EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 103

Results Generated From:
Embase <1980 to 2018 Week 11>
Embase (updates since 2018-03-02)

<1>
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. Copyright © 2018 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<2>
Accession Number
620309141
Author
Saraswat A.; Rahman A.; Singh K.
Institution
(Saraswat, Rahman, Singh) Department of Cardiology, Gold Coast University
Hospital, Gold Coast, Queensland, Australia
(Rahman, Singh) Department of Medicine, Griffith University, Gold Coast,
Queensland, Australia
(Singh) Department of Medicine, University of Adelaide, Adelaide, South
Australia, Australia
Title
An Invasive vs a Conservative Approach in Elderly Patients with
Non-ST-Segment Elevation Myocardial Infarction: Systematic Review and
Meta-Analysis.
Source
Canadian Journal of Cardiology. 34 (3) (pp 330-332), 2018. Date of
Publication: March 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Elderly (>= 75 years) patients form a large sub-group of
non-ST-segment elevation myocardial infarction (NSTEMI) population but are
vastly under-represented in trials. Thus, the benefits of an early
angiography in the elderly remain unclear. In this systematic review, we
compared outcomes of "invasive" and "conservative" strategies of NSTEMI
management in elderly patients. Methods: A comprehensive search of major
databases was performed. We included comparative studies of any design
that enrolled patients >= 75 years, and where outcomes of both strategies
of NSTEMI management were available. Results: Among the included studies
(3 randomized and 6 observational), there were 6340 patients in the
"invasive" group and 13,358 patients in the "conservative" group. The
12-month mortality rate (odds ration [OR], 0.45; p < 0.00001), the 30-day
mortality (OR, 0.50; p = 0.0009), and events of stroke (OR, 0.42; p <
0.00001) were significantly lower in the invasive group. Major bleeding
was higher in the invasive cohort (OR, 1.63; p = 0.03). Analysis of
randomised studies showed lower reinfarction with invasive approach at 12
months (p = 0.0001). Significant heterogeneity was noted among studies
according to study design. Conclusion: The overall benefit with invasive
strategy comes from the data of observational studies that are prone to
selection bias. We believe that there is a need for a large randomized
study in the elderly patients regarding management of
NSTEMI. Copyright © 2017 Canadian Cardiovascular Society

<3>
Accession Number
619763112
Author
Ghadban R.; Enezate T.; Omran J.; Almourani R.; Singla A.; Balla S.
Institution
(Ghadban, Enezate, Omran, Balla) Division of Cardiovascular Medicine,
University of Missouri School of Medicine, Columbia, MO, United States
(Almourani) Division of Endocrinology, Department of Internal Medicine,
University of Missouri School of Medicine, Columbia, MO, United States
(Singla) Division of Cardiovascular Medicine, Department of Internal
Medicine, Tulane University School of Medicine, New Orleans, LA, United
States
Title
Clinical outcomes of PCSK9Is: A meta-analysis of randomized clinical
trials.
Source
Cardiovascular Diagnosis and Therapy. 7 (6) (pp 598-606), 2017. Date of
Publication: 01 Dec 2017.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Previous studies of proprotein convertase subtilisin/kexin
type 9 inhibitors (PCSK9Is) were not designed to detect clinical benefit
and were underpowered for this outcome. However, recently published trials
reported improvement in clinical outcomes. The aim of this meta-analysis
to assess the impact of PCSK9Is on clinical outcomes. Methods: Medline,
Embase and the Cochrane Central Register of Controlled Trials (CENTRAL)
were queried from January 2000 through March 2017. Only randomized
controlled trials (RCTs) comparing clinical outcomes in patients treated
with PCSK9I versus control group were included. Two independent reviewers
selected the studies and extracted data in duplicate. Random-effects
meta-analysis was used to pool outcomes across studies. Study endpoints
included: major adverse cardiovascular events (MACE), myocardial
infarction (MI), stroke, coronary revascularization, cardiovascular (CV)
mortality and all-cause mortality. Results: A total of 62,776 patients
(mean age 61 years, 73% were males) were included from six randomized
clinical trials. In comparison to control group, PCSK9I use was associated
with lower MACE (RR =0.81, 95% CI, 0.70-0.93, P=0.003), MI (RR =0.78, 95%
CI, 0.63-0.97, P=0.03), stroke (RR =0.74, 95% CI, 0.64-0.87, P=0.0002) and
coronary revascularization (RR =0.79, 95% CI, 0.73-0.86, P<0.00001). There
was no statistically significant difference between both groups in terms
of all-cause mortality (RR =1.01, 95% CI, 0.86-1.20, P=0.86) or CV
mortality (RR =0.98, 95% CI, 0.78-1.22, P=0.83). Conclusions: PCSK9Is
should be strongly considered to improve clinical outcomes in patients at
high risk for atherosclerotic CVD. Copyright © Cardiovascular
Diagnosis and Therapy. All rights reserved.

<4>
Accession Number
620645027
Author
Unverzagt S.; Buerke M.; de Waha A.; Haerting J.; Pietzner D.; Seyfarth
M.; Thiele H.; Werdan K.; Zeymer U.; Prondzinsky R.
Institution
(Unverzagt, Haerting) Martin Luther University Halle-Wittenberg, Institute
of Medical Epidemiology, Biostatistics and Informatics, Magdeburge Strase
8, Halle/Saale 06097, Germany
(Buerke, Werdan) Martin Luther University Halle-Wittenberg, Internal
Medicine III, Ernst-Grube-Strasse 49, Halle (Saale) 06097, Germany
(de Waha) Department of Cardiology, Interventional Cardiology Group,
Deutsches Herzzentrum Munchen, Munchen 80636, Germany
(Pietzner) Martin Luther University Halle, Imebi, Magdeburger Str. 8,
Halle, Sachsen-Anhalt 06108, Germany
(Seyfarth) University of Witten-Herdecke, HELIOS Klinikum Wuppertal,
Department of Cardiology, Munchen, Germany
(Thiele) University Clinic Schleswig-Holstein, Campus Lubeck, Medical
Clinic II (Kardiology, Angiology, Intensive Care Medicine), Ratzeburger
Allee 160, Lubeck D-23538, Germany
(Zeymer) Klinikum Ludwigshafen, Medizinische Klinik II, Bremserstrasse 79,
Ludwigshafen 67063, Germany
(Prondzinsky) Carl von Basedow Klinikum Merseburg, Cardiology/Intensive
Care Medicine, Weisse Mauer 42, Merseburg 06217, Germany
Title
Intra-aortic balloon pump counterpulsation (IABP) for myocardial
infarction complicated by cardiogenic shock.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD007398. Date of Publication: 27 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Intra-aortic balloon pump counterpulsation (IABP) is currently
the most commonly used mechanical assist device for patients with
cardiogenic shock due to acute myocardial infarction. Although there has
been only limited evidence from randomised controlled trials, the previous
guidelines of the American Heart Association/American College of
Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) strongly
recommended the use of the IABP in patients with infarction-related
cardiogenic shock on the basis of pathophysiological considerations,
non-randomised trials and registry data. The recent guidelines downgraded
the recommendation based on a meta-analysis which could only include
non-randomised trials showing conflicting results. Up to now, there have
been no guideline recommendations and no actual meta-analysis including
the results of the large randomised multicentre IABP-SHOCK II Trial which
showed no survival benefit with IABP support. This systematic review is an
update of the review published in 2011. Objectives: To evaluate, in terms
of efficacy and safety, the effect of IABP versus non-IABP or other assist
devices guideline compliant standard therapy on mortality and morbidity in
patients with acute myocardial infarction complicated by cardiogenic
shock. Search methods: Searches of CENTRAL, MEDLINE (Ovid) and EMBASE
(Ovid), LILACS, IndMed and KoreaMed, registers of ongoing trials and
proceedings of conferences were updated in October 2013. Reference lists
were scanned and experts in the field contacted to obtain further
information. No language restrictions were applied. Selection criteria:
Randomised controlled trials on patients with acute myocardial infarction
complicated by cardiogenic shock. Data collection and analysis: Data
collection and analysis were performed according to the published
protocol. Individual patient data were provided for six trials and merged
with aggregate data. Summary statistics for the primary endpoints were
hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals
(CIs). Main results: Seven eligible studies were identified from a total
of 2314 references. One new study with 600 patients was added to the
original review. Four trials compared IABP to standard treatment and three
to other percutaneous left assist devices (LVAD). Data from a total of 790
patients with acute myocardial infarction and cardiogenic shock were
included in the updated meta-analysis: 406 patients were treated with IABP
and 384 patients served as controls; 339 patients were treated without
assisting devices and 45 patients with other LVAD. The HR for all-cause
30-day mortality of 0.95 (95% CI 0.76 to 1.19) provided no evidence for a
survival benefit. Different non-fatal cardiovascular events were reported
in five trials. During hospitalisation, 11 and 4 out of 364 patients from
the intervention groups suffered from reinfarction or stroke,
respectively. Altogether 5 out of 363 patients from the control group
suffered from reinfarction or stroke. Reocclusion was treated with
subsequent re-revascularization in 6 out of 352 patients from the
intervention group and 13 out of 353 patients of the control group. The
high incidence of complications such as moderate and severe bleeding or
infection in the control groups has to be attributed to interventions with
other LVAD. Possible reasons for bias were more frequent in small studies
with high cross-over rates, early stopping and the inclusion of patients
with IABP at randomisation. Authors' conclusions: Available evidence
suggests that IABP may have a beneficial effect on some haemodynamic
parameters. However, this did not result in survival benefits so there is
no convincing randomised data to support the use of IABP in
infarct-related cardiogenic shock. Copyright © 2015 The Cochrane
Collaboration.

<5>
Accession Number
620563321
Author
Amos T.; Stein D.J.; Ipser J.C.
Institution
(Amos, Stein, Ipser) University of Cape Town, Department of Psychiatry and
Mental Health, Education Centre, Valkenberg Hospital, Private Bage X1,
Observatory, Cape Town 7925, South Africa
Title
Pharmacological interventions for preventing post-traumatic stress
disorder (PTSD).
Source
Cochrane Database of Systematic Reviews. 2014 (7) (no pagination), 2014.
Article Number: CD006239. Date of Publication: 08 Jul 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Post-traumatic stress disorder (PTSD) is a debilitating
disorder which, after a sufficient delay, may be diagnosed amongst
individuals who respond with intense fear, helplessness or horror to
traumatic events. There is some evidence that the use of pharmacological
interventions immediately after exposure to trauma may reduce the risk of
developing of PTSD. Objectives: To assess the effects of pharmacological
interventions for the prevention of PTSD in adults following exposure to a
traumatic event. Search methods: We searched the Cochrane Depression,
Anxiety and Neurosis Controlled Trials Register (CCDANCTR-Studies and
CCDANCTR-References) (to 14 February 2014). This register contains
relevant reports of randomised controlled trials from the following
bibliographic databases: CENTRAL (all years); EMBASE (1974 to date);
MEDLINE (1950 to date) and PsycINFO (1967 to date). We identified
unpublished trials by searching the National Institute of Health (NIH)
Reporter, the metaRegister of Controlled Trials database (mRCT) and the
WHO International Clinical Trials Registry Platform (to December 2013). We
scanned the reference lists of articles for additional studies. We placed
no constraints on language and setting. Selection criteria: We restricted
studies to randomised controlled trials (RCTs) of pharmacological
interventions compared with placebo for the prevention of PTSD in adults.
Data collection and analysis: Two authors (TA and JI) independently
assessed trials for eligibility and inclusion based on the review
selection criteria. We independently extracted sample, methodological,
outcome and 'Risk of bias' data, as well as the number of side effects,
from each trial and entered these into a customised data extraction form.
We contacted investigators for missing information. We calculated summary
statistics for continuous and dichotomous variables (if provided). We did
not undertake subgroup analyses due to the small number of included
studies. Main results: We included nine short-term RCTs (duration 12 weeks
or less) in the analysis (345 participants; age range 18 to 76 years).
Participants were exposed to a variety of traumas, ranging from assault,
traffic accidents and work accidents to cardiac surgery and septic shock.
Seven studies were conducted at single centres. The seven RCTs included
four hydrocortisone studies, three propranolol studies (of which one study
had a third arm investigating gabapentin), and single trials of
escitalopram and temazepam. Outcome assessment measures included the
Clinician-Administered PTSD Scale (CAPS), the 36-Item Short-Form Health
Survey (SF-36) and the Center for Epidemiological Studies - Depression
Scale (CES-D). In four trials with 165 participants there was moderate
quality evidence for the efficacy of hydrocortisone in preventing the
onset of PTSD (risk ratio (RR) 0.17; 95% confidence interval (CI) 0.05 to
0.56; P value = 0.004), indicating that between seven and 13 patients
would need to be treated with this agent in order to prevent the onset of
PTSD in one patient. There was low quality evidence for preventing the
onset of PTSD in three trials with 118 participants treated with
propranolol (RR 0.62; 95% CI 0.24 to 1.59; P value = 0.32). Drop-outs due
to treatment-emergent side effects, where reported, were low for all of
the agents tested. Three of the four RCTs of hydrocortisone reported that
medication was more effective than placebo in reducing PTSD symptoms after
a median of 4.5 months after the event. None of the single trials of
escitalopram, temazepam and gabapentin demonstrated evidence that
medication was superior to placebo in preventing the onset of PTSD. Seven
of the included RCTs were at a high risk of bias. Differential drop-outs
between groups undermined the results of three studies, while one study
failed to describe how the allocation of medication was concealed. Other
forms of bias that might have influenced study results included possible
confounding through group differences in concurrent medication and
termination of the study based on treatment response. Authors'
conclusions: There is moderate quality evidence for the efficacy of
hydrocortisone for the prevention of PTSD development in adults. We found
no evidence to support the efficacy of propranolol, escitalopram,
temazepam and gabapentin in preventing PTSD onset. The findings, however,
are based on a few small studies with multiple limitations. Further
research is necessary in order to determine the efficacy of
pharmacotherapy in preventing PTSD and to identify potential moderators of
treatment effect. Copyright © 2014 The Cochrane Collaboration.

<6>
Accession Number
620559972
Author
Thyregod H.G.H.; Moller C.H.; Sondergaard L.; Gluud C.; Steinbruchel D.A.
Institution
(Thyregod, Moller, Steinbruchel) Copenhagen University Hospital
Rigshospitalet, Department of Cardiothoracic Surgery, RT 2152, Blegdamsvej
9, Copenhagen 2100, Denmark
(Sondergaard) Copenhagen University Hospital Rigshospitalet, Department of
Cardiology, Copenhagen 2100, Denmark
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Copenhagen University Hospital Rigshospitalet, The Cochrane Hepato-Biliary
Group, Department 7812, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Transcatheter versus optimal medical treatment and surgical aortic valve
replacement for aortic valve stenosis.
Source
Cochrane Database of Systematic Reviews. 2013 (4) (no pagination), 2013.
Article Number: CD010488. 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
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the benefits and harms of TAVI versus optimal
medical therapy or versus SAVR in patients with severe AV
stenosis. Copyright © 2013 The Cochrane Collaboration.

<7>
Accession Number
620990067
Author
Benedetto U.; Altman D.G.; Gerry S.; Gray A.; Lees B.; Angelini G.D.;
Flather M.; Taggart D.P.; Ratnatunga C.; Westaby S.; Cook J.; Wallis C.;
Wos S.; Jasinski M.; Widenka K.; Blach A.; Gocol R.; Hudziak D.; Zurek P.;
Deja M.; Bachowski R.; Mrozek R.; Kargul T.; Domarardzki W.; Frackiewicz
J.; Zamvar V.; Ezakadan D.; Buxton B.; Seevanayagam S.; Matalanis G.;
Rosalion A.; Negri J.; Moten S.; Atkinson V.; Newcomb A.; Polidano P.;
Pana R.; Gerbo S.; O'Keefe P.; von Oppell U.; Mehta D.; Azzu A.; Szafranek
A.; Kulatilake E.; Evans J.; Martin N.; Banner D.; Trivedi U.; Forsyth A.;
Hyde J.; Cohen A.; Lewis M.; Gardner E.; MacKenzie A.; Cooter N.; Joyce
E.; Parker J.; Champney F.; Clark S.; Dark J.; Tocewicz K.; Pillay T.;
Rowling S.; Adams-Hall J.; Bochenek A.; Cisowski M.; Bolkowski M.;
Morawski W.; Guc M.; Krejca M.; Wilczynski M.; Duralek A.; Gerber W.;
Skarysz J.; Shrestha R.; Swiech W.; Szmagala P.; Krzych L.; Pawlak A.;
Kepa K.; Hasan R.; Keenan D.; Prendergast B.; Odom N.; McLaughlin K.;
Cummings-Fosong G.; Mathew C.; Iles-Smith H.; Oomen A.; Desai J.; El-Gamel
A.; John L.; Wendler O.; Andrews M.; Rance K.; Williams R.; Hogervorst V.;
Gregory J.; Jessup J.; Knighton A.; Hoare A.; Ritchie A.; Choong C.; Nair
S.; Jenkins D.; Large S.; Sudarshan C.; Barman M.; Dhital K.; Routledge
T.; Rosengard B.; Munday H.; Rintoul K.; Jarrett E.; Lao-Sirieix S.;
Wilkinson A.; Garner L.; Osmond J.; Holcombe H.; Cale A.; Griffin S.;
Dickson J.; Spyt T.; Hickey M.; Sosnowski A.; Peek G.; Szostek J.;
Hadjinikalaou L.; Logtens E.; Oakley M.; Leji S.; Gaer J.; Amrani M.;
Dreyfus G.; Bahrami T.; de Robertis F.; Baig K.; Asimakopoulos G.; Vohra
H.; Pai V.; Tadjkarimi S.; Soleimani B.; Stavri G.; Bull G.; Collappen H.;
Sadowksi J.; Gaweda B.; Rudzinski P.; Stolinski J.; Konstanty-Kalandyk J.;
Moraes F.; Moraes C.; Wanderley J.; Pepper J.; De Souza A.; Petrou M.;
Trimlett R.; Morgan T.; Gavino J.; Wang S.F.; Chandrasekaran V.;
Kanagasaby R.; Sarsam M.; Ryan H.; Billings L.; Ruddick L.; Achampong A.;
Forster E.; Pawlaczyk R.; Siondalski P.; Rogowski J.; Roszak K.;
Jarmoszewicz K.; Jagielak D.; Gafka S.; Mannam G.; Naguboyin G.; Rao Sajja
L.; Dandu B.; Briffa N.; Braidley P.; Cooper G.; Allen K.; Sangha G.;
Bridge C.; McMellon H.; Casabona R.; Actis Dato G.; Bardi G.; Del Ponte
S.; Forsennati P.; Parisi F.; Punta G.; Flocco R.; Sansone F.; Zingarelli
E.; Dihmis W.; Kuduvali M.; Prince C.; Rogers H.; McQuade L.; Anisimowicz
L.; Bokszanski M.; Pawliszak W.; Kolakowski J.; Lau G.; Ogorzeja W.;
Gumanska I.; Kulinski P.; Podesser B.; Trescher K.; Bernecker O.;
Holzinger C.; Binder K.; Schor I.; Bergmann P.; Kassal H.; Motovova B.;
Trehan N.; Meharwal Z.; Malhotra R.; Goel M.; Kumer B.; Bazaz S.; Bake N.;
Singh A.; Mishka Y.; Gupta R.; Basumatary S.; Zembala M.; Szafron B.;
Pacholewicz J.; Krason M.; Farmas A.; Wojarski J.; Zych B.; Szymanik I.;
Kolwca M.; Mazur W.; Kurowicki A.; Zurek S.; Stacel T.; Jaworska I.;
Sleight P.; Channon K.; Farrell B.; Stables R.; Vermes G.; Pearson J.;
Pitman M.; Yusuf S.; Pocock S.; Julian D.; Treasure T.; Von Oppel U.;
Kanagasabay R.; Collinson J.; Bakhai A.; O'Hanlon R.; Kotecha D.; Qureshi
K.; Geisler T.; Manzano-Espinosa L.
Institution
(Benedetto, Angelini) Bristol Heart Institute, School of Clinical
Sciences, University of Bristol, United Kingdom
(Altman, Gerry) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, University of
Oxford, United Kingdom
(Gray) Nuffield Department of Population Health, Health Economics Research
Centre, University of Oxford, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, United Kingdom
(Flather, Ratnatunga, Westaby, Cook, Wallis, Wos, Jasinski, Widenka,
Blach, Gocol, Hudziak, Zurek, Deja, Bachowski, Mrozek, Kargul,
Domarardzki, Frackiewicz, Zamvar, Ezakadan, Buxton, Seevanayagam,
Matalanis, Rosalion, Negri, Moten, Atkinson, Newcomb, Polidano, Pana,
Gerbo, O'Keefe, von Oppell, Mehta, Azzu, Szafranek, Kulatilake, Evans,
Martin, Banner, Trivedi, Forsyth, Hyde, Cohen, Lewis, Gardner, MacKenzie,
Cooter, Joyce, Parker, Champney, Clark, Dark, Tocewicz, Pillay, Rowling,
Adams-Hall, Bochenek, Cisowski, Bolkowski, Morawski, Guc, Krejca,
Wilczynski, Duralek, Gerber, Skarysz, Shrestha, Swiech, Szmagala, Krzych,
Pawlak, Kepa, Hasan, Keenan, Prendergast, Odom, McLaughlin,
Cummings-Fosong, Mathew, Iles-Smith, Oomen, Desai, El-Gamel, John,
Wendler, Andrews, Rance, Williams, Hogervorst, Gregory, Jessup, Knighton,
Hoare, Ritchie, Choong, Nair, Jenkins, Large, Sudarshan, Barman, Dhital,
Routledge, Rosengard, Munday, Rintoul, Jarrett, Lao-Sirieix, Wilkinson,
Garner, Osmond, Holcombe, Cale, Griffin, Dickson, Spyt, Hickey, Sosnowski,
Peek, Szostek, Hadjinikalaou, Logtens, Oakley, Leji, Gaer, Amrani,
Dreyfus, Bahrami, de Robertis, Baig, Asimakopoulos, Vohra, Pai,
Tadjkarimi, Soleimani, Stavri, Bull, Collappen, Sadowksi, Gaweda,
Rudzinski, Stolinski, Konstanty-Kalandyk, Moraes, Moraes, Wanderley,
Pepper, De Souza, Petrou, Trimlett, Morgan, Gavino, Wang, Chandrasekaran,
Kanagasaby, Sarsam, Ryan, Billings, Ruddick, Achampong, Forster,
Pawlaczyk, Siondalski, Rogowski, Roszak, Jarmoszewicz, Jagielak, Gafka,
Mannam, Naguboyin, Rao Sajja, Dandu, Briffa, Braidley, Cooper, Allen,
Sangha, Bridge, McMellon, Casabona, Actis Dato, Bardi, Del Ponte,
Forsennati, Parisi, Punta, Flocco, Sansone, Zingarelli, Dihmis, Kuduvali,
Prince, Rogers, McQuade, Anisimowicz, Bokszanski, Pawliszak, Kolakowski,
Lau, Ogorzeja, Gumanska, Kulinski, Podesser, Trescher, Bernecker,
Holzinger, Binder, Schor, Bergmann, Kassal, Motovova, Trehan, Meharwal,
Malhotra, Goel, Kumer, Bazaz, Bake, Singh, Mishka, Gupta, Basumatary,
Zembala, Szafron, Pacholewicz, Krason, Farmas, Wojarski, Zych, Szymanik,
Kolwca, Mazur, Kurowicki, Zurek, Stacel, Jaworska, Sleight, Channon,
Farrell, Stables, Vermes, Pearson, Pitman, Yusuf, Pocock, Julian,
Treasure, Von Oppel, Kanagasabay, Collinson, Bakhai, O'Hanlon, Kotecha,
Qureshi, Geisler, Manzano-Espinosa) Norwich Medical School, University of
East Anglia, Norwich, United Kingdom
(Flather) Norfolk and Norwich University Hospitals National Health Service
Foundation Trust, Norwich, United Kingdom
Title
Safety of perioperative aprotinin administration during isolated coronary
artery bypass graft surgery: Insights from the ART (Arterial
Revascularization Trial).
Source
Journal of the American Heart Association. 7 (5) (no pagination), 2018.
Article Number: e007570. Date of Publication: 06 Mar 2018.
Publisher
American Heart Association Inc.
Abstract
Background--There is still uncertainty about the safety of aprotinin for
coronary artery bypass graft surgery. The ART (Arterial Revascularization
Trial) was designed to compare survival after bilateral versus single
internal thoracic artery grafting. Many of the ART patients (=30%)
received perioperative aprotinin. We investigated the association between
perioperative aprotinin administration and short-term (in-hospital) and
long-term outcomes by performing a post hoc analysis of the ART. Methods
and Results--Among patients enrolled in the ART (n=3102) from 2004 to
2007, we excluded those who did not undergo surgery (n=18) and those with
no information about use of perioperative aprotinin (n=9). Finally, 836 of
3076 patients (27%) received aprotinin. Propensity matching was used to
select 536 pairs for final comparison. Aprotinin was also associated with
an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds
ratio, 9.12; 95% confidence interval [CI], 1.15-72.2; P=0.03),
intra-aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds
ratio, 2.26; 95% CI, 1.26-4.07; P=0.006), and acute kidney injury (102
[19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95% CI, 1.03-1.97; P=0.03).
Aprotinin was not associated with a lower incidence of transfusion (37
[6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95% CI, 0.81-2.23; P=0.25) and
reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95% CI,
0.76-2.53; P=0.28). At 5 years, all-cause mortality was significantly
increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard
ratio, 1.51; 95% CI, 1.0-2.28; P=0.045). Conclusions--In the present post
hoc ART analysis, aprotinin was associated with a significantly increased
risk of early and late mortality. Copyright © 2018 The Authors.

<8>
Accession Number
620299310
Author
Wang X.; Wang C.; Ye M.; Lin J.; Jin J.; Hu Q.; Zhu C.; Chen B.
Institution
(Wang, Wang, Ye, Lin, Jin, Hu, Zhu, Chen) Department of Thoracic and
Cardiovascular Surgery, Affiliated Taizhou Hospital, Wenzhou Medical
University, Taizhou, China
Title
Left atrial concomitant surgical ablation for treatment of atrial
fibrillation in cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 13 (1) (no pagination), 2018. Article Number: e0191354. Date of
Publication: January 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction Surgical ablation is a generally established treatment for
patients with atrial fibrillation undergoing concomitant cardiac surgery.
Left atrial (LA) lesion set for ablation is a simplified procedure
suggested to reduce the surgery time and morbidity after procedure. The
present meta-analysis aims to explore the outcomes of left atrial lesion
set versus no ablative treatment in patients with AF undergoing cardiac
surgery. Methods A literature research was performed in six database from
their inception to July 2017, identifying all relevant randomized
controlled trials (RCTs) comparing left atrial lesion set versus no
ablative treatment in AF patient undergoing cardiac surgery. Data were
extracted and analyzed according to predefined clinical endpoints. Results
Eleven relevant RCTs were included for analysis in the present study. The
prevalence of sinus rhythm in ablation group was significantly higher at
discharge, 6-month and 1-year follow-up period. The morbidity including 30
day mortality, late all-cause mortality, reoperation for bleeding,
permanent pacemaker implantation and neurological events were of no
significant difference between two groups. Conclusions The result of our
meta-analysis demonstrates that left atrial lesion set is an effective and
safe surgical ablation strategy for AF patients undergoing concomitant
cardiac surgery. Copyright © 2018 Wang et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<9>
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. Copyright © Med Sci
Monit, 2018.

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

<11>
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. Copyright © 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<12>
Accession Number
614679380
Author
Beckmann S.; Nikolic N.; Denhaerynck K.; Binet I.; Koller M.; Boely E.; De
Geest S.; Berben L.; Burkhalter H.; Claes V.; Helmy R.; Kirsch M.; Leppla
L.; Mauthner O.; Struker M.; Boehler A.; Gerull S.; Huynh-Do U.; Catana
E.; Simcox A.; Seiler A.; Klaghofer R.; Kunzler-Heule P.; Achermann R.;
Amico P.; Aubert J.-D.; Banz V.; Beldi G.; Benden C.; Berger C.; Bochud
P.-Y.; Bucher H.; Buhler L.; Carell T.; Chalandon Y.; de Rougemont O.;
Dickenmann M.; Duchosal M.; Elkrief L.; Fehr T.; Ferrari-Lacraz S.;
Garzoni C.; Soccal P.G.; Gaudet C.; Giostra E.; Golshayan D.; Hadaya K.;
Halter J.; Heim D.; Hess C.; Hillinger S.; Hirsch H.H.; Hofbauer G.; Immer
F.; Laesser B.; Lehmann R.; Lovis C.; Manuel O.; Marti H.-P.; Martin P.Y.;
Meylan P.; Mohacsi P.; Morel P.; Mueller U.; Mueller N.J.; Mueller-McKenna
H.; Muller A.; Muller T.; Mullhaupt B.; Nadal D.; Pascual M.; Passweg J.;
Rick J.; Roosnek E.; Rosselet A.; Rothlin S.; Ruschitzka F.; Schanz U.;
Schaub S.; Schnyder A.; Seiler C.; Stampf S.; Steiger J.; Stirnimann G.;
Toso C.; Van Delden C.; Venetz J.-P.; Villard J.; Wick M.; Wilhelm M.;
Yerly P.
Institution
(Beckmann, Denhaerynck, De Geest) Institute of Nursing Science, University
of Basel, Basel, Switzerland
(Beckmann) Department of Abdomen-Metabolism, University Hospital Zurich,
Zurich, Switzerland
(Nikolic) Department of Neurosurgery, University Hospital Zurich, Zurich,
Switzerland
(Binet) Nephrology and Transplantation Medicine, Cantonal Hospital St
Gallen, St Gallen, Switzerland
(Koller) Transplantation Immunology and Nephrology, University Hospital
Basel, Basel, Switzerland
(Boely) University Hospital of Geneva, Geneva, Switzerland
(De Geest) Department of Public Health and Primary Care, Academic Center
for Nursing and Midwifery, KU Leuven, Leuven, Belgium
Title
Evolution of body weight parameters up to 3 years after solid organ
transplantation: The prospective Swiss Transplant Cohort Study.
Source
Clinical Transplantation. 31 (3) (no pagination), 2017. Article Number:
e12896. Date of Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Obesity and weight gain are serious concerns after solid organ
transplantation (Tx); however, no unbiased comparison regarding body
weight parameter evolution across organ groups has yet been performed.
Using data from the prospective nationwide Swiss Transplant Cohort Study,
we compared the evolution of weight parameters up to 3 years post-Tx in
1359 adult kidney (58.3%), liver (21.7%), lung (11.6%), and heart (8.4%)
recipients transplanted between May 2008 and May 2012. Changes in mean
weight and body mass index (BMI) category were compared to reference
values from 6 months post-Tx. At 3 years post-Tx, compared to other organ
groups, liver Tx recipients showed the greatest weight gain (mean
4.8+/-10.4 kg), 57.4% gained >5% body weight, and they had the highest
incidence of obesity (38.1%). After 3 years, based on their BMI categories
at 6 months, normal weight and obese liver Tx patients, as well as
underweight kidney, lung and heart Tx patients had the highest weight
gains. Judged against international Tx patient data, the majority of our
Swiss Tx recipients' experienced lower post-Tx weight gain. However, our
findings show weight gain pattern differences, both within and across
organ Tx groups that call for preventive measures. Copyright ©
2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<13>
[Use Link to view the full text]
Accession Number
616934442
Author
De Sciscio P.; Brubert J.; De Sciscio M.; Serrani M.; Stasiak J.;
Moggridge G.D.
Institution
(De Sciscio) Departments of Engineering, United Kingdom
(De Sciscio, Brubert, Serrani, Stasiak, Moggridge) Chemical Engineering
and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge
CB3 0AS, United Kingdom
(De Sciscio) Department of General Medicine, Royal Adelaide Hospital,
Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia
Title
Quantifying the Shift Toward Transcatheter Aortic Valve Replacement in
Low-Risk Patients.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (6) (no pagination),
2017. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In recent years, use of transcatheter aortic valve
replacement has expanded to include patients at intermediate- and low-risk
cohorts. We sought to determine disease prevalence and treatment
distribution including transcatheter aortic valve replacement eligibility
in low-risk patients across 37 advanced economies. Methods and Results -
Four systematic searches were conducted across MEDLINE, EMBASE, and the
Cochrane database for studies evaluating disease prevalence, severity,
decision making, and survival in patients with aortic stenosis. Estimates
of disease prevalence and treatment eligibility were calculated using
stochastic simulation and population data for the 37 countries comprising
the International Monetary Fund's advanced economies index. Fifty-six
studies comprising 42 965 patients were included across 5 domains:
prevalence, severity, symptom status, treatment modality, and outcome. The
pooled prevalence in the general population aged 60 to 74 years and >75
years was 2.8% (95% confidence interval [CI], 1.4%-4.1%) and 13.1% (95%
CI, 8.2%-17.9%), respectively - corresponding to an estimated 16.1 million
(95% CI, 12.2-20.3) people in 37 advanced economies. Of these, an
estimated 3.2 million (95% CI, 2.2-4.4) patients have severe aortic
stenosis with 1.9 million (95% CI, 1.3-2.6) eligible for surgical aortic
valve replacement. There are =485 230 (95% CI, 284 550-66 7350)
high-risk/inoperable patients, 152 690 (95% CI, 73 410-263 000)
intermediate-risk patients, and 378 890 (95% CI, 205 130-610 210) low-risk
patients eligible for transcatheter aortic valve replacement. Conclusions
- With a prevalence of 4.5%, an estimated 16.1 million people aged >=60
years across 37 advanced economies have aortic stenosis. Of these, there
are =1.9 million patients eligible for surgical aortic valve replacement
and 1.0 million patients eligible for transcatheter aortic valve
replacement. Copyright © 2017 American Heart Association, Inc.

