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<1>
Accession Number
365045914
Author
Thiele H.; Schuler G.; Neumann F.-J.; Hausleiter J.; Olbrich H.-G.;
Schwarz B.; Hennersdorf M.; Empen K.; Fuernau G.; Desch S.; De Waha S.;
Eitel I.; Hambrecht R.; Bohm M.; Kurowski V.; Lauer B.; Minden H.-H.;
Figulla H.-R.; Braun-Dullaeus R.C.; Strasser R.H.; Rochor K.; Maier
S.K.G.; Mollmann H.; Schneider S.; Ebelt H.; Werdan K.; Zeymer U.
Institution
(Thiele, Schuler, Fuernau, Desch, De Waha, Eitel) Department of Internal
Medicine/Cardiology, University of Leipzig - Heart Center, Strumpellstr.
39, 04289 Leipzig, Germany
(Neumann) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Hausleiter) German Heart Center Munich, Munich, Germany
(Olbrich) Asklepios Clinic Langen-Seligenstadt, Langen, Germany
(Schwarz) Segeberger Kliniken, Bad Segeberg, Germany
(Hennersdorf) SLK Kliniken Heilbronn, Heilbronn, Germany
(Empen) Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Kurowski) University Clinic Schleswig-Holstein, Lubeck, Germany
(Lauer) Zentralklinik Bad Berka, Bad Berka, Germany
(Minden) Oberhavel Kliniken Hennigsdorf, Hennigsdorf, Germany
(Figulla) University Clinic of the Friedrich-Schiller University, Jena,
Germany
(Braun-Dullaeus) Otto-von-Guericke University Magdeburg, Magdeburg,
Germany
(Strasser) Heart Center, Technical University Dresden, Dresden, Germany
(Rochor) Sana Heart Center Cottbus, Cottbus, Germany
(Maier) University Hospital Wurzburg, Wurzburg, Germany
(Mollmann) Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung Ludwigshafen,
Ludwigshafen, Germany
(Ebelt, Werdan) Martin-Luther University Halle-Wittenberg, Halle/Saale,
Germany
(Zeymer) Heart Center Ludwigshafen, Ludwigshafen, Germany
Title
Intraaortic balloon counterpulsation in acute myocardial infarction
complicated by cardiogenic shock: Design and rationale of the Intraaortic
Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.
Source
American Heart Journal. 163 (6) (pp 938-945), 2012. Date of Publication:
June 2012.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: In current guidelines, intraaortic balloon pumping (IABP) is
considered a class 1 indication in cardiogenic shock complicating acute
myocardial infarction. However, evidence is mainly based on retrospective
or prospective registries with a lack of randomized clinical trials.
Therefore, IABP is currently only used in 20% to 40% of cardiogenic shock
cases. The hypothesis of this trial is that IABP in addition to early
revascularization by either percutaneous coronary intervention or coronary
artery bypass grafting will improve clinical outcome of patients in
cardiogenic shock. Study Design: The IABP-SHOCK II study is a 600-patient,
prospective, multicenter, randomized, open-label, controlled trial. The
study is designed to compare the efficacy and safety of IABP versus
optimal medical therapy on the background of early revascularization by
either percutaneous coronary intervention or coronary artery bypass
grafting. Patients will be randomized in a 1:1 fashion to 1 of the 2
treatments. The primary efficacy end point of IABP-SHOCK II is 30-day
all-cause mortality. Secondary outcome measures, such as hemodynamic,
laboratory, and clinical parameters, will serve as surrogate end points
for prognosis. Furthermore, an intermediate and long-term follow-up at 6
and 12 months will be performed. Safety will be assessed, by the GUSTO
bleeding definition, peripheral ischemic complications, sepsis, and
stroke. Conclusions: The IABP-SHOCK II trial addresses important questions
regarding the efficacy and safety of IABP in addition to early
revascularization in patients with cardiogenic shock complicating
myocardial infarction. &#xa9; 2012 Mosby, Inc.

<2>
Accession Number
621391384
Author
Doiron K.A.; Hoffmann T.C.; Beller E.M.
Institution
(Doiron) Bond University, Doctor of Physiotherapy Program, Faculty of
Health Sciences and Medicine, University Drive, Gold Coast, QLD 4229,
Australia
(Hoffmann, Beller) Bond University, Centre for Research in Evidence-Based
Practice (CREBP), University Drive, Gold Coast, QLD 4229, Australia
Title
Early intervention (mobilization or active exercise) for critically ill
adults in the intensive care unit.
Source
Cochrane Database of Systematic Reviews. 2018 (3) (no pagination), 2018.
Article Number: CD010754. Date of Publication: 27 Mar 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Survivors of critical illness often experience a multitude of
problems that begin in the intensive care unit (ICU) or present and
continue after discharge. These can include muscle weakness, cognitive
impairments, psychological difficulties, reduced physical function such as
in activities of daily living (ADLs), and decreased quality of life. Early
interventions such as mobilizations or active exercise, or both, may
diminish the impact of the sequelae of critical illness. Objectives: To
assess the effects of early intervention (mobilization or active
exercise), commenced in the ICU, provided to critically ill adults either
during or after the mechanical ventilation period, compared with delayed
exercise or usual care, on improving physical function or performance,
muscle strength and health-related quality of life. Search methods: We
searched CENTRAL, MEDLINE, Embase and CINAHL. We searched conference
proceedings, reference lists of retrieved articles, databases of trial
registries and contacted experts in the field on 31 August 2017. We did
not impose restrictions on language or location of publications. Selection
criteria: We included all randomized controlled trials (RCTs) or
quasi-RCTs that compared early intervention (mobilization or active
exercise, or both), delivered in the ICU, with delayed exercise or usual
care delivered to critically ill adults either during or after the
mechanical ventilation period in the ICU. Data collection and analysis:
Two researchers independently screened titles and abstracts and assessed
full-text articles against the inclusion criteria of this review. We
resolved any disagreement through discussion with a third review author as
required. We presented data descriptively using mean differences or
medians, risk ratios and 95% confidence intervals. A meta-analysis was not
possible due to the heterogeneity of the included studies. We assessed the
quality of evidence with GRADE. Main results: We included four RCTs (a
total of 690 participants), in this review. Participants were adults who
were mechanically ventilated in a general, medical or surgical ICU, with
mean or median age in the studies ranging from 56 to 62 years. Admitting
diagnoses in three of the four studies were indicative of critical
illness, while participants in the fourth study had undergone cardiac
surgery. Three studies included range-of-motion exercises, bed mobility
activities, transfers and ambulation. The fourth study involved only upper
limb exercises. Included studies were at high risk of performance bias, as
they were not blinded to participants and personnel, and two of four did
not blind outcome assessors. Three of four studies reported only on those
participants who completed the study, with high rates of dropout. The
description of intervention type, dose, intensity and frequency in the
standard care control group was poor in two of four studies. Three studies
(a total of 454 participants) reported at least one measure of physical
function. One study (104 participants) reported low-quality evidence of
beneficial effects in the intervention group on return to independent
functional status at hospital discharge (59% versus 35%, risk ratio (RR)
1.71, 95% confidence interval (CI) 1.11 to 2.64); the absolute effect is
that 246 more people (95% CI 38 to 567) per 1000 would attain independent
functional status when provided with early mobilization. The effects on
physical functioning are uncertain for a range measures: Barthel Index
scores (early mobilization: median 75 control: versus 55, low quality
evidence), number of ADLs achieved at ICU (median of 3 versus 0, low
quality evidence) or at hospital discharge (median of 6 versus 4, low
quality evidence). The effects of early mobilization on physical function
measured at ICU discharge are uncertain, as measured by the Acute Care
Index of Function (ACIF) (early mobilization mean: 61.1 versus control:
55, mean difference (MD) 6.10, 95% CI -11.85 to 24.05, low quality
evidence) and the Physical Function ICU Test (PFIT) score (5.6 versus 5.4,
MD 0.20, 95% CI -0.98 to 1.38, low quality evidence). There is low quality
evidence that early mobilization may have little or no effect on physical
function measured by the Short Physical Performance Battery score at ICU
discharge from one study of 184 participants (mean 1.6 in the intervention
group versus 1.9 in usual care, MD -0.30, 95% CI -1.10 to 0.50), or at
hospital discharge (MD 0, 95% CI -1.00 to 0.90). The fourth study, which
examined postoperative cardiac surgery patients did not measure physical
function as an outcome. Adverse effects were reported across the four
studies but we could not combine the data. Our certainty in the risk of
adverse events with either mobilization strategy is low due to the low
rate of events. One study reported that in the intervention group one out
of 49 participants (2%) experienced oxygen desaturation less than 80% and
one of 49 (2%) had accidental dislodgement of the radial catheter. This
study also found cessation of therapy due to participant instability
occurred in 19 of 498 (4%) of the intervention sessions. In another study
five of 101 (5%) participants in the intervention group and five of 109
(4.6%) participants in the control group had postoperative pulmonary
complications deemed to be unrelated to intervention. A third study found
one of 150 participants in the intervention group had an episode of
asymptomatic bradycardia, but completed the exercise session. The fourth
study reported no adverse events. Authors' conclusions: There is
insufficient evidence on the effect of early mobilization of critically
ill people in the ICU on physical function or performance, adverse events,
muscle strength and health-related quality of life at this time. The four
studies awaiting classification, and the three ongoing studies may alter
the conclusions of the review once these results are available. We
assessed that there is currently low-quality evidence for the effect of
early mobilization of critically ill adults in the ICU due to small sample
sizes, lack of blinding of participants and personnel, variation in the
interventions and outcomes used to measure their effect and inadequate
descriptions of the interventions delivered as usual care in the studies
included in this Cochrane Review.<br/>Copyright &#xa9; 2018 The Cochrane
Collaboration.

<3>
Accession Number
621406964
Author
Fujimoto H.; Yamaguchi O.; Hayami H.; Shimosaka M.; Tsuboi S.; Sato M.;
Takebayashi S.; Morita S.; Saito M.; Goto T.; Kurahashi K.
Institution
(Fujimoto, Yamaguchi, Hayami, Shimosaka, Tsuboi, Sato) Division of
Critical Care, Yokohama City University Medical Center, Minami-ku,
Yokohama, Kanagawa 232-0024, Japan
(Fujimoto, Yamaguchi, Goto) Department of Anesthesiology and Critical Care
Medicine, Yokohama City University Graduate School of Medicine,
Kanazawaku, Yokohama, Kanagawa 236-0004, Japan
(Takebayashi) Radiation Department, Yokohama City University Medical
Center, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
(Morita, Saito) Department of Biostatistics and Epidemiology, Yokohama
City University Graduate School of Medicine, Kanazawa-ku, Yokohama,
Kanagawa 236-0004, Japan
(Kurahashi) Department of Anesthesiology and Intensive Care Medicine,
International University of Health and Welfare, School of Medicine,
Narita, Chiba 286-8686, Japan
Title
Efficacy of continuous versus intermittent subglottic secretion drainage
in preventing ventilator-associated pneumonia in patients requiring
mechanical ventilation: A single-center randomized controlled trial.
Source
Oncotarget. 9 (22) (pp 15876-15882), 2018. Date of Publication: 2018.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Objective: Aspiration of subglottic secretion is a widely used
intervention to prevent ventilator-associated pneumonia (VAP). This study
aimed to compare the efficacy of continuous and intermittent subglottic
secretion drainage (SSD) in preventing VAP. Methods: A single-center
randomized controlled trial was conducted on adult postoperative patients
who were expected to undergo mechanical ventilation for more than 48
hours. Primary outcome measure was incidence of VAP and secondary outcome
measures were length of mechanical ventilation and intensive-care unit
(ICU) stay. Results: Fifty-nine patients received continuous SSD, while 60
patients received intermittent SSD. Of these 119 patients, 88 (74%) were
excluded and 15 and 16 patients were allocated to receive continuous and
intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7
(43.8%) patients in the continuous and intermittent groups, respectively,
(p=0.320). The length of mechanical ventilation was significantly shorter
(p=0.034) in the continuous group (99.5+/-47.1 h) than in the intermittent
group (159.9+/-94.5 h). The length of ICU stay was also shorter (p=0.0097)
in the continuous group (6.3+/-2.1 days) than the intermittent group
(9.8+/-4.8 days). Conclusions: Although continuous SSD did not reduce the
incidence of VAP, it reduced the length of mechanical ventilation and ICU
stay when compared to intermittent SSD.<br/>Copyright &#xa9; Fujimoto et
al.

<4>
Accession Number
615028111
Author
Bartunek J.; Terzic A.; Davison B.A.; Filippatos G.S.; Radovanovic S.;
Beleslin B.; Merkely B.; Musialek P.; Wojakowski W.; Andreka P.; Horvath
I.G.; Katz A.; Dolatabadi D.; El Nakadi B.; Arandjelovic A.; Edes I.;
Seferovic P.M.; Obradovic S.; Vanderheyden M.; Jagic N.; Petrov I.; Atar
S.; Halabi M.; Gelev V.L.; Shochat M.K.; Kasprzak J.D.; Sanz-Ruiz R.;
Heyndrickx G.R.; Nyolczas N.; Legrand V.; Guedes A.; Heyse A.; Moccetti
T.; Fernandez-Aviles F.; Jimenez-Quevedo P.; Bayes-Genis A.;
Hernandez-Garcia J.M.; Ribichini F.; Gruchala M.; Waldman S.A.; Teerlink
J.R.; Gersh B.J.; Povsic T.J.; Henry T.D.; Metra M.; Hajjar R.J.; Tendera
M.; Behfar A.; Alexandre B.; Seron A.; Stough W.G.; Sherman W.; Cotter G.;
Wijns W.
Institution
(Bartunek, Vanderheyden, Heyndrickx, Wijns) Cardiovascular Center,
Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, Aalst
B-9300, Belgium
(Terzic, Gersh, Behfar) Mayo Clinic, Center for Regenerative Medicine,
Department of Cardiovascular Diseases, 200 First Street SW, Rochester, MN
550905, United States
(Davison, Cotter) Momentum Research, Inc, Durham, NC, United States
(Filippatos) National and Kapodistrian University of Athens, School of
Medicine, Attikon University Hospital, Athens, Greece
(Radovanovic) University Hospital Center Bezanijska Kosa, Belgrade, Serbia
(Beleslin) Cardiology Clinic, Clinical Centre of Serbia, Medical School,
University of Belgrade, Belgrade, Serbia
(Merkely) Semmelweis University Heart and Vascular Center, Budapest,
Hungary
(Musialek) Jagiellonian University Department of Cardiac and Vascular
Diseases, John Paul II Hospital, Krakow, Poland
(Wojakowski, Tendera) Third Division of Cardiology, Medical University of
Silesia, Katowice, Poland
(Andreka) Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest,
Hungary
(Horvath) Heart Institute, University of Pecs, Pecs, Hungary
(Katz) Department of Cardiology, Barzilai Medical Center, Israel Faculty
of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
(Dolatabadi, El Nakadi) Division of Cardiology, Centre Hospitalier
Universitaire de Charleroi, Charleroi, Belgium
(Arandjelovic) Cardiology Department, Clinical Hospital Zvezdara,
Belgrade, Serbia
(Edes) Department of Cardiology, University of Debrecen, Debrecen, Hungary
(Seferovic) University of Belgrade School of Medicine, Belgrade University
Medical Center, Belgrade, Serbia
(Obradovic) Clinic of Emergency Medicine, Military Medical Academy, School
of Medicine, University of Defense, Belgrade, Serbia
(Jagic) Clinical Center Kragujevac, Kragujevac, Serbia
(Petrov, Gelev) Department of Cardiology, Angiology and Electrophysiology,
City Clinic Heart and Vascular Institute, Sofia University, Sofia,
Bulgaria
(Atar) Department of Cardiology, Galilee Medical Center, Nahariya, Israel
(Atar, Halabi) Faculty of Medicine in the Galilee, Bar-Ilan University,
Safed, Israel
(Shochat) Heart Institute, Hillel Yaffe Medical Center, Rappaport School
of Medicine, Haifa, Israel
(Kasprzak) Department of Cardiology Medical University of Lodz, Lodz,
Poland
(Sanz-Ruiz, Fernandez-Aviles) Hospital General Universitario Gregorio
Maranon, Madrid, Spain
(Nyolczas) Medical Centre, Hungarian Defense Forces, Budapest, Hungary
(Legrand) Department of Cardiology, Centre Hospitalier Universitaire de
Liege, Liege, Belgium
(Guedes) Department of Cardiology, Universite Catholique de Louvain, CHU
UcL Namur, Yvoir, Belgium
(Heyse) Department of Cardiology, AZ Glorieux, Ronse, Belgium
(Moccetti) Cardiocentro Ticino, Lugano, Switzerland
(Jimenez-Quevedo) Department of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Bayes-Genis) Hospital Universitari Germans Trias i Pujol, Universitat
Autonoma, Barcelona, Spain
(Hernandez-Garcia) Hospital Clinico Universitario Virgen de la Victoria,
Malaga, Spain
(Ribichini) Department of Cardiology, University of Verona, Italy
(Gruchala) Department of Cardiology, Medical University of Gdansk, Gdansk,
Poland
(Waldman) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
(Teerlink) School of Medicine, University of California San Francisco and
Section of Cardiology, San Francisco Veterans Affairs Medical Center, San
Francisco, CA, United States
(Povsic) Duke Clinical Research Institute and Duke Medicine, Durham, NC,
United States
(Henry) Cedars Sinai Heart Institute, Los Angeles, CA, United States
(Metra) Cardiology, Department of Medical and Surgical Specialties,
Radiological Sciences and Public Health, University and Spedali Civili,
Brescia, Italy
(Hajjar) Mount Sinai School of Medicine, New York, NY, United States
(Alexandre, Seron, Sherman) Celyad, Mont Saint Guibert, Belgium
(Stough) Departments of Clinical Research and Pharmacy Practice, Campbell
University College of Pharmacy and Health Sciences, Cary, NC, United
States
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland Galway and Saolta University Healthcare Group,
Galway, Ireland
Title
Cardiopoietic cell therapy for advanced ischaemic heart failure: Results
at 39 weeks of the prospective, randomized, double blind, sham-controlled
CHART-1 clinical trial.
Source
European Heart Journal. 38 (9) (pp 648-660), 2017. Date of Publication: 01
Mar 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Cardiopoietic cells, produced through cardiogenic conditioning of
patients' mesenchymal stem cells, have shown preliminary efficacy. The
Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1)
trial aimed to validate cardiopoiesis-based biotherapy in a larger heart
failure cohort. Methods and results This multinational, randomized,
double-blind, sham-controlled study was conducted in 39 hospitals.
Patients with symptomatic ischaemic heart failure on guideline-directed
therapy (n= 484) were screened; n = 348 underwent bone marrow harvest and
mesenchymal stem cell expansion. Those achieving> 24 million mesenchymal
stem cells (n=315) were randomized to cardiopoietic cells delivered
endomyocardially with a retention-enhanced catheter (n=157) or sham
procedure (n= 158). Procedures were performed as randomized in 271
patients (n = 120 cardiopoietic cells, n= 151 sham). The primary efficacy
endpoint was a Finkelstein Schoenfeld hierarchical composite (all-cause
mortality, worsening heart failure, Minnesota Living with Heart Failure
Questionnaire score, 6-min walk distance, left ventricular end-systolic
volume, and ejection fraction) at 39 weeks. The primary outcome was
neutral (Mann Whitney estimator 0.54, 95% confidence interval [CI] 0.47
0.61 [value> 0.5 favours cell treatment], P = 0.27). Exploratory analyses
suggested a benefit of cell treatment on the primary composite in patients
with baseline left ventricular end-diastolic volume 200-370mL (60% of
patients) (Mann Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No
difference was observed in serious adverse events. One (0.9%)
cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted
or sudden cardiac death. Conclusion The primary endpoint was neutral, with
safety demonstrated across the cohort. Further evaluation of cardiopoietic
cell therapy in patients with elevated end-diastolic volume is
warranted.<br/>Copyright &#xa9; The Author 2016.

