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<1>
Accession Number
26551304
Authors
Rodes-Cabau J. Horlick E. Ibrahim R. Cheema A.N. Labinaz M. Nadeem N.
Osten M. Cote M. Marsal J.R. Rivest D. Marrero A. Houde C.
Institution
(Rodes-Cabau) Department of Cardiology, Quebec Heart and Lung Institute,
Quebec City, Quebec, Canada
(Horlick) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Ibrahim) Department of Cardiology, Montreal Heart Institute, Montreal,
Quebec, Canada
(Cheema) Department of Cardiology, St. Michael's Hospital, Toronto,
Ontario, Canada
(Labinaz) Department of Cardiology, Ottawa Heart Institute, Ottawa,
Ontario, Canada
(Nadeem) Department of Cardiology, Queen Elizabeth II Health Sciences
Centre, Halifax, Nova Scotia, Canada
(Osten) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Cote) Department of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Marsal) Epidemiology Unit of the Cardiology Department, Vall d'Hebron
Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
(Rivest) Department of Neurology, Hotel Dieu de Levis, Quebec City,
Quebec, Canada
(Marrero) Department of Neurology, Centre Hospitalier Universitaire
Georges. L Dumont, Moncton, New Brunswick, Canada
(Houde) Department of Pediatric Cardiology, Centre Hospitalier
Universitaire de Quebec, Quebec City, Quebec, Canada
Title
Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches
After Transcatheter Atrial Septal Defect Closure: The CANOA Randomized
Clinical Trial.
Source
JAMA. 314 (20) (pp 2147-2154), 2015. Date of Publication: 24 Nov 2015.
Abstract
IMPORTANCE: The occurrence of new-onset migraine attacks is a complication
of transcatheter atrial septal defect (ASD) closure. It has been suggested
that clopidogrel may reduce migraine attacks after ASD closure.
OBJECTIVE: To assess the efficacy of clopidogrel, used in addition to
taking aspirin, for the prevention of migraine attacks following ASD
closure.
DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind clinical trial
performed in 6 university hospitals in Canada. Participants were 171
patients with an indication for ASD closure and no history of migraine.
INTERVENTIONS: Patients were randomized (1:1) to receive dual antiplatelet
therapy (aspirin+clopidogrel [the clopidogrel group], n=84) vs single
antiplatelet therapy (aspirin+placebo [the placebo group], n=87) for 3
months following transcatheter ASD closure. The first patient was enrolled
in December 2008, and the last follow-up was completed in February 2015.
MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was the monthly
number of migraine days within the 3 months following ASD closure in the
entire study population. The incidence and severity of new-onset migraine
attacks, as evaluated by the Migraine Disability Assessment questionnaire,
were prespecified secondary end points. A zero-inflated Poisson regression
model was used for data analysis.
RESULTS: The mean (SD) age of the participants was 49 (15) years and 62%
(106) were women. Patients in the clopidogrel group had a reduced mean
(SD) number of monthly migraine days within the 3 months following the
procedure (0.4 [95% CI, 0.07 to 0.69] days) vs the placebo group (1.4 [95%
CI, 0.54 to 2.26] days; difference, -1.02 days [95% CI, -1.94 to -0.10
days]; incident risk ratio [IRR], 0.61 [95% CI, 0.41 to 0.91]; P=.04) and
a lower incidence of migraine attacks following ASD closure (9.5% for the
clopidogrel group vs 21.8% for the placebo group; difference, -12.3% [95%
CI, -23% to -1.6%]; odds ratio [OR], 0.38 [95% CI, 0.15 to 0.89]; P=.03).
Among patients with migraines, those in the clopidogrel group had
less-severe migraine attacks (zero patients with moderately or severely
disabling migraine attacks vs 37% [7 patients] in the placebo group;
difference, -36.8% [95% CI, -58.5% to -15.2%]; P=.046). There were no
between-group differences in the rate of patients with at least 1 adverse
event (16.7% [14 patients] in the clopidogrel group vs 21.8% [19 patients]
in the placebo group; difference, -5.2% [95% CI, -17% to 6.6%]; P=.44).
CONCLUSIONS AND RELEVANCE: Among patients who underwent transcatheter ASD
closure, the use of clopidogrel and aspirin, compared with aspirin alone,
resulted in a lower monthly frequency of migraine attacks over 3 months.
Further studies are needed to assess generalizability and durability of
this effect.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00799045.

<2>
Accession Number
25835756
Authors
Lam J.Y. Lopushinsky S.R. Ma I.W. Dicke F. Brindle M.E.
Title
Treatment Options for Pediatric Patent Ductus Arteriosus: Systematic
Review and Meta-analysis.
Source
Chest. 148 (3) (pp 784-793), 2015. Date of Publication: 01 Sep 2015.
Abstract
BACKGROUND: Patent ductus arteriosus (PDA) in the nonpremature pediatric
patient is currently treated by surgical ligation or catheter occlusion.
There is no clear superiority of one technique over the other. This
meta-analysis compares the clinical outcomes of the two treatment options
for PDA.
METHODS: We performed a literature search of MEDLINE, Embase, PubMed, and
the Cochrane database of randomized controlled trials (RCTs) that took
place between 1950 and February 2014 and hand-searched references from
included studies. We excluded studies of adult or premature patients and
those without a direct comparison between surgical and catheter-based
treatments of PDAs. Outcomes of interest were reintervention, total
complications, length of stay, and cost.
RESULTS: One thousand three hundred thirty-three manuscripts were
screened. Eight studies fulfilled the inclusion criteria (one RCT and
seven observational studies [N = 1,107]). In pooled observational studies,
there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for
reintervention in the surgical ligation group but insignificantly higher
odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were
no complications reported in the RCT, but surgical ligation was associated
with decreased odds for reintervention and a longer length of stay. Funnel
plots revealed a possible publication bias and a quality review identified
comparability bias.
CONCLUSIONS: Both therapies have comparable outcomes. Reintervention is
more common with catheter-based treatment, but overall complication rates
are not higher and hospital stay is shorter. Our data span > 2 decades and
may not reflect current surgical and catheterization outcomes. Large,
randomized, prospective studies may help determine the optimal treatment
strategy.

<3>
Accession Number
26436963
Authors
Makkar R.R. Fontana G. Jilaihawi H. Chakravarty T. Kofoed K.F. de Backer
O. Asch F.M. Ruiz C.E. Olsen N.T. Trento A. Friedman J. Berman D. Cheng W.
Kashif M. Jelnin V. Kliger C.A. Guo H. Pichard A.D. Weissman N.J. Kapadia
S. Manasse E. Bhatt D.L. Leon M.B. Sondergaard L.
Institution
(Makkar, Fontana, Jilaihawi, Chakravarty, Kofoed, de Backer, Asch, Ruiz,
Olsen, Trento, Friedman, Berman, Cheng, Kashif, Jelnin, Kliger, Guo,
Pichard, Weissman, Kapadia, Manasse, Bhatt, Leon, Sondergaard) From
Cedars-Sinai Heart Institute (R.R.M., H.J., T.C., A.T., J.F., D.B., W.C.,
M.K.) and Cedars-Sinai Medical Center (G.F.) - both in Los Angeles;
Rigshospitalet, University of Copenhagen, Copenhagen (K.F.K., O.B.,
N.T.O., L.S.); MedStar Health Research Institute, Washington, DC (F.M.A.,
A.D.P., N.J.W.); Hackensack University Medical Center and Joseph M.
Sanzari Children's Hospital, Hackensack, NJ (C.E.R., V.J.); Lenox Hill
Heart and Vascular Institute of New York (C.A.K.) and Columbia University
Medical Center-New York Presbyterian Hospital (M.B.L.) - both in New York;
St. Jude Medical, Plymouth, MN (H.G., E.M.); Cleveland Clinic, Cleveland
(S.K.); and Brigham and Women's Hospital Heart and Vascular Center and
Harvard Medical School - both in Boston (D.L.B.)
Title
Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves.
Source
The New England journal of medicine. 373 (21) (pp 2015-2024), 2015. Date
of Publication: 19 Nov 2015.
Abstract
BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on
computed tomography (CT) in a patient who had a stroke after transcatheter
aortic-valve replacement (TAVR) during an ongoing clinical trial. This
finding raised a concern about possible subclinical leaflet thrombosis and
prompted further investigation.
METHODS: We analyzed data obtained from 55 patients in a clinical trial of
TAVR and from two single-center registries that included 132 patients who
were undergoing either TAVR or surgical aortic-valve bioprosthesis
implantation. We obtained four-dimensional, volume-rendered CT scans along
with data on anticoagulation and clinical outcomes (including strokes and
transient ischemic attacks [TIAs]).
RESULTS: Reduced leaflet motion was noted on CT in 22 of 55 patients (40%)
in the clinical trial and in 17 of 132 patients (13%) in the two
registries. Reduced leaflet motion was detected among patients with
multiple bioprosthesis types, including transcatheter and surgical
bioprostheses. Therapeutic anticoagulation with warfarin, as compared with
dual antiplatelet therapy, was associated with a decreased incidence of
reduced leaflet motion (0% and 55%, respectively, P=0.01 in the clinical
trial; and 0% and 29%, respectively, P=0.04 in the pooled registries). In
patients who were reevaluated with follow-up CT, restoration of leaflet
motion was noted in all 11 patients who were receiving anticoagulation and
in 1 of 10 patients who were not receiving anticoagulation (P<0.001).
There was no significant difference in the incidence of stroke or TIA
between patients with reduced leaflet motion and those with normal leaflet
motion in the clinical trial (2 of 22 patients and 0 of 33 patients,
respectively; P=0.16), although in the pooled registries, a significant
difference was detected (3 of 17 patients and 1 of 115 patients,
respectively; P=0.007).
CONCLUSIONS: Reduced aortic-valve leaflet motion was shown in patients
with bioprosthetic aortic valves. The condition resolved with therapeutic
anticoagulation. The effect of this finding on clinical outcomes including
stroke needs further investigation. (Funded by St. Jude Medical and
Cedars-Sinai Heart Institute; Portico-IDE ClinicalTrials.gov number,
NCT02000115; SAVORY registry, NCT02426307; and RESOLVE registry,
NCT02318342.).

<4>
Accession Number
25123674
Authors
Sharma V. Deo S.V. Altarabsheh S.E. Cho Y.H. Erwin P.J. Park S.J.
Institution
(Sharma) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
USA ctvsteam@hotmail.com
(Deo) Adventist Wockhardt Heart Institute, Athawalines, Surat, India
Division of Cardiovascular Surgery, University Hospitals, Case Western
Reserve University, Cleveland, OH, USA
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Cho) Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul, South Korea
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
(Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, USA
Title
Comparison of the early haemodynamics of stented pericardial and porcine
aortic valves.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp 4-10), 2015.
Date of Publication: 01 Jan 2015.
Abstract
Data comparing the haemodynamic performance of stented pericardial and
porcine aortic valves are conflicting. Hence, we performed a systematic
review and meta-analysis comparing the early haemodynamic parameters of
stented pericardial and porcine valves in patients undergoing isolated
aortic valve replacement. Medline, EMBASE and Web of Science were queried
for English language original publications from 2000 to 2013. Studies
comparing porcine (PoV) and pericardial (PeV) with regard to their
haemodynamic parameters were included in this review. Continuous data were
pooled using the mean difference (MD) or the standardized mean difference
(SMD). A random-effect inverse weighted analysis was conducted; a
P-value<0.05 is considered statistically significant. Results are
presented with 95% confidence intervals. Thirteen studies (1265 PeV
patients and 871 PoV patients) were included in this analysis. The pooled
transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77)
mmHg; P<0.01]. Limiting this analysis to small valves (19 and 21 mm; eight
studies; 714 patients) revealed that the PeV gradients were significantly
lower [MD -4.5 (-5.7 to -3.2); P=0.001]. The corresponding effective
orifice area of PeV was significantly larger than PoV [SMD 0.42
(0.15-0.69); P<0.01]. A sensitivity analysis comprising only randomized
controlled trials did not significantly alter results. When compared with
porcine valves, stented pericardial aortic valves have lower mean
transvalvular gradients early after implant. Even pericardial valves in
smaller sizes (19 and 21 mm) have a better haemodynamic profile when
compared with their counterparts.

