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<1>
Accession Number
621481761
Author
White W.B.; Saag K.G.; Becker M.A.; Borer J.S.; Gorelick P.B.; Whelton A.;
Hunt B.; Castillo M.; Gunawardhana L.
Institution
(White) University of Connecticut, School of Medicine, Calhoun Cardiology
Center, 263 Farmington Ave., Farmington, CT 06032, United States
(Saag) University of Alabama, Birmingham, United States
(Becker) University of Chicago Medicine, Chicago, United States
(Hunt, Castillo, Gunawardhana) Takeda Development Center Americas,
Deerfield, IL, United States
(Borer) State University of New York, Downstate Medical Center, Brooklyn,
United States
(Gorelick) Michigan State University College of Human Medicine, Grand
Rapids, United States
(Whelton) Johns Hopkins University School of Medicine, Baltimore, United
States
Title
Cardiovascular safety of febuxostat or allopurinol in patients with gout.
Source
New England Journal of Medicine. 378 (13) (pp 1200-1210), 2018. Date of
Publication: 29 Mar 2018.
Publisher
Massachussetts Medical Society
Abstract
Background Cardiovascular risk is increased in patients with gout. We
compared cardiovascular outcomes associated with febuxostat, a nonpurine
xanthine oxidase inhibitor, with those associated with allopurinol, a
purine base analogue xanthine oxidase inhibitor, in patients with gout and
cardiovascular disease. METHODS We conducted a multicenter, double-blind,
noninferiority trial involving patients with gout and cardiovascular
disease; patients were randomly assigned to receive febuxostat or
allopurinol and were stratified according to kidney function. The trial
had a prespecified noninferiority margin of 1.3 for the hazard ratio for
the primary end point (a composite of cardiovascular death, nonfatal
myocardial infarction, nonfatal stroke, or unstable angina with urgent
revascularization). RESULTS In total, 6190 patients underwent
randomization, received febuxostat or allopurinol, and were followed for a
median of 32 months (maximum, 85 months). The trial regimen was
discontinued in 56.6% of patients, and 45.0% discontinued follow-up. In
the modified intention-to-treat analysis, a primary end-point event
occurred in 335 patients (10.8%) in the febuxostat group and in 321
patients (10.4%) in the allopurinol group (hazard ratio, 1.03; upper limit
of the one-sided 98.5% confidence interval [CI], 1.23; P=0.002 for
noninferiority). All-cause and cardiovascular mortality were higher in the
febuxostat group than in the allopurinol group (hazard ratio for death
from any cause, 1.22 [95% CI, 1.01 to 1.47]; hazard ratio for
cardiovascular death, 1.34 [95% CI, 1.03 to 1.73]). The results with
regard to the primary end point and all-cause and cardiovascular mortality
in the analysis of events that occurred while patients were being treated
were similar to the results in the modified intention-to-treat analysis.
CONCLUSIONS In patients with gout and major cardiovascular coexisting
conditions, febuxostat was noninferior to allopurinol with respect to
rates of adverse cardiovascular events. Allcause mortality and
cardiovascular mortality were higher with febuxostat than with
allopurinol.<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<2>
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Accession Number
621612518
Author
Vaidya S.R.; Qamar A.; Arora S.; Devarapally S.R.; Kondur A.; Kaul P.
Institution
(Vaidya, Arora) Department of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, NC 28304, United States
(Devarapally) Division of Cardiology, Davis Regional Medical Center,
Statesville, United States
(Arora, Kaul) Division of Cardiology, University of North Carolina at
Chapel Hill, Chapel Hill, United States
(Vaidya) Department of Internal Medicine, Campbell University School of
Medicine, Lillington, NC, United States
(Kondur) Division of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, MI, United States
(Qamar) Division of Cardiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Kaul) Division of Interventional Cardiology, Piedmont Heart Institute,
Atlanta, GA, United States
Title
Culprit versus multivessel coronary intervention in ST-segment elevation
myocardial infarction: A meta-analysis of randomized trials.
Source
Coronary Artery Disease. 29 (2) (pp 151-160), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The 2015 American College of Cardiology/American Heart
Association update on primary percutaneous coronary intervention (PCI) in
patients with ST-segment elevation myocardial infarction (STEMI)
recommended PCI of the non-infarct-related artery at the time of primary
PCI (class IIb recommendation). Despite evidence supporting complete
revascularization in STEMI, its benefit on mortality rates is uncertain.
Methods We searched all available databases for randomized controlled
trials comparing complete multivessel percutaneous coronary intervention
(CMV PCI) with infarct-artery-only revascularization in patients with
STEMI. Summary risk ratios and 95% confidence intervals (CIs) were
calculated for both the efficacy and safety outcomes. Results Nine
randomized controlled trials fulfilled the inclusion criteria, yielding
2991 patients. Follow-up periods ranged from 6 to 36 months. Compared with
infarct-related artery-only PCI, CMV PCI was associated with significantly
lower rates of major adverse cardiac events [relative risk (RR)=0.54, 95%
CI=0.41-0.71; P<0.00001], cardiovascular mortality (RR=0.48, 95%
CI=0.28-0.80; P=0.005), and repeat revascularization (RR=0.38, 95%
CI=0.30-0.47; P<0.00001). Although, contrast-induced nephropathy and major
bleed rates were comparable between both groups, CMV PCI failed to show
any reduction in all-cause mortality (RR=0.75, 95% CI=0.53-1.07; P=0.11)
and nonfatal myocardial infarction (RR=0.69, 95% CI=0.43-1.10; P=0.12).
Conclusion Our results suggest that in patients with STEMI and multivessel
disease, complete revascularization is safe, and is associated with
reduced risks of major adverse cardiac events and cardiac death along with
a reduced need for repeat revascularization. However, it showed no
beneficial effect on all-cause mortality and nonfatal myocardial
infarction.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<3>
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Accession Number
621612483
Author
Choi W.G.; Prasad M.; Lennon R.; Gulati R.; Prasad A.; Lerman L.O.; Lerman
A.
Institution
(Choi, Prasad, Lennon, Gulati, Prasad, Lerman, Lerman) Department of
Cardiovascular Diseases, United States
(Lerman) Division of Nephrology and Hypertension, Mayo Clinic, 200 First
St SW, Rochester, MN 55905, United States
(Choi) Division of Cardiology, Department of Internal Medicine, Konkuk
University College of Medicine, Chungbuk, South Korea
Title
Long-term darapladib use does not affect coronary plaque composition
assessed using multimodality intravascular imaging modalities: A
randomized-controlled study.
Source
Coronary Artery Disease. 29 (2) (pp 104-113), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Lipoprotein-associated phospholipase A 2 (Lp-PLA 2) may play a
role in plaque progression and vulnerability. We aimed to define plaque
characteristics on multimodality intravascular imaging in patients with
coronary endothelial dysfunction in response to long-term inhibition of
Lp-PLA2 by darapladib. Patients and methods This is a double-blinded,
randomized study screening 70 patients, and enrolling 54 patients with
suspected ischemia, without obstructive disease on angiography and with
coronary endothelial dysfunction by invasive assessment. Patients were
randomized to receive darapladib or placebo for 6 months. Forty patients
underwent multimodality intravascular imaging at baseline and after 6
months of therapy. Several parameters of plaque vulnerability were
measured, including maximum value of lipid core burden index for any of
the 4-mm segment (maxLCBI 4 mm) by near-infrared spectroscopy.
Microchannels and macrophages were assessed using optical coherence
tomography and necrotic core volume by virtual histology intravascular
ultrasound. Results There was no significant difference in maxLCBI 4 mm
[64.56 (7.74, 128.56) vs. 22.43 (0, 75.63), P=0.522] or in macrophage
images angle [-9.5degree (-25.53degree, 12.68degree) vs.-16.7degree
(-28.6degree,-4.8degree), P=0.489] between groups. There was a trend
toward shorter microchannel length in the darapladib arm [0, (-4.4, 0.2)
mm vs. 0.8 (-0.15, 1.9) mm, P=0.08]. Percentage of necrotic core volume
was not significantly different. Conclusion Thus, long-term inhibition of
endogenous Lp-PLA 2 activity with darapladib was not associated with a
change in plaque progression and vulnerability indices after 6 months of
therapy, and the endogenous Lp-PLA 2 pathway may not play a direct role in
the progression of early atherosclerosis in humans.<br/>Copyright &#xa9;
2018 Wolters Kluwer Health, Inc. All rights reserved.

<4>
Accession Number
621159517
Author
Yang S.-C.; Fu N.-K.; Zhang J.; Liang M.; Cong H.-L.; Lin W.-H.; Tian
F.-S.; Lu C.-Z.; Sun T.-T.; Zhang W.-Y.; Ma Z.-H.
Institution
(Yang, Liang, Sun, Zhang, Ma) Tianjin Medical University, Tianjin, China
(Fu, Zhang, Cong) Department of Cardiology, Tianjin Chest Hospital,
Tianjin, China
(Lin) Department of Cardiology, Taida International Cardiovascular
Hospital, Tianjin, China
(Tian) Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin,
China
(Lu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
Title
Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy
Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary
Intervention.
Source
Angiology. 69 (5) (pp 393-399), 2018. Date of Publication: 01 May 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the preventive effect of alprostadil on contrast-induced
nephropathy (CIN) in patients with renal insufficiency undergoing
percutaneous coronary intervention (PCI). A total of 300 patients with
creatinine clearance (crCl) <=60 mL/min undergoing PCI were randomly
assigned to alprostadil or a control group. The primary end point was the
incidence of CIN defined as an increase in serum creatinine (Scr) levels
by >=0.5 mg/dL or>= 25% after administration of the contrast media within
72 hours. The secondary end points were (1) changes in Scr and crCl within
72 hours and (2) the incidence of major adverse events during
hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil
group, and 8.7% (13/150) in the control group (chi² = 5.05, P
=.043).There was no difference regarding the incidence of major adverse
events during hospitalization between the alprostadil group and control
groups (2.7% vs 4.0%, P =.750). Multivariate logistic regression analysis
showed that alprostadil was an independent protective factor for CIN (odds
ratio = 0.136, 95% confidence interval: 0.020-0.944, P =.044).
Prophylactic administration of alprostadil may prevent CIN in patients
with renal insufficiency undergoing PCI.<br/>Copyright &#xa9; 2017, &#xa9;
The Author(s) 2017.

<5>
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, United
States
(Hureau, Weavil, Broxterman, Richardson, Wray, Amann) Geriatric Research,
Education, and Clinical Center, Salt Lake City VA Medical Center, Salt
Lake City, UT, United States
(Thurston, Richardson, Wray, Amann) Department of Nutrition and
Integrative Physiology, University of Utah, Salt Lake City, UT, United
States
(Bledsoe, Jessop, Amann) Department of Anesthesiology, University of Utah,
Salt Lake City, UT, United States
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. 596 (8) (pp 1373-1384), 2018. Date of Publication:
15 Apr 2018.
Publisher
Blackwell Publishing Ltd
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. Abstract: 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 Authors.
The Journal of Physiology &#xa9; 2018 The Physiological Society

<6>
Accession Number
621622146
Author
Cigarroa R.; Elmariah S.
Institution
(Cigarroa) Massachusetts General Hospital, 55 Fruit Street, Bigelow 800,
Boston, MA 02114, United States
(Elmariah) Massachusetts General Hospital, 55 Fruit Street, GRB 800,
Boston, MA 02114, United States
Title
Anticoagulation Management After Transcatheter and Surgical Valve
Replacement.
Source
Current Treatment Options in Cardiovascular Medicine. 20 (5) (no
pagination), 2018. Article Number: 42. Date of Publication: 01 May 2018.
Publisher
Springer Healthcare
Abstract
Valvular heart disease is associated with high morbidity and mortality,
and its prevalence is rising as the population ages. Treatment of severe
valvular disease has historically required surgical correction, which
carries its own risks, but there have been significant advances in valve
replacement technologies and techniques, most notably the development of
percutaneous options for repair and replacement. While valve replacements
alleviate the hemodynamic burden of valvular disease, the synthetic
material comprising part or all of the replacement valve provides nidus
for clot, necessitating antithrombotic therapy. Providing the right
balance between thromboembolic and bleeding risk is made more challenging
by the comorbidities that often co-exist with valve disease in the elderly
patient. The backbone of anticoagulation regimens has been comprised of
aspirin, warfarin, or both, but newer agents are gaining popularity due to
improved convenience and safety profiles. The expanding medical arsenal
brings not only more options but also more complexity with the increasing
number of possible combinations of anticoagulants and valve types. In
general, mechanical heart valves are thought to be the most durable option
with the highest thrombotic risk, requiring anticoagulation with warfarin
with the addition of aspirin. Bioprosthetic valves placed surgically or
percutaneously are less likely to cause thrombus and have been
successfully managed with antiplatelet agents alone. However, concerns
about previously undetected complications coming to light with new imaging
techniques have brought uncertainty about current practice. In order to
provide optimal care for our patients, careful review of the current
literature, guideline recommendations, and the thrombotic and bleeding
risk unique to the individual patient and valve type is
necessary.<br/>Copyright &#xa9; 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<7>
Accession Number
2000646002
Author
Leonard J.R.; Rahouma M.; Abouarab A.A.; Schwann A.N.; Scuderi G.; Lau C.;
Guy T.S.; Demetres M.; Puskas J.D.; Taggart D.P.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Rahouma, Abouarab, Schwann, Scuderi, Lau, Guy, Girardi, Gaudino)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
United Kingdom
Title
Totally endoscopic coronary artery bypass surgery: A meta-analysis of the
current evidence.
Source
International Journal of Cardiology. 261 (pp 42-46), 2018. Date of
Publication: 15 June 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Totally endoscopic coronary artery bypass (TECAB) has emerged
as an alternative to other minimally invasive techniques. However, limited
TECAB results are available to date. The purpose of this systematic review
is to examine the existing literature to give an objective estimate of the
outcomes of TECAB using a meta-analytical approach. Methods: A
comprehensive online review was performed in Ovid MEDLINE Ovid EMBASE and
The Cochrane Library from 2000 to July 2017. Eligible studies included
single arm TECAB studies as well as comparative studies (TECAB vs
minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event
rates and odds ratios (ORs) for operative mortality, perioperative
myocardial infarction (MI), perioperative stroke, graft patency and repeat
revascularization were estimated. Single arm and pairwise comparisons were
performed. Results: Seventeen single arm TECAB articles (3721 patients,
weighted mean follow-up 3.3 years) were included. The pooled event rate
was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28% (95%CI:
1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for perioperative
stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization and 94.8%
(95%CI: 89.3-97.5%) for early graft patency (weighted mean follow-up 10.1
months). On pairwise meta-analysis 376 patients (263 TECAB and 113 MIDCAB)
were included. No difference in operative mortality (OR = 0.25, 95%CI:
0.02-2.83), perioperative MI (OR = 3.09, 95%CI: 0.37-26.12) or
perioperative stroke (OR = 1.33, 95%CI: 0.17-10.26) was found between the
two techniques. Conclusions: TECAB has an acceptably low operative risk
and a good early patency rate. The incidence of perioperative MI requires
further investigation. The dearth of data comparing TECAB to open
approaches compels the need for future comparative trials.<br/>Copyright
&#xa9; 2017 Elsevier Ireland Ltd

<8>
Accession Number
621599246
Author
Tan J.; Song Z.; Bian Q.; Li P.; Gu L.
Institution
(Tan, Song, Bian, Li, Gu) Department of Anesthesiology, Jiangsu Cancer
Hospital, Jiangsu Institute of Cancer Prevention, Cancer Hospital
Affiliated to Nanjing Medical University, Nanjing 210000, China
Title
Effects of volume-controlled ventilation vs. pressure-controlled
ventilation on respiratory function and inflammatory factors in patients
undergoing video-assisted thoracoscopic radical resection of pulmonary
carcinoma.
Source
Journal of Thoracic Disease. 10 (3) (pp 1483-1489), 2018. Date of
Publication: 01 Mar 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: The best ventilation approach for patients undergoing
video-assisted thoracic surgery (ATS) for pulmonary carcinoma remains
undefined. This study aimed to assess hemodynamics, airway pressure,
arterial blood gas, and inflammatory factors in patients undergoing VATS
for pulmonary carcinoma under volume-controlled ventilation (VCV) or
pressure-controlled ventilation (PCV). Methods: This was a prospective
study of 60 patients with pulmonary carcinoma treated at a tertiary center
in 2015-2016. The subjects were randomized to the VCV or PCV group after
anesthesia and total lung ventilation (TLV). Hemodynamics and blood gas
parameters were compared between the two groups pre- OLV (one-lung
ventilation) (T1) and after 30 (T2), 60 (T3), and 120 (T4) minutes of OLV.
Radial artery blood was collected to measure interleukin (IL)-6, IL-10,
and tumor necrosis factor (TNF)-alpha levels. Results: Hemodynamic and
blood gas parameters were similar between the two groups (all P > 0.05).
During OLV, airway resistance (RAW) was significantly lower in the PCV
group compared with the VCV group at T2 (26.0 +/- 3.8 vs. 29.9 +/- 7.3
cmH<inf>2</inf>O/L/s), T3 (26.0 +/- 3.7 vs. 30.2 +/- 7.7
cmH<inf>2</inf>O/L/s), and T4 (25.8 +/- 4.1 vs. 29.6 +/- 6.7
cmH<inf>2</inf>O/L/s). Similar trends were found for peak pressure (Ppeak)
and plateau pressure (Pplat). Mean pressure (Pmean) was similar between
the two groups. Compared with the PCV group, TNF-alpha and IL-6 levels in
the VCV group were significantly increased (all P < 0.05). The levels of
the anti-inflammatory mediator IL-10 were higher in the PCV group compared
with the VCV group. Conclusions: PCV for OLV during radical resection of
pulmonary carcinoma by VATS could reduce Ppeak and downregulate
pro-inflammatory factors, likely decreasing airway injury.<br/>Copyright
&#xa9; 2018, Journal of Thoracic Disease.

<9>
Accession Number
2000647642
Author
Panoulas V.F.; Montorfano M.; Taramasso M.; Giustino G.; La Canna G.;
Latib A.; Colombo A.
Institution
(Panoulas, Montorfano, Taramasso, Giustino, Latib, Colombo) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
(Panoulas, Giustino, Latib, Colombo) EMO-GVM Centro Cuore Columbus, Milan,
Italy
(Panoulas) Imperial College London, National Heart and Lung Institute,
London, United Kingdom
(La Canna) Cardiac surgery echocardiography unit, San Raffaele Scientific
Institute, Milan, Italy
Title
A Tricky Percutaneous Paravalvular Leak Closure Two Years After
Implantation of 3f Enable Sutureless Bioprosthetic Aortic Valve.
Source
Hellenic Journal of Cardiology. 57 (1) (pp 41-44), 2016. Date of
Publication: January - February 2016.
Publisher
Hellenic Cardiological Society
Abstract
Sutureless valves were designed in an attempt to simplify the aortic valve
replacement procedure and reduce extracorporeal circuit time, whilst
allowing complete excision of the calcified native valve using a minimally
invasive approach. Elderly patients with significant comorbidities are
considered to benefit the most, although randomized data are lacking. In
registries of patients treated with implantation of a 3f Enable sutureless
bioprosthetic aortic valve, all patients who developed paravalvular leak
have been treated with valve explantation. This is the first case report
describing a tricky yet successful percutaneous paravalvular leak closure
2 years after implantation of a 3f Enable sutureless aortic
bioprosthesis.<br/>Copyright &#xa9; 2016 Hellenic Cardiological Society

<10>
Accession Number
2000640576
Author
Reindl M.; Reinstadler S.J.; Tiller C.; Kofler M.; Theurl M.; Klier N.;
Fleischmann K.; Mayr A.; Henninger B.; Klug G.; Metzler B.
Institution
(Reindl, Reinstadler, Tiller, Theurl, Klier, Fleischmann, Klug, Metzler)
University Clinic of Internal Medicine III, Cardiology and Angiology,
Medical University of Innsbruck, Anichstrasse 35, Innsbruck A-6020,
Austria
(Kofler) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrasse 35, Innsbruck A-6020, Austria
(Mayr, Henninger) University Clinic of Radiology, Medical University of
Innsbruck, Anichstrasse 35, Innsbruck A-6020, Austria
Title
ACEF score adapted to ST-elevation myocardial infarction patients: The
ACEF-STEMI score.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The age, creatinine and ejection fraction (ACEF) score has
originally been developed for risk stratification of patients undergoing
elective cardiac surgery. In patients with stable coronary artery disease
treated by percutaneous coronary intervention (PCI), the prognostic
accuracy of ACEF could be further improved by modifying the original
scoring system (called "modified ACEF" or "ACEF-MDRD"). We aimed to
specifically adapt the ACEF score for risk assessment of ST-elevation
myocardial infarction (STEMI) patients. Methods: In this observational
study, 390 STEMI patients undergoing primary PCI were included. Clinical
endpoint was the occurrence of major adverse cardiovascular events (MACE)
comprising all-cause mortality, non-fatal re-infarction, stroke and new
congestive heart failure. Results: Original ACEF (area under the curve
(AUC):0.63 [95%CI:0.53-0.73]; p = 0.01) and ACEF-MDRD score (AUC:0.62
[95%CI:0.53-0.72]; p = 0.01) significantly but weakly predicted MACE (n =
41, 11%). The addition of creatinine > 2 mg/dl (as suggested in original
ACEF, p = 0.32) or eGFR steps as proposed in ACEF-MDRD (p = 0.17) to
age/EF ratio were not associated with net reclassification improvements
(NRI), but DELTAeGRF (>10 ml/min/1.73 m² decrease within three
days after PCI) led to an NRI of 0.29 (95%CI:0.14-0.45; p < 0.001).
Replacement of cross-sectional renal assessment by DELTAeGRF and addition
of 3 clinical parameters (diabetes, anterior infarct location and
C-reactive protein), forming the new ACEF-STEMI score, led to a
significant improvement in MACE prediction (AUC:0.75 [95%CI:0.66-0.84]) as
compared to original ACEF or ACEF-MDRD (both p = 0.03). Conclusions: In
STEMI patients undergoing primary PCI, the novel ACEF-STEMI score provided
strong prognostic value and superior discriminative ability as compared to
the previously described original ACEF or ACEF-MDRD scores.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<11>
Accession Number
619323234
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
(Lee, Kim, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Dongsan Medical
Centre, Keimyung University College of Medicine, Daegu, South Korea
(Song) Department of Anaesthesiology and Pain Medicine, Asan Medical
Centre, University of Ulsan College of Medicine, Seoul, South Korea
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: a prospective, randomised trial.
Source
Anaesthesia. 73 (2) (pp 205-215), 2018. Date of Publication: Februaryy
2018.
Publisher
Blackwell Publishing Ltd
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg^-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg^-1 was not associated
with postoperative acute kidney injury in paediatric cardiac
patients.<br/>Copyright &#xa9; 2017 The Association of Anaesthetists of
Great Britain and Ireland

<12>
Accession Number
609745889
Author
Morris A.A.; Kransdorf E.P.; Coleman B.L.; Colvin M.
Institution
(Morris) Division of Cardiology, Emory University, Atlanta, Georgia,
United States
(Kransdorf) Division of Cardiovascular Diseases, Cedars-Sinai Heart
Institute, Beverly Hills, California, United States
(Coleman) Nursing Research and Development, Cedars Sinai Medical Center,
Los Angeles, California, United States
(Colvin) Division of Cardiology, University of Michigan, Ann Arbor,
Michigan, United States
Title
Racial and ethnic disparities in outcomes after heart transplantation: A
systematic review of contributing factors and future directions to close
the outcomes gap.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 953-961), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
The demographics of patients undergoing heart transplantation in the
United States have shifted over the last 10 years, with an increasing
number of racial and ethnic minorities undergoing heart transplant.
Multiple studies have shown that survival of African American patients
after heart transplantation is lower compared with other ethnic groups. We
review the data supporting the presence of this outcome disparity and
examine the multiple mechanisms that contribute. With an increasingly
diverse population in the United States, knowledge of these disparities,
their mechanisms, and ways to improve outcomes is essential.<br/>Copyright
&#xa9; 2016 International Society for Heart and Lung Transplantation

