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<1>
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.

<2>
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

<3>
Accession Number
619465272
Author
Zeng X.; Lincoff A.M.; Schulz-Schupke S.; Steg P.G.; Elbez Y.; Mehran R.;
Stone G.W.; McAndrew T.; Lin J.; Zhang X.; Shi W.; Lei H.; Jing Z.; Huang
W.
Institution
(Zeng, Zhang, Shi, Lei, Huang) Department of Cardiology, The First
Affiliated Hospital, Chongqing Medical University, Chongqing, China
(Lincoff) Cleveland Clinic Foundation, Cleveland, OH, United States
(Schulz-Schupke) ISA Research Center, Deutsches Herzzentrum, Technische
Universitat, Munich, Germany
(Schulz-Schupke) German Center for Cardiovascular Research (DZHK), Partner
Site Munich Heart Alliance, France
(Steg, Elbez) French Alliance for Cardiovascular Clinical Trials (FACT),
DHU-FIRE, Hopital Bichat (Assistance Publique-Hopitaux de Paris),
Universite Paris-Diderot, Sorbonne-Paris Cite and INSERM U-1148, Paris,
France
(Mehran) Department of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, United States
(Stone) Department of Cardiology, New York-Presbyterian Hospital/Columbia
University Medical Center, New York, United States
(McAndrew) Clinical Trials Center, Cardiovascular Research Foundation, New
York, United States
(Lin) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield Medical School, Sheffield, United Kingdom
(Jing) State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital,
Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing, China
Title
Efficacy and safety of bivalirudin in coronary artery disease patients
with mild to moderate chronic kidney disease: Meta-analysis.
Source
Journal of Cardiology. 71 (5) (pp 494-504), 2018. Date of Publication: May
2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Patients with chronic kidney disease (CKD) have elevated
bleeding and ischemic outcomes. We aim to assess the short- and long-term
efficacy and safety of bivalirudin compared to heparin plus glycoprotein
IIb/IIIa inhibitors (GPIs) in coronary artery disease (CAD) patients with
CKD. Methods: Randomized trials were searched in PubMed, Cochrane, and
Embase databases up to January 2017. Among the trials retrieved, efficacy
endpoints were defined as mortality, myocardial infarction (MI), repeat
revascularization, stent thrombosis, and major adverse cardiac events
(MACEs). Safety endpoints were reported as non-coronary artery bypass
grafting (CABG) related major bleeding and thrombolysis in myocardial
infarction (TIMI) major bleeding. Risk ratio (RR) and 95% confidence
interval (CI) were calculated for each outcome using a fixed effect model.
Results: Five studies with a total of 3796 patients were included. In
short-term follow up (30 days), bivalirudin significantly reduced non-CABG
related major bleeding (p = 0.0004) and TIMI major bleeding (p = 0.007)
compared to heparin plus GPIs. No significant differences were observed in
rates of mortality, MI, repeat revascularization, stent thrombosis, and
MACEs between the two groups in short- and long-term follow up (6 months
to 3 years). In patients with ST elevated myocardial infarction (STEMI)
with concurrent CKD, the decreased non-CABG related major bleeding (p =
0.04) without increasing ischemic events was also observed after
short-term follow up. Conclusions: (1) Bivalirudin is safer than and as
effective as heparin plus GPIs in CAD patients with CKD. (2) Impaired
renal function does not affect the safety benefits of bivalirudin. (3)
Similar efficacy profiles were identified between the two groups after
both short- and long-term follow up in the CAD patients with
CKD.<br/>Copyright &#xa9; 2017 Japanese College of Cardiology

<4>
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.

<5>
Accession Number
621915628
Author
Hare G.M.T.; Han K.; Leshchyshyn Y.; Mistry N.; Kei T.; Dai S.Y.; Tsui
A.K.Y.; Pirani R.A.; Honavar J.; Patel R.P.; Yagnik S.; Welker S.L.; Tam
T.; Romaschin A.; Connelly P.W.; Beattie W.S.; Mazer C.D.
Institution
(Hare, Han, Leshchyshyn, Mistry, Kei, Dai, Tsui, Pirani, Yagnik, Mazer)
Department of Anesthesia, St. Michael's Hospital, University of Toronto,
30 Bond Street, Toronto, ON M5B 1W8, Canada
(Hare, Mazer) St. Michael's Hospital Center of Excellence for Patient
Blood Management, Toronto, ON, Canada
(Hare, Mazer) Department of Physiology, University of Toronto, 30 Bond
Street, Toronto, ON M5B 1W8, Canada
(Hare, Connelly, Mazer) Keenan Research Centre for Biomedical Research, Li
Ka Shing Knowledge Institute, Toronto, ON, Canada
(Honavar, Patel) Department of Pathology, Center for Free Radical Biology,
University of Alabama at Birmingham, Birmingham, AL, United States
(Welker, Tam) Department of Perfusion, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Romaschin, Connelly) Department of Laboratory Medicine and Pathobiology,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Connelly) Department of Medicine, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Beattie) Department of Anesthesia, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
Title
Potential biomarkers of tissue hypoxia during acute hemodilutional anemia
in cardiac surgery: A prospective study to assess tissue hypoxia as a
mechanism of organ injury.
Source
Canadian Journal of Anesthesia. (pp 1-13), 2018. Date of Publication: 25
Apr 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hemodilutional anemia is associated with acute kidney injury
(AKI) and mortality in patients undergoing cardiac surgery by mechanisms
that may include tissue hypoxia. Our hypothesis was to assess if changes
in the potential hypoxic biomarkers, including methemoglobin and
erythropoietin, correlated with a decrease in hemoglobin (Hb)
concentration following hemodilution on cardiopulmonary bypass (CPB).
Methods: Arterial blood samples were taken from patients (n = 64)
undergoing heart surgery and CPB at baseline, during CPB, following CPB,
and in the intensive care unit (ICU). Potential hypoxic biomarkers were
measured, including methemoglobin, plasma Hb, and erythropoietin. Data
were analyzed by repeated measures one-way analysis of variance on ranks
and linear regression. Results: Hemoglobin levels decreased following CPB
and methemoglobin increased in the ICU (P < 0.001 for both). No
correlation was observed between the change in Hb and methemoglobin (P =
0.23). By contrast, reduced Hb on CPB correlated with increased lactate,
reduced pH, and increased erythropoietin levels following CPB (P <= 0.004
for all). Increased plasma Hb (P < 0.001) also correlated with plasma
erythropoietin levels (P < 0.001). Conclusion: These data support the
hypothesis that erythropoietin rather than methemoglobin is a potential
biomarker of anemia-induced tissue hypoxia. The observed relationships
between decreased Hb during CPB and the increase in lactate, reduced pH,
and increase in erythropoietin levels suggest that early changes in plasma
erythropoietin may be a pragmatic early biomarker of anemia-induced renal
hypoxia. Further study is required to determine if anemia-induced
increases in erythropoietin may predict AKI in patients undergoing cardiac
surgery. Trial registration: www.clinicaltrials.gov(NCT01883713).
Registered 21 June 2013.<br/>Copyright &#xa9; 2018 Canadian
Anesthesiologists' Society

<6>
Accession Number
621915391
Author
Nozaki S.; Mawatari A.; Nakatani Y.; Hayashinaka E.; Wada Y.; Nomura Y.;
Kitayoshi T.; Akimoto K.; Ninomiya S.; Doi H.; Watanabe Y.
Institution
(Nozaki, Mawatari, Nakatani, Hayashinaka, Wada, Doi, Watanabe) Division of
Bio-Function Dynamics Imaging, RIKEN Center for Life Science Technologies
(CLST), 6-7-3 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
(Nomura, Kitayoshi, Akimoto, Ninomiya) Takeda Pharmaceutical Company
Limited, 12-10 Nihonbashi 2-Chome, Chuo-ku, Tokyo 103-8668, Japan
Title
PET Imaging Analysis of Vitamin B<inf>1</inf> Kinetics with
[¹¹C]Thiamine and its Derivative [¹¹C]Thiamine
Tetrahydrofurfuryl Disulfide in Rats.
Source
Molecular Imaging and Biology. (pp 1-7), 2018. Date of Publication: 20 Mar
2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Thiamine is an essential component of glucose metabolism and
energy production. The disulfide derivative, thiamine tetrahydrofurfuryl
disulfide (TTFD), is better absorbed than readily-available water-soluble
thiamine salts because it does not require the rate-limiting transport
system required for thiamine absorption. However, the detailed
pharmacokinetics of thiamine and TTFD under normal and pathological
conditions have not yet been clarified. C-11-labeled thiamine and TTFD
were recently synthesized by our group. In this study, to clarify the
differences in pharmacokinetics and metabolism of these probes, a
quantitative PET imaging study and radiometabolite analysis of
C-11-labeled thiamine and TTFD were performed in the rat heart.
Procedures: Positron emission tomography (PET) imaging with
[¹¹C]thiamine and [¹¹C]TTFD was performed in normal
rats to determine the pharmacokinetics of these probes, and the
radiometabolites of both probes from the blood and heart tissue were
analyzed by thin-layer chromatography. Results: Accumulation of
[¹¹C]TTFD was significantly higher than that of
[¹¹C]thiamine in the rat heart. Moreover, as a result of the
radiometabolite analysis of heart tissue at 15 min after the injection of
[¹¹C]TTFD, thiamine pyrophosphate, which serves as a cofactor
for the enzymes involved in glucose metabolism, was found as the major
radiometabolite and at a significantly higher level than in the
[¹¹C]thiamine-injected group. Conclusions: PET imaging
techniques for visualizing the kinetics and metabolism of thiamine using
[¹¹C]thiamine and [¹¹C]TTFD were developed in this
study. Consequently, noninvasive PET imaging for the pathophysiology of
thiamine-related cardiac function may provide novel information about
heart failure and related disorders.<br/>Copyright &#xa9; 2018 World
Molecular Imaging Society

<7>
Accession Number
2000680964
Author
Carson J.L.; Stanworth S.J.; Alexander J.H.; Roubinian N.; Fergusson D.A.;
Triulzi D.J.; Goodman S.G.; Rao S.V.; Doree C.; Hebert P.C.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, Rutgers Biomedical Health Sciences, New Brunswick,
NJ, United States
(Stanworth) National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust and University of Oxford, Oxford, United Kingdom
(Alexander, Rao) The Duke Clinical Research Institute, Duke University,
Durham, NC, United States
(Roubinian) Blood Systems Research Institute, San Francisco, CA, United
States
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Ontario, Canada
(Triulzi) The Institute for Transfusion Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Goodman) Centre for Research, Terrence Donnely Heart Centre, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada
(Doree) Systematic Review Initiative, NHS Blood and Transplant, Oxford,
United Kingdom
(Hebert) University of Montreal Hospital Research Centre, Montreal,
Quebec, Canada
Title
Clinical trials evaluating red blood cell transfusion thresholds: An
updated systematic review and with additional focus on patients with
cardiovascular disease.
Source
American Heart Journal. 200 (pp 96-101), 2018. Date of Publication: June
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Several new trials evaluating transfusion strategies in
patients with cardiovascular disease have recently been published,
increasing the number of enrolled patients by over 30%. The objective was
to evaluate transfusion thresholds in patients with cardiovascular
disease. Methods: We conducted an updated systematic review of randomized
trials that compared patients assigned to maintain a lower (restrictive
transfusion strategy) or higher (liberal transfusion strategy) hemoglobin
concentration. We focused on new trial data in patients with
cardiovascular disease. The primary outcome was 30-day mortality. Specific
subgroups were patients undergoing cardiac surgery and with acute
myocardial infarction. Results: A total of 37 trials that enrolled 19,049
patients were appraised. In cardiac surgery, mortality at 30 days was
comparable between groups (risk ratio 0.99; 95% confidence interval
0.74-1.33). In 2 small trials (n = 154) in patients with myocardial
infarction, the point estimate for the mortality risk ratio was 3.88 (95%
CI, 0.83-18.13) favoring the liberal strategy. Overall, from 26 trials
enrolling 15,681 patients, 30-day mortality was not different between
restrictive and liberal transfusion strategies (risk ratio 1.0, 95% CI,
0.86-1.16). Overall and in the cardiovascular disease subgroup, there were
no significant differences observed across a range of secondary outcomes.
Conclusions: New trials in patients undergoing cardiac surgery establish
that a restrictive transfusion strategy of 7 to 8 g/dL is safe and
decreased red cell use by 24%. Further research is needed to define the
optimal transfusion threshold in patients with acute myocardial
infarction.<br/>Copyright &#xa9; 2018

<8>
Accession Number
2000680316
Author
Allen K.B.; Thourani V.H.; Naka Y.; Grubb K.J.; Grehan J.; Patel N.; Guy
T.S.; Landolfo K.; Gerdisch M.; Bonnell M.; Cohen D.J.
Institution
(Allen) Department of Cardiothoracic Surgery, Saint Luke's Mid America
Heart Institute, Kansas City, Missouri, United States
(Thourani) Division of Cardiothoracic Surgery, Department of Surgery,
Emory University School of Medicine, Atlanta, Georgia
(Naka) Division of Cardiothoracic Surgery, Department of Surgery, Columbia
University Medical Center, New York, New York, United States
(Grubb) Department of Cardiovascular and Thoracic Surgery, University of
Louisville, Louisville, Kentucky, United States
(Grehan) Department of Cardiothoracic Surgery, Allina Health, St. Paul,
Minnesota, United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill Hospital, New
York, New York, United States
(Guy) Department of Cardiothoracic Surgery, Temple University,
Philadelphia, Pennsylvania, United States
(Landolfo) Department of Cardiothoracic Surgery, Mayo Clinic,
Jacksonville, Florida, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St. Francis
Health, Indianapolis, Indiana, United States
(Bonnell) Department of Cardiothoracic Surgery, University of Toledo,
Toledo, Ohio, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart
Institute, Kansas City, Missouri, United States
Title
Rigid Plate Fixation Versus Wire Cerclage: Patient-Reported and Economic
Outcomes From a Randomized Trial.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1344-1350), 2018. Date of
Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: In a multicenter randomized trial, sternal closure after
cardiac operations using rigid plate fixation (RPF) compared with wire
cerclage (WC) resulted in improved sternal healing, reduced sternal
complications, and was cost neutral at 6 months. Additional secondary end
points are presented from this trial. Methods: Twelve United States
centers randomized 236 patients to RPF (n = 116) or WC (n = 120).
Patient-reported outcomes measures, including pain, function, and quality
of life scores, were assessed through 6 months and correlated to computed
tomography-derived sternal healing scores using logistic regression. Cost
analysis through 90 days was performed to mimic bundled care models.
Results: All patient-reported outcomes measures were numerically better in
RPF patients than in WC patients at all assessments. RPF resulted in more
patients reporting no sternal pain after coughing at 3 weeks (41.1% vs
19.6%; p = 0.001) and 6 weeks (54.5% vs 35.1%; p = 0.005) and at rest at 6
weeks (74.1% vs 58.8%; p = 0.02) and 3 months (87.6% vs 75.9%; p = 0.03)
compared with WC. Better sternal healing scores correlated to having no
sternal pain at rest (odds ratio, 1.6; 95% confidence interval, 1.2 to
2.2; p = 0.002) and after coughing (odds ratio, 1.6; 95% confidence
interval, 1.2 to 2.2; p = 0.0007). RPF resulted in improvements in the
36-Item Short Form Health Survey quality of life scores at 3 weeks (53.5
+/- 8.7 vs 50.5 +/- 10.4; p = 0.03), 6 weeks (45.3 +/- 8.4 vs 42.7 +/-
8.4; p = 0.03), and 6 months (56.4 +/- 6.8 vs 53.9 +/- 9.0; p = 0.04)
compared with WC. Through 90 days, RPF compared with WC was $1,888 less
(95% confidence interval, -$8,889 to $4,273; p = 0.52). Conclusions: In
patients undergoing sternal closure after median sternotomy, RPF compared
with WC resulted in reduced sternal pain, improved upper extremity
function, and similar total 90-day costs.<br/>Copyright &#xa9; 2018 The
Authors

<9>
Accession Number
618265935
Author
Bhavnani S.P.; Bhavnani S.; Adams D.; Sengupta P.P.; Ryan T.; Narula J.;
Thomas J.; Lang R.; Pellikka P.; Choudhary V.; Iyer V.R.; Dash P.K.;
Barooah B.; Sola S.; Varyani R.; Lingan A.; Murugan V.; Kini P.;
Venkateshvaran A.; Srinivas N.; Barooah A.C.; Subbarao G.V.R.; Shivakumar
C.; Subramaniyan M.; Sengupta S.P.; Bansal M.; Rahaman A.; Patil V.N.;
Kumar N.R.; Gahlot M.Y.; Damani I.M.; Gulati R.; Joshi S.S.; Dubey S.;
Krupa J.; Irfan S.; Vidhyakar R.B.; Bidarkar N.; Shantesh B.K.; Chavan
S.S.; Chandramohan R.; Kumar V.; Tirkey S.; Prasad G.; Lakshmana S.S.;
Malkar R.M.; Manjunath V.; Kumar Reddy K.; Ramesha L.G.; Kumbhalkar S.;
Thadlani J.A.; Basha T.M.N.; Hafeez S.A.; Leelavathi V.; Mathews R.;
Daubert M.; Cleve J.; Burdulis E.; Fauss N.; Lammertin G.; Patel B.;
Petrovets E.; Shah D.; Thurmond K.; Tomberlin D.; Umamaheswar H.; Kadakia
A.
Institution
(Bhavnani) Scripps Clinic and Research Foundation, San Diego, California,
United States
(Sola, Venkateshvaran, Dash) Sri Sathya Sai Institute of Higher Medical
Sciences, Whitefield, Bangalore, India
(Adams) Duke University School of Medicine, Durham, North Carolina, United
States
(Sengupta) West Virginia University Heart and Vascular Institute at West
Virginia University School of Medicine, Morgantown, West Virginia, United
States
Title
A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics.
Source
JACC: Cardiovascular Imaging. 11 (4) (pp 546-557), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to determine whether mobile health (mHealth)
device assessments used as clinical decision support tools at the
point-of-care can reduce the time to treatment and improve long-term
outcomes among patients with rheumatic and structural heart diseases
(SHD). Background: Newly developed smartphone-connected mHealth devices
represent promising methods to diagnose common diseases in
resource-limited areas; however, the impact of technology-based care on
long-term outcomes has not been rigorously evaluated. Methods: A total of
253 patients with SHD were randomized to an initial diagnostic assessment
with wireless devices in mHealth clinics (n = 139) or to standard-care (n
= 114) in India. mHealth clinics were equipped with point-of-care devices
including pocket-echocardiography, smartphone-connected-electrocardiogram
blood pressure and oxygen measurements, activity monitoring, and portable
brain natriuretic peptide laboratory testing. All individuals underwent
comprehensive transthoracic echocardiography to assess the severity of
SHD. The primary endpoint was the time to referral for therapy with
percutaneous valvuloplasty or surgical valve replacement. Secondary
endpoints included the probability of a cardiovascular hospitalization
and/or death over 1 year. Results: An initial mHealth assessment was
associated with a shorter time to referral for valvuloplasty and/or valve
replacement (83 +/- 79 days vs. 180 +/- 101 days; p <0.001) and was
associated with an increased probability for valvuloplasty/valve
replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio:
1.54; 95% CI: 0.96 to 2.47; p = 0.07). Patients randomized to mHealth were
associated with a lower risk of a hospitalization and/or death on
follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83;
p = 0.013). Conclusions: An initial mHealth diagnostic strategy was
associated with a shorter time to definitive therapy among patients with
SHD in a resource-limited area and was associated with improved outcomes.
(A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics;
NCT02881398)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<10>
Accession Number
2000570647
Author
Lyons G.R.; Askin G.; Pua B.B.
Institution
(Lyons, Pua) Department of Radiology, NewYork-Presbyterian Hospital/Weill
Cornell Medicine, 525 East 68th Street, New York, NY 10065, United States
(Askin) Department of Biostatistics and Epidemiology, NewYork-Presbyterian
Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065,
United States
Title
Clinical Outcomes after Pulmonary Cryoablation with the Use of a Triple
Freeze Protocol.
Source
Journal of Vascular and Interventional Radiology. 29 (5) (pp 714-721),
2018. Date of Publication: May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose: To elucidate clinical variables associated with safety and
efficacy in patients after cryoablation of pulmonary tumors with the use
of a triple freeze protocol. Materials and Methods: Percutaneous
cryoablation of pulmonary tumors was performed using Galil Medical
cryoprobes (Arden Hills, Minnesota) with a triple freeze protocol: 67
nodules in 42 patients were treated at a single institution from 2012 to
2016. Average nodule diameter was 1.6 cm (range 0.4-5.9); 13 nodules
(19.4%) were pathologically determined to be a primary lung malignancy,
whereas 54 (80.6%) were metastatic nodules of extrapulmonary origin.
Average patient age was 68.1 years (range 39.6-89.6), and the male-female
ratio was 1.3:1. Ipsilateral thoracic surgery, intervention, or
radiotherapy had been performed before the first cryoablation in 18
patients (42.9%). Mean imaging follow-up was 326 days (range 9-1,152).
Results: Pneumothorax occurred in 19 cases (33.9%), 7 (12.5%) requiring
chest tube, the likelihood of which was significantly greater in patients
with 3 or more cryoprobes (P <.01). Local tumor recurrence/residual
disease occurred in 6 cases (9.0%). Local tumor recurrence was not seen
after ablation of nodules measuring <1.0 cm at the time of procedure, a
significant difference from the recurrence ratee of 14.3% for nodules
measuring >=1.0 cm (P <.05). Likelihood of tumor recurrence/residual
disease did not correlate with tumor pathology, tumor location, or
procedural factors. The estimated marginal probabilities of local
recurrence were 11.4%, 11.4%, and 38.1% at 1, 2, and 3 years after
ablation, respectively. Conclusions: Cryoablation of pulmonary tumors with
the use of a triple freeze protocol is a viable modality with low
recurrence and complication rates.<br/>Copyright &#xa9; 2018 SIR

<11>
Accession Number
621798531
Author
Moazen-Zadeh E.; Abbasi S.H.; Safi-Aghdam H.; Shahmansouri N.;
Arjmandi-Beglar A.; Hajhosseinn Talasaz A.; Salehiomran A.; Forghani S.;
Akhondzadeh S.
Institution
(Moazen-Zadeh, Safi-Aghdam, Akhondzadeh) Psychiatric Research Center,
Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South
Kargar Street, Tehran 13337, Iran, Islamic Republic of
(Abbasi, Shahmansouri, Arjmandi-Beglar, Hajhosseinn Talasaz, Salehiomran)
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Forghani) Razi Vaccine and Serum Research Institute, Karaj, Iran, Islamic
Republic of
Title
Effects of Saffron on Cognition, Anxiety, and Depression in Patients
Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind
Placebo-Controlled Trial.
Source
Journal of Alternative and Complementary Medicine. 24 (4) (pp 361-368),
2018. Date of Publication: April 2018.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Objectives: Cognitive decline, depression, and anxiety are among the major
concerns in patients undergoing coronary artery bypass grafting (CABG).
Crocus sativus L. (saffron) seems to be a promising candidate for
treatment of these conditions. Design: In this 12-week, randomized,
double-blind, placebo-controlled clinical trial, men and women with
on-pump CABG, who had Wechsler Memory Scale (WMS) score >70 and age <70
years, received either saffron capsules (15 mg/twice daily) or placebo.
Patients were excluded if they had history of treatment with saffron or
acetylcholinesterase inhibitors, comorbid neuropsychiatric disorders,
serious medical conditions other than cardiovascular diseases, and
hypersensitivity to herbal compounds. The primary outcome was defined as
the difference in mean total score changes for WMS-Revised from the
baseline to week 12 between the saffron and placebo groups. Secondary
outcomes included difference in mean score changes from baseline to
endpoint between the two treatment groups for Mini Mental Status
Examination and subscales of Hospital Anxiety and Depression Scale
(www.irct.ir; IRCT201408071556N63). Results: No significant difference was
detected in primary or secondary outcomes between the saffron and placebo
groups. Also, no significant time x treatment interaction effect was found
for any of the scales. Conclusions: The results of this trial do not
support the hypothesis of potential benefits of saffron in treatment of
CABG-related neuropsychiatric conditions.<br/>&#xa9; Copyright 2018, Mary
Ann Liebert, Inc. 2018.

<12>
Accession Number
2000625913
Author
Carr J.A.
Institution
(Carr) Department of Thoracic Surgery, Hurley Medical Center, Flint,
Michigan, United States
Title
Role of Fish Oil in Post-Cardiotomy Bleeding: A Summary of the Basic
Science and Clinical Trials.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1563-1567), 2018. Date of
Publication: May 2018.
Publisher
Elsevier USA
Abstract
Background: Omega-3 fatty acids are widely used. This article reviews the
coagulopathic effects of fish oil. Methods: A review was performed of all
English articles that addressed the topic from 1980 to 2017. Results: Fish
oil induces an in vitro coagulopathy in humans due to inhibitory effects
in platelet-to-platelet adhesion and platelet-stimulated thrombin
generation. The effect from fish oil alone is weak, but it is enhanced and
may become clinically noticeable in patients taking antiplatelet therapy,
and, to a lesser extent, in patients on factor Xa inhibitors and warfarin.
In the absence of other anticoagulants, fish oil alone is not capable of
producing a clinically significant coagulopathy that would induce or
contribute to surgical bleeding. Conclusions: Patients who are taking fish
oil without other anticoagulants do not have an increased risk of bleeding
surgical complications. Because of the highly variable amounts of actual
eicosapentaenoic acid and docosahexaenoic acid in commercially available
supplements, thromboelastography with platelet mapping would allow a
surgeon to know if a coagulopathic effect is present in a patient taking
fish oil, especially if the patient was also taking other
anticoagulants.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<13>
Accession Number
621625870
Author
Costa K.M.; Saxena A.K.
Institution
(Costa, Saxena) Department of Pediatric Surgery, Chelsea Children's
Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial
College London, London, United Kingdom
(Costa, Saxena) Ribeirao Preto Medical School, University of Sao Paulo,
Ribeirao Preto, Brazil
Title
Surgical chylothorax in neonates: management and outcomes.
Source
World Journal of Pediatrics. 14 (2) (pp 110-115), 2018. Date of
Publication: 01 Apr 2018.
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Postoperative chylothorax occurs due to trauma to lymphatic
vessels and can occur after any thoracic procedure. This study reviewed
recent literature to evaluate the management and outcomes of surgical
chylothorax in neonates. Methods: PubMed database was searched for
articles in English, Portuguese and Spanish from 2000 to 2016. Data were
collected for surgery, chylothorax management, complications, mortality
and length of hospital stay (LOS). Results: Twenty studies offered 107
neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac
malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH +
extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT)
was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in
one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three
patients (2.8%) did not require any treatment. Octreotide and somatostatin
were used as second or third line treatment in 25 neonates (23.4%), and 15
neonates (14%) underwent 17 surgeries, including thoracic duct ligation
(TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL +
pleurodesis (n = 2), and TDL + placement of hemostat (n = 1).
Complications due to the chylothorax were reported in 27 neonates (25.2%):
hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4),
hypoalbuminemia with cutaneous flushing as colateral effect of
somatostatin (n = 1), loose stool after somatostatin use (n = 1),
pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and
hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4
days (30-93.1 days). Conclusions: Conservative management is appropriate
as initial treatment for neonatal postsurgical chylothorax. Octreotide and
somatostatin are safe in neonates and surgical approach should be
considered in prolonged leaks.<br/>Copyright &#xa9; 2018, Children's
Hospital, Zhejiang University School of Medicine.

