EPICORE Embase Updates: February 2018

Total documents retrieved: 110

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Embase (updates since 2018-02-16)

<1>
Accession Number
620696844
Author
Polderman J.A.W.; van Steen S.C.J.; Thiel B.; Godfried M.B.; Houweling
P.L.; Hollmann M.W.; DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Polderman, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Academic Medical Centre Amsterdam, Amsterdam, Netherlands
(van Steen, DeVries) Department of Endocrinology, Academic Medical Centre
Amsterdam, Amsterdam, Netherlands
(Thiel, Godfried) Department of Anaesthesiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
(Houweling) Department of Anaesthesiology, Diakonessenhuis, Utrecht,
Netherlands
Title
Peri-operative management of patients with type-2 diabetes mellitus
undergoing non-cardiac surgery using liraglutide,
glucose-insulin-potassium infusion or intravenous insulin bolus regimens:
a randomised controlled trial.
Source
Anaesthesia. 73 (3) (pp 332-339), 2018. Date of Publication: March 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
In this open-label multicentre randomised controlled trial, we
investigated three peri-operative treatment strategies to lower glucose
and reduce the need for rescue insulin in patients aged 18-75 years with
type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were
randomly allocated using a web-based randomisation program to
premedication with liraglutide (liraglutide group),
glucose-insulin-potassium infusion (insulin infusion group) or insulin
bolus regimen (insulin bolus group), targeting a glucose < 8.0
mmol.l-1. The primary outcome was the between group difference
in median glucose levels 1 h after surgery. We analysed 150 patients
(liraglutide group n = 44, insulin infusion group n = 53, insulin bolus
group n = 53) according to the intention-to-treat principle. Median (IQR
[range]) plasma glucose 1 h postoperatively was lower in the liraglutide
group compared with the insulin infusion and insulin bolus groups (6.6
(5.6-7.7 [4.2-13.5]) mmol.l-1 vs. 7.5 (6.4-8.3 [3.9-16.6])
mmol.l-1 (p = 0.026) and 7.6 (6.4-8.9 [4.7-13.2])
mmol.l-1) p = 0.006, respectively). The incidence of
hypoglycaemia and postoperative complications did not differ between the
groups. Six patients had pre-operative nausea in the liraglutide group, of
which two had severe nausea, compared with no patients in the insulin
infusion and insulin bolus groups (p = 0.007). The pre-operative
administration of liraglutide stabilised peri-operative plasma glucose
levels and reduced peri-operative insulin requirements, at the expense of
increased pre-operative nausea rates. Copyright © 2017 The
Association of Anaesthetists of Great Britain and Ireland

<2>
Accession Number
620683244
Author
Han Y.; Xu B.; Fu G.; Wang X.; Xu K.; Jin C.; Tao L.; Li L.; Hou Y.; Su
X.; Fang Q.; Chen L.; Liu H.; Wang B.; Yuan Z.; Gao C.; Zhou S.; Sun Z.;
Zhao Y.; Guan C.; Stone G.W.
Institution
(Han, Wang, Xu) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Xu, Sun, Zhao, Guan) Catheter Lab, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Fu, Jin) Department of Cardiology, Sir Run Run Shaw Hospital, Hangzhou,
China
(Tao) Department of Cardiology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China
(Li) Department of Cardiology, The First Affiliated Hospital of Guangxi
Medical University, Nanning, China
(Hou) Department of Cardiology, Nanfang Hospital, Guangzhou, China
(Su) Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
(Fang) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Chen) Department of Cardiology, Fujian Medical University Union Hospital,
Fuzhou, China
(Liu) Department of Cardiology, General Hospital of Chinese People's Armed
Police Forces, Beijing, China
(Wang) Department of Cardiology, Aero Space Center Hospital, Beijing,
China
(Yuan) Department of Cardiology, The First Affiliated Hospital of Xi'an
Jiongtong University, Xi'an, China
(Gao) Department of Cardiology, Henan Provincial People's Hospital,
Zhengzhou, China
(Zhou) Department of Cardiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Stone) Center for Interventional Vascular Therapy, Division of
Cardiology, Presbyterian Hospital and Columbia University, New York, New
York, United States
(Stone) Cardiovascular Research Foundation, New York, New York, United
States
Title
A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable
Scaffold and Metallic Everolimus-Eluting Stents.
Source
JACC: Cardiovascular Interventions. 11 (3) (pp 287-297), 2018. Date of
Publication: 12 Feb 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the safety and effectiveness of
the NeoVas bioresorbable scaffold (BRS) compared with metallic
drug-eluting stents. Background: BRS have the potential to improve very
late outcomes compared with metallic drug-eluting stents, but some BRS
have been associated with increased rates of device thrombosis before
complete bioresorption. NeoVas is a new poly-L-lactic acid BRS that elutes
sirolimus from a poly-D, L-lactide coating. Methods: Eligible patients
with a single de novo native coronary artery lesion with a reference
vessel diameter 2.5 to 3.75 mm and a lesion length <=20 mm were randomized
1:1 to NeoVas BRS versus cobalt-chromium everolimus-eluting stents
(CoCr-EES). Angiographic follow-up was performed in all patients at 1
year. The primary endpoint was angiographic in-segment late loss (LL), and
the major secondary endpoint was the rate of angina. Baseline and
follow-up optical coherence tomography and fractional flow reserve were
performed in a pre-specified subgroup of patients. Results: The authors
randomized 560 patients at 32 centers to treatment with NeoVas (n = 278)
versus CoCr-EES (n = 282). One-year in-segment LL with NeoVas and CoCr-EES
were 0.14 +/- 0.36 mm versus 0.11 +/- 0.34 mm (difference 0.03 mm; upper
1-sided 97.5% confidence interval 0.09 mm; p<inf>noninferiority</inf> <
0.0001; p<inf>superiority</inf> = 0.36). Clinical outcomes at 1 year were
similar in the 2 groups, as were the rates of recurrent angina (27.9% vs.
32.1%; p = 0.26). Optical coherence tomography at 1 year demonstrated a
higher proportion of covered struts (98.7% vs. 96.2%; p < 0.001), less
strut malapposition (0% vs. 0.6%; p <0.001), and a smaller minimal lumen
area (4.71 +/- 1.64 vs. 6.00 +/- 2.15 mm2; p < 0.001) with
NeoVas compared with CoCr-EES respectively, with nonsignificant
differences in fractional flow reserve (0.89 +/- 0.08 vs. 0.91 +/- 0.06; p
= 0.07). Conclusions: The NeoVas BRS was noninferior to CoCr-EES for the
primary endpoint of 1-year angiographic in-segment LL, and resulted in
comparable 1-year clinical outcomes, including recurrent angina. (NeoVas
Bioresorbable Coronary Scaffold Randomized Controlled Trial;
NCT02305485) Copyright © 2018

<3>
Accession Number
620561087
Author
Robinson J.; Hartling L.; Vandermeer B.; Klassen T.P.
Institution
(Robinson, Hartling, Vandermeer) University of Alberta, Department of
Pediatrics, 3-588D, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada
(Klassen) Manitoba Institute of Child Health, 513-715 McDermot Avenue,
Winnipeg, MB R3E 3P4, Canada
Title
Intravenous immunoglobulin for presumed viral myocarditis in children and
adults.
Source
Cochrane Database of Systematic Reviews. 2015 (5) (no pagination), 2015.
Article Number: CD004370. Date of Publication: 20 May 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a previous review. Case reports and case
series have described dramatic responses to intravenous immunoglobulin
(IVIG) in people with presumed viral myocarditis, and its administration
has become commonplace. Objectives: The primary objective of this review
was to compare transplant-free survival of adults and children with
presumed viral myocarditis treated with IVIG versus those who did not
receive IVIG. A secondary objective was to determine if a group of
patients with presumed viral myocarditis could be identified (on the basis
of age, duration of symptoms, acuity of onset of symptoms, cardiac
function at presentation, virological results or the presence or absence
of histological evidence of acute myocarditis on cardiac biopsy in
patients in whom a biopsy was performed) who would be the most likely to
benefit from IVIG. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (2013, Issue 12 of 12), the
Database of Abstracts of Reviews of Effects (DARE) (2013, Issue 4 of 4),
MEDLINE (Ovid, 1946 to January Week 3 2014), EMBASE (Ovid, 1980 to Week 4
2014), the Cumulative Index to Nursing and Allied Health Literature
(CINAHL) EBSCO, Web of Science (Thomson Reuters, 1970 to 24 January 2014),
the Latin American and Caribbean Health Science Information Database
(LILACS) (1982 to 30 January 2014), trials registries and conference
proceedings. We contacted authors of trials and checked reference lists of
relevant papers. We applied no language restrictions. Selection criteria:
We included studies if (1) participants had a clinical diagnosis of acute
myocarditis with a left ventricular ejection fraction (LVEF) <= 0.45, left
ventricular end-diastolic diameter (LVEDD) > 2 standard deviations (SDs)
above the norm or a shortening fraction (SF) > 2 SDs below the mean with
duration of cardiac symptoms < 6 months; (2) participants had no evidence
of non-infectious or bacterial cardiac disease; and (3) participants were
randomly assigned to receive at least 1 g/kg of IVIG versus no IVIG or
placebo. We excluded studies if (1) participants had received
immunosuppression before outcome assessment; or (2) onset of myocarditis
was reported to occur < 6 months post partum. Data collection and
analysis: Two review authors screened searches and extracted data
independently. We assessed quality using the 'Risk of bias' tool.
Meta-analysis was not possible because only two relevant studies were
found, and researchers analysed markedly different populations. Main
results: In this update, review authors added one study to the study from
the original review. The first relevant study involved 62 adults with
recent-onset dilated cardiomyopathy randomly assigned to receive IVIG or
an equivalent volume of 0.1% albumin in a blinded fashion. The overall
risk of bias was unclear. The incidence of death or the requirement for
cardiac transplant or placement of a left ventricular assist device was
low in both groups (odds ratio (OR) for event-free survival 0.52, 95%
confidence interval (CI) 0.12 to 2.30). Follow-up at six months and at 12
months showed equivalent improvement in LVEF (mean difference (MD) 0.00,
95% CI -0.07 to 0.07 at six months; MD 0.01, 95% CI -0.06 to 0.08 at 12
months). Functional capacity as assessed by peak oxygen consumption was
equivalent in the two groups at 12 months (MD -0.80, 95% CI -4.57 to
2.97). Infusion-related side effects were more common in the treated
group, but all were reported to be mild (OR 30.16, 95% CI 1.69 to 539.42).
The second study added at this update included 83 children in India with
suspected viral encephalitis and myocarditis. The overall risk of bias was
high. The odds ratio for event-free survival was 7.39 (95% CI 0.91 to
59.86). Follow-up occurred only until hospital discharge, and LVEF was
49.5% in the treated group versus 35.9% in the placebo group (risk
difference 13.6%, 95% CI 5.1 to 22.1%; P value = 0.001). Authors'
conclusions: Evidence from one trial does not support the use of IVIG for
the treatment of adults with presumed viral myocarditis. The only
paediatric trial had high risk of bias but suggested that benefit may be
seen in the select group of children beyond the neonatal period who have
viral encephalitis with myocarditis. Until higher-quality studies have
demonstrated benefit in a particular group of patients, IVIG for presumed
viral myocarditis should not be provided as routine practice in any
situation. Further studies of the pathophysiology of myocarditis would
lead to improved diagnostic criteria, which would facilitate future
research. Copyright © 2015 The Cochrane Collaboration.

<4>
Accession Number
620551377
Author
Hirji S.A.; Bravo C.A.; Pachon R.E.; Faxon D.P.; Ohman E.M.; Anderson
K.L.; Sidi A.I.; Sketch M.H.; Zarich S.W.; Brennan J.M.
Institution
(Hirji) Brigham and Women's Hospital, Harvard Medical School, Department
of Surgery, 75 Francis Street, Boston, MA 02115, United States
(Bravo) Bridgeport Hospital, Department of Internal Medicine, Section of
Internal Medicine, 267 Grant Street, Bridgeport, CT 06610, United States
(Pachon) Rutgers University, Cell Biology and Molecular Medicine, 185
South Orange Avenue, Newark, NJ 07101, United States
(Faxon) Brigham and Women's Hospital, Cardiovascular Medicine, Brigham
Circle, 1620, Boston, MA 02120-1613, United States
(Ohman) Division of Cardiovascular Medicine, Duke Heart Center, Ambulatory
Care, Programme for Advanced Coronary Diseases, Box 3126, HAFS Building,
Duke University Medical Center, Durham, NC 27710, United States
(Anderson) Duke University, School of Medicine, 201 Trent Drive, Durham,
NC 27705, United States
(Sidi) University of North Carolina, Department of Biology, 201 Councilman
court, Morrisville, NC 27560, United States
(Sketch, Brennan) Duke University Medical Center, Department of
Medicine/Cardiology, DUMC 3157, Durham, NC 27710, United States
(Zarich) Yale New Haven Health System, 267 Grant St, Bridgeport, CT 06610,
United States
Title
Early invasive versus conservative strategy for non-infarct related artery
lesions in ST elevation myocardial infarction with multi-vessel disease.
Source
Cochrane Database of Systematic Reviews. 2015 (12) (no pagination), 2015.
Article Number: CD011986. Date of Publication: 17 Dec 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the effects of early invasive compared to
conservative (medical management) strategy for treating non-infarct
related artery lesions in ST elevation myocardial infarction people with
multi-vessel disease. Copyright © 2015 The Cochrane
Collaboration.

<5>
Accession Number
620560161
Author
Bravo C.; Rondon Clavo C.M.; Oliva P.; Rada G.; Rivera-Cornejo M.;
Torres-Robles R.
Institution
(Bravo) Bridgeport Hospital, Department of Internal Medicine, Section of
Internal Medicine, 267 Grant Street, Bridgeport, CT 06610, United States
(Rondon Clavo) University of Medicine and Dentistry of New Jersey UMDNJ,
Department of Cell Biology and Molecular Medicine, Medical Science
Building, 185 South Orange Avenue, Newark, NJ 07103-2714, United States
(Oliva) Universidad del Desarrollo, Faculty of Dentistry, Barros Arana
1735, Concepcion CP. 4070553, Chile
(Rada) Faculty of Medicine, Pontificia Universidad Catolica de Chile,
Department of Internal Medicine, Evidence Based Health Care Program, Lira
44, Decanato Primer piso, Santiago, Chile
(Rivera-Cornejo, Torres-Robles) Pontificia Universidad Catolica de Chile,
Sistema de Bibliotecas UC, Santiago, Region Metropolitana 8330074, Chile
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
for adults with diabetes and multivessel coronary disease.
Source
Cochrane Database of Systematic Reviews. 2014 (3) (no pagination), 2014.
Article Number: CD011012. Date of Publication: 16 Mar 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the effects of PCI versus CABG for adults with
diabetes and MCD. Copyright © 2014 The Cochrane Collaboration.

<6>
Accession Number
620559966
Author
Koo H.-K.; Lawrence K.A.K.; Musini V.M.
Institution
(Koo, Musini) University of British Columbia, Department of
Anesthesiology, Pharmacology and Therapeutics, 217-2176 Health Sciences
Mall, Vancouver, BC V6T 1Z3, Canada
(Lawrence) Vancouver Coastal Health Authority, Department of
Medicine/Transitional Care Unit, 2307-1255 Bidwell Street, Vancouver, BC
V6G 2K8, Canada
Title
Beta-blockers for preventing aortic dissection in Marfan's syndrome.
Source
Cochrane Database of Systematic Reviews. 2014 (5) (no pagination), 2014.
Article Number: CD011103. Date of Publication: 07 May 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the long-term efficacy and safety of
beta-blocker therapy in people with Marfan's syndrome. Copyright
© 2014 The Cochrane Collaboration.

<7>
Accession Number
620561993
Author
Sibilitz K.L.; Berg S.K.; Tang L.H.; Risom S.S.; Gluud C.; Lindschou J.;
Kober L.; Hassager C.; Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Tang, Kober, Zwisler) The Heart Centre, Rigshospitalet,
Department of Cardiology, Blegdamsvej 9, Copenhagen 2100, Denmark
(Risom, Hassager) Rigshospitalet, The Heart Centre, Blegdamsvej 9,
Copenhagen 2100, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Lindschou) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Taylor) Universities of Exeter Medical School, Institute of Health
Services Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG,
United Kingdom
(Zwisler) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Zwisler) Holbaek Hospital, Department of Cardiology, Holbaek, Denmark
Title
Exercise-based cardiac rehabilitation for adults after heart valve
surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (12) (no pagination), 2013.
Article Number: CD010876. Date of Publication: 13 Dec 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the benefits and harms of exercise-based
intervention programmes (exercise-based interventions alone or in
combination with psycho-educational components), compared to no
intervention, or treatment as usual, in adults who have had heart valve
surgery. In this review we will focus on programmes that include an
exercise-based intervention with, or without, another rehabilitation
component (such as a psycho-educational component). Copyright ©
2013 The Cochrane Collaboration.

<8>
Accession Number
614710300
Author
Huygens S.A.; Takkenberg J.J.M.; Rutten-van Molken M.P.M.H.
Institution
(Huygens, Takkenberg) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and
Management/Institute for Medical Technology Assessment, Erasmus University
Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, Rotterdam 3000
DR, Netherlands
Title
Systematic review of model-based economic evaluations of heart valve
implantations.
Source
European Journal of Health Economics. 19 (2) (pp 241-255), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objective: To review the evidence on the cost-effectiveness of heart valve
implantations generated by decision analytic models and to assess their
methodological quality. Methods: A systematic review was performed
including model-based cost-effectiveness analyses of heart valve
implantations. Study and model characteristics and cost-effectiveness
results were extracted and the methodological quality was assessed using
the Philips checklist. Results: Fourteen decision-analytic models
regarding the cost-effectiveness of heart valve implantations were
identified. In most studies transcatheter aortic valve implantation (TAVI)
was cost-effective compared to standard treatment (ST) in inoperable or
high-risk operable patients (ICER range 18,421-120,779 ) and in all
studies surgical aortic valve replacement (SAVR) was cost-effective
compared to ST in operable patients (ICER range 14,108-40,944 ), but the
results were not consistent on the cost-effectiveness of TAVI versus SAVR
in high-risk operable patients (ICER range: dominant to dominated by
SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per
success compared to mitral valve repair and biological MVR. The
methodological quality of the studies was moderate to good. Conclusion:
This review showed that improvements can be made in the description and
justification of methods and data sources, sensitivity analysis on
extrapolation of results, subgroup analyses, consideration of
methodological and structural uncertainty, and consistency (i.e. validity)
of the models. There are several opportunities for future
decision-analytic models of the cost-effectiveness of heart valve
implantations: considering heart valve implantations in other valve
positions besides the aortic valve, using a societal perspective, and
developing patient-simulation models to investigate the impact of patient
characteristics on outcomes. Copyright © 2017, The Author(s).

<9>
Accession Number
620684169
Author
Sepehripour A.H.; Eckersley M.; Jiskani A.; Casula R.; Athanasiou T.
Institution
(Sepehripour, Eckersley, Jiskani, Casula, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Title
Selective serotonin reuptake inhibitor use and outcomes following cardiac
surgery-a systematic review.
Source
Journal of Thoracic Disease. 10 (2) (pp 1112-1120), 2018. Date of
Publication: 01 Feb 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
A high prevalence of depression is observed in patients undergoing cardiac
surgery, and depression has been shown to be an independent predictor of
morbidity and mortality in this patient population. Selective serotonin
re-uptake inhibitors (SSRIs) are the first-line recommended therapy for
depressive disorders, however due to their platelet inhibitory actions
they have been associated with increased incidences of post-operative
bleeding. This review has sought to address whether the use of SSRIs is
associated with a higher rate of mortality, major adverse events or
bleeding events following cardiac surgery. A retrospective literature
search selected studies comparing the use of SSRIs with no SSRI use in
patients undergoing cardiac surgery. Seven of the ten studies analysed
reported no significant difference in mortality in SSRI users. Five of the
seven studies reporting bleeding events demonstrated no significant
difference in SSRI users. Three of the five studies reporting other
significant morbidity demonstrated no significant difference in SSRI
users. Our study demonstrates the safety of the use of SSRIs for the
treatment of depressive disorders in patients undergoing cardiac
surgery. Copyright © Journal of Thoracic Disease.

<10>
Accession Number
620743485
Author
Weymann A.; Popov A.-F.; Sabashnikov A.; Ali-Hasan-Al-Saegh S.; Ryazanov
M.; Tse G.; Mirhosseini S.J.; Liu T.; Lotfaliani M.; Sedaghat M.; Baker
W.L.; Ghanei A.; Yavuz S.; Zeriouh M.; Izadpanah P.; Dehghan H.; Testa L.;
Nikfard M.; De Oliveira Sa M.P.B.; Mashhour A.; Nombela-Franco L.;
Rezaeisadrabadi M.; D'Ascenzo F.; Zhigalov K.; Benedetto U.; Najafi S.A.;
Szczechowicz M.; Roever L.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.;
Linde C.; Filipiak K.J.; Stone G.W.; Biondi-Zoccai G.; Calkins H.
Institution
(Weymann, Mashhour, Zhigalov, Szczechowicz) Department of Cardiac Surgery,
University Hospital Oldenburg, European Medical School
Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg,
Germany
(Popov, Sabashnikov, Zeriouh) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield-Middlesex, United Kingdom
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov, Zeriouh) Department of Cardiothoracic Surgery, University
Hospital of Cologne, Cologne, Germany
(Ali-Hasan-Al-Saegh, Mirhosseini) Cardiovascular Research Centre, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ali-Hasan-Al-Saegh, Mirhosseini, Dehghan) Consult. Ctr. for Secdry. Res.,
Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ryazanov) CVS Centre at Nizhny Novgorod, Nizhny Novgorod, Russian
Federation
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Liu, Meng, Gong) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Sedaghat, Ghanei, Rezaeisadrabadi) Department of Internal Medicine,
Shahid Beheshti University of Medical Sciences, Yazd, Tehran, Iran,
Islamic Republic of
(Baker) University of Connecticut, Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Izadpanah) Department of Interventional Cardiology, Cardiovascular
Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Nikfard) International Relations Office, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(De Oliveira Sa) University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa) Nucleus of Postgrad. and Res. in Hlth. Sci. of Fac. of
Med. Sci. and Biol. Sci. Institute (FCM/ICB), Recife, Brazil
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Najafi) Department of Cardiology and Internal Medicine, Sankt Katharinen
Hospital, Frankfurt am Main, Germany
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institute, Stockholm, Sweden
(Filipiak) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Title
Baseline and postoperative levels of C-reactive protein and interleukins
as inflammatory predictors of atrial fibrillation following cardiac
surgery: A systematic review and meta-analysis.
Source
Kardiologia Polska. 76 (2) (pp 440-451), 2018. Date of Publication: 16 Feb
2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a leading
arrhythmia with high incidence and serious clinical implications after
cardiac surgery. Cardiac surgery is associated with systemic inflammatory
response including increase in cytokines and activation of endothelial and
leukocyte responses. Aim This systematic review and meta-analysis aimed to
determine the strength of evidence for evaluating the association of
inflammatory markers, such as C-reactive protein (CRP) and interleukins
(IL), with POAF following isolated coronary artery bypass grafting (CABG),
isolated valvular surgery, or a combination of these procedures. Methods:
We conducted a meta-analysis of studies evaluating measured baseline (from
one week before surgical procedures) and postoperative levels (until one
week after surgical procedures) of inflammatory markers in patients with
POAF. A comprehensive search was performed in electronic medical databases
(Medline/PubMed, Web of Science, Embase, Science Direct, and Google
Scholar) from their inception through May 2017 to identify relevant
studies. A comprehensive subgroup analysis was performed to explore
potential sources of heterogeneity. Results: A literature search of all
major databases retrieved 1014 studies. After screening, 42 studies were
analysed including a total of 8398 patients. Pooled analysis showed
baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p <
0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001),
postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative
levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8
(SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590
pg/mL, p < 0.001) to be relevant inflammatory parameters significantly
associated with POAF. Conclusions: Perioperative inflammation is proposed
to be involved in the pathogenesis of POAF. Therefore, perioperative
assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of
predicting and monitoring for POAF. © Copyright 2018 Polskie
Towarzystwo Kardiologiczne.

<11>
Accession Number
620709100
Author
Hua P.; Liu J.; Tao J.; Zou R.; Lin X.; Zhang D.; Yang S.
Institution
(Hua, Tao, Zou, Lin, Zhang) Department of Cardiovascular Surgery, Sun
Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Liu) Department of Vascular Surgery, Henan Provincial People's Hospital,
Zhengzhou 450003, China
(Yang) Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University,
Guangzhou 510120, China
(Zhang) Guangdong Province Key Laboratory of Brain Function and Disease,
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080,
China
Title
Efficacy and Mechanism of Preoperative Simvastatin Therapy on Myocardial
Protection after Extracorporeal Circulation.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
6082430. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Cardiopulmonary bypass (CPB) causes systemic inflammatory
response and ischemia-reperfusion (IR) injury. Objective. To investigate
the effect and mechanism of simvastatin on myocardial injury in cardiac
valve surgery with CPB. Methods. One hundred thirty patients were randomly
assigned to the statin group (n=65) or control group (n=65). Simvastatin
was administered preoperatively and postoperatively. Duration of intensive
care unit stay, duration of assisted ventilation, and left ventricular
ejection fraction were recorded. Plasma was analysed for troponin T
(cTnT), isoenzyme of creatine kinase (CK-MB), tumor necrosis factor alpha
(TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8).
Ultrastructure of the myocardium and autophagosomes were observed.
Beclin-1, LC3-II/I, P62, AMPK, and the phosphorylation of AMPK in
cardiomyocytes were detected. Results. Simvastatin significantly reduced
the duration of assisted ventilation (P=0.030) and ejection fraction was
significantly higher in the statin group (P=0.024). Simvastatin
significantly reduced the levels of cTnT, CK-MB, TNF-alpha, IL-6, and IL-8
(P<0.05), reduced the expression of LC3-II/LC3-I and Beclin 1, and
increased the expression of phosphorylation of AMPK. Simvastatin reduced
the generation of autophagosomes and the ultrastructural injuries to
myocardium. Conclusion. Perioperative statin therapy reduced myocardial
injury by regulating myocardial autophagy and activating the
phosphorylation of AMPK. The registration number of this study is
ChiCTR-TRC-14005164. Copyright © 2017 Ping Hua et al.

<12>
Accession Number
620745323
Author
Elmarakby A.
Institution
(Elmarakby) Utica College, New York, United States
Title
Effect of threshold inspiratory muscle training on maximal inspiratory
pressure and pulmonary gas exchange in patients undergoing coronary artery
bypass graft surgery.
Source
Critical Reviews in Physical and Rehabilitation Medicine. 28 (4) (pp
249-261), 2016. Date of Publication: 2016.
Publisher
Begell House Inc. (E-mail: orders@begellhouse.com)
Abstract
Objective. We sought to determine the effect of threshold inspiratory
muscle training (IMT) on maximum inspiratory pressure (MIP), pulmonary gas
exchange and atelectasis in patients undergoing coronary
revascularization. Design. Overall, 33 male patients were randomly
assigned into intervention group (17 patients) and control group (16
patients). Both groups received customary physical therapy care. The
intervention group received threshold IMT using an inspiratory
threshold-loading device preoperatively, postoperatively (for 15 minutes
twice daily) and during the intensive care unit stay (30 deep breaths,
twice daily) against resistance equal to 30% of MIP. The workload was
increased or decreased based on the patient's perception of exertion or
fatigue using the Borg CR10 scale. MIP, oxygen saturation, and atelectasis
(by calculating the alveolar-arterial oxygen [A-a] gradient) were assessed
perioperatively. Result. Before hospital discharge, the MIP and SpO2 in
the intervention group were significantly higher in the intervention group
than in the control group. In the intervention group, the A-a gradient was
lower than that in the control group immediately after surgery and after
40 hours. Conclusion. IMT caused an increase in both MIP and SpO2 and a
decrease in the A-a gradient, achieving an improvement in gas exchange and
a reduction in atelectasis after coronary revascularization
surgery. Copyright © 2016 by Begell House, Inc.

<13>
Accession Number
620739796
Author
Fayad A.; Shillcutt S.; Meineri M.; Ruddy T.D.; Ansari M.T.
Institution
(Fayad) University of Ottawa, Ottawa, Ontario, Canada
(Shillcutt) University of Nebraska Medical Center, Omaha, NE, USA
(Meineri) University of Toronto, Toronto, Ontario, Canada
(Ruddy) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Ansari) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, Ontario, Canada
Title
Comparative Effectiveness and Harms of Intraoperative Transesophageal
Echocardiography in Noncardiac Surgery: A Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 01 Feb 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Intraoperative use of transesophageal echocardiography (TEE) has become
commonplace in high-risk noncardiac surgeries but the balance of benefits
and harms remains unclear. This systematic review investigated the
comparative effectiveness and harms of intraoperative TEE in noncardiac
surgery. We searched Ovid MEDLINE, PubMed, EMBASE, and the Cochrane
Library from 1946 to March 2017. Two reviewers independently screened the
literature for eligibility. Studies were assessed for the risk of
selection bias, confounding, measurement bias, and reporting bias. Three
comparative and 13 noncomparative studies were included. Intraoperative
TEE was employed in a total of 1912 of 3837 patients. Studies had
important design limitations. Data were not amenable to quantitative
synthesis due to clinical and methodological diversity. Reported incidence
of TEE complications ranged from 0% to 1.7% in patients undergoing various
procedures (5 studies, 540 patients). No serious adverse events were
observed for mixed surgeries (2 studies, 197 patients). Changes in
surgical or medical management attributable to the use of TEE were noted
in 17% to 81% of patients (7 studies, 558 patients). The only randomized
trial of intraoperative TEE was grossly underpowered to detect meaningful
differences in 30-day postoperative outcomes. There is lack of
high-quality evidence of effectiveness and harms of intraoperative TEE in
the management of non-cardiac surgeries. Evidence, however, indicates
timely evaluation of cardiac function and structure, and hemodynamics.
Future studies should be comparative evaluating confounder-adjusted impact
on both intraoperative and 30-day postoperative clinical
outcomes. Copyright © 2018, The Author(s) 2018.

<14>
Accession Number
620743815
Author
Wand S.; Adam E.H.; Wetz A.J.; Meybohm P.; Kunze-Szikszay N.; Zacharowski
K.; Popov A.F.; Moritz A.; Moldenhauer L.; Kaiser J.; Bauer M.; Weber C.F.
Institution
(Wand, Wetz, Kunze-Szikszay, Moldenhauer, Bauer, Weber) Department of
Anesthesiology, University Medical Center Gottingen, Gottingen, Germany
(Adam, Meybohm, Zacharowski, Kaiser) Department of Anesthesia, Intensive
Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt
am Main, Germany
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Medical Center Gottingen, Gottingen, Germany
(Popov, Moritz) Department for Cardiothoracic and Vascular Surgery,
University Hospital Frankfurt, Frankfurt am Main, Germany
Title
The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac
Surgery: A Prospective Bicentric Study.
Source
Clinical and Applied Thrombosis/Hemostasis. (no pagination), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We aimed to identify the prevalence of acetylsalicylic acid (ASA)
nonresponse in patients after coronary artery bypass graft (CABG) surgery
and the possible consequences for the rate of major cardiovascular events.
This prospective, observational, bicentric cohort study was conducted in
two German University hospitals. A total of 400 patients (200 in each
study center) undergoing elective CABG surgery were enrolled after written
informed consent. Platelet function was analyzed on day 3 (d3) and day 5
(d5) postoperatively following stimulation with arachidonic acid
(ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest)
using multiple electrode aggregometry (Multiplate). Individuals with an
ASPItest >=40 AU.min were categorized as ASA nonresponders. A 1-year
follow-up recorded the combined end point of cardiovascular events,
hospital admissions, or deaths related to cardiovascular disease. The
prevalence of ASA nonresponse was 51.5% on d3, and it significantly
increased to 71.3% on d5 (P =.0049). The area under the aggregation curve
in the TRAPtest (P <.0001), the platelet count on d5 (P =.009), and the
cardiopulmonary bypass time (P =.01) were identified as independent
predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events
fulfilling criteria for the combined end point with no difference between
ASA responders and nonresponders. This study indicates a high incidence of
perioperative ASA nonresponse in patients following CABG. No effect on the
incidence of cardiovascular events was recorded in the 1-year follow-up.
Therefore, a randomized dosage adjustment trial should elucidate whether a
tailored ASA treatment after CABG surgery represents a useful
concept. Copyright © 2017, The Author(s) 2017.

<15>
Accession Number
604475007
Author
Ansari M.T.; Ahmadzai N.; Coyle K.; Coyle D.; Moher D.
Institution
(Ansari, Ahmadzai, Moher) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
(Coyle) Brunel University London, Uxbridge, Middlesex, United Kingdom
(Coyle) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Mitral valve clip for treatment of mitral regurgitation: An evidence-based
analysis.
Source
15 (12) (pp 1-104), 2015. Date of Publication: 2015.
Publisher
Health Quality Ontario
Abstract
Background: Many of the 500,000 North American patients with chronic
mitral regurgitation may be poor candidates for mitral valve surgery.
Objective: The objective of this study was to investigate the comparative
effectiveness, harms, and cost-effectiveness of percutaneous mitral valve
repair using mitral valve clips in candidates at prohibitive risk for
surgery. Data Sources: We searched articles in MEDLINE, Embase, and the
Cochrane Library published from 1994 to February 2014 for evidence of
effectiveness and harms; for economic literature we also searched NHS EED
and Tufts CEA registry. Grey literature was also searched. Review Methods:
Primary studies were sought from existing systematic reviews that had
employed reliable search and screening methods. Newer studies were sought
by searching the period subsequent to the last search date of the review.
Two reviewers screened records and assessed study validity. We used the
Cochrane risk of bias tool for randomized, generic assessment for
non-randomized studies, and the Phillips checklist for economic studies.
Results: Ten studies including 1 randomized trial were included. The
majority of the direct comparative evidence compared the mitral valve clip
repair with surgery in patients not particularly at prohibitive surgical
risk. Irrespective of degenerative or functional chronic mitral
regurgitation etiology, evidence of effectiveness and harms is
inconclusive and of very low quality. Very-low-quality evidence indicates
that percutaneous mitral valve clip repair may provide a survival
advantage, at least during the first 1 to 2 years, particularly in
medically managed chronic functional mitral regurgitation. Because of
limitations in the design of studies, the cost-effectiveness of mitral
valve clips in patients at prohibitive risk for surgery also could not be
established. Limitations: Because of serious concerns of risk of bias,
indirectness, and imprecision, evidence is of very low quality.
Conclusions: No meaningful conclusions can be drawn about the comparative
effectiveness, harms, and cost-effectiveness of mitral valve clips in the
population with chronic mitral regurgitation who are at prohibitive risk
for surgery. Copyright © 2015 Medical Advisory Secretariat. All
rights reserved.

<16>
Accession Number
620160644
Author
Leitman M.; Tyomkin V.; Sternik L.; Copel L.; Goitein O.; Vered Z.
Institution
(Tyomkin, Vered) Department of Cardiology, Assaf Harofeh Medical Center,
Zerifin, Israel
(Leitman, Sternik, Copel, Goitein, Vered) Sackler School of Medicine, Tel
Aviv University, Zerifin, Israel
(Sternik) Department of Cardiac Surgery, Sheba Medical Center, Tel
Hashomer, Israel
(Copel) Department of Radiology, Assaf Harofeh Medical Center, Zerifin,
Israel
(Goitein) Department of Radiology, Sheba Medical Center, Tel Hashomer,
Israel
Title
Intramyocardial dissecting hematoma: Two case reports and a meta-analysis
of the literature.
Source
Echocardiography. 35 (2) (pp 260-266), 2018. Date of Publication:
Februaryy 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Until recently, diagnosis of intramyocardial dissecting hematoma (IDH) was
performed during necropsy or at surgery. During the recent years,
echocardiography has permitted clinical suspicion, which usually needed
confirmation with magnetic resonance imaging (MRI). In this study, we
tried to define clinical and imaging features of IDH and predictors of
mortality. We searched the literature for proven cases of IDH and analyzed
them together with 2 of our cases. A total of 40 cases of IDH (2 our
original and 38 literature cases) were included. Mean age was 60. In 32
cases, IDH was a complication of myocardial infarction (MI), in 66%
anterior, a mean time from symptoms to diagnosis was 9 days. Thirty-eight
% underwent surgery. In-hospital mortality was 23%. Multivariate analysis
showed that the strongest independent predictor of mortality (42%) was EF
< 35%; in patients with age >60, mortality risk was 44%; and in the
presence of MI or late diagnosis (>24 hours since symptoms started),
mortality risk was 50%. In summary, IDH is a diagnostic challenge. A high
level of suspicion is needed for prompt diagnosis. Management of these
patients is based on individual clinical and imaging parameters. Low EF,
age > 60, and late diagnosis, all are predictors of in-hospital
mortality. Copyright © 2018 Wiley Periodicals, Inc.

<17>
Accession Number
616039972
Author
Sardar P.; Kundu A.; Bischoff M.; Chatterjee S.; Owan T.; Nairooz R.; Giri
J.; Halkos M.E.; Liberman H.; Douglas J.S.; Mukherjee D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Bischoff) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
(Chatterjee) Division of Cardiovascular Medicine, Temple University School
of Medicine, Philadelphia, PA, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Halkos) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Liberman, Douglas) Clinical Research Unit, Division of Cardiology, Emory
University School of Medicine, Atlanta, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, United States
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
in patients with multivessel coronary artery disease: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 203-212),
2018. Date of Publication: 01 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This meta-analysis evaluated the effectiveness of hybrid
coronary revascularization (HCR) compared to coronary artery bypass
grafting (CABG) for the treatment of multivessel coronary artery disease
(MVCAD). Background: HCR involves a combination of surgical and
percutaneous techniques, which in selected patients may present an
alternative to conventional CABG. Methods: Databases were searched through
June 30, 2016, and studies comparing HCR with CABG for treatment of MVCAD
were selected. We calculated summary odds ratios (ORs) and 95% CIs with
the random-effects model. The primary outcome of interest was the
occurrence of major adverse cardiac and cerebrovascular events (MACCE),
defined as a composite of all cause mortality, myocardial infarction, and
stroke. Results: The analysis included 2,245 patients from 8 studies (1
randomized controlled trial and 7 observational studies). The risk of
MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR, 0.53; 95%
CI, 0.24-1.16). Compared to CABG group, patients in HCR group had similar
risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88), myocardial
infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95% CI,
0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI, 0.58-2.83).
The need for postoperative blood transfusions (OR, 0.29; 95% CI,
0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95% CI
-1.52 to -0.88 days) was significantly lower in the HCR group. Conclusion:
HCR appears to be safe, and has similar outcomes when compared with
conventional CABG. HCR can be a suitable alternative to conventional CABG
in select patients with MVCAD. © 2017 Wiley Periodicals,
Inc. Copyright © 2017 Wiley Periodicals, Inc.

