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<1>
Accession Number
619323234
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
(Lee, Kim, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Dongsan Medical
Centre, Keimyung University College of Medicine, Daegu, South Korea
(Song) Department of Anaesthesiology and Pain Medicine, Asan Medical
Centre, University of Ulsan College of Medicine, Seoul, South Korea
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: a prospective, randomised trial.
Source
Anaesthesia. 73 (2) (pp 205-215), 2018. Date of Publication: Februaryy
2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg^-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg^-1 was not associated
with postoperative acute kidney injury in paediatric cardiac
patients.<br/>Copyright &#xa9; 2017 The Association of Anaesthetists of
Great Britain and Ireland

<2>
Accession Number
620158187
Author
Childers C.P.; Maggard-Gibbons M.; Ulloa J.G.; MacQueen I.T.; Miake-Lye
I.M.; Shanman R.; Mak S.; Beroes J.M.; Shekelle P.G.
Institution
(Childers, Maggard-Gibbons, MacQueen) David Geffen School of Medicine at
UCLA, Department of Surgery, 10833 Le Conte Ave., CHS 72-247, Los Angeles,
CA 90095, United States
(Childers, Mak) UCLA Fielding School of Public Health, Department of
Health Policy and Management, Los Angeles, CA, United States
(Maggard-Gibbons, Ulloa, MacQueen, Miake-Lye, Mak, Beroes, Shekelle)
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,
United States
(Ulloa) UCSF School of Medicine, Department of Surgery, San Francisco, CA,
United States
(Shanman) RAND Corporation, Santa Monica, CA, United States
Title
Perioperative management of antiplatelet therapy in patients undergoing
non-cardiac surgery following coronary stent placement: A systematic
review.
Source
Systematic Reviews. 7 (1) (no pagination), 2018. Article Number: 4. Date
of Publication: 10 Jan 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The correct perioperative management of antiplatelet therapy
(APT) in patients undergoing non-cardiac surgery (NCS) is often debated by
clinicians. American College of Cardiology (ACC) and American Heart
Association (AHA) guidelines recommend postponing elective NCS at least 3
months after stent implantation. Regardless of the timing of surgery,
ACC/AHA guidelines recommend continuing at least ASA throughout the
perioperative period and ideally continuing dual APT (DAPT) therapy
"unless surgery demands discontinuation." The objective of this review was
to ascertain the risks and benefits of APT in the perioperative period, to
assess how these risks and benefits vary by APT management, and the
significance of length of time since stent implantation before operative
intervention. Methods: PubMed, Web of Science, and Scopus were searched
from inception through October 2017. Articles were included if patients
were post PCI with stent placement (bare metal [BMS] or drug eluting
[DES]), underwent elective NCS, and had rates of major adverse cardiac
events (MACE) or bleeding events associated with pre and perioperative APT
therapy. Results: Of 4882 screened articles, we included 16 studies in the
review (1 randomized controlled trial and 15 observational studies).
Studies were small (< 50: n = 5, 51-150: n = 5, >150: n = 6). All studies
included DES with 7 of 16 also including BMS. Average time from stent to
NCS was variable (< 6 months: n = 3, 6-12 months: n = 1, > 12 months: n =
6). At least six different APT strategies were described. Six studies
further utilized bridging protocols using three different pharmacologic
agents. Studies typically included multiple surgical fields with varying
degrees of invasiveness. Across all APT strategies, rates of MACE/bleeding
ranged from 0 to 21% and 0 to 22%. There was no visible trend in
MACE/bleeding rates within a given APT strategy. Stratifying the articles
by type of surgery, timing of discontinuation of APT therapy, bridging vs.
no bridging, and time since stent placement did not help explain the
heterogeneity. Conclusions: Evidence regarding perioperative APT
management in patients with cardiac stents undergoing NCS is insufficient
to guide practice. Other clinical factors may have a greater impact than
perioperative APT management on MACE and bleeding events. Systematic
review registration: PROSPERO CRD42016036607.<br/>Copyright &#xa9; 2018
The Author(s).

<3>
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Accession Number
620231804
Author
Siemens K.; Sangaran D.P.; Hunt B.J.; Murdoch I.A.; Tibby S.M.
Institution
(Siemens, Sangaran, Murdoch, Tibby) PICU, Evelina London Children's
Hospital, St Thomas' Hospital, Westminster Bridge Road, London, United
Kingdom
(Hunt) Department of Haematology, St Thomas' Hospital, London, United
Kingdom
Title
Strategies for Prevention and Management of Bleeding Following Pediatric
Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review.
Source
Pediatric Critical Care Medicine. 19 (1) (pp 40-47), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: We aimed to systematically describe, via a scoping review, the
literature reporting strategies for prevention and management of
mediastinal bleeding post pediatric cardiopulmonary bypass surgery. Data
Sources: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register. Study
Selection: Two authors independently screened publications from 1980 to
2016 reporting the effect of therapeutic interventions on bleeding-related
postoperative outcomes, including mediastinal drain loss, transfusion,
chest re-exploration rate, and coagulation variables. Inclusions: less
than 18 years, cardiac surgery on cardiopulmonary bypass. Data Extraction:
Data from eligible studies were extracted using a standard data collection
sheet. Data Synthesis: Overall, 299 of 7,434 screened articles were
included, with observational studies being almost twice as common (n =
187, 63%) than controlled trials (n = 112, 38%). The most frequently
evaluated interventions were antifibrinolytic drugs (75 studies, 25%),
blood products (59 studies, 20%), point-of-care testing (47 studies, 16%),
and cardiopulmonary bypass circuit modifications (46 studies, 15%). The
publication rate for controlled trials remained constant over time
(4-6/yr); however, trials were small (median participants, 51;
interquartile range, 57) and overwhelmingly single center (98%).
Controlled trials originated from 22 countries, with the United States,
India, and Germany accounting for 50%. The commonest outcomes were
mediastinal blood loss and transfusion requirements; however, these were
defined inconsistently (blood loss being reported over nine different time
periods). The majority of trials were aimed at bleeding prevention (98%)
rather than treatment (10%), nine studies assessed both. Conclusions:
Overall, this review demonstrates small trial sizes, low level of
evidence, and marked heterogeneity of reported endpoints in the included
studies. The need for more, higher quality studies reporting clinically
relevant, comparable outcomes is highlighted. Emerging fields such as the
use of coagulation factor concentrates, goal-directed guidelines, and
anti-inflammatory therapies appear to be of particular interest. This
scoping review can potentially guide future trial design and form the
basis for therapy-specific systematic reviews.<br/>Copyright &#xa9; 2017
by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<4>
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Accession Number
620231785
Author
Lee J.-H.; Jang Y.-E.; Song I.-K.; Kim E.-H.; Kim H.-S.; Kim J.-T.
Institution
(Lee, Jang, Kim, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Song) Department of Anesthesiology and Pain Medicine, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
Title
Near-Infrared Spectroscopy and Vascular Occlusion Test for Predicting
Clinical Outcome in Pediatric Cardiac Patients: A Prospective
Observational Study.
Source
Pediatric Critical Care Medicine. 19 (1) (pp 32-39), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study is designed to determine the feasibility and
utility of vascular occlusion test variables as measured by INVOS
⁽Medtronic, Dublin, Ireland) in pediatric cardiac patients.
Design: A prospective observational study. Setting: A tertiary children's
hospital. Patients: Children less than or equal to 8 years old who were
scheduled for elective cardiac surgery under cardiopulmonary bypass.
Interventions: A vascular occlusion test (3 min of ischemia and
reperfusion) was performed on the calf at three time points: after
induction of anesthesia (T0), during cardiopulmonary bypass (T1), and
after sternal closure (T2). Measurements and Main Results: Baseline
regional tissue hemoglobin oxygen saturation, deoxygenation rate, minimum
regional tissue hemoglobin oxygen saturation, and reoxygenation rate were
measured using INVOS. Influence of age on variables at each measurement
point was also checked using linear regression analysis. Receiver
operating characteristics curve analysis was performed to determine the
ability of vascular occlusion test variables at T2 to predict the
occurrence of major adverse events. Both the deoxygenation and
reoxygenation rates were lowest in T1. There was a tendency to decreased
regional tissue hemoglobin oxygen saturation in younger patients at T0 (r
= 0.37; p < 0.001), T1 (r = 0.33; p < 0.001), and T2 (r = 0.42; p < 0.001)
during vascular occlusion. Minimum regional tissue hemoglobin oxygen
saturation was correlated with age at T0 (r = 0.51; p < 0.001) and T2 (r =
0.35; p = 0.001). Patients with major adverse events had similar baseline
regional tissue hemoglobin oxygen saturation but lower minimum regional
tissue hemoglobin oxygen saturation (48.8% +/- 19.3% vs 63.3% +/- 13.9%; p
< 0.001) and higher reoxygenation rate (4.30 +/- 3.20 vs 2.57 +/- 2.39
%/s; p = 0.008) at T2 compared with those without. The minimum regional
tissue hemoglobin oxygen saturation less than 51% after sternal closure
could predict the occurrence of major adverse events with a sensitivity of
61.1% and a specificity of 85.4%. Conclusions: Vascular occlusion test
using INVOS can be applied in children undergoing cardiac surgery.
Vascular occlusion test variables are influenced by age and
cardiopulmonary bypass. The minimum regional tissue hemoglobin oxygen
saturation less than 51% after sternal closure is associated with worse
clinical outcomes in pediatric cardiac patients.<br/>Copyright &#xa9; 2017
by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<5>
Accession Number
620228197
Author
Gaudino M.; Di Franco A.; Rahouma M.; Tam D.Y.; Iannaccone M.; Deb S.;
D'Ascenzo F.; Abouarab A.A.; Girardi L.N.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Di Franco, Rahouma, Abouarab, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Deb, Fremes) Schulich Heart Centre, Sunnybrook Health Science,
University of Toronto, Toronto, ON, Canada
(Iannaccone, D'Ascenzo) Department of Cardiology, Citta della Scienza e
della Salute, University of Turin, Torino, Italy
(Taggart) University of Oxford, Oxford, United Kingdom
Title
Unmeasured confounders in observational studies comparing bilateral versus
single internal thoracic artery for coronary artery bypass grafting: A
meta-analysis.
Source
Journal of the American Heart Association. 7 (1) (no pagination), 2018.
Article Number: e008010. Date of Publication: 01 Jan 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Observational studies suggest a survival advantage with
bilateral single internal thoracic artery (BITA) versus single internal
thoracic artery grafting for coronary surgery, whereas this conclusion is
not supported by randomized trials. We hypothesized that this
inconsistency is attributed to unmeasured confounders intrinsic to
observational studies. To test our hypothesis, we performed a
meta-analysis of the observational literature comparing BITA and single
internal thoracic artery, deriving incident rate ratio for mortality at
end of follow-up and at 1 year. We postulated that BITA would not affect
1-year survival based on the natural history of coronary artery bypass
occlusion, so that a difference between groups at 1 year could not be
attributed to the intervention. Methods and Results--We searched MEDLINE
and Pubmed to identify all observational studies comparing the outcome of
BITA versus single internal thoracic artery. One-year and long-term
mortality for BITA and single internal thoracic artery were compared in
the propensity-score-matched (PSM) series, that is, the form of
observational evidence less prone to confounders. Thirty-eight
observational studies (174 205 total patients) were selected for final
comparison. In the 12 propensity-score- matched series (34 019 patients),
the mortality reduction for BITA was similar at 1 year and at the end of
follow-up (incident rate ratio, 0.70; 95% confidence interval, 0.60-0.82
versus 0.77; 95% confidence interval, 0.70-0.85; P for subgroup
difference=0.43). Conclusions--Unmeasured confounders, rather than
biological superiority, may explain the survival advantage of BITA in
observational series.<br/>Copyright &#xa9; 2017 The Authors.

<6>
Accession Number
620208198
Author
Li J.-X.; Li Y.; Yan S.-J.; Han B.-H.; Song Z.-Y.; Song W.; Liu S.-H.; Guo
J.-W.; Yin S.; Chen Y.-P.; Xia D.-J.; Li X.; Li X.-Q.; Jin E.-Z.
Institution
(Li, Li, Yan, Han, Song, Song, Liu, Chen, Xia, Li, Li, Jin) Department of
Cardiology, The Fourth Affiliated Hospital of Harbin Medical University,
Harbin, Heilongjiang 150001, China
(Guo) Department of Cardiology, Harbin First Hospital, Harbin,
Heilongjiang 150001, China
(Yin) Department of Pharmacy, The Fourth Affiliated Hospital of Harbin
Medical University, Harbin, Heilongjiang 150001, China
Title
Optimal antithrombotic therapy in patients with atrial fibrillation
following percutaneous coronary intervention: A systemic review and
meta-analysis.
Source
Biomedical Reports. 8 (2) (pp 138-147), 2018. Date of Publication:
February 2018.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
A challenge for antithrombotic treatment is patients who present with
atrial fibrillation (AF) and acute coronary syndrome, particularly in
patients who have undergone coronary percutaneous intervention with
stenting (PCIS). In the present study, a total of nine observational
trials published prior to July 2017 that investigated the effects of dual
antiplatelet therapy (DAPT; aspirin + clopidogrel) and triple oral
antithrombotic therapy (TOAT; DAPT + warfarin) among patients with AF
concurrent to PCIS were collected from the Medline, Cochrane and Embase
databases and conference proceedings of cardiology, gastroenterology and
neurology meetings. A meta-analysis was performed using fixed- or random-
effect models according to heterogeneity. The subgroups were also analyzed
on the occurrence of major adverse cardiac events (MACE), stroke and
bleeding events in the two treatment groups. Analysis of baseline
characteristics indicated that there was no significant difference in the
history of coexistent disease or conventional therapies between the DAPT
and TOAT groups. The primary end point incidence was 2,588 patients in the
DAPT group (n=13,773) and 871 patients in the TOAT group (n=5,262)
following pooling of all nine trials. There was no statistically
significant difference in the incidence of primary end points between the
DAPT and TOAT groups. Odds ratio (OR)=0.96, 95% confidence interval
(CI)=0.73-1.27, P=0.79, with heterogeneity between trials
(I²=82%, P<0.00001). Subsequently, on subgroup analysis, the
results indicated no increased risk of major bleeding or ischemic stroke
in the DAPT or TOAT group. However, compared with the TOAT group, there
was an apparent increased risk of MACE plus ischemic stroke in the DAPT
group (OR=1.62, 95% CI=1.43-1.83, P<0.00001) with heterogeneity between
trials (I²=70%, P=0.01). In conclusion, the present
meta-analysis suggests that TOAT (aspirin + clopidogrel + warfarin)
therapy for patients with AF concurrent to PCIS significantly reduced the
risk of MACE and stroke compared with DAPT (aspirin + clopidogrel)
therapy. Further randomized controlled clinical trials are required to
confirm the efficacy of the optimal antithrombotic therapy in patients
with AF following PCIS.<br/>Copyright &#xa9; 2018, Spandidos Publications.
All rights reserved.

<7>
Accession Number
620207705
Author
Laiq N.; Khan S.; Islam N.; Khan M.N.
Institution
(Laiq, Khan, Islam, Khan) Department of Anaesthesia, Medical Teaching
Institute, Lady Reading Hospital, Peshawar, Pakistan
Title
Effectiveness of continuous positive pressure ventilation in reducing the
length of stay in post cardiac bypass surgery patients.
Source
Journal of Medical Sciences (Peshawar). 25 (2) (pp 257-261), 2017. Date of
Publication: 2017.
Publisher
Khyber Medical College (E-mail: info@jmedsci.com)
Abstract
Objectives: To asses the length of stay using Continuous Positive pressure
ventilation (CPAP) during weaning in post bypass patients in cardiac ICU
and compared this procedure with MV (Mechanical ventilation) by analyzing
cardiac and respiratory parameters and complications. Material and
Methods: A randomized clinical trial was conducted from June 2011 to July
2012 with patients in the cardiac ICU of Lady Reading Hospital Peshawar
Pakistan. Patients of both sexes and ages between 45-70 years, post bypass
surgeries and were on mechanical ventilation for more than 48 hours, who
failed at 30 minutes of spontaneous breathing trial (SBT) were included in
the study. Sealed envelopes were used for random assignment. The
established weaning criteria was routinely followed in the ICU. Before
SBT, the following measurements were carried out: arterial blood gases;
parameters of ventilation such as f (frequency of breaths),V<inf>T</inf>
(Tidal volume), PEEP (Positive end expiratory pressure), FiO2(Fraction of
inspired oxygen), HR(Heart rate), systolic (SBP) diastolic (DBP) blood
pressure and SpO2 (Oxygen saturation).SBT, 30 minutes was given,If failure
occurred before the 30th minute, he/she was included in the group
previously defined by random assignment. Patients in the experimental
group were extubated and placed on CPAP, whereas the other patients (the
control group) returned to MV, which was classified as the conventional
treatment. Spontaneous ventilation mode using a bi-levelCPAP support was
used in experimental group immediately after trachealextubation,. The
interface chosen was facemask. Daily SBT was carried out thereafter in
order to evaluate the possibility of extubation in control group. Results:
Eighty patients who failed T-piece trials ventilation, 40 were placed on
CPAP and 40,on intermittent mandatory ventilation or mechanical
ventilation (IMV). The ages of patients in the CPAP and IMV groups were
45.7+/- 18.12 and 47.10 +/- 18.44 years respectively. In both groups,
ventilation time before T-piece trial was 2 days or 48 hours. Heart and
respiratory parameters were similar for the two groups at 30 minutes of
T-piece trial. The percentage of minor complications in both groups were
lower. The comparisons of gas measurements between the CPAP and IMV groups
showed no significant differences. Patients of the CPAP group had a
shorter stay in the ICU and in the hospital i-e 2.95 +/-0.78 days versus
7.44+1.12 days for IMV group (Table No 2). Mortality was similar in the
two groups. Of the 80 patients in both groups no serious complications
were seen on ventilator support while discharged from the ICU. Conclusion:
The combination of early extubation and CPAP is a good alternative for
ventilation in a group of patients who initially failed weaning. The
length of stay is significantly reduced in Cardiac ICU, compared to
Mechanical ventilation. Therefore, CPAPis a useful and safe strategy that
may be considered during mechanical ventilation weaning.<br/>Copyright
&#xa9; 2017, Khyber Medical College. All rights reserved.

