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<1>
Accession Number
620548208
Author
Bishawi M.; Hattler B.; Almassi G.H.; Spertus J.A.; Quin J.A.; Collins
J.F.; Grover F.L.; Shroyer A.L.
Institution
(Bishawi, Shroyer) Northport VA Medical Center, Northport, NY, United
States
(Bishawi) Duke University Medical Center, Durham, NC, United States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Denver VA
Medical Center, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Almassi) Clement J. Zablocki Veterans Affairs (VA) Medical Center,
Milwaukee, WI, United States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
(Spertus) Saint Luke's Mid America Heart Institute and University of
Missouri, Kansas City, MO, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Point, Perry, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA and Harvard Medical
School, Boston, MA, United States
Title
Preoperative factors associated with worsening in health-related quality
of life following coronary artery bypass grafting in the Randomized On/Off
Bypass (ROOBY) trial.
Source
American Heart Journal. 198 (pp 33-38), 2018. Date of Publication: April
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For advanced coronary disease, coronary artery bypass graft (CABG) surgery
generally improves patients' symptoms and long-term survival.
Unfortunately, some patients experience worse health-related quality of
life (HRQL) after CABG. The objective of this study is to report the
frequency and risk factors associated with 1-year post-CABG HRQL
deterioration. Methods: From 2002 to 2007, 2203 "Randomized On/Off Bypass"
(ROOBY) trial patients randomly received either off-pump or on-pump CABG
at 18 VA medical centers. Subjects completed both baseline and 1-year
Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR-36)
questionnaires to assess HRQL. Using previously published criteria, the
rates of clinically significant changes were determined for the SAQ
[angina frequency (AF), physical limitation (PL), and quality of life
(QoL)] and VR36 [mental component score (MCS) and physical component score
(PCS)] subscales. Multivariate regression models were then used to
identify pre-CABG patient characteristics associated with worsened 1-year
HRQL status for each subscale. Results: Over 80% of patients had an
improvement or no change in SAQ and VR-36 subscale scores 1 year after
CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8%
SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of
1-year HRQL deterioration were diabetes and smoking for the SAQ-AF;
diabetes, chronic obstructive pulmonary disease (COPD), and peripheral
vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL;
diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS.
The baseline score was an independent predictor for worsening in all the
subscales studied. Conclusions: Among VA patients, less than 20%
experienced worse HRQL 1 year after CABG. For patients with low symptom
burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior
stroke, clinicians should be more cautious in pre-CABG counseling as to
their anticipated HRQL improvements.<br/>Copyright &#xa9; 2018

<2>
Accession Number
620508711
Author
Garg A.X.; Shehata N.; McGuinness S.; Whitlock R.; Fergusson D.; Wald R.;
Parikh C.; Bagshaw S.M.; Khanykin B.; Gregory A.; Syed S.; Hare G.M.T.;
Cuerden M.S.; Thorpe K.E.; Hall J.; Verma S.; Roshanov P.S.; Sontrop J.M.;
Mazer C.D.
Institution
(Garg, Cuerden, Sontrop) London Health Sciences Centre, ON, Canada
(Shehata) Mount Sinai Hospital, University of Toronto, ON, Canada
(McGuinness) Cardiothoracic and Vascular Intensive Care Unit, Auckland,
New Zealand
(Whitlock) Population Health Research Institute, Hamilton, ON, Canada
(Fergusson) Ottawa Hospital Research Institute, ON, Canada
(Wald) St. Michael's Hospital, Toronto, ON, Canada
(Parikh) Yale University, New Haven, CT, United States
(Bagshaw) Department of Critical Care Medicine, University of Alberta,
Edmonton, Canada
(Khanykin) Rigshospitalet, Copenhagen University Hospital, Denmark
(Gregory) Foothills Medical Centre, University of Calgary, AB, Canada
(Syed, Roshanov) McMaster University, Hamilton, ON, Canada
(Hare, Hall, Verma, Mazer) St. Michael's Hospital, University of Toronto,
Ontario, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto, ON,
Canada
(Thorpe) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St. Michael's Hospital, Toronto, ON, Canada
Title
Risk of acute kidney injury in patients randomized to a restrictive versus
liberal approach to red blood cell transfusion in cardiac surgery: A
substudy protocol of the transfusion requirements in cardiac surgery III
noninferiority trial.
Source
Canadian Journal of Kidney Health and Disease. 5 (no pagination), 2018.
Date of Publication: 01 Jan 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: When safe to do so, avoiding blood transfusions in cardiac
surgery can avoid the risk of transfusion-related infections and other
complications while protecting a scarce resource and reducing costs. This
protocol describes a kidney substudy of the Transfusion Requirements in
Cardiac Surgery III (TRICS-III) trial, a multinational noninferiority
randomized controlled trial to determine whether the risk of major
clinical outcomes in patients undergoing planned cardiac surgery with
cardiopulmonary bypass is no greater with a restrictive versus liberal
approach to red blood cell transfusion. Objective: The objective of this
substudy is to determine whether the risk of acute kidney injury is no
greater with a restrictive versus liberal approach to red blood cell
transfusion, and whether this holds true in patients with and without
preexisting chronic kidney disease. Design and Setting: Multinational
noninferiority randomized controlled trial conducted in 73 centers in 19
countries (2014-2017). Patients: Patients (~4800) undergoing planned
cardiac surgery with cardiopulmonary bypass. Measurements: The primary
outcome of this substudy is perioperative acute kidney injury, defined as
an acute rise in serum creatinine from the preoperative value (obtained in
the 30-day period before surgery), where an acute rise is defined as
>=26.5 mumol/L in the first 48 hours after surgery or >=50% in the first 7
days after surgery. Methods: We will report the absolute risk difference
in acute kidney injury and the 95% confidence interval. We will repeat the
primary analysis using alternative definitions of acute kidney injury,
including staging definitions, and will examine effect modification by
preexisting chronic kidney disease (defined as a preoperative estimated
glomerular filtration rate [eGFR] <60 mL/min/1.73 m²).
Limitations: It is not possible to blind patients or providers to the
intervention; however, objective measures will be used to assess outcomes,
and outcome assessors will be blinded to the intervention assignment.
Results: Substudy results will be reported by the year 2018. Conclusions:
This substudy will provide generalizable estimates of the risk of acute
kidney injury of a restrictive versus liberal approach to red blood cell
transfusion in the presence of anemia during cardiac surgery done with
cardiopulmonary bypass. Trial Registration: www.clinicaltrials.gov;
clinical trial registration number NCT 02042898.<br/>Copyright &#xa9; The
Author(s) 2018.

<3>
Accession Number
619998937
Author
Lu Y.; Dai W.; Zong Z.; Xiao Y.; Wu D.; Liu X.; Chun Wong G.T.
Institution
(Lu, Dai, Zong, Xiao, Liu) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, China
(Wu) Department of Anesthesiology, Affiliated Fuyang Hospital of Anhui
Medical University, Hefei, China
(Chun Wong) Department of Anesthesiology, University of Hong Kong, Hong
Kong SAR, Hong Kong
Title
Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung
Ventilation in Right Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 297-301),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the quality of lung
deflation of a left-sided double-lumen endotracheal tube (DLT) with a
bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic
surgery (VATS). Design: A prospective, randomized, clinical study.
Setting: A university-affiliated teaching hospital. Participants:
Forty-five adult patients undergoing esophageal tumor surgery using VATS
with right lung deflation. Interventions: Patients were assigned by a
computer-generated randomization sequence to either the left-sided DLT or
BB group. The correct positioning of the airway device was confirmed using
fiberoptic bronchoscopy. Measurements and Main Results: The variables
assessed included: (1) time required to correctly place the devices and to
achieve lung collapse; (2) the number of times the device malpositioned;
(3) the quality of lung deflation as rated by the surgeon; (4) blood
pressure and heart rate at baseline (T<inf>1</inf>), immediately before
(T<inf>2</inf>) and after (T<inf>3</inf>) and 1 minute (T<inf>4</inf>)
after intubation; (5) the number of patients with hypoxemia
(SpO<inf>2</inf> < 90%) during the one-lung ventilation (OLV) period; and
(6) postoperative hoarseness of voice, sore throat, or pulmonary
infection. Of the 45 patients approached for the study, 21 patients in the
DLT group and 19 patients in the BB group were analyzed. The time required
to place the device in the correct position was similar between the 2
groups. The time to achieve right lung collapse in the BB group was
significantly longer (mean difference: 3.232, 95% confidence interval
[CI]: 1.993-4.471; p = 0.003). The quality of lung collapse, OLV duration,
number of patients with device malposition, and hypoxemia in both groups
were similar. There were more patients suffering hoarseness (odds ratio
[OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore throat (OR: 4.29, 95%
CI: 1.14-16.18; p = 0.030) in the DLT group, while no patients developed
postoperative lung infection in either group. Compared to T<inf>1</inf>,
systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR) at
T<inf>2</inf> in both groups were higher (p < 0.05) in the DLT group.
Then, compared to T<inf>2</inf>, sBP and dBP at T<inf>3</inf> and
T<inf>4</inf> and HR at T<inf>3</inf> in the DLT group were higher (p <
0.05). Conclusions: The results of this study showed that BB is an
effective alternative for left one-lung ventilation in right VATS, but
requires a longer time to achieve complete lung collapse. Moreover, the
use of BB caused less hemodynamic perturbation and can reduce
postoperative hoarseness and sore throat.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<4>
Accession Number
618945432
Author
Heir J.S.; Guo S.-L.; Purugganan R.; Jackson T.A.; Sekhon A.K.; Mirza K.;
Lasala J.; Feng L.; Cata J.P.
Institution
(Heir, Purugganan, Jackson, Sekhon, Mirza, Lasala, Cata) Department of
Anesthesiology and Perioperative Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Guo) Department of Anesthesiology, Cathay General Hospital, Taipei,
Taiwan (Republic of China)
(Guo) Department of Anesthesiology, Tri-Service General Hospital and
National Defense Medical Center, Taipei, Taiwan (Republic of China)
(Feng) Department of Biostatistics, The University of Texas MD Anderson
Cancer Center, Houston, TX, United States
Title
A Randomized Controlled Study of the Use of Video Double-Lumen
Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic
Surgery.
Source
32 (1) (pp 267-274), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use
(1) during verification of initial placement and (2) for reconfirmation of
correct placement following repositioning, when either a double-lumen tube
(DLT) or video double-lumen tube (VDLT) was used for lung isolation during
thoracic surgery. Design: A randomized controlled study. Setting:
Single-center university teaching hospital. Participants: The study
comprised 80 patients who were 18 years or older requiring lung isolation
for surgery. Interventions: After institutional review board approval,
patients were randomized prior to surgery to either DLT or VDLT usage.
Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET
View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video
laryngoscopy then verified correct tube position through the view provided
with either VDLT external monitor or FOB. Measurements and Main Results:
Data collected included: sex, body mass index, successful intubation and
endobronchial placement, intubation time, confirmation time of tube
position, FOB use, quality of view, dislodgement of tube, and ability to
forewarn dislodgement of endobronchial cuff and complications. FOB use for
verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100%
[42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7%
[1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning
(VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during
surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to
forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8%
[2/42], p = 0.078). Conclusion: This study demonstrated a reduction of
86.8% in FOB use, which was a similar reduction found in other published
studies.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<5>
Accession Number
618847531
Author
El-Tahan M.R.; Khidr A.M.; Gaarour I.S.; Alshadwi S.A.; Alghamdi T.M.;
Al'ghamdi A.
Institution
(El-Tahan, Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamdi) Anesthesiology
Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University
(formerly University of Dammam), Dammam, Saudi Arabia
Title
A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in
Humans by Users With Mixed Experience: A Randomized Controlled Study.
Source
32 (1) (pp 277-286), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To test the hypothesis that laryngoscopy using the Airtraq
(Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu
A/S, Ballerup, Denmark) would result in a shorter time for successful
double-lumen endobronchial tube (DLT) intubation by users with mixed
experience than the time required using the Macintosh or GlideScope
(Verathon Inc., Bothell, WA) laryngoscopes. Design: A randomized,
prospective, blind study. Setting: A single university hospital.
Participants: The study comprised 133 patients undergoing elective
thoracic surgery. Interventions: Patients were randomly allocated into the
following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34),
Airtraq (n = 35), or KVL (n = 32). Measurements and Main Results: The
following data were recorded: time required for achieving successful DLT
intubation; glottis visualization; optimization maneuvers; first-pass
success rate; intubation difficulty; failure to intubate, defined as an
attempt taking >150 seconds to perform or if peripheral oxygen saturation
<92% was noted; and postoperative sore throat and hoarseness were
recorded. Compared with GlideScope, the Airtraq resulted in shorter times
for achieving successful DLT intubation (median times: 21 s [95%
confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval
46.2-89.1 s], respectively; p = 0.021); a lower score for difficult
intubations (p = 0.023); and fewer optimization maneuvers. The 4
laryngoscopes were associated with comparable glottis visualization;
first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p =
0.522); incidence of oropharyngeal trauma; postoperative sore throat; and
hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures
using the Airtraq due to the inability to advance the DLT through the
glottis opening. The experience of the anesthesiologists in using the 4
devices had a statistically significant negative correlation with the time
to confirmation of endobronchial intubation (Spearman r -0.392; p <
0.001). Conclusion: When used by operators with mixed experience, the
channeled Airtraq required less time for DLT intubation and was easier to
use than the GlideScope, although failures did occur with the Airtraq,
whereas they did not occur with the other systems.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<6>
Accession Number
619159136
Author
Landoni G.; Lomivorotov V.; Silvietti S.; Nigro Neto C.; Pisano A.; Alvaro
G.; Hajjar L.A.; Paternoster G.; Riha H.; Monaco F.; Szekely A.; Lembo R.;
Aslan N.A.; Affronti G.; Likhvantsev V.; Amarelli C.; Fominskiy E.;
Baiardo Redaelli M.; Putzu A.; Baiocchi M.; Ma J.; Bono G.; Camarda V.;
Covello R.D.; Di Tomasso N.; Labonia M.; Leggieri C.; Lobreglio R.; Monti
G.; Mura P.; Scandroglio A.M.; Pasero D.; Turi S.; Roasio A.; Votta C.D.;
Saporito E.; Riefolo C.; Sartini C.; Brazzi L.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Silvietti, Monaco, Lembo, Affronti, Baiardo Redaelli, Camarda,
Di Tomasso, Leggieri, Monti, Scandroglio, Turi, Votta, Riefolo, Sartini,
Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesiology and Intensive Care,
Siberian Biomedical Research Center of the Ministry of Health,
Novosibirsk, Russian Federation
(Nigro Neto) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Pisano) Division of Cardiac Anesthesia and Intensive Care, Azienda
Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
(Alvaro, Bono, Labonia, Saporito) Department of Anesthesia and Intensive
Care, Policlinico Universitario Mater Domini, Catanzaro, Italy
(Hajjar) Surgical Intensive Care, Department of Cardiopneumology, InCor,
University of Sao Paulo., Sao Paulo, Brazil
(Paternoster) Department of Cardiovascular Anaesthesia and Intensive Care,
Ospedale San Carlo, Potenza, Italy
(Riha) Cardiothoracic Anaesthesiology and Intensive Care, Department of
Anaesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Szekely) Department of Anesthesia and Intensive Care, Semmelweis Egyetem,
Budapest, Hungary
(Aslan) Medipol Mega University Hospital, Department of Anesthesiology and
Intensive Care, Istanbul, Turkey
(Likhvantsev) Department of Anesthesia and Intensive Care, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Amarelli) Department of Cardiovascular Surgery and Transplants, Monaldi
Hospital, Azienda dei Colli, Naples, Italy
(Putzu) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
(Baiocchi) Department of Anesthesia and Intensive Care, S. Orsola-Malpighi
University Hospital, Bologna, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Covello) Anesthesia and Intensive Care Unit, Busto Arsizio Hospital, ASST
Valle Olona, Varese, Italy
(Lobreglio, Pasero, Brazzi) Department of Anesthesia and Intensive Care,
A.O.U. Citta della Salute e della Scienza, Turin, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU Cagliari, Department of Medical Sciences "M. Aresu,
Cagliari, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Bellomo) School of Medicine, The University of Melbourne, Parkville,
Melbourne, Australia
(Brazzi) Department of Surgical Sciences, University of Turin, Italy
Title
Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac
Surgery: An Updated Consensus Process.
Source
32 (1) (pp 225-235), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: A careful choice of perioperative care strategies is pivotal to
improve survival in cardiac surgery. However, there is no general
agreement or particular attention to which nonsurgical interventions can
reduce mortality in this setting. The authors sought to address this issue
with a consensus-based approach. Design: A systematic review of the
literature followed by a consensus-based voting process. Setting: A
web-based international consensus conference. Participants: More than 400
physicians from 52 countries participated in this web-based consensus
conference. Interventions: The authors identified all studies published in
peer-reviewed journals that reported on interventions with a statistically
significant effect on mortality in the setting of cardiac surgery through
a systematic Medline/PubMed search and contacts with experts. These
studies were discussed during a consensus meeting and those considered
eligible for inclusion in this study were voted on by clinicians
worldwide. Measurements and Main Results: Eleven interventions finally
were selected: 10 were shown to reduce mortality (aspirin, glycemic
control, high-volume surgeons, prophylactic intra-aortic balloon pump,
levosimendan, leuko-depleted red blood cells transfusion, noninvasive
ventilation, tranexamic acid, vacuum-assisted closure, and volatile
agents), whereas 1 (aprotinin) increased mortality. A significant
difference in the percentages of agreement among different countries and a
variable gap between agreement and clinical practice were found for most
of the interventions. Conclusions: This updated consensus process
identified 11 nonsurgical interventions with possible survival
implications for patients undergoing cardiac surgery. This list of
interventions may help cardiac anesthesiologists and intensivists
worldwide in their daily clinical practice and can contribute to direct
future research in the field.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<7>
Accession Number
619146700
Author
Laine A.; Niemi T.; Schramko A.
Institution
(Laine, Niemi, Schramko) Division of Anesthesiology, Department of
Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki,
Helsinki University Hospital, Helsinki, Finland
Title
Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in
Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study.
Source
32 (1) (pp 131-139), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: Anemia is common after cardiac surgery and, according to some
suggestive evidence, may be associated with increased bleeding, other
morbidity, and mortality. However, transfusion of red blood cells (RBC)
may cause adverse effects and increase cost. The authors hypothesized that
the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding
more than the higher Hb threshold (Hb 100 g/L). Design: Prospective
randomized trial. Type of Hospital: University Hospital of Helsinki,
Finland. Participants: Eighty patients with written informed consent,
scheduled for elective open-heart surgery were randomized in 2 groups.
Interventions: Two study groups had RBC transfusion threshold of either Hb
80 g/L or 100 g/L. These triggers were followed for a 24-hour period
postoperatively. A medical follow-up was carried out for 7 days after
surgery. Measurements and Main Results: Rotational thromboelastometry
(ROTEM) and conventional laboratory tests were performed to evaluate
coagulation. There was no significant difference in bleeding or ROTEM
parameters between the groups. Complication rate and Hb concentration
after 7-day follow-up were not different between the groups, but Group 100
g/L had received twice the amount of RBC transfusions. Conclusion: Hb
threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable
to 100 g/L in terms of bleeding and possibly short-term
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<8>
Accession Number
619467904
Author
Xu J.; Yang X.; Hu X.; Chen X.; Zhang J.; Wang Y.
Institution
(Xu, Yang, Hu, Zhang, Wang) Department of Anesthesiology, Huashan
Hospital, Fudan University, Shanghai, China
(Chen) Department of Cardiothorcic Surgery, Huashan Hospital, Fudan
University, Shanghai, China
Title
Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without
Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.
Source
32 (1) (pp 318-324), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: Thoracic paravertebral block (TPVB) is reported to have
advantages in postoperative pain management in unilateral thoracic
surgeries. Previous studies have demonstrated that dexmedetomidine could
be used as an adjuvant to local anesthetics, with the aim of prolonging
the duration of neural blockade. However, little is known about whether
such a combination could improve the quality of postoperative analgesia
compared with local anesthetic only when TPVB is used for patients
undergoing video-assisted thoracoscopic surgery (VATS). Design: A
prospective, randomized, controlled study. Setting: Single-center
university hospital. Participants: The study included 60 patients
undergoing VATS under general anesthesia. Interventions: The patients were
allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL
only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 mug/kg of
dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided
using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8-of
the surgical side; 5 mL of solution were injected at each point.
Postoperatively, the intravenous nonsteroidal anti-inflammatory drug
flurbiprofen was used as part of multimodal analgesia. Measurements and
Main Results: Pain scores at rest and during coughing were evaluated by a
blinded observer in the postanesthesia care unit postoperatively at 1, 2,
4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory
blockade, postoperative requirements for rescue analgesia, adverse events,
and patient satisfaction also were recorded. There was a significant
reduction in postoperative pain scores at rest starting from the
postoperative 8th hour until the 48th hour and during coughing starting at
the postoperative 4th hour until the 48th hour in the group RD compared
with those in group R (p = 0.043). The dermatomal levels of sensory
blockade were comparable in the 2 groups. Patient satisfaction after
surgery was significantly higher in the group RD than in group R (p <
0.001). Total consumption of the intravenous rescue analgesic morphine and
adverse events were not significantly different between the 2 groups.
Conclusions: Compared with ropivacaine only, the addition of
dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in
patients undergoing VATS prolonged the duration of postoperative analgesia
and improved patient satisfaction without serious side effects when
combined with postoperative intravenous nonsteroidal anti-inflammatory
drug administration.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<9>
Accession Number
619209390
Author
Teng Y.; Ou M.; Yu H.
Institution
(Teng, Ou, Yu) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Feasibility of the Use of Transesophageal Echocardiography as a Surface
Probe for Puncturing and Catheterization of the Internal Jugular Vein: A
Randomized Controlled Pilot Study.
Source
32 (1) (pp 363-369), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare the transesophageal echocardiography (TEE) probe as
a surface probe with the vascular probe for guiding internal jugular vein
(IJV) catheterization. Design: Prospective, randomized, controlled pilot
study. Setting: University hospital. Participants: One hundred cardiac
surgery patients, including 50 adult and 50 pediatric patients.
Interventions: Patients in the TEE probe group received right IJV
catheterization using the TEE probe, while the vascular probe group used
the vascular probe for catheterization. Measurements and Main Results: The
puncture time, first-attempt success rate, quality of the imaging with
needle tip positioning, wire positioning, and catheter positioning were
recorded. The incidence of complication or any adverse event also was
observed. Adult patients: In the vascular probe group, the success rate
for first attempt IJV catheterization was 24/25 (96%), while in the TEE
probe group, the success rate for first attempt IJV catheterization was
25/25 (100%). There was no statistical difference in the puncture time,
image quality, needle tip positioning, wire positioning, and catheter
positioning between groups (p > 0.05). Pediatric patients: The success
rate for first-attempt IJV catheterization was 100% in both groups, and
there were no statistical differences in the puncture time, image quality,
and positioning between the 2 groups (p > 0.05). No complications or
adverse events were observed in either group. Conclusion: The TEE probe,
used as a surface probe, can be used to guide IJV puncturing and
catheterization in cardiac surgery patients with favorable feasibility and
safety.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<10>
Accession Number
619924382
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.;
Kent B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.;
Mazer C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario,
Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, Ontario, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, The
Ottawa Hospital, General Campus, Centre for Practice-Changing Research,
Ottawa, Ontario, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, Ontario, Canada
(MacAdams) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, University of Melbourne, Toronto, Ontario, Canada
(Grocott) Departments of Anesthesia & Perioperative Medicine and Surgery,
University of Manitoba, St. Boniface General Hospital, Winnipeg, Manitoba,
Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, Quebec, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
(Royse, Royse) Department of Surgery, The University of Melbourne, The
Royal Melbourne Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, Ontario, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
Quebec, Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, Ontario, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN, United States
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Royse) Department of Cardiothoracic Anaesthesia, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 121-129),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity. Design: Transfusion Requirements in
Cardiac Surgery (TRICS) III was a multicenter, international, open-label
randomized controlled trial of two commonly used transfusion strategies in
patients having cardiac surgery using a noninferiority trial design
(ClinicalTrials.gov number, NCT02042898). Setting: Eligible patients were
randomized prior to surgery in a 1:1 ratio. Participants: Potential
participants were 18 years or older undergoing planned cardiac surgery
using cardiopulmonary bypass (CPB) with a preoperative European System for
Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more.
Interventions: Five thousand patients; those allocated to a restrictive
transfusion group received a red blood cell (RBC) transfusion if the
hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively
and/or postoperatively. Patients allocated to a liberal transfusion
strategy received RBC transfusion if the Hb was less than 9.5 g/dL
intraoperatively or postoperatively in the intensive care unit or less
than 8.5 g/dL on the ward. Measurements and Main Results: The primary
outcome was a composite of all-cause mortality, myocardial infarction,
stroke, or new onset renal dysfunction requiring dialysis at hospital
discharge or day 28, whichever comes first. The primary outcome was
analyzed as a per-protocol analysis. The trial monitored adherence closely
as adherence to the transfusion triggers is important in ensuring that
measured outcomes reflect the transfusion strategy. Conclusion: By
randomizing prior to surgery, the TRICS III trial captured the most acute
reduction in hemoglobin during cardiopulmonary bypass.<br/>Copyright
&#xa9; 2018