<14>
Accession Number
621903451
Author
Aleknaviciute J.; Tulen J.; Kooiman C.; Kushner S.
Institution
(Aleknaviciute) Erasmus University Medical Center, Psychiatry, Rotterdam,
Netherlands
(Tulen, Kushner) RotterdamNetherlands
(Kooiman) De Viersprong, Psychodynamic Psychotherapy, Rotterdam,
Netherlands
Title
The levonorgestrel-releasing intrauterine device potentiates the systemic
physiological response to psychosocial stress.
Source
European Journal of Contraception and Reproductive Health Care.
Conference: 15th Congress of the European Society of Contraception and
Reproductive Health. Hungary. 23 (Supplement 1) (pp 72-73), 2018. Date of
Publication: 2018.
Publisher
Taylor and Francis Ltd
Abstract
Objective: Controlled family planning has liberated and emancipated women
to pursue more options including paid work and active participation in
society. Today, the broad choice of family planning methods allows women
to make choices that best meet their goals. An increasing number of women
are now choosing long-acting reversible forms of contraceptives (LARC),
such as the levonorgestrel-releasing intrauterine device (LNGIUD).
Although the use of hormonal contraception among women continues to
increase, our knowledge regarding the effects of contraceptive hormonal
preparations on stressinduced physiology remains limited. In particular,
physiological data evaluating the influence of LARC is almost entirely
unexplored. Therefore, we investigated the effects of hormonal
contraception on female stress physiology. Design and methods: We
performed two experimental studies and a cross-sectional study. For each
study, healthy women were included from three groups: LNG-IUD (0.02mg/24
hours), oral ethinylestradiol/levonorgestrel (0.03mg/0.15mg; EE30/LNG) and
natural cycling (NC). Women using hormonal contraceptives for prevention
or treatment of gynaecological or dermatological conditions were excluded.
Study 1 - Salivary cortisol was measured at baseline and at defined
intervals following the Trier Social Stress Test (TSST), a standardised
psychosocial stress procedure. Heart rate was monitored continuously
throughout the TSST. Study 2 - Salivary cortisol and serum total cortisol
were evaluated relative to low-dose (1 mug) adrenocorticotropic hormone
(ACTH) administration. Study 3 - Hair cortisol was measured as a
naturalistic measure of long-term cortisol exposure. Results: Women using
LNG-IUD had an exaggerated salivary cortisol response to the TSST (24.95
+/- 13.45nmol/L), compared to EE30/LNG (3.27 +/- 2.83 nmol/L) and NC
(10.85 +/- 11.03nmol/L) (p<.0001). Heart rate was significantly
potentiated during the TSST in women using LNG-IUD. In response to ACTH
challenge, women using LNG-IUD and EE30/LNG had a blunted salivary
cortisol response, compared to NC (p=.002. Women using LNGIUD had
significantly elevated levels of hair cortisol compared to EE30/LNG or NC
(p<.001). Conclusions: Our findings suggest that LNG-IUD contraception
induces a centrally-mediated sensitissation of both autonomic and
hypothalamic-pituitary-adrenal (HPA) axis responsivity. LNG-IUD
sensitisation of HPA axis responsivity was observed acutely under
standardised laboratory conditions, as well as chronically under
naturalistic conditions, which might influence mood or anxiety.
Longitudinal studies of health-related outcomes of women using
progestin-only contraception are clearly warranted in order to provide
optimal contraceptive counselling and care.

<15>
Accession Number
621903009
Author
Padmanabhan H.; Siau K.; Nevill A.; Luckraz H.; Brookes M.J.
Institution
(Siau, Brookes) Gastroenterology, Royal Wolverhampton NHS Trust,
Wolverhampton, United Kingdom
(Nevill) Research Institute of Health Sciences, University of
Wolverhampton, Wolverhampton, United Kingdom
(Luckraz) Cardiothoracic Surgery, Royal Wolverhampton NHS Trust,
Wolverhampton, United Kingdom
Title
Anaemia does not benefit from intravenous iron therapy in the cardiac
pre-operative patients.
Source
Gut. Conference: British Society of Gastroenterology Annual General
Meeting 2017, BSG 2017. United Kingdom. 66 (Supplement 2) (pp A113), 2017.
Date of Publication: July 2017.
Publisher
BMJ Publishing Group
Abstract
Introduction Preoperative anaemia is a strong predictor of blood
transfusion requirement. Patient Blood Management guidelines highlight the
need for preoperative anaemia assessment and management in order to
optimise haemoglobin prior to elective surgery. However, there is no
randomised control trial elucidating the clinical effectiveness of the
type of iron preparation that should be used preoperatively. The main
objective of this study is to compare the efficacy of intravenous ferric
carboxymaltose (Ferinject) therapy and oral iron on pre-operative
haemoglobin levels in anaemic patients undergoing elective cardiac
surgery. Method 50 anaemic patients who were listed for elective cardiac
surgery were recruited preoperatively and randomised to receive either
oral iron (ferrous sulphate) or intravenous iron (ferric carboxymaltose).
Change in haemoglobin level after an intervention was measured and data
were collected on blood transfusion use and postoperative outcomes.
Comparisons of continuous variables were performed using the t-test for
normally distributed variables and the Mann-Whitney U test for skewed
distributions. Comparisons of categorical variables were performed using
chisquare test. Results There were no differences in the baseline
clinical, demographic characteristics and surgical procedures between the
two groups. The median rise in haemoglobin is higher in the oral iron
group (3.5 g/L; p= 0.72) compared to intravenous group (2 g/L) but was not
statistically significant. The first 12 hour blood loss was high in the
intravenous group (median 655 (IQR 162-1540) ml versus 312.5 (150-1750) ml
in oral iron group ml; p=0.007). There were no comparable differences
observed in post operative outcomes but the mean transfusion was more in
the intravenous group (2.6 vs 1.8, p=0.1). At surgery, intravenous group
had higher ferritin levels than oral group (median 392 mug/L vs 49) mug/l;
p<0.0001) Conclusion Intravenous iron was not effective in improving
preoperative haemoglobin after elective cardiac surgery and did not reduce
blood transfusion requirements. Moreover, intravenous iron appears to
significantly increase the risks of intraoperative bleeding. Larger
randomised controlled trials are needed examining the effect of
intravenous iron on preoperative anaemia and subsequent outcome after
cardiac surgery.

<16>
Accession Number
617431503
Author
Jin S.; Zhou X.
Institution
(Jin) Department of Anesthesia, Jinan Central Hospital Affiliated to
Shandong University, Jinan, Shandong Province 250013, China
(Zhou) Medical Center Tsinghua University, Beijing 100084, China
Title
Influence of dexmedetomidine on cardiac complications in non-cardiac
surgery: a meta-analysis of randomized trials.
Source
International Journal of Clinical Pharmacy. 39 (4) (pp 629-640), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Background The cardiac protection of dexmedetomidine (Dex) in
peri-operative period of patients with non-cardiac surgery is still
controversial. Aim of the Review We aimed to evaluate the influence of Dex
on cardiac complications in peri-operative period of non-cardiac surgery
by using a meta-analysis. Methods PubMed, Embase, the Cochrane library and
Springer databases were searched for relevant studies. Patients in the
eligible studies were divided into Dex group and placebo group. Relative
risk (RR) and the 95 % confidence interval (CI) were calculated to
evaluate the outcomes including all-cause mortality, myocardial
infarction, myocardial ischaemia, hypotension and bradycardia. Subgroup
analysis was performed based on the dosage of Dex. Publication bias was
assessed by Egger's test. Results Twenty double-blind randomized
controlled trials containing 1157 patients were included in this
meta-analysis. The pooled results showed no significant difference between
Dex group and placebo group in peri-operative myocardial infarction,
myocardial ischaemia and all-cause mortality. However, Dex group showed
higher risk of hypotension (RR = 1.46, 95 % CI 1.07, 2.01) and bradycardia
(RR = 1.98, 95 % CI 1.33, 2.95) than that of placebo group. In addition,
significant publication bias was found among studies involving hypotension
and bradycardia. In subgroup analysis, the risk of bradycardia was
significantly higher in 1.0 mug/kg Dex group than that in placebo group.
Besides, a higher risk of hypotension in 0.5 mug/kg Dex group than that in
placebo group was found. Conclusions Dex supplement might not reduce the
risk of cardiac complications but increases the risk of hypotension and
bradycardia in peri-operative period of patients who underwent non-cardiac
surgeries.<br/>Copyright &#xa9; 2017, Springer International Publishing.

<17>
Accession Number
617376161
Author
Piccolo R.; Pilgrim T.; Franzone A.; Valgimigli M.; Haynes A.; Asami M.;
Lanz J.; Raber L.; Praz F.; Langhammer B.; Roost E.; Windecker S.;
Stortecky S.
Institution
(Piccolo, Pilgrim, Franzone, Valgimigli, Asami, Lanz, Raber, Praz,
Windecker, Stortecky) Department of Cardiology, Swiss Cardiovascular
Center Bern, Bern University Hospital, Bern, Switzerland
(Haynes) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Langhammer, Roost) Department of Cardiovascular Surgery, Swiss
Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
Title
Frequency, Timing, and Impact of Access-Site and Non-Access-Site Bleeding
on Mortality Among Patients Undergoing Transcatheter Aortic Valve
Replacement.
Source
JACC: Cardiovascular Interventions. 10 (14) (pp 1436-1446), 2017. Date of
Publication: 24 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to examine the frequency, timing, and
association of access-site and non-access-site bleeding with mortality in
the setting of transcatheter aortic valve replacement (TAVR) during
long-term follow-up. Background Bleeding is frequent and associated with
impaired prognosis in patients undergoing TAVR. It is currently unknown
whether the site of bleeding differentially influences the outcomes of
TAVR patients. Methods In total, 926 consecutive patients undergoing TAVR
from 2007 through 2014 were evaluated. Bleeding was assessed according to
the Valve Academic Research Consortium 2 criteria. The primary outcome of
interest was all-cause mortality up to 5 years of follow-up. Results A
total of 285 patients (30.7%) experienced at least 1 (minor, major, or
life-threatening) bleeding event up to 5 years. Compared with patients not
experiencing bleeding, the adjusted risk for all-cause mortality was
significantly increased among patients with access-site (hazard ratio:
1.34; 95% confidence interval: 1.01 to 1.76; p = 0.04) and non-access-site
bleeding (hazard ratio: 2.08; 95% confidence interval: 1.60 to 2.71; p <
0.001). However, non-access-site bleeding conferred a significantly higher
risk for mortality compared with access-site bleeding (hazard ratio: 1.56;
95% confidence interval: 1.12 to 2.18; p = 0.009). At multivariate
analysis, female sex was a significant correlate of access-site bleeding,
whereas chronic kidney disease and the Society of Thoracic Surgeons score
were significantly associated with non-access-site bleeding. Conclusions
Among patients with severe aortic stenosis undergoing TAVR, access-site
and non-access-site bleeding were independently associated with an
increased risk for mortality, with the greatest risk related to
non-access-site bleeding during long-term follow-up.<br/>Copyright &#xa9;
2017

<18>
Accession Number
617416017
Author
Salih M.; Smer A.; Charnigo R.; Ayan M.; Darrat Y.H.; Traina M.; Morales
G.X.; DiBiase L.; Natale A.; Elayi C.S.
Institution
(Salih) University of Kentucky, Department of Internal Medicine,
Lexington, KY, United States
(Smer) Creighton University School of Medicine, Department of
Cardiovascular Medicine, Omaha, NE, United States
(Charnigo) University of Kentucky, Departments of Biostatistics and
Statistics, Lexington, KY, United States
(Ayan) University of Arkansas Medical Science, Department of
Cardiovascular Medicine, Little Rock, AR, United States
(Darrat, Morales, Elayi) University of Kentucky, Gill Heart Institute and
VAMC, Department of Cardiovascular Medicine, Lexington, KY, United States
(Traina) Cleveland Clinic Abu Dhabi, Department of Cardiovascular
Medicine, Abu Dhabi, United Arab Emirates
(DiBiase, Natale) Texas Cardiac Arrhythmia Institute at St. David's
Medical Center, Austin, TX, United States
Title
Colchicine for prevention of post-cardiac procedure atrial fibrillation:
Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 243 (pp 258-262), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Development of atrial fibrillation after certain cardiac
procedures is a common medical problem. The inflammatory process plays an
important role in the pathogenesis of post-cardiac procedure atrial
fibrillation (PCP-AF). Colchicine, a potent anti-inflammatory agent, has
been used in several studies to reduce the risk of PCP-AF. This
meta-analysis of randomized controlled trials (RCTs) was conducted to
assess the efficacy of colchicine in prevention of PC-PAF. Methods We
searched PubMed, EMBASE, Web of Science, Cochrane Library database and
Google Scholar for RCTs, using terms "Atrial fibrillation, atrial, or
fibrillation and colchicine". The primary end-point was the occurrence of
AF post cardiac procedure, which includes cardiac surgery or pulmonary
vein isolation. The safety end point was the occurrence of any side
effects. Estimated odds ratios (OR) and 95% confidence intervals (CI) were
evaluated. Results A total of six RCTs were included in this
meta-analysis, enrolling a total of 1257 patients. Colchicine
significantly reduced the odds of PCP-AF (OR 0.52; 95% CI, 0.40-0.68, P <
0.001, I² = 0%). However, occurrence of side effects was
significantly higher with colchicine when compared to placebo (OR 2.10;
95% CI, 1.34-3.30, P < 0.001, I² = 0%). The number needed to
treat is 7 and the number needed to harm is 11.2. The proportion of
patients discontinuing treatment was 16%. Conclusion This meta-analysis
shows that colchicine is an effective drug for prevention of PCP-AF.
Colchicine could be considered as a prophylaxis to reduce PCP-AF, with
some risk of treatment discontinuation due to the poor gastrointestinal
tolerance (diarrhea).<br/>Copyright &#xa9; 2017 Elsevier B.V.

<19>
Accession Number
616609141
Author
Priti K.; Agrawal A.; Ranwa B.L.
Institution
(Priti, Agrawal, Ranwa) Dept of cardiology, JLN hospital, Ajmer, Rajasthan
305001, India
Title
High versus low dose statin therapy in Indian patients with acute
ST-segment elevation myocardial infarction undergoing thrombolysis.
Source
Indian Heart Journal. 69 (4) (pp 453-457), 2017. Date of Publication: July
2017.
Publisher
Elsevier B.V.
Abstract
Objectives This study sought to compare high dose versus low dose statin
therapy in Indian patients with ST-segment elevation myocardial infarction
(STEMI) undergoing thrombolysis. Background Randomized trials have
demonstrated that statin treatment reduced major adverse cardiac events
(MACEs) in patients with stable angina pectoris and acute coronary
syndrome. However, randomized studies of statin therapy in Indian patients
with STEMI are scarce. Methods Of 1859 patients with acute STEMI, 1027
eligible patients were randomized to 80-mg (n = 512) or 10-mg (n = 515)
atorvastatin. Primary end point was 30-day incidence of MACE (death from
any cause, myocardial infarction, NSTE-ACS requiring readmission, ischemia
driven revascularization, and stroke). Secondary end points included
individual components of primary end point and ST-segment resolution at 90
min after thrombolysis. Results Two groups did not differ in primary
endpoints of MACEs (8.79% in high dose vs 9.32% in low dose atorvastatin
group, OR = 0.938, 95% CI = 0.612-1.436, P = 0.764). With 80 mg
atorvastatin, there was insignificant reduction in rate of reinfarction,
revascularization and death. Stroke and readmission for NSTE-ACS increased
in 80 mg atrovastatin group, but was not statistically significant.
ST-segment resolution was significantly higher in 80-mg atorvastatin arm
(45.90% vs. 37.67%; p = 0.008). Myalgia was more in 80 mg statin group
(18.06% vs 7.57%, p = 0.0001). Conclusions High-dose atorvastatin did not
show significant difference of MACEs in STEMI patients undergoing
thrombolysis but showed significant improvement in immediate coronary flow
depicted by ST-segment resolution. This benefit of high dose statin is to
be weighed against greater myalgia, drug discontinuation and cost in
Indian patients.<br/>Copyright &#xa9; 2017

<20>
Accession Number
616544711
Author
Shigematsu H.; Kawaguchi M.; Hayashi H.; Takatani T.; Iwata E.; Tanaka M.;
Okuda A.; Morimoto Y.; Masuda K.; Tanaka Y.
Institution
(Shigematsu, Iwata, Tanaka, Okuda, Morimoto, Masuda, Tanaka) Department of
Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara
City, Nara 6348522, Japan
(Kawaguchi, Hayashi, Tanaka) Department of Anesthesiology, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
(Takatani) Division of Central Clinical Laboratory, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
Title
Higher success rate with transcranial electrical stimulation of
motor-evoked potentials using constant-voltage stimulation compared with
constant-current stimulation in patients undergoing spinal surgery.
Source
Spine Journal. 17 (10) (pp 1472-1479), 2017. Date of Publication: October
2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Context During spine surgery, the spinal cord is
electrophysiologically monitored via transcranial electrical stimulation
of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial
electrical stimulation of motor-evoked potential involves the use of
either constant-current or constant-voltage stimulation; however, there
are few comparative data available regarding their ability to adequately
elicit compound motor action potentials. We hypothesized that the success
rates of TES-MEP recordings would be similar between constant-current and
constant-voltage stimulations in patients undergoing spine surgery.
Purpose The objective of this study was to compare the success rates of
TES-MEP recordings between constant-current and constant-voltage
stimulation. Study Design This is a prospective, within-subject study.
Patient Sample Data from 100 patients undergoing spinal surgery at the
cervical, thoracic, or lumbar level were analyzed. Outcome Measures The
success rates of the TES-MEP recordings from each muscle were examined.
Materials and Methods Transcranial electrical stimulation with
constant-current and constant-voltage stimulations at the C3 and C4
electrode positions (international "10-20" system) was applied to each
patient. Compound muscle action potentials were bilaterally recorded from
the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH),
tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles.
Results The success rates of the TES-MEP recordings from the right Del,
right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles
were significantly higher using constant-voltage stimulation than those
using constant-current stimulation. The overall success rates with
constant-voltage and constant-current stimulations were 86.3% and 68.8%,
respectively (risk ratio 1.25 [95% confidence interval: 1.20-1.31]).
Conclusions The success rates of TES-MEP recordings were higher using
constant-voltage stimulation compared with constant-current stimulation in
patients undergoing spinal surgery.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<21>
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.

<22>
Accession Number
620569838
Author
Vaduganathan M.; Qamar A.; Gupta A.; Bajaj N.; Golwala H.B.; Pandey A.;
Bhatt D.L.
Institution
(Vaduganathan, Qamar, Gupta, Bajaj, Golwala, Bhatt) Brigham and Women's
Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass,
United States
(Pandey) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, Tex, United States
Title
Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic
Stroke: Updated Meta-Analysis of Randomized Clinical Trials.
Source
American Journal of Medicine. 131 (5) (pp 575-577), 2018. Date of
Publication: May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Patent foramen ovale closure represents a potential secondary
prevention strategy for cryptogenic stroke, but available trials have
varied by size, device studied, and follow-up. Methods: We conducted a
systematic search of published randomized clinical trials evaluating
patent foramen ovale closure versus medical therapy in patients with
recent stroke or transient ischemic attack using PubMED, EMBASE, and
Cochrane through September 2017. Weighting was by random effects models.
Results: Of 480 studies screened, we included 5 randomized clinical trials
in the meta-analysis in which 3440 patients were randomized to patent
foramen ovale closure (n = 1829) or medical therapy (n = 1611) and
followed for an average of 2.0 to 5.9 years. Index stroke/transient
ischemic attack occurred within 6 to 9 months of randomization. The
primary end point was composite stroke/transient ischemic attack and death
(in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure
reduced the primary end point (0.70 vs 1.48 events per 100 patient-years;
risk ratio [RR], 0.52 [0.29-0.91]; I² = 55.0%) and
stroke/transient ischemic attack (1.04 vs 2.00 events per 100
patient-years; RR, 0.55 [0.37-0.82]; I² = 42.2%) with modest
heterogeneity compared with medical therapy. Procedural bleeding was not
different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83];
I² = 29.2%), but new-onset atrial fibrillation/flutter was
increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69
[2.17-10.12]; I² = 29.3%). Conclusions: In patients with recent
cryptogenic stroke, patent foramen ovale closure reduces recurrent
stroke/transient ischemic attack compared with medical therapy, but is
associated with a higher risk of new-onset atrial
fibrillation/flutter.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<23>
Accession Number
621182080
Author
Blessberger H.; Kammler J.; Domanovits H.; Schlager O.; Wildner B.; Azar
D.; Schillinger M.; Wiesbauer F.; Steinwender C.
Institution
(Blessberger, Kammler, Steinwender) Kepler University Hospital, Medical
Faculty of the Johannes Kepler University Linz, Department of Cardiology,
Krankenhausstrase 9, Med Campus III, Linz 4020, Austria
(Domanovits) Vienna General Hospital, Medical University of Vienna,
Department of Emergency Medicine, Wahringer Gurtel 18-20, Vienna 1090,
Austria
(Schlager, Schillinger) Vienna General Hospital, Medical University of
Vienna, Department of Internal Medicine II, Division of Angiology,
Wahringer Gurtel 18-20, Vienna 1090, Austria
(Wildner) University Library of the Medical University of Vienna,
Information Retrieval Office, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Azar) Landesklinikum Thermenregion Baden, Department of General Surgery,
Wimmergasse 19, Baden 2500, Austria
(Wiesbauer) Division of Cardiology, Vienna General Hospital, Medical
University of Vienna, Department of Internal Medicine II, Wahringerstrasse
18-20, Vienna 1090, Austria
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
Cochrane Database of Systematic Reviews. 2018 (3) (no pagination), 2018.
Article Number: CD004476. Date of Publication: 13 Mar 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Randomized controlled trials have yielded conflicting results
regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue. Objectives:
The objective of this review was to systematically analyse the effects of
perioperatively administered beta-blockers for prevention of
surgery-related mortality and morbidity in patients undergoing any type of
surgery while under general anaesthesia. Search methods: We identified
trials by searching the following databases from the date of their
inception until June 2013: MEDLINE, Embase , the Cochrane Central Register
of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative
Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File,
Science Citation Index Expanded, Life Sciences Collection, Global Health
and PASCAL. In addition, we searched online resources to identify grey
literature. Selection criteria: We included randomized controlled trials
if participants were randomly assigned to a beta-blocker group or a
control group (standard care or placebo). Surgery (any type) had to be
performed with all or at least a significant proportion of participants
under general anaesthesia. Data collection and analysis: Two review
authors independently extracted data from all studies. In cases of
disagreement, we reassessed the respective studies to reach consensus. We
computed summary estimates in the absence of significant clinical
heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and
mean differences (MDs) were used for continuous outcomes. We performed
subgroup analyses for various potential effect modifiers. Main results: We
included 88 randomized controlled trials with 19,161 participants. Six
studies (7%) met the highest methodological quality criteria (studies with
overall low risk of bias: adequate sequence generation, adequate
allocation concealment, double/triple-blinded design with a placebo group,
intention-to-treat analysis), whereas in the remaining trials, some form
of bias was present or could not be definitively excluded (studies with
overall unclear or high risk of bias). Outcomes were evaluated separately
for cardiac and non-cardiac surgery. CARDIAC SURGERY (53 trials) We found
no clear evidence of an effect of beta-blockers on the following outcomes.
* All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants,
moderate quality evidence. * Acute myocardial infarction (AMI): RR 1.04,
95% CI 0.71 to 1.51, 3553 participants, moderate quality evidence. *
Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166 participants, low
quality evidence. * Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02,
1400 participants, low quality evidence. * Hypotension: RR 1.54, 95% CI
0.67 to 3.51, 558 participants, low quality evidence. * Bradycardia: RR
1.61, 95% CI 0.97 to 2.66, 660 participants, low quality evidence. *
Congestive heart failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants,
low quality evidence. Beta-blockers significantly reduced the occurrence
of the following endpoints. * Ventricular arrhythmias: RR 0.37, 95% CI
0.24 to 0.58, number needed to treat for an additional beneficial outcome
(NNTB) 29, 2292 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB five,
6420 participants, high quality evidence. * On average, beta-blockers
reduced length of hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450
participants, low quality evidence). NON-CARDIAC SURGERY (35 trials)
Beta-blockers significantly increased the occurrence of the following
adverse events. * All-cause mortality: RR 1.25, 95% CI 1.00 to 1.57,
11,413 participants, low quality of evidence, number needed to treat for
an additional harmful outcome (NNTH) 167. * Hypotension: RR 1.50, 95% CI
1.38 to 1.64, NNTH 16, 10,947 participants, high quality evidence. *
Bradycardia: RR 2.23, 95% CI 1.48 to 3.36, NNTH 21, 11,033 participants,
moderate quality evidence. We found a potential increase in the occurrence
of the following outcomes with the use of beta-blockers. * Cerebrovascular
events: RR 1.59, 95% CI 0.93 to 2.71, 9150 participants, low quality
evidence. Whereas no clear evidence of an effect was found when all
studies were analysed, restricting the meta-analysis to low risk of bias
studies revealed a significant increase in cerebrovascular events with the
use of beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 265, 8648
participants. Beta-blockers significantly reduced the occurrence of the
following endpoints. * AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 76, 10,958
participants, high quality evidence. * Myocardial ischaemia: RR 0.51, 95%
CI 0.34 to 0.77, NNTB nine, 978 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.73, 95% CI 0.57 to 0.94, NNTB 112, 8744
participants, high quality evidence. We found no clear evidence of an
effect of beta-blockers on the following outcomes. * Ventricular
arrhythmias: RR 0.68, 95% CI 0.31 to 1.49, 476 participants, moderate
quality evidence. * Congestive heart failure: RR 1.18, 95% CI 0.94 to
1.48, 9173 participants, moderate quality evidence. * Length of hospital
stay: mean difference -0.45 days, 95% CI -1.75 to 0.84, 551 participants,
low quality evidence. Authors' conclusions: According to our findings,
perioperative application of beta-blockers still plays a pivotal role in
cardiac surgery, as they can substantially reduce the high burden of
supraventricular and ventricular arrhythmias in the aftermath of surgery.
Their influence on mortality, AMI, stroke, congestive heart failure,
hypotension and bradycardia in this setting remains unclear. In
non-cardiac surgery, evidence shows an association of beta-blockers with
increased all-cause mortality. Data from low risk of bias trials further
suggests an increase in stroke rate with the use of beta-blockers. As the
quality of evidence is still low to moderate, more evidence is needed
before a definitive conclusion can be drawn. The substantial reduction in
supraventricular arrhythmias and AMI in this setting seems to be offset by
the potential increase in mortality and stroke.<br/>Copyright &#xa9; 2018
The Cochrane Collaboration.