<5>
Accession Number
621586283
Author
Kamel E.Z.; Abd-Elshafy S.K.; Sayed J.A.; Mostafa M.M.; Seddik M.I.
Institution
(Kamel, Abd-Elshafy, Sayed) Department of Anesthesia, ICU, and Pain,
Faculty of Medicine, Assiut University, Assiut, Egypt
(Mostafa) Department of Cardiothoracic, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Seddik) Department of Clinical Pathology, Faculty of Medicine, Assiut
University, Assiut, Egypt
Title
Pain alleviation in patients undergoing cardiac surgery; Presternal local
anesthetic and magnesium infiltration versus conventional intravenous
analgesia: A randomized double-blind study.
Source
Korean Journal of Pain. 31 (2) (pp 93-101), 2018. Date of Publication: 01
Apr 2018.
Publisher
Korean Pain Society (E-mail: painfree@hanafos.com)
Abstract
Background: Magnesium is one of the effective, safe local anesthetic
adjuvants that can exert an analgesic effect in conditions presenting
acute and chronic post-sternotomy pain. We studied the efficacy of
continuous infusion of presternal magnesium sulfate with bupivacaine for
pain relief following cardiac surgery. Methods: Ninety adult patients
undergoing valve replacement cardiac surgery randomly allocated into three
groups. In all patients; a presternal catheter was placed for continuous
infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for
48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group
2, versus conventional intravenous paracetamol and ketorolac in group 3.
Rescue analgesia was iv 25 mug fentanyl. Postoperative Visual Analog Scale
(VAS) and fentanyl consumption during the early two postoperative days
were assessed. All patients were followed up over two months for
occurrence of chronic post-sternotomy pain. Results: VAS values showed
high significant differences during the first 48 hours with the least pain
scale in group 1 and significantly least fentanyl consumption (30.8 +/- 7
mug in group 1 vs. 69 +/- 18 mug in group 2, and 162 +/- 3 in group 3
respectively). The incidence of chronic pain has not differed between the
three groups although it was more pronounced in group 3. Conclusions:
Continuous presternal bupivacaine and magnesium infusion resulted in
better postoperative analgesia than both presternal bupivacaine alone or
conventional analgesic groups.<br/>Copyright &#xa9; The Korean Pain
Society, 2018.

<6>
Accession Number
621517647
Author
Liu J.; Zeng Y.; Cui F.; Wang Y.; He P.; Lan L.; Chen S.; Wang W.; Li J.;
He J.
Institution
(Liu, Zeng, Cui, Wang, Li, He) Department of Thoracic Surgery, The First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong,
China
(Liu, Zeng, Cui, Wang, Li, He) Guangzhou Institute of Respiratory Disease
and China State Key Laboratory of Respiratory Disease, Guangzhou,
Guangdong, China
(Wang) Department of Operating Room, The First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
(He) Department of Pathology, The First Affiliated Hospital of Guangzhou
Medical University, Guangzhou, Guangdong, China
(Lan, Chen) Department of Anesthesiology, The First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
Title
The impact of spontaneous ventilation on non-operative lung injury in
thoracic surgery: A randomized controlled rabbit model study.
Source
European Journal of Cardio-thoracic Surgery. 52 (6) (pp 1083-1089), 2017.
Date of Publication: December 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: One-lung ventilation (OLV) with general anaesthesia may
increase adverse effects after thoracic surgery, specifically
ventilator-induced lung injury. Spontaneous ventilation (SV) has no
mechanical ventilation process, thus, we established a rabbit model to
assess non-operative lung injury between OLV and SV. METHODS: Thirty-six
rabbits were randomly divided into 6 groups: OLV and SV (0, 2 and 4 h).
Blood gas analysis was performed after thoracic surgery. Lung tissue and
bronchoalveolar lavage fluid were obtained from the non-operative lung.
Pathological injury score in lung tissue and tumour necrosis factor alpha
(TNF-alpha) level in bronchoalveolar lavage fluid using enzyme-linked
immunosorbent assay were determined. Moreover, messenger RNA and protein
of TNF-alpha in lung tissue were also determined by quantitative reverse
transcriptase polymerase chain reaction and immunohistochemistry. RESULTS:
Compared with the OLV group, significantly higher partial pressure of
carbon dioxide (47.78 +/- 3.57 vs 38.95 +/- 3.88 mmHg, P < 0.01) and
partial pressure of oxygen (101.08 +/- 13.1 vs 85.6 +/- 11.07 mmHg, P <
0.01), as well as a significantly lower pathological injury score (6.83
+/- 1.17 vs 8.83 +/- 1.72, P < 0.05), TNF-alpha level in bronchoalveolar
lavage fluid (290.32 +/- 29.38 vs 368.43 +/- 31.26 pg/ml, P < 0.01),
TNF-alpha messenger RNA (6.31 +/- 1.13 vs 8.6 +/- 1.34, P < 0.01),
immunostaining intensity in lung tissue were found at 4 h in the SV group.
However, there are no significant differences between OLV and SV groups at
2 h (P > 0.05), except in TNF-alpha messenger RNA. CONCLUSIONS: Based on
this rabbit model, SV for thoracic surgery is not inferior to OLV in terms
of lung injury. Considering our results, when performing time-consuming
thoracic procedures under OLV, surgeons should more closely examine
patients for non-operative lung injury postoperatively.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
621517543
Author
Gaudino M.; Alexander J.H.; Bakaeen F.G.; Ballman K.; Barili F.; Calafiore
A.M.; Davierwala P.; Goldman S.; Kappetein P.; Lorusso R.; Mylotte D.;
Pagano D.; Ruel M.; Schwann T.; Suma H.; Taggart D.P.; Tranbaugh R.F.;
Fremes S.
Institution
(Gaudino, Tranbaugh) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Alexander) Duke Clinical Research Institute, Duke Health, Durham, NC,
United States
(Bakaeen) Cleveland Clinic Foundation, Cleveland, OH, United States
(Ballman) Department of Biostatistics and Epidemiology, Weill Cornell
Medicine, New York, NY, United States
(Barili) Department of Cardiovascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
(Calafiore) Fondazione Giovanni Paolo II, Campobasso, Italy
(Davierwala) Herzzentrum Leipzig, Leipzig, Germany
(Goldman) Department of Medicine, University of Arizona, Tucson, AZ,
United States
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Lorusso) Maastricht University Medical Centre, Maastricht, Netherlands
(Mylotte) Galway University Hospitals, Galway, Ireland
(Pagano) University Hospital Birmingham, Birmingham, United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Schwann) The University of Toledo, Toledo, OH, United States
(Suma) Suma Heart Clinic, Tokyo, Japan
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Sunnybrook Health Science, University of Toronto, Toronto, ON,
Canada
Title
Randomized comparison of the clinical outcome of single versus multiple
arterial grafts: The ROMA trial-rationale and study protocol.
Source
European Journal of Cardio-thoracic Surgery. 52 (6) (pp 1031-1040), 2017.
Date of Publication: December 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The primary hypothesis of the ROMA trial is that in patients undergoing
primary isolated non-emergent coronary artery bypass grafting, the use of
2 or more arterial grafts compared with a single arterial graft (SAG) is
associated with a reduction in the composite outcome of death from any
cause, any stroke, post-discharge myocardial infarction and/or repeat
revascularization. The secondary hypothesis is that in these patients, the
use of 2 or more arterial grafts compared with a SAG is associated with
improved survival. The ROMA trial is a prospective, unblinded, randomized
event-driven multicentre trial comprising at least 4300 subjects. Patients
younger than 70 years with left main and/or multivessel disease will be
randomized to a SAG or multiple arterial grafts to the left coronary
system in a 1:1 fashion. Permuted block randomization stratified by the
centre and the type of second arterial graft will be used. The primary
outcome will be a composite of death from any cause, any stroke,
post-discharge myocardial infarction and/or repeat revascularization. The
secondary outcome will be all-cause mortality. The primary safety outcome
will be a composite of death from any cause, any stroke and any myocardial
infarction. In all patients, 1 internal thoracic artery will be
anastomosed to the left anterior descending coronary artery. For patients
randomized to the SAG group, saphenous vein grafts will be used for all
non-left anterior descending target vessels. For patients randomized to
the multiple arterial graft group, the main target vessel of the lateral
wall will be grafted with either a radial artery or a second internal
thoracic artery. Additional grafts for the multiple arterial graft group
can be saphenous veins or supplemental arterial conduits. To detect a 20%
relative reduction in the primary outcome, with 90% power at 5% alpha and
assuming a time-to-event analysis, the sample size must include 845 events
(and 3650 patients). To detect a 20% relative reduction in the secondary
outcome, with 80% power at 5% alpha, the sample size must include 631
events (and 3650 patients). To be conservative, the sample size will be
set at 4300 patients. The primary outcome will be tested according to the
intention-to-treat principle. The primary analysis will be a Cox
proportional hazards regression model, with the treatment arm included as
a covariate. If non-proportional hazards are observed, alternatives to Cox
proportional hazards regression will be explored.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2000626507
Author
Ando M.; Funamoto M.; Cameron D.E.; Sundt T.M.
Institution
(Ando, Funamoto, Cameron, Sundt) Division of Cardiac Surgery,
Massachusetts General Hospital and Harvard Medical School, Boston, Mass,
United States
Title
Concomitant surgical closure of left atrial appendage: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Although percutaneous closure of the left atrial appendage is
supported as a potential alternative to lifelong anticoagulation in
patients with atrial fibrillation, comprehensive evidence on surgical left
atrial appendage closure in heart surgery is limited. Methods: We
conducted a meta-analysis of studies comparing patients who underwent open
cardiac surgery with or without left atrial appendage closure. A
literature search was performed on PubMed, Embase, and Cochrane Trials
databases. Outcomes of interest were 30-day/in-hospital mortality and
cerebrovascular accident. I² statistics were used to evaluate
heterogeneity, and publication bias was evaluated by Begg's and Egger's
tests. Results: We reviewed 1284 articles and selected for main analysis 7
articles including 3897 patients (1963 in the left atrial appendage
closure group and 1934 in the non-left atrial appendage closure group).
Among the 7 studies, 3 were randomized-controlled studies, 3 were
propensity-matched studies, and 1 was a case-matching study. At
30-day/in-hospital follow-up, left atrial appendage closure was
significantly associated with decreased risk of mortality and
cerebrovascular accident (odds ratio, 0.384, 95% confidence interval,
0.233-0.631 for mortality, and odds ratio, 0.622, 95% confidence interval,
0.388-0.998 for cerebrovascular accident). Stratified analysis
demonstrated that this association was more prominent in preoperative
atrial fibrillation strata. Conclusions: Concomitant surgical left atrial
appendage closure should be considered at the time of open cardiac
surgery, particularly among those in atrial fibrillation preoperatively.
The benefit of left atrial appendage closure for patients not in atrial
fibrillation and for those undergoing nonvalvular surgery is still
unclear. Further prospective investigations are indicated.<br/>Copyright
&#xa9; 2018

<9>
Accession Number
2000600177
Author
Bai J.; Gong L.-L.; Li Q.-F.; Wang Z.-H.
Institution
(Bai, Gong, Li, Wang) Department of Endocrinology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
Title
Long-term efficacy and safety of proprotein convertase subtilisin/kexin 9
monoclonal antibodies: A meta-analysis of 11 randomized controlled trials.
Source
Journal of Clinical Lipidology. 12 (2) (pp 277-291.e3), 2018. Date of
Publication: March - April 2018.
Publisher
Elsevier Ltd
Abstract
Background: Monoclonal antibodies targeting proprotein convertase
subtilisin/kexin type 9 (PCSK9) have been shown to significantly reduce
low-density lipoprotein cholesterol (LDL-C) levels. Objective: The purpose
of this study was to assess the long-term efficacy and safety of PCSK9
antibodies. Methods: PubMed, EMBASE, the Cochrane Library, and
ClinicalTrials.gov were searched for relevant studies. Results: A total of
11 studies including 38,235 participants who were treated for at least 48
weeks were included in this meta-analysis. The results suggested that
PCSK9 antibody treatment significantly decreased LDL-C levels (mean
difference, -50.23% [95% confidence interval {CI}, -56.65% to -43.82%])
compared with no PCSK9 antibody treatment and also decreased other
atherogenic lipid fractions. PCSK9 antibody treatment also elicited a
significant reduction in cardiovascular event rates compared with no
antibody treatment (relative risk [RR], 0.86 [95% CI, 0.81-0.92]). This
reduction consisted of separate significant reductions in the rates of
myocardial infarction (RR, 0.73 [95% CI, 0.65-0.82]), coronary
revascularization (RR, 0.79 [95% CI, 0.73-0.87]), and stroke (RR, 0.81
[95% CI, 0.68-0.96]). There were no clear differences in the incidences of
treatment-emergent adverse events (TEAEs), serious TEAEs, or TEAEs of
interest between the 2 groups; moreover, no differences between the 2
groups were found for other laboratory parameters. Conclusion: PCSK9
antibodies have significant effects on reducing LDL-C levels and improve
cardiovascular outcomes. These antibodies have a satisfactory safety
profile, which suggests that they are suitable for use as a long-term
treatment.<br/>Copyright &#xa9; 2018 National Lipid Association

<10>
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.

<11>
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. 32 (3) (no pagination), 2018. Article Number:
e13206. Date of Publication: March 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. Published by John Wiley & Sons Ltd

<12>
Accession Number
619479188
Author
Urso S.; Bellot R.; Tena M.; Rios L.; Martin P.; Valeron D.; Abad C.;
Sadaba R.; Portela F.
Institution
(Urso, Bellot, Tena, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Martin, Valeron) Servicio de Cardiologia, Hospital Universitario Dr.
Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Hospital de Navarra, Pamplona,
Spain
Title
Coronary artery bypass grafting versus drug-eluting stent in patients with
left main stem disease: A systematic review of randomized clinical trials
and of meta-analyses of randomized clinical trials.
Source
Cirugia Cardiovascular. 25 (2) (pp 118-124), 2018. Date of Publication:
March - April 2018.
Publisher
Elsevier Doyma
Abstract
Objective: The aim of this systematic review is to analyze in the
literature the clinical results of coronary artery bypass grafting (CABG)
versus percutaneous coronary intervention with drug-eluting stents in
patients with left main stem disease. Methods: We carried out a literature
search using Pubmed, Google Scholar, Medline, Embase and Cochrane
databases. We limited our search to randomized controlled trials or
meta-analyses carried out on randomized controlled trials, with no year of
publication or language restriction. Results: Eighty-two articles were
found using the search methodology described. Of these, 14 articles were
selected: 7 papers from 5 randomized non-inferiority clinical trials
(SYNTAX, PRECOMBAT, study by Boudriot et al., NOBLE and EXCEL) and 7
meta-analyses. These trials have compared first generation drug-eluting
stents (SYNTAX: stent with paclitaxel; Boudriot et al. and PRECOMBAT:
stent with sirolimus) and second-generation drug-eluting stents (NOBLE:
stent with biolimus; EXCEL: stent with cobalt-chromium everolimus) with
CABG. With reference to the coronary revascularization procedure,
bilateral internal mammary artery use ranged from 7.4% to 54.4%. All the
included randomized trials reported a lower rate of repeated
revascularization in the surgical population. According to the
meta-analyses review, the risk, expressed as odds ratio, of requiring a
new myocardial revascularization procedure by the percutaneous population
compared with that one of the surgical population, ranged from 1.68 to
2.21. Conclusions: Independently from the type of drug eluting stent used
in the percutaneous procedures and despite low rate of bilateral internal
mammary artery used in the surgical group, the risk of requiring a new
myocardial revascularization procedure by the percutaneous population was
twice that one of the surgical population.<br/>Copyright &#xa9; 2017
Sociedad Espanola de Cirugia Toracica-Cardiovascular

<13>
[Use Link to view the full text]
Accession Number
621248423
Author
Nagappa M.; Ho G.; Patra J.; Wong J.; Singh M.; Kaw R.; Cheng D.; Chung F.
Institution
(Nagappa) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre and St Joseph Health Care, Western University,
London, ON, Canada
(Ho, Patra, Wong, Singh, Chung) Department of Anesthesiology and Pain
Medicine, Toronto Western Hospital, University of Toronto, 399 Bathurst
St, Toronto, ON M5T 2S8, Canada
(Kaw) Departments of Hospital Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Kaw) Departments of Outcomes Research (Anesthesiology), Cleveland Clinic,
Cleveland, OH, United States
(Cheng) Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(Cheng) Department of Anesthesia and Perioperative Medicine, Western
University, London, ON, Canada
Title
Postoperative outcomes in obstructive sleep apnea patients undergoing
cardiac surgery: A systematic review and meta-analysis of comparative
studies.
Source
Anesthesia and Analgesia. 125 (6) (pp 2030-2037), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in
patients undergoing cardiac surgery and may predispose patients to
postoperative complications. The purpose of this meta-analysis is to
determine the evidence of postoperative complications associated with OSA
patients undergoing cardiac surgery. METHODS: A literature search of
Cochrane Database of Systematic Reviews, Medline, Medline In-process, Web
of Science, Scopus, EMBASE, Cochrane Central Register of Controlled
Trials, and CINAHL until October 2016 was performed. The search was
constrained to studies in adult cardiac surgical patients with diagnosed
or suspected OSA. All included studies must report at least 1
postoperative complication. The primary outcome is major adverse cardiac
or cerebrovascular events (MACCEs) up to 30 days after surgery, which
includes death from all-cause mortality, myocardial infarction, myocardial
injury, nonfatal cardiac arrest, revascularization process, pulmonary
embolism, deep venous thrombosis, newly documented postoperative atrial
fibrillation (POAF), stroke, and congestive heart failure. Secondary
outcome is newly documented POAF. The other exploratory outcomes include
the following: (1) postoperative tracheal intubation and mechanical
ventilation; (2) infection and/or sepsis; (3) unplanned intensive care
unit (ICU) admission; and (4) duration of stay in hospital and ICU.
Meta-analysis and meta-regression were conducted using Cochrane Review
Manager 5.3 (Cochrane, London, UK) and OpenBUGS v3.0, respectively.
RESULTS: Eleven comparative studies were included (n = 1801 patients; OSA
versus non-OSA: 688 vs 1113, respectively). MACCEs were 33.3% higher odds
in OSA versus non-OSA patients (OSA versus non-OSA: 31% vs 10.6%; odds
ratio [OR], 2.4; 95% confidence interval [CI], 1.38-4.2; P = .002). The
odds of newly documented POAF (OSA versus non-OSA: 31% vs 21%; OR, 1.94;
95% CI, 1.13-3.33; P = .02) was higher in OSA compared to non-OSA. Even
though the postoperative tracheal intubation and mechanical ventilation
(OSA versus non-OSA: 13% vs 5.4%; OR, 2.67; 95% CI, 1.03-6.89; P = .04)
were significantly higher in OSA patients, the length of ICU stay and
hospital stay were not significantly prolonged in patients with OSA
compared to non-OSA. The majority of OSA patients were not treated with
continuous positive airway pressure therapy. Meta-regression and
sensitivity analysis of the subgroups did not impact the OR of
postoperative complications for OSA versus non-OSA groups. CONCLUSIONS:
Our meta-analysis demonstrates that after cardiac surgery, MACCEs and
newly documented POAF were 33.3% and 18.1% higher odds in OSA versus
non-OSA patients, respectively.<br/>Copyright &#xa9; 2017 International
Anesthesia Research Society.

