EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
620701991
Author
Rodriguez-Caulo E.A.; Guijarro-Contreras A.; Otero-Forero J.; Mataro M.J.;
Sanchez-Espin G.; Guzon A.; Porras C.; Such M.; Ordonez A.; Melero-Tejedor
J.M.; Jimenez-Navarro M.
Institution
(Rodriguez-Caulo, Guijarro-Contreras, Otero-Forero, Mataro, Sanchez-Espin,
Guzon, Porras, Such, Melero-Tejedor, Jimenez-Navarro) UGC Area del
Corazon. Servicio de Cirugia Cardiovascular y Cardiologia. Hospital, Univ.
Virgen de Vic de Malaga, Fund. Publica Andaluza para Invest. de Malaga en
Biomedicina y Salud, Universidad de Malaga. Spain. CIBERCV Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Ordonez) UGC Area del Corazon, Servicio de Cirugia Cardiovascular,
Hospital Universitario Virgen del Rocio de Sevilla, Red de Investigacion
Cardiovascular (RIC), Instituto de Salud Carlos III, Madrid, Spain
Title
Quality of life, satisfaction and outcomes after ministernotomy versus
full sternotomy isolated aortic valve replacement (QUALITY-AVR): Study
protocol for a randomised controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 114. Date of
Publication: 17 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: During the last decade, the use of ministernotomy in cardiac
surgery has increased. Quality of life and patient satisfaction after
ministernotomy have never been compared to conventional full sternotomy in
randomised trials. The aim of the study is to determine if this minimally
invasive approach improves quality of life, satisfaction and clinical
morbimortality outcomes. Methods/design: The QUALITY-AVR trial is a
single-blind, single-centre, independent, and pragmatic randomised
clinical trial comparing ministernotomy ("J" shaped upper hemisternotomy
toward right 4th intercostal space) to full sternotomy in patients with
isolated severe aortic stenosis scheduled for elective aortic valve
replacement. One hundred patients will be randomised in a 1:1
computational fashion. Sample size was determined for the primary end
point with alpha error of 0.05 and with power of 90% in detecting
differences between intervention groups of >=0.10 points in change from
baseline quality of life Questionnaire EuroQOL-index (EQ-5D-5L), measured
at 1, 6 or 12months. Secondary endpoints are: the differences in change
from other baseline EQ-5D-5L utilities (visual analogue scale, Health
Index and Severity Index), cardiac surgery specific satisfaction
questionnaire (SATISCORE), a combined safety endpoint of four major
adverse complications at 1month (all-cause mortality, acute myocardial
infarction, neurologic events and acute renal failure), bleeding through
drains within the first 24h, intubation time, postoperative hospital and
intensive care unit length of stay, transfusion needs during the first 72h
and 1-year survival rates. Clinical follow up is scheduled at baseline, 1,
6, and 12months after randomization. All clinical outcomes are recorded
following the Valve Academic Research Consortium 2 criteria. Discussion:
The QUALITY-AVR trial aims to test the hypothesis that ministernotomy
improves quality of life, satisfaction and clinical outcomes in patients
referred for isolated aortic valve replacement. Statistically significant
differences favouring ministernotomy could modify the surgical "gold
standard" for aortic stenosis surgery, and subsequently the need to change
the control group in transcatheter aortic valve implantation trials.
Recruitment started on 18 March 2016. In November 2017, 75 patients were
enrolled.<br/>Copyright &#xa9; 2018 The Author(s).

<2>
Accession Number
620231205
Author
Tegn N.; Abdelnoor M.; Aaberge L.; Ranhoff A.H.; Endresen K.; Gjertsen E.;
Skardal R.; Gullestad L.; Bendz B.
Institution
(Tegn, Aaberge, Endresen, Skardal, Gullestad, Bendz) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Tegn, Gullestad, Bendz) Faculty of Medicine, University of Oslo, Norway
(Abdelnoor) Centre for Biostatistics and Epidemiology, Oslo University
Hospital, Ulleval, Oslo, Norway
(Ranhoff) Diakonhjemmet Hospital and Department of Clinical Science,
University of Bergen, Bergen, Norway
(Gjertsen) Department of Cardiology, Drammen Hospital, Drammen, Norway
Title
Health-related quality of life in older patients with acute coronary
syndrome randomised to an invasive or conservative strategy. The After
Eighty randomised controlled trial.
Source
Age and Ageing. 47 (1) (pp 42-47), 2018. Date of Publication: 01 Jan 2018.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Objective: in the After Eighty study (ClinicalTrials.gov.number,
NCT01255540), patients aged 80 years or more, with non-ST-elevation
myocardial infarction (NSTEMI), and unstable angina pectoris (UAP), were
randomised to either an invasive or conservative management approach. We
sought to compare the effects of these management strategies on health
related quality of life (HRQOL) after 1 year.Methods: the After Eighty
study was a prospective randomised controlled multicenter trial. In total,
457 patients aged 80 or over, with NSTEMI or UAP, were randomised to
either an invasive strategy (n = 229, mean age: 84.7 years), involving
early coronary angiography, with immediate evaluation for percutaneous
coronary intervention, coronary artery bypass graft, optimal medical
therapy, or to a conservative strategy (n = 228, mean age: 84.9 years).
The Short Form 36 health survey (SF-36) was used to assess HRQOL at
baseline, and at the 1-year follow-up.Results: baseline SF-36 completion
was achieved for 208 and 216 patients in the invasive and conservative
groups, respectively. A total of 137 in the invasive group and 136
patients in the conservative group completed the SF-36 form at follow-up.
When comparing the changes from follow-up to baseline (delta) no
significant changes in quality-of-life scores were observed between the
two strategies in any of the domains, expect for a small but statistically
significant difference in bodily pain. This difference in only one of the
SF-36 subscales may not necessarily be clinically significant.Conclusion:
from baseline to the 1 year follow-up, only minor differences in change of
HRQOL as measured by SF-36 were seen by comparing an invasive and
conservative strategy.<br/>Copyright &#xa9; The Author 2017.

<3>
Accession Number
620674692
Author
Entwistle T.R.; Green A.C.; Fildes J.E.; Miura K.
Institution
(Entwistle, Fildes) Transplant Centre, University Hospital of South
Manchester, Manchester M23 9LT, United Kingdom
(Green, Miura) Cancer and Population Studies Group, QIMR Berghofer Medical
Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
(Green) CRUK Manchester Institute, University of Manchester, Wilmslow
Road, Manchester, United Kingdom
(Fildes) Manchester Collaborative Centre for Inflammation Research,
University of Manchester, Manchester, United Kingdom
Title
Adherence to Mediterranean and low-fat diets among heart and lung
transplant recipients: A randomized feasibility study.
Source
Nutrition Journal. 17 (1) (no pagination), 2018. Article Number: 22. Date
of Publication: 14 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Heart and lung transplant recipients are at a substantially
increased risk of cardiovascular disease (CVD). Since both low-fat and
Mediterranean diets can reduce CVD in immunocompetent people at high risk,
we assessed adherence among thoracic transplant recipients allocated to
one or other of these diets for 12 months. Methods: Forty-one transplant
recipients (20 heart; 21 lung) randomized to a Mediterranean or a low-fat
diet for 12 months received diet-specific education at baseline. Adherence
was primarily assessed by questionnaire: 14-point Mediterranean diet
(score 0-14) and 9-point low-fat diet (score 0-16) respectively, high
scores indicating greater adherence. Median scores at baseline, 6 months,
12 months, and 6-weeks post-intervention were compared by dietary group.
We further assessed changes in weight, body mass index (BMI) and serum
triglycerides from baseline to 12 months as an additional indicator of
adherence. Results: In those randomized to a Mediterranean diet, median
scores increased from 4 (range 1-9) at baseline, to 10 (range 6-14) at
6-months and were maintained at 12 months, and also at 6-weeks
post-intervention (median 10, range 6-14). Body weight, BMI and serum
triglycerides decreased over the 12-month intervention period (mean weight
- 1.8 kg, BMI -0.5 kg/m², triglycerides - 0.17 mmol/L). In the
low-fat diet group, median scores were 11 (range 9-14) at baseline;
slightly increased to 12 (range 9-16) at 6 months, and maintained at 12
months and 6 weeks post-intervention (median 12, range 8-15). Mean changes
in weight, BMI and triglycerides were - 0.2 kg, 0.0 kg/m² and -
0.44 mmol/L, respectively. Conclusions: Thoracic transplant recipients
adhered to Mediterranean and low-fat dietary interventions. The change
from baseline eating habits was notable at 6 months; and this change was
maintained at 12 months and 6 weeks post-intervention in both
Mediterranean diet and low-fat diet groups. Dietary interventions based on
comprehensive, well-supported education sessions targeted to both patients
and their family members are crucial to success. Such nutritional
strategies can help in the management of their substantial CVD risk. Trial
registration: The IRAS trial registry (ISRCTN63500150). Date of
registration 27 July 2016. Retrospectively registered.<br/>Copyright
&#xa9; 2018 The Author(s).

<4>
Accession Number
616112927
Author
Brindle M.E.; Roberts D.J.; Daodu O.; Haynes A.B.; Cauley C.; Dixon E.; La
Flamme C.; Bain P.; Berry W.
Institution
(Brindle, Daodu) Department of Surgery, University of Calgary, Calgary,
Canada
(Roberts) Departments of Surgery and Community Health Sciences, University
of Calgary and the Foothills Medical Centre, Calgary, Canada
(Haynes, Cauley) Department of Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Haynes, Berry) Ariadne Labs, Boston, MA, United States
(Dixon) Department of Surgery, University of Calgary and the Foothills
Medical Centre, Calgary, Canada
(La Flamme) Sunnybrook Health Sciences Centre, Toronto, Canada
(Bain) Department of Countway Library, Harvard Medical School, Boston, MA,
United States
Title
Deriving literature-based benchmarks for surgical complications in
high-income countries: A protocol for a systematic review and
meta-Analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e013780. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To improve surgical safety, health systems must identify
preventable adverse outcomes and measure changes in these outcomes in
response to quality improvement initiatives. This requires understanding
of the scope and limitations of available population-level data. To derive
literature-based summary estimates of benchmarks of care, we will
systematically review and meta-Analyse rates of postoperative
complications associated with several common and/or high-risk operations
performed in five high-income countries (HICs). Methods and analysis An
electronic search of PubMed, Embase, Web of Science, Cochrane Central, the
NHS Economic Evaluations Database and Health Technology Assessment
database will be performed to identify studies reviewing national surgical
complication rates between 2000 and 2016. Two reviewers will screen titles
and abstracts and full texts of potentially relevant studies to determine
eligibility for inclusion in the systematic review. We will include
English-language publications using data from health databases in the USA,
Canada, the UK, Australia and New Zealand. We will include studies of
patients who underwent hip or knee arthoplasty, appendectomy,
cholecystectomy, oesophagectomy, abdominal aortic aneurysm repair, aortic
valve replacement or coronary artery bypass graft. Outcomes will include
mortality, length of hospital stay, pulmonary embolism, pneumonia, sepsis
or septic shock, reoperation, surgical site infection, wound
dehiscence/disruption, blood transfusion, bile duct injury, stroke and
myocardial infarction. We will calculate summary estimates of cumulative
incidence, incidence rate, prevalence and occurrence rate of complications
using DerSimonian and Laird random effects models. Heterogeneity in these
estimates will be examined using subgroup analyses and meta-regression. We
will correlate findings within contemporary clinical databases. Ethics and
dissemination This study of secondary data does not require ethics
approval. It will be presented internationally and published in the
peer-reviewed literature. Results will inform a future quality improvement
tool and provide benchmarks of surgical complication rates within HICs.
Trial registration International Prospective Register of Systematic
Reviews (PROSPERO). Registration number CRD42016037519.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017. All rights reserved. No commercial use is
permitted unless otherwise expressly granted.

<5>
Accession Number
614796531
Author
El Amrousy D.M.; Elshmaa N.S.; El-Kashlan M.; Hassan S.; Elsanosy M.;
Hablas N.; Elrifaey S.; El-Feky W.
Institution
(El Amrousy, Hassan, Elsanosy, Hablas, Elrifaey) Pediatric Department,
Tanta University Hospital, Tanta, Egypt
(El-Feky) Cardiothoracic Surgery Department, Tanta University Hospital,
Tanta, Egypt
(Elshmaa, El-Kashlan) Department of Anesthesia and Surgical ICU, Faculty
of Medicine, Tanta University, Tanta, Egypt
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia after pediatric cardiac surgery.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004780. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Postoperative junctional ectopic tachycardia is one of the most
serious arrhythmias that occur after pediatric cardiac surgery, difficult
to treat and better to be prevented. Our aim was to assess the efficacy of
prophylactic dexmedetomidine in preventing junctional ectopic tachycardia
after pediatric cardiac surgery. Methods and Results-A prospective
controlled study was carried out on 90 children who underwent elective
cardiac surgery for congenital heart diseases. Patients were randomized
into 2 groups. Group I (dexmedetomidine group): 60 patients received
dexmedetomidine; Group II (Placebo group): 30 patients received the same
amount of normal saline intravenously. The primary outcome was the
incidence of postoperative junctional ectopic tachycardia. Secondary
outcomes included bradycardia, hypotension, vasoactive inotropic score,
ventilation time, pediatric cardiac care unit stay, length of hospital
stay, and perioperative mortality. The incidence of junctional ectopic
tachycardia was significantly reduced in the dexmedetomidine group (3.3%)
compared with the placebo group (16.7%) with P < 0.005. Heart rate while
coming off cardiopulmonary bypass was significantly lower in the
dexmedetomidine group (130.6+/-9) than the placebo group (144+/-7.1) with
P < 0.001. Mean ventilation time, and mean duration of intensive care unit
and hospital stay (days) were significantly shorter in the dexmedetomidine
group than the placebo group (P < 0.001). However, there was no
significant difference between the 2 groups as regards mortality,
bradycardia, or hypotension (P > 0.005). Conclusion-Prophylactic use of
dexmedetomidine is associated with significantly decreased incidence of
postoperative junctional ectopic tachycardia in children after congenital
heart surgery without significant side effects.<br/>Copyright &#xa9; 2017
The Authors.

<6>
Accession Number
614796490
Author
Hu S.; Zhu Y.; Zhang Y.; Dai J.; Li L.; Dauerman H.; Soeda T.; Wang Z.;
Lee H.; Wang C.; Zhe C.; Wang Y.; Zheng G.; Zhang S.; Jia H.; Yu B.; Jang
I.-K.
Institution
(Hu, Zhu, Zhang, Li, Wang, Zhe, Wang, Zheng, Zhang, Jia, Yu) Department of
Cardiology, The 2nd Affiliated Hospital of Harbin Medical University,
Harbin, China
(Hu, Zhu, Zhang, Li, Wang, Zhe, Wang, Zheng, Zhang, Jia, Yu) The Key
Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin,
China
(Dai) Cardiology Division, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, United States
(Lee) Biostatistics, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, United States
(Dauerman) Division of Cardiology, University of Vermont College of
Medicine/Fletcher Allen Healthcare, Burlington, VT, United States
(Wang) Department of Electrical Engineering and Computer Science,
Massachusetts Institute of Technology, Cambridge, MA, United States
(Soeda) Nara Medical University, Nara, Japan
(Jang) Kyung Hee University, Seoul, South Korea
Title
Management and outcome of patients with acute coronary syndrome caused by
plaque rupture versus plaque erosion: An intravascular optical coherence
tomography study.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004730. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Plaque rupture and erosion are the 2 most common mechanisms for
acute coronary syndromes. However, the outcome of these 2 distinct
pathologies in patients with acute coronary syndromes has never been
studied. Methods and Results-We retrospectively studied 141 patients with
acute coronary syndromes who underwent optical coherence tomography (OCT)
imaging of the culprit lesion prior to stenting from the Massachusetts
General Hospital OCT Registry. Management (stent versus no stent),
poststent OCT findings, and outcomes were compared. Among the 141 culprit
lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%).
Stent implantation was performed in 77 (97.5%) patients with rupture
versus 49 (79.0%) in those with erosion (P < 0.001). Immediately after
percutaneous coronary intervention, OCT showed a higher incidence of
malapposition (37.5% versus 7.3%, P < 0.001), thrombus (59.4% versus
14.6%, P < 0.001), and protrusion (93.8% versus 73.2%, P = 0.008) in the
rupture group compared with the erosion group. Plaque rupture was
associated with a higher incidence of no reflow or slow flow and distal
embolization. Although cardiac event rates were comparable between the two
groups at the 1-year follow-up, none of the erosion patients who were
treated conservatively without stenting had adverse cardiac events.
Conclusions-Unfavorable poststent OCT findings were more frequent in
rupture patients compared with erosion patients. A subset of erosion
patients who were treated conservatively without stenting remained free of
adverse cardiac events for up to 1 year.<br/>Copyright &#xa9; 2017 The
Authors.

