EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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Accession Number
619526119
Author
Yang Y.; Huang F.-Y.; Huang B.-T.; Xiong T.-Y.; Pu X.-B.; Chen S.-J.; Chen
M.; Feng Y.
Institution
(Yang, Huang, Huang, Xiong, Pu, Chen, Chen, Feng) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu, Sichuan 610041, China
Title
The safety of concomitant transcatheter aortic valve replacement and
percutaneous coronary intervention.
Source
Medicine (United States). 96 (48) (no pagination), 2017. Article Number:
e8919. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: TAVR is a rapidly spreading treatment option for severe aortic
valve stenosis. Significant coronary artery disease (CAD) is present in
40% to 75% of patients undergoing TAVR. However, when to treat the
concomitant coronary artery lesions is controversial. Methods: This is a
systematic review comparing concomitant PCI and TAVR versus staged PCI and
TAVR. The OVID database was systematically searched for studies reporting
PCI in patients undergoing TAVR. A random effects model was used to
calculate the pooled odds ratio (OR) with 95% confidence intervals.
Results: Four observational studies and a total of 209 patients were
included in this analysis. Overall 30-day mortality was similar between
concomitant PCI and TAVR versus staged PCI and TAVR [OR: 1.47 (0.47-4.62);
P = .51], renal failure was not significantly different between both
groups [OR: 3.22 (0.61-17.12); P = .17], periprocedural myocardial
infarction was not different between the 2 groups [OR: 1.44 (0.12-16.94);
P = .77], life-threatening bleeding did not differ between both groups
[OR: 0.45 (0.11-1.87); P = .27], and major stroke also was not
significantly different [OR: 3.41 (0.16-74.2); P = .44]. Conclusion: These
data did not show a significant difference in short-term outcomes between
concomitant PCI and TAVR versus staged PCI and TAVR.<br/>Copyright &#xa9;
2017 the Author(s). Published by Wolters Kluwer Health, Inc.

<2>
Accession Number
614929399
Author
Machan L.; Churilov L.; Hu R.; Peyton P.; Tan C.; Pillai P.; Ellard L.;
Harley I.; Story D.; Hayward P.; Matalanis G.; Roubos N.; Seevanayagam S.;
Weinberg L.
Institution
(Machan) University of Melbourne, Victoria, Australia
(Churilov) Florey Institute of Neuroscience and Mental Health, University
of Melbourne, Victoria, Australia
(Hu, Peyton, Tan, Pillai, Ellard, Harley) Department of Anesthesia, Austin
Hospital, Heidelberg, Victoria, Australia
(Story, Weinberg) Department of Anesthesia Perioperative and Pain
Medicine, University of Melbourne, Victoria, Australia
(Story, Weinberg) Department of Surgery and Centre for Anesthesia,
Perioperative and Pain Medicine, University of Melbourne, Victoria,
Australia
(Hayward, Matalanis, Roubos, Seevanayagam) Department of Cardiac Surgery,
Austin Hospital, Heidelberg, Victoria, Australia
Title
Apneic Oxygenation Versus Low-Tidal-Volume Ventilation in Anesthetized
Cardiac Surgical Patients: A Prospective, Single-Center, Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2000-2009),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives To compare the physiology of apneic oxygenation with
low-tidal-volume (VT) ventilation during harvesting of the left internal
mammary artery. Design Prospective, single-center, randomized trial.
Setting Single-center teaching hospital. Participants The study comprised
24 patients who underwent elective coronary artery bypass grafting
surgery. Interventions Apneic oxygenation (apneic group: 12 participants)
and low-VT ventilation (low-VT group: 12 participants) (2.5 mL/kg ideal
body weight) for 15 minutes during harvesting of the left internal mammary
artery. Measurement and Main Results The primary endpoint was an absolute
change in partial pressure of arterial carbon dioxide (PaCO<inf>2</inf>).
Secondary endpoints were changes in arterial pH, pulmonary artery
pressures (PAP), cardiac index, and pulmonary artery acceleration time and
ease of surgical access. The mean (standard deviation) absolute increase
in PaCO<inf>2</inf> was 31.8 mmHg (7.6) in the apneic group and 17.6 mmHg
(8.2) in the low-VT group (baseline-adjusted difference 14.2 mmHg [95%
confidence interval 21.0-7.3], p<0.001). The mean (standard deviation)
absolute decrease in pH was 0.15 (0.03) in the apneic group and 0.09
(0.03) in the low-VT group baseline-adjusted difference 0.06 [95%
confidence interval 0.03-0.09], p<0.001. Differences in the rate of change
over time between groups (time-by-treatment interaction) were observed for
PaCO<inf>2</inf> (p<0.001), pH (p<0.001), systolic PAP (p = 0.002),
diastolic PAP (p = 0.023), and mean PAP (p = 0.034). Both techniques
provided adequate ease of surgical access; however, apneic oxygenation was
preferred predominantly. Conclusions Apneic oxygenation caused a greater
degree of hypercarbia and respiratory acidemia compared with low-VT
ventilation. Neither technique had deleterious effects on PAP or cardiac
function. Both techniques provided adequate ease of surgical
access.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<3>
Accession Number
614111733
Author
Silvestri L.; Weir W.I.; Gregori D.; Taylor N.; Zandstra D.F.; van Saene
J.J.M.; van Saene H.K.F.
Institution
(Silvestri) Department of Anaesthesia and Intensive Care, S. Giovanni di
Dio Hospital, Gorizia, Italy
(Silvestri, Taylor, van Saene, van Saene) Institute of Ageing and Chronic
Disease, University of Liverpool, Liverpool, UK, United States
(Weir) Department of Cardiothoracic Surgery, London Chest Hospital,
London, UK, United States
(Gregori) Department of Cardiological, Thoracic and Vascular Sciences,
Unit of Biostatistics Epidemiology and Public Health, University of
Padova, Padova, Italy
(Zandstra) University of Amsterdam, Amsterdam, Netherlands
Title
Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill
Patients: Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2236-2244),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives Oropharyngeal overgrowth of microorganisms in the critically
ill is a risk factor for lower respiratory tract infection and subsequent
invasion of the bloodstream. Oral chlorhexidine has been used to prevent
pneumonia, but its effect on bloodstream infection never has been assessed
in meta-analyses. The authors explored the effect of oral chlorhexidine on
the incidence of bloodstream infection, the causative microorganism, and
on all-cause mortality in critically ill patients. Design Systematic
review and meta-analysis of published studies. Setting Intensive care
unit. Participants The study comprised critically ill patients receiving
oral chlorhexidine (test group) and placebo or standard oral care (control
group). Interventions PubMed and the Cochrane Register of Controlled
Trials were searched. Odds ratios (ORs) were pooled using the
random-effects model. Measurements and Main Results Five studies including
1,655 patients (832 chlorhexidine and 823 control patients) were
identified. The majority of information was from studies at low or unclear
risk bias; 1 study was at high risk of bias. Bloodstream infection and
mortality were not reduced significantly by chlorhexidine (OR 0.74; 95%
confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53,
respectively). In the subgroup of surgical, mainly cardiac, patients,
chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97).
Chlorhexidine did not affect any microorganism significantly. Conclusion
In critically ill patients, oropharyngeal chlorhexidine did not reduce
bloodstream infection and mortality significantly and did not affect any
microorganism involved. The presence of a high risk of bias in 1 study and
unclear risk of bias in others may have affected the robustness of these
findings.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<4>
Accession Number
618848092
Author
Pesonen E.; Keski-Nisula J.; Passov A.; Vahatalo R.; Puntila J.; Andersson
S.; Suominen P.K.
Institution
(Pesonen, Passov, Vahatalo) Division of Anaesthesiology, Department of
Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland
(Keski-Nisula, Vahatalo, Suominen) Department of Anaesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital, Finland
(Keski-Nisula, Suominen) Division of Anaesthesiology, Department of
Anaesthesiology, Intensive Care and Pain Medicine, Children's Hospital,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Puntila) Department of Paediatric Cardiac and Transplantation Surgery,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Andersson) Children's Hospital, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
Title
Heart-Type Fatty Acid Binding Protein and High-Dose Methylprednisolone in
Pediatric Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 1952-1956),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives Corticosteroids possess cardioprotection in experimental
cardiac ischemia/reperfusion. The authors hypothesized that if
cardioprotection of corticosteroids occured during pediatric cardiac
surgery, then methylprednisolone used in cardiopulmonary bypass prime
would reduce postoperative concentrations of heart-type fatty-acid-binding
protein, a cardiac biomarker. Design A double-blind, placebo-controlled,
randomized clinical trial. Setting Operating room and pediatric intensive
care unit of a university hospital. Participants Forty-five infants and
young children undergoing ventricular or atrioventricular septal defect
correction. Interventions The patients received one of the following: 30
mg/kg of methylprednisolone intravenously after anesthesia induction (n =
15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime
solution (n = 15), or placebo (n = 15). Measurements and Main Results
Plasma heart-type fatty-acid-binding protein (hFABP) was measured.
Preoperatively, hFABP did not differ among the study groups.
Methylprednisolone administered preoperatively and in the cardiopulmonary
bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033)
6 hours postoperatively. hFABP significantly correlated with concomitant
troponin T after protamine administration (R = 0.811, p < 0.001) and 6
hours postoperatively (R = 0.806, p < 0.001). Conclusions
Methylprednisolone in cardiopulmonary bypass prime solution administered
only a few minutes before cardiac ischemia confered cardioprotection of
the same magnitude as preoperative methylprednisolone as indicated by
hFABP concentrations. Rapid cardioprotective actions of corticosteroids in
pediatric heart surgery observed previously experimentally may have
occurred.<br/>Copyright &#xa9; 2017

<5>
Accession Number
618846988
Author
Turan A.; Karimi N.; Zimmerman N.M.; Mick S.L.; Sessler D.I.; Mamoun N.
Institution
(Turan, Karimi, Zimmerman, Sessler) Department of Outcomes Research,
Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
(Zimmerman) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Mick) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland,
OH, United States
(Mamoun) Departments of Cardiothoracic Anaesthesiology and Outcomes
Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
Title
Intravenous Acetaminophen Does Not Decrease Persistent Surgical Pain After
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2058-2064),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objective The authors investigated the hypothesis that perioperative
acetaminophen reduces incisional pain at 30 and 90 days. Design This was a
prospective, randomized, double-blind trial. Setting Tertiary-care
hospital (single center) cardiac surgery unit. Participants Patients
undergoing cardiac surgery via median sternotomy. Interventions Patients
were assigned randomly to intravenous (IV) acetaminophen or IV placebo.
Patients were given 4 doses of 1 g of IV acetaminophen or an equal volume
of saline placebo over 15 minutes every 6 hours for 24 hours starting in
the operating room after sternal closure. Measurements and Main Results
Study participants were assessed by phone for incisional pain severity 30
and 90 days after surgery. Those reporting any incisional pain were asked
to complete the Neuropathic Pain Questionnaire-Short Form and the modified
Brief Pain Inventory. Patients were compared on 30- and 90-day incisional
pain severity using separate multivariable linear regression models. IV
acetaminophen had no effect on 30- and 90-day incisional pain, with an
estimated difference in means (confidence interval) of 0.06 (-0.87 to
0.99) at 30 days (p = 0.88) and 0.07 (-0.71 to 0.86) at 90 days (p =
0.83). Low pain severity, neuropathic pain, and interference at both 30
and 90 days after surgery, regardless of treatment group, were observed.
Conclusions IV acetaminophen did not reduce the incidence or intensity of
incisional pain at 30 days and 90 days after surgery.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<6>
Accession Number
618025581
Author
Zhao B.-C.; Shen P.; Liu K.-X.
Institution
(Zhao, Liu) Department of Anesthesiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Shen) Department of Anesthesiology, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac
Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2086-2092),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives To evaluate whether perioperative statins reduce the risk of
acute kidney injury (AKI) after cardiac surgery. Design Systematic review
and meta-analysis of randomized trials. Setting Perioperative management
in hospitals that perform cardiac surgery. Participants Adult patients
undergoing cardiac surgery. Interventions PubMed, EMBASE, and the Cochrane
Library databases were searched for randomized trials. Random-effects
meta-analyses were performed to compare the effects of statins versus
placebo/control. Trial sequential analysis was conducted to confirm the
results. Measurements and Main Results The primary outcome was incidence
of postoperative AKI. Eight trials enrolling 3,204 patients were included.
The statin arms and the control arms were comparable in incidence of
postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] =
0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI =
0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84
min, 95% CI = -55.53-105.20), intensive care unit length of stay (MD =
0.04 days, 95% CI = -3.13-3.20), hospital length of stay (MD = -0.08 days,
95% CI = -0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI =
0.93-15.14). Trial sequential analysis confirmed that it is unlikely that
perioperative statin therapy could achieve a 20% or more relative risk
reduction in AKI incidence. Conclusions Among patients undergoing cardiac
surgery, perioperative statin treatment did not reduce the risk of AKI.
Statin therapy should not be initiated to prevent AKI following cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<7>
Accession Number
619543971
Author
Masri A.; Al Halabi S.; Karimianpour A.; Gillinov A.M.; Naji P.; Sabik
J.F.; Mihaljevic T.; Svensson L.G.; Rodriguez L.L.; Griffin B.P.; Desai
M.Y.
Institution
(Masri, Al Halabi, Karimianpour, Gillinov, Naji, Sabik, Mihaljevic,
Svensson, Rodriguez, Griffin, Desai) Heart Valve Center, Heart and
Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5,
Cleveland, OH 44195, United States
Title
Impact of additive mitral valve surgery to coronary artery bypass grafting
on mortality in patients with coronary artery disease and ischaemic mitral
regurgitation: A systematic review and meta-analysis of randomized trials
and observational studies.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (1) (pp
33-44), 2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Treatment of ischaemic mitral regurgitation (IMR) remains
controversial. While IMR is associated with worse outcomes, randomized
controlled trials (RCTs) and observational studies provided conflicting
evidence regarding the benefit of mitral valve replacement (MVR) or repair
(MVr) in addition to coronary artery bypass grafting (CABG). We conducted
a meta-analysis incorporating data from published RCTs and observational
studies comparing CABG vs. CABG + MVR/MVr. Methods and results
WesearchedPubMed,MEDLINE, Embase,Ovid, andCochrane for RCTs and
observational studies comparingCABG (Group 1) vs. CABG + MVR/MVr (Group
2). Outcome was 30-day and 1-year mortality after surgical
intervention.Mantel-Haenszel odds ratio (OR) was calculated using
random-effects meta-analysis for the outcome. Heterogeneity was assessed
by I2 statistics. Four RCTs and 11 observational studies met the inclusion
criteria (5781 patients, 507 in RCTs, 5274 in observational studies).
Group 1 vs. 2 weighted mean left ventricular ejection fraction in RCTs and
combined RCTs/observational studies was 41.5+12.3 vs. 40.3+10.4% (P-value
= 0.24) and 45.5+7.2 vs. 38+10% (P-value , 0.001), respectively. In RCTs,
there was no difference in 30-day [OR: 0.95, 95% confidence interval (95%
CI): 0.30-3.08, P = 0.94] or 1-year (OR: 0.90, 95% CI: 0.43-1.87, P =
0.78) mortality, respectively. For combined RCTs/observational studies,
therewas no difference in mortality at 30 days (OR: 0.67, 95% CI:
0.43-1.04, P = 0.08) or at 1 year (OR: 0.90, 95% CI: 0.7-1.15, P = 0.39).
Conclusion In a meta-analysis of RCTs and observational studies of IMR
patients, the addition of MVR/MVr to CABG did not improve
survival.<br/>Copyright &#xa9; The Author 2015.

<8>
Accession Number
618224992
Author
Lee C.-T.; Lin Y.-C.; Yeh Y.-C.; Chen T.-L.; Chen C.-Y.
Institution
(Lee, Yeh) Department of Anesthesiology, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Lin, Chen, Chen) Department of Anesthesiology, Taipei Medical University
Hospital, 252 Wuxing St, Taipei 10031, Taiwan (Republic of China)
(Lin) School of Nursing, College of Nursing, Taipei Medical University,
Taipei, Taiwan (Republic of China)
(Chen, Chen) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
Title
Effects of levosimendan for perioperative cardiovascular dysfunction in
patients receiving cardiac surgery: a meta-analysis with trial sequential
analysis.
Source
Intensive Care Medicine. 43 (12) (pp 1929-1930), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)

<9>
Accession Number
619587320
Author
Shanbhag S.; Kashani A.; Davidson Y.; Nand P.; Ramanathan I.
Institution
(Shanbhag, Kashani, Davidson, Nand, Ramanathan) Auckland City Hospital,
Auckland, New Zealand
Title
Surgical ablation of atrial fibrillation during mitral valve surgery: A
systematic review of the literature.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S384), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: Chronic atrial fibrillation (AF) is commonly present in patients
undergoing mitral valve (MV) surgery. Surgical ablation of AF during MV
surgery is emerging as a reasonable treatment modality. However, there is
no clear consensus despite some of the randomised studies (RCT's)
recommend surgical ablation in control of AF. The present systematic
review aims to critically analyse the utility of surgical ablation in
patients with chronic AF undergoing MV surgery and the evidence for its
use. Methodology: A total of 13 RCT's were selected by utilizing
electronic database from Medline, EMBASE, Cochrane, Scopus and PubMed.
Only RCT's using surgical ablation and control, with follow-up reporting
AF comparisons between the groups were included in the study. Results:
Thirteen trials with 815 participants (437 ablations and 378 controls)
provided data for analysis. The ablation group was associated with
significantly lower incidence of AF recurrence compared to control group
at all time intervals of follow-up (p < 0.00001). There was no difference
between the groups in surgical mortality, late mortality or requirement of
permanent pace maker (PPM). The quality of evidence for these studies as
analysed by GRADE method were moderate level for the different variables.
Conclusions: The result from the present study demonstrates superiority
and safety of surgical ablation in patients with chronic AF undergoing MV
surgery in maintaining short to mid-term sinus rhythm. However further
research is required to evaluate the type of surgical ablation and also
long term follow-up about its utility.