<24>
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.

<25>
Accession Number
621598383
Author
Wang N.; Phan K.
Institution
(Wang, Phan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
Title
Cerebral protection devices in transcatheter aortic valve replacement: A
clinical meta-analysis of randomized controlled trials.
Source
Journal of Thoracic Disease. 10 (3) (pp 1927-1935), 2018. Date of
Publication: 01 Mar 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Neurological complications after undergoing transcatheter
aortic valve replacement (TAVR) may be reduced with cerebral protection
(CP) devices. However, randomized controlled trials (RCTs) have failed to
demonstrate convincing evidence of improvements in hard clinical endpoints
in patients with CP. The aim of this study was to compare clinical
outcomes of TAVR patients with and without CP devices. Methods: Electronic
searches were performed using four electronic databases from their dates
of inception to May 2017. RCTs that reported outcomes for patient cohorts
that underwent TAVR procedures with and without CP were included. Crude
odds ratios (ORs) and 95% confidence intervals were calculated using
random effects model. Results: A total of five RCTs were included,
totalling 643 patients, 386 of whom were randomized to TAVR + CP and 257
with TAVR only. The primary composite endpoint of all-cause mortality and
stroke at 30 days was lower in patients undergoing CP devices compared to
those patients with TAVR alone (OR, 0.54; 95% CI, 0.30 to 0.98). Use of CP
devices was also associated with lower new total lesion volume
(standardised mean difference, -0.49; 95% CI, -0.96 to -0.03). There was a
non-significant reduction in the risk of secondary clinical endpoints of
all-cause mortality, stroke, life-threatening bleed, acute kidney injury
and major vascular complications in patients randomized to TAVR + CP.
Conclusions: Use of CP devices in TAVR appears to be safe and may be
associated with a reduction in stroke/death.<br/>Copyright &#xa9; Journal
of Thoracic Disease.

<26>
Accession Number
621584814
Author
Wang X.; Zhang Y.; Dong Z.; Fan J.; Nie S.; Wei Y.
Institution
(Wang, Fan, Nie) Capital Medical University, Emergency and Critical Care
Center, Beijing Anzhen Hospital, 2 Anzhen Road, Beijing, Chaoyang District
100029, China
(Zhang, Dong) Capital Medical University, Cardiovascular Center, Beijing
Tongren Hospital, Beijing, China
(Wei) Beijing Anzhen Hospital, Capital Medical University, Department of
Otolaryngology Head and Neck Surgery, 2 Anzhen Road, Beijing, Chaoyang
District 100029, China
Title
Effect of continuous positive airway pressure on long-term cardiovascular
outcomes in patients with coronary artery disease and obstructive sleep
apnea: A systematic review and meta-analysis.
Source
Respiratory Research. 19 (1) (no pagination), 2018. Article Number: 61.
Date of Publication: 10 Apr 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Obstructive sleep apnea (OSA) is highly prevalent in patients
with coronary artery disease (CAD) and is associated with recurrent
cardiovascular risk. However, whether treatment with continuous positive
airway pressure (CPAP) reduces this risk remains unclear. We performed a
systematic review and meta-analysis to assess the effect of CPAP on
long-term cardiovascular outcomes in patients with concomitant CAD and
OSA. Methods: We searched the PubMed, EMBASE, and Cochrane library from
their inceptions to October 7, 2017. We included observational studies and
randomized controlled trials (RCTs) that described the association of CPAP
treatment with cardiovascular events in patients with CAD and OSA. The
primary outcome of interest was major adverse cardiovascular event (MACE),
including all-cause or cardiovascular death, myocardial infarction,
stroke, repeat revascularization, or hospitalization for heart failure.
Outcomes data were pooled using random effects models and heterogeneity
assessed with the I² statistic. Results: We identified 9
studies (2 RCTs and 7 observational studies) with 1430 participants. The
median follow-up duration was from 36 to 86.5 months. Treatment with CPAP
was associated with a significantly lower risk of MACE in 6 observational
studies (RR 0.61, 95% CI: 0.39-0.94, P = 0.02), but this was not
reproduced in 2 RCTs (RR 0.57, 95% CI: 0.32-1.02, P = 0.06). Similarly,
CPAP significantly reduced the risk of all-cause death (4 observational
studies) and cardiovascular death (3 observational studies), which were
also not confirmed in RCTs. Conclusions: The use of CPAP in patients with
CAD and OSA might prevent subsequent cardiovascular events, which was only
demonstrated in observational studies, but not in RCTs. The value of CPAP
therapy as second prevention for CAD needs further
investigation.<br/>Copyright &#xa9; 2018 The Author(s).

<27>
Accession Number
2000646002
Author
Leonard J.R.; Rahouma M.; Abouarab A.A.; Schwann A.N.; Scuderi G.; Lau C.;
Guy T.S.; Demetres M.; Puskas J.D.; Taggart D.P.; Girardi L.N.; Gaudino M.
Institution
(Leonard, Rahouma, Abouarab, Schwann, Scuderi, Lau, Guy, Girardi, Gaudino)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
United Kingdom
Title
Totally endoscopic coronary artery bypass surgery: A meta-analysis of the
current evidence.
Source
International Journal of Cardiology. 261 (pp 42-46), 2018. Date of
Publication: 15 June 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Totally endoscopic coronary artery bypass (TECAB) has emerged
as an alternative to other minimally invasive techniques. However, limited
TECAB results are available to date. The purpose of this systematic review
is to examine the existing literature to give an objective estimate of the
outcomes of TECAB using a meta-analytical approach. Methods: A
comprehensive online review was performed in Ovid MEDLINE Ovid EMBASE and
The Cochrane Library from 2000 to July 2017. Eligible studies included
single arm TECAB studies as well as comparative studies (TECAB vs
minimally invasive direct coronary artery bypass (MIDCAB)). Pooled event
rates and odds ratios (ORs) for operative mortality, perioperative
myocardial infarction (MI), perioperative stroke, graft patency and repeat
revascularization were estimated. Single arm and pairwise comparisons were
performed. Results: Seventeen single arm TECAB articles (3721 patients,
weighted mean follow-up 3.3 years) were included. The pooled event rate
was 0.80% (95%CI: 0.60-1.2%) for operative mortality, 2.28% (95%CI:
1.7-3%) for perioperative MI, 1.50% (95%CI: 1.1-2.0%) for perioperative
stroke, 2.99% (95%CI: 1.6-5.4%) for repeat revascularization and 94.8%
(95%CI: 89.3-97.5%) for early graft patency (weighted mean follow-up 10.1
months). On pairwise meta-analysis 376 patients (263 TECAB and 113 MIDCAB)
were included. No difference in operative mortality (OR = 0.25, 95%CI:
0.02-2.83), perioperative MI (OR = 3.09, 95%CI: 0.37-26.12) or
perioperative stroke (OR = 1.33, 95%CI: 0.17-10.26) was found between the
two techniques. Conclusions: TECAB has an acceptably low operative risk
and a good early patency rate. The incidence of perioperative MI requires
further investigation. The dearth of data comparing TECAB to open
approaches compels the need for future comparative trials.<br/>Copyright
&#xa9; 2017 Elsevier Ireland Ltd

<28>
Accession Number
621629656
Author
de Hoogd S.; Ahlers S.J.G.M.; van Dongen E.P.A.; van de Garde E.M.W.;
Daeter E.J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd, Ahlers, van de Garde, Knibbe) Department of Clinical Pharmacy,
St. Antonius Hospital, Nieuwegein, Netherlands
(van Dongen) Department of Anesthesiology and Intensive Care, St. Antonius
Hospital, Nieuwegein, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Dahan) Department of Anesthesiology, Leiden University Medical Center,
Leiden, Netherlands
(Tibboel, Knibbe) Intensive Care and Department of Pediatric Surgery,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
(Knibbe) Division of Pharmacology, Leiden Academic Centre for Drug
Research, Leiden University, Leiden, Netherlands
Title
Randomized Controlled Trial on the Influence of Intraoperative
Remifentanil versus Fentanyl on Acute and Chronic Pain after Cardiac
Surgery.
Source
Pain Practice. 18 (4) (pp 443-451), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Remifentanil has been associated with increased acute and
potentially chronic postoperative pain. The objective of this prospective
randomized controlled trial was to investigate the influence of
intraoperative remifentanil on acute and chronic postoperative pain after
cardiac surgery. Methods: Patients (N = 126) receiving standardized
anesthesia with propofol and intermittent intravenous fentanyl at
predetermined times for cardiac surgery were randomized to
intraoperatively receive either a continuous remifentanil infusion or
additional intermittent intraoperative fentanyl as needed. The primary
endpoint was chronic thoracic pain at 12 months after surgery. Secondary
endpoints were pain at 3 and 6 months after surgery and analgesic
requirements and pain levels in the first 72 hours. Results: There was no
significant difference in incidence of chronic thoracic pain between the
remifentanil and fentanyl groups, respectively (20% vs. 18%; P = 0.817).
At 3 months, however, significantly more patients in the remifentanil
group reported chronic thoracic pain (51% vs. 33%; P = 0.047). This effect
was more pronounced in younger patients and in patients receiving a higher
dose of remifentanil (both P < 0.05). The first 24 and 48 hours
postoperatively, morphine consumption in the remifentanil group was
significantly higher than in the fentanyl group (34.3 mg [interquartile
range (IQR) 25.3 to 48.2] vs. 30.2 mg [IQR 19.2 to 38.1], P = 0.028; and
46.8 mg [IQR 33.8 to 59.2] vs. 39.0 mg [IQR 6.2 to 51.4], P = 0.047,
respectively). Conclusions: Intraoperative use of remifentanil during
cardiac surgery does not impact chronic postoperative pain 1 year after
surgery. Nevertheless, remifentanil increases analgesic requirements and
thoracic pain until 3 months after surgery, and its use is therefore less
favorable during cardiac surgery.<br/>Copyright &#xa9; 2017 The Authors.
Pain Practice published by Wiley Periodicals, Inc. on behalf of World
Institute of Pain

<29>
Accession Number
613825884
Author
Song S.-T.; Bai C.-M.; Zhou J.-W.
Institution
(Song, Bai, Zhou) Department of Cardiothoracic Surgery, Cangzhou Central
Hospital, Cangzhou, China
Title
Serum TNF-alpha levels in children with congenital heart disease
undergoing cardiopulmonary bypass: A cohort study in China and a
meta-analysis of the published literature.
Source
Journal of Clinical Laboratory Analysis. 31 (6) (no pagination), 2017.
Article Number: e22112. Date of Publication: November 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To investigate the changes in tumor necrosis factor alpha
(TNF-alpha) serum levels after cardiopulmonary bypass (CPB) in children
with congenital heart disease (CHD), followed by a meta-analysis to
analyze the clinical value of TNF-alpha in CPB. Methods: Our cohort study
enrolled 67 CHD children, assigned into off-pump group (n=32) and CPB
group (n=35). The TNF-alpha serum levels in two groups were detected by
ELISA before the operation (T1), at the end of the operation (0 hour, T2),
and after 24 hours of the operation (T3). For meta-analysis, literature
search was conducted to identify published case-control articles about the
changes of TNF-alpha serum levels with CPB of CHD. Results: The TNF-alpha
levels in CPB group were lower than that in the off-pump group at T3
(P=.006). TNF-alpha level at T3 was significantly lower than that at T1
and T2 (all P<.05). Meta-analysis results further confirmed that the
TNF-alpha levels of CHD children were dramatically decreased at T3 as
compared to that at T1 and T2 (both P<.001). Conclusion: The TNF-alpha
serum levels showed a transient and dramatic decline after 24 hours of
CPB, and it may act as an important biological indicator for monitoring
the efficacy of CPB in CHD children.<br/>Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<30>
Accession Number
621701712
Author
Nedel W.L.; Deutschendorf C.; Moraes Rodrigues Filho E.
Institution
(Nedel) ICU, Hospital Nossa Senhora da Con-ceicao and the ICU, Hospital de
Clinicas de Porto Alegre, Porto Alegre, Brazil
(Deutschendorf) Infection Control Unit, Hospital de Clinicas de Porto
Alegre, Porto Alegre, Brazil
(Moraes Rodrigues Filho) ICU, Hospital de Clinicas de Porto Alegre, Porto
Alegre, Brazil
Title
High-flow nasal cannula in critically ill subjects with or at risk for
respiratory failure: A systematic review and meta-analysis.
Source
Respiratory Care. 62 (1) (pp 123-132), 2017. Date of Publication: January
2017.
Publisher
American Association for Respiratory Care
Abstract
High-flow nasal cannula (HFNC) oxygen delivery has been gaining attention
as an alternative means of respiratory support for critically ill
patients, with recent studies suggesting equivalent outcomes when compared
with other forms of oxygen therapy delivery. The main objective of this
review was to extract current data about the efficacy of HFNC in
critically ill subjects with or at risk for respiratory failure. We
performed a systematic review of publications (from database inception to
October 2015) that evaluated HFNC in critically ill subjects with or at
risk for acute respiratory failure and performed a meta-analysis comparing
HFNC with noninvasive ventilation (NIV) and with standard oxygen therapy
regarding major outcomes: incidence of invasive mechanical ventilation and
ICU mortality. A total of 9 studies were included. HFNC was not associated
with a reduction in the incidence of invasive mechanical ventilation
compared with NIV (odds ratio [OR] 0.83, 95% CI 0.57-1.20, P =.31) or
standard oxygen therapy (OR 0.49, 95% CI 0.22-1.08, P =.17). Additionally,
HFNC use did not reduce ICU mortality compared with NIV (OR 0.72, 95% CI
0.23-2.21, P =.56) or with standard oxygen therapy (OR 0.69, 95% CI
0.33-1.42, P =.29). There was a trend toward better oxygenation compared
with conventional oxygen therapy but a worse gas exchange compared with
NIV. At this moment, HFNC therapy seems not to be superior to conventional
oxygen therapy or NIV in terms of invasive mechanical ventilation rate or
ICU mortality in critical illness, but new studies are needed to determine
whether HFNC is associated with any difference in major outcomes when
compared with other techniques.<br/>Copyright &#xa9; 2017 Daedalus
Enterprises.

<31>
[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.

<32>
[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).

<33>
[Use Link to view the full text]
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.

<34>
Accession Number
614877547
Author
Clemmensen T.S.; Holm N.R.; Eiskjaer H.; Logstrup B.B.; Christiansen E.H.;
Dijkstra J.; Barkholt T.O.; Terkelsen C.J.; Maeng M.; Poulsen S.H.
Institution
(Clemmensen, Holm, Eiskjaer, Logstrup, Christiansen, Barkholt, Terkelsen,
Maeng, Poulsen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Dijkstra) Division of Image Processing, Leiden University Medical Centre,
Leiden, Netherlands
Title
Layered Fibrotic Plaques Are the Predominant Component in Cardiac
Allograft Vasculopathy: Systematic Findings and Risk Stratification by
OCT.
Source
JACC: Cardiovascular Imaging. 10 (7) (pp 773-784), 2017. Date of
Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aims of this study were to characterize cardiac allograft
vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and
to evaluate the prognostic significance of OCT-determined CAV severity.
Background Intravascular OCT enables in vivo characterization of CAV
microstructure after heart transplantation. Methods Sixty-two patients
undergoing heart transplantation were enrolled at routine angiography from
September 2013 through October 2015 and prospectively followed until
censoring on May 27, 2016. Optical coherence tomographic acquisitions
aimed for the longest possible pull-backs, including proximal segments of
all 3 major vessels. Plaques and bright spots were analyzed by delineating
circumferential borders and measuring the angulation of total
circumference. Layers were contoured for absolute and relative estimates.
Nonfatal CAV progression (NFCP) during follow-up was registered. NFCP
included occluded vessels or severe (>=70%) new angiographic coronary
stenosis or percutaneous coronary intervention. Results A total of 172
vessels were categorized as follows: no CAV, n = 111; mild to moderate CAV
(<70% stenosis), n = 40; and severe CAV (>=70% stenosis), n = 21. Layered
fibrotic plaque (LFP) was the most prevalent plaque component, and the
extent increased with angiographic CAV severity (p < 0.01). During
follow-up, 22 of 172 vessels (13%) experienced NFCP. Median follow-up was
633 days (interquartile range: 432 to 808 days). The extent of LFP (hazard
ratio: 5.0; 95% confidence interval: 2.1 to 12.4; p < 0.0001) and the
extent of bright spots (hazard ratio: 6.2; 95% confidence interval: 2.4 to
15.8, p < 0.001) were strong predictors of NFCP. By combining LFP and
bright spots, a strong NFCP predictive model was obtained (hazard ratio:
8.9; 95% confidence interval: 2.6 to 29.9; p < 0.0001). Conclusions OCT
enables the detection of CAV-associated plaque compositions and allows
early detection and differentiation of vessel wall disease not visible on
angiography. LFP was the most prevalent plaque component, was strongly
associated with NFCP, and may be associated with stepwise CAV progression
caused by organizing mural thrombi. (The GRAFT Study: Evaluation of Graft
Function, Rejection and Cardiac Allograft Vasculopathy in First Heart
Transplant Recipients; NCT02077764)<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<35>
Accession Number
2000567409
Author
Dvirnik N.; Belley-Cote E.P.; Hanif H.; Devereaux P.J.; Lamy A.; Dieleman
J.M.; Vincent J.; Whitlock R.P.
Institution
(Dvirnik, Belley-Cote, Devereaux, Lamy, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario,
Canada
(Dvirnik, Hanif, Lamy, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada
(Devereaux, Lamy, Vincent, Whitlock) Population Health Research Institute,
Hamilton, Ontario, Canada
(Dieleman) Division of Anaesthesiology, Intensive Care, and Emergency
Medicine, University Medical Center Utrecht, Netherlands
(Dieleman) Department of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, Australia
Title
Steroids in cardiac surgery: a systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 120 (4) (pp 657-667), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory
reaction that may contribute to postoperative complications. Preventing
this reaction with steroids may improve outcomes. We performed a
systematic review to evaluate the impact of prophylactic steroids on
clinical outcomes in patients undergoing on-pump cardiac surgery. Methods:
We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised
controlled trials (RCTs) comparing perioperative corticosteroid
administration with a control group in adults undergoing CPB. Outcomes of
interest included mortality, myocardial infarction, and new onset atrial
fibrillation. We assessed the quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation approach. Results:
Fifty-six RCTs published between 1977 and 2015 were included in this
meta-analysis. Mortality was not significantly different between groups
[3.0% (215/7258 patients) in the steroid group and 3.5% (252/7202
patients) in the placebo group; relative risk (RR), 0.85; 95% confidence
interval (CI), 0.71-1.01; P=0.07; I² = 0%]. Myocardial injury
was more frequent in the steroid group [8.0% (560/6989 patients), compared
with 6.9% (476/6929 patients); RR, 1.17, 95% CI, 1.04-1.31; P=0.008;
I²=0%]. New onset atrial fibrillation was lower in the steroid
group [25.7% (1792/6984 patients) compared with 28.3% (1969/6964
patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005, I²=43%]; this
beneficial effect was limited to small trials (P for interaction
<0.00001). Conclusions: After randomising 16 013 patients, steroid
administration at the time of cardiac surgery had an unclear impact on
mortality, increased the risk of myocardial injury, and the impact on
atrial fibrillation should be viewed with caution given that large trials
showed no effect.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<36>
Accession Number
621206984
Author
Nezafati P.; Shomali A.; Kahrom M.; Omidvar Tehrani S.; Dianatkhah M.;
Nezafati M.H.
Institution
(Nezafati) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Shomali) Javad Al Aemeh Hospital, Mashhad, Iran, Islamic Republic of
(Kahrom, Nezafati) Cardiac Surgery, Ghaem Hospital, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Omidvar Tehrani) Student Research Committee, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Dianatkhah) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Title
ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
Background: The present study aimed to compare postoperative complications
commonly revealed after sternotomy closure by new sternal ZipFixTM
(Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire.
Methods: Among the initial 360 subjects, 326 patients enrolled in this
randomised control trial who were candidates for cardiac surgery from
April 2014 to March 2015. After the surgery, the sternal closure was
randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix
(ZF) on the sternal body (n = 168) or with conventional wires (CWs) (n =
158). Patients were followed postoperatively as well as 1, 3, 6, and 12
months after discharge regarding postoperative complications such as pain
severity, dehiscence, and infection including incisional infections
(superficial or deep), and organ/space infection (mediastinitis or
osteomyelitis). Results: The mean age of the ZF and CW groups were 63.58
+/- 10.9 and 62.42 +/- 7.1 years, respectively (p = 0.262). In addition,
there was no significant difference between the two groups' baseline
characteristics (p > 0.05). Our study showed higher mean pain severity
score in the conventional closure group compared with ZipFix closure group
at all study time points (p < 0.001). Infection was seen in 2.76% of the
overall participants with no significant difference of incisional and
organ infection between the two groups throughout the study. After 1-month
follow-up, five patients in the CW group had sternal dehiscence whereas no
patients in ZF had dehiscence (p < 0.001). Conclusions: Our trial
demonstrates greater clinical advantages in terms of pain and sternal
dehiscence post surgery by using sternal ZipFix compared to conventional
steel wire.<br/>Copyright &#xa9; 2018 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<37>
Accession Number
620115798
Author
Shatila M.; Arab W.A.; Fasih N.; Karara K.; Ramadan A.-M.
Institution
(Shatila, Arab, Karara, Ramadan) Cardiothoracic Surgery Department,
University of Alexandria, Egypt
(Fasih) Pediatric Department, University of Alexandria, Egypt
Title
Comparative study between outcome of intercostal tube drainage and video
assisted thoracoscopic surgery in management of complicated parapneumonic
effusion in children.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 26 (1) (pp
68-72), 2018. Date of Publication: March 2018.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Intercostal tube drainage (ICTD) has been known for the
management of complicated parapneumonic effusion (PPE) since the early
1870s. Video assisted thoracoscopic surgery (VATS) has been applied since
the early 1990s. The aim of this study was to compare between both
surgical procedures in children. Methods: This randomized clinical study
included 75 children for drainage of complicated PPE in the Cardiothoracic
Surgery Department of Alexandria University hospital, Egypt. They were
classified into two groups. Group I included 35 children managed by ICTD
while group II included 40 children managed by VATS. Results: The mean age
in group I was 7.81 +/- 4.04 years and 8.93 +/- 1.73 years in group II.
Mean duration on medical therapy before and after intervention was 0.74
+/- 2.83 days in group I and 4.80 +/- 0.94 days in group II, and 11.06 +/-
5.31 days in group I, and 2.88 +/- 1.52 days in group II respectively.
Success rate following primary intervention was 17.1% in group I and 90%
in group II. Average amount of pleural fluid drained was 291.14 +/- 94.86
ml in group I and 156.50 +/- 76.28 ml in group II. The mean hospital stay
following primary intervention was 11.06 days in the first group and 2.43
days in group II. The mean hospital stay after secondary intervention in
group I was 3.74 +/- 2.79. In contrast, it was 1.38 days in group II which
was significantly shorter than that of the group I. Moreover, the mean
total hospital stay was 14.77 +/- 7.12 days in the first group and 7.68
+/- 2.07 days in the second group. Conclusions: VATS is a safe and
effective procedure with low rates of complications. Early VATS should be
the first treatment of choice in children with PPE.<br/>Copyright &#xa9;
2017 The Egyptian Society of Cardio-thoracic Surgery

<38>
Accession Number
621079995
Author
Gottlieb M.; Long B.; Koyfman A.
Institution
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, Illinois, United States
(Long) Department of Emergency Medicine, San Antonio Military Medical
Center, Fort Sam Houston, Texas, United States
(Koyfman) Department of Emergency Medicine, The University of Texas
Southwestern Medical Center, Dallas, Texas, United States
Title
Evaluation and Management of Aortic Stenosis for the Emergency Clinician:
An Evidence-Based Review of the Literature.
Source
Journal of Emergency Medicine. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Introduction: Aortic stenosis is a common condition among older adults
that can be associated with dangerous outcomes, due to both the disease
itself and its influence on other conditions. Objective: This review
provides an evidence-based summary of the current emergency department
(ED) evaluation and management of aortic stenosis. Discussion: Aortic
stenosis refers to significant narrowing of the aortic valve and can be
caused by calcific disease, congenital causes, or rheumatic valvular
disease. Symptoms of advanced disease include angina, dyspnea, and
syncope. Patients with these symptoms have a much higher mortality rate
than asymptomatic patients. Initial evaluation should include an
electrocardiogram, complete blood count, basic metabolic profile,
coagulation studies, troponin, brain natriuretic peptide, type and screen,
and a chest radiograph. Transthoracic echocardiogram is the test of
choice, but point-of-care ultrasound has been found to have good accuracy
when a formal echocardiogram is not feasible. Initial management should
begin with restoring preload and ensuring a normal heart rate, as both
bradycardia and tachycardia can lead to clinical decompensation. For
patients with high blood pressure and heart failure symptoms, nitrate
agents may be reasonable, but hypotension should be avoided. Dobutamine
can increase inotropy. For hypotensive patients, vasopressors should be
used at the lowest effective dose. The treatment of choice is valve
replacement, but extracorporeal membrane oxygenation and percutaneous
balloon dilatation of the aortic valve have been described as temporizing
measures. Conclusion: Aortic stenosis is an important condition that can
lead to dangerous outcomes and requires prompt recognition and
disease-specific management in the ED.<br/>Copyright &#xa9; 2018

<39>
Accession Number
621861298
Author
Cui K.-Y.; Lyu S.-Z.; Song X.-T.; Yuan F.; Xu F.; Zhang M.; Zhang M.-D.;
Wang W.; Zhang D.-F.; Dai J.; Tian J.-F.; Wang Y.-L.
Institution
(Wang) Department of Anesthesiology, Beijing Chaoyang Hospital, Capital
Medical University, Beijing, China
(Cui, Lyu, Song, Yuan, Xu, Zhang, Zhang, Wang, Zhang, Dai, Tian)
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2
Anzhen Road, Beijing 100029, China
Title
Long term outcomes of drug-eluting stent versus coronary artery bypass
grafting for left main coronary artery disease: A meta-analysis.
Source
Journal of Geriatric Cardiology. 15 (2) (pp 162-172), 2018. Date of
Publication: 2018.
Publisher
Science Press
Abstract
Background It is still controversial whether percutaneous coronary
intervention with drug-eluting stent (DES) is safe and effective compared
to coronary artery bypass graft surgery (CABG) for unprotected left main
coronary artery (ULMCA) disease at long-term follow up (>= 3 years).
Methods Eligible studies were selected by searching PubMed, EMBASE, and
Cochrane Library up to December 6, 2016. The primary endpoint was a
composite of death, myocardial infarction (MI) or stroke during the
longest follow-up. Death, cardiac death, MI, stroke and repeat
revascularization were the secondary outcomes. Results Four randomized
controlled trials and twelve adjusted observational studies involving
14,130 patients were included. DES was comparable to CABG regarding the
occurrence of the primary endpoint (HR = 0.94, 95% CI: 0.861.03). Besides,
DES was significantly associated with higher incidence of MI (HR = 1.56,
95% CI: 1.092.22) and repeat revascularization (HR = 3.09, 95% CI:
2.334.10) compared with CABG, while no difference was found between the
two strategies regard as the rate of death, cardiac death and stroke.
Furthermore, DES can reduce the risk of the composite endpoint of death,
MI or stroke (HR = 0.80, 95% CI: 0.670.95) for ULMCA lesions with SYNTAX
score <= 32. Conclusions Although with higher risk of repeat
revascularization, PCI with DES appears to be as safe as CABG for ULMCA
disease at long-term follow up. In addition, treatment with DES could be
an alternative interventional strategy to CABG for ULMCA lesions with low
to intermediate anatomic complexity.<br/>Copyright &#xa9; 2018 JGC All
rights reserved.