<14>
Accession Number
614692569
Author
Kristensen A.W.; Mortensen J.; Berg R.M.G.
Institution
(Kristensen, Mortensen) Department of Clinical Physiology, Nuclear
Medicine & PET, University Hospital Rigshospitalet, Copenhagen, Denmark
(Berg) Department of Clinical Physiology and Nuclear Medicine, Bispebjerg
and Frederiksberg Hospitals, Copenhagen, Denmark
Title
Pulmonary thromboembolism as a complication of lung transplantation.
Source
Clinical Transplantation. 31 (4) (no pagination), 2017. Article Number:
e12922. Date of Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Post-transplantation mortality after lung transplantation (LTX) is higher
than for other solid organ transplantations. Thoracic surgery is
associated with increased risk of thromboembolic complications, and as LTX
recipients lack the collateral bronchial circulation, pulmonary
thromboembolism (PTE) may represent a pertinent yet largely underdiagnosed
cause of post-transplantation respiratory failure. In this systematic
review, we sought to elucidate the occurrence and predilection site of PTE
after LTX, and its potential impact on LTX-associated mortality. Based on
twelve original articles identified by a systematic search strategy in
PubMed, we found that PTE was reported in 4% of LTX recipients, and 38% of
these events occurred within the first 30 days after the LTX procedure. In
single-lung transplantation (SLTX) recipients, 12% were diagnosed with
PTE, with 92% of these affecting the allograft. Of LTX patients diagnosed
with PTE, 11% died within 1 year after LTX and 75% of these deaths
occurred within the first 30 days. Our findings suggest that PTE is a
potentially underdiagnosed cause of early post-LTX respiratory failure.
This should be confirmed in larger studies with systematic follow-up
diagnostic imaging. Copyright © 2017 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<15>
Accession Number
616627141
Author
den Harder A.M.; Snoek A.M.; Leiner T.; Suyker W.J.; de Heer L.M.; Budde
R.P.J.; Lammers J.W.J.; de Jong P.A.; Gondrie M.J.A.
Institution
(den Harder, Snoek, Leiner, de Jong, Gondrie) Department of Radiology,
University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508GA,
Netherlands
(Snoek) Department of Radiology, Sint Antonius Ziekenhuis, P.O. Box 2500,
Nieuwegein 3430EM, Netherlands
(Suyker, de Heer) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, P.O. Box 85500, Utrecht 3508GA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
(Lammers) Department of Respiratory Medicine, University Medical Center
Utrecht, P.O. Box 85500, Utrecht 3508GA, Netherlands
Title
Can routine chest radiography be used to diagnose mild COPD? A nested
case-control study.
Source
European Journal of Radiology. 92 (pp 159-165), 2017. Date of Publication:
July 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether mild stage chronic obstructive pulmonary
disease (COPD) can be detected on chest radiography without substantial
overdiagnosis. Methods A retrospective nested case-control study
(case:control, 1:1) was performed in 783 patients scheduled for
cardiothoracic surgery who underwent both spirometry and a chest
radiograph preoperative. Diagnostic accuracy of chest radiography for
diagnosing mild COPD was investigated using objective measurements and
overall appearance specific for COPD on chest radiography. Inter-observer
variability was investigated and variables with a kappa >0.40 as well as
baseline characteristics were used to make a diagnostic model which was
aimed at achieving a high positive predictive value (PPV). Results Twenty
percent (155/783) had COPD. The PPV of overall appearance specific for
COPD alone was low (37-55%). Factors in the diagnostic model were age,
type of surgery, gender, distance of the right diaphragm apex to the first
rib, retrosternal space, sternodiaphragmatic angle, maximum height right
diaphragm (lateral view) and subjective impression of COPD (using both
views). The model resulted in a PPV of 100%, negative predictive value
(NPV) of 82%, sensitivity of 10% and specificity of 100% with an area
under the curve of 0.811. Conclusions Detection of mild COPD without
substantial overdiagnosis was not feasible on chest radiographs in our
cohort. Copyright © 2017 Elsevier B.V.

<16>
Accession Number
616023486
Author
Ayoub C.; Erthal F.; Abdelsalam M.A.; Murad M.H.; Wang Z.; Erwin P.J.;
Hillis G.S.; Kritharides L.; Chow B.J.W.
Institution
(Ayoub, Abdelsalam) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Ayoub, Kritharides) University of Sydney, New South Wales, Australia
(Erthal, Chow) Department of Medicine (Cardiology), University of Ottawa
Heart Institute, Canada
(Murad, Wang) Evidence-based Practice Center, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Clinic Libraries, Rochester, MN, United States
(Hillis) Department of Cardiology, Royal Perth Hospital, University of
Western Australia, Australia
(Kritharides) Department of Cardiology, Concord Hospital, Sydney Local
Health District, New South Wales, Australia
(Chow) Department of Radiology, University of Ottawa, Canada
Title
Prognostic value of segment involvement score compared to other measures
of coronary atherosclerosis by computed tomography: A systematic review
and meta-analysis.
Source
Journal of Cardiovascular Computed Tomography. 11 (4) (pp 258-267), 2017.
Date of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The segment involvement score (SIS) is a semiquantitative
measure of the extent of atherosclerosis burden by coronary computed
tomography angiography (CTA). We sought to evaluate by meta-analysis the
prognostic value of SIS, and to compare it with other CTA measures of
coronary artery disease (CAD). Methods Electronic databases from 1946 to
January 2016 were searched. Studies reporting SIS, or an equivalent
measure by coronary CTA, and clinical outcomes were included. Maximally
adjusted hazard ratios (HR), predominantly for clinical variables, were
extracted for SIS, obstructive CAD, Agatston coronary artery calcium
score, and plaque composition. These were pooled using DerSimonian-Laird
random effects models. Results Eleven nonrandomized studies with good
methodological quality enrolling 9777 subjects (mean age 61 +/- 11 years,
57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or
all cause death, non-fatal myocardial infarction or late
revascularization), were included. SIS (per segment increase) had pooled
HR of 1.25 (95% CI: 1.16,1.35; I2 = 71.4%, p < 0.001) for MACE.
HR for MACE was 1.37 (95% CI: 1.32,1.42; I2 = 95.6%, p < 0.001)
for number of segments with stenosis (per segment increase), 3.39 (95% CI:
1.65,6.99; I2 = 87.8%, p = 0.001) for obstructive CAD (binary
variable) and 1.00 (95% CI: 1.00,1.01; I2 = 75.0%, p = 0.490)
for Agatston score (per unit increase). HRs by plaque composition
(calcified, non-calcified and mixed; per segment change) were 1.24 (95%
CI: 1.10,1.39; I2 = 81.6%, p = 0.001), 1.20 (95% CI: 0.97,1.48;
I2 = 92.9%, p = 0.093) and 1.27 (95% CI: 1.03,1.58;
I2 = 89.8%, p = 0.029), respectively. Conclusion Despite
heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary
CTA is a strong, independent predictor of cardiovascular
events. Copyright © 2017 Society of Cardiovascular Computed
Tomography

<17>
Accession Number
613545299
Author
Hallgren O.; Svenmarker S.; Appelblad M.
Institution
(Hallgren, Svenmarker, Appelblad) Department of Public Health and Clinical
Medicine, Heart Centre, Umea University, Umea, Sweden
Title
Implementing a Statistical Model for Protamine Titration: Effects on
Coagulation in Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (2) (pp 516-521),
2017. Date of Publication: April 2017.
Publisher
W.B. Saunders
Abstract
Objectives To implement a statistical model for protamine titration.
Design Prospective randomized trial. Setting University hospital.
Participants Sixty (n = 30+30) patients scheduled for elective coronary
artery bypass surgery were randomly assigned to 2 groups. Interventions
Protamine dose calculated according to an algorithm established from a
statistical model or to a fixed protamine-heparin dose ratio (1:1).
Measurements and Main Results Both groups demonstrated comparable patient
demographics and intraoperative data. Coagulation effects were evaluated
using rotational thromboelastometry. Using the statistical model reduced
(p<0.01) the protamine dose from 426+/-43 mg to 251+/-66 mg, followed by
significantly (p<0.01) shorter intrinsic clotting time (208+/-29 seconds
versus 244+/-52 seconds) and stronger clot firmness (p = 0.01), and
effects on indices of extrinsic or fibrinogen coagulation pathways were
insignificant. Test of residual heparin was negative in all patients after
protamine administration, aligned with insignificant (p = 0.27) intergroup
heparinase-verified clotting time differences. Conclusions The statistical
model for protamine titration is clinically feasible and protects the
patient from exposure to excessive doses of protamine, with advantageous
effects on coagulation as measured using rotational thromboelastometry.
Significance regarding clinical outcome is yet to be
defined. Copyright © 2017 Elsevier Inc.

<18>
Accession Number
620645076
Author
Burkhardt B.E.U.; Rucker G.; Stiller B.
Institution
(Burkhardt) Kinderspital Zurich, Department of Cardiology,
Steinwiesstrasse 75, Zurich 8032, Switzerland
(Rucker) Medical Center - University of Freiburg, Center for Medical
Biometry and Medical Informatics, Stefan-Meier-Str. 26, Freiburg 79104,
Germany
(Stiller) Heart Center, University of Freiburg, Department of Congenital
Heart Defects and Pediatric Cardiology, Mathildenstr. 1, Freiburg,
Baden-Wurttemberg 79098, Germany
Title
Prophylactic milrinone for the prevention of low cardiac output syndrome
and mortality in children undergoing surgery for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD009515. Date of Publication: 25 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Children with congenital heart disease often undergo heart
surgery at a young age. They are at risk for postoperative low cardiac
output syndrome (LCOS) or death. Milrinone may be used to provide
inotropic and vasodilatory support during the immediate postoperative
period. Objectives: This review examines the effectiveness of prophylactic
postoperative use of milrinone to prevent LCOS or death in children having
undergone surgery for congenital heart disease. Search methods: Electronic
and manual literature searches were performed to identify randomised
controlled trials. We searched CENTRAL, MEDLINE, EMBASE and Web of Science
in February 2014 and conducted a top-up search in September 2014 as well
as clinical trial registries and reference lists of published studies. We
did not apply any language restrictions. Selection criteria: Only
randomised controlled trials were selected for analysis. We considered
studies with newborn infants, infants, toddlers, and children up to 12
years of age. Data collection and analysis: Two review authors
independently extracted data according to a pre-defined protocol. We
obtained additional information from all study authors. Main results:
Three of the five included studies compared milrinone versus levosimendan,
one study compared milrinone with placebo, and one compared milrinone
verus dobutamine, with 101, 242, and 50 participants, respectively. Three
trials were at low risk of bias while two were at higher risk of bias. The
number and definitions of outcomes were non-uniform as well. In one study
comparing two doses of milrinone and placebo, there was some evidence in
an overall comparison of milrinone versus placebo that milrinone lowered
risk for LCOS (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.28 to
0.96; 227 participants). The results from two small studies do not provide
enough information to determine whether milrinone increases the risk of
LCOS when compared to levosimendan (RR 1.22, 95% CI 0.32 to 4.65; 59
participants). Mortality rates in the studies were low, and there was
insufficient evidence to draw conclusions on the effect of milrinone
compared to placebo or levosimendan or dobutamine regarding mortality, the
duration of intensive care stay, hospital stay, mechanical ventilation, or
maximum inotrope score (where available). Numbers of patients requiring
mechanical cardiac support were also low and did not allow a comparison
between studies, and none of the participants of any study received a
heart transplantation up to the end of the respective follow-up period.
Time to death within three months was not reported in any of the included
studies. A number of adverse events was examined, but differences between
the treatment groups could not be proven for hypotension, intraventricular
haemorrhage, hypokalaemia, bronchospasm, elevated serum levels of liver
enzymes, or a reduced left ventricular ejection fraction < 50% or reduced
left ventricular fraction of shortening < 28%. Our analysis did not prove
an increased risk of arrhythmias in patients treated prophylactically with
milrinone compared with placebo (RR 3.59, 95% CI 0.83 to 15.42; 238
participants), a decreased risk of pleural effusions (RR 1.78, 95% CI 0.92
to 3.42; 231 participants), or a difference in risk of thrombocytopenia on
milrinone compared with placebo (RR 0.86, 95% CI 0.39 to 1.88; 238
participants). Comparisons of milrinone with levosimendan or with
dobutamine, respectively, did not clarify the risk of arrhythmia and were
not possible for pleural effusions or thrombocytopenia. Authors'
conclusions: There is insufficient evidence of the effectiveness of
prophylactic milrinone in preventing death or low cardiac output syndrome
in children undergoing surgery for congenital heart disease, compared to
placebo. So far, no differences have been shown between milrinone and
other inodilators, such as levosimendan or dobutamine, in the immediate
postoperative period, in reducing the risk of LCOS or death. The existing
data on the prophylactic use of milrinone has to be viewed cautiously due
to the small number of small trials and their risk of bias. Copyright
© 2015 The Cochrane Collaboration.

<19>
Accession Number
620561897
Author
Al-Khudairy L.; Hartley L.; Clar C.; Flowers N.; Hooper L.; Rees K.
Institution
(Al-Khudairy, Hartley, Flowers, Rees) Warwick Medical School, University
of Warwick, Division of Health Sciences, Coventry CV4 7AL, United Kingdom
(Clar) Hasenheide 67, Berlin 10967, Germany
(Hooper) University of East Anglia, Norwich Medical School, Norwich
Research Park, Norwich, Norfolk NR4 7TJ, United Kingdom
Title
Omega 6 fatty acids for the primary prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2015 (11) (no pagination), 2015.
Article Number: CD011094. Date of Publication: 16 Nov 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Omega 6 plays a vital role in many physiological functions but
there is controversy concerning its effect on cardiovascular disease (CVD)
risk. There is conflicting evidence whether increasing or decreasing omega
6 intake results in beneficial effects. Objectives: The two primary
objectives of this Cochrane review were to determine the effectiveness
of:1. Increasing omega 6 (Linoleic acid (LA), Gamma-linolenic acid (GLA),
Dihomo-gamma-linolenic acid (DGLA), Arachidonic acid (AA), or any
combination) intake in place of saturated or monounsaturated fats or
carbohydrates for the primary prevention of CVD.2. Decreasing omega 6 (LA,
GLA, DGLA, AA, or any combination) intake in place of carbohydrates or
protein (or both) for the primary prevention of CVD. Search methods: We
searched the following electronic databases up to 23 September 2014: the
Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane
Library (Issue 8 of 12, 2014); MEDLINE (Ovid) (1946 to September week 2,
2014); EMBASE Classic and EMBASE (Ovid) (1947 to September 2014); Web of
Science Core Collection (Thomson Reuters) (1990 to September 2014);
Database of Abstracts of Reviews of Effects (DARE) and Health Technology
Assessment Database, and Health Economics Evaluations Database on the
Cochrane Library (Issue 3 of 4, 2014). We searched trial registers and
reference lists of reviews for further studies. We applied no language
restrictions. Selection criteria: Randomised controlled trials (RCTs) of
interventions stating an intention to increase or decrease omega 6 fatty
acids, lasting at least six months, and including healthy adults or adults
at high risk of CVD. The comparison group was given no advice, no
supplementation, a placebo, a control diet, or continued with their usual
diet. The outcomes of interest were CVD clinical events (all-cause
mortality, cardiovascular mortality, non-fatal end points) and CVD risk
factors (changes in blood pressure, changes in blood lipids, occurrence of
type 2 diabetes). We excluded trials involving exercise or multifactorial
interventions to avoid confounding. Data collection and analysis: Two
review authors independently selected trials for inclusion, extracted the
data, and assessed the risk of bias in the included trials. Main results:
We included four RCTs (five papers) that randomised 660 participants. No
ongoing trials were identified. All included trials had at least one
domain with an unclear risk of bias. There were no RCTs of omega 6 intake
reporting CVD clinical events. Three trials investigated the effect of
increased omega 6 intake on lipid levels (total cholesterol, low density
lipoprotein (LDL-cholesterol), and high density lipoprotein
(HDL-cholesterol)), two trials reported triglycerides, and two trials
reported blood pressure (diastolic and systolic blood pressure). Two
trials, one with two relevant intervention arms, investigated the effect
of decreased omega 6 intake on blood pressure parameters and lipid levels
(total cholesterol, LDL-cholesterol, and HDL-cholesterol) and one trial
reported triglycerides. Our analyses found no statistically significant
effects of either increased or decreased omega 6 intake on CVD risk
factors. Two studies were supported by funding from the UK Food Standards
Agency and Medical Research Council. One study was supported by Lipid
Nutrition, a commercial company in the Netherlands and the Dutch Ministry
of Economic Affairs. The final study was supported by grants from the
Finnish Food Research Foundation, Finnish Heart Research Foundation, Aarne
and Aili Turnen Foundation, and the Research Council for Health, Academy
of Finland. Authors' conclusions: We found no studies examining the
effects of either increased or decreased omega 6 on our primary outcome
CVD clinical endpoints and insufficient evidence to show an effect of
increased or decreased omega 6 intake on CVD risk factors such as blood
lipids and blood pressure. Very few trials were identified with a
relatively small number of participants randomised. There is a need for
larger well conducted RCTs assessing cardiovascular events as well as
cardiovascular risk factors. Copyright © 2015 The Cochrane
Collaboration.

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

<21>
Accession Number
620644980
Author
Arsenault K.A.; Yusuf A.M.; Crystal E.; Healey J.S.; Morillo C.A.; Nair
G.M.; Whitlock R.P.
Institution
(Arsenault, Whitlock) McMaster University, Department of Surgery, David
Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street
East, Hamilton, ON L8l 2X2, Canada
(Yusuf) Population Health Research Institute (McMaster University/Hamilton
Health Sciences), Thrombosis, David Braley Cardiac, Vascular and Stroke
Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Crystal) Schulich Heart Centre, Electrophysiology Programme, Department
of Medicine, Sunny Brook and Women's, University of Toronto, 2075 Bay View
Ave, Toronto M4N 3M5, Canada
(Healey, Morillo, Nair) McMaster University, Medicine, David Braley
Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East,
Hamilton, ON L8L 2X2, Canada
Title
Interventions for preventing post-operative atrial fibrillation in
patients undergoing heart surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (1) (no pagination), 2013.
Article Number: CD003611. Date of Publication: 31 Jan 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Atrial fibrillation is a common post-operative complication of
cardiac surgery and is associated with an increased risk of post-operative
stroke, increased length of intensive care unit and hospital stays,
healthcare costs and mortality. Numerous trials have evaluated various
pharmacological and non-pharmacological prophylactic interventions for
their efficacy in preventing post-operative atrial fibrillation. We
conducted an update to a 2004 Cochrane systematic review and meta-analysis
of the literature to gain a better understanding of the effectiveness of
these interventions. Objectives: The primary objective was to assess the
effects of pharmacological and non-pharmacological interventions for
preventing post-operative atrial fibrillation or supraventricular
tachycardia after cardiac surgery. Secondary objectives were to determine
the effects on post-operative stroke or cerebrovascular accident,
mortality, cardiovascular mortality, length of hospital stay and cost of
treatment during the hospital stay. Search methods: We searched the
Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011),
MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and
CINAHL (from 1981 to July 2011). Selection criteria: We selected
randomized controlled trials (RCTs) that included adult patients
undergoing cardiac surgery who were allocated to pharmacological or
non-pharmacological interventions for the prevention of post-operative
atrial fibrillation or supraventricular tachycardia, except digoxin,
potassium (K+), or steroids. Data collection and analysis: Two
review authors independently abstracted study data and assessed trial
quality. Main results: One hundred and eighteen studies with 138 treatment
groups and 17,364 participants were included in this review. Fifty-seven
of these studies were included in the original version of this review
while 61 were added, including 27 on interventions that were not
considered in the original version. Interventions included amiodarone,
beta-blockers, sotalol, magnesium, atrial pacing and posterior
pericardiotomy. Each of the studied interventions significantly reduced
the rate of post-operative atrial fibrillation after cardiac surgery
compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95%
confidence interval) CI 0.26 to 0.43; I2 = 55%) and sotalol (OR
0.34; 95% CI 0.26 to 0.43; I2 = 3%) appear to have similar
efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73;
I2 = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI
0.34 to 0.54; I2 = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to
0.61; I2 = 50%) and posterior pericardiotomy (OR 0.35; 95% CI
0.18 to 0.67; I2 = 66%) were all found to be effective.
Prophylactic intervention decreased the hospital length of stay by
approximately two-thirds of a day and decreased the cost of hospital
treatment by roughly $1250 US. Intervention was also found to reduce the
odds of post-operative stroke, though this reduction did not reach
statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I2 =
0%). No significant effect on all-cause or cardiovascular mortality was
demonstrated. Authors' conclusions: Prophylaxis to prevent atrial
fibrillation after cardiac surgery with any of the studied pharmacological
or non-pharmacological interventions may be favored because of its
reduction in the rate of atrial fibrillation, decrease in the length of
stay and cost of hospital treatment and a possible decrease in the rate of
stroke. However, this review is limited by the quality of the available
data and heterogeneity between the included studies. Selection of
appropriate interventions may depend on the individual patient situation
and should take into consideration adverse effects and the cost associated
with each approach. Copyright © 2013 The Cochrane Collaboration.

<22>
Accession Number
620519141
Author
Ashfaq A.; Soroya M.S.; Iyengar A.; Federman M.; Reemtsen B.L.
Institution
(Ashfaq, Soroya, Iyengar) David Geffen School of Medicine at UCLA, Los
Angeles, CA, United States
(Federman, Reemtsen) Mattel Children's Hospital, Los Angeles, CA, United
States
(Reemtsen) UCLA Division of Cardiac Surgery, David Geffen School of
Medicine at UCLA, Los Angeles, CA, United States
Title
Heparin-Coated Grafts Reduce Mortality in Pediatric Patients Receiving
Systemic-to-Pulmonary Shunts.
Source
Pediatric Cardiology. 39 (3) (pp 473-477), 2018. Date of Publication: 01
Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
We aimed to evaluate the outcomes of systemic-to-pulmonary (SP) shunt
procedures utilizing heparin-coated (HC) polytetrafluoroethylene (PTFE)
vascular grafts compared to uncoated (non-HC) grafts, in order to observe
any benefits in pediatric patients. Our institution switched from using
non-HC grafts to HC grafts in March 2011. We conducted a retrospective
review of consecutive pediatric patients receiving SP shunts from May 2008
to December 2015. Perioperative variables including baseline
characteristics, morbidity, mortality, and blood product utilization were
evaluated between the HC and non-HC groups. A total of 142 pediatric
patients received SP shunts during the study period: 69 patients received
HC shunts and 73 patients received non-HC shunts. The HC group had
significantly fewer desaturation or arrest events (P < 0.01), fewer shunt
occlusions/thromboses (P < 0.01). There was no statistically significant
difference in unplanned reoperations between groups (P = 0.18). The HC
group demonstrated significantly lower overall 30-day mortality (P <
0.01), as well as shunt-related mortality (P < 0.01). The HC group had
significantly lower postoperative packed red blood cell utilization as
compared to the non-HC group (P < 0.01). In this study, pediatric patients
receiving HC PTFE grafts in SP shunts demonstrated significantly lower
shunt-related mortality. The majority of HC grafts remained patent. These
findings suggest that HC grafts used in SP shunt procedures may benefit
pediatric patients in terms of efficacy and outcomes. Copyright ©
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<23>
Accession Number
620550659
Author
Ren B.; Spitzer E.; Geleijnse M.L.; Zijlstra F.; de Jaegere P.P.T.; Van
Mieghem N.M.; Tijssen J.G.
Institution
(Ren, Spitzer, Geleijnse, Zijlstra, de Jaegere, Van Mieghem) Department of
Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Right ventricular systolic function in patients undergoing transcatheter
aortic valve implantation: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 257 (pp 40-45), 2018. Date of
Publication: 15 Apr 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Right ventricular (RV) systolic dysfunction is associated with
worse survival in patients undergoing surgical aortic valve replacement
(SAVR), yet it is not included in traditional risk scores of transcatheter
aortic valve implantation (TAVI) candidates. We aimed to evaluate the
prognostic value of RV systolic function on clinical outcomes in patients
undergoing TAVI at one year follow-up; and, echocardiographic changes of
RV systolic function up to 12 months after TAVI and compared with SAVR
when possible. Methods and results: This systematic review and
meta-analysis is registered in PROSPERO (CRD42017065761). Studies
investigating RV systolic function with echocardiography in TAVI cohorts
were identified from Medline, Embase and Cochrane databases. We used
random-effects models to assess differences in primary outcomes.
Twenty-one studies were identified, where RV systolic function and
clinical outcomes were assessed in eight (4016 patients) and RV systolic
function changes were evaluated in 14 (1709 patients). For the primary
outcome of all-cause death at one year, RV systolic dysfunction was
associated with a significant 78% relative risk increase (risk ratio[95%
confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit
significant heterogeneity (I2 = 64%, P < 0.01). RV systolic
function was unchanged after TAVI throughout follow-up as shown with
tricuspid annular plane systolic excursion (TAPSE)(mean difference[95%
CI]pre-discharge = 0.03 [-0.92,0.99]mm,1-3 months =
-0.09[-0.89,0.71]mm,6-12 months = 0.52 [-0.29,1.32] mm, all P = NS), while
TAPSE was significantly reduced after SAVR (pre-discharge =
-10.17[-13.11,-7.24]mm, P < 0.01;1-3 months = -7.3[-8.17,-6.44]mm, P <
0.01;6-12 months = -5.99[-7.95,-4.03]mm, P < 0.01). Conclusions: RV
systolic dysfunction was associated with a significant increase in
all-cause mortality at one year after TAVI. RV systolic function was
unchanged after TAVI up to 12 months, whereas deteriorated significantly
after SAVR. Copyright © 2018 Elsevier B.V.

<24>
Accession Number
620127219
Author
Tan W.; Zhang C.; Liu J.; Li X.; Chen Y.; Miao Q.
Institution
(Tan, Zhang, Liu, Li, Chen, Miao) Department of Cardiac Surgery, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing 100730, China
Title
Remote Ischemic Preconditioning has a Cardioprotective Effect in Children
in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled
Trials.
Source
Pediatric Cardiology. 39 (3) (pp 617-626), 2018. Date of Publication: 01
Mar 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
In this updated meta-analysis, we assessed the cardioprotective effect of
remote ischemic preconditioning (RIPC) in pediatric patients undergoing
congenital heart surgery. A total of 9 randomized controlled trials (RCTs)
involving 793 pediatric patients under 18 years old were identified. RIPC
obviously reduced the release of troponin I at 6 h after surgery [standard
mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04;
p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI
-0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to
-0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95%
CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care
unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our
meta-analysis determined that RIPC had cardioprotective effects in the
early postoperative phase. Additional RCTs focused on the cardiac benefits
from RIPC in pediatric patients are warranted. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<25>
Accession Number
620974034
Author
Ghorbanlo M.; Mohaghegh M.R.; Yazdanian F.; Mesbah M.; Totonchi Z.
Institution
(Ghorbanlo, Mesbah) Hasheminejad Kidey Center, School of Medicine, Iran
University of Medical Sciences, Tehran, Iran
(Mohaghegh) Anesthesia and Critical Care Department, Hasheminejad Kidey
Center, School of Medicine, Iran University of Medical Sciences, Tehran,
Iran
(Yazdanian, Totonchi) Rajaie Cardiovascular Medical & Research Center,
Iran University of Medical Sciences, Tehran, Iran
Title
A Comparison Between the Hemodynamic Effects of Cisatracurium and
Atracurium in Patient with Low Function of Left Ventricle who are
Candidate for Open Heart Surgery.
Source
Medical archives (Sarajevo, Bosnia and Herzegovina). 70 (4) (pp 265-268),
2016. Date of Publication: 27 Jul 2016.
Abstract
BACKGROUND: The need for muscle relaxants in general anesthesia in
different surgeries including cardiac surgeries, and the type of relaxant
to be used considering its different hemodynamic effects on patients with
heart disease can be of considerable importance. In this study, the
hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium
in patients whit low function of left ventricle who are candidate for open
heart surgery have been considered.
METHOD: This study has been designed as a randomized prospective
double-blind clinical trial. The target population included all adult
patients with heart disease whose ejection fraction reported by
echocardiography or cardiac catheterization was 35% or less before the
surgery, and were candidate for open heart surgery in Shahid Rajaei Heart
Center. Taking into account the inclusion and exclusion criteria, the
patients were randomly placed in two groups of 30 people each. In the
induction stage, all the patients received midazolam, etomidate, and one
of the considered muscle relaxant, either 0.2 mg/kg of cisatracurium or
0.5mg/kg of Atracurium within one minute. In the maintenance stage of
anesthesia, the patients were administered by infusion of midazolam,
sufentanil and the same muscle relaxant used in the induction stage. The
hemodynamic indexes were recorded and evaluated in different stages of
anesthesia and surgery as well as prior to transfer to ICU.
RESULTS: In regard with descriptive indexes (age and sex distributions,
premedication with cardiac drugs, ejection fraction before surgery, basic
disease) there was no statistically significant difference between the
groups.
CONCLUSIONS: The significant difference of hemodynamic indexes between the
two groups of this study, and the need for hemodynamic stability in all
stages of surgery for patients with low function of left ventricle who are
candidate for open heart surgery, proves that administering Cisatracurium
as the muscle relaxant is advantageous and better.

