EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
621243862
Author
Beaupre L.A.; Wai E.K.; Hoover D.R.; Noveck H.; Roffey D.M.; Cook D.R.;
Magaziner J.S.; Carson J.L.
Institution
(Beaupre) Department of Physical Therapy, University of Alberta, Edmonton,
AB, Canada
(Wai, Roffey) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada
(Wai) Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa,
ON K1H 8M5, Canada
(Wai) Division of Orthopaedic Surgery, Department of Surgery, The Ottawa
Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
(Hoover) Department of Statistics and Biostatistics, Rutgers University,
The State University of New Jersey, 473 Hill Center, Campus Rutgers Univ.
110 Frelinghuysen Rd, Piscataway, NJ 08854-8019, United States
(Noveck, Carson) Division of General Internal Medicine, Rutgers Robert
Wood Johnson Medical School, Rutgers Biomedical and Health Sciences,
Rutgers, The State University of New Jersey, 125 Paterson St, New
Brunswick, NJ 08901, United States
(Cook) Division of General Internal Medicine, Cumming School of Medicine,
University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, AB
T2N 2T9, Canada
(Magaziner) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood
Street, Baltimore, MD 21201, United States
Title
A comparison of outcomes between Canada and the United States in patients
recovering from hip fracture repair: Secondary analysis of the FOCUS
trial.
Source
International Journal for Quality in Health Care. 30 (2) (pp 97-103),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
Objective: To determine if adjusted mortality, walking ability or return
home differed after hip fracture surgery between Canada and the USA.
Design: Secondary analysis of the Functional Outcomes in Cardiovascular
Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data.
Setting: Data were collected from 47 American and Canadian hospitals.
Participants: Overall, 2016 subjects with a hip fracture (USA = 1222
(60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive
transfusion strategy. Subjects were 50 years and older, with
cardiovascular disease and/or risk factors and hemoglobin <100 g/L within
3 days post-surgery. The average age was 82 years and 1527(76%) subjects
were females. Intervention: Demographics, health status and health
services data were collected up to 60 days post-surgery and mortality to a
median of 3 years post-surgery. Main outcomes: Mortality, inability to
walk and return home. Results: US subjects had higher adjusted mortality
than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval:
1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio =
1.25; 1.07-1.45). There were no differences in adjusted outcomes for
walking ability or return home at 30 or 60 days post-surgery. Median
hospital length of stay was longer (P < 0.0001) in Canada (9 days;
interquartile range: 5-18 days) than the US (3 days; 2-5 days). US
subjects (52.9%) were more likely than Canadians (16.8%) to be discharged
to nursing homes for rehabilitation (P < 0.001). Conclusions: Adjusted
survival favored Canadians post hip fracture while walking ability and
return home were not different between countries. The reason(s) for
mortality differences warrant further investigation.<br/>Copyright &#xa9;
The Author(s) 2018. Published by Oxford University Press in association
with the International Society for Quality in Health Care. All rights
reserved.

<2>
Accession Number
616542972
Author
Glass L.; Conway J.
Institution
(Glass, Conway) Department of Pediatrics, Stollery Children's Hospital,
University of Alberta, Edmonton, Alberta, Canada
Title
Innovation in pediatric clinical trials: The need to rethink the
end-point.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 431-432), 2018. Date
of Publication: April 2018.
Publisher
Elsevier USA

<3>
Accession Number
621224531
Author
Niijima S.; Ohmori T.; Kario K.
Institution
(Niijima, Kario) Jichi Medical University School of Medicine, Division of
Cardiovascular Medicine, Department of Medicine, 3311-1 Yakushiji,
Shimotsuke, Tochigi 329-0498, Japan
(Ohmori) Jichi Medical University School of Medicine, Department of
Biochemistry, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
Title
Differential impact of diabetes mellitus on antiplatelet effects of
prasugrel and clopidogrel.
Source
Thrombosis Journal. 16 (1) (no pagination), 2018. Article Number: 5. Date
of Publication: 15 Mar 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Although prasugrel exerts stronger antiplatelet effects
compared with clopidogrel, the factors affecting platelet reactivity under
prasugrel have not been fully determined. This study aimed to find the
novel mechanistic differences between two thienopyridines and identify the
factor that influence platelet reactivity to each drug. Methods: Forty
patients with stable angina who underwent elective percutaneous coronary
intervention were randomly assigned to receive either prasugrel (20 mg) or
clopidogrel (300 mg) as a loading dose. Platelet function (light
transmission, laser light scattering, and vasodilator-stimulated
phosphoprotein phosphorylation) and plasma active metabolite levels were
measured after the loading dose. Results: Prasugrel consistently inhibited
adenosine diphosphate receptor P2Y<inf>12</inf> signalling to abolish
amplification of platelet aggregation. Prasugrel abolished even small
platelet aggregates composed of less than 100 platelets. On the other
hand, clopidogrel inhibited large aggregates but increased small and
medium platelet aggregates. Diabetes was the only independent variable for
determining antiplatelet effects and active metabolite concentration of
prasugrel, but not clopidogrel. Sleep-disordered breathing was
significantly correlated with platelet reactivity in patients who had
clopidogrel. Conclusions: Prasugrel efficiently abolishes residual
P2Y<inf>12</inf> signalling that causes small platelet aggregates, but
these small aggregates are not inhibited by clopidogrel. Considering the
differential effect of diabetes on antiplatelet effects between these two
drugs, the pharmacokinetics of prasugrel, other than cytochrome P450
metabolism, might be affected by diabetes.<br/>Copyright &#xa9; 2018 The
Author(s).

<4>
Accession Number
621323301
Author
Chaudhary F.A.; Pervaz Z.; Ilyas S.; Niaz M.N.
Institution
(Chaudhary) Cardiothoracic Surgery, Rehmatul-lil-Alameen Institute of
Cardiology, PESSI, University of Lahore, Pakistan
(Pervaz) Cardiac Surgery, Sheikh Zayed Hospital, Lahore, Pakistan
(Ilyas) University of Lahore, Pakistan
(Niaz) Rehmatul-lil-Alameen Institute of Cardiology, PESSI, University of
Lahore, Pakistan
Title
Topical use of tranexamic acid in open heart surgery.
Source
Journal of the Pakistan Medical Association. 68 (4) (pp 538-542), 2018.
Date of Publication: April 2018.
Publisher
Pakistan Medical Association
Abstract
Objective: To determine the efficacy of topical pouring of tranexamic acid
in reducing post-operative mediastinal bleeding, requirement for blood
products and the rate of re-exploration for re-securing haemostasis or
relief of pericardial tamponade after open heart surgery. Method: The
prospective, randomised, placebo-controlled, double-blind comparative
study was conducted from March 2013 to September 2015 at
Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social
Security Institution, Lahore, and comprised patients scheduled for primary
isolated elective or urgent open heart surgery. The subjects were divided
into two equal groups. The hetranexamic acid group received cardiac bath
with 2gm of tranexamic acid diluted in 50mlof normal saline, while the
placebo group received cardiac bath without tranexamic acid. Before the
closure of sternum, the solution was poured into pericardial cavity as
cardiac bath while the chest tubes were temporarily clamped. Data was
entered into a pre-designed proforma. Results: Of the 100 subjects, there
were 50(50%) in each of the two groups. There was no difference in
surgical characteristics and perioperative complications in the groups
(p>0.05). After 48 post-operative hours, total blood loss was
significantly less in the tranexamic acid group compared to the placebo
group (p<0.05). Significantly less number of blood pints were transfused
in the acid group than the placebo group (p<0.05). No patient in the acid
group was re-explored for excessive bleeding compared to 4(8%) in the
placebo group. Conclusion: There was significant reduction in
post-operative blood drainage, need of blood products and rate of
re-exploration after topical use of tranexamic acid in open heart
surgery.<br/>Copyright &#xa9; 2018, Pakistan Medical Association. All
rights reserved.

<5>
Accession Number
621394651
Author
Bozbeyoglu E.; Yildirimturk O.; Canga Y.; Bozbay M.; Gumusdag A.;
Hayiroglu M.I.; Uzun A.O.; Kalenderoglu K.; Cinier G.; Keskin M.; Acarel
M.; Eren M.; Pehlivanoglu S.
Institution
(Bozbeyoglu, Yildirimturk, Bozbay, Gumusdag, Hayiroglu, Uzun,
Kalenderoglu, Cinier, Keskin, Eren) Department of Cardiology, Dr. Siyami
Ersek Chest, Heart and Cardiovascular Surgery Training and Research
Hospital, Istanbul, Turkey
(Pehlivanoglu) Department of Cardiology, Baskent University Istanbul
Health Practice and Research Center, Istanbul, Turkey
(Canga) Department of Cardiology, Kartal Yavuz Selim State Hospital,
Istanbul, Turkey
(Acarel) Department of Anesthesia and Reanimation, Dr. Siyami Ersek Chest,
Heart and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
Title
Clinical characteristics and in-hospital outcomes of patients in intensive
cardiac care unit with the diagnosis of massive pericardial effusion.
Source
Anatolian Journal of Cardiology. Conference: 32nd Turkish Cardiology
Congress. Turkey. 16 (Supplement 1) (pp 56-57), 2016. Date of Publication:
October 2016.
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Patients (pts) admitted to the intensive cardiac care
unit (ICCU) with the diagnosis of massive pericardial effusion (MPE)
usually present with clinical symptoms and findings of hemodynamic
compromise where the diagnosis is made by transthoracic echocardiography
(TTE). There is no data in the literature regarding the prevalence,
clinical characteristics and in-hospital outcomes of pts admitted to the
ICCU with the primary diagnosis of MPE. We intended to analyse the
demographical characteristics and clinical outcomes of these pts. Methods:
The data of 4,829 pts who were admitted to ICCU between Sep 2014 and Jan
2016 was analyzed retrospectively as a part of the ICCU electronic
database of our clinic. 83 (1.72%) pts were admitted with primary
diagnosis of MPE. Pts with MPE secondary to the primary diagnosis of acute
myocardial infarction, percutaneous coronary intervention and other
cardiac interventional complications were excluded from the study.
Results: The mean age of the study population was 62.8 years and 48.2%
were male. Medical history of pts revealed 43% hypertension, 22% diabetes
mellitus, 9.6% congestive heart failure, 4.8% myocardial infarction, 4.8%
coronary revascularization, 8.4% malignancy, 13.3% chronic kidney disease.
On presentation 75.9% had echocardiographic and/or clinical findings of
cardiac tamponade (CTp). Percutaneous pericardiocentesis (PPc) in 48.2%
and surgical pericardial drainage in 22.9% of pts was performed and 28.9%
of pts were followed on medical therapy only. During their ICCU
hospitalization 28 pts (33.7%) developed organ failure/ complication
including acute renal failure (23 pts), acute respiratory failure (6 pts),
nodal rhythm (1 pt), pneumonia (1 pt). 9 pts (10.8%) died during their
ICCU hospitalization. Mortality rates were comparable between different
treatment groups (4, 3 and 2 pts died in surgical drainage, PPc, medical
therapy group respectively) (p=0.42). Mortality rate was not affected by
the presence of CTp (6 pts with vs 3 pts without CTp died, p>0.05), or
organ failure/complication (2 pts with vs 26 pts without organ
failure/complication died, p=0.4). Conclusions: In our study population
primary diagnosis of MPE was a rare clinical condition in ICCU
hospitalized pts. PPc or surgical drainage was performed in 71% of pts in
ICCU with the diagnosis of MPE. One third of the pts developed organ
failure/complication. Treatment choice, presence of CTp or organ failure/
complication did not have an impact on mortality rate.

<6>
Accession Number
621391592
Author
Kishimoto Y.; Nakamura Y.; Harada S.; Onohara T.; Kishimoto S.; Kurashiki
T.; Fujiwara Y.; Nishimura M.
Institution
(Kishimoto, Nakamura, Harada, Onohara, Kishimoto, Kurashiki, Fujiwara,
Nishimura) Department of Cardiovascular Surgery, Tottori University
Faculty of Medicine, Yonago, Japan
Title
Can tolvaptan protect renal function in the early postoperative period of
cardiac surgery?: - Results of a single-center randomized controlled study
-.
Source
Circulation Journal. 82 (4) (pp 999-1007), 2018. Date of Publication:
2018.
Publisher
Japanese Circulation Society
Abstract
Background: Oral administration of tolvaptan, a vasopressin V<inf>2</inf>
receptor antagonist, significantly reduces deterioration of renal
function, which has recently been highlighted as an exacerbating factor
for adverse events in patients with acute heart failure. In the present
study we tested the hypothesis that concomitant administration of
tolvaptan with a conventional diuretic is beneficial for perioperative
body fluid management in patients who have undergone cardiac surgery.
Methods and Results: In all, 280 patients who underwent cardiac surgery
were prospectively randomized to concomitant treatment with tolvaptan and
a conventional diuretic (tolvaptan group; 147 patients) or treatment with
a conventional diuretic alone (control group; 133 patients). Groups were
compared in terms of the time required to restore preoperative body weight
and the incidence of worsening renal function (WRF), defined as an
increase in the serum creatinine level >=0.3 mg/dL. The time required to
restore preoperative body weight was significantly shorter in the
tolvaptan than control group (mean [+/-SD] 3.97+/-1.95 vs. 5.02+/-2.83
days, respectively; P<0.001). The incidence of WRF was significantly lower
in the tolvaptan than control group (n=11 [7.5%] vs. n=25 [18.8%],
respectively; P=0.011). Conclusions: Administration of tolvaptan with
conventional diuretics in the early postoperative period after cardiac
surgery could be beneficial in maintaining urine output without affecting
renal function and may thus help avoid WRF.<br/>Copyright &#xa9; 2018,
Japanese Circulation Society. All rights reserved.

<7>
Accession Number
2000591017
Author
Nakao T.; Nakamura T.; Masuda K.; Matsuyama T.; Ushigome H.; Ashihara E.;
Yoshimura N.
Institution
(Nakao, Nakamura, Masuda, Matsuyama, Ushigome, Yoshimura) Department of
Organ Transplantation and Regenerative Surgery, Graduate School of Medical
Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
(Ashihara) Department of Clinical and Translational Physiology, Kyoto
Pharmaceutical University, Kyoto, Japan
Title
Dexamethasone Prolongs Cardiac Allograft Survival in a Murine Model
Through Myeloid-derived Suppressor Cells.
Source
Transplantation Proceedings. 50 (1) (pp 299-304), 2018. Date of
Publication: January - February 2018.
Publisher
Elsevier USA
Abstract
Background: Recently, myeloid-derived suppressor cells (MDSCs) have
attracted considerable attention because of their cancer-promoting and
immunosuppressive effects. The glucocorticoid dexamethasone (Dex) is an
important immunosuppressive agent used to treat autoimmune diseases and
organ transplant rejection. However, the mechanism by which it modulates
the immune system is not completely understood. Material and Methods: In
this study, we investigated the mechanisms by which Dex modulated the
immune response in mice given an allogeneic cardiac transplant. Results:
Dex injection significantly prolonged heart graft survival compared with
phosphate-buffered saline-injected controls. Dex treatment increased the
number of splenic MDSCs. Moreover, Gr-1^high/CD11b⁺
MDSCs and CD3⁺/CD4⁺/Foxp3⁺ regulatory T
cells (Tregs) were significantly increased in the Dex group compared with
controls. Administration of anti-Gr-1 antibody (Ab) to the Dex group
significantly shortened mouse heart graft survival. In addition, anti-Gr-1
Ab treatment significantly reduced Tregs in the Dex + anti-Gr-1
co-treatment group compared with the Dex group. These observations suggest
that Dex treatment increased both MDSCs and Tregs, and that MDSCs
regulated the incidence of Tregs in this immunosuppressive pathway.
Conclusion: An important role of Dex in the prevention of the rejection of
cardiac grafts in mice is to expand MDSCs and Tregs.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<8>
Accession Number
621319794
Author
Zhu Z.; Zhou H.; Ni Y.; Wu C.; Zhang C.; Ling X.
Institution
(Zhu, Zhou, Ni, Wu, Zhang) Department of Anesthesiology, the Second
Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
(Ling) Outpatient-Nursing Department, the Second Affiliated Hospital of
Jiaxing University, Jiaxing, Zhejiang, China
Title
Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A
systematic review and meta-analysis.
Source
Drug Design, Development and Therapy. 12 (pp 521-531), 2018. Date of
Publication: 12 Mar 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Cardiac surgery patients always present with atrial fibrillation
(AF) after admission to the intensive care unit, leading to high mortality
and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication
used for sedation in the intensive care unit; however, whether it can
reduce AF needs to be analyzed. Materials and methods: Three primary
databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of
Controlled Trials (CENTRAL), were searched. All English language and
randomized control designed clinical publications comparing DEX to control
medicines for sedation after elective cardiac surgery were included. Two
independent colleagues conducted the data extraction and quality
assessments. The subgroup analysis was performed according to the medicine
used, age, AF history, and whether previous beta-blocker premedication and
cardiopulmonary bypass (CPB) were applied. The overall incidence of AF was
analyzed. Results: A total of 1,295 patients in nine studies met the
selection criteria among 2,587 studies screened from the database. After
quantitative synthesis, our results revealed that the DEX group was not
associated with a decreased incidence of AF compared with the placebo
(risk ratio [RR] 0.76, 95% CI 0.37, 1.55, P=0.44) and morphine groups (RR
0.86, 95% CI 0.56, 1.31, P=0.48). Subgroup analysis also indicated that
the DEX vs propofol comparison exhibited no difference: 1) for patients of
age >60 years (P=0.69) or <=60 years (P=0.69); 2) under CPB surgery
(P=0.45) or without CPB surgery (P=0.88); 3) with beta-blocker
premedication (P=0.32) or without beta-blocker premedication (P=0.90); and
4) with AF history (RR 1.07, 95% CI 0.85, 1.36, P=0.57) or without AF
history (P=0.30). Conclusion: This meta-analysis revealed that DEX could
not reduce the incidence of AF compared to control medicines following
cardiac surgery. DEX may have an increased influence on AF occurrence if
patients had a history of AF. However, cautious interpretation should be
made due to high clinical heterogeneity.<br/>Copyright &#xa9; 2018 Zhu et
al.

<9>
Accession Number
621393615
Author
Habib A.M.; Elsherbeny A.G.; Almehizia R.A.
Institution
(Habib) Department of Intensive Care, Prince Sultan Cardiac Center, Adult
Cardiac (Surgical) Intensive Care Unit, Prince Sultan Military Medical
City, P. O. Box 7897-X966, Riyadh 11159, Saudi Arabia
(Habib) Department of Critical Care Medicine, Faculty of Medicine, Cairo
University, Cairo, Egypt
(Elsherbeny) Department of Anesthesia, Prince Sultan Cardiac Center,
Prince Sultan Military Medical City, Riyadh, Saudi Arabia
(Elsherbeny) Department of Anesthesia and Intensive Care, Faculty of
Medicine, Cairo University, Cairo, Egypt
(Almehizia) Heart Center Clinical Pharmacist, King Faisal Specialist
Hospital and Research Center, Riyadh, Saudi Arabia
Title
Methylene blue for vasoplegic syndrome postcardiac surgery.
Source
Indian Journal of Critical Care Medicine. 22 (3) (pp 168-173), 2018. Date
of Publication: 01 Mar 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objectives: cardiopulmonary bypass (CPB) can be complicated by vasoplegia
that is refractory to vasopressors. Methylene blue (MB) represents an
alternative in such cases. Patients and Methods: Retrospective
observational historical control-matched study. From 2010 to 2015, all
patients who received MB for vasoplegia post-CPB were included in this
study. Historical controls from the period of 2004 to 2009 were matched.
End-points were the time till improvement of vasoplegia (Ti), 30-day
mortality, cardiac surgical Intensive Care Unit (CSICU) morbidity, and
length of stay (LOS). Results: Twenty-eight patients were matched in both
groups. There were no statistically significant differences between the
two groups in demographic, laboratory data on admission, or hemodynamic
profile before use of MB. Ti and time to complete discontinuation of
vasopressors were statistically significant less in MB group (8.2 +/- 2.6
vs. 29.7 +/- 6.4, P = 0.00 and 22.6 +/- 5.2 vs. 55.3 +/- 9.4, P = 0.00)
respectively. Mortality at day 30 was significantly higher in controls
compared to MB (1 patient [3.6%] vs. 6 patients [21.4%], long rank P =
0.04). CSICU, hospital LOS, and incidence of renal failure was
significantly higher in control group (12.4 +/- 3.7 vs. 7 +/- 1.4, P =
0.03), (19.5 +/- 2.4 vs. 10.9 +/- 3.2, P = 0.05) and (9 patients [32.1%]
vs. 2 patients [7.1%], P = 0.04), respectively. Duration of mechanical
ventilation was less in MB patients; however, did not reach statistical
significance. Conclusions: the use of MB for vasoplegia postcardiac
surgery was associated with rapid recovery of hemodynamics, shorter need
for vasopressors, less ICU mortality, less incidence of renal failure, and
shorter LOS.<br/>Copyright &#xa9; 2018 Medknow Publications. All rights
reserved.

<10>
Accession Number
2000574321
Author
Alrifai A.; Soud M.; Kabach A.; Jobanputra Y.; Masrani A.; El Dassouki S.;
Chadi Alraies M.; Fanari Z.
Institution
(Alrifai, Jobanputra) University of Miami/JFK Medical Center, Atlantis,
FL, United States
(Soud) MedStar Heart and Vascular Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Kabach) Creighton University, School of Medicine, Omaha, NE, United
States
(Masrani) Mallinckrodt Institute of Radiology, Washington University in St
Louis, St Louis, MO, United States
(El Dassouki) Jackson Memorial Hospital/University of Miami, Miller School
of Medicine, Division of Cardiovascular Medicine, Miami, FL, United States
(Chadi Alraies) Wayne State University, Detroit Medical Center, Detroit,
MI, United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine, Wichita, KS, United States
Title
Dual antiplatelet therapy versus single antiplatelet therapy after
transaortic valve replacement: Meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The current guidelines recommend empirical therapy with DAPT
of aspirin and clopidogrel for six months after TAVR. This recommendation
is based on expert consensus only. Giving the lack of clear consensus on
treatment strategy following TAVR. Goal of this meta-analysis is to assess
the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual
antiplatelet therapy (DAPT) following transcatheter aortic valve
replacement (TAVR). Methods and Materials: We performed a meta-analysis
from randomized clinical trials (RCTs) and prospective studies that tested
DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients.
The primary efficacy outcomes were 30 days mortality and stroke. The
primary safety outcomes were major bleeding and major vascular
complications. Results: We included 603 patients from 4 studies. The use
of MAPT was associated with similar mortality rate (5.9% vs. 6.6%; RR =
0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT (1.3%
vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no difference
in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to
1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR 0.58;
95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with
significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI
0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs.
3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). Conclusion: MAPT use after
TAVR is associated with lower rates of major bleeding compared with DAPT
with no significant difference in mortality, stroke or vascular
complications.<br/>Copyright &#xa9; 2018

<11>
Accession Number
2000571932
Author
Zangrillo A.; Alvaro G.; Belletti A.; Pisano A.; Brazzi L.; Calabro M.G.;
Guarracino F.; Bove T.; Grigoryev E.V.; Monaco F.; Boboshko V.A.;
Likhvantsev V.V.; Scandroglio A.M.; Paternoster G.; Lembo R.; Frassoni S.;
Comis M.; Pasyuga V.V.; Navalesi P.; Lomivorotov V.V.
Institution
(Zangrillo, Belletti, Calabro, Bove, Monaco, Scandroglio, Lembo, Frassoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy, United States
(Zangrillo) Vita-Salute San Raffaele University, Milan, Italy, United
States
(Alvaro, Navalesi) Department of Anesthesia and Intensive Care, AOU Mater
Domini Germaneto, Catanzaro, Italy, United States
(Pisano) Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei
Colli - Monaldi Hospital, Naples, Italy, United States
(Brazzi) Department of Anesthesia and Intensive Care, AOU Citta della
Salute e della Scienza, Turin, Italy, United States
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy, United States
(Guarracino) Division of Cardiothoracic Anesthesia and Intensive Care,
Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa,
Italy, United States
(Grigoryev) Department of Anesthesiology and Intensive Care, State
Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo,
Russia, United States
(Boboshko, Lomivorotov) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Center, Novosibirsk, Russia, United
States
(Likhvantsev) Department of Anesthesiology and Intensive Care, Moscow
Regional Clinical and Research Institute, Moscow, Russia, United States
(Paternoster) Department of Anesthesia and Intensive Care, San Carlo
Hospital, Potenza, Italy, United States
(Comis) Department of Cardiovascular Anesthesia and Intensive Care, AO
Ordine Mauriziano, Turin, Italy, United States
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russia, United States
(Navalesi) Department of Medical and Surgical Sciences, Magna Graecia
University, Catanzaro, Italy, United States
Title
Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With
Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A
Substudy of a Multicenter Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: Acute kidney injury (AKI) occurs frequently after cardiac
surgery. Levosimendan might reduce the incidence of AKI in patients
undergoing cardiac surgery. The authors investigated whether levosimendan
administration could reduce AKI incidence in a high-risk cardiac surgical
population. Design: Post hoc analysis of a multicenter randomized trial.
Setting: Cardiac surgery operating rooms and intensive care units of 14
centers in 3 countries. Participants: The study comprised 90 patients who
underwent mitral valve surgery with an estimated glomerular filtration
rate <60 mL/min/1.73 m² and perioperative myocardial
dysfunction. Interventions: Patients were assigned randomly to receive
levosimendan (0.025-0.2 mug/kg/min) or placebo in addition to standard
inotropic treatment. Measurements and Main Results: Forty-six patients
were assigned to receive levosimendan and 44 to receive placebo.
Postoperative AKI occurred in 14 (30%) patients in the levosimendan group
versus 23 (52%) in the placebo group (absolute difference -21.8; 95%
confidence interval -41.7 to -1.97; p = 0.035). The incidence of major
complications also was lower (18 [39%]) in the levosimendan group versus
that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to
-6.90]; p = 0.011). A trend toward lower serum creatinine at intensive
care unit discharge was observed in the levosimendan group (1.18
[0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76]
mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07).
Conclusions: Levosimendan may improve renal outcome in cardiac surgery
patients with chronic kidney disease undergoing mitral valve surgery who
develop perioperative myocardial dysfunction. Results of this exploratory
analysis should be investigated in future properly designed randomized
controlled trials.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<12>
Accession Number
2000571905
Author
Conte S.M.; Florisson D.S.; De Bono J.A.; Davies R.A.; Newcomb A.E.
Institution
(Conte, Florisson, De Bono, Davies, Newcomb) Cardiothoracic Surgery
Department, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
Title
Levosimendan Following Cardiac Surgery.
Source
Heart Lung and Circulation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Ltd
Abstract
A best evidence topic was written to address if perioperative levosimendan
improves mortality following cardiac surgery. Fourteen papers represented
the best available evidence. An older meta-analysis summarising 11 of
these trials concluded that there were fewer deaths in the levosimendan
group compared to the control group (OR 0.41, p < 0.001) however, this was
driven by the results of three included trials by the same author. Three
larger and more recent randomised controlled trials failed to demonstrate
significant differences in mortality. We conclude that levosimendan lacks
robust evidence to substantiate claims of mortality benefit in cardiac
surgery patients and should not be used routinely in such
patients.<br/>Copyright &#xa9; 2018 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<13>
Accession Number
612700970
Author
Wallen M.P.; Skinner T.L.; Pavey T.G.; Hall A.; Macdonald G.A.; Coombes
J.S.
Institution
(Wallen, Skinner, Coombes) Centre for Research on Exercise, Physical
Activity and Health (CRExPAH), School of Human Movement and Nutrition
Sciences, The University of Queensland, Brisbane, Queensland, Australia
(Macdonald) School of Medicine, The University of Queensland, Brisbane,
Queensland, Australia
(Macdonald) Department of Gastroenterology and Hepatology, Princess
Alexandra Hospital, Brisbane, Queensland, Australia
(Hall) Department of Anaesthesia, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
(Pavey) School of Exercise and Nutrition Sciences, Queensland University
of Technology, Brisbane, Queensland, Australia
Title
Safety, adherence and efficacy of exercise training in solid-organ
transplant candidates: A systematic review.
Source
Transplantation Reviews. 30 (4) (pp 218-226), 2016. Date of Publication:
01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Background Patients awaiting solid-organ transplantation may be encouraged
to undertake exercise training to improve pre- and post-transplant
outcomes. However, the safety, adherence and efficacy of exercise training
in this population remain unclear. Methods All randomized, non-randomized
and non-controlled trials of exercise training interventions in
solid-organ transplant candidates were included. The Cochrane risk of bias
tool and a modified Newcastle-Ottawa scale were used to assess procedural
quality. Safety was defined as the number of reported adverse events
during exercise training. Adherence was evaluated from session attendance,
and efficacy as changes in cardiorespiratory fitness (CRF), exercise
capacity, muscular strength, health-related quality of life (HR-QoL) and
lung function. Results Eleven studies involving 874 patients were
included: four randomized controlled, one non-randomized controlled and
six non-controlled trials. Six studies included heart transplant
candidates and five involved patients awaiting lung transplantation. Three
trials included aerobic-only training, one incorporated resistance-only
exercise and seven combined modalities. Twelve adverse events were
reported with four due to exercise, although methods to collect these data
were often omitted. Exercise adherence ranged from 82.5% to 100%, but was
poorly described. No significant between-group changes attributable to
exercise training were demonstrated. However, significant within-group
improvements in CRF, exercise capacity, muscular strength, lung function
and HR-QoL were observed. Conclusions Patients awaiting heart or lung
transplant appear to tolerate exercise training despite the larger number
of adverse events compared to other high-risk populations. Exercise
training demonstrated within-group benefits for several outcomes, with no
significant between-group differences. Randomized controlled trials with
sufficient statistical power are required for all solid-organ transplant
candidates.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<14>
Accession Number
621250003
Author
Grundmann F.; Muller R.-U.; Reppenhorst A.; Hulswitt L.; Spath M.R.;
Kubacki T.; Scherner M.; Faust M.; Becker I.; Wahlers T.; Schermer B.;
Benzing T.; Burst V.
Institution
(Grundmann, Muller, Reppenhorst, Hulswitt, Spath, Kubacki, Schermer,
Benzing, Burst) Department II of Internal Medicine, Center for Molecular
Medicine Cologne, University of Cologne, Germany
(Muller, Schermer, Benzing) Cologne Excellence Cluster on Cellular Stress
Responses in Aging-Associated Diseases (CECAD), University of Cologne,
Germany
(Scherner, Faust, Wahlers) Department of Cardiothoracic Surgery,
University of Cologne, Germany
(Faust) Center for Endocrinology, Diabetes and Preventive Medicine,
University of Cologne, Germany
(Becker) Institute of Medical Statistics and Computational Biology,
University of Cologne, Germany
Title
Preoperative short-term calorie restriction for prevention of acute kidney
injury after cardiac surgery: A randomized, controlled, open-label, pilot
trial.
Source
Journal of the American Heart Association. 7 (6) (no pagination), 2018.
Article Number: e008181. Date of Publication: 20 Mar 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury is a frequent complication after cardiac
surgery and is associated with adverse outcomes. Although short-term
calorie restriction (CR) has proven protective in rodent models of acute
kidney injury, similar effects have not yet been demonstrated in humans.
Methods and Results--CR_KCH (Effect of a Preoperative Calorie Restriction
on Renal Function After Cardiac Surgery) is a randomized controlled trial
in patients scheduled for cardiac surgery. Patients were randomly assigned
to receive either a formula diet containing 60% of the daily energy
requirement (CR group) or ad libitum food (control group) for 7 days
before surgery. In total, 82 patients were enrolled between April 16,
2012, and February 5, 2015. There was no between-group difference in the
primary end point of median serum creatinine increment after 24 hours
(control group: 0.0 mg/dL [-0.1 - (+0.2) mg/dL]; CR group: 0.0 mg/dL [-0.2
- (+0.2) mg/dL]; P=0.39). CR prevented a rise in median creatinine at 48
hours (control group: +0.1 mg/dL [0.0 - 0.3 mg/dL]; CR group: -0.1 mg/dL
[-0.2 - (+0.1) mg/dL]; P=0.03), with most pronounced effects observed in
male patients and patients with a body mass index > 25. This benefit
persisted until discharge: Median creatinine decreased by 0.1 mg/dL (-0.2
- 0.0 mg/dL) in the CR group, whereas it increased by 0.1 mg/dL (0.0 - 0.3
mg/dL; P=0.0006) in the control group. Incidence of acute kidney injury
was reduced by 5.8% (41.7% in the CR group compared with 47.5% in the
control group). Safety-related events did not differ between groups.
Conclusions--Despite disappointing results with respect to creatinine rise
within the first 24 hours, the benefits observed at later time points and
the subgroup analyses suggest the protective potential of short-term CR in
patients at risk for acute kidney injury, warranting further
investigation.<br/>Copyright &#xa9; 2018 The Authors.

