Total documents retrieved: 25
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<1>
Accession Number
2015046346
Authors
Li Y. Guo W. Zhang T. Liu J. Jia S. Liu X. Jia X.
Institution
(Li, Guo, Zhang, Liu, Jia, Liu, Jia) Department of Vascular Surgery,
Clinical Division of Surgery, Chinese PLA General Hospital, 28 Fuxing
Road, Beijing 100853, China
(Zhang, Liu) Department of Vascular Surgery, Peking University People's
Hospital, Beijing, China
Title
Improvement in quality of life in old people with aortic stenosis after
transcatheter aortic valve implantation.
Source
Current Signal Transduction Therapy. 9 (3) (pp 164-171), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: This study aimed to compare the improvement in the quality of
life (QoL) in the long-term follow-up of 12 to 24 months after
transcatheter aortic valve implantation (TAVI) therapy for old people with
severe aortic stenosis. Methods: According to the guidelines provided by
PRISMA, published studies till 15 June, 2014 were retrieved from Google
Scholar, Pubmed, Embase and CNKI. Health-related QoL was evaluated at
beginning and at 12 to 24 months with five kinds of instruments. Funnel
plots were used to test the potential publication bias, and analyze the
source of heterogeneity, such as meta-regression, subgroup and
sensitivity. Results: Our meta-analysis involved ten studies with 1359
patients. Preprocedural summary 12-item Short Form (SF-12) physical and
mental scores showed a significant improvement after one year after TAVI
[weighted mean difference (WMD): -10.61, 95% confidence interval (CI):
-15.06, -6.15; WMD: -6.39, 95%CI: -9.08, -3.70; respectively]. One year
follow-up visit after TAVI revealed significantly improved QoL compared to
baseline in Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol
(EQ-5D) (WMD: -29.44, 95%CI: -33.29, -26.58; WMD: -0.09, 95%CI: -0.12,
-0.06; respectively). At 12 to 24 months, weighted mean 36-item Short-Form
(SF-36) physical improved by 16.96 points (95%CI: -27.77, -6.16) and
SF-36-mental improved by 5.57 points (95%CI: -9.96, -1.19); weighted mean
Minnesota Living with Heart Failure Questionnaire (MLHFQ) decreased by
22.29 points (95%CI: 16.09, 28.48). Conclusion: This technique provides a
promising therapy approach for old patients with severe symptomatic aortic
stenosis in high-risk surgery, and there are significant improvements for
this group in health-related quality of life in the follow-up.
<2>
Accession Number
2015480383
Authors
Svensson L.G. Blackstone E.H. Apperson-Hansen C. Ruggieri P.M. Ainkaran P.
Naugle R.I. Lima B. Roselli E.E. Cooper M. Somogyi D. Tuzcu E.M. Kapadia
S. Clair D.G. Sabik J.F. Lytle B.W.
Institution
(Svensson, Blackstone, Roselli, Clair, Sabik, Lytle) Aortic Center, Heart
and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/Desk J4-1,
Cleveland, OH 44915, United States
(Svensson, Blackstone, Lima, Roselli, Cooper, Sabik, Lytle) Department of
Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Blackstone, Ainkaran) Department of Quantitative Health Sciences,
Cleveland Clinic, Cleveland, OH, United States
(Apperson-Hansen) School of Medicine, Case Western Reserve University,
Cleveland, OH, United States
(Ruggieri) Department of Neuroradiology, Cleveland Clinic, Cleveland, OH,
United States
(Naugle) Department of Psychiatry and Psychology, Cleveland Clinic,
Cleveland, OH, United States
(Somogyi) Department of Perfusion Services, Cleveland Clinic, Cleveland,
OH, United States
(Tuzcu, Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Clair) Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH,
United States
Title
Implications from neurologic assessment of brain protection for total arch
replacement from a randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (5) (pp 1140-1147),
2015. Date of Publication: November 2015.
Publisher
Mosby Inc.
Abstract
Objective The study objective was to perform a randomized trial of brain
protection during total aortic arch replacement and identify the best way
to assess brain injury. Methods From June 2003 to January 2010, 121
evaluable patients were randomized to retrograde (n = 60) or antegrade (n
= 61) brain perfusion during hypothermic circulatory arrest. We assessed
the sensitivity of clinical neurologic evaluation, brain imaging, and
neurocognitive testing performed preoperatively and 4 to 6 months
postoperatively to detect brain injury. Results A total of 29 patients
(24%) experienced neurologic events. Clinical stroke was evident in 1
patient (0.8%), and visual changes were evident in 2 patients; all had
brain imaging changes. A total of 14 of 95 patients (15%) undergoing both
preoperative and postoperative brain imaging had evidence of new white or
gray matter changes; 10 of the 14 patients had neurocognitive testing, but
only 2 patients experienced decline. A total of 17 of 96 patients (18%)
undergoing both preoperative and postoperative neurocognitive testing
manifested declines of 2 or more reliable change indexes; of these 17, 11
had neither imaging changes nor clinical events. Thirty-day mortality was
0.8% (1/121), with no neurologic deaths and a similar prevalence of
neurologic events after retrograde and antegrade brain perfusion (22/60,
37% and 15/61, 25%, respectively; P =.2). Conclusions Although this
randomized clinical trial revealed similar neurologic outcomes after
retrograde or antegrade brain perfusion for total aortic arch replacement,
clinical examination for postprocedural neurologic events is insensitive,
brain imaging detects more events, and neurocognitive testing detects even
more. Future neurologic assessments for cardiovascular procedures should
include not only clinical examination but also brain imaging studies,
neurocognitive testing, and long-term assessment.
<3>
Accession Number
2015383301
Authors
Hwang H.Y. Paeng J.C. Oh H.C. Kim Y.H. Kim K.-B.
Institution
(Hwang, Oh, Kim, Kim) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, 101 Daehak-ro, Chongno-gu, Seoul 110-744, South Korea
(Paeng) Department of Nuclear Medicine, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Title
Comparison of perfusion and thickening between vein and right internal
thoracic artery composite grafts from a randomized trial substudy.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (5) (pp 1187-1194),
2015. Date of Publication: November 2015.
Publisher
Mosby Inc.
Abstract
Background Improvements in myocardial perfusion and thickening were
compared in coronary artery bypass grafting patients who received
saphenous vein (SV) Y-composite grafts versus those who received right
internal thoracic artery ([R]ITA) Y-composite grafts. Methods Of the 224
patients enrolled in a randomized clinical trial, 116 patients (SV group,
n = 65; RITA group, n = 51) in whom myocardial single-photon-emission
computed tomography was performed preoperatively, and at 3 months and 1
year postoperatively, were retrospectively studied. A 20-segment model was
adopted, and a total of 792 ischemic myocardial segments (SV group, n =
443; RITA group, n = 349) were analyzed. The reversibility score (rest
minus stress perfusion value) as an indicator of ischemic myocardium, and
Z-values for segmental myocardial thickening, were calculated. Results
Compared with preoperative values, both myocardial perfusion and segmental
myocardial thickening had improved significantly at 3 months and 1 year
postoperatively (reversibility scores [mean +/- SD] were, respectively:
13.5 +/- 8.0 vs 5.8 +/- 6.2 and 5.1 +/- 6.2, P <.001; Z-values were -1.13
+/- 1.53 vs -0.62 +/- 1.40 and -0.67 +/- 1.35, P <.001). Mixed-effect
model analyses showed no differences in improvements in myocardial
perfusion and segmental myocardial thickening between the 2 groups 1 year
after revascularization. Separate analysis demonstrated less improvement
of myocardial perfusion in the right coronary artery territory of the RITA
group than the SV group, with marginal significance (P =.056). Conclusions
Improvements in myocardial perfusion and segmental myocardial thickening
were similar between the 2 groups at 1 year after revascularization. The
SV, versus the right ITA, composite graft may be more beneficial in
perfusion improvement of the right coronary artery territory.
<4>
Accession Number
2015351937
Authors
Zou Y. Hu C. Ye W. Fan L. Xu L. Zhang A.
Institution
(Zou, Xu, Zhang) Department of Cardiology, First Affiliated Hospital,
Jinan University, 613Wangpu Street, Guangzhou 510630, China
(Zou, Hu, Ye, Fan) Internal Medicine, Guangdong Women and Children
Hospital, Guangzhou, Guangdong, China
Title
Long-term clinical efficacy and safety of adding cilostazol to dual
antiplatelet therapy after drug-eluting stent implantation in coronary
arteries: A meta-analysis of randomized controlled trials.