<13>
Accession Number
610173231
Author
Solberg O.G.; Stavem K.; Ragnarsson A.; Ioanes D.; Arora S.; Endresen K.;
Benth J.S.; Gullestad L.; Gude E.; Andreassen A.K.; Aaberge L.
Institution
(Solberg, Ragnarsson, Arora, Endresen, Gullestad, Gude, Andreassen,
Aaberge) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Solberg, Stavem, Benth) Faculty of Medicine, University of Oslo, Oslo,
Norway
(Stavem) Department of Pulmonary Medicine, Akershus University Hospital,
Lorenskog, Norway
(Stavem, Benth) HOKH, Research Centre, Akershus University Hospital,
Lorenskog, Norway
(Ioanes) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Centre and Centre for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Index of microvascular resistance after early conversion from calcineurin
inhibitor to everolimus in heart transplantation: A sub-study to a 1-year
randomized trial.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 1010-1017), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Microvascular function in transplanted hearts can be evaluated
by methods used in routine left heart catheterization follow-up after
heart transplantation (HTx). This sub-study of a randomized study compared
the effects of everolimus (EVR) and calcineurin inhibitor (CNI) treatment
on microvascular function as expressed by the index of microvascular
resistance (IMR) at 1 year after HTx. A secondary objective was to compare
the change in IMR from 7-11 weeks to 1 year after HTx between randomized
groups. Methods There were 70 HTx recipients included and randomly
assigned to combination therapy (EVR and CNI with early CNI withdrawal) vs
conventional CNI treatment. Coronary physiologic assessment was performed
7-11 weeks and 1 year after HTx. A linear mixed model was used to assess
the group difference at 1 year and the difference in IMR change between
7-11 weeks and 1 year after HTx. Results At 1 year, there was no
significant difference in IMR between the EVR group (17.5 mm Hg.sec +/-
8.9) (mean +/- SD) and the CNI group (14.9 mm Hg.sec +/- 6.6, p = 0.17).
The difference in IMR change between the 2 treatment arms was 1.6 mm
Hg.sec (95% confidence interval, -2.8 to 5.9; p = 0.49). Spearman's rank
correlation coefficient at 1 year after HTx between IMR and maximal
intimal thickness as assessed with intravascular ultrasound in the left
anterior descending artery was -0.13 (p = 0.28). Conclusions In this
prospective, open, randomized study comparing early CNI withdrawal with
mammalian target of rapamycin inhibitors immunosuppression during the
first year after HTx, early transition from CNI-based immunosuppression to
EVR-based treatment did not result in differences in microvascular
function as assessed by the IMR.<br/>Copyright &#xa9; 2016 International
Society for Heart and Lung Transplantation

<14>
Accession Number
621568344
Author
Berwanger O.; Santucci E.V.; Jesuino I.D.A.; Damiani L.P.; Barbosa L.M.;
Nakagawa Santos R.H.; Laranjeira L.N.; Egydio F.D.M.; Borges De Oliveira
J.A.; Dall Orto F.T.C.; De Andrade P.B.; De Castro Bienert I.R.; Bosso
C.E.; Mangione J.A.; Polanczyk C.A.; De Moraes Rego Sousa A.G.; Kalil
R.A.K.; Santos L.D.M.; Sposito A.C.; Rech R.L.; Sousa A.C.S.; Baldissera
F.; Nascimento B.R.; Giraldez R.R.C.V.; Cavalcanti A.B.; Pereira S.B.;
Mattos L.A.; Armaganijan L.V.; Guimaraes H.P.; Rego Sousa J.E.M.;
Alexander J.H.; Granger C.B.; Lopes R.D.; De Barros E Silva P.G.M.; De
Macedo T.A.; Peixoto De Miranda E.J.F.; Godoy L.C.; Dos Santos M.H.H.;
Katz M.; Truffa A.A.M.; Carvalho L.; Oliveira R.; Valois M.V.; Pacheco
B.G.; Kodama A.; Sampaio B.
Institution
(Berwanger, Santucci, De Barros E Silva, Jesuino, Damiani, Nakagawa
Santos, Laranjeira, Borges De Oliveira, Cavalcanti, Pereira, Guimaraes,
Rego Sousa, Pacheco, Kodama, Sampaio) Research Institute, Heart Hospital,
Abilio Soares St 250, Twelfth Floor, Sao Paulo, SP 04005-000, Brazil
(De Barros E Silva, Barbosa, Egydio, Armaganijan, Lopes) Brazilian
Clinical Research Institute, Sao Paulo, Brazil
(Dall Orto) Hospital Do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(De Andrade) Santa Casa de Marilia, Marilia, Brazil
(De Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
(Bosso) Santa Casa de Presidente Prudente/ Instituto Do Coracao de
Presidente Prudente, Presidente Prudente, Brazil
(Mangione) Hospital Sao Francisco de Assis, Braganca Paulista, Brazil
(Polanczyk) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(De Moraes Rego Sousa) Instituto Dante Pazzanese de Cardiologia, Sao
Paulo, Brazil
(Kalil) Instituto de Cardiologia Do Rio Grande Do sul, Porto Alegre,
Brazil
(Santos) Instituto de Cardiologia Do Distrito Federal, Brasilia, Brazil
(Sposito) Faculdade de Ciencias Medicas, Universidade Estadual de
Campinas, Campinas, Brazil
(Rech) Hospital Universitario de Canoas, Canoas, Brazil
(Sousa) Hospital Sao Lucas, Aracaju, Brazil
(Baldissera) Instituto de Pesquisa e Estudos Medicos de Itajai, Itajai,
Brazil
(Nascimento) Hospital Universitario Ciencias Medicas, Belo Horizonte,
Brazil
(Giraldez) Instituto Do Coracao, Sao Paulo, Brazil
(Mattos) Rede D'Or Sao Luiz, Sao Paulo, Brazil
(Alexander, Granger, Lopes) Duke University Medical Center, Duke Clinical
Research Institute, Durham, NC, United States
Title
Effect of loading dose of atorvastatin prior to planned percutaneous
coronary intervention on major adverse cardiovascular events in acute
coronary syndrome the SECURE-PCI randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 319 (13) (pp
1331-1340), 2018. Date of Publication: 03 Apr 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The effects of loading doses of statins on clinical outcomes in
patients with acute coronary syndrome (ACS) and planned invasive
management remain uncertain. OBJECTIVE To determine if periprocedural
loading doses of atorvastatin decrease 30-day major adverse cardiovascular
events (MACE) in patients with ACS and planned invasive management.
DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind,
placebo-controlled, randomized clinical trial conducted at 53 sites in
Brazil among 4191 patients with ACS evaluated with coronary angiography to
proceed with a percutaneous coronary intervention (PCI) if anatomically
feasible. Enrollment occurred between April 18, 2012, and October 6, 2017.
Final follow-up for 30-day outcomes was on November 6, 2017. INTERVENTIONS
Patients were randomized to receive 2 loading doses of 80mg of
atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours
after a planned PCI. All patients received 40mg of atorvastatin for 30
days starting 24 hours after the second dose of study medication. MAIN
OUTCOMES AND MEASURES The primary outcome was MACE, defined as a composite
of all-cause mortality, myocardial infarction, stroke, and unplanned
coronary revascularization through 30 days. RESULTS Among the 4191
patients (mean age, 61.8 [SD, 11.5] years; 1085women [25.9%]) enrolled,
4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent
PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144
(27.3%) had exclusively medical management. At 30 days, 130 patients in
the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had
aMACE (absolute difference, 0.85%[95%CI, -0.70%to 2.41%]; hazard ratio,
0.88; 95%CI, 0.69-1.11; P = .27). No cases of hepatic failurewere
reported; 3 cases of rhabdomyolysis were reported in the placebo group
(0.1%) and 0 in the atorvastatin group. CONCLUSIONS AND RELEVANCE Among
patients with ACS and planned invasive management with PCI, periprocedural
loading doses of atorvastatin did not reduce the rate of MACE at 30 days.
These findings do not support the routine use of loading doses of
atorvastatin among unselected patients with ACS and intended invasive
management.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<15>
Accession Number
619197728
Author
Akinseye O.A.; Jha S.K.; Ibebuogu U.N.
Institution
(Akinseye, Jha, Ibebuogu) Division of Cardiovascular Diseases, Department
of Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
Title
Clinical outcomes of coronary occlusion following transcatheter aortic
valve replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 229-236), 2018. Date
of Publication: March 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary occlusion (CO) is a rare but serious complication
following transcatheter aortic valve replacement (TAVR) with limited
published data. We sought to evaluate the immediate and short-term
outcomes of CO complicating TAVR. Methods: Studies, including case
reports, case series and original articles published from 2002 to 2016
describing CO following TAVR were identified with a systematic electronic
search using the PRISMA Statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. Results: A total of 40 publications describing 96
patients (86 native, 10 bioprosthetic) were identified. Mean age was 83
+/- 7 years and most (81%) were females. The mean logistic EuroSCORE and
STS score was 23.5 +/- 14.6% and 9.1 +/- 3.2% respectively. TAVR access
site was transfemoral in 73% and a balloon expandable valve was used in
78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1
+/- 1.8 mm while the mean RCA ostium height was 10.4 +/- 2.0 mm among
those with RCA occlusion. CO frequently involved the left main coronary
artery (80%) and the most common mechanism was displacement of native
valve leaflet (60%), and most cases occurred within 1-hour
post-implantation (88%). Percutaneous coronary intervention was attempted
in 82 patients and successful in 89%. Procedural death was 10.4%. CO
following TAVR in native aortic valve stenosis was associated with a
30-day mortality rate of 35.3%. Conclusions: CO following TAVR is
associated with a high procedural and 30-day mortality rate despite
aggressive resuscitative measures including percutaneous coronary
intervention.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<16>
Accession Number
617920749
Author
Ando T.; Takagi H.; Telila T.; Afonso L.
Institution
(Ando, Telila, Afonso) Detroit Medical Center/Wayne State University,
Division of Cardiology, Detroit, United States
(Takagi) Shizuoka Medical Center, Division of Cardiovascular Surgery,
Shizuoka, Japan
Title
Comparison of outcomes in new-generation versus early-generation heart
valve in transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 186-191), 2018. Date
of Publication: March 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: New-generation (NG) valves for transcatheter aortic valve
implantation (TAVI) has recently been widely used in real-world practice,
yet its comparative outcomes with early-generation (EG) valves remain
under-explored. Methods: An electronic literature search using PUBMED and
EMBASE was conducted from inception to April 2017 for matched-cohort
studies. Articles that compared the outcomes of NG vs. EG valves post TAVI
with at least one of the following clinical outcome reported were
included: all-cause mortality, major or life-threatening bleeding, major
vascular complications (MVC), significant (more than moderate)
paravalvular regurgitation (PVR), cerebrovascular events, significant
(stage 2 or 3) acute kidney injury (AKI) and new permanent pacemaker
implantation (PPI) that occurred either in-hospital or within 30-days.
Results: A total of 6 observational matched-cohort studies with 585 and
647 patients included in NG and EG valves, respectively, were included. EG
valves were associated with a lower incidence of major or life-threatening
bleeding (5.7% vs. 15.7%, p < 0.00001), significant paravalvular
regurgitation (5.3% vs. 14.4%, p = 0.001), and significant AKI (4.4% vs.
7.5, p = 0.03). All-cause mortality (3.5% vs. 5.0, p = 0.43),
cerebrovascular events (3.4% vs. 2.3%, p = 0.34) and new PPI (11.0% vs.
14.6%, p = 0.52) were similar between the two groups. NG demonstrated
lower tendency of MVC (2.5% vs. 7.2, p = 0.09) compared to EG valves.
Conclusions: NG demonstrated lower rates of significant AKI, significant
PVR and major or life-threatening bleeding while all-cause mortality, new
PPI, and cerebrovascular events remained similar compared to EG
valves.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<17>
Accession Number
621598383
Author
Wang N.; Phan K.
Institution
(Wang, Phan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
Title
Cerebral protection devices in transcatheter aortic valve replacement: A
clinical meta-analysis of randomized controlled trials.
Source
Journal of Thoracic Disease. 10 (3) (pp 1927-1935), 2018. Date of
Publication: 01 Mar 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Neurological complications after undergoing transcatheter
aortic valve replacement (TAVR) may be reduced with cerebral protection
(CP) devices. However, randomized controlled trials (RCTs) have failed to
demonstrate convincing evidence of improvements in hard clinical endpoints
in patients with CP. The aim of this study was to compare clinical
outcomes of TAVR patients with and without CP devices. Methods: Electronic
searches were performed using four electronic databases from their dates
of inception to May 2017. RCTs that reported outcomes for patient cohorts
that underwent TAVR procedures with and without CP were included. Crude
odds ratios (ORs) and 95% confidence intervals were calculated using
random effects model. Results: A total of five RCTs were included,
totalling 643 patients, 386 of whom were randomized to TAVR + CP and 257
with TAVR only. The primary composite endpoint of all-cause mortality and
stroke at 30 days was lower in patients undergoing CP devices compared to
those patients with TAVR alone (OR, 0.54; 95% CI, 0.30 to 0.98). Use of CP
devices was also associated with lower new total lesion volume
(standardised mean difference, -0.49; 95% CI, -0.96 to -0.03). There was a
non-significant reduction in the risk of secondary clinical endpoints of
all-cause mortality, stroke, life-threatening bleed, acute kidney injury
and major vascular complications in patients randomized to TAVR + CP.
Conclusions: Use of CP devices in TAVR appears to be safe and may be
associated with a reduction in stroke/death.<br/>Copyright &#xa9; Journal
of Thoracic Disease.

<18>
[Use Link to view the full text]
Accession Number
621651936
Author
Indolfi C.; Bartorelli A.L.; Berti S.; Golino P.; Esposito G.; Musumeci
G.; Petronio S.; Tamburino C.; Tarantini G.; Ussia G.; Vassanelli C.;
Spaccarotella C.; Violini R.; Mercuro G.; Romeo F.
Institution
(Indolfi, Bartorelli, Berti, Golino, Esposito, Musumeci, Petronio,
Tamburino, Tarantini, Ussia, Vassanelli, Spaccarotella, Violini, Mercuro,
Romeo) Cattedra di Cardiologia, Universita degli Studi Magna Graecia,
Catanzaro, Italy
(Indolfi) Division of Cardiology, Department of Surgical and Medical
Sciences, URT CNR of IFC, Magna Graecia University, Catanzaro, Italy
Title
Updated clinical indications for transcatheter aortic valve implantation
in patients with severe aortic stenosis: Expert opinion of the Italian
Society of Cardiology and GISE.
Source
Journal of Cardiovascular Medicine. 19 (5) (pp 197-210), 2018. Date of
Publication: 01 May 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The introduction of percutaneous treatment of severe aortic stenosis with
transcatheter aortic valve implantation (TAVI) remains one of the greatest
achievements of interventional cardiology. In fact, TAVI emerged as a
better option than either medical therapy or balloon aortic valvuloplasty
for patients who cannot undergo surgical aortic valve replacement (SAVR)
or are at high surgical risk. Recently, increased operator experience and
improved device systems have led to a worldwide trend toward the extension
of TAVI to low-risk or intermediate-risk patients. In this expert opinion
paper, we first discuss the basic pathophysiology of aortic stenosis in
different settings then the key results of recent clinical investigations
on TAVI in intermediate-risk aortic stenosis patients are summarized.
Particular emphasis is placed on the results of the nordic aortic valve
intervention, placement of aortic transcatheter valves (PARTNER) 2 and
Surgical Replacement and Transcatheter Aortic Valve Implantation
Randomized trials. The PARTNER 2 was the first large randomized trial that
evaluated the outcome of TAVI in patients at intermediate risk. The
PARTNER 2 data demonstrated that TAVI is a feasible and reasonable
alternative to surgery in intermediate-risk patients (Society of Thoracic
Surgeons 4-8%), especially if they are elderly or frail. There was a
significant interaction between TAVI approach and mortality, with
transfemoral TAVI showing superiority over SAVR. Moreover, we examine the
complementary results of the recently concluded Surgical Replacement and
Transcatheter Aortic Valve Implantation trial. This prospective randomized
trial demonstrated that TAVI is comparable with surgery (primary end point
12.6% in the TAVI group vs. 14.0% in the SAVR group) in severe aortic
stenosis patients deemed to be at intermediate risk. We review the most
relevant clinical evidence deriving from nonrandomized studies and
meta-analyses. Altogether, clinical outcome available data suggest that
TAVI with a newer generation device might be the preferred treatment
option in this patient subgroup. Finally, the differences between the
latest European and American Guidelines on TAVI were reported and
discussed. The conclusion of this expert opinion article is that TAVI, if
feasible, is the treatment of choice in patients with prohibitive or high
surgical risk and may lead to similar or lower early and midterm mortality
rates compared with SAVR in intermediate-risk patients with severe aortic
stenosis.<br/>Copyright &#xa9; 2018 Italian Federation of Cardiology. All
rights reserved.

<19>
Accession Number
621655408
Author
Atehortua-Lopez L.H.; Mendoza-Franco R.; Escobar-Serna J.F.; Urrego L.A.;
Alzate F.; Jaimes F.
Institution
(Atehortua-Lopez, Alzate) Hospital Universitario San Vicente Fundacion,
Medellin, Colombia
(Atehortua-Lopez, Mendoza-Franco, Escobar-Serna, Urrego) Universidad de
Antioquia, Medellin, Colombia
(Jaimes) Universidad de Antioquia, Research Unit Hospital Pablo Tobon
Uribe, Medellin, Colombia
Title
Effects of hypertonic saline vs normal saline on lactate clearance after
cardiovascular surgery.
Source
Archivos de Cardiologia de Mexico. 88 (2) (pp 100-106), 2018. Date of
Publication: April-June 2018.
Publisher
Instituto Nacional de Cardiologia Ignazio Chavez (E-mail:
archivos@cardiologia.org.mx)
Abstract
Background: The postoperative care of patients subjected to cardiac
surgery frequently require a complete recovery with intravenous fluids,
but crystalloid solutions like normal saline may increase the interstitial
oedema, and it is also well known that fluid overload increases mortality.
Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9%
normal saline (NS) on lactate clearance, as well as the haemodynamic
response of patients during the first day after cardiovascular bypass
surgery. Methods: The study included patients 18 years of age and older
with coronary artery disease and/or heart valve disease, and who underwent
bypass surgery and/or cardiac valve replacement and were randomly assigned
to receive 4 mL/kg of HS or NS intravenously for 30 min once they were
admitted to the ICU. Lactate, arterial blood gases, heart rate, central
venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12,
and 24 h after being admitted to the ICU. The analyses were carried out
with an intention-to-treat principle. Results: Out of a total of 494
patients evaluated, 102 were included and assigned to the HS groups (51
patients) or NS (51 patients). The mean age of the participants was 59 +/-
14 years, and 59.8% were male. No statistically significant differences
were observed between two groups in the lactate clearance, or in any of
the secondary outcomes. Conclusions: Our study failed to show a better
lactate clearance in the group on hypertonic saline, and with no evidence
of a higher incidence of adverse effects in that group.<br/>Copyright
&#xa9; 2017 Instituto Nacional de Cardiologia Ignacio Chavez.

<20>
Accession Number
621661206
Author
Anonymous
Title
Correction to: The effect of 6% hydroxyethyl starch (130/0.4) on acute
kidney injury in paediatric cardiac surgery: a prospective, randomised
trial (Anaesthesia, (2018), 73, 2, (205-215), 10.1111/anae.14129).
Source
Anaesthesia. 73 (5) (pp 656), 2018. Date of Publication: May 2018.
Publisher
Blackwell Publishing Ltd
Abstract
In an article by Oh et al., the control group data for minimum glucose;
mmol.l^-1 was listed incorrectly as 105.9 (1.4). The correct
data is 5.8 (1.4).<br/>Copyright &#xa9; 2018 The Association of
Anaesthetists of Great Britain and Ireland

<21>
Accession Number
621441197
Author
Mitra S.; Florez I.D.; Tamayo M.E.; Mbuagbaw L.; Vanniyasingam T.;
Veroniki A.A.; Zea A.M.; Zhang Y.; Sadeghirad B.; Thabane L.
Institution
(Mitra) Department of Pediatrics, Dalhousie University, IWK Health Center,
5850/5980 University Ave, Halifax, NS B3K 6R8, Canada
(Mitra, Florez, Mbuagbaw, Vanniyasingam, Zea, Zhang, Sadeghirad, Thabane)
Department of Health Research Methods, Evidence and Impact, McMaster
University, Hamilton, ON, Canada
(Florez, Tamayo) Department of Pediatrics, Universidad de Antioquia,
Medellin, Colombia
(Mbuagbaw, Vanniyasingam) Biostatistics Unit, Father Sean o'Sullivan
Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
(Veroniki) Li Ka Shing Knowledge Institute, St Michaels Hospital, Toronto,
ON, Canada
(Sadeghirad) HIV/STI Surveillance Research Center, WHO Collaborating
Center for HIV Surveillance, Kerman University of Medical Sciences,
Kerman, Iran, Islamic Republic of
(Sadeghirad) Institute for Futures Studies in Health, Kerman University of
Medical Sciences, Kerman, Iran, Islamic Republic of
(Sadeghirad) Michael G. DeGroote Institute for Pain Research and Care,
McMaster University, Hamilton, ON, Canada
(Thabane) Department of Pediatrics and Anesthesia, McMaster University,
Hamilton, ON, Canada
Title
Association of placebo, indomethacin, ibuprofen, and acetaminophen with
closure of hemodynamically significant patent ductus arteriosus in preterm
infants a systematic review and meta-analysis.
Source
JAMA - Journal of the American Medical Association. 319 (12) (pp
1221-1238), 2018. Date of Publication: 27 Mar 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Despite increasing emphasis on conservative management of
patent ductus arteriosus (PDA) in preterm infants, different
pharmacotherapeutic interventions are used to treat those developing a
hemodynamically significant PDA. OBJECTIVES To estimate the relative
likelihood of hemodynamically significant PDA closure with common
pharmacotherapeutic interventions and to compare adverse event rates. DATA
SOURCES AND STUDY SELECTION The databases of MEDLINE, Embase, and the
Cochrane Central Register of Controlled Trials were searched from
inception until August 15, 2015, and updated on December 31, 2017, along
with conference proceedings up to December 2017. Randomized clinical
trials that enrolled preterm infants with a gestational age younger than
37 weeks treated with intravenous or oral indomethacin, ibuprofen, or
acetaminophen vs each other, placebo, or no treatment for a clinically or
echocardiographically diagnosed hemodynamically significant PDA. DATA
EXTRACTION AND SYNTHESIS Datawere independently extracted in pairs by 6
reviewers and synthesized with Bayesian random-effects network
meta-analyses. MAIN OUTCOMES AND MEASURES Primary outcome: Hemodynamically
significant PDA closure; secondary: Included surgical closure, mortality,
necrotizing enterocolitis, and intraventricular hemorrhage. RESULTS In 68
randomized clinical trials of 4802 infants, 14 different variations of
indomethacin, ibuprofen, or acetaminophen were used as treatment
modalities. The overall PDA closure rate was 67.4%(2867 of 4256 infants).
A high dose of oral ibuprofen was associated with a significantly higher
odds of PDA closure vs a standard dose of intravenous ibuprofen (odds
ratio [OR], 3.59; 95%credible interval [CrI], 1.64-8.17; absolute risk
difference, 199 [95%CrI, 95-258] more per 1000 infants) and a standard
dose of intravenous indomethacin (OR, 2.35 [95%CrI, 1.08-5.31]; absolute
risk difference, 124 [95%CrI, 14-188] more per 1000 infants). Based on the
ranking statistics, a high dose of oral ibuprofen ranked as the best
pharmacotherapeutic option for PDA closure (mean surface under the
cumulative ranking [SUCRA] curve, 0.89 [SD, 0.12]) and to prevent surgical
PDA ligation (mean SUCRA, 0.98 [SD, 0.08]). There was no significant
difference in the odds of mortality, necrotizing enterocolitis, or
intraventricular hemorrhage with use of placebo or no treatment compared
with any of the other treatment modalities. CONCLUSIONS AND RELEVANCE A
high dose of oral ibuprofen was associated with a higher likelihood of
hemodynamically significant PDA closure vs standard doses of intravenous
ibuprofen or intravenous indomethacin; placebo or no treatment did not
significantly change the likelihood of mortality, necrotizing
enterocolitis, or intraventricular hemorrhage.<br/>Copyright &#xa9; 2018
American Medical Association.

