine supplementation at a dose
of 50 mg/kg combined with artery bypass surgery did not demonstrate any
additional benefit in reverse remodeling. However, evaluation within the
L-carnitine group may indicate a clinical benefit of L-carnitine
supplementation.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<143>
Accession Number
616549163
Author
Totonchi Z.; Hajimiresmaiel S.J.; Azarfarin R.; Pazoki-Toroudi H.; Mahdavi
M.; Korbi M.; Dehaki M.G.; Soltani B.; Gorjipour F.
Institution
(Gorjipour, Dehaki, Totonchi, Azarfarin, Mahdavi, Korbi, Dehaki, Soltani)
Department of Cardiac Surgery, Rajaei Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Vali-Asr Av., Tehran, Iran,
Islamic Republic of
(Hajimiresmaiel) Department of Cardiology, Faculty of Medicine, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Pazoki-Toroudi) Physiology Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Gorjipour) Cellular and Molecular Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Inflammatory cytokine response and cardiac troponin i changes in
cardiopulmonary bypass using two cardioplegia solutions; Del Nido and
modified St. Thomas': A randomized controlled trial.
Source
Perfusion (United Kingdom). 32 (5) (pp 394-402), 2017. Date of
Publication: 01 Jul 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Long intervals of del Nido (DN) solution administration, 90
minutes, may result in rewarming of the myocardial tissue and elevate
metabolic demand and hypoxia. This will potentially increase inflammatory
response due to ischemia-reperfusion injury. We conducted this study to
compare the inflammatory response between patients receiving DN and
multi-dose St Thomas' cardioplegia solution (MST) in cardiopulmonary
bypass (CPB) surgery for the correction of tetralogy of Fallot (TF).
Methods: Fifty-nine pediatric patients undergoing TF total correction
surgery were randomly assigned into two groups: DN and MST. The patients'
demographic data, blood chemistry parameters, hemodynamics and other
clinical variables were recorded. TNF-a, IL-6, IL-8, IL-10 and cTnI were
measured after anesthesia induction (before skin incision), immediately
after cross-clamp removal and 24 hours after admission to the intensive
care unit (ICU). Results: Thirty-two patients of a mean age of 28.0+/-16.4
months received DN and 27 patients of a mean age of 24.2+/-15.9 months
received MST. Perioperative clinical parameters were not significantly
different between the two groups. Cytokine levels for all patients were
significantly increased after surgery. Inter-group comparisons of cytokine
levels demonstrated no significant differences in TNF-alpha, IL-6 and IL-8
cytokines levels. IL-10 level showed a moderately significant increase in
the MST group compared to the DN group after surgery (2.94+/-0.9 vs.
2.46+/-0.61 log10 pg/mL, respectively; p=0.039). Postoperative lactate
level was significantly different between two groups (2.475+/-1.29 vs
1.63+/-0.82 mg/dL in DN and MST groups, respectively; p=0.007). CTnI
levels increased after surgery and remained constant until 24 hours after
surgery. Significant differences between the MST and DN groups, at all
times, were not detected. Conclusions: The anti-inflammatory cytokine
response in the MST group is significantly better than in the DN group.
This may be due to shorter intervals of the MST cardioplegia solution
administration, which prevents rewarming of the myocardium, increased
metabolic demand and hypoxia. Decreasing the intervals of DN
administration may improve its cardioprotective properties.<br/>Copyright
&#xa9; The Author(s) 2016.

<144>
Accession Number
616549002
Author
Ghijselings I.; Himpe D.; Rex S.
