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<1>
Accession Number
26730878
Author
Anderson L.; Thompson D.R.; Oldridge N.; Zwisler A.-D.; Rees K.; Martin
N.; Taylor R.S.
Institution
(Anderson, Thompson, Oldridge, Zwisler, Rees, Martin, Taylor) Institute of
Health Research, University of Exeter Medical School, Veysey Building,
Salmon Pool Lane, Exeter, UK, EX2 4SG
Title
Exercise-based cardiac rehabilitation for coronary heart disease.
Source
The Cochrane database of systematic reviews. 1 (pp CD001800), 2016. Date
of Publication: 2016.
Abstract
BACKGROUND: Coronary heart disease (CHD) is the single most common cause
of death globally. However, with falling CHD mortality rates, an
increasing number of people live with CHD and may need support to manage
their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR)
aims to improve the health and outcomes of people with CHD. This is an
update of a Cochrane systematic review previously published in 2011.
OBJECTIVES: To assess the effectiveness and cost-effectiveness of
exercise-based CR (exercise training alone or in combination with
psychosocial or educational interventions) compared with usual care on
mortality, morbidity and HRQL in patients with CHD.To explore the
potential study level predictors of the effectiveness of exercise-based CR
in patients with CHD.
SEARCH METHODS: We updated searches from the previous Cochrane review, by
searching Cochrane Central Register of Controlled Trials (CENTRAL) (The
Cochrane Library, Issue 6, 2014) from December 2009 to July 2014. We also
searched MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Science
Citation Index Expanded (December 2009 to July 2014).
SELECTION CRITERIA: We included randomised controlled trials (RCTs) of
exercise-based interventions with at least six months' follow-up, compared
with a no exercise control. The study population comprised men and women
of all ages who have had a myocardial infarction (MI), coronary artery
bypass graft (CABG) or percutaneous coronary intervention (PCI), or who
have angina pectoris, or coronary artery disease. We included RCTs that
reported at least one of the following outcomes: mortality, MI,
revascularisations, hospitalisations, health-related quality of life
(HRQL), or costs.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened
all identified references for inclusion based on the above inclusion and
exclusion criteria. One author extracted data from the included trials and
assessed their risk of bias; a second review author checked data. We
stratified meta-analysis by the duration of follow up of trials, i.e.
short-term: 6 to 12 months, medium-term: 13 to 36 months, and long-term: >
3 years.
MAIN RESULTS: This review included 63 trials which randomised 14,486
people with CHD. This latest update identified 16 new trials (3872
participants). The population included predominantly post-MI and
post-revascularisation patients and the mean age of patients within the
trials ranged from 47.5 to 71.0 years. Women accounted for fewer than 15%
of the patients recruited. Overall trial reporting was poor, although
there was evidence of an improvement in quality of reporting in more
recent trials.As we found no significant difference in the impact of
exercise-based CR on clinical outcomes across follow-up, we focused on
reporting findings pooled across all trials at their longest follow-up
(median 12 months). Exercise-based CR reduced cardiovascular mortality
compared with no exercise control (27 trials; risk ratio (RR) 0.74, 95% CI
0.64 to 0.86). There was no reduction in total mortality with CR (47
trials, RR 0.96, 95% CI 0.88 to 1.04). The overall risk of hospital
admissions was reduced with CR (15 trials; RR 0.82, 95% CI 0.70 to 0.96)
but there was no significant impact on the risk of MI (36 trials; RR 0.90,
95% CI 0.79 to 1.04), CABG (29 trials; RR 0.96, 95% CI 0.80 to 1.16) or
PCI (18 trials; RR 0.85, 95% CI 0.70 to 1.04).There was little evidence of
statistical heterogeneity across trials for all event outcomes, and there
was evidence of small study bias for MI and hospitalisation, but no other
outcome. Predictors of clinical outcomes were examined across the longest
follow-up of studies using univariate meta-regression. Results show that
benefits in outcomes were independent of participants' CHD case mix
(proportion of patients with MI), type of CR (exercise only vs
comprehensive rehabilitation) dose of exercise, length of follow-up, trial
publication date, setting (centre vs home-based), study location
(continent), sample size or risk of bias.Given the heterogeneity in
outcome measures and reporting methods, meta-analysis was not undertaken
for HRQL. In five out of 20 trials reporting HRQL using validated
measures, there was evidence of significant improvement in most or all of
the sub-scales with exercise-based CR compared to control at follow-up.
Four trial-based economic evaluation studies indicated exercise-based CR
to be a potentially cost-effective use of resources in terms of gain in
quality-adjusted life years.The quality of the evidence for outcomes
reported in the review was rated using the GRADE method. The quality of
the evidence varied widely by outcome and ranged from low to moderate.
AUTHORS' CONCLUSIONS: This updated Cochrane review supports the
conclusions of the previous version of this review that, compared with no
exercise control, exercise-based CR reduces the risk of cardiovascular
mortality but not total mortality. We saw a significant reduction in the
risk of hospitalisation with CR but not in the risk of MI or
revascularisation. We identified further evidence supporting improved HRQL
with exercise-based CR. More recent trials were more likely to be well
reported and include older and female patients. However, the population
studied in this review still consists predominantly of lower risk
individuals following MI or revascularisation. Further well conducted RCTs
are needed to assess the impact of exercise-based CR in higher risk CHD
groups and also those presenting with stable angina. These trials should
include validated HRQL outcome measures, explicitly report clinical event
outcomes including mortality and hospital admissions, and assess costs and
cost-effectiveness.

<2>
Accession Number
26639040
Author
Kondur A.; Briasoulis A.; Palla M.; Penumetcha A.; Mallikethi-Reddy S.;
Badheka A.; Schreiber T.
Institution
(Kondur) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan
(Briasoulis) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan. Electronic address:
alexbriasoulis@gmail.com
(Palla) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan
(Penumetcha) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan
(Mallikethi-Reddy) Department of Cardiology, Detroit Medical Center, Wayne
State University, Detroit, Michigan
(Badheka) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan
(Schreiber) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, Michigan
Title
Meta-Analysis of Transcatheter Aortic Valve Replacement Versus Surgical
Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis.
Source
The American journal of cardiology. 117 (2) (pp 252-257), 2016. Date of
Publication: 15 Jan 2016.
Abstract
Transcatheter aortic valve replacement (TAVR) is a viable option in the
treatment of severe aortic stenosis in patients at high risk for surgery.
We sought to further investigate outcomes in patients at low to
intermediate risk with aortic stenosis who underwent surgical aortic valve
replacement (SAVR) versus TAVR. We systematically searched the electronic
databases, MEDLINE, PubMed, EMBASE, and Cochrane for prospective cohort
studies of the effects of TAVR versus SAVR on clinical outcomes (30-day
mortality, all-cause mortality, stroke and myocardial infarction, major
vascular complications, paravalvular regurgitation, permanent pacemaker
implantation, major bleeding, and acute kidney injury). We identified 5
clinical studies, examining 1,618 patients in the TAVR group and 1,581
patients in the SAVR group with an average follow-up of 1.05 years. No
difference in all-cause mortality, stroke, and myocardial infarction
between the 2 approaches was found. TAVR was associated with higher rates
of vascular complications, permanent pacemaker implantation, and moderate
or severe paravalvular regurgitation (p <0.001 for all), whereas more
major bleeding events were seen in the SAVR group (p <0.001). In
conclusion, TAVR was found to have similar survival and stroke rates and
lower major bleeding rates as compared with SAVR in patients at low or
intermediate surgical risk. However, SAVR was associated with less
pacemaker placements and paravalvular regurgitation rates.

<3>
Accession Number
26651454
Author
Giannini C.; Fiorelli F.; De Carlo M.; Guarracino F.; Faggioni M.;
Giordano P.; Spontoni P.; Pieroni A.; Petronio A.S.
Institution
(Giannini) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address:
crigiannini@hotmail.it
(Fiorelli) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(De Carlo) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Guarracino) Department of Anaesthesia and Critical Care Medicine, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Faggioni) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Giordano) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Spontoni) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Pieroni) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Petronio) Cardiac Thoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
Title
Comparison of Percutaneous Mitral Valve Repair Versus Conservative
Treatment in Severe Functional Mitral Regurgitation.
Source
The American journal of cardiology. 117 (2) (pp 271-277), 2016. Date of
Publication: 15 Jan 2016.
Abstract
Percutaneous mitral valve repair (PMVR) using the MitraClip System is
feasible and entails clinical improvement even in patients with high
surgical risk and severe functional mitral regurgitation (MR). The aim of
this study was to assess survival rates and clinical outcome of patients
with severe, functional MR treated with optimal medical therapy (OMT)
compared with those who received MitraClip device. Sixty patients treated
with OMT were compared with a propensity-matched cohort of 60 patients who
underwent PMVR. Baseline demographics and echocardiographic variables were
similar between the 2 groups. The mean age of patients was 75 years, and
67% were men. The median logistic EuroSCORE and EuroSCORE II were 17% and
6%, respectively, because of the presence of several co-morbidities. The
mechanism of MR was functional in all cases with an ischemic etiology in
52% of patients. Median left ventricle ejection fraction was 34%. All the
patients were symptomatic for dyspnea with 63% and 12% in the New York
Heart Association class III and IV, respectively. In PMVR group, the
procedure was associated with safety and very low incidence of procedural
complications with no occurrence of procedural and inhospital mortality.
After a median follow-up of 515 days (248 to 828 days), patients treated
with PMVR demonstrated overall survival, survival freedom from cardiac
death and survival free of readmission due to cardiac disease curves
higher than patients treated conservatively (log-rank test p = 0.007, p =
0.002, and p = 0.04, respectively). In conclusion, PMVR offers a valid
option for selected patients with high surgical risk and severe,
functional MR and entails better survival outcomes compared with OMT.

<4>
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Accession Number
20160333463
Author
Elgendy I.Y.; Mahmoud A.N.; Elgendy A.Y.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Elgendy, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
Title
Outcomes with intravascular ultrasound-guided stent implantation.
Source
Circulation: Cardiovascular Interventions. 9 (4) (no pagination), 2016.
Article Number: e003700. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - In the era of drug-eluting stents, it is unknown if
intravascular ultrasound (IVUS) guidance for percutaneous coronary
intervention should be routinely endorsed. This study aimed to determine
if IVUS-guided stent implantation is associated with improved outcomes.
Methods and Results - Randomized trials that reported clinical outcomes
and compared routine IVUS-guided stent implantation with an
angiography-guided approach in the era of drug-eluting stents were
included. Summary estimates were constructed primarily using the Peto
model. Seven trials with 3192 patients were analyzed. The mean length of
the coronary lesions was 32 mm. At a mean of 15 months, routine
IVUS-guided percutaneous coronary intervention was associated with a
reduction in the risk of major adverse cardiac events (6.5% versus 10.3%;
odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly
because of reduction in the risk of ischemia-driven target lesion
revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence
interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5%
versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00;
P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95%
confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the
IVUS-guided group. Conclusions - In the era of drug-eluting stents for
diffuse coronary lesions, IVUS-guided percutaneous coronary intervention
is superior to angiography-guided percutaneous coronary intervention in
reducing the risk of major adverse cardiac events. This is primarily
because of reduction in the risk of ischemia-driven target lesion
revascularization. This analysis also suggests that risk of cardiovascular
mortality and stent thrombosis might be lower with an IVUS-guided
approach.

<5>
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Accession Number
20160332544
Author
Santos A.B.S.; Roca G.Q.; Claggett B.; Sweitzer N.K.; Shah S.J.; Anand
I.S.; Fang J.C.; Zile M.R.; Pitt B.; Solomon S.D.; Shah A.M.
Institution
(Santos, Roca, Claggett, Solomon, Shah) Cardiovascular Division, Brigham
and Women's Hospital, Boston, MA, United States
(Santos) Cardiology Division, Hospital de Clinicas de Porto Alegre,
Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
(Sweitzer) Division of Cardiovascular Medicine, Sarver Heart Center,
University of Arizona, Tucson, AZ, United States
(Shah) Cardiology Division, Northwestern University Feinberg, School of
Medicine, Chicago, IL, United States
(Anand) Cardiovascular Division, VA Medical Center, Minneapolis, MN,
United States
(Fang) Cardiology Division, University of Utah, School of Medicine, Salt
Lake City, UT, United States
(Zile) RHJ Department, Veterans Affairs Medical Center, Medical University
of South Carolina, Charleston, SC, United States
(Pitt) Cardiology Division, University of Michigan, School of Medicine,
Ann Arbor, MI, United States
Title
Prognostic relevance of left atrial dysfunction in heart failure with
preserved ejection fraction.
Source
Circulation: Heart Failure. 9 (4) (no pagination), 2016. Article Number:
e002763. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Left atrial (LA) size is an established marker of risk for
adverse outcomes in heart failure with preserved ejection fraction
(HFpEF). However, the independent prognostic importance of LA function in
HFpEF is not known. Methods and Results - We assessed LA function measured
by speckle-tracking echocardiography in 357 patients with HFpEF enrolled
in the Treatment Of Preserved Cardiac Function Heart Failure With an
Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time
of echocardiography. Lower peak LA strain, indicating LA dysfunction, was
associated with older age, higher prevalence of atrial fibrillation and
left ventricular (LV) hypertrophy, worse LV and right ventricular systolic
function, and worse LV diastolic function. At a mean follow-up of 31
months (interquartile range, 18-43months), 91 patients (25.5%) experienced
the primary composite end point of cardiovascular death, HF
hospitalization, and aborted sudden death. Lower peak LA strain was
associated with a higher risk of the composite end point (hazard ratio,
0.96 per unit of reduction in strain; 95% confidence interval, 0.94-0.99;
P=0.009) and of HF hospitalization alone (hazard ratio, 0.95 per unit of
reduction in strain; 95% confidence interval, 0.92-0.98; P=0.003). The
association of LA strain with incident HF hospitalization remained
significant after adjustment for clinical confounders, but not after
further adjustment for LV global longitudinal strain and the E/E' ratio,
parameters of LV systolic and diastolic function, respectively.
Conclusions - LA dysfunction in HFpEF is associated with a higher risk of
HF hospitalization independent of potential clinical confounders, but not
independent of LV strain and filling pressure. Impairment in LV systolic
and diastolic function largely explains the association between impaired
LA function and higher risk of HF hospitalization in HFpEF.

<6>
Accession Number
20160356913
Author
Barbero U.; Iannaccone M.; D'Ascenzo F.; Barbero C.; Mohamed A.; Annone
U.; Benedetto S.; Celentani D.; Gagliardi M.; Moretti C.; Gaita F.
Institution
(Barbero, Iannaccone, D'Ascenzo, Mohamed, Annone, Benedetto, Celentani,
Gagliardi, Moretti, Gaita) Cardiology Department, Citta Della Salute,
Scienza Hospital, Turin, Italy
(Barbero) Cardiac Surgery Department, Citta Della Salute, Scienza
Hospital, Turin, Italy
Title
64 slice-coronary computed tomography sensitivity and specificity in the
evaluation of coronary artery bypass graft stenosis: A meta-analysis.
Source
International Journal of Cardiology. 216 (pp 52-57), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
A non-invasive approach to define grafts patency and stenosis in the
follow-up of coronary artery bypass graft (CABG) patients may be an
interesting alternative to coronary angiography. 64-slice-coronary
computed tomography is nowadays a diffused non-invasive method that
permits an accurate evaluation of coronary stenosis, due to a high
temporal and spatial resolution. However, its sensitivity and specificity
in CABG evaluation has to be clearly defined, since published studies used
different protocols and scanners. We collected all studies investigating
patients with stable symptoms and previous CABG and reporting the
comparison between diagnostic performances of invasive coronary
angiography and 64-slice-coronary computed tomography. As a result,
sensitivity and specificity of 64-slice-coronary computed tomography for
CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00)
with an area under the curve (AUC) of 0.99. 64-slice-coronary computed
tomography sensitivity and specificity for the presence of any CABG
stenosis > 50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98),
while AUC was 0.99. At meta-regression, neither the age nor the time from
graft implantation had effect on sensitivity and specificity of
64-slice-coronary computed tomography detection of significant CABG
stenosis or occlusion. In conclusion 64-slice-coronary computed tomography
confirmed its high sensitivity and specificity in CABG stenosis or
occlusion evaluation.

<7>
Accession Number
20160351567
Author
Anantha Narayanan M.; Sundaram V.; Reddy Y.N.V.; Baskaran J.; Agnihotri
K.; Badheka A.; Patel N.; Deshmukh A.
Institution
(Anantha Narayanan) Department of Internal Medicine, Creighton University,
School of Medicine, Omaha, NE, United States
(Reddy, Deshmukh) Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Sundaram) Division of Cardiovascular Diseases, University Hospitals, Case
Medical Center, Cleveland, OH, United States
(Reddy) Department of Internal Medicine, Boston University, Medical
Center, Boston, MA, United States
(Baskaran) Sri Venkateshwaraa Medical College Hospital and Research
Center, Puducherry, India
(Agnihotri) Department of Internal Medicine, Saint Peters University
Hospital, New Brunswick, NJ, United States
(Badheka) Department of Cardiology, Everett Clinic, Everett, WA, United
States
(Patel) Department of Cardiology, University of Miami, Miller School of
Medicine, Miami, FL, United States
Title
What is the optimal approach to a non- culprit stenosis after ST-elevation
myocardial infarction - Conservative therapy or upfront revascularization?
An updated meta-analysis of randomized trials.
Source
International Journal of Cardiology. 216 (pp 18-24), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Non-culprit percutaneous coronary intervention (PCI) during a
ST-segment elevation myocardial infarction (STEMI) remains controversial.
We performed a meta-analysis of the published literature comparing a
strategy of complete revascularization (CR) with culprit or target vessel
revascularization (TVR)-only after STEMI in patients with multi-vessel
disease. Methods We searched PubMed/Medline, Cochrane, EMBASE, Web of
Science, CINAHL, Scopus and Google-scholar databases from inception to
March-2016 for clinical trials comparing CR with TVR during PCI for STEMI.
Mantel-Haenszel risk ratio (MH-RR) with 95% confidence intervals (CI) for
individual outcomes was calculated using random-effects model. Results A
total of 7 randomized trials with 2004 patients were included in the final
analysis. Mean follow-up was 25.4 months. Major adverse cardiac events
(MACE) (MH-RR: 0.58, 95% CI: 0.43-0.78, P < 0.001), cardiac deaths (MH-RR:
0.42, 95% CI: 0.24-0.74, P = 0.003) and repeat revascularization (MH-RR:
0.36, 95% CI: 0.27-0.48, P < 0.001) were much lower in the CR group when
compared to TVR. However, there was no significant difference in the risk
of all-cause mortality (0.84, 95% CI: 0.57-1.25, P = 0.394) or recurrent
MI (MH-RR: 0.66, 95% CI: 0.34-1.26, P = 0.205) between the two groups. CR
appeared to be safe with no significant increase in adverse events
including stroke rates (MH-RR: 2.19, 95% CI: 0.59-8.12, P = 0.241),
contrast induced nephropathy (MH-RR: 0.73, 95% CI: 0.34-1.57, P = 0.423)
or major bleeding episodes (MH-RR: 0.72, 95% CI: 0.34-1.54, P = 0.399).
Conclusions CR strategy in STEMI patients with multivessel coronary artery
disease is associated with reduction in MACE, cardiac mortality and need
for repeat revascularization but with no decrease in the risk of
subsequent MI or all-cause mortality. CR was safe however, with no
increase in adverse events including stroke, stent thrombosis or contrast
nephropathy when compared to TVR.

<8>
Accession Number
20160335043
Author
Rasmussen L.A.; Ryhammer P.K.; Greisen J.; Bhavsar R.R.; Lorentzen A.-G.;
Jakobsen C.-J.
Institution
(Rasmussen, Ryhammer, Greisen, Bhavsar, Lorentzen, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle
Juel-Jensens Boulevard 99, Aarhus, N 8200, Denmark
Title
Ultrashort acting remifentanil is not superior to long-acting sufentanil
in preserving cognitive function - A randomized study.
Source
Journal of Clinical Anesthesia. 33 (pp 127-134), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc.
Abstract
Study objective Postoperative cognitive dysfunction (POCD) is a well-known
complication after cardiac surgery and may cause permanent disabilities
with severe consequences for quality of life. The objectives of this study
were, first, to estimate the frequency of POCD after on-pump cardiac
surgery in patients randomized to remifentanil- or sufentanil-based
anesthesia and, second, to evaluate the association between POCD and
quality of recovery and perioperative hemodynamics, respectively. Design
Randomized study. Setting Postoperative cardiac recovery unit, University
Hospital. Patients Sixty patients with ischemic heart disease scheduled
for elective coronary artery bypass grafting +/- aortic valve replacement.
Interventions and handling Randomized to either remifentanil or sufentanil
anesthesia as basis opioid. Postoperative pain management consisted of
morphine in both groups. Measurements Cognitive functioning evaluated
preoperatively and on the 1st, 4th, and 30th postoperative day using the
cognitive test from the Palo Alto Veterans Affairs Hospital. Perioperative
invasive hemodynamics and the quality of recovery was evaluated by means
of invasive measurements and an intensive care unit discharge score. Main
results No difference between opioids in POCD at any time. A negative
correlation was found between preoperative cognitive function and POCD on
the first postoperative day (r = - 0.47; P =.0002). The fraction of
patients with POCD on the first postoperative day was statistically
greater in patients with more than 15 minutes of Svo<inf>2</inf> < 60 (P
=.037; chi² test). Among patients with postoperative
ventilation time exceeding 300 minutes, more patients had POCD on
postoperative day 4 (P =.002). Conclusions We could not demonstrate
differences in POCD between remifentanil and sufentanil based anaesthesia,
but in general, the fraction of patients with POCD seemed smaller than
previously reported. We found an association between POCD and both
perioperative low Svo<inf>2</inf> and postoperative ventilation time,
underlining the importance of perioperative stable hemodynamics and
possible fast-track protocols with short ventilation times to attenuate
POCD.

<9>
Accession Number
20160328811
Author
Cao C.; Liou K.P.; Pathan F.K.; Virk S.; McMonnies R.; Wolfenden H.;
Indraratna P.
Institution
(Cao, Virk, McMonnies, Indraratna) The Systematic Reviews Unit, The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Cao, Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: Meta-analysis of clinical outcomes and cost-effectiveness.
Source
Current Pharmaceutical Design. 22 (13) (pp 1965-1977), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objective: Transcatheter aortic valve implantation (TAVI) has emerged as a
feasible alternative treatment to conventional surgical aortic valve
replacement (AVR) for high-risk patients with aortic stenosis. The present
systematic review aimed to assess the comparative clinical and
cost-effectiveness outcomes of TAVI versus AVR, and meta-analyse
standardized clinical endpoints. Methods: An electronic search was
conducted on 9 online databases to identify all relevant studies. Eligible
studies had to report on either periprocedural mortality or incremental
cost-effectiveness ratio (ICER) to be included for analysis. Results: The
systematic review identified 24 studies that reported on comparative
clinical outcomes, including three randomized controlled trials and ten
matched observational studies involving 7906 patients. Meta-analysis
demonstrated no significant differences in regards to mortality, stroke,
myocardial infarction or acute renal failure. Patients who underwent TAVI
were more likely to experience major vascular complications or arrhythmias
requiring permanent pacemaker insertion. Patients who underwent AVR were
more likely to experience major bleeding. Eleven analyses from 7 economic
studies reported on ICER. Six analyses defined TAVI to be low value, 2
analyses defined TAVI to be intermediate value, and three analyses defined
TAVI to be high value. Conclusion: The present study demonstrated no
significant differences in regards to mortality or stroke between the two
therapeutic procedures. However, the cost-effectiveness and long-term
efficacy of TAVI may require further investigation. Technological
improvement and increased experience may broaden the clinical indication
for TAVI for low-intermediate risk patients in the future.