<11>
Accession Number
618981393
Author
Wilczynski M.; Wybraniec M.T.; Sanak M.; Goral J.; Mizia-Stec K.
Institution
(Wilczynski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
(Wybraniec, Mizia-Stec) First Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland
(Sanak) II Department of Internal Medicine, Division of Molecular Biology
and Clinical Genetics, Jagiellonian University Medical College, Krakow,
Poland
(Goral) Department of Laboratory Medicine, Public Hospital No 7 in
Katowice, Upper Silesia Medical Center, Katowice, Poland
Title
Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary
Artery Bypass Grafting.
Source
32 (1) (pp 178-186), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of the study was to evaluate the impact of
intravenous metamizole on platelet inhibition by aspirin in patients with
coronary artery disease early after on-pump coronary artery bypass
grafting (CABG). Design: Prospective, single-blind, randomized trial.
Setting: Tertiary referal hospital. Participants: The study comprised 43
patients with multivessel coronary artery disease undergoing CABG.
Interventions: Patients were randomized to postoperative intravenous
metamizole +/- opioids (study group; n = 23) or opioids alone (control
group; n = 20). Aspirin was withheld at least 7 days before the surgery
and reinitiated (300 mg) immediately after the procedure prior to
metamizole use, and continued daily thereafter (150 mg). Platelet function
was evaluated using multielectrode impedance aggregometry (acid-induced
platelet activation [ASPI] and collagen-induced platelet activation [COL]
test), P-selectin expression and urinary 11-dehydro-thromboxane
B<inf>2</inf> (11-DTXB<inf>2</inf>) level at baseline, postoperative day
(POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was
defined as ASPI test >400 AU*min. Measurements and Main Results: In all
study participants, postoperative ASPI test value moderately decreased
(1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB<inf>2</inf> level
increased (923.4 v 4367.3 pg/mg, p < 0.001), and P-selectin expression and
COL test value remained stable postprocedure. The decreases of ASPI (p =
0.146) and COL test (p = 0.642), and P-selectin expression (p = 0.318) did
not differ between both groups. Patients in the control group had higher
postoperative increase of urinary 11-DTXB<inf>2</inf> level (p = 0.001).
The prevalence of RPR was high and comparable between study and control
groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p = 0.21).
Multivariate analysis revealed that metamizole use did not predict the
fluctuations of ASPI and COL test values and P-selectin expression, yet it
independently predicted postoperative change of 11-DTXB<inf>2</inf> level
(b = -0.518, p = 0.001). Conclusions: Intravenous metamizole preceded by a
loading dose of aspirin did not modify platelet response to aspirin in the
postoperative period after CABG.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<12>
Accession Number
619216352
Author
Chang J.-E.; Kim H.; Min S.-W.; Lee J.-M.; Ryu J.-H.; Yoon S.; Hwang J.-Y.
Institution
(Chang, Kim, Min, Lee, Hwang) Department of Anesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University Bundang Hospital, Gyeonggi-go, South Korea
(Yoon) Department ofDepartment of Anesthesiology & Pain Medicine, Seoul
National University Hospital, Seoul, South Korea
Title
A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and
GlideScope for Double-Lumen Endobronchial Intubation.
Source
32 (1) (pp 290-296), 2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare GlideScope and lighted stylet for double-lumen
endobronchial tube (DLT) intubation in terms of intubation time, success
rate of first attempt at intubation, difficulty in DLT advancement toward
the glottis, and postoperative sore throat and hoarseness. Design: A
prospective, randomized study. Setting: Medical center governed by a
university hostpial. Participants: Sixty-two adult patients undergoing
thoracic surgery using DLT intubation. Intervention: After the induction
of anesthesia, DLT intubation was performed using GlideScope (n = 32) or
lighted stylet (n = 32). Measurements and Main Results: Number of
intubation attempts, difficulty of DLT advancement toward the glottis,
time taken for DLT intubation, and the incidence and severity of
postoperative sore throat and hoarseness at 1 and 24 hours after surgery
were evaluated. Time taken for DLT intubation was shorter in the lighted
stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53]
s, median [interquartile range], respectively; p < 0.001). DLT advancement
toward the glottis was easier in the lighted stylet group than in the
GlideScope group (p = 0.016). The success rate of DLT intubation in the
first attempt (96.9% v 90.6% for lighted stylet and GlideScope,
respectively), and the incidence and severity of postoperative sore throat
and hoarseness were not different between the two groups. Conclusions: The
use of lighted stylet allowed easier advancement of the DLT toward the
glottis in the oropharyngeal space and reduced time for achieving DLT
intubation compared with GlideScope.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<13>
Accession Number
620600431
Author
Reinhardt S.W.; Lin C.-J.; Novak E.; Brown D.L.
Institution
(Reinhardt) Department of Internal Medicine, Washington University School
of Medicine, St Louis, MO, United States
(Lin, Novak, Brown) Cardiovascular Division, Washington University School
of Medicine, Campus Box 8086, 660 S Euclid Ave, St Louis, MO 63110, United
States
Title
Noninvasive cardiac testing vs clinical evaluation alone in acute chest
pain: A secondary analysis of the ROMICAT-II randomized clinical trial.
Source
JAMA Internal Medicine. 178 (2) (pp 212-219), 2018. Date of Publication:
February 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The incremental benefit of noninvasive testing in addition to
clinical evaluation (history, physical examination, an electrocardiogram
[ECG], and biomarker assessment) vs clinical evaluation alone for patients
who present to the emergency department (ED) with acute chest pain is
unknown. OBJECTIVE: To examine differences in outcomes with clinical
evaluation and noninvasive testing (coronary computed tomographic
angiography [CCTA] or stress testing) vs clinical evaluation alone.
DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective analysis
of data from the randomized multicenter Rule Out Myocardial
Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial.
Data for 1000 patients who presented with chest pain to the EDs at 9
hospitals in the United States were evaluated. INTERVENTIONS: Clinical
evaluation plus noninvasive testing (CCTA or stress test) vs clinical
evaluation alone. MAIN OUTCOMES AND MEASURES: Primary outcomewas length of
stay (LOS). Secondary outcomes included hospital admission, direct ED
discharge, downstream testing, rates of invasive coronary angiography,
revascularization, major adverse cardiac events (MACE), repeated ED visit
or hospitalization for recurrent chest pain at 28 days, and cost. Safety
end points were missed acute coronary syndrome (ACS) and cumulative
radiation exposure during the index visit and follow-up period. RESULTS:
Of the 1000 patients randomized, 118 patients (12%) (mean [SD] age, 53.2
[7.8]; 49 [42%] were female) did not undergo noninvasive testing, whereas
882 (88%) (mean [SD] age, 54.4 [8.14] years; 419 [48%] were female)
received CCTA or stress testing. There was no difference in baseline
characteristics or clinical presentation between groups. Patients who
underwent clinical evaluation alone experienced a shorter LOS (20.3 vs
27.9 hours; P < .001), lower rates of diagnostic testing (P < .001) and
angiography (2%vs 11%; P < .001), lower median costs ($2261.50 vs
$2584.30; P = .009), and less cumulative radiation exposure (0 vs 9.9 mSv;
P < .001) during the 28-day study period. Lack of testing was associated
with a lower rate of diagnosis of ACS (0% vs 9%; P < .001) and less
coronary angiography and percutaneous coronary intervention (PCI) during
the index visit (0% vs 10%; P < .001, and 0% vs 4%; P = .02,
respectively). There was no difference in rates of PCI (2%vs 5%; P = .15),
coronary artery bypass surgery (0% vs 1%; P = .61), return ED visits (5.8%
vs 2.8%; P = .08), or MACE (2%vs 1%; P = .24) in the 28-day follow-up
period. CONCLUSIONS AND RELEVANCE: In patients presenting to the ED with
acute chest pain, negative biomarkers, and a nonischemic ECG result,
noninvasive testing with CCTA or stress testing leads to longer LOS, more
downstream testing, more radiation exposure, and greater cost without an
improvement in clinical outcomes.<br/>Copyright &#xa9; 2017 American
Medical Association. All rights reserved.

<14>
Accession Number
620572051
Author
Richards S.H.; Anderson L.; Jenkinson C.E.; Whalley B.; Rees K.; Davies
P.; Bennett P.; Liu Z.; West R.; Thompson D.R.; Taylor R.S.
Institution
(Richards) Leeds Institute of Health Sciences, University of Leeds, Leeds,
United Kingdom
(Richards, Jenkinson) Primary Care, University of Exeter Medical School,
Exeter, United Kingdom
(Anderson, Taylor) Institute of Health Research, University of Exeter
Medical School, Exeter, United Kingdom
(Whalley) School of Psychology, University of Plymouth, Plymouth, United
Kingdom
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Davies) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Bennett) Department of Psychology, University of Swansea, Swansea, United
Kingdom
(Liu) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(West) Wales Heart Research Institute, Cardiff University, Cardiff, United
Kingdom
(Thompson) School of Nursing & Midwifery, Queen's University, Belfast,
United Kingdom
Title
Psychological interventions for coronary heart disease: Cochrane
systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (3) (pp 247-259), 2018. Date
of Publication: 01 Feb 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although psychological interventions are recommended for the
management of coronary heart disease (CHD), there remains considerable
uncertainty regarding their effectiveness. Design: Systematic review and
meta-analysis of randomised controlled trials (RCTs) of psychological
interventions for CHD. Methods: The Cochrane Central Register of
Controlled Trials, MEDLINE, EMBASE, CINAHL and PsycINFO were searched to
April 2016. Retrieved papers, systematic reviews and trial registries were
hand-searched. We included RCTs with at least 6 months of follow-up,
comparing the direct effects of psychological interventions to usual care
for patients following myocardial infarction or revascularisation or with
a diagnosis of angina pectoris or CHD defined by angiography. Two authors
screened titles for inclusion, extracted data and assessed risk of bias.
Studies were pooled using random effects meta-analysis and meta-regression
was used to explore study-level predictors. Results: Thirty-five studies
with 10,703 participants (median follow-up 12 months) were included.
Psychological interventions led to a reduction in cardiovascular mortality
(rfcelative risk 0.79, 95% confidence interval [CI] 0.63 to 0.98),
although no effects were observed for total mortality, myocardial
infarction or revascularisation. Psychological interventions improved
depressive symptoms (standardised mean difference [SMD] -0.27, 95% CI
-0.39 to -0.15), anxiety (SMD -0.24, 95% CI -0.38 to -0.09) and stress
(SMD -0.56, 95% CI -0.88 to -0.24) compared with controls. Conclusions: We
found that psychological intervention improved psychological symptoms and
reduced cardiac mortality for people with CHD. However, there remains
considerable uncertainty regarding the magnitude of these effects and the
specific techniques most likely to benefit people with different
presentations of CHD.<br/>Copyright &#xa9; 2017, &#xa9; The European
Society of Cardiology 2017.

<15>
Accession Number
616556827
Author
Zakaria D.; Rettiganti M.; Gossett J.M.; Gupta P.
Institution
(Zakaria, Gupta) Department of Pediatrics, Division of Pediatric
Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Rettiganti, Gossett) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
Title
Factors associated with early extubation after superior cavopulmonary
connection: analysis from single ventricle reconstruction trial.
Source
Acta Anaesthesiologica Scandinavica. 61 (7) (pp 722-729), 2017. Date of
Publication: August 2017.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: To evaluate the landscape of early extubation, and identify
factors associated with early extubation (<= 24 h) after superior
cavopulmonary connection (stage 2 operation) among children with single
ventricle anatomy. Methods: Patients undergoing stage 2 operation after
Norwood operation from the Pediatric Heart Network Single Ventricle
Reconstruction (SVR) trial public-use dataset were included. Elastic net
regularized logistic regression models were fitted to evaluate the factors
associated with early extubation after stage 2 operation. Results: In
total, 390 patients from 15 North American centers qualified for
inclusion. Of these, 42 patients (10.8%) were extubated in operating room,
151 patients (38.7%) were extubated outside the operating room within the
first 24 h after stage 2 operation, and the remaining 197 patients (50.5%)
required mechanical ventilation for > 24 h. In adjusted models, factors
associated with early extubation after stage 2 operation were elective
timing of stage 2 operation, lower incidence of post-Norwood
complications, shorter CPB duration for stage 2 operation, and no cardiac
catheterization after Stage 2 operation. We also performed multiple other
alternative analyses to identify factors associated with early extubation
that demonstrated same associations as the primary model. The mean
hospital length of stay after Stage 2 operation was 20% shorter among
patients with early extubation. Conclusions: Data from this large
multicenter study demonstrate that approximately one-half of the patients
undergoing operation for superior cavopulmonary connection are extubated
within 24 h after heart operation. Furthermore, early extubation is
associated with shorter hospital length of stay.<br/>Copyright &#xa9; 2017
The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd

<16>
Accession Number
615245764
Author
De Maria G.L.; Alkhalil M.; Oikonomou E.K.; Wolfrum M.; Choudhury R.P.;
Banning A.P.
Institution
(De Maria, Alkhalil, Wolfrum, Banning) Oxford Heart Centre, NIHR
Biomedical Research Centre, Oxford University Hospitals, Oxford, United
Kingdom
(Choudhury) Radcliffe Department of Medicine, Acute Vascular Imaging
Centre, University of Oxford, Oxford, United Kingdom
(Choudhury) Division of Cardiovascular Medicine, BHF Centre of Research
Excellence, University of Oxford, Oxford, United Kingdom
Title
Role of deferred stenting in patients with ST elevation myocardial
infarction treated with primary percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
Journal of Interventional Cardiology. 30 (3) (pp 264-273), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We conducted a meta-analysis of studies comparing deferred
stenting strategy versus the conventional approach with immediate stenting
in patients with ST elevation myocardial infarction. Background: Deferring
stent after mechanical flow restoration has been proposed as a strategy to
reduce the risk of "no reflow" in patients with STEMI undergoing primary
percutaneous coronary intervention (pPCI). Conflicting evidence is
available currently, especially after the recent publication of three
randomized clinical trials. Methods: Searches in electronic databases were
performed. Comparisons between the two strategies were performed for both
hard clinical endpoints (all cause-mortality, cardiovascular mortality,
unplanned revascularization, myocardial infarction and readmission for
heart failure) and surrogate angiographic endpoints (TIMI flow < 3 and
myocardial blush grade (MBG) < 2). Results: Eight studies (three
randomized and five non-randomized) were deemed eligible, accounting for a
total of 2101 patients. No difference in terms of hard clinical endpoints
was observed between deferred and immediate stenting (OR [95% CI]: 0.79
[0.54-1.15], for all-cause mortality; odds ratio (OR) [95% CI]: 0.79
[0.47-1.31] for cardiovascular mortality; OR [95% CI]: 0.95 [0.64-1.41]
for myocardial infarction; OR [95% CI]: 1.37 [0.87-2.16], for unplanned
revascularization and OR [95% CI]: 0.50 [0.21-1.17] for readmission for
heart failure). Notably, the deferred stenting approach was associated
with improved outcome of the surrogate angiographic endpoints (OR [95%
CI]: 0.43 [0.18-0.99] of TIMI flow < 3 and OR [95% CI]: 0.25 [0.11-0.57]
for MBG < 2. Conclusions: A deferred stenting strategy could be a feasible
alternative to the conventional approach with immediate stenting in
"selected" STEMI patients undergoing pPCI.<br/>Copyright &#xa9; 2017,
Wiley Periodicals, Inc.

<17>
Accession Number
615150250
Author
Wang N.; Lal S.
Institution
(Wang, Lal) University of Sydney, Sydney, NSW, Australia
(Wang, Lal) Royal Prince Alfred Hospital, Camperdown, NSW, Australia
Title
Post-dilation in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Journal of Interventional Cardiology. 30 (3) (pp 204-211), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The aim of this study was to perform a meta-analysis to
compare the outcomes of patients undergoing TAVR with and without balloon
post-dilation (PD). Background: PD is a commonly used technique in TAVR to
minimize paravalvular regurgitation (PVR), albeit supported by little
evidence. Methods: Systematic review and meta-analysis of 6 studies
comparing 889 patients who had PD compared to 4118 patients without PD.
Results: Patients undergoing PD were more likely male (OR 1.92; 95% CI,
1.41-2.61; P < 0.001) and to have coronary artery disease (OR 1.31; 95%
CI, 1.03-1.68; P = 0.03) than those patients not requiring PD. There were
no significant differences in 30-day mortality (OR 1.24; 95% CI,
0.88-1.74; P = 0.22) and myocardial infarction (OR 0.93; 95% CI,
0.46-1.90; P = 0.85). Patients undergoing TAVR did not have higher 1-year
mortality rates (OR 0.98; 95% CI, 0.61-1.56; P = 0.92). The incidence of
stroke was significantly greater in patients with PD (OR, 1.71; 95% CI,
1.10-2.66). PD was able to reduce the incidence of moderate-severe PVR by
15 fold (OR 15.0; 95% CI, 4.2-54.5; P < 0.001), although rates of
moderate-severe PVR were still higher after PD than patients who did not
require PD (OR 3.64; 95% CI, 1.96-6.75; P < 0.001). Conclusions: PD
significantly improves rates of PVR, however careful patient selection is
needed to minimize increased risk of strokes.<br/>Copyright &#xa9; 2017,
Wiley Periodicals, Inc.

<18>
Accession Number
619543098
Author
Buckley L.F.; Dixon D.L.; Wohlford G.F.; Wijesinghe D.S.; Baker W.L.; Van
Tassell B.W.
Institution
(Buckley, Dixon, Wohlford, Wijesinghe, Van Tassell) Department of
Pharmacotherapy and Outcomes Science, Virginia Commonwealth University,
Richmond, VA, United States
(Baker) Department of Pharmacy Practice, School of Pharmacy, University of
Connecticut, Storrs, CT, United States
Title
Intensive versus standard blood pressure control in SPRINTE-ligible
participants of ACCORD-BP.
Source
Diabetes Care. 40 (12) (pp 1733-1738), 2017. Date of Publication: 01 Dec
2017.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
Objective: We sought to determine the effect of intensive blood pressure
(BP) control on cardiovascular outcomes in participants with type 2
diabetes mellitus (T2DM) and additional risk factors for cardiovascular
disease (CVD). Research Design and Methods: This study was a post hoc,
multivariate, subgroup analysis of ACCORD-BP (Action to Control
Cardiovascular Risk in Diabetes Blood Pressure) participants.
Participantswere eligible for the analysis if they were in the standard
glucose control arm of ACCORD-BP and also had the additional CVD risk
factors required for SPRINT (Systolic Blood Pressure Intervention Trial)
eligibility. We used a Cox proportional hazards regression model to
compare the effect of intensive versus standard BP control on CVD
outcomes. The "SPRINT-eligible" ACCORD-BP participantswere pooledwith
SPRINT participants to determine whether the effects of intensive BP
control interacted with T2DM. Results: The mean baseline Framingham
10-year CVD risk scores were 14.5% and 14.8%, respectively, in the
intensive and standard BP control groups. The mean achieved systolic BP
values were 120 and 134 mmHg in the intensive and standard BP control
groups (P <= 0.001). Intensive BP control reduced the composite of CVD
death, nonfatal myocardial infarction (MI), nonfatal stroke, any
revascularization, and heart failure (hazard ratio 0.79; 95% CI 0.65-0.96;
P = 0.02). Intensive BP control also reduced CVD death, nonfatal MI, and
nonfatal stroke (hazard ratio 0.69; 95% CI 0.51-0.93; P = 0.01).
Treatment-related adverse events occurred more frequently in participants
receiving intensive BP control (4.1% vs. 2.1%; P = 0.003). The effect of
intensive BP control on CVD outcomes did not differ between patients with
and without T2DM (P > 0.62). Conclusions: Intensive BP control reduced CVD
outcomes in a cohort of participants with T2DM and additional CVD risk
factors.<br/>Copyright &#xa9; 2017 by the American Diabetes Association.

<19>
Accession Number
617562324
Author
Bongiovanni D.; Kuhl C.; Bleiziffer S.; Stecher L.; Poch F.; Greif M.;
Mehilli J.; Massberg S.; Frey N.; Lange R.; Laugwitz K.-L.; Schymik G.;
Frank D.; Kupatt C.
Institution
(Bongiovanni, Poch, Laugwitz, Kupatt) I. Medizinische Klinik und
Poliklinik, Klinikum Rechts der Isar, Technical University of Munich,
Munich, Germany
(Bongiovanni, Laugwitz, Kupatt) DZHK (German Center for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
(Kuhl, Frey, Frank) Klinik fur Innere Medizin III, Universitatsklinikum
Schleswig-Holstein, Kiel, Germany
(Kuhl, Frey, Frank) DZHK (German Center for Cardiovascular Research),
Partner Site Hamburg/Kiel/lubeck, Lubeck, Germany
(Bleiziffer, Lange) Clinic for Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
(Stecher) Institut fur Medizinische Statistik und Epidemiologie, Technical
University of Munich, Munich, Germany
(Greif, Mehilli, Massberg) Medizinische Klinik und Poliklinik I, Klinikum
Groshadern, LMU University, Munich, Germany
(Schymik) Medizinische Klinik IV, Stadtisches Klinikum Karlsruhe,
Karlsruhe, Germany
Title
Emergency treatment of decompensated aortic stenosis.
Source
Heart. 104 (1) (pp 23-29), 2018. Date of Publication: January 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The optimal treatment of patients with acute and severe
decompensation of aortic stenosis is unclear due to recent advances in
transcatheter interventions and supportive therapies. Our aim was to
assess the early outcome of emergency transcatheter aortic valve
implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV)
followed by TAVI under elective circumstances. Methods Emergency
conditions were defined as: cardiogenic shock with requirement of
catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac
resuscitation or mechanic respiratory support. The data were collected
according to the Valve Academic Research Consortium 2 (VARC-2) criteria.
results In five German centres, 23 patients (logistic Euroscore
37.7%+/-18.1) underwent eTAVI and 118 patients underwent eBAV (logistic
Euroscore 35.3%+/-20.8). In the eTAVI group, immediate procedural
mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After
30 days, cardiovascular mortality for the eTAVI group was 23.8% and for
the eBAV group 33.0% (p=0.40). Analyses adjusting for potential
confounders did not provide evidence of a difference between groups. Of
note, the elective TAVI performed after eBAV (n=32, logistic Euroscore
25.9%+/-13.9) displayed an immediate procedural mortality of 9.4% and a
cardiovascular mortality after 30 days of 15.6%. Major vascular
complications were significantly more likely to occur after eTAVI (p=0.01)
as well as stroke (p=0.01). conclusion In this multicentre cohort,
immediate procedural and 30-day mortality of eTAVI and eBAV were high, and
mortality of secondary TAVI subsequent to eBAV was higher than expected.
Randomised study data are required to define the role of emergency TAVI in
tertiary care centres with current device generations.<br/>Copyright
&#xa9; Article author(s).

<20>
Accession Number
616039972
Author
Sardar P.; Kundu A.; Bischoff M.; Chatterjee S.; Owan T.; Nairooz R.; Giri
J.; Halkos M.E.; Liberman H.; Douglas J.S.; Mukherjee D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Bischoff) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
(Chatterjee) Division of Cardiovascular Medicine, Temple University School
of Medicine, Philadelphia, PA, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Halkos) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Liberman, Douglas) Clinical Research Unit, Division of Cardiology, Emory
University School of Medicine, Atlanta, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, United States
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
in patients with multivessel coronary artery disease: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 203-212),
2018. Date of Publication: 01 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This meta-analysis evaluated the effectiveness of hybrid
coronary revascularization (HCR) compared to coronary artery bypass
grafting (CABG) for the treatment of multivessel coronary artery disease
(MVCAD). Background: HCR involves a combination of surgical and
percutaneous techniques, which in selected patients may present an
alternative to conventional CABG. Methods: Databases were searched through
June 30, 2016, and studies comparing HCR with CABG for treatment of MVCAD
were selected. We calculated summary odds ratios (ORs) and 95% CIs with
the random-effects model. The primary outcome of interest was the
occurrence of major adverse cardiac and cerebrovascular events (MACCE),
defined as a composite of all cause mortality, myocardial infarction, and
stroke. Results: The analysis included 2,245 patients from 8 studies (1
randomized controlled trial and 7 observational studies). The risk of
MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR, 0.53; 95%
CI, 0.24-1.16). Compared to CABG group, patients in HCR group had similar
risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88), myocardial
infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95% CI,
0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI, 0.58-2.83).
The need for postoperative blood transfusions (OR, 0.29; 95% CI,
0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95% CI
-1.52 to -0.88 days) was significantly lower in the HCR group. Conclusion:
HCR appears to be safe, and has similar outcomes when compared with
conventional CABG. HCR can be a suitable alternative to conventional CABG
in select patients with MVCAD. &#xa9; 2017 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<21>
Accession Number
617341487
Author
Tomoaki S.
Institution
(Tomoaki) Department of Cardiovascular Surgery, Shiga University of
Medical Science, Setatsukinowa, Otsu, Shiga 520-2192, Japan
Title
Optimal use of arterial grafts during current coronary artery bypass
surgery.
Source
Surgery Today. 48 (3) (pp 264-273), 2018. Date of Publication: 01 Mar
2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Multiple arterial grafting, including the use of the bilateral internal
thoracic arteries (ITAs), has strong benefits on patient clinical outcomes
after coronary artery bypass grafting (CABG) but is far from commonly
accepted at present. We reviewed the previous randomized and leading
observational studies and assembled an up-to-date profile on multiple
arterial grafting. Many of the previous trials successfully showed the
beneficial effects of arterial grafting after CABG. Although many of these
were retrospective studies, the data presented, mostly from world-famous
surgeons, show that multiple arterial grafting does have advantages with
regard to the long-term patient outcome without increasing rates of early
mortality or morbidity. However, it is true that some surgeons experience
a certain amount of stress when using multiple arterial conduits. Multiple
arterial reconstruction has a strong advantage for patients undergoing
CABG and is now a standard worldwide strategy. Surgeons nowadays need to
make efforts to master arterial conduit techniques properly to provide
state-of-the-art CABG to patients.<br/>Copyright &#xa9; 2017, Springer
Japan KK.