<7>
Accession Number
615013718
Author
Hansen T.B.; Zwisler A.D.; Berg S.K.; Sibilitz K.Lae.; Thygesen L.C.;
Kjellberg J.; Doherty P.; Oldridge N.; Sogaard R.
Institution
(Hansen) Department of Cardiology, Zealand University Hospital, Roskilde,
Sygehusvej 10, Roskilde 4000, Denmark
(Hansen, Thygesen) National Institute of Public Health, University of
Southern Denmark, Odense, Denmark
(Hansen, Zwisler, Berg, Sibilitz) Heart Centre, Department of Cardiology,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Zwisler) Danish Centre for Rehabilitation and Palliative Care, University
of Southern Denmark, University Hospital of Odense, Odense, Denmark
(Kjellberg) National Institute for Regional and Local Government Research,
Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, York, United
Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
Milwaukee, WI, United States
(Sogaard) Department of Public Health, Aarhus University, Aarhus, Denmark
(Sogaard) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
Title
Cost-utility analysis of cardiac rehabilitation after conventional heart
valve surgery versus usual care.
Source
European Journal of Preventive Cardiology. 24 (7) (pp 698-707), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background While cardiac rehabilitation in patients with ischaemic heart
disease and heart failure is considered cost-effective, this evidence may
not be transferable to heart valve surgery patients. The aim of this study
was to investigate the cost-effectiveness of cardiac rehabilitation
following heart valve surgery. Design We conducted a cost-utility analysis
based on a randomised controlled trial of 147 patients who had undergone
heart valve surgery and were followed for 6 months. Methods Patients were
randomised to cardiac rehabilitation consisting of 12 weeks of physical
exercise training and monthly psycho-educational consultations or to usual
care. Costs were measured from a societal perspective and quality-adjusted
life years were based on the EuroQol five-dimensional questionnaire
(EQ-5D). Estimates were presented as means and 95% confidence intervals
(CIs) based on bootstrapping. Costs and effect differences were presented
in a cost-effectiveness plane and were transformed into net benefit and
presented in cost-effectiveness acceptability curves. Results No
statistically significant differences were found in total societal costs
(-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life
years (-0.000; 95% CI -0.021 to 0.020) between groups. However,
approximately 70% of the cost and effect differences were located below
the x-axis in the cost-effectiveness plane, and the cost-effectiveness
acceptability curves showed that the probability for cost- effectiveness
of cardiac rehabilitation compared to usual care is at minimum 75%, driven
by a tendency towards costs savings. Conclusions Cardiac rehabilitation
after heart valve surgery may not have improved health-related quality of
life in this study, but is likely to be cost-effective for society,
outweighing the extra costs of cardiac rehabilitation.<br/>Copyright
&#xa9; European Society of Cardiology 2017.

<8>
Accession Number
615013673
Author
Ribeiro G.S.; Melo R.D.; Deresz L.F.; Dal Lago P.; Pontes M.R.N.; Karsten
M.
Institution
(Ribeiro, Melo, Deresz, Dal Lago, Karsten) Programa de Pos-graduacao em
Ciencias da Reabilitacao, Universidade Federal de Ciencias da Saude de
Porto Alegre (UFCSPA), Brazil
(Deresz) Departamento de Educacao Fisica, Universidade Federal de Juiz de
Fora (UFJF), Brazil
(Dal Lago) Departamento de Fisioterapia, UFCSPA, Brazil
(Pontes) Departamento de Farmacociencias, UFCSPA, Brazil
(Pontes) Unidade de Pesquisa, Hospital Sao Francisco, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Brazil
Title
Cardiac rehabilitation programme after transcatheter aortic valve
implantation versus surgical aortic valve replacement: Systematic review
and meta-analysis.
Source
European Journal of Preventive Cardiology. 24 (7) (pp 688-697), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Aortic stenosis is a valvular heart disease characterised by
fixed obstruction of the left ventricular outflow. It can be managed by
surgical aortic valve replacement (sAVR) or transcatheter aortic valve
implantation (TAVI). This review aimed to describe the evidence supporting
a cardiac rehabilitation programme on functional capacity and quality of
life in aortic stenosis patients after sAVR or TAVI. Methods The search
was conducted on multiple databases from January to March 2016. All
studies were eligible that evaluated the effects of a post-interventional
cardiac rehabilitation programme in aortic stenosis patients. The
methodological quality was assessed using the PEDro scale. Meta-analysis
was performed separately by procedure and between procedures. The walked
distance during the six-minute walk test (6MWD) and Barthel index were
evaluated. The analysis was conducted in Review Manager. Results Five
studies were included (292 TAVI and 570 sAVR patients). The meta-analysis
showed that a cardiac rehabilitation programme was associated with a
significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel
index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43,
1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after
sAVR. In addition, the meta-analysis showed that the cardiac
rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73,
21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36)
after sAVR or TAVI. Conclusions The cardiac rehabilitation programme
improved the functional capacity and quality of life in aortic stenosis
patients. Patients who underwent TAVI benefitted with a cardiac
rehabilitation programme similar to sAVR patients.<br/>Copyright &#xa9;
European Society of Cardiology 2017.

<9>
Accession Number
615000470
Author
Woolf-King S.E.; Anger A.; Arnold E.A.; Weiss S.J.; Teitel D.
Institution
(Woolf-King) Department of Psychology, Syracuse University, Syracuse, NY,
United States
(Woolf-King, Arnold, Weiss) Department of Medicine, University of
California, San Francisco, San Francisco, CA, United States
(Anger) Department of Community Health Systems, School of Nursing,
University of California, San Francisco, San Francisco, CA, United States
(Anger, Teitel) Department of Pediatrics, Pediatric Heart Center,
University of California, San Francisco, San Francisco, CA, United States
Title
Mental health among parents of children with critical congenital heart
defects: A systematic review.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004862. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Parents of children with critical congenital heart defects
(PCCHDs) may be at high risk for mental health morbidity; however, the
literature is not well characterized. Given that compromised parental
mental health can lead to long-term cognitive, health-related, and
behavioral problems in children, a systematic review of this literature
could provide informed recommendations for continued research and enhance
the care of families of children living with critical congenital heart
defects. Methods and Results-We conducted a systematic review using the
Preferred Reporting Items for Systematic Reviews and Meta- Analyses
guidelines that resulted in 30 studies on the mental health of PCCHDs. The
literature revealed that PCCHDs are at an elevated risk for psychological
problems, particularly in the immediate weeks and months following cardiac
surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of
posttraumatic stress disorder, with over 80% presenting with clinically
significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically
elevated symptoms of depression and/or anxiety, and 30% to 80% reported
experiencing severe psychological distress. There was high variability in
measurements used to assess study outcomes, methodological quality, and
sociocultural composition of the parents included in the studies.
Conclusions-There is an urgent need for additional research on the
severity, course, persistence, and moderators of these mental health
problems over time, and for the development and testing of screening
approaches and interventions that can be feasibly delivered in the context
of ongoing pediatric cardiac care.<br/>Copyright &#xa9; 2017 The Authors.

<10>
Accession Number
619188996
Author
Tse G.; Gong M.; Wong S.H.; Wu W.K.K.; Bazoukis G.; Lampropoulos K.; Wong
W.T.; Xia Y.; Wong M.C.S.; Liu T.; Woo J.
Institution
(Tse, Wong, Woo) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Tse, Wong, Wu) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, Hong Kong
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Wu) Department of Anaesthesia and Intensive Care, State Key Laboratory of
Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong
Kong
(Bazoukis, Lampropoulos) Second Department of Cardiology, Laboratory of
Cardiac Electrophysiology, Evangelismos General Hospital of Athens,
Athens, Greece
(Wong) School of Life Sciences, The Chinese University of Hong Kong, Hong
Kong, Hong Kong
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Wong) JC School of Public Health and Primary Care, The Chinese University
of Hong Kong, Hong Kong, Hong Kong
(Wong) State Key Laboratory of Digestive Disease, Chinese University of
Hong Kong, Hong Kong
Title
Frailty and Clinical Outcomes in Advanced Heart Failure Patients
Undergoing Left Ventricular Assist Device Implantation: A Systematic
Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. 19 (3) (pp
255-261.e1), 2018. Date of Publication: March 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Frailty has been identified as a risk factor for adverse
clinical outcomes after cardiac intervention or surgery. However, whether
it increases the risk of adverse outcomes in patients undergoing left
ventricular assist device (LVAD) therapy has been controversial.
Therefore, we conducted a systematic review and meta-analysis of the
frailty measures and clinical outcomes of length of stay and mortality in
this setting. Methods: PubMed and Embase were searched until September 11,
2017, for studies evaluating the association between frailty and clinical
outcomes in advanced heart failure patients undergoing LVAD implantation.
Results: A total of 46 and 79 entries were retrieved from our search
strategy. A total of 13 studies involving 3435 patients were included in
the final meta-analysis (mean age: 57.7 +/- 15.3 years; 79% male,
follow-up duration was 13 +/- 14 months). Compared to nonfrail patients (n
= 2721), frail patients (n = 579) had significantly longer
time-to-extubation (n = 3; mean difference: 45 +/- 6 hours; I²:
0%) and hospital length of stay (n = 4; mean difference: 2.9 +/- 1.2 days;
P =.001; I²: 21%). Frailty was not a predictor of inpatient or
short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence
interval (CI): 0.66-2.26; P >.05; I²: 0%] but predicted
long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P =.001;
I²: 0%). Conclusions: Frailty leads to significantly longer
time to extubation, hospital length of stay, and long-term mortality in
advanced heart failure patients who have undergone LVAD implantation.
Older patients being considered for LVAD implantation should therefore be
assessed for frailty status. The risk and benefit of the procedure should
be explained to the patient, emphasizing that frailty increases the
likelihood of adverse clinical outcomes.<br/>Copyright &#xa9; 2017 AMDA -
The Society for Post-Acute and Long-Term Care Medicine

<11>
Accession Number
620837022
Author
Marie-Helene D.; Carolanne R.; Mathieu S.; Pierre-Alexandre B.; Francois
L.
Institution
(Marie-Helene, Carolanne, Mathieu, Pierre-Alexandre, Francois) Institut
Universitaire de Cardiologie et de Pneumologie, Quebec, Canada
Title
Evaluation of the risk of hyperoxia-induced hypercapnia in obese cardiac
surgery patients: Crossover comparison of two saturation targets and two
oxygen titration modes.
Source
Annals of Intensive Care. Conference: French Intensive Care Society,
International Congress - Reanimation 2018. France. 8 (1 Supplement 1) (no
pagination), 2018. Date of Publication: February 2018.
Publisher
Springer Verlag
Abstract
Introduction: Noxious effects of hyperoxia have been described for more
than 60 years. Recent studies on stable obesity-hypoventilation syndrome
(OHS) patients have risen concern about hyperoxiainduced hypercapnia in
this population, but many questions remain unanswered. How important is
this risk in acute care? Is there a risk in non-OHS obese patients as
well? This study aims to evaluate the risk of hyperoxia-induced
hypercapnia in post-op obese cardiac surgery patients. Patients and
methods: 30 obese patients (BMI > 30) having coronary artery bypass
grafting (CABG) are currently being recruited. Informed written consent is
obtained before inclusion. With a crossover design, we are comparing two
oxygenation strategies immediately after extubation, in terms of their
effect on arterial partial pressure of carbon dioxide (PaCO2)-a peripheral
oxygen saturation (SpO2) target of > 95% achieved with manual titration
(control period) and a SpO2 target of 90% achieved with automatic
titration by a closed-loop system (FreeO2 period). Every patient is
delivered oxygen according to both strategies for 30 min each, in a
randomized order. FreeO2 (Oxynov, Quebec, Canada) is a closed-loop oxygen
delivery system which titrates oxygen flow according to the patient's
real-time SpO2 and a target set by the physician. SpO2, oxygen flow and
heart rate are continuously recorded by FreeO2 during both periods.
Hemodynamic parameters are checked at 10 min intervals and arterial blood
gases are collected at the end of each period. The primary outcome is the
change in PaCO<inf>2</inf> between periods. Results: 17 patients have been
included so far and data for 16 patients are presented here. 13 are men,
mean age is 60 +/- 8 years and mean BMI is 34 +/- 4 kg m2. 9 patients are
responders, as shown by an elevation in PaCO<inf>2</inf> in control period
compared to FreeO2 period, and 7 patients are non-responders. Two distinct
oxygenation profiles are being studied (see Fig. 1). The mean SpO2 for
FreeO2 period is 91.1 +/- 1.3% while it is 97.2 +/- 1.4% for control
period. Mean oxygen flow is 0.7 +/- 0.7 L min for FreeO2 period
(equivalent to < 24% FiO2) while mean FiO2 is 51 +/- 10% for control
period. Conclusion: FreeO2 is helpful in maintaining oxygenation within
target. High SpO2 values may cause an elevation in PaCO<inf>2</inf> in
obese patients after CABG, but more analyses are required for this
outcome. Characteristics of responders and non-responders will be analyzed
after study completion.

<12>
Accession Number
620245760
Author
Yu Y.; Zhang K.; Zhang L.; Zong H.; Meng L.; Han R.
Institution
(Yu, Zhang, Han) Beijing Tiantan Hospital, Capital Medical University,
Department of Anesthesiology, No.6 Tiantan Xili, Beijing 100050, China
(Zhang) School of Public Health, Capital Medical University, Department of
Epidemiology and Health Statistics, No. 129 Mail Box, No. 10 Xitoutiao,
Beijing, Youanmenwai 100069, China
(Zong) Beijing Tiantan Hospital, Capital Medical University, Department of
Urology, No.6 Tiantan Xili, Beijing 100050, China
(Meng) Yale University School of Medicine, Department of Anesthesiology,
New Haven, CT, United States
Title
Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of
brain oxygenation in children and adults.
Source
Cochrane Database of Systematic Reviews. 2018 (1) (no pagination), 2018.
Article Number: CD010947. Date of Publication: 17 Jan 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Various techniques have been employed for the early detection
of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared
spectroscopy (NIRS) is increasingly used in this clinical scenario to
monitor brain oxygenation. However, it is unknown whether perioperative
cerebral NIRS monitoring and the subsequent treatment strategies are of
benefit to patients. Objectives: To assess the effects of perioperative
cerebral NIRS monitoring and corresponding treatment strategies in adults
and children, compared with blinded or no cerebral oxygenation monitoring,
or cerebral oxygenation monitoring based on non-NIRS technologies, on the
detection of cerebral oxygen desaturation events (CDEs), neurological
outcomes, non-neurological outcomes and socioeconomic impact (including
cost of hospitalization and length of hospital stay). Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016,
Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to
20 December 2016). We also searched the World Health Organization (WHO)
International Clinical Trials Registry Platform for ongoing studies on 20
December 2016. We updated this search in November 2017, but these results
have not yet been incorporated in the review. We imposed no language
restriction. Selection criteria: We included all relevant randomized
controlled trials (RCTs) dealing with the use of cerebral NIRS in the
perioperative setting (during the operation and within 72 hours after the
operation), including the operating room, the postanaesthesia care unit
and the intensive care unit. Data collection and analysis: Two authors
independently selected studies, assessed risk of bias and extracted data.
For binary outcomes, we calculated the risk ratio (RR) and its 95%
confidence interval (CI). For continuous data, we estimated the mean
difference (MD) between groups and its 95% CI. As we expected clinical and
methodological heterogeneity between studies, we employed a random-effects
model for analyses and we examined the data for heterogeneity
(I² statistic). We created a 'Summary of findings' table using
GRADEpro. Main results: We included 15 studies in the review, comprising a
total of 1822 adult participants. There are 12 studies awaiting
classification, and eight ongoing studies. None of the 15 included studies
considered the paediatric population. Four studies were conducted in the
abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip
replacement), one study in the carotid endarterectomy setting, and the
remaining 10 studies in the aortic or cardiac surgery setting. The main
sources of bias in the included studies related to potential conflict of
interest from industry sponsorship, unclear blinding status or missing
participant data. Two studies with 312 participants considered
postoperative neurological injury, however no pooled effect estimate could
be calculated due to discordant direction of effect between studies
(low-quality evidence). One study (N = 126) in participants undergoing
major abdominal surgery reported that 4/66 participants experienced
neurological injury with blinded monitoring versus 0/56 in the active
monitoring group. A second study (N = 195) in participants having coronary
artery bypass surgery reported that 1/96 participants experienced
neurological injury in the blinded monitoring group compared with 4/94
participants in the active monitoring group. We are uncertain whether
active cerebral NIRS monitoring has an important effect on the risk of
postoperative stroke because of the low number of events and wide
confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240
participants; low-quality evidence). We are uncertain whether active
cerebral NIRS monitoring has an important effect on postoperative delirium
because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1
study, 190 participants; low-quality evidence). Two studies with 126
participants showed that active cerebral NIRS monitoring may reduce the
incidence of mild postoperative cognitive dysfunction (POCD) as defined by
the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to
0.95, I² = 49%, low-quality evidence). Based on six studies
with 962 participants, there was moderate-quality evidence that active
cerebral oxygenation monitoring probably does not decrease the occurrence
of POCD (decline in cognitive function) at one week after surgery (RR
0.62, 95% CI 0.37 to 1.04, I² = 80%). The different type of
monitoring equipment in one study could potentially be the cause of the
heterogeneity. We are uncertain whether active cerebral NIRS monitoring
has an important effect on intraoperative mortality or postoperative
mortality because of the low number of events and wide confidence interval
(RR 0.63, 95% CI 0.08 to 5.03, I²= 0%; 3 studies, 390
participants; low-quality evidence). There was no evidence to determine
whether routine use of NIRS-based cerebral oxygenation monitoring causes
adverse effects. Authors' conclusions: The effects of perioperative active
cerebral NIRS monitoring of brain oxygenation in adults for reducing the
occurrence of short-term, mild POCD are uncertain due to the low quality
of the evidence. There is uncertainty as to whether active cerebral NIRS
monitoring has an important effect on postoperative stroke, delirium or
death because of the low number of events and wide confidence intervals.
The conclusions of this review may change when the eight ongoing studies
are published and the 12 studies awaiting assessment are classified. More
RCTs performed in the paediatric population and high-risk patients
undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy
and other surgery) are needed.<br/>Copyright &#xa9; 2018 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<13>
Accession Number
620774816
Author
Huang W.; Zhu Y.; Qu H.
Institution
(Huang) Yantai Yuhuangding Hospital, Eastern Operating Room, Yantai,
Shandong, China
(Zhu, Qu) Department of Nursing, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
Title
Use of an alternating inflatable head pad in patients undergoing open
heart surgery.
Source
Medical Science Monitor. 24 (pp 970-976), 2018. Date of Publication: 16
Feb 2018.
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: Preoperative symptoms like occipital pressure ulcers and
alopecia areata (AA) significantly lowered patient quality of life.
Therefore, preoperative nursing was in need of investigation. This study
aimed to compare effects of an alternating inflatable head pad and a gel
pad on occurrence of postoperative pressure ulcers and AA in patients
undergoing open heart surgery. Material/Methods: This was a prospective
study. We allocated randomly 120 patients undergoing surgery (3-7 h) in
the Yantai Yuhuangding Hospital affiliated to Qingdao University, China
from January to October 2015 to the control (gel head pad) or the
experimental (alternating inflatable head pad) group (n=60 per group). The
incidence and severity of occipital pressure ulcer were graded by the
classification system of the European Pressure Ulcer Advisory Panel
(EPUAP). The degree of occipital alopecia was measured by hair pull test.
This study used the t test and chi-square analysis. All statistics were
analyzed by SPSS 21.0. Results: Compared with the control group, there was
a significantly lower incidence and severity of occipital pressure ulcer
and alopecia in the experimental group (9 cases/60 cases vs. 1 case/60
cases, P<0.01). Moreover, multivariate analysis showed the risk of
developing occipital pressure ulcer after surgery was also obviously lower
in the experimental group (OR 1.449-120.798; P<0.005). Hair pull test
revealed that fewer patients in the experimental group had a hair loss
over 10%. Conclusions: The alternating inflatable head pad was effective
in reducing the incidence and severity of occipital pressure ulcer and
alopecia associated with surgery, which benefited the postoperative
nursing and improved patient quality of life.<br/>Copyright &#xa9; Med Sci
Monit, 2018.