<14>
Accession Number
621285266
Author
Zhu H.; Liang Y.; Zuo T.; Zhang M.
Institution
(Zhu, Liang, Zuo, Zhang) Division of Chest Pain Center, Guangdong
Provincial Hospital, The 2nd Clinical College of Guangzhou University of
Chinese Medicine, Guangzhou, China
Title
The prognostic impact of the coronary collateral circulation in patients
with coronary artery disease: A meta-analysis.
Source
Biomedical Research (India). 2017 (Special Issue
ArtificialIntelligentTechniquesforBioMedicalSignalProcessingEdition-I) (pp
S158-S166), 2017. Date of Publication: 2017.
Publisher
Scientific Publishers of India
Abstract
Background: Coronary Collateral Circulation (CCC) is an alternative source
of blood supply to an ischemic myocardial region. The study of animal
models showed that coronary collateral circulation on the myocardial had
obvious protective effect of survival but it for humans the influence of
the prognosis was still controversial. Aims: The aim of this meta-analysis
is to explore the impact of collateral circulation on prognosis. Methods
and results: We performed an electronic literature search of PubMed,
Embase, Chinese Biomedical Database (CBM), China National Knowledge
Infrastructure (CNKI) Cochrane Library, assessed the association between
coronary collateral circulation and prognosis, searched from the 1989 up
to July 2016, there was no language restriction. A total of 16 studies
enrolling 16447 participants were included in this analysis. Patients with
high collateralization showed a reduced mortality compared with those with
low collateralization Risk Ratios (RR) 0.66 [95% Confidence Intervals (CI)
0.54-0.82]; P=0.0001). The RR for 'high collateralization' showed a
reduced incidence of re-infarction compared with those with low
collateralization was 0.69 (95% CI: 0.52~0.92 p=0.01), in patients with
Major Adverse Cardiovascular Events (MACE), it was (RR 0.62 [95% CI
0.46-0.84], p=0.002). Conclusions: Abundant collateral circulation could
reduce coronary heart disease mortality, recurrence of myocardial
infarction and adverse cardiovascular events. However, in the
revascularization, arrthythmia, cardiac death and so on, showed not reach
statistical significance.<br/>Copyright &#xa9; 2018, Scientific Publishers
of India. All rights reserved.

<15>
Accession Number
616981371
Author
Kopriva P.; Griva M.; Tudos Z.
Institution
(Kopriva, Griva) Department of Cardiology, Tomas Bata Regional Hospital,
Zlin, Czech Republic
(Griva) Department of Internal Medicine I - Cardiology, Faculty of
Medicine and Dentistry, Palacky University Olomouc, University Hospital
Olomouc, Czech Republic
(Tudos) Department of Radiology, Faculty of Medicine and Dentistry,
Palacky University Olomouc, University Hospital Olomouc, Czech Republic
Title
Management of cardiac sarcoidosis - A practical guide.
Source
Cor et Vasa. 60 (2) (pp e155-e164), 2018. Date of Publication: April 2018.
Publisher
Elsevier Science B.V.
Abstract
Sarcoidosis is a multi-system granulomatous disorder of unclear etiology
which can affect any organ of the body including the heart. The heart is
involved in up to 25% of sarcoidosis patients. In rare cases, the heart
can be the only organ involved. Involvement of the heart, called cardiac
sarcoidosis, especially if symptomatic, significantly deteriorates the
prognosis for sarcoidosis patients, which is why cardiac sarcoidosis
should be not only considered, but also searched for actively. Despite
recent advances in this field, diagnosis, risk-stratification, and
treatment of cardiac sarcoidosis remains a challenging issue. Fortunately,
several recommendations have been recently formulated which provide
relatively clear guidance on the management of patients with cardiac
sarcoidosis. The cornerstone of management of these patients is a
multidisciplinary approach involving collaboration of cardiologists,
pulmonologists, radiologists, rheumatologists, and other specialists.
Currently, diagnosis of cardiac sarcoidosis is based on an assessment of a
patients' symptoms, physical examination and results of standard ECG,
Holter monitoring and echocardiography. This series of examinations can
identify individuals with possible cardiac sarcoidosis, who should
undergo, as the next step, cardiac magnetic resonance and positron
emission tomography, which are the techniques of choice for the diagnosis
of cardiac sarcoidosis. Histological verification, critical for
establishing a definitive diagnosis, is based - in cases with a typical
picture documented by imaging techniques - on an extracardiac biopsy. In
some cases, when an extracardiac biopsy is not feasible, an endomyocardial
biopsy is needed. The cornerstone of treatment remains corticosteroids, in
some cases in combination with other immunosuppressives, although data on
their efficacy and safety from randomized trials are lacking. As the most
frequent causes of death from cardiac sarcoidosis are heart rhythm
disorders, be it atrioventricular blocks or ventricular arrhythmias, an
irreplaceable role in the management of these patients is played by
implantation of pacemakers and implantable cardioverter/defibrillators
(ICD). One of the most critical issues is risk stratification of patients
who, while not meeting classic criteria for ICD implantation, continue to
be at high risk of sudden cardiac death and therefore should still be
considered for ICD implantation. The last option for patients with
advanced sarcoidosis is heart transplantation. The present paper is an
overview of presentation, diagnosis, and treatment of cardiac sarcoidosis,
with special emphasis on the use of algorithms applicable in routine
clinical practice.<br/>Copyright &#xa9; 2017 The Czech Society of
Cardiology

<16>
Accession Number
621570718
Author
Lee K.H.; Jeong H.K.; Park H.W.; Yoon N.S.; Cho J.G.
Institution
(Lee, Jeong, Park, Yoon, Cho) Chonnam National University Hospital, Heart
Center, Gwangju, South Korea
Title
Triple therapy is superior to dual anti-platelet therapy in atrial
fibrillation patients experiencing acutemyocardial infarction with
percutaneous coronary intervention.
Source
Europace. Conference: 1st Annual Conference of the European Heart Rhythm
Association, EHRA 2018. Spain. 20 (Supplement 1) (pp i66), 2018. Date of
Publication: March 2018.
Publisher
Oxford University Press
Abstract
Background: Oral anticoagulants (OACs) and dual anti-platelet therapy
(DAPT) is needed to reduce thromboembolism and stent thrombosis in atrial
fibrillation (AF) patients experiencing acute myocardial infarction (AMI)
with percutaneous coronary intervention (PCI). Because of the increased
risk of major bleeding, DAPT without warfarin is preferred to triple
therapy (OACs and DAPT) in real world practice. Purpose: We aimed to
compare efficacy and safety between triple therapy and DAPT in AF patients
undergoing PCI due to AMI. Methods: A total of 18,841AMI patients enrolled
in Korean AMI Registry (KAMIR) from Nov 2011 to Dec 2016, constituting
14,748 (80.6%) patients undergoing PCI and 1,708 (9.3%) patients
presenting AF. We analyzed consecutive 1,125 AF patients who underwent PCI
and survived at hospital discharge. One-year clinical outcomes were
compared between triple therapy group (n=384) and DAPT group (n=741).
Primary efficacy end-point was defined as major adverse cardiac and
cerebral events (MACCE), composed of death, recurrent MI, repeated PCI,
and coronary artery bypass grafting (CABG), and new-onset stroke. Primary
safety end-point was major bleeding. Net clinical outcome was defined as
the composite of MACCE and major bleeding, Results: There were no
differences in baseline clinical characteristics, and CHA2DS2-VASc score
between the 2 groups. One-year mortality was higher in DAPT group (8.8%
vs. 5.2%, p=0.032). However, there were no differences in the one-year MI,
repeated PCI, CABG, and new-onset stroke between the 2 groups. Primary
efficacy end-point (13.2% vs. 7.3%, p=0.003) was significantly higher in
DAPT group, whereas primary safety end-point (0.7% vs. 3.6%, p=0.032) was
significantly higher in triple group. Net clinical outcome was
significantly higher in DAPT group (13.2% vs. 8.3%, p=0.032).
Cox-regression analysis adjusting CHA2DS2-VASc score and clinically
important covariates demonstrated that triple therapy reduced primary
efficacy end-point (adjusted hazard ratio [HR] 0.60, 95% confidence
interval [CI] 0.38-0.95, p=0.029) and net clinical outcomes (adjusted HR
0.60, 95% CI 0.38-0.95, p=0.029). Conclusions: Triple therapy was
associated with better efficacy and worse safety clinical outcomes.
However, triple therapy reduced net clinical outcomes including both
efficacy and safety outcomes. Further clinical trials are warranted to
prove comparative efficacy and safety between triple therapy and DAPT in
AF patients experiencing AMI with PCI.

<17>
Accession Number
621570716
Author
Polovina M.; Djikic D.; Vlajkovic A.; Vilotijevic M.; Ostojic M.C.;
Seferovic P.
Institution
(Polovina, Seferovic) University Clinical Center of Serbia, Cardiology
Clinic, Faculty of Medicine, Belgrade, Serbia
(Djikic) University Clinical Center of Serbia, Cardiology Clinic,
Belgrade, Serbia
(Vlajkovic, Vilotijevic, Ostojic) University Belgrade Medical School,
Belgrade, Serbia
Title
Statins and the risk of major adverse cardiac events in patients with
atrial fibrillation without coronary artery disease: A propensity score
adjusted analysis.
Source
Europace. Conference: 1st Annual Conference of the European Heart Rhythm
Association, EHRA 2018. Spain. 20 (Supplement 1) (pp i239), 2018. Date of
Publication: March 2018.
Publisher
Oxford University Press
Abstract
Background: In addition to being a well-recognized risk factor for stroke,
atrial fibrillation (AF) also confers a significant risk of major adverse
cardiac events (MACE), including myocardial infarction (MI) and cardiac
death. Recently, findings from a large multinational European registry
reported a significant reduction in the risk of MACE and all-cause death
in the general population of AF patients treated with statins. Purpose: We
aimed to assess whether statin treatment reduces the 5-year risk of MACE
in a primary prevention cohort of AF patients without overt coronary
artery disease (CAD) at baseline. Methods: a prospective, observational
study including non-valvular AF patients free of CAD, treated at a
tertiary cardiology center (2010 through 2016). At inclusion, CAD was
excluded based on medical records and diagnostic tests (i.e.
stress-exercise echocardiography and/or coronary angiography). Also, data
on clinical and medication history were collected. Statins were prescribed
by treating physicians prior to enrollment, or at study inclusion
according to patients' serum lipid levels and cardiovascular risk. The
study outcome was the composite MACE including non-fatal/fatal (death
within first 30 days) MI, coronary artery revascularization
(percutaneous/surgical) and cardiac death. The association between statins
and the risk of MACE was first analyzed in a conventional Cox univariable
and multivariable models and then in a Cox model adjusted for the
propensity score for using statins (C-statistic for differentiation of
statin use, 0.870) and other potential confounders. Results: of 843
enrolled AF patients (mean age 62.5612.2 years 61.4% male), 363 (43.1%)
received statins. Patients taking statins were older, and more often had a
higher body mass index, hypertension, diabetes, prior stroke, and higher
glucose, total cholesterol, and triglyceride levels (all P<0.05). At
5-year follow-up, the composite MACE occurred in 118 patients (2.8%/year).
The event-rate of MACE was significantly lower in statin users (Figure 1).
In a univariable analysis, statins were associated with a hazard ratio
(HR) of 0.59 (95% confidence interval [CI], 0.41-0.87; P<0.001) for MACE.
This association persisted following adjustment for age, sex,
comorbidities, and medical treatment in a conventional multivariable model
(adjusted HR, 0.73 95% CI, 0.57-0.97 P=0.001). The association was
confirmed after adjustment for the propensity for statin treatment
(propensity-adjusted HR, 0.76 95% CI, 0.63-0.97 P=0.008). Conclusion: Our
results suggest that statins reduce the 5-year risk of MACE (i.e. coronary
events and cardiac death) by 25% in AF patients free of CAD at baseline.
While awaiting further confirmation in randomized trials, this observation
supports a consideration of statin therapy in AF patients at high
cardiovascular risk for primary prevention of adverse cardiovascular
outcomes.

<18>
Accession Number
621570539
Author
Van Stipdonk A.M.W.; Ter Horst I.A.H.; Hoogland R.; Crijns H.J.G.; Prinzen
F.W.; Meine M.; Maass A.H.; Vernooy K.
Institution
(Van Stipdonk, Hoogland, Crijns, Prinzen, Vernooy) Maastricht University
Medical Centre (MUMC), Cardiology, Maastricht, Netherlands
(Ter Horst, Meine) University Medical Center Utrecht, Cardiology, Utrecht,
Netherlands
(Maass) University Medical Center Groningen, Cardiology, Groningen,
Netherlands
Title
Does every left bundle branch block say the same in cardiac
resynchronisation therapy?.
Source
Europace. Conference: 1st Annual Conference of the European Heart Rhythm
Association, EHRA 2018. Spain. 20 (Supplement 1) (pp i33), 2018. Date of
Publication: March 2018.
Publisher
Oxford University Press
Abstract
Background: Left bundle branch block (LBBB) morphology is strongly
associated with positive response to cardiac resynchronisation therapy
(CRT) and hence an important criterion for patient selection in current
guidelines. There are, however, multiple definitions for LBBB, all
consisting of a different set of morphological ECG features. Objective: To
evaluate the association of LBBB according to different definitions and
outcome to CRT and to investigate which morphological ECG features
predominantly contribute to this association. Methods: A retrospective
multicentre study was conducted in 1,492 CRT patients with a baseline
12-lead ECG available. Patients were classified as LBBB or non-LBBB
according to definitions used by European Society of Cardiology (ESC),
American Heart Association (AHA), the MADIT-CRT trial, and Strauss et al.
Primary endpoint was the combination of all-cause mortality, cardiac
transplantation or left ventricular assist device (LVAD) implantation.
Results: Correlation between classification by different LBBB definitions
varied significantly (phi-coefficient (0.22-0.92), with AHA standing out
as highly specific, classifying only 18% of patients as LBBB (panel A).
For each LBBB definition there was a significant association of the
presence of LBBB to the primary endpoint, with a relative risk reduction
ranging from 39 to 43% (panel B). Each definition contained morphological
ECG criteria not contributing to the association with the primary
endpoint. Criteria independently associated to outcome are QS or rS in
lead V1, Notch in lead V5-6, I or aVL, and absence of a Q in lead V5-6, I,
and aVL. Conclusion: Patient groups classified as LBBB by different
definitions show large discrepancies; with very high specificity for AHA
definition. Though LBBB patients according to any definition have
significantly better outcome to CRT than non-LBBB patients, with only
small differences in strength of association. Each LBBB definition
contained redundant morphological criteria, not contributing to the
association with outcome. Only three of a total of eleven criteria are
independently associated to outcome in CRT.

<19>
Accession Number
621570348
Author
Lennerz C.; Barman M.; Sopher M.; Tantawy M.; Kolb C.; Whittaker P.
Institution
(Lennerz, Kolb) German Heart Center, Clinic for Heart and Circulatory
Diseases, Munich, Germany
(Barman) Al Ahli Hospital, Cardiology Department, Doha, Qatar
(Sopher) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Tantawy) Misr University for Science and Technology, Memorial Souad
Kafafi University Hospital, Cardiology, 6 of October City, Egypt
(Whittaker) Wayne State University, Cardiovascular Research Institute,
Department of Emergency Medicine, Detroit, United States
Title
Colchicine for prevention of atrial fibrillation after open-heart surgery:
A systematic review and meta-analysis.
Source
Europace. Conference: 1st Annual Conference of the European Heart Rhythm
Association, EHRA 2018. Spain. 20 (Supplement 1) (pp i72), 2018. Date of
Publication: March 2018.
Publisher
Oxford University Press
Abstract
Background: Post-operative atrial fibrillation (POAF) is the most frequent
complication after open-heart surgery. It is associated with increased
morbidity and mortality, longer hospital stays, and increased healthcare
costs. Prophylactic administration of colchicine may reduce the occurrence
of POAF. Methods: We searched three different databases (PubMed,
ClinicalTrials.gov and CENTRAL) to identify randomized controlled trials
(RCTs) that (1) compared prophylactic use of colchicine to placebo, or
usual care, in patients without a history of atrial fibrillation who
underwent elective open-heart surgery and (2) reported POAF-incidence.
Trials focused on occurrence of atrial fibrillation after percutaneous
interventions or colchicine treatment for non-prophylactic indications
were excluded. A random-effects model was used to pool data for
POAF-incidence, drug-related adverse effects, major adverse events and
hospital length-of-stay. Results: A total of five RCTs (1,412 patients)
were included. Colchicine treatment reduced POAF-events by 30% versus
placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence
interval (CI) 0.57 to 0.84, p=0.0002). Adverse drugrelated effects
increased with colchicine (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93,
p<0.0001). However, major adverse events were unchanged (3.2% vs 3.2%, RR
0.96, 95% CI 0.48 to 1.95, p=0.92). Length-of-stay decreased by 1.2 days
with colchicine (95% CI-1.89 to-0.44, p=0.002). Conclusion: Colchicine
showed superior clinical efficacy compared with usual care for prevention
of atrial fibrillation after cardiac surgery. In addition, colchicine
treatment was associated with shorter hospital stays. These benefits may
outweigh the increased risk of adverse drug-related effects.