<22>
Accession Number
620636828
Author
Anonymous
Title
Western Medical Research Conference 2018.
Source
Journal of Investigative Medicine. Conference: 2018 Western Medical
Research Conference, WMRC 2018. United States. 66 (1) (no pagination),
2018. Date of Publication: January 2018.
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 509 papers. The topics discussed include:
induction of deubiquitinating enzyme USP50 during erythropoiesis and its
potential role in the regulation of ku70 stability; piercing remains a
significant risk factor for nickel contact dermatitis; preliminary results
from an online survey; does the primary language spoken in the home affect
if guardians discuss ingredients/food labels with their child?;
motivational interviewing to treat overweight and obese adolescents: a
systematic review; sexual minority youth who use school-based health
centers report on substance use and quality of care; the role of rest in
recovery after concussion: a comprehensive literature review in children
and adolescents; and treatment with undifferentiated induced pluripotent
stem cell cardiac graft does not worsen cardiac function in rat model of
chronic heart failure (CHF).

<23>
Accession Number
620499772
Author
Niu Z.; Zheng M.; Zhang Z.; Wang B.; Shan S.
Institution
(Niu, Zheng, Zhang, Wang, Shan) Department of Anesthesiology, Cangzhou
Central Hospital, Cangzhou, Hebei Province, China
Title
A randomized controlled study: The effect of endobronchial blocker and
double-lumen endobronchial tube on one-lung ventilation in thoracic spinal
tuberculosis surgery.
Source
International Journal of Clinical and Experimental Medicine. 11 (1) (pp
327-333), 2018. Article Number: IJCEM0067991. Date of Publication: 2018.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To compare the effect of endobronchial blocker and double-lumen
endobronchial tube on one-lung ventilation in thoracic spinal tuberculosis
surgery. Methods: A total of 160 patients with thoracic spinal
tuberculosis who were treated with thoracic surgery under one-lung
ventilation from January 2015 to December 2016 in our hospital were
selected as subjects. Patients were divided into group 1 (using
double-lumen endobronchial tube) and group 2 (using endobronchial blocker)
according to the method of random number table. The differences in scores
of surgical field quality, time of lung collapse, success rate of cannula,
and partial pressure of carbon dioxide (PaCO<inf>2</inf>), partial
pressure of oxygen (PaO<inf>2</inf>), platform airway pressure (Pplat),
and peak airway pressure (Ppeak) during one-lung ventilation and two-lung
ventilation between two groups were compared. After operation, the
occurrence of hoarseness, pulmonary infection, pharyngalgia and other
complications of patients were evaluated by professional anesthetists.
Results: Scores of surgical field quailty and time of lung collapse in
group 2 were higher than those in group 1 while the one-time success rate
of intubation was significantly lower than that in group 1 (all P<0.001).
The PaO<inf>2</inf> of both groups after one-lung ventilation was lower
than that after anesthesia and recovery of double-lumen ventilation (all
P<0.05). And PaO<inf>2</inf> 60 minutes after one-lung ventilation was
lower than that 20 minutes after one-lung ventilation (all P<0.05).
PaO<inf>2</inf> at each time point during one-lung ventilation in group 1
was lower than that in group 2 (all P<0.05). There was no significant
difference in PaCO<inf>2</inf> between two groups at each time point (all
P>0.05). Ppeak and Pplat of two groups were elevated during one-lung
ventilation and it was found that Ppeak and Pplat in group 1 were higher
than those in group 2 at different time points (all P<0.05). The incidence
of complications of hoarseness, pulmonary infection, and pharyngalgia
after operation in group 2 was lower than that in group 1 (all P<0.05).
Conclusion: Endobronchial blocker for thoracic surgery was worthy of
clinical promotion because when compared with double-lumen endobronchial
tube, it has better visual field, slighter blood-gas changes and lower
incidence of complications of hoarseness, pulmonary infection, and
pharyngalgia after operation.<br/>Copyright &#xa9; 2018, E-Century
Publishing Corporation. All rights reserved.

<24>
Accession Number
620635428
Author
Abouarab A.A.; Rahouma M.; Kamel M.; Ghaly G.; Mohamed A.
Institution
(Abouarab) Department of Surgery, Division of Cardiothoracic Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Rahouma, Kamel, Ghaly, Mohamed) Surgical Oncology Department, National
Cancer Institute, Cairo University, 1st Fom Elkhaleeg Square, Masr
ElKadema, Cairo 11796, Egypt
Title
Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A
Systematic Review and Meta-analysis.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 28 (2) (pp
174-185), 2018. Date of Publication: February 2018.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Video-Assisted Thoracic Surgery (VATS) is conventionally
performed through multiple small incisions (C-VATS). Recent studies have
reported encouraging results with the single-incision VATS (S-VATS) over
the conventional technique. However, these studies were either small in
size, unfocused, nonuniform, retrospective, lacking follow-up information,
or focused on pain. We aim to validate previously reported results in a
single large meta-analysis, including only the best evidence studies
available. Methods: Systematic review of the PubMed archive was conducted
to include only full English articles with Newcastle Ottawa Scale score
>=7. The primary outcome was the complications rate while secondary
outcomes were operative time, resected lymph nodes (LNs), chest tube
duration, estimated blood loss, length of postoperative stay (LOS), and
postoperative pain on day 1 after surgery. Odds ratio and standard mean
difference were used as effect estimates. Random model and leave-one-out
analysis were used. Results: A total of 39 studies were included with 4635
patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in
significantly less postoperative pain (P < .001), blood loss (P = .006),
LOS (P < .001), and chest tube duration (P < .001). In lung cancer
patients, the number of retrieved LNs was similar to that of C-VATS (P >
.05). Subgroup comparison of the rate of complications between lung
resections versus other intrathoracic procedures, lung cancer versus
pneumothorax, and lung cancer versus other lung-only lesions did not show
any significant differences between the groups. Conclusion: Performing
S-VATS technique has shown superior postoperative outcomes over the C-VATS
technique in the treatment of thoracic disorders. Substantial benefit was
confirmed in terms of less postoperative pain, blood loss, drainage time,
and postoperative hospital stay.<br/>&#xa9; Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<25>
Accession Number
620617939
Author
Qureshi S.H.; Boulemden A.; Szafranek A.; Vohra H.
Institution
(Qureshi, Boulemden, Szafranek) Department of Cardiac Surgery, Trent
Cardiac Centre, Nottingham University Hospital, City Campus, Nottingham,
United Kingdom
(Vohra) Department of Cardiac Surgery, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
Title
Meta-analysis of sutureless technology versus standard aortic valve
replacement and transcatheter aortic valve replacement.
Source
European Journal of Cardio-thoracic Surgery. 53 (2) (pp 463-471), 2018.
Article Number: ezx307. Date of Publication: 01 Feb 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) using sutureless technology is
a feasible alternative in surgical patients. Comparative evidence against
established strategies such as conventional AVR and transcatheter AVR is
lacking, limiting the assessment of safety and efficacy. METHODS: Medline
search for available evidence was undertaken. The outcomes analysed were
30-day mortality, risk for stroke, myocardial infarction, renal failure,
paravalvular leak and need for permanent pacemaker. Odds ratios were
pooled using fixed- and randomeffect models. A trial sequential analysis
was undertaken to assess the statistical reliability of cumulative
evidence. RESULTS: Twelve studies of moderate methodological quality were
included. Sutureless AVR was associated with at least 30% reduction in
30-day mortality versus transcatheter AVR [odds ratio (95% confidence
interval) 0.40 (0.25, 0.62); P < 0.001] primarily in the low- and
intermediate-risk population and a similar reduction in the risk for
paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no reduction
in the risk for 30-day mortality versus conventional AVR [1.03 (0.56,
1.88); P = 0.93]. There was evidence in favour of conventional AVR with at
least 50% risk reduction in pacemaker implantation against sutureless
technology. There was absence of either benefit or harm vis-a-vis risk for
renal injury or stroke due to lack of required information size.
CONCLUSIONS: Current evidence suggests risk reduction in 30-day mortality
with sutureless AVR versus transcatheter AVR but is inconclusive versus
standard AVR in matched patients. Robust randomized evidence is lacking to
lend support to any potential recommendation.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
620649592
Author
Villablanca P.A.; Mohananey D.; Nikolic K.; Bangalore S.; Slovut D.P.;
Mathew V.; Thourani V.H.; Rode's-Cabau J.; Nunez-Gil I.J.; Shah T.; Gupta
T.; Briceno D.F.; Garcia M.J.; Gutsche J.T.; Augoustides J.G.; Ramakrishna
H.
Institution
(Villablanca, Slovut, Gupta, Briceno, Garcia) Division of Cardiovascular
Diseases, Montefiore Medical Center/Albert Einstein College of Medicine,
New York, NY, United States
(Mohananey) Department of Hospital Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Nikolic, Ramakrishna) Department of Anesthesiology, Mayo Clinic,
Scottsdale, AZ, United States
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center/Albert Einstein College of Medicine, New York, NY, United
States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(Rode's-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Nunez-Gil) Instituto Cardiovascular Hospital Clinico San Carlos, Madrid,
Spain
(Shah) Department of Internal Medicine, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, NY, United States
(Gutsche, Augoustides) Department of Anesthesiology and Critical Care,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
Title
Comparison of local versus general anesthesia in patients undergoing
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 330-342),
2018. Date of Publication: 01 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is typically
performed under general anesthesia (GA). However, there is increasing data
supporting the safety of performing TAVR under local anesthesia/conscious
sedation (LA). We performed a meta-analysis to gain better understanding
of the safety and efficacy of LA versus GA in patients with severe aortic
stenosis undergoing TAVR. Methods and Results: We comprehensively searched
EMBASE, PubMed, and Web of Science. Effect sizes were summarized using
risk ratios (RRs) difference of the mean (DM), and 95% CIs (confidence
intervals) for dichotomous and continuous variables respectively.
Twenty-six studies and 10,572 patients were included in the meta-analysis.
The use of LA for TAVR was associated with lower overall 30-day mortality
(RR, 0.73; 95% CI, 0.57-0.93; P = 0.01), use of inotropic/vasopressor
drugs (RR, 0.45; 95% CI, 0.28-0.72; P < 0.001), hospital length of stay
(LOS) (DM, -2.09; 95% CI, -3.02 to -1.16; P < 0.001), intensive care unit
LOS (DM, -0.18; 95% CI, -0.31 to -0.04; P = 0.01), procedure time (DM,
-25.02; 95% CI, -32.70 to -17.35; P < 0.001); and fluoroscopy time (DM,
-1.63; 95% CI, -3.02 to -0.24; P = 0.02). No differences were observed
between LA and GA for stroke, cardiovascular mortality, myocardial
infarction, permanent pacemaker implantation, acute kidney injury,
paravalvular leak, vascular complications, major bleeding, procedural
success, conduction abnormalities, and annular rupture. Conclusion: Our
meta-analysis suggests that use of LA for TAVR is associated with a lower
30-day mortality, shorter procedure time, fluoroscopy time, ICU LOS,
hospital length of stay, and reduced need for inotropic
support.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<27>
Accession Number
620647616
Author
Shavit L.; Silberman S.; Tauber R.; Merin O.; Bitran D.; Fink D.
Institution
(Shavit) Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem,
Israel
(Silberman, Tauber, Merin, Bitran, Fink) Department of Cardiac Surgery,
Shaare Zedek Medical Center, Jerusalem, Israel
Title
Preoperative aldosterone receptor blockade and outcomes of cardiac surgery
in patients with chronic kidney disease.
Source
Clinical Nephrology. 89 (3) (pp 187-195), 2018. Date of Publication: 01
Mar 2018.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Background and aims: Recent clinical evidence demonstrates that chronic
low-dose mineralocorticoid receptor antagonists (MRA), when added to
optimal treatment, result in reductions in cardiovascular mortality.
However, continuation of MRAs before cardiac surgery in patients with CKD
has never been evaluated and its potential benefit or harm in this
specific clinical setting is largely unknown. Materials and methods: This
is an observational study that included adult CKD patients undergoing
cardiac surgery. Patients were divided into two groups according to
preoperative use of spironolactone (SPL). The studied outcomes were
postoperative acute kidney injury (AKI) requiring dialysis, mortality, and
major morbidities (cardiovascular, neurologic, and infectious). Results:
Data on 698 patients with preoperative CKD stage III and IV were analyzed:
99 received SPL preoperatively and 599 did not. At baseline, patients on
SPL had higher EuroScore and had more complicated surgery. No significant
differences in the incidence of postoperative AKI, myocardial infarction
(MI), cardiovascular accident (CVA), sepsis, and mortality were detected
between groups in both univariate and multivariate analyses. However,
incidence of postoperative low cardiac output state (p < 0.008) was
significantly higher in the SPL group. Propensity score matching analyses
yielded similar results. Conclusions: Although SPL is usually administered
to significantly sicker patients, its use is not associated with increased
major postoperative complications. However, the modulating effect of SPL
in this clinical study remains to be elucidated in a prospective
randomized trial.<br/>Copyright &#xa9; 2018 Dustri-Verlag Dr. K. Feistle.

<28>
Accession Number
620572429
Author
Ahmad Y.; Demir O.; Rajkumar C.; Howard J.P.; Shun-Shin M.; Cook C.;
Petraco R.; Jabbour R.; Arnold A.; Frame A.; Sutaria N.; Ariff B.;
Kanaganayagam G.; Francis D.; Mayet J.; Mikhail G.; Malik I.; Sen S.
Institution
(Ahmad, Demir, Rajkumar, Howard, Shun-Shin, Cook, Petraco, Jabbour,
Arnold, Frame, Sutaria, Ariff, Kanaganayagam, Francis, Mayet, Mikhail,
Malik, Sen) International Centre for Circulatory Health, Hammersmith
Hospital, Imperial College London, London, United Kingdom
Title
Optimal antiplatelet strategy after transcatheter aortic valve
implantation: A meta-analysis.
Source
Open Heart. 5 (1) (no pagination), 2018. Article Number: e000748. Date of
Publication: February 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: International guidelines recommend the use of dual antiplatelet
therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The
recommended duration of DAPT varies between guidelines. In this two-part
study, we (1) performed a structured survey of 45 TAVI centres from around
the world to determine if there is consensus among clinicians regarding
antiplatelet therapy after TAVI; and then (2) performed a systematic
review of all suitable studies (randomised controlled trials (RCTs) and
registries) to determine if aspirin monotherapy can be used instead of
DAPT. Methods: A structured electronic survey regarding antiplatelet use
after TAVI was completed by 45 TAVI centres across Europe, Australasia and
the USA. A systematic review of TAVI RCTs and registries was then
performed comparing DAPT duration and incidence of stroke, bleeding and
death. A variance weighted least squared metaregression was then performed
to determine the relationship of antiplatelet therapy and adverse events.
Results: 82.2% of centres routinely used DAPT after TAVI. Median duration
was 3 months. 13.3% based their practice on guidelines. 11 781 patients
(26 studies) were eligible for the metaregression. There was no benefit of
DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or
bleeding (P=0.91). Discussion: Aspirin monotherapy appears to be as safe
and effective as DAPT after TAVI.<br/>Copyright &#xa9; Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017.

<29>
Accession Number
620561087
Author
Robinson J.; Hartling L.; Vandermeer B.; Klassen T.P.
Institution
(Robinson, Hartling, Vandermeer) University of Alberta, Department of
Pediatrics, 3-588D, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada
(Klassen) Manitoba Institute of Child Health, 513-715 McDermot Avenue,
Winnipeg, MB R3E 3P4, Canada
Title
Intravenous immunoglobulin for presumed viral myocarditis in children and
adults.
Source
Cochrane Database of Systematic Reviews. 2015 (5) (no pagination), 2015.
Article Number: CD004370. Date of Publication: 20 May 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a previous review. Case reports and case
series have described dramatic responses to intravenous immunoglobulin
(IVIG) in people with presumed viral myocarditis, and its administration
has become commonplace. Objectives: The primary objective of this review
was to compare transplant-free survival of adults and children with
presumed viral myocarditis treated with IVIG versus those who did not
receive IVIG. A secondary objective was to determine if a group of
patients with presumed viral myocarditis could be identified (on the basis
of age, duration of symptoms, acuity of onset of symptoms, cardiac
function at presentation, virological results or the presence or absence
of histological evidence of acute myocarditis on cardiac biopsy in
patients in whom a biopsy was performed) who would be the most likely to
benefit from IVIG. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (2013, Issue 12 of 12), the
Database of Abstracts of Reviews of Effects (DARE) (2013, Issue 4 of 4),
MEDLINE (Ovid, 1946 to January Week 3 2014), EMBASE (Ovid, 1980 to Week 4
2014), the Cumulative Index to Nursing and Allied Health Literature
(CINAHL) EBSCO, Web of Science (Thomson Reuters, 1970 to 24 January 2014),
the Latin American and Caribbean Health Science Information Database
(LILACS) (1982 to 30 January 2014), trials registries and conference
proceedings. We contacted authors of trials and checked reference lists of
relevant papers. We applied no language restrictions. Selection criteria:
We included studies if (1) participants had a clinical diagnosis of acute
myocarditis with a left ventricular ejection fraction (LVEF) <= 0.45, left
ventricular end-diastolic diameter (LVEDD) > 2 standard deviations (SDs)
above the norm or a shortening fraction (SF) > 2 SDs below the mean with
duration of cardiac symptoms < 6 months; (2) participants had no evidence
of non-infectious or bacterial cardiac disease; and (3) participants were
randomly assigned to receive at least 1 g/kg of IVIG versus no IVIG or
placebo. We excluded studies if (1) participants had received
immunosuppression before outcome assessment; or (2) onset of myocarditis
was reported to occur < 6 months post partum. Data collection and
analysis: Two review authors screened searches and extracted data
independently. We assessed quality using the 'Risk of bias' tool.
Meta-analysis was not possible because only two relevant studies were
found, and researchers analysed markedly different populations. Main
results: In this update, review authors added one study to the study from
the original review. The first relevant study involved 62 adults with
recent-onset dilated cardiomyopathy randomly assigned to receive IVIG or
an equivalent volume of 0.1% albumin in a blinded fashion. The overall
risk of bias was unclear. The incidence of death or the requirement for
cardiac transplant or placement of a left ventricular assist device was
low in both groups (odds ratio (OR) for event-free survival 0.52, 95%
confidence interval (CI) 0.12 to 2.30). Follow-up at six months and at 12
months showed equivalent improvement in LVEF (mean difference (MD) 0.00,
95% CI -0.07 to 0.07 at six months; MD 0.01, 95% CI -0.06 to 0.08 at 12
months). Functional capacity as assessed by peak oxygen consumption was
equivalent in the two groups at 12 months (MD -0.80, 95% CI -4.57 to
2.97). Infusion-related side effects were more common in the treated
group, but all were reported to be mild (OR 30.16, 95% CI 1.69 to 539.42).
The second study added at this update included 83 children in India with
suspected viral encephalitis and myocarditis. The overall risk of bias was
high. The odds ratio for event-free survival was 7.39 (95% CI 0.91 to
59.86). Follow-up occurred only until hospital discharge, and LVEF was
49.5% in the treated group versus 35.9% in the placebo group (risk
difference 13.6%, 95% CI 5.1 to 22.1%; P value = 0.001). Authors'
conclusions: Evidence from one trial does not support the use of IVIG for
the treatment of adults with presumed viral myocarditis. The only
paediatric trial had high risk of bias but suggested that benefit may be
seen in the select group of children beyond the neonatal period who have
viral encephalitis with myocarditis. Until higher-quality studies have
demonstrated benefit in a particular group of patients, IVIG for presumed
viral myocarditis should not be provided as routine practice in any
situation. Further studies of the pathophysiology of myocarditis would
lead to improved diagnostic criteria, which would facilitate future
research.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<30>
Accession Number
620549256
Author
Holdefer R.N.; Mcauliffe J.; Seubert C.N.; Macdonald D.B.; Shils J.L.;
Edwards M.E.; Cohen B.A.; Sturm P.F.
Institution
(Holdefer) University of Washington School of Medicine, Department of
Rehabilitation, Box 359740, Seattle, WA 98104-2499, United States
(Mcauliffe) Cincinnati Children's Hospital Medical Center, Department of
Anesthesiology, 3333 Burnet Avenue, E3-238, Cincinnati, OH 45229-3039,
United States
(Seubert) University of Florida College of Medicine, Director,
Intraoperative Neurologic Monitoring Laboratory, Shands at UF,
Gainesville, FL, United States
(Macdonald) King Faisal Specialist Hospital and Research Center,
Department of Neurosciences, MBC 76, PO Box 3354, Riyadh 11211, Saudi
Arabia
(Shils) Rush University Medical Center, Department of Anesthesiology, 1750
W. Harrison (Suite 739 jelke), Chicago, IL 60612, United States
(Edwards) University of Florida, University of Florida Health Science
Center Libraries, 1600 SW Archer Road, PO Box 100206, Gainesville, FL
32610-0206, United States
(Cohen) Neurological Monitoring Associates, LLC, 333 West Brown Deer Road,
Suite 240, Milwaukee, WI 53217, United States
(Sturm) Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue,
ML2017, Cincinnati, OH 45229, United States
Title
Intraoperative neuromonitoring for the prevention of iatrogenic injury
during cervical and thoracic spine surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (8) (no pagination), 2015.
Article Number: CD011835. Date of Publication: 11 Aug 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: The primary objective of this systematic review is to test
the hypothesis that interventions performed in response to an IONM alert
reduce the incidence of iatrogenic injury during cervical and thoracic
spine surgeries.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<31>
Accession Number
620549188
Author
Katsura M.; Kuriyama A.; Takeshima T.; Fukuhara S.; Furukawa T.A.
Institution
(Katsura, Takeshima, Fukuhara) Kyoto University Graduate School of
Medicine and Public Health, Department of Healthcare Epidemiology,
Konoe-cho, Yoshida, Sakyo-ku, Kyoto 606-8501, Japan
(Katsura) Hyogo Cancer Center, Department of Surgery, Hyogo, Japan
(Kuriyama) Kurashiki Central Hospital, Department of General Medicine,
1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
(Furukawa) Kyoto University Graduate School of Medicine / School of Public
Health, Department of Health Promotion and Human Behavior, Yoshida
Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
Title
Preoperative inspiratory muscle training for postoperative pulmonary
complications in adults undergoing cardiac and major abdominal surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (10) (no pagination), 2015.
Article Number: CD010356. Date of Publication: 05 Oct 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative pulmonary complications (PPCs) have an impact on
the recovery of adults after surgery. It is therefore important to
establish whether preoperative respiratory rehabilitation can decrease the
risk of PPCs and to identify adults who might benefit from respiratory
rehabilitation. Objectives: Our primary objective was to assess the
effectiveness of preoperative inspiratory muscle training (IMT) on PPCs in
adults undergoing cardiac or major abdominal surgery. We looked at
all-cause mortality and adverse events. Search methods: We searched the
Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10),
MEDLINE (1966 to October 2014), EMBASE (1980 to October 2014), CINAHL
(1982 to October 2014), LILACS (1982 to October 2014), and ISI Web of
Science (1985 to October 2014). We did not impose any language
restrictions. Selection criteria: We included randomized controlled trials
that compared preoperative IMT and usual preoperative care for adults
undergoing cardiac or major abdominal surgery. Data collection and
analysis: Two or more review authors independently identified studies,
assessed trial quality, and extracted data. We extracted the following
information: study characteristics, participant characteristics,
intervention details, and outcome measures. We contacted study authors for
additional information in order to identify any unpublished data. Main
results: We included 12 trials with 695 participants; five trials included
participants awaiting elective cardiac surgery and seven trials included
participants awaiting elective major abdominal surgery. All trials
contained at least one domain judged to be at high or unclear risk of
bias. Of greatest concern was the risk of bias associated with inadequate
blinding, as it was impossible to blind participants due to the nature of
the study designs. We could pool postoperative atelectasis in seven trials
(443 participants) and postoperative pneumonia in 11 trials (675
participants) in a meta-analysis. Preoperative IMT was associated with a
reduction of postoperative atelectasis and pneumonia, compared with usual
care or non-exercise intervention (respectively; risk ratio (RR) 0.53, 95%
confidence interval (CI) 0.34 to 0.82 and RR 0.45, 95% CI 0.26 to 0.77).
We could pool all-cause mortality within postoperative period in seven
trials (431 participants) in a meta-analysis. However, the effect of IMT
on all-cause postoperative mortality is uncertain (RR 0.40, 95% CI 0.04 to
4.23). Eight trials reported the incidence of adverse events caused by
IMT. All of these trials reported that there were no adverse events in
both groups. We could pool the mean duration of hospital stay in six
trials (424 participants) in a meta-analysis. Preoperative IMT was
associated with reduced length of hospital stay (MD -1.33, 95% CI -2.53 to
-0.13). According to the Grades of Recommendation, Assessment, Development
and Evaluation (GRADE) Working Group guidelines for evaluating the impact
of healthcare interventions, the overall quality of studies for the
incidence of pneumonia was moderate, whereas the overall quality of
studies for the incidence of atelectasis, all-cause postoperative death,
adverse events, and duration of hospital stay was low or very low.
Authors' conclusions: We found evidence that preoperative IMT was
associated with a reduction of postoperative atelectasis, pneumonia, and
duration of hospital stay in adults undergoing cardiac and major abdominal
surgery. The potential for overestimation of treatment effect due to lack
of adequate blinding, small-study effects, and publication bias needs to
be considered when interpreting the present findings.<br/>Copyright &#xa9;
2015 The Cochrane Collaboration.