<5>
Accession Number
25312529
Authors
Martucci N. Tracey M. La Rocca A. La Manna C. De Luca G. Rocco G.
Institution
(Martucci) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Tracey) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Rocca) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Manna) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(De Luca) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Rocco) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy g.rocco@istitutotumori.na.it
Title
A pilot prospective randomized, controlled trial comparing LigaSureTM
tissue fusion technology with the ForceTriadTM energy platform to the
electrosurgical pencil on rates of atrial fibrillation after pulmonary
lobectomy and mediastinal lymphadenectomy.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp e13-e18),
2015. Date of Publication: 01 Jan 2015.
Abstract
OBJECTIVES: The use of bipolar sealing devices during pulmonary resection
is particularly useful in thoracoscopic surgery. Theoretically, a bipolar
device, which contains the current in a smaller area and completes the
current cycle only through the tissue between the electrodes, may reduce
the proportion of patients experiencing atrial fibrillation compared with
monopolar devices such as the electrosurgical pencil using which the
current completes the cycle through the patient. We investigated the
impact of the LigaSureTM (LS) tissue fusion technology with the
ForceTriadTM energy platform device on the incidence of postoperative
atrial fibrillation and on the reduction of postoperative chest tube
output and hospital length of stay after open pulmonary lobectomy.
METHODS: A pilot prospective randomized, controlled trial comparing LS
tissue fusion technology with the ForceTriadTM energy platform to the
conventional electrosurgical pencil. Overall, 146 patients with resectable
lung cancer were recruited at the Division of Thoracic Surgery of the
Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, between January 2011
and July 2013. Of these, 119 candidates to open lobectomy for
non-small-cell lung cancer were randomized to either LS tissue fusion
technology with the ForceTriadTM energy platform (LS: 57 patients) or
standard haemostatic procedure (standard treatment, ST: 62 patients) for
hilar and mediastinal nodal dissection. The primary end-point was to
compare the incidence of postoperative atrial fibrillation of LS compared
with ST. The secondary end-point was to compare the efficacy of LS
compared with ST in terms of total chest tube drainage, daily chest tube
drainage and chest tube duration.
RESULTS: There was no statistically significant difference between LS and
ST in terms of postoperative atrial fibrillation (P=0.31). However, LS was
associated to significant reduction of duration of both mediastinal nodal
dissection (P=0.017) and the cumulative chest tube drainage (P=0.025).
CONCLUSIONS: The incidence of atrial fibrillation with LS tissue fusion
technology with the ForceTriadTM energy platform is not reduced as
compared with conventional electrosurgical pencil. However, the use of LS
during mediastinal nodal dissection is associated to shorter duration of
lymphadenectomy and duration of chest tube drainage.

<6>
Accession Number
25798568
Authors
Obadia J.-F. Armoiry X. Iung B. Lefevre T. Mewton N. Messika-Zeitoun D.
Cormier B. Berthiller J. Maucort-Boulch D. Boutitie F. Vaz B. Trochu J.-N.
Vahanian A.
Institution
(Obadia, Armoiry, Iung, Lefevre, Mewton, Messika-Zeitoun, Cormier,
Berthiller, Maucort-Boulch, Boutitie, Vaz, Trochu, Vahanian) Service de
Chirurgie Cardiothoracique et Transplantation, Hopital Cardiothoracique
Louis Pradel, Lyon-Bron, France
Title
The MITRA-FR study: design and rationale of a randomised study of
percutaneous mitral valve repair compared with optimal medical management
alone for severe secondary mitral regurgitation.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
10 (11) (pp 1354-1360), 2015. Date of Publication: 01 Mar 2015.
Abstract
AIMS: Percutaneous mitral valve repair (pMVR) is a new therapeutic option
for mitral valve regurgitation. Positive preliminary results in
non-randomised studies have been published supporting the use of the
MitraClip system in patients with secondary mitral regurgitation (MR) and
poor left ventricular (LV) function contraindicated to surgery. The aim of
the MITRA-FR study is to provide a higher level of evidence for the
efficacy of the MitraClip device in this setting.
METHODS AND RESULTS: The MITRA-FR study is a national, multicentre,
investigator-initiated, open-label, randomised trial to evaluate the
benefits and safety of pMVR using the MitraClip system plus optimal
medical therapy (OMT) compared with OMT alone (control) in patients with
severe symptomatic secondary MR contraindicated to surgical repair. The
trial aims to enrol 144 MitraClip-treated subjects and 144 control (OMT
alone) patients. The primary endpoint is a composite of all-cause
mortality and unplanned hospitalisations for heart failure at 12 months
after randomisation
CONCLUSIONS: MITRA-FR is a randomised controlled national trial designed
to evaluate the performance of pMVR in comparison to OMT in patients with
severe symptomatic secondary MR contraindicated to cardiac surgery.

<7>
Accession Number
2015381157
Authors
Weber B. Bersch-Ferreira A.C. Torreglosa C.R. Ross-Fernandes M.B. Da Silva
J.T. Galante A.P. De Sousa Lara E. Costa R.P. Soares R.M. Biasi Cavalcanti
A. Berwanger O.
Institution
(Weber, Bersch-Ferreira, Torreglosa, Ross-Fernandes, Da Silva, Galante, De
Sousa Lara, Costa, Soares, Biasi Cavalcanti, Berwanger) Research
Institute, Hospital do Coracao (IP-HCor), Rua Abilio Soares 250, 11th
floor, Sao Paulo, SP, Brazil
Title
The Brazilian Cardioprotective Nutritional Program to reduce events and
risk factors in secondary prevention for cardiovascular disease: study
protocol (The BALANCE Program Trial).
Source
American Heart Journal. 171 (1) (pp 73-81.e2), 2016. Date of Publication:
01 Jan 2016.
Publisher
Mosby Inc.
Abstract
This article reports the rationale for the Brazilian Cardioprotective
Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter,
nationwide, randomized, concealed, controlled trial was designed to
investigate the effects of the BALANCE Program in reducing cardiovascular
events. The BALANCE Program consists of a prescribed diet guided by
nutritional content recommendations from Brazilian national guidelines
using a unique nutritional education strategy, which includes suggestions
of affordable foods. In addition, the Program focuses on intensive
follow-up through one-on-one visits, group sessions, and phone calls. In
this trial, participants 45 years or older with any evidence of
established cardiovascular disease will be randomized to the BALANCE or
control groups. Those in the BALANCE group will receive the afore
mentioned program interventions, while controls will be given generic
advice on how to follow a low-fat, low-energy, low-sodium, and
low-cholesterol diet, with a view to achieving Brazilian nutritional
guideline recommendations. The primary outcome is a composite of death
(any cause), cardiac arrest, acute myocardial infarction, stroke,
myocardial revascularization, amputation for peripheral arterial disease,
or hospitalization for unstable angina. A total of 2468 patients will be
enrolled in 34 sites and followed up for up to 48 months. If the BALANCE
Program is found to decrease cardiovascular events and reduce risk
factors, this may represent an advance in the care of patients with
cardiovascular disease.

<8>
Accession Number
2015166171
Authors
Samardzic J. Skoric B. Milicic D.
Institution
(Samardzic, Skoric, Milicic) ZagrebCroatia
Title
Temporal Changes of Platelet Reactivity after Coronary Stenting - A Thing
to Think about.
Source
American Journal of Cardiology. 116 (5) (pp 824), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc.

<9>
Accession Number
20151057844
Authors
Ghatak A. Singh V. Shantha G.P.S. Badheka A. Patel N. Alfonso C.E. Biswas
M. Pancholy S.B. Grines C. O'Neill W.W. De Marchena E. Cohen M.G.
Institution
(Ghatak, Singh, Patel, Alfonso, De Marchena, Cohen) Cardiovascular
Division, University of Miami Miller, School of Medicine, Miami, FL,
United States
(Shantha) Johns Hopkins University Bloomberg, School of Public Health,
Baltimore, MD, United States
(Shantha, Biswas, Pancholy) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Badheka) Yale School of Medicine, New Haven, CT, United States
(Grines) Detroit Medical Center, Detroit, MI, United States
(O'Neill) Henry Ford Health System, Detroit, MI, United States
Title
Aspiration thrombectomy in patients undergoing primary angioplasty for ST
elevation myocardial infarction: An updated meta-analysis.
Source
Journal of Interventional Cardiology. 28 (6) (pp 503-513), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background The Trial of Routine Aspiration Thrombectomy with PCI versus
PCI alone in patients with STEMI (TOTAL trial) refuted the salutary effect
of routine aspiration thrombectomy (AT) in PPCI for patients with
ST-elevation myocardial infarction (STEMI). Objectives We performed an
updated meta-analysis to assess clinical outcomes with AT prior to PPCI
compared with conventional PPCI alone including the additional trial data.
Methods and Results Clinical trials (n = 20) that randomized patients (n =
21,281) with STEMI between Routine AT (n = 10,619) and PPCI (n = 10,662)
were pooled. There was no difference in all-cause mortality between the 2
groups (RR: 0.89, 95%CI: 0.78-1.01, P = 0.08). Stratifying by follow up at
1-month (RR: 0.87, 95%CI: 0.69-1.10, P = 0.25), up to 6 months (RR: 0.91,
95%CI: 0.74-1.13, P = 0.39 and beyond 6 months (RR: 0.88, 95%CI:
0.74-1.05, P = 0.16) yielded similar results. There was a statistically
significant increase risk of stoke rate in the AT arm (RR: 1.51, 95%CI:
1.01-2.25, P = 0.04). The 2 groups were similar with regards to target
vessel revascularization (0.94, 95%CI: 0.83-1.06, P = 0.28) recurrent MI
(RR: 0.96, 95%CI: 0.80-1.16, P = 0.68, MACE events (RR: 0.91 95%CI:
0.81-1.02, P = 0.11), early (0.59, 95%CI: 0.23-1.50, P = 0.27) and late
(RR: 0.91, 95%CI: 0.69-1.18, P = 0.47) stent thrombosis and net clinical
benefit (RR 0.99, 95%CI: 0.91-1.07, P = 0.76). Conclusion Routine AT prior
to PPCI in STEMI is associated with higher risk of stroke. There is no
statistical difference in clinical outcome parameters of mortality, major
adverse cardiac events, target vessel revascularization, stent thrombosis,
and net clinical benefit between AT and PCI alone.

<10>
Accession Number
20151060204
Authors
Jacob K.A. De Heer L.M. De Heer F. Kluin J.
Institution
(Jacob, De Heer, De Heer, Kluin) Department of Cardiothoracic Surgery,
University Medical Centre Utrecht, Utrecht, Netherlands
Title
Chronic alcoholic donors in heart transplantation: A mortality
meta-analysis.
Source
International Journal of Cardiology. 191 (pp 7-10), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd

<11>
Accession Number
20151060177
Authors
Sterling L.H. Windle S.B. Filion K.B. Eisenberg M.J.
Institution
(Sterling, Windle, Filion, Eisenberg) Division of Clinical Epidemiology,
Lady Davis Institute for Medical Research, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Sterling, Filion, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Suite H-421.1, Montreal, QC H3T
1E2, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
Title
Pharmacological management strategies for stroke prevention following
transcatheter aortic valve replacement: A systematic review.
Source
International Journal of Cardiology. 191 (pp 303-311), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The most appropriate pharmacological treatment for stroke
prevention after transcatheter aortic valve replacement (TAVR) is unclear.
We performed a systematic review of randomized controlled trials (RCTs)
and observational studies examining the effect of various pharmacological
treatment regimens on rates of stroke, bleeding, and death after TAVR.
Methods We searched Cochrane Library, Embase, and Medline for RCTs and
observational studies comparing > 2 antithrombotic regimens in TAVR
patients. Included antithrombotic regimens were defined as one or more
antiplatelet agents (aspirin, clopidogrel, prasugrel, or ticagrelor)
and/or anticoagulants (vitamin K antagonists or novel oral
anticoagulants). Results Eight studies (2 RCTs and 6 observational
studies) met our inclusion criteria (n = 1598). Rates of major stroke
ranged from 0% to 5.6% with no detected differences between treatment
arms. All-cause mortality ranged from 5% to 15%, and no differences in
mortality were detected between therapies. A consistent pattern of
reduction in major or life-threatening bleeding was found with a single
antiplatelet therapy (SAPT) compared to dual antiplatelet therapy (DAPT).
However, this difference only reached statistical significance in a single
cohort study (risk ratio 0.24; 95% confidence interval 0.12, 0.46). No
differences between anticoagulant therapies were detected for any
endpoint. Overall, studies were underpowered to detect differences between
treatment groups. Conclusion Similar rates of stroke, bleeding, and
mortality were found among most studies. A trend towards reduced rates of
major or life-threatening bleeding when comparing SAPT to DAPT was found.
Numbers of events were small, highlighting the need for larger studies on
which to base pharmacological recommendations post-TAVR.