<10>
Accession Number
20160328804
Author
Vavuranakis M.; Kolokathis A.-M.; Vrachatis D.A.; Kalogeras K.; Magkoutis
N.A.; Fradi S.; Ghostine S.; Karamanou M.; Tousoulis D.
Institution
(Vavuranakis, Kolokathis, Vrachatis, Kalogeras, Tousoulis) 1st Department
of Cardiology, Hippokration Hospital, National & Kapodistrian University
of Athens, Greece
(Vavuranakis) Department of Cardiovascular Medicine, Ohio State
University, Columbus, OH, United States
(Magkoutis, Fradi, Ghostine) Department of Cardiology, Chirurgical Center
Marie Lannelongue, Le Plessis-Robinson, France
(Karamanou) University Institute of History of Medicine and Public Health,
Lausanne, Switzerland
Title
Atrial fibrillation during or after TAVI: Incidence, implications and
therapeutical considerations.
Source
Current Pharmaceutical Design. 22 (13) (pp 1896-1903), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Aortic stenosis is one of the most frequent valvulopathy of modern time
necessitating interventional therapy when symptoms arise and stenosis
becomes severe. First line treatment has traditionally been surgical
aortic valve replacement (SAVR). However in the last decade transcatheter
aortic valve implantation (TAVI) with bioprosthetic valves has proved to
be a sound solution for high-risk for SAVR or inoperable patients. As
expected implantation of the bioprosthetic device requires administration
of antiplatelet regimen to the patients for a certain period. Atrial
fibrillation (AF) may occur frequently during the peri-procedural period.
In this background, the occurrence of AF after device implantation may be
a challenging issue. Methods: We performed a literature search of PubMed
and Embase database. Published articles reporting the incidence, clinical
implications and description of antithrombotic regimen of New-onset atrial
fibrillation (NOAF) in individuals undergoing TAVI were considered
eligible. Incidence, Implications and Antithrombotic Regimen: The overall
occurrence of NOAF is reported to be 1%-32% after TAVI. Left atrial
enlargement and transapical approach constitute independent predictors for
NOAF. Additionally it has been shown that patients with AF face an
increased risk of death irrespective of the type of AF. Patients, with a
history of AF, present greater rate of death than individuals with NOAF.
NOAF is responsible for cerebrovascular events (CVE) occurring in the
subacute phase (days 1-30) after the procedure. The risk of
stroke/transient ischemic attack after TAVI is increased at least two fold
by the presence of atrial fibrillation. Empirically, a dual antiplatelet
strategy has been used for patients undergoing TAVR, including aspirin and
a thienopyridine. In cases where patients are in need of oral
anticoagulation after TAVI a combination of aspirin or thienopyridine with
acenocoumarol has been the preferred regimen. Discussion: Despite the
continuously crescent use of TAVI for patients with symptomatic severe
aortic stenosis, there are still many aspects of this procedure to be
clarified. A lack of data exists from the available clinical trials
regarding the appropriate anticoagulation therapy for patients with
greater risk for thromboembolic events. As a result, patient's treatment
remains at the discretion of the physician. Conclusion: Limited data are
available regarding the optimal therapeutic regimen in patients undergoing
TAVI who need therapy for AF. Carefully designed clinical studies might
further clarify the incidence and interrelation between atrial
fibrillation and TAVI. The balance between the efficacy and risk of
anticoagulation needs to be further clarified in patients undergoing TAVI.

<11>
Accession Number
20160328801
Author
Maas E.H.A.; Pieters B.M.A.; Van de Velde M.; Rex S.
Institution
(Maas, Pieters) Department of Anesthesiology, University Hospitals Leuven,
Belgium
(Van de Velde) Department of Anesthesiology, University Hospitals Leuven,
Belgium
(Van de Velde) Department of Cardiovascular Sciences, KU Leuven, Belgium
(Rex) Department of Anesthesiology University, Hospitals Leuven, Belgium
(Rex) Department of Cardiovascular Sciences, KU Leuven-University of
Leuven, Belgium
Title
General or local anesthesia for TAVI? A systematic review of the
literature and meta-analysis.
Source
Current Pharmaceutical Design. 22 (13) (pp 1868-1878), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is becoming a
valuable alternative to surgical aortic valve replacement in patients with
severe aortic stenosis that are at high surgical risk or deemed
inoperable. The optimal anesthesia technique for TAVI is still undecided.
We performed a systematic review and metaanalysis to compare the safety of
locoregional anesthesia (LRA) with or without conscious sedation and
general anesthesia (GA) for the TAVI-procedure. Methods: We searched
PUBMED, MEDLINE, EMBASE and the Cochrane central register of controlled
trials from January 1^st 2002 to February 15^th 2015.
The primary outcome parameters searched were 30-days mortality, hospital
length of stay, procedure time, use of adrenergic support, stroke rate,
incidence of myocardial infarction, incidence of acute kidney injury, rate
of procedural succes. Results: Ten studies, including 5919 patients,
fulfilled the inclusion criteria. None of these studies was randomized
resulting in a considerable risk of bias. The choice for a specific
anesthesia technique did neither affect the average 30-day mortality rate
[RR 0.91 (95% CI: 0.53 to 1.56), p=0.72] nor a wide variety of safety
endpoints. LRA for TAVI was associated with a significantly shorter
procedure time when compared to GA, and a reduction in hospital length of
stay. However, LRA significantly increased the risk for implantation of a
permanent pacemaker (RR 1.23, p=0.02) and for paravalvular leakage (RR
1.31, p=0.006.). Conclusion: Neither mortality nor the incidence of major
adverse cardiac and cerebrovascular events after TAVI is affected by the
choice for either LRA or GA.

<12>
Accession Number
20160354189
Author
Huang H.; Li Y.; Sun M.
Institution
(Huang, Li) Department of Cardiology, Sir Run Run Shaw Hospital, Medical
College of Zhejiang University, Hangzhou, Zhejiang, China
(Sun) Department of Gynecology, Women's Hospital, Medical College of
Zhejiang University, Hangzhou, Zhejiang, China
Title
Shorter (<6 months) vs. longer (>12 months) dual antiplatelet therapy
after second-generation drug-eluting stents implantation: A meta-analysis
of randomized controlled trials.
Source
European Heart Journal, Supplement. 18 (pp A54-A62), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Oxford University Press
Abstract
Optimal duration of dual antiplatelet therapy (DAPT) after
second-generation drug-eluting stent (DES) remains unknown. We performed a
meta-analysis to evaluate the efficacy and safety of <6-month vs.
>12-month DAPT after implantation of second-generation DES in order to
estimate the optimal duration of DAPT. We conducted a literature search
for randomized control trials (RCTs) in popular databases including
EMBASE, PubMed, the Cochrane Library, and Scopus. Independent
investigators abstracted the data on outcomes, characteristics, and
qualities of trials included. A fixed-effect model was adopted to pool
odds ratios with 95% confidence intervals of the clinical outcomes
concerned when I²< 25% or P > 0.05, a random-effect model was
applied in other cases. Five published RCTs involving 8407 patients were
included in our analysis. There was no significant difference in definite
or probable stent thrombosis, myocardial infarction, stroke, target vessel
revascularization, all-cause death, and cardiac death between the shorter
duration and the longer duration of DAPT. Moreover, no significant
difference was observed in the incidences of major bleeding and any
bleeding. None of the clinical outcomes differed in patients receiving
everolimus-eluting stent or zotarolimus-eluting stent across DAPT groups.
Shorter DAPT (<6 months) after the second-generation DES implantation has
no increased risks of adverse cardiac and cerebral events compared with
longer DAPT (>12 months). In addition, longer DAPT does not increase
bleeding complications when compared with shorter duration. Published on
behalf of the European Society of Cardiology. All rights reserved.

<13>
Accession Number
20160351944
Author
Ling X.-M.; Fang F.; Zhang X.-G.; Ding M.; Liu Q.-A.-X.; Cang J.
Institution
(Ling, Fang, Zhang, Ding, Liu, Cang) Department of Anesthesiology,
Zhongshan Hospital, Fudan University, Shanghai 200032, China
Title
Effect of parecoxib combined with thoracic epidural analgesia on pain
after thoracotomy.
Source
Journal of Thoracic Disease. 8 (5) (pp 880-887), 2016. Date of
Publication: 01 May 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: Thoracotomy results in severe postoperative pain potentially
leading to chronic pain. We investigated the potential benefits of
intravenous parecoxib on postoperative analgesia combined with thoracic
epidural analgesia (TEA). Methods: Eighty-six patients undergoing thoracic
surgery were randomized into two groups. Patientcontrolled epidural
analgesia (PCEA) was used until chest tubes were removed. Patients
received parecoxib (group P) or placebo (group C) intravenously just 0.5 h
before the operation and every 12 h after operation for 3 days. The
intensity of pain was measured by using a visual analogue scale (VAS) and
recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of
PCA, the side effects and the overall satisfaction to analgesic therapy in
72 h were recorded. Venous blood samples were taken before operation, the
1^st and 3^rd day after operation for plasma cortisol,
adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis
factor-alpha level. The occurrence of residual pain was recorded using
telephone questionnaire 2 and 12 months after surgery. Results:
Postoperative pain scores at rest and on coughing were significantly lower
with the less valid count of PCA and greater patient satisfaction in group
P (P < 0.01). Adverse effect and the days fit for discharge were
comparable between two groups. The cortisol levels in placebo group were
higher than parecoxib group at T2. The level of ACTH both decreased in two
groups after operation but it was significantly lower in group P than that
in group C. There were no changes in plasma IL-6 and TNF-alpha levels
before and after analgesia at T<inf>1</inf> and T<inf>2</inf> (P > 0.05).
The occurrence of residual pain were 25% and 51.2% separately in group P
and C 3 months postoperatively (P < 0.05). Conclusions: Intravenous
parecoxib in multimodal analgesia improves postoperative analgesia
provided by TEA, relieves stress response after thoracotomy, and may
restrain the development of chronic pain.

<14>
Accession Number
20160351931
Author
Phan K.; Zhao D.F.; Zhou J.J.; Karagaratnam A.; Phan S.; Yan T.D.
Institution
(Phan, Zhou, Karagaratnam, Phan, Yan) The Collaborative Research (CORE)
Group, Macquarie University, Sydney, NSW, Australia
(Phan, Zhao, Phan, Yan) The University of Sydney, Sydney, NSW, Australia
Title
Bioprosthetic versus mechanical prostheses for valve replacement in
end-stage renal disease patients: Systematic review and metaanalysis.
Source
Journal of Thoracic Disease. 8 (5) (pp 769-777), 2016. Date of
Publication: 01 May 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: Patients with end-stage renal disease (ESRD) indicated for
dialysis are increasingly requiring cardiac valve surgery. The choice of
bioprosthetic or mechanic valve prosthesis for such patients requires
careful risk assessment. A systematic review and meta-analysis was
performed to assess current evidence available. Methods: A comprehensive
search from six electronic databases was performed from their inception to
February 2015. Results from patients with ESRD undergoing cardiac surgery
for bioprosthetic or mechanical valve replacement were identified.
Results: Sixteen studies with 8,483 patients with ESRD undergoing cardiac
valve replacement surgery were included. No evidence of publication bias
was detected. Prior angioplasty by percutaneous coronary intervention
(PCI) or coronary artery bypass graft (CABG) surgery was significantly
higher in the bioprosthetic group compared to the mechanical group (16.0%
vs. 12.0%, P=0.04); all other preoperative baseline patient
characteristics were similar. There was no significant difference in
30-day mortality or allcause mortality between the two comparisons.
Compared with the mechanical group, the frequency of bleeding (5.2% vs.
6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were
significantly lower in the bioprosthetic group. There were similar rates
of reoperation and valve endocarditis. Conclusions: The present study
demonstrated that patients with ESRD undergoing bioprosthetic or
mechanical valve replacement had similar mid-long term survival. The
bioprosthetic group had lower rates of bleeding and thromboembolism.
Further studies are required to differentiate the impact of valve
location. The presented results may be applicable for ESRD patients
requiring prosthetic valve replacement.

<15>
Accession Number
20160350366
Author
Dunne B.; Murphy M.; Skiba R.; Wang X.; Ho K.; Larbalestier R.; Merry C.
Institution
(Dunne, Murphy, Skiba, Wang, Ho, Larbalestier, Merry) Department of
Cardiothoracic Surgery, Western Australian Cardiothoracic Research and
Audit Group, Fiona Stanley Hospital, Perth, WA 6145, Australia
Title
Sternal cables are not superior to traditional sternal wiring for
preventing deep sternal wound infection.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (5) (pp 594-598),
2016. Date of Publication: 01 May 2016.
Publisher
Oxford University Press
Abstract
OBJECTIVES Deep sternal wound infection is a devastating complication of
cardiac surgery. In the current era of increasing patient comorbidity,
newer techniques must be evaluated in attempts to reduce the rates of deep
sternal wound infection. METHODS A randomized controlled trial comparing
sternal closure with traditional sternal wires in figure-8 formation with
the Pioneer cabling system from Medigroup after adult cardiac surgery was
performed. RESULTS A total of 273 patients were enrolled with 137 and 135
patients randomized to sternal wires and cables group, respectively.
Baseline characteristics between the two groups were well balanced. Deep
sternal wound infection occurred in 0.7% of patients in the wires group
and 3.7% of patients in the cables group (absolute risk difference =
-3.0%, 95% confidence interval: -7.7 to 0.9%; P = 0.12). Patients in the
cables group were extubated slightly earlier than those in the sternal
wires group postoperatively (9.7 vs 12.8 h; P = 0.03). There was, however,
no significant difference in hospital and follow-up pain scores or
analgesia requirements. CONCLUSIONS The Pioneer sternal cabling system
appears to facilitate early extubation after adult cardiac surgery, but it
does not reduce the rate of deep sternal infection Australian.

<16>
Accession Number
20160350346
Author
Mimic B.; Ilic S.; Vulicevic I.; Milovanovic V.; Tomic D.; Mimic A.;
Stankovic S.; Zecevic T.; Davies B.; Djordjevic M.
Institution
(Mimic, Ilic, Vulicevic, Milovanovic, Tomic, Zecevic) Department of
Cardiac Surgery, University Children's Hospital, Tirsova 10, Belgrade
11000, Serbia
(Mimic, Davies) Department of Cardiothoracic Surgery, Great Ormond Street
Hospital, London, United Kingdom
(Ilic, Djordjevic) School of Medicine, University of Belgrade, Belgrade,
Serbia
(Mimic) Department of Anaesthesiology, Clinical Centre of Serbia,
Belgrade, Serbia
(Stankovic) Centre for Medical Biochemistry, Clinical Centre of Serbia,
Belgrade, Serbia
(Djordjevic) Department of Urology, University Children's Hospital,
Belgrade, Serbia
Title
Comparison of high glucose concentration blood and crystalloid
cardioplegia in paediatric cardiac surgery: A randomized clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (5) (pp 553-560),
2016. Date of Publication: 01 May 2016.
Publisher
Oxford University Press
Abstract
OBJECTIVES This study investigates the effects of high glucose content on
patients undergoing cold crystalloid versus cold blood cardioplegia in
terms of early clinical results, functional myocardial recovery and
ischaemia-reperfusion injury in patients undergoing repair of acyanotic
cardiac lesions. METHODS Patients were randomly assigned to receive either
crystalloid (n = 31) or blood cardioplegia (n = 31). Early clinical
results were assessed. Changes in left ventricular fractional shortening,
arterial blood lactate levels, central venous saturation, cardiac Troponin
I release and blood glucose concentration were measured during the first
24 h after ischaemia. RESULTS There was no significant difference in
clinical outcomes and postoperative complication rates between groups. The
postoperative changes in left ventricular function, lactate levels,
central venous saturation and Troponin I were not significantly different
between groups. The use of crystalloid cardioplegia was associated with
significant increases in serum glucose compared with blood cardioplegia.
CONCLUSIONS A high glucose content blood cardioplegia does not show any
advantage compared with crystalloid cardioplegia in terms of clinical
outcomes, functional recovery and the degree of ischaemic injury in
infants and children undergoing repair of acyanotic heart lesions. High
glucose concentration of the cardioplegic solution might potentiate
ischaemia-reperfusion injury and diminish the beneficial effects of blood
cardioplegia.

<17>
Accession Number
20160350183
Author
Leon M.B.; Smith C.R.; Mack M.J.; Makkar R.R.; Svensson L.G.; Kodali S.K.;
Thourani V.H.; Tuzcu E.M.; Miller D.C.; Herrmann H.C.; Doshi D.; Cohen
D.J.; Pichard A.D.; Kapadia S.; Dewey T.; Babaliaros V.; Szeto W.Y.;
Williams M.R.; Kereiakes D.; Zajarias A.; Greason K.L.; Whisenant B.K.;
Hodson R.W.; Moses J.W.; Trento A.; Brown D.L.; Fearon W.F.; Pibarot P.;
Hahn R.T.; Jaber W.A.; Anderson W.N.; Alu M.C.; Webb J.G.
Institution
(Leon, Smith, Mack, Kodali, Doshi, Moses, Hahn, Alu) Columbia University
Medical Center, 161 Ft. Washington Ave., New York, NY 10032, United States
(Williams) New York University Langone Medical Center, New York, United
States
(Mack, Brown) Baylor Scott and White Healthcare, Plano, TX, United States
(Makkar, Trento) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Miller, Fearon) Stanford University, Stanford, CA, United States
(Anderson) Lake ForestCAUnited States
(Svensson, Tuzcu, Kapadia, Jaber) Cleveland Clinic, Cleveland, United
States
(Thourani, Babaliaros) Emory University, Atlanta, United States
(Herrmann, Szeto) University of Pennsylvania, Philadelphia, United States
(Cohen) St. Luke's Mid America Heart Institute, Kansas City, United States
(Zajarias) Washington University, St. Louis, MO, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Dewey) HCA Medical City Dallas Hospital, Dallas, United States
(Kereiakes) Christ Hospital, CT, United States
(Greason) Mayo Clinic, Rochester, MN, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, United States
(Hodson) Providence St. Vincent Hospital, Portland, OR, United States
(Pibarot) Laval University, Quebec, QC, Canada
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
Title
Transcatheter or surgical aortic-valve replacement in intermediate-risk
patients.
Source
New England Journal of Medicine. 374 (17) (pp 1609-1620), 2016. Date of
Publication: 28 Apr 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Previous trials have shown that among high-risk patients with
aortic stenosis, survival rates are similar with transcatheter
aortic-valve replacement (TAVR) and surgical aorticvalve replacement. We
evaluated the two procedures in a randomized trial involving
intermediate-risk patients. METHODS We randomly assigned 2032
intermediate-risk patients with severe aortic stenosis, at 57 centers, to
undergo either TAVR or surgical replacement. The primary end point was
death from any cause or disabling stroke at 2 years. The primary
hypothesis was that TAVR would not be inferior to surgical replacement.
Before randomization, patients were entered into one of two cohorts on the
basis of clinical and imaging findings; 76.3% of the patients were
included in the transfemoral-access cohort and 23.7% in the
transthoracic-access cohort. RESULTS The rate of death from any cause or
disabling stroke was similar in the TAVR group and the surgery group (P =
0.001 for noninferiority). At 2 years, the Kaplan-Meier event rates were
19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in
the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P =
0.25). In the transfemoralaccess cohort, TAVR resulted in a lower rate of
death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62
to 1.00; P = 0.05), whereas in the transthoracic-access cohort, outcomes
were similar in the two groups. TAVR resulted in larger aortic-valve areas
than did surgery and also resulted in lower rates of acute kidney injury,
severe bleeding, and new-onset atrial fibrillation; surgery resulted in
fewer major vascular complications and less paravalvular aortic
regurgitation. CONCLUSIONS In intermediate-risk patients, TAVR was similar
to surgical aortic-valve replacement with respect to the primary end point
of death or disabling stroke.

<18>
Accession Number
20160151539
Author
O'Sullivan K.E.; Bargenda S.; Sugrue D.; Hurley J.
Institution
(O'Sullivan, Bargenda, Hurley) Department of Cardiothoracic Surgery, Mater
Private Hospital, Eccles St., Dublin 7, Ireland
(Sugrue) Department of Cardiology, Mater Private Hospital, Dublin, Ireland
Title
Advances in the management of severe aortic stenosis.
Source
Irish Journal of Medical Science. 185 (2) (pp 309-317), 2016. Date of
Publication: 01 May 2016.
Publisher
Springer-Verlag London Ltd
Abstract
Background: Recent developments in the management of severe aortic
stenosis have resulted in a paradigm shift in the way we view the
condition. Patients previously denied intervention in the form of surgical
aortic valve replacement (SAVR) are now candidates for transcatheter
aortic valve implantation and the risk and age profiles of those
undergoing SAVR are rising with the ageing population. This review article
is designed to provide an overview of developments in the surgical
management of severe aortic stenosis. We also discuss the expanding role
of minimally invasive surgical approaches to outline the current
techniques available to treat patients with severe aortic stenosis.
Methods: PubMed was searched using the terms 'severe aortic stenosis',
'surgical aortic valve replacement', 'transcatheter aortic valve
replacement', 'mechanical aortic valve replacement' and 'sutureless aortic
valve replacement'. Selection of articles was based on peer review,
journal and relevance. Where possible articles from high-impact factor
peer review journals were included. Results: Minimally invasive operative
approaches include mini-sternotomy and mini-thoracotomy. Sutureless aortic
prostheses reduce aortic cross-clamp time and cardiopulmonary bypass time;
however, long-term follow-up data are unavailable at this time. Mechanical
prostheses are advised for those under 60. Conclusion: Multiple advances
in the surgical management of aortic stenosis have occured in the past
decade. An evolving spectrum of surgical and transcatheter interventions
is now available depending on patient age and operative risk.

<19>
Accession Number
20151062043
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Sutureless aortic valve replacement may improve early mortality compared
with transcatheter aortic valve implantation: A meta-analysis of
comparative studies.
Source
Journal of Cardiology. 67 (6) (pp 504-512), 2016. Date of Publication: 01
Jun 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Objectives: To determine which improves clinical outcomes more, sutureless
(including rapid-deployment) aortic valve replacement (AVR) or
transcatheter aortic valve implantation (TAVI), we performed a
meta-analysis of comparative studies. Methods: MEDLINE and EMBASE were
searched through June 2015 using Web-based search engines (PubMed and
OVID). Studies considered for inclusion met the following criteria: the
design was a comparative study; the study population included patients
with severe aortic valve stenosis, patients were assigned to sutureless
AVR versus TAVI; and main outcomes included at least early (in-hospital or
30-day) all-cause mortality. Results: Of 87 potentially relevant articles
screened initially, no randomized controlled trials and 7 observational
comparative studies of sutureless AVR versus TAVI (enrolling a total of
945 patients) were identified and included. The first pooled analysis
demonstrated a statistically significant reduction in mortality with
sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95%
confidence interval (CI), 0.16 to 0.69; p = 0.003; risk difference (RD),
-5.23%; 95% CI, -8.12% to -2.33%; p = 0.0004]. The second pooled analyses
demonstrated no statistically significant difference in bleeding
complications, acute kidney injury, and conduction disturbance between
sutureless AVR and TAVI. The third pooled analysis demonstrated a
statistically significant reduction in paravalvular aortic regurgitation
(AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI,
0.05 to 0.16, p < 0.00001; MD, -22.56%; 95% CI, -36.59% to -8.53%; p =
0.002). Conclusions: Compared with TAVI, sutureless AVR may be associated
with a reduction in early mortality and postoperative paravalvular AR.