<8>
Accession Number
620227273
Author
Sepsas E.; Vachlas K.; Gaitanakis S.; Toufektzian L.; Kainis E.; Gkiozos
I.
Institution
(Sepsas, Vachlas, Gaitanakis, Toufektzian) Thoracic Surgery Department,
<<Sotiria>> Athens Chest Diseases Hospital, Athens, Greece
(Kainis) 10th Department of Respiratory Medicine, <<Sotiria>> Athens Chest
Diseases Hospital, Athens, Greece
(Gkiozos) Oncology Department, 3rd University Medical Clinic of
<<Sotiria>>, Athens, Greece
Title
Recurrence in patients that underwent surgery for lung cancer.
Source
Pneumon. 30 (3) (pp 133-140), 2017. Date of Publication: July-September
2017.
Publisher
Technogramma (E-mail: tech@hol.gr)
Abstract
Introduction: The recording and analysis of lung cancer recurrences in
patients with primary non-small cell lung cancer that initially underwent
radical surgical treatment. Method: This is a retrospective study that
deals with the occurrence of lung cancer recurrences through systematic
postoperative follow-up of 350 Greek patients with primary non-small cell
lung cancer for 5 years. All of these patients underwent radical surgical
treatment in the same Thoracic Surgery Department in the period 1995-2010.
Results: Of the 350 patients, 308 were male and 42 female, 50% had
adenocarcinoma, 40% squamous cell lung carcinomas, 8% undifferentiated
large cell lung carcinomas, and 2% mixed type of adenosquamous lung
carcinomas. A total of 350 interventions were performed, of which 158 were
lobectomy, 42 bilobectomy and 150 pneumonectomy. Of the 350 patients, 130
experienced relapse within five years of which 31 were diagnosed with
local relapse, 65 with distant metastases and 34 with a combination of
both.<br/>Copyright &#xa9; 2017, Technogramma. All rights reserved.

<9>
Accession Number
613613932
Author
Momeni M.; Poncelet A.; Rubay J.; Matta A.; Veevaete L.; Detaille T.;
Houtekie L.; Clement de Clety S.; Derycke E.; Moniotte S.; Sluysmans T.;
Veyckemans F.
Institution
(Momeni, Matta, Veevaete, Veyckemans) Department of Anesthesiology,
Universite Catholique de Louvain, Cliniques Universitaires Saint Luc,
Brussels, Belgium
(Poncelet, Rubay) Department of Cardiac Surgery, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
(Detaille, Houtekie, Clement de Clety, Derycke) Department of Pediatrics
Intensive Care Unit, Universite Catholique de Louvain, Cliniques
Universitaires Saint Luc, Brussels, Belgium
(Moniotte, Sluysmans) Department of Pediatrics, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Title
Does Postoperative Cardiac Troponin-I Have Any Prognostic Value in
Predicting Midterm Mortality After Congenital Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 122-127),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study evaluated the prognostic value of postoperative
cardiac troponin-I (cTnI) in predicting all-cause mortality up to 3 months
after normothermic congenital cardiac surgery. Design Prospective
observational study. Setting University hospital. Participants All
children ages 0 to 10 years. Interventions None. Measurements and Main
Results cTnI was measured after the induction of anesthesia but before the
surgery, at the pediatric intensive care unit arrival, and at 4, 12, and
24 hours postoperatively. Follow-up was extended up to 6 months. Overall,
169 children were analyzed, of whom 165 were survivors and 4 were
nonsurvivors. cTnI levels were significantly higher in nonsurvivors only
at 24 hours (p = 0.047). Children undergoing surgery with cardiopulmonary
bypass (CPB) had significantly higher cTnI concentrations compared with
those without CPB (p<0.001). Logistic regression analysis was performed on
the 146 children in the CPB group with the following predictive variables:
CPB time, postoperative cTnI concentrations, the presence of a cyanotic
malformation, and intramyocardial incision. None of the variables
predicted mortality. Postoperative cTnI concentrations did not predict 6
months mortality. Only cTnI at 24 hours predicted the length of stay in
the pediatric intensive care unit. Conclusions This study did not find
that postoperative cTnI concentration predicted midterm mortality after
normothermic congenital heart surgery. (ClinicalTrials.gov identifier:
NCT01616394).<br/>Copyright &#xa9; 2017 Elsevier Inc.

<10>
Accession Number
615348189
Author
Yang R.-F.; Jiang Z.-M.; Zhang R.-Q.; Yu B.; Wang X.-H.; Wang P.
Institution
(Yang, Jiang) Department of Thoracic Surgery, Qianfoshan Hospital of
Shandong Province, Shandong University, Ji'nan, Shandong 250012, China
(Yang, Zhang, Wang) Department of Thoracic Surgery, Tai'an City Central
Hospital, Tai'an, Shandong 271000, China
(Yu) Department of Colorectal Surgery, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
(Wang) Department of Digestive System, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
Title
Effect of ligation of the thoracic duct during oesophagectomy on the
absorption of D-xylose.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (3) (pp
153-156), 2017. Date of Publication: 01 Mar 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To assess if prophylactic thoracic duct ligation during
oesophagectomy influences the absorptive function of oesophageal cancer
patients. Study Design: Randomized controlled trial. Place and Duration of
Study: Department of Thoracic Surgery, Tai'an City Central Hospital,
Tai'an, from August 2014 to December 2015. Methodology: Based on the
management of the thoracic duct during oesophagectomy, 60 patients were
randomized into two groups. D-xylose absorption test was used to evaluate
the absorptive function. The two-independent-samples t-test was employed
for statistical analysis with statistical significance at p < 0.05.
Results: The serum D-xylose concentration of ligation-group was
significantly lower than that of no-ligation group on the first day after
operation, (t=2.82, p=0.0066). However, there was no significant
differences between them even before operation (t=1.34, p=0.1849).
Conclusion: Ligation of the thoracic duct during oesophagectomy
immediately affected the absorption of D-xylose, which may lead to
malabsorption in the long run.

<11>
Accession Number
611348294
Author
Li Y.; Wang D.; Hu C.; Zhang P.; Zhang D.; Qin S.
Institution
(Li, Wang, Hu, Zhang, Zhang, Qin) Department of Cardiology, First
Affiliated Hospital, Chongqing Medical University, No. 1 Yixueyuan Road,
Chongqing 400016, China
Title
Efficacy and safety of adjunctive trimetazidine therapy for acute
myocardial infarction: a systematic review and meta-analysis.
Source
Cardiology (Switzerland). 135 (3) (pp 188-195), 2016. Date of Publication:
01 Oct 2016.
Publisher
S. Karger AG
Abstract
Background: Several lines of evidence support the clinical use of
trimetazidine as an adjunctive therapy in cardioischemic patients.
Therefore, we assessed here the efficacy and safety of adjunctive
trimetazidine therapy in acute myocardial infarction (MI) patients by a
systematic review and meta-analysis of the current literature. Methods:
PubMed, the Cochrane Library, and the China National Knowledge
Infrastructure databases were searched for clinical studies comparing
adjunctive trimetazidine therapy against placebo in adult acute MI
patients. Several clinical outcomes [early/short-term all-cause mortality,
long-term all-cause mortality, total major adverse cardiac events (MACE),
recurrent nonfatal MI, in-hospital adverse events, target vessel
revascularization (TVR), and coronary artery bypass graft (CABG)] were
analyzed by the intention-to-treat principle. Odds ratios (OR) and their
95% confidence intervals (CI) were derived from the number of outcome
events in each study arm to estimate the association between adjuvant
trimetazidine administration and the various clinical outcomes. A
random-effects model was applied for all meta-analyses. Results: We found
that adjunctive trimetazidine therapy showed a significant effect upon
total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no
significant effect upon early/short-term all-cause mortality, long-term
all-cause mortality, recurrent nonfatal MI, in-hospital adverse events,
TVR, or CABG (p > 0.05). Conclusions: This is the first meta-analysis to
report that adjunctive trimetazidine therapy has a beneficial effect upon
total MACE in acute MI patients. Clinical investigators should consider
further trials on adjunctive trimetazidine therapy in order to better
define its risks and benefits in acute MI patients.<br/>Copyright &#xa9;
2016 S. Karger AG, Basel.

<12>
Accession Number
613511320
Author
Putzu A.; Capelli B.; Belletti A.; Cassina T.; Ferrari E.; Gallo M.; Casso
G.; Landoni G.
Institution
(Putzu, Capelli, Cassina, Casso) Cardiocentro Ticino, Department of
Cardiovascular Anesthesia and Intensive Care, Via Tesserete 48, Lugano,
Switzerland
(Belletti, Landoni) IRCCS San Raffaele Scientific Institute, Department of
Anesthesia and Intensive Care, Via Olgettina 60, Milano, Italy
(Ferrari, Gallo) Cardiocentro Ticino, Department of Cardiac Surgery, Via
Tesserete 48, Lugano, Switzerland
(Landoni) Vita-Salute San Raffaele University, Via Olgettina 58, Milano,
Italy
Title
Perioperative statin therapy in cardiac surgery: A meta-analysis of
randomized controlled trials.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 395. Date of
Publication: 05 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several studies suggest beneficial effects of perioperative
statin therapy on postoperative outcome after cardiac surgery. However,
recent randomized controlled trials (RCTs) show potential detrimental
effects. The objective of this systematic review is to examine the
association between perioperative statin therapy and clinical outcomes in
cardiac surgery patients. Methods: Electronic databases were searched up
to 1 November 2016 for RCTs of preoperative statin therapy versus placebo
or no treatment in adult cardiac surgery. Postoperative outcomes were
acute kidney injury, atrial fibrillation, myocardial infarction, stroke,
infections, and mortality. We calculated odds ratios (ORs) and 95%
confidence intervals (CIs) using fixed-effects meta-analyses. Primary
analysis was restricted to trials with low risk of bias according to
Cochrane methodology, and sensitivity analyses examined whether the risk
of bias of included studies was associated with different results. We
performed trial sequential analysis (TSA) to test the strength of the
results. Results: We included data from 23 RCTs involving 5102 patients.
Meta-analysis of trials with low risk of bias showed that statin therapy
was associated with an increase in acute kidney injury (314 of 1318
(23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26
(95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No
difference in postoperative atrial fibrillation, myocardial infarction,
stroke, infections, or mortality was present. On sensitivity analysis,
statin therapy was associated with a slight increase in hospital
mortality. Meta-analysis including also trials with high or unclear risk
of bias showed no beneficial effects of statin therapy on any
postoperative outcomes. Conclusions: There is no evidence that statin
therapy in the days prior to cardiac surgery is beneficial for patients'
outcomes. Particularly, statins are not protective against postoperative
atrial fibrillation, myocardial infarction, stroke, or infections. Statins
are associated with a possible increased risk of acute kidney injury and a
detrimental effect on hospital survival could not be excluded. Future RCTs
should further evaluate the safety profile of this therapy in relation to
patients' outcomes and assess the more appropriate time point for
discontinuation of statins before cardiac surgery.<br/>Copyright &#xa9;
2016 The Author(s).

<13>
Accession Number
606475748
Author
Guimaraes Marcelino C.A.; Rueda Diaz L.J.; da Cruz D.M.
Institution
(Guimaraes Marcelino, Rueda Diaz, da Cruz) School of Nursing, Instituto
Dante Pazzanese de Cardiologia, Brazil
(Guimaraes Marcelino, Rueda Diaz, da Cruz) The Brazilian Centre for
Evidence-based Healthcare, Brazil
(Rueda Diaz) Industrial University of Santander, Colombia
Title
The effectiveness of interventions in managing treatment adherence in
adult heart transplant patients: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 13 (9) (pp
279-308), 2015. Date of Publication: 2015.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
BACKGROUND: Over the past 20 years, solid organ transplantation has
evolved from experimental treatments to an effective alternative for the
treatment of various diseases, including heart failure. Treatment
non-adherence is a limiting factor for the success of heart transplants. A
systematic review of the evidence is needed to examine the effectiveness
of interventions for managing adherence to treatment in heart transplant
patients. OBJECTIVE: The primary objective of this systematic review was
to synthesize the best available evidence regarding interventions for
managing adherence to pharmacological and non-pharmacological treatments
in heart/heart-lung transplant patients. INCLUSION CRITERIA: Types of
participants:This review considered primary studies that included patients
18 years old or older, who had undergone heart or heart-lung
transplantation (regardless of gender, ethnicity, comorbidities or whether
they had received other treatments or not) who were receiving
pharmacological and non-pharmacological treatments. Types of
interventions: This review considered studies that evaluated the
effectiveness of interventions in managing adherence to pharmacological or
non-pharmacological treatments among adult heart/heart-lung transplant
patients. Primary studies comparing standard care with any type of
intervention to maintain treatment adherence were considered. Types of
studies: This review considered any experimental study design including
randomized controlled trials; other research designs, such as
non-randomized controlled trials and before and after studies, were also
considered for inclusion. Types of outcomes: The primary outcome
considered was patient adherence to pharmacological or non-pharmacological
treatments by means of objective or self-report assessment. SEARCH
STRATEGY: Published and unpublished studies in English, Portuguese and
Spanish were searched in electronic databases. Searches were completed in
January 2014. METHODOLOGICAL QUALITY: Two independent reviewers, using the
standardized critical appraisal instruments from the Joanna Briggs
Institute Meta-Analysis of Statistics Assessment and Review Instrument,
assessed methodological quality. DATA EXTRACTION: Data were extracted
using the standardized data extraction tool from Joanna Briggs Institute
Meta-Analysis of Statistics Assessment and Review Instrument. DATA
SYNTHESIS: Statistical pooling was not possible due to substantial
heterogeneity of the studies; therefore data were presented as a narrative
summary. RESULTS: Three quasi-experimental studies were included in this
review. One study found that a dose reduction of immunosuppressive
medications from a twice-daily to a once-daily regimen had a positive
impact on treatment adherence; one found no significant difference in
treatment adherence between patients who received educational intervention
conducted in a teaching laboratory and those who received standard care;
the third one also reported no significant difference in outcomes between
a multifaceted intervention consisting of internet-based interactive
workshops and standard care. CONCLUSIONS: The current best evidence to
guide decisions regarding interventions to manage treatment adherence in
heart transplant patients is limited. There is weak evidence that
psycho-educational interventions (other than the standard care) has a
positive impact on adherence and that decreasing the complexity of the
treatment regimen by reducing the daily dose of the immunosuppressant drug
improves adherence in heart transplant patients.<br/>Copyright &#xa9;
2015, Joanna Briggs Institute. All rights reserved.

<14>
Accession Number
620274642
Author
Albuquerque Costa N.T.F.; Sancho C.G.
Institution
(Albuquerque Costa) Department of Anesthesiology, Resuscitation and Pain
Treatment, Vic University Hospital, Carrer de Francesc Pla el Vigata 1,
Vic, Barcelona 08500, Spain
(Sancho) Department of Anesthesiology, Resuscitation and Pain Treatment,
Hospital Clinic, University of Barcelona, Barcelona, Spain
Title
Perioperative ultrasound applied to diagnosis and decision making in
anesthesia.
Source
Minerva Anestesiologica. 84 (1) (pp 94-107), 2018. Date of Publication:
January 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Ultrasound is a portable and safe technology that is
increasingly used to assist anesthetic procedures and has been integrated
into the routine practice of a wide range of invasive procedures. As a
complementary diagnostic tool, publications related to perioperative
support other than vascular access and nerve blocks are currently lacking.
EVIDENCE ACQUISITION: Given the growing interest of anesthesiologists in
acquisition of knowledge and skills of ultrasound, we propose a systematic
review of the diagnosis, decision making or change in perioperative
management of non-cardiac surgical patients derived from ultrasound
practice. Of 1112 references found in electronic databases, 62 studies
resulted from the screening process. EVIDENCE SYNTHESIS: A complete
critical reading of 19 full-text publications was carried out with
quantitative analysis of 1825 ultrasound examinations including
echocardiography, neck and laryngeal ultrasound, pulmonary ultrasound and
abdominal ultrasound, all of them performed by anesthesiologists.
Diagnosis applied ultrasound and decision making during perioperative
period resulted in change in the management of 31% with 95% CI of 21.06 to
42.04 and odds ratio of 2.68 (1.77 to 4.06) related to hemodynamic, airway
and respiratory perioperative management. CONCLUSIONS: Since most of the
articles included in this review are observational studies with inherent
design concerns, there is an urgent requirement for randomized controlled
trials in this area. As anesthesiologists become more comfortable and
knowledgeable in ultrasound applied to the perioperative support,
emergence of protocols with multidisciplinary ultrasound exploration is
expected to allow an improvement in perioperative safety.<br/>Copyright
&#xa9; 2017 EDIZIONI MINERVA MEDICA.