<12>
Accession Number
2015232137
Authors
Takesue T. Takeuchi H. Ogura M. Fukuda K. Nakamura R. Takahashi T. Wada N.
Kawakubo H. Kitagawa Y.
Institution
(Takesue, Takeuchi, Ogura, Fukuda, Nakamura, Takahashi, Wada, Kawakubo,
Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Title
A Prospective Randomized Trial of Enteral Nutrition After Thoracoscopic
Esophagectomy for Esophageal Cancer.
Source
Annals of Surgical Oncology. 22 (pp 802-809), 2015. Date of Publication:
01 Dec 2015.
Publisher
Springer New York LLC
Abstract
Background: Several studies have reported that postoperative enteral
nutrition (EN) reduced complications and decreased weight loss and
hospital stay periods; however, the majority of patients analyzed in these
studies underwent open thoracic surgery. No studies have been conducted
regarding EN in patients after thoracoscopic esophagectomy as a less
invasive surgery. The aim of this study was to investigate the efficacy of
EN after thoracoscopic esophagectomy. Methods: Fifty patients who
underwent thoracoscopic esophagectomy for esophageal cancer were divided
into two groups: parenteral nutrition (PN; n = 25) and EN (n = 25). The
rate of weight loss at postoperative day (POD) 14, levels of prealbumin at
POD 10, postoperative complications until POD 14, and other perioperative
data were collected for each group. Results: This study analyzed data for
47 patients. The rate of weight loss at POD 14 was significantly lower in
the EN group (3.0 +/- 3.2 %) than in the PN group (4.0 +/- 3.6 %; p =
0.020). Prealbumin levels were 21.0 +/- 7.5 mg/dL in the PN group and 18.4
+/- 5.8 mg/dL in the EN group at POD 10, with no significant differences
between the groups. However, the incidence of postoperative pneumonia was
higher in the PN group (30.4 %) than in the EN group (12.5 %).
Conclusions: EN could suppress weight loss and reduce the incidence of
pneumonia after thoracoscopic esophagectomy.

<13>
[Use Link to view the full text]
Accession Number
20151053992
Authors
Bittl J.A. He Y. Lang C.D. Dangas G.D.
Institution
(Bittl) Cardiac Catherization Laboratory, Munroe Regional Medical Center,
1221 SE 5th St, Ocala, FL, United States
(He) Office of Research and Methodology, National Center for Health
Statistics, Hyattsville, MD, United States
(Lang) Division of Cardiology, Eastern Maine Medical Center, Bangor, ME,
United States
(Dangas) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Title
Factors Affecting Bleeding and Stent Thrombosis in Clinical Trials
Comparing Bivalirudin with Heparin during Percutaneous Coronary
Intervention.
Source
Circulation: Cardiovascular Interventions. 8 (12) (no pagination), 2015.
Article Number: e002789. Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Patients treated with bivalirudin in randomized clinical trials
of percutaneous coronary intervention generally have less bleeding but
more acute stent thrombosis (ST) than do patients treated with heparin,
but differences have varied among trials. Methods and Results-We modeled
the risk of major hemorrhage and ischemic outcomes 30 days after
percutaneous coronary intervention by treatment assignment and the use of
adjunctive therapies in 18 randomized clinical trials enrolling 41 871
patients. Overall bivalirudin caused less major bleeding (odds ratio [OR],
0.64; 95% confidence interval [CI], 0.53-0.76), more ST (OR, 1.58; 95% CI,
1.19-2.09), and no difference in mortality (OR, 0.93; 95% CI, 0.77-1.14)
than heparin. A risk-benefit analysis identified 19 fewer bleeds and 5
more STs for every 1000 patients treated with bivalirudin in place of
heparin. No significant bleeding advantage of bivalirudin over heparin
could be identified in randomized clinical trials when transradial access
(OR, 0.89; 95% CI, 0.57-1.41) and planned glycoprotein IIb/IIIa inhibitors
were used with bivalirudin in the majority of patients (OR, 1.07; 95% CI,
0.87-1.31). The use of prasugrel or ticagrelor eliminated bleeding
differences (OR, 0.80; 95% CI, 0.63-1.03) but did not reduce the risk of
ST after bivalirudin (OR, 2.20; 95% CI, 1.48-3.27).
Conclusions-Substituting bivalirudin for heparin conferred a tradeoff
between bleeding and ST. Transradial access, adjunctive glycoprotein
IIb/IIIa inhibitors, and potent P2Y12 inhibitors attenuated the bleeding
advantage of bivalirudin over heparin but had no apparent effect on early
ST. New approaches to reduce bleeding and ischemic complications during
percutaneous coronary intervention warrant further investigation.

<14>
Accession Number
20151058422
Authors
Marashi S.M. Saeedinia S.M. Sadeghi M. Movafegh A. Marashi S.
Institution
(Marashi, Saeedinia, Sadeghi, Movafegh, Marashi) Department of
Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Attenuation of hemodynamic responses to intubation by Gabapentin in
coronary artery bypass surgery: A randomized clinical trial.
Source
Acta Medica Iranica. 53 (12) (pp 733-737), 2015. Date of Publication:
2015.
Publisher
Medical Sciences University of Teheran
Abstract
A varieties of medications have been suggested to prevent hemodynamic
instabilities following laryngoscopy and endotracheal intubation. This
study was conducted to determine the beneficial effects of gabapentin on
preventing hemodynamic instabilities associated with intubation in
patients who were a candidate for coronary artery bypass surgery (CABG).
This double blinded randomized, parallel group clinical trial was carried
out on 58 normotensive patients scheduled for elective CABG under general
anesthesia with endotracheal intubation in Shariati Hospital. Patients
were randomly allocated to two groups of 29 patients that received 1200 mg
of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction
and 600 mg, 2 hours before anesthesia induction) as gabapentin group or
received talc powder as placebo (placebo group). Heart rate, mean arterial
pressure, systolic and diastolic blood pressure were measured immediately
before intubation, during intubation, immediately after intubation, 1 and
2 minutes after tracheal intubation. Inter-group comparisons significantly
showed higher systolic and diastolic blood pressure, mean arterial
pressure and heart rate immediately before intubation, during intubation,
immediately after intubation, 1 and 2 minutes after tracheal intubation in
the placebo group in comparison to gabapentin group. The median of anxiety
verbal analog scale (VAS) at the pre-induction room in gabapentin and
placebo groups were 2 and 4, respectively that was significantly lower in
the former group (P. value =0.04); however, regarding median of pain score
no difference was observed between them (P. value =0.07). Gabapentin
(1200mg) given preoperatively can effectively attenuate the hemodynamic
response to laryngoscopy, intubation and also reduce preoperative related
anxiety in patients who were a candidate for CABG.

<15>
[Use Link to view the full text]
Accession Number
20151054103
Authors
Gunduz S. Ozkan M. Kalcik M. Gursoy O.M. Astarciotlu M.A. Karakoyun S.
Aykan A.C. Biteker M. Gokdeniz T. Kaya H. Yesin M. Duran N.E. Sevinc D.
Guneysu T.
Institution
(Gunduz, Ozkan, Kalcik, Gursoy, Astarciotlu, Karakoyun, Aykan, Biteker,
Gokdeniz, Kaya, Yesin, Duran) Department of Cardiology, Kosuyolu Kartal
Heart Training and Research Hospital, Denizer C. No 2, Kartal, Istanbul
34846, Turkey
(Ozkan) Department of Cardiology, Faculty of Medicine, Kars Kafkas
University, Kars, Turkey
(Sevinc, Guneysu) Department of CT Coronary Angiography, Sonomed Imaging
Center, Istanbul, Turkey
Title
Sixty-Four-Section Cardiac Computed Tomography in Mechanical Prosthetic
Heart Valve Dysfunction: Thrombus or Pannus.
Source
Circulation: Cardiovascular Imaging. 8 (12) (no pagination), 2015. Article
Number: e003246. Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Distinguishing pannus and thrombus in patients with
prosthetic valve dysfunction is essential for the selection of proper
treatment. We have investigated the utility of 64-slice multidetector
computed tomography (MDCT) in distinguishing between pannus and thrombus,
the latter amenable to thrombolysis. Methods and Results - Sixty-two (23
men, mean age 44+/-14 years) patients with suspected mechanical prosthetic
valve dysfunction assessed by transesophageal echocardiography were
included in this prospective observational trial. Subsequently, MDCT was
performed before any treatment was started. Periprosthetic masses were
detected by MDCT in 46 patients, and their attenuation values were
measured as Hounsfield Units (HU). Patients underwent thrombolysis unless
contraindicated, and those with a contraindication or failed thrombolysis
underwent surgery. A mass which was completely lysed or surgically
detected as a clot was classified as thrombus, whereas a mass which was
surgically detected as tissue overgrowth was classified as pannus. A
definitive diagnosis could be achieved in 37 patients with 39 MDCT masses
(22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic
masses was significantly lower than that in 17 pannus (87+/-59 versus
322+/-122; P<0.001). Area under the receiver operating characteristic
curve was 0.96 (95% confidence interval: 0.91-0.99; P<0.001), and a cutoff
point of HU>145 provided high sensitivity (87.5%) and specificity (95.5%)
in discriminating pannus from thrombus. Complete lysis was more common for
masses with HU<90 compared with those with HU 90 to 145 (100% versus
42.1%; P=0.007). Conclusions - Sixty-four slice MDCT is helpful in
identifying masses amenable to thrombolysis in patients with prosthetic
valve dysfunction. A high (HU>145) attenuation suggests pannus overgrowth,
whereas a lower value is associated with thrombus formation. A higher
attenuation (HU>90) is associated with reduced lysis rates.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 12

Results Generated From:
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Embase (updates since 2015-12-28)

<1>
Accession Number
2015338820
Authors
Decelis D.A. Adami M.Z. Galea J. Attard-Pizzuto M. Inglott A.S. Azzopardi
L.M.
Institution
(Decelis, Adami, Attard-Pizzuto, Inglott, Azzopardi) Department of
Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta, Msida, Malta
Title
Pharmacist intervention in pain management following heart surgery.
Source
European Journal of Hospital Pharmacy. 22 (5) (pp 306-308), 2015. Date of
Publication: 01 Sep 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Pain is a common symptom in cardiac surgery patients. This
study aimed to investigate the influence of pharmacist intervention to
ease postoperative pain in cardiac surgery patients. Methodology Patients
undergoing heart surgery were randomised to control or intervention. The
intervention group was given systematic verbal information and, at
discharge, a pharmaceutical care plan. Pain score and diary assessment
were compared up to 6 weeks after the surgery. Results 100 patients
participated. Mean Pain Score was lower in the intervention group from
week 1 to 6 (p<0.05). Compliance with analgesic was higher in the
intervention group. Conclusions The intervention improved compliance and
decreased pain score, illustrating the positive effect the pharmacist had
on these patients.

<2>
Accession Number
20151029457
Authors
Zhang L. Gao S.
Institution
(Zhang, Gao) Department of Thoracic Surgery, Cancer Hospital, Chinese
Academy of Medical Sciences, Beijing 100021, China
Title
Robot-assisted thoracic surgery versus open thoracic surgery for lung
cancer: A system review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 8 (10) (pp
17804-17810), 2015. Date of Publication: 30 Oct 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The aim of this meta-analysis is to compare the perioperative morbidity
and mortality outcomes of robotic-assisted thoracic surgery (RATS) with
open thoracic surgery (OTS) for patients with lung cancer. We searched
articles indexed in the Pubmed and Sciencedirect published as of July 2015
that met our predefined criteria. A meta-analysis was performed by
combining the results of reported incidences of perioperative morbidity
and mortality. The relative risk (RR) was used as a summary statistic.
Five eligible articles with 2433 subjects were considered in the analysis
(5 articles for morbidity, while 3 articles for mortality). Overall,
pooled analysis indicated that perioperative morbidity and mortality rate
was significantly lower among patients who underwent RATS than patients
who underwent OTS (for morbidity: RR, 0.83; 95% CI, 0.75 to 0.92; P<0.01;
for mortality: RR, 0.14; 95% CI, 0.03 to 0.59; P=0.007). No evidence of
publication bias was observed. In conclusion, this meta-analysis showed
that RATS resulted in significantly lower perioperative morbidity and
mortality rate compared with OTS cases. Thus, we suggest RATS be an
appropriate alternative to OTS for lung cancer resection. RATS should be
studied further in selected centers and compared with OTS in a randomized
fashion to better define its potential advantages and disadvantages.

<3>
Accession Number
2015531130
Authors
Lin H.M. Seldin D. Hui A.-M. Berg D. Dietrich C.N. Flood E.
Institution
(Lin, Hui, Berg) Millennium Pharmaceuticals, Inc., A Wholly Owned
Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United
States
(Seldin) Boston Medical Center, Boston, MA, United States
(Dietrich, Flood) ICON PRO, 820 W Diamond Ave, Gaithersburg, MD 20878,
United States
Title
The patients perspective on the symptom and everyday life impact of AL
amyloidosis.
Source
Amyloid. 22 (4) (pp 244-251), 2015. Date of Publication: 02 Oct 2015.
Publisher
Taylor and Francis Ltd
Abstract
Introduction: This study aimed to understand the symptomatic impact of
amyloid light-chain (AL) amyloidosis from the patients
perspective.Methods: Four data sources were included: a literature review,
review of online patient blogs, expert clinician interviews and patient
interviews. Patients were recruited through the Amyloidosis Foundation and
physician referral. Phone interviews were conducted and included
open-ended concept elicitation questions. Thematic analysis was performed
to identify symptoms and impacts. Descriptive statistics were used to
characterize the sample. A conceptual model was developed depicting the
impact of disease and treatment.Results: Two hundred seventy abstracts
were identified; 10 articles were deemed relevant. No qualitative studies
were identified, and only three studies included patient-reported
measures. Ten patients completed interviews (mean age 61 [+/-8]; 7 male).
Over 25 signs/symptoms were identified, including fatigue, weakness,
dyspnea, neuropathy, edema, dizziness/lightheadedness, anorexia, diarrhea
and constipation. Impacts included reduced physical and social
functioning, and emotional impacts, including frustration, anxiety and
depression. Findings from the blogs and expert interviews were consistent
with patient reports.Conclusion: Symptoms can vary widely, but a core set
of symptoms were common across patients. The conceptual model derived from
this study can be used to ensure a patient-centered approach to drug
development.