<32>
Accession Number
620551331
Author
Simancas-Racines D.; Osorio D.; Marti-Carvajal A.J.; Arevalo-Rodriguez I.
Institution
(Simancas-Racines, Osorio) Universidad Tecnologica Equinoccial, Facultad
de Ciencias de la Salud Eugenio Espejo, Edificio Bloque D. Of. Centro
Cochrane, Avenida Occidental s/n, y Avenida Mariana de Jesus, Quito,
Casilla Postal 17-01-2764, Ecuador
(Marti-Carvajal) Iberoamerican Cochrane Network, Valencia, Venezuela
(Arevalo-Rodriguez) Fundacion Universitaria de Ciencias de la Salud,
Hospital de San Jose/Hospital Infantil de San Jose, Division of Research,
Carrera 19 N 8a - 32, Bogota D.C., Bogota DC 11001, Colombia
Title
Leukoreduction for the prevention of adverse reactions from allogeneic
blood transfusion.
Source
Cochrane Database of Systematic Reviews. 2015 (12) (no pagination), 2015.
Article Number: CD009745. Date of Publication: 03 Dec 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: A blood transfusion is an acute intervention, implemented to
solve life and health-threatening conditions on a short-term basis.
However, blood transfusions have adverse events, some of them potentially
related to immune modulation or to a direct transmission of infectious
agents (e.g. cytomegalovirus). Leukoreduction is a process in which the
white blood cells are intentionally reduced in packed red blood cells
(PRBCs) in order to reduce the risk of adverse reactions. The potential
benefits of leukoreduced PRBCs in all types of transfused patients for
decreasing infectious and non-infectious complications remain unclear.
Objectives: To determine the clinical effectiveness of leukoreduction of
packed red blood cells for preventing adverse reactions following
allogeneic blood transfusion. Search methods: We ran the most recent
search on 10th November 2015. We searched the Cochrane Injuries Group's
Specialised Register, Cochrane Central Register of Controlled Trials
(CENTRAL, the Cochrane Library), MEDLINE (OvidSP), Embase(OvidSP), CINAHL
Plus (EBSCO), LILACS (BIREME), and clinical trials registers. In addition,
we checked the reference lists of all relevant trials and reviews
identified in the literature searches. Selection criteria: Randomised
clinical trials including patients of all ages requiring PRBC allogeneic
transfusion. Any study was eligible for inclusion, regardless of the
length of participant follow-up or country where the study was performed.
The primary outcome was transfusion-related acute lung injury (TRALI).
Secondary outcomes were death from any cause, infection from any cause,
non-infectious complications and any other adverse event. Data collection
and analysis: At least two review authors independently performed study
selection, 'Risk of bias' assessments and data extraction. We estimated
pooled relative risk for dichotomous outcomes, and we measured statistical
heterogeneity using I2 statistic. The random-effects model was used to
synthesise results. We conducted a trial sequential analysis to assess the
risk of random errors in cumulative meta-analyses. Main results: Thirteen
studies, most including adult patients, met the eligibility criteria. We
found no clear evidence of an effect of leukoreduced PRBC versus
non-leukoreduced PRBC in patients that were randomised to receive
transfusion for the following outcomes: TRALI: RR 0.96, 95% CI 0.67 to
1.36, P = 0.80 from one trial reporting data on 1864 trauma patients. The
accrued information of 1864 participants constituted only 28.5% of the
diversity-adjusted required information size (DARIS) of 6548 participants.
The quality of evidence was low. Death from any cause: RR 0.81, 95% CI
0.58 to 1.12, I2 statistic = 63%, P = 0.20 from nine trials reporting data
on 6485 cardiovascular surgical patients, gastro-oncology surgical
patients, trauma patients and HIV infected patients. The accrued
information of 6485 participants constituted only 55.3% of the DARIS of
11,735 participants. The quality of evidence was very low. Infection from
any cause: RR 0.80, 95% CI 0.62 to 1.03, I2 statistic = 84%, P = 0.08 from
10 trials reporting data on 6709 cardiovascular surgical patients,
gastro-oncology surgical patients, trauma patients and HIV infected
patients. The accrued information of 6709 participants constituted only
60.6% of the DARIS of 11,062 participants. The quality of evidence was
very low. Adverse events: The only adverse event reported as an adverse
event was fever (RR 0.81, 95% CI 0.64 to 1.02; I2 statistic= 0%, P =
0.07). Fever was reported in two trials on 634 cardiovascular surgical and
gastro-oncology surgical patients. The accrued information of 634
participants constituted only 84.4% of the DARIS of 751 participants. The
quality of evidence was low. Incidence of other non-infectious
complications: This outcome was not assessed in any included trial.
Authors' conclusions: There is no clear evidence for supporting or
rejecting the routine use of leukoreduction in all patients requiring PRBC
transfusion for preventing TRALI, death, infection, non-infectious
complications and other adverse events. As the quality of evidence is very
low to low, more evidence is needed before a definitive conclusion can be
drawn.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<33>
Accession Number
620551502
Author
Wilkinson K.L.; Brunskill S.J.; Doree C.; Trivella M.; Gill R.; Murphy
M.F.
Institution
(Wilkinson) Southampton University NHS Hospital, Paediatric and Adult
Cardiothoracic Anaesthesia, Tremona Road, Southampton SO16 6YD, United
Kingdom
(Brunskill, Doree) NHS Blood and Transplant, Systematic Review Initiative,
Level 2, John Radcliffe Hospital, Headington, Oxford, Oxon OX3 9BQ, United
Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Gill) Southampton University Hospital NHS Trust, Department of
Anaesthetics, Tremona Road, Southampton, Hampshire SO16 6YD, United
Kingdom
(Murphy) John Radcliffe Hospital, NHS Blood and Transplant, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Title
Red cell transfusion management for patients undergoing cardiac surgery
for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2014 (2) (no pagination), 2014.
Article Number: CD009752. Date of Publication: 07 Feb 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Congenital heart disease is the most commonly diagnosed
neonatal congenital condition. Without surgery, only 30% to 40% of
patients affected will survive to 10 years old. Mortality has fallen since
the 1990s with 2006 to 2007 figures showing surgical survival at one year
of 95%. Patients with congenital heart disease are potentially exposed to
red cell transfusion at many points in the surgical pathway. There are a
number of risks associated with red cell transfusion that may be
translated into increased patient morbidity and mortality. Objectives: To
evaluate the effects of red cell transfusion on mortality and morbidity on
patients with congenital heart disease at the time of cardiac surgery.
Search methods: We searched 11 bibliographic databases and three ongoing
trials databases including the Cochrane Central Register of Controlled
Trials (CENTRAL) (Issue 5, 2013), MEDLINE (Ovid, 1950 to 11 June 2013),
EMBASE (Ovid, 1980 to 11 June 2013), ClinicalTrials.gov, World Health
Organization (WHO) ICTRP and the ISRCTN Register (to June 2013). We also
searched references of all identified trials, relevant review articles and
abstracts from between 2006 and 2010 of the most relevant conferences. We
did not limit the searches by language of publication. Selection criteria:
We included randomised controlled trials (RCTs) comparing red cell
transfusion interventions in patients undergoing cardiac surgery for
congenital heart disease. We included participants of any age (neonates,
paediatrics and adults) and with any type of congenital heart disease
(cyanotic or acyanotic). We excluded patients with congenital heart
disease undergoing non-cardiac surgery. No co-morbidities were excluded.
Data collection and analysis: Two review authors independently assessed
trial quality and extracted data. We contacted study authors for
additional information. Main results: We identified 11 trials (862
participants). All trials were in neonatal or paediatric populations. The
trials covered only three areas of interest: restrictive versus liberal
transfusion triggers (two trials), leukoreduction versus
non-leukoreduction (two trials) and standard versus non-standard
cardiopulmonary bypass (CPB) prime (seven trials). Owing to the clinical
diversity in the participant groups (cyanotic (three trials), acyanotic
(four trials) or mixed (four trials)) and the intervention groups, it was
not appropriate to pool data in a meta-analysis. No study reported data
for all the outcomes of interest to this review. Risk of bias was mixed
across the included trials, with only attrition bias being low across all
trials. Blinding of study personnel and participants was not always
possible, depending on the intervention being used. Five trials (628
participants) reported the primary outcome: 30-day mortality. In three
trials (a trial evaluating restrictive and liberal transfusion (125
participants), a trial of cell salvage during CPB (309 participants) and a
trial of washed red blood cells during CPB (128 participants)), there was
no clear difference in mortality at 30 days between the intervention arms.
In two trials comparing standard and non-standard CPB prime, there were no
deaths in either randomised group. Long-term mortality was similar between
randomised groups in one trial each comparing restrictive and liberal
transfusion or standard and non-standard CPB prime. Four trials explored a
range of adverse effects following red cell transfusion. Kidney failure
was the only adverse event that was significantly different: patients
receiving cell salvaged red blood cells during CPB were less likely to
have renal failure than patients not exposed to cell salvage (risk ratio
(RR) 0.26, 95% confidence interval (CI) 0.09 to 0.79, 1 study, 309
participants). There was insufficient evidence to determine whether there
was a difference between transfusion strategies for any other severe
adverse events. The duration of mechanical ventilation was measured in
seven trials (768 participants). Overall, there was no consistent
difference in the duration of mechanical ventilation between the
intervention and control arms. The duration of intensive care unit (ICU)
stay was measured in six trials (459 participants). There was no clear
difference in the duration of ICU stay between the intervention arms in
the transfusion trigger and leukoreduction trials. In the standard versus
non-standard CPB prime trials, one trial examining the impact of washing
transfused bypass prime red blood cells showed no clear difference in
duration of ICU stay between the intervention arms, while the trial
assessing ultrafiltration of the priming blood showed a shorter duration
of ICU stay in the ultrafiltration group. Authors' conclusions: There are
only a small number of small and heterogeneous trials so there is
insufficient evidence to assess the impact of red cell transfusion on
patients with congenital heart disease undergoing cardiac surgery
accurately. It is possible that the presence or absence of cyanosis
impacts on trial outcomes, which would necessitate different clinical
management of two groups. Further adequately powered, specific,
high-quality trials are warranted to assess this fully.<br/>Copyright
&#xa9; 2014 The Cochrane Collaboration.

<34>
Accession Number
620562475
Author
Blessberger H.; Kammler J.; Domanovits H.; Schlager O.; Wildner B.; Azar
D.; Schillinger M.; Wiesbauer F.; Steinwender C.
Institution
(Blessberger, Kammler, Steinwender) Linz General Hospital (Allgemeines
Krankenhaus Linz) Johannes Kepler University School of Medicine,
Department of Internal Medicine I - Cardiology, Krankenhausstrase 9, Linz
4020, Austria
(Domanovits) Vienna General Hospital, Medical University of Vienna,
Department of Emergency Medicine, Wahringer Gurtel 18-20, Vienna 1090,
Austria
(Schlager, Schillinger) Vienna General Hospital, Medical University of
Vienna, Department of Internal Medicine II, Division of Angiology,
Wahringer Gurtel 18-20, Vienna 1090, Austria
(Wildner) University Library of the Medical University of Vienna,
Information Retrieval Office, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Azar) Landesklinikum Thermenregion Baden, Department of General Surgery,
Wimmergasse 19, Baden 2500, Austria
(Wiesbauer) Division of Cardiology, Vienna General Hospital, Medical
University of Vienna, Department of Internal Medicine II, Wahringerstrasse
18-20, Vienna 1090, Austria
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
Cochrane Database of Systematic Reviews. 2014 (9) (no pagination), 2014.
Article Number: CD004476. Date of Publication: 18 Sep 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Randomized controlled trials have yielded conflicting results
regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue. Objectives:
The objective of this review was to systematically analyse the effects of
perioperatively administered beta-blockers for prevention of
surgery-related mortality and morbidity in patients undergoing any type of
surgery while under general anaesthesia. Search methods: We identified
trials by searching the following databases from the date of their
inception until June 2013: MEDLINE, EMBASE, the Cochrane Central Register
of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative
Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File,
Science Citation Index Expanded, Life Sciences Collection, Global Health
and PASCAL. In addition, we searched online resources to identify grey
literature. Selection criteria: We included randomized controlled trials
if participants were randomly assigned to a beta-blocker group or a
control group (standard care or placebo). Surgery (any type) had to be
performed with all or at least a significant proportion of participants
under general anaesthesia. Data collection and analysis: Two review
authors independently extracted data from all studies. In cases of
disagreement, we reassessed the respective studies to reach consensus. We
computed summary estimates in the absence of significant clinical
heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and
mean differences (MDs) were used for continuous outcomes. We performed
subgroup analyses for various potential effect modifiers. Main results: We
included 89 randomized controlled trials with 19,211 participants. Six
studies (7%) met the highest methodological quality criteria (studies with
overall low risk of bias: adequate sequence generation, adequate
allocation concealment, double/triple-blinded design with a placebo group,
intention-to-treat analysis), whereas in the remaining trials, some form
of bias was present or could not be definitively excluded (studies with
overall unclear or high risk of bias). Outcomes were evaluated separately
for cardiac and non-cardiac surgery. CARDIAC SURGERY (53 trials) We found
no clear evidence of an effect of beta-blockers on the following outcomes.
* All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants,
moderate quality of evidence. * Acute myocardial infarction (AMI): RR
1.04, 95% CI 0.71 to 1.51, 3553 participants, moderate quality of
evidence. * Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166
participants, low quality of evidence. * Cerebrovascular events: RR 1.52,
95% CI 0.58 to 4.02, 1400 participants, low quality of evidence. *
Hypotension: RR 1.54, 95% CI 0.67 to 3.51, 558 participants, low quality
of evidence. * Bradycardia: RR 1.61, 95% CI 0.97 to 2.66, 660
participants, low quality of evidence. * Congestive heart failure: RR
0.22, 95% CI 0.04 to 1.34, 311 participants, low quality of evidence.
Beta-blockers significantly reduced the occurrence of the following
endpoints. * Ventricular arrhythmias: RR 0.37, 95% CI 0.24 to 0.58, number
needed to treat for an additional beneficial outcome (NNTB) 29, 2292
participants, moderate quality of evidence. * Supraventricular
arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB six, 6420 participants,
high quality of evidence. * On average, beta-blockers reduced length of
hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450 participants, low
quality of evidence). NON-CARDIAC SURGERY (36 trials) We found a potential
increase in the occurrence of the following outcomes with the use of
beta-blockers. * All-cause mortality: RR 1.24, 95% CI 0.99 to 1.54, 11,463
participants, low quality of evidence. Whereas no clear evidence of an
effect was noted when all studies were analysed, restricting the
meta-analysis to low risk of bias studies revealed a significant increase
in all-cause mortality with the use of beta-blockers: RR 1.27, 95% CI 1.01
to 1.59, number needed to treat for an additional harmful outcome (NNTH)
189, 10,845 participants. * Cerebrovascular events: RR 1.59, 95% CI 0.93
to 2.71, 9150 participants, low quality of evidence. Whereas no clear
evidence of an effect was found when all studies were analysed,
restricting the meta-analysis to low risk of bias studies revealed a
significant increase in cerebrovascular events with the use of
beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 255, 8648 participants.
Beta-blockers significantly reduced the occurrence of the following
endpoints. * AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 72, 10,958
participants, high quality of evidence. * Myocardial ischaemia: RR 0.43,
95% CI 0.27 to 0.70, NNTB seven, 1028 participants, moderate quality of
evidence. * Supraventricular arrhythmias: RR 0.72, 95% CI 0.56 to 0.92,
NNTB 111, 8794 participants, high quality of evidence. Beta-blockers
significantly increased the occurrence of the following adverse events. *
Hypotension: RR 1.50, 95% CI 1.38 to 1.64, NNTH 15, 10,947 participants,
high quality of evidence. * Bradycardia: RR 2.24, 95% CI 1.49 to 3.35,
NNTH 18, 11,083 participants, moderate quality of evidence. We found no
clear evidence of an effect of beta-blockers on the following outcomes. *
Ventricular arrhythmias: RR 0.64, 95% CI 0.30 to 1.33, 526 participants,
moderate quality of evidence. * Congestive heart failure: RR 1.17, 95% CI
0.93 to 1.47, 9223 participants, moderate quality of evidence. * Length of
hospital stay: mean difference -0.27 days, 95% CI -1.29 to 0.75, 601
participants, low quality of evidence. Authors' conclusions: According to
our findings, perioperative application of beta-blockers still plays a
pivotal role in cardiac surgery, as they can substantially reduce the high
burden of supraventricular and ventricular arrhythmias in the aftermath of
surgery. Their influence on mortality, AMI, stroke, congestive heart
failure, hypotension and bradycardia in this setting remains unclear. In
non-cardiac surgery, evidence from low risk of bias trials shows an
increase in all-cause mortality and stroke with the use of beta-blockers.
As the quality of evidence is still low to moderate, more evidence is
needed before a definitive conclusion can be drawn. The substantial
reduction in supraventricular arrhythmias and AMI in this setting seems to
be offset by the potential increase in mortality and stroke.<br/>Copyright
&#xa9; 2014 The Cochrane Collaboration.

<35>
Accession Number
620559841
Author
Koranyi S.; Barth J.; Trelle S.; Strauss B.M.; Rosendahl J.
Institution
(Koranyi, Strauss, Rosendahl) University Hospital of Jena, Institute of
Psychosocial Medicine and Psychotherapy, Stoystrasse 3, Jena, Thuringia
07743, Germany
(Barth, Trelle) University of Bern, Institute of Social and Preventive
Medicine, Niesenweg 6, Bern CH-3012, Switzerland
(Trelle) University of Bern, CTU Bern, Bern, Switzerland
Title
Psychological interventions for acute pain after open heart surgery.
Source
Cochrane Database of Systematic Reviews. 2014 (5) (no pagination), 2014.
Article Number: CD009984. Date of Publication: 26 May 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Acute postoperative pain is one of the most disturbing
complaints in open heart surgery, and is associated with a risk of
negative consequences. Several trials investigated the effects of
psychological interventions to reduce acute postoperative pain and improve
the course of physical and psychological recovery of participants
undergoing open heart surgery. Objectives: To compare the efficacy of
psychological interventions as an adjunct to standard care versus standard
care alone or standard care plus attention in adults undergoing open heart
surgery on pain, pain medication, mental distress, mobility, and time to
extubation. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE
(1946 to September 2013), EMBASE (1980 to September 2013), Web of Science
(all years to September 2013), and PsycINFO (all years to September 2013)
for eligible studies. We used the 'related articles' and 'cited by'
options of eligible studies to identify additional relevant studies. We
also checked lists of references of relevant articles and previous
reviews. We also searched the ProQuest Dissertations and Theses Full Text
Database (all years to September 2013) and contacted the authors of
primary studies to identify any unpublished material. Selection criteria:
Randomised controlled trials comparing psychological interventions as an
adjunct to standard care versus standard care alone or standard care plus
attention in adults undergoing open heart surgery. Data collection and
analysis: Two review authors (SK and JR) independently assessed trials for
eligibility, estimated the risk of bias and extracted all data. We
calculated effect sizes for each comparison (Hedges' g) and meta-analysed
data using a random-effects model. Main results: Nineteen trials were
included (2164 participants). No study reported data on the number of
participants with pain intensity reduction of at least 50% from baseline.
Only one study reported data on the number of participants below 30/100 mm
on the Visual Analogue Scale (VAS) in pain intensity. Psychological
interventions have no beneficial effects in reducing pain intensity
measured with continuous scales in the medium-term interval (g -0.02, 95%
CI -0.24 to 0.20, 4 studies, 413 participants, moderate quality evidence)
nor in the long-term interval (g 0.12, 95% CI -0.09 to 0.33, 3 studies,
280 participants, low quality evidence). No study reported data on median
time to remedication or on number of participants remedicated. Only one
study provided data on postoperative analgesic use. Studies reporting data
on mental distress in the medium-term interval revealed a small beneficial
effect of psychological interventions (g 0.36, 95% CI 0.10 to 0.62, 12
studies, 1144 participants, low quality evidence). Likewise, a small
beneficial effect of psychological interventions on mental distress was
obtained in the long-term interval (g 0.28, 95% CI 0.05 to 0.51, 11
studies, 1320 participants, low quality evidence). There were no
beneficial effects of psychological interventions on mobility in the
medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444
participants, low quality evidence) nor in the long-term interval (g 0.29,
95% CI -0.14 to 0.71, 4 studies, 423 participants, low quality evidence).
Only one study reported data on time to extubation. Authors' conclusions:
For the majority of outcomes (two-thirds) we could not perform a
meta-analysis since outcomes were not measured, or data were provided by
one trial only. Psychological interventions have no beneficial effects on
reducing postoperative pain intensity or enhancing mobility. There is low
quality evidence that psychological interventions reduce postoperative
mental distress. Due to limitations in methodological quality, a small
number of studies, and large heterogeneity, we rated the quality of the
body of evidence as low. Future trials should measure crucial outcomes
(e.g. number of participants with pain intensity reduction of at least 50%
from baseline) and should focus to enhance the quality of the body of
evidence in general. Altogether, the current evidence does not clearly
support the use of psychological interventions to reduce pain in
participants undergoing open heart surgery.<br/>Copyright &#xa9; 2014 The
Cochrane Collaboration.

<36>
Accession Number
620561729
Author
Penninga L.; Moller C.H.; Gustafsson F.; Gluud C.; Steinbruchel D.A.
Institution
(Penninga) Rigshospitalet, Copenhagen University Hospital, Copenhagen
Trial Unit, Centre for Clinical Intervention Research, Department 7812,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Moller, Steinbruchel) Rigshospitalet, Copenhagen University Hospital,
Department of Cardiothoracic Surgery, RT 2152, Blegdamsvej 9, Copenhagen
DK-2100, Denmark
(Gustafsson) Copenhagen University Hospital, Department of Cardiology B,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Immunosuppressive T-cell antibody induction for heart transplant
recipients.
Source
Cochrane Database of Systematic Reviews. 2013 (12) (no pagination), 2013.
Article Number: CD008842. Date of Publication: 02 Dec 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Heart transplantation has become a valuable and well-accepted
treatment option for end-stage heart failure. Rejection of the
transplanted heart by the recipient's body is a risk to the success of the
procedure, and life-long immunosuppression is necessary to avoid this.
Clear evidence is required to identify the best, safest and most effective
immunosuppressive treatment strategy for heart transplant recipients. To
date, there is no consensus on the use of immunosuppressive antibodies
against T-cells for induction after heart transplantation. Objectives: To
review the benefits, harms, feasibility and tolerability of
immunosuppressive T-cell antibody induction versus placebo, or no antibody
induction, or another kind of antibody induction for heart transplant
recipients. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (Issue 11, 2012), MEDLINE (Ovid) (1946 to
November Week 1 2012), EMBASE (Ovid) (1946 to 2012 Week 45), ISI Web of
Science (14 November 2012); we also searched two clinical trial registers
and checked reference lists in November 2012. Selection criteria: We
included all randomised clinical trials (RCTs) assessing immunosuppressive
T-cell antibody induction for heart transplant recipients. Within
individual trials, we required all participants to receive the same
maintenance immunosuppressive therapy. Data collection and analysis: Two
authors extracted data independently. RevMan analysis was used for
statistical analysis of dichotomous data with risk ratio (RR), and of
continuous data with mean difference (MD), both with 95% confidence
intervals (CI). Methodological components were used to assess risks of
systematic errors (bias). Trial sequential analysis was used to assess the
risks of random errors (play of chance). We assessed mortality, acute
rejection, infection, Cytomegalovirus (CMV) infection,
post-transplantation lymphoproliferative disorder, cancer, adverse events,
chronic allograft vasculopathy, renal function, hypertension, diabetes
mellitus, and hyperlipidaemia. Main results: In this review, we included
22 RCTs that investigated the use of T-cell antibody induction, with a
total of 1427 heart-transplant recipients. All trials were judged to be at
a high risk of bias. Five trials, with a total of 606 participants,
compared any kind of T-cell antibody induction versus no antibody
induction; four trials, with a total of 576 participants, compared
interleukin-2 receptor antagonist (IL-2 RA) versus no induction; one
trial, with 30 participants, compared monoclonal antibody (other than IL-2
RA) versus no antibody induction; two trials, with a total of 159
participants, compared IL-2 RA versus monoclonal antibody (other than IL-2
RA) induction; four trials, with a total of 185 participants, compared
IL-2 RA versus polyclonal antibody induction; seven trials, with a total
of 315 participants, compared monoclonal antibody (other than IL-2 RA)
versus polyclonal antibody induction; and four trials, with a total of 162
participants, compared polyclonal antibody induction versus another kind,
or dose of polyclonal antibodies. No significant differences were found
for any of the comparisons for the outcomes of mortality, infection, CMV
infection, post-transplantation lymphoproliferative disorder, cancer,
adverse events, chronic allograft vasculopathy, renal function,
hypertension, diabetes mellitus, or hyperlipidaemia. Acute rejection
occurred significantly less frequently when IL-2 RA induction was compared
with no induction (93/284 (33%) versus 132/292 (45%); RR 0.73; 95% CI 0.59
to 0.90; I² 57%) applying the fixed-effect model. No
significant difference was found when the random-effects model was applied
(RR 0.73; 95% CI 0.46 to 1.17; I² 57%). In addition, acute
rejection occurred more often statistically when IL-2 RA induction was
compared with polyclonal antibody induction (24/90 (27%) versus 10/95
(11%); RR 2.43; 95% CI 1.01 to 5.86; I² 28%). For all of these
differences in acute rejection, trial sequential alpha-spending boundaries
were not crossed and the required information sizes were not reached when
trial sequential analysis was performed, indicating that we cannot exclude
random errors. We observed some occasional significant differences in
adverse events in some of the comparisons, however definitions of adverse
events varied between trials, and numbers of participants and events in
these outcomes were too small to allow definitive conclusions to be drawn.
Authors' conclusions: This review shows that acute rejection might be
reduced by IL-2 RA compared with no induction, and by polyclonal antibody
induction compared with IL-2 RA, though trial sequential analyses cannot
exclude random errors, and the significance of our observations depended
on the statistical model used. Furthermore, this review does not show
other clear benefits or harms associated with the use of any kind of
T-cell antibody induction compared with no induction, or when one type of
T-cell antibody is compared with another type of antibody. The number of
trials investigating the use of antibodies against T-cells for induction
after heart transplantation is small, and the number of participants and
outcomes in these RCTs is limited. Furthermore, the included trials are at
a high risk of bias. Hence, more RCTs are needed to assess the benefits
and harms of T-cell antibody induction for heart-transplant recipients.
Such trials ought to be conducted with low risks of systematic and random
error.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.