Source
Thrombosis Research. 136 (5) (pp 870-877), 2015. Date of Publication:
November 2015.
Publisher
Elsevier Ltd
Abstract
Objective To assess the long-term clinical efficacy and safety of adding
cilostazol (TAT) to conventional dual antiplatelet therapy (DAT) for
patients undergoing drug-eluting stent (DES) implantation in coronary
arteries. Methods We performed PUBMED, MEDLINE, EMBASE, and Cochrane
CENTRAL searches for randomized clinical trials of TAT versus DAT in
patients after DES implantation with criteria to include trials with a
follow-up of more than 6 months. Results Seven RCTs with a total of 3487
patients were included in this review. The meta-analysis showed that TAT
was associated with a significant reduction in major adverse cardiac
events (MACEs) (relative risk (RR) = 0.66; 95% CI = 0.50-0.88), target
lesion revascularization (TLR) (RR = 0.61, 95% CI = 0.43-0.84), target
vessel revascularization (TVR) (RR = 0.53, 95% CI = 0.37-0.75), in-stent
restenosis (RR = 0.64, 95% CI = 0.44-0.85), in-segment restenosis (RR =
0.58, 95% CI = 0.43-0.79, P <.01), in-stent late loss (LL) (standardized
mean difference (SMD) = - 0.21, 95% CI = 0.32-0.17), and in-segment LL
(SMD = - 0.27, 95% CI = - 0.38-0.16). TAT also did not appear to
significantly alter any of the other meta-analysis secondary efficacy
outcomes and had similar rates of bleeding, but TAT had significantly
higher rates of rash, gastrointestinal side-effects, headache and drug
discontinuation. Conclusions Compared with standard DAT, the long-term use
of TAT in patients after DES implantation gave more benefits in reducing
the incidence of MACEs, TLR, TVR, in-stent and in-segment LL and
restenosis without increasing bleeding but was associated with an increase
in minor adverse events.
<5>
Accession Number
2015329499
Authors
Nakamura R.E. Vincent J.-L. Fukushima J.T. Almeida J.P.D. Franco R.A. Lee
Park C. Osawa E.A. Pinto Silva C.M. Costa Auler J.O. Landoni G. Barbosa
Gomes Galas F.R. Filho R.K. Hajjar L.A.
Institution
(Nakamura, Fukushima, Almeida, Franco, Lee Park, Osawa, Pinto Silva, Costa
Auler, Barbosa Gomes Galas, Hajjar) Department of Anesthesia and Intensive
Care, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
(Vincent) Department of Intensive Care, Erasme University Hospital, Route
de Lennik 808, Brussels 1070, Belgium
(Landoni) Anesthesiology and Intensive Care, Vita-Salute San Raffaele
University, Milan, Italy
(Filho) Department of Cardiopneumology, Heart Institute, University of Sao
Paulo, Sao Paulo, Brazil
Title
A liberal strategy of red blood cell transfusion reduces cardiogenic shock
in elderly patients undergoing cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (5) (pp 1314-1320),
2015. Date of Publication: November 2015.
Publisher
Mosby Inc.
Abstract
Objective The aim of this study was to compare outcomes in patients
undergoing cardiac surgery who are aged 60 years or more or less than 60
years after implementation of a restrictive or a liberal transfusion
strategy. Methods This is a substudy of the Transfusion Requirements After
Cardiac Surgery (TRACS) randomized controlled trial. In this subgroup
analysis, we separated patients into those aged 60 years or more (elderly)
and those aged less than 60 years randomized to a restrictive or a liberal
strategy of red blood cell transfusion. The primary outcome was a
composite defined as a combination of 30-day all-cause mortality and
severe morbidity. Results Of the 502 patients included in the Transfusion
Requirements After Cardiac Surgery study, 260 (51.8%) were aged 60 years
or more and 242 (48.2%) were aged less than 60 years and were included in
this study. The primary end point occurred in 11.9% of patients in the
liberal strategy group and 16.8% of patients in the restrictive strategy
group (P =.254) for those aged 60 years or more and in 6.8% of patients in
the liberal strategy group and 5.6% of patients in the restrictive
strategy group for those aged less than 60 years (P =.714). However, in
the older patients, cardiogenic shock was more frequent in patients in the
restrictive transfusion group (12.8% vs 5.2%, P =.031). Thirty-day
mortality, acute respiratory distress syndrome, and acute renal injury
were similar in the restrictive and liberal transfusion groups in both age
groups. Conclusions Although there was no difference between groups
regarding the primary outcome, a restrictive transfusion strategy may
result in an increased rate of cardiogenic shock in elderly patients
undergoing cardiac surgery compared with a more liberal strategy.
Cardiovascular risk of anemia may be more harmful than the risk of blood
transfusion in older patients.
<6>
Accession Number
2015313643
Authors
Rogers C.A. Bryan A.J. Nash R. Suleiman M.S. Baos S. Plummer Z. Hillier J.
Davies I. Downes R. Nicholson E. Reeves B.C. Angelini G.D.
Institution
(Rogers, Nash, Baos, Plummer, Reeves) Clinical Trials and Evaluation Unit,
School of Clinical Sciences, University of Bristol, Bristol Royal
Infirmary, Marlborough St, Bristol BS2 8HW, United Kingdom
(Bryan, Suleiman, Hillier, Davies, Downes, Nicholson, Angelini) Bristol
Heart Institute, University Hospitals Bristol National Health Service
Foundation Trust, University of Bristol, Bristol, United Kingdom
Title
Propofol cardioplegia: A single-center, placebo-controlled, randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (6) (pp 1610-1619.e3),
2015. Date of Publication: December 2015.
Publisher
Mosby Inc.
Abstract
Objectives Cardiac surgery with cardiopulmonary bypass and cardioplegic
arrest is an effective treatment for coronary artery and aortic valve
diseases. However, the myocardium sustains reperfusion injury after
ischemic cardioplegic arrest. Our objective was to assess the benefits of
supplementing cardioplegia solution with the general anesthetic propofol
in patients undergoing either coronary artery bypass grafting (CABG) or
aortic valve replacement (AVR). Methods A single-center, double-blind
randomized controlled trial was carried out to compare cardioplegia
solution supplemented with propofol (concentration 6 mug/mL) versus
intralipid (placebo). The primary outcome was cardiac troponin T release
over the first 48 hours after surgery. Results We recruited 101
participants (51 in the propofol group, 50 in the intralipid group); 61
underwent CABG and 40 underwent AVR. All participants were followed to 3
months. Cardiac troponin T release was on average 15% lower with propofol
supplementation (geometric mean ratio, 0.85; 95% confidence interval [CI],
0.73-1.01; P =.051). There were no differences for CABG participants but
propofol-supplemented participants undergoing AVR had poorer postoperative
renal function (geometric mean ratio, 1.071; 95% CI, 1.019-1.125; P
=.007), with a trend toward longer intensive care stay (median, 89.5 vs
47.0 hours; hazard ratio, 0.58; 95% CI, 0.31-1.09; P =.09) and fewer with
perfect health (based on the EQ-5D health utility index) at 3 months (odds
ratio, 0.26; 95% CI, 0.06-1.05; P =.058) compared with the intralipid
group. Safety profiles were similar. There were no deaths. Conclusions
Propofol supplementation in cardioplegia appears to be cardioprotective.
Its influence on early clinical outcomes may differ between CABG and AVR
surgery. A larger, multicenter study is needed to confirm or refute these
suggestions.
<7>
Accession Number
2015552506
Authors
Hossein Almassi G. Carr B.M. Bishawi M. Shroyer A.L. Quin J.A. Hattler B.
Wagner T.H. Collins J.F. Ravichandran P. Cleveland J.C. Grover F.L.
Bakaeen F.G.