<4>
Accession Number
20151043880
Authors
Sher-i-Murtaza M. Rizvi H.M.F.A. Baig M.A.R. Hamid W. Zaman H.
Institution
(Sher-i-Murtaza, Rizvi, Baig, Hamid, Zaman) Department of Cardiac Surgery,
Chaudary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
Title
Myocardial protection with multiport antegrade cold blood cardioplegia and
continuous controlled warm shot through vein grafts during proximal ends
anastomosis in conventional coronary artery bypass graft.
Source
Journal of the Pakistan Medical Association. 66 (1) (pp 53-58), 2016. Date
of Publication: January 2016.
Publisher
Pakistan Medical Association
Abstract
Objective: To evaluate the benefits of simultaneous aortic root and vein
graft cold blood cardioplegia and continuous controlled warm blood
perfusion through vein grafts during proximal aortocoronary anastomosis in
conventional coronary artery bypass graft surgery in patients with
multi-vessel coronary artery disease. Methods: The prospective randomised
study was conducted at Chaudary Pervaiz Elahi Institute of Cardiology,
Multan, Pakistan, from April 2013 to June 2014, and comprised patients of
isolated conventional coronary artery bypass graft surgery. The patients
were randomised into 2 groups; Group I had patients in whom multiperfusion
set was used for cardioplegia and continuous warm blood perfusion through
vein grafts during proximal ends anastomosis, and Group II had patients in
whom routine aortic root antegrade cardioplegia was used with no warm
blood perfusion during proximal anastomosis of vein grafts. Data was
analysed using SPSS 20. Results: There were 434 patients in the study,
with Group 1 having 215(49.5%) being the study group, and Group II having
219(50.5%)being the Control group. The groups showed no significant
difference in the number of grafts, and aortic cross-clamp time (p>0.05
each). Total bypass time was significantly prolonged in the Control Group
(p=0.001). Incidence of intra-operative arrhythmias,
peri-operativemyocardial infarction, need for inotropic support and
intra-aortic balloon counter-pulsation and operative mortality were
significantly higher in the Control group (p<0.05 each). Conclusions:
Simultaneous aortic root and vein graft cold blood cardioplegia and
continuous controlled warm blood perfusion was beneficial for myocardial
protection and early patient outcome.

<5>
Accession Number
20151037357
Authors
Myers S.A. Huben N.B. Yentes J.M. McCamley J.D. Lyden E.R. Pipinos I.I.
Johanning J.M.
Institution
(Myers, Huben, Yentes, McCamley) Center for Research in Human Movement
Variability, School of Health, Physical Education and Recreation,
University of Nebraska Omaha, 6160 University Drive South, Omaha, NE
68182-0860, United States
(Lyden) College of Public Health, Department of Biostatistics, University
of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE
68198, United States
(Pipinos, Johanning) Department of Surgery, Omaha Veterans Affairs Medical
Center, 4101 Woolworth Avenue (121), Omaha, NE 68105, United States
(Johanning) College of Medicine, Department of Surgery, University of
Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198,
United States
Title
Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease.
Source
Rehabilitation Research and Practice. 2015 (no pagination), 2015. Article
Number: 124023. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Accumulating evidence suggests revascularization of peripheral arterial
disease (PAD) limbs results in limited improvement in functional gait
parameters, suggesting underlying locomotor system pathology. Spatial and
temporal (ST) gait parameters are well studied in patients with PAD at
baseline and are abnormal when compared to controls. The purpose of this
study was to systematically review and critically analyze the available
data on ST gait parameters before and after interventions. A full review
of literature was conducted and articles were included which examined ST
gait parameters before and after intervention (revascularization and
exercise). Thirty-three intervention articles were identified based on 154
articles that evaluated ST gait parameters in PAD. Four articles fully
assessed ST gait parameters before and after intervention and were
included in our analysis. The systematic review of the literature revealed
a limited number of studies assessing ST gait parameters. Of those found,
results demonstrated the absence of improvement in gait parameters due to
either exercise or surgical intervention. Our study demonstrates
significant lack of research examining the effectiveness of treatments on
ST gait parameters in patients with PAD. Based on the four published
articles, ST gait parameters failed to significantly improve in patients
with PAD following intervention.

<6>
Accession Number
20151044975
Authors
Brown C.H. Faigle R. Klinker L. Bahouth M. Max L. Laflam A. Neufeld K.J.
Mandal K. Gottesman R.F. Hogue C.W.
Institution
(Brown, Max, Laflam, Hogue) Department of Anesthesiology and Critical Care
Medicine, John Hopkins School of Medicine, Zayed 6208, Johns Hopkins, 1800
Orleans Street, Baltimore, MD 21287, United States
(Faigle, Bahouth, Gottesman) Department of Neurology, Johns Hopkins School
of Medicine, Baltimore, MD, United States
(Klinker) Johns Hopkins University, School of Medicine, Baltimore, MD,
United States
(Neufeld) Department of Psychiatry and Behavioral Sciences, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Mandal) Department of Surgery, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Title
The Association of Brain MRI Characteristics and Postoperative Delirium in
Cardiac Surgery Patients.
Source
Clinical Therapeutics. 37 (12) (pp 2686-2699.e9), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Excerpta Medica Inc.
Abstract
Purpose Delirium is common after cardiac surgery and is associated with
adverse consequences, including cognitive decline. Identification of
vulnerable older adults might allow for early implementation of
delirium-prevention strategies. Brain MRI findings provide insight into
structural brain changes that may identify vulnerable patients. The
purpose of this study was to examine the association between brain MRI
characteristics potentially associated with delirium vulnerability and the
development of postoperative delirium in a nested cohort of patients
undergoing cardiac surgery. Methods We identified 79 cardiac surgery
patients who had brain MRI imaging after cardiac surgery, as part of an
ongoing randomized trial evaluating the efficacy of blood pressure
management based on cerebral autoregulation monitoring versus standard
management for improving neurological outcomes. Cerebral lateral
ventricular size, cortical sulcal width, and white matter hyperintensities
(WMH) on brain MRI scans were graded on a validated 0 to 9 scale, and
categorized into tertiles. New ischemic lesions were characterized as
present or absent. Delirium was assessed using a validated chart-review.
Neuropsychological testing performed before surgery was used to establish
preoperative cognitive baseline. Multivariable logistic regression was
used to assess the independent association between MRI characteristics and
postoperative delirium. Findings The average age of patients was 70.1 +/-
7.8 years old, and 72% were male. Twenty-eight of 79 (35.4%) patients
developed postoperative delirium. Patients with delirium had higher
unadjusted ventricular size (median 4 vs. 3, P = 0.003), and there was a
trend towards higher sulcal sizes and WMH grades. Increasing tertiles of
ventricular size (Odds Ratio [OR] 3.59; 95% Confidence Interval [CI]
1.59-8.12; P = 0.002) and sulcal size (OR 2.15; 95%CI 1.13-4.12; P = 0.02)
were associated with postoperative delirium, with a trend for tertiles of
WMH grade (OR 1.91; 95%CI 0.99-3.68; P = 0.05). In multivariable models
adjusted for logistic EuroSCORE, baseline cognitive status, bypass time,
and any postoperative complication, each tertile of ventricular size was
associated with increased odds of postoperative delirium (OR 3.23 per
tertile increase in ventricular size; 95%CI 1.21-8.60; P = 0.02). There
were no differences in odds of delirium by tertiles of sulcal grade,
tertiles of white matter grade, or presence of new ischemic lesions, in
adjusted models. Implications Increased brain ventricular size was
independently associated with delirium after cardiac surgery. These
results suggest that cerebral atrophy may contribute to increased
vulnerability for postoperative delirium. Baseline brain MRIs may be
useful in identifying cardiac surgery patients at high risk for
postoperative delirium, who might benefit from targeted perioperative
approaches to prevent delirium. ClinicalTrials.gov identifier:
NCT00981474.

<7>
Accession Number
20151034537
Authors
Zhang H. Liu Y. Qiu S. Liang W. Jiang L.
Institution
(Zhang, Liu) Southern Medical University, Guangzhou, Guangdong, China
(Qiu) Department of Medical Ultrasound, The Second Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
(Liang, Jiang) Department of Medical Ultrasound, The Third Affiliated
Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Title
Short-term and long-term survival after revascularization with or without
mitral valve surgery of patients with ischemic mitral valve regurgitation:
A meta-analysis.
Source
Medical Science Monitor. 21 (pp 3784-3791), 2015. Date of Publication: 04
Dec 2015.
Publisher
International Scientific Literature Inc.
Abstract
Background: There is no consensus on whether mitral valve repair or
replacement (MVRR) must be performed to treat ischemic mitral
regurgitation (MVR) after myocardial infarction. Our objective in this
study was to investigate the efficacy of coronary artery bypass grafting
(CABG) combined with or without MVRR for the ischemic MVR.
Material/Methods: An article search was performed in OvidSP, PubMed,
Cochrane Library, and Embase. In these articles, researchers compared the
efficacy of CABG with or without MVRR in treating patients with ischemic
MVR after acute coronary syndrome (ACS). We performed a meta-analysis to
compare the differences in the short-term and longterm survival rates of
patients treated with CABG only and those treated with both CABG and MVRR.
Secondary outcomes were compared with the preoperative and postoperative
degree of MVR, left ventricular end-systolic volume (LVESV), left
ventricular ejection fraction (LVEF), and New York Heart Association
(NYHA) class. Results: Out of the 1183 studies, we selected only 5
articles. A total of 3120 patients were enrolled; the CABG and MVRR group
included 575 patients, while the CABG only group included 2545 patients.
Long-term survival was higher in the CABG only group (hazard ratio [HR],
1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality
was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95;
P=0.18). No differences were found in the degree of residual MVR, the mean
of LVESV, LVEF, or NYHA class. Conclusions: In patients with ischemic MVR,
the short-term survival rate was similar in both groups. Moreover, there
was no significant improvement in the long-term survival rates of patients
treated with both CAG and MVRR.

<8>
Accession Number
20151039754
Authors
Qazi S.M. Sindby E.J. Norgaard M.A.
Institution
(Qazi, Sindby, Norgaard) Department of Cardiothoracic Surgery, Aalborg
University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
Title
Ibuprofen - A safe analgesic during cardiac surgery recovery? A randomized
controlled trial.
Source
Journal of Cardiovascular and Thoracic Research. 7 (4) (pp 141-148), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Postoperative pain-management with non-steroid
anti-inflammatory drugs has been controversial, due to related
side-effects. We investigated whether there was a significant difference
between an oxycodone-based pain-management regimen versus a slow-release
ibuprofen based regimen, in a short term post-cardiac surgery setting.
Particular attention was given to the rate of myocardial infarction,
sternal healing, gastro-intestinal complications, renal failure and
all-cause mortality. Methods: This was a single-centre, open label
parallel design randomised controlled study. Patients, who were undergoing
cardiac surgery for the first time, were randomly allocated either to a
regimen of slow-release oxycodone (10 mg twice daily) or slow-release
ibuprofen (800 mg twice daily) combined with lansoprazole. Data relating
to blood-tests, angiographies, surgical details and administered medicine
were obtained from patient records. The follow-up period was to 37 months
(median 25 months). Results: One hundred eighty-two patients were included
in the trial and available for intention to treat analysis. There were no
significant difference between the groups (P>0.05) in the rates of sternal
healing, postoperative myocardial infarction or gastrointestinal bleeding.
The preoperative levels of creatinine were found to increase by 100% in
nine patients (9.6%) in the ibuprofen group, resulting in an acute renal
injury (in accordance with the RIFLE-criteria). Eight of these patients
returned to normal renal function within 14 days. The levels of creatinine
in patients in the oxycodone group were not found to increase to the same
magnitude. Conclusion: The results of this study suggest that patients
treated postoperatively, following cardiac surgery, are at no greater risk
of harm if short term slow release ibuprofen combined with lansoprazole
treatment is used when compared to an oxycodone based regimen. Renal
function should, however, be closely monitored and in the event of any
decrease in renal function ibuprofen must be discontinued.