<10>
Accession Number
619587289
Author
Seco M.; Puskus J.; Vallely M.; Zhao D.F.; Edelman J.; Bannon P.; Wilson
M.; Byrom M.; Thourani V.; Lamy A.; Taggart D.
Institution
(Seco, Puskus, Vallely, Zhao, Edelman, Bannon, Wilson, Byrom, Thourani,
Lamy, Taggart) Royal Prince Alfred Hospital, Sydney, NSW, Australia
Title
Coronary artery bypass grafting with and without manipulation of the
ascending aorta: A network meta-analysis with 37720 cases.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S383), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: CABG is associated with an increased risk of post-operative
stroke compared to percutaneous coronary intervention. It has been
suggested that CABG techniques that eliminate cardiopulmonary bypass and
reduce aortic manipulation may reduce the incidence of post-operative
stroke. Methods: A systematic review and network meta-analysis was
performed to compare post-operative outcomes between all CABG techniques,
including anaortic off-pump CABG (anOPCABG), off-pump with a partial clamp
(OPCABGPC), off-pump with the clampless Heartstring device (OPCABG-HS),
and traditional on-pump CABG. Studies reporting the primary endpoint,
30-day post-operative stroke rate, were included in the Bayesian network
meta-analysis. Results: There were 13 included studies with 37,720
patients. At baseline, anOPCABG patients had higher previous stroke than
the OPCABG-PC (7.4%vs 6.5%, P = 0.02) and CABG (7.4%vs 3.2%, P = 0.001)
patients. anOPCABGwas the most effective treatment for decreasing the risk
of postoperative stroke (-78% vs CABG, 95% CI 0.14 - 0.33; -66% vs
OPCABG-PC, 0.22 - 0.52; -52% vs OPCABG-HS, 0.27 - 0.86), mortality (-50%
vs CABG, 0.35 - 0.70; -40% vs OPCABG-HS, 0.38 - 0.94), renal failure (-53%
vs CABG, 0.31 - 0.68), bleeding complications (-48% vs CABG, 0.31 - 0.87),
atrial fibrillation (-44% vs OPCABG-HS, 0.49 - 0.89; -29% vs CABG, 0.55 -
0.87; -20% vs OPCABG-PC, 0.68 - 0.97), and shortened length of ICU stay
(-13.3 hours, -19.32 to -7.26, P < 0.0001). Conclusions: Avoidance of
aortic manipulation in anOPCABG may decrease the risk of post-operative
stroke, especially in patients with higher stroke risk. In addition, the
elimination of CPB may reduce the risk of short-term mortality, renal
failure, atrial fibrillation, bleeding, and length of ICU stay.

<11>
Accession Number
619587081
Author
Murali A.; Morrison S.; Moxon J.; Golledge J.
Institution
(Murali, Morrison, Moxon, Golledge) James Cook University, Townsville, QLD
2696, Australia
Title
A meta-analysis of the efficacy of allopurinol in 2691 reducing the
incidence of myocardial infarction (MI).
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S378), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: Myocardial infarction (MI) continues to be a leading cause of
morbidity and mortality. Recent studies have suggested a novel
cardioprotective role for allopurinol. This reviews aims to assess the
efficacy of allopurinol in reducing the incidence of MI. Methodology:
MEDLINE, Scopus, Web of Science, and Cochrane Library databases were
searched for randomised controlled trials (RCT) examining the efficacy of
allopurinol in reducing the incidence of MI. Reference lists of included
stud- ies were also hand-searched. Data extraction and quality assessment
were performed by two independent reviewers. RevMan 5.3was used to
performformal tests of heterogeneity, fixed-effects meta-analysis and
leave-one-out sensitivity analyses. Results: 1034 citations were screened;
only six studies satisfied the inclusion criterion. Published between 1988
and 1995, all of these studies examined the cardioprotective efficacy of
allopurinol in the setting of coronary artery bypass graft (CABG) surgery.
Perioperative MI was reported in 2 (1.77%) of 113 patients randomised to
allopurinol and 14 (12.07%) of 116 control patients. Quality assessment
revealed that methods of randomisation, allocation concealment and
blinding were inconsistently reported. Fixed-effects meta- analysis (I2 =
0%) identified a statistically significant, reduced incidence of MI (RR
0.21, 95% CI: 0.06, 0.70, p- value = 0.01) in allopurinol patients. In
leave-one-out sensi- tivity analyses, the treatment effect became
non-significant with the removal of one of the studies. Conclusion: Based
on limited evidence from small RCTs, allopurinol appears to decrease the
incidence of periopera- tive MI following CABG. Further research is
required to confirm these findings.

<12>
Accession Number
619587045
Author
Doyle M.; Indraratna P.; Brown M.
Institution
(Doyle, Indraratna, Brown) University of Wollongong, Sydney, NSW,
Australia
Title
Early aerobic exercise after coronary artery bypass surgery: A systematic
review.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S365), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Introduction: Aerobic exercise (AE) reduces morbidity and mortality for
patients following coronary artery bypass graft
(CABG)surgery.AEiscommonlycommencedat least 4 weeks following CABG during
outpatient cardiac rehabilitation. AE in the early postoperative period
may improve aerobic and functional capacity of patients at hospital
discharge. The aim of the present study was to assess the outcomes of
early AE following CABG. Methods: A systematic review of the literature
was conducted for studies published on outcomes of patients undergoing
early (commencing within 2 weeks of CABG) aerobic or functional exercise
training. Predefined inclusion criteria included studies reporting on
early (<4 weeks) outcomes. Results: Seven studies were identified
according to selection criteria. A total of 473 patients received early AE
interventions. Functional capacity when measured by 6-minute walk test
(6MWT) was higher in early AE groups (mean = 404.6m) compared with control
groups (mean = 378m). Mean ventilatory anaerobic threshold following early
AE was 12.15 ml/kg/min and mean peak oxygen uptake was 18.2 ml/kg/min.
Early postoperative outcomes included atrial fibrillation (22.9%), deep
sternal wound infection (0%) and mortality (0%). Discussion: This study is
the only review of early exercise following CABG identified from the
current literature. Our results indicate that early AE can be safely
performed in selected patients following uncomplicated CABG, with
improvements in functional and aerobic capacity in the early postoperative
period. Future studies should focus on patient cohorts at higher risk of
acute functional or aerobic deconditioning such as the elderly, obese and
those with functional limitations from comorbidities.

<13>
Accession Number
619586901
Author
Cao C.; Virk S.; Sriravindrarajah A.; Dunn D.; Liou K.; Wolfenden H.
Institution
(Cao, Virk, Sriravindrarajah, Dunn, Liou, Wolfenden) Collaborative
Research (CORE) Group, Sydney, NSW, Australia
Title
A meta-analysis of mitral valve repair versus replacement for ischaemic
mitral regurgitation.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S359-S360), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: The development of ischaemic mitral regurgitation (IMR)
portends a poor prognosis and is associated with adverse long-term
outcomes. Although both mitral valve repair (MVr) and mitral valve
replacement (MVR) have been performed in the surgical management of IMR,
uncertainty remains regarding the optimal approach. The aim of this study
was to meta-analyse these two procedures, with mortality as the primary
endpoint. Methods: Seven databases were systematically searched for
studies reporting perioperative or late mortality following MVr and MVR
for IMR. Data were independently extracted by two reviewers and
meta-analysed according to pre-defined study selection criteria and
clinical endpoints. Results: Overall, 22 observational studies (n = 3,815
patients) and one randomised controlled trial (n = 251) were included.
Meta-analysis demonstrated significantly reduced perioperative mortality
[relative risk (RR) 0.61; 95% confidence intervals (CI), 0.47-0.77; I2 =
0%; p < 0.001] and late mortality (RR, 0.78; 95% CI, 0.67-0.92; I2 = 0%; p
= 0.002) following MVr. This finding was more pronounced in studies with
longer follow-up beyond 3 years. At latest follow-up, recurrence of at
least moderate mitral regurgitation (MR) was higher following MVr (RR,
5.21; 95% CI, 2.66-10.22; I2 = 46%; p < 0.001) but the incidence of mitral
valve re-operations were similar. Conclusions: In the present
meta-analysis, MVr was associated with reduced perioperative and late
mortality compared to MVR, despite an increased recurrence of at least
moderate MR at follow-up. These findings must be considered within the
context of the differing patient characteristics that may affect
allocation to MVr or MVR. Larger prospective studies are warranted to
further compare long-term survival and freedom from re-intervention.

<14>
Accession Number
619586882
Author
Kunz S.; Mirowska-Allen K.; Ianno D.; Seevanayagam S.
Institution
(Kunz, Mirowska-Allen, Ianno, Seevanayagam) Austin Health, Melbourne, VIC,
Australia
Title
First blood: The utility of the initial 2374 haemoglobin in ICU in
predicting the likelihood of post-operative transfusions, over 5 years of
cardiac surgery.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S375), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: Red blood cells (RBCs) are a finite resource. While cardiac
surgery is associated with a higher use of blood products than other
disciplines, the ability to predict the need for RBCs would aid in
efficient resource manage- ment. We examined the utility of the initial
haemoglobin in ICU and its association with the likelihood of transfusion,
along with the number of units transfused. Methodology: A case-control
study was undertaken at a single tertiary institution, reviewing all cases
of CABGs and single valve repair/replacements between January 2011 and
December 2015. Their first haemoglobin on blood gas in ICU wasmeasured and
stratified into groups (<80 g/L being low, 81-100 being normal, 101-120
being high and >120 being very high), as was whether they received a RBC
transfusion fol- lowing this and, if so, the total number of units
administered. Results: Of 912 patients identified, 6 were excluded due to
being in trials that influenced transfusion behaviour. For those that
remained, 111 were within the low haemoglobin group (12%), 430 within the
normal (48%), 288 within the high (32%) and 120 within the very high (8%).
Compared with the normal group, those with a low Hb were 425%more likely
to receive an RBC transfusion (OR 4.24; 95%CI 2.63- 6.86, p = 0.000), and
require 71% more units (IRR 1.71, p = 0.000). While those in the high and
very high groups were less likely to receive a transfusion (OR 0.18; 95%CI
0.12-0.28, & OR 0.017; 95% CI 0.00-0.13, p = 0.000) this did not translate
to a decrease in the number of units transfused (IRR 0.94 & 0.99, p = 0.72
& 0.99). Conclusion: A lower haemoglobin on arrival to ICU fol- lowing
cardiac surgery is correlated with a greater risk of transfusion, and
greater number of units required. This may aid in developing a future
algorithm in predicting require- ments for blood.

<15>
Accession Number
619586836
Author
Kashani A.; Shanbhag S.; Kang N.; Haydock D.; Ramanathan I.
Institution
(Kashani, Shanbhag, Kang, Haydock, Ramanathan) Cardiothoracic Unit,
Auckland City Hospital, Auckland, New Zealand
Title
Radial artery vs. Saphenous vein graft for coronary artery bypass surgery:
A systematic review of the literature.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S374), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: In coronary artery bypass surgery (CABG) apart from left internal
mammary artery (LIMA) the commonly used conduits are the saphenous vein
(SVG) and radial artery (RA). The long term patency of LIMA is well known,
how- ever long term patency of SVG and RA is not yet fully established.
The present systemic review aims to critically analyse long term patency
of SVG and RA in patients under- going conventional CABG surgery.
Methodology: A total of eight randomised studies (RCT's) were selected by
utilising electronic database from Medline, Embase, Cochrane, Scopus and
Pubmed. Only RCT's using SVG and RA and reporting angiographic comparsons
were included in the study. Results: Eight trials with 1885 participants
(1445 RA and 1412 SVG) provided the data for analysis. The RA group was
associated with significantly lower incidence of graft failure compared to
SVG group (p < 0.0001). The RA group also required significantly less
repeat coronary intervention (p < 0.02). The quality of evidence for these
studies as ana- lysed by GRADE method were average to moderate level for
the different variables. Conclusion: The results from the present study
indicate significant long term patency and decreased re-intervention rate
with RA compared to SVG group. However further study is required to
definitively establish this association in different subset of patients
and different coronary artery territories.

<16>
Accession Number
619586801
Author
Oldroyd J.; Baker R.; Jennings S.; Mcquilten Z.; Ruseckaite R.; Kluger R.;
Tran L.; Wood E.
Institution
(Oldroyd, Baker, Jennings, Mcquilten, Ruseckaite, Kluger, Tran, Wood)
Transfusion Research Unit, Melbourne, VIC, Australia
Title
Cardiothoracic surgery patients requiring massive transfusion: Initial
data from the Australian and New Zealand massive transfusion registry
(ANZ-MTR).
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S373), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: To characterise cardiothoracic (CT) surgery patients requiring
massive transfusion (MT) (#8805;5 units red blood cells (RBCs) in 4 h) in
the ANZ-MTR. Methodology: The ANZ-MTR uses electronically stored data from
hospital information systems. All consecutive CT surgery patients who
received aMT between Apr 2011 - Sept 2015 at 22 hospitals were included.
Survival to hospital discharge was obtained from hospital records. Overall
mor- tality post-discharge was obtained from linkage to the National Death
Index. Results: Of 4379 MTR patients, 861 (19.7%) underwent CT surgery;
664 (77.1%) cardiac, 169 (19.6%) thoracic vascular and 28 (3.3%) lung
procedures. 442 (66.6%) of cardiac pro- cedures were male with median
[interquartile range] age 69 [59-77] years compared to 2680 (61.2%) males
aged 63 [47-74] years in the MTR cohort. In cardiac procedures, total
fresh frozen plasma: red blood cell ratio (FFP: RBC) for the episode of
care was 0.6 [0.4-0.8] compared with 0.5 [0.3-0.8] the MTR cohort. 18.3%
of cardiac procedures received prothrombinex compared with 11.0% in theMTR
cohort. 461 (75.1%) cardiac patients survived to discharge compared with
72.7% of the MTR cohort. Overall cardiac patient survival post-discharge
was 71.8% compared with 68.5% in the MTR cohort. Conclusion: Critically
bleeding CT surgery patients in Australia and New Zealand comprise a large
proportion of patients requiringMT. Future studies are needed to exam- ine
the optimal ratio of blood components (e.g. FFP: RBC) and other patient,
procedural and transfusion factors which may influence outcomes in these
patients.

<17>
Accession Number
619586432
Author
Anonymous
Title
ANZSCTS 2016 Annual Scientific Meeting.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
The proceedings contain 150 papers. The topics discussed include:
recannulation of axillary artery in complex cardiac surgery; active
clearance of chest drains to optimize patient outcomes after cardiac
surgery; deep dive into hospital performance for PCI for acute STEMI: the
victorian cardiac outcomes registry (VCOR; laparoscopic assisted thoracic
omentoplasty - a treatment for serious and refractory complications of
cardiothoracic surgery; pleural and pulmonary solitary fibrous tumors: our
experience with this rare tumor; CABG for tripple vessels disease in
patient with severed carotid stenosis; indigenous Australian cardiac
surgery morbidity comparisons; and radial artery vs. saphenous vein graft
for coronary artery bypass surgery: a systematic review of the literature.

<18>
Accession Number
619587421
Author
Klineberg P.; Hinks P.; Playford H.; Meredith G.; Steel R.; Harris C.;
Priestley M.; Miraziz R.; Agbulos G.; Brouwer M.; Dickson C.
Institution
(Klineberg, Hinks, Playford, Meredith, Steel, Harris, Priestley, Miraziz,
Agbulos, Brouwer, Dickson) Westmead Hospital, Sydney, NSW, Australia
Title
Reducing RBC transfusion in cardiac surgery: A single centre's experience
in a multicentre quality improvement initiative of the Australian and New
Zealand collaborative perfusion registry (ANZCPR).
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S385), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: to reduce RBC transfusion within a multicenter project of the
Australian and New Zealand Collaborative Perfusion Registry (ANZCPR)
through implementation of industry guidelines and avoidance of anaemia.
Methodology: This multicenter project was modeled on a single centre 3
phase study, where current processes were identified (phase I) then
newprotocols implemented (phase II) and follow up monitoring of progress
(phase III) [1]. Local sites formed a local multi-disciplinary quality
improvement team to review current practice and incidence of transfusion
for their site (phase 1). Our team included cardiac surgery, anesthetics,
CICU, haematology, blood bank and perfusion. This teamwould then review
current literature and guidelines and select initiatives and changes in
practice they considered worthwhile (phase II). These were then relayed to
staff and introduced. Then a 3 and 6month follow up reporting changes in
incidence of RBC transfusion fed back to teammembers and their staff
(phase III). Concurrently, indications for each transfusion were also
recorded in line with the project model. Results: At our centre, each
discipline was involved in introducing a variety of simple wide-reaching
evidence based strategies with very small costs with spectacular results.
Our centre has had a 57% reduction in the number of RBC units transfused
for our open heart, RBC transfusion rate per 6 months has fallen 20%,
andof those transfused, patients receiving more than 2 units has dropped
13%. Also, a 34% reduction in units of platelets given, 50% reduction in
cryoprecipitate units and 49% reduction in units of FFP transfused. These
changes in practice continue to improve transfusion rates. Conclusion: A
multidisciplinary team approach to RBC conservation using well established
evidence- based guidelines can effectively optimise the use of blood
products in a cardiac surgical setting and in a cost effective manner.