<20>
Accession Number
20160336569
Author
Vedin O.; Hagstrom E.; Budaj A.; Denchev S.; Harrington R.A.; Koenig W.;
Soffer J.; Sritara P.; Stebbins A.; Stewart R.H.A.; Swart H.P.; Viigimaa
M.; Vinereanu D.; Wallentin L.; White H.D.; Held C.
Institution
(Vedin, Hagstrom, Wallentin, White, Held) Department of Medical Sciences,
Cardiology, Uppsala University, Uppsala, Sweden
(Vedin, Hagstrom, Wallentin) Uppsala Clinical Research Center, Uppsala
University, Uppsala, Sweden
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Denchev) Clinic of Cardiology, Medical Institute of Ministry of Interior,
Sofia, Bulgaria
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Soffer) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, PA, United States
(Sritara) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Stebbins) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
University of Auckland, Auckland, New Zealand
(Swart) Department of Cardioresearch, Antonius Ziekenhuis Sneek,
Netherlands
(Viigimaa) Tallinn University of Technology, North Estonia Medical Centre,
Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital, Bucharest, Romania
Title
Tooth loss is independently associated with poor outcomes in stable
coronary heart disease.
Source
European Journal of Preventive Cardiology. 23 (8) (pp 839-846), 2015. Date
of Publication: 2015.
Publisher
SAGE Publications Inc.
Abstract
Objective We investigated associations between self-reported tooth loss
and cardiovascular outcomes in a global stable coronary heart disease
cohort. Methods We examined 15,456 patients from 39 countries with stable
coronary heart disease (prior myocardial infarction, prior
revascularisation or multivessel coronary heart disease) in the STABILITY
trial. At baseline, patients reported number of teeth (26-32 (all), 20-25,
15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression
models adjusted for cardiovascular risk factors and socioeconomic status,
determined associations between tooth loss level (26-32 teeth: lowest
level; no teeth: highest level) and cardiovascular outcomes. Results After
adjustment, every increase in tooth loss level was associated with an
increased risk of the primary outcome, the composite of cardiovascular
death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio
1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17;
1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal
stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial
infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth,
entailed a significantly higher risk of the primary outcome (1.27 (1.08,
1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81
(1.50, 2.20)) and stroke (1.67 (1.15, 2.39)). Conclusions In this large
global cohort of patients with coronary heart disease, self-reported tooth
loss predicted adverse cardiovascular outcomes and all-cause death
independent of cardiovascular risk factors and socioeconomic status.

<21>
[Use Link to view the full text]
Accession Number
20160184636
Author
Alfredsson J.; Stebbins A.; Brennan J.M.; Matsouaka R.; Afilalo J.;
Peterson E.D.; Vemulapalli S.; Rumsfeld J.S.; Shahian D.; Mack M.J.;
Alexander K.P.
Institution
(Alfredsson, Stebbins, Peterson, Alexander) Duke Clinical Research
Institute, Terrace Level, 2400 Pratt St, Durham, NC 27705, United States
(Alfredsson) Department of Cardiology, Linkoping University, Sweden
(Brennan, Matsouaka, Peterson, Vemulapalli, Alexander) Duke University
School of Medicine, Durham, NC, United States
(Afilalo) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Rumsfeld) University of Colorado School of Medicine, Aurora, United
States
(Shahian) Massachusetts General Hospital, Boston, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
Title
Gait speed predicts 30-day mortality after transcatheter aortic valve
replacement: Results from the Society of Thoracic Surgeons/American
College of Cardiology Transcatheter Valve Therapy Registry.
Source
Circulation. 133 (14) (pp 1351-1359), 2016. Date of Publication: 05 Apr
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Surgical risk scores do not include frailty assessments (eg,
gait speed), which are of particular importance for patients with severe
aortic stenosis considering transcatheter aortic valve replacement.
Methods and Results - We assessed the association of 5-m gait speed with
outcomes in a cohort of 8039 patients who underwent transcatheter aortic
valve replacement (November 2011-June 2014) and were included in the
Society of Thoracic Surgeons/American College of Cardiology Transcatheter
Valve Therapy Registry. We evaluated the association between continuous
and categorical gait speed and 30-day all-cause mortality before and after
adjustment for Society of Thoracic Surgeons-predicted risk of mortality
score and key variables. Secondary outcomes included in-hospital
mortality, bleeding, acute kidney injury, and stroke. The overall median
gait speed was 0.63 m/s (25th-75th percentile, 0.47-0.79 m/s), with the
slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5-0.83 m/s)
making up 48%, and normal walkers (>0.83 m/s) constituting 24% of the
population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4%
for the slowest, slow, and normal walkers, respectively (P<0.001). Each
0.2-m/s decrease in gait speed corresponded to an 11% increase in 30-day
mortality (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22).
The slowest walkers had 35% higher 30-day mortality than normal walkers
(adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80),
significantly longer hospital stays, and a lower probability of being
discharged to home. Conclusions - Gait speed is independently associated
with 30-day mortality after transcatheter aortic valve replacement.
Identification of frail patients with the slowest gait speeds facilitates
preprocedural evaluation and anticipation of a higher level of
postprocedural care.

<22>
Accession Number
2015959262
Author
Kaya M.; Utkusavas A.; Erkanli K.; Guler S.; Kyaruzi M.; Birant A.;
Karacalilar M.; Akkus M.; Bakir I.
Institution
(Kaya, Erkanli, Guler, Kyaruzi, Karacalilar, Bakir) Department of
Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Utkusavas) Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
(Birant) Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Akkus) Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Title
The Preventive Effects of Posterior Pericardiotomy with Intrapericardial
Tube on the Development of Pericardial Effusion, Atrial Fibrillation, and
Acute Kidney Injury after Coronary Artery Surgery: A Prospective,
Randomized, Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 64 (3) (pp 217-224), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Georg Thieme Verlag
Abstract
Background Pericardial effusion (PE), atrial fibrillation (AF), and acute
kidney injury (AKI) are commonly found after coronary artery surgery.
These adverse events may also be interwoven in the postoperative period.
In this prospective study, we investigated whether posterior
pericardiotomy (PP) with intrapericardial tube positioned along the right
atrium (pericardial space intervention) is effective in the prevention of
these adverse events. Methods The patients were randomly distributed to
the study and control groups. The study group consisted of patients with
pericardial space intervention, whereas the control group consisted of
patients without pericardial space interventions. In all patients, a
straight tube was placed in the anterior mediastinum and an angled tube
was placed into the left hemithorax. Results A total of 210 patients were
studied: 107 in the control group and 103 in the study group.
Statistically significant results were obtained in the amount of PE,
cardiac tamponade, AF (p = 0.019), and AKI during the postoperative
period, in favor of the study group. Length of hospital stay was
significantly shorter in the study group (6.11 +/- 2.31, p = 0.009).
Conclusion The PP with intrapericardial tube approach is safe, easy, and
effective in the prevention of PE, cardiac tamponade, and AF. The use of
this approach may reduce the risk of developing AKI during the
postoperative period. Besides, this technique also reduces the length of
hospital stay.

<23>
Accession Number
20160347967
Author
Amin N.; Tarwade P.; Shetmahajan M.; Pramesh C.; Jiwnani S.; Mahajan A.;
Purandare N.
Institution
(Amin, Tarwade, Shetmahajan) Department of Anesthesiology, Tata Memorial
Center, Mumbai, Maharashtra, India
(Pramesh, Jiwnani) Division of Thoracic Surgery, Tata Memorial Centre,
Mumbai, Maharashtra, India
(Mahajan) Department of Radiodiagnosis, Tata Memorial Centre, Mumbai,
Maharashtra, India
(Purandare) Department of Nuclear Medicine, Tata Memorial Centre, Mumbai,
Maharashtra, India
Title
A randomized trial to assess the utility of preintubation adult fiberoptic
bronchoscope assessment in patients for thoracic surgery requiring
one-lung ventilation.
Source
Annals of Cardiac Anaesthesia. 19 (2) (pp 251-255), 2016. Date of
Publication: April-June 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Confirmation of placement of Double lumen endobronchial tubes (DLETT) and
bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB)
is the most preferred practice worldwide. Most centers possess standard
adult FOBs, some, particularly in developing countries might not have
access to the pediatric.sized devices. We have evaluated the role of
preintubation airway assessment using the former, measuring the distance
from the incisors to the carina and from carina to the left and right
upper lobe bronchus in deciding the depth of insertion of the lung
isolation device. Methods: The study was a randomized, controlled,
double.blind trial consisting of 84 patients (all >18 years) undergoing
thoracic surgery over a 12.month period. In the study group (n = 38),
measurements obtained during FOB with the adult bronchoscope decided the
depth of insertion of the lung isolation device. In the control group (n =
46), DLETTs and BBs were placed blindly followed by clinical confirmation
by auscultation. Selection of the type and size of the lung isolation
device was at the discretion of the anesthesiologist conducting the case.
In all cases, pediatric FOB was used to confirm accurate placement of
devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8
patients), preintubation airway measurements significantly improved the
success rate of optimal placement of lung isolation device from 25%
(11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device
placement at initial insertion was 4.7% (4/84). Incidence of malposition
was 10% (8/80) with 4 cases in each group. The incidence of suboptimal
placement was lower in the study group at 38.9% (14/36) versus 65.9%
(29/44). Conclusions: Preintubation airway measurements with the adult FOB
reduces airway manipulations and improves the success rate of optimal
placement of DLETT and BB.

<24>
Accession Number
20160347963
Author
Jain V.; Mehta Y.; Gupta A.; Sharma R.; Raizada A.; Trehan N.
Institution
(Jain) Department of Critical Care and Anaesthesiology, Medanta-The
Medicity, Cardiac Anaesthesia, Medanta-The Medicity, Sector-38 Gurgaon,
Haryana 122 001, India
(Mehta) Medanta Institute of Critical Care and Anaesthesia, Medanta-The
Medicity, Gurgaon, India
(Gupta) Department of Critical Care and Emergency, Sharda University,
Greater Noida, UP, India
(Sharma) Medanta Institute of Kidney and Urology, Medanta-The Medicity,
Gurgaon, India
(Raizada) Department of Biochemistry, Medanta-The Medicity, Gurgaon, India
(Trehan) CTVS, Medanta-The Medicity, Gurgaon, India
Title
The role of neutrophil gelatinase-associated lipocalin in predicting acute
kidney injury in patients undergoing off-pump coronary artery bypass
graft: A pilot study.
Source
Annals of Cardiac Anaesthesia. 19 (2) (pp 225-230), 2016. Date of
Publication: April-June 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Acute kidney injury (AKI) is a commonly encountered
postoperative complication after cardiac surgery especially in high risk
patients. AKI though seen more commonly after conventional on pump
coronary artery bypass surgery (CCABG), is not uncommon after off pump
coronary bypass surgery (OPCAB). Various biomarkers have shown promise
over last one decade as an early marker for predicting AKI
postoperatively. NGAL is one such biomarker whose concentration is
increased in urine after any nephrotoxic and ischemic insult. The
objective of this study was to assess the role of urine NGAL in predicting
AKI after OPCAB in patients with increased risk of developing AKI. Design:
A prospective cohort study. Setting: A clinical study in a multi specialty
hospital. Participants: Eighty patients. Materials and Methods: study was
approved by the hospital research ethics committee. 80 patients posted for
OPCAB with an increased risk of developing AKI defined as having a
Cleveland Clinic Foundation Acute renal failure scoring System score of >6
were included in the study. Patients with coronary angiography (CAG)
within 48 hrs prior to surgery, pre-existing AKI, preoperative renal
replacement therapy (RRT) and CKD stage 5 were excluded. Urine NGAL level
before the start of surgery baseline and at 4 hrs post surgery were done.
Renal function tests were assessed on the day of surgery (4 hrs post
surgery) and on the next three days. Result: Seven patients developed AKI
as defined by acute kidney infection network (AKIN) and risk injury
failure loss end stage (RIFLE) criteria for AKI. NGAL value at 4 hrs in
patients who developed AKI was significantly higher than in those patients
who did not develop AKI (P < 0.05). Conclusion: urine NGAL is an early
biomarker of acute kidney injury in patients undergoing OPCAB surgeries.
However, large multicentre studies may be needed to confirm it.

<25>
Accession Number
20160343128
Author
Gilani S.R.A.; Hussain G.; Ahmad N.; Baig M.A.R.; Zaman H.
Institution
(Gilani, Hussain, Ahmad, Baig, Zaman) Department of Cardiac Surgery,
Choudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
Title
Comparison of post-operative atelectasis in patients undergoing coronary
artery bypass grafting with and without pre-operative incentive
spirometry.
Source
Journal of Postgraduate Medical Institute. 30 (2) (pp 169-172), 2016. Date
of Publication: 2016.
Publisher
Postgraduate Medical Institute
Abstract
Objective: To see the effect of pre-operative incentive spirometry on
postoperative atelectasis in patients undergoing Coronary Artery Bypass
Grafting. Methodology: This was a randomized prospective study. The
duration of study was 05 months from 01-02-2015 to 31-06-2015. A total
number of 170 patients were included in this study. In Group I, there were
patients in whom incentive spirometry was done before surgery (Study
group). While in Group II patients pre-operative spirometry was not done
(Control group). There were 85 patients in each group. Data was analyzed
using SPSS Version 19. Chi-square test and independent sample t-test were
used for analysis of qualitative and quantitative variable respectively.
P-value < 0.05 was taken as a significant difference. Results: There were
42.4% patients who have positive smoking history in group I as compared to
only 24.7% smoker patients in group II (p-value 0.02). Ventilation time
was significantly less in group I patients, it was 5.49+2.28 hours versus
6.74+5.46 hours in group II patients (p-value 0.05). Incidence of
post-operative atelectasis was 14.10% in group I and 27.10% in group II
patients (p-value 0.04). So we found that pre-operative incentive
spirometry results in considerable reduction in incidence of
post-operative atelectasis and it also can reduce ventilation time as
well. Conclusion: Pre-operative incentive spirometry helps to reduce and
prevent post-operative atelectasis in patients undergoing coronary artery
bypass grafting.

<26>
Accession Number
20160341707
Author
Punthakee Z.; Gerstein H.C.; Bosch J.; Tyrwhitt J.; Jung H.; Lee S.F.;
Lonn E.; Marsden T.; McKelvie R.; McQueen M.J.; Morillo C.A.; Yusuf S.;
Dagenais G.R.; Diaz R.; Maggioni A.P.; Probstfield J.; Ramachandran A.;
Riddle M.C.; Ryden L.E.; Badings E.A.; Birkeland K.I.; Cardona E.;
Commerford P.; Davies M.; Fodor J.G.; Gomis R.; Hanefeld M.; Hildebrandt
P.; Kacerovsky-Bielesz G.; Keltai M.; Lanas F.; Lewis B.S.;
Lopez-Jaramillo P.; Marin-Neto J.; Marre M.; Mendoza I.; Pan C.Y.; Pirags
V.; Rosenstock J.; Spinas G.A.; Sreenan S.; Syvanne M.; Yale J.-F.
Institution
(Punthakee, Gerstein, Bosch, Tyrwhitt, Jung, Lee, Lonn, Marsden, McKelvie,
McQueen, Morillo, Yusuf) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri Research
Center, Florence, Italy
(Probstfield) University of Washington, Seattle, WA, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, OR, United States
(Ryden) Cardiology Unit, Department of Medicine K2, Karolinska Institute,
Stockholm, Sweden
(Badings) Department of Cardiology Research, Deventer Hospital, Deventer,
Netherlands
(Birkeland) Oslo University Hospital, University of Oslo, Oslo, Norway
(Cardona) Universidad de Guadalajara, Guadalajara, Mexico
(Commerford) University of Cape Town, Cape Town, South Africa
(Davies) University of Leicester, Diabetes Research Centre, Leicester,
United Kingdom
(Fodor) University of Ottawa, Heart Institute, Ottawa, ON, Canada
(Gomis) L'Institut d'Investigacions Biomediques August Pi i Sunyer,
Barcelona, Spain
(Hanefeld) GWT-TUD GmbH, Studycenter Prof. Hanefeld, Dresden, Germany
(Hildebrandt) Department of Cardiology and Endocrinology, Frederiksberg
Hospital, Frederiksberg, Denmark
(Kacerovsky-Bielesz) Hanusch-Krankenhaus Diabetesambulanz, Mauerbach,
Austria
(Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Lanas) Universidad de La Frontera, Temuco, Chile
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lopez-Jaramillo) Fundacion Oftalmologica de Santander (FOSCAL),
Universidad de Santander, Bucaramanga, Colombia
(Marin-Neto) Faculdade de Medicina de Riberirao Preto USP, Ribeirao Preto,
Brazil
(Marre) Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique des
Hopitaux de Paris, Paris, France
(Mendoza) Urologico San Roman, Caracas, Venezuela
(Pan) Chinese PLA General Hospital, Beijing, China
(Pirags) Centre of Endocrinology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Rosenstock) Dallas Diabetes and Endocrine Center at Medical City, Dallas,
TX, United States
(Spinas) University Hospital Zurich, Zurich, Switzerland
(Sreenan) 3U Diabetes, Connolly Hospital Blanchardstown, Dublin, Ireland
(Syvanne) Finnish Heart Association, Helsinki, Finland
(Yale) McGill University, Montreal, QC, Canada
Title
Cardiovascular and other outcomes postintervention with insulin glargine
and omega-3 fatty acids (ORIGINALE).
Source
Diabetes Care. 39 (5) (pp 709-716), 2016. Date of Publication: May 2016.
Publisher
American Diabetes Association Inc.
Abstract
OBJECTIVE: The Outcome Reduction With Initial Glargine Intervention
(ORIGIN) trial reported neutral effects of insulin glargine on
cardiovascular outcomes and cancers and reduced incident diabetes in
high-cardiovascular risk adults with dysglycemia after 6.2 years of active
treatment. Omega-3 fatty acids had neutral effects on cardiovascular
outcomes. The ORIGIN and Legacy Effects (ORIGINALE) study measured
posttrial effects of these interventions during an additional 2.7 years.
RESEARCH DESIGN AND METHODS: Surviving ORIGIN participants attended up to
two additional visits. The hazard of clinical outcomes during the entire
follow-up period from randomization was calculated. RESULTS: Of 12,537
participants randomized, posttrial data were analyzed for 4,718 originally
allocated to insulin glargine (2,351) versus standard care (2,367), and
4,771 originally allocatedto omega-3 fatty acid supplements (2,368) versus
placebo (2,403). Posttrial, small differences in median HbA1c persisted
(glargine 6.6% [49 mmol/mol], standard care 6.7% [50 mmol/mol], P =
0.025). From randomization to the end of posttrial follow-up, no
differences were found between the glargine and standard care groups in
myocardial infarction, stroke, or cardiovascular death (1,185 vs. 1,165
events; hazard ratio 1.01 [95%CI 0.94-1.10]; P = 0.72); myocardial
infarction, stroke, cardiovascular death, revascularization, or
hospitalization for heart failure (1,958 vs. 1,910 events; 1.03
[0.97-1.10]; P = 0.38); or any cancer (524 vs. 529 events; 0.99
[0.88-1.12]; P = 0.91) or between omega-3 and placebo groups in
cardiovascular death (688 vs. 700; 0.98 [0.88-1.09]; P = 0.68) or other
outcomes. CONCLUSIONS: During >6 years of treatment followed by >2.5 years
of observation, insulin glargine had neutral effects on health outcomes
and salutary effects on metabolic control, whereas omega-3 fatty acid
supplementation had no effect.

<27>
Accession Number
26633306
Author
Simancas-Racines D.; Osorio D.; Marti-Carvajal A.J.; Arevalo-Rodriguez I.
Institution
(Simancas-Racines, Osorio, Marti-Carvajal, Arevalo-Rodriguez) Facultad de
Ciencias de la Salud Eugenio Espejo, Universidad Tecnologica Equinoccial,
Avenida Occidental s/n, y Avenida Mariana de Jesus, Edificio Bloque D. Of.
Centro Cochrane, Quito, Ecuador, Casilla Postal 17-01-2764
Title
Leukoreduction for the prevention of adverse reactions from allogeneic
blood transfusion.
Source
The Cochrane database of systematic reviews. 12 (pp CD009745), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: A blood transfusion is an acute intervention, implemented to
solve life and health-threatening conditions on a short-term basis.
However, blood transfusions have adverse events, some of them potentially
related to immune modulation or to a direct transmission of infectious
agents (e.g. cytomegalovirus). Leukoreduction is a process in which the
white blood cells are intentionally reduced in packed red blood cells
(PRBCs) in order to reduce the risk of adverse reactions. The potential
benefits of leukoreduced PRBCs in all types of transfused patients for
decreasing infectious and non-infectious complications remain unclear.
OBJECTIVES: To determine the clinical effectiveness of leukoreduction of
packed red blood cells for preventing adverse reactions following
allogeneic blood transfusion.
SEARCH METHODS: We ran the most recent search on 10th November 2015. We
searched the Cochrane Injuries Group's Specialised Register, Cochrane
Central Register of Controlled Trials (CENTRAL, the Cochrane Library),
MEDLINE (OvidSP), Embase(OvidSP), CINAHL Plus (EBSCO), LILACS (BIREME),
and clinical trials registers. In addition, we checked the reference lists
of all relevant trials and reviews identified in the literature searches.
SELECTION CRITERIA: Randomised clinical trials including patients of all
ages requiring PRBC allogeneic transfusion. Any study was eligible for
inclusion, regardless of the length of participant follow-up or country
where the study was performed. The primary outcome was transfusion-related
acute lung injury (TRALI). Secondary outcomes were death from any cause,
infection from any cause, non-infectious complications and any other
adverse event.
DATA COLLECTION AND ANALYSIS: At least two review authors independently
performed study selection, 'Risk of bias' assessments and data extraction.
We estimated pooled relative risk for dichotomous outcomes, and we
measured statistical heterogeneity using I2 statistic. The random-effects
model was used to synthesise results. We conducted a trial sequential
analysis to assess the risk of random errors in cumulative meta-analyses.
MAIN RESULTS: Thirteen studies, most including adult patients, met the
eligibility criteria. We found no clear evidence of an effect of
leukoreduced PRBC versus non-leukoreduced PRBC in patients that were
randomised to receive transfusion for the following outcomes: TRALI: RR
0.96, 95% CI 0.67 to 1.36, P = 0.80 from one trial reporting data on 1864
trauma patients. The accrued information of 1864 participants constituted
only 28.5% of the diversity-adjusted required information size (DARIS) of
6548 participants. The quality of evidence was low. Death from any cause:
RR 0.81, 95% CI 0.58 to 1.12, I2 statistic = 63%, P = 0.20 from nine
trials reporting data on 6485 cardiovascular surgical patients,
gastro-oncology surgical patients, trauma patients and HIV infected
patients. The accrued information of 6485 participants constituted only
55.3% of the DARIS of 11,735 participants. The quality of evidence was
very low. Infection from any cause: RR 0.80, 95% CI 0.62 to 1.03, I2
statistic = 84%, P = 0.08 from 10 trials reporting data on 6709
cardiovascular surgical patients, gastro-oncology surgical patients,
trauma patients and HIV infected patients. The accrued information of 6709
participants constituted only 60.6% of the DARIS of 11,062 participants.
The quality of evidence was very low. Adverse events: The only adverse
event reported as an adverse event was fever (RR 0.81, 95% CI 0.64 to
1.02; I2 statistic= 0%, P = 0.07). Fever was reported in two trials on 634
cardiovascular surgical and gastro-oncology surgical patients. The accrued
information of 634 participants constituted only 84.4% of the DARIS of 751
participants. The quality of evidence was low. Incidence of other
non-infectious complications: This outcome was not assessed in any
included trial.
AUTHORS' CONCLUSIONS: There is no clear evidence for supporting or
rejecting the routine use of leukoreduction in all patients requiring PRBC
transfusion for preventing TRALI, death, infection, non-infectious
complications and other adverse events. As the quality of evidence is very
low to low, more evidence is needed before a definitive conclusion can be
drawn.