<22>
Accession Number
615550152
Author
Feguri G.R.; De Lima P.R.L.; De Cerqueira Borges D.; Toledo L.R.; Batista
L.N.; E Silva T.C.; Segri N.J.; De Aguilar-Nascimento J.E.
Institution
(Feguri) Federal University of Mato Grosso, Cuiaba, Brazil
(Feguri, De Cerqueira Borges, Batista, E Silva) General University
Hospital, Cuiaba, Brazil
(Feguri) UNIC - University of Cuiaba, Cuiaba, Brazil
(De Lima) Cardiovascular Department, General University Hospital, Cuiaba,
Brazil
(Toledo) Nutrition Service, General University Hospital, Cuiaba, Brazil
(Segri) Department of Statistics, Federal University of Mato Grosso,
Cuiaba, Brazil
(De Aguilar-Nascimento) Federal University of Mato Grosso, UNIVAG Medical
School, Varzea Grande, Brazil
(Feguri) Rua Mal. Floriano Peixoto, 1520/503 - Duque de Caxias II, Cuiaba
CEP:78045-395, Brazil
Title
Preoperative carbohydrate load and intraoperatively infused omega-3
polyunsaturated fatty acids positively impact nosocomial morbidity after
coronary artery bypass grafting: A double-blind controlled randomized
trial.
Source
Nutrition Journal. 16 (1) (no pagination), 2017. Article Number: 24. Date
of Publication: 20 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A strategy of limited preoperative fasting, with carbohydrate
(CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty
acids (omega-3 PUFA), has seldom been tried in cardiovascular surgery.
Brief fasting, followed by CHO intake 2 h before anesthesia, may improve
recovery from CABG procedures and lower perioperative vasoactive drug
requirements. Infusion of omega-3 PUFA may reduce occurrences of
postoperative atrial fibrillation (POAF) and shorten hospital stays. The
aim of this study was to assess morbidity (especially POAF) in ICU
patients after coronary artery bypass grafting (CABG)/cardiopulmonary
bypass (CPB) in combination, if preoperative fasts are curtailed in favor
of CHO loading, and omega-3 PUFA are infused intraoperatively. Methods:
Fifty-seven patients undergoing CABG were randomly assigned to receive
12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing
omega-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without
infusing omega-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h
before anesthesia) plus intraoperative omega-3 PUFA (0.2 mcg/kg) (CHO +
W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative
omega-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables
and mortality were analyzed, examining the incidence of POAF, as well as
the need for inotropic vasoactive drugs during surgery and in ICU.
Results: Two deaths occurred (3.5%), but there were no instances of
bronchoaspiration and mediastinitis. Neither ICU stays nor total
postoperative stays differed by group (P > 0.05). Patients given
preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer
instances of hospital infection (RR = 0.29, 95%CI 0.09-0.94; P = 0.023)
and were less reliant on vasoactive amines during surgery (RR = 0.60, 95%
CI 0.38-0.94; P = 0.020). Similarly, the number of patients requiring
vasoactive drugs while recovering in ICU differed significantly by group
(P = 0.008), showing benefits in patients given CHO loads. The overall
incidence of POAF was 29.8% (17/57), differing significantly by group (P =
0.009). Groups given omega-3 PUFA (W3 and CHO + W3 groups) experienced
significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56-15.02; P =
0.001). Conclusion: Preoperative curtailment of fasting was safe in this
cohort. When implemented in conjunction with CHO loading and infusion of
omega-3 PUFA during surgery, expedited recovery from CABG with CPB was
observed. Trial registration: NCT: 03017001<br/>Copyright &#xa9; 2017 The
Author(s).

<23>
Accession Number
617068216
Author
Udesh R.; Natarajan P.; Jeevanantham V.; Gleason T.G.; Badhwar V.;
Thirumala P.D.
Institution
(Udesh, Natarajan, Thirumala) Department of Neurological Surgery,
University of Pittsburgh School of Medicine, Center for Clinical
Neurophysiology, Presbyterian-Suite B-400 200 Lothrop Street, Pittsburgh,
PA 15213, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, OK, United States
(Badhwar) Division of Cardiothoracic Surgery, West Virginia University,
Morgantown, WV, United States
Title
Perioperative strokes following surgical correction of mitral valves: A
systematic review and meta-analysis.
Source
European Neurology. 78 (1-2) (pp 63-70), 2017. Date of Publication: 01 Aug
2017.
Publisher
S. Karger AG
Abstract
Objective: The primary aim of this meta-analysis was to quantify the
impact of perioperative strokes on stroke-related mortality after open
mitral valve (MV) procedures were performed. Methods: An electronic search
of the PubMed, Embase, and the Web of Science databases was performed to
retrieve articles published up to December 2015, relevant to patients
undergoing MV procedures. Data were extracted from the final list of 25
studies to calculate a summary OR for 30-day stroke-related mortality.
Results: The stroke rate in the total sample population was 1.62%
(73/4,498). The 30-day all-cause mortality rate was 3.51% (158/4,498). The
percentage of total deaths caused by stroke was 6.87%. The summary OR of
stroke-related mortality following MV procedures was estimated to be 7.22
(95% CI 4.13-12.63, p < 0.0001). A subgroup analysis was done for studies
involving concomitant MV surgery and coronary artery bypass grafting. The
summary estimate of the subgroup showed an OR of 8.508 (95% CI
1.552-46.622, p = 0.0136). Conclusion: Perioperative strokes following
open MV procedures may be associated with more than 7 times greater odds
of 30-day stroke-related mortality. They appear to be more commonly
occurring than what is reported by current literature, making further
studies investigating possible mechanisms and preventive measures a
priority.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<24>
Accession Number
613098948
Author
Elrggal M.E.; Kotb G.A.; Elghitani A.; Zyada R.
Institution
(Elrggal) Department of Nephrology, Kidney and Urology Center, Alexandria,
Egypt
(Kotb) Department of Nephrology, Alexandria University Students' Hospital,
Alexandria, Egypt
(Elghitani) Department of Clinical Pharmacy, Kidney and Urology Center,
Alexandria, Egypt
(Zyada) Department of Nephrology, Alexandria Main University Hospital,
Alexandria, Egypt
Title
Coronary revascularization in chronic kidney disease patients, external
validity of meta-analysis results.
Source
Kidney International. 90 (5) (pp 1131-1132), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier B.V.

<25>
Accession Number
2000568333
Author
Kulik A.; Abreu A.M.; Boronat V.; Kouchoukos N.T.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, FL, United States
(Kouchoukos) Division of Cardiovascular and Thoracic Surgery, Missouri
Baptist Medical Center, BJC Healthcare, St. Louis, MO, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
Title
Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale
and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft
events and thrombosis) randomized controlled trial (NCT02053909).
Source
Contemporary Clinical Trials. 68 (pp 45-51), 2018. Date of Publication:
May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale: Saphenous vein graft disease remains a major limitation of
coronary artery bypass graft surgery (CABG). Up to 20% of vein grafts will
occlude within the first year after CABG despite standard aspirin
antiplatelet therapy. However, more potent postoperative platelet
inhibition with ticagrelor may improve graft patency. The goal of this
study will be to evaluate the efficacy of ticagrelor, as compared to
aspirin, for the prevention of saphenous vein graft occlusion following
CABG. Study design: The Ticagrelor Antiplatelet Therapy to Reduce Graft
Events and Thrombosis (TARGET) study is a multi-center double-blind
randomized controlled trial enrolling patients who have undergone
multi-vessel CABG with at least one saphenous vein graft. Patients are
being randomized to receive either aspirin 81 mg twice per day or
ticagrelor 90 mg twice per day for 2 years starting within 7 days after
surgery. The projected enrollment is 150 patients in each arm (300 total
patients). Patients will undergo computed tomography (CT) coronary
angiography at 1 and 2 years after surgery to assess the incidence of vein
graft occlusion and stenosis. Conclusion: To our knowledge, this trial is
the first prospective study to evaluate the impact of early postoperative
ticagrelor on 1- and 2-year graft patency after CABG. Furthermore, it is
also the first trial to use a novel antiplatelet agent as a standalone,
without aspirin, after CABG. Should ticagrelor reduce the incidence of
postoperative graft occlusion, the results of this study will redefine
modern antiplatelet management following coronary bypass surgery
(ClinicalTrials.gov NCT02053909).<br/>Copyright &#xa9; 2018 Elsevier Inc.

<26>
Accession Number
619240293
Author
Verdoia M.; Barbieri L.; Nardin M.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, Nardin, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont
University, Novara, Italy
(Barbieri) Department of Cardiology, Ospedale S. Andrea, Vercelli, Italy
(Nardin) Department of Medicine, ASST "Spedali Civili", University of
Brescia, Brescia, Italy
(Suryapranata) Department of Cardiology, University Medical Centre St
Radboud, Nijmegen, Netherlands
Title
Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in
Transcatheter Aortic Valve Replacement: Indirect Comparison and
Meta-analysis.
Source
Revista Espanola de Cardiologia. 71 (4) (pp 257-266), 2018. Date of
Publication: April 2018.
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: There is uncertainty on the correct
management of antithrombotic therapies after transcatheter aortic valve
replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently
recommended on an empirical basis. The aim of the present meta-analysis
was to assess the safety and effectiveness of DAPT in patients undergoing
TAVR. Methods: Studies comparing different antithrombotic regimens after
TAVR were included. The primary endpoint was 30-day overall mortality.
Results: We included 9 studies, 5 comparing DAPT with aspirin monotherapy
and 4 comparing DAPT with monoantiplatelet therapy (MAPT) + oral
anticoagulation. Among 7991 patients, 72% were on DAPT. The median
follow-up was 3.5 months. Mortality was significantly lower in the DAPT
group (12.2% vs 14.4%; OR, 0.81; 95%CI, 0.70-0.93; P =.003;
P<inf>het</inf> =.93), with similar benefits compared with aspirin
monotherapy (OR, 0.80; 95%CI, 0.69-0.93; P =.004; P<inf>het</inf> =.60),
which were not statistically significant when compared with MAPT + oral
anticoagulation (OR, 0.86; 95%CI, 0.55-1.35; P =.51; P<inf>het</inf>
=.97). A similar trend for DAPT was observed for stroke (OR, 0.83 95%CI,
0.63-1.10; P =.20; P<inf>het</inf> =.67), with no increase in the rate of
major bleedings (OR, 1.69; 95%CI, 0.86-3.31; P =.13;
P<inf>het</inf><.0001). On indirect comparison analysis, no benefit in
survival, stroke, or bleedings was identified for additional oral
anticoagulation. Conclusions: The present meta-analysis supports the use
of DAPT after TAVR, reducing mortality and offering slight benefits in
stroke, with no increase in major bleedings compared with MAPT. The
strategy of aspirin + oral anticoagulation did not provide significant
benefits compared with MAPT or DAPT. Full English text available from:
www.revespcardiol.org/en<br/>Copyright &#xa9; 2017 Sociedad Espanola de
Cardiologia

<27>
Accession Number
619130547
Author
Marengoni A.; Rizzuto D.; Fratiglioni L.; Antikainen R.; Laatikainen T.;
Lehtisalo J.; Peltonen M.; Soininen H.; Strandberg T.; Tuomilehto J.;
Kivipelto M.; Ngandu T.
Institution
(Marengoni) Department of Clinical and Experimental Sciences, University
of Brescia, Brescia, Italy
(Marengoni, Rizzuto, Fratiglioni, Kivipelto) Aging Research Center,
Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm University, Stockholm, Sweden
(Fratiglioni) Stockholm Gerontology Research Center, Stockholm, Sweden
(Antikainen, Strandberg) Center for Life Course Health
Research/Geriatrics, University of Oulu, Oulu, Finland
(Antikainen, Strandberg) Medical Research Center Oulu, Oulu University
Hospital, Oulu, Finland
(Antikainen) Oulu City Hospital, Oulu, Finland
(Laatikainen, Lehtisalo, Peltonen, Tuomilehto, Kivipelto, Ngandu)
Department of Public Health Solutions, Chronic Disease Prevention Unit,
National Institute for Health and Welfare, Helsinki, Finland
(Laatikainen) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Laatikainen) Joint municipal authority for North Karelia social and
health services, Joensuu, Finland
(Lehtisalo, Tuomilehto) Department of Public Health, University of
Helsinki, Helsinki, Finland
(Soininen, Kivipelto) Institute of Clinical Medicine/Neurology, University
of Eastern Finland, Kuopio, Finland
(Strandberg) University of Helsinki, Helsinki University Hospital,
Helsinki, Finland
(Tuomilehto) South Ostrobothnia Central Hospital, Seinajoki, Finland
(Tuomilehto) Dasman Diabetes Institute, Dasman, Kuwait
(Tuomilehto) Diabetes Research Group, King Abdulaziz University, Jeddah,
Saudi Arabia
(Kivipelto, Ngandu) Division of Clinical Geriatrics, Center for Alzheimer
Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Stockholm, Sweden
(Kivipelto) Stockholms Sjukhem, Research & Development unit, Stockholm,
Sweden
Title
The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise,
Cognitive Training, and Monitoring of Vascular Risk on Chronic
Morbidity-the FINGER Randomized Controlled Trial.
Source
Journal of the American Medical Directors Association. 19 (4) (pp
355-360.e1), 2018. Date of Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To verify whether a multidomain intervention lowers the risk of
developing new chronic diseases in older adults. Methods: Multicenter,
double-blind randomized controlled trial started in October 2009, with
2-year follow-up. A total of 1260 people aged 60 to 77 years were enrolled
in the Finnish Geriatric Intervention Study to Prevent Cognitive
Impairment and Disability (FINGER). Participants were randomly assigned in
a 1:1 ratio to a 2-year multidomain intervention (n = 631) (nutritional
guidance, exercise, cognitive training, and management of metabolic and
vascular risk factors) or a control group (n = 629) (general health
advice). Data on most common chronic diseases were collected by a
physician at baseline and 2 years later. Results: At 2-year follow-up, the
average number of new chronic diseases was 0.47 [standard deviation (SD)
0.7] in the intervention group and 0.58 (SD 0.8) in the control group (P
<.01). The incidence rate per 100 person-years for developing 1+ new
disease(s) was 17.4 [95% confidence interval (CI) = 15.1-20.1] in the
intervention group and 20.5 (95% CI = 18.0-23.4) in the control group; for
developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and 6.1 (95% CI =
4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5) and 1.8 (95% CI
= 1.1-2.8), respectively. After adjustment for age, sex, education,
current smoking, alcohol intake, and the number of chronic diseases at
baseline, the intervention group had a hazard ratio ranging from 0.80
(0.66-0.98) for developing 1+ new chronic disease(s) to 0.38 (0.16-0.88)
for developing 3+ new chronic diseases compared to the control group.
Conclusions: Findings from this randomized controlled trial suggest that a
multidomain intervention could reduce the risk of developing new chronic
diseases in older people.<br/>Copyright &#xa9; 2017 AMDA - The Society for
Post-Acute and Long-Term Care Medicine

<28>
Accession Number
621295616
Author
Zhang J.-J.; Gao X.-F.; Han Y.-L.; Kan J.; Tao L.; Ge Z.; Tresukosol D.;
Lu S.; Ma L.-K.; Li F.; Yang S.; Zhang J.; Munawar M.; Li L.; Zhang R.-Y.;
Zeng H.-S.; Santoso T.; Xie P.; Jin Z.-N.; Han L.; Yin W.-H.; Qian X.-S.;
Li Q.-H.; Hong L.; Paiboon C.; Wang Y.; Liu L.-J.; Zhou L.; Wu X.-M.; Wen
S.-Y.; Lu Q.-H.; Yuan J.-Q.; Chen L.-L.; Lavarra F.; Rodriguez A.E.; Zhou
L.-M.; Ding S.-Q.; Vichairuangthum K.; Zhu Y.-S.; Yu M.-Y.; Chen C.;
Sheiban I.; Xia Y.; Tian Y.-L.; Shang Z.-L.; Jiang Q.; Zhen Y.-H.; Wang
X.; Ye F.; Tian N.-L.; Lin S.; Liu Z.-Z.; Chen S.-L.
Institution
(Zhang, Gao, Ge, Ye, Tian, Lin, Liu, Chen) Department of Cardiology,
Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu,
China
(Han) Department of Cardiology, General Hospital of Shenyang Military,
Shenyang, China
(Kan, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing, China
(Tao) Department of Cardiology, Xijing Hospital, 4th Military Medical
University, Xi'an, China
(Tresukosol) Department of Cardiology, Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Lu) Department of Cardiology, Taicang People's Hospital, Taicang, China
(Ma) Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui,
China
(Li) Department of Cardiology, Huainan Eastern Hospital, Huainan, China
(Yang) Department of Cardiology, Yixin People's Hospital, Yixing, China
(Zhang) Department of Cardiology, Cangzhou Central Hospital, Cangzhou,
China
(Munawar) Department of Cardiology, Binawaluya Cardiac Center, Jakarta,
Indonesia
(Li) Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
Guangdong, China
(Zhang) Department of Cardiology, Shanghai Ruijin Hospital, Shanghai,
China
(Zeng) Department of Cardiology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
(Santoso) Department of Cardiology, Medistra Hospital, University of
Indonesia, Jakarta, Indonesia
(Xie) Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
(Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Han) Department of Cardiology, Changshu First People's Hospital,
Changshu, China
(Yin) Department of Cardiology, Cheng-Hsin General Hospital, Taipei,
Taiwan (Republic of China)
(Qian) Department of Cardiology, Zhangjiagang First People's Hospital,
Zhangjiagang, China
(Li) Department of Cardiology, Changzhou Hospital of Traditional Chinese
Medicine, Changzhou, China
(Hong) Department of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, Jiangxi, China
(Paiboon) Department of Cardiology, Bangkok General Hospital, Bangkok,
Thailand
(Wang) Department of Cardiology, Xia'Men Zhongshan Hospital, Xia'men,
China
(Liu) Department of Cardiology, Huainan First People's Hospital, Huainan,
China
(Zhou) Department of Cardiology, Jintan People's Hospital, Jintan, China
(Wu) Department of Cardiology, Wuxi Third People's Hospital, Wuxi, China
(Wen) Department of Cardiology, Daqing Oil General Hospital, Daqing, China
(Lu) Department of Cardiology, Second Hospital of Shandong University,
Ji'nan, China
(Yuan) Department of Cardiology, Xinyang Central Hospital, Xinyang, Henan,
China
(Chen) Department of Cardiology, Fujian Union Hospital, Fuzhou, China
(Lavarra) Department of Cardiology, Jilin Heart Hospital, Changchun, China
(Rodriguez) Department of Cardiology, Otamendi Hospital, Buenos Aires,
Argentina
(Zhou) Department of Cardiology, Chuzhou First People's Hospital, Chuzhou,
China
(Ding) Department of Cardiology, Huainan Xinhua Hospital, Huainan, China
(Vichairuangthum) Department of Cardiology, Bangplee Hospital, Bangkok,
Thailand
(Zhu) Department of Cardiology, Huai'an Second People's Hospital, Huai'an,
China
(Yu) Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China
(Chen) Department of Cardiology, Affiliated Hospital of Guangdong Medical
University, Guangzhou, China
(Sheiban) Department of Cardiology, University of Turin, Turin, Italy
(Xia) Department of Cardiology, Affiliated Hospital of Xuzhou Medical
University, Xuzhou, China
(Tian) Department of Cardiology, Xuyi People's Hospital, Xuyi, China
(Shang) Department of Cardiology, Wuxi Huishan District People's Hospital,
Wuxi, China
(Jiang) Department of Cardiology, Anqing First People's Hospital, Anqing,
China
(Zhen) Department of Cardiology, Liyang Hospital of Traditional Chinese
Medicine, Liyang, China
(Wang) Department of Cardiology, Lianyungang Hospital of Traditional
Chinese Medicine, Lianyungang, China
Title
Treatment effects of systematic two-stent and provisional stenting
techniques in patients with complex coronary bifurcation lesions:
Rationale and design of a prospective, randomised and multicentre
DEFINITION II trial.
Source
BMJ Open. 8 (3) (no pagination), 2018. Article Number: e020019. Date of
Publication: 01 Mar 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Provisional stenting (PS) for simple coronary bifurcation
lesions is the mainstay of treatment. A systematic two-stent approach is
widely used for complex bifurcation lesions (CBLs). However, a randomised
comparison of PS and two-stent techniques for CBLs has never been studied.
Accordingly, the present study is designed to elucidate the benefits of
two-stent treatment over PS in patients with CBLs. Methods and analysis
This DEFINITION II study is a prospective, multinational, randomised,
endpoint-driven trial to compare the benefits of the two-stent technique
with PS for CBLs. A total of 660 patients with CBLs will be randomised in
a 1:1 fashion to receive either PS or the two-stent technique. The primary
endpoint is the rate of 12-month target lesion failure defined as the
composite of cardiac death, target vessel myocardial infarction (MI) and
clinically driven target lesion revascularisation. The major secondary
endpoints include all causes of death, MI, target vessel
revascularisation, in-stent restenosis, stroke and each individual
component of the primary endpoints. The safety endpoint is the occurrence
of definite or probable stent thrombosis. Ethics and dissemination The
study protocol and informed consent have been approved by the
Institutional Review Board of Nanjing First Hospital, and accepted by each
participating centre. Written informed consent was obtained from all
enrolled patients. Findings of the study will be published in a
peer-reviewed journal and disseminated at conferences.<br/>Copyright
&#xa9; 2018 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article). All rights reserved.