<15>
Accession Number
621249995
Author
Scott D.A.; Evered L.; Maruff P.; MacIsaac A.; Maher S.; Silbert B.S.
Institution
(Scott, Evered, Maher, Silbert) Centre for Anaesthesia and Cognitive
Function, Department of Anaesthesia and Acute Pain Medicine, St Vincent's
Hospital, Melbourne, Australia
(MacIsaac) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Scott, Evered, Silbert) Anaesthesia, Perioperative and Pain Medicine
Unit, Melbourne Medical School, University of Melbourne, Australia
(MacIsaac) Department of Medicine, University of Melbourne, Australia
(Maruff) Florey Institute for Neuroscience and Mental Health, Parkville,
VIC, Australia
Title
Cognitive function before and after left heart catheterization.
Source
Journal of the American Heart Association. 7 (6) (no pagination), 2018.
Article Number: e008004. Date of Publication: 20 Mar 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Hospital procedures have been associated with cognitive change
in older patients. This study aimed to document the prevalence of mild
cognitive impairment in individuals undergoing left heart catheterization
(LHC) before the procedure and the incidence of cognitive decline to 3
months afterwards. Methods and Results--We conducted a prospective,
observational, clinical investigation of elderly participants undergoing
elective LHC. Cognition was assessed using a battery of written tests and
a computerized cognitive battery before the LHC and then at 3 months
afterwards. The computerized tests were also administered at 24 hours (or
discharge) and 7 days after LHC. A control group of 51 community
participants was recruited to calculate cognitive decline using the
Reliable Change Index. Of 437 participants, mild cognitive impairment was
identified in 226 (51.7%) before the procedure. Computerized tests
detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5%
at 7 days. At 3 months, written tests detected an incidence of cognitive
decline of 13.1% and computerized tests detected an incidence of 8.5%.
Cognitive decline at 3 months using written tests was associated with
increasing age, whereas computerized tests showed cognitive decline was
associated with baseline amnestic mild cognitive impairment, diabetes
mellitus, and prior coronary stenting. Conclusions--More than half the
patients aged > 60 years presenting for LHC have mild cognitive
impairment. LHC is followed by cognitive decline in 8% to 13% of
individuals at 3 months after the procedure. Subtle cognitive decline both
before and after LHC is common and may have important clinical
implications.<br/>Copyright &#xa9; 2018 The Authors.

<16>
Accession Number
621249873
Author
Junejo F.; Akhtar M.I.; Hamid M.; Ahmed S.S.; Minai F.; Amanullah M.
Institution
(Junejo, Akhtar, Hamid, Ahmed, Minai, Amanullah) Department of
Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan
Title
Comparison between intravenous boluses versus infusion of tranexamic acid
(TXA) to reduce bleeding in paediatric cyanotic congenital heart disease
(CHD) surgeries.
Source
Journal of the College of Physicians and Surgeons Pakistan. 28 (3) (pp
180-183), 2018. Date of Publication: 01 Mar 2018.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare the intravenous boluses and intravenous continuous
infusion of tranexamic acid (TXA) to reduce postoperative bleeding in
cyanotic congenital heart disease surgeries. Study Design: Single-blinded
randomised clinical trial. Place and Duration of Study: Anaesthesia
Department, The Aga Khan University Hospital, Karachi, from July 2016 to
April 2017. Methodology: Sixty patients of cyanotic congenital heart
disease, undergoing either palliative or corrective surgery involving
cardiopulmonary bypass (CPB), were recruited. These 60 patients were
divided randomly into two groups. The infusion group received intravenous
infusion of TXA at 5 mg/kg/hour while the bolus group received three
intravenous boluses of 10 mg/kg after induction, after going to bypass and
after protamine reversal. Data was collected through predesigned proforma.
There were two primary outcomes: postoperative bleeding in the first 24
hours, and chest closure time. Results: Postoperative bleeding was 13.94
(10.27-20.18) ml/kg in the first 24 hours in infusion group and 15.05
(9.04- 23.50) ml/kg in the bolus group. Chest closure time was 38.5
(25-45) in infusion group and 30 (20-46.25) minutes in the bolus group.
There was no statistically significant and clinical difference between
both groups regarding postoperative bleeding in the first 24 hours and
chest closure time. Conclusion: These infusion and bolus groups had
comparable postoperative bleeding and chest closure time.<br/>Copyright
&#xa9; Journal of the College of Physicians and Surgeons Pakistan 2018.

<17>
Accession Number
621211160
Author
He S.-J.; Liu Q.; Li H.-Q.; Tian F.; Chen S.-Y.; Weng J.-X.
Institution
(He, Liu, Li, Tian, Chen, Weng) Department of Cardiology, Shenzhen Sun
Yat-sen Cardiovascular Hospital, Shenzhen, China
Title
Role of statins in preventing cardiac surgery-associated acute kidney
injury: An updated meta-analysis of randomized controlled trials.
Source
Therapeutics and Clinical Risk Management. 14 (pp 475-482), 2018. Date of
Publication: 05 Mar 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: The prevention of cardiac surgery-associated acute kidney
injury (CSA-AKI) by statins remains controversial. Therefore, the present
meta-analysis including randomized controlled trials (RCTs) was performed
to assess the effect of perioperative statin on CSA-AKI. Methods: Two
reviewers independently searched for RCTs about perioperative statin for
prevention of CSA-AKI. The primary endpoint was CSA-AKI. Relative risk was
calculated between statin and placebo for preventing CSA-AKI using the
random-effect model or fixed-effect model according to different
heterogeneity. Results: Eight RCTs met inclusion criteria, including five
studies with atorvastatin, two with rosuvastatin, and one with
simvastatin. There were 1,603 patients receiving statin treatment and
1,601 with placebo. Perioperative statin therapy did not reduce the
incidence of CSA-AKI (relative risk =1.17, 95% CI: 0.98-1.39, p=0.076).
Furthermore, perioperative statin increased the risk of CSA-AKI in the
subgroup analysis with clear definition of CSA-AKI and those with JADAD
score >3. Perioperative rosuvastatin produced slightly significantly
higher risk of AKI than atorvastatin therapy (p=0.070). Statin
intervention both pre and post surgery slightly increased the risk of
CSA-AKI versus preoperative statin therapy alone (p=0.040). Conclusions:
Perioperative statin therapy might increase the risk of CSA-AKI after
cardiac surgery.<br/>Copyright &#xa9; 2018 He et al.

<18>
Accession Number
621195497
Author
Piccioni F.; Segat M.; Falini S.; Umari M.; Putina O.; Cavaliere L.;
Ragazzi R.; Massullo D.; Taurchini M.; Naja C.D.; Droghetti A.
Institution
(Piccioni) Department of Critical Care Medicine and Support Therapy,
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
(Segat, Falini, Umari) Department of Perioperative Medicine, Intensive
Care and Emergency, Cattinara University Hospital, Trieste, Italy
(Putina) Anesthesiology and Intensive Care Unit, Mantova, Italy
(Cavaliere) Anesthesiology and Intensive Care Unit I, IRCCS Casa Sollievo
della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
(Ragazzi) Department of Morphology, Surgery and Experimental Medicine,
Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
(Massullo) Anesthesiology and Intensive Care Unit, Azienda Ospedaliera
Sant'Andrea, Rome, Italy
(Taurchini, Naja) Department of Thoracic Surgery, IRCCS Casa Sollievo
della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
(Droghetti) Thoracic Surgery Division, Mantova, Italy
Title
Enhanced recovery pathways in thoracic surgery from Italian VATS Group:
Perioperative analgesia protocols.
Source
Journal of Thoracic Disease. 10 (Supplement4) (pp S555-S563), 2018. Date
of Publication: 01 Mar 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive
technique that allows a faster recovery after thoracic surgery. Although
enhanced recovery after surgery (ERAS) principles seem reasonably
applicable to thoracic surgery, there is little literature on the
application of such a strategy in this context. In regard to pain
management, ERAS pathways promote the adoption of a multimodal strategy,
tailored to the patients. This approach is based on combining systemic and
loco-regional analgesia to favour opioid-sparing strategies. Thoracic
paravertebral block is considered the first-line loco-regional technique
for VATS. Other techniques include intercostal nerve block and serratus
anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol
are essential part of the multimodal treatment of pain. Also, adjuvant
drugs can be useful as opioid-sparing agents. Nevertheless, the treatment
of postoperative pain must take into account opioid agents too, if
necessary. All above is useful for careful planning and execution of a
multimodal analgesic treatment to enhance the recovery of patients. This
article summarizes the most recent evidences from literature and authors'
experiences on perioperative multimodal analgesia principles for
implementing an ERAS program after VATS lobectomy.<br/>Copyright
&#xa9;2009 - 2018 AME Publishing Company.

<19>
Accession Number
621323224
Author
Cao J.Y.; Lee S.Y.; Phan K.; Ayer J.; Celermajer D.S.; Winlaw D.S.
Institution
(Cao, Lee, Phan, Ayer, Celermajer, Winlaw) Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Phan) NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private
Hospital, Sydney, NSW, Australia
(Ayer, Winlaw) Heart Centre for Children, The Children's Hospital at
Westmead, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
Title
Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis
of Studies Comparing the Hybrid and Norwood Procedures.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 9 (2) (pp
224-233), 2018. Date of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The hybrid strategy is an alternative to the traditional Norwood procedure
for initial palliation of infants with hypoplastic left heart syndrome
(HLHS) who are deemed to be at high surgical risk. Numerous single-center
studies have compared the two procedures, showing similar early outcomes,
although the cohort sizes are likely insufficiently powered to detect
significant differences. The current meta-analysis aims to explore the
early morbidity and mortality associated with the hybrid compared to the
Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were
systematically searched, and 14 studies were included for statistical
synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality
was significantly higher in the hybrid patients (relative risk [RR] =
1.54, P <.05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage
mortality was comparable between the two groups (RR = 0.88, P >.05, 95%
CI: 0.46-1.70). Six-month (RR = 0.89, P <.05, 95% CI: 0.80-1.00) and
one-year (RR = 0.88, P <.05, 95% CI: 0.78-1.00) transplant-free survival
was also inferior among the hybrid patients. Furthermore, the hybrid
patients required more reinterventions following initial surgical
palliation (RR = 1.48, P <.05, 95% CI: 1.09-2.01), although the two groups
had comparable length of hospital and intensive care unit stay
postoperatively. In conclusion, our results suggest that the hybrid
procedure is associated with worse early survival compared to the
traditional Norwood when used for initial palliation of infants with HLHS.
However, due to the hybrid being used preferentially for high-risk
patients, definitive conclusions regarding the efficacy of the procedure
cannot be drawn.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<20>
Accession Number
613819482
Author
Langlois P.L.; Hardy G.; Manzanares W.
Institution
(Langlois) Department of Anesthesiology and Reanimation, Faculty of
Medicine and Health Sciences, Sherbrooke University Hospital, Sherbrooke,
Quebec, Canada
(Hardy) Ipanema Research Trust, Auckland, New Zealand
(Manzanares) Department of Critical Care, Intensive Care Unit, University
Hospital, Faculty of Medicine, UDELAR, Montevideo, Uruguay
Title
Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An
updated systematic review and meta-analysis.
Source
Clinical Nutrition. 36 (3) (pp 737-746), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Background Omega-3 polyunsaturated fatty acids (omega-3 PUFA)
supplementation is an attractive therapeutic option for patients
undergoing open-heart surgery due to their anti-inflammatory and
anti-arrhythmic properties. Several randomized controlled trials (RCT)
have found contradictory results for perioperative omega-3 PUFA
administration. Therefore, we conducted an updated systematic review and
meta-analysis evaluating the effects of perioperative omega-3 PUFA on some
clinically important outcomes for cardiac surgery. Methods A systematic
literature search was conducted to find RCT evaluating clinical outcomes
after omega-3 PUFA therapy in adult patients undergoing cardiac surgery.
Intensive care unit (ICU) length of stay (LOS) was the primary outcome;
secondary outcomes were hospital LOS, postoperative atrial fibrillation
(POAF), mortality and duration of mechanical ventilation (MV). Predefined
subgroup analysis and sensibility analysis were performed. Results A total
of 19 RCT including 4335 patients met inclusion criteria. No effect of
omega-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95%
confidence interval, CI -10.28 to 4.39, P = 0.43). However, omega-3 PUFA
reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and
POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No
effects were found on mortality or MV duration. Heterogeneity remained in
subgroup analysis and we found a significant POAF reduction when omega-3
PUFA doses were administered to patients exposed to extra-corporeal
circulation. Oral/enteral administration seemed to further reduce POAF.
Conclusions In patients undergoing cardiac surgery, omega-3 PUFA
supplementation by oral/enteral and parenteral route reduces hospital LOS
and POAF. Nonetheless considerable clinical and statistical heterogeneity
weaken our findings.<br/>Copyright &#xa9; 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<21>
Accession Number
610253343
Author
Seres D.S.; Ippolito P.R.
Institution
(Seres, Ippolito) Division of Preventive Medicine and Nutrition,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Seres) Institute of Human Nutrition, Columbia University Medical Center,
New York, NY, United States
Title
Pilot study evaluating the efficacy, tolerance and safety of a
peptide-based enteral formula versus a high protein enteral formula in
multiple ICU settings (medical, surgical, cardiothoracic).
Source
Clinical Nutrition. 36 (3) (pp 706-709), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Introduction Predigested, peptide-based enteral formulas are commonly used
to promote GI tolerance in critically ill patients, but studies comparing
these against polymeric enteral formulas are lacking. We performed a
prospective, randomized clinical comparison pilot study to assess safety,
tolerance and effectiveness of a peptide-based enteral product. Methods
Critically ill patients from ICUs, including medical, surgical, and
cardiothoracic, were randomized to either of two enteral feeding products:
Group A: Peptide-based, high Protein, high omega-3 fat (Vital
AF, Abbott Nutrition); Group B: high protein standard enteral
formula (Osmolite, Abbott Nutrition). Tolerance and
comorbidities as well as enteral feeding volume were collected at baseline
and then daily for up to 21 days, or until the patient was discharged from
the ICU. Results A total of 49 patients were included, 25 (51%) on group
A, 24 (49%) on group B. Adverse events and undesired gastrointestinal
events at baseline and mean intake (ml/d and percent of goal) post
baseline were not different between the groups. There were significantly
fewer days with adverse events (p = 0.0336, odds ratio = 3.02, standard
error = 1.60, n = 24 per group) and undesired gastrointestinal events (p =
0.0489, odds ratio = 2.79, standard error = 1.48, n = 24 per group) in
group A. There was no difference in other clinical outcomes. Conclusion
This pilot study suggests that feeding a peptide-based formula to ICU
patients may be associated with a statistically significant reduction in
the number of days during which adverse events occurred as compared to a
standard formula.<br/>Copyright &#xa9; 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<22>
Accession Number
620675644
Author
Olsson A.; Alfredsson J.; Ramstrom S.; Svedjeholm R.; Kenny D.; Hakansson
E.; Berglund J.S.; Berg S.
Institution
(Olsson, Berglund) Blekinge Institute of Technology, Department of Health
Science, Karlskrona, Sweden
(Olsson) Department of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Olsson) Department of Cardio-Thoracic Surgery, Blekinge Hospital,
Karlskrona, Sweden
(Alfredsson) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Ramstrom) Department of Clinical and Experimental Medicine, Linkoping
University, Linkoping, Sweden
(Svedjeholm, Hakansson, Berg) Department of Cardio-Thoracic and Vascular
Surgery and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Kenny) Clinical Research Centre, Royal College of Surgeons in Ireland,
Dublin, Ireland
Title
Better platelet function, less fibrinolysis and less hemolysis in
re-transfused residual pump blood with the Ringer's chase technique - a
randomized pilot study.
Source
Perfusion (United Kingdom). 33 (3) (pp 185-193), 2018. Date of
Publication: 01 Apr 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Residual pump blood from the cardiopulmonary bypass (CPB)
circuit is often collected into an infusion bag (IB) and re-transfused. An
alternative is to chase the residual blood into the circulation through
the arterial cannula with Ringer's acetate. Our aim was to assess possible
differences in hemostatic blood quality between these two techniques.
Methods: Forty adult patients undergoing elective coronary artery bypass
graft surgery with CPB were randomized to receive the residual pump blood
by either an IB or through the Ringer's chase (RC) technique. Platelet
activation and function (impedance aggregometry), coagulation and
hemolysis variables were assessed in the re-transfused blood and in the
patients before, during and after surgery. Results are presented as median
(25-75 quartiles). Results: Total hemoglobin and platelet levels in the
re-transfused blood were comparable with the two methods, as were soluble
platelet activation markers P-selectin and soluble glycoprotein VI (GPVI).
Platelet aggregation (U) in the IB blood was significantly lower compared
to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32)
vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50
(29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59),
p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086
(891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3
(0.3-0.48), p<0.01. Other coagulation variables showed no difference
between the groups. Conclusions: The handling of blood after CPB increases
hemolysis, impairs platelet function and activates coagulation and
fibrinolysis. The RC technique preserved the blood better than the
commonly used IB technique.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<23>
Accession Number
618106868
Author
Ando T.; Takagi H.; Briasoulis A.; Telila T.; Slovut D.P.; Afonso L.;
Grines C.L.; Schreiber T.
Institution
(Ando, Telila, Grines, Schreiber) Division of Cardiology, Wayne State
University, Detroit Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Slovut) Division of Cardiothoracic Surgery and Cardiology, Montefiore
Medical Center, Bronx, NY, United States
(Afonso) Division of Cardiology, Wayne State University, Detroit, MI,
United States
Title
A systematic review of reported cases of combined transcatheter aortic and
mitral valve interventions.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 124-134),
2018. Date of Publication: 01 Jan 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To summarize the published data of combined transcatheter
aortic and mitral valve intervention (CTAMVI). Background: CTAMVI, a
combination of either transcatheter aortic valve replacement (TAVR) or
transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve
replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring
(TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive
alternative in high-surgical risk patients with combined aortic and mitral
valve disease. However, its procedural details and clinical outcomes have
not been well described. Methods: We performed a systematic review of all
the published articles from PUBMED and EMBASE. Results: A total of 37
studies with 60 patients were included. The indication for CTAMVI was high
or inoperable surgical risk and symptomatic severe aortic stenosis (92%)
or severe aortic regurgitation (8%) combined with moderate to
severe/severe mitral stenosis (30%) or moderate/severe mitral
regurgitation (65%) or both (5%). In majority of the cases, aortic valve
intervention was performed prior to the mitral valve. Mortality rate were
25% for TAVR + TMVR (range 42 days to 10 months), 17% for TAVR + TMViV/ViR
(range 13 days to 6 months), 0% for TAViV + TMViV/ViR (range 6-365 days),
and 15% for TAVR/ViV + PMVR (range 17 days to 419 days). Significant (more
than moderate) paravalvular regurgitation post-procedure was rare.
Conclusions: CTAMVI appears to confer reasonable clinical outcome. Further
large study is warranted to clarify the optimal strategy, procedural
details and clinical outcomes in the future.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<24>
Accession Number
618550969
Author
Ando T.; Briasoulis A.; Telila T.; Afonso L.; Grines C.L.; Takagi H.
Institution
(Ando, Telila, Afonso) Division of Cardiology, Wayne State University,
Harper Hospital, Detroit, MI, United States
(Ando, Takagi) ALICE (All-Literature Investigation Cardiovascular
Evidence) group, United States
(Briasoulis) Division of Heart Failure, Mayo Clinic, Rochester, MN, United
States
(Grines) Division of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
Does mild paravalvular regurgitation post transcatheter aortic valve
implantation affect survival? A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 135-147),
2018. Date of Publication: 01 Jan 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: To assess the impact of post transcatheter aortic valve
implantation (TAVI) mild paravalvular regurgitation (PVR) on mortality.
More than moderate PVR after TAVI has decreased with the advent of
new-generation prosthetic valves. However, mild PVR remains common and its
clinical impact has been inconsistent. We aimed to assess the impact of
mild PVR through meta-analysis. Methods and Results: A systematic
literature search was conducted through PUBMED and EMBSE. Manuscripts that
reported hazard ratio (HR) with 95% confidence interval (CI) for clinical
outcome of interest (all-cause and cardiac mortality) has been included.
Random-effects model was used for calculation of HR. A total of 25
articles including total of 21,018 patients were finally included for
quantitative synthesis (meta-analysis). Our pooled analysis demonstrated
higher all-cause mortality in patients with mild PVR compared to
none/trivial PVR (HR 1.26, 95%CI 1.11-1.43, I²=45%, p < 0.001)
(follow up duration range 6 months to 5 years). Significant heterogeneity
among studies was observed (p for heterogeneity = 0.005). Egger's test
showed no evidence of publication bias. Cardiovascular mortality was
increased in patients with mild PVR compared with none/trivial PVR (HR
1.28, 95%CI 1.05-1.57, I²=8%, p = 0.02) (follow up duration
range 1-3 years). Conclusions: Mild PVR was associated with increased
all-cause and cardiovascular mortality after TAVI. Whether further
interventions in mild PVR is of benefit, has yet to be
determined.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<25>
Accession Number
619347036
Author
Atchison C.M.; Amankwah E.; Wilhelm J.; Arlikar S.; Branchford B.R.; Stock
A.; Streiff M.; Takemoto C.; Ayala I.; Everett A.; Stapleton G.; Jacobs
M.L.; Jacobs J.P.; Goldenberg N.A.
Institution
(Atchison) Undergraduate Medical Education, Department of Pediatrics,
University of South Florida Morsani College of Medicine, Tampa, FL, United
States
(Amankwah) Department of Oncology, Johns Hopkins University School of
Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, United States
(Amankwah, Arlikar, Ayala, Goldenberg) Johns Hopkins All Children's Cancer
and Blood Disorders Institute, St. Petersburg, FL, United States
(Wilhelm, Everett, Stapleton, Jacobs, Jacobs, Goldenberg) Johns Hopkins
All Children's Heart Institute, St. Petersburg, FL, Russian Federation
(Branchford) Section of Hematology/Oncology/Bone Marrow Transplantation,
Department of Pediatrics, University of Colorado School of Medicine
Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, United
States
(Stock) Division of Critical Care Medicine, Rush University Medical
Center, Chicago, IL, United States
(Streiff, Takemoto, Goldenberg) Divisions of Hematology, Departments of
Pediatrics And/or Medicine, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Takemoto, Ayala, Goldenberg) Johns Hopkins Medicine Pediatric Thrombosis
Program, Johns Hopkins All Children's Hospital, Johns Hopkins Children's
Center, St. Petersburg, FL, United States
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Jacobs, Jacobs) Department of Surgery, Division of Cardiothoracic
Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
Title
Risk factors for hospital-associated venous thromboembolism in critically
ill children following cardiothoracic surgery or therapeutic cardiac
catheterisation.
Source
Cardiology in the Young. 28 (2) (pp 234-242), 2018. Date of Publication:
01 Feb 2018.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Paediatric hospital-associated venous thromboembolism is a
leading quality and safety concern at children's hospitals. Objective The
aim of this study was to determine risk factors for hospital-associated
venous thromboembolism in critically ill children following cardiothoracic
surgery or therapeutic cardiac catheterisation. Methods We conducted a
retrospective, case-control study of children admitted to the
cardiovascular intensive care unit at Johns Hopkins All Children's
Hospital (St. Petersburg, Florida, United States of America) from 2006 to
2013. Hospital-associated venous thromboembolism cases were identified
based on ICD-9 discharge codes and validated using radiological record
review. We randomly selected two contemporaneous cardiovascular intensive
care unit controls without hospital-associated venous thromboembolism for
each hospital-associated venous thromboembolism case, and limited the
study population to patients who had undergone cardiothoracic surgery or
therapeutic cardiac catheterisation. Odds ratios and 95% confidence
intervals for associations between putative risk factors and
hospital-associated venous thromboembolism were determined using
univariate and multivariate logistic regression. Results Among 2718
admissions to the cardiovascular intensive care unit during the study
period, 65 met the criteria for hospital-associated venous thromboembolism
(occurrence rate, 2%). Restriction to cases and controls having undergone
the procedures of interest yielded a final study population of 57
hospital-associated venous thromboembolism cases and 76 controls. In a
multiple logistic regression model, major infection (odds ratio=5.77, 95%
confidence interval=1.06-31.4), age <=1 year (odds ratio=6.75, 95%
confidence interval=1.13-160), and central venous catheterisation (odds
ratio=7.36, 95% confidence interval=1.13-47.8) were found to be
statistically significant independent risk factors for hospital-associated
venous thromboembolism in these children. Patients with all three factors
had a markedly increased post-test probability of having
hospital-associated venous thromboembolism. Conclusion Major infection,
infancy, and central venous catheterisation are independent risk factors
for hospital-associated venous thromboembolism in critically ill children
following cardiothoracic surgery or cardiac catheter-based intervention,
which, in combination, define a high-risk group for hospital-associated
venous thromboembolism.<br/>Copyright &#xa9; Cambridge University Press
2017.

<26>
Accession Number
621380141
Author
Yamac A.H.; Ismayiloglu Z.; Kucukbuzcu S.; Nadir A.; Bacaksiz A.; Ozdemir
R.
Institution
(Yamac, Ismayiloglu, Kucukbuzcu, Nadir, Bacaksiz, Ozdemir) Department of
Cardiology, Bezm-i Alem Foundation Gureba Training and Research Hospital,
Istanbul, Turkey
Title
Altered expression of micro-RNA 199a and increased levels of cardiac SIRT1
protein are associated with the occurrence of atrial fibrillation after
coronary artery bypass graft surgery.
Source
Anatolian Journal of Cardiology. Conference: 33rd Turkish Cardiology
Congress. Turkey. 18 (Supplement 1) (pp 4), 2017. Date of Publication:
October 2017.
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: Postoperative atrial fibrillation (POAF) is a
potentially life-threatening complication after coronary artery bypass
graft (CABG) surgery. The expression of the cardioprotective SIRT1 protein
with its antioxidant activity is increased in cardiac tissue of patients
suffering from POAF. So far, information is lacking about the relationship
between SIRT1 regulating micro RNAs (miRs), SIRT1 protein and the
occurence of POAF. Methods: A total of 63 patients undergoing CABG were
recruited and biopsies were obtained from the right atrial appendage
during cannulation. Postoperative, all patients were rhythm-monitored
until discharge and randomized to POAF (n=20) or sinus rhythm (n=43). The
expression of the micro RNAs miR-199a and miR-195 was quantified by Real
Time PCR. SIRT1 protein was detected by Westen Blot analysis. Results: The
relative expression of miR-199a in the POAF group was significantly
decreased compared to the control group (0.77+/-0.27 vs 1.11+/-0.69,
p=0.022) Accordingly, SIRT 1 protein was significantly induced in tissue
probes of patients with POAF (p<0.001). Conclusions: Altered expression of
the SIRT1 protein regulating miR-199a in human atrial tissue was found to
be related to the occurrence of POAF, indicating its usefulness as a
biomarker for cardiac surgery management.

