EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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.<br/>Copyright &#xa9; 2017, Springer-Verlag GmbH Germany.

<2>
Accession Number
620356189
Author
Hill G.D.; Ginde S.; Rios R.; Frommelt P.C.; Hill K.D.
Institution
(Hill, Ginde, Rios, Frommelt) Division of Cardiology, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
(Hill) Division of Cardiology, Department of Pediatrics, Duke University,
Durham, NC, United States
Title
Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic
Valve Stenosis: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 5 (8) (no pagination), 2016.
Article Number: e003931. Date of Publication: August 2016.
Publisher
American Heart Association Inc.
Abstract
Background: Optimal initial treatment for congenital aortic valve stenosis
in children remains unclear between balloon aortic valvuloplasty (BAV) and
surgical aortic valvotomy (SAV). Methods and Results: We performed a
contemporary systematic review and meta-analysis to compare survival in
children with congenital aortic valve stenosis. Secondary outcomes
included frequency of at least moderate regurgitation at hospital
discharge as well as rates of aortic valve replacement and reintervention.
Single- and dual-arm studies were identified by a search of PubMed
(Medline), Embase, and the Cochrane database. Overall 2368 patients from
20 studies were included in the analysis, including 1835 (77%) in the BAV
group and 533 (23%) in the SAV group. There was no difference between SAV
and BAV in hospital mortality (OR=0.98, 95% CI 0.5-2.0, P=0.27,
I²=22%) or frequency of at least moderate aortic regurgitation
at discharge (OR=0.58, 95% CI 0.3-1.3, P=0.09, I²=54%).
Kaplan-Meier analysis showed no difference in long-term survival or
freedom from aortic valve replacement but significantly more
reintervention in the BAV group (10-year freedom from reintervention of
46% [95% CI 40-52] for BAV versus 73% [95% CI 68-77] for SAV, P<0.001).
Results were unchanged in a sensitivity analysis restricted to infants (<1
year of age). Conclusions: Although higher rates of reintervention suggest
improved outcomes with SAV, indications for reintervention may vary
depending on initial intervention. When considering the benefits of a
less-invasive approach, and clinical equipoise with respect to more
clinically relevant outcomes, these findings support the need for a
randomized controlled trial.<br/>Copyright &#xa9; 2016 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley
Blackwell.

<3>
Accession Number
620356117
Author
Roche S.L.; Timberlake K.; Manlhiot C.; Balasingam M.; Wilson J.; George
K.; Mccrindle B.W.; Kantor P.F.
Institution
(Roche, Manlhiot, Mccrindle, Kantor) Department of Medicine, University of
Toronto, Canada
(Timberlake) Faculty of Pharmacy, Univeristy of Toronto, Canada
(Roche, Timberlake, Manlhiot, Balasingam, Wilson, George, Mccrindle,
Kantor) The Labatt Family Heart Center, The Hospital for Sick Children,
Toronto, Canada
(Roche) Peter Munk Cardiac Centre, Toronto General Hospital, Toronto,
Canada
(Kantor) Stollery Children's Hospital, University of Alberta, Edmonton,
AB, Canada
Title
Angiotensin-Converting Enzyme Inhibitor Initiation and Dose Uptitration in
Children With Cardiovascular Disease: A Retrospective Review of Standard
Clinical Practice and a Prospective Randomized Clinical Trial.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003230. Date of Publication: May 2016.
Publisher
American Heart Association Inc.
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) are a
mainstay of medical management in pediatric cardiology. However, there are
no data defining how best to initiate and uptitrate the dose of these
medications in children. Methods and Results: Retrospective chart review
revealed only 24% of our pediatric cardiology inpatients were discharged
on predefined optimal doses of ACEIs and few underwent further dose
uptitration in the 8 weeks after hospital discharge. Therefore, 2
alternative protocols for initiation of captopril were compared in a
prospective randomized clinical trial. A "rapid uptitration" protocol
reached an optimal dose on day 3, whereas the alternative, "prolonged
uptitration" protocol, reached an optimal dose on day 9. Forty-6 patients
(54% male) were recruited to the trial, with a median age of 0.7 year (IQR
0.5-2.3 years). Captopril was initiated while in intensive care in 39% of
patients and on the cardiology ward in 61%. There were no differences
between the protocols in episodes of hypotension, symptomatic hypotension,
or indices of renal function. Patients following the rapid protocol
reached higher doses of captopril (0.93+/-0.24 versus 0.57+/-0.38 mg/kg
per dose, P<0.0001) and were more likely to have achieved the predefined
target (88% versus 43%, P=0.002) and optimal ACEI doses (80% versus 29%,
P=0.001) before discharge. Conclusions: A protocol of rapid ACEI dose
uptitration for infants and children with cardiovascular disease can be
introduced safely, even in patients receiving intensive care therapy.
Compared with standard clinical practice or with a more prolonged
protocol, rapid ACEI dose uptitration achieves a higher dosage in this
population with no evident disadvantages.<br/>Copyright &#xa9; 2016 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley Blackwell.

<4>
Accession Number
620526731
Author
Van Den Bergh W.M.; Dieleman J.M.; Slooter A.J.C.; Van Dijk D.
Institution
(Van Den Bergh) Department of Critical Care, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Dieleman) Department of Anesthesiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine and Brain Center
Rudolf Magnus, University Medical Center Utrecht, Utrecht University,
Utrecht, Netherlands
Title
Use of cardiopulmonary bypass and full heparinisation in patients with an
asymptomatic intracranial aneurysm.
Source
Netherlands Journal of Critical Care. 26 (1) (pp 20-22), 2018. Date of
Publication: January 2018.
Publisher
Netherlands Society of Intensive Care (E-mail: post@nvic.nl)
Abstract
Introduction: The overall prevalence of unruptured intracranial aneurysms
is 3.2%. The rupture risk of an intracranial aneurysm during
cardiopulmonary bypass requiring full heparinisation is unknown. Patients
and Methods: Rupture risk was assessed using data from a trial in which
dexamethasone was compared with placebo in 4482 patients undergoing
cardiac surgery with cardiopulmonary bypass. Results: Not a single
haemorrhagic stroke occurred during surgery and only one patient had a
subarachnoid haemorrhage three weeks after cardiac surgery. Discussion:
Although the actual prevalence of intracranial aneurysms in the study
population is unknown, based on patient characteristics, it is likely that
the incidence is not below the average of 3.2% of the general population.
So probably at least 143 patients with an intracranial aneurysm underwent
surgery with full heparinisation without any rupture. Conclusion:
Cardiopulmonary bypass with heparinisation is not a risk factor for
rupture of an intracranial aneurysm. An unruptured intracranial aneurysm
should not hinder lifesaving surgery for which cardiopulmonary bypass is
required.<br/>Copyright &#xa9; 2018 NVIC. All rights reserved.

<5>
Accession Number
620524564
Author
Lee M.S.; Shlofmitz E.; Kong J.; Lluri G.; Srivastava P.K.; Shlofmitz R.
Institution
(Lee, Kong, Lluri, Srivastava) UCLA Medical Center, 100 Medical Plaza, Los
Angeles, CA 90095, United States
(Shlofmitz) Northwell Health, Manhasset, NY, United States
(Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
Title
Impact of the Use of Intravascular Imaging on Patients Who Underwent
Orbital Atherectomy.
Source
Journal of Invasive Cardiology. 30 (2) (pp 77-80), 2018. Date of
Publication: February 2018.
Publisher
HMP Communications
Abstract
OBJECTIVES: We assessed the impact of intravascular ultrasound
(IVUS)/optical coherence tomography (OCT) on outcomes of patients who
underwent orbital atherectomy. BACKGROUND: Intravascular imaging provides
enhanced lesion morphology assessment and optimization of percutaneous
coronary intervention (PCI) outcomes. Severe coronary artery calcification
increases the complexity of PCI and is associated with worse clinical
outcomes. Orbital atherectomy modifies calcified plaque, facilitating
stent delivery and optimizing stent expansion. The impact of IVUS/OCT on
clinical outcomes after orbital atherectomy is unknown. METHODS: Of the
458 consecutive real-world patients in our retrospective multicenter
registry, a total of 138 patients (30.1%) underwent orbital atherectomy
with IVUS/OCT. The primary safety endpoint was the rate of 30-day major
adverse cardiac and cerebrovascular events, comprised of death, myocardial
infarction (MI), target-vessel revascularization (TVR), and stroke.
RESULTS: The IVUS/OCT group and no-imaging group had similar rates of the
primary endpoint (1.5% vs 2.5%; P<=.48) as well as death (1.5% vs 1.3%;
P<=.86), MI (1.5% vs 0.9%; P<=.63), TVR (0% vs 0%; P<=NS), and stroke (0%
vs 0.3%; P<=.51). The 30-day stent thrombosis rates were low in both
groups (0.7% vs 0.9%; P<=.82). Emergent coronary artery bypass graft
surgery was uncommonly performed in both groups (0.0% vs 0.9%; P<=.25).
CONCLUSION: Orbital atherectomy guided by intravascular imaging is
feasible and safe. A large prospective randomized trial is needed to
determine the clinical benefit of IVUS/OCT during PCI with orbital
atherectomy.

<6>
Accession Number
620537856
Author
Mingxing F.; Landoni G.; Zangrillo A.; Monaco F.; Lomivorotov V.V.; Hui
C.; Novikov M.; Nepomniashchikh V.; Fominskiy E.
Institution
(Mingxing, Hui) Department of Intensive Care, The Third Hospital, Hebei
Medical University, Shijiazhuang, Hebei Province, P.R. China
(Landoni, Zangrillo, Monaco, Fominskiy) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Milan,
Italy
(Lomivorotov, Nepomniashchikh, Fominskiy) Department of Anesthesia and
Intensive Care, Siberian Biomedical Research Center of the Ministry of
Health, Novosibirsk, Russia
(Novikov) Department of Anesthesia and Intensive Care, Medical Center of
Saint-Petersburg State University, Saint-Petersburg, Russia
Title
Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: There is experimental evidence that phosphocreatine (PCr) can
decrease ischemia/reperfusion injury of the heart. The authors
investigated if PCr would improve heart performance as compared with
standard treatment in cardiac surgery. Design: Meta-analysis of randomized
controlled trials. Setting: Hospitals. Participants: Adult and pediatric
patients undergoing cardiac surgery. Interventions: The ability of PCr to
improve cardiac outcomes as compared with standard treatment was
investigated. Measurements and Main Results: PubMed/Medline, Embase,
Scopus, Cochrane Library, China National Knowledge Infrastructure,
WANGFANG DATA, and VIP Paper Check System were searched to March 1 2017.
The authors included 26 randomized controlled trials comprising 1,948
patients. Random and fixed-effects models were used to estimate odds ratio
(OR) and mean difference (MD) with 95% confidence interval (CI). PCr use
was associated with reduced rates of intraoperative inotropic support (27%
v 44%; OR 0.47, 95% CI 0.35-0.61; p < 0.001), major arrhythmias (16% v
28%; OR 0.44, 95% CI 0.27-0.69; p < 0.001), as well as increased
spontaneous recovery of the cardiac rhythm immediately after aortic
declamping (50% v 34%; OR 2.45, 95% CI 1.82-3.30; p < 0.001) as compared
with standard treatment. The use of PCr decreased myocardial damage and
augmented left ventricular ejection fraction in the postoperative period;
however, MD for these outcomes were small and do not seem to be clinically
significant. Conclusions: In randomized trials, PCr administration was
associated with reduced rates of intraoperative inotropic support and
major arrhythmias, and increased spontaneous recovery of the cardiac
rhythm after aortic declamping. Large multicenter evidence is needed to
validate these findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<7>
Accession Number
620536758
Author
Ebrahimi R.; Gupta S.; Carr B.M.; Bishawi M.; Bakaeen F.G.; Almassi G.H.;
Collins J.; Grover F.L.; Quin J.A.; Wagner T.H.; Shroyer A.L.W.; Hattler
B.
Institution
(Ebrahimi) Department of Cardiology, Veterans Affairs Greater Los Angeles
Healthcare System, Los Angeles, California
(Ebrahimi) Department of Medicine, University of California Los Angeles,
Los Angeles, California
(Gupta, Carr, Bishawi, Shroyer) Research Service, Northport VA Medical
Center, Northport, New York
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
(Bishawi) Cardiovascular and Thoracic Surgery, Duke University Medical
Center, Durham, North Carolina
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio
(Almassi) Milwaukee VA Medical Center, Milwaukee, Wisconsin
(Almassi) Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee,
Wisconsin
(Collins) Cooperative Studies Program Coordinating Center, Perry Point,
Maryland
(Grover, Shroyer) Research Service, VA Eastern Colorado Healthcare System,
Denver, Colorado
(Grover) Cardiothoracic Surgery, the University of Colorado School of
Medicine at the Anschutz Medical Campus, Aurora, Colorado
(Quin) Cardiac Surgery, VA Boston Healthcare System, West Roxbury,
Massachusetts
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park,
California
(Wagner) Department of Health Research and Policy, Stanford University,
Stanford, California
(Hattler) Cardiology, VA Eastern Colorado Health Care System, Denver,
Colorado
(Hattler) Department of Medicine, Division of Cardiology, University of
Colorado School of Medicine at the Anschutz Medical Campus, Aurora,
Colorado
Title
Comparison of Outcomes and Costs Associated With Aspirin +/- Clopidogrel
After Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Optimal antiplatelet therapy after coronary artery bypass graft (CABG)
surgery remains controversial. This study evaluated the role of dual
antiplatelet therapy using aspirin and clopidogrel (DAPT) versus
antiplatelet therapy using aspirin only (ASA) on post-CABG clinical
outcomes and costs. In the Department of Veterans Affairs Randomized
On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively
collected beginning in year 2 of this study to include 1,525 of the 2,203
original ROOBY patients who received aspirin after CABG. Discretionarily,
surgeons after CABG administered either DAPT or ASA treatments. The ROOBY
trial's primary 30-day composite (mortality or perioperative morbidity),
1-year composite (all-cause death, repeat revascularization, or nonfatal
myocardial infarction), and costs were compared for these 2 strategies. Of
the 1,525 subjects, 511 received DAPT and 1,014 received ASA. DAPT
subjects, compared with ASA subjects, had lower rates of preoperative left
ventricular ejection fraction of >=45% (78.8% vs 85.7%, p <0.001), on-pump
CABG (36.6% vs 57.1%, p = 0.001), and endoscopic vein harvesting (30.0% vs
42.8%, p <0.001). ASA patients were more likely to have earlier aspirin
administration and receive 325 versus 81 mg dosages. The 30-day composite
outcome rate was significantly lower for DAPT patients compared with ASA
patients (3.3% vs 7.1%, p = 0.003), but the 1-year composite outcome was
equal between the 2 groups (12.0% vs12.0%, p = 1.0). At 1 year, there were
no cost differences between the 2 groups. Propensity analyses did not
significantly alter the results. In conclusion, DAPT appeared safe and was
associated with fewer 30-day adverse outcomes than aspirin only and with
no 1-year outcome or cost differences.<br/>Copyright &#xa9; 2017.