Institution
(Hossein Almassi) Department of Cardiothoracic Surgery, Medical College of
Wisconsin, Veterans Affairs Medical Center, 9200 W Wisconsin Ave,
Milwaukee, WI 53226, United States
(Carr, Shroyer) Department of Surgery, Northport Veterans Affairs Medical
Center, Stony Brook School of Medicine, Stony Brook, NY, United States
(Bishawi) Department of Cardiovascular and Thoracic Surgery, Duke
University Medical Center, Durham, NC, United States
(Quin) Department of Cardiac Surgery, Veterans Affairs Boston Healthcare
System, West Roxbury, MA, United States
(Hattler, Cleveland, Grover) Department of Cardiology, Veterans Affairs
Eastern Colorado Health Care System Denver, University of Colorado, School
of Medicine, Anschutz Medical Campus, Aurora, CO, United States
(Wagner) Veterans Affairs Palo Alto Health Economics Resource Center,
Menlo Park, CA, United States
(Collins) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
(Ravichandran) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Bakaeen) Department of Surgery, Portland Veterans Affairs Medical Center,
Oregon Health Sciences University, Portland, OR, United States
(Collins) Cardiothoracic Surgery, Baylor College of Medicine, Houston
Veterans Affairs Medical Center, Houston, TX, United States
Title
Resident versus attending surgeon graft patency and clinical outcomes in
on- versus off-pump coronary artery bypass surgery Read at the 95th Annual
Meeting of the American Association for Thoracic Surgery, Seattle,
Washington, April 25-29, 2015.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (6) (pp 1428-1437.e1),
2015. Date of Publication: December 2015.
Publisher
Mosby Inc.
Abstract
Objective Controversy exists regarding ideal approaches in teaching
residents complex and/or new surgical techniques in part because
consequences on patient outcomes are largely unknown. This study compared
patient outcomes for cases in which residents (rather than attending
surgeons) performed most of the distal anastomoses as primary surgeons,
during on- and off-pump coronary artery bypass grafting (CABG). Methods
This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial
compared clinical outcomes and 1-year graft patency for cases in which
residents versus attending surgeons were the primary operator. Comparisons
were made between on-pump and off-pump techniques. Results From July 2003
through May 2007, a total of 1272 ROOBY nonemergent CABG patients were
randomized at 16 Veterans Affairs centers where residents were active
participants. Residents were the primary surgeon (ie, performed <50% of
the distal anastomoses) more frequently in on-pump (77.9%) than in
off-pump (67.4%) cases. Between these 2 techniques, no were found
differences in baseline patient characteristics; short-term and 1-year
morbidity and mortality rates were no different for residents versus
attendings in CABG cases. FitzGibbon A graft patency rates were similar
for resident versus attendings completed distal anastomoses for on-pump
(83.0% vs 82.4%) compared with off-pump (77.2% vs 76.6%) procedures.
Conclusions In the ROOBY trial, short-term and 1-year patient outcomes and
graft patency rates did not differ between resident and attending
surgeons, demonstrating that with appropriate patient selection and
resident supervision, residents can perform advanced, novel surgical
techniques with outcomes similar to those of attending surgeons.
<8>
[Use Link to view the full text]
Accession Number
2015550530
Authors
Lam D.M.H. Choi S.-W. Wong S.S.C. Irwin M.G. Cheung C.-W.
Institution
(Lam, Irwin) Department of Anaesthesiology, Queen Mary Hospital, United
Kingdom
(Choi, Wong, Cheung) Laboratory and Clinical Research Institute for Pain,
Department of Anaesthesiology, University of Hong Kong, 102, Pokfulam
Road, Hong Kong, Hong Kong
Title
Efficacy of pregabalin in acute postoperative pain under different
surgical categories a meta-analysis.
Source
Medicine (United States). 94 (46) (pp e1944), 2015. Date of Publication:
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The efficacy of pregabalin in acute postsurgical pain has been
demonstrated in numerous studies; however, the analgesic efficacy and
adverse effects of using pregabalin in various surgical procedures remain
uncertain. We aim to assess the postsurgical analgesic efficacy and
adverse events after pregabalin administration under different surgical
categories using a systematic review and meta-analysis of randomized
controlled trials. A search of the literature was performed between August
2014 to April 2015, using PubMed, Ovid via EMBASE, Google Scholar, and
ClinicalTrials.gov with no limitation on publication year or language.
Studies considered for inclusion were randomized controlled trials,
reporting on relevant outcomes (2-, 24-hour pain scores, or 24 hour
morphine-equivalent consumption) with treatment with perioperative
pregabalin. Seventy-four studies were included. Pregabalin reduced pain
scores at 2 hours in all categories: cardiothoracic (Hedge's g and 95%CI,
0.442 [0.752 to 0.132], P0.005), ENT (Hedge g and 95%CI, 0.684 [1.051 to
0.316], P<0.0001), gynecologic (Hedge g, 95%CI, 0.792 [1.235 to 0.350],
P<0.0001), laparoscopic cholecystectomy (Hedge g, 95%CI,-0.600 [-0.989
to-0.210], P0.003), orthopedic (Hedge g, 95%CI, 0.507 [0.812 to 0.202],
P0.001), spine (Hedge g, 95%CI, 0.972 [1.537 to 0.407], P0.001), and
miscellaneous procedures (Hedge g, 95%CI, 1.976 [2.654 to 1.297],
P<0.0001). Pregabalin reduced 24-hour morphine consumption in gynecologic
(Hedge g, 95%CI, 1.085 [1.582 to 0.441], P0.001), laparoscopic
cholecystectomy (Hedge g, 95%CI,-0.886 [-1.652 to-0.120], P0.023),
orthopedic (Hedge g, 95%CI, 0.720 [1.118 to 0.323], P<0.0001), spine
(Hedge g, 95%CI, 1.016 [1.732 to 0.300], P0.005), and miscellaneous
procedures (Hedge g, 95%CI, 1.329 [2.286 to 0.372], P0.006). Pregabalin
resulted in significant sedation in all surgical categories except ENT,
laparoscopic cholecystectomy, and gynecologic procedures. Postoperative
nausea and vomiting was only significant after pregabalin in miscellaneous
procedures. Analgesic effects and incidence of adverse effects of using
pregabalin are not equal in different surgical categories.
<9>
Accession Number
2015542835
Authors
Hong S.-J. Kim B.-K. Shin D.-H. Nam C.-M. Kim J.-S. Ko Y.G. Choi D. Kang
T.-S. Kang W.-C. Her A.-Y. Kim Y. Hur S.-H. Hong B.-K. Kwon H. Jang Y.
Hong M.-K. Yang J.-Y. Cheon D.W. Lee S.W. Kim B.-O. Ahn C.-M. Chang H.-J.
Choi S.-H. Cho D.-K. Choi E.-Y. Shim J.-Y. Yoon S.-J. Kim J.-Y. Hong M.K.
Lee S.-G. Yoon J.H. Jeon D.-W. Cho Y.-H. Choi J.-W. Rhee S.-J. Choi R.-K.
Lee S.-Y. Kim W.-H. Lee N.-H. Hong Y.-J. Choi H.-H. Park J.-P. Lim S.-W.
Institution
(Hong) Department of Internal Medicine, Sanggye Paik Hospital, Inje
University, Seoul, South Korea
(Hong, Kim, Shin, Kim, Ko, Choi, Jang, Hong) Division of Cardiology,
Severance Cardiovascular Hospital, Yonsei University College of Medicine,
Seoul, South Korea
(Nam) Department of Preventive Medicine and Biostatistics, Yonsei
University College of Medicine, Seoul, South Korea
(Kang) Dankook University College of Medicine, Cheonan, South Korea
(Kang) Gil Hospital, Gachon University College of Medicine, Incheon, South
Korea
(Her, Kim) School of Medicine, Kangwon National University, Chuncheon,
South Korea
(Hur) Keimyung University College of Medicine, Daegu, South Korea
(Hong, Kwon) Kangnam Severance Hospital, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Division of Cardiology, Severance Cardiovascular
Hospital, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea
(Jang, Hong) Cardiovascular Research Institute, Yonsei University College
of Medicine, Seoul, South Korea
(Hong) Yonsei University College of Medicine, Seoul, South Korea
(Hong) GSH, Seoul, South Korea
(Lee) Ulsan University Hospital, Ulsan, South Korea
(Yoon) Wonju Christian Hospital, Wonju, South Korea
(Yoon) GGUH, Incheon, South Korea
(Jeon) DUH, Cheonan, South Korea
(Jeon) NHIC Ilsan Hospital, Ilsan, South Korea
(Cho) Myongji Hospital, Goyang, South Korea
(Choi) Seoul Eulji Hospital, Seoul, South Korea
(Rhee) Wonkwang University Hospital, Iksan, South Korea
(Choi) Sejong General Hospital, Bucheon, South Korea
(Lee) Inje University Ilsan Paik Hosital, Ilsan, South Korea
(Kim) KUDH, Daegu, South Korea
(Kim) Daejeon Eulji University Hospital, Dae-jeon, South Korea
(Lee) Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
(Lee) KNUH, Chuncheon, South Korea
(Hong) Chunnam National University Hospital, Kwangju, South Korea
(Choi) Hallym University Chunchun Scared Hospital, Chuncheon, South Korea
(Park) Jeonnju Presbyterian Medical Center, Jeonju, South Korea
(Lim) CHA University Medical Center, Seongnam, South Korea
Title
Effect of intravascular ultrasound-guided vs angiography- guided
everolimus-eluting stent implantation: The IVUS-XPL randomized clinical
trial.