<40>
Accession Number
621789378
Author
Weinstein E.J.; Levene J.L.; Cohen M.S.; Andreae D.A.; Chao J.Y.; Johnson
M.; Hall C.B.; Andreae M.H.
Institution
(Weinstein, Levene) Albert Einstein College of Medicine of Yeshiva
University, 1300 Morris Park Ave, Bronx, NY 10461, United States
(Cohen, Chao) Montefiore Medical Center, Albert Einstein College of
Medicine, Department of Anesthesiology, 111 E 210 Street, Bronx, NY
N4-005, United States
(Andreae) Milton S Hershey Medical Center, Department of Allergy/
Immunology, 500 University Dr, Hershey, PA 17033, United States
(Johnson) Teachers College, Columbia University, Human Development, New
York, NY 10027, United States
(Hall) Albert Einstein College of Medicine, Division of Biostatistics,
Department of Epidemiology and Population Health, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Andreae) Milton S Hershey Medical Centre, Department of Anesthesiology
and Perioperative Medicine, 500 University Drive, H187, Hershey, PA 17033,
United States
Title
Local anaesthetics and regional anaesthesia versus conventional analgesia
for preventing persistent postoperative pain in adults and children.
Source
Cochrane Database of Systematic Reviews. 2018 (4) (no pagination), 2018.
Article Number: CD007105. Date of Publication: 25 Apr 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Regional anaesthesia may reduce the rate of persistent
postoperative pain (PPP), a frequent and debilitating condition. This
review was originally published in 2012 and updated in 2017. Objectives:
To compare local anaesthetics and regional anaesthesia versus conventional
analgesia for the prevention of PPP beyond three months in adults and
children undergoing elective surgery. Search methods: We searched CENTRAL,
MEDLINE, and Embase to December 2016 without any language restriction. We
used a combination of free text search and controlled vocabulary search.
We limited results to randomized controlled trials (RCTs). We updated this
search in December 2017, but these results have not yet been incorporated
in the review. We conducted a handsearch in reference lists of included
studies, review articles and conference abstracts. We searched the
PROSPERO systematic review registry for related systematic reviews.
Selection criteria: We included RCTs comparing local or regional
anaesthesia versus conventional analgesia with a pain outcome beyond three
months after elective, non-orthopaedic surgery. Data collection and
analysis: At least two review authors independently assessed trial quality
and extracted data and adverse events. We contacted study authors for
additional information. We presented outcomes as pooled odds ratios (OR)
with 95% confidence intervals (95% CI), based on random-effects models
(inverse variance method). We analysed studies separately by surgical
intervention, but pooled outcomes reported at different follow-up
intervals. We compared our results to Bayesian and classical (frequentist)
models. We investigated heterogeneity. We assessed the quality of evidence
with GRADE. Main results: In this updated review, we identified 40 new
RCTs and seven ongoing studies. In total, we included 63 RCTs in the
review, but we were only able to synthesize data on regional anaesthesia
for the prevention of PPP beyond three months after surgery from 41
studies, enrolling a total of 3143 participants in our inclusive analysis.
Evidence synthesis of seven RCTs favoured epidural anaesthesia for
thoracotomy, suggesting the odds of having PPP three to 18 months
following an epidural for thoracotomy were 0.52 compared to not having an
epidural (OR 0.52 (95% CI 0.32 to 0.84, 499 participants, moderate-quality
evidence). Simlarly, evidence synthesis of 18 RCTs favoured regional
anaesthesia for the prevention of persistent pain three to 12 months after
breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297
participants, low-quality evidence). Pooling data at three to 8 months
after surgery from four RCTs favoured regional anaesthesia after caesarean
section with an OR of 0.46, (95% CI 0.28 to 0.78; 551 participants,
moderate-quality evidence). Evidence synthesis of three RCTs investigating
continuous infusion with local anaesthetic for the prevention of PPP three
to 55 months after iliac crest bone graft harvesting (ICBG) was
inconclusive (OR 0.20, 95% CI 0.04 to 1.09; 123 participants, low-quality
evidence). However, evidence synthesis of two RCTs also favoured the
infusion of intravenous local anaesthetics for the prevention of PPP three
to six months after breast cancer surgery with an OR of 0.24 (95% CI 0.08
to 0.69, 97 participants, moderate-quality evidence). We did not
synthesize evidence for the surgical subgroups of limb amputation, hernia
repair, cardiac surgery and laparotomy. We could not pool evidence for
adverse effects because the included studies did not examine them
systematically, and reported them sparsely. Clinical heterogeneity,
attrition and sparse outcome data hampered evidence synthesis. High risk
of bias from missing data and lack of blinding across a number of included
studies reduced our confidence in the findings. Thus results must be
interpreted with caution. Authors' conclusions: We conclude that there is
moderate-quality evidence that regional anaesthesia may reduce the risk of
developing PPP after three to 18 months after thoracotomy and three to 12
months after caesarean section. There is low-quality evidence that
regional anaesthesia may reduce the risk of developing PPP three to 12
months after breast cancer surgery. There is moderate evidence that
intravenous infusion of local anaesthetics may reduce the risk of
developing PPP three to six months after breast cancer surgery. Our
conclusions are considerably weakened by the small size and number of
studies, by performance bias, null bias, attrition and missing data.
Larger, high-quality studies, including children, are needed. We caution
that except for breast surgery, our evidence synthesis is based on only a
few small studies. On a cautionary note, we cannot extend our conclusions
to other surgical interventions or regional anaesthesia techniques, for
example we cannot conclude that paravertebral block reduces the risk of
PPP after thoracotomy. There are seven ongoing studies and 12 studies
awaiting classification that may change the conclusions of the current
review once they are published and incorporated.<br/>Copyright &#xa9; 2018
The Cochrane Collaboration.

<41>
Accession Number
621773546
Author
Wang M.-L.; Wang Y.-P.; Hung M.-H.; Hsu H.-H.; Chen J.-S.; Yang F.-S.;
Cheng Y.-J.
Institution
(Wang, Wang, Hung, Yang, Cheng) Department of Anesthesiology, National
Taiwan University Hospital, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Wang, Hung) Graduate Institute of Clinical Medicine, National Taiwan
University College of Medicine, Taipei, Taiwan (Republic of China)
(Hsu, Chen) Department of Surgery, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
(Chen) Department of Traumatology, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
Title
Is fibre-optic bronchoscopy necessary to confirm the position of
rigid-angled endobronchial blockers before thoracic surgery? A randomized
controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 53 (1) (pp 241-246), 2018.
Date of Publication: January 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To determine the success rate of blind insertion and the
usefulness of fibre-optic bronchoscopy for directing rigid-angled
endobronchial blockers (EBs) to the correct side and achieving
satisfactory surgical fields. METHODS: A randomized trial was designed to
determine the extent to which the Coopdech Endobronchial Blocker Tube
(Daiken Medical Co., Ltd) could successfully be placed through either
auscultation (n = 57) or fibre-optic bronchoscopy (n = 55) in patients
scheduled for thoracic surgery. The placement time was recorded and
quality of the thoracoscopic operation field was determined by the
thoracic surgeon. Anaesthesiologists with varying thoracic experience
levels were enrolled. RESULTS: The success rates of insertion through
auscultation were 100% (32 of 32) for the right side and 88% (22 of 25)
for the left side. Placement through auscultation was faster than that
through bronchoscopy (mean 89.6 vs 141.1 s, P = 0.008) in the right-sided
procedure but non-significant in the left-sided procedure (mean 138.5 vs
130 s, P = 0.795). Surgical grading of the operation field was not
significantly different between both techniques (P = 0.502). Experienced
anaesthesiologists took less time to position EBs (mean 91.0 vs 138.0 s, P
= 0.015). Surgical grading was comparable between specialists and
residents (P = 0.058). CONCLUSIONS: Once an EB was correctly inserted and
confirmed through auscultation, the corresponding surgical satisfaction
was comparable to that through bronchoscopy. In the majority of cases,
bronchoscopy is unnecessary for correct and efficient EB positioning.
However, bronchoscopy is still mandatory in left-sided EB insertion and in
patients with deviated tracheobronchial anatomy.<br/>Copyright &#xa9; The
Author 2017.

<42>
Accession Number
2000542856
Author
Fareed S.; Bassiony A.
Institution
(Fareed, Bassiony) Maadi Armed Forces Hospital, Maadi, Cairo, Egypt
Title
Early outcome of mini aortic valve replacement surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 26 (1) (pp
1-7), 2018. Date of Publication: March 2018.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Minimally invasive aortic valve surgery (MIAVS) has evolved
into a well-tolerated, efficient surgical treatment option in experienced
centers, providing greater patient satisfaction and lower complication
rates. Potential advantages of MIAVR arise from the concept that patient
morbidity and potential mortality could be reduced without compromising
the excellent results of the conventional procedure which include improved
cosmetic results, safer access in the case of reoperation, less
postoperative bleeding, lower intensive care unit (ICU) and in-hospital
stays, as well as the absence of sternal wound infection. These results
were achievable also in high-risk patients. Reduced pain and hospital
length of stay, decreased time until return to full activity and decreased
blood product use have also been demonstrated. Methods: Sixty patients
with aortic valve disease randomized into two equal groups; group "A"
underwent aortic valve surgery through a minimally invasive limited upper
sternotomy. Group "B" underwent aortic valve surgery through a full median
sternotomy. The Pain was evaluated on 2nd, 3rd day post-operatively and at
the 3rd, 6th month after discharge. Echocardiographic data were performed
preoperatively and at the 3rd, 6th month after discharge in all patients.
Standard aortic and bicaval cannulation with cold antegrade crystalloid
cardioplegia was adopted in group"B" while in group "A" femoral vein with
ascending aortic cannulation was adopted with antegrade blood
cardioplegia. Results: There was no statistical difference between the two
groups preoperatively regarding their age, sex, NYHA class, EF%, LA
dimension, spirometric study. There was no operative mortality in both
groups but few postoperative complications occurred in both groups. Total
hospital stay, ICU stay, postoperative bleeding, inotropic requirement,
ventilatory support, blood transfusion was less in group "A" with better
cosmetic appearance, and more cost effective. Conclusions: Limited upper
sternotomy minimally invasive technique for aortic valve replacement
provides excellent exposure of the aortic valve and offers a better
cosmetic scar. In addition, minimally invasive limited upper sternotomy is
as safe as full median sternotomy for aortic valve surgery, with fewer
complications and postoperative pain, less ICU and hospital stay, fast
recovery to work with limited movement restriction after surgery. It is
better to use the limited upper sternotomy incision as an initial approach
for aortic valve surgery.<br/>Copyright &#xa9; 2017 The Egyptian Society
of Cardio-thoracic Surgery

<43>
Accession Number
2000537654
Author
Lee C.; Lee C.H.; Lee G.; Lee M.; Hwang J.
Institution
(Lee, Lee, Lee) Department of Anesthesiology and Pain Medicine, Wonkwang
University School of Medicine, Iksang, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Konkuk University
School of Medicine, South Korea
(Hwang) Department of Orthopaedic Surgery, Hallym University Kangnam
Sacred Heart Hospital, Seoul, South Korea
Title
The effect of the timing and dose of dexmedetomidine on postoperative
delirium in elderly patients after laparoscopic major non-cardiac surgery:
A double blind randomized controlled study.
Source
Journal of Clinical Anesthesia. 47 (pp 27-32), 2018. Date of Publication:
June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: There were few clinical data dosing and timing regimen
for preventing postoperative delirium. The present study aimed to
investigate the effect of the timing and dose of dexmedetomidine on
postoperative delirium in elderly patients after laparoscopic major
non-cardiac surgery. Patients and interventions: A total of 354 patients
>65 years of age undergoing laparoscopic major non-cardiac surgery under
general anesthesia received a dexmedetomidine 1 mug/kg bolus followed by
0.2-0.7 mug/kg/h infusion from induction of anesthesia to the end of
surgery [group D1]); a dexmedetomidine (1 mug/kg bolus [group D2]); or
saline (group S) 15 min before the end of surgery. Measurements: The
incidence and duration of delirium for 5 days after surgery and the
cytokine (tumor necrosis factor-alpha TNFalpha interleukin [IL]-1 beta
IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1 h and 24
h after surgery. Main results: Group D1 reduced incidence and duration of
delirium and group D2 decreased its duration in patients with delirium
compared to group S. IL-6 levels were significantly lower at 1 h and 24 h
after surgery in group D1 than in group S, and lower at 24 h after surgery
than in group D2. IL-6 levels in group D2 were significantly lower only at
1 h after surgery than in group S. However, IL-6 levels in delirious
patients in group D2 were significantly lower at 1 h and 24 h after
surgery than those in group S. Cortisol levels 1 h after surgery were
significantly lower in groups D1 and D2 than in group S. Conclusions: The
dose and timing of dexmedetomidine appeared to be important in preventing
delirium. The reduced incidence and duration of delirium by
dexmedetomidine was associated with reduced levels of IL-6 24 h after
surgery.<br/>Copyright &#xa9; 2018

<44>
Accession Number
621868232
Author
Ker W.S.; Nunes T.H.P.; Nacif M.S.; Mesquita C.T.
Institution
(Ker, Nunes, Mesquita) Setor de Medicina Nuclear, Hospital Universitario
Antonio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niteroi, RJ,
Brazil
(Nacif) Servico de Radiologia, Hospital Universitario Antonio Pedro
(HUAP), Universidade Federal Fluminense (UFF), Niteroi, RJ, Brazil
Title
Practical implications of myocardial viability studies.
Source
Arquivos Brasileiros de Cardiologia. 110 (3) (pp 278-288), 2018. Date of
Publication: March 2018.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Many non-invasive methods, such as imaging tests, have been developed
aiming to add a contribution to existing studies in estimating patients'
prognosis after myocardial injury. This prognosis is proportional to
myocardial viability, which is evaluated in coronary artery disease and
left ventricular dysfunction patients only. While myocardial viability
represents the likelihood of a dysfunctional muscle (resulting from
decreased oxygen supply for coronary artery obstruction), hibernation
represents post-interventional functional recovery itself. This article
proposes a review of pathophysiological basis of viability, diagnostic
methods, prognosis and future perspectives of myocardial viability. An
electronic bibliographic search for articles was performed in PubMed,
Lilacs, Cochrane and Scielo databases, according to pre-established
criteria. The studies showed the ability of many imaging techniques in
detecting viable tissues in dysfunctional areas of left ventricle
resulting from coronary artery injuries. These techniques can identify
patients who may benefit from myocardial revascularization and indicate
the most appropriate treatment.<br/>Copyright &#xa9; 2018, Arquivos
Brasileiros de Cardiologia. All rights reserved.

<45>
Accession Number
621766577
Author
Scarfe A.J.; Schuhmann-Hingel S.; Duncan J.K.; Ma N.; Atukorale Y.N.;
Cameron A.L.
Institution
(Scarfe, Duncan, Ma, Atukorale, Cameron) Australian Safety and Efficacy
Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal
Australasian College of Surgeons, Adelaide, SA, Australia
(Schuhmann-Hingel) KAGes - Styrian Hospitals Holding, Graz, Australia
Title
Continuous paravertebral block for post-cardiothoracic surgery analgesia:
A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1010-1018), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A continuous paravertebral block is used when pain relief is required
beyond the duration of a single-injection paravertebral block. Surgical
procedures requiring an incision into the pleural cavity are some of the
most painful procedures postoperatively and, if not managed appropriately,
can lead to chronic pain. The current gold standard for
post-cardiothoracic surgery pain management is epidural analgesia, which
has contraindications, a failure rate of up to 12% and risk of
complications such as epidural abscess and spinal haematoma. This
systematic review and meta-analysis aimed to investigate the use of a
continuous paravertebral block for post-cardiothoracic surgery analgesia.
Randomized controlled trials evaluating the continuous paravertebral block
against epidural analgesia, wound infiltration, placebo or standard care
(intravenous opioids) for post-cardiothoracic surgery analgesia were
considered for inclusion in the systematic review. PubMed, EMBASE, The
Cochrane Library and the University of York Centre for Reviews and
Dissemination databases were searched from inception to 15 September 2014.
Risk of bias and generalizability were assessed using a modified Downs and
Black checklist. A meta-analysis was conducted on suitable studies
comparing the continuous paravertebral nerve block with epidural
anaesthesia, with fixed-effects models being used to pool the effects.
Twenty-three randomized controlled trials with 1120 participants were
included. The continuous paravertebral block was associated with a
significant improvement in incidence of nausea and vomiting (odds ratio =
0.29, 95% confidence interval = [0.16, 0.56]), hypotension (odds ratio =
0.16, 95% confidence interval = [0.06, 0.41]) and urinary retention (odds
ratio = 0.22, 95% confidence interval = [0.09, 0.52]) compared with the
epidural block. No statistically significant difference in pain relief was
reported. The continuous paravertebral block has equivalent analgesic
effects to epidural analgesia, wound infiltration and standard care, but
is associated with a lower incidence of nausea and vomiting, hypotension
and urinary retention than epidural analgesia.<br/>Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<46>
Accession Number
621856106
Author
Uno T.; Wada K.; Matsuda S.; Terada Y.; Oita A.; Kawase A.; Takada M.
Institution
(Uno, Wada, Matsuda, Terada, Oita) Department of Pharmacy, National
Cerebral and Cardiovascular Center, Suita, Japan
(Uno, Takada) Division of Clinical Drug Informatics, Faculty of Pharmacy,
Kindai University, Higashi-osaka, Japan
(Kawase) Department of Pharmacy, Faculty of Pharmacy, Kindai University,
Higashi-osaka, Japan
(Uno, Wada, Takada) Division of Cardiovascular Drugs, Therapy, Kindai
University Graduate School of Pharmacy, Higashi-osaka, Japan
Title
Impact of the CYP3A5*1 Allele on the Pharmacokinetics of Tacrolimus in
Japanese Heart Transplant Patients.
Source
European Journal of Drug Metabolism and Pharmacokinetics. (pp 1-9), 2018.
Date of Publication: 24 Apr 2018.
Publisher
Springer-Verlag France (22, Rue de Palestro, Paris 75002, France)
Abstract
Background and Objective: Tacrolimus, a major immunosuppressant used after
transplantation, is associated with large interindividual variation
involving genetic polymorphisms in metabolic processes. A common variant
of the cytochrome P450 (CYP) 3A5 gene, CYP3A5*3, affects blood
concentrations of tacrolimus. However, tacrolimus pharmacokinetics at the
early stage of transplantation have not been adequately studied in heart
transplantation. We retrospectively examined the impact of the CYP3A5
genotype on tacrolimus pharmacokinetics at the early stage of heart
transplantation. Methods: The tacrolimus pharmacokinetic profile was
obtained from 65 patients during the first 5 weeks after heart
transplantation. Differences in the patients' characteristics and
tacrolimus pharmacokinetic parameters between the CYP3A5 expresser (*1/*1
or *1/*3 genotypes) and non-expresser (*3/*3 genotype) groups were
assessed by the Chi-square test, Student's t test, or Mann-Whitney U test.
Results: The CYP3A5 *1/*1, *1/*3, and *3/*3 genotypes were detected in 5,
22, and 38 patients, respectively. All patients started clotrimazole
therapy approximately 1 week after starting tacrolimus. Apparent clearance
and dose/weight to reach the target trough concentration (C<inf>0</inf>)
were significantly higher in the expresser group than in the non-expresser
group (0.32 vs. 0.19 L/h/kg, p = 0.0003; 0.052 vs. 0.034 mg/kg/day, p =
0.0002); there were no significant differences in the area under the
concentration-time curve from 0 to 12 h (AUC<inf>0-12</inf>) and
concentrations at any sampling time point between the two groups.
Conclusion: Similar concentration-time curves for tacrolimus were obtained
in the expresser and non-expresser groups by dose adjustment based on
therapeutic drug monitoring. These results demonstrate the importance of
the CYP3A5 genotype in tacrolimus dose optimization based on therapeutic
drug monitoring after heart transplantation.<br/>Copyright &#xa9; 2018
Springer International Publishing AG, part of Springer Nature

<47>
Accession Number
621769611
Author
Guerra F.; Scappini L.; Maolo A.; Campo G.; Pavasini R.; Shkoza M.;
Capucci A.
Institution
(Guerra, Scappini, Maolo, Shkoza, Capucci) Cardiology and Arrhythmology
Clinic, Marche Polytechnic University, University Hospital 'Ospedali
Riuniti', Italy
(Campo, Pavasini) Cardiology Department, Universita degli Studi di
Ferrara, Ospedale Sant'Anna, Italy
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc risk factors as predictors of stroke
after acute coronary syndrome: A systematic review and meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7 (3) (pp 264-274),
2018. Date of Publication: 01 Apr 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Stroke is a rare but serious complication of acute coronary
syndrome. At present, no specific score exists to identify patients at
higher risk. The aim of the present study is to test whether each clinical
variable included in the CHA<inf>2</inf>DS<inf>2</inf>-VASc score retains
its predictive value in patients with recent acute coronary syndrome,
irrespective of atrial fibrillation. Methods: The meta-analysis was
conducted according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines. All clinical trials and
observational studies presenting data on the association between
stroke/transient ischemic attack incidence and at least one
CHA<inf>2</inf>DS<inf>2</inf>-VASc item in patients with a recent acute
coronary syndrome were considered in the analysis. Atrial fibrillation
diagnosis was also considered. Results: The whole cohort included 558,193
patients of which 7108 (1.3%) had an acute stroke and/or transient
ischemic attack during follow-up (median nine months;
1^st-3^rd quartile 1-12 months). Age and previous
stroke had the highest odds ratios (odds ratio 2.60; 95% confidence
interval 2.21-3.06 and odds ratio 2.74; 95% confidence interval 2.19-3.42
respectively), in accordance with the two-point value given in the
CHA<inf>2</inf>DS<inf>2</inf>-VASc score. All other factors were
positively associated with stroke, although with lower odds ratios. Atrial
fibrillation, while present in only 11.2% of the population, confirmed its
association with an increased risk of stroke and/or transient ischemic
attack (odds ratio 2.04; 95% confidence interval 1.71-2.44). Conclusions:
All risk factors included in the CHA<inf>2</inf>DS<inf>2</inf>-VASc score
are associated with stroke/ transient ischemic attack in patients with
recent acute coronary syndrome, and retain similar odds ratios to what
already seen in atrial fibrillation. The utility of
CHA<inf>2</inf>DS<inf>2</inf>-VASc score for risk stratification of stroke
in patients with acute coronary syndrome remains to be
determined.<br/>Copyright &#xa9; 2016, &#xa9; The European Society of
Cardiology 2016.

<48>
Accession Number
621598231
Author
Hwang J.; Shin J.S.; Son J.H.; Min T.J.
Institution
(Hwang, Shin) Department of Thoracic and Cardiovascular Surgery, Korea
University Ansan Hospital, Korea University College of Medicine, Ansan,
South Korea
(Son) Korea University Post-Graduate School of Medicine, Seoul, South
Korea
(Min) Department of Anesthesiology and Pain Medicine, Korea University
Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
Title
Non-intubated thoracoscopic bullectomy under sedation is safe and
comfortable in the perioperative period.
Source
Journal of Thoracic Disease. 10 (3) (pp 1703-1710), 2018. Date of
Publication: 01 Mar 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Non-intubated thoracoscopic surgery can be performed under
sedation using adjuvant regional anesthesia, however, the benefits of
non-intubated thoracoscopic surgery under sedation have not yet been
completely verified. In this study, we compare the perioperative safety
and pain complaints of sedation without intubation in thoracoscopic
bullectomy with that of conventional general anesthesia with double-lumen
intubation and mechanical ventilation. Methods: Forty-one patients with
primary spontaneous pneumothorax who were scheduled for thoracoscopic
bullectomy were enrolled in this study. Twenty-one patients were under
sedation anesthesia (SA group) and 20 patients were under general
anesthesia (GA group). In SA group, sedation was done with dexmedetomidine
(a loading dose of 1 mug/kg for 10 min and then maintained in dosages of
0.3-1 mug/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in
GA group, induction with propofol and rocuronium, intubation with double
lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was
done. In both groups, thoracoscopic bullectomy was performed in the same
manner and all operations were conducted by single surgeon. Time for
anesthesia [including emergence time and post-anesthesia care unit (PACU)
recovery time] and operation, postoperative pain, sore throat, hoarseness,
adverse events (nausea, vomiting, hypotension and bradycardia), dose of
rescue analgesic drug used for 24 hours post-operatively and perioperative
arterial blood gas analysis were recorded. Results: The times for
anesthesia, operation and emergence were significantly shorter in SA than
GA. Incidence of sore throat were significantly lower in SA. The
difference of other adverse events in the two groups was not significant.
Conclusions: Our study demonstrated that compared to double-lumen
intubation with general anesthesia, non-intubation with sedation for
bullectomy for primary spontaneous pneumothorax was safe and efficient to
reduce perioperative time.<br/>Copyright &#xa9; Journal of Thoracic
Disease.