<26>
Accession Number
620888939
Author
Cantoni V.; Sollini M.; Green R.; Berchiolli R.; Lazzeri E.; Mannarino T.;
Acampa W.; Erba P.A.
Institution
(Cantoni, Green, Mannarino, Acampa) Department of Advanced Biomedical
Sciences, University Federico II, Naples, Italy
(Sollini) Department of Biomedical Sciences, Humanitas University, Pieve
Emanuele, Milan, Italy
(Berchiolli) Vascular Surgery, Department of Translational Research and
Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
(Lazzeri, Erba) Department of Translational Research and Advanced
Technologies in Medicine, Regional Center of Nuclear Medicine, University
of Pisa, Pisa, Italy
(Acampa) Institute of Biostructure and Bioimaging, National Council of
Research, Naples, Italy
Title
Comprehensive meta-analysis on [18F] FDG PET/CT and
radiolabelled leukocyte SPECT-SPECT/CT imaging in infectious endocarditis
and cardiovascular implantable electronic device infections.
Source
Clinical and Translational Imaging. 6 (1) (pp 3-18), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Background: The use of medical imaging has significantly increased over
the past decade in all fields of medicine according to the advances in
imaging technology. Cardiac infection represents an emblematic example
where the use of nuclear molecular techniques is evolving as an important
supplementary method for patients with suspected infection and diagnostic
difficulties. Positron emission computed tomography (PET/CT) using
fluor-18-fluorodeoxyglucose ([18F]FDG) and single-photon emission computed
tomography (SPECT) using radiolabeled leukocyte (WBC) have been widely
used in the diagnosis of infections. The aim of the present work is to
provide a systematic review and meta-analysis of the published data on the
use of hybrid nuclear medicine imaging [18F]FDG PET/CT and radiolabeled
leukocyte SPECT in the diagnostic workup of patients with IE and CIED
infection. Materials and methods: An English literature search was
performed using the PubMed, Cochrane and Web of Science databases to
identify articles. Studies were included if they assessed the diagnostic
accuracy of [18F]FDG PET/CT and SPECT or SPECT/CT WBC in the diagnosis of
possible infection, provided detailed criteria of a reference standard for
diagnosis of infection, and provided sufficient data to determine
sensitivity and specificity of [18F]FDG PET/CT and WBC SPECT-SPECT/CT. A
first analysis was performed considering IE as endpoint and compared
[18F]FDG PET/CT and WBC SPECT-SPECT/CT imaging. A second analysis
considered CIED as endpoint was performed only on [18F]FDG PET imaging
without a comparison with SPECT-SPECT/CT. Two additional analysis were
performed, including (i) the sub-analysis of the manuscripts dealing with
IE that were evaluated considering separately the ones dealing with NVE
and PVE, (ii) the sub-analysis of the manuscripts for IE and CIED where
patients underwent a specific preparation before undergoing [18F]FDG
PET/CT scan. Results: The IE group included 14 [18F]FDG PET/CT and 3
SPECT/CT studies, while the CIED infection set comprised 13 [18F]FDG
PET/CT and 1 SPECT/CT. For the subsequent sub-analysis within the group of
IE studies, we included seven studies for NVE (all the ones with < 50%
patients with native valve) and 11 studies for PVE (all patients with
prosthetic valve or with > 50% patients with prosthetic valve). The
sub-analysis, considering preparation protocols before [18F]FDG PET/CT
scan, included 17 studies. [18F]FDG PET/CT had good specificity (89%) and
lower sensitivity (71%), with high heterogeneity amongst studies. In the
sub-analysis of 18 manuscripts dealing with NVE and PVE, sensitivity and
specificity for NVE are 71 and 97%, respectively, while for PVE
sensitivity and specificity were 83 and 92%. For WBC SPECT/CT, we found an
overall sensitivity of 80% and specificity of 100%, even in the early
post-intervention phase. When proper patients' preparation is performed,
sensitivity increased from 72 to 76% and specificity from 86 to 90%.
Conclusions: [18F]FDG PET/CT and WBC SPECT/CT are useful for the diagnosis
of IE and CIED infection. WBC SPECT-SPECT/CT appears to be slightly more
specific than [18F]FDG PET/CT. On the other hand, [18F]FDG PET/CT has the
advantage of being faster and very sensitive, with the great potential to
allow an overall evaluation of the burden of the disease including
clinically relevant extra-cardiac foci of infection, leading to timely and
appropriate patients' management. Copyright © 2018, Italian
Association of Nuclear Medicine and Molecular Imaging.

<27>
Accession Number
620965240
Author
Yao Y.; Shen H.; Zhou Y.; Yang Z.; Huang H.
Institution
(Yao, Shen, Zhou, Yang, Huang) Department of Thoracic Surgery, Ningbo No.
2 Hospital, Haishu, Ningbo, Zhejiang 315000, China
Title
Efficacy of thoracoscopic surgery in the treatment of lung cancer in the
perioperative period and its effects on serum D-dimer.
Source
Oncology Letters. 15 (4) (pp 4397-4403), 2018. Date of Publication: April
2018.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The aim of this study was to investigate the feasibility and safety of
thoracoscopic surgery in the treatment of lung cancer and its effect on
serum D-dimer. A total of 218 patients with lung cancer treated in the
Department of Thoracic Surgery of Ningbo No. 2 Hospital from January 1,
2013 to December 31, 2016, were retrospectively analyzed. Of the 218
patients, 120 patients underwent thoracotomy (thoracotomy group) and 98
patients underwent thoracoscopic surgery (thoracoscopy group). The
clinical efficacy in the perioperative period and serum D-dimer level were
compared between the two groups. In the present study, the intraoperative
blood loss, blood transfusion rate, postoperative hospital stay, thoracic
drainage time and volume in the thoracoscopy group were significantly
shorter or smaller than those in the thoracotomy group (P<0.05), but there
was no statistically significant difference in the average operation time
between the thoracoscopy and the thoracotomy group. The incidence rate
from moderate to severe pains in incisions after operation, the use rate
of analgesics and the average disappearance time of the pain in incisions
in the thoracoscopy were lower than those in the thoracotomy group
(P<0.05). The amount of serum D-dimer immediately after operation in the
thoracotomy group was significantly increased compared with that before
operation (P<0.05), but there was no significant increase in the
thoracoscopy group. At 24 h after operation, the serum D-dimer level in
the two groups was further increased (P<0.05), and the comparison between
the two groups showed that the levels of serum D-dimer in the thoracoscopy
group immediately and at 24 h after operation were significantly lower
than those in the thoracotomy group (P<0.05). The incidence rate of
postoperative complications in the thoracoscopy was lower than that in the
thoracotomy group, but the difference was not statistically significant.
Our results show that thoracoscopic surgery is feasible and safe in the
treatment of lung cancer. Compared with the thoracotomy group, the
intraoperative condition and postoperative recovery have obvious
advantages. The postoperative blood of patients is hypercoagulable and
D-dimer increased gradually after 24 h. The effect of thoracoscopic
surgery on serum D-dimer is relatively less effective. Copyright
© 2018, Spandidos Publications. All rights reserved.

<28>
Accession Number
617341487
Author
Tomoaki S.
Institution
(Tomoaki) Department of Cardiovascular Surgery, Shiga University of
Medical Science, Setatsukinowa, Otsu, Shiga 520-2192, Japan
Title
Optimal use of arterial grafts during current coronary artery bypass
surgery.
Source
Surgery Today. 48 (3) (pp 264-273), 2018. Date of Publication: 01 Mar
2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Multiple arterial grafting, including the use of the bilateral internal
thoracic arteries (ITAs), has strong benefits on patient clinical outcomes
after coronary artery bypass grafting (CABG) but is far from commonly
accepted at present. We reviewed the previous randomized and leading
observational studies and assembled an up-to-date profile on multiple
arterial grafting. Many of the previous trials successfully showed the
beneficial effects of arterial grafting after CABG. Although many of these
were retrospective studies, the data presented, mostly from world-famous
surgeons, show that multiple arterial grafting does have advantages with
regard to the long-term patient outcome without increasing rates of early
mortality or morbidity. However, it is true that some surgeons experience
a certain amount of stress when using multiple arterial conduits. Multiple
arterial reconstruction has a strong advantage for patients undergoing
CABG and is now a standard worldwide strategy. Surgeons nowadays need to
make efforts to master arterial conduit techniques properly to provide
state-of-the-art CABG to patients. Copyright © 2017, Springer
Japan KK.

<29>
Accession Number
616523419
Author
Sethi A.; Singbal Y.; Rastogi U.; Prasad V.S.
Institution
(Sethi, Rastogi) Department of Interventional Cardiology, Icahn School of
Medicine at Mount Sinai, NY, United States
(Singbal) Department of Cardiology, University of Queensland, Brisbane,
Australia
(Prasad) Department of Cardiology, Loma Linda University, CA, United
States
Title
Late Incomplete stent apposition is associated with late/very late stent
thrombosis: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (3) (pp 365-375),
2018. Date of Publication: 15 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: There is a lingering controversy in the current literature
about the impact of late incomplete stent apposition (LISA) on clinical
outcomes, especially stent thrombosis (ST). Therefore, we aimed to
synthesize the available evidence evaluating the association between LISA
and adverse clinical outcomes. Methods: We systematically searched
electronic databases for studies reporting clinical outcomes in patients
with and without LISA. Relevant study characteristics and clinical
outcomes were extracted. Incidence rate ratios (IRR) and 95% Confidence
Interval (CI) were computed. Sensitivity analyses were done. Results:
Sixteen studies with 4,946 patients; 666 patients with 20,035
patient-months follow up with LISA and 4,280 patients with 121,855
patient-months follow up without LISA were included. The estimated
prevalence of LISA at follow up was 16% (95% CI 12-20%). The incidences of
late/very late ST (IRR = 4.81, 95% CI 2.68-8.62) and myocardial infarction
(MI) (IRR = 3.09, 95% CI 1.72-5.55) were significantly higher in the LISA
group compared to patients without LISA. Subset analysis of studies
reporting Academic Research Consortium definitive/probable ST (IRR = 4.98;
95% CI 2.51-9.89) and acquired LISA (IRR = 3.67, 95% CI 1.5-9.0) similarly
showed increased risk of late/very late ST. The results of sensitivity
analyses were consistent. There was no difference in cardiac death and
target lesion revascularization. Conclusion: The presence of LISA at a
follow up of 6-18 months after stent implantation is associated with a
higher risk of late/very late ST and MI. Additional studies are required
to establish a cause and effect, and inform the management strategy.
© 2017 Wiley Periodicals, Inc. Copyright © 2017 Wiley
Periodicals, Inc.

<30>
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. Copyright
© 2018 The Authors.

<31>
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. Copyright © 2018

<32>
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. Copyright © 2017 AMDA -
The Society for Post-Acute and Long-Term Care Medicine

<33>
Accession Number
620645114
Author
Lewicki M.; Ng I.; Schneider A.G.
Institution
(Lewicki) Monash Medical Centre, Department of Nephrology, 246 Clayton
Road, Clayton, VIC 3168, Australia
(Lewicki) Monash University, Department of Medicine, Clayton, VIC,
Australia
(Lewicki, Ng, Schneider) Monash University, Department of Epidemiology and
Preventative Medicine, Clayton, VIC, Australia
(Ng) Royal Melbourne Hospital, Department of Anaesthesia, Parkville, VIC,
Australia
(Schneider) Hospitalo-Universitaire Vaudois (CHUV), Intensive Care Unit,
Lausanne, Switzerland
Title
HMG CoA reductase inhibitors (statins) for preventing acute kidney injury
after surgical procedures requiring cardiac bypass.
Source
Cochrane Database of Systematic Reviews. 2015 (3) (no pagination), 2015.
Article Number: CD010480. Date of Publication: 11 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Acute kidney injury (AKI) is common in patients undergoing
cardiac surgery among whom it is associated with poor outcomes, prolonged
hospital stays and increased mortality. Statin drugs can produce more than
one effect independent of their lipid lowering effect, and may improve
kidney injury through inhibition of postoperative inflammatory responses.
Objectives: This review aimed to look at the evidence supporting the
benefits of perioperative statins for AKI prevention in hospitalised
adults after surgery who require cardiac bypass. The main objectives were
to 1) determine whether use of statins was associated with preventing AKI
development; 2) determine whether use of statins was associated with
reductions in in-hospital mortality; 3) determine whether use of statins
was associated with reduced need for RRT; and 4) determine any adverse
effects associated with the use of statins. Search methods: We searched
the Cochrane Renal Group's Specialised Register to 13 January 2015 through
contact with the Trials' Search Co-ordinator using search terms relevant
to this review. Selection criteria: Randomised controlled trials (RCTs)
that compared administration of statin therapy with placebo or standard
clinical care in adult patients undergoing surgery requiring
cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need
for renal replacement therapy (RRT) as an outcome were eligible for
inclusion. All forms and dosages of statins in conjunction with any
duration of pre-operative therapy were considered for inclusion in this
review. Data collection and analysis: All authors extracted data
independently and assessments were cross-checked by a second author.
Likewise, assessment of study risk of bias was initially conducted by one
author and then by a second author to ensure accuracy. Disagreements were
arbitrated among authors until consensus was reached. Authors from two of
the included studies provided additional data surrounding post-operative
SCr as well as need for RRT. Meta-analyses were used to assess the
outcomes of AKI, SCr and mortality rate. Data for the outcomes of RRT and
adverse effects were not pooled. Adverse effects taken into account were
those reported by the authors of included studies. Main results: We
included seven studies (662 participants) in this review. All except one
study was assessed as being at high risk of bias. Three studies assessed
atorvastatin, three assessed simvastatin and one investigated
rosuvastatin. All studies collected data during the immediate
perioperative period only; data collection to hospital discharge and
postoperative biochemical data collection ranged from 24 hours to 7 days.
Overall, pre-operative statin treatment was not associated with a
reduction in postoperative AKI, need for RRT, or mortality. Only two
studies (195 participants) reported postoperative SCr level. In those
studies, patients allocated to receive statins had lower postoperative SCr
concentrations compared with those allocated to no drug treatment/placebo
(MD 21.2 mol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately
reported in only one study; no difference was found between the statin
group compared to placebo. Authors' conclusions: Analysis of currently
available data did not suggest that preoperative statin use is associated
with decreased incidence of AKI in adults after surgery who required
cardiac bypass. Although a significant reduction in SCr was seen
postoperatively in people treated with statins, this result was driven by
results from a single study, where SCr was considered as a secondary
outcome. The results of the meta-analysis should be interpreted with
caution; few studies were included in subgroup analyses, and significant
differences in methodology exist among the included studies. Large high
quality RCTs are required to establish the safety and efficacy of statins
to prevent AKI after cardiac surgery. Copyright © 2015 The
Cochrane Collaboration.

<34>
Accession Number
620559616
Author
Pedersen T.; Nicholson A.; Hovhannisyan K.; Moller A.M.; Smith A.F.; Lewis
S.R.
Institution
(Pedersen) Head and Orthopaedic Center, University of Copenhagen
Rigshospitalet, HOC 2101 Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Nicholson) University of Liverpool, Liverpool Reviews and Implementation
Group, Second Floor, Whelan Build., The Quadrangle, Brownlow Hill,
Liverpool L69 3GB, United Kingdom
(Hovhannisyan) University of Copenhagen Rigshospitalet, The Cochrane
Anaesthesia Review Group, Blegdamsvej 9, Afsnit 5211, rum 1204, Copenhagen
2100, Denmark
(Moller) University of Copenhagen Herlev Hospital Rigshospitalet, The
Cochrane Anaesthesia Review Group, Department of Anaesthesiology, Herlev
Ringvej, Herlev 2730, Denmark
(Smith) Royal Lancaster Infirmary, Department of Anaesthetics, Ashton
Road, Lancaster, Lancashire LA1 4RP, United Kingdom
(Lewis) Royal Lancaster Infirmary, Pointer Court 1, Ashton Road, Lancaster
LA1 1RP, United Kingdom
Title
Pulse oximetry for perioperative monitoring.
Source
Cochrane Database of Systematic Reviews. 2014 (3) (no pagination), 2014.
Article Number: CD002013. Date of Publication: 17 Mar 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a review last published in Issue 9, 2009,
of The Cochrane Library. Pulse oximetry is used extensively in the
perioperative period and might improve patient outcomes by enabling early
diagnosis and, consequently, correction of perioperative events that might
cause postoperative complications or even death. Only a few randomized
clinical trials of pulse oximetry during anaesthesia and in the recovery
room have been performed that describe perioperative hypoxaemic events,
postoperative cardiopulmonary complications and cognitive dysfunction.
Objectives: To study the use of perioperative monitoring with pulse
oximetry to clearly identify adverse outcomes that might be prevented or
improved by its use. The following hypotheses were tested. 1. Use of pulse
oximetry is associated with improvement in the detection and treatment of
hypoxaemia. 2. Early detection and treatment of hypoxaemia reduce
morbidity and mortality in the perioperative period. 3. Use of pulse
oximetry per se reduces morbidity and mortality in the perioperative
period. 4. Use of pulse oximetry reduces unplanned respiratory admissions
to the intensive care unit (ICU), decreases the length of ICU readmission
or both. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) (2013, Issue 5), MEDLINE (1966 to June 2013),
EMBASE (1980 to June 2013), CINAHL (1982 to June 2013), ISI Web of Science
(1956 to June 2013), LILACS (1982 to June 2013) and databases of ongoing
trials; we also checked the reference lists of trials and review articles.
The original search was performed in January 2005, and a previous update
was performed in May 2009. Selection criteria: We included all controlled
trials that randomly assigned participants to pulse oximetry or no pulse
oximetry during the perioperative period. Data collection and analysis:
Two review authors independently assessed data in relation to events
detectable by pulse oximetry, any serious complications that occurred
during anaesthesia or in the postoperative period and intraoperative or
postoperative mortality. Main results: The last update of the review
identified five eligible studies. The updated search found one study that
is awaiting assessment but no additional eligible studies. We considered
studies with data from a total of 22,992 participants that were eligible
for analysis. These studies gave insufficient detail on the methods used
for randomization and allocation concealment. It was impossible for study
personnel to be blinded to participant allocation in the study, as they
needed to be able to respond to oximetry readings. Appropriate steps were
taken to minimize detection bias for hypoxaemia and complication outcomes.
Results indicated that hypoxaemia was reduced in the pulse oximetry group,
both in the operating theatre and in the recovery room. During observation
in the recovery room, the incidence of hypoxaemia in the pulse oximetry
group was 1.5 to three times less. Postoperative cognitive function was
independent of perioperative monitoring with pulse oximetry. A single
study in general surgery showed that postoperative complications occurred
in 10% of participants in the oximetry group and in 9.4% of those in the
control group. No statistically significant differences in cardiovascular,
respiratory, neurological or infectious complications were detected in the
two groups. The duration of hospital stay was a median of five days in
both groups, and equal numbers of in-hospital deaths were reported in the
two groups. Continuous pulse oximetry has the potential to increase
vigilance and decrease pulmonary complications after cardiothoracic
surgery; however, routine continuous monitoring did not reduce transfer to
an ICU and did not decrease overall mortality. Authors' conclusions: These
studies confirmed that pulse oximetry can detect hypoxaemia and related
events. However, we found no evidence that pulse oximetry affects the
outcome of anaesthesia for patients. The conflicting subjective and
objective study results, despite an intense methodical collection of data
from a relatively large general surgery population, indicate that the
value of perioperative monitoring with pulse oximetry is questionable in
relation to improved reliable outcomes, effectiveness and efficiency.
Routine continuous pulse oximetry monitoring did not reduce transfer to
the ICU and did not decrease mortality, and it is unclear whether any real
benefit was derived from the application of this technology for patients
recovering from cardiothoracic surgery in a general care
area. Copyright © 2014 The Cochrane Collaboration.

<35>
Accession Number
620615776
Author
Punjasawadwong Y.; Chau-in W.; Laopaiboon M.; Punjasawadwong S.
Institution
(Punjasawadwong) Chiang Mai University, Department of Anesthesiology,
Faculty of Medicine, Chiang Mai 50200, Thailand
(Chau-in) Faculty of Medicine, Khon Kaen University, Department of
Anesthesiology, 19-32 Chuabchuen Road, Khon Kaen, Thailand
(Laopaiboon) Khon Kaen University, Department of Biostatistics and
Demography, Faculty of Public Health, Khon Kaen 40002, Thailand
(Punjasawadwong) Faculty of Medicine, Chiang Mai University, Department of
Anesthesiology, Chiang Mai 50200, Thailand
Title
Processed electroencephalogram indices for amelioration of postoperative
delirium and cognitive dysfunction following non-cardiac and
non-neurosurgical procedures.
Source
Cochrane Database of Systematic Reviews. 2014 (8) (no pagination), 2014.
Article Number: CD011283. Date of Publication: 30 Aug 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess whether the use of processed EEG indices (BIS,
narcotrend index, CSI , SE and RE, PSI, SNAP II Index, IoC, AAI, and
AEP-index) as guides to anaesthetic delivery can reduce the risk of POCD
and POD in non-cardiac surgical or non-neurosurgical patients undergoing
general anaesthesia compared with standard practice where only clinical
signs are used. Copyright © 2014 The Cochrane Collaboration.

<36>
Accession Number
620615771
Author
Anderson L.; Taylor R.S.
Institution
(Anderson, Taylor) University of Exeter Medical School, Institute of
Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United
Kingdom
Title
Cardiac rehabilitation for people with heart disease: An overview of
Cochrane systematic reviews.
Source
Cochrane Database of Systematic Reviews. 2014 (8) (no pagination), 2014.
Article Number: CD011273. Date of Publication: 15 Aug 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: The primary aim of this overview is to summarise the
research question, methods and findings of the Cochrane reviews on cardiac
rehabilitation (CR) and to provide a 'friendly front end' to this
portfolio of reviews. In addition, we will aim to: Identify the
opportunities for merging and splitting across the reviews to inform the
direction of future Cochrane CR review updates; Identify key evidence gaps
across the reviews to inform de novo Cochrane CR reviews; and Identify
disparities in current reporting outputs and provide recommendations to
encourage uniformity of reporting of future trials and systematic
reviews. Copyright © 2014 The Cochrane Collaboration.

<37>
Accession Number
620615714
Author
Smith M.D.; Mccall J.; Plank L.; Herbison G.P.; Soop M.; Nygren J.
Institution
(Smith) Southland Hospital, Department of General Surgery, Kew Road,
Invercargill 9840, New Zealand
(Mccall) Dunedin School of Medicine, University of Otago, Department of
Surgical Sciences, PO Box 913, Dunedin 9054, New Zealand
(Plank) University of Auckland, Department of Surgery, Private Bag 92019,
Auckland 1142, New Zealand
(Herbison) Dunedin School of Medicine, University of Otago, Department of
Preventive and Social Medicine, PO Box 913, Dunedin 9054, New Zealand
(Soop) Salford Royal NHS Foundation Trust, Department of Surgery, Stott
Lane, Salford, United Kingdom
(Nygren) Institution of Clinical Sciences at Danderyds Hospital, Centre
for Gastrointestinal Disease, Ersta Hospital and Karolinska Institutet,
Stockholm, Sweden
Title
Preoperative carbohydrate treatment for enhancing recovery after elective
surgery.
Source
Cochrane Database of Systematic Reviews. 2014 (8) (no pagination), 2014.
Article Number: CD009161. Date of Publication: 14 Aug 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Preoperative carbohydrate treatments have been widely adopted
as part of enhanced recovery after surgery (ERAS) or fast-track surgery
protocols. Although fast-track surgery protocols have been widely
investigated and have been shown to be associated with improved
postoperative outcomes, some individual constituents of these protocols,
including preoperative carbohydrate treatment, have not been subject to
such robust analysis. Objectives: To assess the effects of preoperative
carbohydrate treatment, compared with placebo or preoperative fasting, on
postoperative recovery and insulin resistance in adult patients undergoing
elective surgery. Search methods: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (2014, Issue 3), MEDLINE (January
1946 to March 2014), EMBASE (January 1947 to March 2014), the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (January 1980 to
March 2014) and Web of Science (January 1900 to March 2014) databases. We
did not apply language restrictions in the literature search. We searched
reference lists of relevant articles and contacted known authors in the
field to identify unpublished data. Selection criteria: We included all
randomized controlled trials of preoperative carbohydrate treatment
compared with placebo or traditional preoperative fasting in adult study
participants undergoing elective surgery. Treatment groups needed to
receive at least 45 g of carbohydrates within four hours before surgery or
anaesthesia start time. Data collection and analysis: Data were abstracted
independently by at least two review authors, with discrepancies resolved
by consensus. Data were abstracted and documented pro forma and were
entered into RevMan 5.2 for analysis. Quality assessment was performed
independently by two review authors according to the standard
methodological procedures expected by The Cochrane Collaboration. When
available data were insufficient for quality assessment or data analysis,
trial authors were contacted to request needed information. We collected
trial data on complication rates and aspiration pneumonitis. Main results:
We included 27 trials involving 1976 participants Trials were conducted in
Europe, China, Brazil, Canada and New Zealand and involved patients
undergoing elective abdominal surgery (18), orthopaedic surgery (4),
cardiac surgery (4) and thyroidectomy (1). Twelve studies were limited to
participants with an American Society of Anaesthesiologists grade of I-II
or I-III. A total of 17 trials contained at least one domain judged to be
at high risk of bias, and only two studies were judged to be at low risk
of bias across all domains. Of greatest concern was the risk of bias
associated with inadequate blinding, as most of the outcomes assessed by
this review were subjective. Only six trials were judged to be at low risk
of bias because of blinding. In 19 trials including 1351 participants,
preoperative carbohydrate treatment was associated with shortened length
of hospital stay compared with placebo or fasting (by 0.30 days; 95%
confidence interval (CI) 0.56 to 0.04; very low-quality evidence). No
significant effect on length of stay was noted when preoperative
carbohydrate treatment was compared with placebo (14 trials including 867
participants; mean difference -0.13 days; 95% CI -0.38 to 0.12). Based on
two trials including 86 participants, preoperative carbohydrate treatment
was also associated with shortened time to passage of flatus when compared
with placebo or fasting (by 0.39 days; 95% CI 0.70 to 0.07), as well as
increased postoperative peripheral insulin sensitivity (three trials
including 41 participants; mean increase in glucose infusion rate measured
by hyperinsulinaemic euglycaemic clamp of 0.76 mg/kg/min; 95% CI 0.24 to
1.29; high-quality evidence). As reported by 14 trials involving 913
participants, preoperative carbohydrate treatment was not associated with
an increase or a decrease in the risk of postoperative complications
compared with placebo or fasting (risk ratio of complications 0.98, 95% CI
0.86 to 1.11; low-quality evidence). Aspiration pneumonitis was not
reported in any patients, regardless of treatment group allocation.
Authors' conclusions: Preoperative carbohydrate treatment was associated
with a small reduction in length of hospital stay when compared with
placebo or fasting in adult patients undergoing elective surgery. It was
found that preoperative carbohydrate treatment did not increase or
decrease postoperative complication rates when compared with placebo or
fasting. Lack of adequate blinding in many studies may have contributed to
observed treatment effects for these subjective outcomes, which are
subject to possible biases. Copyright © 2014 The Cochrane
Collaboration.

<38>
Accession Number
620563002
Author
Rees K.; Hartley L.; Flowers N.; Clarke A.; Hooper L.; Thorogood M.;
Stranges S.
Institution
(Rees, Hartley, Flowers, Clarke, Stranges) Warwick Medical School,
University of Warwick, Division of Health Sciences, Coventry CV4 7AL,
United Kingdom
(Hooper) University of East Anglia, Norwich Medical School, Norwich
Research Park, Norwich NR4 7TJ, United Kingdom
(Thorogood) Division of Health Sciences, Public Health and Epidemiology,
Warwick Medical School, University of Warwick, Gibbet Hill, Coventry CV4
7AL, United Kingdom
Title
'Mediterranean' dietary pattern for the primary prevention of
cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2013 (8) (no pagination), 2013.
Article Number: CD009825. Date of Publication: 12 Aug 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The Seven Countries study in the 1960s showed that populations
in the Mediterranean region experienced lower cardiovascular disease (CVD)
mortality probably as a result of different dietary patterns. Later
observational studies have confirmed the benefits of adherence to a
Mediterranean dietary pattern on CVD risk factors. Clinical trial evidence
is limited, and is mostly in secondary prevention. Objectives: To
determine the effectiveness of a Mediterranean dietary pattern for the
primary prevention of CVD. Search methods: We searched the following
electronic databases: the Cochrane Central Register of Controlled Trials
(CENTRAL, Issue 9 of 12, September 2012); MEDLINE (Ovid, 1946 to October
week 1 2012); EMBASE (Ovid, 1980 to 2012 week 41); ISI Web of Science
(1970 to 16 October 2012); Database of Abstracts of Reviews of Effects
(DARE), Health Technology Assessment Database and Health Economics
Evaluations Database (Issue 3 of 12, September 2012). We searched trial
registers and reference lists of reviews and applied no language
restrictions. Selection criteria: We selected randomised controlled trials
in healthy adults and adults at high risk of CVD. A Mediterranean dietary
pattern was defined as comprising at least two of the following
components: (1) high monounsaturated/saturated fat ratio, (2) low to
moderate red wine consumption, (3) high consumption of legumes, (4) high
consumption of grains and cereals, (5) high consumption of fruits and
vegetables, (6) low consumption of meat and meat products and increased
consumption of fish, and (7) moderate consumption of milk and dairy
products. The comparison group received either no intervention or minimal
intervention. Outcomes included clinical events and CVD risk factors. Data
collection and analysis: Two review authors independently extracted data
and contacted chief investigators to request additional relevant
information. Main results: We included 11 trials (15 papers) (52,044
participants randomised). Trials were heterogeneous in the participants
recruited, in the number of dietary components and follow-up periods.
Seven trials described the intervention as a Mediterranean diet. Clinical
events were reported in only one trial (Women's Health Initiative 48,835
postmenopausal women, intervention not described as a Mediterranean diet
but increased fruit and vegetable and cereal intake) where no
statistically significant effects of the intervention were seen on fatal
and non-fatal endpoints at eight years. Small reductions in total
cholesterol (-0.16 mmol/L, 95% confidence interval (CI) -0.26 to -0.06;
random-effects model) and low-density lipoprotein (LDL) cholesterol (-0.07
mmol/L, 95% CI -0.13 to -0.01) were seen with the intervention. Subgroup
analyses revealed statistically significant greater reductions in total
cholesterol in those trials describing the intervention as a Mediterranean
diet (-0.23 mmol/L, 95% CI -0.27 to -0.2) compared with control (-0.06
mmol/L, 95% CI -0.13 to 0.01). Heterogeneity precluded meta-analyses for
other outcomes. Reductions in blood pressure were seen in three of five
trials reporting this outcome. None of the trials reported adverse events.
Authors' conclusions: The limited evidence to date suggests some
favourable effects on cardiovascular risk factors. More comprehensive
interventions describing themselves as the Mediterranean diet may produce
more beneficial effects on lipid levels than those interventions with
fewer dietary components. More trials are needed to examine the impact of
heterogeneity of both participants and the intervention on
outcomes. Copyright © 2013 The Cochrane Collaboration.

<39>
Accession Number
620645154
Author
Vilela A.T.; Grande A.J.; Palma J.H.; Buffolo E.; Riera R.
Institution
(Vilela, Palma, Buffolo) Universidade Federal de Sao Paulo, Department of
Surgery, Rua Borges Lagoa, 977, ap 121, Vila Clementino, Sao Paulo
04038032, Brazil
(Grande, Riera) Centro de Estudos de Medicina Baseada em Evidencias e
Avaliacao Tecnologica em Saude, Brazilian Cochrane Centre, R. Borges
Lagoa, 564 cj 63, Sao Paulo 04038000, Brazil
Title
Transcatheter valve implantation versus aortic valve replacement for
aortic stenosis in high-risk patients.
Source
Cochrane Database of Systematic Reviews. 2013 (1) (no pagination), 2013.
Article Number: CD010304. Date of Publication: 31 Jan 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To assess the effectiveness and safety of TAVI compared
with aortic valve replacement in patients with severe aortic stenosis with
high-risk of death. Copyright © 2013 The Cochrane Collaboration.