<9>
Accession Number
20151038638
Authors
Yang H.C. Lee J. Ahn S. Cho S. Kim K. Jheon S. Kim J.S.
Institution
(Yang) Center for Lung Cancer, Research Institute and Hospital, National
Cancer Center, Goyang, South Korea
(Lee, Cho, Kim, Jheon, Kim) Department of Thoracic and Cardiovascular
Surgery, Seoul National University College of Medicine, Seoul, South Korea
(Ahn) Medical Research Collaborating Center, Seoul National University
Bundang Hospital, Seoul National University College of Medicine, Seoul,
South Korea
Title
Pain control of thoracoscopic major pulmonary resection: Is pre-emptive
local bupivacaine injection able to replace the intravenous patient
controlled analgesia?.
Source
Journal of Thoracic Disease. 7 (11) (pp 1960-1969), 2015. Date of
Publication: 2015.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: The aim of this open-label, non-inferiority trial was to
evaluate whether pre-emptive local bupivacaine injection (PLBI) can
replace intravenous patient controlled analgesia (IV PCA) in
video-assisted thoracic surgery (VATS) major pulmonary resection. Methods:
A total of 86 patients scheduled for VATS segmentectomy/lobectomy were
randomly assigned into two groups. The PLBI group (n=42) received 0.5%
bupivacaine wound infiltration before skin incision, and the IV PCA group
(n=44) received a continuous infusion of fentanyl with a basal rate of 10
mug/mL/h. Visual analogue scale (VAS; range, 0-10) was measured as the
primary endpoint. The secondary endpoint was an additional use of
analgesics and drug induced side effects. Results: Both groups showed no
difference in terms of age, sex, disease entity, operation time, chest
tube indwelling time, and hospital stay. Serial pain scores between the
PLBI and IV PCA groups demonstrated no statistical differences
(non-inferiority margin; DELTAVAS =1.0) (Recovery room: 8.3+/-2.1 vs.
8.5+/-1.7; Day 0: 5.1+/-1.6 vs. 5.2+/-1.4; Day 1: 3.5+/-1.6 vs. 3.3+/-1.2;
Day 2: 2.7+/-1.3 vs. 2.5+/-1.2; Day 3: 2.3+/-1.3 vs. 2.1+/-1.5; 1 week
after discharge: 3.0+/-1.7 vs. 2.8+/-1.5; 1 month: 1.9+/-1.2 vs. 2.3+/-1.4
and 2 months: 1.5+/-1.2 vs. 1.3+/-1.2; 95% confidential interval (CI) of
DELTAVAS < 1.0; P > 0.05). The mean one-additional usage of IV analgesics
was needed in the PLBI group (3.3+/-2.1 vs. 2.3+/-1.3; P=0.03). The
occurrence of nausea/vomiting was higher in the IV PCA group (12.5% vs.
38.9%; P=0.026) and 41.7% of IV PCA patients experienced drug side effects
that required IV PCA removal within postoperative day (POD) 1.
Conclusions: PLBI is a simple, safe, effective, and economical method,
which is not inferior to IV PCA in VATS major pulmonary resection.

<10>
[Use Link to view the full text]
Accession Number
20151041050
Authors
Pokushalov E. Kozlov B. Romanov A. Strelnikov A. Bayramova S. Sergeevichev
D. Bogachev-Prokophiev A. Zheleznev S. Shipulin V. Lomivorotov V.V.
Karaskov A. Po S.S. Steinberg J.S.
Institution
(Pokushalov, Romanov, Strelnikov, Bayramova, Sergeevichev,
Bogachev-Prokophiev, Zheleznev, Lomivorotov, Karaskov) State Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
(Kozlov, Shipulin) Institute of Cardiology, Siberian Division, Russian
Academy of Medical Sciences, Tomsk, Russian Federation
(Po) Heart Rhythm Institute, University of Oklahoma, Health Sciences
Center, Oklahoma City, United States
(Steinberg) University of Rochester, School of Medicine and Dentistry,
Arrhythmia Institute, 200 West 57th St, New York, NY 10019, United States
(Steinberg) RidgewoodNJUnited States
Title
Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection
into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery: One-Year
Follow-Up of a Randomized Pilot Study.
Source
Circulation: Arrhythmia and Electrophysiology. 8 (6) (pp 1334-1341), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Animal models suggest that the neurotransmitter inhibitor, botulinum
toxin, when injected into the epicardial fat pads can suppress atrial
fibrillation inducibility. The aim of this prospective randomized
double-blind study was to compare the efficacy and safety of botulinum
toxin injection into epicardial fat pads for preventing atrial
tachyarrhythmias. Methods and Results-Patients with history of paroxysmal
atrial fibrillation and indication for coronary artery bypass graft
surgery were randomized to botulinum toxin (Xeomin, Merz, Germany; 50 U/1
mL at each fat pad; n=30) or placebo (0.9% normal saline, 1 mL at each fat
pad; n=30) injection into epicardial fat pads during surgery. Patients
were followed for 1 year to assess maintenance of sinus rhythm using an
implantable loop recorder. All patients in both groups had successful
epicardial fat pad injections without complications. The incidence of
early postoperative atrial fibrillation within 30 days after coronary
artery bypass graft was 2 of 30 patients (7%) in the botulinum toxin group
and 9 of 30 patients (30%) in the placebo group (P=0.024). Between 30 days
and up to the 12-month follow-up examination, 7 of the 30 patients in the
placebo group (27%) and none of the 30 patients in the botulinum toxin
group (0%) had recurrent atrial fibrillation (P=0.002). There were no
complications observed during the 1-year follow-up. Conclusions-Botulinum
toxin injection into epicardial fat pads during coronary artery bypass
graft provided substantial atrial tachyarrhythmia suppression both early
as well as during 1-year follow-up, without any serious adverse events.

<11>
Accession Number
20151034681
Authors
Avila-Alvarez A. Del Cerro Marin M.J. Bautista-Hernandez V.
Institution
(Avila-Alvarez) Department of Neonatology, Complexo Hospitalario
Universitario de A Coruna, A Coruna, (CHUAC), A Coruna, Spain
(Del Cerro Marin) Department of Pediatric Cardiology, Hospital
Universitario Ramon y Cajal, Madrid, Spain
(Bautista-Hernandez) Department of Cardiovascular Surgery, Complexo
Hospitalario Universitario A Coruna (CHUAC), Congenital and Structural
Heart Disease, Instituto de Investigacion Biomedica A Coruna (INIBIC), A
Coruna, Spain
Title
Pulmonary vasodilators in the management of low cardiac output syndrome
after pediatric cardiac surgery.
Source
Current Vascular Pharmacology. 14 (1) (pp 37-47), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Pulmonary hypertension is among the causes of low cardiac output syndrome
after neonatal and pediatric cardiac surgery. In the setting of transient
postoperative myocardial dysfunction, even a moderate elevation of
pulmonary pressure can result in heart dysfunction and circulatory
collapse. Although, specific pharmacological manipulation of pulmonary
vascular resistance is frequently required in the perioperative period,
there is no widely standardized management. In this review, a systematic
literature search of PubMed and MEDLINE databases using relevant terms was
performed. All clinical trials and relevant manuscripts, along with
important physiological, pharmacological, and evidence-based
considerations involving the use of pulmonary vasodilators in the
management of low cardiac output syndrome after cardiac surgery were
reviewed. This article addresses the fifth of eight topics comprising the
special issue entitled "Pharmacologic strategies with afterload reduction
in low cardiac output syndrome after pediatric cardiac surgery".

<12>
Accession Number
72123322
Authors
Gukop P. Gutman N. Bilkhu R. Shety A. Karapanagiotidis G.T. Momin A.
Institution
(Gukop, Gutman, Bilkhu, Shety, Karapanagiotidis, Momin) St George's
Hospital NHS Trust, Department of Cardio-Thoracic Surgery, London, United
Kingdom
Title
Who might benefit from early aspirin after coronary artery surgery?.
Source
Cardiology (Switzerland). Conference: 11th International Congress on
Coronary Artery Disease, ICCAD 2015 Florence Italy. Conference Start:
20151129 Conference End: 20151202. Conference Publication: (var.pagings).
132 (pp 126), 2015. Date of Publication: November 2015.
Publisher
S. Karger AG
Abstract
Aims: Early postoperative aspirin (300mg) administered within 6 hours
following CABG has been shown to be optimal for prevention of saphenous
vein graft (SVG) occlusion. Early aspirin has shown significant benefit in
reducing SVG occlusion, MI, stroke, renal failure and bowel infarction,
and subsequent mortality. The efficacy of early post-operative aspirin on
vein graft patency diminishes the later it is administered. It has optimal
benefit at 6 hours, significantly reduced benefit at 24 hours and no
benefit after 48hours post CABG. However the maximum benefit has been
demonstrated when administered at one hour post CABG. Method: ACC/AHA,
EACTS and ACCP have issued guidelines recommending administration of early
aspirin or an alternative (clopidogrel, ticlopidine and indobufen) at
6hours or soon after bleeding has settled as the standard of care for
optimisation of SVG patency. The ACCP guideline has also suggested that
optimal prevention of cardiovascular complication should merit higher
value than the small risk of post-operative bleeding. Several randomised
controlled studies (level 1 evidence) including a meta-analysis have shown
that administration of early aspirin following CABG is not associated with
increased blood loss or transfusion requirements. Post-operative bleeding
has been identified as a significant reason for non-administration of
early aspirin in a prospective study performed at our own institution.
Results: It is essential to define/quantify the postoperative blood loss
that precludes administration of early aspirin. Conclusion: This will
enhance prompt administration in some cases and guide judgement especially
in patients with high risk factors for vein graft
thrombosis.Administration at 6 hours is the optimal time to give aspirin
as long as bleeding has settled. Individualising the administration of
early aspirin based on clinical judgement on case to case basis would
maximise its benefit. We thus advocate a bespoke method of early aspirin
administration post CABG.

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Total documents retrieved: 17

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<1>
Accession Number
20151031313
Authors
Wolk R. Bertolet M. Brooks M.M. Pratley R.E. Sobel B.E. Frye R.L. Singh P.
Calvin A.D. Rutter M.K. Mooradian A.D. Somers V.K.
Institution
(Wolk, Frye, Singh, Calvin, Somers) Division of Cardiovascular Diseases,
Department of Medicine, Mayo Clinic, Rochester, United States
(Wolk) Pfizer Global Research and Development, Pfizer Inc., 445 Eastern
Point Rd, Grotona, CT 06340, United States
(Bertolet, Brooks) University of Pittsburgh, United States
(Pratley) Florida Hospital Diabetes and Translational Research Institutes,
Orlando, United States
(Sobel) University of Vermont, Burlington, United States
(Rutter) Endocrinology and Diabetes Research Group, Institute of Human
Development, Faculty of Medical and Human Sciences, University of
Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, Central Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre,
United Kingdom
(Mooradian) Division of Endocrinology, Diabetes and Metabolism, College of
Medicine-Jacksonville, University of Florida, United States
Title
Differential effects of insulin sensitization and insulin provision
treatment strategies on concentrations of circulating adipokines in
patients with diabetes and coronary artery disease in the BARI 2D trial.
Source
European Journal of Preventive Cardiology. 23 (1) (pp 50-58), 2016. Date
of Publication: 01 Jan 2016.
Publisher
SAGE Publications Inc.
Abstract
Aims To determine the effects of insulin sensitization (IS) and insulin
provision (IP) treatment strategies on adipokines associated with
cardiovascular disease in patients with type 2 diabetes mellitus and
coronary artery disease in the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial (BARI 2D). Methods and results Changes in
adipokine levels were compared in patients with type 2 diabetes mellitus
and coronary artery disease randomized to IS (n = 1037) versus IP (n =
1019) treatment strategies in BARI 2D. Circulating concentrations of
leptin, adiponectin, monocyte chemoattractant protein-1, tumor necrosis
factor-alpha, interleukin 6 and C-reactive protein were evaluated at
baseline and one year. IS and IP treatment strategies exerted significant
(p < 0.0001) differential effects on: leptin (IS: 0.02% decrease, p =
0.01; IP: 13% increase, p < 0.0001); adiponectin (IS: 73% increase, p <
0.0001; IP: no change, p = 0.52); interleukin 6 (IS: 14% decrease, p <
0.0001; IP: no change, p = 0.68). Changes in monocyte chemoattractant
protein-1 and tumor necrosis factor-alpha were not statistically different
between groups. C-reactive protein decreased, but the effect was
significantly greater in the IS group (-32%, p < 0.0001) than in the IP
group (-5%, p = 0.0005). Conclusion The IS and IP treatment strategies
exerted divergent effects on adipokine and inflammatory profile in
patients with type 2 diabetes mellitus and coronary artery disease. The IS
treatment strategy-induced changes may be more favorable than the IP
treatment strategy regarding cardiovascular pathophysiology.