Institution
(Ghijselings, Rex) Department of Anaesthesiology, University Hospitals
Leuven, Herestraat 49, Leuven 3000, Belgium
(Himpe) Department of Anaesthesiology, ZNA Middelheim, Antwerp, Belgium
(Rex) Department of Cardiovascular Sciences, University Hospitals of
Leuven, KU Leuven, Leuven, Belgium
Title
Safety of gelatin solutions for the priming of cardiopulmonary bypass in
cardiac surgery: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 32 (5) (pp 350-362), 2017. Date of
Publication: 01 Jul 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
This systematic review and meta-analysis was conducted to evaluate the
safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when
used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE
(Pubmed), Embase and CENTRAL were searched. We included only randomized,
controlled trials comparing CPB-priming with gelatin with either
crystalloids or HES-solutions of the newest generation. The primary
endpoint was the blood loss during the first 24 hours. Secondary outcomes
included perioperative transfusion requirements, postoperative kidney
function, postoperative ventilation times and length of stay on the
intensive care unit. Sixteen studies were identified, of which only ten
met the inclusion criteria, representing a total of 824 adult patients: 4
studies compared gelatin with crystalloid, and 6 studies gelatin with HES
priming. Only 2 of the studies comparing HES and gelatin reported
postoperative blood loss after 24 hours. No significant difference in
postoperative blood loss was found when results of both studies were
pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled
results of 3 studies comparing gelatin and crystalloids as a priming
solution could not demonstrate significant differences in postoperative
bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No
differences regarding any of the secondary outcomes could be identified.
This systematic review suggests gelatins to have a safety profile which is
non-inferior to modern-generation tetrastarches or crystalloids. However,
the grade of evidence is rated low owing to the poor methodological
quality of the included studies, due to inconsistent outcome reporting and
lack of uniform endpoint definitions.<br/>Copyright &#xa9; The Author(s)
2016.

<145>
Accession Number
614197149
Author
Akowuah E.; Goodwin A.T.; Owens W.A.; Hancock H.C.; Maier R.; Kasim A.;
Mellor A.; Khan K.; Murphy G.; Mason J.
Institution
(Akowuah, Goodwin, Owens, Mellor, Khan) The James Cook University
Hospital, South Tees Hospitals NHS Foundation Trust, Cardiothoracic
Division, Marton Road, Middlesbrough TS4 3BW, United Kingdom
(Hancock, Maier, Kasim) Durham University, Durham Clinical Trials Unit,
School of Medicine, Pharmacy and Health, Queen's Campus, University
Boulevard, Thornaby, Stockton-on-Tees TS17 6BH, United Kingdom
(Murphy) University of Leicester, Clinical Sciences Wing, Glenfield
General Hospital, Department of Cardiovascular Sciences, Leicester LE3
9QP, United Kingdom
(Mason) University of Warwick, Warwick Medical School, Coventry CV4 7AL,
United Kingdom
Title
Manubrium-limited ministernotomy versus conventional sternotomy for aortic
valve replacement (MAVRIC): Study protocol for a randomised controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 46. Date of
Publication: 28 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Aortic valve replacement is one of the most common cardiac
surgical procedures performed worldwide. Conventional aortic valve
replacement surgery is performed via a median sternotomy; the sternum is
divided completely from the sternal notch to the xiphisternum. Minimally
invasive aortic valve replacement, using a new technique called
manubrium-limited ministernotomy, divides only the manubrium from the
sternal notch to 1 cm below the manubrio-sternal junction. More than one
third of patients undergoing conventional sternotomy develop clinically
significant bleeding requiring post-operative red blood cell transfusion.
Case series data suggest a potentially clinically significant difference
in red blood cell transfusion requirements between the two techniques.