<27>
Accession Number
621380116
Author
Rustamova Y.
Institution
(Rustamova) Azerbaijan Medical University Therapy Clinic, Baku, Azerbaijan
Title
CMR imaging for evaluation the myocardial viability in patient underwent
percutaneous coronary intervention after previous myocardial infarction.
Source
Anatolian Journal of Cardiology. Conference: 33rd Turkish Cardiology
Congress. Turkey. 18 (Supplement 1) (pp 82), 2017. Date of Publication:
October 2017.
Publisher
Turkish Society of Cardiology
Abstract
Background and Aim: To evaluate the efficacy of percutaneous coronary
intervention (PCI) in pts with postinfarction myocardial viability by CMR
with delayed enhancement (DE). Methods: 224 pts were included in the
study. In the preoperative period, all pts were randomized into 3 groups.
In the I group (n = 81), myocardial viability was determined by CMR with
DE, in group II (n=78) - stress echocardiography with low dose dobutamine
(LDDSE), and in group III (n=65) - CMR with DE and LDDSE. Criteria for
evaluating long-term outcomes: the incidence of adverse MACE, the dynamic
of myocardial kinetics and the volume of viable myocardium. Results:
Drug-eluting stents of IId and IIId generation were implanted in all pts.
After PCI during hospitalization, the survival rate of pts was 100%, no
complication of PCI was reported. Long-term results were estimated in 193
pts, 70 of whom were in gr. I, 68 - in gr. II and 55 - in fr. III. The
total incidence of MACE was 2.8, 8.8 and 5.4%, respectively, in groups
(p<0.05), with no significant differences in the survival and frequency of
nonfatal MI. Repeated interventions on the stented segment of the arteries
were different in groups I and II (1.4 and 5.9%, respectively, p<0.05). By
the end of the study, the dynamics of recovery of LV regional wall motion
abnormalities was more significant in groups I and III, almost 30%,
compared with group II (p<0.05). Thereto in all 3 groups positive
myocardial remodeling and the significant increase of LVEF were noted. The
likelihood of functional recovery of viable myocardium is directly related
to the time of previous MI (r=0.54, p<0.05). In pts from groups I and III
the mass of viable but dysfunctional myocardium was significantly
decreased (37 and 34%, respectively (p<0.05). Conclusions: CMR with
delayed enhancement is more effective and sensitive method for determining
the indications for myocardial revascularization in patients with previous
MI compared to LDDSE. In comparison to LDDSE CMR with delayed enhancement
allows significantly better evaluate the dynamics of functional recovery
of dysfunctional but viable myocardium and its remodeling after the
revascularization. In order to determine the myocardial viability in pts
with previous MI and long-term benefit of PCI the combination of two
methods - CMR with delayed enhancement and LDDSE - does not have a
significant advantages on using the CMR with delayed enhancement only.

<28>
Accession Number
621382238
Author
Anonymous
Title
Lancet-CAMS Health Summit, 2017.
Source
The Lancet. Conference: Chinese Academy of Medical Sciences Health Summit,
CAMS 2017. China. 390 (SPEC.ISS 1) (no pagination), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group
Abstract
The proceedings contain 6 papers. The topics discussed include: effects of
the integrated healthcare delivery system on 270 pilot cities in 2016: a
mixed methods study; cost estimate and budget impact analysis of
implementing the new guidelines for management of hepatitis C virus in
China: a micro-costing study; psychosocial interventions to improve
quality of life for men with prostate cancer: a network meta-analysis of
31 randomized controlled trials; efficacy and safety of medical expulsion
therapy for ureteral calculi: a systematic review and network
meta-analysis; effect of human development on the relationship between
generalized trust and health: an international cross-sectional
investigation; and early outcomes of perioperative statin therapy for
elderly patients undergoing off-pump coronary artery bypass surgery: a
propensity score-matched study.

<29>
Accession Number
621388452
Author
Meng F.; Ma J.; Wang W.; Lin B.
Institution
(Meng) Department of Cardiology, China Japan Union Hospital of Jilin
University, Changchun, China
Title
Meta-analysis of interleukin 6, 8, and 10 between off-pump and on-pump
coronary artery bypass groups.
Source
Bosnian journal of basic medical sciences. 17 (2) (pp 85-94), 2017. Date
of Publication: 20 May 2017.
Abstract
This study aimed to evaluate the role of off-pump coronary artery bypass
(CAB) surgery on the decrease of postoperative inflammatory responses in
patients. We systematically searched databases of PubMed and Embase to
select the related studies. Interleukin (IL) 6, 8, and 10 were used as
outcomes and pooled analysis was performed using R 3.12 software.
Standardized mean differences (SMDs) and their 95% confidence intervals
(95% CIs) were considered as effect estimates. A total of 27 studies,
including 1340 participants, were recruited in this meta-analysis. The
pooled analyses showed that postoperative concentration of IL-10 at 12
hours was significantly lower in off-pump CAB group compared to on-pump
CAB group (SMD = -1.3640, 95% CI = -2.0086--0.7193). However, no
significant differences were found in pre and postoperative concentrations
of IL-6 and 8 between off-pump and on-pump CAB groups. These results
suggest that there is no advantage of off-pump CAB surgery in the
reduction of inflammation compared to on-pump CAB surgery.

<30>
Accession Number
621329537
Author
Paling F.P.; Olsen K.; Ohneberg K.; Wolkewitz M.; Fowler V.G.; DiNubile
M.J.; Jafri H.S.; Sifakis F.; Bonten M.J.M.; Harbarth S.J.; Kluytmans
J.A.J.W.
Institution
(Paling, Olsen, Bonten, Kluytmans) Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
(Ohneberg, Wolkewitz) Institute for Medical Biometry and Statistics,
University Medical Center Freiburg, Freiburg, Germany
(Fowler) Division of Infectious Diseases, Duke University Medical Center,
Durham, NC, United States
(DiNubile) Merck & Company Incorporation, Kenilworth, NJ, United States
(Jafri) MedImmune, Gaithersburg, MD, United States
(Sifakis) AstraZeneca Pharmaceuticals LP, Gaithersburg, MD, United States
(Bonten) Department of Medical Microbiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Harbarth) Geneva University Hospitals and Medical School, Geneva,
Switzerland
(Kluytmans) Amphia Hospital, Breda, Netherlands
Title
Risk prediction for Staphylococcus aureus surgical site infection
following cardiothoracic surgery; A secondary analysis of the V710-P003
trial.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0193445. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Identifying patients undergoing cardiothoracic surgery at high
risk of Staphylococcus aureus surgical site infection (SSI) is a
prerequisite for implementing effective preventive interventions. The
objective of this study was to develop a risk prediction model for S.
aureus SSI or bacteremia after cardiothoracic surgery based on
pre-operative variables. Materials/Methods Data from the Merck Phase
IIb/III S. aureus vaccine (V710-P003) clinical trial were analyzed. In
this randomized placebo-controlled trial, the effect of preoperative
vaccination against S. aureus was investigated in patients undergoing
cardiothoracic surgery. The primary outcome was deep/superficial S. aureus
SSI or S. aureus bacteremia through day 90 after surgery. Performance,
calibration, and discrimination of the final model were assessed. Results
Overall 164 out of 7,647 included patients (2.1%) developed S. aureus
infection (149 SSI, 15 bacteremia, 28 both). Independent risk factors for
developing the primary outcome were pre-operative colonization with S.
aureus (OR 3.08, 95% confidence interval [CI] 2.23-4.22), diabetes
mellitus (OR 1.87, 95% CI 1.34-2.60), BMI (OR 1.02 per kg/m²,
95% CI 0.99-1.05), and CABG (OR 2.67, 95% CI 1.91-3.78). Although
vaccination had a significant (albeit modest) protective effect, it was
omitted from the model because its addition did not significantly change
the coefficients of the final model and V710-vaccine development has been
discontinued due to insufficient efficacy. The final prediction model had
moderate discriminative accuracy (AUC-value, 0.72). Conclusion
Pre-operative S. aureus colonization status, diabetes mellitus, BMI, and
type of surgical procedure moderately predicted the risk of S. aureus SSI
and/or bacteremia among patients undergoing cardiothoracic
surgery.<br/>Copyright &#xa9; 2018 Paling 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.

<31>
Accession Number
621378811
Author
Daci A.; Bozalija A.; Cavolli R.; Alaj R.; Beretta G.; Krasniqi S.
Institution
(Daci, Bozalija) Department of Pharmacy, Faculty of Medicine, University
of Prishtina, Prishtina, Serbia
(Cavolli, Alaj) Cardiovascular Surgery Clinic, University Clinical Center
of Kosovo, Prishtina, Serbia
(Beretta) Department of Pharmaceutical Sciences, Universita degli Studi di
Milano, Milan, Italy
(Krasniqi) Department of Pharmacology, Faculty of Medicine, University of
Prishtina, Prishtina, Serbia
Title
Pharmacotherapy evaluation and utilization in coronary artery bypass
grafting patients in Kosovo during the period 2016-2017.
Source
Open Access Macedonian Journal of Medical Sciences. 6 (3) (pp 498-505),
2018. Date of Publication: 15 Mar 2018.
Publisher
Open Access Macedonian Journal of Medical Sciences (E-mail:
mspiroski@id-press.eu)
Abstract
BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realised in patients
with critical or advanced disease of coronary arteries. There are
different pharmacotherapeutic approaches which are used as management,
treatment and preventive therapy in cardiovascular disease or related
comorbidities. Performing a successful surgery, pharmacotherapy, and
increase of bypass patency rate remains a serious challenge. AIM: This
study aims to analyse the patient characteristics undergoing CABG and
evaluation of their drug utilisation rate and daily dosages in the
perioperative period. MATERIAL AND METHODS: Data were collected from 102
patients in the period 2016-2017 and detailed therapeutic prescription and
dosages, patient characteristics were analysed before the operation, after
the operation and visit after operation in the Clinic of Cardiac
surgery-University Clinical Center of Kosovo. RESULTS: Our findings had
shown that patients provided to have normal biochemical parameters in the
clinic before the operation, and were related to cardiovascular diseases
and comorbidities and risk factors with mainly elective intervention. The,
however, higher utilisation of cardiovascular drugs such as beta blockers,
diuretics, anticoagulants, statins and lower calcium blockers, ACEi, ARBs,
hydrochlorothiazide, amiodarone were founded. ARBs, beta blockers,
statins, nitrates and nadroparin utilisation decreased after operation and
visit after the operation, whereas amiodarone only in the visit after the
operation. Diuretics are increased after the operation which decreases in
the visit after the operation. Regarding the daily dosage, only metoprolol
was increased in the visit after operation (P < 0.001) and visit after
operation (P < 0.05) whereas losartan and furosemide were increased (P <
0.01) and (P < 0.05) respectively. CONCLUSION: The study showed that beta
blockers, statins, aspirin, nitrates (before the operation), furosemide
and spironolactone are the most utilised drugs. However, we found low
utilisation rate for ACEi, ARBs, clopidogrel, nadroparin, warfarin,
xanthines, amiodarone, calcium blockers. Daily dosages were different
compared to before CABG only in metoprolol, losartan, and
furosemide.<br/>Copyright &#xa9; 2018 Armond Daci, Adnan Bozalija, Raif
Cavolli, Rame Alaj, Giangiacomo Beretta, Shaip Krasniqi.

<32>
Accession Number
621378620
Author
Habibi M.R.; Habibi V.; Habibi A.; Soleimani A.
Institution
(Habibi, Soleimani) Department of Anesthesiology, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Medical Student, Faculty of Medicine, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
Title
Lidocaine dose-response effect on postoperative cognitive deficit:
meta-analysis and meta-regression.
Source
Expert Review of Clinical Pharmacology. 11 (4) (pp 361-371), 2018. Date of
Publication: 03 Apr 2018.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: The true influence of the perioperative intravenous
lidocaine on the development of postoperative cognitive deficit (POCD) in
coronary artery bypass grafting (CABG) remains controversial. The
principal aim is to undertake a meta-regression to determine whether
moderator variables mediate the relationship between lidocaine and POCD.
Areas covered: We searched the Web of Science, PubMed database, Scopus and
the Cochrane Library database (up to June 2017) and systematically
reviewed a list of retrieved articles. Our final review includes only
randomized controlled trials (RCTs) that compared infusion of lidocaine
and placebo during cardiopulmonary bypass (CPB). Mantel-Haenszel risk
ratio (MH RR) and corresponding 95% confidence interval (CI) was used to
report the overall effect and meta-regression analysis. A total of 688
patients in five RCTs were included. POCD occurred in 34% of all cases.
Perioperative lidocaine reduces POCD (MH RR 0.702 (95% CI: 0.541-0.909).
Younger age, male gender, longer CPB and higher concentration of lidocaine
significantly mediate the relationship between lidocaine and POCD in
favour of the neuroprotective effect of lidocaine. Expert commentary: The
neuroprotective effect of lidocaine on POCD is consistent in spite of
longer CPB time. A higher concentration of lidocaine strengthened the
neuroprotective effect of lidocaine.<br/>Copyright &#xa9; 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<33>
Accession Number
621375589
Author
Pressler A.; Forschner L.; Hummel J.; Haller B.; Christle J.W.; Halle M.
Institution
(Pressler, Forschner, Hummel, Christle, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Technische Universitat Munchen,
Germany
(Haller) Institute for Medical Statistics and Epidemiology, Technische
Universitat Munchen, Germany
(Christle) Department of Medicine, Stanford University, USA
(Halle) DZHK (German Center for Cardiovascular Research), partner site
Munich Heart Alliance, Germany
Title
Long-term effect of exercise training in patients after transcatheter
aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot
study.
Source
European Journal of Preventive Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Increased exercise capacity favourably influences clinical
outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI
randomised pilot trial, eight weeks of endurance and resistance training
(training group, TG) shortly after transcatheter aortic valve implantation
resulted in significantly improved exercise capacity, muscular strength
and quality of life compared to usual care (UC). However, the long-term
clinical benefits of such an intervention are unknown. Design: A
randomised controlled trial. Methods: SPORT:TAVI participants underwent
reassessment of trial endpoints 24 +/- 6 months after baseline: maximal
oxygen uptake (VO<inf>2</inf>peak) and anaerobic threshold
(VO<inf>2</inf>AT) were assessed with cardiopulmonary exercise testing,
muscular strength with one-repetition maximum testing, quality of life
with the Kansas City cardiomyopathy and medical outcomes study 12-item
short-form health survey questionnaires, and prosthetic aortic valve
function with echocardiography. Results: Of 27 original participants (TG
13; UC 14; age 81 +/- 6 years), more patients had died during follow-up in
UC (n = 5) than in TG (n = 2; P = 0.165); three further patients (TG 1; UC
2) were unavailable for other reasons. In the remaining patients (TG 10;
UC 7), a significant between-group difference in favour of TG was observed
for change in VO<inf>2</inf>AT from baseline (2.7 ml/min/kg (95%
confidence interval 0.8-4.6); P = 0.008), but not for change in
VO<inf>2</inf>peak (2.1 ml/min/kg (-1.1-5.4); P = 0.178). Changes in
muscular strength and quality of life did not differ between groups over
time. Overall, prosthetic valve function remained intact in both groups.
Conclusions: Eight weeks of exercise training shortly after transcatheter
aortic valve implantation resulted in preserved long-term improvements in
VO<inf>2</inf>AT, but not VO<inf>2</inf>peak, muscular strength or quality
of life compared to usual care. The findings emphasise the importance of
ongoing exercise interventions following transcatheter aortic valve
implantation to maintain initial improvements long term. Clinical Trial
Registration (original trial): Clinicaltrials.gov
NCT01935297.<br/>Copyright &#xa9; 2018, The European Society of Cardiology
2018.

<34>
Accession Number
621383492
Author
Zuckerman W.A.; Zeevi A.; Mason K.L.; Feingold B.; Bentlejewski C.;
Addonizio L.J.; Blume E.D.; Canter C.E.; Dipchand A.I.; Hsu D.T.; Shaddy
R.E.; Mahle W.T.; Demetris A.J.; Briscoe D.M.; Mohanakumar T.; Ahearn
J.M.; Ikle D.N.; Armstrong B.D.; Morrison Y.; Diop H.; Odim J.; Webber
S.A.
Institution
(Zuckerman, Addonizio) Division of Pediatric Cardiology Columbia
University Medical Center New York, NY USA
(Zeevi, Bentlejewski, Demetris) Department of Pathology University of
Pittsburgh Medical Center Pittsburgh, PA USA
(Mason, Ikle, Armstrong) Rho Inc., Federal Systems Division Chapel Hill NC
USA
(Feingold) Department of Pediatrics and Clinical and Translational Science
University of Pittsburgh School of Medicine Pittsburgh, PA USA
(Blume) Department of Pediatric Cardiology Boston Children's Hospital
Boston, MA USA
(Canter) Division of Pediatric Cardiology Washington University School of
Medicine St. Louis MO USA
(Dipchand) Labatt Family Heart Center Department of Paediatrics Hospital
for Sick Children Toronto, ON Canada
(Hsu) Division of Pediatric Cardiology Children's Hospital at Montefiore
Bronx, NY USA
(Shaddy) Division of Pediatric Cardiology Children's Hospital of
Philadelphia Philadelphia, PA USA
(Mahle) Division of Pediatric Cardiology Children's Healthcare of Atlanta
Atlanta, GA USA
(Briscoe) Transplant Research Program Division of Pediatric Nephrology
Harvard Medical School Boston, MA USA
(Mohanakumar) Norton Thoracic Institute Saint Joseph Hospital and Medical
Center Phoenix, AZ USA
(Ahearn) Department of Medicine Allegheny Health Network Pittsburgh, PA
USA
(Morrison, Diop, Odim) Transplantation Branch National Institute of
Allergy and Infectious Diseases National Institutes of Health Bethesda, MD
USA
(Webber) Division of Pediatric Cardiology Monroe Carrell Jr. Children's
Hospital at Vanderbilt Nashville, TN USA
Title
Study rationale, design, and pretransplantation alloantibody status: A
first report of Clinical Trials in Organ Transplantation in Children-04
(CTOTC-04) in pediatric heart transplantation.
Source
American Journal of Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Anti-HLA donor-specific antibodies are associated with worse outcomes
after organ transplantation. Among sensitized pediatric heart candidates,
requirement for negative donor-specific cytotoxicity crossmatch increases
wait times and mortality. However, transplantation with positive
crossmatch may increase posttransplantation morbidity and mortality. We
address this clinical challenge in a prospective, multicenter,
observational cohort study of children listed for heart transplantation
(Clinical Trials in Organ Transplantation in Children-04 [CTOTC-04]).
Outcomes were compared among sensitized recipients who underwent
transplantation with positive crossmatch, nonsensitized recipients, and
sensitized recipients without positive crossmatch. Positive crossmatch
recipients received antibody removal and augmented immunosuppression,
while other recipients received standard immunosuppression with
corticosteroid avoidance. This first CTOTC-04 report summarizes study
rationale and design and relates pretransplantation sensitization status
using solid-phase technology. Risk factors for sensitization were
explored. Of 317 screened patients, 290 were enrolled and 240 underwent
transplantation. Core laboratory evaluation demonstrated that more than
half of patients were anti-HLA sensitized. Greater than 80% of sensitized
patients had class I (with or without class II) HLA antibodies, and
one-third of sensitized patients had at least 1 HLA antibody with median
fluorescence intensity of >=8000. Logistic regression models demonstrated
male sex, weight, congenital heart disease history, prior allograft, and
ventricular assist device are independent risk factors for
sensitization.<br/>Copyright &#xa9; 2018 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<35>
Accession Number
615615840
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 241 (pp 142-148), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results We included data from 5 randomized trials and
4595 patients. At 30 days, CABG was associated with higher stroke (OR 2.54
[95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45
[95% CI, 1.00-2.10]), with no other significant differences compared to
PCI. At 1 year, CABG reduced repeat revascularization (OR 0.56 [95% CI,
0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5
years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67])
and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions From the present updated meta-analysis of available studies on
LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5 years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<36>
[Use Link to view the full text]
Accession Number
617243460
Author
Tume L.N.; Baines P.B.; Guerrero R.; Hurley M.A.; Johnson R.; Kalantre A.;
Ramaraj R.; Ritson P.C.; Walsh L.; Arnold P.D.
Institution
(Tume, Baines, Ritson, Walsh) PICU, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
(Tume, Hurley) University of Central Lancashire, College of Health and
Wellbeing, Preston, United Kingdom
(Guerrero, Johnson, Kalantre, Ramaraj, Arnold) Alder Hey Children's NHS
Foundation Trust, Liverpool, United Kingdom
Title
Pilot Study Comparing Closed Versus Open Tracheal Suctioning in
Postoperative Neonates and Infants with Complex Congenital Heart Disease.
Source
Pediatric Critical Care Medicine. 18 (7) (pp 647-654), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To determine the hemodynamic effect of tracheal suction method
in the first 36 hours after high-risk infant heart surgery on the PICU and
to compare open and closed suctioning techniques. Design: Pilot randomized
crossover study. Setting: Single PICU in United Kingdom. Participants:
Infants undergoing surgical palliation with Norwood Sano, modified
Blalock-Taussig shunt, or pulmonary artery banding in the first 36 hours
postoperatively. Interventions: Infants were randomized to receive open or
closed (in-line) tracheal suctioning either for their first or second
study tracheal suction in the first 36 hours postoperatively. Measurements
and Main Results: Twenty-four infants were enrolled over 18 months, 11
after modified Blalock-Taussig shunt, seven after Norwood Sano, and six
after pulmonary artery banding. Thirteen patients received the open
suction method first followed by the closed suction method second, and 11
patients received the closed suction method first followed by the open
suction method second in the first 36 hours after their surgery. There
were statistically significant larger changes in heart rate (p = 0.002),
systolic blood pressure (p = 0.022), diastolic blood pressure (p = 0.009),
mean blood pressure (p = 0.007), and arterial saturation (p = 0.040) using
the open suction method, compared with closed suctioning, although none
were clinically significant (defined as requiring any intervention).
Conclusions: There were no clinically significant differences between
closed and open tracheal suction methods; however, there were
statistically significant greater changes in some hemodynamic variables
with open tracheal suctioning, suggesting that closed technique may be
safer in children with more precarious physiology.<br/>Copyright &#xa9;
2017 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<37>
[Use Link to view the full text]
Accession Number
615665559
Author
Palermo J.; Dart A.B.; De Mello A.; Devarajan P.; Gottesman R.; Garcia
Guerra G.; Hansen G.; Joffe A.R.; Mammen C.; Majesic N.; Morgan C.;
Skippen P.; Pizzi M.; Palijan A.; Zappitelli M.
Institution
(Palermo, Gottesman, Pizzi, Palijan, Zappitelli) Divisions of Nephrology
and Pediatric Critical Care Medicine, Department of Pediatrics, Montreal
Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
(Dart) Section of Nephrology, Department of Pediatrics and Child Health,
University of Manitoba, Winnipeg, MB, Canada
(De Mello, Mammen) Division of Nephrology, British Columbia Children's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
(Garcia Guerra, Joffe) Department of Pediatrics, University of Alberta,
Women and Children's Health Research Institute, Edmonton, AL, Canada
(Hansen) Section of Pediatric Intensive Care, Department of Pediatrics and
Child Health, University of Manitoba, Children's Hospital, Winnipeg, MB,
Canada
(Majesic, Morgan) Division of Nephrology, Department of Pediatrics,
University of Alberta, Edmonton, AL, Canada
(Skippen) Pediatric Intensive Care Unit, Children's Heart Centre, British
Columbia Children's Hospital, Vancouver, BC, Canada
Title
Biomarkers for Early Acute Kidney Injury Diagnosis and Severity
Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the
ICU.
Source
Pediatric Critical Care Medicine. 18 (6) (pp e235-e244), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Acute kidney injury occurs early in PICU admission and
increases risks for poor outcomes. We evaluated the feasibility of a
multicenter acute kidney injury biomarker urine collection protocol and
measured diagnostic characteristics of urine neutrophil
gelatinase-associated lipocalin, interleukin-18, and liver fatty acid
binding protein to predict acute kidney injury and prolonged acute kidney
injury. Design: Prospective observational pilot cohort study. Setting:
Four Canadian tertiary healthcare PICUs. Patients: Eighty-one children 1
month to 18 years old. Exclusion criteria were as follows: Cardiac
surgery, baseline severe kidney disease, and inadequate urine or serum for
PICU days 1-3. Interventions: PICUs performed standardized urine
collection protocol to obtain early PICU admission urine samples, with
deferred consent. Measurements and Main Results: Study barriers and
facilitators were recorded. Acute kidney injury was defined based on
Kidney Disease: Improving Global Outcomes serum creatinine criteria (acute
kidney injury<inf>serum creatinine</inf>) and by serum creatinine and
urine output criteria (acute kidney injury<inf>serum creatinine+urine
output</inf>) Prolonged acute kidney injury was defined as acute kidney
injury duration of 48 hours or more. PICU days 1-3 neutrophil
gelatinase-associated lipocalin, interleukin-18, and liver fatty acid
binding protein were evaluated for acute kidney injury prediction (area
under the curve). Biomarkers on the first day of acute kidney injury
attainment (day 1 acute kidney injury) were evaluated for predicting
prolonged acute kidney injury. Eighty-two to 95% of subjects had urine
collected from PICU days 1-3. Acute kidney injury<inf>serum
creatinine</inf> developed in 16 subjects (20%); acute kidney
injury<inf>serum creatinine+urine output</inf> developed in 38 (47%). On
PICU day 1, interleukin-18 predicted acute kidney injury<inf>serum
creatinine</inf> with area under the curve=0.82, but neutrophil
gelatinase-associated lipocalin and liver fatty acid binding protein
predicted acute kidney injury<inf>serum creatinine</inf> with area under
the curve of less than or equal to 0.69; on PICU day 2, area under the
curve was higher (not shown). Interleukin-18 and liver fatty acid binding
protein on day 1 acute kidney injury predicted prolonged acute kidney
injury<inf>serum creatinine</inf> (area under the curve=0.74 and 0.83,
respectively). When acute kidney injury<inf>serum creatinine+urine
output</inf> was used to define acute kidney injury, biomarker area under
the curves were globally lower. Conclusions: Protocol urine collection to
procure early admission samples is feasible. Individual biomarker acute
kidney injury prediction performance is highly variable and modest. Larger
studies should evaluate utility and cost effectiveness of using early
acute kidney injury biomarkers.<br/>Copyright &#xa9; 2017 by the Society
of Critical Care Medicine and the World Federation of Pediatric Intensive
and Critical Care Societies.

<38>
Accession Number
619122345
Author
Levy J.H.; Rossaint R.; Zacharowski K.; Spahn D.R.
Institution
(Levy) Department of Anesthesiology, Duke University School of Medicine,
Durham, NC, United States
(Rossaint) Department of Anaesthesiology, RWTH Aachen University Hospital,
Aachen, Germany
(Zacharowski) Department of Anaesthesiology, Intensive Care Medicine &
Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Spahn) Institute of Anesthesiology, University and University Hospital of
Zurich, Zurich, Switzerland
Title
What is the evidence for platelet transfusion in perioperative settings?.
Source
Vox Sanguinis. 112 (8) (pp 704-712), 2017. Date of Publication: November
2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: Platelet transfusions are widely administered
to restore perioperative haemostasis in haemorrhagic patients; however,
the role of platelet transfusion is not well understood and administration
is often based on empiric data. This review aims to explore consensus
regarding platelet transfusion trigger, dose and how the haemostatic
efficacy of platelet transfusion was assessed for the treatment of
perioperative bleeding. Materials and Methods: A literature search was
carried out using MEDLINE (PubMed) on 28 February 2017, to identify
publications reporting the effect of platelet transfusion in relation to
triggers, dose and assessment of haemostatic efficacy in bleeding patients
in a perioperative setting. Results: Eight publications were identified
across a variety of settings, covering both prophylactic and therapeutic
platelet transfusion in adult patients; the majority of the reports were
in cardiac surgery. A high degree of variability was observed in the
published studies, with only 50% of articles specifying a trigger for
platelet transfusion. The most commonly used trigger was platelet count
(25% of publications), with no consensus identified regarding the platelet
count values used as triggers. Doses reported per transfusion varied from
1 to 12 units, and outcome measures were mixed, although the majority of
publications (63%) assessed the requirement for transfusion with other
blood products. Conclusion: The lack of consensus in published studies
hinders our ability to draw conclusions regarding platelet transfusion and
highlights the need for further studies to assess the appropriate dose and
triggers for use in perioperative patients.<br/>Copyright &#xa9; 2017
International Society of Blood Transfusion

<39>
Accession Number
621181599
Author
Epstein N.
Institution
(Epstein) School of Medicine, State University of New York, Stony Brook,
United States
(Epstein) Winthrop Neuro Science, NYU Winthrop Hospital, Mineola, NY,
United States
Title
Cerebrospinal fluid drains reduce risk of spinal cord injury for
thoracic/thoracoabdominal aneurysm surgery: A review.
Source
Surgical Neurology International. 9 (1) (no pagination), 2018. Article
Number: 48. Date of Publication: 01 Jan 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The risk of spinal cord injury (SCI) due to decreased cord
perfusion following thoracic/thoracoabdominal aneurysm surgery (T/TL-AAA)
and thoracic endovascular aneurysm repair (TEVAR) ranges up to 20%. For
decades, therefore, many vascular surgeons have utilized cerebrospinal
fluid drainage (CSFD) to decrease intraspinal pressure and increase blood
flow to the spinal cord, thus reducing the risk of SCI/ischemia. Methods:
Multiple studies previously recommend utilizing CSFD following
T/TL-AAA/TEVAR surgery to treat SCI by increasing spinal cord blood flow.
Now, however, CSFD (keeping lumbar pressures at 5-12 mmHg) is largely
utilized prophylactically/preoperatively to avert SCI along with other
modalities; avoiding hypotension (mean arterial pressures >80-90 mmHG),
inducing hypothermia, utilizing left heart bypass, and employing
intraoperative neural monitoring [somatosensory (SEP) or motor evoked
(MEP) potentials]. In addition, preoperative magnetic resonance
angiography (MRA) and computed tomographic angiography (CTA) scans
identify the artery of Adamkiewicz to determine its location, and
when/whether reimplantation/reattachment of this critical artery and or
other major segmental/lumbar arterial feeders are warranted. Results:
Utilizing CSFD for 15-72 postoperative hours in T/TL-AAA/TEVAR surgery has
reduced the risks of SCI from a maximum of 20% to a minimum of 2.3%. The
major complications of CSFD include; spinal and cranial epidural/subdural
hematomas, VI nerve palsies, retained catheters, meningitis/infection, and
spinal headaches. Conclusions: By increasing blood flow to the spinal cord
during/after T/TL-AAA/TEVAR surgery, CSFD reduces the incidence of
permanent SCI from, up to 10-20% down to down to 2.3-10%. Nevertheless,
major complications, including spinal/cranial subdural hematomas, still
occur.<br/>Copyright &#xa9; 2017 Surgical Neurology International.