<19>
Accession Number
619587420
Author
Litton E.; Reid C.; Smith J.; Yarad L.; Bass F.; Delaney A.; Hillis G.;
Jacques T.; Marrow N.; Mcgiffin D.; Mcguinness S.; Playford H.
Institution
(Litton, Reid, Smith, Yarad, Bass, Delaney, Hillis, Jacques, Marrow,
Mcgiffin, Mcguinness, Playford) Fiona Stanley Hospital, WA, Australia
Title
Prophylactic intra-aortic balloon counterpulsation in high risk cardiac
surgery: The pinball programme of research and linked-data pilot RCT.
Source
Heart Lung and Circulation. Conference: 2016 Annual Scientific Meeting of
the Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2016. Australia. 26 (Supplement 3) (pp S402-S403), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: Prophylactic intra-aortic balloon pump (IABP) therapy in high
risk patients undergoing CABG surgery may reduce mortality. However, the
quality of the available evidence is low and there is substantial
variability in use. Although there is a need to generate high quality
evidence, several issues first need to be addressed, including equipoise
for enrolment into a RCT, delivery of prophylactic IABP in a trial setting
and study recruitment rate. The aim of the PINBALL pilot RCT is to address
these issues and assess the feasibility of a definitive trial.
Methodology: PINBALL is a multidisciplinary collaboration involving the
ANZSCTS Database Program. The current pilot study builds on a programme of
registry-linked research, nesting an RCT within a high quality database.
Patients are screened for eligibility i.e. they have no exclusion criteria
and are listed for CABG surgery, the treating surgical team is uncertain
as to the benefit of prophylactic IABP and there is one or more of:
severely impaired left ventricular function, recent or ongoing myocardial
ischaemia, or critical coronary artery stenosis. Results: The pilot RCT
has screened 100 and enrolled 17 participants at five centres (planned
sample size is 40), randomising patients to either prophylactic IABP in
addition to standard care, or standard care alone. Recruitment rate is
currently 0.5 (range 0.1-0.7) participants per site per month. Treatment
according to enrolment status occurred in 7/8 (88%) and 9/9 (100%) of
participants in the IABP and no IABP arms respectively. Conclusion:
Randomization to an IABP trial appears feasible, however current
recruitment rate is low, suggesting a definitive trial would require a
substantial number of sites and time.

<20>
Accession Number
619566363
Author
Bigna J.J.; Noubiap J.J.; Nansseu J.R.; Aminde L.N.
Institution
(Bigna) Department of Epidemiology and Public Health, Centre Pasteur of
Cameroon, Yaounde, Cameroon
(Bigna) University of Paris Sud XI, Faculty of Medicine, Le Kremlin
Bicetre, France
(Noubiap) Groote Schuur Hospital and University of Cape Town, Department
of Medicine, Cape Town, South Africa
(Nansseu) University of Yaounde 1, Department of Public Health, Faculty of
Medicine and Biomedical Sciences, Yaounde, Cameroon
(Nansseu) Sickle Cell Disease Unit, Mother and Child Centre of the Chantal
Biya Foundation, Yaounde, Cameroon
(Nansseu) Ministry of Public Health, Department of Disease, Epidemics and
Pandemics Control, Yaounde, Cameroon
(Aminde) Clinical Research Education, Networking and Consultancy (CRENC),
Douala, Cameroon
(Aminde) University of Queensland, School of Public Health, Faculty of
Medicine and Biomedical Sciences, Brisbane, Australia
Title
Prevalence and etiologies of pulmonary hypertension in Africa: A
systematic review and meta-analysis.
Source
BMC Pulmonary Medicine. 17 (1) (no pagination), 2017. Article Number: 183.
Date of Publication: 08 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite the recent increasing worldwide attention towards
pulmonary hypertension (PH), its epidemiology remains poorly described in
Africa. Accordingly, we performed a systematic review and meta-analysis of
PH prevalence, incidence and etiologies in Africa. Methods: We searched
PubMed, EMBASE, African Journals Online, and Africa Index Medicus.
Published observational studies until September 20, 2017, including adult
participants residing in Africa were considered. Two review authors
independently selected studies, assessed included studies for
methodological quality, and extracted data. A random-effects model was
used for meta-analysis. Heterogeneity was evaluated by the chi
² test on Cochrane's Q statistic which is quantified by
I² values. Using Newcastle-Ottawa Scale, we considered a score
of 0-4, 5-7, and 8-10 as indicative of high, moderate, and low risk of
bias in included studies, respectively. Results: Of 1611 entries, 25
studies were retained. Twelve (48%), seven (28%), and six (24%) papers had
respectively a low, moderate and high risk of bias. The prevalence of PH
widely varied across different populations: 9.8% (95% confidence interval:
3.2-19.3; I²=99.4%; 6 studies) in 11,163 people presenting with
cardiac complaints; 10.6% (4.3-19.1; I²=90.3%; 4 studies) in
937 HIV-infected people; 32.9% (17.6-50.4; I²=97.2%; 3 studies)
in 2077 patients with heart failure; 23.2% (15.2-32.2;
I²=59.4%; 3 studies) in 248 patients on hemodialysis; 12.9%
(11.8-14.0; I²=79.7%; 2 studies) in 3750 patients with
rheumatic heart disease; 36.9% (29.7-44.3; I²=79.7; 2 studies)
in 79 patients with sickle cell disease; 62.7% (49.0-74.7; 1 study) in 51
patients with chronic obstructive pulmonary disease; 25.4% (16.3-37.3; 1
study) in 63 patients with systemic lupus erythematous; 68.7% (62.8-74.1;
1 study) in 259 patients with cardiac surgery; and 7.4% (4.6-11.9; 1
study) in 202 patients with systemic sclerosis. No study reported PH
incidence. From one international study (n=209), PH etiologies were: left
heart disease (68.9%), pulmonary arterial hypertension (15.8%), lung
disease and/or hypoxia (12.0%), chronic thromboembolic PH (1.9%) and
unclear/multifactorial PH (15.8%). Conclusion: The prevalence of PH is
relatively high in some populations in Africa, perhaps mainly driven by
left heart diseases, highlighting the need for context-specific
interventions.<br/>Copyright &#xa9; 2017 The Author(s).

<21>
Accession Number
619592509
Author
Ramanathan K.; Abel J.G.; Park J.E.; Fung A.; Mathew V.; Taylor C.M.;
Mancini G.B.J.; Gao M.; Ding L.; Verma S.; Humphries K.H.; Farkouh M.E.
Institution
(Ramanathan, Abel, Fung, Taylor, Mancini, Humphries) University of British
Columbia, Vancouver, Canada
(Park, Gao, Humphries) BC Centre for Improved Cardiovascular Health,
Vancouver, Canada
(Mathew) Loyola University Medical Center and Stritch School of Medicine,
Maywood, Illinois, United States
(Ding) Cardiac Services British Columbia, Vancouver, Canada
(Verma) St. Michael's Hospital, Toronto, Canada
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
Title
Surgical Versus Percutaneous Coronary Revascularization in Patients With
Diabetes and Acute Coronary Syndromes.
Source
Journal of the American College of Cardiology. 70 (24) (pp 2995-3006),
2017. Date of Publication: 19 December 2017.
Publisher
Elsevier USA
Abstract
Background Randomized trial data support the superiority of coronary
artery bypass grafting (CABG) surgery over percutaneous coronary
intervention (PCI) in diabetic patients with multivessel coronary artery
disease (MV-CAD). However, whether this benefit is seen in a real-world
population among subjects with stable ischemic heart disease (SIHD) and
acute coronary syndromes (ACS) is unknown. Objectives The main objective
of this study was to assess the generalizability of the FREEDOM (Future
REvascularization Evaluation in Patients with Diabetes Mellitus: Optimal
Management of Multi-vessel Disease) trial in real-world practice among
patients with diabetes mellitus and MV-CAD in residents of British
Columbia, Canada. Additionally, the study evaluated the impact of mode of
revascularization (CABG vs. PCI with drug-eluting stents) in diabetic
patients with ACS and MV-CAD. Methods In a large population-based database
from British Columbia, this study evaluated major cardiovascular outcomes
in all diabetic patients who underwent coronary revascularization between
2007 and 2014 (n = 4,661, 2,947 patients with ACS). The primary endpoint
(major adverse cardiac or cerebrovascular events [MACCE]) was a composite
of all-cause death, nonfatal myocardial infarction, and nonfatal stroke.
The risk of MACCE with CABG or PCI was compared using multivariable
adjustment and a propensity score model. Results At 30-days
post-revascularization, for ACS patients the odds ratio for MACCE favored
CABG 0.49 (95% confidence interval [CI]: 0.34 to 0.71), whereas among SIHD
patients MACCE was not affected by revascularization strategy (odds ratio:
1.46; 95% CI: 0.71 to 3.01; p<inf>interaction</inf> <0.01). With a median
follow-up of 3.3 years, the late (31-day to 5-year) benefit of CABG over
PCI no longer varied by acuity of presentation, with a hazard ratio for
MACCE in ACS patients of 0.67 (95% CI: 0.55 to 0.81) and the hazard ratio
for SIHD patients of 0.55 (95% CI: 0.40 to 0.74; p<inf>interaction</inf> =
0.28). Conclusions In diabetic patients with MV-CAD, CABG was associated
with a lower rate of long-term MACCE relative to PCI for both ACS and
SIHD. A well-powered randomized trial of CABG versus PCI in the ACS
population is warranted because these patients have been largely excluded
from prior trials.<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<22>
Accession Number
619592387
Author
Baron S.J.; Chinnakondepalli K.; Magnuson E.A.; Kandzari D.E.; Puskas
J.D.; Ben-Yehuda O.; van Es G.-A.; Taggart D.P.; Morice M.-C.; Lembo N.J.;
Brown W.M.; Banning A.; Simonton C.A.; Kappetein A.P.; Sabik J.F.; Serruys
P.W.; Stone G.W.; Cohen D.J.
Institution
(Baron, Chinnakondepalli, Magnuson, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine, Kansas
City, Missouri, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Puskas, Lembo, Brown) Mount Sinai Medical Center, New York, New York,
United States
(Ben-Yehuda, Stone) Cardiovascular Research Foundation, New York, New
York, United States
(van Es) Cardialysis, Rotterdam, Netherlands
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Morice) Ramsay Generale de Sante, Hospital Prive Jacques Cartier, Massy,
France
(Simonton) Abbott Vascular Inc., Abbott Park, Illinois, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, New York, United States
Title
Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for
Left-Main Disease: Results From the EXCEL Trial.
Source
Journal of the American College of Cardiology. 70 (25) (pp 3113-3122),
2017. Date of Publication: 26 December 2017.
Publisher
Elsevier USA
Abstract
Background The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial compared
outcomes in patients with unprotected left main coronary artery disease
(LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous
coronary intervention (PCI) using everolimus-eluting stents. Whereas rates
of death, stroke, and myocardial infarction were similar at 36 months,
event timing and repeat revascularization rates differed by treatment
group. Objectives To understand the effects of revascularization strategy
from the patient's perspective, a prospective quality of life (QoL)
substudy was performed alongside the EXCEL trial. Methods Between
September 2010 and March 2014, 1,905 patients with LMCAD were randomized
to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy.
QoL was assessed at baseline and 1, 12, and 36 months using the Seattle
Angina Questionnaire, the 12-Item Short Form Health Survey, the Rose
Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D.
Differences between PCI and CABG were assessed using longitudinal
random-effect growth curve models. Results Over 36 months, both PCI and
CABG were associated with significant improvements in QoL compared with
baseline. At 1 month, PCI was associated with better QoL than CABG. By 12
months though, these differences were largely attenuated, and by 36
months, there were no significant QoL differences between PCI and CABG.
Conclusions Among selected patients with LMCAD, both PCI and CABG result
in similar QoL improvement through 36 months, although a greater early
benefit is seen with PCI. Taken together with the 3-year clinical results
of EXCEL, these findings suggest that PCI and CABG provide similar
intermediate-term outcomes for patients with LMCAD. (Evaluation of Xience
Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization [EXCEL]; NCT01205776)<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<23>
Accession Number
619592900
Author
Bangalore S.; Bhatt D.L.
Institution
(Bangalore) Department of Medicine, Cardiac Catheterization Laboratory,
Cardiovascular Clinical Research Center, New York University School of
Medicine, New York, New York, United States
(Bhatt) Department of Medicine, Brigham and Women's Hospital Heart &
Vascular Center, Harvard Medical School, Boston, Massachusetts, United
States
Title
Do We Need a Trial of DES Versus CABG Surgery in Diabetic Patients With
ACS?.
Source
Journal of the American College of Cardiology. 70 (24) (pp 3007-3009),
2017. Date of Publication: 19 December 2017.
Publisher
Elsevier USA

<24>
Accession Number
617931165
Author
Villablanca P.A.; Al-Bawardy R.; Mohananey D.; Maraboto C.; Weinreich M.;
Gupta T.; Briceno D.F.; Ramakrishna H.
Institution
(Villablanca) New York University Langone Medical Center, New York, NY,
United States
(Al-Bawardy) Division of Cardiology, Massachusetts General
Hospital/Harvard Medical School, Boston, MA, United States
(Mohananey) Department of Internal Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Maraboto) Department of Medicine, Jacobi Medical Center/Albert Einstein
College of Medicine, New York, NY, United States
(Weinreich, Gupta, Briceno) Division of Cardiovascular Diseases,
Montefiore Medical Center/Albert Einstein College of Medicine, New York,
NY, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
Title
Bivalirudin versus heparin in patients undergoing percutaneous
transcatheter aortic valve interventions: A systematic review and
meta-analysis.
Source
Journal of Interventional Cardiology. 30 (6) (pp 586-594), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bivalirudin may be an effective anticoagulation alternative to
heparin as anticoagulant agent in percutaneous transcatheter aortic valve
interventions (PAVI). We aimed to compare safety and efficacy of
bivalirudin versus heparin as the procedural anticoagulant agent in
patients undergoing PAVI. Methods: We conducted an electronic database
search of all published data. The primary efficacy endpoints were
all-cause mortality, cardiovascular mortality, myocardial infarction, and
stroke. Safety endpoints include major and life-threatening bleed
according to VARC and BARC bleeding, blood transfusion, vascular
complications, and acute kidney injury. Odds ratios (OR) and 95%
confidence intervals (CI) computed using the Mantel-Haenszel method.
Results: Three studies (n = 1690 patients) were included, one randomized
trial and two observational studies. There was a significant difference
favoring bivalirudin over heparin for myocardial infarction (OR 0.41,
95%CI 0.20-0.87). There was no significant difference in all-cause
mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality
(OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular
complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03,
95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and
life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR
0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve
interventions, no difference was seen between the use of bivalirudin and
heparin as the procedural anticoagulant agent, except for a significant
lower myocardial infarction events when bivalirudin was used. Further
large randomized trials are needed to confirm current
results.<br/>Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<25>
Accession Number
619495358
Author
Zhou Z.; Wang Z.; Zheng Z.; Cao J.; Zhang C.; He Z.; Lv W.; Hu J.
Institution
(Zhou, Wang, Cao, Zhang, He, Lv, Hu) Department of Thoracic Surgery, The
First Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou, China
(Zheng) Department of Ultrasound Imaging, The First Affiliated Hospital,
College of Medicine, Zhejiang University, Hangzhou, China
Title
An "alternative finger" in robotic-assisted thoracic surgery:
Intraoperative ultrasound localization of pulmonary nodules.
Source
Medical Ultrasonography. 19 (4) (pp 374-379), 2017. Date of Publication:
2017.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (E-mail:
dfodor@ymail.com)
Abstract
Aim: Robotic-assisted thoracic surgery (RATS) has become a promising
treatment for pulmonary neoplasms. During RATS, intraoperative
ultrasonography can act as an "alternative finger" to "touch" and locate
lesions, especially pulmonary nodules. This study was aimed to investigate
the efficacy of intraoperative ultrasonographic localization during da
Vinci RATS procedures. Material and methods: Patients with pulmonary
nodules were randomly divided into an Experimental Group and Control Group
in which nodules were respectively located using intraoperative
ultrasonography or by the surgeon's anatomic knowledge. The success rates
and relevant localization factors were compared between the groups and
analyzed to conclude the efficacy of intraoperative ultrasonography.
Additionally, the intraoperative ultrasonography learning curve was
analyzed to evaluate each surgeon's ability to independently perform
intraoperative ultrasonography. Results: Thirty-four patients were
included in the study (n = 17/group). Respectively, the Experimental Group
and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had
average ages of 55.5 and 55.8 years. In the Experimental group,
ultrasonographic localization for mixed ground-glass nodules with CT
values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By
contrast, the localization efficacy in Control Group was 20.0% (p=0.032).
A single surgeon without prior experience performed intraoperative
ultrasonography in 20 cases, and the latter 10 procedures required
significantly less time relative to the former 10 procedures (p=0.000).
Conclusions: During RATS, the use of intraoperative ultrasonography as an
"alternative finger" to "touch" and find the accurate location of
pulmonary nodules, especially mixed ground-glass nodules, is warranted.

<26>
Accession Number
619450210
Author
Dalbeth N.; Saag K.G.; Palmer W.E.; Choi H.K.; Hunt B.; MacDonald P.A.;
Thienel U.; Gunawardhana L.
Institution
(Dalbeth) University of Auckland, Auckland, New Zealand
(Saag) University of Alabama at Birmingham, United States
(Palmer, Choi) Massachusetts General Hospital, Harvard Medical School,
Boston, United States
(Hunt, MacDonald, Gunawardhana) Takeda Development Center Americas,
Deerfield, IL, United States
(Thienel) RRD International, Rockville, MD, United States
Title
Effects of Febuxostat in Early Gout: A Randomized, Double-Blind,
Placebo-Controlled Study.
Source
Arthritis and Rheumatology. 69 (12) (pp 2386-2395), 2017. Date of
Publication: December 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To assess the effect of treatment with febuxostat versus
placebo on joint damage in hyperuricemic subjects with early gout (1 or 2
gout flares). Methods: In this double-blind, placebo-controlled study, 314
subjects with hyperuricemia (serum uric acid [UA] level of >=7.0 mg/dl)
and early gout were randomized 1:1 to receive once-daily febuxostat 40 mg
(increased to 80 mg if the serum UA level was >=6.0 mg/dl on day 14) or
placebo. The primary efficacy end point was the mean change from baseline
to month 24 in the modified Sharp/van der Heijde erosion score for the
single affected joint. Additional efficacy end points included change from
baseline to month 24 in the Rheumatoid Arthritis Magnetic Resonance
Imaging Scoring (RAMRIS) scores for synovitis, erosion, and edema in the
single affected joint, the incidence of gout flares, and serum UA levels.
Safety was assessed throughout the study. Results: Treatment with
febuxostat did not lead to any notable changes in joint erosion over 2
years. In both treatment groups, the mean change from baseline to month 24
in the modified Sharp/van der Heijde erosion score for the single affected
joint was minimal, with no between-group differences. However, treatment
with febuxostat significantly improved the RAMRIS synovitis score at month
24 compared with placebo treatment (change from baseline -0.43 versus
-0.07; P <0.001), decreased the overall incidence of gout flares (29.3%
versus 41.4%; P < 0.05), and improved serum UA control (62.8% versus 5.7%;
P < 0.001). No major safety concerns were reported. Conclusion:
Urate-lowering therapy with febuxostat improved magnetic resonance
imaging-determined synovitis and reduced the incidence of gout flares in
subjects with early gout.<br/>Copyright &#xa9; 2017 The Authors. Arthritis
& Rheumatology published by Wiley Periodicals, Inc. on behalf of American
College of Rheumatology.