Given the implications for National Health Service resources and patient
outcomes, a definitive trial is needed. Methods/design: This is a
single-centre, single-blind, randomised controlled trial comparing aortic
valve replacement surgery using manubrium-limited ministernotomy
(intervention) and conventional median sternotomy (usual care). Two
hundred and seventy patients will be randomised in a 1:1 ratio between the
intervention and control arms, stratified by baseline logistic EuroSCORE
and haemoglobin value. Patients will be followed for 12 weeks from
discharge following their index operation. The primary outcome is the
proportion of patients who receive a red blood cell transfusion
post-operatively within 7 days of surgery. Secondary outcomes include red
blood cell and blood product transfusions, blood loss, re-operation rates,
sternal wound pain, quality of life, markers of inflammatory response,
hospital discharge, health care utilisation, cost and cost effectiveness
and adverse events. Discussion: This is the first trial to examine aortic
valve replacement via manubrium-limited ministernotomy versus conventional
sternotomy when comparing red blood cell transfusion rates following
surgery. Surgical trials present significant challenges; strengths of this
trial include a rigorous research design, standardised surgery performed
by experienced consultant cardiothoracic surgeons, an agreed anaesthetic
regimen, patient blinding and consultant-led patient recruitment. The
MAVRIC trial will demonstrate that complex surgical trials can be
delivered to exemplary standards and provide the community with the
knowledge required to inform future care for patients requiring aortic
valve replacement surgery. Trial registration: International Standard
Randomised Controlled Trial Number (ISRCTN) ISRCTN29567910. Registered on
3 February 2014.<br/>Copyright &#xa9; 2017 The Author(s).

<146>
Accession Number
615921300
Author
Ostadal P.; Rokyta R.; Kruger A.; Vondrakova D.; Janotka M.; Smid O.;
Smalcova J.; Hromadka M.; Linhart A.; Belohlavek J.
Institution
(Ostadal, Kruger, Vondrakova, Janotka) Department of Cardiology, Na
Homolce Hospital, Prague, Czech Republic
(Rokyta, Hromadka) Department of Cardiology, University Hospital and
Faculty of Medicine Pilsen, Charles University, Czech Republic
(Smid, Smalcova, Linhart, Belohlavek) 2nd Department of Medicine -
Department of Cardiovascular Medicine, First Faculty of Medicine, Charles
University and General University Hospital, Prague, Czech Republic
Title
Extra corporeal membrane oxygenation in the therapy of cardiogenic shock
(ECMO-CS): rationale and design of the multicenter randomized trial.
Source
European Journal of Heart Failure. 19 (Supplement 2) (pp 124-127), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims: Extracorporeal membrane oxygenation (ECMO) in veno-arterial
configuration represents an increasingly used method for circulatory
support. ECMO in cardiogenic shock offers rapid improvement of circulatory
status and significant increase in tissue perfusion. Current evidence on
the use of ECMO in cardiogenic shock remains insufficient. The aim of the
ECMO-CS trial is to compare two recognized therapeutic approaches in the
management of severe cardiogenic shock: early conservative therapy and
early implantation of veno-arterial ECMO on the background of standard
care. Methods: Eligible patients have either rapidly deteriorating or
severe cardiogenic shock, defined using echocardiography, hemodynamic and
metabolic criteria. Patients are randomized to the one of two arms:
immediate veno-arterial ECMO therapy or early conservative therapy. All
other diagnostic and therapeutic procedures are performed as per current
standard of care, including other cardiovascular interventions (i.e.
percutaneous coronary intervention or cardiac surgery). Follow-up includes
visits at 30 days, 6 months and 12 months. Primary endpoint is a composite
of death from any cause, resuscitated circulatory arrest, and implantation
of another mechanical circulatory support device at 30 days. The sample
size of 120 individuals (60 in each arm) provides 80% power to detect 50%
reduction of primary endpoint, at alpha = 0.05. Patient recruitment
started in October 2014. Conclusion: The results of the ECMO-CS trial may
significantly influence current practice in the management of patients
with severe and rapidly deteriorating cardiogenic shock. ECMO-CS trial
registration number is NCT02301819.<br/>Copyright &#xa9; 2017 The Authors.
European Journal of Heart Failure &#xa9; 2017 European Society of
Cardiology

<147>
Accession Number
615921235
Author
Meani P.; Gelsomino S.; Natour E.; Johnson D.M.; Rocca H.-P.B.L.;
Pappalardo F.; Bidar E.; Makhoul M.; Raffa G.; Heuts S.; Lozekoot P.; Kats
S.; Sluijpers N.; Schreurs R.; Delnoij T.; Montalti A.; Sels J.W.; van de
Poll M.; Roekaerts P.; Poels T.; Korver E.; Babar Z.; Maessen J.; Lorusso
R.