<18>
Accession Number
620647616
Author
Shavit L.; Silberman S.; Tauber R.; Merin O.; Bitran D.; Fink D.
Institution
(Shavit) Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem,
Israel
(Silberman, Tauber, Merin, Bitran, Fink) Department of Cardiac Surgery,
Shaare Zedek Medical Center, Jerusalem, Israel
Title
Preoperative aldosterone receptor blockade and outcomes of cardiac surgery
in patients with chronic kidney disease.
Source
Clinical Nephrology. 89 (3) (pp 187-195), 2018. Date of Publication: 01
Mar 2018.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Background and aims: Recent clinical evidence demonstrates that chronic
low-dose mineralocorticoid receptor antagonists (MRA), when added to
optimal treatment, result in reductions in cardiovascular mortality.
However, continuation of MRAs before cardiac surgery in patients with CKD
has never been evaluated and its potential benefit or harm in this
specific clinical setting is largely unknown. Materials and methods: This
is an observational study that included adult CKD patients undergoing
cardiac surgery. Patients were divided into two groups according to
preoperative use of spironolactone (SPL). The studied outcomes were
postoperative acute kidney injury (AKI) requiring dialysis, mortality, and
major morbidities (cardiovascular, neurologic, and infectious). Results:
Data on 698 patients with preoperative CKD stage III and IV were analyzed:
99 received SPL preoperatively and 599 did not. At baseline, patients on
SPL had higher EuroScore and had more complicated surgery. No significant
differences in the incidence of postoperative AKI, myocardial infarction
(MI), cardiovascular accident (CVA), sepsis, and mortality were detected
between groups in both univariate and multivariate analyses. However,
incidence of postoperative low cardiac output state (p < 0.008) was
significantly higher in the SPL group. Propensity score matching analyses
yielded similar results. Conclusions: Although SPL is usually administered
to significantly sicker patients, its use is not associated with increased
major postoperative complications. However, the modulating effect of SPL
in this clinical study remains to be elucidated in a prospective
randomized trial. Copyright © 2018 Dustri-Verlag Dr. K. Feistle.

<19>
Accession Number
620635428
Author
Abouarab A.A.; Rahouma M.; Kamel M.; Ghaly G.; Mohamed A.
Institution
(Abouarab) Department of Surgery, Division of Cardiothoracic Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Rahouma, Kamel, Ghaly, Mohamed) Surgical Oncology Department, National
Cancer Institute, Cairo University, 1st Fom Elkhaleeg Square, Masr
ElKadema, Cairo 11796, Egypt
Title
Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A
Systematic Review and Meta-analysis.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 28 (2) (pp
174-185), 2018. Date of Publication: February 2018.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Video-Assisted Thoracic Surgery (VATS) is conventionally
performed through multiple small incisions (C-VATS). Recent studies have
reported encouraging results with the single-incision VATS (S-VATS) over
the conventional technique. However, these studies were either small in
size, unfocused, nonuniform, retrospective, lacking follow-up information,
or focused on pain. We aim to validate previously reported results in a
single large meta-analysis, including only the best evidence studies
available. Methods: Systematic review of the PubMed archive was conducted
to include only full English articles with Newcastle Ottawa Scale score
>=7. The primary outcome was the complications rate while secondary
outcomes were operative time, resected lymph nodes (LNs), chest tube
duration, estimated blood loss, length of postoperative stay (LOS), and
postoperative pain on day 1 after surgery. Odds ratio and standard mean
difference were used as effect estimates. Random model and leave-one-out
analysis were used. Results: A total of 39 studies were included with 4635
patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in
significantly less postoperative pain (P < .001), blood loss (P = .006),
LOS (P < .001), and chest tube duration (P < .001). In lung cancer
patients, the number of retrieved LNs was similar to that of C-VATS (P >
.05). Subgroup comparison of the rate of complications between lung
resections versus other intrathoracic procedures, lung cancer versus
pneumothorax, and lung cancer versus other lung-only lesions did not show
any significant differences between the groups. Conclusion: Performing
S-VATS technique has shown superior postoperative outcomes over the C-VATS
technique in the treatment of thoracic disorders. Substantial benefit was
confirmed in terms of less postoperative pain, blood loss, drainage time,
and postoperative hospital stay. © Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<20>
Accession Number
620617939
Author
Qureshi S.H.; Boulemden A.; Szafranek A.; Vohra H.
Institution
(Qureshi, Boulemden, Szafranek) Department of Cardiac Surgery, Trent
Cardiac Centre, Nottingham University Hospital, City Campus, Nottingham,
United Kingdom
(Vohra) Department of Cardiac Surgery, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
Title
Meta-analysis of sutureless technology versus standard aortic valve
replacement and transcatheter aortic valve replacement.
Source
European Journal of Cardio-thoracic Surgery. 53 (2) (pp 463-471), 2018.
Article Number: ezx307. Date of Publication: 01 Feb 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) using sutureless technology is
a feasible alternative in surgical patients. Comparative evidence against
established strategies such as conventional AVR and transcatheter AVR is
lacking, limiting the assessment of safety and efficacy. METHODS: Medline
search for available evidence was undertaken. The outcomes analysed were
30-day mortality, risk for stroke, myocardial infarction, renal failure,
paravalvular leak and need for permanent pacemaker. Odds ratios were
pooled using fixed- and randomeffect models. A trial sequential analysis
was undertaken to assess the statistical reliability of cumulative
evidence. RESULTS: Twelve studies of moderate methodological quality were
included. Sutureless AVR was associated with at least 30% reduction in
30-day mortality versus transcatheter AVR [odds ratio (95% confidence
interval) 0.40 (0.25, 0.62); P < 0.001] primarily in the low- and
intermediate-risk population and a similar reduction in the risk for
paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no reduction
in the risk for 30-day mortality versus conventional AVR [1.03 (0.56,
1.88); P = 0.93]. There was evidence in favour of conventional AVR with at
least 50% risk reduction in pacemaker implantation against sutureless
technology. There was absence of either benefit or harm vis-a-vis risk for
renal injury or stroke due to lack of required information size.
CONCLUSIONS: Current evidence suggests risk reduction in 30-day mortality
with sutureless AVR versus transcatheter AVR but is inconclusive versus
standard AVR in matched patients. Robust randomized evidence is lacking to
lend support to any potential recommendation. Copyright © The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<21>
Accession Number
620083185
Author
Hellhammer K.; Afzal S.; Tigges R.; Spieker M.; Rassaf T.; Zeus T.;
Westenfeld R.; Kelm M.; Horn P.
Institution
(Hellhammer, Afzal, Tigges, Spieker, Zeus, Westenfeld, Kelm, Horn)
University Hospital Dusseldorf, Medical Faculty, Dept. of Medicine,
Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf,
Germany
(Rassaf) University Hospital Essen, Medical Faculty, Dept. of Medicine,
Division of Cardiology and Vascular Medicine, Essen, Germany
Title
High body mass index is a risk factor for difficult deep sedation in
percutaneous mitral valve repair.
Source
PLoS ONE. 13 (1) (no pagination), 2018. Article Number: e0190590. Date of
Publication: January 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The safety and efficacy of deep sedation (DS) in
MitraClip procedures have been shown previously. However,
clinical experience demonstrates that in some patients DS is difficult to
achieve. We hypothesize that some patient characteristics can predict
difficult DS. Methods We prospectively analysed 69 patients undergoing
MitraClip procedures using DS. Application of DS was graded as
simple (group 1) or difficult (group 2) depending on a cumulative score
based on one point for each of the following criteria: decrease in oxygen
saturation, retention of carbon dioxide, disruptive body movements, and
the need for catecholamines. Patients with one point or less were
classified as group 1, and patients with two or more points were
classified as group 2. Results In 58 of 69 patients (84.1%), the
performance of DS was simple, while in 11 patients (15.9%), DS was
difficult to achieve. Patients with difficult DS were characterized by a
higher body mass index (33.7 +/- 6.0 kg/m2 vs. 26.1 +/- 4.1; p
= 0.001), younger age (67 +/- 13 years vs. 75 +/- 13 years; p = 0.044),
and reduced left ventricular ejection fraction (36% +/- 10 vs. 45% +/- 14;
p = 0.051) and presented more often with an obstructive sleep apnoea
syndrome (6.9% vs. 45.5%; p = 0.003). In the multivariate analysis, body
mass index was an independent predictor of difficult DS. Using a body mass
index of 31 kg/m2 as a cut-off value, the sensitivity of
predicting difficult DS was 73%, and the specificity was 88%. Using a body
mass index of 35 kg/m2 as a cut-off value, the specificity
increased to 97%, with a sensitivity of 36%. Conclusion In patients with a
higher body mass index who undergo MitraClip procedures, DS
might be difficult to perform. Copyright © 2018 Hellhammer et al.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source
are credited.

<22>
Accession Number
618803469
Author
Hounsome J.; Greenhalgh J.; Schofield-Robinson O.J.; Lewis S.R.; Cook
T.M.; Smith A.F.
Institution
(Hounsome) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
(Greenhalgh) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
(Schofield-Robinson, Lewis) Patient Safety Research Unit, Department of
Anaesthesia, Royal Lancaster Infirmary, Lancaster, United Kingdom
(Cook) Royal United Hospital Bath NHS Foundation Trust, Bath, United
Kingdom
(Cook) School of Clinical Sciences, University of Bristol, Bristol, United
Kingdom
(Smith) Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster,
United Kingdom
Title
Nitrous oxide-based vs. nitrous oxide-free general anaesthesia and
accidental awareness in surgical patients: an abridged Cochrane systematic
review.
Source
Anaesthesia. 73 (3) (pp 365-374), 2018. Date of Publication: March 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Accidental awareness during general anaesthesia can arise from a failure
to deliver sufficient anaesthetic agent, or from a patient's resistance to
an expected sufficient dose of such an agent. Awareness is 'explicit' if
the patient is subsequently able to recall the event. We conducted a
systematic review into the effect of nitrous oxide used as part of a
general anaesthetic on the risk of accidental awareness in people over the
age of five years undergoing general anaesthesia for surgery. We included
15 randomised controlled trials, 14 of which, representing a total of 3439
participants, were included in our primary analysis of the frequency of
accidental awareness events. The awareness incidence rate was rare within
these studies, and all were considered underpowered with respect to this
outcome. The risk of bias across all studies was judged to be high, and
76% of studies failed adequately to conceal participant allocation. We
considered the available evidence to be of very poor quality. There were a
total of three accidental awareness events reported in two studies, one of
which reported that the awareness was the result of a kink in a propofol
intravenous line. There were insufficient data to conduct a meta- or
sub-group analysis and there was insufficient evidence to draw
outcome-related conclusions. We can, however, recommend that future
studies focus on potentially high-risk groups such as obstetric or cardiac
surgery patients, or those receiving neuromuscular blocking drugs or total
intravenous anaesthesia. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<23>
Accession Number
614796546
Author
Qiao J.; Zhang B.; Wang J.; Zhao Y.; Yang R.; Du H.; Jiang J.; Jin C.;
Xiong E.
Institution
(Qiao, Zhang, Wang, Zhao, Yang, Du, Jiang, Jin, Xiong) Department of
Cardiology, Tongling People's Hospital, Tongling, Anhui, China
Title
Deferred versus immediate stenting in patients with ST-segment elevation
myocardial infarction: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004838. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-A number of studies have evaluated the efficacy of deferred
stenting vs immediate stenting in patients with STsegment elevation
myocardial infarction, but the findings were not consistent across these
studies. This meta-analysis aims to assess optimal treatment strategies in
patient with ST-segment elevation myocardial infarction. Methods and
Results-We searched the PubMed, EMBASE, and the Cochrane Library for
studies that assessed deferred vs immediate stenting in patients with
ST-segment elevation myocardial infarction. Nine studies including 1456
patients in randomized controlled trials and 719 patients in observational
studies were included in the meta-analysis. No significant differences
were observed in the incidence of no- or slow-reflow between deferred
stenting and immediate stenting in randomized controlled trials (odds
ratio [OR] 0.51, 95%CI 0.17-1.53, P=0.23, I2=70%) but not in
observational studies (OR 0.13, 95%CI 0.06- 0.31, P<0.0001,
I2=0%). Deferred stenting was associated with an increase in
long-term left ventricular ejection fraction (weighted mean difference
1.90%, 95%CI 0.77-3.03, P=0.001, I2=0%). No significant
differences were observed in the rates of major adverse cardiovascular
events (OR 0.53, 95%CI 0.27-1.01, P=0.06 [randomized OR 0.98, 95%CI
0.73-1.30, P=0.87, I2=0%; nonrandomized OR 0.30, 95%CI
0.15-0.58, P=0.0004, I2=0%]), major bleeding (OR=0.1.61, 95%CI
0.70-3.69, P=0.26, I2=0%), death (OR=0.78, 95% CI 0.53-1.15,
P=0.22, I2=0%), MI (OR=0.97, 95%CI 0.34-2.78, P=0.96,
I2=35%) and target vessel revascularization (OR 0.97, 95%CI
0.40-2.37, P=0.95, I2=24%), between deferred and immediate
stenting. Conclusions-Compared with immediate stenting, a
deferred-stenting strategy did not reduce the occurrence of no- or
slowreflow, death, myocardial infarction, or repeat revascularization
compared with immediate stenting in patients with ST-segment elevation
myocardial infarction, but showed an improved left ventricular function in
the long term. Copyright © 2017 The Authors.

<24>
Accession Number
620562841
Author
Carranza C.L.; Moller C.H.; Lindschou J.; Olsen P.S.; Gluud C.
Institution
(Carranza, Moller, Olsen) Rigshospitalet, Copenhagen University Hospital,
Department of Cardiothoracic Surgery, Blegdamsvej 9, Copenhagen 2100,
Denmark
(Lindschou) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Mammario-arterial anastomosis versus aorto-arterial anastomosis as
proximal anastomotic sites in coronary artery bypass surgery for patients
with multivessel disease.
Source
Cochrane Database of Systematic Reviews. 2015 (4) (no pagination), 2015.
Article Number: CD011610. Date of Publication: 30 Apr 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To investigate the benefits and harms of using the left
mammary artery compared with the ascending aorta as the anastomotic site
for second choice arterial graft in coronary artery bypass surgery in
patients with multivessel disease. Copyright © 2015 The Cochrane
Collaboration.

<25>
Accession Number
620548826
Author
Stern A.; Green H.; Paul M.; Vidal L.; Leibovici L.
Institution
(Stern) Rambam Health Care Campus, Division of Infectoius Diseases,
Ha-aliya 8 St, Haifa 33705, Israel
(Green, Vidal) Beilinson Hospital, Rabin Medical Center, Department of
Medicine E, 39 Jabotinski Street, Petah Tikva 49100, Israel
(Paul) Rambam Health Care Campus, Division of Infectious Diseases,
Ha-aliya 8 St, Haifa 33705, Israel
(Leibovici) Rabin Medical Center, Beilinson Hospital, Department of
Medicine E, Kaplan Street, Petah Tikva 49100, Israel
Title
Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised
patients.
Source
Cochrane Database of Systematic Reviews. 2014 (10) (no pagination), 2014.
Article Number: CD005590. Date of Publication: 01 Oct 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Pneumocystis pneumonia (PCP) is a disease affecting
immunocompromised patients. PCP among these patients is associated with
significant morbidity and mortality. Objectives: To assess the
effectiveness of PCP prophylaxis among non-HIV immunocompromised patients;
and to define the type of immunocompromised patient for whom evidence
suggests a benefit for PCP prophylaxis. Search methods: Electronic
searches of the Cochrane Central Register of Controlled Trials (CENTRAL)
(The Cochrane Library 2014, Issue 1), MEDLINE and EMBASE (to March 2014),
LILACS (to March 2014), relevant conference proceedings; and references of
identified trials. Selection criteria: Randomised controlled trials (RCTs)
or quasi-RCTs comparing prophylaxis with an antibiotic effective against
PCP versus placebo, no intervention, or antibiotic(s) with no activity
against PCP; and trials comparing different antibiotics effective against
PCP among immunocompromised non-HIV patients. We only included trials in
which Pneumocystis infections were available as an outcome. Data
collection and analysis: Two review authors independently assessed risk of
bias in each trial and extracted data from the included trials. We
contacted authors of the included trials to obtain missing data. The
primary outcome was documented PCP infections. Risk ratios (RR) with 95%
confidence intervals (CI) were estimated and pooled using the
random-effects model. Main results: Thirteen trials performed between the
years 1974 and 2008 were included, involving 1412 patients. Four trials
included 520 children with acute lymphoblastic leukemia and the remaining
trials included adults with acute leukemia, solid organ transplantation or
autologous bone marrow transplantation. Compared to no treatment or
treatment with fluoroquinolones (inactive against Pneumocystis), there was
an 85% reduction in the occurrence of PCP in patients receiving
prophylaxis with trimethoprim/sulfamethoxazole, RR of 0.15 (95% CI 0.04 to
0.62; 10 trials, 1000 patients). The evidence was graded as moderate due
to possible risk of bias. PCP-related mortality was also significantly
reduced, RR of 0.17 (95% CI 0.03 to 0.94; nine trials, 886 patients) (low
quality of evidence due to possible risk of bias and imprecision), but in
trials comparing PCP prophylaxis against placebo or no treatment there was
no significant effect on all-cause mortality (low quality of evidence due
to imprecision). Occurrence of leukopenia or neutropenia and their
duration were not reported consistently. No significant differences in
overall adverse events or events requiring discontinuation were seen
comparing trimethoprim/sulfamethoxazole to no treatment or placebo (four
trials, 470 patients, moderate quality evidence). No differences between
once daily versus thrice weekly trimethoprim/sulfamethoxazole were seen
(two trials, 207 patients). Authors' conclusions: Given an event rate of
6.2% in the control groups of the included trials, prophylaxis for PCP
using trimethoprim/sulfamethoxazole is highly effective among non-HIV
immunocompromised patients, with a number needed to treat to prevent PCP
of 19 patients (95% CI 17 to 42). Prophylaxis should be considered for
patients with a similar baseline risk of PCP. Copyright © 2014
The Cochrane Collaboration.

<26>
Accession Number
620551209
Author
de Cates A.N.; Farr M.R.B.; Wright N.; Jarvis M.C.; Rees K.; Ebrahim S.;
Huffman M.D.
Institution
(de Cates, Farr, Jarvis, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry CV4 7AL, United Kingdom
(Wright) NHS Warwickshire, Public Health Department, Warwick, United
Kingdom
(Ebrahim) London School of Hygiene and Tropical Medicine, Department of
Non-communicable Disease Epidemiology, Keppel Street, London WC1E 7HT,
United Kingdom
(Huffman) Northwestern University, Feinberg School of Medicine,
Departments of Preventive Medicine and Medicine (Cardiology), 680 N. Lake
Shore Drive, Suite 1400, Chicago, IL 60611, United States
Title
Fixed-dose combination therapy for the prevention of cardiovascular
disease.
Source
Cochrane Database of Systematic Reviews. 2014 (4) (no pagination), 2014.
Article Number: CD009868. Date of Publication: 16 Apr 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death and
disability worldwide, yet CVD risk factor control and secondary prevention
rates remain low. A fixed-dose combination of blood pressure and
cholesterol lowering and antiplatelet treatments into a single pill, or
polypill, has been proposed as one strategy to reduce the global burden of
CVD by up to 80% given its potential for better adherence and lower costs.
Objectives: To determine the effectiveness of fixed-dose combination
therapy on reducing fatal and non-fatal CVD events and on improving blood
pressure and lipid CVD risk factors for both primary and secondary
prevention of CVD. We also aimed to determine discontinuation rates,
adverse events, health-related quality of life, and costs of fixed-dose
combination therapy. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013,
Issue 6), MEDLINE Ovid (1946 to week 2 July 2013), EMBASE Ovid (1980 to
Week 28 2013), ISI Web of Science (1970 to 19 July 2013), and the Database
of Abstracts of Reviews of Effects (DARE), Health Technology Assessment
Database (HTA), and Health Economics Evaluations Database (HEED) (2011,
Issue 4) in The Cochrane Library. We used no language restrictions.
Selection criteria: We included randomised controlled trials of a
fixed-dose combination therapy including at least one blood pressure
lowering and one lipid lowering component versus usual care, placebo, or a
single drug active component for any treatment duration in adults >= 18
years old with no restrictions on presence or absence of pre-existing
cardiovascular disease. Data collection and analysis: Three review authors
independently selected studies for inclusion and extracted the data. We
evaluated risk of bias using the Cochrane risk of bias assessment tool. We
sought to include outcome data on all-cause mortality, fatal and non-fatal
CVD events, adverse events, changes in systolic and diastolic blood
pressure, total and low density lipoprotein (LDL) cholesterol
concentrations, discontinuation rates, quality of life, and costs. We
calculated risk ratios (RR) for dichotomous data and weighted mean
differences (MD) for continuous data with 95% confidence intervals (CI)
using fixed-effect models when heterogeneity was low (I2 < 50%)
and random-effects models when heterogeneity was high (I2 >
50%). Main results: We found nine randomised controlled trials with a
total of 7047 participants. Seven of the nine trials evaluated the effects
of fixed-dose combination therapy on primary CVD prevention, and the trial
length ranged from six weeks to 15 months. We found a moderate to high
risk of bias in the domains of selection, performance, detection,
attrition, and other types of bias in five of the nine trials. Compared
with the comparator groups, the effects of the fixed-dose combination
treatment on mortality (1.2% versus 1.0%, RR 1.26, 95% CI 0.67 to 2.38, N
= 3465) and cardiovascular events (4.0% versus 2.9%, RR 1.38, 95% CI 0.91
to 2.10, N = 2479) were uncertain (low quality evidence). The low event
rates for these outcomes, limited availability of data as only two out of
nine trials reported on these outcomes, and a high risk of bias in at
least one domain suggest that these results should not be viewed with
confidence. Adverse events were common in both the intervention (30%) and
comparator (24%) groups, with participants randomised to fixed-dose
combination therapy being 20% (95% CI 9% to 30%) more likely to report an
adverse event. Notably, no serious adverse events were reported. Compared
with placebo, the rate of discontinuation among participants randomised to
fixed-dose combination was higher (14% versus 11%, RR 1.26 95% CI 1.02 to
1.55). The weighted mean differences in systolic and diastolic blood
pressure between the intervention and control arms were -7.05 mmHg (95% CI
-10.18 to -3.87) and -3.65 mmHg (95% CI -5.44 to -1.85), respectively. The
weighted mean differences (95% CI) in total and LDL cholesterol between
the intervention and control arms were -0.75 mmol/L (95% CI -1.05 to
-0.46) and -0.81 mmol/L (95% CI -1.09 to -0.53), respectively. There was a
high degree of statistical heterogeneity in comparisons of blood pressure
and lipids (I2 >= 70% for all) that could not be explained, so
these results should be viewed with caution. Fixed-dose combination
therapy improved adherence to a multi-drug strategy by 33% (26% to 41%)
compared with usual care, but this comparison was reported in only one
study. The effects of fixed-dose combination therapy on quality of life
are uncertain, though these results were reported in only one trial. No
trials reported costs. Authors' conclusions: Compared with placebo, single
drug active component, or usual care, the effects of fixed-dose
combination therapy on all-cause mortality or CVD events are uncertain;
only few trials report these outcomes and the included trials were
primarily designed to observe changes in CVD risk factor levels rather
than clinical events. Reductions in blood pressure and lipid parameters
are generally lower than those previously projected, though substantial
heterogeneity of results exists. Fixed-dose combination therapy is
associated with modest increases in adverse events compared with placebo,
single drug active component, or usual care but may be associated with
improved adherence to a multidrug regimen. Ongoing trials of fixed-dose
combination therapy will likely inform key outcomes. Copyright ©
2014 The Cochrane Collaboration.

<27>
Accession Number
620559841
Author
Koranyi S.; Barth J.; Trelle S.; Strauss B.M.; Rosendahl J.
Institution
(Koranyi, Strauss, Rosendahl) University Hospital of Jena, Institute of
Psychosocial Medicine and Psychotherapy, Stoystrasse 3, Jena, Thuringia
07743, Germany
(Barth, Trelle) University of Bern, Institute of Social and Preventive
Medicine, Niesenweg 6, Bern CH-3012, Switzerland
(Trelle) University of Bern, CTU Bern, Bern, Switzerland
Title
Psychological interventions for acute pain after open heart surgery.
Source
Cochrane Database of Systematic Reviews. 2014 (5) (no pagination), 2014.
Article Number: CD009984. Date of Publication: 26 May 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Acute postoperative pain is one of the most disturbing
complaints in open heart surgery, and is associated with a risk of
negative consequences. Several trials investigated the effects of
psychological interventions to reduce acute postoperative pain and improve
the course of physical and psychological recovery of participants
undergoing open heart surgery. Objectives: To compare the efficacy of
psychological interventions as an adjunct to standard care versus standard
care alone or standard care plus attention in adults undergoing open heart
surgery on pain, pain medication, mental distress, mobility, and time to
extubation. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE
(1946 to September 2013), EMBASE (1980 to September 2013), Web of Science
(all years to September 2013), and PsycINFO (all years to September 2013)
for eligible studies. We used the 'related articles' and 'cited by'
options of eligible studies to identify additional relevant studies. We
also checked lists of references of relevant articles and previous
reviews. We also searched the ProQuest Dissertations and Theses Full Text
Database (all years to September 2013) and contacted the authors of
primary studies to identify any unpublished material. Selection criteria:
Randomised controlled trials comparing psychological interventions as an
adjunct to standard care versus standard care alone or standard care plus
attention in adults undergoing open heart surgery. Data collection and
analysis: Two review authors (SK and JR) independently assessed trials for
eligibility, estimated the risk of bias and extracted all data. We
calculated effect sizes for each comparison (Hedges' g) and meta-analysed
data using a random-effects model. Main results: Nineteen trials were
included (2164 participants). No study reported data on the number of
participants with pain intensity reduction of at least 50% from baseline.
Only one study reported data on the number of participants below 30/100 mm
on the Visual Analogue Scale (VAS) in pain intensity. Psychological
interventions have no beneficial effects in reducing pain intensity
measured with continuous scales in the medium-term interval (g -0.02, 95%
CI -0.24 to 0.20, 4 studies, 413 participants, moderate quality evidence)
nor in the long-term interval (g 0.12, 95% CI -0.09 to 0.33, 3 studies,
280 participants, low quality evidence). No study reported data on median
time to remedication or on number of participants remedicated. Only one
study provided data on postoperative analgesic use. Studies reporting data
on mental distress in the medium-term interval revealed a small beneficial
effect of psychological interventions (g 0.36, 95% CI 0.10 to 0.62, 12
studies, 1144 participants, low quality evidence). Likewise, a small
beneficial effect of psychological interventions on mental distress was
obtained in the long-term interval (g 0.28, 95% CI 0.05 to 0.51, 11
studies, 1320 participants, low quality evidence). There were no
beneficial effects of psychological interventions on mobility in the
medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444
participants, low quality evidence) nor in the long-term interval (g 0.29,
95% CI -0.14 to 0.71, 4 studies, 423 participants, low quality evidence).
Only one study reported data on time to extubation. Authors' conclusions:
For the majority of outcomes (two-thirds) we could not perform a
meta-analysis since outcomes were not measured, or data were provided by
one trial only. Psychological interventions have no beneficial effects on
reducing postoperative pain intensity or enhancing mobility. There is low
quality evidence that psychological interventions reduce postoperative
mental distress. Due to limitations in methodological quality, a small
number of studies, and large heterogeneity, we rated the quality of the
body of evidence as low. Future trials should measure crucial outcomes
(e.g. number of participants with pain intensity reduction of at least 50%
from baseline) and should focus to enhance the quality of the body of
evidence in general. Altogether, the current evidence does not clearly
support the use of psychological interventions to reduce pain in
participants undergoing open heart surgery. Copyright © 2014 The
Cochrane Collaboration.

<28>
Accession Number
620563360
Author
Schnabel A.; Reichl S.U.; Zahn P.K.; Pogatzki-Zahn E.
Institution
(Schnabel, Pogatzki-Zahn) University Hospital Munster, Department of
Anesthesiology, Intensive Care and Pain Medicine, Munster, Germany
(Reichl) Paracelsus Medical University, Department of Anesthesiology,
Perioperative and Intensive Care Medicine, Salzburg, Austria
(Zahn) Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil GmbH
Bochum, Dept. of Anaesthesiology and Intensive Care Med., Palliative Care
Med. and Pain Management, Ruhr University, Bochum, Germany
Title
Nalbuphine for postoperative pain treatment in children.
Source
Cochrane Database of Systematic Reviews. 2014 (7) (no pagination), 2014.
Article Number: CD009583. Date of Publication: 31 Jul 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Several surveys over the past few years have demonstrated that
postoperative pain in children is not treated appropriately. One
pharmacological treatment option in a multimodal approach for
postoperative pain treatment is the systemic administration of opioids.
However, opioids are rarely used for postoperative pain treatment in
children due to fear of adverse events. One long-standing opioid for
systemic use is nalbuphine, a kappa-receptor agonist and mu-receptor
antagonist. The efficacy of nalbuphine is believed to be similar to
morphine. Increased dosing might result in a ceiling effect, and thus less
analgesia than expected. In addition, there might be a lower risk for
opioid-induced side effects (nausea, vomiting) and severe adverse events
(respiratory depression) due to the antagonistic effect of the
mu-receptor. Nalbuphine may be an useful opioid for postoperative use in
children, but exact efficacy (e.g. compared to other commonly used
opioids) has not been determined yet. Objectives: To assess the efficacy
and adverse events of nalbuphine for acute postoperative pain treatment in
children undergoing surgery. Search methods: We systematically searched
the following databases: The Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2013, Issue 7), MEDLINE via Pubmed
(January 1966 to July 2013) and EMBASE via Ovid (January 1947 to July
2013). We did not impose any restrictions regarding language or
publication date. We checked all reference lists of retrieved articles for
additional references. Selection criteria: All randomised controlled
trials (RCTs) investigating nalbuphine compared with placebo or other
opioids were included. Data collection and analysis: Two review authors
independently scanned the retrieved articles and made a decision regarding
inclusion or exclusion of studies for this review. The same authors also
performed the data extraction and the assessment of risk of bias. Main
results: Ten RCTs including 658 patients were finally included in this
systematic review. Five trials compared nalbuphine with placebo. Data from
one out of five studies for the outcome moderate/severe pain following
nalbuphine compared to placebo gave a risk ratio (RR) 1 hour
postoperatively (postop) of 0.1 (95% confidence interval (CI) 0.01 to
0.71; low quality evidence) and a RR 2 hours postop of 0.14 (95% CI 0.02
to 1.06; low quality evidence). The estimated RR based on data from a
single study indicated that nalbuphine reduced the requirement for
analgesia two hours postop (RR 0.47; 95% CI 0.27 to 0.84; low quality
evidence). Two included trials compared nalbuphine with morphine and
showed a nonsignificant lower or comparable RR for moderate/severe pain at
1 hour postop (RR 0.84; 95% CI 0.12 to 5.74; low quality evidence), and 2
hours postop (RR 1.09; 95% CI 0.59 to 2.01; low quality evidence) for
nalbuphine versus morphine. Four trials compared nalbuphine with tramadol
for postoperative pain; data from one trial (per outcome) revealed a lower
but nonsignificant RR for the need of additional rescue analgesics in
children receiving nalbuphine (RR 2 hours postop 0.75; 95% CI 0.39 to
1.43; low quality evidence) (RR 12 hours postop 0.33; 95% CI 0.04 to 2.77;
low quality evidence). One out of three trials comparing nalbuphine with
pethidine demonstrated that the RR was not significantly lower following
nalbuphine administration compared to pethidine (RR 2 hours postop 1.07;
95% CI 0.52 to 2.23; low quality evidence) (RR 24 hours postop 1.13; 95%
CI 0.52 to 2.44; very low quality evidence). The most common adverse event
was postoperative nausea and vomiting (PONV). Only one included trial
reported that the RR for PONV in the postoperative care unit (PACU) was
not significantly higher following nalbuphine compared to placebo (RR
1.00; 95% CI 0.16 to 6.42; low quality evidence) nor to morphine (RR 1.33;
95% CI 0.64 to 2.77; low quality evidence). Authors' conclusions: Because
the overall quality of available evidence was low, this systematic review
could not definitively show that the analgesic efficacy of nalbuphine is
superior compared to placebo. Furthermore, due to the lack of significant
results the comparison with other common opioids is also unclear. The same
holds true for the evidence focusing on adverse events following
nalbuphine compared to placebo or other opioid administration. The
evidence is limited, because studies did not report conclusively all
important postoperative pain outcomes (e.g. number of patients with the
need for rescue analgesia, postoperative pain scores). Thus, a
quantitative analysis was not possible for many major aspects (e.g. rescue
analgesia, pain scores) and heterogeneity could not be further
explored. Copyright © 2014 The Cochrane Collaboration.

<29>
Accession Number
620561994
Author
Fakhry F.; Fokkenrood H.J.P.; Rouwet E.V.; Teijink J.A.W.; Spronk S.;
Hunink M.G.M.
Institution
(Fakhry, Spronk, Hunink) Erasmus MC, Departments of Epidemiology and
Radiology, Dr Molewaterplein 40, PO Box 2040, Rotterdam 3015 GD,
Netherlands
(Fokkenrood, Teijink) Catharina Hospital, Department of Vascular Surgery,
Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Rouwet) Erasmus MC, Department of Vascular Surgery, Rotterdam,
Netherlands
(Spronk) Dutch Health Care Inspectorate, Department of Research and
Innovation, Utrecht, Netherlands
Title
Endovascular revascularisation versus conservative management for
intermittent claudication.
Source
Cochrane Database of Systematic Reviews. 2013 (5) (no pagination), 2013.
Article Number: CD010512. Date of Publication: 31 May 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: The main objective of this systematic review is to
summarise the (added) effect of EVR on functional performance and QoL in
the management of intermittent claudication. Copyright © 2013 The
Cochrane Collaboration.

<30>
Accession Number
618782328
Author
Hulst A.H.; Polderman J.A.W.; Ouweneel E.; Pijl A.J.; Hollmann M.W.;
DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Polderman, Ouweneel, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
(Pijl) Department of Anaesthesiology, Medical Centre Slotervaart,
Amsterdam, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
Title
Peri-operative continuation of metformin does not improve glycaemic
control in patients with type 2 diabetes: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 20 (3) (pp 749-752), 2018. Date of
Publication: March 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Historically, metformin was withheld before surgery for fear of
metformin-associated lactic acidosis. Currently, however, this risk is
deemed to be low and guidelines have moved towards the continuation of
metformin. We hypothesized that continuing metformin peri-operatively
would lower postoperative serum glucose level without an effect on plasma
lactate levels. We performed a single-blind multicentre randomized
controlled trial in people with type 2 diabetes mellitus scheduled for
non-cardiac surgery and continued (MF+ group) or withheld (MF- group)
metformin before surgery. The main outcome measures were the differences
in peri-operative plasma glucose and lactate levels. We randomized 70
patients (37 MF+ group and 33 MF- group) with type 2 diabetes mellitus.
Postoperative glucose levels were similar in the MF+ and the MF- groups
(8.2 +/- 1.8 vs 8.3 +/- 2.3 mmol/L P =.95) Although preoperative lactate
levels were slightly higher in the MF+ group compared with the MF- group
(1.5 vs 1.2 mmol/L; P =.02), the postoperative lactate levels were not
significantly different (1.2 vs 1.0 mmol/L; P =.18). In conclusion,
continuation of metformin during elective non-cardiac surgery does not
improve glucose control or raise lactate levels to a clinically relevant
degree. Copyright © 2017 John Wiley & Sons Ltd

<31>
Accession Number
620728548
Author
Compton F.; Wahed M.A.; Gregoric I.; Dasgupta A.; Tint H.
Institution
(Compton, Wahed, Gregoric, Dasgupta, Tint) University of Texas McGovern
Medical School, Houston, United States
Title
Intraoperative administration of antifbrinolytic drug tranexamic acid is
not associated with decreased intraoperative blood loss during major
cardiac surgery.
Source
American Journal of Clinical Pathology. Conference: 52nd Annual Academy of
Clinical Laboratory Physicians and Scientists Meeting, ACLPS 2017. United
States. 149 (Supplement 1) (pp S177-S178), 2018. Date of Publication:
January 2018.
Publisher
Oxford University Press
Abstract
Antifbrinolytic drugs such as tranexamic acid are used to prevent blood
loss in many clinical situations, including trauma patients and during
cardiac surgery. The goal of this study is to examine the effectiveness of
tranexamic acid in preventing intraoperative blood loss during major
cardiac surgery. Out of an initial 81 patients undergoing major cardiac
surgery (both coronary artery bypass and valve repair procedures) at our
teaching hospital, 67 patients were selected for this study. Patients
receiving signifcant intraoperative transfusion and or K-centra were
excluded. In the frst study, we selected patients who received no blood
product and compared estimated blood loss, decrease in percent hemoglobin
and hematocrit following surgery between two groups of patients, one group
receiving no tranexamic acid (n = 17) and another group receiving
tranexamic acid (n = 25). In the second study, we combined these patients
with patients receiving modest amounts of blood products (1-2 units) and
compared these parameters between two groups of patients (25 patients
received no tranexamic acid, 42 patients received tranexamic acid).
Statistical analyses were performed using independent t-test, two-tailed,
and a difference was considered statistically signifcant at 95% confdence
interval or higher (P =.05). In patients who received no blood products
during surgery, those who received no tranexamic acid showed statistically
signifcant reduced estimated blood loss (mean: 713.5 mL, SD: 351.6, n =
17) compared to those who received tranexamic acid (mean 987.2 mL, SD
459.9, n = 25). However, no statistically signifcant difference was
observed in percent reduced hemoglobin concentration or percent reduced
hematocrit associated with surgery between these two groups of patients.
We observed similar results when patients receiving no blood products and
patients receiving modest amount of blood products were combined based on
use of tranexamic acid or not, as only estimated blood loss between these
two groups was statistically signifcant (estimated blood loss in patients
not receiving tranexamic acid: mean 814.0 mL, SD 501.6, n = 25; and
estimated blood loss in patients receiving tranexamic acid: mean 1,207.1
mL, SD 488.6, n = 42). We conclude that intraoperative antifbrinolytic
therapy with tranexamic acid does not reduce intraoperative blood loss
during major cardiac surgery, which contradicts popular belief.

