EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
618266150
Author
Vaccaro O.; Masulli M.; Nicolucci A.; Bonora E.; Del Prato S.; Maggioni
A.P.; Rivellese A.A.; Squatrito S.; Giorda C.B.; Sesti G.; Mocarelli P.;
Lucisano G.; Sacco M.; Signorini S.; Cappellini F.; Perriello G.; Lapolla
A.; Giordano C.; Buzzetti R.; Clemente G.; Di Cianni G.; Iannarelli R.;
Cordera R.; La Macchia O.; Zamboni C.; Scaranna C.; Boemi M.; Iovine C.;
Lauro D.; Leotta S.; Dall'Aglio E.; Cannarsa E.; Tonutti L.; Pugliese G.;
Bossi A.C.; Anichini R.; Dotta F.; Di Benedetto A.; Citro G.; Antenucci
D.; Ricci L.; Giorgino F.; Santini C.; Gnasso A.; De Cosmo S.; Zavaroni
D.; Vedovato M.; Consoli A.; Calabrese M.; di Bartolo P.; Fornengo P.;
Riccardi G.; D'Angelo F.; Giansanti R.; Tanase L.; Lanari L.; Testa I.;
Pancani F.; Ranchelli A.; Vagheggi P.; Scatona A.; Fontana L.; Laviola L.;
Tarantino L.; Ippolito C.; Gigantelli V.; Manicone M.; Conte E.; Trevisan
R.; Rota R.; Dodesini A.R.; Reggiani G.M.; Montesi L.; Mazzella N.;
Forlani G.; Caselli C.; Di Luzio R.; Mazzotti A.; Aiello A.; Barrea A.;
Musto A.; D'Amico F.; Sinagra T.; Longhitano S.; Trowpea V.; Sparti M.;
Italia S.; Lisi E.; Grasso G.; Pezzino V.; Insalaco F.; Carallo C.;
Scicchitano C.; De Franceschi M.S.; Calbucci G.; Ripani R.; Corsi L.;
Cuneo G.; Corsi S.; Romeo F.; Lesina A.; Comoglio M.; Bonetto C.; Robusto
A.; Nada E.; Asprino V.; Cetraro R.; Impieri M.; Lucchese G.; Donnarumma
G.; Tizio B.; Lenza L.; Paraggio P.; Tomasi F.; Dozio N.; Scalambra E.;
Mannucci E.; Lamanna C.; Cignarelli M.; Macchia O.L.; Fariello S.;
Sorrentino M.R.; Franzetti I.; Radin R.; Annunziata F.; Bonabello L.A.;
Durante A.; Dolcino M.; Gallo F.; Mazzucchelli C.; Aleo A.; Melga P.;
Briatore L.; Maggi D.; Storace D.; Cecoli F.; D'Ugo E.; Pupillo M.;
Baldassarre M.P.A.; Salvati F.; Minnucci A.; De Luca A.; Zugaro A.;
Santarelli L.; Bosco A.; Petrella V.; La Verghetta G.G.; D'Andrea S.;
Giuliani A.E.; Polidoro W.L.; Sperandio A.; Sciarretta F.; Pezzella A.;
Carlone A.; Venditti C.; Foffi C.; Carbone S.; Cipolloni L.; Moretti C.;
Leto G.; Serra R.; Petrachi F.; Romano I.; Lacaria E.; Russo L.; Goretti
C.; Sannino C.; Gregori G.; Dolci M.; Bruselli L.; Mori M.L.; Baccetti F.;
Del Freo M.; Cucinotta D.; Giunta L.; Ruffo M.C.; Cannizzaro D.; Pintaudi
B.; Perrone G.; Pata P.; Ragonese F.; Lettina G.; Mancuso T.; Coppolino
A.; Piatti P.M.; Monti L.; Stuccillo M.; Lucotti P.; Setola M.; Crippa
G.V.; Loi C.; Oldani M.; Bottalico M.L.; Pellegata B.; Bonomo M.;
Menicatti L.S.M.; Resi V.; Bertuzzi F.; Disoteo E.O.; Pizzi G.; Annuzzi
G.; Capaldo B.; Nappo R.; Auciello S.M.; Turco A.A.; Costagliola L.; Corte
G.D.; Vallefuoco P.; Nappi F.; Vitale M.; Cocozza S.; Ciano O.; Massimino
E.; Garofalo N.; Avogaro A.; Guarneri G.; Fedele D.; Sartore G.; Chilelli
N.C.; Burlina S.; Bonsembiante B.; Galluzzo A.; Torregrossa V.;
Mancastroppa G.; Arsenio L.; Cioni F.; Caronna S.; Papi M.; Santeusanio
F.; Calagreti G.; Timi A.; Tantucci A.; Marino C.; Ginestra F.; Di Biagio
R.; Taraborelli M.; Miccoli R.; Bianchi C.; Garofolo M.; Politi K.S.;
Penno G.; Livraga S.; Calzoni F.; Mancastroppa G.L.F.; Corsini E.;
Tedeschi A.; Gagliano M.S.; Ippolito G.; Salutini E.; Cervellino F.;
Natale M.; Salvatore V.; Zampino A.; Sinisi R.; Arcangeli A.; Zogheri A.;
Guizzotti S.; Longo R.; Pellicano F.; Scolozzi P.; Termine S.; Luberto A.;
Ballardini G.; Babini A.C.; Trojani C.; Mazzuca P.; Bruglia M.; Ciamei M.;
Genghini S.; Zannoni C.; Rangel G.; Salvi L.; Zappaterreno A.; Cordone S.;
Simonelli P.; Meggiorini M.; Frasheri A.; Di Pippo C.; Maglio C.;
Mazzitelli G.; Rinaldi M.E.; Galli A.; Romano M.; D'Angelo P.; Suraci C.;
Bacci S.; Palena A.P.; Genovese S.; Mancino M.; Rondinelli M.; Capone F.;
Calabretto E.; Bulgheroni M.; Bucciarelli L.; Ceccarelli E.; Fondelli C.;
Santacroce C.; Guarino E.; Nigi L.; Lalli C.; Di Vizia G.; Scarponi M.;
Montani V.; Di Bernardino P.; Romagni P.; Dolcetti K.; Forte E.;
Potenziani S.; Tamburo L.; Perin P.C.; Prinzis T.; Gruden G.; Bruno G.;
Zucco C.; Perotta M.; Marena S.; Monsignore S.; Panero F.; Ponzi F.;
Carpinteri R.; Casagrande M.L.; Coletti M.F.; Balini A.; Filopanti M.;
Madaschi S.; Pulcina A.; Grimaldi F.; Venturini G.; Agus S.; Pagnutti S.;
Guidotti F.; Cavarape A.; Cigolini M.; Pichiri I.; Brangani C.; Fainelli
G.; Tomasetto E.; Zoppini G.; Galletti A.; Perrone D.; Capra C.; Bianchini
F.; Ceseri M.; Di Nardo B.; Sasso E.; Bartolomei B.; Suliman I.; Fabbri
G.; Romano G.; Maturo N.; Nunziata G.; Capobianco G.; De Simone G.; Villa
V.; Rota G.; Pentangelo C.; Carbonara O.; Caiazzo G.; Cutolo M.;
Sorrentino T.; Mastrilli V.; Amelia U.; Masi S.; Corigliano G.; Gaeta I.;
Armentano V.; Calatola P.; Capuano G.; Angiulli B.; Auletta P.; Petraroli
E.; Iodice C.E.; Agrusta M.
Institution
(Vaccaro, Masulli, Rivellese, Riccardi) Department of Clinical Medicine
and Surgery, University of Naples Federico II, Naples, Italy
(Iovine) Diabetes Unit, University of Naples Federico II, Naples, Italy
(Nicolucci, Lucisano, Sacco) Center for Outcomes Research and Clinical
Epidemiology (CORESEARCH), Pescara, Italy
(Bonora) Division of Endocrinology, Diabetes and Metabolism, University
and Hospital Trust of Verona, Verona, Italy
(Del Prato) Department of Clinical & Experimental Medicine, University of
Pisa, Pisa, Italy
(Maggioni) National Association of Hospital Cardiologists (ANMCO) Research
Center, Florence, Italy
(Squatrito) Diabetes Unit, University Hospital Garibaldi-Nesima of
Catania, Catania, Italy
(Giorda) Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino,
Italy
(Sesti) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Italy
(Gnasso) Department of Clinical and Experimental Medicine, Magna Graecia
University of Catanzaro, Italy
(Mocarelli, Signorini, Cappellini) University Department Laboratory
Medicine, Hospital of Desio, Monza, Italy
(Perriello) Endocrinology and Metabolism, University of Perugia, Perugia,
Italy
(Babini) Medical Division, Rimini Hospital, Rimini, Italy
(Lapolla) Dipartimento di Medicina, Universita di Padova, Padova, Italy
(Gregori) Diabetes Unit, Massa Carrara, Azienda Unita Sanitarie Locali
(USL) Toscana Nord Ovest, Carrara, Italy
(Giordano) Section of Endocrinology, Diabetology and Metabolic Diseases,
University of Palermo, Palermo, Italy
(Corsi) Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
(Buzzetti) Department of Experimental Medicine, Sapienza University, Rome,
Italy
(Pugliese) Department of Clinical and Molecular Medicine, Sapienza
University, Rome, Italy
(Clemente) Institute for Research on Population and Social
Policies-National Research Council, Penta di Fisciano, Italy
(Di Cianni) Diabetes and Metabolism, Livorno Hospital, Livorno, Italy
(Iannarelli) Diabetes Unit, Department of Medicine, San Salvatore
Hospital, L'Aquila, Italy
(Cordera) Diabetes Unit, School of Medicine, University of Genova,
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino
Hospital, Genova, Italy
(La Macchia) Endocrinology, Azienda Ospedaliero Universitaria Ospedali
Riuniti, Foggia, Italy
(Zamboni) Diabetes Unit, University of Ferrara, Ferrara, Italy
(Scaranna) Endocrinology and Diabetology, Azienda Socio Sanitaria
Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
(Boemi) Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e
Cura Anziani, Ancona, Italy
(Lauro) Department of Systems Medicine, University of Rome Tor Vergata,
Rome, Italy
(Leotta) UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
(Dall'Aglio) Clinical and Experimental Medicine, University of Parma,
Parma, Italy
(Cannarsa) Diabetes Unit, San Liberatore Hospital, Atri Teramo, Italy
(Tonutti) Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit,
Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
(Bossi) ASST Bergamo Ovest, Treviglio, Italy
(Anichini) Diabetes Unit, USL 3, Pistoia, Italy
(Dotta) Diabetes Unit, Department of Medicine, Surgery and Neurosciences,
University of Siena, Siena, Italy
(Di Benedetto) Department of Clinical and Experimental Medicine,
University of Messina, Messina, Italy
(Citro) Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di
Potenza, Potenza, Italy
(Antenucci) Diabetes Unit, Renzetti Hospital, ASL 2 Abruzzo, Lanciano,
Italy
(Ricci) Diabetes Unit, USL Sud Est, Toscana, Italy
(Giorgino) Department of Emergency and Organ Transplantation,
Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari,
Apulia, Italy
(Santini) Department Endocrinology and Diabetology, Cesena Hospital,
Cesena, Italy
(De Cosmo) Unit of Internal Medicine, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo, Italy
(Zavaroni) Diabetes Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
(Vedovato) Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
(Consoli) Department of Medicine and Aging Sciences, Aging and
Translational Medicine Research Center (CeSI-Met), D'Annunzio University,
Chieti-Pescara, Italy
(Calabrese) Diabetes Unit, USL Toscana Centro, Prato, Italy
(di Bartolo) Diabetes Unit, Ravenna Internal Medicine Department, Romagna
Local Health Unit, Ravenna, Italy
(Fornengo) Department of Medical Sciences, University of Turin, Turin,
Italy
Title
Effects on the incidence of cardiovascular events of the addition of
pioglitazone versus sulfonylureas in patients with type 2 diabetes
inadequately controlled with metformin (TOSCA.IT): a randomised,
multicentre trial.
Source
The Lancet Diabetes and Endocrinology. 5 (11) (pp 887-897), 2017. Date of
Publication: November 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The best treatment option for patients with type 2 diabetes in
whom treatment with metformin alone fails to achieve adequate glycaemic
control is debated. We aimed to compare the long-term effects of
pioglitazone versus sulfonylureas, given in addition to metformin, on
cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT
was a multicentre, randomised, pragmatic clinical trial, in which patients
aged 50-75 years with type 2 diabetes inadequately controlled with
metformin monotherapy (2-3 g per day) were recruited from 57 diabetes
clinics in Italy. Patients were randomly assigned (1:1), by permuted
blocks randomisation (block size 10), stratified by site and previous
cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea
(5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in
accordance with local practice). The trial was unblinded, but event
adjudicators were unaware of treatment assignment. The primary outcome,
assessed with a Cox proportional-hazards model, was a composite of first
occurrence of all-cause death, non-fatal myocardial infarction, non-fatal
stroke, or urgent coronary revascularisation, assessed in the modified
intention-to-treat population (all randomly assigned participants with
baseline data available and without any protocol violations in relation to
inclusion or exclusion criteria). This study is registered with
ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008,
and Jan 15, 2014, 3028 patients were randomly assigned and included in the
analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas
(glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At
baseline, 335 (11%) participants had a previous cardiovascular event. The
study was stopped early on the basis of a futility analysis after a median
follow-up of 57.3 months. The primary outcome occurred in 105 patients
(1.5 per 100 person-years) who were given pioglitazone and 108 (1.5 per
100 person-years) who were given sulfonylureas (hazard ratio 0.96, 95% CI
0.74-1.26, p=0.79). Fewer patients had hypoglycaemias in the pioglitazone
group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0.0001).
Moderate weight gain (less than 2 kg, on average) occurred in both groups.
Rates of heart failure, bladder cancer, and fractures were not
significantly different between treatment groups. Interpretation In this
long-term, pragmatic trial, incidence of cardiovascular events was similar
with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as
add-on treatments to metformin. Both of these widely available and
affordable treatments are suitable options with respect to efficacy and
adverse events, although pioglitazone was associated with fewer
hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca,
and Italian Diabetes Society.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<2>
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.

<3>
Accession Number
2000609395
Author
Khoynezhad A.; DelaRosa J.; Moon M.R.; Brinkman W.T.; Thompson R.B.; Desai
N.D.; Malaisrie S.C.; Girardi L.N.; Bavaria J.E.; Reece T.B.
Institution
(Khoynezhad) Department of Cardiovascular Surgery, MemorialCare Health
System, Long Beach, California, United States
(DelaRosa) Cardiothoracic Surgery, Portneuf Medical Center, Pocatello,
Idaho, United States
(Moon) Department of Cardiothoracic Surgery, Washington University, St.
Louis, Missouri, United States
(Brinkman) Department of Cardiothoracic Surgery, Baylor Scott & White,
Plano, Texas, United States
(Thompson) Department of Cardiothoracic Surgery, Bryan Heart, Lincoln,
Nebraska, United States
(Desai, Bavaria) Division of Cardiovascular Surgery, Department of
Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United
States
(Malaisrie) Division of Cardiac Surgery, Department of Surgery,
Northwestern University, Chicago, Illinois, United States
(Girardi) Department of Cardiothoracic Surgery, Cornell University, New
York, New York, United States
(Reece) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado Hospital, Aurora, Colorado, United States
Title
Facilitating Hemostasis After Proximal Aortic Surgery: Results of The
PROTECT Trial.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1357-1364), 2018. Date of
Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: This study intended to evaluate the safety and hemostatic
efficacy of a novel vascular sealant (Tridyne; Neomend, Inc, Irvine, CA)
compared with an accepted adjunctive hemostatic agent applied to aortotomy
and sutures lines in cardiovascular operations. Methods: Patients
undergoing aortic valve replacement, ascending aortic replacement, or
aortic root replacement were randomly assigned 2:1 to Tridyne (n = 107) or
Gelfoam Plus (Baxter Healthcare Corp, Hayward, CA) (n = 51). These groups
were similar with regard to age, sex, race, medical history, duration of
bypass and cross-clamping, and number of suture lines treated. Suture
lines were treated after confirmation of some leakage but before formal
removal of the clamp. Results: The median bleeding time was significantly
lower for Tridyne versus Gelfoam Plus (0 versus 10.0 minutes, p < 0.0001).
Immediate hemostasis was achieved in 59.4% of the Tridyne group versus
16.0% of Gelfoam Plus group (p < 0.0001). A significantly greater
proportion of patients in the Tridyne group achieved successful hemostasis
at the aortic suture line than patients in the Gelfoam Plus group (85.7%
versus 40.0%, p < 0.0001). The Clinical Events Committee adjudicated 7
patients with possible device-related serious adverse events: 3 patients
(2.9%) in the Tridyne group and 4 patients (8.2%) in the Gelfoam Plus
group (p = 0.2097). Conclusions: Tridyne was safe and effective when used
as an adjunct to conventional hemostasis to treat high-pressure vessels in
patients who receive anticoagulation agents, in reducing time to
hemostasis, and in promoting both immediate and persistent
hemostasis.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<4>
Accession Number
2000570896
Author
Elbadawi A.; Elgendy I.Y.; Saad M.; Megaly M.; Mentias A.; Abuzaid A.S.;
Shahin H.I.; Goswamy V.; Abowali H.; London B.
Institution
(Elbadawi, Goswamy) Department of Internal Medicine, Rochester General
Hospital, Rochester, New York, United States
(Elbadawi, Abowali) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, Florida, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arkansas, United States
(Megaly) Division of Cardiovascular Medicine, Hennepin County Medical
Center/Minneapolis Heart Institute, Abbot Northwestern Hospital,
Minneapolis, Minnesota, United States
(Mentias, London) Department of Cardiovascular Medicine, University of
Iowa, Iowa City, Iowa, United States
(Abuzaid) Sidney Kimmel Medical College at Thomas Jefferson
University/Christiana Care Health System, Newark, Delaware, United States
(Shahin) Department of Pharmaceutics and Pharmaceutical Technology,
Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future
University in Egypt, Cairo, Egypt
Title
Meta-Analysis of Trials on Prophylactic Use of Levosimendan in Patients
Undergoing Cardiac Surgery.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1403-1410), 2018. Date of
Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: The role of prophylactic levosimendan in patients undergoing
cardiac surgery is controversial. Methods: We performed a computerized
search of Medline, Embase, and Cochrane databases through September 2017
for randomized trials evaluating the prophylactic use of levosimendan in
patients undergoing cardiac surgery (ie, patients without low cardiac
output syndrome). The main study outcome was mortality at 30 days.
Results: The final analysis included 16 randomized trials with total of
2,273 patients. There was no statistically significant difference in
mortality at 30 days between levosimendan and control groups (relative
risk 0.68, 95% confidence interval [CI]: 0.45 to 1.03). Subgroup analysis
showed no statistically significant difference in mortality at 30 days for
patients with reduced left ventricular ejection fraction compared with
patients having preserved left ventricular ejection fraction (p for
interaction = 0.12). Further analysis suggested that levosimendan might be
associated with improved mortality at 30 days when compared with
active-control but not when compared with placebo (p for interaction =
0.01). The levosimendan group had a significant reduction in acute kidney
injury (relative risk 0.59, 95% CI: 0.38 to 0.92), intensive care unit
stay (standardized mean difference = -0.21, 95% CI: -0.29 to -0.13), and
ventilation time (standardized mean difference = -0.43, 95% CI: -0.61 to
-0.25), whereas it had higher rates of atrial fibrillation (relative risk
1.11, 95% CI: 1.00 to 1.24). No statistically significant differences were
observed between groups in mortality beyond 30 days, postoperative
dialysis, or myocardial infarction. Conclusions: Prophylactic use of
levosimendan does not appear to reduce the mortality at 30 days or beyond
30 days in patients undergoing cardiac surgery. This lack of benefit was
noted irrespective of the LVEF.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons

<5>
Accession Number
618044503
Author
Giugliano R.P.; Pedersen T.R.; Park J.-G.; De Ferrari G.M.; Gaciong Z.A.;
Ceska R.; Toth K.; Gouni-Berthold I.; Lopez-Miranda J.; Schiele F.; Mach
F.; Ott B.R.; Kanevsky E.; Pineda A.L.; Somaratne R.; Wasserman S.M.;
Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Giugliano, Park, Kanevsky, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United
States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(De Ferrari) Department of Molecular Medicine, University of Pavia and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, The Medical University of Warsaw, Warsaw, Poland
(Ceska) Center of Preventive Cardiology, 3rd Department Internal Medicine,
University General Hospital and 1st Medical Faculty, Prague, Czech
Republic
(Toth) 1st Department of Medicine, University of Pecs, Pecs, Hungary
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lopez-Miranda) Lipids and Atherosclerosis Unit, Maimonides Biomedical
Research Institute of Cordoba, Reina Sofia University Hospital, University
of Cordoba, CIBEROBN, Cordoba, Spain
(Schiele) University Hospital Center Besancon, Besancon, France
(Mach) Hopital Cantonal, Hopitaux Universitaires de Geneva, Geneva,
Switzerland
(Ott) Rhode Island Hospital, Department of Neurology, Alpert Medical
School of Brown University, Providence, RI, United States
(Pineda, Somaratne, Wasserman) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
Clinical efficacy and safety of achieving very low LDL-cholesterol
concentrations with the PCSK9 inhibitor evolocumab: a prespecified
secondary analysis of the FOURIER trial.
Source
The Lancet. 390 (10106) (pp 1962-1971), 2017. Date of Publication: 28
October - 3 November 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: LDL cholesterol is a well established risk factor for
atherosclerotic cardiovascular disease. How much one should or safely can
lower this risk factor remains debated. We aimed to explore the
relationship between progressively lower LDL-cholesterol concentrations
achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial
of evolocumab, a monoclonal antibody to proprotein convertase
subtilisin-kexin type 9 (PCSK9). Methods: In this prespecified secondary
analysis of 25 982 patients from the randomised FOURIER trial, the
relationship between achieved LDL-cholesterol concentration at 4 weeks and
subsequent cardiovascular outcomes (primary endpoint was the composite of
cardiovascular death, myocardial infarction, stroke, coronary
revascularisation, or unstable angina; key secondary endpoint was the
composite of cardiovascular death, myocardial infarction, or stroke) and
ten prespecified safety events of interest was examined over a median of
2.2 years of follow-up. We used multivariable modelling to adjust for
baseline factors associated with achieved LDL cholesterol. This trial is
registered with ClinicalTrials.gov, number NCT01764633. Findings: Between
Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a
treatment in the FOURIER study. 1025 (4%) patients did not have an LDL
cholesterol measured at 4 weeks and 557 (2%) had already had a primary
endpoint event or one of the ten prespecified safety events before the
week-4 visit. From the remaining 25 982 patients (94% of those randomly
assigned) 13 013 were assigned evolocumab and 12 969 were assigned
placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol
concentrations of less than 0.5 mmol/L, 8003 (31%) patients achieved
concentrations between 0.5 and less than 1.3 mmol/L, 3444 (13%) patients
achieved concentrations between 1.3 and less than 1.8 mmol/L, 7471 (29%)
patients achieved concentrations between 1.8 to less than 2.6 mmol/L, and
4395 (17%) patients achieved concentrations of 2.6 mmol/L or higher. There
was a highly significant monotonic relationship between low
LDL-cholesterol concentrations and lower risk of the primary and secondary
efficacy composite endpoints extending to the bottom first percentile
(LDL-cholesterol concentrations of less than 0.2 mmol/L; p=0.0012 for the
primary endpoint, p=0.0001 for the secondary endpoint). Conversely, no
significant association was observed between achieved LDL cholesterol and
safety outcomes, either for all serious adverse events or any of the other
nine prespecified safety events. Interpretation: There was a monotonic
relationship between achieved LDL cholesterol and major cardiovascular
outcomes down to LDL-cholesterol concentrations of less than 0.2 mmol/L.
Conversely, there were no safety concerns with very low LDL-cholesterol
concentrations over a median of 2.2 years. These data support further
LDL-cholesterol lowering in patients with cardiovascular disease to well
below current recommendations. Funding: Amgen.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<6>
Accession Number
621716761
Author
Baysal E.; Midilli T.S.
Institution
(Baysal) Department of Fundamentals Nursing, Ege University School of
Nursing, Izmir, Turkey
(Midilli) Department of Fundamentals Nursing, Manisa Celal Bayar
University School of Health, Manisa, Turkey
Title
Effects of structured patient education on knowledge level and inr control
of patients receiving warfarin: Randomized controlled trial.
Source
Pakistan Journal of Medical Sciences. 34 (2) (pp 240-426), 2018. Date of
Publication: March-April 2018.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To determine the effects of patient education about the safety
of warfarin therapy on related-knowledge levels and on International
Normalized Ratio (INR) control. Methods: In the study, randomized
controlled experimental study design was used. It was conducted between
September 2014-March 2015 with 63 patients who use warfarin at least two
months at cardiology and cardiovascular surgery outpatient departments of
two different hospitals in Manisa. Participants in the intervention group
received one-to-one education about the safety of warfarin therapy and a
booklet. Participants in the control group received usual care. Patients'
warfarin knowledge levels in both groups were measured three times at
monthly intervals. Results: Before education warfarin knowledge levels
were inadequate in intervention group, but it was higher after education
and reached a good level. No significant difference was found between the
International Normalized Ratio controls of the two groups. No significant
relationship was found between pre- and post-education warfarin knowledge
levels and the INR number in the therapeutic range. Conclusion: One-to-one
education supported by written and visual material was effective in
increasing patients' warfarin knowledge levels.<br/>Copyright &#xa9; 2018,
Professional Medical Publications. All rights reserved.

<7>
Accession Number
621716704
Author
Ahmad R.A.; Ahmad S.S.; Hamid Khan W.; Furqan A.
Institution
(Ahmad, Ahmad) Department of Anesthesia, Chaudhry Pervaiz Elahi Institute
of Cardiology (CPEIC), Multan, Pakistan
(Hamid Khan) Department of Cardiac Surgery, Chaudhry Pervaiz Elahi
Institute of Cardiology (CPEIC), Multan, Pakistan
(Furqan) Department of Anaesthesia, Nishtar Medical University, Multan,
Pakistan
Title
Comparing the efficacy of morphine alone with morphine and MgSo4 in pain
management after coronary artery bypass surgery.
Source
Pakistan Journal of Medical Sciences. 34 (2) (pp 352-356), 2018. Date of
Publication: March-April 2018.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To compare the effectiveness of Morphine alone and Morphine
with MgSo4 in pain management after CABG surgery. Methods: This randomized
control trial was conducted in the department of anesthesia and critical
care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from
November 2016 to June 2017. All collected data was entered and analyzed by
using computer software SPSS version 23.1. Quantitative data like age, VAS
score was analyzed and presented as mean and standard deviation. Similarly
qualitative data like gender and ASA status was calculated and presented
as frequency and percentages. Independent sample T-test was applied for
significance of VAS score. P value <=0.05 was considered as significant.
Results: A total number of 150 patients of both genders were included in
this study. The main outcome variables of our study were VAS score. It was
observed that, in group (M), the mean VAS score after 4, 12 and 24 hours
of operation was 5.24+/-1.61, 5.8+/-2.27 and 5.44+/-2.27 respectively. And
in group (MM), the mean VAS score after 4, 12 and 24 hours of operation
was 4.36+/-2.58, 3.48+/-2.10 and 4.12+/-1.05 respectively. It was noted
that both groups had statically significant difference of VAS score, as
group (M) had higher VAS score than group (MM). Conclusion: Morphine with
Mgso4 has better efficacy as compared to morphine alone when used as
analgesic agent after CABG surgery.<br/>Copyright &#xa9; 2018,
Professional Medical Publications. All rights reserved.

<8>
Accession Number
621684232
Author
Lindqvist H.M.; Gjertsson I.; Eneljung T.; Winkvist A.
Institution
(Lindqvist, Winkvist) Department of Internal Medicine and Clinical
Nutrition, Institute of Medicine, Sahlgrenska Academy, University of
Gothenburg, Gothenburg 405 30, Sweden
(Gjertsson, Eneljung) Department of Rheumatology and Inflammation
Research, Institute of Medicine, Sahlgrenska Academy, University of
Gothenburg, Gothenburg 405 30, Sweden
Title
Influence of blue mussel (Mytilus edulis) intake on disease activity in
female patients with rheumatoid arthritis: The MIRA randomized cross-over
dietary intervention.
Source
Nutrients. 10 (4) (no pagination), 2018. Article Number: 481. Date of
Publication: 13 Apr 2018.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
Rheumatoid Arthritis (RA) is a chronic inflammatory disease. This study
evaluates the effect of blue mussel intake on disease activity and quality
of life in women with RA. Thirty-nine women with established RA and a
disease activity score 28 (DAS28) >3.0 were recruited to a randomized 2 x
11-week cross-over dietary intervention. The participants continued with
their medication and habitual diet and exchanged one cooked meal a day,
five days a week, with a meal including 75 g blue mussels or 75 g meat.
Diets were switched after an eight week washout period. Data regarding
quality of life (SF-36), blood lipids, erythrocyte sediment rate (ESR),
C-reactive protein (CRP) and tender and swollen joints were examined at
the start and end of each dietary period. Thirty women completed one
period, and twenty-three completed both. Intake of the blue mussel diet
led to a significant reduction of DAS28-CRP (p = 0.048), but not DAS28.
The number of EULAR (European League Against Rheumatism) criteria moderate
and good responders were higher when consuming blue mussel diet (p =
0.036). Blood lipids did not change. To conclude, blue mussel intake
reduced disease symptoms in women with RA and improved perceived health.
The reported effects need to be confirmed by non-patient reported
outcomes, such as inflammation markers.<br/>Copyright &#xa9; 2018 by the
authors. Licensee MDPI, Basel, Switzerland.

<9>
[Use Link to view the full text]
Accession Number
621682094
Author
Cho S.-M.; Deshpande A.; Pasupuleti V.; Hernandez A.V.; Uchino K.
Institution
(Cho, Uchino) Cerebrovascular Center, Neurological Institute, Cleveland
Clinic, 9500 Euclid Ave S80, Cleveland, OH 44195, United States
(Deshpande) Medicine Institute, Cleveland Clinic, OH, United States
(Pasupuleti) ProEd Communications Inc, Cleveland, OH, United States
(Hernandez) School of Medicine, Universidad Peruana de Ciencias Aplicadas,
Lima, Peru
(Hernandez) School of Pharmacy, University of Connecticut, Storrs, United
States
(Hernandez) Hartford Hospital Evidence-Based Practice Center, CT, United
States
Title
Radiographic and clinical brain infarcts in cardiac and diagnostic
procedures a systematic review and meta-analysis.
Source
Stroke. 48 (10) (pp 2753-2759), 2017. Date of Publication: October 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose: The incidence of periprocedural brain infarcts
varies among cardiovascular procedures. In a systematic review, we
compared the ratio of radiographic brain infarcts (RBI) to strokes and
transient ischemic attacks across cardiac and vascular procedures.
Methods: We searched MEDLINE and 5 other databases for brain infarcts in
aortic valve replacement, coronary artery bypass grafting, cardiac
catheterization, and cerebral angiogram through September 2015. We
followed the PRISMA (preferred reporting items for systematic reviews and
meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as
ratio of stroke plus transient ischemic attack rate to RBI rate. Results:
Twenty-nine studies involving 2124 subjects met the inclusion criteria. In
meta-analysis of aortic valve replacements with 494 people, 69.4% (95%
confidence interval (CI), 57.6%-81.4%) had RBIs, whereas 3.6% (95% CI,
2.0%-5.2%) had clinical events (RR, 0.08; 95% CI, 0.05-0.12). Coronary
artery bypass grafting among 204 patients had 27.4% (95% CI, 6.0%-48.8%)
RBIs and 2.4% (95% CI, 0.3%-4.5%) clinical events (RR, 0.11; 95% CI,
0.05-0.26). Cardiac catheterization among 833 people had 8.0% (95% CI,
4.1%-12.0%) RBIs, and 0.6% (95% CI, 0.1%-1.1%) had clinical events (RR,
0.16; 95% CI, 0.08-0.31). Cerebral angiogram among 593 people had 12.8%
(95% CI, 6.6-19.0) RBIs and 0.6% (95% CI, 0%-13%) clinical events (RR,
0.10; 95% CI, 0.04-0.27). The RR of all procedures was 0.10 (95% CI,
0.07-0.13) without differences in the RRs across procedures (P=0.29).
Conclusions: One of 10 people with periprocedural RBIs during cardiac
surgeries and invasive vascular diagnostic procedures resulted in strokes
or transient ischemic attacks, which may serve as a potential surrogate
marker of procedural proficiency and perhaps as a predictor of risk for
periprocedural strokes.<br/>Copyright &#xa9; 2017 American Heart
Association, Inc.

<10>
[Use Link to view the full text]
Accession Number
621681966
Author
Weimar C.; Bilbilis K.; Rekowski J.; Holst T.; Beyersdorf F.; Breuer M.;
Dahm M.; Diegeler A.; Kowalski A.; Martens S.; Mohr F.W.; Ondrasek J.;
Reiter B.; Roth P.; Seipelt R.; Siggelkow M.; Steinhoff G.; Moritz A.;
Wilhelmi M.; Wimmer-Greinecker G.; Diener H.-C.; Jakob H.; Ose C.; Scherag
A.; Knipp S.C.
Institution
(Weimar, Diener) Department of Neurology, University Hospital Essen,
Hufelandstrasse 55, Essen 45122, Germany
(Bilbilis, Ose) Universitatsklinikum Essen, Zentrum fur Klinische Studien
(ZKSE), Germany
(Rekowski) Universitatsklinikum Essen, Institut fur Medizinische
Informatik, Biometrie und Epidemiologie (IMIBE), Germany
(Holst, Jakob, Knipp) Universitatsklinikum Essen, Klinik fur Thorax- und
Kardiovaskulare Chirurgie, Germany
(Beyersdorf) Universitats-Herzzentrum Freiburg-Bad Krozingen, Klinik fur
Herz- und Gefaschirurgie, Germany
(Breuer) Universitatsklinikum Jena, Klinik fur Herz- und Thoraxchirurgie,
Jena, Germany
(Breuer) Zentralklinik Bad Berka, Germany
(Dahm) Westpfalz-Klinikum, Klinik fur Thorax-, Herz- und Gefaschirurgie,
Kaiserslautern, Germany
(Diegeler) Herzund Gefasklinik Bad Neustadt/Saale, Klinik fur
Kardiochirurgie, Bad Neustadt an der Saale, Germany
(Kowalski, Siggelkow) Universitatsklinikum Schleswig-Holstein, Campus
Kiel, Klinik fur Herz- und Gefaschirurgie, Kiel, Germany
(Martens) Universitatsklinikum Munster, Klinik fur Herzchirurgie, Germany
(Mohr) Herzzentrum Leipzig, Universitatsklinik, Klinik fur Herzchirurgie,
Leipzig, Germany
(Ondrasek) Centrum Kardiovaskularni a Transplantacni Chirurgie, Brno,
Czech Republic
(Reiter) Universitares Herzzentrum Hamburg, Klinik und Poliklinik fur
Herz- und Gefaschirurgie, Germany
(Roth) Universitatsklinikum Giesen und Marburg, Herz-, Kinderherz- und
Gefaschirurgie, Giessen, Germany
(Seipelt) Universitatsmedizin Gottingen, Abteilung fur Thorax-,Herz und
Gefaschirurgie, Gottingen, Germany
(Seipelt) SHG Kliniken Volklingen, Klinik fur Herz- und Thoraxchirurgie,
Volklingen, Germany
(Siggelkow) Imland Klinik, Gefas- und Thoraxchirurgie, Rendsburg, Germany
(Steinhoff) Universitat Rostock, Klinik und Poliklinik fur Herzchirurgie,
Germany
(Moritz) Johann Wolfgang-Goethe-Universitat, Klinik fur Thorax-, Herz- und
thorakale Gefaschirurgie, Frankfurt, Germany
(Wilhelmi) Medizinische Hochschule Hannover, Klinik fur Herz-, Thorax-,
Transplantations- und Gefaschirurgie, Hannover, Germany
(Wimmer-Greinecker) Herz- und Gefaszentrum Bad Bevensen, Klinik fur
Herz-Thorax-Chirurgie, Bad Bevensen, Germany
(Scherag) Universitatsklinikum Jena, Klinische Epidemiologie, Center for
Sepsis Control and Care (CSCC), Germany
Title
Safety of simultaneous coronary artery bypass grafting and carotid
endarterectomy versus isolated coronary artery bypass grafting a
randomized clinical trial.
Source
Stroke. 48 (10) (pp 2769-2775), 2017. Date of Publication: October 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose: The optimal operative strategy in patients with
severe carotid artery disease undergoing coronary artery bypass grafting
(CABG) is unknown. We sought to investigate the safety and efficacy of
synchronous combined carotid endarterectomy and CABG as compared with
isolated CABG. Methods: Patients with asymptomatic high-grade carotid
artery stenosis >=80% according to ECST (European Carotid Surgery Trial)
ultrasound criteria (corresponding to >=70% NASCET [North American
Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were
randomly assigned to synchronous carotid endarterectomy+CABG or isolated
CABG. To avoid unbalanced prognostic factor distributions, randomization
was stratified by center, age, sex, and modified Rankin Scale. The primary
composite end point was the rate of stroke or death at 30 days. Results:
From 2010 to 2014, a total of 129 patients were enrolled at 17 centers in
Germany and the Czech Republic. Because of withdrawal of funding after
insufficient recruitment, enrolment was terminated early. At 30 days, the
rate of any stroke or death in the intention-to-treat population was 12/65
(18.5%) in patients receiving synchronous carotid endarterectomy+CABG as
compared with 6/62 (9.7%) in patients receiving isolated CABG (absolute
risk reduction, 8.8%; 95% confidence interval, -3.2% to 20.8%;
P<inf>WALD</inf>=0.12). Also for all secondary end points at 30 days and 1
year, there was no evidence for a significant treatment-group effect
although patients undergoing isolated CABG tended to have better outcomes.
Conclusions: Although our results cannot rule out a treatment-group effect
because of lack of power, a superiority of the synchronous combined
carotid endarterectomy+CABG approach seems unlikely. Five-year follow-up
of patients is still ongoing.<br/>Copyright &#xa9; 2017 The Author(s).

<11>
Accession Number
621774603
Author
Villablanca P.A.; Mohananey D.; Ramakrishna H.
Institution
(Villablanca) Department of Cardiovascular MedicineNew York UniversityNew
York, New York
(Mohananey) Department of Hospital MedicineCleveland ClinicCleveland, Ohio
(Ramakrishna) Department of AnesthesiologyMayo ClinicScottsdale, Arizona
Title
Comparison of local versus general anesthesia in patients undergoing
transcatheter aortic valve replacement: An updated meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)

<12>
Accession Number
621774423
Author
Jahnukainen T.; Keski-Nisula J.; Tainio J.; Valkonen H.; Patila T.;
Jalanko H.; Suominen P.
Institution
(Jahnukainen, Tainio, Jalanko) Department of Pediatric Nephrology and
Transplantation Children's Hospital University of Helsinki and Helsinki
University Hospital Helsinki Finland
(Keski-Nisula, Valkonen, Suominen) Department of Anesthesia and Intensive
Care Children's Hospital University of Helsinki and Helsinki University
Hospital Helsinki Finland
(Patila) Department of Pediatric Surgery Children's Hospital University of
Helsinki and Helsinki University Hospital Helsinki Finland
(Suominen) Deceased 9 January 2018
Title
Efficacy of corticosteroids in prevention of acute kidney injury in
neonates undergoing cardiac surgery-A randomized controlled trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Heart surgery requiring cardiopulmonary bypass (CPB) causes an
inflammatory response which may further induce acute kidney injury (AKI).
In the present randomized controlled study we evaluated whether
corticosteroids can prevent CPB related AKI in neonates undergoing heart
surgery. Methods: Forty neonates were randomized to receive 2 mg/kg
methylprednisolone followed by hydrocortisone infusion 0.2 mg/kg/h
perioperatively with tapering doses for 5 days, or placebo administered in
a similar fashion. The primary outcome was the inflammatory response
(plasma concentrations of interleukins 6 and 10). The correspondence of
the interleukin concentrations with AKI was analysed as secondary outcome.
In addition, plasma and urine neutrophil gelatinase-associated lipocalin
(NGAL), plasma cystatin C, and urine kidney injury molecule-1 (KIM-1)
levels were measured. Results: Six patients (15%) developed post-operative
AKI. No significant difference in the AKI occurrence between the treatment
(n = 2) and the placebo (n = 4) groups could be found (risk ratio 2.00,
95% confidence interval 0.41-9.71; P = .661) despite significant reduction
in inflammatory response in the treatment group. One patient in the
treatment group and two patients in the placebo group required acute
peritoneal dialysis. Plasma creatinine and cystatin C or urine NGAL and
KIM-1 concentrations did not differ between the treatment and the placebo
group. Conclusions: Significantly reduced inflammatory reaction induced by
corticosteroid treatment in neonates undergoing cardiac surgery did not
reduce the incidence of AKI defined by KDIGO classification or decrease
the rise of AKI biomarkers.<br/>Copyright &#xa9; 2018 The Acta
Anaesthesiologica Scandinavica Foundation.