<15>
Accession Number
620289788
Author
Romanov A.; Pokushalov E.; Elesin D.; Bogachev-Prokophiev A.; Ponomarev
D.; Losik D.; Bayramova S.; Strelnikov A.; Shabanov V.; Pidanov O.;
Kropotkin E.; Ivanickii E.; Karaskov A.; Steinberg J.S.
Institution
(Romanov, Pokushalov, Elesin, Bogachev-Prokophiev, Ponomarev, Losik,
Bayramova, Strelnikov, Shabanov, Karaskov) State Research Institute of
Circulation Pathology, Novosibirsk, Russia
(Pidanov) Clinical Hospital of the Presidential Administration, Moscow,
Russia
(Kropotkin, Ivanickii) Center of Cardiovascular Surgery, Krasnoyarsk,
Russia
(Steinberg) University of Rochester School of Medicine & Dentistry, New
York, New York
Title
Effect of left atrial appendage excision on procedure outcome in patients
with persistent atrial fibrillation undergoing surgical ablation.
Source
Heart rhythm. 13 (9) (pp 1803-1809), 2016. Date of Publication: 01 Sep
2016.
Abstract
BACKGROUND: Catheter ablation is less successful for treatment of
persistent atrial fibrillation (PersAF) than for paroxysmal atrial
fibrillation. Some studies suggest that left atrial appendage (LAA)
isolation in addition to pulmonary vein isolation (PVI) is required to
maximize the benefits for PersAF after ablation.
OBJECTIVE: The purpose of this study was to compare the efficacy and
safety of 2 surgical ablation approaches for PersAF via video-assisted
thoracoscopy: PVI + box lesion and PVI + box lesion + LAA excision.
METHODS: We randomly assigned 176 patients with PersAF to video-assisted
thoracoscopic surgical ablation with PVI + box lesion (88 patients) or PVI
+ box lesion + LAA excision (88 patients). The primary endpoint was
freedom from any documented atrial arrhythmia lasting >30 seconds after a
single ablation procedure without antiarrhythmic drug (AAD).
RESULTS: After 18 months of follow-up, 61 of 86 patients (70.9%) assigned
to PVI + box lesion were free from recurrent atrial fibrillation compared
to 64 of 87 patients (73.6%) assigned to PVI + box lesion + LAA excision
after a single ablation procedure without AAD (P = .73). Freedom from any
atrial arrhythmia after a single procedure with or without AAD was also
nonsignificant (70.9% vs 74.7%, respectively). There were no significant
differences between groups with regard to adverse events, including death,
transient ischemic attack, stroke, pneumothorax, and hydrothorax.
CONCLUSION: Among patients with PersAF, no reduction in the rate of
recurrent atrial fibrillation was found when LAA excision was performed in
addition to PVI and box lesion during surgical ablation.<br/>Copyright
&#xa9; 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights
reserved.

<16>
Accession Number
620245810
Author
Liu Y.; Sheng B.; Wang S.; Lu F.; Zhen J.; Chen W.
Institution
(Liu, Sheng, Wang, Lu, Zhen, Chen) Capital Medical University, Department
of Intensive care unit, Beijing Shijitan Hospital, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Title
Dexmedetomidine prevents acute kidney injury after adult cardiac surgery:
A meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 7. Date
of Publication: 15 Jan 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Dexmedetomidine has been shown to confer direct renoprotection
by stabilizing the sympathetic system, exerting anti-inflammatory effects
and attenuating ischemia/reperfusion (I/R) injury in preclinical studies.
Results from clinical trials of dexmedetomidine on acute kidney injury
(AKI) following adult cardiac surgery are controversial. Methods: We
searched EMBASE, PubMed, and Cochrane CENTRAL databases for randomized
controlled trials (RCTs) comparing the renal effect of dexmedetomidine
versus placebo or other anesthetic drugs in adult patients undergoing
cardiac surgery. The primary outcome was the incidence of AKI. The
secondary outcomes were mechanical ventilation (MV) duration, intensive
care unit (ICU) stay and hospital length of stay(LOS), and postoperative
mortality (in-hospital or within 30 days). Results: Ten trials with a
total of 1575 study patients were selected. Compared with controls,
dexmedetomidine significantly reduced the incidence of postoperative AKI
[68/788 vs 97/787; odds ratio(OR), 0.65; 95% confidence interval (CI),
0.45-0.92; P = 0.02; I² = 0.0%], and there was no difference
between groups in postoperative mortality (4/487 vs 11/483; OR, 0.43; 95%
CI, 0.14-1.28; P = 0.13; I² = 0.0%), MV duration [in days; n =
1229; weighted mean difference(WMD), -0.22; 95% CI, -2.04 to 1.70; P =
0.81], ICU stay (in days; n = 1363; WMD, -0.85; 95% CI, -2.14 to 0.45; P =
0.20), and hospital LOS (in days; n = 878; WMD, -0.24; 95% CI, -0.71 to
0.23; P = 0.32). Conclusions: Perioperative administration of
dexmedetomidine in adult patients undergoing cardiac surgery may reduce
the incidence of postoperative AKI. Future trials are needed to determine
the dose and timing of dexmedetomidine in improving outcomes, especially
in patients with decreased baseline kidney function.<br/>Copyright &#xa9;
2018 The Author(s).

<17>
Accession Number
620274571
Author
Menger J.; Urbanek B.; Dze-Dworschak K.S.; Wolf V.; Fischer A.; Rinosl H.;
Dworschak M.
Institution
(Menger, Urbanek, Dze-Dworschak, Wolf, Fischer, Rinosl, Dworschak)
Division of Cardiothoracic and Vascular Anesthesia and Intensive Care
Medicine, Vienna General Hospital, Medical University of Vienna, Wahringer
Gurtel 18-20, Vienna 1090, Austria
Title
Earplugs during the first night after cardiothoracic surgery may improve a
fast-track protocol.
Source
Minerva Anestesiologica. 84 (1) (pp 49-57), 2018. Date of Publication:
January 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Sleep deprivation after major surgery is common and associated
with worse outcome. Noise is one important reason for sleep fragmentation,
which contributes to enhanced morbidity. The purpose of this work was to
evaluate the impact of earplugs on patients' sleep quality during their
first night after cardiothoracic surgery to eventually improve an existing
fast-track concept. METHODS: Sixty-three patients undergoing
cardiothoracic surgery eligible for a postoperative fast-track regimen on
our cardiothoracic post anesthesia care unit (C-PACU) were prospectively
included. They were randomized to either sleep with or without earplugs.
Quality of sleep was measured using questionnaires for patients and
nurses. Required pain medications, pain intensity, and length of hospital
stay were secondary outcome variables. RESULTS: Twenty-seven patients were
randomized to the intervention group (earplugs) and 36 to the control
group. Mean (SD) age was 61 (12) years. Self-reported quality of sleep was
better in the intervention group (median, IQR [range]: 3, 2-4 [1-5] vs. 4,
3-5 [1-5]; scale: 1, "excellent," to 5, "very poor"; P=0.025). Patients of
the intervention group also experienced less severe pain (P=0.047) despite
similar dosages of administered analgesics and expressed improved
satisfaction regarding their C-PACU stay (P=0.032). CONCLUSIONS:
Implementation of the use of earplugs in a fast-track concept following
cardiothoracic surgery is efficient and easy. Earplugs improved the
quality of sleep as well as patient satisfaction and attenuated pain
intensity. They may thereby contribute to a faster recovery, less
morbidity, and reduced costs. (Cite this article as: Menger J, Urbanek B,
Skhirtladze-Dworschak K, Wolf V, Fischer A, Rinosl H, et al. Earplugs
during the first night after cardiothoracic surgery may improve a
fast-track protocol. Minerva Anestesiol 2018;84:49-57.<br/>Copyright
&#xa9; 2017 EDIZIONI MINERVA MEDICA.

<18>
Accession Number
620283292
Author
Nayyar M.; Donovan K.M.; Khouzam R.N.
Institution
(Nayyar, Donovan, Khouzam) Division of Cardiovascular Diseases, University
of Tennessee Health Science Center, Memphis, TN, United States
Title
When more is not better-Appropriately excluding patients from mechanical
circulatory support therapy.
Source
Annals of Translational Medicine. 6 (1) (no pagination), 2018. Article
Number: 9. Date of Publication: January 2018.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Mechanical circulatory support (MCS) devices are continually evolving and
are providing greater hemodynamic support. This review was conducted to
evaluate the prophylactic use of MCS in hemodynamically stable patients
who were awaiting future coronary artery revascularization. A thorough
review of published literature was conducted to evaluate for patients and
clinical scenarios that are indicated for MCS, including hemodynamically
stable and unstable patients awaiting revascularization. Although there
have been several studies demonstrating the benefit of MCS use in
hemodynamically unstable patients, there was limited trials in patients
that were hemodynamically stable. The use of prophylactic MCS was limited
to intra-aortic balloon pump (IABP) in "high risk" patients awaiting
coronary artery bypass grafting (CABG). This review article was conducted
to evaluate for possible prophylactic MCS in patients awaiting
revascularization. In hemodynamically stable patients, literature is
limited to the use of IABP for "high-risk" patients awaiting CABG. A
thorough review of literature suggest that hemodynamically stable patients
likely would not benefit from prophylactic placement MCS while awaiting
revascularization although further clinical trials are needed to identify
the ideal patients and clinical scenarios for the use of
MCS.<br/>Copyright &#xa9; Annals of Translational Medicine.

<19>
Accession Number
620283289
Author
Bob-Manuel T.; Kadire S.; Heckle M.R.; Wang J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Kadire, Heckle, Ibebuogu) Division of Cardiovascular
Diseases, Department of Medicine, University of Tennessee Health Science
Center, Methodist University Hospital, Memphis, TN, United States
(Wang) Division of Biostatistics and Epidemiology, Department of
Preventive Medicine, University of Tennessee Health Science Center,
Memphis, TN, United States
Title
Outcomes following transcatheter aortic valve replacement in patients with
native aortic valve regurgitation.
Source
Annals of Translational Medicine. 6 (1) (no pagination), 2018. Article
Number: 8. Date of Publication: January 2018.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Due to the absence of annular calcification for device anchoring, it is
presumed that transcatheter aortic valve replacement (TAVR) is not
suitable for the treatment of native aortic valve regurgitation (NAVR)
resulting in very limited data and experience concerning its safety and
efficacy. We sought to review published data on the safety and efficacy of
TAVR in high-risk patients with NAVR. Studies including case reports, case
series and original articles published between 2002 and 2016 on TAVR in
patients with NAVR were identified with a systematic electronic search
using the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. A total of 30 publications describing 182 patients
were identified. Most patients (54%) were men, with a mean age of
70.1+/-2.6 years, mean logistic European System for Cardiac Operative Risk
Evaluation score (EuroSCORE) of 21.8%+/-4.5% and mean Society of Thoracic
Surgeons (STS) score of 8%+/-1.8% for mortality. The majority (87%) of
patients had severe NAVR with no valvular calcification. TAVR was mostly
performed through the femoral (58.8%) and apical (33.1%) approach. Device
success, defined by VARC-2, was achieved in 86.3% of our study population.
A second valve was required in 17 patients (9.3%) during the index
procedure for residual aortic regurgitation or malposition. Post-procedure
aortic regurgitation of grade 1 or less was present in 80 patients (81%).
Pacemaker implantation was required post procedure in 17 patients (9.3%).
The 30-day and 1-year mortality was 11.9% and 16.2%, respectively. TAVR is
associated with favorable pacemaker implantation and 1-year mortality
rates with a high 30-day mortality among selected patients with
NAVR.<br/>Copyright &#xa9; Annals of Translational Medicine.

<20>
Accession Number
620226443
Author
Sane S.; Khoshkbary M.; Abbasyvash R.; Mahoori A.R.
Institution
(Sane, Khoshkbary, Abbasyvash, Mahoori) Department of Anesthesiology,
Urmia University of Medical Sciences, Urmia, Iran, Islamic Republic of
Title
Evaluation of the effect of preoperative oral Tizanid in on the rate of
anesthetic consumption & hemodynamic changes in Tiva (total intravenous
anesthesia).
Source
Journal of Global Pharma Technology. 8 (12) (pp 441-446), 2016. Date of
Publication: 2016.
Publisher
Journal of Global Pharma Technology (E-mail: shweta11982@gmail.com)
Abstract
Objective: Materials and Methods: A double-blind clinical trial has been
performed on 50 candidates for elective laparoscopic colecystectomy
undergoing general anesthesia in Educational Hospital of Imam Khomeiny
uromieh, Iran. 25 randomly selected patients (the case group) were given 4
mg of oral Tizanidine 90 minutes before the induction of anesthesia
whereas the remaining subjects (the control group) were given placebo.
Bispectral index "BIS" level before induction and after Tizanid in
premedication, Induction time(Time of bispectral index "BIS" to reach 60),
Mean arterial pressure and heart rate before and after induction of
anesthesia, and after intubation and 10 min after peritoneal gas
insufflations and in intraoperative period and after extubation, and the
needed Propofol & Remifentanyl dosage were measured and recorded. Data
analysis was done with T-test and Chi-squared test, using SPSS software
version 19.Results: BIS level before induction and after tizanidin
premedication was 91.04+/-1.13 & 94.56+/-1.82 in control and case group
respectively (p valu<0.01). Induction time was 56.9+/-5.35 and 80.2+/-2.9
seconds in control and case group respectively (p valu<0.009). Average
propofol & remifentanyl needed dose for anesthesia maintenance in case
group was 28.95% & 33.3% less than the needed amount in the control group
respectively. There is no difference in mean arterial pressure and heart
rate before and after induction of anesthesia between the two groups.
Variations of mean arterial pressure and heart rate after intubation and
10 min after peritoneal gas insufflations and in intraoperative period and
after extubation, were less in Tizanidine group generally. Conclusions:
Using oral Tizanidine as a premedication decreased BIS level & diminished
induction time of anesthesia decreased required Propofol and remifentanyl
& yielded stability in mean arterial pressure and heart rate during
surgery. Considering its short duration of action, Tizanidine use as a
premedication is recommended for sedation and stabilization of hemodynamic
responses during the operations.<br/>Copyright &#xa9; 2009-2016, JGPT.

<21>
Accession Number
620280776
Author
He H.; Ke B.; Li Y.; Han F.; Li X.; Zeng Y.
Institution
(He, Ke, Li, Li, Zeng) Department of Emergency Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Anzhen Road Second, Chaoyang
District, Beijing 100029, China
(Han) Department of Epidemiology, Beijing Anzhen Hospital, Beijing
Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical
University, Beijing 100029, China
Title
Novel oral anticoagulants in the preoperative period: a meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-11), 2018. Date of
Publication: 17 Jan 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this study is to evaluate the efficacy and safety of novel
oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing
different operations. We performed a systematic review of MEDLINE, EMBASE,
Cochrane Controlled Trials Register, and reports presented at scientific
meetings. The efficacy and safety of NOACs during the perioperative period
was compared to that using warfarin. Of the 2652 studies initially
reviewed, we identified 9 that included 15,880 patients for the
meta-analysis. Compared to warfarin, dabigatran increased the risk of
major bleeding (RR 1.37, 95% CI 1.06-1.78, P = 0.02). Apixaban (RR 0.63,
95% CI 0.40-0.99, P = 0.04) reduced thrombotic events. NOAC therapy
decreased thrombotic events in patients undergoing non-cardiac surgery (RR
0.68, 95% CI 0.50-0.92, P = 0.02). Compared to warfarin, the
administration of NOACs in the perioperative period has the same risk of
thromboembolism and major bleeding. But patients undergoing non-cardiac
surgery may benefit more from perioperative NOAC therapy. Apixaban may
reduce thrombotic events and dabigatran increases the risk of major
bleeding during the perioperative period.<br/>Copyright &#xa9; 2018
Springer Science+Business Media, LLC, part of Springer Nature

<22>
Accession Number
620280126
Author
Tkachuk S.; Collins K.; Ensom M.H.H.
Institution
(Tkachuk, Collins, Ensom) Faculty of Pharmaceutical Sciences, The
University of British Columbia, Vancouver, Canada
(Tkachuk, Collins, Ensom) Children's and Women's Health Centre of British
Columbia, Vancouver, Canada
Title
The Relationship Between Vancomycin Trough Concentrations and AUC/MIC
Ratios in Pediatric Patients: A Qualitative Systematic Review.
Source
Pediatric Drugs. (pp 1-12), 2018. Date of Publication: 17 Jan 2018.
Publisher
Springer International Publishing
Abstract
Background: In adults, the area under the concentration-time curve (AUC)
divided by the minimum inhibitory concentration (MIC) is associated with
better clinical and bacteriological response to vancomycin in patients
with methicillin-resistant Staphylococcus aureus who achieve target
AUC/MIC >= 400. This target is often extrapolated to pediatric patients
despite the lack of similar evidence. The impracticalities of calculating
the AUC in practice means vancomycin trough concentrations are used to
predict the AUC/MIC. Objective: This review aimed to determine the
relationship between vancomycin trough concentrations and AUC/MIC in
pediatric patients. Methods: We searched the MEDLINE and Embase databases,
the Cochrane Database of Systematic Reviews, and the Cochrane Central
Register of Controlled Trials using the medical subject heading (MeSH)
terms vancomycin and AUC and pediatric* or paediatric*. Articles were
included if they were published in English and reported a relationship
between vancomycin trough concentrations and AUC/MIC. Results: Of 122
articles retrieved, 11 met the inclusion criteria. One trial reported a
relationship between vancomycin trough concentrations, AUC/MIC, and
clinical outcomes but was likely underpowered. Five studies found troughs
6-10 mg/l were sufficient to attain an AUC/MIC > 400 in most general
hospitalized pediatric patients. One study in patients undergoing
cardiothoracic surgery found a trough of 18.4 mg/l achieved an AUC/MIC >
400. Two oncology studies reported troughs >= 15 mg/l likely attained an
AUC/MIC >= 400. In critical care patients: one study found a trough of 9
mg/l did not attain the AUC/MIC target; another found 7 mg/l corresponded
to an AUC/MIC of 400. Conclusions: Potential vancomycin targets varied
based on the population studied but, for general hospitalized pediatric
patients, troughs of 6-10 mg/l are likely sufficient to achieve AUC/MIC >=
400. For MIC >= 2 mg/l, higher troughs are likely necessary to achieve an
AUC/MIC >= 400. More research is needed to determine the relationships
between vancomycin trough concentrations, AUC/MIC, and clinical
outcomes.<br/>Copyright &#xa9; 2018 Springer International Publishing AG,
part of Springer Nature

