EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
24297433
Authors
Penninga L. Moller C.H. Gustafsson F. Gluud C. Steinbruchel D.A.
Institution
(Penninga) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen, Denmark, DK-2100.
Title
Immunosuppressive T-cell antibody induction for heart transplant
recipients.
Source
The Cochrane database of systematic reviews. 12 (pp CD008842), 2013. Date
of Publication: 2013.
Abstract
Heart transplantation has become a valuable and well-accepted treatment
option for end-stage heart failure. Rejection of the transplanted heart by
the recipient's body is a risk to the success of the procedure, and
life-long immunosuppression is necessary to avoid this. Clear evidence is
required to identify the best, safest and most effective immunosuppressive
treatment strategy for heart transplant recipients. To date, there is no
consensus on the use of immunosuppressive antibodies against T-cells for
induction after heart transplantation. To review the benefits, harms,
feasibility and tolerability of immunosuppressive T-cell antibody
induction versus placebo, or no antibody induction, or another kind of
antibody induction for heart transplant recipients. We searched the
Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2012),
MEDLINE (Ovid) (1946 to November Week 1 2012), EMBASE (Ovid) (1946 to 2012
Week 45), ISI Web of Science (14 November 2012); we also searched two
clinical trial registers and checked reference lists in November 2012. We
included all randomised clinical trials (RCTs) (24/90 (27%) versus 10/95
(11%); RR 2.43; 95% CI 1.01 to 5.86; I(2) 28%). For all of these
differences in acute rejection, trial sequential alpha-spending boundaries
were not crossed and the required information sizes were not reached when
trial sequential analysis was performed, at a high risk of bias. Hence,
more RCTs are needed to assess the benefits and harms of T-cell antibody
induction for heart-transplant recipients. Such trials ought to be
conducted with low risks of systematic and random error.

<2>
Accession Number
24374731
Authors
Bradt J. Dileo C. Potvin N.
Institution
(Bradt) Department of Creative Arts Therapies, College of Nursing and
Health Professions, Drexel University, 1505 Race Street, rm 1041,
Philadelphia, PA, USA, 19102.
Title
Music for stress and anxiety reduction in coronary heart disease patients.
Source
The Cochrane database of systematic reviews. 12 (pp CD006577), 2013. Date
of Publication: 2013.
Abstract
Individuals with coronary heart disease (CHD) often suffer from severe
distress due to diagnosis, hospitalization, surgical procedures,
uncertainty of outcome, fear of dying, doubts about progress in recovery,
helplessness and loss of control. Such adverse effects put the cardiac
patient at greater risk for complications, including sudden cardiac death.
It is therefore of crucial importance that the care of people with CHD
focuses on psychological as well as physiological needs.Music
interventions have been used to reduce anxiety and distress and improve
physiological functioning in medical patients; however its efficacy for
people with CHD needs to be evaluated. To update the previously published
review that examined the effects of music interventions with standard care
versus standard care alone on psychological and physiological responses in
persons with CHD. We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) on The Cochrane Library (2012, Issue 10), MEDLINE
(OvidSP, 1950 to October week 4 2012), EMBASE (OvidSP, 1974 to October
week 5 2012), CINAHL (EBSCOhost, 1982 to 9 November 2012), PsycINFO
(OvidSP, 1806 to October week 5 2012), LILACS (Virtual Health Library,
1982 to 15 November 2012), Social Science Citation Index (ISI, 1974 to 9
November 2012), a number of other databases, and clinical trial registers.
We also conducted handsearching of journals and reference lists. We
applied no language restrictions. We included all randomized controlled
trials and quasi-randomized trials that compared music interventions and
standard care with standard care alone for persons with confirmed CHD. Two
review authors independently extracted data and assessed methodological
quality, seeking additional information from the trial researchers when
necessary. We present results using weighted mean differences for outcomes
measured by the same scale, and standardized mean differences for outcomes
measured by different scales. We used post-intervention scores. In cases
of significant baseline difference, we used change scores (changes from
baseline). We identified four new trials for this update. In total, the
evidence for this review rests on 26 trials (1369 participants). Listening
to music was the main intervention used, and 23 of the studies did not
include a trained music therapist.Results indicate that music
interventions have a small beneficial effect on psychological distress in
people with CHD and this effect is consistent across studies (MD = -1.26,
95% CI -2.30 to -0.22, P = 0.02, I² = 0%). Listening to music
has a moderate effect on anxiety in people with CHD; however results were
inconsistent across studies (SMD = -0.70, 95% CI -1.17 to -0.22, P =
0.004, I² = 77%). Studies that used music interventions in
people with myocardial infarction found more consistent anxiety-reducing
effects of music, with an average anxiety reduction of 5.87 units on a 20
to 80 point score range (95% CI -7.99 to -3.75, P < 0.00001, I²
= 53%). Furthermore, studies that used patient-selected music resulted in
greater anxiety-reducing effects that were consistent across studies (SMD
= -0.89, 95% CI -1.42 to -0.36, P = 0.001, I² = 48%). Findings
indicate that listening to music reduces heart rate (MD = -3.40, 95% CI
-6.12 to -0.69, P = 0.01), respiratory rate (MD = -2.50, 95% CI -3.61 to
-1.39, P < 0.00001) and systolic blood pressure (MD = -5.52 mmHg, 95% CI -
7.43 to -3.60, P < 0.00001). Studies that included two or more music
sessions led to a small and consistent pain-reducing effect (SMD = -0.27,
95% CI -0.55 to -0.00, P = 0.05). The results also suggest that listening
to music may improve patients' quality of sleep following a cardiac
procedure or surgery (SMD = 0.91, 95% CI 0.03 to 1.79, P = 0.04).We found
no strong evidence for heart rate variability and depression. Only one
study considered hormone levels and quality of life as an outcome
variable. A small number of studies pointed to a possible beneficial
effect of music on opioid intake after cardiac procedures or surgery, but
more research is needed to strengthen this evidence. This systematic
review indicates that listening to music may have a beneficial effect on
anxiety in persons with CHD, especially those with a myocardial
infarction. Anxiety-reducing effects appear to be greatest when people are
given a choice of which music to listen to.Furthermore, listening to music
may have a beneficial effect on systolic blood pressure, heart rate,
respiratory rate, quality of sleep and pain in persons with CHD. However,
the clinical significance of these findings is unclear. Since many of the
studies are at high risk of bias, these findings need to be interpreted
with caution. More research is needed into the effects of music
interventions offered by a trained music therapist.

<3>
Accession Number
23720096
Authors
Fredericks S. Yau T.
Institution
(Fredericks) Ryerson University, Toronto, ON, Canada
(Yau) University of Toronto, ON, Canada
Title
Educational Intervention Reduces Complications and Rehospitalizations
After Heart Surgery.
Source
Western Journal of Nursing Research. 35 (10) (pp 1251-1265), 2013. Date of
Publication: November 2013.
Abstract
The effectiveness of in-hospital self-care patient education, delivered to
patients following heart surgery, is questionable, as evidence indicates
individuals are not able to absorb and/or retain information at this time.
In the absence of adequate instruction, individuals will not have the
relevant information to engage in specific self-care behaviors, resulting
in the onset of complications and/or hospital readmissions. The purpose of
this pilot study was to collect preliminary evidence to demonstrate the
impact of an individualized education intervention given above and beyond
usual care, delivered, at two points in time, following hospital
discharge. A randomized controlled trial was used in which 34 patients
were randomly assigned to one of two groups. Chi-square analyses to
examine differences between groups on complications and hospital
readmission rates were conducted. Findings point to the impact of the
intervention in reducing the number of hospital readmissions and
complications at 3 months following hospital discharge. The Author(s)
2013.

<4>
Accession Number
2014214754
Authors
Mrozinski P. Lango R. Biedrzycka A. Kowalik M.M. Pawlaczyk R. Rogowski J.
Institution
(Mrozinski, Lango, Biedrzycka, Kowalik) Department of Cardiac
Anaesthesiology, Medical University of Gdansk, ul. Debinki 7, 80-211
Gdansk, Poland
(Pawlaczyk, Rogowski) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Poland
Title
Comparison of haemodynamics and myocardial injury markers under desflurane
vs propofol anaesthesia for off-pump coronary surgery. A prospective
randomised trial.
Source
Anaesthesiology Intensive Therapy. 46 (1) (pp 4-13), 2014. Date of
Publication: January-March 2014.
Publisher
Via Medica
Abstract
Background: Several studies have highlighted that volatile anaesthetics
improve myocardial protection in cardiopulmonary bypass coronary surgery.
However, the haemodynamic effect of desflurane in off-pump coronary
surgery has not been clarified yet. Our study hypothesis was that
desflurane-fentanyl anaesthesia could decrease myocardial injury markers
and improve haemodynamics compared to propofol-fentanyl in patients
undergoing off-pump coronary surgery. Methods: Design: Prospective
randomised open-label study. Sixty elective patients with left ventricular
ejection fraction above 30% received either desflurane (group D, n = 32)
or propofol (group P, n = 28), in addition to fentanyl and vecuronium
bromide anaesthesia for off-pump coronary surgery. Assessment of
haemodynamic function included thermodilution continuous cardiac output
and right ventricular end diastolic volume. Results: No significant
differences in cardiac output, stroke volume and mean arterial pressure
were noted between groups. The only observed difference in haemodynamic
profile was that group D demonstrated improved stability, expressed as
left ventricular stroke work index (LVSWI). Decrease in LVSWI after
performing distal anastomoses was smaller in D compared to P (median
value: -14.3 and -19.8 [g m m ^-2 beat^-1]),
respectively (P = 0.029). Oxygen uptake index (VO₂I) and oxygen
extraction ratio (OER) after skin incision were lower in D, while blood
lactate concentration was slightly higher after surgery in D compared to
P. The groups did not differ with respect to CK-MB and troponin I
concentration. Conclusions: This study demonstrated no difference between
desflurane and propofol anaesthesia for off-pump coronary surgery in major
haemodynamic parameters, as well as in myocardial injury markers and the
long-term outcome. However, the study indicated that desflurane might
accelerate recovery of myocardial contractility, as assessed by LVSWI.
Lower oxygen uptake and elevated lactate under desflurane anaesthesia
indicated a discrete shift towards anaerobic metabolism. Clinical trial
registration information: NCT00528515 (http://www.clinicaltrials.gov/
ct2/show/NCT00528515?term= NCT00528515&rank = 1).

<5>
Accession Number
2014210202
Authors
Arulkumaran N. Corredor C. Hamilton M.A. Ball J. Grounds R.M. Rhodes A.
Cecconi M. Mahajan R.P.
Institution
(Arulkumaran, Corredor, Hamilton, Ball, Grounds, Rhodes, Cecconi, Mahajan)
Department of Intensive Care Medicine, St George's Hospital, London SW17
0QT, United Kingdom
Title
Cardiac complications associated with goal-directed therapy in high-risk
surgical patients: A meta-analysis.
Source
British Journal of Anaesthesia. 112 (4) (pp 648-659), 2014. Date of
Publication: April 2014.
Publisher
Oxford University Press
Abstract
SummaryPatients with limited cardiopulmonary reserve are at risk of
mortality and morbidity after major surgery. Augmentation of oxygen
delivery index (DO₂I) with i.v. fluids and inotropes
(goal-directed therapy, GDT) has been shown to reduce postoperative
mortality and morbidity in high-risk patients. Concerns regarding cardiac
complications associated with fluid challenges and inotropes may prevent
clinicians from performing GDT in patients who need it most. We
hypothesized that GDT is not associated with an increased risk of cardiac
complications in high-risk, non-cardiac surgical patients. We performed a
systematic search of Medline, Embase, and CENTRAL databases for randomized
controlled trials (RCTs) of GDT in high-risk surgical patients. Studies
including cardiac surgery, trauma, and paediatric surgery were excluded.
We reviewed the rates of all cardiac complications, arrhythmias,
myocardial ischaemia, and acute pulmonary oedema. Meta-analyses were
performed using RevMan software. Data are presented as odds ratios (ORs),
[95% confidence intervals (CIs)], and P-values. Twenty-two RCTs including
2129 patients reported cardiac complications. GDT was associated with a
reduction in total cardiovascular (CVS) complications [OR=0.54,
(0.38-0.76), P=0.0005] and arrhythmias [OR=0.54, (0.35-0.85), P=0.007].
GDT was not associated with an increase in acute pulmonary oedema
[OR=0.69, (0.43-1.10), P=0.12] or myocardial ischaemia [OR=0.70,
(0.38-1.28), P=0.25]. Subgroup analysis revealed the benefit is most
pronounced in patients receiving fluid and inotrope therapy to achieve a
supranormal DO₂I, with the use of minimally invasive cardiac
output monitors. Treatment of high-risk surgical patients GDT is not
associated with an increased risk of cardiac complications; GDT with
fluids and inotropes to optimize DO₂I during early GDT reduces
postoperative CVS complications. The Author [2013].

<6>
Accession Number
2014210125
Authors
Kristeller J.L. Jankowski A. Reinaker T.
Institution
(Kristeller) Department of Pharmacy Practice, Wilkes University, 84 W.
South Street, Wilkes-Barre, PA 18766, United States
(Jankowski) Geisinger Medical Center, Danville, PA, United States
(Reinaker) Department of Pharmacy, York Hospital, York, PA, United States
Title
Role of corticosteroids during cardiopulmonary bypass.
Source
Hospital Pharmacy. 49 (3) (pp 232-236), 2014. Date of Publication: 01 Mar
2014.
Publisher
Facts and Comparisons
Abstract
Corticosteroids are commonly used in the peri-operative setting for
patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The
inflammatory response to CPB is associated with organ dysfunction and
increased mortality. Corticosteroids reduce biochemical inflammatory
markers associated with CPB, however the impact on clinical outcomes is
mixed. The purpose of this article is to evaluate the evidence of changes
in clinical outcomes associated with the peri-operative administration of
corticosteroids in patients undergoing cardiac surgery with CPB.
Randomized, placebo-controlled trials and meta-analyses were reviewed for
evidence evaluating the impact of corticosteroids on clinical outcomes
including mortality, myocardial infarction, atrial fibrillation (AF),
duration of intubation, length of intensive care unit (ICU) or hospital
stay, hyperglycemia, and gastrointestinal complications. Most of the
relevant studies are underpowered to assess major clinical outcomes.
Although corticosteroids likely reduce the risk of AF, this needs to be
evaluated when used in addition to or in lieu of other anti-arrhythmic
agents. Evidence does not equivocally support the use of corticosteroids
to improve clinical outcomes in cardiac surgery patients. 2014 Thomas
Land Publishers, Inc.

<7>
Accession Number
2014210156
Authors
Hutcheson J.D. Aikawa E. Merryman W.D.
Institution
(Hutcheson) Center for Interdisciplinary Cardiovascular Sciences, Brigham
and Women's Hospital, Harvard Medical School, 3 Blackfan Circle, Boston,
MA 02115, United States
(Aikawa) Center for Excellence in Vascular Biology, Brigham and Women's
Hospital, Harvard Medical School, 3 Blackfan Circle, Boston, MA 02115,
United States
(Merryman) Department of Biomedical Engineering, Vanderbilt University,
2213 Garland Avenue, Nashville, TN 37212, United States
Title
Potential drug targets for calcific aortic valve disease.
Source
Nature Reviews Cardiology. 11 (4) (pp 218-231), 2014. Date of Publication:
April 2014.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Calcific aortic valve disease (CAVD) is a major contributor to
cardiovascular morbidity and mortality and, given its association with
age, the prevalence of CAVD is expected to continue to rise as global life
expectancy increases. No drug strategies currently exist to prevent or
treat CAVD. Given that valve replacement is the only available clinical
option, patients often cope with a deteriorating quality of life until
diminished valve function demands intervention. The recognition that CAVD
results from active cellular mechanisms suggests that the underlying
pathways might be targeted to treat the condition. However, no such
therapeutic strategy has been successfully developed to date. One hope was
that drugs already used to treat vascular complications might also improve
CAVD outcomes, but the mechanisms of CAVD progression and the desired
therapeutic outcomes are often different from those of vascular diseases.
Therefore, we discuss the benchmarks that must be met by a CAVD treatment
approach, and highlight advances in the understanding of CAVD mechanisms
to identify potential novel therapeutic targets. 2014 Macmillan
Publishers Limited.

<8>
Accession Number
2014208873
Authors
Fernando D.K. McIntosh A.M. Bladin P.F. Wilson S.J.
Institution
(Fernando, Wilson) Melbourne School of Psychological Sciences, The
University of Melbourne, Parkville 3010, Australia
(McIntosh) Melbourne Brain Centre, Department of Medicine, The Royal
Melbourne Hospital, The University of Melbourne, Melbourne, Australia
(McIntosh, Wilson) Epilepsy Research Centre, Department of Medicine,
Austin Health, The University of Melbourne, Australia
(McIntosh) Department of Neurology, The Royal Melbourne Hospital,
Melbourne, Australia
(McIntosh) Department of Neurology, Austin Health, Melbourne, Australia
(Bladin, Wilson) Comprehensive Epilepsy Program, Austin Health, Melbourne,
Australia
Title
Common experiences of patients following suboptimal treatment outcomes:
Implications for epilepsy surgery.
Source
Epilepsy and Behavior. 33 (pp 144-151), 2014. Date of Publication: April
2014.
Publisher
Academic Press Inc.
Abstract
Few studies have investigated the patient experience of unsuccessful
medical interventions, particularly in the epilepsy surgery field. The
present review aimed to gain insight into the patient experience of
seizure recurrence after epilepsy surgery by examining the broader
literature dealing with suboptimal results after medical interventions
(including epilepsy surgery). To capture the patient experience, the
literature search focused on qualitative research of patients who had
undergone medically unsuccessful interventions, published in English in
scholarly journals. Twenty-two studies were found of patients experiencing
a range of suboptimal outcomes, including seizure recurrence, cancer
recurrence and progression, unsuccessful joint replacement, unsuccessful
infertility treatment, organ transplant rejection, coronary bypass graft
surgery, and unsuccessful weight-loss surgery. In order of frequency, the
most common patient experiences included the following: altered social
dynamics and stigma, unmet expectations, negative emotions, use of coping
strategies, hope and optimism, perceived failure of the treating team,
psychiatric symptoms, and control issues. There is support in the epilepsy
surgery literature that unmet expectations and psychiatric symptoms are
key issues for patients with seizure recurrence, while other common
patient experiences have been implied but not systematically examined.
Several epilepsy surgery specific factors influence patient perceptions of
seizure recurrence, including the nature of postoperative seizures, the
presence of postoperative complications, and the need for increased
postoperative medications. Knowledge of common patient experiences can
assist in the delivery of patient follow-up and rehabilitation services
tailored to differing outcomes after epilepsy surgery. 2014 Elsevier Inc.