<13>
Accession Number
621774379
Author
Unolt M.; Versacci P.; Anaclerio S.; Lambiase C.; Calcagni G.; Trezzi M.;
Carotti A.; Crowley T.B.; Zackai E.H.; Goldmuntz E.; Gaynor J.W.; Digilio
M.C.; Mcdonald-Mcginn D.M.; Marino B.
Institution
(Unolt, Versacci, Anaclerio, Lambiase, Marino) Department of Pediatrics
and Pediatric Neuropsychiatry Sapienza University of RomeRome Italy
(Calcagni, Trezzi, Carotti) Department of Pediatric Cardiology and Cardiac
SurgeryBambino Gesu Pediatric HospitalRome Italy
(Crowley, Zackai, Mcdonald-Mcginn) Division of Human GeneticsThe
Children's Hospital of PhiladelphiaPhiladelphia, Pennsylvania
(Goldmuntz, Gaynor) The Cardiac Center, The Children's Hospital of
PhiladelphiaPhiladelphia, Pennsylvania
(Digilio) Division of Medical GeneticsBambino Gesu Pediatric HospitalRome,
Italy
Title
Congenital heart diseases and cardiovascular abnormalities in 22q11.2
deletion syndrome: From well-established knowledge to new frontiers.
Source
American Journal of Medical Genetics, Part A. (no pagination), 2018. Date
of Publication: 2018.
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Congenital heart diseases (CHDs) and cardiovascular abnormalities are one
of the pillars of clinical diagnosis of 22q11.2 deletion syndrome
(22q11.2DS) and still represent the main cause of mortality in the
affected children. In the past 30 years, much progress has been made in
describing the anatomical patterns of CHD, in improving their diagnosis,
medical treatment, and surgical procedures for these conditions, as well
as in understanding the underlying genetic and developmental mechanisms.
However, further studies are still needed to better determine the true
prevalence of CHDs in 22q11.2DS, including data from prenatal studies and
on the adult population, to further clarify the genetic mechanisms behind
the high variability of phenotypic expression of 22q11.2DS, and to fully
understand the mechanism responsible for the increased postoperative
morbidity and for the premature death of these patients. Moreover, the
increased life expectancy of persons with 22q11.2DS allowed the expansion
of the adult population that poses new challenges for clinicians such as
acquired cardiovascular problems and complexity related to multisystemic
comorbidity. In this review, we provide a comprehensive review of the
existing literature about 22q11.2DS in order to summarize the knowledge
gained in the past years of clinical experience and research, as well as
to identify the remaining gaps in comprehension of this syndrome and the
possible future research directions.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<14>
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.

<15>
Accession Number
621517543
Author
Gaudino M.; Alexander J.H.; Bakaeen F.G.; Ballman K.; Barili F.; Calafiore
A.M.; Davierwala P.; Goldman S.; Kappetein P.; Lorusso R.; Mylotte D.;
Pagano D.; Ruel M.; Schwann T.; Suma H.; Taggart D.P.; Tranbaugh R.F.;
Fremes S.
Institution
(Gaudino, Tranbaugh) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Alexander) Duke Clinical Research Institute, Duke Health, Durham, NC,
United States
(Bakaeen) Cleveland Clinic Foundation, Cleveland, OH, United States
(Ballman) Department of Biostatistics and Epidemiology, Weill Cornell
Medicine, New York, NY, United States
(Barili) Department of Cardiovascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
(Calafiore) Fondazione Giovanni Paolo II, Campobasso, Italy
(Davierwala) Herzzentrum Leipzig, Leipzig, Germany
(Goldman) Department of Medicine, University of Arizona, Tucson, AZ,
United States
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Lorusso) Maastricht University Medical Centre, Maastricht, Netherlands
(Mylotte) Galway University Hospitals, Galway, Ireland
(Pagano) University Hospital Birmingham, Birmingham, United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Schwann) The University of Toledo, Toledo, OH, United States
(Suma) Suma Heart Clinic, Tokyo, Japan
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Sunnybrook Health Science, University of Toronto, Toronto, ON,
Canada
Title
Randomized comparison of the clinical outcome of single versus multiple
arterial grafts: The ROMA trial-rationale and study protocol.
Source
European Journal of Cardio-thoracic Surgery. 52 (6) (pp 1031-1040), 2017.
Date of Publication: December 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The primary hypothesis of the ROMA trial is that in patients undergoing
primary isolated non-emergent coronary artery bypass grafting, the use of
2 or more arterial grafts compared with a single arterial graft (SAG) is
associated with a reduction in the composite outcome of death from any
cause, any stroke, post-discharge myocardial infarction and/or repeat
revascularization. The secondary hypothesis is that in these patients, the
use of 2 or more arterial grafts compared with a SAG is associated with
improved survival. The ROMA trial is a prospective, unblinded, randomized
event-driven multicentre trial comprising at least 4300 subjects. Patients
younger than 70 years with left main and/or multivessel disease will be
randomized to a SAG or multiple arterial grafts to the left coronary
system in a 1:1 fashion. Permuted block randomization stratified by the
centre and the type of second arterial graft will be used. The primary
outcome will be a composite of death from any cause, any stroke,
post-discharge myocardial infarction and/or repeat revascularization. The
secondary outcome will be all-cause mortality. The primary safety outcome
will be a composite of death from any cause, any stroke and any myocardial
infarction. In all patients, 1 internal thoracic artery will be
anastomosed to the left anterior descending coronary artery. For patients
randomized to the SAG group, saphenous vein grafts will be used for all
non-left anterior descending target vessels. For patients randomized to
the multiple arterial graft group, the main target vessel of the lateral
wall will be grafted with either a radial artery or a second internal
thoracic artery. Additional grafts for the multiple arterial graft group
can be saphenous veins or supplemental arterial conduits. To detect a 20%
relative reduction in the primary outcome, with 90% power at 5% alpha and
assuming a time-to-event analysis, the sample size must include 845 events
(and 3650 patients). To detect a 20% relative reduction in the secondary
outcome, with 80% power at 5% alpha, the sample size must include 631
events (and 3650 patients). To be conservative, the sample size will be
set at 4300 patients. The primary outcome will be tested according to the
intention-to-treat principle. The primary analysis will be a Cox
proportional hazards regression model, with the treatment arm included as
a covariate. If non-proportional hazards are observed, alternatives to Cox
proportional hazards regression will be explored.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<16>
Accession Number
617215622
Author
Krishnamoorthy B.; Critchley W.R.; Thompson A.J.; Payne K.; Morris J.;
Venkateswaran R.V.; Caress A.L.; Fildes J.E.; Yonan N.
Institution
(Krishnamoorthy, Venkateswaran, Yonan) Department of Cardiothoracic
Surgery, University Hospital of South Manchester NHS Foundation Trust,
Manchester M23 9LT, United Kingdom
(Morris) Department of Medical Statistics, University Hospital of South
Manchester NHS Foundation Trust, United Kingdom
(Krishnamoorthy, Critchley, Fildes) Manchester Collaborative Centre for
Inflammation Research, Faculty of Biology, Medicine and Health, University
of Manchester, United Kingdom
(Thompson, Payne) Manchester Centre for Health Economics, University of
Manchester, United Kingdom
(Caress) School of Nursing and Midwifery, University of Manchester, United
Kingdom
(Krishnamoorthy) Faculty of Health and Social Care, Edge Hill University,
Ormskirk, Lancashire, United Kingdom
Title
Study comparing vein integrity and clinical outcomes in open vein
harvesting and 2 types of endoscopic vein harvesting for coronary artery
bypass grafting: The VICO randomized clinical trial (vein integrity and
clinical outcomes).
Source
Circulation. 136 (18) (pp 1688-1702), 2017. Date of Publication: October
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Current consensus statements maintain that endoscopic vein
harvesting (EVH) should be standard care in coronary artery bypass graft
surgery, but vein quality and clinical outcomes have been questioned. The
VICO trial (Vein Integrity and Clinical Outcomes) was designed to assess
the impact of different vein harvesting methods on vessel damage and
whether this contributes to clinical outcomes after coronary artery bypass
grafting. METHODS: In this single-center, randomized clinical trial,
patients undergoing coronary artery bypass grafting with an internal
mammary artery and with 1 to 4 vein grafts were recruited. All veins were
harvested by a single experienced practitioner. We randomly allocated 300
patients into closed tunnel CO<inf>2</inf> EVH (n=100), open tunnel
CO<inf>2</inf> EVH (n=100), and traditional open vein harvesting (n=100)
groups. The primary end point was endothelial integrity and muscular
damage of the harvested vein. Secondary end points included clinical
outcomes (major adverse cardiac events), use of healthcare resources, and
impact on health status (quality-adjusted life-years). RESULTS: The open
vein harvesting group demonstrated marginally better endothelial integrity
in random samples (85% versus 88% versus 93% for closed tunnel EVH, open
tunnel EVH, and open vein harvesting; P<0.001). Closed tunnel EVH
displayed the lowest longitudinal hypertrophy (1% versus 13.5% versus 3%;
P=0.001). However, no differences in endothelial stretching were observed
between groups (37% versus 37% versus 31%; P=0.62). Secondary clinical
outcomes demonstrated no significant differences in composite major
adverse cardiac event scores at each time point up to 48 months. The
quality-adjusted life-year gain per patient was 0.11 (P<0.001) for closed
tunnel EVH and 0.07 (P=0.003) for open tunnel EVH compared with open vein
harvesting. The likelihood of being cost-effective, at a predefined
threshold of 20 000 per quality-adjusted life-year gained, was 75% for
closed tunnel EVH, 19% for open tunnel EVH, and 6% for open vein
harvesting. CONCLUSIONS: Our study demonstrates that harvesting techniques
affect the integrity of different vein layers, albeit only slightly.
Secondary outcomes suggest that histological findings do not directly
contribute to major adverse cardiac event outcomes. Gains in health status
were observed, and cost-effectiveness was better with closed tunnel EVH.
High-level experience with endoscopic harvesting performed by a dedicated
specialist practitioner gives optimal results comparable to those of open
vein harvesting.<br/>Copyright &#xa9; 2017 American Heart Association,
Inc.

<17>
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Accession Number
621749966
Author
Mousavi Malek N.; Zakerimoghadam M.; Esmaeili M.; Kazemnejad A.
Institution
(Mousavi Malek, Zakerimoghadam) School of Nursing and Midwifery, Tehran
University of Medical Sciences, Nosrat St Tohid Sq, Tehran, Iran, Islamic
Republic of
(Esmaeili) School of Nursing and Midwifery, Nursing and Midwifery Care
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Kazemnejad) Department of Biostatics, Tarbiat Modares University, Tehran,
Iran, Islamic Republic of
Title
Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep before
Coronary Artery Bypass Grafting.
Source
Critical Care Nursing Quarterly. 41 (2) (pp 161-169), 2018. Date of
Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study to examine the effects of supportive-educational
nurse-led intervention on the patients' anxiety and sleep before the
coronary artery bypass grafting. The current clinical trial recruited 160
patients (N = 160) waiting for the coronary artery bypass grafting by
random block sampling and divided them into two 80-people experimental and
control groups. Spielberger's State Anxiety Inventory was completed on the
first day. The Groningen's Sleep Quality Index was also completed by the
patients on the day of surgery. Data were analyzed in SPSS software
version 16, using descriptive and inferential statistics tests. The mean
anxiety score in the experimental group decreased to 48.39, whereas in the
control group, the mean anxiety score saw a rise after the intervention
(61.09). The comparison of the mean quality of sleep the night before the
surgery for both groups showed that sleep in the control group compared
with sleep in the experimental group had a lower quality, and
statistically, it was significant (P <.001). Results showed that
nonpharmacological and supportive interventions can reduce patients'
anxiety and sleep disturbance before the coronary artery bypass grafting.
According to the results, nonpharmacological therapies should be placed at
the top of nurses' tasks.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health,
Inc. All rights reserved.

<18>
Accession Number
2000680281
Author
Kawatsu S.; Sasaki K.; Sakatsume K.; Takahara S.; Hosoyama K.; Masaki N.;
Suzuki Y.; Hayatsu Y.; Yoshioka I.; Sakuma K.; Adachi O.; Akiyama M.;
Kumagai K.; Motoyoshi N.; Kawamoto S.; Saiki Y.
Institution
(Kawatsu, Sasaki, Sakatsume, Takahara, Hosoyama, Masaki, Suzuki, Hayatsu,
Yoshioka, Sakuma, Adachi, Akiyama, Kumagai, Motoyoshi, Kawamoto, Saiki)
Division of Cardiovascular Surgery, Tohoku University Graduate School of
Medicine, Sendai, Miyagi, Japan
Title
Predictors of Heparin Resistance Before Cardiovascular Operations in
Adults.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1316-1321), 2018. Date of
Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: Heparin resistance (HR) is often encountered during
cardiovascular operations that require cardiopulmonary bypass. Clinical
risk factors and the mechanism underlying heparin resistance are yet to be
determined. The aim of this study was to elucidate the clinically valid
preoperative predictors related to HR. Methods: The study evaluated 489
patients undergoing cardiovascular operations. Of these, 25 patients
presented with HR and received antithrombin III for the initiation of
cardiopulmonary bypass with an effective activated coagulation time. The
remaining 464 patients, who did not receive antithrombin III, served as
controls (NHR). Preoperative patient demographic and laboratory data were
analyzed to identify risk factors for HR. Results: The preoperative
laboratory data showed platelet count, fibrinogen, D-dimer, creatinine,
and C-reactive protein were significantly higher in the HR group than in
the NHR group. As expected, the antithrombin III level was significantly
lower overall in the HR group (86.0% vs 95.5%, p = 0.009); however, 80% of
the patients in the HR group showed normal antithrombin III levels
preoperatively. Multivariable logistic regression analysis identified
chronic aortic dissection, chronic obstructive pulmonary disease, smoking,
and elevated fibrinogen levels as independent predictors for HR.
Conclusions: HR was shown to be associated with preoperative high
fibrinogen levels, a smoking habit, and a preoperative diagnosis of
chronic, but not acute, aortic dissection, with chronic obstructive
pulmonary disease as comorbidity. Administration of antithrombin III
resolved HR in all of the affected patients, even when their preoperative
antithrombin III level was within the normal limit.<br/>Copyright &#xa9;
2018 The Society of Thoracic Surgeons

<19>
Accession Number
621761760
Author
Roever L.; Resende E.S.; Diniz A.L.D.; Penha-Silva N.; O'Connell J.L.;
Gomes P.F.S.; Zanetti H.R.; Roerver-Borges A.S.; Veloso F.C.; Fidale T.M.;
Casella-Filho A.; Dourado P.M.M.; Chagas A.C.P.; Ali-Hasan-Al-Saegh S.;
Reis P.E.O.; De Melo Pinto R.; Oliveira G.B.F.; Avezum A.; Neto M.; Duraes
A.; Lisboa Da Silva R.M.F.; Grande A.J.; Denardi C.; Lopes R.D.; Nerlekar
N.; Alizadeh S.; Hernandez A.V.; Biondi-Zoccai G.
Institution
(Roever, Resende, Diniz, Penha-Silva, O'Connell, Gomes, Zanetti,
Roerver-Borges, Veloso, Fidale, De Melo Pinto) Federal University of
Uberlandia, Department of Clinical Research, Heart Institute (InCor),
Master Institute of Education President Antonio Carlos, IMEPAC, Araguari,
Uberlandia, Minas Gerais, Brazil
(Zanetti) Department of Clinical Research, HCFMUSP-University of Sao Paulo
Medical School, Department of Cardiology, Sao Paulo, Brazil
(Casella-Filho, Dourado, Chagas) Faculty of Medicine ABC, Department of
Cardiology, Santo-Andre, Brazil
(Chagas) Cardiovascular Research Center, Shahid Sadoughi University of
Medical Sciences, Department of Cardiology, Yazd, Iran, Islamic Republic
of
(Ali-Hasan-Al-Saegh) Department of Specialized and General Surgery,
Fluminense Federal University, Rio de Janeiro, Brazil
(Reis) Dante Pazzanese Institute of Cardiology, Brazil
(Oliveira, Avezum) Dante Pazzanese Institute of Cardiology, Department of
Clinical Research, Sao Paulo, Brazil
(Neto, Duraes) Graduate Program in Medicine and Health, Department of
Heath and Sciences, Federal University of Bahia, Brazil
(Lisboa Da Silva) Federal University of Minas Gerais, Department of
Cardiology MG, Brazil
(Grande) Federal University of Mato Grosso, MT, Department of Medicine,
Brazil
(Denardi) FOP Unicamp, Department of Clinical Research, Division of
Cardiology, Duke University Medical Center, Department of Clinical
Research, Durham, NC, United States
(Lopes) Monash Cardiovascular Research Centre and MonashHeart, Department
of Cardiology, Clayton, VIC, Australia
(Nerlekar) Tehran University of Medical Sciences, Department of Medicine,
University of Connecticut/Hartford Hospital Evidence-Based Practice
Center, Hartford, United States
(Alizadeh) Department of Comparative Effectiveness and Outcomes Research
Health Outcomes, CT, United States
(Hernandez) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
Title
Statins in adult patients with HIV.
Source
Medicine (United States). 97 (15) (no pagination), 2018. Article Number:
e0116. Date of Publication: 01 Apr 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients with HIV have been found to suffer from lipid
abnormalities, including elevated levels of total and LDLcholesterol as
well as triglyceride levels. Abnormal lipid levels are associated with an
increased risk of developing cardiovascular diseases, which are
significant causes of mortality among the general population. Therefore,
the objective of the current study is to conduct a systematic review with
network meta-analysis to compare the effects of statins classes on HIV
patients. Methods: Randomized clinical trials (RCTs) and observational
studies published in English up to 31 December 2017, and which include
direct and/or indirect evidence, will be included. Studies will be
retrieved by searching four electronic databases and crossreferencing.
Dual selection and abstraction of data will occur. The primary outcome
will all-cause mortality, new event of acute myocardial infarction, stroke
(hemorrhagic and ischemic), hospitalization for acute coronary syndrome
and urgent revascularization procedures and cardiovascular mortality.
Secondary outcomes will be assessment of the differences in change of
total cholesterol (TC), low-density lipoprotein (LDL-C), apolipoprotein B
(ApoB), high density lipoprotein (HDL-C). Risk of bias will be assessed
using the Cochrane Risk of Bias assessment instrument for RCTs and the
Strengthening the Reporting of Observational Studies in Epidemiology
instrument for observational studies. Network meta-analysis will be
performed using multivariate random-effects meta-regression models. The
surface under the cumulative ranking curve will be used to provide a
hierarchy of statins that reduce cardiovascular mortality in HIV patients.
A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used
to assess the risk of bias in eligible RCTs. Results will be synthesized
and analyzed using network meta-analysis (NMA). Overall strength of the
evidence and publication bias will be evaluated. Subgroup and sensitivity
analysis will also be performed. ResultsandConclusion: Ethics approval was
not required for this study because it was based on published studies. The
results and findings of this study will be submitted and published in a
scientific peer-reviewed journal. The evidence will determine which
combination of interventions are most promising for current practice and
further investigation. Trial registration number: PROSPERO
(CRD42017072996). Abbreviations: AMI = acute myocardial infarction, ART =
antiretroviral therapy, CIs = confidence intervals, CV cardiovascular, HDL
= high-density lipoprotein, HIV = human immunodeficiency virus, LDL =
low-density lipoprotein, MD = mean difference, RCT = randomized clinical
trials, RR = risk ratio, WC = waist circumference.<br/>Copyright &#xa9;
2018 the Author(s). Published by Wolters Kluwer Health, Inc.

<20>
[Use Link to view the full text]
Accession Number
621761732
Author
Xue J.; Yao Y.; Liu L.
Institution
(Xue, Liu) Department of Orthopaedics, West China Hospital, Sichuan
University, No 37 in Road Guoxue, Chengdu 610041, China
(Yao) Department of Orthopaedics, PLA 452th Hospital, Chengdu, China
Title
Treatment of tuberculous aortic pseudoaneurysm associated with vertebral
tuberculosis.
Source
Medicine (United States). 97 (15) (no pagination), 2018. Article Number:
e0382. Date of Publication: 01 Apr 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Tuberculous aortic pseudoaneurysm associated with vertebral
tuberculosis is a rare disease but with very high mortality. We review the
literature and find 19 reports with 22 patients. Here we report three
cases with vertebral tuberculosis, who also have tuberculous
pseudoaneurysm of the aorta. These patients were treated by different
methods. We try to analyze the epidemiology, pathogenesis, presentation,
and management of this disease to find the best treatment. Patient
concerns: The patients presented with different symptoms such as pain
(chest, abdominal or back), fever, blood volume reduction or hemorrhagic
shock symptoms. Large mass also could be observed by imaging. In addition
to clinical manifestations, enhanced computed tomography or magnetic
resonance imaging could also help the diagnosis of this disease.
Diagnoses: Tuberculous aortic pseudoaneurysm associated with vertebral
tuberculosis. Interventions: Three patients were treated with
anti-tuberculosis(TB) drugs or combined with different sequences surgical
treatment: Case 1 refused to receive pseudoaneurysm surgery and only had
anti-TB drug treatment; Case 2 received thoracic spinal surgery first;
Case 3 received endovascular stent grafting. Outcomes: Two patients (case
1 and case 2) who refused to undergo aneurysm surgery died. The last
patient (case 3) underwent endovascular repair and antibiotic therapy for
tuberculosis, and the postoperative course was uneventful; the patient
recovered and survived. Lessons: Once the diagnosis of tuberculous
pseudoaneurysm is confirmed, surgical treatment should be provided
immediately combined with anti-tuberculosis drugs. The aim of the
treatment is to save lives, prevent relapse, and facilitate the return to
normal life, regardless of the size of the pseudoaneurysm. The
pseudoaneurysm should be treated first to prevent aneurysm rupture before
the vertebral tuberculosis surgery. Abbreviations: CRP = C-reactive
protein, CT = computed tomography, ESR = erythrocyte sedimentation rate,
MRI = magnetic resonance imaging, TB = tuberculosis, WBC = white blood
cell count.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<21>
Accession Number
621761102
Author
Gandhi H.; Sarvaia A.; Malhotra A.; Acharya H.; Shah K.; Rajavat J.
Institution
(Gandhi, Sarvaia, Rajavat) Department of Cardiac Anesthesia, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat 380 016,
India
(Malhotra) Department of Cardio Vascular and Thoracic Surgery, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
(Acharya, Shah) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
Title
Effects of glargine insulin on glycemic control in patients with diabetes
mellitus type II undergoing off-pump coronary artery bypass graft.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 167-172), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The prevalence of diabetes mellitus in patients requiring
coronary artery bypass grafting (CABG) is noticeably high (20%-30%). These
patients have inferior perioperative outcome, reduced long-term survival,
and high risk of recurrent episodes of angina. To improve perioperative
outcome surgical unit defined satisfactory glycemic control is desired
during this period. Hence, the aim of our study is to compare the efficacy
of glargine insulin combination with continuous human insulin infusion for
perioperative glycemic control in patients with diabetes undergoing CABG.
Materials and Methods: Fifty Patients, who were posted for off-pump CABG
with diabetes mellitus type II, were randomized in two group, Group I
normal saline + human insulin infusion during the perioperative period,
Group II (glargine group): Glargine + human insulin infusion during
perioperative period. Results: During surgery and in the postoperative
period, random blood sugar and human insulin requirement are significantly
higher in control group than glargine group. Other infection, step-up
antibiotics, intensive care unit (ICU) stay, and hospital stay were
significantly higher in control groups in postoperative period.
Conclusion: Our study results suggest that glargine effectively manages
blood glucose level with significantly greater control over postoperative
morbidity.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<22>
Accession Number
621761084
Author
Soliman R.; Ragheb A.
Institution
(Soliman) Department of Anesthesia, Cairo University, Egypt
(Soliman, Ragheb) Prince Sultan Cardiac Centre, Riyadh, Al-Hassa, Saudi
Arabia
(Ragheb) National Heart Institute, Cairo, Egypt
Title
Assessment of the effect of two regimens of milrinone infusion in
pediatric patients undergoing fontan procedure: A randomized study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 134-140), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to compare the effect of two different
regimens of milrinone on hemodynamics and oxygen saturation in pediatric
patients undergoing Fontan procedure. Design: This was a randomized study.
Setting: Cardiac centers. Patients: This study included 116 patients
undergoing Fontan procedure. Material and Methods: Group E: Milrinone was
started as infusion 0.5 mug/kg/min without a loading dose at the beginning
of cardiopulmonary bypass (CPB) followed by infusion 0.5-0.75 mug/kg/min
in the pediatric cardiac surgical intensive care unit (PSICU). Group L:
Milrinone was started as a loading dose 50 mug/kg over 10 min before
weaning from CPB followed by infusion 0.5-0.75 mug/kg/min in the PSICU.
Measurements: Heart rate, mean arterial blood pressure, central venous
pressure, transpulmonary pressure, cardiac index, pharmacological support,
lactate level, urine output, oxygen saturation, ICU, and hospital length
of stay. Main Results: There were no changes in the heart rate and mean
arterial blood pressure (P > 0.05). The increase in the postoperative
central venous pressure, transpulmonary pressure and lactate level was
lower in Group E than Group L (P < 0.05). The increase in the
postoperative cardiac index, oxygen saturation, and urine output was
higher in Group E than Group L (P < 0.05). The requirement for
pharmacological support was lower in the Group E (P < 0.05). The ICU and
hospital length of stay were shorter in the Group E than Group L (P <
0.05). Conclusion: Early use of milrinone during Fontan procedure
facilitated the weaning from CPB, decreased the elevation in the central
venous pressure, transpulmonary gradient pressure, and the requirement for
pharmacological support. Furthermore, it increased the cardiac index and
arterial oxygen saturation.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<23>
Accession Number
621761074
Author
Desai P.M.; Sarkar M.S.; Umbarkar S.R.
Institution
(Desai, Sarkar, Umbarkar) Department of Anesthesiology, Seth GS Medical
College and KEM Hospital, A703, Noopur Apartments, PG Rood, Malad West,
Mumbai, Maharashtra 400 064, India
Title
Prophylactic preoperative levosimendan for off-pump coronary artery bypass
grafting in patients with left ventricular dysfunction: Single-centered
randomized prospective study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 123-128), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Off-pump coronary artery bypass surgery (OPCAB) is often
complicated by hemodynamic instability, especially in patients with prior
left ventricular (LV) dysfunction and appropriate choice of inotrope plays
a vital role in perioperative management of these patients. Aim and
Objective: To study hemodynamic effects and immediate outcome of
prophylactic infusion of levosimendan in patients with the LV dysfunction
undergoing OPCAB surgery and whether this strategy helps in successful
conduct of OPCAB surgery. Materials and Methods: After Institutional
Ethics Committee approval, 60 patients posted for elective OPCAB surgery
were randomly divided into two groups (n = 30 each). Patients with the LV
ejection fraction <30% were included. Study group was started on injection
levosimendan (@ 0.1 mug/kg/min) in the previous night before surgery and
continued for 24 h including intraoperative period. Hemodynamic monitoring
included heart rate, invasive blood pressure, cardiac index (CI),
pulmonary capillary wedge pressure (PCWP), pulse oximetry, and arterial
blood gases with serum lactates at as T0 (baseline), T1 (15 min after
obtuse marginal and/or PDA anastomoses), T2 (at end of surgery), T3 (6 h
after surgery in Intensive Care Unit [ICU]), T4 (12 h after surgery), and
T5 (24 h after surgery in ICU). Vasopressor was added to maintain mean
arterial pressure >60 mmHg. Chi-square/Fisher's exact/Mid P exact test and
Student's t-tests were applied for categorical and continuous data.
Results: CI was greater and PCWP reduced significantly in Group L during
intraoperative and early postoperative period. Serum lactate concentration
was lower in patients pretreated with levosimendan. Incidence of
postoperative atrial fibrillation (POAF) (36.6 vs. 6.6%; P = 0.01), low
cardiac output syndrome (LCOS) (30% vs. 6%; P = 0.02), and acute kidney
injury (23.3% vs. 6.7%; P = 0.04) was less in Group L. Three patients
(10%) in control group required conversion to cardiopulmonary bypass (CPB)
as compared to none in the study group. There was no difference regarding
ICU or hospital stay and mortality in both groups. Conclusion:
Preoperative levosimendan helps in successful conduct of OPCAB and reduces
the incidence of LCOS, POAF, conversion to CPB, and requirement of
intra-aortic balloon pump.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<24>
Accession Number
621757027
Author
Kouerinis I.A.; Tolia M.; Zagouri F.; Nikolaou M.; Tsoukalas N.; Kyrgias
G.; Dimopoulos M.A.; Vlachopoulos C.; Karathanassis I.; Zoubouli C.K.;
Kokakis I.; Kouloulias V.; Triantafillou K.
Institution
(Kouerinis, Vlachopoulos, Karathanassis, Triantafillou) First Department
of Cardiothoracic Surgery, Hippokration University Hospital, Athens,
Greece
(Tolia, Kyrgias) University of Thessaly, School of Health Sciences,
Faculty of Medicine, Department of Radiotherapy, Biopolis, Larissa 41110,
Greece
(Zagouri, Dimopoulos) Department of Clinical Therapeutics, Alexandra
Hospital, Medical School, University of Athens, Athens, Greece
(Nikolaou) Department of Internal Medicine, Oncology Unit, Hippokration
University Hospital, Athens, Greece
(Tsoukalas) Oncology Clinic, 401 General Military Hospital, Athens, Greece
(Zoubouli) Department of Pathology, Hippokration Hospital, Athens, Greece
(Kokakis, Kouloulias) First Department of Radiology, Radiotherapy Unit,
Aretaieion University Hospital, Medical School of Athens, Greece
Title
Stage-II thymoma and emergency coronary artery bypass. To irradiate or not
to irradiate to avoid radiation induced vascular injury? Case report and
literature review.
Source
Journal of B.U.ON.. 22 (6) (pp 1385-1389), 2017. Date of Publication:
November-December 2017.
Publisher
Zerbinis Publications (E-mail: nasisath@gmail.com)
Abstract
Purpose: The purpose of this study was to present the controversial role
of adjuvant radiotherapy to a 72-year-old male patient with Masaoka stage
II thymoma and coronary artery bypass and to review the relevant
literature. Methods: The data were collected by relevant studies on PubMed
and EMBASE. Articles up to March 2017 were included. Results: Although the
radiation-induced vascular injury to the internal thoracic artery and its
suitability for grafting in a patient who is candidate for coronary artery
bypass is documented, the possible catastrophic effect of adjuvant
radiotherapy to existing grafts in a patient with prior bypass surgery has
not been fully investigated. Conclusion: The application of radiotherapy
in a patient with R0 stage II thymoma is currently considered of 2B level
of evidence but its potential occlusive effect to an underlying coronary
graft may dramatically affect the survival of the patient and accordingly
drop the level of evidence of its use.<br/>Copyright &#xa9; 2017 Zerbinis
Publications. All rights reserved.

<25>
Accession Number
621756065
Author
D'Journo X.B.; Falcoz P.-E.; Alifano M.; Le Rochais J.-P.; D'Annoville T.;
Massard G.; Regnard J.F.; Icard P.; Marty-Ane C.; Trousse D.; Doddoli C.;
Orsini B.; Edouard S.; Million M.; Lesavre N.; Loundou A.; Baumstarck K.;
Peyron F.; Honore S.; Dizier S.; Charvet A.; Leone M.; Raoult D.; Papazian
L.; Thomas P.A.
Institution
(D'Journo, Trousse, Doddoli, Orsini, Thomas) Service de Chirurgie
Thoracique, Chemin des Bourrely, Hopital Nord, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille cedex 20 13915,
France
(Falcoz, Massard) Service de Chirurgie Thoracique, Nouvel Hopital Civil,
Strasbourg University, Strasbourg, France
(Alifano, Regnard) Service de Chirurgie Thoracique, Hopital Cochin,
Assistance Publique Hopitaux de Paris, Paris Descartes University, Paris,
France
(Le Rochais, Icard) Service de Chirurgie Thoracique, Hopital de la cote de
Nacre, Caen University, Caen, France
(D'Annoville, Marty-Ane) Service de Chirurgie Thoracique, Hopital Arnaud
de Villeneuve, Montpellier University, Montpellier, France
(D'Journo, Doddoli, Edouard, Million, Leone, Raoult, Thomas) Unite de
Recherche sur les Maladies Infectieuses et Tropicales Emergentes
(URMITE),UM63, CNRS 7278, IRD 198 INSERM U1095, Institut
Hospitalo-Universitaire Mediterranee Infection, Marseille Aix-Marseille
Univ., Marseille, France
(Lesavre, Leone) Centre d'Investigation Clinique, Hopital Nord, Assistance
Publique Hopitaux de Marseille, Aix-Marseille University, Marseille,
France
(Loundou, Baumstarck) Unite d'aide methodologique, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Peyron, Honore) Service Clinique de Pharmacologie, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Dizier, Charvet, Leone) Service d'Anesthesie-Reanimation, Hopital Nord,
Assistance Publique Hopitaux de Marseille, Aix-Marseille University,
Marseille, France
(Papazian) Reanimation des Detresses Respiratoires et Infections Severes,
Hopital Nord, Assistance Publique Hopitaux de Marseille, Aix-Marseille
University, Marseille, France
Title
Oropharyngeal and nasopharyngeal decontamination with chlorhexidine
gluconate in lung cancer surgery: a randomized clinical trial.
Source
Intensive Care Medicine. (pp 1-10), 2018. Date of Publication: 18 Apr
2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Respiratory complications are the leading causes of morbidity and
mortality after lung cancer surgery. We hypothesized that oropharyngeal
and nasopharyngeal decontamination with chlorhexidine gluconate (CHG)
would be an effective method to reduce these complications as reported in
cardiac surgery. Methods: In this multicenter parallel-group randomized
double-blind placebo-controlled trial, we enrolled consecutive adults
scheduled for anatomical pulmonary resection for lung cancer.
Perioperative decontamination consisted in oropharyngeal rinse solution
(0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary
outcome measure was the proportion of patients requiring postoperative
invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome
measures included occurrence of respiratory and non-respiratory
healthcare-associated infections (HAIs) and outcomes within 90 days.
Results: Between July 2012 and April 2015, 474 patients were randomized.
Of them, 24 had their surgical procedure cancelled or withdrew consent.
The remaining 450 patients were included in a modified intention-to-treat
analysis: 226 were allocated to CHG and 224 to the placebo. Proportions of
patients requiring postoperative MV were not significantly different [CHG
14.2%; placebo 15.2%; relative risks (RRs) 0.93; 95% confidence interval
(CI) 0.59-1.45; P = 0.76]. Neither of the proportions of patients with
respiratory HAIs were different (CHG 13.7%; placebo 12.9%; RRs 1.06; 95%
CI 0.66-1.69; P = 0.81). The CHG group had significantly decreased
incidence of bacteremia, surgical-site infection and overall
Staphylococcus aureus infections. However, there were no significant
between-group differences for hospital stay length, change in tracheal
microbiota, postoperative antibiotic utilization and outcomes by day 90.
Conclusions: CHG decontamination decreased neither MV requirements nor
respiratory infections after lung cancer surgery. Additionally, CHG did
not change tracheal microbiota or postoperative antibiotic utilization.
Trial Registration: This study is registered on ClinicalTrials.gov, number
NCT01613365.<br/>Copyright &#xa9; 2018 Springer-Verlag GmbH Germany, part
of Springer Nature and ESICM

<26>
Accession Number
621755580
Author
Verdoia M.; Barbieri L.; Kedhi E.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita," Eastern Piedmont
University, Novara, Italy
(Barbieri) Presidio Ospedaliero S. Andrea, Vercelli, Italy
(Kedhi) Department of Cardiology, Isala Hospital, Zwolle, UMC St Radboud,
Nijmegen, the Netherlands
(Suryapranata) UMC St Radboud, Nijmegen, the Netherlands
Title
Percutaneous Versus Surgical Revascularization for Left Main or
Multivessel Coronary Artery Disease: Results From a Large-Scale
Meta-Analysis in the Era of Drug-Eluting Stents.
Source
Angiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The best treatment options for left main (LM) or multivessel coronary
disease (MVD) are still debated. We performed a meta-analysis of
randomized trials comparing percutaneous versus surgical revascularization
for LM or MVD. Primary end point was overall mortality. Secondary end
points were major adverse cardiovascular events, recurrent myocardial
infarction, repeated revascularization, or stroke. A total of 8 randomized
trials were included, involving 8694 patients, 50% undergoing percutaneous
coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality
was 8.2% with no difference for PCI versus coronary artery bypass grafting
(CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P
=.24, P for heterogeneity [P<inf>het</inf>] =.01). However, CABG was
slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P =.008,
P<inf>het</inf> =.14 for PCI) whereas noninferior for LM disease (OR [95%
CI] = 0.88 [0.60-1.29]; P =.50, P<inf>het</inf> =.10, P interaction =.03).
A similar benefit with CABG was also observed in terms of repeated
coronary revascularization, whereas PCI significantly reduced stroke. This
meta-analysis shows that surgical coronary revascularization still offers
advantages in survival and recurrent ischemic events compared to PCI using
drug-eluting stents (DES) in MVD although burdened by an increased risk of
stroke. In LM disease, CABG did not provide outcome benefits but was
associated with a higher risk of stroke compared to PCI. Additional
randomized trials are certainly needed with new-generation
DES.<br/>Copyright &#xa9; 2018, The Author(s) 2018.

<27>
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.

<28>
Accession Number
615878879
Author
Toikkanen V.; Rinne T.; Laurikka J.; Porkkala H.; Tarkka M.; Mennander A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Department of Cardiothoracic
Surgery, Heart Center, Tampere University Hospital and University of
Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, Tampere, Finland
Title
Pulmonary vascular resistance index during coronary artery bypass surgery
with aprotinin.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. 77 (5) (pp
315-320), 2017. Date of Publication: 04 Jul 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Low pulmonary vascular resistance index (PVRI) reflects favorable
redundant pulmonary circulation following coronary artery bypass grafting
with cardiopulmonary bypass surgery (CPB). This randomized study
investigated whether aprotinin given in different modalities impacts PVRI
after coronary artery bypass grafting. A total of 40 patients undergoing
coronary artery bypass grafting were randomized to four groups according
to aprotinin dose: (1) high dose, (2) early low dose, (3) late low dose,
and (4) without aprotinin. Oxygenation index, pulmonary shunt,
alveolar-arterial oxygen gradient and PVRI were determined. PVRI was
calculated as the transpulmonary pressure gradient divided by cardiac
index multiplied by 80. The results showed that PVRI remained relative low
in all patients provided aprotinin regardless of treatment dosage; PVRI
increased at 4 h after restarting ventilation after CPB in patients
without aprotinin as compared with aprotinin (266 +/- 137, 266 +/- 115,
244 +/- 86 vs. 386 +/- 121, dynes-s-cm^- ⁵,
respectively, p =.047). Elevated postoperative PVRI was predictive for
patients without aprotinin (AUC 0.668; SE 0.40; p <.0001; CI 0.590-0.746).
There were no statistical differences in oxygenation index, pulmonary
shunt or alveolar-arterial oxygen gradient between the groups. In
conclusion, aprotinin maintains a low PVRI in elective patients with
healthy lungs during CPB. We suggest that aprotinin maintains pulmonary
arterial endothelial integrity.<br/>Copyright &#xa9; 2017 Medisinsk
Fysiologisk Forenings Forlag (MFFF).