<32>
Accession Number
620729127
Author
Areco J.; Terra D.; Cavalleri F.; Salisbury S.; Rodriguez A.
Institution
(Areco, Terra, Cavalleri, Salisbury, Rodriguez) Surgery Division,
Department of Anesthesiology, Thorax Institute, Montevideo, Uruguay
(Areco, Terra, Cavalleri, Salisbury, Rodriguez) Hospital De Clinicas,
Universidad De la Republica, Asociacion Espanola, Montevideo, Uruguay
Title
Lung blockage assessment through ultrasound in thorax surgery: First
experience in our medium.
Source
Critical Ultrasound Journal. Conference: 13th WINFOCUS World Congress on
Ultrasound in Emergency and Critical Care. Argentina. 9 (Supplement 1) (no
pagination), 2017. Date of Publication: 2017.
Publisher
Springer-Verlag Italia s.r.l.
Abstract
Goal: Assessing the validity and effectiveness of pulmonary ultrasound
against clinical method to corroborate left selective intubation on thorax
surgery. Materials and methods: Transversal study, observational,
prospective, double blind. 59 patients in 2 different stages where
included: (1-n 15 technique development; 2-n 44). After intubation with
left double-lumen tube, sequential clamping of both lights, both
clinically assessment of position and through ultrasound with subsequent
confirmation through fibrobronchoscopy (reference standards) Stage 2
results: In 56.8% (n = 25) of cases the tube was placed properly.
Ultrasound validation (proper collocation): sensitivity of 84.0% (IC 95%
63.1-94.7), specificity of 94.7% (IC 95% 71.9-99.7), positive predictive
values 95.4% (IC 95% 75.1-99.7), negative predictive value 81.8% (IC at
95% 59.0-94.0). Validity of pulmonary auscultation: sensitivity of 96.0%
(IC at 95% 77.7-99.8), specificity of 100% (IC at 95% 79.1-100), positive
predictive values of 100% (IC at 95% 82.8-100), negative predictive value
of 95% (IC at 95% 73.1-99.7). Discussion: The difference in results with
other authors might respond to difference in expertise (first experience
on our medium), wider inclusion criteria, and number of patients. We
propose increasing the "n" and adding other ultrasonic signs of
assessment. Conclusion: Ultrasound is presented in a promising way as a
complementary tool to clinic evaluation.

<33>
Accession Number
620729035
Author
Ragg C.
Institution
(Ragg) Angioclinic Vein Centers, Berlin, Germany
Title
Updates on percutaneous valvuloplasty.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 23), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: If vein dilatation is the major component of
a valve insufficiency, long-term diameter reduction by external
compression may be a solution. Percutaneous valvuloplasty (PVP) using
cross-linked hyaluronan to achieve diameter reduction has been recently
introduced. Now, a first evaluation of an approved commercial product was
performed. Method: In this prospective controlled study, 22 patients with
proximal GSV valve incompetence but preserved and mobile valve structures
according to 8 -16MHz ultrasound analysis were included (8 f, 4m, 32 -54
yr/o): Vein diameter was 7.0 -12.0, mean 8.6mm). PVP was performed by use
of a cross-linked hyaluronan acid (Princess Volume, Croma) and a safety
cannula (Sterimedix). Results: Orthograde flow was established in 20/22
cases (90.9%). Gel volumina varied from 4 -13 ml (mean: 8.2 ml. There were
no adverse reactions. At one year follow-up, orthograde flow was present
in 14/20 cases (70.0%). 5/6 cases (83,3%) with recurring reflux
successfully received supplementary hyaluronan injections of 2 -6 ml. At
one year follow-up, the assisted success rate was 95%. Conclusions:
Percutaneous valvuloplasty is the first minimal-invasive method to
eliminate venous reflux while fully preserving the target vein. It is
effective and safe. Early detection of vein disease is mandatory to
fulfill eligibility. Maintenance injections will be required in few year's
intervals, like known from esthetic hyaluronan applications.

<34>
Accession Number
620729032
Author
Lohr J.; Wright E.; Leuenberger K.; Jiang J.
Institution
(Lohr) Lohr Surgical Specialists LLC, Cincinnati, OH, United States
(Wright) University of Cincinnati, School of Medicine, Cincinnati, OH,
United States
(Leuenberger) US Oncology, Cincinnati, OH, United States
(Jiang) Mercy Health West, Cincinnati, OH, United States
Title
Is a Negative ELISA for Heparin-Induced Thrombocytopenia Really Negative?.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 61), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: To increase awareness that a negative
enzyme-linked immunosorbent assay (ELISA) test may represent a false
negative result. Serotonin assays are confirmatory but are no longer being
routinely done in order to contain costs. This practice needs to be
carefully considered especially when platelet counts remain low. We
describe a case of heparin induced thrombocytopenia in a patient with a
negative ELISA test. Method: Case report and retrospective review of
literature of heparin and heparin-induced thrombocytopenia (HIT)
antibodies and testing. Results: The patient is a 58 year old male who
underwent aortic prosthetic valve replacement and aortic reconstruction.
His hospital course was complicated by bowel perforation and subtotal
colectomy seven days post-op. All labs were consistent with his hospital
course at that time. Ten days later while the patient was on a heparin
drip, he developed a persistent decline in platelet count. At this point,
an ELISA test was negative. Further testing, four days later included a
serotonin release assay, which came back positive for HIT. He was treated
with Argatroban. Conclusions: In a patient population where
anticoagulation is imperative, when should we be suspicious of false
negatives? The multitude of tests for HIT has varying degrees of
sensitivity and specificity. Providers must be aware that false negatives
can and do occur with both platelet aggregation studies and ELISA antibody
tests. In a patient who is not recovering as expected, there must be
suspicion for HIT and the most definitive test, the serotonin release
assay, must be performed. In some circumstances, where there is a high
degree of suspicion for HIT, it may be beneficial to bypass initial ELISA
or platelet aggregation screening tests in favor of the serotonin release
assay which will have the best chance of catching patients who may
otherwise not be discovered. Treatment and testing should be tailored to
the clinical situation.

<35>
Accession Number
620728980
Author
Kumar K.; Qualls E.; Thakur A.; Thakur V.
Institution
(Kumar) Affiliated with Medical Practice of Dr. Anjani Thakur, Turlock,
CA, United States
(Qualls) California State University, Stanislaus, Turlock, CA, United
States
(Thakur, Thakur) Valley Vein Health Center, Turlock, CA, United States
Title
Paradigm shifts in surgery and what we can expect for the future.
Source
Phlebology. Conference: 31st Annual Congress of the American College of
Phlebology, ACP 2017. United States. 32 (2 Supplement 1) (pp 50-51), 2017.
Date of Publication: December 2017.
Publisher
SAGE Publications Ltd
Abstract
Objective/Purpose Statement: Innovations in health care have shifted
standards of surgical treatment throughout history. The purpose of this
systematic review is to reflect on the paradigm shift of endovenous
ablation in the treatment of venous insufficiency and the circumstances in
which it arose, as well as conduct a comparative historical analysis of
similar paradigm shifts for other surgical interventions. Through this
comparison, we can begin to predict trends for future paradigm shifts and
how they will improve the surgical management of disease. Method: The
PubMed database was used to identify scholarly articles that allowed a
historical overview of changes in surgery paradigms. This analysis
occurred between December of 2016 and February of 2017. The articles
identified ranged from the 1920's to present. The data was analyzed to
determine changes in case volume, treatment efficacy, doctor and patient
responses to the new treatment at the time of implementation, and economic
factors in healthcare diffusion that allowed the novel treatment to become
the new treatment paradigm. Results: Specifically, the paradigm shift of
endovenous ablation modeled that of previous shifts such as peptic ulcer
disease, pulmonary tuberculosis, coronary artery bypass grafting versus
coronary angioplasty, abdominoperineal resection versus chemoradiation
therapy, and open versus laparoscopic cholecystectomy. These surgeries had
previously utilized a more invasive and often less effective treatment
modality than the newly introduced paradigm. Endovenous radiofrequency
ablation and endovenous laser ablation, compared to sclerotherapy and
ligation, have become the first-line treatments of chronic venous
insufficiency due to the lesser degree of invasiveness. Ligation alone
demonstrated a 43-71% failure rate at 5 years and ligation in conjunction
with stripping had a 25-60% failure rate. This ranged from 5 to 34 years
within the available literature.64-68 Niedzwiecki68 identified a host of
research relating risk factors associated with vein stripping and ligation
-an aggregate 0.5% average incidence of pulmonary embolism, an average 1%
incidence of deep venous thrombosis (DVT), an 8% incidence of infection,
and an approximately 0.5% incidence of lymphedema. 69-76 Paresthesia
occurred in nearly 1 in 4 patients treated by stripping from the
saphenofemoral junction, while an average of 1 in 10 patients noted
paresthesia limited to above the knee saphenous stripping66,77-80.
Endovenous laser ablation studies demonstrated high success rates
initially (ranging from 97-100%), as did early trials of laparoscopy in
treatment of acute cholecystectomy. Regarding peptic ulcer disease, we
found that the introduction of a surgical alternative, cimetidine and
proton pump inhibitors, decreased surgical management through partial
vagotomy in the U.S. by 50% between 1966 and 1978. This study also found a
significant decrease in peptic ulcer complications in the mid-eighties
that coincided with the discovery of H pylori as a causative agent for
peptic ulcer disease. 10 Rates of surgery declined from 8 to 3.3 per
100,000 individuals between 1988 and 2003 in men, and 5.5 to 2.7 in women.
Its rapid implementation was attributed to a nearly 20% savings in
treatment cost and reduced invasiveness. In pulmonary tuberculosis
management, several papers were found after the mid-1950's to address
surgical management of the disease as only secondary to administration of
isoniazid (and later) rifampicin, pyrazinamide and ethambutol.
Antimycobacterial therapy was significantly less invasive and led to a
much better quality of life outlook than earlier induced pneumothorax.
Bypass grafting was once a staple procedure in the treatment of stable
coronary artery disease, but between 2001 and 2011, the volume of CABG
operations in the U.S. decreased by nearly 46% -from 395,000 to 213,700.33
This trend was also demonstrated across the majority of OECD (Organization
for Economic Cooperation and Development) countries between 2000 and 2012.
Among European countries, Spain and France show angioplasty rates at
nearly 90%. A study conducted by the London School of Economics analyzing
healthcare diffusion found that nearly 30% of angioplasty procedures are a
direct substitutes for CABG, demonstrating a cost savings of nearly 60;
however, this shift occurred much more rapidly in wealthier nations. The
treatment of anal carcinoma saw a large shift after the publication of the
Nigro protocol of chemoradiative therapy. As of 2001, abdominoperineal
resection is performed in only 20% to 30% of rectal cancer patients across
OECD countries. Knab et al argued that there is little downside to an
attempt at laparoscopy in a patient without previous upper abdominal
surgery and that 100% of operations for acute cholecystitis should be
initiated laparoscopically. Studies also showed similar morbidity and
mortality between laparoscopic and open surgery and decreased length of
hospital stay -sometimes less than 24 hours -and decreased postoperative
pain. Several contributing factors to a successful shift were identified,
such as increased efficacy and shorter recovery period; however, some
procedures showed a shift even with resistance from physicians, like
laparoscopy initially, given significant benefits. Conclusions: Today, the
primary treatment of venous insufficiency no longer involves stripping or
ligation procedures, and demonstrated a safe and effective modality that
led to the wide availability of endovenous ablation therapy. The most
common characteristics of a successful paradigm shift were found to be
increased efficacy, minimal invasiveness, a short recovery period, cost
savings, decreased retreatment necessity, and safety. These criteria may
help us to predict which new technological advances will become future
first-line treatments, and even which treatments -such as tuberculosis
amid multidrug resistance -may regress to pre-paradigm protocols.

<36>
Accession Number
620726230
Author
Mejia O.A.V.; Sa M.P.B.O.; Deininger M.O.; Dallan L.R.P.; Segalote R.C.;
Oliveira M.A.P.; Atik F.A.; Santos M.A.D.; Silva P.G.M.B.E.; Milani R.M.;
Hueb A.C.; Monteiro R.; Lima R.C.; Lisboa L.A.F.; Dallan L.A.O.; Puskas
J.; Jatene F.B.
Institution
(Mejia, Sa, Dallan, Hueb, Monteiro, Lisboa, Dallan, Jatene) Instituto do
Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade
de Sao Paulo (InCor-HCFMUSP), Sao Paulo, SP, Brazil
(Sa, Lima) Universidade de Pernambuco (UPE), Recife, PE, Brazil
(Deininger) Hospital Alberto Urquiza Wanderley - Unimed, Joao Pessoa, PB,
Brazil
(Segalote) Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ,
Brazil
(Oliveira) Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP,
Brazil
(Atik) Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil
(Santos) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
(Silva) Total Cor Hospital - Sao Paulo, SP, Brazil
(Milani) Pontificia Universidade Catolica do Parana (PUCPR), Curitiba, PR,
Brazil
(Hueb) Hospital das Clinicas Samuel Libanio, Pouso Alegre, Minas Gerais,
Brazil
(Lima) Division of Cardiovascular Surgery, Pronto-Socorro Cardiologico de
Pernambuco (PROCAPE), Recife, PE, Brazil
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's New York, NY, USA
Title
Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients:
Study Protocol for the FRAGILE Multicenter Randomized Controlled Trial.
Source
Brazilian journal of cardiovascular surgery. 32 (5) (pp 428-434), 2017.
Date of Publication: 01 Sep 2017.
Abstract
INTRODUCTION: Advances in modern medicine have led to people living longer
and healthier lives. Frailty is an emerging concept in medicine yet to be
explored as a risk factor in cardiac surgery. When it comes to CABG
surgery, randomized controlled clinical trials have primarily focused on
low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients
(BBS), but not on frail patients. Therefore, we believe that off-pump CABG
could be an important technique in patients with limited functional
capacity to respond to surgical stress. In this study, the authors
introduce the new national, multicenter, randomized, controlled trial
"FRAGILE", to be developed in the main cardiac surgery centers of Brazil,
to clarify the potential benefit of off-pump CABG in frail patients.
METHODS: FRAGILE is a two-arm, parallel-group, multicentre, individually
randomized (1:1) controlled trial which will enroll 630 patients with
blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3
years), which aims to compare adverse cardiac and cerebrovascular events
after off-pump versus on-pump CABG in pre-frail and frail patients.
Primary outcomes will be all-cause mortality, acute myocardial infarction,
cardiac arrest with successful resuscitation, low cardiac output
syndrome/cardiogenic shock, stroke, and coronary reintervention. Secondary
outcomes will be major adverse cardiac and cerebrovascular events,
operative time, mechanical ventilation time, hyperdynamic shock, new onset
of atrial fibrillation, renal replacement therapy, reoperation for
bleeding, pneumonia, length of stay in intensive care unit, length of stay
in hospital, number of units of blood transfused, graft patency, rate of
complete revascularization, neurobehavioral outcomes after cardiac
surgery, quality of life after cardiac surgery and costs.
DISCUSSION: FRAGILE trial will determine whether off-pump CABG is superior
to conventional on-pump CABG in the surgical treatment of pre-frail and
frail patients.
TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02338947. Registered on
August 29th 2014; last updated on March 21st 2016.

<37>
Accession Number
620726208
Author
Sa M.P.B.O.; Soares A.F.; Miranda R.G.A.; Araujo M.L.; Menezes A.M.; Silva
F.P.V.; Lima R.C.
Institution
(Sa, Soares, Miranda, Araujo, Menezes, Silva, Lima) Division of
Cardiovascular Surgery, Pronto-Socorro Cardiologico de Pernambuco
(PROCAPE), Recife, PE, Brazil
(Sa, Soares, Miranda, Araujo, Menezes, Silva, Lima) Universidade de
Pernambuco (UPE), Recife, PE, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculdade de Ciencias Medicas de Pernambuco/Instituto de Ciencias
Biologicas (FCM/ICB), Recife, PE, Brazil
Title
CABG Surgery Remains the best Option for Patients with Left Main Coronary
Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled
Trials.
Source
Brazilian journal of cardiovascular surgery. 32 (5) (pp 408-416), 2017.
Date of Publication: 01 Sep 2017.
Abstract
OBJECTIVE: To compare the safety and efficacy of coronary artery bypass
grafting (CABG) with percutaneous coronary intervention (PCI) using
drug-eluting stents (DES) in patients with unprotected left main coronary
artery (ULMCA) disease.
METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles were searched for clinical studies
that reported outcomes at 1-year follow-up after PCI with DES and CABG for
the treatment of ULMCA stenosis. Five studies fulfilled our eligibility
criteria and they included a total of 4.595 patients (2.298 for CABG and
2.297 for PCI with DES).
RESULTS: At 1-year follow-up, there was no significant difference between
CABG and DES groups concerning the risk for death (risk ratio [RR] 0.973,
P=0.830), myocardial infarction (RR 0.694, P=0.148), stroke (RR 1.224,
P=0.598), and major adverse cerebrovascular and cardiovascular events (RR
0.948, P=0.680). The risk for target vessel revascularization (TVR) was
significantly lower in the CABG group compared to the DES group (RR 0.583,
P<0.001). It was observed no publication bias regarding the outcomes, but
only the outcome TVR was free from substantial statistical heterogeneity
of the effects. In the meta-regression, there was evidence that the factor
"female gender" modulated the effect regarding myocardial infarction
rates, favoring the CABG strategy.
CONCLUSION: CABG surgery remains the best option of treatment for patients
with ULMCA disease, with lower TVR rates.

<38>
Accession Number
620728255
Author
Moscarelli M.; Terrasini N.; Nunziata A.; Punjabi P.; Angelini G.; Solinas
M.; Buselli A.; Sarto P.D.; Haxhiademi D.
Institution
(Moscarelli) GVM Care and Research, Anthea Hospital, Bari, Italy
(Terrasini, Nunziata, Sarto, Haxhiademi) Operative Unit of Anesthesiology,
G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa,
Italy
(Punjabi) Imperial College of London, Hammersmith Hospital, London, UK
(Angelini) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, UK
(Solinas) Operative Unit of Cardiac Surgery, G. Pasquinucci Heart
Hospital, Fondazione Toscana G. Monasterio, Massa, Italy
(Buselli) Perfusion Department, G. Pasquinucci Heart Hospital, Fondazione
Toscana G. Monasterio, Massa, Italy
Title
A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve
Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: Minimally invasive mitral valve repair may be associated with
prolonged cardioplegic arrest times and ischemic reperfusion injury.
Intravenous (propofol) and volatile (sevoflurane) anesthesia are used
routinely during cardiac surgery and are thought to provide
cardioprotection; however, the individual contribution of each regimen to
cardioprotection is unknown. Therefore, the authors sought to compare the
cardioprotective effects of propofol and sevoflurane anesthesia in
patients undergoing minimally invasive mitral valve repair. Design: A
single-center single-blind randomized controlled trial. Setting: A
specialized regional cardiac surgery center in Italy. Participants: The
study enrolled 62 adults undergoing elective isolated minimally invasive
mitral valve repair for degenerative disease. Exclusion criteria included
secondary mitral regurgitation, previously treated coronary artery
disease, diabetes mellitus, chronic renal failure requiring dialysis,
atrial fibrillation, and documented allergy to either propofol or
sevoflurane. Interventions: All patients received video-assisted minimally
invasive right minithoracotomy. Patients were randomized to receive
propofol or sevoflurane anesthesia in a 1:1 ratio. Measurements and Main
Results: Cardiac troponin I release was measured over the first 72 hours
postoperatively. Operative, cross-clamp, and total bypass times were
similar between groups. Cardiac troponin I release was reduced
nonsignificantly in the propofol group (p = 0.62), and peak troponin I
release was correlated with cross-clamp time in both groups. There were no
differences in terms of intraoperative lactate release and blood pH
between groups. Conclusion: Propofol and sevoflurane anesthesia were
associated with similar degrees of myocardial injury, indicating
comparable cardioprotection. Myocardial injury was related directly to the
duration of cardioplegic arrest. Copyright © 2018 Elsevier Inc.

<39>
Accession Number
620719225
Author
Gunaydin S.; Robertson C.; Budak A.B.; Gourlay T.
Institution
(Gunaydin, Budak) Department of Cardiovascular Surgery, Numune Training &
Research Hospital, Ankara, Turkey
(Robertson, Gourlay) Department of Biomedical Engineering, University of
Strathclyde, Glasgow, UK
Title
Comparative evaluation of blood salvage techniques in patients undergoing
cardiac surgery with cardiopulmonary bypass.
Source
Perfusion (United Kingdom). (no pagination), 2017. Date of Publication: 01
Aug 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The primary objective of this study was to test and compare
the efficacy of currently available intraoperative blood salvage systems
via a demonstration of the level of increase in percentage concentration
of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in
the end product. Methods: In a prospective, randomized study, data of 80
patients undergoing elective cardiac surgery with cardiopulmonary bypass
in a 6-month period was collected, of which the volume aspirated from the
surgical field was processed by either the HemoSep Novel Collection Bag
(Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a
cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad
Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased
from 23.05%+/-2.7 to 43.02%+/-12 in Group 1 and from 24.5+/-2 up to
55.2+/-9 in Group 2 (p=0.013). The mean number of platelets rose to
225200+/-47000 from 116400 +/-40000 in the HemoSep and decreased from
125200+/-25000 to 96500+/-30000 in the cell-saver group (p=0.00001). The
leukocyte count was concentrated significantly better in Group 1 (from
10100+/-4300 to 18120+/-7000; p=0.001). IL-6 levels (pg/dL) decreased from
223+/-47 to 83+/-21 in Group 1 and from 219+/-40 to 200+/-40 in Group 2
(p=0.001). Fibrinogen was protected significantly better in the HemoSep
group (from 185+/-35 to 455+/-45; p=0.004). Conclusions: Intraoperative
blood salvage systems functioned properly and the resultant blood product
was superior in terms of red blood cell species. The HemoSep group had
significantly better platelet and leukocyte concentrations and fibrinogen
content. Copyright © 2017, The Author(s) 2017.

<40>
Accession Number
620719044
Author
Weinberg L.; Chiam E.; Hooper J.; Liskaser F.; Hawkins A.K.; Massie D.;
Ellis A.; Tan C.O.; Story D.; Bellomo R.
Institution
(Weinberg, Hooper, Liskaser, Hawkins, Tan) Department of Anesthesia,
Austin Health, Heidelberg, Victoria, Australia
(Weinberg, Chiam) Department of Surgery, The University of Melbourne,
Austin Health, Victoria, Australia
(Massie, Ellis) Department of Clinical Pharmacology & Therapeutics, Austin
Hospital, Heidelberg, Victoria, Australia
(Story) Anesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, Victoria, Australia
(Bellomo) Department of Intensive Care, The University of Melbourne,
Victoria, Australia
Title
Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump
prime: a prospective double-blind randomized trial.
Source
Perfusion (United Kingdom). (no pagination), 2017. Date of Publication: 01
Nov 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The mechanisms of acid-base changes during cardiopulmonary
bypass (CPB) remain unclear. We tested the hypothesis that, when used as
CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution
(HS) have differential mechanisms of action in their contribution to
acid-base changes. Methods: We performed a prospective, double-blind,
randomized trial in adult patients undergoing elective cardiac surgery
with CPB. Participants received a CPB prime solution of 2000 mL, with
either PL or HS. The primary endpoint was the standard base excess (SBE)
value measured at 60 minutes after full CPB flows (SBE60min). Secondary
outcomes included changes in SBE, pH, chloride, sodium, lactate,
gluconate, acetate, strong ion difference and strong ion gap at two
(T2min), five (T5min), ten (T10min), thirty (T30min) and sixty (T60min)
minutes on CPB. The primary outcome was measured using a two-tailed
Welch's t-test. Repeated measures ANOVA was used to test for differences
between time points. Results: Twenty-five participants were randomized to
PL and 25 to HS. Baseline characteristics, EURO and APACHE scores,
biochemistry, hematology and volumes of cardioplegia were similar. Mean
(SD) SBE at T60min was -1.3 (1.4) in the PL group and -0.1 (2.7) in the HS
group; p=0.55. No significant differences in SBE between the groups was
observed during the first 60 minutes (p=0.48). During CPB, there was
hyperacetatemia and hypergluconatemia in the PL group and hyperlactatemia
and hyperchloremia in the HS group. No significant difference between the
groups in plasma bicarbonate levels and total weak acid levels were found.
Complications and intensive care unit and hospital length of stays were
similar. Conclusions: During CPB, PL and HS did not cause a significant
metabolic acidosis. There was hyperacetatemia and hypergluconatemia with
PL and hyperchloremia and hyperlactatemia with HS. These physiochemical
effects appear clinically innocuous. Copyright © 2017, The
Author(s) 2017.

<41>
Accession Number
620572455
Author
Foroutan F.; Alba A.C.; Guyatt G.; Posada J.D.; Hing N.N.F.; Arseneau E.;
Meade M.; Hanna S.; Badiwala M.; Ross H.
Institution
(Foroutan, Alba, Posada, Hing, Badiwala, Ross) Cardiology, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Foroutan, Guyatt, Arseneau, Meade, Hanna) Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
Title
Predictors of 1-year mortality in heart transplant recipients: A
systematic review and meta-analysis.
Source
Heart. 104 (2) (pp 151-160), 2018. Date of Publication: January 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective A systematic summary of the observational studies informing
heart transplant guideline recommendations for selection of candidates and
donors has thus far been unavailable. We performed a metaanalysis to
better understand the impact of such known risk factors. Methods We
systematically searched and metaanalysed the association between known
pretransplant factor and 1-year mortality identified by multivariable
regression models. Our review used the Grading of Recommendations,
Assessment, Development and Evaluation for assessing the quality of
assessment. We pooled risk estimates by using random effects models.
Results Recipient variables including age (HR 1.16 per 10-year increase,
95% CI 1.10-1.22, high quality), congenital aetiology (HR 2.35, 95% CI
1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62,
high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to
1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09,
low quality) and short-term mechanical circulatory support (MCS) (HR 2.47,
95% CI 1.04 to 5.87, low quality) were significantly associated with
1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to
1.26, high quality) and female donor to male recipient sex mismatch (HR
1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated
with 1-year mortality. None of the operative factors proved significant
predictors. Conclusion High-quality and moderate-quality evidence
demonstrates that recipient age, congenital aetiology, creatinine,
pulsatile MCS, donor age and female donor to male recipient sex mismatch
are associated with 1-year mortality post heart transplant. The results of
this study should inform future guideline and predictive model
development. Copyright © 2018 Article author(s).

<42>
Accession Number
620596463
Author
Cassese S.; Byrne R.A.; Juni P.; Wykrzykowska J.J.; Puricel S.; Ndrepepa
G.; Schunkert H.; Fusaro M.; Cook S.; Kimura T.; Henriques J.P.S.; Serruys
P.W.; Windecker S.; Kastrati A.
Institution
(Cassese, Byrne, Ndrepepa, Schunkert, Fusaro, Kastrati) Deutsches
Herzzentrum Munchen, Technische Universitat Munchen, Lazarettstrasse, 36,
Munich 80636, Germany
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Department of Medicine, University of Toronto,
Toronto, Canada
(Wykrzykowska, Henriques) AMC Heartcenter, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Puricel, Cook) Department of Cardiology, University and Hospital
Fribourg, Fribourg, Switzerland
(Schunkert, Kastrati) DZHK (German Centre for Cardiovascular Research),
Munich Heart Alliance, Munich, Germany
(Kimura) Department of Cardiovascular Medicine, Kyoto University Hospital,
Kyoto, Japan
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Windecker) Department of Cardiology, Bern University Hospital, University
of Bern, Bern, Switzerland
Title
Midterm clinical outcomes with everolimus-eluting bioresorbable scaffolds
versus everolimus-eluting metallic stents for percutaneous coronary
interventions: A metaanalysis of randomised trials.
Source
EuroIntervention. 13 (13) (pp 1565-1573), 2018. Date of Publication:
January 2018.
Publisher
EuroPCR
Abstract
Aims: The aim of this meta-analysis was to compare the midterm clinical
outcomes of patients treated with an everolimus-eluting bioresorbable
vascular scaffold (BVS) versus an everolimus-eluting metallic stent (EES)
for percutaneous coronary interventions. Methods and results: We performed
a meta-analysis of aggregate data by searching Medline, EMBASE, Cochrane
databases and proceedings of international meetings for randomised trials
reporting the clinical outcomes beyond one year of patients treated with
BVS versus EES. The primary efficacy and safety outcomes were target
lesion failure (TLF) and definite/probable stent (scaffold) thrombosis
(ST), respectively. Secondary outcomes were the individual components of
the primary efficacy outcome (cardiac death, target vessel myocardial
infarction [MI], and ischaemia-driven target lesion revascularisation
[ID-TLR]). A total of 5,583 patients randomly received BVS (n=3,261) or
EES (n=2,322) in seven trials. Weighted median follow-up was 26.6 months.
Patients treated with BVS versus EES showed a higher risk of TLF (odds
ratio [OR] 1.35, 95% confidence interval [CI]: 1.11-1.65; p=0.0028) due to
a higher risk of target vessel MI (OR 1.68, 95% CI: 1.21-2.33; p=0.008)
and ID-TLR (OR 1.42, 95% CI: 1.10-1.84; p=0.007) though the risk for
cardiac death was not statistically different (OR 0.89, 95% CI: 0.55-1.43;
p=0.56). Patients treated with BVS versus EES showed a higher risk of
definite/probable ST (OR 3.24, 95% CI: 1.92-5.49; p<0.0001), particularly
in the period beyond one year after implantation (OR 4.03, 95% CI:
1.49-10.87; p=0.006). Conclusions: At midterm follow-up, patients treated
with BVS as compared to those treated with EES display a higher risk of
target lesion failure and scaffold thrombosis. Copyright © Europa
Digital & Publishing 2018.

<43>
Accession Number
620586659
Author
Kim T.K.; Hong D.M.; Lee S.H.; Paik H.; Min S.H.; Seo J.-H.; Jung C.-W.;
Bahk J.-H.
Institution
(Kim, Hong, Lee, Paik, Min, Seo, Jung, Bahk) Department of Anaesthesiology
and Pain Medicine, Seoul National University Hospital, Seoul National
University College of Medicine, Seoul, South Korea
Title
Effect-site concentration of remifentanil required to blunt haemodynamic
responses during tracheal intubation: A randomized comparison between
single-and double-lumen tubes.
Source
Journal of International Medical Research. 46 (1) (pp 430-439), 2018. Date
of Publication: 01 Jan 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To investigate the effect-site concentration of remifentanil
required to blunt haemodynamic responses during tracheal intubation with a
single-lumen tube (SLT) or a double-lumen tube (DLT). Methods: Patients
scheduled for thoracic surgery requiring one-lung ventilation were
randomly allocated to either the SLT or DLT group. All patients received a
target-controlled infusion of propofol and a predetermined concentration
of remifentanil. Haemodynamic parameters during intubation were recorded.
The effect-site concentration of remifentanil was determined using a
delayed up-and-down sequential allocation method. Results: A total of 92
patients were enrolled in the study. The effective effect-site
concentrations of remifentanil required to blunt haemodynamic responses in
50% of patients (EC<inf>50</inf>) estimated by isotonic regression with
bootstrapping was higher in the DLT than the SLT group (8.5 ng/ml [95%
confidence interval (CI) 8.0-9.5 ng/ml] versus 6.5 ng/ml [95% CI 5.6-6.7
ng/ml], respectively). Similarly, the effective effect-site concentrations
of remifentanil in 95% of patients in the DLT group was higher than the
SLT group (9.9 ng/ml [95% CI 9.8-10.0 ng/ml] versus 7.0 ng/ml [95% CI 6.9-
7.0 ng/ml], respectively). Conclusions: This study demonstrated that a
DLTrequires a 30% higher EC<inf>50</inf> of remifentanil than does an SLT
to blunt haemodynamic responses during tracheal intubation when combined
with a target-controlled infusion of propofol. Copyright © The
Author(s) 2017.

<44>
Accession Number
616899496
Author
Wang Y.; Zhu S.; Gao P.; Zhou J.; Zhang Q.
Institution
(Wang, Zhou, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Off-pump versus on-pump coronary surgery in patients with chronic kidney
disease: a meta-analysis.
Source
Clinical and Experimental Nephrology. 22 (1) (pp 99-109), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Patients with chronic kidney disease (CKD) have worse adverse
cardiovascular outcomes after coronary artery bypass grafting (CABG).
However, the adverse cardiovascular outcomes between off-pump coronary
artery bypass grafting (OPCAB) versus on-pump coronary artery bypass
grafting (ONCAB) in these patients have been a subject of debate. Methods:
We undertook a comprehensive literature search of PubMed, Embase, and the
Cochrane Library database to identify all relevant studies comparing
techniques between OPCAB and ONCAB in CKD patients. We pooled the odds
ratios (ORs) and hazard ratios (HRs) from individual studies and conducted
heterogeneity, quality assessment, and publication bias analyses. Results:
This meta-analysis includes 17 studies with 201,889 patients. In CKD
patients, OPCAB was associated with significantly lower early mortality as
compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was
associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI
0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95;
p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005),
pneumonia, prolonged ventilation, and shorter hospital stays. No
difference was found regarding long-term survival (HR 1.08; 95% CI
0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38;
p = 0.26). Conclusions: Compared with ONCAB, OPCAB is associated with
superior postoperative morbidity and the early mortality in CKD patients.
Long-term survival is comparable between the two surgical
revascularizations. Copyright © 2017, Japanese Society of
Nephrology.

<45>
Accession Number
614230170
Author
Cao S.; Jin S.; Cao J.; Shen J.; Zhang H.; Meng Q.; Pan B.; Yu Y.
Institution
(Cao, Jin, Cao, Shen, Zhang, Meng, Pan, Yu) Department of Medical
Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road,
Harbin 150081, China
Title
Malignant pericardial mesothelioma: A systematic review of current
practice.
Source
Herz. 43 (1) (pp 61-68), 2018. Date of Publication: 01 Feb 2018.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Malignant mesothelioma is a rare but aggressive tumor, with a
high misdiagnosis rate and overall bleak prognosis. In 0.7% of all cases,
the origin is the pericardium. Methods: The present study is a review of
the literature published in recent decades focusing on the advances in
clinical manifestations, radiological findings, diagnosis, differential
diagnosis, and treatment of malignant pericardial mesothelioma (MPM).
Results: No clear relationship has been established between the etiologies
and the development of MPM. Clinical symptoms and signs are nonspecific
when present. The main presentations are chest pain and dyspnea. Imaging
plays an important role in the detection, characterization, staging, and
posttreatment follow-up. The definitive diagnosis is made on the basis of
pathological findings. Chest radiography and echocardiography are common
techniques used initially, but their roles are limited. Computed
tomography and magnetic resonance imaging have an advantage in depicting
the thickened pericardium, mediastinal lymph node, tumor, and the
extension of adjacent structures. Surgery is the most important treatment
modality and remains palliative in most cases, while the roles of chemo-
and radiotherapy are unsatisfactory. Conclusion: Clinical trials of
malignant pleural and peritoneal mesothelioma remain important for MPM
management. Multimodality treatment of surgery, chemotherapy,
radiotherapy, and immunotherapy is expected to have a role in the
treatment of MPM. Copyright © 2016, Springer Medizin Verlag
Berlin.