<28>
Accession Number
20160324997
Author
Khalil M.; Al-Agaty A.; Asaad O.; Mahmoud M.; Omar A.S.; Abdelrazik A.;
Mostafa M.
Institution
(Khalil, Al-Agaty, Asaad) Anesthesia Department, Cairo University, Giza,
Egypt
(Mahmoud, Abdelrazik) Critical Care Department, Cairo University, Giza,
Egypt
(Omar) Critical Care Department, Cairo University, Beni-Suef Division,
Giza, Egypt
(Mostafa) Cardiology Department, Ain-Shams University, Giza, Egypt
Title
A comparative study between propofol and dexmedetomidine as sedative
agents during performing transcatheter aortic valve implantation.
Source
Journal of Clinical Anesthesia. 32 (pp 242-247), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Inc.
Abstract
Objective The type of sedative drugs could play a major role in providing
hemodynamic stability which is crucial during transcatheter aortic valve
implantation (TAVI) procedure. The aim of this study is to compare
propofol with dexmedetomidine for conscious sedation during TAVI. Design A
prospective randomized pilot study. Patients Fifty patients with a mean
age of 74 years, American Society of Anesthesiologists 3-4, complaining
from severe aortic stenosis were enrolled in this study to undergo TAVI.
Interventions The propofol group (group P; n = 25) received a bolus dose
of 0.5 mg/kg propofol followed by a continuous intravenous infusion of
propofol at a rate of 30 to 50 mug kg^-1 min^-1, and
the dexmedetomidine group (group D; n = 25) received dexmedetomidine at a
loading dose of 1 mug/kg and then a continuous intravenous infusion of
dexmedetomidine at a rate of 0.5 mug kg^-1 h^-1.
Measurements Heart rate, mean arterial blood pressure, number of
phenylephrine boluses, oxygen saturation, sedation, and satisfaction
scores were measured just after the start of infusion of the sedation
drugs and at the end of the procedure. Postoperative complications were
also recorded. Results There was a statistically significant reduction in
the heart rate in group D in comparison to group P where it was 67.28 +/-
6.9 beats/min in the first group in comparison to 78 +/- 6.9 beats/min in
the last one (P <.001). The mean arterial blood pressure was statistically
significant lower in group D in comparison to group P (58.12 +/- 5.4 mm Hg
in group D vs 68.24 +/- 11.4 mm Hg in group P; P <.001). Also, the number
of phenylephrine boluses was higher in group D than in group P (36.5 +/-
7.17 in group D vs 20.6 +/- 2.07 in group p; P <.001). No difference
between the 2 groups regarding oxygen saturation, sedation, pain,
satisfaction scores, and postoperative complications. Conclusion During
TAVI, dexmedetomidine may be associated with significant hypotension and
bradycardia rather than propofol.

<29>
Accession Number
20160269136
Author
Brown C.H.; Laflam A.; Max L.; Lymar D.; Neufeld K.J.; Tian J.; Shah A.S.;
Whitman G.J.; Hogue C.W.
Institution
(Brown, Laflam, Max, Lymar, Hogue) Department of Anesthesiology and
Critical Care Medicine, Johns Hopkins University, School of Medicine, 1800
Orleans, Baltimore, MD 21287, United States
(Neufeld) Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University, School of Medicine, Baltimore, United States
(Whitman) Division of Cardiac Surgery, Johns Hopkins University, School of
Medicine, Baltimore, United States
(Tian) Department of Biostatistics, Johns Hopkins Bloomberg, School of
Public Health, Baltimore, MD, United States
(Shah) Department of Surgery, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
The Impact of Delirium after Cardiac Surgical Procedures on Postoperative
Resource Use.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1663-1669), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Delirium is a common complication after cardiac surgical
procedures and is associated with increased morbidity and mortality.
However, whether rigorously assessed postoperative delirium is associated
with an increased length of stay in the intensive care unit (LOS-ICU),
length of stay (LOS), and hospital charges is not clear. Methods Patients
(n = 66) undergoing coronary artery bypass or valve operations, or both,
were enrolled in a nested cohort study. Rigorous delirium assessments were
conducted using the Confusion Assessment Method. LOS-ICU and LOS were
obtained from the medical record, and hospital charges were obtained from
administrative data reported to the state. Because of the skewed
distribution of outcome variables, outcomes were compared using rank-sum
tests, as well as median regression incorporating propensity scores.
Results Patients who developed delirium (56%) versus no delirium (43%) had
increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to
136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median
LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and
increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs.
$41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models
adjusted for patient-related and surgical characteristics and
complications, the results for LOS-ICU and cost remained highly
significant, although the results for LOS were attenuated on the basis of
the specific statistical model. Increased severity of delirium was
associated with both increased LOS-ICU and increased charges in a
dose-response manner. Conclusions Delirium after cardiac surgical
procedures is independently associated with both increased LOS-ICU and
higher hospital charges. Because delirium is potentially preventable,
targeted delirium-prevention protocols for high-risk patients may
represent an important strategy for quality improvement.

<30>
Accession Number
20160263139
Author
Wang J.; Yu W.; Gao M.; Gu C.; Yu Y.
Institution
(Wang, Yu, Gao, Gu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence
of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk
Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17
Studies.
Source
Annals of Thoracic Surgery. 101 (5) (pp 2007-2019), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
This meta-analysis investigated the effects of preoperative prophylactic
intraaortic balloon pump placement on postoperative renal function and
short-term death of high-risk patients undergoing coronary artery bypass
grafting. We found that preoperative prophylactic intraaortic balloon pump
support reduced the incidence of coronary artery bypass
grafting-associated acute kidney injury and short-term death and
dramatically decreased the incidence of postoperative renal replacement
therapy by 82% compared with high-risk patients without the procedure.
This is the first meta-analysis to demonstrate significant beneficial
effects of preoperative prophylactic intraaortic balloon pump on renal
function in high-risk patients undergoing coronary artery bypass grafting.

<31>
Accession Number
20160120207
Author
Amin S.; Pinho-Gomes A.-C.; Taggart D.P.
Institution
(Amin, Taggart) Department of Cardiovascular Surgery, University of
Oxford, John Radcliffe Hospital, Headley Way, Headington OX3 9DU, United
Kingdom
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals Trust, Oxford, United Kingdom
Title
Relationship of Intraoperative Transit Time Flowmetry Findings to
Angiographic Graft Patency at Follow-Up.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1996-2006), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Early and late graft occlusion remains a significant complication of
coronary artery bypass grafting. Transit time flowmetry is the most
commonly used imaging technique to assess graft patency intraoperatively.
Although the value of transit time flowmetry for intraoperative quality
control of coronary anastomosis is well established, its standard
variables for predicting eventual graft failure remain controversial. This
review readdresses the issue of intraoperative transit time flowmetry,
with a particular emphasis on defining cutoff values for standard
variables and correlating them with the ability to predict midterm and
long-term graft patency for arterial and venous conduits. Further research
is warranted to support clinically useful recommendations on the
intraoperative application and interpretation of transit time flowmetry.

<32>
Accession Number
20160101449
Author
Mookhoek A.; Korteland N.M.; Arabkhani B.; Di Centa I.; Lansac E.; Bekkers
J.A.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Mookhoek, Korteland, Arabkhani, Bekkers, Bogers, Takkenberg) Erasmus
University Medical Center, Department of Cardiothoracic Surgery, PO Box
2040, Rotterdam 3000 CA, Netherlands
(Di Centa) Hopital Foch, Suresnes, France
(Lansac) Institut Mutualiste Montsouris, Paris, France
Title
Bentall Procedure: A Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1684-1690), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background The Bentall procedure is considered the gold standard in the
treatment of patients requiring aortic root replacement. An up-to-date
overview of outcomes after the Bentall procedure is lacking. Methods We
conducted a systematic review and meta-analysis of characteristics of and
long-term outcome after the Bentall procedure with a mechanical valve
prosthesis. Pooling was performed using the inverse variance method within
a random-effects model. Outcome events are reported as linearized
occurrence rates (percentage per patient year) with 95% confidence
intervals. Results In total, 46 studies with 7,629 patients (mean age, 50
years; 76% men) were selected. Pooled early mortality was 6% (422
patients). During a mean follow-up of 6 years (49,175 patient-years), the
annual linearized occurrence rate for late mortality was 2.02% (1.77%-
2.31%; 892 patients), for aortic root reoperation it was 0.46%
(0.36%-0.59%), for hemorrhage it was 0.64% (0.47%-0.87%), for
thromboemboli it was 0.77% (0.60%-1.00%), for endocarditis it was 0.39%
(0.33%-0.46%), and for major adverse valve-related events it was 2.66%
(2.17%-3.24%). Operations performed in more recent years were associated
with lower rates of aortic root reoperation (beta = -0.452; p = 0.015).
Conclusions This systematic review illustrates that rates of aortic root
reoperation after the Bentall procedure have decreased over the years.
However, late mortality, major bleeding, and thromboembolic complications
remain a concern. This report may be used to benchmark the potential
therapeutic benefit of novel surgical approaches, such as valve-sparing
aortic root replacement.

<33>
Accession Number
20160043799
Author
Lima E.G.; Hueb W.; Gersh B.J.; Rezende P.C.; Garzillo C.L.; Favarato D.;
Hueb A.C.; Rahmi Garcia R.M.; Franchini Ramires J.A.; Filho R.K.
Institution
(Lima, Hueb, Rezende, Garzillo, Favarato, Hueb, Rahmi Garcia, Franchini
Ramires, Filho) Department of Clinical Cardiology, Heart Institute
(InCor), University of Sao Paulo, Av Dr Eneas de Carvalho Aguiar 44, Sao
Paulo 05403-000, Brazil
(Gersh) Mayo Clinic Foundation, Rochester, MN, United States
Title
Impact of Chronic Kidney Disease on Long-Term Outcomes in Type 2 Diabetic
Patients with Coronary Artery Disease on Surgical, Angioplasty, or Medical
Treatment.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1735-1744), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Coronary artery disease (CAD) among patients with diabetes and
chronic kidney disease (CKD) is not well studied, and the best treatment
for this condition is not established. Our aim was to compare three
therapeutic strategies for CAD in diabetic patients stratified by renal
function. Methods Patients with multivessel CAD that underwent coronary
artery bypass graft (CABG), angioplasty (percutaneous coronary
intervention [PCI]), or medical therapy alone (MT) were included. Data
were analyzed according to glomerular filtration rate in three strata:
normal (>90 mL/min), mild CKD (60 to 89 mL/min), and moderate CKD (30 to
59 mL/min). End points comprised overall rate of mortality, acute
myocardial infarction, and need for additional revascularization. Results
Among patients with normal renal function (n = 270), 122 underwent CABG,
72 PCI, and 76 MT; among patients with mild CKD (n = 367), 167 underwent
CABG, 92 PCI, and 108 MT; and among patients with moderate CKD (n = 126),
46 underwent CABG, 40 PCI, and 40 MT. Event-free survival was 80.4%,
75.7%, 67.5% for strata 1, 2, and 3, respectively (p = 0.037). Survival
rates among patients with no, mild, and moderate CKD are 91.1%, 89.6%, and
76.2%, respectively (p = 0.001) (hazard ratio 0.69; 95% confidence
interval 0.51 to 0.95; p = 0.024 for stratum 1 versus 3). We found no
differences for overall number of deaths or acute myocardial infarctions
irrespective of strata. The need of new revascularization was different in
all strata, favoring CABG (p < 0.001, p < 0.001, and p = 0.029 for no,
mild, and moderate CKD, respectively). Conclusions Mortality rates were
higher in patients with mild and moderate CKD. Higher event-free survival
was observed in the CABG group among patients with no and mild CKD.

<34>
Accession Number
20160339978
Author
Benedetto U.; Gaudino M.; Ng C.; Biondi-Zoccai G.; D'Ascenzo F.; Frati G.;
Girardi L.N.; Angelini G.D.; Taggart D.P.
Institution
(Benedetto, Ng, Angelini) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Upper Maudlin St, Bristol BS2 8HW, United
Kingdom
(Gaudino, Girardi) Division of Cardio-thoracic Surgery, Cornell
University, New York, NY, United States
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
(D'Ascenzo) Dipartimento Di Scienze Mediche, Divisione di Cardiologia,
Citta della Salute e della Scienza, Turin, Italy
(Frati) Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli,
Italy
(Taggart) Nuffield Department of Surgical Sciences, Oxford University
Hospital, Oxford, United Kingdom
Title
Coronary surgery is superior to drug eluting stents in multivessel
disease. Systematic review and meta-analysis of contemporary randomized
controlled trials.
Source
International Journal of Cardiology. 210 (pp 19-24), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective Current randomized controlled trials (RCTs) comparing
percutaneous coronary intervention with drug eluting stent (DES-PCI) with
coronary artery bypass grafting (CABG) in multivessel disease are
underpowered to detect a difference in hard clinical end-points such as
mortality, myocardial infarction and stroke. We aimed to overcome this
limitation by conducting a meta-analysis of contemporary RCTs. Methods A
systematic literature search was conducted for all RCTs comparing DES-PCI
versus CABG in multivessel disease published through May 2015. Inverse
variance weighting was used to pool data from individual studies (< 1
favouring DES-PCI and > 1 CABG favouring surgery). Results A total of five
randomized trials including 4563 subjects were analysed. After an average
follow-up of 3.4 years, DES-PCI was associated with a significantly
increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P < 0.001),
MI (HR 2.02; 95%CI 1.57-2.58; P < 0.001) and repeat revascularization (HR
2.54; 95%CI 2.07-3.11; P = < 0.001). CABG marginally increased the risk of
stroke (HR 0.70; 95%CI 0.50-0.98; P = 0.04). The absolute risk reduction
for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG
was larger than the absolute risk reduction for stroke (0.9%) with
DES-PCI. Conclusion In patients with multivessel coronary disease, CABG
was found to be superior to DES-PCI by reducing the risk of mortality and
subsequent myocardial infarction at the expense of a marginally increased
risk of stroke.

<35>
Accession Number
20160320920
Author
Leung A.A.; Nerenberg K.; Daskalopoulou S.S.; McBrien K.; Zarnke K.B.;
Dasgupta K.; Cloutier L.; Gelfer M.; Lamarre-Cliche M.; Milot A.; Bolli
P.; Tremblay G.; McLean D.; Tobe S.W.; Ruzicka M.; Burns K.D.; Vallee M.;
Prasad G.V.R.; Lebel M.; Feldman R.D.; Selby P.; Pipe A.; Schiffrin E.L.;
McFarlane P.A.; Oh P.; Hegele R.A.; Khara M.; Wilson T.W.; Penner S.B.;
Burgess E.; Herman R.J.; Bacon S.L.; Rabkin S.W.; Gilbert R.E.; Campbell
T.S.; Grover S.; Honos G.; Lindsay P.; Hill M.D.; Coutts S.B.; Gubitz G.;
Campbell N.R.C.; Moe G.W.; Howlett J.G.; Boulanger J.-M.; Prebtani A.;
Larochelle P.; Leiter L.A.; Jones C.; Ogilvie R.I.; Woo V.; Kaczorowski
J.; Trudeau L.; Petrella R.J.; Hiremath S.; Drouin D.; Lavoie K.L.; Hamet
P.; Fodor G.; Gregoire J.C.; Lewanczuk R.; Dresser G.K.; Sharma M.; Reid
D.; Lear S.A.; Moullec G.; Gupta M.; Magee L.A.; Logan A.G.; Harris K.C.;
Dionne J.; Fournier A.; Benoit G.; Feber J.; Poirier L.; Padwal R.S.; Rabi
D.M.
Institution
(Leung) Division of Endocrinology and Metabolism, Department of Medicine,
University of Calgary, Calgary, AB, Canada
(Nerenberg) Department of Medicine and Department of Obstetrics and
Gynecology, University of Calgary, Calgary, AB, Canada
(Daskalopoulou, Dasgupta) Divisions of General Internal Medicine, Clinical
Epidemiology and Endocrinology, Department of Medicine, McGill University,
McGill University Health Centre, Montreal, QC, Canada
(McBrien) Departments of Family Medicine and Community Health Sciences,
Institute for Public Health, Cumming School of Medicine, University of
Calgary, Calgary, AB, Canada
(Zarnke, Herman) Division of General Internal Medicine, University of
Calgary, Calgary, AB, Canada
(Cloutier) Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec,
Canada
(Gelfer) Department of Family Medicine, University of British Columbia,
Copeman Healthcare Centre, Vancouver, BC, Canada
(Lamarre-Cliche, Larochelle) Institut de Recherches Cliniques de Montreal,
Universite de Montreal, Montreal, QC, Canada
(Milot, Lebel) Department of Medicine, Universite Laval, Quebec, QC,
Canada
(Bolli) Ambulatory Internal Medicine Teaching Clinic, St Catharines, ON,
Canada
(Tremblay) CHU-Quebec-Hopital St Sacrement, Quebec, QC, Canada
(McLean, Lewanczuk) University of Alberta, Edmonton, AB, Canada
(Tobe, Prasad, Gupta, Logan) University of Toronto, Toronto, ON, Canada
(Ruzicka, Burns) Division of Nephrology, Department of Medicine, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
(Vallee) Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal,
QC, Canada
(Feldman) Discipline of Medicine, Memorial University of Newfoundland, St
John's, NL, Canada
(Selby) Centre for Addiction and Mental Health, University of Toronto,
Toronto, ON, Canada
(Pipe) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Schiffrin) Department of Medicine and Lady Davis Institute for Medical
Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
(McFarlane) Division of Nephrology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Oh) University Health Network, University of Toronto, Toronto, ON, Canada
(Hegele) Departments of Medicine (Division of Endocrinology) and
Biochemistry, Western University, London, ON, Canada
(Khara) Vancouver Coastal Health Addiction Services, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
(Wilson) Department of Medicine, University of Saskatchewan, Saskatoon,
SK, Canada
(Penner) Department of Internal Medicine, University of Manitoba,
Winnipeg, MB, Canada
(Burgess) Department of Medicine, University of Calgary, Calgary, AB,
Canada
(Bacon) Department of Exercise Science, Concordia University, and Montreal
Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal,
QC, Canada
(Rabkin) Vancouver Hospital, University of British Columbia, Vancouver,
BC, Canada
(Gilbert) Division of Endocrinology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Campbell) Department of Psychology, University of Calgary, Calgary, AB,
Canada
(Grover) Division of Clinical Epidemiology, Montreal General Hospital,
Montreal, QC, Canada
(Honos) University of Montreal, Montreal, QC, Canada
(Lindsay) Best Practices and Performance, Heart and Stroke Foundation,
Toronto, ON, Canada
(Hill) Department of Clinical Neurosciences, Hotchkiss Brain Institute,
University of Calgary, Calgary, AB, Canada
(Coutts) Departments of Clinical Neurosciences and Radiology, Hotchkiss
Brain Institute, University of Calgary, Calgary, AB, Canada
(Gubitz) Division of Neurology, Halifax Infirmary, Dalhousie University,
Halifax, NS, Canada
(Campbell) Medicine, Community Health Sciences, Physiology and
Pharmacology, Libin Cardiovascular Institute of Alberta, University of
Calgary, Calgary, AB, Canada
(Moe) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Howlett) Departments of Medicine and Cardiac Sciences, University of
Calgary, Calgary, AB, Canada
(Boulanger) Charles LeMoyne Hospital Research Centre, Sherbrooke
University, Sherbrooke, QC, Canada
(Prebtani, Gupta) McMaster University, Hamilton, ON, Canada
(Leiter) Keenan Research Centre in the Li Ka Shing Knowledge Institute of
St Michael's Hospital, And University of Toronto, Toronto, ON, Canada
(Jones) University of British Columbia, Vancouver, BC, Canada
(Ogilvie) University Health Network, Departments of Medicine and
Pharmacology, University of Toronto, Toronto, ON, Canada
(Woo) University of Manitoba, Winnipeg, MB, Canada
(Kaczorowski) Universite de Montreal and CHUM, Montreal, QC, Canada
(Trudeau) Division of Internal Medicine, McGill University, Montreal, QC,
Canada
(Petrella) Department of Family Medicine, Western University, London, ON,
Canada
(Hiremath) Faculty of Medicine, University of Ottawa, Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(Drouin) Faculty of Medicine, Universite Laval, Quebec, QC, Canada
(Lavoie) Department of Psychology, University of Quebec at Montreal
(UQAM), Montreal, QC, Canada
(Hamet) Faculte de Medicine, Universite de Montreal, Montreal, QC, Canada
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Gregoire) Universite de Montreal, Institut de cardiologie de Montreal,
Montreal, QC, Canada
(Dresser) Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
(Sharma) The Canadian Stroke Network, Ottawa, ON, Canada
(Reid) Canadian Forces Health Services, Department of National Defence and
Dietitians of Canada, Ottawa, ON, Canada
(Lear) Faculty of Health Sciences, Simon Fraser University, Vancouver, BC,
Canada
(Moullec) Research Center, Hopital du Sacre-Coeur de Montreal, Public
Health School, University of Montreal, Montreal, QC, Canada
(Magee) St George's, University of London, London, United Kingdom
(Harris, Dionne) Department of Pediatrics, University of British Columbia,
Vancouver, BC, Canada
(Fournier) Service de cardiologie, Centre Hospitalier Universitaire
Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
(Benoit) Service de nephrologie, Centre Hospitalier Universitaire
Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
(Feber) Division of Neurology, Department of Pediatrics, Children's
Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
(Poirier) Centre Hospitalier Universitaire de Quebec et Faculte de
Pharmacie, Universite Laval, Quebec, QC, Canada
(Padwal) Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Rabi) Departments of Medicine, Community Health and Cardiac Sciences,
University of Calgary, Calgary, AB, Canada
Title
Hypertension Canada's 2016 Canadian Hypertension Education Program
Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk,
Prevention, and Treatment of Hypertension.
Source
Canadian Journal of Cardiology. 32 (5) (pp 569-588), 2016. Date of
Publication: 01 May 2016.
Publisher
Pulsus Group Inc.
Abstract
Hypertension Canada's Canadian Hypertension Education Program Guidelines
Task Force provides annually updated, evidence-based recommendations to
guide the diagnosis, assessment, prevention, and treatment of
hypertension. This year, we present 4 new recommendations, as well as
revisions to 2 previous recommendations. In the diagnosis and assessment
of hypertension, automated office blood pressure, taken without
patient-health provider interaction, is now recommended as the preferred
method of measuring in-office blood pressure. Also, although a serum lipid
panel remains part of the routine laboratory testing for patients with
hypertension, fasting and nonfasting collections are now considered
acceptable. For individuals with secondary hypertension arising from
primary hyperaldosteronism, adrenal vein sampling is recommended for those
who are candidates for potential adrenalectomy. With respect to the
treatment of hypertension, a new recommendation that has been added is for
increasing dietary potassium to reduce blood pressure in those who are not
at high risk for hyperkalemia. Furthermore, in selected high-risk
patients, intensive blood pressure reduction to a target systolic blood
pressure < 120 mm Hg should be considered to decrease the risk of
cardiovascular events. Finally, in hypertensive individuals with
uncomplicated, stable angina pectoris, either a beta-blocker or calcium
channel blocker may be considered for initial therapy. The specific
evidence and rationale underlying each of these recommendations are
discussed. Hypertension Canada's Canadian Hypertension Education Program
Guidelines Task Force will continue to provide annual updates.