Institution
(Meani, Rocca, Delnoij, Sels) Cardiology Department Maastricht University
Medical Center +, Maastricht, Netherlands
(Gelsomino, Natour, Johnson, Bidar, Makhoul, Heuts, Lozekoot, Kats,
Sluijpers, Schreurs, Poels, Korver, Babar, Maessen, Lorusso) Department of
Cardiothoracic Surgery, Maastricht University Medical Center +,
Maastricht, Netherlands
(Pappalardo) Cardiac Surgery Intensive Care Unit, San Raphael Hospital,
Milan, Italy
(Delnoij, Montalti, Sels, van de Poll, Roekaerts) Intensive Care
Department, Maastricht University Medical Center +, Maastricht,
Netherlands
(Raffa) Cardiac Surgery and Heart Transplantation Unit; Department for the
Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, Mediterranean Institute for Transplantation and Advanced
Specialized Therapies (ISMETT), Palermo, Italy
Title
Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life
support: a Review of the Current Literature.
Source
European Journal of Heart Failure. 19 (Supplement 2) (pp 84-91), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Introduction/Aim: Veno-arterial extracorporeal membrane oxygenation (V-A
ECMO) support is increasingly used in refractory cardiogenic shock and
cardiac arrest, but is characterized by a rise in afterload of the left
ventricle (LV) which may ultimately either further impair or delay cardiac
contractility improvement. The aim of this study was to provide a
comprehensive overview regarding the different LV venting techniques and
results currently available in the literature. Methods: A systematic
literature search was performed in the PubMed database: 207 articles
published between 1993 and 2016 were included. Papers dealing with
pre-clinical studies, overlapping series, and association with other
assist devices were excluded from the review, with 45 published papers
finally selected. Heterogeneous indications for LV unloading were
reported. The selected literature was divided into subgroups, according to
the location or the performed procedure for LV venting. Results: Case
reports or case series accounted for 60% of the papers, while
retrospective study represented 29% of them. Adult series were present in
67%, paediatric patients in 29%, and a mixed population in 4%. LV
unloading was performed percutaneously in 84% of the cases. The most
common locations of unloading was the left atrium (31%), followed by
indirect unloading (intra-aortic balloon pump) (27%), trans-aortic (27%),
LV (11%), and pulmonary artery (4%). Percutaneous trans-septal approach
was reported in 22%. Finally, the unloading was conducted surgically in
16%,with open chest surgery in 71%, and minimally invasive surgery in 29%
of surgical cases. Conclusion: Nowadays, only a few data are available
about left heart unloading in V-A ECMO support. Despite the well-known
controversy, IABP remains widely used in combination with V-A ECMO.
Percutaneous approaches utilizing unloading devices is becoming an
increasingly used option. However, further studies are required to
establish the optimal LV unloading method.<br/>Copyright &#xa9; 2017 The
Authors. European Journal of Heart Failure &#xa9; 2017 European Society of
Cardiology

<148>
Accession Number
614524760
Author
Barbero C.; Ricci D.; Stura E.C.; Pellegrini A.; Marchetto G.; Qarra S.E.;
Boffini M.; Passera R.; Valentini M.C.; Rinaldi M.