Source
JAMA - Journal of the American Medical Association. 314 (20) (pp
2155-2163), 2015. Date of Publication: 24 Nov 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE:Use of intravascular ultrasound (IVUS) promotes better clinical
outcomes for coronary intervention in complex coronary lesions. However,
randomized data demonstrating the clinical usefulness of IVUS are limited
for lesions treated with drug-eluting stents. OBJECTIVE:To determine
whether the long-term clinical outcomes with IVUS-guided drug-eluting
stent implantation are superior to those with angiography-guided
implantation in patients with long coronary lesions. DESIGN, SETTING, AND
PARTICIPANTS: The Impact of Intravascular Ultrasound Guidance on Outcomes
of Xience Prime Stents in Long Lesions (IVUS-XPL) randomized, multicenter
trial was conducted in 1400 patients with long coronary lesions (implanted
stent>28 mmin length) between October 2010 and July 2014 at 20 centers in
Korea. INTERVENTIONS: Patients were randomly assigned to receive
IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting
stent implantation. MAIN OUTCOMES AND MEASURES: Primary outcome measure
was the composite of major adverse cardiac events, including cardiac
death, target lesion-related myocardial infarction, or ischemia-driven
target lesion revascularization at 1 year, analyzed by intention-to-treat.
RESULTS: One-year follow-up was complete in 1323 patients (94.5%). Major
adverse cardiac events at 1 year occurred in 19 patients (2.9%) undergoing
IVUS-guided and in 39 patients (5.8%) undergoing angiography-guided stent
implantation (absolute difference, -2.97% [95% CI, -5.14%to -0.79%])
(hazard ratio [HR], 0.48 [95% CI, 0.28 to 0.83], P = .007). The difference
was driven by a lower risk of ischemia-driven target lesion
revascularization in patients undergoing IVUS-guided (17 [2.5%]) compared
with angiography-guided (33 [5.0%]) stent implantation (HR, 0.51 [95% CI,
0.28 to 0.91], P = .02). Cardiac death and target lesion-related
myocardial infarction were not significantly different between the 2
groups. For cardiac death, there were 3 patients (0.4%) in the IVUS-guided
group and 5 patients (0.7%) in the angiography-guided group (HR, 0.60 [95%
CI, 0.14 to 2.52], P = .48). Target lesion-related myocardial infarction
occurred in 1 patient (0.1%) in the angiography-guided stent implantation
group (P = .32). CONCLUSIONS AND RELEVANCE: Among patients requiring long
coronary stent implantation, the use of IVUS-guided everolimus-eluting
stent implantation, compared with angiography-guided stent implantation,
resulted in a significantly lower rate of the composite of major adverse
cardiac events at 1 year. These differences were primarily due to lower
risk of target lesion revascularization.
<10>
Accession Number
2015133905
Authors
Zhang Y. Ma L. Zhao H.
Institution
(Zhang, Ma, Zhao) Department of Cardiothoracic Surgery, First Affiliated
Hospital, Zhejiang University, Hangzhou 310003, China
Title
Efficacy of mitral valve repair as an adjunct procedure to coronary artery
bypass grafting in moderate ischemic mitral regurgitation: A meta-analysis
of randomized trials.
Source
Journal of Cardiac Surgery. 30 (8) (pp 623-630), 2015. Date of
Publication: 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objective Whether moderate ischemic mitral regurgitation (IMR) should be
repaired during coronary artery bypass grafting (CABG) is still uncertain.
This meta-analysis of randomized controlled trials (RCTs) evaluated the
efficacy of adding mitral valve repair (MVR) to CABG in patients with
moderate IMR. Methods We searched PubMed, the Cochrane Library, and the
Web of Science for RCTs that compared the efficacy of CABG plus MVR with
CABG alone. Four RCTs that included 505 patients met the eligibility
criteria. Results CABG + MVR significantly reduced the risk of
intermediate residual mitral regurgitation (MR) grade >2+ compared with
CABG alone (risk ratio [RR] = 0.20, 95% confidence interval [CI]
0.04-0.92, p = 0.04), but did not have advantages on 30-day/in-hospital
mortality (RR = 1.06, 95% CI 0.37-3.09, p = 0.91), intermediate mortality
(RR = 0.90, 95% CI 0.48-1.67, p = 0.73), risk of intermediate NYHA class
>II (RR = 0.62, 95% CI 0.24-1.62, p = 0.33), intermediate left ventricular
ejection fraction (LVEF) (SMD = 0.04%, 95% CI -0.35 to 0.42, p = 0.84),
and intermediate LV end-systolic volume index (LVESVI) (SMD = -0.20
mL/m<sup>2</sup>, 95% CI -0.92 to 0.51, p = 0.58). Conclusion Compared
with CABG alone, adding MVR to CABG in patients with moderate IMR reduces
the residual MR grade, but has no significant effect on mortality,
intermediate NYHA class, LVEF, and LVESVI. Further RCTs with larger sample
size and longer follow-up are needed to more clearly elucidate the
efficacy of MVR as an adjunct procedure to CABG in patients with moderate
IMR.
<11>
Accession Number
2015549033
Authors
Maghbooli Z. Hossein-Nezhad A.
Institution
(Maghbooli) Endocrinology and Metabolism Research Center, Endocrinology
and Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hossein-Nezhad) Osteoporosis Research Center, Endocrinology and
Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, 5th Floor Shariati Hospital, North Kargar Avenue, Tehran
1411413137, Iran, Islamic Republic of
(Hossein-Nezhad) Department of Medicine, Section of Endocrinology,
Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory,
Boston University Medical Center, Boston, MA, United States
Title
Transcriptome and molecular endocrinology aspects of epicardial adipose
tissue in cardiovascular diseases: A systematic review and meta-analysis
of observational studies.
Source
BioMed Research International. 2015 , 2015. Article Number: 926567. Date
of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The objective of this study was to perform a systematic review of
published literature on differentially expressed genes (DEGs) in human
epicardial adipose tissue (EAT) to identify molecules associated with
CVDs. A systematic literature search was conducted in PubMed, SCOPUS, and
ISI Web of Science literature databases for papers published before
October 2014 that addressed EAT genes and cardiovascular diseases (CVDs).
We included original papers that had performed gene expressions in EAT of
patients undergoing open-heart surgery. The Reporting Recommendations for
Tumor Marker Prognostic Studies (PRIMARK) assessment tool was also used
for methodological quality assessment. From the 180 papers identified by
our initial search strategy, 40 studies met the inclusion criteria and
presented DEGs in EAT samples from patients with and without CVDs. The
included studies reported 42 DEGs identified through comparison of
EAT-specific gene expression in patients with and without CVDs. Among the
42 DEGs, genes involved in regulating apoptosis had higher enrichment
scores. Notably, interleukin-6 (IL-6) and tumor protein p53 (TP53) were
the main hub genes in the network. The results suggest that regulation of
apoptosis in EAT is critical for CVD development. Moreover, IL-6 and TP53
as hub genes could serve as biomarkers and therapeutic targets for CVDs.
<12>
Accession Number
2015547707
Authors
Schreiner W. Dudek W. Sirbu H.