<49>
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

<50>
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

<51>
Accession Number
613143233
Author
Ladia V.; Panchal H.B.; ONeil 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
(ONeil) 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

<52>
Accession Number
621797108
Author
Naidu N.; Somashekhar S.P.
Institution
(Naidu, Somashekhar) Manipal Comprehensive Cancer Centre-Manipal Hospital,
Surgical Oncology, Bangalore, India
Title
Prospective study on total robotic three stage esophagectomy for
esophageal cancer - A single institute Indian experience.
Source
European Journal of Cancer. Conference: European Cancer Congress, ECCO
2017. Netherlands. 72 (Supplement 1) (pp S82-S83), 2017. Date of
Publication: February 2017.
Publisher
Elsevier Ltd
Abstract
Background: Newer advances in the surgical treatment arena of Esophageal
cancer is throwing great prospects of adding up to human life with lesser
sufferings, Robotic surgery being one of them. Hence, a study to evaluate
the safety and technical feasibility of robotic assisted three stage
esophagectomy along with its short term oncological outcome was done as
follows. Material and Methods: A prospective, non-randomised study
involving sixty-two consecutive histologically proven surgically
resectable (T1-3, N0-1, M0) carcinoma esophagus patients at Manipal
Institute, Bangalore from July 2011 to June 2016 was conducted. All
underwent total robotic assisted transthoracic and trans-peritoneal three
stage esophagectomy with subsequent follow-up for 24 months. Results: The
mean age of the study group was 60 years with average hospital stay of 9
days. Histologically, 69.35% (n = 43) were diagnosed as squamous cell
carcinoma and remaining adenocarcinoma 30.65% (n = 19), with lower one
third of esophagus as the most common site, 61.29% (n = 38). For initial
10 cases, total docking time, thoracic docking time, total operative time,
thoracic phase operative time were slightly higher followed by lesser
values for subsequent cases with a mean of 33.20+/-4.16 min, 13.76+/-3.43
min, 321.13+/-13.75 min and 57.04+/-9.15 min respectively. The mean blood
loss was around 256.32+/-17.52 ml. The mean lymph node yield was 32 and
one case required conversion to open method. Major Post-op complications
were encountered in 7 cases. Two cases required ventilator support for one
day, 15 cases had an ICU stay of 1 day, 5 cases for 2 days and in one case
with MI for 15 days. There was no in-hospital or 30 day mortality. All had
microscopic negative resection margins. However, one patient recurred with
positive cervical and mediastinal lymph nodes in the follow up period.
Median follow up was 24 months (2-48). Conclusion: Robotic assisted three
stage esophagectomy has the benefits of minimally invasive surgery and
immediate oncological outcomes are comparable to conventional open
surgery. It gives 3-dimensional, magnified view and endowrist gives better
dexterity with intuitive movements. These technical advantages make
oncologically sound surgery. Therefore total robotic three stage
esophagectomy is a safe and feasible technique for the treatment of
esophageal cancer.

<53>
Accession Number
621803933
Author
Cortes-Puch I.; Wiley B.M.; Sun J.; Klein H.G.; Welsh J.; Danner R.L.;
Eichacker P.Q.; Natanson C.
Institution
(Cortes-Puch, Wiley, Sun, Danner, Eichacker, Natanson) Critical Care
Medicine Department, Clinical Center National Institutes of Health
Bethesda, Maryland USA
(Wiley) Department of Cardiovascular Diseases Mayo Clinic Rochester,
Minnesota USA
(Klein) Department of Transfusion Medicine, Clinical Center National
Institutes of Health Bethesda, Maryland USA
(Welsh) National Institutes of Health Library National Institutes of
Health Bethesda, Maryland USA
Title
Risks of restrictive red blood cell transfusion strategies in patients
with cardiovascular disease (CVD): A meta-analysis.
Source
Transfusion Medicine. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To evaluate the risks of restrictive red blood cell transfusion
strategies (haemoglobin 7-8 gdL^-1) in patients with and without
known cardiovascular disease (CVD). Background: Recent guidelines
recommend restrictive strategies for CVD patients hospitalised for non-CVD
indications, patients without known CVD and patients hospitalised for CVD
corrective procedures. Methods/Materials: Database searches were conducted
through December 2017 for randomised clinical trials that enrolled
patients with and without known CVD, hospitalised either for
CVD-corrective procedures or non-cardiac indications, comparing effects of
liberal with restrictive strategies on major adverse coronary events
(MACE) and death. Results: In CVD patients not undergoing cardiac
interventions, a liberal strategy decreased (P=0.01) the relative risk
(95% CI) (RR) of MACE [0.50 (0.29-0.86)] (I² =0%). Among
patients without known CVD, the incidence of MACE was lower (1.7 vs 3.9%),
and the effect of a liberal strategy on MACE [0.79, (0.39-1.58)] was
smaller and non-significant but not different from CVD patients (P=0.30).
Combining all CVD and non-CVD patients, a liberal strategy decreased MACE
[0.59, (0.39-0.91); P=0.02]. Conversely, among studies reporting
mortality, a liberal strategy decreased mortality in CVD patients (11.7%
vs.13.3%) but increased mortality (19.2% vs 18.0%) in patients without
known CVD [interaction P=0.05; ratio of RR 0.73, (0.53-1.00)]. A liberal
strategy also did not benefit patients undergoing cardiac surgery; data
were insufficient for percutaneous cardiac procedures. Conclusions: In
patients hospitalised for non-cardiac indications, liberal transfusion
strategies are associated with a decreased risk of MACE in both those with
and without known CVD. However, this only provides a survival benefit to
CVD patients not admitted for CVD-corrective procedures.<br/>Copyright
&#xa9; 2018 British Blood Transfusion Society.

<54>
Accession Number
621796319
Author
Panigrahi D.; Roychowdhury S.; Guhabiswas R.; Rupert E.; Das M.; Narayan
P.
Institution
(Panigrahi, Roychowdhury, Guhabiswas, Rupert) Department of Cardiac
Anesthesia, NH Rabindranath Tagore International Institute of Cardiac
Sciences, Kolkata, India
(Das, Narayan) Department of Cardiac Surgery, NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Title
Myocardial protection following del Nido cardioplegia in pediatric cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2018. Date of
Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: This study was designed to compare myocardial protection with
del Nido cardioplegia and conventional blood cardioplegia in children
undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery
categories 1 and 2. Methods: Sixty patients were randomized into 2 groups
receiving del Nido cardioplegia solution or conventional blood
cardioplegia. Myocardial injury was assessed using biochemical markers
(troponin I and creatine kinase-MB). Vasoactive-inotropic scores were
calculated to compare inotropic requirements. Results: Demographic
characteristics, cardiopulmonary bypass time, and aortic crossclamp time
were comparable in the 2 groups. Time-related changes in troponin I and
creatine kinase-MB were similar in both groups. Statistically significant
differences were seen in total cardioplegia volume requirement (p <
0.0001), number of cardioplegia doses given (p < 0.0001), packed red cell
volume usage during cardiopulmonary bypass (p < 0.02), and time taken to
restore spontaneous regular rhythm (p < 0.0001). Vasoactive-inotropic
scores on transfer to the intensive care unit (p < 0.040) and at 24 h (p <
0.030) were significantly lower in the del Nido group. Duration of
mechanical ventilation, intensive care unit stay, and hospital stay were
comparable in the 2 groups. Conclusions: Our results show that del Nido
cardioplegia solution is as safe as conventional blood cardioplegia.
Moreover, it provides the benefits of reduced dose requirement, lower
consumption of allogenic blood on cardiopulmonary bypass, quicker
resumption of spontaneous regular cardiac rhythm, and less inotropic
support requirement on transfer to the intensive care unit and at 24 h,
compared to conventional blood cardioplegia.<br/>Copyright &#xa9; 2018,
The Author(s) 2018.

<55>
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.

<56>
Accession Number
621703780
Author
Koskinas K.C.; Siontis G.C.M.; Piccolo R.; Mavridis D.; Raber L.; Mach F.;
Windecker S.
Institution
(Koskinas, Siontis, Piccolo, Raber, Windecker) Department of Cardiology,
University Hospital Bern, Bern 3010, Switzerland
(Mavridis) Department of Primary Education, University of Ioannina,
Ioannina, Greece
(Mavridis) Centre de Recherche Epidemiologie et Statistique Sorbonne Paris
Cite (CRESS-UMR1153), Inserm/Universite Paris Descartes, Paris, France
(Mach) Department of Cardiology, Geneva University Hospital, Geneva 1205,
Switzerland
Title
Effect of statins and non-statin LDL-lowering medications on
cardiovascular outcomes in secondary prevention: A meta-analysis of
randomized trials.
Source
European Heart Journal. 39 (14) (pp 1172-1180), 2018. Date of Publication:
07 Apr 2018.
Publisher
Oxford University Press
Abstract
Aims: Current evidence on dyslipidaemia management has expanded to novel
treatments and very low achieved levels of low-density lipoprotein
cholesterol (LDL-C). We sought to compare the clinical impact of
more-intensive vs. less-intensive LDL-C lowering by means of statins and
currently recommended non-statin medications in secondary prevention.
Methods and results: We searched Medline, EMBASE, and Cochrane databases
for randomized controlled trials of statins, ezetimibe, proprotein
convertase subtilisin-kexin type 9 (PCSK9) inhibitors, or bile acid
sequestrants with >500 patients followed for >=1 year. We employed
random-effects models using risk ratios (RRs) with 95% confidence
intervals (CIs) to compare outcomes. We included 19 trials (15 of statins,
3 of PCSK9 inhibitors, and 1 of ezetimibe) with 152 507 patients randomly
assigned to more-intensive (n = 76 678) or less-intensive treatment (n =
75 829). Moreintensive treatment was associated with 19% relative risk
reduction for the primary outcome, major vascular events (MVEs; RR 0.81,
95% CI 0.77-0.86). Risk reduction was greater across higher baseline
levels and greater achieved reductions of LDL-C. The clinical benefit was
significant across varying types of more-intensive treatment and was
consistent for statins (RR 0.81, 95% CI 0.76-0.86) and non-statin agents
(PCSK9 inhibitors and ezetimibe; RR 0.85, 95% CI 0.77-0.94) as active
(more-intensive) intervention (P-interaction = 0.38). Each 1.0 mmol/L
reduction in LDLC was associated with 19% relative decrease in MVE. Death,
cardiovascular death, myocardial infarction, stroke, and coronary
revascularization also favoured more-intensive treatment. Conclusion:
Reduction of MVE is proportional to the magnitude of LDL-C lowering across
a broad spectrum of on-treatment levels in secondary prevention. Statin
intensification and add-on treatment with PCSK9 inhibitors or ezetimibe
are associated with significant reduction of cardiovascular morbidity in
this very high-risk population.<br/>Copyright &#xa9; The Author 2017.

<57>
Accession Number
621614120
Author
Friedman D.F.; Goel R.; Heddle N.M.; Hopkins C.K.; Karp J.K.; Pagano M.B.;
Perumbeti A.; Ramsey G.; Roback J.D.; Schwartz J.; Shaz B.H.; Spinella
P.C.; Cohn C.S.; Cushing M.M.; Kelley J.; Klapper E.
Institution
(Cushing, Goel, Cushing) Department of Pathology, Weill Cornell Medicine,
New York, NY, United States
(Kelley, Kelley) Department of Laboratory Medicine, The University of
Texas MD Anderson Cancer Center, Houston, TX, United States
(Klapper, Klapper) Department of Pathology and Laboratory Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Friedman) Blood Bank and Transfusion Medicine Department, Children's
Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA,
United States
(Heddle) McMaster Center for Transfusion Research, McMaster University,
Hamilton, ON, Canada
(Hopkins) Blood Systems Inc., Scottsdale, AZ, United States
(Karp) Department of Pathology, Anatomy, and Cell Biology, Thomas
Jefferson University Hospitals, Philadelphia, PA, United States
(Pagano) Transfusion Medicine Division, Department of Laboratory Medicine,
University of Washington, Seattle, WA, United States
(Perumbeti) Department of Pathology and Laboratory Medicine, Children's
Hospital Los Angeles, Los Angeles, CA, United States
(Ramsey) Department of Pathology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Roback) Department of Pathology and Laboratory Medicine, Emory University
School of Medicine, Atlanta, GA, United States
(Schwartz) Department of Pathology and Cell Biology, Columbia University
Medical Center and the New York-Presbyterian Hospital, United States
(Shaz) New York Blood Center, New York, NY, United States
(Spinella) Department of Pediatrics, Division of Pediatric Critical Care,
Washington University School of Medicine, St Louis, MO, United States
(Cohn, Cohn) Department of Laboratory Medicine and Pathology, University
of Minnesota, Minneapolis, MN, United States
Title
Critical developments of 2017: a review of the literature from selected
topics in transfusion. A committee report from the AABB Clinical
Transfusion Medicine Committee.
Source
Transfusion. 58 (4) (pp 1065-1075), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: The AABB compiles an annual synopsis of the published
literature covering important developments in the field of Transfusion
Medicine. For the first time, an abridged version of this work is being
made available in TRANSFUSION, with the full-length report available as an
Appendix S1 (available as supporting information in the online version of
this paper). STUDY DESIGN AND METHODS: Papers published in 2016 and early
2017 are included, as well as earlier papers cited for background.
Although this synopsis is comprehensive, it is not exhaustive, and some
papers may have been excluded or missed. RESULTS: The following topics are
covered: duration of red blood cell storage and clinical outcomes, blood
donor characteristics and patient outcomes, reversal of bleeding in
hemophilia and for patients on direct oral anticoagulants, transfusion
approach to hemorrhagic shock, pathogen inactivation, pediatric
transfusion medicine, therapeutic apheresis, and extracorporeal support.
CONCLUSION: This synopsis may be a useful educational tool.<br/>Copyright
&#xa9; 2018 AABB

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

<59>
Accession Number
621164192
Author
Doering B.K.; Glombiewski J.A.; Rief W.
Institution
(Doering) Catholic University Eichstatt-Ingolstadt, Eichstatt, Germany
(Glombiewski) University of Koblenz-Landau, Landau, Germany
(Rief) Philipps-University Marburg, Marburg, Germany
Title
Expectation-Focused Psychotherapy to Improve Clinical Outcomes.
Source
International Review of Neurobiology. 138 (pp 257-270), 2018. Date of
Publication: 2018.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Placebo research has shown that patients' expectations are among the
strongest predictors of treatment outcome regarding various medical
conditions. Therefore, interventions focusing on the change of such
expectations might be most effective. This could be of relevance not only
for outcome expectations but also for disease-specific, problem-specific,
and treatment-specific expectations. A theoretical model is introduced to
illustrate the conditions for expectation change and persistence.
Strategies for patients regarding how to devalue learning effects in
expectation violation situations are exemplified, and ways to optimize
expectation-violating effects are highlighted. Data from a large
randomized controlled trial serve as a practical example and demonstrate
the effect of a presurgery optimization of expectations in patients
scheduled for heart surgery (coronary artery bypass grafting). Disability
scores that were obtained 6 months postsurgery confirmed that patients who
participated in preoperative psychological interventions, which aimed at
optimizing expectations, demonstrate the best outcome after heart surgery.
Practical aspects of the intervention are presented, and suggestions on
implementing these procedures to optimize outcome in medical interventions
are discussed. Psychotherapy is conceptualized as an intervention that
should target expectation violation of disorder- and treatment-specific
expectations.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<60>
Accession Number
621784022
Author
Murphy C.V.; Coffey R.; Calvitti K.; Abdel-Rasoul M.; Bailey J.K.; Chlan
L.; Jones L.M.
Institution
(Murphy, Coffey, Calvitti, Abdel-Rasoul, Bailey, Chlan, Jones) Ohio State
University Medical Center, Columbus, OH, United States
Title
Safety, feasibility and acceptability of patient-controlled anxiolysis
with dexmedetomidine for burn care dressing changes.
Source
Journal of Burn Care and Research. Conference: 50th Annual Meeting of the
American Burn Association, ABA 2018. United States. 39 (Supplement 1) (pp
S98), 2018. Date of Publication: April 2018.
Publisher
Oxford University Press
Abstract
Introduction: Anxiety in anticipation of procedural pain can lower the
nociceptive threshold, sensitize the wound, and potentiate the perception
of pain. Few studies have evaluated interventions directed at reducing
procedural anxiety in burn patients. This pilot study aimed to evaluate
patient controlled anxiolysis using dexmedetomidine (PCA-DEX) in patients
undergoing burn dressing changes. Methods: This was a prospective,
open-label pilot study to determine the safety, feasibility, and
acceptability of PCADEX. Adult patients admitted for thermal injury within
48 hours of injury with an expected length of stay of at least 3 days were
eligible. Patients with active alcohol withdrawal, hemodynamic
instability, acute hepatitis or liver failure, acute stroke, seizures,
acute myocardial infarction, severe cognitive or communications
difficulties, inability to use PCA pump, or if pregnant or incarcerated
were excluded. PCA-DEX included a loading dose, continuous infusion, and
patientadministered boluses for up to 5 days. Vital signs were monitored
prior to and every 10 minute throughout PCA-DEX. Procedural pain and
anxiety were evaluated before and after each dressing change using the
visual analog scale. Nursing and patient satisfaction were evaluated after
each dressing change. Summary statistics are reported as mean + standard
deviation or median [inter-quartile range] and categorical variables are
reported as frequencies (%) where relevant. Results: Twenty patients were
included; 11 (55%) males and 9 (45%) females with a mean age of 45.1 +
16.9 years and median TBSA of 7 [IQR 4-9.5]%. Substance abuse history
included 6 (30%) patients with drug abuse, 7 (35%) with tobacco use, and 1
(5%) with alcohol abuse. One (5%) patient had a history of anxiety. Median
pre-procedure heart rate (HR) and systolic blood pressure (SBP) on day 1
were 82 [75-97] bpm and 147 [128-170] mmHg. Overall PCADEX was tolerated
well with a median post-procedure HR of 72 [66-82] bpm and SBP 115
[99-141] mmHg. One patient was withdrawn due to severe bradycardia (heart
rate <45 bpm); 4 patients experienced mild hypotension (blood pressure
85-89/45-49 mmHg). Median pain pre-procedure (49.5 [30.5-80]) decreased to
44 [13-67]) post-procedure, while median anxiety also decreased (from 34.5
[13-70] to 15.5 [5-43]). The majority of both nurses and patients were
either satisfied or highly satisfied with PCA-DEX overall (78.1% for
nursing, 86.5% for patients). Conclusions: PCA-DEX is a safe and feasible
method of anxiolysis during burn dressing changes with high acceptability
rates. Applicability of Research to Practice: PCA-DEX is a novel method to
provide patient driven anxiolysis during dressing changes. A randomized,
controlled trial is warranted to confirm the efficacy of PCA-DEX.

<61>
Accession Number
621787181
Author
Kiaii B.; Reardon M.; Popma J.; Serruys P.; Mieghem N.V.
Institution
(Kiaii, Reardon, Popma, Serruys, Mieghem) London Cardiac Institute,
London, Canada
Title
Clinical impact of atrial fibrillation following surgical or transcatheter
aortic valve replacement in patients at intermediate surgical risk:
Results from the surtavi trial.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Studies randomizing transcatheter aortic valve replacement
(TAVR) to surgical aortic valve replacement (SAVR) have demonstrated that
new-onset atrial fibrillation (NOAF) is a more common procedural
complication following SAVR than TAVR. Little is known about whether the
prognosis of either atrial fibrillation at baseline or NOAF depends on
treatment modality. Methods: The Surgical Replacement and Transcatheter
Aortic Valve Implantation (SURTAVI) trial randomized 1,746 patients with
severe, symptomatic aortic stenosis deemed intermediate risk for surgical
mortality 1:1 to TAVR using a self-expanding device or SAVR. Of them,
1,660 patients underwent an attempted TAVR or surgical procedure. Patients
were analyzed according to history of atrial fibrillation (N=243 TAVR,
N=211 SAVR), NOAF (N=93 TAVR, N=286 SAVR), or normal sinus rhythm before
and after treatment (N=528 TAVR, N=299 SAVR). Clinical outcomes to one
year were assessed. Results: New-onset or worsening atrial fibrillation
was more frequent with SAVR at one year (17.8% TAVR vs. 45.8% SAVR;
p<0.001). Patients with NOAF following TAVR or SAVR incurred a higher risk
of 1-year all-cause mortality compared to patients in normal sinus rhythm
(7.5% vs. 5.1% for TAVR, 6.7% vs. 3.1% for SAVR), however the prognostic
impact of NOAF did not depend on treatment (p=0.81). Patients with a
history of atrial fibrillation had incrementally higher mortality
following both TAVR and SAVR, but the highest risk was associated with
SAVR (9.1% for TAVR vs. 11.5% for SAVR). Predictors of NOAF according to
treatment will be presented at the meeting. Conclusion: In SURTAVI, the
development of NOAF was more than twice as likely following SAVR than
TAVR. NOAF increased the risk of 1-year mortality, independent of
treatment modality.

<62>
Accession Number
621787160
Author
Anonymous
Title
67th Annual Scientific Session of the American College of Cardiology and
i2 Summit: Innovation in Intervention, ACC.18.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
The proceedings contain 2597 papers. The topics discussed include:
predictors for neoatherosclerosis in sirolimus-eluting stents over 10
years after implantation; acute myocardial infarction during pregnancy and
the puerperium in the united states; a systematic review and meta-analysis
of dual anti-platelet therapy versus antiplatelet monotherapy after
coronary artery bypass graft surgery; comparing the likelihood ratios of
the duke chest pain score and heart score in predicting inducible ischemia
by nuclear stress test; efficacy and safety of pre-procedural prasugrel in
asians undergoing percutaneous coronary intervention for acute coronary
syndrome: a report from a Japanese multicenter registry; effect of chronic
kidney disease on different intensity statin utilization in patients with
coronary artery disease: a single tertiary center experience; long-term
survival between off versus on pump coronary artery bypass grafting: a
systematic review and meta-analysis of randomized controlled trials; and
levels of non-high-density lipoprotein cholesterol do not negatively
impact the ability of the PCSK9 inhibitor, evolocumab, to promote
regression of coronary atherosclerosis.

<63>
Accession Number
621787021
Author
Robert P.; MacIa J.-C.; Albat B.; Lattuca B.; Labour J.; Akodad M.; Gandet
T.; Schmutz L.; Delseny D.; Maupas E.; Piot C.; Targosz F.; Robert G.;
Cayla G.; Leclercq F.
Institution
(Robert, MacIa, Albat, Lattuca, Labour, Akodad, Gandet, Schmutz, Delseny,
Maupas, Piot, Targosz, Robert, Cayla, Leclercq) University Hospital of
Montpellier, Montpellier, France, University Hospital of Nimes Nimes
France
Title
Prior balloon valvuloplasty versus direct transcatheter aortic valve
implantation (directavi): Preliminary findings on the first 128 randomized
patients.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Balloon predilatation of the aortic valve has been regarded as
an essential step during the transcatheter aortic valve implantation
(TAVI) procedure but recent evidence has suggested that aortic
valvuloplasty may induce complications. The purpose of the DIRECTAVI study
was to evaluate the efficacy and safety of direct implantation of the
Edwards SAPIEN 3 transcatheter heart valve (THV), a balloon-expandable low
profle new-generation THV. Methods: This randomized controlled trial
compares TAVI performed with prior balloon valvuloplasty or direct
implantation of the valve in 240 patients. The trial tests the hypothesis
that the strategy of direct implantation of the SAPIEN THV is non inferior
to current medical practice using predilatation of the valve. The primary
endpoint is procedural success at 72h and secondary endpoints include
complications at 30-day follow-up (VARC-2 criteria). We report preliminary
results from the 128 frst patients. Results: Between May 2016 and July
2017, 128 patients were included in the randomized DIRECTAVI study. The
primary end point was achieved for 63 patients (95.5%) in the direct
implantation group compared with 62 patients in the group with
predilatation (95.5% vs 100 % respectively, p = 0.25). There were no major
vascular complications in the direct implantation group versus 3 in the
group with predilatation (0% vs 4.8% repsectively, p = 0.11). There were
no signifcant difference in major or life threatening bleeding between the
2 groups (0% vs 2%, respectively, p = 0, 23). Length of procedure (47min
[40-60] vs 50min [40-60] respectively, p = 0,57), incidence of post
dilatation (0 vs 0 respectively, p = 1), radiation exposure (3227 cGy.cm2
[2395-4358] vs 3048 cGy.cm2 [1779-4656] respectively, p = 0,67), contrast
volume injection (72 cc [60-96] Vs 75 cc [60-91] respectively, p = 0,89)
and pacemaker implantation (8 vs 9 respectively, p = 0,8) were not
signifcant different. Conclusion: According to these preliminary results
of a randomized study, TAVI without balloon aortic valvuloplasty seems to
provide safety and feasibility comparable to the TAVI with balloon aortic
valvuloplasty with the new generation SAPIEN 3 THV.

<64>
Accession Number
621787005
Author
Shkolnik E.; Burneikaite G.; Celutkiene J.; Scherbak M.; Zuoziene G.;
Petrauskiene B.; Butkuviene I.; Trush E.; Laucevicius A.; Vasyuk Y.
Institution
(Shkolnik, Burneikaite, Celutkiene, Scherbak, Zuoziene, Petrauskiene,
Butkuviene, Trush, Laucevicius, Vasyuk) Yale New Haven Health Bridgeport
Hospital, Bridgeport, CT, USA, Vilnius University Hospital Vilnius
Lithuania
Title
Efficacy of extracorporeal shockwave myocardial revascularization therapy
in patients with stable angina pectoris: Multicentre randomized double
blind placebo controlled study.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: recent studies showed that the application of low intensity
shockwaves may induce angiogenesis and ameliorate myocardial ischemia in
patients with refractory angina. The aim of the study was to investigate
the efficacy of cardiac shock wave therapy (CSWT) in improvement of
exercise tolerance in patients with stable angina. Methods: this study was
a prospective randomized double blind placebo controlled multicentre trial
(1 site in Lithuania and 1 in Russia). The study was registered on
Clinicaltrials.gov (NCT02339454). Inclusion criteria: documented CAD,
exercise angina not controlled by the standard therapy, stable doses of
antianginal medications for at least 4 weeks, documented ST-segment
depression >= 1mm during Treadmill exercise test. CSWT was performed using
a commercially available SW generator system (Medispec, USA). CSWT
consisted of 9 sessions with 3 sessions per week and was performed on 1, 5
and 9 study week. To each treatment zone (1 cm) 100 impulses were applied.
Unlike previous studies CSWT was not limited to ischemic area, but was
applied to all LV segments per protocol. During frst study week CSWT was
delivered to basal segments of left ventricle (2 zones in each wall in
apical 4-, 2-, 3-chamber positions). During ffth week-to middle segments,
during ninth week-to apical segments respectively. Results: a total of 69
patients who met the inclusion criteria were randomized into group A (n
=35) and group B (n=34). The mean age of the patients was 69.2+/-8.1 years
in the group A and 67.7+/-8.4 years in the group B. The other main
clinical characteristics were similar in both groups. CSWT was well
tolerated, but didn't result in signifcant improvement of primary outcome
at 6 months compared to placebo: change in total exercise duration
(53.6+/-106.5 vs 77.4+/-129.8 sec, p=0.482) or secondary outcomes: change
in time to 1 mm ST-depression (109.6+/-160.8 vs 94.2+/-100.3 sec,
p=0.656), number of angina attacks per week, nitroglycerin consumption,
CCS angina class. Conclusion: in this double blind placebo controlled
study CSWT applied to all segments of left ventricle didn't result in
signifcant improvement of clinical or exercise variables in patients with
angina compared to placebo.