<23>
Accession Number
620273996
Author
Benedetto U.; Altman D.G.; Gerry S.; Gray A.; Lees B.; Flather M.; Taggart
D.P.
Institution
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Oxford, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Norwich, United Kingdom
Title
Off-pump versus on-pump coronary artery bypass grafting: Insights from the
Arterial Revascularization Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The long-term effects of off-pump coronary artery bypass
continue to be controversial because some studies have reported increased
adverse event rates with off-pump coronary artery bypass when compared
with on-pump coronary artery bypass. The Arterial Revascularization Trial
compared survival after bilateral versus single internal thoracic artery
grafting. The choice of off-pump coronary artery bypass versus on-pump
coronary artery bypass was based on the surgeon's discretion. We performed
a post hoc analysis of the Arterial Revascularization Trial to compare
5-year outcomes with 2 strategies. Methods: Among 3102 patients enrolled
in the Arterial Revascularization Trial, we selected 1260 patients who
underwent off-pump coronary artery bypass versus 1700 patients who
underwent on-pump coronary artery bypass with cardioplegic arrest for the
present comparison. Primary outcomes were 5-year mortality and incidence
of major cardiac and cerebrovascular events, including cardiovascular
death, myocardial infarction, cerebrovascular accident, and
revascularization after index procedure. Propensity score matching
selected 1260 pairs for final comparison. Stratified Cox models were used
for treatment effect estimate. Results: Hospital mortality was comparable
between off-pump coronary artery bypass and on-pump coronary artery bypass
groups (12 [1.0%] vs 15 [1.2%]; P = .7). Conversion rate to on-pump during
off-pump coronary artery bypass was 29 of 1260 (2.3%). When compared with
off-pump coronary artery bypass not converted, off-pump coronary artery
bypass converted to on-pump presented a remarkably higher hospital
mortality (10.3% vs 0.7%; P < .001). At 5 years, the mortality rate was
110 (8.9%) versus 102 (8.3%) in the off-pump coronary artery bypass and
on-pump coronary artery bypass groups, respectively, with no significant
difference (hazard ratio, 1.14; 95% confidence interval, 0.86-1.52; P =
.35). Incidence of major cardiac and cerebrovascular events was 175 (14.3)
versus 169 (13.8) in the off-pump coronary artery bypass and on-pump
coronary artery bypass groups, respectively, with no significant
difference (hazard ratio, 1.05; 95% confidence interval, 0.84-1.31; P =
.65). Conclusions: The present post hoc Arterial Revascularization Trial
analysis supports the hypothesis that both off-pump coronary artery bypass
and on-pump coronary artery bypass are equally effective and
safe.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery.

<24>
Accession Number
620272450
Author
Albert C.; Albert A.; Kube J.; Bellomo R.; Wettersten N.; Kuppe H.;
Westphal S.; Haase M.; Haase-Fielitz A.
Institution
(Albert, Albert, Haase) Medical Faculty Otto-von-Guericke University,
Magdeburg, Germany
(Albert, Albert, Haase) Diaverum Deutschland, Potsdam, Germany
(Kube) Clinic of Nephrology and Hypertension, Diabetes and Endocrinology,
Otto-von-Guericke University, Magdeburg, Germany
(Kube) Department of Intensive Care, German Heart Center Leipzig,
University Clinic, Leipzig, Germany
(Bellomo) Department of Intensive Care, The Austin Hospital, Melbourne,
Australia
(Wettersten) Division of Cardiovascular Medicine, University of
California, San Diego, La Jolla, Calif
(Kuppe) Department of Anesthesiology, The German Heart Center, Berlin,
Germany
(Westphal) Institute of Laboratory Medicine, Hospital Dessau, Dessau,
Germany
(Haase-Fielitz) Brandenburg Medical School (MHB) and Heart Center
Brandenburg, Department of Cardiology, Bernau, Germany
(Haase-Fielitz) Institute of Social Medicine and Health Economics,
Otto-von-Guericke University, Magdeburg, Germany
Title
Urinary biomarkers may provide prognostic information for subclinical
acute kidney injury after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: This study aimed to determine the biomarker-specific outcome
patterns and short-and long-term prognosis of cardiac surgery-asoociated
acute kidney injury (AKI) identified by standard criteria and/or urinary
kidney biomarkers. Methods: Patients enrolled (N = 200), originated a
German multicenter study (NCT00672334). Standard risk injury, failure,
loss, and end-stage renal disease classification (RIFLE) criteria
(including serum creatinine and urine output) and urinary kidney biomarker
test result (neutrophil gelatinase-associated lipocalin, midkine,
interleukin 6, and proteinuria) were used for diagnosis of postoperative
AKI. Primary end point was acute renal replacement therapy or in-hospital
mortality. Long-term end points among others included 5-year mortality.
Patients with single-biomarker-positive subclinical AKI (RIFLE negative)
were identified. We controlled for systemic inflammation using C-reactive
protein test. Results: Urinary biomarkers (neutrophil
gelatinase-associated lipocalin, midkine, and interleukin 6) were
identified as independent predictors of the primary end point. Neutrophil
gelatinase-associated lipocalin, midkine, or interleukin 6 positivity or
de novo/worsening proteinuria identified 21.1%, 16.9%, 30.5%, and 48.0%
more cases, respectively, with likely subclinical AKI (biomarker
positive/RIFLE negative) additionally to cases with RIFLE positivity
alone. Patients with likely subclinical AKI (neutrophil
gelatinase-associated lipocalin or interleukin 6 positive) had increased
risk of primary end point (adjusted hazard ratio, 7.18; 95% confidence
interval, 1.52-33.93 [. P = .013] and hazard ratio, 6.27; 95% confidence
interval, 1.12-35.21 [. P = .037]), respectively. Compared with
biomarker-negative/RIFLE-positive patients, neutrophil
gelatinase-associated lipocalin positive/RIFLE-positive or
midkine-positive/RIFLE-positive patients had increased risk of primary end
point (odds ratio, 9.6; 95% confidence interval, 1.4-67.3 [. P = .033] and
odds ratio, 14.7; 95% confidence interval, 2.0-109.2 [. P = .011],
respectively). Three percent to 11% of patients appear to be influenced by
single-biomarker-positive subclinical AKI. During follow-up, kidney
biomarker-defined short-term outcomes appeared to translate into long-term
outcomes. Conclusions: Urinary kidney biomarkers identified RIFLE-negative
patients with high-risk subclinical AKI as well as a higher risk subgroup
of patients among RIFLE-AKI-positive patients. These findings support the
concept that urinary biomarkers define subclinical AKI and higher risk
subpopulations with worse long-term prognosis among standard patients with
AKI.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery.

<25>
Accession Number
620258769
Author
Song L.; Li J.; Guan C.; Jing Q.; Lu S.; Yang L.; Xu K.; Yang Y.; Xu B.;
Han Y.
Institution
(Song, Yang) Department of CardiologyFu Wai Hospital, National Center for
Cardiovascular DiseasesBeijing China
(Li, Jing, Xu, Han) Department of CardiologyGeneral Hospital of Shenyang
Military RegionShenyang China
(Guan, Xu) Catheterization LaboratoryFu Wai Hospital, National Center for
Cardiovascular DiseasesBeijing China
(Lu) Department of CardiologyAffiliated Anzhen Hospital of Capital Medical
UniversityBeijing China
(Yang) Department of CardiologyKunming General Hospital of Chengdu
Military RegionKunming China
Title
Randomized comparison of novel biodegradable polymer and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year
Outcomes of the I-LOVE-IT 2 Trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to compare the long-term outcomes of the novel
biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES)
versus the durable polymer sirolimus-eluting stent (DP-SES) in the
I-LOVE-IT2 trial. Backgrounds: Comparisons of the long-term safety and
efficiency of the BP-DES versus the DP-DES are limited. Methods: A total
of 2,737 patients eligible for coronary stenting were randomized to the
BP-SES or DP-SES group at a 2:1 ratio. The primary endpoint of target
lesion failure (TLF) was defined as a composite of cardiac death, target
vessel myocardial infarction (MI), or clinically indicated target lesion
revascularization. Results: A three-year clinical follow-up period was
available for 2,663 (97.3%) patients. There were no significant
differences in TLF (8.9% vs. 8.6%, P=0.81), patient-oriented composite
endpoint (PoCE) (15.2% vs.14.5%, P=0.63), or individual components between
the BP-SES and DP-SES. Definite/probable stent thrombosis (ST) was low and
similar at 3 years (0.8% vs. 1.0%, P=0.64). Landmark analysis of 1-3 years
showed that the TLF (2.7% vs. 2.6%, P=0.81), PoCE (6.2% vs. 5.1%, P=0.28),
and definite/probable ST (0.4% vs. 0.4%, P=1.00) were comparable between
the 2 arms. Conclusions: In this prospective randomized trial, the BP-SES
showed similar clinical results versus the DP-SES in terms of safety and
efficacy outcomes over a 3-year follow-up period.<br/>Copyright &#xa9;
2018 Wiley Periodicals, Inc.

<26>
Accession Number
620256610
Author
Angleitner P.; Kaider A.; Gokler J.; Moayedifar R.; Osorio-Jaramillo E.;
Zuckermann A.; Laufer G.; Aliabadi-Zuckermann A.
Institution
(Angleitner, Gokler, Moayedifar, Osorio-Jaramillo, Zuckermann, Laufer,
Aliabadi-Zuckermann) Division of Cardiac Surgery, Department of Surgery,
Medical University of Vienna, Vienna, Austria
(Kaider) Center for Medical Statistics, Informatics, and Intelligent
Systems, Medical University of Vienna, Vienna, Austria
Title
High-dose catecholamine donor support and outcomes after heart
transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier USA
Abstract
Background: Higher dose norepinephrine donor support is a frequent reason
for donor heart decline, but its associations with outcomes after heart
transplantation are unclear. Methods: We retrospectively analyzed 965
patients transplanted between 1992 and 2015 in the Heart Transplant
Program Vienna. Stratification was performed according to donor
norepinephrine dose administered before organ procurement (Group 0: 0
mug/kg/min; Group 1: 0.01 to 0.1 mug/kg/min; Group 2: >0.1 mug/kg/min).
Sub-stratification of Group 2 was performed for comparison of high-dose
subgroups (Group HD 1: 0.11 to 0.4 mug/kg/min; Group HD 2: >0.4
mug/kg/min). Associations between groups and outcome variables were
investigated using a multivariable Cox proportional hazards model and
logistic regression analyses. Results: Donor norepinephrine dose groups
were not associated with overall mortality (Group 1 vs 0: hazard ratio
[HR] 1.12, 95% confidence interval [CI] 0.87 to 1.43; Group 2 vs 0: HR
1.07, 95% CI 0.82 to 1.39; p = 0.669). No significant group differences
were found for rates of 30-day mortality (p = 0.35), 1-year mortality (p =
0.897), primary graft dysfunction (p = 0.898), prolonged ventilation (p =
0.133) and renal replacement therapy (p = 0.324). Groups 1 and 2 showed
higher rates of prolonged intensive care unit stay (18.9% vs 28.5% vs
27.5%, p = 0.005). High-dose subgroups did not differ significantly in
1-year mortality (Group HD 1: 14.3%; Group HD 2: 17.8%; p = 0.549).
Conclusions: Acceptance of selected donor hearts supported by higher doses
of norepinephrine may be a safe option to increase the donor organ
pool.<br/>Copyright &#xa9; 2018 International Society for the Heart and
Lung Transplantation.

<27>
Accession Number
620169971
Author
Zhang B.; Wang G.; Liu X.; Wang T.-L.; Chi P.
Institution
(Zhang, Wang) Department of Anesthesiology, Xuan Wu Hospital, Capital
Medical University, Beijing, China
(Zhang, Liu, Chi) Department of Anesthesiology, Beijing You An Hospital,
Capital Medical University, Beijing, China
(Wang) Department of Medical Insurance, Beijing You An Hospital, Capital
Medical University, Beijing, China
Title
The opioid-sparing effect of perioperative dexmedetomidine combined with
Oxycodone infusion during open hepatectomy: A randomized controlled trial.
Source
Frontiers in Pharmacology. 8 (JAN) (no pagination), 2018. Article Number:
940. Date of Publication: 04 Jan 2018.
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: A large right subcostal incision performed by open hepatectomy
is associated with significant post-operative pain and distress. However,
post-operative analgesia solutions still need to be devised. We
investigated the effects of intra- and post-operative infusion of
dexmedetomidine (Dex) combined with oxycodone during open hepatectomy.
Methods: In this prospective, randomized and double-blind investigation,
52 patients undergoing selective open hepatectomy were divided into Dex
group (DEX infusion at an initial loading dose of 0.5 mug.kg^-1
over 10 min before intubation then adjusted to a maintenance dose of 0.3
mug.kg^-1.h^-1 until incision suturing) or control
(Con) group (0.9% sodium chloride was administered). Patient-controlled
analgesia was administered for 48 h after surgery (Dex group: 60 mg
oxycodone and 360 mug DEX diluted to 120 ml and administered at a bolus
dose of 2 ml, with 5 min lockout interval and a 1 h limit of 20 ml. Con
group: 60 mg oxycodone alone with the same regimen). The primary outcome
was post-operative oxycodone consumption. The secondary outcomes included
requirement of narcotic and vasoactive drugs, hemodynamics, incidence of
adverse effects, satisfaction, first exhaust time, pain intensity, and the
Ramsay Sedation Scale. Results: Post-operative oxycodone consumption was
significantly reduced in Dex group from 4 to 48 h after surgery (P <
0.05). Heart rate in Dex group was statistically decreased from T1 (just
before intubation) to T6 (20 min after arriving at the post-anesthesia
care unit), while mean arterial pressure was significantly decreased from
T1 to T3 (during surgical incision; P < 0.05). The consumption of propofol
and remifentanil were significantly decreased in Dex group (P < 0.05). The
VAS scores at rest at 1, 4, and 8 h and with cough at 24, and 48 h after
surgery were lower, the first exhaust time were shorter, satisfaction with
pain control was statistically higher and the incidence of nausea and
vomiting was less in Dex group than in Con group (all P < 0.05).
Conclusion: The combination of DEX and oxycodone could reduce oxycodone
consumption and the incidence of nausea and vomiting, enhance the
analgesic effect, improves patient satisfaction and shorten the first
exhaust time.<br/>Copyright &#xa9; 2018 Zhang, Wang, Liu, Wang and Chi.

<28>
[Use Link to view the full text]
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.

<29>
Accession Number
614111787
Author
Paraskevas K.I.; Nduwayo S.; Saratzis A.N.; Naylor A.R.
Institution
(Paraskevas, Nduwayo, Saratzis, Naylor) The Department of Vascular Surgery
at Leicester Royal Infirmary, Leicester, United Kingdom
Title
Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic
Review and Meta-Analysis.
Source
European Journal of Vascular and Endovascular Surgery. 53 (3) (pp
309-319), 2017. Date of Publication: 01 Mar 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objectives The aim was to determine 30-day outcomes in patients with
concurrent carotid and cardiac disease who underwent carotid artery
stenting (CAS) followed by coronary artery bypass grafting (CABG). Methods
This was a systematic review with searches of PubMed/Medline, Embase, and
Cochrane databases. "Same-day" procedures involved CAS + CABG being
performed on the same day, and "staged" interventions involved at least 1
day's delay between undergoing CAS and then CABG. Results There were 31
eligible studies (2727 patients), with 80% being neurologically
asymptomatic with unilateral stenoses. Overall, the 30-day death/stroke
rate was 7.9% (95% confidence interval [CI] 6.9-9.2), while
death/stroke/MI was 8.8% (95% CI 7.3-10.5). Staged CAS + CABG was
associated with 30-day death/stroke rate of 8.5% (95% CI 7.3-9.7) compared
with 5.9% (95% CI 4.0-8.5) after "same-day" procedures. Outcomes following
CAS + CABG in neurologically symptomatic patients were poorer, with
procedural stroke rates of 15%. There were five antiplatelet (APRx)
strategies: (a) no APRx (death/stroke/MI, 4.2%; no data on bleeding
complications); (b) single APRx before CAS and CABG, then dual APRx after
CABG (death/stroke/MI, 6.7%; 7.3% bleeding complications); (c) dual APRx
pre-CAS down to one APRx pre-CABG (death/stroke/MI, 10.1%; 2.8% bleeding
complications); (d) dual APRx pre-CAS, both stopped pre-CABG
(death/stroke/MI, 14.4%); (e) dual APRx pre-CAS and continued through CABG
(death/stroke/MI, 16%). There were insufficient data on bleeding
complication in the last two strategies. Conclusions In a cohort of
predominantly asymptomatic patients with unilateral carotid stenoses, the
30-day rate of death/stroke was about 8%. Notwithstanding the effect of
potential biases, this meta-analysis did not find evidence that outcomes
after same-day CAS + CABG were higher than after staged interventions.
However, outcomes were poorer in neurologically symptomatic patients. More
data are required to establish the optimal antiplatelet strategy in
patients undergoing same-day or staged CAS + CABG.<br/>Copyright &#xa9;
2016 European Society for Vascular Surgery

<30>
Accession Number
620225400
Author
Manish P.; Arun G.; Kumsi S.
Institution
(Manish, Arun, Kumsi) Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore, Karnataka
560069, India
Title
Papaverine on Internal Mammary artery flow-comparitive study of
intraluminal versus topical.
Source
Journal of Cardiovascular Disease Research. 8 (4) (pp 157-159), 2017. Date
of Publication: October-December 2017.
Publisher
EManuscript Technologies (E-mail: journals@emanuscript.in)
Abstract
Background: Coronary artery bypass grafting (CABG) is the commonest method
for surgical revascularisation and Left Internal Mammary artery (LIMA) is
the conduit of choice. However it may develop vasospasm during harvesting.
Vasodilators like Papaverine have been proposed to relieve vasospasm and
hence increase blood flow. However the optimal method of papaverine
application is not clear. In this study we have compared the effects of
intraluminal versus topical application of papaverine on LIMA flow.
Methods: This was prospective randomized controlled trial of 60 patients.
They were divided into two groups: group 1 (n=30; intraluminal papaverine
application) and group 2 (n=30; topical papaverine application). LIMA was
harvested, divided and the blood flow from distal cut end was measured
under controlled hemodynamics, before papaverine application and 5 min
after papaverine application. Results: In group 1, the mean blood flow was
61.07+/-3.1 ml/min before papaverine application and 119.6+/-3.72 ml/min
after intraluminal instillation (p value <0.0001). In group 2, it was
60.4+/-2.24 ml/min before and 72.13+/-2.56 ml/min after papaverine topical
application. The increase in blood flow observed in group 1 was 95.84%
versus 19.42% in group 2. Conclusion: In this trial, while papaverine
increased blood flow with both methods, it caused a higher rate of
increase of blood flow with intraluminal instillation than with topical
application.<br/>Copyright &#xa9; 2017 Phcog.Net. All rights reserved.