<9>
Accession Number
2014210292
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of large randomized trials for mid-term major cardio- and
cerebrovascular events following off-pump versus on-pump coronary artery
bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 522-524),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
To determine whether off-pump coronary artery bypass grafting (CABG)
increases mid-term major adverse cardiovascular (and cerebrovascular)
events MACCE over on-pump CABG, we performed a meta-analysis of exclusive
large randomized controlled trials (RCTs). Databases including MEDLINE,
EMBASE and the Cochrane Central Register of Controlled Trials were
searched through October 2013 using Web-based search engines (PubMed and
OVID). Eligible studies were RCTs of off-pump vs on-pump CABG enrolling
>100 patients in each procedure and reporting MACCE at the time of >1 year
follow-up. Mixed-effects meta-regression analyses were performed to
determine whether the effects of off-pump CABG on MACCE were modulated by
the prespecified factors. Eight RCTs enrolling 10 954 patients were
identified and included. A pooled analysis demonstrated no statistically
significant difference in off-pump and on-pump CABG (hazard ratio, 1.10;
95% confidence interval, 0.93-1.29; P = 0.27). In general, exclusion of
any single study from the analysis did not substantially alter the overall
result of our analysis. There was no evidence of significant publication
bias. Meta-regression coefficients were not statistically significant for
mean age, proportion of men and that of diabetes. In conclusion, off-pump
CABG appears not to increase mid-term MACCE over on-pump CABG. The Author
2013.

<10>
Accession Number
2014210289
Authors
Sastry P. Tocock A. Coonar A.S.
Institution
(Sastry, Tocock, Coonar) Department of Cardiothoracic Surgery, Papworth
Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Adrenalectomy for isolated metastasis from operable non-small-cell lung
cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 495-497),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'in [patients with
isolated adrenal metastasis from operable/operated non-small cell lung
cancer] is [adrenalectomy] superior [to chemo/radiotherapy alone for
achieving long-term survival]?' Altogether >160 papers were found using
the reported search, of which 3 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. We conclude that the body of
evidence is small, retrospective and not formally controlled. As such
interpretation is limited by selection bias in assignment of patients.
These limitations notwithstanding, surgical resection is associated with
prolonged survival for patients with isolated adrenal metastasis from
non-small cell lung cancer (NSCLC). Patient selection is probably
critical. Factors that are important are: otherwise early tumour, node
(TN) status of the lung primary and R0 resection, long disease-free
interval and confidence that there are no other sites of metastasis.
Patients with ipsilateral adrenal metastasis may derive the greatest
survival benefit from adrenalectomy, since spread to the ipsilateral gland
may occur via direct lymphatic channels in the retroperitoneum.
Involvement of the contralateral adrenal may signify haematogenous spread
and therefore, a more aggressive process. Adrenalectomy must be
accompanied by regional lymph node clearance to reduce the chance of
further spread from the adrenal itself. The Author 2013.

<11>
Accession Number
2014210288
Authors
Ogutu P. Werner R. Oertel F. Beyer M.
Institution
(Ogutu, Oertel, Beyer) Department of Cardiothoracic Surgery, Klinikum
Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
(Werner) Department of Cardiovascular Surgery, Herz-Neuro-Zentrum
Bodensee, Kreuzlingen, Switzerland
Title
Should patients with asymptomatic significant carotid stenosis undergo
simultaneous carotid and cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 511-518),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiovascular surgery was written according to a
structured protocol. The question addressed was whether patients with
severe asymptomatic carotid and coronary artery diseases should undergo
simultaneous carotid endarterectomy (CEA) and coronary artery bypass
grafting (CABG). A total of 624 papers were found using the reported
search, of which 20 represent the best evidence to answer the clinical
question. The author, journal, date and country of publication, patient
group studied, study type, relevant outcomes, results and study results of
these papers are tabulated. Previous cohort studies showed mixed results,
while advocating for the necessity of a randomized controlled trial (RCT).
A recent RCT showed that patients undergoing prophylactic or simultaneous
CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1-3
months after CABG (7.7%), without significant perioperative mortality
difference. This study included patients with unilateral severe (>70%)
asymptomatic carotid stenosis requiring CABG. An earlier partly randomized
trial also showed better outcomes for patients undergoing simultaneous
procedures (P = 0.045). Interestingly, systematic reviews previously
failed to show compelling evidence supporting prophylactic CEA. This could
be partly due to the fact that these reviews collectively analyse
different cohort qualities. Neurological studies have, however, shown
reduced cognitive and phonetic quality and function in patients with
unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one
RCTs comparing lone carotid artery stenting (CAS) and CEA informed the
American Heart Association guidelines, which declared CAS comparable with
CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the
risk of death/stroke for CAS alone is double that for CEA alone in the
acute phase following onset of symptoms, while CEA alone is associated
with a doubled risk of myocardial infarction. There is, however, no
significant difference for combined 30-day risk of death/stroke/myocardial
infarction. Outcomes of hybrid or simultaneous CAS/CABG procedures show
comparable results, albeit from rather small cohorts. While current
evidence leans towards simultaneous CEA/CABG, the emergence of hybrid
operating theatres in various institutions may allow larger cohorts with
subsequent significant data on simultaneous CAS/CABG. A randomized
controlled trial comparing both approaches would be crucial in informing
future updates of existing guidelines. The Author 2013.

<12>
Accession Number
2014210286
Authors
Zakkar M. Kanagasabay R. Hunt I.
Institution
(Zakkar, Kanagasabay, Hunt) Department of Cardiothoracic, St. George's
Hospital, Blackshaw Road, SW17 0QT London, United Kingdom
Title
No evidence that manual closure of the bronchial stump has a lower failure
rate than mechanical stapler closure following anatomical lung resection.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 488-493),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether manual closure of
the bronchial stump is safer with lower failure rates than mechanical
closure using a stapling device following anatomical lung resection. One
hundred and twenty-nine papers were identified using the search below.
Eight papers presented the best evidence to answer the clinical question
as they included sufficient number of patients to reach conclusions
regarding the issues of interest for this review. Complications,
complication rates and operation time were included in the assessment. The
author, journal, date and country of publication, patient group studied,
study type, relevant outcomes, results and study weaknesses of the papers
are tabulated. When looking at manual vs mechanical staples, it was noted
that stapler failure can occur in around 4% of cases. The rate of
bronchopleural fistula (BPF) development varied more in patients who
underwent manual closure (1.5-12.5%) than in patients who underwent
mechanical closure (1-5.7%). Although most of the studies reviewed showed
no statistical differences between manual and mechanical closure in terms
of BPF development, one study, however, showed that manual closure was
significantly associated with lower numbers of postoperative BPF, while
another study showed that mechanical closure is significantly associated
with lower incidence of BPF. When looking at the role of the learning
curve and training opportunities, it seems that the surgeon's inexperience
when using mechanical staples can contribute to BPF development. A
surgeon's experience can play a major role in the prevention of BPF
development in patients having manual closure. Manual closure can provide
a cheap and reliable technique when compared with costs incurred from
using staplers, it is applicable in all situations and can be taught to
surgeons in training with an acceptable risk. However, there is a lack of
evidence to suggest that manual closure is better than mechanical stapler
closure following anatomical lung resection. The Author 2013.

<13>
Accession Number
2014215569
Authors
Choquet S. Varnous S. Deback C. Golmard J.L. Leblond V.
Institution
(Choquet, Leblond) Clinical Hematology Unit, CHU la Pitie Salpetriere
Hospital, APHP, Paris, France
(Varnous) Department of Heart Surgery, CHU la Pitie Salpetriere Hospital,
APHP, Paris, France
(Deback) Virology Laboratory, CHU la Pitie Salpetriere Hospital, APHP,
Paris, France
(Golmard) Department of Biostatistics, CHU la Pitie Salpetriere Hospital,
APHP, Paris, France
Title
Adapted treatment of epstein-barr virus infection to prevent
posttransplant lymphoproliferative disorder after heart transplantation.
Source
American Journal of Transplantation. 14 (4) (pp 857-866), 2014. Date of
Publication: April 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Up to 35% of posttransplant lymphoproliferative disorder (PTLD) cases
occur within 1 year of transplantation, and over 50% are associated with
Epstein-Barr virus (EBV). EBV primary infection and reactivation are PTLD
predictive factors, but there is no consensus for their treatment. We
conducted a prospective single-center study on 299 consecutive
heart-transplant patients treated with the same immunosuppressive regimen
and monitored by repetitive EBV viral-load measurements and endomyocardial
biopsies to detect graft rejection. Immunosuppression was tapered on EBV
reactivation with EBV viral loads >10⁵copies/mL or primary
infection. In the absence of response at 1 month or a viral load
>10⁶copies/mL, patients received one rituximab infusion
(375mg/m²). All patients responded to treatment without
increased graft rejection. One primary infection case developed a possible
PTLD, which completely responded to diminution of immunosuppression, and
one patient, whose EBV load was unevaluable, died of respiratory
complications secondary to PTLD. Compared with a historical cohort of 820
patients, PTLD incidence was decreased (p=0.033) by a per-protocol
analysis. This is the largest study on EBV primary infection/reactivation
treatment, the first using rituximab following solid organ transplantation
to prevent PTLD and the first to demonstrate an acceptable tolerability
profile in this setting. Copyright 2014 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<14>
Accession Number
2014209147
Authors
Pandit A. Aryal M.R. Pandit A.A. Jalota L. Kantharajpur S. Hakim F.A. Lee
H.R.
Institution
(Pandit, Pandit, Hakim, Lee) Division of Cardiovascular Diseases, Mayo
Clinic, Scottsdale Arizona, United States
(Aryal, Jalota) Department of Internal Medicine, Reading Health System,
West Reading, PA, United States
(Kantharajpur) Department of Medicine, Huntsville Hospital, Alabama,
United States
Title
Amplatzer PFO Occluder Device may Prevent Recurrent Stroke in Patients
with Patent Foramen Ovale and Cryptogenic Stroke: A Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. 23 (4) (pp 303-308), 2014. Date of
Publication: April 2014.
Publisher
Elsevier BV
Abstract
Objective: To review efficacy of percutaneous closure of patent foramen
ovale compared with medical therapy in prevention of recurrent strokes in
patients with cryptogenic stroke. Methods and Results: Electronic
databases; PUBMED, EMBASE, Cochrane registry and web of knowledge were
searched for relevant studies. In three randomised clinical trials
involving 2303 participants, risk of the recurrent strokes (pooled HR
0.62, 95% CI=0.36-1.07, P=0.09, I² =10%) did not show benefit
with device closure when compared with medical therapy group on
meta-analysis of all three trials. However, on sensitivity analysis in
trials using Amplatzer PFO occluder device, the closure of PFO was
associated with significantly lower recurrent strokes (pooled HR=0.44, 95%
CI=0.21-0.94, P=0.03, I²=0%) compared with medical therapy.
Conclusion: The closure of PFO with Amplatzer PFO occluder device was
associated with significant reduction in recurrent strokes in patients
with cryptogenic stroke and patent foramen ovale. The better outcome in
prevention of secondary stroke in patients with cryptogenic stroke and PFO
may be associated with type of closure device used. 2013 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<15>
Accession Number
2014209108
Authors
De Luca G. Schaffer A. Verdoia M. Suryapranata H.
Institution
(De Luca, Schaffer, Verdoia) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting
stents in diabetic patients with multivessel coronary artery disease.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 24 (4) (pp 344-354),
2014. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
Background and aim: Clinical trials have reported lower mortality and
repeated revascularization rate in diabetic patients treated with coronary
artery bypass grafting (CABG) as compared to percutaneous
revascularization. However, these studies were conducted in the era of
bare-metal stents. Therefore, we performed a meta-analysis to compare CABG
to PCI with drug-eluting stents (DES) in diabetic patients with
multivessel and/or left main disease. Methods and results: The literature
was scanned by formal search of electronic databases (Medline, EMBASE, and
Cochrane databases), and major international scientific session abstracts
from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4
randomized and 10 non-randomized) trials were finally included, with a
total of 7072 patients. Up to 5 years follow-up, CABG was associated with
a reduction in mortality (7.3% vs 10.4%, OR[95%CI]=0.65[0.55-0.77],
p<0.0001; phet=0.00001), with similar results in both RCTs
(OR[95%CI]=0.64[0.50-0.82], p=0.0005) and NRCTs
(OR[95%CI]=0.75[0.6-0.94)], p=0.01) (p int=0.93). A significant
relationship was observed between risk profile and benefits in mortality
with CABG (p<0.001). CABG reduced target vessel revascularization (TVR;
5.2% vs 15.7%, OR[95%CI]=0.30[0.25-0.36], p<0.00001, p het=0.02), with a
relationship between risk profile and the benefits from CABG as compared
to DES (p<0.0001). CABG was associated with a lower rate of MACCE (14.9%
vs 22.9%, OR[95%CI]=0.59[0.51-0.67], p<0.00001, p het<0.00001) but higher
risk of CVA (3.6% vs 1.4%, OR[95%CI]=2.34[1.63-3.35], p<0.00001, p
het=0.71). Conclusions: The present meta-analysis demonstrates that among
diabetic patients with multivessel disease and/or left main disease, CABG
provides benefits in mortality and TVR, especially in high-risk patients
but it is counterbalanced by a higher risk of stroke. Future trials are
certainly needed in the era of new DES and improved antiplatelet
therapies. 2013 Elsevier B.V.

<16>
Accession Number
2014209481
Authors
Hakim F.A. Aryal M.R. Pandit A. Pandit A.A. Alegria J.R. Kendall C.B.
Click R.L.
Institution
(Hakim, Pandit, Pandit, Alegria, Kendall) Division of Cardiovascular
Diseases, Department of Medicine, Mayo Clinic College of Medicine, 13400 E
Shea Blvd, Scottsdale, AZ 85259, United States
(Aryal) Department of Internal Medicine, Reading Health System, West
Reading, PA, United States
(Click) Division of Cardiovascular Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
Title
Papillary fibroelastoma of the pulmonary valve - A systematic review.
Source
Echocardiography. 31 (2) (pp 234-240), 2014. Date of Publication: February
2014.
Publisher
Blackwell Publishing Inc.
Abstract
The pulmonary valve is the least affected site for valvular papillary
fibroelastoma. With increasing use of routine echocardiography and other
modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE)
are being recognized more frequently. PVPFE is more often an incidental
diagnosis and symptomatic patients usually present with shortness of
breath. Embolic phenomena and right ventricular outflow tract obstruction
are the most serious complications of PVPFE. Since PVPFE is rare, the
purpose of this systematic review is to address demographic
characteristics, the clinical presentation, management, and outcome of
this benign tumor of the pulmonary valve. 2013, Wiley Periodicals, Inc.