<27>
Accession Number
613228302
Author
Hallifax R.J.; Yousuf A.; Jones H.E.; Corcoran J.P.; Psallidas I.; Rahman
N.M.
Institution
(Hallifax, Yousuf, Corcoran, Psallidas, Rahman) Oxford Centre for
Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford,
United Kingdom
(Jones) Faculty of Health Sciences, School of Social and Community
Medicine, University of Bristol, Bristol, United Kingdom
Title
Effectiveness of chemical pleurodesis in spontaneous pneumothorax
recurrence prevention: A systematic review.
Source
Thorax. 72 (12) (pp 1121-1131), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Spontaneous pneumothorax is a common pathology. International
guidelines suggest pleurodesis for non-resolving air leak or recurrence
prevention at second occurrence. This study comprehensively reviews the
existing literature regarding chemical pleurodesis efficacy. Design We
systematically reviewed the literature to identify relevant randomised
controlled trials (RCTs), case-control studies and case series. We
described the findings of these studies and tabulated relative recurrence
rates or ORs (in studies with control groups). Meta-analysis was not
performed due to substantial clinical heterogeneity. Results Of 560
abstracts identified by our search strategy, 50 were included in our
systematic review following screening. Recurrence rates in patients with
chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc
poudrage (four studies (n=249)) provided recurrence rates of between 2.5%
and 10.2% with the only RCT suggesting an OR of 0.10 compared with
drainage alone. In comparison, talc administration during video-assisted
thoracic surgery (VATS) from eight studies (n=2324) recurrence was between
0.0% and 3.2%, but the RCT did not demonstrate a significant difference
compared with bleb/bullectomy alone. Minocycline appears similarly
effective post-VATS (recurrence rates 0.0-2.9%). Prolonged air leak and
recurrence prevention using tetracycline via chest drain (n=726) is likely
to provide recurrence rates between 13.0% and 33.3% and autologous blood
patch pleurodesis (n=270) between 15.6% and 18.2%. Conclusions Chemical
pleurodesis postsurgical treatment or via thoracoscopy appears to be most
effective. Evidence for definitive success rates of each agent is limited
by the small number of randomised trials or other comparative
studies.<br/>Copyright &#xa9; 2017 Published by the BMJ Publishing Group
Limited.

<28>
Accession Number
617315797
Author
Benedetto U.; Caputo M.; Guida G.; Bucciarelli-Ducci C.; Thai J.; Bryan
A.; Angelini G.D.
Institution
(Benedetto, Caputo, Guida, Bucciarelli-Ducci, Thai, Bryan, Angelini)
Bristol Heart Institute, University of Bristol, School of Clinical
Sciences, Bristol, United Kingdom
Title
Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of
Randomized Controlled Trials.
Source
Seminars in Thoracic and Cardiovascular Surgery. 29 (3) (pp 301-310),
2017. Date of Publication: 03 Feb 2017.
Publisher
W.B. Saunders
Abstract
Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac
surgery, there is still paucity of evidence to prove its benefit in terms
of neurologic protection. Therefore, we conducted a meta-analysis of
available randomized controlled trials comparing CDI vs standard de-airing
maneuvers. Electronic searches were performed to identify relevant
randomized controlled trials. Primary outcomes investigated were
postoperative stroke, neurocognitive deterioration, and in-hospital
mortality. Risk difference (RD) was used as summary statistic. Pooled
estimates were obtained by means of random-effects model to account for
possible clinical diversity and methodological variation between studies.
Eight studies were identified with 668 patients randomized to CDI (n =
332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was
2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95%
confidence interval [CI] -2% to 2%; P = 0.87; I² = 0%).
Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the
CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62;
I² = 0%). Neurocognitive deterioration rate was 12% vs 21% in
the CDI and control group, respectively, but this difference was not
statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35;
I² = 0%). The present meta-analysis did not find any
significant protective effect from the use of CDI when compared with
manual de-airing maneuvers in terms of clinical outcomes, including
postoperative neurocognitive decline.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<29>
Accession Number
615772173
Author
He Z.M.; Schoebel C.; Penzel T.; Fietze I.; Ye Z.
Institution
(He, Ye) Department of Respiratory and Critical Care Medicine, Karamay
Central Hospital, Karamay, China
(Schoebel, Penzel, Fietze) Sleep Medicine Center, Charite University
Hospital, Luisenstr.13, Berlin 10117, Germany
Title
Sleep-disordered breathing and severe aortic stenosis.
Source
Somnologie. 21 (4) (pp 265-272), 2017. Date of Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Aortic stenosis (AS) has been associated with sleep-disordered
breathing (SDB), obstructive sleep apnea (OSA), and central sleep apnea
(CSA). In patients undergoing transcatheter aortic valve implantation
(TAVI), CSA may contribute to sudden cardiac death. Knowledge regarding
complications and management of patients with TAVI and CSA is limited.
This review defines the clinical manifestations of SDB, especially CSA,
associated with AS and TAVI therapy. Prevalence, mechanisms, risk factors,
and treatment options are reported. Methods: Pubmed, Medline, and the
Cochrane Database of Systematic Reviews were searched for prospective and
retrospective studies, as well as case reports, in which SDB in AS was
confirmed by polysomnography. Apnea was defined as a >90% reduction of
airflow from baseline for >10 s; hypopnea as a >30% reduction in airflow
with >=4% O<inf>2</inf> desaturation; apnea-hypopnea index (AHI) as the
number of apnea and hypopnea episodes/h of sleep. AHI >5/h defined SDB. If
the recording showed more than 50% central apnea events, this was defined
as CSA; otherwise as OSA. Results: Five studies reporting on 299 patients
were included. Patients with severe AS had a high prevalence of SDB
(235/299; 78.6%). In AS patients, CSA had a prevalence of 105/251 (41.8%)
and OSA of 93/248 (37.5%). Studies reported a strong association with SDB
severity. TAVI for severe aortic valve stenosis improved CSA in two
studies but had no impact on OSA. Positive airway pressure therapy appears
the best treatment for CSA in patients with TAVI. Continuous positive
airway pressure (CPAP) may be ineffective in eliminating central apnea or
even increase CSA. Adaptive servo ventilation (ASV) and bilevel positive
airway pressure (BPAP) ventilation are alternative treatments. Conclusion:
The prevalence of SDB in AS patients ranges from 71 to 95%. The most
important risk factor for higher CSA severity in AS patients was heart
failure (HF). ASV and CPAP have demonstrated efficacy in treating SDB in
patients with HF. Limited data and clinical experience are available for
ASV treatment of patients with AS-associated SDB. Prospective studies on
quality life and ASV treatment in these patients are needed.<br/>Copyright
&#xa9; 2017, Springer Medizin Verlag GmbH.

<30>
Accession Number
617739032
Author
Conte J.V.; Hermiller J.; Resar J.R.; Deeb G.M.; Gleason T.G.; Adams D.H.;
Popma J.J.; Yakubov S.J.; Watson D.; Guo J.; Zorn G.L.; Reardon M.J.
Institution
(Conte, Resar) Departments of Surgery and Medicine, Johns Hopkins
University, Baltimore, Maryland, United States
(Hermiller) St. Vincent's Heart Center of Indiana, Indianapolis, Indiana,
United States
(Deeb) Department of Surgery, University of Michigan, Ann Arbor, Michigan,
United States
(Gleason) Department of Surgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania, United States
(Adams) Department of Cardiovascular Surgery, Mount Sinai Medical Center,
New York, New York, United States
(Popma) Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, Massachusetts, United States
(Yakubov, Watson) Riverside Methodist Hospital, Columbus, Ohio, United
States
(Guo) Medtronic, Minneapolis, Minnesota, United States
(Zorn) Cardiovascular Research Institute, University of Kansas Hospital,
Kansas City, Kansas, United States
(Reardon) Department of Surgery, Houston Methodist DeBakey Heart and
Vascular Center, Houston, Texas, United States
Title
Complications After Self-expanding Transcatheter or Surgical Aortic Valve
Replacement.
Source
Seminars in Thoracic and Cardiovascular Surgery. 29 (3) (pp 321-330),
2017. Date of Publication: 03 Feb 2017.
Publisher
W.B. Saunders
Abstract
Procedural complications following transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) are usually reported as
retrospective analyses. We report the first comparison of complications
following SAVR or self-expanding TAVR from a prospectively randomized
study of high-risk SAVR patients. Three hundred ninety-five TAVR and 402
SAVR patients were prospectively enrolled and randomized 1:1 to TAVR with
a CoreValve bioprosthesis or a surgical bioprosthetic valve. The rates of
major procedural and vascular complications occurring (periprocedurally
(0-3 days) and early (4-30 days)) were compared for TAVR vs SAVR patients.
All-cause mortality, stroke, myocardial infarction, and major infection
were similar in both periods post procedure. Within 0-3 days, the major
vascular complication rate was significantly higher with TAVR (P = 0.003).
Life-threatening or disabling bleeding (P < 0.001), encephalopathy (P =
0.02), atrial fibrillation (P < 0.001), and acute kidney injury (P <
0.001) were significantly higher with SAVR. Non-iliofemoral TAVR
approaches had a higher incidence of major or life-threatening or
disabling bleeding at 0-3days (P < 0.05). Procedural complications unique
to TAVR included coronary occlusion 0.5% (2) and TAVR pop outs 2.8% (11)
with no valve embolizations. Pop outs were similar between iliofemoral
2.8% (9/324) and non-iliofemoral approaches 3.0% (2/66). Procedural
complications unique to SAVR included aortic dissection 0.8% (3/357) and
injury to other heart structures 2.0% (7/357). The procedural complication
profiles of TAVR and SAVR are unique. Intraoperative deaths were seen in
TAVR only. Mortality at 3 and 30 days was similar. The higher incidence of
some complications likely reflects the greater invasiveness of SAVR in
this aged high-risk population.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<31>
Accession Number
618808249
Author
Talwar S.; Bhoje A.; Sreenivas V.; Makhija N.; Aarav S.; Choudhary S.K.;
Airan B.
Institution
(Talwar, Bhoje, Choudhary, Airan) Department of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Sreenivas) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
(Makhija) Department of Cardiac Anesthesiology, All India Institute of
Medical Sciences, New Delhi, India
(Aarav) Department of Pathology, All India Institute of Medical Sciences,
New Delhi, India
Title
Comparison of del Nido and St Thomas Cardioplegia Solutions in Pediatric
Patients: A Prospective Randomized Clinical Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 29 (3) (pp 366-374),
2017. Date of Publication: 03 Feb 2017.
Publisher
W.B. Saunders
Abstract
We conducted a prospective randomized trial to compare del Nido (DN)
cardioplegia with conventional cold blood cardioplegia (St Thomas [STH])
in pediatric patients. We randomized 100 pediatric patients aged <=12
years undergoing elective repair of ventricular septal defects and
tetralogy of Fallot to the DN and the STH groups. In the DN group, a 20
mL/kg single dose was administered. In the STH group, a 30 mL/kg dose was
administered, followed by repeated doses at 25- to 30-minute intervals.
The primary outcome was cardiac index that was measured 4 times intra- and
postoperatively. Troponin-I, interleukin-6, and tissue necrosis
factor-alpha were measured. Myocardial biopsy was obtained to assess
electron-microscopic ultrastructural changes. Cardiac indices were
significantly higher in the DN group than in the STH group 2 hours after
termination of cardiopulmonary bypass (P = 0.0006), after 6 hours (P =
0.0006), and after 24 hours (P <= 0.0001). On repeated measure regression
analysis, the cardiac index was on an average 0.50 L/min/m²
higher in the DN group than in the STH group at any time point (P =
0.002). Duration of mechanical ventilation (P = 0.01), intensive care unit
stay (P = 0.01), and hospital stay (P = 0.0007) was significantly lower in
the DN group. Patients in the DN group exhibited lower troponin-I release
24 hours following cardiopulmonary bypass (P = 0.021). Electron
microscopic studies showed more myofibrillar disarray in the STH group (P
= 0.02). Use of long-acting DN cardioplegia solution was associated with
better preservation of cardiac index, lesser troponin-I release, and
decreased morbidity. Ultrastructural changes showed better preservation of
myofibrillar architecture.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<32>
Accession Number
619567912
Author
Kane A.M.; Kelleman M.S.; Oster M.E.
Institution
(Kane, Oster) Children's Healthcare of Atlanta, Emory University, Atlanta,
GA, United States
(Kelleman) Children's Healthcare of Atlanta, Atlanta, GA, United States
Title
Predictors of ECMO survival following the norwood procedure: An analysis
of the pediatric heart network public use dataset.
Source
Congenital Heart Disease. Conference: American Academy of Pediatrics
Section on Cardiology and Cardiac Surgery, SOCCS 2015. United States. 10
(5) (pp 477-478), 2015. Date of Publication: September - October 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Infants with hypoplastic left heart syndrome (HLHS) who undergo
stage I palliation with the Norwood procedure have a high risk of
mortality in the postoperative period, with the subset of these patients
who require extracorporeal membrane oxygenation (ECMO) having very poor
survival to hospital discharge. Previous studies of this subset have
reported single-center experience with ECMO following the Norwood
procedure and data from a nationwide ECMO database. The objective of our
study was to determine important demographic, preoperative, or operative
factors for survival to discharge for patients who required ECMO after the
Norwood procedure using data from a multi-center prospective study.
Methods: We retrospectively reviewed data collected prospectively from the
Pediatric Heart Network Single Ventricle Reconstruction trial public use
dataset. Briefly, the Pediatric Heart Network Single Ventricle
Reconstruction trial randomized infants with HLHS to receive either
modified Blalock-Taussig shunt or right ventricle-to-pulmonary artery
conduit during the Norwood procedure at 15 centers in North America from
2004- 2008. For our study, the primary outcome was in-hospital mortality
following the Norwood procedure among patients who were placed on ECMO
during the postoperative hospitalization. We performed multivariable
logistic regression to identify demographic factors (such as gestational
age, sex, race, birth weight, anatomic diagnosis, and presence of genetic
abnormalities), preoperative hospital course variables (such as need for
procedures on the atrial septum, intubation, and preoperative
complications), and operative characteristics (such as age at time of
Norwood, shunt type received, intraoperative anatomic findings,
intraoperative perfusion strategy, and bypass time) that were associated
with in-hospital mortality, adjusting for center. Results: Of 549 patients
with HLHS who underwent stage I palliation with the Norwood procedure, 56
required ECMO during the postoperative hospitalization. Of these, 28
patients (50%) survived to hospital discharge, with 24 eventually
proceeding to stage II palliation and 4 being lost to follow-up. In the
final multivariable model, exterior ascending aorta diameter of <2.5mm
measured intraoperatively was the only significant predictor of
in-hospital mortality after the Norwood procedure (OR 6.21, 95% CI
2.26-17.08, p=0.0004), but low birthweight <2.5kg was near significant (OR
3.80, 95% CI 0.88-16.36, p=0.07). There were no other factors,
demographic, preoperative, or surgical, that were near significant.
Conclusion: Patients with HLHS undergoing the Norwood procedure who
require postoperative ECMO have a 50% mortality rate. The greatest
predictor of mortality in this group is the patient-specific factor of
aortic diameter, with clinical or operative factors not being significant.

<33>
Accession Number
619500418
Author
Omar H.R.; Guglin M.
Institution
(Omar) Internal Medicine Department, Mercy Medical Center, Clinton, IA,
United States
(Guglin) Division of Cardiovascular Medicine, Linda and Jack Gill Heart
Institute, University of Kentucky, Lexington, KY, United States
Title
Clinical and prognostic significance of positive hepatojugular reflux on
discharge in acute heart failure: Insights from the ESCAPE trial.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
5734749. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. There has been a decline in emphasis of the value of physical
examination in heart failure (HF) with increased reliance on cardiac
imaging. We aim to study the clinical and prognostic significance of
positive hepatojugular reflux (HJR) on discharge in patients hospitalized
with HF. Methods. Using the ESCAPE trial data, patients were compared
according to the presence or absence of a positive HJR on discharge. The
primary study endpoints were all-cause mortality and a composite endpoint
of death, rehospitalization, and cardiac transplant during the first 6
months after discharge. Results. Among 392 patients (age: 56 years, 74%
men), the HJR correlated well with clinical and objective hemodynamic
markers of volume overload including right atrial pressure (RAP, = 0.002),
pulmonary capillary wedge pressure (PCWP, = 0.006), and inferior vena cava
size during inspiration ( = 0.005) and expiration ( = 0.003). The RAP had
the highest AUC for predicting a positive HJR on admission (AUC: 0.655, =
0.004) and discharge (AUC: 0.672, = 0.001). Cox's proportional hazards
analysis revealed that a positive HJR on discharge is an independent
predictor of 6-month mortality (estimated hazard ratio: 1.689; 95% CI:
1.032-2.764; = 0.037) after adjusting for age, baseline creatinine,
baseline hematocrit, baseline NYHA class, chronic obstructive pulmonary
disease, and the presence of tricuspid regurgitation. Conclusion. The HJR
should be routinely checked in patients admitted with acute HF throughout
hospitalization and especially on discharge as it serves as an important
prognostic marker for postdischarge outcomes.<br/>Copyright &#xa9; 2017
Hesham R. Omar and Maya Guglin.