<2>
Accession Number
20151020676
Authors
Mathew P.J. Sailam S. Sivasailam R. Thingnum S.K.S. Puri G.D.
Institution
(Mathew, Sailam, Sivasailam, Puri) Department of Anaesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh PIN-160012, India
(Thingnum) Department of Cardiothoracic Surgery, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Title
Performance of target-controlled infusion of propofol using two different
pharmacokinetic models in open heart surgery - A randomised controlled
study.
Source
Perfusion (United Kingdom). 31 (1) (pp 45-53), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
We compared the performance of a propofol target-controlled infusion (TCI)
using Marsh versus PGIMER models in patients undergoing open heart
surgery, in terms of measured plasma levels of propofol and objective
pharmacodynamic effect. Methods: Twenty-three, ASA II/III adult patients
aged 18-65 years and scheduled for elective open heart surgery received
Marsh or PGIMER (Postgraduate Institute of Medical Education and Research)
pharmacokinetic models of TCI for the induction and maintenance of
anaesthesia with propofol in a randomized, active-controlled,
non-inferiority trial. The plasma levels of propofol were measured at
specified time points before, during and after bypass. Results: The
performances of both the models were similar, as determined by the error
(%) in maintaining the target plasma concentrations: MDPE of -5.0 (-12.0,
5.0) in the PGIMER group vs -6.4 (-7.7 to 0.5) in the Marsh group and
MDAPE of 9.1 (5, 15) in the PGIMER group vs 8 (6.7, 10.1) in the Marsh
group. These values indicate that both models over-predicted the plasma
propofol concentration. Conclusions: The new pharmacokinetic model based
on data from Indian patients is comparable in performance to the
commercially available Marsh pharmacokinetic model.

<3>
Accession Number
20151020667
Authors
Stanzel R.D.P. Henderson M.
Institution
(Stanzel, Henderson) Nova Scotia Health Authority, Canada
Title
Clinical evaluation of contemporary oxygenators.
Source
Perfusion (United Kingdom). 31 (1) (pp 15-25), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
Advances in cardiopulmonary bypass equipment have played a critical role
in improving outcomes for cardiac surgery patients. Recent advancements
include reduced priming volumes, biocompatible coatings and gaseous
microemboli handling, as well as the incorporation of an arterial filter
into the oxygenator. The purpose of this study was to conduct a
comprehensive clinical evaluation of adult oxygenators on the market.
Oxygenators assessed included the Sorin Synthesis (n = 30), the Sorin
Inspire 6F (n = 10) and Inspire 8F (n = 30), the Terumo FX15 (n = 13) and
FX25 (n = 30), the Maquet Quadrox-i (n = 30) and the Medtronic Fusion (n =
30). Parameters assessed included functional prime volumes, gas exchange,
pressure gradients and the effects on patient hematology. The Synthesis
had the largest functional prime volume (1426 ml), the FX15 the lowest
(956 ml). The Inspire 6F, 8F and Fusion had the greatest O<inf>2</inf>
transfer. The Sorin oxygenators required the lowest sweep gas flows to
obtain a PaCO<inf>2</inf> of 40 mmHg. The Sorin oxygenators had the
largest pressure gradients. While no differences were observed for
hemoglobin and platelet levels post cross-clamp removal, the Sorin
Synthesis and Inspire 8F had the largest increases in white blood cell
(WBC) counts (122% and 141% of baseline, respectively) and neutrophils
(162% and 185% of baseline, respectively). The data demonstrate that no
single product is superior in all aspects. The choice of ideal oxygenator
depends on the aspect(s) of oxygenator performance the perfusion team
believes most clinically acceptable based on available data.

<4>
Accession Number
20151020664
Authors
Chew S.T.H. Ng R.R.G. Liu W. Goh S.G. Caleb M.G. Ti L.K.
Institution
(Chew) Department of Anaesthesiology, Singapore General Hospital, 20
College Road, Academia, Level 5, Singapore 169856, Singapore
(Chew) Department of Cardiovascular and Metabolic Disorders, Duke-National
University of Singapore, Graduate Medical School, Singapore, Singapore
(Ng, Liu, Ti) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Goh, Caleb) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Singapore, Singapore
(Ti) Department of Anaesthesia, National University Health System,
Singapore, Singapore
Title
Miniaturized versus conventional cardiopulmonary bypass and acute kidney
injury after cardiac surgery.
Source
Perfusion (United Kingdom). 31 (1) (pp 60-67), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication after
coronary artery bypass grafting (CABG). There are conflicting reports
whether a miniaturized cardiopulmonary bypass (MCPB) system is associated
with a lower AKI incidence compared with conventional cardiopulmonary
bypass (CCPB). It is unknown if AKI risk factors differ between the two
groups. We assessed if MCPB decreases AKI after CABG and compared the risk
factors between both groups. Methods: Sixty-eight Asian patients
presenting for elective CABG at a tertiary heart centre were enrolled.
They were randomly assigned to MCPB (n=34) or CCPB group (n=34) and
followed up in a single-blinded, prospective, randomized, controlled
trial. The primary outcome was Acute Kidney Injury Network stage 1 AKI.
Results: The AKI incidence was 21.5% and was not significantly different
between patients undergoing MCPB versus CCPB (21.9% versus 21.2%,
p=0.948). The first CPB haematocrit was independently associated with AKI
in the MCPB group (Relative Risk [RR]=0.484, 95% Confidence Interval
[CI]=0.268-0.876, p=0.016); post-operative blood loss and inflammation
were independently associated with AKI in the CCPB group (RR=1.005,
95%CI=1.003-1.007, p<0.001; RR=1.018, 95%CI=1.010-1.028, p<0.001).
Conclusion: The MCPB system is not associated with a lower incidence of
AKI in Asian patients undergoing CABG. Risk factors for AKI differed
between patients using the MCPB and CCPB systems.

<5>
Accession Number
20151011127
Authors
Blaha J. Mraz M. Kopecky P. Strtesky M. Lips M. Matias M. Kunstyr J.
Porizka M. Kotulak T. Kolnikova I. Simanovska B. Zakharchenko M. Rulisek
J. Sachl R. Anyz J. Novak D. Lindner J. Hovorka R. Svacina S. Haluzik M.
Institution
(Blaha, Kopecky, Strtesky, Lips, Matias, Kunstyr, Porizka, Kotulak,
Kolnikova, Simanovska, Zakharchenko, Rulisek, Sachl) Department of
Anesthesia, Resuscitation and Intensive Medicine, General University
Hospital, Charles University in Prague First Faculty of Medicine, Prague 1
128 08, Czech Republic
(Mraz, Svacina, Haluzik) Third Department of Medicine-Department of
Endocrinology and Metabolism, General University Hospital, Charles
University in Prague First Faculty of Medicine, Prague 1 128 08, Czech
Republic
(Lindner) Second Department of Surgery- Department of Cardiovascular
Surgery, General University Hospital, Charles University in Prague First
Faculty of Medicine, Prague 1 128 08, Czech Republic
(Anyz, Novak) Department of Cybernetics, Faculty of Electrical
Engineering, Czech Technical University, Prague 2 121 35, Czech Republic
(Hovorka) Institute of Metabolic Science, University of Cambridge,
Cambridge CB2 3AD, United Kingdom
Title
Perioperative tight glucose control reduces postoperative adverse events
in nondiabetic cardiac surgery patients.
Source
Translational Endocrinology and Metabolism. 100 (8) (pp 3081-3089), 2015.
Date of Publication: 2015.
Publisher
Endocrine Society
Abstract
Context: Tight glucose control (TGC) reduces morbidity and mortality in
patients undergoing elective cardiac surgery, but only limited data about
its optimal timing are available to date. Objective: The purpose of this
article was to compare the effects of perioperative vs postoperative
initiation of TGC on postoperative adverse events in cardiac surgery
patients. Design: This was a single center, single-blind, parallel-group,
randomized controlled trial. Settings: The setting was an academic
tertiary hospital. Participants: Participants were 2383 hemodynamically
stable patients undergoing major cardiac surgery with expected
postoperative intensive care unit treatment for at least 2 consecutive
days. Intervention: Intensive insulin therapy was initiated
perioperatively or postoperatively with a target glucose range of 4.4 to
6.1 mmol/L. Main Outcome Measures: Adverse events from any cause during
postoperative hospital stay were compared. Results: Inthewholecohort,
perioperatively initiatedTGCmarkedlyreducedthenumberofpostoperative
complications(23.2%vs34.1%,95%confidenceinterval[CI],0.60-0.78)despiteonly
minimalimprovement in glucose control (blood glucose, 6.6 +/- 0.7 vs 6.7
+/- 0.8 mmol/L, P < .001; time in target range, 39.3% +/-
13.7%vs37.3%+/-13.8%,P<.001).Thepositive effects ofTGConpostoperative
complicationsweredriven by nondiabetic subjects (21.3% vs 33.7%, 95% CI,
0.54-0.74; blood glucose 6.5+/-0.6 vs 6.6+/-0.8 mmol/L, not significant;
time in target range, 40.8% +/- 13.6% vs 39.7% +/- 13.8%, not
significant), whereas no significant effect was seen in diabetic patients
(29.4% vs 35.1%, 95% CI, 0.66-1.06) despite significantly better glucose
control in the perioperative group (blood glucose, 6.9+/-1.0 vs 7.1+/-0.8
mmol/L, P<.001; time in target range, 34.3%+/-12.7% vs 30.8%+/-11.5%,
P<.001). Conclusions: Perioperative initiation of intensive insulin
therapy during cardiac surgery reduces postoperative morbidity in
nondiabetic patients while having a minimal effect in diabetic subjects.

<6>
Accession Number
20151022946
Authors
Mansourian S. Bina P. Fehri A. Karimi A.A. Boroumand M.A. Abbasi K.
Institution
(Mansourian, Bina, Fehri, Karimi, Boroumand, Abbasi) Department of Cardiac
Surgery, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Preoperative oral pentoxifylline in case of coronary artery bypass
grafting with left ventricular dysfunction (ejection fraction equal to/
less than 30%).
Source
Anadolu Kardiyoloji Dergisi. 15 (12) (pp 1014-1019), 2015. Date of
Publication: 01 Dec 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Objective: Most coronary artery bypass grafts are done by applying
cardiopulmonary bypass, which usually induces unwanted inflammatory
reactions and impairs the outcomes. In order to minimize the perilous
response of cardiopulmonary bypass, pentoxifylline was getting used
orally. Methods: In a prospective, placebo-controlled, randomized clinical
trial, 178 coronary artery bypass graft candidates with ejection fraction
lower/equal to 30%, divided into two equal groups (pentoxifylline and
control), participated in the study. Pentoxifylline patients received 400
mg pentoxifylline 3 times a day for 3 days before operation. The outcomes
were compared between groups using student's t-test, Mann-Whitney U-test,
Pearson chi-square, or Fisher's exact test. Results: Pentoxifylline
administration did not significantly affect troponin-T (p=0.68), but it
reduced tumor necrosis factor-alpha (p=0.01) and interleukin- 6 (p=0.01).
It improved left ventricular ejection fraction significantly (p=0.01).
White blood cell and platelet counts, hemoglobin, and hematocrit were not
influenced by pentoxifylline. The drug did not affect blood urea nitrogen
and creatinine, occurrence of renal failure, cerebrovascular accidents,
and in-hospital mortality rate. The need for an intra-aortic balloon pump,
cardiopulmonary bypass, and aortic crossclamp times were not affected,
either. Pentoxifylline decreased the intensive care unit stay (p<0.001),
ventilation time, 10.4 hours in the pentoxifylline group against 14.7
hours in the control group (p=0.01), and the requirement of inotropic
agents (p=0.02) and blood transfusion (p=0.01). Conclusion: Pentoxifylline
has more beneficial potencies in reducing adverse events after coronary
artery bypass graft using cardiopulmonary bypass, than what are known.

<7>
Accession Number
2015317374
Authors
Miell J. Dhanjal P. Jamookeeah C.
Institution
(Miell) Department of Endocrinology, University Hospital Lewisham, London,
United Kingdom
(Dhanjal) Otsuka Pharmaceutical UK Limited, Gallions, Wexham Springs,
Framewood Road, Wexham SL3 6PJ, United Kingdom
(Jamookeeah) Otsuka Pharmaceutical Europe Limited, Wexham, United Kingdom
Title
Evidence for the use of demeclocycline in the treatment of hyponatraemia
secondary to SIADH: A systematic review.
Source
International Journal of Clinical Practice. 69 (12) (pp 1396-1417), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Aims Hyponatraemia (HN) is the most common electrolyte balance disorder in
clinical practice. Since the 1970s, demeclocycline has been used in some
countries to treat chronic HN secondary to syndrome of inappropriate
antidiuretic hormone secretion (SIADH). The precise mechanism of action of
demeclocycline is unclear, but has been linked to the induction of
nephrogenic diabetes insipidus. Furthermore, the safety profile of
demeclocycline is variable with an inconsistent time to onset, and a
potential for complications. There has been no systematic evaluation of
the use of demeclocycline for the treatment of HN secondary to SIADH to
date. A systematic literature review was performed to obtain an insight
into the clinical safety and efficacy of demeclocycline for this
condition. Methods Embase^TM, MEDLINE,
MEDLINE In-Process, and The Cochrane Library were searched on
two occasions using MeSH terms combined with free-text terms. References
were screened by two independent reviewers. Relevant publications were
then extracted by two independent reviewers, with a third reviewer
collating and finalising extractions. Results The searches returned a
total of 705 hits. 632 abstracts were screened after the removal of
duplicates. Following screening, 35 full-length publications were
reviewed. Of these, 17 were excluded, resulting in 18 studies deemed
relevant for data extraction. Two were randomised controlled trials
(RCTs), 16 were non-RCTs, and 10 were case reports. Discussion Although
most reports suggest that demeclocycline can address serum sodium levels
in specific patients with HN, efficacy is variable, and may depend upon
the underlying aetiology. Demeclocycline dose adjustments can be complex,
and as its use in clinical practice is not well defined, it can differ
between healthcare professionals. Conclusion There is a lack of clinical
and economic evidence supporting the use of demeclocycline for HN
secondary to SIADH. Patients receiving demeclocycline for HN secondary to
SIADH must be closely monitored.