<29>
Accession Number
620775591
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(Bjornnes) Institute of Nursing and Health Promotion, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, Ontario, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, Ontario,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto,
Ontario, Canada
(Lalloo, Stinson) The Hospital for Sick Children, The Peter Gilgan Centre
for Research and Learning, Toronto, Ontario, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, Florida, United States
(McGillion) School of Nursing, McMaster University, Hamilton, Ontario,
Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, Ontario, Canada
Title
Self-Management Interventions for Women With Cardiac Pain: A Systematic
Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 34 (4) (pp 458-467), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. Methods: Using methods described
by the Evidence for Policy and Practice Information and Co-ordinating
Centre at the Institute of Education, 7 databases were systematically
searched to examine and synthesize the evidence on self-management
interventions for women with cardiac pain and cardiac pain equivalents,
such as fatigue, dyspnea, and exhaustion. Results: Our search yielded
22,402 article titles and abstracts. Of these, 57 randomized controlled
trials were included in a final narrative synthesis, comprising data from
13,047 participants, including 5299 (41%) women. Self-management
interventions targeting cardiac pain in women compared with a control
population reduced (1) cardiac pain frequency and cardiac pain proportion
(obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3)
dyspnea at 2 months. There was no evidence of group differences in
postprocedural (percutaneous coronary intervention or cardiac surgery)
pain. Results indicated that self-management interventions for cardiac
pain were more effective if they included a greater proportion of women
(standardized mean difference [SMD], -0.01; standard error, 0.003; P =
0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to
-0.03), and collaboration/support from health care providers (SMD, -0.57;
95% CI, -1.00 to -0.14). Conclusions: The results of this review suggest
that self-management interventions reduce cardiac pain and cardiac pain
equivalents.<br/>Copyright &#xa9; 2017 Canadian Cardiovascular Society

<30>
[Use Link to view the full text]
Accession Number
617003265
Author
Wang J.; Shu C.; Wu Z.; Zhao J.; Ma Y.; Huang B.; Yuan D.; Yang Y.; Bian
H.; He Y.; Wang Z.
Institution
(Wang, Shu, He) West China School of Medicine, West China Hospital,
Sichuan University, Chengdu, Sichuan Province, China
(Wang, Shu, Wu, Zhao, Ma, Huang, Yuan, Yang) Department of Vascular
Surgery, West China Hospital, Sichuan University, 37 Guo Xue Alley,
Chengdu, Sichuan Province 610041, China
(Bian) Department of Statistics, Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(He) Institute of Genetics and Molecular Medicine, Western General
Hospital, University of Edinburgh, Edinburgh, United Kingdom
(Wang) Department of Gastrointestinal Surgery, West China Hospital,
Sichuan University, 37 Guo Xue Alley, Chengdu, Sichuan Province 610041,
China
Title
Percutaneous Vascular Interventions Versus Bypass Surgeries in Patients
with Critical Limb Ischemia.
Source
Annals of Surgery. 267 (5) (pp 846-857), 2018. Date of Publication: 01 May
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: The aim of our study was to compare percutaneous vascular
interventions (PVI) versus bypass surgeries (BSX) in patients with
critical limb ischemia (CLI). Background: Previous relevant reviews with
limited numbers of included studies did not strictly confine the inclusion
criteria to CLI, also involving patients with severe claudication, which
may introduce bias in the decision-making of CLI revascularization.
Current treatment strategies for CLI still remain controversial. Methods:
We performed a meta-analysis of all available randomized controlled trials
and observational clinical studies comparing PVI with BSX in CLI patients.
Primary endpoints included overall survival, amputation-free survival,
30-day mortality, and major adverse cardiovascular and cerebrovascular
events. Results: We identified 45 cohorts and 1 RCT in over 20,903
patients. In overall population, PVI reduced the risks of 30-day mortality
[odds ratio (OR) 0.69, 95% confidence interval (CI) 0.51-0.95), major
adverse cardiovascular and cerebrovascular events (OR 0.42, 95% CI
0.29-0.61), and surgical site infection (OR 0.31, 95% CI 0.19-0.51), but
increased the risks of long-term all-cause mortality [hazard ratio (HR)
1.16, 95% CI 1.05-1.27) and primary patency failure (HR 1.31, 95% CI
1.08-1.58). When compared with autogenous BSX, PVI was also associated
with additional increased risks of long-term death or amputation (HR 1.41,
95% CI 1.02-1.94) and secondary patency failure (HR 1.51, 95% CI
1.17-1.95). In patients with infrapopliteal lesions, we found PVI had
inferior primary patency (HR 1.39, 95% CI 1.10-1.75) compared with BSX.
Conclusion: For patients in good physical condition with long
life-expectancy, BSX may represent a better choice compared with PVI,
particularly when autogenous bypass is available. While enhanced
perioperative care for cardiovascular events and surgical site should be
considered in patients underwent BSX to achieve comparable short-term
outcomes provided by PVI.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc. All rights reserved.

<31>
Accession Number
621398121
Author
Chan B.; Butler E.; Frost S.A.; Chuan A.; Aneman A.
Institution
(Chan, Butler) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Frost, Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
(Frost, Chuan, Aneman) Ingham Institute for Applied Medical Research,
Sydney, NSW, Australia
(Frost, Chuan, Aneman) South Western Sydney Clinical School, University of
New South Wales, Sydney, NSW, Australia
(Frost) Centre for Applied Nursing Research, Western Sydney University,
Sydney, NSW, Australia
(Chuan) Department of Anaesthesia, Liverpool Hospital, Liverpool, NSW,
Australia
Title
Cerebrovascular autoregulation monitoring and patient-centred outcomes
after cardiac surgery: a systematic review.
Source
Acta Anaesthesiologica Scandinavica. 62 (5) (pp 588-599), 2018. Date of
Publication: May 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Impaired cerebrovascular autoregulation (CVAR) is observed in
up to 20% of cardiac surgical patients. This systematic review aims to
evaluate the association between impaired CVAR, measured by current
monitoring techniques, and patient-centred outcomes in adults following
cardiac surgery. Methods: MEDLINE, EMBASE, PubMed, MEDLINE In-Process and
Cochrane Library were systematically searched through 8 December 2017.
Studies were included if they assessed associations between CVAR and
patient-centred outcomes in the adult cardiac surgical population. The
primary outcome of this systematic review was mortality. Secondary
outcomes were stroke, delirium and acute kidney injury. Risk of bias was
systematically assessed, and the GRADE methodology was used to evaluate
the quality of evidence across outcomes. Results: Eleven observational
studies and no randomised controlled trials met the inclusion criteria.
Due to methodological heterogeneity, meta-analysis was not possible. There
was a high risk of bias within individual studies and low quality of
evidence across outcomes. Of the included studies, one assessed mortality,
five assessed stroke, four assessed delirium, and three assessed acute
kidney injury. No reliable conclusions can be drawn from the one study
assessing mortality. Interpretation of studies investigating CVAR and
stroke, delirium and acute kidney injury was complicated by the lack of
standardisation of monitoring techniques as well as varying definitions of
impaired CVAR. Conclusions: There is a paucity of high quality evidence
for CVAR monitoring and its associations with outcome measures in
post-cardiac surgical patients, highlighting the need for future
studies.<br/>Copyright &#xa9; 2018 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<32>
Accession Number
620001638
Author
Hou X.; Chen Z.; Sun C.; Zhang G.; Wu S.; Liu Z.
Institution
(Hou, Zhang, Wu, Liu) Department of Orthopaedics, Peking University
Shougang Hospital China, Beijing, China
(Chen, Sun) Department of Orthopaedics, Peking University Third Hospital,
Beijing, China
Title
A systematic review of complications in thoracic spine surgery for
ossification of ligamentum flavum.
Source
Spinal Cord. 56 (4) (pp 301-307), 2018. Date of Publication: 01 Apr 2018.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Study design: Systematic review. Objectives: The aim of this systematic
review is to summarize the incidence of complications, to relate
complication incidence to procedures performed, to assess the impact of
the year of study publication and follow-up duration on complication
incidence. Methods: The authors conducted the Cochrane Central Register of
Controlled Trials, PubMed, and EMBASE searches for relevant literatures.
The incidence of complications was summarized. Correlation of the
incidence with year of study publications, follow-up duration, and the
surgical outcome was statistically evaluated. Results: A total of 16
studies met our inclusion criteria, including 475 patients. All of these
studies were retrospective case series. The mean age of patients ranged
from 55 to 64 years. Average follow-up duration ranged from 26 to 65
months. Partial patients in four studies underwent surgeries and reserved
posterior structure of the spinal canal. The others underwent operations
removing posterior structure of spinal canal. The mean recovery rate from
each individual study varied between 31 and 68% and the pooled neurologic
function recovery rate was 53% (95% CI: 43-62%). The mean complication
rate was 24%. Cerebrospinal fluid leakage was the most reported
postoperative complication (19%), then neurologic deterioration (5%).
Other complications included local infections, wound dehiscence, increased
kyphotic deformity, an hematoma. Conclusions: Operations removing
posterior structure of spinal canal are the main technique to decompress
spinal cord. Cerebrospinal fluid leakage and postoperative neurologic
deterioration were the most reported complications.<br/>Copyright &#xa9;
2017 The Author(s) 2017, under exclusive licence to the International
Spinal Cord Society.

<33>
Accession Number
621642157
Author
Criquet A.; Mai E.; Saucourt C.; Vogt S.; Giganti P.; Baron S.; Roncalli
J.; Lairez O.; Lagente C.; Lebrin M.; Ioannides K.; Manrique A.; Saloux
E.; Leroux L.; Goin V.; Roubille F.; Lefevre T.; Hovasse T.; Vanzetto G.;
Derenne S.; Tertrais K.; Newby D.; Cruden N.; Mills N.; Greenwood J.;
Wheatcroft S.; Dickinson A.; Black A.; Henon P.
Institution
(Criquet, Mai, Saucourt, Vogt, Giganti, Baron, Henon) CellProthera,
Mulhouse, France
(Roncalli, Lairez, Lagente, Lebrin, Ioannides) Rangueil Hospital,
Toulouse, France
(Manrique, Saloux) Caen Hospital, Caen, France
(Leroux, Goin) Haut-Leveque Hospital, Haut-Leveque, France
(Roubille) Arnaud De Villeneuve Hospital, Montpellier, France
(Lefevre, Hovasse) Jacques Cartier Hospital, Massy, France
(Vanzetto) La Tronche Hospital, Grenoble, France
(Derenne, Tertrais) EFS, Nantes, France
(Newby, Cruden, Mills) Royal Infirmary Hospital, Edinburgh, United Kingdom
(Greenwood, Wheatcroft) JubileeWing Hospital, Leeds, United Kingdom
(Dickinson, Black) Newcastle Biomanufacturing Facility,
Newcastle-upon-Tyne, United Kingdom
Title
Challenges between clinical sites and cell therapy facilities in the
excellent trial (expanded cell endocardiac transplantation), a phase I/IIb
clinical trial.
Source
Cytotherapy. Conference: 25th Annual Meeting of the International Society
for Cellular Therapy, ISCT 2017. United Kingdom. 19 (5 Supplement 1) (pp
S21-S22), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Introduction: Autologous injection of Peripheral Blood CD34+ stem cells
during a CABG surgery previously brought positive outcomes in AMI
patients. CellProthera set the StemXpand technology that expands
peripheral blood CD34+ stem cells, with one StemPack kit per patient. The
medical device was validated with inter-sites manufacturing comparisons,
to prove the reproducibility and the robustness of our process. The named
ProtheraCytes IND is injected via the BIOCARDIA device. The American and
European regulatory Authorities named this type of cellular compounds MTMM
(More Than Minimally Manipulated) or ATMP (Advanced Therapy Medicinal
Product). This breakthrough approach circumscrible the patient from
leukapheresis and CABG surgery. Hypothesis: Autologous stem cell injection
strives to demonstrate the infarcted tissue regeneration. The type, the
quantity of cells, the way to inject them and the time of administration
are the major factors to assess the safety and efficacy. Methods:
NCT02669810 is an international, multicentric, randomized, opened label,
controlled trial. The cMRI and 99mTc SPECT core lab is blinded. 44 AMI
patients will be randomized. 8 clinical centers and 2 cell therapy centers
are involved. The manufacturing sites yield the ProtheraCytes ATMP. The
inclusion period is of 1 year with a 6 months following-up. The patient is
screened after signed informed consent. A LVEF remaining below or equal to
45% and identification of non-viable cardiac segments allow the patient be
randomized. In the Verum arm, after a 5 days G-CSF administrations, a
blood harvest is made on the 6th days; the cGMP manufacturing process is
to yield the ProtheraCytes, IND to be injected with the Biocardia system
on the 15th day after randomization. The primary objective is the safety
from the first G-CSF administration to 6 months after the ProtheraCytes
injection in AMI patients with a LVEF <= 45% at baseline vs Standard of
Care. The main secondary objective is the efficacy on the same time scale.
MACE, SAE, AE combined incidences will be assessed as primary endpoint.
The secondary endpoint is set on the improvement of the Left Ventricle End
Systolic Volume and viability improvement assessment of the infarcted
segments. Results: Outcomes will be featured during the ISCT Session.
Conclusions: The EXCELLENT Trial strives to demonstrate the ProtheraCytes
injection may induce structural and functional regeneration and may
prevent heart failure.

<34>
Accession Number
2000636375
Author
Lammers A.; Mitin T.; Moghanaki D.; Thomas C.R.; Timmerman R.; Golden
S.E.; Thakurta S.; Dziadziuszko R.; Slatore C.G.
Institution
(Lammers) Department of Hematology and Medical Oncology, Oregon Health and
Science University, Portland, Oregon, United States
(Lammers, Golden, Thakurta, Slatore) VA Portland Health Care System,
Health Services Research & Development, Portland, Oregon, United States
(Mitin, Thomas, Slatore) Department of Radiation Medicine, Oregon Health
and Science University-Knight Cancer Institute, Portland, Oregon, United
States
(Moghanaki) Radiation Oncology Service, Hunter Holmes McGuire Veterans
Affairs Medical Center, Richmond, Virginia, United States
(Moghanaki) Department of Radiation Oncology, Virginia Commonwealth
University, Richmond, Virginia, United States
(Timmerman) Department of Radiation Oncology, University of Texas
Southwestern Medical Center, Dallas, Texas, United States
(Dziadziuszko) Department of Oncology and Radiotherapy, Medical University
of Gdansk, Poland
(Slatore) Pulmonary and Critical Care Medicine, Oregon Health and Science
University, Portland, Oregon, United States
(Slatore) Pulmonary and Critical Care Medicine, VA Portland Health Care
System, Portland, Oregon, United States
Title
Lung cancer specialists' opinions on treatment for stage I non-small cell
lung cancer: A multidisciplinary survey.
Source
Advances in Radiation Oncology. 3 (2) (pp 125-129), 2018. Date of
Publication: April - June 2018.
Publisher
Elsevier Inc
Abstract
Purpose: The current standard of care for surgically eligible stage I
non-small cell lung cancer (NSCLC) is surgical resection, but emerging
data suggest that stereotactic body radiation therapy (SBRT) is
potentially as effective as surgery. However, specialist views of the
current evidence about SBRT and how they would incorporate a randomized
controlled trial (RCT) into practice is unclear. We sought to understand
specialist opinions about evidence regarding treatment of stage I NSCLC
and how this translates into practice and clinical trial implementation.
Methods and materials: We used a 28-item, web-based survey that invited
all participating providers from the American Society for Radiation
Oncology, American Thoracic Society Thoracic Oncology Assembly, and the
International Association for the Study of Lung Cancer to share opinions
regarding practice beliefs, treatment of stage I NSCLC, and a clinical
trial scenario. Results: A total of 959 surveys were completed; 64% were
from radiation oncologists (ROs) and 49% were from outside the United
States. The majority of ROs (80%) reported that current evidence indicates
that SBRT has the same or a better benefit compared with surgery for
surgically eligible patients with stage I NSCLC; 28% of non-radiation
oncologists (NROs) indicated the same (P <.01). Almost all ROs (94%),
compared with 62% of NROs, would permit surgically eligible patients to
enroll in an RCT of SBRT versus surgery (P <.01). Most ROs (82%) and NROs
(87%) believed that changing practice in thoracic surgery would be
somewhat difficult, very difficult, or impossible (P =.066) even if an RCT
showed better survival with SBRT. Conclusions: NROs believe that SBRT is
much less effective than surgery, contrary to ROs, who believe that they
are similar. Most would support an RCT, but NROs would do so less. Changes
in surgical practice may be challenging even if an RCT shows better
mortality and quality of life with SBRT. These results are helpful in the
creation and dissemination of RCTs that are designed to understand this
question.<br/>Copyright &#xa9; 2018

<35>
Accession Number
2000644989
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Zembala
M.; Gasior M.; Zembala M.O.
Institution
(Tajstra, Hawranek, Gierlotka, Gasior) 3rd Chair and Department of
Cardiology, SMDZ in Zabrze, Silesian Center for Heart Diseases, Medical
University of Silesia, Katowice, Poland
(Hrapkowicz, Filipiak, Zembala, Zembala) Department of Cardiac, Vascular
and Endovascular Surgery and Transplantology, Silesian Center for Heart
Diseases, Medical University of Silesia, Zabrze, Poland
Title
Hybrid Coronary Revascularization in Selected Patients With Multivessel
Disease: 5-Year Clinical Outcomes of the Prospective Randomized Pilot
Study.
Source
JACC: Cardiovascular Interventions. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aimed to investigate the 5-year clinical follow-up
of the Hybrid Revascularization for Multivessel Coronary Artery Disease
(HYBRID) trial. Background: HYBRID trial, the only randomized study
involving thorough analysis of outcome after the 2 procedures, suggested
that hybrid coronary revascularization (HCR) is feasible in selected
patients with multivessel coronary disease referred for conventional
coronary artery bypass grafting (CABG). There are currently no long-term
outcome data from randomized trials in this setting. Methods: A total of
200 patients with multivessel coronary disease referred for conventional
surgical revascularization were randomly assigned to undergo HCR or CABG.
The primary endpoint was the occurrence of all-cause mortality at 5 years.
Results: Nine patients (4 in HCR and 5 in CABG group) were lost to the
5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG group)
formed the basis of this study. The groups were well balanced in terms of
pre-procedural characteristics. All-cause mortality at 5-year follow-up
was similar in the 2 groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69).
The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat
revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p =
0.35), and major adverse cardiac and cerebrovascular events (45.2% vs.
53.4%; p = 0.39) were also similar in the 2 groups. Conclusions: HCR has
similar 5-year all-cause mortality when compared with conventional
coronary bypass grafting (Safety and Efficacy Study of Hybrid
Revascularization in Multivessel Coronary Artery Disease;
NCT01035567).<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<36>
Accession Number
2000644715
Author
Kalra R.; Vohra R.; Negi M.; Aggarwal N.; Aggarwal M.; Joshi R.
Institution
(Kalra, Vohra, Negi, Joshi, Aggarwal, Aggarwal, Joshi) Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi 110060, India
Title
Feasibility of initiating early enteral nutrition after congenital heart
surgery in neonates and infants.
Source
Clinical Nutrition ESPEN. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
Objective: To assess the feasibility of initiating enteral nutrition
support with first 24 h of congenital heart repairs in neonates and
Infants and its impact on outcomes following surgery. Design: It is a
prospective randomized control single blind study. Setting: It is a single
centre prospective study carried out in a tertiary care centre at
Pediatric cardiac intensive care unit. Patients: All patients with the
cyanotic congenital heart disease with increase pulmonary blood flow,
weighing less than 5 kg and undergoing congenital heart repair during the
study period were included in the study. Patients with single ventricle
status, those undergoing palliative procedures (PA band), open chest,
requiring ECMO before leaving operating room, having any other
contraindication for starting enteral feeding or those who refuse for
consent were excluded from study. Interventions: The patients were
randomized into two groups. Group 1 received trophic feeds (10-20
ml/kg/day) starting 4-6 h after surgery while feeds children in group 2
were kept NPO and received feeds after 48 h after surgery. Measurements
and main results: 15 children enrolled in both the groups. Both
pre-operative and intraoperative variables were comparable in both the
groups. There was no complication (vomiting, diarrhea, NEC, bowel
necrosis) noted in the children who received feeds after surgery. Mean
duration of mechanical ventilation in the feeds group was 58.2 +/- 4.71 h,
which was less then significantly less than those in the NPO group (P
value 0.05). Similarly, duration of ICU stay was only 179.04 +/- 41.28 h
in feeds group as compared to 228.72 +/- 85.44 h in the NPO group.
Conclusions: Neonates and Infants tolerate feeds immediately following
congenital heart repairs. Moreover, feeds appear to decrease duration of
mechanical ventilation and duration of ICU stay.<br/>Copyright &#xa9; 2018
European Society for Clinical Nutrition and Metabolism