<36>
Accession Number
20160314275
Author
Zajac P.; Zycinski P.; Qawoq H.; Jankowski L.; Peruga J.; Wcislo T.;
Pagorek P.; Peruga J.Z.; Kasprzak J.D.; Plewka M.
Institution
(Zajac, Zycinski, Qawoq, Jankowski, Wcislo, Pagorek, Peruga, Kasprzak,
Plewka) Department and Chr. of Cardiology, Medical University of Lodz, ul.
Kniaziewicza 1/5, Lodz 91-347, Poland
(Peruga) Cardiology Service, Ludwik Perzyna Regional Specialist Hospital,
Kalisz, Poland
Title
Outcomes of percutaneous coronary intervention in Patients after previous
coronary artery bypass surgery.
Source
Kardiologia Polska. 74 (4) (pp 322-330), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Patients after previous coronary artery bypass grafting (CABG)
often require repeat percutaneous revascularisation due to poor patency
rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data
are available to evaluate different percutaneous revascularisation
strategies in patients after previous CABG. Aim: To evaluate outcomes of
percutaneous coronary intervention (PCI) in patients after previous CABG,
including the effect of treatment on the quality of life and symptoms, and
secondly to assess the relation between angiographic factors and treatment
outcomes Methods: This was a prospective observational study which
included 78 patients after previous CABG. Following coronary angiography,
the patients were assigned to one of three groups: group A (n = 20), PCI
of a SVG (PCI SVG); group B (n = 29), PCI of a native coronary artery (PCI
NA); group C (n = 29), control group that received medical treatment (MT)
only. Duration of follow-up was 12 months. Results: Compared to MT
patients, patients treated with PCI had significantly higher Canadian
Cardiovascular Society (CCS) class (2.75 vs. 2.41, p = 0.03) and more
frequently had coronary angiography performed due to unstable angina (57%
vs. 31%, p = 0.04). Patients in the PCI SVG group had significantly older
SVG conduits compared to the PCI NA group (13.4 years vs. 8.2 years, p =
0.005). At 12 months of follow-up, we found a significant improvement in
the EQ-5D index of the quality of life, and a significant reduction in CCS
class in the PCI SVG group (0.66 vs. 0.7, p = 0.0003, and 2.75 vs. 1.9, p
< 0.001, respectively) and in the PCI NA group (0.65 vs. 0.72, p < 0.001,
and 2.75 vs. 2.17, p < 0.001, respectively), but no improvement in the MT
group. Treatment outcomes did not differ significantly between the three
groups (combined endpoint rate 20% vs. 13% vs. 27.5%, p = 0.37). In
multivariate analysis, SVG age > 11 years was identified as a significant
predictor of poor outcomes in patients treated with PCI after previous
CABG. Conclusions: PCI in patients after previous CABG does not improve
prognosis but significantly improves the quality of life and reduces
symptom severity.

<37>
Accession Number
20160336580
Author
Hu X.-L.; Chen Y.; Zhou Z.-D.; Ying J.; Hu Y.-H.; Xu G.-H.
Institution
(Hu, Chen, Zhou, Ying, Hu, Xu) Department of Anesthesiology, Second
Affiliated Hospital, Nanchang University, No. 1, Minde Road, Nanchang,
Jiangxi Province 330006, China
Title
Posterior pericardiotomy for the prevention of atrial fibrillation after
coronary artery bypass grafting: A meta-analysis of randomized controlled
trials.
Source
International Journal of Cardiology. 215 (pp 252-256), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Posterior pericardiotomy (PP) has been shown to be effective in
patients after cardiac surgery complicated by a reduced the incidence of
atrial fibrillation (AF). However, the role of PP in patients following
coronary artery bypass graft (CABG) remains ambiguous. We aimed to
systematically evaluate the efficacy of PP in preventing postoperative AF
in adult patients after CABG. Methods Studies were identified by searching
multiple electronic databases (PubMed, Embase, and the Cochrane Library)
through February, 2016, and by reviewing reference lists of obtained
articles. The outcome measure was the incidence of postoperative AF. The
meta-analysis was performed with the fixed-effect model or random-effect
model according to heterogeneity. Results Ten randomized trials
incorporating 1648 patients were included in this meta-analysis (822 in
the PP group and 826 in the control group). The cumulative incidence of AF
was 10.6% in the PP group and 24.9% in the control group. Meta-analysis
with all studies using a random-effects model suggested that PP had
significant effect on the prevention of postoperative AF (I²
55%; P < 0.00001; OR, 0.36; 95% CI, 0.23-0.56; RR, 0.45; 95% CI,
0.31-0.64). Sensitivity analyses by methodological quality and surgical
technique yields similar results. Conclusions This meta-analysis indicates
that PP shows beneficial efficacy in preventing postoperative AF in adult
patients after CABG. This finding encourages the use of PP to prevent
postoperative AF after CABG, but, more high quality randomized controlled
trials are still warranted to confirm the safety.

<38>
Accession Number
2015397295
Author
Meisner A.; Kerr K.F.; Thiessen-Philbrook H.; Coca S.G.; Parikh C.R.
Institution
(Meisner, Kerr) Department of Biostatistics, University of Washington,
Seattle, WA, United States
(Thiessen-Philbrook, Parikh) Section of Nephrology, Program of Applied
Translational Research, Department of Medicine, New Haven, CT, United
States
(Coca) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(Parikh) VA Medical Center, 60 Temple Street, New Haven, CT 06510, United
States
Title
Methodological issues in current practice may lead to bias in the
development of biomarker combinations for predicting acute kidney injury.
Source
Kidney International. 89 (2) (pp 429-438), 2016. Date of Publication: 01
Feb 2016.
Publisher
Elsevier
Abstract
Individual biomarkers of renal injury are only modestly predictive of
acute kidney injury (AKI). Using multiple biomarkers has the potential to
improve predictive capacity. In this systematic review, statistical
methods of articles developing biomarker combinations to predict AKI were
assessed. We identified and described three potential sources of bias
(resubstitution bias, model selection bias, and bias due to center
differences) that may compromise the development of biomarker
combinations. Fifteen studies reported developing kidney injury biomarker
combinations for the prediction of AKI after cardiac surgery (8 articles),
in the intensive care unit (4 articles), or other settings (3 articles).
All studies were susceptible to at least one source of bias and did not
account for or acknowledge the bias. Inadequate reporting often hindered
our assessment of the articles. We then evaluated, when possible (7
articles), the performance of published biomarker combinations in the
TRIBE-AKI cardiac surgery cohort. Predictive performance was markedly
attenuated in six out of seven cases. Thus, deficiencies in analysis and
reporting are avoidable, and care should be taken to provide accurate
estimates of risk prediction model performance. Hence, rigorous design,
analysis, and reporting of biomarker combination studies are essential to
realizing the promise of biomarkers in clinical practice.

<39>
Accession Number
20160349324
Author
Tacconi F.; Pompeo E.
Institution
(Tacconi, Pompeo) Department of Thoracic Surgery, Policlinico Tor Vergata
University, Rome, Italy
Title
Non-intubated video-assisted thoracic surgery: Where does evidence stand?.
Source
Journal of Thoracic Disease. 8 (pp S364-S375), 2016. Date of Publication:
01 Apr 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
In recent years, non-intubated video-assisted thoracic surgery (NIVATS)
strategies are gaining popularity worldwide. The main goal of this
surgical practice is to achieve an overall improvement of patients'
management and outcome thanks to the avoidance of side-effects related to
general anesthesia (GA) and one-lung ventilation. The spectrum of expected
benefits is multifaceted and includes reduced postoperative morbidity,
faster discharge, decreased hospital costs and a globally reduced
perturbation of patients' well-being status. We have conducted a
literature search to evaluate the available evidence on this topic.
Meta-analysis of collected results was also done where appropriate.
Despite some fragmentation of data and potential biases, the available
data suggest that NIVATS operations can reduce operative morbidity and
hospital stay when compared to equipollent procedures performed under GA.
Larger, well designed prospective studies are thus warranted to assess the
effectiveness of NIVATS as far as to investigate comprehensively the
various outcomes. Multi-institutional and multidisciplinary cooperation
will be welcome to establish uniform study protocols and to help address
the questions that are to be answered yet.

<40>
Accession Number
20160340478
Author
Rashidi M.; Esmaily S.; Fiane A.E.; Gude E.; Atonseth K.; Ueland T.;
Gustafsson F.; Eiskjaer H.; Radegran G.; Dellgren G.
Institution
(Rashidi, Fiane) Department of Cardiothoracic Surgery, Oslo University
Hospital, Oslo, Norway
(Rashidi, Atonseth) Department of Plastic and Reconstructive Surgery, Oslo
University Hospital, Oslo, Norway
(Esmaily, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Fiane, Atonseth, Ueland) Faculty of Medicine, University of Oslo, Norway
(Gude) Department of Cardiology, Oslo University Hospital, Oslo, Norway
(Ueland) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen Inflammatory Research Center, University of Oslo,
Oslo, Norway
(Ueland) K.G. Jebsen Thrombosis Research and Expertise Center, University
of Tromso, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital and Department of Clinical Sciences Lund, Cardiology, Lund
University, Lund, Sweden
Title
Wound complications and surgical events in de novo heart transplant
patients treated with everolimus: Post-hoc analysis of the SCHEDULE trial.
Source
International Journal of Cardiology. 210 (pp 80-84), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives The use of mammalian target of rapamycin (mTOR) inhibitors have
been limited by adverse events (AE), including delayed wound healing. We
retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian
heart transplant (HTx) everolimus (EVE) de novo trial with early
calcineurin (CNI) avoidance (SCHEDULE). The aim of the study was to
compare wound complications between EVE and CNI based regimen. Materials
and methods A total of 115 patients (mean age 51 +/- 13 years, 73% men)
were randomized within five days post-HTx to low dose EVE and reduced dose
Cyclosporine (CyA) followed by early CyA withdrawal (EVE group; n = 56) or
standard CyA regimen (CyA group; n = 59). All AE/SAEs were prospectively
recorded according to the SCHEDULE study protocol, and re-assessed
retrospectively by two independent reviewers. Wound complication as
primary endpoint was defined as any complication associated with failure
of tissue healing. Secondary endpoint was total number of events involving
surgical intervention. Results There were no significant differences
between the groups with regards to wound complications (EVE = 20, CyA =
12)(p = 0.08) or total surgical events (EVE = 38, CyA = 34) (p = 0.44).
Age > 54.5 years (median) was an overall risk factor for surgical wound
complications regardless of treatment group (p = 0.025). There was no
difference in the EVE versus CyA group with regards to other surgical
events. Majority of events were in 1/3 of the patients. Conclusion De novo
initiation of EVE and early CyA withdrawal in HTx patients did not show
any significant differences in wound complications or in total surgical
events. Majority of complications were seen in a small number of patients.

<41>
Accession Number
20160312145
Author
Karimi Galougahi K.; Maehara A.; Mintz G.S.; Shlofmitz R.A.; Stone G.W.;
Ali Z.A.
Institution
(Karimi Galougahi, Maehara, Stone, Ali) Center for Interventional Vascular
Therapy, Division of Cardiology, New York Presbyterian Hospital and
Columbia University, New York, NY, United States
(Karimi Galougahi, Maehara, Mintz, Stone, Ali) Cardiovascular Research
Foundation, New York, NY, United States
(Shlofmitz) St. Francis Hospital, Roslyn, New York, NY, United States
Title
Update on Intracoronary Optical Coherence Tomography: a Review of Current
Concepts.
Source
Current Cardiovascular Imaging Reports. 9 (6) (no pagination), 2016.
Article Number: 16. Date of Publication: 01 Jun 2016.
Publisher
Current Medicine Group LLC 1
Abstract
Purpose of review: The advent of intracoronary optical coherence
tomography (OCT) has been a significant leap forward in the ability to
visualize coronary structures with unprecedented resolution. However, the
clinical application of this imaging modality has lagged behind rapid
technological advances. One of the main reasons for the lack of wider
clinical uptake has been the paucity of appropriately designed prospective
randomized studies to demonstrate the impact of OCT on outcome measures
after percutaneous coronary intervention (PCI). Recent findings: Over the
last couple of years, studies from large registries have shown the impact
of OCT in decision-making in PCI, with several further reports providing
valuable insights into the natural history of the atherosclerotic disease
process and the modulating effects of therapies. Furthermore, guidance of
PCI by OCT, including the appropriate use of newer generations of coronary
stents, has been the focus of multiple studies. Summary: In this
contemporary review, we provide a brief overview of the recently published
data and highlight the multiple areas that need further clarification as
OCT is further incorporated into routine clinical practice.

<42>
Accession Number
20160309978
Author
Nappi F.; Spadaccio C.; Chello M.; Lusini M.; Acar C.
Institution
(Nappi, Spadaccio, Chello, Lusini) Department of Cardiovascular Surgery,
University Campus Bio-Medico, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint
Denis, France
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
Title
Double row of overlapping sutures for downsizing annuloplasty decreases
the risk of residual regurgitation in ischaemicmitral valve repair.
Source
European Journal of Cardio-thoracic Surgery. 49 (4) (pp 1182-1187), 2016.
Article Number: ezv291. Date of Publication: 01 Apr 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The aim of this study was to evaluate a novel insertion
technique of the prosthetic ring that would further magnify the degree of
annulus narrowing, thereby reducing the potential for a residual leak in
ischaemic mitral valve repair. METHODS: Thirty-six patients with ischaemic
mitral regurgitation (MR) were randomly assigned into two groups. In 18
patients, the prosthetic ring was inserted in the conventional manner with
a single row of sutures (control group). In the remaining 18 patients, the
ring was attached using a double row of sutures tied both on the inner and
on the outer part of the sewing cuff. Both groups had similar preoperative
clinical and echocardiographic characteristics with severe leaflet
tethering: mean tenting area >2.5 cm², mean anterior leaflet
angle >25degree and posterior leaflet angle >45degree. The mean prosthetic
ring sizes inserted in both groups were identical (mean: 27.3 mm).
RESULTS: At 12 months, there was no clinical event except for 1
rehospitalization in the control group. The mean mitral regurgitation
grade was higher in the control group than in the group with the double
row of sutures at 1.6 +/- 0.9 vs 0.7 +/- 0.3 (P = 0.0003). Annulus
diameter reduction was less pronounced in the control group when compared
with the group with the double row of sutures, both in the parasternal
long-axis: 29.3 +/- 3 vs 26.3 +/- 3 mm (P = 0.0003) and in apical
four-chamber views: 31 +/- 3 vs 28 +/- 2 mm (P = 0.003). Leaflet tethering
indices were greater in the control group than in the group with the
double row of sutures: tenting area: 1.42 +/- 0.3 vs 1.1 +/- 0.5 cm2 (P =
0.002), anterior leaflet angle: 33 +/- 3degree vs 28 +/- 5degree (P =
0.0009) and posterior leaflet angle: 110 +/- 13degree vs 80 +/- 11degree
(P = 0.0001). Left ventricular function parameters were not statistically
different among the two groups. CONCLUSION: A double row of overlapping
sutures for attaching the prosthetic ring in downsizing annuloplasty is
more efficient in narrowing the mitral annulus than the conventional
technique in ischaemic mitral repair. Even in high-risk patients whose
leaflets were severely tethered on echocardiography, it almost eliminated
the risk of MR recurrence in this study.

<43>
Accession Number
20160309951
Author
Deppe A.-C.; Arbash W.; Kuhn E.W.; Slottosch I.; Scherner M.; Liakopoulos
O.J.; Choi Y.-H.; Wahlers T.
Institution
(Deppe, Arbash, Kuhn, Slottosch, Scherner, Liakopoulos, Choi, Wahlers)
Department of Cardiothoracic Surgery, Heart Center of the University of
Cologne, Cologne, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Current evidence of coronary artery bypass grafting off-pump versus
on-pump: A systematic review with meta-analysis of over 16 900 patients
investigated in randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 49 (4) (pp 1031-1041), 2016.
Article Number: ezv268. Date of Publication: 01 Apr 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
In the present systematic review with meta-analysis, we sought to
determine the current strength of evidence for or against off-pump and
on-pump coronary artery bypass grafting (CABG) with regard to hard
clinical end-points, graft patency and cost-effectiveness. We performed a
meta-analysis of only randomized controlled trials (RCT) which reported at
least one of the desired end-points including: (i) major adverse cardiac
and cerebrovascular events (MACCE), (ii) all-cause mortality, (iii)
myocardial infarction, (iv) cerebrovascular accident, (v) repeat
revascularization, (vi) graft patency and (vii) cost-effectiveness. The
pooled treatment effects [odds ratio (OR) or weighted mean difference, 95%
confidence intervals (95% CIs)] were assessed using a fixed or random
effects model. A total of 16 904 patients from 51 studies were identified
after literature search of the major databases using a predefined keyword
list. The incidence of MACCE did not differ between the groups, neither
during the first 30 days (OR: 0.93; 95% CI: 0.82-1.04) nor for the longest
available follow-up (OR: 1.01; 95% CI: 0.92-1.12). While the incidence of
mid-term graft failure (OR: 1.37; 95% CI: 1.09-1.72) and the need for
repeat revascularization (OR: 1.55; 95% CI: 1.33-1.80) was increased after
off-pump surgery, on-pump surgery was associated with an increased
occurrence of stroke (OR: 0.74; 95% CI: 0.58-0.95), renal impairment (OR:
0.79; 95% CI: 0.71-0.89) and mediastinitis (OR: 0.44; 95% CI: 0.31-0.62).
There was no difference with regard to hard clinical end-points between
on- or off-pump surgery, including myocardial infarction or mortality. The
present systematic review emphasizes that both off- and on-pump surgery
provide excellent and comparable results in patients requiring surgical
revascularization. The choice for either strategy should take into account
the individual patient profile (comorbidities, life expectancy, etc.) and
importantly, the surgeon's experience in performing on- or off-pump CABG
in their routine practice.

<44>
Accession Number
2015342731
Author
Aggarwal R.; Harling L.; Efthimiou E.; Darzi A.; Athanasiou T.; Ashrafian
H.
Institution
(Aggarwal, Harling, Efthimiou, Darzi, Athanasiou, Ashrafian) The
Department of Surgery and Cancer, Imperial College London, 10th Floor,
Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College
Healthcare NHS Trust at St Mary's Hospital, Praed Street, London W2 1NY,
United Kingdom
(Harling, Athanasiou) Department of Cardiothoracic Surgery, Imperial
College Healthcare NHS Trust, London, United Kingdom
(Efthimiou, Ashrafian) Department of Bariatric Surgery, Chelsea and
Westminster Hospital, London, United Kingdom
Title
The Effects of Bariatric Surgery on Cardiac Structure and Function: a
Systematic Review of Cardiac Imaging Outcomes.
Source
Obesity Surgery. 26 (5) (pp 1030-1040), 2016. Date of Publication: 01 May
2016.
Publisher
Springer New York LLC
Abstract
Background: Obesity is associated with cardiac dysfunction,
atherosclerosis, and increased cardiovascular risk. It can be lead to
obesity cardiomyopathy and severe heart failure, which in turn raise
morbidity and mortality while carrying a negative impact on quality of
life. There is increasing clinical and mechanistic evidence on the
metabolic and weight loss effects of bariatric surgery on improving
cardiac structure and function in obese patients. Objectives: The
objective of this study was to quantify the effects of bariatric surgery
on cardiac structure and function by appraising cardiac imaging changes
before and after metabolic operations. Methods: This is a comprehensive
systematic review of studies reporting pre-operative and post-operative
echocardiographic or magnetic resonance cardiac indices in obese patients
undergoing bariatric surgery. Studies were quality scored, and data were
meta-analyzed using random effects modeling. Results: Bariatric surgery is
associated with significant improvements in the weighted incidence of a
number of cardiac indices including a decrease in left ventricular mass
index (11.2 %, 95 % confidence intervals (CI) 8.2-14.1 %), left
ventricular end-diastolic volume (13.28 ml, 95 % CI 5.22-21.34 ml), and
left atrium diameter (1.967 mm, 95 % CI 0.980-2.954). There were
beneficial increases in left ventricular ejection fraction (1.198 %, 95
%CI -0.050-2.347) and E/A ratio (0.189 %, 95 %CI -0.113-0.265).
Conclusions: Bariatric surgery offers beneficial cardiac effects on
diastolic function, systolic function, and myocardial structure in obese
patients. These may derive from surgical modulation of an enterocardiac
axis. Future studies must focus on higher evidence levels to better
identify the most successful bariatric approaches in preventing and
treating the broad spectrum of obesity-associated heart disease while also
enhancing treatment strategies in the management of obesity
cardiomyopathy.

<45>
Accession Number
2015427490
Author
Cho J.S.; Shim J.-K.; Soh S.; Kim M.K.; Kwak Y.-L.
Institution
(Cho, Shim, Soh, Kim, Kwak) Department of Anesthesiology and Pain
Medicine, Anesthesia and Pain Research Institute, Yonsei Cardiovascular
Hospital, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-gu, Seoul 120-752, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Perioperative dexmedetomidine reduces the incidence and severity of acute
kidney injury following valvular heart surgery.
Source
Kidney International. 89 (3) (pp 693-700), 2016. Date of Publication: 01
Mar 2016.
Publisher
Elsevier
Abstract
Acute kidney injury (AKI) following cardiac surgery is closely
interrelated with hemodynamic instability and sympathetic activity, and
adversely influences prognosis. Here, we investigated in a randomized
placebo-controlled trial whether dexmedetomidine, an alpha2 adrenoreceptor
agonist, could prevent AKI after valvular heart surgery. Two hundred
patients undergoing valvular heart surgery were randomly assigned to equal
placebo or treatment groups. Dexmedetomidine was infused at a rate of 0.4
mug/kg/h starting immediately after anesthetic induction and continuing
for 24 h after surgery. We then assessed the incidence of AKI during the
first 48 postoperative hours, hemodynamic variables, and a composite of
major morbidity end points. The incidence of AKI, based on Acute Kidney
Injury Network criteria, was significantly lower in the treatment group
compared with the control group (14 vs. 33%). The dexmedetomidine group
exhibited a significantly lower incidence of a composite of major
morbidity end points (21 vs. 38%) and a significantly shorter length of
intensive care unit stay (3 [2, 3] days vs. 3 [2, 4] days) compared with
the control group. Thus, perioperative infusion of dexmedetomidine
effectively reduced both the incidence and severity of AKI, and improved
outcome in patients undergoing valvular heart surgery without untoward
hemodynamic side effects.