<34>
[Use Link to view the full text]
Accession Number
619573979
Author
Scodellaro T.; McKenzie J.M.; D'Udekem Y.; Butt W.; Namachivayam S.P.
Institution
(Scodellaro, McKenzie, Butt, Namachivayam) Paediatric Intensive Care Unit,
Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC
3052, Australia
(Scodellaro, McKenzie, D'Udekem, Butt, Namachivayam) Department of
Paediatrics, University of Melbourne, Melbourne, VIC, Australia
(D'Udekem) Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC,
Australia
(D'Udekem, Butt, Namachivayam) Murdoch Children's Research Institute,
Melbourne, VIC, Australia
Title
Extubation Failure Is Associated with Increased Mortality Following First
Stage Single Ventricle Reconstruction Operation.
Source
Pediatric Critical Care Medicine. 18 (12) (pp 1136-1144), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To identify the prevalence, causes, risk factors, and outcomes
associated with extubation failure following first stage single ventricle
reconstruction surgery. Design: Retrospective cohort analysis of neonates
who underwent a first stage single ventricle reconstruction operation.
Extubation failure was defined as endotracheal reintubation within 48
hours of first extubation attempt. Setting: The Royal Children's Hospital,
Melbourne. Patients: Data were collected for all infants who underwent a
Norwood or Damus-Kaye-Stansel procedure between 2005 and 2014 at our
institution. Interventions: None. Measurements and Main Results:
Extubation failure occurred in 23 of 137 neonates (16.8%; 95% CI,
11.0-24.1%) who underwent a trial of extubation. Overall, 42 patients
(30.7%) were extubated to room air, 88 (64.2%) to nasal continuous
positive airway pressure, and seven (5.1%) to high-flow nasal cannulae,
though there was no major difference in extubation failure rates between
these three groups (p = 0.37). The median time to reintubation was 16.7
hours (interquartile range, 3.2-35.2), and male infants failed extubation
more frequently (63.2% vs 87.0%; p = 0.02), although age, gestation,
weight, cardiac diagnosis (hypoplastic left heart syndrome vs other single
ventricle conditions), shunt type (modified Blalock-Taussig vs right
ventricle-pulmonary artery shunt), intraoperative perfusion times,
preextubation mechanical ventilation duration, preextubation acid-base
status, and postoperative fluid balance were not related to extubation
outcome. Infants who failed extubation had a higher intensive care
mortality (19.4% vs 3.5%; p = 0.03) and in-hospital mortality (30.4% vs
6.1%; p < 0.001). Conclusions: There is a high prevalence of extubation
failure following first stage single ventricle reconstruction, and this is
associated with considerably worse patient outcomes. The high prevalence
and also the wide variation in rates of extubation failure in reported
literature provide with an opportunity for implementation of quality
assurance activities to minimize this complication and improve
outcomes.<br/>Copyright &#xa9; 2017 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<35>
Accession Number
619550521
Author
Foroutan F.; Guyatt G.H.; Otto C.M.; Siemieniuk R.A.; Schandelmaier S.;
Agoritsas T.; Vandvik P.O.; Bhagra S.; Bagur R.
Institution
(Foroutan, Guyatt, Siemieniuk, Schandelmaier, Agoritsas) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON L8S 4L8, Canada
(Foroutan, Bhagra) Heart Failure/Transplant Program, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Otto) Division of Cardiology, Department of Medicine, University of
Washington School of Medicine, Seattle, WA, United States
(Siemieniuk) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Agoritsas) Division of General Internal Medicine, Division of Clinical
Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
(Vandvik) Department of Internal Medicine, Innlandet Hospital
Trust-division Gjovik, Gjovik, Norway
(Vandvik) Institute of Health and Society, University of Oslo, Faculty of
Medicine, Gjovik, Norway
(Bagur) Division of Cardiology, Departments of Medicine and Epidemiology
and Biostatistics, London Health Sciences Centre, Western University,
London, ON, Canada
(Bagur) Keele Cardiovascular Research Group, Institute of Applied Clinical
Science, Centre for Prognosis Research, Keele University, Stoke-on-Trent,
United Kingdom
Title
Structural valve deterioration after transcatheter aortic valve
implantation.
Source
Heart. 103 (23) (pp 1899-1905), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Transcatheter aortic valve implantation (TAVI), widely used to
treat high-risk patients with severe symptomatic aortic stenosis, has
recently been extended to younger patients at lower operative risk in whom
long-term durability of TAVI devices is an important concern. Therefore,
we conducted a systematic review and meta-analysis of observational
studies addressing the frequency of structural valve deterioration (SVD)
after TAVI. Methods We searched Medline, Embase, Cochrane Database of
Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We
included observational studies following patients with TAVI for at least 2
years. Independently and in duplicate, we evaluated study eligibility,
extracted data, and assessed risk of bias for SVD post-TAVI. Our review
used the GRADE system to assess quality of evidence. We pooled incidence
rates using a random effects model. Results Thirteen studies including
8914 patients, with a median follow-up between 1.6 and 5 years, reported
an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The
pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to
73.44 per 100 patient years). Of those who developed SVD, 12% underwent
valve re-intervention. Confidence in the evidence was moderate due to
inconsistency among studies. Conclusion Structural valve deterioration is
probably an infrequent event within the first 5 years after TAVI.
Ascertaining the impact of SVD and the need for valve-related
re-interventions to inform recommendations for patients with a longer
life-expectancy will require studies including a large number of patients
with longer follow-up (>10 years).<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<36>
Accession Number
619567760
Author
Nouri J.M.; Sohrabi B.; Moradian S.T.; Ghiasi S.M.S.
Institution
(Nouri, Sohrabi, Moradian) Nursing Faculty, Baqiyatallah University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Ghiasi) Medical Faculty, Anesthetist, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of adaptive support ventilation weaning mode in conventional or
standard methods on respiratory and hemodynamic performance indices: A
randomized clinical trial.
Source
Trauma Monthly. 22 (5) (no pagination), 2017. Article Number: e37663. Date
of Publication: September 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: zistaorgan@gmail.com)
Abstract
Background: Adaptive support ventilation (ASV) is one of the advanced
modes of ventilation. The available evidence regarding the process of
tracheal extubation indicates that staff working in intensive care unit
usually performs the weaning process according to their own experiences
and conventional methods. Objectives: This study aimed to assess the
effect of weaning with adaptive support ventilation in two conventional or
standard methods on respiratory and hemodynamic performance indices in
patients undergoing coronary artery bypass graft (CABG) surgery. Methods:
In this clinical trial, 100 patients candidate for coronary artery bypass
graft (CABG) surgery at Jamaran hospital were allocated to experimental
and control groups in 2015. Each group had patients. The conventional
method of ASV was used in the control group without any intervention,
while the standard method of ASV was applied in the experimental group.
The groups were compared in terms of arterial blood gases, vital signs,
atelectasis, and duration of weaning process. Results: There was no
statistically significant difference between the experimental and control
groups in terms of demographic variables and disease history. Also,
duration of mechanical ventilation and weaning process, duration of the
patient's trigger to the tracheal extubation as well as other respiratory
performance indicators and vital signs were similar between the groups (P
> 0.05). Conclusions: The results of this study indicate that in stable
patients who have no history of lung problems, there is no need to apply
the difficult weaning protocol. These patients can be weaned without any
complication.<br/>Copyright &#xa9; 2016, Trauma Monthly.

<37>
Accession Number
619580089
Author
Dudzinski D.M.; Bhatia R.S.; Mi M.Y.; Isselbacher E.M.; Picard M.H.;
Weiner R.B.
Institution
(Dudzinski, Isselbacher, Picard, Weiner) Cardiac Ultrasound Laboratory,
Cardiology Division, Massachusetts General Hospital, Boston, United States
(Bhatia) Institute for Health System Solutions and Virtual Care, Women's
College Hospital, Toronto, ON, Canada
(Mi) Department of Medicine, Beth Israel Deaconess Medical Center, Boston,
MA, United States
Title
Effect of educational intervention on the rate of rarely appropriate
outpatient echocardiograms ordered by attending academic cardiologists: A
randomized clinical trial.
Source
JAMA Cardiology. 1 (7) (pp 805-812), 2016. Date of Publication: October
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Appropriate use criteria-based educational initiatives have
been shown to improve transthoracic echocardiography (TTE) ordering
practices of physicians in training. Whether such an intervention is
successful with attending cardiologists remains unknown. OBJECTIVE: To
prospectively investigate the effect of an appropriate use criteria-based
educational intervention on ordering of outpatient TTEs by attending
academic cardiologists. DESIGN, SETTING, AND PARTICIPANTS: We conducted a
prospective, randomized clinical trial of an educational intervention
designed to reduce the number of outpatient TTEs that were deemed to be
rarely appropriate by published appropriate use criteria. Investigators
classifying TTEs were blinded to participant groupings. The study was
conducted within the cardiology division at the Massachusetts General
Hospital, an academic quaternary care hospital. Staff members of the
cardiology division were included; 66 cardiologists were randomized. The
study was conducted from November 19, 2013, to June 1, 2014. An analysis
of the evaluable population was performed. INTERVENTIONS: The appropriate
use criteria-based educational intervention consisted of a review lecture
and electronic information card, as well as monthly individual physician
feedback via email. The email described the percentage of rarely
appropriate TTEs as well as the appropriate use criteria rationale for
classifying studies as rarely appropriate. MAIN OUTCOMES AND MEASURES: We
hypothesized a priori that the educational intervention would reduce the
number of rarely appropriate TTEs. The primary outcome was the rate of
rarely appropriate TTEs. RESULTS: Of the 66 cardiologists enrolled in the
study, 65 were included in the analysis (1 intervention cardiologist
retired from practice during the study). The participants' mean (SD) age
was 50.6 (10.5) years; 48 (73%) were men. Following intervention, the
proportion of rarely appropriate TTEs was significantly lower in the
intervention vs control group (143 of 1359 [10.5%] vs 285 of 1728 [16.5%];
odds ratio [OR], 0.59 [95% CI, 0.39-0.88]; P = .01), and there was a
nonsignificant increase in the proportion of appropriate TTEs in the
intervention vs control group (1054 [77.6%] vs 1244 [72.0%]; OR, 1.38 [95%
CI, 0.93-2.05]; P = .11). The most common of the 428 rarely appropriate
indications were routine surveillance within 3 years after prosthetic
valve insertion (73 [17.1%]), routine surveillance within 1 year for
moderate or severe valvular stenosis (64 [15.0%]), and routine
surveillance of cardiomyopathy (45 [10.5%]) or ventricular function (36
[8.4%]). CONCLUSIONS AND RELEVANCE: An appropriate use criteria-based
educational and feedback intervention reduced the number of rarely
appropriate TTEs ordered by attending academic cardiologists. This
strategy may be feasible to improve TTE utilization among cardiologists,
and this type of intervention warrants study in other practice
environments. TRIAL REGISTRATION: clinicalrials.gov Identifier:
NCT01968642.<br/>Copyright 2016 American Medical Association. All rights
reserved.

<38>
Accession Number
619567289
Author
Okitsu K.; Iritakenishi T.; Imada T.; Kuri M.; Shibata S.C.; Fujino Y.
Institution
(Okitsu, Iritakenishi, Imada, Kuri, Shibata, Fujino) Department of
Anesthesiology and Intensive Care Medicine, Osaka University Graduate
School of Medicine, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
Title
Choice of desflurane or propofol for the maintenance of general anesthesia
does not affect the risk of periprocedural myocardial damage in patients
undergoing transfemoral transcatheter aortic valve implantation.
Source
Journal of Anesthesia. (pp 1-8), 2017. Date of Publication: 06 Dec 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: This study aimed to reveal whether the occurrence of
periprocedural myocardial damage (PMD) decreases in patients who received
volatile anesthetics to maintain general anesthesia compared with those
who received propofol during transcatheter aortic valve implantation
(TAVI). Methods: We included one hundred and forty adult patients who
underwent transfemoral TAVI under general anesthesia from January 2015 to
March 2017 in this single-center retrospective review. We compared the
rate of patients who developed PMD between those who received desflurane
(Group D, n = 72) and propofol (Group P, n = 68) for anesthetic
maintenance. PMD was represented by the peak levels of creatine kinase
myocardial band (CK-MB) and troponin I within 72 h following the procedure
and defined as an increase >5 times in CK-MB or >15 times in troponin I
compared with the institutional upper reference limits. Further analysis
was performed to identify the independent predictors of PMD. Results:
There was no significant difference in the rate of PMD between groups
(Group D 72.2% to Group P 70.6%, P = 0.85) or levels of CK-MB (Group D
7.85 [1.3-72.7] ng/mL to Group P 8.45 [1.8-49.7] ng/mL; P = 0.59) and
troponin I (Group D 1.061 [0.050-10.8] ng/mL to Group P 1.214 [0.036-29.0]
ng/mL; P = 0.97). The risk of PMD was higher in patients with more
intraprocedural blood loss (odds ratio 1.49 per 100 mL, P = 0.048) and
lower in those with an implanted permanent pacemaker (odds ratio 0.17; P =
0.02). Conclusions: Desflurane does not appear to be more cardioprotective
than propofol when used for anesthetic maintenance in patients undergoing
transfemoral TAVI.<br/>Copyright &#xa9; 2017 Japanese Society of
Anesthesiologists

<39>
Accession Number
619562411
Author
Rao S.N.; Shenoy M P.; Gopalakrishnan M.; Kiran B A.
Institution
(Rao, Kiran B) Deptartment of Nephrology, K.S.Hegde Medical Academy,
Derlakatte, Mangalore, Karnataka, India
(Shenoy M, Gopalakrishnan) Department of Cardiothoracic Surgery, K.S.Hegde
Medical Academy, Derlakatte, Mangalore, Karnataka, India
Title
Applicability of the Cleveland clinic scoring system for the risk
prediction of acute kidney injury after cardiac surgery in a South Asian
cohort.
Source
Indian Heart Journal. (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier B.V.
Abstract
Background: Acute Kidney Injury (AKI) after cardiac surgery is a frequent
post-operative complication associated with an increased risk of
mortality, morbidity and hospital costs. Preoperative risk scores such as
the Cleveland Clinic Scoring Tool (CCST) have been validated in Western
population group to identify patients at higher risk of AKI and may
facilitate preventive strategies. However the scoring tool has not been
validated systematically in a South Asian cohort. We aimed to evaluate the
applicability of the CCST in prediction of AKI after open cardiac surgery
in a South-Indian tertiary care centre. Materials and methods: A
retrospective study of all patients who underwent elective open cardiac
surgery over a 4. year period from Jan 2012 to Dec 2015 at a single centre
were included and relevant details extracted from a comprehensive chart
review. The primary outcome was AKI as defined by the K-DIGO criteria.
Patients were risk stratified as per the CCST to assess for prediction of
AKI into low risk (0-2), intermediate risk (3-5) and high risk (>6)
groups. Results: A total of 276 patients underwent open cardiac surgery
with mean age of 51.5+/- 13.06 yrs. This included 177 (64.1%) males and 99
females (35.8%). Overall incidence of AKI was 6.88%.Mean age, gender, BMI,
preoperative serum creatinine, diabetes mellitus, chronic obstructive
pulmonary disease, cardiopulmonary bypass time was similar in patients who
developed AKI vs those who did not have AKI postoperatively. The mean CCST
scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and
3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A
total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%)
received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%)
had received preoperative statins. Comparison of drug use between the two
groups revealed that preoperative use of ACEI/ARB was associated with
highest risk of AKI (P = 0.006). Mortality rate was also high at 15.7% in
those with AKI compared to 3.1% in non-AKI group (p = 0.04). Conclusion:
The modified Cleveland Clinic Scoring Tool was valid in risk
identification of patients with severe stage of AKI but did not have
strong discrimination for early AKI stages. Preoperative statin use did
not protect against AKI in our study, however preoperative ARB/ACEI use
was significantly associated with occurrence of postoperative
AKI.<br/>Copyright &#xa9; 2017.