<40>
Accession Number
620926083
Author
Spickermann T.; Hagl C.; Brenner P.; Pichlmaier M.; Dalla-Pozza R.; Haas
N.; Ulrich S.; Hakami L.
Institution
(Spickermann, Hagl, Brenner, Pichlmaier, Hakami) Department of Heart
Surgery, Hospital of the Ludwig-Maximilians-University (LMU) Munich,
Munich, Germany
(Dalla-Pozza, Haas, Ulrich) Department of Pediatric Cardiology, Hospital
of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
Title
ABO-incompatible Heart Transplantation (HTX) in infants and newborns could
decrease the death risk on waiting list: "A Meta-Analysis".
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Introduction: Due to an increasing waiting time for available donor organs
in pediatric heart transplantation (pHTx) ABO-incompatible HTx (HTxi) may
be a satisfying option and probably an unpreventable one. There is an
immunological window of tolerance during the human embryonic development
which persists into the time of infancy. It has the potential of
developing natural antibodies to ABO-antigens. This process plays a
significant role in ABOi organ transplantation and could maintain
long-term tolerance to a certain degree in the setting of HTxi. Methods:
This systematic review and meta-analyses aims at providing an overview of
the reported outcome of infants and small children with end stage heart
failure after undergoing a HTx. MEDLINE, Embase, PubMed, and Web of
Science were searched for original research studies. A systematic
literature search for publications reporting the outcome after pHTx
published between 2001 and 2017 was conducted. Studies written in English
with a study size of more than 10 patients were included. The primary
outcome was mortality at HTx-listing and one year after ABO-compatible HTx
(HTxc) or HTxi. Exploratory data analysis of four studies was analyzed.
Two types of model (FE model = fixed effect model, RE model = random
effect model) were represented. Primary outcome measure was all-cause
mortality or delisting on the HTx list. Results: Total mortality on HTx
list in all groups was: I2 = 89.9%, 95% CI = 64%, 99.3%. Delisted from HTx
list because of recovering or worsening of clinical status before HTx: I2
= 72.6%, 95% CI = 16.8%, 97.5%. HTxc: I2 = 99%, 95%CI = 97.3%, 99.8%. 43%
of the patients were transplanted HTxc in average with a 95% confidence
interval of 0.41, 0.45. HTxi showed: I2 = 99%, 95%CI = 99.1%, 99.9%. 12%
of the patients were transplanted with an HTxi with a 95% confidence
interval in average of 0.11, 0.14. 12 months survival after HTx was: I2 =
87.5%, 95%CI = 56.1%, 99.1%. 86% of the patients survived 12 months after
HTx in average with a 95% confidence interval of 0.84, 0.88. Conclusion:
HTxi is a good option with similar results compared with HTxc in infants.
It might avoid the long waiting time and minimizes the risk of death on
the waiting list. However, long-term results are yet to be determined, as
well as complications and risks. Aspects such as renal function,
bacterial-, viral- and fungalinfection, graft vasculopathy, the risk for
malignancy and chronic rejection after HTxi remain to be examined closely.

<41>
Accession Number
620926069
Author
Friedrich I.; Donovan J.; Kraiker P.; Fassbinder R.; Hauptmann K.E.;
Paraforos A.
Institution
(Friedrich, Donovan, Paraforos) Herz- und Thoraxchirurgie, Krankenhaus der
Barmherzigen Bruder, Trier, Germany
(Kraiker) Abt. fur Anasthesie und Intensivmedizin, Krankenhaus der
Barmherzigen Bruder, Trier, Germany
(Fassbinder) Abt. Radiologie, Krankenhaus der Barmherzigen Bruder, Trier,
Germany
(Hauptmann) Abt. f. Kardiologie, Krankenhaus der Barmherzigen Bruder,
Trier, Germany
Title
External stenting of vein grafts is safe and effective: Single-center
report from the multicenter randomized VEST III trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objective: Progressive saphenous vein graft (SVG) disease is still the
main limitation of the long term clinical outcome of CABG. External
stenting of vein grafts has the potential to reduce disease development
and progression over the long term. First studies in humans have optimized
the implantation technique and have shown its potential to significantly
mitigate intimal hyperplasia, reduce oscillatory shear stress and improve
SVG lumen uniformity 1 year after CABG. The VEST III trial is designed to
evaluate whether external SVG stenting inhibits disease progression
(intimal hyperplasia and lumen irregularities) 2 years after CABG. The
current interim study objective is to assess the early patency of stented
and non-stented SVGs 6 months after CABG. Methods: 35 CABG patients with
multi-vessel disease were enrolled in the VEST III trial at our hospital.
In addition to an internal mammary artery graft, each patient received one
external stent to a single SVG randomized to either the right or left
coronary territories while one or more non-stented SVG served as
control(s). Graft patency was confirmed at 6 months using CT angiography.
Results: A total of 35 patients (mean age 66.0 +/- 7.1 years, 97% males)
were enrolled in Trier between 10/2015 and 1/2017. External stent
deployment was successful in 100% of patients. All SVG were harvested in
an open manner. Baseline grafting parameters, such as host coronary artery
diameter and graft length, were similar between the stented and
non-stented groups. During surgery, transient time flow measurements and
pulsatility indices in the stented and non-stented groups were 36.1 +/-
14.8 and 2.0 +/- 0.8 and 37.42 +/- 15.2 and 2.3 +/- 1.3 respectively. Over
all MACCE rate was 14.3% during the reported study period (mean follow up
481 days, range 229-681 days). To date, 6 month CT angiography has been
completed for all 35 patients (100% followup). The total number of grafts
was 105 of which 103 are patent (98.1%). Early patency of LIMA grafts was
97% (34/35). Early patency of stented SVG to the right and left
territories were 100% (17/17) and 100% (18/18) respectively compared with
100% (18/18) and 94.4% (17/18) in the non-stented group Conclusion:
External stenting of SVG safe and adds no additional risk for midterm
patency. In the long-term follow-up of this trial, coronary angiography
with IVUS will be used to determine the efficacy of external stenting in
the reduction of intimal hyperplasia and vein graft degeneration.

<42>
Accession Number
620926046
Author
Diab M.; Tasar R.; Sponholz C.; Bauer M.; Lehmann T.; Farber G.;
Brunkhorst F.; Doenst T.
Institution
(Diab, Tasar, Farber) Klinik fur Herz- und Thoraxchirurgie,
Friedrich-Schiller-Universitat Jena, Jena, Germany
(Sponholz, Bauer) Department of Anesthesiology, Universitatsklinikum Jena,
Jena, Germany
(Lehmann) Department of Statistics and Biometry,
Friedrich-Schiller-Universitat Jena, Jena, Germany
(Brunkhorst, Doenst) Center for Clinical Studies,
Friedrich-Schiller-Universitat Jena, Jena, Germany
Title
Inflammatory and vasoactive mediator profiles during valvular surgery for
infective endocarditis versus noninfectious valvular heart disease.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: More than half of Infective endocarditis (IE) patients require
cardiac surgery which is associated with high mortality. One of the
leading causes of death in IE patients is postoperative multiple organ
dysfunction syndrome (MODS). The contamination of blood with bacteria and
cell debris during cardiac surgery might stimulate the release of
cytokines and vasoactive peptides leading to circulatory failure. Methods:
We planned a monocentric, prospective case-control diagnostic study
comparing two groups of patients undergoing cardiac surgery for IE or for
non-infectious valvular heart disease (VHD). We measured plasma profiles
of cytokines and vasoactive peptides at 7 defined time points in all
patients. We used sequential organ failure assessment (SOFA) score to
evaluate organ dysfunction. The study is registered in the German Register
of Clinical Studies, ID: NCT02727413. Results: Between May and December
2016 we included 20 patients in each group. Mean age was 65.1 +/- 9.9.
Both groups showed similar distribution of age and gender. Patients with
IE had a higher preoperative EuroSCORE II (18.6 +/- 17.4 versus 1.8 +/-
1.3), and SOFA score (6.9 +/- 2.6 vs 3.8 +/- 1.1, p < 0.001) than patients
in the control group. Preoperative pro-Adrenomedullin (proADM) was higher
in IE patients compared with control group (1.77 vs 0.59, p = 0.017).
Preoperative ProADM performed well in predicting mortality in patients
with IE (area under the curve for receiver operating characteristic was
0.747). Pro - atrial natriuretic peptide, IL-1-beta, IL- 6, IL-10, IL-18,
TNF-alpha and Endothelin-I were significantly higher in patients with IE
at different time points. The level of proADM, IL-6, IL-10, and TNF-alpha
dramatically increased during cardiopulmonary bypass in IE patients.
In-hospital mortality was higher in IE patients (35% vs. 5%; p < 0.001).
Incidence of postoperative organ dysfunction was higher in IE patients
(SOFA 9.3 +/- 3.2 vs. 6.6 +/- 1.6, p = 0.014). Conclusion: Our results
show that during endocarditis surgery plasma levels of cytokines and
vasoactive peptides are significantly higher compared with surgery for
non-endocarditis valvular disease. This difference is associated with
higher postoperative morbidity and mortality. This association sets the
stage for a prospective randomized study aiming at reducing intraoperative
cytokines and vasoactive peptides.

<43>
Accession Number
620925994
Author
Banerjee P.; Cuculi F.; Toggweiler S.; Kobza R.; Muller C.; Syburra T.;
Muller X.; Matt P.
Institution
(Banerjee, Muller, Syburra, Muller, Matt) Division of Cardiac Surgery,
Cantonal Hospital Lucerne, Lucerne, Switzerland
(Cuculi, Toggweiler, Kobza) Division of Cardiology, Cantonal Hospital
Lucerne, Lucerne, Switzerland
Title
Ticagrelor does not increase postoperative complications regarding
bleeding and the need for transfusions compared to clopidogrel or aspirin
in off-pump coronary artery bypass surgery.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objective: We hypothesized that patients treated with ticagrelor compared
with those treated with clopidogrel or aspirin before off-pump coronary
artery bypass surgery (OPCAB) are at increased risk of hemorrhagic
complications needing transfusions and are more likely to need surgical
reexploration. Method: Preoperative and postoperative clinical data were
collected prospectively of 548 consecutive patients treated preoperatively
with ticagrelor and aspirin (group T, n = 34), clopidogrel and aspirin
(group C, n = 127) or only aspirin (group A, n = 387) before undergoing
isolated OPCAB at our institution from 2010 to 2016. Results: Patient
demographics showed no significant differences among patient groups,
however more patients in the ticagrelor and the clopidogrel group
underwent urgent/emergent OPCAB compared with those under aspirin
treatment, 20% vs 16% vs 4% (p < 0.001). Chest tube drainage showed no
significant differences among patient groups 12 hours after OPCAB, 416ml
(group T) vs 491.7ml (group C) vs 453.9ml (group A), and a slight increase
in chest tube drainage 24 hours after surgery in those with clopidogrel
compared with those with ticagrelor, 778.1ml (group C) vs 622.1ml (group
T, p = 0.02), but not compared with aspirin 720.8 ml (group A).The number
of transfusions of red blood cells, platelets and fresh-frozen plasma were
significantly higher in the clopidogrel compared with the aspirin group (p
= 0.01), but there was no significant difference in those with ticagrelor
and aspirin only. No patient needed surgical reexploration for bleeding
complications among all three groups. In-hospital mortality was 0% (group
T), 2.3% (group C) and 0.8% (group A). Conclusion: Pretreatment with
ticagrelor, compared with clopidogrel or aspirin, in patients undergoing
OPCAB does not increase postoperative bleeding complications and the need
for platelet transfusions. Therefore, pretreatment with ticagrelor should
not be a reason to delay OPCAB surgery.

<44>
Accession Number
620925986
Author
Knipp S.C.; Holst T.; Rekowski J.; Bilbilis K.; Scherag A.; Diener H.C.;
Jakob H.; Weimar C.
Institution
(Knipp, Holst, Jakob) Department of Thoracic and Cardiovascular Surgery,
University Hospital Essen, West German Heart and Vascular Center, Essen,
Germany
(Rekowski) Institute for Medical Informatics, Biometry and Epidemiology,
University Hospital Essen, Essen, Germany
(Bilbilis) Center for Clinical Trials, University Hospital Essen, Essen,
Germany
(Scherag) Department of Clinical Epidemiology, Center for Sepsis Control
and Care, Jena University Hospital, Jena, Germany
(Diener, Weimar) Department of Neurology, University Hospital Essen,
Essen, Germany
Title
Randomized clinical trial on carotid endarterectomy in patients with
asymptomatic carotid artery stenosis undergoing Coronary Artery Bypass
Grafting (CABACS).
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The optimal strategy to manage patients with severe carotid
artery disease who require coronary artery bypass grafting (CABG) is
unknown. We sought to investigate the safety and efficacy of synchronous
combined carotid endarterectomy (CEA) and CABG as compared with isolated
CABG. Methods: The present trial was an investigator-initiated,
randomized, controlled, open, multi-center, group sequential trial
(CABACS). Patients were recruited from 12/2010 through 12/2014 in 17
tertiary care cardiovascular centers in Germany and the Czech Republic.
Patients with high-grade carotid artery stenosis >=80% according to ECST
ultrasound criteria (corresponding to >=70% NASCET) who required CABG
surgery were assigned to synchronous CEA+CABG or isolated CABG using a
web-based stratified block randomization (1:1, stratified by center, age <
60 versus >=60 years, sex, modified Rankin Scale Score 0-1 versus 2-3).
The primary composite endpoint was the rate of stroke or death at 30 days.
Results: Due to withdrawal of funding following insufficient recruitment,
enrollment was terminated early. At 30 days, the rate of stroke or death
from any cause in the intention-to-treat population was 12/65 (18.5%) in
patients receiving synchronous CEA+CABG as compared with 6/62 (9.7%) in
patients receiving isolated CABG (absolute risk reduction, 8.8%; 95%
confidence interval [CI], -3.2-20.8%; pWALD=0.12). Also for all secondary
endpoints at 30 days, there was no evidence for a treatment group effect
although patients undergoing isolated CABG tended to have better outcomes.
For instance, the composite rate of stroke, myocardial infarction or death
was 12 (18.5%) after CEA+CABG as compared with 7 (11.3%) after isolated
CABG (Hazard ratio [HR], 1.64; CI, 0.69-3.88; p = 0.32). At 1 year, there
were more strokes after synchronous CEA+CABG but the difference was not
significant (11 [18.3%] versus 4 [7.0%]; HR, 2.61; CI, 0.88-7.73; p =
0.10). Conclusions: Although our results cannot rule out a treatment group
effect due to lack of power, a superiority of the synchronous combined
CEA+CABG approach seems unlikely. Five-year follow-up of patients is
still.

<45>
Accession Number
620925981
Author
Nicolini F.; Reichart D.; Reichenspurner H.; Biancari F.
Institution
(Nicolini) University of Parma, Parma, Italy
(Reichart, Reichenspurner) University Heart Center, University of Hamburg,
Hamburg, Germany
(Biancari) Oulu University Hospital, Oulu, Finland
Title
Utility of glycated hemoglobin screening in patients undergoing elective
coronary artery surgery.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Background: Patients with increased glycated hemoglobin (HbA1c) seem to be
at increased risk of sternal wound infection (SWI) after coronary artery
bypass grafting (CABG). However, it is unclear whether increased baseline
HbA1c levels may also affect other postoperative outcomes. Methods: Data
on preoperative levels of HbA1c were collected from 2606 patients
undergoing elective isolated CABG from 2015 to 2016 and included in the
prospective, multicenter E-CABG registry. Results: The prevalence of HbA1c
>=53mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin
dependent diabetics 53.5% and among insulin dependent diabetics 67.1% (p <
0.001). The prevalence of HbA1c >75 mmol/mol (9.0%) among non-diabetics
was 0.5%, among non-insulin dependent diabetics 5.8% and among insulin
dependent diabetics 10.6% (p < 0.001). A baseline level of HbA1c
>=53mmol/mol (7.0%) was a significant predictor of SWI (10.7% vs 3.3%,
adjusted p-value < 0.001), deep SWI/mediastinitis (3.8% vs 1.3%, adjusted
pvalue 0.001) and acute kidney injury (27.4% vs 19.8%, adjusted p-value
0.042). In patients without history of diabetes, HbA1c >=53mmol/mol (7.0%)
was predictive of postoperative stroke (5.9% vs 0.8%, p < 0.001); in
patients with diabetes, HbA1c >=53mmol/mol (7.0%) was only predictive of
SWI (11.1% vs 4.8%, p = 0.001). Among patients undergoing single internal
mammary artery grafting, the rates of SWI (crude rates, HbA1c <
53mmol/mol: 2.4%; 53-75mmol/mol: 9.0%; > 75mmol/mol: 13.3%, adjusted
p-value < 0.001) as well as deep SWI/mediastinitis (crude rates, HbA1c <
53mmol/mol: 0.9%; 53-75mmol/mol: 3.2%; > 75mmol/mol: 5.0%, adjusted
p-value 0.016) increased significantly along with increasing HbA1c. Among
patients undergoing bilateral internal mammary artery grafting, the rates
of SWI (crude rates, HbA1c < 53mmol/mol: 4.1%; 53- 75mmol/mol: 9.6%;
>75mmol/mol: 17.1%, adjusted p-value 0.002) increased significantly along
with increasing HbA1c, whereas a trend was observed for deep
SWI/mediastinitis (crude rates, HbA1c < 53mmol/mol: 1.7%; 53-75mmol/mol:
3.3%; >75mmol/mol: 7.3%, adjusted p-value 0.170). Conclusions: Patients
with increased HbA1c levels are at higher risk of SWI, deep
SWI/mediastinitis and acute kidney injury. With increasing HbA1c values,
the rates of SWI and deep SWI/mediastinitis are increasing in patients
receiving single or bilateral internal mammary artery grafting. In
patients without history of diabetes, elevated HbA1c values were
predictive of postoperative stroke.

<46>
Accession Number
620925979
Author
Boeken U.; Keymel S.; Veulemans V.; Saeed D.; Lichtenberg A.; Kelm M.;
Westenfeld R.
Institution
(Boeken, Saeed, Lichtenberg) Kardiovaskulare Chirurgie, Uniklinik
Dusseldorf, Dusseldorf, Germany
(Keymel, Veulemans, Kelm, Westenfeld) Kardiologie, Pneumologie und
Angiologie, Uniklinik Dusseldorf, Dusseldorf, Germany
Title
Reduction of nephro- and neurotoxicity by usage of extended-release
calcineurin inhibition after heart transplantation.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Nephro- and Neurotoxicity as side effects of calcineurin
inhibitors (CI) determine morbidity and mortality of patients after heart
transplantation (HTX). Potential mechanisms of toxicity include high peak
plasma concentrations of CIs with intrarenal vasoconstriction. Tacrolimus
as common CI is available as standard-release tacrolimus (Tac) as well as
an extended-release tacrolimus (Tac-ER). It was our aim to analyze whether
application of the CI tacrolimus with extended release has beneficial
effects after HTX. Methods: Retrospective analyses of 20 patients with
regular follow-up after HTX. 10 patients received permanent therapy with
Tac. In 10 patients therapy with the CI was switched from Tac to Tac-ER.
Endpoints included renal function, variance of CI through level and
variance of the prescribed CI doses 3 visits before and after conversion
in comparison to patients with permanent Tac therapy, furthermore
occurrence of neurologic complications such as tremor or somnolence.
Results: Patient groups were comparable regarding interval after
transplantation and immunosuppressive regime. Renal function at conversion
was comparable between study groups (GFR Tac: 54 +/- 19; Tac-ER: 49 +/- 13
mL/min; p = 0.51). After conversion from Tac to Tac-ER an increasing
improvement of the glomerular filtration rate was observed (mean T1-T3: 46
+/- 16 vs. T6: 55 +/- 14 mL/min; p = 0.05). In the study group with
permanent Tac medication GFR remained unchanged. Therapy in both study
groups resulted in a stable immunosuppression as assessed by standard
deviation of intraindividual CI through levels. Following conversion to
Tac-ER, even somewhat lesser adaptions of the CI dose to obtain stable
immunosuppression were noted (4 vs. 7 in response to 60 through level
measurements; p = 0.26). Also, intraindividual deviation of the prescribed
CI dose was not increased during the therapy with Tac-ER (0.2 +/- 0.3 vs.
0.4 +/- 0.5 mg). No case of transplant rejection was observed. Regarding
neurologic outcome we observed by trend a reduction of episodes of tremor
or somnolence in patients after switch to Tac-Er. Conclusion: The results
from this small retrospective analysis indicate a promising trend for
reduced nephroand neurotoxicity in patients after heart transplantation
receiving the calcineurin inhibitor tacrolimus in extended-release form. A
conversion to extended-release tacrolimus is safe and feasible requiring
no more dose adaptions.

<47>
Accession Number
620925936
Author
Donovan T.J.; Friedrich I.; Sino S.; Greber N.
Institution
(Donovan, Friedrich, Sino, Greber) Klinik fur Herz- und Thoraxchirurgie,
Krankenhaus der Barmherzigen Bruder, Trier, Germany
Title
Sternal application of vancomycin greatly reduces the incidence of sternal
wound complications in patients undergoing cardiosurgical procedures.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Sternal dehiscence and deep sternal infections are serious and
debilitating complications of median sternotomy for cardiosurgical
procedures. The efficacy of vancomycin, used either systemically, locally
or in combination has been examined by various groups with differing
results. We therefore decided to compare patients in whom vancomycin paste
was applied to the sternum to a control group that did not receive
vancomycin. Methods: For this prospective, all-comer crossover study we
divided our surgical team into a verum and control group. During the first
phase, surgeons in the verum group applied a paste consisting of 4.5 g
vancomycin powder and 3-5 ml saline to the spongiosa of the divided
sternum before closure. In the control group, no vancomycin was used.
After 6 months, all surgeons were transferred to the verum group. Results:
During the first phase, performed between July 1st, 2015 and December 1st,
2015, cardiac surgery using sternotomy was performed in 184 patients in
the verum and 105 patients in the control cohort. The overall incidence of
sternal wound complications was 4.1% (n = 12). In the control group, the
complication rate was quite high at 10.5% (n = 11), compared with 0.5% in
the verum group (n = 1). Crossover of all surgeons from the control to the
verum group took place on January 1st, 2016. Following crossover, the
incidence of sternal wound complication for all patients (n = 1273)
dropped to 1.2% (n = 16) during a continuing observation period of more
than 18 months (p < 0.0001). Side effects were not observed. The cost of
treatment in Germany amounts to about six Euros/patient. The number needed
to treat is 34.5, which corresponds to a cost/prevented case of only 207
Euros. The average length of stay for patients with sternal wound
complications was 42 days, compared with 10 days for patients without
sternal complications. At a daily treatment cost of ~150 Euros, ~105,000
Euros in wound treatment costs have been saved through the use of
vancomycin at a total cost of ~7,750 Euros. The resultant savings since
2016 is ~97,250 Euros. Conclusion: Locally applied vancomycin appears to
be a safe and highly effective in reducing the incidence of sternal wound
complications following cardiac surgery. Given the encouraging results of
this preliminary study, a large-scale randomized follow-up trial should be
performed to confirm our findings.

<48>
Accession Number
620925929
Author
Useini D.; Haldenwang P.; Schlomicher M.; Taghiyev Z.; Moustafine V.;
Christ H.; Bechtel M.; Strauch J.
Institution
(Useini, Haldenwang, Schlomicher, Taghiyev, Moustafine, Bechtel, Strauch)
Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
(Christ) Uniklinik Koln, Cologne, Germany
Title
Mid-term outcome of TA-TAVI for aortic stenosis and porcelain aorta and a
systematic review: TF or TA-TAVI for aortic stenosis and porcelain aorta?.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Aim: The data relating to the outcome of the patients undergoing
transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS)
and porcelain aorta (PAo) are very scarce. We aimed to analyze, early and
mid-term outcome of the patients undergoing transapical-TAVI (TA-TAVI) at
our institution. Additionally, we postulated that the TA approach may be
associated with favorable neurological outcome, so we conduct a systematic
literature review comparing the transfemoral (TF) and TA approach in
patients with PAo. Methods: 15 inoperable patients (ES II 10.68%, STS
6.39%, age 73, male 86%) from 2011 to 2017 underwent TA-TAVI for sever AS
and PAo at our institution. The assessment of PAo was done either
intraoperatively after aborted sternotomy or via CT for elective TAVI.
According to VARC-2 definitions, device success, early safety, clinical
efficacy and time related valve safety were evaluated. Furthermore, a
systematic review of the main registries and studies was performed and the
TF and TA-TAVI approaches in terms of mortality and neurological outcome
were compared. Results: Peripheral vascular (73.3%) and coronary artery
disease (86.6%) were very frequent, 60% were Redos and 20% with
experienced stroke. Median follow up time was 16 months. In all patients,
TA-TAVI was performed with a rate of success 100%: P mean 8 +/- 4 mm Hg
with no PVL <= 2. 30-days mortality was 6.6%. No disabling stroke was
registered. No coronary ischemia was observed. 6 months/1 year/2 year
survival rate was 93%/ 82%/ 50% respectively. In the main registries and
studies the PAo occurs in the TAVI population with a high incidence (10.7%
in German TAVI Registry, 19% in PARTNER B cohort). Although the high
incidence of PAo, only The German and Canadian TAVI registries are
reporting of outcomes in patients with PAo. In Canadian registry (PAo
incidence 18%), stroke 3.0% in TF vs 1.7% in TA. The German Registry
results: Mortality, stroke and coronary ischemia rates significant higher
in patients with PAo (81.6% TF approach). A five-center study (Castrodeza
et al) results: 30 days mortality: 13.63% in TF vs 0% in TA. Stroke:
22.72% in TF vs 0% in TA. Conclusion: TA-TAVI can be performed with very
high success in patients with PAo. Very good early and midterm outcomes
can be achieved. The TF approach in patients with PAo is likely to be
associated with high mortality and stroke rates.

<49>
Accession Number
620925897
Author
Deppe A.C.; Weber C.; Mihaylova M.; Sonntag D.; Braun I.; Liakopoulos O.;
Choi Y.H.; Wahlers T.
Institution
(Deppe, Weber, Mihaylova, Sonntag, Braun, Liakopoulos, Choi, Wahlers)
Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Universitatsklinikum
Koln, Koln, Germany
Title
Impact of cytokine removal during cardiopulmonary bypass with cytosorb.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The surgical trauma and the use of the cardiopulmonary bypass
(CPB) induce a systematic inflammatory response (SIRS) which is associated
with increased morbidity and mortality. Therefore, strategies to reduce
the inflammatory response have a potential benefit for cardiac surgical
patients. The clinical benefit of reduced release of proinflammatory
cytokines such as IL-6, Il-8 and TNF-a with the use of a cytokine
adsorbing filter (Cytosorb) during CPB remains unclear. Therefore, this
prospective, observational pilot study was conducted to determine the
clinical impact of the use of a cytokine adsorbing filter during CPB.
Methods: In this prospective pilot study we randomly assigned patients
scheduled for elective on-pump coronary bypass surgery either to the
Control (n = 97) or to the Cytosorb group (n = 94) receiving Cytosorb
therapy during CPB. Inflammatory response (Il-6; Il-8; TNF-a) and clinical
flow-up (MACCE; kidney injury, length of ventilation, catecholamine
support, and stay) were analyzed. (NCT02213939). Results: Parameters of
inflammatory response to CPB (83.0 +/- 27.4 minute) were significantly
reduced in the Cytosorb group. Cytosorb therapy leads to shorter
catecholamine support (p = 0.015), ventilation (p < 0.001), and ICU stay
(p = 0.05). Trends in clinical endpoints without significance were seen in
a reduced infection rate (24% versus 33%; p = 0.194) and less wound
healing complications (4% versus 11%) in the Cytosorb compared with the
Control group. Conclusion: The use of Cytosorb during cardiopulmonary
bypass is not inferior to standard of care. The usage of the filter is
feasible and save. Cytosorb reduces cytokines and inflammatory response
compared with CPB. Trends in improved clinical recovery and reduced
incidences of infection is under further investigation.

<50>
Accession Number
620925841
Author
Becher M.; Sinning C.; Schrage B.; Fluschnik N.; Waldeyer C.; Seiffert M.;
Bernhardt A.; Reichenspurner H.; Blankenberg S.; Twerenbold R.; Westermann
D.
Institution
(Becher, Sinning, Schrage, Fluschnik, Waldeyer, Seiffert, Bernhardt,
Reichenspurner, Blankenberg, Twerenbold, Westermann) Universitares
Herzzentrum Hamburg, Hamburg, Germany
Title
Risk prediction in patients with venoarterial extracorporeal membrane
oxygenation for cardiopulmonary support: Insights from a european
nationwide registry.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Background: Venoarterial extracorporeal membrane oxygenation (va-ECMO) is
a common strategy for prolonged mechanical cardiopulmonary support despite
limited outcome data. The aim of this study was to analyze the incidence
of va-ECMO therapy as well as describe practice and outcome utilizing
complete nationwide data. Moreover, we defined mortality-based predictors
for va-ECMO treatment. Methods: We analyzed characteristics, complications
and 30-day outcomes of all va-ECMO procedures performed in Germany from
2007 to 2015. Multivariate regression analysis identified the following 14
predictor variables of in-hospital mortality: Age >65 years (y),
non-elective admission, atrial fibrillation, hypertension, hyperlipidemia,
pulmonary hypertension, liver disease, coronary artery disease, congestive
heart failure, acute coronary syndrome, sepsis, acute respiratory distress
syndrome (ARDS), prior cardiopulmonary resuscitation (CPR) and heart
transplantation. The ECMO-ACCEPTS-score was established using the 14
variables and internally validated in a 1:1 randomly selected derivation/
validation design. Results: A total of 9,258 va-ECMO procedures were
performed between 2007 and 2015 (61 +/- 17 years of age, male 70.1%). The
annual number of va-ECMO procedures steadily increased by more than
30-fold from 93 procedures in 2007 to 2,849 in 2015 with a large increase
in 2013. The overall 30-day in-hospital mortality was 58.6% and did not
significantly change over time. Strong predictors of 30-day in-hospital
mortality were age >65 years, CPR prior to va-ECMO and especially its
combination (mortality: no CPR/ <; 65y, 43.6%; no CPR/ <=65 years, 61.9%;
CPR/ <; 65y, 65.5%, CPR/<=65 years, 75.1%). The ECMO-ACCEPTS-score,
derived among randomly selected 4,629 patients, showed excellent
discrimination of 30-day in-hospital mortality in the validation cohort of
the remaining 4,629 patients. Conclusion: The incidence of va-ECMO
increased by more than factor 30 in Germany between 2007 and 2015, whereas
in-hospital mortality remained unaffected. Prior CPR and age >65 years are
critical factors for mortality of patients undergoing va-ECMO. The
ECMO-ACCEPTS-score may be a useful tool to improve early risk prediction
among candidates for va-ECMO to assist in restoring circulation.

<51>
Accession Number
620925831
Author
Jebran A.F.; Asch S.; Shekar S.; Bireta C.; Niehaus A.; Danner B.C.;
Baraki H.; Kutschka I.
Institution
(Jebran, Asch, Shekar, Bireta, Niehaus, Danner, Baraki, Kutschka)
Universitatsmedizin Gottingen, Gottingen, Germany
Title
Surgical treatment of native isolated pulmonary valve endocarditis: A
systematic review of the literature.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objective: Isolated pulmonary valve endocarditis (IPVE) is a rare clinical
entity among right-sided endocarditis. While antibiotic treatment is
recommended as a first line strategy, indication, timing and the technique
for the surgical approach is less clear. We took a case of IPVE at our
department as an incentive to perform a systematic review on the
indication, technique and outcome of surgical treatment for IPVE. Methods:
A systematic search for IPVE was performed on PubMed and Google Scholar
using the terms "pulmonary valve endocarditis," "pulmonic valve
endocarditis" and "right-sided endocarditis" for the time between 2009 and
2017. Only English papers reporting on native IPVE in the adult was
included. Patient characteristics, risk factors, etiopathogenesis and
treatment modalities were extracted and analyzed. Results: Systematic
literature review identified 194 reports. After excluding duplicates and
papers without fulltext access 29 papers reporting 34 cases could be
included. Most of the patients reported were male (66%), mean age was 49
+/- 17 years with a range of 19-82. Predisposing factors were undetected
congenital heart disease (VSD, ASD) (17%), intravenous drug abuse (17%),
and central venous catheter (11%). Staphylococci were detected in 38% of
the cases as the causative primary microorganisms. 62% of the patients
suffered from septic emboli to the lung. Mean duration between onset of
symptoms and diagnosis was 37 +/- 31 days, the interval between diagnosis
and surgery was 14 +/- 12 days. Clinical deterioration and embolic
complications were the main indications for surgery in 43% of the cases:
60% received surgical treatment and 40% remained on medical treatment.
Valve replacement was performed using bio prosthesis (12), homografts (2)
or mechanical prosthesis (1). The remaining patients received valve repair
with autologous pericardium (5) or valvectomy (1). Mortality was
significantly lower in the surgical group. Complication rate was
significantly higher in the medical group, whereas no adverse events were
reported after surgery early and in the mean follow-up time of 11 +/- 19
months. Conclusion: Isolated native pulmonary valve endocarditis is an
uncommon, therefore late diagnosed and yet potentially fatal entity.
Surgical treatment of native IPVE can be performed with good early and
mid-term results. Therefore, it should be considered early in the
treatment course, if medical treatment fails and the patient is in danger
of complications.