<8>
Accession Number
620396891
Author
Shore-Lesserson L.; Baker R.A.; Ferraris V.A.; Greilich P.E.; Fitzgerald
D.; Roman P.; Hammon J.W.
Institution
(Shore-Lesserson) Department of Anesthesiology, Zucker School of Medicine
at Hofstra Northwell, Hempstead, New York, United States
(Baker) Cardiac Surgery Research and Perfusion, Flinders University and
Flinders Medical Center, Adelaide, South Australia, Australia
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, Lexington, Kentucky, United States
(Greilich) Department of Anesthesiology and Pain Management, University of
Texas-Southwestern Medical Center, Dallas, Texas, United States
(Fitzgerald) Division of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, South Carolina, United States
(Roman) Department of Anesthesiology, Saint Anthony Hospital, Lakewood,
Colorado, United States
(Hammon) Department of Cardiothoracic Surgery, Wake Forest University
School of Medicine, Winston-Salem, North Carolina, United States
Title
The Society of Thoracic Surgeons, The Society of Cardiovascular
Anesthesiologists, and The American Society of ExtraCorporeal Technology:
Clinical Practice Guidelines *-Anticoagulation During Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. 105 (2) (pp 650-662), 2018. Date of
Publication: February 2018.
Publisher
Elsevier USA
Abstract
Despite more than a half century of "safe" cardiopulmonary bypass (CPB),
the evidence base surrounding the conduct of anticoagulation therapy for
CPB has not been organized into a succinct guideline. For this and other
reasons, there is enormous practice variability relating to the use and
dosing of heparin, monitoring heparin anticoagulation, reversal of
anticoagulation, and the use of alternative anticoagulants. To address
this and other gaps, The Society of Thoracic Surgeons, the Society of
Cardiovascular Anesthesiologists, and the American Society of
Extracorporeal Technology developed an Evidence Based Workgroup. This was
a group of interdisciplinary professionals gathered to summarize the
evidence and create practice recommendations for various aspects of CPB.
To date, anticoagulation practices in CPB have not been standardized in
accordance with the evidence base. This clinical practice guideline was
written with the intent to fill the evidence gap and to establish best
practices in anticoagulation therapy for CPB using the available evidence.
To identify relevant evidence, a systematic review was outlined and
literature searches were conducted in PubMed using standardized medical
subject heading (MeSH) terms from the National Library of Medicine list of
search terms. Search dates were inclusive of January 2000 to December
2015. The search yielded 833 abstracts, which were reviewed by two
independent reviewers. Once accepted into the full manuscript review
stage, two members of the writing group evaluated each of 286 full papers
for inclusion eligibility into the guideline document. Ninety-six
manuscripts were included in the final review. In addition, 17 manuscripts
published before 2000 were included to provide method, context, or
additional supporting evidence for the recommendations as these papers
were considered sentinel publications. Members of the writing group wrote
and developed recommendations based on review of the articles obtained and
achieved more than two thirds agreement on each recommendation. The
quality of information for a given recommendation allowed assessment of
the level of evidence as recommended by the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Recommendations were written in the three following areas: (1) heparin
dosing and monitoring for initiation and maintenance of CPB; (2) heparin
contraindications and heparin alternatives; and (3) reversal of
anticoagulation during cardiac operations. It is hoped that this guideline
will serve as a resource and will stimulate investigators to conduct more
research and to expand on the evidence base on the topic of
anticoagulation therapy for CPB.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons, International Anesthesia Research Society, and the
American Society of ExtraCorporeal Technology

<9>
Accession Number
619009547
Author
Soliman R.; Hussien M.
Institution
(Soliman) Departments of Cardiac Anesthesia, Madinah Cardiac Center,
Almadinah Almonwarah, Saudi Arabia
(Soliman) Department of Anesthesia, Cairo University, Giza, Egypt
(Hussien) Cardiac Surgery, Madinah Cardiac Center, Almadinah Almonwarah,
Saudi Arabia
Title
Comparison of the renoprotective effect of dexmedetomidine and dopamine in
high-risk renal patients undergoing cardiac surgery: A double-blind
randomized study.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 408-415), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The purpose of the current study was to compare the
renoprotective effects of continuous infusion of dexmedetomidine and
dopamine in high-risk renal patients undergoing cardiac surgery. Design: A
double-blind randomized study. Setting: Cardiac Centers. Patients: One
hundred and fifty patients with baseline serum creatinine level >=1.4
mg/dl were scheduled for cardiac surgery with cardiopulmonary bypass.
Intervention: The patients were classified into two groups (each = 75):
Group Dex - the patients received a continuous infusion of dexmedetomidine
0.4 mug/kg/h without loading dose during the procedure and the first 24
postoperative hours and Group Dopa - the patients received a continuous
infusion of dopamine 3 mug/kg/min during the procedure and the first 24
postoperative hours. Measurements: The monitors included serum creatinine,
creatinine clearance, blood urea nitrogen, and urine output. Main Results:
The creatinine levels and blood urea nitrogen decreased at days 1, 2, 3,
4, and 5 in Dex group and increased in patients of Dopa group (P < 0.05).
The creatinine clearance increased at days 1, 2, 3, 4, and 5 in Dex group
and decreased in patients of Dopa group (P < 0.05). The amount of urine
output was too much higher in the Dex group than the Dopa group (P <
0.05). Conclusions: The continuous infusion of dexmedetomidine during
cardiac surgery has a renoprotective effect and decreased the
deterioration in the renal function in high-risk renal patients compared
to the continuous infusion of dopamine.<br/>Copyright &#xa9; 2017 Annals
of Cardiac Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<10>
Accession Number
609203018
Author
Karthikesalingam A.; Holt P.J.; Thompson M.M.; Bak A.A.A.; Pattynama P.M.;
Van Voorthuisen A.E.; Grobbee D.E.; Hunink M.G.; Van Engelshoven J.M.;
Jacobs M.J.H.M.; De Mol B.A.J.M.; Van Bockel J.H.; Reekers J.; Tielbeek
X.; Boekema N.; Heuveling L.M.; Sikking I.; Cuypers P.W.M.; De Bruin J.L.;
Baas A.F.; Prinssen M.; Buth J.; Tielbeek A.V.; Blankensteijn J.D.; Balm
R.; Reekers J.A.; Van Sambeek M.R.H.M.; Pattynama P.; Verhoeven E.L.G.;
Prins T.; Van Der Ham A.C.; Van Der Velden J.J.I.M.; Van Sterkenburg
S.M.M.; Ten Haken G.B.; Bruijninckx C.M.A.; Van Overhagen H.; Tutein
Nolthenius R.P.; Hendriksz T.R.; Teijink J.A.W.; Odink H.F.; De Smet
A.A.E.A.; Vroegindeweij D.; Van Loenhout R.M.M.; Rutten M.J.; Hamming
J.F.; Lampmann L.E.H.; Bender M.H.M.; Pasmans H.; Vahl A.C.; De Vries C.;
MacKaay A.J.C.; Van Dortmont L.M.C.; Van Der Vliet A.J.; Schultze Kool
L.J.; Boomsma J.H.B.; Van H.R.; De Mol Van Otterloo J.C.A.; De Rooij
T.P.W.; Smits T.M.; Yilmaz E.N.; Wisselink W.; Van Den Berg F.G.; Visser
M.J.T.; Van Der Linden E.; Schurink G.W.H.; De Haan M.; Smeets H.J.;
Stabel P.; Van Elst F.; Poniewierski J.; Vermassen F.E.G.
Institution
(De Bruin, Blankensteijn) Division of Vascular Surgery, Department of
Surgery, VU University Medical Center, Amsterdam, Netherlands
(De Bruin, Karthikesalingam, Holt, Thompson) Division of Vascular Surgery,
St George's Vascular Institute, St George's Healthcare NHS Trust, St James
Wing, Blackshaw Rd, London SW17 0QT, United Kingdom
(Prinssen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Title
Predicting reinterventions after open and endovascular aneurysm repair
using the St George's Vascular Institute score.
Source
Journal of Vascular Surgery. 63 (6) (pp 1428-1433e1), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Identifying patients at risk for aneurysm rupture and sac
expansion after open and endovascular abdominal aortic aneurysm (AAA)
repair (EVAR) may help to attenuate this risk by intensifying follow-up
and early detection of problems. The goal of this study was to validate
the St George's Vascular Institute (SGVI) score to identify patients at
risk for a secondary intervention after elective aneurysm repair. Methods
A post hoc on-treatment analysis of a randomized trial comparing open AAA
repair and EVAR was performed. In this multicenter trial, 351 patients
were randomly assigned to undergo open AAA repair or EVAR. Information on
survival and reinterventions was available for all patients at 5 years
postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair
was completed in 173 patients and EVAR in 171, based on an on-treatment
analysis. Because 17 patients had incomplete anatomic data, 327 patients
(157 open repair and 170 EVAR) were available for analysis. During 6 years
of follow-up, 78 patients underwent at least one reintervention. The SGVI
score, which is calculated from preoperative AAA morphology using aneurysm
and iliac diameter, predictively dichotomized patients into groups at
high-risk or low-risk for a secondary intervention. The observed freedom
from reintervention was compared between groups at predicted high-risk and
predicted low-risk. Results The 20 patients in the high-risk group were
indeed at higher risk for a secondary intervention compared with the 307
patients predicted to be at low risk (hazard ratio [HR], 3.82; 95%
confidence interval [CI], 2.05-7.11; P <.001). Discrimination between
high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI,
1.93-8.51; P <.001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P
=.033). Conclusions The SGVI score appears to be a useful tool to predict
reintervention risk in patients after open repair and EVAR.<br/>Copyright
&#xa9; 2016 Society for Vascular Surgery.

<11>
Accession Number
619136992
Author
Rivinius R.; Helmschrott M.; Ruhparwar A.; Rahm A.-K.; Darche F.F.; Thomas
D.; Bruckner T.; Ehlermann P.; Katus H.A.; Doesch A.O.
Institution
(Rivinius, Helmschrott, Rahm, Darche, Thomas, Ehlermann, Katus, Doesch)
Department of Cardiology, Angiology and Pneumology, Heidelberg University
Hospital, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
(Ruhparwar) Department of Cardiac Surgery, Heidelberg University Hospital,
Heidelberg, Germany
(Rahm) Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
(Bruckner) Institute for Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
Title
Control of cardiac chronotropic function in patients after heart
transplantation: effects of ivabradine and metoprolol succinate on resting
heart rate in the denervated heart.
Source
Clinical Research in Cardiology. 107 (2) (pp 138-147), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Patients after heart transplantation (HTX) present with sinus
tachycardia due to graft denervation. As elevated heart rates negatively
affect survival, the aim of this study was to analyze the effects of
ivabradine vs metoprolol succinate on heart rate, left ventricular (LV)
mass and survival following HTX. Methods: This observational retrospective
single-center study assessed 84 patients continuously receiving either
ivabradine (n = 40) or metoprolol succinate (n = 44) within 2 years after
HTX. Patients with dual therapy (ivabradine and metoprolol succinate),
other beta blockers, amiodarone, or digitalis were excluded. Patient
characteristics, post-transplant medication, heart rates, LV mass, and
survival were investigated. Results: Analysis of patient characteristics,
immunosuppressive drug regimen, and post-transplant medication showed no
significant differences between groups except for ivabradine and
metoprolol succinate. Baseline heart rates differed not significantly
between patients treated with ivabradine [87.0 beats per minute (bpm)] and
metoprolol succinate (86.2 bpm; P = 0.6395). At 2-year follow-up, patients
with ivabradine (76.7 bpm) had a significantly lower heart rate compared
to baseline (P < 0.0001) and to metoprolol succinate (82.0 bpm; P =
0.0283). LV mass in patients receiving ivabradine was lower at 2-year
follow-up compared to baseline (P = 0.0067) and patients receiving
metoprolol succinate (P = 0.0179). Patients with ivabradine had a superior
2-year survival after HTX (P = 0.0049). Conclusion: Treatment with
ivabradine in patients within 2 years after HTX significantly reduced
post-transplant heart rate and LV mass and was associated with a superior
survival in comparison with patients receiving metoprolol
succinate.<br/>Copyright &#xa9; 2017, Springer-Verlag GmbH Germany.

<12>
Accession Number
618803178
Author
Liu J.-Z.; Li X.-F.; Miao Q.; Zhang C.-J.
Institution
(Liu, Li, Miao, Zhang) Department of Cardiac Surgery, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing, China
Title
Surgical treatment of active native mitral infective endocarditis: A
meta-analysis of current evidence.
Source
Journal of the Chinese Medical Association. 81 (2) (pp 147-154), 2018.
Date of Publication: February 2018.
Publisher
Elsevier Ltd
Abstract
Background: The native mitral lesion of active infective endocarditis
implies a poor prognosis and is associated with adverse short- or
long-term results without surgical treatment. Both mitral valvuloplasty
(MVP) and mitral valve replacement (MVR) have been performed in the
treatment of active native mitral infective endocarditis (ANMIE). However,
the outcomes of the two approaches remain unclear. The aim of this study
was to systematically review the two procedures with mortality and
survival as the primary endpoints. Methods: A systematic review of the
literature was conducted to identify all relevant studies with comparative
data on MVP versus MVR for the treatment of ANMIE. Information on baseline
characteristics of patients, operation method, quality of literature,
follow-up, and so forth was abstracted using standardized protocols.
Pooled odds ratio (OR) or hazard ratio (HR) was calculated and possible
publication bias was tested. Results: Nine comparative observational
studies with a total of 633 patients (MVP = 265, MVR = 368) were
identified for qualitative assessment, data extraction, and analysis. The
summary OR for operative mortality, comparing repair with replacement, was
0.37 (95% CI 0.0.18-0.80; p = 0.0005). Summary 1- and 5-year HRs for
event-free survival were 0.43 (95% CI 0.20-0.92; p = 0.03) and 0.44 (95%
CI 0.25-0.77, p = 0.004), respectively (repair vs. replacement). Summary
1- and 5-year survival HRs were 0.51 (95% CI 0.24-1.08; p = 0.08) and 0.55
(95% CI 0.32-0.96; p = 0.004), respectively (repair vs. replacement). No
heterogeneity was revealed between studies, and possible publication bias
was insignificant. Conclusions: This meta-analysis suggests that MVP may
be associated with superior postoperative survival outcomes compared with
MVR. MVP is desirable, if possible, as a durable alternative to
replacement. However, we must consider the influence of different patient
characteristics and surgeons' preferences on the choice of surgical
approach, and additional powered clinical trials will be required to
confirm these findings.<br/>Copyright &#xa9; 2017

<13>
Accession Number
618947562
Author
Faraji R.; Behjati-Ardakani M.; Moshtaghioun S.M.; Kalantar S.M.;
Namayandeh S.M.; Soltani M.; Emami M.; Zandi H.; Firoozabadi A.D.;
Kazeminasab M.; Ahmadi N.; Sarebanhassanabadi M.
Institution
(Faraji, Behjati-Ardakani, Namayandeh, Soltani, Emami, Firoozabadi,
Ahmadi, Sarebanhassanabadi) Yazd Cardiovascular Research Center, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Moshtaghioun) Department of Biology, Faculty of Science, Yazd University,
Yazd, Iran, Islamic Republic of
(Kalantar) Medical Genetic Research and Clinical Centre for Infertility,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Zandi) Department of Microbiology, Faculty of Medicine, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Kazeminasab) Student Research Committee, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Title
The diagnosis of microorganism involved in infective endocarditis (IE) by
polymerase chain reaction (PCR) and real-time PCR: A systematic review.
Source
Kaohsiung Journal of Medical Sciences. 34 (2) (pp 71-78), 2018. Date of
Publication: February 2018.
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by
sequencing may be identified as the etiology of infective endocarditis
(IE) from surgically removed valve tissue; therefore, we reviewed the
value of molecular testing in identifying organisms' DNA in the studies
conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect,
Cochrane, PubMed, and Medline electronic databases without any time
limitations up to December 2016 for English studies reporting
microorganisms involved in infective endocarditis microbiology using PCR
and real-time PCR. Most studies were prospective. Eleven out of 12 studies
used valve tissue samples and blood cultures while only 1 study used whole
blood. Also, 10 studies used the molecular method of PCR while 2 studies
used real-time PCR. Most studies used 16S rDNA gene as the target gene.
The bacteria were identified as the most common microorganisms involved in
infective endocarditis. Streptococcus spp. and Staphylococcus spp. were,
by far, the most predominant bacteria detected. In all studies, PCR and
real-time PCR identified more pathogens than blood and tissue cultures;
moreover, the sensitivity and specificity of PCR and real-time PCR were
more than cultures in most of the studies. The highest sensitivity and
specificity were 96% and 100%, respectively. The gram positive bacteria
were the most frequent cause of infective endocarditis. The molecular
methods enjoy a greater sensitivity compared to the conventional blood
culture methods; yet, they are applicable only to the valve tissue of the
patients undergoing cardiac valve surgery.<br/>Copyright &#xa9; 2017

<14>
Accession Number
620118711
Author
She X.-W.; Gu Y.-B.; Xu C.; Li C.; Ding C.; Chen J.; Zhao J.
Institution
(She, Xu, Li, Ding, Chen, Zhao) Department of Thoracic Surgery, The First
Affiliated Hospital of Soochow University, Suzhou, China
(She) Department of Thoracic Surgery, Suzhou Municipal Hospital North
District, Nanjing Medical University, Suzhou, China
(Gu) Department of Radiology, The First Affiliated Hospital of Soochow
University, Suzhou, China
Title
Three-dimensional (3D)- computed tomography bronchography and angiography
combined with 3D-video-assisted thoracic surgery (VATS) versus
conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of
non-small cell lung cancer.
Source
Thoracic Cancer. 9 (2) (pp 305-309), 2018. Date of Publication: Februaryy
2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Compared to the pulmonary lobe, the anatomical structure of
the pulmonary segment is relatively complex and prone to variation, thus
the risk and difficulty of segmentectomy is increased. We compared
three-dimensional computed tomography bronchography and angiography
(3D-CTBA) combined with 3D video-assisted thoracic surgery (3D-VATS) to
perform segmentectomy to conventional two-dimensional (2D)-VATS for the
treatment of non-small cell lung cancer (NSCLC). Methods: We
retrospectively reviewed the data of randomly selected patients who
underwent 3D-CTBA combined with 3D-VATS (3D-CTBA-VATS) or 2D-VATS at the
Department of Thoracic Surgery, The First Affiliated Hospital of Soochow
University Hospital, from January 2014 to May 2017. Results: The operative
duration of 3D group was significantly shorter than the 2D group (P <
0.05). There was no significant difference in the number of dissected
lymph nodes between the two groups (P > 0.05). The extent of
intraoperative bleeding and postoperative drainage in the 3D group was
significantly lower than in the 2D group (P < 0.05). Chest tube duration
in the 3D group was shorter than in the 2D group (P < 0.05). Incidences of
pulmonary infection, atelectasis, and arrhythmia were not statistically
different between the two groups (P > 0.05). However, hemoptysis and
pulmonary air leakage (>3d) occurred significantly less frequently in the
3D than in the 2D group (P < 0.05). Conclusion: 3D-CTBA-VATS is a more
accurate and smooth technique and leads to reduced intraoperative and
postoperative complications.<br/>Copyright &#xa9; 2018 The Authors.
Thoracic Cancer published by China Lung Oncology Group and John Wiley &
Sons Australia, Ltd

<15>
Accession Number
620505661
Author
Khedr M.H.
Institution
(Khedr) Cardiology Department, Zagazig University, Shaibet an Nakareyah,
Markaz El- Zakazik 44519, Egypt
Title
Single vs. dual antiplatelet therapy effect on short-term graft patency
postcoronary artery bypass grafting using multidetector computed
tomography coronary angiography.
Source
European Heart Journal, Supplement. Conference: 44th Annual International
Congress of the Egyptian Society of Cardiology, CardioEgypt 2017. Egypt.
19 (Supplement F) (pp F12), 2017. Date of Publication: November 2017.
Publisher
Oxford University Press
Abstract
Introduction: There is a high prevalence of venous graft closure within 3
months after coronary artery bypass grafting (CABG) surgery. The main
mechanism at this stage is graft thrombosis, which sets the stage for
graft stenosis and occlusion. Multidetector computed tomography coronary
angiography (CTA) has become an important imaging modality for
non-invasive assessment of coronary artery disease (CAD) including
patients post-CABG. In 5-10% of patients with CAD, aspirin therapy failed
to arouse a complete antiplatelet response. Clopidogrel is used to reduce
ischaemic events and mortality in patients with CAD. Objective: Our study
aimed to evaluate the effect of dual antiplatelet therapy using aspirin
plus clopidogrel vs. aspirin alone on the short-term patency of venous and
arterial grafts post-CABG. Methods: Fifty patients post-CABG were
randomized into two groups: Group A (25 patients) received aspirin 150
mg/day and Group B (25 patients) received aspirin 150 mg/day plus
clopidogrel 75 mg/day. All patients underwent multislice detector computed
tomography angiography (MDCTA) 3 months post-CABG using 128-dual source
Siemens Flash definition scanner. All the scans were ECG gated. Each graft
was classified as patent (flow visible), occluded, or not analysable (e.g.
because the graft was obscured by a metal ligature clip or because the
image quality was poor). Results: A total of 119 grafts were scanned and
divided into 25 arterial grafts in Group A and 24 arterial grafts in Group
B, 35 SVGs in Group A (out of which there were 2 sequential grafts) and 31
SVGs in Group B. Conclusion: Dual antiplatelet therapy with aspirin plus
clopidogrel is not superior to aspirin alone in the patency of venous and
arterial grafts post-CABG during shortterm follow-up.