<14>
Accession Number
620852327
Author
Lazar R.M.; Pavol M.A.; Bormann T.; Dwyer M.G.; Kraemer C.; White R.;
Zivadinov R.; Wertheimer J.C.; Thone-Otto A.; Ravdin L.D.; Naugle R.;
Mechanic-Hamilton D.; Garmoe W.S.; Stringer A.Y.; Bender H.A.; Kapadia
S.R.; Kodali S.; Ghanem A.; Linke A.; Mehran R.; Virmani R.; Nazif T.;
Parhizgar A.; Leon M.B.
Institution
(Lazar) Department of Neurology, University of Alabama at Birmingham,
Birmingham, Alabama, United States
(Pavol) Department of Neurology, Columbia University Medical Center, New
York, New York, United States
(Bormann) Department of Neurology, Medical Center-University of Freiburg,
Freiburg, Germany
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, SUNY/Buffalo,
Buffalo, New York, United States
(Kraemer) North American Science Associates, Minneapolis, Minnesota,
United States
(White) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Wertheimer) Department of Physical Medicine and Rehabilitation,
Cedars-Sinai Medical Center, Los Angeles, California, United States
(Thone-Otto) Clinic for Cognitive Neurology, University of Leipzig,
Leipzig, Germany
(Ravdin) Department of Neurology, Weill Medical College of Cornell
University, New York, New York, United States
(Naugle) Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United
States
(Mechanic-Hamilton) Department of Neurology, University of Pennsylvania,
Philadelphia, Pennsylvania, United States
(Garmoe) Psychology Department, MedStar Health, Washington, DC, United
States
(Stringer) Department of Rehabilitation Medicine, Emory University,
Atlanta, Georgia
(Bender) Department of Neurology, Mount Sinai School of Medicine, New
York, New York, United States
(Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio, United States
(Kodali, Nazif, Leon) Department of Medicine, Columbia University Medical
Center, New York, New York, United States
(Ghanem) Department of Cardiology, Asklepios St Georg, Hamburg, Germany
(Linke) Herzzentrum Leipzig-Universitatsklinik, Leipzig, Germany
(Mehran) Department of Medicine, Mount Sinai School of Medicine, New York,
New York, United States
(Virmani) CV Path Institute, Gaithersburg, Maryland, United States
(Parhizgar) Claret Medical, Santa Rosa, California, United States
Title
Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before
Undergoing Transcatheter Aortic Valve Replacement: Insights From the
SENTINEL Trial.
Source
JACC: Cardiovascular Interventions. 11 (4 Supplement) (pp 384-392), 2018.
Date of Publication: 26 Feb 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to determine baseline neurocognition before
transcatheter aortic valve replacement (TAVR) and its correlations with
pre-TAVR brain imaging. Background: TAVR studies have not shown a
correlation between diffusion-weighted image changes and neurocognition.
The authors wanted to determine the extent to which there was already
impairment at baseline that correlated with cerebrovascular disease.
Methods: SENTINEL (Cerebral Protection in Transcatheter Aortic Valve
Replacement) trial patients had cognitive assessments of attention,
processing speed, executive function, and verbal and visual memory.
Z-scores were based on normative means and SDs, combined into a primary
composite z-score. Brain magnetic resonance images were obtained pre-TAVR
on 3-T scanners with a T2 fluid-attenuated inversion recovery (FLAIR)
sequence. Scores <=-1.5 SD below the normative mean (7th percentile) were
considered impairment. Paired t tests compared within-subject scores, and
chi-square goodness-of-fit compared the percentage of subjects below -1.5
SD. Correlation and regression analyses assessed the relationship between
neurocognitive z-scores and T2 lesion volume. Results: Among 234 patients
tested, the mean composite z-score was -0.65 SD below the normative mean.
Domain scores ranged from -0.15 SD for attention to -1.32 SD for executive
function. On the basis of the >=1.5 SD normative reference, there were
significantly greater percentages of impaired scores in the composite
z-score (13.2%; p = 0.019), executive function (41.9%; p < 0.001), verbal
memory (p < 0.001), and visual memory (p < 0.001). The regression model
between FLAIR lesion volume and baseline cognition showed statistically
significant negative correlations. Conclusions: There was a significant
proportion of aortic stenosis patients with impaired cognition before
TAVR, with a relationship between baseline cognitive function and lesion
burden likely attributable to longstanding cerebrovascular disease. These
findings underscore the importance of pre-interventional testing and
magnetic resonance imaging in any research investigating post-surgical
cognitive outcomes in patients with cardiovascular disease.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<15>
Accession Number
620853844
Author
Ali W.E.; Vaidya S.R.; Ejeh S.U.; Okoroafor K.U.
Institution
(Ali, Vaidya, Ejeh) Department of Internal Medicine, Cape Fear Valley
Medical Center, Campbell University School of Osteopathic Medicine, 1638
Owen Drive, Fayetteville, NC 28304, United States
(Ali, Vaidya, Ejeh, Okoroafor) Department of Medicine - Cardiology, Cape
Fear Valley Medical Center, Fayetteville, NC, United States
Title
Meta-analysis study comparing percutaneous coronary intervention/drug
eluting stent versus coronary artery bypass surgery of unprotected left
main coronary artery disease.
Source
Medicine (United States). 97 (7) (no pagination), 2018. Article Number:
e9909. Date of Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Results on the safety and long-term efficacy of drug-eluting
stent placement in unprotected left main coronary artery disease (ULMCAD)
compared with those of coronary artery bypass surgery (CABG) remain
inconsistent across randomized clinical trials and recent meta-analysis
studies. We aimed to compare the clinical outcomes and safety over short-
and long-term follow-ups by conducting a meta-analysis of large pooled
data from randomized controlled trials and up-to-date observational
studies. Methods: A systematic review of PubMed, Google Scholar, Medline,
and reference lists of related articles was performed for studies
conducted in the drug-eluting stent era, to compare percutaneous coronary
intervention (PCI) with CABG in ULMCAD. The primary outcome was major
adverse cardiovascular and cerebrovascular events (MACCE), myocardial
infarction (MI), stroke, all-cause mortality, and revascularization after
at least 1-year follow-up. In-hospital and 30-day clinical outcomes were
considered secondary outcomes. Furthermore, a subgroup analysis of studies
with >=5 years follow-up was performed to test the sustainability of
clinical outcomes. Results: A total of 29 studies were extracted with
21,832 patients (10,424 in PCI vs 11,408 in CABG). Pooled analysis
demonstrated remarkable differences in long-term follow-up (>=1 year)
MACCE (odds ratio [OR] 1.42, 95% CI 1.27-1.59), P<.00001), repeat
revascularization (OR 3.00, 95% CI 2.41-3.73, P<.00001), and MI (OR 1.32,
95% CI 1.14-1.53, P=.0002), favoring CABG over PCI. However, stroke risk
was significantly lower in the PCI group. Subgroup analysis of studies
with >=5 years follow-up showed similar outcomes except for the
noninferiority outcome of MACCE in the PCI arm. However, the PCI group
proved good safety profile after a minimum of 30-day follow-up with lower
MACCE outcome. Conclusion: PCI for ULMCAD can be applied with
attentiveness in carefully selected patients. MI and the need for
revascularization remain drawbacks and areas of concern among previous
studies. Nonetheless, it has been proven safe during short-term
follow-up.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<16>
Accession Number
2000461742
Author
Head S.J.; Milojevic M.; Daemen J.; Ahn J.-M.; Boersma E.; Christiansen
E.H.; Domanski M.J.; Farkouh M.E.; Flather M.; Fuster V.; Hlatky M.A.;
Holm N.R.; Hueb W.A.; Kamalesh M.; Kim Y.-H.; Makikallio T.; Mohr F.W.;
Papageorgiou G.; Park S.-J.; Rodriguez A.E.; Sabik J.F.; Stables R.H.;
Stone G.W.; Serruys P.W.; Kappetein A.P.
Institution
(Head, Milojevic, Papageorgiou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
(Daemen, Boersma) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Papageorgiou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Ahn, Kim, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Domanski, Farkouh, Fuster) Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Domanski, Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre, University of Toronto, Toronto, ON, Canada
(Flather) Norwich Medical School University of East Anglia and Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Hlatky) Stanford University School of Medicine, Stanford, CA, United
States
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kamalesh) Richard L Roudebush VA Medical Center, Indianapolis, IN, United
States
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Mohr) Department of Cardiac Surgery, Herzzentrum Universitat Leipzig,
Leipzig, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Sabik) Department Surgery, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Stone) Columbia University Medical Center and the Center for Clinical
Trials, Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Imperial College London, London, United Kingdom
Title
Mortality after coronary artery bypass grafting versus percutaneous
coronary intervention with stenting for coronary artery disease: a pooled
analysis of individual patient data.
Source
The Lancet. (no pagination), 2018. Date of Publication: 2018.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Numerous randomised trials have compared coronary artery
bypass grafting (CABG) with percutaneous coronary intervention (PCI) for
patients with coronary artery disease. However, no studies have been
powered to detect a difference in mortality between the revascularisation
strategies. Methods: We did a systematic review up to July 19, 2017, to
identify randomised clinical trials comparing CABG with PCI using stents.
Eligible studies included patients with multivessel or left main coronary
artery disease who did not present with acute myocardial infarction, did
PCI with stents (bare-metal or drug-eluting), and had more than 1 year of
follow-up for all-cause mortality. In a collaborative, pooled analysis of
individual patient data from the identified trials, we estimated all-cause
mortality up to 5 years using Kaplan-Meier analyses and compared PCI with
CABG using a random-effects Cox proportional-hazards model stratified by
trial. Consistency of treatment effect was explored in subgroup analyses,
with subgroups defined according to baseline clinical and anatomical
characteristics. Findings: We included 11 randomised trials involving 11
518 patients selected by heart teams who were assigned to PCI (n=5753) or
to CABG (n=5765). 976 patients died over a mean follow-up of 3.8 years (SD
1.4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
score was 26.0 (SD 9.5), with 1798 (22.1%) of 8138 patients having a
SYNTAX score of 33 or higher. 5 year all-cause mortality was 11.2% after
PCI and 9.2% after CABG (hazard ratio [HR] 1.20, 95% CI 1.06-1.37;
p=0.0038). 5 year all-cause mortality was significantly different between
the interventions in patients with multivessel disease (11.5% after PCI vs
8.9% after CABG; HR 1.28, 95% CI 1.09-1.49; p=0.0019), including in those
with diabetes (15.5% vs 10.0%; 1.48, 1.19-1.84; p=0.0004), but not in
those without diabetes (8.7% vs 8.0%; 1.08, 0.86-1.36; p=0.49). SYNTAX
score had a significant effect on the difference between the interventions
in multivessel disease. 5 year all-cause mortality was similar between the
interventions in patients with left main disease (10.7% after PCI vs 10.5%
after CABG; 1.07, 0.87-1.33; p=0.52), regardless of diabetes status and
SYNTAX score. Interpretation: CABG had a mortality benefit over PCI in
patients with multivessel disease, particularly those with diabetes and
higher coronary complexity. No benefit for CABG over PCI was seen in
patients with left main disease. Longer follow-up is needed to better
define mortality differences between the revascularisation strategies.
Funding: None.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<17>
Accession Number
619459883
Author
Hasaniya N.; Razzouk A.; Newcombe J.; Hassneiah D.; Heimes J.; Gysbers J.;
Martens T.; Bailey L.
Institution
(Hasaniya, Razzouk, Newcombe, Hassneiah, Heimes, Gysbers, Martens, Bailey)
Department of Cardiovascular and Thoracic Surgery, Loma Linda University
Children's Hospital, Loma Linda, California, United States
Title
An Absorbable Hydrogel Spray Reduces Postoperative Mediastinal Adhesions
After Congenital Heart Surgery.
Source
Annals of Thoracic Surgery. 105 (3) (pp 837-842), 2018. Date of
Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Adhesions encountered during reoperative cardiac surgery can
prolong operative time and increase operative risk. The purpose of this
clinical study was to investigate the antiadhesion property of a synthetic
bioabsorbable polymer spray after cardiac reoperations in infants.
Methods: A prospective randomized double-blinded study was designed. Forty
infants requiring staged cardiac operations were randomly allocated to a
study group (n = 20) or a control group (n = 20). The appropriate volume
of the polymer was sprayed onto the mediastinal surfaces before chest
closure after the first surgical procedure in the study group. At
reoperation, adhesions were evaluated by a blinded investigator following
a 5-grade scoring system. Five predetermined anatomic areas were scored.
Incision to extracorporeal circulation time was also analyzed. Results: In
all, 40 subjects were enrolled into the study. Four babies died before the
second operation. Three others were missed for reevaluation. The control
group (n = 16) had longer incision to extracorporeal circulation time (38
+/- 10 minutes) than the study group (n = 17; 23 +/- 6 minutes; p <
0.001). The control subjects had significantly more severe adhesions than
the study group at all five mediastinal areas: (1) retrosternal (p <
0.001); (2) base of the heart (large vessels [p < 0.05]); (3) right side
(p < 0.01); (4) left side (p < 0.02); and (5) diaphragmatic side of the
mediastinum (p < 0.001). Conclusions: The use of synthetic bioabsorbable
polymer sealant spray at the end of primary pediatric cardiac surgery
reduces the intensity of mediastinal adhesions and the reentry time in
infants undergoing repeat median sternotomy.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<18>
Accession Number
620757044
Author
Wahal C.; Kumar A.; Pyati S.
Institution
(Wahal, Kumar, Pyati) Department of Anesthesiology, Division of Regional
Anesthesia and Pain Management, Veterans Affairs Medical Center, Duke
University School of Medicine, NC, United States
Title
Advances in regional anaesthesia: A review of current practice, newer
techniques and outcomes.
Source
Indian Journal of Anaesthesia. 62 (2) (pp 94-102), 2018. Date of
Publication: February 2018.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Advances in ultrasound guided regional anaesthesia and introduction of
newer long acting local anaesthetics have given clinicians an opportunity
to apply novel approaches to block peripheral nerves with ease.
Consequently, improvements in outcomes such as quality of analgesia, early
rehabilitation and patient satisfaction have been observed. In this
article we will review some of the newer regional anaesthetic techniques,
long acting local anaesthetics and adjuvants, and discuss evidence for key
outcomes such as cancer recurrence and safety with ultrasound
guidance.<br/>Copyright &#xa9; 2018 Indian Journal of Anaesthesia.