<31>
Accession Number
616541696
Author
Grocott H.P.; Lee Y.H.; Waszynski C.M.; Waberski W.; Apakama G.P.; Aquino
K.G.; Arya V.K.; Avidan M.S.; Abdallah A.B.; Dicks R.S.; Downey R.J.;
Emmert D.A.; Escallier K.E.; Fritz B.A.; Fardous H.; Funk D.J.; Gipson
K.E.; Girardi L.N.; Grocott H.; Gruber A.T.; Hudetz J.A.; Inouye S.K.;
Ivascu N.S.; Jacobsohn E.; Jayant A.; Kashani H.H.; Kavosh M.S.; Kunkler
B.S.; Lee Y.; Lenze E.J.; Mashour G.A.; Maybrier H.R.; McKinney A.S.;
McKinnon S.L.; Mickle A.M.; Monterola M.; Muench M.R.; Murphy M.R.; Noh
G.-J.; Pagel P.S.; Pryor K.O.; Rogers E.M.; Redko M.; Schmitt E.M.;
Sivanesan L.; Steinkamp M.L.; Tellor B.; Thomas S.; Upadhyayula R.T.;
Veselis R.A.; Vlisides P.E.; Waszynski C.; Yulico H.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
United States
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, United States
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, United States
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, United States
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, United States
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, United States
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT,
United States
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, United States
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife,
Boston, MA, United States
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: an international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. 390 (10091) (pp 267-275), 2017. Date of Publication: 15 - 21
July 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding National Institutes of Health and
Cancer Center Support.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<32>
Accession Number
605559111
Author
Elgendy I.Y.; Mahmoud A.; Shuster J.J.; Doukky R.; Winchester D.E.
Institution
(Elgendy, Winchester) Division of Cardiovascular Medicine, University of
Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277,
Gainesville, FL 32610, United States
(Mahmoud) Department of Medicine, University of Florida College of
Medicine, Gainesville, FL, United States
(Shuster) Department of Health Outcomes and Policy, University of Florida,
Gainesville, FL, United States
(Doukky) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
Title
Outcomes after inappropriate nuclear myocardial perfusion imaging: A
meta-analysis.
Source
Journal of Nuclear Cardiology. 23 (4) (pp 680-689), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The relationship between inappropriate MPI and cardiovascular
outcomes is poorly understood. We sought to systematically review the
literature on appropriate use criteria (AUC) for MPI, including temporal
trend of inappropriate testing and resulting cardiovascular outcomes.
Methods: We searched the MEDLINE database for studies related to AUC and
MPI. The co-primary outcomes were abnormal test results and the presence
of cardiac ischemia. Random effects odds ratios (OR) were constructed
using DerSimonian-Laird method. Results: A total of 22 studies with 23,443
patients were included. The prevalence of inappropriate testing was 14.8%
[95% confidence interval (CI) 11.6%-18.7%]. Inappropriate MPI studies were
less likely to be abnormal (OR 0.41 95% CI 0.35-0.49, P < .0001) and to
demonstrate ischemia (OR 0.40, 95% CI 0.24-0.67, P < .0001) compared to
appropriate testing. No difference in the rate of inappropriate tests was
detected based on the midpoint of the enrollment year (P = .54). The
pattern of ordering inappropriate studies was not different between
cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51-1.06, P =
.10). Conclusion: Inappropriate MPI studies are less likely to yield
abnormal results or demonstrate myocardial ischemia. The rate of
inappropriate MPI has not decreased over time.<br/>Copyright &#xa9; 2015,
American Society of Nuclear Cardiology.

<33>
Accession Number
611437234
Author
Meesters M.I.; Veerhoek D.; De Lange F.; De Vries J.-W.; De Jong J.R.;
Romijn J.W.A.; Kelchtermans H.; Huskens D.; Van Der Steeg R.; Thomas
P.W.A.; Burtman D.T.M.; Van Barneveld L.J.M.; Vonk A.B.A.; Boer C.
Institution
(Meesters, De Jong, Romijn, Van Der Steeg, Thomas, Burtman, Boer)
Department of Anaesthesiology, VU University Medical Centre, Amsterdam,
Netherlands
(Veerhoek, Van Barneveld, Vonk) Cardio-thoracic Surgery, VU University
Medical Centre, Amsterdam, Netherlands
(De Lange, De Vries) Department of Anaesthesiology, Department of Cardiac
Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
(Kelchtermans, Huskens) Synapse B. V., Maastricht, Netherlands
Title
Effect of high or low protamine dosing on postoperative bleeding following
heparin anticoagulation in cardiac surgery a randomised clinical trial.
Source
Thrombosis and Haemostasis. 116 (2) (pp 251-261), 2016. Date of
Publication: August 2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
While experimental data state that protamine exerts intrinsic
anticoagulation effects, protamine is still frequently overdosed for
heparin neutralisation during cardiac surgery with cardiopulmonary bypass
(CPB). Since comparative studies are lacking, we assessed the influence of
two protamine-to-heparin dosing ratios on perioperative haemostasis and
bleeding, and hypothesised that protamine overdosing impairs the
coagulation status following cardiac surgery. In this open-label,
multicentre, single-blinded, randomised controlled trial, patients
undergoing on-pump coronary artery bypass graft surgery were assigned to a
low (0.8; n=49) or high (1.3; n=47) protamine-to-heparin dosing group. The
primary outcome was 24-hour blood loss. Patient haemostasis was monitored
using rotational thromboelasto-metry and a thrombin generation assay. The
low protamine-to-heparin dosing ratio group received less protamine (329
+/- 95 vs 539 +/- 117 mg; p<0.001), while post-protamine activated
clotting times were similar among groups. The high dosing group revealed
increased intrinsic clotting times (236 +/- 74 vs 196 +/- 64 s; p=0.006)
and the maximum post-protamine thrombin generation was less suppressed in
the low dosing group (38 +/- 40% vs 6 +/- 9%; p=0.001). Postoperative
blood loss was increased in the high dosing ratio group (615 ml; 95%> CI
500-830 ml vs 470 ml; 95%> CI 420-530 ml; p=0.021) when compared to the
low dosing group, respectively. More patients in the high dosing group
received fresh frozen plasma (11%> vs 0%>; p=0.02) and platelet
concentrate (21%> vs 6%>; p=0.04) compared to the low dosing group. Our
study confirms in vitro data that abundant protamine dosing is associated
with increased postoperative blood loss and higher transfusion rates in
cardiac surgery.<br/>Copyright &#xa9; Schattauer 2016.

<34>
Accession Number
611437254
Author
Silvain J.; Storey R.F.; Cayla G.; Esteve J.-B.; Dillinger J.-G.; Rousseau
H.; Tsatsaris A.; Baradat C.; Salhi N.; Hamm C.W.; Lapostolle F.; Lassen
J.F.; Collet J.-P.; Ten Berg J.M.; Van 'T Hof A.W.; Montalescot G.
Institution
(Silvain, Collet, Montalescot) Universite Paris 06 INSERM-UMRS 1166,
Institut de Cardiologie, Pitie-Salpetriere University Hospital (AP-HP),
Paris, France
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Cayla) Service de Cardiology, CHU Caremeau, Nimes, France
(Esteve) CHU de la Reunion, Reunion - Le Raincy-Montfermeil, Montfermeil,
France
(Dillinger) Department of Cardiology, INSERM U942 Hopital Lariboisiere,
AP-HP Paris Diderot University, Paris, France
(Rousseau) Unite de Recherche Clinique, Hopital Lariboisiere, Paris,
France
(Tsatsaris, Baradat) AstraZeneca, Rueil Malmaison, France
(Salhi) AstraZeneca, Luton, United Kingdom
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Lapostolle) SAMU 93, Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus N, Denmark
(Ten Berg) Department of Cardiology, St Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Van 'T Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
Title
P2Y<inf>12</inf> receptor inhibition and effect of morphine in patients
undergoing primary PCI for ST-segment elevation myocardial infarction: The
PRIVATE-ATLANTIC study.
Source
Thrombosis and Haemostasis. 116 (2) (pp 369-378), 2016. Date of
Publication: August 2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
PRIVATE-ATLANTIC (P2Y<inf>12</inf> Receptor Inhibition with VASP Testing
using Elisa kit during the ATLANTIC study) is a pre-specified substudy of
the randomised, double-blind ATLANTIC trial in patients with ST-segment
elevation myocardial infarction, designed to help interpret the main trial
results. The primary objective of ATLANTIC was to assess coronary
reperfusion prior to percutaneous coronary intervention (PCI) with prevs
in-hospital ticagrelor 180 mg loading dose (LD). PRIVATE-ATLANTIC assessed
platelet inhibition in 37 patients by measurement of
vasodilator-associated stimulated phosphoprotein (VASP) platelet
reactivity index (PRI) and VerifyNow platelet reactivity units (PRU)
before angiogram (T1), immediately after PCI (T2), 1 (T3), and 6 (T4)
hours (h) after PCI, and before next study drug administration (T5). The
median time difference between the two ticagrelor LD was 41 minutes.
Platelet reactivity was unaffected at T1 when measured by VASP-PRI (89.8
vs 93.9% for pre- and in-hospital ticagrelor, respectively; p = 0.18) or
PRU (239 vs 241; p = 0.82). Numerical differences were apparent at T2 and
maximal at T3. Morphine administration significantly delayed onset of
platelet inhibition at T3 (VASP-PRI 78.2 vs 23.4%% without morphine; p =
0.0116) and T4 (33.1 vs 11.0%>; p = 0.0057). In conclusion, platelet
inhibition in ATLANTIC was unaffected by pre-hospital ticagrelor
administration at the time of initial angiogram due to the short transfer
delay. The maximum difference in platelet inhibition was detected 1 h
after PCI (T3). Morphine administration was associated with delayed onset
of action of ticagrelor and appeared more important than timing of
ti-cagrelor administration.<br/>Copyright &#xa9; Schattauer 2016.

<35>
Accession Number
611588110
Author
Cheng J.; Gao J.; Shuai X.; Wang G.; Tao K.
Institution
(Cheng, Gao, Shuai, Wang, Tao) Department of Gastrointestinal Surgery,
Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, Hubei, China
Title
The comprehensive summary of surgical versus non-surgical treatment for
obesity: A systematic review and meta-analysis of randomized controlled
trials.
Source
Oncotarget. 7 (26) (pp 39216-39230), 2016. Date of Publication: 2016.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Background: Bariatric surgery has emerged as a competitive strategy for
obese patients. However, its comparative efficacy against non-surgical
treatments remains ill-defined, especially among nonseverely obese crowds.
Therefore, we implemented a systematic review and meta-analysis in order
for an academic addition to current literatures. Methods: Literatures were
retrieved from databases of PubMed, Web of Science, EMBASE and Cochrane
Library. Randomized trials comparing surgical with nonsurgical therapies
for obesity were included. A Revised Jadad's Scale and Risk of Bias
Summary were employed for methodological assessment. Subgroups analysis,
sensitivity analysis and publication bias assessment were respectively
performed in order to find out the source of heterogeneity, detect the
outcome stability and potential publication bias. Results: 25 randomized
trials were eligibly included, totally comprising of 1194 participants.
Both groups displayed well comparability concerning baseline parameters (P
> 0.05). The pooled results of primary endpoints (weight loss and diabetic
remission) revealed a significant advantage among surgical patients rather
than those receiving non-surgical treatments (P < 0.05). Furthermore,
except for certain cardiovascular indicators, bariatric surgery was
superior to conventional arms in terms of metabolic secondary parameters
(P < 0.05). Additionally, the pooled outcomes were confirmed to be stable
by sensitivity analysis. Although Egger's test (P < 0.01) and Begg's test
(P<0.05) had reported the presence of publication bias among included
studies, "Trim-and-Fill" method verified that the pooled outcomes remained
stable. Conclusion: Bariatric surgery is a better therapeutic option for
weight loss, irrespective of follow-up duration, surgical techniques and
obesity levels.

<36>
Accession Number
605717690
Author
AlJaroudi W.; Campagnoli T.; Fughhi I.; Wassouf M.; Ali A.; Doukky R.
Institution
(AlJaroudi) Division of Cardiovascular Medicine, Clemenceau Medical
Center, Beirut, Lebanon
(Campagnoli, Fughhi, Wassouf, Doukky) Division of Cardiology, Rush
University Medical Center, Chicago, IL, United States
(Ali) Department of Radiology and Nuclear Medicine, Rush University
Medical Center, Chicago, IL, United States
(Doukky) Division of Cardiology, John H. Stroger Jr. Hospital of Cook
County, 1901 W. Harrison St., Suite # 3620, Chicago, IL 60612, United
States
Title
Prognostic value of heart rate response during regadenoson stress
myocardial perfusion imaging in patients with end stage renal disease.
Source
Journal of Nuclear Cardiology. 23 (3) (pp 560-569), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Blunted heart rate response (HRR) to vasodilator stress agents
is associated with worse outcomes. There are limited data assessing the
effect of impaired HRR to regadenoson among patients with end-stage renal
disease (ESRD) undergoing stress myocardial perfusion imaging (MPI).
Methods: We prospectively followed patients with ESRD enrolled in the
ASSUAGE and ASSUAGE-CKD trials. HRR was defined as 100*(peak stress heart
rate-resting heart rate)/resting heart rate. Study cohort was dichotomized
to blunted and normal HRR groups according to an established median HRR
value <28% or >=28%, which were propensity-score matched based on 22
clinical and imaging covariates. The Primary endpoint was all-cause death.
The secondary cardiac-specific endpoints included: (1) the composite
endpoint of cardiac death or myocardial infarction; (2) the composite
endpoint of cardiac death, myocardial infarction, or late (>90 days)
coronary revascularization. Results: There were 303 patients followed for
35 +/- 10 months. In the entire cohort, there was a stepwise increase in
the rates of death and all secondary endpoints with worsening HRR (P
values <=.001). Blunted HRR (<28%) was associated with increased risk of
death (unadjusted hazard ratio 4.10 [1.98-8.46], P < .001) and all
secondary endpoints (P <= .001). After multivariate adjustment, HRR
remained an independent predictor of mortality and secondary endpoints
whether used as continuous or dichotomous variable, and added incremental
prognostic value for all-cause death (P = .046). Blunted HRR was
associated with increased event rate among patients with normal myocardial
perfusion (P = .001) and abnormal perfusion (P = .053). In the
propensity-matched cohort of 132 patients (66 in each group), blunted HRR
was associated with significant increase in all-cause death (21% vs. 5%,
HR 5.09 [1.46-17.7], P=.011), and similarly for the secondary endpoints.
Conclusion: Blunted HRR (<28%) to regadenoson is a strong and independent
predictor of death and cardiovascular events in patients with ESRD and
adds incremental prognostic value.<br/>Copyright &#xa9; 2015, American
Society of Nuclear Cardiology.