<37>
Accession Number
616478038
Author
Landoni G.; Lomivorotov V.; Pisano A.; Nigro Neto C.; Benedetto U.; Biondi
Zoccai G.; Gemma M.; Frassoni S.; Agro F.E.; Baiocchi M.; Barbosa Gomes
Galas F.R.; Bautin A.; Bradic N.; Carollo C.; Crescenzi G.; Elnakera A.M.;
El-Tahan M.R.; Fominskiy E.; Farag A.G.; Gazivoda G.; Gianni S.; Grigoryev
E.; Guarracino F.; Hanafi S.; Huang W.; Kunst G.; Kunstyr J.; Lei C.;
Lembo R.; Li Z.-J.; Likhvantsev V.; Lozovskiy A.; Ma J.; Monaco F.;
Navalesi P.; Nazar B.; Pasyuga V.; Porteri E.; Royse C.; Ruggeri L.; Riha
H.; Santos Silva F.; Severi L.; Shmyrev V.; Uvaliev N.; Wang C.B.; Wang
C.-Y.; Winterton D.; Yong C.-Y.; Yu J.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Gemma, Frassoni, Gianni, Lembo, Monaco, Ruggeri, Winterton,
Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan 20132, Italy
(Lomivorotov, Shmyrev) Siberian Biomedical Research Center, Department of
Anesthesiology and Intensive Care, Novosibirsk, Russian Federation
(Pisano) Cardiac Anesthesia and Intensive Care Unit, Monaldi Hospital
A.O.R.N. "Dei Colli", Via L. Bianchi Naples 80131, Italy
(Nigro Neto) Anesthesia Section of Cardiothoracic Surgery, Dante Pazzanese
Institute of Cardiology, Sao Paulo, Brazil
(Benedetto) University of Bristol, School of Clinical Sciences, Bristol
Heart Institute, Bristol, United Kingdom
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Agro) Anaesthesia, Intensive Care and Pain Management Department,
University School of Medicine Campus Bio-Medico, Rome, Italy
(Baiocchi) Anesthesia and Intensive Care, S. Orsola-Malpighi University
Hospital, Bologna, Italy
(Barbosa Gomes Galas) Anesthesia and Intensive care, Heart Institute,
University of Sao Paulo, Sao Paulo, Brazil
(Bautin) Department of Anesthesiology and Intensive Care, Federal Almazov
North-West Medical Research Centre, Saint-Petersburg, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Carollo) Department of Medicine, Anesthesia and Intensive Care Unit,
Padova University Hospital, Via Cesare Battisti 256, Padova 35128, Italy
(Crescenzi) Anestesia e Terapia Intensiva Cardiochirurgica, Humanitas
Research Hospital, Rozzano, Italy
(Elnakera) Anesthesia and Intensive Care, Faculty of Medicine, Zagazig
University, Zagazig, Egypt
(El-Tahan) Cardiothoracic Anaesthesia & Surgical Intensive Care, King Fahd
Hospital, University of Dammam, Al Khobar, Saudi Arabia
(Fominskiy) Department of Anaesthesia and Intensive Care, Siberian
Biomedical Research Center of the Ministry of Health, Novosibirsk, Russian
Federation
(Farag) Department of Anaesthesia and Intensive Care, King Abdullah
Medical City in Holy Capital "KAMC-HC", Makkah, Saudi Arabia
(Gazivoda) Department of Anesthesiology and Intensive Care, Cardiovascular
Institute `Dedinje`, Belgrade, Serbia
(Grigoryev) Deputy Director for Clinical and Scientific Affairs,
Scientific Research Institute of Complex Issues of Cardiovascular Disease,
Kemerovo, Russian Federation
(Guarracino) Department of Anaesthesia and Critical Care Medicine, Azienda
Ospedaliero-Universitaria Pisana, Via Paradisa 2, Pisa 56123, Italy
(Hanafi) Department of Anaesthesiology and Intensive Care, Sarawak General
Hospital, Kuching, Sarawak, Malaysia
(Huang) Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan,
China
(Kunst) Department of Anaesthetics, King's College Hospital NHS Foundation
Trust, London, United Kingdom
(Kunstyr) Department of Anesthesiology and Intensive Care, First Faculty
of Medicine, General University Hospital in Prague, Prague, Czech Republic
(Lei) Department of Anesthesiology and Perioperative Medicine, 1st
Affiliative Hospital (Xijing Hospital), Fourth Military Medical
University, Xi'an, China
(Li) Department of Anesthesiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Likhvantsev) Anesthesiology and Intensive Care Department, Moscow
Clinical Regional Research Institute, Shepkina st., 61/2, Moscow, Russian
Federation
(Lozovskiy) Department of Anesthesiology and Intensive Care, Ural
Institute of Cardiology, Ekaterinburg, Russian Federation
(Ma, Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Navalesi) Anesthesia and Intensive Care, Dipartimento Scienze Mediche e
Chirurgiche, Universita della Magna Graecia, Catanzaro, Italy
(Nazar) Cardiothoracic ICU and Anaesthesia, MKCC, West Riffa, Bahrain
(Pasyuga) Department of Cardiac Aneasthesia and Intensive Care, Astrakhan
Federal Centre for Cardiac Surgery, Astrakhan, Russian Federation
(Porteri) Dipartimento Cardiotoracico, Azienda Ospedaliera Spedali Civili,
Brescia, Italy
(Royse) Department of Surgery, The University of Melbourne, Level 6
Clinical Medical Research Building, Melbourne, Australia
(Riha) Cardiothoracic Anesthesiology and Intensive Care, Institute for
Clinical and Experimental Medicine, Prague, Czech Republic
(Santos Silva) Anesthetic Department, Hospital de Santa Maria, Lisboa,
Portugal
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Roma, Italy
(Uvaliev) Department-Anesthesia and Intensive Care, ACIBADEM City Clinic
Burgas, Burgas, Bulgaria
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Yu) Department of Anesthesiology, Qilu Hospital of Shandong University,
Shandong, China
(Bellomo) The University of Melbourne, Melbourne, Victoria, Australia
(Biondi Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
Title
MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of
volatile anesthetics. Rationale and design.
Source
Contemporary Clinical Trials. 59 (pp 38-43), 2017. Date of Publication:
August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective There is initial evidence that the use of volatile anesthetics
can reduce the postoperative release of cardiac troponin I, the need for
inotropic support, and the number of patients requiring prolonged
hospitalization following coronary artery bypass graft (CABG) surgery.
Nevertheless, small randomized controlled trials have failed to
demonstrate a survival advantage. Thus, whether volatile anesthetics
improve the postoperative outcome of cardiac surgical patients remains
uncertain. An adequately powered randomized controlled trial appears
desirable. Design Single blinded, international, multicenter randomized
controlled trial with 1:1 allocation ratio. Setting Tertiary and
University hospitals. Interventions Patients (n = 10,600) undergoing
coronary artery bypass graft will be randomized to receive either volatile
anesthetic as part of the anesthetic plan, or total intravenous
anesthesia. Measurements and main results The primary end point of the
study will be one-year mortality (any cause). Secondary endpoints will be
30-day mortality; 30-day death or non-fatal myocardial infarction
(composite endpoint); cardiac mortality at 30 day and at one year;
incidence of hospital re-admission during the one year follow-up period
and duration of intensive care unit, and hospital stay. The sample size is
based on the hypothesis that volatile anesthetics will reduce 1-year
unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05,
and a power of 0.9. Conclusions The trial will determine whether the
simple intervention of adding a volatile anesthetic, an intervention that
can be implemented by all anesthesiologists, can improve one-year survival
in patients undergoing coronary artery bypass graft surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<38>
Accession Number
616775548
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital and Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, FL, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Title
Intensive versus moderate atorvastatin therapy and one-year graft patency
after CABG: Rationale and design of the ACTIVE (Aggressive Cholesterol
Therapy to Inhibit Vein Graft Events) randomized controlled trial
(NCT01528709).
Source
Contemporary Clinical Trials. 59 (pp 98-104), 2017. Date of Publication:
August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale Saphenous vein graft disease remains a major limitation of
coronary artery bypass graft surgery (CABG). Statin therapy inhibits the
development of vein graft disease and improves outcomes after CABG.
However, it is unclear whether treatment with high-dose statins will
further slow the process of vein graft disease and improve graft patency,
as compared to conventional moderate doses. Therefore, the goal of this
study will be to evaluate the efficacy of high-dose statin therapy versus
moderate-dose statin therapy for the prevention of saphenous vein graft
occlusion following CABG. Study design The Aggressive Cholesterol Therapy
to Inhibit Vein Graft Events (ACTIVE) trial is a multi-center double-blind
randomized controlled trial enrolling patients who have undergone
multi-vessel CABG with at least one saphenous vein graft. Patients will be
randomized to receive either atorvastatin 80 mg daily or atorvastatin 10
mg daily for one year starting within 5 days after surgery. The target
enrollment is 100 patients in each arm (200 patients total). Lipid levels
will be assessed every 3 months. After one year, patients will undergo
computed tomography (CT) coronary angiography to assess the incidence of
vein graft occlusion and stenosis. Conclusion This trial is the first
prospective study to evaluate the impact of early postoperative high-dose
statin therapy on graft patency after CABG. Should high-dose statin
therapy reduce the incidence of postoperative graft occlusion, the results
will add to the growing evidence supporting the role of high-intensity
statins for modern lipid management after coronary surgical
revascularization (ClinicalTrials.gov NCT01528709).<br/>Copyright &#xa9;
2017

<39>
Accession Number
610949338
Author
Singh S.M.; D'Avila A.; Kim Y.-H.; Aryana A.; Mangrum J.M.; Michaud G.F.;
Dukkipati S.R.; Barrett C.D.; Heist E.K.; Parides M.K.; Thorpe K.E.; Reddy
V.Y.
Institution
(Singh) Schulich Heart Program, Sunnybrook Health Sciences Center,
University of Toronto, Toronto, ON, Canada
(D'Avila, Dukkipati, Parides, Reddy) Helmsley Cardiac Arrhythmia Service,
Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New
York, NY 10029, United States
(D'Avila) Instituto de Pesquisa em Arritmia Cardiaca, Florianopolis, South
Carolina, Brazil
(Kim) Cardiovascular Division, Korea University Medical Center, Seoul,
South Korea
(Aryana) Mercy General Hospital, Dignity Health Heart and Vascular
Institute, Sacramento, CA, United States
(Mangrum) Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
(Michaud) Cardiovascular Division, Brigham and Women's Hospital, Harvard
University, Boston, MA, United States
(Barrett) Al-Sabah Arrhythmia Institute, Mount Sinai St Luke's-Roosevelt
Hospital, New York, NY, United States
(Heist) Heart Center, Massachusetts General Hospital, Boston, MA, United
States
(Thorpe) Dalla Lana School of Public Health, Keenan Research Centre, Li Ka
Shing Knowledge Institute of St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Title
The modified stepwise ablation guided by low-dose ibutilide in chronic
atrial fibrillation trial (The MAGIC-AF Study).
Source
European Heart Journal. 37 (20) (pp 1614-1621), 2016. Date of Publication:
21 May 2016.
Publisher
Oxford University Press
Abstract
Aims Complex fractionated atrial electrograms (CFAE) are targeted during
persistent atrial fibrillation (AF) ablation. However, many CFAE sites are
non-specific resulting in extensive ablation. Ibutilide has been shown to
reduce left atrial surface area exhibiting CFAE. We hypothesized that
ibutilide administration prior to CFAE ablation would identify sites
critical for persistent AF maintenance allowing for improved procedural
efficacy and long-term freedom from atrial arrhythmias. Methods and
results Two hundred patients undergoing a first-ever persistent AF
catheter ablation procedure were randomly assigned to receive either 0.25
mg of intravenous ibutilide or saline placebo upon completion of pulmonary
vein isolation. Complex fractionated atrial electrogram sites were then
targeted with ablation. The primary efficacy endpoint was the 1-year
single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs.
Similar procedural characteristics (procedure, fluoroscopy, and ablation
times) were observed with both strategies despite a greater reduction in
left atrial surface area with CFAE sites (8 vs. 1%, P < 0.0001) and AF
termination during CFAE ablation with ibutilide compared with placebo (75
vs. 57%, P = 0.007). The primary efficacy endpoint was achieved in 56% of
patients receiving ibutilide and 49% receiving placebo (P = 0.35). No
significant differences in peri-procedural complications were observed in
both groups. Conclusion Despite a reduction in CFAE area and greater AF
termination during CFAE ablation, procedural characteristics and clinical
outcomes were unchanged when CFAE ablation was guided by ibutilide
administration. Clinical trial registration information ClinicalTrials.gov
number: NCT01014741. Published on behalf of the European Society of
Cardiology. All rights reserved.<br/>Copyright &#xa9; The Author 2016.

<40>
Accession Number
612936805
Author
Glaser N.; Jackson V.; Holzmann M.J.; Franco-Cereceda A.; Sartipy U.
Institution
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Cardiothoracic
Surgery and Anesthesiology, Karolinska University Hospital, Stockholm
SE-171 76, Sweden
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Holzmann) Department of Emergency Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Holzmann) Department of Internal Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Aortic valve replacement with mechanical vs. biological prostheses in
patients aged 50-69 years.
Source
European Heart Journal. 37 (34) (pp 2658-2667), 2016. Date of Publication:
2016.
Publisher
Oxford University Press
Abstract
Aims: The objective was to investigate the long-term all-cause mortality
in patients aged 50-69 years after aortic valve replacement (AVR) with
bioprosthetic or mechanical valves. Methods and results: All patients aged
50-69 years who had undergone AVR in Sweden 1997-2013 were identified from
the SwedishWebsystem for Enhancement and Development of Evidence-based
care in Heart disease Evaluated According to Recommended Therapies
register. Subsequent patient-level record linkage with national
health-data registers provided patient characteristics, vital status, and
clinical outcomes. Of the 4545 patients, 60% (2713/4545) had received
mechanical valves and 40% (1832/4545) bioprostheses. In 1099 propensity
score-matched patient pairs, 16% (180/1099) had died in the mechanical
valve group and 20% (217/1099) in the bioprosthetic group; mean follow-up
6.6 (maximum 17.2) years. Survival was higher in the mechanical than in
the bioprosthetic group: 5-, 10-, and 15-year survival 92, 79, and 59% vs.
89, 75, and 50%; hazard ratio 1.34; 95% confidence interval (CI)
1.09-1.66; P = 0.006. There was no difference in stroke [subdistribution
hazard ratio (sHR) 1.04; 95% CI 0.72-1.50, P = 0.848]; however, the risk
for aortic valve reoperation was higher (sHR 2.36; 95% CI 1.42-3.94, P =
0.001), and for major bleeding lower (sHR 0.49; 95% CI 0.34-0.70, P <
0.001), in patients who had received bioprostheses than in those with
mechanical valves. Conclusion: Patients aged 50-69 years who received
mechanical valves had better long-term survival after AVR than those with
bioprostheses. The risk of stroke was similar; however, patients with
bioprostheses had a higher risk of aortic valve reoperation and a lower
risk of major bleeding.<br/>Copyright &#xa9; The Author 2016.

<41>
Accession Number
372981373
Author
Kaur N.; Pandey A.; Negi H.; Shafiq N.; Reddy S.; Kaur H.; Chadha N.;
Malhotra S.
Institution
(Kaur, Pandey, Negi, Shafiq, Malhotra) Department of Pharmacology,
Institute of Medical Education and Research, Chandigarh, India
(Reddy) Department of Cardiology, Institute of Medical Education and
Research, Chandigarh, India
(Kaur) ICMR- Advanced Centre for Evidence Based Child Health, Advance
Paediatric Centre, Institute of Medical Education and Research,
Chandigarh, India
(Chadha) Dr. Tulsi das Library, Institute of Medical Education and
Research, Chandigarh, India
Title
Effect of HDL-raising drugs on cardiovascular outcomes: A systematic
review and meta-regression.
Source
PLoS ONE. 9 (4) (no pagination), 2014. Article Number: e94585. Date of
Publication: 11 Apr 2014.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Substantial residual cardiovascular risk remains after optimal
LDL lowering in patients of established coronary artery disease. A number
of therapeutic agents that raise HDL-C have been tested in clinical trials
to cover this risk. However, the results of clinical trials are
conflicting. Objectives: To determine whether raising HDL-C with
pharmacologic therapies translates into beneficial cardiovascular outcomes
and to find out if this change was proportional to the percentage change
in HDL levels. Methods: Electronic and printed sources were searched up to
August, 2013 for randomised controlled trials (RCTs) using at least one of
the HDL raising therapies for secondary prevention of adverse
cardiovascular events over optimal LDL levels. Data from eligible studies
were pooled for the following outcomes: all cause mortality,
cardiovascular disease mortality, hospitalization for unstable angina,
non-fatal myocardial infarction, coronary revascularization and ischemic
stroke. Mantel Haensnzel fixed effect model was used preferentially.
Meta-regression was done to see the correlation of change in HDL levels
and cardiovascular outcomes. Pooled odds ratios with 95% confidence
interval (CI) were calculated. Results: A total of 12 RCTs including
26,858 patients with follow up period ranging from 1 year to 6.2 years
were included in the analysis. Pooled analysis showed no significant
difference in all-cause mortality between the treatment and control group
(Pooled OR 1.07; 95% CI 0.98-1.16, p = 0.15). No significant difference
was found between the groups for any of the secondary outcomes. Similarly
no correlation was seen between percentage change in HDL and adverse
cardiovascular outcomes on meta-regression analysis. Conclusion:
Increasing HDL levels via pharmacological manipulation beyond optimal
lipid lowering therapy for secondary prevention is not beneficial. &#xa9;
2014 Kaur et al.

<42>
Accession Number
612143853
Author
Bakos Z.; Ostenfeld E.; Markstad H.; Werther-Evaldsson A.; Roijer A.;
Arheden H.; Carlsson M.; Borgquist R.
Institution
(Bakos, Borgquist) Arrhythmia Clinic, Lund University, Skane University
Hospital, Getingevagen 4, Lund 221 85, Sweden
(Ostenfeld, Arheden, Carlsson) Center For Medical Imaging and Physiology,
Department of Clinical Physiology, Lund University and Skane University
Hospital, Lund 221 85, Sweden
(Markstad) Center for Medical Imaging and Physiology, Lund University,
Skane University Hospital, Getingevagen 4, Lund 221 85, Sweden
(Werther-Evaldsson, Roijer) Clinic for Heart Failure and Valvular Disease,
Lund University, Skane University Hospital, Getingevagen 4, Lund 221 85,
Sweden
Title
A comparison between radial strain evaluation by speckle-tracking
echocardiography and cardiac magnetic resonance imaging, for assessment of
suitable segments for left ventricular lead placement in cardiac
resynchronization therapy.
Source
Europace. 16 (12) (pp 1779-1786), 2014. Date of Publication: 08 Oct 2014.
Publisher
Oxford University Press
Abstract
Aims: A cut-off of 9.8% maximum speckle-tracking radial strain in the
segment with the latest mechanical delay has been proposed as predictive
for selecting the best left ventricular lead placement for positive
response on cardiac resynchronization therapy (CRT).However, pacing
transmural scar should be avoided, and the purpose of this studywas to
evaluate the ability of echocardiographic radial strain to predict the
presence of scar in the left ventricle segments. Methods and results: A
total of 404 left ventricular segments were analysed, from 34 patients
eligible for CRT. Pre-operative cardiac magnetic resonance (CMR) and
echocardiography were performed, and maximal strain values from
echocardiography speckle tracking were compared with CMR data. Hypokinesia
and strain values showed a strong correlation (P < 0.001). Even though
segments with CMR-verified scar had lower strain values than segments
without scar (14.8+/-7 vs. 16.0+/-10), the predictive value of the
proposed 9.8% cut-off was low (sensitivity 33% and specificity 72%). Scar
burden was higher in ischaemic patients (13.5 vs. 5.3% P = 0.0001).
Relative difference in strain values (target segment strain compared with
the average strain value of the adjacent segments) was higher if there was
transmural scar in the target segment as compared with a hypokinetic but
viable target segment (87 vs. 38% difference, P = 0.03). Conclusion:
Speckle tracking radial strain should ideally be complemented by CMR for
accurate assessment of viability, especially for patients with ischaemic
aetiology of heart failure where transmural scar is more common.
Comparison of strain values with the adjacent segments may be helpful for
assessing viability. Published on behalf of the European Society of
Cardiology. All rights reserved.<br/>Copyright &#xa9; The Author 2014.

<43>
Accession Number
620559155
Author
Poh C.L.; d'Udekem Y.
Institution
(Poh, d'Udekem) Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Vic, Australia
(Poh, d'Udekem) Department of Paediatrics, University of Melbourne,
Melbourne, Vic, Australia
(Poh, d'Udekem) Heart Research, The Murdoch Childrens Research Institute,
Melbourne, Vic, Australia
Title
Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and
Predictors of Late Death.
Source
Heart Lung and Circulation. 27 (5) (pp 552-559), 2018. Date of
Publication: May 2018.
Publisher
Elsevier Ltd
Abstract
Aim: We now know that 20-40% of patients with a single ventricle will
develop heart failure after the second decade post-Fontan surgery.
However, we remain unable to risk-stratify the cohort to identify patients
at highest risk of late failure and death. We conducted a systematic
review of all reported late outcomes for patients with a Fontan
circulation to identify predictors of late death. Methods: We searched
MEDLINE, Embase and PubMed with subject terms ("single ventricle"
"Hypoplastic left heart syndrome" "congenital heart defects" or "Fontan
procedure") AND ("heart failure" "post-operative complications" "death"
"cause of death" "transplantation" or "follow-up studies") for relevant
studies between January 1990 and December 2015. Variables identified as
significant predictors of late death on multivariate analysis were
collated for meta-analysis. Survival data was extrapolated from
Kaplan-Meier survival curves to generate a distribution-free summary
survival curve. Results: Thirty-four relevant publications were
identified, with a total of 7536 patients included in the analysis. Mean
follow-up duration was 114 months (range 24-269 months). There were 688
(11%) late deaths. Predominant causes of death were late Fontan failure
(34%), sudden death (19%) and perioperative death (16%). Estimated mean
survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93-96),
91% (95%CI 89-93) and 82% (95%CI 77-85). Significant predictors of late
death include prolonged pleural effusions post Fontan surgery (HR1.18,
95%CI 1.09-1.29, p < 0.001), protein losing enteropathy (HR2.19, 95%CI
1.69-2.84, p < 0.001), increased ventricular end diastolic volume (HR1.03
per 10 ml/BSA increase, 95%CI 1.02-1.05, p < 0.001) and having a permanent
pacemaker (HR12.63, 95%CI 6.17-25.86, p < 0.001). Conclusions: Over 80% of
patients who survive Fontan surgery will be alive at 20 years. Developing
late sequelae including protein losing enteropathy, ventricular
dysfunction or requiring a pacemaker predict a higher risk of late
death.<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)

<44>
Accession Number
614942113
Author
Twerenbold R.; Jaeger C.; Gimenez M.R.; Wildi K.; Reichlin T.;
Nestelberger T.; Boeddinghaus J.; Grimm K.; Puelacher C.; Moehring B.;
Pretre G.; Schaerli N.; Campodarve I.; Rentsch K.; Steuer S.; Osswald S.;
Mueller C.
Institution
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller) Department
of Cardiology, University Hospital Basel, Petersgraben 4, Basel CH-4031,
Switzerland
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller)
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel,
Basel, Switzerland
(Campodarve) Servicio de Urgencias y Medicina Interna, Hospital Del Mar,
Barcelona, Spain
(Rentsch) Laboratory Medicine, University Hospital Basel, Basel,
Switzerland
(Steuer) Emergency Department, Kantonsspital Luzern, Luzern, Switzerland
Title
Impact of high-sensitivity cardiac troponin on use of coronary
angiography, cardiac stress testing, and time to discharge in suspected
acute myocardial infarction.
Source
European Heart Journal. 37 (44) (pp 3324-3332a), 2016. Date of
Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: High-sensitivity cardiac troponin (hs-cTn) assays provide higher
diagnostic accuracy for acute myocardial infarction (AMI) when compared
with conventional assays, but may result in increased use of unnecessary
coronary angiographies due to their increased detection of cardiomyocyte
injury in conditions other than AMI. Methods and results: We evaluated the
impact of the clinical introduction of high-sensitivity cardiac troponin T
(hs-cTnT) on the use of coronary angiography, stress testing, and time to
discharge in 2544 patients presenting with symptoms suggestive of AMI to
the emergency department (ED) within a multicentre study either before
(1455 patients) or after (1089 patients) hscTnT introduction. Acute
myocardial infarction was more often the clinical discharge diagnosis
after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina
less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The
rate of coronary angiography was similar before and after the introduction
of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary
angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the
use of stress testing was substantially reduced from 29 to 19% (P <
0.001). In outpatients, median time to discharge from the ED decreased by
79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after
the introduction of hs-cTnT (P = 0.002). Conclusion: The clinical
introduction of hs-cTn does not lead to an increased or inappropriate use
of coronary angiography. Introduction of hs-cTn is associated with an
improved rule-out process and thereby reduces the need for stress testing
and time to discharge.<br/>Copyright &#xa9; The Author 2016.

<45>
Accession Number
619601031
Author
Shah P.R.; Reynolds P.S.; Pal N.; Tang D.; McCarthy H.; Spiess B.D.
Institution
(Shah, Reynolds, Pal, Spiess) Department of Anesthesiology, Virginia
Commonwealth University-Medical College of Virginia, Richmond, VA, United
States
(Reynolds, Spiess) Department of Anesthesiology, College of Medicine,
University of Florida, Gainesville, FL 32610, United States
(Tang, McCarthy) Department of Surgery, Virginia Commonwealth
University-Medical College of Virginia, Richmond, VA, United States
Title
Hydroxocobalamin for the treatment of cardiac surgery-associated
vasoplegia: a case series.
Source
Canadian Journal of Anesthesia. 65 (5) (pp 560-568), 2018. Date of
Publication: 01 May 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Vasoplegia is a clinical syndrome marked by severe arteriolar
vasodilatation, hypotension, and low systemic vascular resistance
refractory to multiple vasopressor treatment. We report our experience
with hydroxocobalamin (B<inf>12</inf>) infusion as a potential rescue
adjunct for refractory vasoplegia during cardiopulmonary bypass (CPB).
Methods: We performed a retrospective chart review of 33 patients
undergoing cardiac surgery between 1 January 2013 and 31 December 2015,
who were given intravenous B<inf>12</inf> for refractory hypotension
during, or immediately following, CPB. We assessed mean arterial pressure
(MAP) responses using semi-parametric group-based models (trajectory
analysis). Vasopressor use was evaluated by norepinephrine-equivalent
rates calculated five minutes prior, and up to 60 min following,
B<inf>12</inf> administration. Results: Patients were mostly male (82%),
had a mean (SD) age of 53 (13) yr, and median (IQR) EuroSCORE mortality
index of 9 [4-40]. Four patterns of MAP responses to B<inf>12</inf> were
identified. In Group 1 ("poor responders") nine of 33 patients (27%) had
the highest median [IQR] mortality risk (EuroSCORE 40 [4-52]), lowest mean
pre-B<inf>12</inf> MAP (50 mmHg), and minimal hemodynamic response in
spite of continued vasopressor support. In contrast, Group 2 "responders"
(8/33, 24%) showed a brisk MAP response (> 15 mmHg) to B<inf>12</inf>,
sustained for > 60 min post-infusion, with 50% vasopressor reduction.
Groups 3 and 4 had the lowest median mortality risk (EuroSCORE 8) and
highest pre-B<inf>12</inf> MAP (72 mmHg). Although Group 3 patients
("sustainers"; 9/33, 27%) showed a sustained MAP improvement, those in
Group 4 ("rebounders"; 7/33, 21%) were characterized by hypertensive
overshoot followed by a decrease in MAP. Conclusion: These data indicate
considerable heterogeneity in patient response to B<inf>12</inf>,
potentially dependent on both patient preoperative condition and
non-standardized time of administration. B<inf>12</inf> may provide a
useful alternative therapy for refractory hypotension and vasoplegia, but
controlled clinical trials to assess efficacy are needed.<br/>Copyright
&#xa9; 2017, Canadian Anesthesiologists' Society.