<46>
Accession Number
20160304690
Author
Ather S.; Bavishi C.P.; Bhatia V.; Bajaj N.S.; Leesar M.A.
Institution
(Ather, Bhatia, Bajaj, Leesar) Division of Cardiology, University of
Alabama at Birmingham, Birmingham, AL, United States
(Bavishi) Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital
Center, New York, NY, United States
Title
Comparison of failure rates of crossing side branch with pressure vs.
coronary guidewire: A meta-analysis.
Source
European Journal of Clinical Investigation. 46 (5) (pp 448-459), 2016.
Date of Publication: 01 May 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: The aim of this study was to compare the failure rates of
crossing side branch (SB) with pressure guidewire vs. coronary guidewire
after main vessel (MV) stenting in coronary bifurcation lesions (CBL).
Background: Percutaneous coronary intervention of CBL is technically
difficult. The European Bifurcation Club recommends performing either
fractional flow reserve (FFR) estimation of the SB or final kissing
balloon inflation (FKBI) after the MV stenting when a significant SB
ostial stenosis is present. Even though FFR is recommended in CBL, there
is concern about SB crossing with pressure guidewire among
interventionists. Materials and methods: We undertook a comprehensive
literature search to identify all relevant studies reporting the failure
rates of SB crossing after MV stenting with either pressure or coronary
guidewire. A random effects model was used to compare the failure rates
between the two approaches. Results: Our search identified six studies
that reported failure rates of SB crossing with a pressure guidewire (n =
648) and 11 studies that reported failure rates of SB crossing with a
coronary guide-wire (n = 2601). Estimated pooled failure rate was 3.9%
(95% CI: 1.5% to 9.6%) for inability to cross SB with pressure guidewire.
Estimated pooled failure rate of SB crossing with coronary guidewire was
3.1% (95% CI: 1.5% to 6.2%). There was no significant difference between
the failure rates in the two groups (P = 0.70). Conclusion: The failure
rates of SB crossing after MV stenting are low with both pressure and
coronary guidewire procedures, with no significant difference between the
two approaches.

<47>
Accession Number
20160302192
Author
Padulles A.; Colom H.; Bestard O.; Melilli E.; Sabe N.; Rigo R.; Niubo J.;
Torras J.; Llado L.; Manito N.; Caldes A.; Cruzado J.M.; Griny J.M.;
Lloberas N.
Institution
(Padulles) IDIBELL, Pharmacy Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Colom) Pharmacy and Pharmaceutical Technology Department, School of
Pharmacy, University of Barcelona, Barcelona, Spain
(Bestard, Melilli, Torras, Caldes, Cruzado, Griny, Lloberas) IDIBELL,
Nephrology Department, Hospital Universitari de Bellvitge, Barcelona,
Spain
(Sabe) IDIBELL, Infectious Diseases Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Rigo) IDIBELL, Biochemistry Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Niubo) IDIBELL, Microbiology Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Llado) IDIBELL, Digestive Surgery Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Manito) IDIBELL, Cardiology Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
Title
Contribution of population pharmacokinetics to dose optimization of
ganciclovir-valganciclovir in solid-organ transplant patients.
Source
Antimicrobial Agents and Chemotherapy. 60 (4) (pp 1992-2002), 2016. Date
of Publication: April 2016.
Publisher
American Society for Microbiology
Abstract
Treatment of solid-organ transplant (SOT) patients with ganciclovir
(GCV)-valganciclovir (VGCV) according to the manufacturer's
recommendations may result in over- or underexposure. Bayesian prediction
based on a population pharmacokinetics model may optimize GCV-VGCV dosing,
achieving the area under the curve (AUC) therapeutic target. We conducted
a two-arm, randomized, open-label, 40% superiority trial in adult SOT
patients receiving GCV-VGCV as prophylaxis or treatment of cytomegalovirus
infection. Group A was treated according to the manufacturer's
recommendations. For group B, the dosing was adjusted based on target
exposures using a Bayesian prediction model (NONMEM). Fifty-three patients
were recruited (27 in group A and 26 in group B). About 88.6% of patients
in group B and 22.2% in group A reached target AUC, achieving the 40%
superiority margin (P<0.001; 95% confidence interval [CI] difference, 47
to 86%). The time to reach target AUC was significantly longer in group A
than in group B (55.9+/-8.2 versus 15.8 2.3 days, P<0.001). A shorter time
to viral clearance was observed in group B than in group A (12.5 versus
17.6 days; P 0.125). The incidences of relapse (group A, 66.67%, and group
B, 9.01%) and late-onset infection (group A, 36.7%, and group B, 7.7%)
were higher in group A. Neutropenia and anemia were related to GCV
overexposure. GCV-VCGV dose adjustment based on a population
pharmacokinetics Bayesian prediction model optimizes GCV-VGCV exposure.
(This study has been registered at ClinicalTrials.gov under registration
no. NCT01446445.).

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 23

Results Generated From:
Embase <1980 to 2016 Week 19>
Embase (updates since 2016-04-28)

<1>
Accession Number
26433633
Author
Kowalewski M.; Pawliszak W.; Malvindi P.G.; Bokszanski M.P.; Perlinski D.;
Raffa G.M.; Kowalkowska M.E.; Zaborowska K.; Navarese E.P.; Kolodziejczak
M.; Kowalewski J.; Tarelli G.; Taggart D.P.; Anisimowicz L.
Institution
(Kowalewski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland; Faculty of Health Sciences,
Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland;
Systematic Investigation and Research on Interventions and Outcomes
(SIRIO) MEDICINE Research Network, Dusseldorf, Germany. Electronic
address:
(Pawliszak) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Bokszanski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
(Perlinski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo
per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Kowalkowska) Systematic Investigation and Research on Interventions and
Outcomes (SIRIO) MEDICINE Research Network, Dusseldorf, Germany;
Department and Clinic of Obstetrics, Gynecology, and Oncological
Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Zaborowska) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
(Navarese) Systematic Investigation and Research on Interventions and
Outcomes (SIRIO) MEDICINE Research Network, Dusseldorf, Germany; Division
of Cardiology, Pulmonology and Vascular Medicine, Department of Internal
Medicine, Heinrich-Heine-University, Dusseldorf, Germany
(Kolodziejczak) Systematic Investigation and Research on Interventions and
Outcomes (SIRIO) MEDICINE Research Network, Dusseldorf, Germany; Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Tarelli) Department of Cardiac Surgery, Humanitas Clinical and Research
Center, Rozzano, Milan, Italy
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
Title
Off-pump coronary artery bypass grafting improves short-term outcomes in
high-risk patients compared with on-pump coronary artery bypass grafting:
Meta-analysis.
Source
The Journal of thoracic and cardiovascular surgery. 151 (1) (pp 60-77),
2016. Date of Publication: 01 Jan 2016.
Abstract
OBJECTIVES: To assess the benefits and risks of off-pump coronary artery
bypass (OPCAB) versus coronary artery bypass grafting (CABG) through a
meta-analysis of randomized controlled trials (RCTs), and to investigate
the relationship between outcomes and patient risk profile.
METHODS: PubMed, Embase, the Cumulative Index of Nursing and Allied Health
Literature, Scopus, Web of Science, Cochrane Library, and major conference
proceedings databases were searched for RCTs comparing OPCAB and CABG and
reporting short-term (< 30 days) outcomes. Endpoints assessed were
all-cause mortality, myocardial infarction (MI), and cerebral stroke.
RESULTS: The meta-analysis included 100 studies, with a total of 19,192
subjects. There was no difference between the 2 techniques with respect to
all-cause mortality and MI (odds ratio [OR], 0.88; 95% confidence interval
[CI], 0.71-1.09; P = .25; I(2) = 0% and OR, 0.90; 95% CI, 0.77-1.05; P =
.19; I(2) = 0%, respectively). OPCAB was associated with a significant 28%
reduction in the odds of cerebral stroke (OR, 0.72; 95% CI, 0.56-0.92; P =
.009; I(2) = 0%). A significant relationship between patient risk profile
and benefits from OPCAB was found in terms of all-cause mortality (P <
.01), MI (P < .01), and cerebral stroke (P < .01).
CONCLUSIONS: OPCAB is associated with a significant reduction in the odds
of cerebral stroke compared with conventional CABG. In addition, benefits
of OPCAB in terms of death, MI, and cerebral stroke are significantly
related to patient risk profile, suggesting that OPCAB should be strongly
considered in high-risk patients.

<2>
Accession Number
27040723
Author
Velazquez E.J.; Lee K.L.; Jones R.H.; Al-Khalidi H.R.; Hill J.A.; Panza
J.A.; Michler R.E.; Bonow R.O.; Doenst T.; Petrie M.C.; Oh J.K.; She L.;
Moore V.L.; Desvigne-Nickens P.; Sopko G.; Rouleau J.L.
Institution
(Velazquez) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Lee) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Jones) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Al-Khalidi) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Hill) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Panza) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Michler) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Bonow) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Doenst) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Petrie) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Oh) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(She) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Moore) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Desvigne-Nickens) From the Division of Cardiology (E.J.V.), Departments
of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery
(R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke
University Medical Center, Durham, NC; the University of Florida,
Gainesville (J.A.H.); Westchester Medical Center and New York Medical
College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular
Surgery, Montefiore Medical Center, Albert Einstein College of Medicine,
New York (R.E.M.); Northwestern University Feinberg School of Medicine,
Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University
Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany
(T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow,
United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division
of Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Sopko) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
(Rouleau) From the Division of Cardiology (E.J.V.), Departments of
Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.),
and Duke Clinical Research Institute (L.S., V.L.M.), Duke University
Medical Center, Durham, NC; the University of Florida, Gainesville
(J.A.H.); Westchester Medical Center and New York Medical College,
Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York
(R.E.M.); Northwestern University Feinberg School of Medicine, Chicago
(R.O.B.); the Department of Cardiothoracic Surgery, University Hospital
Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow
University and Golden Jubilee National Hospital, Glasgow, United Kingdom
(M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of
Cardiovascular Sciences, National Heart, Lung, and Blood Institute,
Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart
Institute, Montreal (J.L.R.)
Title
Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.
Source
The New England journal of medicine. 374 (16) (pp 1511-1520), 2016. Date
of Publication: 21 Apr 2016.
Abstract
BACKGROUND: The survival benefit of a strategy of coronary-artery bypass
grafting (CABG) added to guideline-directed medical therapy, as compared
with medical therapy alone, in patients with coronary artery disease,
heart failure, and severe left ventricular systolic dysfunction remains
unclear.
METHODS: From July 2002 to May 2007, a total of 1212 patients with an
ejection fraction of 35% or less and coronary artery disease amenable to
CABG were randomly assigned to undergo CABG plus medical therapy (CABG
group, 610 patients) or medical therapy alone (medical-therapy group, 602
patients). The primary outcome was death from any cause. Major secondary
outcomes included death from cardiovascular causes and death from any
cause or hospitalization for cardiovascular causes. The median duration of
follow-up, including the current extended-follow-up study, was 9.8 years.
RESULTS: A primary outcome event occurred in 359 patients (58.9%) in the
CABG group and in 398 patients (66.1%) in the medical-therapy group
(hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval
[CI], 0.73 to 0.97; P=0.02 by log-rank test). A total of 247 patients
(40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy
group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to
0.93; P=0.006 by log-rank test). Death from any cause or hospitalization
for cardiovascular causes occurred in 467 patients (76.6%) in the CABG
group and in 524 patients (87.0%) in the medical-therapy group (hazard
ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test).
CONCLUSIONS: In a cohort of patients with ischemic cardiomyopathy, the
rates of death from any cause, death from cardiovascular causes, and death
from any cause or hospitalization for cardiovascular causes were
significantly lower over 10 years among patients who underwent CABG in
addition to receiving medical therapy than among those who received
medical therapy alone. (Funded by the National Institutes of Health; STICH
[and STICHES] ClinicalTrials.gov number, NCT00023595.).

<3>
Accession Number
26541831
Author
Etnel J.R.; Elmont L.C.; Ertekin E.; Mokhles M.M.; Heuvelman H.J.;
Roos-Hesselink J.W.; de Jong P.L.; Helbing W.A.; Bogers A.J.; Takkenberg
J.J.
Institution
(Etnel) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Elmont) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Ertekin) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Mokhles) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Heuvelman) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, The Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, The Netherlands
(de Jong) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Helbing) Department of Pediatric Cardiology, Erasmus University Medical
Center-Sophia Children's Hospital, Rotterdam, The Netherlands
(Bogers) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, The Netherlands
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, The Netherlands. Electronic address:
j.j.m.takkenberg@erasmusmc.nl
Title
Outcome after aortic valve replacement in children: A systematic review
and meta-analysis.
Source
The Journal of thoracic and cardiovascular surgery. 151 (1) (pp 143-152),
2016. Date of Publication: 01 Jan 2016.
Abstract
RESULTS: Thirty-four publications reporting on 42 cohorts were included in
this review: 26 concerning the Ross procedure (n = 2409), 13 concerning
mechanical prosthesis aortic valve replacement (n = 696), and 3 concerning
homograft aortic valve replacement (n = 224). There were no studies on
bioprostheses that met our inclusion criteria. The pooled mean patient age
was 9.4 years, 12.8 years, and 8.9 years for Ross, mechanical prosthesis,
and homograft recipients, respectively. Pooled mean follow-up was 6.6
years. The Ross procedure was associated with lower early (4.20%; 95%
confidence interval [CI], 3.37-5.22 vs 7.34%; 95% CI, 5.21-10.34 vs
12.82%; 95% CI, 8.91-18.46) and late mortality (0.64%/y; 95% CI, 0.49-0.84
vs 1.23%/y; 95% CI, 0.85-1.79 vs 1.59%/y; 95% CI, 1.03-2.46) compared with
mechanical prosthesis aortic valve replacement and homograft aortic valve
replacement, respectively. No significantly different aortic valve
reoperation rates were observed between the Ross procedure and mechanical
prosthesis aortic valve replacement (1.60%/y; 95% CI, 1.27-2.02 vs
1.07%/y; 95% CI, 0.68-1.68, respectively), whereas homograft aortic valve
replacement was associated with significantly higher aortic valve
reoperation rates (5.44%/y; 95% CI, 4.24-6.98). The Ross
procedure-associated right ventricular outflow tract reoperation rate was
1.91% per year (95% CI, 1.50-2.44).
CONCLUSIONS: This systematic review illustrates that all currently
available aortic valve substitutes are associated with suboptimal results
in children, reflecting the urgent need for reliable and durable repair
techniques and innovative replacement solutions for this challenging group
of patients.
METHODS: A systematic literature search for publications reporting outcome
after pediatric aortic valve replacement published between January 1990
and May 2015 was conducted. Studies written in English with a study size
of more than 30 patients were included.
OBJECTIVE: Despite an increasing interest in pediatric aortic valve
repair, aortic valve replacement in children may be unavoidable. The
evidence on outcome after pediatric aortic valve replacement is limited
and usually reported in small case series. This systematic review and
meta-analysis aims to provide an overview of reported outcome of pediatric
patients after aortic valve replacement.

<4>
Accession Number
20160153197
Author
Liao Y.-B.; He Z.-X.; Zhao Z.-G.; Wei X.; Zuo Z.-L.; Li Y.-J.; Xiong
T.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, He, Zhao, Wei, Zuo, Li, Xiong, Xu, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
Title
The relationship between chronic obstructive pulmonary disease and
transcatheter aortic valve implantation - A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (pp 570-578), 2016.
Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective The present study was performed to investigate the relationship
between chronic obstructive pulmonary disease (COPD) and transcatheter
aortic valve implantation (TAVI). Background: Controversies regarding the
relationship between COPD and TAVI have intensified. Methods: A literature
review of the PubMed online database was performed, and articles published
between January 1, 2002 and March 20, 2015 were analyzed. Random-effect
and fixed-effect models were used, depending on the between-study
heterogeneity. Results: A total of 28 studies, involving 51,530 patients,
were identified in our review. The burden of COPD ranged from 12.5% to
43.4%, and COPD negatively impacted both short-term and long-term
all-cause survival (30 days: odds ratio [OR], 1.43, 95% CI, 1.14-1.79; >2
years: hazard ratio [HR], 1.34, 95% CI, 1.12-1.61). COPD was also
associated with increased short-term and mid-term cardiac-cause mortality
(30 days: OR, 1.29, 95% CI, 1.02-1.64; 1 year: HR: 1.09, 1.02-1.17).
Moreover, COPD (OR, 1.97, 95% CI, 1.29-3.0) predicted post-TAVI acute
kidney disease. Importantly, chronic kidney disease (CKD) (HR, 1.2, 95%
CI, 1.1-1.32) and the distance of the 6 minute walk test (6MWT) (HR, 1.16,
1.06-1.27) predicted TAVI futility in patients with COPD. Conclusion: COPD
is common among patients undergoing TAVI, and COPD impacts both short- and
long-term survival. COPD patients, who had a lower BMI, shorter distance
of 6MWT and CKD, were at higher risk for TAVI futility.

<5>
[Use Link to view the full text]
Accession Number
20160060161
Author
Zhang L.; Gao S.
Institution
(Zhang, Gao) Department of Cerebral Surgery, Cancer Hospital Chinese,
Academy of Medical Sciences, No. 17, Panjiayuan Chaoyang District, Beijing
100021, China
Title
Systematic review and meta-analysis of atrial fibrillation prophylaxis
after lung surgery.
Source
Journal of Cardiovascular Pharmacology. 67 (4) (pp 351-357), 2016. Date of
Publication: April 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Atrial fibrillation (AF), which increases morbidity and mortality, is a
common occurrence after thoracic surgery and pulmonary resection. Despite
several investigations on various prophylactic measures for AF prevention,
the studies were not uniform and do not use similar controls making it
difficult to arrive at a meaningful conclusion. In the present systematic
analysis review, we evaluated the efficacy of different prophylactic
approaches to prevent AF after lung surgery in randomized trials reported
during 1991-2014. A total of 12 trials were identified that met the
criteria set for this meta-analysis. Among different trials, amiodarone
was found to be most effective in preventing postoperative AF (risk ratio,
0.22; P < 0.0001;95% confidence interval: 0.09-0.54). There were no
significant prophylactic effects by MgSO4 (risk ratio, 1.24; P < 0.007;
95% confidence interval, 0.27-5.68), digoxin, or Ca²⁺ blockers.
Single use of amiodarone was able to lower the incidence of AF from 39.2%
to 8.3% and seemed to be safe with no major complications. Although
several prophylactic measures have been tried to curtail the incidence of
AF in patients after lung surgery, prophylaxis with amiodarone seems to be
most effective of treatments studied.

<6>
Accession Number
20160318746
Author
Ando T.; Briasoulis A.; Holmes A.A.; Afonso L.; Schreiber T.; Kondur A.
Institution
(Ando, Briasoulis, Afonso, Schreiber, Kondur) Wayne State University,
Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, United
States
(Holmes) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY 10467, United States
Title
Transcatheter aortic valve replacement versus surgical aortic valve
replacement in patients with previous coronary artery bypass surgery: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 215 (pp 14-19), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Patients with severe aortic stenosis (AS) and previous coronary
artery bypass graft (CABG) surgery have increased risk for aortic valve
replacement. Whether surgical aortic valve replacement (SAVR) or
transcatheter aortic valve replacement (TAVR) offers better outcomes in
this population is unclear. We aimed to assess outcomes of TAVR and SAVR
in patients with previous CABG. Methods A systematic literature search of
Medline, EMBASE and Cochrane library was conducted. Studies that reported
clinical outcomes (perioperative or mid-term all-cause-mortality,
cardiovascular mortality, pacemaker implantation, hospital duration and
stroke) were included. Random-effect modeling was used to calculate odds
ratios (ORs) and 95% confidence intervals (CIs). Results Five cohort
studies including a total of 872 patients (423 in TAVR, 449 in SAVR) were
analyzed. STS scores were comparable between the two groups. No difference
in all-cause-mortality, cardiovascular mortality and stroke at 30 days, 1
year and total follow-up period was seen between the two groups. TAVR
patients had higher pacemaker implantation rates (OR 3.41, 95% CI
1.66-6.38, p < 0.001, I² = 21%) and shorter hospital stay (-
2.63 days, 95% CI - 5.20 to - 0.04, p = 0.05, I² = 43%).
Conclusions Patients with previous CABG who underwent TAVR had similar
perioperative and long-term survival while experiencing more pacemaker
implantations and shorter hospital stay compared to those who had SAVR
making TAVR a safe and efficacious alternative to SAVR.