<37>
Accession Number
620561650
Author
Bradt J.; Dileo C.; Potvin N.
Institution
(Bradt) College of Nursing and Health Professions, Drexel University,
Department of Creative Arts Therapies, 1505 Race Street, rm 1041,
Philadelphia, PA 19102, United States
(Dileo) Boyer College of Music and Dance, Temple University, Department of
Music Therapy and The Arts and Quality of Life Research Center,
Philadelphia, United States
(Potvin) College of Nursing and Health Professions, Drexel University,
Department of Creative Arts Therapies, 1505 Race Street, rm 1041,
Philadelphia, PA 19102, United States
Title
Music for stress and anxiety reduction in coronary heart disease patients.
Source
Cochrane Database of Systematic Reviews. 2013 (12) (no pagination), 2013.
Article Number: CD006577. Date of Publication: 28 Dec 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Individuals with coronary heart disease (CHD) often suffer
from severe distress due to diagnosis, hospitalization, surgical
procedures, uncertainty of outcome, fear of dying, doubts about progress
in recovery, helplessness and loss of control. Such adverse effects put
the cardiac patient at greater risk for complications, including sudden
cardiac death. It is therefore of crucial importance that the care of
people with CHD focuses on psychological as well as physiological needs.
Music interventions have been used to reduce anxiety and distress and
improve physiological functioning in medical patients; however its
efficacy for people with CHD needs to be evaluated. Objectives: To update
the previously published review that examined the effects of music
interventions with standard care versus standard care alone on
psychological and physiological responses in persons with CHD. Search
methods: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) on The Cochrane Library (2012, Issue 10), MEDLINE (OvidSP, 1950
to October week 4 2012), EMBASE (OvidSP, 1974 to October week 5 2012),
CINAHL (EBSCOhost, 1982 to 9 November 2012), PsycINFO (OvidSP, 1806 to
October week 5 2012), LILACS (Virtual Health Library, 1982 to 15 November
2012), Social Science Citation Index (ISI, 1974 to 9 November 2012), a
number of other databases, and clinical trial registers. We also conducted
handsearching of journals and reference lists. We applied no language
restrictions. Selection criteria: We included all randomized controlled
trials and quasi-randomized trials that compared music interventions and
standard care with standard care alone for persons with confirmed CHD.
Data collection and analysis: Two review authors independently extracted
data and assessed methodological quality, seeking additional information
from the trial researchers when necessary. We present results using
weighted mean differences for outcomes measured by the same scale, and
standardized mean differences for outcomes measured by different scales.
We used post-intervention scores. In cases of significant baseline
difference, we used change scores (changes from baseline). Main results:
We identified four new trials for this update. In total, the evidence for
this review rests on 26 trials (1369 participants). Listening to music was
the main intervention used, and 23 of the studies did not include a
trained music therapist. Results indicate that music interventions have a
small beneficial effect on psychological distress in people with CHD and
this effect is consistent across studies (MD = -1.26, 95% CI -2.30 to
-0.22, P = 0.02, I2 = 0%). Listening to music has a moderate effect on
anxiety in people with CHD; however results were inconsistent across
studies (SMD = -0.70, 95% CI -1.17 to -0.22, P = 0.004, I2 = 77%). Studies
that used music interventions in people with myocardial infarction found
more consistent anxiety-reducing effects of music, with an average anxiety
reduction of 5.87 units on a 20 to 80 point score range (95% CI -7.99 to
-3.75, P < 0.00001, I2 = 53%). Furthermore, studies that used
patient-selected music resulted in greater anxiety-reducing effects that
were consistent across studies (SMD = -0.89, 95% CI -1.42 to -0.36, P =
0.001, I2 = 48%). Findings indicate that listening to music reduces heart
rate (MD = -3.40, 95% CI -6.12 to -0.69, P = 0.01), respiratory rate (MD =
-2.50, 95% CI -3.61 to -1.39, P < 0.00001) and systolic blood pressure (MD
= -5.52 mmHg, 95% CI - 7.43 to -3.60, P < 0.00001). Studies that included
two or more music sessions led to a small and consistent pain-reducing
effect (SMD = -0.27, 95% CI -0.55 to -0.00, P = 0.05). The results also
suggest that listening to music may improve patients' quality of sleep
following a cardiac procedure or surgery (SMD = 0.91, 95% CI 0.03 to 1.79,
P = 0.04). We found no strong evidence for heart rate variability and
depression. Only one study considered hormone levels and quality of life
as an outcome variable. A small number of studies pointed to a possible
beneficial effect of music on opioid intake after cardiac procedures or
surgery, but more research is needed to strengthen this evidence. Authors'
conclusions: This systematic review indicates that listening to music may
have a beneficial effect on anxiety in persons with CHD, especially those
with a myocardial infarction. Anxiety-reducing effects appear to be
greatest when people are given a choice of which music to listen to.
Furthermore, listening to music may have a beneficial effect on systolic
blood pressure, heart rate, respiratory rate, quality of sleep and pain in
persons with CHD. However, the clinical significance of these findings is
unclear. Since many of the studies are at high risk of bias, these
findings need to be interpreted with caution. More research is needed into
the effects of music interventions offered by a trained music
therapist.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.

<38>
Accession Number
620561263
Author
Svircevic V.; Passier M.M.; Nierich A.P.; van Dijk D.; Kalkman C.J.; van
der Heijden G.J.
Institution
(Svircevic, Passier, Kalkman) University Medical Center Utrecht,
Department of Perioperative Care and Emergency Medicine, PO Box 85500,
Mailstop E 03.511, Utrecht 3508 GA, Netherlands
(Nierich) Isala Clinics, Thoracic Anaesthesiology and Intensive care, PO
Box 10500, Zwolle 8000 GM, Netherlands
(van Dijk) University Medical Center Utrecht, Division of Anesthesiology,
Intensive Care and Emergency Medicine, PO Box 85500, Utrecht 3508 GA,
Netherlands
(van der Heijden) Academic Center for Dentistry Amsterdam (ACTA),
Department of Social Dentistry, Gustav Mahlerlaan 3004, Amsterdam 1081LA,
Netherlands
Title
Epidural analgesia for cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (6) (no pagination), 2013.
Article Number: CD006715. Date of Publication: 06 Jun 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: A combination of general anaesthesia (GA) with thoracic
epidural analgesia (TEA) may have a beneficial effect on clinical outcomes
by reducing the risk of perioperative complications after cardiac surgery.
Objectives: The objective of this review was to determine the impact of
perioperative epidural analgesia in cardiac surgery on perioperative
mortality and cardiac, pulmonary or neurological morbidity. We performed a
meta-analysis to compare the risk of adverse events and mortality in
patients undergoing cardiac surgery under general anaesthesia with and
without epidural analgesia. Search methods: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) (2012, Issue 12) in The
Cochrane Library; MEDLINE (PubMed) (1966 to November 2012); EMBASE (1989
to November 2012); CINHAL (1982 to November 2012) and the Science Citation
Index (1988 to November 2012). Selection criteria: We included randomized
controlled trials comparing outcomes in adult patients undergoing cardiac
surgery with either GA alone or GA in combination with TEA. Data
collection and analysis: All publications found during the search were
manually and independently reviewed by the two authors. We identified 5035
titles, of which 4990 studies did not satisfy the selection criteria or
were duplicate publications, that were retrieved from the five different
databases. We performed a full review on 45 studies, of which 31
publications met all inclusion criteria. These 31 publications reported on
a total of 3047 patients, 1578 patients with GA and 1469 patients with GA
plus TEA. Main results: Through our search (November 2012) we have
identified 5035 titles, of which 31 publications met our inclusion
criteria and reported on a total of 3047 patients. Compared with GA alone,
the pooled risk ratio (RR) for patients receiving GA with TEA showed an
odds ratio (OR) of 0.84 (95% CI 0.33 to 2.13, 31 studies) for mortality;
0.76 (95% CI 0.49 to 1.19, 17 studies) for myocardial infarction; and 0.50
(95% CI 0.21 to 1.18, 10 studies) for stroke. The relative risks (RR) for
respiratory complications and supraventricular arrhythmias were 0.68 (95%
CI 0.54 to 0.86, 14 studies) and 0.65 (95% CI 0.50 to 0.86, 15 studies)
respectively. Authors' conclusions: This meta-analysis of studies,
identified to 2010, showed that the use of TEA in patients undergoing
coronary artery bypass graft surgery may reduce the risk of postoperative
supraventricular arrhythmias and respiratory complications. There were no
effects of TEA with GA on the risk of mortality, myocardial infarction or
neurological complications compared with GA alone.<br/>Copyright &#xa9;
2013 The Cochrane Collaboration.

<39>
Accession Number
620561163
Author
Massel D.R.; Little S.H.
Institution
(Massel) Cardiology, London Health Sciences Centre, University Campus, 339
Windermere Road, London, ON N6A 5A5, Canada
(Little) Cardiovascular Imaging Section, Department of Cardiology, The
Methodist DeBakey Heart and Vascular Center, Weill Medical College of
Cornell University, 6550 Fannin Street, SM-677, Houston, TX 77030, United
States
Title
Antiplatelet and anticoagulation for patients with prosthetic heart
valves.
Source
Cochrane Database of Systematic Reviews. 2013 (7) (no pagination), 2013.
Article Number: CD003464. Date of Publication: 09 Jul 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients with prosthetic heart valves are at increased risk
for valve thrombosis and arterial thromboembolism. Oral anticoagulation
alone, or the addition of antiplatelet drugs, has been used to minimise
this risk. An important issue is the effectiveness and safety of the
latter strategy. Objectives: This is an update of our previous review; the
goal was to create a valid synthesis of all available, methodologically
sound data to further assess the safety and efficacy of combined oral
anticoagulant and antiplatelet therapy versus oral anticoagulant
monotherapy in patients with prosthetic heart valves. Search methods: We
updated the previous searches from 2003 and 2010 on 16 January 2013 and
searched the Cochrane Central Register of Controlled Trials (CENTRAL) on
The Cochrane Library (2012, Issue 12), MEDLINE (OVID, 1946 to January Week
1 2013), and EMBASE (OVID, 1980 to 2013 Week 02). We have also looked at
reference lists of individual reports, review articles, meta-analyses, and
consensus statements. We included reports published in any language or in
abstract form. Selection criteria: All reports of randomised controlled
trials comparing standard-dose oral anticoagulation to standard-dose oral
anticoagulation and antiplatelet therapy in patients with one or more
prosthetic heart valves. Data collection and analysis: Two review authors
independently performed the search strategy, assessed trials for inclusion
and study quality, and extracted data. We collected adverse effects
information from the trials. Main results: One new study has been
identified and included in this update. In total, 13 studies involving
4122 participants were included in this review update. Years of
publication ranged from 1971 to 2011. Compared with anticoagulation alone,
the addition of an antiplatelet agent reduced the risk of thromboembolic
events (odds ratio (OR) 0.43, 95% confidence interval (CI) 0.32 to 0.59; P
< 0.00001) and total mortality (OR 0.57, 95% CI 0.42 to 0.78; P = 0.0004).
Aspirin and dipyridamole reduced these events similarly. The risk of major
bleeding was increased when antiplatelet agents were added to oral
anticoagulants (OR 1.58, 95% CI 1.14 to 2.18; P = 0.006). For major
bleeding, there was no evidence of heterogeneity between aspirin and
dipyridamole and in the comparison of trials performed before and after
1990, around the time when anticoagulation standardisation with the
international normalised ratio was being implemented. A lower daily dose
of aspirin (< 100 mg) may be associated with a lower major bleeding risk
than higher doses. Authors' conclusions: Adding antiplatelet therapy,
either dipyridamole or low-dose aspirin, to oral anticoagulation decreases
the risk of systemic embolism or death among patients with prosthetic
heart valves. The risk of major bleeding is increased with antiplatelet
therapy. These results apply to patients with mechanical prosthetic valves
or those with biological valves and indicators of high risk such as atrial
fibrillation or prior thromboembolic events. The effectiveness and safety
of low-dose aspirin (100 mg daily) appears to be similar to higher-dose
aspirin and dipyridamole. In general, the quality of the included trials
tended to be low, possibly reflecting the era when the majority of the
trials were conducted (1970s and 1980s when trial methodology was less
advanced).<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.

<40>
Accession Number
620551067
Author
Hemmingsen B.; Lund S.S.; Gluud C.; Vaag A.; Almdal T.P.; Hemmingsen C.;
Wetterslev J.
Institution
(Hemmingsen) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Lund, Hemmingsen) Private, Copenhagen, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Vaag) Rigshospitalet and Copenhagen University, Department of
Endocrinology, Diabetes and Metabolism, Afsnit 7652, Kobenhavn N 2200,
Denmark
(Almdal) Copenhagen University Hospital Gentofte, Department of Medicine
F, Hellerup 2900, Denmark
(Wetterslev) Rigshospitalet, Copenhagen University Hospital, Copenhagen
Trial Unit, Centre for Clinical Intervention Research, Department 7812,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Targeting intensive glycaemic control versus targeting conventional
glycaemic control for type 2 diabetes mellitus.
Source
Cochrane Database of Systematic Reviews. 2013 (11) (no pagination), 2013.
Article Number: CD008143. Date of Publication: 11 Nov 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients with type 2 diabetes mellitus (T2D) have an increased
risk of cardiovascular disease and mortality compared to the background
population. Observational studies report an association between reduced
blood glucose and reduced risk of both micro- and macrovascular
complications in patients with T2D. Our previous systematic review of
intensive glycaemic control versus conventional glycaemic control was
based on 20 randomised clinical trials that randomised 29,986 participants
with T2D. We now report our updated review. Objectives: To assess the
effects of targeted intensive glycaemic control compared with conventional
glycaemic control in patients with T2D. Search methods: Trials were
obtained from searches of The Cochrane Library, MEDLINE, EMBASE, Science
Citation Index Expanded, LILACS, and CINAHL (all until December 2012).
Selection criteria: We included randomised clinical trials that
prespecified targets of intensive glycaemic control versus conventional
glycaemic control targets in adults with T2D. Data collection and
analysis: Two authors independently assessed the risk of bias and
extracted data. Dichotomous outcomes were assessed by risk ratios (RR) and
95% confidence intervals (CI). Health-related quality of life and costs of
intervention were assessed with standardized mean differences (SMD) and
95% Cl. Main results: Twenty-eight trials with 34,912 T2D participants
randomised 18,717 participants to intensive glycaemic control versus
16,195 participants to conventional glycaemic control. Only two trials had
low risk of bias on all risk of bias domains assessed. The duration of the
intervention ranged from three days to 12.5 years. The number of
participants in the included trials ranged from 20 to 11,140. There were
no statistically significant differences between targeting intensive
versus conventional glycaemic control for all-cause mortality (RR 1.00,
95% CI 0.92 to 1.08; 34,325 participants, 24 trials) or cardiovascular
mortality (RR 1.06, 95% CI 0.94 to 1.21; 34,177 participants, 22 trials).
Trial sequential analysis showed that a 10% relative risk reduction could
be refuted for all-cause mortality. Targeting intensive glycaemic control
did not show a statistically significant effect on the risks of
macrovascular complications as a composite outcome in the random-effects
model, but decreased the risks in the fixed-effect model (random RR 0.91,
95% CI 0.82 to 1.02; and fixed RR 0.93, 95% CI 0.87 to 0.99; P = 0.02;
32,846 participants, 14 trials). Targeting intensive versus conventional
glycaemic control seemed to reduce the risks of non-fatal myocardial
infarction (RR 0.87, 95% CI 0.77 to 0.98; P = 0.02; 30,417 participants,
14 trials), amputation of a lower extremity (RR 0.65, 95% CI 0.45 to 0.94;
P = 0.02; 11,200 participants, 11 trials), as well as the risk of
developing a composite outcome of microvascular diseases (RR 0.88, 95% CI
0.82 to 0.95; P = 0.0008; 25,927 participants, 6 trials), nephropathy (RR
0.75, 95% CI 0.59 to 0.95; P = 0.02; 28,096 participants, 11 trials),
retinopathy (RR 0.79, 95% CI 0.68 to 0.92; P = 0.002; 10,300 participants,
9 trials), and the risk of retinal photocoagulation (RR 0.77, 95% CI 0.61
to 0.97; P = 0.03; 11,212 participants, 8 trials). No statistically
significant effect of targeting intensive glucose control could be shown
on non-fatal stroke, cardiac revascularization, or peripheral
revascularization. Trial sequential analyses did not confirm a reduction
of the risk of non-fatal myocardial infarction but confirmed a 10%
relative risk reduction in favour of intensive glycaemic control on the
composite outcome of microvascular diseases. For the remaining
microvascular outcomes, trial sequential analyses could not establish firm
evidence for a 10% relative risk reduction. Targeting intensive glycaemic
control significantly increased the risk of mild hypoglycaemia, but
substantial heterogeneity was present; severe hypoglycaemia (RR 2.18, 95%
CI 1.53 to 3.11; 28,794 participants, 12 trials); and serious adverse
events (RR 1.06, 95% CI 1.02 to 1.10; P = 0.007; 24,280 participants, 11
trials). Trial sequential analysis for a 10% relative risk increase showed
firm evidence for mild hypoglycaemia and serious adverse events and a 30%
relative risk increase for severe hypoglycaemia when targeting intensive
versus conventional glycaemic control. Overall health-related quality of
life, as well as the mental and the physical components of health-related
quality of life did not show any statistical significant differences.
Authors' conclusions: Although we have been able to expand the number of
participants by 16% in this update, we still find paucity of data on
outcomes and the bias risk of the trials was mostly considered high.
Targeting intensive glycaemic control compared with conventional glycaemic
control did not show significant differences for all-cause mortality and
cardiovascular mortality. Targeting intensive glycaemic control seemed to
reduce the risk of microvascular complications, if we disregard the risks
of bias, but increases the risk of hypoglycaemia and serious adverse
events.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.

<41>
Accession Number
620550917
Author
Abraha I.; Romagnoli C.; Montedori A.; Cirocchi R.
Institution
(Abraha) Regional Health Authority of Umbria, Epidemiology Department, Via
Mario Angeloni, 61, Perugia 06124, Italy
(Romagnoli) AUSL 2, Prevention Department, via Guerra 21, Perugia 06100,
Italy
(Montedori) Regional Health Authority of Umbria, Health Planning Service,
Via Mario Angeloni 61, Perugia, Umbria 06124, Italy
(Cirocchi) University of Perugia, Department of General Surgery, Terni,
Italy
Title
Thoracic stent graft versus surgery for thoracic aneurysm.
Source
Cochrane Database of Systematic Reviews. 2013 (9) (no pagination), 2013.
Article Number: CD006796. Date of Publication: 11 Sep 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Thoracic aortic aneurysm (TAA) is an uncommon disease with an
incidence of 10.4 per 100,000 inhabitants. It occurs mainly in older
individuals and is evenly distributed among both sexes. There are no signs
or symptoms indicative of the presence of the disease. Progressive but
unpredictable enlargement of the dilated aorta is the natural course of
the disease and can lead to rupture. Open chest surgical repair using
prosthetic graft interposition has been a conventional treatment for TAAs.
Despite improvements in surgical procedures perioperative complications
remain significant. The alternative option of thoracic endovascular
aneurysm repair (TEVAR) is considered a less invasive and potentially
safer technique, with lower morbidity and mortality compared with
conventional treatment. Evidence is needed to support the use of TEVAR for
these patients, rather than open surgery. Objectives: The aim of this
review is to assess the efficacy of TEVAR versus conventional open surgery
in patients with TAAs. Search methods: For this update the Cochrane
Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the
Specialised Register (last searched March 2013) and CENTRAL (2013, Issue
2). Selection criteria: Randomised controlled trials in which patients
with TAAs were randomly assigned to TEVAR or open surgical repair. Data
collection and analysis: Two review authors independently identified and
evaluated potential trials for eligibility. Excluded studies were further
checked by another author. We did not perform any statistical analyses as
no randomised controlled trials were identified. Main results: We did not
find any published or unpublished randomised controlled trials comparing
TEVAR with conventional open surgical repair for the treatment of thoracic
aortic aneurysms. Authors' conclusions: Though stent grafting of the
thoracic aorta is technically feasible and non-randomised studies suggest
reduction of early outcomes such as paraplegia, mortality and hospital
stay, high quality randomised controlled trials assessing all clinically
relevant outcomes including open-conversion, aneurysm exclusion,
endoleaks, and late mortality are needed.<br/>Copyright &#xa9; 2013 The
Cochrane Collaboration.

<42>
Accession Number
620550893
Author
Zacharias M.; Mugawar M.; Herbison G.P.; Walker R.J.; Hovhannisyan K.;
Sivalingam P.; Conlon N.P.
Institution
(Zacharias) Dunedin Hospital, Department of Anaesthesia and Intensive
Care, Great King Street, Private Bag 192, Dunedin, New Zealand
(Mugawar) St Vincent's University Hospital, Department of Anaesthesia and
Intensive Care Medicine, Elm Park, Dublin 4, Ireland
(Herbison) Dunedin School of Medicine, University of Otago, Department of
Preventive and Social Medicine, PO Box 913, Dunedin 9054, New Zealand
(Walker) University of Otago, Department of Medicine, Dunedin School of
Medicine, PO Box 913, Dunedin 9015, New Zealand
(Hovhannisyan) Rigshospitalet, The Cochrane Anaesthesia Review Group,
Blegdamsvej 9, Afsnit 5211, rum 1204, Copenhagen 2100, Denmark
(Sivalingam) Princess Alexandra Hospital, Department of Anaesthesia,
Ipswich Road, Woolloongabba, Brisbane 4102, Australia
(Conlon) St Vincent's University Hospital, Department of Anaesthesia, Elm
Park, Dublin 4, Ireland
Title
Interventions for protecting renal function in the perioperative period.
Source
Cochrane Database of Systematic Reviews. 2013 (9) (no pagination), 2013.
Article Number: CD003590. Date of Publication: 11 Sep 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Various methods have been used to try to protect kidney
function in patients undergoing surgery. These most often include
pharmacological interventions such as dopamine and its analogues,
diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE)
inhibitors, N-acetyl cysteine (NAC), atrial natriuretic peptide (ANP),
sodium bicarbonate, antioxidants and erythropoietin (EPO). Objectives:
This review is aimed at determining the effectiveness of various measures
advocated to protect patients' kidneys during the perioperative period. We
considered the following questions: (1) Are any specific measures known to
protect kidney function during the perioperative period? (2) Of measures
used to protect the kidneys during the perioperative period, does any one
method appear to be more effective than the others? (3) Of measures used
to protect the kidneys during the perioperative period,does any one method
appear to be safer than the others? Search methods: In this updated
review, we searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library, Issue 2, 2012), MEDLINE (Ovid SP) (1966
to August 2012) and EMBASE (Ovid SP) (1988 to August 2012). We originally
handsearched six journals (Anesthesia and Analgesia, Anesthesiology,
Annals of Surgery, British Journal of Anaesthesia, Journal of Thoracic and
Cardiovascular Surgery, and Journal of Vascular Surgery) (1985 to 2004).
However, because these journals are properly indexed in MEDLINE, we
decided to rely on electronic searches only without handsearching the
journals from 2004 onwards. Selection criteria: We selected all randomized
controlled trials in adults undergoing surgery for which a treatment
measure was used for the purpose of providing renal protection during the
perioperative period. Data collection and analysis: We selected 72 studies
for inclusion in this review. Two review authors extracted data from all
selected studies and entered them into RevMan 5.1; then the data were
appropriately analysed. We performed subgroup analyses for type of
intervention, type of surgical procedure and pre-existing renal
dysfunction. We undertook sensitivity analyses for studies with high and
moderately good methodological quality. Main results: The updated review
included data from 72 studies, comprising a total of 4378 participants. Of
these, 2291 received some form of treatment and 2087 acted as controls.
The interventions consisted most often of different pharmaceutical agents,
such as dopamine and its analogues, diuretics, calcium channel blockers,
ACE inhibitors, NAC, ANP, sodium bicarbonate, antioxidants and EPO or
selected hydration fluids. Some clinical heterogeneity and varying risk of
bias were noted amongst the studies, although we were able to meaningfully
interpret the data. Results showed significant heterogeneity and indicated
that most interventions provided no benefit. Data on perioperative
mortality were reported in 41 studies and data on acute renal injury in 44
studies (all interventions combined). Because of considerable clinical
heterogeneity (different clinical scenarios, as well as considerable
methodological variability amongst the studies), we did not perform a
meta-analysis on the combined data. Subgroup analysis of major
interventions and surgical procedures showed no significant influence of
interventions on reported mortality and acute renal injury. For the
subgroup of participants who had pre-existing renal damage, the risk of
mortality from 10 trials (959 participants) was estimated as odds ratio
(OR) 0.76, 95% confidence interval (CI) 0.38 to 1.52; the risk of acute
renal injury (as reported in the trials) was estimated from 11 trials (979
participants) as OR 0.43, 95% CI 0.23 to 0.80. Subgroup analysis of
studies that were rated as having low risk of bias revealed that 19
studies reported mortality numbers (1604 participants); OR was 1.01, 95%
CI 0.54 to 1.90. Fifteen studies reported data on acute renal injury
(criteria chosen by the individual studies; 1600 participants); OR was
1.03, 95% CI 0.54 to 1.97. Authors' conclusions: No reliable evidence from
the available literature suggests that interventions during surgery can
protect the kidneys from damage. However, the criteria used to diagnose
acute renal damage varied in many of the older studies selected for
inclusion in this review, many of which suffered from poor methodological
quality such as insufficient participant numbers and poor definitions of
end points such as acute renal failure and acute renal injury. Recent
methods of detecting renal damage such as the use of specific biomarkers
and better defined criteria for identifying renal damage (RIFLE (risk,
injury, failure, loss of kidney function and end-stage renal failure) or
AKI (acute kidney injury)) may have to be explored further to determine
any possible benefit derived from interventions used to protect the
kidneys during the perioperative period.<br/>Copyright &#xa9; 2013 The
Cochrane Collaboration.