<29>
Accession Number
616517874
Author
Arroyo D.; Gendre G.; Schukraft S.; Kallinikou Z.; Muller O.; Baeriswyl
G.; Stauffer J.-C.; Goy J.-J.; Togni M.; Cook S.; Puricel S.
Institution
(Arroyo, Gendre, Schukraft, Kallinikou, Baeriswyl, Stauffer, Goy, Togni,
Cook, Puricel) Hospital & University Fribourg, Fribourg, Switzerland
(Muller) Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Title
Comparison of everolimus- and biolimus-eluting coronary stents with
everolimus-eluting bioresorbable vascular scaffolds: Two-year clinical
outcomes of the EVERBIO II trial.
Source
International Journal of Cardiology. 243 (pp 121-125), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Data from randomized controlled trials have shown that the
ABSORB BVS is non-inferior to Cobalt Chromium everolimus-eluting stents at
2 years. Methods & results The EVERBIO II trial (Comparison of Everolimus-
and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable
Vascular Scaffold) is a single-center, assessor-blind, randomized
controlled trial enrolling 240 patients with an allocation ration of 1:1:1
conducted at University and Hospital Fribourg, Switzerland. The studied
devices were an everolimus-eluting persistent polymer stent (EES), a
biolimus-eluting stent with bioabsorbable polymer (BES) and a fully
bioresorbable vascular scaffold (BVS). Clinical end points collected at 9
months, 12 months, and 2 years, were academic research consortium defined
composites, device thrombosis and target-vessel revascularization.
Clinical follow-up at 2 years was available in 96% (N = 77) of patients in
the EES group, in 100% (N = 80) in the BES and 99% (N = 77) in the BVS
group. The device-oriented composite end point of cardiac death,
target-vessel myocardial infarction and target-lesion revascularization
occurred in 13 (16%) patients treated with EES, in 7 (9%) patients treated
with BES and in 16 (21%) patients treated with BVS. There was no
significant difference when the metallic stents were compared to the BVS
(p = 0.12). There was one late scaffold thrombosis throughout the trial in
the BVS group, and no definite stent thrombosis in either EES or BES
treated patients. Conclusions The current analysis shows no significant
differences with regard to clinical outcomes at 2 years between BVS and
the best-in-class metallic DES. Event rates were numerically higher in
BVS-treated patients. However, when BVS were compared to BES alone, the
occurrence of device related adverse events was significantly
increased.<br/>Copyright &#xa9; 2017

<30>
Accession Number
616072832
Author
den Boer S.L.; du Marchie Sarvaas G.J.; Klitsie L.M.; van Iperen G.G.;
Tanke R.B.; Helbing W.A.; Backx A.P.C.M.; Rammeloo L.A.J.; Dalinghaus M.;
ten Harkel A.D.J.
Institution
(den Boer, Helbing, Dalinghaus) Departments of Pediatrics, Division of
Pediatric Cardiology, Sophia Children's Hospital, Erasmus University
Medical Center, Rotterdam, Netherlands
(du Marchie Sarvaas) Departments of Pediatrics, Division of Pediatric
Cardiology, Beatrix Children's Hospital, University Medical Center
Groningen, Groningen, Netherlands
(Klitsie, ten Harkel) Departments of Pediatrics, Division of Pediatric
Cardiology, Leiden University Medical Center, Leiden, Netherlands
(van Iperen) Departments of Pediatrics, Division of Pediatric Cardiology,
Wilhelmina Children's Hospital, University Medical Center Utrecht,
Utrecht, Netherlands
(Tanke) Departments of Pediatrics, Division of Pediatric Cardiology,
Radboud University Medical Center, Nijmegen, Netherlands
(Backx) Departments of Pediatrics, Division of Pediatric Cardiology, Emma
Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
(Rammeloo) Departments of Pediatrics, Division of Pediatric Cardiology,
Free University Medical Center, Amsterdam, Netherlands
Title
Distribution of strain patterns in children with dilated cardiomyopathy.
Source
Echocardiography. 34 (6) (pp 881-887), 2017. Date of Publication: June
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aimed to evaluate the predicting value of
quantitative and qualitative dyssynchrony parameters as assessed by
two-dimensional speckle tracking echocardiography (STE) on outcome in
children with dilated cardiomyopathy (DCM). Furthermore, the
reproducibility of these parameters was investigated. Background: In
previous studies in adults with heart failure, several dyssynchrony
parameters have been shown to be a valuable predictor of clinical outcome.
Methods: This multicenter, prospective study included 75 children with DCM
and 75 healthy age-matched controls. Using STE, quantitative (time to
global peak strain and parameters describing intraventricular time
differences) and qualitative dyssynchrony parameters (pattern analysis) of
the apical four-chamber, three-chamber, two-chamber views, and the short
axis of the left ventricle were assessed. Cox regression was used to
identify risk factors for the primary endpoints of death or heart
transplantation. Inter-observer and intra-observer variability were
described. Results: During a median of 21 months follow-up, 10 patients
(13%) reached an endpoint. Although quantitative dyssynchrony measures
were higher in patients as compared to controls, the inter-observer and
intra-observer variability were high. Pattern analysis showed mainly
reduced strain, instead of dyssynchronous patterns. Conclusions: In this
study, quantitative dyssynchrony parameters were not reproducible,
precluding their use in children. Qualitative pattern analysis showed
predominantly reduced strain, suggesting that in children with DCM
dyssynchrony may be a minor problem.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<31>
Accession Number
616204717
Author
Guerrero Orriach J.L.; Galan Ortega M.; Ramirez Fernandez A.; Ramirez
Aliaga M.; Moreno Cortes M.I.; Ariza Villanueva D.; Florez Vela A.;
Alcaide Torres J.; Santiago Fernandez C.; Matute Gonzalez E.; Alsina
Marcos E.; Escalona Belmonte J.J.; Rubio Navarro M.; Garrido Sanchez L.;
Cruz Manas J.
Institution
(Guerrero Orriach, Galan Ortega, Ramirez Fernandez, Ramirez Aliaga, Moreno
Cortes, Ariza Villanueva, Florez Vela, Escalona Belmonte, Rubio Navarro,
Cruz Manas) Department of Cardio-Anaesthesiology, University Hospital
Virgen de la Victoria, Malaga, Spain
(Guerrero Orriach) Instituto de Investigaciones Biomedicas de Malaga
(IBIMA), University Hospital Virgen de la Victoria, Malaga, Spain
(Alcaide Torres, Santiago Fernandez) CIBER Unidad de Gestion Clinica de
Endocrinologia y Nutricion, Malaga, Spain
(Matute Gonzalez) Department of Anesthesia, Hospital Universitario Sanitas
La Moraleja, Spain
(Alsina Marcos) Department of Anesthesia, Hospital Universitario La Paz,
Madrid, Spain
(Garrido Sanchez) CIBER Fisiologia de la Obesidad y Nutricion (CIBEROBN),
Instituto de Salud Carlos III, Malaga, Spain
(Garrido Sanchez) Unidad de Gestion Clinica de Endocrinologia y Nutricion,
Spain
Title
Cardioprotective efficacy of sevoflurane vs. propofol during induction
and/or maintenance in patients undergoing coronary artery
revascularization surgery without pump: A randomized trial.
Source
International Journal of Cardiology. 243 (pp 73-80), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose Pre and post-operative administration of sevoflurane in myocardial
revascularization surgery provides enhanced cardioprotective effects
exerted by pharmacologic pre- and post-conditioning, as compared to
propofol. The identification of the enzymes involved in conditioning
mechanisms is crucial to the understanding of the effects of sevoflurane
in cardiac surgery patients. The impact of sevoflurane on another crucial
target organ-the kidney-was also assessed. Methods Ninety patients
undergoing off-pump myocardial revascularization surgery were allocated to
receive either intra- and postoperative sevoflurane (SS), intraoperative
sevoflurane and postoperative propofol (SP), or intra- and postoperative
propofol (PP)). Troponin I and hemodynamic parameters were monitored
during the first 48 postoperative hours; blood and urine samples were
collected at baseline and at 24 h to determine Akt, ERK1/2, PKG, iNO,
bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. Results The
enzymes were overexpressed in the SS group, remained unchanged in the SP
group, and decreased in the PP group. Renal function was best preserved in
the SS group. Conclusions The overexpression of enzymes induced by
intraoperative anesthesia and postoperative sedation with sevoflurane
reduces myocardial damage and improves renal function in patients
undergoing off-pump myocardial revascularization surgery.<br/>Copyright
&#xa9; 2017

<32>
Accession Number
609133179
Author
Morgan C.T.; Manlhiot C.; McCrindle B.W.; Dipchand A.I.
Institution
(Morgan, Manlhiot, McCrindle, Dipchand) Labatt Family Heart Centre,
Department of Pediatrics, Hospital for Sick Children, University of
Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
Title
Outcome, incidence and risk factors for stroke after pediatric heart
transplantation: An analysis of the International Society for Heart and
Lung Transplantation Registry.
Source
Journal of Heart and Lung Transplantation. 35 (5) (pp 597-602), 2016. Date
of Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background In the registry of the International Society for Heart and Lung
Transplantation (ISHLT), cerebrovascular accidents are the fifth most
common cause for mortality after pediatric heart transplantation (PHTx),
but details are lacking in the literature. The purpose of this analysis of
the ISHLT registry was to determine the prevalence, risk factors and
outcomes of stroke after PHTx. Methods Data from the ISHLT registry (1998
to 2010) were used to identify all patients whose primary transplantation
was performed at <18 years of age. Of the 10,441 transplants reviewed,
9,837 primary transplants and 604 retransplants were analyzed. Results
Three hundred thirty-three (3%) patients had a stroke after PHTx; 54% were
male, median age at PHTx was 6 years (0 to 17 years), and 44% had a
diagnosis of congenital heart disease (CHD). Freedom from stroke was 99%
at 1 month, 97% at 5 years, 95% at 10 years and 91% at 20 years post-PHTx.
After a stroke, survival at 1 month, 1 year and 5 years was 83%, 69% and
55%, respectively. Multivariable independent risk factors for stroke
included a primary diagnosis of congenital heart disease [hazard ratio
(HR) 1.4 (1.1 to 1.7), p = 0.01], previous stroke [HR 4.5 (3.2 to 6.2), p
< 0.001], history of aborted sudden death [HR 1.5 (1.1 to 2), p = 0.01],
ventricular assist device [HR 1.5 (1.1 to 2.2), p = 0.03] or
extracorporeal membrane oxygenation [HR 1.7 (1.2 to 2.2), p = 0.01],
post-operative dialysis [HR 3.3 (2.3 to 4.7), p < 0.001], infection
requiring antibiotics before discharge [HR 1.9 (1.4 to 2.5), p < 0.001],
pacemaker implantation [HR 1.6 (1 to 2.5), p = 0.04] or drug-treated
hypertension [HR 1.4 (1.1 to 1.8), p = 0.003] during follow-up.
Conclusions Stroke after pediatric heart transplantation is associated
with increased mortality. Congenital heart disease and mechanical support
both portend greater risk, in addition to markers of increased pre- and
post-transplant medical acuity.<br/>Copyright &#xa9; 2016 International
Society for Heart and Lung Transplantation.

<33>
Accession Number
608518396
Author
Cuenca S.; Ruiz-Cano M.J.; Gimeno-Blanes J.R.; Jurado A.; Salas C.;
Gomez-Diaz I.; Padron-Barthe L.; Grillo J.J.; Vilches C.; Segovia J.;
Pascual-Figal D.; Lara-Pezzi E.; Monserrat L.; Alonso-Pulpon L.;
Garcia-Pavia P.
Institution
(Cuenca, Segovia, Alonso-Pulpon, Garcia-Pavia) Heart Failure and Inherited
Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario
Puerta de Hierro, Manuel de Falla 2, Majadahonda, Madrid 28222, Spain
(Ruiz-Cano, Jurado) Heart Failure and Heart Transplantation Unit,
Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid,
Spain
(Gimeno-Blanes, Pascual-Figal) Department of Cardiology, Hospital
Universitario Virgen de la Arrixaca, Murcia, Spain
(Salas) Department of Pathology, Hospital Universitario Puerta de Hierro,
Madrid, Spain
(Gomez-Diaz, Monserrat) Health in Code, A Coruna, Spain
(Padron-Barthe, Lara-Pezzi, Garcia-Pavia) Myocardial Biology Programme,
Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
(Grillo) Department of Cardiology, Hospital Universitario Nuestra Senora
de Candelaria, Tenerife, Spain
(Vilches) Department of Immunology, Hospital Universitario Puerta de
Hierro, Madrid, Spain
Title
Genetic basis of familial dilated cardiomyopathy patients undergoing heart
transplantation.
Source
Journal of Heart and Lung Transplantation. 35 (5) (pp 625-635), 2016. Date
of Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Dilated cardiomyopathy (DCM) is the most frequent cause of
heart transplantation (HTx). The genetic basis of DCM among patients
undergoing HTx has been poorly characterized. We sought to determine the
genetic basis of familial DCM HTx and to establish the yield of modern
next generation sequencing (NGS) technologies in this setting. Methods
Fifty-two heart-transplanted patients due to familial DCM underwent NGS
genetic evaluation with a panel of 126 genes related to cardiac conditions
(59 associated with DCM). Genetic variants were initially classified as
pathogenic mutations or as variants of uncertain significance (VUS). Final
pathogenicity status was determined by familial cosegregation studies.
Results Initially, 24 pathogenic mutations were found in 21 patients
(40%); 25 patients (48%) carried 19 VUS and 6 (12%) did not show any
genetic variant. Familial evaluation of 220 relatives from 36 of the 46
families with genetic variants confirmed pathogenicity in 14 patients and
allowed reclassification of VUS as pathogenic in 17 patients, and as
non-pathogenic in 3 cases. At the end of the study, the DCM-causing
mutation was identified in 38 patients (73%) and 5 patients (10%) harbored
only VUS. No genetic variants were identified in 9 cases (17%).
Conclusions The genetic spectrum of familial DCM patients undergoing HTx
is heterogeneous and involves multiple genes. NGS technology plus detailed
familial studies allow identification of causative mutations in the vast
majority of familial DCM cases. Detailed familial studies remain critical
to determine the pathogenicity of underlying genetic defects in a
substantial number of cases.<br/>Copyright &#xa9; 2016 International
Society for Heart and Lung Transplantation.

<34>
Accession Number
604343874
Author
Casey A.; Itrakjy A.; Birkett C.; Clethro A.; Bonser R.; Graham T.;
Mascaro J.; Pagano D.; Rooney S.; Wilson I.; Nightingale P.; Crosby C.;
Elliott T.
Institution
(Casey, Elliott) Department of Clinical Microbiology, University Hospitals
Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham,
Edgbaston, Birmingham, United Kingdom
(Itrakjy, Birkett, Clethro, Bonser, Graham, Mascaro, Pagano, Rooney,
Wilson) Department of Cardiothoracic Surgery, University Hospitals
Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham,
Edgbaston, Birmingham, United Kingdom
(Nightingale) Wolfson Computer Laboratory, University Hospitals Birmingham
NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, United Kingdom
(Crosby) CareFusion Corporation, San Diego, CA, United States
Title
A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5%
w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest
of the long saphenous vein used in coronary artery bypass grafting.
Source
American Journal of Infection Control. 43 (8) (pp 816-820), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Chlorhexidine gluconate (CHG) is often recommended for skin
antisepsis; however, the most efficacious concentration is currently
unclear. Our objective was to compare the efficacy of 70% isopropyl
alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin
preparation in patients undergoing coronary artery bypass grafting.
Methods One hundred patients were randomized to 1 of the 2 CHG
concentrations. The designated antiseptic was applied to the skin of the
operative site of patients before long saphenous vein harvest. Bacterial
counts on the skin incision site were determined at various time points to
assess any immediate and persistent antimicrobial activity. The number of
patients developing surgical site infection was also determined. Results
The total numbers of microorganisms on the skin 2 minutes after skin
antisepsis and after wound closure was lower with 2% CHG/70% IPA compared
with 0.5% CHG/70% IPA (P =.033 and P =.016, respectively). Six of 41
patients in the 0.5% CHG/70%IPA group developed a superficial surgical
site infection compared with 2 of 44 patients in the 2% CHG/70% IPA group
(relative risk, 3.22; 95% confidence interval, 0.63-22.75; P =.147).
Conclusions Isopropyl alcohol (70%) containing 2% CHG compared with 0.5%
CHG reduces the number of microorganisms detectable on a surgical
patient's skin perioperatively.<br/>Copyright &#xa9; 2015 Association for
Professionals in Infection Control and Epidemiology, Inc.

<35>
Accession Number
621555172
Author
Choi J.W.; Jang M.-J.; Kim K.H.; Hwang H.Y.
Institution
(Choi, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Title
Repair versus replacement for the surgical correction of tricuspid
regurgitation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 748-755), 2018.
Date of Publication: 01 Apr 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage
in preserving right ventricular function and disadvantages such as a
higher risk of repair failure in the long-term compared with tricuspid
valve replacement (TVR). This study was conducted to compare the results
of TVr with those of TVR to find an optimal treatment option. METHODS: A
literature search of 5 databases was performed. The primary outcome was
all-cause mortality. Secondary outcomes were tricuspid reoperation and
valve-related events. Subgroup analyses were performed according to the
risk of bias, year of publication and proportions of patients with
tricuspid regurgitation Grade >= 3, functional aetiology and isolated
tricuspid valve surgery. Publication bias was explored using the funnel
plot and Egger's test. RESULTS: Seventeen retrospective studies involving
4561 patients (TVr group = 3432 patients and TVR group = 1129 patients)
were included. A pooled analysis showed that the risk of all-cause
mortality was significantly higher in the TVR group than in the TVr group
[hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no
significant differences in tricuspid valve reoperation in 6 studies and
valve-related events in 5 studies between the TVR and TVr groups [hazard
ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91- 2.38),
respectively]. None of the subgroup analyses demonstrated a significant
difference in the hazard ratio of all-cause mortality. No publication bias
was identified for the primary and secondary outcomes. CONCLUSIONS: This
meta-analysis indicates that TVr is more beneficial compared with TVR in
terms of all-cause mortality. From the available data, TVr is not
associated with an increased risk of tricuspid reoperation compared with
TVR.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<36>
Accession Number
621555156
Author
Drury N.E.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.; Barron
D.J.; Jones T.J.
Institution
(Drury, Patel, Oswald, Stickley, Barron, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United
Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Title
Randomized controlled trials in children's heart surgery in the 21st
century: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 724-731), 2018.
Date of Publication: 01 Apr 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Randomized controlled trials are the gold standard for
evaluating health care interventions, yet are uncommon in children's heart
surgery. We conducted a systematic review of clinical trials in paediatric
cardiac surgery to evaluate the scope and quality of the current
international literature. METHODS: We searched MEDLINE, CENTRAL and
LILACS, and manually screened retrieved references and systematic reviews
to identify all randomized controlled trials reporting the effect of any
intervention on the conduct or outcomes of heart surgery in children
published in any language since January 2000; secondary publications and
those reporting inseparable adult data were excluded. Two reviewers
independently screened studies for eligibility and extracted data; the
Cochrane Risk of Bias tool was used to assess for potential biases.
RESULTS: We identified 333 trials from 34 countries randomizing 23 902
children. Most were early phase (313, 94.0%), recruiting few patients
(median 45, interquartile range 28-82), and only 11 (3.3%) directly
evaluated a surgical intervention. One hundred and nine (32.7%) trials
calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51
(15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring
Committee. The overall risk of bias was low in 22 (6.6%), high in 69
(20.7%) and unclear in 242 (72.7%). CONCLUSIONS: The recent literature in
children's heart surgery contains few late-phase clinical trials. Most
trials did not conform to the accepted standards of reporting, and the
overall risk of bias was low in few studies. There is a need for
high-quality, multicentre clinical trials to provide a robust evidence
base for contemporary paediatric cardiac surgical practice.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<37>
Accession Number
618878302
Author
van Dongen I.M.; Elias J.; Meijborg V.M.F.; De Bakker J.M.T.; Limpens J.;
Conrath C.E.; Henriques J.P.S.
Institution
(van Dongen, Elias, Meijborg, De Bakker, Conrath, Henriques) Department of
Cardiology, Academic Medical Center Amsterdam, Netherlands
(Limpens) Medical Library, Academic Medical Center Amsterdam, Netherlands
Title
Electrocardiographic changes after successful recanalization of a chronic
total coronary occlusion. A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 221-228), 2018. Date
of Publication: March 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Observational studies suggest that in patients with a CTO
successful recanalization is associated with better clinical outcome. This
could be related to a reduction in the occurrence of arrhythmias, which
may result from modifications of the hibernating myocardium in a CTO
region. Methods and results: We aimed to evaluate the effect of CTO PCI on
electrophysiological parameters, and conducted a systematic review and
meta-analysis according to the PRISMA guidelines. MEDLINE and EMBASE were
searched. Titles and abstracts identified by the search strategy were
independently screened by two investigators. Data were extracted and used
for meta-analyses where possible. In total, eight studies incorporating
467 patients were included in this review, evaluating the effect of
successful CTO PCI on various ECG parameters. Three studies showed a
significant decrease in mean QT dispersion of 17.46 ms [95% CI
10.62-24.30] after successful CTO PCI. QTc dispersion also decreased
significantly, with a mean decrease of 18.74 ms [95% CI 11.53-25.94]. In
one trial a significant decrease in Tp-e interval in leads V2 and V5, and
a significant decrease in Tp-e/QT ratio in leads V2 and V5 post-CTO PCI
were observed. Conclusions: This first systematic review and meta-analysis
suggests that successful CTO PCI is associated with an immediate decrease
in ECG parameters that reflect heterogeneity in depolarization and
repolarization, which could lead to a reduction in the risk for
ventricular arrhythmias and sudden cardiac death. We raise the hypothesis
that hibernating myocardium in a CTO region may not be as deeply "in
sleep" as one would assume.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<38>
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.

<39>
Accession Number
2000586564
Author
Pinho-Gomes A.-C.; Azevedo L.; Ahn J.-M.; Park S.-J.; Hamza T.H.; Farkouh
M.E.; Serruys P.W.; Milojevic M.; Kappetein A.P.; Stone G.W.; Lamy A.;
Fuster V.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences (MEDCIDS) & Centre for Health Technology and Services
Research (CINTESIS), Faculty of Medicine, Porto University, Porto,
Portugal
(Ahn, Park) Asan Medical Center, University of Ulsan College of Medicine,
Ulsan, South Korea
(Hamza) New England Research Institutes, Watertown, Massachusetts, United
States
(Farkouh) Peter Munk Cardiac Centre and Heart & Stroke/Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
(Serruys, Milojevic) Imperial College of London, London, United Kingdom
(Kappetein) Department of Thoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Stone) The New York Presbyterian Hospital, Columbia University Medical
Center, Cardiovascular Research Foundation, New York, New York, United
States
(Lamy) Department of Surgery, Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Fuster) Mount Sinai Cardiovascular Institute, New York, New York, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
Title
Compliance With Guideline-Directed Medical Therapy in Contemporary
Coronary Revascularization Trials.
Source
Journal of the American College of Cardiology. 71 (6) (pp 591-602), 2018.
Date of Publication: 13 February 2018.
Publisher
Elsevier USA
Abstract
Background: Despite the well-established benefits of secondary
cardiovascular prevention, the importance of concurrent medical therapy in
clinical trials of coronary revascularization is often overlooked.
Objectives: The goal of this study was to assess compliance with
guideline-directed medical therapy (GDMT) in clinical trials and its
potential impact on the comparison between percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG). Methods:
The Cochrane Central Register of Controlled Trials and MEDLINE were
searched from 2005 to August 2017. Clinical trial registries and reference
lists of relevant studies were also searched. Randomized controlled trials
comparing PCI with drug-eluting stents versus CABG and reporting medical
therapy after revascularization were included. The study outcome was
compliance with GDMT, defined as the following: 1) any antiplatelet agent
plus beta-blocker plus statin (GDMT1); and 2) any antiplatelet agent plus
beta-blocker plus statin plus angiotensin-converting enzyme
inhibitor/angiotensin receptor blocker (GDMT2). Data collection and
analysis were performed according to the methodological recommendations of
The Cochrane Collaboration. Results: From a total of 439 references, 5
trials were included based on our inclusion and exclusion criteria.
Overall, compliance with GDMT1 was low and decreased over time from 67% at
1 year to 53% at 5 years. Compliance with GDMT2 was even lower and
decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1
and GDMT2 was higher in PCI than in CABG at all time points.
Meta-regression suggested an association between lower use of GDMT1 and
adverse clinical outcomes in PCI versus CABG at 5 years. Conclusions:
Compliance with GDMT in contemporary clinical trials remains suboptimal
and is significantly lower after CABG than after PCI, which may influence
the comparison of clinical trial endpoints between those study
groups.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<40>
Accession Number
621586283
Author
Kamel E.Z.; Abd-Elshafy S.K.; Sayed J.A.; Mostafa M.M.; Seddik M.I.
Institution
(Kamel, Abd-Elshafy, Sayed) Department of Anesthesia, ICU, and Pain,
Faculty of Medicine, Assiut University, Assiut, Egypt
(Mostafa) Department of Cardiothoracic, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Seddik) Department of Clinical Pathology, Faculty of Medicine, Assiut
University, Assiut, Egypt
Title
Pain alleviation in patients undergoing cardiac surgery; Presternal local
anesthetic and magnesium infiltration versus conventional intravenous
analgesia: A randomized double-blind study.
Source
Korean Journal of Pain. 31 (2) (pp 93-101), 2018. Date of Publication: 01
Apr 2018.
Publisher
Korean Pain Society (E-mail: painfree@hanafos.com)
Abstract
Background: Magnesium is one of the effective, safe local anesthetic
adjuvants that can exert an analgesic effect in conditions presenting
acute and chronic post-sternotomy pain. We studied the efficacy of
continuous infusion of presternal magnesium sulfate with bupivacaine for
pain relief following cardiac surgery. Methods: Ninety adult patients
undergoing valve replacement cardiac surgery randomly allocated into three
groups. In all patients; a presternal catheter was placed for continuous
infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for
48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group
2, versus conventional intravenous paracetamol and ketorolac in group 3.
Rescue analgesia was iv 25 mug fentanyl. Postoperative Visual Analog Scale
(VAS) and fentanyl consumption during the early two postoperative days
were assessed. All patients were followed up over two months for
occurrence of chronic post-sternotomy pain. Results: VAS values showed
high significant differences during the first 48 hours with the least pain
scale in group 1 and significantly least fentanyl consumption (30.8 +/- 7
mug in group 1 vs. 69 +/- 18 mug in group 2, and 162 +/- 3 in group 3
respectively). The incidence of chronic pain has not differed between the
three groups although it was more pronounced in group 3. Conclusions:
Continuous presternal bupivacaine and magnesium infusion resulted in
better postoperative analgesia than both presternal bupivacaine alone or
conventional analgesic groups.<br/>Copyright &#xa9; The Korean Pain
Society, 2018.

<41>
Accession Number
620792055
Author
Nguyen L.S.; Coutance G.; Ouldamar S.; Zahr N.; Brechot N.; Galeone A.;
Bougle A.; Lebreton G.; Leprince P.; Varnous S.
Institution
(Nguyen, Coutance, Ouldamar, Galeone, Lebreton, Leprince, Varnous) Cardiac
and Thoracic Surgery Department, Cardiology Institute, Pitie Salpetriere
University Hospital, Paris, France
(Zahr) Pharmacology Department, Pitie Salpetriere University Hospital,
Paris, France
(Brechot) Critical Care Medicine, Cardiology Institute, Pitie Salpetriere
University Hospital, Paris, France
(Bougle) Anesthesiology & Intensive Care Medicine Department, Cardiology
Institute, Pitie-Salpetriere University Hospital, Paris, France
Title
Performance of existing risk scores around heart transplantation:
validation study in a 4-year cohort.
Source
Transplant International. 31 (5) (pp 520-530), 2018. Date of Publication:
May 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Several risk scores exist to help identify best candidate recipients for
heart transplantation (HTx). This study describes the performance of five
heart failure risk scores and two post-HTx mortality risk scores in a
French single-centre cohort. All patients listed for HTx through a 4-year
period were included. Waiting-list risk scores [Heart Failure Survival
Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-Analysis Global
Group in Chronic Heart Failure (MAGGIC), Organized Program to Initiate
Lifesaving Treatment in Hospitalized Patients with Heart Failure
(OPTIMIZE-HF) and Get With The Guidelines-Heart Failure (GWTG-HF)] and
post-HTx scores Index for Mortality Prediction After Cardiac
Transplantation (IMPACT and CARRS) were computed. Main outcomes were
1-year mortality on waiting list and after HTx. Performance was assessed
using receiver operator characteristic (ROC), calibration and
goodness-of-fit analyses. The cohort included 414 patients. Waiting-list
mortality was 14.0%, and post-HTx mortality was 16.3% at 1-year follow-up.
Heart failure risk scores had adequate discrimination regarding
waiting-list mortality (ROC AUC for HFSS = 0.68, SHFM = 0.74, OPTIMIZE-HF
= 0.72, MAGGIC = 0.70 and GWTG = 0.77; all P-values <0.05). On the
contrary, post-HTx risk scores did not discriminate post-HTx mortality
(AUC for IMPACT = 0.58, and CARRS = 0.48, both P-values >0.50). Subgroup
analysis on patients undergoing HTx after ventricular assistance device
(VAD) implantation (i.e. bridge-to-transplantation) (n = 36) showed an
IMPACT AUC = 0.72 (P < 0.001). In this single-centre cohort, existing
heart failure risk scores were adequate to predict waiting-list mortality.
Post-HTx mortality risk scores were not, except in the VAD
subgroup.<br/>Copyright &#xa9; 2018 Steunstichting ESOT

<42>
Accession Number
614965856
Author
Barrett C.S.; Chan T.T.; Wilkes J.; Bratton S.L.; Thiagarajan R.R.
Institution
(Barrett) Department of Cardiology, School of Medicine, University of
Colorado, Children's Hospital Colorado, Box 100, 13123 E 16th Ave.,
Aurora, CO 80045, United States
(Chan) University of Washington, Seattle Children's Hospital, Seattle, WA,
United States
(Wilkes) Intermountain Healthcare Data Analyst, Salt Lake City, UT, United
States
(Bratton) University of Utah, Salt Lake City, UT, United States
(Thiagarajan) Harvard Medical School, Boston Children's Hospital, Boston,
MA, United States
Title
Association of pediatric cardiac surgical volume and mortality after
cardiac ECMO.
Source
ASAIO Journal. 63 (6) (pp 802-809), 2017. Date of Publication: 20 Mar
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Centers with higher surgical and extracorporeal membrane oxygenation
(ECMO) volumes have improved survival for children undergoing pediatric
cardiac surgery and ECMO, respectively. We examined the relationship
between both cardiac surgical and cardiac ECMO volumes, with survival.
Using data from the Pediatric Health Information System, we reviewed
patients who underwent ECMO during the hospitalization for cardiac surgery
or heart transplantation from January 2003 to June 2014. Among 106,967
patients in 43 centers undergoing a Risk Adjustment for Congenital Heart
Surgery-1 1-6 procedure (n = 104,951) or cardiac transplantation (n =
2,016), 2.9% (n = 3,069) underwent ECMO support. Centers were categorized
into volume quartiles based on annual ECMO and cardiac surgical volumes.
Multivariable logistic regression models controlling for clustering by
center and adjusting for factors associated with mortality were
constructed. Although mortality was lower in ECMO centers that performed
>=7 ECMO runs (odds ratio [OR]: 0.44, 95% confidence interval [CI]:
0.22-0.88)] and centers performing >=158 cardiac surgical cases (OR: 0.37,
95% CI: 0.22-0.63), surgical volume was more strongly associated with ECMO
mortality. Centers with higher cardiac surgical volume had fewer ECMO
complications. Cardiac surgical volume, compared with ECMO volume, is more
strongly associated with cardiac ECMO survival.<br/>Copyright &#xa9; 2017
by the ASAIO.

<43>
Accession Number
621729753
Author
Toribio M.; Neilan T.G.; Stone L.; Rokicki A.; Rivard C.; Calkins J.C.;
O'Hara M.; Awadalla M.; Triant V.; Szczepaniak L.S.; Zanni M.V.
Institution
(Toribio, Neilan, Stone, Rokicki, Rivard, Calkins, O'Hara, Awadalla,
Triant, Szczepaniak, Zanni) Massachusetts General Hospital, Boston, MA,
United States
Title
Myocardial steatosis in relation to cardiac dysfunction among women living
with HIV.
Source
Topics in Antiviral Medicine. Conference: 25th Conference on Retroviruses
and Opportunistic Infections, CROI 2018. United States. 26 (Supplement 1)
(pp 301s-302s), 2018. Date of Publication: April 2018.
Publisher
International Antiviral Society
Abstract
Background: Among women living with HIV (WLHIV) with access to ART, heart
failure incidence is increased and outcomes are poor. Heart failure is
typically preceded by an asymptomatic stage of diastolic dysfunction.
Studies in diverse patient populations have suggested myocardial
steatosis, or increased intramyocardial triglyceride content, predisposes
to diastolic dysfunction. Among WLHIV, data on cardiac structure and
function are scarce. We hypothesized asymptomatic WLHIV would demonstrate
myocardial steatosis and diastolic dysfunction as compared with women
without HIV. Methods: In this prospectively recruited cross-sectional
cohort study, 18 asymptomatic WLHIV on ART and 6 asymptomatic women
without HIV completed cardiac magnetic resonance spectroscopy, cardiac
magnetic resonance imaging, and metabolic phenotyping procedures. Women
with heart failure, diabetes, and current use of lipid-lowering
medications were excluded. Intramyocardial triglyceride content and left
atrial passive ejection fraction (a measure of diastolic function) were
compared between groups and intra-group correlations were assessed.
Results: WLHIV and women without HIV did not differ with respect to age
(52.1 vs. 51.7 years, p=0.84), BMI (31.5 vs. 29.7 kg/m2, p=0.61),
prevalence of hypertension (22 vs. 33%, p=0.62), HbA1c (5.6 vs. 5.5%,
p=0.51), or LDL cholesterol (113 vs. 109 mg/dl, p=0.76). Circulating
triglyceride levels were higher among WLHIV (107 vs. 69 mg/dl, p=0.01).
Among WLHIV, duration of known HIV was 19+/-9 years, 100% were on ART,
median VL was 19 copies/ml (IQR 19, 19), and median CD4 was 558 cells/mm3
(IQR 450, 773). Notably, the intramyocardial triglyceride content was over
three-times higher among WLHIV (0.49 [0.39, 2.09] vs. 0.13 [0.11, 0.23] %,
p=0.004) (Figure, Panel A). Further, left atrial passive ejection fraction
was reduced among WLHIV (28+/-9 vs. 38 +/-6 %, p=0.02) (Figure, Panel B).
Among WLHIV, intramyocardial triglyceride content was not related to BMI
(p=0.92) or to circulating triglyceride levels (p=0.34), but was inversely
related to left atrial passive ejection fraction (rho -0.51, p=0.03).
Conclusion: Asymptomatic WLHIV on ART evidence a more than three-fold
increase in intramyocardial triglyceride content in relation to diastolic
dysfunction, as compared with age- and BMI-matched women without HIV.
Further studies are needed to determine whether strategies targeting
myocardial steatosis also improve diastolic function and potentially
prevent heart failure among WLHIV. (Figure Presented).

<44>
Accession Number
621678120
Author
Kolkailah A.A.; Alreshq R.S.; Muhammed A.M.; Zahran M.E.; Anas El-Wegoud
M.; Nabhan A.F.
Institution
(Kolkailah) John H. Stroger, Jr. Hospital of Cook County, Department of
Medicine, Chicago, IL, United States
(Alreshq) Albany Medical College, Department of Medicine, Albany, NY,
United States
(Muhammed, Zahran) Faculty of Medicine, Ain Shams University, Department
of Cardiology, Cairo, Egypt
(Anas El-Wegoud) Egyptian Center for Evidence Based Medicine (ECEBM), 8
Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.,
Cairo 11646, Egypt
(Nabhan) Ain Shams University, Department of Obstetrics and Gynaecology,
Faculty of Medicine, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo 11351,
Egypt
Title
Transradial versus transfemoral approach for diagnostic coronary
angiography and percutaneous coronary intervention in people with coronary
artery disease.
Source
Cochrane Database of Systematic Reviews. 2018 (4) (no pagination), 2018.
Article Number: CD012318. Date of Publication: 18 Apr 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiovascular disease (CVD) is the major cause of mortality
worldwide. Coronary artery disease (CAD) contributes to half of
mortalities caused by CVD. The mainstay of management of CAD is medical
therapy and revascularisation. Revascularisation can be achieved via
coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI). Peripheral arteries, such as the femoral or radial
artery, provide the access to the coronary arteries to perform diagnostic
or therapeutic (or both) procedures. Objectives: To assess the benefits
and harms of the transradial compared to the transfemoral approach in
people with CAD undergoing diagnostic coronary angiography (CA) or PCI (or
both). Search methods: We searched the following databases for randomised
controlled trials on 10 October 2017: Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core
Collection. We also searched ClinicalTrials.gov and the World Health
Organization International Clinical Trials Registry Platform in August
2017. There were no language restrictions. Reference lists were also
checked and we contacted authors of included studies for further
information. Selection criteria: We included randomised controlled trials
that compared transradial and transfemoral approaches in adults (18 years
of age or older) undergoing diagnostic CA or PCI (or both) for CAD. Data
collection and analysis: We used the standard methodological procedures
expected by Cochrane. At least two authors independently screened trials,
extracted data, and assessed the risk of bias in the included studies. We
contacted trial authors for missing information. We used risk ratio (RR)
for dichotomous outcomes and mean difference (MD) or standardised mean
difference (SMD) for continuous data, with their 95% confidence intervals
(CIs). All analyses were checked by another author. Main results: We
identified 31 studies (44 reports) including 27,071 participants and two
ongoing studies. The risk of bias in the studies was low or unclear for
several domains. Compared to the transfemoral approach, the transradial
approach reduced short-term net adverse clinical events (NACE) (i.e.
assessed during hospitalisation and up to 30 days of follow-up) (RR 0.76,
95% CI 0.61 to 0.94; 17,133 participants; 4 studies; moderate quality
evidence), cardiac death (RR 0.69, 95% CI 0.54 to 0.88; 11,170
participants; 11 studies; moderate quality evidence). However, short-term
myocardial infarction was similar between both groups (RR 0.91, 95% CI
0.81 to 1.02; 19,430 participants; 11 studies; high quality evidence). The
transradial approach had a lower procedural success rate (RR 0.97, 95% CI
0.96 to 0.98; 25,920 participants; 28 studies; moderate quality evidence),
but was associated with a lower risk of all-cause mortality (RR 0.77, 95%
CI 0.62 to 0.95; 18,955 participants; 10 studies; high quality evidence),
bleeding (RR 0.54, 95% CI 0.40 to 0.74; 23,043 participants; 20 studies;
low quality evidence), and access site complications (RR 0.36, 95% CI 0.22
to 0.59; 16,112 participants; 24 studies; low quality evidence). Authors'
conclusions: Transradial approach for diagnostic CA or PCI (or both) in
CAD may reduce short-term NACE, cardiac death, all-cause mortality,
bleeding, and access site complications. There is insufficient evidence
regarding the long-term clinical outcomes (i.e. beyond 30 days of
follow-up).<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<45>
Accession Number
621677283
Author
Chiam E.; Bellomo R.; Churilov L.; Weinberg L.
Institution
(Chiam, Weinberg) Department of Surgery, University of Melbourne, Austin
Hospital, Heidelberg, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg, VIC,
Australia
(Churilov) Florey Institute of Neuroscience and Mental Health, Melbourne
Brain Centre, Heidelberg, VIC, Australia
(Weinberg) Anesthesia, Perioperative and Pain Medicine, University of
Melbourne, Victoria, Australia
Title
The hemodynamic effects of intravenous paracetamol (acetaminophen) vs
normal saline in cardiac surgery patients: A single center placebo
controlled randomized study.
Source
PLoS ONE. 13 (4) (no pagination), 2018. Article Number: e0195931. Date of
Publication: April 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The hemodynamic effects of intravenous (IV) paracetamol in patients
undergoing cardiac surgery are unknown. We performed a prospective single
center placebo controlled randomized study with parallel group design in
adult patients undergoing elective cardiac surgery. Participants received
paracetamol (1 gram) IV or placebo (an equal volume of 0.9% saline)
preoperatively followed by two postoperative doses 6 hours apart. The
primary endpoint was the absolute change in systolic (SBP) 30 minutes
after the preoperative infusion, analysed using an ANCOVA model. Secondary
endpoints included absolute changes in mean arterial pressure (MAP) and
diastolic blood pressure (DPB), and other key hemodynamic variables after
each infusion. All other endpoints were analysed using random-effect
generalized least squares regression modelling with individual patients
treated as random effects. Fifty participants were randomly assigned to
receive paracetamol (n = 25) or placebo (n = 25). Post preoperative
infusion, paracetamol decreased SBP by a mean (SD) of 13 (18) mmHg, p =
0.02, compared to a mean (SD) of 1 (11) mmHg with saline. Paracetamol
decreased MAP and DBP by a mean (SD) of 9 (12) mmHg and 8 (9) mmHg (p =
0.01 and 0.02), respectively, compared to a mean (SD) of 1 (8) mmHg and 0
(6) mmHg with placebo. Postoperatively, there were no significant
differences in pressure or flow based hemodynamic parameters in both
groups. This study provides high quality evidence that the administration
of IV paracetamol in patients undergoing cardiac surgery causes a
transient decrease in preoperative blood pressure when administered before
surgery but no adverse hemodynamic effects when administered in the
postoperative setting.<br/>Copyright &#xa9; 2018 Chiam 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.