<8>
Accession Number
20151021402
Authors
Laiq N. Majid A. Nawab J. Malik A.
Institution
(Laiq, Majid, Nawab, Malik) Department of Cardiothoracic Anaesthesia, Post
Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
Title
Central venous catheterization and cardiac surgeries.
Source
Journal of Medical Sciences (Peshawar). 23 (3) (pp 137-140), 2015. Date of
Publication: July 2015.
Publisher
Khyber Medical College
Abstract
Objective: To compare the rate of complications and ease of insertion
between internal jugular vs subclavian central venous catheterization in
patients undergoing cardiac surgeries. Material and Methods: This
randomized clinical control study was conducted in the department of
Cardiothracic Anesthesia PGMI/Lady Reading Hospital, Peshawar from April
2013 to November 2014. A totol number of 200 patients were randomly
assigned in one of the two groups,i-e 100 in internal jugular group and
100 patients in subclavian group for central venous catheterization.
Patients's demographic data, rate of complications and ease of insertion
between the two groups were recorded and compared. Calculations were done
using the SPSS, software pakage, Version 17. Results: There was no
statistically significant difference between the Ages, sex, weight and the
type of surgery in the two studied groups. Efficacy in terms of ease of
insertion was more in internal jugular group as the number of attempts
were less, comared to subclavian group. Rate of complications were more in
subclavian group compared to internal jugular group (P value < 0.05)
except infection rate which was noted to be high in internal jugular group
(P value < 0.05). Conclusion: Internal jugular vein is an easy access
having less complications for central venous catheterization compared to
subclavian vein.

<9>
Accession Number
20151025848
Authors
Kadda O. Manginas A. Stavridis G. Balanos D. Kotiou M. Panagiotakos D.B.
Institution
(Kadda) Department of Critical Care, School of Medicine, University of
Athens, Athens, Greece
(Manginas) Department of Cardiology, Mediterraneo Hospital, Athens, Greece
(Stavridis, Balanos, Kotiou) Department of Cardiac Surgery, Onassis
Cardiac Surgery Center, Athens, Greece
(Panagiotakos) Department of Nutrition and Dietetics, School of Health
Science and Education, Harokopio University, 46 Paleon Polemiston St
Glyfada, Athens 166 74, Greece
Title
Gender Analysis in the Outcomes of a Lifestyle Intervention among Patients
Who Had an Open Heart Surgery.
Source
Angiology. 67 (1) (pp 66-74), 2016. Date of Publication: 01 Jan 2016.
Publisher
SAGE Publications Inc.
Abstract
The aim of this study was to evaluate the gender-oriented differences in
the outcomes of a lifestyle intervention trial (diet, smoking cessation,
and exercise) among patients who had open heart surgery. A randomized,
nonblind intervention study was performed on 500 patients who had open
heart surgery. Immediately after hospital discharge, 250 patients were
randomly allocated lifestyle intervention by receiving oral and written
information in the form of a booklet with specific educational information
for postoperative rehabilitation. The remaining 250 patients received the
regular oral instructions. The applied lifestyle intervention proved to be
beneficial only in men as far as quitting smoking (relative risk [RR]:
0.36, confidence interval [CI]: 0.16-0.80; P =.01) and returning to work
(RR: 0.35, CI: 0.13-0.92; P =.03) are concerned. For both genders, no
significant associations between dietary and physical activity
recommendations were observed. Conclusion: Lifestyle nursing intervention
immediately after open heart surgery had a beneficial effect on men 1 year
after the surgery but not on women. Thus, there is a need for
gender-specific studies among women.

<10>
Accession Number
20151020591
Authors
Healy D.A. Boyle E. McCartan D. Bourke M. Medani M. Ferguson J. Yagoub H.
Bashar K. O'Donnell M. Newell J. Canning C. McMonagle M. Dowdall J. Cross
S. O'Daly S. Manning B. Fulton G. Kavanagh E.G. Burke P. Grace P.A.
Moloney M.C. Walsh S.R.
Institution
(Healy, Bashar, Canning, Kavanagh, Burke, Grace) Department of Vascular
Surgery, University Hospital Limerick, Limerick, Ireland
(Boyle, Manning, Fulton) Department of Surgery Cork, University Hospital,
Cork, Ireland
(McCartan, Bourke, Medani, McMonagle, Dowdall, Cross) Department of
Surgery, University Hospital Waterford, Waterford, Ireland
(Ferguson, Yagoub) Department of Medicine, Graduate Entry Medical School,
University of Limerick, Limerick, Ireland
(O'Donnell, Newell, O'Daly) Clinical Research Facility, National
University of Ireland Galway, Galway, Ireland
(Moloney) Health Research Institute, University of Limerick, Limerick,
Ireland
(Walsh) Department of Surgery, National University of Ireland Galway,
Galway, Ireland
Title
A multicenter pilot randomized controlled trial of remote ischemic
preconditioning in major vascular surgery.
Source
Vascular and Endovascular Surgery. 49 (8) (pp 220-227), 2015. Date of
Publication: 01 Nov 2015.
Publisher
SAGE Publications Inc.
Abstract
A pilot randomized controlled trial that evaluated the effect of remote
ischemic preconditioning (RIPC) on clinical outcomes following major
vascular surgery was performed. Eligible patients were those scheduled to
undergo open abdominal aortic aneurysm repair, endovascular aortic
aneurysm repair, carotid endarterectomy, and lower limb revascularization
procedures. Patients were randomized to RIPC or to control groups. The
primary outcome was a composite clinical end point comprising any of
cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac
arrest, congestive cardiac failure, cerebrovascular accident, renal
failure requiring renal replacement therapy, mesenteric ischemia, and
urgent cardiac revascularization. Secondary outcomes were components of
the primary outcome and myocardial injury as assessed by serum troponin
values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14
(14.1%) of 99 RIPC group patients (P =.446). There were no significant
differences in secondary outcomes. Our trial generated data that will
guide future trials. Further trials are urgently needed.

<11>
Accession Number
20151020459
Authors
Amoli A.I. Bozorgi A. Talasaz A.H. Omran A.S. Mortazavi S.H. Jalali A.
Nasirpour S. Jenab Y.
Institution
(Amoli, Bozorgi, Talasaz, Omran, Mortazavi, Jalali, Nasirpour, Jenab)
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Efficacy of colchicine versus placebo for the treatment of pericardial
effusion after open-heart surgery: A randomized, placebo-controlled trial.
Source
American Heart Journal. 170 (6) (pp 1195-1201), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Pericardial effusion (PE), a common complication after
open-heart surgery, accounts for 50% to 85% of patients. Although
reversible in most of the cases, it could be life threatening in the
occurrence of tamponade in large effusions. We aimed to determine the
therapeutic efficacy of colchicine on PE after open-heart surgery. Methods
The study is a prospective, randomized, triple-blind, placebo-controlled
single-center trial at Tehran Heart Center. A total of 149 patients with
mild or moderate PE in transthoracic echocardiography were randomly
assigned to receive 1 mg/d colchicine (n = 74) or 1 tablet of placebo (n =
75) for 2 weeks and then underwent follow-up echocardiography. Results
Baseline and clinical characteristics were not significantly different
between the 2 study groups except for age (P =.02) and graft numbers (P
=.005). There was no significant difference in pretreatment and
posttreatment PE sizes between the 2 study groups (P =.440 and.844,
respectively). Median (25th-75th percentiles) of effusion changes was 5 mm
(1-7.6 mm) in the colchicine group and 5 mm (1-6.6 mm) in the placebo
group (P =.932). Intervention had no significant impact on pretreatment
and posttreatment effusion values and changes in isolated coronary artery
bypass graft surgery patients (P =.607,.539, and.628, respectively). After
adjustment for possible confounders, there was still no significant
difference in postoperative PE between the 2 study groups (t = -0.285, P
=.776). Conclusion We concluded that prescription of colchicine does not
seem to be effective in treatment of asymptomatic postoperative PE. This
could be justified in case that the etiology of most of the PEs might be
contribution of noninflammatory factors which are better to be dealt with
observational approaches.

<12>
Accession Number
20151020450
Authors
Nicholls S.J. Lincoff A.M. Barter P.J. Brewer H.B. Fox K.A.A. Gibson C.M.
Grainger C. Menon V. Montalescot G. Rader D. Tall A.R. McErlean E.
Riesmeyer J. Vangerow B. Ruotolo G. Weerakkody G.J. Nissen S.E.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA 5001, Australia
(Lincoff, Menon, McErlean, Nissen) Cleveland Clinic Coordinating Center
for Clinical Research, Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Barter) University of New South Wales, Sydney, Australia
(Brewer) Medstar Research Institute, Hyattsville, MD, United States
(Fox) University of Edinburgh, Edinburgh, United Kingdom
(Gibson) Harvard Medical School, Boston, MA, United States
(Grainger) Duke Clinical Research Institute, Durham, NC, United States
(Montalescot) Pitie-Salpetriere University Hospital, Paris, France
(Rader) University of Pennsylvania, Philadelphia, PA, United States
(Tall) Columbia University, New York City, NY, United States
(Riesmeyer, Vangerow, Ruotolo, Weerakkody) Eli Lilly and Company,
Indianapolis, IN, United States
Title
Assessment of the clinical effects of cholesteryl ester transfer protein
inhibition with evacetrapib in patients at high-risk for vascular
outcomes: Rationale and design of the ACCELERATE trial.
Source
American Heart Journal. 170 (6) (pp 1061-1069), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Potent pharmacologic inhibition of cholesteryl ester
transferase protein by the investigational agent evacetrapib increases
high-density lipoprotein cholesterol by 54% to 129%, reduces low-density
lipoprotein cholesterol by 14% to 36%, and enhances cellular cholesterol
efflux capacity. The ACCELERATE trial examines whether the addition of
evacetrapib to standard medical therapy reduces the risk of cardiovascular
(CV) morbidity and mortality in patients with high-risk vascular disease.
Study Design ACCELERATE is a phase 3, multicenter, randomized,
double-blind, placebo-controlled trial. Patients qualified for enrollment
if they have experienced an acute coronary syndrome within the prior 30 to
365 days, cerebrovascular accident, or transient ischemic attack; if they
have peripheral vascular disease; or they have diabetes with coronary
artery disease. A total of 12,092 patients were randomized to evacetrapib
130 mg or placebo daily in addition to standard medical therapy. The
primary efficacy end point is time to first event of CV death, myocardial
infarction, stroke, hospitalization for unstable angina, or coronary
revascularization. Treatment will continue until 1,670 patients reached
the primary end point; at least 700 patients reach the key secondary
efficacy end point of CV death, myocardial infarction, and stroke, and the
last patient randomized has been followed up for at least 1.5 years.
Conclusions ACCELERATE will establish whether the cholesteryl ester
transfer protein inhibition by evacetrapib improves CV outcomes in
patients with high-risk vascular disease.

<13>
Accession Number
20151020442
Authors
Celano C.M. Millstein R.A. Bedoya C.A. Healy B.C. Roest A.M. Huffman J.C.
Institution
(Celano, Millstein, Bedoya, Huffman) Department of Psychiatry,
Massachusetts General Hospital, 55 Fruit Street/Blake 11, Boston, MA,
United States
(Celano, Millstein, Bedoya, Healy) Harvard Medical School, Boston, MA,
United States
(Healy, Huffman) Department of Neurology, Massachusetts General Hospital,
Boston, MA, United States
(Roest) Interdisciplinary Center Psychopathology and Emotion Regulation,
Department of Psychiatry, University of Groningen, University Medical
Center Groningen, Groningen, Netherlands
Title
Association between anxiety and mortality in patients with coronary artery
disease: A meta-analysis.
Source
American Heart Journal. 170 (6) (pp 1105-1115), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Depression and anxiety are common in patients with coronary
artery disease (CAD). Although depression clearly has been associated with
mortality in this population, the relationship between anxiety and
mortality is less clear. Accordingly, we performed a series of
meta-analyses to (1) examine the relationship between anxiety and
mortality in patients with established CAD and (2) determine if this
relationship differs in patients with stable CAD compared to those who
have just had an acute coronary syndrome (ACS). Methods and results
Systematic literature searches identified 44 articles (total N = 30,527)
evaluating the prospective relationship between anxiety and mortality in
individuals with established CAD. A series of 8 adjusted and unadjusted
meta-analyses were performed to examine this relationship across all
patients, with sensitivity analyses completed in post-ACS and stable CAD
cohorts. In unadjusted analyses, anxiety was associated with a moderate
increase in mortality risk (odds ratio 1.21 per SD increase in anxiety).
However, when adjusting for covariates, nearly all associations became
nonsignificant. In sensitivity analyses, anxiety was associated with an
increased risk of poor outcomes in the stable CAD - but not post-ACS -
cohort. Conclusions These analyses confirm that anxiety is associated with
increased risk of mortality in patients with CAD; however, this
relationship is not as strong as that of depression and may be explained
partly by other clinical factors. If anxiety screening is performed, it
should be performed during a period of clinical stability and should
target anxiety disorders rather than anxiety symptoms alone.