<37>
Accession Number
620235302
Author
Waite I.; Massey T.; Baghai M.; Wendler O.; Deshpande R.; Greenwood S.
Institution
(Waite) Kings College Hospital NHS Trust, Department of Physiotherapy,
London, United Kingdom
(Waite, Massey, Baghai, Wendler, Deshpande) Kings College Hospital,
Department of Cardiology, London, United Kingdom
(Greenwood) Kings College Hospital, Physiotherapy and Renal Medicine,
London, United Kingdom
(Greenwood) King's College Hospital, Renal Medicine, Division of
Transplantation Immunology and Mucosal Biology, London, United Kingdom
Title
Home-based Preoperative Rehabilitation (PREHAB) to improve physical
function and reduce hospital length of stay for frail patients undergoing
cardiac surgery.
Source
Physiotherapy (United Kingdom). Conference: Physiotherapy UK Conference
2017. United Kingdom. 103 (Supplement 1) (pp e117), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ltd
Abstract
Purpose: By the year UK population will be aged lation present with
greater comorbidities and frailty, posing significant risk to a successful
post-operative recovery. Wait times for elective cardiac surgery vary but
evidence shows patients ultimately deteriorate functionally and psychologi
cally during this period prior to surgery. This prospective one-group
pre-test, post-test study was designed to assess the feasibility of a
Pre-operative Reha bilitation (PREHAB) home-based exercise programme, to
optimise pre-operative physical function and frailty in patients awaiting
elective Coronary Artery By-Pass Graft (CABG) or Valve surgery. Methods:
Consenting patients listed for cardiac surgery, with a wait time >=
siotherapist in the surgical clinic and assessed at baseline. Outcome
measures included The Duke activity score Index (DASI), The Short Physical
Performance Battery Protocol (SPPB), The sion of exercise, continued
weekly until the patient attended the Surgical Pre-assessment clinic where
all outcome meas ures were re-assessed. Results: Inificant mean difference
in tance was shown to be significantly associated with hospital LOS (r =
cidate the influence frailty could have in reducing length of stay. A
large randomised controlled study is required to reveal the potential
beneficial effects of PREHAB in this patient population. Implications:
Early pre-operative identification of frailty with immediate physiotherapy
intervention could see signifi cant implications in reducing both the need
for post-operative rehabilitation and patient length of stay. Further
evidencemay lead to greater physiotherapy involvement in pre-operative
cardiothoracic clinics with a view to optimising patients for surgery.

<38>
Accession Number
620253616
Author
Estienne L.; Esposito P.; Serpieri N.; Domenech M.V.; Calatroni M.;
Libetta C.; Rampino T.
Institution
(Estienne, Esposito, Serpieri, Domenech, Calatroni, Libetta, Rampino)
SOCIO SIN Presentatore: Pasquale Esposito Department of Nephrology,
Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo,
Pavia, Italy
Title
Rhabdomyolysys-associated acute kidney injury in a patient with carnitine
palmitoyltransferase II deficiency.
Source
Blood Purification. Conference: 35th Vicenza Course on AKI and CRRT.
Italy. 44 (3) (pp 179), 2017. Date of Publication: October 2017.
Publisher
S. Karger AG
Abstract
Introduction: Rhabdomyolysis is a common cause of acute kidney injury
(AKI), often secondary to the use of certain drugs (i.e. statins) or to
post-traumatic muscular damage. Metabolic conditions, even when involving
muscular tissue, rarely result in severe renal damage. Here, we report a
case of a patient who experienced AKI and multi-organ failure caused by
rhabdomyolysis due to a genetic defect in carnitine palmitoyltransferase
II (CPTII) enzyme. Case Report: A 66-year-old man presented to the
Emergency Department with tremors, dyspnoea, nausea, polyarthralgia and
dysuria. Blood pressure on admission was 210/110 mm Hg and blood analysis
confirmed a suspected diagnosis of severe rhabdomyolysis (CPK 167,000
mU/mL, AST 3488 mU/mL, ALT 746 mU/mL, LDH 3416 mU/mL) and altered renal
function (creatinine 2.28 mg/dL, urea 56 mg/dL). Urine analysis showed
haematuria and leukocyturia. After admission, infusive therapy with saline
solutions was begun, but in few hours the patient presented a severe
worsened of dyspnoea. He was then transferred to the Intensive Care Unit
(ICU) where, in light of his rapid deterioration of gas exchanges and
hemodynamic instability, the patient was intubated and vasoactive amines
were administrated. In the meantime, creatinine increased further (5.53
mg/dl) and urine output decreased to the point of anuria, so CRRT was
started. Later, CPK serum levels gradually decreased and electromyography
showed severe muscle damage, in the absence of signs of acute denervation.
A week after the admission into the ICU, respiratory and cardiac
conditions improved, while kidney injury persisted. However, in the
following days, in concomitance with reduction of CPK levels (87 mU/ml),
renal function progressively improved, so that it was possible to withdraw
hemodialysis (creatinine 2.04 mg/dl). To explain the cause of the
extensive muscle damage, that was conceivably on the basis of pulmonary,
cardiac and renal failure, we did a more thorough investigation into the
patient's past medical records. Systematic review of past records showed
an analogue episode of muscle damage six years before, when after a
quadruple CABG surgery for a three-vessel coronary disease, he presented a
significant increase in CPK levels (27095 mU/ml), though the aetiology
remained unknown. Subsequently, to better define the nature of the
muscular damage we tested for myositis that returned negative and a
subsequent muscle biopsy revealed primary metabolic myopathy. Biochemical
analyses showed an insufficient beta oxidation of fatty acids, with an
associated severe carnitine deficit. Ultimately, we proceeded to genetic
analysis that finally revealed a diagnosis of CPT II deficiency
[homozygosis for c.338C>T (p. S113L)]. Conclusions: CPT-II deficiency is a
long-chain fatty acid oxidation deficiency that causes energy depletion in
myocytes during prolonged exercise leading to rhabdomyolysis. Clinical
manifestations are usually seen in children, but are rarely observed in
adults. This case highlights that metabolic alterations should be
carefully taken into consideration when evaluating patients with AKI of
unclear origin.

<39>
Accession Number
620237846
Author
Bentley-Lewis R.; Claggett B.; Liu J.; Maggioni A.P.; Mcmurray J.J.V.;
Tardif J.-C.; Kober L.V.; Solomon S.D.; Lewis E.F.
Institution
(Bentley-Lewis, Claggett, Liu, Maggioni, Mcmurray, Tardif, Kober, Solomon,
Lewis) Boston, MA, Florence, Italy, Glasgow, United Kingdom, Montreal, QC,
Canada, Copenhagen, Denmark
Title
Baseline characteristics and cardiovascular outcomes in women with a
history of gestational diabetes in the evaluation of lixisenatide in acute
coronary syndrome trial.
Source
Diabetes. Conference: 76th Scientific Sessions of the American Diabetes
Association, ADA 2016. United States. 65 (Supplement 1) (pp A356), 2016.
Date of Publication: 2016.
Publisher
American Diabetes Association Inc.
Abstract
Gestational diabetes mellitus (GDM) has been increasing in prevalence and
its influence on cardiovascular (CV) disease risk has been increasingly
recognized. We aimed to examine the baseline characteristics and CV
outcomes of women with and without a history of GDM. The Evaluation of
LIXisenatide in Acute Coronary Syndrome (ELIXA) trial was a randomized,
double-blind, placebo-controlled, parallel-group, multicenter study of
lixisenatide in patients with type 2 diabetes and recent acute coronary
syndrome (ACS). Women enrolled provided details regarding GDM history and
insulin use during pregnancy. We then compared women with and without a
history of GDM according to baseline clinical characteristics; CV and
diabetes medications; lifestyle data; patient-reported outcome data
obtained from the Diabetes Health Profile (DHP-18); and subsequent CV
outcomes. Among the 1861 women enrolled in ELIXA, women with a history of
GDM (n=51) compared to women without a GDM history (n=1810) were signifi-
cantly younger (54 +/- 11 vs. 63 +/- 9 yrs; p < 0.001); had an earlier age
at diabetes diagnosis (36 +/- 9 vs. 52 +/- 11 yrs; p < 0.001); and had a
higher HbA1c (median [IQR], 8.2 [7.2, 9.2] vs. 7.6 [6.7, 8.7]%; p =
0.035). Women with a history of GDM had more percutaneous coronary
interventions (76.5 vs. 56.8%; p = 0.005); more coronary artery bypass
grafts (13.7 vs. 6.0%; p = 0.025); and less mobility-difficulty reported
compared to women without a GDM history (21.1 vs. 46.9%; p = 0.027).
During a median follow-up of 25 months, the allcause death, CV death,
myocardial infarction, heart failure, and stroke event rates were
statistically similar between women with and without GDM. Among women with
type 2 diabetes and recent ACS, women with a GDM history were younger at
age of diabetes onset and had more CV revascularizations than women
without a GDM history. Further examination of GDM and CV outcomes is
warranted. (NCT01147250).

<40>
Accession Number
620255431
Author
Beningfield A.; Jones A.
Institution
(Beningfield, Jones) Discipline of Physiotherapy, College of Healthcare
Sciences, James Cook University, Townsville, Australia
Title
Peri-operative chest physiotherapy for paediatric cardiac patients: A
systematic review and meta-analysis.
Source
Physiotherapy (United Kingdom). (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Background: Chest physiotherapy (CPT) is implemented before and after
congenital heart disease (CHD) surgery in paediatrics to prevent and treat
postoperative pulmonary complications (PPC). Currently, there are no
systematic reviews or meta-analyses on the efficacy of CPT in this
population. Objective: To conduct a systematic review and meta-analysis to
determine whether peri-operative CPT is safe and effective for paediatric
patients with CHD. Data sources: A literature search was conducted on
PEDro, MEDLINE, CINAHL, Informit, The Cochrane Library and Scopus in March
and April 2016. Eligibility criteria: English peer-reviewed articles that
utilised CPT before or after cardiac surgery for paediatric CHD.
Systematic reviews were excluded. Data extraction and synthesis: Completed
by two independent researchers using the Crowe Critical Appraisal Tool.
Data were collated using a piloted data extraction tool. Mix Version
2.0.1.4 was used for meta-analysis, and data were extracted using an odds
ratio (with a random effects model). Results: Eleven studies met the
inclusion criteria for the systematic review. Variable results were found
regarding the effect of CPT on peripheral oxygen saturation and pain.
Meta-analysis showed that CPT did not prevent pneumonia (odds ratio (OR)
2.01; 95% confidence interval (CI) 0.80 to 5.05; P = 0.13), and did not
prevent or treat atelectasis (OR 1.27; 95% CI 0.18 to 8.87; P = 0.81).
Limitations: There was a lack of high-quality studies. The included
studies were comprised of heterogeneous treatment, limiting external
validity. Conclusion: Active therapies such as mobilisation, deep
breathing and incentive spirometry were more effective than passive
treatment. Percussion led to oxygen desaturation, and percussion,
vibration and suctioning increased the risk of developing atelectasis.
Systematic review registration number CRD42015024768.<br/>Copyright &#xa9;
2017 Chartered Society of Physiotherapy.

<41>
Accession Number
52845523
Author
Von Birgelen C.; Sen H.; Lam M.K.; Danse P.W.; Jessurun G.A.J.; Hautvast
R.W.M.; Van Houwelingen G.K.; Schramm A.R.; Gin R.M.T.J.; Louwerenburg
J.W.; De Man F.H.A.F.; Stoel M.G.; Lowik M.M.; Linssen G.C.M.; Said
S.A.M.; Nienhuis M.B.; Verhorst P.M.J.; Basalus M.W.Z.; Doggen C.J.M.;
Tandjung K.
Institution
(Von Birgelen, Sen, Lam, Van Houwelingen, Louwerenburg, De Man, Stoel,
Lowik, Verhorst, Basalus, Tandjung) Department of Cardiology,
Thoraxcentrum Twente, 7513 ER Enschede, Netherlands
(Von Birgelen, Doggen) Department of Health Technology and Services
Research, University of Twente, Enschede, Netherlands
(Danse, Gin) Department of Cardiology, Rijnstate Hospital, Arnhem,
Netherlands
(Jessurun, Schramm) Department of Cardiology, Scheper Hospital, Emmen,
Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Linssen, Said) Department of Cardiology, Hospital Group Twente, Almelo
and Hengelo, Netherlands
(Nienhuis) Department of Cardiology, Queen Beatrix Hospital, Winterswijk,
Netherlands
Title
Third-generation zotarolimus-eluting and everolimus-eluting stents in
all-comer patients requiring a percutaneous coronary intervention (DUTCH
PEERS): A randomised, single-blind, multicentre, non-inferiority trial.
Source
The Lancet. 383 (9915) (pp 413-423), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Third-generation, permanent-polymer-based drug-eluting stents
with novel, flexible designs might be more easily delivered than previous
generations of stents in complex coronary lesions, but might be less
longitudinally stable. We aimed to assess the safety and efficacy in
all-comer patients of two third-generation stents that are often used
clinically, but that have not yet been compared, and one of which has not
previously been assessed in a randomised trial. Methods: In this
investigator-initiated, single-blind, multicentre, randomised, two-arm,
non-inferiority trial, patients aged 18 years and older who required a
percutaneous coronary intervention with implantation of a drug-eluting
stent were recruited from four study sites in the Netherlands. We randomly
assigned patients by independently managed computer-generated allocation
sequences in a 1:1 ratio to receive either cobalt-chromium-based
zotarolimus-eluting stents (Resolute Integrity, Medtronic, Santa Rosa, CA,
USA) or platinum-chromium-based everolimus-eluting stents (Promus Element,
Boston Scientific, Natick, MA, USA). Patients and analysts were masked to
the allocated stent, but treating clinicians were not. The primary
endpoint of target-vessel failure was a composite of safety (cardiac death
or target-vessel-related myocardial infarction) and efficacy
(target-vessel revascularisation) at 12 months, analysed by intention to
treat (with a non-inferiority margin of 3.6%). This trial is registered
with ClinicalTrials.gov, number NCT01331707. Findings: Between Nov 25,
2010, and May 24, 2012, 1811 eligible all-comer patients, with 2371 target
lesions, were enrolled in the study. 370 (20%) patients presented with
ST-elevation myocardial infarction and 447 (25%) with non-ST-elevation
myocardial infarction. 906 patients were assigned to receive
zotarolimus-eluting stents and 905 to receive everolimus-eluting stents.
Ease of stent delivery was shown by very low numbers of patients requiring
treatment other than their assigned study treatment (six [1%] in the
zotarolimus-eluting stent group vs five [1%] in the everolimus-eluting
stent group; p=0.22). 12-month follow-up results were available for 1810
patients (one patient in the zotarolimus-eluting stent group withdrew
consent). The primary endpoint was met by 55 (6%) of 905 patients in the
zotarolimus-eluting stent group and 47 (5%) of 905 in the
everolimus-eluting stent group. The zotarolimus-eluting stent was
non-inferior to the everolimus-eluting stent (absolute risk diff erence
0.88%, 95% CI-1.24% to 3.01%; upper limit of one-sided 95% CI 2.69%;
non-inferiority p=0.006). We noted no significant between-group diff
erences in individual components of the primary endpoint. Definite stent
thrombosis occurred in three (0.3%) patients in the zotarolimus-eluting
stent group and six (0.7%) patients in the everolimus-eluting stent group
(p=0.34). Longitudinal stent deformation was seen only in the
everolimus-eluting stent group (nine [1.0%] of 905 vs 0 of 906, p=0.002;
nine of 1591 [0.6%] everolimus-eluting stents implanted became deformed),
but was not associated with any adverse events. Interpretation: Both
stents were similarly efficacious and safe, and provided excellent
clinical outcomes, especially in view of the large number of patients who
presented with acute myocardial infarctions. Funding: Boston Scientific,
Medtronic.

<42>
Accession Number
620232413
Author
Pavlovic J.; Hedlin H.; Yang J.; Jiang X.; Robbins J.; Schnatz P.F.
Institution
(Pavlovic) Neurology, Albert Einstein College of Medicine, Bronx, NY,
United States
(Hedlin, Yang) Quantitative Sciences Unit, Stanford University, Palo Alto,
CA, United States
(Robbins) Medicine, UC Davis, Sacramento, CA, United States
(Jiang) ObGyn, Reading Hospital, Reading, PA, United States
(Jiang) ObGyn, Jefferson, Philadelphia, PA, United States
(Schnatz) ObGyn and Medicine, Reading Hospital, Reading, PA, United States
(Schnatz) ObGyn and Medicine, Jefferson, Philadelphia, PA, United States
Title
The relationship between migraine, cardiovascular disease (CVD) and
hormone therapy (HT) in postmenopausal women in the women's health
initiative study (WHI).
Source
Menopause. Conference: 28th Annual Meeting of the North American Menopause
Society. United States. 24 (12) (pp 1429), 2017. Date of Publication:
December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The evidence for the relationship between migraine and
cardiovascular disease has been conflicting, depending on aura status, age
of the population and CVD outcomes examined. The association between
exogenous estrogen use and increased risk of stroke in women who have
migraine with aura, has led to the recommendation that combined oral
contraceptives (COCs) shall be avoided in migraine with aura and used with
caution in migraine without aura. In comparison with COCs, the effect of
hormone therapy (HT) on migraine and subsequent cardiovascular disease
(CVD) risk, has not been extensively studied. The objective of the study
was to further examine the relationship of migraine with incident
composite CVD events and it's interaction with HT use, in both the Women's
Health Initiative observational study (WHI-OS) and hormone therapy trial
(WHI-HT) cohorts. Design: Incident CVD events were defined as the earliest
of any following CVD outcomes: MI, stroke, Angioplasty of coronary
arteries, Coronary bypass surgery, Coronary Heart Disease, Deep Vein
Thrombosis, or Pulmonary Embolism. Migraine status was determined based on
self-reported physician diagnosis at baseline. Hormone use status was
defined by the randomization group within the HT trial (E, E&P and
placebo). Cox proportional hazards regression models were used to
determine whether migraine status predicts incident CVD, while adjusting
for recognized potential confounders. Multivariate imputations were used
in all models. The presence of effect modification was evaluated by
testing the significance of the interaction between hormone use status and
migraine using a Wald test. Where significant interactions were detected,
we present the estimated hazard ratio and confidence interval stratified
by hormone use. Tests were two-sided and conducted at the 0.05
significance level and all model estimates are shown with 95% confidence
intervals. Results: WHI OS Analyses: Among 93,676 women in the WHI OS,
25,878 were excluded due to either pre-existing CVD or missing of end
follow-up day. Of the remaining 67,903 participants, 7,322 (10.8%) had
history of migraine, with the largest proportion (45.1%) in the youngest
age group (50-59 years). The migraine group had more whites (87.5% vs
83.1%) and Latinos (4.1% vs 3.9%), while the control group had more
African Americans (8.1% vs 5%) and Asians (3.4% vs 2%) Women with migraine
tended to drink and exercise less than those without migraine, and had
higher vitamin D and calcium intake. Migraineurs were more likely to have
night sweats (SMD=0.137) and hot flashes (SMD=0.163). There was no
increased risk of incident composite CVD events in women with history of
migraine the WHI-OS cohort, with HR (95% CI) of 1.04 (0.82,1.31) in fully
adjusted models (p=0.742, Table 1a). WHI HT Analyses: Of 17,357
participants in the HT, 1,482 reported migraine. A non-significant
decrease in composite CVD events was observed in migraine group (HR=0.71
(0.46,1.11) p=0.135) (Table1b). Comparison of women with migraine who
received HT (E or E&P) vs placebo did not show HT as an effect modifier
for the association between migraine and composite CVD (HR 1.04 (0.42,
2.58) p=0.929). Conclusion: We did not detect significant risk of incident
composite CVD events associated with history of migraine in this
longitudinal cohort of older postmenopausal women. Furthermore, hormone
therapy was not an effect modifier of this relationship. As migraine is
highly prevalent in the population and women with migraine are often
advised to avoid HT, these findings may have significant public health
implications. Further work should be done on exploring different
categories of CVD events in different subpopulations of women with
migraine.