<46>
Accession Number
619169404
Author
Thein P.M.; White K.; Banker K.; Lunny C.; Mirzaee S.; Nasis A.
Institution
(Thein) Department of Medicine, Monash Medical Centre, Monash Health,
Melbourne, Vic, Australia
(Thein, White, Banker) Monash University, School of Public Health and
Preventive Medicine, Melbourne, Vic, Australia
(Lunny) Department of Epidemiology and Preventive Medicine, School of
Public Health and Preventive Medicine, Cochrane Australia, Melbourne, Vic,
Australia
(Mirzaee, Nasis) MonashHeart, Monash Cardiovascular Research Centre,
Monash Health Department of Medicine (MMC), Monash University, Melbourne,
Vic, Australia
Title
Preoperative Use of Oral Beta-Adrenergic Blocking Agents and the Incidence
of New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic
Review and Meta-Analysis.
Source
Heart Lung and Circulation. 27 (3) (pp 310-321), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Current epidemiological data suggests that postoperative
atrial fibrillation or atrial flutter (POAF) causes significant morbidity
and mortality after cardiac surgery. The literature for prophylactic
management of POAF is limited, resulting in the lack of clear guidelines
on management recommendations. Aim: To examine the efficacy of
prophylactic rate control agents in reducing the incidence of new-onset
POAF in patients undergoing elective cardiac surgery. Methods: Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and Medline were
systematically searched for blinded randomised controlled studies (RCT)
evaluating adults with no history of atrial fibrillation randomised to a
pharmacological agent (either beta blocker, calcium channel blocker or
digoxin), compared to placebo. Utilising Cochrane guidance, three
reviewers screened, extracted and the quality of the evidence was
assessed. We used a random effects meta-analysis to compare a rate-control
agent with placebo. Results: Five RCTs (688 subjects, mean age 61 +/- 8.9,
69% male) were included. Beta blocker administration prior to elective
cardiac surgery significantly reduced the incidence of POAF (OR 0.43,
95%Cl [0.30-0.61], I2 = 0%) without significant impact on
ischaemic stroke (OR 0.49, 95%Cl [0.10-2.44], I2 = 0%),
non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44], I2
= 0%), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I2 = 0%),
or length of stay (mean -0.96 days 95%Cl [-1.49 to -0.42], I2 =
0%). An increased rate of bradycardic episodes was observed (OR 3.53,
95%Cl [1.22-10.23], I2 = 0%). Conclusions: This review suggests
that selective administration of prophylactic oral beta blockers prior to
elective cardiac surgery is safe and may reduce the incidence of
POAF. Copyright © 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<47>
Accession Number
615868878
Author
Nazer R.I.; Albarrati A.M.
Institution
(Nazer) Department of Cardiac Science, King Fahad Cardiac Center, College
of Medicine, King Saud University, Riyadh, Saudi Arabia
(Albarrati) Department of Rehabilitation Science, College of Applied
Medical Science, King Saud University, Riyadh, Saudi Arabia
Title
Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After
Coronary Bypass Surgery.
Source
Heart Lung and Circulation. 27 (3) (pp 371-376), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Topical cooling with ice slush as an adjunct for myocardial
protection during cardiac surgery has been shown to cause freezing injury
of the phrenic nerves. This can cause diaphragmatic dysfunction and
respiratory complications. Methods: Twenty (n = 20) male patients between
the ages of 40 and 60 years were equally randomised to undergo elective
coronary artery bypass grafting (CABG) with either cold cardioplegic
arrest with topical ice slush cooling or cold cardioplegic arrest without
the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to
compare inspiratory muscle strength. Results: There was no difference in
the preoperative SNIF in the two randomised groups. In the immediate
postoperative period, the ice slush group had worse SNIF (33.5 +/- 9.6 cm
H2O versus 47.8 +/- 12.2 cm H2O; p = 0.009). The pre-home discharge SNIF
was still significantly lower for the ice slush group despite a noted
improvement in SNIF recovery in both groups (38.3 +/- 10.6 cm H2O versus
53.5 +/- 13.2 cm H2O; p = 0.011). Two patients in the ice slush group had
left diaphragmatic dysfunction with none in the control group. Conclusion:
The use of topical ice slush is associated with freezing injury of the
phrenic nerves. This will adversely affect the inspiratory muscle force
which may lead to respiratory complications after surgery. Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<48>
Accession Number
620401046
Author
Collet J.-P.; Cayla G.; Ennezat P.-V.; Leclercq F.; Cuisset T.; Elhadad
S.; Henry P.; Belle L.; Cohen A.; Silvain J.; Barthelemy O.; Beygui F.;
Diallo A.; Vicaut E.; Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Montalescot) Sorbonne Universite Paris 6,
ACTION Study Group, Institut de Cardiologie Hopital Pitie-Salpetriere
(APHP), INSERM UMRS, Paris 1166, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Universite de
Montpellier, Nimes, France
(Ennezat) Cardiologie, Pole Thorax et Vaisseaux, CHU La Tronche, Grenoble,
France
(Leclercq) Cardiologie, Hopital Arnaud de Villeneuve-CHU Montpellier,
France
(Cuisset) Department of Cardiology, CHU Timone and Aix-Marseille Univ,
INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis,
Faculty of Medicine, Marseille F-13385, France
(Elhadad) Cardiologie, CH de Lagny-Marne la Vallee, Jossigny, France
(Henry) Cardiologie, CHU Lariboisiere (APHP), Paris, France
(Belle) Cardiologie, Centre Hospitalier d'Annecy, France
(Cohen) Cardiologie, CHU Saint-Antoine (APHP), Paris, France
(Beygui) Cardiologie, Hopital de la Cote de Nacre, Caen, France
(Diallo, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), France and Universite Denis Diderot, Paris, France
Title
Systematic detection of polyvascular disease combined with aggressive
secondary prevention in patients presenting with severe coronary artery
disease: The randomized AMERICA Study.
Source
International Journal of Cardiology. 254 (pp 36-42), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The prevalence and associated-risk of asymptomatic multisite
artery disease (MSAD) in high risk coronary patients are unknown. Whether
systematic identification and aggressive management of asymptomatic MSAD
is clinically relevant in high risk coronary patients has not been
evaluated. Methods: We randomly assigned 521 high risk coronary patients
defined by the presence of three-vessel coronary disease (n = 304) or
recent acute coronary syndrome beyond the age of 75 years (n = 215) to
either a strategy of systematic detection of asymptomatic MSAD combined
with an aggressive secondary prevention (n = 263) or to a more
conventional strategy based on treatment of coronary artery disease only
with standard of care (n = 258). The primary end point was the time to
first occurrence of death, any organ failure or ischemic event leading to
re-hospitalization through two years of follow-up. Results: The pro-active
strategy identified asymptomatic MSAD in 21.7% of patients with few
revascularizations (3.6%); the pro-active pharmacological secondary
prevention was obtained in > 85% of patients and life-style changes in <
60% of patients. At 2-year follow-up, the primary end point occurred in
44.9% of patients in the pro-active group and 43.0% of patients in the
conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34].
The rate of major bleeding did not differ significantly between groups
(4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). Conclusion: In high risk
coronary patients, there is no apparent benefit of a systematic detection
of asymptomatic extra-coronary atherothrombotic disease and intensified
treatment over a 2-year follow-up period. (Funded by the Academic Allies
in Cardiovascular Trials Initiatives and Organized Networks and Institut
de l'Atherothrombose; AMERICA ClinicalTrials.gov number,
NCT00445835). Copyright © 2017 Elsevier Ireland Ltd

<49>
Accession Number
620607562
Author
van der Heijden L.C.; Kok M.M.; Zocca P.; Sen H.; Lowik M.M.; Mariani S.;
de Man F.H.A.F.; Hartmann M.; Stoel M.G.; Gert van Houwelingen K.;
Louwerenburg J.H.W.; Linssen G.C.M.; Doggen C.J.M.; Grandjean J.G.; von
Birgelen C.
Institution
(van der Heijden, Kok, Zocca, Sen, Lowik, de Man, Hartmann, Stoel, Gert
van Houwelingen, Louwerenburg, von Birgelen) Department of Cardiology,
Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
(Mariani, Grandjean) Department of Cardiothoracic Surgery, Thoraxcentrum
Twente, Medisch Spectrum Twente, Enschede, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo and
Hengelo, Netherlands
(Doggen, von Birgelen) Department of Health Technology and Services
Research, MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Long-term outcome of consecutive patients with previous coronary bypass
surgery, treated with newer-generation drug-eluting stents.
Source
Journal of the American Heart Association. 7 (3) (no pagination), 2018.
Article Number: e007212. Date of Publication: 01 Feb 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Percutaneous coronary intervention (PCI) in patients with
previous coronary artery bypass grafting (CABG) is associated with adverse
clinical events. Although newer generation drug-eluting stents showed
favorable short-term safety profiles, there is a lack of long-term outcome
data. We evaluated the impact of previous CABG on 5-year clinical outcomes
of patients treated with PCI using newer-generation drug-eluting stents.
Methods and Results--In this patient-level pooled analysis of the
prospective TWENTE (The Real-World Endeavor Resolute versus Xience V
Drug-Eluting Stent Study in Twente) trial and nonenrolled TWENTE registry,
we assessed a consecutive series of patients who underwent PCI with
newer-generation drug-eluting stents for non-ST-segment-elevation acute
coronary syndromes or stable angina. Of all 1709 patients, 202 (11.8%) had
a history of CABG. Patients with previous CABG had significantly higher
5-year rates of cardiac death (10.4% versus 4.3%; P < 0.001) and target
vessel revascularization (25.0% versus 8.1%; P < 0.001). These differences
remained statistically significant after adjustment for differences in
baseline characteristics. Landmark analysis revealed that from 1- to
5-year follow-up, the rates of cardiac death (8.1% versus 3.2%; P < 0.001)
and target vessel revascularization (17.1% versus 5.9%; P < 0.001) were
significantly higher in patients with previous CABG. Among patients with a
history of CABG, PCI of an obstructed vein graft was associated with a
higher rate of 5-year target vessel revascularization (P=0.003).
Conclusions--At 5-year follow-up after PCI with newer-generation
drug-eluting stents, the risk of cardiac death and target vessel
revascularization was significantly higher in patients with previous CABG.
The target vessel revascularization rate was highest in patients who
underwent PCI of obstructed vein grafts. Copyright © 2018 The
Authors.

<50>
Accession Number
620597915
Author
Rashid H.N.; Gooley R.P.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Nasis A.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Gooley, Nerlekar, Ihdayhid, McCormick, Nasis, Cameron, Brown)
Monash Cardiovascular Research Centre, Monash University and MonashHeart,
Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
Title
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector
computed tomography is associated with adverse cerebrovascular events: A
meta-analysis of observational studies.
Source
EuroIntervention. 13 (15) (pp e1748-e1755), 2018. Date of Publication:
February 2018.
Publisher
EuroPCR
Abstract
Aims: Leaflet thrombosis (LT) has become increasingly recognised following
transcatheter and surgical aortic bioprosthetic valve (ABV) replacement
and can be reliably identified by multidetector computed tomography
(MDCT). However, it is an ongoing debate whether MDCT-defined LT is
associated with adverse cerebrovascular outcomes. We sought to perform a
systematic review and meta-analysis in order to assess the incidence and
clinical outcomes associated with MDCT-defined leaflet thrombosis
following (ABV) replacement. Methods and results: Electronic databases
were searched for studies that performed mandatory MDCT imaging following
ABV replacement. The primary endpoint was the incidence of cerebrovascular
events, defined as a composite of stroke or transient ischaemic attack
(TIA). Secondary endpoints included major adverse cerebrovascular and
cardiovascular events (MACCE), stroke, TIA, death or myocardial
infarction. In total, six studies met the inclusion criteria with 11.6%
(198/1,704) of patients having MDCT-defined LT. The prevalence of LT
following transcatheter and surgical ABV replacement was 13.2% and 3.6%,
respectively. Cerebrovascular events were significantly increased in
patients with LT (odds ratio [OR] 3.38, 95% CI: 1.78-6.41, p<0.001). The
risk of MACCE (OR 2.10, 95% CI: 1.21-3.64, p<0.001) and TIA (OR 5.86, 95%
CI: 2.05-16.75, p<0.001) was also increased in patients with LT, although
there were no differences in the incidence of stroke (OR 2.43, 95% CI:
1.00-5.93, p=0.05), death (OR 0.92, 95% CI: 0.42-2.03, p=0.84) or
myocardial infarction (OR 1.72, 95% CI: 0.34-9.78, p=0.54) between groups.
Conclusions: MDCT-defined LT following ABV replacement is associated with
a significantly increased risk of adverse cerebrovascular events. Further
prospective studies are required to ascertain whether LT can be prevented
or treated with pharmacological strategies. Copyright © Europa
Digital & Publishing 2018. All rights reserved.

<51>
Accession Number
620572429
Author
Ahmad Y.; Demir O.; Rajkumar C.; Howard J.P.; Shun-Shin M.; Cook C.;
Petraco R.; Jabbour R.; Arnold A.; Frame A.; Sutaria N.; Ariff B.;
Kanaganayagam G.; Francis D.; Mayet J.; Mikhail G.; Malik I.; Sen S.
Institution
(Ahmad, Demir, Rajkumar, Howard, Shun-Shin, Cook, Petraco, Jabbour,
Arnold, Frame, Sutaria, Ariff, Kanaganayagam, Francis, Mayet, Mikhail,
Malik, Sen) International Centre for Circulatory Health, Hammersmith
Hospital, Imperial College London, London, United Kingdom
Title
Optimal antiplatelet strategy after transcatheter aortic valve
implantation: A meta-analysis.
Source
Open Heart. 5 (1) (no pagination), 2018. Article Number: e000748. Date of
Publication: February 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: International guidelines recommend the use of dual antiplatelet
therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The
recommended duration of DAPT varies between guidelines. In this two-part
study, we (1) performed a structured survey of 45 TAVI centres from around
the world to determine if there is consensus among clinicians regarding
antiplatelet therapy after TAVI; and then (2) performed a systematic
review of all suitable studies (randomised controlled trials (RCTs) and
registries) to determine if aspirin monotherapy can be used instead of
DAPT. Methods: A structured electronic survey regarding antiplatelet use
after TAVI was completed by 45 TAVI centres across Europe, Australasia and
the USA. A systematic review of TAVI RCTs and registries was then
performed comparing DAPT duration and incidence of stroke, bleeding and
death. A variance weighted least squared metaregression was then performed
to determine the relationship of antiplatelet therapy and adverse events.
Results: 82.2% of centres routinely used DAPT after TAVI. Median duration
was 3 months. 13.3% based their practice on guidelines. 11 781 patients
(26 studies) were eligible for the metaregression. There was no benefit of
DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or
bleeding (P=0.91). Discussion: Aspirin monotherapy appears to be as safe
and effective as DAPT after TAVI. Copyright © Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017.

<52>
Accession Number
619924238
Author
Santhanam H.; Yang L.; Chen Z.; Tai B.-C.; Rajgor D.D.; Quek S.-C.
Institution
(Santhanam, Yang, Rajgor, Quek) Department of Paediatrics, Yong Loo Lin
School of Medicine, National University of Singapore, Singapore
(Santhanam, Yang, Rajgor, Quek) Khoo Teck Puat-National University
Children's Medical Institute, National University Health System, Singapore
(Chen) Investigational Medicine Unit, National University Health System,
Singapore
(Tai) Saw Swee Hock School of Public Health, National University of
Singapore, Singapore, Singapore
Title
A meta-analysis of transcatheter device closure of perimembranous
ventricular septal defect.
Source
International Journal of Cardiology. 254 (pp 75-83), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: While transcatheter device closure of ventricular septal
defects (VSDs) is gaining popularity, concerns remain about adverse
events; particularly heart block in peri-membranous VSDs (pmVSDs). The aim
of this study is to ascertain outcomes of transcatheter device closure of
pmVSDs through a meta-analysis of current literature. Methods: A PubMed
and Scopus search for studies in English on device closure of pmVSDs
published till end-February 2017 was performed. Exclusion criteria
included case series already included in multi-centre studies, sample size
< 5, and VSD acquired following myocardial infarction. Pooled estimates of
success and complications was obtained using the random effects model.
Results: A total of 54 publications comprising 6762 patients with pmVSDs
were included. The mean age of patients ranged from 1.6 to 37.4 years. The
pooled estimate of successful device implantation is 97.8% (95% CI: 96.8
to 98.6). The most common complication is residual shunt (15.9%; 95% CI:
10.9 to 21.5). Other complications include arrhythmias (10.3%; 95% CI: 8.3
to 12.4) and valvular defects (4.1%; 95% CI: 2.4 to 6.1). The pooled
estimate of complete atrioventricular block (cAVB) is 1.1% (95% CI: 0.5 to
1.9). Conclusion: Our meta-analysis suggests that device closure of pmVSDs
is a safe and effective procedure. The complication of cAVB is low but
significant. The risk is expected to further reduce with newer devices
which are less stiff with improved profiles. Further studies validating
this will be useful in formulating guidelines for device closure of
pmVSDs. Copyright © 2017 Elsevier Ireland Ltd

<53>
Accession Number
620608858
Author
Li D.; Hirata Y.; Zhou X.; Masuzawa A.; Ono M.; An Q.
Institution
(Li, An) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang, Sichuan 610041, China
(Li, Hirata, Masuzawa, Ono) Department of Cardiac Surgery, University of
Tokyo, Tokyo, Japan
(Zhou) Evidence-Based Medicine Research Center, School of Basic Medical
Sciences, Jiangxi University of Traditional Chinese Medicine, Jiangxi,
China
Title
Effect of cone reconstruction on right ventricular function in patients
with Ebstein's anomaly: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 301-306),
2018. Date of Publication: 01 Feb 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Cone reconstruction (CR) is a novel technique for surgically
treating the tricuspid valve and right ventricle (RV) in patients with
Ebstein's anomaly. However, precise changes in the RV function after CR
remain unclear. This study aimed to evaluate the RV size and New York
Heart Association (NYHA) functional class by conducting a meta-analysis of
reported data. METHODS The MEDLINE, EMBASE, Cochrane Library and China
National Knowledge Infrastructure databases were searched for relevant
studies. The variables were RV measurements, NYHA functional classes and
tricuspid valve regurgitation grades. A fixed/random effects model was
used to summarize the estimates of mean difference with standard error.
Sensitivity analysis was conducted to ascertain the primary origin of the
heterogeneity. RESULTS Nine studies that involved 210 patients were
included. The results demonstrated that after CR, the functional RV volume
significantly decreased, NYHA functional class improved and tricuspid
valve regurgitation grade decreased. CONCLUSIONS Thus, CR appeared to be a
positive approach for Ebstein's anomaly, with good results being obtained
for the RV size and NYHA functional class. Because some limitations could
not be overcome, studies with more data on RV and longer follow-ups are
required to confirm our study results. Copyright © 2017 The
Author.

<54>
Accession Number
620608825
Author
Meco M.; Miceli A.; Montisci A.; Donatelli F.; Cirri S.; Ferrarini M.; Lio
A.; Glauber M.
Institution
(Meco) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
(Miceli, Montisci, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Center, Istituto Clinico sant'Ambrogio, Gruppo Ospedaliero
San Donato, Via G. Faravelli 16, Milan 20149, Italy
(Miceli) Department of Clinical Science at South Bristol, University of
Bristol, Bristol, United Kingdom
(Donatelli) Department of Cardiac Surgery, University of Milan, Milan,
Italy
Title
Sutureless aortic valve replacement versus transcatheter aortic valve
implantation: A meta-analysis of comparative matched studies using
propensity score matching.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 207-209),
2018. Date of Publication: 01 Feb 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare outcomes of
patients undergoing transcatheter aortic valve implantation (TAVI) with
those undergoing surgical aortic valve replacement using sutureless
valves. METHODS: A systematic review and meta-analysis in accordance with
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement was performed. RESULTS: No randomized controlled trials
were identified. Six comparative studies using propensity score matching
met the inclusion criteria. This meta-analysis identified 1462 patients in
that 731 patients underwent surgical aortic valve replacement using
sutureless valves (SU) and 731 patients underwent a TAVI. The 30-day or
in-hospital mortality was lower in the SU group [odds ratio (OR) 0.54, 95%
confidence interval (CI) 0.36-0.80; P = 0.003]. In the TAVI group, the
incidence of postoperative stroke was higher (OR 0.36, 95% CI 0.17-0.79; P
= 0.01). The incidence of moderate or severe paravalvular regurgitation
was higher in the TAVI group (OR 0.22, 95% CI 0.14-0.35; P = 0.001). There
were neither differences in the postoperative renal failure (OR 1.44, 95%
CI 0.46-4.58; P = 0.53) nor in the number of patients requiring
postoperative pacemaker implantation (OR 1.06, 95% CI 0.54-2.08; P =
0.86). Patients in the SU group required more transfusions (OR 4.47, 95%
CI 2.77-7.21; P = 0.0001), whereas those in the TAVI group had higher
major vascular complications (OR 0.06, 95% CI 0.01-0.25; P = 0.0001).
Intensive care unit stay was not different (mean difference 0.99, 95%
CI-1.22 to 1.40; P = 0.53). One-year survival was better in the SU group
(Peto OR 0.35, 95% CI 0.18-0.67; P = 0.001), as was the 2-year survival
(Peto OR 0.38, 95% CI 0.17-0.86; P = 0.001). CONCLUSIONS: Surgical aortic
valve replacement using sutureless valves is associated with better early
and mid-term outcomes compared with TAVI in high-or intermediate-risk
patients. Copyright © 2017 The Author.

<55>
Accession Number
620590629
Author
Berwanger O.; de Barros e Silva P.G.M.; Dall Orto F.T.C.; de Andrade P.B.;
de Castro Bienert I.R.; Bosso C.E.; Mangione J.; Polanczyk C.A.; Sousa A.;
Kalil R.; de Moura Santos L.; Sposito A.C.; Rech R.L.; Sousa A.C.S.;
Baldissera F.; Nascimento B.R.; de Andrade Jesuino I.; Santucci E.V.;
Damiani L.P.; Laranjeira L.N.; Borges de Oliveira J.A.; Giraldez R.R.;
Cavalcanti A.B.; Pereira S.B.; Mattos L.A.; Armaganijan L.V.; Guimaraes
H.P.; Sousa J.E.; Alexander J.H.; Granger C.B.; Lopes R.D.
Institution
(Berwanger, de Barros e Silva, Dall Orto, de Andrade, de Castro Bienert,
Bosso, Mangione, Polanczyk, Sousa, Kalil, de Moura Santos, Sposito, Rech,
Sousa, Baldissera, Nascimento, de Andrade Jesuino, Santucci, Damiani,
Laranjeira, Borges de Oliveira, Giraldez, Cavalcanti, Pereira, Mattos,
Armaganijan, Guimaraes, Sousa, Alexander, Granger, Lopes) Research
Institute-Heart Hospital (HCor), Rua Abilio Soares 250, 12th floor, Sao
Paulo, SP 04005-000, Brazil
Title
Rationale and design of the Statins Evaluation in Coronary procedUres and
REvascularization: The SECURE-PCI Trial.
Source
American Heart Journal. 198 (pp 129-134), 2018. Date of Publication: April
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Previous evidence suggests that acute treatment with statins
reduce atherosclerotic complications, including periprocedural myocardial
infarction, but currently, there are no large, adequately powered studies
to define the effects of early, high-dose statins in patients with acute
coronary syndrome (ACS) and planned invasive management. Objectives: The
main goal of Statins Evaluation in Coronary procedUres and
REvascularization (SECURE-PCI) Trial is to determine whether the early use
of a loading dose of 80 mg of atorvastatin before an intended percutaneous
coronary intervention followed by an additional dose of 80 mg 24 hours
after the procedure will be able to reduce the rates of major
cardiovascular events at 30 days in patients with an ACS. Design: The
SECURE-PCI study is a pragmatic, multicenter, double-blind,
placebo-controlled randomized trial planned to enroll around 4,200
patients in 58 different sites in Brazil. The primary outcome is the rate
of major cardiovascular events at 30 days defined as a composite of
all-cause mortality, nonfatal acute myocardial infarction, nonfatal
stroke, and coronary revascularization. The SECURE PCI is a large
randomized trial testing a strategy of early, high-dose statin in patients
with ACS and will provide important information about the acute treatment
of this patient population. Copyright © 2018

<56>
Accession Number
620572435
Author
Lee J.C.; Branch K.R.; Hamilton-Craig C.; Krieger E.V.
Institution
(Lee, Branch, Hamilton-Craig, Krieger) Division of Cardiology, Department
of Medicine, University of Washington, Seattle, WA, United States
(Hamilton-Craig) Centre for Advanced Imaging, University of Queensland,
Brisbane, QLD, Australia
(Hamilton-Craig) Department of Cardiology, Heart and Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
(Krieger) Seattle Adult Congenital Heart Service, University of
Washington, School of Medicine, Seattle, WA 98195, United States
Title
Evaluation of aortic regurgitation with cardiac magnetic resonance
imaging: A systematic review.
Source
Heart. 104 (2) (pp 103-110), 2018. Date of Publication: January 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
This review summaries the utility, application and data supporting use of
cardiac magnetic resonance imaging (CMR) to evaluate and quantitate aortic
regurgitation. We systematically searched Medline and PubMed for original
research articles published since 2000 that provided data on the
quantitation of aortic regurgitation by CMR and identified 11 articles for
review. Direct aortic measurements using phase contrast allow quantitation
of volumetric flow across the aortic valve and are highly reproducible and
accurate compared with echocardiography. However, this technique requires
diligence in prescribing the correct imaging planes in the aorta.
Volumetric analytic techniques using differences in ventricular volumes
are also highly accurate but less than phase contrast techniques and only
accurate when concomitant valvular disease is absent. Comparison of both
aortic and ventricular data for internal data verification ensures
fidelity of aortic regurgitant data. CMR data can be applied to many types
of aortic valve regurgitation including combined aortic stenosis with
regurgitation, congenital valve diseases and post-transcatheter valve
placement. CMR also predicts those patients who progress to surgery with
high overall sensitivity and specificity. Future studies of CMR in
patients with aortic regurgitation to quantify the incremental benefit
over echocardiography as well as prediction of cardiovascular events are
warranted. Copyright © Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2018.

<57>
Accession Number
620499772
Author
Niu Z.; Zheng M.; Zhang Z.; Wang B.; Shan S.
Institution
(Niu, Zheng, Zhang, Wang, Shan) Department of Anesthesiology, Cangzhou
Central Hospital, Cangzhou, Hebei Province, China
Title
A randomized controlled study: The effect of endobronchial blocker and
double-lumen endobronchial tube on one-lung ventilation in thoracic spinal
tuberculosis surgery.
Source
International Journal of Clinical and Experimental Medicine. 11 (1) (pp
327-333), 2018. Article Number: IJCEM0067991. Date of Publication: 2018.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To compare the effect of endobronchial blocker and double-lumen
endobronchial tube on one-lung ventilation in thoracic spinal tuberculosis
surgery. Methods: A total of 160 patients with thoracic spinal
tuberculosis who were treated with thoracic surgery under one-lung
ventilation from January 2015 to December 2016 in our hospital were
selected as subjects. Patients were divided into group 1 (using
double-lumen endobronchial tube) and group 2 (using endobronchial blocker)
according to the method of random number table. The differences in scores
of surgical field quality, time of lung collapse, success rate of cannula,
and partial pressure of carbon dioxide (PaCO<inf>2</inf>), partial
pressure of oxygen (PaO<inf>2</inf>), platform airway pressure (Pplat),
and peak airway pressure (Ppeak) during one-lung ventilation and two-lung
ventilation between two groups were compared. After operation, the
occurrence of hoarseness, pulmonary infection, pharyngalgia and other
complications of patients were evaluated by professional anesthetists.
Results: Scores of surgical field quailty and time of lung collapse in
group 2 were higher than those in group 1 while the one-time success rate
of intubation was significantly lower than that in group 1 (all P<0.001).
The PaO<inf>2</inf> of both groups after one-lung ventilation was lower
than that after anesthesia and recovery of double-lumen ventilation (all
P<0.05). And PaO<inf>2</inf> 60 minutes after one-lung ventilation was
lower than that 20 minutes after one-lung ventilation (all P<0.05).
PaO<inf>2</inf> at each time point during one-lung ventilation in group 1
was lower than that in group 2 (all P<0.05). There was no significant
difference in PaCO<inf>2</inf> between two groups at each time point (all
P>0.05). Ppeak and Pplat of two groups were elevated during one-lung
ventilation and it was found that Ppeak and Pplat in group 1 were higher
than those in group 2 at different time points (all P<0.05). The incidence
of complications of hoarseness, pulmonary infection, and pharyngalgia
after operation in group 2 was lower than that in group 1 (all P<0.05).
Conclusion: Endobronchial blocker for thoracic surgery was worthy of
clinical promotion because when compared with double-lumen endobronchial
tube, it has better visual field, slighter blood-gas changes and lower
incidence of complications of hoarseness, pulmonary infection, and
pharyngalgia after operation. Copyright © 2018, E-Century
Publishing Corporation. All rights reserved.

<58>
Accession Number
620585026
Author
Pearman C.M.; Poon S.S.; Bonnett L.J.; Haldar S.; Wong T.; Mediratta N.;
Gupta D.
Institution
(Pearman, Poon, Gupta) Department of Cardiology, Liverpool Heart and Chest
Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
(Mediratta) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, United Kingdom
(Pearman) Division of Cardiovascular Sciences, School of Medical Sciences,
Manchester Academic Health Science Centre, University of Manchester,
United Kingdom
(Bonnett) Department of Biostatistics, University of Liverpool, United
Kingdom
(Haldar, Wong) Heart Rhythm Centre, NIHR Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Foundation Trust,
Institute of Cardiovascular Medicine and Science, Imperial College London,
United Kingdom
Title
Minimally invasive epicardial surgical ablation alone versus hybrid
ablation for atrial fibrillation: A systematic review and meta-analysis.
Source
Arrhythmia and Electrophysiology Review. 6 (4) (pp 202-209), 2017. Date of
Publication: Winter 2017.
Publisher
Radcliffe Publishing Ltd (E-mail: managingeditor@radcliffecardiology.com)
Abstract
Maintaining sinus rhythm in patients with non-paroxysmal AF is an elusive
goal. Some suggest that hybrid ablation, combining minimally invasive
epicardial surgical ablation with endocardial catheter ablation, may be
more effective than either modality alone. However, randomised trials are
lacking. We investigated whether hybrid ablation is more effective than
epicardial ablation alone at preventing recurrent AF by performing a
systematic review and meta-analysis. The review was prospectively
registered with PROSPERO (CRD42016043389). MEDLINE and EMBASE were
searched for studies of standalone minimally invasive epicardial ablation
of AF and/or hybrid ablation, identifying 41 non-overlapping studies
comprising 2737 patients. A random-effects meta-analysis, meta-regression
and sensitivity analysis were performed. Single-procedure survival free
from atrial arrhythmias without antiarrhythmic drugs was similar between
epicardial-alone and hybrid approaches at 12 months (epicardial alone 71.5
%; [95 % CI 66.1-76.9], hybrid 63.2 %; [95 % CI 51.5-75.0]) and 24 months
(epicardial alone 68.5 %; [95 % CI 57.7-79.3], hybrid 57.0 %; [95 % CI
33.6-80.4]). Freedom from atrial arrhythmias with AADs and rates of
unplanned additional catheter ablations were also similar between groups.
Major complications occurred more often with hybrid ablation (epicardial
alone 2.9 %; [95 % CI 1.9-3.9], hybrid 7.3 %; [95 % CI 4.2-10.5]).
Meta-regression suggested that bipolar radiofrequency energy and
thoracoscopic access were associated with greater efficacy, but adjusting
for these factors did not unmask any difference between epicardial-alone
and hybrid ablation. Hybrid and epicardial ablation alone appear to be
equally effective treatments for AF, although hybrid ablation may be
associated with higher complication rates. These data derived from
observational studies should be verified with randomised
data. Copyright © 2017 RADCLIFFE CADIOLOGY.

<59>
Accession Number
612964878
Author
Levin A.; Sklyuev S.; Felker I.; Tceymach E.; Krasnov D.
Institution
(Levin, Sklyuev) Clinical Department, Novosibirsk TB Research Institute,
Ohotskaya St 81a, Novosibirsk 630110, Russian Federation
(Felker, Krasnov) Scientific Department, Novosibirsk TB Research
Institute, Novosibirsk, Russian Federation
(Tceymach) Altai Medical State University, Operative Surgery and
Topographic Anatomy Department, Barnaul, Russian Federation
Title
Endobronchial valve treatment of destructive multidrugresistant
tuberculosis.
Source
International Journal of Tuberculosis and Lung Disease. 20 (11) (pp
1539-1545), 2016. Date of Publication: 01 Nov 2016.
Publisher
International Union against Tubercul. and Lung Dis.
Abstract
BACKGROUND: In accordance with the existing hypothesis, the application of
an endobronchial valve (EbV) leads to selective curative atelectasis of
the affected part of the lung, contributing to early closure of cavities.
OBJECTIVE: To assess the effect of EbV treatment on the course of
tuberculosis (TB). METHODS: We compared the efficacy of EbV treatment and
complex second-line treatment in treating patients with destructive
pulmonary multidrug-resistant TB (MDR-TB). Bacteriological conversion and
closure of cavities were selected as criteria to assess the effectiveness
of EbV application. A total of 102 patients with destructive MDR-TB were
enrolled into the study and randomly divided into two groups: 49 patients
had an EbV installed (intervention group) and 53 patients received complex
second-line treatment (control group). Complex chemotherapy was
administered to both groups throughout the study period. RESULTS: The cure
rate in the short- and long-term follow-up periods in the intervention
group was shown to be much higher, 95.9% by bacteriological conversion and
67.3% by cavity closure. On comparison with the control group, this was
respectively 37.7% and 20.7% (P < 0.0001). CONCLUSIONS: The application of
EbV treatment can significantly improve the effectiveness of second-line
chemotherapy regimens in MDR-TB patients. Copyright © 2016 The
Union.

<60>
Accession Number
620549055
Author
Boardman H.M.P.; Hartley L.; Eisinga A.; Main C.; Roque i Figuls M.;
Bonfill Cosp X.; Gabriel Sanchez R.; Knight B.
Institution
(Boardman) University of Oxford, John Radcliffe Hospital, Department of
Cardiovascular Medicine, Oxford OX3 9DU, United Kingdom
(Hartley) Warwick Medical School, University of Warwick, Division of
Health Sciences, Coventry, Warwickshire CV4 7AL, United Kingdom
(Eisinga) UK Cochrane Centre, National Institute for Health Research,
Summertown Pavilion, Middle Way, Oxford, Oxfordshire OX2 7LG, United
Kingdom
(Main) University of Birmingham, Cancer Research UK Clinical Trials Unit
(CRCTU), School of Cancer Sciences, Birmingham B15 2TT, United Kingdom
(Roque i Figuls) CIBER Epidemiologia y Salud Publica (CIBERESP),
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB
Sant Pau), Sant Antoni Maria Claret 171, Edif. Casa de Convalescencia,
Barcelona, Catalunya 08041, Spain
(Bonfill Cosp) CIBER Epidemiologia y Salud Publica (CIBERESP), Universitat
Autonoma de Barcelona, Iberoamerican Cochrane Centre - Biomedical Research
Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavilion
18 (D-13), Barcelona, Catalunya 08025, Spain
(Gabriel Sanchez) Hospital Universitario de la Paz, Universidad Autonoma
de Madrid, Instituto de Investigacion IdiPAZ, Red Espanola de
Investigacion Cardiovascular RD/12/0042/0008, Diego De Leon 62, Planta 9,
Madrid 28006, Spain
(Knight) University of Exeter Medical School, NIHR Exeter Clinical
Research Facility, Exeter, United Kingdom
Title
Hormone therapy for preventing cardiovascular disease in post-menopausal
women.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD002229. Date of Publication: 10 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Evidence from systematic reviews of observational studies
suggests that hormone therapy may have beneficial effects in reducing the
incidence of cardiovascular disease events in post-menopausal women,
however the results of randomised controlled trials (RCTs) have had mixed
results. This is an updated version of a Cochrane review published in
2013. Objectives: To assess the effects of hormone therapy for the
prevention of cardiovascular disease in post-menopausal women, and whether
there are differential effects between use in primary or secondary
prevention.Secondary aims were to undertake exploratory analyses to (i)
assess the impact of time since menopause that treatment was commenced (>=
10 years versus < 10 years), and where these data were not available, use
age of trial participants at baseline as a proxy (>= 60 years of age
versus < 60 years of age); and (ii) assess the effects of length of time
on treatment. Search methods: We searched the following databases on 25
February 2014: Cochrane Central Register of Controlled Trials (CENTRAL) in
The Cochrane Library, MEDLINE, EMBASE and LILACS. We also searched
research and trials registers, and conducted reference checking of
relevant studies and related systematic reviews to identify additional
studies. Selection criteria: RCTs of women comparing orally administered
hormone therapy with placebo or a no treatment control, with a minimum of
six months follow-up. Data collection and analysis: Two authors
independently assessed study quality and extracted data. We calculated
risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome. We
combined results using random effects meta-analyses, and undertook further
analyses to assess the effects of treatment as primary or secondary
prevention, and whether treatment was commenced more than or less than 10
years after menopause. Main results: We identified six new trials through
this update. Therefore the review includes 19 trials with a total of
40,410 post-menopausal women. On the whole, study quality was good and
generally at low risk of bias; the findings are dominated by the three
largest trials. We found high quality evidence that hormone therapy in
both primary and secondary prevention conferred no protective effects for
all-cause mortality, cardiovascular death, non-fatal myocardial
infarction, angina, or revascularisation. However, there was an increased
risk of stroke in those in the hormone therapy arm for combined primary
and secondary prevention (RR 1.24, 95% CI 1.10 to 1.41). Venous
thromboembolic events were increased (RR 1.92, 95% CI 1.36 to 2.69), as
were pulmonary emboli (RR 1.81, 95% CI 1.32 to 2.48) on hormone therapy
relative to placebo. The absolute risk increase for stroke was 6 per 1000
women (number needed to treat for an additional harmful outcome (NNTH) =
165; mean length of follow-up: 4.21 years (range: 2.0 to 7.1)); for venous
thromboembolism 8 per 1000 women (NNTH = 118; mean length of follow-up:
5.95 years (range: 1.0 to 7.1)); and for pulmonary embolism 4 per 1000
(NNTH = 242; mean length of follow-up: 3.13 years (range: 1.0 to 7.1)). We
performed subgroup analyses according to when treatment was started in
relation to the menopause. Those who started hormone therapy less than 10
years after the menopause had lower mortality (RR 0.70, 95% CI 0.52 to
0.95, moderate quality evidence) and coronary heart disease (composite of
death from cardiovascular causes and non-fatal myocardial infarction) (RR
0.52, 95% CI 0.29 to 0.96; moderate quality evidence), though they were
still at increased risk of venous thromboembolism (RR 1.74, 95% CI 1.11 to
2.73, high quality evidence) compared to placebo or no treatment. There
was no strong evidence of effect on risk of stroke in this group. In those
who started treatment more than 10 years after the menopause there was
high quality evidence that it had little effect on death or coronary heart
disease between groups but there was an increased risk of stroke (RR 1.21,
95% CI 1.06 to 1.38, high quality evidence) and venous thromboembolism (RR
1.96, 95% CI 1.37 to 2.80, high quality evidence). Authors' conclusions:
Our review findings provide strong evidence that treatment with hormone
therapy in post-menopausal women overall, for either primary or secondary
prevention of cardiovascular disease events has little if any benefit and
causes an increase in the risk of stroke and venous thromboembolic
events. Copyright © 2015 The Cochrane Collaboration.

<61>
Accession Number
620549212
Author
Kirmani B.H.; Jones S.G.; Chung D.A.; Williams R.J.N.N.; Malaisrie S.C.
Institution
(Kirmani, Jones, Chung, Williams) Liverpool Heart and Chest Hospital,
Cardiothoracic Surgery, Thomas Drive, Liverpool, Mersyside L14 3PE, United
Kingdom
(Malaisrie) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
Title
Limited versus full sternotomy for aortic valve replacement.
Source
Cochrane Database of Systematic Reviews. 2015 (8) (no pagination), 2015.
Article Number: CD011793. Date of Publication: 04 Aug 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the effects of minimally invasive aortic valve
replacement via a limited sternotomy versus conventional aortic valve
replacement via median sternotomy in people with aortic valve disease
requiring surgical replacement. Copyright © 2015 The Cochrane
Collaboration.

<62>
Accession Number
620551193
Author
Fisher S.A.; Brunskill S.J.; Doree C.; Mathur A.; Taggart D.P.;
Martin-Rendon E.
Institution
(Fisher, Brunskill, Doree) NHS Blood and Transplant and Systematic Review
Initiative, John Radcliffe Hospital, Level 2, Headington, Oxford, Oxon OX3
9BQ, United Kingdom
(Mathur) William Harvey Research Institute, Department of Clinical
Pharmacology, Charterhouse Square, London EC1M 6BQ, United Kingdom
(Taggart) John Radcliffe Hospital, Oxford Heart Centre, Oxford OX3 9DU,
United Kingdom
(Martin-Rendon) NHS Blood and Transplant, Stem Cell Research Department,
John Radcliffe Hospital, Headington, Oxford OX3 9BQ, United Kingdom
Title
Stem cell therapy for chronic ischaemic heart disease and congestive heart
failure.
Source
Cochrane Database of Systematic Reviews. 2014 (4) (no pagination), 2014.
Article Number: CD007888. Date of Publication: 29 Apr 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: A promising approach to the treatment of chronic ischaemic
heart disease (IHD) and heart failure is the use of stem cells. The last
decade has seen a plethora of randomised controlled trials (RCTs)
developed worldwide which have generated conflicting results. Objectives:
The critical evaluation of clinical evidence on the safety and efficacy of
autologous adult bone marrow-derived stem cells (BMSC) as a treatment for
chronic ischaemic heart disease (IHD) and heart failure. Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(The Cochrane Library, 2013, Issue 3), MEDLINE (from 1950), EMBASE (from
1974), CINAHL (from 1982) and the Transfusion Evidence Library (from
1980), together with ongoing trial databases, for relevant trials up to
31st March 2013. Selection criteria: Eligible studies included RCTs
comparing autologous adult stem/progenitor cells with no autologous
stem/progenitor cells in participants with chronic IHD and heart failure.
Co-interventions such as primary angioplasty, surgery or administration of
stem cell mobilising agents, were included where administered to treatment
and control arms equally. Data collection and analysis: Two review authors
independently screened all references for eligibility, assessed trial
quality and extracted data. We undertook a quantitative evaluation of data
using fixed-effect meta-analyses. We evaluated heterogeneity using the
I2 statistic; we explored considerable heterogeneity
(I2 > 75%) using a random-effects model and subgroup analyses.
Main results: We include 23 RCTs involving 1255 participants in this
review. Risk of bias was generally low, with the majority of studies
reporting appropriate methods of randomisation and blinding, Autologous
bone marrow stem cell treatment reduced the incidence of mortality (risk
ratio (RR) 0.28, 95% confidence interval (CI) 0.14 to 0.53, P = 0.0001, 8
studies, 494 participants, low quality evidence) and rehospitalisation due
to heart failure (RR 0.26, 95% CI 0.07 to 0.94, P = 0.04, 2 studies, 198
participants, low quality evidence) in the long term (>=12 months). The
treatment had no clear effect on mortality (RR 0.68, 95% CI 0.32 to 1.41,
P = 0.30, 21 studies, 1138 participants, low quality evidence) or
rehospitalisation due to heart failure (RR 0.36, 95% CI 0.12 to 1.06, P =
0.06, 4 studies, 236 participants, low quality evidence) in the short term
(< 12 months), which is compatible with benefit, no difference or harm.
The treatment was also associated with a reduction in left ventricular end
systolic volume (LVESV) (mean difference (MD) -14.64 ml, 95% CI -20.88 ml
to -8.39 ml, P < 0.00001, 3 studies, 153 participants, moderate quality
evidence) and stroke volume index (MD 6.52, 95% CI 1.51 to 11.54, P =
0.01, 2 studies, 62 participants, moderate quality evidence), and an
improvement in left ventricular ejection fraction (LVEF) (MD 2.62%, 95% CI
0.50% to 4.73%, P = 0.02, 6 studies, 254 participants, moderate quality
evidence), all at long-term follow-up. Overall, we observed a reduction in
functional class (New York Heart Association (NYHA) class) in favour of
BMSC treatment during short-term follow-up (MD -0.63, 95% CI -1.08 to
-0.19, P = 0.005, 11 studies, 486 participants, moderate quality evidence)
and long-term follow-up (MD -0.91, 95% CI -1.38 to -0.44, P = 0.0002, 4
studies, 196 participants, moderate quality evidence), as well as a
difference in Canadian Cardiovascular Society score in favour of BMSC (MD
-0.81, 95% CI -1.55 to -0.07, P = 0.03, 8 studies, 379 participants,
moderate quality evidence). Of 19 trials in which adverse events were
reported, adverse events relating to the BMSC treatment or procedure
occurred in only four individuals. No long-term adverse events were
reported. Subgroup analyses conducted for outcomes such as LVEF and NYHA
class revealed that (i) route of administration, (ii) baseline LVEF, (iii)
cell type, and (iv) clinical condition are important factors that may
influence treatment effect. Authors' conclusions: This systematic review
and meta-analysis found moderate quality evidence that BMSC treatment
improves LVEF. Unlike in trials where BMSC were administered following
acute myocardial infarction (AMI), we found some evidence for a potential
beneficial clinical effect in terms of mortality and performance status in
the long term (after at least one year) in people who suffer from chronic
IHD and heart failure, although the quality of evidence was
low. Copyright © 2014 The Cochrane Collaboration.