<40>
Accession Number
621210734
Author
Hamaba H.; Miyata Y.; Hayashi Y.
Institution
(Hamaba, Miyata, Hayashi) Anesthesiology Service, Sakurabashi-Watanabe
Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
Title
Pulmonary artery catheter placement in patients with a history of
tricuspid ring annuloplasty, with pulmonary stenosis, and with the
transvenous pacemaker leads: is it difficult?.
Source
JA Clinical Reports. 4 (1) (no pagination), 2018. Article Number: 26. Date
of Publication: 01 Dec 2018.
Publisher
Springer Berlin Heidelberg

<41>
Accession Number
621200762
Author
Syburra T.; Nicol E.; Mitchell S.; Bron D.; Rosendahl U.; Pepper J.
Institution
(Syburra) Department of Cardiac Surgery, Luzerner Kantonsspital, Luzern,
Switzerland
(Nicol) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Mitchell) Civil Aviation Authority, Gatwick Airport, United Kingdom
(Bron) Aeromedical Centre, Swiss Air Force, Dubendorf, Switzerland
(Rosendahl, Pepper) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, London, United Kingdom
Title
To fly as a pilot after cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 505-511), 2018.
Date of Publication: 01 Mar 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Aircrew are responsible for safe and reliable aircraft operations.
Cardiovascular disease accounts for 50% of all pilot licences declined or
withdrawn for medical reasons in Western Europe and is the most common
cases of sudden incapacitation in flight. Aircrew retirement age is
increasing (up to age 65) in a growing number of airlines and the burden
of subclinical, but potentially significant, coronary atherosclerosis is
unknown in qualified pilots above age 40. Safety considerations are
paramount in aviation medicine, and the most dreaded cardiovascular
complications are thromboembolic events and rhythm disturbances due to
their potential for sudden incapacitation. In aviation, the current
consensus risk threshold for an acceptable level of controlled risk of
acute incapacitation is 1% (for dual pilot commercial operations), a
percentage calculated using engineering principles to ensure the incidence
of a fatal air accident is no greater than 1 per 107 h of flying. This is
known as the '1% safety rule'. To fly as a pilot after cardiac surgery is
possible; however, special attention to perioperative planning is
mandatory. Choice of procedure is crucial for license renewal. Licensing
restrictions are likely to apply and the postoperative follow-up requires
a tight scheduling. The cardiac surgeon should always liaise and
communicate with the pilot's aviation medicine examiner prior to and
following cardiac surgery.<br/>Copyright &#xa9; The Author 2017. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<42>
Accession Number
621200759
Author
Gozdek M.; Raffa G.M.; Suwalski P.; Kolodziejczak M.; Anisimowicz L.;
Kubica J.; Navarese E.P.; Kowalewski M.
Institution
(Gozdek, Anisimowicz, Kowalewski) Department of Cardiac Surgery,
Cardiovascular Institute, Dr Antoni Jurasz Memorial University Hospital,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior, Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, Poland
(Kolodziejczak) Cardiovascular Institute, Collegium Medicum in Bydgoszcz,
University of Nicolaus Copernicus, Torun, Poland
(Kubica) Department of Cardiology and Internal Medicine, Cardiovascular
Institute, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Navarese) Inova Center for Thrombosis Research and Drug Development,
Inova Heart and Vascular Institute, Fairfax, VA, United States
Title
Comparative performance of transcatheter aortic valve-in-valve
implantation versus conventional surgical redo aortic valve replacement in
patients with degenerated aortic valve bioprostheses: Systematic review
and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (3) (pp 495-504), 2018.
Date of Publication: 01 Mar 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The objective of this report was to directly compare, by means of a
systematic review and meta-analysis, redo surgical aortic valve
replacement (re-sAVR) with valve-in-valve transcatheter aortic valve
implantation (ViV TAVI) for patients with failed degenerated aortic
bioprostheses. Multiple databases were screened for all available reports
comparing ViV TAVI with re-sAVR in patients with failing degenerated
aortic bioprostheses. The primary outcome was all-cause mortality
determined from the longest available survival data. Five observational
studies (n = 342) were included in the meta-analysis; patients in the ViV
TAVI group were older and had a higher baseline risk compared to those in
the re-sAVR group. Although there was no statistical difference in
procedural mortality [risk ratio (RR) 0.74, 95% confidence interval (CI)
0.18-2.97; P = 0.67], 30-day mortality (RR 1.29, 95% CI 0.44-3.78; P =
0.64) and cardiovascular mortality (RR 0.91, 95% CI 0.30-2.70; P = 0.86)
at a mean follow-up period of 18 months, cumulative survival analysis
favoured surgery with borderline statistical significance (ViV TAVI versus
re-sAVR: hazard ratio 1.91, 95% CI 1.03-3.57; P = 0.039). ViV TAVI was
associated with a significantly lower rate of permanent pacemaker
implantations (RR 0.37, 95% CI 0.20-0.68; P = 0.002) and shorter intensive
care unit (P < 0.001) and hospital stays (P = 0.020). In contrast, re-sAVR
offered superior echocardiographic outcomes: lower incidence of
patient-prosthesis mismatch (P = 0.008), fewer paravalvular leaks (P =
0.023) and lower mean postoperative aortic valve gradients in the
prespecified analysis (P = 0.017). The ViV TAVI approach is a safe and
feasible alternative to re-sAVR that may offer an effective, less invasive
treatment for patients with failed surgical aortic valve bioprostheses who
are inoperable or at high risk. Re-sAVR should remain the standard of
care, particularly in the low-risk population, because it offers superior
haemodynamic outcomes with low mortality rates.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<43>
Accession Number
621160347
Author
Wolff G.; Navarese E.P.; Brockmeyer M.; Lin Y.; Karathanos A.;
Kolodziejczak M.; Kubica J.; Polzin A.; Zeus T.; Westenfeld R.; Andreotti
F.; Kelm M.; Schulze V.
Institution
(Wolff, Brockmeyer, Lin, Karathanos, Polzin, Zeus, Westenfeld, Kelm,
Schulze) Department of Internal Medicine, Division of Cardiology,
Pulmonology and Vascular Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Kolodziejczak, Kubica) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Andreotti) Department of Cardiovascular Science, Catholic University of
the Sacred Heart, Rome, Italy
(Wolff, Navarese, Brockmeyer, Lin, Kolodziejczak, Kubica, Kelm, Schulze)
Systematic Investigation and Research on Interventions and Outcomes
(SIRIO)-Medicine Research Network, United States
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Inova Heart And Vascular Institute, Fairfax Medical Campus, Falls Church,
VA, United States
Title
Perioperative aspirin therapy in non-cardiac surgery: A systematic review
and meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 258 (pp 59-67), 2018. Date of
Publication: 01 May 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aspirin is a key element in prevention of cardiovascular and
thromboembolic events. During non-cardiac surgery however, its balance of
bleeding risks and benefits remains unclear. Methods: A systematic review
and meta-analysis of randomized controlled trials was performed. Online
databases were screened for clinical trials randomizing aspirin to no
aspirin therapy in non-cardiac surgery. Clinical outcomes of all-cause
mortality and cardiovascular mortality, arterial ischemic events, venous
thromboembolic events and bleeding events were separately evaluated.
Results: Seven RCTs comprising 28,302 patients were included. All-cause
mortality (3.7% vs. 3.8%; odds ratio (OR) 0.97, CI 0.86-1.10) and
cardiovascular mortality (2.0% vs. 2.1%, OR 0.92; CI 0.78-1.09) were not
different in aspirin vs. no aspirin groups. Arterial ischemic events
showed no differences, including myocardial infarction (2.5% (aspirin) vs.
2.5% (no aspirin)), cerebrovascular events (0.6% (aspirin) vs. 0.6% (no
aspirin)) and peripheral arterial events (0.2% (aspirin) vs. 0.3% (no
aspirin)). Aspirin significantly reduced the risk for venous
thromboembolic events (VTE; 1.5% (aspirin) vs. 2.0% (no aspirin); OR 0.74,
CI 0.59-0.94, p = 0.02). Perioperative major bleeding was significantly
more frequent in aspirin groups (4.4% vs. 3.7%; OR 1.18, CI 1.05 to 1.33,
p = 0.007). Conclusion: Aspirin remained neutral with respect to overall
survival, cardiovascular mortality and arterial ischemic events. It
reduced venous thromboembolic events at the expense of perioperative major
bleedings. Thus, this analysis supports recommendations against
perioperative aspirin continuation/initiation in cardiovascular disease
patients at intermediate risk, as well as recommendations of aspirin for
VTE prophylaxis in orthopedic patients only.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<44>
Accession Number
620620471
Author
Gu W.-J.; Hou B.-L.; Kwong J.S.W.; Tian X.; Qian Y.; Cui Y.; Hao J.; Li
J.-C.; Ma Z.-L.; Gu X.-P.
Institution
(Gu, Hou, Kwong, Qian, Cui, Hao, Li, Ma, Gu) Department of Anesthesiology,
Nanjing Drum Tower Hospital, Medical College of Nanjing University,
Nanjing 210008, China
(Tian) Department of Neurology, The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Neurology, Chongqing
400016, China
Title
Association between intraoperative hypotension and 30-day mortality, major
adverse cardiac events, and acute kidney injury after non-cardiac surgery:
A meta-analysis of cohort studies.
Source
International Journal of Cardiology. 258 (pp 68-73), 2018. Date of
Publication: 01 May 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The association between intraoperative hypotension (IOH) and
postoperative outcomes is not fully understood. We performed a
meta-analysis to determine whether IOH is associated with increased risk
of 30-day mortality, major adverse cardiac events (MACEs) and acute kidney
injury (AKI) after non-cardiac surgery. Methods: We searched PubMed and
Embase through May 2016 to identify cohort studies that investigated the
association between IOH and risk of 30-day mortality, MACEs, or AKI in
adult patients after non-cardiac surgery. Ascertainment of IOH and
assessment of outcomes were defined by the individual study. Considering
the level of clinical heterogeneity, adjusted odds ratios (ORs) with 95%
confidence interval (CIs) were pooled using a random-effects model. This
meta-analysis is registered on PROSPERO (CRD42016049405). Results: We
included 14 cohort studies that were heterogeneous in terms of definition
of IOH. IOH alone was associated with increased risk of 30-day mortality
(OR 1.29 [95% CI, 1.19-1.41]), MACEs (OR 1.59 [95% CI, 1.23-2.05]),
especially myocardial injury (OR 1.67 [95% CI, 1.31-2.13]), and AKI (OR
1.39 [95% CI, 1.09-1.77]). Triple low (IOH coincident with low bispectral
index and low minimum alveolar concentration) also predicts increased risk
of 30-day mortality (OR 1.32 [95% CI, 1.03-1.68]). Conclusions: IOH alone
significantly increases the risk of postoperative 30-day mortality, MACEs,
especially myocardial injury, and AKI in adult patients after non-cardiac
surgery. Triple low also predicts increased risk of 30-day mortality after
non-cardiac surgery. These findings provide evidence that IOH should be
recognized as an independent risk factor for postoperative adverse
outcomes after non-cardiac surgery.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<45>
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.<br/>Copyright &#xa9; 2018 The Cochrane
Collaboration.

<46>
Accession Number
621085186
Author
Karanfil E.O.T.; Moller A.M.
Title
Preoperative inspiratory muscle training prevents pulmonary complications
after cardiac surgery - a systematic review.
Source
Danish Medical Journal. 65 (3) (no pagination), 2018. Article Number:
A5450. Date of Publication: March 2018.
Publisher
Danish Medical Association
Abstract
INTRODUCTION: Post-operative pulmonary complications are a common cause of
morbidity and mortality in patients undergoing heart surgery. The aim of
this systematic review was to determine if preoperative inspiratory muscle
training could prevent the development of pneumonia and atelectasis in
patients undergoing coronary artery bypass grafting (CABG) or heart valve
surgery. METHODS:Systematic searches were performed in MED-LINE, Embase
and the Cochrane Library. The included studies compared the development of
pneumonia and atelectasis in CABG patients or heart valve surgery patients
who were prescribed either preoperative inspiratory muscle training or
usual care. The quality of the studies was assessed using the Cochrane
Risk of Bias Tool. RESULTS: The search yielded 2,479 records. The
inclusion criteria were fulfilled by five studies. All the studies were
randomised controlled trials. We found that the development of both
pneumonia and atelectasis was significantly reduced among patients who
received inspiratory muscle training preoperatively compared with patients
treated with usual care. CONCLUSIONS: Preoperative inspiratory muscle
training may reduce the risk of developing pneumonia and atelectasis.
However, more trials are needed to support and strengthen the evidence
found in this systematic review before routine implementation of this kind
of training preoperatively.<br/>Copyright &#xa9; 2018, Danish Medical
Association. All rights reserved.

<47>
Accession Number
621179874
Author
Romano R.; Cristescu S.M.; Risby T.H.; Marczin N.
Institution
(Romano, Marczin) Section of Anaesthetics, Pain Medicine and Intensive
Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London, London, United Kingdom
(Cristescu) Department of Molecular and Laser Physics, Institute of
Molecules and Materials, Radboud University, Nijmegen, Netherlands
(Risby) Department of Environmental Health Sciences, Bloomberg School of
Public Health, Johns Hopkins University, Baltimore, United States
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
Title
Lipid peroxidation in cardiac surgery: Towards consensus on biomonitoring,
diagnostic tools and therapeutic implementation.
Source
Journal of Breath Research. 12 (2) (no pagination), 2018. Article Number:
027109. Date of Publication: April 2018.
Publisher
Institute of Physics Publishing (E-mail: helen.craven@iop.org)
Abstract
This review focuses on oxidative stress and more specifically lipid
peroxidation in cardiac surgery, one of the fundamental theories of
perioperative complications. We present the molecular pathways leading to
lipid peroxidation and integrate analytical methods that allow detection
of lipid peroxidation markers in the fluid phase with those focusing on
volatile compounds in exhaled breath. In order to explore the accumulated
data in the literature, we present a systematic review of quantitative
analysis of malondialdehyde, a widely used lipid peroxidation product at
various stages of cardiac surgery. This exploration reveals major
limitations of existing studies in terms of variability of reported values
and significant gaps due to discrete and variable sampling times during
surgery. We also appraise methodologies that allow real-time and
continuous monitoring of oxidative stress. Complimentary techniques
highlight that beyond the widely acclaimed contribution of the
cardiopulmonary bypass technology and myocardial reperfusion injury, the
use of diathermy contributes significantly to intraoperative lipid
peroxidation. We conclude that there is an urgent need to implement the
theory of oxidative stress towards a paradigm change in the clinical
practice. Firstly, we need to acquire definite and irrefutable information
on the link between lipid peroxidation and post-operative complications by
building international consensus on best analytical approaches towards
generating qualitatively and quantitatively comparable datasets in
coordinated multicentre studies. Secondly, we should move away from
routine low-risk surgeries towards higher risk interventions where there
is major unmet clinical need for improving patient journey and outcomes.
There is also need for consensus on best therapeutic interventions which
could be tested in convincing large scale clinical trials. As future
directions, we propose combination of fluid phase platforms and
'metabography', an extended form of capnography - including real-time
analysis of lipid peroxidation and volatile footprints of metabolism - for
better patient phenotyping prior to and during high risk surgery towards
molecular prediction, stratification and monitoring of the patient's
journey.<br/>Copyright &#xa9; 2018 IOP Publishing Ltd.

<48>
Accession Number
620524701
Author
Sadjadieh G.; Engstrom T.; Helqvist S.; Hofsten D.E.; Kober L.; Pedersen
F.; Laursen P.N.; Nepper-Christensen L.; Clemmensen P.; Moller-Helgestad
O.K.; Sorensen R.; Ravkilde J.; Terkelsen C.J.; Jorgensen E.; Saunamaki
K.; Tilsted H.-H.; Kelbaek H.; Holmvang L.
Institution
(Sadjadieh, Engstrom, Helqvist, Hofsten, Kober, Pedersen, Laursen,
Nepper-Christensen, Sorensen, Jorgensen, Saunamaki, Tilsted, Holmvang)
Department of Cardiology, Rigshospitalet-Copenhagen University Hospital,
Denmark
(Clemmensen) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Universitatsklinikum Hamburg-Eppendorf,
Hamburg, Germany
(Clemmensen) Department of Medicine, Nykobing F Hospital, Nykobing F,
Denmark
(Clemmensen, Moller-Helgestad) Department of Cardiology, University of
Southern Denmark, Odense, Denmark
(Ravkilde) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Terkelsen) Department of Cardiology, Skejby-Aarhus University Hospital,
Aarhus, Denmark
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
Title
Relation of Bleeding Events to Mortality in Patients With ST-Segment
Elevation Myocardial Infarction Treated by Percutaneous Coronary
Intervention (a DANAMI-3 Substudy).
Source
American Journal of Cardiology. 121 (7) (pp 781-788), 2018. Date of
Publication: 01 Apr 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Bleeding events in relation to treatment of ST-segment elevation
myocardial infarction (STEMI) have previously been associated with
mortality. In this study, we investigated the incidence and prognosis of,
and variables associated with serious bleedings within 30 days after
primary percutaneous coronary intervention in patients from The Third
Danish Study of Optimal Acute Treatment of Patients with ST-Segment
Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts
were read within 30 days postadmission to assess bleeding events using
thrombolysis in myocardial infarction (TIMI) and Bleeding Academic
Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in
59 patients (2.7%). Variables associated with TMMB were female gender
(hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p
<0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to
3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2
to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2,
p = 0.001). Undergoing 2 in-hospital procedures were not associated with
increased risk of TMMB. TMMB was strongly associated with 30-day mortality
in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not
with mortality days 31 to 365. When excluding fatal bleedings from the
analysis, a TMMB was no longer associated with 30-day mortality. In
conclusion, we found that in a contemporary STEMI-population, the
incidence of 30-day TMMB was low. A TMMB was strongly associated with
30-day mortality but not with mortality days 31 to 365. If patients
survived a serious bleeding, their short- and long-term prognoses were not
affected.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<49>
Accession Number
615332267
Author
Glantz H.; Johansson M.C.; Thunstrom E.; Guron C.W.; Uzel H.; Saygin M.;
Herlitz J.; Peker Y.
Institution
(Glantz) Dept. of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Johansson, Guron) Dept. of Molecular and Clinical Medicine/Clinical
Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom, Peker) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom) Dept. of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Uzel) Dept. of Cardiology, Sahlgrenska University Hospital/Molndal,
Gothenburg, Sweden
(Saygin) Dept. of Physiology, Faculty of Medicine, Suleyman Demirel
University, Isparta, Turkey
(Herlitz) Center of Prehospital Care of Western Sweden, University College
of Boras, Sweden
(Peker) Dept. of Pulmonary Medicine, Marmara University, Istanbul, Turkey
Title
Effect of CPAP on diastolic function in coronary artery disease patients
with nonsleepy obstructive sleep apnea: A randomized controlled trial.
Source
International Journal of Cardiology. 241 (pp 12-18), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Obstructive sleep apnea (OSA) has been associated with worse
diastolic function in patients with coronary artery disease (CAD). This
analysis determined whether continuous positive airway pressure (CPAP)
treatment would improve diastolic function in CAD patients with nonsleepy
OSA. Methods Between December 2005 and November 2010, 244 revascularized
CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) >= 15/h,
Epworth Sleepiness Scale [ESS] score < 10) were randomly assigned to CPAP
or no-CPAP. Echocardiographic measurements were obtained at baseline, and
after 3 and 12 months. Results A total of 171 patients with preserved left
ventricular ejection fraction (>= 50%), no atrial fibrillation or severe
valve abnormalities, and technically adequate echocardiograms at baseline
and follow-up visits were included (CPAP, n = 87; no-CPAP, n = 84). In the
intention-to-treat analysis, CPAP had no significant effect on
echocardiographic parameters of mild (enlarged left atrium or decreased
diastolic relaxation velocity) or worse (increased E/e filling index
[presumed elevated left ventricular filling pressure]) diastolic function.
Post-hoc analysis revealed a significant association between CPAP usage
for >= 4 h/night and an increase in diastolic relaxation velocity at 12
months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p =
0.039) after adjustment for age, sex, body mass index, and left atrium
diameter at baseline. Conclusions CPAP did not improve diastolic
dysfunction in CAD patients with nonsleepy OSA. However, good CPAP
adherence was significantly associated with an increase in diastolic
relaxation velocity after one year.<br/>Copyright &#xa9; 2017 Elsevier
Ireland Ltd

<50>
[Use Link to view the full text]
Accession Number
610791883
Author
Pineda A.M.; Carvalho N.; Gowani S.A.; Desouza K.A.; Santana O.; Mihos
C.G.; Stone G.W.; Beohar N.
Institution
(Pineda, Carvalho, Gowani, Desouza, Santana, Mihos, Beohar) Division of
Cardiology, Columbia University, Mount Sinai Medical Center, Cardiac
Catheterization Laboratory, Miami Beach, FL 33140, United States
(Stone) Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
Title
Managing Multivessel Coronary Artery Disease in Patients with ST-Elevation
Myocardial Infarction: A Comprehensive Review.
Source
Cardiology in Review. 25 (4) (pp 179-188), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Multivessel coronary artery disease (CAD) is found in up to 60% of the
patients presenting with an ST-elevation myocardial infarction (STEMI) and
worsens the prognosis proportional to the extent of CAD severity. However,
the 2013 American College of Cardiology/American Heart Association STEMI
guidelines, based on mostly observational data, had recommended against a
routine noninfarct-related artery percutaneous coronary intervention
(PCI). After these guidelines were published, a handful of randomized
trials became available, and they suggested that PCI of significant
lesions in a noninfarct-related artery at the time of primary PCI might
result in improved patient outcomes. The incidence of major adverse
cardiac events was significantly reduced by 55% at 1 year and 65% at 2
years in patients undergoing angiographically guided PCI of nonculprit
vessels at the time of primary PCI, in 2 different randomized trials.
Fractional flow reserve-guided PCI of nonculprit vessels in this setting
has also been shown to reduce cardiac events by 44% at 1 year.
Meta-analyses of both nonrandomized and randomized trials have also
suggested that complete revascularization at the time of STEMI
significantly improves outcomes, including long-term all-cause mortality.
In view of the emerging data, a focused update on primary PCI was
published in 2015 and suggested that PCI of noninfarct-related arteries
might be considered in selected patients. This article is a comprehensive
review of the literature on the treatment of multivessel CAD in patients
with STEMI, which provides the reader a critical analysis of the available
information to determine the best therapeutic approach.

<51>
Accession Number
614116973
Author
Drake-Brockman T.F.E.; Ramgolam A.; Zhang G.; Hall G.L.; von
Ungern-Sternberg B.S.
Institution
(Drake-Brockman, Ramgolam, von Ungern-Sternberg) Department of Anaesthesia
and Pain Management, Princess Margaret Hospital for Children, Perth, WA,
Australia
(Drake-Brockman, von Ungern-Sternberg) School of Medicine and
Pharmacology, University of Western Australia, Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, University of
Western Australia, Perth, WA, Australia
(Hall) Centre of Child Health Research, University of Western Australia,
Perth, WA, Australia
(Ramgolam, Hall, von Ungern-Sternberg) Children's Lung Health, Telethon
Kids Institute, Perth, WA, Australia
(Zhang) School of Public Health, Curtin University, Perth, WA, Australia
(Hall) School of Physiotherapy and Exercise Science, Curtin University,
Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, Curtin
University, Perth, WA, Australia
Title
The effect of endotracheal tubes versus laryngeal mask airways on
perioperative respiratory adverse events in infants: a randomised
controlled trial.
Source
The Lancet. 389 (10070) (pp 701-708), 2017. Date of Publication: 18 Feb
2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Perioperative respiratory adverse events (PRAE) are the most
common critical incidents in paediatric anaesthesia and occur more often
in infants. Use of laryngeal mask airways (LMAs) is associated with
reduced PRAE compared with endotracheal tubes in older children (>1 year).
We aimed to evaluate the effect of these devices on the incidence of PRAE
in infants. Methods We did a randomised controlled trial at the Princess
Margaret Hospital for Children in Perth (WA, Australia) by recruiting
infants (aged 0-12 months) undergoing general (with or without regional or
local) anaesthesia with anticipated fentanyl dose 1 mug/kg or lower for
minor elective surgery. We excluded patients contraindicated for LMA or
endotracheal tube; who had known cardiac disease or airway or thoracic
malformations; who were receiving midazolam premedication; who were
undergoing airway, thoracic, or abdomen surgery at the time of
participation; and if the parents did not speak English. Written parental
or guardian consent was obtained before enrolment. Participants were
randomly assigned (1:1), by computer-generated variable block
randomisation, to receive an LMA (PRO-Breathe, Well Lead Medical Co Ltd,
Panyu, China) or an endotracheal tube (Microcuff, Halyard Health Inc,
Atlanta, GA, USA). Sealed randomisation envelopes were used to conceal
device assignment. An interim analysis was planned once half the number of
infants needed (145) had been recruited. The primary outcome was incidence
of PRAE, assessed in the intention-to-treat population. The institutional
ethics committee at the Princess Margaret Hospital for Children granted
ethical approval (1786/EP). The trial is registered with the Australian
New Zealand Clinical Trials Registry (ACTRN12610000250033). Findings The
trial began on July 8, 2010, and was ended early on May 7, 2015, after the
interim analysis results met the study stopping rules. During this time,
239 infants were assessed and 181 eligible infants were randomly assigned
to receive an LMA (n=85) or an endotracheal tube (n=95). Four infants were
not included in the analysis (two due to cancelled procedures, one did not
meet inclusion criteria, and one with missing dataset). In the
intention-to-treat analysis, PRAE occurred in 50 (53%) infants in the
endotracheal tube group and in 15 (18%) infants in the LMA group (risk
ratio [RR] 2.94, 95% CI 1.79-4.83, p<0.0001). Laryngospasm and
bronchospasm (major PRAE) were recorded in 18 (19%) infants in the
endotracheal tube group and in three (4%) infants in the LMA group (RR
5.30, 95% CI 1.62-17.35, p=0.002). No deaths were reported. Interpretation
In infants undergoing minor elective procedures, LMAs were associated with
clinically significantly fewer PRAE and lower occurrence of major PRAE
(laryngospasm and bronchospasm) than endotracheal tubes. This difference
should be a consideration in airway device selection. Funding Princess
Margaret Hospital Foundation, National Health and Australian Medical
Research Council, Stan Perron Charitable Trust, and Callahan
Estate.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<52>
Accession Number
619240293
Author
Verdoia M.; Barbieri L.; Nardin M.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, Nardin, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont
University, Novara, Italy
(Barbieri) Department of Cardiology, Ospedale S. Andrea, Vercelli, Italy
(Nardin) Department of Medicine, ASST "Spedali Civili", University of
Brescia, Brescia, Italy
(Suryapranata) Department of Cardiology, University Medical Centre St
Radboud, Nijmegen, Netherlands
Title
Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in
Transcatheter Aortic Valve Replacement: Indirect Comparison and
Meta-analysis.
Source
Revista Espanola de Cardiologia. 71 (4) (pp 257-266), 2018. Date of
Publication: April 2018.
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: There is uncertainty on the correct
management of antithrombotic therapies after transcatheter aortic valve
replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently
recommended on an empirical basis. The aim of the present meta-analysis
was to assess the safety and effectiveness of DAPT in patients undergoing
TAVR. Methods: Studies comparing different antithrombotic regimens after
TAVR were included. The primary endpoint was 30-day overall mortality.
Results: We included 9 studies, 5 comparing DAPT with aspirin monotherapy
and 4 comparing DAPT with monoantiplatelet therapy (MAPT) + oral
anticoagulation. Among 7991 patients, 72% were on DAPT. The median
follow-up was 3.5 months. Mortality was significantly lower in the DAPT
group (12.2% vs 14.4%; OR, 0.81; 95%CI, 0.70-0.93; P =.003;
P<inf>het</inf> =.93), with similar benefits compared with aspirin
monotherapy (OR, 0.80; 95%CI, 0.69-0.93; P =.004; P<inf>het</inf> =.60),
which were not statistically significant when compared with MAPT + oral
anticoagulation (OR, 0.86; 95%CI, 0.55-1.35; P =.51; P<inf>het</inf>
=.97). A similar trend for DAPT was observed for stroke (OR, 0.83 95%CI,
0.63-1.10; P =.20; P<inf>het</inf> =.67), with no increase in the rate of
major bleedings (OR, 1.69; 95%CI, 0.86-3.31; P =.13;
P<inf>het</inf><.0001). On indirect comparison analysis, no benefit in
survival, stroke, or bleedings was identified for additional oral
anticoagulation. Conclusions: The present meta-analysis supports the use
of DAPT after TAVR, reducing mortality and offering slight benefits in
stroke, with no increase in major bleedings compared with MAPT. The
strategy of aspirin + oral anticoagulation did not provide significant
benefits compared with MAPT or DAPT. Full English text available from:
www.revespcardiol.org/en<br/>Copyright &#xa9; 2017 Sociedad Espanola de
Cardiologia