Institution
(Barbero, Ricci, Stura, Pellegrini, Marchetto, Qarra, Boffini, Rinaldi)
Department of Cardiovascular and Thoracic Surgery, University of Turin,
Corso Bramante 88, Turin 10126, Italy
(Passera) Department of Nuclear Medicine, University of Turin, Turin,
Italy
(Valentini) Department of Neuroradiology, University of Turin, Turin,
Italy
Title
Magnetic resonance imaging for cerebral lesions during minimal invasive
mitral valve surgery: Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 76. Date of
Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recent data have highlighted a higher rate of neurological
injuries in minimal invasive mitral valve surgery (MIMVS) compared with
the standard sternotomy approach; therefore, the role of specific clamping
techniques and perfusion strategies on the occurrence of this complication
is a matter of discussion in the medical literature. The purpose of this
trial is to prospectively evaluate major, minor and silent neurological
events in patients undergoing right mini-thoracotomy mitral valve surgery
using retrograde perfusion and an endoaortic clamp or a transthoracic
clamp. Methods/design: A prospective, blinded, randomized controlled study
on the rate of neurological embolizations during MIMVS started at the
University of Turin in June 2014. Major, minor and silent neurological
events are being investigated through standard neurological evaluation and
magnetic resonance imaging assessment. The magnetic resonance imaging
protocol includes conventional sequences for the morphological and
quantitative assessment and nonconventional sequences for the white matter
microstructural evaluation. Imaging studies are performed before surgery
as baseline assessment and on the third postoperative day and, in patients
who develop postoperative ischemic lesions, after 6 months. Discussion:
Despite recent concerns raised about the endoaortic setting with
retrograde perfusion, we expect to show equivalence in terms of
neurological events of this technique compared with the transthoracic
clamp in a selected cohort of patients. With the first results expected in
December 2016 the findings would be of help in confirming the efficacy and
safety of MIMVS. Trial registration: ClinicalTrials.gov, Identifier:
NCT02818166. Registered on 8 February 2016 - trial retrospectively
registered.<br/>Copyright &#xa9; The Author(s).

<149>
Accession Number
619437583
Author
Saxena A.; Virk S.A.; Bowman S.R.A.; Jeremy R.; Bannon P.G.
Institution
(Saxena, Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
(Saxena, Bannon) Sydney Medical School, University of Sydney, Sydney, NSW,
Australia
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, NSW, Australia
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Vic, Australia
(Jeremy) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Title
Heart Valve Surgery Performed by Trainee Surgeons: Meta-Analysis of
Clinical Outcomes.
Source
Heart Lung and Circulation. 27 (4) (pp 420-426), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Ltd
Abstract
Background: Cardiac surgical units must balance trainee education with the
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 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 inclusion criteria,
reporting on five patient cohorts undergoing mitral valve surgery (n =
3975), six undergoing aortic valve replacement (AVR) (n = 6236) and three
undergoing combined AVR and coronary artery bypass grafting (CABG) (n =
3495). Perioperative mortality was not significantly different between
trainee and consultant cases for mitral valve 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 significantly
different between trainee and consultant cases. There was a paucity of
mid-term survival data. Conclusions: 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 and echocardiographic data are
required to assess long-term durability and safety.<br/>Copyright &#xa9;
2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<150>
Accession Number
621005179
Author
Lin M.-H.; Kamel H.; Singer D.E.; Wu Y.-L.; Lee M.
Institution
(Lin, Lee) Chang Gung Univ, College of Medicine and Chang Gung Memorial
Hosp, Chiayi, Puzi City, Chiayi County, Taiwan (Republic of China)
(Kamel) Weill Cornell Medicine, New York, NY, United States
(Singer) Harvard Med Sch, Boston, MA, United States
(Wu) Chang Gung Univ, Taoyuan, Taiwan (Republic of China)
Title
Perioperative atrial fibrillation increased risks of stroke and mortality:
A meta-analysis.
Source
Stroke. Conference: American Heart Association/American Stroke Association
2018 International Stroke Conference and State-of-the-Science Stroke
Nursing Symposium. United States. 49 (Supplement 1) (no pagination), 2018.