<52>
Accession Number
620925795
Author
Weber C.; Deppe A.C.; Esser M.; Eghbalzadeh K.; Djordjevic I.; Braun I.;
Gassa A.; Sabashnikov A.; Kuhn E.; Choi Y.H.; Madershahian N.; Liakopoulos
O.; Wahlers T.
Institution
(Weber, Deppe, Esser, Eghbalzadeh, Djordjevic, Braun, Gassa, Sabashnikov,
Kuhn, Choi, Madershahian, Liakopoulos, Wahlers) Uniklinik Koln, Koln,
Germany
Title
Levosimendan reduces mortality and postoperative acute kidney injury in
high-risk cardiac surgery patients: A meta-analysis of 3,130 patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 47th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2018.
Germany. 66 (Supplement 1) (no pagination), 2018. Date of Publication:
January 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The calcium sensitizer levosimendan increases cardiac
contractility without increasing intracellular calcium or oxygen
consumption and induces vasodilation. Levosimendan has already shown
favorable hemodynamic effects in patients with acute heart failure. In
this meta-analysis we aimed to determine the current evidence for
administration of levosimendan in high-risk patients undergoing cardiac
surgery. Methods: We performed a meta-analysis of randomized controlled
trials (RCT) and observational trials (OT) retrieved from a literature
search in PubMed, EMBASE and Cochrane Library. Only the trials comparing
the administration of levosimendan in cardiac surgery patients with a
control group (treated with another inotrope, standard of care or an
intra-aortic balloon pump (IABP)) were included. In addition at least one
clinical outcome had to be mentioned: Mortality, myocardial infarction,
low cardiac output syndrome, stroke, acute kidney injury, dialysis, atrial
fibrillation, prolonged inotropic support, length of ICU and hospital
stay. The pooled treatment effects (odds ratio (OR), 95%-confidence
intervals (95%-CI)) were assessed using a fixed or random effects model.
Results: The literature search retrieved a total of 35 trials (24 RCT, 10
OT, 1 pilot study) involving 3,130 cardiac surgery patients. Levosimendan
was administered in 1574 patients (50.3%) and 1556 patients (49.7%)
received the standard or control treatment. Patients treated with
levosimendan showed a significantly reduced mortality (OR: 0.68;
95%-CI:0.50-0.92; p = 0.01). Furthermore levosimendan seems to restore
adequate organ perfusion, as postoperative acute kidney injury was
significantly decreased in the levosimendan group (18%) compared with
control group (22%) (OR: 0.62; 95%-CI: 0.47-0.84; p = 0.002). However,
with regard to subgroup analysis no statistical differences were found
between the levosimendan group compared with IABP group due to small study
sizes. Compared with standard therapy levosimendan seems to be beneficial
in the following endpoints: Mortality, low cardiac output syndrome, acute
kidney injury, postoperative dialysis and prolonged inotropic support.
Conclusion: Current evidence from RCT and OT suggests beneficial effects
for the perioperative administration of levosimendan in high-risk patients
undergoing cardiac surgery.

<53>
Accession Number
620926463
Author
Lambert L.; Azzi L.; Desy F.; Vutcovici M.; Boothroyd L.; Briere A.;
Bogaty P.; De Guise M.
Title
Comprehensive evaluation of an evolving transcatheter technology.
Source
International Journal of Technology Assessment in Health Care. Conference:
14th Annual Meeting of the Health Technology Assessment International,
HTAi 2017. Italy. 33 (Supplement 1) (pp 148-149), 2017. Date of
Publication: 2017.
Publisher
Cambridge University Press
Abstract
INTRODUCTION: Our cardiovascular evaluation unit is mandated to evaluate
transcatheter aortic valve implantation (TAVI) in the province of Quebec.
In 2012, it was recommended that only patients at too high risk for
surgery receive TAVI. In partnership with our six hospital TAVI programs,
we have measured indicators of structure, process and outcomes since
2013.We are collaborating with multidisciplinary clinical experts to
update recommendations for optimal use. Herein, we present the evolving
portrait of TAVI in Quebec and identify priority issues. METHODS: Clinical
data were collected and analyzed for all TAVI performed from 1 April 2013
to 31 March 2016. Regular site feedback was provided. A systematic review
of recent guidelines and randomized trials facilitated the interpretation
of "real world" results and formulation of provincial quality standards.
RESULTS: Provincial TAVI volume increased from 294 in 2013-14 to 340 in
2014-15, and to 360 in 2015-16. Patient age and sex distribution remained
relatively constant over time (median age 83 years; 47 percent female).
However, the median predicted risk of operative mortality (STS score)
decreased in the latest period [6 percent (Interquartile Range, IQR: 4-9)
versus 7 percent (IQR: 4-9) versus 4 percent (IQR: 3-7)], suggesting TAVI
is increasingly being performed in lower-risk patients. Clinical
documentation and processes of care generally improved. Thirty-day
mortality decreased (6.1 percent versus 4.1 percent versus 2.8 percent).
The literature review identified two central issues: TAVI futility in
patients who are too sick and apparent non-inferiority of TAVI compared
with surgical valve replacement in medium-risk patients. CONCLUSIONS: Our
province-wide TAVI evaluation indicates improving processes and outcomes.
Patient selection remains the key in our universal healthcare system, with
the need to minimize futile and costly therapy and offer TAVI to those
most likely to benefit. Continued monitoring of clinical practice and
newly-established quality standards, in close collaboration with clinical
teams, remains essential to promote optimal use of this evolving
technology.

<54>
Accession Number
620925494
Author
Miao J.; Zhao Y.; Moon J.; Redman M.W.
Institution
(Miao, Zhao, Moon, Redman) SWOG Statistics and Data Management Center,
Fred Hutchinson Cancer Research Center, United Kingdom
Title
SWOG s1700: An institutional cluster-randomized trial of a surgical lymph
node specimen collection kit in the cooperative group setting.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background Approximately 60,000 patients annually undergo resection for
nonsmall cell lung cancer (NSCLC) in the US. Most of them will not achieve
long-term survivorship and the status of nodal involvement is the most
powerful determinant of prognosis. Accurate pathologic nodal staging
requires the combination of surgical dissection of the appropriate hilar
and mediastinal lymph nodes and thorough pathologic examination of lymph
modes present within the lung resection specimen. S1700 or SILENT
(Strategies to Improve Lymph Node Examination of Non-Small Cell Lung
Tumors), a trial proposed by SWOG, is designed to evaluate a lymph node
specimen collection kit. It is anticipated that this simple intervention
on how the surgeon does his/her lymph node sampling, will improve the
accuracy of pathologic nodal staging of resected lung cancer. It was
determined that a cluster randomized trial (CRT) design is necessary to
address this question. Conduct of a CRT is rarely done (to almost never)
in the Cooperative Groups within the US. Methods Institutions will be
randomized to implement the intervention versus usual care. Randomization
will be stratified by institution characteristics (3 factors:
institutional volume, thoracic surgery fellowship training program,
dedicated general thoracic surgeon present). In order to randomize all
institutions at the same time, a run-in phase will be implemented to allow
for sites to obtain institutional and regulatory approvals. In addition,
objectives of the run-in phase are to provide a more accurate assessment
of local accrual and preliminary estimates of outcomes. The primary
objective of this study is to compare the 3-year disease free survival
(DFS) among patients at institutions randomized to implement the
intervention to those randomized to usual care. The secondary objective is
to compare the frequency of patient up-staging (from cn0/1 to pn1/2/3)
following surgical resection among patients receiving intervention to
those receiving usual care. Given feasibility considerations, the planned
goal is to limit participation to 40 institutions (20 randomized to
implement the intervention and 20 to continue with usual care). Given
historical data, it is estimated that the intraclass correlation
coefficient is 0.01. Sample size calculations were based on Xie & Waksman.
(Stat Med. 2003 Sep 30;22(18):2835-46). Results The study design is based
on a design with 80% power to detect a 50% improvement in DFS (HR =0.67)
at the 1-sided 0.025 level. We assume uniform accrual and an average
accrual rate of 15 patients/site/year. Under independence, the total
sample would be 568. Accounting for within institution correlation, the
total accrual is 670 patients (an inflation of 18%), accrued over 2 years
with 3 years of follow-up. Discussion In an era of increasing costs for
cancer care, low-cost and relatively simple interventions such as the one
being evaluated in SILENT are very valuable. Careful consideration of
design and implementation can lead to a valuable resource and address an
important yet simple question.

<55>
Accession Number
620925420
Author
Edwards J.; Pike K.; Baos S.; Caputo M.; Rogers C.A.
Institution
(Edwards, Pike, Rogers) Clinical Trials and Evaluation Unit, School of
Clinical Sciences, University of Bristol, United Kingdom
(Baos) School of Social and Community Medicine, University of Bristol,
United Kingdom
(Caputo) Bristol Royal Hospital for Children, Division of Women and
Children, University Hospitals Bristol NHS Foundation Trust, United
Kingdom
Title
Concealing the randomised allocation in trials: Experience from the
thermic trials.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background In paediatric open-heart surgery body cooling during
cardiopulmonary bypass (CPB) is commonly used to help protect vital
organs. However, hypothermia can have detrimental effects. Thermic-1 was a
parallelgroup open randomised controlled trial which recruited 59 children
undergoing heart surgery between 2002 and 2004. Patients were randomised
to receive either hypothermic (28 degreeC) or normothermic (35 degreeC -37
degreeC) CPB. Thermic-2 followed on from Thermic-1, randomising 141
patients between 2012 and 2014. The co-primary outcomes included
intubation time and length of post-operative stay. Methods Randomisation:
The 10-year gap between phases saw changes in randomisation systems. In
Thermic-1 allocations were placed in opaque sequentially numbered sealed
envelopes, which were given to the clinical fellow managing the study.
Thermic-2 was managed by the clinical trials unit with allocation
determined by secure computerised system. Data capture: Data capture
processes also changed between the two phases. A clinical fellow collected
data on Excel spreadsheets in Thermic 1, whereas data were collected by
research nurses in Thermic-2 and then entered into a purpose-designed
database. Statistical analysis: Data from the two trials were pooled in
one overall analysis adjusted for study phase. Interaction terms were
added to the models to examine differences between trial phases. Results
Baseline characteristics: Imbalances in patient demographics were observed
in Thermic-1; participants allocated to the normothermic group were on
average 3 years older (median 7.5 years [IQR 3.5-10.6] vs 4.3 [2.2-11.5])
and more likely to be male (68% vs. 48%). In contrast, in Thermic-2 no
imbalance was observed; the median age was 2.3 years (0.5-5.2) in the
normothermic group vs 2.9 (0.5-6.0) and there were similar proportions of
males in the two groups (43% vs. 44%). Primary outcomes: Pooling the data
across both phases, intubation time was slightly shorter in the
normothermic group (median 10.6 hours [IQR 5.9-25.3] vs 16.4 [6.1-26.6]),
although this was not statistically significant (hazard ratio [HR] 1.14,
95% CI 0.86-1.51, p-value = 0.36). The median duration of post-operative
stay was 6.0 days in both groups (IQR 5.0-7.0); HR 1.06 (95% CI
0.80-1.40), p-value = 0.70. Examining the results by phase found no
difference in treatment estimates for intubation time. However a
significant difference between the two phases was found for length of stay
(p-value for interaction = 0.079). The estimated HR was 1.57 (95% CI
0.93-2.64) in Thermic-1, i.e. Marginally favouring the normothermic group,
compared to 0.90 (95% CI 0.65-1.26) in Thermic-2. Discussion The imbalance
in baseline characteristics suggests that Thermic-1 results are at high
risk of bias due to inadequate concealment of randomisation. Allocation
compliance was only collected in Thermic-2, so the true extent of
non-compliance could not be determined. Additionally, the differing
results for post-operative stay suggest the study was also at risk of
detection bias; the age and gender differences did not account for the
difference observed. While the decision to extubate is protocol driven,
the decision to discharge patients lies with the clinical team. The
results illustrate the importance of methodological rigour in the design
and conduct of clinical trials and provide a valuable example of the
importance of working with methodologists.

<56>
Accession Number
620925374
Author
Maishman R.; Reeves B.C.; Benedetto U.; Rogers C.A.
Institution
(Maishman, Reeves, Rogers) University of Bristol Clinical Trials and
Evaluation Unit, United Kingdom
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
Title
Variability in composite outcomes reported in cardiac surgery studies: A
literature review.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background Composite outcomes are often reported in randomised controlled
trials, particularly for safety endpoints. Use of a composite endpoint can
allow a study to provide information about safety when the rates of
component adverse events are low, but risks aggregating events that are
not affected by the intervention. We undertook a literature review to
explore the variability in composite outcomes used in cardiac surgery
studies, to inform the development of an objective measure of recovery.
Methods and results All published articles reporting at least one
short-term composite outcome assessed within three months of cardiac
surgery were identified. One hundred and fifty four papers were
identified, reporting 166 composite outcomes; 64 different adverse events
were included across the composite outcomes. Death was a component in the
majority of composites (135/166, 81%), as were cerebrovascular events
(105/166, 63%), myocardial infarction (MI) (81/166, 49%), renal
failure/acute kidney injury (AKI) (78/166, 47%) and
reoperation/revascularisation (42/166, 25%). Two "established" composite
outcomes were identified in the review, Major Adverse Cardiac Events
(MACE) and Major Adverse Cardiac and Cerebrovascular Events (MACCE), but
the definitions for both differed across studies. Assuming MACCE includes
death, cerebrovascular events, MI and reoperation/revascularisation,
16/166 composites included these four components; 12 of these 16 also
included other adverse events, suggesting that the currently used
composite outcomes are based on, but not restricted to, existing MACCE
definitions. Other adverse events that were commonly included together in
composite outcomes were renal failure and death/cerebrovascular event, and
prolonged ventilation and death/cerebrovascular event. The majority of
composite outcomes were binary outcomes (any event vs. none) that gave
equal importance to all components. Two studies investigated the relative
weighting assigned to adverse events in MACCE, both among patients and one
among trialists, and reported that respondents assigned different
weightings to each of the adverse events within the composite. Differences
between the weightings assigned by patients and clinical trialists were
also reported, with patients rating MI and stroke the same as or worse
than death, but trialists rating death as the most severe. Discussion This
review has highlighted the variability in the way composite outcomes for
cardiac surgery studies have been defined. The range of events included
supports the need for the development of a composite outcome including a
range of adverse events to give a more complete picture of recovery.
Furthermore, these findings support the need for composite outcomes to
incorporate weightings, particularly when adverse events differ in their
impact on patient recovery, and for the views of both patients and
clinicians to be considered when assessing the relative importance of
different adverse events if the composite outcome is intended to give an
overall assessment of recovery. Variation was seen in the definitions used
for some events (e.g. renal failure) across studies; there is a need for
consistent definitions to be agreed to aid synthesis of results from
different cardiac surgery studies in metaanalyses.

<57>
Accession Number
620925332
Author
Culliford L.; Brierley R.; Betts J.; Lamb J.; Maishman R.; Reeves B.;
Rogers C.
Institution
(Culliford, Brierley, Betts, Lamb, Maishman, Reeves, Rogers) University of
Bristol, United Kingdom
Title
Does appearance matter? A study within a study.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background A central tenet of recruitment to clinical studies is that
participants take part freely, armed with full information about the
study. There has been little research into how the appearance of the
information may affect recruitment. A study of Patient Information
Leaflets (PILs) concluded that PILs need 'to be well structured and
designed in an appealing manner'. These aspects have not yet gained
sufficient attention [1]. In the case of paper information leaflets,
production of a high quality attractive leaflet is possible, but may
require specialist software, and incur extra costs for colour printing.
Without the evidence of benefit, the additional resources may not be
justified. Methods To investigate if the appearance of pils affects
recruitment, we chose to embed a randomised controlled trial (RCT) within
the Outcome Monitoring After Cardiac Surgery (OMACS) study. OMACS uses
routine NHS data alongside participant questionnaires, and consent is
sought by post at 3 months post-surgery. OMACS was chosen as the 'host'
study as around 120 patients are approached for participation per month,
allowing evidence to be collected quickly. Participants are randomised to
receive one of 3 PILs: a tri-fold coloured leaflet produced using a
graphic design package, indesign, (PIL A), a coloured A4 sheet produced in
Microsoft Word (PIL B), and a standard A4 black and white sheet (PIL C).
Both coloured leaflets are printed professionally. The information
contained in each leaflet is identical and participants do not know about
the randomised element of OMACS. The sample size is 1590 which, assuming a
consent rate of 70% (based on a previous similar postal questionnaire
study that achieved this (personal communication)), will provide 90% power
to detect a 10% difference in consent rate between any pair of PIL
formats, with an overall significance level of 5%. Results After 5 months,
we have sent out 436 invitation letters and have 182 consented
participants. Consent rates for each PIL are: A-68/181 (38%) B-76/180
(42%) C-76/180 (42%) An unexpected finding is that consent rates are much
lower across the study than was anticipated. We are currently
investigating possible reasons for this. If the current trend continues we
will review the implications for the sample size and power of the study.
There are a number of differences between OMACS and the previous study
which may explain the difference in response rates. Previously, the timing
of the approach for consent is different (1 year versus 3 months) and
patient packs were simpler with fewer documents than used in the OMAC
study. In attempt to cater for participants' preferences, OMACS invites
participants to elect for alternative response methods (e.g. Postal versus
internet questionnaire) and also allows them to opt out of some aspects of
the study. The previous study did not include this diversity of options.
Conclusion At this early stage, no formal conclusions can be drawn as to
the effect of the appearance of the PIL. One year results with a formal
comparison between the rates of each group will be presented.

<58>
Accession Number
620925058
Author
Maishman R.; Reeves B.C.; Angelini G.D.; Rogers C.A.
Institution
(Maishman, Reeves, Rogers) University of Bristol Clinical Trials and
Evaluation Unit, United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, United Kingdom
Title
Patterns of adverse events after cardiac surgery.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background After cardiac surgery, post-operative adverse events are common
and many patients experience several events. Some are frequent and less
severe, others are rare but serious. Most trials are under-powered to
detect differences in specific adverse events and event rates are often
described but not formally compared. We have examined the timing and
ordering of adverse events to inform the development of a composite
objective measure of "recovery" for use in cardiac surgery trials. Methods
A cohort of 1102 patients having coronary artery bypass grafting in four
trials was assembled. Data on 11 adverse events, recorded consistently
across trials, were analysed. For each event, the timing was compared
between patients with and without other adverse events. For the subgroup
with multiple events, the timing of other events experienced relative to a
target event (before, on the same day as, or after the target event; each
event considered as the target in turn) was summarised. Sequential pattern
mining techniques were used to identify common sequences of events in
patients with at least two adverse events. Results Common adverse events
were supraventricular tachycardia/atrial fibrillation (SVT/AF) (341/1102,
31%) and suspected infections (312/1102, 28%); half of those with both
complications (62/124) had the SVT/AF prior to infection. Reoperation
occurred less frequently (56/1102, 5%), and typically occurred alongside
other events (44/56, 79%). Where reoperation and reintubation both
occurred, they typically happened on the same day whereas, when
reoperation and suspected infection both occurred, reoperation usually
preceded the infection. Trends were less apparent for rarer complications,
but patients who had both a myocardial infarction (MI) and SVT/AF (10/13
of those who had an MI) all had the MI first. Most events occurred early
during the post-operative stay, and timings were similar between patients
with one or multiple events. Exceptions to this were reoperation, which
happened later in patients with multiple events (although most
reoperations were still within one day of surgery) and gastrointestinal
complications (which tended to occur later in patients with multiple
events). Unlike other events, tracheostomy happened at any time during the
post-operative stay but, when this occurred, it was typically the final
event reported. Twelve frequently occurring "event sequences" were
identified, two of which included three events. 5% of patients with two or
more events had SVT/AF and suspected infections following a reoperation;
25% of patients who needed reoperation went on to have SVT/AF and
suspected infections. Also, suspected infections and reintubation were
followed by a tracheostomy in 6% of after. Discussion The collection of
comprehensive adverse event data across trials has allowed us to identify
temporal relationships between different events. Some patterns were
expected while others were less so. Some events are complications (e.g.
MI), while others represent actions taken as a result of complication(s)
occurring (e.g. Reoperation or reintubation). Working with clinicians, we
are using these observations to inform discussions about which events to
include in a composite outcome describing "post-operative course" and the
relative importance of events.

<59>
Accession Number
620925045
Author
Pike K.; Rogers C.A.; Murphy G.J.; Caputo M.; MacGowan A.; Reeves B.C.
Institution
(Pike, Rogers, Reeves) Clinical Trials and Evaluation Unit, University of
Bristol, United Kingdom
(Murphy) University of Leicester, United Kingdom
(Caputo) Bristol Royal Hospital for Children, United Kingdom
(MacGowan) Southmead Hospital, United Kingdom
Title
Use of instrumental variables within randomised controlled trials.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background Randomised controlled trials (RCTs) are widely considered the
gold standard study design for quantifying the effect of an intervention,
due to the minimal risk of bias from confounding. Some RCTs are designed
whereby subjects are randomised to different strategies, for example
differing criteria for red blood cell (RBC) transfusions to be given,
rather than specifically to an intervention or control treatment. In such
studies the groups should differ substantially overall in terms of the
intervention received (e.g. The average number of RBC units transfused),
but within each of the randomised groups there will be heterogeneity in
the intervention received. Such situations give an opportunity to estimate
across the RCT as a whole the effect of differing amounts of intervention
(i.e. An observational analysis within the RCT). The latter can be
estimated using instrumental variable (IV) techniques with randomised
allocation as an instrument, avoiding the problem of confounding (measured
or unmeasured) that is often a concern in observational analyses. Methods
We have used this approach in three RCTs. In the titre2 trial a liberal
RBC transfusion strategy after cardiac surgery was compared with a more
restrictive strategy, creating two groups with different risks of
transfusion and distributions of numbers of RBC units transfused. The
Thermic trials compared paediatric cardiac surgery performed at warmer
(normothermic) vs colder (hypothermic) temperatures, generating groups
with different average surgery temperatures. Finally, the RAPIDO trial
compared a rapid diagnostic pathway with the conventional method for
patients with blood stream infections, with the resultant groups differing
substantially in terms of the time until microbiological information is
returned from the laboratory. In addition to the primary
intention-to-treat (ITT) analyses an IV analysis was performed for each
trial, with randomised allocation as an instrument. Such models estimate
different effects to the ITT analyses, namely: each RBC unit transfused on
severe post-operative complication (titre2); each degree Celsius on
intubation duration (Thermic); each hour in the time to provision of
microbiological information on mortality (RAPIDO). Models were fitted in
Stata. For titre2 and RAPIDO IV poisson models for binary outcomes were
used. For Thermic an IV linear regression model was used. Results For
titre2 the ITT estimate of the odds ratio for allocation (liberal vs
restrictive) on post-operative severe complications was 0.87, 95%
confidence interval (CI) (0.72-1.05). The IV estimate of the relative risk
of each unit transfused on outcome was 0.89, 95% CI (0.75-1.06). In the
Thermic trials the geometric mean ratio (GMR) from the ITT analysis of the
effect of allocation (normothermic vs hypothermic) on intubation duration
was 0.77, 95% CI (0.57-1.04). The IV estimate of the GMR of each degree
Celsius was 0.95 (0.89, 1.02). Results from the RAPIDO trial are
forthcoming. Discussion Although the ITT and IV models are estimating
different effects we anticipated that the direction of effects would be
consistent, which was the case in the examples we considered. The use of
IV techniques to address secondary objectives in RCTs can be a useful tool
in certain settings, although such models are generally low powered.

<60>
Accession Number
620925018
Author
Culliford L.; Hopkins E.; Maishman R.; Reeves B.; Rogers C.
Institution
(Culliford, Maishman, Reeves, Rogers) University of Bristol, United
Kingdom
(Hopkins) University Hospitals Bristol NHS Trust, United Kingdom
Title
Collecting trial quality data about complications routinely: A study
within a study to maximize efficiency.
Source
Trials. Conference: 4th International Clinical Trials Methodology
Conference , ICTMC and the 38th Annual Meeting of the Society for Clinical
Trials. United Kingdom. 18 (Supplement 1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
BioMed Central Ltd.
Abstract
Background At our institution we are establishing a research nurse-led
programme to collect in-hospital complication data on all cardiac surgery
patients who provide consent. This initiative is part of a wider programme
of research to investigate associations between phenotypic and genotypic
characteristics with complications and speed of recovery after cardiac
surgery. Data will be extracted from participant's paper and electronic
medical notes and collated using a purpose-designed dedicated data
collection tool. Information can be obtained by either i) visiting the
ward daily, with the opportunity to talk to nurses involved in
participants' care, and recording events almost as they happen or ii)
extracting data after the patient has been discharged home. Nurses who
collect data for randomised trials believe that method i) takes longer but
method ii) results in events being missed. To investigate these beliefs we
are planning to randomise nurses (and patients) to collect the data either
by method i) or method ii). Methods Research nurses will be assigned a
random selection of patients and told the method of data collection to use
for each. All nurses will use both methods (for different patients) and
each patient will have their data collected by different nurses using the
different approaches. Patients and nurses will be assigned using a
balanced incomplete block design to ensure balance across the nurses and
by collection method. Each nurse will be blinded to the data collected by
another member of the team on the same patient. We propose to compare data
collected for completeness as well as the time taken to collect the data.
The study is planned to run over 2 months from December 2016 and will
capture data on 96 patients. 72 patients will be reviewed twice, once by
each method and 24 patients will be assessed 4 times, twice by each
method. Six nurses in the cardiac surgery team have agreed to take part.
Each nurse will undertake 40 reviews on 16 patients. Results and
Conclusion The study is ongoing. Full results will be presented at the
meeting. This research was funded by the National Institute for Health
Research Biomedical Research Unit in Cardiovascular Disease at the
University Hospitals Bristol NHS Foundation Trust and the University of
Bristol. Disclaimer This abstract presents independent research funded by
the National Institute for Health Research (NIHR). The views expressed are
those of the author(s) and not necessarily those of the NHS, the NIHR or
the Department of Health.

<61>
Accession Number
620804174
Author
Smit B.; Smulders Y.M.; van der Wouden J.C.; Oudemans-van Straaten H.M.;
Spoelstra-de Man A.M.E.
Institution
(Smit, Oudemans-van Straaten, Spoelstra-de Man) VU University Medical
Center, Department of Intensive Care, De Boelelaan 1117, Amsterdam MB
1007, Netherlands
(Smulders) VU University Medical Center, Department of Internal Medicine,
Amsterdam, Netherlands
(van der Wouden) VU University Medical Center, Department of General
Practice and Elderly Care Medicine, Amsterdam Public Health research
institute, Amsterdam, Netherlands
Title
Hemodynamic effects of acute hyperoxia: Systematic review and
meta-analysis.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 45. Date of
Publication: 25 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In clinical practice, oxygen is generally administered to
patients with the intention of increasing oxygen delivery. Supplemental
oxygen may, however, cause arterial hyperoxia, which is associated with
hemodynamic alterations. We performed a systematic review and
meta-analysis of the literature to determine the effect of hyperoxia on
central hemodynamics and oxygen delivery in healthy volunteers and
cardiovascular-compromised patients. Methods: PubMed and EMBASE were
searched up to March 2017. Studies with adult humans investigating changes
in central hemodynamics or oxygen delivery induced by acute normobaric
hyperoxia were included. Studies focusing on lung, retinal, or brain
parameters were not included. We extracted subject and oxygen exposure
characteristics, indexed and unindexed values for heart rate, stroke
volume, cardiac output, mean arterial pressure (MAP), systemic vascular
resistance, and oxygen delivery during normoxia and hyperoxia. For
quantitative synthesis of the data, a random-effects ratio of means (RoM)
model was used. Results: We identified 33 studies with 42 datasets. Study
categories included healthy volunteers (n = 22 datasets), patients with
coronary artery disease (CAD; n = 6), heart failure (HF; n = 6), coronary
artery bypass graft (CABG; n = 3) and sepsis (n = 5). Hyperoxia (arterial
oxygen tension of 234-617 mmHg) reduced cardiac output (CO) by 10-15% in
both healthy volunteers (-10.2%, 95% confidence interval (CI) -12.9% to
-7.3%) and CAD (-9.6%, 95% CI -12.3% to -6.9%) or HF patients (-15.2%, 95%
CI -21.7% to -8.2%). No significant changes in cardiac output were seen in
CABG or septic patients (-3%). Systemic vascular resistance increased
remarkably in patients with heart failure (24.6%, 95% CI 19.3% to 30.1%).
In healthy volunteers, and those with CAD and CABG, the effect was smaller
(11-16%) and was virtually absent in patients with sepsis (4.3%, 95% CI
-3.2% to 12.3%). No notable effect on MAP was found in any group (2-3%).
Oxygen delivery was not altered by hyperoxia. Considerable heterogeneity
existed between study results, likely due to methodological differences.
Conclusions: Hyperoxia may considerably decrease cardiac output and
increase systemic vascular resistance, but effects differ between patient
categories. Heart failure patients were the most sensitive while no
hemodynamic effects were seen in septic patients. There is currently no
evidence supporting the notion that oxygen supplementation increases
oxygen delivery. Copyright © 2018 The Author(s).

<62>
Accession Number
620892214
Author
Yousef A.; MacDonald Z.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Latib A.; Rodes-Cabau J.; Labinaz M.;
Hibbert B.
Institution
(Yousef, MacDonald, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Latib, Labinaz, Hibbert) CAPITAL Research Group, Division of Cardiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and
San Raffaele Scientific Institute, Milan, Italy
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Simard, Hibbert) Department of Cellular and Molecular Medicine,
University of Ottawa, Ottawa, ON, Canada
Title
Transcatheter aortic valve implantation (TAVI) for native aortic valve
regurgitation - A systematic review -.
Source
Circulation Journal. 82 (3) (pp 895-902), 2018. Date of Publication: 2018.
Publisher
Japanese Circulation Society
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
standard of care for management of high-risk patients with aortic
stenosis. Limited data is available regarding the performance of TAVI in
patients with native aortic valve regurgitation (NAVR). Methods and
Results: We performed a systematic review from 2002 to 2016. The primary
outcome was device success as per VARC-2 criteria. Secondary endpoints
included procedural complications, and 30-day and 1-year mortality rates.
A total of 175 patients were included from 31 studies. Device success was
reported in 86.3% of patients - with device failure driven by moderate
aortic regurgitation (AR >=3+) and/or need for a second device. Procedural
complications were rare, with no procedural deaths, myocardial infarctions
or annular ruptures reported. Procedural safety was acceptable with a low
30-day incidence of stroke (1.5%). The 30-day and 1-year overall mortality
rates were 9.6% and 20.0% (cardiovascular death, 3.8% and 10.1%,
respectively). Patients receiving 2nd-generation valves demonstrated
similar safety profiles with greater device success compared with
1st-generation valves (96.2% vs. 78.4%). This was driven by the higher
incidence of second-valve implantation (23.4% vs. 1.7%) and significant
paravalvular leak (8.3% vs. 0.0%). Conclusions: TAVI demonstrates
acceptable safety and efficacy in high-risk patients with severe NAVR.
Second-generation valves may afford a similar safety profile with improved
device success. Dedicated studies are needed to definitively establish the
efficacy of TAVI in this population. Copyright © 2018, Japanese
Circulation Society. All rights reserved.