<17>
Accession Number
2014212718
Authors
Stefanelli F. Meoli I. Cobuccio R. Curcio C. Amore D. Casazza D. Tracey M.
Rocco G.
Institution
(Stefanelli, Meoli, Cobuccio) Division of Pneumology, AORN Dei Colli
'Monaldi Hospital', Naples, Italy
(Curcio, Amore, Casazza) Division of Thoracic Surgery, AORN Dei Colli
'Monaldi Hospital', Naples, Italy
(Tracey, Rocco) Division of Thoracic Surgery, Istituto Nazionale dei
Tumori 'Pascale Foundation', Naples, Italy
Title
High-intensity training and cardiopulmonary exercise testing in patients
with chronic obstructive pulmonary disease and non-small-cell lung cancer
undergoing lobectomy.
Source
European Journal of Cardio-thoracic Surgery. 44 (4) (pp e260-e265), 2013.
Article Number: ezt375. Date of Publication: October 2013.
Publisher
Elsevier
Abstract
OBJECTIVES: Peak VO₂, as measure of physical performance is
central to a correct preoperative evaluation in patients with both
nonsmall- cell lung cancer (NSCLC) and chronic obstructive pulmonary
disease (COPD) because it is closely related both to operability criteria
and the rate of postoperative complications. Strategies to improve peak
VO₂, as a preoperative pulmonary rehabilitation programme
(PRP), should be considered favourably in these patients. In order to
clarify the role of pulmonary rehabilitation, we have evaluated the
effects of 3-week preoperative high-intensity training on physical
performance and respiratory function in a group of patients with both
NSCLC and COPD who underwent lobectomy. METHODS: We studied 40 patients
with both NSCLC and COPD, age < 75 years, TNM stages I-II, who underwent
lobectomy. Patients were randomly divided into two groups (R and S): Group
R underwent an intensive preoperative PRP, while Group S underwent only
lobectomy. We evaluated peak VO₂ in all patients at Time 0
(T0), after PRP/before surgery in Group R/S (T1) and 60 days after
surgery, respectively, in both groups (T2). RESULTS: There was no
difference between groups in peak VO₂ at T0, while a
significant difference was observed both at T1 and T2. In Group R, peak
VO₂ improves significantly from T0 to T1: 14.9 + 2.3-17.8 + 2.1
ml/kg/min + standard deviation (SD), P < 0.001 (64.5 + 16.5- 76.1 + 14.9%
predicted + SD, P < 0.05) and deteriorates from T1 to T2: 17.8 + 2.1-15.1
+ 2.4, P < 0.001 (76.1 + 14.9-64.6 + 15.5, P < 0.05), reverting to a
similar value to that at T0, while in Group S peak VO₂ did not
change from T0 to T1 and significantly deteriorates from T1 to T2: 14.5 +
1.2-11.4 + 1.2 ml/kg/min + SD, P < 0.00001 (60.6 + 8.4-47.4 + 6.9%
predicted + SD, P < 0.00001). CONCLUSIONS: PRP was a valid preoperative
strategy to improve physical performance in patients with both NSCLC and
COPD and this advantage was also maintained after surgery. The Author
2013.The Author 2013. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
2014212679
Authors
Taioli E. Leea D.-S. Lesserc M. Floresa R.
Institution
(Taioli, Leea, Floresa) Division of Thoracic Surgery, Mount Sinai Medical
Center, 1190 Fifth Avenue, Box 1028, New York, NY 10029, United States
(Taioli) Epidemiology Program, North Shore LIJ-Hofstra School of Medicine,
New York, NY, United States
(Lesserc) Center for Biostatistics, North Shore LIJ-Hofstra School of
Medicine, New York, NY, United States
Title
Long-term survival in video-assisted thoracoscopic lobectomy vs open
lobectomy in lung-cancer patients: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 44 (4) (pp 591-597), 2013.
Article Number: ezt051. Date of Publication: October 2013.
Publisher
Elsevier
Abstract
Video-assistedthoracicsurgery (VATS) lobectomy is an appealing alternative
to open lobectomy via thoracotomy for non-small-cell lung cancer. However,
there is no clear consensus in regard to the superior approach for
long-term outcomes. The data are limited to small series, which precludes
further clarification. Meta-analysis of these studies was performed in
order to obtain a more objective determination of the oncological
feasibility of VATS lobectomy. A systematic review of the PubMed and
Embase databases was performed. Twenty observational studies reporting
long-term outcomes were included, involving 2106 VATS and 2661 thoracotomy
patients. There was an advantage in long-term mortality for patients who
underwent VATS vs patients who underwent thoracotomy (meta difference in
survival: 5%; 95% CI: 3-6%) with large heterogeneity among studies (Q =
42.6; P-value: 0.001; I² = 55.7%). There was no evidence of
publication bias. Compared with open lobectomy, VATS lobectomy appears to
have improved long-term outcomes. The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<19>
Accession Number
2014206305
Authors
Forcillo J. Perrault L.P.
Institution
(Forcillo, Perrault) Cardiac Surgery Department, Montreal Heart Institute,
Universite de Montreal, Canada
Title
Armentarium of topical hemostatic products in cardiovascular surgery: An
update.
Source
Transfusion and Apheresis Science. 50 (1) (pp 26-31), 2014. Date of
Publication: February 2014.
Publisher
Elsevier Ltd
Abstract
Within Canada, 2.6. million in-hospital surgical procedures are completed
annually. Significant bleeding following is the most common surgical
complication, occurring in up to 25% of all surgeries. Bleeding causes
increased mortality and morbidity, by increasing the number of
transfusions required, secondary to increased cumulative blood loss, and
by causing hemodynamic instability. A solution to this issue encountered
during surgery is the use of hemostatic products. The objectives of this
manuscript are (1) to review the spectrum of hemostatic products available
in cardiovascular surgery and (2) to provide an update on new topical
products soon available, or in development, for optimizing hemostasis
during surgical procedures. 2014 Elsevier Ltd.

<20>
Accession Number
2014209306
Authors
Stanger O. Aigner I. Schimetta W. Wonisch W.
Institution
(Stanger, Aigner) Department of Cardiac Surgery, Research, Amino Acid
Metabolism, Paracelsus Medical University Salzburg, Salzburg, Austria
(Schimetta) Institute of Systems Sciences, University of Linz, Linz, Upper
Austria, Austria
(Wonisch) Clinical Institute of Medical and Chemical Laboratory
Diagnostics, Medical University of Graz, Graz, Styria, Austria
(Wonisch) Institute of Physiological Chemistry, Center for Physiological
Medicine, Medical University of Graz, Graz, Styria, Austria
(Stanger) Clinical Research and Development INSELSPITAL, Department of
Caldiovascular Surgery, Bern University Hospital, Bern, Bern, Switzerland
Title
Antioxidant supplementation attenuates oxidative stress in patients
undergoing coronary artery bypass graft surgery.
Source
Tohoku Journal of Experimental Medicine. 232 (2) (pp 145-154), 2014. Date
of Publication: February 2014.
Publisher
Tohoku University Medical Press
Abstract
Ischemia-reperfusion has been reported to be associated with augmented
oxidative stress in the course of surgery, which might be causally
involved in the onset of atrial fibrillation (AF), the most common
arrhythmia after cardiac surgery. We hypothesized that supplementation of
antioxidants and n-3 polyunsaturated fatty acids (n-3 PUFAs) might lower
the incidence of AF following coronary artery bypass graft (CABG) surgery.
In the present study, by monitoring oxidative stress in the course of CABG
surgery, we analyzed the efficacy of vitamins (ascorbic acid and alpha
-tocopherol) and/or n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic
acid). Subjects (n = 75) were divided into 4 subgroups: control, vitamins,
n-3 PUFAs, and a combination of vitamins and n-3 PUFAs. Fluorescent
techniques were used to measure the antioxidative capacity, i.e. ability
to inhibit oxidation. Total peroxides, endogenous peroxidase activity, and
antibodies against oxidized LDL (oLAb) were used as serum oxidative stress
biomarkers. Post-operative increase in oxidative stress was associated
with the consumption of antioxidants and a simultaneous onset of AF. This
was confirmed through an increased peroxide level and a decreased oLAb
titer in control and n-3 PUFAs groups, indicating the binding of
antibodies to oxidative modified epitopes. In both subgroups that were
supplemented with vitamins, total peroxides decreased, and the maintenance
of a constant IgG antibody titer was facilitated. However, treatment with
vitamins or n-3 PUFAs was inefficient with respect to AF onset and its
duration. We conclude that the administration of vitamins attenuates
post-operative oxidative stress in the course of CABG surgery. 2014
Tohoku University Medical Press.

<21>
Accession Number
2014205552
Authors
Ziabakhsh-Tabary S. Jalalian R. Mokhtari-Esbuie F. Habibi M.R.
Institution
(Ziabakhsh-Tabary) Department of Cardiac Surgery, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Jalalian) Department of Cardiovascular, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Mokhtari-Esbuie) Fatemeh Zahra Hospital, Mazandaran University of Medical
Science, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Fatemeh Zahra Hospital, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Echocardiographic evaluation of the effects of a single bolus of
erythropoietin on reducing ischemia-reperfusion injuries during coronary
artery bypass graft surgery; a randomized, double-blind, placebo-control
study.
Source
Iranian Journal of Medical Sciences. 39 (2) (pp 94-101), 2014. Date of
Publication: 2014.
Publisher
Shiraz University of Medical Sciences
Abstract
Background: Erythropoietin (EPO) is known as a regulating hormone for the
production of red blood cells, called erythropoiesis. Some studies have
shown that EPO exerts some non-hematopoietic protective effects on
ischemia-reperfusion injuries in myocytes. Using echocardiography, we
evaluated the effect of EPO infusion on reducing ischemia-reperfusion
injuries and improvement of the cardiac function shortly after coronary
artery bypass graft surgery (CABG). Methods: Forty-three patients were
recruited in this study and randomly divided into two groups: the EPO
group, receiving standard medication and CABG surgery plus EPO (700 IU/
kg), and the control group, receiving standard medication and CABG surgery
plus normal saline (10 cc) as placebo. The cardiac function was assessed
through echocardiography before as well as at 4 and 30 days after CABG.
Results: Echocardiography indicated that the ejection fraction had no
differences between the EPO and control groups at 4 days (47.05+6.29 vs.
45.90+4.97; P=0.334) and 30 days after surgery (47.27+28 vs. 46.62+5.7;
P=0.69). There were no differences between the EPO and control groups in
the wall motion score index at 4 (P=0.83) and 30 days after surgery
(P=0.902). In the EPO group, there was a reduction in left ventricular
end-systolic and end-diastolic diameters (LVESD and LVEDD, respectively),
as compared to the control group. Conclusion: Our results indicated that
perioperative exogenous EPO infusion could not improve the ventricular
function and wall motion index in the immediate post-CABG weeks.
Nevertheless, a reduction in LVEDD and LVESD at 4 days and 30 days after
CABG in the EPO group, by comparison with the control group, suggested
that EPO correlated with a reduction in the remodeling of myocytes and
reperfusion injuries early after CABG.

<22>
Accession Number
2014200995
Authors
Lupi A. Rognoni A. Secco G.G. Lazzero M. Nardi F. Fattori R. Bongo A.S.
Agostoni P. Sheiban I.
Institution
(Lupi, Rognoni, Lazzero, Nardi, Bongo) Hospital Cardiology, Maggiore della
Carita Hospital, Novara, Italy
(Secco) Department of Clinical and Experimental Medicine, University of
Eastern Piedmont, Maggiore della Carita Hospital, Novara, Italy
(Secco, Fattori) Division of Interventional Cardiology, Ospedali Riuniti
Marche Nord, Pesaro, Italy
(Agostoni) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Sheiban) Interventional Cardiology, Division of Cardiology, University of
Turin, Turin, Italy
Title
Biodegradable versus durable polymer drug eluting stents in coronary
artery disease: Insights from a meta-analysis of 5834 patients.
Source
European Journal of Preventive Cardiology. 21 (4) (pp 411-424), 2014. Date
of Publication: April 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: Biodegradable polymer drug eluting stents (BP-DES) have been
developed to overcome the limitations of first generation durable polymer
DES (DP-DES) but the clinical results of different BP-DES are not
consistent. We performed a meta-analysis to compare the outcomes of BP-DES
and DP-DES in the treatment of coronary artery disease (CAD). Methods and
results: Online databases including MEDLINE were searched for studies
comparing BP-DES and DP-DES for obstructive CAD that reported rates for
overall mortality, myocardial infarction (MI), late stent thrombosis
(LST), target lesion revascularization (TLR) and late lumen loss (LLL)
with a follow-up of >6 months. Ten studies (5834 patients) with a 1-year
median follow-up were included in the meta-analysis. When comparing
patients treated with DP-DES and BP-DES those treated with BP-DES had
lower LLL (in-stent: weighted mean difference (WMD) -0.10 mm, 95% CI=-0.17
to -0.03 mm, 0.004; in-segment: WMD >0.06 mm, 95% CI=-0.10 to -0.01 mm,
0.01) with lower TLR rates (OR 0.67, 95% CI=-0.47 to 0.98, 0.04). However,
BP-DES did not improve mortality (OR 0.97, 95% CI=-0.73 to 1.29, 0.83), MI
(OR 1.13, 95% CI=-0.87 to 1.46, 0.36) or LST rates (OR 0.64, 95% CI=-0.36
to 1.16, 0.14). A pre-specified subgroup analysis of Biolimus BP-DES
confirmed significant LLL reduction without differences in other clinical
endpoints. Meta-regression analysis demonstrated a strong significant
inverse correlation between LLL and reference coronary diameter (p
<0.001). Conclusions: Our present meta-analysis showed that BP-DES when
compared with DP-DES significantly reduced LLL and TVR but without clear
benefits on mortality, MI and LST rates. (Clinicaltrials.gov identifier:
NCT01466634). The European Society of Cardiology 2012.

<23>
Accession Number
2014203365
Authors
Bertolaccini L. Viti A. Cavallo A. Terzi A.
Institution
(Bertolaccini, Viti, Cavallo, Terzi) Division of Thoracic Surgery, S.
Croce e Carle Hospital, Cuneo, Italy
Title
Results of Li-Tho trial: A prospective randomized study on effectiveness
of ligasure in lung resections.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 693-698), 2014.
Article Number: ezt445. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
OBJECTIVE: The role of electro-thermal bipolar tissue sealing system
(LigaSure. (LS); Covidien, Inc., CO, USA) in thoracic surgery is still
undefined. Reports of its use are still limited. The objective of the
trial was to evaluate the cost and benefits of LS in major lung resection
surgery. METHODS: A randomized blinded study of a consecutive series of
100 patients undergoing lobectomy was undertaken. After muscle-sparing
thoracotomy and classification of lung fissures according to Craig-Walker,
patients with fissure Grade 2-4 were randomized to Stapler group or LS
group fissure completion. Recorded parameters were analysed for
differences in selected intraoperative and postoperative outcomes.
Statistical analysis was performed with the bootstrap method. Pearson's
chi² test and Fisher's exact test were used to calculate
probability value for dichotomous variables comparison. Cost-benefit
evaluation was performed using Pareto optimal analysis. RESULTS: There
were no significant differences between groups, regarding demographic and
baseline characteristics. No patient was withdrawn from the study; no
adverse effect was recorded. There was no mortality or major complications
in both groups. There were no statistically significant differences as to
operative time or morbidity between patients in the LS group compared with
the Stapler group. In the LS group, there was a not statistically
significant increase of postoperative air leaks in the first 24
postoperative hours, while a statistically significant increase of
drainage amount was observed in the LS group. No statistically significant
difference in hospital length of stay was observed. Overall, the LS group
had a favourable multi-criteria analysis of cost/benefit ratio with a good
'Pareto optimum'. CONCLUSIONS: LS is a safe device for thoracic surgery
and can be a valid alternative to Staplers. In this setting, LS allows
functional lung tissue preservation. As to costs, LS seems equivalent to
Staplers. The Author 2013. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<24>
Accession Number
2014203356
Authors
Bertholdt S. Latal B. Liamlahi R. Pretre R. Scheer I. Goetti R. Dave H.
Bernet V. Schmitz A. Von rhein M. Knirsch W. Sennhauser F.H. Plecko B.R.
Kretschmar O. Batinic K. Dimitropoulos A. Kellenberger C. Makki M. Hug
M.I. Burki C. Weiss M. Hagmann C.
Institution
(Bertholdt, Liamlahi, Knirsch) Pediatric Cardiology, University Children's
Hospital, Zurich, Switzerland
(Latal, Von rhein) Child Development Center, University Children's
Hospital, Zurich, Switzerland
(Pretre, Dave) Congenital Cardiovascular Surgery, University Children's
Hospital, Zurich, Switzerland
(Scheer, Goetti) Diagnostic Imaging, University Children's Hospital,
Zurich, Switzerland
(Bernet) Pediatric Intensive Care and Neonatology, University Children's
Hospital, Zurich, Switzerland
(Schmitz) Anaesthesia, University Children's Hospital, Zurich, Switzerland
(Sennhauser) University Children's Hospital, Pediatrics, Zurich,
Switzerland
(Hagmann) University Hospital Zurich, Neonatology, Switzerland
Title
Cerebral lesions on magnetic resonance imaging correlate with preoperative
neurological status in neonates undergoing cardiopulmonary bypass surgery.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 625-632), 2014.
Article Number: ezt422. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
Objectives: To determine the prevalence, spectrum and course of cerebral
lesions in neonates with congenital heart disease (CHD) undergoing full
flow cardiopulmonary bypass (CPB) surgery using magnetic resonance imaging
(MRI) and to examine the correlation between cerebral lesions and clinical
neurological abnormalities. Methods: Prospective cohort study of neonates
with d-transposition of the great arteries (n = 22), univentricular heart
malformation with hypoplastic aortic arch (n = 6) and aortic arch
obstructions (n = 2) undergoing CPB. Neonates underwent cerebral MRI and
blinded standardized neurological examination before (median day 6) and
after surgery (day 13). The MRI findings were compared with those of 20
healthy controls. Results: Preoperative cerebral lesions were present in 7
of 30 patients (23%) with isolated mild or moderate white matter injury
(WMI) (n = 4), isolated small cerebral stroke (n = 1) and combined WMI and
stroke (n = 2). None of the healthy controls had cerebral lesions on MRI.
CHD neonates with preoperative cerebral lesions had more neurological
abnormalities (P = 0.01) than neonates without cerebral lesions. Low
arterial oxygen saturation (P = 0.03) was a risk factor for preoperative
cerebral lesions, while balloon atrioseptostomy (P = 0.19) was not. After
surgery, preoperative cerebral lesions persisted in 5 of 7 neonates, and 2
neonates (7%) showed signs of additional WMI in their postoperative MRI.
Conclusions: In neonates with severe CHD, WMI was the predominant
preoperative finding, while cerebral strokes were less frequent. New
postoperative lesions were rare. Preoperative neurological abnormalities
correlated with the presence of cerebral lesions on MRI. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
71397588
Authors
Cao C. Manganas C. Ang S. Yan T.D.
Institution
(Cao, Ang, Yan) Systematic Reviews Unit, Collaborative Research Group,
Australia
(Manganas) Cardiothoracic Surgery, St. George Hospital, Australia
Title
A systematic review and meta-analysis on pulmonary resections by robotic
videoassisted thoracic surgery.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S1121), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: Pulmonary resection by robotic-video assisted thoracic surgery
(RVATS) has been performed for selected patients in specialized centers
over the past decade. Despite encouraging results from case-series
reports, there remains a lack of robust clinical evidence for this
relatively novel surgical technique. The present systematic review aimed
to assess the short- and longterm safety and efficacy of RVATS. Methods:
Nine relevant and updated studies were identified from 12 institutions
using five electronic databases. Endpoints included perioperative
morbidity and mortality, conversion rate, operative time, length of
hospitalization, intraoperative blood loss, duration of chest drainage,
recurrence rate and long-term survival. In addition, cost analyses and
quality of life assessments were also systematically evaluated.
Comparative outcomes were meta-analyzed when data were available. Results:
All institutions used the same master-slave robotic system (da Vinci,
Intuitive Surgical, Sunnyvale, California) and most patients underwent
lobectomies for early-stage non-small cell lung cancers. Perioperative
mortality rates for patients who underwent pulmonary resection by RVATS
ranged from 0 - 3.8%, whilst overall morbidity rates ranged from 10 - 39%.
Two propensity-score analyses compared patients with malignant disease who
underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis
was performed to identify a trend towards fewer complications after RVATS.
In addition, one cost analysis and one quality of life study reported
improved outcomes for RVATS when compared to open thoracotomy. Conclusion:
Results of the present systematic review suggest that RVATS is feasible
and can be performed safely for selected patients in specialized centers.
Perioperative outcomes including postoperative complications were similar
to historical accounts of conventional VATS. A steep learning curve for
RVATS was identified in a number of institutional reports, which was most
evident in the first 20 cases. Future studies should aim to present data
with longer follow-up, clearly defined surgical outcomes, and through an
intention-to-treat analysis. (Table presented) .