<46>
Accession Number
620932281
Author
Wee I.J.Y.; Stonier T.; Harrison M.; Choong A.M.T.L.
Institution
(Wee, Stonier, Harrison, Choong) SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Stonier) Princess Alexandra Hospital, Harlow, London, United Kingdom
(Harrison) Department of General Surgery, Sir Charles Gairdner Hospital,
Perth, Australia
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Title
Transcarotid transcatheter aortic valve implantation: A systematic review.
Source
71 (6) (pp 525-533), 2018. Date of Publication: June 2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The carotid artery is a novel access route for transcatheter
aortic valve implantation (TAVI), especially useful in patients unsuitable
for traditional access routes including transfemoral (TF), subclavian,
transapical (TAp), and aortic (TAo). This systematic review summarizes the
evidence on TAVI via the carotid artery for its efficacy and safety.
Methods: A systematic review was conducted as per the Preferred Reporting
Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines
on three online databases: Medline (via Pubmed), SCOPUS, and Cochrane
Database. Results: There were 8 non-randomized controlled trials
identified comprising 650 patients in four TAVI vascular access sites:
transcarotid (TC) (N = 364), TF (N = 100), TAp (N = 151), TAo (N = 35).
The 30-day rates of mortality and neurological complications for TC TAVI
were 6.5% and 3.8%, respectively, with 1 incidence of myocardial
infarction. Other complications included vascular complications (7.7%),
insertion of new pacemaker (17.4%), atrial fibrillation (5.2%), and acute
kidney injury (6.9%), bleeding episodes (14.3%), of which 13 (3.6%) cases
were life-threatening; 5 (1.4%) were major; and 35 (9.3%) were minor
cases. Follow-up to 1 year showed 19 further deaths. There were no
significant differences in terms of mortality rates [risk ratio (RR) =
0.31, 95%CI 0.05-1.79; p = 0.19] and onset of dialysis treatment (RR =
2.53, 95%CI 0.31-19.78; p = 0.38) between the TC and TAp groups.
Conclusion: The available data on TC TAVI show comparable technical
feasibility with other traditional access routes, representing a viable
alternative. However, the paucity of data warrants the need for larger
randomized controlled trials to establish a firm conclusion.<br/>Copyright
&#xa9; 2018 Japanese College of Cardiology

<47>
Accession Number
620929942
Author
Brixner V.; Kiessling A.-H.; Madlener K.; Muller M.M.; Leibacher J.;
Dombos S.; Weber I.; Pfeiffer H.-U.; Geisen C.; Schmidt M.; Henschler R.;
North A.; Huang N.; Mufti N.; Erickson A.; Ernst C.; Rico S.; Benjamin
R.J.; Corash L.M.; Seifried E.
Institution
(Brixner, Muller, Leibacher, Dombos, Weber, Pfeiffer, Geisen, Schmidt,
Seifried) Institute for Transfusion Medicine and Immunohematology of
Johann Wolfgang Goethe University and German Red Cross Blood Donor
Service, Frankfurt am Main, Germany
(Kiessling) Department of Thoracic and Cardiovascular Surgery, Johann
Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
(Madlener) Department of Haemostaseology and Transfusion Medicine,
Kerckhoff-Klinik, Bad Nauheim, Germany
(Henschler) Blood Center Zurich, Swiss Red Cross, Schlieren, Switzerland
(Henschler) Red Cross Blood Service Graubunden, Chur, Switzerland
(North, Huang, Mufti, Erickson, Ernst, Rico, Benjamin, Corash) Cerus
Corporation, Concord, CA, United States
Title
Red blood cells treated with the amustaline (S-303) pathogen reduction
system: a transfusion study in cardiac surgery.
Source
Transfusion. 58 (4) (pp 905-916), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Nucleic acid-targeted pathogen inactivation technology using
amustaline (S-303) and glutathione (GSH) was developed to reduce the risk
of transfusion-transmitted infectious disease and transfusion-associated
graft-versus-host disease with red blood cell (RBC) transfusion. STUDY
DESIGN AND METHODS: A randomized, double-blind, controlled study was
performed to assess the in vitro characteristics of amustaline-treated
RBCs (test) compared with conventional (control) RBCs and to evaluate
safety and efficacy of transfusion during and after cardiac surgery. The
primary device efficacy endpoint was the postproduction hemoglobin (Hb)
content of RBCs. Exploratory clinical outcomes included renal and hepatic
failure, the 6-minute walk test (a surrogate for cardiopulmonary
function), adverse events (AEs), and the immune response to
amustaline-treated RBCs. RESULTS: A total of 774 RBC unis were produced.
Mean treatment difference in Hb content was -2.27 g/unit (95% confidence
interval, -2.61 to -1.92 g/unit), within the prespecified equivalence
margins (+/-5 g/unit) to declare noninferiority. Amustaline-treated RBCs
met European guidelines for Hb content, hematocrit, and hemolysis.
Fifty-one (25 test and 26 control) patients received study RBCs. There
were no significant differences in RBC usage or other clinical outcomes.
Observed AEs were within the spectrum expected for patients of similar age
undergoing cardiovascular surgery requiring RBCs transfusion. No patients
exhibited an immune response specific to amustaline-treated RBCs.
CONCLUSION: Amustaline-treated RBCs demonstrated equivalence to control
RBCs for Hb content, have appropriate characteristics for transfusion, and
were well tolerated when transfused in support of acute anemia. Renal
impairment was characterized as a potential efficacy endpoint for pivotal
studies of RBC transfusion in cardiac surgery.<br/>Copyright &#xa9; 2018
The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of
AABB

<48>
Accession Number
620915430
Author
Baschin M.; Selleng S.; Hummel A.; Diedrich S.; Schroeder H.W.; Kohlmann
T.; Westphal A.; Greinacher A.; Thiele T.
Institution
(Baschin, Westphal, Greinacher, Thiele) Abteilung Transfusionsmedizin,
Institut fur Immunologie und Transfusionsmedizin, Greifswald, Germany
(Selleng) Klinik fur Anasthesiologie, Universitatsmedizin Greifswald,
Greifswald, Germany
(Hummel) Klinik und Poliklinik fur Innere Medizin B, Universitatsmedizin
Greifswald, Greifswald, Germany
(Diedrich) Klinik und Poliklinik fur Chirurgie, Universitatsmedizin
Greifswald, Greifswald, Germany
(Schroeder) Klinik fur Neurochirurgie, Universitatsmedizin Greifswald,
Greifswald, Germany
(Kohlmann) Institut fur Community Medicine, Universitatsmedizin
Greifswald, Greifswald, Germany
Title
Preoperative platelet transfusions to reverse antiplatelet therapy for
urgent non-cardiac surgery: an observational cohort study.
Source
Journal of Thrombosis and Haemostasis. 16 (4) (pp 709-717), 2018. Date of
Publication: April 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Essentials An increasing number of patients requiring surgery receive
antiplatelet therapy (APT). We analyzed 181 patients receiving presurgery
platelet transfusions to reverse APT. No coronary thrombosis occurred
after platelet transfusion. This justifies a prospective trial to test
preoperative platelet transfusions to reverse APT. Summary: Background
Patients receiving antiplatelet therapy (APT) have an increased risk of
perioperative bleeding and cardiac adverse events (CAE). Preoperative
platelet transfusions may reduce the bleeding risk but may also increase
the risk of CAE, particularly coronary thrombosis in patients after recent
stent implantation. Objectives To analyze the incidence of perioperative
CAE and bleeding in patients undergoing non-cardiac surgery using a
standardized management of transfusing two platelet concentrates
preoperatively and restart of APT within 24-72 h after surgery. Methods A
cohort of consecutive patients on APT treated with two platelet
concentrates before non-cardiac surgery between January 2012 and December
2014 was retrospectively identified. Patients were stratified by the risk
of major adverse cardiac and cerebrovascular events (MACCE). The primary
objective was the incidence of CAE (myocardial infarction, acute heart
failure and cardiac troponine T increase). Secondary objectives were
incidences of other thromboembolic events, bleedings, transfusions and
mortality. Results Among 181 patients, 88 received aspirin, 21 clopidogrel
and 72 dual APT. MACCE risk was high in 63, moderate in 103 and low in 15
patients; 67 had cardiac stents. Ten patients (5.5%; 95% CI, 3.0-9.9%)
developed a CAE (three myocardial infarctions, four cardiac failures and
three troponin T increases). None was caused by coronary thrombosis.
Surgery-related bleeding occurred in 22 patients (12.2%; 95% CI,
8.2-17.7%), making 12 re-interventions necessary (6.6%; 95% CI,
3.8-11.2%). Conclusion Preoperative platelet transfusions and early
restart of APT allowed urgent surgery and did not cause coronary
thromboses, but non-thrombotic CAEs and re-bleeding occurred. Randomized
trials are warranted to test platelet transfusion against other management
strategies.<br/>Copyright &#xa9; 2018 International Society on Thrombosis
and Haemostasis

<49>
Accession Number
618556258
Author
Reddy G.; Wang Z.; Nishimura R.A.; Greason K.L.; Yoon S.-H.; Makkar R.R.;
Holmes D.R.
Institution
(Reddy, Wang, Nishimura, Greason, Holmes) Department of Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, United States
(Yoon, Makkar) Department of Cardiovascular Diseases, Cedars Sinai Medical
Center, Los Angeles, CA, United States
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Systematic review and meta analyses of observational studies.
Source
Catheterization and Cardiovascular Interventions. 91 (5) (pp 975-983),
2018. Date of Publication: 01 Apr 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to perform a systematic review and
meta-analyses of observational studies of transcatheter aortic valve
replacement (TAVR) for bicuspid aortic valve stenosis (BcAV). Background:
TAVR for BcAV stenosis has been associated with an increased incidence of
paravalvular leaks, valve malposition, pacemaker placement and all-cause
mortality. The conclusions drawn have been limited by small sample sizes.
The use of TAVR for BcAV stenosis remains controversial. Methods: We
searched multiple databases from the inception of the databases through
September 30, 2016 for studies of TAVR for BcAV stenosis. We included all
observational studies with more than one patient and at least 1 month of
outcomes. Results: We analyzed 13 observational studies with 758 patients.
Meta analyses showed device success rate of 95% [95% confidence interval
(CI) 90.2% to 98.5%] and an early safety event in 16.9% [95% CI 12.2% to
22%]. At 30 days, moderate to severe paravalvular leak was seen in 12.2%
[95% CI 3.1% to 24.8%] and new pacemaker implantation in 17.9% [95% CI
14.2% to 22%]. All-cause mortality was 3.7% [95% CI 2.1% to 5.6%], which
should be viewed in the context of an STS PROM of 5.0%. Conclusions: This
analysis suggests that TAVR for BcAV is not associated with excess
mortality. The incidence of paravalvular leaks and pacemaker implant is
increased compared to tricuspid aortic valve cohorts undergoing TAVR, and
operators should weigh these potential complications against the clinical
benefit provided by TAVR for BcAV patients at high risk for surgical valve
replacement.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<50>
Accession Number
620684103
Author
Tam D.Y.; Hughes A.; Fremes S.E.; Youn S.; Hancock-Howard R.L.; Coyte
P.C.; Wijeysundera H.C.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Tam, Hughes, Fremes, Youn, Hancock-Howard, Coyte, Wijeysundera) Institute
of Health Policy, Management and Evaluation, University of Toronto,
Toronto, Ontario, Canada
(Hughes, Wijeysundera) Program of Child Health Evaluative Services, The
Hospital for Sick Children, Peter Gilgan Centre For Research and Learning,
University of Toronto, Toronto, Ontario, Canada
(Wijeysundera) Division of Cardiology, Schulich Heart Centre, Department
of Medicine, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Ontario, Canada
Title
A cost-utility analysis of transcatheter versus surgical aortic valve
replacement for the treatment of aortic stenosis in the population with
intermediate surgical risk.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (5) (pp 1978-1988.e1),
2018. Date of Publication: May 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Although transcatheter aortic valve implantation has been shown
to be noninferior to surgical aortic valve replacement in patients with
severe aortic stenosis at intermediate surgical risk, the
cost-effectiveness of this strategy in this population is unknown. Our
objective was to conduct a cost-utility analysis comparing transcatheter
aortic valve implantation with surgical aortic valve replacement in the
population with intermediate risk severe aortic stenosis. Methods: A fully
probabilistic Markov model with 30-day cycles was constructed from the
Canadian third-party payer's perspective to estimate the difference in
cost and effectiveness (measured as quality-adjusted life years) of
transcatheter aortic valve implantation versus surgical aortic valve
replacement for intermediate-risk patients over a lifetime time horizon,
discounted at 1.5% per annum. Clinical trial data from The Placement of
Aortic Transcatheter Valve 2 informed the efficacy inputs. Costs (adjusted
to 2016 Canadian dollars) were obtained from the Canadian Institute of
Health Information and the Ontario Schedule of Benefits. Incremental
cost-effectiveness ratios were calculated. Results: In the base-case
analysis, total lifetime costs for transcatheter aortic valve implantation
were $10,548 higher than surgical aortic valve replacement but added 0.23
quality-adjusted life years, for an incremental cost-effectiveness ratio
of $46,083/quality-adjusted life-years gained. Deterministic 1-way
analyses showed that the incremental cost-effectiveness ratio was
sensitive to rates of complications and cost of the transcatheter aortic
valve implantation prosthesis. There was moderate-to-high parameter
uncertainty; transcatheter aortic valve implantation was the preferred
option in only 52.7% and 55.4% of the simulations at a $50,000 and
$100,000 per quality-adjusted life years willingness-to-pay thresholds,
respectively. Conclusions: On the basis of current evidence, transcatheter
aortic valve implantation may be cost-effective for the treatment of
severe aortic stenosis in patients with intermediate surgical risk. There
remains moderate-to-high uncertainty surrounding the base-case incremental
cost-effectiveness ratio.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<51>
Accession Number
619158324
Author
Slavich M.; Pizzetti G.; Vella A.M.; Carlucci C.; Margonato D.; Spoladore
R.; Fragasso G.; Margonato A.
Institution
(Slavich, Pizzetti, Vella, Margonato, Spoladore, Fragasso, Margonato)
Division of Cardiology, IRCCS Ospedale San Raffaele, Milano, Italy
(Carlucci) Hematology Project Foundation, Vicenza, Italy
Title
Extracorporeal myocardial shockwave therapy; a precious blast for
refractory angina patients.
Source
Cardiovascular Revascularization Medicine. Part A. 19 (3) (pp 263-267),
2018. Date of Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Refractory Angina Pectoris (RAP) dramatically affects
patients' life quality and medical costs. External Shockwave Myocardial
Revascularization (ESMR) improves the cardiac blood flow thanks to its
pro-angiogenetic action on ischaemic tissues. We hereby describe our
experience of ESMR in RAP patients. Materials and methods: This is a
retrospective study encompassing all patients referred to OSR for RAP
treatment. Efficacy of ESMR was assessed considering the difference
between pre and post therapy data in SAQ score and CCS, stress test
performance, 24 h ECG monitoring, NT-proBNP and echocardiographic
measures. Results: From a total of 97 patients with RAP, 19 patients
underwent ESMR, whereas 4 were considered as control group. After the end
of the treatment, ESWT group showed a significant improvement in CCS class
(- 1.32 +/- 0.58; p < 0.001) and in each of the five variables of the SAQ
score (p < 0.05). Patients also improved their exercise duration (50,74
+/- 29.40 seconds; p < 0,001) and double product (1340,53 +/- 1321,77; p <
0,001) and reduced the number of daily ST segment depression (- 1,16 +/-
1,01; p < 0,01). Ejection Fraction (2,05 +/- 1,84%; p < 0,01) and Cardiac
Output (0,20 +/- 0,28 L, p < 0,01) improved too. No changes were
documented in the control group. Conclusion: ESMR is an efficient therapy
for refractory angina capable to improve both symptoms and instrumental
tests.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<52>
Accession Number
621615524
Author
Ehrlich M.; Mahr S.; Schrutka L.; Ad N.; Laufer G.; Stix G.
Institution
(Ehrlich, Mahr, Laufer) Dept. Cardiac Surgery, Univ. of Vienna, Vienna,
Austria
(Schrutka, Stix) Dept. Cardiology, Univ. of Vienna, Vienna, Austria
(Ad) Washington Adventist Hospital, Washingotn, United States
Title
The use of beat to beat non-invasive 3D mapping to guide concomitant
surgical ablation for atrial fibrillation: First clinical application.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 14th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2018.
France. 51 (1 Supplement 1) (pp S124), 2018. Date of Publication: 2018.
Publisher
Springer New York LLC
Abstract
Objective: To assess with a noninvasive three-dimensional, beatby- beat
3Dmapping technique, themechanismof persistent atrial fibrillation (PAF)
to guide a bi-atrial vs. left atrial only ablation approach in patients
requiring concomitant surgery. Patients and Methods: In this pilot trial,
four patients (three males; mean age 69 years) with persistent AF were
mapped preoperatively with a non-invasive surface system (ECVUETM,
Cardioinsight Inc., Cleveland). All patients were candidates for mitral
valve surgery. In two patients, tricuspid valve repair was also performed.
Cox Maze III/IV was performed using combined cryoablation and bipolar
radiofrequency and the left appendage was removed in all cases. Median
preprocedural duration of AF as well as diameter of the left atrium were
36 months and 60 mm, respectively. Atrial regions were divided according
to the Bordeaux classification figure). Results: Preoperative mapping was
successful in all patients with clear identification of the potential
mechanism of AF. Bi-atrial pathology was recognized in all subjects. Rotor
and macro re-entry activity was present in all patients, whereas only
three patients had focal activity (Table 1). Rotor activity in the right
atriumwas documented in all patients (Table 1). At 3 months follow-up, all
patients were free from AF recurrence and were discontinued of
antiarrhythmic drugs. Conclusion: This is the first report on the
preoperative use of the ECUVETMin surgical candidates for concomitant
surgical procedures. The fact that bi-atrial mechanism for atrial
fibrillation was detected in all patients emphasizes the importance of a
Coxmaze III/IV procedure. Preoperative mapping carries the potential to
significantly improve our understanding in the pathophysiology of AF and
better guide the surgical ablation procedure of choice in a single
patient.

<53>
Accession Number
621585628
Author
Solo K.; Martin J.; Lavi S.; Kabali C.; John-Baptiste A.; Nevis I.F.;
Choudhury T.; Mamas M.A.; Bagur R.
Institution
(Solo, Martin, John-Baptiste, Bagur) Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, Western
University, London, ON, Canada
(Martin, John-Baptiste) Department of Anesthesia and Perioperative
Medicine, Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(Lavi, Choudhury, Bagur) Division of Cardiology, London Health Sciences
Centre, London, ON, Canada
(Kabali) Epidemiology Division, University of Toronto, Dalla Lana School
of Public Health, Toronto, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
(Nevis) Health Quality Ontario, London, ON, Canada
(Mamas, Bagur) Keele Cardiovascular Research Group, Institute for Applied
Clinical Science, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, University of Keele, Keele, United Kingdom
Title
Antithrombotic therapy in patients receiving saphenous vein coronary
artery bypass grafts: A protocol for a systematic review and network
metaanalysis.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019555. Date of
Publication: 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The current evidence for the prevention of saphenous vein
graft failure (SVGF) after coronary artery bypass graft (CABG) surgery
consists of direct head-tohead comparison of treatments (including
placebo) in randomised-controlled trials (RCTs) and observational studies.
However, summarising the evidence using traditional pairwise meta-analyses
does not allow the inclusion of data from treatments that have not been
compared head to head. Exclusion of such comparisons could impact the
precision of pooled estimates in a metaanalysis. Hence, to address the
challenge of whether aspirin alone or in addition to another
antithrombotic agent is a more effective regimen to improve SVG patency, a
network meta-analysis (NMA) is necessary. The objectives of this study are
to synthesise the available evidence on antithrombotic agents (or their
combination) and estimate the treatment effects among direct and indirect
treatment comparisons on SVGF and major adverse cardiovascular events, and
to generate a treatment ranking according to their efficacy and safety
outcomes. Methods: We will perform a systematic review of RCTs evaluating
antithrombotic agents in patients undergoing CABG. A comprehensive English
literature search will be conducted using electronic databases and grey
literature resources to identify published and unpublished articles. Two
individuals will independently and in duplicate screen potential studies,
assess the eligibility of potential studies and extract data. Risk of bias
and quality of evidence will also be evaluated independently and in
duplicate. We will investigate the data to ensure its suitability for NMA,
including adequacy of the outcome data and transitivity of treatment
effects. We plan to estimate the pooled direct, indirect and the mixed
effects for all antithrombotic agents using a NMA. Ethics and
dissemination: Due to the nature of the study, there are no ethical
concerns nor informed consent required. We anticipate that this NMA will
be the first to simultaneously assess the relative effects of multiple
antithrombotic agents in patients undergoing CABG. The results of this NMA
will inform clinicians, patients and guideline developers the best
available evidence on comparative effects benefits of antithrombotic
agents after CABG while considering the side effect profile to support
future clinical decision-making. We will disseminate the results of our
systematic review and NMA through a peerreviewed journal.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<54>
Accession Number
621583733
Author
Godai K.; Hasegawa-Moriyama M.; Matsunaga A.; Kanmura Y.
Institution
(Godai, Hasegawa-Moriyama, Matsunaga, Kanmura) Department of
Anesthesiology and Critical Care Medicine, Graduate School of Medical and
Dental Sciences, Kagoshima University, Kagoshima, Japan
Title
Phenylephrine does not improve oxygenation during one-lung ventilation: A
randomized, double-blind, cross-over study.
Source
PLoS ONE. 13 (4) (no pagination), 2018. Article Number: e0195576. Date of
Publication: April 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Phenylephrine is an alpha<inf>1</inf> adrenergic receptor
agonist that causes pulmonary vasoconstriction, and so may effectively
enhance hypoxic pulmonary vasoconstriction (HPV). However, there is little
evidence that phenylephrine augments HPV in clinical situations. This
study aimed to evaluate the clinical effects of phenylephrine infusion on
oxygenation during one-lung ventilation (OLV) in patients undergoing
thoracic surgery. Methods This was a prospective, randomized,
double-blind, cross-over study. Included patients were those undergoing
elective thoracic surgery in the lateral decubitus position with OLV.
Patients were randomly allocated to two groups. The N-P group initially
had OLV with normal saline infusion for 30 minutes; after a 10 minute
interval, OLV was then maintained with phenylephrine infusion for 30
minutes. The P-N group had the drug-infusion in the reverse order. The
primary outcome was arterial partial pressure of oxygen. Secondary
outcomes were mean arterial pressure, heart rate, pulse pressure
variation, perfusion index, and difference between bladder and skin
temperature. Statistical analysis was performed using the student t-test,
Fisher's exact test, and ANOVA for Cross-over design. P <; 0.05 was
considered statistically significant. Results Twenty-nine patients were
analyzed. Although phenylephrine infusion significantly increased mean
arterial pressure (P <; 0.001), arterial partial pressure of oxygen did
not differ between the two timepoints (P = 0.19). There was no carryover
effect in arterial partial pressure of oxygen (P = 0.14). Phenylephrine
infusion significantly decreased heart rate (P = 0.02) and pulse pressure
variation (P <; 0.001). Conclusions Phenylephrine infusion did not improve
oxygenation during OLV. The present results indicate that phenylephrine
does not have clinically meaningful effects on HPV.<br/>Copyright &#xa9;
2018 Godai 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.