<7>
Accession Number
20160323297
Author
O'Donoghue M.L.; Glaser R.; Cavender M.A.; Aylward P.E.; Bonaca M.P.;
Budaj A.; Davies R.Y.; Dellborg M.; Fox K.A.A.; Gutierrez J.A.T.; Hamm C.;
Kiss R.G.; Kovar F.; Kuder J.F.; Im K.A.; Lepore J.J.; Lopez-Sendon J.L.;
Ophuis T.O.; Parkhomenko A.; Shannon J.B.; Spinar J.; Tanguay J.-F.; Ruda
M.; Steg P.G.; Theroux P.; Wiviott S.D.; Laws I.; Sabatine M.S.; Morrow
D.A.
Institution
(O'Donoghue, Cavender, Bonaca, Gutierrez, Kuder, Im, Wiviott, Sabatine,
Morrow) TIMI Study Group, Cardiovascular Division, Brigham and Women's
Hospital, 350 Longwood Ave, Boston, MA 02115, United States
(Glaser, Davies, Lepore, Laws) Metabolic Pathways and Cardiovascular Unit,
Research and Development, GlaxoSmithKline, Collegeville, PA, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Dellborg) Sahlgrenska University Hospital, Ostra and Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Hamm) Kerckhoff Heart Center, Bad Nauheim, University of Giessen,
Giessen, Germany
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Kovar) Department of Internal Medicine I, Jessenius Faculty of Medicine
in Martin, Comenius University in Bratislava, Martin, Slovakia
(Lopez-Sendon) Cardiovascular Division, University Hospital La Paz,
Madrid, Spain
(Ophuis) Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Shannon) PAREXEL International, Durham, NC, United States
(Spinar) University Hospital, Jihlavska, Brno, Czech Republic
(Tanguay, Theroux) Montreal Heart Institute, University of Montreal,
Montreal, QC, Canada
(Ruda) Cardiology Research Center, Moscow, Russian Federation
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, Paris,
France
Title
Effect of losmapimod on cardiovascular outcomes in patients hospitalized
with acute myocardial infarction: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 315 (15) (pp
1591-1599), 2016. Date of Publication: 19 Apr 2016.
Publisher
American Medical Association
Abstract
Importance: p38 Mitogen-activated protein kinase (MAPK)-stimulated
inflammation is implicated in atherogenesis, plaque destabilization, and
maladaptive processes inmyocardial infarction (MI). Pilot data in a phase
2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor
losmapimod attenuates inflammation and may improve outcomes. Objective: To
evaluate the efficacy and safety of losmapimod on cardiovascular outcomes
in patients hospitalized with an acutemyocardial infarction. Design,
Setting, and Patients: LATITUDE-TIMI 60, a randomized, placebo-controlled,
double-blind, parallel-group trial conducted at 322 sites in 34 countries
from June 3, 2014, until December 8, 2015. Part A consisted of a leading
cohort (n = 3503) to provide an initial assessment of safety and
exploratory efficacy before considering progression to part B
(approximately 22 000 patients). Patients were considered potentially
eligible for enrollment if they had been hospitalized with an acute MI and
had at least 1 additional predictor of cardiovascular risk. Interventions:
Patients were randomized to either twice-daily losmapimod (7.5mg; n =
1738) or matching placebo (n = 1765) on a background of
guideline-recommended therapy. Patients were treated for 12 weeks and
followed up for an additional 12 weeks. Main Outcomes and Measures: The
primary end pointwas the composite of cardiovascular death, MI, or severe
recurrent ischemia requiring urgent coronary revascularization with the
principal analysis specified at week 12. Results: In part A, among the
3503 patients randomized (median age, 66 years; 1036 [29.6%] were women),
99.1%had complete ascertainment for the primary outcome. The primary end
point occurred by 12 weeks in 123 patients treated with placebo (7.0%) and
139 patients treated with losmapimod (8.1%; hazard ratio, 1.16; 95%CI,
0.91-1.47; P = .24). The on-treatment rates of serious adverse events were
16.0%with losmapimod and 14.2% with placebo. Conclusions and Relevance:
Among patients with acute MI, use of losmapimod compared with placebo did
not reduce the risk of major ischemic cardiovascular events. The results
of this exploratory efficacy study did not justify proceeding to a larger
efficacy trial in the existing patient population.

<8>
Accession Number
20160306234
Author
Naghshtabrizi B.; Sohrabi Z.; Emami F.; Manafi B.; Membari S.
Institution
(Naghshtabrizi, Sohrabi, Emami, Membari) Department of Cardiology, Ekbatan
University Hospital, Hamadan University of Medical Sciences, Hamadan,
Iran, Islamic Republic of
(Manafi) Department of Cardiac Surgery, Ekbatan University Hospital,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Evaluation of the incidence of major adverse cardiac and cerebrovascular
events after percutaneous coronary intervention or coronary artery bypass
graft on proximal left anterior descending artery with and without other
coronary arteries involvement.
Source
International Cardiovascular Research Journal. 10 (2) (pp 61-66), 2016.
Date of Publication: 2016.
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: Major Adverse Cardiac and Cerebrovascular Events (MACCE)
include cardiac death, nonfatal Myocardial Infarction (MI),
cerebrovascular events, and Target Vessel Revascularization (TVR) that may
happen after Percutaneous Coronary Intervention (PCI) or Coronary Artery
Bypass Graft (CABG). Objectives: This study aimed to compare the incidence
of MACCE between the patients who underwent PCI or CABG due to significant
Left Anterior Descending (LAD) stenosis with and without other coronary
arteries involvement. Patients and Methods: This randomized mixed cohort
study was conducted on 400 patients with Coronary Artery Disease (CAD),
200 with proximal LAD stenosis and 200 with non-proximal LAD stenosis,
selected through census. Half of each group underwent PCI and the rest
underwent CABG. The participants were followed at fixed intervals after
the procedure and the incidence of MACCE was documented in their
checklists. Then, relative risk index was used to compare the two groups
regarding the incidence of MACCE. Statistical analysis was done using the
Stata software, version 11 and P < 0.05 was considered to be statistically
significant. Results: The study participants included 281 males and 119
females with the mean age of 61.36 +/- 10.66 years. The results showed a
significant difference between the two groups regarding the incidence of
MACCE (31.58% vs. 3%, P = 0.001). However, no significant difference was
found between the effects of PCI with drug eluting stent and CABG on
proximal LAD (3.70% vs. 3%, P = 1.00). Conclusions: Considering the
incidence of MACCE, CABG had no superiority over DES for proximal LAD
stenosis.

<9>
[Use Link to view the full text]
Accession Number
20160060442
Author
Kinnaird T.; Anderson R.; Ossei-Gerning N.; Mamas M.A.; Ludman P.; Moat N.
Institution
(Kinnaird, Anderson, Ossei-Gerning) Department of Cardiology, University
Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
(Mamas) Cardiovascular Research Group, Institute of Cardiovascular
Sciences, University of Manchester, Manchester, United Kingdom
(Ludman) Department of Cardiology, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
Sidney Street, London, United Kingdom
Title
Revascularization for left anterior descending artery stenosis: A review
of the evidence that supports practice.
Source
Cardiology in Review. 24 (3) (pp 136-140), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Disease of the proximal left anterior descending (LAD) artery is a common
pathological finding often combined with disease in other coronary
arteries. In this article, we review specifically the evidence (and the
guidelines arising from the data) for lesions isolated to the proximal LAD
only. Critical review of the data reveals limitations with few trials that
reflect contemporary practice. Much of the data are observational rather
than from randomized trials, and therefore subject to bias. We identified
2 randomized trials of drug-eluting stents versus left internal mammary
artery grafting for isolated lesions of the proximal LAD. One reported no
difference in major adverse cardiovascular events, but at an early
timepoint (6 months), which is likely to be too early to reveal treatment
differences. In the second trial, target lesion revascularization excess
was noted in the drug-eluting stent arm. Therefore, at the current time,
there are little data available to inform interventional cardiologists as
to the best revascularization strategy for isolated lesions of the
proximal LAD. Further randomized, controlled trials are needed.

<10>
[Use Link to view the full text]
Accession Number
2015484558
Author
Marti D.; Salido L.; Mestre J.L.; Esteban M.J.; Casas E.; Jimenez-Mena M.;
Pey J.; Sanmartin M.; Hernandez-Antolin R.; Zamorano J.L.
Institution
(Marti, Salido, Mestre, Esteban, Casas, Jimenez-Mena, Pey, Sanmartin,
Hernandez-Antolin, Zamorano) Interventional Cardiology Unit, Department of
Cardiology, Central Defense Hospital, University of Alcala, Glorieta del
Ejercito, S/N, Madrid 28047, Spain
Title
Impact of thrombus burden on procedural and mid-term outcomes after
primary percutaneous coronary intervention.
Source
Coronary Artery Disease. 27 (3) (pp 169-175), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective Angiographic thrombus burden (TB) can be assessed early and
enable a decision on intervention. The aim of this study was to analyze
its effect on the incidence of cardiac events after a primary percutaneous
coronary intervention. Patients and methods We carried out a prospective
study of 480 consecutive ST-segment elevation myocardial infarction
patients treated by systematic primary percutaneous coronary intervention.
Large TB was defined as thrombus length at least 2 vessel diameters or as
solid thrombus obtained through catheter aspiration. The primary outcome
measure was a composite of death, reinfarction, or target vessel
revascularization. Results A total of 205 (47%) patients fulfilled the
criteria for large TB. These patients were more frequently treated with
abciximab (62.0 vs. 35.8%, P<0.001), showed more angiographic
complications (26.6 vs. 13.7%, P=0.001), and had larger infarcts (peak
troponin I, 74 vs. 50 ng/ml, P=0.015). During a follow-up of 19+/- 5
months, the rates of primary outcome were similar between groups of small
and large TB (16.2 vs. 12.8%, hazard ratio: 0.88, 95% confidence interval:
0.46-1.67, P=0.691). There were no differences in the rates of definite
stent thrombosis (0.5 vs. 2.2%, P=0.190). Conclusion Large TB is
associated with larger infarct size, but not with worse mid-term outcomes.
Selective use of adjuvant therapies according to TB may be an effective
approach to reduce thrombotic complications.

<11>
Accession Number
20160240593
Author
Tam M.K.P.; Wong W.T.; Gomersall C.D.; Tian Q.; Ng S.K.; Leung C.C.H.;
Underwood M.J.
Institution
(Tam, Ng) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, Hong Kong
(Wong, Gomersall, Tian, Leung) Department of Anaesthesia and Intensive
Care, The Chinese University of Hong Kong, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, Shatin, Hong Kong
Title
A randomized controlled trial of 2 protocols for weaning cardiac surgical
patients receiving adaptive support ventilation.
Source
Journal of Critical Care. 33 (pp 163-168), 2016. Date of Publication: 01
Jun 2016.
Publisher
W.B. Saunders
Abstract
Purpose: This study aims to compare the effectiveness of weaning with
adaptive support ventilation (ASV) incorporating progressively reduced or
constant target minute ventilation in the protocol in postoperative care
after cardiac surgery. Material and methods: A randomized controlled
unblinded study of 52 patients after elective coronary artery bypass
surgery was carried out to determine whether a protocol incorporating a
decremental target minute ventilation (DTMV) results in more rapid weaning
of patients ventilated in ASV mode compared to a protocol incorporating a
constant target minute ventilation. Results: Median duration of mechanical
ventilation (145 vs 309 minutes; P =.001) and intubation (225 vs 423
minutes; P =.005) were significantly shorter in the DTMV group. There was
no difference in adverse effects (42% vs 46%) or mortality (0% vs 0%)
between the 2 groups. Conclusions: Use of a DTMV protocol for
postoperative ventilation of cardiac surgical patients in ASV mode results
in a shorter duration of ventilation and intubation without evidence of
increased risk of adverse effects.

<12>
Accession Number
20160294454
Author
Ruggieri V.G.; Anselmi A.; Chabanne C.; Lelong B.; Flecher E.; Verhoye
J.-P.; Leguerrier A.
Institution
(Ruggieri, Anselmi, Chabanne, Lelong, Flecher, Verhoye, Leguerrier)
Division of Thoracic and Cardiovascular Surgery, Pontchaillou University
Hospital, Rennes, France
Title
Three-year haemodynamic performance of the St Jude Trifecta bioprosthesis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 972-977), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: To examine the haemodynamic performance of the St Jude
Trifecta valve for aortic valve replacement (AVR) at 3 years after
implantation. METHODS: In a single-centre, prospective, observational,
independent study, we enrolled 122 patients who had AVR using a Trifecta
bioprosthesis in the July 2010-June 2011 period. A clinical and
echocardiographic in-house follow-up was scheduled. RESULTS: In our
series, 14.7% of patients received a 19-mm, 28.7% had a 21-mm, 35.2% had a
23-mm and 21.3% had a greater-size prosthesis. There were no cases of
operative mortality or of valve-related complications both early and at
follow-up (except one sudden unexplained death). Completeness of the
3-year echocardiographic follow-up was 80% among survivors. The average
mean transvalvular gradient (mTVG) at 3 years was 14.2, 10.8, 8.6, 7.1 and
6.8 mmHg (sizes 19 to 27/29, respectively). There was no statistically
significant difference between average mTVGs measured immediately after
implantation versus at the 3-year follow-up in the overall population. The
average peak transvalvular gradient (pTVG) at 3 years was 25, 20, 16.8,
13.9 and 14.4 mmHg (sizes 19 to 27/29, respectively). The average indexed
effective orifice area (iEOA) at 3 years was 0.8, 0.9, 1, 1.3 and 1.3
cm²/m² (sizes 19-27, respectively). The rate of
moderate patient- prosthesis mismatch (PPM) at 3 years was 15.7%; there
were two instances of severe PPM (2.2%). All cases of PPM occurred in the
19, 21 and 23 mm size subgroups. CONCLUSIONS: The Trifecta valve retains
its excellent haemodynamic properties at the 3-year follow-up. The rate of
PPMis considerably low.

<13>
Accession Number
20160294453
Author
Keyl C.; Schneider J.; Beyersdorf F.; Ruile P.; Siepe M.; Pioch K.;
Schneider R.; Jander N.
Institution
(Keyl, Pioch) Department of Anesthesiology, Heart Center Freiburg
University, Bad Krozingen, Germany
(Schneider, Ruile, Schneider, Jander) Department of Cardiology and
Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany
(Beyersdorf, Siepe) Department of Cardiovascular Surgery, Heart Center
Freiburg University, Bad Krozingen, Germany
Title
Right ventricular function after aortic valve replacement: A pilot study
comparing surgical and transcatheter procedures using 3D echocardiography.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 966-971), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Previous studies have found that standard echocardiographic
measures of right ventricular (RV) function were impaired after surgical
replacement of the aortic valve (SAVR), but not after transcatheter aortic
valve implantation (TAVI). We used 3D echocardiography to gain further
insight into the changes of RV performance in patient undergoing SAVR or
TAVI. METHODS: We conducted a prospective non-randomized study with two
parallel groups and performed echocardiographic evaluation in 20 patients
with aortic stenosis undergoing SAVR (age 77 +/- 4 years), and in 20
patients undergoing TAVI via the transfemoral approach (age 83 +/- 6
years) 1 week before and between the fifth and seventh day after the
procedure. RESULTS: Tricuspid annular plane systolic excursion was
postoperatively markedly reduced in patients undergoing SAVR (13 +/- 2 vs
26 +/- 4 mm, post- vs preoperative, P < 0.001), but not in patients
undergoing TAVI (24 +/- 7 vs 24 +/- 5 mm, P = 0.90). Fractional shortening
of the RV midcavity transverse diameter, however, increased after SAVR (50
+/- 8 vs 31 +/- 11%, P < 0.001) in contrast to TAVI (33 +/- 10 vs 34 +/-
9%, P = 0.85). The RV ejection fraction, assessed by 3D echocardiography,
remained unchanged in both patient groups (SAVR, 55 +/- 6 vs 55 +/- 7%, P
= 0.52; TAVI, 56 +/- 8 vs 54 +/- 7%, P = 0.28). CONCLUSIONS: RV
longitudinal contraction decreased after SAVR, whereas RV transverse
contraction increased. Both parameters did not change after TAVI. RV
ejection fraction and RV stroke volume remained constant irrespective of
the technique of aortic valve replacement, thus indicating that global
systolic RV function is not compromised after SAVR.

<14>
Accession Number
20160294451
Author
Gavina C.; Falcao-Pires I.; Pinho P.; Manso M.-C.; Goncalves A.;
Rocha-Goncalves F.; Leite-Moreira A.
Institution
(Gavina, Goncalves, Rocha-Goncalves) Department of Medicine, Faculty of
Medicine, University of Porto, Porto, Portugal
(Falcao-Pires, Leite-Moreira) Department of Physiology and Cardiothoracic
Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
(Pinho, Leite-Moreira) Department of Cardiothoracic Surgery, Centro
Hospitalar Sao Joao, Porto, Portugal
(Manso) Department of Biostatistics, Faculty of Health Sciences,
University Fernando Pessoa - CIAGEB-UFP, Porto, Portugal
(Manso) REQUIMTE, University of Porto, Porto, Portugal
Title
Relevance of residual left ventricular hypertrophy after surgery for
isolated aortic stenosis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 952-959), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Persistent left ventricular (LV) hypertrophy after surgery is
frequent, but its clinical relevance is controversial. We evaluated if
residual LV hypertrophy (LVH) is associated with clinical outcomes after
aortic valve replacement (AVR) for severe aortic stenosis (AS). METHODS:
We analysed clinical and echocardiographic parameters before and after
AVR, in a prospective cohort of 132 patients with severe AS. The mean
follow-up was 6.0 +/- 1.5 years. Clinical endpoints were all-cause death
and combination of as in all-cause death and non-fatal cardiovascular
hospitalization. At AVR, myocardial biopsies for collagen volume fraction
(CVF) evaluation were done in 56 random patients. RESULTS: Residual LVH
was present in 44% of patients after AVR. Patients with residual LVH were
older, more frequently women and had hypertension (HT). Preoperatively,
they had higher LV mass indices (LVMI), higher E/e' and left atrial volume
indices, as well as lower peak systolic annular velocity. Female gender,
HT, LVMI and E/e' were independent predictors of persistent LVH. CVF at
the time of surgery was higher in those with residual LVH (20.0 +/- 14.6
vs 13.2 +/- 11.5%, P = 0.027). The risk of all-cause death and non-fatal
cardiovascular hospitalization was higher in patients with residual LVH
[OR 2.89 (95% CI 1.12-7.44); P = 0.035], but there were no differences in
all-cause mortality. Residual LVH was associated with a worse outcome in
women but not in men. CONCLUSIONS: Residual LVH after AVR is common and is
associated with worse prognosis, particularly in women. In addition, HT,
higher baseline LVM and worse diastolic dysfunction can help to identify
patients at risk for incomplete normalization of LVM.

<15>
Accession Number
20160294416
Author
Zhou F.; Luo Q.; Wang L.; Han L.
Institution
(Zhou, Luo, Wang, Han) Division of Nephrology, Ningbo No. 2 Hospital,
Affiliated Hospital of Ningbo University School of Medical, Ningbo,
Zhejiang, China
Title
Diagnostic value of neutrophil gelatinase-associated lipocalin for early
diagnosis of cardiac surgery-associated acute kidney injury: A
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 746-755), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as
one of the most sensitive and specific biomarkers for predicting cardiac
surgery-associated acute kidney injury (CSA-AKI); however, variable
performance characteristics have been reported. We therefore performed a
diagnostic meta-analysis to investigate the diagnostic accuracy of NGAL in
early (within 12 h postoperatively) diagnosis of CSA-AKI using established
guidelines. The search was carried out electronically with Medline
(through PubMed interface), Embase, Cochrane library, ISI Web of Science,
Scopus and ClinicalTrials.gov (up to 5 September 2014), and hand-searching
was also done. Two reviewers conducted study inclusion, data extractions
and quality assessment of the studies independently. The diagnostic
capacity of NGAL for CSA-AKI was assessed using pooled sensitivity and
specificity, diagnostic odds ratio (DOR), area under the summary receiver
operating characteristic curve (AUC). Meta-Disc 1.4 and STATA 12.0 were
used to investigate the source of heterogeneity and to perform the
meta-analysis. Twenty-four studies (33 data sets of 4066 patients) were
considered, which were all of good methodological quality. The overall
pooled sensitivity of NGAL for the diagnosis of AKI was 0.68 [95%
confidence interval (CI), 0.65-0.70], and specificity was 0.79 (95% CI,
0.77-0.80). The overall pooled positive likelihood ratio and negative
likelihood ratio were 3.98 (95% CI, 3.05-5.20) and 0.33 (95% CI,
0.24-0.45), respectively, with a DOR of 13.05 (95% CI, 7.85-21.70). The
receiver operating characteristic analysis showed an AUC [standard error
(SE)] of 0.86 (0.02) and with a Q*-value (SE) of 0.79 (0.02). Subgroup
analysis showed that NGAL had better predictive ability in
neonates/children compared with adults (DOR, 19.37; AUC, 0.89 vs DOR,
8.98; AUC, 0.83), and adults without pre-existing renal insufficiency
(PRI) had higher diagnostic value than adults without PRI to predict
CSA-AKI (DOR, 15.43; AUC, 0.87 vs DOR, 6.56; AUC, 0.81). Both plasma/serum
and urine NGAL had the highly predictive nature for early diagnosis of
CSA-AKI (DOR, 13.09; AUC, 0.85 vs DOR, 13.20; AUC, 0.88), while lower DOR
and AUC values were shown (DOR, 8.31; AUC, 0.81) when measured using
standardized clinical platforms, compared with research-based assays (DOR,
19.22; AUC, 0.89). I²-values showed substantial heterogeneity,
which mainly stems from characteristics of patient population (P = 0.037).
NGAL diagnostic accuracy in early detection of CSA-AKI is high, especially
in neonates/children or adults with normal baseline renal function.

<16>
Accession Number
20160294415
Author
Soylu E.; Harling L.; Ashrafian H.; Rao C.; Casula R.; Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Rao, Casula, Athanasiou) Department of Surgery
and Cancer, Imperial College, London, United Kingdom
Title
A systematic review of the safety and efficacy of distal coronary artery
anastomotic devices.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 732-745), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Interest in minimally invasive and off-pump cardiac surgical techniques
has promoted the development of automated distal anastomotic devices
(DADs) to facilitate construction of coronary artery anastomosis. Several
DADs have been proposed for potential use in coronary surgery. However, a
number of technical failures and uncertainty around both short-term
morbidity and long-term patency have limited the generalized uptake of
these devices. A systematic literature search identified 28 studies,
incorporating 970 patients who underwent coronary artery bypass grafting
using a DAD. Eight different devices were identified including Heartflo,
St Jude, U-clip, vessel closure system, C-port, magnetic vascular
positioner and coronary anastomosis coupler. Thirty-day mortality,
cardiac-specific mortality and myocardial infarction were equal between
DADs and hand-sewn cases (1.3, 0.3 and 0.8%, respectively). The overall
proportion of postoperative haemorrhage was higher in the anastomotic
device group (2.3%) than in the group with hand-sewn anastomoses (1.5%)
although not statistically significant. Overall graft patency was 97.2% at
< 1 month, 94.6% at 1-3 months and 92.3% at > 3 months. Of the currently
available systems, the U-clip device was found to provide the best overall
postoperative outcomes, which included a patency of 96.1% at > 3months.
The current literature is limited by its predominantly observational study
design and lack of directly comparative studies. Furthermore, inter-study
variation in patient selection, anticoagulation strategies and follow-up
periods prevents quantitative comparison. Future research necessitates
multicentre randomized, controlled studies to provide a direct comparison
of current and future anastomotic device systems with established
hand-sewn techniques in both the short and long term.

<17>
Accession Number
20160315853
Author
Tu C.-C.; Hsu P.-K.
Institution
(Tu) Division of Thoracic Surgery, Department of Surgery, Chang Bing Show
Chwan Memorial Hospital, Changhua, Taiwan (Republic of China)
(Hsu) Division of Thoracic Surgery, Department of Surgery, Taipei Veterans
General Hospital, Taipei, Taiwan (Republic of China)
(Hsu) School of Medicine, National Yang-Ming University, Taipei, Taiwan
(Republic of China)
Title
Global development and current evidence of uniportal thoracoscopic
surgery.
Source
Journal of Thoracic Disease. 8 (pp S308-S318), 2016. Date of Publication:
01 Mar 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
In the era of video-assisted thoracoscopic surgery (VATS), uniportal and
single incision thoracoscopic surgeries are gaining popularity. The
spectrum of uniportal VATS indications is now almost equal to that of
conventional VATS. For example, successful uniportal sleeve lobectomy, rib
segmental resection, and management of intraoperative bleeding have all
been reported. According to published data in the English-language
literature, more than 9,545 uniportal VATS have been performed to date,
including 1,293 lobectomies, 1,024 procedures for pneumothorax, and 6,845
sympathectomies. Of the 192 articles discussing this topic, 35 were
conducted in Spain, and there were an increasing number of publications
from China, Korea, and other Asian countries. There were 41 technical and
review articles, all of which provided an excellent foundation of surgical
concept and skill learning. The benefits of uniportal VATS include better
surgical geometry and cosmetics. Regarding postoperative outcomes,
thirteen out of the 15 articles reviewed showed that uniportal VATS has
similar or superior outcomes to conventional VATS. Most studies
demonstrated that uniportal VATS produced less postoperative pain and
paresthesia. In conclusion, uniportal VATS can produce excellent operative
outcome, which is becoming a mature surgical approach in thoracic disease,
supported by fast-accumulating and abundant experience.