<26>
Accession Number
71397062
Authors
Cao C. Manganas C. Ang S. Peeceeyen S. Yan T.D.
Institution
(Cao, Ang, Yan) Systematic Reviews Unit, Collaborative Research Group,
Australia
(Manganas, Peeceeyen) Cardiothoracic Surgery, St. George Hospital,
Australia
Title
Video-assisted thoracic surgery versus open thoracotomy for non-small cell
lung cancer-a meta-analysis of propensity score matched patients.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S824), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: This meta-analysis aims to compare the perioperative outcomes
of video-assisted thoracic surgery (VATS) versus open thoracotomy for
propensity score-matched patients with early stage non-small cell lung
cancer (NSCLC). Methods: Four relevant studies with propensity
score-matched patients were identified from six electronic databases.
Endpoints included perioperative mortality and morbidity, individual
postoperative complications and duration of hospitalization. Results:
indicate that all-cause perioperative mortality was similar between VATS
and open thoracotomy. However, patients who underwent VATS were found to
have significantly fewer overall complications, and significantly lower
rates of prolonged air leak, pneumonia, atrial arrhythmias and renal
failure. In addition, patients who underwent VATS had a significantly
shorter length of hospitalization compared to patients who underwent open
thoracotomy. Conclusion: In view of a paucity of high level clinical
evidence in the form of large, well-designed randomized controlled trials,
propensity score matching may provide the highest level of evidence to
compare VATS with open thoracotomy for patients with NSCLC. The present
meta-analysis demonstrated superior perioperative outcomes for patients
who underwent VATS, including overall complication rates and duration of
hospitalization. (Table Presented).

<27>
Accession Number
71397034
Authors
Syrigos K.N. Boura P. Tsapas C. Nikolaou A. Kalavrouziotis G. Reveliotis
K. Charpidou A.
Institution
(Syrigos, Boura, Tsapas, Nikolaou, Kalavrouziotis, Reveliotis, Charpidou)
Oncology Unit Gpp, Sotiria General Hospital, Greece
Title
Wedge resection and segmentectomy in patients with stage I non-small cell
lung cancer.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S809), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: The use of resections lesser than lobectomy as definitive
management of a stage I non-small cell lung carcinoma (NSCLC) is a topic
that creates controversy in the global medical community. To describe the
current conclusions concerning the relative indications of each type of
resection in the surgical treatment of stage I NSCLC, as well as the
international results from their application concerning the local
recurrence, disease-free survival, and five-year survival rates. Methods:
Thirty four prospective and retrospective studies registered in PubMed and
Scopus electronic databases during the last twenty five years were
reviewed. Bibliographies and handsearching of journals were used to
identify trials. Studies' authors, citations, objectives, and results were
extracted. No meta-analysis was used. Validation of results was discussed.
Results: Segmentectomies were superior to wedge resections in terms of
local recurrence and cancer-related survival rates. Sublobar resections
were superior to lobectomy concerning preservation of pulmonary
parenchyma. It was recommended that high-risk patients undergo
segmentectomy. Lobectomies were superior to segmentectomies only for
tumors >2 cm (T2bN0M0) as regarding disease-free and overall 5-year
survival. There was no significant difference for tumors <2 cm in most
studies. Free surgical margins were crucial for local control rates.
Systematic lymphadenectomy was mandatory regardless of type of resection.
In cases of pure bronchoalveolar carcinoma, segmentectomy was recommended.
Shorter hospital stay was achieved with sublobar resections. Conclusion:
The choice of type of resection for T1aN0M0 tumors should rely on specific
patient and tumor characteristics. Patient age and tumor size are the most
important factors. Further prospective randomized trials are needed to
determine minimal resections in early lung cancer patients.

<28>
Accession Number
71395965
Authors
Darling G.E. Dickie J. Malthaner R. Mcknight L. Sallay Y. Hunter A. Li Y.
Mcleod R.
Institution
(Darling) Division of Thoracic Surgery, Toronto General Hospital,
University of Toronto, Canada
(Dickie) Surgery, Lakeridge Health Centre, Canada
(Malthaner) Surgery, London Health Sciences Centre, Canada
(Mcknight, Sallay, Hunter, Li, Mcleod) Surgical Oncology, Cancer Care
Ontario, Canada
Title
Quality indicators in thoracic surgery: The importance of process
indicators in lung cancer.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S166-S167), 2013.
Date of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: Outcome after surgery is the result of many components of the
care pathway. The Thoracic Surgery Community of Practice of Cancer Care
Ontario developed quality indicators which reflected processes of care as
well as outcomes. Methods: A systematic review of the literature
identified potential indicators in the care of lung cancer patients which
were relevant to thoracic surgery. These were then evaluated using a
modified Delphi process. Seventeen indicators were chosen from seven
domains: pre-operative assessment, staging, surgery, pathology, adjuvant
therapy, surgical outcomes and miscellaneous based on actionability,
validity, usefulness, discriminability, and feasibility. Data obtained
from administrative databases is reported for 4 process indicators and 3
outcome indicators. Results: Of the 3242 patients diagnosed with Stage I
and Stage II non-small cell lung cancer in 2009 and 2010, 2172 (67%)
received a surgical consultation and 1524 (47%) underwent resection within
3 months of diagnosis. For the 1075 Stage I and Stage II patients over age
75 only 634 (59%) received a surgical consultation and 322 ( 32%)
underwent resection. Of the 2302 patients resected in total (all stages),
only 736 (32%) had invasive mediastinal staging(IMS) prior to
resection:15% for sublobar resections; 30% for stage I; and 42% for stage
II. Surprisingly only 42% of patients with stage III disease had IMS. IMS
was also performed in an additional 23% of patients for whom stage data
was unavailable. In a similar cohort of patients resected in 2011-2012,
only 28% had >10 lymph nodes removed at the time of resection but this did
not include nodes assessed by IMS. However, for 20% of patients lymph node
resection data was not available or could not be determined. Positive
resection margins were reported in 7% of patients, however in a further 7%
of patients margins could not be assessed. 30 day mortality for lobectomy
was 1.9%, reoperation rate was 2.8% (2.0% for same day as resection).
Conclusion: Initial results of 7 quality indicators in thoracic surgery
identified some quality gaps in processes of care as well as limitations
in databases. Evaluation of process indicators allowed feedback to
thoracic surgeons and pathologists who identified quality improvement
opportunities. Rate of surgical consultation and resection for stage I and
II disease was lower than expected as were rates of invasive mediastinal
staging especially for patients with stage III disease for whom cytologic
or histologic confirmation is recommended. To address variable
intraoperative lymph node assessment, systematic lymph node sampling or
complete mediastinal lymphadenectomy was recommended to standardize
intraoperative lymph node assessment. Quality improvement opportunities
for pathologists also included dissection of intralobar lymph nodes,
standardization of pathological processing and margin assessment. Feedback
of quality indicator data was important in stimulating quality improvement
initiatives by thoracic surgeons and pathologists.

<29>
Accession Number
71395910
Authors
Rami-Porta R.
Institution
(Rami-Porta) Thoracic Surgery, Hospital Universitari Mutua Terrassa, Spain
Title
Feedback and closing remarks.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S127), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
The Cochrane Collaboration celebrates its 20th anniversary this year. (1,
2) With around 28,000 people involved in 53 Cochrane Review Groups in
about 100 countries and more than 5,000 systematic reviews, the Cochrane
Collaboration has assisted clinicians, patients, researchers, policy
makers and other health professionals to make decisions on a large number
of healthrelated topics. Around 400 systematic reviews are on screening,
prevention or treatment of different cancers, and they collectively
analyse nearly 5,000 studies. (2) Forty-one systematic reviews are on lung
cancer and mesothelioma: 21 of them deal with non-small cell lung cancer
and 8, on small cell lung cancer; 7 are related to general aspects of
treatment; 3 are about prevention and early detection; and 2 are about
mesothelioma. (3) A Cochrane systematic review is the final product of a
highly elaborated process. Today's Workshop has gone through all this
process starting with the definition of a question that needs to be
answered with the highest certainty. The question is reflected in the
TITLE of the review, the first submission to the review group editors that
the potential authors do. Once the title has been approved, potential
authors have to write and submit a PROTOCOL, a larger document that
includes the background of the topic, the methodology to be used, with
inclusion and exclusion criteria of studies and patients, the therapeutic
interventions that will be included, the search strategy, and relevant
references. After approval of this second phase of the process by the
review group editors, the authors have to write the final document, the
SYSTEMATIC REVIEW, which is internally and externally reviewed. Most
systematic reviews analyse randomised clinical trials only, because this
is the best research instrument we have in clinical practice. The
conclusions derived from these reviews have a high level of evidence -
that can even be increased if meta-analyses can be done combining data
from the different studies. (4) The meticulous search of published and
unpublished data, the careful identification of biases and the sound
methodology provide reliable information on the effectiveness of a certain
therapeutic intervention, that can be recommended to patients with similar
characteristics to those of the patients included in the reviewed studies.
(5) Many questions need to be answer in lung cancer therapy. However,
randomized clinical trials are relatively few, especially in my specific
field: thoracic surgery. We all should feel the responsibility to
participate and include patients in clinical trials. No doubt,
participation demands an extra effort from us: selecting patients, taking
the time to explain the trial to the patients, abiding by randomization
rules, sticking to the protocol and so on. But the effort pays off,
because the conclusions we draw from randomized clinical trials are the
most reliable and solid we can now have on therapeutic interventions. I
would like to encourage the audience to participate in clinical trials.
The more randomized clinical trials we complete, the more systematic
reviews and greater the level of evidence on specific issues of lung
cancer and other health-related problems.

<30>
Accession Number
71395889
Authors
Midthun D. Milne D.
Institution
(Midthun) Pulmonary Medicine Mayo Clinic, United States
(Milne) Auckland Dhb Radiology, New Zealand
Title
A practical approach to the incidental pulmonary nodule.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S106), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
A Practical Approach to the Incidental Pulmonary Nodule David Midthun,
M.D. David Milne, M.D. The finding of a pulmonary nodule (or multiple
nodules) on an imaging study presents a decision point for the patient and
physician. In the absence of a completely sensitive and specific
non-invasive test for malignancy, the physician and patient must weigh the
options for management. The vast majority of such nodules are benign;
however the detection of a nodule may be the first and only point in time
of a chance of cure in the patient with lung cancer. Guidelines for nodule
evaluation by the American college of Chest physicians (ACCP) and the
Fleischner Society may help guide the decision making. Studies of lung
cancer screening have shown high rates of nodule detection and that the
rate is related to the CT slice thickness (collimation) used. Screening
with 10 mm collimation results in detection of one or more nodules in
approximately 20-25% of participants, 5 mm collimation increases this to
40-50% of participants, and 1.25 mm collimation raises detection to as
high as 60%. A review of the data from 8 CT studies in high risk patients
(current or former smokers, age 50 or above) reported that likelihood of
malignancy was 0 to 1% for nodules < 5 mm, 6 to 28% for nodules 5 to 10
mm, 33 to 60% for nodules > 11-20 mm, and 64 to 82% for nodules > 20-30
mm. The finding of a nodule on CT should first prompt review of any
available old images that might include the nodule for comparison. Review
of old images may show that the nodule is growing or, alternatively,
establish that it has been stable for 2 or more years. Stability in size
over a two-year period has been established as an excellent indicator of
benignancy for a solid nodule. If old images are not available, nodules <
8 mm may be observed with follow-up CT at an interval determined by the
nodule size. Evidence for nodule growth is a hallmark of malignancy and
should lead to a staging PET-CT scan (in those who are candidates for
surgery) and consideration of prompt resection. Calcification in a benign
pattern is an excellent indicator that a nodule is a granuloma and needs
no further pursuit. Eccentric calcification should maintain concern for
malignancy. Ground-glass nodules (GGN) are nodules of low density
(attenuation) that are generally only visible by CT scan. They deserve
special mention as they may represent low-grade adenocarcinomas which
behave differently than most malignancies presenting as solid nodules.
Malignant GGNs typically exhibit slow growth with doubling times on
average over 400 days and, for this reason, the 2-year stability rule for
solid nodules doesn't apply and a longer period of follow-up is needed.
PET scanning is not helpful to distinguish malignancy due to the low
density of the lesions, and needle biopsy is often nondiagnostic. GGNs may
show growth or stay the same size yet develop a solid component in the
process of progression. PET scanning uses the injection of the glucose
analog 18F-2-fluorodeoxyglucose (FDG) and identifies elevated metabolic
activity. Nodule enhancement is an indication that a nodule is more likely
malignant than benign, and absence of enhancement is a strong predictor
that a nodule is benign. In a multicenter prospective study reported that
FDGPET had an overall sensitivity of 92% and a specificity of 90% for
detecting malignant nodules, yet the sensitivity fell to only 80% when
nodules of 15 mm or smaller were analyzed. A meta-analysis of pulmonary
nodules showed that PET had a sensitivity of 94% and a specificity of 86%.
The lower limit of solid nodule size for PET applicability using current
techniques is about 8-10 mm. A growing nodule that shows no enhancement on
PET should still be considered suspicious for malignancy and prompt needle
biopsy or resection. If multiple nodules are present, then evaluation is
dictated by the largest nodule. Observation may be appropriate for
patients with nodules that are larger than 8-10 mm and have a low
likelihood of malignancy based lack of enhancement. Whether or not an
indeterminate nodule > 8-10 mm should be biopsied is the subject of
considerable debate and practices vary. The two biopsy techniques for
assessment of nodules are bronchoscopy and transthoracic needle aspiration
(TTNA). Bronchoscopy with fluoroscopy alone has a yield of less than 20%
in the setting of malignant nodules less than 2 centimeters and in the
range of 40- 60% when the nodule is 3-4 cm. Studies of guided bronchoscopy
using endobronchial ultrasound and/or electromagnetic guidance have shown
marked improvements in diagnostic yield over standard fluoroscopic
guidance. Studies using one or more of these techniques have shown yields
of 60 to 80% of peripheral nodules of a mean diameter of 2- to 25 mm.
Yields remain highest with TTNA; multiple studies report yields of 90% and
above for nodules < 2 cm and 95% for nodules > 2 cm. Pneumothorax is the
most frequent complication of TTNA. Likelihood of obtaining a specific
diagnosis in the setting of a benign lesion is problematic for both
bronchoscopy and TTNA. Decision as to the method of biopsy involves lesion
size, location, presence of a bronchus leading to the lesion, and
comorbidities. Preoperative diagnosis may not be needed for lesions that
show growth or are nearing 3cm and are PET avid due to the high likelihood
of malignancy and low likelihood a biopsy is going to provide a specific
benign diagnosis. An exception would be in countries where there is a high
prevalence of tuberculosis where sampling may remain appropriate.
Resection is the ultimate management for many lesions that remain
indeterminate after imaging evaluation especially in a high risk
individual. There are currently too many benign nodules removed
surgically. Series of video assisted thoracic surgery (VATS) have reported
benign nodules representing as high as 50-86% of nodules resected.
Reduction in benign nodule resections may be achieved by observing smaller
nodules, by utilizing PET-CT, and by performing biopsy by TTNA or
bronchoscopy when information is discordant.