<63>
Accession Number
620867720
Author
Gasser S.; Reichenspurner H.; Girdauskas E.
Institution
(Gasser, Reichenspurner, Girdauskas) Department of Cardiovascular Surgery,
University Heart Centre Hamburg, Martinistrasse 52, Hamburg 20251, Germany
Title
Genomic analysis in patients with myxomatous mitral valve prolapse:
Current state of knowledge.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 41. Date of Publication: 27 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Myxomatous mitral valve prolapse is a common cardiac
abnormality. Morbus Barlow is characterized by excess myxomatous leaflet
tissue, bileaflet prolapse or billowing, chordae elongation and annular
dilatation with or without calcification. Extensive myxoid degeneration
with destruction of the normal three-layered leaflet tissue architecture
is observed histologically in such patients. Autosomal dominant
inheritance with an age and sex-dependent expression has long been
recognised. This review explores the current understanding of the genetics
of bileaflet prolapse, with a focus on genetic analysis and the role for
echocardiographical screening of the first degree relatives of affected
patients. Methods: Systematic literature searches were performed using
PubMed and Embase up to September 2017. In Disse et al.'s study (study
one) first degree relatives of 25 patients with Morbus Barlow who
underwent mitral valve repair were screened for bileaflet valve prolapse.
In Nesta et al.'s study one family with three living generations of 43
individuals with 9 confirmed cases of MVP was screened. Genotyping was
performed in four families for 344 microsatellite markers from Chromosome
1 to 16. Results: In study one, autosomal dominant inheritance was shown
in four pedigrees. Genome-wide linkage analysis of the most informative
pedigree (24 individuals, three generations) showed a significant linkage
for markers mapping to chromosome 16p. Linkage to this locus was confirmed
in a second family within the same study, but was excluded in the
remaining two pedigrees. In study two an autosomal dominant locus was
mapped to chromosome 13. 8 of the 9 individuals affected were found to
suffer from bileaflet prolapse. Conclusions: Barlow's disease is a
heritable trait but the genetic causes remain largely elusive.
Ch16p11.2-p12.1 is the only locus proven to be associated with bileaflet
prolapse. Locus 13.q31.3-q32.1 was shown to cause bileaflet as well as
posterior leaflet prolapse. This review intends to make physicians aware
of genetic causes of myxomatous mitral valve prolapse, thereby emphasising
the importance of cardiological examination of first-degree relatives of
patients with Morbus Barlow. Integrated and more comprehensive studies are
needed for identification of genes involved in this heterogenic disease.
Further genomic studies may facilitate more individualised and accurate
risk assessment and may help to develop possible preventive stategies for
patients in the future. Copyright © 2018 The Author(s).

<64>
Accession Number
2000494126
Author
Khaitan P.G.; D'Amico T.A.
Institution
(Khaitan) Division of Thoracic Surgery, Department of General Surgery,
Georgetown University School of Medicine, Medstar Washington Hospital
Center, Washington, DC, United States
(D'Amico) Division of Thoracic Surgery, Department of Surgery, Duke
University Medical Center, Durham, NC, United States
Title
Milestones in thoracic surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To highlight some of the legendary figures in the medical field
who have paved the path of thoracic surgery today. Methods: We reviewed
historical articles and landmark studies published in anesthesiology,
pulmonology, and thoracic surgery, and summarized them as they pertain to
current practice. Results: Throughout our article, we have attempted to
chronologically depict how our field has evolved, starting from the
development of the stethoscope to reconstructing the esophagus using an
extracorporeal tube to minimally invasive complex surgeries that we
practice today. Conclusions: We hope that our article can inspire the
young minds to further grow the field and take it to higher
levels. Copyright © 2018 The American Association for Thoracic
Surgery

<65>
Accession Number
620932281
Author
Wee I.J.Y.; Stonier T.; Harrison M.; Choong A.M.T.L.
Institution
(Wee, Stonier, Harrison, Choong) SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Stonier) Princess Alexandra Hospital, Harlow, London, United Kingdom
(Harrison) Department of General Surgery, Sir Charles Gairdner Hospital,
Perth, Australia
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Title
Transcarotid transcatheter aortic valve implantation: A systematic review.
Source
Journal of Cardiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The carotid artery is a novel access route for transcatheter
aortic valve implantation (TAVI), especially useful in patients unsuitable
for traditional access routes including transfemoral (TF), subclavian,
transapical (TAp), and aortic (TAo). This systematic review summarizes the
evidence on TAVI via the carotid artery for its efficacy and safety.
Methods: A systematic review was conducted as per the Preferred Reporting
Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines
on three online databases: Medline (via Pubmed), SCOPUS, and Cochrane
Database. Results: There were 8 non-randomized controlled trials
identified comprising 650 patients in four TAVI vascular access sites:
transcarotid (TC) (N = 364), TF (N = 100), TAp (N = 151), TAo (N = 35).
The 30-day rates of mortality and neurological complications for TC TAVI
were 6.5% and 3.8%, respectively, with 1 incidence of myocardial
infarction. Other complications included vascular complications (7.7%),
insertion of new pacemaker (17.4%), atrial fibrillation (5.2%), and acute
kidney injury (6.9%), bleeding episodes (14.3%), of which 13 (3.6%) cases
were life-threatening; 5 (1.4%) were major; and 35 (9.3%) were minor
cases. Follow-up to 1 year showed 19 further deaths. There were no
significant differences in terms of mortality rates [risk ratio (RR) =
0.31, 95%CI 0.05-1.79; p = 0.19] and onset of dialysis treatment (RR =
2.53, 95%CI 0.31-19.78; p = 0.38) between the TC and TAp groups.
Conclusion: The available data on TC TAVI show comparable technical
feasibility with other traditional access routes, representing a viable
alternative. However, the paucity of data warrants the need for larger
randomized controlled trials to establish a firm conclusion. Copyright
© 2018 Japanese College of Cardiology.

<66>
Accession Number
620929942
Author
Brixner V.; Kiessling A.-H.; Madlener K.; Muller M.M.; Leibacher J.;
Dombos S.; Weber I.; Pfeiffer H.-U.; Geisen C.; Schmidt M.; Henschler R.;
North A.; Huang N.; Mufti N.; Erickson A.; Ernst C.; Rico S.; Benjamin
R.J.; Corash L.M.; Seifried E.
Institution
(Brixner, Muller, Leibacher, Dombos, Weber, Pfeiffer, Geisen, Schmidt,
Seifried) Institute for Transfusion Medicine and Immunohematology of
Johann Wolfgang Goethe University and German Red Cross Blood Donor
ServiceFrankfurt am MainGermany
(Kiessling) Department of Thoracic and Cardiovascular SurgeryJohann
Wolfgang Goethe University Hospital FrankfurtFrankfurt am MainGermany
(Madlener) Department of Haemostaseology and Transfusion
MedicineKerckhoff-KlinikBad NauheimGermany
(Henschler) Blood Center Zurich, Swiss Red Cross, SchlierenSwitzerland
(Henschler) Red Cross Blood Service GraubundenChurSwitzerland
(North, Huang, Mufti, Erickson, Ernst, Rico, Benjamin, Corash) Cerus
CorporationConcord, California
Title
Red blood cells treated with the amustaline (S-303) pathogen reduction
system: A transfusion study in cardiac surgery.
Source
Transfusion. (no pagination), 2018. Date of Publication: 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Nucleic acid-targeted pathogen inactivation technology using
amustaline (S-303) and glutathione (GSH) was developed to reduce the risk
of transfusion-transmitted infectious disease and transfusion-associated
graft-versus-host disease with red blood cell (RBC) transfusion. STUDY
DESIGN AND METHODS: A randomized, double-blind, controlled study was
performed to assess the in vitro characteristics of amustaline-treated
RBCs (test) compared with conventional (control) RBCs and to evaluate
safety and efficacy of transfusion during and after cardiac surgery. The
primary device efficacy endpoint was the postproduction hemoglobin (Hb)
content of RBCs. Exploratory clinical outcomes included renal and hepatic
failure, the 6-minute walk test (a surrogate for cardiopulmonary
function), adverse events (AEs), and the immune response to
amustaline-treated RBCs. RESULTS: A total of 774 RBC unis were produced.
Mean treatment difference in Hb content was -2.27 g/unit (95% confidence
interval, -2.61 to -1.92 g/unit), within the prespecified equivalence
margins (+/-5 g/unit) to declare noninferiority. Amustaline-treated RBCs
met European guidelines for Hb content, hematocrit, and hemolysis.
Fifty-one (25 test and 26 control) patients received study RBCs. There
were no significant differences in RBC usage or other clinical outcomes.
Observed AEs were within the spectrum expected for patients of similar age
undergoing cardiovascular surgery requiring RBCs transfusion. No patients
exhibited an immune response specific to amustaline-treated RBCs.
CONCLUSION: Amustaline-treated RBCs demonstrated equivalence to control
RBCs for Hb content, have appropriate characteristics for transfusion, and
were well tolerated when transfused in support of acute anemia. Renal
impairment was characterized as a potential efficacy endpoint for pivotal
studies of RBC transfusion in cardiac surgery. Copyright © 2018
AABB.

<67>
Accession Number
620922720
Author
Kodumuri V.; Balasubramanian S.; Vij A.; Siddamsetti S.; Sethi A.;
Khalafallah R.; Khosla S.
Institution
(Kodumuri, Balasubramanian, Vij, Siddamsetti) Division of Cardiology, John
H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
(Sethi) Department of Cardiology, Chicago Cardiology Institute,
Schaumberg, Illinois
(Khalafallah) Department of Biology, Loyola University Health System,
Maywood, Illinois
(Khosla) Department of Cardiology, Rosalind Franklin University of
Medicine and Sciences, North Chicago, Illinois
Title
A Meta-Analysis Comparing Percutaneous Coronary Intervention With
Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected
Left Main Disease.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) is the preferred revascularization
strategy for unprotected left main disease (UPLMD). Multiple small-scale
trials and registry data showed that percutaneous coronary intervention
(PCI) with drug-eluting stents (DES) is a noninferior strategy with a
Class IIa American College of Cardiology/American Heart Association
recommendation in patients with high surgical risk and favorable anatomy.
However, 2 recent large-scale randomized trials showed conflicting
evidence. We conducted a meta-analysis of the existing data to compare
outcomes of PCI with DES versus CABG for UPLMD. Four randomized and 8
nonrandomized trials involving 10,284 patients were included. Primary end
point was composite of death, stroke, or myocardial infarction (MI) at 3
years or longer. Secondary end points were MACCE (Major Adverse Cardiac
and Cerebrovascular Events) and its individual components (death, stroke,
MI, or repeat revascularization). Mantel-Haenszel random effects model was
used to calculate combined odds ratio for outcomes. A separate analysis of
randomized data was also performed. There was no significant difference in
primary composite outcome between PCI and CABG. However, MACCE was
significantly higher in PCI, primarily driven by significantly high repeat
revascularization. A subgroup analysis stratified by Synergy between PCI
with Taxus and Cardiac Surgery (SYNTAX) score showed that MACCE and repeat
revascularization were not significantly different between PCI and CABG in
low to intermediate SYNTAX score (<33), whereas they were significantly
higher in PCI with higher SYNTAX score. Thus, although CABG remains the
preferred method of treatment in UPLMD, PCI with DES can be considered as
a reasonable alternative in patients with favorable anatomy and high
surgical risk. Copyright © 2018 Elsevier Inc.

<68>
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. Copyright © 2018 Shoukry
and Sharaf.

<69>
Accession Number
620843382
Author
Riegger H.; Hollinger A.; Seifert B.; Toft K.; Blum A.; Zehnder T.;
Siegemund M.
Institution
(Riegger, Hollinger, Blum, Zehnder, Siegemund) University Hospital Basel,
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency
Medicine and Pain Therapy, Basel, Switzerland
(Seifert) University of Zurich, Epidemiology, Biostatistics and Prevention
Institute, Zurich, Switzerland
(Toft) See-Spital, Horgen and Kilchberg branches, Department for
Anesthesia, Intensive Care and Emergency Medicine, Horgen and Kilchberg,
Switzerland
Title
Baden Prevention and Reduction of Incidence of Postoperative Delirium
Trial (PRIDe): A phase IV multicenter, randomized, placebo-controlled,
double-blind clinical trial of ketamine versus haloperidol for prevention
of postoperative delirium.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 142. Date of
Publication: 26 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is a neurobehavioural syndrome that frequently
develops in the postoperative setting. The incidence of elderly patients
who develop delirium during hospital stay ranges from 10 to 80% (Schonauer
et al., J Pept Sci. 2017). Delirium was first described more than half a
century ago in the cardiac surgery population (Blachy and Starr, Am J
Psychiatry 121:371-5, 1964), where it was already discovered as a state
that might be accompanied by serious complications such as prolonged ICU
and hospital stay, reduced quality of life and increased mortality.
Furthermore, the duration of delirium is associated with worse long-term
cognitive function in the general ICU population (Sessler et al., Am J
Respir Crit Care Med 166:1338-44, 2002). This long-term experience with
delirium suggests a high socioeconomic burden and has been a focus of many
studies (Nishio et al., Crit Care Med 5:953-7, 1997; Ehlenbach et al.,
JAMA 303:763-70, 2010; Jahangir et al., World J Cardiol 3:383-7, 2011;
Abegunde et al., Lancet 370:1929-1938, 2007; Darmon et al., Intensive Care
Med 43:829-840, 2017; Marino et al., J Nephrol 28:717-24, 2015; Ng LL et
al., J Am Coll Cardiol 69:56-69, 2017; Sezen et al., J Pharmacol Exp Ther
287:238-45, 1998; Kim et al., Ann Lab Med 37:388-97, 2017). Due to the
multifactorial origin of delirium, we have several but no incontestable
options for prevention and symptomatic treatment. Overall, delirium
represents a high burden not only for patient and family members, but also
for the medical care team that aims to prevent postoperative delirium to
avoid serious consequences associated with it. The purpose of this study
is to determine whether postoperative delirium can be prevented by the
combination of established preventive agents. In addition, measured levels
of pre- and postoperative cortisol, neuron specific enolase (NSE) and
S-100beta will be used to investigate dynamics of these parameters in
delirious and non-delirious patients after surgery. Methods/design: The
Baden PRIDe Trial is an investigator-initiated, phase IV, two-centre,
randomised, placebo-controlled, double-blind clinical trial for the
prevention of delirium with haloperidol, ketamine, and the combination of
both vs. placebo in 200 patients scheduled for surgery. We would like to
investigate superiority of one of the three treatment arms (i.e.,
haloperidol, ketamine, combined treatment) to placebo. Discussion: There
is limited but promising evidence that haloperidol and ketamine can be
used to prevent delirium. Clinical care for patients might improve as the
results of this study may lead to better algorithms for the prevention of
delirium. Copyright © 2018 The Author(s).

<70>
Accession Number
620843371
Author
Nielsen D.V.; Torp-Pedersen C.; Skals R.K.; Gerds T.A.; Karaliunaite Z.;
Jakobsen C.-J.
Institution
(Nielsen, Karaliunaite, Jakobsen) Aarhus University Hospital, Department
of Anesthesia and Intensive Care, Palle Juul-Jensens Boulevard, Aarhus N
8200, Denmark
(Torp-Pedersen) Aalborg University, Department of Health, Science and
Technology, Frederiks Bajersvej, Aalborg 9220, Denmark
(Skals) Aalborg University Hospital, Unit of Epidemiology and
Biostatistics, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
(Gerds) University of Copenhagen, Department of Public Health, Section of
Biostatistics, Oester Farimagsgade 5, Copenhagen 1014, Denmark
Title
Intraoperative milrinone versus dobutamine in cardiac surgery patients: A
retrospective cohort study on mortality.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 51. Date of
Publication: 26 Feb 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several choices of inotropic therapy are available and used in
relation to cardiac surgery. Comparisons are necessary to select optimal
therapy. In Denmark, dobutamine and milrinone are the two inotropic agents
most commonly used to treat post-bypass low cardiac output syndrome. This
study compares all-cause mortality with these drugs. Methods: In a
retrospective observational study we investigated 10,700 consecutive
patients undergoing cardiac surgery from 1 April 2006 to 31 December 2013
at Aarhus and Aalborg University Hospitals in the Central and Northern
Denmark Region. Prospectively entered data in the Western Danish Heart
Registry on intraoperative use of inotropes were used to identify 952
patients treated with milrinone, 418 patients treated with dobutamine, and
82 patients receiving a combination of the two inotropes. All-cause
mortality among patients receiving dobutamine was compared to all-cause
mortality among milrinone receivers. Multiple logistic regression analyses
including preoperative and intraoperative variables along with g-formula
analyses were used to model 30-day and 1-year mortality risks. Reported
were standardized mortality risk differences between the treatment groups.
Results: Among patients receiving intraoperative dobutamine, 18 (4.3%)
died within 30 days and 49 (11.7%) within 1 year. Corresponding 30-day and
1-year mortality for milrinone receivers were 81 (8.5%) and 170 (17.9%).
Risk of death within 30 days and 1 year was increased for intraoperative
milrinone compared to dobutamine with a standardized risk difference of
4.06% (confidence interval (CI) 1.23; 6.89, p = 0.005) and 4.77% (CI 0.39;
9.15, p = 0.033), respectively. Sensitivity analyses including adjustment
for milrinone preference, hemodynamic instability prior to cardiopulmonary
bypass, and separate analyses on hospital level all confirmed a sign
toward increased mortality among milrinone receivers. Conclusions:
Intraoperative use of milrinone in cardiac surgery may be associated with
an increase in all-cause mortality compared to use of
dobutamine. Copyright © 2018 The Author(s).

<71>
Accession Number
620915430
Author
Baschin M.; Selleng S.; Hummel A.; Diedrich S.; Schroeder H.W.; Kohlmann
T.; Westphal A.; Greinacher A.; Thiele T.
Institution
(Baschin, Westphal, Greinacher, Thiele) Abteilung Transfusionsmedizin
Institut fur Immunologie und Transfusionsmedizin Greifswald Germany
(Selleng) Klinik fur Anasthesiologie Universitatsmedizin Greifswald
Greifswald Germany
(Hummel) Klinik und Poliklinik fur Innere Medizin B Universitatsmedizin
Greifswald Greifswald Germany
(Diedrich) Klinik und Poliklinik fur Chirurgie Universitatsmedizin
Greifswald Greifswald Germany
(Schroeder) Klinik fur Neurochirurgie Universitatsmedizin Greifswald
Greifswald Germany
(Kohlmann) Institut fur Community Medicine Universitatsmedizin Greifswald
Greifswald Germany
Title
Preoperative platelet transfusions to reverse antiplatelet therapy for
urgent non-cardiac surgery: An observational cohort study.
Source
Journal of Thrombosis and Haemostasis. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials: An increasing number of patients requiring surgery receive
antiplatelet therapy (APT). We analyzed 181 patients receiving presurgery
platelet transfusions to reverse APT. No coronary thrombosis occurred
after platelet transfusion. This justifies a prospective trial to test
preoperative platelet transfusions to reverse APT. Summary: Background:
Patients receiving antiplatelet therapy (APT) have an increased risk of
perioperative bleeding and cardiac adverse events (CAE). Preoperative
platelet transfusions may reduce the bleeding risk but may also increase
the risk of CAE, particularly coronary thrombosis in patients after recent
stent implantation. Objectives: To analyze the incidence of perioperative
CAE and bleeding in patients undergoing non-cardiac surgery using a
standardized management of transfusing two platelet concentrates
preoperatively and restart of APT within 24-72 h after surgery. Methods: A
cohort of consecutive patients on APT treated with two platelet
concentrates before non-cardiac surgery between January 2012 and December
2014 was retrospectively identified. Patients were stratified by the risk
of major adverse cardiac and cerebrovascular events (MACCE). The primary
objective was the incidence of CAE (myocardial infarction, acute heart
failure and cardiac troponine T increase). Secondary objectives were
incidences of other thromboembolic events, bleedings, transfusions and
mortality. Results: Among 181 patients, 88 received aspirin, 21
clopidogrel and 72 dual APT. MACCE risk was high in 63, moderate in 103
and low in 15 patients; 67 had cardiac stents. Ten patients (5.5%; 95% CI,
3.0-9.9%) developed a CAE (three myocardial infarctions, four cardiac
failures and three troponin T increases). None was caused by coronary
thrombosis. Surgery-related bleeding occurred in 22 patients (12.2%; 95%
CI, 8.2-17.7%), making 12 re-interventions necessary (6.6%; 95% CI,
3.8-11.2%). Conclusion: Preoperative platelet transfusions and early
restart of APT allowed urgent surgery and did not cause coronary
thromboses, but non-thrombotic CAEs and re-bleeding occurred. Randomized
trials are warranted to test platelet transfusion against other management
strategies. Copyright © 2018 International Society on Thrombosis
and Haemostasis.

<72>
Accession Number
620743485
Author
Weymann A.; Popov A.-F.; Sabashnikov A.; Ali-Hasan-Al-Saegh S.; Ryazanov
M.; Tse G.; Mirhosseini S.J.; Liu T.; Lotfaliani M.; Sedaghat M.; Baker
W.L.; Ghanei A.; Yavuz S.; Zeriouh M.; Izadpanah P.; Dehghan H.; Testa L.;
Nikfard M.; De Oliveira Sa M.P.B.; Mashhour A.; Nombela-Franco L.;
Rezaeisadrabadi M.; D'Ascenzo F.; Zhigalov K.; Benedetto U.; Najafi S.A.;
Szczechowicz M.; Roever L.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.;
Linde C.; Filipiak K.J.; Stone G.W.; Biondi-Zoccai G.; Calkins H.
Institution
(Weymann, Mashhour, Zhigalov, Szczechowicz) Department of Cardiac Surgery,
University Hospital Oldenburg, European Medical School
Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg,
Germany
(Popov, Sabashnikov, Zeriouh) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield-Middlesex, United Kingdom
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov, Zeriouh) Department of Cardiothoracic Surgery, University
Hospital of Cologne, Cologne, Germany
(Ali-Hasan-Al-Saegh, Mirhosseini) Cardiovascular Research Centre, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ali-Hasan-Al-Saegh, Mirhosseini, Dehghan) Consult. Ctr. for Secdry. Res.,
Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ryazanov) CVS Centre at Nizhny Novgorod, Nizhny Novgorod, Russian
Federation
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Liu, Meng, Gong) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Sedaghat, Ghanei, Rezaeisadrabadi) Department of Internal Medicine,
Shahid Beheshti University of Medical Sciences, Yazd, Tehran, Iran,
Islamic Republic of
(Baker) University of Connecticut, Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Izadpanah) Department of Interventional Cardiology, Cardiovascular
Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Nikfard) International Relations Office, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(De Oliveira Sa) University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa) Nucleus of Postgrad. and Res. in Hlth. Sci. of Fac. of
Med. Sci. and Biol. Sci. Institute (FCM/ICB), Recife, Brazil
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Najafi) Department of Cardiology and Internal Medicine, Sankt Katharinen
Hospital, Frankfurt am Main, Germany
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institute, Stockholm, Sweden
(Filipiak) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Title
Baseline and postoperative levels of C-reactive protein and interleukins
as inflammatory predictors of atrial fibrillation following cardiac
surgery: A systematic review and meta-analysis.
Source
Kardiologia Polska. 76 (2) (pp 440-451), 2018. Date of Publication: 16 Feb
2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a leading
arrhythmia with high incidence and serious clinical implications after
cardiac surgery. Cardiac surgery is associated with systemic inflammatory
response including increase in cytokines and activation of endothelial and
leukocyte responses. Aim This systematic review and meta-analysis aimed to
determine the strength of evidence for evaluating the association of
inflammatory markers, such as C-reactive protein (CRP) and interleukins
(IL), with POAF following isolated coronary artery bypass grafting (CABG),
isolated valvular surgery, or a combination of these procedures. Methods:
We conducted a meta-analysis of studies evaluating measured baseline (from
one week before surgical procedures) and postoperative levels (until one
week after surgical procedures) of inflammatory markers in patients with
POAF. A comprehensive search was performed in electronic medical databases
(Medline/PubMed, Web of Science, Embase, Science Direct, and Google
Scholar) from their inception through May 2017 to identify relevant
studies. A comprehensive subgroup analysis was performed to explore
potential sources of heterogeneity. Results: A literature search of all
major databases retrieved 1014 studies. After screening, 42 studies were
analysed including a total of 8398 patients. Pooled analysis showed
baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p <
0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001),
postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative
levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8
(SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590
pg/mL, p < 0.001) to be relevant inflammatory parameters significantly
associated with POAF. Conclusions: Perioperative inflammation is proposed
to be involved in the pathogenesis of POAF. Therefore, perioperative
assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of
predicting and monitoring for POAF. © Copyright 2018 Polskie
Towarzystwo Kardiologiczne.

<73>
Accession Number
620790240
Author
Nardin M.; Verdoia M.; Barbieri L.; Schaffer A.; Suryapranata H.; De Luca
G.
Institution
(Nardin, Verdoia, Barbieri, Schaffer, De Luca) Division of Cardiology,
Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern
Piedmont University, Novara, Italy
(Nardin) Division of Internal Medicine, ASST "Spedali Civili" Brescia,
University of Brescia, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Radial vs femoral approach in acute coronary syndromes: A meta-analysis of
randomized trials.
Source
Current Vascular Pharmacology. 16 (1) (pp 79-92), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Substantial improvements have been achieved with percutaneous
coronary intervention (PCI) for the treatment of Acute Coronary Syndromes
(ACS). Nevertheless, bleeding still affects outcomes. The radial approach
for PCI has shown important benefits on access site complications, but is
still not achieving universal consensus as first choice in acute settings.
Therefore, we performed a comprehensive meta-analysis of randomized trials
comparing radial vs femoral approach in PCI for ACS. Methods: The
literature and main scientific session abstracts were scanned for
randomized studies comparing radial vs femoral approach for PCI in ACS.
Primary endpoint was mortality within 30-days. Secondary endpoints were:
1) Major Adverse Cardiovascular Events (MACE), 2) major bleeding, and, 3)
vascular complications. Results: We included 17 randomized trials,
enrolling 19325 patients. A total of 9635 patients were randomized to the
radial approach and 9690 to the femoral approach. The radial approach was
associated with a significant reduction in mortality (1.8 vs 2.5%, odds
ratio, OR [95% CI] = 0.72 [0.59,0.88], p = 0.001,
p<inf>heterogeneity</inf> = 0.31) and in major bleeding complications
compared with the femoral approach (1.5 vs 2.6%, OR [95% CI] = 0.57 [0.47,
0.71], p < 0.00001, p<inf>heterogeneity</inf> = 0.59), with similar
advantages observed for both ST-elevation myocardial infarction and non-ST
segment elevation ACS. MACE occurrence and vascular complications were
also reduced with the radial approach (OR [95% CI] = 0.82 [0.74, 0.92], p
= 0.0005, and OR [95% CI] = 0.52 [0.47, 0.58], p < 0.00001, respectively).
Our results were not influenced by patient risk profile or the
antithrombotic strategy applied. Conclusion: Our meta-analysis shows that
among ACS patients undergoing PCI, the radial approach is associated with
a significant reduction in mortality, major bleeding complications, MACE
and vascular complication compared with the femoral
approach. Copyright © 2018 Bentham Science Publishers.

<74>
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. Copyright © 2018, © The European Society of
Cardiology 2018.

<75>
Accession Number
618782328
Author
Hulst A.H.; Polderman J.A.W.; Ouweneel E.; Pijl A.J.; Hollmann M.W.;
DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Hulst, Polderman, Ouweneel, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
(Pijl) Department of Anaesthesiology, Medical Centre Slotervaart,
Amsterdam, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
Title
Peri-operative continuation of metformin does not improve glycaemic
control in patients with type 2 diabetes: A randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 20 (3) (pp 749-752), 2018. Date of
Publication: March 2018.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Historically, metformin was withheld before surgery for fear of
metformin-associated lactic acidosis. Currently, however, this risk is
deemed to be low and guidelines have moved towards the continuation of
metformin. We hypothesized that continuing metformin peri-operatively
would lower postoperative serum glucose level without an effect on plasma
lactate levels. We performed a single-blind multicentre randomized
controlled trial in people with type 2 diabetes mellitus scheduled for
non-cardiac surgery and continued (MF+ group) or withheld (MF- group)
metformin before surgery. The main outcome measures were the differences
in peri-operative plasma glucose and lactate levels. We randomized 70
patients (37 MF+ group and 33 MF- group) with type 2 diabetes mellitus.
Postoperative glucose levels were similar in the MF+ and the MF- groups
(8.2 +/- 1.8 vs 8.3 +/- 2.3 mmol/L P =.95) Although preoperative lactate
levels were slightly higher in the MF+ group compared with the MF- group
(1.5 vs 1.2 mmol/L; P =.02), the postoperative lactate levels were not
significantly different (1.2 vs 1.0 mmol/L; P =.18). In conclusion,
continuation of metformin during elective non-cardiac surgery does not
improve glucose control or raise lactate levels to a clinically relevant
degree. Copyright © 2017 John Wiley & Sons Ltd

<76>
Accession Number
616785293
Author
Henderson R.
Institution
(Henderson) Trent Cardiac Centre, Nottingham University Hospitals, City
Hospital Campus, Hucknall Road, Nottingham NG51PB, United Kingdom
Title
Early invasive strategy in patients with non-ST segment elevation acute
coronary syndrome delays death or MI by 18 months.
Source
Evidence-Based Medicine. 22 (3) (pp 97), 2017. Date of Publication: June
2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<77>
Accession Number
614330437
Author
Cotti E.; Arrica M.; Di Lenarda A.; Serri S.B.; Bassareo P.; Padeletti L.;
Mercuro G.
Institution
(Cotti, Serri) Department of Conservative Dentistry and Endodontics,
University of Cagliari, Cagliari, Italy
(Arrica) Department of Surgery, Microsurgery and Medical Sciences,
University of Sassari, Sassari, Italy
(Di Lenarda) Cardiovascular Centre of Trieste, University of Trieste,
Trieste, Italy
(Bassareo, Mercuro) Department of Cardiology, University of Cagliari,
Cagliari, Italy
(Padeletti) Department of Cardiology, University of Florence, Florence,
Italy
Title
The perioperative dental screening and management of patients undergoing
cardiothoracic, vascular surgery and other cardiovascular invasive
procedures: A systematic review.
Source
European Journal of Preventive Cardiology. 24 (4) (pp 409-425), 2017. Date
of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background One controversial issue in the relationship between oral care
and cardiovascular diseases is how and whether to manage oral infections
prior to cardiovascular surgery or other cardiovascular invasive
procedures. Design We designed a systematic review to assess the
information available on three main questions. Is there an agreement on
the need for dental evaluation and treatment before cardiovascular
interventions? Are consistent clinical recommendations or protocols
available? Is dental treatment prior to cardiovascular interventions
effective? Methods A systematic electronic search of MEDLINE, Scopus and
Web of Science was performed from the database inceptions up to 31 April
2016. Searches were performed using Boolean operators to combine medical
subject headings and free text words. Because this review included a
large, heterogeneous group of study designs and sources, the results were
synthesised in a narrative approach. Results In total, 2447 studies were
identified: 2099 (+241 duplicates) were excluded after screening; 107 were
included for full-text assessment; 55 were excluded for not meeting the
inclusion criteria; and 11 were not available. Thus, 44 studies meeting
the inclusion criteria were analysed. We found that, for patients
undergoing cardiovascular surgery, there is a general agreement on the
need for screening and treatment of dental infections, but not on the
protocols. We also found that there are conflicting indications on when
and to what extent to perform the treatment and that the risk-to-benefit
ratios for these treatments are controversial. Conclusion No satisfactory
answers regarding dental care before cardiovascular invasive procedures
are available. Copyright © European Society of Cardiology.