<20>
Accession Number
621570179
Author
Ferretto S.; Testolina M.; Nguyen K.; Martin M.; Susana A.; Migliore F.;
Iliceto S.; Leoni L.; Bertaglia E.
Institution
(Ferretto, Testolina, Nguyen, Martin, Susana, Migliore, Iliceto, Leoni,
Bertaglia) University Hospital of Padova, Cardiac, Vascular and Thoracic
Science, Padua, Italy
Title
Pocket complications after device-based therapy in patients with chronic
heart failure.
Source
Europace. Conference: 1st Annual Conference of the European Heart Rhythm
Association, EHRA 2018. Spain. 20 (Supplement 1) (pp i243-i244), 2018.
Date of Publication: March 2018.
Publisher
Oxford University Press
Abstract
Background: Recent heart failure (HF) guidelines highlight the importance
of devicebased therapy as an important component in the management of
patients with chronic HF (CHF). In fact implantable
cardioverter-defibrillator (ICD) results in a significant reduction of
mortality and cardiac resynchronization therapy (CRT) improves symptoms
and left ventricular function. However patients with CHF have also
important comorbidities and frailty and often anticoagulant (AC) or
antiplatelet (AP) therapies are necessary. These factors expose the pts to
higher risk of pocket hematoma during device implantation or replacement.
Purpose: The purpose of the study was to identify the clinical factors
associated with hematoma formation after CRT or ICD device implantation or
replacement in patients with CHF, NYHA class II-III, and to compare CHF
patients with a control population of patients NYHA I on AC therapy.
Results: The study included 123 patients, with a mean age 72.0 years and a
mean ejection fraction (EF) of 40%. The 35.8% underwent ICD implantation,
the 13.0% CRT implantation, the 47.1% ICD o CRT replacement. Forty-two
(42.1%) patients suffered atrial fibrillation, 10 (8.1%) had severe
impaired renal function, 28 (23.0%) diabetes; 15 (12.2%) had previous
mechanical valve replacement and 4 (3.3%) transcatheter aortic valve
implantation. The 52.0% was on AC therapy (28 patients with warfarin, 30
with low molecular weight heparin (LMWH), 6 with new oral AC [NAO], the
14.6% was on AC and AP therapy, the 9.8% was on dual AP therapy. Pocket
hematoma occurred in 11 pts (8.5%) in 6 cases pocket revision was
necessary. At univariate analysis risk factors for pocket complications
resulted AC therapy (hematoma in 15.6% vs 1.7%, p=0.007), mechanical valve
prosthesis (hematoma in 33.3% vs 5.6%, p <0.001), recent TAVI implantation
(hematoma in 50.0% vs 7.6%, p=0.003) at the limit of statistical
significance were young age (mean age of 60.9 years in patients with
hematoma vs 73.2 years, p=0.05) and EF 35% (hematoma in 4.5% vs 14.3%,
p=0.05). Complications were mainly observed after ICD or CRT implantation
(p=0.001). Among AC therapies, LMWH was significantly associated with
pocket complication (hematoma was observed in the 7.1% of patients on
warfarin, in the 23.3% of patients in LMWH and in the 9.1% of patients in
NAO, p=0.007). At multivariate analysis previous mechanical valve
prosthesis and young age were confirmed as predictors of pocket hematoma.
Comparing the CHF population with a control population of 100 patients on
AC therapy with a mean age of 75.5 615.1 years, the incidence of pocket
hematoma resulted significantly lower (1% vs 8.5%, p=0.008). Conclusion:
Patients with CHF presented a high risk of pocket complication after ICD
or CRT implantation/replacement and the main predictors of hematoma are
high LMWH doses for mechanical valve prosthesis. The risk of pocket
hematoma resulted significantly higher than in patients NYHA I on AC
therapy.

<21>
Accession Number
621569204
Author
Harley C.; Visvanathan A.; Anand A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, United Kingdom
(MacLullich, Shenkin) Delirium Research Group, Geriatric Medicine,
University of Edinburgh, United Kingdom
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation (TAVI): A systematic review and
metaanalysis.
Source
Age and Ageing. Conference: British Geriatrics Society Spring Meeting
2016. United Kingdom. 46 (Supplement 1) (pp i25), 2017. Date of
Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an
increasingly common intervention for patients with aortic stenosis deemed
high-risk for major cardiac surgery, but identifying those who will
benefit can be challenging. Frailty reflects physiological reserve and may
be a useful prognostic marker in this population. We performed a
systematic review and meta-analysis of the association between frailty and
outcomes after TAVI. Methods: Five databases were searched between January
2000 and May 2015. From 2,623 articles screened, 54 were assessed for
eligibility. Ten cohort studies (n = 4,592) met the inclusion criteria of
reporting a measure of frailty with early (<=30 days) or late ( > 30 days)
mortality and procedural complications following TAVI as defined by the
Vascular Academic Research Consortium (VARC). Results: Frailty was
associated with increased early mortality in four studies (n = 1,900) (HR
2.35, 95% CI 1.78-3.09, p < 0.001), and increased late mortality in seven
studies (n = 3159) (HR 1.63, 95% CI 1.34-1.97, p < 0.001). Objective
frailty tools identified an even higher risk group for late mortality (HR
2.63, 95% CI 1.87-3.70, p < 0.001). Frail individuals undergoing TAVI have
a mortality rate of 34 deaths per 100 patient years, compared to 19 deaths
per 100 patient years in non-frail patients. There was limited reporting
of VARC procedural outcomes in relation to frailty, preventing
meta-analysis. Conclusions: Frailty assessment in an already vulnerable
TAVI population identifies individuals at even greater risk of poor
outcomes. Use of objective frailty tools may inform patient selection, but
this requires further assessment in large prospective registries.

<22>
Accession Number
621568344
Author
Berwanger O.; Santucci E.V.; Jesuino I.D.A.; Damiani L.P.; Barbosa L.M.;
Nakagawa Santos R.H.; Laranjeira L.N.; Egydio F.D.M.; Borges De Oliveira
J.A.; Dall Orto F.T.C.; De Andrade P.B.; De Castro Bienert I.R.; Bosso
C.E.; Mangione J.A.; Polanczyk C.A.; De Moraes Rego Sousa A.G.; Kalil
R.A.K.; Santos L.D.M.; Sposito A.C.; Rech R.L.; Sousa A.C.S.; Baldissera
F.; Nascimento B.R.; Giraldez R.R.C.V.; Cavalcanti A.B.; Pereira S.B.;
Mattos L.A.; Armaganijan L.V.; Guimaraes H.P.; Rego Sousa J.E.M.;
Alexander J.H.; Granger C.B.; Lopes R.D.; De Barros E Silva P.G.M.; De
Macedo T.A.; Peixoto De Miranda E.J.F.; Godoy L.C.; Dos Santos M.H.H.;
Katz M.; Truffa A.A.M.; Carvalho L.; Oliveira R.; Valois M.V.; Pacheco
B.G.; Kodama A.; Sampaio B.
Institution
(Berwanger, Santucci, De Barros E Silva, Jesuino, Damiani, Nakagawa
Santos, Laranjeira, Borges De Oliveira, Cavalcanti, Pereira, Guimaraes,
Rego Sousa, Pacheco, Kodama, Sampaio) Research Institute, Heart Hospital,
Abilio Soares St 250, Twelfth Floor, Sao Paulo, SP 04005-000, Brazil
(De Barros E Silva, Barbosa, Egydio, Armaganijan, Lopes) Brazilian
Clinical Research Institute, Sao Paulo, Brazil
(Dall Orto) Hospital Do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(De Andrade) Santa Casa de Marilia, Marilia, Brazil
(De Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
(Bosso) Santa Casa de Presidente Prudente/ Instituto Do Coracao de
Presidente Prudente, Presidente Prudente, Brazil
(Mangione) Hospital Sao Francisco de Assis, Braganca Paulista, Brazil
(Polanczyk) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(De Moraes Rego Sousa) Instituto Dante Pazzanese de Cardiologia, Sao
Paulo, Brazil
(Kalil) Instituto de Cardiologia Do Rio Grande Do sul, Porto Alegre,
Brazil
(Santos) Instituto de Cardiologia Do Distrito Federal, Brasilia, Brazil
(Sposito) Faculdade de Ciencias Medicas, Universidade Estadual de
Campinas, Campinas, Brazil
(Rech) Hospital Universitario de Canoas, Canoas, Brazil
(Sousa) Hospital Sao Lucas, Aracaju, Brazil
(Baldissera) Instituto de Pesquisa e Estudos Medicos de Itajai, Itajai,
Brazil
(Nascimento) Hospital Universitario Ciencias Medicas, Belo Horizonte,
Brazil
(Giraldez) Instituto Do Coracao, Sao Paulo, Brazil
(Mattos) Rede D'Or Sao Luiz, Sao Paulo, Brazil
(Alexander, Granger, Lopes) Duke University Medical Center, Duke Clinical
Research Institute, Durham, NC, United States
Title
Effect of loading dose of atorvastatin prior to planned percutaneous
coronary intervention on major adverse cardiovascular events in acute
coronary syndrome the SECURE-PCI randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 319 (13) (pp
1331-1340), 2018. Date of Publication: 03 Apr 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The effects of loading doses of statins on clinical outcomes in
patients with acute coronary syndrome (ACS) and planned invasive
management remain uncertain. OBJECTIVE To determine if periprocedural
loading doses of atorvastatin decrease 30-day major adverse cardiovascular
events (MACE) in patients with ACS and planned invasive management.
DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind,
placebo-controlled, randomized clinical trial conducted at 53 sites in
Brazil among 4191 patients with ACS evaluated with coronary angiography to
proceed with a percutaneous coronary intervention (PCI) if anatomically
feasible. Enrollment occurred between April 18, 2012, and October 6, 2017.
Final follow-up for 30-day outcomes was on November 6, 2017. INTERVENTIONS
Patients were randomized to receive 2 loading doses of 80mg of
atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours
after a planned PCI. All patients received 40mg of atorvastatin for 30
days starting 24 hours after the second dose of study medication. MAIN
OUTCOMES AND MEASURES The primary outcome was MACE, defined as a composite
of all-cause mortality, myocardial infarction, stroke, and unplanned
coronary revascularization through 30 days. RESULTS Among the 4191
patients (mean age, 61.8 [SD, 11.5] years; 1085women [25.9%]) enrolled,
4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent
PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144
(27.3%) had exclusively medical management. At 30 days, 130 patients in
the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had
aMACE (absolute difference, 0.85%[95%CI, -0.70%to 2.41%]; hazard ratio,
0.88; 95%CI, 0.69-1.11; P = .27). No cases of hepatic failurewere
reported; 3 cases of rhabdomyolysis were reported in the placebo group
(0.1%) and 0 in the atorvastatin group. CONCLUSIONS AND RELEVANCE Among
patients with ACS and planned invasive management with PCI, periprocedural
loading doses of atorvastatin did not reduce the rate of MACE at 30 days.
These findings do not support the routine use of loading doses of
atorvastatin among unselected patients with ACS and intended invasive
management.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<23>
Accession Number
621566025
Author
Velasco P.; Alcaraz Romero A.J.; Oikonomopoulou N.; Benito M.; Moya R.;
Sanchez A.
Institution
(Velasco, Benito, Moya, Sanchez) Complutense University of Madrid, Spain
(Alcaraz Romero) University Hospital of Getafe, Madrid, Spain
(Oikonomopoulou) Pediatric Intensive Care Unit, General University
Hospital "Gregorio Maranon", Madrid, Spain
Title
Hospital-acquired hyponatremia: Does the type of fluid therapy affect
children admitted to intensive care?.
Source
Revista Chilena de Pediatria. 89 (1) (pp 42-49), 2018. Date of
Publication: January-February 2018.
Publisher
Sociedad Chilena de Pediatria
Abstract
Introduction: The objective of this study was to evaluate the association
between the type of initial fluid therapy used (isotonic or hypotonic
solutions) and the development of hyponatremia, the plasma chlorine values
and the tolerance of venous access. Patients and Method: Retrospective
cohort study in a Pediatric Intensive Care Unit (PICU) of a high
complexity hospital. There were included children younger than 15 years
old hospitalized during the first semester of 2010 and 2013 who received
intravenous maintenance fluid therapy, excluding patients undergoing
cardiac surgery, kidney transplant and admissions that lasted less than 24
hours. Epidemiological, comorbidity and admission- related data were
collected, including type of solution received, sodium and chlorine values
in the first 72 hours of hospitalization and the incidence of
extravasation of peripheral intravenous lines. Results: 111 children were
included; 68 children (61.3%) were treated with hypotonic solutions and 43
(38.7%) with isotonic solutions. There were no differences in pathology
and severity, and also in the volume of fluid received. Among the patients
who received hypotonic solutions, 28 (41.2%) developed hyponatremia, wich
was moderate (Na <130 mEq/Kg) in 11 cases, compared with 8 children
(18.6%) who received isotonic solutions, with only one case of moderate
hyponatremia (p = 0.027). No cases of hypernatremia were recorded, and
there were no differences in plasma chlorine values. There was also no
increased frequency of venous access loss in patients treated with
isotonic solutions (4.7% versus 7.4%, p = 0.704). Conclusion: Treatment
with initial isotonic solutions in children hospitalized in PICU is
associated with a lower incidence and severity of hyponatremia, without
changes in the plasma chlorine values and it is well tolerated by
peripheral intravenous lines.<br/>Copyright &#xa9; 2018, Sociedad Chilena
de Pediatria. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
617399445
Author
Palla M.; Briasoulis A.; Siddiqui F.; Alesh I.; Afonso L.
Institution
(Palla, Briasoulis, Siddiqui, Alesh, Afonso) Division of Cardiology,
Detroit Medical Center, Wayne State University, Detroit, MI 48226, United
States
Title
Long (>12 Months) and Short (<6 Months) Versus Standard Duration of Dual
Antiplatelet Therapy after Coronary Stenting: A Systematic Review and
Meta-Analysis.
Source
American Journal of Therapeutics. 24 (4) (pp e468-e476), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Dual antiplatelet therapy (DAPT) is recommended for 6-12 months after
drug-eluting stent (DES) implantation to prevent ischemic events and late
stent thrombosis. The optimal duration of DAPT has not been established.
We performed a meta-analysis of the comparative effects of short and long
versus standard duration DAPT duration on adverse cardiovascular and major
bleeding. We conducted an EMBASE and MEDLINE search for studies in which
patients were randomized to treatment with a different duration of DAPT.
We included studies that provided data on DES selection, DAPT regimen and
duration, and incidence of the selected endpoints at the end of the
follow-up period. We identified 5 prospective randomized studies comparing
short versus standard duration DAPT and 3 comparing long versus standard
duration DAPT with a total of 28,343 patients. Short-term DAPT has similar
incidence of stent thrombosis, MI, and death compared to standard duration
DAPT, whereas major bleeding was significantly lower in short duration
DAPT. Long-term DAPT was associated with lower rates of stent thrombosis
and MI but significantly increased major bleeding and all-cause mortality
compared to standard duration DAPT. In this meta-analysis of prospective
controlled studies we found that short duration DAPT is safer and as
effective as standard duration DAPT in patients with second-generation
DES. Extended DAPT is associated with less ischemic events at the expense
of high bleeding and mortality rates.<br/>Copyright &#xa9; 2015 Wolters
Kluwer Health, Inc. All rights reserved.

<25>
Accession Number
616603492
Author
Garg A.; Rao S.V.; Visveswaran G.; Agrawal S.; Sharma A.; Garg L.; Mahata
I.; Garg J.; Singal D.; Cohen M.; Kostis J.B.
Institution
(Garg, Singal) Department of Medicine, Saint Peter's University Hospital,
Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick,
NJ 08901, United States
(Garg, Kostis) Cardiovascular Institute, Rutgers Robert Wood Johnson
Medical School, New Brunswick, NJ, United States
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Visveswaran, Cohen) Division of Cardiology, Newark Beth Israel Medical
Center, Newark, NJ, United States
(Agrawal) Division of Cardiology, St. Luke's University Hospital,
Bethlehem, PA, United States
(Sharma) Division of Cardiology, State University of New York Downstate,
Brooklyn, NY, United States
(Garg, Garg) Division of Cardiology, Lehigh Valley Hospital, Allentown,
PA, United States
(Mahata) Division of Cardiology, Tulane University, New Orleans, LA,
United States
Title
Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement
in Low-Intermediate Surgical Risk Patients: A Systematic Review and
Meta-Analysis.
Source
Journal of Invasive Cardiology. 29 (6) (pp 209-216), 2017. Date of
Publication: June 2017.
Publisher
HMP Communications
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a viable
alternative to surgical aortic valve replacement (SAVR) in patients with
severe aortic stenosis (SAS) who are at high risk for surgery. We sought
to evaluate the outcomes of TAVR vs SAVR in low-intermediate risk patients
with SAS. METHODS AND RESULTS: We performed random-effects meta-analysis
of randomized controlled trials (RCTs) and propensity-matched
observational studies comparing TAVR vs SAVR for low-intermediate risk
patients. Five RCTs and 5 observational studies with a total of 6891
patients (3489 TAVR patients; 3402 SAVR patients) were included. Pooled
data from RCTs showed no significant differences in all-cause mortality
between TAVR and SAVR at 30 days (risk ratio [RR], 1.04; 95% confidence
interval [CI], 0.73-1.47) and intermediate-term follow-up (RR, 0.86; 95%
CI, 0.67-1.10). A trend toward decreased mortality was found with TAVR
using the self-expandable vs balloon-expandable valves (RR, 0.77; 95% CI,
0.52-1.15 and RR, 1.91; 95% CI, 0.25-14.53, respectively) and transfemoral
vs transthoracic approach (RR, 0.74; 95% CI, 0.55-1.01 and RR, 2.09; 95%
CI, 0.40-11.03, respectively). Compared to SAVR, TAVR was associated with
similar risks of stroke (RR, 0.91; 95% CI, 0.74-1.11) and myocardial
infarction (RR, 1.00; 95% CI, 0.71-1.41). Furthermore, risks of major
vascular complications, moderate-severe paravalvular regurgitation, and
new permanent pacemaker implantation were higher with TAVR, whereas SAVR
was associated with higher rates of acute kidney injury, atrial
fibrillation, and major or life-threatening bleed. Finally, the above
results from RCTs were consistent with pooled analyses of observational
studies. CONCLUSION: TAVR appears to be a suitable alternative for
patients with SAS who are at low-intermediate risk for SAVR.