<53>
Accession Number
617490152
Author
Perez Vela J.L.; Jimenez Rivera J.J.; Alcala Llorente M.A.; Gonzalez de
Marcos B.; Torrado H.; Garcia Laborda C.; Fernandez Zamora M.D.; Gonzalez
Fernandez F.J.; Martin Benitez J.C.
Institution
(Perez Vela) Servicio de Medicina Intensiva, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Jimenez Rivera) Servicio de Medicina Intensiva, Complejo Hospitalario
Universitario de Canarias, Tenerife, Spain
(Alcala Llorente) Servicio de Medicina Intensiva, Fundacion Jimenez Diaz,
Madrid, Spain
(Gonzalez de Marcos) Servicio de Medicina Intensiva, Hospital
Universitario de La Princesa, Madrid, Spain
(Torrado) Servicio de Medicina Intensiva, Hospital Universitario de
Bellvitge, Barcelona, Spain
(Garcia Laborda) Servicio de Medicina Intensiva, Hospital Universitario
Miguel Servet, Zaragoza, Spain
(Fernandez Zamora) Servicio de Medicina Intensiva, Hospital Universitario
Carlos Haya, Malaga, Spain
(Gonzalez Fernandez) Servicio de Medicina Intensiva, Hospital
Universitario Virgen Macarena, Sevilla, Spain
(Martin Benitez) Servicio de Medicina Intensiva, Hospital Clinico
Universitario San Carlos, Madrid, Spain
Title
Low cardiac output syndrome in the postoperative period of cardiac
surgery. Profile, differences in clinical course and prognosis. The ESBAGA
study.
Source
Medicina Intensiva. 42 (3) (pp 159-167), 2018. Date of Publication: April
2018.
Publisher
Ediciones Doyma, S.L.
Abstract
Objectives: An analysis is made of the clinical profile, evolution and
differences in morbidity and mortality of low cardiac output syndrome
(LCOS) in the postoperative period of cardiac surgery, according to the 3
diagnostic subgroups defined by the SEMICYUC Consensus 2012. Design: A
multicenter, prospective cohort study was carried out. Setting: ICUs of
Spanish hospitals with cardiac surgery. Patients: A consecutive sample of
2,070 cardiac surgery patients was included, with the analysis of 137
patients with LCOS. Interventions: No intervention was carried out.
Results: The mean patient age was 68.3 +/- 9.3 years (65.2% males), with a
EuroSCORE II of 9.99 +/- 13. NYHA functional class III-IV (52.9%), left
ventricular ejection fraction < 35% (33.6%), AMI (31.9%), severe PHT
(21.7%), critical preoperative condition (18.8%), prior cardiac surgery
(18.1%), PTCA/stent placement (16.7%). According to subgroups, 46 patients
fulfilled hemodynamic criteria of LCOS (group A), 50 clinical criteria
(group B), and the rest (n = 41) presented cardiogenic shock (group C).
Significant differences were observed over the evolutive course between
the subgroups in terms of time subjected to mechanical ventilation (114.4,
135.4 and 180.3 min in groups A, B and C, respectively; P <.001), renal
replacement requirements (11.4, 14.6 and 36.6%; P =.007), multiorgan
failure (16.7, 13 and 47.5%), and mortality (13.6, 12.5 and 35.9%; P
=.01). The mean maximum lactate concentration was higher in cardiogenic
shock patients (P =.002). Conclusions: The clinical evolution of these
patients leads to high morbidity and mortality. We found differences
between the subgroups in terms of the postoperative clinical course and
mortality.<br/>Copyright &#xa9; 2017 Elsevier Espana, S.L.U. y SEMNIM

<54>
Accession Number
620775591
Author
Parry M.; Bjornnes A.K.; Victor J.C.; Ayala A.P.; Lenton E.; Clarke H.;
Harvey P.; Lalloo C.; McFetridge-Durdle J.; McGillion M.H.; Price J.;
Stinson J.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, Ontario, Canada
(Bjornnes) Institute of Nursing and Health Promotion, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway
(Victor) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
(Ayala, Lenton) Gerstein Science Information Centre, University of
Toronto, Toronto, Ontario, Canada
(Clarke) Pain Research Unit, University Health Network, Toronto, Ontario,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto,
Ontario, Canada
(Lalloo, Stinson) The Hospital for Sick Children, The Peter Gilgan Centre
for Research and Learning, Toronto, Ontario, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, Florida, United States
(McGillion) School of Nursing, McMaster University, Hamilton, Ontario,
Canada
(Price) Women's College Research Institute, Women's College Hospital,
Toronto, Ontario, Canada
Title
Self-Management Interventions for Women With Cardiac Pain: A Systematic
Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 34 (4) (pp 458-467), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cardiac pain is considered the primary indicator of coronary
artery disease (CAD). Existing reviews lack appropriate numbers of women
or sex-based subgroup analyses, or both; thus, the benefits of
self-management (women with cardiac pain actively participating in their
own care and treatment) remain uncertain. Methods: Using methods described
by the Evidence for Policy and Practice Information and Co-ordinating
Centre at the Institute of Education, 7 databases were systematically
searched to examine and synthesize the evidence on self-management
interventions for women with cardiac pain and cardiac pain equivalents,
such as fatigue, dyspnea, and exhaustion. Results: Our search yielded
22,402 article titles and abstracts. Of these, 57 randomized controlled
trials were included in a final narrative synthesis, comprising data from
13,047 participants, including 5299 (41%) women. Self-management
interventions targeting cardiac pain in women compared with a control
population reduced (1) cardiac pain frequency and cardiac pain proportion
(obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3)
dyspnea at 2 months. There was no evidence of group differences in
postprocedural (percutaneous coronary intervention or cardiac surgery)
pain. Results indicated that self-management interventions for cardiac
pain were more effective if they included a greater proportion of women
(standardized mean difference [SMD], -0.01; standard error, 0.003; P =
0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to
-0.03), and collaboration/support from health care providers (SMD, -0.57;
95% CI, -1.00 to -0.14). Conclusions: The results of this review suggest
that self-management interventions reduce cardiac pain and cardiac pain
equivalents.<br/>Copyright &#xa9; 2017 Canadian Cardiovascular Society

<55>
Accession Number
621354323
Author
Gomboeva S.B.; Ryabov V.V.; Lugacheva Y.G.; Kulagina I.V.
Institution
(Gomboeva, Lugacheva, Kulagina) Cardiology Research Institute, Tomsk
National Research Medical Centre, Russian Academy of Sciences, Tomsk,
Russian Federation
(Ryabov) National Research Tomsk State University, Tomsk, Russian
Federation
Title
Folate metabolism gene polymorphisms in patients with acute coronary
syndrome with nonobstructive coronary atherosclerosis.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care Congress 2018. Italy. 7 (1 Supplement 1) (pp 135),
2018. Date of Publication: March 2018.
Publisher
SAGE Publications Inc.
Abstract
The aim of the study was to investigate the frequency of unfavorable
allelic variants of the genes associated with risk of thrombophilia of
folate metabolism gene in patients with ACS in NOCA. Material and methods:
Investigation is nonrandomized, open, controlled: NCT02655718. Inclusion
criteria comprised NOCA (normal coronary arteries/plaques <50%), confirmed
by invasive coronary angiography, aged over 18 years at the time of
randomization. Individuals who had previously undergone coronary artery
revascularization were excluded from the study. For included patients were
analyzed 4 genes of folate metabolism: MTHFR (677 C>T), (1298 A>), (MTR
2756 A>G), MTRR (66A>G). The genotypes were determined by polymerase chain
reaction methods. Results: 913 patients were hospitalized with ACS in
2015-2016, 44 (4.8%) had NOCA confirmed by invasive coronary angiography.
42(95%) patients were Russian, 1(3%)-Armenian, 1(3%)-Korean. Proportion of
man were 19(66%), 25 (57%)-women. Average age was 54 +/- 11. 43 (96.6%)
individuals with NOCA had at least one homozygous or heterozygous
unfavorable genotype of the folate metabolism gene. Unfavorable
heterozygous variants of genotypes of folate metabolism genes were
detected in 37 (84%) patients, including combination of 3 SNPs in 7 (16%)
individuals; 2 SNP-in 16 (36%), 1 SNP-in 14 (32%). In 7 (16%) patients,
heterozygous genotypes of genes of folate metabolism enzymes, predisposing
to the development of thrombophilia, were not determined. At least one
unfavorable homozygous genotype of folate metabolism genes was registered
in 26 (59%) of the examined patients, including. 3(7%) individuals
identified a combination of 2 SNP. The frequency of registration of
unfavorable homozygous genotypes of MTHFR (1298 A> C), MTR (2756 A> G),
MTRR (66A> G) and heterozygotes for MTHFR (677 C> T) in study group more
than in European population, the frequency of the homozygote for the
allele A of the MTRR gene (66A> G)-lower. Conclusion: The proportion of
patients with NOCA among patients with ACS in 2015-2016 was 4.8%. The
prevalence of adverse allelic variants of folate metabolism genes
associated with risk of thrombophilia in patients with ACS and NOCA was
96.6%.

<56>
Accession Number
621354154
Author
Alekseeva Y.; Vishlov E.V.; Markov V.A.; Ryabov V.V.
Institution
(Alekseeva, Vishlov) Cardiology Reseach Institute, Tomsk National Reseach
Medical Centre, Russian Academy of Scince, Tomsk, Russian Federation
(Markov, Ryabov) Siberian State Medical University, Tomsk, Russian
Federation
Title
Clinical study of recombinant non-immunogenic staphylokinase.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care Congress 2018. Italy. 7 (1 Supplement 1) (pp 203),
2018. Date of Publication: March 2018.
Publisher
SAGE Publications Inc.
Abstract
Background: Profibrinolytic properties of staphylokinase has been known
for more than 40 years. There were number of trials which presented high
efficacy of staphylokinase in different doses and low-level hemorrhagic
complications in patients with myocardial infarction with ST-segment
elevation (STEMI). One of advantages of this drug is the highest
fibrin-selectivity among all thrombolytics. But the main limit of
staphylokinase administration is production of anti-staphylokinase
antibodies. In 2012 a new thrombolytic was developed. It was recombinant
non-immunogenic staphylokinase. Three aminoacids in immunodominate epitope
of native staphylokinase were replaced to develop a non-immunogenic
variant. In previous clinical trials recommended dose and the way of
administration (bolus injection/infusion/bolus-infusion) have not been
determined. The purpose: To assess the efficacy and safety of different
recombinant non-immunogenic staphylokinase doses and ways of
administration of in patients with STEMI. Materials and methods: The study
included 68 patients with STEMI in the first 6 hours after the onset of
disease. The patients were divided into 3 groups. The first group (n=27)
was treated by intravenous administration of 15 mg recombinant
non-immunogenic staphylokinase given as a single bolus. The second group
(n=20) was treated with a double bolus of 10 mg and 5 mg given 30 minutes
apart. And the third group (n=21) received 15 mg recombinant
non-immunogenic staphylokinase given as a 10 mg bolus and infusion of 5 mg
over 30 minutes. All patients received aspirin, P2Y12 inhibitor and
heparin infusion. After the thrombolysis all the patients were undergone
coronary angiography (CAG) with percutaneous coronary intervention (PCI).
The main evaluated indicants were frequency of the coronary artery
reperfusion by ECG over 90 minutes after thrombolytic therapy, coronary
blood flow according to the CAG (TIMI), the frequency of bleeding
complications (TIMI classification), mortality. Results: We observed
comparable results between groups. There was not difference between
frequency of coronary artery reperfusion on ECG and CAG. TIMI-3
reperfusion grade was achieved in 62,9% of a single bolus recombinant
non-immunogenic staphylokinase patients versus 50% of double bolus
patients and versus 57% of a 10 mg bolus and infusion of 5 mg over 30
minutes (p < 0,05). Complications (predominantly microhematuria) were
occurred in both groups in equal frequency. We did not observe fatal cases
and allergic reactions in groups. Plasma fibrinogen levels were unaffected
in all groups. Conclusion: Recombinant non-immunogenic staphylokinase
showed efficacy and safety as a thrombolytic agent in different doses and
ways of administration. Simultaneously further randomized or large
non-randomized studies investigating the way and dosage of recombinant
staphylokinase administration are required.

<57>
Accession Number
621354024
Author
Gomboeva S.B.; Ryabov V.V.; Lugacheva Y.G.; Kulagina I.V.
Institution
(Gomboeva, Lugacheva, Kulagina) Cardiology Research Institute, Tomsk
National Research Medical Centre, Russian Academy of Sciences, Tomsk,
Russian Federation
(Ryabov) National Research Tomsk State University, Tomsk, Russian
Federation
Title
Haemostatic gene polymorphisms in acute coronary syndrome with
nonobstructive coronary atherosclerosis.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care Congress 2018. Italy. 7 (1 Supplement 1) (pp 127-128),
2018. Date of Publication: March 2018.
Publisher
SAGE Publications Inc.
Abstract
The aim of the study was to investigate the prevalence of 8 haemostatic
gene polymorphisms associated with thrombophilia in patients with acute
coronary syndrome (ACS) with nonobstructive coronary atherosclerosis
(NOCA). Material and methods: Investigation is nonrandomized, open,
controlled: NCT02655718. We present the results of patients admitted to
the emergency department of cardiology due to ACS in 2015-2016. Inclusion
criteria comprised NOCA (normal coronary arteries/plaques <50%), confirmed
by invasive coronary angiography, aged over 18 years at the time of
randomization. Individuals who had previously undergone coronary artery
revascularization were excluded from the study. For 29 patients were
analyzed 8 haemostatic gene polymorphisms: F2 (20210 G> A), F5 (1691 G>
A), F7 (10976G> A), F13 163 G> T), F1 (-455G> A), GP Ia-IIa (807C> T), GP
IIb-IIIa (1565 T> C), PAI-I (-675 5G> 4G).The genotypes were determined by
polymerase chain reaction methods. Results: Among 913 patients who were
hospitalized with ACS, 44 (4.8%) had NOCA. Including 19 men (66%) and 25
(57%) women, the average age of patients was 54 +/- 11 years. Among 29
patients in 28 (96.6%) individuals with NOCA had at least one homozygous
or heterozygous for unfavorable alleles genotype of haemostatic system.
The homozygous genotype for adverse allelic variants was registered in 13
(44.8%) patients by polymorphic variants of the following genes: FXIII, GP
Ia-IIa, GP IIb-IIIa, PAI-1, including 2 unfavorable homozygous genotype
for variants of GP IIb-IIIa and PAI-1 genes. One patient (3.4%) had
unfavorable heterozygous genotypes according to 5 studied variants
predisposing to the development of thrombophilia; seven (24.1%) have
heterozygous genotypes of 4 SNP, ten (34.5%) have heterozygous genotypes
of 3 SNP, seven (24.1%) have 2 SNPs, two (6.9%)-2 SNP each; Only two
(6.9%) individuals did not have adverse alleles in the heterozygous state.
The frequency of registration of homozygous genotypes for alleles
predisposing to thromboses for all the studied polymorphic variants in the
survey sample is within the limits shown for the european population, and
the frequency of heterozygotes registration for variants of the F V, FVII,
FXIII, FI gene, it exceeds estimates of heterozygotes prevalence in
european population. Conclusion: The proportion of patients with NOCA
among patients with ACS in 2015-2016 was 4.8%. The prevalence of adverse
allelic variants of clotting factor genes associated with risk of
thrombophilia in patients with ACS and NOCA was 96.6%.

<58>
Accession Number
621353660
Author
Abcha F.; Boukhris M.; Labidi O.; Bendag N.; Najjar H.; El Ghardallou M.;
Benmrad I.; Barakett N.
Institution
(Abcha, Labidi, El Ghardallou, Benmrad, Barakett) Nabeul University
Hospital, Cardiology Departement, nabeul, Tunisia
(Boukhris, Najjar) Abderrahmen Mami Hospital, Cardiology Department,
Ariana, Tunisia
(Bendag) Faculty of Medicine of Tunis, tunis, Tunisia
Title
Does complete revascularization in elderly with multi-vessel disease
improve clinical outcomes in the setting of acute coronary syndrome?.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care Congress 2018. Italy. 7 (1 Supplement 1) (pp 120),
2018. Date of Publication: March 2018.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Several recent studies have shown improvement of clinical
outcomes with complete revascularization in acute coronary syndrome (ACS).
The latest guidelines of European society of cardiology recommended to
treat non infract related artery before discharge. Objective: We sought to
evaluate the effectiveness of complete revascularization in a population
of elderly patients in the setting of ACS. Method: We prospectively
followed a cohort of admitted patients with ACS, all with age >=75 years
and multivessel disease between January 2015 and June 2016 for up to 1
year. The primary endpoint was major adverse cardiac or cerebrovascular
events (MACCE), a composite of death, non-procedural myocardial
infarction, repeat coronary revascularisation, and stroke. Result: One
hundred four patients (104) were enrolled in our cohort, 26 (25 %) were
women. Mean age was 79 +/- 4 years, with a maximum of 93 years. More than
the half of our patients had hypertension 56.7% and diabetes 57.7%. Fifty
one percent of our patients were smoker. Mean ejection systolic fraction
was 58 %+/- 9. The median SYNTAX score was 19 [2-44].The Third of our
patients had three-vessel disease. Complete revascularization was achieved
in 60.6% of cases. In the Cox regression analysis, the incidence of the
composite endpoint was significantly higher in the incomplete
revascularization group within the 12-months follow-up period (24.7% vs
11.1%; P=0.001). Conclusion: Our study showed that complete
revascularization in elderly patients with ACS and multivessel disease
improve clinical outcomes. More randomized trials are needed to conclude
about the efficiency of this strategy in elderly patients.

<59>
Accession Number
621353638
Author
Gospodinova M.; Cherneva Z.H.; Peichev I.; Denchev S.
Institution
(Gospodinova, Cherneva, Peichev, Denchev) Military Medical Academy of
Sofia, Department of Internal Medicine, Clinic of Cardiology, Sofia,
Bulgaria
Title
Disease profile, length of stay and in-hospital mortality in the cardiac
intensive care unit.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care Congress 2018. Italy. 7 (1 Supplement 1) (pp 53),
2018. Date of Publication: March 2018.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate the disease profile in patients admitted to the CICU
in a multiprofile teaching hospital without invasive cardiology and
cardiac surgery, and to determine the association of cardiovascular and
noncardiovascular illnesses with the length of stay (LOS) and in-hospital
mortality. Methods: We studied 950 admissions between June 1, 2016 and May
31, 2017. Through retrospective systematic review of the electronic
database we collected data about the leading and concomitant diagnoses,
demographic and clinical data, LOS and causes of death. Results: The
leading diagnosis was cardiovascular in 72% of patients-decompensated
heart failure (33%), atrial fibrillation (15%), stroke (11%), acute
coronary syndrome without ST elevation (6%), pulmonary embolism (3%),
infective endocarditis (1%), pericarditis (2%), other arrhythmias (1%).
Pneumonia, exacerbated chronic obstructive pulmonary disease (COPD) with
respiratory failure (6%), exacerbated chronic kidney failure (4%),
diabetes mellitus (4%), gastrointestinal diseases (3%) and sepsis (2%)
were the most frequent noncardiovascular leading diagnosis. A respiratory
and kidney failure and sepsis were found in 10% of all patients as
secondary diagnosis. The median LOS was 6 days cardiovascular and 10 days
in non-cardiovascular patients. In-hospital mortality was 13% and stroke
was the most common cause (40%). The other cardiovascular diseases were
28% of the in-hospital mortality. Acute and exacerbated respiratory and
kidney failure, gastrointestinal bleeding, decompensated diabetes mellitus
and sepsis accounted for 32% of in-hospital mortality. Conclusion: A
significant number of patients with acute or exacerbated
non-cardiovascular diseases as a leading or concomitant diagnosis were
treated in the CICU. These patients, as well as patients with severely
decompensated heart failure and stroke had prolonged LOS and increased
in-hospital mortality. The diversity of diseases treated in CICU
necessitates more complex management by a multidisciplinary team.

<60>
Accession Number
621368763
Author
Floyd S.; Craig S.W.; Topley D.; Tullmann D.
Institution
(Floyd) Shawn Floyd, DNP, RN, ACNP, is a nurse practitioner with the Lung
Transplant Team at the University of Virginia Health System. Sarah W.
Craig, PhD, RN, CNS, is a clinical nurse specialist and an assistant
professor of nursing at the University of Virginia School of Nursing.
Darla Topley, DNP, RN, CNS, is a clinical nurse specialist working in the
Thoracic and Cardiovascular Intensive Care Unit at the University of
Virginia Health System. Dorothy Tullmann, PhD, RN, CNL, is an associate
professor of nursing and the MSN & DNP Programs and director at the
University of Virginia School of Nursing. The authors have disclosed that
they have no significant relationship with, or financial interest in, any
commercial companies pertaining to this article
Title
Evaluation of a Progressive Mobility Protocol in Postoperative
Cardiothoracic Surgical Patients.
Source
Dimensions of critical care nursing : DCCN. 35 (5) (pp 277-282), 2016.
Date of Publication: 01 Sep 2016.
Abstract
Cardiothoracic surgical patients are at high risk for complications
related to immobility, such as increased intensive care and hospital
length of stay, intensive care unit readmission, pressure ulcer
development, and deep vein thrombosis/pulmonary embolus. A progressive
mobility protocol was started in the thoracic cardiovascular intensive
care unit in a rural academic medical center. The purpose of the
progressive mobility protocol was to increase mobilization of
postoperative patients and decrease complications related to immobility in
this unique patient population. A matched-pairs design was used to compare
a randomly selected sample of the preintervention group (n = 30) to a
matched postintervention group (n = 30). The analysis compared outcomes
including intensive care unit and hospital length of stay, intensive care
unit readmission occurrence, pressure ulcer prevalence, and deep vein
thrombosis/pulmonary embolism prevalence between the 2 groups. Although
this comparison does not achieve statistical significance (P < .05) for
any of the outcomes measured, it does show clinical significance in a
reduction in hospital length of stay, intensive care unit days, in
intensive care unit readmission rate, and a decline in pressure ulcer
prevalence, which is the overall goal of progressive mobility. This study
has implications for nursing, hospital administration, and therapy
services with regard to staffing and cost savings related to fewer
complications of immobility. Future studies with a larger sample size and
other populations are warranted.

<61>
Accession Number
2000570319
Author
Kanwar A.; Thaden J.J.; Nkomo V.T.
Institution
(Kanwar) Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA,
United States
(Kanwar) Mayo Clinic College of Medicine and Science, Rochester, MN,
United States
(Thaden, Nkomo) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Title
Management of Patients With Aortic Valve Stenosis.
Source
Mayo Clinic Proceedings. 93 (4) (pp 488-508), 2018. Date of Publication:
April 2018.
Publisher
Elsevier Ltd
Abstract
With increased life expectancy and aging of the population, aortic
stenosis is now one of the most common valvular heart diseases. Early
recognition and management of aortic stenosis are of paramount importance
because untreated symptomatic severe disease is universally fatal. The
advent of transcather aortic valve replacement technologies provides
exciting avenues of care to patients with this disease in whom traditional
surgical procedures could not be performed or were associated with high
risk. This review for clinicians offers an overview of aortic stenosis and
updated information on the current status of various treatment strategies.
An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was
performed from conception July 1, 2016, through November 30, 2017, using
the terms aortic stenosis, aortic valve replacement, transcatheter aortic
valve replacement (TAVR), transcatheter aortic valve insertion (TAVI),
surgical aortic valve replacement, aortic stenosis flow-gradient patterns,
low-flow aortic valve stenosis, natural history, stress testing,
pathophysiology, bicuspid aortic valve, and congenital aortic valve
disease.<br/>Copyright &#xa9; 2018 Mayo Foundation for Medical Education
and Research

<62>
Accession Number
2000568333
Author
Kulik A.; Abreu A.M.; Boronat V.; Kouchoukos N.T.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, FL, United States
(Kouchoukos) Division of Cardiovascular and Thoracic Surgery, Missouri
Baptist Medical Center, BJC Healthcare, St. Louis, MO, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
Title
Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale
and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft
events and thrombosis) randomized controlled trial (NCT02053909).
Source
Contemporary Clinical Trials. 68 (pp 45-51), 2018. Date of Publication:
May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale: Saphenous vein graft disease remains a major limitation of
coronary artery bypass graft surgery (CABG). Up to 20% of vein grafts will
occlude within the first year after CABG despite standard aspirin
antiplatelet therapy. However, more potent postoperative platelet
inhibition with ticagrelor may improve graft patency. The goal of this
study will be to evaluate the efficacy of ticagrelor, as compared to
aspirin, for the prevention of saphenous vein graft occlusion following
CABG. Study design: The Ticagrelor Antiplatelet Therapy to Reduce Graft
Events and Thrombosis (TARGET) study is a multi-center double-blind
randomized controlled trial enrolling patients who have undergone
multi-vessel CABG with at least one saphenous vein graft. Patients are
being randomized to receive either aspirin 81 mg twice per day or
ticagrelor 90 mg twice per day for 2 years starting within 7 days after
surgery. The projected enrollment is 150 patients in each arm (300 total
patients). Patients will undergo computed tomography (CT) coronary
angiography at 1 and 2 years after surgery to assess the incidence of vein
graft occlusion and stenosis. Conclusion: To our knowledge, this trial is
the first prospective study to evaluate the impact of early postoperative
ticagrelor on 1- and 2-year graft patency after CABG. Furthermore, it is
also the first trial to use a novel antiplatelet agent as a standalone,
without aspirin, after CABG. Should ticagrelor reduce the incidence of
postoperative graft occlusion, the results of this study will redefine
modern antiplatelet management following coronary bypass surgery
(ClinicalTrials.gov NCT02053909).<br/>Copyright &#xa9; 2018 Elsevier Inc.

<63>
Accession Number
621364753
Author
Naseri M.H.; Madani H.; Tafti S.H.A.; Farahani M.M.; Saleh D.K.;
Hosseinnejad H.; Hosseini S.; Hekmat S.; Ahmadi Z.H.; Dehghani M.; Saadat
A.; Mardpour S.; Hosseini S.E.; Esmaeilzadeh M.; Sadeghian H.; Bahoush G.;
Bassi A.; Amin A.; Fazeli R.; Sharafi Y.; Arab L.; Movahhed M.; Davaran
S.; Ramezanzadeh N.; Kouhkan A.; Hezavehei A.; Namiri M.; Kashfi F.;
Akhlaghi A.; Sotoodehnejadnematalahi F.; Dizaji A.V.; Gourabi H.; Syedi
N.; Shahverdi A.; Baharvand H.; Aghdami N.
Institution
(Naseri) Department of Surgery, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Madani, Mardpour, Hosseini, Fazeli, Arab, Kouhkan, Namiri,
Sotoodehnejadnematalahi, Shahverdi, Baharvand, Aghdami) Department of
Regenerative Medicine, Cell Science Research Center, Royan Institute for
Stem Cell Biology and Technology, ACECR, Tehran, Iran, Islamic Republic of
(Tafti, Sadeghian, Davaran, Ramezanzadeh) Research Department, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Farahani) Department of Echocardiography, Baqiyatallah Hospital, Tehran,
Iran, Islamic Republic of
(Saleh) Department of Cardiology, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Hosseinnejad, Dehghani) Department of Cardiac Surgery, Lavasani Hospital,
Social Security Organization, Tehran, Iran, Islamic Republic of
(Hosseini) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hekmat, Movahhed) Department of Nuclear Medicine, Hasheminejad Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ahmadi) Transplantation Research Center, Masih Daneshvari Hospital,
Shaheed Beheshti University of Medical Science, Darabad, Niavaran, Tehran,
Iran, Islamic Republic of
(Saadat, Sharafi) Department of Internal Medicine, Baqiyatallah Hospital,
Tehran, Iran, Islamic Republic of
(Hosseini) School of Nursing and Midwifery, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Esmaeilzadeh) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bahoush) Department of Pediatrics, Ali Asghar Pediatric Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bassi) Department of Hematology and Oncology, Firoozgar Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Amin) Department of Heart Failure and Transplantation, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hezavehei) Department of Internal Medicine, Lavasani Hospital, Social
Security Organization, Tehran, Iran, Islamic Republic of
(Kashfi, Akhlaghi) Department of Epidemiology and Reproductive Health,
Reproductive Epidemiology Research Center, Royan Institute for
Reproductive Biomedicine, Tehran, Iran, Islamic Republic of
(Dizaji) Department of Reproductive Imaging, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran, Islamic Republic of
(Gourabi) Department of Genetics, Reproductive Biomedicine Research
Center, ACECR, Tehran, Iran, Islamic Republic of
(Syedi) School of Pharmacy and Medical Sciences, Sansom Institute for
Health Research, University of South Australia, SA, Australia
Title
COMPARE CPM-RMI Trial: Intramyocardial transplantation of autologous bone
marrow-derived CD133+ Cells and MNCs during CABG in patients with recent
MI: A Phase II/III, multicenter, placebo-controlled, randomized,
double-blind clinical trial.
Source
Cell Journal. 20 (2) (pp 267-277), 2018. Date of Publication: Summer 2018.
Publisher
Royan Institute (ACECR) (E-mail: info@royaninstitute.org)
Abstract
Objective: The regenerative potential of bone marrow-derived mononuclear
cells (MNCs) and CD133+ stem cells in the heart varies in terms of their
pro-angiogenic effects. This phase II/III, multicenter and double-blind
trial is designed to compare the functional effects of intramyocardial
autologous transplantation of both cell types and placebo in patients with
recent myocardial infarction (RMI) post-coronary artery bypass graft.
Materials and Methods: This was a phase II/III, randomized, double-blind,
placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent
myocardial infarction) conducted in accordance with the Declaration of
Helsinki that assessed the safety and efficacy of CD133 and MNCs compared
to placebo in patients with RMI. We randomly assigned 77 eligible RMI
patients selected from 5 hospitals to receive CD133+ cells, MNC, or a
placebo. Patients underwent gated single photon emission computed
tomography assessments at 6 and 18 months post-intramyocardial
transplantation. We tested the normally distributed efficacy outcomes with
a mixed analysis of variance model that used the entire data set of
baseline and between-group comparisons as well as within subject (time)
and groupxtime interaction terms. Results: There were no related serious
adverse events reported. The intramyocardial transplantation of both cell
types increased left ventricular ejection fraction by 9% [95% confidence
intervals (CI): 2.14% to 15.78%, P=0.01] and improved decreased systolic
wall thickening by -3.7 (95% CI: -7.07 to -0.42, P=0.03). The CD133 group
showed significantly decreased non-viable segments by 75% (P=0.001)
compared to the placebo and 60% (P=0.01) compared to the MNC group. We
observed this improvement at both the 6- and 18-month time points.
Conclusion: Intramyocardial injections of CD133+ cells or MNCs appeared to
be safe and efficient with superiority of CD133+ cells for patients with
RMI. Although the sample size precluded a definitive statement about
clinical outcomes, these results have provided the basis for larger
studies to confirm definitive evidence about the efficacy of these cell
types (Registration Number: NCT01167751).<br/>Copyright &#xa9; 2018 Royan
Institute (ACECR). All Rights Reserved.