<78>
Accession Number
614320247
Author
Claes J.; Buys R.; Budts W.; Smart N.; Cornelissen V.A.
Institution
(Claes, Buys, Budts) Department of Cardiovascular Sciences, Division of
Cardiology, Herestraat 49 Box 7003, KU Leuven 3000, Belgium
(Buys, Cornelissen) Department of Rehabilitation Sciences, Research Group
of Cardiovascular Rehabilitation, KU Leuven, Belgium
(Budts) Department of Cardiology, University Hospitals Leuven, Belgium
(Smart) School of Science and Technology, University of New England,
Armidale, NSW, Australia
Title
Longer-term effects of home-based exercise interventions on exercise
capacity and physical activity in coronary artery disease patients: A
systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 24 (3) (pp 244-256), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Exercise-based cardiovascular rehabilitation (CR) improves
exercise capacity (EC), lowers cardiovascular risk profile and increases
physical functioning in the short term. However, uptake of and adherence
to a physically active lifestyle in the long run remain problematic.
Home-based (HB) exercise programmes have been introduced in an attempt to
enhance long-term adherence to recommended levels of physical activity
(PA). The current systematic review and meta-analysis aimed to compare the
longer-term effects of HB exercise programmes with usual care (UC) or
centre-based (CB) CR in patients referred for CR. Design Systematic review
and meta-analysis. Methods Non-randomised controlled trials (RCTs) or
randomised trials comparing the effects of HB exercise programmes with UC
or CB rehabilitation on EC and/or PA, with a follow-up period of >=12
months and performed in coronary artery disease patients, were searched in
four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied
Health Literature (CINAHL) and the Cochrane Central Register of Controlled
trials (CENTRAL)) from their inception until September 7, 2016.
Standardised mean differences (SMDs) were calculated and pooled by means
of random effects models. Risk of bias, publication bias and heterogeneity
among trials were also assessed. Results Seven studies could be included
in the meta-analysis on EC, but only two studies could be included in the
meta-analysis on PA (total number of 1440 patients). The results showed no
significant differences in EC between HB rehabilitation and UC (SMD 0.10,
95% confidence interval (CI) -0.13 to 0.33). There was a small but
significant difference in EC in favour of HB compared to CB rehabilitation
(SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37,
95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more effective
than CB rehabilitation in terms of maintaining EC. The small number of
studies warrants the need for more RCTs evaluating the long-term effects
of different CR interventions on EC and PA behaviour, as this is the
ultimate goal of CR. Copyright © European Society of Cardiology.

<79>
Accession Number
616105938
Author
Voitov A.; Omelchenko A.; Gorbatykh Y.; Zaitsev G.; Arkhipov A.; Soynov
I.; Bogachev-Prokophiev A.; Karaskov A.
Institution
(Voitov, Omelchenko, Gorbatykh, Zaitsev, Arkhipov, Soynov,
Bogachev-Prokophiev, Karaskov) Department of Congenital Heart Surgery,
State Research Institute of Blood Circulation Pathology, Novosibirsk,
Russian Federation
Title
Outcomes of perventricular off-pump versus conventional closure of
ventricular septal defects: A prospective randomized study.
Source
European Journal of Cardio-thoracic Surgery. 51 (5) (pp 980-986), 2017.
Article Number: ezx002. Date of Publication: 01 May 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Perventricular device closure (PVDC) of ventricular septal
defects (VSDs) has demonstrated excellent clinical results. However, no
prospective studies have compared PVDC with the conventional approach
(CA). METHODS: Between June 2012 and August 2014, 640 consecutive patients
with isolated VSD were enrolled in the study, and randomized into the PVDC
group (n = 320) and the CA group (n = 320). The mean ages were 36.2 (10;
36) months and 36.2 (10; 36) months, respectively. The average weights
were 13.9 (8.1; 15.0) kg and 14.5 (6.9; 13.8) kg, respectively. The mean
follow-up was 24.9 (standard deviation 1.8) months. RESULTS: No early or
late deaths occurred in either group. The procedural success rate reached
96.6% in the PVDC group, with a 3.4% conversion rate to CA. Mean procedure
time was 56.9 (30; 70) min in the PVDC group and 162 (120; 180) min in the
CA group (P = 0.000). Thirteen (3.9%) patients in the CA group and only 4
(1.3%) in the PVDC group required postoperative blood transfusion in the
intensive care unit (P = 0.040). At the final follow-up, significantly
more residual shunts were found in the CA group. No rhythm or conduction
disorders occurred in any patient of either group. CONCLUSIONS: According
to the mid-term follow-up results, PVDC has similar efficacy to CA for VSD
closure. The off-pump PVDC technique reduces blood product transfusion and
the procedural time and minimizes surgical trauma while providing
excellent cosmetic results. Copyright © The Author 2017.
Published by Oxford University Press. All rights reserved.

<80>
Accession Number
613808216
Author
Yardley M.; Gullestad L.; Bendz B.; Bjorkelund E.; Rolid K.; Arora S.;
Nytroen K.
Institution
(Yardley, Gullestad, Bendz, Bjorkelund, Rolid, Arora, Nytroen) Department
of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Yardley) The Norwegian Health Association, Oslo, Norway
(Yardley, Gullestad, Bendz, Nytroen) Faculty of Medicine, University of
Oslo, Oslo, Norway
(Gullestad) Center for Heart Failure Research, Faculty of Medicine,
University of Oslo, Oslo, Norway
Title
Long-term effects of high-intensity interval training in heart transplant
recipients: A 5-year follow-up study of a randomized controlled trial.
Source
Clinical Transplantation. 31 (1) (no pagination), 2017. Article Number:
e12868. Date of Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Previous studies have demonstrated that high-intensity
interval training (HIT) is superior to moderate-continuous exercise in
general and in cardiovascular diseases. Recently, we also found HIT safe
and efficient after heart transplantation (HTx). This study reports the
5-year long-term effects. Design and Methods: Forty-one HTx patients who
had completed the previous 12-month randomized controlled trial, comparing
HIT intervention with usual care, were eligible. In particular, we
measured VO<inf>2peak</inf>, muscular capacity, intravascular ultrasound,
and questionnaires measuring physical and mental health. Results: The
baseline mean+/-SD values were as follows: age; 49.1+/-16.5 years, men;
68%, time since HTx: 4.1+/-2.2 years. Within the HIT group, initial
VO<inf>2peak</inf> increased significantly from 27.7+/-5.7 to 31.2+/-5.3
mL/kg/min. However, during the next 4 years, VO<inf>2peak</inf> decreased
to 26.0+/-6.2 mL/kg/min. The control group showed slightly decreasing
VO<inf>2peak</inf> values during the entire 5-year period. The HIT group
reported significantly less anxiety symptoms, but there were no long-term
differences in VO<inf>2peak</inf>, muscular capacity, or cardiac allograft
vasculopathy between the groups. The similar VO<inf>2peak</inf> values
correspond to our findings of similar everyday activity. Conclusion: Our
findings suggest that intermittent periods of HIT may be necessary to
maintain the initial benefits gained from the intervention. However, HIT
probably reduces the burden of anxiety, which is a frequent health issue
following HTx. Copyright © 2016 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<81>
Accession Number
614252762
Author
Tarricone R.; Callea G.; Ogorevc M.; Prevolnik Rupel V.
Institution
(Tarricone) Department of Policy Analysis and Public Management, Bocconi
University, Milan, Italy
(Tarricone, Callea) Centre for Research on Health and Social Care
Management (CERGAS), Bocconi University, Milan, Italy
(Ogorevc, Prevolnik Rupel) Institute for Economic Research, Ljubljana,
Slovenia
Title
Improving the Methods for the Economic Evaluation of Medical Devices.
Source
Health Economics (United Kingdom). 26 (Supplement 1) (pp 70-92), 2017.
Date of Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Medical devices (MDs) have distinctive features, such as incremental
innovation, dynamic pricing, the learning curve and organisational impact,
that need to be considered when they are evaluated. This paper
investigates how MDs have been assessed in practice, in order to identify
methodological gaps that need to be addressed to improve the
decision-making process for their adoption. We used the Consolidated
Health Economic Evaluation Reporting Standards (CHEERS) checklist
supplemented by some additional categories to assess the quality of
reporting and consideration of the distinctive features of MDs. Two case
studies were considered: transcatheter aortic valve implantation (TAVI)
representing an emerging technology and implantable cardioverter
defibrillators (ICDs) representing a mature technology. Economic
evaluation studies published as journal articles or within Health
Technology Assessment reports were identified through a systematic
literature review. A total of 19 studies on TAVI and 41 studies on ICDs
were analysed. Learning curve was considered in only 16% of studies on
TAVI. Incremental innovation was more frequently mentioned in the studies
of ICDs, but its impact was considered in only 34% of the cases. Dynamic
pricing was the most recognised feature but was empirically tested in less
than half of studies of TAVI and only 32% of studies on ICDs. Finally,
organisational impact was considered in only one study of ICDs and in
almost all studies on TAVI, but none of them estimated its impact. By
their very nature, most of the distinctive features of MDs cannot be fully
assessed at market entry. However, their potential impact could be
modelled, based on the experience with previous MDs, in order to make a
preliminary recommendation. Then, well-designed post-market studies could
help in reducing uncertainties and make policymakers more confident to
achieve conclusive recommendations. © 2017 The Authors. Health
Economics published by John Wiley & Sons, Ltd. Copyright © 2017
The Authors. Health Economics published by John Wiley & Sons, Ltd.

<82>
Accession Number
613755577
Author
Morrison L.J.; Devlin S.M.; Kontos M.C.; Cheskes S.; Aufderheide T.P.;
Christenson J.; Ornato J.P.; Stiell I.G.; Rac V.E.; Thomas A.J.; Wigginton
J.G.; Dorian P.
Institution
(Morrison) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Division of Emergency Medicine, Department of Medicine, University of
Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
(Devlin) Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York,
NY, United States
(Kontos) Pauley Heart Center, Division of Cardiology, Virginia
Commonwealth University, Richmond, VA, United States
(Cheskes) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Sunnybrook Centre for Prehospital Medicine, Division of Emergency
Medicine, Department of Family and Community Medicine University of
Toronto, 77 Browns Line, Suite 100, Toronto, Ontario M8W 3S2, Canada
(Aufderheide) Medical College of Wisconsin, Department of Emergency
Medicine, 9200W. Wisconsin Avenue, Pavilion 1P, Milwaukee, WI 53226,
United States
(Christenson) University of British Columbia, Department of Emergency
Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, British
Columbia V5Z 1M9, Canada
(Ornato) Department of Emergency Medicine, Virginia Commonwealth
University, Richmond, VA, United States
(Stiell) Department of Emergency Medicine, Ottawa Hospital Research
Institute, University of Ottawa, Clinical Epidemiology Unit, F6 1053
Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
(Rac) THETA (Toronto Health Economics and Technology Assessment)
Collaborative, Toronto General Research Institute, University Health
Network and Leslie Dan Pharmacy Building, 6th Floor, Room 651, 144 College
Street, Toronto, Ontario M5S 3M2, Canada
(Thomas) School of Medicine, Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239-3098, United States
(Wigginton) University of Texas Southwestern Medical Center, 5323 Harry
Hines Boulevard, Dallas, TX 75390, United States
(Dorian) Division of Cardiology, Department of Medicine, St Michael's
Hospital and University of Toronto, Toronto, Ontario, Canada
Title
The association of maximum Troponin values post out-of-hospital cardiac
arrest with electrocardiographic findings, cardiac reperfusion procedures
and survival to discharge: A sub-study of ROC PRIMED.
Source
Resuscitation. 111 (pp 82-89), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The role of Troponin (Tn) levels in the management of patients
post out-of-hospital cardiac arrest (OHCA) is unclear. Methods All OHCA
patients enrolled in the Resuscitation Outcomes Consortium Prehospital
Resuscitation using an IMpedance valve and Early versus Delayed analysis
trial and admitted to hospital with a Tn level and a 12-lead
electrocardiogram were stratified by ST elevation (STE) or no STE in a
regression model for survival to discharge adjusted for Utstein predictors
and site. Results Of the 15,617 enrolled OHCA patients, 4118 (26%)
survived to admission to hospital; 17% (693) were STE and 77% (3188) were
no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion
rates were higher when Tn level >2 ng/ml (p > 0.1 ng/ml) improved with a
diagnostic cardiac catheterization (p < 0.001). Conclusions Elevated Tn
levels >2 ng/ml were associated with improved survival to discharge in
patients post OHCA with STE. Survival in patients with no STE and Tn
values >0.1 ng/ml was higher when associated with diagnostic cardiac
catheterization or treated with reperfusion or
revascularization. Copyright © 2016 Elsevier Ireland Ltd

<83>
Accession Number
616708673
Author
Ursoniu S.; Mikhailidis D.P.; Serban M.-C.; Penson P.; Toth P.P.; Ridker
P.M.; Ray K.K.; Kees Hovingh G.; Kastelein J.J.; Hernandez A.V.; Manson
J.E.; Rysz J.; Banach M.
Institution
(Ursoniu) Department of Functional Sciences, Discipline of Public
HealthDiscipline of Public Health, "Victor Babes" University of Medicine
and Pharmacy, Timisoara, Romania
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Campus,
University College London Medical School, University College London (UCL),
London, United Kingdom
(Serban) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Serban) Department of Functional Sciences, Discipline of
PathophysiologyDiscipline of Pathophysiology, "Victor Babes" University of
Medicine and Pharmacy, Timisoara, Romania
(Penson) School of Pharmacy and Biomolecular Sciences, Liverpool John
Moores University, Liverpool, United Kingdom
(Toth) Preventive Cardiology, CGH Medical Center, Sterling, Illinois,
United States
(Toth) The Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Baltimore, MD, United States
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Ray) Department of Primary Care and Public Health, School of Public
Health, Imperial College London, United Kingdom
(Kees Hovingh, Kastelein) Department of Vascular Medicine, Academic
Medical Center, Amsterdam, Netherlands
(Hernandez) Health Outcomes and Clinical Epidemiology Section, Department
of Quantitative Health Sciences, Lerner Research Institute, Cleveland
Clinic, Cleveland, OH, United States
(Hernandez) School of Medicine, Universidad Peruana de Ciencias Aplicadas
(UPC), Lima, Peru
(Manson) Division of Preventive Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Manson) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Rysz, Banach) Department of Hypertension, Chair of Nephrology and
Hypertension, Medical University of Lodz, Poland
(Banach) Cardiovascular Research Centre, University of Zielona Gora,
Zielona Gora, Poland
(Banach) Polish Mother's Memorial Hospital Research Institute, Lodz,
Poland
Title
The effect of statins on cardiovascular outcomes by smoking status: A
systematic review and meta-analysis of randomized controlled trials.
Source
Pharmacological Research. 122 (pp 105-117), 2017. Date of Publication:
August 2017.
Publisher
Academic Press
Abstract
Smoking is an important risk factor for cardiovascular disease (CVD)
morbidity and mortality. The impact of statin therapy on CVD risk by
smoking status has not been fully investigated. Therefore we assessed the
impact of statin therapy on CVD outcomes by smoking status through a
systematic review of the literature and meta-analysis of available
randomized controlled trials (RCTs). The literature search included
EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to
identify RCTs that investigated the effect of statin therapy on cumulative
incidence of major CVD endpoints (e.g. non-fatal myocardial infarction,
revascularization, unstable angina, and stroke). Relative risks (RR)
ratios were calculated from the number of events in different treatment
groups for both smokers and non-smokers. Finally 11 trials with 89,604
individuals were included. The number of smokers and non-smokers in the
statin groups of the analyzed studies was 8826 and 36,090, respectively.
The RR for major CV events was 0.73 (95% confidence interval [CI]:
0.67-0.81; p < 0.001) in nonsmokers and 0.72 (95%CI: 0.64-0.81; p < 0.001)
in smokers. Moderate to high heterogeneity was observed both in
non-smokers (I2 = 77.1%, p < 0.001) and in smokers
(I2 = 51.6%, p = 0.024) groups. Smokers seemed to benefit
slightly more from statins than non-smokers according to the number needed
to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control
event rates. The number of avoided events per 1000 individuals was 42.5
(95%CI: 28.9-54.6) in smokers and 37.3 (95%CI: 27.2-46.4) in non-smokers.
In conclusion, this meta-analysis suggests that the effect of statins on
CVD is similar for smokers and non-smokers, but in terms of NNTs and
number of avoided events, smokers seem to benefit more although
non-significantly. Copyright © 2017

<84>
Accession Number
613437635
Author
Pilarczyk K.; Haake N.; Heckmann J.; Carstens H.; Haneya A.; Cremer J.;
Jakob H.; Pizanis N.; Kamler M.
Institution
(Pilarczyk, Haake) Department of Intensive Care Medicine, imland Klinik
Rendsburg, Rendsburg, Germany
(Pilarczyk, Heckmann, Carstens, Jakob, Pizanis, Kamler) Department of
Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center
Essen, University Hospital Essen, Essen, Germany
(Haneya, Cremer) Department of Cardiovascular Surgery, University of
Schleswig-Holstein, Kiel, Germany
Title
Is universal antifungal prophylaxis mandatory in adults after lung
transplantation? A review and meta-analysis of observational studies.
Source
Clinical Transplantation. 30 (12) (pp 1522-1531), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Lung transplant (LTX) recipients are at high risk of invasive
Aspergillus infections (IAI). However, no randomized-controlled trials
(RCT) or international guidelines on antifungal prophylaxis (AFP) in the
LTX population exist. Methods: A meta-analysis was performed to determine
whether AFP reduces the rate of IAI after LTX. A total of six eligible
observational studies (five with no prophylaxis, one with targeted
prophylaxis, three studies including heart/lung transplantation) with a
total of 748 patients were included. Results: The pooled odds ratio (OR)
for IAI (62 IFI in the intervention arm and 82 in the control group) was
0.234 (95% confidence interval [CI] 0.097-0.564, P=0.001, z=-3.237).
Pooled studies were characterized by substantial heterogeneity
(I2=66.64%); number needed to treat was 6.8. A subgroup
analyses with exclusion of heart transplant recipients also showed a
statistically significant reduction in IAI with AFP (OR 0.183, 95% CI
0.0449-0.744, P=0.018). Conclusion: This study suggests that universal
antifungal prophylaxes reduces incidence of IAI after LTX. However,
included studies are limited by small sample size, single-center structure
without randomization, mixed population (including heart/heart-lung
transplant), and heterogeneity due to variations in immunosuppression,
type, and duration of AFP. Therefore, there is a clear need for an
adequately powered RCT. Copyright © 2016 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<85>
Accession Number
616903783
Author
Liao Y.-B.; Deng X.-X.; Meng Y.; Zhao Z.-G.; Xiong T.-Y.; Meng X.-J.; Zuo
Z.-L.; Li Y.-J.; Cao J.-Y.; Xu Y.-N.; Chen M.; Feng Y.
Institution
(Liao, Zhao, Xiong, Zuo, Li, Cao, Xu, Chen, Feng) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
(Deng) Department of General Family Medicine, West China Hospital, Sichuan
University, Chengdu, China
(Meng) Department of Urology Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Meng) Department of Gastrointestinal Surgery, West China Hospital,
Sichuan University, Chengdu, China
Title
Predictors and outcome of acute kidney injury after transcatheter aortic
valve implantation: A systematic review and meta-analysis.
Source
EuroIntervention. 12 (17) (pp 2067-2074), 2017. Date of Publication: April
2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this systematic review and meta-analysis was to
investigate the predictors and outcome of acute kidney injury (AKI) after
transcatheter aortic valve implantation (TAVI). Methods and results: There
were 35 articles recruiting 13,256 patients included in our study.
Hypertension (odds ratio [OR] 1.92, 95% CI: 1.44 to 2.56), diabetes
mellitus (OR 1.33, 95% CI: 1.20 to 1.47), peripheral artery disease (OR
1.28, 95% CI: 1.14 to 1.45) and a left ventricular ejection fraction <40%
(OR 1.50, 95% CI: 1.19 to 1.88) were identified as significant independent
predictors of AKI. In addition to the aforementioned comorbidities,
procedure-related/post-TAVI factors such as transapical access (OR 1.68,
95% CI: 1.44 to 1.97), major bleeding (OR 1.82, 95% CI: 1.37 to 2.40) and
transfusion (OR 1.30, 95% CI: 1.12 to 1.51) were also associated with a
higher risk of AKI. Importantly, the risk of short-term all-cause death
increased progressively with the aggravating severity of AKI (OR, 30 days:
stage 1: 3.41; stage 2: 4.0; stage 3: 11.02; one year: stage 1: 1.95;
stage 2: 2.82; stage 3: 7.34), as determined by a univariate analysis.
After eliminating confounders, AKI remained linked to a higher risk for
both short-term (30 days: HR 2.12, 95% CI: 1.59 to 2.83) and long-term (>3
years: HR 1.37, 95% CI: 1.27 to 1.48) all-cause mortality. Conclusions:
The reason for the occurrence of AKI was multifactorial, including
baseline characteristics, procedure-related and post-TAVI factors. It
appeared that even stage 1 AKI exerted detrimental effects on survival
within one year, and AKI was also independently linked to mortality beyond
three years. Copyright © Europa Digital & Publishing 2017. All
rights reserved.

<86>
Accession Number
620888728
Author
Useini D.; Haldenwang P.-L.; Schlomicher M.; Markthaler L.; Christ H.;
Strauch J.T.
Institution
(Useini, Haldenwang, Schlomicher, Markthaler, Strauch) Ruhr University
Bochum, Department of Cardiothoracic Surgery, Bochum, Germany
(Christ) University Cologne, Institute of Medical Statistics, Informatics
and Epidemiology, Cologne, Germany
Title
Does the preoperative cardio-CT lead to an increased incidence of
postoperative acute renal injury following TA-TAVI?.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: Acute kidney injury (AKI) represents a severe complication
after transapical transcatheter aortic valve implantation (TA-TAVI), which
is known to increase the post-procedural morbidity and mortality. Although
the superiority of information from the computer tomography with contrast
media (Cardio-CT) when compared with transesophageal echocardiography
(TEE) for aortic annulus sizing is proved, the Cardio-CT is considered
critically due to the contrast media application, especially in patients
with compromised renal function. Aim of our study was to evaluate the
impact of a preoperative Cardio-CT on the incidence of postoperative AKI
after TA-TAVI. Methods: A total of 229 consecutive high-risk patients (84
+/- 7 years, 57% male, EuroSCORE II 8 +/- 6%) with aortic stenosis
underwent TA-TAVI in our institution between 01/2011 and 08/2016. Patients
with chronic dialysis were excluded. In conformity with our policy switch
in 01/2014 from TEE to Cardio-CT for annulus sizing, the cohort was
divided in two groups: 113 (51%) patients who received TEE vs 110 (49%)
who received Cardio-CT (128 detector rows, rapid electrocardiographicaly
gated) 48h before TA-TAVI with application of 60 ml Solutrast 370. The
occurrence of a post-procedural AKI was defined according to the VARC-2
criteria. For data analysis Chi-Quadrat, Fisher, Kruskal-Wallis and
Mann-Whitney-U tests were used. Results: The preoperative risk evaluation
was similar in both groups (EuroSCORE II: CT 8.2 +/- 6.5% vs. TEE 7.8 +/-
6.2%). Overall AKI occurred in 75 patients (35.2%), with no
group-difference (CT: 46.7% vs TEE: 53.3%; p = 0,567). Preoperative
chronic kidney injury (CKI) was seen in 102 patients (45.7%), with 39.2%
in the CTand 60.8% in the TEE-group. Here AKI occur in 32,4%in CT vs 39,3%
in TEE p = 0,88. A postoperative renal replacement therapy (RRT) was
needed in 24 patients (12.3%), with a lower incidence in patients with
preoperative Cardio-CT (CT: 5.7% vs TEE 17.8%; p = 0.01). Patients with
pre-existing CKI needed RRT in CT 15.6% versus TEE 25.4% (p < 0.001). The
intra-hospital mortality was 13%. Three patients from the TEE- and none
from the CT-group died due to AKI-related complications. Conclusion: The
preoperative Cardio-CT is a safe investigation method for aortic annulus
sizing which is not associated with an increased incidence of AKI. Since
our results are related only to TA-TAVI, where an additional burden for
the exposure of the iliac arteries is not necessary, these findings should
be proved for TFTAVI.

<87>
Accession Number
620888691
Author
Harmel E.; Schofer N.; Deuschl F.; Linder M.; Reichenspurner H.;
Blankenberg S.; Schafer U.; Conradi L.
Institution
(Harmel, Schofer, Deuschl, Linder, Reichenspurner, Blankenberg, Schafer,
Conradi) University Heart Center Hamburg, Departments of Cardiovascular
Surgery and Cardiology, Hamburg, Germany
Title
Latest generation transcatheter heart valves in small aortic annuli:
Predictors for increased transprosthetic gradients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Aim of this study was to evaluate the procedural success rate
and causes for device failure in patients with small annular dimensions
undergoing transfemoral transcatheter aortic valve implantation (TFTAVI)
with various latest generation transcatheter heart valves (THV). Methods:
Data was derived from our dedicated database. All patients with
perimeter-derived annulus diameter < 23 mm as assessed by multislice
computed tomography (MSCT), receiving latest generation THV were included
for analysis. All outcome parameters were evaluated in accordance with
Valve Academic Research Consortium (VARC)-2 definitions. Results: A total
of 141 patients were included in the study (95.04% (134/141) female, 81.40
+/- 7.56 years, European System for Cardiac Operative Risk Evaluation
(logEuroSCORE I) 15.66 +/- 10.98%, Society of Thoracic Surgeons (STS)
score 5.74 +/- 5.76%. Patients received the following THV: Sapien 3
(39.01%, 55/141), AcurateNeo (29.79%, 42/141), Lotus (17.02%, 24/141),
Portico (9.22%, 13/141), EvolutR (4.26%, 6/141), or DirectFlow (0.71%,
1/141). Overall 30-day mortality and device success were 5.67% (8/141) and
92.91% (131/141) respectively. Reasons for device failure were mean
transprosthetic gradient >=20 mm Hg (70.00%, 7/10), >= moderate
paravalvular leakage (20.00%, 2/10) and procedural mortality (10.00%,
1/10). In subsequent analyses, patients were stratified according to
resultant mean gradient at discharge: group 1 < 10 mm Hg (42.55%, 60/141),
group 2 >=10 - < 20 mm Hg (52.48%, 74/141), group 3 >=20 mm Hg (4.96%,
7/141). No differences between groups were found regarding body surface
area, annular size, overall calcium load in the THV landing zone, left
ventricular function, or prevalence of anticoagulation (all p > 0.10). The
most commonly used THV in groups 1 and 3 were the AcurateNeo THV (45.00%,
27/60) and the Lotus THV (42.86%, 3/7) respectively. Degree of THV
oversizing was higher in group 1 compared with group 3 (12.27 +/- 14.40%
vs. 5.85 +/- 5.99%). Conclusion: The most common cause for device failure
in patients with small annuli is an elevated residual mean transprosthetic
gradient. No patient specific variables were identified to predict high
transprosthetic gradients within this cohort of patients. Whether THV type
or degree of oversizing might have an impact regarding this issue remains
elusive at present and warrants further investigations as data from larger
patient cohorts become available.

<88>
Accession Number
620888650
Author
Stange S.; Doerr F.; Gassa A.; Seo J.; Heldwein M.; Macherey S.; Wahlers
T.; Hekmat K.
Institution
(Stange, Doerr, Gassa, Seo, Heldwein, Wahlers, Hekmat) Uniklinik Koln,
Koln, Germany
(Macherey) Universitat Koln, Koln, Germany
Title
Best evidence topic: Avoidance and treatment of a bronchial stump
insufficiency following major lung surgery.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Almost a century after the first successful pneumonectomy
postoperative insufficiency of the bronchus stump remains one of the most
feared complications in thoracic surgery. This complication is not only
associated with high mortality and morbidity, but also the treatment
itself is challenging for the surgeon. Methods: A best evidence topic in
thoracic surgery was written according to a structured protocol. The
literature research was executed in Medline and the Cochrane Database on
July 30, 2016. In addition, a cross screening of references of all
potential articles was performed. All studies published since 1999 in
English and German language were considered relevant. Results: Our
systematic literature research revealed 19 studies with a total of over
3,885 patients after exclusion of all non-relevant publications. There was
a high heterogeneity among the publications in relation to the tissue used
to augment the bronchial stump and most of them didn't apply any kind of
randomization. The decisions were made by the surgeon and in most cases a
coverage of the bronchus stump was only done in elderly patients with
increased risk factors. Nevertheless, the bronchial stump seems to be
covered more often after pneumonectomy particularly on the right side.
There was no significant advantage of bronchus stump reinforcement in most
publications owing the above mentioned reasons. However, a bronchus stump
insufficiency occurred significant more frequent after hand-sutured stump
closure (3.5 vs. 12.5%; p < 0.005) and after right pneumonectomy (1 vs.
8%; p < 0.005). If insufficiency has already happened the studies reported
mortality rates up to 71%. Conclusion: For that reason it is necessary to
know the common underlying risk factors of a bronchial stump insufficiency
to avoid this complication. A coverage of the bronchus stump with well
vascularized tissue should be performed, especially after right sided
pneumonectomy. However, if an insufficiency of the bronchus stump has
already occurred, rapid diagnosis followed by emergency rethoracotomy is
mandatory. .

<89>
Accession Number
620888609
Author
Harmel E.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel) University Heart Center Hamburg, Hamburg, Germany
(Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg, Germany
Title
Impact of subannular reconstruction on the late reoccurrence of functional
mitral regurgitation after mitral valve repair: A meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objective: The surgical treatment of functional mitral regurgitation (MR)
remains a challenging problem due to the high reoccurrence rate of MR.
Undersized ring annuloplasty only inadequately addresses the underlying
ventricular disease, including papillary muscle displacement and
subsequent leaflet tethering. Subannular reconstruction techniques have
been developed to address these drawbacks of annuloplasty. The aim of our
study was to evaluate the potential impact of adding such subannular
techniques, on the late re-occurrence rate of functional MR. Methods: A
systematic literature search was conducted on PubMed, Embase and Google
Scholar, using the terms "mitral valve annuloplasty" "functional mitral
regurgitation," "subannular mitral valve repair," "posterior leaflet
augmentation" and "papillary muscle relocation." Meta-analysis was
conducted using Comprehensive Meta-Analysis version 3 (Biostat, Englewood,
New Jersey). Cumulative events were compared as odds ratios with a 95%
confidence interval. The primary endpoint of the study was recurrence of
mitral regurgitation >2 after mitral valve repair, as defined by follow
up- echocardiography. Only studies reporting long-term echocardiographic
outcome, defined as more than three years postoperatively, were
considered. Results: The keyword-based search revealed a total of 1728
potential publications. After removal of duplicate studies and exclusion
of experimental and laboratory studies, abstract screening was conducted
and yielded 70 relevant papers. Full-text review revealed 27 eligible
manuscripts, while long-term echocardiographic data were available only in
11 (40,7%) of them. The cumulative number of 1247 patients included in
these studies served as our study population. At time of 3-5 years follow
up after mitral valve repair, our meta-analysis demonstrated a
significantly lower late recurrence rate of mitral regurgitation >2 in
those patients, who underwent annuloplasty in combination with subannular
reconstruction (OR 0.33, 95% C.I. 0,23-0,5, p = 0,01). Conclusion: The
combination of subannular reconstruction and mitral valve annuloplasty
significantly reduces the late re-occurrence of functional MR after mitral
valve repair when compared with annuloplasty alone.