<26>
Accession Number
616876010
Author
Fujihara N.; Lark M.E.; Fujihara Y.; Chung K.C.
Institution
(Fujihara, Fujihara) International Research Fellow, Plastic Surgery
Section, University of Michigan, Ann Arbor, MI, United States
(Fujihara, Fujihara) Department of Hand Surgery, Nagoya University,
Nagoya, Japan
(Lark) Research Associate, University of Michigan Medical School, Ann
Arbor, MI, United States
(Chung) Professor of Surgery, Department of Surgery, Section of Plastic
Surgery, Assistant Dean for Faculty Affairs, University of Michigan
Medical School, Ann Arbor, MI, United States
Title
The effect of economic downturn on the volume of surgical procedures: A
systematic review.
Source
International Journal of Surgery. 44 (pp 56-63), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Economic downturn can have a wide range of effects on medicine
at both individual and national levels. We aim to describe these effects
in relation to surgical volume to guide future planning for physician
specialization, patient expectations in the face of economic crises, or
estimating healthcare expenditure. We hypothesized that because of high
out-of-pocket costs, cosmetic procedure volumes would be most affected by
economic decline. Methods A systematic review was conducted using MEDLINE,
Embase, and ABI/INFORMS. The main search terms were "economic recession"
and "surgical procedures, operative". Studies were included if surgical
volumes were measured and economic indicators were used as predictors of
economic conditions. Results Twelve studies were included, and the most
common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and
cardiac surgeries (n = 2). The majority of studies found that in periods
of economic downturn, surgical volume decreased. Among the eight studies
using Pearson's correlation analysis, there were no significant
differences between cosmetic procedures and other elective procedures,
indicating that cosmetic procedures may display trends similar to those of
non-cosmetic elective procedures in periods of economic downturn.
Conclusions Surgical volume generally decreased when economic indicators
declined, observed for both elective and non-elective surgery fields.
However, a few specific procedure volumes such as vasectomy and caesarean
section for male babies increased during the economic downturn. Knowledge
of these trends can be useful for future surgical planning and
distribution of healthcare resources.<br/>Copyright &#xa9; 2017 IJS
Publishing Group Ltd

<27>
Accession Number
617521944
Author
Hayashida K.; Yasuda S.; Matsumoto T.; Amaki M.; Mizuno S.; Tobaru T.;
Jujo K.; Ootomo T.; Yamaguchi J.; Fukuda K.; Saito S.; Foster E.; Qasim
A.; Kitakaze M.; Yozu R.; Takayama M.
Institution
(Hayashida, Fukuda, Yozu) Keio University School of Medicine, Tokyo, Japan
(Yasuda, Amaki, Kitakaze) National Cerebral and Cardiovascular Center,
Suita, Japan
(Matsumoto, Ootomo) Sendai Kousei Hospital, Sendai, Japan
(Mizuno, Saito) Shonan Kamakura General Hospital, Kanagawa, Japan
(Tobaru, Takayama) Sakakibara Heart Institute, Tokyo, Japan
(Jujo, Yamaguchi) Tokyo Women's Medical University Hospital, Tokyo, Japan
(Foster, Qasim) University of California at San Francisco, CA, United
States
Title
AVJ-514 trial: Baseline characteristics and 30-day outcomes following
mitraclip treatment in a Japanese cohort.
Source
Circulation Journal. 81 (8) (pp 1116-1122), 2017. Date of Publication:
2017.
Publisher
Japanese Circulation Society
Abstract
Background: The MitraClip system is a transcatheter-based therapeutic
option for patients with chronic mitral regurgitation (MR) who are at high
risk for surgery. A prospective, multicenter, single-arm study was
initiated to confirm the transferability of this system to Japan. Methods
and Results: Patients with symptomatic chronic moderate-to-severe (3+) or
severe (4+) functional or degenerative MR with a Society of Thoracic
Surgery (STS) score >=8%, or the presence of 1 predefined risk factor were
enrolled. Patients with left ventricular (LV) ejection fraction (EF) <30%
were excluded. MR severity and LV function were assessed by an independent
echocardiography core lab. Primary outcome included major adverse events
(MAE) at 30 days and acute procedural success (APS). A total of 30
patients (age: 80+/-7 years; STS score: 10.3%+/-6.6%) were treated with
the MitraClip. At baseline, all patients had MR 3+/4+ with 53%/47%
patients with degenerative/functional etiology with mean LVEF of
50.2+/-12.8%, and 37% of patients were NYHA class III/IV. APS was achieved
in 86.7% with no occurrence of MAE. At 30 days, 86.7% of patients had MR
<=2+ and 96.7% were NYHA class I/II. Conclusions: The MitraClip procedure
resulted in clinically meaningful improvements in MR severity, function
and quality of life measures, and low MAE rates. These early results
suggest the transferability of this therapy to appropriately selected
Japanese patients. (Trial Registration: clinicaltrials.gov Identifier
NCT02520310.)<br/>Copyright &#xa9; 2017, Japanese Circulation Society. All
rights reserved.

<28>
Accession Number
616411702
Author
Lin H.; Zhang Y.-M.
Institution
(Lin, Zhang) Heart Center, First Affiliated Hospital of Xinjiang Medical
University, Urumqi, Xinjiang 830054, China
Title
The effect of Ezetimibe and Simvastatin Combination Therapy on
percutaneous coronary intervention patients.
Source
International Journal of Cardiology. 242 (pp 1-3), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Evaluating the short-term influence of Ezetimibe and Simvastatin
Combination Therapy on LDL-C, TG and hs-CRP expression level in patients
with percutaneous coronary intervention. Methods 57 cases of percutaneous
coronary intervention patients were selected, and randomly divided into
two groups: Simvastatin (40 mg/day) and Ezetimibe (10 mg/day) combination
therapy group (observation group) with 28 patients, Simvastatin (40
mg/day) group (control group) with 29 patients. Each group was treated for
10 days. After treatment, compare blood lipid LDL-C, TG, hs-CRP levels
with each other and the results before treatment. Results Comparison of
the results of the 10th day with the baseline: LDL-C, TG decreased
significantly (P < 0.01) in the observation group, while the control group
did not have a significantly change (P > 0.05). Comparison of observation
group and control group: after treatment, LDL-C and TG decreased more
significantly in the observation group than the control group (- 27.2% vs
- 14.6%, P < 0.05). Whether according to LDL-C < 2.07 mmol/L standard or
LDL-C < 1.8 mmol/L standard, the compliance rate of the observation group
was significantly better than the control group, the results were (69% vs
28.9%, P < 0.05) and (47.6% vs 13.2% P < 0.05), respectively. After 10
days treatment, comparing to baseline, hs-CRP was significantly lowered in
these two groups (P < 0.01). And there is no liver and kidney toxicity,
myopathy and other adverse reactions during treatment. Conclusions
Combination therapy of Ezetimibe (10 mg/day) and Simvastatin (40 mg/day)
was more effective than mono-therapy with Simvastatin (40 mg/day) on
reducing LDL-C, TG and hs-CRP level in percutaneous coronary intervention
patients, leading to more significant anti-inflammatory
effect.<br/>Copyright &#xa9; 2016

<29>
Accession Number
613892570
Author
Owens R.E.; Kabra R.; Oliphant C.S.
Institution
(Owens) Department of Pharmacy: Clinical and Administrative Sciences,
University of Oklahoma College of Pharmacy, Oklahoma City, OK, United
States
(Kabra) Division of Cardiology, Department of Internal Medicine,
University of Tennessee Health Science Center, Methodist University
Hospital, Memphis, TN, United States
(Oliphant) Department of Clinical Pharmacy, University of Tennessee
College of Pharmacy, Methodist University Hospital, Memphis, TN, United
States
Title
Direct oral anticoagulant use in nonvalvular atrial fibrillation with
valvular heart disease: a systematic review.
Source
Clinical Cardiology. 40 (6) (pp 407-412), 2017. Date of Publication: June
2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Direct oral anticoagulants (DOACs) are indicated for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF), which, according to
the American College of Cardiology/American Heart Association/Heart Rhythm
Society atrial fibrillation (AF) guidelines, excludes patients with
rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or
mitral valve repair. However, the data regarding use of DOACs in AF
patients with other types of valvular heart disease (VHD) are unclear. We
aimed to summarize and evaluate the literature regarding the safety and
efficacy of DOAC use in NVAF patients with other types of VHD. After an
extensive literature search, a total of 1 prospective controlled trial, 4
subanalyses, and 1 abstract were identified. Efficacy of the DOAC agents
in NVAF patients with VHD mirrored the overall trial results. Bleeding
risk was significantly increased in VHD patients treated with rivaroxaban,
but not for dabigatran or apixaban. Of the bioprosthetic valve patients
enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic
Events in Atrial Fibrillation (ARISTOTLE) trial, no safety or efficacy
concerns were identified. In conclusion, subanalyses of DOAC landmark AF
trials revealed that dabigatran, rivaroxaban, and apixaban may be safely
used in AF patients with certain types of VHD: aortic stenosis, aortic
regurgitation, and mitral regurgitation. More evidence is needed before
routinely recommending these agents for patients with bioprosthetic valves
or mild mitral stenosis. Patients with moderate to severe mitral stenosis
or mechanical valves should continue to receive warfarin, as these
patients were excluded from all landmark AF trials.<br/>Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<30>
Accession Number
615430352
Author
Peterson S.; Su J.A.; Szmuszkovicz J.R.; Johnson R.; Sargent B.
Institution
(Peterson) Division of Pediatric Rehabilitation Medicine, Physical
Therapy, Children's Hospital Los Angeles, Los Angeles, CA, United States
(Peterson, Sargent) Division of Biokinesiology & Physical Therapy, Herman
Ostrow School of Dentistry, University of Southern California, Los
Angeles, CA, United States
(Su, Szmuszkovicz) Division of Cardiology, Department of Pediatrics,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Johnson) Norris Medical Library, University of Southern California, Los
Angeles, CA, United States
Title
Exercise capacity following pediatric heart transplantation: A systematic
review.
Source
Pediatric Transplantation. 21 (5) (no pagination), 2017. Article Number:
e12922. Date of Publication: August 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving
at least 10 years post-HT. The purpose of this systematic review is to
synthesize the literature on exercise capacity of pediatric HT recipients
to improve understanding of the mechanisms that may explain the decreased
exercise capacity. Six databases were searched for studies that compared
the exercise capacity of HT recipients <=21 years old with a control group
or normative data. Sixteen studies were included. Pediatric HT recipients,
as compared to controls or normative data, exhibit significantly higher
resting HR, and at peak exercise exhibit significantly decreased HR,
VO<inf>2</inf>, power, work, minute ventilation, and exercise duration.
Peak VO<inf>2</inf> appears to improve within the first 2.5 years post-HT;
peak work remains constant; and there is inconclusive evidence that peak
HR, HR recovery, and HR reserve improve with time since HT. These results
are discussed in the context of the mechanisms that may explain the
impaired exercise capacity of pediatric HT recipients, including
chronotropic incompetence, graft dysfunction, side effects of
immunosuppression therapy, and deconditioning. In addition, the limited
literature on rehabilitation after pediatric HT is
summarized.<br/>Copyright &#xa9; 2017 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd

<31>
Accession Number
615145662
Author
Wang J.; Yu W.; Zhou Y.; Yang Y.; Li C.; Liu N.; Hou X.; Wang L.
Institution
(Wang, Yu, Wang) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Zhou, Yang, Li, Liu, Hou) Center for Cardiac Intensive Care,
Beijing An Zhen Hospital Capital Medical University, Beijing, China
Title
Independent Risk Factors Contributing to Acute Kidney Injury According to
Updated Valve Academic Research Consortium-2 Criteria After Transcatheter
Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13
Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (3) (pp 816-826),
2017. Date of Publication: June 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study aimed to examine the risk factors for transcatheter
aortic valve implantation (TAVI)-associated acute kidney injury (AKI)
according to the AKI definition from the Valve Academic Research
Consortium-2 (VARC-2). Setting A meta-analysis. Participants A total of
661 patients with post-TAVI AKI according to the VARC-2 definition and
2,012 controls were included in the meta-analysis. Interventions Patients
undergoing TAVI were included in this meta-analysis. Measurements and Main
Results Multiple electronic databases were searched using predefined
criteria. The diagnosis of AKI was based on the VARC-2 classification. The
authors found that preoperative New York Heart Association class IV (odds
ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous
chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement
for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated
significantly with an increased risk for post-TAVI AKI. Furthermore,
previous peripheral vascular disease (PVD), hypertension, atrial
fibrillation, congestive heart failure, diabetes mellitus, and stroke were
also risk factors for TAVI-associated AKI. Additionally, transfemoral
access significantly correlated with a reduced risk for post-TAVI AKI (OR,
0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of
Thoracic Surgeons Score, the logistic European System for Cardiac
Operative Risk Evaluation, aortic valve area, mean pressure gradient, left
ventricular ejection fraction, age, body mass index, contrast volume, and
valve type, had no impact on the association between the risk factors and
post-TAVI AKI. Subgroup analysis of the eligible studies presenting
multivariate logistic regression analysis on the independent risk factors
for post-TAVI AKI revealed that previous CKD, previous PVD, and
transapical access were independent risk factors for TAVI-associated AKI.
Conclusions The current meta-analysis suggested that previous CKD,
previous PVD, and transapical access may be independent risk factors for
TAVI-associated AKI.<br/>Copyright &#xa9; 2017

<32>
Accession Number
614976482
Author
Galat A.; Guellich A.; Bodez D.; Slama M.; Dijos M.; Zeitoun D.M.;
Milleron O.; Attias D.; Dubois-Rande J.-L.; Mohty D.; Audureau E.; Teiger
E.; Rosso J.; Monin J.-L.; Damy T.
Institution
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Rosso, Monin,
Damy) UPEC, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Rosso, Monin,
Damy) MondorAmyloidosis Network, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Teiger, Rosso, Monin, Damy)
Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Creteil
F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Monin, Damy)
INSERM U955, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Monin, Damy) DHU
A-TVB, Creteil F-94000, France
(Slama) Department of Cardiology, AP-HP, Antoine Beclere Teaching
Hospital, Clamart F-92140, France
(Dijos) Department of Cardiology, Bordeaux Teaching Hospital, Pessac
F-33604, France
(Zeitoun, Milleron) Department of Cardiology, AP-HP, Bichat Teaching
Hospital, Paris F-75018, France
(Attias) Department of Cardiology, Centre Cardiologique du Nord,
Saint-Denis F-93200, France
(Mohty) Department of Cardiology, Dupuytren Teaching Hospital, Limoges
F-87042, France
(Audureau) Department of Public Health, Henri-Mondor Teaching Hospital,
Creteil F-94000, France
(Audureau) CEpiA (Clinical Epidemiology and Ageing), EA4393, Universite
Paris Est (UPE), UPEC, Creteil F-94000, France
Title
Aortic stenosis and transthyretin cardiac amyloidosis: The chicken or the
egg?.
Source
European Heart Journal. 37 (47) (pp 3525-3531), 2016. Date of Publication:
01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Aortic stenosis (AS) and transthyretin cardiac amyloidosis
(TTR-CA) are both frequent in elderly. The combination of these two
diseases has never been investigated. Aims To describe patients with
concomitant AS and TTR-CA. Methods Six cardiologic French centres
identified retrospectively cases of patients with severe or moderate AS
associated with TTR-CA hospitalized during the last 6 years. Results
Sixteen patients were included. Mean+SD age was 79+6 years, 81% were men.
Sixty per cent were NYHA III-IV, 31% had carpal tunnel syndrome, and 56%
had atrial fibrillation. Median (Q1;Q4) NT-proBNP was 4382 (2425;4730)
pg/mL and 91% had elevated cardiac troponin level. Eighty-eight per cent
had severe AS (n = 14/16), of whom 86% (n = 12) had low-gradient AS.
Mean+SD interventricular septum thickness was 18+4 mm. Mean left
ventricular ejection fraction and global LS were 50+13% and 27+4%,
respectively. Diagnosis of TTR-CAwas histologically proven in 38%, and was
based on strong cardiac uptake of the tracer at biphosphonate scintigraphy
in the rest. Eighty-one per cent had wild-type TTR-CA (n = 13), one had
mutated Val122I and 19% did not had genetic test (n = 3). Valve
replacement was surgical in 63% and via transcatheter in 13%. Median
follow-up in survivors was 33 (16;65) months. Mortality was of 44% (n = 7)
during the whole follow-up period. Conclusions Combination of AS and
TTR-CA may occur in elderly patients particularly those with a low-flow
low-gradient AS pattern and carries bad prognosis. Diagnosis of TTR-CA in
AS is relevant to discuss specific treatment and management.<br/>Copyright
&#xa9; The Author 2016.

<33>
Accession Number
614976424
Author
Siontis G.C.M.; Praz F.; Pilgrim T.; Mavridis D.; Verma S.; Salanti G.;
Sondergaard L.; Juni P.; Windecker S.
Institution
(Siontis, Praz, Pilgrim, Windecker) Department of Cardiology, INSELSPITAL,
Bern University Hospital, University of Bern, Bern 3010, Switzerland
(Mavridis, Salanti) Department of Hygiene and Epidemiology, University of
Ioannina, School of Medicine, Ioannina, Greece
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Salanti) Institute of Social and Preventive Medicine, Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Salanti) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, Canada
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of severe aortic stenosis: A meta-analysis of
randomized trials.
Source
European Heart Journal. 37 (47) (pp 3503-3512a), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In view of the currently available evidence from randomized trials,
we aimed to compare the collective safety and efficacy of transcatheter
aortic valve implantation (TAVI) vs. surgical aortic valve replacement
(SAVR) across the spectrum of risk and in important subgroups. Methods and
results Trials comparing TAVI vs. SAVR were identified through Medline,
Embase, and Cochrane databases. The primary outcome was death from any
cause at 2 years.We performed random-effects meta-analyses to combine the
available evidence and to evaluate the effect in different subgroups. This
systematic review and meta-analysis is registered with PROSPERO
(CRD42016037273). We identified four eligible trials including 3806
participants, who were randomly assigned to undergo TAVI (n = 1898) or
SAVR (n = 1908). For the primary outcome of death from any cause, TAVI
when compared with SAVR was associated with a significant 13% relative
risk reduction [hazard ratio (95% CI): 0.87 (0.76-0.99); P = 0.038] with
homogeneity across all trials irrespective of TAVI device (Pinteraction =
0.306) and baseline risk (Pinteraction = 0.610). In subgroup analyses,
TAVI showed a robust survival benefit over SAVR for patients undergoing
transfemoral access [0.80 (0.69-0.93); P = 0.004], but not transthoracic
access [1.17 (0.88-1.56); P = 0.293] (Pinteraction = 0.024) and in female
[0.68 (0.50-0.91); P = 0.010], but not male patients [0.99 (0.77-1.28); P
= 0.952] (Pinteraction = 0.050). Secondary outcomes of kidney injury,
new-onset atrial fibrillation, and major bleeding favoured TAVI, while
major vascular complications, incidence of permanent pacemaker
implantation, and paravalvular regurgitation favoured SAVR. Conclusion
Compared with SAVR, TAVI is associated with a significant survival benefit
throughout 2 years of follow-up. Importantly, this superiority is observed
irrespective of the TAVI device across the spectrum of intermediate and
high-risk patients, and is particularly pronounced among patients
undergoing transfemoral TAVI and in females.<br/>Copyright &#xa9; The
Author 2016.