<46>
Accession Number
621726140
Author
Gialama F.; Prezerakos P.; Apostolopoulos V.; Maniadakis N.
Institution
(Gialama, Maniadakis) Department of Health Services Management, National
School of Public Health, 196 Alexandras Avenue, Athens 115 21, Greece
(Prezerakos) Department of Nursing Studies, University of Peloponnese,
Efstathiou and Stamatikis Valioti and Plateon, Sparti 23100, Greece
(Apostolopoulos) Administration, Athens Medical Group, Filadelfeos and
Kefalariou 1, Square Kefalariou, Kifisia, Athens 14562, Greece
Title
Systematic review of the cost-effectiveness of transcatheter interventions
for valvular heart disease.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 4 (2) (pp
81-90), 2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve implantation (TAVI) and transcatheter mitral
valve repair (TMVR) are increasingly used for managing patients with
valvular heart disease to whom surgery presents a high-risk. As these are
costly procedures, a systematic review of studies concerned with their
economic assessment was undertaken. The search was performed in PubMed and
the Cochrane Library and followed recommended methodological steps.
Studies were screened and their data were retrieved and were synthesized
using a narrative approach. Twenty-four, good to high quality, evaluations
were identified, representing different viewpoints, modelling techniques
and willingness-topay thresholds. Studies show that in high-risk patients
with symptomatic aortic stenosis, TAVI may be cost-effective compared with
medical management (MM) across many health care settings. In contrast,
studies of TAVI compared with surgical aortic valve replacement (SAVR)
yield conflicting and inconclusive results. The limited data available
show that TMVR may also be cost-effective relative to MM in mitral valve
disease. Existing evidence indicates that transcatheter techniques may be
cost-effective options, relative to MM, in high-risk patients with
valvular disease. Nonetheless, more research is needed to establish their
economic value further, to investigate the drives of cost-effectiveness,
and to evaluate surgical with transcatheter techniques in aortic valvular
disease.<br/>Copyright &#xa9; 2018 The Author(s). Published on behalf of
the European Society of Cardiology. All rights reserved.

<47>
Accession Number
621726137
Author
Barman M.; Tantawy M.; Sopher M.; Lennerz C.
Institution
(Barman, Tantawy, Sopher, Lennerz) Department of Social Policy, London
School of Economics, Houghton St, London WC2A 2AE, United Kingdom
(Barman) Cardiology Department, Al Ahli Hospital, Ahmed Bin Ali St, Doha,
Qatar
(Tantawy) Cardiology Department, Misr University for Science and
Technology, 26th of July Corridor, Giza Governorate, Egypt
(Sopher) Cardiology, Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust, Castle Ln E, Bournemouth BH7 7DW, United Kingdom
(Lennerz) Deutsches Herzzentrum Munchen, Klinik fur Herz- und
Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische
Universitat Munchen, Lazarettstrase 36, Munich 80636, Germany
Title
Cost-effectiveness of colchicine treatment on post-operative atrial
fibrillation events in patients of major cardiac surgery.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 4 (2) (pp
126-131), 2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
Aims Post-operative atrial fibrillation (POAF) occurs in 20-50% of
patients amid post-operative stay after Cardiac Surgery. We intend to
determine whether colchicine therapy in patients undergoing cardiac
surgery is a costeffective strategy for prevention of POAF. To undertake
cost utility analysis and calculate incremental cost utility ratio (ICUR)
for colchicine therapy in these subgroup of patients. Methods and results
Design Decision tree model to calculate the ICUR comparing two treatment
strategies in patients undergoing cardiac surgery. One wherein patients
received colchicine along with usual care and second where they received
placebo or just usual care. Cost utility analysis was undertaken using
relevant data from the systematic review and metaanalysis of the available
randomized controlled trials till June 2016 and mean cost calculations
from validated available sources across various jurisdictions. Results
Colchicine treatment based on mean costs for life expectancy calculated at
10 years' post-surgery using recommended discounting rates of 3.5% was e
17544.80 cheaper per quality-adjusted life-year (QALY) gained. The
incremental cost is negative and the incremental effect (QALY) is positive
(South East quadrant), Hence the intervention of colchicine treatment is
unequivocally cost-effective, meaning it is dominant and achieves better
outcomes at a lower cost. Conclusion Our findings provide a benchmark for
current and future analyses relating to effectiveness of colchicine on
POAF events after cardiac surgery. Currently, there are few reports that
provide cutting edge estimates of the higher expenses associated with
POAF. Future analyses should likewise explore the impact of added costs
from using pharmacologic efforts to prevent and treat POAF after cardiac
surgery.<br/>Copyright &#xa9; 2018 The Author(s). Published on behalf of
the European Society of Cardiology. All rights reserved.

<48>
Accession Number
2000596810
Author
Fitzgerald J.; Lenihan M.; Callum J.; McCluskey S.A.; Srinivas C.; van
Rensburg A.; Karkouti K.
Institution
(Fitzgerald, Lenihan, McCluskey, Srinivas, van Rensburg, Karkouti)
Department of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Callum) Department of Clinical Pathology, Sunnybrook Health Sciences
Centre, University of Toronto, Toronto, ON, Canada
(McCluskey, Srinivas, van Rensburg, Karkouti) Peter Munk Cardiac Centre,
Toronto General Hospital, University Health Network, Toronto, ON, Canada
Title
Use of prothrombin complex concentrate for management of coagulopathy
after cardiac surgery: a propensity score matched comparison to plasma.
Source
British Journal of Anaesthesia. 120 (5) (pp 928-934), 2018. Date of
Publication: May 2018.
Publisher
Elsevier Ltd
Abstract
Background: An important cause of coagulopathy in cardiac surgery is
impaired thrombin generation. While plasma is often used to correct this
element of the coagulopathy, studies in vitro suggest that prothrombin
complex concentrates (PCCs) might be more effective. Comparative data,
however, are scant. Methods: We compared the outcomes of those who
received only plasma with those who received PCCs (with or without plasma)
for management of coagulopathy in patients who underwent cardiac surgery
with cardiopulmonary bypass at a single institution from 2012 to 2016.
Propensity score matching was used to obtain between-group balance.
Primary outcome was avoidance of perioperative red cell transfusions.
Other outcomes were incidence of massive transfusion (more than nine red
cell units), refractory bleeding (requiring factor VIIa), and adverse
events. Results: Of 6362 patients, 1151 (18.2%) received plasma without
any PCCs, and 204 (3.2%) received PCCs, either with (n=125) or without
plasma (n=79). Overall, patient risk-profile was higher in the PCCs group.
In a well-balanced propensity score match that included 117 patients per
group, the odds ratio (OR) for red cell avoidance was 2.4-fold [95%
confidence interval (CI) 1.2-4.8] higher in the PCCs group. Massive
transfusion (OR 0.58; 95% CI 0.33-1.0) and refractory bleeding (OR 0.49;
95% CI 0.24-1.03) incidences were almost significantly lower in the PCCs
group. The adverse event profiles were similar. Conclusions: Our
exploratory study suggests that the use of PCCs as part of a multifaceted
coagulation management strategy may have blood-sparing effects. Their
incorporation into clinical practice, however, must await determination of
their risk-benefit profile via multicentre randomised
trials.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<49>
[Use Link to view the full text]
Accession Number
621738909
Author
Pitre L.; Garbee D.; Tipton J.; Schiavo J.; Pitt A.
Institution
(Pitre, Garbee, Tipton, Schiavo, Pitt) Louisiana Ctr. for Prom. of Optimal
Health Outcomes: A Joanna Briggs Institute Center of Excellence,
Switzerland
Title
Effects of preoperative intrathecal morphine on postoperative intravenous
morphine dosage: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (4) (pp
867-870), 2018. Date of Publication: 01 Apr 2018.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The purpose of this systematic review is to
describe the effect of preoperative intrathecal morphine (ITM) on
postoperative intravenous (IV) morphine dosage during the first
postoperative day. This systematic review will compare the postoperative
IV morphine dosage of patients receiving ITM plus morphine morphine-based
patient-controlled analgesia (PCA), to patients receiving PCA morphine
without ITM. This will establish the magnitude of the postoperative
morphine sparing effect of ITM. This review aims to answer the following
specific question: In adult abdominal and thoracic surgery patients
undergoing general anesthesia (GA), what is the effect of ITM plus PCA
morphine, compared to PCA morphine alone, on total IV morphine dosage (in
milligrams) during the first 24 hours after surgery?<br/>Copyright &#xa9;
2018 THE JOANNA BRIGGS INSTITUTE.

<50>
[Use Link to view the full text]
Accession Number
621681840
Author
Phan K.; Luc J.G.Y.; Xu J.; Maltais S.; Stulak J.M.; Yan T.D.;
Tchantchaleishvili V.
Institution
(Phan, Xu, Tchantchaleishvili) Faculty of Medicine, University of Sydney,
Sydney, Australia
(Phan, Yan) Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Luc) Department of Surgery, Faculty of Medicine and Dentistry, University
of Alberta, Edmonton, AB, Canada
(Maltais, Stulak) Department of Cardiovascular Surgery, Mayo Clinic and
Foundation, Rochester, MN, United States
(Yan) Department of Cardiothoracic Surgery, University of Sydney, Royal
Prince Alfred Hospital, Sydney, Australia
(Tchantchaleishvili) Department of Surgery, Division of Cardiac Surgery,
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
14642, United States
(Tchantchaleishvili) Department of Surgery, Division of Cardiothoracic
Surgery, Thomas Jefferson University, Philadelphia, PA, United States
Title
Utilization and outcomes of temporary mechanical circulatory support for
graft dysfunction after heart transplantation.
Source
ASAIO Journal. 63 (6) (pp 695-703), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Graft dysfunction is the main cause of early mortality after heart
transplantation. In cases of severe graft dysfunction, temporary
mechanical circulatory support (TMCS) may be necessary. The aim of this
systematic review was to examine the utilization and outcomes of TMCS in
patients with graft dysfunction after heart transplantation. Electronic
search was performed to identify all studies in the English literature
assessing the use of TMCS for graft dysfunction. All identified articles
were systematically assessed for inclusion and exclusion criteria. Of the
5,462 studies identified, 41 studies were included. Among the 11,555
patients undergoing heart transplantation, 695 (6.0%) required TMCS with
patients most often supported using venoarterial extracorporeal membrane
oxygenation (79.4%) followed by right ventricular assist devices (11.1%),
biventricular assist devices (BiVADs) (7.5%), and left ventricular assist
devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be
supported longer (p = 0.003), have a higher death by cardiac event (p =
0.013) and retransplantation rate (p = 0.015). In contrast, patients
supported with BiVAD and LVAD were more likely to be weaned off support (p
= 0.020). Overall, no significant difference was found in pooled 30 day
survival (p = 0.31), survival to discharge (p = 0.19), and overall
survival (p = 0.51) between the subgroups. Temporary mechanical
circulatory support is an effective modality to support patients with
graft dysfunction after heart transplantation. Further studies are needed
to establish the optimal threshold and strategy for TMCS and to augment
cardiac recovery and long-term survival.<br/>&#xa9; Copyright 2017 by the
ASAIO.

<51>
Accession Number
2000669038
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, China
Title
Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane
Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: To investigate the clinical outcomes of adult patients
receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy
cardiogenic shock (PCS). Design: Meta-analysis of 20 observational
studies. Setting: Hospitals that perform cardiac surgery. Participants:
The study included 2,877 PCS patients undergoing ECMO from 20
observational studies. Interventions: ECMO use. Measurements and Main
Results: Twenty observational studies were selected for final analysis.
The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in
PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0%
(19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%).
The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate
of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure
was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was
16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%).
Most of the included studies commonly revealed that age >65 years,
pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer
duration of ECMO, and neurologic complications were risk factors of
in-hospital mortality in PCS patients undergoing ECMO. Conclusions: The
short-term and midterm survival rates of PCS patients treated with ECMO
were disappointingly low, and post-ECMO complication rates were relatively
high.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<52>
Accession Number
620401061
Author
Fan H.; Ximing Q.
Institution
(Fan, Ximing) Department of Cardiac Surgery, Sir Run Run Shaw Hospital,
School of Medicine, Zhejiang University, Hangzhou 310020, China
Title
Treatment options for the closure of secundum atrial septal defects: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 254 (pp 89), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Elsevier Ireland Ltd

<53>
[Use Link to view the full text]
Accession Number
621343004
Author
Liu S.; Li Z.; Liu Z.; Hu Z.; Zheng G.
Institution
(Liu, Li, Liu, Hu, Zheng) Department of Anesthesiology, Henan Provincial
People's Hospital, Henan University, Zhengzhou, Henan 450003, China
Title
Blood transfusion and risk of atrial fibrillation after coronary artery
bypass graft surgery: A meta-analysis of cohort studies.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e9700. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study was to systematically evaluate the effect of blood
transfusion (BT) on postoperative atrial fibrillation (AF) in adult
patients who had undergone coronary artery bypass grafting (CABG) surgery.
PubMed, Embase, and Cochrane Library databases from inception to January
2017 were searched. Cohort studies were searched that evaluated the
association between BT and the risk of postoperative AF in adult patients
who had undergone CABG surgery. Study quality was assessed by using the
Newcastle-Ottawa scale (NOS). A meta-analysis was performed with the
random-effect model. Eight cohort studies involving 7401 AF cases and
31,069 participants were identified and included in our data analysis. The
pooled odds ratio of postoperative AF in patients with BT was 1.45 (95%
confidence interval, 1.26-1.67), with significant heterogeneity (P <
.0001, I² = 79%). Excluding one study that had an off-pump CABG
did not significantly impact this result (odds ratio, 1.36; 95% confidence
interval, 1.23-1.50; n = 7). To examine the stability of the primary
results, we performed subgroup analyses. The association between BT and
the risk of postoperative AF was similar, as determined in the stratified
analyses conducted according to study design, type of surgery, and
country. The findings of the present meta-analysis demonstrated a
statistically significant increase in postoperative AF risk among adult
patients with BT. Further prospective large-scale studies are needed to
establish causality and to elucidate the underlying
mechanisms.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<54>
Accession Number
617271317
Author
Huang S.-Q.; Zhang J.; Zhang X.-X.; Liu L.; Yu Y.; Kang X.-H.; Wu X.-M.;
Zhu S.-M.
Institution
(Huang, Zhang, Zhang, Liu, Yu, Kang, Zhu) Department of Anesthesiology,
The First Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou, Zhejiang 310000, China
(Wu) Department of Anesthesiology, Zhejiang Provincial People's Hospital,
People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014,
China
Title
Can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt
during one-lung ventilation in adults undergoing thoracic surgery? A
meta-analysis of randomized, placebo-controlled trials.
Source
Chinese Medical Journal. 130 (14) (pp 1707-1714), 2017. Date of
Publication: 20 Jul 2017.
Publisher
Chinese Medical Association (B9, Kanara Business Centre, off Link Road,
Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: One-lung ventilation (OLV) is a common ventilation technology
during thoracic surgery that can cause serious clinical problems. We aimed
to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt
during OLV in adults undergoing thoracic surgery with dexmedetomidine
(Dex) versus placebo to assess the influence and safety of using Dex.
Methods: Randomized controlled trials comparing lung protection in
patients who underwent thoracic surgery with Dex or a placebo were
retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI
database. The following information was extracted from the paper: arterial
oxygen partial pressure (PaO<inf>2</inf>), PaO<inf>2</inf>/inspired oxygen
concentration (PaO<inf>2</inf>/FiO<inf>2</inf>, oxygenation index [OI]),
intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP),
heart rate (HR), tumor necrosis factor-alpha (TNF-alpha), interleukin
(IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA). Results:
Fourteen randomized controlled trials were included containing a total of
625 patients. Compared with placebo group, Dex significantly increased
PaO<inf>2</inf>/FiO<inf>2</inf> (standard mean difference [SMD] = 0.98,
95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt
(SMD= -1.22, 95% CI [-2.20, -0.23], P = 0.020), HR (SMD= -0.69, 95% CI
[-1.20, 0.17], P = 0.009), MAP (SMD= -0.44, 95% CI [-0.84, 0.04], P =
0.030), the concentrations of TNF-alpha (SMD = -1.55, 95% CI [-2.16,
-0.95], P <0.001), and IL-6 (SMD = -1.53, 95% CI [-2.37, -0.70], P =
0.0003) were decreased in the treated group, when compared to placebo
group. No significant difference was found in MDA (SMD = -1.14, 95% CI
[-3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [-0.29, 1.10], P =
0.250) between the Dex group and the placebo group. Funnel plots did not
detect any significant publication bias. Conclusions: Dex may improve OI
and reduce intrapulmonary shunt during OLV in adults undergoing thoracic
surgery. However, this conclusion might be weakened by the limited number
of pooled studies and patients.<br/>Copyright &#xa9; 2017 Chinese Medical
Journal.

<55>
Accession Number
617172936
Author
Mahmud E.; Naghi J.; Ang L.; Harrison J.; Behnamfar O.; Pourdjabbar A.;
Reeves R.; Patel M.
Institution
(Mahmud, Naghi, Ang, Harrison, Behnamfar, Pourdjabbar, Reeves, Patel)
Division of Cardiovascular Medicine, University of California San Diego,
Sulpizio Cardiovascular Center, La Jolla, California, United States
Title
Demonstration of the Safety and Feasibility of Robotically Assisted
Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of
the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary
Intervention).
Source
JACC: Cardiovascular Interventions. 10 (13) (pp 1320-1327), 2017. Date of
Publication: 10 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aims of this study were to evaluate the feasibility and
technical success of robotically assisted percutaneous coronary
intervention (R-PCI) for the treatment of coronary artery disease (CAD) in
clinical practice, especially in complex lesions, and to determine the
safety and clinical success of R-PCI compared with manual percutaneous
coronary intervention (M-PCI). Background R-PCI is safe and feasible for
simple coronary lesions. The utility of R-PCI for complex coronary lesions
is unknown. Methods All consecutive PCI procedures performed robotically
(study group) or manually (control group) over 18 months were included.
R-PCI technical success, defined as the completion of the procedure
robotically or with partial manual assistance and without a major adverse
cardiovascular event, was determined. Procedures ineligible for R-PCI
(i.e., atherectomy, planned 2-stent strategy for bifurcation lesion,
chronic total occlusion requiring hybrid approach) were excluded for
analysis from the M-PCI group. Clinical success, defined as completion of
the PCI procedure without a major adverse cardiovascular event, procedure
time, stent use, and fluoroscopy time were compared between groups.
Results A total of 315 patients (mean age 67.7 +/- 11.8 years; 78% men)
underwent 334 PCI procedures (108 R-PCIs, 157 lesions, 78.3% type B2/C;
226 M-PCIs, 336 lesions, 68.8% type B2/C). Technical success with R-PCI
was 91.7% (rate of manual assistance 11.1%, rate of manual conversion
7.4%, rate of major adverse cardiovascular events 0.93%). Clinical success
(99.1% with R-PCI vs. 99.1% with M-PCI; p = 1.00), stent use (stents per
procedure 1.59 +/- 0.79 with R-PCI vs. 1.54 +/- 0.75 with M-PCI; p =
0.73), and fluoroscopy time (18.2 +/- 10.4 min with R-PCI vs. 19.2 +/-
11.4 min with M-PCI; p = 0.39) were similar between the groups, although
procedure time was longer in the R-PCI group (44:30 +/- 26:04 min:s vs.
36:34 +/- 23:03 min:s; p = 0.002). Propensity-matched analysis confirmed
that procedure time was longer in the robotic group (42:59 +/- 26:14 min:s
with R-PCI vs. 34:01 +/- 17:14 min:s with M-PCI; p = 0.007), although
clinical success remained similar (98.8% with R-PCI vs. 100% with M-PCI; p
= 1.00). Conclusions This study demonstrates the feasibility, safety, and
high technical success of R-PCI for the treatment of complex coronary
disease. Furthermore, comparable clinical outcomes, without an adverse
effect on stent use or fluoroscopy time, were observed with R-PCI and
M-PCI.<br/>Copyright &#xa9; 2017 American College of Cardiology Foundation

<56>
Accession Number
616556363
Author
Rodes-Cabau J.; Masson J.-B.; Welsh R.C.; Garcia del Blanco B.; Pelletier
M.; Webb J.G.; Al-Qoofi F.; Genereux P.; Maluenda G.; Thoenes M.; Paradis
J.-M.; Chamandi C.; Serra V.; Dumont E.; Cote M.
Institution
(Rodes-Cabau, Paradis, Chamandi, Dumont, Cote) Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Masson) Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec,
Canada
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, Alberta, Canada
(Garcia del Blanco, Serra) Hospital Universitari Vall d'Hebron, Barcelona,
Spain
(Pelletier) Saint John's Regional Hospital, Saint John, New Brunswick,
Canada
(Webb) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Al-Qoofi) Foothills Hospital, Calgary, Alberta, Canada
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Maluenda) Hospital San Borja Arriaran, Santiago de Chile, Chile
(Thoenes) Leman Research Institute, Geneva, Switzerland
Title
Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment
Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable
Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following
Transcatheter Aortic Valve Implantation) Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 10 (13) (pp 1357-1365), 2017. Date of
Publication: 10 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare aspirin plus clopidogrel
with aspirin alone as antithrombotic treatment following transcatheter
aortic valve replacement (TAVR) for the prevention of ischemic events,
bleeding events, and death. Background Few data exist on the optimal
antithrombotic therapy following TAVR. Methods This was a randomized
controlled trial comparing aspirin (80 to 100 mg/day) plus clopidogrel (75
mg/day) (dual antiplatelet therapy [DAPT]) versus aspirin alone
(single-antiplatelet therapy [SAPT]) in patients undergoing TAVR with a
balloon-expandable valve. The primary endpoint was the occurrence of
death, myocardial infarction (MI), stroke or transient ischemic attack, or
major or life-threatening bleeding (according to Valve Academic Research
Consortium 2 definitions) within the 3 months following the procedure. The
trial was prematurely stopped after the inclusion of 74% of the planned
study population. Results A total of 222 patients were included, 111
allocated to DAPT and 111 to SAPT. The composite of death, MI, stroke or
transient ischemic attack, or major or life-threatening bleeding tended to
occur more frequently in the DAPT group (15.3% vs. 7.2%, p = 0.065). There
were no differences between groups in the occurrence of death (DAPT, 6.3%;
SAPT, 3.6%; p = 0.37), MI (DAPT, 3.6%; SAT, 0.9%; p = 0.18), or stroke or
transient ischemic attack (DAPT, 2.7%; SAPT, 0.9%; p = 0.31) at 3 months.
DAPT was associated with a higher rate of major or life-threatening
bleeding events (10.8% vs. 3.6% in the SAPT group, p = 0.038). There were
no differences between groups in valve hemodynamic status post-TAVR.
Conclusions This small trial showed that SAPT (vs. DAPT) tended to reduce
the occurrence of major adverse events following TAVR. SAPT reduced the
risk for major or life-threatening events while not increasing the risk
for MI or stroke. Larger studies are needed to confirm these results.
(Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve
Implantation: The ARTE Trial [ARTE], NCT01559298; Aspirin Versus
Aspirin+Clopidogrel as Antithrombotic Treatment Following TAVI [ARTE],
NCT02640794)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<57>
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.

<58>
Accession Number
2000592933
Author
Smart N.A.; Dieberg G.; King N.
Institution
(Smart, Dieberg) School of Science and Technology, University of New
England, Armidale, Australia, United States
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth, United Kingdom
Title
Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting.
Source
Journal of the American College of Cardiology. 71 (9) (pp 983-991), 2018.
Date of Publication: 6 March 2018.
Publisher
Elsevier USA
Abstract
Background: When comparing effects of on- versus off-pump coronary artery
bypass grafting (CABG), it is important to assess the long-term clinical
outcomes. However, most research conducted thus far has concentrated on
short-term outcomes and ignored the long-term clinical outcomes,
especially the 5-year outcomes of the largest randomized controlled
trials. Objectives: The aim of this systematic review and meta-analysis
was to investigate the long-term clinical outcomes of on- versus off-pump
CABG. Methods: To identify potential studies systematic searches were
carried out using various databases. The search strategy included the key
concepts of cardiopulmonary bypass AND off-pump AND long term OR 5-year
outcomes. This was followed by a meta-analysis investigating mortality,
incidence of myocardial infarction, incidence of angina, need for
revascularization, and incidence of stroke. Results: Six studies totaling
8,145 participants were analyzed. In the on-pump group mortality was
12.3%, compared with 13.9% in the off-pump group. The odds ratio (OR) for
this comparison was 1.16 (95% confidence interval [CI]: 1.02 to 1.32; p =
0.03; 13.9% vs. 12.3%). In contrast, there were no differences in the
incidence of myocardial infarction (OR: 1.06: 95% CI: 0.91 to 1.25; p =
0.45; 8.4% vs. 7.9%), incidence of angina (OR: 1.09; 95% CI: 0.75 to 1.57;
p = 0.65; 2.3% vs. 2.1%), need for revascularization (OR: 1.15; 95% CI:
0.95 to 1.40; p = 0.16; 5.9% vs. 5.1%), and the incidence of stroke (OR:
0.78; 95% CI: 0.56 to 1.10; p = 0.16; 2.2% vs. 2.8%). Conclusions:
Statistically, on-pump CABG appeared to offer superior long-term survival,
although the clinical significance of this may be more
uncertain.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<59>
Accession Number
621431082
Author
Gurbel P.A.; Tantry U.S.; D'Andrea D.; Chung T.; Alexander J.H.; Bliden
K.P.; Wright S.D.; Tricoci P.
Institution
(Gurbel, Tantry, Bliden) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls
Church, VA 22042, United States
(D'Andrea, Chung, Wright) CSL Behring, King of Prussia, PA, United States
(Alexander, Tricoci) Duke Clinical Research Institute, Durham, NC, United
States
Title
Evaluation of potential antiplatelet effects of CSL112 (Apolipoprotein A-I
[Human]) in patients with atherosclerosis: results from a phase 2a study.
Source
Journal of Thrombosis and Thrombolysis. 45 (4) (pp 469-476), 2018. Date of
Publication: 01 May 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
CSL112 (Apolipoprotein A-I [Human]), an infusible, plasma-derived
apolipoprotein A-I, is being developed to reduce cardiovascular events
following acute myocardial infarction (AMI). A predecessor compound
(CSL111) demonstrated a potential antiplatelet effect. A phase 2a
multicentre, randomised, single-ascending dose study in patients with
stable atherosclerotic disease receiving dual antiplatelet therapy (DAPT)
assessed the potential additive effects of CSL112 administration on
platelet function and increase bleeding risk in the subacute period after
AMI. Patients (n = 44) on aspirin (75-325 mg/day) and either clopidogrel
(75 mg/day, n = 37) or prasugrel (10 mg/day, n = 7) for > 30 days
alongside standard-of-care therapy were randomised to a single dose of
placebo or CSL112: 1.7, 3.4, or 6.8 g. Light transmission aggregometry was
used to assess platelet aggregation in response to 2 mM arachidonic acid,
5 and 20 micro&#32;M adenosine diphosphate, and 4 micro&#32;g/mL collagen,
pre-dose (baseline) and up to 48 h post-dosing. Compared to placebo,
CSL112 had no clinically meaningful time- or dose-dependent effects on
maximum platelet aggregation in response to any agonist, by either dose or
renal function subgroup (p > 0.05). Coagulation parameters showed little
variation over time or between treatment groups (p > 0.05). CSL112, when
co-administered with standard DAPT, did not significantly influence
platelet aggregation in response to agonists and is, therefore, not
expected to significantly increase bleeding risk when administered with
antiplatelet therapies.<br/>Copyright &#xa9; 2018, The Author(s).

<60>
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.

<61>
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
Journal of Cardiology. 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

<62>
Accession Number
2000632947
Author
Kikuta Y.; Cook C.M.; Sharp A.S.P.; Salinas P.; Kawase Y.; Shiono Y.;
Giavarini A.; Nakayama M.; De Rosa S.; Sen S.; Nijjer S.S.; Al-Lamee R.;
Petraco R.; Malik I.S.; Mikhail G.W.; Kaprielian R.R.; Wijntjens G.W.M.;
Mori S.; Hagikura A.; Mates M.; Mizuno A.; Hellig F.; Lee K.; Janssens L.;
Horie K.; Mohdnazri S.; Herrera R.; Krackhardt F.; Yamawaki M.; Davies J.;
Takebayashi H.; Keeble T.; Haruta S.; Ribichini F.; Indolfi C.; Mayet J.;
Francis D.P.; Piek J.J.; Di Mario C.; Escaned J.; Matsuo H.; Davies J.E.
Institution
(Kikuta, Cook, Shiono, Sen, Nijjer, Al-Lamee, Petraco, Malik, Mikhail,
Kaprielian, Mayet, Francis, Davies) Imperial College London and
Hammersmith Hospital NHS Trust, London, United Kingdom
(Kikuta, Hagikura, Takebayashi, Haruta) Fukuyama Cardiovascular Hospital,
Fukuyama, Japan
(Sharp) Royal Devon and Exeter Hospital and University of Exeter, Exeter,
United Kingdom
(Salinas, Herrera, Escaned) Hospital Clinico San Carlos, Faculty of
Medicine, Complutense University, Madrid, Spain
(Kawase, Matsuo) Gifu Heart Center, Gifu, Japan
(Giavarini, Di Mario) Royal Brompton Hospital and Harefield Trust, London,
United Kingdom
(Nakayama) Toda Central General Hospital, Toda, Japan
(De Rosa, Indolfi) Universita degli Studi Magna Graecia di Catanzaro,
Catanzaro, Italy
(Wijntjens, Piek) Academic Medical Centre, Amsterdam, Netherlands
(Mori, Yamawaki) Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
(Mates) Na Homolce Hospital, Prague, Czech Republic
(Mizuno) St Luke's International Hospital, Tokyo, Japan
(Hellig) Sunninghill Hospital, Johannesburg, University of Cape Town,
South Africa
(Lee) United Lincolnshire Hospital, Lincoln, United Kingdom
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Horie) Sendai Kousei Hospital, Sendai, Japan
(Mohdnazri, Davies, Keeble) Essex Cardiothoracic Centre, Basildon and
Anglia Ruskin University, Chelmsford, Essex, United Kingdom
(Krackhardt) Charite-Universitatsmedizin Campus Virchow, Berlin, Germany
(Ribichini) University of Verona, Verona, Italy
Title
Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts
Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary
Results of the International Multicenter iFR GRADIENT Registry.
Source
JACC: Cardiovascular Interventions. 11 (8) (pp 757-767), 2018. Date of
Publication: 23 April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the accuracy of instantaneous
wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous
coronary intervention (PCI) physiological outcomes, and to quantify how
often iFR pullback alters PCI strategy in real-world clinical settings.
Background: In tandem and diffuse disease, offline analysis of continuous
iFR pullback measurement has previously been demonstrated to accurately
predict the physiological outcome of revascularization. However, the
accuracy of the online analysis approach (iFR pullback) remains untested.
Methods: Angiographically intermediate tandem and/or diffuse lesions were
entered into the international, multicenter iFR GRADIENT (Single
instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts
Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery
Disease) registry. Operators were asked to submit their procedural
strategy after angiography alone and then after iFR-pullback measurement
incorporating virtual PCI and post-PCI iFR prediction. PCI was performed
according to standard clinical practice. Following PCI, repeat iFR
assessment was performed and the actual versus predicted post-PCI iFR
values compared. Results: Mean age was 67 +/- 12 years (81% male). Paired
pre- and post-PCI iFR were measured in 128 patients (134 vessels). The
predicted post-PCI iFR calculated online was 0.93 +/- 0.05; observed
actual iFR was 0.92 +/- 0.06. iFR pullback predicted the post-PCI iFR
outcome with 1.4 +/- 0.5% error. In comparison to angiography-based
decision making, after iFR pullback, decision making was changed in 52
(31%) of vessels; with a reduction in lesion number (-0.18 +/- 0.05
lesion/vessel; p = 0.0001) and length (-4.4 +/- 1.0 mm/vessel; p <
0.0001). Conclusions: In tandem and diffuse coronary disease, iFR pullback
predicted the physiological outcome of PCI with a high degree of accuracy.
Compared with angiography alone, availability of iFR pullback altered
revascularization procedural planning in nearly one-third of
patients.<br/>Copyright &#xa9; 2018 The Authors

<63>
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.

<64>
Accession Number
620383465
Author
Kverneland L.S.; Kramer P.; Ovroutski S.
Institution
(Kverneland) Department of Internal Medicine, Herlev Hospital, Copenhagen,
Denmark
(Kverneland, Kramer, Ovroutski) Department of Congenital Heart
Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
Title
Five decades of the Fontan operation: A systematic review of international
reports on outcomes after univentricular palliation.
Source
Congenital Heart Disease. 13 (2) (pp 181-193), 2018. Date of Publication:
March/April 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Almost fifty years after its first clinical application, the modified
Fontan operation is among the most frequently performed procedures in
congenital heart disease surgery in children today. The objective of this
review is to systematically summarize the international evolution of
outcomes in regard to morbidity and mortality of patients with Fontan
palliation. All studies published over the past five decades with more
than 100 Fontan patients included were screened. In eligible studies,
information concerning preoperative patients' characteristics, Fontan
modifications employed, early mortality, long-term survival and frequency
of relevant complications was extracted. Ultimately, thirty-one studies
published by the largest surgical centers with an overall number of 9390
patients were included in this review. The extracardiac total
cavopulmonary anastomosis is the most frequently used Fontan modification.
Hemodynamic data demonstrate a rigorous overall adherence to suggested
Fontan selection criteria. The analysis showed a clear trend toward
improved early and long-term survival over the time period covered.
Although inconsistently reported, severe complications such as
arrhythmias, thromboembolic events and protein-losing enteropathy as well
as reoperations and reinterventions were frequent. In conclusion, patients
palliated for complex univentricular heart malformations nowadays benefit
from the experience and technical developments of the past decades and
have a significantly improved long-term prognosis. However, important
issues concerning postoperative long-term morbidity and mortality are
still unsolved and clear intrinsic limitations of the Fontan circulation
are becoming evident as the population of Fontan patients
ages.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<65>
Accession Number
2000597707
Author
Fitzsimons S.; Evans J.; Parameshwar J.; Pettit S.J.
Institution
(Fitzsimons, Evans, Parameshwar, Pettit) Transplant Unit, Papworth
Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
(Fitzsimons, Evans, Parameshwar, Pettit) Department of Public Health and
Primary Care, University of Cambridge, Cambridge, United Kingdom
Title
Utility of troponin assays for exclusion of acute cellular rejection after
heart transplantation: A systematic review.
Source
Journal of Heart and Lung Transplantation. 37 (5) (pp 631-638), 2018. Date
of Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: Acute cellular rejection (ACR) is a common complication in the
first year after heart transplantation (HT). Routine surveillance for ACR
is undertaken by endomyocardial biopsy (EMB). Measurement of cardiac
troponins (cTn) in serum is an established diagnostic test of cardiac
myocyte injury. This systematic review aimed to determine whether cTn
measurement could be used to diagnose or exclude ACR. Methods: PubMed,
Google Scholar and the JHLT archive were searched for studies reporting
the result of a cTn assay and a paired surveillance EMB. Significant ACR
was defined as International Society for Heart and Lung Transplantataion
(ISHLT) Grade >=3a/>=2R. Considerable heterogeneity between studies
precluded quantitative meta-analysis. Individual study sensitivity and
specificity data were examined and used to construct a pooled hierarchical
summary receiver-operator characteristic (ROC) curve. Results: Twelve
studies including 993 patients and 3,803 EMBs, of which 3,729 were paired
with cTn levels, had adequate data available for inclusion. The overall
rate of significant ACR was 12%. There was wide variation in diagnostic
performance. cTn assays demonstrated sensitivity of 8% to 100% and
specificity of 13% to 88% for detection of ACR. The positive predictive
value (PPV) was low but the negative predictive value (NPV) was relatively
high (79% to 100%). High-sensitivity cTn assays had greater sensitivity
and NPV than conventional cTn assays for detection of ACR (sensitivity:
82% to 100% vs 8% to 77%; NPV: 97% to 100% vs 81% to 95%, respectively).
Conclusions: cTn assays do not have sufficient specificity to diagnose ACR
in place of EMB. However, hs-cTn assays may have sufficient sensitivity
and negative predictive value to exclude ACR and limit the need for
surveillance EMB. Further research is required to assess this
strategy.<br/>Copyright &#xa9; 2018 International Society for the Heart
and Lung Transplantation

<66>
Accession Number
620256610
Author
Angleitner P.; Kaider A.; Gokler J.; Moayedifar R.; Osorio-Jaramillo E.;
Zuckermann A.; Laufer G.; Aliabadi-Zuckermann A.
Institution
(Angleitner, Gokler, Moayedifar, Osorio-Jaramillo, Zuckermann, Laufer,
Aliabadi-Zuckermann) Division of Cardiac Surgery, Department of Surgery,
Medical University of Vienna, Vienna, Austria
(Kaider) Center for Medical Statistics, Informatics, and Intelligent
Systems, Medical University of Vienna, Vienna, Austria
Title
High-dose catecholamine donor support and outcomes after heart
transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (5) (pp 596-603), 2018. Date
of Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: Higher dose norepinephrine donor support is a frequent reason
for donor heart decline, but its associations with outcomes after heart
transplantation are unclear. Methods: We retrospectively analyzed 965
patients transplanted between 1992 and 2015 in the Heart Transplant
Program Vienna. Stratification was performed according to donor
norepinephrine dose administered before organ procurement (Group 0: 0
micro&#32;g/kg/min; Group 1: 0.01 to 0.1 micro&#32;g/kg/min; Group 2: >0.1
micro&#32;g/kg/min). Sub-stratification of Group 2 was performed for
comparison of high-dose subgroups (Group HD 1: 0.11 to 0.4
micro&#32;g/kg/min; Group HD 2: >0.4 micro&#32;g/kg/min). Associations
between groups and outcome variables were investigated using a
multivariable Cox proportional hazards model and logistic regression
analyses. Results: Donor norepinephrine dose groups were not associated
with overall mortality (Group 1 vs 0: hazard ratio [HR] 1.12, 95%
confidence interval [CI] 0.87 to 1.43; Group 2 vs 0: HR 1.07, 95% CI 0.82
to 1.39; p = 0.669). No significant group differences were found for rates
of 30-day mortality (p = 0.35), 1-year mortality (p = 0.897), primary
graft dysfunction (p = 0.898), prolonged ventilation (p = 0.133) and renal
replacement therapy (p = 0.324). Groups 1 and 2 showed higher rates of
prolonged intensive care unit stay (18.9% vs 28.5% vs 27.5%, p = 0.005).
High-dose subgroups did not differ significantly in 1-year mortality
(Group HD 1: 14.3%; Group HD 2: 17.8%; p = 0.549). Conclusions: Acceptance
of selected donor hearts supported by higher doses of norepinephrine may
be a safe option to increase the donor organ pool.<br/>Copyright &#xa9;
2018 International Society for the Heart and Lung Transplantation

<67>
Accession Number
621719733
Author
Wilkens S.J.; Smith P.; Patel A.
Institution
(Wilkens) Pediatric Cardiology, Stanford University, Lucile Packard
Children's Hospital, Palo Alto, CA, United States
(Smith) Northwestern University, Chicago, IL, United States
(Patel) Pediatric Cardiology, Northwestern University, Ann and Robert H.
Lurie Children's Hospital of Chicago, Chicago, IL, United States
Title
Narrative review of ethical considerations in pediatric heart
transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S403), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Advancements in pediatric heart transplantation have led to
improvement in survival for children who develop end stage heart failure.
Conversations regarding prognostication, management discussions, and
treatment options have similarly shifted. Given the severity of the
illness, significant morbidity and mortality risk involved, and limited
resource of donor organs, ethical dilemmas often arise. This narrative
review aims to evaluate the existing evidence on ethical issues in
pediatric heart transplantation. Methods: We searched PubMed MEDLINE,
Embase, Web of Science, Cochrane Database of Controlled Trials, and CINAHL
databases from inception to 12/31/2016. We used controlled vocabulary when
possible. Search terms included, but not limited to: 'terminal care',
'medical futility', 'ethics', 'morals', 'informed consent' and 'heart
failure', 'heart transplantation', 'cardiomyopathies', 'congenital heart
defects' and 'pediatric', 'child', 'adolescent', 'infant'. An independent
double data extraction was performed to screen and select the relevant
articles based on the predefined inclusion and exclusion criteria.
Results: We identified 48 articles spanning the years 1984-2016.
Twentynine studies were published between 1984-1995, 8 between 1996-2005,
and 11 between 2005-2016. We identified 7 categories of articles: 12
opinion/ commentary/editorial articles, 14 ethical reviews, 4 medical
review papers, 2 cross-sectional survey studies, 8 case-report/series
papers, 2 legal reviews, and 6 grey literature articles. On analysis of
the studies, the following ethical themes emerged: informed consent,
decision making, legal standards, organ distribution and resource
allocation, surgical innovation, xenotransplantation, anencephalic infants
as organ donors, use of mechanical support, and research/experimentation.
Conclusion: There is a critical need to explore ethical questions related
to pediatric heart transplantation. Although themes of informed consent,
decision making, organ distribution, and resource allocation remained
constant, the existing literature is mainly comprised of opinion,
commentary and review papers. Future studies should focus on
evidence-based approaches to understand existing and emerging ethical
issues.