Institution
(Schreiner, Dudek, Sirbu) Department of Thoracic Surgery, University
Hospital Erlangen, Erlangen, Germany
Title
Is salvage surgery for recurrent non-small-cell lung cancer after
definitive non-operative therapy associated with reasonable survival?.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (5) (pp 682-684),
2015. Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether salvage pulmonary
resection is possible and worthwhile for patients with recurrence of
non-small-cell lung cancer (NSCLC) after prior definitive non-operative
therapy. A total of nine reports were identified using the reported
search, of which four represented the best available 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. All studies were retrospective. In
total, 48 pulmonary salvage resections were performed in 47 patients after
prior definitive radiation, chemoradiation or stereotactic body radiation
therapy, of which 28 were lobectomies (including 1 sleeve lobectomy), 12
pneumonectomies, 4 bilobectomies and 4 sublobar resections (2
segmentectomies and 2 wedge resections). Postoperative complications
ranged from 0 to 58% (mean from four studies 42.5%). Only one study
reported any mortality (4%), the other three had zero mortality. Median
postoperative survival was reported in two studies and ranged from 9 to 30
months. Experience with salvage lung resection for locally recurrent
NSCLC, after prior definitive non-surgical treatment, remains limited.
Therefore, this analysis was based on only 48 resections in 47 patients
from four retrospective studies. Nevertheless, the published data suggest
that salvage lung surgery for recurrent, previously non-operatively
managed non-small-cell lung cancer is a worthwhile treatment option with
good survival, acceptable morbidity and low mortality.
<13>
Accession Number
2015547705
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Zeriouh M. Dehghan A.M. Shahidzadeh
A. Akbar Karimi-Bondarabadi A. Sabashnikov A. Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Dehghan, Shahidzadeh, Akbar
Karimi-Bondarabadi) Cardiovascular Research Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Zeriouh, Sabashnikov, Popov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and
Harefield NHS Foundation Trust, Middlesex, London UB9 6JH, United Kingdom
Title
Safety and efficacy of glucose-insulin-potassium treatment in coronary
artery bypass graft surgery and percutaneous coronary intervention.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (5) (pp 667-676),
2015. Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
The purpose of this meta-analysis was to evaluate protective effects of
glucose-insulin-potassium (GIK) on outcomes after coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI). We
systematically searched Medline/Pubmed, Elsevier, Embase, Web of Knowledge
and Google Scholar. A total of 1206 studies were retrieved during the
extensive literature search of all major databases; however, 38 trials
reporting the end-point of interest were selected. We performed a pooled
analysis of outcomes following PCI: incidence of cardiac arrest [odds
ratio (OR) of 0.91; 95% confidence interval (CI): 0.76-1.09; P = 0.3],
stroke (OR of 1.71; 95% CI: 0.37-1.37; P = 0.3), cardiogenic shock (OR of
1.02; 95% CI: 0.92-1.14; P = 0.6), reinfarction (OR of 0.95; 95% CI:
0.81-1.14; P = 0.5) and mortality (OR of 1.04; 95% CI: 0.96-1.13; P =
0.3); and following CABG: incidence of atrial fibrillation (OR of 0.86;
95% CI: 0.70-1.05; P = 0.1), incidence of ventricular fibrillation (OR of
0.83; 95% CI: 0.62-1.13; P = 0.2), reinfarction (OR of 0.97; 95% CI:
0.74-1.27; P = 0.8), infection (OR of 1.04; 95% CI: 0.67-1.62; P = 0.8),
length of intensive care unit stay (LIS) [standard mean differences (SMD)
of -0.27; 95% CI: -0.40 to -0.14; P = 0.000], length of hospital stay
(LHS) (SMD of -0.035; 95% CI: -0.12 to -0.05; P = 0.4) and mortality (OR
of 0.72; 95% CI: 0.41-1.26; P = 0.2). Our results showed that GIK did not
have considerable cardioprotective effects. However, patients undergoing
CABG seem to be better responders to GIK therapy compared with patients
undergoing PCI. Furthermore, in contrast to CABG, GIK therapy in patients
undergoing PCI might be associated with more complications rather than
protective effects.
<14>
Accession Number
2015539803
Authors
Cirillo F. Hinkelbein J. Romano G.M. Piazza O. Servillo G. De Robertis E.
Institution
(Cirillo, Romano, Servillo, De Robertis) Department of Neurosciences,
Reproductive and Odontostomatological Sciences, University of Naples
Federico II, Via S. Pansini, 5, Napoli 80131, Italy
(Cirillo, Hinkelbein) Department for Anaesthesiology and Intensive Care
Medicine, University Hospital Cologne, Kerpener Str. 62, Cologne 50937,
Germany
(Piazza) Department of Medicine and Surgery, Universita di Salerno,
Baronissi, SA, Italy
Title
Ventilator associated pneumonia and tracheostomy.
Source
Trends in Anaesthesia and Critical Care. 5 (6) (pp 184-187), 2015. Date of
Publication: December 2015.
Publisher
Churchill Livingstone
Abstract
This literature review focuses on the association between the incidence of
ventilator-associated pneumonia (VAP) and the time of tracheostomy in
different critical settings and analyses literature published during the
last five years. VAP is still a major problem in many mechanically
ventilated patients, and tracheostomy, bypassing the mouth and allowing
better oral hygiene, seems to show a benefit in terms of reduction of
incidence of VAP. Recent evidences suggest that tracheostomy, the earlier
it is performed, gives a benefit in this sense. Anyway, timing of
tracheostomy is strictly depending on the type of critical environment.
<15>
Accession Number
2015535382
Authors
Urban P. Meredith I.T. Abizaid A. Pocock S.J. Carrie D. Naber C. Lipiecki
J. Richardt G. Iniguez A. Brunel P. Valdes-Chavarri M. Garot P. Talwar S.
Berland J. Abdellaoui M. Eberli F. Oldroyd K. Zambahari R. Gregson J.
Greene S. Stoll H.-P. Morice M.-C.
Institution
(Urban) Hopital de la Tour, Geneva 1217, Switzerland
(Eberli) Triemli Hospital, Zurich, Switzerland
(Greene, Stoll) Biosensors Europe, Morges, Switzerland
(Meredith) MonashHeart and Monash University, Melbourne, VIC, Australia
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Pocock, Gregson) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Talwar) Dorset Heart Centre Royal Bournemouth Hospital, Bournemouth,
United Kingdom
(Oldroyd) West of Scotland Regional Heart, Lung Centre Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Carrie) Toulouse Rangueil Hospital, Toulouse, France
(Lipiecki) Pole Sante Republique, Clermont-Ferrand, France
(Brunel) Clinique de la Fontaine, Dijon, France
(Garot) Hopital Claude Galien, Institut Cardiovasculaire Paris Sud (ICPS),
Generale de Sante, Quincy-sous-Senart, France
(Berland) Clinique Saint Hilaire, Rouen, France
(Abdellaoui) Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
(Morice) ICPS, Generale de Sante, Massy, France
(Naber) Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Essen,
Germany
(Richardt) Herzzentrum Segeberger Kliniken, Bad Segeberg, Germany
(Iniguez) Complejo Hospital Meixoeiro, Vigo, Spain
(Valdes-Chavarri) Arrixaca University Hospital, Murcia, Spain
(Zambahari) Institute Jantung Negara, Kuala Lumpur, Malaysia
Title
Polymer-free drug-coated coronary stents in patients at high bleeding
risk.
Source
New England Journal of Medicine. 373 (21) (pp 2038-2047), 2015. Date of
Publication: 19 Nov 2015.
Publisher
Massachussetts Medical Society
Abstract
Background Patients at high risk for bleeding who undergo percutaneous
coronary intervention (PCI) often receive bare-metal stents followed by 1
month of dual antiplatelet therapy. We studied a polymer-free and
carrier-free drug-coated stent that transfers umirolimus (also known as
biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall
over a period of 1 month. Methods In a randomized, double-blind trial, we
compared the drug-coated stent with a very similar bare-metal stent in
patients with a high risk of bleeding who underwent PCI. All patients
received 1 month of dual antiplatelet therapy. The primary safety end
point, tested for both noninferiority and superiority, was a composite of
cardiac death, myocardial infarction, or stent thrombosis. The primary
efficacy end point was clinically driven target-lesion revascularization.