<18>
Accession Number
20160272702
Author
Sibilitz K.L.; Berg S.K.; Tang L.H.; Risom S.S.; Gluud C.; Lindschou J.;
Kober L.; Hassager C.; Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Tang, Risom, Kober, Hassager, Zwisler) Rigshospitalet,
Copenhagen University Hospital, Department of Cardiology, The Heart
Centre, Blegdamsvej 9, Copenhagen 2100, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Lindschou) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Taylor) University of Exeter Medical School, Institute of Health
Research, Exeter EX2 4SG, United Kingdom
Title
Exercise-based cardiac rehabilitation for adults after heart valve
surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (3) (no pagination), 2016.
Article Number: CD010876. Date of Publication: March 21, 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Exercise-based cardiac rehabilitation may benefit heart valve
surgery patients. We conducted a systematic review to assess the evidence
for the use of exercise-based intervention programmes following heart
valve surgery. Objectives: To assess the benefits and harms of
exercise-based cardiac rehabilitation compared with no exercise training
intervention, or treatment as usual, in adults following heart valve
surgery. We considered programmes including exercise training with or
without another intervention (such as a psycho-educational component).
Search methods: We searched: the Cochrane Central Register of Controlled
Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE);
MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS
(Bireme); and Conference Proceedings Citation Index-S (CPCI-S) on Web of
Science (Thomson Reuters) on 23 March 2015. We handsearched Web of
Science, bibliographies of systematic reviews and trial registers
(ClinicalTrials.gov, Controlled-trials.com, and The World Health
Organization International Clinical Trials Registry Platform). Selection
criteria: We included randomised clinical trials that investigated
exercise-based interventions compared with no exercise intervention
control. The trial participants comprised adults aged 18 years or older
who had undergone heart valve surgery for heart valve disease (from any
cause) and received either heart valve replacement, or heart valve repair.
Data collection and analysis: Two authors independently extracted data. We
assessed the risk of systematic errors ('bias') by evaluation of bias risk
domains. Clinical and statistical heterogeneity were assessed.
Meta-analyses were undertaken using both fixed-effect and random-effects
models. We used the GRADE approach to assess the quality of evidence. We
sought to assess the risk of random errors with trial sequential analysis.
Main results: We included two trials from 1987 and 2004 with a total 148
participants who have had heart valve surgery. Both trials had a high risk
of bias. There was insufficient evidence at 3 to 6 months follow-up to
judge the effect of exercise-based cardiac rehabilitation compared to no
exercise on mortality (RR 4.46 (95% confidence interval (CI) 0.22 to
90.78); participants = 104; studies = 1; quality of evidence: very low)
and on serious adverse events (RR 1.15 (95% CI 0.37 to 3.62); participants
= 148; studies = 2; quality of evidence: very low). Included trials did
not report on health-related quality of life (HRQoL), and the secondary
outcomes of New York Heart Association class, left ventricular ejection
fraction and cost. We did find that, compared with control (no exercise),
exercise-based rehabilitation may increase exercise capacity (SMD -0.47,
95% CI -0.81 to -0.13; participants = 140; studies = 2, quality of
evidence: moderate). There was insufficient evidence at 12 months
follow-up for the return to work outcome (RR 0.55 (95% CI 0.19 to 1.56);
participants = 44; studies = 1; quality of evidence: low). Due to limited
information, trial sequential analysis could not be performed as planned.
Authors' conclusions: Our findings suggest that exercise-based
rehabilitation for adults after heart valve surgery, compared with no
exercise, may improve exercise capacity. Due to a lack of evidence, we
cannot evaluate the impact on other outcomes. Further high-quality
randomised clinical trials are needed in order to assess the impact of
exercise-based rehabilitation on patient-relevant outcomes, including
mortality and quality of life.

<19>
Accession Number
20160263289
Author
Byrne M.; Doherty S.; Fridlund B.G.; Martensson J.; Steinke E.E.; Jaarsma
T.; Devane D.
Institution
(Byrne) National University of Ireland, Galway, School of Psychology, St.
Anthony's, Galway, County Galway, Ireland
(Doherty) RCSI, Department of Population and Health Science, School of
Psychology, St Stephens Green, Beaux Lane House, Dublin, Ireland
(Fridlund) Jonkoping University, School of Health Sciences, P O Box 1026,
Jonkoping 551 11, Sweden
(Martensson) Jonkoping University, Department of Nursing, School of Health
Sciences, P O Box 1026, Jonkoping 551 11, Sweden
(Steinke) Wichita State University, School of Nursing, 1845 Fairmount,
Wichita, KS 67260-0041, United States
(Jaarsma) University of Linkoping, Department of Social and Welfare
Studies, Kungsgatan 40, Norrkoping 601074, Sweden
(Devane) National University of Ireland Galway, School of Nursing and
Midwifery, University Road, Galway, Ireland
Title
Sexual counselling for sexual problems in patients with cardiovascular
disease.
Source
Cochrane Database of Systematic Reviews. 2016 (2) (no pagination), 2016.
Article Number: CD010988. Date of Publication: 24 Feb 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Sexual problems are common among people with cardiovascular
disease. Although clinical guidelines recommend sexual counselling for
patients and their partners, there is little evidence on its
effectiveness. Objectives: To evaluate the effectiveness of sexual
counselling interventions (in comparison to usual care) on
sexuality-related outcomes in patients with cardiovascular disease and
their partners. Search methods: We searched CENTRAL, MEDLINE, EMBASE, and
three other databases up to 2 March 2015 and two trials registers up to 3
February 2016. Selection criteria: Randomised controlled trials (RCTs) and
quasi-RCTs, including individual and cluster RCTs. We included studies
that compared any intervention to counsel adult cardiac patients about
sexual problems with usual care. Data collection and analysis: We used
standard methodological procedures expected by Cochrane. Main results: We
included three trials with 381 participants. We were unable to pool the
data from the included studies due to the differences in interventions
used; therefore we synthesised the trial findings narratively. Two trials
were conducted in the USA and one was undertaken in Israel. All trials
included participants who were admitted to hospital with myocardial
infarction (MI), and one trial also included participants who had
undergone coronary artery bypass grafting. All trials followed up
participants for a minimum of three months post-intervention; the longest
follow-up timepoint was five months. One trial (N = 92) tested an
intensive (total five hours) psychotherapeutic sexual counselling
intervention delivered by a sexual therapist. One trial (N = 115) used a
15-minute educational video plus written material on resuming sexual
activity following a MI. One trial (N = 174) tested the addition of a
component that focused on resumption of sexual activity following a MI
within a hospital cardiac rehabilitation programme. The quality of the
evidence for all outcomes was very low. None of the included studies
reported any outcomes from partners. Two trials reported sexual function.
One trial compared intervention and control groups on 12 separate sexual
function subscales and used a repeated measures analysis of variance
(ANOVA) test. They reported statistically significant differences in
favour of the intervention. One trial compared intervention and control
groups using a repeated measures analysis of covariance (ANCOVA), and
concluded: "There were no significant differences between the two groups
[for sexual function] at any of the time points". Two trials reported
sexual satisfaction. In one trial, the authors compared sexual
satisfaction between intervention and control and used a repeated measured
ANOVA; they reported "differences were reported in favour of the
intervention". One trial compared intervention and control with a repeated
measures ANCOVA and reported: "There were no significant differences
between the two groups [for sexual satisfaction] at any of the
timepoints". All three included trials reported the number of patients
returning to sexual activity following MI. One trial found some evidence
of an effect of sexual counselling on reported rate of return to sexual
activity (yes/no) at four months after completion of the intervention
(relative risk (RR) 1.71, 95% confidence interval (CI) 1.26 to 2.32; one
trial, 92 participants, very low quality of evidence). Two trials found no
evidence of an effect of sexual counselling on rate of return to sexual
activity at 12 week (RR 1.01, 95% CI 0.94 to 1.09; one trial, 127
participants, very low quality of evidence) and three month follow-up (RR
0.98, 95% CI 0.88 to 1.10; one trial, 115 participants, very low quality
of evidence). Two trials reported psychological well-being. In one trial,
no scores were reported, but the trial authors stated: "No treatment
effects were observed on state anxiety as measured in three points in
time". In the other trial no scores were reported but, based on results of
a repeated measures ANCOVA to compare intervention and control groups, the
trial authors stated: "The experimental group had significantly greater
anxiety at one month post MI". They also reported: "There were no
significant differences between the two groups [for anxiety] at any other
time points". One trial reporting relationship satisfaction and one trial
reporting quality of life found no differences between intervention and
control. No trial reported on satisfaction in how sexual issues were
addressed in cardiac rehabilitation services. Authors' conclusions: We
found no high quality evidence to support the effectiveness of sexual
counselling for sexual problems in patients with cardiovascular disease.
There is a clear need for robust, methodologically rigorous, adequately
powered RCTs to test the effectiveness of sexual counselling interventions
for people with cardiovascular disease and their partners.

<20>
Accession Number
20160263264
Author
Yeung J.H.; Gates S.; Naidu B.V.; Wilson M.J.; Gao Smith F.
Institution
(Yeung, Gao Smith) Heart of England NHS Foundation Trust, Birmingham
Heartlands Hospital, Academic Department of Anaesthesia, Critical Care,
Pain and Resuscitation, Birmingham Heartlands Hospital, 1/F MIDRU
Building, Bordersley Green East, Birmingham B9 5SS, United Kingdom
(Yeung) University of Birmingham, School of Clinical and Experimental
Medicine, College of Medical and Dental Sciences, Birmingham, United
Kingdom
(Gates) Division of Health Sciences, Warwick Medical School, The
University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill Road,
Coventry CV4 7AL, United Kingdom
(Naidu) Heart of England NHS Foundation Trust, Department of Thoracic
Surgery, Birmingham Heartlands Hospital, Bordersley Green East, Birmingham
B9 5SS, United Kingdom
(Wilson) The University of Sheffield, School of Health and Related
Research, Sheffield, United Kingdom
(Gao Smith) College of Medical and Dental Sciences, University of
Birmingham, School of Clinical and Experimental Medicine, Birmingham,
United Kingdom
Title
Paravertebral block versus thoracic epidural for patients undergoing
thoracotomy.
Source
Cochrane Database of Systematic Reviews. 2016 (2) (no pagination), 2016.
Article Number: CD009121. Date of Publication: February 21, 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Operations on structures in the chest (usually the lungs)
involve cutting between the ribs (thoracotomy). Severe post-thoracotomy
pain can result from pleural (lung lining) and muscular damage,
costovertebral joint (ribcage) disruption and intercostal nerve (nerves
that run along the ribs) damage during surgery. Poor pain relief after
surgery can impede recovery and increase the risks of developing
complications such as lung collapse, chest infections and blood clots due
to ineffective breathing and clearing of secretions. Effective management
of acute pain following thoracotomy may prevent these complications and
reduce the likelihood of developing chronic pain. A multi-modal approach
to analgesia is widely employed by thoracic anaesthetists using a
combination of regional anaesthetic blockade and systemic analgesia, with
both non-opioid and opioid medications and local anaesthesia blockade.
There is some evidence that blocking the nerves as they emerge from the
spinal column (paravertebral block, PVB) may be associated with a lower
risk of major complications in thoracic surgery but the majority of
thoracic anaesthetists still prefer to use a thoracic epidural blockade
(TEB) as analgesia for their patients undergoing thoracotomy. In order to
bring about a change in practice, anaesthetists need a review that
evaluates the risk of all major complications associated with thoracic
epidural and paravertebral block in thoracotomy. Objectives: To compare
the two regional techniques of TEB and PVB in adults undergoing elective
thoracotomy with respect to: 1. analgesic efficacy;2. the incidence of
major complications (including mortality);3. the incidence of minor
complications;4. length of hospital stay;5. cost effectiveness. Search
methods: We searched for studies in the Cochrane Central Register of
Controlled Trials (CENTRAL 2013, Issue 9); MEDLINE via Ovid (1966 to 16
October 2013); EMBASE via Ovid (1980 to 16 October 2013); CINAHL via EBSCO
host (1982 to 16 October 2013); and reference lists of retrieved studies.
We handsearched the Journal of Cardiothoracic Surgery and Journal of
Cardiothoracic and Vascular Anesthesia (16 October 2013). We reran the
search on 31st January 2015. We found one additional study which is
awaiting classification and will be addressed when we update the review.
Selection criteria: We included all randomized controlled trials (RCTs)
comparing PVB with TEB in thoracotomy, including upper gastrointestinal
surgery. Data collection and analysis: We used standard methodological
procedures expected by Cochrane. Two review authors (JY and SG)
independently assessed the studies for inclusion and then extracted data
as eligible for inclusion in qualitative and quantitative synthesis
(meta-analysis). Main results: We included 14 studies with a total of 698
participants undergoing thoracotomy. There are two studies awaiting
classification. The studies demonstrated high heterogeneity in insertion
and use of both regional techniques, reflecting real-world differences in
the anaesthesia techniques. Overall, the included studies have a moderate
to high potential for bias, lacking details of randomization, group
allocation concealment or arrangements to blind participants or outcome
assessors. There was low to very low-quality evidence that showed no
significant difference in 30-day mortality (2 studies, 125 participants.
risk ratio (RR) 1.28, 95% confidence interval (CI) 0.39 to 4.23, P value =
0.68) and major complications (cardiovascular: 2 studies, 114
participants. Hypotension RR 0.30, 95% CI 0.01 to 6.62, P value = 0.45;
arrhythmias RR 0.36, 95% CI 0.04 to 3.29, P value = 0.36, myocardial
infarction RR 3.19, 95% CI 0.13, 76.42, P value = 0.47); respiratory: 5
studies, 280 participants. RR 0.62, 95% CI 0.26 to 1.52, P value = 0.30).
There was moderate-quality evidence that showed comparable analgesic
efficacy across all time points both at rest and after coughing or
physiotherapy (14 studies, 698 participants). There was moderate-quality
evidence that showed PVB had a better minor complication profile than TEB
including hypotension (8 studies, 445 participants. RR 0.16, 95% CI 0.07
to 0.38, P value < 0.0001), nausea and vomiting (6 studies, 345
participants. RR 0.48, 95% CI 0.30 to 0.75, P value = 0.001), pruritis (5
studies, 249 participants. RR 0.29, 95% CI 0.14 to 0.59, P value = 0.0005)
and urinary retention (5 studies, 258 participants. RR 0.22, 95% CI 0.11
to 0.46, P value < 0.0001). There was insufficient data in chronic pain
(six or 12 months). There was no difference found in and length of
hospital stay (3 studies, 124 participants). We found no studies that
reported costs. Authors' conclusions: Paravertebral blockade reduced the
risks of developing minor complications compared to thoracic epidural
blockade. Paravertebral blockade was as effective as thoracic epidural
blockade in controlling acute pain. There was a lack of evidence in other
outcomes. There was no difference in 30-day mortality, major
complications, or length of hospital stay. There was insufficient data on
chronic pain and costs. Results from this review should be interpreted
with caution due to the heterogeneity of the included studies and the lack
of reliable evidence. Future studies in this area need well-conducted,
adequately-powered RCTs that focus not only on acute pain but also on
major complications, chronic pain, length of stay and costs.

<21>
Accession Number
20160295807
Author
Egypto Rosa V.E.; De Santis Andrade Lopes A.S.; Duenhas Accorsi T.A.;
Cordeiro Fernandes J.R.; Spina G.S.; Sampaio R.O.; Paixao M.R.;
Pomerantzeff P.M.; Lemos Neto P.A.; Tarasoutchi F.
Institution
(Egypto Rosa, De Santis Andrade Lopes, Duenhas Accorsi, Cordeiro
Fernandes, Spina, Sampaio, Paixao) Clinical Unit of Heart Valve Disease,
Brazil
(Pomerantzeff, Tarasoutchi) Surgical Unit of Heart Valve Disease, Brazil
(Lemos Neto) Hemodynamics Unit, Brazil
(Egypto Rosa, De Santis Andrade Lopes, Duenhas Accorsi, Cordeiro
Fernandes, Spina, Sampaio, Paixao, Pomerantzeff, Lemos Neto, Tarasoutchi)
Instituto Do Coracao (InCor) Do Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, SP, Brazil
Title
EuroSCORE II and STS as mortality predictors in patients undergoing TAVI.
Source
Revista da Associacao Medica Brasileira. 62 (1) (pp 32-37), 2016. Date of
Publication: January-February 2016.
Publisher
Associacao Medica Brasileira
Abstract
Introduction: the EuroSCORE II and STS are the most used scores for
surgical risk stratification and indication of transcatheter aortic valve
implantation (TAVI). However, its role as a tool for mortality prediction
in patients undergoing TAVI is still unclear. Objective: to evaluate the
performance of the EuroSCORE II and STS as predictors of in-hospital and
30-day mortality in patients undergoing TAVI. Methods: we included 59
symptomatic patients with severe aortic stenosis that underwent TAVI
between 2010 and 2014. The variables were analyzed using Student's t-test
and Fisher's exact test and the discriminative power was evaluated using
receiver operating characteristic curve (ROC) and area under the curve
(AUC) with a 95% confidence interval. Results: mean age was 81+/-7.3
years, 42.3% men. The mean EuroSCORE II was 7.6+/-7.3 % and STS was
20.7+/-10.3%. Transfemoral procedure was performed in 88.13%, transapical
in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and
30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS
higher than the survivors (33.7+/-16.7 vs. 18.6+/-7.3% p=0,0001 for STS
and 13.9+/-16.1 vs. 4.8+/-3.8% p=0.0007 for EuroSCORE II). The STS showed
an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences
in the discrimination ability using ROC curves (p=0.72). Conclusion: in
this cohort, the STS and EuroSCORE II were predictors of in-hospital and
30-days mortality in patients with severe aortic stenosis undergoing TAVI.

<22>
Accession Number
20160287542
Author
Sharma P.; Patel K.; Baria K.; Lakhia K.; Malhotra A.; Shah K.; Patel S.
Institution
(Sharma, Patel, Baria, Lakhia, Malhotra) Department of Cardiovascular and
Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center,
Asarwa, Ahmedabad, Gujarat, India
(Shah, Patel) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Asarwa, Ahmedabad, Gujarat, India
Title
Procalcitonin level for prediction of postoperative infection in cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 24 (4) (pp 344-349), 2016. Date
of Publication: 2016.
Publisher
SAGE Publications Inc.
Abstract
Background Diagnosing infection after cardiac surgery remains difficult
due to the systemic inflammatory response induced by cardiopulmonary
bypass. We compared procalcitonin levels with white blood cell counts as
predictors of infection after cardiac surgery. Methods We prospectively
enrolled 100 consecutive adult cardiac patients. Postoperative white blood
cell counts, serum procalcitonin levels, and blood cultures were examined.
Result The sensitivity and specificity of white blood cell count and
procalcitonin > 2 ng mL^-1 were 60% and 100%, 58.8% and 42.5%,
respectively. Procalcitonin > 7 ng mL^-1 had 95% sensitivity and
80% specificity. Receiver-operating characteristic analysis showed a
greater area under the curve for procalcitonin level (p < 0.0001) compared
to white blood cell count (p = 0.31). Patients with positive blood
cultures had significantly higher procalcitonin levels (51.97 +/- 39.62
vs. 6.67 +/- 10.73 ng mL^-1), Acute Physiology and Chronic
Health Evaluation-II scores (16.95 +/- 3.24 vs. 13.60 +/- 2.98), and
intensive care unit stay (6.35 +/- 3.42 vs. 4.6 +/- 2.2 days).
Non-survivors had significantly higher Acute Physiology and Chronic Health
Evaluation-II scores (19.09 +/- 1.30 vs. 13.67 +/- 2.97) and procalcitonin
levels (43.83 +/- 52.15 vs. 12.26 +/- 19.89 ng mL^-1) but on
logistic regression analysis, only Acute Physiology and Chronic Health
Evaluation-II score was an independent risk factor for mortality.
Conclusion The diagnostic accuracy of procalcitonin for bacterial
infection is fairly high. Acute Physiology and Chronic Health
Evaluation-II score is a better predictor of mortality and morbidity than
absolute procalcitonin level. Procalcitonin > 7 ng mL^-1 can
prognosticate and identify the high-risk group.

<23>
Accession Number
72259845
Author
Salzmann S.; Euteneuer F.; Auer C.J.; Laferton J.A.; Schedlowski M.;
Moosdorf R.; Rief W.
Institution
(Salzmann, Euteneuer, Auer, Laferton, Rief) Clinical Psychology and
Psychotherapy, Philipps University of Marburg, Marburg, Hessen, Germany
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Clinic Essen, Essen, Nordrhein-Westfalen,
Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Germany
Title
Pre-surgical psychological interventions lead to reduced levels of
adrenaline and cortisol after surgery in coronary artery bypass graft
patients: The PSY-heart study.
Source
Psychosomatic Medicine. Conference: 74th Annual Meeting of the American
Psychosomatic Society, APS 2016 Denver, CO United States. Conference
Start: 20160309 Conference End: 20160312. Conference Publication:
(var.pagings). 78 (3) (pp A29), 2016. Date of Publication: April 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Outcomes of coronary artery bypass graft (CABG) surgeries are
associated with patients' pre-surgical expectations. Pre-surgical
psychological interventions targeting patients' expectations could help to
buffer patients stress response and to improve recovery after heart
surgery. This study examines whether pre-surgical psychological
interventions are capable of influencing the biological stress response
after CABG-surgery. Methods: Randomized controlled trial with assessments
at 10 days before surgery, post psychological intervention (day of
hospital admission, but before surgery) and post-surgery (6-8 days later).
Eligible patients (N=92) scheduled for elective on pump CABG or CABG with
valve replacement surgery were approached before hospital admission.
Standard medical care (SMC) was compared to two additional preoperative
psychological interventions: Either the expectation manipulation
intervention (EMI) to optimize patients' expectations about course and
outcomes, or the same amount of therapeutic attention with a focus on a
good therapeutic relationship and emotional expression, but without
specifically working on expectations (supportive therapy, or SUP). Main
outcomes were plasma adrenaline, noradrenaline and cortisol levels and
patients' disability expectations post-surgery. Results:EMI (P=.018) and
SUP (P=.009) led to significantly lower post-surgery adrenaline levels
compared to SMC only. SUP led to lower cortisol levels compared to SMC
after surgery (P=.021); time and treatment group interacted significantly
(F=2.01;P=.029;eta²=.147) while controlling for disability
expectations, demographic, psychological and medical variables. Higher
disability expectations at baseline were associated with higher adrenaline
levels after surgery (F=5.682;P=.021;eta²=.071), and patients'
baseline expectations were associated with changes of patients' adrenaline
levels over time(F=10.32,P<.001;eta² =.122). Conclusions: In
addition to standard medical care, preoperative psychological
interventions seem to be able to buffer psychobiological stress responses
and could thus facilitate recovery from CABG-surgery. (Figure Presented).