<16>
Accession Number
620505345
Author
Champion S.; Zieger L.; Hemery C.
Institution
(Champion, Zieger, Hemery) Intensive Care Unit, Parly 2 Clinic, Ramsay
Generale de Sante, Le Chesnay 78150, France
Title
Prophylaxis of postoperative nausea and vomiting after cardiac surgery in
high-risk patients: A randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 8-14), 2018. Date of
Publication: January-March 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: The role of prophylaxis for postoperative nausea and vomiting
(PONV) in cardiac surgery is under debate. Aims: To study the risk factors
for PONV after cardiac surgery and the role of betamethasone with or
without droperidol for its prevention. Setting and Design: Randomized
open-label controlled study comparing standard care with PONV prophylaxis
from February to November 2016. Methods: Five hundred and two patients
with planned nonemergent cardiac surgery were included. Interventions: In
the intervention arm, PONV prophylaxis (4 mg betamethasone with/without
0.625 mg droperidol) was administered in high-risk patients (two or more
risk factors). Patients in the control arm were treated as per routine
hospital practices. Results: Female sex, past history of PONV, and
migraines were associated with a significantly increased risk of PONV,
while motion sickness, smoking status, and volatile anesthetics were not.
Pain and treatment with nefopam or ketoprofen were associated with an
increased risk of PONV. PONV was less frequent in the active arm compared
to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs.
15.3 mm, P = 0.043). Among the 180 patients (35.6%) with >=2 risk factors,
prophylaxis was associated with reduced PONV (intention-to-treat: 46.8%
vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In
multivariate analysis, prophylaxis was independently associated with PONV
(odds ratio [OR]: 0.324, 95% confidence interval: 0.167-0.629, P =
0.0009), as were female sex, past history of PONV, and migraines (OR:
3.027, 3.031, and 2.160 respectively). No drug-related side effects were
reported. Conclusion: Betamethasone with/without droperidol was effective
in decreasing PONV in high risk cardiac surgical patients without any side
effect.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia, Published
by Wolters Kluwer- Medknow.

<17>
Accession Number
620505314
Author
Kuppuswamy B.; Davis K.; Sahajanandan R.; Ponniah M.
Institution
(Kuppuswamy, Davis, Sahajanandan, Ponniah) Department of Anaesthesia,
Christian Medical College, Vellore, Tamil Nadu, India
Title
A randomized controlled trial comparing the myocardial protective effects
of isoflurane with propofol in patients undergoing elective coronary
artery bypass surgery on cardiopulmonary bypass, assessed by changes in
N-terminal brain natriuretic peptide.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 34-40), 2018. Date of
Publication: January-March 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The objective of the study is to compare the myocardial
protective effects of isoflurane with propofol in patients undergoing
elective coronary artery bypass surgery on cardiopulmonary bypass (CPB),
the cardio protection been assessed by changes in N-terminal brain
natriuretic peptide (NT proBNP). Methodology and Design: This study is
designed as a participant blinded, prospective randomized clinical trial.
Setting: Christian Medical College Hospital, Vellore, India. Participants:
Patients undergoing elective coronary artery bypass surgery on CPB.
Intervention: Anesthesia was maintained with 0.8-1.2 end tidal
concentrations of isoflurane in the isoflurane group and in the propofol
group, anesthesia was maintained with propofol infusion as described by
Roberts et al. Measurements: Hemodynamic data were recorded at frequent
intervals during the surgery and up to 24 h in the Intensive Care Unit
(ICU). The other variables that were measured include duration of
mechanical ventilation, dose and duration of inotropes in ICU, (inotrope
score), duration of ICU stay, NT proBNP levels before induction and 24 h
postoperatively, creatine kinase-MB levels in the immediate postoperative,
first and second day. Results: Mean heart rate was significantly higher in
propofol group during sternotomy, (P = 0.021). Propofol group had a
significantly more number of patients requiring nitroglycerine in the
prebypass period (P = 0.01). The increase in NT proBNP from preoperative
to postoperative value was lesser in the isoflurane group compared to
propofol even though the difference was not statistically significant. The
requirement of phenylephrine to maintain mean arterial pressure within 20%
of baseline, mechanical ventilation duration, inotrope use, duration of
ICU stay and hospital stay were found to be similar in both groups.
Conclusion: Propofol exhibit comparable myocardial protective effect like
that of isoflurane in patients undergoing coronary artery bypass graft
surgery. Considering the unproven mortality benefit of isoflurane and the
improved awareness of green OT concept, propofol may be the ideal
alternative to volatile anesthetics, at least in patients with good left
ventricular function.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia, Published by Wolters Kluwer- Medknow.

<18>
Accession Number
620505305
Author
Kundra T.S.; Thimmarayappa A.; Dhananjaya M.; Manjunatha N.
Institution
(Kundra, Thimmarayappa, Dhananjaya, Manjunatha) Department of Cardiac
Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
(Kundra) Kothi No. 184, Phase 4, Mohali, Punjab, India
Title
Dexmedetomidine for prevention of skeletal muscle ischaemia-reperfusion
injury in patients with chronic limb ischaemia undergoing aortobifemoral
bypass surgery: A prospective double-blind randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 22-25), 2018. Date of
Publication: January-March 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Dexmedetomidine is a selective alpha-2 agonist used for
sedation. It has also been shown to have myocardial protective effect and
prevent ischemia-reperfusion injury in off-pump coronary artery bypass
patients. The aim of our study was to assess the effect of dexmedetomidine
for prevention of skeletal muscle ischemia-reperfusion injury in patients
undergoing aortobifemoral bypass surgery. Methodology: Sixty adult
patients (Group dexmedetomidine n = 30, Group normal saline n = 30)
undergoing aortobifemoral bypass surgery were recruited over 3 months.
Randomization was done using a computer-generated random table. The
attending anesthesiologist would be blinded to whether the drug/normal
saline was being administered. He would consider each unlabeled syringe as
containing dexmedetomidine and calculate the volume to be infused via a
syringe pump accordingly. Dexmedetomidine infusion (1 mcg/kg) over 15
minutes was given as a loading dose, followed by maintenance infusion of
0.5 mcg/kg/h till 2 h postprocedure in Group dexmedetomidine (D) while the
same volume of normal saline was given in the control Group C till 2 h
postprocedure. Creatine phosphokinase (CPK) values were noted at baseline
(T0), 6 h (T1), 12 h (T2), and 24 h (T3) after the procedure. Hemodynamic
variables (heart rate [HR] and mean blood pressure [MAP]) were recorded at
T0, T1, T2, and T3. Results were analyzed using unpaired Student's t-test,
P < 0.05 was considered statistically significant. Results: MAP and HR
significantly decreased in Group D as compared to control group (P <
0.05). However, the decrease was never <20% of the baseline. The CPK
values at 6, 12, and 24 h were statistically significant between the two
groups. Conclusion: Dexmedetomidine prevents skeletal muscle
ischemia-reperfusion injury in patients undergoing aortobifemoral bypass
surgery.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia,
Published by Wolters Kluwer- Medknow.

<19>
Accession Number
620505293
Author
Anonymous
Title
Erratum: Comparison of the renoprotective effect of dexmedetomidine and
dopamine in high-risk renal patients undergoing cardiac surgery: A
double-blind randomized study (Annals of Cardiac Anaesthesia (2017) 20
(408-415) DOI: 10.4103/aca.ACA_57_17).
Source
Annals of Cardiac Anaesthesia. 21 (1) (pp 108), 2018. Date of Publication:
January-March 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
In the article titled "Comparison of the Renoprotective Effect of
Dexmedetomidine and Dopamine in High?risk Renal Patients Undergoing
Cardiac Surgery: A Double?blind Randomized Study", published on pages
408-415, Issue 4, Volume 20 of Annals of Cardiac Anaesthesia,[1] the
affiliation of Mohamed Hussien was written incomplete as Cardiac Surgery,
Madinah Cardiac Center, Almadinah Almonwarah, Saudi Arabia instead of
Cardiac Surgery, Madinah Cardiac Center, lmadinah Almonwarah, Saudi
Arabia, Cardiac Surgery, Alazhar University, Egypt.<br/>Copyright &#xa9;
2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow.

<20>
Accession Number
620519141
Author
Ashfaq A.; Soroya M.S.; Iyengar A.; Federman M.; Reemtsen B.L.
Institution
(Ashfaq, Soroya, Iyengar) David Geffen School of Medicine at UCLA, Los
Angeles, CA, United States
(Federman, Reemtsen) Mattel Children's Hospital, Los Angeles, CA, United
States
(Reemtsen) UCLA Division of Cardiac Surgery, David Geffen School of
Medicine at UCLA, Los Angeles, CA, United States
Title
Heparin-Coated Grafts Reduce Mortality in Pediatric Patients Receiving
Systemic-to-Pulmonary Shunts.
Source
Pediatric Cardiology. (pp 1-5), 2018. Date of Publication: 13 Jan 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
We aimed to evaluate the outcomes of systemic-to-pulmonary (SP) shunt
procedures utilizing heparin-coated (HC) polytetrafluoroethylene (PTFE)
vascular grafts compared to uncoated (non-HC) grafts, in order to observe
any benefits in pediatric patients. Our institution switched from using
non-HC grafts to HC grafts in March 2011. We conducted a retrospective
review of consecutive pediatric patients receiving SP shunts from May 2008
to December 2015. Perioperative variables including baseline
characteristics, morbidity, mortality, and blood product utilization were
evaluated between the HC and non-HC groups. A total of 142 pediatric
patients received SP shunts during the study period: 69 patients received
HC shunts and 73 patients received non-HC shunts. The HC group had
significantly fewer desaturation or arrest events (P < 0.01), fewer shunt
occlusions/thromboses (P < 0.01). There was no statistically significant
difference in unplanned reoperations between groups (P = 0.18). The HC
group demonstrated significantly lower overall 30-day mortality (P <
0.01), as well as shunt-related mortality (P < 0.01). The HC group had
significantly lower postoperative packed red blood cell utilization as
compared to the non-HC group (P < 0.01). In this study, pediatric patients
receiving HC PTFE grafts in SP shunts demonstrated significantly lower
shunt-related mortality. The majority of HC grafts remained patent. These
findings suggest that HC grafts used in SP shunt procedures may benefit
pediatric patients in terms of efficacy and outcomes.<br/>Copyright &#xa9;
2018 Springer Science+Business Media, LLC, part of Springer Nature

<21>
Accession Number
620513169
Author
Asmussen S.; Przkora R.; Maybauer D.M.; Fraser J.F.; Sanfilippo F.;
Jennings K.; Adamzik M.; Maybauer M.O.
Institution
(Asmussen, Adamzik) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University
Bochum, Bochum, Germany
(Asmussen, Przkora, Maybauer, Jennings, Maybauer) Departments of
Anesthesiology and Epidemiology and Biostatistics, The University of Texas
Medical Branch, Galveston, TX, USA
(Asmussen, Fraser, Maybauer) Critical Care Research Group, Prince Charles
Hospital, The University of Queensland, Brisbane, Queensland, Australia
(Przkora) Department of Anesthesiology, College of Medicine, University of
Florida, Gainesville, FL, USA
(Maybauer, Maybauer) Department of Cardiothoracic Anaesthesia and Critical
Care, St George's Hospital, London, UK
(Sanfilippo) Department of Anesthesia and Intensive Care, IRCCS-ISMETT
(Istituto Mediterraneo per i Trapianti e Terapie ad Alta
Specializzazione), Palermo, Italy
(Sanfilippo) Department of Anaesthesiology and Intensive Care, Philipps
University, Marburg, Germany
(Maybauer) Cardiothoracic Anaesthesia and Intensive Care, Central
Manchester University Hospitals NHS Foundation Trust, Manchester Royal
Infirmary, University of Manchester, UK
Title
Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive
Care.
Source
Journal of Intensive Care Medicine. (no pagination), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Acupuncture treatment has been employed in China for over 2500
years and it is used worldwide as analgesia in acute and chronic pain.
Acupuncture is also used in general anesthesia (GA). The aim of this
systematic review and meta-analysis was to assess the efficacy of
electroacupuncture (EA) in addition to GA in patients undergoing cardiac
surgery. Methods: We searched 3 databases (Pubmed, Cochrane Library, and
Web of Science-from 1965 until January 31, 2017) for randomized controlled
trials (RCTs) including patients undergoing cardiac surgery and receiving
GA alone or GA + EA. As primary outcomes, we investigated the association
between GA + EA approach and the dosage of intraoperative anesthetic drugs
administered, the duration of mechanical ventilation (MV), the
postoperative dose of vasoactive drugs, the length of intensive care unit
(ICU) and hospital stay, and the levels of troponin I and cytokines.
Results: The initial search yielded 477 citations, but only 7 prospective
RCTs enrolling a total of 321 patients were included. The use of GA + EA
reduced the dosage of intraoperative anesthetic drugs (P <.05), leading to
shorter MV time (P <.01) and ICU stay (P <.05) as well as reduced
postoperative dose of vasoactive drugs (P <.001). In addition,
significantly lower levels of troponin I (P <.01) and tumor necrosis
factor alpha (P <.01) were observed. Conclusion: The complementary use of
EA for open-heart surgery reduces the duration of MV and ICU stay, blunts
the inflammatory response, and might have protective effects on the heart.
Our findings stimulate future RCT to provide definitive
recommendations.<br/>Copyright &#xa9; 2017, The Author(s) 2017.