Results We enrolled 2466 patients. At 390 days, the primary safety end
point had occurred in 112 patients (9.4%) in the drug-coated-stent group
and in 154 patients (12.9%) in the bare-metal-stent group (risk
difference,-3.6 percentage points; 95% confidence interval [CI],-6.1
to-1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for
noninferiority and P = 0.005 for superiority). During the same time
period, clinically driven target-lesion revascularization was needed in 59
patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%)
in the bare-metal-stent group (risk difference,-4.8 percentage points; 95%
CI,-6.9 to-2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001).
Conclusions Among patients at high risk for bleeding who underwent PCI, a
polymer-free umirolimus-coated stent was superior to a bare-metal stent
with respect to the primary safety and efficacy end points when used with
a 1-month course of dual antiplatelet therapy.
<16>
Accession Number
2015541041
Authors
Kaier K. Gutmann A. Vach W. Sorg S. Siepe M. Von Zur Muhlen C. Moser M.
Blanke P. Beyersdorf F. Zehender M. Bode C. Reinohl J.
Institution
(Kaier, Vach) Clinical Epidemiology, Center for Medical Biometry and
Medical Informatics, Medical Center, University of Freiburg,
Stefan-Meier-Str. 26, Freiburg D-79104, Germany
(Kaier, Gutmann, Von Zur Muhlen, Moser, Zehender, Bode, Reinohl)
Department of Cardiology, Heart Center Freiburg University, Freiburg,
Germany
(Sorg, Siepe, Beyersdorf) Department of Cardiovascular Surgery, Heart
Center Freiburg University, Freiburg, Germany
(Blanke) Department of Diagnostic Radiology, Medical Center, University of
Freiburg, Freiburg, Germany
Title
"Heart Team" decision making in elderly patients with symptomatic aortic
valve stenosis who underwent AVR or TAVI - A look behind the curtain.
Results of the prospective TAVI Calculation of Costs Trial (TCCT).
Source
EuroIntervention. 11 (7) (pp 793-798), 2015. Date of Publication: November
2015.
Publisher
EuroPCR
Abstract
Aims: Little is known about how "Heart Team" treatment decisions among
patients suitable for either surgical aortic valve replacement (AVR) or
transcatheter aortic valve implantation (TAVI) are made under routine
conditions. Methods and results: The "Heart Team" decision-making process
was analysed with respect to 124 patients of a non-randomised prospective
clinical trial that included patients aged >75 years: 41 patients
underwent AVR and 83 underwent TAVI. By use of the non-parametric
classification and regression tree (CART) methodology, 21 baseline
parameters were tested to reconstruct the decision process
retrospectively. Next, multivariate logistic and Cox regression models
were fitted to evaluate the decision and outcome relevance (two-year
survival) of the parameters as identified in the CART procedure. For
patients with a baseline EuroSCORE I >13.48%, no further cut-off points
were identified and the majority of these patients underwent TAVI. Among
patients with a baseline EuroSCORE I <13.48%, age and left ventricular
ejection fraction (LVEF) were identified as further relevant decision
parameters. The decision relevance of EuroSCORE I (p=0.003), age (p=0.024)
and LVEF (p=0.047) were confirmed by multivariate analysis; however,
outcome relevance can be confirmed for EuroSCORE I (p=0.015) only, while
treatment decision (TAVI or AVR) was not a significant predictor of
mortality (p=0.655). Conclusions: Despite or even because of the
systematic risk selection according to EuroSCORE I values, we observed
two-year survival rates of about 75% regardless of whether the patient
received TAVI or AVR, suggesting that the decisions made by the "Heart
Team" were appropriate.
<17>
Accession Number
2015541067
Authors
Kelbaek H. Holmvang L. Richardt G. Eberli F.R. Stella P. Buszman P.E.
Neumann F.-J. Serruys P.W. Windecker S. Widimsky P. Belardi J.A. Silber S.
Institution
(Kelbaek, Holmvang) Cardiac Catheterization Laboratory, Department of
Cardiology, Heart Center, Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Richardt) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Eberli) Department of Cardiology, University Hospital, Zurich,
Switzerland
(Stella) Department of Cardiology, University Medical Center, Utrecht,
Netherlands
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Neumann) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
(Windecker) Department of Interventional Cardiology, Bern University
Hospital, Bern, Switzerland
(Widimsky) Cardiocenter Kralovske Vinohrady, Charles University, Prague,
Czech Republic
(Belardi) Instituto Cardiovascular de Buenos Aires, Buenos Aires,
Argentina
(Silber) Heart Center of the Isar, Munich, Germany
Title
Clinical results with the Resolute zotarolimus-eluting stent in total
coronary occlusions.
Source
EuroIntervention. 11 (6) (pp 650-657), 2015. Date of Publication: October
2015.
Publisher
EuroPCR
Abstract
Aims: We conducted a pooled post hoc analysis (RESOLUTE All Comers and
RESOLUTE International) of patients who had the Resolute
zotarolimus-eluting stent (R-ZES) implanted in revascularised total
occlusions (TO) compared with patients treated with R-ZES for non-occluded
lesions. Methods and results: Patients were divided into three groups:
chronic TO (CTO; n=256), non-chronic TO (n=292), and no occlusion
(n=2,941). Clinical and safety outcomes assessed through two years
included target lesion failure (TLF: cardiac death, target vessel
myocardial infarction, and clinically driven target lesion
revascularisation) and Academic Research Consortium definite or probable
stent thrombosis. The rate of TLF at two years was not significantly
different among patients in the CTO (9.1%), TO (9.8%), and no occlusion
(10.4%) groups (log-rank p=0.800); neither were the components of TLF.
Definite or probable stent thrombosis occurred more frequently in the TO
group (2.8% vs. 1.2% in the CTO and 1.1% in the group with no occlusion,
p=0.027). There were 10 late and six very late stent thrombosis events.
Conclusions: Apart from a higher rate of stent thrombosis in patients with
TO, patients with totally occluded coronary arteries who receive
revascularisation with an R-ZES have clinical outcomes comparable to those
who receive a similar stent in non-occluded lesions.
<18>
Accession Number
2015541065
Authors
Genereux P. Campos C.M. Yadav M. Palmerini T. Caixeta A. Xu K. Francese
D.P. Dangas G.D. Mehran R. Leon M.B. Serruys P.W. Stone G.W.
Institution
(Genereux, Yadav, Leon, Stone) New York-Presbyterian Hospital, Columbia
University, Medical Center, New York, NY, United States
(Genereux, Xu, Francese, Dangas, Mehran, Leon, Stone) Columbia University,
Medical Center, Cardiovascular Research Foundation, 111 E. 59th St., New
York, NY 10022, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Campos, Serruys) Department of Interventional Cardiology, Erasmus
University, Medical Center, Thoraxcenter, Rotterdam, Netherlands
(Campos) Department of Interventional Cardiology, Heart Institute (InCor),
University of Sao Paulo, Medical School, Sao Paulo, Brazil
(Palmerini) Istituto di Cardiologia, Policlinico S. Orsola, University of
Bologna, Bologna, Italy
(Caixeta) Hospital Israelita Albert Einstein, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Dangas, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Title
Reasonable incomplete revascularisation after percutaneous coronary
intervention: The SYNTAX Revascularisation Index.
Source
EuroIntervention. 11 (6) (pp 634-642), 2015. Date of Publication: October
2015.
Publisher
EuroPCR
Abstract
Aims: Incomplete revascularisation is common after percutaneous coronary
intervention (PCI). While the absolute amount of residual coronary artery
disease (CAD) after PCI has been shown to be associated with worse
outcomes, whether the proportion of treated CAD is prognostically
important remains to be determined. We sought to quantify the proportion
of CAD burden treated by PCI and to evaluate its impact on outcomes using
a new prognostic instrument - the SYNTAX Revascularisation Index (SRI).
Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX
score (rSS) were determined from 2,618 angiograms of patients enrolled in
the prospective ACUITY trial. The SRI was then calculated for each patient
using the following formula: SRI=(1-[rSS/bSS])x100. Outcomes were examined
according to three SRI groups (SRI=100% [complete revascularisation],
50-99%, and <50%). The median bSS was nine (IQR 5, 16), and after PCI the
median rSS was one (IQR 0, 6). The median SRI was 85% (IQR 50, 100), and
was 100% in 1,079 patients (41.2%), 50-99% in 907 patients (34.6%), and
<50% in 632 patients (24.1%). One-year adverse outcomes, including death,
were inversely proportional to the SRI. An SRI cut-off of <80% (present in
1,189 [45.4%] patients after PCI) had the best prognostic accuracy for
prediction of death (area under the curve 0.60, 95% confidence interval
[CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an
independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95%
CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS
showed superior accuracy and predictive capability for one-year mortality.