<65>
Accession Number
621786787
Author
Dolmatova E.; Moazzami K.; Solanki P.; Maher J.; Klapholz M.; Waller A.
Institution
(Dolmatova, Moazzami, Solanki, Maher, Klapholz, Waller) Rutgers New Jersey
Medical School, Newark, NJ, United States
Title
Percutaneous ventricular assist device versus intra-aortic balloon pump
for hemodynamic support in patients with cardiogenic shock: Insights from
nationwide inpatient sample.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Percutaneous ventricular assist devices (PVAD) and
intra-aortic balloon pump (IABP) provide mechanical support for patients
in cardiogenic shock (CS). However, comparative outcomes of these
therapies in a large real-world study remains unclear. Methods: Data was
obtained from the National Inpatient Sample, years 2010 to 2014. Diagnosis
of CS and procedures performed for hemodynamic support were identifed
through appropriate International Classifcation of Diseases, Ninth
Revision, Clinical Modifcation codes. A 1:1 ratio propensity matching with
the nearest neighbor method without replacement was performed. Matched
pairs were generated after controlling for age, sex, race, co-morbidities
and the presence of percutaneous coronary intervention (PCI) during index
hospitalization. Results: Over the 5-year period, an estimated 502,808
patients were hospitalized with CS in the United States, of which 5,995
and 104,391 patients received a PVAD or IABP, respectively. Among patients
receiving mechanical support, 43% and 39% underwent PCI during index
hospitalization with PVAD and IABP, respectively. After propensity score
matching, 5,932 patients with PVADs were matched in a 1:1 ratio with
patients with IABP. In-hospital mortality was signifcantly higher for
patients receiving PVAD compared to IABP (42.9% vs 25.7%, P<0.001). PVAD
group had higher rate of bleeding (9.4% vs 6.1%, P=0.002), and device
related complications (7.6% vs 4.6%, P=0.01), but lower rate of infections
(0.4% vs 1.2%, P=0.02). Rate of vascular complications was similar between
the two groups (2.2% vs 3%, P=0.19). Results were similar when excluding
patients with PCI or coronary artery bypass grafting. The median length of
stay was longer among patients with PVAD compared to IABP (12 [ICR 5-17]
vs 8 [ICR 3-11] days, P< 0.001) Conclusion: There was higher in-hospital
mortality, bleeding and device related complications in patients receiving
PVAD compared to IABP. However, there has been an increasing trend in use
of PVAD. With higher in-hospital mortality, device related complications
and longer length of stay, randomized trials are needed to really
determine whether use of PVAD leads to improved outcomes.

<66>
Accession Number
621786469
Author
Kahlon T.K.; Daloul Y.; Majeed I.; Othman H.; Kamath R.
Institution
(Kahlon, Daloul, Majeed, Othman, Kamath) St. John Hospital and Medical
Center, Detroit, MI, United States
Title
Obstructive prosthetic valve thrombosis (OPVT) management: Do we know
enough?.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: OPVT is a life threatening complication with incidence of
0.1-3% per patient-year. While surgery remains the gold standard for large
thrombus, thrombolytics may be a potential substitute. We report a case of
successful transesophageal echocardiography (TEE) guided therapy of mitral
OPVT using low dose, slow infusion of thrombolytics. Case: A 61-year-old
female with mechanical mitral valve presented with class IV heart failure.
Physical exam was notable for tachypnea, hypoxia, distended neck veins,
crackles at the lung bases and reduced mechanical valve sound. OPVT was
suspected and patient was started on intravenous heparin. TEE evaluation
revealed severe pulmonary hypertension with mean mitral valve gradient of
26 MMHG, reduced leafet mobility, large thrombus adherent to the valve and
left atrial wall. Decision-making: Due to comorbidities, in consult with
cardiothoracic surgery, patient was administered low dose (25 mg) tPA over
6 hours. Repeat TEE showed favorable response and a second dose of tPA was
given 24 hours later.Serial echocardiographic evaluation and fuoroscopy
revealed signifcant drop in mean gradient (5 MMHG) and pulmonary arterial
pressure, improvement in leafet mobility and near resolution of the
thrombus. No embolic or hemorrhagic complications were seen and she did
well on 3-month follow up. [Image Presented] Conclusion: In the absence of
randomized data, low dose infusion of thrombolytics may be a safe frst
line therapy for OPVT with surgery reserved for failed thrombolysis.

<67>
Accession Number
621786440
Author
Visan A.C.; Thom H.; Dorobantu D.M.; Fudulu D.; Keeney E.; Sharabiani
M.T.A.; Round J.; Stoica S.C.
Institution
(Visan, Thom, Dorobantu, Fudulu, Keeney, Sharabiani, Round, Stoica)
Bristol Heart Institute, Bristol, United Kingdom University of Bristol,
Bristol, United Kingdom
Title
The ross procedure versus prosthetic valve replacement: Towards better
solutions in young and middle-aged adults-systematic review, meta-analysis
and value of information analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Mounting evidence suggests that the Ross procedure is superior
to conventional aortic valve replacement (AVR) in young adults. We aimed
to build an economic model using the latest and most relevant evidence.
Methods: MEDLINE, EMBASE and the Cochrane Library were searched for
studies published between 1990-2016 in adults aged >18 years. 8,370
studies were screened, assessed by full text and rated for inclusion by a
second independent reviewer. Data from 41 observational studies and 2
trials were pooled using a random effects model. A Markov
cost-effectiveness model was designed based on a review of existing models
and in line with clinical advice. This model estimated lifetime costs and
quality adjusted life years (QALY) for patients treated by the Ross
procedure versus prosthetic AVR. Results: We identifed 48 cohorts with a
total number of 12,975 patients and mean follow-up 7.1 years. Mortality
over follow-up in the Ross subset was signifcantly lower (0.54%, 95% CI
[0.45;0.64] vs 1.14%, 95% CI [1.11;1.74] and 2.50%, 95% CI [1.80;3.59])
when compared to mechanical and tissue AVR respectively. Bleeding rates
were lower in Ross patients compared to prosthetic AVR (0.26%, 95% CI
[0.19;0.37] vs 0.86%, 95% CI [0.62;1.18] and 0.57%, 95% CI [0.39;0.84]).
Reoperation rates were lower in Ross patients (0.54%, 95% CI [0.42;0.69])
when compared to tissue AVR (1.28%, 95% CI [0.88;1.85]) but higher in
comparison to mechanical AVR (0.37%, 95% CI [0.27;0.50]). At a
willingness-to-pay threshold of 20,000 per QALY and when compared to
conventional AVR, the Ross procedure has a lifetime incremental net
monetary beneft of 60,997, incremental QALY of 3.69 and incremental costs
of 12,803, primarily due to lower mortality rates. Extended to an
estimated annual average of 927 patients eligible for the Ross procedure
in the United Kingdom, value of information analysis suggests that a trial
would be cost-effective. Conclusion: This meta-analysis emphasizes current
data on long-term superiority of the Ross operation over conventional AVR
in selected patients. Further, the Ross operation may be more
cost-effective, but remaining uncertainty justifes the need for high
quality randomised clinical trials.

<68>
Accession Number
621786398
Author
Gerodias F.; Locnen S.A.; Gerodias A.; Datukan J.; Mariano P.
Institution
(Gerodias, Locnen, Gerodias, Datukan, Mariano) St. Luke's Medical Center,
Quezon City, Philippines
Title
Anticoagulation with vitamin K antagonists versus antiplatelet therapy
early after bioprosthetic valve implantation in the prevention of
thromboembolism: A meta-analysis of randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: The optimum medical therapy in the 1st 3 months after surgical
bioprosthetic valve implantation (BVI) remains controversial. Current
guidelines of the American College of Cardiology recommend anticoagulation
with vitamin K antagonists (VKA) (level IIa) or antiplatelet (AP) using
aspirin (level IIa) post-surgery, which are based on non-randomized
studies. Hence, we performed a meta-analysis of randomized controlled
trials (RCTs) comparing the efficacy and safety of VKA vs AP therapy early
after surgical BVI. Methods: Extensive search of PubMed, Medline, Cochrane
and Ovid was done for articles published until September 2017. Studies
were limited to RCTs comparing VKA vs AP therapy among patients who
underwent surgical BVI. Outcome measures include thromboembolism,
all-cause mortality and major bleeding. Statistical analysis was done
using Review manager V5.3. Results: Three RCTs with 590 patients were
included. There were no differences in thromboembolic events between VKA
and AP group (15 (5%) vs 20 (6.8%) p = 0.37) or all-cause mortality (14
(4.7%) vs 17 (5.8%) p = 0.64). There was a higher incidence of major
bleeding in the VKA group (18 (6%) vs 7 (2.4%)), which was statistically
signifcant (OR 2.63 (95% CI [1.08-6.43] p = 0.03)). Conclusion: AP therapy
had similar rates of thromboembolic events and mortality compared to
anticoagulation therapy using VKA among patients who underwent surgical
BVI. Due to lower rates of major bleeding, we recommend AP therapy over
VKA early after surgical BVI.

<69>
Accession Number
621786320
Author
Sethi P.; Akintoye E.; Thompson P.; Mozaffarian D.; Harris W.
Institution
(Sethi, Akintoye, Thompson, Mozaffarian, Harris) University of South
Dakota, Sanford School of Medicine, Sioux Falls, SD, USA, Tufts
University, Boston, MA, USA
Title
Higher plasma omega 3 fatty acid levels are associated with reduced risk
for bleeding after cardiac surgery.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Omega 3 fatty acids (n-3 FAs) are used for cardiovascular
disease prevention. There have been theoretical concerns about N-3 FAs
increasing the risk for bleeding, especially during surgery. The OPERA
trial was a multi-center, double-blind, randomized trial that tested the
effects of N-3 FA supplementation for 2-3 days pre-surgery on
post-operative atrial fibrillation. In secondary analyses, the effects of
N-3 FA supplementation on bleeding outcomes were evaluated Methods: Of
1516 patients scheduled for cardiac surgery, data on N-3 FA levels on the
morning of surgery was available for 552 patients-280 received N-3FAs and
272 received placebo. We investigated association between circulating
plasma N-3 FA levels and 1) risk of postoperative bleeding, and 2) the
number of units of blood transfused Results: The sum of three long-chain
N-3 FAs[docosahexaenoic acid (DHA), docosapentaenoic acid (DPA) and
eicosapentaenoic acid (EPA)] in plasma phospholipids was 4.8% in placebo
group and 6.4% in intervention group(p <0.0001). The table shows the risk
for postoperative bleeding as a function of plasma N-3FA level quartiles.
The number of blood units needed during surgery was analyzed on a
continuous basis in a model adjusting for age, sex, BMI, and 4
bleeding-related drugs use. For 1-SD increase in the N-3 FA level, OR (95%
CI) was 0.91 (0.88-0.95; p = 0.014) Conclusion: Higher N-3FA levels were
associated with a reduced risk of postoperative bleeding and need for
blood transfusion in cardiac surgery.

<70>
Accession Number
621786084
Author
Sengodan P.; Jobanputra Y.; Sankaramangalam K.; Athappan G.; Jaber W.;
White J.; Mick S.; Navia J.; Krishnaswamy A.; Tuzcu E.M.; Kapadia S.
Institution
(Sengodan, Jobanputra, Sankaramangalam, Athappan, Jaber, White, Mick,
Navia, Krishnaswamy, Tuzcu, Kapadia) Cleveland Clinic Foundation,
Cleveland, OH, United States
Title
Safety and efficacy of percutaneous mitral valve-in-valve and mitral
valve-in-ring procedures: Systematic review and pooled analysis of 30 day
and one year outcomes.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: The purpose of this study was to perform a systematic review
and pooled analysis of the literature to evaluate 30 day and one year
outcomes of transcatheter mitral valve-in-valve (VIV) and valve-in-ring
(VIR) procedures. Transcatheter treatment of failed mitral valves and
rings after cardiac surgery have increasingly been performed for the
elderly with multiple comorbidities. Data from the Valve-in-Valve
International Data Registry revealed that, although procedural success was
achieved in most of these cases, there were several safety and efficacy
concerns. Methods: All studies reporting data on either mitral VIV and/or
VIR with a minimum of fve patients were identifed using electronic search
and pooled using weighted proportional analysis. Results: A total of 14
studies comprising of 187 patients were identifed in the mitral VIV group,
and 7 studies with 57 patients were identifed in the mitral VIR group. The
30-day pooled estimate of incidence of all-cause mortality in the mitral
VIV group was 10% (95% Confdence Interval (CI): 6% to 16%), valve
embolization-7% (95% CI: 4% to 13%), stroke-5% (95% CI: 2% to 9%), major
bleeding-11% (95% CI of 6% to 19%), valve thrombosis-5% (95 CI: 2% to
14%), and at 1 year the all-cause mortality was 16% (95% CI: 10% to 25%)
valve thrombosis-10% (95 CI: 4% to 20%), stroke-6% (95% CI: 2% to 15%),
major bleeding-14% (95% CI of 7% to 26%) and valve thrombosis-5% (95 CI:
2% to 14%). With regards to the mitral VIR group, the 30-day pooled
estimate for all-cause mortality was 11% (95% CI: 5% to 24%), for renal
failure it was 9% (95% CI: 3% to 24%), valve embolization was 13% (95% CI:
5% to 30%) and left ventricular outfow tract obstruction was 17%, (95% CI:
7% to 34%). The all-cause mortality at one year was estimated to be about
29% (95% CI: 16% to 47%) for the mitral VIR group. Conclusion: Mitral VIV
and VIR procedures are safe and feasible for failing mitral valves and
rings in high risk surgical candidates. The long-term safety and efficacy
data at and beyond 1 year for both mitral VIV and VIR need to be
established.

<71>
Accession Number
621786067
Author
Yudi M.; Tang G.H.-L.; Khan A.; Majeed F.; Sharma S.K.; Kini A.S.
Institution
(Yudi, Tang, Khan, Majeed, Sharma, Kini) Mount Sinai Hospital, New York,
NY, United States
Title
Coronary angiography and percutaneous coronary intervention in patients
with transcatheter aortic valve prosthesis: A systematic review and
practical algorithm.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: There is a high prevalence of coronary artery disease (CAD) in
patients with severe aortic stenosis who undergo transcatheter aortic
valve replacement (TAVR). As TAVR expands to lower risk patients,
progressive CAD will necessitate future coronary angiography (CA) and
percutaneous coronary intervention (PCI). Few data describing the
feasibility of coronary reaccess post TAVR have been reported. Methods: We
undertook a rigorous systematic review to identify all published peer
reviewed articles describing CA and/or PCI in patients post TAVR. We
assessed proportion of patients who had selective CA and successful PCI,
stratifed by the two available FDA-approved valves, namely Medtronic
CoreValve (MC) and Edwards Sapien (ES) valve. Results: Eighteen published
articles reporting on 161 patients who had CA and/or PCI post TAVR were
identifed; the largest 66 patients. A majority of patients had either ES
(N=69, 43%) or CV (N=86, 53%). Patients with MC had signifcantly lower
rates of successful selective CA (46/82 [56%] vs 62/64 [97%], p=0.001) and
lower rates of successful PCI (44/47 [94%] vs 29/29 [100%], p=0.01) than
ES. We propose an algorithm to aid in CA and PCI in patients with prior ES
and CV TAVR. Conclusion: Selective coronary reaccess and successful PCI
appears to be an issue particularly in patients with the self-expanding
MC, which by design, always extends beyond the coronary ostia. A simple
algorithm has been proposed to overcome these difficulties.

<72>
Accession Number
621786052
Author
Li A.; Collado F.M.; Kavinsky C.; Poulin M.-F.
Institution
(Li, Collado, Kavinsky, Poulin) Rush University Medical Center, Chicago,
IL, United States
Title
Patient characteristics influencing coronary obstruction in transcatheter
aortic valve replacement with low coronary height.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Low coronary ostium height, defined as <=10mm above the
annulus by computed tomography (CT), is associated with an increased risk
of coronary obstruction during transcatheter aortic valve replacement
(TAVR). Specific anatomical factors predictive of coronary occlusion in
this subset of population remain unknown. Methods: A systematic review of
the literature was performed using PubMed, OVID, and Cochrane Library
through October 1, 2017. Inclusion criteria were patients with at least
one coronary ostium height of <=10 mm CT and who underwent a TAVR. Studies
that did not provided specific left or right coronary ostia height we
excluded. A total of 10 publications detailing a total 24 patients were
identifed. 32 patients from our institution with similar criteria were
also included (total 56 patients). Results: Baseline characteristics
between the 2 groups were similar except for a smaller aortic annulus area
in patients who had an occlusion (345.3+/-103.9 versus 426.6+/-71.9mm2,
P=0.43). The mean age was 79.6+/-9.3 years, and 68% were female. The mean
body-mass index was 28.1+/-5.5 kg/m2. 18% of cases were valve-in-valve
TAVR. The mean left coronary height was 8.1mm+/-1.8, mean right coronary
height was 12.7+/-3.0mm. The mean annulus area was 419.5+/-77.3 mm2, mean
aortic annulus diameter was 22.9+/-2.4mm and mean sinus of valsalva
diameter was 29.2+/-2.7mm. The valve size used was <=26mm in 80% of cases.
Balloon-expandable valve were used more often (61%) than self-expandable
valves (39%). Coronary protection was used in 39% of cases. There were 11
cases of coronary obstruction (19.9%), 82% of which were left sided. There
was one reported case of right sided occlusion and one case of delayed
bilateral occlusion. Nine improved with percutaneous coronary
intervention, no death was recorded. Use of coronary protection during
TAVR was associated with less coronary occlusion (P=0.01). Valve-in-valve
TAVR, type of valve used and implantation depth were not associated with
more occlusion (P=0.74, P=0.825 and P=0.35, respectively). Conclusion:
TAVR in low LMCA can be achieved successfully in patients with low
coronary takeoff. Patients with smaller Coronary protection is associated
with less coronary occlusion.

<73>
Accession Number
621785937
Author
Asch F.M.; Vannan M.; Singh S.; Khandheria B.; Little S.; Allocco D.;
Meredith I.; Feldman T.; Reardon M.; Weissman N.
Institution
(Asch, Vannan, Singh, Khandheria, Little, Allocco, Meredith, Feldman,
Reardon, Weissman) MedStar Health Research Institute, Washington, DC,
United States
Title
Hemodynamic profile and echocardiographic outcomes at 1 year of the lotus
transcatheter aortic valve in high and extreme surgical risk patients: An
analysis from the reprise III randomized controlled trial.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: There is a growing variety of transcatheter aortic valves
(TAVI) available for patients with severe aortic stenosis (AS). The Lotus
Valve system (LVS) is a mechanically-expanded, fully repositionable and
retrievable device with an adaptive seal to minimize paravalvular leak
(PVL). We aim to describe the hemodynamic profle and PVL of the LVS up to
a 1 year post implantation in the Reprise III clinical trial. Methods:
Reprise III is a randomized multicenter clinical trial of patients with
high-risk AS. Echocardiograms with Doppler were obtained following a
standard protocol up to 12 months post implant and analyzed by an echo
core lab (MedStar Health) following VARC and ASE standards. Mean gradient
(MG), aortic valve area (AVA) and Doppler velocity index (DVI) are
reported. PVL was evaluated with a multiparametric approach. Results: A
Lotus valve was implanted in 577 patients. Implanted sizes were 23 mm,
25mm and 27mm in 30.5%, 35.3% and 34.2% of patients, respectively. Age was
83 +/-7 years, 50.1% were female and STS score was 6.7+/-4.0. Overall, at
hospital discharge the MG was 12.2+/-5.1 mmHg, AVA 1.64+/-0.5 cm2 and DVI
0.50+/-0.13. PVL at 12 months was moderate or higher in 0.9% of cases.
Hemodynamic values per valve size during follow-up are shown in the Table.
Conclusion: The Lotus TAVI system has an excellent hemodynamic profle that
remains stable up to a 1 year after implant. The rate of PVL is minimal.
The reported values should be used as reference for the continued
follow-up of patients implanted with Lotus.

<74>
Accession Number
621785919
Author
Varosy P.; Masoudi F.A.; Reisman M.; Shipley R.; Stein K.; Ellenbogen K.A.
Institution
(Varosy, Masoudi, Reisman, Shipley, Stein, Ellenbogen) Boston Scientifc,
Maple Grove, MN, United States
Title
Procedural safety of watchman implantation: The us nested post approval
study.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: The US WATCHMAN New Enrollment Post Approval Surveillance
Analysis Plan (NESTed SAP) is designed to assess safety and effectiveness
of the WATCHMAN Device. Methods: Eligible patients undergoing WATCHMAN
implantation were collected through the NCDR Left Atrial Appendage
Occlusion Registry (LAAO Registry). The primary composite safety endpoint
included death, ischemic stroke, systemic embolism, or
device/procedure-related events necessitating cardiac surgery or major
endovascular intervention within either 7-days post-implant or hospital
discharge, whichever occurred later. Results: Sites (132) contributed to
the planned enrollment of 1000 patients (4/16-11/16). Compared with
previous trials and registries (Figure), the patients were older and had
higher baseline stroke and bleeding risks (mean age 76.5+/-8.1,
CHA2DS2-VASc 5.0+/-1.4, HAS-BLED 2.7+/-1.0, 38% female). The composite
primary safety endpoint event rate of 1.49% compares favorably to rates
observed in prior trials. The upper 95% confdence interval for the primary
safety endpoint (2.32%) was below the pre-specified threshold (3.36%).
Conclusion: Procedural safety results from the US NESTed Post-approval
study are consistent with prior clinical studies in a higher risk
population. Continued clinical outcomes surveillance will guide LAAO as an
option for high risk patients with nonvalvular atrial fibrillation who
have reasons to seek an alternative to oral anticoagulation.

<75>
Accession Number
621785837
Author
Halabi S.A.; Newman J.; Farkouh M.E.; Fortuin D.; Leya F.; Sweeney J.;
Webb J.; Lopez J.; Steen L.; Lewis B.; Darki A.; Mathew V.
Institution
(Halabi, Newman, Farkouh, Fortuin, Leya, Sweeney, Webb, Lopez, Steen,
Lewis, Darki, Mathew) Loyola University Medical Centre, Maywood, IL,
United States
Title
Dual-versus mono-antiplatelet therapy in patients undergoing TAVR: A meta
- analysis of randomized controlled trials and observational studies.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Current guidelines recommend dual-antiplatelet strategy (DAPT)
following transcatheter aortic valve replacement (TAVR), however some
studies have suggested that mono-antiplatelet strategy (MAPT) may be
equally effcacious with an improved safety profle. Methods: We conducted a
meta-analysis of prospective randomized controlled trials (RCT) and
observational studies that compared DAPT to MAPT in patients undergoing
TAVR. Study quality and heterogeneity were assessed using Jadad score,
Newcastle-Ottawa Scale and Cochran's Q statistics. Mantel-Haenszel
relative risks were calculated using random effect models. Results: Six
studies met our inclusion criteria, 3 RCTs and 3 observational studies,
involving 896 patients. In patients undergoing TAVR, DAPT use was
associated with increased 30 day risk of the primary endpoint of death,
myocardial infarction, stroke or TIA, and major or life threatening
bleeding (RR 2.11 95% CI: 1.39, 3.21; p<0.001), largely due to increased
major bleeding (RR, 2.78; 95% CI: 1.73 to 4.45; p < 0.001) and major
vascular complications (RR, 1.81; 95% CI: 1.02 to 3.20; P 0.04); there was
no difference in the rate of all-cause mortality (RR, 1.26; 95% CI: 0.66
to 2.39; p 0.49), stroke (RR, 1.14; 95% CI: 0.37 to 3.54; p 0.82) or a
combined end point of stroke or TIA (RR, 0.98; 95% CI: 0.39 to 2.47; p
0.97) between the groups. At 6 months, DAPT use was also associated with
increased major bleeding (relative risk, 2.73; 95% CI: 1.30 to 5.73; P <
0.001) without a decrease in stroke (relative risk, 1.44; 95% CI: 0.72 to
2.87; P 0.30) or mortality (relative risk, 0.97; 95% CI: 0.26 to 3.63; P
0.96). There was no evidence of signifcant heterogeneity or publication
bias among the reported outcomes. Conclusion: In patients undergoing TAVR,
DAPT versus MAPT is associated with increased short and intermediate term
risk of major bleeding and major vascular complications without a beneft
in ischemic complications or mortality. The increase in vascular
complications with DAPT has not previously been reported.