<55>
Accession Number
621562750
Author
Ney J.; Hoffmann K.; Meybohm P.; Goetzenich A.; Kraemer S.; Benstom C.;
Weber N.C.; Bickenbach J.; Rossaint R.; Marx G.; Zacharowski K.; Bernhagen
J.; Stoppe C.
Institution
(Ney, Rossaint) Department of Anesthesiology, Medical Faculty, RWTH Aachen
University, Aachen 52074, Germany
(Ney, Hoffmann, Benstom, Bickenbach, Marx, Stoppe) Department of Intensive
Care Medicine, Medical Faculty, RWTH Aachen University, Aachen 52074,
Germany
(Meybohm, Zacharowski) Departments of Anesthesiology, Intensive Care
Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt 60590,
Germany
(Goetzenich, Kraemer) Department of Thoracic, Cardiac and Vascular
Surgery, Medical Faculty, RWTH Aachen University, Aachen 52074, Germany
(Weber) Department of Anesthesiology, Laboratory of Experimental Intensive
Care and Anesthesiology, L.E.I.C.A, Amsterdam 1105 AZ, Netherlands
(Bernhagen) Vascular Biology, Institute for Stroke and Dementia Research,
Ludwig-Maximilians-University of Munich Hospital, Munich 80539, Germany
Title
Remote ischemic preconditioning does not affect the release of humoral
factors in propofol-anesthetized cardiac surgery patients: A secondary
analysis of the RIPHeart study.
Source
International Journal of Molecular Sciences. 19 (4) (no pagination), 2018.
Article Number: 1094. Date of Publication: 05 Apr 2018.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
In contrast to several smaller studies, which demonstrate that remote
ischemic preconditioning (RIPC) reduces myocardial injury in patients that
undergo cardiovascular surgery, the RIPHeart study failed to demonstrate
beneficial effects of troponin release and clinical outcome in
propofol-anesthetized cardiac surgery patients. Therefore, we addressed
the potential biochemical mechanisms triggered by RIPC. This is a
predefined prospective sub-analysis of the randomized and controlled
RIPHeart study in cardiac surgery patients (n = 40) that was recently
published. Blood samples were drawn from patients prior to surgery, after
RIPC of four cycles of 5 min arm ischemia/5 min reperfusion (n = 19) and
the sham (n = 21) procedure, after connection to cardiopulmonary bypass
(CPB), at the end of surgery, 24 h postoperatively, and 48 h
postoperatively for the measurement of troponin T, macrophage migration
inhibitory factor (MIF), stromal cell-derived factor 1 (CXCL12), IL-6,
CXCL8, and IL-10. After RIPC, right atrial tissue samples were taken for
the measurement of extracellular-signal regulated kinase (ERK1/2), protein
kinase B (AKT), Glycogen synthase kinase 3 (GSK-3beta), protein kinase C
(PKC"), and MIF content. RIPC did not significantly reduce the troponin
release when compared with the sham procedure. MIF serum levels
intraoperatively increased, peaking at intensive care unit (ICU) admission
(with an increase of 48.04%, p = 0.164 in RIPC; and 69.64%, p = 0.023 over
the baseline in the sham procedure), and decreased back to the baseline 24
h after surgery, with no differences between the groups. In the right
atrial tissue, MIF content decreased after RIPC (1.040 +/- 1.032 Arbitrary
units [au] in RIPC vs. 2.028 +/- 1.631 [au] in the sham procedure, p <
0.05). CXCL12 serum levels increased significantly over the baseline at
the end of surgery, with no differences between the groups. ERK1/2, AKT,
GSK-3beta, and PKC<inf>epsilon</inf> phosphorylation in the right atrial
samples were no different between the groups. No difference was found in
IL-6, CXCL8, and IL10 serum levels between the groups. In this cohort of
cardiac surgerypatients that received propofol anesthesia, we could not
show a release of potential mediators of signaling, nor an effect on the
inflammatory response, nor an activation of well-established protein
kinases after RIPC. Based on these data, we cannot exclude that
confounding factors, such as propofol, may have interfered with
RIPC.<br/>Copyright &#xa9; 2018 by the authors. Licensee MDPI, Basel,
Switzerland.

<56>
Accession Number
2000640419
Author
Wang Y.; Zhou Y.; Zhang L.; Zhu J.
Institution
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo, China
(Zhou, Zhang, Zhu) Department of Cardiology, The First Affiliated
Hospital, Zhejiang University, School of Medicine, Hangzhou, China
Title
Midterm outcome of transcatheter versus surgical aortic valve replacement
in low to intermediate risk patients: A meta-analysis of randomized
controlled trials.
Source
Journal of Cardiology. 71 (6) (pp 534-539), 2018. Date of Publication:
June 2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Current guidelines recommend transcatheter aortic valve
replacement (TAVR) in patients with severe symptomatic aortic stenosis
(AS) who are not suitable for conventional surgical aortic valve
replacement (SAVR). In light of the recent trend in performing TAVR in
patients with lower risk profile, we assessed the midterm outcome
comparing TAVR and SAVR for the treatment of patients with severe AS at
low to intermediate risk. Methods: PubMed, EBSCO, and Cochrane CENTRAL
were systematically searched for randomized controlled trials that
reported the clinical outcomes of TAVR versus SAVR in patients at low to
intermediate surgical risk with at least 2 years of follow-up. Clinical
endpoints including death, acute kidney injury, myocardial infarction,
stroke, permanent pacemaker implantation, and life-threatening bleeding
events were assessed. Results: From 2000 to 2017, 4 clinical studies
comprising 4355 patients were identified. At 2-year follow-up, TAVR was
associated with similar rate of death from any cause (RR 0.86; 95%CI:
0.67-1.10), cardiovascular death (RR 0.88; 95%CI: 0.73-1.06), and stroke
(RR 0.97; 95%CI: 0.81-1.15). TAVR reduced incidence of bleeding events (RR
0.45; 95%CI: 0.28-0.73) and acute kidney injury (RR 0.48; 95%CI:
0.25-0.93). However, TAVR was associated with higher rate of permanent
pacemaker implantation (RR 3.01; 95%CI: 1.04-8.72). Conclusion: In
patients at low to intermediate surgical risk, midterm clinical outcomes
of TAVR were similar to SAVR in survival and stroke rate, superior in
reducing life-threatening bleeding, acute kidney injury, and new-onset
atrial fibrillation, but inferior in increasing permanent pacemaker
implantation.<br/>Copyright &#xa9; 2018 Japanese College of Cardiology

<57>
Accession Number
621613392
Author
Chakravarty T.; Jilaihawi H.; Doctor N.; Fontana G.; Forrester J.S.; Cheng
W.; Makkar R.
Institution
(Chakravarty, Jilaihawi, Doctor, Fontana, Forrester, Cheng, Makkar)
Cedars-Sinai Heart Institute, Los Angeles, CA, United States
Title
Complications after Transfemoral Transcatheter Aortic Valve Replacement
with a Balloon-Expandable Prosthesis: The Importance of Preventative
Measures and Contingency Planning.
Source
Catheterization and Cardiovascular Interventions. 91 (5) (pp E29-E42),
2018. Date of Publication: 01 Apr 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Transcatheter aortic valve replacement (TAVR) with balloon-expandable
Edwards-SAPIEN valve was superior to standard therapy in inoperable
patients and noninferior to surgical aortic valve replacement in high
surgical-risk, but operable patients, with severe symptomatic aortic
stenosis in the randomized controlled PARTNER trial. Since the first case
of TAVR with a balloon-expandable valve in 2002, several groups have
reported their experience with balloon-expandable valves with
high-procedural success. In the United States, the balloon-expandable
Edwards-SAPIEN valve is the only transcatheter heart valve approved by the
FDA for commercial use. Moreover, this is only in high-risk inoperable
patients. Despite increasing experience with the TAVR procedure, it can be
associated with complications, which can be technically challenging, even
for an experienced operator. Complications associated with TAVR include
vascular complications, valve malpositioning, regurgitation, embolization,
coronary compromise, conduction abnormalities, stroke/transient ischemic
attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse.
A thorough understanding of the procedure is essential for pre-emptive
planning for procedural complications and early identification and
management of complications are necessary for procedural success. We
hereby review our experience of transfemoral TAVR with balloon-expandable
valves, offer practical tips to maximize the likelihood of procedural
success, describe pre-emptive strategies to prevent peri-procedural
complications and bailout measures to manage them, should they occur.
&#xa9; 2018 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<58>
[Use Link to view the full text]
Accession Number
621633338
Author
Chen L.; Hua X.; Song J.; Wang L.
Institution
(Chen, Song, Wang) Department of Cardiovascular Surgery, Chinese Academy
of Medical Sciences and Peking Union Medical College, 167A Beilishi Road,
Xi Cheng District, Beijing 100037, China
(Hua, Song) State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
Title
Which aortic clamp strategy is better to reduce postoperative stroke and
death: Single center report and a meta-analysis.
Source
Medicine (United States). 97 (12) (no pagination), 2018. Article Number:
e0221. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Stroke is severe complication of coronary artery bypass
grafting (CABG) which may be associated with clamp strategy, there are 2
strategies to clamp aorta including single aortic clamp (SAC) and partial
aortic clamp (PAC). It is controversial that which clamping strategy is
better to reduce the postoperative stroke and death, so this study aims to
investigate which is better for reducing postoperative stroke and death
within 30 days. Methods: We collected 469 patients who had on-pump CABG in
Fuwai Hospital during January 2014 to July 2015. The SAC group consisted
of 265 patients while the PAC group included 204 patients. We compared the
2 group patient difference. At the same time, 12 studies were identified
by systematic search. The odds ratio (OR) was used as effect index to
compare SAC and PAC strategy by fix-effect modeling. We also tested
heterogeneity and publication bias. The primary end point of study was
occurrence of postoperative stroke within 30 days of operation, the second
end point of study was the incidence of 30-day mortality. Results: The
single center retrospective study showed that the patients in the SAC
group were older than those in the PAC group (62.5+/-8.1 vs 60.3+/-8.0
years, P=.01). The proportions of peripheral vascular disease and
hypertension of SAC were higher than PAC (71 (26.8%) versus 36 (17.6%),
P=.02; 183 (69.1%) versus 115 (56.4%), P=.01, respectively). Besides, the
number of vascular anastomosis was more in the SAC group (3.29+/-0.74
versus 2.97+/-0.974, P<.001). The linear-regression analysis suggested
that the time of cardiopulmonary bypass of SAC was shorter than the PAC
group (93.2+/-22.4 vs.103.4+/-26.8minutes, P-regression<.001) and
postoperative death within 30-days was similar (1 (0.4%) vs. 2 (1.0%),
P-regression=.47). There was no stroke occurring in both the groups. And
the meta-analysis suggested the postoperative stroke and death within
30-days were similar between SAC group and PAC group (OR: 0.78, 95% CI:
0.58-1.06; OR: 0.82, 95% CI: 0.61-1.10; respectively). Moreover, subgroup
meta-analysis also had the same results. Conclusion: There was no
significant difference between SAC and PAC clamping strategy on
postoperative stroke and death within 30-days; however, SAC can reduce the
usage time of cardiopulmonary bypass.<br/>Copyright &#xa9; 2018 the
Author(s). Published by Wolters Kluwer Health, Inc.

<59>
Accession Number
621629656
Author
de Hoogd S.; Ahlers S.J.G.M.; van Dongen E.P.A.; van de Garde E.M.W.;
Daeter E.J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd, Ahlers, van de Garde, Knibbe) Department of Clinical Pharmacy,
St. Antonius Hospital, Nieuwegein, Netherlands
(van Dongen) Department of Anesthesiology and Intensive Care, St. Antonius
Hospital, Nieuwegein, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Dahan) Department of Anesthesiology, Leiden University Medical Center,
Leiden, Netherlands
(Tibboel, Knibbe) Intensive Care and Department of Pediatric Surgery,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
(Knibbe) Division of Pharmacology, Leiden Academic Centre for Drug
Research, Leiden University, Leiden, Netherlands
Title
Randomized Controlled Trial on the Influence of Intraoperative
Remifentanil versus Fentanyl on Acute and Chronic Pain after Cardiac
Surgery.
Source
Pain Practice. 18 (4) (pp 443-451), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Remifentanil has been associated with increased acute and
potentially chronic postoperative pain. The objective of this prospective
randomized controlled trial was to investigate the influence of
intraoperative remifentanil on acute and chronic postoperative pain after
cardiac surgery. Methods: Patients (N = 126) receiving standardized
anesthesia with propofol and intermittent intravenous fentanyl at
predetermined times for cardiac surgery were randomized to
intraoperatively receive either a continuous remifentanil infusion or
additional intermittent intraoperative fentanyl as needed. The primary
endpoint was chronic thoracic pain at 12 months after surgery. Secondary
endpoints were pain at 3 and 6 months after surgery and analgesic
requirements and pain levels in the first 72 hours. Results: There was no
significant difference in incidence of chronic thoracic pain between the
remifentanil and fentanyl groups, respectively (20% vs. 18%; P = 0.817).
At 3 months, however, significantly more patients in the remifentanil
group reported chronic thoracic pain (51% vs. 33%; P = 0.047). This effect
was more pronounced in younger patients and in patients receiving a higher
dose of remifentanil (both P < 0.05). The first 24 and 48 hours
postoperatively, morphine consumption in the remifentanil group was
significantly higher than in the fentanyl group (34.3 mg [interquartile
range (IQR) 25.3 to 48.2] vs. 30.2 mg [IQR 19.2 to 38.1], P = 0.028; and
46.8 mg [IQR 33.8 to 59.2] vs. 39.0 mg [IQR 6.2 to 51.4], P = 0.047,
respectively). Conclusions: Intraoperative use of remifentanil during
cardiac surgery does not impact chronic postoperative pain 1 year after
surgery. Nevertheless, remifentanil increases analgesic requirements and
thoracic pain until 3 months after surgery, and its use is therefore less
favorable during cardiac surgery.<br/>Copyright &#xa9; 2017 The Authors.
Pain Practice published by Wiley Periodicals, Inc. on behalf of World
Institute of Pain

<60>
Accession Number
621625870
Author
Costa K.M.; Saxena A.K.
Institution
(Costa, Saxena) Department of Pediatric Surgery, Chelsea Children's
Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial
College London, London, United Kingdom
(Costa, Saxena) Ribeirao Preto Medical School, University of Sao Paulo,
Ribeirao Preto, Brazil
Title
Surgical chylothorax in neonates: management and outcomes.
Source
World Journal of Pediatrics. (pp 1-6), 2018. Date of Publication: 05 Mar
2018.
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Postoperative chylothorax occurs due to trauma to lymphatic
vessels and can occur after any thoracic procedure. This study reviewed
recent literature to evaluate the management and outcomes of surgical
chylothorax in neonates. Methods: PubMed database was searched for
articles in English, Portuguese and Spanish from 2000 to 2016. Data were
collected for surgery, chylothorax management, complications, mortality
and length of hospital stay (LOS). Results: Twenty studies offered 107
neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac
malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH +
extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT)
was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in
one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three
patients (2.8%) did not require any treatment. Octreotide and somatostatin
were used as second or third line treatment in 25 neonates (23.4%), and 15
neonates (14%) underwent 17 surgeries, including thoracic duct ligation
(TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL +
pleurodesis (n = 2), and TDL + placement of hemostat (n = 1).
Complications due to the chylothorax were reported in 27 neonates (25.2%):
hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4),
hypoalbuminemia with cutaneous flushing as colateral effect of
somatostatin (n = 1), loose stool after somatostatin use (n = 1),
pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and
hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4
days (30-93.1 days). Conclusions: Conservative management is appropriate
as initial treatment for neonatal postsurgical chylothorax. Octreotide and
somatostatin are safe in neonates and surgical approach should be
considered in prolonged leaks.<br/>Copyright &#xa9; 2018 Children's
Hospital, Zhejiang University School of Medicine

<61>
Accession Number
621610469
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States
Title
A Contemporary Meta-Analysis of Antegrade versus Retrograde Cerebral
Perfusion for Thoracic Aortic Surgery.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2018. Date of
Publication: 06 Apr 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective To determine which of antegrade and retrograde cerebral
perfusion (ACP and RCP) surpasses for a reduction in postoperative
incidence of neurological dysfunction and all-cause death in thoracic
aortic surgery, we performed a meta-analysis of contemporary comparative
studies. Methods MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were searched from January 2010 to June 2017. For each
study, data regarding the endpoints in both the ACP and RCP groups were
used to generate odds ratios (ORs) and 95% confidence intervals (CIs).
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic ORs in the fixed-effect model. Results We
identified and included 19 eligible studies with a total of 15,365
patients undergoing thoracic aortic surgery by means of ACP (a total of
7,675 patients) or RCP (a total of 7,690 patients). Pooled analysis
demonstrated no statistically significant differences in postoperative
incidence of stoke (17 studies enrolling a total of 9,421 patients; OR,
0.92; 95% CI, 0.79-1.08; p = 0.32) and mortality (16 studies including a
total of 14,452 patients; OR, 1.07; 95% CI, 0.90-1.26; p = 0.46) between
ACP and RCP, whereas a trend toward a significant reduction in incidence
of temporary neurological dysfunction (TND) for ACP (12 studies enrolling
a total of 7922 patients; OR, 0.85; 95% CI, 0.69-1.04; p = 0.12) was
found. Conclusion In thoracic aortic surgery, postoperative incidence of
stroke and mortality was similar between ACP and RCP, whereas a trend
toward a reduction of TND incidence existed in ACP. <br/>Copyright &#xa9;
2018, Georg Thieme Verlag KG. All rights reserved.

<62>
Accession Number
617433874
Author
Kraal J.J.; Elske Van Den Akker-Van Marle M.; Abu-Hanna A.; Stut W.; Peek
N.; Kemps H.M.C.
Institution
(Kraal, Abu-Hanna) Department of Medical Informatics, Academic Medical
Center, Meibergdreef 9, AZ Amsterdam 1105, Netherlands
(Elske Van Den Akker-Van Marle) Department of Medical Decision Making,
Leiden University Medical Center, Netherlands
(Stut) Personal Health Department, Philips Research, Netherlands
(Peek) Health EResearch Centre, University of Manchester, United Kingdom
(Kemps) Department of Cardiology, Maxima Medical Center Veldhoven,
Netherlands
Title
Clinical and cost-effectiveness of home-based cardiac rehabilitation
compared to conventional, centre-based cardiac rehabilitation: Results of
the FIT@Home study.
Source
European Journal of Preventive Cardiology. 24 (12) (pp 1260-1273), 2017.
Date of Publication: 01 Aug 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim Although cardiac rehabilitation improves physical fitness after a
cardiac event, many eligible patients do not participate in cardiac
rehabilitation and the beneficial effects of cardiac rehabilitation are
often not maintained over time. Home-based training with telemonitoring
guidance could improve participation rates and enhance long-term
effectiveness. Methods and results We randomised 90 low-to-moderate
cardiac risk patients entering cardiac rehabilitation to three months of
either home-based training with telemonitoring guidance or centre-based
training. Although training adherence was similar between groups,
satisfaction was higher in the home-based group (p = 0.02). Physical
fitness improved at discharge (p < 0.01) and at one-year follow-up (p <
0.01) in both groups, without differences between groups (home-based p =
0.31 and centre-based p = 0.87). Physical activity levels did not change
during the one-year study period (centre-based p = 0.38, home-based p =
0.80). Healthcare costs were statistically non-significantly lower in the
home-based group (437 per patient, 95% confidence interval -562 to 1436, p
= 0.39). From a societal perspective, a statistically non-significant
difference of 3160 per patient in favour of the home-based group was found
(95% confidence interval -460 to 6780, p = 0.09) and the probability that
it was more cost-effective varied between 97% and 75% (willingness-to-pay
of 0 and 100,000 per quality-adjusted life-years, respectively).
Conclusion We found no differences between home-based training with
telemonitoring guidance and centre-based training on physical fitness,
physical activity level or health-related quality of life. However,
home-based training was associated with a higher patient satisfaction and
appears to be more cost-effective than centre-based training. We conclude
that home-based training with telemonitoring guidance can be used as an
alternative to centre-based training for low-to-moderate cardiac risk
patients entering cardiac rehabilitation.<br/>Copyright &#xa9; European
Society of Cardiology.

<63>
[Use Link to view the full text]
Accession Number
614665368
Author
Hoechter D.J.; Shen Y.-M.; Kammerer T.; Gunther S.; Weig T.; Schramm R.;
Hagl C.; Born F.; Meiser B.; Preissler G.; Winter H.; Czerner S.; Zwissler
B.; Mansmann U.U.; Von Dossow V.
Institution
(Hoechter, Kammerer, Weig, Czerner, Zwissler, Von Dossow) Department of
Anesthesiology, University Hospital, Ludwig-Maximilians-University (LMU),
Marchioninistr. 15, Munich D-81377, Germany
(Shen, Mansmann) Institute of Medical Biometry and Epidemiology,
Ludwig-Maximilians-University (LMU), Munich, Germany
(Gunther, Schramm, Hagl, Born) Clinic of Cardiac Surgery, University
Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
(Schramm, Meiser) Transplantation Center, University Hospital,
Ludwig-Maximilians-University (LMU), Munich, Germany
(Preissler, Winter) Department of General, Visceral, Transplant, Vascular
and Thoracic Surgery, University Hospital, Ludwig-Maximilians-University
(LMU), Munich, Germany
Title
Extracorporeal Circulation during Lung Transplantation Procedures: A
Meta-Analysis.
Source
ASAIO Journal. 63 (5) (pp 551-561), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Extracorporeal circulation (ECC) is an invaluable tool in lung
transplantation (lutx). More than the past years, an increasing number of
centers changed their standard for intraoperative ECC from cardiopulmonary
bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with
differing results. This meta-analysis reviews the existing evidence. An
online literature research on Medline, Embase, and PubMed has been
performed. Two persons independently judged the papers using the
ACROBAT-NRSI tool of the Cochrane collaboration. Meta-analyses and
meta-regressions were used to determine whether veno-arterial ECMO
(VA-ECMO) resulted in better outcomes compared with CPB. Six papers - all
observational studies without randomization - were included in the
analysis. All were considered to have serious bias caused by
heparinization as co-intervention. Forest plots showed a beneficial trend
of ECMO regarding blood transfusions (packed red blood cells (RBCs) with
an average mean difference of -0.46 units [95% CI = -3.72, 2.80],
fresh-frozen plasma with an average mean difference of -0.65 units [95% CI
= -1.56, 0.25], platelets with an average mean difference of -1.72 units
[95% CI = -3.67, 0.23]). Duration of ventilator support with an average
mean difference of -2.86 days [95% CI = -11.43, 5.71] and intensive care
unit (ICU) length of stay with an average mean difference of -4.79 days
[95% CI = -8.17, -1.41] were shorter in ECMO patients. Extracorporeal
membrane oxygenation treatment tended to be superior regarding 3 month
mortality (odds ratio = 0.46, 95% CI = 0.21-1.02) and 1 year mortality
(odds ratio = 0.65, 95% CI = 0.37-1.13). However, only the ICU length of
stay reached statistical significance. Meta-regression analyses showed
that heterogeneity across studies (sex, year of ECMO implementation, and
underlying disease) influenced differences. These data indicate a benefit
of the intraoperative use of ECMO as compared with CPB during lung
transplant procedures regarding short-term outcome (ICU stay). There was
no statistically significant effect regarding blood transfusion needs or
long-term outcome. The superiority of ECMO in lutx patients remains to be
determined in larger multi-center randomized trials.<br/>Copyright &#xa9;
2017 by the ASAIO.