Conclusions: The SRI is a newly described method for quantifying the
proportion of CAD burden treated by PCI. Given its correlation with
mortality, and pending external validation, the SRI may be useful in
assessing the degree of revascularisation after PCI, with SRI >80%
representing a reasonable goal. However, the rSS showed superior
predictive capability for one-year mortality.
<19>
Accession Number
72103499
Authors
Cao C. Tian D. Ang S. Virk S. Novis E. Wilcox C. Yan T.
Institution
(Cao, Tian, Ang, Virk, Novis, Wilcox, Yan) Systematic Review Unit,
Collaborative Research (CORE) Group, Sydney, Australia
(Cao) Department of Cardiothoracic Surgery, Prince of Wales Hospital,
Sydney, Australia
(Cao) University of New South Wales, Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Title
A meta-analysis of endoscopic versus conventional open radial artery
harvesting for coronary artery bypass graft surgery.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2015
Melbourne, VIC Australia. Conference Start: 20150813 Conference End:
20150816. Conference Publication: (var.pagings). 24 (pp S408), 2015. Date
of Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Objective: The radial artery has been demonstrated to provide superior
long-term patency outcomes compared to saphenous veins for selected
patients who undergo coronary artery bypass graft surgery. Recently,
endoscopic radial artery harvesting has been popularised to improve
cosmetic and perioperative outcomes. However, concerns have been raised
regarding the effects on long-term survival and graft patency of this
relatively novel technique. The present meta-analysis aimed to assess the
safety and efficacy of endoscopic radial artery harvesting versus the
conventional open approach. Methods: A systematic review of the current
literature was performed on five electronic databases. All comparative
studies on endoscopic versus open radial artery harvesting were included
for analysis. Primary endpoints included mortality and recurrent
myocardial infarction. Secondary endpoints included graft patency, wound
infection, haematoma formation, and paraesthesia. Results: Twelve studies
involving 3314 patients were included for meta-analysis according to
predefined selection criteria. There were no statistically significant
differences in overall mortality, recurrent myocardial infarction or graft
patency between the two surgical techniques. However, patients who
underwent endoscopic harvesting were found to have significantly lower
incidences of wound infection, haematoma formation and paraesthesia.
Conclusions: Current literature on endoscopic harvesting of the radial
artery for coronary artery bypass graft surgery is limited by relatively
short follow-up periods and differences in patient selection and surgical
techniques. In addition, there are currently no randomised-controlled
trials to provide robust clinical data. However, the available evidence
suggests that the endoscopic approach is associated with superior
perioperative outcomes without clear evidence demonstrating compromised
patency or survival outcomes.
<20>
Accession Number
72103273
Authors
Virk S. Tian D. Liou K. Pathan F. Novis E. Wilcox C. Cao C.
Institution
(Virk, Tian, Novis, Wilcox, Cao) Systematic Review Unit, Collaborative
Research (CORE) Group, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
(Cao) Department of Cardiothoracic Surgery, Prince of Wales Hospital,
Sydney, Australia
(Cao) University of New South Wales, Sydney, Australia
Title
Systematic review of percutaneous coronary intervention and transcatheter
aortic valve implantation for concomitant aortic stenosis and coronary
artery disease.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2015
Melbourne, VIC Australia. Conference Start: 20150813 Conference End:
20150816. Conference Publication: (var.pagings). 24 (pp S305), 2015. Date
of Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Objective: Co-existing coronary artery disease (CAD) is common in patients
with severe aortic stenosis (AS). Although transcatheter aortic valve
implantation (TAVI) has emerged as a feasible alternative to surgical
aortic valve replacement (SAVR) for high-risk patients with AS, the
optimal treatment of CAD in patients undergoing TAVI remains unclear.
Combined PCI and TAVI have been performed in selected institutions, but
clinical outcomes remain uncertain. The present systematic review aimed to
assess the safety and efficacy of combined PCI and TAVI for patients with
severe AS and CAD. Methods: An electronic search was conducted on six
databases to identify all relevant studies and the outcomes were
statistically summarised. The primary endpoints included 30-day mortality
and 12-month survival. Secondary endpoints were measured according to the
Valve Academic Research Consortium criteria. Results: From seven studies
involving 363 patients, periprocedural mortality was 8.8%. At 30-days,
pooled incidences of stroke, vascular complications and major bleeding
were 2.9%, 5.4% and 16.3%, respectively. Acute renal failure developed in
3.8% of patients, 2.7% had myocardial infarction and 19.9% required a
permanent pacemaker. Overall survival at 1- and 2-years was 81.2% and
73.8%, respectively. Conclusions: PCI and TAVI can be performed for
high-risk patients with severe AS and CAD. However, their perioperative
mortality may be higher than those with isolated AS who require TAVI
alone. Mid-term outcomes are more encouraging, but longer follow-up is
needed in future studies to compare with clinical outcomes of surgical
candidates who undergo SAVR and coronary artery bypass graft surgery.
<21>
Accession Number
72103170
Authors
Cao C. Virk S. Liou K. Pathan F. Wilcox C. Novis E. Yan T.
Institution
(Cao, Virk, Wilcox, Novis, Yan) Systematic Review Unit, Collaborative
Research (CORE) Group, Sydney, Australia
(Cao) Department of Cardiothoracic Surgery, Prince of Wales Hospital,
Sydney, Australia
(Cao) University of New South Wales, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
Title
A systematic review and meta-analysis of clinical and cost-effective
outcomes of transcatheter aortic valve implantation versus surgical aortic
valve replacement.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2015
Melbourne, VIC Australia. Conference Start: 20150813 Conference End:
20150816. Conference Publication: (var.pagings). 24 (pp S258), 2015. Date
of Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Objective: Transcatheter aortic valve implantation (TAVI) has emerged as a
feasible alternative treatment to conventional surgical aortic valve
replacement (AVR) for high-risk patients with aortic stenosis. The present
systematic review aimed to assess the comparative clinical and
cost-effectiveness outcomes of TAVI versus AVR, and metaanalyse
standardised clinical endpoints. Methods: An electronic search was
conducted on 9 online databases to identify all relevant studies. Eligible
studies must report on either periprocedural mortality or incremental
costeffectiveness ratio (ICER) to be included for analysis. Results: The
systematic review identified 24 studies that reported on comparative
clinical outcomes, including three randomised controlled trials and ten
matched observational studies involving 7906 patients. Meta-analysis
demonstrated no significant differences in regards to mortality, stroke,
myocardial infarction or acute renal failure. Patients who underwent TAVI
were more likely to result in major vascular complications or arrhythmias
requiring permanent pacemaker. Patients who underwent AVR were more likely
to result in major bleeding. Eleven analyses from 7 economic studies
reported on ICER. Six analyses defined TAVI to be low value, 2 analyses
defined TAVI to be intermediate value, and three analyses defined TAVI to
be high value. Conclusions: The present study demonstrated no significant
differences in regards to mortality or stroke between the two therapeutic
procedures. However, the cost-effectiveness and long-term efficacy of TAVI
may require further investigation. Technological improvement and increased
experience may broaden the clinical indication for TAVI for
lowintermediate risk patients in the future.
<22>
Accession Number
72102868
Authors
Sharma M. Eskandari M. Marwick T.