<40>
Accession Number
619555472
Author
Chivasso P.; Bruno V.D.; Marsico R.; Annaiah A.S.; Curtis A.; Zebele C.;
Angelini G.D.; Bryan A.J.; Rajakaruna C.
Institution
(Chivasso, Bruno, Marsico, Annaiah, Curtis, Zebele, Angelini, Bryan,
Rajakaruna) Department of Cardiac Surgery, Bristol Heart Institute,
University Hospitals Bristol, Bristol, United Kingdom
Title
Effectiveness and Safety of Aprotinin Use in Thoracic Aortic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To determine the effectiveness and safety of aprotinin use in
adult patients undergoing thoracic aortic surgery. Design: Single-center,
retrospective study. Setting: All cases performed at a single university
hospital. Participants: Between January 2004 and December 2014, 846 adult
patients underwent thoracic aortic surgery. Due to missing or duplicated
data on primary outcomes, 314 patients were excluded. The final sample of
532 patients underwent surgery on the thoracic aorta. Interventions: The
patients were divided in the following 2 groups: 107 patients (20.1%)
received aprotinin during the surgery, which represented the study group,
whereas the remaining 425 patients (79.9%) underwent surgery without the
use of aprotinin. Measurements and Main Results: To adjust for patient
selection and preoperative characteristics, a propensity score-matched
analysis was conducted. Mean total blood loss at 12 hours after surgery
was similar between the 2 groups. The blood product transfusion rates did
not differ in the 2 groups, except for the rate of fresh frozen plasma
transfusion being significantly higher in the aprotinin group.
Re-exploration for bleeding and the incidence of a major postoperative
bleeding event were similar between the groups. Rates of in-hospital
mortality, renal failure, and cerebrovascular accidents did not show any
statistically significant difference. Aprotinin did not represent a risk
factor for mortality over the long term (hazard ratio 1.14, 95% confidence
interval 0.62-2.08, p = 0.66). Conclusions: The use of aprotinin
demonstrated a limited effect in reducing postoperative bleeding and
prevention of major bleeding events. Aprotinin did not adversely affect
early outcomes and long-term survival.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<41>
Accession Number
617056265
Author
Bai A.D.; Agarwal A.; Steinberg M.; Showler A.; Burry L.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Agarwal) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, Ontario, Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Clinical predictors and clinical prediction rules to estimate initial
patient risk for infective endocarditis in Staphylococcus aureus
bacteraemia: a systematic review and meta-analysis.
Source
Clinical Microbiology and Infection. 23 (12) (pp 900-906), 2017. Date of
Publication: December 2017.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Objectives We conducted a meta-analysis to summarize diagnostic properties
of risk factors and clinical prediction rules for diagnosing infective
endocarditis (IE) in Staphylococcus aureus bacteraemia (SAB). Methods We
searched MEDLINE, Embase, and the Cochrane Database from inception to 6
January 2016 to identify studies evaluating risk factors and clinical
prediction rules for IE in SAB patients. Pooled estimates of diagnostic
properties for main risk factors were calculated using a bivariate random
effects model. Results Of 962 articles identified, 30 studies were
included. These involved 16 538 SAB patients including 1572 IE cases. Risk
factors with positive likelihood ratio (PLR) greater than 5 included
embolic events (PLR 12.7, 95% CI 9.2-17.7), pacemakers (PLR 9.7, 95% CI
3.7-21.2), history of previous IE (PLR 8.2, 95% CI 3.1-22.0), prosthetic
valves (PLR 5.7, 95% CI 3.2-9.5), and intravenous drug use (PLR 5.2, 95%
CI 3.8-6.9). The only clinical factor with negative likelihood ratio (NLR)
less than 0.5 was documented clearance of bacteraemia within 72 hours (NLR
range 0.32-0.35). Of the nine published clinical prediction rules for
ruling out IE, five had an NLR below 0.1. Conclusions SAB patients with
high-risk features (embolic events, pacemakers, prosthetic valves,
previous IE, or intravenous drug use) should undergo a trans-esophageal
echocardiography (TEE) for IE. Clinical prediction rules show promise in
safely ruling out endocarditis, but require validation in future
studies.<br/>Copyright &#xa9; 2017 European Society of Clinical
Microbiology and Infectious Diseases

<42>
Accession Number
617716751
Author
Iliadis C.; Lee S.; Kuhr K.; Metze C.; Matzik A.-S.; Michels G.; Rudolph
V.; Baldus S.; Pfister R.
Institution
(Iliadis, Lee, Metze, Matzik, Michels, Rudolph, Baldus, Pfister)
Department III of Internal Medicine, Heart Center, University of Cologne,
Kerpener Str. 62, Cologne 50937, Germany
(Kuhr) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Title
Functional status and quality of life after transcatheter mitral valve
repair: a prospective cohort study and systematic review.
Source
Clinical Research in Cardiology. 106 (12) (pp 1005-1017), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Estimating the quantitative effect of transcatheter mitral
valve repair on functional parameters and quality of life is important for
individual treatment decision-making. Methods: We combined data from a
prospective monocentric cohort study (N = 215) with data from a systematic
literature review (PubMed search term "mitraclip", till 30.04.2016) on
patients undergoing MitraClip with at least mortality after discharge
reported as an outcome. Effects on functional parameters were reported as
range of mean change. Results: 36 observational studies and 1 randomized
controlled trial were identified. Due to substantial heterogeneity of
effect estimates (I²-heterogeneity >75%) and inadequate quality
of studies with a lack of comparison group in 97.4% and lack of an
independent assessment of outcomes in 86.8%, no pooled estimates were
calculated. All studies reported improvements of mean New York Heart
Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores
(4.4-9.2 for physical component score, 2.6-8.9 for mental component
score), 6-min walk distance [(6MWD) 2-336 m] and Minnesota Living with
Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with
improvements regarded as clinically relevant in 20 of 29 studies for NYHA
class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in
all of 8 studies for MLWHFQ. Conclusion: MitraClip therapy provides
improvements in physical capacity, physical and mental functioning and
disease-specific quality of life in the majority of patients. However,
more comparative and high-quality studies are required for understanding
the heterogeneity of results, which is crucial for optimal patient
selection.<br/>Copyright &#xa9; 2017, Springer-Verlag GmbH Germany.

<43>
Accession Number
619543549
Author
Anonymous
Title
9th International Symposium on Intensive Care and Emergency Medicine for
Latin America.
Source
Critical Care. Conference: 9th International Symposium on Intensive Care
and Emergency Medicine for Latin America. Brazil. 21 (2 Supplement 1) (no
pagination), 2017. Date of Publication: June 2017.
Publisher
BioMed Central Ltd.
Abstract
The proceedings contain 60 papers. The topics discussed include:
complications associated with the use of temporary pacemakers in
hospitalized patients awaiting definitive implant procedure in a public
hospital in Sao Paulo; omentopexy as a mechanism of stem cell implantation
and revascularization in the ischemic myocardium; anxiety and depressive
symptoms in adults and elderly submitted to cardiac surgery; the effects
of weekend admission on the mortality of patients admitted to intensive
care units: the role of organizational factors; outcome of oncological
patients admitted to ICU for full treatment who were discharged on
exclusive palliative care with consensus to no readmission to ICU;
characteristics and outcomes of critical palliative patients in a private
intensive care unit; and risk factors for intensive care acquired
weakness: a systematic review and meta-analysis.

<44>
Accession Number
619526827
Author
Ferreira G.; Ribeiro J.; Galas F.; Gaiotto F.; Lisboa L.; Fukushima J.;
Rizk S.; Almeida J.; Jatene F.; Osawa E.; Franco R.; Kalil R.; Hajjar L.
Institution
(Ferreira, Ribeiro, Galas, Gaiotto, Lisboa, Fukushima, Rizk, Almeida,
Jatene, Osawa, Franco, Kalil, Hajjar) University of Sao Paulo, Brazi, Sao
Paulo, Brazil
Title
Effect of preoperative intra-aortic balloon pump on outcomes following
cardiac surgery in high-risk patients: A prospective randomized clinical
trial.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Intra-aortic balloon pump (IABP) is the most common used
device in the setting of cardiac surgery. It improves cardiac output,
reduces systemic vascular resistance and decreases afterload. In high-risk
patients, the prophylactic use in cardiac surgery might reduce
postoperative complications, such as cardiogenic shock and myocardial
ischemia. However, in the last years, the evidence regarding the
prophylactic use of IABP is controversial, mainly based in retrospective
data. This study aims to evaluate the role of prophylactic IABP in
reducing complications in high-risk patients undergoing cardiac surgery.
Methods: A prospective randomized controlled trial that evaluated 181
patients undergoing coronary artery bypass at the Heart Institute of the
University of Sao Paulo from 2014 April to 2016 June to receive or not
intraaortic balloon pump after anesthesia induction just before skin
incision. Inclusion criteria were left ventricular ejection fraction
(LVEF) < = 40% and/or EuroSCORE > = 6. Eligible patients were randomly
assigned, in a 1:1 ratio, to IABP group (n = 90) or control group (n =
91). The primary outcome was the composite endpoint of mortality and major
morbidity in 30 days after cardiac surgery (cardiogenic shock, stroke,
acute renal failure, mediastinitis, prolonged mechanical ventilation and
need for reoperation. Results: The primary outcome was observed in 47.8%
in the IABP group and 46.2% in the control group (P = 0.456). Patients
from the IABP group had a greater duration of inotrope use (51 hours
[32-94] vs 39 hours [25-66], P = 0.007) and longer intensive care unit
length of stay (five days [3-8] vs four days [3-6], P = 0.035). The length
of hospital stay was similar (13 days [9-18] vs 11 days [8-17], P = 0.302)
between groups. Conclusions: Preoperative IABP use did not reduce 30-day
major complications in high-risk patients undergoing cardiac surgery.

<45>
Accession Number
619526810
Author
Caldas J.; Panerai R.; Ferreira G.; Camara L.; Zeferino S.; Jardim J.;
Bor-Seng-Shu E.; Oliveira M.; Norgueira R.; Groehs R.; Ferreira-Santos L.;
Galas F.; Oliveira G.; Almeida J.; Robinson T.; Jatene F.; Hajjar L.
Institution
(Caldas, Ferreira, Camara, Zeferino, Jardim, Bor-Seng-Shu, Oliveira,
Norgueira, Groehs, Ferreira-Santos, Galas, Oliveira, Almeida, Jatene,
Hajjar) University of Sao Paulo, Sao Paulo, Brazil
(Panerai, Robinson) University of Leicester, Leicester, United Kingdom
Title
Cerebral hemodynamic in high-risk cardiac patients undergoing cardiac
surgery with cardiopulmonary bypass: The role of intraaortic balloon.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: To assess the effects of intra-aortic balloon pump (IABP) on
cerebral hemodynamics in high-risk patients undergoing cardiac surgery
with cardio-pulmonary bypass (CPB). Methods: A prospective, randomized,
single-center, pilot study was performed in a surgical ICU of a university
teaching hospital. Sixtyseven high-risk patients undergoing coronary
artery bypass surgery was included, and were randomized in a 1:1 ratio to
surgery with or without IABP. Cerebral blood flow velocity (CBFV,
transcranial Doppler) and blood pressure (BP, Finometer or intra-arterial
line) were continuously recorded over 5 minutes preoperatively (T1), after
24 h (T2) and 7 days after surgery (T3). Autoregulation index (ARI) was
estimated from the CBFV response to a step change in BP derived by
transfer function analysis. Diagnosis of delirium was based on the
Confusion Assessment Method for ICU. Two cognitive scales were applied
before and 6 months after surgery. Results: No significant differences
were found in the IABP group in comparison with controls for CBFV or ARI.
The incidence of delirium or cognitive decline was similar for both
groups. Conclusions: IABP does not affect cerebral hemodynamic or rates of
post-surgical delirium and cognitive decline after cardiac surgery with
CPB. These results suggest that IABP per se is unlikely to contribute to
the occurrence of early or late neurological complications of cardiac
surgery. (Figure Presented).

<46>
Accession Number
619526561
Author
Marouli D.; Chatzimichali A.; Kolyvaki S.; Panteli A.; Diamantaki E.;
Pediaditis E.; Sirogianni P.; Ginos P.; Kondili E.; Georgopoulos D.;
Askitopoulou H.
Institution
(Marouli, Chatzimichali, Kolyvaki, Panteli, Diamantaki, Pediaditis,
Sirogianni, Ginos, Kondili, Georgopoulos, Askitopoulou) University
Hospital, Heraklion, Greece
Title
Intra-operative chloride load and peri-operative acute kidney injury in
high-risk surgical patients.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction Peri-operative Acute Kidney Injury (AKI) is a common and
serious compli-cation after major surgery [1]. Whereas peri-operative risk
factors associated with AKI after cardiac surgery have been well described
[2], this is not the case for major non-cardiac surgery. Recently, the
impact of a high chloride load on the pathogenesis of AKI has been
suggested [3]. This study was performed in order to identify possible
intra-operative risk factors linked to peri-operative AKI development in a
group of non-cardiac surgery patients. Methods This single-centre,
prospective observational study included adults undergoing elective major
abdominal (including vascular) surgery. Patients with chronic kidney
disease (CKD) stage IV or V were excluded. AKI was defined according to
Acute Kidney Injury Network (AKIN) criteria within 48 hours after surgery
[4]. Patients pre-operative demographics (sex, age, hypertension, coronary
artery disease, congestive heart failure, chronic obstructive pulmonary
disease, diabetes mellitus, CKD stage) and intra-operative anaesthetic
management (type of surgery, intravenous fluids, blood products,
vasopressors, mean arterial blood pressure, urine output and blood loss)
were evaluated as possible AKI predictors. Furthermore, chloride ion
content of intra-operatively administered crystalloids and colloids was
estimated. Results Of 61 patients (47 males) included in the study, 10
(16.4%) developed postoperative AKI (AKI group) and 51 did not (non-AKI
group). After uni-variate analysis, four intra-operative variables were
identified as predictors of AKI: Intra-operative blood loss (p = 0.002),
transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p =
0.038), as well as high intra-operative chloride load (p = 0.033, AUC =
0.715 +/- 0.095, cut off value >500mEq). The remaining pre-and
intra-operative variables did not differ significantly between the two
groups. Conclusions: Isotonic saline administration has recently been
associated with post-operative AKI, possibly as a result of the excess
chloride load during cardiac surgery [5]. Our study's preliminary results
indicate that a high intra-operatively administered chloride load is
strongly associated with increased risk of post-operative AKI in patients
undergoing elective major non-cardiac surgery. References Hobson C et al.:
Ann Surg 2015; 261:1207-1214 McNeal J et al.: Crit Care 2016; 20 (187):2-9
Krajewski ML et al.: Br J Surg 2015; 102 (101):124-36 Acute Kidney Injury
Work Group: Kidney Intern 2012; 2:1-138 Kim JY et al.: Crit Care 2015;
19:350.

<47>
Accession Number
619526444
Author
Biderman P.; Van Heerden P.; Avitzur Y.; Solomon S.; Iakobishvili Z.;
Carmi U.; Gorfil D.; Singer P.
Institution
(Biderman, Iakobishvili, Carmi, Gorfil, Singer) Rabin Medical Center,
Petah Tikvah, Israel
(Van Heerden) Hadassah University Hospital, Jerusalem, Israel
(Avitzur) Hospital for Sick Kids, Toronto, Canada
(Solomon) Lunguard Pty Ltd, Yavne, Israel
Title
The efficacy of a novel peristaltic feeding tube (PFT) in reducing reflux
and aspiration of gastric contents in mechanically-ventilated patients.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction Gastro-esophageal reflux (GER) is common in ventilated
patients and is a cause of VAP. We recently described the development of a
unique device called the peristaltic feeding tube (PFT) (Lunguard, Yavne,
Israel) [1]. The PFT (Fig. 30) uses simulated peristalsis to seal the
esophagus to fluid moving retrogradely, whilst allowing normal drainage of
fluid and secretions moving ante-gradely. Here we de-scribe the first
trial of the PFT in ventilated patients. Methods There were 10 subjects in
the treatment (PFT) group and 10 patients in the control group, who had
all undergone elective cardiac surgery and were ventilated in the ICU
afterwards. The PFT was placed on admission to the ICU. In the control
group a standard nasogastric tube (NGT) was inserted. Specimens were
collected by suctioning from the oro-pharynx and from above the tracheal
tube balloon every hour and from the trachea twice per eight hour shift.
Samples were analyzed by ELISA for Pepsin A as a marker for secretions of
gastric origin. Results: The two groups were comparable (demographics and
duration of ventilation). There were statistically more specimens positive
for Pepsin A in the control group in the oropharynx and above the ETT
cuff, but not in the trachea (Table 13). Conclusions The PFT reduced the
amount of GER in ventilated patients. A larger study is required to
determine whether this translates to a reduction in VAP.

<48>
Accession Number
619526343
Author
Cole O.; Scawn N.; Balciunas M.; Blascovics I.; Vuylsteke A.; Salaunkey K.
Institution
(Cole, Balciunas, Blascovics, Vuylsteke, Salaunkey) Papworth Hospital,
Cambridge, United Kingdom
(Scawn) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Title
Glysure versus standard blood glucose monitoring device in patients
undergoing cardiac surgery.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction Meticulous euglycemia is known to improve outcomes in
critically ill patients [1]. However attempting to maintain a tight
glucose control regime does lead to dangerous life threatening
hypoglycemic episodes [2]. Continous blood glucose monitoring (CGM) can
potentially improve euglycemic control by providing immediate feedback to
insulin's ef-fects and probably reduce the workload of the nurses. Methods
After obtaining R&D approvals and patient consent, patients under-going
elective cardiac surgery in 2 centres were enrolled. A non-randomised,
non-treatment, open label prospective study was performed where blood
glucose results from Glysure's CGM was compared with the conventional
blood gas analyser (Siemens RAPI-DLab 1200 Systems). Results: 27 patients
were monitored for an average duration of 19.9 hrs, 161 samples (average
of 6/patient) were obtained. Mean absolute relative deviation (MARD) was
10.34%. The correlation coefficient (r) between the GlySure and
intermittent measurement was 0.737. Conclusions: Glysure based CGM is
1.Reliable. 2.Records Glycemic trends accurately. 3.Reduces workload of
nurses. References Van den Berghe G, et al. Intensive insulin therapy in
critically ill patients. NEJM. 2001 Nov 8;345(19):1359-67. Investigators
TN-SS. Intensive versus Conventional Glucose Control in Critically Ill
Patients. NEJM. 2009 Mar 26;360(13):1283-97.

<49>
Accession Number
619527092
Author
Almeida E.; Almeida J.; Landoni G.; Galas F.; Fukushima J.; Fominskiy E.;
De Brito C.; Cavichio L.; Almeida L.; Ribeiro U.; Osawa E.; Boltes R.;
Battistella L.; Hajjar L.
Institution
(Almeida, Almeida, Galas, Fukushima, De Brito, Cavichio, Almeida, Ribeiro,
Osawa, Boltes, Battistella, Hajjar) Instituto Do Cancer, Sao Paulo, Brazil
(Landoni) IRCCS San Raffaele Scientific Institute, Milan, Italy
(Fominskiy) Academician en Meshalkin Novosibirsk State Budget Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
Title
Early mobilization program improves functional capacity after major
abdominal cancer surgery: A randomized and controlled trial.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction Major abdominal oncology surgery is associated with
substantial postoperative loss of functional capacity and decline in
physical status that may turn cancer therapy impractical and compromise
patient outcomes. Exercise is an effective intervention to improve
outcomes after high-risk surgery. Methods We performed a single-blind,
randomized and controlled trial in patients who underwent major abdominal
oncology surgery in a tertiary university hospital. Patients were
randomized to an early mobilization postoperative program based on
supervised aerobic exercise, resistance and flexibility training or to
standard rehabilitation care. The primary outcome was inability to walk,
defined as the inability to cross the room or to walk a distance of 3
meters without human assistance, at postoperative day 5. Results: A total
of 108 patients were enrolled, 54 into the early mobilization program
group and 54 into the standard rehabilitation care group. Nine (16.7%)
patients in the early mobilization group were not able to cross the room
or to walk 3 meters without human assistance at postoperative day 5
compared to 21 (38.9%) of patients in the standard rehabilitation group (P
= 0.01) with an absolute risk reduction of 22.2% (95%CI 5, 9 to 38.6%) and
a number needed to treat of 5 (95% CI 3 to 17). Conclusions An early
postoperative mobilization program improves functional capacity compared
to a standard rehabilitation care in patients undergoing major elective
abdominal oncology surgery. Reference Castelino T, Fiore JF Jr,
Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early
mobilization protocols on postoperative outcomes following abdominal and
thoracic surgery: A systematic review. Surgery 2016; 159: 991-1003.