<31>
Accession Number
71391087
Authors
Surer S. Toktas F. Yavuz S. Turk T. Ata Y. Vural A.H. Goncu M.T. Yasar
N.G. Yalcinkaya U.
Institution
(Surer, Toktas, Yavuz, Turk, Ata, Vural, Goncu) Department of
Cardiovasculer Surgery, Bursa Yuksek Ihtisas Training and Research
Hospital, Bursa, Turkey
(Yasar) Faculty of Veterinary Medicine, Uludat University, Bursa, Turkey
(Yalcinkaya) Department of Pathology, Faculty of Medicine, Uludat
University, Bursa, Turkey
Title
The effect of transforming growth factor EB on regulation of intimal
hyperplasia in a rabbit carotid anastomosis model.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S79), 2014. Date of Publication: 01
Apr 2014.
Publisher
Elsevier Inc.
Abstract
Objective: The aim of the study was to investigate the effect of
transforming growth factor- b (TGF- beta) on regulation of intimal
hyperplasia in rabbit carotid anastomosis model. Methods: This
experimental, prospective, randomized controlled study was performed on
total of 20, six-month-old,New Zealand white young female rabbits
(2300+300g body weight) were used in this study. After anaesthesia,the
right carotid artery of each rabbits were transected and both ends
anastomosed.Rabbits were divided into four groups of five animal search:
T1 (tikagrelor: 5 mg/kg, po, daily), T2 (tikagrelor: 10 mg/kg, po, daily),
T3(tikagrelor: 20 mg/kg, po, daily), and C (control) group received
sterile PBS (phosphate buffered saline 2 ml/kg/day/p.o) for 3 weeks
postoperatively. After the sacrification, firstly anastomosis segment on
the right carotid artery and secondly a part of the left carotid artery of
each rabbit were isolated. Arterial sections were evaluated
histomorphologically and immunohistochemically with staining using
antibodies against transforming growth factor-beta. Results: In the
control group, the intima/media ratio was significantly higher than the
controlateral normal artery and TGF- beta scores increased maximum. In the
tikagrelol groups(T2,T3) (p<0.05), this ratio had significantly decreased
when compared with the control group (p< 0.05) and TGF- beta scores
decreased when the dose of ticagrelor that blocks ADP-induced platelet
aggregation increased. Conclusion: TGF- beta can plays an major role in
the development of intimal hyperplasia after vascular injury.

<32>
Accession Number
71391018
Authors
Dotan O.F.
Institution
(Dotan) Adana Numune Education and Training Hospital, Turkey
Title
Levosimendan use decreases atrial fibrillation in patients after coronary
artery bypass grafting: A pilot study.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S48-S49), 2014. Date of Publication:
01 Apr 2014.
Publisher
Elsevier Inc.
Abstract
Atrial fibrillation (AF) often occurs after coronary artery bypass
grafting (CABG) and can result in increased morbidity and mortality due to
complications. In the present study, our goal was to investigate whether
the use of levosimendan can reduce the frequency of AF after coronary
artery bypass grafting in patients with poor left ventricle function. To
investigate the effectiveness of levosimendan in the prophylaxis of AF, we
conducted a prospective, randomized, placebo-controlled clinical study on
200 consecutive patients in whom we performed elective CABG operations.
Baseline characteristics were similar in both groups. A control group of
100 patients were treated with placebo (500 mL saline solution), whereas
the levosimendan group (n = 100 patients) was treated with levosimendan.
High-sensitivity C-reactive protein, cardiac troponin, and creatine
kinase-MB levels were measured before surgery and 5 days postoperatively.
AF occurred in 12% of the levosimendan group and 36% of the control group.
The occurrence of AF was significantly lower in the levosimendan group (P
< 0.05). The duration of AF in the levosimendan group was significantly
shorter than that in the control group (4.83 + 1.12 and 6.50 + 1.55 hours,
respectively; P = 0.028). Our research showed that C-reactive protein was
higher postoperatively in the control group than in the levosimendan group
(P < 0.05). The incidence of postoperative AF in the levosimendan group
was reduced significantly in patients with poor left ventricle function
after CABG operations. (Figure Presented).

<33>
Accession Number
71390922
Authors
Cay S. Topaloglu S. Aras D. Ozeke O. Canpolat U. Aydogdu S.
Institution
(Cay, Topaloglu, Aras, Ozeke, Canpolat, Aydogdu) Department of Cardiology,
Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
Title
Meta-analysis of trials comparing cryothermal energy and radio frequency
energy for ablation of isthmus dependent atrial flutter.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S10), 2014. Date of Publication: 01
Apr 2014.
Publisher
Elsevier Inc.
Abstract
Background: Catheter ablation of isthmus dependent atrial flutter is
highly effective to maintain sinus rhythm. Cryothermal or radiofrequency
energy can be used for ablation. Aim: The aim was to perform a
meta-analysis of clinical studies comparing cryothermal and radiofrequency
energies for isthmus dependent atrial flutter ablation. Methods: Medline,
EMBASE and Cochrane were searched for the topic. Data from 6 randomized
clinical trials were included in the analysis. Acute and follow-up
procedure related clinical outcomes were defined as percent of patients
with bidirectional conduction block, pain perception at procedure,
procedural time, and freedom from arrhythmia during a minimum 3-month
follow-up. Results: The percent of patients with bidirectional conduction
block was significantly higher in radiofrequency ablation compared to
cryoablation (OR 0.432, 95% CI 0.235 - 0.793, p = 0.0067). Pain perception
at procedure was lower with cryoablation than radiofrequency ablation
(p<0.001). However, procedural time was not different between cryothermal
and radiofrequency energies (p>0.05). Lastly, higher proportions of
patients without arrhythmia during follow-up in radiofrequency group
compared to cryoablation group were detected (OR 2.497, 95% CI 1.007 -
6.190, p = 0.0483) (Figure). Conclusion: Although total procedural time
was not different between 2 energy types, the prevalence of bidirectional
conduction block, pain perception and proportion of symptom-free patients
were higher with radiofrequency energy (Figure Presented).

<34>
Accession Number
71393523
Authors
Khalil A. Suff N. Grande A. Carvalho J. Cooper D. Thilaganathan B.
Institution
(Khalil, Carvalho, Thilaganathan) St. George's University Hospital,
London, United Kingdom
(Suff, Grande) University College London, London, United Kingdom
(Carvalho) Royal Brompton Hospital, London, United Kingdom
(Cooper) King's College London, London, United Kingdom
Title
Brain abnormalities and neurodevelopmental delay in congenital heart
disease: Systematic review and meta-analysis.
Source
Archives of Disease in Childhood: Fetal and Neonatal Edition. Conference:
16th Annual Conference of the British Maternal and Fetal Medicine Society
Dublin Ireland. Conference Start: 20130425 Conference End: 20130426.
Conference Publication: (var.pagings). 98 , 2013. Date of Publication:
April 2013.
Publisher
BMJ Publishing Group
Abstract
Objectives Studies have demonstrated an association between congenital
heart disease (CHD) and neurodevelopmental delay, partly attributed to the
risk of brain injury during cardiac surgery. However, neuroimaging studies
have demonstrated a high incidence of preoperative brain abnormalities.
The aim of this study was to perform a systematic review in order to
quantify the non-surgical risk of brain abnormalities and
neurodevelopmental delay in fetuses/newborns with CHD. Methods MEDLINE,
EMBASE and The Cochrane Library, without language restrictions were
searched electronically, utilising combinations of the terms congenital
heart, cardiac, neurologic, neurodevelopment, MRI, ultrasound,
neuroimaging, autopsy, preoperative and outcome. Reference lists of
relevant articles and reviews were hand searched for additional reports.
Cohort and case-control studies were included. Case reports and editorials
were excluded. Between-study heterogeneity was assessed using the I2
statistic. Results The search yielded 9,129 citations. Full manuscripts
were retrieved for 119, and 30 were included in the review and
meta-analysis. 21 studies (n = 953) have reported brain abnormalities in
fetuses, newborn or infants with CHD, either preoperatively or in those
who did not undergo congenital cardiac surgery. The remaining 9 studies (n
= 512) have reported preoperative data on neurodevelopmental assessment in
newborn or infants with CHD. The prevalence of brain abnormalities was 36%
(95% CI, 26%, 47%; I² = 90.5%) and of the neurodevelopmental
delay 42% (95% CI, 34%, 51%; I² = 68.9%), though with
heterogeneity between studies. Conclusions In the absence of chromosomal
or genetic abnormalities, fetuses with CHD are at increased risk of brain
abnormalities and neurodevelopmental delay, which are independent of the
surgical risk.

<35>
Accession Number
71387024
Authors
Jiang X. Clark M. Juhn A. Singh R.K. Schnatz P.F.
Institution
(Jiang, Clark, Juhn, Singh, Schnatz) ObGyn, Reading Hospital, West
Reading, PA, United States
(Jiang, Schnatz) ObGyn, Jefferson Medical College, Thomas Jefferson
University, Philadelphia, PA, United States
Title
Mammographically detected breast arterial calcifications and coronary
artery disease: A meta-analysis.
Source
Menopause. Conference: 24th Annual Meeting of the North American Menopause
Society, NAMS 2013 Dallas, TX United States. Conference Start: 20131009
Conference End: 20131012. Conference Publication: (var.pagings). 20 (12)
(pp 1323), 2013. Date of Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Coronary artery disease (CAD) and strokes continue to be the
leading causes of morbidity and mortality among women in the United
States. Regular screening mammograms are recommended for women after age
40 due to their ability to assist in the early detection of breast cancer.
The investigators of many recent studies have analyzed the relationship
between breast arterial calcifications (BACs), seen on mammography, with
both CAD and strokes. We conducted a meta-analysis of the current
literature to deduce the strength of this association. Design: Using the
search terms "breast arterial calcification", "breast artery calcium",
"breast vascular calcification", "coronary artery disease", "coronary
heart disease", "cardiovascular disease", "myocardial infarction", "angina
pectoris", "abnormal coronary angiography", "coronary artery bypass
graft", "stroke" and "peripheral vascular disease", our literature search
revealed 75 articles. Limiting our search to articles that analyzed only
CAD and/or stroke, 35 full manuscripts were reviewed. Of these articles,
16 were included in the final analysis. Results: Two cohort studies were
analyzed, one prospective and one retrospective where n=14,215. The odds
ratio (OR) for developing CAD in those with BAC, vs. those without BAC, is
1.61, 95% CI: 1-33-1.95, and p<0.0001. For stroke, the OR=1.79, 95% CI:
1.55-2.23 and p<0.0001. There were 10 cross-sectional studies analyzed
with CAD as the primary outcome, diagnosed by coronary angiography, where
n=3,952. The OR of CAD in those with BAC, vs. those without BAC, is 3.86,
95% CI: 3.25-4.59 and p<0.0001. For stroke, 7 cross-sectional studies were
analyzed where n=19,011. The OR of stroke in those with BAC, vs. those
without BAC, is 1.77, 95% CI: 1.45-2.16 and p<0.0001. Conclusion: These
results suggest that BAC is significantly associated with both CAD and
stroke. Although previous studies have been criticized regarding sample
sizes and study designs, a recent prospective study along with this robust
data set and meta-analysis adds to our knowledge. While more prospective
studies are warranted to clarify whether BACs are truly a predictor of the
future development of CAD and stroke, there clearly appears to be an
association. In light of this, it may be beneficial to routinely report
BACs on mammograms to alert providers to the increased risk for the
presence of, vs. development of, CAD and / or stroke.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 24

Results Generated From:
Embase <1980 to 2014 Week 14>
Embase (updates since 2014-03-28)

<1>
Accession Number
24193288
Authors
Lopez C. Facciolo F. Lequaglie C. Rendina E.A. Saita S. Dell'Amore D.
Sollitto F. Urciuoli G. Loizzi M. Cisternino M.L. Granone P. Angelelli A.
Cardillo F Mucilli G. Rienzo G.D.I.
Institution
(Lopez, Rienzo) Division of Thoracic Surgery, V. Fazzi Hospital, Piazza
Muratore, 73100 Lecce, Italy
(Facciolo) Division of Thoracic Surgery, Regina Elena National Cancer
Institute, Rome, Italy
(Lequaglie) Division of Thoracic Surgery, I.R.C.C.S. C.R.O.B. Cancer
Institute, Rionero in Vulture, Potenza, Italy
(Rendina) Division of Thoracic Surgery, University la Sapienza -
sant'Andrea Hospital, Rome, Italy
(Saita) Division of Thoracic Surgery, Vittorio Emanuele Hospital, Catania,
Italy
(Dell'Amore) Division of Thoracic Surgery, Morgagni Hospital, Forli, Italy
(Sollitto) Division of Thoracic Surgery, Ospedali Riuniti - University of
Foggia, Foggia, Italy
(Urciuoli) Division of Thoracic Surgery, S. Carlo Hospital, Potenza, Italy
(Loizzi) Division of Thoracic Surgery, Policlinico Hospital, University of
Bari, Bari, Italy
(Cisternino) Division of Thoracic Surgery, S. Paolo Hospital, Bari, Italy
(Granone) Division of Thoracic Surgery, Catholic University Policlinico A.
Gemelli, Rome, Italy
(Angelelli) Division of Thoracic Surgery, Card. G. Panico Hospital,
Tricase, Lecce, Italy
(Cardillo F Mucilli) Division of Thoracic Surgery, S. Camillo-Forlanini
Hospital, Rome, Italy
(Cardillo F Mucilli) Division of Thoracic Surgery, Ospedale Clinicizzato
SS. Annunziata, University of Chieti, Chieti, Italy
Title
Efficacy and safety of fibrin sealant patch in the treatment of air
leakage in thoracic surgery.
Source
Minerva Chirurgica. 68 (6) (pp 559-567), 2013. Date of Publication:
December 2013.
Abstract
Aim. Air leakage represents a major problem in lung surgery. Absorbable
fibrin sealant patch (AFSP), a collagen sponge coated with human
fibrinogen and thrombin, can be used as an adjunct to primary stapling or
suturing. This study compared the efficacy of AFSP with manual suturing
after primary stapling. Methods. This was a prospective, multicenter,
randomized study. Patients undergoing lobectomy, bilobectomy, anatomical
segmentectomy for lung cancer or wedge resection for pulmonary metastasis
with air leakage grade 1 or 2 according to Macchiarini scale after stapler
suture were randomized to receive AFSP or standard surgical treatment
(ST). The primary endpoint was the reduction of intraoperative air leakage
intensity. Duration of postoperative air leakage and number of days until
removal of last chest drain were secondary endpoints. Safety was recorded
for all patients. Results. A total of 346 patients were enrolled in 14
centres, 179 of whom received AFSP and 167 ST. Intraoperative air leak
intensity was reduced in 90.5% of AFSP patients and 82% of ST patients
(P=0.03). A significant reduction in postoperative air leakage duration
was observed in the AFSP group (P=0.0437). The median number of days until
removal of last drainage was 6 (3-37) in the AFSP group and 7 (2-27) in
the ST (P=0.38). Occurrence of adverse events was comparable in both
groups. Conclusion. AFSP was more efficacious than standard ST as an
adjunct to primary stapiing in reducing intraoperative air leakage
intensity and duration of postoperative air leakage in patients undergoing
pulmonary surgery. AFSP was well tolerated.

<2>
Accession Number
24434889
Authors
Packer A.C. Pires P.F. Dibai-Filho A.V. Rodrigues-Bigaton D.
Institution
(Packer) From the Laboratory of Therapeutic Resources, Postgraduate
Program in Physiotherapy, Universidade Metodista de Piracicaba,
Piracicaba, Sao Paulo, Brazil.
Title
Effects of upper thoracic manipulation on pressure pain sensitivity in
women with temporomandibular disorder: a randomized, double-blind,
clinical trial.
Source
American journal of physical medicine & rehabilitation / Association of
Academic Physiatrists. 93 (2) (pp 160-168), 2014. Date of Publication: Feb
2014.
Abstract
The aim of the present study was to evaluate the effects of upper thoracic
manipulation on pain in subjects with temporomandibular disorder.
Thirty-two women with a diagnosis of temporomandibular disorder were
randomly allocated to an experimental group (n = 16), submitted to upper
thoracic manipulation, and a placebo group (n = 16), submitted to a
procedure in the thoracic region with no therapeutic effect. All
volunteers underwent an evaluation of pain in the masticatory muscles and
the temporomandibular joint using an algometer and the visual analog scale
before and immediately after the procedure as well as after 48-72 hrs.
Two-way repeated-measures analysis of variance was used for the intragroup
and intergroup analyses, with the level of significance set to 5% (P <
0.05). Cohen d was calculated for the determination of the effect size. No
significant group-by-time interaction was found (P > 0.05) for algometry
in any analysis, and Cohen d revealed no significant effect of the
treatment. Moreover, no significant group-by-time interaction was found
for facial pain intensity determined using the visual analog scale (P >
0.05), and Cohen d also revealed no significant effect of the treatment
regarding this variable. On the basis of the present findings, upper
thoracic spinal manipulation does not lead to a reduction in pain in women
with temporomandibular disorder.

<3>
Accession Number
2014207641
Authors
Harskamp R.E. Bagai A. Halkos M.E. Rao S.V. Bachinsky W.B. Patel M.R. De
Winter R.J. Peterson E.D. Alexander J.H. Lopes R.D.
Institution
(Harskamp, Rao, Patel, Peterson, Alexander, Lopes) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Harskamp, De Winter) Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Bagai) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Halkos) Emory University, School of Medicine, Atlanta, GA, United States
(Bachinsky) Pinnacle Health Cardiovascular Institute, Harrisburg Hospital,
Harrisburg, PA, United States
Title
Clinical outcomes after hybrid coronary revascularization versus coronary
artery bypass surgery: A meta-analysis of 1,190 patients.
Source
American Heart Journal. 167 (4) (pp 585-592), 2014. Date of Publication:
April 2014.
Publisher
Mosby Inc.
Abstract
Background Hybrid coronary revascularization (HCR) represents a minimally
invasive revascularization strategy in which the durability of the
internal mammary artery to left anterior descending artery graft is
combined with percutaneous coronary intervention to treat remaining
lesions. We performed a systematic review and meta-analysis to compare
clinical outcomes after HCR with conventional coronary artery bypass graft
(CABG) surgery. Methods A comprehensive EMBASE and PUBMED search was
performed for comparative studies evaluating in-hospital and 1-year death,
myocardial infarction (MI), stroke, and repeat revascularization. Results
Six observational studies (1 case control, 5 propensity adjusted)
comprising 1,190 patients were included; 366 (30.8%) patients underwent
HCR (185 staged and 181 concurrent), and 824 (69.2%) were treated with
CABG (786 off-pump, 38 on-pump). Drug-eluting stents were used in 328
(89.6%) patients undergoing HCR. Hybrid coronary revascularization was
associated with lower in-hospital need for blood transfusions, shorter
length of stay, and faster return to work. No significant differences were
found for the composite of death, MI, stroke, or repeat revascularization
during hospitalization (odds ratio 0.63, 95% CI 0.25-1.58, P =.33) and at
1-year follow-up (odds ratio 0.49, 95% CI 0.20-1.24, P =.13). Comparisons
of individual components showed no difference in all-cause mortality, MI,
or stroke, but higher repeat revascularization among patients treated with
HCR. Conclusions Hybrid coronary revascularization is associated with
lower morbidity and similar in-hospital and 1-year major adverse
cerebrovascular or cardiac events rates, but greater requirement for
repeat revascularization compared with CABG. Further exploration of this
strategy with adequately powered randomized trials is warranted. 2014
Mosby, Inc.