<19>
Accession Number
620536758
Author
Ebrahimi R.; Gupta S.; Carr B.M.; Bishawi M.; Bakaeen F.G.; Almassi G.H.;
Collins J.; Grover F.L.; Quin J.A.; Wagner T.H.; Shroyer A.L.W.; Hattler
B.
Institution
(Ebrahimi) Department of Cardiology, Veterans Affairs Greater Los Angeles
Healthcare System, Los Angeles, California, United States
(Ebrahimi) Department of Medicine, University of California Los Angeles,
Los Angeles, California, United States
(Gupta, Carr, Bishawi, Shroyer) Research Service, Northport VA Medical
Center, Northport, New York, United States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester,
Minnesota, United States
(Bishawi) Cardiovascular and Thoracic Surgery, Duke University Medical
Center, Durham, North Carolina, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Almassi) Milwaukee VA Medical Center, Milwaukee, Wisconsin, United States
(Almassi) Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee,
Wisconsin, United States
(Collins) Cooperative Studies Program Coordinating Center, Perry Point,
Maryland, United States
(Grover, Shroyer) Research Service, VA Eastern Colorado Healthcare System,
Denver, Colorado, United States
(Grover) Cardiothoracic Surgery, the University of Colorado School of
Medicine at the Anschutz Medical Campus, Aurora, Colorado, United States
(Quin) Cardiac Surgery, VA Boston Healthcare System, West Roxbury,
Massachusetts, United States
(Wagner) VA Palo Alto Health Economics Resource Center, Menlo Park,
California, United States
(Wagner) Department of Health Research and Policy, Stanford University,
Stanford, California, United States
(Hattler) Cardiology, VA Eastern Colorado Health Care System, Denver,
Colorado, United States
(Hattler) Department of Medicine, Division of Cardiology, University of
Colorado School of Medicine at the Anschutz Medical Campus, Aurora,
Colorado, United States
Title
Comparison of Outcomes and Costs Associated With Aspirin+/-Clopidogrel
After Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 121 (6) (pp 709-714), 2018. Date of
Publication: 15 Mar 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Optimal antiplatelet therapy after coronary artery bypass graft (CABG)
surgery remains controversial. This study evaluated the role of dual
antiplatelet therapy using aspirin and clopidogrel (DAPT) versus
antiplatelet therapy using aspirin only (ASA) on post-CABG clinical
outcomes and costs. In the Department of Veterans Affairs Randomized
On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively
collected beginning in year 2 of this study to include 1,525 of the 2,203
original ROOBY patients who received aspirin after CABG. Discretionarily,
surgeons after CABG administered either DAPT or ASA treatments. The ROOBY
trial's primary 30-day composite (mortality or perioperative morbidity),
1-year composite (all-cause death, repeat revascularization, or nonfatal
myocardial infarction), and costs were compared for these 2 strategies. Of
the 1,525 subjects, 511 received DAPT and 1,014 received ASA. DAPT
subjects, compared with ASA subjects, had lower rates of preoperative left
ventricular ejection fraction of >=45% (78.8% vs 85.7%, p <0.001), on-pump
CABG (36.6% vs 57.1%, p = 0.001), and endoscopic vein harvesting (30.0% vs
42.8%, p <0.001). ASA patients were more likely to have earlier aspirin
administration and receive 325 versus 81 mg dosages. The 30-day composite
outcome rate was significantly lower for DAPT patients compared with ASA
patients (3.3% vs 7.1%, p = 0.003), but the 1-year composite outcome was
equal between the 2 groups (12.0% vs12.0%, p = 1.0). At 1 year, there were
no cost differences between the 2 groups. Propensity analyses did not
significantly alter the results. In conclusion, DAPT appeared safe and was
associated with fewer 30-day adverse outcomes than aspirin only and with
no 1-year outcome or cost differences.<br/>Copyright &#xa9; 2017

<20>
Accession Number
620753805
Author
Hua P.; Liu J.; Tao J.; Lin X.; Zou R.; Zhang D.; Yang S.
Institution
(Hua, Tao, Lin, Zou, Zhang) Department of Cardiovascular Surgery, Sun
Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
(Liu) Department of Vascular Surgery, Henan Provincial People's Hospital,
Zhengzhou, China
(Yang) The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Yang) Guangdong Province Key Laboratory of Brain Function and Disease,
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
Title
Safety and efficacy of the perioperative administration of recombinant
human brain natriuretic peptide (rhBNP): A systematic review and
meta-analysis.
Source
Therapeutics and Clinical Risk Management. 14 (pp 313-321), 2018. Date of
Publication: 20 Feb 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objective: Retrospective studies and a meta-analysis were performed to
evaluate the safety and effectiveness of the perioperative administration
of recombinant human brain natriuretic peptide (rhBNP) during cardiac
surgery under extracorporeal circulation. Methods: Computerized literature
searches were performed in Medline, Embase, The Cochrane Library, CNKI,
CBM, and WANFANG to find randomized controlled trials (RCTs) related to
the perioperative administration of rhBNP during cardiac surgery starting
from the database inception until December 2016. Two researchers
independently performed study screening, information extraction, and
quality evaluation according to the inclusion/exclusion criteria, and a
meta-analysis was performed using RevMan 5.2 software. Results: A total of
12 studies were analyzed, including 12 RCTs and 727 patients. The
meta-analysis results indicated that the perioperative administration of
rhBNP could reduce the occurrence rate of postoperative complications,
length of intensive care unit (ICU) stay, length of hospital stay, and
serum creatinine (Scr) levels, and increase the 24-hour urine volume;
however, it did not affect the postoperative mortality rate. Conclusion:
The perioperative administration of rhBNP during cardiac surgery was safe
and effective, and could improve the prognosis of the
patients.<br/>Copyright &#xa9; 2018 Hua et al.

<21>
Accession Number
620737575
Author
Shoukry A.A.; Sharaf A.G.S.
Institution
(Shoukry, Sharaf) Anesthesia department, Ain Shams University, Cairo,
Egypt
Title
Nasopharyngeal airway versus laryngeal mask airway during diagnostic
flexible fiber-optic bronchoscope in children.
Source
Open Anesthesiology Journal. 12 (pp 1-7), 2018. Date of Publication: 01
Jan 2018.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Pediatric fibreoptic diagnostic bronchoscope under general
anesthesia using Supraglottic devices as Laryngeal Mask Airway (LMA) and
nasopharyngeal airway (NPA) are one of the variable techniques used for
patient's ventilation during this procedure. Objective: We studied the
effect of both devices on hypoxemia, the duration of the procedure,
recovery time and the overall propofol consumption. Methods: Ninety
patients of both sexes, aged 5-10 years, American society of
Anesthesiology class I & II scheduled for diagnostic fibreoptic
bronchoscope under general anesthesia were divided randomly into two equal
groups; LMA group & NPA group, during the procedure: heart rate, non
invasive blood pressure, peripheral arterial oxygen saturation
(SpO<inf>2</inf>), arterial partial pressure of carbon
dioxide(PaCO<inf>2</inf>), time of procedure, recovery time and total dose
of propofol were measured and compared for each patient in both groups.
Results: Hypoxemia & desaturation incidence was more in LMA group than NPA
group with high significant difference (p-value 0.005). Also the duration
of procedure, recovery time in PACU, and total dose of propofol consumed
were significantly less in the NPA group (p< 0.001). With no difference in
hemodynamic status and PaCO<inf>2</inf>. Conclusion: The use of NPA as
supraglottic ventilating device for children undergoing diagnostic
flexible fibreoptic bronchoscopy is considered a good alternative for
shortening the bronchoscopy time with less incidence of hypoxemia and
better recovery time compared to LMA.<br/>Copyright &#xa9; 2018 Shoukry
and Sharaf.

<22>
Accession Number
620823604
Author
Khan D.; Fjerbaek A.; Andreasen J.J.; Thorup C.B.; Dinesen B.
Institution
(Khan, Fjerbaek, Dinesen) Department of Welfare and Technology, Aalborg
University, Aalborg, Denmark
(Khan) Department of Health Science and Technology, Aalborg University,
Aalborg, Denmark
(Fjerbaek) Department of Occupational Therapy and Physiotherapy, Aalborg
University Hospital, Aalborg, Denmark
(Andreasen, Thorup) Department of Cardiothoracic Surgery, Aalborg
University Hospital, Aalborg, Denmark
(Andreasen, Thorup) Department of Clinical Medicine, Aalborg University,
Aalborg, Denmark
(Thorup) Clinical Nursing Research Unit, Aalborg University Hospital,
Aalborg, Denmark
Title
Cardiac surgery patients' e-health literacy and their use of a digital
portal.
Source
Health Education Journal. (no pagination), 2018. Date of Publication: 01
Feb 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To determine how cardiac patients use the Activeheart.dk
digital toolbox Methods: Mixed-methods study. A total of n = 33 cardiac
surgical patients were enrolled in a study, which encouraged use of the
Activeheart portal for 4 weeks after discharge. Patients were surveyed
with respect to their demographic characteristics, e-health literacy
skills, use of the Internet and use of the portal. In addition to the
questionnaire survey, qualitative interviews were conducted with six
randomly selected patients in order to study users' experiences with and
use of the portal. Results: Quantitative results showed no relation
between cardiac patients' prior e-health literacy skills and their use of
the portal. Approximately 25 out of 31 patients stated that they had the
skills to seek, locate and use health information on the Internet. Among
the 17 patients who completed the first and second questionnaires, nine
rarely used Activeheart.dk, four used it several times per month, and four
several times per week. In 10 out of 16 replies, Activeheart.dk was rated
as relevant or very relevant. Themes from the qualitative interviews
revealed that the effects of medication and emotional, physical and
cognitive changes had a higher impact on the use of the portal than prior
e-health literacy skills. Conclusion: While participants' e-health
literacy skills ratings were high, and while participants stated that the
content of the portal was relevant, their actual use of the portal
remained limited. No relationship was found between participants' e-health
literacy skills and their use of the portal. Factors such as patient
motivation, resources and timing of the intervention's introduction seemed
to be of greater importance.<br/>Copyright &#xa9; 2018, The Author(s)
2018.

<23>
Accession Number
614710300
Author
Huygens S.A.; Takkenberg J.J.M.; Rutten-van Molken M.P.M.H.
Institution
(Huygens, Takkenberg) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and
Management/Institute for Medical Technology Assessment, Erasmus University
Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, Rotterdam 3000
DR, Netherlands
Title
Systematic review of model-based economic evaluations of heart valve
implantations.
Source
European Journal of Health Economics. 19 (2) (pp 241-255), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objective: To review the evidence on the cost-effectiveness of heart valve
implantations generated by decision analytic models and to assess their
methodological quality. Methods: A systematic review was performed
including model-based cost-effectiveness analyses of heart valve
implantations. Study and model characteristics and cost-effectiveness
results were extracted and the methodological quality was assessed using
the Philips checklist. Results: Fourteen decision-analytic models
regarding the cost-effectiveness of heart valve implantations were
identified. In most studies transcatheter aortic valve implantation (TAVI)
was cost-effective compared to standard treatment (ST) in inoperable or
high-risk operable patients (ICER range 18,421-120,779 ) and in all
studies surgical aortic valve replacement (SAVR) was cost-effective
compared to ST in operable patients (ICER range 14,108-40,944 ), but the
results were not consistent on the cost-effectiveness of TAVI versus SAVR
in high-risk operable patients (ICER range: dominant to dominated by
SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per
success compared to mitral valve repair and biological MVR. The
methodological quality of the studies was moderate to good. Conclusion:
This review showed that improvements can be made in the description and
justification of methods and data sources, sensitivity analysis on
extrapolation of results, subgroup analyses, consideration of
methodological and structural uncertainty, and consistency (i.e. validity)
of the models. There are several opportunities for future
decision-analytic models of the cost-effectiveness of heart valve
implantations: considering heart valve implantations in other valve
positions besides the aortic valve, using a societal perspective, and
developing patient-simulation models to investigate the impact of patient
characteristics on outcomes.<br/>Copyright &#xa9; 2017, The Author(s).

<24>
Accession Number
618763459
Author
Dall'Ara G.; Marzocchi A.; Taglieri N.; Moretti C.; Rodino G.; Chiarabelli
M.; Bottoni P.; Marrozzini C.; Sabattini M.R.; Bacchi-Reggiani M.-L.;
Rapezzi C.; Saia F.
Institution
(Dall'Ara, Marzocchi, Taglieri, Moretti, Rodino, Chiarabelli, Bottoni,
Marrozzini, Sabattini, Bacchi-Reggiani, Rapezzi, Saia) Cardiology Unit,
Cardio-Thoraco-Vascular Department, University Hospital of Bologna,
Policlinico S. Orsola-Malpighi, Bologna, Italy
(Dall'Ara) Dottorato di ricerca XXXdegreeciclo, Scienze
Cardio-Nefro-Toraciche, University of Bologna, Bologna, Italy
Title
Randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing: The pacing versus no pacing (PNP) study.
Source
Journal of Interventional Cardiology. 31 (1) (pp 51-59), 2018. Date of
Publication: Februaryy 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background: BAV technique is poorly standardized. Methods: One
hundred consecutive patients were randomly assigned 1:1 between BAV
performed with or without RP. Exclusion criteria were an immediate
indication for surgical or transcatheter aortic valve replacement,
presentation in cardiogenic shock or pulmonary edema refractory to medical
stabilization. Results: There were 51 patients in the BAV group performed
with RP, 49 in the BAV group without RP (noRP). Procedural success (50%
hemodynamic gradient reduction) was achieved in 37.3% and 55.1%,
respectively (P = 0.16). Fewer people in the noRP group complained of poor
tolerance to the procedure (16% vs 41%). The primary efficacy endpoint, a
50% reduction in the mean echocardiographic trans-aortic gradient, was met
in 21/49 patients in the noRP group compared to 20/51 in the RP (42.9% vs
39.2%; P = 0.84). No significant difference between the groups was
observed in the primary safety endpoint, a 30-day composite of death,
myocardial infarction, stroke, acute aortic regurgitation, and BARC
bleeding >=3 (8.2% noRP vs 13.7%; P = 0.53). The noRP group required fewer
bailout temporary pacemakers (P = 0.048) and had a lower incidence of
moderate/severe renal function worsening (4.1% vs 17.6%; P = 0.052).
Conclusions: Rapid ventricular pacing did not influence BAV efficacy or
safety and tolerance was slightly worse.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<25>
Accession Number
620606953
Author
Kooiman J.; De Vries J.-P.P.M.; Der Heyden J.V.; Sijpkens Y.W.J.; van
Dijkman P.R.M.; Wever J.J.; van Overhagen H.; Vahl A.C.; Aarts N.;
Verberk-Jonkers I.J.A.M.; Brulez H.F.H.; Hamming J.F.; van der Molen A.J.;
Cannegieter S.C.; Putter H.; van den Hout W.B.; Kilicsoy I.; Rabelink
T.J.; Huisman M.V.
Institution
(Kooiman, Kilicsoy, Huisman) Department of Thrombosis and Hemostasis,
Leiden University Medical Center, Leiden, Netherlands
(Kooiman, Rabelink) Department of Nephrology, Leiden University Medical
Center, Leiden, Netherlands
(De Vries) Department of Vascular Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Der Heyden) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Sijpkens) Department of Internal Medicine, Bronovo Hospital, The Hague,
Netherlands
(van Dijkman) Department of Cardiology, Bronovo Hospital, the Hague,
Netherlands
(Wever) Department of Vascular Surgery, Haga Teaching Hospital, The Hague,
Netherlands
(van Overhagen) Department of Radiology, Haga Teaching Hospital, The
Hague, Netherlands
(Vahl) Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Aarts) Department of Radiology, Bronovo Hospital, The Hague, Netherlands
(Verberk-Jonkers) Department of Nephrology, Maasstad Hospital, Rotterdam,
Netherlands
(Brulez) Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam,
Netherlands
(Hamming) Department of Vascular Surgery, Leiden University Medical
Center, Leiden, Netherlands
(van der Molen) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(Cannegieter) Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, Netherlands
(Putter) Department of Medical Statistics, Leiden University Medical
Center, Leiden, Netherlands
(van den Hout) Department of Medical Decision Making, Leiden University
Medical Center, Leiden, Netherlands
Title
Randomized trial of one-hour sodium bicarbonate vs standard periprocedural
saline hydration in chronic kidney disease patients undergoing
cardiovascular contrast procedures.
Source
PLoS ONE. 13 (2) (no pagination), 2018. Article Number: e0189372. Date of
Publication: February 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Guidelines advise periprocedural saline hydration for
prevention of contrast induced-acute kidney injury (CI-AKI). We analysed
whether 1-hour sodium bicarbonate hydration administered solely prior to
intra-arterial contrast exposure is non-inferior to standard
periprocedural saline hydration in chronic kidney disease (CKD) patients
undergoing elective cardiovascular diagnostic or interventional contrast
procedures. Methods We performed an open-label multicentre non-inferiority
trial between 2011-2014. Patients were randomized to 1 hour pre-procedure
sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline
hydration (1000 ml 0.9%, N = 165) prior to and following contrast
administration (2000 ml of saline total). Primary outcome was the relative
serum creatinine increase (%) 48-96 hours post contrast exposure.
Secondary outcomes were: incidence of CI-AKI (serum creatinine
increase>25% or >44?mol/L), recovery of renal function, the need for
dialysis, and hospital costs within two months follow-up. Results Mean
relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the
bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean
difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI
occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12
(7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0%
and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required
dialysis. Mean costs for preventive hydration and clinical preparation for
the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for
saline (p < 0.001). Conclusion Short hydration with sodium bicarbonate
prior to elective cardiovascular diagnostic or therapeutic contrast
procedures is non-inferior to standard periprocedural saline hydration in
CKD patients with respect to renal safety and results in considerable
healthcare savings.<br/>Copyright &#xa9; 2018 Kooiman et al. This is an
open

<26>
Accession Number
620684169
Author
Sepehripour A.H.; Eckersley M.; Jiskani A.; Casula R.; Athanasiou T.
Institution
(Sepehripour, Eckersley, Jiskani, Casula, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, United Kingdom
Title
Selective serotonin reuptake inhibitor use and outcomes following cardiac
surgery-a systematic review.
Source
Journal of Thoracic Disease. 10 (2) (pp 1112-1120), 2018. Date of
Publication: 01 Feb 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
A high prevalence of depression is observed in patients undergoing cardiac
surgery, and depression has been shown to be an independent predictor of
morbidity and mortality in this patient population. Selective serotonin
re-uptake inhibitors (SSRIs) are the first-line recommended therapy for
depressive disorders, however due to their platelet inhibitory actions
they have been associated with increased incidences of post-operative
bleeding. This review has sought to address whether the use of SSRIs is
associated with a higher rate of mortality, major adverse events or
bleeding events following cardiac surgery. A retrospective literature
search selected studies comparing the use of SSRIs with no SSRI use in
patients undergoing cardiac surgery. Seven of the ten studies analysed
reported no significant difference in mortality in SSRI users. Five of the
seven studies reporting bleeding events demonstrated no significant
difference in SSRI users. Three of the five studies reporting other
significant morbidity demonstrated no significant difference in SSRI
users. Our study demonstrates the safety of the use of SSRIs for the
treatment of depressive disorders in patients undergoing cardiac
surgery.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<27>
Accession Number
620562831
Author
Hartley L.; Clar C.; Ghannam O.; Flowers N.; Stranges S.; Rees K.
Institution
(Hartley, Ghannam, Flowers, Stranges, Rees) Warwick Medical School,
University of Warwick, Division of Health Sciences, Coventry, Warwickshire
CV4 7AL, United Kingdom
(Clar) Freelance, Hasenheide 67, Berlin 10967, Germany
Title
Vitamin K for the primary prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2015 (9) (no pagination), 2015.
Article Number: CD011148. Date of Publication: 21 Sep 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: A deficiency in vitamin K has been associated with increased
calcium deposition and coronary artery calcification, which may lead to
cardiovascular disease. Objectives: To determine the effectiveness of
vitamin K supplementation as a single nutrient supplement for the primary
prevention of cardiovascular disease. Search methods: We searched the
following electronic databases: the Cochrane Central Register of
Controlled Trials (CENTRAL, Issue 8 of 12, 2014); MEDLINE (Ovid, 1946 to
September week 2 2014); EMBASE Classic + EMBASE (Ovid, 1947 to September
18 2014); Science Citation Index Expanded (SCI-EXPANDED) and Conference
Proceedings Citation Index, Science (CPCI-S) (both 1990 to 17 September
2014) on Web of Science (Thomson Reuters); Database of Abstracts of
Reviews of Effects (DARE); Health Technology Assessment Database and
Health Economics Evaluations Database (Issue 3 of 4, 2014). We searched
trial registers and reference lists of reviews for further studies. We
applied no language restrictions. Selection criteria: We included
randomised controlled trials of vitamin K supplementation as a single
nutrient supplement, lasting at least three months, and involving healthy
adults or adults at high risk of cardiovascular disease. The comparison
group was no intervention or placebo. The outcomes of interest were
cardiovascular disease clinical events and cardiovascular disease risk
factors. Data collection and analysis: Two review authors independently
selected trials for inclusion, abstracted the data and assessed the risk
of bias. Main results: We included only one small trial (60 participants
randomised) which overall was judged to be at low risk of bias. The study
examined two doses of menaquinone (vitamin K2) over 3 months in healthy
participants aged 40 to 65 years. The primary focus of the trial was to
examine the effects of menaquinone (subtype MK7) on different matrix Gla
proteins (MGP - vitamin K dependent proteins in the vessel wall) at
different doses, but the authors also reported blood pressure and lipid
levels. The trial did not report on our primary outcomes (cardiovascular
disease clinical events) as it was small, short term and conducted in
healthy participants. In terms of cardiovascular disease risk factors, no
effects were seen for vitamin K2 on blood pressure or lipid levels,
although the trial was small and findings are limited. The trial did not
report any of our other secondary outcomes. Authors' conclusions: The very
limited results of this review highlight the lack of evidence currently
available to determine the effectiveness of vitamin K supplementation for
the primary prevention of cardiovascular disease, and demonstrate the need
for further high quality trials in this area.<br/>Copyright &#xa9; 2015
The Cochrane Collaboration.