<63>
Accession Number
620551502
Author
Wilkinson K.L.; Brunskill S.J.; Doree C.; Trivella M.; Gill R.; Murphy
M.F.
Institution
(Wilkinson) Southampton University NHS Hospital, Paediatric and Adult
Cardiothoracic Anaesthesia, Tremona Road, Southampton SO16 6YD, United
Kingdom
(Brunskill, Doree) NHS Blood and Transplant, Systematic Review Initiative,
Level 2, John Radcliffe Hospital, Headington, Oxford, Oxon OX3 9BQ, United
Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Gill) Southampton University Hospital NHS Trust, Department of
Anaesthetics, Tremona Road, Southampton, Hampshire SO16 6YD, United
Kingdom
(Murphy) John Radcliffe Hospital, NHS Blood and Transplant, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Title
Red cell transfusion management for patients undergoing cardiac surgery
for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2014 (2) (no pagination), 2014.
Article Number: CD009752. Date of Publication: 07 Feb 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Congenital heart disease is the most commonly diagnosed
neonatal congenital condition. Without surgery, only 30% to 40% of
patients affected will survive to 10 years old. Mortality has fallen since
the 1990s with 2006 to 2007 figures showing surgical survival at one year
of 95%. Patients with congenital heart disease are potentially exposed to
red cell transfusion at many points in the surgical pathway. There are a
number of risks associated with red cell transfusion that may be
translated into increased patient morbidity and mortality. Objectives: To
evaluate the effects of red cell transfusion on mortality and morbidity on
patients with congenital heart disease at the time of cardiac surgery.
Search methods: We searched 11 bibliographic databases and three ongoing
trials databases including the Cochrane Central Register of Controlled
Trials (CENTRAL) (Issue 5, 2013), MEDLINE (Ovid, 1950 to 11 June 2013),
EMBASE (Ovid, 1980 to 11 June 2013), ClinicalTrials.gov, World Health
Organization (WHO) ICTRP and the ISRCTN Register (to June 2013). We also
searched references of all identified trials, relevant review articles and
abstracts from between 2006 and 2010 of the most relevant conferences. We
did not limit the searches by language of publication. Selection criteria:
We included randomised controlled trials (RCTs) comparing red cell
transfusion interventions in patients undergoing cardiac surgery for
congenital heart disease. We included participants of any age (neonates,
paediatrics and adults) and with any type of congenital heart disease
(cyanotic or acyanotic). We excluded patients with congenital heart
disease undergoing non-cardiac surgery. No co-morbidities were excluded.
Data collection and analysis: Two review authors independently assessed
trial quality and extracted data. We contacted study authors for
additional information. Main results: We identified 11 trials (862
participants). All trials were in neonatal or paediatric populations. The
trials covered only three areas of interest: restrictive versus liberal
transfusion triggers (two trials), leukoreduction versus
non-leukoreduction (two trials) and standard versus non-standard
cardiopulmonary bypass (CPB) prime (seven trials). Owing to the clinical
diversity in the participant groups (cyanotic (three trials), acyanotic
(four trials) or mixed (four trials)) and the intervention groups, it was
not appropriate to pool data in a meta-analysis. No study reported data
for all the outcomes of interest to this review. Risk of bias was mixed
across the included trials, with only attrition bias being low across all
trials. Blinding of study personnel and participants was not always
possible, depending on the intervention being used. Five trials (628
participants) reported the primary outcome: 30-day mortality. In three
trials (a trial evaluating restrictive and liberal transfusion (125
participants), a trial of cell salvage during CPB (309 participants) and a
trial of washed red blood cells during CPB (128 participants)), there was
no clear difference in mortality at 30 days between the intervention arms.
In two trials comparing standard and non-standard CPB prime, there were no
deaths in either randomised group. Long-term mortality was similar between
randomised groups in one trial each comparing restrictive and liberal
transfusion or standard and non-standard CPB prime. Four trials explored a
range of adverse effects following red cell transfusion. Kidney failure
was the only adverse event that was significantly different: patients
receiving cell salvaged red blood cells during CPB were less likely to
have renal failure than patients not exposed to cell salvage (risk ratio
(RR) 0.26, 95% confidence interval (CI) 0.09 to 0.79, 1 study, 309
participants). There was insufficient evidence to determine whether there
was a difference between transfusion strategies for any other severe
adverse events. The duration of mechanical ventilation was measured in
seven trials (768 participants). Overall, there was no consistent
difference in the duration of mechanical ventilation between the
intervention and control arms. The duration of intensive care unit (ICU)
stay was measured in six trials (459 participants). There was no clear
difference in the duration of ICU stay between the intervention arms in
the transfusion trigger and leukoreduction trials. In the standard versus
non-standard CPB prime trials, one trial examining the impact of washing
transfused bypass prime red blood cells showed no clear difference in
duration of ICU stay between the intervention arms, while the trial
assessing ultrafiltration of the priming blood showed a shorter duration
of ICU stay in the ultrafiltration group. Authors' conclusions: There are
only a small number of small and heterogeneous trials so there is
insufficient evidence to assess the impact of red cell transfusion on
patients with congenital heart disease undergoing cardiac surgery
accurately. It is possible that the presence or absence of cyanosis
impacts on trial outcomes, which would necessitate different clinical
management of two groups. Further adequately powered, specific,
high-quality trials are warranted to assess this fully. Copyright
© 2014 The Cochrane Collaboration.

<64>
Accession Number
620561874
Author
Moazzami K.; Roohi A.; Moazzami B.
Institution
(Moazzami) Massachusetts General Hospital, Harvard Medical School,
Cardiovascular Research Center (CVRC), 149 Street, Charlestown, MA, United
States
(Roohi, Moazzami) Babol University of Medical Sciences, Ganje Afrooze
Avenue, Babol, Iran, Islamic Republic of
Title
Granulocyte colony stimulating factor therapy for acute myocardial
infarction.
Source
Cochrane Database of Systematic Reviews. 2013 (5) (no pagination), 2013.
Article Number: CD008844. Date of Publication: 31 May 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Acute myocardial infarction (AMI) is the leading cause of
death in developed countries, and current treatment modalities have failed
to regenerate the dead myocardium resulting from the ischemic damage. Stem
cells have the potential to regenerate the damaged myocardium. These cells
can be mobilized from the bone marrow by factors such as granulocyte
colony stimulating factor (G-CSF). Objectives: To assess the effects of
stem cell mobilization following granulocyte colony stimulating factor
therapy in patients with acute myocardial infarction. Search methods: We
searched CENTRAL (The Cochrane Library Issue 4, 2010), MEDLINE (1950 to
November week 3, 2010), EMBASE (1980 to 2010 week 48), BIOSIS Previews
(1969 to 30 November 2010), ISI Science Citation Index Expanded (1970 to 4
December 2010) and ISI Conference Proceedings Citation Index - Science
(1990 to 4 December 2010). We also checked reference lists of articles.
Selection criteria: We included randomized controlled trials including
participants with a clinical diagnosis of AMI who were randomly allocated
to the subcutaneous administration of G-CSF through a daily dose of 2.5, 5
or 10 microgram/kg for four to six days or placebo. No age or other
restrictions were applied for the selection of patients. Data collection
and analysis: Two authors independently selected trials, assessed trials
for eligibility and methodological quality, and extracted data regarding
the clinical efficacy and adverse outcomes. Disagreements were resolved by
the third author. Main results: We included seven trials reported in 30
references in the review (354 participants). In all trials, G-CSF was
compared with placebo preparations. Dosage of G-CSF varied among studies,
ranging from 2.5 to 10 microgram/kg/day. Regarding overall risk of bias,
data regarding the generation of randomization sequence and incomplete
outcome data were at a low risk of bias; however, data regarding binding
of personnel were not conclusive. The rate of mortality was not different
between the two groups (RR 0.64, 95% CI 0.15 to 2.80, P = 0.55). Regarding
safety, the limited amount of evidence is inadequate to reach any
conclusions regarding the safety of G-CSF therapy. Moreover, the results
did not show any beneficial effects of G-CSF in patients with AMI
regarding left ventricular function parameters, including left ventricular
ejection fraction (RR 3.41, 95% CI -0.61 to 7.44, P = 0.1), end systolic
volume (RR -1.35, 95% CI -4.68 to 1.99, P = 0.43) and end diastolic volume
(RR -4.08, 95% CI -8.28 to 0.12, P = 0.06). It should also be noted that
the study was limited since the trials included lacked long enough follow
up durations. Authors' conclusions: Limited evidence from small trials
suggested a lack of benefit of G-CSF therapy in patients with AMI. Since
data of the risk of bias regarding blinding of personnel were not
conclusive, larger RCTs with appropriate power calculations and longer
follow up durations are required in order to address current uncertainties
regarding the clinical efficacy and therapy-related adverse events of
G-CSF treatment. Copyright © 2013 The Cochrane Collaboration.

<65>
Accession Number
615119481
Author
Zafar F.; Jaquiss R.D.; Almond C.S.; Lorts A.; Chin C.; Rizwan R.; Bryant
R.; Tweddell J.S.; Morales D.L.S.
Institution
(Zafar, Lorts, Chin, Rizwan, Bryant, Tweddell, Morales) Cincinnati
Children's Hospital Medical Center, Cincinnati, Ohio, United States
(Jaquiss) Duke University School of Medicine, Durham, North Carolina,
United States
(Almond) Stanford University School of Medicine, San Francisco,
California, United States
Title
Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring
system to predict 1-year mortality in pediatric heart transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (3) (pp 332-339), 2018. Date
of Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: In this study we sought to quantify hazards associated with
various donor factors into a cumulative risk scoring system (the Pediatric
Heart Donor Assessment Tool, or PH-DAT) to predict 1-year mortality after
pediatric heart transplantation (PHT). Methods: PHT data with complete
donor information (5,732) were randomly divided into a derivation cohort
and a validation cohort (3:1). From the derivation cohort, donor-specific
variables associated with 1-year mortality (exploratory p-value < 0.2)
were incorporated into a multivariate logistic regression model. Scores
were assigned to independent predictors (p < 0.05) based on relative odds
ratios (ORs). Results: The final model had an acceptable predictive value
(c-statistic = 0.62). The significant 5 variables (ischemic time, stroke
as the cause of death, donor-to-recipient height ratio, donor left
ventricular ejection fraction, glomerular filtration rate) were used for
the scoring system. The validation cohort demonstrated a strong
correlation between the observed and expected rates of 1-year mortality (r
= 0.87). The risk of 1-year mortality increases by 11% (OR 1.11 [1.08 to
1.14]; p < 0.001) in the derivation cohort and 9% (OR 1.09 [1.04 to 1.14];
p = 0.001) in the validation cohort with an increase of 1-point in score.
Mortality risk increased 5 times from the lowest to the highest donor
score in this cohort. Based on this model, a donor score range of 10 to 28
predicted 1-year recipient mortality of 11% to 31%. Conclusion: This novel
pediatric-specific, donor risk scoring system appears capable of
predicting post-transplant mortality. Although the PH-DAT may benefit
organ allocation and assessment of recipient risk while controlling for
donor risk, prospective validation of this model is
warranted. Copyright © 2018 International Society for the Heart
and Lung Transplantation

<66>
Accession Number
620678735
Author
Orlando P.; Nicolini F.; Gherli T.; Molardi A.; Silvestri S.; Bruge F.;
Littarru G.P.; Tiano L.
Institution
(Orlando, Silvestri, Bruge, Tiano) Department of Life and Environmental
Sciences, Polytechnic University of Marche, Italy
(Nicolini, Gherli, Molardi) Cardiac Surgery Unit, Unversity of Parma,
Italy
(Littarru) Department of Clinical and Dental Sciences, Polytechnic
University of Marche, Italy
Title
Ubiquinol supplemenetation in elderly patients undergoing aortic valve
replacement: Biochemical and clinical effects.
Source
Free Radical Biology and Medicine. Conference: OCC 2017 World Congress and
the SFRR-Europe 2017 Annual Conference. Germany. 108 (Supplement 1) (pp
S97), 2017. Date of Publication: July 2017.
Publisher
Elsevier Inc.
Abstract
There is a steady rise in the mean age of patients affected by heart
disease undergoing cardiac surgery. However senescent myocardium has
reduced tolerance to ischemic stress and there are clear indications about
age-associated deficit in myocardial performance after operatory stress.
CoQ10 improve several conditions related to bioenergetic deficit or
increased exposure to oxidative stress. The use of ubiquinol, the reduced
form of CoQ10, is promising in these clinical settings, on the basis of
its superior bioavailability and of the alleged impaired CoQ10-reducing
capacity in the elderly. In this study clinical and biochemical effects of
ubiquinol were evaluated in 46 patients undergoing aortic valve
replacement. They, affected by severe aortic stenosis, were randomized
into 2 groups, placebo and CoQ10 group supplemented with 400mg/day of
ubiquinol starting, 7 days before surgery and continuing for 1 month after
cardiac intervention. CoQ10 levels, its oxidative status and IL-6,
TNF-alpha and S100 protein concentration in plasma were assessed.
Moreover, main cardiac adverse effects in the postoperatory phase, NYHA
class, contractility and myocardial hypertrophy were evaluated. Ubiquinol
treatment improve basal (before surgery) oxidative status of CoQ10 and
considerably mitigate increased oxidation related to the operation.

<67>
Accession Number
620697056
Author
Khan M.M.; Herrmann N.; Gallagher D.; Gandell D.; Fremes S.E.;
Wijeysundera H.C.; Radhakrishnan S.; Sun Y.R.; Lanctot K.L.
Institution
(Khan, Herrmann, Sun, Lanctot) Neuropsychopharmacology Research Group,
Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto,
ON, Canada
(Khan, Sun, Lanctot) Department of Pharmacology and Toxicology, University
of Toronto, Toronto, ON, Canada
(Herrmann, Gallagher, Lanctot) Department of Psychiatry, Sunnybrook Health
Sciences Centre and University of Toronto, Toronto, ON, Canada
(Gandell) Department of Geriatric Medicine, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Fremes, Wijeysundera, Radhakrishnan) Schulich Heart Centre, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada
Title
Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A
Metaanalysis.
Source
Journal of the American Geriatrics Society. 66 (2) (pp 254-262), 2018.
Date of Publication: Februaryy 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To quantitatively summarize changes in cognitive performance
in individuals with severe aortic stenosis undergoing transcatheter aortic
valve implantation (TAVI). Design: Metaanalysis. Participants: Individuals
undergoing TAVI (N = 1,065 (48.5% male) from 18 studies, average age
>=80). Measurements: The MEDLINE, EMBASE, and Cochrane Central databases
were searched for original peer-reviewed reports assessing cognitive
performance using standardized cognitive tests before and after TAVI. Data
were extracted for cognitive scores before TAVI; perioperatively (within 7
days after TAVI); 1, 3, and 6 months after TAVI, and 12 to 34 months after
TAVI (over the long term). Standardized mean differences (SMDs) were
generated using random-effects models for changes in cognition at each
time point. Metaregression analyses were conducted to assess the
association between population and procedural characteristics and
cognitive outcomes. Risk of bias was assessed. Results: There were no
significant changes from baseline in perioperative cognitive performance
(SMD = 0.05, 95% confidence interval (CI) = -0.08-0.18; z = 0.75, P =.46),
although overall cognitive performance had improved significantly 1 month
after TAVI (SMD = -0.33, 95% CI = -0.50 to -0.16; z = 3.83, P <.001).
There were no differences in cognitive performance 3 and 6 months after
TAVI or over the long term. Cognitive outcomes were not associated with
any covariates in regression analyses. Conclusion: Cognitive performance
is preserved after TAVI, suggesting TAVI is not detrimental to
cognition. © 2017, Copyright the Authors Journal compilation
© 2017, The American Geriatrics Society

<68>
Accession Number
620717743
Author
Erdem A.F.; Sahin Y.N.; Dogan N.; Umudum Z.; Bayar F.; Bulut C.; Alici
H.A.; Erkut B.; Cesur M.; Ceviz M.
Institution
(Erdem) Department of Anesthesiology and Reanimation, Medical Faculty,
Sakarya University, Sakarya, Turkey
Title
Effects of sevoflurane and propofol on S100beta and neuron-specific
enolase protein levels during cardiopulmonary bypass.
Source
Nigerian journal of clinical practice. 19 (2) (pp 278-283), 2016. Date of
Publication: 01 Mar 2016.
Abstract
AIM: Cardiopulmonary bypass (CPB) is associated with the release of
S100beta and neuron-specific enolase (NSE) indicating cerebral cell
injury. The purpose of the present study was to evaluate the effect of
propofol and sevoflurane on S100beta and NSE levels in patients undergoing
coronary artery bypass grafting (CABG).
MATERIALS AND METHODS: Twenty male patients undergoing CABG were randomly
allocated into two groups. One group received sevoflurane (GS) and the
other received propofol (GP). Arterial blood samples for analysis of
S100beta and NSE levels were taken preoperatively (T1), 30 min after
initiation of CPB (T2), at the end of CPB (T3), 1 (T4), 6 (T5) and 24 h
(T6) postoperatively.
RESULTS: S100beta level was significantly higher compared to all analyzed
times at T3 in both groups (P < 0.001). S100beta level was significantly
higher in GP than GS only at T2 (P = 0.002). NSE level was significantly
higher at T3, T4 and T5 than T1 in the GP (P = 0.001, 0.002 and 0.023,
respectively), while a significant increase was seen at T3 and T4 in GS
group (P = 0.001 and 0.047, respectively).
CONCLUSION: Our findings showed that both S100beta and NSE levels
similarly increased during CPB and immediately after CPB during
sevoflurane and propofol based anesthesia.

<69>
Accession Number
620606953
Author
Kooiman J.; De Vries J.-P.P.M.; Der Heyden J.V.; Sijpkens Y.W.J.; van
Dijkman P.R.M.; Wever J.J.; van Overhagen H.; Vahl A.C.; Aarts N.;
Verberk-Jonkers I.J.A.M.; Brulez H.F.H.; Hamming J.F.; van der Molen A.J.;
Cannegieter S.C.; Putter H.; van den Hout W.B.; Kilicsoy I.; Rabelink
T.J.; Huisman M.V.
Institution
(Kooiman, Kilicsoy, Huisman) Department of Thrombosis and Hemostasis,
Leiden University Medical Center, Leiden, Netherlands
(Kooiman, Rabelink) Department of Nephrology, Leiden University Medical
Center, Leiden, Netherlands
(De Vries) Department of Vascular Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Der Heyden) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Sijpkens) Department of Internal Medicine, Bronovo Hospital, The Hague,
Netherlands
(van Dijkman) Department of Cardiology, Bronovo Hospital, the Hague,
Netherlands
(Wever) Department of Vascular Surgery, Haga Teaching Hospital, The Hague,
Netherlands
(van Overhagen) Department of Radiology, Haga Teaching Hospital, The
Hague, Netherlands
(Vahl) Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Aarts) Department of Radiology, Bronovo Hospital, The Hague, Netherlands
(Verberk-Jonkers) Department of Nephrology, Maasstad Hospital, Rotterdam,
Netherlands
(Brulez) Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam,
Netherlands
(Hamming) Department of Vascular Surgery, Leiden University Medical
Center, Leiden, Netherlands
(van der Molen) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Putter) Department of Medical Statistics, Leiden University Medical
Center, Leiden, Netherlands
(van den Hout) Department of Medical Decision Making, Leiden University
Medical Center, Leiden, Netherlands
Title
Randomized trial of one-hour sodium bicarbonate vs standard periprocedural
saline hydration in chronic kidney disease patients undergoing
cardiovascular contrast procedures.
Source
PLoS ONE. 13 (2) (no pagination), 2018. Article Number: e0189372. Date of
Publication: February 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Guidelines advise periprocedural saline hydration for
prevention of contrast induced-acute kidney injury (CI-AKI). We analysed
whether 1-hour sodium bicarbonate hydration administered solely prior to
intra-arterial contrast exposure is non-inferior to standard
periprocedural saline hydration in chronic kidney disease (CKD) patients
undergoing elective cardiovascular diagnostic or interventional contrast
procedures. Methods We performed an open-label multicentre non-inferiority
trial between 2011-2014. Patients were randomized to 1 hour pre-procedure
sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline
hydration (1000 ml 0.9%, N = 165) prior to and following contrast
administration (2000 ml of saline total). Primary outcome was the relative
serum creatinine increase (%) 48-96 hours post contrast exposure.
Secondary outcomes were: incidence of CI-AKI (serum creatinine
increase>25% or >44?mol/L), recovery of renal function, the need for
dialysis, and hospital costs within two months follow-up. Results Mean
relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the
bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean
difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI
occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12
(7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0%
and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required
dialysis. Mean costs for preventive hydration and clinical preparation for
the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for
saline (p < 0.001). Conclusion Short hydration with sodium bicarbonate
prior to elective cardiovascular diagnostic or therapeutic contrast
procedures is non-inferior to standard periprocedural saline hydration in
CKD patients with respect to renal safety and results in considerable
healthcare savings. Copyright © 2018 Kooiman et al. This is an
open

<70>
Accession Number
620645114
Author
Lewicki M.; Ng I.; Schneider A.G.
Institution
(Lewicki) Monash Medical Centre, Department of Nephrology, 246 Clayton
Road, Clayton, VIC 3168, Australia
(Lewicki) Monash University, Department of Medicine, Clayton, VIC,
Australia
(Lewicki, Ng, Schneider) Monash University, Department of Epidemiology and
Preventative Medicine, Clayton, VIC, Australia
(Ng) Royal Melbourne Hospital, Department of Anaesthesia, Parkville, VIC,
Australia
(Schneider) Hospitalo-Universitaire Vaudois (CHUV), Intensive Care Unit,
Lausanne, Switzerland
Title
HMG CoA reductase inhibitors (statins) for preventing acute kidney injury
after surgical procedures requiring cardiac bypass.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD010480. Date of Publication: 11 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Acute kidney injury (AKI) is common in patients undergoing
cardiac surgery among whom it is associated with poor outcomes, prolonged
hospital stays and increased mortality. Statin drugs can produce more than
one effect independent of their lipid lowering effect, and may improve
kidney injury through inhibition of postoperative inflammatory responses.
Objectives: This review aimed to look at the evidence supporting the
benefits of perioperative statins for AKI prevention in hospitalised
adults after surgery who require cardiac bypass. The main objectives were
to 1) determine whether use of statins was associated with preventing AKI
development; 2) determine whether use of statins was associated with
reductions in in-hospital mortality; 3) determine whether use of statins
was associated with reduced need for RRT; and 4) determine any adverse
effects associated with the use of statins. Search methods: We searched
the Cochrane Renal Group's Specialised Register to 13 January 2015 through
contact with the Trials' Search Co-ordinator using search terms relevant
to this review. Selection criteria: Randomised controlled trials (RCTs)
that compared administration of statin therapy with placebo or standard
clinical care in adult patients undergoing surgery requiring
cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need
for renal replacement therapy (RRT) as an outcome were eligible for
inclusion. All forms and dosages of statins in conjunction with any
duration of pre-operative therapy were considered for inclusion in this
review. Data collection and analysis: All authors extracted data
independently and assessments were cross-checked by a second author.
Likewise, assessment of study risk of bias was initially conducted by one
author and then by a second author to ensure accuracy. Disagreements were
arbitrated among authors until consensus was reached. Authors from two of
the included studies provided additional data surrounding post-operative
SCr as well as need for RRT. Meta-analyses were used to assess the
outcomes of AKI, SCr and mortality rate. Data for the outcomes of RRT and
adverse effects were not pooled. Adverse effects taken into account were
those reported by the authors of included studies. Main results: We
included seven studies (662 participants) in this review. All except one
study was assessed as being at high risk of bias. Three studies assessed
atorvastatin, three assessed simvastatin and one investigated
rosuvastatin. All studies collected data during the immediate
perioperative period only; data collection to hospital discharge and
postoperative biochemical data collection ranged from 24 hours to 7 days.
Overall, pre-operative statin treatment was not associated with a
reduction in postoperative AKI, need for RRT, or mortality. Only two
studies (195 participants) reported postoperative SCr level. In those
studies, patients allocated to receive statins had lower postoperative SCr
concentrations compared with those allocated to no drug treatment/placebo
(MD 21.2 mol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately
reported in only one study; no difference was found between the statin
group compared to placebo. Authors' conclusions: Analysis of currently
available data did not suggest that preoperative statin use is associated
with decreased incidence of AKI in adults after surgery who required
cardiac bypass. Although a significant reduction in SCr was seen
postoperatively in people treated with statins, this result was driven by
results from a single study, where SCr was considered as a secondary
outcome. The results of the meta-analysis should be interpreted with
caution; few studies were included in subgroup analyses, and significant
differences in methodology exist among the included studies. Large high
quality RCTs are required to establish the safety and efficacy of statins
to prevent AKI after cardiac surgery. Copyright © 2015 The
Cochrane Collaboration.

<71>
Accession Number
620645076
Author
Burkhardt B.E.U.; Rucker G.; Stiller B.
Institution
(Burkhardt) Kinderspital Zurich, Department of Cardiology,
Steinwiesstrasse 75, Zurich 8032, Switzerland
(Rucker) Medical Center - University of Freiburg, Center for Medical
Biometry and Medical Informatics, Stefan-Meier-Str. 26, Freiburg 79104,
Germany
(Stiller) Heart Center, University of Freiburg, Department of Congenital
Heart Defects and Pediatric Cardiology, Mathildenstr. 1, Freiburg,
Baden-Wurttemberg 79098, Germany
Title
Prophylactic milrinone for the prevention of low cardiac output syndrome
and mortality in children undergoing surgery for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD009515. Date of Publication: 25 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Children with congenital heart disease often undergo heart
surgery at a young age. They are at risk for postoperative low cardiac
output syndrome (LCOS) or death. Milrinone may be used to provide
inotropic and vasodilatory support during the immediate postoperative
period. Objectives: This review examines the effectiveness of prophylactic
postoperative use of milrinone to prevent LCOS or death in children having
undergone surgery for congenital heart disease. Search methods: Electronic
and manual literature searches were performed to identify randomised
controlled trials. We searched CENTRAL, MEDLINE, EMBASE and Web of Science
in February 2014 and conducted a top-up search in September 2014 as well
as clinical trial registries and reference lists of published studies. We
did not apply any language restrictions. Selection criteria: Only
randomised controlled trials were selected for analysis. We considered
studies with newborn infants, infants, toddlers, and children up to 12
years of age. Data collection and analysis: Two review authors
independently extracted data according to a pre-defined protocol. We
obtained additional information from all study authors. Main results:
Three of the five included studies compared milrinone versus levosimendan,
one study compared milrinone with placebo, and one compared milrinone
verus dobutamine, with 101, 242, and 50 participants, respectively. Three
trials were at low risk of bias while two were at higher risk of bias. The
number and definitions of outcomes were non-uniform as well. In one study
comparing two doses of milrinone and placebo, there was some evidence in
an overall comparison of milrinone versus placebo that milrinone lowered
risk for LCOS (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.28 to
0.96; 227 participants). The results from two small studies do not provide
enough information to determine whether milrinone increases the risk of
LCOS when compared to levosimendan (RR 1.22, 95% CI 0.32 to 4.65; 59
participants). Mortality rates in the studies were low, and there was
insufficient evidence to draw conclusions on the effect of milrinone
compared to placebo or levosimendan or dobutamine regarding mortality, the
duration of intensive care stay, hospital stay, mechanical ventilation, or
maximum inotrope score (where available). Numbers of patients requiring
mechanical cardiac support were also low and did not allow a comparison
between studies, and none of the participants of any study received a
heart transplantation up to the end of the respective follow-up period.
Time to death within three months was not reported in any of the included
studies. A number of adverse events was examined, but differences between
the treatment groups could not be proven for hypotension, intraventricular
haemorrhage, hypokalaemia, bronchospasm, elevated serum levels of liver
enzymes, or a reduced left ventricular ejection fraction < 50% or reduced
left ventricular fraction of shortening < 28%. Our analysis did not prove
an increased risk of arrhythmias in patients treated prophylactically with
milrinone compared with placebo (RR 3.59, 95% CI 0.83 to 15.42; 238
participants), a decreased risk of pleural effusions (RR 1.78, 95% CI 0.92
to 3.42; 231 participants), or a difference in risk of thrombocytopenia on
milrinone compared with placebo (RR 0.86, 95% CI 0.39 to 1.88; 238
participants). Comparisons of milrinone with levosimendan or with
dobutamine, respectively, did not clarify the risk of arrhythmia and were
not possible for pleural effusions or thrombocytopenia. Authors'
conclusions: There is insufficient evidence of the effectiveness of
prophylactic milrinone in preventing death or low cardiac output syndrome
in children undergoing surgery for congenital heart disease, compared to
placebo. So far, no differences have been shown between milrinone and
other inodilators, such as levosimendan or dobutamine, in the immediate
postoperative period, in reducing the risk of LCOS or death. The existing
data on the prophylactic use of milrinone has to be viewed cautiously due
to the small number of small trials and their risk of bias. Copyright
© 2015 The Cochrane Collaboration.

<72>
Accession Number
620615714
Author
Smith M.D.; Mccall J.; Plank L.; Herbison G.P.; Soop M.; Nygren J.
Institution
(Smith) Southland Hospital, Department of General Surgery, Kew Road,
Invercargill 9840, New Zealand
(Mccall) Dunedin School of Medicine, University of Otago, Department of
Surgical Sciences, PO Box 913, Dunedin 9054, New Zealand
(Plank) University of Auckland, Department of Surgery, Private Bag 92019,
Auckland 1142, New Zealand
(Herbison) Dunedin School of Medicine, University of Otago, Department of
Preventive and Social Medicine, PO Box 913, Dunedin 9054, New Zealand
(Soop) Salford Royal NHS Foundation Trust, Department of Surgery, Stott
Lane, Salford, United Kingdom
(Nygren) Institution of Clinical Sciences at Danderyds Hospital, Centre
for Gastrointestinal Disease, Ersta Hospital and Karolinska Institutet,
Stockholm, Sweden
Title
Preoperative carbohydrate treatment for enhancing recovery after elective
surgery.
Source
Cochrane Database of Systematic Reviews. 2014 (8) (no pagination), 2014.
Article Number: CD009161. Date of Publication: 14 Aug 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Preoperative carbohydrate treatments have been widely adopted
as part of enhanced recovery after surgery (ERAS) or fast-track surgery
protocols. Although fast-track surgery protocols have been widely
investigated and have been shown to be associated with improved
postoperative outcomes, some individual constituents of these protocols,
including preoperative carbohydrate treatment, have not been subject to
such robust analysis. Objectives: To assess the effects of preoperative
carbohydrate treatment, compared with placebo or preoperative fasting, on
postoperative recovery and insulin resistance in adult patients undergoing
elective surgery. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (2014, Issue 3), MEDLINE (January
1946 to March 2014), EMBASE (January 1947 to March 2014), the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (January 1980 to
March 2014) and Web of Science (January 1900 to March 2014) databases. We
did not apply language restrictions in the literature search. We searched
reference lists of relevant articles and contacted known authors in the
field to identify unpublished data. Selection criteria: We included all
randomized controlled trials of preoperative carbohydrate treatment
compared with placebo or traditional preoperative fasting in adult study
participants undergoing elective surgery. Treatment groups needed to
receive at least 45 g of carbohydrates within four hours before surgery or
anaesthesia start time. Data collection and analysis: Data were abstracted
independently by at least two review authors, with discrepancies resolved
by consensus. Data were abstracted and documented pro forma and were
entered into RevMan 5.2 for analysis. Quality assessment was performed
independently by two review authors according to the standard
methodological procedures expected by The Cochrane Collaboration. When
available data were insufficient for quality assessment or data analysis,
trial authors were contacted to request needed information. We collected
trial data on complication rates and aspiration pneumonitis. Main results:
We included 27 trials involving 1976 participants Trials were conducted in
Europe, China, Brazil, Canada and New Zealand and involved patients
undergoing elective abdominal surgery (18), orthopaedic surgery (4),
cardiac surgery (4) and thyroidectomy (1). Twelve studies were limited to
participants with an American Society of Anaesthesiologists grade of I-II
or I-III. A total of 17 trials contained at least one domain judged to be
at high risk of bias, and only two studies were judged to be at low risk
of bias across all domains. Of greatest concern was the risk of bias
associated with inadequate blinding, as most of the outcomes assessed by
this review were subjective. Only six trials were judged to be at low risk
of bias because of blinding. In 19 trials including 1351 participants,
preoperative carbohydrate treatment was associated with shortened length
of hospital stay compared with placebo or fasting (by 0.30 days; 95%
confidence interval (CI) 0.56 to 0.04; very low-quality evidence). No
significant effect on length of stay was noted when preoperative
carbohydrate treatment was compared with placebo (14 trials including 867
participants; mean difference -0.13 days; 95% CI -0.38 to 0.12). Based on
two trials including 86 participants, preoperative carbohydrate treatment
was also associated with shortened time to passage of flatus when compared
with placebo or fasting (by 0.39 days; 95% CI 0.70 to 0.07), as well as
increased postoperative peripheral insulin sensitivity (three trials
including 41 participants; mean increase in glucose infusion rate measured
by hyperinsulinaemic euglycaemic clamp of 0.76 mg/kg/min; 95% CI 0.24 to
1.29; high-quality evidence). As reported by 14 trials involving 913
participants, preoperative carbohydrate treatment was not associated with
an increase or a decrease in the risk of postoperative complications
compared with placebo or fasting (risk ratio of complications 0.98, 95% CI
0.86 to 1.11; low-quality evidence). Aspiration pneumonitis was not
reported in any patients, regardless of treatment group allocation.
Authors' conclusions: Preoperative carbohydrate treatment was associated
with a small reduction in length of hospital stay when compared with
placebo or fasting in adult patients undergoing elective surgery. It was
found that preoperative carbohydrate treatment did not increase or
decrease postoperative complication rates when compared with placebo or
fasting. Lack of adequate blinding in many studies may have contributed to
observed treatment effects for these subjective outcomes, which are
subject to possible biases. Copyright © 2014 The Cochrane
Collaboration.

<73>
Accession Number
620644980
Author
Arsenault K.A.; Yusuf A.M.; Crystal E.; Healey J.S.; Morillo C.A.; Nair
G.M.; Whitlock R.P.
Institution
(Arsenault, Whitlock) McMaster University, Department of Surgery, David
Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street
East, Hamilton, ON L8l 2X2, Canada
(Yusuf) Population Health Research Institute (McMaster University/Hamilton
Health Sciences), Thrombosis, David Braley Cardiac, Vascular and Stroke
Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Crystal) Schulich Heart Centre, Electrophysiology Programme, Department
of Medicine, Sunny Brook and Women's, University of Toronto, 2075 Bay View
Ave, Toronto M4N 3M5, Canada
(Healey, Morillo, Nair) McMaster University, Medicine, David Braley
Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East,
Hamilton, ON L8L 2X2, Canada
Title
Interventions for preventing post-operative atrial fibrillation in
patients undergoing heart surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (1) (no pagination), 2013.
Article Number: CD003611. Date of Publication: 31 Jan 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Atrial fibrillation is a common post-operative complication of
cardiac surgery and is associated with an increased risk of post-operative
stroke, increased length of intensive care unit and hospital stays,
healthcare costs and mortality. Numerous trials have evaluated various
pharmacological and non-pharmacological prophylactic interventions for
their efficacy in preventing post-operative atrial fibrillation. We
conducted an update to a 2004 Cochrane systematic review and meta-analysis
of the literature to gain a better understanding of the effectiveness of
these interventions. Objectives: The primary objective was to assess the
effects of pharmacological and non-pharmacological interventions for
preventing post-operative atrial fibrillation or supraventricular
tachycardia after cardiac surgery. Secondary objectives were to determine
the effects on post-operative stroke or cerebrovascular accident,
mortality, cardiovascular mortality, length of hospital stay and cost of
treatment during the hospital stay. Search methods: We searched the
Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011),
MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and
CINAHL (from 1981 to July 2011). Selection criteria: We selected
randomized controlled trials (RCTs) that included adult patients
undergoing cardiac surgery who were allocated to pharmacological or
non-pharmacological interventions for the prevention of post-operative
atrial fibrillation or supraventricular tachycardia, except digoxin,
potassium (K+), or steroids. Data collection and analysis: Two
review authors independently abstracted study data and assessed trial
quality. Main results: One hundred and eighteen studies with 138 treatment
groups and 17,364 participants were included in this review. Fifty-seven
of these studies were included in the original version of this review
while 61 were added, including 27 on interventions that were not
considered in the original version. Interventions included amiodarone,
beta-blockers, sotalol, magnesium, atrial pacing and posterior
pericardiotomy. Each of the studied interventions significantly reduced
the rate of post-operative atrial fibrillation after cardiac surgery
compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95%
confidence interval) CI 0.26 to 0.43; I2 = 55%) and sotalol (OR
0.34; 95% CI 0.26 to 0.43; I2 = 3%) appear to have similar
efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73;
I2 = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI
0.34 to 0.54; I2 = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to
0.61; I2 = 50%) and posterior pericardiotomy (OR 0.35; 95% CI
0.18 to 0.67; I2 = 66%) were all found to be effective.
Prophylactic intervention decreased the hospital length of stay by
approximately two-thirds of a day and decreased the cost of hospital
treatment by roughly $1250 US. Intervention was also found to reduce the
odds of post-operative stroke, though this reduction did not reach
statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I2 =
0%). No significant effect on all-cause or cardiovascular mortality was
demonstrated. Authors' conclusions: Prophylaxis to prevent atrial
fibrillation after cardiac surgery with any of the studied pharmacological
or non-pharmacological interventions may be favored because of its
reduction in the rate of atrial fibrillation, decrease in the length of
stay and cost of hospital treatment and a possible decrease in the rate of
stroke. However, this review is limited by the quality of the available
data and heterogeneity between the included studies. Selection of
appropriate interventions may depend on the individual patient situation
and should take into consideration adverse effects and the cost associated
with each approach. Copyright © 2013 The Cochrane Collaboration.