<64>
Accession Number
621344135
Author
Perrier-Melo R.J.; Figueira F.A.M.S.; Guimaraes G.V.; Costa M.C.
Institution
(Perrier-Melo, Costa) Universidade de Pernambuco (UPE), Recife, PE, Brazil
(Figueira) Instituto de Medicina Integral Professor Fernando Figueira,
Recife, PE, Brazil
(Guimaraes) Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Title
High-intensity interval training in heart transplant recipients: A
systematic review with meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (2) (pp 188-194), 2018. Date of
Publication: February 2018.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Heart transplantation (HTx) is considered an efficient and gold-standard
procedure for patients with end-stage heart failure. After surgery,
patients have lower aerobic power (VO<inf>2</inf> max) and compensatory
hemodynamic responses. The aim of the present study was to assess through
a systematic review with meta-analysis whether high-intensity interval
training (HIIT) can provide benefits for those parameters. This is a
systematic review with meta-analysis, which searched the databases and
data portals PubMed, Web of Science, Scopus, Science Direct and Wiley
until December 2016 (pairs). The following terms and descriptors were
used: "heart recipient" OR "heart transplant recipient" OR "heart
transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS
and Mesh were: "heart transplantation'' OR "cardiac transplantation". The
words used in combination (AND) were: "exercise training" OR "interval
training" OR "high intensity interval training" OR "high intensity
training" OR "anaerobic training" OR "intermittent training" OR "sprint
training". The initial search identified 1064 studies. Then, only those
studies assessing the influence of HIIT on the post-HTx period were added,
resulting in three studies analyzed. The significance level adopted was
0.05. Heart transplant recipients showed significant improvement in
VO<inf>2</inf>peak, heart rate and peak blood pressure in 8 to 12 weeks of
intervention.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de
Cardiologia. All rights reserved.

<65>
[Use Link to view the full text]
Accession Number
621343004
Author
Liu S.; Li Z.; Liu Z.; Hu Z.; Zheng G.
Institution
(Liu, Li, Liu, Hu, Zheng) Department of Anesthesiology, Henan Provincial
People's Hospital, Henan University, Zhengzhou, Henan 450003, China
Title
Blood transfusion and risk of atrial fibrillation after coronary artery
bypass graft surgery: A meta-analysis of cohort studies.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e9700. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study was to systematically evaluate the effect of blood
transfusion (BT) on postoperative atrial fibrillation (AF) in adult
patients who had undergone coronary artery bypass grafting (CABG) surgery.
PubMed, Embase, and Cochrane Library databases from inception to January
2017 were searched. Cohort studies were searched that evaluated the
association between BT and the risk of postoperative AF in adult patients
who had undergone CABG surgery. Study quality was assessed by using the
Newcastle-Ottawa scale (NOS). A meta-analysis was performed with the
random-effect model. Eight cohort studies involving 7401 AF cases and
31,069 participants were identified and included in our data analysis. The
pooled odds ratio of postoperative AF in patients with BT was 1.45 (95%
confidence interval, 1.26-1.67), with significant heterogeneity (P <
.0001, I² = 79%). Excluding one study that had an off-pump CABG
did not significantly impact this result (odds ratio, 1.36; 95% confidence
interval, 1.23-1.50; n = 7). To examine the stability of the primary
results, we performed subgroup analyses. The association between BT and
the risk of postoperative AF was similar, as determined in the stratified
analyses conducted according to study design, type of surgery, and
country. The findings of the present meta-analysis demonstrated a
statistically significant increase in postoperative AF risk among adult
patients with BT. Further prospective large-scale studies are needed to
establish causality and to elucidate the underlying
mechanisms.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<66>
[Use Link to view the full text]
Accession Number
621342986
Author
Yoo J.Y.; Park S.Y.; Kim J.Y.; Kim M.; Haam S.J.; Kim D.H.
Institution
(Yoo, Park, Kim, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon
16499, South Korea
(Haam) Department of Cardiovascular and Thoracic Surgery, Ajou University
School of Medicine, Suwon, South Korea
Title
Comparison of the McGrath videolaryngoscope and the Macintosh laryngoscope
for double lumen endobronchial tube intubation in patients with manual
in-line stabilization: A randomized controlled trial.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e0081. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Double lumen endobronchial tube (DLT) intubation is commonly
used for one-lung ventilation in thoracic surgery. However, because of its
large size and shape, it is difficult to perform intubation compared with
a single lumen tube. The aim of this randomized controlled trial was to
determine whether the McGrath videolaryngoscope has any advantage over the
direct Macintosh laryngoscope for DLT intubation in patients with a
simulated difficult airway. Methods: Forty-four patients (19-60 years of
age); scheduled to undergo general anesthesia with one-lung ventilation
were assigned to 1 of 2 groups: DLT intubation with the McGrath
videolaryngoscope (ML group [n = 22]); or conventional Macintosh
laryngoscope (DL group [n = 22]). After manual in-line stabilization was
applied as a way of simulating a difficult airway, the time required for
intubation and the quality of glottic view were evaluated. Results: The
time to successful intubation was not different between the 2 groups (ML
group, 45 s [interquartile range, 38-52 s] versus DL group, 54 s [45-59
s]; P = .089). The McGrath videolaryngoscope, however, provided a
significantly better glottic view. Modified Cormack and Lehane grade was
better (P < .001), and the percentage of glottis opening score was higher
in the ML group (P < .001). Overall intubation difficulty scale score was
lower in the ML group (1 [0-2]) versus the DL group (3 [2-4]) (P < .001).
Conclusion: The McGrath videolaryngoscope improved glottic view and
resulted in lower overall intubation difficulty scale score in patients
with in-line stabilization.<br/>Copyright &#xa9; 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<67>
[Use Link to view the full text]
Accession Number
621342930
Author
Liu Q.; Wu H.; Wang J.; Li X.-M.
Institution
(Liu) Qingdao University, Qingdao, China
(Wu, Li) Department of Anesthesiology, Linyi City People's Hospital, Linyi
276000, China
(Wang) Department of Anesthesiology, Shandong Lunan Ophthalmologic
Hospital, Linyi, China
Title
Effects of Shenmai injection on the values of CO, SV, and EF in patients
undergoing off-pump coronary artery bypass graft: A randomized, clinical
trial.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e0085. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: To explore the effects of Shenmai (SM) injection on the values
of cardiac output (CO), stroke volume (SV), and the ejection fraction (EF)
in patients treated with off-pump coronary artery bypass graft (OPCABG).
Methods: Forty patients undergoing OPCABG were randomly divided into SM
group (n = 20) and the 5% glucose (G) group (n = 20). The control liquids
were injected from the beginning of the operation to the start of coronary
artery bypass graft (CABG). The values of CO, SV, and EF before induction
(t<inf>1</inf>), at the beginning of operation (t<inf>2</inf>), 30 minutes
after the start of operation (t<inf>3</inf>), at the beginning of coronary
artery bypass graft (t<inf>4</inf>), at the end of coronary artery bypass
graft (CABG) (t<inf>5</inf>), and at the end of operation (t<inf>6</inf>)
were recorded. Results: The values of CO, SV, and EF in the patients of SM
group at t<inf>3</inf> to t<inf>6</inf> were found to be significantly
higher than those at t<inf>1</inf> (P < .05). The values of CO, SV, and EF
in the patients of G group were found to be increased at t<inf>5</inf> and
t<inf>6</inf> (P < .05). At t<inf>3</inf> and t<inf>4</inf>, the values of
CO, SV, and EF in SM group were significantly higher than those in the G
group (P < .05). Conclusion: In patients with OPCABG, the infusion of SM
injection can effectively increase the values of CO, SV, and EF and
increase the safety of anesthesia management.<br/>Copyright &#xa9; 2018
the Author(s). Published by Wolters Kluwer Health, Inc.

<68>
Accession Number
621363859
Author
Alba A.C.; Foroutan F.; Ng Fat Hing N.K.V.; Fan C.-P.S.; Manlhiot C.; Ross
H.J.
Institution
(Alba, Foroutan, Ng Fat Hing, Ross) Heart Failure and Transplantation
Program Toronto General Hospital University Health Network Toronto, ON
Canada
(Fan, Manlhiot) The Hospital for Sick Children University of Toronto
Toronto, ON Canada
Title
Incidence and predictors of sudden cardiac death after heart
transplantation: A systematic review and meta-analysis.
Source
Clinical Transplantation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Sudden cardiac death (SCD) is an important post-transplant
problem being responsible for ~10% of deaths. We conducted a systematic
review and meta-analysis to evaluate incidence and predictors of
post-heart transplant SCD and the use of implantable cardiac defibrillator
(ICD). Methods: Citations were identified in electronic databases and
references of included studies. Observational studies on adults reporting
on incidence and predictors of post-transplant SCD and ICD use were
selected. We meta-analyzed SCD in person-years using random effects
models. We qualitatively summarized predictors. Results: This study
includes 55 studies encompassing 47 901 recipients. The pooled incidence
rate of SCD was 1.30 per 100 person-years (95% CI: 1.08-1.52). Cardiac
allograft vasculopathy (CAV) was associated with higher SCD risk (2.40 per
100 patient-years, 95% CI: 1.46-3.34). Independent predictors of SCD
identified by two moderate-quality studies were older donor age, younger
recipient age, non-Caucasian race, reduced left ventricular ejection
fraction, rejection, infection, and cancer. Authors rarely reported on ICD
use. Conclusion: This meta-analysis found that post-transplant SCD risk in
heart transplant recipients is higher than that in the general population.
CAV was associated with increased SCD risk. Observational studies
reporting on absolute risk of SCD are needed to better identify
populations at a clinically significant increased risk.<br/>Copyright
&#xa9; 2018 John Wiley & Sons A/S.

<69>
Accession Number
617936119
Author
Chen X.; Huang T.; Cao X.; Xu G.
Institution
(Chen, Cao) Grade 2013, The Second Clinical Medical College of Nanchang
University, Nanchang, Jiangxi, China
(Huang, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi
330006, China
Title
Comparative Efficacy of Drugs for Preventing Acute Kidney Injury after
Cardiac Surgery: A Network Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 18 (1) (pp 49-58), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Springer International Publishing
Abstract
Background: Acute kidney injury (AKI) occurs frequently after cardiac
surgery and has been associated with increased hospital length of stay,
mortality, and costs. Objective: We aimed to evaluate the efficacy of
pharmacologic strategies for preventing AKI after cardiac surgery.
Methods: We searched PubMed, Embase, the Cochrane Central Register of
Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of
relevant articles about trials. The outcome was the occurrence of AKI.
This is the first network meta-analysis of the different prevention
strategies using Bayesian methodology. Results: The study included 63
articles with 19,520 participants and evaluated the effect of ten
pharmacologic strategies to prevent AKI in patients undergoing cardiac
surgery. Compared with placebo, the odds ratio (OR) for the occurrence of
AKI was 0.24 [95% confidence interval (CI) 0.16-0.34] with natriuretic
peptide, 0.33 (95% CI 0.14-0.70) with fenoldopam, 0.54 (95% CI 0.31-0.84)
with dexmedetomidine, 0.56 (95% CI 0.29-0.95) with low-dose
erythropoietin, 0.63 (95% CI 0.43-0.88) with levosimendan, 0.76 (95% CI
0.52-1.10) with steroids, 0.83 (95% CI 0.48-1.40) with high-dose
erythropoietin, 0.85 (95% CI 0.64-1.14) with N-acetylcysteine, 0.96 (95%
CI 0.69-1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70-1.41) with
statins. The surface under the cumulative ranking curve probabilities
indicated that natriuretic peptide was the best treatment therapy and that
fenoldopam ranked second. Conclusions: Natriuretic peptide is probably the
preferred pharmacologic strategy to prevent AKI in adult patients
undergoing cardiac surgery, especially in those at high risk of
AKI.<br/>Copyright &#xa9; 2017, Springer International Publishing AG.

<70>
Accession Number
619359373
Author
Efremov S.; Lomivorotov V.; Stoppe C.; Shilova A.; Shmyrev V.; Deryagin
M.; Karaskov A.
Institution
(Efremov, Lomivorotov, Shmyrev, Deryagin, Karaskov) Department of
Anesthesiology and Intensive Care, E. Meshalkin National Medical Research
Center, Novosibirsk 630055, Russian Federation
(Stoppe) Department of Intensive Care Medicine, University Hospital, RWTH
Aachen University, Aachen 52074, Germany
(Shilova) Laboratory Diagnostics Department, E. Meshalkin National Medical
Research Center, Novosibirsk 630055, Russian Federation
Title
Standard vs. Calorie-dense immune nutrition in haemodynamically
compromised cardiac patients: A prospective randomized controlled pilot
study.
Source
Nutrients. 9 (11) (no pagination), 2017. Article Number: 1264. Date of
Publication: 20 Nov 2017.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
Background. The aim of study was to test the hypothesis that early enteral
nutrition (EN) with calorie-dense and protein rich enteral formula
improves enteral energy and protein delivery in critically ill cardiac
patients. Methods. Prospective randomized pilot study of 40 ventilated
adult patients undergoing elective cardiac surgery with use of
cardiopulmonary bypass receiving inotropic support postoperatively.
Patients were to receive either standard isocaloric (1000 Kcal/L and 38
g/L protein) early EN (n = 20) or calorie-dense and protein-rich (1300
Kcal/L and 66.7 g/L protein) early EN (n = 20). Results. The mean time to
EN initiation was 27 +/- 11 h. Early EN with the calorie-dense formula
provided significantly more energy and protein enteral delivery on the
2nd, (p < 0.0001), 5th (p = 0.036), and 7th days (p = 0.024), and was
associated with higher levels of prealbumin concentration on the 14th day
(0.13 +/- 0.01 g/L and 0.21 +/- 0.1 g/L; p = 0.04) and significantly
increased levels of transferrin on the 3rd, 5th, and 7th day (p < 0.05)
after surgery. Conclusion. Present findings support hypothesis that early
EN using a calorie-dense and protein rich formula leads to better enteral
energy and protein delivery and higher levels of short-lived serum
proteins.<br/>Copyright &#xa9; 2017 by the authors. Licensee MDPI, Basel,
Switzerland.

<71>
Accession Number
616691743
Author
Ando T.; Takagi H.; Briasoulis A.; Umemoto T.
Institution
(Ando) Detroit Medical Center, Division of Cardiology, Detroit, MI, United
States
(Takagi, Umemoto) Shizuoka Medical Center, Division of Cardiovascular
Surgery, Shizuoka, Japan
(Briasoulis) Mayo Clinic, Division of Heart Failure, Rochester, MN, United
States
Title
Does diabetes mellitus impact prognosis after transcatheter aortic valve
implantation? Insights from a meta-analysis.
Source
Journal of Cardiology. 70 (5) (pp 484-490), 2017. Date of Publication:
November 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Diabetes mellitus (DM) is well known to increase mortality in
several cardiovascular diseases. However, the prognostic impact of DM
following transcatheter aortic valve implantation (TAVI) remains
controversial. We sought to assess the impact of DM on perioperative
(in-hospital or 30-day) complications and mid-term (>=1 year) all-cause
mortality after TAVI through meta-analysis. Methods A comprehensive
literature search of PUBMED and EMBASE was conducted through January 1st
2002 to May 15th 2016. Articles that reported adjusted hazards ratio (HRs)
or unadjusted HR for mid-term all-cause mortality with 95% confidence
intervals (CIs) of DM or insulin dependent DM (IDDM) on mid-term all-cause
mortality post TAVI were included in the analysis. A meta-analysis was
performed with combination of both adjusted HR and un-adjusted HR.
Sensitivity analysis was performed with only the adjusted HR.
Random-effects model was used to calculate the pooled effect size. Results
A total of 22 observational cohort studies were identified with 28,440
(8998 DM and 19,442 non-DM) patients. The risk of perioperative
complications (myocardial infarction, bleeding, major vascular
complications, stroke, and new-onset atrial fibrillation) was similar
between DM and non-DM cohorts. A meta-analysis of all-cause mortality of
DM (19 studies after excluding 3 studies that only reported HR of IDDM on
mid-term all-cause mortality, 8808 DM and 17,829 non-DM patients) resulted
in significantly worse outcome (HR 1.21, 95%CI 1.10-1.34, p = 0.0002,
I² = 53%) in DM patients compared to non-DM patients post-TAVI.
Sensitivity analysis showed consistent results. Subgroup analysis (4
studies with 267 IDDM versus 2161 non-IDDM) demonstrated that IDDM was
associated with higher all-cause mortality (HR 2.05, 95%CI 1.54-2.73, p <
0.00001, I² = 0%) following TAVI. Conclusions DM was associated
with similar perioperative complications but was associated with increased
mid-term all-cause mortality after TAVI. Further study of the causes of
increased mortality during the follow-up may lead to improved
outcome.<br/>Copyright &#xa9; 2017 Japanese College of Cardiology

<72>
Accession Number
617202393
Author
Mihos C.G.; Yucel E.; Santana O.
Institution
(Mihos, Yucel) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Santana) The Division of Cardiology at Columbia University, Mount Sinai
Heart Institute, Miami Beach, FL, United States
Title
The role of papillary muscle approximation in mitral valve repair for the
treatment of secondary mitral regurgitation.
Source
European Journal of Cardio-thoracic Surgery. 51 (6) (pp 1023-1030), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Secondary mitral regurgitation (MR) is present in up to half of patients
with dilated cardiomyopathy, and is associated with a poor prognosis. It
primarily results from progressive left ventricular remodelling, papillary
muscle displacement and tethering of the mitral valve leaflets. Mitral
valve repair with an undersized ring annuloplasty is the reparative
procedure of choice in the treatment of secondary MR. However, this
technique is associated with a 30-60% incidence of recurrent moderate or
greater MR at mid-term follow-up, which results in progressive
deterioration of left ventricular function and increased morbidity.
Combined mitral valve repair and papillary muscle approximation has been
applied in order to address both the annular and subvalvular dysfunction
that coexist in secondary MR, which include graft and suture-based
techniques. Herein, we provide a systematic review of the published
literature regarding the technical aspects, clinical application, and
outcomes of mitral valve repair with combined ring annuloplasty and
papillary muscle approximation for the treatment of secondary
MR.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<73>
Accession Number
616709453
Author
Amrane H.; Porta F.; Van Boven A.J.; Kappetein A.P.; Head S.J.;
Rodes-Cabau J.
Institution
(Amrane, Porta) Department of Cardiothoracic Surgery, Medisch Centrum
Leeuwarden, Postbus 888, Leeuwarden 8901 BR, Netherlands
(Van Boven) Department of Cardiology, Medisch Centrum Leeuwarden,
Leeuwarden, Netherlands
(Kappetein, Head) Department of Cardiothoracic Surgery, Erasmus Medical
Center, Rotterdam, Netherlands
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, QC, Canada
Title
A meta-analysis on clinical outcomes after transaortic transcatheter
aortic valve implantation by the heart team.
Source
EuroIntervention. 13 (2) (pp e168-e176), 2017. Date of Publication: June
2017.
Publisher
EuroPCR
Abstract
Aims: We aimed to perform a meta-analysis on transaortic (TAo)
transcatheter aortic valve implantation (TAVI) in order to gain more
insight into the safety and efficacy of the approach in addition to the
data available from selected centres with small numbers of patients.
Methods and results: PubMed and EMBASE were searched on 31 August 2016.
The search yielded 251 studies, of which 16 with 1,907 patients were
included in the meta-analysis. All were observational, single-arm studies.
The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%;
I²=0) among nine studies. Device success among 10 studies was
91% (95% CI: 86.7-94.0%; I²=25.5). Major vascular complications
occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I²=60.8).
Moderate or severe paravalvular leakage/ aortic valve regurgitation
(PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I²=58.9).
Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%;
I²=26.5) of patients. Pooled 30-day post-TAVI complication
rates were 9.9% (95% CI: 8.6-11.3%; I²=0) for mortality, 3.7%
(95% CI: 2.4-5.6%; I²=28.7) for all stroke, and 1.0% for
myocardial infarction (95% CI: 0.5-1.7%; I²=0). The Valve
Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred
at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I²=58.7).
Conclusions: In this meta-analysis of observational studies, transaortic
TAVI appears to be a safe procedure with low complication
rates.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All rights
reserved.

<74>
Accession Number
616477000
Author
Vilchinsky N.; Ginzburg K.; Fait K.; Foa E.B.
Institution
(Vilchinsky, Fait) Department of Psychology, Bar-Ilan University,
Ramat-Gan 52900, Israel
(Ginzburg) The Bob Shapell School of Social Work, Tel Aviv University,
Ramat-Aviv, Israel
(Foa) Center for the Treatment and Study of Anxiety, University of
Pennsylvania, Department of Psychiatry, Philadelphia, PA 19104, United
States
Title
Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review.
Source
Clinical Psychology Review. 55 (pp 92-106), 2017. Date of Publication:
July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The goal of the current systematic review was to provide an overview of
the findings in the field of Cardiac-Disease-Induced Posttraumatic Stress
Disorder (CDI-PTSD) in order to establish CDI-PTSD as a valid diagnostic
entity for a wide spectrum of cardiac diseases and related medical
procedures. In accordance with PRISMA guidelines, we conducted a
systematic electronic literature search. Of the 3202 citations identified,
150 studies meeting the selection criteria were reviewed. Our main
findings were that the prevalence of CDI-PTSD ranged between 0% and 38%
(averaging at 12%) and was highly dependent on the assessment tool used.
The most consistent risk factors are of a psychological nature (e.g.,
pre-morbid distress). The consequences of CDI-PTSD range from psychosocial
difficulties to lack of adherence and heightened mortality rates. Much
inconsistency in the field was found with regard to patients who present
with diagnoses other than acute coronary syndrome (e.g., cardiac arrest)
and who undergo potentially traumatic medical procedures (e.g.,
defibrillator implantation). Yet the current review seems to strengthen
the conceptualization of CDI-PTSD as a valid diagnostic entity, at least
with regard to acute cardiac events.<br/>Copyright &#xa9; 2017 Elsevier
Ltd

<75>
Accession Number
616226313
Author
Norlund F.; Olsson E.M.G.; Pingel R.; Held C.; Svardsudd K.; Gulliksson
M.; Burell G.
Institution
(Norlund, Olsson) Department of Women's and Children's Health, Uppsala
University, Box 564, Uppsala SE-751 22, Sweden
(Pingel, Svardsudd, Gulliksson, Burell) Department of Public Health and
Caring Sciences, Uppsala University, Sweden
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Centre, Uppsala University, Sweden
Title
Psychological mediators related to clinical outcome in cognitive
behavioural therapy for coronary heart disease: A sub-analysis from the
SUPRIM trial.
Source
European Journal of Preventive Cardiology. 24 (9) (pp 917-925), 2017. Date
of Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The Secondary Prevention in Uppsala Primary Healthcare Project
(SUPRIM) was a randomized controlled trial of a group-based cognitive
behavioural therapy stress management programme for patients with coronary
heart disease. The project was successful in reducing the risk of fatal or
non-fatal first recurrent cardiovascular events. The aim of this study was
to analyse the effect of cognitive behavioural therapy on self-rated
stress, somatic anxiety, vital exhaustion and depression and to study the
associations of these factors with the reduction in cardiovascular events.
Methods A total of 362 patients were randomly assigned to intervention or
usual care groups. The psychological outcomes were assessed five times
during 24 months and analysed using linear mixed models. The mediating
roles of the outcomes were analysed using joint modelling of the
longitudinal and time to event data. Results The intervention had a
positive effect on somatic anxiety (p < 0.05), reflecting a beneficial
development over time compared with the controls. Stress, vital exhaustion
and depression did not differ between the groups over time. Mediator
analysis suggested that somatic anxiety may have mediated the effect of
treatment on cardiovascular events. Conclusions The intervention had a
small positive effect on somatic anxiety, but did not affect stress, vital
exhaustion or depression in patients with coronary heart disease. Somatic
anxiety was associated with an increased risk of cardiovascular events and
might act as a partial mediator in the treatment effect on cardiovascular
events. However, the mechanisms between the intervention and the
protective cardiovascular outcome remain to be identified.<br/>Copyright
&#xa9; European Society of Cardiology 2017.

<76>
Accession Number
613982128
Author
Vincent J.-L.; e Silva A.Q.; Couto L.; Taccone F.S.
Institution
(Vincent, e Silva, Couto, Taccone) Department of Intensive Care, Erasme
Hospital, Universite Libre de Bruxelles, Route de Lennik 808, Brussels
1070, Belgium
Title
The value of blood lactate kinetics in critically ill patients: A
systematic review.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 257. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The time course of blood lactate levels could be helpful to
assess a patient's response to therapy. Although the focus of published
studies has been largely on septic patients, many other studies have
reported serial blood lactate levels in different groups of acutely ill
patients. Methods: We performed a systematic search of PubMed, Science
Direct, and Embase until the end of February 2016 plus reference lists of
relevant publications. We selected all observational and interventional
studies that evaluated the capacity of serial blood lactate concentrations
to predict outcome. There was no restriction based on language. We
excluded studies in pediatric populations, experimental studies, and
studies that did not report changes in lactate values or all-cause
mortality rates. We separated studies according to the type of patients
included. We collected data on the number of patients, timing of lactate
measurements, minimum lactate level needed for inclusion if present, and
suggested time interval for predictive use. Results: A total of 96 studies
met our criteria: 14 in general ICU populations, five in general surgical
ICU populations, five in patients post cardiac surgery, 14 in trauma
patients, 39 in patients with sepsis, four in patients with cardiogenic
shock, eight in patients after cardiac arrest, three in patients with
respiratory failure, and four in other conditions. A decrease in lactate
levels over time was consistently associated with lower mortality rates in
all subgroups of patients. Most studies reported changes over 6, 12 or 24
hrs, fewer used shorter time intervals. Lactate kinetics did not appear
very different in patients with sepsis and other types of patients. A few
studies suggested that therapy could be guided by these measurements.
Conclusions: The observation of a better outcome associated with
decreasing blood lactate concentrations was consistent throughout the
clinical studies, and was not limited to septic patients. In all groups,
the changes are relatively slow, so that lactate measurements every 1-2
hrs are probably sufficient in most acute conditions. The value of lactate
kinetics appears to be valid regardless of the initial
value.<br/>Copyright &#xa9; 2016 The Author(s).

<77>
Accession Number
620719225
Author
Gunaydin S.; Robertson C.; Budak A.B.; Gourlay T.
Institution
(Gunaydin, Budak) Department of Cardiovascular Surgery, Numune Training &
Research Hospital, Ankara, Turkey
(Robertson, Gourlay) Department of Biomedical Engineering, University of
Strathclyde, Glasgow, United Kingdom
Title
Comparative evaluation of blood salvage techniques in patients undergoing
cardiac surgery with cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 33 (2) (pp 105-109), 2018. Date of
Publication: 01 Mar 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The primary objective of this study was to test and compare
the efficacy of currently available intraoperative blood salvage systems
via a demonstration of the level of increase in percentage concentration
of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in
the end product. Methods: In a prospective, randomized study, data of 80
patients undergoing elective cardiac surgery with cardiopulmonary bypass
in a 6-month period was collected, of which the volume aspirated from the
surgical field was processed by either the HemoSep Novel Collection Bag
(Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a
cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad
Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased
from 23.05%+/-2.7 to 43.02%+/-12 in Group 1 and from 24.5+/-2 up to
55.2+/-9 in Group 2 (p=0.013). The mean number of platelets rose to
225200+/-47000 from 116400 +/-40000 in the HemoSep and decreased from
125200+/-25000 to 96500+/-30000 in the cell-saver group (p=0.00001). The
leukocyte count was concentrated significantly better in Group 1 (from
10100+/-4300 to 18120+/-7000; p=0.001). IL-6 levels (pg/dL) decreased from
223+/-47 to 83+/-21 in Group 1 and from 219+/-40 to 200+/-40 in Group 2
(p=0.001). Fibrinogen was protected significantly better in the HemoSep
group (from 185+/-35 to 455+/-45; p=0.004). Conclusions: Intraoperative
blood salvage systems functioned properly and the resultant blood product
was superior in terms of red blood cell species. The HemoSep group had
significantly better platelet and leukocyte concentrations and fibrinogen
content.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<78>
Accession Number
620560223
Author
da Silva K.R.; Costa R.; Rodrigues C.G.; Schasechter A.; Nobre M.C.;
Passman R.; Mark D.B.
Institution
(da Silva, Costa, Nobre) Heart Institute (InCor), Hospital das Clinicas,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Rodrigues) Global Research and Innovation Network (GRINN), Porto Alegre,
Brazil
(Schasechter, Passman) Northwestern University, Feinberg School of
Medicine, Chicago, IL, United States
(Mark) Duke Clinical Research Institute, Durham, NC, United States
Title
Quality of life in patients with implantable cardioverter-defibrillator:
systematic review of randomized controlled trials.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 196-206), 2018.
Date of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Implantable cardioverter-defibrillator (ICD) therapy
significantly improves the survival of patients who are at high risk for
sudden cardiac death. However, it is unclear whether this survival is
accompanied by impairment on quality of life (QoL). Objectives: This
systematic review sought to describe whether ICD therapy, as compared with
standard treatment, can have an impact on QoL outcomes. Methods: Extensive
literature searches were carried out in PubMed, EMBASE, LILACS and
Cochrane Library. Eligible studies were randomized controlled trials
(RCTs) of ICD versus medical therapy that reported valid and reliable
measures of QoL. Included studies were reviewed to determine baseline
patient characteristics, mean duration of follow-up, questionnaires used
to assess QoL and association between QoL scores and ICD shock therapy.
Results: Seven studies, enrolling a total of 5,701 patients, were included
in this review. The analyzed trials showed conflicting results about the
impact of ICD on QoL outcomes. Among the secondary prevention studies,
CIDS reported a clear benefit from ICD and AVID showed no difference
between ICD and amiodarone groups. Of the primary prevention trials,
AMIOVIRT, MADIT II, DEFINITE, and SCD-HeFT found no evidence of impaired
QoL in patients with an ICD. Evidence for an association between ICD
shocks and QoL was mixed and seemed to depend on the interval between
shocks and QoL assessment. Conclusion: There was no evidence of impaired
QoL in patients with an ICD. However, ICD patients must be educated of all
possible risks and benefits, including transitory declines in QoL after
ICD shocks.<br/>Copyright &#xa9; 2017, &#xa9; The European Society of
Cardiology 2017.