<68>
Accession Number
621719709
Author
Mundisugih J.; Fernando H.; Bergin P.; Hare J.; Kaye D.M.; Leet A.S.;
Taylor A.J.
Institution
(Mundisugih, Fernando, Bergin, Hare, Kaye, Leet, Taylor) Department of
Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
Title
The optimal initial immunosuppressive strategy for orthotopic heart
transplantation in renal dysfunction-a comparison of commonly used
regimes.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S419-S420),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Renal dysfunction is a common complication following orthotopic
heart transplantation (OHTx) that may be worsened by the early initiation
of calcineurin inhibitors (CNI), especially in patients with pre-existing
renal impairment. As a result, delayed initiation of CNI or CNI-free
immunosuppression regimes are sometimes unavoidable, and temporizing
strategies involving anti-thymocyte globulin (ATG) or basiliximab are used
as an adjunct to immunosuppressive protocols. However, the most effective
strategy for preventing acute cellular rejection (ACR) in this context is
uncertain. Methods: We reviewed all OHTx in our institution between
January 2012 and June 2017. The standard therapy consisted of
mycophenolate, prednisolone, and tacrolimus. In the presence of
significant renal impairment, an early CNI free regime with basiliximab
+/- ATG was utilized. In these patients either delayed tacrolimus or the
CNI sparing agent everolimus was then added within the first week
depending on renal function. Patients were excluded if they received other
immunosuppressive strategies or if they died within 4 weeks of OHTx.
Patients were assigned to cohorts based on the initial immunosuppressive
strategy. All cardiac biopsy were performed weekly and ACR was classified
as the International Society for Heart and Lung Transplantation (ISHLT)
Class >= IIR. The primary endpoint was the freedom rate of ACR within 4
weeks of OHTx. Results: Of 126 cases, 93 patients made up the study
population; 21 patients received standard therapy, 64 patients received an
initial CNI free regime with basiliximab alone, and 8 patients received
ATG and basiliximab. Freedom from ACR was greater in patients treated with
ATG and basiliximab (all rejection free), compared with 40/64 patients
(63%) treated with basiliximab and 10/21 patients (48%) treated with
standard therapy (p < 0.05, log rank test). In patients treated with
basiliximab alone, early administration (< 24 hours) was associated with a
higher freedom from ACR compared to >= 24 hours, (72% vs 29%, p < 0.05).
Conclusion: The combination of ATG and basiliximab is more effective in
preventing ACR than either standard therapy or basiliximab alone. In
patients treated with basiliximab alone, the rates of ACR were no worse
than standard therapy; however it is most effective when administered
within 24 hours.

<69>
Accession Number
621719703
Author
Nytroen K.; Rolid K.; Andreassen A.K.; Yardley M.; Bjorkelund E.; Authen
A.R.; Grov I.; Gude E.; Wigh J.P.; Dall C.H.; Gustafsson F.; Karason K.;
Gullestad L.
Institution
(Nytroen, Rolid, Andreassen, Yardley, Bjorkelund, Authen, Grov, Gude,
Gullestad) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
(Wigh, Karason) Sahlgrenska University Hospital, Gothenburg, Sweden
(Dall) Department of Cardiology, Bispebjerg University Hospital,
Copenhagen, Denmark
(Gustafsson) Rigshospitalet University Hospital, Copenhagen, Denmark
Title
Effect of high-intensity interval training in de novo heart transplant
recipients-1 year follow up (The HITTS study).
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S196), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Summary of Objectives: There is no consensus on how, when or at what
intensity exercise should be performed and organized after heart
transplantation (HTx). We have recently shown that high-intensity interval
training (HIT) is safe, well tolerated and efficacious in maintenance HTx
recipients. So far there have been no studies with HIT in de novo HTx
patients. The major reason for this has been a concern for adverse effects
due to a denervated heart. However, we and others have demonstrated that a
partial reinnervation takes place with a near normalization of the heart
rate (HR) response to exercise during the first year after HTx, possibly
explaining the tolerability to this form of exercise in maintenance HTx
patients. In contrast, the newly transplanted heart totally lacks
innervation and consequently the heart rate response is greatly reduced.
Heart failure patients are frequentlydeconditioned with low muscular
capacity. Since muscular capacity is an important determinant of exercise
capacity, our hypothesis is that HIT should be introduced as early as
possible after surgery and will result in a clinically meaningful
improvement in exercise capacity, muscular strength and quality of life
(QoL). Thus, we have extended the HIT protocol also to de novo HTx
patients (the HITTS study; High-intensity Interval Training in de novo
Heart Transplant Recipients in Scandinavia). Methods: The HITTS study is a
RCT including 80 adult de novo HTx patients (the intervention will be
completed December 2017), randomized 1:1 to either HIT (4x4 min intervals
at 85-95% of peak heart rate (HR) or regular moderate continuous training
(MICT) (60-80% of peak HR). The intervention starts three months post HTx
and lasts for nine months. The intervention is carried out in the primary
health care setting; at local rehabilitation centers run by authorized
physical therapists. Endpoints: The primary outcome is the effect of HIT
vs MICT on aerobic exercise capacity as assessed by peak VO2, measured
with breath by breath gas exchange on a treadmill or bicycle ergometer.
Metabolic/respiratory measures include peak VO2 and VE/VCO2 slope.
Secondary outcomes are: Isokinetic muscular strength, body composition,
left ventricular function, hemodynamics, HR response, relevant circulation
biomarkers, QoL, tolerability, safety and adverse events.

<70>
Accession Number
621719676
Author
Belkin M.N.; Nnanabu J.; Mehta P.P.; Feldman T.; Penicka M.; Giannini C.;
Fiorelli F.; Braun D.; Swaans M.; Heyden J.V.; Claeys M.; Orban M.;
Kalantari S.; Raikhelkar J.; Sarswat N.; Kim G.; Sayer G.; Uriel N.
Institution
(Belkin, Nnanabu, Mehta) Internal Medicine Residency Program, Department
of Medicine, University of Chicago, Chicago, IL, United States
(Feldman) Cardiology, NorthShore University Health System, Evanston, IL,
United States
(Penicka) Cardiology, OLV Clinic, Aalst, Belgium
(Giannini, Fiorelli) Cardiology, Aziena Ospedaliero Universitaria Pisana,
Pisa, Italy
(Braun) Cardiology, Klinikum der Universitat Munchen, Munich, Germany
(Swaans, Heyden) Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Claeys) Cardiology, University Hospital Antwerp, Edegem, Belgium
(Orban) Cardiology, Ludwig-Maximilians-Universitat Munchen, Munich,
Germany
(Kalantari, Raikhelkar, Sarswat, Kim, Sayer, Uriel) Cardiology, University
of Chicago, Chicago, IL, United States
Title
Outcomes following mitraclip in advanced heart failure patients: A
meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S201), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Mitral regurgitation (MR) is associated with increased mortality
in heart failure patients. Mitraclip has shown similar mortality, but less
morbidity, in comparison with surgical repair, and it is indicated in
patients at high surgical risk. Further analysis has suggested worse
outcomes in patients with advanced heart failure. This study aims to
assess outcomes following Mitraclip placement in patients with advanced
heart failure (either EF < 35% and/or NYHA class IV symptoms). Methods:
The Ovid Medline, Cochrane, and Scopus databases (through 12/2016) were
searched. Randomized controlled trials, prospective, and retrospective
studies of Mitraclip use in patients with mortality outcomes at 12-month
follow-up were included. Results: Of 595 studies identified, 25 were
included, of which 10, evaluating 1,042 patients, provided additional
essential data, 13 did not respond, and 2 denied our request. Average age
was 72.5 years, 28.9% were female, and 69% had functional MR. A
significant increase in mortality was noted in patients with EF < 35%
compared to those with EF > 35%. Mortality rates were 19.8% and 12.8%,
respectively, and RR 1.53 (95% CI 1.08-2.17, p= 0.02). Patients with NYHA
IV symptoms at the start of the study had a significant increase in
mortality, with a rate of 33.7% vs 13.6% for NYHA I-III, and RR 2.08 (95%
CI 1.58-2.73, p< 0.00001). In 5 studies with data comparing those with EF
< 35% and NYHA IV symptoms to those with EF > 35% and NYHA I-III symptoms,
mortality rates were significantly increased in the former group, 28.6% vs
7.2%, respectively, and RR 4.05 (95% CI 1.90-8.62, p= 0.003). Conclusion:
Mitraclip implantation in patients with advanced heart failure was
associated with significantly increased rates of mortality at 12-month
follow-up, with one in three NYHA class IV patients undergoing Mitraclip
dead within one year. This meta-analysis calls for evaluation of
advancedheart failure options (i.e. left ventricular assist device or
heart transplant) as an alternative to Mitraclip (Figure presented).

<71>
Accession Number
621719668
Author
Menachem J.N.; Lindenfeld J.; Schlendorf K.; Shah A.S.; Bichell D.P.; Book
W.; Brinkley D.; Danter M.; Frischhertz B.; Keebler M.; Kogon B.; Mettler
B.; Rossano J.; Sacks S.B.; Young T.; Wigger M.; Zalawadiya S.
Institution
(Menachem, Lindenfeld, Schlendorf, Shah, Bichell, Brinkley, Danter,
Frischhertz, Keebler, Mettler, Sacks, Wigger, Zalawadiya) Vanderbilt
University Medical Center, Nashville, TN, United States
(Book) Emory University, Atlanta, GA, United States
(Kogon) University of Mississippi, Jackson, MS, United States
(Rossano) Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Young) Ochsner Health System, New Orleans, LA, United States
Title
Transplant center volume impacts survival among ACHD patients undergoing
heart transplantation - An analysis of the UNOS registry.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S424-S425),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Adult congenital heart disease (ACHD) patients undergoing heart
transplant (HT) have inferior outcomes compared to non-ACHD patients. The
impact of transplant center volume on outcomes in this area has not been
well studied. Methods: Using the UNOS data registry, we analyzed ACHD
patients undergoing HT between 1/2000 and 12/2015. Excluding transplants
in patients <18 years retransplants, and history of any solid organ
transplant, center volumes were stratified into three groups: low-volume
(LVC) (ref. category; <14 HT/year, n= 221), medium-volume (MVC) (14-38
HT/year, n = 362), and high-volume (HVC) (>38 HT/year, n= 244).
Kaplan-Meier survival and multivariable Cox-proportional hazard analyses
were performed to assess 1-year risk of mortality of transplanted ACHD
patients across groups. Results: 827 ACHD patients were identified (age
36+/-13years; 60% men, 84% Caucasian). HT patients at LVC were younger
(30+/-12years), had lower body mass index (23.6+/-4.9 kg/m²)
and higher estimated glomerular filtration rate (eGFR 117+/-67) compared
to MVC (age: 38+/-12years, BMI:25.2+/-5.5 kg/m² and
eGFR:95+/-72) and HVC (age:38+/-13years, BMI:25.2+/-5.5, eGFR:91+/-39)
(p<0.01 for all). Donors at LVC- were younger (25+/-11years) with lower
creatinine (1.1+/-0.7mg/dL) compared to MVC (age:28+/-11years,
creatinine:1.3+/-1) (Figure presented) (Table presented) and HVC
(age:31+/-12years, creatinine:1.3+/-1.3) (p<0.05 for all). Compared to
LVC, patients transplanted at MVC and HVC had lower risk of 1-year
mortality (adjusted hazard ratio:0.61 for MVC, 95% confidence interval
(CI):0.42-0.88, p= 0.008; aHR:0.57 for HVC, 95% CI:0.38-0.87, p= 0.009).
Conclusion: 1-year survival in ACHD patients undergoing HT is influenced,
in part, by transplant center volume, with LVC performing poorly relative
to MVC and HVC. 1-year survival of ACHD HT at MVC and HVC is approaching
that of non-ACHD patients. Strategies to improve transplant outcomes in
ACHD patients are needed, such as development of regional ACHD transplant
centers.

<72>
Accession Number
621719667
Author
Relbo Authen A.; Grov I.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran
G.; Gude E.; Jansson K.; Solbu D.; Arora S.; Dellgren G.; Andreassen A.K.;
Gullestad L.
Institution
(Relbo Authen, Grov, Gude, Arora, Andreassen) Department of Cardiology,
Oslo University Hospital Rikshospitalet, Oslo, Norway
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Skejby University Hospital, Aarhus,
Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital, Lund University, Lund, Sweden
(Jansson) Dept of Cardiology County Hospital, Linkoping University,
Linkoping, Sweden
(Solbu) Novartis Employee, Novartis Norway AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) Department of Cardiology, K.G. Jebsen Cardiac Research Centre,
Oslo University Hospital, Oslo, Norway
Title
The effect of everolimus vs calcineurin inhibitors on quality of life
during 5-6 years follow-up after heart transplantation: The results of a
randomized controlled trial (SCHEDULE).
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S300), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Due to long term complications of calcineurin inhibitors (CNI) in
heart transplantation (HTx), there has been an increasing interest in
everolimus (EVR)-based regimens allowing for CNI withdrawal. However, EVR
has been associated with a different adverse effect profile, which may
impact quality of life (QoL). We examined QoL in The Scandinavian heart
transplant everolimus de novo study with early CNI avoidance (SCHEDULE
trial). Our aim was to compare QoL in patients treated with a CNI-based
regimen versus a CNI free EVR based regimen after 1, 3 and 5-6 years
follow up, after HTx. Methods: 115 patients (mean age 51+/-13 years, 27 %
women) were randomly assigned within 5 days postoperatively to low dose
EVR and reduced dose CsA followed by CsA withdrawal in week 7-11 (EVR
group; n= 56) or standard CsA dosage (CNI group; n= 59). Of these, a
number of 52, 49 and 46 recipients attended in the EVR Group, pluss 56, 51
and 47 in the CNI group one, three and six years later. The primary
endpoint was renal function assessed by measured glomerular filtration
rate (mGFR) at 1, 3, and 5-6 years post HTx. Secondary objectives were
number of rejections, serious adverse events (SAE) and QoL. QoL was
assessed pre HTx, 1, 3, and 5-6 years post HTx by the Short Form-36,
21-item Beck Depression Inventory (BDI) & Euroqual (EQ 5D). Results:
During the first 12 and 36 months the EVR group as compared with the CNI
group demonstrated improved renal function and reduced progression of
coronary artery vasculopathy (CAV). More biopsy proven rejections occurred
in the EVR-group during the first year, but not thereafter. The rates of
SAE were similar in both groups. During the first year QoL improved
significantly in both EVR and CNI treated patients, without any
significant differences between groups after 1 and 3 years. The 5-6-year
follow up data on QoL, renal function, CAV and SAE are completed in
November 2017, and will be presented. Conclusion: Early elimination of CsA
and replacement with an EVR-based immunosuppression resulted in a similar
improvement in QoL as treatment with conventional CNI-regimen 1 and 3 year
after HTx. The 5-6-year follow up on QoL, will be presented when
completed, after November 2017.

<73>
Accession Number
621719646
Author
Imamura T.; Murks C.; Riley T.; Powers J.; Chung B.; Nguyen A.; Rodgers
D.; Raikhelkar J.; Kalantari S.; Costanzo M.R.; Jorde U.; Ota T.; Song T.;
Onsager D.; Juricek C.; Jeevanandam V.; Kim G.; Sayer G.; Uriel N.
Institution
(Imamura, Murks, Riley, Powers, Chung, Nguyen, Rodgers, Raikhelkar,
Kalantari, Ota, Song, Onsager, Juricek, Jeevanandam, Kim, Sayer, Uriel)
University of Chicago, Chicago, IL, United States
(Costanzo) Advocate Heart Institute, Naperville, IL, United States
(Jorde) Montefiore Medical Center, New York, NY, United States
Title
Comparison of survival and readmission rates in patients 65 and older
undergoing heart transplantation or LVAD implantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S320-S321),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Heart transplantation (HTx) is the gold standard therapy for
patients with advanced heart failure. However, recent improvements in LVAD
outcomes have raised the question of whether LVAD is a viable alternative
to HTx in a subset of patients that are at higher risk of
transplant-related complications. The purpose of this study was to compare
clinical outcomes, including hospital readmission rates, in patients aged
65 and older treated with LVAD versus HTx. Methods: A standard protocol to
manage both LVAD and HTx patients was implement in a large academic
medical center since 2014. Clinical outcomes among patients aged 65-72,
including all-cause death and readmissions, were compared between these
two therapies. Results: 57 patients (37 LVAD patients and 20 HTx patients)
aged 65-72 years old who received heart replacement therapy between
2014-2017 were enrolled. There were no differences in baseline
characteristics between the groups (age 68.6 +/- 2.8 years vs. 67.5 +/-
1.9 years and 76% male vs. 80% male, respectively). One-year survival
trended to be higher in the transplant group (95% vs 78%, p = 0.10; Figure
1A). However, readmission-free survival was similar (HTx 5% vs. LVAD 17%,
p = 0.41; Figure 1B). The readmission event per patient-year was similar
as well (HTx 2.25 +/- 1.19 events/year vs. LVAD 2.68 +/- 2.80 events/year,
p = 0.44; Figure 1C). The main causes of readmission were gastrointestinal
bleeding (20%) in the LVAD group and infection (36%) in the HTx group.
Conclusion: LVAD therapy had comparable 1-year survival and
hospitalization rate with HTx in patients aged 65-72 years old. Longer
follow up studies are needed to assess if it is time to preform a
randomized study between LVAD and HTx in this patients population. (Figure
presented).

<74>
Accession Number
621719569
Author
Briasoulis A.; Inampudi C.; Alvarez P.; Voruganti D.C.; Ando T.; Bhama
J.K.
Institution
(Briasoulis, Inampudi, Alvarez) Department of Internal
Medicine-Cardiology, University of Iowa Hospitals and Clinics, Iowa, IA,
United States
(Voruganti) Department of Internal Medicine, University of Iowa Hospitals
and Clinics, Iowa, IA, United States
(Ando) Department of Internal Medicine-Cardiology, Wayne State University,
Division of Cardiology, Detroit, MI, United States
(Bhama) Department of Surgery-Cardiothoracic Surgery, University of Iowa
Hospitals and Clinics, Iowa, IA, United States
Title
Induction immunosuppressive therapy in cardiac transplantation: A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S106-S107),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Approximately 50 percent of heart transplant programs currently
employ a strategy of induction therapy (IT) with either Interleukin-2
receptor antagonists (IL2RA) or Polyclonal anti-thymocyte antibodies
(ATG), during the early postoperative period. However, the overall utility
of induction is uncertain and data comparing induction protocols are
limited. Methods: The authors searched PubMed, the Cochrane Central
Register of Controlled Trials, and ClinicalTrials.gov through October,
2017, for randomized controlled trials (RCTs) or observational controlled
observational studies of IT vs no IT and IL2RA vs ATG. Inverse variance
fixedeffects models with odds ratio (OR) as the effect measure were used
for primary analyses. Main outcomes moderate to severe rejection,
all-cause mortality, infection and cancer. Results: The authors' search
retrieved 2,449 studies, of which 11 met criteria for inclusion (9 RCTs
and 2 observational studies). Quality of evidence for RCTs was moderate to
high. Overall, patients receiving IT had similar risk of
moderate-to-severe-rejection, all-cause death, infection and cancer with
patients who did not receive IT (Figure). Use of IL2RA was associated with
significantly higher risk of moderate-to-severe rejection than ATG (OR:
3.4; 95% CI: 1.4 to 8.1, Figure), but similar risk of death, infections
and cancer. Conclusion: The use of IT was not associated with any benefits
or harms compared with no IT. Moderate to severe rejection might be
reduced by ATG compared with IL2RA (Figure presented).

<75>
Accession Number
621719557
Author
Mokadam N.A.; Pagani F.D.; Boyce S.W.; Slaughter M.S.; Selzman C.H.; Pham
D.T.; Aaronson K.D.; Vassiliades T.A.; Milano C.A.
Institution
(Mokadam) University of Washington, Seattle, WA, United States
(Pagani, Aaronson) University of Michigan, Ann Arbor, MI, United States
(Boyce) MedStar Health, Washington, DC, United States
(Slaughter) University of Louisville, Louisville, KY, United States
(Selzman) University of Utah, Salt Lake City, UT, United States
(Pham) Northwestern, Chicago, IL, United States
(Vassiliades) Medtronic, Framingham, MA, United States
(Milano) Duke University, Durham, NC, United States
Title
The effects of concomitant procedures at the time of LVAD implant for
patients in the ENDURANCE and ENDURANCE supplemental trials.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S194), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Advanced heart failure patients often have other pathologies that
can be surgically treated at the time of left ventricular assist device
(LVAD) implantation. Further investigation of concomitant procedures such
as valve repairs/replacements, ICD insertion, and septal defect repairs
are necessary. Methods: This is a retrospective analysis of all subjects
in the ENDURANCE (n= 445) and ENDURANCE Supplemental (n= 465) trials.
Figure 1 shows the frequency of concurrent valve procedures. After
grouping by device type and concurrent cardiac valve repair types, adverse
event profiles and Kaplan Meier survival outcomes were compared. Results:
In patients receiving an HVAD, 23.8% (144/604) had a concurrent valve
procedure compared to 27.1% (83/306) of patients receiving the control
device (p= NS). Kaplan Meier survival estimates at five years for patients
with and without a concurrent valve procedure were not significantly
different for either the study device (p= 0.38) or control device patients
(p= 0.83). Adverse event profiles were likewise generally similar for
patients with and without concurrent cardiac valve procedures. However,
study device patients who had a cardiac valve procedure had a lower
incidence of pump thrombosis (13.2%, 19/144, p= 0.047) compared to those
without a valve procedure (20.8%, 81/390). Ischemic cerebrovascular
accidents were also less frequent for the concurrent valve group (12.5%,
18/144, p= 0.056) compared to the patients without a valve procedure
(20.0%, 78/390). The incidence of pump thrombosis and ischemic
cerebrovascular accidents was not different for control patients with and
without concurrent procedures. Conclusion: Patients with and without
cardiac valve repairs at the time of implantation did not show a
significant difference in survival at five years. However, concurrent
valve repair with HVAD implantation was associated with reduced adverse
events which could play a role in determining concomitant treatment
strategies (Figure presented).

<76>
Accession Number
621719545
Author
Pahl E.; Andrei A.; Vant Hof K.; Liu M.; Shankel T.; Chinnock R.; Miyamoto
S.; Ambardekar A.V.; Anderson A.; Addonizio L.J.; Latif F.; Lefkowitz D.;
Goldberg L.; Hollander S.; Pham M.; Weissberg-Benchell J.; Cool N.; Yancy
C.; Grady K.L.
Institution
(Pahl, Vant Hof) Cardiology, Ann and Robert H. Lurie Children's Hospital
of Chicago, Chicago, IL, United States
(Andrei, Anderson) Cardiology, Northwestern University Feinberg School of
Medicine, Chicago, IL, United States
(Liu) Cardiology, Bluhm Cardiovascular Institute, Chicago, IL, United
States
(Shankel, Chinnock) Cardiology, Loma Linda University, Loma Linda, CA,
United States
(Miyamoto) Pediatric Cardiology, University of Colorado, Denver, CO,
United States
(Ambardekar) Cardiology, University of Colorado, Denver, CO, United States
(Addonizio, Latif) Cardiology, Columbia University, New York, NY, United
States
(Lefkowitz) Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Goldberg) Univeristy of Pennsylvania, Philadelphia, PA, United States
(Hollander, Pham) Stanford University, Palo Alto, CA, United States
(Weissberg-Benchell) Ann and Robert H. Lurie Children's Hospital of
Chicago, Chicago, IL, United States
(Cool) Bluhm Cardiovascular Institute, Chicago, IL, United States
(Yancy, Grady) Northwestern University Feinberg School of Medicine,
Chicago, IL, United States
Title
Pediatric heart transplantation: Transitioning to adult care TRANSIT.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S392-S393),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Pediatric heart transplant (HT) recipients who transition to
adult care as young adults are at risk for rejection and death. We
assessed whether an intervention focused on enhancing adherence could
improve outcomes for these patients (pts). Methods: Pts were randomized to
the intervention group (IG) or usual care (UC). The intervention focused
on enhancing HT knowledge, self-care, selfadvocacy, and support via
computer-based education modules and individualized discussion with HT
coordinators, delivered before and through 3 months post transition, with
follow-up through 6 months. Outcomes: (1) immunosuppression levels, (2) pt
self-report of adherence, and (3) episodes of acute rejection,
rehospitalization, and death. Medical records data were collected at
baseline, 3 and 6 months. Groups were compared via t-tests and chi square.
Results: The 88 pts (IG [n= 43]) and UC [n= 45]) were enrolled over 3
years at 6 U.S. pediatric sites, paired with local adult sites. At 6
months follow-up, 37 IG pts (86%) and 41 UC pts (91%) were retained.
Baseline demographics were similar in the IG and UC groups: age 21 +/- 3.2
vs 22 +/- 3.3 years; female 44% vs 49%; Caucasian 81% vs 76%; and > high
school education 61% vs 69%, respectively. Most pts in both groups were on
tacrolimus (tacro) (IG= 70% vs UC= 62%). At 3 months after transition, pts
in IG and UC had similar mean tacro levels (6.1 +/-1.8 vs 6.3 +/- 2.2),
although IG pts had blood levels within target range more frequently than
UC pts (83% vs 47%, p= 0.005). At 3 months, tacro standard deviation (SD)
trended toward better adherence in the IG (1.05 vs 1.77, P = .08),
although these tacro SDs are consistent with good adherence in both
groups. By 6 months tacro SD levels were not significantly different: IG
1.48 vs UC 1.41. At 3 and 6 months, there were no significant differences
in pt self-report of adherence, mortality (none), acute rejection (2 pts
vs 0 pts), and re-hospitalization (8 vs 4) for IG and UC, respectively.
Conclusion: This pilot study confirmed successful transition with good
retention of a cohort of young adult HT pts. Although our educational
intervention may be efficacious at 3 months for some pt outcomes (i.e.,
tacro levels), at 6 months follow-up, no differences were detected between
groups for any outcomes. Extension of the intervention period after
transfer may be needed. More study is warranted in a larger randomized
controlled trial.

<77>
Accession Number
621719540
Author
Strueber M.; Cheung A.; Mokadam N.A.; Weiselthaler G.; Lee S.; Boeve T.;
Maltais S.; Pretorius V.; Danter M.; Vassiliades T.A.; McGee E.
Institution
(Strueber) Beth Israel Medical Center, Newark, NJ, United States
(Cheung) University of British Columbia, Vancouver, BC, Canada
(Mokadam) University of Washington, Seattle, WA, United States
(Weiselthaler) University of California San Francisco, San Francisco, CA,
United States
(Lee, Boeve) Spectrum Health, Grand Rapids, MI, United States
(Maltais) Mayo Clinic, Rochester, NY, United States
(Pretorius) University of California San Diego, San Diego, CA, United
States
(Danter) Vanderbilt University Medical Center, Nashville, TN, United
States
(Vassiliades) Medtronic, Framingham, MA, United States
(McGee) Loyola University Medical Center, Maywood, IL, United States
Title
Impact of the thoracotomy implant approach on average length of stay and
rehospitalizations in the HVAD LATERAL trial.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S83-S84),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The LATERAL Trial was designed to demonstrate the safety and
effectiveness of the HVAD System for refractory, end-stage heart failure
implanted via a thoracotomy approach. However, the key secondary endpoint
of improvement in the mean length of stay and rehospitalizations had not
been reported. Methods: The prespecified secondary endpoint in the LATERAL
Trial included an improvement in the mean length of initial hospital stay
as compared to a performance goal of median sternotomy subjects. The mean
length of initial hospital stay was compared to 26.1 days with a standard
deviation of 22.8 days and a median of 20 days based on sternotomy
approach data from the Bridge to Transplantation Continued Access Protocol
(BTT CAP) population (N= 242). Results: The 144 subjects in the study had
advanced heart failure associated with a substantial risk of death, as
evidenced by over 80% of subjects classified as Intermacs Profile 1-3 and
over 60% with ejection fractions lower than 20%. The mean length of
initial hospital stay (initial recovery and step down unit) was 18 +/-
12.36 days, significantly less than the 26.1 day performance goal (P<
0.0001). Mean length of stay in the intensive care unit (ICU) was 8 +/-
9.82 days. Rehospitalization was documented in 70.1% of patients within 6
months post implant in this bridge to transplant population. A freedom
from rehospitalization curve is presented in Figure 1. The most common
reason for rehospitalization was heart transplant (27.7%), followed by
anticoagulation adjustments (19.8%). Conclusion: This analysis of the
secondary endpoint of the LATERAL Trial demonstrated a significant benefit
in overall length of hospital stay in patients undergoing HVAD implant via
thoracotomy approach. These data add to the growing evidence that this
approach can be performed safely and effectively, perhaps also with some
advantages compared to sternotomy (Figure presented).

<78>
Accession Number
621719538
Author
Butts R.; Dipchand A.; Sutcliffe D.; Bano M.; Morrow R.; Kirk R.
Institution
(Butts, Sutcliffe, Bano, Kirk) Pediatrics, University of Texas
Southwestern, Dallas, TX, United States
(Dipchand) Pediatrics, SickKids Hospital of Toronto, Toronto, ON, Canada
(Morrow) Pediatrics, Children's Medical Center of Dallas, Dallas, TX,
United States
Title
Pretransplant amiodarone use and post-transplant outcomes in pediatric
heart transplant: A propensity score analysis of the ISHLT transplant
registry.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S400), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Amiodarone is used in children awaiting transplant who have or
develop arrhythmias. An association between pre-transplant amiodarone use
and worse early post-transplant graft survival in adult heart
transplantation has been established. There are no studies investigating
associations of pre-transplant amiodarone and post-transplant outcomes in
pediatric heart transplantation Methods: The ISHLT thoracic transplant
registry was queried for primary pediatric heart transplant recipients
(age < 18 years), between January 1, 2000 and June 30, 2015 who had
reporting of pre-transplant amiodarone. Propensity matching was used to
reduce bias. Primary endpoint was overall graft survival. Secondary
endpoints were one year graft survival, cause of graft failure, early
rejection, dialysis after transplant, and cardiac reoperation. Graft
survival was assessed by constructing a Cox proportional hazard model. One
year graft survival was assessed by logistic regression. Other endpoints
were compared between amiodarone cohorts utilizing chi-square test
Results: Pre-transplant amiodarone use was recorded in 465 of 4773 (9.7%)
transplants. Pre-transplant amiodarone recipients were older, more likely
to have cardiomyopathy, and less likely to be on ECMO (table). Utilizing
propensity score matching, differences between cohorts were removed
(table). After propensity score matching, amiodarone was not associated
with overall graft loss (HR= 0.80, p= 0.06) or one year graft survival (p=
0.41). Cause of graft failure (vasculopathy v. rejection v. primary
dysfunction v. other) did not differ between groups (p= 0.09). The
amiodarone cohort did not experience more rejection prior to discharge (p=
0.76), dialysis prior to discharge (p= 0.31), or cardiac reoperation (p=
0.35). Conclusion: In pediatric heart transplantation, pre-transplant
amiodarone use does not appear to confer an increased risk for graft loss
or early posttransplant morbidities. (Table presented).

<79>
Accession Number
621719503
Author
Savtchenko A.; Milligan J.; Alba C.; Kobulnik J.
Institution
(Savtchenko, Milligan) Core Internal Medicine, University of Toronto,
Toronto, ON, Canada
(Alba) Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Kobulnik) Cardiology, Sinai Health System, Toronto, ON, Canada
Title
Acceptable peri-operative risk for cardiac transplant: Physician and
patient perspectives.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S236), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Due to the absolute scarcity of donor hearts, the heart
transplant team at our institution will not offer transplant if the
peri-operative risk of mortality is felt to be greater than 20%. The aim
of this study was to evaluate the perspectives of physicians, physicians
imagining themselves as patients and patients. We hypothesized that all
three groups would differ with respect to acceptable peri-operative risk
and that each group would accept a risk greater than 20%. Methods: We
invited 645 physicians with cardiac transplant related publications to
partake in a survey. Participants were then randomized to survey A or B.
Survey A asked their acceptable peri-operative risk of mortality for
cardiac transplant in a hypothetical patient with congenital heart
disease. Survey B was an identical survey but asked physicians to answer
from the perspective of the hypothetical patient. Survey C asked 55
patients with heart failure their acceptable peri-operative risk for the
same scenario. Each survey described the scarcity of donor hearts.
Results: The response rate for physicians was 11% and for patients was
93%. Response number for surveys A, B and C were 37 (24% surgeons), 32
(23% surgeons) and 51. Mean acceptable risk of peri-operative mortality
was lower for survey A vs. survey C (45+/-27% vs. 56+/-20%, P= 0.04). The
mean acceptable peri-operative risk for survey B was 50+/-25%. Median
acceptable risks for surveys A, B, and C were 40%, 50% and 50%. All groups
on average accepted a peri-operative risk of mortality significantly
greater than our current threshold of 20% (P< 0.05). Conclusion: As
stewards of this absolute scarce societal resource, it is critical that we
understand acceptable peri-operative risk of cardiac transplant from the
perspective of all stakeholders. This preliminary data suggests that even
those who are very informed may accept a peri-operative risk much higher
than 20%. Future work should explore other perspectives; this may result
in more ethically sound decisions in high-risk cases.

<80>
Accession Number
621719486
Author
Ramaswamy M.; Beeman A.; Henwood S.; Hawkyard A.; Robertson A.; Ridout D.;
Walker A.; Patel R.; Simmonds J.; Muthialu N.
Institution
(Ramaswamy, Beeman, Henwood, Hawkyard, Robertson, Simmonds, Muthialu)
Great Ormond Street Hospital for Children, London, United Kingdom
(Ridout, Walker, Patel) University College London, London, United Kingdom
Title
Supplemental use of blood cardioplegia before graft implantation in
pediatric heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S399-S400),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Optimal preservation of donor myocardium in heart transplantation
is unknown. Despite many novel approaches, the best option currently
available is meticulous usage of cardioplegia (crystalloid or
blood-based). Adult studies have shown improved outcomes with supplemental
administration of cardioplegia before graft implantation. Similar studies
in children are lacking. The aim of this study is to analyze if
supplemental use of blood cardioplegia before graft implantation can
improve outcomes in pediatric heart transplantation. Methods:
Retrospective study performed in a single institution. All pediatric
patients who had heart transplantation from January 2007 to December 2016
(10 years) were included. They were divided into three groups based on
additional use of cardioplegia before graft implantation: no cardioplegia
(NC), crystalloid cardioplegia (CC) and blood cardioplegia (BC). Factors
analyzed included recipient's pre-transplant status [gender, age,
anthropometry, diagnosis, mechanical circulatory support (MCS), renal
failure and renal dialysis], donor details (gender, age, weight, use of
inotropes before harvest) and surgical information (graft ischemic time,
cardiopulmonary bypass time). The primary outcome was primary graft
failure (PGF), defined as use of MCS or poor ventricular function
demonstrated on echocardiography in early postoperative period. Secondary
outcomes were ventilation days, intensive care unit (ICU) days, new-onset
acute kidney injury, new-onset renal dialysis, mortality at 30 days and
survival beyond 30 days. Results: Out of 165 eligible children (NC = 22,
CC = 28, BC = 115), 34 had PGF. There was no significant difference
between the groups in the primary outcome (NC = 2, CC = 6, BC = 26, p =
0.35) and secondary outcomes [median ventilation days: NC = 4, CC = 3.5,
BC = 5, p = 0.37; median ICU days: NC = 9, CC = 8, BC = 10, p = 0.43;
new-onset acute kidney injury: NC = 17, CC = 19, BC = 87, p = 0.66;
new-onset renal dialysis: NC = 6, CC = 6, BC = 31, p = 0.83; 30-day
mortality: NC = 0, CC = 1, BC = 5, p = 0.61 and long-term survival (CC vs.
NC: HR = 1.13, 95%CI = 0.19 to 6.77, p = 0.89 & BC vs. NC: HR = 2.55,
95%CI = 0.59 to 11.02, p = 0.21)]. Conclusion: Supplemental use of blood
cardioplegia before graft implantation offers no advantage in early
outcomes of pediatric heart transplantation. Prospective, randomized,
multi-center studies are required.

<81>
Accession Number
621719463
Author
Duero Posada J.G.; Moayedi Y.; Alhussein M.; Bhagra S.; Fan S.; Manlhiot
C.; Stehlik J.; Dipchand A.I.; Ross H.J.
Institution
(Duero Posada, Alhussein) Cardiology, University Health Network, Toronto,
ON, Canada
(Moayedi) Cardiology, Stanford University, Palo Alto, CA, United States
(Bhagra) Cardiothoracic Transplantation, Papworth Hospital NHS Foundation
Trust, Papworth Everard, Cambridge, United Kingdom
(Fan, Dipchand) Cardiology, Hospital for Sick Children, Toronto, ON,
Canada
(Manlhiot, Ross) Cardiology, Ted Rogers Centre for Heart Research,
Toronto, ON, Canada
(Stehlik) Cardiology, University of Utah School of Medicine, Salt Lake
City, UT, United States
Title
Clinical outcomes associated with mtori initiation in adult heart
transplant: An ISHLT registry analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S19), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: mTOR inhibitor (mTORi) use after heart transplant (HT) has
increased. We aimed to examine the effect of early mTORi initiation on
clinical outcomes after HT. Methods: Consecutive adults undergoing primary
HT (2005-2014) reported to the ISHLT registry were assessed. Exclusion:
multi-organ recipients and patients with no first annual visit. A
propensity score was generated, two groups were matched 1:1 and compared:
early mTORi users (e-mTORi) in whom mTORi was initiated at time of
hospital discharge and continued until end of 1st year post-HT and
patients never exposed to mTORi (n-mTORi). The primary outcome was
re-transplant free survival, secondary outcomes were: treated acute
rejection episode (ARE) and freedom from non-skin cancer malignancy.
Outcomes were analyzed using the Kaplan-Meier method. Results: 15,018
adult HT recipients were identified; 967 (6.4%) e-mTORi and 12,267
n-mTORi, mean follow up was 4 years [2-6.9]. Of these, 931 e-mTORi were
matched to n-mTORi, these 1862 patients were included in the main
analysis. At baseline, e-mTORi users were more likely to have a history of
any malignancy (9.8% vs 6.6% p< 0.001). Baseline creatinine was not
different between groups (1.2 mg/dL +/- 0.5 p= 0.5). Re-transplant free
survival was not significantly different between groups (HR= 1.010
[0.762-1.340] p = 0.94); e-mTORi users were at increased risk of ARE (HR=
1.316 [1.050-1.649] p= 0.017), non-skin cancer (HR= 1.6 [1.199-2.135] p=
0.001) and renal dysfunction (HR= 1.552 [1.305-1.846] p< 0.001). The risk
of post-transplant vasculopathy was not significantly different between
groups (p= 0.68) Conclusion: Similar to clinical trials, 'real-life'
e-mTORi was associated with higher risk of treated ARE, but no increased
mortality. Higher pre-transplant malignancy in e-mTORi suggests clinician
preference for mTORi given possible antineoplastic effects. However,
e-mTORi users remained at increased risk of non-skin cancer malignancy and
renal dysfunction (Figure presented).