<43>
Accession Number
620231205
Author
Tegn N.; Abdelnoor M.; Aaberge L.; Ranhoff A.H.; Endresen K.; Gjertsen E.;
Skardal R.; Gullestad L.; Bendz B.
Institution
(Tegn, Aaberge, Endresen, Skardal, Gullestad, Bendz) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Tegn, Gullestad, Bendz) Faculty of Medicine, University of Oslo, Norway
(Abdelnoor) Centre for Biostatistics and Epidemiology, Oslo University
Hospital, Ulleval, Oslo, Norway
(Ranhoff) Diakonhjemmet Hospital and Department of Clinical Science,
University of Bergen, Bergen, Norway
(Gjertsen) Department of Cardiology, Drammen Hospital, Drammen, Norway
Title
Health-related quality of life in older patients with acute coronary
syndrome randomised to an invasive or conservative strategy. The After
Eighty randomised controlled trial.
Source
Age and Ageing. 47 (1) (pp 42-47), 2018. Date of Publication: 01 Jan 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Objective: in the After Eighty study (ClinicalTrials.gov.number,
NCT01255540), patients aged 80 years or more, with non-ST-elevation
myocardial infarction (NSTEMI), and unstable angina pectoris (UAP), were
randomised to either an invasive or conservative management approach. We
sought to compare the effects of these management strategies on health
related quality of life (HRQOL) after 1 year.Methods: the After Eighty
study was a prospective randomised controlled multicenter trial. In total,
457 patients aged 80 or over, with NSTEMI or UAP, were randomised to
either an invasive strategy (n = 229, mean age: 84.7 years), involving
early coronary angiography, with immediate evaluation for percutaneous
coronary intervention, coronary artery bypass graft, optimal medical
therapy, or to a conservative strategy (n = 228, mean age: 84.9 years).
The Short Form 36 health survey (SF-36) was used to assess HRQOL at
baseline, and at the 1-year follow-up.Results: baseline SF-36 completion
was achieved for 208 and 216 patients in the invasive and conservative
groups, respectively. A total of 137 in the invasive group and 136
patients in the conservative group completed the SF-36 form at follow-up.
When comparing the changes from follow-up to baseline (delta) no
significant changes in quality-of-life scores were observed between the
two strategies in any of the domains, expect for a small but statistically
significant difference in bodily pain. This difference in only one of the
SF-36 subscales may not necessarily be clinically significant.Conclusion:
from baseline to the 1 year follow-up, only minor differences in change of
HRQOL as measured by SF-36 were seen by comparing an invasive and
conservative strategy.<br/>Copyright &#xa9; The Author 2017.

<44>
Accession Number
619718095
Author
Ando T.; Takagi H.; Grines C.L.
Institution
(Ando, Grines) Division of Cardiology, Department of Internal Medicine,
Detroit Medical Center, 3990 John R, Detroit, MI 48201, United States
(Takagi) Division of Cardiovascular Surgery, Department of Surgery,
Shizuoka Medical Center, Shizuoka, Japan
Title
Transfemoral, transapical and transcatheter aortic valve implantation and
surgical aortic valve replacement: A meta-analysis of direct and adjusted
indirect comparisons of early and mid-term deaths.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (3) (pp 484-492),
2017. Date of Publication: 01 Sep 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation
(TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical
(TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because
previous meta-analyses only included a limited number of adjusted studies
or several non-adjusted studies, our goal was to compare and summarize the
outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the
RCT and propensity-matched cohort studies with direct and adjusted
indirect comparisons to reach more precise conclusions. We hypothesized
that TF-TAVI would offer surgical candidates a better outcome compared
with SAVR and TA-TAVI because of its potential for fewer myocardial
injuries. A literature search was conducted through PUBMED and EMBASE
through June 2016. Only RCTs and propensity-matched cohort studies were
included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and
TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect
meta-analysis was calculated from the direct metaanalysis. The effect
sizes of direct and indirect meta-analyses were then combined. A
random-effects model was used to calculate the hazards ratio and the odds
ratio with 95% confidence intervals. Early (in-hospital or 30 days) and
mid-term (>=1 year) all-cause mortality rates were assessed. Our search
resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217)
studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and
SAVR, respectively. Direct meta-analyses and combined direct and indirect
meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were
similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct
metaanalyses (odds ratio 0.64, P = 0.35) and direct and indirect
meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with
TFTAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct
meta-analysis and became significant after addition of the indirect
meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P =
0.003). In conclusion, TF-TAVI was associated with similar early and
mid-term deaths compared with SAVR. The number of early deaths was not
significantly different between TF-TAVI and TA-TAVI, whereas there were
fewer mid-term deaths with TF-TAVI than with TA-TAVI.

<45>
Accession Number
619905965
Author
Heim C.; Gocht A.; Weyand M.; Ensminger S.
Institution
(Heim, Gocht, Weyand) Department of Cardiac Surgery, University of
Erlangen-Nuremberg, Erlangen, Germany
(Ensminger) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
Title
New Targets for the Prevention of Chronic Rejection after Thoracic Organ
Transplantation.
Source
Thoracic and Cardiovascular Surgeon. 66 (1) (pp 20-30), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
The gold standard for the treatment of terminal heart failure and
irreversible lung diseases includes thoracic organ transplantation. The
major obstacle for long-term survival after successful transplantation is
chronic rejection, an ongoing immunomodulatory disease so far without
effective therapy. Therefore, the aim of this review is to elucidate
scientific efforts targeting different new mechanisms of cardiac allograft
vasculopathy (CAV) and chronic lung allograft dysfunction (CLAD). For this
purpose, we performed a systematic review of the literature to assess
recent strategies in transplant immunology research. We searched MEDLINE
from 2015 up to date for articles addressing the following keywords: CAV,
transplant vasculopathy, transplant arteriosclerosis, CLAD, bronchiolitis
obliterans transplant, and obliterative bronchiolitis transplant. All
articles including experimental models in the field of transplant
immunology addressing new aspects for the prevention of chronic rejection
after heart and lung transplantation were included in this review. The
prevention of chronic rejection would clearly improve the survival of
patients after heart and lung transplantation. Interesting targets were
addressed in recent research, but further research is necessary to
effectively treat this life-threatening disease in transplant
recipients.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart,
New York.

<46>
Accession Number
620195767
Author
Zamani M.M.; Najafi A.; Sehat S.; Janforooz Z.; Derakhshan P.; Rokhtabnak
F.; Kiaee M.M.; Kholdebarin A.; Ghorbanlo M.; Hemadi M.H.; Ghodraty M.R.
Institution
(Zamani, Sehat, Rokhtabnak, Kholdebarin, Hemadi, Ghodraty) Department of
Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Najafi) Department of Anesthesiology and Critical Care, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Janforooz, Kiaee, Ghorbanlo) Department of Anesthesiology and Pain
Medicine, Moheb Hospital, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Derakhshan) Department of Anesthesiology and Pain Medicine, Rasoul Akram
Hospital, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
The effect of intraoperative lung protective ventilation vs conventional
ventilation, on postoperative pulmonary complications after
cardiopulmonary bypass.
Source
Journal of Cardiovascular and Thoracic Research. 9 (4) (pp 221-228), 2017.
Date of Publication: 2017.
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: This study aimed to evaluate the effects of high
positive-end expiratory pressure (PEEP) and low tidal volume (TV) and
recruitment maneuver, on postoperative pulmonary complications (PPCs)
after coronary artery bypass grafting (CABG) surgery. Methods: This study
is a randomized double blind clinical trial on 64 patients who were
undergoing CABG surgery, and were randomly divided into two groups of
conventional ventilation (C-Vent) with TV of 9 mL/kg and PEEP=0 cm H2O,
and lung protective ventilation (P-Vent), with 6 mL/ kg TV and PEEP=10 cm
H2O with recruitment maneuver every 30 minutes. Measures of PPCs and
modified clinical pulmonary infection score (mCPIS), were assessed for the
first 24 hours of postoperative time in order to evaluate the pulmonary
complications. Results: P-Vent with 31 patients and C-Vent with 30
patients, participated in the stage of data analysis. Demographic, and
preoperative laboratory results showed no significant difference between
two groups. During surgery, cardiovascular complications were higher in
P-Vent group (P = 0.61) but pulmonary complications were higher in C-Vent
group (P = 0.26). Extubation time was not significantly different between
two groups, and also components of arterial blood gases (ABG) of 24 hours
after surgery showed no significant difference between the two groups.
Pathologic changes in the chest X-ray (CXR) of 24 hours after surgery,
were lower in P-Vent group, but the difference was not significant (P =
0.22). The PPC criteria was less positive in P-Vent (2 patients) vs 9
patients in C-Vent group (P = 0.02) and mCPIS score was significantly
lower in P-Vent group (1.2 +/- 1.4) than C-Vent group (2 +/- 1.6) (P =
0.048). Conclusion: Lung protective strategy during and after cardiac
surgery, reduces the postoperative mCPIS in patients undergoing open heart
surgery for CABG.<br/>Copyright &#xa9; 2017 The Author (s).

<47>
Accession Number
619892770
Author
Altun G.; Hemsinli D.; Pulathan Z.; Civelek A.
Institution
(Altun, Pulathan) Department of Cardiovascular Surgery, Karadeniz
Technical University, Faculty of Medicine, Trabzon, Turkey
(Hemsinli) Department of Cardiovascular Surgery, Kanuni Education and
Research Hospital, Trabzon, Turkey
(Civelek) Department of Cardiovascular Surgery, Medical Park Hospital,
Ordu, Turkey
Title
Emergency coronary bypass surgery in patients under the influence of dual
antiplatelet therapy: Effects of tranexamic acid and desmopressin acetate.
Source
Turkish Journal of Medical Sciences. 47 (6) (pp 1708-1714), 2017. Date of
Publication: 2017.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: Bleeding in patients undergoing coronary artery bypass
grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of
significant morbidity and mortality. The aim of this study is to examine
the perioperative hemostatic effects of tranexamic acid (TnX-A) and
desmopressin acetate (Des) in these patients. Materials and methods: This
clinical study was planned in a prospective and randomized manner.
Fifty-four patients were enrolled and classified into 4 different groups.
They were compared in terms of various bleeding and transfusion
parameters. Results: No significant differences were observed between the
groups in pre/intraoperative data apart from closure times.
Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups
were significantly higher than those in the Des and TnX-A+Des groups at
the end of postoperative drug infusion. Mean duration of closure times,
first 3-h and total postoperative amounts of drainage, administered
volumes of erythrocyte suspension/fresh frozen plasma, cost of blood
products, length of intubation, length of stay in the intensive care unit,
and time to discharge were also significantly higher in the Des and
control groups. Conclusion: Des had no significant effect on bleeding
control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A
infusion alone in these patient groups had a positive effect on
hemostasis-related data.<br/>Copyright &#xa9; TUBITAK.

<48>
Accession Number
617722383
Author
Kurfirst V.; Mokraaek A.; Aanadyova J.; Frana R.; Zeman P.
Institution
(Kurfirst, Mokraaek, Aanadyova, Frana, Zeman) Department of Cardiac
Surgery, Hospital of Aeske Budjovice, Bozeny Nemcove 54, Aeske Budjovice
37001, Czech Republic
Title
Epicardial clip occlusion of the left atrial appendage during cardiac
surgery provides optimal surgical results and long-term stability.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 37-40), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Occlusion of the left atrial appendage (LAA) has become an
integral and important part of the surgical treatment of atrial
fibrillation. Different methods of surgical occlusion of the LAA have been
associated with varying levels of short- A nd long-term success for
closure. The purpose of this study was to evaluate long-term results of
epicardial placement and endocardial occlusion in patients undergoing
cardiac operative procedures. METHODS: A total of 101 patients (average
age 65.7 years) undergoing cardiac operative procedures with the
epicardial AtriClip Exclusion System of the LAA were enrolled in the
study. The AtriClip was placed via a sternotomy or a thoracotomy or from a
thoracoscopic approach. Postoperative variables, such as thromboembolic
events, clip stability and endocardial leakage around the device, were
examined by transoesophageal echocardiography (TEE) and/or computed
tomography. RESULTS: Perioperative clip implantation was achieved in 98%
of patients. TEE and/or computed tomography conducted during the follow-up
period, comprising 1873 patient-months with a mean duration of 18 +/- 11
months, revealed no clip migration, no leakage around the device and no
clot formation near the remnant cul-de-sac. During the follow-up period, 4
of the cardiac patients experienced transitory ischaemic attacks, whereas
no patient experienced a cerebrovascular attack. CONCLUSIONS: The
Epicardial AtriClip Exclusion System of the LAA appears to be a feasable
and safe operative method with a high success rate. Long-term follow-up
confirmed clip stability, complete occlussion of the LAA and absence of
any atrial fibrilation-related thromboembolic events. These results need
to be confirmed by a larger, multicentre study.<br/>Copyright &#xa9; 2017
The Author.

<49>
Accession Number
617722341
Author
Song Y.; Xu F.; Du J.; Zhang J.; Feng W.
Institution
(Song, Xu, Du, Zhang, Feng) Department of Cardiac Surgery, Fuwai Hospital
of Chinese Academy of Medical Sciences, Peking Union Medical College,
Beilishi Road No. 167, Beijing 100037, China
Title
Coronary endarterectomy with coronary artery bypass graft decreases graft
patency compared with isolated coronary artery bypass graft: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 30-36), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: This meta-analysis aims to assess the graft patency
quantitatively and statistically. METHODS: Eleven observational studies
were identified by systematic literature search, incorporating 3311
patients undergoing coronary endarterectomy (CE) + coronary artery bypass
graft (CABG) and 3990 undergoing isolated CABG, which were analysed using
random-effects modelling. Heterogeneity, quality of scoring and risk of
bias were assessed and reangiographic outcomes were documented. RESULTS:
Adjunctive CE decreased graft patency [odds ratios = 0.43, 95% confidence
interval [0.29-0.63], z = 4.33, P < 0.0001] with moderate heterogeneity,
while the baseline demographics differed considerably. CONCLUSIONS:
Whether CE remains a viable option to CABG requires novel studies
collecting corresponding data from bench to bedside. To achieve
satisfactory efficacy, surgeons should carefully weigh possible benefits
and adverse effects of CE and prepare the surgical strategy
adequately.<br/>Copyright &#xa9; 2017 The Author.

<50>
Accession Number
620214377
Author
Patel A.; Mookerji N.; Jen T.; Lalu M.; McIsaac D.
Institution
(Patel, Mookerji, Jen, Lalu, McIsaac) University of Ottawa, Ottawa
Hospital Research Institute, Canada
Title
A systematic review of perioperative interventions to improve outcomes in
frail elderly patients having surgery.
Source
Canadian Journal of Anesthesia. Conference: 2017 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2017. Canada. 64 (1 Supplement 1)
(pp S72-S73), 2017. Date of Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Introduction: Older patients undergo surgery at a high rate, and
experience an increased rate of adverse outcomes (1, 2). A growing
literature identifies frailty, an aggregate expression of vulnerability to
adverse outcomes due to age- and disease- related deficits, as a key
predictor of morbidity and mortality in older surgical patients (3-5).
Importantly, frailty may be a modifiable risk factor. However, there are
no syntheses of interventions to improve post-operative outcomes in frail
surgical patients. We conducted a systematic review of studies testing
interventions in frail surgical patients in order to improve outcomes, as
outlined by the Institute for Healthcare Improvement's Triple Aim
framework (health, cost, and experience). Methods: The need for ethical
approval was waived. A protocol was registered a priori
(2016:CRD42016039909). We searched the Cochrane, Medline, PubMed, CINAHL,
and EMBASE databases using a search strategy. The grey literature was also
evaluated. Studies testing interventions specifically in frail surgical
patients, or studies in which frailty-specific subgroup analysis was
possible, were included. Studies that defined the frailty criteria were
included, but studies were not limited to specific frailty definitions.
Study screenings, full text reviews, data extraction and risk of bias
assessments were done in duplicate using piloted forms in DistillerSR.
Qualitative synthesis was performed, per our protocol. Results: Our
initial screening identified 2593 titles and abstracts for review, of
which 11 were included for final analysis (6 RCTs, 5 non-RCTs). Surgery
populations included general surgery, cardiac, orthopedic and mixed.
Interventions were applied during the perioperative (1), preoperative (3)
and postoperative (7) periods, and included exercise, multicomponent
geriatric-specific interventions, and blood transfusion triggers. Exercise
therapy was consistently associated with improved outcomes (Figure 1).
Geriatric-specific protocols suffered from difficulties in implementation
and poor adherence. Liberal blood transfusion triggers had no impact on
mortality or other outcomes (Figure 1). Substantial heterogeneity was
noted across studies in terms of frailty instruments used and the types of
outcomes reported. Risk of bias was moderate to high in all studies.
Discussion: Despite the clear emergence of frailty as an important
perioperative risk factor, few studies evaluating interventions specific
to frail surgical patients were identified. Development and evaluation of
frailty-specific interventions in low risk of bias trials is urgently
needed. Such trials should consider perioperative exercise therapy
interventions, and should follow best practice guidelines for the
development and evaluation of complex interventions. (Figure Presented).