<43>
Accession Number
620561350
Author
Liakopoulos O.J.; Kuhn E.W.; Slottosch I.; Wassmer G.; Wahlers T.
Institution
(Liakopoulos, Kuhn, Slottosch, Wahlers) Heart Center, University of
Cologne, Department of Cardiothoracic Surgery, Kerpener Strasse 62,
Cologne 50924, Germany
(Wassmer) University of Cologne, Department for Medical Statistics,
Informatics and Epidemiology, Kerpener Strasse 62, Cologne 50924, Germany
Title
Preoperative statin therapy for patients undergoing cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2012 (4) (no pagination), 2012.
Article Number: CD008493. Date of Publication: 18 Apr 2012.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients referred to cardiac surgery for cardiovascular
disease are at significant risk for the development of post-operative
major adverse events despite significant advances in surgical techniques
and perioperative care. Statins (HMG-CoA reductase inhibitors) have gained
a pivotal role in the primary and secondary prevention of coronary artery
disease, and are thought to improve perioperative outcomes in patients
undergoing cardiac surgery. Objectives: To determine the effectiveness of
a preoperative statin therapy in patients undergoing cardiac surgery.
Search methods: We searched CENTRAL (Issue 2 of 4, 2010 on The Cochrane
Library), MEDLINE (1950 to May, Week 1 2010), EMBASE (1980 to 2010 Week
19), and the metaRegister of Controlled Trials. Additionally, ongoing
trials were searched through the National Research Register, the
ClinicalTrials.gov registry and grey literature. Conference indices from
relevant scientific meetings (2006-2009) were screened online for eligible
trials. No language restrictions were applied. Selection criteria: All
randomized controlled trials comparing any statin treatment before cardiac
surgery, for any given duration and dose, to no preoperative statin
therapy (standard of care) or placebo. Data collection and analysis: Two
authors evaluated trial quality and extracted data from titles and
abstracts identified from the electronic database searches according to
pre-defined criteria. Accordingly, full text articles of potentially
relevant studies that met the inclusion criteria were retrieved to assess
definite eligibility for inclusion. Effect measures are reported as odds
ratios (OR) or weighted mean difference (WMD) with 95% confidence
intervals (95%-CI). Main results: Eleven randomized controlled studies
including a total of 984 participants undergoing on- or off-pump cardiac
surgical procedures were identified. Pooled analysis showed that statin
pre-treatment before surgery reduced the incidence of post-operative
atrial fibrillation (AF) (OR 0.40; 95%-CI: 0.29 to 0.55; p<0.01), but
failed to influence short-term mortality (OR 0.98, 95%-CI: 0.14 to 7.10;
p=0.98) or post-operative stroke (OR 0.70, 95%-CI: 0.14 to 3.63; p=0.67).
In addition, statin therapy was associated with a shorter length of stay
of patients on the intensive care unit (ICU) (WMD: -3.39 hours; 95%-CI:
-5.77 to -1.01) and in-hospital (WMD: -0.48 days; 95%-CI: -0.85 to -0.11)
where significant heterogeneity was observed. There was no reduction in
myocardial infarction (OR 0.52; 95%-CI: 0.2. to 1.30) or renal failure (OR
0.41; 95%-CI: 0.15 to 1.12). These results were unaffected after subgroup
analysis. No major or minor perioperative statin side-effects were
reported from trials investigating this safety endpoint. Authors'
conclusions: Preoperative statin therapy reduces the odds of
post-operative atrial fibrillation (AF) and shortens the stay on the ICU
and in the hospital. Statin pretreatment had no influence on perioperative
mortality, stroke, myocardial infarction or renal failure. Since analysed
studies included mainly patients undergoing myocardial revascularizations
the results cannot be extrapolated to patients undergoing other cardiac
procedures such as heart valve or aortic surgery.<br/>Copyright &#xa9;
2013 The Cochrane Collaboration.

<44>
Accession Number
620620471
Author
Gu W.-J.; Hou B.-L.; Kwong J.S.W.; Tian X.; Qian Y.; Cui Y.; Hao J.; Li
J.-C.; Ma Z.-L.; Gu X.-P.
Institution
(Gu, Hou, Kwong, Qian, Cui, Hao, Li, Ma, Gu) Department of Anesthesiology,
Nanjing Drum Tower Hospital, Medical College of Nanjing University,
Nanjing 210008, China
(Tian) Department of Neurology, The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Neurology, Chongqing
400016, China
Title
Association between intraoperative hypotension and 30-day mortality, major
adverse cardiac events, and acute kidney injury after non-cardiac surgery:
A meta-analysis of cohort studies.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The association between intraoperative hypotension (IOH) and
postoperative outcomes is not fully understood. We performed a
meta-analysis to determine whether IOH is associated with increased risk
of 30-day mortality, major adverse cardiac events (MACEs) and acute kidney
injury (AKI) after non-cardiac surgery. Methods: We searched PubMed and
Embase through May 2016 to identify cohort studies that investigated the
association between IOH and risk of 30-day mortality, MACEs, or AKI in
adult patients after non-cardiac surgery. Ascertainment of IOH and
assessment of outcomes were defined by the individual study. Considering
the level of clinical heterogeneity, adjusted odds ratios (ORs) with 95%
confidence interval (CIs) were pooled using a random-effects model. This
meta-analysis is registered on PROSPERO (CRD42016049405). Results: We
included 14 cohort studies that were heterogeneous in terms of definition
of IOH. IOH alone was associated with increased risk of 30-day mortality
(OR 1.29 [95% CI, 1.19-1.41]), MACEs (OR 1.59 [95% CI, 1.23-2.05]),
especially myocardial injury (OR 1.67 [95% CI, 1.31-2.13]), and AKI (OR
1.39 [95% CI, 1.09-1.77]). Triple low (IOH coincident with low bispectral
index and low minimum alveolar concentration) also predicts increased risk
of 30-day mortality (OR 1.32 [95% CI, 1.03-1.68]). Conclusions: IOH alone
significantly increases the risk of postoperative 30-day mortality, MACEs,
especially myocardial injury, and AKI in adult patients after non-cardiac
surgery. Triple low also predicts increased risk of 30-day mortality after
non-cardiac surgery. These findings provide evidence that IOH should be
recognized as an independent risk factor for postoperative adverse
outcomes after non-cardiac surgery.<br/>Copyright &#xa9; 2017 Elsevier
B.V.

<45>
Accession Number
620566218
Author
Vavuranakis M.; Kalogeras K.; Kolokathis A.M.; Vrachatis D.; Magkoutis N.;
Siasos G.; Oikonomou E.; Kariori M.; Papaioannou T.; Lavda M.; Moldovan
C.; Katsarou O.; Tousoulis D.
Institution
(Vavuranakis, Kalogeras, Kolokathis, Vrachatis, Magkoutis, Siasos,
Oikonomou, Kariori, Papaioannou, Lavda, Moldovan, Katsarou, Tousoulis)
First Department of Cardiology, Hippokration Hospital, Medical School,
National and Kapodistrian University of Athens, Ilioupoli, Greece
Title
Antithrombotic therapy in TAVI.
Source
Journal of Geriatric Cardiology. 15 (1) (pp 66-75), 2018. Date of
Publication: 2018.
Publisher
Science Press (E-mail: shengtaixuebao@mail.rcees.ac.cn)
Abstract
Transcatheter aortic valve implantation (TAVI) carries a significant
thromboembolic and concomitant bleeding risk, not only during the
procedure but also during the periprocedural period. Many issues
concerning optimal antithrombotic therapy after TAVI are still under
debate. In the present review, we aimed to identify all relevant studies
evaluating antithrombotic therapeutic strategies in relation to clinical
outcomes after the procedure. Four randomized control trials (RCT) were
identified analyzing the post-TAVI antithrombotic strategy with all of
them utilizing aspirin lifelong plus clopidogrel for 36 months. Seventeen
registries have been identified, with a wide variance among them regarding
baseline characteristics, while concerning antiplatelet therapy,
clopidogrel duration was ranging from 312 months. Four non-randomized
trials were identified, comparing single vs. dual antiplatelet therapy
after TAVI, in respect of investigating thromboembolic outcome events over
bleeding complications. Finally, limited data from a single RCT and a
retrospective study exist with regards to anticoagulant treatment during
the procedure and the optimal antithrombotic therapy when concomitant
atrial fibrillation. In conclusion, due to the high risk and frailty of
the treated population, antithrombotic therapy after TAVI should be
carefully evaluated. Diminishing ischaemic and bleeding complications
remains the main challenge in these patients with further studies to be
needed in this field.<br/>Copyright &#xa9; 2018 JGC All rights reserved.

<46>
Accession Number
616899496
Author
Wang Y.; Zhu S.; Gao P.; Zhou J.; Zhang Q.
Institution
(Wang, Zhou, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Off-pump versus on-pump coronary surgery in patients with chronic kidney
disease: a meta-analysis.
Source
Clinical and Experimental Nephrology. 22 (1) (pp 99-109), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Patients with chronic kidney disease (CKD) have worse adverse
cardiovascular outcomes after coronary artery bypass grafting (CABG).
However, the adverse cardiovascular outcomes between off-pump coronary
artery bypass grafting (OPCAB) versus on-pump coronary artery bypass
grafting (ONCAB) in these patients have been a subject of debate. Methods:
We undertook a comprehensive literature search of PubMed, Embase, and the
Cochrane Library database to identify all relevant studies comparing
techniques between OPCAB and ONCAB in CKD patients. We pooled the odds
ratios (ORs) and hazard ratios (HRs) from individual studies and conducted
heterogeneity, quality assessment, and publication bias analyses. Results:
This meta-analysis includes 17 studies with 201,889 patients. In CKD
patients, OPCAB was associated with significantly lower early mortality as
compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was
associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI
0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95;
p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005),
pneumonia, prolonged ventilation, and shorter hospital stays. No
difference was found regarding long-term survival (HR 1.08; 95% CI
0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38;
p = 0.26). Conclusions: Compared with ONCAB, OPCAB is associated with
superior postoperative morbidity and the early mortality in CKD patients.
Long-term survival is comparable between the two surgical
revascularizations.<br/>Copyright &#xa9; 2017, Japanese Society of
Nephrology.

<47>
Accession Number
620612371
Author
Stepanov V.A.; Makeeva O.A.; Marusin A.V.; Bocharova A.V.; Vagaitseva
K.V.; Markova V.V.; Minaycheva L.I.; Buikin S.V.; Zhukova I.A.; Zhukova
N.G.
Institution
(Stepanov, Makeeva, Marusin, Bocharova, Vagaitseva, Minaycheva, Buikin)
Institute of Medical Genetics, Tomsk, Russian Federation
(Makeeva, Markova, Minaycheva, Buikin, Zhukova, Zhukova) Center for
Clinical Trials, Nebbiolo, LLC, Tomsk, Russian Federation
(Zhukova, Zhukova) Siberian State Medical University, Tomsk, Russian
Federation
Title
Variability in APOE-TOMM40-PVRL2 locus and other genomic regions
contributes to cognitive performance ina population based study of Russian
elderly.
Source
Alzheimer's and Dementia. Conference: Alzheimer's Association
International Conference, AAIC 2017. United Kingdom. 13 (7) (pp P1494),
2017. Date of Publication: July 2017.
Publisher
Elsevier Inc.
Abstract
Background: Genetic variability contributes to the age of onset of the
late onset Alzheimer's disease as well as to cognitive performance in
normal subjects. A set of 62 single nucleotide variants was tested in
respect to Montreal Cognitive Assessment (MoCA) total score in 708 older
subjects randomly selected from a large urban elderly population from
Tomsk, Russia. Methods: Volunteers were identified through the local
centralized medical care system and were invited for neurocognitive
assessment as a part of a study of normal aging of the brain. Detailed
information was collected on 2000+ individuals, including demographics,
medical history, and family history. 62 SNPs in 45 genes previously
reported to be associated with cognitive performance and/or Alzheimer's
disiease in multiple GWAS or meta-analysis studies were genotyped in two
multiplex reactions using MALDI-TOF mass spectrometry. Results: Mean age
was 7265 years (from 56 to 90), 77.1% of the sample were female. Age
(r=-0.338,p<0.001) and education (r=+0.422,p<0.001) significantly
influenced MoCA total score, but male and female subjects performed
similarly. Arterial hypertension was reported by 82.4% of participants,
42.9% reported hypercholesterolemia, 38.4% were obese, 32.3% had one or
more other cardiovascular conditions (defined as history of heart attack,
pacemaker, or valve replacement), 28.5% had atrial fibrillation, 19.3%
reported type 2 diabetes, and 8.5% survived stroke. MoCA scores corrected
for covariates were subjected to analysis of variance in order to estimate
the contribution of genetic factors to variability of cognitive functions.
11 out of 62 SNPs were significantly associated with the variance of MoCA
scores. Most significant contribution was found for
APOC3-APOE-TOMM40-PVRL2 gene cluster located on chromosome 19q13.32. 8.6%
of the MoCA scores variance is attributable to the cumulative effect of
linked genetic markers at this 41 kb locus. The effect of single SNPs at
this cluster varied from 0.7% to 1.8%. Other significant signals were
detected for variants at CSMD1, CNTNAP2, SORL1, FBXO40, DCHS2,and ACSM1
loci. Conclusions: This study confirms the significant contribution of
genetic variation of APOE-TOMM40 linked markers and points out to several
novel loci associated with the cognitive performance in normal elderly
population.

<48>
Accession Number
620608865
Author
Garner M.; Ahmed E.; Gatiss S.; West D.
Institution
(Garner, Ahmed, West) Department of Thoracic Surgery, University Hospitals
Bristol, Upper Maudlin Street, Bristol BS28HW, United Kingdom
(Gatiss) Department of Obstetrics and Gynaecology, City Hospitals
Sunderland, Sunderland, United Kingdom
Title
Hormonal manipulation after surgery for catamenial pneumothorax.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 319-322),
2018. Date of Publication: 01 Feb 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether hormonal
manipulation with gonadotrophin-releasing hormone analogues reduces the
risk of recurrent catamenial pneumothorax after surgery, compared with
surgery alone. Altogether 819 papers were found using the reported search,
of which 7 represented the best evidence to answer the clinical question.
The authors, date, journal, country of publication, study type, level of
evidence, patient group studied, relevant outcomes and results of these
papers are tabulated. Of the 7 papers selected, 6 demonstrated a reduction
in recurrence of catamenial pneumothorax with the use of
gonadotrophin-releasing hormone analogues, whereas in the single paper
where surgery alone was performed, no evidence of recurrence was
demonstrated. We therefore conclude that, based on very small
retrospective observational studies, gonadotrophin-releasing hormone
analogues used as an adjunct to surgical intervention may reduce the risk
of recurrent pneumothorax, when compared with either no hormonal therapy
or oestrogen-progesterone therapy, but should be initiated and supervised
by gynaecologists who will be familiar with the therapy and the potential
side effects.<br/>Copyright &#xa9; 2017 The Author.

<49>
Accession Number
620608825
Author
Meco M.; Miceli A.; Montisci A.; Donatelli F.; Cirri S.; Ferrarini M.; Lio
A.; Glauber M.
Institution
(Meco) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
(Miceli, Montisci, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Center, Istituto Clinico sant'Ambrogio, Gruppo Ospedaliero
San Donato, Via G. Faravelli 16, Milan 20149, Italy
(Miceli) Department of Clinical Science at South Bristol, University of
Bristol, Bristol, United Kingdom
(Donatelli) Department of Cardiac Surgery, University of Milan, Milan,
Italy
Title
Sutureless aortic valve replacement versus transcatheter aortic valve
implantation: A meta-analysis of comparative matched studies using
propensity score matching.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (2) (pp 207-209),
2018. Date of Publication: 01 Feb 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare outcomes of
patients undergoing transcatheter aortic valve implantation (TAVI) with
those undergoing surgical aortic valve replacement using sutureless
valves. METHODS: A systematic review and meta-analysis in accordance with
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement was performed. RESULTS: No randomized controlled trials
were identified. Six comparative studies using propensity score matching
met the inclusion criteria. This meta-analysis identified 1462 patients in
that 731 patients underwent surgical aortic valve replacement using
sutureless valves (SU) and 731 patients underwent a TAVI. The 30-day or
in-hospital mortality was lower in the SU group [odds ratio (OR) 0.54, 95%
confidence interval (CI) 0.36-0.80; P = 0.003]. In the TAVI group, the
incidence of postoperative stroke was higher (OR 0.36, 95% CI 0.17-0.79; P
= 0.01). The incidence of moderate or severe paravalvular regurgitation
was higher in the TAVI group (OR 0.22, 95% CI 0.14-0.35; P = 0.001). There
were neither differences in the postoperative renal failure (OR 1.44, 95%
CI 0.46-4.58; P = 0.53) nor in the number of patients requiring
postoperative pacemaker implantation (OR 1.06, 95% CI 0.54-2.08; P =
0.86). Patients in the SU group required more transfusions (OR 4.47, 95%
CI 2.77-7.21; P = 0.0001), whereas those in the TAVI group had higher
major vascular complications (OR 0.06, 95% CI 0.01-0.25; P = 0.0001).
Intensive care unit stay was not different (mean difference 0.99, 95%
CI-1.22 to 1.40; P = 0.53). One-year survival was better in the SU group
(Peto OR 0.35, 95% CI 0.18-0.67; P = 0.001), as was the 2-year survival
(Peto OR 0.38, 95% CI 0.17-0.86; P = 0.001). CONCLUSIONS: Surgical aortic
valve replacement using sutureless valves is associated with better early
and mid-term outcomes compared with TAVI in high-or intermediate-risk
patients.<br/>Copyright &#xa9; 2017 The Author.

<50>
Accession Number
620572455
Author
Foroutan F.; Alba A.C.; Guyatt G.; Posada J.D.; Hing N.N.F.; Arseneau E.;
Meade M.; Hanna S.; Badiwala M.; Ross H.
Institution
(Foroutan, Alba, Posada, Hing, Badiwala, Ross) Cardiology, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Foroutan, Guyatt, Arseneau, Meade, Hanna) Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
Title
Predictors of 1-year mortality in heart transplant recipients: A
systematic review and meta-analysis.
Source
Heart. 104 (2) (pp 151-160), 2018. Date of Publication: January 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective A systematic summary of the observational studies informing
heart transplant guideline recommendations for selection of candidates and
donors has thus far been unavailable. We performed a metaanalysis to
better understand the impact of such known risk factors. Methods We
systematically searched and metaanalysed the association between known
pretransplant factor and 1-year mortality identified by multivariable
regression models. Our review used the Grading of Recommendations,
Assessment, Development and Evaluation for assessing the quality of
assessment. We pooled risk estimates by using random effects models.
Results Recipient variables including age (HR 1.16 per 10-year increase,
95% CI 1.10-1.22, high quality), congenital aetiology (HR 2.35, 95% CI
1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62,
high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to
1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09,
low quality) and short-term mechanical circulatory support (MCS) (HR 2.47,
95% CI 1.04 to 5.87, low quality) were significantly associated with
1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to
1.26, high quality) and female donor to male recipient sex mismatch (HR
1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated
with 1-year mortality. None of the operative factors proved significant
predictors. Conclusion High-quality and moderate-quality evidence
demonstrates that recipient age, congenital aetiology, creatinine,
pulsatile MCS, donor age and female donor to male recipient sex mismatch
are associated with 1-year mortality post heart transplant. The results of
this study should inform future guideline and predictive model
development.<br/>Copyright &#xa9; 2018 Article author(s).

<51>
Accession Number
620549121
Author
Kuhn E.W.; Slottosch I.; Wahlers T.; Liakopoulos O.J.
Institution
(Kuhn, Slottosch, Wahlers, Liakopoulos) Heart Center, University of
Cologne, Department of Cardiothoracic Surgery, Kerpener Strasse 62,
Cologne 50924, Germany
Title
Preoperative statin therapy for patients undergoing cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (8) (no pagination), 2015.
Article Number: CD008493. Date of Publication: 13 Aug 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Patients referred to cardiac surgery for cardiovascular
disease are at significant risk for the development of major postoperative
adverse events despite significant advances in surgical techniques and
perioperative care. Statins (5-hydroxy-3-methylglutaryl-co-enzyme A
(HMG-CoA) reductase inhibitors) have gained a pivotal role in the primary
and secondary prevention of coronary artery disease and are thought to
improve perioperative outcomes in patients undergoing cardiac surgery.
This review is an updated version of a review that was first published in
2012. Objectives: To determine the effectiveness of preoperative statin
therapy in patients undergoing cardiac surgery. Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(2013, Issue 11), MEDLINE (1950 to November 2013 Week 3), EMBASE (1980 to
3 December 2013 (Week 48)) and the metaRegister of Controlled Trials.
Additionally, we searched ongoing trials through the National Research
Register, the ClinicalTrials.gov registry and grey literature. We screened
online conference indices from relevant scientific meetings (2006 to 2014)
to look for eligible trials. We applied no language restrictions.
Selection criteria: All randomised controlled trials comparing any statin
treatment before cardiac surgery, for any given duration and dose, versus
no preoperative statin therapy (standard of care) or placebo. Data
collection and analysis: Two review authors evaluated trial quality and
extracted data from titles and abstracts identified by electronic database
searches according to predefined criteria. Accordingly, we retrieved
full-text articles of potentially relevant studies that met the inclusion
criteria to assess definitive eligibility for inclusion. We reported
effect measures as odds ratios (ORs) or weighted mean differences (WMDs)
with 95% confidence intervals (95% CIs). Main results: We identified 17
randomised controlled studies including a total of 2138 participants
undergoing on-pump or off-pump cardiac surgical procedures, and added to
this review six studies with 1154 additional participants. Pooled analysis
showed that statin treatment before surgery reduced the incidence of
postoperative atrial fibrillation (AF) (OR 0.54, 95% CI 0.43 to 0.67; P
value < 0.01; 12 studies, 1765 participants) but failed to influence
short-term mortality (OR 1.80, 95% CI 0.38 to 8.54; P value = 0.46; two
studies, 300 participants) or postoperative stroke (OR 0.70, 95% CI 0.14
to 3.63; P value = 0.67; two studies, 264 participants). In addition,
statin therapy was associated with a shorter stay for patients on the
intensive care unit (ICU) (WMD -3.19 hours, 95% CI -5.41 to -0.98; nine
studies, 721 participants) and in the hospital (WMD -0.48 days, 95% CI
-0.78 to -0.19; 11 studies, 1137 participants) when significant
heterogeneity was observed. Results showed no reduction in myocardial
infarction (OR 0.48, 95% CI 0.21 to 1.13; seven studies, 901 participants)
or renal failure (OR 0.57, 95% CI 0.30 to 1.10; five studies, 467
participants) and were not affected by subgroup analysis. Trials
investigating this safety endpoint reported no major or minor
perioperative side effects of statins. Authors' conclusions: Preoperative
statin therapy reduces the odds of postoperative atrial fibrillation (AF)
and shortens the patient's stay on the ICU and in the hospital. Statin
pretreatment had no influence on perioperative mortality, stroke,
myocardial infarction or renal failure, but only two of all included
studies assessed mortality. As analysed studies included mainly
individuals undergoing myocardial revascularisation, results cannot be
extrapolated to patients undergoing other cardiac procedures such as heart
valve or aortic surgery.<br/>Copyright &#xa9; 2015 The Cochrane
Collaboration.