<82>
Accession Number
621719449
Author
Baran D.A.; Menchavez E.; Zucker M.J.; Gidea C.; Camacho M.
Institution
(Baran) Advanced Heart Failure and Transplant, Sentara Heart Hospital,
Norfolk, VA, United States
(Menchavez, Zucker) Heart Failure and Transplant, Newark Beth Israel
Medical Center, Newark, NJ, United States
(Gidea, Camacho) Newark Beth Israel Medical Center, Newark, NJ, United
States
Title
One Tac trial: Renal function after conversion from twice daily to
extended release tacrolimus.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S420), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Summary of Objectives: Renal dysfunction is a significant cause of
morbidity in heart transplant recipients with nearly half of patients with
an abnormal serum creatinine by 5 years post-transplant. While calcineurin
antagonists such as tacrolimus clearly cause chronic kidney injury, the
time course of renal deterioration is not well characterized. Whether the
decline of renal function is constant or may be modified by the dosing of
such drugs is unknown. We hypothesized that conversion from standard
(short-acting) tacrolimus to a sustained release form would be associated
with an improvement or stabilization of kidney function in heart
transplant recipients. In addition, we wanted to prospectively examine
differences based on patient ethnic group. Methods: This was a
prospective, non-randomized trial of conversion of adult heart transplant
patients from standard tacrolimus twice a day to sustained release
tacrolimus (Astagraf) daily administration. Key inclusion criteria were
post-transplant interval between 1-15 years, with at least one measurement
of serum creatinine in the 6 months prior to enrollment and on tacrolimus
based immunosuppression without rejection in the prior 90 days. The
primary endpoint was the change in GFR slope between the 6 months prior to
study enrollment and 6 months post-study enrollment. Selected secondary
endpoints include the change in glomerular filtration rate (GFR) between
study entry and 6 as well as 12 months post-study enrollment as well as
the change in GFR slope between the 6 months prior to study and 12 months
post-study enrollment. Results: From March 2016-Nov 2017 we enrolled 76
adult heart transplant recipients (79 % male, 18 % African-American, mean
age 62.7 +/- 9.1 years). 9.3 % were on concomitant mycophenolate mofetil.
The baseline tacrolimus dose was 5.4 +/- 3.0 mg/daily with a level of 7.7
+/- 1.9 ng/dL and baseline creatinine 1.4 +/- 0.5. The mean GFR was
64.7+/- 25.1 ml/hr. The Astagraf initial dose as 5.6 +/- 3 mg/day which is
approximately 5 % higher than the total non-sustained release dose. The
outcomes will be presented at the time of the Annual meeting, reflecting 6
month follow-up for 64/76 of the patients as of mid March 2018.

<83>
Accession Number
621719446
Author
Andreassen A.K.
Institution
(Andreassen) Oslo University Hospital, Oslo, Norway
Title
Scandinavian heart transplant everolimus de novo study with early
calcineurin inhibitors avoidance (schedule): Results after 6 years of
follow-up.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S18), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Summary of Objectives: The SCHEDULE trial investigated whether initiation
of the proliferation signal inhibitor everolimus and early cyclosporine
avoidance could improve renal function and reduce cardiac allograft
vasculopathy in de-novo heart transplant recipients. After 12 months, we
reported significantly higher measured glomerular filtration rates (mGFR)
among patients treated with everolimus vs. conventional cyclosporine
(79.8+/-17.7 vs. 61.5+/-19.6 mL/kg/1.73 m2; p< 0.001), and significantly
reduced incidence of cardiac allograft vasculopathy (CAV) (50.0% vs.
64.6%; p= 0.003) and CAV progression (DELTA maximal intimal thickness;
0.03+/-0.06 vs. 0.08+/-0.12 mm; p< 0.01) assessed by IVUS. Both
developments in mGFR and CAV remained significantly in favor of everolimus
treatment also in our reports after 36 months. With a further extension of
the treatment period to 6 years, results of renal function and CAV
according to study arm will be presented. Methods: The SCHEDULE trial is a
multicenter trial with 115 de-novo heart transplant recipients randomized
to low exposure everolimus with reducedexposure cyclosporine (cyclosporine
withdrawn after 7-11 weeks) or standard-exposure cyclosporine, both with
mycophenolate and corticosteroids. The 6 year follow-up of the SCHEDULE
trial has been completed, with assessments of renal function, angiography
with IVUS, echocardiography, and adverse events available by 01.12.17.
Endpoints: The primary endpoint is renal function as assessed by mGFR.
Secondary endpoints include eGFR and creatinine, maximal intimal
thickness, serious adverse events including a composite of major clinical
adverse events, non-fatal major cardiac events, and non-fatal major
cardiac events +angiographic CAV.

<84>
Accession Number
621719431
Author
Holmstrom E.; Tuuminen R.; Syrjala S.; Krebs R.; Rouvinen E.; Nykanen A.;
Lemstrom K.
Institution
(Holmstrom, Tuuminen, Syrjala, Krebs, Rouvinen) Transplantation
Laboratory, University of Helsinki, Helsinki, Finland
(Nykanen, Lemstrom) Cardiothoracic Surgery, Helsinki University Hospital,
Helsinki, Finland
Title
Proinflammatory cytokines as biomarkers for severe primary graft
dysfunction after heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S104), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Donor brain death, cold preservation, and subsequent
ischemiareperfusion injury all participate in the pathology of primary
graft dysfunction (PGD) and trigger immune responses. Our experimental
studies suggest that this early immune response may initiate
proinflammatory and profibrotic processes and develop into chronic
rejection. In this clinical study, we investigated the role of
proinflammatory cytokines as biomarkers for PGD. Methods: We analyzed 84
donor-recipient pairs collected in a prospective, blinded single-center
trial. We collected donor and recipient plasma samples and measured heart
failure and myocardial injury markers proBNP, TnT, TnI, and CKMBm, as well
as a panel of 47 inflammatory factors with a Multiplex immunoassay before
transplantation and 1, 6, and 24 hours after reperfusion. Results:
According to ISHLT criteria, 7.1% of patients had mild, 11.9% had
moderate, and 9.5% had severe PGD. Clinically, mild and moderate PGD did
not differ from normal graft function. Mild PGD presented similar cytokine
response as patients without PGD. Moderate PGD associated with increased
postoperative levels of CX3CL1, and IL-6 and-18 (P< 0.05). Severe PGD
linked to increased TnT, TnI, and lactate release (P< 0.001), longer
hospital and ICU length of stays (P< 0.005), and increased 30-day
mortality (P< 0.001) compared to patients without PGD. Severe PGD involved
increased postoperative levels of CCL20, CX3CL1, CXCL1, IL-6,-10, and-18,
PlGF, and VEGF (P< 0.05-0.0001). Higher donor PDGF-BB and hemoglobin,
prolonged graft ischemia time, and need of red blood cell infusions during
operation were risk factors for severe PGD (all P< 0.05). Conclusion: Our
results suggest that both mild and moderate PGD have similar clinical
outcome as patients without any graft dysfunction. However, when looked on
a cytokine level, mild PGD patients present similar inflammatory response
as patients with normal graft function, whereas moderate PGD links with
increased systemic inflammatory response. Severe PGD, however, is both
clinically relevant and leads to a steep induction of systemic
proinflammatory response. Also, higher donor plasma PDGF-BB was linked
with development of severe PGD after HTx. We suggest that these pre-and
postoperative biomarkers may be used for risk evaluation, and as a
platform for therapeutic interventions against severe PGD.

<85>
Accession Number
621719430
Author
Wong K.; Pereira N.; Kushwaha S.
Institution
(Wong, Kushwaha) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Pereira) Department of Cardiovascular Diseases, Molecular Pharmacology
and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
Title
Average daily dose of mycophenolate mofetil in the first posttransplant
year and long term clinical outcomes: A single center retrospective study.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S420), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Mycophenolate mofetil (MMF) is routinely used as an
immunosuppressant following heart transplantation. Adjustments in MMF
dosing due to side effects are common but the effect of such decreased
dosing on clinical outcome is unknown. Methods: This was a retrospective
study with all adult patients received heart transplantation at Mayo
Clinic, Rochester, Minnesota from 1995-2014 with MMF as initial
immunosuppressive regime retrieved. Average MMF dose was calculated by
dividing the cumulative MMF dose with the number of days from initial
hospital discharge to one year after heart transplantation. All
endomyocardial biopsy results were retrieved for calculation of the
rejection score and severe rejection-free survival. Results: A total of
154 consecutive adult heart transplant recipients were included.
Low-normal dose group (LNDG) and high dose group (HDG) were defined as
average MMF daily dose of less than or equal to 2000mg/ day and more than
2000mg/day respectively. Patients in LNDG had significantly lower acute
cellular rejection (ACR) score (0.345 vs 0.474, p< 0.001). Survival free
from severe ACR, defined as grade 2R or more, conditional on severe
ACR-free survival to 1 year was significantly better in LNDG compared to
HDG (89% vs 70.9% at 10 year, p= 0.021) while long term actuarial survival
conditional on survival to 1 year was similar between the two groups
(76.1% vs 74.3% at 10 year, p= 0.489). Multivariate analysis revealed LNDG
was independently associated with lower risk of rejection (OR= 0.163, p=
0.001) and had significant better severe ACR-free survival conditional on
severe ACR-free survival to 1 year (HR= 0.367, p= 0.043). Conclusion:
Average MMF daily dose less than or equal to 2000mg/day in the first
post-transplant year due to intolerance was associated with lower risk of
cellular rejection and no significant difference in long term actuarial
survival. The role of altered pharmacokinetics of MMF in these two groups
needs to be explored.

<86>
Accession Number
621719428
Author
Kuhn M.A.; Gordon B.M.; Razzouk A.J.; Bock M.J.; Chinnock R.E.; Bailey
L.L.
Institution
(Kuhn, Gordon, Bock, Chinnock) Pediatrics, Loma Linda University
Children's Hospital, Loma Linda, CA, United States
(Razzouk, Bailey) Cardiothoracic Surgery, Loma Linda University Children's
Hospital, Loma Linda, CA, United States
Title
Intravascular ultrasound in the diagnosis of cardiac allograft
vasculopathy in pediatric heart transplant recipients: A 20 year single
center review.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S191), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The purpose of this study was to retrospectively evaluate the
longterm use of intravascular ultrasound (IVUS) in diagnosing cardiac
allograft vasculopathy (CAV) in pediatric heart transplant recipients.
Methods: IVUS was part of the annual evaluation starting at age 7, and was
repeated at least every other year whilst in our care. Morphometric
analysis was performed on each study at 10 randomized segments and was
graded using Stanford classification (SC). A SC grade of 3 (moderate) or 4
(severe) was considered significant for CAV. The presence of SC 3 or 4
(IVUS +) was compared to graft loss, retransplant, and cause of death:
CAV, acute rejection, lymphoproliferative disease, other. IVUS + was
compared to age at transplant (< 1 year, < 1 month), pre-transplant
diagnosis, donor age, prolonged ischemic time, CMV, prior bypass, early
and late acute rejection, and > 5 rejection episodes. Chi square analysis
and Kaplan-Meier were used to compare data. A P-value of 0.05 was
considered significant. Results: Since 1997, 213 patients underwent 804
IVUS studies. There were no major complications. Three patients had
transient vasospasm. IVUS + correlated with graft loss, re-transplant, and
CAV as a cause of death (p < 0.001). There was no significant correlation
with other causes of death. There was a significant difference in
long-term freedom from graft loss (P < 0.001) and CAV (P < 0.001)
(figures). Heart transplant at < 1 year and those with HLHS were less
likely to be IVUS + (both P = 0.003). Older donor age and prior bypass
were more likely to be IVUS + (both P = 0.05). Other parameters were not
significant. Conclusion: The presence of moderate to severe intimal
thickening (Stanford Class 3 or 4) on IVUS was strongly associated with
the development of CAV and eventual graft loss over time. Future research
should focus on early intervention and long-term follow up in this
high-risk population (Figure presented).

<87>
Accession Number
621719417
Author
Starling R.C.; Armstrong B.; Morrison Y.R.; Sayegh M.H.; Chandraker A.
Institution
(Starling) Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Armstrong) Rho Federal Systems Division, Chapel Hill, NC, United States
(Morrison) Transplantation Branch, NIH, Rockville, MD, United States
(Sayegh) Internal Medicine, American University of Beirut, Beirut, Lebanon
(Chandraker) Nephrology, Brigham and Womens Hospital, Boston, MA, United
States
Title
Multicenter study to determine up to 5 year clinical outcome of heart
transplant recipient receiving rituximab versus placebo outcomes in
subjects previously randomized in the CTOT-11 study.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S18), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Summary of Objectives: The CTOT-11 study was to determine the cumulative
impact of rituximab on the development of cardiac allograft vasculopathy
(CAV) in unsensitized heart transplant recipients in the first year
post-transplant. The study used intravascular ultrasound (IVUS) as a
volumetric measure of CAV to compare CAV development in patients treated
with rituximab and placebo. Subjects were randomized (1:1) to placebo (IV
day 0 and 12 post-transplant) plus conventional immunosuppression versus
induction therapy with anti-CD20 mAb. The primary endpoint was the change
from baseline to 1 year in percent atheroma volume (PAV) measured by IVUS
in a target coronary artery. Surprisingly at 1 year, paired IVUS showed a
significant increase in PAV (6.8 +/-8.2 vs 1.9 +/-4.4 p= 0.0019) in the
rituximab treated group. Methods: Outcomes data will be collected from 145
patients randomized to rituximab versus placebo from 17 sites. The
investigators will focus on long term major adverse cardiovascular events.
In the 86 subjects with evaluable baseline and 12 month IVUS assessments
the composite of time to event will be analyzed. Participants who are 3
years post-transplant (+/-8 months) will be included. For all evaluable
subjects, Kaplan-Meier survival curve techniques will be used to assess
the primary composite endpoint, allowing for variable followup time among
subjects. Endpoints: The primary endpoint is a composite of time to event
of the following: Death due to Cardiac Allograft vasculopathy (CAV),
Re-transplantation due to CAV, Re-Listed due to CAV, LVAD for CAV,
Percutaneous coronary intervention (PCI), Myocardial Infarction, Surgical
revascularization for CAV, or ISHLT CAV Grade 2 or 3 (moderate or severe).
The secondary endpoint is individual components of the primary endpoint.
In the 86 subjects with evaluable baseline and 12 month IVUS assessments
in the CTOT-11 study, composite of time to event of the following: Death
due to Cardiac Allograft Vasculopathy (CAV), Re-transplantation due to
CAV, Re-Listed due to CAV, LVAD for CAV, Percutaneous coronary
intervention (PCI), Myocardial Infarction, Surgical revascularization for
CAV, ISHLT CAV Grade 2 or 3 (moderate or severe) will be analyzed.

<88>
Accession Number
621719345
Author
Wanek M.R.; Hodges K.; Persaud R.; Moazami N.
Institution
(Wanek) Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United
States
(Hodges) Department of Thoarcic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Persaud) Department of Pharmacy, Florida Hospitals, Orlando, FL, United
States
(Moazami) Department of Cardiothoracic Surgery, New York University
Langone Health, New York, NY, United States
Title
Low-dose prothrombin complex concentrates for warfarin reversal prior to
heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S418), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: While use of prothrombin complex concentrate (PCC) has become
common for warfarin reversal, data regarding use in the heart
transplantation and in patients with mechanical circulatory support (MCS),
is limited. The purpose of this study is to assess the impact of PCC for
preoperative warfarin reversal prior to heart transplantation. Methods:
This was a non-interventional, retrospective analysis evaluating outcomes
before and after institution of a low-dose PCC-based warfarin reversal
protocol prior to heart transplantation. Consecutive adult patients
presenting for heart transplantation on warfarin with an INR > 1.5 from
2010 to 2017 were included. Patients in the study group received an
INR-based dose of 10-20 units/kg PCC in addition to vitamin-K for INR
reversal. The primary endpoint was utilization of individual blood
products. Secondary endpoints included: in-hospital mortality, reoperation
for bleeding, delayed sternal closure, thromboembolic events, duration of
chest tube use, time to extubation, and ICU and hospital length of stay.
Results: Compared to the historical cohort (n= 49), significantly fewer
patients in the PCC cohort (n= 57) received perioperative antifibrinolytic
therapy (56.1% vs. 95.9%, p< 0.001) due to a national shortage during the
study period. Other pertinent baseline characteristics including
proportion of patients with MCS (74% vs 75%, p= 0.817) were similar
between groups. Patients in the PCC cohort received significantly less
fresh frozen plasma (FFP) than the control group (6 units [IQR 3-8] vs. 8
units [IQR 6-10], p= 0.002). There was a significant increase in
cryoprecipitate utilization in the PCC cohort, which may be attributable
to decreased intraoperative antifibrinolytic use. Utilization of PRBC and
platelet transfusions were similar between groups. There were no
differences in thrombotic complications between the PCC and control groups
( 12.3% vs 8.2%, p= 0.488) or other secondary endpoints. Conclusion: A
PCC-based warfarin reversal protocol significantly reduced FFP utilization
and delivered reliable INR normalization without impacting other
clinically important surgical outcomes. These data suggest that PCC is a
valuable tool for INR normalization in patients presenting for heart
transplantation that could safely reduce blood product utilization and
associated complications.

<89>
Accession Number
621719338
Author
Patel J.; Kittleson M.; Czer L.; Geft D.; Dimbil S.; Levine R.; Kearney
B.; Kransdorf E.; Esmailian F.; Kobashigawa J.A.
Institution
(Patel, Kittleson, Czer, Geft, Dimbil, Levine, Kearney, Kransdorf,
Esmailian, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
Title
In sensitized pre-transplant patients, does IVIG after heart transplant
have any benefit?.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S440), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Strategies for sensitized patients undergoing heart transplant
include post-op anti-thymocyte globulin (ATG) induction therapy as well as
intravenous immunoglobulin (IVIG). We sought to assess whether the
combination of IVIG and ATG affects the development of donor-specific
antibodies (DSA) post-heart transplant (HTx) and clinical outcomes.
Methods: Between 2010 and 2015, we assessed 585 heart transplant patients.
Of these, 43 patients were treated with both ATG induction therapy and
IVIG and 215 were treated with ATG alone. Endpoints included 2-year
freedom from de novo DSA development, 2-year survival, and 2-year freedom
from cardiac allograft vasculopathy as defined by >= 30% stenosis by
angiography. Results: The ATG and IVIG group compared to the ATG alone
group had a significantly higher pre-transplant mean PRA (72.0% vs 58.3%,
p= 0.044). Patients given ATG and IVIG had a similar 2-year freedom from
de novo DSA development (see table). There was no significant difference
in 2-year survival or 2-year freedom from CAV between the groups.
Conclusion: Patients who were treated with both ATG and IVIG compared to
ATG induction therapy alone had similar outcomes. However, the addition of
IVIG to ATG may have had benefit as this group had significantly higher
pre-transplant PRA in which 2-year de novo DSA development and clinical
outcomes were similar between study groups. Longer follow-up is needed to
confirm these findings. (Table presented).

<90>
Accession Number
621719300
Author
Baker W.L.; Steiger S.; Martin S.; Patel N.; Radojevic J.; Darsaklis K.;
O'Bara L.; Kutzler H.; Dougherty J.; Feingold A.; Hammond J.; Fusco D.;
Gluck J.A.
Institution
(Baker) University of Connecticut, Storrs, CT, United States
(Steiger, Martin, Patel, Radojevic, Darsaklis, O'Bara, Kutzler, Dougherty,
Feingold, Hammond, Fusco, Gluck) Hartford Hospital, Hartford, CT, United
States
Title
Questioning the tacrolimus dogma: Does early dose control matter?.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S417-S418),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Tacrolimus is the mainstay of immunosuppressive strategies post
orthotopic heart transplantation (OHT). The relationship of tacrolimus
control, measured by time to therapeutic trough (TTT) or time within
therapeutic range (TTR) to post-OHT acute rejection is unclear. We
evaluated if tacrolimus TTT or TTR in the 30 days post OHT impacts
rejection. Methods: This is a single-center, retrospective cohort study of
consecutive adult OHT patients receiving standard immunosuppression with
tacrolimus, mycophenolate mofetil, and prednisone without routine
induction therapy. Tacrolimus was dosed to trough whole blood
concentrations of 10-15 ng/mL for 30-days. Surveillance endomyocardial
biopsies were performed weekly for 4 weeks with ISHLT scheme histologic
grading. Outcomes included the effect of TTT and TTR (Rosendaal method) on
30-day clinical rejection, 1R/1B, and > 2R histologic occurrence. We
assessed for categorical and continuous differences between groups using
chi-square and Student's t-test/ Mann Whitney-U respectively. Results: 78
patients underwent OHT age 56.2 +/- 12.7 years. During the 30-days post
OHT, clinical rejection, 1R/1B, and > 2R rejection occurred in 10 (12.8%),
23 (29.5%), and 15 (19.2%) patients respectively. For clinical rejection
vs no rejection groups, the TTT was median 9.5, IQR 8-10.8 days and TTR
mean 33.7%, SD 13.6% vs. TTT 9.0 (7-13) days and TTR 36.1% (20%) (p= 0.822
& p= 0.723 respectively) (Figure). Similarly, we observed no significant
differences in TTT or TTR in patients who developed grade 1R/1B (p= 0.73 &
p= 0.66) or grade > 2R histology (p= 0.94 & p= 0.95). No antibody mediated
rejection was observed. Subgroup analysis showed that achieving TTT within
1 week (N= 24) did not lower early rejection (p= 0.13) or histologic
grading (p= 0.6). Conclusion: Neither time to nor time in therapeutic
tacrolimus range predicted acute rejection within 30 days of OHT
questioning the currentlyaccepted tacrolimus dogma of short TTT.
Longer-duration follow-up is ongoing to further investigate these
findings. (Figure presented).

<91>
Accession Number
621719276
Author
Broch K.; Massey R.J.; Murbraech K.; Gude E.; Andreassen A.K.; Gullestad
L.
Institution
(Broch, Massey, Murbraech, Gude, Andreassen, Gullestad) Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
Title
Longitudinal development in left ventricular volume, mass and function in
heart transplant recipients - Results from the NOCTET trial.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S417), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Allograft failure is an important cause of morbidity and
mortality in heart transplant recipients. Several reasons for graft
dysfunction: hypertension, kidney failure, vasculopathy and allograft
hypertrophy, have been attributed to treatment with calcineurin
inhibitors. Inhibitors of the mechanistic target of rapamycin (mTOR) may
have a more favourable cardiovascular profile. We used data from the
randomised, controlled NOCTET trial to assess if treatment with an
mTOR-inhibitor attenuates allograft hypertrophy and prevents left
ventricular dysfunction. Methods: In the NOCTET trial, we randomized
stable heart transplant recipients to treatment with a combination of
everolimus (Evr) and lowdose cyclosporine (CyA) vs standard therapy with
CyA. We performed echocardiograms every year for five years after
randomisation. Images were analysed by an experienced sonographer (RM),
who was blinded to treatment allocation. This abstract reports data from
the 75 patients recruited in Oslo. We used mixed-model ANOVA to assess
changes in left ventricular mass (LVM), end-diastolic diameter, and
ejection fraction (EF) across treatment arms during follow-up. Results:
Baseline characteristics are shown in the table. 9 patients died during
follow-up, 6 were allocated to the combination therapy. Overall, LVM
increased from 150 to 171 g over 5 years (F = 9.9; p < 0.001). There was
no between-group difference (F for time*treatment interaction term = 1.3;
p = 0.29). Left ventricular end-diastolic diameter and EF remained
unchanged over time (F = 0.7; p = 0.56 and F = 1.8; p = 0.13,
respectively) with no between-group differences. Conclusion: In stable
heart transplant recipients, there is an increase in LVM with time,
whereas left ventricular diameter and EF remain unchanged. Compared with
standard calcineurin inhibitor-based therapy, combination therapy with Evr
and low-dose CyA does not affect left ventricular mass, diameter or
systolic function. (Table presented).

<92>
Accession Number
621719258
Author
Santiago E.; Farrero M.; Ivey-Miranda J.; Castel M.; Garcia-Alvarez A.;
Perez-Villa F.
Institution
(Santiago, Farrero, Castel, Garcia-Alvarez, Perez-Villa) Heart Failure and
Heart Transplantation Program, Hospital Clinic, Barcelona, Spain
(Ivey-Miranda) Hospital de Cardiologia, Centro Medico Nacional Siglo XXI,
Mexico City, Mexico
Title
Initial experience with bosentan for the management of pulmonary
hypertension after heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S417), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The presence of pulmonary hypertension (PH) after heart
transplantation is associated to right ventricular dysfunction (RVD) and
increased morbidity and mortality. We present our experience with bosentan
for the treatment of PH in the postoperative period after cardiac
transplantation. Methods: In the immediate posttransplant, patients with
PH (defined by mean pulmonary artery pressure > 25 mmHg and/or pulmonary
vascular resistance (PVR) > 2.5 Woods units measured by a Swan-Ganz
catheter) and/or with RVD, received bosentan by nasogastric tube (first
dose 62,5 mg, increasing to 125 mg BID after 12 hours, if tolerated)
(bosentan group, BG). Pulmonary hemodynamics before and after the
initiation of bosentan were recorded. Baseline characteristics, adverse
events and clinical outcomes were registered for patients in the BG and
compared with patients not receiving bosentan (control group, CG). All
patients received induction therapy with basiliximab. Tacrolimus or
cyclosporine were started on postoperative day 7. Results: Eighty-seven
consecutive patients with cardiac transplantation were included in the
study. Twenty-one patients (24%) had PH and/or RVD in the immediate
posttransplant and were treated with bosentan: 62.5 mg once a day (n= 5),
62.5 mg BID (n= 7) or 125 mg BID (n= 9) (BG). After bosentan initiation,
there were significant decreases in systolic (42.5+/-7.9 to 38.1+/-8.0
mmHg, p= 0.015), diastolic (21.4+/-4.4 to 17.8+/-5.5 mmHg, p= 0.008) and
mean (29.6+/-4.9 to 25+/-5.5 mmHg, p= 0.001) pulmonary artery pressures,
transpulmonary gradient (13.1+/-3.3 to 9.7+/-3.5 mmHg, p< 0.001),
diastolic gradient (5.2+/-3.7 to 2.3+/-3.4 mmHg, p= 0.001) and PVR
(2.2+/-1.2 to 1.6+/-0.8 Wood units, p= 0.015). In the BG there was a more
significant decrease in PVR (DELTA 0.97+/-0.96 vs. DELTA 0.31+/-0.82, p=
0.014) and PAPM (DELTA 4.57+/-5.22 mmHg vs. DELTA 1.18+/-4.98, p= 0.009)
in the first 24 hours posttransplant, compared to the CG. There were not
significant differences in adverse events and clinical outcomes between BG
and CG. There were no clinically significant interactions between bosentan
and the immunosuppressive treatment. Conclusion: Bosentan treatment
immediatellly after heart transplatation in recipients with PH was
associated to a significant decrease in PVR. Bosentan was well tolerated,
even associated to other pulmonary vasodilatators (PV) and to the
immunosuppressive treatment.

<93>
Accession Number
621719211
Author
Arora S.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran G.; Aaberge L.;
Gude E.; Solbu D.; Dellgren G.; Andreassen A.K.; Gullestad L.
Institution
(Arora, Aaberge, Gude, Andreassen, Gullestad) Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Karason, Dellgren) Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Cardiology, Copenhagen University Hospital, Copenhagen,
Denmark
(Eiskjaer) Cardiology, Skejby University Hospital, Aarhus, Denmark
(Radegran) Cardiology, Skane University Hospital, Lund, Sweden
(Solbu) Novartis Norge, Oslo, Norway
Title
The effect of everolimus initiation and early calcineurin inhibitor
withdrawal on allograft vasculopathy in de-novo heart transplant
recipients: Results of the schedule trial after 6 years.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S36), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The SCHEDULE (Scandinavian heart transplant everolimus denovo
study with early calcineurin inhibitors avoidance) trial has sought to
evaluate whether initiation of the proliferation signal inhibitor
everolimus and total early cyclosporine elimination can significantly
reduce the development of CAV in de-novo HTx recipients. We have
previously reported that patients treated with everolimus demonstrated
significantly reduced CAV progression when compared to cyclosporine
therapy at both 12 and 36 months (12-month IVUS examination revealed
DELTAMaximal Intimal Thickness (MIT) 0.02+/-0.05 versus 0.08+/-0.12 mm (p<
0.01), DELTAPercent Atheroma Volume (PAV) 1.2+/-2.0 versus 3.7+/-4.1% (p<
0.01), DELTATotal Atheroma Volume (TAV)-0.13+/-20.5 mm3 versus 11.1+/-27.6
mm3 (p= 0.08) and 36-month examination showed DELTAMlT 0.09+/-0.05 versus
0.15+/-0.16 mm (p= 0.01), DELTAPAV 5.4+/-3.1 versus 7.6+/-5.9% (p= 0.02),
DELTATAV 33.9+/-71.2 mm3 versus 54.2+/-96.0 mm3 (p= 0.26), respectively).
Treatment according to study arm has been further extended to a total
treatment period of 6 years and the IVUS results of this follow-up period
will be presented. In addition, Virtual Histology (VH) data will be
included to assess the morphological changes associated with everolimus
treatment. Methods: The SCHEDULE trial is a multicenter Scandinavian trial
where 115 de-novo HTx recipients were originally randomized to everolimus
with complete CNI withdrawal (EVE-group) 7-11 weeks after HTx or standard
CNI-based immunosuppression (CNI group). The 6 year IVUS and VH follow-up
for the SCHEDULE trial has been completed and results will be available by
01.12.2017. Results: Endpoints: Overall, 64 patients have matched IVUS
examinations at baseline and 1, 3 and 6 years post-randomization. In
accordance with established consensus guidelines, the three independent
IVUS endpoints MIT, PAV and TAV are being evaluated and will be utilized
to evaluate progression of CAV in the two treatment arms at 1, 3 and 6
years post-randomization. Morphological tissue assessment using Virtual
Histology analysis at the same timepoints will also be performed.
Conclusion: Intravascular ultrasound results of the SCHEDULE trial after 6
years of follow-up will be presented as a late-breaking trial.

<94>
Accession Number
621719201
Author
Murbraech K.; Massey R.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran
G.; Solbu D.; Broch K.; Gude E.; Andreassen A.; Gullestad L.
Institution
(Murbraech, Massey, Broch, Gude, Andreassen, Gullestad) Cardiology, Oslo
University Hospital, Oslo, Norway
(Karason) Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
(Gustafsson) Cardiology, Copenhagen University Hospital, Copenhagen,
Denmark
(Eiskjaer) Cardiology, Skejby University Hospital, Aarhus, Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital, Lund, Sweden
(Solbu) Novartis, Oslo, Norway
Title
The effect of everolimus vs calcineurin inhibitors on left ventricular
mass in de novo heart transplant recipients after 3 years follow-up -
Results from the randomized controlled SCHEDULE trial.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S416), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Cardiac allograft hypertrophy is common after heart
transplantation (HTX) and associated with increased long-term mortality.
Post-transplant hypertension, kidney failure, vasculopathy and allograft
hypertrophy has been attributed to treatment with calcineurin inhibitors.
Inhibitors of the mechanistic target of rapamycin (mTOR) may have
beneficial effects on cardiac function and reduce left ventricular mass
(LVM) in HTX. However, the effect of mTOR inhibitors on LVM remains
unknown in de novo HTX. Methods: In the SCHEDULE-RCT we randomized de novo
heart transplant recipients to early conversion to everolimus (EVR) vs
cyclosporine (CyA). We performed echocardiography at 7 weeks, 1 year and 3
years. Among the 115 patients in the SCHEDULE trial, complete data for the
calculation of LVM was available in 83 patients at 7 weeks, 82 at 1 year
and 53 after 3 years. We used mixed models to assess the changes in LVM
between the treatment arms during follow-up. Left ventricular hypertrophy
(LVH) was defined as an LVM index > 116 g/m² in males and > 95
g/m² in females. All images were analyzed by an experienced
sonographer (RM), to avoid interobserver variability. Results: Patient
demographics at baseline are shown in the table. Overall, we observed a
drop in LVM index in both groups after 1 year follow-up (EVR: 94 +/- 21
g/m² to 85 +/- 22 g/m², CyA: 90 +/- 18
g/m² to 81 +/- 17 g/m², p < 0.01 for both), with no
between-group difference (EVR: DELTA -10 +/- 18, CyA: DELTA -9 +/- 13). In
a subgroup of patients available at 3 years follow-up, we found a further
nominal decrease in LVM index in both groups (EVR: 80 +/- 18
g/m², CyA: 78 +/- 15 g/m²). The proportion of
patients with LVH fell significantly across treatment arms, from 21 % at
baseline to only 3 % at 3 years, with no between-group difference.
Conclusion: In de novo HTX, LVM index and LVH fell significantly during 3
years follow-up, irrespective of immunosuppressive treatment. (Table
presented).

<95>
Accession Number
621719182
Author
Yang Y.; Sulejmani N.; Jantz A.; Summers B.; Dhanekula A.; Williams C.;
Nemeh H.; Lanfear D.
Institution
(Yang, Sulejmani, Jantz, Summers, Dhanekula, Williams, Nemeh, Lanfear)
Henry Ford Hospital, Detroit, MI, United States
Title
Precision medicine for tacrolimus dosing in heart transplant recipients.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S416), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Interpatient variability in tacrolimus requirements are large and
influenced by multiple factors including cytochrome P450 (CYP) genetics,
specifically by CYP3A5 and to a lesser extent CYP3A4. Tacrolimus dosing
tailored to CYP genotype has been shown to shorten time to therapeutic
range in kidney transplant but data in heart transplant recipients is
sparse and findings are variable. We recently implemented weight and
genotype-based initial tacrolimus dosing in our heart transplant program.
The objective of this study is to examine the impact of genetically
tailored tacrolimus dosing on achieving therapeutic trough levels.
Methods: This is a retrospective cohort study of adult heart transplant
recipients from January 2014 to August 2017. Patients were divided into
the standarddosing cohort (those transplanted between January 2014 and
October 2015) or the genetic tailored-dosing cohort (those transplanted
after policy implementation in October 2015). Patients who received
multiple organ transplantations, switched to cyclosporine therapy, or did
not have data for the entire study period were excluded. The primary
endpoint was days to a therapeutic tacrolimus trough level (10-15 ng/mL).
The key secondary endpoint was the percentage of tacrolimus levels within
range over the first month after transplant. These were compared between
groups using Student's t-test. Results: In total, 63 patients met
inclusion criteria, 28 patients prior to the policy change (standard-dose
group) and 35 patients after the policy change (tailored-dose group).
There were no differences between groups in terms of age, sex, race, or
body mass index (p= NS). The tailored-dose group had a nearly 3 day sooner
average time to therapeutic range (4.5 +/- 2.6 days) compared to the
standard-dosing group (7.3 +/- 4.7 days) which was statistically
significant (p= 0.0067). Similarly, the tailored-dosing group had on
average a greater proportion of days within the therapeutic window at 40%
compared to an average of 31% in the standard-dosing group (p= 0.01).
Conclusion: Personalized tacrolimus dosing was feasible, shortened the
time to achieve therapeutic levels, and increased the proportion of
tacrolimus levels within therapeutic trough range.

<96>
Accession Number
621719159
Author
Hoskova L.; Malek I.; Melenovsky V.; Kautzner J.; Netuka I.; Franekova J.;
Jabor A.
Institution
(Hoskova, Malek, Melenovsky, Kautzner, Netuka) Heart Center, IKEM, Prague,
Czech Republic
(Franekova, Jabor) Department of Laboratory Methods, IKEM, Prague, Czech
Republic
Title
The effect of dual renin-angiotensin system blockade compared to
conventional antihypertensive combination on blood pressure and renal
function after heart transplantation: A randomized controlled trial.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S353-S354),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Altered cardiovascular regulation and use of immunosuppressive
drugs after heart transplantation (HTx) are associated with development of
arterial hypertension (AHT) and nephrotoxicity. HTx-related AHT can be
difficult to control and combination of antihypertensives is often
necessary. We compared the effect of the standard antihypertensive
medication (aHTM) with dual blockade of the renin-angiotensin system (dual
RAS combination) on blood pressure control and renal functions. Methods:
Between 2010 and 2013, we enrolled 73 patients who developed AHT in the
first six months after HTx. We randomized them in two groups: group 1 (44
patients) assigned to standard aHTM therapy consisting of 2-4 aHTM:
calcium channel blocker (CCB), beta-blocker (BB), diuretic and ACE
inhibitor; and group 2 (29 patients) assigned to combination of ACE
inhibitor and angiotensin receptor blocker with CCB or BB or diuretic (2
to 4 aHTM). The follow up was 24 months. Systolic blood pressure (SBP) and
diastolic blood pressure (DBP), glomerular filtration (GFR as CKD-EPI) and
albuminuria (ACR albumin/creatinine ) were serially measured (3,6,9,12,18,
and 24^th month). Results: Both groups were comparable with
respect to basic parameters such as age, sex, BMI and comorbidities. The
mean levels of tacrolimus were not significantly different between groups.
The blood pressure control was attained to similar level in both groups:
SBP 127.9+/-2.1 mmHg vs. 129.3+/-2.3 mmHg and DBP 82.3+/-1,5 mmHg vs
82.7+/-0.9mmHg. After 24 months, GFR was maintained in group 2 (1.2+/-0.05
ml/sec/1.73m²), in contrast to group 1 where GFR dropped
(1.0+/-0.06 ml/sec/1,73m²), p< 0.05. In comparison to group 1
(ACR 12.0+/-3.2 g/mol), albuminuria was markedly lower in group 2 (ACR
2.8+/-1.2 g/mol), p< 0.05 during the follow up period. Three patients
discontinued study because of hyperkalemia> 5,4 mmol/L (2 patients) and
GFR< 0,5 ml/s (1 patient). Conclusion: Blood pressure was effectively
controlled in both treatment groups. However combination of aHTM with dual
RAS blockade significantly reduced albuminuria and maintained of
glomerular filtration rate. This study indicated that dual RAS blockade
might be more renoprotective in some HTx patients.