<28>
Accession Number
620562424
Author
Benstoem C.; Stoppe C.; Liakopoulos O.J.; Meybohm P.; Clayton T.C.; Yellon
D.M.; Hausenloy D.J.; Goetzenich A.
Institution
(Benstoem, Goetzenich) University Hospital Aachen, Department of
Cardiothoracic Surgery, Pauwelsstrasse 30, Aachen, North Rhine Westphalia
52074, Germany
(Stoppe) University Hospital Aachen, Department of Anesthesiology,
Pauwelsstrasse 30, Aachen, North Rhine Westphalia 52074, Germany
(Liakopoulos) Heart Center, University of Cologne, Department of
Cardiothoracic Surgery, Kerpener Str. 62, Cologne 50937, Germany
(Meybohm) University Hospital Frankfurt, Department of Anesthesiology,
Intensive Care and Pain Medicine, Theodor-Stern-Kai 7, Frankfurt am Main
60590, Germany
(Clayton) London School of Hygiene and Tropical Medicine, Department of
Medical Statistics, Keppel Street, London WC1E 7HT, United Kingdom
(Yellon) University College London Hospital and Medical School, Department
of Medicine, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Hausenloy) University College London, The Hatter Cardiovascular
Institute, 67 Chenies Mews, London WC1E 6HX, United Kingdom
Title
Remote ischaemic preconditioning for coronary artery bypass grafting.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD011719. Date of Publication: 02 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the benefits and harms of remote ischaemic
preconditioning in patients undergoing coronary artery bypass grafting,
with or without valve surgery.<br/>Copyright &#xa9; 2015 The Cochrane
Collaboration.

<29>
Accession Number
620562338
Author
Hartley L.; Lee M.S.; Kwong J.S.W.; Flowers N.; Todkill D.; Ernst E.; Rees
K.
Institution
(Hartley, Flowers, Todkill, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry, Warwickshire CV4 7AL,
United Kingdom
(Lee) Korea Institute of Oriental Medicine, Medical Research Division,
461-24 Jeonmin-dong, Yuseong-gu, Daejeon 305-811, South Korea
(Kwong) West China Hospital, Sichuan University, Chinese Cochrane Center,
Chinese Evidence-Based Medicine Center, No. 37, Guo Xue Xiang, Chengdu,
Sichuan 610041, China
(Ernst) Peninsula Medical School, University of Exeter, Complementary
Medicine Department, Exeter, United Kingdom
Title
Qigong for the primary prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD010390. Date of Publication: 11 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Two major determinants of cardiovascular disease (CVD) are a
sedentary lifestyle and stress. Qigong involves physical exercise, mind
regulation and breathing control to restore the flow of Qi (a pivotal life
energy). As it is thought to help reduce stress and involves exercise,
qigong may be an effective strategy for the primary prevention of CVD.
Objectives: To determine the effectiveness of qigong for the primary
prevention of CVD. Search methods: We searched the following electronic
databases: the Cochrane Central Register of Controlled Trials (CENTRAL)
(November 2014, Issue 10 of 12); MEDLINE (Ovid) (1946 to 2014 October week
4); EMBASE Classic + EMBASE (Ovid) (1947 to 2014 November 4); Web of
Science Core Collection (1970 to 31 October 2014); Database of Abstracts
of Reviews of Effects (DARE), Health Technology Assessment Database and
Health Economics Evaluations Database (November 2014, Issue 4 of 4). We
searched several Asian databases (inception to July 2013) and the Allied
and Complementary Medicine Database (AMED) (inception to December 2013),
as well as trial registers and reference lists of reviews and articles; we
also approached experts in the field and applied no language restrictions
in our search. Selection criteria: Randomised controlled trials lasting at
least three months involving healthy adults or those at high risk of CVD.
Trials examined any type of qigong, and comparison groups provided no
intervention or minimal intervention. Outcomes of interest included
clinical CVD events and major CVD risk factors. We did not include trials
that involved multi-factorial lifestyle interventions or weight loss. Data
collection and analysis: Two review authors independently selected trials
for inclusion. Two review authors extracted data from included studies and
assessed the risk of bias. Main results: We identified 11 completed trials
(1369 participants) and one ongoing trial. Trials were heterogeneous in
participants recruited, qigong duration and length of follow-up periods.
We were unable to ascertain the risk of bias in nine trials published in
Chinese, as insufficient methodological details were reported and we were
unable to contact the study authors to clarify this. We performed no
meta-analyses, as trials were small and were at significant risk of bias.
Clinical events were detailed in subsequent reports of two trials when
statistically significant effects of qigong were seen for all-cause
mortality, stroke mortality and stroke incidence at 20 to 30 years after
completion of the trials. However, these trials were designed to examine
outcomes in the short term, and it is not clear whether qigong was
practised during extended periods of follow-up; therefore effects cannot
be attributed to the intervention. None of the included studies reported
other non-fatal CVD events. Six trials provided data that could be used to
examine the effects of qigong on blood pressure. Reductions in systolic
blood pressure (SBP) and diastolic blood pressure (DBP) were seen in three
and two trials, respectively. Three trials examined the effects of qigong
on blood lipids when favourable effects were seen in one trial for total
cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides,
and two trials showed favourable effects on high-density lipoprotein (HDL)
cholesterol. The only trial considered at low risk of selection and
detection bias did not demonstrate statistically significant effects on
CVD risk factors with qigong, but this study was small and was
underpowered. None of the included studies reported incidence of type 2
diabetes (T2D), adverse events, quality of life or costs. Authors'
conclusions: Currently, very limited evidence is available on the
effectiveness of qigong for the primary prevention of CVD. Most of the
trials included in this review are likely to be at high risk of bias, so
we have very low confidence in the validity of the results. Publication of
the ongoing trial will add to the limited evidence base, but further
trials of high methodological quality with sufficient sample size and
follow-up are needed to be incorporated in an update of this review before
the effectiveness of qigong for CVD prevention can be
established.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<30>
Accession Number
620559541
Author
Robertson L.; Andras A.
Institution
(Robertson) The University of Edinburgh The Medical School, Centre for
Population Health Sciences, Teviot Place, Edinburgh EH8 9AG, United
Kingdom
(Andras) Freeman Hospital, Department of Vascular Surgery, Newcastle upon
Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, United
Kingdom
Title
Prostanoids for intermittent claudication.
Source
Cochrane Database of Systematic Reviews. 2013 (4) (no pagination), 2013.
Article Number: CD000986. Date of Publication: 30 Apr 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Peripheral arterial disease (PAD) is a common cause of
morbidity in the general population. While numerous studies have
established the efficacy of prostanoids in PAD stages III and IV, the
question of the role of prostanoids as an alternative or additive
treatment in patients suffering from intermittent claudication (PAD II)
has not yet been clearly answered. This is an update of a Cochrane Review
first published in 2004. Objectives: To determine the effects of
prostanoids in patients with intermittent claudication (IC) Fontaine stage
II. Search methods: For this update, the Cochrane Peripheral Vascular
Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised
Register (last searched January 2013) and CENTRAL (2012, Issue 12).
Clinical trials databases were searched for details of ongoing or
unpublished studies. In addition, reference lists of relevant articles
were checked. Selection criteria: Randomised clinical trials of
prostanoids versus placebo or alternative ('control') treatment in people
with intermittent claudication were considered for inclusion. Data
collection and analysis: Two authors independently assessed trial quality
and extracted data. Primary outcomes included pain-free walking distance
(PFWD) and maximum walking distance (MWD), presented as mean change in
walking distance during the course of the trial (% improvement) and as
final walking distance (that is walking distance, in metres, after
treatment) for the prostanoid and control groups. Main results: Eighteen
trials with a total of 2773 patients were included (16 in the original
review and a further two in this update). As the majority of trials did
not report standard deviations for the primary PFWD and MWD outcomes, it
was often not possible to test for the statistical significance of any
improvements in walking distance between groups. The quality of individual
trials was variable and usually unclear due to insufficient reporting
information. Comparison between trials was hampered by the use of
different treadmill testing protocols, including different walking speeds
and gradients. Such limitations in the data and the trial heterogeneity
meant it was not possible to meaningfully pool results by meta-analysis.
Four trials compared prostaglandin E1 (PGE1) with placebo; individual
trials showed significant increases in walking distances with
administration of PGE1 and in several trials the walking capacity remained
increased after termination of treatment. Compared with pentoxifylline,
PGE1 was associated with a higher final PFWD and MWD but these results
were based on final walking distances rather than changes in walking
distance from baseline. When PGE1 was compared with other treatments
including laevadosin, naftidrofuryl and L-arginine, improvements in
walking distances over time were observed for both PGE1 and the
alternative treatment, but it was not possible from the data available to
analyse statistically whether or not one treatment was more effective than
the other. Six studies compared various preparations of prostacyclins
(PGI2) with placebo. In one study using three different dosages of
iloprost, PFWD and MWD appeared to increase in a dose-dependent manner;
iloprost was associated with headache, pain, nausea and diarrhoea, leading
to a higher rate of treatment withdrawal. Of three studies using beraprost
sodium, one showed an improvement in PFWD and MWD compared with placebo
while two showed no significant benefit. Beraprost sodium was associated
with an increased incidence of drug-related adverse events. Of two studies
on taprostene, the results of one in particular must be interpreted with
caution due to an imbalance in walking capacity at baseline.
Comprehensive, high quality data on outcomes such as quality of life,
ankle brachial index, venous occlusion plethysmography and
haemorrheological parameters were lacking. Authors' conclusions: Whilst
results from some individual studies suggested a beneficial effect of
PGE1, the quality of these studies and of the overall evidence available
is insufficient to determine whether or not patients with intermittent
claudication derive clinically meaningful benefit from the administration
of prostanoids. Further well-conducted randomised, double blinded trials
with a sufficient number of participants to provide statistical power are
required to answer this question.<br/>Copyright &#xa9; 2013 The Cochrane
Collaboration.

<31>
Accession Number
620800556
Author
Lammers A.; Golden S.; Thomas C.R.; Mitin T.; Moghanaki D.; Timmerman
R.D.; Slatore C.
Institution
(Lammers, Thomas, Mitin, Slatore) Oregon Health and Science University,
Portland, OR, United States
(Golden) VA Portland Health Care System, Portland, OR, United States
(Moghanaki) Hunter Holmes McGuire Veterans Affairs Medical Center,
Richmond, VA, United States
(Timmerman) University of Texas, Southwestern Medical Center, Dallas, TX,
United States
Title
Lung cancer specialists' opinions on treatments for Stage I lung cancer: A
multidisciplinary survey.
Source
International Journal of Radiation Oncology Biology Physics. Conference:
58th Annual Meeting of the American Society for Radiation Oncology, ASTRO
2016. United States. 96 (2 Supplement 1) (pp S172-S173), 2016. Date of
Publication: October 2016.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Several trials comparing surgical resection to
stereotactic body radiation therapy (SBRT) for surgically-eligible
patients with stage I non-small cell lung cancer (NSCLC) were halted
because of inability to accrue participants. This lack of accrual was
likely related to differing viewpoints on the effectiveness of each
therapy. We sought to understand specialists' opinions about evidence
regarding treatment of Stage I NSCLC, how clinicians translate evidence
into practice, and how specialists weigh oncologic outcomes vs quality of
life (QOL) in order to guide the conduct of future trials and
implementation strategies. Materials/Methods: We conducted a 28-item,
web-based survey. We invited all participating providers listed in the
following medical society directories: American Society for Radiation
Oncology (ASTRO), American Thoracic Society (ATS), Thoracic Oncology
Assembly, and the International Association for the Study of Lung Cancer
(IASLC). We received IRB approval. Descriptive statistics are reported.
Results: We collected data from 1018 respondents with the following
response rates: ATS 60 (6.6%), IASLC 399 (7.2%), and ASTRO 559 (6.4%).
Most respondents were radiation oncologists (RO) (64.0%). Most ROs,
(65.6%), felt that for surgically-eligible patients with stage I NSCLC,
current evidence for the efficacy of SBRT is "the same" as surgery in
terms of oncologic outcomes while most non-radiation oncologists (NRO)
(pulmonary, medical oncology, thoracic surgery) felt SBRT is "a little
worse," (63.5%). Both groups believed this was based on "neither strong
nor weak" evidence, (42.0% vs 38.6%). When asked to consider a randomized
trial of SBRT vs. surgery for surgically-eligible patients with stage I
NSCLC, 94.4% of ROs agreed or strongly agreed that they would permit their
patients to enroll while only 61.9% of NROs responded similarly. When
asked about the lowest level of efficacy that would convince clinicians to
recommend SBRT over surgery, the majority of both groups favored allowing
SBRT with equal (within 5%) 5-year mortality rates: 71.0% of ROs and 55.8%
of NROs. We then asked "if the trial showed that SBRT decreased QOL less
than surgery, how would you change your answers?" Most ROs (46.7%) would
accept "a little larger mortality" difference, while 55.4% of NROs
responded it "wouldn't change my decision." Assuming a trial showed equal
5 year mortality and a higher QOL in those receiving SBRT, many clinicians
believed that changing practice in thoracic surgery would be "somewhat
difficult"; 47.1% for both ROs and NROs. Conclusion: Most
surgically-eligible patients with NSCLC do not routinely see a radiation
oncologist prior to treatment. Our results suggest it may be difficult to
enroll these patients into treatment trials. Furthermore, changing
practice patterns may be problematic even if such a trial showed SBRT had
equivalent mortality but improved QOL.

<32>
Accession Number
620799955
Author
Sapir E.; Tao Y.; Lin J.; Kollar L.; Schipper M.; Chugh R.; Schuetze S.M.;
Biermann J.S.; Lawrence T.S.; Feng M.
Institution
(Sapir, Lin, Chugh, Biermann) University of Michigan Health System, Ann
Arbor, MI, United States
(Tao, Feng) University of Michigan, Ann Arbor, MI, United States
(Kollar) University of Washington Medical Center, Seattle, WA, United
States
(Schipper) Department of Biostatistics, University of Michigan, Ann Arbor,
MI, United States
(Schuetze) Department of Internal Medicine, Division of
Hematology/Oncology, University of Michigan, Ann Arbor, MI, United States
(Lawrence) Department of Radiation Oncology, University of Michigan, Ann
Arbor, MI, United States
Title
Surgical resection or stereotactic body radiation therapy for sarcoma
patients with pulmonary metastases.
Source
International Journal of Radiation Oncology Biology Physics. Conference:
58th Annual Meeting of the American Society for Radiation Oncology, ASTRO
2016. United States. 96 (2 Supplement 1) (pp S26), 2016. Date of
Publication: October 2016.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Aggressive management of oligometastases from
sarcoma can result in long-term survival and a chemotherapy-free holiday.
Surgical resection is considered to be the treatment of choice, with
stereotactic body radiotherapy (SBRT) generally offered to patients who
are not candidates for surgical resection due to co-morbidities or concern
about residual lung function. We examined outcomes of resection and SBRT
for patients with sarcoma oligometastases at our institution and
identified predictive factors for local control, with the hypothesis that
overall local control would be similar. Materials/Methods: After
IRB-approval, we queried our institutional thoracic surgery and radiation
oncology databases, supplemented with an institutional query using
diagnosis and billing codes for sarcoma, lung metastases, lung resections,
and SBRT. We applied inverse probability of treatment weighting to adjust
for imbalances in treatment assignment. Freedom from local progression
(FFLP) for surgical resection was defined as absence of recurrence at the
resection line, while FFLP for SBRT was defined as the absence of
progression within or at the PTV margin. Results: Between 1997 and 2014,
78 patients (pts) with 127 lung lesions were treated with surgical
resection and 26 pts with 47 pulmonary metastases were ablated with SBRT.
Median tumor size was 1.5 cm (0.1-12.8) and 1.4 cm (0.4-4.8),
respectively, for surgically and SBRT-managed pulmonary metastases. Median
follow-up was 20.9 months (1 to 224) and 15.3 months (2 to 57) for
patients treated with surgical resection and SBRT, respectively (P =
0.01). On average, pts in the SBRT group were older (age 60 v 52, P =
0.03), had received more prior systemic therapies (1.98 vs. 1.29, P=0.01)
and had a higher presence of active extrathoracic disease at treatment
start (59.6% vs. 29.9%, P < 0.001). Local control was not different
between groups when adjusted for size, other sites of active disease, age,
and performance status (HR = 1.47, 95% CI 0.20 - 10.9, P =0.71). 1- and
2-yr FFLP rates for all resected lung lesions vs SBRT were 96.8% and 96.8%
vs 97.4% and 97.4%. 1 and 2- year overall survival (OS) were 92.6% and
62.2% for surgery pts and 88.1% and 57.9% for SBRT pts, with no difference
between groups (HRZ0.71, 95% CI =0.39 - 1.29, P = 0.27). 1 and 2-year
progression free survival (PFS) were 33.4% and 15.7% for surgery pts and
42.3% and 21.6% for SBRT pts, with no significant difference between
groups (HR = 1.21, 95% CI =0.87 - 1.68, P = 0.25). Grade 3+ adverse events
were observed in five pts treated with surgery vs. none in pts with SBRT.
Conclusion: In this series SBRT provides similar LC, PFS, and OS compared
with surgical resection of lung metastases from sarcoma, and thus may
serve as a safe alternative to surgical resection. A randomized,
prospective study is required to determine if there is comparable
long-term survival with SBRT vs. surgery for treatment of sarcoma lung
metastases.