<22>
Accession Number
620405045
Author
Deja M.A.; Wiaderkiewicz R.; Czekaj P.; Czech E.; Malinowski M.; Machej
L.; Weglarzy A.; Kowalowka A.; Piekarska M.; Szurlej B.; Latusek T.
Institution
(Deja, Malinowski, Kowalowka, Piekarska, Szurlej, Latusek) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Malinowski, Kowalowka, Piekarska) Department of Cardiac Surgery,
Upper-Silesian Heart Centre, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech) Department of Histology and Embryology,
School of Medicine in Katowice, Medical University of Silesia, ul. Medykow
18, Katowice 40-752, Poland
(Machej) Department of Anaesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anaesthesia, Upper-Silesian Heart Centre,
Katowice, Poland
Title
Remote Ischaemic PrEconditioning of Human Myocardium (RIPE): Study
protocol for a double-blinded randomised controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 136-143), 2018. Date of Publication: 2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Remote preconditioning has been shown to be a potent
protective phenomenon in many animals. Several studies aimed to
demonstrate it was feasible in humans by trying to show its protective
effect during cardiac surgery. Of these, some small studies and one larger
trial were positive while two other bigger studies showed no effectiveness
of remote preconditioning as assessed by levels of postoperatively
released cardiac markers. Recently, two large clinical trials also failed
to prove the benefit of remote preconditioning in cardiac surgery. No
study showed that remote preconditioning actually increases resistance of
human myocardium to standardised ischaemic and reperfusion stimulus in
experimental settings. In animal studies, remote preconditioning was shown
to improve mitochondrial function and structure, but such data on human
myocardium are scarce. Aim: The aim of the study is to determine whether
remote preconditioning protects human myocardium against
ischaemia-reperfusion injury in both in vivo and in vitro conditions.
Methods: The trial is designed as a single-centre, double-blinded,
sham-controlled trial of 120 patients. We randomise (1:1) patients
referred for coronary artery bypass grafting for stable coronary artery
disease to remote preconditioning or "sham" intervention. The remote
preconditioning is obtained by three cycles of 5 min inflation and 5 min
deflation of a blood pressure cuff on the right arm. Postoperative course
including myocardial enzymes profile will be analysed. Moreover, in the
in-vitro arm the clinically preconditioned myocardium will be assessed for
function, mitochondria structure, and mitochondria-dependent apoptosis.
The informed consent of all patients is obtained before enrolment into the
study by the investigator. The study conforms to the spirit and the letter
of the declaration of Helsinki. Results and conclusions: In case the
effect of remote preconditioning is not measurable in ex-vivo assessment,
any future attempt at implementing this phenomenon in clinical practice
may be futile and should not be continued until the effect can be
confirmed in a controlled experimental setting. The study might therefore
indicate future directions in trials of clinical implementation of remote
preconditioning. Trial Registration: Clinical Trials Register
(Clinicaltrials.gov) identifier: NCT01994707. The study was approved by
Institutional Review Board of the Medical University of Silesia
(KNW/0022/KB1/160/12).<br/>Copyright &#xa9; Polskie Towarzystwo
Kardiologiczne 2018.

<23>
Accession Number
620405039
Author
Weymann A.; Ali-Hasan-Al-Saegh S.; Popov A.-F.; Sabashnikov A.;
Mirhosseini S.J.; Liu T.; Tse G.; Lotfaliani M.; Ghanei A.; Testa L.;
D'Ascenzo F.; Benedetto U.; Dehghan H.; Roever L.; De Oliveira Sa M.P.B.;
Baker W.L.; Yavuz S.; Zeriouh M.; Mashhour A.; Nombela-Franco L.; Jang
J.-S.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.; Linde C.; Filipiak
K.J.; Biondi-Zoccai G.; Calkins H.; Stone G.W.
Institution
(Weymann, Mashhour) Department of Cardiac Surgery, University Hospital
Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky
University Oldenburg, Oldenburg, Germany
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom
(Ali-Hasan-Al-Saegh, Popov, Sabashnikov, Mirhosseini) Cardiovascular
Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Popov, Sabashnikov) Department of Thoracic and Cardiovascular Surgery,
University Hospital Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov) Department of Cardiothoracic Surgery, University Hospital of
Cologne, Cologne, Germany
(Liu, Meng, Gong) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Ghanei) Department of Internal Medicine, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(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
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(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 Postgraduate and Research in Health Sciences
of Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
(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
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, Jin-gu, Busan, South Korea
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institutet, Stockholm, Sweden
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(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
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
Title
Haematological indices as predictors of atrial fibrillation following
isolated coronary artery bypass grafting, valvular surgery, or combined
procedures: A systematic review with meta-analysis.
Source
Kardiologia Polska. 76 (1) (pp 107-118), 2018. Date of Publication: 2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: New postoperative atrial fibrillation (POAF) is one of the
most critical and common complications after cardiovascular surgery
precipitating early and late morbidities. Complete blood count (CBC) is an
imperative blood test in clinical practice, routinely used in the
examination of cardiovascular diseases. Aim: This systematic review with
meta-analysis aimed to determine the strength of evidence for evaluating
the association of haematological indices in CBC tests with atrial
fibrillation following isolated coronary artery bypass graft (CABG),
isolated valvular surgery, or a combination of these treatments. Methods:
We conducted a meta-analysis of studies evaluating pre- and postoperative
haematological indices in patients with POAF. A comprehensive subgroup
analysis was performed to explore potential sources of heterogeneity.
Results: A literature search of all major databases retrieved 732 studies.
After screening, 22 studies were analysed including a total of 6098
patients. Pooled analysis showed preoperative platelet count (PC)
(weighted mean difference [WMD] = -7.07 x 10⁹/L and p < 0.001),
preoperative mean platelet volume (MPV) (WMD = 0.53 FL and p < 0.001),
preoperative white blood cell count (WBC) (WMD = 0.130 x 10⁹/L
and p < 0.001), preoperative neutrophil-to-lymphocyte ratio (NLR) (WMD =
0.33 and p < 0.001), preoperative red blood cell distribution width (RDW)
(WMD = 0.36% and p < 0.001), postoperative WBC (WMD = 1.36 x
10⁹/L and p < 0.001), and postoperative NLR (WMD = 0.74 and p <
0.001) as associated factors with POAF. Conclusions: Haematological
indices may predict the risk of POAF before surgery. These
easily-performed tests should definitely be taken into account in patients
undergoing isolated CABG, valvular surgery, or combined
procedures.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2018.

<24>
Accession Number
620405038
Author
Soleimani A.; Habibi M.R.; Kiabi F.H.; Alipour A.; Habibi V.; Azizi S.;
Zeydi A.E.; Sohrabi F.B.
Institution
(Soleimani, Habibi, Kiabi) Department of Anaesthesiology, Imam Khomeini
Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Azizi) Department of Pathology, Faculty of Paramedicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Sohrabi) Mazandaran Heart Centre, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Title
The effect of intravenous N-acetylcysteine on prevention of atrial
fibrillation after coronary artery bypass graft surgery: A double-blind,
randomised, placebo-controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 99-106), 2018. Date of Publication: 2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Atrial fibrillation (AF) is one of the most frequently
occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.
Aim: The aim of this study was to evaluate the effect of intravenous
N-acetylcysteine (NAC) on the prevention of AF after CABG surgery.
Methods: In a double-blind, randomised controlled trial, a total of 150
patients who were scheduled for on-pump CABG surgery were randomly
assigned into two groups. In group A, patients received an intravenous NAC
infusion (50 mg/kg) after induction of anaesthesia. These patients
additionally received two intravenous doses of NAC on postoperative days 1
and 2. Patients in group B received normal saline (as a placebo) with the
same volume, during the same time interval. During the first three days
after surgery, postoperative AF (POAF) was assessed by continuous
electrocardiogram monitoring; serum high-sensitivity C-reactive protein
(hsCRP) level was also assessed before and three days after surgery.
Results: During follow-up, 17 patients (17/141, 12.1%) developed POAF.
POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%)
patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p = 0.02). In
the multivariable logistic regression analysis, the only predictor of AF
after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06-0.73; p =
0.01). Also, the hsCRP level trend in the NAC group was different from the
trend in the control group (group time interaction or interaction effect)
(p < 0.001). Conclusions: It seems that perioperative intravenous NAC
therapy can be effectively used to reduce inflammation and the incidence
of POAF after CABG surgery.<br/>Copyright &#xa9; Polskie Towarzystwo
Kardiologiczne 2018.

<25>
Accession Number
614410314
Author
Desborough M.J.R.; Oakland K.A.; Landoni G.; Crivellari M.; Doree C.;
Estcourt L.J.; Stanworth S.J.
Institution
(Desborough, Oakland, Doree, Estcourt, Stanworth) NHS Blood and
Transplant, John Radcliffe Hospital, Oxford, United Kingdom
(Desborough, Estcourt, Stanworth) Oxford Clinical Research in Transfusion
Medicine, Nuffield Division of Clinical Laboratory Sciences, University of
Oxford, Oxford, United Kingdom
(Oakland) Department of Colorectal Surgery, Oxford University Hospitals
NHS Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Landoni, Crivellari) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Desmopressin for treatment of platelet dysfunction and reversal of
antiplatelet agents: a systematic review and meta-analysis of randomized
controlled trials.
Source
Journal of Thrombosis and Haemostasis. 15 (2) (pp 263-272), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials The optimal management of patients with platelet dysfunction
undergoing surgery is unclear. This meta-analysis compared perioperative
administration of desmopressin to placebo. Desmopressin reduced red cell
transfusions, blood loss and risk of re-operation due to bleeding. There
were too few events to determine if there was a change in the risk of
thrombotic events. Summary: Background Platelet dysfunction, including
that caused by antiplatelet agents, increases the risk of perioperative
bleeding. The optimal management of patients with platelet dysfunction
undergoing surgery is unclear. Objectives To assess whether desmopressin
reduces perioperative allogeneic red cell transfusion and bleeding in
patients with platelet dysfunction. Patients/Methods We searched for
randomized controlled trials in The Cochrane Central Register of
Controlled Trials, MEDLINE, PubMed, Embase, the Transfusion Evidence
Library and the ISI Web of Science to 7th July 2016. Data were pooled
using mean difference (MD), relative risks or Peto odds ratios (pOR) using
a random-effects model. Results Ten trials with 596 participants were
identified, all in the setting of cardiac surgery. Platelet dysfunction
was due to antiplatelet agents in six trials and cardiopulmonary bypass in
four trials. Patients treated with desmopressin were transfused with fewer
red cells (MD, -0.65 units; 95% Confidence Interval [CI], -1.16 to -0.13
units), lost less blood (MD, -253.93 mL; 95% CI, -408.01 to -99.85 mL) and
had a lower risk of re-operation due to bleeding (pOR, 0.39; 95% CI,
0.18-0.84). The GRADE quality of evidence was very low to moderate,
suggesting considerable uncertainty over the results. Conclusions
Desmopressin may be a useful agent to reduce bleeding and transfusion
requirements for people with platelet dysfunction or with a history of
recent antiplatelet drug administration undergoing cardiac
surgery.<br/>Copyright &#xa9; 2016 International Society on Thrombosis and
Haemostasis

<26>
Accession Number
615494573
Author
Vasheghani Farahani A.; Yousefi Azar A.; Goodarzynejad H.R.; Khorrami E.;
Hosseinzadeh-Attar M.J.; Oshnouei S.; Alizadeh Ghavidel A.; Golfeshan E.;
Ghourban Pour F.
Institution
(Vasheghani Farahani) Department of Cardiology, School of Medicine, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Yousefi Azar) Department of Operating Room Technology, Faculty of
Paramedical Sciences, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Yousefi Azar) Rajaie Cardiovascular Medical & Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Goodarzynejad) Tehran Heart Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Khorrami, Hosseinzadeh-Attar) Department of Clinical Nutrition, School of
Nutritional Sciences and Dietetics, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Oshnouei) Reproductive Health Research Center, Urmia University of
Medical Sciences, Urmia, Iran, Islamic Republic of
(Alizadeh Ghavidel) Rajaie Cardiovascular Medical & Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Golfeshan) Qum University of Medical Sciences, Qum, Iran, Islamic
Republic of
(Ghourban Pour) Rajaie Cardiovascular Medical & Research Center, Tehran,
Iran, Islamic Republic of
Title
Fish oil supplementation for primary prevention of atrial fibrillation
after coronary artery bypass graft surgery: A randomized clinical trial.
Source
International Journal of Surgery. 42 (pp 41-48), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ltd
Abstract
Background Atrial fibrillation (AF) after cardiac surgery is a common
complication that may influence patients' early and long term outcomes and
hospital costs. The purpose of this study was to assess the effect of fish
oil on occurrence of AF following coronary artery bypass graft surgery
(CABG). Methods This study was a single-center, randomized, double
blinded, placebo-controlled clinical trial. Four-hundred and one patients
undergoing coronary artery bypass graft surgery were randomly assigned to
receive 2 g/d fish oil or placebo (olive oil) for at least 5 days before
surgery. The primary end point was defined as time to AF improvement After
AF incidence following isolated CABG or a need for pharmacologic therapy
or cardioversion. Results The time to AF improvement in intervention group
was shorter than control group (HR: 2.05; 95% CI = 0.70-6.22, P = 0.20).
The incidence of AF in the intervention and control groups was 8.40% vs.
14.07% respectively (p = 0.07). Mean total duration of AF was 20.96 +/-
4.71 h in intervention groups and 46.87 +/- 7.44 h in control groups (p =
0.04). Mean duration of stay in the ICU and total hospital stay showed a
significant reduction in the intervention group (p = 0.003 and p = 0.04,
respectively). Conclusion The consumption of PUFA leads to a shorter time
to AF improvement, which was not statistically significant. The incidence
of AF in patients undergoing CABG surgery was decreased by approximately
5.7%; which was statistically on the borderline. Fish oil reduced median
length of stay in the ICU and hospital. Further well-designed studies are
needed to overcome the limitations of the existing trials and provide
conclusive conclusions.<br/>Copyright &#xa9; 2017 IJS Publishing Group Ltd

<27>
Accession Number
614346906
Author
Soleimani M.; Masoumi N.; Nooraei N.; Lashay A.; Safarinejad M.R.
Institution
(Soleimani, Masoumi, Lashay) Department of Urology, Shahid Modarress
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Nooraei) Department of Anesthesiology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Safarinejad) Clinical Center for Urological Disease Diagnosis, Private
Clinic Specializing in Urological and Andrological Genetics, Tehran, Iran,
Islamic Republic of
Title
The effect of fibrinogen concentrate on perioperative bleeding in
transurethral resection of the prostate: a double-blind placebo-controlled
and randomized study.
Source
Journal of Thrombosis and Haemostasis. 15 (2) (pp 255-262), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials Perioperative bleeding during prostate surgery is still a
common morbidity. Anticoagulant and antiplatelet medications contribute to
the risk of hemorrhage and prolonged hospital stay. Multiple
pharmacological agents have been proposed, but none of them have been
widely accepted. It is crucial to find a safe and effective modality to
reduce hemorrhage. Summary: Background Hemorrhage during transurethral
resection of the prostate (TUR-P) has always been a concern. Several
studies have shown preoperative administration of fibrinogen concentrate
to have promising results in reducing hemorrhage in cardiac surgery.
Objectives To investigate the hemostatic effect of fibrinogen concentrate
administration on reducing the amount of bleeding during TUR-P in patients
with benign prostatic hyperplasia. Methods Sixty men with benign prostatic
hyperplasia, who were chosen to undergo TUR-P, entered this prospective
randomized double-blind placebo-controlled study. The participants were
randomly assigned to two groups: treatment (n = 31) and placebo (n = 29).
They received an infusion of 2 g of fibrinogen concentrate (treatment
group) or normal saline (placebo group) before surgery. Data regarding the
amount of bleeding, the operation and complications were recorded and
analyzed. Results No difference was observed in bleeding between the
fibrinogen and placebo groups during (521 mL versus 557 mL, respectively)
and after (291 mL versus 341 mL, respectively) surgery. This lack of
difference was also seen in operation time (43 min versus 42 min),
irrigating fluid volume used during (17 L versus 19 L) and after (29 L
versus 28 L) surgery, and resected adenoma volume (19 g versus 19 g). The
mean blood pressure was also similar in both groups as a confounding
factor for the amount of bleeding. Conclusion Preoperative administration
of fibrinogen concentrate had no significant influence on intraoperative
and postoperative bleeding in TUR-P surgery.<br/>Copyright &#xa9; 2016
International Society on Thrombosis and Haemostasis