<76>
Accession Number
621785744
Author
Kereiakes D.; Meduri C.; Makkar R.; Linke A.; Babaliaros V.; Stoler R.;
Mishkel G.; Rizik D.G.; Iyer V.; Schindler J.; Allocco D.; Meredith I.;
Reardon M.; Feldman T.
Institution
(Kereiakes, Meduri, Makkar, Linke, Babaliaros, Stoler, Mishkel, Rizik,
Iyer, Schindler, Allocco, Meredith, Reardon, Feldman) Christ Hospital
Heart and Vascular Center, Cincinnati, OH, USA, The Lindner Research
Center Cincinnati OH USA
Title
Pacemaker dependency following transcatheter aortic valve implantation: A
subanalysis of the reprise III randomized controlled clinical trial.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Conduction abnormalities leading to permanent pacemaker (PM)
implantation are common after transcatheter aortic valve replacement
(TAVR). As TAVR expands to younger and/or lower risk patients (pts), the
long-term consequences of PM implantation are a concern. It is unknown how
often permanent PM remain required as PM dependency has not been
methodically assessed in TAVR trials. We performed a systematic,
prespecified, protocol-driven assessment of PM dependency in REPRISE III.
Methods: In REPRISE III, 903 pts with high/extreme surgical risk and
symptomatic aortic stenosis were randomized 2:1 to Lotus or CoreValve
(CV). PM dependency was assessed by decreasing pacing rate by 10 beats per
minute (bpm) until i) observation of native rhythm, ii) symptom onset, or
iii) 30 bpm was reached. Paced ventricular beats (%) were also captured.
PM dependency was defined as pts who were symptomatic or did not have a
native rhythm. Results: At 30d and 1 y, 38% and 44% of pts with a new PM
were pacemaker dependent based on the definition above. In pts with a new
PM, the % of ventricular beats that were paced was 65% and 57% at 30d and
1y, respectively. Mortality and other clinical outcomes were not worse in
pts with or without PM dependency (Table). Additional analyses including a
breakdown by valve type will be available for ACC 2018. Conclusion:
Approximately 40% of PM pts were dependent at 30d (based on a prespecified
trial definition); this rate was similat at 1y.

<77>
Accession Number
621785635
Author
Lee M.M.Y.; Petrie M.; Rocchiccioli P.; Simpson J.; Jackson C.; Brown A.;
Corcoran D.; Mangion K.; Cialdella P.; Sidik N.; McEntegart M.; Shaukat
A.; Rae A.; Hood S.; Peat E.; Findlay I.; Murphy C.; Cormack A.; Bukov N.;
Balachandran K.; Ford I.; Wu O.; McConnachie A.; Barry S.; Berry C.
Institution
(Lee, Petrie, Rocchiccioli, Simpson, Jackson, Brown, Corcoran, Mangion,
Cialdella, Sidik, McEntegart, Shaukat, Rae, Hood, Peat, Findlay, Murphy,
Cormack, Bukov, Balachandran, Ford, Wu, McConnachie, Barry, Berry)
University of Glasgow, Glasgow, United Kingdom
Title
Non-invasive versus invasive management in patients with prior coronary
artery bypass surgery with a non-st segment elevation acute coronary
syndrome: Comparisons between the randomized controlled pilot trial and
registry.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Elderly patients with multi-morbidity are often
under-represented in clinical trials. The CABG-ACS pilot trial
(NCT01895751) prospectively assessed reasons for entering the trial or
registry and subsequent outcomes. Methods: Patients with a non-ST segment
elevation acute coronary syndrome (NSTE-ACS) and prior coronary artery
bypass graft (CABG) admitted to 4 hospitals were randomized to invasive or
non-invasive management. Non-randomized patients entered a follow-up
registry. The primary efficacy outcome was a composite of all-cause death,
rehospitalization for refractory ischemia/angina, myocardial infarction
(MI) and hospitalization due to heart failure. The primary safety outcome
was the composite of bleeding, stroke, procedure-related MI and worsening
renal function. A blinded Clinical Event Committee independently assessed
events. EuroQol-5 Dimensions (EQ-5D) was assessed at 6 monthly intervals
for >=18 months. Results: 217 patients with prior CABG and unplanned
hospitalization for suspected ACS were screened. 84 subjects did not
consent (>=1 reasons): 43 not NSTE-ACS, 35 unsuitable for invasive
management, 9 refractory ischemia, 3 unable to consent. Of 133 eligible
subjects, 60 (mean+/-SD age 71+/-9 years, 28% female) entered the trial
and 73 (age 72+/-10 years, 27% female) entered the registry (preferences:
physician 79%, patient 40% or both 18%). Compared to trial patients,
registry patients had signifcantly more valve disease, lower hemoglobin,
worse New York Heart Association class and higher frailty index. Baseline
EQ-5D, medications and left internal mammary artery grafts were similar.
Registry patients had signifcantly more medication changes due to
recurrent angina and more urgent inpatient invasive procedures. The
primary efficacy outcome occurred in 49% registry vs. 43% trial patients
(HR (95% CI) 1.12 (0.77,1.63); p=0.601). Primary safety outcomes were
similar (22% registry vs. 28% trial; HR 0.76 (0.42,1.38); p=0.425). EQ-5D
health status was lower in the registry at 6 months (p=0.011) but not at 1
year (p=0.068). Conclusion: Compared to trial patients, the registry had
excess morbidity but their longer term health outcomes were similar.

<78>
Accession Number
621785561
Author
Haddad T.M.; Parekh J.; Jhand A.; Kabach A.; Azzouz M.S.; White M.; Alla
V.; Del Core M.
Institution
(Haddad, Parekh, Jhand, Kabach, Azzouz, White, Alla, Del Core) Creighton
University School of Medicine, Omaha, NE, United States
Title
Outcomes of post-operative atrial fibrillation after coronary artery
bypass graft surgery: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Post-operative atrial fibrillation (POAF) is common after
coronary artery bypass graft (CABG) surgery. Many studies have evaluated
the outcomes of POAF in patients undergoing CABG, but have demonstrated
inconsistent results. We therefore systematically reviewed published
literature and performed a meta-analysis to assess the outcomes of POAF
after CABG. Methods: PubMed, Cochrane Library, and Web of Science
databases were searched for studies evaluating the impact of POAF after
CABG. POAF was defined as a new incidence of atrial fibrillation
post-CABG. Primary endpoints were major adverse cardiac events (MACE)
including all-cause mortality, stroke, and myocardial infarction (MI).
Secondary outcomes were mortality, stroke, and MI. Odd ratio (OR) and 95%
confdence intervals (CI) were used to evaluate the categorical variables.
The analysis was done with the DerSimonian and Laird random effect model.
Results: Six retrospective and fve prospective cohort studies met the
criteria for inclusion with a total of 83,080 patients (POAF group:
19,392; no POAF group: 63,688). Mean age was 64.2 years old, and 73% were
male. Follow-up varied between 4 to 8 years. Patients who had POAF had
signifcantly higher MACE. Secondary outcomes showed that the POAF group
had higher mortality and stroke, but no signifcant difference in MI
([Figure Presented]). Conclusion: Our analysis suggests that patients with
POAF after CABG have higher risk of major cardiac events, particularly
stroke and all-cause mortality.

<79>
Accession Number
621785543
Author
De Waard D.; Manlucu J.; Gillis A.; Sapp J.; Tang A.; Wells G.; Parkash R.
Institution
(De Waard, Manlucu, Gillis, Sapp, Tang, Wells, Parkash) Dalhousie
University, Halifax, Canada
Title
The effect of cardiac resynchronization therapy on outcomes in women: A
substudy of the resynchronization-defibrillation for ambulatory heart
failure trial.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Cardiac resynchronization therapy with defibrillator (CRT-D)
has demonstrated reduced mortality and heart failure (HF) hospitalizations
in patients with left ventricular dysfunction. Prior studies have
suggested that women may beneft more than men from CRT-D. Using a post hoc
analysis of the Resynchronization-Defibrillation for Ambulatory Heart
Failure Trial (RAFT), we sought to further evaluate CRT-D beneft on
mortality and HF hospitalization in women versus men. Methods: Baseline
characteristics were compared between men and women that were randomized
to either implantable cardioverter-defibrillator (ICD) or CRT-D treatment
as part of RAFT. In a multivariable Cox proportional hazards model,
outcomes (mortality and HF hospitalization) were also compared between men
and women. Results: There were 1490 (83%) men (732 ICD, 758 CRT-D) and 308
(17%) women (172 ICD, 136 CRT-D) included in the analysis. Mean follow-up
was 40 months. Women had more non-ischemic heart disease (54.87% vs
28.72%, p=<0.0001) and left bundle branch block/interventricular
conduction delay (89.61% vs 82.28%, p=0.0016) and worse NYHA Class (25.32%
vs 18.93%, p=0.0106), but less ischemic heart disease (45.13% vs 71.28%,
p=<0.0001), permanent atrial fibrillation/futter (9.09% vs 13.49%,
p=0.035), previous percutaneous coronary intervention/coronary artery
bypass grafting (29.55% vs 52.89%, p=<0.0001) and peripheral vascular
disease (6.82% vs 10.54%, p=0.0467). Women with CRT-D had signifcantly
reduced incidence of death and HF hospitalization compared to men with
CRT-D (HR 0.52, 95% CI (0.33,0.81), p<0.001) on multivariable analysis.
Conclusion: Women have more favorable outcomes with CRT-D as compared to
men, even after adjusting for differences in baseline characteristics over
a prolonged follow-up. Whether these improved outcomes are due to inherent
gender differences in the underlying myocardial substrate or to an
enhanced response to CRT-D will require further research.

<80>
Accession Number
621785523
Author
Goel S.; Siddiqui S.; Agarwal C.; Borgen E.; Shani J.; Frankel R.
Institution
(Goel, Siddiqui, Agarwal, Borgen, Shani, Frankel) Maimonides Medical
Center, Brooklyn, NY, United States
Title
New ipsilateral balloon occlusion technique for percutaneous closure after
transfemoral aortic valve replacement and comparison with routine
crossover balloon occlusion technique.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Vascular complications are associated with increased mortality
following TAVR. The novel ipsilateral balloon occlusion technique (IBOT)
involves passage of a balloon catheter from the ipsilateral superfcial
femoral artery to enable controlled closure of large-sheath access-site.
This study compares the IBOT with the commonly used crossover balloon
occlusion technique (CBOT) after transfemoral TAVR Methods: Consecutive
patients who underwent transfemoral TAVR at our institution were
retrospectively studied. Patients who had routine CBOT (n =41) were
compared to IBOT (n= 59). The primary endpoints were technical success and
30-day occurrence of access-site-related Valve Academic Research
Consortium (VARC) 2 defined vascular and/or bleeding complications. The
Fisher's exact test was used to compare the two groups Results: IBOT was
successfully performed in 95% of the patients. At 30 days, life
threatening/disabling bleeding occurred in 4 patients (6.8%) in IBOT group
and 2 patients (4.9%) in CBOT group. Major bleeding was similar in both
groups. Incidence of major vascular complication was slightly higher in
CBOT group (4.9% versus 3.4%) and minor vascular complications
predominated in IBOT group (8.5% versus 4.9%). None of the end points
statistically differed between the groups due to small patient population
Conclusion: IBOT for TAVR access site closure is comparable to routine
CBOT after transfemoral TAVR and can be used in patients with unfavorable
iliac anatomy.

<81>
Accession Number
621785466
Author
Witberg G.; Zusman O.; Codner P.; Assali A.; Kornowski R.
Institution
(Witberg, Zusman, Codner, Assali, Kornowski) Rabin Medical Center, Petah
Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
Title
Impact of coronary artery revascularization completeness on outcomes of
patients with coronary artery disease undergoing transcatheter aortic
valve replacement: A meta-analysis of studies using the residual syntax
score.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: coronary artery disease (CAD) is highly prevalent in patients
undergoing transcatheter aortic valve replacement (TAVR). In the overall
CAD population, complete revascularization (CR) or "reasonable" incomplete
revascularization (ICR), are associated with improved outcomes, whether
the same applies for the TAVR population is still a matter of debate.
Methods: We conducted a systematic review and meta-analysis of studies
that examined the prognostic effect of revascularization completeness in
patients undergoing TAVR, using the residual SYNTAX score (rSS) to
separate between "reasonable" ICR and ICR. Results: Six studies with a
total of 3,107 patients were included. The duration of follow-up ranged
ranged from 0.7-3 years. Overall, ICR was associated with an increased
risk for mortality. This was true when comparing ICR patients to those
with no CAD (OR 1.72, 95% CI 1.06-2.78, p=0.03), to those with
"reasonable" ICR (OR 1.69, 95% CI 1.26-2.28, p<0.001) or to both groups
combined (OR 1.71, 95% CI 1.36-2.16, p<0.001)-Figure 1A-C. On the
contrary, patients in the "reasonable" ICR category did not show an
increased risk for mortality, when compared to those with no CAD (OR 1.11,
95% CI 0.89-1.39, p=0.33) Figure 1D. Conclusion: Our results suggest that
for CAD patients undergoing TAVR, an rSS guided revascularization strategy
may carry signifcant benefts in terms of mortality. Adequate
revascularization may offer a unique and valuable opportunity to improve
the prognosis of these patients.

<82>
Accession Number
621785465
Author
Shah A.; Stawiarski K.; Gaddam S.; Axiyan M.; Fishman R.; Tuohy E.
Institution
(Shah, Stawiarski, Gaddam, Axiyan, Fishman, Tuohy) Bridgeport Hospital
Yale University School of Medicine, Bridgeport, CT, United States
Title
Clinical outcomes for medtronic evolut-r versus core valve transcatheter
aortic valve implantation.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has evolved from
the use of the Medtronic frst generation CoreValve to the second
generation Evolut R valve. Most studies have showed comparable if not
improved performance of the Evolut R. However, individual trials are based
on single center experiences. We conducted an updated meta-analysis to
investigate the clinical outcomes of the Medtronic CoreValve versus the
Evolut R. Methods: The MEDLINE/PUBMED database was searched for articles
comparing CoreValve and Evolut R outcomes published until February 2017.
The primary endpoint was all-cause mortality. Secondary endpoints were
permanent pacemaker (PPM) implantation, cerebral vascular accidents (CVA)
and vascular complications. Meta-analysis was done using a fxed effects
model and results were expressed as Odds ratio (OR) with 95% Confdence
Intervals (CI). Results: Four studies met inclusion criteria. A total of
9737 patients were included with 2917 undergoing TAVR with the Evolut R.
Mortality beneft was seen in patients receiving the Evolut R valve
(OR=0.729; CI: 0.535-0.994; p=0.046) but did not improve the rate of CVA
(OR=1.097; CI: 0.838-1437; p=0.499), vascular complications (OR=0.785;
CI:0.580-1.064; p=0.119) or need for PPM (OR=0.931; CI:0.784-1.107;
p=0.420). [Figure Presented] Conclusion: This mortality beneft supports
the preferred use of the Evolut R in TAVR. Future studies are required to
confrm these observations and address the challenge of improving other
clinical outcomes.

<83>
Accession Number
621785324
Author
Schroeder L.; Buckley J.; Martin R.; Stroud R.E.; Nadeau E.K.; Barrs R.W.;
Graham E.
Institution
(Schroeder, Buckley, Martin, Stroud, Nadeau, Barrs, Graham) Medical
University of South Carolina, Charleston, SC, United States
Title
Plasma neutrophil gelatinase-associated lipocalin is associated with acute
kidney injury and clinical outcomes in neonates undergoing cardiopulmonary
bypass.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Plasma neutrophil gelatinase-associated lipocalin (NGAL) has
been shown to correlate with acute kidney injury and clinical outcomes in
pediatric and adult populations, however, this finding has not been
clearly established in neonates undergoing cardiac surgery. The objective
of this study was to determine if plasma NGAL levels were associated with
acute kidney injury and clinical outcomes in neonates with congenital
heart disease undergoing cardiopulmonary bypass (CPB). Methods: A
secondary analysis of a prospective, randomized controlled trial of 63
neonates undergoing cardiac surgery with CPB was performed. Plasma NGAL
levels were measured pre-operatively, at the cessation of CPB, 4, 12 and
24 hours post-operatively. Associations between these levels and clinical
outcomes were explored. Results: Plasma NGAL peaked at 12 hours post-CPB
and more than doubled compared to pre-operative levels. Higher
pre-operative and 24 hour post-operative NGAL levels were associated with
acute kidney injury, longer duration of mechanical ventilation, ICU and
hospital lengths of stay and total hospital charges ([Table Presented]).
Conclusion: Both pre-operative and 24 hour post-operative plasma NGAL
levels are associated with acute kidney injury and worse clinical outcomes
in neonates undergoing cardiac surgery. Plasma NGAL levels may have a role
in risk stratifcation for predicting post-operative renal dysfunction as
well as providing a potential clinical trajectory in the post-operative
period.

<84>
Accession Number
621785302
Author
Parekh J.; Aggarwal G.; Thandra A.; Arora R.; Alla V.
Institution
(Parekh, Aggarwal, Thandra, Arora, Alla) Creighton University Medical
Center, Omaha, NE, United States
Title
Pre-transplant use of amiodarone in pre-transplant cardiomyopathy patients
is associated with increased cardiovascular risk: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Patients with end-stage heart failure are frequently on
amiodarone for treatment and prevention of life threatening ventricular
arrhythmias. Multiple studies have been published in the past year with
varying results. Methods: We searched PubMed, Cochrane and Google Scholar
for terms "amiodarone", "heart transplant", "end-stage heart failure" and
their combinations. Studies reporting mortality and need for pacemaker
were included. Results: A total of 12 studies including 17403 patients
were included in the final analysis out of which 5 were published in the
last year. Pre-transplant amiodarone use was associated with signifcantly
increased mortality (Odds ratio (OR) 1.86, 95% confdence interval (CI)
1.20-2.86, p=0.005) and need for pacemaker (OR 1.47, 95% CI 1.24 to 1.75,
p<0.0001) postoperatively. Conclusion: Meta-analysis of the available
literature suggests signifcantly worse outcomes with pre-operative
amiodarone use. Both mortality and need for pacemaker post-operatively
were signifcantly higher in the amiodarone group. Randomized control
trials are needed to further confrm these findings.

<85>
Accession Number
621785244
Author
Filho G.C.F.; Fernandes A.D.F.; Rivera M.; Nasi G.; Cardoso R.; Goldberger
J.; Mitrani R.
Institution
(Filho, Fernandes, Rivera, Nasi, Cardoso, Goldberger, Mitrani) University
of Miami, Miami, FL, United States
Title
Substrate modification for the management of symptomatic brugada syndrome:
A systematic review.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Ablation techniques have been described for the management of
symptomatic Brugada syndrome, but this treatment is still considered
experimental. We performed a systematic review of the current evidence on
substrate modifcation to manage patients with symptomatic Brugada
syndrome. Methods: PubMed, Embase and Scopus were searched for articles
describing the use of catheter ablation with substrate modifcation for the
management of symptomatic Brugada syndrome. Results: We included 18
manuscripts, 9 case series and 9 case reports, totalizing 213 patients. In
180 (84.5%) patients, epicardial mapping with substrate modifcation was
performed, while 33 (15.5%) patients had endocardial-only mapping and
ablation. During a 5 to 78-month follow-up, the success rates in
preventing ventricular fibrillation or polymorphic ventricular tachycardia
(VF/PMVT) were 96.7% and 75.8% with epicardial and endocardial ablation,
respectively. Elimination of type I Brugada-pattern ECG was attained in
98.3% and 34.8% of patients undergoing epicardial and endocardial
ablation, respectively. Post-procedural VF/PMVT inducibility was present
in 2.4% and 50% of the epicardial and endocardial-only ablation groups,
respectively. VF/PMVT occurred in 10 of the 12 (83.3%) patients who had
persistent or recurrent J-ST elevation on the right precordial leads
during follow-up, whereas none of the 170 patients who had complete
resolution of the J-ST elevation had recurrence of VF/PMVT. Pharmacologic
provocation with a sodium channel blocker was performed in 3 studies and
augmented the low-voltage area by 1.6 and >2 times in 2 series involving
149 patients. Among patients who underwent both epicardial and endocardial
mapping, there was no identifable endocardial substrate in 39 of 42
(92.9%) cases. Conclusion: Epicardial substrate modifcation appears to be
more effective than endocardial-only approach for preventing VF/PMVT.
Pharmacologic provocation increased the low-voltage area. Persistent or
recurrent J-ST elevation appears to be a marker of failure of the ablation
therapy. Ablation seems to be acceptable strategy in patients with VF/PMVT
and/or ICD shocks after standard therapy has failed.

<86>
Accession Number
621785243
Author
Thakur U.; Muthalaly R.; Wong N.C.; Ha F.J.; Cameron J.; Brown A.; Smith
J.; Nerlekar N.
Institution
(Thakur, Muthalaly, Wong, Ha, Cameron, Brown, Smith, Nerlekar) Monash
Cardiovascular Research Centre, Clayton, Australia
Title
Long-term survival between off versus on pump coronary artery bypass
grafting: A systematic review and meta-analysis of randomized controlled
trials.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: The long-term survival between off vs. on-pump coronary artery
bypass grafting (OFF-CABG vs. ON-CABG) is unknown with individual trials
underpowered for mortality. We performed a meta-analysis of randomized
controlled trials reporting extended follow-up comparing OFF-vs. ON-CABG.
Methods: Online databases were searched until October 2017. The primary
endpoint was all cause death. Secondary endpoints included myocardial
infarction (MI), repeat revascularization and stroke. Data were analyzed
at longest Results: Six studies with 8,142 patients were included. Mean
follow up was 5.5+/-1.0 year. Death occurred in 14.3% (584/4,074) of
OFF-CABG and 12.7% (519/4,068) of ON-CABG. There was a signifcantly
increased risk of mortality with OFF-CABG (RR 1.12 (1.01-1.25), p=0.04)
(Figure). There was no signifcant difference in MI (RR 1.06 (0.91-1.22),
p=0.47), revascularisation (RR 1.14 (0.96-1.37), p=0.14) or stroke (RR 0.8
(0.57-1.10), p=0.16) between surgical strategies. Conclusion: ON-CABG is
associated with improved mortality compared with OFF-CABG but no
signifcant increase in myocardial infarction, repeat revascularisation or
stroke.

<87>
Accession Number
621785205
Author
Nalluri N.; Atti V.; Kumar V.; Munir A.B.; Asti D.; Saouma S.; Gaddam S.;
Randhawa M.; Zgheib M.; Karam B.; Spagnola J.; Royzman R.; Kandov R.;
Tamburrino F.; Maniatis G.; Lafferty J.; Kliger C.
Institution
(Nalluri, Atti, Kumar, Munir, Asti, Saouma, Gaddam, Randhawa, Zgheib,
Karam, Spagnola, Royzman, Kandov, Tamburrino, Maniatis, Lafferty, Kliger)
Hofstra Northwell School of Medicine at Staten Island University Hospital,
New York, NY, USA, Hofstra Northwell School of Medicine at Lenox Hill
Hospital New York NY USA
Title
Valve in valve transcatheter aortic valve implantation versus redo
surgical aortic valve replacement in failing bioprosthetic valves: An
updated meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Patients presenting with failed bioprosthetic (BP) valves are
rising, hence the need for further intervention. Valve in
Valve-Transcatheter Aortic Valve Implantation (ViV-TAVI) has emerged as an
alternative to the redo-Surgical Aortic Valve Replacement (redo-SAVR),
which has been the standard of care. However, the utility of ViV-TAVI in
this high risk population is poorly understood. Methods: A systematic
electronic search of the scientifc literature was performed in PubMed,
EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov. Only studies which
evaluated the safety and efficacy of ViV-TAVI and redo-SAVR in failed BP
valves were included. Results: Four observational studies were eligible
and included 440 patients, of whom 226 underwent ViV-TAVI and 214
underwent redo-SAVR. There was no signifcant between ViV-TAVI and
redo-SAVR for mortality at 30 days (OR: 0.97, CI: 0.39 to 2.39; p= 0.94)
and 1 year (OR:1.28, CI: 0.66 to 2.50; p= 0.46). ViV-TAVI had lower risk
of permanent pacemaker implantation (PPM) (OR: 0.43, CI: 0.21 to 0.89; p=
0.02) and Acute Kidney Injury (OR: 0.34, CI: 0.16 to 0.76; p= 0.008) with
a trend towards increased risk of paravalvular leak (OR: 5.45, CI: 0.94 to
31.58; p= 0.06). There was no signifcant difference for stroke (p= 0.83)
and major bleeding (p= 0.21). Conclusion: There was no signifcant
difference in mortality between ViV-TAVI and redo-SAVR. ViV-TAVI had lower
risk of PPM implantation and AKI with a trend towards increased risk of
paravalvular leak.

<88>
Accession Number
621785130
Author
Halliday B.; Baksi A.; Gulati A.; Ali A.; Newsome S.; Arzanauskaite M.;
Izgi C.; Lota A.; Tayal U.; Vassiliou V.; Cook S.; Cleland J.; Pennell D.;
Prasad S.
Institution
(Halliday, Baksi, Gulati, Ali, Newsome, Arzanauskaite, Izgi, Lota, Tayal,
Vassiliou, Cook, Cleland, Pennell, Prasad) Royal Brompton Hospital,
National Heart and Lung Insititute, Imperial College, London, United
Kingdom
Title
Defining the relationship between the extent of mid-wall late gadolinium
enhancement and adverse heart failure events in patients with dilated
cardiomyopathy.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Data on the association between the extent of mid-wall late
gadolinium enhancement (LGE) and heart failure (HF) outcomes is lacking.
Methods: We used proportional hazard modelling to examine the association
between mid-wall LGE extent and a HF composite end-point (HF death,
unplanned HF hospitalisation and cardiac transplantation) in consecutive
patients referred with DCM. Results: Out of 874 patients enrolled (588
male, median LVEF 39%, median age 52 years) mid-wall LGE was present in
300 (34.3%) cases (median extent 3.8%, IQR 2.0:6.7%). Over a median
follow-up of 4.9 years, 115 (13.2%) patients met the HF end-point.
Following adjustment for LVEF, age and sex, LGE was associated with a
greater incidence of HF events (hazard ratio [HR] 2.02; 95% CI 1.52:3.33;
p<0.001). The cut-off percentage extent with the largest C-statistic for
the prediction of HF events was 1.29%. Estimated HRs for patients with an
LGE extent of 0-2.5%, 2.5-5% and >5%, compared to patients without LGE,
were 1.53 (95% CI 0.88-2.68), 1.76 (1.05-2.96) and 2.47 (1.52-4.03)
([Figure Presented]). Modelling LGE as a linear trend, per percent
increase in the extent, provided a poor ft to the data, while modelling
LGE as a log linear trend provided reasonable ft to the data. Conclusion:
We demonstrate a non-linear relationship between LGE extent and HF events
suggesting a large increase in risk associated with even small degrees of
fibrosis. The presence of mid-wall LGE may be used to help select patients
more likely to require advanced HF therapies.

<89>
Accession Number
621785119
Author
Sato T.; Cheng R.; Azarbal B.; Levine R.; Dimbil S.; Thottam M.; Esmailian
F.; Czer L.; Kobashigawa J.
Institution
(Sato, Cheng, Azarbal, Levine, Dimbil, Thottam, Esmailian, Czer,
Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
Title
Does ex vivo perfusion lead to more or less intimal thickening in the
first-year post-heart transplantation?.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: 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 signifcantly shortened cold ischemic time vs 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 frst-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 (18 pts) or OCS (16 pts). 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), 1-yr freedom from rejection were examined.
Results: 18 pts (OCS: n=5, CS: n=13) had paired IVUS. There was no
signifcant difference in DELTAMIT>=0.5 mm between the groups. Mean MIT
change from baseline to 1-yr was also similar. There was no signifcant
difference in 1-yr survival, freedom from NF-MACE or rejection (Table).
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 confrm these findings. [Table Presented].