<33>
Accession Number
620799646
Author
Marmelo F.; Rocha V.; Goncalves D.
Institution
(Marmelo, Rocha, Goncalves) Department of Surgery and Physiology of the
Faculty of Medicine of Porto, Porto, Portugal
(Rocha) Sao Martinho Hospital, Valongo, Portugal
(Goncalves) Ave Valley Superior School of Health, Famalicao, Portugal
Title
The impact of prehabilitation on post-surgical complications in patients
undergoing non-urgent cardiovascular surgical intervention: Systematic
review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (4) (pp 404-417), 2018. Date
of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Cardiac surgery is an aggressive procedure, inducing a great
level of stress and disturbance to the homeostasis of the organism and
underlying several postoperative complications. Surgical prehabilitation
comprises pre-operative physical conditioning designed to improve the
physiological and functional capacities of the individual, prepare the
organism for surgical stress and reduce the risk of postoperative
morbidity. Aim: This systematic review and meta-analysis is aimed at
evaluating the ability of prehabilitation to prevent post-surgical
complications in cardiac patients. Methods: We selected studies conducted
among patients who were waiting for non-urgent cardiac surgical
procedures, where a comparison between prehabilitation and standard
treatment was made. A total of 3650 possible studies were researched, of
which eight were selected for inclusion. Results: A reduction in the
number of complications in the groups submitted to prehabilitation (odds
ratio = 0.41; 95% confidence interval (CI): 0.28-0.62; p < 0.001;
I²= 0%) was observed, as well as a significant increase in
maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95%
CI: 0.35-0.96; p < 0.001; I²= 58%), a non-significant decrease
in the length of stay (SMD = -0.56; 95% CI: -1.13, 0.01; p = 0.05;
I²= 93%), a non-significant increase in the distance walked by
the intervention group in the six-minute walk test (SMD = 0.89; 95% CI
-0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time
(SMD = -0.03; 95% CI: -0.22, 0.16; p = 0.75; I²= 0%).
Conclusion: Prehabilitation reduces the number of post-surgical
complications and increases maximal inspiratory pressure; a reduction in
the length of stay and an improvement of functional capacities are also
probable.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of
Cardiology 2018.

<34>
Accession Number
620744398
Author
Gianos E.; Schoenthaler A.; Guo Y.; Zhong J.; Weintraub H.; Schwartzbard
A.; Underberg J.; Schloss M.; Newman J.D.; Heffron S.; Fisher E.A.; Berger
J.S.
Institution
(Gianos, Weintraub, Schwartzbard, Underberg, Schloss, Newman, Heffron,
Fisher, Berger) Department of Medicine, Division of Cardiology, Center for
the Prevention of Cardiovascular Disease, New York University School of
Medicine, New York, NY, United States
(Heffron, Fisher, Berger) Marc and Ruti Bell Program in Vascular Biology,
New York University School of Medicine, New York, NY, United States
(Schoenthaler, Guo, Zhong) Department of Population Health, Center for
Healthful Behavioral Change, New York University School of Medicine, New
York, NY, United States
Title
Investigation of Motivational Interviewing and Prevention Consults to
Achieve Cardiovascular Targets (IMPACT) trial.
Source
American Heart Journal. 199 (pp 37-43), 2018. Date of Publication: May
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients undergoing cardiovascular (CV) procedures often have
suboptimal CV risk factor control and may benefit from strategies
targeting healthy lifestyle behaviors and education. Implementation of
prevention strategies may be particularly effective at this point of
heightened motivation. Methods: A prospective, randomized, pilot study was
conducted in 400 patients undergoing a nonurgent CV procedure (cardiac
catheterization +/- revascularization) to evaluate the impact of different
prevention strategies. Patients were randomized in a 1:1:1 fashion to
usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC;
group B, n = 130), or PC plus behavioral intervention program
(telephone-based motivational interviewing and optional tailored text
messages) (group C, n = 133). The primary end point was the DELTA change
in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6
month. Results: The mean age was 64.6 +/- 10.8 years, 23.7% were female,
and 31.5% were nonwhite. After 6 months, the absolute difference in
non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P
<.001). There were no between-group differences in the primary end point
for the combined PC groups (B and C) versus UC, with a DELTA adjusted
between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P =.16).
Patients in the PC groups were more likely to be on high-intensity statins
at 6 months (52.9% vs 38.1%, P =.01). After excluding participants with
baseline non-HDL-C <100 mg/dL (initial exclusion criterion), DELTA
non-HDL-C and DELTA low-density lipoprotein cholesterol were improved in
the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P
=.04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P
=.03). Conclusions: Although non-HDL-C reduction at 6 months following a
nonurgent CV procedure was not significant in the overall cohort, an
increased uptake in high-potency statins may translate into improved
long-term health outcomes and cost reductions.<br/>Copyright &#xa9; 2018

<35>
Accession Number
620792055
Author
Nguyen L.S.; Coutance G.; Ouldamar S.; Zahr N.; Brechot N.; Galeone A.;
Bougle A.; Lebreton G.; Leprince P.; Varnous S.
Institution
(Nguyen, Coutance, Ouldamar, Galeone, Lebreton, Leprince, Varnous) Cardiac
and Thoracic Surgery Department Cardiology Institute Pitie Salpetriere
University Hospital Paris France
(Zahr) Pharmacology Department Pitie Salpetriere University Hospital Paris
France
(Brechot) Critical Care Medicine Cardiology Institute Pitie Salpetriere
University Hospital Paris France
(Bougle) Anesthesiology and Intensive Care Medicine Department Cardiology
Institute Pitie-Salpetriere University Hospital Paris France
Title
Performance of existing risk scores around heart transplantation:
Validation study in a 4-year cohort.
Source
Transplant International. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Several risk scores exist to help identify best candidate recipients for
heart transplantation (HTx). This study describes the performance of five
heart failure risk scores and two post-HTx mortality risk scores in a
French single-centre cohort. All patients listed for HTx through a 4-year
period were included. Waiting-list risk scores [Heart Failure Survival
Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-Analysis Global
Group in Chronic Heart Failure (MAGGIC), Organized Program to Initiate
Lifesaving Treatment in Hospitalized Patients with Heart Failure
(OPTIMIZE-HF) and Get With The Guidelines-Heart Failure (GWTG-HF)] and
post-HTx scores Index for Mortality Prediction After Cardiac
Transplantation (IMPACT and CARRS) were computed. Main outcomes were
1-year mortality on waiting list and after HTx. Performance was assessed
using receiver operator characteristic (ROC), calibration and
goodness-of-fit analyses. The cohort included 414 patients. Waiting-list
mortality was 14.0%, and post-HTx mortality was 16.3% at 1-year follow-up.
Heart failure risk scores had adequate discrimination regarding
waiting-list mortality (ROC AUC for HFSS = 0.68, SHFM = 0.74, OPTIMIZE-HF
= 0.72, MAGGIC = 0.70 and GWTG = 0.77; all P-values <0.05). On the
contrary, post-HTx risk scores did not discriminate post-HTx mortality
(AUC for IMPACT = 0.58, and CARRS = 0.48, both P-values >0.50). Subgroup
analysis on patients undergoing HTx after ventricular assistance device
(VAD) implantation (i.e. bridge-to-transplantation) (n = 36) showed an
IMPACT AUC = 0.72 (P < 0.001). In this single-centre cohort, existing
heart failure risk scores were adequate to predict waiting-list mortality.
Post-HTx mortality risk scores were not, except in the VAD
subgroup.<br/>Copyright &#xa9; Steunstichting ESOT.

<36>
Accession Number
620784697
Author
Mayr N.P.; Wiesner G.; van der Starre P.; Hapfelmeier A.; Goppel G.; Kasel
A.M.; Hengstenberg C.; Husser O.; Schunkert H.; Tassani-Prell P.
Institution
(Mayr, Wiesner, Tassani-Prell) Institut fur Anasthesiologie, Deutsches
Herzzentrum Munchen des Freistaates Bayern, Technische Universitat
Munchen, Lazarettstr. 36, Munich 80636, Germany
(van der Starre) Department of Anesthesiology and Perioperative Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Hapfelmeier) Institut fur Medizinische Statistik und Epidemiologie,
Klinikum Rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Goppel) Klinik fur Herz- und Gefaschirurgie, Deutsches Herzzentrum
Munchen des Freistaates Bayern, Technische Universitat Munchen, Munich,
Germany
(Kasel, Hengstenberg, Husser, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen des Freistaates
Bayern, Technische Universitat Munchen, Munich, Germany
(Hengstenberg, Schunkert) Partner Site Munich Heart Alliance, Munich,
Germany
Title
Dexmedetomidine versus propofol-opioid for sedation in transcatheter
aortic valve implantation patients: a retrospective analysis of
periprocedural gas exchange and hemodynamic support.
Source
Canadian Journal of Anesthesia. (pp 1-11), 2018. Date of Publication: 20
Feb 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Different sedation regimens have been described for use during
transfemoral transcatheter aortic valve implantation (tf-TAVI) for
treatment in patients with severe aortic stenosis. The purpose of this
study was to compare dexmedetomidine (DEX) with a combination of
propofol-opioid (PO) with respect to periprocedural gas exchange and
hemodynamic support. Methods: Data from a cohort of patients sedated with
either DEX or PO for tf-TAVI were retrospectively analyzed from a
prospectively maintained TAVI registry. Operative risk was determined from
comorbidities and risk scores. Periprocedural partial pressure of carbon
dioxide (P<inf>a</inf>CO<inf>2</inf>) was chosen as the primary endpoint.
Other differences in gas exchange, need for catecholamine therapy, the
frequency of conversion to general anesthesia, and need for sedative
"rescue therapy" (in DEX patients) were secondary endpoints. Inverse
probability of treatment weighting (IPTW) was used for analysis to
minimize any selection bias. Results: Of the 297 patients (140 PO, 157
DEX) included, the median [interquartile range] periprocedural
P<inf>a</inf>CO<inf>2</inf> values of DEX patients were significantly
lower than in PO patients (40 [36-45] mmHg vs 44 [40-49] mmHg,
respectively; median difference -4 mmHg; 95% confidence interval, -5 to -3
mmHg; P < 0.001). Hypercapnia (P<inf>a</inf>CO<inf>2</inf> > 45 mmHg) was
significantly less frequent in DEX patients compared with the PO group
(25% vs 42%, respectively; P = 0.005). Vasopressor support was more
frequent in the PO group compared with DEX (68% vs 25%, respectively; P <
0.001). Conversion to general anesthesia was not different between groups
(9%, PO vs 3%, DEX; P = 0.051). Additional sedatives/opioids were required
in 25 (16%) of the DEX patients. Conclusions: In sedated TAVI patients,
DEX was associated with lower P<inf>a</inf>CO<inf>2</inf> values and
reduced requirements for vasopressor support, making it a promising
alternative to PO for sedation during TAVI. Trial registration:
www.ClinicalTrials.gov(NCT01390675). Registered 11 July
2011.<br/>Copyright &#xa9; 2018 Canadian Anesthesiologists' Society

<37>
Accession Number
620755833
Author
Ribeiro I.B.; Ngu J.M.C.; Lam B.-K.; Edwards R.A.
Institution
(Ribeiro, Ngu, Lam) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, Ontario, Canada
(Edwards) Center for Interprofessional Studies and Innovation,
Massachusetts General Hospital Institute of Health Professions, Boston,
Massachusetts, United States
Title
Simulation-Based Skill Training for Trainees in Cardiac Surgery: A
Systematic Review.
Source
Annals of Thoracic Surgery. 105 (3) (pp 972-982), 2018. Date of
Publication: March 2018.
Publisher
Elsevier USA
Abstract
Background: Simulation-based training has been an important part of the
solution to address the shortfalls in cardiac surgery training. This
review was conducted to identify and systematically summarize existing
evidence on outcomes and methodological quality of simulation-based skills
training for cardiac surgery trainees. Methods: MEDLINE, Embase, and ERIC
(Education Resources Information Center) databases were searched. Studies
included peer-reviewed publications with simulation-based skill training
in cardiac surgery programs with outcome measures of performance. Data
extraction covered the type of skills training, simulator type and
fidelity, the level of trainees, assessment tools, assessors, study design
and its components, strengths and limitations, and elements required for
the Medical Education Research Study Quality Instrument score. The review
followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Results: Of 16 studies that met the criteria,
only four (25%) randomized controlled trials were identified, and the
remaining were observational studies. Seven observational studies (43.7%)
were single-group pre-post tests. The mean number of trainees was 20.4
(SD, 14.1). Low-fidelity simulators were used in 13 studies (81.2%). Most
of the studies (81.3%) were high quality based on a Medical Education
Research Study Quality Instrument score of 12 or more. Evidence of
assessment tool validation was absent among all studies. No study outcome
measures were directed to skills transfer to the operating room or patient
outcomes. Overall learning outcomes' effect sizes were consistently high
(2.2; SD, 1.6), with junior residents benefitting most (effect size, 2.8;
SD, 2.2) Conclusions: Simulation-based skill training is associated with
improved learning outcomes for cardiac surgery trainees with large effect
sizes, but more behavior-level outcomes are required to fully assess its
value.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<38>
Accession Number
620562875
Author
Martin N.; Germano R.; Hartley L.; Adler A.J.; Rees K.
Institution
(Martin) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
(Germano) University of Naples Federico II, Division of Nutrition,
Department of Clinical Medicine and Surgery, Naples, Italy
(Hartley, Rees) Warwick Medical School, University of Warwick, Division of
Health Sciences, Coventry, Warwickshire CV4 7AL, United Kingdom
(Adler) London School of Hygiene and Tropical Medicine, Department of
Non-communicable Disease Epidemiology, Keppel Street, London WC1E 7HT,
United Kingdom
Title
Nut consumption for the primary prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2015 (9) (no pagination), 2015.
Article Number: CD011583. Date of Publication: 28 Sep 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Nuts contain a number of nutritional attributes which may be
cardioprotective. A number of epidemiological studies have shown that nut
consumption may have a beneficial effect on people who have cardiovascular
disease (CVD) risk factors. However, results from randomised controlled
trials (RCTs) are less consistent. Objectives: To determine the
effectiveness of nut consumption for the primary prevention of CVD. Search
methods: We searched the following electronic databases: the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of
Science Core Collection, CINAHL, Database of Abstracts of Reviews of
Effects (DARE), Health Technology Assessment Database (HTA) and Health
Economics Evaluations Database (HEED) up to 30 July 2015. We searched
trial registers and reference lists of reviews for further studies. We did
not apply any language restrictions. Selection criteria: We included RCTs
of dietary advice to increase nut consumption or provision of nuts to
increase consumption lasting at least three months and including healthy
adults or adults at moderate and high risk of CVD. The comparison group
was no intervention or minimal intervention. The outcomes of interest were
CVD clinical events and CVD risk factors. Data collection and analysis:
Two review authors independently selected trials for inclusion, abstracted
the data and assessed the risk of bias in included trials. Main results:
We included five trials (435 participants randomised) and one ongoing
trial. One study is awaiting classification. All trials examined the
provision of nuts to increase consumption rather than dietary advice. None
of the included trials reported on the primary outcomes, CVD clinical
events, but trials were small and short term. All five trials reported on
CVD risk factors. Four of these trials provided data in a useable format
for meta-analyses, but heterogeneity precluded meta-analysis for most of
the analyses. Overall trials were judged to be at unclear risk of bias.
There were variable and inconsistent effects of nut consumption on CVD
risk factors (lipid levels and blood pressure). Three trials monitored
adverse events. One trial reported an allergic reaction to nuts and three
trials reported no significant weight gain with increased nut consumption.
None of the included trials reported on other secondary outcomes,
occurrence of type 2 diabetes as a major risk factor for CVD,
health-related quality of life and costs. Authors' conclusions: Currently
there is a lack of evidence for the effects of nut consumption on CVD
clinical events in primary prevention and very limited evidence for the
effects on CVD risk factors. No conclusions can be drawn and further high
quality longer term and adequately powered trials are needed to answer the
review question.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<39>
Accession Number
620562007
Author
Afshari A.; Wikkelso A.; Brok J.; Moller A.M.; Wetterslev J.
Institution
(Afshari) Rigshospitalet, The Cochrane Anaesthesia Review Group and
Copenhagen Trial Unit, Department of Paediatric and Obstetric Anaesthesia,
Blegdamsvej 9, Afsnit 3342, rum 52, Copenhagen 2100, Denmark
(Wikkelso) Herlev University Hospital, Department of Anaesthesiology,
Herlev, Denmark
(Brok) Rigshospitalet, Paediatric Department 4072, Blemdagsvej 9,
Copenhagen 2100 O, Denmark
(Moller) Herlev University Hospital, The Cochrane Anaesthesia Review
Group, Rigshospitalet and Department of Anaesthesiology, Herlev Ringvej,
Herlev 2730, Denmark
(Wetterslev) Rigshospitalet, Copenhagen University Hospital, Copenhagen
Trial Unit, Centre for Clinical Intervention Research, Department 7812,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor
haemotherapy versus usual care in patients with massive transfusion.
Source
Cochrane Database of Systematic Reviews. 2011 (3) (no pagination), 2011.
Article Number: CD007871. Date of Publication: 16 Mar 2011.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Severe bleeding and coagulopathy as a result of massive
transfusion are serious clinical conditions that are associated with high
mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are
increasingly used to guide transfusion strategy but their roles remain
disputed. Objectives: To systematically assess the benefits and harms of a
TEG or ROTEM guided transfusion strategy in randomized trials involving
patients with severe bleeding. Search methods: Randomized clinical trials
(RCTs) were identified from electronic databases: Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue
9); MEDLINE; EMBASE; Science Citation Index Expanded; International Web of
Science; CINAHL; LILACS; and the Chinese Biomedical Literature Database
(up to 31st October 2010). We contacted trial authors, authors of previous
reviews, and manufacturers in the field. Selection criteria: We included
all RCTs, irrespective of blinding or language, that compared transfusion
guided by TEG or ROTEM to transfusion guided by clinical judgement and
standard laboratory tests, or both. Data collection and analysis: Two
authors independently abstracted data; they resolved any disagreements by
discussion. We presented pooled estimates of the intervention effects on
dichotomous outcomes as relative risks (RR) and on continuous outcomes as
mean differences, with 95% confidence intervals (CI). Our primary outcome
measure was all cause mortality. We performed subgroup and sensitivity
analyses to assess the effect of TEG or ROTEM in adults and children on
various clinical and physiological outcomes. We assessed the risk of bias
through assessment of trial methodological components and the risk of
random error through trial sequential analysis. Main results: We included
nine RCTs with a total of 776 participants; only one trial had a low risk
of bias. We found two ongoing trials but were unable to retrieve any data
from them. Compared with standard treatment, TEG or ROTEM showed no
statistically significant effect on overall mortality (3.78% versus 5.11%,
RR 0.77, 95% CI 0.35 to 1.72; I² = 0%) but only five trials
provided data on mortality. Our analyses demonstrated a statistically
significant effect of TEG or ROTEM on the amount of bleeding (MD -85.05
ml, 95% CI -140.68 to -29.42; I² = 26%) but failed to show any
statistically significant effect on other predefined outcomes. Authors'
conclusions: There is an absence of evidence that TEG or ROTEM improves
morbidity or mortality in patients with severe bleeding. Application of a
TEG or ROTEM guided transfusion strategy seems to reduce the amount of
bleeding but whether this has implications for the clinical condition of
patients is still uncertain. More research is needed.<br/>Copyright &#xa9;
2013 The Cochrane Collaboration.