<34>
Accession Number
614959242
Author
Hong S.J.; Ahn C.M.; Kim B.-K.; Ko Y.-G.; Hur S.-H.; Yu C.W.; Lee S.-J.;
Choi C.U.; Kim J.S.; Yoon J.S.; Hong Y.J.; Choi J.-W.; Choi S.-H.; Jang
Y.; Lim D.-S.
Institution
(Hong, Ahn, Yu, Lim) Department of Cardiology, Cardiovascular Center,
Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul
136-705, South Korea
(Ahn, Kim, Ko, Jang) Severance Cardiovascular Hospital, Yonsei University,
50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Hur) Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu,
Daegu 700-712, South Korea
(Lee) Soonchunhyang University Medical Center, 23-20, Byeongmyeong-dong,
Dongnam-gu, Cheonan, Chungcheongnam-do 31151, South Korea
(Choi) Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul
08308, South Korea
(Kim) Sejong General Hospital, Sosabon-dong, Sosa-gu, Bucheon-si,
Gyeonggi-do 14754, South Korea
(Yoon) Yonsei University Wonju College of Medicine, Wonju Christian
Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Wonju 220-701, South Korea
(Hong) Chonnam National University Hospital, 77 Yongbong-ro, Buk-gu,
Gwangju 500-757, South Korea
(Choi) Eulji General Hospital, 68 Hangeulbiseok-Ro, Nowon-Gu, Seoul 01830,
South Korea
(Choi) Samsung Medical Center, Sungkyunkwan University School of Medicine,
81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
Title
Prospective randomized comparison of clinical and angiographic outcomes
between everolimus-eluting vs. zotarolimus-eluting stents for treatment of
coronary restenosis in drug-eluting stents:Intravascular ultrasound
volumetric analysis (RESTENT-ISR trial).
Source
European Heart Journal. 37 (45) (pp 3409-3418), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims At present no proven standard treatment for drug-eluting stent (DES)
restenosis is available, and the efficacy and safety of everolimus-eluting
stent (EES) and zotarolimus-eluting stent (ZES) for DES restenosis are
limited. The purpose of this prospective, randomized 9-month intracoronary
ultrasound (IVUS) and 3-year clinical follow-up study was to compare the
effects of EESs and ZESs on neointima volume and major adverse
cardiovascular events (MACEs) such as death, myocardial infarction (MI),
target lesion revascularization (TLR) and stent thrombosis in DES
restenosis patients. Methods and results Patients were eligible for this
study if they were between 40 and 75 years old with in-stent
restenosis>50% by quantitative coronary angiographic analysis in DES or
within 5mm of the stent edges with signs of ischaemia. Eligible patients
(n=304, 146 women and 158 men) were randomly assigned to receive either
EES (158 patients) or ZES (146 patients). The primary endpoint of the
study was to compare neointima volume between the EES and ZES groups at
the 9-month follow-up IVUS. MACEs, including death, non-fatal MI, stent
thrombosis and the need for repeated TLR within 3 years, were noted. The
9-month angiographic and IVUS follow-up showed no significant differences
in late lumen loss (0.4060.56 vs. 0.4560.61 mm, P=0.57, respectively) and
neointima volume (0.5160.48 vs. 0.5660.54mm3/1 mm, P=0.47, respectively)
in the EES and the ZES groups. Composite MACEs such as death, MI, stent
thrombosis and TLR during 3-year follow-up were comparable between the two
groups [15.8% (n=25) in the EES group and 22.6% (n=33) in the ZES group,
P=0.276], independent of de novo DES type, sex, age, body mass index,
presence of diabetes, hypertension and dyslipidaemia. Conclusions Patients
with first- and second-generation DES restenosis, both EES and ZES
implantation were effective and safe in reducing neointima volume and late
loss with a comparable rate of MACEs independent of cardiovascular risk
factors.<br/>Copyright &#xa9; 2016 The Author All rights reserved.

<35>
Accession Number
614959240
Author
Ferenc M.; Gick M.; Comberg T.; Rothe J.; Valina C.; Toma A.; Loffelhardt
N.; Hochholzer W.; Riede F.; Kienzle R.-P.; Achtari A.; Neumann F.-J.
Institution
(Ferenc, Gick, Comberg, Rothe, Valina, Toma, Loffelhardt, Hochholzer,
Riede, Kienzle, Achtari, Neumann) Division of Cardiology and Angiology II,
University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Title
Culotte stenting vs. TAP stenting for treatment of de-novo coronary
bifurcation lesions with the need for side-branch stenting: The
Bifurcations Bad Krozingen (BBK) II angiographic trial.
Source
European Heart Journal. 37 (45) (pp 3399-3405), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In percutaneous coronary intervention for de-novo coronary
bifurcation lesions, the optimal technique for provisional side-branch
stenting is still a matter of debate. We tested whether in this setting
culotte stenting reduces the incidence of restenosis as compared with
T-and-protrusion (TAP) stenting. Methods and Results This trial included
300 patients with a coronary bifurcation lesion requiring a side-branch
stent. Patients were randomly assigned to culotte stenting or TAP stenting
using drug-eluting stents in a 1:1 fashion. Primary endpoint was maximal
per cent diameter stenosis of the bifurcation lesion at 9-month
angiographic follow-up. As clinical endpoints we assessed target lesion
re-intervention (TLR) and target lesion failure (composite of cardiac
death, target vessel myocardial infarction, and TLR). Angiographic
follow-up was available in 91% of the patients. After culotte stenting,
the maximum per cent diameter stenosis in the treated bifurcation lesion
was 21620% as compared with 27625% after TAP stenting (P=0.038). The
respective corresponding binary restenosis rates were 6.5 and 17%
(P=0.006). The 1-year incidence of TLR was 6.0% after culotte stenting vs.
12.0% after T-stenting (P=0.069). Target lesion failure occurred in 6.7%
of the culotte group and in 12.0% of the TAP group (P=0.11). Only one
patient of the culotte group incurred a definite stent thrombosis during
1-year follow-up. Conclusions Compared with the TAP stenting, culotte
stenting was associated with a significantly lower incidence of
angiographic restenosis.<br/>Copyright &#xa9; 2016 The Author All rights
reserved.

<36>
Accession Number
614959238
Author
Yamaji K.; Raber L.; Zanchin T.; Spitzer E.; Zanchin C.; Pilgrim T.;
Stortecky S.; Moschovitis A.; Billinger M.; Schonenberger C.; Eberli F.;
Juni P.; Luscher T.F.; Heg D.; Windecker S.
Institution
(Yamaji, Raber, Zanchin, Spitzer, Zanchin, Pilgrim, Stortecky,
Moschovitis, Billinger, Schonenberger, Windecker) Department of
Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Eberli) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Juni) Applied Health Research Centre (AHRC), Department of Medicine and
Institute of Health Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Luscher) Department of Cardiology, University Hospital Zurich, Zurich,
Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
Title
Ten-year clinical outcomes of first-generation drug-eluting stents: The
Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) VERY LATE trial.
Source
European Heart Journal. 37 (45) (pp 3386-3395), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Compared with bare metal stents, first-generation drug-eluting stents
(DES) are associated with an increased risk of late restenosis and stent
thrombosis (ST). Whether this risk continues or attenuates during
long-term follow-up remains unknown. Methods and results We extended the
follow-up of 1012 patients [sirolimus-eluting stent (SES): N=503 and
paclitaxel-eluting stent (PES): N=509] included in the all-comers,
randomized Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) trial to 10 years. Follow-up was complete in
895 patients (88.4%) at 10 years. At 1, 5, and 10 years of follow-up,
rates of ischaemia-driven target lesion revascularization (ID-TLR) were
8.1%, 14.6% and 17.7%, respectively, and rates of ST were 1.9%, 4.5% and
5.6%, respectively. The annual risks of ID-TLR and definite ST were
significantly higher between 1 and 5 years as compared with the 5- to
10-year period [ID-TLR: 1.8% vs. 0.7%/year, hazard ratio (HR) 0.36, 95%
confidence intervals (95% CI) 0.21-0.62, P<0.001; definite ST: 0.67% vs.
0.23%/year, HR 0.31, 95% CI 0.13-0.75, P=0.01]. The attenuation of the
risk of ID-TLR and ST beyond 5 years was independent of age. Major adverse
events (cardiac death, myocardial infarction, and ID-TLR) occurred in
33.7% of SES- and 33.8% of PES-treated patients (P=0.72). Conclusions
During long-term follow-up through 10 years, the annual risks of ID-TLR
and definite ST significantly decreased beyond 5 years after
first-generation DES implantation. These findings may have important
implications for secondary prevention after percutaneous coronary
intervention with first-generation DES including long-term antiplatelet
therapy.<br/>Copyright &#xa9; 2016 The Author All rights reserved.

<37>
Accession Number
620396849
Author
Gallouche M.; Barone-Rochette G.; Pavese P.; Bertrand B.; Vanzetto G.;
Bouvaist H.; Pierre I.; Schmitt D.; Fauconnier J.; Caspar Y.; Recule C.;
Picot-Gueraud R.; Stahl J.P.; Mallaret M.R.; Landelle C.
Institution
(Gallouche, Mallaret, Landelle) Hospital Hygiene Unit, Grenoble Alpes
University Hospital, Grenoble, France
(Barone-Rochette, Bertrand, Vanzetto, Bouvaist) Cardiology Unit, Grenoble
Alpes University Hospital, Grenoble, France
(Barone-Rochette, Vanzetto) INSERM U1039, Bioclinic Radiopharmaceutics
Laboratory, Grenoble, France
(Barone-Rochette, Vanzetto) French Alliance Clinical Trial, French
Clinical Research Infrastructure Network, Toulouse, France
(Pavese, Pierre, Stahl) Infectious Diseases Unit, Grenoble Alpes
University Hospital, Grenoble, France
(Schmitt) Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
(Fauconnier) Medical Information Department, Grenoble Alpes University
Hospital, Grenoble, France
(Fauconnier, Mallaret, Landelle) University Grenoble Alpes/CNRS, ThEMAS
TIM-C UMR 5525, Grenoble, France
(Caspar, Recule) Bacteriology Laboratory, Grenoble Alpes University
Hospital, Grenoble, France
(Picot-Gueraud) Interhospital Network for Prevention of Nosocomial
Infections, Grenoble Alpes University Hospital, Grenoble, France
Title
Incidence and prevention of infective endocarditis and bacteraemia after
transcatheter aortic valve implantation in a French university hospital: a
retrospective study.
Source
Journal of Hospital Infection. 99 (1) (pp 94-97), 2018. Date of
Publication: May 2018.
Publisher
W.B. Saunders Ltd
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation
(TAVI) is a rare but severe complication. Among 326 patients who underwent
TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11
(3.4%) cases of bacteraemia were identified. No cases of IE were linked to
the intervention; one was due to Staphylococcus aureus despite a screening
and targeted decolonization strategy. This underscores the need for
randomized studies to evaluate the benefit and cost-effectiveness of this
policy.<br/>Copyright &#xa9; 2017 The Healthcare Infection Society

<38>
Accession Number
621548319
Author
Bigelow A.; Ghanayem N.; Thompson N.; Scott J.; Cassidy L.; Hoffman G.
Institution
(Bigelow, Ghanayem, Thompson, Scott, Cassidy, Hoffman) Children's Hospital
of Wisconsin, United States
Title
Arginine vasopressin concentration and chest tube output post-fontan
palliation.
Source
World Journal for Pediatric and Congenital Hearth Surgery. Conference:
Cardiology 2018: 21st Update on Pediatric and Congenital Cardiovascular
Disease. United States. 9 (2) (pp NP65-NP66), 2018. Date of Publication:
March 2018.
Publisher
SAGE Publications Inc.
Abstract
Background: Treatments for preventing and managing low-cardiac output
syndrome after congenital heart surgery with car-diopulmonary bypass (CPB)
include preload augmentation, infu-sions of phosphodiesterase inhibitors
and catecholamines with primary goals of increasing systemic perfusion,
and with secondary effects on vasomotor tone. Vasopressin, a vasoactive
drug with efficacy in septic shock, has also been utilized to improve
postoperative hemodynamics after cardiac surgery in children. Vasopressin
is a neurohypopphyseal hormone with diverse actions on water balance,
vasomotor tone, and contractility. Vasopressin concentration and the use
of vasopressin infusion have been described in a number of studies in
various disease states. The aim of our study is to evaluate the impact of
vasopressin and AVP concentration on the early postoperative course in
patients undergoing the Fontan operation. Methods: The Institutional
Review Board approved this double-blinded, randomized, placebo-controlled
study of vaso-pressin use in patients undergoing Fontan palliation.
Hemody-namic measures, urinary output, fluid balance, and chest tube
drainage were recorded hourly for 48 hours, and arginine vaso-pressin
(AVP) concentration was obtained at five different times. Patients
undergoing Fontan palliation at Children's Hos-pital of Wisconsin since
January 2017 have been screened for study eligibility. We herein report
preliminary findings of relationship of AVP concentrations to hemodynamics
and fluid balance in the first ten patients. Data are expressed as median
(IQR). Results: Patients were aged 1,121 (IQR 1,004, 1,485) days, weighed
14.6 kg (13, 15.3). CPB time was 61 (56, 86) minutes at 35degreeC (34,
35). All patients were extubated prior to ICU admission. Total chest tube
drainage was 23 (17, 29) cm/kg on day 1, 9 (6,18) cm/kg on day 2, and 2
(1, 53) cm/kg on day 3. AVP levels rose from 1.7 (1.1, 4.3) pre-CPB to 74
(15, 200) post-CPB, 59 (27, 76) on day 1, 68 (30,82) on day 2, and 21
(17,36) on day 3. Total chest tube output was not related to CVP, LAP, or
AVP concentrations but was positively related to both epinephrine and
norepinephrine infusion doses. Conclusions: These results suggest that
chest tube drainage following Fontan palliation is poorly responsive to
standard hemodynamic management or total vasopressin concentration. The
role for exogenous vasopressin in managing fluid balance and chest tube
drainage remains unclear.

<39>
Accession Number
621548204
Author
Ducker C.; Zimmermann N.; Bartkowski K.; Hohlfeld T.
Institution
(Ducker) Universitatsmedizin Gottingen, Institut fur Klinische
Pharmakologie, Gottingen, Germany
(Zimmermann, Bartkowski, Hohlfeld) Universitatsklinikum Dusseldorf,
Institut fur Pharmakologie und Klinische Pharmakologie, Dusseldorf,
Germany
Title
Metamizol analgesia after coronary artery bypass surgery achieves plasma
concentrations that can severely interfere with the antiplatelet action of
aspirin.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. Conference: 84th Annual
Meeting of the German Society for Experimental and Clinical Pharmacology
and Toxicology, DGPT and the 20th Annual Meeting of the Association of the
Clinical Pharmacology Germany, VKliPha 2018. Germany. 391 (Supplement 1)
(pp S30-S31), 2018. Date of Publication: February 2018.
Publisher
Springer Verlag
Abstract
Aspirin largely improves survival early after coronary artery bypass
surgery (CABP, Mangano et al, 2002). However, we have previously
demonstrated frequent platelet nonresponse to aspirin after CABG. One
possible cause is postoperative analgesia by the nonopioid analgesic
metamizol, which we have previously shown to interfere with platelet COX-1
inhibition by aspirin. The present study examined whether metamizol, when
given after CABP surgery, may attenuate or prevent the antiplatelet effect
of aspirin. We collected a total of 242 plasma samples from 83 patients
(age 37-88) within days 1-10 after CABP. All patients received metamizol
post surgery at approved doses according to clinical routine. The samples
were examined by HPLC for methylaminoantipyrine (MAA), the primary active
metamizol metabolite. Aminoantipyrine (AA) and acetylaminoantipyrine (AAA)
were also determined. Further, patient plasma was exposed to platelets
from healthy donors in order to examine the antiplatelet action of aspirin
in vitro by arachidonic acid-induced light transmission aggregometry (LTA)
and platelet thromboxane formation (TXB2, immunoassay). Selected samples
were used to study the effect of aspirin on arachidonic acid-induced
platelet P-selectin expression (flow cytometry). Overall, plasma
concentrations of MAA varied within a wide range from 0-649.8 muM. Similar
variation was seen with AA and AAA. LTA revealed a remarkable impairment
of patient-derived plasma with the antiplatelet effect of 30 muM aspirin.
This was significantly (p<0.05) dependent of the actual MAA concentration
in plasma. The interaction became apparent at about 1 muM MAA and was
maximal at >=10 muM. The other metamizol metabolites (AA, AAA) appeared
not to influence the antiplatelet action of aspirin. Similar results were
obtained for the effect of aspirin on platelet TXB2 formation. Platelet
P-selectin expression in the presence of MAA-free patient plasma and 30
muM aspirin (control) was 5.2+/-1.2%, but was increased up to 13.9+/-3.9%
under identical conditions except for patient plasma containing high (>=10
muM) concentrations of metamizol (p<0.05 vs. control). Taken together, the
results demonstrate that metamizol, when administered for postoperative
analgesia during the first 10 days after CABP, achieves plasma
concentrations that can severely interfere with the antiplatelet action of
aspirin. Further studies should examine the potential impact on clinical
outcome.

<40>
Accession Number
621548169
Author
Salciccioli K.B.; Moffet B.S.; Cabrera A.G.
Institution
(Salciccioli, Moffet, Cabrera) Baylor College of Medicine, United States
Title
Antiepileptic drug use and outcomes after stage i palliation of
hypoplastic left heart syndrome.
Source
World Journal for Pediatric and Congenital Hearth Surgery. Conference:
Cardiology 2018: 21st Update on Pediatric and Congenital Cardiovascular
Disease. United States. 9 (2) (pp NP34-NP35), 2018. Date of Publication:
March 2018.
Publisher
SAGE Publications Inc.
Abstract
Background: Neurologic and neurodevelopmental morbidities are increasingly
recognized following congenital heart surgery. In infants with hypoplastic
left heart syndrome (HLHS), clinical seizures have been identified as a
risk factor for neurodevelopmental impairment. Furthermore, hospital
discharge with an antiepileptic drug (AED) has been associated with more
than a 10-fold increased relative risk of interstage mortality. Little is
known about whether AED use correlates with immediate postoperative
morbidity and mortality in this population. Methods: Retrospective review
using the Pediatric Health Information System (PHIS) administrative
database identified infants with HLHS who underwent a Norwood operation
with placement of either a Blalock-Taussig or Sano shunt between January
1, 2004, and September 30, 2015. Patient demographics, length of hospital
stay (LOS), in-hospital mortality, readmission, use of extracorporeal
membrane oxygenation (ECMO), and use of AEDs were collected. Descriptive
statistics were used to characterize the population. Student's t-test,
Fisher's exact test, and multivariate logistic regression were used to
identify differences in patients who received AEDs compared to patients
who did not receive and AED. Results: A total of 2,825 infants with HLHS
who underwent a Norwood operation during the specified time interval were
identified, of which 1,752 (62%) were male. The majority were Caucasian (n
= 1,949, 69%). 445 (16%) patients required ECMO. Cerebrovascular event was
documented in 170 (6%) patients. AEDs were used in 676 (24%) patients.
Patients who received AEDs were significantly more likely to suffer
in-house mortality than those who did not (20% vs 15%, respectively, P
=.000). Length of stay was also significantly longer (P <.001) in patients
who received AEDs (53 + 51 days) compared to those who did not (37 + 31
days). Conclusions: In infants with HLHS, postoperative AED use after
stage I palliation is associated with increased in-hospital mortality and
longer length of hospital stay. This study demon-strates that patients who
receive AEDs are a high-risk group with regard to mortality and resources
utilization. Further work is needed to better understand the role of AEDs
in these outcomes.