<90>
Accession Number
621785024
Author
Mohanty B.D.; Coylewright M.; Liu Y.; Li S.X.; Fradley M.; Alu M.; Mack
M.J.; Kapadia S.; Kodali S.K.; Thourani V.H.; Makkar R.; Leon M.B.;
Malenka D.
Institution
(Mohanty, Coylewright, Liu, Li, Fradley, Alu, Mack, Kapadia, Kodali,
Thourani, Makkar, Leon, Malenka) University of South Florida, Tampa, FL,
USA, Geisel School of Medicine at Dartmouth Lebanon NH USA
Title
Characteristics and clinical outcomes in patients with prior chest
radiation undergoing TAVR: Observations from the partner 2 trial and
registries.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Although patients with severe aortic stenosis and prior chest
radiation (cXRT) perform poorly with surgical aortic valve replacement
(AVR), cXRT is not included in the Society of Thoracic Surgeons (STS) risk
score. Differences in characteristics and outcomes in patients undergoing
transcatheter AVR (TAVR) with and without prior cXRT, have not been
adequately characterized. Methods: Pooled data from the PARTNER 2A and 2B
trials and S3 registry were queried for patients with prior cXRT (62)
versus those without (3,830). Clinical, procedural and imaging
characteristics were compared. The primary outcome was a composite of
death, any stroke, and rehospitalization over 2 years follow-up. Results:
Signifcant baseline differences are listed (Table). Immediate
re-intervention with a second valve for post implant moderate-severe
aortic regurgitation was higher in cXRT patients (4.8% [3/62] vs 0.8%
[29/3830], p = 0.0004). Rates of bleeding, vascular complications, acute
kidney injury, new pacemaker implant, myocardial infarction or infection
were statistically similar. Through 2 years follow-up, there was no
difference in the primary outcome (34.5% vs 35.1%, p = 0.76) or mortality
(21.2% vs 18.6%, p = 0.82). Conclusion: Patients with prior cXRT carry a
unique co-morbidity profle, including lower age and STS scores. Despite
historical concern for poor outcomes with surgery, these patients
demonstrate long term outcomes similar to that of TAVR patients not
treated with cXRT.

<91>
Accession Number
621784936
Author
Kanjanahattakij N.; Rattanawong P.; Krishnamoorthy P.; Sirinvaravong N.;
Chongsathidkiet P.; Lapumnuaypol K.; Witzke C.; Figueredo V.
Institution
(Kanjanahattakij, Rattanawong, Krishnamoorthy, Sirinvaravong,
Chongsathidkiet, Lapumnuaypol, Witzke, Figueredo) Einstein Medical Center,
Philadelphia, PA, United States
Title
Anemia and mortality in patients undergoing transcatheter aortic valve
replacement (TAVR): A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a treatment
option for patients with severe aortic stenosis (AS) with high surgical
risk. Anemia is a common comorbidity in the TAVR population. Small studies
have suggested that anemia is associated long-term mortality in patients
who underwent TAVR. However, there are no meta-analyses to further assess
this association. Methods: Studies were systematically searched from
electronic database including EMBASE and MEDLINE. Inclusion criteria were
adult population with aortic stenosis who underwent transcatheter aortic
valve replacement (TAVR), and number of patients with pre-procedural
anemia was reported. Outcomes were long-term mortality. Pooled effect size
was calculated with a random-effect model, weighted for the inverse of
variance. Heterogeneity was assessed with I². Results: A pooled
analysis of 4 studies examining long-term mortality showed that anemia was
associated with increased long-term mortality in patients with TAVR (fgure
1). The pooled OR was 1.77 (95% CI 1.33-2.35). There was signifcant
heterogeneity across the studies (I² = 73%). Subgroup analysis
of only larger studies showed that there remained an association between
anemia and mortality (OR 1.55; 95% CI 1.36-1.78) with decreased
heterogeneity (I² = 0%). Conclusion: This study suggested an
association between pre-procedural anemia and increased long-term
mortality after TAVR. Further study of the pathophysiology underlying this
association is needed.

<92>
Accession Number
621784933
Author
Sathananthan J.; Murdoch D.J.; Lindman B.R.; Zajarias A.; Jaber W.; Cremer
P.; Wood D.; Cheung A.; Ye J.; Hahn R.T.; Crowley A.; Leon M.B.; Mack
M.J.; Webb J.G.
Institution
(Sathananthan, Murdoch, Lindman, Zajarias, Jaber, Cremer, Wood, Cheung,
Ye, Hahn, Crowley, Leon, Mack, Webb) Centre for Heart Valve Innovation,
St. Paul's Hospital, Vancouver, Canada
Title
Implications of concomitant tricuspid regurgitation in patients undergoing
transcatheter aortic valve implantation for degenerated surgical aortic
bioprosthesis: Insights from partner 2 aortic valve-in-valve registry.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Valve-in-valve (VIV) treatment with transcatheter aortic valve
replacement (TAVR) is a viable option for patients with failing aortic
bioprosthetic valves. Patients with concomitant tricuspid regurgitation
(TR) may have worse outcomes and the optimal management remains
undetermined. We sought to assess the implications of concomitant TR in
patients undergoing VIV TAVR. Methods: The multicenter PARTNER (Placement
of Aortic Transcatheter Valves) 2 VIV trial and continued access registry
enrolled patients with symptomatic degenerated surgical aortic
bioprosthesis who were high risk for reoperation. Outcomes were assessed
between patients with <=mild TR versus moderate/severe TR. Changes in TR
severity at follow-up were assessed. Results: A total of 237 patients (90
initial registry, 147 continued access) underwent VIV procedures with a
mean age of 78.7 years+/-10.8 years and mean Society of Thoracic Surgeon
(STS) score of 9.1+/- 4.8%. In this cohort, 162 (68%)patients had <=mild
TR, and 75 (32%) patients had moderate/severe TR. Patients with
moderate/severe TR were more likely to be female (48% vs 33.3%, p=0.03)
and to have pulmonary hypertension (28% vs 8%, p<0.0001). While there was
no difference in New York Heart Association class III/IV symptomatic
status (89.3% vs 91.4%, p=0.62) or moderate/severe right ventricular
dysfunction (9.4% vs 16.9%, p=0.11), patients with moderate/severe TR were
more likely to be high surgical risk with an STS score of >8 (62.7% vs
46.9%, p=0.02). There was no difference in a composite endpoint of death
and rehospitalization between <=mild TR and moderate/severe TR, either at
30 days (9.9% vs 10.7%, p=0.85) or at 1-year follow-up (23.2% vs 24.1%,
p=0.80). There was a signifcant improvement in overall moderate/severe TR
from baseline at 30 days (31.1% vs 21.1%, p=0.002), which was sustained at
1-year follow-up (38.0% vs 22.8%, p=0.004). Conclusion: Despite having
higher predicted surgical risk, the presence of TR was not a predictor of
long term outcomes. Importantly there was signifcant improvement in TR
severity at both short and long term follow-up. In selected patients
undergoing VIV TAVR, it may be appropriate to conservatively manage
concomitant TR.

<93>
Accession Number
621784846
Author
Basu D.; Pokharel H.; Tiwari A.
Institution
(Basu, Pokharel, Tiwari) MedStar Good Samaritan Hospital, Baltimore, MD,
United States
Title
South asian ethnicity associated with narrow coronary arteries: A
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Coronary artery diameter in South Asians has been investigated
as a risk factor in the development of coronary artery disease with
variable findings. Studies have compared the diameter but not the vessel
cross-sectional area which would determine the atheroma burden required to
have a hemodynamically signifcant lesion. We performed a meta-analysis
comparing the coronary artery cross sectional area between Caucasians and
South Asians Methods: A search was done in PubMed, SCOPUS, Medline,
Dynamed and Cochrane. Studies comparing Caucasians with South Asians or
Indo Asians, adjusting for body surface area, were included. 5 studies met
the criteria. The cross-sectional surface area of the arterial segments
was then calculated from the diameter of the included studies. The
comparison was done under a fxed-effects model and a two-sided t-test was
used to assess if Caucasians have larger coronary artery cross sectional
area. Results: ([Table Presented]) Caucasians have a larger coronary
artery cross sectional area compared at different points on the coronary
system except for the proximal Left Circumfex region. No signifcant
difference was found in the distal Left Circumfex and mid RCA segments.
Conclusion: South Asians have a smaller coronary artery cross sectional
area which possibly increases the risk of developing early and severe
Coronary Artery Disease and puts them at a higher risk for post cardiac
procedure complications and adverse events making South Asian ethnicity a
high-risk group.

<94>
Accession Number
621784830
Author
Halabi S.A.; Newman J.; Farkouh M.E.; Fortuin D.; Leya F.; Sweeney J.;
Webb J.; Lopez J.; Steen L.; Lewis B.; Darki A.; Mathew V.
Institution
(Halabi, Newman, Farkouh, Fortuin, Leya, Sweeney, Webb, Lopez, Steen,
Lewis, Darki, Mathew) Loyola University Medical Centre, Maywood, IL,
United States
Title
Dual-versus mono-antiplatelet therapy in patients undergoing TAVR: A
meta-analysis of randomized controlled trials and observational studies.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Current guidelines recommend dual-antiplatelet strategy (DAPT)
following transcatheter aortic valve replacement (TAVR), however some
studies have suggested that mono-antiplatelet strategy (MAPT) may be
equally effcacious with an improved safety profle. Methods: We conducted a
meta-analysis of prospective randomized controlled trials (RCT) and
observational studies that compared DAPT to MAPT in patients undergoing
TAVR. Study quality and heterogeneity were assessed using Jadad score,
Newcastle-Ottawa Scale and Cochran's Q statistics. Mantel-Haenszel
relative risks were calculated using random effect models. Results: Six
studies met our inclusion criteria, 3 RCTs and 3 observational studies,
involving 896 patients. In patients undergoing TAVR, DAPT use was
associated with increased 30 day risk of the primary endpoint of death,
myocardial infarction, stroke or TIA, and major or life threatening
bleeding (RR 2.11 95% CI: 1.39, 3.21; p<0.001), largely due to increased
major bleeding (RR, 2.78; 95% CI: 1.73 to 4.45; p < 0.001) and major
vascular complications (RR, 1.81; 95% CI: 1.02 to 3.20; P 0.04); there was
no difference in the rate of all-cause mortality (RR, 1.26; 95% CI: 0.66
to 2.39; p 0.49), stroke (RR, 1.14; 95% CI: 0.37 to 3.54; p 0.82) or a
combined end point of stroke or TIA (RR, 0.98; 95% CI: 0.39 to 2.47; p
0.97) between the groups. At 6 months, DAPT use was also associated with
increased major bleeding (relative risk, 2.73; 95% CI: 1.30 to 5.73; P <
0.001) without a decrease in stroke (relative risk, 1.44; 95% CI: 0.72 to
2.87; P 0.30) or mortality (relative risk, 0.97; 95% CI: 0.26 to 3.63; P
0.96). There was no evidence of signifcant heterogeneity or publication
bias among the reported outcomes. Conclusion: In patients undergoing TAVR,
DAPT versus MAPT is associated with increased short and intermediate term
risk of major bleeding and major vascular complications without a beneft
in ischemic complications or mortality. The increase in vascular
complications with DAPT has not previously been reported.

<95>
Accession Number
621784799
Author
Smulders M.; Kietselaer B.; Wildberger J.; Dagnelie P.; Rocca H.-P.B.-L.;
Mingels A.; Van Cauteren Y.; Theunissen R.; Post M.; Schalla S.; Van Kuijk
S.; Das M.; Kim R.; Crijns H.; Bekkers S.
Institution
(Smulders, Kietselaer, Wildberger, Dagnelie, Rocca, Mingels, Van Cauteren,
Theunissen, Post, Schalla, Van Kuijk, Das, Kim, Crijns, Bekkers)
Maastricht UMC+, Maastricht, Netherlands
Title
Cardiovascular magnetic resonance or computed tomography angiography first
versus a routine invasive strategy in high-sensitive troponin-positive
suspected non-st-elevation myocardial infarction: Randomized controlled
trial.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: The majority of patients with suspected troponin-positive
acute coronary syndrome (ACS) is routinely scheduled for invasive coronary
angiography (ICA). In the high-sensitive troponin era however, up to one
third does not have obstructive coronary artery disease (CAD). The primary
hypothesis is whether a cardiovascular magnetic resonance (CMR) or
computed tomography angiography (CTA) frst versus a routine invasive
strategy reduces the proportion of ICA with no detrimental effect on
clinical outcome. Methods: In this single center randomized controlled
trial, 207 patients (64 years on average, 62% male) with acute chest pain,
elevated high sensitive cardiac troponin T levels and inconclusive
electrocardiogram were randomized to a routine invasive, CMR frst or CTA
frst strategy. ICA was recommended only when CMR or CTA indicated
myocardial ischemia, infarction or obstructive CAD. The primary and
secondary endpoints were the proportion of patients undergoing ICA during
initial hospitalization and one-year clinical outcome (major adverse
cardiac events and procedure related complications), respectively.
Results: In the routine invasive strategy, 38% of patients did not have
obstructive CAD. Overall, a CMR or CTA frst versus a routine invasive
strategy reduced the proportion of ICA (87%, 66%, 100%, respectively,
p<0.001), especially at lower baseline troponin levels (15-50ng/L; 80%,
58%, 100%, respectively, p<0.001). When recommendations after non-invasive
imaging results were strictly followed, the proportion of ICA were 77% for
CMR and 65% for CTA. Clinical outcome was similar in the CMR, CTA and
routine invasive strategy (9%, 6%, 9% experienced major adverse cardiac
events (p=0.733) and 12%, 13%, 16% had procedure related complications
(p=0.739), respectively). Conclusion: A novel strategy of implementing CMR
or CTA frst in the diagnostic process in suspected high-sensitive
troponin-positive non-ST-elevation ACS reduces the proportion of ICA with
no detrimental effect on clinical outcome.

<96>
Accession Number
621784780
Author
Racsa P.; Sutton B.; Cornett D.; Ellis J.
Institution
(Racsa, Sutton, Cornett, Ellis) Humana Inc., Louisville, KY, USA,
University of Louisville School of Medicine Louisville KY USA
Title
Using a 1:1:1 propensity score matched cohort to analyze the comparative
effectiveness of new oral anticoagulant therapy used for stroke
prophylaxis in non-valvular atrial fibrillation.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Only recently have differences in the real-world effectiveness
of new oral anticoagulants (NOAC) come to light. The objective of this
study was to examine differences in clinical outcomes and cost of NOAC for
stroke prophylaxis in patients with non-valvular atrial fibrillation
(NVAF). Methods: Retrospective analysis identifed patients aged 22-89
years with commercial or Medicare coverage, diagnosed with NVAF, who newly
initiated dabigatran, rivaroxaban, or apixaban between 10/1/2010 and
09/30/2015. Inclusion required 12 months continuous enrollment prior to
the frst NOAC prescription (index date), and 6 months continuous
enrollment after index date (unless death occurred within 6 months).
Pre-index, patients were excluded if they had previous NOAC therapy;
cardiac surgery, pericarditis, or myocarditis 3 months prior to NVAF;
valvular disease; or hyperthyroidism. Those who switched NOAC or had a
proportion of days covered <80% post-index were excluded. Cohorts were
matched 1:1:1 using propensity score matching (PSM). Primary outcomes of
stroke and major bleed occurrence over time, identifed by ICD-9 codes,
were assessed via Kaplan-Meier pairwise hazard ratios. Patients without
event were censored at the earliest occurrence of disenrollment,
discontinuation of index drug, death, or end of study period. Total costs
as per-patient-per-month (PPPM) were compared using Wilcoxon Signed Rank
test. Results: PSM resulted in a sample of 717 patients for each of the
apixaban, dabigatran, and rivaroxaban cohorts (total n=2,151). At
baseline, matched groups were similar except for higher dyspepsia and
coagulopathy rates in the apixaban group. Patients on dabigatran were less
likely to experience a major bleed (HR 0.42, 95% CI 0.18-0.96, p=0.04)
compared to rivaroxaban but not apixaban. Stroke rates were similar across
groups. No statistically signifcant pairwise differences were found
between apixaban, dabigatran, and rivaroxaban in median PPPM costs.
Conclusion: Rivaroxaban was associated with a signifcantly higher risk of
bleeding compared to dabigatran. Apixaban and dabigatran appear to be
comparable options for stroke prophylaxis.

<97>
Accession Number
621784755
Author
Ragalie W.; Stamm K.; Hidestrand P.; Hidestrand M.; Donna M.; Liang H.L.;
Goetsch M.; Stendahl G.; Simpson P.; Katz R.; Tomita-Mitchell A.; Kindel
S.J.; Zangwill S.; Mitchell M.
Institution
(Ragalie, Stamm, Hidestrand, Hidestrand, Donna, Liang, Goetsch, Stendahl,
Simpson, Katz, Tomita-Mitchell, Kindel, Zangwill, Mitchell) Children's
Hospital of Wisconsin, Milwaukee, WI, United States
Title
Novel assay to calculate donor fraction of cell-free dna in heart
transplantation.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Donor fraction (DF) of cell-free DNA (cf-DNA) has been
proposed as a noninvasive surveillance method in heart transplantation. We
present our pilot experience with a novel assay to quantify DF (%) with a
clinically practical throughput and turnaround time. Methods: A blinded
study was performed in which blood samples were collected from heart
transplant recipients at a single center prior to endomyocardial biopsy
(EMB) and coronary angiography. DF of cf-DNA was quantifed using a
targeted approach and compared to biopsy and angiography results using two
distinct methods, with donor genotype (Method 1), and without donor
genotype (Method 2) (TAI Diagnostics, Milwaukee, WI). Results: 158 samples
were associated with EMB. By Method 1, median DF was 0.11% (IQR
0.06-0.21%) in CR0 associated samples, 0.37% (IQR 0.15-0.72%) in CR1
associated samples, and 0.97% (IQR 0.88-1.06%) in CR2 associated samples
(p=0.027). Empirical optimal cutpoint of DF for ruling out CR2 rejection
was 0.87% (95% CI 0.78-0.97% (p=0.009) and area under the curve (AUC) was
0.97. Sensitivity was 100% and specificity was 93%. By Method 2, median DF
was 0.25% (IQR 0.17-0.39%) in CR0 associated samples, 0.89% (IQR
0.44-5.35%) in CR1 associated samples, and 1.22% (IQR 1.04-5.18%) in CR2
associated samples (p<0.001). Empirical optimal cutpoint for ruling out
CR2 rejection was 0.89% (95% CI 0.46-1.70%). AUC was 0.95. Sensitivity was
100% and specificity was 89%. 116 samples were associated with coronary
angiography. By Method 1, median DF was 0.09% (IQR 0.06-0.20%) for samples
not associated with cardiac allograft vasculopathy (CAV) and 0.47% (IQR
0.27-0.71%) for CAV associated samples (p=0.05). By Method 2, median DF
was 0.27% (IQR 0.16-0.52%) for samples not associated with CAV and 0.55%
(IQR 0.38-0.1.22%) for CAV associated samples (p=0.057). Conclusion: DF
quantifcation by a novel assay has excellent sensitivity for acute
cellular rejection and utility in ruling out CAV. We found a stepwise DF
increase among CR0, CR1, and CR2 associated biopsies, suggesting
progressive allograft injury with increasing rejection grades. Paired
sample analysis demonstrates the ability to use this assay in the absence
of donor genotyping.

<98>
Accession Number
621784712
Author
Goel K.; Baheti S.; Akerblom A.; Eriksson N.; Wallentin L.; Goodman S.;
Jenkins G.; Bielinski S.; Roger V.; Rihal C.; Pereira N.
Title
Novel cyp2c19 genetic variants associated with stent thrombosis: A next
generation sequencing study.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background Commonly tested Loss-of-function (LOF) alleles in CYP2C19 are
present in 30-40% of patients who experience stent thrombosis. The
objective of this study was to identify novel genetic variants in CYP2C19
gene associated with stent thrombosis. Methods We included 70 patients
with definite stent thrombosis while on clopidogrel who had stored DNA
samples in our institutional (n=12) or PLATO trial (n=70) biorepository.
Cases were matched 1:1 with controls for age, race, sex, diabetes, type of
stent, and presentation. All controls were on clopidogrel and free of
recurrent events. Clinical Pharmacogenetics (PGx) Implementation
Consortium (CPIC) guidelines were used to determine the list of known PGx
variants and dbSNP version 142 was used to assess novel variants. Whole
exome sequencing was performed using the protocol for Agilent's SureSelect
Human All Exon v5 + UTRs 75 MB kit and additional custom primers were
designed to cover the entire CYP2C19 gene. Results Mean age was 63 +/- 12
years, and 71 % were male. We identified a total of 456 single nucleotide
variants (SNV) in the CYP2C19 gene (cases: 376; controls: 288), of which 5
were synonymous, 6 non-synonymous, 46 indels and 449 intronic SNVs. There
were 168 vs. 80 novel CYP2C19 variants and 10 vs. 5 indels in cases vs.
controls, respectively. Four SNVs (3 missense and 1 synonymous) were
present only in cases, whereas 3 SNVs (1 misssense, 1 synonymous and 1
intron) were unique to controls. There were no detectable differences in
the frequency of LOF CYP2C19*2 allele (cases 34% vs. controls 31 %) or
other CPIC annotated PGx variants in cases and controls. After excluding
the known PGx variants, there were 10 indels (all intronic) out of which 7
were novel in cases and were not present in controls. Conclusion We
describe several novel genetic variants in the CYP2C19 gene in patients
treated with clopidogrel after coronary stenting. We identified 168 novel
SNVs and 10 novel indels in the CYP2C19 gene of patients with stent
thrombosis. Four SNVs and 9 indels were unique to cases. Functional
validation of these CYP2C19 genetic variants may provide important
insights of CYP2C19 and the pathophysiology of stent thrombosis in
clopidogrel treated patients.

<99>
Accession Number
621784585
Author
Yamashita K.; Ranjan R.; Selzman C.; Nan H.; Dosdall D.J.
Institution
(Yamashita, Ranjan, Selzman, Nan, Dosdall) University of Utah, Salt Lake
City, UT, United States
Title
Meta analysis of risk factors for post-operative atrial fibrillation.
Source
Journal of the American College of Cardiology. Conference: 67th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.18. United States. 71 (11 Supplement 1)
(no pagination), 2018. Date of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Atrial fibrillation (AF) is a common arrhythmia following
cardiac surgery and is associated with increased healthcare costs,
complications, and mortality. The etiology of Post-operative Atrial
Fibrillation (POAF) is incompletely understood and its prediction remains
suboptimal. Our purpose is to Identify of risk factors contributing to
POAF is useful for detecting high-risk patients. Methods: A systematic
search of PubMed, MEDLINE, and EMBASE was performed. Twenty four studies
about POAF prediction, published from 2001 to May 2017, were included in
this analysis with a total of 36,834 subjects. Data were pooled using
univariable analysis as hazard ratios (HRs) or odds ratios (ORs) with 95%
confdence intervals (CIs). Twenty-four trials were carried out in the USA
and Europe and 16 studies were prospective cohort studies. Results: The
standardized mean difference (SMD) between POAF and Non-POAF groups was
signifcantly different (reported as SMD: 95% CI) for age (0.55: 0.47 to
0.63), left atrial diameter (0.45: 0.15 to 0.75), and LV ejection fraction
(0.30: 0.14 to 0.47). The pooled odds ratios (reported as OR: 95% CI)
demonstrated that heart failure (1.56: 1.31 to 1.96), chronic obstructive
pulmonary disease (1.36: 1.13 to 1.64), hypertension (1.29: 1.12 to 1.48),
and myocardial infarction (1.18: 1.05 to 1.34) were signifcant predictors
of POAF incidence, while diabetes was marginally signifcant (1.06: 1.00 to
1.13). Conclusion: The present analysis suggested that older age, larger
LAd, lower EF, hypertension, COPD, and HF were signifcant risk factors for
POAF.

<100>
Accession Number
621740386
Author
Shehada S.-E.; Elhmidi Y.; Ozturk O.; Kasel M.; Frangieh A.H.; Mourad F.;
Benedik J.; El Bahi J.; El Gabry M.; Thielmann M.; Jakob H.; Wendt D.
Institution
(Shehada, Mourad, Benedik, El Bahi, El Gabry, Thielmann, Jakob, Wendt)
Department of Thoracic and Cardiovascular Surgery, West-German Heart and
Vascular Center Essen, University of Duisburg-Essen, Duisburg, Germany
(Elhmidi) Department of Cardiovascular Surgery, German Heart Center
Munich, Technical University Munich, Munich, Germany
(Ozturk) Department of Cardiovascular Surgery, Klinikum Bogenhausen,
Munich, Germany
(Kasel, Frangieh) Department of Cardiology, German Heart Center Munich,
Technical University Munich, Munich, Germany
Title
Transcatheter versus surgical aortic valve replacement after previous
cardiac surgery: A systematic review and meta-Analysis.
Source
Cardiology Research and Practice. 2018 (no pagination), 2018. Article
Number: 4615043. Date of Publication: 2018.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aim. Aortic valve replacement (AVR) in patients with prior cardiac surgery
might be challenging. Transcatheter aortic valve replacement (TAVR) offers
a promising alternative in such patients. We therefore aimed at comparing
the outcomes of patients with aortic valve diseases undergoing TAVR versus
those undergoing surgical AVR (SAVR) after previous cardiac surgery.
Methods and Results. MEDLINE, EMBASE, and the Cochrane Central Register
were searched. Seven relevant studies were identified, published between
01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac
surgery (97.6 prior CABG): 49.2 underwent TAVR, whereas 50.8 underwent
SAVR. Incidence of stroke (3.8 versus 7.9, p=0.04) and major bleeding (8.3
versus 15.3, p=0.04) was significantly lower in the TAVR group. Incidence
of mild/severe paravalvular leakage (14.4/10.9 versus 0, p<0.0001) and
pacemaker implantation (11.3 versus 3.9, p=0.01) was significantly higher
in the TAVR group. There were no significant differences in the incidence
of acute kidney injury (9.7 versus 8.7, p=0.99), major adverse
cardiovascular events (8.7 versus 12.3, p=0.21), 30-day mortality (5.1
versus 5.5, p=0.7), or 1-year mortality (11.6 versus 11.8, p=0.97) between
the TAVR and SAVR group. Conclusions. TAVR as a redo procedure offers a
safe alternative for patients presenting with aortic valve diseases after
previous cardiac surgery especially those with prior CABG.<br/>Copyright
&#xa9; 2018 Sharaf-Eldin Shehada et al.