<52>
Accession Number
620609218
Author
Struck R.; Wittmann M.; Muller S.; Meybohm P.; Muller A.; Bagci S.
Institution
(Struck, Wittmann, Muller) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Muller) Department of Anesthesiology and Intensive Care and Emergency
Medicine and Pain Therapy, Kemperhof Koblenz, Gemeinschaftsklinikum
Mittelrhein, Koblenz, Germany
(Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Muller, Bagci) Neonatology and Pediatric Intensive Care, Children's
Hospital, University of Bonn, Bonn, Germany
Title
Effect of Remote Ischemic Preconditioning on Intestinal
Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A
Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: Cardiopulmonary bypass (CPB) surgery commonly threatens the
heart and remote organs with ischemia-reperfusion injury. Transient
episodes of ischemia to nonvital tissue, known as remote ischemic
preconditioning (RIPC), is thought to help local and remote vital organs
to withstand subsequent ischemic insults. Design: Prospective, randomized,
double-blinded control trial. Setting: Tertiary referral academic teaching
hospital. Participants: Thirty patients undergoing elective CPB surgery.
Intervention: RIPC was achieved via three 5-minute cycles of upper limb
ischemia using a blood pressure cuff or control (sham cuff). Measurements
and Main Results: Primary outcome was the occurrence of intestinal injury,
as measured by an increase in intestinal fatty acid binding protein
(I-FABP). Secondary outcomes included incidence of gastrointestinal
complications and duration of intensive care unit (ICU) stay. RIPC did not
affect serum IFABP levels at the end of surgery and on the first
postoperative day (p = 0.697 and p = 0.461, respectively). For all
patients, mean I-FABP levels significantly increased at the end of surgery
and decreased to under baseline levels on the first postoperative day
(from a mean [+/- standard deviation] baseline value of 764 +/- 492 pg/mL
to 2,002 +/- 974 pg/mL and decreased to 568 +/- 319 pg/mL, p < 0.001). All
patients remained clinically absent of gastrointestinal complications
until hospital discharge. Duration of ICU stay was not correlated with
I-FABP levels at the end of surgery. Neither duration of CPB nor duration
of aortic clamping significantly correlated with postoperative I-FABP
levels. Conclusions: These findings suggest that RIPC does not affect
intestinal injury in patients undergoing CPB surgery. In patients
undergoing cardiac surgery, intestinal injury appears to be moderate and
transient without any clinical relevant complication.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<53>
Accession Number
365300092
Author
Gerstein H.C.; Bosch J.; Dagenais G.R.; Diaz R.; Jung H.; Maggioni A.P.;
Pogue J.; Probstfield J.; Ramachandran A.; Riddle M.C.; Ryden L.E.; Yusuf
S.
Institution
(Gerstein, Yusuf) Department of Medicine, Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) Population Health Research Institute and School of Rehabilitation
Science, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Jung) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
Research Center, Florence, Italy
(Pogue) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(Probstfield) University of Washington, Seattle, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, United States
(Ryden) Department of Medicine, Karolinska Institute, Stockholm, Sweden
Title
Basal insulin and cardiovascular and other outcomes in dysglycemia.
Source
New England Journal of Medicine. 367 (4) (pp 319-328), 2012. Date of
Publication: 26 Jul 2012.
Publisher
Massachussetts Medical Society
Abstract
Background: The provision of sufficient basal insulin to normalize fasting
plasma glucose levels may reduce cardiovascular events, but such a
possibility has not been formally tested. Methods: We randomly assigned
12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus
impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes
to receive insulin glargine (with a target fasting blood glucose level of
<=95 mg per deciliter [5.3 mmol per liter]) or standard care and to
receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial
design. The results of the comparison between insulin glargine and
standard care are reported here. The coprimary outcomes were nonfatal
myocardial infarction, nonfatal stroke, or death from cardiovascular
causes and these events plus revascularization or hospitalization for
heart failure. Microvascular outcomes, incident diabetes, hypoglycemia,
weight, and cancers were also compared between groups. Results: The median
follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of
incident cardiovascular outcomes were similar in the insulin-glargine and
standard-care groups: 2.94 and 2.85 per 100 person-years, respectively,
for the first coprimary outcome (hazard ratio, 1.02; 95% confidence
interval [CI], 0.94 to 1.11; P = 0.63) and 5.52 and 5.28 per 100
person-years, respectively, for the second coprimary outcome (hazard
ratio, 1.04; 95% CI, 0.97 to 1.11; P = 0.27). New diabetes was diagnosed
approximately 3 months after therapy was stopped among 30% versus 35% of
1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI,
0.64 to 1.00; P = 0.05). Rates of severe hypoglycemia were 1.00 versus
0.31 per 100 person-years. Median weight increased by 1.6 kg in the
insulin-glargine group and fell by 0.5 kg in the standard-care group.
There was no significant difference in cancers (hazard ratio, 1.00; 95%
CI, 0.88 to 1.13; P = 0.97). Conclusions: When used to target normal
fasting plasma glucose levels for more than 6 years, insulin glargine had
a neutral effect on cardiovascular outcomes and cancers. Although it
reduced new-onset diabetes, insulin glargine also increased hypoglycemia
and modestly increased weight.<br/>Copyright &#xa9; 2012 Massachusetts
Medical Society.

<54>
Accession Number
620585343
Author
Datzmann T.; Hoenicka M.; Reinelt H.; Liebold A.; Gorki H.
Institution
(Datzmann, Reinelt) Department of Cardiac Anesthesiology, University
Hospital Ulm, Ulm, Germany
(Hoenicka, Liebold, Gorki) Department Cardiothoracic and Vascular Surgery,
University Hospital Ulm, Ulm, Germany
Title
Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on
Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A
Post Hoc Subgroup Analysis of a Prospective Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 205-211),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: The restriction of hydroxyethyl starch (HES) has mandated
changes in volume management based on data of critically ill patients.
Reliable data of structural renal damage after HES treatment in cardiac
surgical patients are lacking. The influence of 6% HES 130/0.4 was
investigated in this study. Design: An exploratory post hoc subgroup
analysis of a prospective trial was performed. Setting: The study was
carried out at a university hospital. Participants: Forty-four low-risk
cardiac surgical patients were examined. Interventions: Twenty-two
patients received only crystalloid solutions, and 22 were treated with
balanced 6% HES 130/0.4. Measurements and Main Results: Functional renal
parameters and the structural biomarkers alpha-glutathione S-transferase,
kidney injury molecule-1, liver fatty acid-binding protein, and neutrophil
gelatinase-associated lipocalin were investigated. Volume balances,
vasopressor dosages, blood losses, and coagulation parameters were
compared. Most functional and structural renal parameters did not differ
between the groups (serum creatinine p = 0.8380). Liver fatty acid-binding
protein was transiently higher in the HES group only at 24 hours
postoperatively (p = 0.0002). No differences in mortality, acute kidney
injury, and need for renal replacement therapy were observed. Blood
coagulation was significantly more compromised in the HES group at
intensive care unit arrival (factor II, p = 0.0012; factor X, p = 0.0031;
thrombocytes, p = 0.0010). Blood losses, and vasopressor dosages tended to
be higher in HES-treated patients without significance. Conclusion:
Overall, the values and time courses of the biomarkers used did not
indicate evidence of a mechanism for tubular injury caused by
HES.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<55>
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.

<56>
Accession Number
611367894
Author
Coelho-Filho O.R.; Shah R.; Lavagnoli C.F.R.; Barros J.C.; Neilan T.G.;
Murthy V.L.; de Oliveira P.P.M.; Souza J.R.M.; de Oliveira Severino
E.S.B.; de Souza Vilarinho K.A.; da Mota Silveira Filho L.; Garcia J.;
Semigran M.J.; Coelho O.R.; Jerosch-Herold M.; Petrucci O.
Institution
(Coelho-Filho, Lavagnoli, Barros, de Oliveira, Souza, de Oliveira
Severino, de Souza Vilarinho, da Mota Silveira Filho, Coelho, Petrucci)
Faculty of Medical Science, State University of Campinas (UNICAMP),
Campinas, Sao Paulo, Brazil
(Shah) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Neilan, Garcia, Semigran) Massaschussetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Murthy) Cardiovascular Medicine Division, Department of Medicine,
University of Michigan, Ann Arbor, MI, United States
(Murthy) Nuclear Medicine Division, Department of Radiology, University of
Michigan, Ann Arbor, MI, United States
(Jerosch-Herold) Noninvasive Cardiovascular Imaging Program,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Jerosch-Herold) Department of Radiology, Brigham and Women's Hospital,
Boston, MA, United States
(Petrucci) Division of Cardiothoracic Surgery, Section of Pediatric
Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO,
United States
(Coelho-Filho) Discipline of Cardiology, Department of Internal Medicine,
Hospital das Clinicas, State University of Campinas, UNICAMP, Rua Vital
Brasil, 251-Cidade Universitaria "Zeferino Vaz", Campinas-SP, Sao Paulo
CEP 13083-888, Brazil
(Coelho-Filho) Fundacao Centro Medico de Campinas, Campinas, Sao Paulo,
Brazil
Title
Myocardial tissue remodeling after orthotopic heart transplantation: a
pilot cardiac magnetic resonance study.
Source
34 (1) (pp 15-24), 2018. Date of Publication: 01 Jan 2018.
Publisher
Springer Netherlands
Abstract
After orthotopic heart transplantation (OHT), the allograft undergoes
characteristic alterations in myocardial structure, including hypertrophy,
increased ventricular stiffness, ischemia, and inflammation, all of which
may decrease overall graft survival. Methods to quantify these phenotypes
may clarify the pathophysiology of progressive graft dysfunction post-OHT.
We performed cardiac magnetic resonance (CMR) with T1 mapping in 26 OHT
recipients (mean age 47 +/- 7 years, 30 % female, median follow-up
post-OHT 6 months) and 30 age-matched healthy volunteers (mean age 50.5
+/- 15 years; LVEF 63.5 +/- 7 %). OHT recipients had a normal left
ventricular ejection fraction (LVEF 65.3 +/- 11 %) with higher LV mass
relative to age-matched healthy volunteers (114 +/- 27 vs. 85.8 +/- 18 g;
p < 0.001). There was no late gadolinium enhancement in either group. Both
myocardial extracellular volume fraction (ECV) and intracellular lifetime
of water (tau<inf>ic</inf>), a measure of cardiomyocyte hypertrophy, were
higher in patients post-OHT (ECV: 0.39 +/- 0.06 vs. 0.28 +/- 0.03, p <
0.0001; tau<inf>ic</inf>: 0.12 +/- 0.08 vs. 0.08 +/- 0.03, p < 0.001). ECV
was associated with LV mass (r = 0.74, p < 0.001). In follow-up, OHT
recipients with normal biopsies by pathology (ISHLT grade 0R) in the first
year post-OHT exhibited a lower ECV relative to patients with any
rejection >=2R (0.35 +/- 0.02 for 0R vs. 0.45 +/- 0, p < 0.001). Higher
ECV but not LVEF was significantly associated with a reduced
rejection-free survival. After OHT, markers of tissue remodeling by CMR
(ECV and tau<inf>ic</inf>) are elevated and associated with myocardial
hypertrophy. Interstitial myocardial remodeling (by ECV) is associated
with cellular rejection. Further research on the impact of graft
preservation and early immunosuppression on tissue-level remodeling of the
allograft is necessary to delineate the clinical implications of these
findings.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
Dordrecht.

<57>
Accession Number
620565773
Author
Li Q.; Chen C.; Li T.; Xiong J.-Y.; Qin Z.; Luo M.; Tan Z.-X.; Liu T.; Yin
X.-R.; Yu H.; Zhou R.-H.
Institution
(Yu, Li, Chen, Li, Xiong, Qin, Luo, Tan, Liu, Yin, Yu, Zhou) Department of
Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan,
China
(Yu) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Effect of intralipid on myocardial injury during valve replacement surgery
with concomitant radiofrequency ablation.
Source
Medicine (United States). 97 (1) (no pagination), 2018. Article Number:
9603. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: This study aimed to evaluate the effect of intralipid
postconditioning (ILPC) on myocardial damage in patients undergoing valve
replacement surgery with concomitant radiofrequency ablation (RFA) for
atrial fibrillation (AF). Methods: Randomized patient and assessor-blind
controlled trial conducted in adult patients undergoing valve replacement
surgery with concomitant RFA. Sixty-nine patients were randomly assigned
to ILPC group (n = 34) or control group (n = 35): ILPC group received an
intravenous infusion of 20% intralipid (2 mL/kg) just 10 minutes before
aortic cross-unclamping, and control group received an equivalent volume
of normal saline. Serum cardiac troponin-T (cTnT) and creatine kinase-MB
(CK-MB) was measured before surgery and at 4, 12, 24, 48, and 72 hours
after surgery. The primary endpoints were the 72-hour area under the curve
(AUC) for cTnT and CK-MB. Results: The total 72-hour AUC of cTnT (P = .33)
and CK-MB (P = .52) were comparable between 2 groups. The left ventricle
ejection fraction at discharge (P = .011) was higher in the ILPC group
than that in the control group, while the AF recurrence did not differ
significantly between 2 groups. Conclusions: There was no observed
beneficial effect of ILPC on myocardial injury documented by the cardiac
biomarkers in patients undergoing valve replacement surgery with
concomitant RFA, and the effect of intralipid against myocardial I/R
injury is undetectable within the background of massive biomarker release
following ablation owing to localized myocardial necrosis. Besides, there
are no other published data about the cardioprotective role of intralipid
in patients undergoing this procedure and benefits of this protection need
further studies to validate.<br/>Copyright &#xa9; 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<58>
[Use Link to view the full text]
Accession Number
620564259
Author
Hu W.; Tong J.; Kuang X.; Chen W.; Liu Z.
Institution
(Hu, Kuang, Chen, Liu) Department of Cardiology, Second Clinical
Institute, Chongqing Medical University, Chongqing 400010, China
(Tong) Department of Respirology, Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
Title
Influence of proton pump inhibitors on clinical outcomes in coronary heart
disease patients receiving aspirin and clopidogrel.
Source
Medicine (United States). 97 (3) (no pagination), 2018. Article Number:
e9638. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Proton pump inhibitors (PPIs) are usually prescribed to protect
against gastrointestinal bleeding in patients on dual antiplatelet
therapy. This meta-Analysis reviewed clinical outcomes in patients taking
aspirin and clopidogrel, with and without concomitant PPIs to address
concerns of adverse reactions.Methods:We searched PubMed, Embase, and the
Cochrane Library for articles published between January 1, 2010 and April
11, 2017. The primary end points were major adverse cardiovascular events
and gastrointestinal bleeding. Secondary end points were myocardial
infarction, stent thrombosis, revascularization, cardiogenic death, and
all-cause mortality.Results:The meta-Analysis included 33,492 patients in
4 randomized controlled trials and 8 controlled observational studies.
Overall, patients taking PPIs had statistical differences in major adverse
cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI]
1.07-1.28); P = .001; I² = 28.3%], gastrointestinal bleeding
[OR 0.58 (95% CI 0.36-0.92); P = .022; I² = 80.6%], stent
thrombosis [OR 1.30 (95% CI 1.01-1.68); P = .041; I² = 0%], and
revascularization [OR 1.20 (95% CI 1.04-1.38); P = .011; I² =
5.1%], compared those not taking PPIs. There were no significant
differences in myocardial infarction [OR 1.03 (95% CI 0.87-1.22); P =
.742; I² = 0%], cardiogenic death [OR 1.09 (95% CI 0.83-1.43);
P = .526; I² = 0%], or all-cause mortality [OR 1.08 (95% CI
0.93-1.25); P = .329; I² = 0%).Conclusions:Among the patients
taking aspirin and clopidogrel, the results indicated that the combined
use of PPIs increased the rates of major adverse cardiovascular events,
stent thrombosis, and revascularization.<br/>Copyright &#xa9; 2018 the
Author(s).

<59>
[Use Link to view the full text]
Accession Number
620564128
Author
Tong J.; Yu Q.; Li C.; Shao X.; Xia Y.
Institution
(Tong, Yu, Li, Shao, Xia) Affiliated Hospital of Xuzhou Medical
University, Xuzhou, Jiangsu 221000, China
Title
Successful revascularization of noninfarct related artery with chronic
total occlusion among acute myocardial infarction patients.
Source
Medicine (United States). 97 (3) (no pagination), 2018. Article Number:
e9655. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Randomized trials and meta-Analyses demonstrated that chronic
total occlusion (CTO) in noninfarct related artery (n-IRA) was associated
with increased all-cause mortality. Recently, several observational
studies suggested that the successful revascularization of n-IRA with CTO
decreased all-cause mortality.Methods:A systematic search was performed in
Cochrane Controlled Trials Registry, PubMed, MEDLINE, and EMBASE databases
for relevant studies. Article assessing the prognostic role of
revascularization of n-IRA with CTO was enrolled in this meta-Analysis.
Data and characteristics of each study were extracted. A meta-Analysis was
performed to generate pooled odds ratio (OR) and 95% confidence intervals
(95% CIs) for outcomes. The primary outcome was major adverse cardiac
events (MACE). Beg funnel plot was used to evaluate publication
bias.Results:Four observational studies and one randomized controlled
trial involving 1083 patients were enrolled for analysis. Compared with
nonreperfusion, the successful percutaneous coronary intervention (PCI) of
n-IRA with CTO was related to decreased all-cause mortality (OR was 0.34,
and 95% CI was 0.2-0.59; P = .0001).Conclusions:Successful PCI of n-IRA
with CTO could significantly decrease all-cause mortality, cardiac
mortality, MACE, and stroke in acute myocardial infarction patients. In
addition, it was not associated with the increased risk of repeat
revascularization and myocardial infarction.<br/>Copyright &#xa9; 2018 the
Author(s).

<60>
Accession Number
616969434
Author
Gnanappa G.K.; Rashid I.; Celermajer D.; Ayer J.; Puranik R.
Institution
(Gnanappa) Paediatrics, The Heart Centre for Children, The Children's
Hospital at Westmead and Cardiac MRI, Cardiovascular Magnetic Resonance,
Sydney, NSW, Australia
(Rashid) Cardiovascular Magnetic Resonance, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Ayer) Paediatric Cardiology, The Heart Centre for Children, The
Children's Hospital at Westmead and The University of Sydney, Sydney, NSW,
Australia
(Puranik) Cardiology and Cardiac MR, Royal Prince Alfred Hospital, The
Heart Centre for Children, The Children's Hospital at Westmead and
Cardiovascular Magnetic Resonance, Sydney, NSW, Australia
Title
Reproducibility of Cardiac Magnetic Resonance Imaging (CMRI)-Derived Right
Ventricular Parameters in Repaired Tetralogy of Fallot (ToF).
Source
Heart Lung and Circulation. 27 (3) (pp 381-385), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Quantification of right ventricular (RV) volumes is
challenging owing to variable reproducibility and is especially so in
congenital heart disease. Cardiac magnetic resonance (CMR) has the ability
to more comprehensively survey the entire right ventricle and is currently
considered the gold standard. Aims: We aimed to determine the
inter-observer reproducibility of CMR-derived RV volumes generated by two
independent and experienced (SCMR Level III) observers in Tetralogy of
Fallot (ToF) patients with varying degrees of RV dilatation. Methods: We
performed a retrospective analysis of 120 consecutive patients with
repaired ToF who underwent CMR. Two blinded observers calculated RV
volumes in each oblique short axis slice independently. Bland-Altman
analysis and inter-observer correlation coefficients (ICC) were assessed.
Results: The coefficients of variation for RV parameters were: 2.9%, 8%
and 3.4% for right ventricular end diastolic volume (RVEDV), right
ventricular end systolic volume (RVESV) and right ventricular ejection
fraction (RVEF) respectively. For RVEDV the interobserver correlation was
0.992 demonstrating excellent volumetric correlation between observers.
The mean difference between the observers for right ventricular end
diastolic volume index (RVEDVi) was 2.5 ml/m² (95% limits of
agreement -7.3 to 12.2 ml/m²). For patients with mild-moderate
RV dilatation (RVEDVi <150 ml/m²) the mean difference of RVEDVi
was 1.8 ml/m² (95% limits of agreement -5.7 to 9.3
ml/m²). For patients with severe RV dilatation (RVEDVi >= 150
ml/m²) the mean difference was -3.4 ml/m² (95%
limits of agreement -8.6 to 15.4 ml/m²). Conclusions: In
patients with repaired ToF and variable degrees of RV dilatation, CMR
assessment of RV volumes and function has high inter-observer
reproducibility. This allows for optimal timing of pulmonary valve
replacement, based on progression of RV dilatation over
time.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<61>
Accession Number
619169404
Author
Thein P.M.; White K.; Banker K.; Lunny C.; Mirzaee S.; Nasis A.
Institution
(Thein) Department of Medicine, Monash Medical Centre, Monash Health,
Melbourne, Vic, Australia
(Thein, White, Banker) Monash University, School of Public Health and
Preventive Medicine, Melbourne, Vic, Australia
(Lunny) Department of Epidemiology and Preventive Medicine, School of
Public Health and Preventive Medicine, Cochrane Australia, Melbourne, Vic,
Australia
(Mirzaee, Nasis) MonashHeart, Monash Cardiovascular Research Centre,
Monash Health Department of Medicine (MMC), Monash University, Melbourne,
Vic, Australia
Title
Preoperative Use of Oral Beta-Adrenergic Blocking Agents and the Incidence
of New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic
Review and Meta-Analysis.
Source
Heart Lung and Circulation. 27 (3) (pp 310-321), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Current epidemiological data suggests that postoperative
atrial fibrillation or atrial flutter (POAF) causes significant morbidity
and mortality after cardiac surgery. The literature for prophylactic
management of POAF is limited, resulting in the lack of clear guidelines
on management recommendations. Aim: To examine the efficacy of
prophylactic rate control agents in reducing the incidence of new-onset
POAF in patients undergoing elective cardiac surgery. Methods: Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and Medline were
systematically searched for blinded randomised controlled studies (RCT)
evaluating adults with no history of atrial fibrillation randomised to a
pharmacological agent (either beta blocker, calcium channel blocker or
digoxin), compared to placebo. Utilising Cochrane guidance, three
reviewers screened, extracted and the quality of the evidence was
assessed. We used a random effects meta-analysis to compare a rate-control
agent with placebo. Results: Five RCTs (688 subjects, mean age 61 +/- 8.9,
69% male) were included. Beta blocker administration prior to elective
cardiac surgery significantly reduced the incidence of POAF (OR 0.43,
95%Cl [0.30-0.61], I² = 0%) without significant impact on
ischaemic stroke (OR 0.49, 95%Cl [0.10-2.44], I² = 0%),
non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44], I²
= 0%), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I² = 0%),
or length of stay (mean -0.96 days 95%Cl [-1.49 to -0.42], I² =
0%). An increased rate of bradycardic episodes was observed (OR 3.53,
95%Cl [1.22-10.23], I² = 0%). Conclusions: This review suggests
that selective administration of prophylactic oral beta blockers prior to
elective cardiac surgery is safe and may reduce the incidence of
POAF.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<62>
Accession Number
615868878
Author
Nazer R.I.; Albarrati A.M.
Institution
(Nazer) Department of Cardiac Science, King Fahad Cardiac Center, College
of Medicine, King Saud University, Riyadh, Saudi Arabia
(Albarrati) Department of Rehabilitation Science, College of Applied
Medical Science, King Saud University, Riyadh, Saudi Arabia
Title
Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After
Coronary Bypass Surgery.
Source
Heart Lung and Circulation. 27 (3) (pp 371-376), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Ltd
Abstract
Background: Topical cooling with ice slush as an adjunct for myocardial
protection during cardiac surgery has been shown to cause freezing injury
of the phrenic nerves. This can cause diaphragmatic dysfunction and
respiratory complications. Methods: Twenty (n = 20) male patients between
the ages of 40 and 60 years were equally randomised to undergo elective
coronary artery bypass grafting (CABG) with either cold cardioplegic
arrest with topical ice slush cooling or cold cardioplegic arrest without
the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to
compare inspiratory muscle strength. Results: There was no difference in
the preoperative SNIF in the two randomised groups. In the immediate
postoperative period, the ice slush group had worse SNIF (33.5 +/- 9.6 cm
H2O versus 47.8 +/- 12.2 cm H2O; p = 0.009). The pre-home discharge SNIF
was still significantly lower for the ice slush group despite a noted
improvement in SNIF recovery in both groups (38.3 +/- 10.6 cm H2O versus
53.5 +/- 13.2 cm H2O; p = 0.011). Two patients in the ice slush group had
left diaphragmatic dysfunction with none in the control group. Conclusion:
The use of topical ice slush is associated with freezing injury of the
phrenic nerves. This will adversely affect the inspiratory muscle force
which may lead to respiratory complications after surgery.<br/>Copyright
&#xa9; 2017 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<63>
Accession Number
620597915
Author
Rashid H.N.; Gooley R.P.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Nasis A.; Cameron J.D.; Brown A.J.
Institution
(Rashid, Gooley, Nerlekar, Ihdayhid, McCormick, Nasis, Cameron, Brown)
Monash Cardiovascular Research Centre, Monash University and MonashHeart,
Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
Title
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector
computed tomography is associated with adverse cerebrovascular events: A
meta-analysis of observational studies.
Source
EuroIntervention. 13 (15) (pp e1748-e1755), 2018. Date of Publication:
February 2018.
Publisher
EuroPCR
Abstract
Aims: Leaflet thrombosis (LT) has become increasingly recognised following
transcatheter and surgical aortic bioprosthetic valve (ABV) replacement
and can be reliably identified by multidetector computed tomography
(MDCT). However, it is an ongoing debate whether MDCT-defined LT is
associated with adverse cerebrovascular outcomes. We sought to perform a
systematic review and meta-analysis in order to assess the incidence and
clinical outcomes associated with MDCT-defined leaflet thrombosis
following (ABV) replacement. Methods and results: Electronic databases
were searched for studies that performed mandatory MDCT imaging following
ABV replacement. The primary endpoint was the incidence of cerebrovascular
events, defined as a composite of stroke or transient ischaemic attack
(TIA). Secondary endpoints included major adverse cerebrovascular and
cardiovascular events (MACCE), stroke, TIA, death or myocardial
infarction. In total, six studies met the inclusion criteria with 11.6%
(198/1,704) of patients having MDCT-defined LT. The prevalence of LT
following transcatheter and surgical ABV replacement was 13.2% and 3.6%,
respectively. Cerebrovascular events were significantly increased in
patients with LT (odds ratio [OR] 3.38, 95% CI: 1.78-6.41, p<0.001). The
risk of MACCE (OR 2.10, 95% CI: 1.21-3.64, p<0.001) and TIA (OR 5.86, 95%
CI: 2.05-16.75, p<0.001) was also increased in patients with LT, although
there were no differences in the incidence of stroke (OR 2.43, 95% CI:
1.00-5.93, p=0.05), death (OR 0.92, 95% CI: 0.42-2.03, p=0.84) or
myocardial infarction (OR 1.72, 95% CI: 0.34-9.78, p=0.54) between groups.
Conclusions: MDCT-defined LT following ABV replacement is associated with
a significantly increased risk of adverse cerebrovascular events. Further
prospective studies are required to ascertain whether LT can be prevented
or treated with pharmacological strategies.<br/>Copyright &#xa9; Europa
Digital & Publishing 2018. All rights reserved.