<74>
Accession Number
620697698
Author
Hlavicka J.; Vanek T.; Jarkovsky J.; Benesova K.
Institution
(Hlavicka, Vanek) Cardiocenter, Cardiac Surgery Department, Kralovske
Vinohrady University Hospital and 3th Medical School of Charles
University, Prague, Czech Republic
(Jarkovsky, Benesova) Institute of Health Information and Statistics of
the Czech Republic, Prague, Czech Republic
(Jarkovsky, Benesova) Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
Title
Use of OPCAB in Czechia 2010-2015: Have we learned any lessons?.
Source
Cor et Vasa. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Science B.V.
Abstract
Introduction: Off-pump coronary artery bypass grafting (OPCAB) is a
well-established technique for coronary revascularization, which is used
worldwide as well as in the Czech Republic (CZ). However, the number of
patients undergoing this procedure varies from department to department.
We wanted to see if the very latest publications regarding off-pump
coronary revascularization had changed the way the procedure was viewed by
Czech heart surgeons. Methods: Data from the Czech National Register of
Cardiac Surgery were used to evaluate trends in the number OPCAB cases, in
patients with ischemic heart disease, and to analyze the factors that
surgeons routinely used when opting for the OPCAB strategy. The study
period was 2010-2015. Results: OPCAB was performed at all 12 cardiac
surgery departments in the CZ. Overall, we found a slight decrease of the
total number of isolated revascularizations in the CZ per annum between
2010 and 2015 (from 3884 to 3569), the percentage of OPCAB cases also
declined over the study period (from 26.7% to 24.9%). Over the study, the
average age of OPCAB patients increased (66.2 vs. 68.1 years) and included
patients with increasingly greater numbers of comorbidities. The average
total OPCAB surgery time decreased (3.3 vs. 3.1. h) and compared to
standard revascularization, OPCAB took significantly less time (3.1 vs.
3.3. h, P <. 0.001). The number of peripheral anastomosis performed
off-pump was significantly lower than on cardiopulmonary bypass (CPB) and,
in general, has decreased (2.1 vs. 3.0, P <. 0.001 in 2010 and 1.9 vs.
2.9, P <. 0.001 in 2015 resp.). Conclusions: The prevalence of OPCAB in
Czech Republic has decreased. However, it is unclear whether this is due
to the recent widely respected prospective randomized clinical trials.
Published papers have not shown the superiority of OPCAB in high-risk
patients, yet Czech cardiac surgeons prefer this strategy, especially in
patients with a history of renal insufficiency. In that point, the
community of Czech cardiac surgeons seems to have become more conservative
with a trend toward incomplete revascularization. Copyright ©
2018 The Czech Society of Cardiology.

<75>
Accession Number
620707338
Author
Asami M.; Stortecky S.; Praz F.; Lanz J.; Raber L.; Franzone A.; Piccolo
R.; Siontis G.C.M.; Heg D.; Valgimigli M.; Wenaweser P.; Roost E.;
Windecker S.; Pilgrim T.
Institution
(Asami, Stortecky, Praz, Lanz, Raber, Franzone, Piccolo, Siontis,
Valgimigli, Wenaweser, Windecker, Pilgrim) Department of Cardiology, Swiss
Cardiovascular Center, Bern University Hospital, Bern, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Roost) Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern
University Hospital, Bern, Switzerland
Title
Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes
After Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Imaging. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of this study was to investigate the association
between right ventricular dysfunction (RVD) and cardiovascular death after
transcatheter aortic valve replacement (TAVR). Background: There is
conflicting evidence on the effect of RVD on clinical outcomes after TAVR.
Methods: A total of 1,116 TAVR patients (age 82 +/- 6 years; 51% female)
who were consecutively enrolled into a prospective registry underwent
detailed pre-operative assessment of right ventricular (RV) function and
were dichotomized into 2 groups for the purposes of the present
retrospective analysis. RVD was assessed using fractional area change
(<35%), tricuspid annular plane systolic excursion (<1.7 cm), and systolic
movement of the RV lateral wall by tissue Doppler imaging (<9.5 cm/s). RVD
was found in 325 (29.1%) patients. The primary outcome was cardiovascular
death at 1 year. Results: After adjustment for comorbidities, patients
with RVD had a higher risk of cardiovascular death at 1 year compared with
patients with normal RV function (20.1% vs. 7.1%; adjusted hazard ratio
[HR<inf>adj</inf>]: 2.94; 95% confidence interval [CI]: 2.02 to 4.27; p <
0.001). The difference emerged within the first 30 days after TAVR (9.0%
vs. 2.2%; HR<inf>adj</inf>: 4.62; 95% CI: 2.51 to 8.50; p < 0.001).
Normalization of RV function after TAVR was found in 57.4% of patients
with RVD at baseline. There was a gradient of increasing risk of
cardiovascular death among patients with normal RV function, RVD recovery
(HR<inf>adj</inf>: 2.16; 95% CI: 1.16 to 4.02), new RVD (HR<inf>adj</inf>:
3.93; 95% CI: 2.09 to 7.39), and maintained RVD (HR<inf>adj</inf>: 8.74;
95% CI: 5.33 to 14.3), respectively. Conclusions: RVD at baseline was
associated with a more than 2-fold increased risk of cardiovascular death
at 1 year after TAVR, with a gradient of risk according to RVD recovery.
(Swiss TAVI Registry; NCT01368250). Copyright © 2018 American
College of Cardiology Foundation.

<76>
Accession Number
620299310
Author
Wang X.; Wang C.; Ye M.; Lin J.; Jin J.; Hu Q.; Zhu C.; Chen B.
Institution
(Wang, Wang, Ye, Lin, Jin, Hu, Zhu, Chen) Department of Thoracic and
Cardiovascular Surgery, Affiliated Taizhou Hospital, Wenzhou Medical
University, Taizhou, China
Title
Left atrial concomitant surgical ablation for treatment of atrial
fibrillation in cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 13 (1) (no pagination), 2018. Article Number: e0191354. Date of
Publication: January 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction Surgical ablation is a generally established treatment for
patients with atrial fibrillation undergoing concomitant cardiac surgery.
Left atrial (LA) lesion set for ablation is a simplified procedure
suggested to reduce the surgery time and morbidity after procedure. The
present meta-analysis aims to explore the outcomes of left atrial lesion
set versus no ablative treatment in patients with AF undergoing cardiac
surgery. Methods A literature research was performed in six database from
their inception to July 2017, identifying all relevant randomized
controlled trials (RCTs) comparing left atrial lesion set versus no
ablative treatment in AF patient undergoing cardiac surgery. Data were
extracted and analyzed according to predefined clinical endpoints. Results
Eleven relevant RCTs were included for analysis in the present study. The
prevalence of sinus rhythm in ablation group was significantly higher at
discharge, 6-month and 1-year follow-up period. The morbidity including 30
day mortality, late all-cause mortality, reoperation for bleeding,
permanent pacemaker implantation and neurological events were of no
significant difference between two groups. Conclusions The result of our
meta-analysis demonstrates that left atrial lesion set is an effective and
safe surgical ablation strategy for AF patients undergoing concomitant
cardiac surgery. Copyright © 2018 Wang et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<77>
Accession Number
618003838
Author
Sedaghat-Hamedani F.; Kayvanpour E.; Tugrul O.F.; Lai A.; Amr A.; Haas J.;
Proctor T.; Ehlermann P.; Jensen K.; Katus H.A.; Meder B.
Institution
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Lai, Amr, Haas, Ehlermann, Katus,
Meder) Institute for Cardiomyopathy, Department of Medicine III,
University of Heidelberg, INF 410, Heidelberg 69120, Germany
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Amr, Haas, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Proctor, Jensen) Institute of Medical Biometry and Informatics,
University of Heidelberg, Heidelberg, Germany
Title
Clinical outcomes associated with sarcomere mutations in hypertrophic
cardiomyopathy: a meta-analysis on 7675 individuals.
Source
Clinical Research in Cardiology. 107 (1) (pp 30-41), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic
cardiovascular disease, which goes along with increased risk for sudden
cardiac death (SCD). Despite the knowledge about the different causal
genes, the relationship between individual genotypes and phenotypes is
incomplete. Methods and results: We retrieved PubMed/Medline literatures
on genotype-phenotype associations in patients with HCM and mutations in
MYBPC3, MYH7, TNNT2, and TNNI3. Altogether, 51 studies with 7675 HCM
patients were included in our meta-analysis. The average frequency of
mutations in MYBPC3 (20%) and MYH7 (14%) was higher than TNNT2 and TNNI3
(2% each). The mean age of HCM onset for MYH7 mutation positive patients
was the beginning of the fourth decade, significantly earlier than
patients without sarcomeric mutations. A high male proportion was observed
in TNNT2 (69%), MYBPC3 (62%) and mutation negative group (64%). Cardiac
conduction disease, ventricular arrhythmia and heart transplantation (HTx)
rate were higher in HCM patients with MYH7 mutations in comparison to
MYBPC3 (p < 0.05). Furthermore, SCD was significantly higher in patients
with sarcomeric mutations (p < 0.01). Conclusion: A pooled dataset and a
comprehensive genotype-phenotype analysis show that the age at disease
onset of HCM patients with MYH7 is earlier and leads to a more severe
phenotype than in patient without such mutations. Furthermore, patients
with sarcomeric mutations are more susceptible to SCD. The present study
further supports the clinical interpretation of sarcomeric mutations in
HCM patients. Copyright © 2017, Springer-Verlag GmbH Germany.

<78>
Accession Number
620412984
Author
Risom S.S.
Institution
(Risom) University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen
2100, Denmark
(Risom) Institute of Nursing, Metropolitan University College, Copenhagen,
Denmark
Title
Cardiac rehabilitation in real life.
Source
International Journal of Cardiology. 255 (pp 154-155), 2018. Date of
Publication: 15 Mar 2018.
Publisher
Elsevier Ireland Ltd

<79>
Accession Number
620401061
Author
Fan H.; Ximing Q.
Institution
(Fan, Ximing) Department of Cardiac Surgery, Sir Run Run Shaw Hospital,
School of Medicine, Zhejiang University, Hangzhou 310020, China
Title
Treatment options for the closure of secundum atrial septal defects: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 254 (pp 89), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Elsevier Ireland Ltd

<80>
Accession Number
620031659
Author
Bangalore S.; Toklu B.; Stone G.W.
Institution
(Bangalore) Division of Cardiology, New York University School of
Medicine, New York, New York, United States
(Toklu) Division of Cardiology, Mt. Sinai Beth Israel Medical Center, New
York, New York, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, New York, United
States
Title
Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary
Intervention in Patients With ST-Segment Elevation Myocardial Infarction
and Multivessel Coronary Disease.
Source
American Journal of Cardiology. 121 (5) (pp 529-536), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Recently, several randomized controlled trials (RCT) in patients with
ST-segment elevation myocardial infarction (STEMI) and multivessel disease
(MVD) have compared a strategy of routine multivessel percutaneous
coronary intervention (PCI) performed either as a single procedure or as
staged procedures to culprit-only PCI. All of these trials have been
underpowered for clinical end points. We searched PubMed, Embase, and
Cochrane Central Register of Controlled Trials for RCT comparing
multivessel PCI with culprit-only PCI in patients with STEMI and MVD. The
primary efficacy outcome was the composite rate of death or MI. Other
efficacy outcomes included death, MI, and repeat revascularization. Safety
outcomes were contrast-associated acute kidney injury, stroke, and major
bleeding. Pairwise direct comparison and mixed-treatment comparison
network meta-analyses were performed. Eleven trials that enrolled 3,150
patients with a total of 5,296 patient-years of follow-up were included.
In direct comparison meta-analysis, single-procedure multivessel PCI was
associated with a reduction in the risk of death or MI (rate ratio [RR] =
0.52; 95% confidence interval [CI] 0.37 to 0.73; p <0.001), due to less
death (RR = 0.64; 95% CI 0.40 to 1.02; p = 0.06) and MI (RR = 0.42; 95% CI
0.25 to 0.69; p <0.0001) compared with culprit-only PCI. No heterogeneity
(I2 = 0) was present between studies. In contrast, staged
multivessel PCI did not significantly reduce death or MI compared with
culprit-only PCI. Both multivessel PCI strategies reduced the risk of
repeat revascularization without significant differences in safety
outcomes. Results were consistent in the mixed-treatment comparison
meta-analysis. In conclusion, the present meta-analysis suggests that
single-procedure multivessel PCI may be the preferred strategy in patients
with STEMI and MVD. Copyright © 2017 Elsevier Inc.

<81>
Accession Number
619344479
Author
Wang H.-B.; Ji P.; Zhao X.-S.; Xu H.; Yan X.-Y.; Yang Q.; Yao C.; Gao
R.-L.; Wu Y.-F.; Qiao S.-B.
Institution
(Wang, Yan, Yao, Wu) Peking University Clinical Research Institute,
Beijing, China
(Ji) Shenzhen-Peking University, Hongkong University of Science and
Technology Medical Center, Shenzhen, China
(Zhao) Department of Cardiology, Beijing Jishuitan Hospital, Fourth
Clinical Medical College of Peking University, Beijing, China
(Xu, Gao, Qiao) Department of Cardiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking
Union Medical College, Beijing, China
(Yang) Guangzhou Recomgen Biotech Co. Ltd, Guangzhou, China
Title
Recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) versus
alteplase (rt-PA) as fibrinolytic therapy for acute ST-segment elevation
myocardial infarction (China TNK STEMI): Protocol for a randomised,
controlled, non-inferiority trial.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016838. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aim To evaluate the efficacy and safety of recombinant human TNK
tissue-type plasminogen activator (rhTNK-tPA) in lowering major adverse
cardiovascular and cerebrovascular events (MACCEs) in Chinese acute
ST-segment elevation myocardial infarction (STEMI) patients. Methods and
analysis The study is designed as a multicentre, randomised, controlled
non-inferiority phase IV trial with balanced randomisation (1:1) in
patients with STEMI. The planned sample size is 6200 participants (or 3100
per arm). Participants with STEMI will be randomised to receive either
rhTNK-tPA or alteplase (rt-PA), with stratification by research centre,
age and the time from symptom onset to randomisation. All patients will
receive concomitant antiplatelet and anticoagulant therapy before
fibrinolytic therapy. The participants assigned to the intervention group
will receive an intravenous bolus of 16 mg rhTNK-tPA, while those assigned
to the control group will receive an intravenous bolus of 8 mg rt-PA
followed by 42 mg infusion over 90 mins. Other medications can also be
administered at the discretion of the cardiologists in charge. All
participants will be followed up for the primary study endpoint, the
occurrence of MACCEs within 30 days after fibrinolytic therapy, which is
defined as all-cause mortality, non-fatal re-infarction, non-fatal stroke,
percutaneous coronary intervention (PCI) due to thrombolysis failure, and
PCI due to reocclusion. Both intention-to-treat and per-protocol analyses
will be done for the primary analyses. Ethics and dissemination The study
procedures and informed consent form were approved by all participating
hospitals. The results will be disseminated in peer review journals and
academic conferences. This multicentre randomised controlled trial will
provide high-quality data about the efficacy and safety of rhTNK-tPA and,
once approved, its easier use should help improve the application of
reperfusion therapy and hence the treatment outcomes of STEMI patients.
Trial registration number NCT02835534. Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<82>
Accession Number
620647604
Author
He W.; Su Q.; Liang J.; Sun Y.; Wang X.; Li L.
Institution
(He, Su, Liang, Sun, Wang, Li) Department of Cardiology, The First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
Title
The protective effect of nicorandil on cardiomyocyte apoptosis after
coronary microembolization by activating Nrf2/HO-1 signaling pathway in
rats.
Source
Biochemical and Biophysical Research Communications. 496 (4) (pp
1296-1301), 2018. Date of Publication: 19 Feb 2018.
Publisher
Elsevier B.V. (E-mail: apjcs@harcourt.com)
Abstract
Background: Myocardial apoptosis is considered to be the chief cause of
progressive cardiac dysfunction induced by coronary microembolization
(CME), and the Nrf2/HO-1 signaling pathway is involved in CME-induced
myocardial apoptosis. Nicorandil (NIC) has multiple beneficial
cardiovascular effects on myocardial injury. Therefore, this study was
undertaken to analyze the role of NIC pretreatment in the inhibiting
myocardial apoptosis after CME in rats. Methods: Forty rats were divided
into Sham group, CME group, CME plus NIC (NIC) group, and CME plus
AAV9-Nrf2 (AAV9-Nrf2) group (n = 10 per group). CME-induced myocardial
apoptosis model was established through injecting plastic microspheres (42
muM) into the left ventricle except the Sham group. NIC group received
nicorandil 3 mg/(kg.d) for 7 days before the operation. Cardiac function
was assessed by echocardiography. The mRNA expression level of Nrf2 was
detected by RT-PCR. The protein expression levels of Nrf2, HO-1, Bcl-2,
Bax and cleaved caspase-3 were detected by Western blot. The size of the
microinfarction area was measured by HBFP staining; myocardial apoptosis
was analyzed by TUNEL staining. Results: Compared with the sham group, the
cardiac function and the expression level of Nrf2, HO-1 and Bcl-2were
decreased, while myocardial apoptosis and the expression of Bax and
cleaved caspase-3 were increased in the CME group. Compared with the CME
group, cardiac function was significantly improved, the expression levels
of Nrf2, HO-1, and Bcl-2 were increased, the expression of Bax and cleaved
caspase-3 were decreased, and the myocardial apoptosis was attenuated in
the NIC group and AAV9-Nrf2 group. Conclusion: NIC pretreatment
effectively inhibit CME-induced myocardial apoptosis and improve cardiac
function. The protective effects are mediated through the activation of
the Nrf2/HO-1 signaling in cardiomyocytes. Copyright © 2018
Elsevier Inc.

<83>
Accession Number
620684293
Author
Li M.; Zou H.; Xu G.
Institution
(Li, Zou, Xu) Department of Nephrology, the Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, China
Title
Corrigendum to "The prevention of statins against AKI and mortality
following cardiac surgery: A meta-analysis" [Int. J. Cardiol. 222 (Nov 1
2016) 260-6].
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd

<84>
Accession Number
620684103
Author
Tam D.Y.; Hughes A.; Fremes S.E.; Youn S.; Hancock-Howard R.L.; Coyte
P.C.; Wijeysundera H.C.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Tam, Hughes, Fremes, Youn, Hancock-Howard, Coyte, Wijeysundera) Institute
of Health Policy, Management and Evaluation, University of Toronto,
Toronto, Ontario, Canada
(Hughes, Wijeysundera) Program of Child Health Evaluative Services, The
Hospital for Sick Children, Peter Gilgan Centre For Research and Learning,
University of Toronto, Toronto, Ontario, Canada
(Wijeysundera) Division of Cardiology, Schulich Heart Centre, Department
of Medicine, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Ontario, Canada
Title
A cost-utility analysis of transcatheter versus surgical aortic valve
replacement for the treatment of aortic stenosis in the population with
intermediate surgical risk.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Although transcatheter aortic valve implantation has been shown
to be noninferior to surgical aortic valve replacement in patients with
severe aortic stenosis at intermediate surgical risk, the
cost-effectiveness of this strategy in this population is unknown. Our
objective was to conduct a cost-utility analysis comparing transcatheter
aortic valve implantation with surgical aortic valve replacement in the
population with intermediate risk severe aortic stenosis. Methods: A fully
probabilistic Markov model with 30-day cycles was constructed from the
Canadian third-party payer's perspective to estimate the difference in
cost and effectiveness (measured as quality-adjusted life years) of
transcatheter aortic valve implantation versus surgical aortic valve
replacement for intermediate-risk patients over a lifetime time horizon,
discounted at 1.5% per annum. Clinical trial data from The Placement of
Aortic Transcatheter Valve 2 informed the efficacy inputs. Costs (adjusted
to 2016 Canadian dollars) were obtained from the Canadian Institute of
Health Information and the Ontario Schedule of Benefits. Incremental
cost-effectiveness ratios were calculated. Results: In the base-case
analysis, total lifetime costs for transcatheter aortic valve implantation
were $10,548 higher than surgical aortic valve replacement but added 0.23
quality-adjusted life years, for an incremental cost-effectiveness ratio
of $46,083/quality-adjusted life-years gained. Deterministic 1-way
analyses showed that the incremental cost-effectiveness ratio was
sensitive to rates of complications and cost of the transcatheter aortic
valve implantation prosthesis. There was moderate-to-high parameter
uncertainty; transcatheter aortic valve implantation was the preferred
option in only 52.7% and 55.4% of the simulations at a $50,000 and
$100,000 per quality-adjusted life years willingness-to-pay thresholds,
respectively. Conclusions: On the basis of current evidence, transcatheter
aortic valve implantation may be cost-effective for the treatment of
severe aortic stenosis in patients with intermediate surgical risk. There
remains moderate-to-high uncertainty surrounding the base-case incremental
cost-effectiveness ratio. Copyright © 2018 The American
Association for Thoracic Surgery.

<85>
Accession Number
620683046
Author
Gygax E.; Kaeser H.-U.; Stalder M.; Gahl B.; Rieben R.; Carrel T.; Erdoes
G.
Institution
(Gygax, Kaeser, Stalder, Carrel) Department of Cardiovascular Surgery,
InselspitalUniversity Hospital Bern, University of BernBern Switzerland
(Gahl) Clinical Trials Unit, InselspitalUniversity Hospital Bern,
University of BernBern Switzerland
(Rieben) Department for Biomedical Research, InselspitalUniversity
Hospital Bern, University of BernBern Switzerland
(Erdoes) Department of Anesthesiology and Pain Therapy,
InselspitalUniversity Hospital Bern, University of BernBern Switzerland
Title
Type II Minimal-Invasive Extracorporeal Circuit for Aortic Valve
Replacement: A Randomized Controlled Trial.
Source
Artificial Organs. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Extracorporeal circulation triggers systemic inflammatory response and
coagulation disorders which may lead to unfavorable clinical outcome. A
type II minimally-invasive extracorporeal circuit (MiECC) is a closed
system with markedly reduced artificial surface as compared to
conventional extracorporeal circuits (CECC). The aim of this study was to
investigate and compare inflammatory responses, complement activation and
selected clinical end-points in isolated surgical aortic valve replacement
(SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients
were prospectively randomized to MiECC or CECC perfusion regimen.
Complement activation (sC5b-9), inflammation (IL-6, TNF-alpha,
sCD40-ligand) and activation of the coagulation system (D-dimer,
TAT-complex) were determined before operation, at 2 hours and 24 hours
after surgery. Clinical end-points included perfusion time, transfusion of
allogeneic blood products, postoperative bleeding, sepsis, new onset of
atrial fibrillation, stroke and in-hospital mortality. Patient
characteristics and baseline plasma markers were similar in both groups.
Levels for sC5b-9, TNF-alpha, sCD40 ligand, TAT-complex and D-dimers were
not significantly different between MiECC and CECC at 2 hours and 24 hours
after surgery. The IL-6 plasma concentration was lower in the CECC group
at 24 hours (P=0.026, vs. MiECC). Comparisons of the baseline level to
values at 2 hours and 24 hours, adjusted for the type of oxygenator and
hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours
(P=0.013), but no difference at 24 hours (P=0.990). Compared with CECC,
MiECC patients had a shorter perfusion time (P=0.037) and less transfusion
requirements (P=0.04). In this selected cohort of SAVR patients, the type
II MiECC was not inferior to CECC in terms of inflammatory response and
complement activation. Thus, MiECC might be an alternative perfusion
strategy to conventional. Copyright © 2018 International Center
for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

<86>
Accession Number
620676738
Author
Chowdary P.; Tang A.; Watson D.; Besser M.; Collins P.; Creagh M.D.;
Qureshi H.; Rokicka M.; Nokes T.; Diprose P.; Gill R.
Institution
(Chowdary) Katharine Dormandy Haemophilia Centre and Thrombosis Unit,
Royal Free Hospital, London, United Kingdom
(Tang, Watson) Lancashire Cardiac Centre, Blackpool Teaching Hospital FT,
Blackpool, United Kingdom
(Tang) Faculty of Health and Medicine, Lancaster University, Lancaster,
United Kingdom
(Besser) Addenbrooke's Hospital, University of Cambridge, Cambridge,
United Kingdom
(Collins) Arthur Bloom Haemophilia Centre, University Hospital of Wales,
Cardiff, United Kingdom
(Creagh) Department of Haematology, Royal Cornwall Hospital, Truro, United
Kingdom
(Qureshi) Department of Transfusion Medicine, Glenfield Hospital,
Leicester, United Kingdom
(Rokicka) Royal Blackburn Hospital, Blackburn, United Kingdom
(Nokes) Derriford Hospital, Plymouth, United Kingdom
(Diprose, Gill) Department of Anaesthesia, University Hospital
Southampton, Southampton, United Kingdom
(Tang) Deceased
Title
Retrospective Review of a Prothrombin Complex Concentrate (Beriplex P/N)
for the Management of Perioperative Bleeding Unrelated to Oral
Anticoagulation.
Source
Clinical and Applied Thrombosis/Hemostasis. (no pagination), 2018. Date of
Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
A multicenter, retrospective, observational study of 4-factor prothrombin
complex concentrate (PCC) and/or fresh frozen plasma (FFP) use within
routine clinical care unrelated to vitamin K antagonists was conducted.
The PCC was administered preprocedure for correction of coagulopathy
(prophylactic cohort) and treatment of bleeding postsurgery (treatment
cohort). Of the 445 patients included, 40 were in the prophylactic cohort
(PCC alone [n = 16], PCC and FFP [n = 5], FFP alone [n = 19]) and 405 were
in the treatment cohort (PCC alone [n = 228], PCC and FFP [n = 123], FFP
alone [n = 54]). Cardiovascular surgery was the most common setting. PCC
doses ranged between 500 and 5000 IU. Effectiveness (assessed
retrospectively) was reported as effective in 93.0% in the PCC-only group
(95% confidence interval, 89.1% to 95.9%), 78.9% (70.8% to 85.6%) with PCC
and FFP, and 86.3% (76.2% to 93.2%) with FFP alone. In the treatment
cohort, international normalized ratio was significantly reduced in all 3
groups. In patients who received PCC, the rate of thromboembolic events
(1.9%) was below rates in the literature for similar procedures. PCCs
offer a potential alternative to FFP in the management of perioperative
bleeding unrelated to oral anticoagulant therapy. Copyright ©
2018, The Author(s) 2018.

<87>
Accession Number
620676488
Author
Svendsen O.S.; Farstad M.; Mongstad A.; Haaverstad R.; Husby P.; Kvalheim
V.L.
Institution
(Svendsen, Farstad, Husby) Department of Anesthesia and Intensive Care,
Haukeland University Hospital, Bergen, Norway
(Mongstad, Haaverstad, Kvalheim) Section for Cardiothoracic Surgery,
Department for Heart Disease, Haukeland University Hospital, Bergen,
Norway
(Haaverstad, Kvalheim) Department of Clinical Science, Faculty of
Medicine, University of Bergen, Bergen, Norway
(Husby) Department of Clinical Medicine, Faculty of Medicine, University
of Bergen, Bergen, Norway
Title
Is the use of hydroxyethyl starch as priming solution during cardiac
surgery advisable? A randomized, single-center trial.
Source
Perfusion (United Kingdom). (no pagination), 2017. Date of Publication: 01
Dec 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The use of cardiopulmonary bypass (CPB) leads to increased
fluid filtration and edema. The use of artificial colloids to counteract
fluid extravasation during cardiac surgery is controversial. Beneficial
effects on global fluid loading, leading to better cardiac performance and
hemodynamics, have been claimed. However, renal function and coagulation
may be adversely affected, with unfavorable impact on outcome following
cardiac surgery. Methods: Forty patients were randomly allocated to study
groups receiving either acetated Ringer's solution (CT group) or
hydroxyethyl starch (HES group, Tetraspan) as CPB priming
solution. Fluid balance, bleeding and hemodynamics, including cardiac
output, were followed postoperatively. The occurrence of acute kidney
injury was closely registered. Results: Two patients were excluded from
further analyzes due to surgical complications. Fluid accumulation was
attenuated in the HES group (3374 (883) ml) compared with the CT group
(4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation
was accompanied by an increased cardiac index immediately after surgery
(2.7 (0.4) L/min/m2 in the HES group and 2.1 (0.3)
L/min/m2 in the CT group (p<0.001)). No increase in bleeding
could be demonstrated in the HES group. Three patients, all of them in the
HES group, experienced acute kidney injury postoperatively. Conclusions:
CPB priming with HES solution lowers fluid loading during bypass and
improves cardiac function in the early postoperative period. The
manifestation of acute kidney injury exclusively in the HES group of
patients raises doubts about the use of HES products in conjunction with
cardiac surgery.
(https://clinicaltrials.gov/ct2/show/NCT01511120) Copyright ©
2017, The Author(s) 2017.

<88>
Accession Number
620675740
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Scharpenberg M.; Troitzsch D.;
Johansen P.; Nygaard H.; Eberle T.; Michael Hasenkam J.
Institution
(Bauer, Schaarschmidt) MediClin Heart Centre Coswig, Department of
Cardiovascular Perfusion, Coswig, Saxony-Anhalt, Germany
(Bauer, Eberle) MediClin Heart Centre Coswig, Department of Anaesthesia
and Intensive Care Medicine Coswig, Saxony-Anhalt, Germany
(Hausmann) MediClin Heart Centre Coswig, Department of Cardiothoracic and
Vascular Surgery, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) University of Bremen, Competence Center for Clinical
Trials, Bremen, Germany
(Troitzsch) Zoll Lifebridge, Ampfing, Bayern, Germany
(Johansen) Department of Engineering, Aarhus University, Jutland, Denmark
(Nygaard, Michael Hasenkam) Aarhus University, Department of Cardio
Thoracic and Vascular Surgery, Aarhus University Hospital and Department
of Clinical Medicine, Aarhus, Jutland, Denmark
Title
Shed-blood-separation and cell-saver: an integral Part of MiECC?
Shed-blood-separation and its influence on the perioperative inflammatory
response during coronary revascularization with minimal invasive
extracorporeal circulation systems - a randomized controlled trial.
Source
Perfusion (United Kingdom). (no pagination), 2017. Date of Publication: 01
Sep 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The postoperative systemic inflammatory response after
cardiopulmonary bypass (CPB) is still an undesirable side-effect after
cardiac surgery. It is most likely caused by blood contact with foreign
surfaces and by the surgical trauma itself. However, the recirculation of
activated shed mediastinal blood is another main cause of blood cell
activation and cytokine release. Minimal invasive extracorporeal
circulation (MiECC) comprises a completely closed circuit, coated surfaces
and the separation of suction blood. We hypothesized that MiECC, with
separated cell saved blood, would induce less of a systemic inflammatory
response than MiECC with no cell-saver. The aim of this study was,
therefore, to investigate the impact of cell washing shed blood from the
operating field versus direct return to the ECC on the biomarkers for
systemic inflammation. Material and methods: In the study, patients with
MiECC and cell-saver were compared with the control group, patients with
MiECC and direct re-transfusion of the drawn blood shed from the surgical
field. Results: High amounts of TNF-alpha (+ 120% compared to serum blood)
were found in the shed blood itself, but a significant reduction was
demonstrated with the use of a cell-saver (TNF-alpha ng/l post-ECC 10 min:
9.5+/-3.5 vs. 19.7+/-14.5, p<0.0001). The values for procalcitonin were
not significantly increased in the control group (6h: 1.07+/-3.4 vs.
2.15+/-9.55, p=0.19) and lower for C-reactive protein (CRP) (24h:
147.1+/-64.0 vs.134.4+/-52.4 p=0.28). Conclusion: The use of a cell-saver
and the processing of shed blood as an integral part of MiECC
significantly reduces the systemic cytokine load. We, therefore, recommend
the integration of cell-saving devices in MiECC to reduce the
perioperative inflammatory response. Copyright © 2017, The
Author(s) 2017.

<89>
Accession Number
620675644
Author
Olsson A.; Alfredsson J.; Ramstrom S.; Svedjeholm R.; Kenny D.; Hakansson
E.; Berglund J.S.; Berg S.
Institution
(Olsson, Berglund) Blekinge Institute of Technology, Department of Health
Science, Karlskrona, Sweden
(Olsson) Department of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Olsson) Department of Cardio-Thoracic Surgery, Blekinge Hospital,
Karlskrona, Sweden
(Alfredsson) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Ramstrom) Department of Clinical and Experimental Medicine, Linkoping
University, Linkoping, Sweden
(Svedjeholm, Hakansson, Berg) Department of Cardio-Thoracic and Vascular
Surgery and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Kenny) Clinical Research Centre, Royal College of Surgeons in Ireland,
Dublin, Ireland
Title
Better platelet function, less fibrinolysis and less hemolysis in
re-transfused residual pump blood with the Ringer's chase technique - a
randomized pilot study.
Source
Perfusion (United Kingdom). (no pagination), 2017. Date of Publication: 01
Sep 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Residual pump blood from the cardiopulmonary bypass (CPB)
circuit is often collected into an infusion bag (IB) and re-transfused. An
alternative is to chase the residual blood into the circulation through
the arterial cannula with Ringer's acetate. Our aim was to assess possible
differences in hemostatic blood quality between these two techniques.
Methods: Forty adult patients undergoing elective coronary artery bypass
graft surgery with CPB were randomized to receive the residual pump blood
by either an IB or through the Ringer's chase (RC) technique. Platelet
activation and function (impedance aggregometry), coagulation and
hemolysis variables were assessed in the re-transfused blood and in the
patients before, during and after surgery. Results are presented as median
(25-75 quartiles). Results: Total hemoglobin and platelet levels in the
re-transfused blood were comparable with the two methods, as were soluble
platelet activation markers P-selectin and soluble glycoprotein VI (GPVI).
Platelet aggregation (U) in the IB blood was significantly lower compared
to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32)
vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50
(29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59),
p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086
(891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3
(0.3-0.48), p<0.01. Other coagulation variables showed no difference
between the groups. Conclusions: The handling of blood after CPB increases
hemolysis, impairs platelet function and activates coagulation and
fibrinolysis. The RC technique preserved the blood better than the
commonly used IB technique. Copyright © 2017, The Author(s) 2017.