<41>
Accession Number
621548094
Author
Hernandez N.B.; Penk J.; Connolly J.; Li Y.
Institution
(Hernandez, Penk, Connolly, Li) Advocate Children's Hospital, United
States
Title
Use of vasopressin following the fontan operation: A pilot study.
Source
World Journal for Pediatric and Congenital Hearth Surgery. Conference:
Cardiology 2018: 21st Update on Pediatric and Congenital Cardiovascular
Disease. United States. 9 (2) (pp NP32), 2018. Date of Publication: March
2018.
Publisher
SAGE Publications Inc.
Abstract
Background: Prolonged pleural drainage remains one of the most significant
complications after the Fontan operation. It is associated with
considerable morbidity and significant resource utilization. Vasopressin
may target several mechanisms that led to prolonged chest tube drainage. A
retrospective report using historical controls of vasopressin utilization
after the Fontan operation demonstrated significant reduction in pleural
drainage and length of stay. This is a pilot study to evaluate
feasibility, safety, and effect size of vasopressin infusion after the
Fontan operation. Methods: Randomized, double-blind, placebo-control,
pilot study. Inclusion criteria were age 1.5 to 7 years undergoing a
nonfenestrated, extracardiac Fontan. Patients were excluded for planned
arch reconstruction, re-do Fontan procedure, or evidence of renal
insufficiency. The vasopressin group received 0.4 mU/kg/min for 48 hours
starting once the patient was off cardiopulmonary bypass. The placebo
group received normal saline at the same rate and timing as the treatment
group. The amount and duration of chest tube drainage and length of
hospital stay were compared between the two groups. Results: Eleven
patients were enrolled from March 2017 to October 2017. Six patients were
randomized to the vasopressin group and five to the placebo group. One
patient from the placebo group was withdrawn from the primary analysis due
to significantly prolonged chylous effusion. There were no significant
differences in demographics or preoperative risk factors between the
groups. Three patients in the vasopressin group received cardioplegia
whereas one patient in the placebo group did. There was no significant
difference between the vasopressin and placebo groups in chest tube output
(59 mL/kg versus 49 mL/kg total, respectively) and mean length of hospital
stay (6.8 days versus 6.7 days, respectively). Fluid balance through chest
tube removal was more negative in the vasopressin group with a median
of-24 mL/kg (-120 to 85 mL/kg) versus-6 mL/kg (-15 to+57 mL/kg), but this
was not statistically significant. There were no significant complications
related to vasopressin use. One patient in the placebo group was
readmitted ten days after discharge due to recurrent pleural effusion.
Conclusions: Vasopressin was well tolerated in children after the Fontan
operation. This study demonstrates feasibility of our protocol with no
significant associated side effects due to vasopressin in this patient
population. This pilot study adds useful preliminary data for a planned
multicenter trial to evaluate vasopressin efficacy in decreasing pleural
drainage and length of stay.

<42>
Accession Number
621547919
Author
Flores S.; Elhoff J.; Bronicki R.; Mery C.; Alsaied T.; Ahdab F.
Institution
(Flores, Elhoff, Bronicki, Mery, Alsaied, Ahdab) Texas Children's
Hospital, United States
Title
Peritoneal dialysis versus standard diuretic regimen in children after
congenital cardiac surgery.
Source
World Journal for Pediatric and Congenital Hearth Surgery. Conference:
Cardiology 2018: 21st Update on Pediatric and Congenital Cardiovascular
Disease. United States. 9 (2) (pp NP52), 2018. Date of Publication: March
2018.
Publisher
SAGE Publications Inc.
Abstract
Background: Fluid management remains one of the central tasks following
congenital cardiac surgery. Some centers have reported improved outcomes
with the routine early application of peritoneal dialysis (PD). However,
it is not entirely clear if early implementation of PD is advantageous,
with recently published studies presenting conflicting findings. We
conducted a meta-analysis on the comparison of outcomes following
congenital cardiac surgery in patients who received PD compared to those
who received standard diuretic regimen (SDR). Methods: A comprehensive
database search was conducted, including Medline, Embase, Cochrane Central
register of Controlled Trials, Cochrane Database of Systematic Reviews,
and Scopus through January 2017. Only studies that made a direct
comparison between PD and standard diuretic regimen were included.
Outcomes of interest were: negative fluid balance at day 1, 10% fluid
overload, hours to negative fluid balance, fluid balance by post-operative
day, mechanical ventilation days, delayed extubation, cardiac intensive
care unit length of stay (LOS), hospital LOS, electrolyte abnormalities,
number of electrolyte repletion, duration of inotropic support, mortality,
incidence of peritonitis with PD, incidence of communication with chest
tube with PD, incidence of low cardiac output syndrome during PD, need for
mechanical support, and time to delayed chest closure. Results: Initial
search identified 213 studies for title and abstract screening. Following
initial screening, 86 studies were selected for full-text screening.
Eleven studies were identified for data extraction with a total of 209
patients receiving PD and 739 patients receiving standard diuretic
regimen. Only 1 of the 11 included studies prospectively randomized
patients to receive PD versus SDR. The mean age for the PD group was 11
days (SD 14.4) and for the SDR group 9.4 days (SD 5.5). The mean RACHS-1
score for the PD group was 4.2 (SD 1.5) and for the SDR group 4.8 days (SD
1.8). The mean baseline creatinine level for the PD group was 0.8 mg/dL
(SD 0.2) and for the SDR group 0.5 mg/dL (SD 0.2). The utilization of
peritoneal dialysis was associated with a 2.49 increased odds of mortality
in comparison to patients who received SDR (95% CI: 1.2-5.15). There was
no statistical difference in negative fluid balance after postoperative
day 1, OR 1.9 (95% CI: 0.92-3.94), incidence of peritonitis, OR 1.98 (95%
CI: 0.31-12.83), or need for mechanical support, OR 3.6 (95% CI:
0.29-44.46). Conclusions: Our findings suggest that there are increased
odds of mortality in children after congenital cardiac surgery who
received PD versus SDR. The meta-analysis did not identify differences
between groups related to negative fluid balance after postoperative day
1, incidence or peritonitis, or need for mechanical support. There is a
need of prospective multi-center studies to establish if PD utilization is
beneficial in selected children after cardiac surgery.

<43>
Accession Number
621532863
Author
Willson L.A.; Spence K.; Loughran-Fowlds A.
Institution
(Willson, Spence, Loughran-Fowlds) Grace Centre for Newborn Intensive
Care, Children's Hospital at Westmead, Sydney Children's Hospitals
Network, Westmead, Australia
Title
Introducing a feeding protocol for cardiac surgical neonates: A
developmental, whole of admission approach.
Source
Journal of Paediatrics and Child Health. Conference: 22nd Annual Congress
of the Perinatal Society of Australia and New Zealand, PSANZ 2018. New
Zealand. 54 (Supplement 1) (pp 125), 2018. Date of Publication: March
2018.
Publisher
Blackwell Publishing
Abstract
Background: Grace Centre for Newborn Intensive Care has a strong
developmental approach to the care of neonates. Feeding is a component of
developmental care. Approximately 40% of admissions to Grace each year are
for cardiac surgery in the immediate neonatal period. Most of these babies
are born at term. Many will have difficulties in achieving full oral feeds
at discharge. This can be associated with the type of cardiac lesion,
intraoperative factors or genetic conditions. It has been suggested that
increasing oral feeding opportunities preoperatively may have a positive
impact on feeding after surgery. Not all cardiac babies can feed before
surgery and may fatigue with feeds after surgery. Some babies require
ongoing respiratory support and cannot feed orally. Methods: A literature
search of feeding protocols for cardiac surgical, preterm and other
vulnerable neonates was undertaken. A review of feeding practices in Grace
and developmental care literature was also performed. Prototypes of a
protocol were trialled and modified following staff feedback. Results: A
feeding protocol flow chart was produced that begins at admission and
incorporates feeding associated experiences as well as assessment of
actual oral feeding and recommendation for gastric tube top up. An
accompanying record sheet shows progress and can be used as part of
handover. Conclusions: This is an ongoing quality improvement project.

<44>
Accession Number
621508783
Author
Kulason K.; Nouchi R.; Hoshikawa Y.; Noda M.; Okada Y.; Kawashima R.
Institution
(Kulason, Nouchi, Kawashima) Department of Advanced Brain Science,
Institute of Development, Aging and Cancer, Tohoku University, Sendai,
Japan
(Kulason) New York Institute of Technology College of Osteopathic
Medicine, New York, NY, United States
(Nouchi) Creative Interdisciplinary Research Division, Frontier Research
Institute for Interdisciplinary Science, Tohoku University, Sendai, Japan
(Nouchi) Human and Social Response Research Division, International
Research Institute of Disaster Science, Tohoku University, Sendai, Japan
(Hoshikawa) Department of Thoracic Surgery, Fujita Health University
School of Medicine, Toyoake, Japan
(Hoshikawa, Noda, Okada) Department of Thoracic Surgery, Institute of
Development, Aging and Cancer, Tohoku University, Sendai, Japan
(Kawashima) Division of Developmental Cognitive Neuroscience, Institute of
Development, Aging and Cancer, Tohoku University, Sendai, Japan
Title
The beneficial effects of cognitive training with simple calculation and
reading aloud (SCRA) in the elderly postoperative population: A pilot
randomized controlled trial.
Source
Frontiers in Aging Neuroscience. 10 (MAR) (no pagination), 2018. Article
Number: 68. Date of Publication: 28 Mar 2018.
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: There has been little research conducted regarding cognitive
treatments for the elderly postsurgical population. Patients aged >=60
years have an increased risk of postoperative cognitive decline, a
condition in which cognitive functions are negatively affected. This
cognitive decline can lead to a decline in quality of life. In order to
maintain a high quality of life, the elderly postsurgical population may
benefit from treatment to maintain and/or improve their cognitive
functions. This pilot study investigates the effect of simple calculation
and reading aloud (SCRA) cognitive training in elderly Japanese
postsurgical patients. Methods: Elderly patients undergoing
non-cardiovascular thoracic surgery under general anesthesia were
recruited (n = 12). Subjects were randomly divided into two groups-one
that receives 12 weeks of SCRA intervention, and a waitlisted control
group. Before and after the intervention, we measured cognitive function
[Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery
(FAB), computerized Cogstate Brief Battery (CBB)] and emotional state
[General Health Questionnaire-12 (GHQ-12), Geriatric Depression Scale
(GDS), Quality of Life Scale-5 (QOL-5)]. Results: Group difference
analyses using ANCOVA with permutation test showed that the intervention
SCRA group had a significant improvement in FAB motor programming
sub-score, GDS, and QOL-5 compared to the control group. Within-group
analyses using Wilcoxon signed-rank test to compare baseline and follow-up
showed that the SCRA intervention group total FAB scores, FAB motor
programming sub-scores, and QOL-5 scores were significantly improved.
Discussion: This pilot study showed that there are important implications
for the beneficial effects of SCRA intervention on cognitive function and
emotional state in the postoperative elderly population; however, further
investigations are necessary to reach any conclusions.<br/>Copyright
&#xa9; 2018 Kulason, Nouchi, Hoshikawa, Noda, Okada and Kawashima.

<45>
Accession Number
621562107
Author
Eisen A.; Cannon C.P.; Blazing M.A.; Bohula E.A.; Park J.-G.; Murphy S.A.;
White J.A.; Giugliano R.P.; Braunwald E.
Institution
(Eisen, Cannon, Bohula, Park, Murphy, Giugliano, Braunwald) TIMI Study
Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard
Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115,
USA
(Blazing, White) Duke Clinical Research Institute, Durham, NC, USA
Title
The benefit of adding ezetimibe to statin therapy in patients with prior
coronary artery bypass graft surgery and acute coronary syndrome in the
IMPROVE-IT trial.
Source
European heart journal. 37 (48) (pp 3576-3584), 2016. Date of Publication:
21 Dec 2016.
Abstract
AIMS: To examine the efficacy and safety of ezetimibe added to statin in
patients with prior coronary artery bypass graft surgery (CABG) following
hospitalization for an acute coronary syndrome (ACS).
METHODS AND RESULTS: In the IMPROVE-IT trial, post-ACS patients with mean
low density lipoprotein cholesterol (LDL-C) of 93.8mg/dL at presentation
were randomized to simvastatin/ezetimibe or simvastatin/placebo. The
primary endpoint was cardiovascular death, major coronary event or stroke,
and the median follow-up was 6 years. Efficacy and safety endpoints were
examined by prior CABG status. Among 18134 patients, 1684 (9.3%) had a
prior CABG (median age 69 years, 82% male). During the trial, the median
time-weighted LDL-C level was 55.0mg/dL with simvastatin/ezetimibe vs.
69.9mg/dL with simvastatin/placebo in patients with prior CABG (P<0.001),
and it was 53.6mg/dL vs. 69.5mg/dL, respectively, in patients without
prior CABG (P<0.001). The rate of the primary endpoint was higher in
patients with vs. without prior CABG [56% vs. 32%, adj. hazard ratio 1.45,
95% confidence interval (CI) 1.33-1.58]. Patients with prior CABG
receiving simvastatin/ezetimibe had an 8.8% (95% CI 3.1-14.6%) lower
absolute risk over simvastatin/placebo in the primary endpoint, whereas
patients without prior CABG had a 1.3% (95% CI 0-2.6%) lower absolute risk
(P-interaction=0.02). There were no between-group significant differences
in safety endpoints.
CONCLUSION: The clinical benefit of adding ezetimibe to statin appears to
be enhanced in patients with prior CABG, supporting the use of intensive
lipid lowering therapy in these high-risk patients following
ACS.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author 2016. For Permissions,
please email: journals.permissions@oup.com.

<46>
Accession Number
621516817
Author
Ochiai T.; Saito S.; Yamanaka F.; Shishido K.; Tanaka Y.; Yamabe T.;
Shirai S.; Tada N.; Araki M.; Naganuma T.; Watanabe Y.; Yamamoto M.;
Hayashida K.
Institution
(Ochiai, Saito, Yamanaka, Shishido, Tanaka) Department of Cardiology,
Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa
247-8533, Japan
(Yamabe) Department of Cardiovascular Surgery, Shonan Kamakura General
Hospital, Kamakura, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Watanabe) Department of Cardiology, Teikyo University, School of
Medicine, Tokyo, Japan
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan
(Yamamoto) Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
(Hayashida) Department of Cardiology, Keio University, School of Medicine,
Tokyo, Japan
Title
Renin-angiotensin system blockade therapy after transcatheter aortic valve
implantation.
Source
Heart. 104 (8) (pp 644-651), 2018. Date of Publication: April 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The persistence of left ventricular (LV) hypertrophy is
associated with poor clinical outcomes after transcatheter aortic valve
implantation (TAVI) for aortic stenosis. However, the optimal medical
therapy after TAVI remains unknown. We investigated the effect of renin
'angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality
in patients undergoing TAVI. Methods Between October 2013 and April 2016,
1215 patients undergoing TAVI were prospectively enrolled in the Optimized
CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was
stratified according to the postoperative usage of RAS blockade therapy
with angiotensin-converting enzyme (ACE) inhibitors or
angiotensin-receptor blockers (ARBs). Patients with at least two
prescriptions dispensed 180 days apart after TAVI and at least a 6-month
follow-up constituted the RAS blockade group (n=371), while those not
prescribed any ACE inhibitors or ARBs after TAVI were included in the no
RAS blockade group (n=189). Results At 6 months postoperatively, the RAS
blockade group had significantly greater LV mass index regression than the
no RAS blockade group ('9+/-24% vs '2+/-25%, p=0.024). Kaplan-Meier
analysis revealed a significantly lower cumulative 2-year mortality in the
RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%;
log-rank test, p=0.031). After adjusting for confounding factors, RAS
blockade therapy was associated with significantly lower all-cause
mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025). Conclusions
Postoperative RAS blockade therapy is associated with greater LV mass
index regression and reduced all-cause mortality. These data need to be
confirmed by a prospective randomised controlled outcome
trial.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2018. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.

<47>
Accession Number
2000592933
Author
Smart N.A.; Dieberg G.; King N.
Institution
(Smart, Dieberg) School of Science and Technology, University of New
England, Armidale, Australia, United States
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth, United Kingdom
Title
Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting.
Source
Journal of the American College of Cardiology. 71 (9) (pp 983-991), 2018.
Date of Publication: 6 March 2018.
Publisher
Elsevier USA
Abstract
Background: When comparing effects of on- versus off-pump coronary artery
bypass grafting (CABG), it is important to assess the long-term clinical
outcomes. However, most research conducted thus far has concentrated on
short-term outcomes and ignored the long-term clinical outcomes,
especially the 5-year outcomes of the largest randomized controlled
trials. Objectives: The aim of this systematic review and meta-analysis
was to investigate the long-term clinical outcomes of on- versus off-pump
CABG. Methods: To identify potential studies systematic searches were
carried out using various databases. The search strategy included the key
concepts of cardiopulmonary bypass AND off-pump AND long term OR 5-year
outcomes. This was followed by a meta-analysis investigating mortality,
incidence of myocardial infarction, incidence of angina, need for
revascularization, and incidence of stroke. Results: Six studies totaling
8,145 participants were analyzed. In the on-pump group mortality was
12.3%, compared with 13.9% in the off-pump group. The odds ratio (OR) for
this comparison was 1.16 (95% confidence interval [CI]: 1.02 to 1.32; p =
0.03; 13.9% vs. 12.3%). In contrast, there were no differences in the
incidence of myocardial infarction (OR: 1.06: 95% CI: 0.91 to 1.25; p =
0.45; 8.4% vs. 7.9%), incidence of angina (OR: 1.09; 95% CI: 0.75 to 1.57;
p = 0.65; 2.3% vs. 2.1%), need for revascularization (OR: 1.15; 95% CI:
0.95 to 1.40; p = 0.16; 5.9% vs. 5.1%), and the incidence of stroke (OR:
0.78; 95% CI: 0.56 to 1.10; p = 0.16; 2.2% vs. 2.8%). Conclusions:
Statistically, on-pump CABG appeared to offer superior long-term survival,
although the clinical significance of this may be more
uncertain.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<48>
Accession Number
2000589364
Author
Asleh R.; Briasoulis A.; Kremers W.K.; Adigun R.; Boilson B.A.; Pereira
N.L.; Edwards B.S.; Clavell A.L.; Schirger J.A.; Rodeheffer R.J.; Frantz
R.P.; Joyce L.D.; Maltais S.; Stulak J.M.; Daly R.C.; Tilford J.; Choi
W.-G.; Lerman A.; Kushwaha S.S.
Institution
(Asleh, Briasoulis, Kremers, Adigun, Boilson, Pereira, Edwards, Clavell,
Schirger, Rodeheffer, Frantz, Joyce, Maltais, Stulak, Daly, Tilford, Choi,
Lerman, Kushwaha) Department of Cardiovascular Diseases and Health
Sciences Research and the William J. von Liebig Center for Transplantation
and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, United
States
Title
Long-Term Sirolimus for Primary Immunosuppression in Heart Transplant
Recipients.
Source
Journal of the American College of Cardiology. 71 (6) (pp 636-650), 2018.
Date of Publication: 13 February 2018.
Publisher
Elsevier USA
Abstract
Background: Small studies have reported superiority of sirolimus (SRL)
over calcineurin inhibitor (CNI) in mitigating cardiac allograft
vasculopathy (CAV) after heart transplantation (HT). However, data on the
long-term effect on CAV progression and clinical outcomes are lacking.
Objectives: The aim of this study was to test the long-term safety and
efficacy of conversion from CNI to SRL as maintenance therapy on CAV
progression and outcomes after HT. Methods: A cohort of 402 patients who
underwent HT and were either treated with CNI alone (n = 134) or converted
from CNI to SRL (n = 268) as primary immunosuppression was analyzed. CAV
progression was assessed using serial coronary intravascular ultrasound
during treatment with CNI (n = 99) and after conversion to SRL (n = 235)
in patients who underwent at least 2 intravascular ultrasound studies.
Results: The progression in plaque volume (2.8 +/- 2.3 mm³/mm
vs. 0.46 +/- 1.8 mm³/mm; p < 0.0001) and plaque index (plaque
volume-to-vessel volume ratio) (12.2 +/- 9.6% vs. 1.1 +/- 7.9%; p <
0.0001) were significantly attenuated when treated with SRL compared with
CNI. Over a mean follow-up period of 8.9 years from time of HT, all-cause
mortality occurred in 25.6% of the patients and was lower during treatment
with SRL compared with CNI (adjusted hazard ratio: 0.47; 95% confidence
interval: 0.31 to 0.70; p = 0.0002), and CAV-related events were also less
frequent during treatment with SRL (adjusted hazard ratio: 0.35; 95%
confidence interval: 0.21 to 0.59; p < 0.0001). Further analyses suggested
more attenuation of CAV and more favorable clinical outcomes with earlier
conversion to SRL (<=2 years) compared with late conversion (>2 years)
after HT. Conclusions: Early conversion to SRL is associated with
attenuated CAV progression and with lower long-term mortality and fewer
CAV-related events compared with continued CNI use.<br/>Copyright &#xa9;
2018 American College of Cardiology Foundation