<40>
Accession Number
620770447
Author
Saeed F.; Farooq T.; Islam H.
Institution
(Saeed, Farooq, Islam) New York Medical College, Westchester Medical
Center, Valhalla, NY, United States
Title
Post-transplant primary effusion lymphoma-report of a very rare case with
literature review.
Source
American Journal of Clinical Pathology. Conference: 2017 American Society
for Clinical Pathology, ASCP Annual Meeting. United States. 149
(Supplement 1) (pp S68), 2018. Date of Publication: January 2018.
Publisher
Oxford University Press
Abstract
Post-transplant primary effusion lymphomas (PT-PEL) are extremely rare and
often associated with fatal outcome. These are human herpesvirus 8
(HHV8)/Kaposi sarcoma herpesvirus (KSHV)-associated aggressive large
B-cell lymphoma, typically presenting as serous effusions without
detectable tumor masses. Kaposi sarcoma often precedes PT-PEL. PEL carries
a very poor prognosis with a median survival time of less than six months.
We report a recent such rare case of PT-PEL at our institution with
concurrent Kaposi sarcoma in a cardiac transplant patient and present
review of literature. The patient is a 63-year-old-man with congestive
heart failure due to ischemic cardiomyopathy, who underwent cardiac
transplantation five months ago. He was diagnosed with
HHV8/KSHV-associated Kaposi sarcoma eight years ago and treated with
chemoradiotherapy. He now presented with shortness of breath and
left-sided exudative pleural effusion. ThinPrep slide and cell block
revealed uniform single large atypical cells with high N:C ratio, coarsely
granular chromatin and prominent nucleoli. The atypical tumor cells were
positive for CD45, CD138, MUM1, CD30, and HHV8, while negative for CD20,
Pax5, CD4, CD8, CD56, Alk-1, EBV, EMA, bcl2, bcl6, cyclin-D1, CD3, CD5,
and CD10. Ki67 showed very high nuclear proliferation index (>95%). FISH
showed immunoglobulin heavy chain (IgH) gene rearrangement. Combining all,
the diagnosis of PT-PEL was made. Review of literature showed, PT-PEL is
extremely rare. Since first described in 1998, only 12 cases have been
reported, and only three of them were cardiac transplant recipients; two
of these also had post-transplant Kaposi sarcoma. In contrast to reported
cases, our case had HHV8/KSHV infection preceding the transplant with
development of Kaposi sarcoma. PT-PEL is an extremely rare disease in
reported literature. The case described here occurred in a patient with
history of Kaposi sarcoma with subsequent cardiac transplantation, due to
immune suppression with reactivation of HHV8/KSHV infection.

<41>
Accession Number
620775591
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(Bjornnes) Institute of Nursing and Health Promotion, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, Ontario, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, Ontario,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto,
Ontario, Canada
(Lalloo, Stinson) The Hospital for Sick Children, The Peter Gilgan Centre
for Research and Learning, Toronto, Ontario, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, Florida, USA
(McGillion) School of Nursing, McMaster University, Hamilton, Ontario,
Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, Ontario, Canada
Title
Self-Management Interventions for Women with Cardiac Pain: A Systematic
Review and Meta-Analysis.
Source
Canadian Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. Methods: Using methods described
by the Evidence for Policy and Practice Information and Co-ordinating
Centre at the Institute of Education, 7 databases were systematically
searched to examine and synthesize the evidence on self-management
interventions for women with cardiac pain and cardiac pain equivalents,
such as fatigue, dyspnea, and exhaustion. Results: Our search yielded
22,402 article titles and abstracts. Of these, 57 randomized controlled
trials were included in a final narrative synthesis, comprising data from
13,047 participants, including 5299 (41%) women. Self-management
interventions targeting cardiac pain in women compared with a control
population reduced (1) cardiac pain frequency and cardiac pain proportion
(obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3)
dyspnea at 2 months. There was no evidence of group differences in
postprocedural (percutaneous coronary intervention or cardiac surgery)
pain. Results indicated that self-management interventions for cardiac
pain were more effective if they included a greater proportion of women
(standardized mean difference [SMD], -0.01; standard error, 0.003; P =
0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to
-0.03), and collaboration/support from health care providers (SMD, -0.57;
95% CI, -1.00 to -0.14). Conclusions: The results of this review suggest
that self-management interventions reduce cardiac pain and cardiac pain
equivalents.<br/>Copyright &#xa9; 2017 Canadian Cardiovascular Society.

<42>
Accession Number
620605196
Author
Kang J.; Koo B.-K.; Hu X.; Lee J.M.; Hahn J.-Y.; Yang H.-M.; Shin E.-S.;
Nam C.-W.; Doh J.-H.; Lee B.-K.; Ahn C.; Wang J.; Tahk S.-J.
Institution
(Kang, Koo) Seoul National University Hospital, Seoul, South Korea
(Koo) Institute on Aging, Seoul National University, Seoul, South Korea
(Hu, Wang) 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
(Lee, Hahn) Samsung Medical Center, Seoul, South Korea
(Yang, Tahk) Ajou University Hospital, Suwon, South Korea
(Shin) Ulsan University Hospital, Seoul, South Korea
(Shin) Division of Cardiology, Dietrich Bonhoeffer Hospital, Academic
Teaching Hospital of University of Greifswald, Griefwald, Germany
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Doh) Inje University Ilsan Hospital, Ilsan, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
Title
Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided
Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate
Stenosis (FLAVOUR): Rationale and design of a randomized clinical trial.
Source
American Heart Journal. 199 (pp 7-12), 2018. Date of Publication: May
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Coronary angiography has limitations in defining the
ischemia-causing stenotic lesion, especially in cases with intermediate
coronary stenosis. Fractional flow reserve (FFR) is a current standard
method to define the presence of ischemia, and intravascular ultrasound
(IVUS) is the most commonly used invasive imaging tool that can provide
the lesion geometry and can provide the information on plaque
vulnerability. The primary aim of this study is to compare the safety and
efficacy of FFR-guided and IVUS-guided percutaneous coronary intervention
(PCI) strategies in patients with intermediate coronary stenosis. Trial
design: Comparison of Fractional FLow Reserve And Intravascular
ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients
with InteRmediate Stenosis (FLAVOUR) trial is an international,
multicenter, prospective, randomized clinical trial. A total of 1,700
consecutive patients with intermediate stenosis (40%-70% by visual
estimation) in a major epicardial coronary artery will be randomized 1:1
to receive either FFR-guided or IVUS-guided PCI strategy. Patients will be
treated with PCI according to the predefined criteria for
revascularization; FFR <= 0.80 in the FFR-guided group and Minimal Lumen
Area (MLA) <=3 mm² (or 3 mm² < MLA <=4
mm² and plaque burden >70%) in the IVUS-guided group. The
primary end point is the patient-oriented composite outcome, which is a
composite of all-cause death, myocardial infarction, and any repeat
revascularization at 24 months after randomization. We will test
noninferiority of current standard FFR-guided PCI strategy compared with
IVUS-guided decision for PCI and stent optimization strategy. Conclusion:
The FLAVOUR trial will compare the safety and efficacy of FFR- and
IVUS-guided PCI strategies in patients with intermediate coronary
stenosis. This study will provide an insight on optimal evaluation and
treatment strategy for patients with intermediate coronary
stenosis.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<43>
Accession Number
620649618
Author
Misumida N.; Moliterno D.J.
Institution
(Misumida, Moliterno) Gill Heart Institute and Division of Cardiovascular
Medicine, University of Kentucky, Lexington, KY, United States
Title
Hybrid coronary revascularization: Time for a new comparator?.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 213-214),
2018. Date of Publication: 01 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The present meta-analysis found no significant difference between hybrid
coronary revascularization (HCR) and bypass surgery (CABG) regarding
intermediate-term major adverse cardiac and cerebrovascular events. HCR is
feasible, historically with higher revascularization rates but less
perioperative morbidity With a comparable frequency of repeat
revascularization between current-generation drug-eluting stents and CABG,
future trials of HCR are considering multi-vessel PCI as the new
comparator.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<44>
Accession Number
620649608
Author
Mahmoud A.N.; Saad M.; Elgendy A.Y.; Mentias A.; Elgendy I.Y.
Institution
(Mahmoud, Elgendy, Elgendy) Division of Cardiovascular Medicine,
Department of Medicine, University of Florida, Gainesville, FL, United
States
(Saad) Department of Medicine, University of Arkansas, Little Rock, AR,
United States
(Mentias) Department of Medicine, University of Iowa, Iowa City, IA,
United States
Title
Deferred or immediate stent implantation for primary percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 91 (2) (pp 260-264),
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: To perform a meta-analysis of randomized trials comparing a
deferred versus immediate stenting strategy for primary percutaneous
coronary intervention (PCI). Background: Deferred stent implantation has
emerged as a potential strategy aiming to reduce the thrombus burden and
improve micro-vascular reperfusion during primary PCI. Methods: Electronic
databases were searched for randomized trials that compared a deferred
stent implantation versus immediate stent implantation strategy in
patients undergoing primary PCI. Random effects risk ratios (RR) were
estimated for the outcomes of interest. Results: Four trials with 1,570
patients were included. A deferred stent implantation strategy was
associated with a lower incidence of no-/slow reflow (RR 0.49, 95%
confidence interval [CI] 0.24-0.96), and improved myocardial blush grade 3
(RR 1.42, 95% CI 1.14-1.77). At a mean follow up of 34 +/- 15 months, both
strategies were associated with a similar risk of all-cause mortality (RR
0.85, 95% CI 0.58-1.24), cardiovascular mortality (RR 0.84, 95% CI
0.48-1.45), reinfarction (RR 1.54, 95% CI 0.43-5.49), and stent thrombosis
(RR = 0.35, 95% CI 0.04-3.35, P = 0.36). Conclusion: In patients
undergoing primary PCI, deferred stent implantation is associated with
improvement in surrogate outcomes, but does not appear to improve clinical
outcomes. Future randomized trials are encouraged to identify the patient
population who might benefit from a deferred stent implantation strategy
(e.g., high thrombus burden).<br/>Copyright &#xa9; 2017 Wiley Periodicals,
Inc.

<45>
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.

<46>
Accession Number
620559023
Author
Li J.; Ju J.; Chen Z.; Liu J.; Lu F.; Gao R.; Xu H.
Institution
(Li, Ju) Graduate School, Beijing University of Chinese Medicine, Beijing
100029, China
(Chen, Xu) China Academy of Chinese Medical Sciences, Cardiovascular
Diseases Center, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
(Liu) China Academy of Chinese Medical Sciences, Graduate School, Beijing
100700, China
(Lu, Gao) China Academy of Chinese Medical Sciences, Institute of Clinical
Pharmacology, Xiyuan Hospital, XiYuan CaoChang 1, Beijing 100091, China
Title
Guanxinning tablet for patients who switch from dual antiplatelet therapy
to aspirin alone after percutaneous coronary intervention: Study protocol
for a cluster randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 93. Date of
Publication: 07 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-year dual antiplatelet therapy (DAPT), generally aspirin
in combination with a P2Y12 receptor inhibitor, has been a standard
treatment for patients undergoing percutaneous coronary intervention
(PCI). Prolonged DAPT has proven itself effective in further reducing
cardiovascular events, yet with increased risk of bleeding. Thus, it is of
great necessity to find an alternative drug that is as effective but safer
and more economic than the P2Y12 inhibitors after termination of one-year
DAPT. Methods: We will conduct a cluster randomized controlled trial in
3600 eligible post-PCI patients from 36 tertiary hospitals (100 patients
per hospital) across mainland China. The hospitals served as clusters are
randomized in a 2:1 ratio to Guanxinning tablet (GXNT) plus aspirin or
aspirin alone for 12 months, with other conventional treatment applied in
both groups. After the treatment period, all patients will be followed up
for another 12 months. The primary outcome measure is composite
cardiovascular events including cardiovascular death, non-fatal myocardial
infarction, stent thrombosis, revascularization, ischemic stroke, and
re-admission due to unstable angina. Secondary outcome measures are
all-cause mortality, each individual component of the primary outcome
measure, and stopping or reducing the rate of nitroglycerin
administration. Adverse events, including bleeding, will be closely
monitored during the whole trial period. In addition, a cost-effectiveness
study of GXNT for the study population will be conducted along with this
trial. Discussion: This trial aims to determine whether the addition of
GXNT will further improve prognosis without increasing bleeding risk for
patients with coronary artery disease who have switched from DAPT to
aspirin alone after PCI. Completion of this clinical trial might provide a
novel, promising, and safer alternative to P2Y12 inhibitors for prolonged
antiplatelet therapy in post-PCI patients.<br/>Copyright &#xa9; 2018 The
Author(s).