<51>
Accession Number
620214361
Author
Vaishnav V.; Sharma D.; Mustafa R.
Institution
(Vaishnav) St Catherines General Hospital, Canada
(Sharma) M.S. University Baroda, India
(Mustafa) University of Missouri-Kansas City, United States
Title
Impact of cerebral oxygen saturation monitoring on perioperative outcomes:
A systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. Conference: 2017 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2017. Canada. 64 (1 Supplement 1)
(pp S61-S62), 2017. Date of Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Introduction: Intraoperative cerebral hypoxia or desaturations has been
linked to adverse clinical outcomes like postoperative cognitive deficit
(POCD), neurologic events and prolonged hospital stay. Several
observational studies have claimed usefulness of non-invasive monitoring
of regional cerebral oxygen saturation (rSO2) by near-infrared
spectroscopy (NIRS) for patients undergoing high risk procedures like
cardiac surgery. Small scale randomized controlled trials (RCT) have
highlighted the role of early identification and reversal of
intra-operative cerebral desaturation events (CDE) on major organ
morbidity and mortality1-5. However these studies are underpowered and
lack methodological quality. This systematic review aims to synthesize
evidence for clinical utility of rSO2 monitoring on perioperative
outcomes. Methods: We conducted search on Ovid Medline, EMBASE, CENTRAL,
DARE and grey literature like clinicaltrials.gov to identify RCTs
conducted on adult patients undergoing surgery where NIRS monitoring was
compared to blinded NIRS or no NIRS monitoring. Each eligible study was
assessed for risk of bias, conflicts of interest and publication bias.
Forest plots on RevMan software were created using outcome data for POCD,
intra-operative CDEs, post-operative stroke, postoperative ICU stay, acute
renal failure requiring dialysis and 30 day mortality. A GRADE profile
summary 6 was created for each outcome. We did sensitivity analysis and
sub-group analysis which were specified a priori. We explored for
heterogeneity in studies and created funnel plots. Results: We identified
20 eligible studies from our literature search and finally considered 6
RCTs for review and meta-analysis. There is a large effect estimate for
outcome like POCD (OR: 0.61, 95% CI: 0.43-0.86; p=0.004) and cerebral
desaturation events (OR: 0.66, 95% CI: 0.47- 0.93; p=0.02) in favour of
rSO2 monitoring. The GRADE evidence for both outcomes is of moderate
quality. The subgroup analysis indicated significant utility of rSO2
monitoring for cardiac surgery patients as compared to major abdominal
surgery patients for POCD (OR: 0.61, 95% CI: 0.43-0.86, p = 0.004). The
overall confidence in estimates for reduction in length of ICU stay with
use of NIRS is low. For other outcomes like neurologic events, acute renal
failure and 30 day mortality, the evidence is very low and recommendation
is weak. Heterogeneity among studies was not significant with p-value
>0.05. Discussion: rSO2 is a useful physiologic parameter to identify CDEs
and reduce incidence of POCD in cardiac surgery patients. Large RCTs are
required to upgrade the quality of evidence and generate evidence for
other outcomes where it wasn't true absence of effect. The
cost-effectiveness would influence policy makers and clinicians to
recommend a 'goal directed rSO2 maintenance' to modify perioperative
clinical outcomes for a safer patient care. Improved quality of life
reduces health care burden for patients & system. (Table Presented).

<52>
Accession Number
620214343
Author
Nakadate Y.; Sato H.; Sato T.; Roque P.; Wykes L.; Schriker T.
Institution
(Nakadate, Sato, Sato, Schriker) Department of Anesthesiology, McGill
University Health Centre Glen Site, Royal Victoria Hospital, Canada
(Roque, Wykes) McGill University, Canada
Title
Effect of intranasal insulin administration on glycemia during cardiac
surgery.
Source
Canadian Journal of Anesthesia. Conference: 2017 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2017. Canada. 64 (1 Supplement 1)
(pp S53-S54), 2017. Date of Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Introduction The intranasal administration of insulin has been shown to
improve both memory performance and metabolic integrity of the brain in
patients suffering from Alzheimer's disease or cognitive impairment1.
Postoperative cognitive dysfunction is an increasing health problem as
more elderly patients undergo major surgical procedures2. We have
previously demonstrated that the intravenous administration of insulin
preserves both short and long-term memory function after open heart
surgery3. Insulin applied via nasal spray bypasses the blood-brain-barrier
and causes a sustained elevation of insulin concentrations in the
cerebrospinal fluid4. While intranasal insulin has been shown not to alter
peripheral insulin levels in non-surgical subjects4, the influence of
intranasal insulin administration on glycemia during major surgery is
unknown. Methods With the approval from the local research ethics board,
we approached non-diabetic patients scheduled for elective cardiac surgery
requiring cardiopulmonary bypass. Patients scheduled for procedures with
anticipated deep hypothermic circulatory arrest were excluded. Using a
computer-generated randomization schedule consenting patients were
allocated to three groups (Group 1: placebo, Group 2: 40IU intranasal
insulin, Group 3: 80IU intranasal insulin). Participating researchers,
anesthesiologists and surgeons were blinded to the group assignment.
Insulin was applied using a sterile metered nasal dispenser after the
induction of general anesthesia and endotracheal intubation. Arterial
blood samples were collected over two hours, every 10 minutes before CPB
and every 30 minutes during CPB. Hypoglycemia was defined as a blood
glucose level < 3.5 mmol/L. A total of 45 patients is required to detect a
significant difference in glycemia between the three groups. Results We
present present data from an interim analysis performed after 20 patients
(Group 1 n=8, Group 2 n=6, Group 3 n=6). Patient demographics, surgical
and anesthetic data are comparable between groups. After 10 to 30 minutes
of insulin administration there is a trend towards lower blood glucose
levels in patients receiving insulin compared to baseline and patients in
the placebo group (Figure). No episode of hypoglycemia was observed at any
point in time. Conclusion Preliminary data suggest that the intranasal
administration of 40IU or 80IU of insulin does not cause hypoglycemia
during cardiac surgery. Whether there is a significant dose dependent
effect on glycemia remains to be seen. (Figure Presented).

<53>
Accession Number
620214336
Author
Doyle Y.; Segun P.; Naraine N.; McShane K.; Lau W.; Honjo O.; Skelton T.
Institution
(Doyle, Segun, Lau, Honjo, Skelton) Sick Kids, Canada
(Naraine, McShane) Laboratory Medicine, Ontario Transfusion Coordinators
(ONTRAC), Canada
Title
The use of pre-operative oral iron therapy to reduce intra-operative
transfusion during paediatric cardiac surgery.
Source
Canadian Journal of Anesthesia. Conference: 2017 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2017. Canada. 64 (1 Supplement 1)
(pp S144-S145), 2017. Date of Publication: June 2017.
Publisher
Springer New York LLC
Abstract
INTRODUCTION: Pre-operative iron has been shown to reduce intra-operative
red cell transfusion volumes for a variety of elective major surgical
cases. Paediatric patients undergoing surgery for congenital cardiac
lesions frequently have significant transfusion requirements, often
associated with a variety of risks such as increased lenth of stay,
morbidity and mortality. However, it has been proven that lower
haematocrit values in infants undergoing congenital cardiac surgery had
higher lactate levels and lower cardiac index scores. These children also
had worse psychomotor development scores at 1 year of age. While there
have been multiple studies suggesting that pre-operative iron reduces
transfusion requirements for adult patients undergoing major surgery,
there is sparse evidence regarding paediatric patients. Our aim was to
examine the impact of the use of pre-operative oral iron therapy on
reducing exposure to allogenic blood transfusion in paediatric patients
undergoing elective cardiac surgery. METHODS: We have performed a
retrospective analysis of 282 patients weighing greater than 12kg for
elective cardiac surgery at our institution from 2011-2014. 141 patients
received oral iron therapy preoperatively, of varying duration, which was
prescribed by our blood conservation nurse. 141 patients in the control
group did not receive iron therapy. Our primary endpoint was the volume of
packed red blood cells (PRBCs)transfused per kg body weight during
patients hospital stay. Adjustment was made for cardiopulmonary bypass
times for final analysis. RESULTS: 68.09 % of the patients who received
iron were transfused compared to 65.96 % of patients who did not receive
iron. The relative risk of transfusion, accounting for all blood products,
in patients who received iron was 1.05(0.82, 1.34) with a p value of 0.7
In the unadjusted analysis, the mean volume of PRBCs per kg was 12.17
(9.39, 14.96) in patients on iron therapy versus 16.49 (12.78, 20.2) on
those not on iron therapy, with a trend toward significance (p= 0.067)
With adjustment for bypass times, we demonstrated that giving iron
pre-operatively results in 13.28ml/kg (2.73, 23.83) decrease in PRBCs
transfused, with a p-value of 0.047. There was no difference in the
average length of stay between the two patient groups. DISCUSSION: This
study has shown that pre-operative oral iron therapy reduces the rates of
transfusion of red cells in elective cardiac surgery for children weighing
over 12kg, when adjusting for time on cardioplumonary bypass. These
results provide a new knowledge as previous studies have only shown a
reduction in transfusion in cardiac surgery patients when combining both
iron and erythropoiten. (Table Presented).

<54>
Accession Number
620214296
Author
Durr C.E.; McKay W.; Peeling A.; Guo R.; Lange T.; O'Brien J.
Institution
(Durr, McKay, O'Brien) University of Saskatchewan, Canada
(Peeling) Year 4-Class of 2017, Canada
(Guo) Year 2- Class of 2019, Canada
(Lange) Year 3- Class of 2018, Canada
Title
Tracheal cuff palpation to ensure correct endotracheal tube depth.
Source
Canadian Journal of Anesthesia. Conference: 2017 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS 2017. Canada. 64 (1 Supplement 1)
(pp S234-S235), 2017. Date of Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Background An endotracheal tube (ETT) should be placed with the tip >2.5cm
above the carina and cuff below the cricoid cartilage to avoid
endobronchial intubation or inadvertent extubation with neck movement.
Based on current literature, the average success for oral intubation is
85.3%.1Palpating the ETT tip as it slides down the trachea during
intubation is effective in pediatrics.2 We studied palpation of the
inflated ETT cuff after intubation while moving the ETT, which is not
normal clinical practice, and hypotheses were that it may damage the
tracheal mucosa, and achieve correct ETT depth. Throat pain was measured
as a surrogate for upper airway damage. Methods With Ethics Board
approval, informed consent was obtained from 150 participants. Design:
Single blind randomized controlled trial with blinded patients and
assessors. Subjects: Adult patients requiring intubation with ETT for
anesthesia. (Patients undergoing head, neck, or cardiac surgery were
excluded.) Palpation group: After intubation by the attending
anesthesiologist, cuff pressure was set to 50cmH2O during palpation, then
reset to ideal pressure after palpation. 3 The investigator placed three
fingers along the anterior trachea from cricoid cartilage, to sternal
notch, then moved the ETT down, then up while palpating until the cuff was
between the cricoid cartilage and sternal notch. Control group: The
investigator taped the ETT where it was placed by the intubating
anesthesiologist ETT depth measurement: Measurements were taken with a
fibre-optic bronchoscope from the carina to the tip of the ETT, to the
cricothyroid membrane, and depth at the teeth. Tracheal damage: In the
recovery room, blinded nurses assessed patient-reported throat pain on a
scale of 0-10. Those with a pain score of 4 or more were considered to
have pain. Results In the palpation group, 63 of 75 patients had the ETT
at the correct depth compared to 51 of 75 did (p=0.035). Ten participants
in the palpation group had pain; 21 in the control group (p=0.028). The
palpation group had an average pain score of 0.6 +/- 1.6; the control
group was 1.5 +/- 2.1. To see if it was a learned technique, we compared
our first 10 attempts to the rest of the study. In our first 10 patients,
4 ETT were misplaced using palpation; in the remaining attempts showed 7
of 65 (p=0.047). Discussion Palpation of the moving tracheal cuff did not
worsen throat pain, improved ETT positioning, and was learnable. It
requires no equipment and can be used outside the hospital, where many
errors in ETT placement occur1. Future research will investigate whether
this technique can replace X-rays to confirm placement of the ETT in a
patient in Intensive Care. This could reduce costs and avoid radiation.

<55>
Accession Number
620219830
Author
Leaper D.; Wilson P.; Assadian O.; Edmiston C.; Kiernan M.; Miller A.;
Bond-Smith G.; Yap J.
Institution
(Leaper) University of Newcastle upon Tyne , UK
(Wilson) University College of London Hospitals NHS Foundation Trust , UK
(Assadian) University of Huddersfield , UK
(Edmiston) Medical College of Wisconsin , UK
(Kiernan) University of West London , UK
(Miller) University Hospitals of Leicester NHS Trust , UK
(Bond-Smith) Oxford University Hospitals NHS Trust , UK
(Yap) Barts Health NHS Trust , UK
Title
The role of antimicrobial sutures in preventing surgical site infection.
Source
Annals of the Royal College of Surgeons of England. 99 (6) (pp 439-443),
2017. Date of Publication: 01 Jul 2017.
Abstract
INTRODUCTION Healthcare associated infections (HCAIs) are falling
following widespread and enforced introduction of guidelines, particularly
those that have addressed antibiotic resistant pathogens such as
methicillin resistant Staphylococcus aureus or emergent pathogens such as
Clostridium difficile, but no such decline has been seen in the incidence
of surgical site infection (SSI), either in the UK, the EU or the US. SSI
is one of the HCAIs, which are all avoidable complications of a surgical
patient's pathway through both nosocomial and community care. METHODS This
report is based on a meeting held at The Royal College of Surgeons of
England on 21 July 2016. Using PubMed, members of the panel reviewed the
current use of antiseptics and antimicrobial sutures in their specialties
to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in
surgical practice may help in reducing reliance on antibiotics in
infection prevention and control, especially in the perioperative period
of open elective colorectal, hepatobiliary and cardiac operative
procedures. The wider use of antiseptics includes preoperative showering,
promotion of hand hygiene, (including the appropriate use of surgical
gloves), preoperative skin preparation (including management of hair
removal), antimicrobial sutures and the management of dehisced surgical
wounds after infection. The meeting placed emphasis on the level I
evidence that supports the use of antimicrobial sutures, particularly in
surgical procedures after which the SSI rate is high (colorectal and
hepatobiliary surgery) or when a SSI can be life threatening even when the
rate of SSI is low (cardiac surgery).

<56>
Accession Number
620208406
Author
Biancari F.; Kinnunen E.-M.; Kiviniemi T.; Tauriainen T.; Anttila V.;
Airaksinen J.K.E.; Brascia D.; Vasques F.
Institution
(Biancari, Brascia) Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Kinnunen, Tauriainen) Department of Surgery, University of
Oulu, Oulu, Finland
(Biancari, Kiviniemi, Anttila, Airaksinen) Heart Center, Turku University
Hospital and University of Turku, Turku, Finland
(Vasques) Department of Anesthesia, Padua University Hospital, Padua,
Italy
Title
Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to pool data on the proportion and
prognostic impact of sources of bleeding in patients requiring
re-exploration after adult cardiac surgery. Design: Systematic review of
the literature and meta-analysis. Setting: Multistitutional study.
Measurements and Main Results: A literature review was performed to
identify studies published since 1990 evaluating the outcome after
reoperation for bleeding or tamponade after adult cardiac surgery.
Eighteen studies including 5,1497 patients fulfilled the selection
criteria. Reoperation for bleeding/tamponade was performed in 2,455
patients (4.6%; 95% confidence interval [CI] 3.9%-5.2%, I²
92%). These had a significantly higher risk of in-hospital/30-day
mortality compared with patients not reoperated for bleeding (pooled
rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52-4.32; I² 47%;
8 studies; 25,463 patients). Surgical sites of bleeding were identified in
65.7% of cases (95% CI 58.3%-73.2%; I² 94%), cardiac site
bleeding in 40.9% of cases (95% CI 29.7%-52.0%; I² 94%), and
mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%-37.3%;
I² 94%). The main sites of bleeding were the body of the graft
(20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal
mammary artery harvest site (13.0%), and anastomoses (9.9%). In
metaregression, surgical site bleeding was associated with a lower risk of
in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003).
Conclusions: Surgical site bleeding is identified in two-thirds of
patients undergoing re-exploration after adult cardiac surgery. Meticulous
surgical technique and systematic intraoperative checking of potential
surgical sites of bleeding at the time of the original cardiac surgery may
reduce the risk of such a severe complication.<br/>Copyright &#xa9; 2017
Elsevier Inc.