<28>
Accession Number
620134617
Author
Athanasopoulos L.V.; Casula R.P.; Punjabi P.P.; Abdullahi Y.S.; Athanasiou
T.
Institution
(Athanasopoulos) Department of Cardiovascular Surgery, Texas Heart
Institute, Houston, TX, United States
(Casula, Punjabi, Abdullahi, Athanasiou) Department of Cardiothoracic
Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
Title
A technical review of subvalvular techniques for repair of ischaemic
mitral regurgitation and their associated echocardiographic and survival
outcomes.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 975-982),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Subvalvular techniques are gaining ground as adjunct procedures for
addressing ischaemic mitral regurgitation. The aim of this study was to
describe the different techniques and assess their results. A systematic
review of the literature was performed. The end points of interest were
recurrence of mitral regurgitation, cardiac events and early and late
echocardiographic measurements. After initial screening, 450 articles were
identified, of which 24 provided the best available evidence on the topic.
The different subvalvular techniques had similar mortality rates when
compared with the standard restrictive annuloplasty. Recurrence of mitral
regurgitation was of lower degree and the remodelling process was better
for these techniques. Reoperation rates were also quite low. The
subvalvular techniques showed superiority, addressing more successfully
the leaflet tethering. However, larger randomized studies are needed to
confirm these early positive results.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<29>
Accession Number
620134596
Author
Geng J.; Qian J.; Si W.; Cheng H.; Ji F.; Shen Z.
Institution
(Geng, Qian, Si, Cheng, Ji) Department of Anesthesiology, First Affiliated
Hospital of Soochow University, 899 Pinghai Rd, Gusu District, Suzhou
215000, China
(Shen) Jiangsu Province's Key Medical Center for Cardiovascular Surgery,
Suzhou, Jiangsu, China
Title
The clinical benefits of perioperative antioxidant vitamin therapy in
patients undergoing cardiac surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 966-974),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
The clinical benefits of perioperative antioxidant vitamin therapy in
cardiac patients remain controversial. Here, we conducted a meta-analysis
to determine the strength of the evidence supporting the perioperative use
of antioxidant vitamins in patients undergoing cardiac surgery. We
searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane
Library) for randomized controlled trials that reported the effects of
antioxidant vitamin therapy on patients undergoing cardiac surgery until 6
June 2016. Risk ratio (RR) or mean difference (MD) and its 95% confidence
interval (95% CI) served as the summarized results. Heterogeneity among
included studies was evaluated using the I 2 statistic, which help
determine which effect model to apply. We constructed a funnel plot to
assess the existence of publication bias. Sensitivity analyses were also
conducted to evaluate the robustness of the outcomes. Twelve trials with
1584 cardiac patients were included. Compared with placebo or no
antioxidant vitamin therapy, administration of antioxidant vitamin therapy
resulted in a reduction in postoperative atrial fibrillation (POAF) (RR
0.55, 95% CI 0.42, 0.73, P < 0.0001), duration of hospital stay (MD -0.68,
95% CI -0.98, -0.39, P < 0.00001), intensive care unit length of stay (MD
-0.21, 95% CI -0.30, -0.12, P < 0.00001) and intubation time (MD -2.41,
95% CI -3.83, -0.98, P = 0.001). Our results also showed a trend towards a
decrease in postoperative complications (RR 0.72, 95% CI 0.48, 1.08, P =
0.11) and duration of POAF (MD -1.950, 95% CI -3.28, 0.29, P = 0.10). This
meta-analysis demonstrated that perioperative antioxidant vitamin therapy
in patients undergoing cardiac surgery can reduce the incidence of POAF,
duration of hospital stay, intensive care unit length of stay and
intubation time.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<30>
Accession Number
620134566
Author
An J.; Shi F.; Liu S.; Ma J.; Ma Q.
Institution
(An, Shi, Liu, Ma, Ma) Department of Cardiac Surgery, Second Hospital of
Hebei Medical University, Shi Jiazhuang 050000, China
Title
Preoperative statins as modifiers of cardiac and inflammatory outcomes
following coronary artery bypass graft surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 958-965),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Early postoperative cardiac complications of coronary artery bypass graft
surgery, such as atrial fibrillation (AF) or myocardial infarction (MI),
may be beneficially modulated by preoperative statins, involving their
anti-inflammatory effects. There is uncertainty on the clinical merit of
statin pretreatment. Addressing this, we conducted a meta-analysis of
early cardiac complications and inflammatory markers following statin
pretreatment in coronary artery bypass graft surgery. A search of Medline
and Cochrane databases was undertaken to identify suitable studies. A
meta-analysis was carried out for early cardiac (AF, MI, myocardial injury
markers) and inflammatory (cytokines, C-reactive protein) outcomes. We
identified 17 suitable studies that featured data from the total of 2796
patients. Twelve studies (1260 treated and 1263 untreated patients)
reported AF incidence. Statin pretreatment was associated with a
significant decrease of AF incidence: odds ratio 0.44 (95% confidence
interval: 0.27-0.70; P = 0.003). Seven studies (381 treated and 277
untreated patients) reported useful data on MI. Unlike in AF, no
significant modulation of postoperative MI in association with statin
pretreatment could be observed: odds ratio 0.62 (95% confidence interval:
0.21-1.81; P = 0.62). Five studies (248 treated and 245 untreated
patients) provided data on postoperative rise of C-reactive protein. This
rise was significantly downregulated in statin-pretreated patients:
standardized mean difference -0.44 (95% confidence interval: -0.78 to
-0.11; P = 0.02). Thus, postoperative AF incidence is the biggest
beneficiary of statin pretreatment in coronary artery bypass graft
surgery. This effect is associated with beneficial modulation of systemic
inflammatory markers.<br/>Copyright &#xa9; The Author 2017. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<31>
Accession Number
620356210
Author
Mccullough P.A.; Bennett-Guerrero E.; Chawla L.S.; Beaver T.; Mehta R.L.;
Molitoris B.A.; Eldred A.; Ball G.; Lee H.-J.; Houser M.T.; Khan S.
Institution
(Mccullough) Texas A and M, Department of Internal Medicine Baylor
University Medical Center, Baylor Heart and Vascular Institute, Baylor
Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United
States
(Mccullough) The Heart Hospital, Plano, TX, United States
(Bennett-Guerrero) Stony Brook Medicine Health Science Center, Stony
Brook, NY, United States
(Chawla) George Washington School of Medicine, Department of Internal
Medicine, Veterans Affairs Medical Center, Washington, DC, United States
(Beaver) Department of Thoracic and Cardiovascular Surgery, University of
Florida, Gainesville, FL, United States
(Mehta) Department of Internal Medicine, University of California San
Diego Medical Center, San Diego, CA, United States
(Molitoris) Department of Internal Medicine, Indiana University,
Indianapolis, IN, United States
(Eldred, Houser, Khan) Renal Clinical Development, AbbVie Inc., North
Chicago, IL, United States
(Ball, Lee) Statistics, AbbVie Inc., North Chicago, IL, United States
(Khan) Quark Pharmaceuticals, Fremont, CA, United States
Title
ABT-719 for the Prevention of Acute Kidney Injury in Patients Undergoing
High-Risk Cardiac Surgery: A Randomized Phase 2b Clinical Trial.
Source
Journal of the American Heart Association. 5 (8) (no pagination), 2016.
Article Number: e003549. Date of Publication: August 2016.
Publisher
American Heart Association Inc.
Abstract
Background: Patients undergoing cardiac surgeries with cardiopulmonary
bypass (on-pump) have a high risk for acute kidney injury (AKI). We tested
ABT-719, a novel alpha-melanocyte-stimulating hormone analog, for
prevention of AKI in postoperative cardiac surgery patients. Methods and
Results: This phase 2b randomized, double-blind, placebo-controlled trial
included adult patients with stable renal function undergoing high-risk
on-pump cardiac surgery in the United States and Denmark. Participants
received placebo (n=61) or cumulative ABT-719 doses of 800 (n=59), 1600
(n=61), or 2100 mug/kg (n=59). Primary outcome was development of AKI
based on Acute Kidney Injury Network (AKIN) criteria, measured utilizing
preoperative creatinine value and maximum value within 48 hours and urine
output within the first 42 hours postsurgery. Secondary outcomes included
incidence of AKI based on maximal changes from baseline in novel AKI
biomarkers over a 72-hour period after clamp release and length of
intensive care unit stays through 90 days postsurgery. A total of 65.5%,
62.7%, and 69.6% of patients in the 800-, 1600-, and 2100-mug/kg groups,
respectively, developed AKI (stages 1, 2, and 3 combined) versus 65.5% in
the placebo group (for each pair-wise comparison with placebo, P=0.966,
0.815, and 0.605, respectively). Adverse events occurred at a similar rate
in all treatment groups. Conclusions: ABT-719 treatment did not lower AKI
incidence using AKIN criteria, influence the elevations of novel
biomarkers, or change 90-day outcomes in patients after cardiac
surgery.<br/>Copyright &#xa9; 2016 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley Blackwell.

<32>
Accession Number
620356209
Author
Shore S.; Smolderen K.G.; Spertus J.A.; Kennedy K.F.; Jones P.G.; Zhao Z.;
Wang T.Y.; Arnold S.V.
Institution
(Shore) Emory University School of Medicine, Atlanta, GA, United States
(Smolderen) Ghent University, Ghent, Belgium
(Smolderen, Spertus, Kennedy, Jones, Arnold) Mid America Heart Institute,
Kansas City, MO, United States
(Smolderen, Spertus, Arnold) University of Missouri Kansas City, Kansas
City, MO, United States
(Zhao) Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN,
United States
(Wang) Duke University, Durham, NC, United States
Title
Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned
Revascularization Following Acute Myocardial Infarction.
Source
Journal of the American Heart Association. 5 (8) (no pagination), 2016.
Article Number: e003129. Date of Publication: August 2016.
Publisher
American Heart Association Inc.
Abstract
Background: Rehospitalizations following acute myocardial infarction for
unplanned coronary revascularization and unstable angina (UA) are often
included as parts of composite end points in clinical trials. Although
clearly costly, the clinical relevance of these individual components has
not been described. Methods and Results: Patients enrolled in a
prospective, 24-center, US acute myocardial infarction registry were
followed for 1 year after an acute myocardial infarction for
rehospitalizations, that were independently adjudicated by experienced
cardiologists. Patients who did and did not experience UA or
revascularization rehospitalization were propensity matched using greedy
matching. Among 3283 patients with acute myocardial infarction who were
included, mean age was 59 years, 33% were female, and 70% were white.
Rehospitalization rates for UA and unplanned revascularization at 1 year
were 5.0% and 4.1%, respectively. After propensity matching, we included
2433 patients in the UA rehospitalization group and 2410 in the unplanned
revascularization group. Using weighted proportional hazards Cox
regression, there was no significant association between a
rehospitalization for UA and 5-year all-cause mortality (9.6% versus
13.8%; adjusted hazard ratio 0.87, 95% CI 0.60-1.16). Patients
rehospitalized for unplanned revascularization had a lower 5-year
mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50-0.92)
compared with those without such rehospitalizations. Nevertheless,
patients with UA and unplanned revascularization had a substantially
greater hazard of subsequent rehospitalizations compared with patients
without such events (UA: hazard ratio 4.36, 95% CI 3.48-5.47;
revascularization: hazard ratio 4.38, 95% CI 3.53-5.44). Conclusions:
Rehospitalizations for UA and unplanned revascularization in the year
after an acute myocardial infarction are associated with higher risks of
subsequent rehospitalizations but not with mortality.<br/>Copyright &#xa9;
2016 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley Blackwell.

<33>
Accession Number
620496768
Author
Ko J.S.; Whiting Z.; Nguyen C.; Liu R.W.; Gilmore A.
Title
A Randomized Prospective Study Of The Use Of Ipads In Reducing Anxiety
During Cast Room Procedures.
Source
The Iowa orthopaedic journal. 36 (pp 128-132), 2016. Date of Publication:
2016.
Abstract
BACKGROUND: Cast room procedures can be a source of anxiety for children.
Various techniques, including music therapy, have been evaluated as a way
to ease this anxiety. The use of iPads as a form of distraction during
cast room procedures has not previously been evaluated and was the purpose
of the current study.
METHODS: 146 children and adolescents who underwent cast room procedures
during June- August 2015 were randomly assigned to one of three groups:
no-iPad, iPad with video, or iPad with game. Patient heart rates were
measured using a pulse oximeter in the waiting room, before the procedure,
during the procedure, and after the procedure. Mean values for each group
were calculated at each time interval and compared both between groups and
within groups over time.
RESULTS: There were no significant differences in baseline (waiting room)
heart rate between the no-iPad and iPad groups. When compared with the
no-iPad group, there was a trend toward decreased heart rate in the video
group (p=0.13) and a significant increase in heart rate in the game group
(p=0.026) before the procedure. There were no significant decreases in
heart rate within any of the groups when comparing the waiting room heart
rates with the during procedure heart rates. There was a significant
difference between the no-iPad and video groups (p=0.047) when comparing
the change in heart rate from baseline to before the procedure, with a
decreased heart rate observed in the video group.
CONCLUSIONS: The results of this study show a significant decrease in
heart rate when transitioning from the waiting room to the cast room while
watching videos on the iPad. iPad-based video delivery appears to decrease
anxiety prior to cast room procedures. iPad-based game play is difficult
to assess as elevations in heart rate prior to the procedure are presumed
to be related to game play and confound the observed effect it may have on
anxiety related to the procedure.

<34>
Accession Number
620354133
Author
Hanif H.; Belley-Cote E.P.; Alotaibi A.; Dvirnik N.; Neupane B.; Beyene
J.; Eikelboom J.W.; Holmes D.; Whitlock R.P.
Institution
(Hanif, Belley-Cote, Alotaibi, Neupane, Beyene, Whitlock) Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
ON, Canada
(Hanif, Alotaibi, Dvirnik, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Eikelboom, Whitlock) Population Health Research Institute, 237 Barton St.
East, Hamilton, ON L8L 2X2, Canada
(Holmes) Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic College of Medicine, Mayo Clinic and Mayo
Foundation, Rochester, MN, United States
Title
Left atrial appendage occlusion for stroke prevention in patients with
atrial fibrillation: A systematic review and network meta-analysis of
randomized controlled trials.
Source
Journal of Cardiovascular Surgery. 59 (1) (pp 128-139), 2018. Date of
Publication: February 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Atrial fibrillation (AF) is one of the leading causes of
stroke. Risks associated with oral anticoagulation (OAC) limit adherence
to recommended therapy. Left atrial appendage (LAA) occlusion is a
treatment alternative in patients with AF. We performed a network
meta-analysis (NMA) of randomized trials evaluating the efficacy of LAA
occlusion compared with oral anticoagulant, antiplatelet, and placebo for
stroke prevention. We also assessed the impact of LAA occlusion on
mortality, major bleeding, and operative time. EVIDENCE ACQUISITION: We
searched MEDLINE, EMBASE, PubMed, and Cochrane Library for randomized
trials comparing percutaneous or surgical LAA occlusion with standard of
care in AF patients. EVIDENCE SYNTHESIS: Conventional meta-analysis found
no difference between groups for stroke (5 trials, 1285 patients;RR 0.78,
95% CI 0.47-1.29), and a significant reduction in mortality (5 trials,
1285 patients; RR 0.71, 95% CI 0.51-0.99) favouring LAA occlusion. NMA
demonstrated a trend towards reduction in stroke (OR 0.84, 95% CrI
0.47-1.55) and mortality (OR 0.69, 95% CrI 0.44-1.10) for LAA occlusion
versus warfarin, but no statistically significant effect. Statistical
ranking curves placed LAA occlusion as the most efficacious treatment on
the outcomes of stroke and mortality when compared to warfarin, aspirin,
or placebo. No significant differences between groups were seen in major
bleeding or operative time for surgical trials. The overall quality of the
evidence was low as assessed by GRADE. CONCLUSIONS: LAA occlusion appears
to preserve the benefits of OAC therapy for stroke prevention in patients
with AF, but the current evidence is of low quality.<br/>Copyright &#xa9;
2017 Edizioni Minerva Medica.