Date of Publication: January 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although perioperative atrial fibrillation is believed to be
self-limited, several studies have shown an association between
perioperative atrial fibrillation and higher risk of perioperative stroke
and mortality. Objectives: To perform a systematic review and
meta-analysis to - 1) comprehensively evaluate the qualitative and
quantitative relationships of perioperative atrial fibrillation with
subsequent risk of stroke and mortality; 2) assess any differences in
outcomes among major subgroups. Methods: We searched PudMed and EMBASE for
articles published from 1966 to December 2016. We included studies that
assessed and reported quantitative estimates of the multivariate adjusted
hazard ratio (HR) and 95% confidence interval (CI) for subsequent stroke
and mortality associated with perioperative or postoperative atrial
fibrillation, or both. We excluded studies that had a cross-sectional or
case-control design, that included patients with preexisting atrial
fibrillation before surgery, and that did not report 95% CI. Result: There
were eight articles included in our primary analysis: three articles
included both stroke and mortality as endpoints, four articles only
assessed mortality, and one article only evaluated stroke. Pooling results
using a random-effect model showed an association between perioperative
atrial fibrillation and both subsequent stroke risk (HR, 1.6; 95% CI,
1.3-2.0) and mortality risk (HR, 1.3; 95% CI, 1.2-1.3) (Figure). In
subgroup analyses, the association between perioperative atrial
fibrillation and stroke was stronger in patients who underwent non-cardiac
surgery (HR, 2.0; 95% CI, 1.8-2.3) than in those who received cardiac
surgery (HR, 1.5; 95% CI, 1.2-1.8). Conclusions: New onset perioperative
atrial fibrillation is associated with an increased risk of both stroke
and mortality. This association is stronger among those undergoing
non-cardiac surgery than cardiac surgery.

<151>
Accession Number
621044361
Author
Yaman Aktas Y.; Karabulut N.
Institution
(Yaman Aktas) Department of Surgical Nursing, The Faculty of Health
Science, Giresun University, Giresun, Turkey
(Karabulut) Department of Surgical Nursing, The Faculty oh Health Science,
Ataturk University, Erzurum, Turkey
Title
The effects of music therapy in endotracheal suctioning of mechanically
ventilated patients.
Source
Nursing in critical care. 21 (1) (pp 44-52), 2016. Date of Publication: 01
Jan 2016.
Abstract
RESULTS: The mean scores of the Ramsay Sedation Scale during endotracheal
aspiration were respectively 1.88 and 1.55 in the experimental and control
group and the difference between the groups was statistically significant
(p = 0.003). The mean score of Critical-Care Pain Observation Tool during
endotracheal suctioning in the experimental group was found to be lower
statistically than those of the control group (p < 0.001). There were no
significant differences before, during and 20 min after suctioning between
the two groups with regard to systolic blood pressure, diastolic blood
pressure, heart rate and oxygen saturation (p > 0.05).
CONCLUSIONS: The results of this study implies that music therapy can be
effective practice for nurses attempting to reduce patients' pain and
control sedation level in patients on mechanical ventilators during
endotracheal suctioning.
RELEVANCE TO CLINICAL PRACTICE: It is recommended that music therapy
should be added to the routine nursing care for mechanically ventilated
patients.
BACKGROUND: Endotracheal suctioning has been identified as a painful
procedure for critically ill patients.
AIM: To determine the effect of music therapy on pain intensity, sedation
level and physiological parameters during endotracheal suctioning of
mechanically ventilated patients in cardiovascular surgery intensive care
unit (ICU).
DESIGN: Experimental survey.
METHODS: The study was conducted between May 2010 and June 2013 in Ordu
Medical Park Hospital Cardiovascular Surgery Intensive Care Unit. The
study sample consisted of 66 patients (33 experimental and 33 control) who
complied with the criteria of inclusion for the study. Data was collected
using the 'Patient Information Form', 'Critical-Care Pain Observation
Tool', 'Ramsay Sedation Scale' and 'Form of Physiological
Parameters'.<br/>Copyright &#xa9; 2015 British Association of Critical
Care Nurses.

<152>
Accession Number
620969845
Author
Ruffini E.; Filosso P.L.; Guerrera F.; Lausi P.; Lyberis P.; Oliaro A.
Institution
(Ruffini, Filosso, Guerrera, Lausi, Lyberis, Oliaro) Thoracic Surgery,
University of Torino, Torino, Italy
Title
Optimal surgical approach to thymic malignancies: New trends challenging
old dogmas.