<97>
Accession Number
621719157
Author
Bertoldi L.F.; Perna E.; Giglio A.F.; Ammirati E.; Cipriani M.G.; Garascia
A.; Macera F.; D'Angelo L.; Varrenti M.; Costetti A.; Nonini S.;
Gagliardone M.P.; Russo C.; Camici P.G.; Frigerio M.
Institution
(Bertoldi, Perna, Giglio, Ammirati, Cipriani, Garascia, Macera, D'Angelo,
Varrenti, Costetti, Nonini, Gagliardone, Russo, Frigerio) DeGasperis
CardioCenter, Niguarda Hospital, Milan, Italy
(Camici) Cardiothoracic Department, San Raffaele Hospital, Milan, Italy
Title
Which "roadmap" in patients with advanced or refractory heart failure,
eligible for LVAD and heart transplantation?.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S311), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Left ventricular assist device (LVAD) therapy improves survival
in inotrope-dependent heart failure patients (pts) and can make pts with
pulmonary hypertension and/or end-organ dysfunction eligible for heart
transplantation (HTx), but device-related complications are frequent. In
Italy donor hearts supply is much lower than demand, and stable LVAD pts
have no priority for organ allocation. Thus, HTx candidates may refuse
LVAD and ask for less invasive therapy when ambulatory, and prefer
short-term support when deteriorating, despite the risk of death while
awaiting or after emergency HTx. We report on pts treated with LVAD or
repeated Levosimendan as a bridge to HTx or to candidacy at a single
Italian center. Methods: Baseline characteristics, 1-year survival on
original therapy (freedom from death, emergency HTx, or delayed LVAD
implant), 1 and 5-years overall survival were evaluated in HTx-eligible
pts treated with repeated Levosimendan or LVAD, starting Jan 2006 to Feb
2016 (n= 115, 83% males, median age 52 y, mean LVEF 24%, wedge pressure 23
mmHg, cardiac index 1.63 l/min/m²). Results: As per medical
choice and patients' preferences, 67 pts (58%) were initially treated with
Levosimendan (LEVO) and 48 (42%) with LVAD (iLVAD). LEVO pts were less
compromised and smaller than iLVAD pts (Intermacs > 4 60 vs 37%, p< 0.001;
BMI 24 + 4 vs 27 + 4.5 kg/m², p= 0.004), had smaller left
ventricles and worse right ventricular function. In the first year there
were 3 deaths, 19 delayed LVAD implants (dLVAD), 7 emergency plus 7
elective HTx in LEVO pts vs 7 deaths, 5 emergency plus 3 elective HTx in
iLVAD pts, with 51% LEVO vs 75% iLVAD pts surviving on original therapy, p
< 0.02. Median follow-up at March 31, 2017 was 1526 days, IQR 1025-2262.
26/67 LEVO pts (39%) underwent dLVAD (median delay 173 days, IQR 82-377)
with 69% 1-year survival on LVAD. Median time on original treatment was
186 days (IQR 84-436) for LEVO and 420 days (IQR 263-838) for iLVAD pts
(p= 0.02). Despite shorter time on original therapy, LEVO pts had similar
1-year (85% vs 77%) and superior 5-years overall survival (68% vs 50%, p<
0.02) compared to iLVAD pts. Conclusion: In LVAD- and HTx-eligible pts,
repeated Levosimendan may serve as temporary treatment, until HTx or until
pts recognize the need for additional therapy. LVAD pts deserve some
priority for HTx to prevent late device-related complications and deaths.

<98>
Accession Number
621719129
Author
Hoemann B.; Takayama H.; Wright M.; Jennings D.L.; Han J.; Restaino S.;
Colombo P.C.; Farr M.; Naka Y.; Takeda K.
Institution
(Hoemann, Takayama, Wright, Jennings, Han, Restaino, Colombo, Farr, Naka,
Takeda) Columbia University College of Physicians and Surgeons, New York
City, NY, United States
Title
Discontinuing amiodarone treatment prior to heart transplant may lower
incidence of severe primary graft dysfunction.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S104-S105),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Recent studies have shown an increase in post-transplant adverse
outcomes and primary graft dysfunction (PGD) in patients treated with
amiodarone prior to heart transplant (HT). We hypothesized that
discontinuation of amiodarone before HT may lower the incidence of severe
PGD. Methods: This was a retrospective study of 381 adult HT recipients at
our institution between January 2010 and June 2017. The six-month
cumulative amiodarone dosage and amiodarone dose on the day of HT was
collected for each recipient. Within six months prior to HT, 197 did not
receive amiodarone (Group 1), 142 continued amiodarone to HT (Group 2),
and 42 had amiodarone treatment discontinued before HT (Group 3). Severe
PGD was defined by the International Society of Heart and Lung
Transplantation report consensus. Results: The average recipient age was
54.2+/-11.8 years and 283 (74.3%) were men. Of the 381 participants, 53
(13.9%) developed severe PGD. Group 2 had significantly higher incidence
of severe PGD among groups (Figure). Multivariate analysis revealed the
presence of a ventricular-assist device (OR = 2.77, 95% CI = 1.34-5.73,
p-value = 0.006) and continued amiodarone treatment to HT (OR = 4.30, 95%
CI = 2.29-8.08, p-value = < 0.001) to be independent risk factors for the
development of severe PGD. Additionally, patients in Group 2 had a
significantly higher risk of severe PGD when compared to Group 3 (OR =
4.42, 95% CI = 1.42-13.74, p-value = 0.010). Patients in Group 3 had no
difference in the risk of severe PGD when compared to Group 1 (OR = 2.09,
95% CI = 0.59-7.43; p-value = 0.254). Conclusion: Patients who
discontinued amiodarone treatment prior to HT showed similar outcomes of
severe PGD compared to patients who received no amiodarone treatment prior
to OHT.

<99>
Accession Number
621719107
Author
Holmstrom E.; Tuuminen R.; Krebs R.; Rouvinen E.; Nykanen A.; Lemstrom K.
Institution
(Holmstrom, Tuuminen, Krebs, Rouvinen) Transplantation Laboratory,
University of Helsinki, Helsinki, Finland
(Nykanen, Lemstrom) Transplantation Laboratory, Cardiothoracic Surgery,
Helsinki University Hospital, Helsinki, Finland
Title
Donor plasma VEGF as a biomarker for early graft failure after heart
transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S103), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Donor brain death (BD) and the subsequent catecholamine and
cytokine storm induce hemodynamic and microvascular dysfunction in donor
heart, and targeting this may benefit heart transplant (HTx) recipients.
However, the role of different factors in cytokine storm for recipient
outcome remains to be elucidated. Vascular endothelial growth factor
(VEGF) is a proinflammatory factor affecting vasodilation and
microvascular permeability. Here, we studied the effect of donor plasma
VEGF levels on early outcomes after HTx. Methods: We analyzed 84 HTx
donor-recipient pairs collected in a prospective, blinded single-center
trial conducted 2010-2016. After declaring brain death, donor plasma VEGF
was analyzed by Multiplex ELISA. In the recipient, we measured plasma
levels of proBNP, TnT, TnI, and CK-MBm at 1, 6, 12, and 24 hours after HTx
as biomarkers for early graft failure and myocardial injury. The
recipients were divided into equal tertiles based on the donor plasma
VEGF-low, moderate, and high. Results: High donor plasma VEGF was linked
to increased plasma release of TnT, TnI, and proBNP (P< 0.05-0.01),
increased inotropic and mechanical circulatory support use (P<
0.05-0.001), trend for decreased early mean arterial pressure (P=
0.05-0.09), prolonged intubation time, and ICU and hospital length of
stays (P< 0.05-0.01) of the recipient, compared to patients with
transplants from donors with low plasma VEGF. Patients receiving heart
from donors with high plasma VEGF had increased need for renal replacement
therapy and inhaled nitric oxide (P< 0.001-0.05). Conclusion: Our results
suggest that donor plasma VEGF may be used as a biomarker for early graft
failure and complicated postoperative outcome after HTx. Donor VEGF may
have potential as an expanded donor criterion, and targeting donor VEGF
may benefit the recipient.

<100>
Accession Number
621719081
Author
Antonczyk K.; Niklewski T.; Antonczyk R.; Zakliczynski M.; Zembala M.;
Kukulski T.
Institution
(Antonczyk, Niklewski, Antonczyk, Zakliczynski, Zembala) Department of
Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian
Center for Heart Diseases, Zabrze, Poland
(Kukulski) Department of Cardiology, Congenital Heart Diseases and
Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
Title
Assessment of myocardial strain using speckle tracking echocardiography
within the first 12 months after orthotopic heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S331-S332),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Recent advances in strain imaging may allow a more appropriate
monitoring of subtle myocardial changes after orthotopic heart
transplantation (OHT). This study aimed to explore longitudinal left
ventricular (LV) and right ventricular (RV) function during the 12-month
follow-up period, in relation to acute cellular rejections (ACRs) degree
>= 2R and their response to intensify therapy with intravenous steroids.
Methods: 45 adult heart transplant recipients were prospectively assessed
from January 2016 until May 2017. Echocardiography was performed at
baseline and with routine biopsies at 2 weeks, 1, 2, 3, 6, 9, 12 months
after OHT. Changes in graft function were evaluated before, during and in
the resolving period of ACR. Results: A total of 220 pairs of biopsy and
strain analysis were performed. Moderate ACR (2R) was seen in 30 biopsies
(13,6%). In the serial assessment, longitudinal strain parameters of LV
(global and 4-, 2-, 3-chamber) and RV (global and free wall) were
decreased at the baseline and improved significantly (P < .001) within 12
months after OHT (Fig. 1). The degree of improvement was (Figure
presented) not influenced by ACR episodes. There were no significant
differences in circumferential, radial deformation and mechanical
dyssynchrony. Reduced LV and RV longitudinal strain were related to ACR
degree 2R and increased significantly (P < .0005) during three days
intravenous methylprednisolone therapy (Fig. 2). Conclusion: We found an
acute improvement post steroid therapy of ACR as well as a progressive
recovery of LV and RV longitudinal function during the first year after
OHT.

<101>
Accession Number
621719074
Author
Fraser C.D.; Grimm J.C.; Zhou X.; Lui C.; Suarez Pierre A.; Crawford T.C.;
Magruder J.T.; Jacobs M.L.; Hibino N.; Vricella L.A.
Institution
(Fraser, Grimm, Zhou, Lui, Suarez Pierre, Crawford, Magruder, Jacobs,
Hibino, Vricella) Division of Cardiac Surgery, Johns Hopkins Hospital,
Baltimore, MD, United States
Title
A novel recipient risk score to predict 1-year mortality in pediatric
heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S97-S98),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Given the shortage of available donor organs in pediatric heart
transplantation (PHT), pre-transplant risk stratification may assist in
organ allocation and recipient optimization. As such, we sought to
construct a novel scoring system to pre-operatively stratify a patient's
risk of 1-year mortality after PHT based on recipient-specific
characteristics. Methods: The UNOS database was queried for pediatric (<
18 years) patients undergoing PHT between 2000 and 2016. The population
was randomly divided in a 4:1 fashion into derivation and validation
cohorts. A multivariable logistic regression model for 1-year mortality
was constructed within the derivation cohort. Points were then assigned to
independent predictors (p < 0.05) based on relative odds ratios. Risk
groups were established based on easily applicable, whole-integer score
cutoffs. Results: During the study period, 5,863 patients underwent PHT
and 1-year mortality was 10.7% (n= 564). There was a similar distribution
of variables between the derivation (n = 4,691) and validation (n = 1,172)
cohorts. Of the 9 covariates included in the final model, 8 were
ultimately allotted point values (Table 1). Of these, pre-transplant ECMO
support, previous transplant and pre-transplant mechanical ventilation
were the strongest predictors of 1-year mortality. The low-risk (score
0-9), intermediate-risk (score 10-20), and high-risk (score > 20) groups
had a 6.2%, 12.8%, and 27.8% overall risk of 1-year mortality (p < 0.001),
respectively. Both intermediate-risk (OR 2.16, 95% CI: 1.8-2.7, p < 0.001)
and high-risk (OR 5.99, 95% CI: 4.8-7.6, p < 0.001) scores were associated
with increased risk of 1-year mortality when compared to the low-risk
group. Conclusion: This novel risk score is the first pediatric-specific,
recipient based system to predict 1-year mortality after PHT. Its use
could assist providers in the identification of patients at highest risk
of poor posttransplant outcomes and may also aid in pre-transplant
optimization of these children (Table presented).

<102>
Accession Number
621719028
Author
Burchill L.J.; Mueller B.; Fan C.; Manlhiot C.; Ross H.J.; Alba A.
Institution
(Burchill) Knight Cardiovascular Institute Adult Congenital Heart Program,
Oregon Health Science University, Portland, OR, United States
(Mueller, Fan, Manlhiot) CV Data Management Centre, Hospital for Sick
Children, Toronto, ON, Canada
(Ross, Alba) Ted Rogers Center of Excellence in Heart Function, Toronto
General Hospital, University Health Network, Toronto, ON, Canada
Title
A new prediction model for quantifying mortality risk in congenital heart
disease (CHD) patients after heart transplant (HTx).
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S392), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: To develop a new predictive model for estimating mortality risk
in CHD HTx recipients. Methods: CHD HTx recipients (age > 10) from the
ISHLT registry (2005-2013) were randomly divided into training (n= 966)
and validation (n= 415) samples. In the derivation cohort, survival random
forest models identified the five most important variables for post HTx
survival: gender mismatch, bilirubin, creatinine clearance, recipient age
and recipient/ donor age ratio. A CHD risk score (CRS) was created based
upon their association with mortality. Survival among low (score < 10%),
medium and high risk (> 20%) patients was compared. After re-calibration
in the validation cohort the CRS was compared to IMPACT (a non-CHD HTx
risk score) evaluating discrimination (c-statistic), calibration (observed
vs predicted survival) and risk reclassification (net absolute
reclassification index -NARI). Results: Of 1,381 CHD recipients, 377 (27%)
died after HTx during 2.8 median follow-up years. Whereas IMPACT
classified all patients as medium and high risk (Figure 1A) the CRS
classified a small proportion (4%) of CHD recipients as low risk. In the
validation cohort, CRS showed better discrimination than the IMPACT score
[Figure 1B, c-statistic 0.65 (0.59-0.70) vs 0.62 (CI 0.56-0.68) for
IMPACT]. The CRS showed adequate calibration while IMPACT's calibration
was poor (Fig 1C). The CRS better classified patients without events but
misclassified patients with events leading to a similar net risk
reclassification to IMPACT[NARI 0.13 [-0.05, 0.38], p = 0.12]. Conclusion:
A new prediction model that incorporates 5 simple variables with adequate
discrimination, excellent calibration and better identification of low
risk CHD HTx recipients is presented. (Figure presented).

<103>
Accession Number
621718963
Author
Choi J.; Luc J.G.; Moncho Escriva E.; Phan K.; Rizvi S.A.; Patel S.;
Entwistle J.W.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Choi, Rizvi, Patel, Entwistle, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Luc) University of Alberta, Edmonton, AB, Canada
(Moncho Escriva) University of Granada, Granada, Spain
(Phan) University of New South Wales, Sydney, Australia
Title
Impact of concomitant mitral valve surgery for mitral regurgitation during
lvad implantation: Systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S75), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Significant preexisting mitral regurgitation (MR) is common in
patients with end-stage heart failure undergoing continuous-flow left
ventricular assist device (CF-LVAD) implantation. However, the indications
and outcomes of concomitant mitral valvular (MV) intervention remain
unknown. The aim of this systematic review was to evaluate the effect of
concurrent MV surgery (repair or replacement) as compared to no surgery in
patients with moderate to severe or severe MR undergoing CF-LVAD
implantation. Methods: Electronic search was performed to identify all
studies in the English literature assessing concurrent MV surgery in
patients with MR who were undergoing CF-LVAD implantation. All identified
articles were systematically assessed for inclusion and exclusion
criteria. Results: Total of 8 studies with 2469 patients were pooled for
analysis. 445 patients (18%) had moderate to severe or severe MR. Mean age
was 67 (95% CI, 62-73) years, and 74% (95% CI, 65-81%) were male. 94% (95%
CI, 88-97%) of the patients received a HeartMate II LVAD, while 6% (95%
CI, 2-12%) received a HeartWare HVAD. 113/445 patients (25.4%) received
concurrent MV surgery during CF-LVAD implantation. There was no
significant difference in mean cardiopulmonary bypass time [MR surgery:
154 (95% CI, 31-278) minutes, no MR surgery: 119 (95% CI, 38-199) minutes,
p= 0.64] or mean hospital length of stay [MR surgery: 21 (95% CI, 0-81)
days, no MR surgery: 18 (95% CI, 8-29) days, p= 0.93]. On follow-up,
freedom from > moderate MR was 100% (95% CI, 91-100%) in MR surgery group,
and 74% (95% CI, 8-100%) in no MR surgery group (p= 0.12). Mean left
ventricular end-diastolic diameter was comparable between the two groups
[MR surgery: 60 (95% CI, 0-132) mm, no MR surgery: 65 (95% CI, 53-78) mm,
p= 0.51]. Survival was comparable at six months [MR surgery: 77% (95% CI,
61-88%), no MR surgery: 81% (95% CI, 58-93%), p= 0.75], one year [MR
surgery: 72% (95% CI, 61-81%), no MR surgery: 80% (95% CI, 66-89%), p=
0.36], and two years [MR surgery: 65% (95% CI, 55-74%), no MR surgery: 70%
(95% CI, 55-81%), p= 0.56]. Conclusion: There is no clear advantage of
concomitant MV surgery during CF-LVAD placement. When performed, however,
there are no adverse outcomes associated with it. Larger, more granular
data are needed to study the effects of underlying MR pathology and MV
surgery type on outcomes.

<104>
Accession Number
621718931
Author
Tjugum S.L.; Heeney S.A.; Corkish M.E.; Hollis I.B.
Institution
(Tjugum, Heeney, Corkish, Hollis) University of North Carolina Medical
Center, Chapel Hill, NC, United States
Title
Safety and tolerability of high intensity statin therapy in heart
transplant patients receiving immunosuppression with tacrolimus.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S307), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Following heart transplantation (HT), HMG CoA reductase
inhibitors (statins) have been shown to reduce total and low-density
lipoprotein (LDL) cholesterol, development of cardiac allograft
vasculopathy (CAV), and mortality. Several studies in HT patients have
demonstrated the safety and efficacy of low or moderate intensity statins,
however little data exists using high intensity (HI) statins (atorvastatin
40-80 mg/day or rosuvastatin 20-40 mg/day) in patients receiving
tacrolimus. All patients at our institution are prescribed a moderate
intensity statin at time of HT, but are converted to HI statin if they
develop hyperlipidemia or CAV. The aim of this study was to evaluate the
safety and efficacy of HI statins compared to moderate intensity statins
in HT recipients. Methods: This single center, retrospective analysis
included all adult HT recipients at our institution from January 1, 2005
to December 31, 2015 receiving tacrolimus and HI statin therapy at any
time during post-transplant follow-up. Included patients fully tolerated
moderate intensity statins before being switched to HI statin. Data was
collected six months before and after conversion from moderate intensity
to HI statin therapy. The primary outcome, safety and tolerability, was
defined as the absence of myalgias, hepatotoxicity, rhabdomyolysis, or any
HI statin dose reduction/discontinuation due to adverse drug events. The
secondary efficacy end point was the mean reduction in total and LDL
cholesterol after the conversion. Statistical analyses were conducted
using the McNemar's and Wilcoxon Signed Rank tests. Results: A total of
153 heart transplants performed during the study period were assessed for
inclusion. Among the 25 patients included, one (4%; p = 1.00) experienced
myalgias. No instances of rhabdomyolysis or hepatotoxicity were observed.
HI statin dose reduction/discontinuation did not occur within 6 months
post-conversion. The mean tacrolimus trough level during time on HI statin
was 7.3 ng/mL. The average reduction in total and LDL cholesterol after
initiation of HI statin was 35 mg/dL (p = 0.01) and 20 mg/dL (p = 0.07),
respectively. Conclusion: High intensity statin therapy appears safe and
efficacious in HT recipients receiving tacrolimus and is a reasonable
option for treatment of hyperlipidemia refractory to lower intensity
statins.

<105>
Accession Number
621718927
Author
Rushton S.; Hogg R.; Banner N.; Simon A.; Venkateswaran R.; Shaw S.;
Al-Attar N.; Dalzell J.; Schueler S.; MacGowan G.; Mascaro J.; Sern L.;
Tsui S.; Parameshwar J.
Institution
(Rushton, Hogg) NHS Blood and Transplant, Bristol, United Kingdom
(Banner, Simon) Harefield Hospital, London, United Kingdom
(Venkateswaran, Shaw) Wythenshawe Hospital, Manchester, United Kingdom
(Al-Attar, Dalzell) Golden Jubilee National Hospital, Glasgow, United
Kingdom
(Schueler, MacGowan) Freeman Hospital, Newcastle, United Kingdom
(Mascaro, Sern) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Tsui, Parameshwar) Papworth Hospital, Cambridge, United Kingdom
Title
Patient survival and therapeutic outcomes in the UK bridge to heart
transplant ventricular assist device population.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S267-S268),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The aim of our study was to examine medium-term patient survival
and therapeutic outcomes in an unselected cohort of adult patients who
received an implantable left ventricular assist device (LVAD) as a bridge
to heart transplant in the UK. We used the UK's comprehensive national VAD
database to compare various outcomes for the two main devices implanted
over a 7 year period. Some UK centres started LVAD programmes during this
period. Methods: Patients who received a HeartMate II (HMII) (N= 122) or
HeartWare (HVAD) (N= 230) between January 2007 and December 2013 were
considered. Primary outcomes were urgent heart transplant listing, receipt
of a transplant and patient death. Secondary outcomes were pump thrombosis
and stroke. The Kaplan-Meier method was used to analyse outcomes by device
type. Results: Overall, the median duration of support was 534 days with
81 (24%) patients registered on the urgent heart transplant list during
the study period and 63 of these receiving a transplant. A further 22
patients received a transplant from the non-urgent list. There was no
difference between device types with regards to time to urgent listing and
time to transplant (3 year: p= 0.3 and 0.7 respectively). The overall
patient survival rate at 3 years was 50% with no difference between
devices (p= 0.6). A composite end point representing time free of urgent
listing, pump exchange or death gave a 3 year rate of 34%, suggesting a
high incidence of serious complications for both devices (p= 0.95). 36
patients experienced pump thrombosis with a rate per 100 patient months of
support of 0.36 and 0.58 for HMII and HVAD respectively (p= 0.3). There
was a total of 85 strokes in the cohort with no difference between devices
(p= 0.4). (Figure presented) Conclusion: Use of LVAD is effective in
bridging patients to a transplant but the rate of serious complications
remains high. There were no significant differences between the two
devices and although this was not a randomised trial there were some
similarities with the ENDURANCE trial.

<106>
Accession Number
621718875
Author
Sato T.; Azarbal B.; Cheng R.; Esmailian F.; Patel J.; Kittleson M.; Czer
L.; Levine R.; Dimbil S.; Khayal T.; Kobashigawa J.A.
Institution
(Sato, Azarbal, Cheng, Esmailian, Patel, Kittleson, Czer, Levine, Dimbil,
Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Khayal) Transmedics, Andover, MA, United States
Title
Does ex vivo perfusion lead to more or less intimal thickening in the
first-year post-heart transplantation?.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S410-S411),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The Organ Care System (OCS), an ex-vivo heart perfusion system,
is a physiologic alternative to cold organ storage (CS) for transport. In
studies, OCS significantly shortened cold ischemic time compared to CS.
However, OCS requires 2 short ischemic times when the heart is placed on
and off the device. It is not known if this harms the coronary vascular
bed. We examined patients (pts) placed on OCS with first-yr intravascular
ultrasound (IVUS), as a sensitive and predictive assessment of early
cardiac allograft vasculopathy (CAV). Methods: Between 2011-13, 39 heart
transplant pts enrolled in the PROCEED 2 trial at our institution were
randomized to CS or OCS. IVUS was performed at 4-6 weeks (baseline) and 1
yr (paired). Diagnosis of CAV was based on >= 0.5 mm increase in maximal
intimal thickness (MIT) from baseline in a matched site. Clinical
outcomes- 1-yr survival, 1-yr freedom from non-fatal major cardiac events
(NF-MACE - myocardial infarction, new onset heart failure, coronary
intervention, defibrillator/pacemaker implant, stroke), 1-yr freedom from
rejection were examined. Results: Thirty-nine pts were randomized and
underwent HTx by OCS (n= 16) or CS (n= 18). Of these, 18 pts (OCS: n= 5,
CS: n= 13) with paired IVUS at baseline and 1 year post-transplant were
examined. There was no significant difference in the proportion of pts
with DELTA MIT >= 0.5 mm between the two groups. The mean change in MIT
from baseline to 1-year posttransplant was similar between the two groups.
There was no significant difference in 1-year survival, 1-year freedom
from NF-MACE or 1-year freedom from the various forms of rejection.
Conclusion: Development of CAV by IVUS in donor hearts preserved with OCS
and CS is similar. This implies that OCS does not harm the coronary
vascular bed and is a promising platform for donor heart transport. Larger
sample sizes are needed to confirm these findings. (Table presented).

<107>
Accession Number
621718862
Author
Rivard A.; Koizumi N.
Institution
(Rivard) Department of Radiology, Cleveland Clinic, Abu Dhabi, United Arab
Emirates
(Koizumi) George Mason University, Arlington, VA, United States
Title
Human leukocyte compatibility and heart transplant survival using a
validated matching algorithm.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S183), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Cold ischemic time and post-operative complications are
associated with 30-day mortality of the donor graft. However, long-term
patient survival is related primarily to tissue matching, vasculopathy,
immunosuppression, and infection. This study examines the preeminent role
of tissue matching using an algorithm to examine the effect of randomly
allocated HLA: A, B, and DR donor heart loci on long term patient survival
in the largest retrospective study known to date. Methods: A STAR data
file of 121,368 orthotopic heart transplant patients comprising a 10 year
period from January 1st, 2003 to December 31st, 2015 was provided by UNOS
in IRB approved study. Data from all 209 transplant centers was extracted
into a relational database with a validated UNOS independent algorithm for
mismatching based upon an HLA equivalency table forming a Cox proportional
hazard model whereby a score of 0 assigned for no HLA: A, B, or DR
mismatches. A score of 1 to 6 based upon further pairs of mismatches. Data
was excluded for more than 4 missing loci. Rates of graft survival were
then calculated based upon Kaplan-Meier methodology. Results: Out of 21878
heart transplants meeting inclusion criteria; the number of patients with
zero or 1 mismatch was 398 (1.8%) and mean rate graft survival at 700 days
was 90% (+/-0.02). For patients with 2 to 6 mismatches, the survival was
85.1%, 84.8%, 83.3%, 82.9%, 82.5% at 700 days (p< 0.01). After an initial
rapid drop in from immediate 30 day causes of mortality, the survival
curves of >= 4 mismatches is significantly worse than those patients with
< 3 mismatches (p < 0.001). Using a Cox survival regression analysis of
the HLA loci; only DR mismatching is a significant factor that influences
patient mortality (p = 0.003). Conclusion: As recapitulated in this large
study, long-term heart transplant patient survival is directly related to
the degree of tissue matching. Wellmatched grafts have a significant
advantage over poorly matched donor hearts. Although, donor heat
allocation is a random process due to short cold ischemic time available
for transportation of the organ and based upon our results, all future
effort for donor/recipient matching should be concentrated on DR matching
using DNA-based molecular typing.

<108>
Accession Number
621718851
Author
Lourenco L.M.; Truman Z.; Murks C.; Riley T.; Powers J.; Reilly M.;
Kalantari S.; Raikhelkar J.; Sarswat N.; Kim G.; Sayer G.; Uriel N.
Institution
(Lourenco, Truman) Pharmacy Services, University of Chicago Medicine,
Chicago, IL, United States
(Murks, Riley, Powers, Reilly, Kalantari, Raikhelkar, Sarswat, Kim, Sayer,
Uriel) Cardiology, University of Chicago Medicine, Chicago, IL, United
States
Title
Association between tacrolimus concentration/dose ratio and renal function
following cardiac transplant.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S306), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Tacrolimus (TAC) is highly effective at preventing rejection and
prolonging graft function in heart transplant (HT) recipients. The
nephrotoxic effect of TAC remains one of its most significant limitations.
TAC induced nephrotoxicity is strongly associated with the concentration
of TAC in whole blood; emerging data suggests that the rate of drug
metabolism may also contribute. The ratio of TAC blood concentration to
TAC dose (C/D ratio) has been shown to be a reliable marker for the rate
of metabolism in renal transplant recipients, but has not been evaluated
in HT patients. This study aimed to characterize the relationship between
the rate of TAC metabolism and its effects on renal function in HT
recipients. Methods: A retrospective, single-center study was conducted on
all adult HT recipients between 1/2008 and 9/2016. Multi-organ transplant
recipients were excluded. Fast versus slow TAC metabolizers were
characterized according to the C/D ratio, with fast metabolizers defined
as a C/D ratio of < 1.09 and slow metabolizers defined as a C/D ratio of
>= 1.09. TAC dose, whole blood concentration, renal function, cardiac
graft function, and liver function tests were evaluated at 1, 3, 6, 12,
24, and 36 months post-transplant. Results: 76 patients were enrolled
(Table 1). Average patient age was 54 years old; 71% were male and 43%
were African American. There was no significant difference in renal
function at 1, 3, 6, 12, or 24 months between fast and slow TAC
metabolizers. No between group differences were seen at months 1, 3, 6,
12, or 24 in patients who were and were not receiving concomitant
ketoconazole for its CYP3A4 inhibition. Conclusion: This study found no
statistically significant relationship between worsening renal function
and patients deemed to be fast TAC metabolizers. Larger, randomized
studies are warranted to further elucidate TAC nephrotoxicity and the
development of minimization strategies that do not compromise clinical
efficacy. (Table presented).

<109>
Accession Number
621718828
Author
Breslin N.T.; Salerno D.; Restaino S.; Latif F.; Takeda K.; Takayama H.;
Farr M.; Colombo P.; Jennings D.L.
Institution
(Breslin, Salerno, Jennings) Pharmacy, New York-Presbyterian, New York,
NY, United States
(Restaino, Latif, Farr, Colombo) Medicine, New York- Presbyterian, New
York, NY, United States
(Takeda, Takayama) Surgery, New York- Presbyterian, New York, NY, United
States
Title
Pre-transplant amiodarone reduces weight-based tacrolimus dosing
requirements in heart transplant recipients.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S306), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Amiodarone (AMIO) use prior to heart transplant (HT) is
associated with a higher rate of severe primary graft dysfunction (PGD)
and mortality. AMIO also alters the pharmacokinetics of medications
metabolized via cytochrome P450. No data exist regarding the interaction
between pretransplant AMIO and tacrolimus concentrations. Methods:
Single-center retrospective study of patients who received HT between
January 1, 2014 through June 30, 2016. A therapeutic tacrolimus
concentration was defined as a trough level between 8 - 15 ng/mL for two
consecutive days. The primary outcome was the weight-based dosing
requirements for patients receiving AMIO prior to HT as compared to those
without prior receipt of AMIO. Secondary outcomes include the incidence of
cellular rejection and mortality within 6-months posttransplant. Results:
Multi-organ transplant recipients (n= 3), re-transplants (n= 9), and those
receiving AMIO post-transplant (n= 7) were excluded from analysis. Of the
81 HT patients included, 34 (42%) received AMIO prior to HT. Patient
characteristics were similar, with the exception of PGD incidence (38% in
AMIO vs. 8.5% in control, p = 0.001). Median time to therapeutic
concentration was 8 days (IQR: 7, 10) in AMIO compared to 9 days (IQR:
7,11). The median therapeutic dose was 0.1 (IQR: 0.07, 0.12) vs. 0.13
(IQR: 0.09, 0.17) mg/kg/day in the AMIO and control groups, respectively,
(p = 0.0076). Further stratified, median therapeutic dose was
significantly lower in patients with PGD (Figure 1). However, regression
analysis identified AMIO as an independent factor for lower weight-based
doses of tacrolimus (p = 0.026) after adjusting for PGD. There was no
significant difference in mortality or rejection. Conclusion: Patients
receiving AMIO prior to HT require lower weightbased doses of tacrolimus,
suggesting a potential pharmacokinetic alteration. (Figure presented).

<110>
Accession Number
621718812
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Nubret-Le Coniat K.; Flecher E.;
Cantrelle C.; Audry B.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent) Agence
de la Biomedecine, Saint-Denis la plaine, France
(Nubret-Le Coniat) CHU Bordeaux, Bordeaux, France
(Flecher) CHU Rennes, Rennes, France
Title
A novel transplant riskscore (TRS) incorporating recipient and donor
variables and center effect.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S182), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: The new French heart allocation system aims to reduce waitlist
mortality and extend donor pool without being detrimental to
post-transplant survival. Recently, we developed a Candidate Risk Score
(CRS) which ranks candidates according to their heart failure severity.
This study was designed to generate and validate a Transplant Risk Score
(TRS) incorporating recipient and donor characteristics in addition to
center random effect that predicts 1-year post-transplant mortality.
Methods: The study included all single-organ adult heart recipients
transplanted between January 2010 and December 2014. This population was
randomly divided in a 2:1 ratio into derivation and validation cohorts.
The association of variables at listing and at transplant with 1-year
post-transplant mortality was assessed within the derivation cohort with
mixed Cox model considering center random effect. The predictors were used
to generate the TRS. Results: During the study period, 1,776 patients were
transplanted. The derivation (n= 1 184) and validation cohorts (n= 592)
were similar. Factors associated with 1-year post-transplant mortality
included in the TRS were: recipient age > 50, valvular cardiomyopathy or
congenital heart disease, history of cardiac surgery, diabetes mellitus,
mechanical ventilation, glomerular filtration rate and bilirubin level at
transplant, donor age > 55 and donor female gender. The C-index of the TRS
was 0.67 in the derivation cohort and 0.64 in the validation cohort. In
the validation cohort, the correlation between observed and predicted
1-year post-transplant mortality was excellent (r= 0.81). One-year
post-transplant survival was 91%, 77% and 59% in respectively low-risk
(TRS 0-10), medium-risk (TRS 11-20) and high-risk (TRS > 20) classes
(Figure 1). Conclusion: TRS provides an accurate prediction of
post-transplant mortality based on recipient and donor characteristics
with good discrimination and calibration. It will be incorporated in the
new French heart allocation system to optimize post-transplant outcomes
(Figure presented).

<111>
Accession Number
621718807
Author
Poglajen G.; Frljak S.; Cerar A.; Zemljic G.; Okrajsek R.; Sebestjen M.;
Androcec V.; Jaklic M.; Vrtovec B.
Institution
(Poglajen, Frljak, Cerar, Zemljic, Okrajsek, Sebestjen, Androcec, Jaklic,
Vrtovec) Advanced Heart Failure and Transplantation Center, UMC Ljubljana,
Ljubljana, Slovenia
Title
Safety and efficacy of extended release tacrolimus after heart
transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S326-S327),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Although standard release tacrolimus (SRT) has been a mainstay of
immunosuppression after heart transplantation (HTX), data on extended
release tacrolimus (ERT) are lacking. We sought to compare the effects of
SRT and ERT in HTX receipients. Methods: In a prospective cross-over
single-center study we enrolled 43 HTX recipients transplanted between
2014 and 2016. At baseline all patients received SRT and were followed for
6 months. Then SRT was switched for ERT, and patients were followed for
another 6 months. All patients were followed on monthly intervals; at each
visit clinical and biochemical data were collected; echocardiography was
performed every 6 months. Renal dysfunction was defined as estimated
glomerular filtration rate (eGFR)< 90mL/ min/1.73 m2. Patients with a
history of acute rejection, sensitized patients and patients bridged to
HTX with LVAD were excluded from the study. Results: Of 43 patients 32
(75%) were male and the average age was 55+/-12 years, 25 (58%) had renal
dysfunction, 10 (23%) diabetes and 26 (56%) hypertension. When comparing
the two treatment strategies we found no differences between SRT and ERT
in tacrolimus Co level (7.1+/-1.3 ng/mL in SRT vs. 7.0+/-1.6 ng/mL in
ERT;P= 0.72), % of Co fluctuation (18+/-11% in SRT vs. 18+/-8% in ERT;P=
0.79) and drug dose (2.9+/-1.5 mg in SRT vs. 3.5+/-1.7 mg;P= 0.13). Renal
function and glucose metabolism remained unchanged (eGFR: 77+/-14
mL/min/1.73m² in SRT vs. 74+/-13 mL/min/1.73m² in
ERT;P= 0.38; HbA1c: 5,8+/-0,9% in SRT vs. 5,9+/-0,9% ERT;P= 0.68). We
found no change in left and right ventricular function (LVEF: 65+/-6% in
SRT vs. 66+/-7% in ERT;P= 0,92; TAPSE:1,7+/-0,3 cm in SRT vs. 1,8+/-0,2 cm
in ERT;P= 0,62). Also, troponin levels and allograft rejection rates
remained comparable (troponin:0,01+/-0,01 pg/mL in SRT vs. 0,01+/-0,02
pg/mL in ERT;P= 0,29; rejection rates: 0% in SRT vs. 2% in ERT;P= 0,2).
When stratifying patients according to baseline renal function, no decline
in eGFR was found in patients with normal renal function (eGFR: 87+/-5
mL/min/1.73m² in SRT vs. 86+/-7 mL/min/1.73m² in
ERT;P= 0.48) or decreased renal function (eGFR: 68+/-11
mL/min/1.73m² in SRT vs. 66+/-12 mL/min/1.73m² in
ERT;P= 0.65). Conclusion: In patients after HTX the effects of ERT appear
to be comparable to SRT. Further, larger studies are needed to confirm
these data and to investigate whether ERT can be used as a
standard-of-care strategy in a broad population of HTX recipients.

<112>
Accession Number
621718784
Author
Krebs R.; Kankainen M.; Holmstrom E.; Lukac J.; Ojala T.; Mattila P.;
Nykanen A.; Lemstrom K.
Institution
(Krebs, Holmstrom, Lukac, Nykanen, Lemstrom) Transplantation Laboratory,
University of Helsinki, Helsinki, Finland
(Kankainen, Ojala, Mattila) Institute for Molecular Medicine Finland,
University of Helsinki, Helsinki, Finland
Title
Donor simvastatin treatment alters the gene expression profile of human
cardiac allografts during ischemia and reperfusion.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S346-S347),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Recently, we were able to show in a randomized clinical trial
that simvastatin treatment of brain-dead donors reduces
ischemia-reperfusion injury in human cardiac allograft recipients. Here,
we analyze myocardial transcriptome changes in cardiac allografts after
donor simvastatin treatment. Methods: 84 heart transplant donors received
80 mg of simvastatin via nasogastric tube (n= 42), or no treatment (n= 42)
in a prospective, doubleblinded randomized controlled trial. Transmural
Tru-Cut biopsies were taken from the apex of left ventricle of the donor
heart immediately before reperfusion and 1 hour after reperfusion. 10
heart biopsies from donors without treatment and 10 heart biopsies from
donors with simvastatin treatment will be analyzed with RNA sequencing.
(Figure presented) Results: The preliminary analysis of RNA sequencing
data from the myocardial biopsies by hierarchical clustering analysis
revealed 307 differentially expressed genes in the control or simvastatin
group. Shades of red and blue are used to illustrate whether the
expression value is above (red) or below (blue) the mean expression value
across all samples (average linkage method, with Pearson Correlation as a
distance metric; Figure 1). At the pathway level, our results pointed to
alterations in functions such as TNF and MAPK signaling as well as stress
and inflammatory responses. Conclusion: We have recently shown that donor
simvastatin treatment induces a protective effect against IRI in heart
transplant recipients. Here, we were able to detect differential
expression of genes in the myocardium that may lie behind the beneficial
effects of simvastatin treatment. Further analysis will be conducted to
explore expression changes at the gene and pathway level, and the final
pathway analysis of the results will be presented at the ISHLT 2018
congress.

<113>
Accession Number
621718752
Author
Sell M.L.; Haney A.L.; Sprott K.; Burnette A.; Henderson H.; Savage A.
Institution
(Sell, Haney, Sprott) Pharmacy, Medical University of South Carolina,
Charleston, SC, United States
(Burnette, Henderson, Savage) Pediatric Cardiology, Medical University of
South Carolina, Charleston, SC, United States
Title
Safety and efficacy of rabbit anti-thymocyte globulin induction in
pediatric patients undergoing cardiac transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S114), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Limited data are available in pediatric cardiac transplant
patients that focus on the safety and efficacy of rabbit anti-thymocyte
globulin (rATG) induction therapy. The aim of this study was to evaluate
the use of rATG induction therapy in pediatric patients undergoing cardiac
transplantation. Methods: A retrospective, single-center, cohort study was
conducted at a large academic medical institution. Patients were included
if they underwent cardiac transplantation by the pediatric cardiac
transplant team at the institution between January 1, 1998 and July 1,
2017. The primary objective was to determine the rate of overall graft
loss in patients receiving rATG induction therapy as compared with those
without rATG induction therapy. Secondary objectives included rate of
acute rejection, time to first rejection, development of donor specific
antibodies (DSAs), development of transplant coronary artery disease
(TCAD), and safety of rATG induction compared with no rATG induction
(i.e., infection, malignancy). Results: Thirty-nine patients who received
rATG induction and 36 patients without rATG induction were identified and
included in the analysis. On average, the patients who received rATG
induction were older and had higher panel reactive antibody and baseline
serum creatinine (Table 1). There was no significant difference in overall
graft loss, however there was a significant difference in time to graft
loss as seen in Figure 1 (P = 0.014). There were a significantly greater
number of acute rejection episodes in patients who did not receive rATG (P
= 0.005), but no significant differences in the number of infections or
development of a malignancy, TCAD, or DSAs. Conclusion: Patients who
received rATG induction therapy were at higher risk of rejection at
baseline. The use of rATG was not associated with a higher overall risk of
graft loss, infection, or malignancy but did reduce the number of acute
rejections suffered by pediatric patients post-cardiac transplantation
(Figure presented).