<35>
Accession Number
619613489
Author
Aboul-Hassan S.S.; Stankowski T.; Marczak J.; Peksa M.; Nawotka M.;
Stanislawski R.; Kryszkowski B.; Cichon R.
Institution
(Aboul-Hassan, Marczak, Peksa, Nawotka, Stanislawski) Department of
Cardiac Surgery, MEDINET Heart Center Ltd., Nowa Sol, Poland
(Stankowski) Department of Cardiac Surgery, Sana-Heart Center Cottbus,
Cottbus, Germany
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Kryszkowski) Department of General and Oncological Surgery, Hospital in
Jelenia Gora, Jelenia Gora, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Title
The use of preoperative aspirin in cardiac surgery: A systematic review
and meta-analysis.
Source
Journal of Cardiac Surgery. 32 (12) (pp 758-774), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Despite the fact that aspirin is of benefit to patients
following coronary artery bypass grafting (CABG), continuation or
administration of preoperative aspirin before CABG or any cardiac surgical
procedure remains controversial. Therefore, we performed a systematic
review and meta-analysis to assess the influence of preoperative aspirin
administration on patients undergoing cardiac surgery. Materials and
Methods: Medline database was searched using OVID SP interface. Similar
searches were performed separately in EMBASE, PubMed, and Cochrane Central
Registry of Controlled Trials. Results: Twelve randomized controlled
trials and 28 observational studies met our inclusion criteria and were
included in the meta-analysis. The use of preoperative aspirin in patients
undergoing CABG at any dose is associated with reduced early mortality as
well as a reduced incidence of postoperative acute kidney injury (AKI).
Low-dose aspirin (<=160 mg/d) is associated with a decreased incidence of
perioperative myocardial infarction (MI). Administration of preoperative
aspirin at any dose in patients undergoing cardiac surgery increases
postoperative bleeding. Despite this effect of preoperative aspirin, it
did not increase the rates of surgical re-exploration due to excessive
postoperative bleeding nor did it increase the rates of packed red blood
cell transfusions (PRBC) when preoperative low-dose aspirin (<=160 mg/d)
was administered. Conclusions: Preoperative aspirin increases the risk for
postoperative bleeding. However, this did not result in an increased need
for chest re-exploration and did not increase the rates of PRBC
transfusion when preoperative low-dose (<=160 mg/d) aspirin was
administered. Aspirin at any dose is associated with decreased mortality
and AKI and low-dose aspirin (<=160 mg/d) decreases the incidence of
perioperative MI.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<36>
Accession Number
619741433
Author
Quin J.A.; Hattler B.; Shroyer A.L.W.; Kemp D.; Almassi G.H.; Bakaeen
F.G.; Carr B.M.; Bishawi M.; Collins J.F.; Grover F.L.; Wagner T.H.
Institution
(Quin) Surgical Service, Veterans Affairs Boston Healthcare System, West
Roxbury, MA, United States
(Quin) Harvard Medical School, Boston, MA, United States
(Hattler) Department of Medicine, Division of Cardiology, Veterans Affairs
Eastern Colorado Health Care System, Denver, CO, United States
(Hattler, Grover) School of Medicine at the Anschutz Medical Campus,
University of Colorado, Aurora, CO, United States
(Shroyer) Research and Development Office, Northport Veterans Affair
Medical Center, Northport, NY, United States
(Shroyer) Research and Development Office, Eastern Colorado Health Care
System, Department of Veterans Affairs, Denver, CO, United States
(Kemp, Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Almassi) Surgical Services, Zablocki Veterans Affairs Medical Center,
Milwaukee, WI, United States
(Almassi) Department of Surgery, Division of Cardiothoracic Surgery,
Medical College of Wisconsin, Milwaukee, WI, United States
(Bakaeen) Pittsburgh VA Medical Center, Pittsburgh, PA, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Carr, Bishawi) Research and Development Office, Northport Veterans
Affairs Medical Center, Northport, NY, United States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, MN,
United States
(Bishawi) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, NC, United States
(Grover) Department of Surgery, Veterans Affairs Eastern Colorado Health
Care System, Denver, CO, United States
(Wagner) Veterans Affairs Palo Alto Health Economics Resource Center,
Menlo Park, CA, United States
(Wagner) Department of Surgery, Stanford University, Stanford, CA, United
States
Title
Concordance between administrative data and clinical review for mortality
in the randomized on/off bypass follow-up study (ROOBY-FS).
Source
Journal of Cardiac Surgery. 32 (12) (pp 751-756), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The optimal methodology to identify cardiac versus non-cardiac
cause of death following cardiac surgery has not been determined. Methods:
The Randomized On/Off Bypass Trial was a multicenter, randomized,
controlled clinical trial of 2203 patients (February 2002-May 2008)
comparing 1-year cardiac outcomes between off-pump and on-pump bypass
surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program
funded a follow-up study to assess 5-year outcomes including mortality.
Deaths were identified and confirmed using the National Death Index (NDI),
VA Vital Status file, and medical records. An Endpoints Committee (EC)
reviewed patient medical records and classified each cause of death as
cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI
death certificates were independently used to classify deaths as cardiac
or non-cardiac. Cause of death was compared between the NDI and EC
classifications and concordance measured, using Kappa statistics. Results:
Of the 297 5-year deaths identified by the NDI and/or VA vital status file
and confirmed by the EC, 219 had adequate patient records for EC cause of
death determination. The EC adjudicated 141 of these deaths as non-cardiac
and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as
cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). Conclusions: Since
concordance between EC and NDI cause of death classifications was only
moderate, caution should be exercised in relying exclusively on NDI data
to determine cause of death. A hybrid approach, integrating multiple
information sources, may provide the most accurate approach to classifying
cause of death.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<37>
Accession Number
615318675
Author
Hoshijima H.; Denawa Y.; Mihara T.; Takeuchi R.; Kuratani N.; Mieda T.;
Iwase Y.; Shiga T.; Wajima Z.; Nagasaka H.
Institution
(Hoshijima, Takeuchi, Mieda, Iwase, Nagasaka) Department of
Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama,
Japan
(Denawa) Department of Anesthesiology, Allegheny Health Network, PA,
United States
(Mihara) Departments of Anesthesiology and Critical Care Medicine,
Yokohama City University Graduate School of Medicine, Yokohama, Japan
(Kuratani) Department of Anesthesiology, Saitama Children's Medical
Center, Saitama, Japan
(Shiga) Department of Anesthesia, Chemotherapy Research Institute, Kaken
Hospital, International University of Health and Welfare, Chiba, Japan
(Wajima) Department of Anesthesiology, International University of Health
and Welfare Shioya Hospital, Tochigi, Japan and Department of
Anesthesiology, International University of Health and Welfare Hospital,
Tochigi, Japan
(Wajima) Department of Anesthesiology, Tokyo Medical University, Hachioji
Medical Center, Tokyo, Japan
Title
Efficacy of prophylactic doses of intravenous nitroglycerin in preventing
myocardial ischemia under general anesthesia: A systematic review and
meta-analysis with trial sequential analysis.
Source
Journal of Clinical Anesthesia. 40 (pp 16-22), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective To evaluate the efficacy of intravenous nitroglycerin
(TNG) in preventing intraoperative myocardial ischemia (MI) under general
anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate
(HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure
(PCWP) associated with TNG administration both before and after the
induction of anesthesia. Design Meta-analysis. Setting Operating room,
cardiac surgery or non-cardiac surgery, all surgeries were elective
measurements. We performed a computerized search of articles on PubMed,
Scopus, and the Cochrane Central Register of Controlled Trials.
Meta-analysis was performed using Review Manager. The data from the
individual trials were combined using a random-effects model to calculate
either the pooled relative risk (RR) or the weighted mean difference (WMD)
with 95% confidence interval (CI). We conducted trial sequential analysis
(TSA). The primary outcome was the incidence of MI and the secondary
outcomes were hemodynamic changes (HR, MBP, and PCWP). Main Results Using
electronic databases, we selected 10 trials with a total of 353 patients
for our review. Prophylactic intravenous TNG did not significantly
decrease the incidence of MI (RR = 0.61; CI, 0.33 to 1.13; P = 0.12;
I² = 55). TSA corrected the CI to 0.05 to 7.39 and showed that
9.5% of the required information size was achieved. In terms of
hemodynamic changes, intravenous TNG significantly reduced MBP in
comparison with the placebo (MBP pre-induction: WMD = - 7.27; 95% CI -
14.2 to - 0.33; P = 0.04; I² = 97%; MBP post-induction: WMD = -
5.13; 95% CI - 9.17 to - 1.09; P = 0.01; I² = 73%). Conclusions
Our analyses showed that prophylactic intravenous TNG does not reduce the
incidence of intraoperative MI. Moreover, TSA suggests that further
studies are necessary to confirm the results (GRADE: very low).
Prophylactic doses of intravenous TNG significantly reduced the MBP both
pre and post anesthesia induction (GRADE: very low).<br/>Copyright &#xa9;
2017 Elsevier Inc.

<38>
Accession Number
617838285
Author
Stopyra J.P.; Miller C.D.; Hiestand B.C.; Lefebvre C.W.; Nicks B.A.; Cline
D.M.; Askew K.L.; Riley R.F.; Russell G.B.; Hoekstra J.W.; Mahler S.A.
Institution
(Stopyra, Miller, Hiestand, Lefebvre, Nicks, Cline, Askew, Hoekstra,
Mahler) Department of Emergency Medicine, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Russell) Department of Biostatistical Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Riley) Division of Cardiology, University of Washington, Seattle, WA,
United States
Title
Validation of the No Objective Testing Rule and Comparison to the HEART
Pathway.
Source
Academic Emergency Medicine. 24 (9) (pp 1165-1168), 2017. Date of
Publication: September 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The no objective testing rule (NOTR) is a decision aid
designed to safely identify emergency department (ED) patients with chest
pain who do not require objective testing for coronary artery disease.
Objectives: The objective was to validate the NOTR in a cohort of U.S. ED
patients with acute chest pain and compare its performance to the HEART
Pathway. Methods: A secondary analysis of 282 participants enrolled in the
HEART Pathway randomized controlled trial was conducted. Each patient was
classified as low risk or at risk by the NOTR. Sensitivity for major
adverse cardiac events (MACE) at 30 days was calculated in the entire
study population. NOTR and HEART Pathways were compared among patients
randomized to the HEART Pathway in the parent trial using McNemar's test
and the net reclassification improvement (NRI). Results: Major adverse
cardiac events occurred in 22/282 (7.8%) participants, including no
deaths, 16/282 (5.6%) with myocardial infarction (MI), and 6/282 (2.1%)
with coronary revascularization without MI. NOTR was 100% (95% confidence
interval [CI] = 84.6%-100%) sensitive for MACE and identified 78/282
patients (27.7%, 95% = CI 22.5-33.3%) as low risk. In the HEART Pathway
arm (n = 141), both NOTR and HEART Pathway identified all patients with
MACE as at risk. Compared to NOTR, the HEART Pathway was able to correctly
reclassify 27 patients without MACE as low risk, yielding a NRI of 20.8%
(95% CI = 11.3%-30.2%). Conclusions: Within a U.S. cohort of ED patients
with chest pain, the NOTR and HEART Pathway were 100% sensitive for MACE
at 30 days. However, the HEART Pathway identified more patients suitable
for early discharge than the NOTR.<br/>Copyright &#xa9; 2017 by the
Society for Academic Emergency Medicine

<39>
Accession Number
615953030
Author
Vaquero Roncero L.M.; Sanchez Poveda D.; Valdunciel Garcia J.J.; Sanchez
Barrado M.E.; Calvo Vecino J.M.
Institution
(Vaquero Roncero, Sanchez Poveda, Valdunciel Garcia, Sanchez Barrado,
Calvo Vecino) Service of Anesthesiology, Reanimation and Pain Medicine,
Complejo Asistencial Universitario de Salamanca, CAUSA, Spain
Title
Perioperative use of angiotensin-converting-enzyme inhibitors and
angiotensin receptor antagonists.
Source
Journal of Clinical Anesthesia. 40 (pp 91-98), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Clinical repercussions of perioperative treatment with
ACEIs/ARBs. Design Systematic review according to PRISMA statement.
Setting Perioperative period. Patients 29 studies 11 cases/cases series,
12 observational studies and 6 randomized studies. Measurements Arterial
blood pressure differences, refractory hypotension, other comorbidities.
Main results The studies show different results regarding the topics
measured. They are divided in the results regarding blood pressure, long
term morbidities and effects in neuraxial anesthesia. Conclusions
Withholding AECI/ARBs on the morning prior to surgery could be recommended
as a potentially effective measure, with a low level of evidence, in order
to reduce the appearance of hypotension in the perioperative period of
non-cardiac surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<40>
Accession Number
619012736
Author
Ezhov M.V.; Afanasieva O.I.; Il'ina L.N.; Safarova M.S.; Adamova I.Y.;
Matchin Y.G.; Konovalov G.A.; Akchurin R.S.; Pokrovsky S.N.
Institution
(Ezhov, Afanasieva, Il'ina, Safarova, Adamova, Matchin, Akchurin,
Pokrovsky) Cardiology Research Center, 3rd Cherepkovskaya Street, 15a,
Moscow 121552, Russian Federation
(Konovalov) MEDSI Clinic, Georgian Lane, 3a, Moscow 123056, Russian
Federation
Title
Association of lipoprotein(a) level with short- and long-term outcomes
after CABG: The role of lipoprotein apheresis.
Source
Atherosclerosis Supplements. 30 (pp 187-192), 2017. Date of Publication:
November 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To evaluate the association of lipoprotein(a) [Lp(a)] level with
short- and long-term outcomes after coronary artery bypass grafting (CABG)
and to assess the effect of a 12 month course of weekly lipoprotein
apheresis on vein graft patency and coronary atherosclerosis course in
post-CABG patients with hyperlipidemia. Methods This study was performed
in patients after successful CABG and consisted of three parts: a) a
retrospective part with computed tomography assessment of vein graft
patency in patients with first-year recurrence of chest pain after CABG (n
= 102); b) a prospective trial with evaluation of cardiovascular outcomes
during follow up time up to 15 years in relation to baseline Lp(a) levels
(n = 356); c) an 12-months interventional controlled study in 50 patients
with low-density lipoprotein cholesterol (LDL-C) levels >2.6 mmol/L prior
to the operation despite statin treatment that allocated into 2 groups:
active (n = 25, weekly apheresis by cascade plasma filtration (CPF) plus
atorvastatin), and control (n = 25, atorvastatin alone). Results Patients
subjected to computed tomography were divided in two groups: 66 (65%) with
at least one vein graft occlusion and 36 (35%) without occlusions. Lp(a)
levels were significantly higher in patients with occluded grafts with a
median (95% confidence intervals (CI)) of 24 (17-42) mg/dL vs. 12 (6-24)
mg/dL in patients with patent grafts, p < 0.01. Over a mean of 8.5 +/- 3.5
years (range 0.9-15.0 years), the primary and secondary endpoints were
registered in 46 (13%) and 107 (30%) patients, respectively. Patients with
Lp(a) >=30 mg/dL were at significantly greater risk for the primary
endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03,
p < 0.001) and secondary endpoint (HR 3.47, 95%CI 2.48-4.85, p < 0.001)
than patients with Lp(a) values <30 mg/dL. During the CPF procedure LDL-C
levels decreased by 59 +/- 14%, Lp(a) levels by 49 +/- 15. The frequency
of vein graft occlusions at study end was 14.3% (11 of 77) in the
apheresis group and 27.4% (23 of 84) in the control group, p < 0.05.
Progression of atherosclerosis was obtained in 26 (14.2%) segments of
native coronary arteries in the apheresis group and in 50 (25.0%) segments
of the control group. Regression signs were found in 30 (16.4%) and 19
(9.5%) segments, stabilization in 127 (69.4%) and 131 (65.5%) segments,
respectively (chi² = 9.37, p < 0.01). A Lp(a) level higher than
30 mg/dL was associated with a three-fold increased risk of vein grafts
occlusion during first year after CABG, p < 0.001. Conclusion Our data
suggest that elevated Lp(a) is associated with a significantly increasing
rate of one-year vein graft occlusions and adverse long-term
cardiovascular outcomes whereas the use of lipoprotein apheresis improves
vein graft patency during the first year after CABG.<br/>Copyright &#xa9;
2017 Elsevier B.V.