<79>
Accession Number
620675740
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Scharpenberg M.; Troitzsch D.;
Johansen P.; Nygaard H.; Eberle T.; Hasenkam J.M.
Institution
(Bauer, Schaarschmidt) MediClin Heart Centre Coswig, Department of
Cardiovascular Perfusion, Coswig, Saxony-Anhalt, Germany
(Bauer, Eberle) MediClin Heart Centre Coswig, Department of Anaesthesia
and Intensive Care Medicine, Coswig, Saxony-Anhalt, Germany
(Hausmann) MediClin Heart Centre Coswig, Department of Cardiothoracic and
Vascular Surgery, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) University of Bremen, Competence Center for Clinical
Trials, Bremen, Germany
(Troitzsch) Zoll Lifebridge, Ampfing, Bayern, Germany
(Johansen) Department of Engineering, Aarhus University, Jutland, Denmark
(Nygaard, Hasenkam) Aarhus University, Department of Cardio Thoracic and
Vascular Surgery, Aarhus University Hospital and Department of Clinical
Medicine, Aarhus, Jutland, Denmark
Title
Shed-blood-separation and cell-saver: an integral Part of MiECC?
Shed-blood-separation and its influence on the perioperative inflammatory
response during coronary revascularization with minimal invasive
extracorporeal circulation systems - a randomized controlled trial.
Source
Perfusion (United Kingdom). 33 (2) (pp 136-147), 2018. Date of
Publication: 01 Mar 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The postoperative systemic inflammatory response after
cardiopulmonary bypass (CPB) is still an undesirable side-effect after
cardiac surgery. It is most likely caused by blood contact with foreign
surfaces and by the surgical trauma itself. However, the recirculation of
activated shed mediastinal blood is another main cause of blood cell
activation and cytokine release. Minimal invasive extracorporeal
circulation (MiECC) comprises a completely closed circuit, coated surfaces
and the separation of suction blood. We hypothesized that MiECC, with
separated cell saved blood, would induce less of a systemic inflammatory
response than MiECC with no cell-saver. The aim of this study was,
therefore, to investigate the impact of cell washing shed blood from the
operating field versus direct return to the ECC on the biomarkers for
systemic inflammation. Material and methods: In the study, patients with
MiECC and cell-saver were compared with the control group, patients with
MiECC and direct re-transfusion of the drawn blood shed from the surgical
field. Results: High amounts of TNF-alpha (+ 120% compared to serum blood)
were found in the shed blood itself, but a significant reduction was
demonstrated with the use of a cell-saver (TNF-alpha ng/l post-ECC 10 min:
9.5+/-3.5 vs. 19.7+/-14.5, p<0.0001). The values for procalcitonin were
not significantly increased in the control group (6h: 1.07+/-3.4 vs.
2.15+/-9.55, p=0.19) and lower for C-reactive protein (CRP) (24h:
147.1+/-64.0 vs.134.4+/-52.4 p=0.28). Conclusion: The use of a cell-saver
and the processing of shed blood as an integral part of MiECC
significantly reduces the systemic cytokine load. We, therefore, recommend
the integration of cell-saving devices in MiECC to reduce the
perioperative inflammatory response.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<80>
Accession Number
2000546250
Author
Roumie C.L.; Patel N.J.; Munoz D.; Bachmann J.; Stahl A.; Case R.; Leak
C.; Rothman R.; Kripalani S.
Institution
(Roumie, Patel, Rothman, Kripalani) Division of General Internal Medicine
and Public Health, Department of Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
(Roumie) Veterans Health Administration-Tennessee Valley Healthcare System
Geriatric Research Education Clinical Center (GRECC), HSR&D Center,
Nashville, TN, United States
(Roumie, Patel, Stahl, Case, Leak, Rothman, Kripalani) Center for Health
Services Research, Vanderbilt University Medical Center, Nashville, TN,
United States
(Roumie, Patel, Rothman, Kripalani) Center for Clinical Quality and
Implementation Research, Vanderbilt University Medical Center, Nashville,
TN, United States
(Munoz, Bachmann) Division of Cardiovascular Medicine, Department of
Medicine, Vanderbilt University Medical Center, Nashville, TN, United
States
(Munoz, Bachmann) Vanderbilt Translational and Clinical Cardiovascular
Research Center (VTRACC), Vanderbilt University Medical Center, Nashville,
TN, United States
Title
Design and outcomes of the Patient Centered Outcomes Research Institute
coronary heart disease cohort study.
Source
Contemporary Clinical Trials Communications. 10 (pp 42-49), 2018. Date of
Publication: June 2018.
Publisher
Elsevier Inc
Abstract
Background: The Patient Centered Outcomes Research Institute (PCORI)
established Clinical Data Research Networks (CDRNs) to support pragmatic
research. The objective was to electronically identify, recruit, and
survey coronary heart disease (CHD) patients and describe their
characteristics, health status, and willingness to participate in future
research. Methods: We developed a computable phenotype and assembled CHD
patients 30 years or older and had visits or hospitalizations between 2009
and 2015. A sample of patients was surveyed between August 2014 and
September 2015. Survey administration included the following methods:
face-to-face, telephone, paper or web portal. Survey items covered broad
domains including: health literacy and numeracy, and socio-demographics,
physical and mental health, health behaviors, access to medical care, and
willingness to participate in future research. Results: Of 5517 approached
patients, 2605 completed the survey. Participants were mostly white
(~88%), male (68%) and had a median age of 69 years (interquartile range
[IQR] 61-76 years). Most respondents' health literacy and numeracy were
adequate (83.2% and 84.3%, respectively). Only 4% of respondents reported
that their overall health or physical health was excellent. The majority
(~58%) reported that their health was good or very good, while 40%
reported that their general and physical health were fair or poor. The
majority reported that their quality of life was good to excellent (81%).
Limitations in physical health and function were common, including
often/always having fatigue (25%), pain (38.7%), or sleep difficulty
(19.7%). A patient sample (n = 1936) was provided with a trial summary
which would randomize their aspirin dose; and 63% reported that they would
consider participating. Conclusion: Many patients with CHD had limitations
in physical health. However, the majority reported a good or excellent
quality of life.<br/>Copyright &#xa9; 2018

<81>
Accession Number
620625700
Author
Olsen S.J.S.; Schirmer H.; Bonaa K.H.; Hanssen T.A.
Institution
(Olsen) Division of Internal Medicine, University Hospital of North
Norway, Norway
(Olsen, Schirmer, Hanssen) Cardiovascular Research Group, The Arctic
University of Norway, Norway
(Schirmer, Hanssen) Department of Heart Disease, University Hospital of
North Norway, Norway
(Bonaa) Department of Community Medicine, The Arctic University of Norway,
Norway
(Bonaa) Department of Public Health and Nursing, Norwegian University of
Science and Technology, Norway
(Bonaa) Clinic for Heart Disease, St. Olavs University Hospital,
Trondheim, Norway
Title
Cardiac rehabilitation after percutaneous coronary intervention: Results
from a nationwide survey.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 273-279), 2018.
Date of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim: The purpose of this study was to estimate the proportion of Norwegian
coronary heart disease patients participating in cardiac rehabilitation
programmes after percutaneous coronary intervention, and to determine
predictors of cardiac rehabilitation participation. Methods: Participants
were patients enrolled in the Norwegian Coronary Stent Trial. We assessed
cardiac rehabilitation participation in 9013 of these patients who had
undergone their first percutaneous coronary intervention during 2008-2011.
Of these, 7068 patients (82%) completed a self-administered questionnaire
on cardiac rehabilitation participation within three years after their
percutaneous coronary intervention. Results: Twenty-eight per cent of the
participants reported engaging in cardiac rehabilitation. Participation
rate differed among the four regional health authorities in Norway,
varying from 20%-31%. Patients undergoing percutaneous coronary
intervention for an acute coronary syndrome were more likely to
participate in cardiac rehabilitation than patients with stable angina
(odds ratio 3.2; 95% confidence interval 2.74-3.76). A multivariate
statistical model revealed that men had a 28% lower probability (p<0.001)
of participating in cardiac rehabilitation, and the odds of attending
cardiac rehabilitation decreased with increasing age (p<0.001).
Contributors to higher odds of cardiac rehabilitation participation were
educational level >12 years (odds ratio 1.50; 95% confidence interval
1.32-1.71) and body mass index>25 (odds ratio 1.19; 95% confidence
interval 1.05-1.36). Prior coronary artery bypass graft was associated
with lower odds of cardiac rehabilitation participation (odds ratio 0.47;
95% confidence interval 0.32-0.70) Conclusion: The estimated cardiac
rehabilitation participation rate among patients undergoing first-time
percutaneous coronary intervention is low in Norway. The typical
participant is young, overweight, well-educated, and had an acute coronary
event. These results varied by geographical region.<br/>Copyright &#xa9;
2017, &#xa9; The European Society of Cardiology 2017.

<82>
Accession Number
618953020
Author
Arora S.; Vaidya S.R.; Strassle P.D.; Misenheimer J.A.; Rhodes J.A.; Ramm
C.J.; Wheeler E.N.; Caranasos T.G.; Cavender M.A.; Vavalle J.P.
Institution
(Arora, Misenheimer, Ramm, Cavender, Vavalle) Division of Cardiology,
University of North Carolina, Chapel Hill, NC 27599-7075, United States
(Vaidya) Division of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC 28304, United States
(Strassle) Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC 27599-7400, United
States
(Strassle, Caranasos) Department of Surgery, UNC School of Medicine,
Chapel Hill, NC 27599-7050, United States
(Misenheimer) Division of Cardiology, The Medical College of Georgia at
Augusta University, Augusta, GA 30912, United States
(Rhodes, Wheeler) Campbell University School of Osteopathic Medicine,
Lillington, NC 27546, United States
Title
Meta-analysis of transfemoral TAVR versus surgical aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. 91 (4) (pp 806-812),
2018. Date of Publication: 01 Mar 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was
shown to have lower risks of death or disabling strokes as compared to
SAVR, whereas the outcomes with transthoracic TAVR were comparable with
SAVR. Methods: We searched PubMed, EMBASE, Web of Science, and Google
Scholar for all comparison studies between TAVR and SAVR and mortality as
an outcome, irrespective of surgical risk. Randomized controlled trials
and propensity-score-matched cohort studies that used a transfemoral
approach exclusively or stratified results by route of access and reported
data for TF-TAVR patients were eligible for inclusion. Outcomes of
interest included 30-day and 1-year mortality, and 30-day complications.
If significant heterogeneity was found in the random effects
meta-analyses, a sensitivity analysis which individually removed each
study was conducted. Results: Seven studies reported results on TF-TAVR.
Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95%
CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day
risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was
associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI
0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and
myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher
incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and
pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions: TF-TAVR
is associated with lower 30-day risks of myocardial infarction compared to
SAVR. Further studies are required to investigate the role of myocardial
injury on overall TF-TAVR outcomes.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<83>
Accession Number
620999453
Author
Nikbakht M.; Ahmadi F.; Vaseghi G.; Talasaz A.H.; Eshraghi A.; Naderi J.;
Daneshme M.A.
Institution
(Nikbakht) Department of Pharmacology, Faculty of Medicine, Yasuj
University of Medical Sciences, Yasuj, Iran, Islamic Republic of
(Ahmadi, Daneshme) Department of Medicinal Chemistry, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Vaseghi) Isfahan Cardiovascular Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Talasaz) Department of Clinical Pharmacy, School of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eshraghi) Department of Clinical Pharmacy, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Naderi) Applied Physiology Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Title
The role of N-acetylcysteine in platelet aggregation and reperfusion
injury in recent years.
Source
Current Clinical Pharmacology. 12 (2) (pp 83-91), 2017. Date of
Publication: 01 May 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: N-acetylcysteine (NAC) is an amino acid that contains a
cysteine group and is currently used widely in various fields of medical
research especially in cardiology. In this review, potential benefits of
NAC in the aggregation of platelet and reperfusion injury are evaluated.
Methods: The available evidence was collected by searching Scopus,
Pub-Med, Medline, Cochrane central register of controlled trials, and
Cochrane database systematic reviews. Our searching was performed without
time limitation and only English language articles were included in this
review. Key words used as search terms included "N-acetylcysteine",
"platelet aggregation", "reperfusion injury". Results: Over the past
decade, several investigations were carried out to ascertain reperfusion
injury and antiplatelet properties of NAC, and in this article the results
of investigations in both models (human and animal) were addressed in
detail. The results revealed that NAC has an important antiplatelet
property in animal models while this effect is not very significant in
human models and needs more investigations. However, its reperfusion
injury in both models is worth noticing. Conclusion: Due to the limited
data about effectiveness of NAC in both human and animal as antiplatelet
agent, more investigation is needed to evaluate NAC efficacy in platelet
aggregation and reperfusion injury especially in human studies in the
future.<br/>Copyright &#xa9; 2017 Bentham Science Publishers.

<84>
Accession Number
619446154
Author
D'Souza R.; Ostro J.; Shah P.S.; Silversides C.K.; Malinowski A.; Murphy
K.E.; Sermer M.; Shehata N.
Institution
(D'Souza, Malinowski, Murphy, Sermer) Department of Obstetrics and
Gynaecology, Division of Maternal and Fetal Medicine, University of
Toronto, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(D'Souza, Shah, Murphy, Shehata) Institute of Health Policy, Management
and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T
3M6, Canada
(Ostro) Department of Medicine, Division of Hematology, University of
Toronto, Toronto, Canada
(Shah) Department of Paediatrics, Division of Neonatology, Mount Sinai
Hospital, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
(Silversides) Department of Medicine, Division of Cardiology Obstetric
Medicine Program, University of Toronto, 700 University Avenue, Toronto,
ON M5G 1Z5, Canada
(Shehata) Departments of Medicine and Laboratory Medicine and
Pathobiology, Mount Sinai Hospital, Division of Hematology, 700 University
Avenue, Toronto, ON M5G 1Z5, Canada
Title
Anticoagulation for pregnant women with mechanical heart valves: A
systematic review andmeta-Analysis.
Source
European Heart Journal. 38 (19) (pp 1509-1516), 2017. Date of Publication:
May 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To review maternal and foetal outcomes in women with mechanical heart
valves (MHVs) treated with vitamin-K antagonists (VKAs), first-Trimester
heparin followed by VKAs (sequential treatment), low molecular weight
heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order
to inform practice. Methods and results Medline, Embase and Central were
searched from inception until February 2016. Two reviewers independently
screened 1786 titles, reviewed 110 full-Texts and extracted data and
assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence
intervals) was calculated for maternal and foetal outcomes. Included
studies had a moderate or high risk-ofbias. With VKAs, sequential
treatment and LMWH, maternal mortality occurred in 0.9% (0.4-1.4), 2.0%
(0.8-3.1) and 2.9% (0.2-5.7), thromboembolic complications in 2.7%
(1.4-4.0), 5.8% (3.8-7.7) and 8.7% (3.9-13.4), livebirths in 64.5%
(48.8-80.2), 79.9% (74.3-85.6) and 92.0% (86.1-98.0) and
anticoagulant-related foetal/neonatal adverse events (embryopathy or
foetopathy) in 2.0% (0.3-3.7), 1.4% (0.3-2.5) and 0%, respectively. When
UFH is used throughout pregnancy, 11.2% (2.8-19.6) suffered thromboembolic
complications. Foetal loss and adverse events occurred with
first-Trimester warfarin doses<= 5 mg/day, although there were more
livebirths [83.6% (75.8-91.4) vs. 43.9% (32.8-55.0)] and fewer foetal
anomalies [2.3% (0.7-4.0) vs. 12.4% (3.3-21.6)] with lower doses than with
warfarin> 5mg/day. Conclusions VKAs are associated with fewest maternal
complications but also with fewest livebirths. Sequential treatment does
not eliminate anticoagulant-related foetal/neonatal adverse events. LMWH
is associated with the highest number of livebirths. The safety of UFH
throughout pregnancy and first-Trimester warfarin <= 5 mg/day remains
unconfirmed.<br/>Copyright &#xa9; The Author 2017.

<85>
[Use Link to view the full text]
Accession Number
614298593
Author
Gilron I.; Vandenkerkhof E.; Katz J.; Kehlet H.; Carley M.
Institution
(Gilron) Departments of Anesthesiology and Perioperative Medicine and
Biomedical and Molecular Sciences, Kingston General Hospital, Queen's
University, 76 Stuart St, Kingston, ON K7L 2V7, Canada
(Vandenkerkhof, Carley) School of Nursing, Queen's University, Kingston,
Canada
(Katz) Department of Psychology, York University, Toronto, ON, Canada
(Kehlet) Section for Surgical Pathophysiology, Rigshospitalet Copenhagen
University, Copenhagen, Denmark
Title
Evaluating the Association between Acute and Chronic Pain after Surgery.
Source
Clinical Journal of Pain. 33 (7) (pp 588-594), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aim/Objectives/Background: There is a need to predict chronic (Z3mo)
postsurgical pain (CPSP). Acute (<7 d) pain is a predictor, that is, more
severe pain is associated with higher CPSP risk. However, reported
associations vary widely. Methods: Using a systematic search, we examined
associations between 2 acute pain measures (pain at rest [PAR] and
movement-evoked pain [MEP]) and CPSP outcomes (considering severity vs.
any "nonzero" pain only) in 22 studies. Results: Seven studies reported
the relationship between CPSP and both PAR and MEP. Of these, 2/7 reported
no association, 3/7 reported significant associations for both PAR and
MEP, 1/7 reported an association for PAR only, and 1/7 reported an
association for MEP only. Six of another 7 studies reporting only the
association for MEP found a significant relationship. Three of the 5
studies that did not specify whether acute pain outcomes were PAR or MEP
reported a significant relationship. Another 3 studies reporting a
relationship with CPSP did not specify whether this was for PAR, MEP, or
both. All investigations incorporating severity of CPSP in their analyses
(n=7) demonstrated a significant relationship, whereas only 10 of the 15
studies that dichotomized CPSP outcome as "no pain" versus "any"/"nonzero
pain" were positive. Conclusions: Overall, evidence for an association
between acute and chronic pain is moderate at best. However, closer
attention to pain measurement methods will clarify the relationships
between acute pain and CPSP. We propose that future CPSP predictor studies
assess both PAR and MEP acutely and also incorporate CPSP severity in
their analyses.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<86>
[Use Link to view the full text]
Accession Number
613247328
Author
Luo M.; Liu X.; Ning L.; Sun Y.; Cai Y.; Shen S.
Institution
(Luo, Ning, Sun, Cai, Shen) Department of Anesthesiology, Xinhua Hospital,
School of Medicine, Shanghai Jiaotong University, 1665# Kongjiang Road,
Shanghai 200092, China
(Liu) Pain Management Center, Xinhua Hospital, School of Medicine,
Shanghai Jiaotong University, China
(Luo) Department of Anesthesiology, Huashan Hospital, School of Medicine,
Fudan University, Shanghai, China
Title
Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks
and Conventional Patient-controlled Intravenous Analgesia for Pain Control
after the Nuss Procedure in Children.
Source
Clinical Journal of Pain. 33 (7) (pp 604-610), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Patients experience severe pain after pectus excavatum (PE)
surgery. The aim of this prospective, randomized study was to compare
analgesic effects of ultrasonography-guided bilateral intercostal nerve
blocks (UG-ICNBs) with those of conventional patient-controlled
intravenous analgesia (PCIA) on acute pain after the Nuss procedure for PE
repair in children. Methods: A prospective randomized study was performed
in children with PE who were scheduled for the Nuss procedure.
Participants were randomly assigned to receive either UG-ICNBs or PCIA for
postoperative analgesia. Faces Pain Scale-Revised scores, opioid
consumption, analgesia-associated side effects (respiratory depression,
pruritus, nausea, vomiting) during the first 24 hours, and lengths of stay
in the postanesthesia care unit (PACU) and hospital were recorded after
the surgery. Results: Sixty-two children undergoing the Nuss procedure
were enrolled in the trial. Faces Pain Scale-Revised scores were
significantly decreased in the UG-ICNBs group compared with the PCIA group
for up to 6 hours after surgery. The opioid doses required in the PACU and
during the first 24 hours after surgery were significantly greater in the
PCIA group compared with the UG-ICNBs group. Accordingly, patients in the
UG-ICNBs group showed a lower incidence of analgesia-associated side
effects and faster PACU discharge compared with the PCIA group.
Conclusions: Our study suggests that UG-ICNBs might be more effective than
PCIA for postoperative analgesia in children who undergo the Nuss
procedure for PE.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.
All rights reserved.

<87>
Accession Number
616511082
Author
Chan V.; Chu M.W.A.; Leong-Poi H.; Latter D.A.; Hall J.; Thorpe K.E.; De
Varennes B.E.; Quan A.; Tsang W.; Dhingra N.; Yared K.; Teoh H.; Chu F.V.;
Chan K.-L.; Mesana T.G.; Connelly K.A.; Ruel M.; Juni P.; Mazer C.D.;
Verma S.
Institution
(Chan, Mesana, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(Chan, Ruel) School of Epidemiology Public Health and Preventive Medicine,
University of Ottawa, Ottawa, ON, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Center,
University of Western Ontario, London, ON, Canada
(Leong-Poi, Connelly) Division of Cardiology, St Michael's Hospital,
Toronto, ON, Canada
(Leong-Poi, Quan, Teoh, Connelly, Verma) Keenan Research Centre for
Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Quan, Teoh, Connelly, Mazer, Verma) Li Ka Shing Knowledge
Institute, St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Tsang, Connelly, Mazer) Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Latter, Quan, Dhingra, Teoh, Verma) Division of Cardiac Surgery, St
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Latter, Verma) Department of Surgery, University of Toronto, Toronto, ON,
Canada
(Hall, Thorpe, Juni) Applied Health Research Centre, St Michael's
Hospital, Toronto, ON, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
(De Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Tsang) Division of Cardiology, University Health Network, Toronto, ON,
Canada
(Yared) Division of Cardiology, Scarborough Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, St Michael's Hospital,
Toronto, ON, Canada
(Chu) Department of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
(Chan) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Juni) Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital, Toronto, ON,
Canada
Title
Randomised trial of mitral valve repair with leaflet resection versus
leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2
Trial).
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: 015032. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background The gold-standard treatment of severe mitral regurgitation (MR)
due to degenerative disease is valve repair, which is surgically performed
with either a leaflet resection or leaflet preservation approach. Recent
data suggest that functional mitral stenosis (MS) may occur following
valve repair using a leaflet resection strategy, which adversely affects
patient prognosis. A randomised comparison of these two approaches to
mitral repair on functional MS has not been conducted. Methods and
analysis This is a prospective, multicentre randomised controlled trial
designed to test the hypothesis that leaflet preservation leads to better
preservation of mitral valve geometry, and therefore, will be superior to
leaflet resection for the primary outcome of functional MS as assessed by
12-month mean mitral valve gradient at peak exercise. Eighty-eight
patients with posterior leaflet prolapse will be randomised
intraoperatively once deemed by the operating surgeon to feasibly undergo
mitral repair using either a leaflet resection or leaflet preservation
approach. Secondary end points include comparison of repair strategies
with regard to mitral valve orifice area, leaflet coaptation height, 6 min
walk test and a composite major adverse event end point consisting of
recurrent MR >=2+, death or hospital readmission for congestive heart
failure within 12 months of surgery. Ethics and dissemination
Institutional ethics approval has been obtained from all enrolling sites.
Overall, there remains clinical equipoise regarding the mitral valve
repair strategy that is associated with the least likelihood of functional
MS. This trial hopes to introduce high-quality evidence to help surgical
decision making in this context. Trial registration number
NCT02552771.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2017. All rights
reserved.

<88>
Accession Number
615342823
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
A meta-analysis of effects of transcatheter versus surgical aortic valve
replacement on left ventricular ejection fraction and mass.
Source
International Journal of Cardiology. 238 (pp 31-36), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine which procedure, transcatheter aortic valve
implantation (TAVI) or surgical aortic valve replacement (SAVR), for
severe aortic stenosis (AS) improves follow-up left ventricular (LV)
function or hypertrophy more effectively, we performed the first
meta-analysis of comparative studies reporting LV ejection fraction (LVEF)
or mass (LVM) after TAVI versus SAVR. Methods Studies considered for
inclusion met the following criteria: the article was written in English;
the design was a comparative study; the study population was patients with
severe AS; patients were assigned to TAVI versus SAVR; and outcomes
included follow-up (6-12-month) LVEF or LVM. For each study, data
regarding fractional changes in LVEF or LVM in both the TAVI and SAVR
groups were used to generate mean differences (MDs) and 95% confidence
intervals (CIs). Results Our search identified 8 eligible studies. Two
studies with baseline LVEF < 40% demonstrated significantly greater
fractional changes in LVEF after TAVI than after SAVR. A pooled analysis
of 6 studies demonstrated no statistically significant difference in
fractional changes in LVEF between TAVI and SAVR (MD, 3.25%; 95% CI,
-1.30% to 7.80%; p = 0.16). Another pooled analysis of 5 studies
demonstrated significantly greater fractional changes (i.e. less
fractional "reductions") in LVM after TAVI than after SAVR (MD, 4.75%; 95%
CI, 2.18% to 7.32%; p = 0.0003). Conclusions For patients with severe AS,
SAVR may be associated with greater improvement in LVM, probably not in
LVEF, at 6-12 months. For limited patients with reduced LVEF, TAVI might
be associated with greater improvement in LVEF.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<89>
Accession Number
621132571
Author
Kosmac N.; Vidmar G.; Virag M.; Osredkar J.; Knezevic I.
Institution
(Kosmac, Osredkar, Knezevic) University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Vidmar) University Rehabilitation Institute, Ljubljana, Slovenia
(Virag) University of Ljubljana, Faculty of Economics, Ljubljana, Slovenia
Title
Comparison of sevoflurane and propofol anaesthetic regimes in respect to
the release of troponin I and cystatin C in off-pump myocardial
revascularisation: A randomised controlled trial.
Source
Signa Vitae. 12 (1) (pp 36-42), 2016. Date of Publication: 05 Oct 2016.
Publisher
Pharmamed Mado Ltd. (Zatisje 8 g, Zagreb 10000, Croatia. E-mail:
marija.karamarko@pharmamed.com)
Abstract
Objective. Sevoflurane has been used in cardiac surgery because of its
protective effects on the myocardium from ischaemic injury. We wanted to
test the hypothesis that sevoflurane has beneficial effects on the heart
and kidneys in comparison to propofol. Methods. We conducted a randomised
controlled study, with balanced randomization blocked by sex. The
participants were 62 patients undergoing off-pump myocardial
revascularization (44 men and 18 women), who did not have a myocardial
infarction less than 24 hours before the start of the operation and who
had normal serum values of troponin I preoperatively. The surgery and the
measurements were conducted according to the same protocol for both
groups. Propofol was used for the induction of anaesthesia in both groups;
anaesthesia was continued with either propofol or sevoflurane. Troponin I
and cystatin C plasma concentrations were determined in eight consecutive
blood samples, starting before induction of anaesthesia and ending 48
hours after admission to the intensive care unit (ICU). The data were
log-transformed and analysed using analysis of variance. Results. We
observed a clear and highly statistically significant effect of time for
troponin I (p<0.001) without statistically significant differences between
the groups (either main or interaction effects). For the majority of
patients, the measurements rose quickly upon reperfusion and reached a
peak 12 hours after admission to the ICU, descending approximately back to
the reperfusion level 48 hours after admission to the ICU. Similar
inferences were reached for cystatin C, for which the time-course was
approximately bath-shaped. Conclusion. We observed no clear superiority of
either sevoflurane or propofol anaesthetic regime in off-pump myocardial
revascularisation.<br/>Copyright &#xa9; 2016, Pharmamed Mado Ltd. All
rights reserved.

<90>
Accession Number
620280126
Author
Tkachuk S.; Collins K.; Ensom M.H.H.
Institution
(Tkachuk, Collins, Ensom) Faculty of Pharmaceutical Sciences, The
University of British Columbia, Vancouver, Canada
(Tkachuk, Collins, Ensom) Children's and Women's Health Centre of British
Columbia, Vancouver, Canada
Title
The Relationship Between Vancomycin Trough Concentrations and AUC/MIC
Ratios in Pediatric Patients: A Qualitative Systematic Review.
Source
Pediatric Drugs. 20 (2) (pp 153-164), 2018. Date of Publication: 01 Apr
2018.
Publisher
Springer International Publishing
Abstract
Background: In adults, the area under the concentration-time curve (AUC)
divided by the minimum inhibitory concentration (MIC) is associated with
better clinical and bacteriological response to vancomycin in patients
with methicillin-resistant Staphylococcus aureus who achieve target
AUC/MIC >= 400. This target is often extrapolated to pediatric patients
despite the lack of similar evidence. The impracticalities of calculating
the AUC in practice means vancomycin trough concentrations are used to
predict the AUC/MIC. Objective: This review aimed to determine the
relationship between vancomycin trough concentrations and AUC/MIC in
pediatric patients. Methods: We searched the MEDLINE and Embase databases,
the Cochrane Database of Systematic Reviews, and the Cochrane Central
Register of Controlled Trials using the medical subject heading (MeSH)
terms vancomycin and AUC and pediatric* or paediatric*. Articles were
included if they were published in English and reported a relationship
between vancomycin trough concentrations and AUC/MIC. Results: Of 122
articles retrieved, 11 met the inclusion criteria. One trial reported a
relationship between vancomycin trough concentrations, AUC/MIC, and
clinical outcomes but was likely underpowered. Five studies found troughs
6-10 mg/l were sufficient to attain an AUC/MIC > 400 in most general
hospitalized pediatric patients. One study in patients undergoing
cardiothoracic surgery found a trough of 18.4 mg/l achieved an AUC/MIC >
400. Two oncology studies reported troughs >= 15 mg/l likely attained an
AUC/MIC >= 400. In critical care patients: one study found a trough of 9
mg/l did not attain the AUC/MIC target; another found 7 mg/l corresponded
to an AUC/MIC of 400. Conclusions: Potential vancomycin targets varied
based on the population studied but, for general hospitalized pediatric
patients, troughs of 6-10 mg/l are likely sufficient to achieve AUC/MIC >=
400. For MIC >= 2 mg/l, higher troughs are likely necessary to achieve an
AUC/MIC >= 400. More research is needed to determine the relationships
between vancomycin trough concentrations, AUC/MIC, and clinical
outcomes.<br/>Copyright &#xa9; 2018, Springer International Publishing AG,
part of Springer Nature.