<64>
Accession Number
620586659
Author
Kim T.K.; Hong D.M.; Lee S.H.; Paik H.; Min S.H.; Seo J.-H.; Jung C.-W.;
Bahk J.-H.
Institution
(Kim, Hong, Lee, Paik, Min, Seo, Jung, Bahk) Department of Anaesthesiology
and Pain Medicine, Seoul National University Hospital, Seoul National
University College of Medicine, Seoul, South Korea
Title
Effect-site concentration of remifentanil required to blunt haemodynamic
responses during tracheal intubation: A randomized comparison between
single-and double-lumen tubes.
Source
Journal of International Medical Research. 46 (1) (pp 430-439), 2018. Date
of Publication: 01 Jan 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To investigate the effect-site concentration of remifentanil
required to blunt haemodynamic responses during tracheal intubation with a
single-lumen tube (SLT) or a double-lumen tube (DLT). Methods: Patients
scheduled for thoracic surgery requiring one-lung ventilation were
randomly allocated to either the SLT or DLT group. All patients received a
target-controlled infusion of propofol and a predetermined concentration
of remifentanil. Haemodynamic parameters during intubation were recorded.
The effect-site concentration of remifentanil was determined using a
delayed up-and-down sequential allocation method. Results: A total of 92
patients were enrolled in the study. The effective effect-site
concentrations of remifentanil required to blunt haemodynamic responses in
50% of patients (EC<inf>50</inf>) estimated by isotonic regression with
bootstrapping was higher in the DLT than the SLT group (8.5 ng/ml [95%
confidence interval (CI) 8.0-9.5 ng/ml] versus 6.5 ng/ml [95% CI 5.6-6.7
ng/ml], respectively). Similarly, the effective effect-site concentrations
of remifentanil in 95% of patients in the DLT group was higher than the
SLT group (9.9 ng/ml [95% CI 9.8-10.0 ng/ml] versus 7.0 ng/ml [95% CI 6.9-
7.0 ng/ml], respectively). Conclusions: This study demonstrated that a
DLTrequires a 30% higher EC<inf>50</inf> of remifentanil than does an SLT
to blunt haemodynamic responses during tracheal intubation when combined
with a target-controlled infusion of propofol.<br/>Copyright &#xa9; The
Author(s) 2017.

<65>
Accession Number
620565502
Author
Peters F.; Eveslage M.; Gallitz I.; Wempe C.; Meybohm P.; Van Aken H.K.;
Steinbicker A.U.
Institution
(Peters, Gallitz, Wempe, Van Aken, Steinbicker) Department of
Anaesthesiology, Intensive Care and Pain Medicine, University Hospital
Munster, University of Munster, Albert-Schweitzer Campus 1, Munster 48149,
Germany
(Eveslage) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
(Meybohm) Department of Anaesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Frankfurt/M., Germany
Title
Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin
Levels in Cardiothoracic Surgical Patients on the ICU - an Observational
Pilot Study about Anaemia Treatment with Intravenous Iron.
Source
Transfusion Medicine and Hemotherapy. 45 (1) (pp 42-46), 2018. Date of
Publication: 01 Jan 2018.
Publisher
S. Karger AG
Abstract
Background: Post-operative anaemia is associated with increased morbidity
and mortality. Positive effects of post-operative intravenous iron (IVI)
after elective orthopaedic, abdominal and genitourinary surgery have been
reported. The current observational trial investigated the prevalence of
post-operative anaemia, the effect of IVI on haemoglobin levels, the use
of blood transfusions and diagnoses related to infections. Methods: 1,265
patients on five ICUs of Munster University Hospital were screened for
post-operative anaemia. On one ICU, patients were screened for iron
deficiency and, if indicated, supplemented with 500 mg of ferric
carboxymaltose. Primary outcome measures were haemoglobin levels,
C-reactive protein, white blood cell count, transfusion requirements,
documented infection and antibiotic treatment. Results: Anaemia was
prevalent in 86.2% of patients upon ICU admission. 429 patients were
screened for iron deficiency anaemia. 95 patients were eligible, 35 were
treated with IVI. An increase of +0.4 g/dl in Hb levels 7 days after IVI
compared to -0.1 g/dl in non-treated anaemic patients was observed. The
number of RBC transfusions, ICD codes related to infections and infectious
parameters were similar between groups. Conclusions: IVI treatment was
safe and resulted in higher median Hb levels. Randomized controlled trials
are required to support the hypotheses of this study.<br/>Copyright &#xa9;
2018 S. Karger GmbH, Freiburg.

<66>
Accession Number
620561402
Author
Spencer S.; Tang A.; Khoshbin E.
Institution
(Spencer) Lancaster University, Faculty of Health and Medicine, Bailrigg,
Lancaster, Lancashire LA1 4YD, United Kingdom
(Tang) Victoria Hospital, Department of Cardiothoracic Surgery, Lancashire
Cardiac Centre, Blackpool, Lancashire FY3 8NR, United Kingdom
(Khoshbin) University Hospital of South Manchester, Cardiothoracic
Surgery, Southmoor Road, Wythemshawe, Manchester, Cheshire M23 9LT, United
Kingdom
Title
Leukodepletion for patients undergoing heart valve surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (7) (no pagination), 2013.
Article Number: CD009507. Date of Publication: 31 Jul 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: There is some evidence for the benefits of leukodepletion in
patients undergoing coronary artery surgery. Its effectiveness in higher
risk patients, such as those undergoing heart valve surgery, particularly
in terms of overall clinical outcomes, is currently unclear. Objectives:
To assess the beneficial and harmful effects of leukodepletion on
clinical, patient-reported and economic outcomes in patients undergoing
heart valve surgery. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (2013, Issue 3 of 12) in The
Cochrane Library, the NHS Economic Evaluations Database (1960 to April
2013), MEDLINE Ovid (1946 to April week 2 2013), EMBASE Ovid (1947 to Week
15 2013), CINAHL (1982 to April 2013) and Web of Science (1970 to 17 April
2013) on 19 April 2013. We also searched the World Health Organization
(WHO) International Clinical Trials Registry Platform (ICTRP), the US
National Institutes of Health (NIH) clinical trials database and the
International Standard Randomised Controlled Trial Number Register
(ISRCTN) in April 2013 for ongoing studies. No language or time period
restrictions were applied. We examined the reference lists of all included
randomised controlled trials and contacted authors of identified trials.
We searched the 'grey' literature at OpenGrey and handsearched relevant
conference proceedings. Selection criteria: Randomised controlled trials
comparing a leukocyte-depleting arterial line filter with a standard
arterial line filter, on the arterial outflow of the heart-lung bypass
circuit, in elective patients undergoing heart valve surgery. Data
collection and analysis: Data were collected on the study characteristics,
three primary outcomes (1. post-operative in-hospital all-cause mortality
within three months, 2. post-operative all-cause mortality excluding
inpatient mortality < 30 days, 3. length of stay in hospital, 4. adverse
events and serious adverse events) and seven secondary outcomes (1.
tubular or glomerular kidney injury, 2. validated health-related quality
of life scales, 3. validated renal injury scales, 4. use of continuous
veno-venous haemo-filtration, 5. length of stay in intensive care, 6.
costs of care). Data were extracted by one author and verified by a second
author. Insufficient data were available to perform a meta-analysis or
sensitivity analysis. Main results: Eight studies were eligible for
inclusion in the review but data on prespecified review outcomes were
available from only one, modestly powered (24 participants) study (Hurst
1997). There were no differences between a leuko-depleting versus standard
filter in length of stay in the intensive care unit (ICU) (mean difference
(MD) 0.80 days; 95% confidence interval (CI) -0.24 to 1.84) or length of
hospital stay (MD 0.20 days; 95% CI -1.78 to 2.18). Authors' conclusions:
There are currently insufficient good quality trials with valve surgery
patients to inform recommendations for changes in clinical practice. A
future National Institute for Health Research (NIHR)-funded feasibility
study (recruiting mid-year 2013) comparing leukodepletion with a standard
arterial line filter in patients undergoing elective heart valve surgery
(the ROLO trial) will be the largest study to date and will make a
significant contribution to future updates of this review.<br/>Copyright
&#xa9; 2013 The Cochrane Collaboration.

<67>
Accession Number
620568177
Author
Chaikriangkrai K.; Jhun H.Y.; Shantha G.P.S.; Abdulhak A.B.; Tandon R.;
Alqasrawi M.; Klappa A.; Pancholy S.; Deshmukh A.; Bhama J.; Sigurdsson G.
Institution
(Chaikriangkrai, Shantha, Abdulhak, Tandon, Alqasrawi, Klappa, Bhama,
Sigurdsson) Heart and Vascular Center, University of Iowa Hospitals and
Clinics, Iowa City, IA
(Jhun) Department of Medicine, University of Kansas Medical Center, Kansas
City, KS
(Pancholy) The Wright Center for Graduate Medical Education, Scranton, PA
(Deshmukh) Mayo Clinic, Rochester, MN
Title
Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve
Replacement: Systematic Review and Meta-Analysis.
Source
Journal of Thoracic Imaging. (no pagination), 2018. Date of Publication:
31 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: In aortic stenosis patients referred for surgical and
transcatheter aortic valve replacement (AVR), the evidence of diagnostic
accuracy of coronary computed tomography angiography (CCTA) has been
limited. The objective of this study was to investigate the diagnostic
accuracy of CCTA for significant coronary artery disease (CAD) in patients
referred for AVR using invasive coronary angiography (ICA) as the gold
standard. Materials and Methods: We searched databases for all diagnostic
studies of CCTA in patients referred for AVR, which reported diagnostic
testing characteristics on patient-based analysis required to pool summary
sensitivity, specificity, positive-likelihood ratio, and
negative-likelihood ratio. Significant CAD in both CCTA and ICA was
defined by >50% stenosis in any coronary artery, coronary stent, or bypass
graft. Results: Thirteen studies evaluated 1498 patients (mean age, 74y;
47% men; 76% transcatheter AVR). The pooled prevalence of significant
stenosis determined by ICA was 43%. Hierarchical summary
receiver-operating characteristic analysis demonstrated a summary area
under curve of 0.96. The pooled sensitivity, specificity, and
positive-likelihood and negative-likelihood ratios of CCTA in identifying
significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06,
respectively. In subgroup analysis, the diagnostic profiles of CCTA were
comparable between surgical and transcatheter AVR. Conclusions: Despite
the higher prevalence of significant CAD in patients with aortic stenosis
than with other valvular heart diseases, our meta-analysis has shown that
CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for
ICA. Our study illustrates a need for further study of the potential role
of CCTA in preoperative planning for AVR.<br/>Copyright &#xa9; 2018
Wolters Kluwer Health, Inc. All rights reserved.

<68>
Accession Number
620594411
Author
Colella T.J.F.; King-Shier K.
Institution
(Colella) University Health Network/Toronto Rehab Cardiovascular
Prevention & Rehabilitation Program, Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(King-Shier) Faculty of Nursing, Department of Community Health Sciences,
University of Calgary, Alberta, Canada
Title
The effect of a peer support intervention on early recovery outcomes in
men recovering from coronary bypass surgery: A randomized controlled
trial.
Source
European Journal of Cardiovascular Nursing. (no pagination), 2017. Date of
Publication: 01 Aug 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background and aim: Examine the effect of a professionally-guided
telephone peer support intervention on recovery outcomes including
depression, perceived social support, and health services utilization
after coronary artery bypass graft surgery (CABG). Methods: A randomized
controlled trial was conducted with post-coronary artery bypass graft
surgery men (N=185) who were randomized before hospital discharge. The
intervention arm received telephone-based peer support through weekly
telephone calls from a peer volunteer over six weeks, initiated within 3-4
days of discharge. Results: Although a significant difference was detected
in pre-intervention depression scores at discharge, there were no
differences between groups in changes in depression scores at six weeks
(p=0.08), 12 weeks (0.49) or over time (p=0.51); and no significant
differences in perceived social support scores over time (p=0.94). At 12
weeks, the intervention group had significantly lower incidence of health
services utilization (family physician (p=0.02) and emergency room
(p=0.04)). Conclusions: Healthcare providers need to continue to
investigate novel interventions to enhance social support and reduce
depression in cardiac patients.<br/>Copyright &#xa9; 2017, The European
Society of Cardiology 2017.

<69>
[Use Link to view the full text]
Accession Number
615007679
Author
Penna M.; Markar S.R.; Mackenzie H.; Hompes R.; Cunningham C.
Institution
(Penna, Markar, Mackenzie) Department of Surgery and Cancer, Imperial
College London, London, United Kingdom
(Penna, Hompes, Cunningham) Department of Colorectal Surgery, Churchill
Hospital, University Hospitals of Oxford, Old Road, Oxford OX3 7LE, United
Kingdom
Title
Laparoscopic Lavage Versus Primary Resection for Acute Perforated
Diverticulitis: Review and Meta-analysis.
Source
267 (2) (pp 252-258), 2018. Date of Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To compare clinical outcomes after laparoscopic lavage (LL) or
colonic resection (CR) for purulent diverticulitis. Background:
Laparoscopic lavage has been suggested as an alternative treatment for
traditional CR. Comparative studies to date have shown conflicting
results. Methods: Electronic searches of Embase, Medline, Web of Science,
and Cochrane databases were performed. Weighted mean differences (WMD)
were calculated for effect size of continuous variables and pooled odds
ratios (POR) calculated for discrete variables. Results: A total of 589
patients recruited from 3 randomized controlled trials (RCTs) and 4
comparative studies were included; 85% as Hinchey III. LL group had
younger patients with higher body mass index and lower ASA grades, but
comparable Hinchey classification and previous diverticulitis rates. No
significant differences were noted for mortality, 30-day reoperations and
unplanned readmissions. LL had higher rates of intraabdominal abscesses
(POR = 2.85; 95% confidence interval, CI, 1.52-5.34; P = 0.001),
peritonitis (POR = 7.80; 95% CI 2.12-28.69; P = 0.002), and increased
long-term emergency reoperations (POR = 3.32; 95% CI 1.73-6.38; P <
0.001). Benefits of LL included shorter operative time, fewer cardiac
complications, fewer wound infections, and shorter hospital stay. Overall,
90% had stomas after CR, of whom 74% underwent stoma reversal within
12-months. Approximately, 14% of LL patients required a stoma; 48%
obtaining gut continuity within 12-months, whereas 36% underwent elective
sigmoidectomy. Conclusions: The preservation of diseased bowel by LL is
associated with approximately 3 times greater risk of persistent
peritonitis, intraabdominal abscesses and the need for emergency surgery
compared with CR. Future studies should focus on developing composite
predictive scores encompassing the wide variation in presentations of
diverticulitis and treatment tailored on case-by-case basis.<br/>&#xa9;
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.

<70>
Accession Number
620505875
Author
Bartykowszki A.; Kolossvary M.; Jermendy A.L.; Karady J.; Szilveszter B.;
Karolyi M.; Balogh O.; Sax B.; Merkely B.; Maurovich-Horvat P.
Institution
(Bartykowszki, Kolossvary, Jermendy, Karady, Szilveszter, Karolyi, Sax,
Merkely, Maurovich-Horvat) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor St,
Budapest H-1122, Hungary
(Balogh) Department of Cardiology, Gottsegen Gyorgy National Cardiology
Institute, Budapest, Hungary
Title
Image quality of prospectively ECG-triggered coronary CT angiography in
heart transplant recipients.
Source
American Journal of Roentgenology. 210 (2) (pp 314-319), 2018. Date of
Publication: February 2018.
Publisher
American Roentgen Ray Society
Abstract
OBJECTIVE. Cardiac allograft vasculopathy (CAV) is among the top causes of
death 1 year after heart transplantation (HTx). Coronary CT angiography
(CTA) is a potential alternative to invasive imaging in the diagnosis of
CAV. However, the higher heart rate (HR) of HTx recipients prompts the use
of retrospective ECG-gating, which is associated with higher radiation
dose, a major concern in this patient population. Therefore, we sought to
evaluate the feasibility and image quality of low-radiation-dose
prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND
METHODS. In total, 1270 coronary segments were evaluated in 50 HTx
recipients and 50 matched control subjects who did not undergo HTx. The
control subjects were selected from our clinical database and were matched
for age, sex, body mass index, HR, and coronary dominance. Scans were
performed using 256-MDCT with prospective ECG-triggering. The degree of
motion artifacts was evaluated on a per-segment basis on a 4-point
Likert-type scale. RESULTS. The median HR was 74.0 beats/min
(interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0
beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p =
0.58). In the HTx group, more segments had diagnostic image quality
compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p <
0.001). The mean effective radiation dose was low in both groups (3.7 mSv
[IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the
control group; p = 0.24). CONCLUSION. Prospectively ECG-triggered coronary
CTA examinations of HTx recipients yielded diagnostic image quality with
low radiation dose. Coronary CTA is a promising noninvasive alternative to
routine catheterization during follow-up of HTx recipients to diagnose
CAV.<br/>Copyright &#xa9; American Roentgen Ray Society.

<71>
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.

<72>
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.

<73>
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.

<74>
Accession Number
620559205
Author
Ikram A.; Mohiuddin H.; Zia A.; Siddiqui H.U.; Javadikasgari H.;
Koprivanac M.; Raza S.; Zafar A.
Institution
(Ikram, Zafar) Department of Neurology, University of New Mexico,
Albuquerque, NM, United States
(Mohiuddin, Zia) Department of Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Siddiqui, Javadikasgari) Department of Thoracic and Cardiovascular
Surgery, Cleveland Clinic, Cleveland, OH, United States
(Koprivanac) Department of Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Raza) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
Title
Does epiaortic ultrasound screening reduce perioperative stroke in
patients undergoing coronary surgery? A topical review.
Source
Journal of Clinical Neuroscience. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Churchill Livingstone
Abstract
Although the occurrence of stroke in patients undergoing coronary artery
bypass grafting (CABG) is decreasing, it remains an important concern.
Therefore, it is important to identify and adopt strategies that can
decrease the incidence of stroke in these patients. One of the strategies
that have demonstrated the potential to decrease the rate of post-CABG
stroke is an assessment of aorta for atherosclerosis before surgery and
changing the surgical plan accordingly to minimize the stroke risk. This
assessment can be done through palpation of the aorta, transesophageal
echocardiography (TEE), and epiaortic ultrasound scanning (EAS). EAS has
shown superiority over both palpation and TEE for intraoperative
evaluation of aorta. However, despite the evidence demonstrating reduced
stroke rates with the EAS-guided approach, EAS is not yet the standard of
care procedure in patients undergoing CABG. Therefore, we have reviewed
the literature for evidence that supports the routine use of EAS in
patients undergoing coronary surgery and have presented solutions to
overcome the barriers to its routine use.<br/>Copyright &#xa9; 2018
Elsevier Ltd.

<75>
Accession Number
620559155
Author
Poh C.L.; d'Udekem Y.
Institution
(Poh, d'Udekem) Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Vic, Australia
(Poh, d'Udekem) Department of Paediatrics, The University of Melbourne,
Melbourne, Vic, Australia
(Poh, d'Udekem) Heart Research, Murdoch Childrens Research Institute,
Melbourne, Vic, Australia
Title
Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and
Predictors of Late Death.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
Aim: We now know that 20-40% of patients with a single ventricle will
develop heart failure after the second decade post-Fontan surgery.
However, we remain unable to risk-stratify the cohort to identify patients
at highest risk of late failure and death. We conducted a systematic
review of all reported late outcomes for patients with a Fontan
circulation to identify predictors of late death. Methods: We searched
MEDLINE, Embase and PubMed with subject terms ("single ventricle",
"Hypoplastic left heart syndrome", "congenital heart defects" or "Fontan
procedure") AND ("heart failure", "post-operative complications", "death",
"cause of death", "transplantation" or "follow-up studies") for relevant
studies between January 1990 and December 2015.Variables identified as
significant predictors of late death on multivariate analysis were
collated for meta-analysis. Survival data was extrapolated from
Kaplan-Meier survival curves to generate a distribution-free summary
survival curve. Results: Thirty-four relevant publications were
identified, with a total of 7536 patients included in the analysis. Mean
follow-up duration was 114 months (range 24-269 months). There were 688
(11%) late deaths. Predominant causes of death were late Fontan failure
(34%), sudden death (19%) and perioperative death (16%). Estimated mean
survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93-96),
91% (95%CI 89-93) and 82% (95%CI 77-85). Significant predictors of late
death include prolonged pleural effusions post Fontan surgery (HR1.18,
95%CI 1.09-1.29, p. <. 0.001), protein losing enteropathy (HR2.19, 95%CI
1.69-2.84, p. <. 0.001), increased ventricular end diastolic volume
(HR1.03 per 10. ml/BSA increase, 95%CI 1.02-1.05, p. <. 0.001) and having
a permanent pacemaker (HR12.63, 95%CI 6.17-25.86, p. <. 0.001).
Conclusions: Over 80% of patients who survive Fontan surgery will be alive
at 20 years. Developing late sequelae including protein losing
enteropathy, ventricular dysfunction or requiring a pacemaker predict a
higher risk of late death.<br/>Copyright &#xa9; 2017 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ).

<76>
Accession Number
620554491
Author
Leonard J.R.; Abouarab A.A.; Tam D.Y.; Girardi L.N.; Gaudino M.F.L.;
Fremes S.E.
Institution
(Leonard, Abouarab, Girardi, Gaudino) Department of Cardiothoracic
SurgeryWeill Cornell MedicineNew York, New York
(Tam, Fremes) Division of Cardiac SurgerySchulich Heart CentreSunnybrook
Health Sciences CentreUniversity of TorontoToronto, OntarioCanada
Title
The radial artery: Results and technical considerations.
Source
Journal of Cardiac Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The radial artery (RA) is a frequently used conduit for
coronary artery bypass graft (CABG). We review the results of the use of
the RA in CABG patients and discuss the unique technical considerations
when using this conduit. Methods: A literature search was performed in
PubMed through December 2017 on the comparative efficacy of the RA to
other conduits and technical considerations for the use of the RA in CABG
surgery. Results: When compared to the saphenous vein graft, the RA proved
to be superior in graft patency in multiple randomized clinical trials.
The RA was associated with better clinical outcomes in observational
studies. The debate over the second best arterial conduit remains
unresolved between the RA and the right internal thoracic artery.
Preoperative evaluation of the patient's coronary anatomy and the quality
of the RA is imperative to achieve the best clinical outcome with RA
grafting. Conclusion: With careful preoperative planning and attention to
technical details, the RA is an excellent choice as the second conduit for
CABG surgery.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<77>
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

<78>
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

<79>
Accession Number
620550659
Author
Ren B.; Spitzer E.; Geleijnse M.L.; Zijlstra F.; de Jaegere P.P.T.; Van
Mieghem N.M.; Tijssen J.G.
Institution
(Ren, Spitzer, Geleijnse, Zijlstra, de Jaegere, Van Mieghem) Department of
Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam, The
Netherlands
Title
Right ventricular systolic function in patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Right ventricular (RV) systolic dysfunction is associated with
worse survival in patients undergoing surgical aortic valve replacement
(SAVR), yet it is not included in traditional risk scores of transcatheter
aortic valve implantation (TAVI) candidates. We aimed to evaluate the
prognostic value of RV systolic function on clinical outcomes in patients
undergoing TAVI at one year follow-up; and, echocardiographic changes of
RV systolic function up to 12 months after TAVI and compared with SAVR
when possible. Methods and results: This systematic review and
meta-analysis is registered in PROSPERO (CRD42017065761). Studies
investigating RV systolic function with echocardiography in TAVI cohorts
were identified from Medline, Embase and Cochrane databases. We used
random-effects models to assess differences in primary outcomes.
Twenty-one studies were identified, where RV systolic function and
clinical outcomes were assessed in eight (4016 patients) and RV systolic
function changes were evaluated in 14 (1709 patients). For the primary
outcome of all-cause death at one year, RV systolic dysfunction was
associated with a significant 78% relative risk increase (risk ratio[95%
confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit
significant heterogeneity (I² = 64%, P < 0.01). RV systolic
function was unchanged after TAVI throughout follow-up as shown with
tricuspid annular plane systolic excursion (TAPSE)(mean difference[95%
CI]pre-discharge = 0.03 [-0.92,0.99]mm,1-3 months =
-0.09[-0.89,0.71]mm,6-12 months = 0.52 [-0.29,1.32] mm, all P = NS), while
TAPSE was significantly reduced after SAVR (pre-discharge =
-10.17[-13.11,-7.24]mm, P < 0.01;1-3 months = -7.3[-8.17,-6.44]mm, P <
0.01;6-12 months = -5.99[-7.95,-4.03]mm, P < 0.01). Conclusions: RV
systolic dysfunction was associated with a significant increase in
all-cause mortality at one year after TAVI. RV systolic function was
unchanged after TAVI up to 12 months, whereas deteriorated significantly
after SAVR.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<80>
Accession Number
620544679
Author
Liu T.T.; Li L.; Wan L.; Zhang C.H.; Yao W.L.
Institution
(Liu, Wan, Zhang, Yao) Department of Anaesthesiology Tongji Medical
College Huazhong University of Science and Technology WuhanChina
(Li) Department of Physiology Hubei University of Chinese Medicine
WuhanChina
Title
Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube
intubation in thoracic surgery: A systematic review and meta-analysis
trials.
Source
Anaesthesia. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Double-lumen intubation is more difficult than single-lumen tracheal
intubation. Videolaryngoscopes have many advantages in airway management.
However, the advantages of videolaryngoscopy for intubation with a
double-lumen tube remain controversial compared with traditional Macintosh
laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library
and the Web of Science for randomised controlled trials comparing
videolaryngoscopy with Macintosh laryngoscopy for double-lumen tube
intubation. We found that videolaryngoscopy provided a higher success rate
at first attempt for double-lumen tube intubation, with an odds ratio
(95%CI) of 2.77 (1.92-4.00) (12 studies, 1215 patients, moderate-quality
evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or
dental injuries during double-lumen tube intubation, odds ratio (95%CI)
0.36 (0.15-0.85) (11 studies, 1145 patients, low-quality evidence, p =
0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54
(0.36-0.81) (7 studies, 561 patients, moderate-quality evidence, p =
0.003), compared with Macintosh laryngoscopy. There were no significant
differences in intubation time, with a standardised mean difference
(95%CI) of -0.10 (-0.62 to 0.42) (14 studies, 1310 patients, very
low-quality evidence, p = 0.71); and the incidence of postoperative voice
change, odds ratio (95%CI) 0.53 (0.21-1.31) (7 studies, 535 patients,
low-quality evidence, p = 0.17). Videolaryngoscopy led to a higher
incidence of malpositioned double-lumen tube, with an odds ratio (95%CI)
of 2.23 (1.10-4.52) (six studies, 487 patients, moderate-quality evidence,
p = 0.03).<br/>Copyright &#xa9; 2018 The Association of Anaesthetists of
Great Britain and Ireland.