<4>
Accession Number
2014207619
Authors
Jones W.S. Dolor R.J. Hasselblad V. Vemulapalli S. Subherwal S. Schmit K.
Heidenfelder B. Patel M.R.
Institution
(Jones, Dolor, Hasselblad, Vemulapalli, Subherwal, Schmit, Heidenfelder,
Patel) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Jones, Vemulapalli, Patel) Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Dolor, Schmit, Heidenfelder) Duke Evidence-based Practice Center, Duke
Clinical Research Institute, Duke University, Durham, NC, United States
Title
Comparative effectiveness of endovascular and surgical revascularization
for patients with peripheral artery disease and critical limb ischemia:
Systematic review of revascularization in critical limb ischemia.
Source
American Heart Journal. 167 (4) (pp 489-498.e7), 2014. Date of
Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Background For patients with critical limb ischemia (CLI), the optimal
treatment to enhance limb preservation, prevent death, and improve
functional status is unknown. We performed a systematic review and
meta-analysis to assess the comparative effectiveness of endovascular
revascularization and surgical revascularization in patients with CLI.
Methods We systematically searched PubMed, Embase, and the Cochrane
Database of Systematic Reviews for relevant English-language studies
published from January 1995 to August 2012. Two investigators screened
each abstract and full-text article for inclusion, abstracted the data,
and performed quality ratings and evidence grading. Random-effects models
were used to compute summary estimates of effects, with endovascular
treatment as the control group. Results We identified a total of 23
studies, including 1 randomized controlled trial, which reported no
difference in amputation-free survival at 3 years (odds ratio [OR] 1.22,
95% CI 0.84-1.77) and all-cause mortality (OR 1.07, 0.73-1.56) between the
2 treatments. Meta-analysis of the observational studies showed a
statistically nonsignificant reduction in all-cause mortality at 6 months
(11 studies, OR 0.85, 0.57-1.27) and amputation-free survival at 1 year (2
studies, OR 0.76, 0.48-1.21) in patients treated with endovascular
revascularization. There was no difference in overall death, amputation,
or amputation-free survival at >2 years. Conclusions The currently
available literature suggests that there is no difference in clinical
outcomes for patients with CLI treated with endovascular or surgical
revascularization. There is a paucity of high-quality data available to
guide clinical decision making, especially as it pertains to patient
subgroups or anatomical considerations. 2014 Mosby, Inc.

<5>
Accession Number
2014197943
Authors
Hausenloy D.J. Kunst G. Boston-Griffiths E. Kolvekar S. Chaubey S. John L.
Desai J. Yellon D.M.
Institution
(Hausenloy, Boston-Griffiths, Yellon) Hatter Cardiovascular Institute,
University College London, Hospital and Medical School, 67 Chenies Mews,
London WC1E 6HX, United Kingdom
(Kunst) Department of Anaesthetics, King's College Hospital NHS Foundation
Trust, London, United Kingdom
(Kolvekar) Department of Cardiothoracic Surgery, Heart Hospital, UCL,
London, United Kingdom
(Chaubey, John, Desai) Department of Cardiothoracic Surgery, King's
College Hospital NHS Foundation Trust, London, United Kingdom
Title
The effect of cyclosporin-A on peri-operative myocardial injury in adult
patients undergoing coronary artery bypass graft surgery: A randomised
controlled clinical trial.
Source
Heart. 100 (7) (pp 544-549), 2014. Date of Publication: April 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: Cyclosporin-A (CsA) has been reported to reduce myocardial
infarct size in both the experimental and clinical settings. This
protective effect is dependent on its ability to prevent the opening of
the mitochondrial permeability transition pore, a critical determinant of
cell death in the setting of acute ischaemia-reperfusion injury. Whether
CsA can reduce the extent of perioperative myocardial injury (PMI) in
patients undergoing coronary artery bypass graft (CABG) surgery is
unknown, and is investigated in this randomised controlled clinical trial.
Methods: 78 adult patients undergoing elective CABG surgery were
randomised to receive either an intravenous bolus of CsA (2.5 mg/kg) or
placebo administered after induction of anaesthesia and prior to
sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin
T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72 h after surgery. Results:
There was no significant difference in mean peak cTnT levels between
control (n=43) and CsA treatment (n=40) patients (0.56+0.06 ng/mL with
control vs 0.35+0.05 ng/mL with CsA; p=0.07). However, in higher-risk
patients with longer cardiopulmonary bypass times, there was a significant
reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative
cTnT rise by 0.03 ng/mL for every 10 min, when compared with control.
Conclusions: In patients with longer cardiopulmonary bypass times, a
single intravenous bolus of CsA administered prior to CABG surgery reduced
the extent of PMI.

<6>
Accession Number
2014197948
Authors
Achilli F. Malafronte C. Maggiolini S. Lenatti L. Squadroni L. Gibelli G.
Capogrossi M.C. Dadone V. Gentile F. Bassetti B. Gennaro F.D. Camisasca P.
Calchera I. Valagussa L. Colombo G.I. Pompilio G.
Institution
(Achilli, Camisasca, Calchera, Valagussa) Department of Cardiology, San
Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
(Malafronte, Lenatti) Department of Cardiology, A. Manzoni Hospital,
Lecco, Italy
(Maggiolini) Department of Cardiology, San L. Mandic Hospital, Merate,
Lecco, Italy
(Squadroni) Department of Cardiology, San Carlo Hospital, Milan, Italy
(Gibelli) Cardiology Unit, Clinica San Carlo, Paderno Dugnano, Italy
(Capogrossi) Laboratory of Vascular Pathology, Istituto Dermopatico
dell'Immacolata IRCCS, Rome, Italy
(Dadone, Gentile) Department of Cardiology, Bassini Hospital, Cinisello
Balsamo, Milan, Italy
(Bassetti, Pompilio) Department of Clinical and Community Sciences,
University of Milan, Milan, Italy
(Gennaro) Department of Radiology, San Gerardo Hospital, Monza, Italy
(Colombo) Laboratory of Immunology and Functional Genomics, Centro
Cardiologico Monzino IRCCS, Milan, Italy
(Pompilio) Laboratory of Vascular Biology and Regenerative Medicine,
Centro Cardiologico Monzino IRCCS, Milan, Italy
(Pompilio) Department of Cardiovascular Surgery, Centro Cardiologico
Monzino IRCCS, Milan, Italy
Title
G-CSF treatment for STEMI: Final 3-year follow-up of the randomised
placebo-controlled STEM-AMI trial.
Source
Heart. 100 (7) (pp 574-581), 2014. Date of Publication: April 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: To assess whether granulocyte colonystimulating factor (G-CSF)
treatment induces a sustained benefit on adverse remodelling in patients
with large anterior ST-elevation myocardial infarction (STEMI) and left
ventricular (LV) dysfunction after successful reperfusion. Methods: The
STEM-AMI Trial was a prospective, placebo-controlled, multicentre study.
Sixty consecutive patients with a first anterior STEMI, who underwent
primary percutaneous coronary intervention 2-12 h after symptom onset,
with LV ejection fraction (LVEF) <45% measured by echocardiography within
12 h after successful revascularisation (TIMI flow score >2), were
randomised 1:1 to G-CSF (5 mumg/Kg body weight b.i.d.) or placebo.
Clinical events and Major Adverse Cardiac and Cerebrovascular Event
(MACCE) were monitored, and LVEF, LV end-diastolic (LVEDV) and
end-systolic (LVESV) volumes, and infarct size were evaluated by MRI at
the final 3-year follow-up. Results: Fifty-four patients completed the
study, of whom 35 with MRI. No significant differences were found in
mortality and MACCE between G-CSF and placebo-treated groups. The 3-year
infarct size was not different between groups, whereas LVEDV was
significantly lower in G-CSF (n=20) than in placebo (n=15) patients
(170.1+8.1 vs 197.2+8.9 mL, respectively; p=0.033 at analysis of
covariance). A significant inverse correlation was detected in G-CSF
patients between the number of circulating CD34 cells at 30 days after
reperfusion and the 3-year absolute and indexed LVEDV (=-0.71, 95% CI
-0.90 to -0.30, and =-0.62, -0.86 to -0.14, respectively), or their change
over time (r=-0.59, -0.85 to -0.11, and r=-0.55, -0.83 to -0.06,
respectively). Conclusions: G-CSF therapy may be beneficial in attenuating
ventricular remodelling subsequent to a large anterior STEMI in the long
term. No differences have been detected in clinical outcome.

<7>
Accession Number
2014206726
Authors
Monk-Hansen T. Dall C.H. Christensen S.B. Snoer M. Gustafsson F. Rasmusen
H. Prescott E.
Institution
(Monk-Hansen, Dall, Snoer, Rasmusen, Prescott) Department of Cardiology,
Bispebjerg University Hospital, Bispebjerg Bakke 23, byg. 67, 2400
Kobenhavn NV, Denmark
(Christensen, Gustafsson) Department of Cardiology, Rigshospitalet
University Hospital, Copenhagen, Denmark
Title
Interval training does not modulate diastolic function in heart transplant
recipients.
Source
Scandinavian Cardiovascular Journal. 48 (2) (pp 91-98), 2014. Date of
Publication: April 2014.
Publisher
Informa Healthcare
Abstract
Objectives. This study investigates the effect of aerobic interval
training on diastolic function at rest and during exercise in stable heart
transplant (HTx) recipients. Design. Twenty-three stable HTx recipients
(74% males, mean age 50 + 14.9 years) were recruited to a training
programme. Intervention was 8 weeks intensive training or control in a
randomized controlled design. Results. At baseline, participants had
normal or mild diastolic dysfunction at rest. During exercise, mean E/e'
increased from 9.0 (+ 2.8) to 12.8 (+ 7.7) (p = 0.09), E/A increased from
2.1 (+ 0.6) to 2.6 (+ 0.7) (p = 0.02), and deceleration time decreased by
over 50 ms, all markers of increased filling pressure. There were no
correlations between diastolic function and VO2peak at baseline. After
intervention VO2peak increased from 23.9 (+ 4.5) to 28.3(+ 6) ml/kg/min in
the training group (difference between groups p = 0.0018). No consistent
pattern of improvement in diastolic function at rest or during exercise
was seen. Conclusion. The study does not support a role of diastolic
dysfunction in the limited exercise capacity of HTx recipients and
suggests that in these patients peripheral factors are of greater
importance. 2014 Informa Healthcare.

<8>
Accession Number
2014200206
Authors
Ge Y.-Z. Yu P. Jia R.-P. Wu R. Ding A.-X. Li L.-P. Zhao Y. Feng Y.-M. Gui
Z.-L. Liao S.
Institution
(Ge, Yu, Jia, Wu, Zhao, Feng, Gui, Liao) Department of Urology and Center
of Renal Transplantation, Nanjing First Hospital, Nanjing Medical
University, 68 Changle Road, Nanjing 210006, China
(Ding) Department of General Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
(Li) Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing
Medical University, 68 Changle Road, Nanjing 210006, China
Title
Association between transforming growth factor beta-1 +869T/C polymorphism
and acute rejection of solid organ allograft: A meta-analysis and
systematic review.
Source
Transplant Immunology. 30 (2-3) (pp 76-83), 2014. Date of Publication:
March 2014.
Publisher
Elsevier
Abstract
Background: Transforming growth factor beta-1(TGFB1) is involved in the
acute rejection (AR) episodes of solid organ transplant recipients.
However, results from published studies on the association between
donor/recipient TGFB1 + 869 T/C polymorphism and AR risk are conflicting
and inconclusive. Methods: PUBMED, EMBASE, CNKI and Wanfang Database were
searched to identify eligible studies investigating the association
between donor/recipient TGFB1 +. 869. T/C polymorphism and AR risk.
Statistical analysis was performed by using STATA 10.0. Results: A total
of 29 studies were included. Overall, the donor TGFB1 + 869 T/C
polymorphism was significantly associated with AR risk in heterozygote
comparison (CT vs. TT: OR = 1.67, 95%CI, 1.17-2.39; P heterogeneity =
0.285) and dominant model (CC vs. TC/TT: OR = 1.47, 95%CI, 1.05-2.06; P
heterogeneity = 0.445). In addition, subgroup analysis revealed that CT
variant (CT vs. TT: OR = 1.97, 95%CI, 1.20-3.25; P heterogeneity = 0.777)
and CC/CT genotype (CC/CT vs. TT: OR = 1.72, 95%CI, 1.07, 2.78; P
heterogeneity = 0.619) within donors contributed to higher risk of AR in
recipients administrated with CsA or FK506, compared with those applied
only CsA. On the other hand, no significant association between recipient
TGFB1 + 869 T/C polymorphism and AR was detected in all genetic models.
Conclusions: This meta-analysis and systematic review suggested that donor
TGFB1 + 869 T/C polymorphism was significantly associated with AR of solid
organ transplant recipients, and especially among patients in CsA/FK 506
group compared with those in CsA group. 2014 Elsevier B.V.

<9>
Accession Number
2014191805
Authors
Wang K. Pan X. Tang Q. Pang Y.
Institution
(Wang, Pan, Tang, Pang) Department of Pediatrics, First Affiliated
Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning
530021, Guangxi Autonomous Region, China
Title
Catheterization therapy vs surgical closure in pediatric patients with
patent ductus arteriosus: A meta-analysis.
Source
Clinical Cardiology. 37 (3) (pp 188-194), 2014. Date of Publication: March
2014.
Publisher
John Wiley and Sons Inc.
Abstract
Background Patent ductus arteriosus (PDA) remains a common congenital
heart disease in pediatric patients, and the new trend of catheterization
therapy is still associated with some potential risks and complications.
Hypothesis Compared with surgical closure, the clinical effect of
catheterization therapy in pediatric PDA patients requires meta-analysis.
Methods A systematic literature search of PubMed, Cochrane Library,
Embase, Science Citation Index, Web of Science, and the Chinese
Biomedicine literature database was conducted. Eligible studies included
controlled trials of pediatric PDA patients receiving catheterization
therapy vs surgical closure. Relative risks (RRs), standard mean
differences, and 95% confidence intervals (CIs) were calculated and
heterogeneity was assessed with the I² test. Results Seven
studies with a total of 810 patients met the inclusion criteria.
Catheterization therapy neither significantly increased the primary
success rate (RR: 0.92, 95% CI: 0.82-1.03, P = 0.16) nor reduced the total
postprocedure complications (RR: 0.74, 95% CI: 0.44-1.25, P = 0.26) and
blood transfusion (RR: 1.10, 95% CI: 0.16-7.67, P = 0.93). Catheterization
was associated with a statistically significant increase in residual
shunts (RR: 5.19, 95% CI: 1.41-19.20, P = 0.01) and reduction in length of
hospital stay (standard mean difference: -1.66, 95% CI: -2.65 to -0.67, P
= 0.001). Conclusions Catheterization therapy in pediatric PDA patients
did not show a significant advantage in primary success rate, total
complications, or blood transfusion, but it was associated with increase
in residual shunts and reduction in length of hospital stay. 2014 Wiley
Periodicals, Inc.

<10>
Accession Number
2014191610
Authors
Dicecco S.R. Francisco-Ziller N.
Institution
(Dicecco, Francisco-Ziller) Mayo Clinic Hospital, Rochester Methodist
Campus, 201 West Center Street, Rochester, MN 55902, United States
Title
Obesity and organ transplantation: Successes, failures, and opportunities.
Source
Nutrition in Clinical Practice. 29 (2) (pp 171-191), 2014. Date of
Publication: April 2014.
Publisher
SAGE Publications Ltd
Abstract
The increasing rate of societal obesity is also affecting the transplant
world through obesity in candidates and donors as well as its
posttransplant repercussions. Being overweight and obese has been shown to
have significant effects on both short- and long-term complications as
well as patient and graft survival. However, much of the comorbidity can
be controlled or prevented with careful patient selection and aggressive
management. A team approach to managing obesity and its comorbidities both
pre- and posttransplant is essential for successful transplant outcomes.
Complicating understanding the results of obesity research is the
inclusion different weight categories, use of listing vs transplant
weights, patient populations large enough for statistical power, and
changes in transplant management, especially immunosuppression protocols,
anti-infection protocols, and operative techniques. Much more research is
needed regarding many elements, including safe weight loss before
transplantation, prevention of weight gain after transplant, genomic
influences, and the role of bariatric surgery in the transplant process.
2014 American Society for Parenteral and Enteral Nutrition.