<14>
Accession Number
20151020441
Authors
Prati F. Romagnoli E. Limbruno U. Pawlowski T. Fedele S. Gatto L. Di Vito
L. Pappalardo A. Ramazzotti V. Picchi A. Trivisonno A. Materia L.
Pfiatkosky P. Paoletti G. Marco V. Tavazzi L. Versaci F. Stone G.W.
Institution
(Prati, Gatto, Di Vito, Pappalardo, Ramazzotti) San Giovanni Hospital,
Rome, Italy
(Prati, Romagnoli, Gatto, Materia, Paoletti, Marco) Centro per la Lotta
Contro l'Infarto-CLI Foundation, Rome, Italy
(Limbruno, Picchi) Misericordia Hospital, Grosseto, Italy
(Pawlowski, Pfiatkosky) Central Clinical Hospital, Ministry of Interior,
Warsaw, Poland
(Fedele) Sandro Pertini Hospital, Rome, Italy
(Trivisonno, Versaci) Ospedale Civile Ferdinando Veneziale, Isernia, Italy
(Tavazzi) GVM Care and Research, E.S. Health Science Foundation,
Cotignola, Italy
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Randomized evaluation of intralesion versus intracoronary abciximab and
aspiration thrombectomy in patients with ST-elevation myocardial
infarction: The COCTAIL II trial.
Source
American Heart Journal. 170 (6) (pp 1116-1123), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Thrombus burden and distal embolization are predictive of
no-reflow during primary percutaneous coronary intervention (PCI) in
patients with acute ST-elevation myocardial infarction (STEMI). We sought
to compare the efficacy of pharmacological and catheter-based strategies
for thrombus in patients with STEMI and high atherothrombotic burden.
Methods Between January 2012 and December 2013, 128 STEMI patients
undergoing primary PCI at 5 centers were randomly assigned in a 2 x 2
factorial design to intracoronary (IC) abciximab bolus (via the guide
catheter) versus intralesion (IL) abciximab bolus, each with versus
without aspiration thrombectomy (AT). Study end points were residual
intrastent atherothrombotic burden, defined as the number of
cross-sections with residual tissue area >10% as assessed by optical
coherence tomography, and indices of angiographic and myocardial
reperfusion. Results Residual intrastent atherothrombotic burden did not
significantly differ with IL versus IC abciximab (median [interquartile
range] 6.0 [1-15] vs 6.0 [2-11], P =.806) and with AT versus no aspiration
(6.0 [1-13] vs 6.0 [2-12], P =.775). Intralesion abciximab administration
was associated with improved angiographic myocardial reperfusion in terms
of thrombolysis in myocardial infarction (TIMI) flow (3 [3-3] vs 3 [2-3],
P =.040), corrected TIMI frame count (12 +/- 5 vs 17 +/- 16, P =.021), and
myocardial blush grade (3 [2-3] vs 3 [2-3], P =.035). In particular, IL
abciximab was associated with higher occurrence of final TIMI 3 flow (90%
vs 73.8%, P =.032) and myocardial blush grade 3 (71.6% vs 52.4%, P =.039).
Conversely, AT had no significant effect on indices of angiographic or
myocardial reperfusion. Conclusions In patients with STEMI and high
thrombotic burden, neither IL versus IC abciximab nor AT versus no
aspiration reduced postprocedure intrastent atherothrombotic burden in
patients with STEMI undergoing primary PCI. However, IL abciximab improved
indices of angiographic and myocardial reperfusion compared to IC
abciximab, benefits not apparent with AT.

<15>
Accession Number
20151020439
Authors
Spencer F.A. Sekercioglu N. Prasad M. Lopes L.C. Guyatt G.H.
Institution
(Spencer, Guyatt) Department of Medicine, McMaster University, Faculty of
Health Sciences, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
(Sekercioglu, Guyatt) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Prasad) Department of Community Medicine, Pt. B. D. Sharma Postgraduate
Institute of Medical Sciences, Rohtak Haryana, India
(Lopes) University of Sorocaba, UNISO, Sorocaba, Brazil
Title
Culprit vessel versus immediate complete revascularization in patients
with ST-segment myocardial infarction - A systematic review.
Source
American Heart Journal. 170 (6) (pp 1133-1139), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Guidelines suggest percutaneous intervention (PCI) of only the
culprit artery in patients presenting with ST-segment elevation myocardial
infarction (STEMI) and multivessel coronary artery disease. However,
recent randomized controlled trials (RCTs) suggest benefit to performing
PCI of other stenotic vessels at the same time as culprit vessel PCI.
Methods We conducted a systematic review with complete case meta-analysis
and sensitivity analyses. Data sources included MEDLINE, EMBASE, Cochrane
Register of Controlled Trials, and CINAHL from 1946 to March 2014; MEDLINE
and EMBASE from March 2014 to March 2015; and scanning of literature for
new studies until August 2015. All RCTs comparing multivessel versus
culprit-only PCI in patients with STEMI were eligible. The primary
outcomes of interest were recurrent myocardial infarction (MI), recurrent
revascularization, and mortality. We combined data from trials to estimate
the pooled risk ratio (RR) and associated 95% CIs using random-effects
models. Results Five RCTs including 1,606 patients of whom 1,568 had
complete data proved eligible. Multivessel revascularization was
associated with decreased risk of repeat revascularization (RR 0.36, 95%
CI 0.27-0.49, risk difference 9.7% over 2 years) and recurrent nonfatal MI
(RR 0.58, 95% CI 0.36-0.93, risk difference 1.8% over 2 years), without
increase in mortality (RR 0.82, 95% CI 0.53-1.26) or other adverse events.
Conclusions Pooled data provide moderate-certainty evidence that
performance of multivessel PCI will provide an appreciable reduction in
nonfatal MI and high-certainty evidence that it will reduce need for
repeat revascularization. Patients are likely to place a high value on
these benefits.

<16>
Accession Number
72115664
Authors
Westerdahl E.
Institution
(Westerdahl) Orebro University, Orebro, Sweden
Title
Deep breathing techniques after cardiac surgery.
Source
Physiotherapy (United Kingdom). Conference: World Confederation for
Physical Therapy Congress 2015 Singapore Singapore. Conference Start:
20150501 Conference End: 20150504. Conference Publication: (var.pagings).
101 (pp eS1622-eS1623), 2015. Date of Publication: May 2015.
Publisher
Elsevier Ltd
Abstract
Background: Chest physiotherapy is routinely prescribed in order to reduce
or prevent pulmonary impairments after cardiac surgery. Besides early
mobilization, positioning and shoulder girdle exercises, various breathing
exercises are recommended to the spontaneously breathing postoperative
patient. Different breathing exercises are recommended in different parts
of the world, and there is no consensus about the most effective breathing
technique after cardiac surgery. Purpose: The purpose of this review is to
provide a brief overview of postoperative breathing exercises for patients
undergoing cardiac surgery via sternotomy, and to discuss and suggest an
optimal technique for the performance of deep breathing exercises.
Methods: A narrative systematic review approach. Results: Deep breathing
exercises with or without mechanical devices have been shown to have
positive effects on atelectasis, lung volumes, oxygenation and dyspnoea.
However, arbitrary instructions are given, and recommendations on
performance and duration vary. Scientific evidence for the efficacy has
been lacking until recently, and there is a lack of trials describing how
postoperative breathing exercises actually should be performed. A maximal
slow inspiration with an inspiratory hold at peak inspiration is
advocated. Teaching of deep breathing exercises should be based on a
maximal slow inspiration. An inspiratory hold at peak inspiration is
advocated to promote airway opening and resolve atelectasis. A positive
expiratory pressure on expiration decreases respiratory rate and increases
lung volumes, and thus consequently may improve gas exchange. The
postoperative breathing technique is feasible and easily performed by
cardiac surgical patients. Conclusion(s): There is evidence that chest
physiotherapy and deep breathing exercises in the early postoperative
course after cardiac surgery can improve recovery. However, there is a
need for further research to discover whether mechanical devices have a
physiological effect on pulmonary postoperative recovery or if it is
rather a question of breathing technique. Implications: Postoperative deep
breathing exercises are used to treat existing pulmonary impairments
gained during the surgery and to prevent further postoperative
deterioration. One feasible suggestion is to perform slow deep breaths,
with or without the aid of a mechanical device, hourly during waking hours
the first postoperative days after cardiac surgery.

<17>
Accession Number
72114350
Authors
Hong S. Alison J. Milross M. Dignan R.
Institution
(Hong) Liverpool Hospital, Physiotherapy, Sydney, Australia
(Alison, Milross) University of Sydney, Physiotherapy, Sydney, Australia
(Alison) Royal Prince Alfred Hospital, Physiotherapy, Sydney, Australia
(Dignan) Liverpool Hospital, Cardiothoracic Surgery, Sydney, Australia
Title
Does regional anaesthesia after coronary artery bypass graft surgery
improve pain control and walking distance? a RCT.
Source
Physiotherapy (United Kingdom). Conference: World Confederation for
Physical Therapy Congress 2015 Singapore Singapore. Conference Start:
20150501 Conference End: 20150504. Conference Publication: (var.pagings).
101 (pp eS586-eS587), 2015. Date of Publication: May 2015.
Publisher
Elsevier Ltd
Abstract
Background: Pain after coronary artery bypass graft (CABG) surgery affects
early rehabilitation1. Previous studies using continuous local anaesthetic
in cardiac surgery2 have assessed resting pain2 and time to ambulate2. No
studies have evaluated the effect of regional anaesthesia on walking
distance and pain scores during physiotherapy sessions post cardiac
surgery. Purpose: To determine the effect of continuous infusion of
ropivacaine (ropivacaine group) compared to placebo infusion (placebo
group) or usual care (usual care group) in patients after CABG surgery on
distance walked, pain scores before and after physiotherapy treatment and
number of patients discharged from physiotherapy by postoperative day 4.
Methods: Multicentre, double blind, randomised controlled trial.
Participants: Low to moderate risk CABG surgery patients with at least one
internal mammary artery graft. Intervention: Before sternotomy closure
patients were randomised. For the ropivacaine group and the placebo group
two catheters from the On-Q Pain Buster device were tunnelled
parasternally and the device filled with either 0.5% ropivacaine
(ropivacaine group) or normal saline (placebo group) with continuous
infusion at fixed rate of 4 mL/h for 96 hours for both. Usual care group
did not receive a device. All groups had patient-controlled analgesia and
or oral analgesia. Outcome measures: Walking distance on postoperative
days (POD) 1 to 4, pain scores using 10 cm visual analogue scale (VAS)
before and after morning and afternoon physiotherapy sessions each day,
and the proportion of patients discharged from physiotherapy on POD 4.
Analysis: Repeated measures ANOVA and Chi square for proportions were
used. Results: Seventy-five participants with mean age 60 (SD 11) years
were randomised into ropivacaine group (n = 26), placebo group (n = 25),
and control group (n = 24). There were no significant differences in
distance walked or pain scores on any post-operative day between groups.
46% of patients in ropivacaine group were discharged from physiotherapy on
POD4, 32% in placebo and 33% in usual care with no significant differences
between groups. Group as a whole (n = 72) showed walking distance
increased from 1 meter on POD1 to 183 meters on POD4; and linear reduction
in pain score from 42 millimetres on POD1 to 15 millimetres on POD4, p <
0.001 for both. The VAS pain scores were significantly higher after
physiotherapy sessions, p<0.001. The difference in mean VAS pain score
before and after physiotherapy sessions decreased linearly across days, p
< 0.01. Conclusion(s): Infusion of ropivacaine post CABG surgery did not
increase distance walked, reduce pain after physiotherapy sessions or
increase number of patients discharged from physiotherapy by POD4 compared
to placebo or control. Implications: Current pain management of CABG is as
effective as continuous local anaesthetic infusion in subpectoral
position. Pain relief should be considered prior to physiotherapy
sessions.

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EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Your autoalert was checked against the latest changes but no relevant documents were found.
Total documents retrieved: 0

Results Generated From:
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Embase (updates since 2015-12-17)



Set Search Results
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