<50>
Accession Number
619527674
Author
Osawa E.; Carter D.; Sardo S.; Almeida J.; Galas F.; Rizk S.; Franco R.;
Hajjar L.; Landoni G.
Institution
(Osawa, Carter, Sardo, Almeida, Galas, Rizk, Franco, Hajjar) Heart
Institute, Sao Paulo, Brazil
(Landoni) San Raffaele, Milan, Italy
Title
Nitric oxide in cardiac surgery. A meta-analysis of randomized trials.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Nitric oxide may be used in many medical conditions, such as
primary pulmonary hypertension and acute pulmonary embolism. In the
setting of cardiac surgery, its role is unknown. The aim of this study was
to to investigate the efficacy and safety of perioperative administration
of nitric oxide in cardiac surgery. Methods: The authors conducted a
systematic review of randomized, controlled, parallel-group trials in
accordance with a previously registered protocol (International
Prospective Register of Systematic Reviews registration no. PROSPERO
2016:CRD42016032702), from inception to March 2016. Primary outcome was
intensive care unit (ICU) stay, secondary outcomes were mortality,
duration of mechanical ventilation, reduction of mean pulmonary artery
pressure. Results: The study included 17 RCTs comprising 760 patients. We
calculated the pooled odds ratio (OR) and the mean difference (MD) with
Random-Effects model. Quantitative synthesis of data demonstrated a
significant reduction in the length of ICU stay (mean difference -0.33
days, CI [-0.59, -0.07] p = 0.01) and of mechanical ventilation duration
(MD -4.88 hours, CI [-8.07, -1.69] p = 0.003) when compared to controls
with no differences in mortality. Conclusions: Nitric oxide might be
beneficial in patients with pulmonary hypertension undergoing cardiac
surgery. Large randomized trials are needed in order to further assess its
effect on survival. (Figure Presented).

<51>
Accession Number
619527657
Author
Liu X.; Holmberg M.J.; Uber A.; Montissol S.; Donnino M.; Andersen L.W.
Institution
(Liu, Holmberg, Uber, Montissol, Donnino, Andersen) Beth Israel Deaconess
Medical Center, Boston, MA, United States
Title
In vitro ubiquinol increases cellular oxygen consumption in peripheral
blood mononuclear cells from patients with metabolic stress.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: The objective of the current study was to investigate the
effects of in vitro ubiquinol (coenzyme Q10) administration on cellular
oxygen consumption in peripheral blood mononuclear cells (PBMCs) from
patients undergoing coronary artery bypass grafting. Ubiquinol (Coenzyme
Q10) is a mitochondrial molecule that is essential for adequate aerobic
metabolism. This population was evaluated to capture pre- and post blood
sampling for patients in a state of severe metabolic stress. Methods:
Patients scheduled for coronary artery bypass grafting with
cardiopulmonary bypass were enrolled at Beth Israel Deaconess Medical
Center, a tertiary care center in Boston, USA, between January 2015 and
July 2015. Blood was drawn and PMBCs were isolated from the patient before
and after surgery. Cells were then randomized to either treatment with
placebo or 1 mu g/mL ubiquinol. The complete mitochondrial respiration
profiles were measured using XF Cell Stress Mito Kit (Seahorse Bioscience)
to reveal the key parameters of cellular oxygen consumption. Wilcoxon
Signed Rank test was used to analyze differences in oxygen consumption
rate between groups. Results: Basal cellular oxygen consumption was
available on 23 patients pre-operatively and 17 patients post-operatively.
The mean age was 71 (SD: 7), and 22/26 (85%) were male. We found a
significant difference in post-operative relative basal (1.1 mL/min/mg
difference [0.9, 1.6], p < 0.001) oxygen consumption and maximal (4.2 mL/
min/mg difference [0.3, 7.0], p = 0.01) oxygen consumption between the
ubiquinol and placebo group. There were no significant differences in
pre-operative basal (1.0 mL/min/mg [-0.9, 2.2], p = 0.08) or maximal (0.5
mL/min/mg [-4.3, 7.3], p = 0.56) cellular oxygen consumption between the
ubiquinol and placebo. Conclusions: In a sample of cardiac surgery
patients, in vitro administration of ubiquinol enhanced post-operative
cellular oxygen consumption. These findings suggest ubiquinol may have
potential as a mitochondrial resuscitator in states of metabolic stress,
akin to typical physiology for critically ill patients in a state of
shock.

<52>
Accession Number
619527644
Author
Ulici A.; Reidt S.; Lam T.; Jancik J.
Institution
(Ulici, Reidt, Lam, Jancik) Hennepin County Medical Center, Minneapolis,
MN, United States
Title
Clevidipine versus sodium nitroprusside as adjunct therapy to esmolol in
aortic dissection.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: The purpose of this study was to compare clevidipine (CLEV)
vs sodium nitroprusside (SNP) as adjunct agents to esmolol (ESM) for blood
pressure (BP) management in aortic dissection. Intravenous (IV)
vasodilators are commonly added to beta-blocking agents to reach BP goals
in aortic dissection [1]. Our institution has transitioned to adding CLEV
instead of SNP to standard therapy ESM for initial BP management. CLEV has
been proven efficacious in lowering BP in both pre- and post-operative
cardiac procedures and hypertensive emergencies [2, 3]. To our knowledge,
this is the first study to evaluate CLEV use in acute aortic dissection.
Methods: A single-center retrospective chart review evaluated all patients
diagnosed with aortic dissection from September 2010 through September
2016. Included patients were over 18 years old with new diagnosis of
aortic dissection at presentation, were initiated on ESM as their primary
beta blocker, received CLEV or SNP adjunct therapy and had complete
hemodynamic data. Excluded patients were initiated on IV beta-blockers
other than ESM, received other concomitant IV anti-hypertensive therapies,
did not reach primary endpoint prior to surgical management, or were
pregnant or breastfeeding. The primary endpoint was defined as time to
reach patient specific systolic blood pressure (SBP) goals after ESM
initiation. The secondary endpoint was defined as efficacy of CLEV and SNP
for maintaining BP within patient specific goals using area under the
curve (AUC) analysis of both positive and negative excursions until 24
hours post agent initiation or time of surgical management, whichever was
less. Statistical analyses were conducted using R statistical software.
Results: Fourteen patients were included in final analyses: CLEV = 8, SNP
= 6. The majority of patients were male (78.5%) diagnosed with Stanford
Type-B aortic dissection (54.1%). Median SBP immediately prior to
initiation of ESM was 162 mm Hg vs 160.5 mm Hg for CLEV and SNP groups,
respectively. SBP goal was reached in a median 1.68 hours vs 1.03 hours
for CLEV and SNP, respectively (p = 0.99). Median AUC was lower for
patients treated with CLEV (206.9 mm Hg x min/hr vs 538.9 mm Hg x min/hr;
p = 0.1079). Conclusions: CLEV administration during initial aortic
dissection medical management showed similar efficacy to SNP when used as
adjunct therapy to ESM. CLEV is a reasonable alternative to SNP in acute
aortic dissection based on our institution's evaluation.

<53>
Accession Number
619527566
Author
Kalasbail P.; Garrett F.; Kulstad E.
Institution
(Kalasbail) Cleveland Clinic, Cleveland, OH, United States
(Garrett) Garrett Technologies, Northbrook, IL, United States
(Kulstad) Advocate Christ Medical Center, Oak Lawn, IL, United States
Title
Influence of an esophageal cooling and warming device on patient
temperature in the operating room.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Temperature management is important for a number of clinical
conditions, and a variety of methods exist to effect changes in body
temperature. In general, these methods are divided into external (surface)
or internal/core (intravascular) approaches. A new device (the ECD, or
Esophageal Cooling/Warming Device) utilizes a closed circulation of cooled
or warmed water via the esophageal route to achieve patient heat transfer,
offering core temperature control without the need to access the
intravascular space. We sought to measure the influence of this device on
the temperature of patients undergoing surgical procedures in the
operating room. Methods: This was a secondary analysis of data from a
prospective interventional study of patients undergoing elective
non-cardiac surgery at the Cleveland Clinic, USA. The primary outcome was
quantification of heat transferred to or from patients. Under this IRB
approved study, after written informed consent, patients were subjected to
two distinct 30-minute periods of either warming or cooling (with the
order randomized), during which inlet temperature, outlet temperature, and
flow rate through the ECD was measured, providing the data necessary for
heat balance calculations. In this secondary analysis we examined patient
temperatures recorded during the study, and determined mean temperature
change over each 30 minute interval. Temperatures were recorded using
zero-flux cutaneous thermometry (3 M SpotOn). Results: Nineteen patients
were enrolled in this study from April to November, 2016. During the
warming cycle, mean patient starting temperature was 35.5 C +/-0.52 C,
increasing to 35.8 +/-0.62 C over 30 minutes. The mean warming rate was
0.56 +/-0.64 C/hr. During the cooling cycle, mean patient starting
temperature was 35.7 C +/-0.61 C, decreasing to 35.3 +/-0.61 C over 30
minutes. The mean cooling rate was 0.88 +/-0.87 C/hr. The finding that
cooling was faster than warming may be attributed to the greater
difference in core-to-perfusion temperature (water temperature of 7 C
cooling, 42 C warming); however, extraneous factors such as patient
exposure, body habitus, external warming, and room temperature, may also
have influenced performance. Conclusions: Although patients differed
slightly in their rates of temperature change, these data suggest that
patient temperature modulation utilizing the esophageal route is
effective, and that clinically meaningful core patient temperature change
can be attained in both cooling and warming, without the need to access
the intra-vascular space.

<54>
Accession Number
619527550
Author
Baron D.M.; Baron-Stefaniak J.; Leitner G.C.; Ullrich R.
Institution
(Baron, Baron-Stefaniak, Leitner, Ullrich) Medical University of Vienna,
Vienna, Austria
Title
Transfusion of stored blood induces pulmonary vasoconstriction in
critically ill patients after cardiac surgery: A double-blind, randomized
clinical trial.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Transfusion of packed red blood cells (PRBCs) stored for 40
days increased pulmonary arterial pressure (PAP) and pulmonary vascular
resistance (PVR) in lambs [1]. These vasoconstrictor effects were
augmented by endothelial dysfunction. Furthermore, transfusion of PRBCs
stored for 40 days increased PAP in obese adults [2]. We hypothesized that
transfusion of PRBCs stored for prolonged periods would induce pulmonary
vasoconstriction in critically ill patients after cardiac surgery.
Methods: This study was performed as a double-blind, parallel-group,
randomized clinical trial at the Medical University of Vienna after local
ethics committee approval and registration at clinicaltrial-s.org
(NCT02050230). Written informed consent was obtained before enrollment.
Critically ill patients requiring one unit of PRBCs as standard care were
randomized to receive PRBCs stored for < =14 days (fresh PRBCs; fPRBCs) or
standard-issue PRBCs (siPRBCs; the oldest compatible unit available in the
blood bank) over 15 min. The increase of PAP during transfusion (DELTA
PAP) was defined as primary outcome parameter. PAP, mean arterial pressure
(MAP), and cardiac output (CO) were measured at baseline and after
transfusion. PVR and systemic vascular resistance (SVR) were calculated.
Concentrations of macrophage migration inhibitory factor (MIF) and
syndecan-1 (SDC1) in serum and in supernatant of PRBCs were measured with
ELISA. Statistical analysis was performed with Welch's test. Results: Six
patients received fPRBCs (storage duration 10 +/- 3 days) and five
patients received siPRBCs (storage duration 33 +/- 4 days). Demographic
patient data did not differ among groups. DELTA PAP was greater after
transfusion of siPRBCs than fPRBCs (7 +/- 3 vs. 2 +/- 2 mmHg, P = 0.01).
Similarly, PVR (81 +/- 50 vs.-1 +/- 37 dyn . s . cm-5, P = 0.01) and SVR
(166+/-61 vs. 9+/-72 dyn.s.cm-5, P=0.004) increased to a greater extent
after transfusion of siPRBCs than fPRBCs. Changes in MAP (P = 0.12) and CO
(P = 0.21) did not differ among groups. siPRBCs increased systemic MIF
concentrations by 56 +/- 70% (P = 0.02), while fPRBCs did not (P= 0.54).
Concentrations of MIF were greater in supernatants of siPRBC units (521
+/- 436 ng/ml) than in those of fPRBC units (158 +/- 115 ng/ml, P =
0.002). Systemic SDC1 concentrations increased after transfusion of fPRBCs
and siPRBCs (P< 0.05), but did not differ among groups (P = 0.99).
Conclusions: Transfusion of standard-issue PRBCs induces pulmonary
vasoconstriction in critically ill patients after cardiac surgery.

<55>
Accession Number
619527418
Author
Abruzzi F.; Azevedo Peixoto Primo J.; Marques Filho P.; Stormorvski De
Andrade J.; Matos Brenner K.; Scorsato Boeira M.; Leaes C.; Rodrigues C.;
Vessozi A.; SantAnna MacHado A.; Weiler M.
Institution
(Abruzzi, Azevedo Peixoto Primo, Marques Filho, Stormorvski De Andrade,
Matos Brenner, Scorsato Boeira, Rodrigues, Vessozi, SantAnna MacHado,
Weiler) Hospital Ernesto Dornelles, Porto Alegre, Brazil
(Leaes) Hospital Mae de Deus, Porto Alegre, Brazil
Title
Ultra early mobilization reduces the time of mechanical ventilation and
ICU stay.
Source
Critical Care. Conference: 37th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 21 (1 Supplement 1) (no pagination),
2017. Date of Publication: March 2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction Prolonged use of mechanical ventilation can lead to a number
of deleterious effects on patients admitted in intensive care units. Early
mobilization provides a reduction in the days of mechanical ventilation
during the permanence in the ICU and also provides an improvement in the
quality of life. Therefore our study aimed to evaluate the initial effect
of physiotherapeutic treatment during the period of hospitalization at the
ICU and measure the time of mechanical ventilation. Methods The sample was
characterized with patients admitted in the ICU who were able to received
physiotherapy sessions. We evaluated the patients in 3 moments: 0-12 hours
(P1), those that were attended between 13-24 hours (P2) and those that
were attended after 24 hours (P3).The data were analyzed by ANOVA/SNK and
were expressed as mean +/- standard deviation. Significant p <0.05.
Results: There were includes 120 patients, these 54.4% were male. The mean
age was 77.1 +/- 11.9. P3 had a lower SAPS III (P3 vs. P1, P2 F(2.304) =
9.4, P <0.05). The underlying pathologies of these patients were: chronic
obstructive pulmonary disease 5.9%, acute respiratory failure 15.7%,
sepsis 28.2%, stroke 3.3%, postoperative of abdominal surgery 5.6%,
cardiovascular surgery 19.7% and others 21.6%. We observed that patients
who started treatment within a period of less than 24 hours had a shorter
mechanical ventilation time (F(2, 275) = 13.5, p <0.05) and a reduction in
hospitalization time (F(2, 434) = 29.5. p <0.05) compared to the P3 group
(>24 h). There were no incidents during the mobilization or accidental
extubation process in any of the groups. Conclusions Our study
demonstrates the importance of early physiotherapeutic treatment that may
help reduce ICU length of stay and decrease the mechanical ventilation
time. No incident or damage occurred to the patients, which reinforces
that early mobilization is safe and viable. Our data demonstrate that it
is important to encourage early mobilization in critically ill patients.
References PARRY, Selina M.; PUTHUCHEARY, Zudin A. The impact of extended
bed rest on the musculoskeletal system in the critical care environment.
Extreme Physiology & Medicine, 2015. SCHWEICKERT, William D et al. Early
physical and occupational therapy in mechanically ventilated, critically
ill patients: a randomised controlled trial. The Lancet, 2009.

<56>
Accession Number
619544490
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, United
Kingdom
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(MacLullich, Shenkin) Edinburgh Delirium Research Group, Geriatric
Medicine, University of Edinburgh, Edinburgh, United Kingdom
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (2) (pp
123-132), 2017. Date of Publication: 01 Apr 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an increasingly
common intervention for patients with aortic stenosis deemed high risk for
major cardiac surgery, but identifying those who will benefit can be
challenging. Frailty reflects physiological reserve and may be a useful
prognostic marker in this population. We performed a systematic review and
meta-analysis of the association between frailty and outcomes after TAVI.
Methods and results Five databases were searched between January 2000 and
May 2015. From 2623 articles screened, 54 were assessed for eligibility.
Ten cohort studies (n = 4592) met the inclusion criteria of reporting a
measure of frailty with early (=30 days) or late (>30 days) mortality and
procedural complications following TAVI as defined by the Valve Academic
Research Consortium (VARC). Frailty was associated with increased early
mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P <
0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63,
95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even
higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P <
0.001). Frail individuals undergoing TAVI have a mortality rate of 34
deaths per 100 patient years, compared with 19 deaths per 100 patient
years in non-frail patients. There was limited reporting of VARC
procedural outcomes in relation to frailty, preventing meta-analysis.
Conclusion Frailty assessment in an already vulnerable TAVI population
identifies individuals at even greater risk of poor outcomes. Use of
objective frailty tools may inform patient selection, but this requires
further assessment in large prospective registries.<br/>Copyright &#xa9;
The Author 2016.