Institution
(Sharma) Alfred Hospital, Melbourne, Australia
(Eskandari) Kings College Hospital NHS Foundation Trust London, United
Kingdom
(Marwick) Menzies Research Institute Tasmania, Australia
Title
Hypertension in aortic stenosis: A systematic review.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2015
Melbourne, VIC Australia. Conference Start: 20150813 Conference End:
20150816. Conference Publication: (var.pagings). 24 (pp S127), 2015. Date
of Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Aims: To establish the effect of idiopathic arterial hypertension (HT) on
LV function, geometry and remodelling in the setting of aortic stenosis
(AS) and its impact on prognosis and outcomes. In addition we evaluated
the efficacy and safety of anti-HT agents in patients with moderate to
severe AS. Methods: A search was performed in the Cochrane, Pubmed and
Embase databases using the MESH or Entree terms "aortic valve stenosis",
"hypertension", "blood pressure", "ventricular function", "ventricular
dysfunction", "prognosis", "mortality" and "symptoms", and 1156 articles
were reviewed. Key demographics and outcomes of patients in 82 suitable
studies were performed. Results: Patients with concurrent AS and arterial
HT had worse degrees of LV hypertrophy effect size 0.33 p value= 0.05 and
systolic function effect size 0.0 p= 0.01 using Cohen's method compared to
their normotensive counterparts. They experienced more rapid development
of symptoms effect size 0.076 p> 0.05 and greater degrees of diastolic
dysfunction effect size 0.28 p=0.05. HT post aortic valve replacement
impaired reverse LV remodelling and is associated with a poorer outcome.
Appropriate antihypertensive agents are well tolerated and beneficial in
the setting of AS. Conclusion: HT in moderate to severe AS resulted in
worsening LV hypertrophy and more rapid development of symptoms.
<23>
[Use Link to view the full text]
Accession Number
72101627
Authors
Dempsey A. Legault R. Mehl J. Steyn J. Hatton K.
Title
A pilot study to evaluate the effect of peep during transport to the ICU
following cardiac surgery.
Source
Critical Care Medicine. Conference: 45th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2015 Orlando, FL United States.
Conference Start: 20160220 Conference End: 20160224. Conference
Publication: (var.pagings). 43 (12 SUPPL. 1) (pp 28), 2015. Date of
Publication: December 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: We hypothesized that the use of PEEP during transport
from the operating room to the ICU after cardiac surgery will decrease
lung derecruitment. The primary objectives of this pilot study were 1) to
assess the feasibility of performing a randomized controlled trial (RCT)
to study PEEP during transport in this patient population, 2) to assess
the impact on the change in PaO2/Fi02 ratio (P/F) and the time to
extubation, and 3) if a favorable trend was noted, to predict the number
of patients that would be needed to power a future and larger trial.
Methods: This was a single-center, blinded, randomized, controlled pilot
study performed in 30 patients. Patients were randomized prior to surgery
to one of three groups to receive 0, 5, or 10 cm H2O of PEEP during
transport. All OR and ICU clinicians were blinded to the PEEP valve
setting. Intraoperative, transport, and postoperative ventilation was
standardized according to the ARDSnet protocol. The delta P/F of each
patient was defined as the difference in P/F immediately before and
shortly after transport from the OR to the ICU, based on ABG results.
Results: No patients experienced significant hemodynamic instability
during transport. With the exception of gender, there were no
statistically significant differences in multiple baseline patient and
procedure characteristics. There was a non-statistically significant trend
toward increased mean delta P/F with PEEP compared to no PEEP. The trend
toward increased P/F was greatest with PEEP=10. In addition, there was
also a non-statistically significant trend toward decreased time to
extubation with PEEP compared to no PEEP. Conclusions: The results of this
pilot study demonstrate that the methodology was feasible for a future RCT
to study PEEP during transport in this population. In addition, we were
able to calculate group sample size for a future trial using a two-tailed
sample size calculation. According to our data, we will need to enroll at
least 132 patients in a future study to detect a statistically significant
difference when comparing 0 and 10 cm H2O of PEEP.
<24>
[Use Link to view the full text]
Accession Number
72101527
Authors
Parke R. McGuinness S. Cowdrey K.-A. Gilder E. McCarthy L.
Title
Preoperative risk influences outcomes when a restrictive fluid regime is
used after cardiac surgery.
Source
Critical Care Medicine. Conference: 45th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2015 Orlando, FL United States.
Conference Start: 20160220 Conference End: 20160224. Conference
Publication: (var.pagings). 43 (12 SUPPL. 1) (pp 2), 2015. Date of
Publication: December 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: IV fluid therapy is a ubiquitous component of
post-operative Intensive Care Unit (ICU) care for cardiac surgical
patients. We have previously reported a study to investigate the safety
and efficacy of a restrictive fluid regime in patients after cardiac
surgery. Further analysis sought to quantify the association between
surgical risk and observed outcomes to inform future study design.
Methods: Single-center randomized controlled trial of a restrictive fluid
regime versus usual care in patients after cardiac surgery. Outcomes
included the amount of fluid administered and ICU length of stay. This
analysis stratified patients enrolled into the study as EUROSCORE II >0.9
(higher risk) or <0.9 (low risk). Results: 144 participants were included.
Low risk group included 59 participants (30 usual care vs. 29
intervention) while the higher risk group included 85 participants (44
usual care vs. 41 intervention). In higher risk patients significant
reductions in ICU length of stay (ICULOS) (median [IQR] 23.1 [20.2-49.2]
vs. 43.7 [23.4- 84.4] p=0.012) and total fluid bolus administered (1740mls
[375-3437] vs. 3125 [1375-5873] p=0.005) were seen in the intervention
group when compared to usual care. The differences in the low risk group
were not significant for ICULOS (22.6 [20.6-35.5] vs. 22.2 [18.7-32.8]
p=0.33) and total fluid bolus administered (1250mls [800-3250] vs. 2250
[1438-3625] p=0.09). Conclusions: These results demonstrate that cardiac
surgical patients with a higher preoperative risk score may have a better
response to a restrictive fluid regime and this may be associated with a
reduction in ICU length of stay. These results suggest that a planned
multicenter study of this strategy targeting higher risk patients is both
justified and feasible and that enrolling this group of patients is more
likely to see a result in the primary outcome of reduced length of ICU
stay.
<25>
[Use Link to view the full text]
Accession Number
72101522
Authors
Guerra G.G. Seal R. Joffe A. Duff J. Ross D. Rebeyka I. Dinu I. Robertson
C.
Title
Pediatric remote ischemic pre-conditioning prior to complex cardiac
surgery: The prep pilot trial.
Source
Critical Care Medicine. Conference: 45th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2015 Orlando, FL United States.
Conference Start: 20160220 Conference End: 20160224. Conference
Publication: (var.pagings). 43 (12 SUPPL. 1) (pp 1), 2015. Date of
Publication: December 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Remote Ischemic Pre-Conditioning (RIPC) refers to the
finding that a brief ischemia-reperfusion event to a tissue results in
subsequent protection from a more severe ischemia-reperfusion event to a
different tissue/ organ. There are only a few pediatric RIPC studies that
show conflicting results. Hence, we conducted a randomized controlled
trial (RCT) to determine the effect of early and late RIPC on the acute
outcomes of infants after surgery for congenital heart disease (CHD).
Methods: Pilot double blind RCT of RIPC vs. control (sham-RIPC) in infants
(<6 weeks old) going for surgery for CHD. Patients were randomly assigned
in a 1:1 ratio to receive an RIPC stimulus or control. RIPC was performed
at 24-48 hr pre-operatively, and again before CPB. RIPC was done
sequentially on each lower limb for 2 cycles. In the control group the
cuff was placed underneath the legs. Blinding was achieved by covering the
patients' legs during the intervention. Forty-five infants were enrolled
the study (23 in the RIPC group and 22 in the control group), patients
were analyzed on an intention to treat basis. Results: Baseline
characteristics were similar across both groups. There were no significant
differences between the RIPC group and the control group in the highest
blood lactate level day 1 post-operative (5.6+3.3 vs. 4.4+3.8 mmol/L;
P=0.103), time of blood lactate < 2mmol/L (18.9+17.8 vs. 15.5+12.5 hr;
P=0.461) or inotrope scores day 1 post-operative (20.3+23.8 vs. 11.2+6.5
hr; P=0.094). Between groups, there was no significant difference in
troponin levels (at 3, 6, 12 and 24 hr), or creatinine levels (day 1 to 5)
after surgery. Days on mechanical ventilation (4.6+3.4 vs. 12.8+29.1 days;
P=0.193), intensive care length of stay (PCICU LOS) (5.1+2.8 vs. 14.3+32.2
days; P=0.190) and hospital LOS (5.1+2.8 vs. 14.3+32.2 days; P=0.052) were
shorter in the RIPC; but these differences were not statistically
significant. Conclusions: In infants who underwent surgery for CHD, our
RCT on early and late RIPC did not find any significant difference in
acute outcomes. A larger trial may be necessary.