<11>
Accession Number
2014181284
Authors
Jolly S.S. Cairns J. Yusuf S. Niemela K. Steg P.G. Worthley M. Ferrari E.
Cantor W.J. Fung A. Valettas N. Rokoss M. Olivecrona G.K. Widimsky P.
Cheema A.N. Gao P. Mehta S.R.
Institution
(Jolly, Yusuf, Valettas, Rokoss, Gao, Mehta) McMaster University,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Cairns, Fung) University of British Columbia, Vancouver, BC, Canada
(Niemela) Tampere University Hospital, Heart Center, Tampere, Finland
(Steg) Universite Paris-Diderot, Paris, France
(Worthley) University of Adelaide, Royal Adelaide Hospital, Adelaide,
Australia
(Ferrari) Hopital Pasteur, Nice, France
(Cantor) Southlake Regional Health Centre, University of Toronto, ON,
Canada
(Olivecrona) Skane University Hospital, Lund, Sweden
(Widimsky) Charles University, Hospital Kralovske Vinohrady, Prague, Czech
Republic
(Cheema) St. Michael's Hospital, University of Toronto, ON, Canada
Title
Procedural volume and outcomes with radial or femoral access for coronary
angiography and intervention.
Source
Journal of the American College of Cardiology. 63 (10) (pp 954-963), 2014.
Date of Publication: 18 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives The study sought to evaluate the relationship between
procedural volume and outcomes with radial and femoral approach.
Background RIVAL (RadIal Vs. femorAL) was a randomized trial of radial
versus femoral access for coronary angiography/intervention (N = 7,021),
which overall did not show a difference in primary outcome of death,
myocardial infarction, stroke, or non-coronary artery bypass graft major
bleeding. Methods In pre-specified subgroup analyses, the hazard ratios
for the primary outcome were compared among centers divided by tertiles
and among individual operators. A multivariable Cox proportional hazards
model was used to determine the independent effect of center and operator
volumes after adjusting for other variables. Results In high-volume radial
centers, the primary outcome was reduced with radial versus femoral access
(hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but
not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume
centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021).
High-volume centers enrolled a higher proportion of ST-segment elevation
myocardial infarction (STEMI). After adjustment for STEMI, the benefit of
radial access persisted at high-volume radial centers. There was no
difference in the primary outcome between radial and femoral access by
operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28),
intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI:
0.74 to 1.65; interaction p = 0.536). However, in a multivariable model,
overall center volume and radial center volume were independently
associated with the primary outcome but not femoral center volume (overall
percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96;
radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00,
95% CI: 0.94 to 1.07; p = 0.98). Conclusions Procedural volume and
expertise are important, particularly for radial percutaneous coronary
intervention. 2014 by the American College of Cardiology Foundation
Published by Elsevier Inc.

<12>
Accession Number
2014194161
Authors
Wang Y.F. Yao M. Liu H.B. Yang Y.J. Xie J.M. Jia X.W. Pan H.J. Wang C.Y.
Institution
(Wang, Xie, Jia, Pan, Wang) Department of Cardiovascular Disease,
Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
(Yao, Liu, Yang) Department of Cardiovascular Disease, Cardiovascular
Institute and Fu Wai Hospital, Chinese Academy Medical Science and Peking
Union Medical College, Beijing 100037, China
Title
Correlation between balloon release pressure and no-reflow in patients
with acute myocardial infarction undergoing direct percutaneous coronary
intervention.
Source
Chinese Medical Journal. 127 (6) (pp 1008-1011), 2014. Date of
Publication: 2014.
Publisher
Chinese Medical Association
Abstract
Background Balloon release pressure may increase the incidence of no
reflow after direct percutaneous coronary intervention (PCI). This
randomized controlled study was designed to analyze the correlation
between balloon release pressure and no-reflow in patients with acute
myocardial infarction (AMI) undergoing direct PCI. Methods There were 156
AMI patients who underwent PCI from January 1, 2010 to December 31, 2012,
and were divided into two groups according to the stent inflation
pressure: a conventional pressure group and a high pressure group. After
PCI, angiography was conducted to assess the thrombolysis in myocardial
infarction (TIMI) grade with related artery. Examinations were undertaken
on all patients before and after the operation including cardiac enzymes,
total cholesterol, low-density lipoprotein, blood glucose, homocysteine,
beta-thromboglobulin (beta-TG), Hamilton depression scale (HAMD) and
self-rating anxiety scale (SAS). After interventional therapy, the
afore-mentioned parameters in both the conventional pressure group and
high pressure group were again analyzed. Results The results showed that
CK-MB, HAMD, SAS were significantly different (P <0.05) in all patients
after PCI, especially the CK-MB in the high pressure group ((25.7+7.6) U/L
vs. (76.7+11.8) U/L). CK-MB, HAMD, SAS, and beta-TG were comparative
before PCI but they were significantly changed (P <0.05) after
intervention. No-reflow phenomenon occurred in 13 patients in the high
pressure group, which was significantly higher than in the conventional
pressure group (17.11% vs. 6.25%, P <0.05). Conclusion In stent
implantation, using a pressure less than 1823.4 kPa balloon to release
pressure may be the better choice to reduce the occurrence of no-reflow
following direct PCI.

<13>
Accession Number
2014197225
Authors
Genereux P. Cohen D.J. Williams M.R. Mack M. Kodali S.K. Svensson L.G.
Kirtane A.J. Xu K. McAndrew T.C. Makkar R. Smith C.R. Leon M.B.
Institution
(Genereux, Williams, Kodali, Kirtane, Smith, Leon) Columbia University
Medical Center, New York Presbyterian Hospital, 161 Fort Washington
Avenue, New York, NY 10032, United States
(Genereux, Kodali, Kirtane, Xu, McAndrew, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Mack) Baylor Healthcare System, Plano, TX, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
Title
Bleeding complications after surgical aortic valve replacement compared
with transcatheter aortic valve replacement: Insights from the PARTNER i
trial (Placement of Aortic Transcatheter Valve).
Source
Journal of the American College of Cardiology. 63 (11) (pp 1100-1109),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives This study sought to identify the incidence, predictors, and
prognostic impact of bleeding complications (BC) after surgical aortic
valve replacement (SAVR) compared with transcatheter aortic valve
replacement (TAVR). Background Bleeding complications after SAVR and TAVR
are frequent and may be associated with an unfavorable prognosis. Methods
In the randomized controlled PARTNER (Placement of Aortic Transcatheter
Valve) I trial, 657 patients from cohort A (operable high risk) were
randomly assigned to SAVR or TAVR (transfemoral [TF] if iliofemoral access
was suitable or transapical [TA] if not) and received the designated
treatment. First-generation Edwards SAPIEN valves and delivery systems
(Edwards Lifesciences, Irvine, California) were used for TAVR, through a
22- or 24-F sheath. The 30-day rates of major BC (modified Valve Academic
Research Consortium definitions), predictors of BC, and their association
with 1-year mortality were assessed. Results A total of 71 (22.7%), 27
(11.3%), and 9 (8.8%) patients had major BC within 30 days of the
procedure after SAVR, TF-TAVR, and TA-TAVR, respectively (p < 0.0001).
SAVR was associated with a significantly higher 30-day rate of transfusion
(17.9%) than either TF-TAVR (7.1%) or TA-TAVR (4.8%; p < 0.0001).
Independent predictors of major BC were the occurrence of major vascular
complications and use of intraprocedural hemodynamic support among TF-TAVR
patients, severe procedural complications requiring conversion to open
surgery among TA-TAVR patients, and the presence of low hemoglobin at
baseline among SAVR patients. Major BC was identified as the strongest
independent predictor of 1-year mortality among the full cohort. However,
risk-adjusted analyses demonstrated a significant interaction between BC
and treatment strategy with respect to mortality, suggesting that BC after
SAVR have a greater impact on prognosis than after TAVR. Conclusions Among
high-risk aortic stenosis patients enrolled in the PARTNER I randomized
trial, BC were more common after SAVR than after TAVR and were also
associated with a worse long-term prognosis. (THE PARTNER TRIAL: Placement
of AoRTic TraNscathetER Valve Trial; NCT00530894) 2014 by the American
College of Cardiology Foundation.

<14>
Accession Number
2014197224
Authors
Lindman B.R. Pibarot P. Arnold S.V. Suri R.M. McAndrew T.C. Maniar H.S.
Zajarias A. Kodali S. Kirtane A.J. Thourani V.H. Tuzcu E.M. Svensson L.G.
Waksman R. Smith C.R. Leon M.B.
Institution
(Lindman, Maniar, Zajarias) Cardiovascular Division, Washington University
School of Medicine, Campus Box 8086, 660 South Euclid Avenue, St. Louis,
MO 63110, United States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Arnold) Saint Luke's Mid-America Heart Institute, Kansas City MO, United
States
(Suri) Mayo Clinic, Rochester MN, United States
(McAndrew, Kodali, Kirtane, Leon) Cardiovascular Research Foundation, New
York NY, United States
(Kodali, Kirtane, Smith, Leon) Columbia University Medical Center, New
York Presbyterian Hospital, New York NY, United States
(Thourani) Emory University School of Medicine, Atlanta GA, United States
(Tuzcu, Svensson) Cleveland Clinic Foundation, Cleveland OH, United States
(Waksman) MedStar Washington Hospital Center, Washington DC, United States
Title
Transcatheter versus surgical aortic valve replacement in patients with
diabetes and severe aortic stenosis at high risk for surgery: An analysis
of the PARTNER trial (Placement of Aortic Transcatheter Valve).
Source
Journal of the American College of Cardiology. 63 (11) (pp 1090-1099),
2014. Date of Publication: 25 Mar 2014.
Publisher
Elsevier USA
Abstract
Objectives The goal of this study was to determine whether a less-invasive
approach to aortic valve replacement (AVR) improves clinical outcomes in
diabetic patients with aortic stenosis (AS). Background Diabetes is
associated with increased morbidity and mortality after surgical AVR for
AS. Methods Among treated patients with severe symptomatic AS at high risk
for surgery in the PARTNER (Placement of Aortic Transcatheter Valve)
trial, we examined outcomes stratified according to diabetes status of
patients randomly assigned to receive transcatheter or surgical AVR. The
primary outcome was all-cause mortality at 1 year. Results Among 657
patients enrolled in PARTNER who underwent treatment, there were 275
patients with diabetes (145 transcatheter, 130 surgical). There was a
significant interaction between diabetes and treatment group for 1-year
all-cause mortality (p = 0.048). Among diabetic patients, all-cause
mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the
surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to
0.99]; p = 0.04). Results were consistent among patients treated via
transfemoral or transapical routes. In contrast, among nondiabetic
patients, there was no significant difference in all-cause mortality at 1
year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were
similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p =
0.88), but the rate of renal failure requiring dialysis >30 days was lower
in the transcatheter group (0% vs. 6.1%; p = 0.003). Conclusions Among
patients with diabetes and severe symptomatic AS at high risk for surgery,
this post-hoc stratified analysis of the PARTNER trial suggests there is a
survival benefit, no increase in stroke, and less renal failure from
treatment with transcatheter AVR compared with surgical AVR. (The PARTNER
Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894) 2014
by the American College of Cardiology Foundation.

<15>
Accession Number
2014197285
Authors
Jang J.-S. Song Y.-J. Kang W. Jin H.-Y. Seo J.-S. Yang T.-H. Kim D.-K. Cho
K.-I. Kim B.-H. Park Y.H. Je H.-G. Kim D.-S.
Institution
(Jang, Song, Kang, Jin, Seo, Yang, Kim, Kim) Department of Cardiology,
Busan Paik Hospital, University of Inje College of Medicine, Busan, South
Korea
(Cho) Department of Cardiology, Kosin University Medical Center, Busan,
South Korea
(Kim) Department of Cardiology, Pusan National University Hospital, Busan,
South Korea
(Park, Je) Department of Cardiology and Cardiovascular Surgery, Pusan
National University Yangsan Hospital, Yangsan, South Korea
Title
Intravascular ultrasound-guided implantation of drug-eluting stents to
improve outcome: A meta-analysis.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 233-243), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to systematically review and perform
a meta-analysis of randomized trials and observational studies of
intravascular ultrasound (IVUS)-guided versus angiography-guided
implantation of drug-eluting stents (DES). Background: Although studies in
the bare-metal stents era suggested that there were clinical benefits to
IVUS guidance, it is still controversial whether percutaneous coronary
intervention (PCI) with DES guided by IVUS leads to better clinical
outcomes. Methods: Relevant studies published through March 31, 2013, were
searched for and identified in the electronic databases. Summary estimates
were obtained using a random-effects model. Results: From 138 initial
citations, 3 randomized trials and 12 observational studies with 24,849
patients (11,793 IVUS-guided and 13,056 angiography-guided) were included
in this study. Comparison of IVUS- versus angiography-guided PCI disclosed
odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence
interval [CI]: 0.69 to 0.91; p = 0.001). IVUS-guided PCI was also
associated with significantly lower rates of all-cause mortality (OR:
0.64; 95% CI: 0.51 to 0.81; p < 0.001), myocardial infarction (OR: 0.57;
95% CI: 0.42 to 0.78; p < 0.001), target vessel revascularization (OR:
0.81; 95% CI: 0.68 to 0.95; p = 0.01), and stent thrombosis (OR: 0.59; 95%
CI: 0.42 to 0.82; p = 0.002). A meta-analysis of propensity-matched
studies demonstrated similar results in terms of clinical outcomes, but
not repeat revascularization. Conclusions: IVUS-guided DES implantation is
associated with significantly lower rates of adverse clinical events
compared with angiography guidance. Further study is needed to clarify
which subgroups of subjects with IVUS guidance will have greater benefit.
2014 by the American College of Cardiology Foundation.

<16>
Accession Number
2014196131
Authors
Puskas J. Gerdisch M. Nichols D. Quinn R. Anderson C. Rhenman B. Fermin L.
McGrath M. Kong B. Hughes C. Sethi G. Wait M. Martin T. Graeve A.
Institution
(Puskas) Department of Cardiothoracic Surgery, Emory University Hospital
Midtown, Medical Office Tower, 550 Peachtree St, NE, 6th Fl, Atlanta, GA
30308, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St Francis
Health, Indianapolis, IN, United States
(Nichols, Anderson, Graeve) Department of Cardiothoracic Surgery,
Multicare Tacoma General, Tacoma, WA, United States
(Quinn) Department of Cardiothoracic Surgery, Maine Medical, Portland, MI,
United States
(Rhenman, Fermin) Department of Cardiothoracic Surgery, Southern Arizona
Veterans Affairs Hospital, Tucson, AZ, United States
(McGrath) Department of Cardiothoracic Surgery, Sentara Norfolk General
Hospital, Norfolk, VA, United States
(Kong) Department of Cardiothoracic Surgery, St Joseph Mercy Hospital,
Ypsilanti, MI, United States
(Hughes) Department of Cardiothoracic Surgery, Duke University, Durham,
NC, United States
(Sethi) Department of Cardiothoracic Surgery, University of Arizona,
Tucson, AZ, United States
(Wait) Department of Cardiothoracic Surgery, University of Texas, Dallas,
TX, United States
(Martin) Department of Cardiothoracic Surgery, University of Florida,
Gainesville, FL, United States
Title
Reduced anticoagulation after mechanical aortic valve replacement: Interim
results from the Prospective Randomized On-X Valve Anticoagulation
Clinical Trial randomized Food and Drug Administration investigational
device exemption trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (4) (pp 1202-1211.E2),
2014. Date of Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Objective Under Food and Drug Administration investigational device
exemption, the Prospective Randomized On-X Anticoagulation Clinical Trial
(PROACT) has been testing the safety of less aggressive anticoagulation
than recommended by the American College of Cardiology/American Heart
Association guidelines after implantation of an approved bileaflet
mechanical valve. Methods In this first limb of the PROACT, patients with
elevated risk factors for thromboembolism were randomized at 33 US centers
to receive lower dose warfarin (test international normalized ratio [INR],
1.5-2.0) or continue standard warfarin (control INR, 2.0-3.0), 3 months
after mechanical aortic valve replacement. The INR was adjusted by home
monitoring; all patients received 81 mg aspirin daily. Adverse events were
independently adjudicated. Results A total of 375 aortic valve replacement
patients were randomized into control (n = 190) and test (n = 185) groups
from September 2006 to December 2009. The mean age + standard deviation
was 55.2 + 12.5 years; 79% were men; and 93% were in sinus rhythm
preoperatively. Calcific degeneration was present in 67%; active
endocarditis was excluded. Concomitant procedures included coronary artery
bypass grafting (27%), aortic aneurysm repair (14%), and other (25%). The
follow-up duration averaged 3.82 years (755.7 patient-years [pt-yrs] for
control; 675.2 pt-yrs for test). The mean INR was 2.50 + 0.63 for the
control and 1.89 + 0.49 for the test groups (P <.0001). The test group
experienced significantly lower major (1.48% vs 3.26%/pt-yr; P =.047) and
minor (1.32% vs 3.41%/pt-yr; P =.021) bleeding rates. The incidence of
stroke, transient ischemic attack, total neurologic events, and all-cause
mortality were similar between the 2 groups. Conclusions INR can be safely
maintained between 1.5 and 2.0 after aortic valve replacement with this
approved bileaflet mechanical prosthesis. With low-dose aspirin, this
resulted in a significantly lower risk of bleeding, without a significant
increase in thromboembolism.