<64>
Accession Number
616892223
Author
You T.; Yi K.; Ding Z.-H.; Hou X.-D.; Liu X.-G.; Wang X.-K.; Ge L.; Tian
J.-H.
Institution
(You, Yi, Hou, Liu, Wang) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, Lanzhou, China
(Ding) Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
(Ge, Tian) Evidence-Based Medicine Center, Lanzhou University, Lanzhou,
China
Title
Transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of perimembranous ventricular septal defects in
children: A protocol for a network meta-analysis.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e015642. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Both transcatheter device closure and surgical repair are
effective treatments with excellent midterm outcomes for perimembranous
ventricular septal defects (pmVSDs) in children. The mini-invasive
periventricular device occlusion technique has become prevalent in
research and application, but evidence is limited for the assessment of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. This study comprehensively compares the efficacy, safety and costs
of transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of pmVSDs in children using Bayesian network
meta-analysis. Methods and analysis A systematic search will be performed
using Chinese Biomedical Literature Database, China National Knowledge
Infrastructure, PubMed, EMBASE.com and the Cochrane Central Register of
Controlled Trials to include random controlled trials, prospective or
retrospective cohort studies comparing the efficacy, safety and costs of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. The risk of bias for the included prospective or retrospective
cohort studies will be evaluated according to the risk of bias in
non-randomised studies of interventions (ROBINS-I). For random controlled
trials, we will use risk of bias tool from Cochrane Handbook version
5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2
software. Ethics and dissemination Ethical approval and patient consent
are not required since this study is a network meta-analysis based on
published trials. The results of this network meta-analysis will be
submitted to a peer-reviewed journal for publication.<br/>Copyright &#xa9;
2017 Article author(s).

<65>
Accession Number
616752452
Author
Zhang D.; Yin D.; Song C.; Zhu C.; Kirtane A.J.; Xu B.; Dou K.
Institution
(Zhang, Yin, Song, Zhu, Xu, Dou) State Key Laboratory of Cardiovascular
Disease, Cardiovascular Institute, Fuwai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Zhang, Yin, Song, Zhu, Xu, Dou) Department of Cardiology, Cardiovascular
Institute, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Kirtane) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
Title
A randomised comparison of Conventional versus Intentional straTegy in
patients with high Risk prEdiction of Side branch OccLusion in coronary
bifurcation interVEntion: Rationale and design of the CIT-RESOLVE trial.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e016044. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction The intentional strategy (aggressive side branch (SB)
protection strategy: Elective two-stent strategy or jailed balloon
technique) is thought to be associated with lower SB occlusion rate than
conventional strategy (provisional two-stent strategy or jailed wire
technique). However, most previous studies showed comparable outcomes
between the two strategies, probably due to no risk classification of SB
occlusion when enrolling patients. There is still no randomised trial
compared the intentional and conventional strategy when treating
bifurcation lesions with high risk of SB occlusion. We aim to investigate
if intentional strategy is associated with significant reduction of SB
occlusion rate compared with conventional strategy in high-risk patients.
Methods and analysis The Conventional versus Intentional straTegy in
patients with high Risk prEdiction of Side branch OccLusion in coronary
bifurcation interVEntion (CIT-RESOLVE) is a prospective, randomised,
single-blind, multicentre clinical trial comparing the rate of SB
occlusion between the intentional strategy group and the conventional
strategy group (positive control group) in a consecutive cohort of
patients with high risk of side branch occlusion defined by V-RESOLVE
score, which is a validated angiographic scoring system to evaluate the
risk of SB occlusion in bifurcation intervention and used as one of the
inclusion criteria to select patients with high SB occlusion risk
(V-RESOLVE score >=12). A total of 21 hospitals from 10 provinces in China
participated in the present study. 566 patients meeting all
inclusion/exclusion criteria are randomised to either intentional strategy
group or conventional strategy group. The primary endpoint is SB occlusion
(defined as any decrease in thrombolysis in myocardial infarction flow
grade or absence of flow in SB after main vessel stenting). All patients
are followed up for 12-month postdischarge. Ethics and dissemination The
protocol has been approved by all local ethics committee. The ethics
committee have approved the study protocol, evaluated the risk to benefit
ratio, allowed operators with a minimum annual volume of 200 cases to
participate in the percutaneous coronary intervention procedure and
permitted them to perform both conventional and intentional strategies.
Written informed consent would be acquired from all participants. The
findings of the trial will be shared by the participant hospitals and
disseminated through peer-reviewed journals. Trial registration number
NCT02644434; Pre-results.<br/>Copyright &#xa9; 2017 Article author(s).

<66>
Accession Number
613242361
Author
Kuck K.-H.; Furnkranz A.; Chun K.R.J.; Metzner A.; Ouyang F.; Schluter M.;
Elvan A.; Lim H.W.; Kueffer F.J.; Arentz T.; Albenque J.-P.; Tondo C.;
Kuhne M.; Sticherling C.; Brugada J.
Institution
(Kuck, Metzner, Ouyang, Schluter) Department of Cardiology, Asklepios
Klinik St. Georg, Lohmuhlenstr. 5, Hamburg 20099, Germany
(Furnkranz, Chun) Cardioangiologisches Centrum Bethanien, Frankfurt,
Germany
(Elvan) Isala Klinieken, Zwolle, Netherlands
(Lim, Kueffer) Medtronic Inc., Minneapolis, MN, United States
(Arentz) Herz-Zentrum, Bad Krozingen, Germany
(Albenque) Clinique Pasteur, Toulouse, France
(Tondo) Centro Cardiologico Monzino, University of Milan, Milan, Italy
(Kuhne, Sticherling) Universitatsspital Basel, Basel, Switzerland
(Brugada) Hospital Clinic, University of Barcelona, Barcelona, Spain
Title
Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial
fibrillation: Reintervention, rehospitalization, and quality-of-life
outcomes in the FIRE and ICE trial.
Source
European Heart Journal. 37 (38) (pp 2858-2865), 2016. Date of Publication:
2016.
Publisher
Oxford University Press
Abstract
Aims The primary safety and efficacy endpoints of the randomized FIRE AND
ICE trial have recently demonstrated non-inferiority of cryoballoon vs.
radiofrequency current (RFC) catheter ablation in patients with
drug-refractory symptomatic paroxysmal atrial fibrillation (AF). The aim
of the current study was to assess outcome parameters that are important
for the daily clinical management of patients using key secondary
analyses. Specifically, reinterventions, rehospitalizations, and
quality-of-life were examined in this randomized trial of cryoballoon vs.
RFC catheter ablation. Methods and results Patients (374 subjects in the
cryoballoon group and 376 subjects in the RFC group) were evaluated in the
modified intention-to-treat cohort. After the index ablation, log-rank
testing over 1000 days of follow-up demonstrated that there were
statistically significant differences in favour of cryoballoon ablation
with respect to repeat ablations (11.8% cryoballoon vs. 17.6% RFC; P =
0.03), direct-current cardioversions (3.2% cryoballoon vs. 6.4% RFC; P =
0.04), all-cause rehospitalizations (32.6% cryoballoon vs. 41.5% RFC; P =
0.01), and cardiovascular rehospitalizations (23.8% cryoballoon vs. 35.9%
RFC; P < 0.01). There were no statistical differences between groups in
the quality-of-life surveys (both mental and physical) as measured by the
Short Form-12 health survey and the EuroQol five-dimension questionnaire.
There was an improvement in both mental and physical quality-of-life in
all patients that began at 6 months after the index ablation and was
maintained throughout the 30 months of follow-up. Conclusion Patients
treated with cryoballoon as opposed to RFC ablation had significantly
fewer repeat ablations, direct-current cardioversions, all-cause
rehospitalizations, and cardiovascular rehospitalizations during
follow-up. Both patient groups improved in quality-of-life scores after AF
ablation.<br/>Copyright &#xa9; 2016 The Author 2016.

<67>
Accession Number
611147629
Author
Stewart R.A.H.; Wallentin L.; Benatar J.; Danchin N.; Hagstrom E.; Held
C.; Husted S.; Lonn E.; Stebbins A.; Chiswell K.; Vedin O.; Watson D.;
White H.D.
Institution
(Stewart, Benatar, White) Green Lane Cardiovascular Service, Auckland City
Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New
Zealand
(Wallentin, Hagstrom, Held, Vedin) Department of Medical Sciences,
Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University,
Uppsala, Sweden
(Danchin) Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux
de Paris, INSERM U-970, Universite Paris Descartes, Paris, France
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Lonn) Department of Medicine, Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(Stebbins, Chiswell) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Watson) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Research Triangle Park, NC, United States
Title
Dietary patterns and the risk of major adverse cardiovascular events in a
global study of high-risk patients with stable coronary heart disease.
Source
European Heart Journal. 37 (25) (pp 1993-2001), 2016. Date of Publication:
01 Jul 2016.
Publisher
Oxford University Press
Abstract
Objectives To determine whether dietary pattern assessed by a simple
self-administered food frequency questionnaire is associated with major
adverse cardiovascular events (MACE) in high-risk patients with stable
coronary artery disease. Background A Mediterranean dietary pattern has
been associated with lower cardiovascular (CV) mortality. It is less
certain whether foods common in western diets are associated with CV risk.
Methods At baseline, 15 482 (97.8%) patients (mean age 67 +/- 9 years)
with stable coronary heart disease from 39 countries who participated in
the Stabilisation of atherosclerotic plaque by initiation of darapladib
therapy (STABILITY) trial completed a life style questionnaire which
included questions on common foods. A Mediterranean diet score (MDS) was
calculated for increasing consumption of whole grains, fruits, vegetables,
legumes, fish, and alcohol, and for less meat, and a 'Western diet score'
(WDS) for increasing consumption of refined grains, sweets and deserts,
sugared drinks, and deep fried foods. A multi-variable Cox proportional
hazards models assessed associations between MDS or WDS and MACE, defined
as CV death, non-fatal myocardial infarction, or non-fatal stroke. Results
After a median follow-up of 3.7 years MACE occurred in 7.3% of 2885
subjects with an MDS >=15, 10.5% of 4018 subjects with an MDS of 13-14,
and 10.8% of 8579 subjects with an MDS <=12. A one unit increase in MDS
>12 was associated with lower MACE after adjusting for all covariates (+1
category HR 0.95, 95% CI 0.91, 0.98, P = 0.002). There was no association
between WDS (adjusted model +1 category HR 0.99, 95% CI 0.97, 1.01) and
MACE. Conclusion Greater consumption of healthy foods may be more
important for secondary prevention of coronary artery disease than
avoidance of less healthy foods typical of Western diets.<br/>Copyright
&#xa9; 2016 The Author 2016.

<68>
Accession Number
612982015
Author
Stratz C.; Nuhrenberg T.; Amann M.; Cederqvist M.; Kleiner P.; Valina
C.M.; Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Stratz, Nuhrenberg, Amann, Cederqvist, Kleiner, Valina, Trenk, Neumann,
Hochholzer) University Heart Center Freiburg - Bad Krozingen, Department
of Cardiology and Angiology II, Bad Krozingen, Germany
Title
Impact of reticulated platelets on antiplatelet response to
thienopyridines is independent of platelet turnover.
Source
Thrombosis and Haemostasis. 116 (5) (pp 941-948), 2016. Date of
Publication: November 2016.
Publisher
Schattauer GmbH (E-mail: iaorl@iaorl.org)
Abstract
Reticulated platelets are associated with impaired antiplatelet response
to thienopyridines. It is uncertain whether this interaction is caused by
a decreased drug exposure due to high platelet turnover reflected by
elevated levels of reticulated platelets or by intrinsic properties of
reticulated platelets. This study sought to investigate if the impact of
reticulated platelets on early antiplatelet response to thienopyridines is
mainly caused by platelet turnover as previously suggested. Elective
patients undergoing coronary intervention were randomised to loading with
clopidogrel 600 mg or prasugrel 60 mg (n=200). Adenosine diphosphate
(ADP)-induced platelet reactivity was determined by impedance aggregometry
before, at 30, 60, 90, and 120 minutes and at day 1 after loading.
Immature platelet count was assessed as marker of reticulated platelets by
flow cytometry. Platelet reactivity increased with rising levels of
immature platelet count in both groups. This effect was more distinctive
in patients on clopidogrel as compared to patients on prasugrel. Overall,
immature platelet count correlated well with on-treatment platelet
reactivity at all timepoints (p < 0.001). These correlations did not
change over time in the entire cohort as well as in patients treated with
clopidogrel or prasugrel indicating an effect independent of platelet
turnover (comparison of correlations 120 minutes/day 1: p = 0.64). In
conclusion, the association of immature platelet count with impaired
antiplatelet response to thienopyridines is similar early and late after
loading. This finding suggests as main underlying mechanism another effect
of reticulated platelets on thienopyridines than platelet
turnover.<br/>Copyright &#xa9; Schattauer 2016.

<69>
Accession Number
621499410
Author
Wu Q.; Wang T.; Chen S.; Zhou Q.; Li H.; Hu N.; Feng Y.; Dong N.; Yao S.;
Xia Z.
Institution
(Wu, Wang, Chen, Zhou, Hu, Feng, Yao) Department of Anaesthesiology,
Institute of Anaesthesiology and Critical Care Medicine, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
1277 Jiefang Avenue, Wuhan 430022, China
(Li, Xia) State Key Laboratory of Pharmaceutical Biotechnology, University
of Hong Kong, 21 Sassoon Road, Hong Kong, Hong Kong
(Li, Xia) Department of Anaesthesiology, University of Hong Kong, 102
Pokfulam Road, Hong Kong, Hong Kong
(Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, 1277
Jiefang Avenue, Wuhan 430022, China
Title
Cardiac protective effects of remote ischaemic preconditioning in children
undergoing tetralogy of fallot repair surgery: A randomized controlled
trial.
Source
European Heart Journal. 39 (12) (pp 1028-1037), 2018. Date of Publication:
21 Mar 2018.
Publisher
Oxford University Press
Abstract
Aims Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia
in distant tissues protects the heart against myocardial
ischaemia-reperfusion injury (IRI) in children undergoing open-heart
surgery, although its effectiveness in adults with comorbidities is
controversial. The effectiveness and mechanism of RIPC with respect to
myocardial IRI in children with tetralogy of Fallot (ToF), a severe
cyanotic congenital cardiac disease, undergoing open heart surgery are
unclear. We hypothesized that RIPC can confer cardioprotection in children
undergoing ToF repair surgery. Methods and results Overall, 112 ToF
children undergoing radical open cardiac surgery using cardiopulmonary
bypass (CPB) were randomized to either a RIPC group (n = 55) or a control
group (n = 57). The RIPC protocol consisted of three cycles of 5-min lower
limb occlusion and 5-min reperfusion using a cuff-inflator. Serum
inflammatory cytokines and cardiac injury markers were measured before
surgery and after CPB. Right ventricle outflow tract (RVOT) tissues were
collected during the surgery to assess hypoxia-inducible factor
(Hif)-1alpha and other signalling proteins. Cardiac mitochondrial injury
was assessed by electron microscopy. The primary results showed that the
length of stay in the intensive care unit (ICU) was longer in the control
group than in the RIPC group (52.30 +/- 13.43 h vs. 47.55 +/- 10.34 h,
respectively, P = 0.039). Patients in the control group needed longer
post-operative ventilation time compared to the RIPC group (35.02 +/- 6.56
h vs. 31.96 +/- 6.60 h, respectively, P = 0.016). The levels of
post-operative serum troponin-T at 12 and 18 h, CK-MB at 24 h, as well as
the serum h-FABP levels at 6 h, after CPB were significantly lower, which
was coincident with significantly higher protein expression of cardiac
Hif-1alpha, p-Akt, p-STAT3, p-STAT5, and p-eNOS and less vacuolization of
mitochondria in the RIPC group compared to the control group. Conclusion
In ToF children undergoing open heart surgery, RIPC attenuates myocardial
IRI and improves the short-term prognosis.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<70>
Accession Number
620922720
Author
Kodumuri V.; Balasubramanian S.; Vij A.; Siddamsetti S.; Sethi A.;
Khalafallah R.; Khosla S.
Institution
(Kodumuri, Balasubramanian, Vij, Siddamsetti) Division of Cardiology, John
H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
(Sethi) Department of Cardiology, Chicago Cardiology Institute,
Schaumberg, Illinois, United States
(Khalafallah) Department of Biology, Loyola University Health System,
Maywood, Illinois, United States
(Khosla) Department of Cardiology, Rosalind Franklin University of
Medicine and Sciences, North Chicago, Illinois, United States
Title
A Meta-Analysis Comparing Percutaneous Coronary Intervention With
Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected
Left Main Disease.
Source
American Journal of Cardiology. 121 (8) (pp 924-933), 2018. Date of
Publication: 15 April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) is the preferred revascularization
strategy for unprotected left main disease (UPLMD). Multiple small-scale
trials and registry data showed that percutaneous coronary intervention
(PCI) with drug-eluting stents (DES) is a noninferior strategy with a
Class IIa American College of Cardiology/American Heart Association
recommendation in patients with high surgical risk and favorable anatomy.
However, 2 recent large-scale randomized trials showed conflicting
evidence. We conducted a meta-analysis of the existing data to compare
outcomes of PCI with DES versus CABG for UPLMD. Four randomized and 8
nonrandomized trials involving 10,284 patients were included. Primary end
point was composite of death, stroke, or myocardial infarction (MI) at 3
years or longer. Secondary end points were MACCE (Major Adverse Cardiac
and Cerebrovascular Events) and its individual components (death, stroke,
MI, or repeat revascularization). Mantel-Haenszel random effects model was
used to calculate combined odds ratio for outcomes. A separate analysis of
randomized data was also performed. There was no significant difference in
primary composite outcome between PCI and CABG. However, MACCE was
significantly higher in PCI, primarily driven by significantly high repeat
revascularization. A subgroup analysis stratified by Synergy between PCI
with Taxus and Cardiac Surgery (SYNTAX) score showed that MACCE and repeat
revascularization were not significantly different between PCI and CABG in
low to intermediate SYNTAX score (<33), whereas they were significantly
higher in PCI with higher SYNTAX score. Thus, although CABG remains the
preferred method of treatment in UPLMD, PCI with DES can be considered as
a reasonable alternative in patients with favorable anatomy and high
surgical risk.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<71>
Accession Number
621589228
Author
Gupta S.; Belley-Cote E.P.; Sarkaria A.; Pandey A.; Spence J.; Mcclure G.;
Panchal P.; Jaffer I.H.; An K.; Eikelboom J.; Whitlock R.P.
Institution
(Gupta, Jaffer, Whitlock) Department of Surgery, McMaster University,
Hamilton, Ontario, Canada
(Gupta, Belley-Cote, Spence, Mcclure, Whitlock) Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton,
Ontario, Canada
(Belley-Cote, Eikelboom) Department of Medicine, McMaster University,
Hamilton, Ontario, Canada
(Belley-Cote, Eikelboom, Whitlock) Perioperative and Surgery Program,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
Ontario, Canada
(Sarkaria) Department of Medicine, School of Medicine, Queen's University,
Kingston, Ontario, Canada
(Pandey, Jaffer) Experimental Thrombosis and Atherosclerosis Program,
Thrombosis and Atherosclerosis Research Institute, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Pandey, Panchal) Department of Health Sciences, McMaster University,
Hamilton, Ontario, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, Ontario,
Canada
(Mcclure, An) Michael DeGroote School of Medicine, McMaster University,
Hamilton, Ontario, Canada
Title
International Normalized Ratio Targets for Left-Sided Mechanical Valve
Replacement.
Source
Thrombosis and Haemostasis. (no pagination), 2018. Date of Publication: 03
Apr 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Guidelines recommend higher international normalized ratio
(INR) targets for patients with mechanical valves believed to be at higher
risk for thromboembolism. Higher INR targets are associated with increased
bleeding risk. We performed a systematic review and meta-analysis
assessing effects of lower and higher INR targets on thromboembolic and
bleeding risk in patients with mechanical heart valves. Methods We
searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled
trials (RCTs) evaluating lower versus higher INR targets for adults with
bileaflet mechanical valves. We performed title and abstract screening,
full-text review, risk of bias evaluation and data collection
independently and in duplicate. We pooled data using a random effects
model and used the Grading of Recommendations Assessment, Development and
Evaluation framework to evaluate overall quality of evidence. Results We
identified six RCTs ( n = 5,497). Lower INR targets were associated with
significantly less bleeding-22% versus 40% (relative risk [RR]: 0.54, 95%
confidence interval [CI]: 0.31, 0.93, p = 0.03, very low quality). There
was no difference in thromboembolism-2% in both groups (RR: 1.28, 95% CI:
0.88, 1.85, p = 0.20, very low quality) or mortality-5.5% with lower INR
targets versus 8.5% (RR: 1.00, 95% CI: 0.82, 1.21, p = 0.47, moderate
quality). Conclusion In patients with mechanical valves, higher INR
targets are not supported by current evidence, which is of very low
quality. In fact, our systematic review suggests that lower INR targets
offer significantly lower bleeding risks with no significant difference in
thromboembolic risk. <br/>Copyright &#xa9; 2018, Schattauer GmbH. All
rights reserved.

<72>
Accession Number
621588365
Author
Mukaida H.; Matsushita S.; Inotani T.; Nakamura A.; Amano A.
Institution
(Mukaida, Matsushita, Amano) Department of Cardiovascular Surgery, Faculty
of Medicine, Juntendo University, Tokyo, Japan
(Mukaida, Inotani) Department of Clinical Engineering, Juntendo University
Hospital, Tokyo, Japan
(Nakamura) Department of Clinical Engineering, Faculty of Health Sciences,
Kyorin University, Tokyo, Japan
Title
Continuous renal replacement therapy with a polymethyl methacrylate
membrane hemofilter suppresses inflammation in patients after open-heart
surgery with cardiopulmonary bypass.
Source
Journal of Artificial Organs. (pp 1-8), 2018. Date of Publication: 05 Feb
2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Cardiopulmonary bypass (CPB) induces a complex inflammatory response
involving an increase in inflammatory cytokines, called postperfusion
syndrome. Previous studies demonstrated that adsorption of the serum
cytokines can reduce acute inflammation and improve clinical outcomes. In
this study, patients were placed on continuous renal replacement therapy
(CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter
immediately after the start of an open-heart surgery with CPB and
throughout the postoperative course to prevent postperfusion syndrome. The
aim of this study was to assess whether continuous CRRT using a PMMA
filter (PMMA-CRRT) could affect cytokine expression and improve
perioperative outcomes. We designed a randomized controlled trial, which
included 19 consecutive adult patients on maintenance dialysis and 7
consecutive adult patients who were not on maintenance dialysis (NHD
group). Patients on maintenance dialysis were randomly divided into two
groups: Ten patients who received CRRT with a polysulfone membrane
hemofilter (PS group) and nine patients who received CRRT with a PMMA
membrane (PMMA group). Blood samples were collected from the radial or
brachial artery at five different time points. Comparisons between the PS,
PMMA, and NHD groups revealed a significant main effect of time on changes
in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p <
0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery
were significantly lower in the PMMA group than in the PS group, while
other cytokines measured in this study were not significantly different.
In addition, clinical outcomes were not significantly different between
the groups. The continuous use of PMMA-CRRT throughout the perioperative
period suppressed serum IL-6 and IL-8 concentrations, although there were
no differences in clinical outcomes.<br/>Copyright &#xa9; 2018 The
Japanese Society for Artificial Organs