<57>
[Use Link to view the full text]
Accession Number
619543893
Author
O'Lynn C.; Cooper A.; Blackwell L.
Institution
(O'Lynn, Blackwell) Chamberlain University, Joanna Briggs Institute
Affiliated Group, Chamberlain University College of Nursing, Chicago, IL,
United States
(Cooper) UCSF Centre for Evidence Synthesis and Implementation, Joanna
Briggs Institute Center of Excellence, San Francisco, CA, United States
Title
Perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures: A qualitative
systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (11) (pp
2707-2722), 2017. Date of Publication: 01 Nov 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Clinical practice frequently involves the practitioner touching
patients' bodies in areas that are highly personal. If inappropriately
performed, such intimate touch may result in much anxiety, confusion and
misinterpretation. Examination of evidence is necessary to guide practice
in this area to mitigate risks and foster optimal clinicianpatient
relations and care. Objectives The objective of this qualitative
systematic review was to identify and synthesize findings on the
perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures Inclusion criteria
Types of participants The current review considered studies that included
patients who had received a clinician's touch during intimate care and
procedures. Phenomena of interest The current review considered
qualitative studies that evaluated patients' perceptions, experiences and
preferences of a clinician's touch during intimate care and procedures.
Types of studies The current review considered studies that collected
qualitative data and included studies using designs such as phenomenology,
grounded theory, ethnography, action research, qualitative description,
focus group methodology and feminist research. In the absence of research
studies, other text such as opinion papers and reports were considered.
Context The current review considered studies that included patients'
perceptions, experiences and preferences of a clinician's touch during
intimate care and procedures. Intimate care is likely to occur in any
clinical setting where patients need assistance with personal care, where
physical examinations occur, or in settings were gynecologic,
genitourinary, lower intestinal, dermatologic, cardiac or other procedures
involving highly personal areas of the body are performed. Search strategy
A three-step search strategy was used to find published and unpublished
studies in English from 1970 to 2016, searching various databases which
included searches of reference lists of studies selected for appraisal.
Methodological quality Included studies were assessed for methodological
quality independently by two reviewers using the Joanna Briggs Institute
Qualitative Assessment and Review Instrument (JBI-QARI) prior to
inclusion. Of the two studies included in the review, one did not discuss
ontological and epistemological assumptions, and the other did not include
the personal assumptions and role of the researcher. Data extraction Data
were extracted using the data extraction tool from the JBI-QARI. The data
extracted included details about the phenomenon of interest, populations
and study methods. Data synthesis Qualitative findings were synthesized
using JBI-QARI. Results Two studies were included in this review. Seven
findings were organized into three categories and one synthesized finding,
"clinician respect". The finding suggests that clients prefer engaged and
meaningful communication prior to and during an intimate touch encounter,
expect autonomy over their bodies and desire shared decision making
relative to how and by whom intimate touch is provided. Conclusion The
synthesized finding from this review suggests that: Healthcare educators
introduce clinician respect as an approach to care activities that involve
intimate touch. (Grade B) Clinicians practice with overall respect toward
their patients by communicating clearly, honoring patients' concerns and
preferences, and engaging patients in decision making to improve patients'
comfort with intimate touch. (Grade B) More research is needed to explore
the perceptions and preferences for intimate touch among diverse
populations, generations, cultures and contexts. Particular exploration is
needed for populations with additional vulnerabilities to
misunderstandings, anxiety and abuse, such as pediatric and geriatric
patients, and patients with physical, mental and cognitive
impairments.<br/>Copyright &#xa9; 2017 The Joanna Briggs Institute.

<58>
Accession Number
619544418
Author
Ariyaratne T.V.; Yap C.-H.; Ademi Z.; Rosenfeldt F.; Duffy S.J.; Billah
B.; Reid C.M.
Institution
(Ariyaratne, Yap, Ademi, Duffy, Billah, Reid) Centre of Cardiovascular
Research and Education in Therapeutics, Department of Epidemiology and
Preventive Medicine (DEPM), Monash University, 99 Commercial Rd,
Melbourne, VIC 3004, Australia
(Yap) Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
(Ademi) Institute of Pharmaceutical Medicine (ECPM), University of Basel,
Basel, Switzerland
(Rosenfeldt) Cardiac Surgical Research Unit, Department of Cardiothoracic
Surgery, Alfred Hospital, Melbourne, VIC, Australia
(Duffy) Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
Title
A systematic review of cost-effectiveness of percutaneous coronary
intervention vs. surgery for the treatment of multivessel coronary artery
disease in the drug-eluting stent era.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (4) (pp
261-270), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The suitability of percutaneous coronary intervention (PCI), compared
with coronary artery bypass grafting (CABG), for patients with complex
multivessel coronary artery disease (MVCAD) remains a contentious topic.
While the body of evidence regarding the clinical effectiveness of these
revascularization strategies is growing, there is limited evidence
concerning their long-term cost-effectiveness. We aim to critically
appraise the body of literature investigating the cost-effectiveness of
CABG compared with PCI using stents, and to assess the quality of the
economic evidence available. Methods and results A systematic review was
performed across six electronic databases; Medline, Embase, the NHS
Economic Evaluation Database, the Database of Abstracts of Reviews of
Effects, the health technology assessment database, and the Cochrane
Library. All studies comparing economic attractiveness of CABG vs. PCI
using bare-metal stents (BMS) or drug-eluting stents (DES) in balanced
groups of patients were considered. Sixteen studies were included. These
comprised studies of conventional CABG vs. BMS (n 1/4 8), or DES (n 1/4
4); off-pump CABG vs. BMS (n 1/4 2), or DES (n 1/4 1); and minimally
invasive direct CABG vs. BMS (n 1/4 2). The majority adopted a healthcare
payer perspective (n 1/4 14). The incremental cost-effectiveness ratios
(ICERs) reported across studies varied widely according to perspective and
time horizon. Favourable lifetime ICERs were reported for CABG in three
trials. For patients with left main coronary artery disease, however, DES
was reported as the dominant (more effective and cost-saving) strategy in
one study. Conclusion Overall, CABG rather than PCI was the favoured
cost-effective treatment for complex MVCAD in the long term. While the
evidence base for the cost-effectiveness of DES compared with CABG is
growing, there is a need for more evaluations adopting a societal
perspective, and time horizons of a lifetime or 10 or more
years.<br/>Copyright &#xa9; The Author 2016.

<59>
Accession Number
619446154
Author
D'Souza R.; Ostro J.; Shah P.S.; Silversides C.K.; Malinowski A.; Murphy
K.E.; Sermer M.; Shehata N.
Institution
(D'Souza, Malinowski, Murphy, Sermer) Department of Obstetrics and
Gynaecology, Division of Maternal and Fetal Medicine, University of
Toronto, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(D'Souza, Shah, Murphy, Shehata) Institute of Health Policy, Management
and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T
3M6, Canada
(Ostro) Department of Medicine, Division of Hematology, University of
Toronto, Toronto, Canada
(Shah) Department of Paediatrics, Division of Neonatology, Mount Sinai
Hospital, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(Silversides) Department of Medicine, Division of Cardiology Obstetric
Medicine Program, University of Toronto, 700 University Avenue, Toronto,
ON M5G 1Z5, Canada
(Shehata) Departments of Medicine and Laboratory Medicine and
Pathobiology, Mount Sinai Hospital, Division of Hematology, 700 University
Avenue, Toronto, ON M5G 1Z5, Canada
Title
Anticoagulation for pregnant women with mechanical heart valves: A
systematic review andmeta-Analysis.
Source
European Heart Journal. 38 (19) (pp 1509-1516), 2017. Date of Publication:
May 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To review maternal and foetal outcomes in women with mechanical heart
valves (MHVs) treated with vitamin-K antagonists (VKAs), first-Trimester
heparin followed by VKAs (sequential treatment), low molecular weight
heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order
to inform practice. Methods and results Medline, Embase and Central were
searched from inception until February 2016. Two reviewers independently
screened 1786 titles, reviewed 110 full-Texts and extracted data and
assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence
intervals) was calculated for maternal and foetal outcomes. Included
studies had a moderate or high risk-ofbias. With VKAs, sequential
treatment and LMWH, maternal mortality occurred in 0.9% (0.4-1.4), 2.0%
(0.8-3.1) and 2.9% (0.2-5.7), thromboembolic complications in 2.7%
(1.4-4.0), 5.8% (3.8-7.7) and 8.7% (3.9-13.4), livebirths in 64.5%
(48.8-80.2), 79.9% (74.3-85.6) and 92.0% (86.1-98.0) and
anticoagulant-related foetal/neonatal adverse events (embryopathy or
foetopathy) in 2.0% (0.3-3.7), 1.4% (0.3-2.5) and 0%, respectively. When
UFH is used throughout pregnancy, 11.2% (2.8-19.6) suffered thromboembolic
complications. Foetal loss and adverse events occurred with
first-Trimester warfarin doses<= 5 mg/day, although there were more
livebirths [83.6% (75.8-91.4) vs. 43.9% (32.8-55.0)] and fewer foetal
anomalies [2.3% (0.7-4.0) vs. 12.4% (3.3-21.6)] with lower doses than with
warfarin> 5mg/day. Conclusions VKAs are associated with fewest maternal
complications but also with fewest livebirths. Sequential treatment does
not eliminate anticoagulant-related foetal/neonatal adverse events. LMWH
is associated with the highest number of livebirths. The safety of UFH
throughout pregnancy and first-Trimester warfarin <= 5 mg/day remains
unconfirmed.<br/>Copyright &#xa9; The Author 2017.

<60>
Accession Number
617023983
Author
Busch C.; Pfitzer C.; Raschzok S.; Miera O.; Berger F.; Schmitt K.R.
Institution
(Busch, Pfitzer, Raschzok, Miera, Berger, Schmitt) Department of Pediatric
Cardiology, Deutsches Herzzentrum Berlin, Germany
(Pfitzer) Berlin Institute of Health (BIH), Berlin, Germany
(Berger) Department of Pediatric Cardiology, Charite -
Universitaetsmedizin Berlin, Germany
(Berger) DZHK (German Centre for Cardiovascular Research), partner site
Berlin, Germany
Title
Clinical outcome and inflammatory response after transfusion of washed and
unwashed red blood cells in children following cardiovascular surgery.
Source
Progress in Pediatric Cardiology. 47 (pp 73-79), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Children frequently require red blood cell transfusion after cardiac
surgery, which can generate an inflammatory response that is associated
with increased morbidity and mortality. The aim of this study was to
evaluate the inflammatory response and clinical effect of RBC transfusion
in children. In a pediatric prospective controlled clinical trial 48
children were randomized to an unwashed or washed red blood cell
transfusion group after cardiac surgery. Red blood cells were washed using
an auto transfusion device with blood gas analyses of the packed red blood
cells performed before transfusion. Vital parameters, blood analyses, and
plasma concentrations of cytokines were measured before and 24 h after
transfusion. Forty-five children were included with 23 receiving unwashed
and 22 washed red blood cells. Washing reduced hemoglobin, potassium, and
glucose while increasing sodium concentration in the packed red blood
cells. Increased levels of hemoglobin, hematocrit, and erythrocyte counts
were observed in both groups after transfusion. Increased levels of
cytokine expression (IL-1alpha IL-6, IL-8, MCP-1, and TARC) were detected
in the group receiving unwashed red blood cells, while IL-8 levels were
reduced in patients receiving washed red blood cells. Also, the percentage
increase of cytokine concentrations (IL-6, IL-8, MCP-1, and GP-VI) before
in comparison to after transfusion was lower in patients receiving washed
red blood cells. No significant differences in clinical outcome parameters
were observed between the two groups. Transfusion of red blood cells
induces a pro-inflammatory reaction which can be diminished by washing the
red blood cells before transfusion. Further clinical trials with larger
patient cohorts receiving multiple transfusions are needed to better
evaluate the clinical outcome.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<61>
Accession Number
619479166
Author
Nguyen L.S.; Merzoug M.; Estagnasie P.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Merzoug, Estagnasie, Brusset, Squara) CMC Ambroise Pare, Critical
Care Medicine Department, 25-27 Boulevard Victor Hugo, Neuilly-sur-Seine
92200, France
(Aubert, Waldmann, Grinda) CMC Ambroise Pare, Cardiac Surgery Department,
Neuilly-sur-Seine, France
(Law Koune, Gibert) CMC Ambroise Pare, Anesthesiology Department,
Neuilly-sur-Seine, France
Title
Low tidal volume mechanical ventilation against no ventilation during
cardiopulmonary bypass heart surgery (MECANO): Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 582. Date of
Publication: 02 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications are a leading cause of
morbidity and mortality after cardiac surgery. There are no
recommendations on mechanical ventilation associated with cardiopulmonary
bypass (CPB) during surgery and anesthesiologists perform either no
ventilation (noV) at all during CPB or maintain low tidal volume (LTV)
ventilation. Indirect evidence points towards better pulmonary outcomes
when LTV is performed but no large-scale prospective trial has yet been
published in cardiac surgery. Design: The MECANO trial is a single-center,
double-blind, randomized, controlled trial comparing two mechanical
ventilation strategies, noV and LTV, during cardiac surgery with CPB. In
total, 1500 patients are expected to be included, without any
restrictions. They will be randomized between noV and LTV on a 1:1 ratio.
The noV group will receive no ventilation during CPB. The LTV group will
receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive
end-expiratory pressure of 5 cmH2O. The primary endpoint will be a
composite of all-cause mortality, early respiratory failure defined as a
ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg
at 1 hour after arrival in the ICU, heavy oxygenation support (defined as
a patient requiring either non-invasive ventilation, mechanical
ventilation or high-flow oxygen) at 2 days after arrival in the ICU or
ventilator-acquired pneumonia defined by the Center of Disease Control.
Lung recruitment maneuvers will be performed in the noV and LTV groups at
the end of surgery and at arrival in ICU with an insufflation at +30 cmH20
for 5 seconds. Secondary endpoints are those composing the primary
endpoint with the addition of pneumothorax, CPB duration, quantity of
postoperative bleeding, red blood cell transfusions, revision surgery
requirements, length of stay in the ICU and in the hospital and total
hospitalization costs. Patients will be followed until hospital discharge.
Discussion: The MECANO trial is the first of its kind to compare in a
double-blind design, a no-ventilation to a low-tidal volume strategy for
mechanical ventilation during cardiac surgery with CPB, with a primary
composite outcome including death, respiratory failure and postoperative
pneumonia. Trial registration: ClinicalTrials.gov, NCT03098524. Registered
on 27 February 2017.<br/>Copyright &#xa9; 2017 The Author(s).

<62>
Accession Number
619524269
Author
Guo L.Z.; Kim M.H.; Shim C.H.; Choi S.Y.; Serebruany V.L.
Institution
(Guo, Kim, Serebruany) Department of Cardiology, College of Medicine,
Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan 602-715, South
Korea
(Guo, Kim, Shim, Choi) Department of Cardiology, Fourth Affiliated
Hospital of Harbin Medical University, Harbin, China
(Guo) Heart Drug Research Laboratories TM, Osler Medical Building, Johns
Hopkins University, 7600 Osler Drive, Baltimore, MD 21204, United States
Title
Impact of renal impairment on platelet reactivity and clinical outcomes
during chronic dual antiplatelet therapy following coronary stenting.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 2 (3) (pp
145-151), 2016. Date of Publication: 01 Jul 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Clinical utilization of dual antiplatelet therapy (DAPT) in patients
with renal impairment (RI) following percutaneous coronary interventions
(PCI) represents an urgent, unmet need choosing optimal agents, duration
of treatment, and potential dose/regimen adjustment. The lack of any large
randomized trials specifically in RI patients, and the absence of the
uniformed clinical data reporting policy, clouds the reality. Moreover,
triaging RI patients is problematic due to ongoing kidney deterioration,
and the fact that RI patients are prone to both vascular occlusions and
bleeding. Methods and results Seven hundred and one Korean patients
receiving DAPT with aspirin 100 mg/daily and clopidogrel 75 mg/daily after
PCI were prospectively enrolled in the study. Patients were dichotomized
into five groups according to RI: Estimated glomerular filtration rate
(EGFR) > 90 mL/min/1.73 m2 (RI1), 60-89 mL/min/1.73 m2 (RI2), 30-59
mL/min/1.73 m2 (RI3), < 30 mL/min/1.73 m2 (RI4), and undergoing dialysis
(RI5). Major adverse clinical events (MACEs; cardiovascular death,
myocardial infarction, stent thrombosis, and stroke) were collected for 1
year. Platelet reactivity by Verify Now TM assay and EGFR were
simultaneously assessed at 1 month after maintenance DAPT. Patients with
RI exhibited a gradual significant increase of residual platelet
reactivity during DAPT, dependent on EGFR deterioration [191+72 PRU (RI1)
vs. 216+78 PRU (RI2) vs. 248+80 PRU (RI3) vs. 264+70 PRU (RI4) vs. 317+96
PRU (RI5), P , 0.001] being the highest in the dialyses group. Declined
EGFR has been gradually associated with advancing age (OR = 1.03, 95% CI =
1.00-1.05; P = 0.032), female gender (OR = 1.7, 95% CI = 1.1-2.5; P =
0.01), diminished smoking rates (OR = 0.6, 95% CI = 0.37-1.00; P = 0.05),
hypertension (OR = 1.8, 95% CI = 1.3-2.5; P , 0.001); diabetes (OR = 1.5,
95% CI = 1.1-2.1; P = 0.007), and MACE (HR = 13.9; 95% CI = 1.6-124.3; P =
0.02 for RI4; and HR = 31.9; 95% CI = 2.9-351.9; P = 0.005 for dialysis),
but not for bleeding (P = 0.143). Major adverse clinical event risks still
remained significant for RI4 (P = 0.027) and RI5 (P = 0.002) by
multivariate Cox hazard regression estimates. Conclusion Renal impairment
is associated with gradual elevation of residual platelet reactivity while
on DAPT, enhancing MACE risks, but not bleeding events. These data should
be confirmed in a large randomized outcome-driven trial, and may justify
future maintenance-phase DAPT regimen/dose adjustment in RI
patients.<br/>Copyright &#xa9; The Author 2015.