<90>
Accession Number
618954521
Author
Cardoso R.; Knijnik L.; Bhonsale A.; Miller J.; Nasi G.; Rivera M.; Blumer
V.; Calkins H.
Institution
(Cardoso, Bhonsale, Miller, Calkins) Division of Cardiology, Department of
Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United
States
(Knijnik, Nasi, Rivera, Blumer) Division of Cardiology, Department of
Medicine, University of Miami-Jackson Memorial Hospital, Miami, Florida,
United States
Title
An updated meta-analysis of novel oral anticoagulants versus vitamin K
antagonists for uninterrupted anticoagulation in atrial fibrillation
catheter ablation.
Source
Heart Rhythm. 15 (1) (pp 107-115), 2018. Date of Publication: January
2018.
Publisher
Elsevier B.V.
Abstract
Background: Catheter ablation is recommended as a first- or second-line
rhythm control therapy for selected patients with atrial fibrillation
(AF). There is a wide variability in the periprocedural management of oral
anticoagulation in patients undergoing AF ablation. Objective: We aimed to
perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs
vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients
undergoing AF ablation. Methods: Databases and conference abstracts were
searched. Studies were excluded if oral anticoagulants were held at any
periprocedural period. The primary outcomes were stroke or transient
ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962
patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%)
and not different between groups (odds ratio [OR] 0.66; 95% confidence
interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events
was also not significantly different between NOACs (8%) and VKAs (9.6%)
(OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in
the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50;
95% CI 0.30-0.84; P <.01). This finding was confirmed in a subgroup
analysis of randomized and cohort studies with matched controls (OR 0.45;
95% CI 0.24-0.83; P =.01). There was no significant difference in the
outcomes of individual NOACs and VKAs, although these analyses may have
been underpowered to detect minor differences in such rare outcomes.
Conclusion: In patients undergoing AF ablation, uninterrupted
periprocedural NOACs are associated with a low incidence of stroke or TIA
and a significant reduction in major bleeding as compared with
uninterrupted VKAs. Copyright © 2017 Heart Rhythm Society

<91>
Accession Number
617532618
Author
Hernandez J.M.; Urso S.; Tena M.A.; Sadaba R.; Portela F.
Institution
(Hernandez) Servicio de Cardiologia, Hospital San Roque, Maspalomas, Spain
(Urso, Tena, Sadaba, Portela) Servicio de Cirugia Cardiaca, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
Title
Percutaneous left appendage closure: A systematic review of safety and
efficacy events.
Source
Cirugia Cardiovascular. 25 (1) (pp 17-23), 2018. Date of Publication:
January 2018.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
Introduction and objectives: The aim of the present study is to
systematically review the success rate of percutaneous left atrial
appendage closure, its efficacy and safety, and the incidence of
peri-device leakage. Methods: A bibliographic search was performed using
the Google Scholar, MEDLINE, EMBASE and Cochrane databases, restricting
this search in English and collecting articles published until 2016. Our
analysis was limited to those studies that met the following inclusion
criteria: 1) studies with a prospective unicenter, prospective multicenter
and retrospective multicentre design. 2) Studies that had a sample size >=
80 patients. Results: Data from the two clinical trials (PROTECT-AF and
PREVAIL) suggest that percutaneous exclusion of the left atrial appendage
provides a similar long-term rate of cerebrovascular embolic events and
mortality compared to warfarin therapy. In the PROTECT AF study, an
incidence of peri-device leak of 39% is documented. The remaining studies,
which analyze patients with contraindications to anticoagulation and
without a control group, report a significant rate of severe complications
related to the procedure (up to 13,7%), the most frequent cause being
pericardial effusion and/or cardiac tamponade. Conclusions: Percutaneous
closure of the left atrial appendage is associated with a significant
incidence of severe periprocedural complications and peri-device
leak. Copyright © 2017 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<92>
[Use Link to view the full text]
Accession Number
620029560
Author
Jiang L.-C.; Cao J.-Y.; Chen M.
Institution
(Jiang, Cao, Chen) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Coronary artery aneurysm combined with other multiple aneurysms at
multiple locations: A case report and systematic review.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9230. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Coronary artery aneurysm (CAA) with concomitant aneurysms at
multiple sites is quite unusual and rare. The characteristics and the
etiology of this phenomenon are unknown. Methods: Herein, we present a
case with right coronary aneurysm with concomitant abdominal aorta as well
as right renal artery aneurysm. A systematic review of the literatures
regarding CAA with other coexisting aneurysms at multiple locations was
also conducted on Medline and Embase databases. Results: A total of 76
patients (male gender: 58; age: 37.4 +/- 26.5) including the present case
were included in the final study. The most common etiology of CAA with
multiple aneurysms was Kawasaki (43.3%) and atherosclerotic disease
(16.4%). CAA was the most frequently found at the right coronary artery
(62.7%), following, left anterior descending (51%), left main (43.1%), and
left circumflex (35.3%). The most common concomitant aneurysms were
abdominal aorta (52.6%) and iliac artery (50%). In addition, 60.5% of the
patients had an involved bilateral peripheral artery. Conclusion: CAA with
coexisting systemic aneurysms in multiple sites is quite rare. And it
usually involves multiple aneurysms at the coronary and bilateral
peripheral arteries simultaneously. Currently, there are no general
consensus regarding the clinical characteristics, diagnostic method, and
treatment of these cases. Copyright © 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<93>
[Use Link to view the full text]
Accession Number
620029352
Author
Han D.; Liu Y.G.; Pan S.; Luo Y.; Li J.; Ou-Yang C.
Institution
(Han, Pan) Anesthesia Department, Capital Institute of Pediatrics
Affiliated Children's Hospital, China
(Liu, Ou-Yang) Anesthesia Center, Capital Medical University Affiliated
Beijing Anzhen Hospital, 2 Anzhen Street, Chaoyang District, Beijing
100029, China
(Luo) Cardiac Surgery Division, Capital Institute of Pediatrics Affiliated
Children's Hospital, China
(Li) Clinical Physiology Laboratory, Capital Institute of Pediatrics,
Beijing, China
Title
Comparison of hemodynamic effects of sevoflurane and ketamine as basal
anesthesia by a new and direct monitoring during induction in children
with ventricular septal defect: A prospective, randomized research.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9039. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Sevoflurane and ketamine are commonly used to obtain sedation
and facilitate intravenous anesthetic induction in children undergoing
cardiac surgery who are uncooperative. We used a new and direct systemic
hemodynamic monitoring technique pressure recording analytical method and
compared the hemodynamic effects of sevoflurane and ketamine to facilitate
intravenous anesthetic induction. Methods: Forty-four children with
ventricular septal defect (2.2 +/- 1.2 years) were enrolled and randomized
to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for
sedation, followed by intravenous midazolam-sufentanil induction and
tracheal intubation. Recorded parameters included heart rate (HR),
arterial pressures, stroke volume index (SVI), cardiac index (CI),
systemic vascular resistance index (SVRI), the maximal slope of systolic
upstroke (dp/dt<inf>max</inf>) after sedation obtained with sevoflurane or
ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10
minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac
power output (CPO) were calculated. Results: As compared with Group S,
Group K had faster decreases during intravenous anesthetic induction in
arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI,
dp/dt<inf>max</inf>, RPP, lower SVI, CI, CPO (P < .05 for all) during the
study period. Conclusion: As compared with sevoflurane, ketamine
facilitated intravenous anesthetic induction exerts unfavorable effects on
systemic hemodynamic and myocardial energetic in children with ventricular
septal defect. Copyright © 2017 the Author(s). Published by
Wolters Kluwer Health, Inc.

<94>
[Use Link to view the full text]
Accession Number
620029131
Author
Brandao S.M.G.; Hueb W.; Ju Y.T.; De Lima A.C.P.; Polanczyk C.A.; Cruz
L.N.; Garcia R.M.R.; Takiuti M.E.; Bocchi E.A.
Institution
(Brandao, Hueb, Garcia, Bocchi) Instituto Do Coracao (InCor), Hospital das
Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP,
Brazil
(Ju, De Lima) Institute of Mathematics and Statistics, Department of
Statistics, University of Sao Paulo, Sao Paulo, SP, Brazil
(Polanczyk) Post Graduate Program in Cardiology and Cardiovascular
Disease, Federal University of Rio Grande Do sul, Brazil
(Polanczyk, Cruz) Instituto Nacional para Avaliacao de Tecnologia em
Saude, IATS/CNPq, Porto Alegre, RS, Brazil
Title
Utility and quality-adjusted life-years in coronary artery disease:
Five-year follow-up of the MASS II trial.
Source
Medicine (United States). 96 (50) (no pagination), 2017. Article Number:
e9113. Date of Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study evaluated the utility and quality-of-life year
measurements for patients with coronary artery disease who underwent any
of 3 therapeutic strategies with a 5-year follow-up. Methods:
Quality-of-life data were obtained from the Medicine, Angioplasty, or
Surgery Study II trial. To obtain utilities, the 36-Item Short-Form
questionnaire was converted to a 6-Dimensional Health State Classification
System. Results: Of the 611 initial patients, 579 completed the
questionnaire. In all, 188 patients received the surgical treatment-194
the percutaneous, and the remaining 197 the medical. The median utility
scores for the 5 years analyzed were 0.809 (95% confidence interval [CI]
0.794-0.842) for patients assigned to percutaneous coronary intervention,
0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI
0.761-0.809) for coronary artery bypass graft surgery. The difference
between percutaneous coronary intervention and medical treatment was
statistically significant (P < .05, Dunn test). The median cumulative
quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936)
for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95%
CI 3.638-3.890) for surgery. Additionally, the median quality-of-life
years between percutaneous and medical treatment was 0.262 (95% CI
0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI
0.036-0.413), and between surgery and percutaneous coronary intervention
it was -0.038 (95% CI -0.221 to -0.146). Conclusion: Coronary artery
bypass surgery and percutaneous coronary intervention were similar
regarding cumulative quality-of-life years; however, they were both
superior to that of medical treatment. The results presented are valuable
data for further cost-utility studies. Copyright © 2017 the
Author(s). Published by Wolters Kluwer Health, Inc.

<95>
Accession Number
614135626
Author
Edwards S.J.; Crawford F.; van Velthoven M.H.; Berardi A.; Osei-Assibey
G.; Bacelar M.; Salih F.; Wakefield V.
Institution
(Edwards, Crawford, van Velthoven, Berardi, Osei-Assibey, Bacelar, Salih,
Wakefield) BMJ Technology Assessment Group, London, United Kingdom
Title
The use of fibrin sealant during non-emergency surgery: A systematic
review of evidence of benefits and harms.
Source
Health Technology Assessment. 20 (94) (pp i, 224), 2016. Date of
Publication: December 2016.
Publisher
NIHR Journals Library
Abstract
Background: Fibrin sealants are used in different types of surgery to
prevent the accumulation of post-operative fluid (seroma) or blood
(haematoma) or to arrest haemorrhage (bleeding). However, there is
uncertainty around the benefits and harms of fibrin sealant use.
Objectives: To systematically review the evidence on the benefits and
harms of fibrin sealants in non-emergency surgery in adults. Data sources:
Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including
the Cochrane Database of Systematic Reviews, the Database of Abstracts of
Reviews of Effects, the Health Technology Assessment database and the
Cochrane Central Register of Controlled Trials)] were searched from
inception to May 2015. The websites of regulatory bodies (the Medicines
and Healthcare products Regulatory Agency, the European Medicines Agency
and the Food and Drug Administration) were also searched to identify
evidence of harms. Review methods: This review included randomised
controlled trials (RCTs) and observational studies using any type of
fibrin sealant compared with standard care in non-emergency surgery in
adults. The primary outcome was risk of developing seroma and haematoma.
Only RCTs were used to inform clinical effectiveness and both RCTs and
observational studies were used for the assessment of harms related to the
use of fibrin sealant. Two reviewers independently screened all titles and
abstracts to identify potentially relevant studies. Data extraction was
undertaken by one reviewer and validated by a second. The quality of
included studies was assessed independently by two reviewers using the
Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for
Reviews and Dissemination guidance for adverse events for observational
studies. A fixed-effects model was used for meta-analysis. Results: We
included 186 RCTs and eight observational studies across 14 surgical
specialties and five reports from the regulatory bodies. Most RCTs were
judged to be at an unclear risk of bias. Adverse events were
inappropriately reported in observational studies. Meta-analysis across
non-emergency surgical specialties did not show a statistically
significant difference in the risk of seroma for fibrin sealants versus
standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95%
confidence interval (CI) 0.68 to 1.04; p = 0.13; I2 = 12.7%],
but a statistically significant benefit was found on haematoma development
in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01;
I2 = 0%). Adverse events related to fibrin sealant use were
reported in 10 RCTs and eight observational studies across surgical
specialties, and 22 RCTs explicitly stated that there were no adverse
events. One RCT reported a single death but no other study reported
mortality or any serious adverse events. Five regulatory body reports
noted death from air emboli associated with fibrin sprays. Limitations: It
was not possible to provide a detailed evaluation of individual RCTs in
their specific contexts because of the limited resources that were
available for this research. In addition, the number of RCTs that were
identified made it impractical to conduct independent data extraction by
two reviewers in the time available. Conclusions: The effectiveness of
fibrin sealants does not appear to vary according to surgical procedures
with regard to reducing the risk of seroma or haematoma. Surgeons should
note the potential risk of gasembolism if spray application of fibrin
sealants is used and not to exceed the recommended pressure and spraying
distance. Future research should be carried out in surgery specialties for
which only limited datawere found, including neurological, gynaecological,
oral and maxillofacial, urology, colorectal and orthopaedics surgery (for
any outcome); breast surgery and upper gastrointestinal (development of
haematoma); and cardiothoracic heart or lung surgery (reoperation rates).
In addition, studies need to use adequate sample sizes, to blind
participants and outcome assessors, and to follow reporting
guidelines. Copyright © Queen's Printer and Controller of HMSO
2016.

<96>
Accession Number
611908892
Author
Reeves B.C.; Pike K.; Rogers C.A.; Brierley R.C.M.; Stokes E.A.;
Wordsworth S.; Nash R.L.; Miles A.; Mumford A.D.; Cohen A.; Angelini G.D.;
Murphy G.J.
Institution
(Reeves, Pike, Rogers, Brierley, Nash, Miles) Clinical Trials and
Evaluation Unit, School of Clinical Sciences, University of Bristol,
Bristol, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Oxford, United Kingdom
(Mumford) School of Cellular and Molecular Medicine, University of
Bristol, Bristol, United Kingdom
(Cohen) Division of Specialised Services, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Angelini) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Leicester, United Kingdom
Title
A multicentre randomised controlled trial of transfusion indication
threshold reduction on transfusion rates, morbidity and health-care
resource use following cardiac surgery (TITRe2).
Source
Health Technology Assessment. 20 (60) (pp 1-259), 2016. Date of
Publication: August 2016.
Publisher
NIHR Journals Library
Abstract
Background: Uncertainty about optimal red blood cell transfusion
thresholds in cardiac surgery is reflected in widely varying transfusion
rates between surgeons and cardiac centres. Objective: To test the
hypothesis that a restrictive compared with a liberal threshold for red
blood cell transfusion after cardiac surgery reduces post-operative
morbidity and health-care costs. Design: Multicentre, parallel randomised
controlled trial and within-trial cost-utility analysis from a UK NHS and
Personal Social Services perspective. We could not blind health-care staff
but tried to blind participants. Random allocations were generated by
computer and minimised by centre and operation. Setting: Seventeen
specialist cardiac surgery centres in UK NHS hospitals. Participants:
Patients aged > 16 years undergoing non-emergency cardiac surgery with
post-operative haemoglobin < 9 g/dl. Exclusion criteria were: unwilling to
have transfusion owing to beliefs; platelet, red blood cell or clotting
disorder; ongoing or recurrent sepsis; and critical limb ischaemia.
Interventions: Participants in the liberal group were eligible for
transfusion immediately after randomisation (post-operative haemoglobin <
9 g/dl); participants in the restrictive group were eligible for
transfusion if their post-operative haemoglobin fell to < 7.5 g/dl during
the index hospital stay. Main outcome measures: The primary outcome was a
composite outcome of any serious infectious (sepsis or wound infection) or
ischaemic event (permanent stroke, myocardial infarction, gut infarction
or acute kidney injury) during the 3 months after randomisation. Events
were verified or adjudicated by blinded personnel. Secondary outcomes
included blood products transfused; infectious events; ischaemic events;
quality of life (European Quality of Life-5 Dimensions); duration of
intensive care or high-dependency unit stay; duration of hospital stay;
significant pulmonary morbidity; all-cause mortality; resource use, costs
and cost-effectiveness. Results: We randomised 2007 participants between
15 July 2009 and 18 February 2013; four withdrew, leaving 1000 and 1003 in
the restrictive and liberal groups, respectively. Transfusion rates after
randomization were 53.4% (534/1000) and 92.2% (925/1003). The primary
outcome occurred in 35.1% (331/944) and 33.0% (317/962) of participants in
the restrictive and liberal groups [odds ratio (OR) 1.11, 95% confidence
interval (CI) 0.91 to 1.34; p = 0.30], respectively. There were no
subgroup effects for the primary outcome, although some sensitivity
analyses substantially altered the estimated OR. There were no differences
for secondary clinical outcomes except for mortality, with more deaths in
the restrictive group (4.2%, 42/1000 vs. 2.6%, 26/1003; hazard ratio 1.64,
95% CI 1.00 to 2.67; p = 0.045). Serious post-operative complications
excluding primary outcome events occurred in 35.7% (354/991) and 34.2%
(339/991) of participants in the restrictive and liberal groups,
respectively. The total cost per participant from surgery to 3 months
postoperatively differed little by group, just 182 less (standard error
488) in the restrictive group, largely owing to the difference in red
blood cells cost. In the base-case cost-effectiveness results, the point
estimate suggested that the restrictive threshold was cost-effective;
however, this result was very uncertain partly owing to the negligible
difference in quality-adjusted life-years gained. Conclusions: A
restrictive transfusion threshold is not superior to a liberal threshold
after cardiac surgery. This finding supports restrictive transfusion due
to reduced consumption and costs of red blood cells. However, secondary
findings create uncertainty about recommending restrictive transfusion and
prompt a new hypothesis that liberal transfusion may be superior after
cardiac surgery. Reanalyses of existing trial datasets, excluding all
participants who did not breach the liberal threshold, followed by a
meta-analysis of the reanalysed results are the most obvious research
steps to address the new hypothesis about the possible harm of red blood
cell transfusion.. Copyright © Queen's Printer and Controller of
HMSO 2016.

<97>
Accession Number
610521584
Author
Field J.K.; Duffy S.W.; Baldwin D.R.; Brain K.E.; Devaraj A.; Eisen T.;
Green B.A.; Holemans J.A.; Kavanagh T.; Kerr K.M.; Ledson M.; Lifford
K.J.; McRonald F.E.; Nair A.; Page R.D.; Parmar M.K.B.; Rintoul R.C.;
Screaton N.; Wald N.J.; Weller D.; Whynes D.K.; Williamson P.R.;
Yadegarfar G.; Hansell D.M.
Institution
(Field, Green, McRonald, Yadegarfar) Department of Molecular and Clinical
Cancer Medicine, Institute of Translational Medicine, University of
Liverpool, Liverpool, United Kingdom
(Duffy) Centre for Cancer Prevention, Wolfson Institute of Preventive
Medicine, Queen Mary University of London, London, United Kingdom
(Baldwin) Respiratory Medicine Unit, David Evans Research Centre,
Department of Respiratory Medicine, Nottingham University Hospitals,
Nottingham, United Kingdom
(Brain, Lifford) Division of Population Medicine, College of Biomedical
and Life Sciences, Cardiff University, Cardiff, United Kingdom
(Devaraj, Hansell) Department of Radiology, Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Eisen) Department of Oncology, University of Cambridge, Cambridge, United
Kingdom
(Holemans) Department of Radiology, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Kavanagh) Lung Cancer Patient Advocate, Liverpool, United Kingdom
(Kerr) Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United
Kingdom
(Ledson) Department of Respiratory Medicine, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Nair) Department of Radiology, Guy's and St Thomas' NHS Foundation Trust,
London, United Kingdom
(Page) Department of Thoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Parmar) MRC Clinical Trials Unit, University College London, London,
United Kingdom
(Rintoul) Department of Thoracic Oncology, Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
(Screaton) Department of Radiology, Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
(Wald) Centre for Environmental and Preventive Medicine, Wolfson Institute
of Preventive Medicine, Queen Mary University of London, London, United
Kingdom
(Weller) School of Clinical Sciences and Community Health, University of
Edinburgh, Edinburgh, United Kingdom
(Whynes) School of Economics, University of Nottingham, Nottingham, United
Kingdom
(Williamson) Department of Biostatistics, Institute of Translational
Medicine, University of Liverpool, Liverpool, United Kingdom
Title
The UK lung cancer screening trial: A pilot randomised controlled trial of
low-dose computed tomography screening for the early detection of lung
cancer.
Source
Health Technology Assessment. 20 (40) (no pagination), 2016. Date of
Publication: May 2016.
Publisher
NIHR Journals Library
Abstract
Background: Lung cancer kills more people than any other cancer in the UK
(5-year survival < 13%). Early diagnosis can save lives. The USA-based
National Lung Cancer Screening Trial reported a 20% relative reduction in
lung cancer mortality and 6.7% all-cause mortality in low-dose computed
tomography (LDCT)-screened subjects. Objectives: To (1) analyse LDCT lung
cancer screening in a high-risk UK population, determine optimum
recruitment, screening, reading and care pathway strategies; and (2)
assess the psychological consequences and the health-economic implications
of screening. Design: A pilot randomised controlled trial comparing
intervention with usual care. A population-based risk questionnaire
identified individuals who were at high risk of developing lung cancer
(>=5% over 5 years). Setting: Thoracic centres with expertise in lung
cancer imaging, respiratory medicine, pathology and surgery: Liverpool
Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.
Participants: Individuals aged 50-75 years, at high risk of lung cancer,
in the primary care trusts adjacent to the centres. Interventions: A
thoracic LDCT scan. Follow-up computed tomography (CT) scans as per
protocol. Referral to multidisciplinary team clinics was determined by
nodule size criteria. Main outcome measures: Population-based recruitment
based on risk stratification; management of the trial through web-based
database; optimal characteristics of CT scan readers (radiologists vs.
radiographers); characterisation of CT-detected nodules utilising
volumetric analysis; prevalence of lung cancer at baseline;
sociodemographic factors affecting participation; psychosocial measures
(cancer distress, anxiety, depression, decision satisfaction); and
cost-effectiveness modelling. Results: A total of 247,354 individuals were
approached to take part in the trial; 30.7% responded positively to the
screening invitation. Recruitment of participants resulted in 2028 in the
CT arm and 2027 in the control arm. A total of 1994 participants underwent
CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36
out of 42 (85.7%) of the screen-detected cancers were identified as stage
1 or 2, and 35 (83.3%) underwent surgical resection as their primary
treatment. Lung cancer was more common in the lowest socioeconomic group.
Short-term adverse psychosocial consequences were observed in participants
who were randomised to the intervention arm and in those who had a major
lung abnormality detected, but these differences were modest and
temporary. Rollout of screening as a service or design of a full trial
would need to address issues of outreach. The health-economic analysis
suggests that the intervention could be cost-effective but this needs to
be confirmed using data on actual lung cancer mortality. Conclusions: The
UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with
4055 randomised individuals. The data from the UKLS provide evidence that
adds to existing data to suggest that lung cancer screening in the UK
could potentially be implemented in the 60-75 years age group, selected
via the Liverpool Lung Project risk model version 2 and using CT
volumetry-based management protocols. Copyright © Queen's Printer
and Controller of HMSO 2016.

<98>
Accession Number
618763459
Author
Dall'Ara G.; Marzocchi A.; Taglieri N.; Moretti C.; Rodino G.; Chiarabelli
M.; Bottoni P.; Marrozzini C.; Sabattini M.R.; Bacchi-Reggiani M.-L.;
Rapezzi C.; Saia F.
Institution
(Dall'Ara, Marzocchi, Taglieri, Moretti, Rodino, Chiarabelli, Bottoni,
Marrozzini, Sabattini, Bacchi-Reggiani, Rapezzi, Saia) Cardiology Unit,
Cardio-Thoraco-Vascular Department, University Hospital of Bologna,
Policlinico S. Orsola-Malpighi, Bologna, Italy
(Dall'Ara) Dottorato di ricerca XXXdegreeciclo, Scienze
Cardio-Nefro-Toraciche, University of Bologna, Bologna, Italy
Title
Randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing: The pacing versus no pacing (PNP) study.
Source
Journal of Interventional Cardiology. 31 (1) (pp 51-59), 2018. Date of
Publication: Februaryy 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background: BAV technique is poorly standardized. Methods: One
hundred consecutive patients were randomly assigned 1:1 between BAV
performed with or without RP. Exclusion criteria were an immediate
indication for surgical or transcatheter aortic valve replacement,
presentation in cardiogenic shock or pulmonary edema refractory to medical
stabilization. Results: There were 51 patients in the BAV group performed
with RP, 49 in the BAV group without RP (noRP). Procedural success (50%
hemodynamic gradient reduction) was achieved in 37.3% and 55.1%,
respectively (P = 0.16). Fewer people in the noRP group complained of poor
tolerance to the procedure (16% vs 41%). The primary efficacy endpoint, a
50% reduction in the mean echocardiographic trans-aortic gradient, was met
in 21/49 patients in the noRP group compared to 20/51 in the RP (42.9% vs
39.2%; P = 0.84). No significant difference between the groups was
observed in the primary safety endpoint, a 30-day composite of death,
myocardial infarction, stroke, acute aortic regurgitation, and BARC
bleeding >=3 (8.2% noRP vs 13.7%; P = 0.53). The noRP group required fewer
bailout temporary pacemakers (P = 0.048) and had a lower incidence of
moderate/severe renal function worsening (4.1% vs 17.6%; P = 0.052).
Conclusions: Rapid ventricular pacing did not influence BAV efficacy or
safety and tolerance was slightly worse. Copyright © 2017, Wiley
Periodicals, Inc.

<99>
Accession Number
620626443
Author
Kim J.Y.; Song S.H.; Cho J.H.; Cho H.R.
Institution
(Kim, Song, Cho) 1 Department of Orthopedic Surgery, Myongji Hospital,
Seonam University College of Medicine, Goyang-si, Gyeonggi-do, Republic of
Korea
(Cho) 2 Department of Anesthesiology and Pain Medicine, Myongji Hospital,
Seonam University College of Medicine, Goyang-si, Gyeonggi-do, Republic of
Korea
Title
Comparison of clinical efficacy among remifentanil, nicardipine, and
remifentanil plus nicardipine continuous infusion for hypotensive
anesthesia during arthroscopic shoulder surgery.
Source
Journal of orthopaedic surgery (Hong Kong). 25 (2) (pp 2309499017716251),
2017. Date of Publication: 01 May 2017.
Abstract
METHODS: For this study, we enrolled 45 consecutive patients who were
scheduled to have arthroscopic rotator cuff repair surgery and randomly
allocated them into remifentanil (group R, n = 15), nicardipine (group N,
n = 15), and remifentanil plus nicardipine (group RN, n = 15) groups.
During the surgeries, these drugs were administered with continuous
infusion. We analyzed the mean arterial pressure (MAP) and heart rate
during surgery, stay time in the recovery room, visual analogue scale
(VAS) scores, use of antiemetics in the recovery room, and postoperative
blood urea nitrogen and creatinine changes.
PURPOSE: Hypotensive anesthesia is crucial during arthroscopic shoulder
surgery to reduce bleeding and allow for clear visibility. The aim of this
study was to compare the clinical efficacy of continuous infusion of
remifentanil, nicardipine, and remifentanil plus nicardipine to control
hypotensive anesthesia in arthroscopic shoulder surgery.
RESULTS: The VAS score in the recovery room was higher for group R (mean
5.6, SD 1.4) than for groups N (mean 3.9, SD 0.9) and RN (mean 4.0, SD
1.1; p = 0.000). There were no statistical differences regarding other
clinical variables among the three groups (all p > 0.05) except for MAP at
120 min of surgery between groups N and RN (N: 84.67 (SD 10.7) mmHg, RN:
65.4 (SD 9.2) mmHg, p = 0.027).
CONCLUSION: The continuous infusion of remifentanil plus nicardipine
appeared to be advantageous for maintaining hypotensive anesthesia until
120 min of arthroscopic shoulder surgery without rebound pain in a
postanesthesia care unit.

<100>
Accession Number
620583694
Author
Buggeskov K.B.; Gronlykke L.; Risom E.C.; Wei M.L.; Wetterslev J.
Institution
(Buggeskov, Gronlykke, Risom) Copenhagen University Hospital,
Rigshospitalet, Department of Thoracic Anaesthesiology, Blegdamsvej 9,
Copenhagen 2100, Denmark
(Wei) West China Hospital, Sichuan University, Chinese Evidence-Based
Medicine Centre, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Wetterslev) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Pulmonary artery perfusion versus no perfusion during cardiopulmonary
bypass for open heart surgery in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (2) (no pagination), 2018.
Article Number: CD011098. Date of Publication: 08 Feb 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Available evidence has been inconclusive on whether pulmonary
artery perfusion during cardiopulmonary bypass (CPB) is associated with
decreased or increased mortality, pulmonary events, and serious adverse
events (SAEs) after open heart surgery. To our knowledge, no previous
systematic reviews have included meta-analyses of these interventions.
Objectives: To assess the benefits and harms of single-shot or continuous
pulmonary artery perfusion with blood (oxygenated or deoxygenated) or a
preservation solution compared with no perfusion during cardiopulmonary
bypass (CPB) in terms of mortality, pulmonary events, serious adverse
events (SAEs), and increased inflammatory markers for adult surgical
patients. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index
Expanded, and advanced Google for relevant studies. We handsearched
retrieved study reports and scanned citations of included studies and
relevant reviews to ensure that no relevant trials were missed. We
searched for ongoing trials and unpublished trials in the World Health
Organization International Clinical Trials Registry Platform (ICTRP) and
at clinicaltrials.gov (4 July 2017). We contacted medicinal firms
producing preservation solutions to retrieve additional studies conducted
to examine relevant interventions. Selection criteria: We included
randomized controlled trials (RCTs) that compared pulmonary artery
perfusion versus no perfusion during CPB in adult patients ( 18 years).
Data collection and analysis: Two independent review authors extracted
data, conducted fixed-effect and random-effects meta-analyses, and
calculated risk ratios (RRs) or odds ratios (ORs) for dichotomous
outcomes. For continuous data, we have presented mean differences (MDs)
and 95% confidence intervals (CIs) as estimates of the intervention
effect. To minimize the risk of systematic error, we assessed risk of bias
of included trials. To reduce the risk of random errors caused by sparse
data and repetitive updating of cumulative meta-analyses, we applied Trial
Sequential Analyses (TSAs). We used GRADE principles to assess the quality
of evidence. Main results: We included in this review four RCTs (210
participants) reporting relevant outcomes. Investigators randomly assigned
participants to pulmonary artery perfusion with blood versus no perfusion
during CPB. Only one trial included the pulmonary artery perfusion
intervention with a preservation solution; therefore we did not perform
meta-analysis. Likewise, only one trial reported patient-specific data for
the outcome "pulmonary events"; therefore we have provided no results from
meta-analysis. Instead, review authors added two explorative secondary
outcomes for this version of the review: the ratio of partial pressure of
oxygen in arterial blood (PaO<inf>2</inf>) to fraction of inspired oxygen
(FiO<inf>2</inf>); and intubation time. Last, review authors found no
comparable data for the secondary outcome inflammatory markers. The effect
of pulmonary artery perfusion on all-cause mortality was uncertain (Peto
OR 1.78, 95% CI 0.43 to 7.40; TSA adjusted CI 0.01 to 493; 4 studies, 210
participants; GRADE: very low quality). Sensitivity analysis of one trial
with overall low risk of bias (except for blinding of personnel during the
surgical procedure) yielded no evidence of a difference for mortality
(Peto OR 1.65, 95% CI 0.27 to 10.15; 1 study, 60 participants). The TSA
calculated required information size was not reached and the futility
boundaries did not cross; thus this analysis cannot refute a 100% increase
in mortality. The effect of pulmonary artery perfusion with blood on SAEs
was likewise uncertain (RR 1.12, 95% CI 0.66 to 1.89; 3 studies, 180
participants; GRADE: very low quality). Data show an association between
pulmonary artery perfusion with blood during CPB and a higher
postoperative PaO<inf>2</inf>/FiO<inf>2</inf> ratio (MD 27.80, 95% CI 5.67
to 49.93; 3 studies, 119 participants; TSA adjusted CI 5.67 to 49.93;
GRADE: very low quality), although TSA could not confirm or refute a 10%
increase in the PaO<inf>2</inf>/FiO<inf>2</inf> ratio, as the required
information size was not reached. Authors' conclusions: The effects of
pulmonary artery perfusion with blood during cardiopulmonary bypass (CPB)
are uncertain owing to the small numbers of participants included in
meta-analyses. Risks of death and serious adverse events may be higher
with pulmonary artery perfusion with blood during CPB, and robust evidence
for any beneficial effects is lacking. Future randomized controlled trials
(RCTs) should provide long-term follow-up and patient stratification by
preoperative lung function and other documented risk factors for
mortality. One study that is awaiting classification (epub abstract with
preliminary results) may change the results of this review when full study
details have been published. Copyright © 2018 The Cochrane
Collaboration.

<101>
Accession Number
620563210
Author
Hemmingsen B.; Lund S.S.; Gluud C.; Vaag A.; Almdal T.P.; Wetterslev J.
Institution
(Hemmingsen, Wetterslev) Department 7812, Rigshospitalet, Copenhagen
University Hospital, Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Lund) Boehringer Ingelheim Pharma GmbH and Co. KG, Ingelheim, Germany
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Vaag) Rigshospitalet and Copenhagen University, Department of
Endocrinology, Diabetes and Metabolism, Afsnit 7652, Kobenhavn N 2200,
Denmark
(Almdal) Copenhagen University Hospital Gentofte, Department of Medicine
F, Hellerup 2900, Denmark
Title
Targeting intensive glycaemic control versus targeting conventional
glycaemic control for type 2 diabetes mellitus.
Source
Cochrane Database of Systematic Reviews. 2015 (7) (no pagination), 2015.
Article Number: CD008143. Date of Publication: 29 Jul 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients with type 2 diabetes mellitus (T2D) have an increased
risk of cardiovascular disease and mortality compared to the background
population. Observational studies report an association between reduced
blood glucose and reduced risk of both micro- and macrovascular
complications in patients with T2D. Our previous systematic review of
intensive glycaemic control versus conventional glycaemic control was
based on 20 randomised clinical trials that randomised 29, 986
participants with T2D. We now report our updated review. Objectives: To
assess the effects of targeted intensive glycaemic control compared with
conventional glycaemic control in patients with T2D. Search methods:
Trials were obtained from searches of The Cochrane Library, MEDLINE,
EMBASE, Science Citation Index Expanded, LILACS, and CINAHL (all until
December 2012). Selection criteria: We included randomised clinical trials
that prespecified targets of intensive glycaemic control versus
conventional glycaemic control targets in adults with T2D. Data collection
and analysis: Two authors independently assessed the risk of bias and
extracted data. Dichotomous outcomes were assessed by risk ratios (RR) and
95% confidence intervals (CI). Health-related quality of life and costs of
intervention were assessed with standardized mean differences (SMD) and
95% Cl. Main results: Twenty-eight trials with 34,912 T2D participants
randomised 18,717 participants to intensive glycaemic control versus
16,195 participants to conventional glycaemic control. Only two trials had
low risk of bias on all risk of bias domains assessed. The duration of the
intervention ranged from three days to 12.5 years. The number of
participants in the included trials ranged from 20 to 11,140. There were
no statistically significant differences between targeting intensive
versus conventional glycaemic control for all-cause mortality (RR 1.00,
95% CI 0.92 to 1.08; 34,325 participants, 24 trials) or cardiovascular
mortality (RR 1.06, 95% CI 0.94 to 1.21; 34,177 participants, 22 trials).
Trial sequential analysis showed that a 10% relative risk reduction could
be refuted for all-cause mortality. Targeting intensive glycaemic control
did not show a statistically significant effect on the risks of
macrovascular complications as a composite outcome in the random-effects
model, but decreased the risks in the fixed-effect model (random RR 0.91,
95% CI 0.82 to 1.02; and fixed RR 0.93, 95% CI 0.87 to 0.99; P = 0.02;
32,846 participants, 14 trials). Targeting intensive versus conventional
glycaemic control seemed to reduce the risks of non-fatal myocardial
infarction (RR 0.87, 95% CI 0.77 to 0.98; P = 0.02; 30,417 participants,
14 trials), amputation of a lower extremity (RR 0.65, 95% CI 0.45 to 0.94;
P = 0.02; 11,200 participants, 11 trials), as well as the risk of
developing a composite outcome of microvascular diseases (RR 0.88, 95% CI
0.82 to 0.95; P = 0.0008; 25,927 participants, 6 trials), nephropathy (RR
0.75, 95% CI 0.59 to 0.95; P = 0.02; 28,096 participants, 11 trials),
retinopathy (RR 0.79, 95% CI 0.68 to 0.92; P = 0.002; 10,300 participants,
9 trials), and the risk of retinal photocoagulation (RR 0.77, 95% CI 0.61
to 0.97; P = 0.03; 11,212 participants, 8 trials). No statistically
significant effect of targeting intensive glucose control could be shown
on non-fatal stroke, cardiac revascularization, or peripheral
revascularization. Trial sequential analyses did not confirm a reduction
of the risk of non-fatal myocardial infarction but confirmed a 10%
relative risk reduction in favour of intensive glycaemic control on the
composite outcome of microvascular diseases. For the remaining
microvascular outcomes, trial sequential analyses could not establish firm
evidence for a 10% relative risk reduction. Targeting intensive glycaemic
control significantly increased the risk of mild hypoglycaemia, but
substantial heterogeneity was present; severe hypoglycaemia (RR 2.18, 95%
CI 1.53 to 3.11; 28,794 participants, 12 trials); and serious adverse
events (RR 1.06, 95% CI 1.02 to 1.10; P = 0.007; 24,280 participants, 11
trials). Trial sequential analysis for a 10% relative risk increase showed
firm evidence for mild hypoglycaemia and serious adverse events and a 30%
relative risk increase for severe hypoglycaemia when targeting intensive
versus conventional glycaemic control. Overall health-related quality of
life, as well as the mental and the physical components of health-related
quality of life did not show any statistical significant differences.
Authors' conclusions: Although we have been able to expand the number of
participants by 16% in this update, we still find paucity of data on
outcomes and the bias risk of the trials was mostly considered high.
Targeting intensive glycaemic control compared with conventional glycaemic
control did not show significant differences for all-cause mortality and
cardiovascular mortality. Targeting intensive glycaemic control seemed to
reduce the risk of microvascular complications, if we disregard the risks
of bias, but increases the risk of hypoglycaemia and serious adverse
events. Copyright © 2015 The Cochrane Collaboration.

<102>
Accession Number
620563204
Author
Desborough M.; Sandu R.; Brunskill S.J.; Doree C.; Trivella M.; Montedori
A.; Abraha I.; Stanworth S.
Institution
(Desborough) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Oxford, United Kingdom
(Sandu) The Liverpool Heart and Chest Hospital, Department of Anaesthesia,
13 Allerton Rd, Liverpool L18 1LY, United Kingdom
(Brunskill, Doree) NHS Blood and Transplant, Systematic Review Initiative,
Level 2, John Radcliffe Hospital, Headington, Oxford, Oxon OX3 9BQ, United
Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Montedori) Regional Health Authority of Umbria, Health Planning Service,
Via Mario Angeloni 61, Perugia, Umbria 06124, Italy
(Abraha) Azienda Ospedaliera di Perugia, Servizio Immunotrasfusionale,
Perugia, Italy
(Stanworth) Oxford University Hospitals and the University of Oxford,
National Institute for Health Research (NIHR), Oxford Biomedical Research
Centre, Oxford OX3 9BQ, United Kingdom
Title
Fresh frozen plasma for cardiovascular surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (7) (no pagination), 2015.
Article Number: CD007614. Date of Publication: 14 Jul 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Fresh frozen plasma (FFP) is a blood component containing
procoagulant factors, which is sometimes used in cardiovascular surgery
with the aim of reducing the risk of bleeding. The purpose of this review
is to assess the risk of mortality for patients undergoing cardiovascular
surgery who receive FFP. Objectives: To evaluate the risk to benefit ratio
of FFP transfusion in cardiovascular surgery for the treatment of bleeding
patients or for prophylaxis against bleeding. Search methods: We searched
11 bibliographic databases and four ongoing trials databases including the
Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2015),
MEDLINE (OvidSP, 1946 to 21 April 2015), EMBASE (OvidSP, 1974 to 21 April
2015), PubMed (e-publications only: searched 21 April 2015),
ClinicalTrials.gov, World Health Organization (WHO) ICTRP and the ISRCTN
Register (searched 21 April 2015). We also searched the references of all
identified trials and relevant review articles. We did not limit the
searches by language or publication status. Selection criteria: We
included randomised controlled trials in patients undergoing major cardiac
or vascular surgery who were allocated to a FFP group or a comparator (no
plasma or an active comparator, either clinical plasma (any type) or a
plasma-derived blood product). We included participants of any age
(neonates, children and adults). We excluded studies of plasmapheresis and
plasma exchange. Data collection and analysis: Two authors screened all
electronically derived citations and abstracts of papers identified by the
review search strategy. Two authors assessed risk of bias in the included
studies and extracted data independently. We took care to note whether FFP
was used therapeutically or prophylactically within each trial. Main
results: We included 15 trials, with a total of 755 participants for
analysis in the review. Fourteen trials compared prophylactic use of FFP
against no FFP. One study compared therapeutic use of two types of plasma.
The timing of intervention varied, including FFP transfusion at the time
of heparin neutralisation and stopping cardiopulmonary bypass (CPB) (seven
trials), with CPB priming (four trials), after anaesthesia induction (one
trial) and postoperatively (two trials). Twelve trials excluded patients
having emergency surgery and nine excluded patients with coagulopathies.
Overall the trials were small, with only four reporting an a priori sample
size calculation. No trial was powered to determine changes in mortality
as a primary outcome. There was either high risk of bias, or unclear risk,
in the majority of trials included in this review. There was no difference
in the number of deaths between the intervention arms in the six trials
(with 287 patients) reporting mortality (very low quality evidence). There
was also no difference in blood loss in the first 24 hours for
neonatal/paediatric patients (four trials with 138 patients; low quality
evidence): mean difference (MD) -1.46 ml/kg (95% confidence interval (CI)
-4.7 to 1.78 ml/kg); or adult patients (one trial with 120 patients): MD
-12.00 ml (95% CI -101.16 to 77.16 ml). Transfusion with FFP was inferior
to control for preventing patients receiving any red cell transfusion:
Peto odds ratio (OR) 2.57 (95% CI 1.30 to 5.08; moderate quality
evidence). There was a difference in prothrombin time within two hours of
FFP transfusion in eight trials (with 210 patients; moderate quality
evidence) favouring the FFP arm: MD -0.71 seconds (95% CI -1.28 to -0.13
seconds). There was no difference in the risk of returning to theatre for
reoperation (eight trials with 398 patients; moderate quality evidence):
Peto OR 0.81 (95% CI 0.26 to 2.57). Only one included study reported
adverse events as an outcome and reported no significant adverse events
following FFP transfusion. Authors' conclusions: This review has found no
evidence to support the prophylactic administration of FFP to patients
without coagulopathy undergoing elective cardiac surgery. There was
insufficient evidence about treatment of patients with coagulopathies or
those who are undergoing emergency surgery. There were no reported adverse
events attributable to FFP transfusion, although there was a significant
increase in the number of patients requiring red cell transfusion who were
randomised to FFP. Variability in outcome reporting between trials
precluded meta-analysis for many outcomes across all trials, and there was
evidence of a high risk of bias in most of the studies. Further adequately
powered studies of FFP, or comparable pro-haemostatic agents, are required
to assess whether larger reductions in prothrombin time translate into
clinical benefits. Overall the evidence from randomised controlled trials
for the safety and efficacy of prophylactic transfusion of FFP for cardiac
surgery is insufficient. Copyright © 2015 The Cochrane
Collaboration.