<114>
Accession Number
621718695
Author
Javaheri A.; Novak E.; Lavine K.; Rader D.J.; Starling R.; Chandraker
A.K.; Baran D.; Heeger P.S.; Stehlik J.
Institution
(Javaheri, Novak, Lavine) Medicine, Washington University of Saint Louis,
Saint Louis, MO, United States
(Rader) Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Starling) Medicine, Cleveland Clinic, Cleveland, OH, United States
(Chandraker) Medicine, Harvard Medical School, Boston, MA, United States
(Baran) Medicine, Sentara Advanced Heart Failure Center, Norfolk, VA,
United States
(Heeger) Medicine, Mount Sinai School of Medicine, New York, NY, United
States
(Stehlik) Medicine, University of Utah, Salt Lake City, UT, United States
Title
Pre-transplant macrophage cholesterol efflux capacity is associated with
angiographic cardiac allograft vasculopathy in a multi-center
observational study.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S35-S36),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Reduced macrophage cholesterol efflux capacity (CEC) is
associated with accelerated early cardiac allograft vasculopathy (CAV)
based on intravascular ultrasound (Javaheri et al., JHLT, 2016). However,
whether reduced CEC is associated with clinically defined, angiographic
CAV and clinical events remains controversial. We tested the hypothesis
that reduced pre-transplant CEC is associated with incident, angiographic
CAV and mortality in the Clinical Trials in Organ Transplantation 18
(CTOT18) trial. Methods: CTOT18 was a multi-center, observational study of
heart transplant patients previously enrolled in CTOT05 who consented to 4
years follow up. Of the 200 patients enrolled, 79 had available blood
samples and paired angiographic data. We measured CEC in vitro (validated
assay, coefficient of variation < 5%) in pre-transplant apolipoprotein
B-depleted serum. Each patient's CEC was normalized to a pool of healthy
controls (hence CEC< 1.0 is reduced). CAV was adjudicated yearly by
coronary angiography. The relationship between CEC and CAV outcomes was
tested via student t-test and a competing risks model. Results: Out of 79
subjects with available blood samples for CEC determination, 14 met the
clinical CAV endpoint, and 19 met the combined endpoint of CAV or death.
Mean CEC was 0.79 +/- 0.03 in subjects who developed CAV compared to 0.99
+/- 0.04 in subjects without CAV (p= 0.0069, Figure). For the outcome of
CAV or death the mean CEC was 0.84 +/- 0.04 vs 0.99 +/- 0.03, p= 0.03,
respectively. After adjustment for high-density lipoprotein cholesterol
levels in a competing risks model, lower CEC remained associated with risk
of CAV (HR 0.57 per 0.1 unit increase in CEC, 95% CI 0.37-0.89, p= 0.013).
Conclusion: Reduced pre-transplant macrophage CEC is associated with
post-transplant CAV. As safe therapies that raise CEC are available, their
benefit in transplant recipients should tested in a clinical trial (Figure
presented).

<115>
Accession Number
621718644
Author
Van Setten J.; De Jonge N.; Cole B.S.; Chang B.; Holmes M.V.; Baan C.C.;
Manintveld O.C.; Peeters A.M.; Dominguez F.; Kush K.K.; Garcia-Pavia P.;
Rossano J.W.; De Weger R.A.; Moore J.H.; Keating B.; Asselbergs F.W.
Institution
(Van Setten, De Jonge, De Weger, Asselbergs) University Medical Center
Utrecht, Utrecht, Netherlands
(Cole, Chang, Holmes, Rossano, Moore, Keating) University of Pennsylvania,
Philadelphia, PA, United States
(Baan, Manintveld, Peeters) Erasmus MC, Rotterdam, Netherlands
(Dominguez, Garcia-Pavia) Puerta de Hierro University Hospital, Madrid,
Spain
(Kush) Stanford University, Stanford, CA, United States
Title
The role of loss-of-function mutations on development of rejection after
heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S324-S325),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Heart transplant donor/recipient (D-R) matching is suboptimal.
Besides HLA, also other genetic factors play a role in graft rejection.
Possible sources of genetic variation underpinning rejection are
Loss-of-Function (LoF) variants ablating two copies of a given gene,
resulting in incompatibility across the proteomes of donor and recipient.
We have developed a pipeline to identify human knockouts and aim to
associate the detected knockout genes with acute rejection after heart
transplantation. Methods: iGeneTRAiN is a large-scale international
consortium, which consist of over 12,000 solid organ D-R pairs, including
888 heart transplant D-R pairs. All samples were genotyped and untyped
variants were imputed using a combined reference panel of the Genome of
the Netherlands and the 1000 Genomes Project. Effects of genetic variants
were annotated with ENSEMBL's Variant Effect Predictor using the LOFTEE
plugin. For each D-R pair, genes were identified that are inactive in both
copies in a transplant recipient but present in at least one functional
copy in the corresponding donor. These genes were tested for association
with rejection using cox proportional hazard models. Results: In total,
827 genes were inactive in both copies in the recipient but active in the
donor in at least one D-R pair. We identified three genes associated with
rejection after heart transplantation (P < 3 x 10-5 to correct for the
number of tests). Conclusion: We identified three genes associated with
acute rejection after heart transplantation. We aim to increase our sample
of heart transplant D-R pairs and to conduct cross-organ meta-analyses
including lung, liver, and kidney transplants, maximizing statistical
power to identify novel genes. We ultimately aim to translate genetic data
into clinical applications such as more optimal genomic compatibility
matching of D-R pairs and immune suppression therapy dosing.

<116>
Accession Number
621718636
Author
Chahal D.; Sepehry A.; Nazzari H.; Wright A.J.; Toma M.
Institution
(Chahal, Sepehry, Nazzari, Wright, Toma) University of British Columbia,
Vancouver, BC, Canada
Title
The impact of left ventricular assist device infections on post cardiac
transplant survival: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S134-S135),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Left ventricular assist devices (LVADs) improve survival for
patients with end stage heart failure while they await transplantation,
but may develop infections. The impact that LVAD related infections have
on outcomes after transplantation is not well studied. We sought to
determine if LVAD infection negatively influences survival after
transplantation. Methods: We searched Medline, Embase, and Cochrane
Central Register of Controlled Trials for eligible full text studies. We
also searched study bibliographies. Eligible studies included those that
identified LVAD related infections and reported on post-transplant
outcomes. Meta-analyses of posttransplant survival were conducted
utilizing a random effects model. Results: We identified 2373 records; 13
cohort studies were selected (n= 6631, 82% male, mean age 50 +/-14 years).
3718 continuous flow LVADs and 1752 pulsatile LVADs were identified. Of
these, 2586 (39 %) developed LVAD related infections. Patients with LVAD
related infections were younger (49.7 +/-13.1 vs. 52.5 +/-12.5, p = 0.02),
had higher mean BMIs (28.5 vs. 26.6, p < 0.01), and longer LVAD support
times (252 days vs. 198 days, p < 0.01). LVAD infection patients had lower
incidence of ischemic etiology of heart failure (40% vs. 44%).
Meta-analysis of all studies demonstrated significantly increased
post-transplant mortality in thosepatients who had a documented LVAD
infection (HR 1.3, 95% CI 1.16-1.46, p< 0.001) (Fig 1). Sub-group
meta-analyses by continuous flow and pulsatile device type demonstrated
significant hazard ratios (1.47, 95% CI 1.22-1.76, p< 0.001 and 1.71, 95%
CI 1.19-2.45, p= 0.004, respectively). Meta-analyses by driveline or
bloodstream infection type did not display significance, likely due to
small sample size. Sub-group meta-analyses by study size where greater
than 100 patients were included also revealed a significant hazard ratio
(HR 1.35, 95% CI 1.18-1.54, p< 0.001). Post-hoc meta-regression revealed
significant impact of age, BMI, ischemic etiology and LVAD duration on
post-transplant survival. Conclusion: LVAD infection patients have higher
BMIs and longer LVAD support times. LVAD related infections may result in
a 30% increase in post cardiac transplantation mortality. This may be due
to increased rejection or infectious events after transplantation.

<117>
Accession Number
621718613
Author
Lange N.; Baker W.L.; Shullo M.; Latif F.; Restaino S.; Takeda K.;
Takayama H.; Naka Y.; Farr M.; Colombo P.; Jennings D.L.
Institution
(Lange, Latif, Restaino, Takeda, Takayama, Naka, Farr, Colombo, Jennings)
Columbia University Medical Center, New York, NY, United States
(Baker) University of Connecticut, Storrs, CT, United States
(Shullo) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S90-S91),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: Data describing the effects of mTOR inhibitors in heart
transplant (HT) patients comes from relatively small studies and
controversy exists regarding their specific role. We performed a
meta-analysis of randomized trials to evaluate the efficacy and safety of
mTOR inhibitors in HT patients. Methods: We performed a systematic
literature search of Medline and Embase through July 2017 to identify
studies evaluating mTOR inhibitors in HT patients; we included all studies
reporting at least one outcome of interest, which were coronary allograft
vasculopathy (CAV), renal function, acute cellular rejection (ACR),
cytomegalovirus (CMV) infection, and discontinuation due to adverse drug
events (ADE). Non-randomized studies and duplicate data were excluded.
Data were pooled using a Hartung-Knapp random-effects model producing a
mean difference (MD; for continuous data) or odds ratio (OR; for
dichotomous data) and 95% confidence interval (CI). Results: A total of 10
randomized trials reported at least one outcome of interest. CAV endpoints
were significantly improved with mTOR containing regimens (FIGURE)
compared to calcineurin inhibitor/mycophenolate mofetil (CNI/MMF). Rates
of CMV infection were also significantly reduced (OR 0.26; 95% CI
[0.19-0.35]) with mTOR regimens compared to CNI/MMF therapy. ACR was more
frequent with CNI-sparing regimens (4.79 [2.42-9.46]), but similar between
CNI/mTOR versus CNI/MMF regimens (p> 0.05). eGFR was significantly
improved with CNI-sparing therapies (MD 12.13 ml/min [2.51-21.76]), but
was similar between CNI/mTOR versus CNI/MMF regimens (p> 0.05). Rates of
discontinuation due to ADE were numerically higher in mTOR regimens
compared to CNI/MMF (2.97 [0.78-11.37]). Conclusion: mTOR-containing
regimens can attenuate CAV and CMV risk in HT recipients. A mTOR/MMF
combination preserves renal function but increases the risk of ACR (Table
presented).

<118>
Accession Number
621718593
Author
Baran D.A.; Kapoor S.; Vijaykumar S.; Gidea C.; Camacho M.; Zucker M.J.
Institution
(Baran) Advanced Heart Failure and Transplant, Sentara Heart Hospital,
Norfolk, VA, United States
(Kapoor, Vijaykumar, Gidea, Camacho, Zucker) Newark Beth Israel Medical
Center, Newark, NJ, United States
Title
TICTAC 10: Ten year follow-up of the tacrolimus in combination tacrolimus
alone compared trial.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S18-S19),
2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: For the last 35 years, the standard for post-transplant
immunosuppression has been "triple therapy". The Tacrolimus in
Combination, Tacrolimus Alone Compared (TICTAC) trial challenged this
conventional wisdom and was conducted from 2004-2008 and published in
2011. We now present the 10 year followup. Methods: From 2004-2008, 150
adult de novo heart transplant patients (pts) were enrolled from 2
centers. All pts received tacrolimus, mycophenolate mofetil (MMF) and
steroids. Pts were randomized in a 1:1 fashion within 14 days following
transplant to either discontinue mycophenolate mofetil (MONO group) or to
continue the drug long-term (COMBO group). All pts were weaned from
corticosteroids by protocol by 8 weeks post-transplant. 5 pts were lost to
followup after the trial publication. Survival curves are constructed with
Kaplan-Meier method and compared with log rank. Results: 145 pts (115 men,
30 women) were followed until death or July 2017. There were 75 MONO pts
and 69 COMBO pts. The recipient agewas 54.6 +/-11.3 years. The median
followup was 10 years in both groups. The survival (figure) was 68 % and
80.9 % at 10 years in the MONO and COMBO groups respectively (p= 0.15).
The freedom from CAV was similar with 75.6 % freedom in the MONO group and
84.6 in COMBO (p= 0.11). Classified by ISHLT nomenclature, the incidence
of CAV in the MONO group was 77 % CAV 0, 9.5 % CAV 1, 10.8 % CAV 2, 2.7 %
CAV 3. For the combo group it was 86.7 CAV 0, 4.4 % CAV 1, 7.4 % CAV 2 and
1.5 % CAV 3. Crossover occurred relatively commonly in the trial. 21 / 69
COMBO pts (30.4 %) crossed over to MONO and 7/75 (9.3 %) of MONO pts
crossed over to COMBO. Survival and freedom from CAV both tended to be
lower in pts who crossed over to COMBO. The 10 year survival was 71.4 %
and freedom from CAV 64.3 % in this group. Conclusion: The survival of pts
in the TICTAC trial was excellent. Rapid steroid taper which was common to
both groups is safe, well tolerated and may contribute to the excellent
results seen. There is a trend towards less CAV with combination therapy
with MMF and tacrolimus (Figure presented).

<119>
Accession Number
621718554
Author
Nance G.; Serluco A.; Deshpande S.R.; Garro R.; George R.P.; Kelleman
M.S.; Liverman R.
Institution
(Nance, Serluco, Liverman) Children's Healthcare of Atlanta, Atlanta, GA,
United States
(Deshpande) Pediatric Cardiology, Emory University, Children's Healthcare
of Atlanta, Atlanta, GA, United States
(Garro, George) Pediatric Nephrology, Emory University, Children's
Healthcare of Atlanta, Atlanta, GA, United States
(Kelleman) Emory University, Atlanta, GA, United States
Title
Cytomegalovirus (CMV) infection in pediatric solid organ transplant
recipients and role of prophylaxis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. France. 37 (4 Supplement 1) (pp S364), 2018.
Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Purpose: CMV is an opportunistic infection that can lead to significant
complications post-transplant. Purpose of this study was to assess
incidence of CMV infection in pediatric solid organ transplants, assess
the use of valganciclovir (VGC) prophylaxis and impact of dose adjustments
on break through CMV viremia. Methods: A single center retrospective study
of 399 pediatric kidney, liver, and heart transplant recipients from
2010-2015 was performed in the setting of protocol-driven CMV prophylaxis
with oral VGC. Patient demographic data, CMV serostatus, transplant
immunosuppression regimen, anti-viral prophylaxis, CMV viremia development
and treatment data were collected. Multivariate logistic regression
analysis of the data was performed to assess risk factors associated with
CMV viremia. Results: Of the 399 patients in this review, 85 patients
(21.3%) developed CMV viremia while 314 patients (78.7%) did not develop
CMV viremia with protocol-driven CMV prophylaxis at 1 year
post-transplant. Of those with viremia, 34 (40%) were primary infections
developed while not receiving VGC prophylaxis, 27(32%) were infections
developed while receiving VGC prophylaxis, and 24 (28%) were late
infections developed after completion of 6 months of VGC prophylaxis.
Analysis of the data revealed a significantly higher risk of CMV viremia
in liver (HR 2.34, p= 0.001) and heart (HR 1.94, p= 0.022) transplant
recipients as compared to kidney. 48 patients experienced significant
adverse effects from valganciclovir prophylaxis (mainly neutropenia) and
subsequent dose reductions were made to their regimen. Multivariate
analysis found the risk for CMV viremia was 2-fold higher (HR 2.16, p=
0.022) in patients when the dose was adjusted for side effects. Overall 6
patients developed ganciclovir-resistant CMV viremia requiring treatment
with foscarnet and/or cidofovir. Conclusion: CMV viremia is common
post-transplant in pediatric solid organ recipients even on prophylaxis
with valganciclovir. Dose reduction of valganciclovir prophylaxis for
adverse effect management places patients at an increased risk for CMV
viremia suggesting other means of adverse effect management should be used
in high risk populations. Long term impact of early prophylaxis and
aggressive treatment of CMV viremia on transplant recipients needs further
study.

<120>
Accession Number
621721524
Author
Vinogradskiy Y.; Jackson M.; Schubert L.; Jones B.; Castillo R.; Castillo
E.; Guerrero T.; Mitchell J.; Kavanagh B.; Miften M.
Institution
(Vinogradskiy, Jackson, Schubert, Jones, Mitchell, Kavanagh, Miften)
University of Colorado Denver, Aurora, CO, United States
(Castillo) University Texas Medical Branch of Galveston, League City, TX,
United States
(Castillo, Guerrero) Beaumont Health System, Royal Oak, MI, United States
Title
4DCT-ventilation: A novel imaging modality for thoracic surgical
evaluation.
Source
Medical Physics. Conference: 58th Annual Meeting and Exhibition of the
American Association of Physicists in Medicine, AAPM 2016. United States.
43 (6 PART2) (pp 3792), 2016. Date of Publication: June 2016.
Publisher
John Wiley and Sons Ltd.
Abstract
Purpose: The current standard-of-care imaging used to evaluate lung cancer
patients for surgical resection is nuclear-medicine ventilation. Surgeons
use nuclear-medicine images along with pulmonary function tests (PFT) to
calculate percent predicted postoperative (%PPO) PFT values by estimating
the amount of functioning lung that would be lost with surgery.
4DCT-ventilation is an emerging imaging modality developed in radiation
oncology that uses 4DCT data to calculate lung ventilation maps. We
perform the first retrospective study to assess the use of
4DCT-ventilation for pre-operative surgical evaluation. The purpose of
this work was to compare %PPO-PFT values calculated with 4DCT-ventilation
and nuclear-medicine imaging. Methods: 16 lung cancer patients
retrospectively reviewed had undergone 4DCTs, nuclear-medicine imaging,
and had Forced Expiratory Volume in 1 second (FEV1) acquired as part of a
standard PFT. For each patient, 4DCT data sets, spatial registration, and
a density-change based model were used to compute 4DCT-ventilation maps.
Both 4DCT and nuclear-medicine images were used to calculate %PPO-FEV1
using %PPO-FEV1=pre-operative FEV1^*(1-fraction of total
ventilation of resected lung). Fraction of ventilation resected was
calculated assuming lobectomy and pneumonectomy. The %PPO-FEV1 values were
compared between the 4DCT-ventilation-based calculations and the
nuclear-medicine-based calculations using correlation coefficients and
average differences. Results: The correlation between %PPO-FEV1 values
calculated with 4DCT-ventilation and nuclear-medicine were 0.81 (p<0.01)
and 0.99 (p<0.01) for pneumonectomy and lobectomy respectively. The
average difference between the 4DCT-ventilation based and the
nuclear-medicine-based %PPO-FEV1 values were small, 4.1+/-;8.5% and
2.9+/-;3.0% for pneumonectomy and lobectomy respectively. Conclusion: The
high correlation results provide a strong rationale for a clinical trial
translating 4DCT-ventilation to the surgical domain. Compared to
nuclear-medicine, 4DCT-ventilation is cheaper, does not require a
radioactive contrast agent, provides a faster imaging procedure, and has
improved spatial resolution. 4DCT-ventilation can reduce the cost and
imaging time for patients while providing improved spatial accuracy and
quantitative results for surgeons.

<121>
Accession Number
2000662509
Author
Leone A.M.; Lassandro Pepe F.; Arioti M.; Crea F.
Institution
(Leone, Lassandro Pepe, Arioti, Crea) Department of Cardiovascular
Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Rome,
Italy
Title
Contrast Fractional Flow Reserve (cFFR): A pragmatic response to the call
for simplification of invasive functional assessment.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Aim: To review the current approaches to simplify functional assessment of
coronary stenosis with particular regard for contrast Fractional Flow
Reserve (cFFR). Methods and results: Maximal hyperaemia to assess FFR is
perceived as time-consuming, costly, unpleasant for the patient and
associated with side effects. Resting indexes, like Pd/Pa and iFR, have
been proposed to circumvent the use of vasodilators as well as an approach
based on the administration of contrast medium to induce coronary
vasodilation, the cFFR. Contrast FFR can be obtained quickly, at very low
cost in the absence of substantial side effects. Among these alternative
indexes, cFFR shows the best correlation with FFR, reduces the use of
adenosine even more than a hybrid resting approach but has not yet been
tested in a randomized, controlled trial with clinical end-points.
Conclusion: cFFR represents a cheap, safe and effective alternative to
FFR, able to facilitate the dissemination of a functional approach to
myocardial revascularization.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<122>
Accession Number
621711072
Author
Mauri V.; Deuschl F.; Frohn T.; Schofer N.; Linder M.; Kuhn E.; Schaefer
A.; Rudolph V.; Madershahian N.; Conradi L.; Rudolph T.K.; Schafer U.
Institution
(Mauri, Frohn, Rudolph, Rudolph) Department of Cardiology, Heart Center,
University of Cologne, Kerpener Str. 62, Cologne 50937, Germany
(Deuschl, Schofer, Schafer) Department of General and Interventional
Cardiology, University Heart Center Hamburg, Martinistrase 52, Hamburg
20246, Germany
(Linder, Schaefer, Conradi) Department for Cardiovascular Surgery,
University Heart Center Hamburg, Hamburg, Germany
(Kuhn, Madershahian) Department of Cardiothoracic Surgery, Heart Center,
University of Cologne, Cologne, Germany
Title
Predictors of paravalvular regurgitation and permanent pacemaker
implantation after TAVR with a next-generation self-expanding device.
Source
Clinical Research in Cardiology. (pp 1-10), 2018. Date of Publication: 17
Apr 2018.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: To identify predictors of paravalvular regurgitation (PVR) and
permanent pacemaker implantation (PPI) following TAVR with a
next-generation self-expanding device. Methods and results: Device landing
zone (DLZ) calcification, angiographic implantation depth, and baseline
and procedural characteristics were analyzed in 212 patients being treated
with the ACURATE neo aortic bioprosthesis. PVR was none/trace in 57.1% and
>= mild in 42.9% (37% mild, 6% moderate). DLZ calcification (705 (IQR
240-624) vs. 382 (IQR 240-624) mm³; P < 0.001) as well as
absolute calcium asymmetry (233 +/- 159 vs. 151 +/- 151 mm³; P
< 0.001) was significantly higher in patients with PVR >= mild. On
multivariate analysis, calcification of the aortic valve cusps (AVC) >
410.6 mm³ was independently associated with PVR >= mild. PPI
rate was 10.3% (n = 20). Patients with and without need for PPI had
similar total DLZ calcium volume (740 (IQR 378-920) vs. 536 (IQR 315-822)
mm³; P = 0.263), but exhibited different calcium distribution
patterns: LVOT calcium > 41.4 mm³ in the sector below the left
coronary cusp (LVOT<inf>LC</inf>) was associated with increased PPI risk
(26.9 vs. 7.7%; P = 0.008). Conclusions: The quantity of AVC calcium
predicts residual PVR. Multivariable analysis identified LVOT<inf>LC</inf>
calcium, pre-existing RBBB, and age > 82.7 years as independent predictors
of PPI. Based on these risk factors, a patient's individual PPI risk can
be stratified ranging from 3.8 to 100%.<br/>Copyright &#xa9; 2018
Springer-Verlag GmbH Germany, part of Springer Nature

<123>
[Use Link to view the full text]
Accession Number
617535199
Author
Park C.; Kim J.Y.; Kim C.; Chang C.H.
Institution
(Park, Kim, Kim, Chang) Department of Anesthesiology and Pain Medicine and
Anesthesia, Pain Research Institute, Gangnam Severance Hospital, Yonsei
University, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, South Korea
Title
Nicardipine Effects on Renal Function during Spine Surgery.
Source
Clinical Spine Surgery. 30 (7) (pp E954-E958), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design: Single-center, prospective, randomized, and single-blinded
clinical trial was conducted in patients (n=64) undergoing anterior or
posterior spinal interbody fusion. Objective: To investigate the renal
protective effect of nicardipine during deliberate hypotension for spine
surgery by measuring creatinine clearance (Ccr), serum cystatin C, urine
output, and fractional excretion of sodium (FE Na). Summary of Background
Data: Deliberate hypotension during spine surgery may result in ischemic
tissue damage of the kidney. Nicardipine is reported to dilate the renal
artery and increase glomerular filtration rate. Previous studies reported
the renal protective effect of nicardipine during cardiac surgery under
cardiopulmonary bypass and robot-assisted laparoscopic surgery. Materials
and Methods: Patients were randomized to receive nicardipine (nicardipine
group, n=32) or normal saline (control group, n=32). Deliberate
hypotension of mean arterial pressure at 50-65 mm Hg was maintained during
surgery. Ccr, serum cystatin C, urine output, and FE Na were measured
before surgery, after surgery, and postoperative day 1 (POD1). The RIFLE
(risk, injury, failure, loss, and end stage renal disease) criteria of the
patients were evaluated. Results: In the nicardipine group, Ccr at POD1
was increased compared with that after surgery. In both groups, serum
cystatin C at POD1 was decreased compared with that before surgery and
urine output at POD1 was decreased compared with that after surgery. FE Na
at POD1 in the control group was higher than that in the nicardipine group
and was increased compared with that after surgery. Using RIFLE criteria,
6 patients in the control group and 2 patients in the nicardipine group
were classified as having acute kidney injury. Conclusions: Nicardipine
increased Ccr and attenuated the increase in FE Na at POD1 in patients
undergoing spine surgery under deliberate hypotension.<br/>Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc.

<124>
Accession Number
612060236
Author
Cle-Ovejero A.; Valmaseda-Castellon E.
Institution
(Cle-Ovejero) University of Barcelona Dental School, Spain
(Valmaseda-Castellon) Barcelona University Dental School, IDIBELL
Institute, Spain
Title
Haemostatic agents in apical surgery. A systematic review.
Source
Medicina Oral Patologia Oral y Cirugia Bucal. 21 (5) (pp e652-e657), 2016.
Date of Publication: September 2016.
Publisher
Medicina Oral, Patologia Oral y Cirugia Bucal (E-mail: jced@jced.es)
Abstract
Background: Blood presence in apical surgery can prevent the correct
vision of the surgical field, change the physical properties of filling
materials and reduce their sealing ability. Objectives: To describe which
are the most effective and safest haemostatic agents to control bleeding
in patients undergoing apical surgery. Material and Methods. We carried
out a systematic review, using Medline and Cochrane Library databases, of
human clinical studies published in the last 10 years. Results: The agents
that proved more effective in bleeding control were calcium sulphate
(100%) and collagen plus epinephrine (92.9%) followed by ferric sulphate
(60%), gauze packing (30%) and collagen (16.7%). When using aluminium
chloride (Expasyl), over 90% of the apical lesions improved, but this
agent seemed to increase swelling. Epinephrine with collagen did not
significantly raise either blood pressure or heart rate. Conclusions:
Despite the use of several haemostatic materials in apical surgery, there
is little evidence on their effectiveness and safety. The most effective
haemostatic agents were calcium sulphate and epinephrine plus collagen.
Epinephrine plus collagen did not seem to significantly raise blood
pressure or heart rate during surgery. Aluminium chloride did not increase
postoperative pain but could slightly increase postoperative swelling.
Randomized clinical trials are needed to assess the haemostatic
effectiveness and adverse effects of haemostatic materials in apical
surgery.<br/>Copyright &#xa9; Medicina Oral S. L.

<125>
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.

<126>
[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.

<127>
Accession Number
621531340
Author
Deng H.-Y.; Qin C.-L.; Qiu X.-M.; Zhou Q.
Institution
(Deng, Qin, Qiu, Zhou) Lung Cancer Center, West China Hospital, Sichuan
University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Does high body mass index have any impact on survival of patients
undergoing oesophagectomy for oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 693-695),
2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does high body mass index
(BMI) have any impact on survival of patients undergoing oesophagectomy
for oesophageal cancer?' A total of 232 papers were found using the
reported search, of which 8 papers represented the best evidence to answer
the clinical question, which included 1 meta-analysis and 7 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. One meta-analysis and 4 cohort studies provided the
evidence that high BMI was significantly correlated with a better survival
of oesophageal cancer patients undergoing oesophagectomy, while the other
3 cohort studies found that high BMI had no impact on the survival of
those patients. We conclude that patients with high BMI may have a better
prognosis than those with normal BMI undergoing oesophagectomy for
oesophageal cancer.<br/>Copyright &#xa9; The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<128>
Accession Number
621531250
Author
Zhao Y.; Peng H.; Li X.; Qin Y.; Cao F.; Peng D.; Liu J.
Institution
(Zhao, Peng, Cao, Peng) Department of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Li, Qin, Liu) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Anzhen Road, Chaoyang District, Beijing 100029, China
Title
Dual antiplatelet therapy after coronary artery bypass surgery: Is there
an increase in bleeding risk? A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 573-582),
2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES: There is increasing evidence that dual antiplatelet therapy
(DAPT) when compared with single antiplatelet therapy may improve venous
graft patency after coronary artery bypass graft. However, it is not yet
known whether postoperative administration of DAPT may increase the
potential risk of bleeding, especially in the early postoperative period.
METHODS: We searched studies on PubMed, Embase, Web of Science and the
Cochrane Central Register of Controlled Trials. Relative risk (RR) was
pooled with 95% confidence intervals (CIs) for dichotomous data. Prior
subgroup analyses were performed to look for potential heterogeneity.
RESULTS: Thirteen studies involving 23 591 participants were included. Our
meta-analysis showed that DAPT does not increase the risk of major
bleeding (randomized controlled trials group: RR = 1.28, 95% CI 0.951.71;
cohort studies group: RR = 0.99, 95% CI 0.661.51) and minor bleeding
(randomized controlled trials group: RR = 1.15, 95% CI 0.731.81; cohort
studies group: RR = 0.84, 95% CI 0.371.93) when compared with single
antiplatelet therapy. Meanwhile, DAPT does not increase the incidence of
major bleeding events during hospitalization (randomized controlled trials
group: RR = 1.27, 95% CI 0.911.78; cohort studies group: RR = 0.50, 95% CI
0.122.09). Sensitivity analyses showed that our results are stable, and
there was no evidence of publication bias. CONCLUSIONS: DAPT does not
increase the risk of major bleeding and minor bleeding when compared with
single antiplatelet therapy. Postoperative administration of DAPT is
considered to be safe in patients after coronary artery bypass graft, even
in the early postoperative period.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<129>
Accession Number
621531233
Author
Tomsic A.; Arabkhani B.; Schoones J.W.; Van Brakel T.J.; Takkenberg
J.J.M.; Palmen M.; Klautz R.J.M.
Institution
(Tomsic, Arabkhani, Van Brakel, Palmen, Klautz) Department of
Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600,
Leiden 2300, Netherlands
(Schoones) Walaeus Library, Leiden University Medical Centre, Leiden,
Netherlands
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Outcome reporting for surgical treatment of degenerative mitral valve
disease: A systematic review and critical appraisal.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 566-572),
2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES: Standardized outcome reporting is of critical importance for
performance monitoring, improvement of existing techniques and
introduction of novel technologies. Whether outcome reporting for surgical
treatment of degenerative mitral valve disease complies with the
guidelines has not been assessed to date. METHODS: A systematic review of
PubMed, EMBASE, Web of Science and the Cochrane Library was conducted for
articles published between 1 January 2009 and 7 March 2016. Inclusion
criteria were adult patient population (n >- 200) and surgical
intervention for degenerative mitral valve disease. The quality of
reported outcome was compared with the standard recommended by the
guidelines on reporting morbidity and mortality after cardiac valve
interventions. RESULTS: Forty-two non-randomized clinical studies were
included: 4 provided early and 38 provided early and late outcome data.
Early echocardiographic outcome was reported in 49% of studies. Freedom
from reintervention, the indication for reintervention and the follow-up
echocardiographic outcome were reported in 97%, 59% and 79% of studies
providing late outcome data, respectively. The KaplanMeier method was used
to assess the freedom from recurrent mitral regurgitation in 60% (18/30)
of studies, whereas 7% (2/30) of studies applied a longitudinal data
analysis. Recurrent mitral regurgitation was most commonly defined as
moderate (Grade 2+; 60%) or severe (Grade 4+; 37%) regurgitation.
CONCLUSIONS: There is a significant discordance between the
guidelines-based recommendations and actual reporting of outcome for
surgical treatment of degenerative mitral valve disease. Better adherence
to the guidelines would raise the quality and generalizability of clinical
data reporting.<br/>Copyright &#xa9; The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<130>
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

<131>
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

<132>
[Use Link to view the full text]
Accession Number
617417903
Author
Mohananey D.; Jobanputra Y.; Kumar A.; Krishnaswamy A.; Mick S.; White
J.M.; Kapadia S.R.
Institution
(Mohananey, Krishnaswamy) Department of Hospital Medicine, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Jobanputra, Kumar, White, Kapadia) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
(Mick) Department of Cadiothoracic Surgery, Cleveland Clinic, OH, United
States
Title
Clinical and Echocardiographic Outcomes Following Permanent Pacemaker
Implantation after Transcatheter Aortic Valve Replacement: Meta-Analysis
and Meta-Regression.
Source
Circulation: Cardiovascular Interventions. 10 (7) (no pagination), 2017.
Article Number: e005046. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Transcatheter aortic valve replacement has become the
procedure of choice for inoperable, high-risk, and many intermediate-risk
patients with aortic stenosis. Conduction abnormalities are a common
finding after transcatheter aortic valve replacement and often result in
permanent pacemaker (PPM) implantation. Data pertaining to the clinical
impact of PPM implantation are controversial. We used meta-analysis
techniques to summarize the effect of PPM implantation on clinical and
echocardiographic outcomes after transcatheter aortic valve replacement.
Methods and Results - Data were summarized as Mantel-Haenszel relative
risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and
as standardized mean difference and 95% CI for continuous variables We
used the Higgins I² statistic to evaluate heterogeneity. We
found that patients with and without PPM have similar all-cause mortality
(RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI,
0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and
stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also
comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16),
cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial
infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI,
0.47-1.04) at 1 year. We observed that the improvement in left ventricular
ejection fraction was significantly greater in the patients without PPM
(standardized mean difference, 0.22; 95% CI, 0.12-0.32). Conclusions - PPM
implantation is not associated with increased risk of all-cause mortality,
cardiovascular mortality, stroke, or myocardial infarction both at short-
and long-term follow-up. However, PPM is associated with impaired left
ventricular ejection fraction recovery post-transcatheter aortic valve
replacement.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<133>
Accession Number
617243610
Author
Kikuchi K.; Mori M.
Institution
(Kikuchi) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, No.753
Jinghan Ave, Wuhan 430022, China
(Mori) Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT,
United States
Title
Minimally invasive coronary artery bypass grafting: A systematic review.
Source
Asian Cardiovascular and Thoracic Annals. 25 (5) (pp 364-370), 2017. Date
of Publication: 01 Jun 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
To minimize surgical morbidity in coronary artery bypass grafting,
minimally invasive cardiac surgery has gained popularity. Minimally
invasive coronary artery bypass grafting offers unique advantages compared
to conventional off-pump coronary artery bypass or minimally invasive
direct coronary artery bypass in that it enables the surgeon to harvest
and graft bilateral internal thoracic arteries via a small thoracotomy
while being conducted completely off-pump. This review focuses on current
evidence behind off-pump coronary artery bypass, multi-arterial
revascularization, patient populations that would most benefit from
bilateral internal thoracic artery minimally invasive coronary artery
bypass grafting, the surgical technique, and early outcomes. By overcoming
the perceived inability to utilize bilateral internal thoracic arteries in
minimally invasive coronary artery bypass grafting, the new technique
further expands the armamentarium of surgeons and cardiologists. Hybrid
coronary revascularization with bilateral internal thoracic artery
minimally invasive coronary artery bypass grafting further augments the
appeal of the next generation of minimally invasive cardiac
surgery.<br/>Copyright &#xa9; The Author(s) 2016.

<134>
Accession Number
613143233
Author
Ladia V.; Panchal H.B.; O'Neil T.J.; Sitwala P.; Bhatheja S.; Patel R.;
Ramu V.; Mukherjee D.; Mahmud E.; Paul T.K.
Institution
(Ladia, Panchal, Sitwala, Bhatheja, Patel, Ramu, Paul) Department of
Internal Medicine, East Tennessee State University, Johnson City,
Tennessee, United States
(O'Neil) Department of Internal Medicine, Mountain Home VA Medical Center,
Johnson City, Tennessee, United States
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, El Paso, Texas, United States
(Mahmud) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of California, San Diego, California, United States
Title
Incidence of Renal Failure Requiring Hemodialysis Following Transcatheter
Aortic Valve Replacement.
Source
American Journal of the Medical Sciences. 352 (3) (pp 306-313), 2016. Date
of Publication: September 2016.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Studies have shown that iodinated radiocontrast use is
associated with acute renal failure especially in the presence of chronic
kidney disease and multiple factors modulate this risk. The purpose of
this meta-analysis is to compare the incidence of renal failure requiring
hemodialysis between transfemoral (TF) and transapical (TA) transcatheter
aortic valve replacement using the Edwards valve. Methods: The PubMed
database was searched from January 2000 through December 2014. A total of
10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR
procedures using the Edwards valve were included. Variables of interest
were baseline logistic EuroSCORE, prevalence of diabetes mellitus,
hypertension, peripheral arterial disease, chronic kidney disease and
amount of contrast used. The primary endpoint was incidence of renal
failure requiring hemodialysis. The odds ratio and 95% CI were computed
and P < 0.05 was considered as the level of significance. Results: The
logistic EuroSCORE was significantly higher in TA compared to TF (P =
0.001) TAVR. The amount of contrast (mL) used was significantly higher in
the TF group compared to the TA group (mean difference: 36.9, CI:
25.7-48.1, P < 0.001). The incidence of hemodialysis following the
procedure was significantly higher in the TA group compared to TF group
(odds ratio = 4.3, CI: 2.4-7.8, P < 0.00001). Conclusions: This
meta-analysis suggests that despite the lower amount of contrast used in
TA-TAVR, the incidence of renal failure requiring hemodialysis was higher
with the Edwards valve. This suggests that the incidence of renal failure
requiring hemodialysis after TAVR is associated with baseline
comorbidities in the TA-TAVR group rather than the volume of contrast
used.<br/>Copyright &#xa9; 2016 Southern Society for Clinical
Investigation

<135>
Accession Number
2000645663
Author
Teerakanok J.; Tantrachoti P.; Chariyawong P.; Nugent K.
Institution
(Teerakanok, Tantrachoti, Chariyawong, Nugent) Department of Internal
Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas,
United States
Title
Acute Amiodarone Pulmonary Toxicity After Surgical Procedures.
Source
American Journal of the Medical Sciences. 352 (6) (pp 646-651), 2016. Date
of Publication: December 2016.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Amiodarone can cause toxicity in several organs, including
amiodarone-induced pulmonary toxicity which is a subacute or chronic
complication. Amiodarone-induced acute respiratory distress syndrome
(ARDS) in postoperative patients is a rare acute complication. The PubMed
and Google Scholar databases were searched. Seven retrospective and
prospective case series and 10 case reports of amiodarone-induced
postoperative ARDS were reviewed. All patients received amiodarone
chronically or during the perioperative period. Forty-three out of 285
patients (15%) reported in the retrospective and prospective studies
developed amiodarone-induced ARDS. Most of the patients were men in age
group 60-80 who had undergone cardiothoracic surgery. All patients had
general anesthesia and exposure to high concentrations of oxygen. The
onset of symptoms ranged from 2 hours to 2 weeks after surgery. The
mortality rate of amiodarone-induced ARDS after surgery was approximately
10%. Ten case reports were evaluated using Naranjo criteria. Two cases had
definite amiodarone toxicity, and 8 had probable toxicity based on these
criteria. The incidence of amiodarone-induced postoperative ARDS was
approximately 15% in these studies. Most operations involved
cardiothoracic surgery. Elderly patients on high-dose and long-term
amiodarone treatment were at increased risk. This diagnosis is challenging
owing to the lack of definite diagnostic criteria; careful clinical
evaluation and early drug withdrawal may reduce the severity of this
complication.<br/>Copyright &#xa9; 2016 Southern Society for Clinical
Investigation