<41>
Accession Number
615411194
Author
Zhai M.; Kang F.; Han M.; Huang X.; Li J.
Institution
(Zhai, Li) School of Medicine, Shandong University, Ji nan, Shandong,
China
(Zhai, Kang, Han, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
Title
The effect of dexmedetomidine on renal function in patients undergoing
cardiac valve replacement under cardiopulmonary bypass: A double-blind
randomized controlled trial.
Source
Journal of Clinical Anesthesia. 40 (pp 33-38), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective We attempted to explore the effect of Dex on renal
function in patients with cardiac valve replacement under cardiopulmonary
bypass (CPB). Design We designed a prospective, randomized,
placebo-controlled, single-center, parallel-arm double-blind trial.
Setting Operating room. Patients Seven-two eligible patients were randomly
divided into Dex group and placebo group. Interventions Dexmedetomidine
(Dex) (0.6 mug.kg^{- 1}) was administered in patients of Dex group
at 15 min before anesthesia induction, followed by a treatment of 0.2
mug.kg^{- 1}.h^{- 1} Dex until the end of operation.
Patients in placebo group were treated with normal saline equally.
Measurements The levels of serum urea nitrogen (BUN), creatinine (Cr),
neutrophil gelatinase-associated lipocalin (NGAL), urine interleukin-8
(IL-18) and superoxide dismutase (SOD) activity were tested before
anesthesia induction (T1) and after operation at 0, 12 h, 24 h and 72 h
(T2-5). The urine output during operation and the post-operative
complication of acute kidney injury (AKI) were recorded. Main results The
levels of BUN and Cr were significantly increased at T5, and similar
findings were found in the levels of NGAL and urine IL-18 at T3 and T4.
The SOD activity was significantly declined at T2 and T3 in the two
groups. The levels of BUN and Cr at T5 and the NGAL level at T3 and T4
were significantly lower in Dex group, comparable to placebo group. The
intraoperative urine output was significantly increased and the
postoperative incidence of AKI was significantly lower in Dex group.
Conclusions Dex may attenuate the renal injury and decrease the incidence
of AKI in patients undergoing cardiac valve replacement under
CPB.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<42>
Accession Number
619391736
Author
Daimee U.A.; Vermilye K.; Rosero S.; Schuger C.D.; Daubert J.P.; Zareba
W.; McNitt S.; Polonsky B.; Moss A.J.; Kutyifa V.
Institution
(Daimee, Vermilye, Rosero, Zareba, McNitt, Polonsky, Moss, Kutyifa) Heart
Research Follow-Up Program, University of Rochester Medical Center,
Rochester, NY, United States
(Schuger) Division of Cardiology, Henry Ford Hospital, Detroit, MI, United
States
(Daubert) Cardiology Division, Duke University Medical Center, Durham, NC,
United States
Title
Heart failure severity, inappropriate ICD therapy, and novel ICD
programming: a MADIT-RIT substudy.
Source
PACE - Pacing and Clinical Electrophysiology. 40 (12) (pp 1405-1411),
2017. Date of Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The effects of heart failure (HF) severity on risk of
inappropriate implantable cardioverter-defibrillator (ICD) therapy have
not been thoroughly investigated. We aimed to study the association
between HF severity and inappropriate ICD therapy in MADIT-RIT. Methods:
MADIT-RIT randomized 1,500 patients to three ICD programming arms:
conventional (Arm A), high-rate cut-off (Arm B: >=200 beats/min), and
delayed therapy (Arm C: 60-second delay for >=170 beats/min). We evaluated
the association between New York Heart Association (NYHA) class III (n =
256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A
patients with ICD-only and cardiac resynchronization therapy with
defibrillator (CRT-D). We additionally assessed benefit of novel ICD
programming in Arms B and C versus Arm A by NYHA classification. Results:
In Arm A, the risk of inappropriate therapy was significantly higher in
those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] =
2.55, confidence interval [CI]: 1.51-4.30, P < 0.001) and CRT-D patients
(HR = 3.73, CI: 1.14-12.23, P = 0.030). This was consistent for
inappropriate ATP and inappropriate ICD therapy < 200 beats/min, but not
for inappropriate shocks. Novel ICD programming significantly reduced
inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR =
0.08, P < 0.001; Arm C vs Arm A: HR = 0.17, P < 0.001) and NYHA I-II (Arm
B vs Arm A: HR = 0.25, P < 0.001; Arm C vs Arm A: HR = 0.28, P < 0.001).
Conclusion: Patients with more severe HF are at increased risk for
inappropriate ICD therapy, particularly ATP due to arrhythmias < 200
beats/min. Novel programming with high-rate cut-off or delayed detection
reduces inappropriate ICD therapies in both mild and moderate
HF.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<43>
Accession Number
616381451
Author
El Dib R.; Guimaraes Pereira J.E.; Agarwal A.; Gomaa H.; Ayala A.P.; Botan
A.G.; Braz L.G.; de Oliveira L.D.; Lopes L.C.; Mathew P.J.
Institution
(El Dib, Botan, de Oliveira) Institute of Science and Technology, Unesp -
Univ Estadual Paulista, Sao Jose dos Campos, Sao Paulo, Brazil
(El Dib, Guimaraes Pereira, Braz) Department of Anaesthesiology, Botucatu
Medical School, Unesp - Univ Estadual Paulista, Botucatu, Sao Paulo,
Brazil
(El Dib) McMaster Institute of Urology, McMaster University, Hamilton,
Ontario, Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Canada
(Gomaa) Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
(Ayala) Gerstein Science Information Centre, University of Toronto,
Toronto, Canada
(Lopes) Pharmaceutical Science Graduate Course, University of Sorocaba,
Sao Paulo, Brazil
(Mathew) Department of Anaesthesia and Intensive Care, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Title
Inhalation versus intravenous anaesthesia for adults undergoing on-pump or
off-pump coronary artery bypass grafting: A systematic review and
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 40 (pp 127-138), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective To compare the use of inhalation versus intravenous
anaesthesia for adults undergoing on-pump or off-pump coronary artery
bypass grafting. Design A systematic review. Setting A hospital-affiliated
university. Measurements The following databases were searched: the
Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10),
MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the
GRADE approach to rate overall certainty of the evidence. Results In total
we included 58 studies with a total of 6105 participants. The
methodological quality was difficult to assess as it was poorly reported
in 35 included studies (three or more domains were rated as unclear risk
of bias). Two trials of sevoflurane showed a statistically significant
reduction in death within 180 to 365 days of surgery (on-pump) (RR 4.10,
95% CI 1.42 to 11.79; p = 0.009; I² = not applicable; high
quality of evidence). There was also a statistically significant
difference favouring sevoflurane compared to propofol on both inotropic
(RR 2.11, 95% CI 1.53 to 2.90; p < 0.00001; I² = 0%) and
vasoconstrictor support needed (RR 1.51, 95% CI 1.04 to 2.22; p = 0.03;
I² = 0%) after coronary artery bypass grafting on-pump. Two
trials of sevoflurane (MD - 0.22, 95% CI - 0.41 to - 0.03; p = 0.02;
I² = 0%) and two further trials of desflurane (MD - 0.33, 95%
CI - 0.45 to - 0.20; p < 0.00001; I² = 82%) showed a
statistically significant difference on cardiac index during and after
coronary artery bypass grafting on-pump, respectively. Conclusions There
is high quality evidence that sevoflurane reduces death within 180 to 365
days of surgery and, inotropic and vasoconstrictor support compared to
propofol for patients undergoing coronary artery bypass grafting. There is
also some evidence showing that the cardiac index is minimally influenced
by administration of sevoflurane and desflurane compared to
propofol.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<44>
Accession Number
617557334
Author
Stehouwer M.C.; de Vroege R.; Hoohenkerk G.J.F.; Hofman F.N.; Kelder J.C.;
Buchner B.; de Mol B.A.; Bruins P.
Institution
(Stehouwer) Department of Extracorporeal Circulation, St Antonius
Hospital, Nieuwegein, Netherlands
(de Vroege, Buchner) Department of Extracorporeal Circulation, HAGA
Hospital, The Hague, Netherlands
(Hoohenkerk) Department of Cardiothoracic Surgery, HAGA Hospital, The
Hague, Netherlands
(Hofman) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(de Mol) Section Cardiovascular Biomechanics, Faculty of Biomedical
Technology, University of Technology, Eindhoven, Netherlands
(Bruins) Department of Anaesthesiology, Intensive Care and Pain
Management, St Antonius Hospital, Nieuwegein, Netherlands
Title
Carbon Dioxide Flush of an Integrated Minimized Perfusion Circuit Prior to
Priming Prevents Spontaneous Air Release Into the Arterial Line During
Clinical Use.
Source
Artificial Organs. 41 (11) (pp 997-1003), 2017. Date of Publication:
November 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Recently, an oxygenator with an integrated centrifugal blood pump (IP) was
designed to minimize priming volume and to reduce blood foreign surface
contact even further. The use of this oxygenator with or without
integrated arterial filter was compared with a conventional oxygenator and
nonintegrated centrifugal pump. To compare the air removal characteristics
60 patients undergoing coronary artery bypass grafting were alternately
assigned into one of three groups to be perfused with a minimized
extracorporeal circuit either with the conventional oxygenator, the
oxygenator with IP, or the oxygenator with IP plus integrated arterial
filter (IAF). Air entering and leaving the three devices was measured
accurately with a bubble counter during cardiopulmonary bypass. No
significant differences between all groups were detected, considering air
entering the devices. Our major finding was that in both integrated
devices groups incidental spontaneous release of air into the arterial
line in approximately 40% of the patients was observed. Here, detectable
bolus air (>500 micro&#32;m) was shown in the arterial line, whereas in
the minimal extracorporeal circulation circuit (MECC) group this
phenomenon was not present. We decided to conduct an amendment of the
initial design with METC-approval. Ten patients were assigned to be
perfused with an oxygenator with IP and IAF. Importantly, the integrated
perfusion systems used in these patients were flushed with carbon dioxide
(CO<inf>2</inf>) prior to priming of the systems. In the group with
CO<inf>2</inf> flush no spontaneous air release was observed in all cases
and this was significantly different from the initial study with the group
with the integrated device and IAF. This suggests that air spilling may be
caused by residual air in the integrated device. In conclusion,
integration of a blood pump may cause spontaneous release of large air
bubbles (>500 micro&#32;m) into the arterial line, despite the presence of
an integrated arterial filter. CO<inf>2</inf> flushing of an integrated
cardiopulmonary bypass system prior to priming may prevent spontaneous air
release and is strongly recommended to secure patient
safety.<br/>Copyright &#xa9; 2017 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<45>
Accession Number
611333295
Author
Long K.H.; Moriarty J.P.; Ransom J.E.; Lennon R.J.; Mathew V.; Gulati R.;
Sandhu G.S.; Rihal C.S.
Institution
(Long) Health Economics Consulting LLC, 855 Village Center Dr #111, St.
Paul, MN 55127, United States
(Moriarty) Division of Health Care Policy and Research, College of
Medicine, Mayo Clinic, Rochester, MN, United States
(Ransom, Lennon) Division of Biomedical Statistics and Informatics,
College of Medicine, Mayo Clinic, Rochester, MN, United States
(Mathew, Gulati, Sandhu, Rihal) Department of Cardiovascular Diseases,
College of Medicine, Mayo Clinic, Rochester, MN, United States
(Mathew) Department of Radiology, College of Medicine, Mayo Clinic,
Rochester, MN, United States
Title
Economic and clinical impact of routine weekend catheterization services.
Source
American Journal of Managed Care. 22 (7) (pp e233-e240), 2016. Date of
Publication: July 2016.
Publisher
Ascend Media (E-mail: medentcirc@ascendmedia.com)
Abstract
Objectives: To assess the impact of weekend cardiac catheterization (cath)
services for nonemergent inpatients. Study Design: Retrospective cohort
study of patients undergoing cath before and after Saturday cath service
availability (CSA). Methods: Cohorts included Friday and Saturday
admissions with cath (with or without revascularization) on the subsequent
Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and
Friday or Saturday admissions undergoing cath the subsequent or same
Saturday from January 1, 2009, to December 31, 2010 (post-CSA events).
Administrative and registry data provided demographics, comorbidities,
percutaneous coronary intervention (PCI) details, adverse events, hospital
length of stay (LOS), and inpatient expenditures. We used generalized
linear modeling to predict LOS and costs, and logistic regression to
estimate the likelihood of adverse events during follow-up. Results: We
identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243
patients). Cohorts were similar in age (66 years), sex (59% male), and
level of comorbidity. PCI use was higher following CSA (42% vs 26%; P
<.001), with procedural success accomplished in 95% and 94% of pre- and
post-CSA patients, respectively. Adjusted clinical outcomes were similar
(odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P =
.55; OR for 30-day revascularization, 1.14; P = .68). Models predict an
average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001)
yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of
difference, -$3611 to $3576). Conclusions: Weekend CSA for routine
inpatients was clinically safe and effective, and reduced hospital LOS.
Similar inpatient costs likely reflect a shift in case mix in this
nonrandomized study.<br/>Copyright &#xa9; 2016, Ascend Media. All rights
reserved.

<46>
Accession Number
613091822
Author
Anonymous
Title
Association of the magnitude of weight loss and changes in physical
fitness with long-term cardiovascular disease outcomes in overweight or
obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD
randomised clinical trial.
Source
The Lancet Diabetes and Endocrinology. 4 (11) (pp 913-921), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Findings from the Look AHEAD trial showed no significant
reductions in the primary outcome of cardiovascular disease incidence in
adults with type 2 diabetes randomly assigned to an intensive lifestyle
intervention for weight loss compared with those randomly assigned to
diabetes support and education (control). We examined whether the
incidence of cardiovascular disease in Look AHEAD varied by changes in
weight or fitness. Methods Look AHEAD was a randomised clinical trial done
at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to
April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76
years with type 2 diabetes were assigned (1:1) to an intensive lifestyle
intervention or diabetes support and education. In this observational,
post-hoc analysis, we examined the association of magnitude of weight loss
and fitness change over the first year with incidence of cardiovascular
disease. The primary outcome of the trial and of this analysis was a
composite of death from cardiovascular causes, non-fatal acute myocardial
infarction, non-fatal stroke, or admission to hospital for angina. The
secondary outcome included the same indices plus coronary artery bypass
grafting, carotid endartectomy, percutaneous coronary intervention,
hospitalisation for congestive heart failure, peripheral vascular disease,
or total mortality. We adjusted analyses for baseline differences in
weight or fitness, demographic characteristics, and risk factors for
cardiovascular disease. The Look AHEAD trial is registered with
ClinicalTrials.gov, number NCT00017953. Findings For the analyses related
to weight change, we excluded 311 ineligible participants, leaving a
population of 4834; for the analyses related to fitness change, we
excluded 739 participants, leaving a population of 4406. In analyses of
the full cohort (ie, combining both study groups), over a median 10.2
years of follow-up (IQR 9.5-10.7), individuals who lost at least 10% of
their bodyweight in the first year of the study had a 21% lower risk of
the primary outcome (adjusted hazard ratio [HR] 0.79, 95% CI 0.64-0.98;
p=0.034) and a 24% reduced risk of the secondary outcome (adjusted HR
0.76, 95% CI 0.63-0.91; p=0.003) compared with individuals with stable
weight or weight gain. Achieving an increase of at least 2 metabolic
equivalents in fitness change was associated with a significant reduction
in the secondary outcome (adjusted HR 0.77, 95% CI 0.61-0.96; p=0.023) but
not the primary outcome (adjusted HR 0.78, 0.60-1.03; p=0.079). In
analyses treating the control group as the reference group, participants
in the intensive lifestyle intervention group who lost at least 10% of
their bodyweight had a 20% lower risk of the primary outcome (adjusted HR
0.80, 95% CI 0.65-0.99; p=0.039), and a 21% lower risk of the secondary
outcome (adjusted HR 0.79, 95% CI 0.66-0.95; p=0.011); however, change in
fitness was not significantly associated with a change in the primary
outcome. Interpretation The results of this post-hoc analysis of Look
AHEAD suggest an association between the magnitude of weight loss and
incidence of cardiovascular disease in people with type 2 diabetes. These
findings suggest a need to continue to refine approaches to identify
individuals who are most likely to benefit from lifestyle interventions
and to develop strategies to improve the magnitude of sustained weight
loss with lifestyle interventions. Funding US National Institute of
Diabetes and Digestive and Kidney Diseases.<br/>Copyright &#xa9; 2016
Elsevier Ltd

<47>
Accession Number
613438639
Author
Morche J.; Mathes T.; Pieper D.
Institution
(Morche) The University Hospital of Cologne (AoR), Institute of Health
Economics and Clinical Epidemiology, Gleueler Str. 176-178, Cologne 50935,
Germany
(Mathes, Pieper) Witten/Herdecke University, Faculty of Health, School of
Medicine, Institute for Research in Operative Medicine, Ostmerheimer Str.
200, Building 38, Cologne 51109, Germany
Title
Relationship between surgeon volume and outcomes: A systematic review of
systematic reviews.
Source
Systematic Reviews. 5 (1) (no pagination), 2016. Article Number: 204. Date
of Publication: 29 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The surgeon volume-outcome relationship has been discussed for
many years and its existence or nonexistence is of importance for various
reasons. A lot of empirical work has been published on it. We aimed to
summarize systematic reviews in order to present current evidence.
Methods: Medline, Embase, Cochrane database of systematic reviews (CDSR),
and health technology assessment websites were searched up to October 2015
for systematic reviews on the surgeon volume-outcome relationship. Reviews
were critically appraised, and results were extracted and synthesized by
type of surgical procedure/condition. Results: Thirty-two reviews
reporting on 15 surgical procedures/conditions were included.
Methodological quality of included systematic reviews assessed with the
assessment of multiple systematic reviews (AMSTAR) was generally moderate
to high albeit included literature partly neglected considering
methodological issues specific to volume-outcome relationship. Most
reviews tend to support the presence of a surgeon volume-outcome
relationship. This is most clear-cut in colorectal cancer, bariatric
surgery, and breast cancer where reviews of high quality show large
effects. Conclusions: When taking into account its limitations, this
overview can serve as an informational basis for decision makers. Our
results seem to support a positive volume-outcome relationship for most
procedures/conditions. However, forthcoming reviews should pay more
attention to methodology specific to volume-outcome relationship. Due to
the lack of information, any numerical recommendations for minimum volume
thresholds are not possible. Further research is needed for this
issue.<br/>Copyright &#xa9; 2016 The Author(s).

<48>
Accession Number
620425472
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) The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou 510120, China
(Yang) 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 (pp 6082430), 2017. Date of
Publication: 2017.
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.

<49>
Accession Number
620423241
Author
Staveski S.; Abrajano C.; Casazza M.; Bair E.; Quan H.; Dong E.; Petty A.;
Felix K.; Roth S.J.
Institution
(Staveski, Abrajano, Casazza, Bair, Quan, Dong, Petty, Felix, Roth) Sandra
Staveski is an assistant professor, Research in Patient Services,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Claire
Abrajano, May Casazza, and Ellen Bair are nurse practitioners and Hanson
Quan, Emily Dong, Amy Petty, and Katie Felix are cardiovascular surgery
physician assistants, Lucile Packard Children's Hospital Stanford,
Stanford University Medical Center, Palo Alto, California. Stephen J. Roth
is a professor, Department of Pediatrics, and chief, Division of Pediatric
Cardiology, at the Stanford University School of Medicine. He is a
pediatric cardiac intensivist and director, Children's Heart Center, at
Lucile Packard Children's Hospital Stanford
Title
Silver-Impregnated Dressings for Sternotomy Incisions to Prevent Surgical
Site Infections in Children.
Source
American journal of critical care : an official publication, American
Association of Critical-Care Nurses. 25 (5) (pp 402-408), 2016. Date of
Publication: 01 Sep 2016.
Abstract
BACKGROUND: The consequences of surgical site infections can be severe and
range from short-term delays in discharge from the hospital to
life-threatening infections such as mediastinitis.
OBJECTIVES: To evaluate the effectiveness of silver-impregnated dressings
in decreasing surgical site infections in children after cardiac surgery.
METHODS: A randomized, controlled trial was used to compare
silver-impregnated dressings (59 participants) with standard dressings (58
participants). The study team supervised all dressing changes after a
sternotomy and ensured adherence with the hospital's bundle for reduction
of surgical site infections. The ASEPSIS tool was used to evaluate sternal
wounds for evidence of infection.
RESULTS: The 2 groups had comparable Risk Adjustment for Congenital Heart
Surgery scores, age, sex, weight, height, operating room characteristics,
and number of chest tubes and/or pacemaker wires. No surgical site
infections occurred in any study participant. Infections did occur,
however, during the same period, in cardiac surgical patients who were not
enrolled in the study.
CONCLUSIONS: The evidence did not support the superiority of
silver-impregnated dressings for prevention of surgical site infections in
children after cardiac surgery. Adherence to a bundle for prevention of
surgical site infections may have decreased the incidence of such
infections in the study population during the study period.<br/>Copyright
&#xa9;2016 American Association of Critical-Care Nurses.