<17>
Accession Number
2014193901
Authors
Vonk A.B.A. Veerhoek D. Van Den Brom C.E. Van Barneveld L.J.M. Boer C.
Institution
(Vonk, Veerhoek, Van Barneveld) Department of Cardio-thoracic Surgery,
Institute for Cardio-vascular Research, VU University Medical Center,
Amsterdam, Netherlands
(Van Den Brom, Boer) Department of Anesthesiology, VU University Medical
Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
Title
Individualized heparin and protamine management improves rotational
thromboelastometric parameters and postoperative hemostasis in valve
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 235-241),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objectives This study investigated whether a tailored approach to heparin
and protamine management improved thromboelastometric parameters after
cardiopulmonary bypass and reduced postoperative blood loss compared with
activated coagulation time (ACT)-based fixed target heparin and protamine
management. Design Randomized controlled study. Setting Tertiary
university hospital. Participants Patients undergoing elective valve
surgery (n = 38). Interventions Heparin and protamine management were
based either on the ACT (n = 19) or hemostasis management system (HMS)
measurements (n = 19; HMS Plus; Medtronic, Minneapolis, MN). Measurements
and Main Results The target ACT for initiation of cardiopulmonary bypass
was 480 seconds. Study variables included rotational thromboelastometry
EXTEM (extrinsic coagulation), HEPTEM (intrinsic coagulation with
heparinase), and FIBTEM (fibrin part of clot formation) tests and 24-hour
blood loss. The use of HMS reduced the median protamine-to-heparin ratio
from 1.00 (1.00-1.00) to 0.62 (0.56-0.66; p<0.001). The ACT group showed a
prolonged postbypass clotting time for both EXTEM (86+13 seconds v 78+10
seconds; p = 0.05) and HEPTEM (217+58 seconds v 183+24 seconds; p = 0.03)
tests. There was a moderate correlation between protamine dosing with the
EXTEM and HEPTEM clotting time (r = 0.42; p = 0.009 and r = 0.38; p =
0.02, respectively). The number of patients with more than 450 mL/24 hours
was higher in the ACT than in the HMS group (42% v 12%; p = 0.04).
Conclusions Individualized heparin and protamine management decreased the
protamine-to-heparin ratio, improved postbypass thromboelastometric
hemostatic parameters, and reduced the incidence of severe blood loss
compared with an ACT-based strategy, supporting the added value of this
approach for hemostatic optimization during cardiac surgery. 2014
Elsevier Inc.

<18>
Accession Number
2014196086
Authors
Chen T. Jiang N. Wang L. Guo Z. Han J. Jing S. Liu J.
Institution
(Chen) Chest Clinical Research Center, Tianjin Medical University,
Tianjin, China
(Jiang, Wang, Guo, Han, Jing, Liu) Division of Cardiac Surgery, Tianjin
Chest Hospital, 93 Xi'an Road, Heping District, Tianjin 300000, China
Title
The significance of natriuretic peptide in treatment of pulmonary
hypertension after mitral valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 147 (4) (pp 1362-1367),
2014. Date of Publication: April 2014.
Publisher
Mosby Inc.
Abstract
Objectives To compare the therapeutic efficacy of recombinant human brain
natriuretic peptide and prostaglandin E1 in the treatment of pulmonary
hypertension after mitral valve replacement. Methods Sixty patients with
postoperative pulmonary hypertension were divided randomly into 3 groups
that received saline, prostaglandin E1, and natriuretic peptide infusions
for 12 hours each. The hemodynamics data were monitored consecutively, and
the levels of thromboxane A2 and cyclic guanosine monophosphate were
detected pretreatment, after treatment, and 1 week after surgery. Results
The arterial pressure, pulmonary arterial pressure, and pulmonary
capillary wedge pressure decreased 1 hour after prostaglandin E1 treatment
and rebounded after treatment discontinuation. The pulmonary arterial
pressure and pulmonary capillary wedge pressure in the natriuretic peptide
group decreased 3 hours after treatment; pulmonary arterial pressure
decreased less than that of the prostaglandin group, and there was no
evidence of hemodynamic rebound after treatment discontinuation. The
natriuretic peptide had no significant effects on arterial pressure. In
both the prostaglandin and natriuretic peptide groups, cyclic guanosine
monophosphate increased after the treatment, which was even higher in the
latter group. Prostaglandin E1 could lead to the decrease of thromboxane
A2, which was not seen in the natriuretic peptide group. Conclusions Both
brain natriuretic peptide and prostaglandin E1 can effectively reduce
pulmonary hypertension; however, natriuretic peptide has a slower and
milder efficacy. The effects of these 2 drugs in reducing the pulmonary
arterial pressure may be mediated through different pathways.

<19>
Accession Number
2014193892
Authors
Lenkin A.I. Zaharov V.I. Lenkin P.I. Smetkin A.A. Bjertnaes L.J. Kirov
M.Y.
Institution
(Lenkin) City Hospital 1 of Arkhangelsk, Department of Anesthesiology and
Intensive Care Medicine, Suvorov Street 1, Arkhangelsk, 163001, Russian
Federation
(Zaharov, Lenkin, Smetkin, Kirov) Department of Anesthesiology and
Intensive Care Medicine, Northern State Medical University, Arkhangelsk,
Russian Federation
(Bjertnaes, Kirov) Department of Clinical Medicine (Anesthesiology),
Faculty of Health Sciences, University of Tromsoe, Tromsoe, Norway
Title
Monitoring of anesthetic depth during surgical correction of acquired
valvular disorders: Single center, randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 301-307),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective The authors' primary objective was to test the hypothesis that
Cerebral State Index (CSI)-guided control of anesthetic depth might reduce
the consumption of anesthetics and shorten the duration of ICU and
hospital stays after surgical correction of combined valve disorders.
Design Single center, randomized trial. Setting City Hospital Number 1 of
Arkhangelsk, Russian Federation. Participants Fifty adult patients with
combined valve disorders requiring surgical correction. Interventions The
patients were randomized into 2 groups. In the CSI group, anesthetic depth
was monitored, and the rate of infusion of propofol was titrated to
maintain the depth of anesthesia corresponding to a CSI of 40-60. In the
control group, the depth of anesthesia was monitored clinically, and the
dosage of propofol was administered according to the recommendations of
the manufacturer. Measurements and Main Results All patients received
standard perioperative monitoring. Consumption of anesthetics and length
of ICU and hospital stays were recorded. Preoperative patient
characteristics did not differ significantly between the groups. In the
CSI group, average intraoperative doses of midazolam and propofol were
reduced by 41% and 19%, respectively (p<0.01). Maintenance of anesthesia
guided by CSI shortened the time until fit for ICU discharge by 50% and
reduced the lengths of ICU and postoperative hospital stays by 35% and
25%, respectively (p< 0.05). Conclusions Monitoring of anesthetic depth
reduces the requirements for midazolam and propofol, resulting in a faster
recovery and a shorter postoperative ICU and hospital stay after surgical
correction of combined valve disorders. 2014 Elsevier Inc.

<20>
Accession Number
2014193880
Authors
Guay J. Ochroch E.A.
Institution
(Guay) Department of Anesthesiology, University of Montreal, Montreal, QC,
Canada
(Ochroch) Department of Anesthesiology, University of Pennsylvania Health
System, Philadelphia, PA, United States
Title
Effects of adding statins before surgery on mortality and major morbidity:
A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 255-266),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective To re-evaluate the effects of adding a statin before surgery on
mortality at 30 days and at 1 year and on major morbidity at 0-30 days.
Design A meta-analysis of parallel, randomized, controlled trials
published in English. Setting A university-based electronic search.
Participants Adult patients undergoing any type of procedure. Intervention
Adding a statin before a procedure compared to a placebo or no
intervention. Measurements and Main Results A search for all randomized
controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the
Cochrane Central Register of Controlled Trials in November 2012. The
quality of each study was assessed with the Cochrane Collaboration Tools.
An I-square >25% was chosen as the cut-off point for heterogeneity
exploration. The search produced 29 trials. Statins reduced the 0-30 days'
risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61);
I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no
statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95),
acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10
(0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26
(0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was
slightly decreased with atorvastatin: standardized mean difference (SMD)
-0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p =
0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with
simvastatin SMD -0.04 (-0.41, 0.48). Conclusions Adding a statin before a
high risk cardiac procedure reduces the 0-30 days' risk of myocardial
infarction. 2014 Elsevier Inc.

<21>
Accession Number
2014193881
Authors
Lomivorotov V.V. Shmirev V.A. Efremov S.M. Ponomarev D.N. Moroz G.B.
Shahin D.G. Kornilov I.A. Shilova A.N. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Shmirev, Efremov, Ponomarev, Moroz, Shahin, Kornilov,
Shilova, Lomivorotov, Karaskov) Research Institute of Circulation
Pathology, Department of Anesthesiology and Intensive Care, Novosibirsk,
Russian Federation
Title
Hypothermic versus normothermic cardiopulmonary bypass in patients with
valvular heart disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 295-300),
2014. Date of Publication: April 2014.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to test the hypothesis that
normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic
CPB in terms of cardiac protection (cTnI level) and outcome in patients
with valvular heart disease. Design Prospective randomized study. Setting
A tertiary cardiothoracic referral center. Participants 140 patients who
had valvular heart disease, with/without coronary artery disease,
surgically treated under CPB. Interventions The patients were allocated
randomly to undergo either hypothermic (temperature [T], 31 C-32 C) or
normothermic CPB (T>36 C). Measurements and Main Results The primary
endpoint was the dynamics of troponin I. The secondary endpoints were
ventilation time, the need for inotropic support, intensive care unit
(ICU) and hospital stay durations, complications, and mortality. There
were no significant intergroup differences in dynamics of troponin I.
Ventilation time was significantly lower in the hypothermic group (6 (5-9)
and 8 (5-12); p = 0.01). Conclusions Normothermic CPB in patients with
valvular heart disease was as effective as hypothermic perfusion in terms
of myocardial protection after the surgery assessed by cTnI release. The
short ventilation duration in patients who underwent hypothermic CPB needs
to be confirmed in a future investigation. 2014 Elsevier Inc.

<22>
Accession Number
2014186545
Authors
Jellema L.-J.C. Backus B.E. Six A.J. Braam R. Groenemeijer B. Van Der
Zaag-Loonen H.J. Tio R. Van Suijlen J.D.E.
Institution
(Jellema, Backus, Six, Braam, Groenemeijer, Van Der Zaag-Loonen, Tio, Van
Suijlen) Gelre Ziekenhuizen Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ
Apeldoorn, Netherlands
Title
The value of clinical and laboratory diagnostics for chest pain patients
at the emergency department.
Source
Clinical Chemistry and Laboratory Medicine. 52 (2) (pp 259-266), 2014.
Date of Publication: February 2014.
Publisher
Walter de Gruyter and Co.
Abstract
Background: The focus during the diagnostic process for patients with
acute chest pain is to discriminate patients who can be safely discharged
from those who are at risk for an acute coronary syndrome (ACS). In this
study the diagnostic value of the clinical examination is compared with
laboratory testing of troponin., Methods: This study included 710 chest
pain patients who presented at the ED of two hospitals in the Netherlands.
Clinical examination and laboratory testing were combined in the recently
developed HEART-score. The diagnostic values of clinical presentation,
troponin and the HEART-score for a major adverse coronary event (MACE) and
an ACS within 6 weeks were assessed. Furthermore, the improvement of HEART
with the second troponin measurement after 6 h was assessed using the net
reclassification improvement (NRI)., Results: The use of HEART (AUCMACE:
0.77; AUCACS: 0.82) obtains a higher diagnostic value than troponin
(AUCMACE: 0.72; AUCACS: 0.74) or clinical evaluation (AUCMACE: 0.69;
AUCACS: 0.74). Statistical significant different AUCs were obtained when
HEART is compared to troponin or clinical evaluation (p < 0.01). The use
of the second troponin test (after 6 h of admission) within HEART resulted
in an improvement of 8.0%., Conclusions: The HEART-score combines clinical
evaluation and results from laboratory testing, which should be used
together, to discriminate patients at risk of a cardiac event from
patients who can be safely discharged. In addition, it is shown that a
second troponin measurement slightly improves the discriminative ability
of the HEART-score.

<23>
Accession Number
2014197290
Authors
Abdel-Wahab M. Comberg T. Buttner H.J. El-Mawardy M. Chatani K. Gick M.
Geist V. Richardt G. Neumann F.-J.
Institution
(Abdel-Wahab, El-Mawardy, Chatani, Geist, Richardt) Cardiology Department,
Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Comberg, Buttner, Gick, Neumann) Cardiology Department, University Heart
Center Bad Krozingen, Bad Krozingen, Germany
Title
Aortic regurgitation after transcatheter aortic valve implantation with
balloon- and self-expandable prostheses: A pooled analysis from a 2-center
experience.
Source
JACC: Cardiovascular Interventions. 7 (3) (pp 284-292), 2014. Date of
Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to assess aortic regurgitation (AR) after
transcatheter aortic valve implantation (TAVI) with the self-expandable
Medtronic CoreValve (MCV) (Medtronic Inc., Minneapolis, Minnesota) versus
balloon-expandable Edwards Sapien XT valve (ESV) (Edwards Lifesciences,
Irvine, California). Background: AR after TAVI has been associated with
poor survival, but limited data exist comparing MCV with ESV. Methods: We
pooled the prospective TAVI databases of 2 German centers. The primary
endpoint was more-than-mild post-TAVI AR assessed by echocardiography. We
also assessed device success and survival within 1 year. Endpoints were
adjudicated according to the Valve Academic Research Consortium criteria
and analyzed by unadjusted and propensity-score-adjusted models. Results:
A total of 394 patients were included, 276 treated with MCV and 118 with
ESV. More-than-mild AR was significantly higher with MCV than with ESV
(12.7% vs. 2.6%, p = 0.002). This difference remained significant after
propensity adjustment (adjusted odds ratio [OR]: 4.59, 95% confidence
interval [CI]: 1.03 to 20.44). The occurrence of any degree of AR was also
higher with MCV (71.6% vs. 56.9%, p = 0.004). Device success was mainly
influenced by the occurrence of AR and was consequently higher with ESV
(95.8% vs. 86.6%, p = 0.007), but this was not significant after
propensity adjustment (adjusted OR: 0.34, 95% CI: 0.11 to 1.03, p = 0.06).
At 1 year, survival was comparable between both valve types (83.8% MCV vs.
88.2% ESV, p = 0.42), but was significantly worse in patients with
more-than-mild AR (69.8% vs. 87.4%, p = 0.004) and in those with device
failure (65.6% vs. 87.4%, p < 0.001). Conclusions: More-than-mild AR after
TAVI was more frequent with MCV than with ESV. This finding deserves
consideration, as more-than-mild AR was associated with higher mortality
at 1 year. 2014 by the American College of Cardiology Foundation.

<24>
Accession Number
2014187821
Authors
Cuff D.J. Pupello D.R.
Institution
(Cuff, Pupello) Suncoast Orthopaedic Surgery and Sports Medicine,
Foundation for Orthopaedic Research and Education, Tampa, FL, United
States
(Cuff) Suncoast Orthopaedic Surgery and Sports Medicine, 836 Sunset Lake
Boulevard, Venice, FL 34292, United States
(Pupello) Foundation for Orthopaedic Research and Education, 13020 North
Telecom Parkway, Tampa, FL 33637, United States
Title
Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the
treatment of proximal humeral fractures in elderly patients.
Source
Journal of Bone and Joint Surgery - Series A. 95 (22) (pp 2050-2055),
2013. Date of Publication: 20 Nov 2013.
Publisher
Journal of Bone and Joint Surgery Inc.
Abstract
Background: Treatment of complex three and four-part proximal humeral
fractures with hemiarthroplasty in elderly patients has yielded mixed
clinical results. Reverse shoulder arthroplasty has emerged as a treatment
option for comminuted proximal humeral fractures for these patients. The
purpose of the study was to perform a prospective evaluation of patient
outcomes comparing hemiarthroplasty and reverse shoulder arthroplasty for
the treatment of comminuted proximal humeral fractures in elderly
patients. Methods: Fifty-three consecutive elderly patients (average age,
74.4 years) underwent an arthroplasty for a complex proximal humeral
fracture. Indications for arthroplasty were four-part fractures,
three-part fractures with severe comminution of the greater tuberosity,
and fractures that involved an articular split of the humeral head.
Twenty-six patients underwent hemiarthroplasty (the HA group), followed by
twenty-seven patients who underwent reverse shoulder arthroplasty (the RSA
group). A total of forty-seven patients (twenty-three in the HA group and
twenty-four in the RSA group) were available for follow-up at a minimum of
two years. Results: Final average outcome scores were lower in the HA
group than in the RSA group (American Shoulder and Elbow Surgeons [ASES]
score of 62 versus 77 [p = 0.0001] and Simple Shoulder Test [SST] of 5.8
versus 7.4 [p = 0.0062]), and patient-reported satisfaction was lower in
the HA group than in the RSA group (61% versus 91%; p = 0.038).
Radiographic healing of the tuberosities occurred in 61% of the patients
in the HA group compared with 83% of the patients in the RSA group (p =
0.17). Forward elevation of the arm was higher in the RSA group
(139degree) than in the HA group (100degree) (p = 0.0002), but no
significant differences were observed for shoulder external rotation or
internal rotation. Complication rates in both groups were similar. Three
patients (13%) in the HA group elected revision to reverse shoulder
arthroplasty because of failed tuberosity healing and resultant shoulder
pseudoparesis. Conclusions: In this series, reverse shoulder arthroplasty
resulted in better clinical outcomes and a similar complication rate
compared with hemiarthroplasty for the treatment of comminuted proximal
humeral fractures in the elderly. Level of Evidence: Therapeutic Level II.
See Instructions for Authors for a complete description of levels of
evidence.