Source
Lung Cancer. 118 (pp 161-170), 2018. Date of Publication: April 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Until recently, the surgical approach to thymic tumors has remained
basically unchanged. The collaborative effort led by ITMIG with the
collaboration of regional and society-based interest groups (ESTS, JART)
produced an enthusiastic surge of interest in testing the new
technological advances in thoracic surgery and many historical dogmas in
thymic surgery have been questioned and challenged. The present review
addresses the new trends in the optimal surgical management of thymic
tumors based on the review of the current literature. 1.
Minimally-invasive techniques (MIT) including video-assisted thoracic
surgery (VATS) and robotic-assisted thoracic Surgery (RATS) are now to be
considered the standard of care in early-stage thymic tumors. MIT are no
inferior to open approaches in terms of postoperative complications,
loco-regional recurrence rates and survival. MIT are associated with a
shorter length of stay, reduced intraoperative blood loss and better
cosmetic results. 2. The adoption of the ITMIG/IASLC TNM staging system
for thymic tumors requires a paradigm shift among thoracic surgeons to
include regional lymphadenectomy according to the IASLC/ITMIG nodal map in
the surgical management of thymic tumors. 3. A limited thymectomy instead
of total thymectomy along with the removal of the thymic tumor in
nonmyasthenic Stage I-II tumors has been proposed by some authors,
although the results are not uniform. Until more mature data is available,
adherence to the current guidelines recommending total thymectomy in
addition to thymomectomy is always indicated. 4. In locally-advanced Stage
IVa patients with pleural involvement, major pleural resections, including
pleurectomy/decortication or extrapleural pneumonectomy are indicated,
provided a complete resection of the pleural deposits is anticipated,
usually in a multidisciplinary setting, with excellent long-term results.
The incorporation of these new concepts and techniques in the surgical
armamentarium of the thoracic surgeons dealing with thymic malignancies
will certainly be of help in the optimal management of these
patients.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<153>
Accession Number
621031127
Author
Kockerling F.; Schug-Pass C.; Bittner R.
Institution
(Kockerling, Schug-Pass) Department of Surgery and Center for Minimally
Invasive Surgery, Academic Teaching Hospital of Charite Medical School,
Vivantes Hospital, Neue Bergstrasse 6, Berlin 13585, Germany
(Bittner) Hernia Center, Winghofer Medicum, Winghofer Strasse 42,
Rottenburg am Neckar 72108, Germany
Title
A word of caution: never use tacks for mesh fixation to the diaphragm!.
Source
Surgical Endoscopy and Other Interventional Techniques. (pp 1-8), 2018.
Date of Publication: 16 Jan 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The mesh fixation technique used in repair of hiatal hernias
and subxiphoid ventral and incisional hernias must meet strenuous
requirements. In the literature, there are reports of life-threatening
complications with cardiac tamponade and a high mortality rate on using
tacks. The continuing practice of tack deployment for mesh fixation to the
diaphragm and esophageal hiatus should be critically reviewed. Methods: In
a systematic search of the available literature in May 2017, 23 cases of
severe penetrating cardiac complications were identified. The authors
became aware of two other cases in which they acted as medical experts.
Furthermore, the instructions for use issued by the manufacturers of the
tacks were reviewed with regard to their deployment in the diaphragm.
Results: Twenty-three of 25 cases (92%) with severe cardiac injuries and
subsequent cardiac tamponade were triggered by the use of tacks in the
diaphragm. In six cases (24%), these related to ventral and incisional
hernias with extension to the subxiphoid area, and in 19 cases (76%) to
mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result
of pericardial and/or heart muscle injury with cardiac tamponade despite
heart surgery intervention. In the tack manufacturers' instructions for
use, their deployment in the diaphragm, in particular in the vicinity of
the heart, is contraindicated. Likewise, the existing guidelines urgently
advise against the use of tacks in the diaphragm, recommending instead
alternative fixation techniques. Conclusions: Tacks should not be used for
mesh fixation in the diaphragm above the costal arch.<br/>Copyright &#xa9;
2018 The Author(s)

<154>
Accession Number
621001986
Author
Hureau T.J.; Weavil J.C.; Thurston T.S.; Broxterman R.M.; Nelson A.D.;
Bledsoe A.D.; Jessop J.E.; Richardson R.S.; Wray D.W.; Amann M.