<50>
Accession Number
620406275
Author
Xu Y.; Li Y.; Bao W.; Qiu S.
Institution
(Xu, Li, Bao, Qiu) Department of Cardiovascular Surgery, The Second
Hospital of Shandong University, Jinan, Shandong 250033, China
Title
Protective effects of recombinant human brain natriuretic peptide in
perioperative period during open heart surgery.
Source
Experimental and Therapeutic Medicine. 15 (3) (pp 2869-2873), 2018. Date
of Publication: March 2018.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The aim of the present study was to evaluate the protective effects and
safety aspects of recombinant human brain natriuretic peptide (rhBNP) on
cardiac functions of patients undergoing open-heart surgery during
perioperative period. In total, 150 patients undergoing open heart surgery
in the Second Hospital of Shandong Universty from August 2015 to July 2016
were randomly divided into control group and observation group each with
75 cases. Patients in control group were treated by routine rehabilitation
while patients in the observation group were treated by both the routine
rehabilitation and rhBNP. All the observations were made before operation,
after operation and 7 days after operation. The changes of N-terminal
pro-brain natriuretic peptide (NT-proBNP) of patients, the left
ventricular ejection fraction (LVEF), cardiac function [Cardiac output
(CO), pulmonary capillary wedge pressure (PAWP) and central venous
pressure (CVP)] of patients were measured. Further, respirator support
time, ICU stay time, incidence of complications and vital signs (BP, HR,
SaO2) of patients in the two groups were also compared. NT-proBNP levels
of all patients improved after operation but it decreased in both groups
after 7 days of operation. The decrease of NT-proBNP levels in observation
group was significantly higher than that of control group. Whereas, LVEF,
CO, PAWP and CVP of patients in both the groups increased after operation
but effects were significantly higher in the observation group after 7
days of medication. Respirator support time and ICU stay time of patients
in observation group were significantly shorter than those in control
group, and the incidence of postoperative complications of patients in the
observation group were significantly lower than the control group.
Moreover, BP, HR and SaO2 of patients in observation group were
significantly elevated in comparison to control group (P<0.05).
Recombinant human brain natriuretic peptide (rhBNP) could significantly
improve the cardiac functions of patients after open heart surgery, and is
safe as well as reliable.<br/>Copyright &#xa9; 2018, Spandidos
Publications. All rights reserved.

<51>
Accession Number
620406133
Author
Zhou M.; Wang Q.; Zhang Q.; Liu Y.; Zhan L.; Shu A.
Institution
(Zhou, Wang, Zhang, Liu, Zhan, Shu) Department of Anesthesiology, The
People's Hospital of China Three Gorges University, The First People's
Hospital of Yichang, Yichang, Hubei 443000, China
Title
Application of pre-injection of dexmedetomidine of different doses in
pediatric intravenous general anesthesia without tracheal intubation.
Source
Experimental and Therapeutic Medicine. 15 (3) (pp 2973-2977), 2018. Date
of Publication: March 2018.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
This study observed the clinical efficacy of pre-injection of
dexmedetomidine of different doses before surgery and the adverse
reactions during the recovery period in pediatric intravenous general
anesthesia without tracheal intubation. Pediatric patients who received
general anesthesia without tracheal intubation before surgery from January
2016 to March 2017 were randomly divided into four groups (n=30), and were
respectively treated with intravenous pump infusion of loaded
dexmedetomidine of high-dose (2.5 mug/kg), middle-dose (1.5 mug/kg) and
low-dose (0.5 mug/kg), while the children in the control group received
injection of normal saline in same dose. Then, the mean arterial pressure
(MAP) at different time points (5 and 10 min after administration, after
anesthesia and after surgery), heart rate, Ramsay sedation score changes
and adverse reactions during recovery period of anesthesia of pediatric
patients were compared among four groups. At 5 and 10 min after
administration, Ramsay scores of high-dose group and middle-dose group
were higher than that of the control group, and the differences had
statistical significance (P<0.05). There was no significant difference in
comparison of Ramsay scores between low-dose group and the control group.
The MAP and heart rate after anesthesia and after surgery of pediatric
patients with pump infusion of dexmedetomidine in the three groups were
decreased significantly compared to those of the control group, and the
differences had statistical significance (P<0.05). The incidence rate of
adverse reaction of pediatric patients during the recovery period after
pump infusion in the three groups and the control group was,
respec-tively, 13/30, 8/30, 7/30 and 8/30, and the differences were
statistically significant (P<0.05). The sedative effect and safety of
pre-injection of dexmedetomidine in pediatric intravenous general
anesthesia without tracheal intubation are promising, and the medium
dosage can maximize the anesthetic effect with less side
effects.<br/>Copyright &#xa9; 2018, Spandidos Publications. All rights
reserved.

<52>
Accession Number
620454145
Author
Witberg G.; Lador A.; Yahav D.; Kornowski R.
Institution
(Witberg, Lador, Kornowski) Department of CardiologyRabin medical
centerPetach, Tikva Israel
(Witberg, Lador, Yahav, Kornowski) Sackler Faculty of MedicineTel-Aviv
universityTel, Aviv Israel
(Yahav) Infectious diseases unit, Rabin medical centerPetach, Tikva Israel
(Witberg, Lador) Guy Witberg and Adi Lador contributed equally to this
study
Title
Transcatheter versus surgical aortic valve replacement in patients at low
surgical risk: A meta-analysis of randomized trials and propensity score
matched observational studies.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although transcatheter aortic valve replacement (TAVR) is
officially indicated for high risk aortic stenosis (AS) patients, the
procedure is increasingly being performed in patients who are not at high
surgical risk, including a substantial number of low risk patients.
However, data on the benefit of TAVR in this patient population is
limited. Methods: We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) and observational studies with
propensity score matching (PSM) of TAVR versus surgical aortic valve
replacement (SAVR) in patients who are at low surgical risk. The primary
outcome was all-cause mortality. The secondary outcomes included stroke,
myocardial infarction, bleeding, and various procedural complications.
Results: Six studies (2 RCTs and 4 PSM studies) totaling 3,484 patients
were included. Follow-up ranged from 3 months to 3 years (median 2 years).
The short-term mortality was similar with either TAVR or SAVR (2.2% for
TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56-1.41, P=0.62), however, TAVR
was associated with increased risk for intermediate-term mortality (17.2%
for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11-1.89, P=0.006). In terms
of periprocedural complications, TAVR was associated with reduced risk for
bleeding and renal failure and an increase in vascular complications and
Pacemaker implantation. Conclusions: In patients who are at low surgical
risk, TAVR seems to be associated with increased mortality risk. Until
more data in this population is available, SAVR should remain the
treatment of choice for these patients.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<53>
Accession Number
620453952
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular SurgeryShizuoka Medical
CenterShizuoka Japan
(Ando) Department of CardiologyDetroit Medical CenterDetroit, Michigan
Title
Long-term survival after transcatheter versus surgical aortic valve
replacement for aortic stenosis: A meta-analysis of observational
comparative studies with a propensity-score analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To synthesize evidence regarding long-term survival after
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR) for severe aortic stenosis (AS) from real-world
clinical practice, we performed a meta-analysis of observational studies
with a propensity-score analysis and >=3-year follow-up. Methods:
Databases including MEDLINE and EMBASE were searched through April 2017
using PubMed and OVID. Eligible studies were observational comparative
studies with a propensity-score analysis of TAVI versus SAVR enrolling
patients with severe AS and reporting >=3-year all-cause mortality as an
outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of
follow-up (including early) mortality for TAVI versus SAVR was extracted
from each individual study. Results: Our search identified 14 eligible
studies enrolling a total of 4,197 patients. A pooled analysis of all the
14 studies demonstrated a statistically significant 54% increase in
mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for
effect<0.00001; P for heterogeneity=0.14; I²=30%). Several
sensitivity analyses did not substantially change the statistically
significant benefit for SAVR. There was no evidence of significant
publication bias. Conclusions: On the basis of a meta-analysis of 14
observational comparative studies with a propensity-score analysis
including a total of >=4,000 patients, TAVI is associated with worse
>=3-year overall survival than SAVR.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<54>
Accession Number
620308544
Author
Hernandez E.G.; Perez A.R.; Gilard J.F.; Alamo M.N.M.; Socorro M.E.;
Suarez P.R.; Esquinas A.M.
Institution
(Hernandez, Perez) Anesthesiology Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Gilard, Suarez) Thoracic Surgery Service, Hospital Universitario de Gran
Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
(Perez, Gilard) Department of Medical and Surgical Sciences, School of
Medicine, University of Las Palmas de Gran Canaria, Spain
(Alamo, Socorro) Physical Medicine and Rehabilitation Service, Hospital
Universitario de Gran Canaria, Doctor Negrin, Spain
(Esquinas) Intensive Care and Non Invasive Ventilatory Unit, Hopital
Morales Meseguer, Murcia, Spain
Title
Prophylactic use of non-invasive mechanical ventilation in lung resection.
Source
European Review for Medical and Pharmacological Sciences. 22 (1) (pp
190-198), 2018. Date of Publication: 2018.
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous
to lung resection and 17 hours postoperatively improves respiratory
function. In order to do this, we studied the results of arterial blood
gases and portable spirometry in the immediate postoperative period and at
the first and third postoperative day. Secondary objectives included
evaluating whether this same pattern decreases the incidence of
postoperative pulmonary complications (PPC) and hospital stay. PATIENTS
AND METHODS: This was a prospective, randomized clinical study. Between
January 2012 and June 2013, 50 patients who had undergone lung resection
with posterolateral thoracotomy were assigned to one of two groups by a
random number generator according to whether or not they would receive
prophylactic BiPAP pre- and postoperatively. RESULTS: The results of the
gasometric and spirometric values were similar in both groups. There were
no statistically significant differences (p > 0.05). There was not a
decrease in the incidence of PPC in the group that received prophylactic
BiPAP. Likewise, postoperative stay was similar in both groups. The BiPAP
group was 6.60 +/- 4 days and the non BiPAP group was 6.84 +/- 3.94 days
(p = 0.63). CONCLUSIONS: One drawback of this work was the limited number
of hours that BiPAP was employed, and when compared to other studies, the
application of low-pressure support. We did not find any significant
differences between using prophylactic BiPAP or not, suggesting that such
treatment should not be performed indiscriminately. More investigations
are needed with a larger number of patients in order to better evaluate
the possible benefits of using prophylactic BiPAP in thoracic surgery.

<55>
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.<br/>Copyright &#xa9; 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.

<56>
[Use Link to view the full text]
Accession Number
620336278
Author
Boese C.K.; Centeno L.; Walters R.W.
Institution
(Boese, Centeno, Walters) CHI Health Mercy Council Bluffs, Council Bluffs,
IA, United States
(Walters) Department of Medicine, Creighton University, Omaha, NE, United
States
Title
Blood Conservation Using Tranexamic Acid Is Not Superior to
Epsilon-Aminocaproic Acid after Total Knee Arthroplasty.
Source
Journal of Bone and Joint Surgery - American Volume. 99 (19) (pp
1621-1628), 2017. Date of Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) are
synthetic amino acid derivatives that interfere with fibrinolysis,
promoting hemostasis by pharmacological means. Although both drugs have
been shown to decrease blood loss with a minimal risk of thromboembolic
adverse events following cardiac and vascular surgery, we are aware of
only 1 published trial that directly compared the antifibrinolytic effects
of EACA with those of TXA after total knee arthroplasty (TKA). The primary
aim of this prospective, randomized, controlled trial was to determine
whether TXA provides superior blood conservation following TKA compared
with that provided by EACA. Methods: A total of 194 patients scheduled to
undergo a primary unilateral TKA in the same community-based hospital were
prospectively randomized to receive intravenous EACA (n = 96) or TXA (n =
98). Both the patients and the operating surgeons were blinded to the
treatment assignments. Primary outcome measures included transfusions,
estimated blood loss, and the drop in the hemoglobin (Hgb) level.
Secondary outcomes measures included the change in the serum creatinine
level, postoperative complications, and length of hospital stay. Results:
Although the patients who received TXA averaged less estimated blood loss
than the patients who received EACA (t<inf>185</inf> = 2.18, p = 0.031;
mean difference = 144.2 mL, 95% confidence interval = 13.62 to 274.78 mL),
no transfusions were required in either group. We observed no
statistically significant or clinically relevant between-group differences
in the change in Hgb or serum creatinine level, postoperative
complications, or length of hospital stay. Conclusions: Although the
estimated blood loss was significantly greater in the EACA group, no
transfusions were required and no significant between-group differences
were observed for any other outcomes measured. We concluded that EACA may
be an acceptable alternative to TXA for blood conservation following TKA,
although replication of our results in noninferiority trials is necessary.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a
complete description of levels of evidence.<br/>Copyright &#xa9;2017 BY
THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

<57>
Accession Number
620396849
Author
Gallouche M.; Barone-Rochette G.; Pavese P.; Bertrand B.; Vanzetto G.;
Bouvaist H.; Pierre I.; Schmitt D.; Fauconnier J.; Caspar Y.; Recule C.;
Picot-Gueraud R.; Stahl J.P.; Mallaret M.R.; Landelle C.
Institution
(Gallouche, Mallaret, Landelle) Hospital Hygiene Unit, Grenoble Alpes
University Hospital, Grenoble, France
(Barone-Rochette, Bertrand, Vanzetto, Bouvaist) Cardiology Unit, Grenoble
Alpes University Hospital, Grenoble, France
(Barone-Rochette, Vanzetto) INSERM U1039, Bioclinic Radiopharmaceutics
Laboratory, Grenoble, France
(Barone-Rochette, Vanzetto) French Alliance Clinical Trial, French
Clinical Research Infrastructure Network, Toulouse, France
(Pavese, Pierre, Stahl) Infectious Diseases Unit, Grenoble Alpes
University Hospital, Grenoble, France
(Schmitt) Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
(Fauconnier) Medical Information Department, Grenoble Alpes University
Hospital, Grenoble, France
(Fauconnier, Mallaret, Landelle) University Grenoble Alpes/CNRS, ThEMAS
TIM-C UMR 5525, Grenoble, France
(Caspar, Recule) Bacteriology Laboratory, Grenoble Alpes University
Hospital, Grenoble, France
(Picot-Gueraud) Interhospital Network for Prevention of Nosocomial
Infections, Grenoble Alpes University Hospital, Grenoble, France
Title
Incidence and prevention of infective endocarditis and bacteraemia after
transcatheter aortic valve implantation in a French university hospital: A
retrospective study.
Source
Journal of Hospital Infection. (no pagination), 2018. Date of Publication:
2018.
Publisher
W.B. Saunders Ltd
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation
(TAVI) is a rare but severe complication. Among 326 patients who underwent
TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11
(3.4%) cases of bacteraemia were identified. No cases of IE were linked to
the intervention; one was due to Staphylococcus aureus despite a screening
and targeted decolonization strategy. This underscores the need for
randomized studies to evaluate the benefit and cost-effectiveness of this
policy.<br/>Copyright &#xa9; 2017 The Healthcare Infection Society.

<58>
Accession Number
620395143
Author
Wang H.; Chen J.; Zhao L.
Institution
(Wang, Chen, Zhao) Department of Cardiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, China
Title
N-3 polyunsaturated fatty acids for prevention of postoperative atrial
fibrillation: updated meta-analysis and systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. (pp 1-11), 2018. Date
of Publication: 29 Jan 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background or purpose: N-3 polyunsaturated fatty acids (PUFA) have been
postulated to have an anti-arrhythmic effect on postoperative atrial
fibrillation (POAF), with conflicting results among studies. This study on
pooled data evaluated the effect of PUFA on POAF among patients undergoing
cardiac surgery. Methods: The Pubmed, EMBASE, and CENTRAL databases were
searched without restriction on language for randomized controlled trials
on the effect of PUFA on POAF that were published before August 31, 2017.
The incidence of POAF was extracted as primary endpoint. Pooled data were
assessed by using a random-effects model. Results: Out of 269 articles
identified, 14 studies with 3570 patients were eligible and included in
the meta-analysis. PUFA reduced incidence of POAF (RR 0.84 [95% CI
0.73-0.98], P = 0.03). The funnel plot and fail-safe number suggested
insignificant publication bias. In sensitivity and subgroup analyses, (1)
PUFA was effective in preventing POAF for eicosapentaenoic acid (EPA)/DHA
< 1 (0.51 [0.36-0.73], P = 0.0003) but not EPA/DHA > 1 or unknown; (2) the
efficacy in reducing POAF was apparent when placebo was usual care (0.59
[0.44-0.80], P = 0.0005), but not when placebo was non-fish oils; and (3)
PUFA reduced POAF after CABG (0.68 [0.47-0.97], P = 0.03), but not other
cardiac surgery. Conclusions: PUFA appears to reduce the incidence of
POAF. However, the said protective effect may be influenced by EPA/DHA
ratio, with < 1 appearing preferable. PUFA efficacy on POAF prevention
appeared insignificant when compared with non-fish oils and only apparent
in the setting of CABG alone. Further studies are needed to confirm the
effect of PUFA on POAF and to assess the proper use of PUFA against
POAF.<br/>Copyright &#xa9; 2018 Springer Science+Business Media, LLC, part
of Springer Nature