<103>
Accession Number
620562384
Author
Ohlsson A.; Shah P.S.
Institution
(Ohlsson) University of Toronto, Departments of Paediatrics, Obstetrics
and Gynaecology, Institute of Health Policy, Management and Evaluation,
600 University Avenue, Toronto, ON M5G 1X5, Canada
(Ohlsson) Mount Sinai Hospital, Department of Paediatrics, 600 University
Avenue, Toronto, ON M5G 1X5, Canada
(Shah) University of Toronto Mount Sinai Hospital, Department of
Paediatrics and Institute of Health Policy, Management and Evaluation, 600
University Avenue, Toronto, ON M5G 1XB, Canada
Title
Paracetamol (acetaminophen) for prevention or treatment of pain in
newborns.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD011219. Date of Publication: 25 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Newborn infants have the ability to experience pain. Newborns
treated in neonatal intensive care units are exposed to numerous painful
procedures. Healthy newborns are exposed to pain if the birth process
consists of assisted vaginal birth by vacuum extraction or by forceps and
during blood sampling for newborn screening tests. Objectives: Primary
objective To determine the efficacy and safety of paracetamol for the
prevention or treatment of procedural/postoperative pain or pain
associated with clinical conditions in neonates. Secondary objective To
review the effects of various doses and routes of administration (enteral,
intravenous or rectal) of paracetamol for the prevention or treatment of
pain in neonates. We designed the main comparisons according to intention
of use, that is, paracetamol for prevention or treatment of pain. We
included separate comparisons based on the painful
intervention/procedure/condition (heel lance, insertion of nasogastric
tube, insertion of intravenous catheter, lumbar puncture, assisted vaginal
birth, postoperative pain, birth trauma, congenital anomalies such as
myelomeningocoele and open cutaneous lesions) and the mode of
administration of paracetamol. Within these comparisons, we planned to
assess in subgroups (when possible) effects based on postmenstrual age
(PMA) at the birth of randomly assigned infants (< 28 weeks, 28 weeks to
31 + 6 weeks, 32 weeks to 36 + 6 weeks and >= 37 weeks) or based on birth
weight (or current weight) categories (<= 1000 grams, 1001 to 1500 grams,
1501 to 2500 grams and >= 2501 grams) Search methods: We used the standard
search strategy of the Cochrane Neonatal Review Group including electronic
searches of the Cochrane Central Register of Controlled Trials (CENTRAL)
(October 2014), MEDLINE (1966 to October 2014), EMBASE (1980 to October
2014) and the Cumulative Index to Nursing and Allied Health Literature
(CINAHL) (1982 to October 2014). We applied no language restrictions. We
conducted electronic searches of abstracts from meetings of the Pediatric
Academic Societies (2000 to 2014) and the Perinatal Society of Australia
and New Zealand (2010 to 2014). We searched clinical trial registries for
ongoing trials and the Web of Science for articles quoting identified
randomised controlled trials. We searched the first 200 hits on Google
ScholarTM to identify grey literature. Selection criteria: We
included randomised and quasi-randomised controlled trials of paracetamol
for the prevention or treatment of pain in neonates (<= 30 days of age).
Data collection and analysis: Two review authors independently extracted
data from the full-text articles using a specifically designed form. We
used this form to decide trial inclusion/exclusion, to extract data from
eligible trials and to request additional published information from
authors of the original reports. We entered and cross-checked data using
RevMan 5.3.3 software. When noted, we resolved differences by mutual
discussion and consensus. Main results: We included eight trials with low
risk of bias, which assessed paracetamol use for the treatment of pain in
614 infants. Painful interventions studied included heel lance, assisted
vaginal birth, eye examination for ascertainment of retinopathy of
prematurity (ROP) and postoperative care following major surgery. Results
of individual studies could not be combined in meta-analyses as the
painful conditions, the use of paracetamol and comparison interventions
and the outcome measures differed. Paracetamol compared with water, cherry
elixir or EMLA cream did not significantly reduce pain following heel
lance. The Premature Infant Pain Profile score (PIPP) within three minutes
following lancing was higher in the paracetamol group than in the oral
glucose group (mean difference (MD) 2.21, 95% confidence interval (CI)
0.72 to 3.70; one study, 38 infants). Paracetamol did not reduce "modified
facies scores" after assisted vaginal birth (one study, 119 infants). In
another study (n = 123), the Echelle de Douleur et d'Inconfort du
Nouveau-Ne score at two hours of age was significantly higher in the group
that received paracetamol suppositories than in the placebo suppositories
group (MD 1.00, 95% CI 0.60 to 1.40). In that study, when infants were
subjected to a heel lance at two to three days of age, Bernese Pain Scale
for Neonates scores were higher in the paracetamol group than in the
placebo group, and infants spent a longer time crying (MD 19 seconds, 95%
CI 14 to 24). For eye examinations, no significant reduction in PIPP
scores in the first or last 45 seconds of eye examination was reported,
nor at five minutes after the eye examination. In one study (n = 81), the
PIPP score was significantly higher in the paracetamol group than in the
24% sucrose group (MD 3.90, 95% CI 2.92 to 4.88). For postoperative care
following major thoracic or abdominal surgery, the total amount of
morphine (mug/kg) administered over 48 hours was significantly less among
infants randomly assigned to the paracetamol group than in those randomly
assigned to the morphine group (MD -157 mug/kg, 95% CI -27 to -288). No
adverse events were noted in any study. Authors' conclusions: Paracetamol
does not significantly reduce pain associated with heel lance or eye
examinations. Paracetamol given after assisted vaginal birth may increase
the response to later painful exposures. Paracetamol should not be used
for painful procedures given its lack of efficacy and its potential for
adverse effects. Paracetamol may reduce the total need for morphine
following major surgery, and for this aspect of paracetamol use, further
research is needed. Copyright © 2015 The Cochrane Collaboration.

<104>
Accession Number
620562314
Author
Di Nisio M.; Peinemann F.; Porreca E.; Rutjes A.W.
Institution
(Di Nisio, Rutjes) University G. D'Annunzio of Chieti-Pescara, Department
of Medical, Oral and Biotechnological Sciences, via dei Vestini 31, Chieti
66013, Italy
(Di Nisio) Academic Medical Center, Department of Vascular Medicine,
Amsterdam, Netherlands
(Peinemann) Children's Hospital, University of Cologne, Pediatric Oncology
and Hematology, Kerpener Str. 62, Cologne, NW 50937, Germany
(Porreca) University G. D'Annunzio Foundation, Department of Medicine and
Aging; Centre for Aging Sciences (Ce.S.I.), Internal Medicine Unit, 31 Via
dei Vestini, Chieti 66100, Italy
(Rutjes) Fondazione Universita G. D'Annunzio, Centre for Systematic
Reviews, via dei Vestini 31, Chieti 66100, Italy
(Rutjes) University of Bern, Institute of Social and Preventive Medicine
(ISPM), Finkenhubelweg 11, Bern 3012, Switzerland
Title
Primary prophylaxis for venous thromboembolism in patients undergoing
cardiac or thoracic surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD009658. Date of Publication: 19 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiac and thoracic surgery are associated with an increased
risk of venous thromboembolism (VTE). The safety and efficacy of primary
thromboprophylaxis in patients undergoing these types of surgery is
uncertain. Objectives: To assess the effects of primary thromboprophylaxis
on the incidence of symptomatic VTE and major bleeding in patients
undergoing cardiac or thoracic surgery. Search methods: The Cochrane
Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the
Specialised Register (last searched May 2014) and CENTRAL (2014, Issue 4).
The authors searched the reference lists of relevant studies, conference
proceedings, and clinical trial registries. Selection criteria: Randomised
controlled trials (RCTs) and quasi-RCTs comparing any oral or parenteral
anticoagulant or mechanical intervention to no intervention or placebo, or
comparing two different anticoagulants. Data collection and analysis: We
extracted data on methodological quality, participant characteristics,
interventions, and outcomes including symptomatic VTE and major bleeding
as the primary effectiveness and safety outcomes, respectively. Main
results: We identified 12 RCTs and one quasi-RCT (6923 participants), six
for cardiac surgery (3359 participants) and seven for thoracic surgery
(3564 participants). No study evaluated fondaparinux, the new oral direct
thrombin, direct factor Xa inhibitors, or caval filters. All studies had
major study design flaws and most lacked a placebo or no treatment control
group. We typically graded the quality of the overall body of evidence for
the various outcomes and comparisons as low, due to imprecise estimates of
effect and risk of bias. We could not pool data because of the different
comparisons and the lack of data. In cardiac surgery, 71 symptomatic VTEs
occurred in 3040 participants from four studies. In a study of 2551
participants, representing 85% of the review population in cardiac
surgery, the combination of unfractionated heparin with pneumatic
compression stockings was associated with a 61% reduction of symptomatic
VTE compared to unfractionated heparin alone (1.5% versus 4.0%; risk ratio
(RR) 0.39; 95% confidence interval (CI) 0.23 to 0.64). Major bleeding was
only reported in one study, which found a higher incidence with vitamin K
antagonists compared to platelet inhibitors (11.3% versus 1.6%, RR 7.06;
95% CI 1.64 to 30.40). In thoracic surgery, 15 symptomatic VTEs occurred
in 2890 participants from six studies. In the largest study evaluating
unfractionated heparin versus an inactive control the rates of symptomatic
VTE were 0.7% versus 0%, respectively, giving a RR of 6.71 (95% CI 0.40 to
112.65). There was insufficient evidence to determine if there was a
difference in the risk of major bleeding from two studies evaluating
fixed-dose versus weight-adjusted low molecular weight heparin (2.7%
versus 8.1%, RR 0.33; 95% CI 0.07 to 1.60) and unfractionated heparin
versus low molecular weight heparin (6% and 4%, RR 1.50; 95% CI 0.26 to
8.60). Authors' conclusions: The evidence regarding the efficacy and
safety of thromboprophylaxis in cardiac and thoracic surgery is limited.
Data for important outcomes such as pulmonary embolism or major bleeding
were often lacking. Given the uncertainties around the benefit-to-risk
balance, no conclusions can be drawn and a case-by-case risk evaluation of
VTE and bleeding remains preferable. Copyright © 2015 The
Cochrane Collaboration.

<105>
Accession Number
620561090
Author
Briones E.; Lacalle J.R.; Marin-Leon I.; Rueda J.-R.
Institution
(Briones) Primary Care District. IBIS-CIBERESP, Public Health Unit, Avda
Jerez s/n, Antiguo Hospital Militar, Sevilla 41014, Spain
(Lacalle) Universidad de Sevilla, Preventive Medicine and Public Health,
Avenida Sanchez Pizjuan, Sevilla 41009, Spain
(Marin-Leon) Hospital Universitario Virgen del Rocio, IBIS-CIBERESP,
Department of Internal Medicine, Manuel Siurot, Office 2nd floor, Sevilla
41013, Spain
(Rueda) University of the Basque Country, Department of Preventive
Medicine and Public Health, Barrio Sarriena S.N., Leioa, Bizkaia E-48080,
Spain
Title
Transmyocardial laser revascularization versus medical therapy for
refractory angina.
Source
Cochrane Database of Systematic Reviews. 2015 (2) (no pagination), 2015.
Article Number: CD003712. Date of Publication: 27 Feb 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a review previously published in 2009.
Chronic angina and advanced forms of coronary disease are increasingly
more frequent. In spite of the improvement in the efficacy of available
revascularization treatments, a subgroup of patients continue suffering
from refractory angina. Transmyocardial laser revascularization (TMLR) has
been proposed to improve the clinical situation of these patients.
Objectives: To assess the effects (both benefits and harms) of TMLR versus
optimal medical treatment in people with refractory angina who are not
candidates for percutaneous coronary angioplasty or coronary artery bypass
graft, in alleviating angina severity, reducing mortality and improving
ejection fraction. Search methods: We searched the following resources up
to June 2014: the Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, EMBASE, the metaRegister of Controlled Trials
database, ClinicalTrials.gov, and the WHO International Clinical Trials
Registry. We applied no languages restrictions. We also checked reference
lists of relevant papers. Selection criteria: We selected studies if they
fulfilled the following criteria: randomized controlled trials (RCTs) of
TMLR, by thoracotomy, in patients with Canadian Cardiovascular Society or
New York Heart Association angina grade III-IV who were excluded from
other revascularization procedures. Data collection and analysis: Three
authors independently extracted data for each trial about the population
and interventions compared and assessed the risk of bias of the studies,
evaluating randomisation sequence generation, allocation concealment,
blinding (of participants, personnel and outcome assessors), incomplete
outcome data, selective outcome reporting, and other potential sources of
bias. Main results: From a total of 502 references, we retrieved 47 papers
for more detailed evaluation. We selected 20 papers, reporting data from
seven studies, which included 1137 participants, of which 559 were
randomized to TMLR. Participants and professionals were not blinded, which
suggests high risk of performance bias. Overall, 43.8% of participants in
the treatment group decreased two angina classes, as compared with 14.8%
in the control group: odds ratio (OR) 4.63, 95% confidence interval (CI)
3.43 to 6.25), and heterogeneity was present. Mortality by
intention-to-treat analysis was similar in both groups at 30 days (4.0% in
the TMLR group and 3.5% in the control group), and one year (12.2% in the
TMLR group and 11.9% in the control group). However, the 30-day mortality
as-treated was 6.8% in the TMLR group and 0.8% in the control group
(pooled OR was 3.76, 95% CI 1.63 to 8.66), mainly due to a higher
mortality in participants crossing from standard treatment to TMLR. The
assessment of subjective outcomes, such as improvement in angina, was
affected by a high risk of bias and this may explain the differences
found. Other adverse events such as myocardial infarction, arrhythmias or
heart failure, were not considered in this review, as they were not
predefined outcomes in trials design and they show a high inconsistency
across studies. No new trials on transmyocardial laser revascularization
have been published in the last ten years and it is very unlikely that new
research will be undertaken in this field. Authors' conclusions: This
review shows that risks associated with TMLR outweigh the potential
clinical benefits. Subjective outcomes are subject to high risk of bias
and no differences were found in survival, but a significant increase in
postoperative mortality and other safety outcomes suggests that the
procedure may pose unacceptable risks. Copyright © 2015 The
Cochrane Collaboration.

<106>
Accession Number
620561076
Author
Goel R.R.; Abidia A.; Hardy S.C.
Institution
(Goel) East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital
(Trust HQ), Vascular Surgery, Haslingden Road, Blackburn BB2 3HH, United
Kingdom
(Abidia) The Princess Alexandra Hospital, Department of Surgery, Hamstel
Road, Harlow, Essex CM20 1QX, United Kingdom
(Hardy) Blackburn Royal Infirmary, Department of Surgery, Bolton Road,
Blackburn BB2 3LR, United Kingdom
Title
Surgery for deep venous incompetence.
Source
Cochrane Database of Systematic Reviews. 2015 (2) (no pagination), 2015.
Article Number: CD001097. Date of Publication: 23 Feb 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Chronic deep venous incompetence (DVI) is caused by
incompetent vein valves and/or blockage of large-calibre leg veins and
causes a range of symptoms including recurrent ulcers, pain and swelling.
Most surgeons accept that well-fitted graduated compression stockings
(GCS) and local care of wounds serve as adequate treatment for most
patients, but sometimes symptoms are not controlled and ulcers recur
frequently, or they do not heal despite compliance with conservative
measures. In these situations, in the presence of severe venous
dysfunction, surgery has been advocated by some vascular surgeons. This is
an update of the review first published in 2000. Objectives: To assess the
effects of surgical management of deep venous incompetence in terms of
ulcer healing, ulcer recurrence and alleviation of symptoms. Search
methods: For this update, the Cochrane Peripheral Vascular Diseases Group
Trials Search Co-ordinator searched the Specialised Register (last
searched October 2014) and the Cochrane Central Register of Controlled
Trials (CENTRAL) (2014, Issue 9). Selection criteria: Randomised
controlled trials of surgical treatment for patients with DVI. Data
collection and analysis: For this update, two review authors (RRG and SCH)
extracted data independently. All included studies required full risk of
bias assessment in line with current procedures of The Cochrane
Collaboration. Two review authors (RRG and SCH) independently assessed
risk of bias and consulted with a third review author (AA) when necessary.
Main results: Four studies with 273 participants were included. All
included studies reported clinical outcomes following valvuloplasty. We
found no studies investigating other surgical procedures for the treatment
of patients with DVI. All included studies investigated primary valve
incompetence. We found no trials that investigated the results of surgery
for secondary valvular incompetence or the obstructive form of DVI.
Because different outcome measures were used, it was not possible to pool
the results of included studies. The methodological quality of the
included studies was low, mainly because information regarding
randomisation and blinding was missing, or because data were incomplete or
were presented poorly. Ulcer healing and ulcer recurrence were not
reported in one study, and the remaining three studies did not include
participants with ulcers or with active ulceration. Three studies reported
no significant complications of surgery and no incidence of DVT during
follow-up. One study did not report on the occurrence of complications.
Clinical changes were assessed by subjective and objective measurements,
as specified in the clinical, aetiological, anatomical, and
pathophysiological (CEAP) classification score. This requires vascular
laboratory measurements of lower limb haemodynamics before and after
surgery. Tests include an overall evaluation of venous function with
venous refilling time (VRT) or ambulatory venous pressure (AVP). Two small
trials comparing external valvuloplasty using limited anterior plication
in combination with ligation of incompetent superficial veins against
ligation alone (L) showed that ligation plus limited anterior plication
produced significant improvement in AVP: The mean difference was -15 mm Hg
(95% confidence interval (CI) -20.9 to -9.0) at one year and -15 mm Hg
(95% CI -21 to -8.9) at two years. Sustainable statistically significant
improvement in AVP and VRT was achieved by ligation and limited anterior
plication at 10 years in one study. However, AVP values after surgery
remained relatively high, causing its benefit to be questioned. Similarly,
another study including participants who were deteriorating preoperatively
showed sustained mild clinical improvement for seven years in those
subjected to valvuloplasty compared with participants undergoing
superficial venous surgery alone. However, this benefit was lost when the
condition of participants was stable preoperatively. One small study (n =
40) with grade 3 reflux and no participants with ulcers reported that
external valvuloplasty of the femoral vein combined with surgical repair
of the superficial venous system improved the haemodynamic status of the
lower limbs, restored valvular function more effectively and achieved
better outcomes than surgical repair of the superficial venous system
alone. Authors' conclusions: No evidence was found for benefit or harm of
valvuloplasty in the treatment of patients with DVI secondary to primary
valvular incompetence. The individual trials included in this review were
small; they used different methods of assessment and overall were of poor
quality. They did not include participants with severe DVI. Trials
investigating the effects of other surgical procedures on deep veins are
needed. Until the findings of such trials become available, the benefit of
valvuloplasty remains uncertain. Copyright © 2015 The Cochrane
Collaboration.

<107>
Accession Number
620559616
Author
Pedersen T.; Nicholson A.; Hovhannisyan K.; Moller A.M.; Smith A.F.; Lewis
S.R.
Institution
(Pedersen) Head and Orthopaedic Center, University of Copenhagen
Rigshospitalet, HOC 2101 Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Nicholson) University of Liverpool, Liverpool Reviews and Implementation
Group, Second Floor, Whelan Build., The Quadrangle, Brownlow Hill,
Liverpool L69 3GB, United Kingdom
(Hovhannisyan) University of Copenhagen Rigshospitalet, The Cochrane
Anaesthesia Review Group, Blegdamsvej 9, Afsnit 5211, rum 1204, Copenhagen
2100, Denmark
(Moller) University of Copenhagen Herlev Hospital Rigshospitalet, The
Cochrane Anaesthesia Review Group, Department of Anaesthesiology, Herlev
Ringvej, Herlev 2730, Denmark
(Smith) Royal Lancaster Infirmary, Department of Anaesthetics, Ashton
Road, Lancaster, Lancashire LA1 4RP, United Kingdom
(Lewis) Royal Lancaster Infirmary, Pointer Court 1, Ashton Road, Lancaster
LA1 1RP, United Kingdom
Title
Pulse oximetry for perioperative monitoring.
Source
Cochrane Database of Systematic Reviews. 2014 (3) (no pagination), 2014.
Article Number: CD002013. Date of Publication: 17 Mar 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a review last published in Issue 9, 2009,
of The Cochrane Library. Pulse oximetry is used extensively in the
perioperative period and might improve patient outcomes by enabling early
diagnosis and, consequently, correction of perioperative events that might
cause postoperative complications or even death. Only a few randomized
clinical trials of pulse oximetry during anaesthesia and in the recovery
room have been performed that describe perioperative hypoxaemic events,
postoperative cardiopulmonary complications and cognitive dysfunction.
Objectives: To study the use of perioperative monitoring with pulse
oximetry to clearly identify adverse outcomes that might be prevented or
improved by its use. The following hypotheses were tested. 1. Use of pulse
oximetry is associated with improvement in the detection and treatment of
hypoxaemia. 2. Early detection and treatment of hypoxaemia reduce
morbidity and mortality in the perioperative period. 3. Use of pulse
oximetry per se reduces morbidity and mortality in the perioperative
period. 4. Use of pulse oximetry reduces unplanned respiratory admissions
to the intensive care unit (ICU), decreases the length of ICU readmission
or both. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (2013, Issue 5), MEDLINE (1966 to June 2013),
EMBASE (1980 to June 2013), CINAHL (1982 to June 2013), ISI Web of Science
(1956 to June 2013), LILACS (1982 to June 2013) and databases of ongoing
trials; we also checked the reference lists of trials and review articles.
The original search was performed in January 2005, and a previous update
was performed in May 2009. Selection criteria: We included all controlled
trials that randomly assigned participants to pulse oximetry or no pulse
oximetry during the perioperative period. Data collection and analysis:
Two review authors independently assessed data in relation to events
detectable by pulse oximetry, any serious complications that occurred
during anaesthesia or in the postoperative period and intraoperative or
postoperative mortality. Main results: The last update of the review
identified five eligible studies. The updated search found one study that
is awaiting assessment but no additional eligible studies. We considered
studies with data from a total of 22,992 participants that were eligible
for analysis. These studies gave insufficient detail on the methods used
for randomization and allocation concealment. It was impossible for study
personnel to be blinded to participant allocation in the study, as they
needed to be able to respond to oximetry readings. Appropriate steps were
taken to minimize detection bias for hypoxaemia and complication outcomes.
Results indicated that hypoxaemia was reduced in the pulse oximetry group,
both in the operating theatre and in the recovery room. During observation
in the recovery room, the incidence of hypoxaemia in the pulse oximetry
group was 1.5 to three times less. Postoperative cognitive function was
independent of perioperative monitoring with pulse oximetry. A single
study in general surgery showed that postoperative complications occurred
in 10% of participants in the oximetry group and in 9.4% of those in the
control group. No statistically significant differences in cardiovascular,
respiratory, neurological or infectious complications were detected in the
two groups. The duration of hospital stay was a median of five days in
both groups, and equal numbers of in-hospital deaths were reported in the
two groups. Continuous pulse oximetry has the potential to increase
vigilance and decrease pulmonary complications after cardiothoracic
surgery; however, routine continuous monitoring did not reduce transfer to
an ICU and did not decrease overall mortality. Authors' conclusions: These
studies confirmed that pulse oximetry can detect hypoxaemia and related
events. However, we found no evidence that pulse oximetry affects the
outcome of anaesthesia for patients. The conflicting subjective and
objective study results, despite an intense methodical collection of data
from a relatively large general surgery population, indicate that the
value of perioperative monitoring with pulse oximetry is questionable in
relation to improved reliable outcomes, effectiveness and efficiency.
Routine continuous pulse oximetry monitoring did not reduce transfer to
the ICU and did not decrease mortality, and it is unclear whether any real
benefit was derived from the application of this technology for patients
recovering from cardiothoracic surgery in a general care
area. Copyright © 2014 The Cochrane Collaboration.

<108>
Accession Number
620563321
Author
Amos T.; Stein D.J.; Ipser J.C.
Institution
(Amos, Stein, Ipser) University of Cape Town, Department of Psychiatry and
Mental Health, Education Centre, Valkenberg Hospital, Private Bage X1,
Observatory, Cape Town 7925, South Africa
Title
Pharmacological interventions for preventing post-traumatic stress
disorder (PTSD).
Source
Cochrane Database of Systematic Reviews. 2014 (7) (no pagination), 2014.
Article Number: CD006239. Date of Publication: 08 Jul 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Post-traumatic stress disorder (PTSD) is a debilitating
disorder which, after a sufficient delay, may be diagnosed amongst
individuals who respond with intense fear, helplessness or horror to
traumatic events. There is some evidence that the use of pharmacological
interventions immediately after exposure to trauma may reduce the risk of
developing of PTSD. Objectives: To assess the effects of pharmacological
interventions for the prevention of PTSD in adults following exposure to a
traumatic event. Search methods: We searched the Cochrane Depression,
Anxiety and Neurosis Controlled Trials Register (CCDANCTR-Studies and
CCDANCTR-References) (to 14 February 2014). This register contains
relevant reports of randomised controlled trials from the following
bibliographic databases: CENTRAL (all years); EMBASE (1974 to date);
MEDLINE (1950 to date) and PsycINFO (1967 to date). We identified
unpublished trials by searching the National Institute of Health (NIH)
Reporter, the metaRegister of Controlled Trials database (mRCT) and the
WHO International Clinical Trials Registry Platform (to December 2013). We
scanned the reference lists of articles for additional studies. We placed
no constraints on language and setting. Selection criteria: We restricted
studies to randomised controlled trials (RCTs) of pharmacological
interventions compared with placebo for the prevention of PTSD in adults.
Data collection and analysis: Two authors (TA and JI) independently
assessed trials for eligibility and inclusion based on the review
selection criteria. We independently extracted sample, methodological,
outcome and 'Risk of bias' data, as well as the number of side effects,
from each trial and entered these into a customised data extraction form.
We contacted investigators for missing information. We calculated summary
statistics for continuous and dichotomous variables (if provided). We did
not undertake subgroup analyses due to the small number of included
studies. Main results: We included nine short-term RCTs (duration 12 weeks
or less) in the analysis (345 participants; age range 18 to 76 years).
Participants were exposed to a variety of traumas, ranging from assault,
traffic accidents and work accidents to cardiac surgery and septic shock.
Seven studies were conducted at single centres. The seven RCTs included
four hydrocortisone studies, three propranolol studies (of which one study
had a third arm investigating gabapentin), and single trials of
escitalopram and temazepam. Outcome assessment measures included the
Clinician-Administered PTSD Scale (CAPS), the 36-Item Short-Form Health
Survey (SF-36) and the Center for Epidemiological Studies - Depression
Scale (CES-D). In four trials with 165 participants there was moderate
quality evidence for the efficacy of hydrocortisone in preventing the
onset of PTSD (risk ratio (RR) 0.17; 95% confidence interval (CI) 0.05 to
0.56; P value = 0.004), indicating that between seven and 13 patients
would need to be treated with this agent in order to prevent the onset of
PTSD in one patient. There was low quality evidence for preventing the
onset of PTSD in three trials with 118 participants treated with
propranolol (RR 0.62; 95% CI 0.24 to 1.59; P value = 0.32). Drop-outs due
to treatment-emergent side effects, where reported, were low for all of
the agents tested. Three of the four RCTs of hydrocortisone reported that
medication was more effective than placebo in reducing PTSD symptoms after
a median of 4.5 months after the event. None of the single trials of
escitalopram, temazepam and gabapentin demonstrated evidence that
medication was superior to placebo in preventing the onset of PTSD. Seven
of the included RCTs were at a high risk of bias. Differential drop-outs
between groups undermined the results of three studies, while one study
failed to describe how the allocation of medication was concealed. Other
forms of bias that might have influenced study results included possible
confounding through group differences in concurrent medication and
termination of the study based on treatment response. Authors'
conclusions: There is moderate quality evidence for the efficacy of
hydrocortisone for the prevention of PTSD development in adults. We found
no evidence to support the efficacy of propranolol, escitalopram,
temazepam and gabapentin in preventing PTSD onset. The findings, however,
are based on a few small studies with multiple limitations. Further
research is necessary in order to determine the efficacy of
pharmacotherapy in preventing PTSD and to identify potential moderators of
treatment effect. Copyright © 2014 The Cochrane Collaboration.

<109>
Accession Number
620562526
Author
Vale N.; Nordmann A.J.; Schwartz G.G.; de Lemos J.; Colivicchi F.; den
Hartog F.; Ostadal P.; Macin S.M.; Liem A.H.; Mills E.J.; Bhatnagar N.;
Bucher H.C.; Briel M.
Institution
(Vale) St Mary's Hospital, McGill University, Family Medicine, 377 Rue
Jean Brilliant, Montreal, QC H3T 1M5, Canada
(Nordmann) University Hospital Basel, Institute for Clinical Epidemiology
and Biostatistics, Hebelstrasse 10, Basel 4031, Switzerland
(Schwartz) VA Medical Center and University of Colorado, 1055 Clermont St,
Denver, CO, United States
(de Lemos) University of Texas Southwestern Medical School,
Cardiology/Internal Medicine, 5909 Harry Hines Blvd, Dallas, TX, United
States
(Colivicchi) S. Filippo Neri Hospital, Cardiovascular Department, 330
Viale Gorgia da Leontini, Rome 00124, Italy
(den Hartog) Gelderse Vallei Hospital, Cardiology Department, postbus
9025, Ede 6710 HN, Netherlands
(Ostadal) Na Homolce Hospital, Department of Cardiology, Prague, Czech
Republic
(Macin) Instituto de Cardiologia, Coronary Intensive Care Unit, Juana F
Cabrel, Corrientes, Argentina
(Liem) Franciscus Gasthuis Rotterdam, Department of Cardiology, Rotterdam,
Netherlands
(Mills) University of Ottawa, Faculty of Health Sciences, 451 Smyth Road,
Ottawa, ON K1H 8M5, Canada
(Bhatnagar) McMaster University, Department of Clinical Epidemiology and
Biostatistics, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
(Bucher, Briel) University Hospital Basel (USB), Basel Institute for
Clinical Epidemiology and Biostatistics, Basel, Switzerland
Title
Statins for acute coronary syndrome.
Source
Cochrane Database of Systematic Reviews. 2014 (9) (no pagination), 2014.
Article Number: CD006870. Date of Publication: 01 Sep 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The early period following the onset of acute coronary
syndrome (ACS) represents a critical stage of coronary heart disease, with
a high risk of recurrent events and deaths. The short-term effects of
early treatment with statins on patient-relevant outcomes in patients
suffering from ACS are unclear. This is an update of a review previously
published in 2011. Objectives: To assess the effects, both harms and
benefits, of early administered statins in patients with ACS, in terms of
mortality and cardiovascular events. Search methods: We updated the
searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1
2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to
2013) on 12 April 2013. We applied no language restrictions. We
supplemented the search by contacting experts in the field, by reviewing
the reference lists of reviews and editorials on the topic, and by
searching trial registries. Selection criteria: Randomized controlled
trials (RCTs) comparing statins with placebo or usual care, with
initiation of statin therapy within 14 days following the onset of ACS,
follow-up of at least 30 days, and reporting at least one clinical
outcome. Data collection and analysis: Two authors independently assessed
risk of bias and extracted data. We calculated risk ratios (RRs) for all
outcomes in the treatment and control groups and pooled data using
random-effects models. Main results: Eighteen studies (14,303 patients)
compared early statin treatment versus placebo or no treatment in patients
with ACS. The new search did not identify any new studies for inclusion.
There were some concerns about risk of bias and imprecision of summary
estimates. Based on moderate quality evidence, early statin therapy did
not decrease the combined primary outcome of death, non-fatal myocardial
infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence
interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06)
of follow-up when compared to placebo or no treatment. There were no
statistically significant risk reductions from statins for total death,
total myocardial infarction, total stroke, cardiovascular death,
revascularization procedures, and acute heart failure at one month or at
four months, although there were favorable trends related to statin use
for each of these endpoints. Moderate quality evidence suggests that the
incidence of unstable angina was significantly reduced at four months
following ACS (RR 0.76, 95% CI 0.59 to 0.96). There were nine individuals
with myopathy (elevated creatinine kinase levels more than 10 times the
upper limit of normal) in statin-treated patients (0.13%) versus one
(0.015%) in the control groups. Serious muscle toxicity was mostly limited
to patients treated with simvastatin 80 mg. Authors' conclusions: Based on
moderate quality evidence, due to concerns about risk of bias and
imprecision, initiation of statin therapy within 14 days following ACS
does not reduce death, myocardial infarction, or stroke up to four months,
but reduces the occurrence of unstable angina at four months following
ACS. Serious side effects were rare. Copyright © 2014 The
Cochrane Collaboration.

<110>
Accession Number
620562966
Author
Wikkelso A.; Lunde J.; Johansen M.; Stensballe J.; Wetterslev J.; Moller
A.M.; Afshari A.
Institution
(Wikkelso) University of Copenhagen Herlev Hospital, Department of
Anaesthesiology, Herlev, Denmark
(Lunde) Rigshospitalet, Copenhagen University Hospital, Juliane Marie
Centre - Anaesthesia and Surgical Clinic Department 4013, Delfingade 51,1,
Copenhagen 28893435, Denmark
(Johansen) Rigshospitalet, Copenhagen University Hospital, Department of
Anaesthesiology, Centre of Neuroanaesthesia, Copenhagen, Denmark
(Stensballe) Copenhagen University Hospital, Rigshospitalet, Department of
Anaesthesiology, Centre of Head and Orthopaedics Section for Transfusion
Medicine, Capital Region Blood Bank, Blegdamsvej 9, Copenhagen DK-2100 KBH
O, Denmark
(Wetterslev) Rigshospitalet, Copenhagen University Hospital, Copenhagen
Trial Unit, Centre for Clinical Intervention Research, Department 7812,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Moller) University of Copenhagen Herlev Hospital, The Cochrane
Anaesthesia Review Group, Rigshospitalet Department of Anaesthesiology,
Herlev Ringvej, Herlev 2730, Denmark
(Afshari) Hopitaux Universitaires de Geneve, Pediatric and Neonatal
Intensive Care Service, Rue Willy-Donze, Geneva 1211, Switzerland
(Afshari) Rigshospitalet, Copenhagen University Hospital, Juliane Marie
Centre, Department of Anaesthesiology, Copenhagen, Denmark
Title
Fibrinogen concentrate in bleeding patients.
Source
Cochrane Database of Systematic Reviews. 2013 (8) (no pagination), 2013.
Article Number: CD008864. Date of Publication: 29 Aug 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Hypofibrinogenaemia is associated with increased morbidity and
mortality, but the optimal treatment level, the use of preemptive
treatment and the preferred source of fibrinogen remain disputed.
Fibrinogen concentrate is increasingly used and recommended for bleeding
with acquired haemostatic deficiencies in several countries, but evidence
is lacking regarding indications, dosing, efficacy and safety. Objectives:
We assessed the benefits and harms of fibrinogen concentrate compared with
placebo or usual treatment for bleeding patients. Search methods: We
searched the following electronic databases: the Cochrane Central Register
of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8);
MEDLINE (1950 to 9 August 2013); EMBASE (1980 to 9 August 2013);
International Web of Science (1964 to 9 August 2013); CINAHL (1980 to 9
August 2013); LILACS (1982 to 9 August 2013); and the Chinese Biomedical
Literature Database (up to 10 November 2011), together with databases of
ongoing trials. We contacted trial authors, authors of previous reviews
and manufacturers in the field. Selection criteria: We included all
randomized controlled trials (RCTs), irrespective of blinding or language,
that compared fibrinogen concentrate with placebo/other treatment or no
treatment in bleeding patients, excluding neonates and patients with
hereditary bleeding disorders. Data collection and analysis: Three review
authors independently abstracted data; we resolved any disagreements by
discussion. Our primary outcome measure was all-cause mortality. We
performed subgroup and sensitivity analyses to assess the effects of
fibrinogen concentrate in adults and children in terms of various clinical
and physiological outcomes. We presented pooled estimates of the effects
of intervention on dichotomous outcomes as risk ratios (RRs) and on
continuous outcomes as mean differences, with 95% confidence intervals
(CIs). We assessed the risk of bias through assessment of trial
methodological components and the risk of random error through trial
sequential analysis. Main results: We included six RCTs with a total of
248 participants; none of the trials were determined to have overall low
risk of bias. We found 12 ongoing trials, from which we were unable to
retrieve any data. Only two trials provided data on mortality, and one was
a zero event study; thus the meta-analysis showed no statistically
significant effect on overall mortality (2.6% vs 9.5%, RR 0.28, 95% CI
0.03 to 2.33). Our analyses on blood transfusion data suggest a beneficial
effect of fibrinogen concentrate in reducing the incidence of allogenic
transfusions (RR 0.47, 95% CI 0.31 to 0.72) but show no effect on other
predefined outcomes, including adverse events such as thrombotic episodes.
Authors' conclusions: In the six available RCTs of elective surgery,
fibrinogen concentrate appears to reduce transfusion requirements, but the
included trials are of low quality with high risk of bias and are
underpowered to detect mortality, benefit or harm. Furthermore, data on
mortality are lacking, heterogeneity is high and acute or severe bleeding
in a non-elective surgical setting remains unexplored. Currently, weak
evidence supports the use of fibrinogen concentrate in bleeding patients,
as tested here in primarily elective cardiac surgery. More research is
urgently needed. Copyright © 2013 The Cochrane Collaboration.

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