<47>
Accession Number
620562474
Author
Hooper L.; Martin N.; Abdelhamid A.; Davey Smith G.
Institution
(Hooper, Abdelhamid) University of East Anglia, Norwich Medical School,
Norwich Research Park, Norwich, Norfolk NR4 7TJ, United Kingdom
(Martin) London School of Hygiene and Tropical Medicine, Department of
Non-communicable Disease Epidemiology, Keppel Street, London WC1E 7HT,
United Kingdom
(Davey Smith) University of Bristol, MRC Integrative Epidemiology Unit,
School of Social and Community Medicine, Oakfield House, Oakfield Grove,
Clifton, Bristol BS8 2BN, United Kingdom
Title
Reduction in saturated fat intake for cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD011737. Date of Publication: 10 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Reducing saturated fat reduces serum cholesterol, but effects
on other intermediate outcomes may be less clear. Additionally it is
unclear whether the energy from saturated fats that are lost in the diet
are more helpfully replaced by polyunsaturated fats, monounsaturated fats,
carbohydrate or protein. This review is part of a series split from and
updating an overarching review. Objectives: To assess the effect of
reducing saturated fat intake and replacing it with carbohydrate (CHO),
polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on
mortality and cardiovascular morbidity, using all available randomised
clinical trials. Search methods: We updated our searches of the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE
(Ovid) on 5 March 2014. We also checked references of included studies and
reviews. Selection criteria: Trials fulfilled the following criteria: 1)
randomised with appropriate control group; 2) intention to reduce
saturated fat intake OR intention to alter dietary fats and achieving a
reduction in saturated fat; 3) not multifactorial; 4) adult humans with or
without cardiovascular disease (but not acutely ill, pregnant or
breastfeeding); 5) intervention at least 24 months; 6) mortality or
cardiovascular morbidity data available. Data collection and analysis: Two
review authors working independently extracted participant numbers
experiencing health outcomes in each arm, and we performed random-effects
meta-analyses, meta-regression, subgrouping, sensitivity analyses and
funnel plots. Main results: We include 15 randomised controlled trials
(RCTs) (17 comparisons, ~59,000 participants), which used a variety of
interventions from providing all food to advice on how to reduce saturated
fat. The included long-term trials suggested that reducing dietary
saturated fat reduced the risk of cardiovascular events by 17% (risk ratio
(RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons,
53,300 participants of whom 8% had a cardiovascular event, I2 65%, GRADE
moderate quality of evidence), but effects on all-cause mortality (RR
0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and
cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421
participants) were less clear (both GRADE moderate quality of evidence).
There was some evidence that reducing saturated fats reduced the risk of
myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01;
11 trials, 53,167 participants), but evidence for non-fatal myocardial
infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants)
was unclear and there were no clear effects on stroke (any stroke, RR
1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These
relationships did not alter with sensitivity analysis. Subgrouping
suggested that the reduction in cardiovascular events was seen in studies
that primarily replaced saturated fat calories with polyunsaturated fat,
and no effects were seen in studies replacing saturated fat with
carbohydrate or protein, but effects in studies replacing with
monounsaturated fats were unclear (as we located only one small trial).
Subgrouping and meta-regression suggested that the degree of reduction in
cardiovascular events was related to the degree of reduction of serum
total cholesterol, and there were suggestions of greater protection with
greater saturated fat reduction or greater increase in polyunsaturated and
monounsaturated fats. There was no evidence of harmful effects of reducing
saturated fat intakes on cancer mortality, cancer diagnoses or blood
pressure, while there was some evidence of improvements in weight and BMI.
Authors' conclusions: The findings of this updated review are suggestive
of a small but potentially important reduction in cardiovascular risk on
reduction of saturated fat intake. Replacing the energy from saturated fat
with polyunsaturated fat appears to be a useful strategy, and replacement
with carbohydrate appears less useful, but effects of replacement with
monounsaturated fat were unclear due to inclusion of only one small trial.
This effect did not appear to alter by study duration, sex or baseline
level of cardiovascular risk. Lifestyle advice to all those at risk of
cardiovascular disease and to lower risk population groups should continue
to include permanent reduction of dietary saturated fat and partial
replacement by unsaturated fats. The ideal type of unsaturated fat is
unclear.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.

<48>
Accession Number
620562314
Author
Di Nisio M.; Peinemann F.; Porreca E.; Rutjes A.W.
Institution
(Di Nisio, Rutjes) University G. D'Annunzio of Chieti-Pescara, Department
of Medical, Oral and Biotechnological Sciences, via dei Vestini 31, Chieti
66013, Italy
(Di Nisio) Academic Medical Center, Department of Vascular Medicine,
Amsterdam, Netherlands
(Peinemann) Children's Hospital, University of Cologne, Pediatric Oncology
and Hematology, Kerpener Str. 62, Cologne, NW 50937, Germany
(Porreca) University G. D'Annunzio Foundation, Department of Medicine and
Aging; Centre for Aging Sciences (Ce.S.I.), Internal Medicine Unit, 31 Via
dei Vestini, Chieti 66100, Italy
(Rutjes) Fondazione Universita G. D'Annunzio, Centre for Systematic
Reviews, via dei Vestini 31, Chieti 66100, Italy
(Rutjes) University of Bern, Institute of Social and Preventive Medicine
(ISPM), Finkenhubelweg 11, Bern 3012, Switzerland
Title
Primary prophylaxis for venous thromboembolism in patients undergoing
cardiac or thoracic surgery.
Source
Cochrane Database of Systematic Reviews. 2015 (6) (no pagination), 2015.
Article Number: CD009658. Date of Publication: 19 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiac and thoracic surgery are associated with an increased
risk of venous thromboembolism (VTE). The safety and efficacy of primary
thromboprophylaxis in patients undergoing these types of surgery is
uncertain. Objectives: To assess the effects of primary thromboprophylaxis
on the incidence of symptomatic VTE and major bleeding in patients
undergoing cardiac or thoracic surgery. Search methods: The Cochrane
Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the
Specialised Register (last searched May 2014) and CENTRAL (2014, Issue 4).
The authors searched the reference lists of relevant studies, conference
proceedings, and clinical trial registries. Selection criteria: Randomised
controlled trials (RCTs) and quasi-RCTs comparing any oral or parenteral
anticoagulant or mechanical intervention to no intervention or placebo, or
comparing two different anticoagulants. Data collection and analysis: We
extracted data on methodological quality, participant characteristics,
interventions, and outcomes including symptomatic VTE and major bleeding
as the primary effectiveness and safety outcomes, respectively. Main
results: We identified 12 RCTs and one quasi-RCT (6923 participants), six
for cardiac surgery (3359 participants) and seven for thoracic surgery
(3564 participants). No study evaluated fondaparinux, the new oral direct
thrombin, direct factor Xa inhibitors, or caval filters. All studies had
major study design flaws and most lacked a placebo or no treatment control
group. We typically graded the quality of the overall body of evidence for
the various outcomes and comparisons as low, due to imprecise estimates of
effect and risk of bias. We could not pool data because of the different
comparisons and the lack of data. In cardiac surgery, 71 symptomatic VTEs
occurred in 3040 participants from four studies. In a study of 2551
participants, representing 85% of the review population in cardiac
surgery, the combination of unfractionated heparin with pneumatic
compression stockings was associated with a 61% reduction of symptomatic
VTE compared to unfractionated heparin alone (1.5% versus 4.0%; risk ratio
(RR) 0.39; 95% confidence interval (CI) 0.23 to 0.64). Major bleeding was
only reported in one study, which found a higher incidence with vitamin K
antagonists compared to platelet inhibitors (11.3% versus 1.6%, RR 7.06;
95% CI 1.64 to 30.40). In thoracic surgery, 15 symptomatic VTEs occurred
in 2890 participants from six studies. In the largest study evaluating
unfractionated heparin versus an inactive control the rates of symptomatic
VTE were 0.7% versus 0%, respectively, giving a RR of 6.71 (95% CI 0.40 to
112.65). There was insufficient evidence to determine if there was a
difference in the risk of major bleeding from two studies evaluating
fixed-dose versus weight-adjusted low molecular weight heparin (2.7%
versus 8.1%, RR 0.33; 95% CI 0.07 to 1.60) and unfractionated heparin
versus low molecular weight heparin (6% and 4%, RR 1.50; 95% CI 0.26 to
8.60). Authors' conclusions: The evidence regarding the efficacy and
safety of thromboprophylaxis in cardiac and thoracic surgery is limited.
Data for important outcomes such as pulmonary embolism or major bleeding
were often lacking. Given the uncertainties around the benefit-to-risk
balance, no conclusions can be drawn and a case-by-case risk evaluation of
VTE and bleeding remains preferable.<br/>Copyright &#xa9; 2015 The
Cochrane Collaboration.

<49>
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.

<50>
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.

<51>
Accession Number
620548907
Author
de Oliveira Carvalho P.E.; da Silva M.V.M.; Rodrigues O.R.; Cataneo A.J.M.
Institution
(de Oliveira Carvalho) Marilia Medical School, Evidence Based Health
Actions Department and Thoracic Surgery, Avenida Monte Carmelo, 800,
Bairro Fragata, Marilia, Sao Paulo 17519-030, Brazil
(da Silva) FAMEMA, Orthopaedics and Traumatology, Av. Aziz Atalah s/n,
Marilia 17519000, Brazil
(Rodrigues) Mogi das Cruzes Medical School, Mogi das Cruzes, Sao Paulo,
Brazil
(Cataneo) Universidade Estadual Paulista (UNESP), Department of Surgery,
Distrito de Rubiao Junior, s/n, Sao Paulo 18618-970, Brazil
Title
Surgical interventions for treating pectus excavatum.
Source
Cochrane Database of Systematic Reviews. 2014 (10) (no pagination), 2014.
Article Number: CD008889. Date of Publication: 29 Oct 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Pectus excavatum is characterized by a depression of the
anterior chest wall (sternum and lower costal cartilages) and is the most
frequently occurring chest wall deformity. The prevalence ranges from 6.28
to 12 cases per 1000 around the world. Generally pectus excavatum is
present at birth or is identified after a few weeks or months; however,
sometimes it becomes evident only at puberty. The consequence of the
condition on a individual's life is variable, some live a normal life and
others have physical and psychological symptoms such as: precordial pain
after exercises; impairments of pulmonary and cardiac function; shyness
and social isolation. For many years, sub-perichondrial resection of the
costal cartilages, with or without transverse cuneiform osteotomy of the
sternum and placement of a substernal support, called conventional
surgery, was the most accepted option for surgical repair of these
patients. From 1997 a new surgical repair called, minimally invasive
surgery, became available. This less invasive surgical option consists of
the retrosternal placement of a curved metal bar, without resections of
the costal cartilages or sternum osteotomy, and is performed by
videothoracoscopy. However, many aspects that relate to the benefits and
harms of both techniques have not been defined. Objectives: To evaluate
the effectiveness and safety of the conventional surgery compared with
minimally invasive surgery for treating people with pectus excavatum.
Search methods: With the aim of increasing the sensitivity of the search
strategy we used only terms related to the individual's condition (pectus
excavatum); terms related to the interventions, outcomes and types of
studies were not included. We searched the Cochrane Central Register of
Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR.
Additionally we searched yet reference lists of articles and conference
proceedings. All searches were done without language restriction. Date of
the most recent searches: 14 January 2014. Selection criteria: We
considered randomized or quasi-randomized controlled trials that compared
traditional surgery with minimally invasive surgery for treating pectus
excavatum. Data collection and analysis: Two review authors independently
assessed the eligibility of the trials identified and agreed trial
eligibility after a consensus meeting. The authors also assessed the risk
of bias of the eligible trials. Main results: Initially we located 4111
trials from the electronic searches and two further trials from other
resources. All trials were added into reference management software and
the duplicates were excluded, leaving 2517 studies. The titles and
abstracts of these 2517 studies were independently analyzed by two authors
and finally eight trials were selected for full text analysis, after which
they were all excluded, as they did not fulfil the inclusion criteria.
Authors' conclusions: There is no evidence from randomized controlled
trials to conclude what is the best surgical option to treat people with
pectus excavatum.<br/>Copyright &#xa9; 2014 The Cochrane Collaboration.

<52>
Accession Number
620562848
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Medical Center - University of Freiburg, Center for Medical
Biometry and Medical Informatics, Stefan-Meier-Str. 26, Freiburg 79104,
Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in children undergoing surgery for congenital heart
disease.
Source
Cochrane Database of Systematic Reviews. 2014 (9) (no pagination), 2014.
Article Number: CD011312. Date of Publication: 25 Sep 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in children having undergone surgery for congenital
heart disease.<br/>Copyright &#xa9; 2014 The Cochrane Collaboration.

<53>
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.

<54>
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.

<55>
Accession Number
620551006
Author
Main C.; Knight B.; Moxham T.; Gabriel Sanchez R.; Sanchez Gomez L.M.;
Roquei Figuls M.; Bonfill Cosp X.
Institution
(Main) Peninsula College of Medicine and Dentistry, Peninsula Technology
Assessment Group (PenTAG), Noy Scott House, Barrack Road, Exeter EX2 5DW,
United Kingdom
(Knight) University of Exeter Medical School, NIHR Exeter Clinical
Research Facilt, Exeter, United Kingdom
(Moxham) Florida Atlantic University, Wimberly Library, 777 Glades Road,
Boca Raton, FL 33431, United States
(Gabriel Sanchez) Hospital Universitario de la Paz, Universidad Autonoma
de Madrid, Instituto de Investigacion IdiPAZ, Red Espanola de
Investigacion Cardiovascular RD/12/0042/0008, Diego De Leon 62, Planta 9,
Madrid 28006, Spain
(Sanchez Gomez) Instituto de Salud Carlos III, Agencia de Evaluacion
Tecnologias Sanitarias, Monforte de Lemos 5, Madrid, Spain
(Roquei Figuls) CIBER Epidemiologia y Salud Publica (CIBERESP),
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB
Sant Pau), Sant Antoni Maria Claret 171, Edifici Casa de Convalescencia,
Barcelona, Catalunya 08041, Spain
(Bonfill Cosp) CIBER Epidemiologia y Salud Publica (CIBERESP), Spain -
Universitat Autonoma de Barcelona, Iberoamerican Cochrane Centre,
Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni M.
Claret 171, Casa de Convalescencia, Barcelona, Catalonia 08041, Spain
Title
Hormone therapy for preventing cardiovascular disease in post-menopausal
women.
Source
Cochrane Database of Systematic Reviews. 2013 (4) (no pagination), 2013.
Article Number: CD002229. Date of Publication: 30 Apr 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Evidence from systematic reviews of observational studies
suggest that hormone replacement therapy (HT) may have beneficial effects
in reducing the incidence of cardiovascular disease (CVD) events in
post-menopausal women. This is an updated version of a Cochrane review
first published in 2005 (Gabriel-Sanchez 2005). Objectives: To assess the
effects of HT for the prevention of CVD in post-menopausal women, and
whether there are differential effects between use of single therapy alone
compared to combination HT and use in primary or secondary prevention.
Search methods: We searched the following databases to April 2010:
Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane
Library, MEDLINE, EMBASE and LILACS. Selection criteria: Randomised
controlled trials (RCTs) of women comparing orally administered HT with
placebo with a minimum of six-months follow-up. Data collection and
analysis: Two authors independently assessed study quality and extracted
data. Risk Ratios (RR) with 95% confidence intervals were calculated for
each outcome. Results were combined using fixed-effect meta-analyses, and
where possible, further stratified analyses conducted to assess the effect
of time on treatment. Additionally, univariate meta-regression analyses
were undertaken to assess whether length of trial follow-up, single or
combination treatment, or whether treatment for primary or secondary
prevention were potential predictors for a number of CVD outcomes in the
trials. Main results: Four new trials were identified through the update;
one trial included in the previous review was excluded. Therefore the
review included 13 trials with a total of 38,171 post-menopausal women.
Overall, single and combination HT in both primary and secondary
prevention conferred no protective effects for all cause mortality, CVD
death, non-fatal MI, or angina. There were no significant differences in
the number of coronary artery by-pass procedures or angioplasties
performed between the trial arms. However there was an increased risk of
stroke for both primary and secondary prevention when combination and
single HT was combined, RR 1.26 (95% CI 1.11 to 1.43), in venous
thromboembolic events, RR 1.89 (95% CI 1.58 to 2.26) and in pulmonary
embolism RR 1.84 (95% CI 1.42 to 2.37) relative to placebo. The associated
numbers needed-to-harm (NNH) were 164, 109 and 243 for stroke, venous
thromboembolism and pulmonary embolism respectively. Authors' conclusions:
Treatment with HT in post-menopausal women for either primary or secondary
prevention of CVD events is not effective, and causes an increase in the
risk of stroke, and venous thromboembolic events. HT should therefore only
be considered for women seeking relief from menopausal symptoms.
Short-term HT treatment should be at the lowest effective dose, and used
with caution in women with predisposing risk factors for CVD
events.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.

<56>
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.

<57>
Accession Number
620758587
Author
Meco M.; Montisci A.; Miceli A.; Panisi P.; Donatelli F.; Cirri S.;
Ferrarini M.; Lio A.; Glauber M.
Institution
(Meco, Montisci, Miceli, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo
Ospedaliero San Donato, Milan, Italy
(Donatelli) Chair of Cardiac Surgery, University of Milan, Milan, Italy
(Panisi) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
Title
Sutureless perceval aortic valve versus conventional stented
bioprostheses: Meta-analysis of postoperative and midterm results in
isolated aortic valve replacement.
Source
Journal of the American Heart Association. 7 (4) (no pagination), 2018.
Article Number: e006091. Date of Publication: 01 Feb 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Aortic stenosis is the most common valvular disease and has a
dismal prognosis without surgical treatment. The aim of this meta-analysis
was to quantitatively assess the comparative effectiveness of the Perceval
(LivaNova) valve versus conventional aortic bioprostheses. Methods and
Results--A total of 6 comparative studies were identified, including 639
and 760 patients who underwent, respectively, aortic valve replacement
with the Perceval sutureless valve (P group) and with a conventional
bioprosthesis (C group). Aortic cross-clamping and cardiopulmonary bypass
duration were significantly lower in the P group. No difference in
postoperative mortality was shown for the P and C groups (2.8% versus
2.7%, respectively; odds ratio [OR]: 0.99 [95% confidence interval (CI),
0.52-1.88]; P=0.98). Incidence of postoperative renal failure was lower in
the P group compared with the C group (2.7% versus 5.5%; OR: 0.45 [95% CI,
0.25-0.80]; P=0.007). Incidence of stroke (2.3% versus 1.7%; OR: 1.34 [95%
CI, 0.56-3.21]; P=0.51) and paravalvular leak (3.1% versus 1.6%; OR: 2.52
[95% CI, 0.60-1.06]; P=0.21) was similar, whereas P group patients
received fewer blood transfusions than C group patients (1.16+/-1.2 versus
2.13+/-2.2; mean difference: 0.99 [95% CI, -1.22 to -0.75]; P=0.001). The
incidence of pacemaker implantation was higher in the P than the C group
(7.9% versus 3.1%; OR: 2.45 [95% CI, 1.44-4.17]; P=0.001), whereas
hemodynamic Perceval performance was better (transvalvular gradient
23.42+/-1.73 versus 22.8+/-1.86; mean difference: 0.90 [95% CI,
0.62-1.18]; P=0.001), even during follow-up (10.98+/-5.7 versus
13.06+/-6.2; mean difference: -2.08 [95% CI, -3.96 to -0.21]; P=0.030). We
found no difference in 1-year mortality. Conclusions--The Perceval
bioprosthesis improves the postoperative course compared with conventional
bioprostheses and is an option for high-risk patients.<br/>Copyright
&#xa9; 2018 The Authors.