<90>
Accession Number
620888590
Author
Thaqi N.; Cetinkaya A.; Holubec T.; Skwara W.; Richter M.; Schonburg M.;
Doss M.; Walter T.
Institution
(Thaqi, Cetinkaya, Holubec, Skwara, Richter, Schonburg, Doss, Walter)
Kerckhoff Klinik, Heart Surgery, Bad Nauheim, Germany
Title
Minimally invasive mitral valve repair for posterior leaflet prolapse
comparison of surgical techniques.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The aim of this study was to compare outcomes of neochordae
implantation versus triangular resection in posterior leaflet (P2)
prolapse, in the setting of minimally invasive surgery (MIS). Methods: A
total of 933 patients received video assisted MIS mitral repair, via right
anterior mini thoracotomy, between January 2010 and December 2014, at our
institution from this cohort, 462 presented with P2 prolapse, off those
307 patients received neochordae implantation with pre-measured Goretex
"loops" and 155 received triangular resection. All patient data were
prospectively entered into the data base Echocardiographic and clinical
outcomes were evaluated at 30 days. Results: 30-day mortality was 1.9% (n
= 3) in the neochord group (NG) versus 1.6% (n = 5) resection group (RG)
(p = 0.7). Cross clamp times were 84 +/- 32 minute (NG) versus 93 +/- 32.1
minute (RG). Intra-operative revision of mitral valve repair, due to
mitral regurgitation >= II, was comparable between the groups at 1.6% (NG)
versus 1.3% (RG). Systolic anterior motion occurred in 2.6% (NG) versus
6.5% (RG). Mean annuloplasty ring diameters were 32 mm (NG) versus 30 mm
(RG). Conclusion: Mitral valve reconstruction can be performed by minimal
invasive access with good results using both techniques. The use of
pre-measured neochords results in significantly improved hemodynamics. In
our experience, the ease of the neochord technique is particularly
attractive for surgeons performing mitral valve repair through a minimally
invasive approach. .

<91>
Accession Number
620888483
Author
Gherli R.; Reichart D.; Gulbins H.; Reichenspurner H.; Biancari F.
Institution
(Gherli) Camillo-Forlanini Hospital, Rome, Italy
(Reichart, Gulbins, Reichenspurner) University Heart Center Hamburg,
Hamburg, Germany
(Biancari) Oulu University Hospital, Oulu, Finland
Title
Ticagrelor compared with aspirin alone in acute coronary syndrome patients
undergoing isolated coronary artery bypass grafting.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: This study evaluated the safety and efficacy of preoperative
use of ticagrelor in acute coronary syndrome (ACS) patients undergoing
coronary artery bypass grafting (CABG) as compared with aspirin alone.
Methods: This study includes 786 ACS patients undergoing isolated CABG
from the prospective, European multicenter CABG registry (E-CABG).
Severity of bleeding was categorized according to the Universal Definition
of Perioperative Bleeding (UDPB), Platelet Inhibition and Patient Outcomes
(PLATO) and E-CABG criteria. Results: Ticagrelor was administered in 290
(36.1%) patients and 496 (63.9%) received aspirin alone. Patients in the
aspirin group had a higher operative risk (EuroScore II: 3.6 +/- 5.0 vs.
3.1 +/- 5.2%, p< 0.001). Chest tube output (470 +/- 389 vs. 454 +/- 273
mL, p = 0.08), RBC transfusion (43.8 vs. 39.0%, p = 0.19), and
FFP/Octaplas (5.4 vs. 7.2%, p = 0.31) and resternotomy for bleeding (3.4
vs. 3.1%, p = 0.806) were similar in the aspirin and ticagrelor groups.
However, patients receiving ticagrelor required more platelets transfusion
(13.1 vs. 5.6%, p< 0.001, and 0.7 +/- 3.7 vs. 0.2 +/- 1.3 units, p< 0.001,
respectively). Propensity score adjusted analysis showed that ticagrelor
was associated with a significantly higher risk of platelets transfusion,
while bleeding-related and other adverse outcome end-points were similar
in the study groups. A significantly higher risk of severe-massive
bleeding according to the UDPB, E-CABG and PLATO criteria was observed
only among patients (10%) in whom ticagrelor was administered one day
before or until surgery. Conclusion: The use of ticagrelor in ACS patients
before CABG is safe and associated similar bleeding risk as compared with
aspirin alone, particularly if discontinued >24 hours from surgery.
However, an increased usage of platelets transfusion has been observed.

<92>
Accession Number
620888464
Author
Anonymous
Title
46th Annual Meeting of the German Society for Thoracic and Cardiovascular
Surgery, DGTHG 2017.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
The proceedings contain 309 papers. The topics discussed include:
metabolism of intraoperatively administered histidine in the context of
Bretschneider cardioplegia; pericardial fluids or cardiopulmonary bypass:
is there a major culprit for changes in coagulation and inflammation?;
intra-aortic balloon pump therapy before cardiac surgery: a systematic
review and meta-analysis of 9,212 patients; novel postoperative atrial
fibrillation risk prediction from preoperative high-resolution ECG-based
assessment of nonlinear heart rate dynamics; prospective real-world
evaluation of an interdisciplinary blood management protocol for patients
undergoing cardiac surgery; thoracic osteochondroma: diagnostic and
therapeutic challenge; combined myocardial, sympathetic and renal ablation
strategy in a severe case of idiopathic ventricular fibrillation: report
of a case; methemoglobin formation in erythrocytes stored for different
time periods during extracorporeal circulation; postoperative delirium:
examination of 1N206 cardio-surgical patients of a single university
center during one-year period; the association of the COMT-genotype and
postoperative pain perception at hospital discharge in patients undergoing
cardiac surgery: an analysis from the COMT-cohort study; and lower
mortality and lower incidence of device failure after one year on left
ventricular assist device support as a bridge to heart transplantation.

<93>
Accession Number
620888437
Author
Deppe A.C.; Weber C.; Liakopoulos O.J.; Zeriouh M.; Slottosch I.; Scherner
M.; Kuhn E.; Choi Y.H.; Wahlers T.
Institution
(Deppe, Weber, Liakopoulos, Zeriouh, Slottosch, Scherner, Kuhn, Choi,
Wahlers) Klinik und Poliklinik fur Herz- und Thoraxchirurgie,
Universitatsklinikum Koln, Koln, Germany
Title
Intra-aortic balloon pump therapy before cardiac surgery: A systematic
review and meta-analysis of 9,212 patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Significant changes in the use of IABP in patients who are
planned for revascularization lead us to perform a wide systematic review
with meta-analysis including cardiac surgery patients. Methods: We
performed a meta-analysis of randomized (RCT) and observational trials
(OT) that fulfilled our inclusion criteria: (1) Group comparison of
patients with prophylactic IABP implantation before CABG with a control
group; (2) reporting at least one desired clinical endpoint, including
all-cause mortality, myocardial infarction, cerebrovascular accident
(CVA), renal failure. Pooled treatment effects (odds ratio (OR) or
weighted mean difference (WMD), 95% confidence intervals (95%CI)) were
assessed using a fixed or random effects model. Subgroup analyses for
on-pump or off-pump revascularization were also performed. Results: A
total of 7 RCTs and 16 OTs including 9,212 patients were identified after
systematic literature search of major databases. Absolute risk reduction
for mortality in RCTs was 4.4% (OR: 0.43; 95% CI: 0.25-0.73; p = 0.0025).
Subgroup analyses revealed only a benefit for off-pump patients (OR: 0.42;
95% CI: 0.20-0.84; p = 0.0008), whereas no beneficial effect was seen in
the on-pump group (OR: 1.10; 95% CI: 0.90-1.34; p = 0.07). In the entire
collective, prophylactic IABP use before cardiac surgery also decreased
risk for myocardial infarction (OR: 0.58; 95% CI: 0.43-0.78; p = 0.004),
CVA (OR: 0.67; 95% CI: 0.47-0.97; p = 0.042), and renal failure (OR: 0.62;
95% CI: 0.47-0.83; p = 0.0014). Conclusion: Prophylactic IABP use in
high-risk patient before cardiac surgery should be considered, especially
in high-risk patients prior off-pump revascularization.

<94>
Accession Number
620888435
Author
Puluca N.; Doppler S.; Lahm H.; Zhang Z.; Dressen M.; Deutsch M.A.; Lange
R.; Krane M.
Institution
(Puluca, Doppler, Lahm, Zhang, Dresen, Deutsch, Lange, Krane) Department
of Cardiovascular Surgery, German Heart Center Munich, Clinic at the
Technical University, Munchen, Germany
Title
Cardiosphere-derived cells: A possible source for regenerative cell
therapy in congenital heart diseases.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Cardiosphere-derived cells (CDCs), a heterogeneous mix of
cardiac cells with ambiguous identity, have been used in preclinical and
clinical trials with variable success. Transplantation of CDCs into adult
patients after myocardial infarction did not improve cardiac function
significantly while administration to children with congenital heart
disease was beneficial. Therefore, we aimed to characterize CDCs from
surgical patients with varying age and compared their properties to those
of adipose-tissue-derived fibroblasts (AFs) and cardiac fibroblast (CFs).
Methods: CDCs, AFs and CFs were cultivated from neonate (>10 days) to
adult (>25 years) patients with variable cardiac pathotypes undergoing
cardiac surgery. CDCs were generated according to a previously published
and well-established 3-step protocol. AFs were generated from subcutaneous
fat samples and CFs from different patients were cultivated from cardiac
biopsies. At passages 0 to 2 flow cytometry analysis, immunohistochemical
stainings and gene expression analyses were performed with appropriate
antibodies and primer sets. Results: CDCs and corresponding AF populations
from the same patient expressed the mesenchymal stem cell marker CD105 to
a similar extent (>90%) as measured by flow cytometry. Both cell types,
CDCs and AFs, were negative for the hematopoietic marker CD45. Cardiac
fibroblasts (CFs) obtained from different patients showed similar
properties for these two markers. qRT-PCR confirmed these results. The
fibroblast marker CD90 was expressed on more than 90% of cultivated AFs
and CFs whereas the percentage was highly variable in CDCs (20% to 98%).
Immunohistochemical staining for DDR2, another fibroblast marker, revealed
expression on the majority of cultivated CDCs, AFs and CFs. Finally, gene
expression levels of essential cardiac developmental markers like GATA4 or
NKX2.5 were evaluated by qPCR. Preliminary results suggest a trend toward
a higher expression in CDCs derived from children compared with those
established from adult patients. Conclusion: Clinical trials have shown
first beneficial effects of CDCs in patients with congenital heart
disease. Our results showed comparable properties between CDCs and
different fibroblast populations. However, CDCs derived from children
tended to express specific cardiac transcription factors more abundantly
which may be one reason for their superior performance after
transplantation compared with adult CDCs.

<95>
Accession Number
620888423
Author
Panholzer B.; Jussli-Melchers J.; Huenges K.; Grothusen C.; Kowalski A.;
Schoneich F.; Schottler J.; Cremer J.; Haneya A.
Institution
(Panholzer, Jussli-Melchers, Huenges, Grothusen, Kowalski, Schoneich,
Schottler, Cremer, Haneya) Cardiovascular Surgery, University of
Schleswig-Holstein, Campus Kiel, Kiel, Germany
Title
Mid-term outcome of total arterial myocardial revascularization in
patients older than 70 years.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The aim of our study was to assess the benefit of total
arterial revascularization compared with conventional coronary artery
bypass graft (CABG) surgery for patients older than 70 years. Methods: In
a retrospective study, between 01/2005 and 12/2011, a total of 178
patients older than 70 years (age: 75.2 +/- 4.0 years; 68.5% male)
underwent isolated CABG and total arterial revascularization in our
institution. This cohort was matched for age-, gender- and EuroSCORE to
178 patients who underwent conventional CABG (left internal thoracic
artery plus saphenous veins). Major adverse cardiac and cerebrovascular
events (MACCE) were evaluated. Results: Demographic data were similar in
both groups. In the study group, bilateral internal thoracic arteries were
used in 104 patients (58.4%) and the radial artery grafts were used in 153
patients (86%). Intraoperatively, the number of distal anastomoses (3.6
+/- 0.6 vs. 2.9 +/- 0.8; p < 0.001) was significantly higher in the
control group. Postoperatively, no significant differences in
complications and major morbidity were observed between the groups. 30
days survival (97.2 vs. 96.1%) was similar between the groups. At a median
follow-up of 6.1 +/- 2.7 years (range: 3.2-10.6 years), one-year (97.2 vs.
95.5%), 3 years (96.1 vs. 94.4%) and 5 years (95.5 vs. 92.2%) survival
rates were satisfactory for both groups. However, the study group was
associated with lower rates of repeat revascularization (3.4 vs. 9.6%; p =
0.029). Conclusion: Our analysis suggests that total arterial
revascularization improves clinical outcome of elderly undergoing CABG.
However, randomized, prospective studies with prolonged follow-up are
needed to investigate the role of total arterial revascularization in this
patient Population.

<96>
Accession Number
620888421
Author
Zayat R.; Menon A.; Goetzenich A.; Schaelte G.; Stoppe C.; Simon T.P.;
Tewarie L.; Moza A.; Autschbach R.
Institution
(Zayat, Menon, Goetzenich, Tewarie, Moza, Autschbach) RWTH University
Hospital Aachen, Department of Thoracic and Cardiovascular Surgery,
Aachen, Germany
(Schaelte) RWTH University Hospital Aachen, Department of Anesthesiology,
Aachen, Germany
(Stoppe, Simon) RWTH University Hospital Aachen, Department of Intensive
Care and Intermediate Care, Aachen, Germany
Title
Benefits of ultra-fast-track anesthesia in left ventricular assist device
implantation: Propensity score matched analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Objectives: The use of left ventricular assist devices (LVADs) has gained
significant importance for treatment of end-stage heart failure.
Fast-track procedures are well established in cardiac surgery, whereas
knowledge of their benefits after LVAD implantation is sparse. We
hypothesized that ultra-fast-track anesthesia (UFTA) with intheater
extubation or at a maximum of 4 hour after surgery is feasible in
INTERMACS level 3 and 4 patients and might prevent postoperative
complications. Methods: From March, 2010 to March, 2012, 53 LVADs (50
Heart Mate II and 3 Heart Ware) were implanted in patients in our
department. UFTA was successfully performed (LVAD ultra ) in 13 patients.
After propensity score matching, we compared the LVAD ultra group with a
matched group (LVAD match ) receiving conventional anesthesia management.
Results: Patients in the LVAD ultra group had significantly lower
incidences of pneumonia (p = 0.035), sepsis (p = 0.007), delirium (p =
0.049) and right ventricular failure (p = 0.007). They showed a
significantly higher cardiac index in the first 24 hour (p = 0.023); a
significantly lower central venous pressure (p = 0.014) and a
significantly shorter ICU stay (p = 0.005). Kaplan-Meier analysis after
four years of follow-up showed no significant difference in survival.
Conclusion: In this pilot study, we demonstrated the feasibility of
ultra-fast-track anesthesia in LVAD implantation in patients with
INTERMACS level 3-4. Patients had a lower incidence of postoperative
complications, better hemodynamic performance, shorter length of ICU stay
and lower incidence of RVF after UFTA. Prospective randomized
investigations should examine the preservation of right ventricular
function in larger numbers and identify appropriate selection criteria.

<97>
Accession Number
620888404
Author
Baumgarten H.; Steinmetz C.; Borst C.; Walther T.; Walther C.
Institution
(Baumgarten, Walther) Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim,
Germany
(Steinmetz) Kerckhoff Klinik, Kerckhoff Rehabilitation Center, Bad
Nauheim, Germany
(Borst, Walther) Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
Title
Preoperative exercise training before elective coronary artery bypass
graft surgery: A prospective randomized evaluation on feasibility and
effects on operative outcomes.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: One recommendation for patients with three vessel disease
(3VD) requiring coronary artery bypass graft (CABG) surgery to avoid
further symptomatic acceleration is physical inactivity. We established a
safe preoperative endurance training protocol and evaluate the effects
upon postoperative outcomes. Methods: Patients with stable and
asymptomatic 3VD were assessed by a heart team, gave written informed
consent and were randomized to a training group (TG) and a control group
(CG). Patients refusing to participate in the TG were transferred to the
CG. Patients in the TG completed 6 sessions of aerobic endurance training
within two weeks. Exercise intensity was set at 70% VO<inf>2</inf>peak. An
ergospirometry was performed at baseline, one day prior surgery, and at
the beginning and at the end of cardiac rehabilitation. Baseline,
operative and postoperative characteristics were collected. Results: In
this ongoing study, 69 patients were randomized to TG (n = 21) and CG (n =
48). Mean age was 65.5 +/- 8.13 years in the training group and 68.6 +/-
7.21 years in the control group. 14,3% (n = 3) patients were female in the
TG and 8,8% (n = 4) in the CG. Mean number of bypass graft were 3.3 +/-
1.13 in the training and 3.4 +/- 0.89 in the control group. Complete
revascularization was achieved in all patients, as well as the use of the
left internal mammary artery. There was neither in-hospital nor 30-day
mortality. Maximal oxygen consumption (VO<inf>2</inf>max) was higher in
training patients preoperatively (VO<inf>2</inf>max: 1688 +/- 490 ml/min.
versus 1366 +/- 333 ml/min.) and at the end of rehabilitation
(VO<inf>2</inf>max: 1381 +/- 261 versus 1142 +/- 337). Conclusion:
Exercise training prior CABG for patients with stable 3VD is feasible and
safe for both, the pre- and postoperative period. Preliminary data trend
toward a better oxygen consumption in the training group. Longer follow-
up will be performed.

<98>
Accession Number
620888401
Author
Gorki H.; Nakamura J.; Kunert A.; Hoenicka M.; Liebold A.
Institution
(Gorki, Nakamura, Kunert, Hoenicka, Liebold) Universitat Ulm, Herz-,
Thorax- und Gefaschirurgie, Ulm, Germany
Title
Pericardial fluids or cardiopulmonary bypass: Is there a major culprit for
changes in coagulation and inflammation?.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: Cardiac operations on conventional cardiopulmonary bypass
(CPB) are regularly followed by a rise of coagulation and inflammation
markers. Whether this is caused by CPB itself or rather by direct
recirculation of pericardial fluids is still under debate. Methods: 48
CABG patients operated on with conventional CPB were prospectively
randomized either for recirculation or for cell saving of pericardial
suction fluids. Markers of coagulation and inflammation were measured
before operation and at 4 time points intraoperatively and up to 24 hours
postoperatively. Results: Thrombin-antithrombin-complexes (TAT, half life
time 5 minute) showed lower values intraoperatively (5.8 mug/L [5.4-7.3]
vs. 22.2 mug/L [11.3-38.4]) and at ICU arrival (14.9 mug/L [10.8-19.0] vs.
27.6 mug/L [22.7- 50.7]) in the cell saving group (p < 0.0001). D-dimers
(half life time > 5 hour) tended to remain lower in the cell saving group
intraoperatively and up to 6-hour post-op (p < 0.14). Other markers
(leukocytes p = 0.47, intercellular adhesion molecule 1 p = 0.61, tumor
necrosis factor alpha p = 0.20) were comparable between groups and
increased during the tested time interval. Conclusion: Recirculation of
pericardial shed blood had only short term influence on coagulation
markers in this study on low risk patients. Since TAT is a concisely
reacting marker, it probably best reflects the effect of recirculated
pericardial fluids. The operation on conventional CPB still remains a
culprit for changes in coagulation and inflammation.

<99>
Accession Number
620888399
Author
Reents W.; Boning A.; Kappert U.; Hilker M.; Doenst T.; Ursulescu A.;
Rastan A.; Treede H.; Riess F.C.; Mehlhorn U.; Strauch J.; Zacher M.;
Diegeler A.; Borgermann J.
Institution
(Reents, Zacher, Diegeler) Herz-und Gefasklinik Bad Neustadt,
Kardiochirurgie, Bad Neustadt a. d. Saale, Germany
(Boning) Universitatsklinik Giessen, Klinik fur Herz- und Gefaschirurgie,
Giesen, Germany
(Kappert) Herzzentrum Dresden Universitatsklinik, Dresden, Germany
(Hilker) Universitatsklinikum Regensburg, Klinik und Poliklinik fur Herz,
Thorax- und herznahe Gefaschirurgie, Regensburg, Germany
(Doenst) Universitatsklinik Jena, Klinik fur Herz- und Thoraxchirurgie,
Jena, Germany
(Ursulescu) Robert-Bosch-Krankenhaus, Herzchirurgie, Stuttgart, Germany
(Rastan) Herzzentrum Leipzig GmbH, Klinik fur Herz- und Gefaschirurgie,
Leipzig, Germany
(Treede) Universitares Herzzentrum, Herz- und Gefaschirurgie, Hamburg,
Germany
(Ries) Albertinen Herz- und Gefaszentrum, Kardiochirurgie, Hamburg,
Germany
(Mehlhorn) HELIOS Klinik fur Herzchirurgie Karlsruhe GmbH, Karlsruhe,
Germany
(Strauch) Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil /
Ruhr-Universitat Bochum, Herz- und Thoraxchirurgie, Bochum, Germany
(Borgermann) Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik fur
Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
Title
Stroke after on-pump or off-pump coronary artery bypass
grafting-exploratory analysis of the gopcabe trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: Coronary artery bypass grafting without cardiopulmonary bypass
(off-pump CABG) may reduce severe adverse events including preoperative
stroke. Methods: In the German Off Pump Coronary Artery Bypass in Elderly
patients (GOPCABE) trial, the rate of major adverse cardiovascular events
was compared in 2,394 elderly (>75 years) patients undergoing CABG with
(on-pump) or without (off-pump) CPB. This exploratory post hoc analysis
investigated the impact of surgical aortic manipulation on the rate of
stroke. Results: There was no significant difference in the rate of stroke
within 30 days after surgery between both groups (off-pump: 2.2%; on-pump:
2.7%; odds ratio 0.83 [0.5-1.38]; p = 0.47). Within the off-pump group
different degrees of aortic manipulation did not lead to significant
different stroke rates (tangential clamping: 2.3%; OR: 0.86 [0.47-1.60];
clampless device: 1.8%; OR: 0.53 [0.06-4.69]; no aortic manipulation:
2.4%; OR: 1.19 [0.35-4.06]). An aggregate analysis including more than
10,000 patients out of the four recent major trials also yielded
comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%;
on-pump: 1.7%; OR: 0.87 [0.64-1.20]). Conclusion: Within recent
prospective randomized multicenter trials off-pump CABG did not result in
lower stroke rates. The possible intrinsic benefit of off-pump CABG may be
offset by the complexity of the operative therapy as well as the multiple
pathomechanisms involved in perioperative stroke.

<100>
Accession Number
620888394
Author
Furukawa N.; Kuss O.; Emmel E.; Scholtz S.; Scholtz W.; Becker T.; Fujita
B.; Ensminger S.; Gummert J.; Borgermann J.
Institution
(Furukawa, Emmel, Becker, Fujita, Ensminger, Gummert, Borgermann) Herz-
und Diabeteszentrum NRW, Klinik fur Thorax- und Kardiovaskularchirurgie,
Bad Oeynhausen, Germany
(Kuss) Institut fur Biometrie und Epidemiologie, Deutsches
Diabetes-Zentrum, Leibniz Institut fur Diabetes Research, Dusseldorf,
Germany
(Scholtz, Scholtz) Herz- und Diabeteszentrum NRW, Klinik fur Kardiologie,
Bad Oeynhausen, Germany
Title
Aortic valve replacement via ministernotomy versus transcatheter aortic
valve implantation in intermediate risk patients: Propensity score
analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 46th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2017.
Germany. 65 (Supplement 1) (no pagination), 2017. Date of Publication:
January 2017.
Publisher
Georg Thieme Verlag
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an
established method in inoperable and highrisk patients. The extent to
which the findings from this patient collective are relevant to patients
with only an intermediate risk is unclear. Against this background, we
investigated periprocedural outcome, as well as midterm survival in all
patients who underwent aortic valve replacement (AVR) via ministernotomy,
transapical or transfemoral TAVI at our hospital. Methods: A prospective
register was taken from a single-center recording all aortic valve
replacements via ministernotomy (MIC, n = 1,177), transapical (TA, n =
363) and transfemoral (TF, n = 507) aortic valve implantations during the
period from July 2009 to October 2014. Propensity score matching was
performed based on 24 preoperative risk factors. Results: We were able to
find 92 triplets, MIC versus TA versus TF at moderate risk (EuroScore II
3.5 vs. 3.5 vs. 3.2; STS 4.4 vs. 4.7 vs. 4.6). In the comparison there
were no significant periprocedural differences regarding 30d mortality,
stroke or myocardial infarction. Regarding mid-term survival, the TA
procedure showed a tendency toward a less favorable outcome. Conclusion:
The periprocedural results between MIC, TA and TF are comparable in
patients at intermediate surgical risk. The tendency in the TA group
toward a less favorable survival outcome could be due to an additional
confounding factor, e.g., frailty, for which we were unable to perform
adjustments in this analysis. Long-term data from randomized studies are
required to exclude a tendency toward a less favorable survival outcome
for TAVI compared with MIC-AVR in patients at intermediate-risk.

<101>
Accession Number
620887280
Author
Van Swelm R.; Wetzels J.; Verweij V.; Laarakkers C.; Pertijs J.; Masereeuw
R.; Swinkels D.
Institution
(Van Swelm, Wetzels, Verweij, Laarakkers, Pertijs, Masereeuw, Swinkels)
Radboudumc, Netherlands
Title
Hepcidin: A novel treatment for heme-mediated kidney injury?.
Source
American Journal of Hematology. Conference: 6th Meeting of the
International BioIron Society. China. 91 (3) (pp E203), 2016. Date of
Publication: March 2016.
Publisher
Wiley-Liss Inc.
Abstract
In multiple clinical observational studies it has been demonstrated that
increased urinary hepcidin levels are associated with reduced risk of
developing acute kidney injury (AKI) due to hemolysis and hypoxia in
cardiac surgery patients. This study aimed to get more insight in renal
hepcidin handling and its potential protective effects against
heme-mediated AKI. C57Bl/6 mice were treated with i) a single i.p. dose of
10 mug human hepcidin-25 (hhep25) to study renal handling of systemic
hepcidin, ii) a single i.v. dose of 5 mg hemoglobin (Hb) to induce AKI,
and iii) Hb combined with hhep25 to evaluate the protective effects of
hhep25 on Hb-mediated kidney injury. Hhep25 levels in plasma and urine
were measured and distinguished from murine endogenous hepcidin-1 levels
using matrix-assisted laser desorption/ionization time-of-flight mass
spectrometry (MALDI-TOF MS). Systemically administered hhep25 was cleared
rapidly from plasma and excreted in the urine. Hhep25 was biologically
active in mice as observed by a negative feedback on mouse endogenous
hepcidin1 plasma levels (60% reduction, p<0.05) and hepatic mRNA
expression (10-fold decrease, p<0.05). In addition to hhep25, we also
detected the smaller isoforms hhep22 and hhep20 in urine, but not in
plasma, showing that hhep25 is degraded in the tubular lumen. Urine hhep25
was 20-fold increased in megalin deficient mice compared to control
(p<0.05) and immunofluorescence staining showed that hepcidin was present
in tubules expressing megalin, but NOT in megalin-deficient tubules,
demonstrating that megalin is responsible for hhep25 uptake in the
proximal tubules. Administration of hhep25 simultaneously or 4h after Hb
injection in wildtype mice significantly attenuated the Hb-induced rise in
urinary NGAL (p<0.05) and KIM1 (p<0.05) levels, and renal IL6 (p<0.05) and
NGAL (p<0.05) mRNA expression. Interestingly, simultaneous administration
of Hb and hhep25, but not Hb or hhep25 alone, resulted in an increase in
renal Hamp1 mRNA expression (15 fold, p<0.05), suggesting that besides
systemic filtered hepcidin, also locally produced hepcidin may be involved
in renal protection. Administration of hhep25 to Hb-treated mice reduced
renal mRNA expression of HO-1, DMT1, H-ferritin and Lferritin (all
p<0.05), possibly reflecting the mechanisms by which hepcidin exerts its
protective effects. In conclusion, systemic hepcidin is filtered to the
urine, partly reabsorbed via megalin in the proximal tubules and degraded
in the tubular lumen. Moreover, our data suggest that both systemically
delivered hepcidin and locally produced hepcidin are involved in renal
protection against heme-induced AKI.

<102>
Accession Number
620862454
Author
Gould R.; McFadden S.L.; Sands A.J.; McCrossan B.A.; Horn S.; Prise K.M.;
Doyle P.; Hughes C.M.
Institution
(Gould) Institute of Nursing and Health Research, Ulster University,
Jordanstown Campus, Shore Road, Newtownabbey, United Kingdom
Title
Removal of scatter radiation in paediatric cardiac catheterisation: a
randomised controlled clinical trial.
Source
Journal of radiological protection : official journal of the Society for
Radiological Protection. 37 (3) (pp 742-760), 2017. Date of Publication:
01 Sep 2017.
Abstract
OBJECTIVE: This study sought to determine if DNA integrity was compromised
by ionising radiation from paediatric cardiac catheterisations and if dose
optimisation techniques allowed DNA integrity to be maintained.
MATERIALS AND METHODS: Children were imaged using either: (i) an
anti-scatter grid (current departmental protocol), (ii) no anti-scatter
grid or, (iii) no anti-scatter grid and a 15 cm air-gap between the child
and the x-ray detector. Dose area product and image quality were assessed,
lifetime attributable cancer risk estimates were calculated and DNA
double-strand breakages quantified using the gammaH2AX assay.
RESULTS: Consent was obtained from 70 parents/guardians/children. Image
quality was sufficient for each procedure performed. Removal of the
anti-scatter grid resulted in dose reductions of 20% (no anti-scatter
grid) and 30% (15 cm air-gap), DNA double-strand break reductions of 30%
(no anti-scatter grid) and 20% (15 cm air-gap) and a reduction of
radiation-induced cancer mortality risk of up to 45%.
CONCLUSION: Radiation doses received during paediatric cardiac
catheterisation procedures resulted in a significant increase in DNA
damage while maintaining acceptable image quality and diagnostic efficacy.
It is feasible to remove the anti-scatter grid resulting in a reduction in
DNA damage to the patient. The gammaH2AX assay may be used for assessment
of dose optimisation strategies in children.

<103>
Accession Number
620809982
Author
Li Y.-R.; Tsai S.-S.; Chen D.-Y.; Chen S.-T.; Sun J.-H.; Chang H.-Y.; Liou
M.-J.; Chen T.-H.
Institution
(Li, Tsai, Chen, Sun, Chang, Liou) Division of Endocrinology and
Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital,
Taoyuan, Taiwan (Republic of China)
(Chen) Division of Cardiology, Department of Internal Medicine, Chang Gung
Memorial Hospital, Taoyuan, Taiwan (Republic of China)
(Chen) Division of Cardiology, Department of Internal Medicine, Chang Gung
Memorial Hospital, No.222, Maijin Road, Keelung, Taiwan (Republic of
China)
(Chen) Chang Gung University College of Medicine, Taoyuan, Taiwan
(Republic of China)
Title
Linagliptin and cardiovascular outcomes in type 2 diabetes after acute
coronary syndrome or acute ischemic stroke.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
2. Date of Publication: 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The cardiovascular safety and efficacy of linagliptin, a
dipeptidyl peptidase-4 inhibitor, in patients with type 2 diabetes
mellitus (T2DM) after acute coronary syndrome (ACS) or acute ischemic
stroke (AIS) are unclear. The aim of our real-world cohort study was to
evaluate the cardiovascular outcomes of linagliptin in patients with T2DM
after ACS or AIS. Methods: An open observational noncrossover
retrospective cohort study was conducted between June 1, 2012 and December
31, 2013 utilizing Taiwan National Health Insurance Research Database. A
total of 1203 patients with T2DM after ACS or AIS were selected as the
study cohort. Cardiovascular safety and efficacy of linagliptin were
evaluated by comparing outcomes of 401 subjects receiving linagliptin
after ACS or AIS to 802 matched control subjects not receiving any
incretin-based therapy after ACS or AIS. The primary composite outcome
included cardiovascular death, non-fatal myocardial infarction and
non-fatal ischemic stroke. Results: The primary composite outcome after
15-month follow-up was 7% (28 patients) in the linagliptin group compared
with 6.1% (49 patients) in the control group [hazard ratio (HR) 1.06; 95%
confidence interval (CI).66-1.68]. The linagliptin group also had similar
risks of all-cause mortality, hospitalization for heart failure,
percutaneous coronary intervention and coronary artery bypass grafting
compared to the control group in terms of the secondary outcomes.
Conclusions: In T2DM patients after ACS or AIS, treatment with linagliptin
was not associated with increased risks of cardiovascular death, non-fatal
myocardial infarction, or non-fatal ischemic stroke. Copyright ©
The Author(s). 2018.

EPICORE Embase Updates

Saturday, March 10, 2018

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me