Institution
(Hureau, Weavil, Broxterman, Nelson, Richardson, Wray, Amann) Department
of Internal Medicine University of Utah Salt Lake City, UT USA
(Hureau, Weavil, Broxterman, Richardson, Wray, Amann) Geriatric Research
Education, and Clinical Center, Salt Lake City VA Medical Center Salt Lake
City, UT USA
(Thurston, Richardson, Wray, Amann) Department of Nutrition and
Integrative Physiology University of Utah Salt Lake City, UT USA
(Bledsoe, Jessop, Amann) Department of Anesthesiology University of Utah
Salt Lake City, UT USA
Title
Identifying the role of group III/IV muscle afferents in the carotid
baroreflex control of mean arterial pressure and heart rate during
exercise.
Source
Journal of Physiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Key points: We investigated the contribution of group III/IV muscle
afferents to carotid baroreflex resetting during electrically evoked (no
central command) and voluntary (requiring central command) isometric knee
extension exercise. Lumbar intrathecal fentanyl was used to attenuate the
central projection of mu-opioid receptor-sensitive group III/IV leg muscle
afferent feedback. Spontaneous carotid baroreflex control was assessed by
loading and unloading the carotid baroreceptors with a variable pressure
neck chamber. Group III/IV muscle afferents did not influence spontaneous
carotid baroreflex responsiveness at rest or during exercise. Afferent
feedback accounted for at least 50% of the exercise-induced increase in
the carotid baroreflex blood pressure and heart rate operating points,
adjustments that are critical for an appropriate cardiovascular response
to exercise. These findings suggest that group III/IV muscle afferent
feedback is, independent of central command, critical for the resetting of
the carotid baroreflex blood pressure and heart rate operating points, but
not for spontaneous baroreflex responsiveness. This study sought to
comprehensively investigate the role of metabolically and mechanically
sensitive group III/IV muscle afferents in carotid baroreflex
responsiveness and resetting during both electrically evoked (EVO, no
central command) and voluntary (VOL, requiring central command) isometric
single-leg knee-extension (15% of maximal voluntary contraction; MVC)
exercise. Participants (n = 8) were studied under control conditions
(CTRL) and following lumbar intrathecal fentanyl injection (FENT) to
inhibit mu-opioid receptor-sensitive lower limb muscle afferents.
Spontaneous carotid baroreflex control of mean arterial pressure (MAP) and
heart rate (HR) were assessed following rapid 5 s pulses of neck pressure
(NP, +40 mmHg) or suction (NS, -60 mmHg). Resting MAP (87 +/- 10 mmHg) and
HR (70 +/- 8 bpm) were similar between CTRL and FENT conditions (P > 0.4).
In terms of spontaneous carotid baroreflex responsiveness, FENT did not
alter the change in MAP or HR responses to NP (+13 +/- 5 mmHg, P = 0.85;
+9 +/- 3 bpm; P = 0.99) or NS (-13 +/- 5 mmHg, P = 0.99; -24 +/- 11 bpm; P
= 0.49) at rest or during either exercise protocol, which were of a
remarkably similar magnitude to rest. In contrast, FENT administration
reduced the exercise-induced resetting of the operating point for MAP and
HR during both EVO (116 +/- 10 mmHg to 100 +/- 15 mmHg and 93 +/- 14 bpm
to 82 +/- 10 bpm) and VOL (107 +/- 13 mmHg to 100 +/- 17 mmHg and 89 +/-
10 bpm to 72 +/- 10 bpm) exercise bouts. Together, these findings document
that group III/IV muscle afferent feedback is critical for the resetting
of the carotid baroreflex MAP and HR operating points, independent of
exercise-induced changes in central command, but not for spontaneous
carotid baroreflex responsiveness.<br/>Copyright &#xa9; 2018 The
Physiological Society.