<91>
Accession Number
2000562443
Author
Hessian R.; Jabagi H.; Ngu J.M.C.; Rubens F.D.
Institution
(Hessian) Divisions of Cardiology, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Jabagi, Ngu, Rubens) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, Ontario, Canada
Title
Coronary Surgery in Women and the Challenges We Face.
Source
Canadian Journal of Cardiology. 34 (4) (pp 413-421), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
This review was undertaken to understand the dynamics that have shaped our
current treatment of women who undergo coronary artery bypass grafting
(CABG) and summarize the current literature on surgical revascularization
in women. There has been improved access to CABG over the past several
decades. Despite this, compared with men, CABG in women involves fewer
grafts and less frequent use of arterial grafts, the latter having
improved long-term patency compared with saphenous vein grafts. We attempt
to determine whether the adverse clinical profile of women, when referred
for CABG is responsible for this finding. Female coronary anatomy and
pathophysiology are reviewed and an attempt is made to understand how this
might affect decisions of selection and outcome measures post CABG. We
review the short-term, long-term, and quality of life outcomes in women.
These data are taken from large databases, as well as from more recent
publications. Randomized controlled trial data and meta-analytic data are
used when available. Differential use of and outcomes of surgical
strategies, including off-pump CABG and total arterial revascularization,
are contrasted with those in men. This review shows that there continues
to be widespread differences in surgical approach to coronary artery
disease in female vs male patients. We provide evidence suggestive of the
existence of issues specific to women that affect selection for surgical
procedures and outcomes in women. More work is required to understand the
reason for these differences and how to optimize sex-specific
outcomes.<br/>Copyright &#xa9; 2018 Canadian Cardiovascular Society

<92>
Accession Number
621276214
Author
Chen X.; Huang T.; Cao X.; Xu G.
Institution
(Chen, Huang, Xu) Department of Nephrology, The Second Affiliated Hospital
of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang,
Jiangxi 330006, China
(Chen, Cao) Grade 2013, The Second Clinical Medical College of Nanchang
University, Nanchang, Jiangxi, China
Title
Erratum to: Comparative Efficacy of Drugs for Preventing Acute Kidney
Injury after Cardiac Surgery: A Network Meta-Analysis (American Journal of
Cardiovascular Drugs, (2018), 18, 1, (49-58), 10.1007/s40256-017-0245-0).
Source
American Journal of Cardiovascular Drugs. 18 (2) (pp 153), 2018. Date of
Publication: 01 Apr 2018.
Publisher
Springer International Publishing
Abstract
In the print publication, the affiliations were incorrectly published. The
author affiliations which previously read Xi Chen¹ . Tianlun
Huang² . Xuan Cao¹ . Gaosi Xu^{2 1}Grade
2013, The Second Clinical Medical College of Nanchang University,
Nanchang, Jiangxi, People's Republic of China ²Department of
Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1,
Minde Road, Donghu District, 330006 Nanchang, Jiangxi, People's Republic
of China.<br/>Copyright &#xa9; 2018, Springer International Publishing AG,
part of Springer Nature.

<93>
Accession Number
2000556010
Author
Ozaki S.; Kawase I.; Yamashita H.; Uchida S.; Takatoh M.; Kiyohara N.
Institution
(Ozaki, Kawase, Yamashita, Uchida, Takatoh, Kiyohara) Department of
Cardiovascular Surgery, Toho University Ohashi Medical Center, Tokyo,
Japan
Title
Midterm outcomes after aortic valve neocuspidization with
glutaraldehyde-treated autologous pericardium.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: We had previously reported the short-term results of the aortic
valve neocuspidization (AVNeo) procedure. We have now evaluated the
midterm results with the longest follow-up of 118 months. Methods: From
April 2007 through December 2015, 850 patients were treated with AVNeo
using autologous pericardium. Medical records of these patients were
retrospectively reviewed. The procedure was on the basis of independent
tricuspid replacement using autologous pericardium. The distances between
the commissures were measured with an original sizing device, the
pericardial cusp was trimmed using an original template, and then sutured
to the annulus. Results: There were 534 patients with aortic stenosis, 254
with aortic regurgitation, 61 with aortic stenoregurgitation, 19 with
infective endocarditis, and 5 with a previous aortic valve procedure.
Besides 596 patients with tricuspid aortic valve, 224 patients had
bicuspid valve, 28 had unicuspid valve, and 2 had quadricuspid valve.
There were 444 male and 406 female patients. The median age was 71 (range,
13-90) years old. Preoperative echocardiography revealed a peak pressure
gradient average of 68.9 +/- 36.3 mm Hg with aortic stenosis. Surgical
annular diameter was 20.9 +/- 3.3 mm. There was no conversion to a
prosthetic valve replacement. There were 16 in-hospital mortalities.
Postoperative echocardiography revealed a peak pressure gradient average
of 19.5 +/- 10.3 mm Hg 1 week after surgery and 15.2 +/- 6.3 mm Hg 8 years
after surgery. Fifteen patients needed reoperation (13 infective
endocarditis, 1 break of thread, and 1 tear of cusp case). The mean
follow-up period was 53.7 +/- 28.2 months. Actuarial freedom from death,
cumulative incidence of reoperation, and that of recurrent moderate aortic
regurgitation or greater was 85.9%, 4.2%, and 7.3%, respectively, with the
longest follow-up of 118 months. Conclusions: The midterm outcomes of
AVNeo using autologous pericardium were satisfactory in 850 patients with
various aortic valve diseases. However, further randomized, multicenter
prospective studies are needed to confirm the results of the current
study.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<94>
Accession Number
620537856
Author
Mingxing F.; Landoni G.; Zangrillo A.; Monaco F.; Lomivorotov V.V.; Hui
C.; Novikov M.; Nepomniashchikh V.; Fominskiy E.
Institution
(Mingxing, Hui) Department of Intensive Care, The Third Hospital, Hebei
Medical University, Shijiazhuang, Hebei Province, China
(Landoni, Zangrillo, Monaco, Fominskiy) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Milan,
Italy
(Lomivorotov, Nepomniashchikh, Fominskiy) Department of Anesthesia and
Intensive Care, Siberian Biomedical Research Center of the Ministry of
Health, Novosibirsk, Russian Federation
(Novikov) Department of Anesthesia and Intensive Care, Medical Center of
Saint-Petersburg State University, Saint-Petersburg, Russian Federation
Title
Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 762-770),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: There is experimental evidence that phosphocreatine (PCr) can
decrease ischemia/reperfusion injury of the heart. The authors
investigated if PCr would improve heart performance as compared with
standard treatment in cardiac surgery. Design: Meta-analysis of randomized
controlled trials. Setting: Hospitals. Participants: Adult and pediatric
patients undergoing cardiac surgery. Interventions: The ability of PCr to
improve cardiac outcomes as compared with standard treatment was
investigated. Measurements and Main Results: PubMed/Medline, Embase,
Scopus, Cochrane Library, China National Knowledge Infrastructure,
WANGFANG DATA, and VIP Paper Check System were searched to March 1 2017.
The authors included 26 randomized controlled trials comprising 1,948
patients. Random and fixed-effects models were used to estimate odds ratio
(OR) and mean difference (MD) with 95% confidence interval (CI). PCr use
was associated with reduced rates of intraoperative inotropic support (27%
v 44%; OR 0.47, 95% CI 0.35-0.61; p < 0.001), major arrhythmias (16% v
28%; OR 0.44, 95% CI 0.27-0.69; p < 0.001), as well as increased
spontaneous recovery of the cardiac rhythm immediately after aortic
declamping (50% v 34%; OR 2.45, 95% CI 1.82-3.30; p < 0.001) as compared
with standard treatment. The use of PCr decreased myocardial damage and
augmented left ventricular ejection fraction in the postoperative period;
however, MD for these outcomes were small and do not seem to be clinically
significant. Conclusions: In randomized trials, PCr administration was
associated with reduced rates of intraoperative inotropic support and
major arrhythmias, and increased spontaneous recovery of the cardiac
rhythm after aortic declamping. Large multicenter evidence is needed to
validate these findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<95>
Accession Number
619185339
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Title
Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 731-738),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: Adjustment in the doses of opioids has been a focus of interest
for achieving better fast-track conditions in cardiac anesthesia, but
relatively sparse information exists on the potential effect of
psychologic and behavioral factors, such as stress, anxiety, and type of
personality, on anesthesia requirements and patient turnover in the
cardiac recovery unit (CRU); to the authors' knowledge, this particular
focus has not been systematically investigated. In this randomized study,
the authors tested the hypothesis that low-dose sufentanil, compared with
a standard dose, can improve fast-track parameters and the overall quality
of recovery. Opioid requirements related to personality type, pain
sensitivity, and preoperative stress and anxiety also were assessed.
Design: A randomized, prospective study. Participants: The study comprised
60 patients scheduled for elective coronary artery bypass grafting with or
without aortic valve replacement. Setting: A university hospital.
Interventions: Patients were randomly assigned to receive either a
standard dose (bolus 0.5 micro&#32;g/kg) or low dose (bolus 0.25
micro&#32;g/kg) of sufentanil combined with propofol. Measurements and
Main Results: The primary outcome variables were ventilation time and
eligible time to discharge from the CRU. The secondary objective was to
evaluate the relationship between opioid requirements and personality
type, pain sensitivity, and preoperative stress and anxiety. The groups
were comparable in selected demographics and perioperative parameters.
There was no difference between groups in ventilation time (low dose: 191
[163-257] v standard dose: 205 [139-279] min; p = 0.405); eligible CRU
discharge time (10.3 +/- 5.0 v 10.3 +/- 4.2 h; p = 0.978); or
administration of postoperative morphine (25 [11-34) v 27 [10-39] g; p =
0.790). There was no difference between groups in total sufentanil
administration and various preoperative psychologic and behavioral test
levels nor in the time to reach bispectral index <50 during induction,
except that personality type A demonstrated a longer induction time of 10
(8-12) minutes versus 6 (4-8) minutes in low-score patients. Conclusion: A
lower dose of sufentanil, compared with a standard dose, does not enhance
fast-track conditions significantly.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<96>
Accession Number
621102322
Author
Caldas J.R.; Haunton V.J.; Panerai R.B.; Hajjar L.A.; Robinson T.G.
Institution
(Caldas, Hajjar) Department of Anesthesia, Heart Institute, University of
Sao Paulo, Surgical Intensive Care, Av. Dr. Eneas de Carvalho Aguiar 44,
Sao Paulo 05403-000, Brazil
(Caldas) Hospital Sao Rafael, Salvador, Bahia, Brazil
(Haunton, Panerai, Robinson) Department of Cardiovascular Sciences,
University of Leicester, Leicester, United Kingdom
(Panerai, Robinson) NIHR Leicester Biomedical Research Centre, University
of Leicester, Leicester, United Kingdom
(Hajjar) Department of Cardiopneumology, Heart Institute, University of
Sao Paulo, Brazil
Title
Cerebral autoregulation in cardiopulmonary bypass surgery: A systematic
review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 494-503),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
Cardiopulmonary bypass surgery is associated with a high incidence of
neurological complications, including stroke, delirium and cognitive
impairment. The development of strategies to reduce the incidence of such
neurological events has been hampered by the lack of a clear understanding
of their pathophysiology. Cerebral autoregulation (CA), which describes
the ability of the brain to maintain a stable cerebral blood flow over a
wide range of cerebral perfusion pressures despite changes in blood
pressure, is known to be impaired in various neurological disorders.
Therefore, we aimed to systematically review studies reporting indices of
CA in cardiopulmonary bypass surgery. Databases such as MEDLINE, Web of
Science, Cochrane Database of Systematic Reviews and EMBASE were searched
for relevant articles. Titles, abstracts and full texts of articles were
scrutinized according to predefined selection criteria. Two independent
reviewers undertook the methodological quality screening nd data
extraction of the included studies. Twenty of 2566 identified studies were
relevant. Studies showed marked heterogeneity and weaknesses in key
methodological criteria (e.g. population size and discussion of
limitations). All but 3 of the 20 studies described impairments of CA with
cardiac surgery. Eleven studies investigated clinical outcomes, and 9 of
these found a significant relationship between these and impaired CA.
There is a general agreement that cardiac surgery is associated with
changes in CA and that clinical outcomes appear to be significantly
related to impaired CA. Further studies are now needed to determine
prognostic significance and to inform future therapeutic
strategies.<br/>Copyright &#xa9; The Author 2017.

<97>
Accession Number
621102309
Author
Sigl S.; Del Frari B.; Harasser C.; Schwabegger A.H.
Institution
(Sigl, Del Frari, Harasser, Schwabegger) Department of Plastic,
Reconstructive and Aesthetic Surgery, Medical University Innsbruck,
Anichstrasse 35, Innsbruck 6020, Austria
Title
The effect on cardiopulmonary function after thoracoplasty in pectus
carinatum: A systematic literature review.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 474-479),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES: Creating an aesthetically appealing result using
thoracoplasty, especially when correcting extensive deformities, but only
causing low morbidity, is challenging. The frequency of thoracoplasties in
cases of pectus carinatum (PC) has increased due to improved experience
and modified surgical techniques, resulting in low morbidity and low
complication rates. The indications for surgical treatment are still
controversial and, in most cases, remain aesthetic or psychological rather
than physiological. However, whether cardiopulmonary function changes
after surgical repair remains a matter of controversy. We sought to
investigate and shed light on published knowledge regarding this question.
METHODS: We searched MEDLINE and PubMed databases, using various defined
search phrases and inclusion criteria, to identify articles on pre- and
postoperative cardiopulmonary evaluation and outcomes. RESULTS: Six
studies met the inclusion criteria: 5 studies evaluated patients with PC
for cardiopulmonary outcomes after chest wall surgery and 1 did so
following conservative compression treatment. In these studies, surgical
and conservative orrection of PC did not reduce absolute lung volumes and
spirometric measurements and consequently had no pathogenic effect on
cardiopulmonary function. CONCLUSIONS: The results of this systematic
review suggest that surgical correction of PC has no symptomatic
pathogenic effect on cardiopulmonary function. The results, however,
revealed both heterogeneity in the examinations used and inconsistent
methods within each study. Further prospective trials with a stronger
methodological design are necessary to objectively confirm that surgical
correction of PC does not impair cardiopulmonary function.<br/>Copyright
&#xa9; The Author 2017.

<98>
Accession Number
621102293
Author
Lowres N.; Mulcahy G.; Jin K.; Gallagher R.; Neubeck L.; Freedman B.
Institution
(Lowres, Freedman) Heart Research Institute, University of Sydney,
Building D17, Sydney, NSW 2006, Australia
(Lowres, Mulcahy, Freedman) Charles Perkins Centre, University of Sydney,
Sydney, Australia
(Jin, Gallagher, Neubeck) Sydney Nursing School, University of Sydney,
Sydney, Australia
(Neubeck) School of Health and Social Care, Edinburgh Napier University,
Edinburgh, United Kingdom
(Neubeck) School of Nursing and Midwifery, Faculty of Medicine, Nursing,
and Health Sciences, Flinders University, Adelaide, Australia
Title
Incidence of postoperative atrial fibrillation recurrence in patients
discharged in sinus rhythm after cardiac surgery: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (3) (pp 504-511),
2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
Postoperative atrial fibrillation (POAF) is associated with increased
stroke risk and mortality post-discharge. POAF is often considered
transient; however, recurrence is likely under-recognized as symptoms are
an unreliable guide. Surveillance post-discharge may identify asymptomatic
POAF recurrences in patients discharged in sinus rhythm. Therefore, we
performed a systematic review and meta-analysis of studies investigating
POAF recurrence post-discharge, in patients with new-onset POAF following
cardiac surgery who reverted to sinus rhythm prior to discharge. Two
independent reviewers searched medical databases, clinical trial
registries, reference lists and the Internet. After screening from 6525
studies, 8 studies were identified (n = 1157 participants, mean age 66 +/-
10 years and 73% men). Monitoring methods included the following:
telemetry during twice-daily exercise sessions (n = 2), continuous
telemetry for 3 weeks (n = 1), daily 20-s electrocardiography (ECG) using
wearable event recorder (n = 1), 30-s single-lead ECG, 4 times/day (n = 1)
and implanted continuous monitoring (n = 2). The incidence rate of POAF
recurrence identified through non-invasive monitoring in the first 4 weeks
post-discharge was 28.3% [confidence interval (CI) 23.0-33.6%]; recurring
12 +/- 5 days (mean +/- SD) post-surgery. The incidence rate identified
through implanted continuous monitoring was 61-100% within 2 years.
Between 40% and 93% of episodes were asymptomatic. In one small study
reporting stroke risk, 8 of 10 patients with recurrence were
guideline-indicated (CHA2DS2-VASc score >2) for oral anticoagulation for
stroke prevention. Monitoring for POAF recurrence post-hospital discharge
identifies significant numbers of early asymptomatic recurrences in
patients at high risk of stroke who may benefit from anticoagulation for
stroke prevention. More intense monitoring is more likely to identify POAF
recurrence. Future research is required to investigate the prognostic
significance of POAF recurrence, especially stroke and mortality
risk.<br/>Copyright &#xa9; The Author 2017.

<99>
Accession Number
621231985
Author
Lee A.K.Y.; Kong A.Y.H.; Kong C.F.
Institution
(Lee, Kong, Kong) Department of Anaesthesiology, Singapore General
Hospital, Singapore
Title
Performance of TCI Propofol Using the Schnider Model for Cardiac Surgery
on Cardiopulmonary Bypass-A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 723-730),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: This pilot study aimed to evaluate the performance of
target-controlled infusion (TCI) of propofol using the Schnider
pharmacokinetic model in patients undergoing cardiac surgery requiring
cardiopulmonary bypass. Design: This was a prospective pharmacokinetic
study. Setting: A tertiary care hospital. Participants: This study is
comprised of 10 patients, aged between 46 and 81, who underwent elective
cardiac surgery requiring the use of cardiopulmonary bypass.
Interventions: Anesthetic technique was standardized. Hypnosis was
maintained using TCI of propofol, titrated to achieve a bispectral index
of 30 to 60. Calculated plasma propofol concentrations were recorded at 5
time points in total, before, during, and after cardiopulmonary bypass.
Blood propofol concentration was measured at each of these time points.
Measurements and Main Results: The prediction errors and absolute
prediction errors were calculated for each sample. From these, the median
prediction error (MDPE) and its absolute value (MDAPE) were derived.
Agreement between predicted and measured propofol concentrations was
assessed using a Bland-Altman plot. Mean prediction errors were also
compared pre-, on, and post-bypass using the generalized linear latent and
mixed model. The MDPE and MDAPE were both found to be 45%, indicating
significant bias toward under-prediction in the Schnider pharmacokinetic
model. This bias was increased at an average propofol concentration of 4.5
mug/mL and above. A significant decrease in mean prediction error was
noted while on bypass (45.6%, 95% confidence intervals 9.2-82.1).
Conclusions: The performance of the Schnider pharmacokinetic model for TCI
propofol was poor, with a tendency toward under-prediction of blood
propofol concentration, especially at higher average concentrations of
propofol. While mitigating the risk of awareness, the risk of other
adverse effects like hypotension and cardiorespiratory depression is
increased. Patients should therefore be adequately monitored, and
predicted plasma propofol concentrations taken in context with other
patient parameters. A lower target concentration of propofol is probably
sufficient to maintain an adequate depth of anesthesia as measured by
BIS.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<100>
Accession Number
621231977
Author
Liu Z.; Zhao L.; Jia Q.; Yang X.; Liang S.J.; He W.
Institution
(Liu, Jia, Yang, Liang, He) Department of Anesthesiology, First Hospital
of Qinhuangdao, Qinhuangdao, Hebei, China
(Zhao) Department of Emergency, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei, China
Title
Chest Computed Tomography Image for Accurately Predicting the Optimal
Insertion Depth of Left-Sided Double-Lumen Tube.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 855-859),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: The main objective of this study was to assess the feasibility
and accuracy of measuring the distance between the vocal cord and carina
using chest computer tomography (CT) as a guide for the intubation of a
left-sided double-lumen tube (LDLT). Design: Single-center, prospective,
randomized study. Setting: Local hospital in China. Participants: Sixty
adult patients undergoing elective thoracic surgery requiring an LDLT for
one lung ventilation were enrolled in this study. Interventions: Patients
were randomly allocated to the following 2 groups: blind intubation group
(B group, n = 30) or chest computed tomography-guided group (C group, n =
30). The placement of the LDLT was accomplished using 1 of the 2
intubation methods. After intubation, an independent anesthesiologist
evaluated the position of the LDLT and carina and bronchial injuries using
fiber optic bronchoscopy. The number of optimal positions, the time for
LDLT intubation, the time for fiber optic bronchoscope confirmation, and
carina and bronchial injuries were recorded. Results: Sixteen of 30
intubations in the B group were in optimal position, whereas 27 of 30
intubations in the C group were in optimal position; the difference was
statistically significant (p < 0.01). The time for intubation of the LDLT
took 118.0 +/- 26.2 seconds in the B group and 71.5 +/- 8.7 seconds in the
C group (p < 0.01). The time for position confirmation using fiber optic
bronchoscope took 40.8 +/- 15.8 seconds in the B group and 18.7 +/- 7.9
seconds in the C group (p < 0.05). The incidences of carina and bronchial
injuries were obviously lower in the C group (occurred in 3 of 30 cases)
than in the B group (11 of 30 cases) p < 0.05. The incidences of
postoperative sore throat and hoarseness showed no significant differences
between the 2 groups (p > 0.05). Conclusion: This study demonstrated that
the method of measuring the distance between the vocal cord and carina
according to the chest CT as a guide for the intubation of LDLT is more
effective and more accurate than the blind intubation
method.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<101>
Accession Number
621231973
Author
Wang Y.-C.; Huang C.-H.; Tu Y.-K.
Institution
(Wang, Huang) Department of Anaesthesiology, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Tu) Institute of Epidemiology & Preventive Medicine, College of Public
Health, National Taiwan University, Taipei, Taiwan (Republic of China)
Title
Effects of Positive Airway Pressure and Mechanical Ventilation of the
Lungs During Cardiopulmonary Bypass on Pulmonary Adverse Events After
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (2) (pp 748-759),
2018. Date of Publication: April 2018.
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether different ventilation strategies during
cardiopulmonary bypass (CPB) can improve outcomes in adult cardiac surgery
patients. Design: Systematic review of randomized controlled trials with
meta-analyses. Setting: Clinical trials for human studies up to July 2016
were obtained from electronic databases (Medline, Embase, PubMed, and the
Cochrane Central Register of Controlled Trials) and reference lists of
relevant randomized trials and review articles. Participants: Adult
patients undergoing cardiac surgery. Interventions: Patients who underwent
cardiac surgery with CPB and ventilation or continuous positive airway
pressure (CPAP). Measurements and Main Results: Fifteen randomized
controlled trials with 748 patients were analyzed. In cardiac surgery,
CPAP use during CPB was associated with an improved alveolar-arterial
oxygen gradient difference compared with no CPAP (weighted mean difference
[WMD] = 4.11 kPa; 95% confidence interval [CI] = 0.85-7.37; I²
= 28.8%). Ventilation during CPB did not improve the postoperative
hypoxemia score (WMD = 30.94; 95% CI = -20.76 to 82.63; I² =
61%) or diffusion capacity compared with the apnea group (WMD = 2.59 kPa;
95% CI = -2.49 to 7.67; I² = 81.3%). Neither CPAP nor
ventilation during CPB was associated with a shorter mechanical
ventilation time or hospital stay. Conclusions: CPAP during CPB improved
the alveolar-arterial oxygen gradient difference compared with apnea, but
ventilation during CPB did not. Neither CPAP nor ventilation during CPB
demonstrated evidence of improving clinical outcomes in low- or
intermediate-risk patients for elective cardiac surgery. The findings are
inconclusive because of heterogeneity and small sample
sizes.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<102>
Accession Number
620208381
Author
Ferket B.S.; Oxman J.M.; Iribarne A.; Gelijns A.C.; Moskowitz A.J.
Institution
(Ferket, Oxman, Gelijns, Moskowitz) Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Ferket) Institute for Healthcare Delivery Science, Department of
Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(Iribarne) The Dartmouth Institute for Health Policy and Clinical
Practice, One Medical Center Drive, Lebanon, NH, United States
Title
Cost-effectiveness analysis in cardiac surgery: A review of its concepts
and methodologies.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp
1671-1681.e11), 2018. Date of Publication: April 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<103>
Accession Number
620258769
Author
Song L.; Li J.; Guan C.; Jing Q.; Lu S.; Yang L.; Xu K.; Yang Y.; Xu B.;
Han Y.
Institution
(Song, Yang) Department of Cardiology, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Li, Jing, Xu, Han) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Guan, Xu) Catheterization Laboratory, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Lu) Department of Cardiology, Affiliated Anzhen Hospital of Capital
Medical University, Beijing, China
(Yang) Department of Cardiology, Kunming General Hospital of Chengdu
Military Region, Kunming, China
Title
Randomized comparison of novel biodegradable polymer and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year
Outcomes of the I-LOVE-IT 2 Trial.
Source
Catheterization and Cardiovascular Interventions. 91 (Supplement 1) (pp
608-616), 2018. Date of Publication: 15 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to compare the long-term outcomes of the novel
biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES)
versus the durable polymer sirolimus-eluting stent (DP-SES) in the
I-LOVE-IT2 trial. Backgrounds: Comparisons of the long-term safety and
efficiency of the BP-DES versus the DP-DES are limited. Methods: A total
of 2,737 patients eligible for coronary stenting were randomized to the
BP-SES or DP-SES group at a 2:1 ratio. The primary endpoint of target
lesion failure (TLF) was defined as a composite of cardiac death, target
vessel myocardial infarction (MI), or clinically indicated target lesion
revascularization. Results: A three-year clinical follow-up period was
available for 2,663 (97.3%) patients. There were no significant
differences in TLF (8.9% vs. 8.6%, P = 0.81), patient-oriented composite
endpoint (PoCE) (15.2% vs.14.5%, P = 0.63), or individual components
between the BP-SES and DP-SES. Definite/probable stent thrombosis (ST) was
low and similar at 3 years (0.8% vs. 1.0%, P = 0.64). Landmark analysis of
1-3 years showed that the TLF (2.7% vs. 2.6%, P = 0.81), PoCE (6.2% vs.
5.1%, P = 0.28), and definite/probable ST (0.4% vs. 0.4%, P = 1.00) were
comparable between the 2 arms. Conclusions: In this prospective randomized
trial, the BP-SES showed similar clinical results versus the DP-SES in
terms of safety and efficacy outcomes over a 3-year follow-up
period.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<104>
[Use Link to view the full text]
Accession Number
614735343
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent)
Direction Prelevement Greffe Organes-Tissus, Saint-Denis La Plaine 93212,
France
(Leprince) Service de Chirurgie Cardio-vasculaire, Hopital de la Pitie
Salpetriere, Paris, France
(Porcher) Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Paris U1153, France
Title
Prediction of waitlist mortality in adult heart transplant candidates: The
candidate risk score.
Source
Transplantation. 101 (9) (pp 2175-2182), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The cardiac allocation system in France is currently based on urgency and
geography.Medical urgency is defined by therapies without considering
objective patient mortality risk factors. This study aimed to develop a
waitlist mortality risk score from commonly available candidate variables.
Methods. The study included all patients, aged 16 years or older,
registered on the national registry CRISTAL for first single-organ heart
transplantation between January 2010 and December 2014. This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables at listing with 1-year waitlist
death or delisting for worsening medical condition was assessed within the
derivation cohort. The predictors were used to generate a candidate risk
score (CRS). Validation of the CRS was performed in the validation cohort.
Concordance probability estimation (CPE) was used to evaluate the
discriminative capacity of the models. Results. During the study period,
2333 patients were newly listed. The derivation (n =1 555) and the
validation cohorts (n = 778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate, and total bilirubin level were included in a simplified model and
incorporated into the score. The Concordance probability estimation of the
CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort.
The correlation between observed and expected 1-year waitlist mortality in
the validation cohort was 0.87. Conclusions. The candidate risk score
provides an accurate objective prediction of waitlist mortality. It is
currently being used to develop a modified cardiac allocation system in
France.<br/>Copyright &#xa9; 2017 Wolters Kluwer.

<105>
Accession Number
608748329
Author
Sharma G.; Anantha Krishnan R.; Bohra V.; Ramakrishnan S.; Naik N.; Seth
S.; Juneja R.; Kalaivani M.; Bahl V.K.
Institution
(Sharma, Naik, Seth, Juneja) Department of Cardiology, All India Institute
of Medical Sciences, New Delhi 110029, India
(Anantha Krishnan, Bohra) Senior Resident, Department of Cardiology, All
India Institute of Medical Sciences, New Delhi 110029, India
(Ramakrishnan) Additional Professor, Department of Cardiology, All India
Institute of Medical Sciences, New Delhi 110029, India
(Kalaivani) Scientist-II, Department of Biostatistics, All India Institute
of Medical Sciences, New Delhi 110029, India
(Bahl) Professor & Head, Department of Cardiology, All India Institute of
Medical Sciences, New Delhi 110029, India
Title
Evaluation of early direct current cardioversion for maintenance of sinus
rhythm in rheumatic atrial fibrillation following successful balloon
mitral valvotomy.
Source
Indian Heart Journal. 68 (4) (pp 486-492), 2016. Date of Publication: July
- August 2016.
Publisher
Elsevier B.V.
Abstract
Background: Patients with rheumatic mitral stenosis (MS) and atrial
fibrillation (AF) are at risk for thromboembolism and restoration of sinus
rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral
valvotomy (PBMV) improves hemodynamics, but may not be enough to restore
SR. Methods: Prospective randomized study aimed at evaluating efficacy of
early direct current cardioversion (DCCV) following successful PBMV in
patients with long-standing AF. Group 1 (n = 20) had patients of rheumatic
MS with AF who underwent successful PBMV. Group 2 (n = 15) patients were
DC cardioverted and administered oral Amiodarone for 6 weeks. Primary
endpoint was maintenance of SR after 6 months. Secondary endpoints were
functional capacity, number of embolic episodes, adverse drug effects, and
all-cause mortality. Results: In Group 2, all patients underwent
successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group
1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to
AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p = 0.001), with
relative risk of 7.1 (1.95, 25.9, 95% CI, p = 0.001) for patients to be in
AF who underwent only successful PBMV, i.e. Group 1. There was significant
improvement in quality of life (SF36) score in Group 2 (p = 0.001), with
no deaths, stroke, or adverse drug effects in either group. Conclusion: In
patients with rheumatic MS and AF, early DCCV and a short-duration oral
Amiodarone, following successful PBMV, may be a reasonable strategy to
attain long-term SR.<br/>Copyright &#xa9; 2016