<49>
Accession Number
2000588798
Author
Kosmidou I.; Chen S.; Kappetein A.P.; Serruys P.W.; Gersh B.J.; Puskas
J.D.; Kandzari D.E.; Taggart D.P.; Morice M.-C.; Buszman P.E.; Bochenek
A.; Schampaert E.; Page P.; Sabik J.F.; McAndrew T.; Redfors B.;
Ben-Yehuda O.; Stone G.W.
Institution
(Kosmidou, Chen, McAndrew, Redfors, Ben-Yehuda, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, New York, United
States
(Kosmidou) Arrhythmia Center, Department of Cardiology, St. Francis
Hospital, Roslyn, New York, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Gersh) Department of Cardiovascular Medicine, Mayo Clinic College of
Medicine, Rochester, Minnesota, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Morice) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Paris, France
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
(Schampaert, Page) Hopital du Sacre-Coeur de Montreal, Montreal, Canada
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland,
Ohio, United States
(Ben-Yehuda, Stone) NewYork-Presbyterian Hospital/Columbia University
Medical Center, New York, New York, United States
Title
New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The
EXCEL Trial.
Source
Journal of the American College of Cardiology. 71 (7) (pp 739-748), 2018.
Date of Publication: 20 February 2018.
Publisher
Elsevier USA
Abstract
Background: There is limited information on the incidence and prognostic
impact of new-onset atrial fibrillation (NOAF) following percutaneous
coronary intervention (PCI) and coronary artery bypass grafting (CABG) for
left main coronary artery disease (LMCAD). Objectives: This study sought
to determine the incidence of NOAF following PCI and CABG for LMCAD and
its effect on 3-year cardiovascular outcomes. Methods: In the EXCEL
(Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization) trial, 1,905 patients with
LMCAD and low or intermediate SYNTAX scores were randomized to PCI with
everolimus-eluting stents versus CABG. Outcomes were analyzed according to
the development of NOAF during the initial hospitalization following
revascularization. Results: Among 1,812 patients without atrial
fibrillation on presentation, NOAF developed at a mean of 2.7 +/- 2.5 days
after revascularization in 162 patients (8.9%), including 161 of 893
(18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p
< 0.0001). Older age, greater body mass index, and reduced left
ventricular ejection fraction were independent predictors of NOAF in
patients undergoing CABG. Patients with versus without NOAF had a
significantly longer duration of hospitalization, were more likely to be
discharged on anticoagulant therapy, and had an increased 30-day rate of
Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs.
5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an
independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard
ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001),
death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p =
0.0006), and the primary composite endpoint of death, MI, or stroke (22.6%
vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004).
Conclusions: In patients with LMCAD undergoing revascularization in the
EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The
development of NOAF was strongly associated with subsequent death and
stroke in CABG-treated patients. Further studies are warranted to
determine whether prophylactic strategies to prevent or treat atrial
fibrillation may improve prognosis in patients with LMCAD who are
undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization [EXCEL];
NCT01205776)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<50>
Accession Number
2000586564
Author
Pinho-Gomes A.-C.; Azevedo L.; Ahn J.-M.; Park S.-J.; Hamza T.H.; Farkouh
M.E.; Serruys P.W.; Milojevic M.; Kappetein A.P.; Stone G.W.; Lamy A.;
Fuster V.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences (MEDCIDS) & Centre for Health Technology and Services
Research (CINTESIS), Faculty of Medicine, Porto University, Porto,
Portugal
(Ahn, Park) Asan Medical Center, University of Ulsan College of Medicine,
Ulsan, South Korea
(Hamza) New England Research Institutes, Watertown, Massachusetts, United
States
(Farkouh) Peter Munk Cardiac Centre and Heart & Stroke/Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
(Serruys, Milojevic) Imperial College of London, London, United Kingdom
(Kappetein) Department of Thoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Stone) The New York Presbyterian Hospital, Columbia University Medical
Center, Cardiovascular Research Foundation, New York, New York, United
States
(Lamy) Department of Surgery, Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Fuster) Mount Sinai Cardiovascular Institute, New York, New York, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
Title
Compliance With Guideline-Directed Medical Therapy in Contemporary
Coronary Revascularization Trials.
Source
Journal of the American College of Cardiology. 71 (6) (pp 591-602), 2018.
Date of Publication: 13 February 2018.
Publisher
Elsevier USA
Abstract
Background: Despite the well-established benefits of secondary
cardiovascular prevention, the importance of concurrent medical therapy in
clinical trials of coronary revascularization is often overlooked.
Objectives: The goal of this study was to assess compliance with
guideline-directed medical therapy (GDMT) in clinical trials and its
potential impact on the comparison between percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG). Methods:
The Cochrane Central Register of Controlled Trials and MEDLINE were
searched from 2005 to August 2017. Clinical trial registries and reference
lists of relevant studies were also searched. Randomized controlled trials
comparing PCI with drug-eluting stents versus CABG and reporting medical
therapy after revascularization were included. The study outcome was
compliance with GDMT, defined as the following: 1) any antiplatelet agent
plus beta-blocker plus statin (GDMT1); and 2) any antiplatelet agent plus
beta-blocker plus statin plus angiotensin-converting enzyme
inhibitor/angiotensin receptor blocker (GDMT2). Data collection and
analysis were performed according to the methodological recommendations of
The Cochrane Collaboration. Results: From a total of 439 references, 5
trials were included based on our inclusion and exclusion criteria.
Overall, compliance with GDMT1 was low and decreased over time from 67% at
1 year to 53% at 5 years. Compliance with GDMT2 was even lower and
decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1
and GDMT2 was higher in PCI than in CABG at all time points.
Meta-regression suggested an association between lower use of GDMT1 and
adverse clinical outcomes in PCI versus CABG at 5 years. Conclusions:
Compliance with GDMT in contemporary clinical trials remains suboptimal
and is significantly lower after CABG than after PCI, which may influence
the comparison of clinical trial endpoints between those study
groups.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<51>
Accession Number
621555196
Author
Chen G.-J.; Lo W.-C.; Tseng H.-W.; Pan S.-C.; Chen Y.-S.; Chang S.-C.
Institution
(Chen, Pan, Chang) Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lo) Graduate Institute of Epidemiology and Preventive Medicine, College
of Public Health, National Taiwan University, Taipei, Taiwan (Republic of
China)
(Tseng, Chen) Department of Surgery, National Taiwan University Hospital,
Taipei, Taiwan (Republic of China)
(Chen, Chang) College of Medicine, National Taiwan University, Taipei,
Taiwan (Republic of China)
Title
Outcome of surgical intervention for aortic root abscess: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 807-814), 2018.
Date of Publication: 01 Apr 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic root abscess (ARA) is a catastrophic complication of
aortic root endocarditis, involving both native and prosthetic valves,
which often warrants surgical intervention. Currently, aortic valve
replacement (AVR) and aortic root replacement (ARR) are the most widely
employed techniques. However, evidence that directly compares these
methods is scarce. In this meta-analysis, we aimed to describe the
surgical outcome of ARA when using different surgical methods. METHODS: In
this meta-analysis, we performed literature searches in the EMBASE and
PubMed databases and reviewed articles describing postoperative results of
ARA that were published before 30 June 2016. After extracting the
published data, we used a random-effects model to perform meta-analysis
and compare the postoperative outcomes of ARA after management with AVR or
ARR. RESULTS: Seven published studies were included in this meta-analysis,
which includes 781 episodes of infective endocarditis complicated with
ARA. There was no significant difference in the 30-day postoperative
mortality rate among patients receiving ARR [23.8%, 95% confidence
interval (CI) 17.8-30.6] compared with AVR (19.1%, 95% CI 13.3-26.1%),
with a relative risk ratio of 1.30 (95% CI 0.84-2.00). However, patients
receiving ARR were associated with statistically significant lower rates
of reoperation within 1 year (relative risk 0.50, 95% CI 0.26-0.94).
CONCLUSIONS: In our meta-analysis, ARR was associated with a 50% risk
reduction of reoperation within 1 year among patients with ARA. There was
no significant difference in the 30-day postoperative mortality rate
between patients receiving ARR and patients receiving AVR; comparison of
the long-term outcomes after these 2 procedures warrants further
investigation.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<52>
Accession Number
621555172
Author
Choi J.W.; Jang M.-J.; Kim K.H.; Hwang H.Y.
Institution
(Choi, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Title
Repair versus replacement for the surgical correction of tricuspid
regurgitation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 748-755), 2018.
Date of Publication: 01 Apr 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage
in preserving right ventricular function and disadvantages such as a
higher risk of repair failure in the long-term compared with tricuspid
valve replacement (TVR). This study was conducted to compare the results
of TVr with those of TVR to find an optimal treatment option. METHODS: A
literature search of 5 databases was performed. The primary outcome was
all-cause mortality. Secondary outcomes were tricuspid reoperation and
valve-related events. Subgroup analyses were performed according to the
risk of bias, year of publication and proportions of patients with
tricuspid regurgitation Grade >= 3, functional aetiology and isolated
tricuspid valve surgery. Publication bias was explored using the funnel
plot and Egger's test. RESULTS: Seventeen retrospective studies involving
4561 patients (TVr group = 3432 patients and TVR group = 1129 patients)
were included. A pooled analysis showed that the risk of all-cause
mortality was significantly higher in the TVR group than in the TVr group
[hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no
significant differences in tricuspid valve reoperation in 6 studies and
valve-related events in 5 studies between the TVR and TVr groups [hazard
ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91- 2.38),
respectively]. None of the subgroup analyses demonstrated a significant
difference in the hazard ratio of all-cause mortality. No publication bias
was identified for the primary and secondary outcomes. CONCLUSIONS: This
meta-analysis indicates that TVr is more beneficial compared with TVR in
terms of all-cause mortality. From the available data, TVr is not
associated with an increased risk of tricuspid reoperation compared with
TVR.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<53>
Accession Number
621555156
Author
Drury N.E.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.; Barron
D.J.; Jones T.J.
Institution
(Drury, Patel, Oswald, Stickley, Barron, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United
Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Title
Randomized controlled trials in children's heart surgery in the 21st
century: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 53 (4) (pp 724-731), 2018.
Date of Publication: 01 Apr 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Randomized controlled trials are the gold standard for
evaluating health care interventions, yet are uncommon in children's heart
surgery. We conducted a systematic review of clinical trials in paediatric
cardiac surgery to evaluate the scope and quality of the current
international literature. METHODS: We searched MEDLINE, CENTRAL and
LILACS, and manually screened retrieved references and systematic reviews
to identify all randomized controlled trials reporting the effect of any
intervention on the conduct or outcomes of heart surgery in children
published in any language since January 2000; secondary publications and
those reporting inseparable adult data were excluded. Two reviewers
independently screened studies for eligibility and extracted data; the
Cochrane Risk of Bias tool was used to assess for potential biases.
RESULTS: We identified 333 trials from 34 countries randomizing 23 902
children. Most were early phase (313, 94.0%), recruiting few patients
(median 45, interquartile range 28-82), and only 11 (3.3%) directly
evaluated a surgical intervention. One hundred and nine (32.7%) trials
calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51
(15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring
Committee. The overall risk of bias was low in 22 (6.6%), high in 69
(20.7%) and unclear in 242 (72.7%). CONCLUSIONS: The recent literature in
children's heart surgery contains few late-phase clinical trials. Most
trials did not conform to the accepted standards of reporting, and the
overall risk of bias was low in few studies. There is a need for
high-quality, multicentre clinical trials to provide a robust evidence
base for contemporary paediatric cardiac surgical practice.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<54>
Accession Number
621547553
Author
Meybohm P.; Kohlhaas M.; Stoppe C.; Gruenewald M.; Renner J.; Bein B.;
Albrecht M.; Cremer J.; Coburn M.; Schaelte G.; Boening A.; Niemann B.;
Sander M.; Roesner J.; Kletzin F.; Mutlak H.; Westphal S.;
Laufenberg-Feldmann R.; Ferner M.; Brandes I.F.; Bauer M.; Stehr S.N.;
Kortgen A.; Wittmann M.; Baumgarten G.; Meyer-Treschan T.; Kienbaum P.;
Heringlake M.; Schoen J.; Treskatsch S.; Smul T.; Wolwender E.; Schilling
T.; Fuernau G.; Bogatsch H.; Brosteanu O.; Hasenclever D.; Zacharowski K.;
Stevanovic A.; Rossaint R.; Felzen M.; Goetzenich A.; Moormann T.; Chalk
K.; Knuefermann P.; Recht T.; Hoeft A.; Winterhalter M.; Iken S.;
Wiedenbeck C.; Schwarzmann G.; Lindau S.; Zierer A.; Fichtlscherer S.;
Goerlach G.; Wollbrueck M.; Boening U.; Weigand M.; Strauchmann J.; August
K.; Morsbach K.U.; Paxian M.; Reinhard K.; Scholz J.; Broch O.; Francksen
H.; Kuhr B.; Heinze H.; Paarmann H.; Sievers H.-H.; Klotz S.; Hachenberg
T.; Werner C.; Mauff S.; Alms A.; Bergt S.; Roewer N.
Institution
(Meybohm, Kohlhaas, Mutlak, Westphal, Zacharowski, Lindau) Department of
Anesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Frankfurt am Main, Germany
(Stoppe, Coburn, Schaelte, Sander) Department of Anesthesiology, Medical
Faculty, RWTH Aachen University, Aachen, Germany
(Gruenewald, Renner, Bein, Albrecht, Roesner) Department of Anesthesiology
and Intensive Care Medicine, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), Germany
(Bein, Cremer) Department of Cardiovascular Surgery, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), Germany
(Fuernau) University Heart Luebeck, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), Germany
(Fuernau) Department of Anesthesiology and Intensive Care Medicine,
Asklepios Hospital St. Georg Hamburg, Germany
(Boening, Niemann, Goerlach, Wollbrueck, Boening) Department of
Cardiovascular Surgery, University of Giessen, Germany
(Sander) Department of Anesthesiology and Intensive Care, University of
Giessen, Germany
(Sander, Treskatsch) Department of Anesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite MitteBerlin,
Germany
(Renner, Roesner) Department of Anesthesiology and Intensive Care,
Suedstadt Hospital Rostock, Germany
(Renner, Roesner, Kletzin) Clinic of Anesthesiology and Intensive Care
Medicine, University Hospital Rostock, Germany
(Laufenberg-Feldmann, Ferner, Werner, Mauff) Department of Anesthesiology,
Medical Center of Johannes Gutenberg-University, Mainz, Germany
(Brandes, Bauer, Strauchmann, August) Department of Anesthesiology and
Intensive Care Medicine, University Hospital Goettingen, Germany
(Bauer) Department of Anesthesiology and Intensive Care, Klinikum Region
Hannover, Germany
(Stehr, Kortgen, Morsbach, Paxian, Reinhard) Department of Anesthesiology
and Intensive Care Medicine, Jena University Hospital, Jena, Germany
(Stehr) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Germany
(Wittmann, Baumgarten) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Germany
(Baumgarten) Department of Anesthesiology and Intensive Care Medicine,
Johanniter Hospital Bonn, Germany
(Meyer-Treschan, Kienbaum, Winterhalter) Department of Anesthesiology and
Intensive Care Medicine, University Hospital Duesseldorf, Germany
(Heringlake, Schoen) Department of Anesthesiology and Intensive Care
Medicine, University Luebeck, Germany
(Schoen) Department of Anesthesiology and Intensive Care Medicine,
Hospital Neuruppin, Germany
(Smul, Wolwender, Schilling) Department of Anesthesiology, University
Hospital Wuerzburg, Germany
(Smul, Hachenberg) Department of Anesthesiology, University Hospital
Magdeburg, Germany
(Bogatsch, Brosteanu) Clinical Trial Centre, University Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Germany
(Stevanovic, Rossaint, Felzen) Department of Anesthesiology, Medical
Faculty RWTH Aachen University, Aachen, Germany
(Goetzenich) Department of Thoracic and Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Campus Charite Mitte, Berlin, Germany
(Moormann, Chalk) Department of Anesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite Mitte,
Berlin, Germany
(Knuefermann, Recht, Hoeft) Department of Anesthesiology and Intensive
Care Medicine, University Hospital Bonn, Bonn, Germany
(Iken, Wiedenbeck, Schwarzmann, Zierer) Department of Thoracic and
Cardiovascular Surgery, University of Giessen, Germany
(Fichtlscherer) Internal Medicine III: Cardiology, Angiology, Nephrology,
University of Giessen, Germany
(Weigand) Department of Anesthesiology, University Hospital Goettingen,
Germany
(Renner, Scholz, Broch, Francksen, Kuhr) Department of Anesthesiology and
Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus
Kiel, Germany
(Heinze, Paarmann) Department of Anesthesiology, University Hospital
Luebeck, Luebeck, Germany
(Sievers, Klotz) Department of Cardiac and Thoracic Vascular Surgery,
University Hospital Magdeburg, Germany
(Alms, Bergt) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Roewer) Department of Anesthesiology, University Hospital Wuerzburg,
Wuerzburg, Germany
Title
RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) study:
Myocardial dysfunction, postoperative neurocognitive dysfunction, and 1
year follow-up.
Source
Journal of the American Heart Association. 7 (7) (no pagination), 2018.
Article Number: e008077. Date of Publication: 01 Apr 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Remote ischemic preconditioning (RIPC) has been suggested to
protect against certain forms of organ injury after cardiac surgery.
Previously, we reported the main results of RIPHeart (Remote Ischemic
Preconditioning for Heart Surgery) Study, a multicenter trial randomizing
1403 cardiac surgery patients receiving either RIPC or sham-RIPC. Methods
and Results--In this follow-up paper, we present 1-year follow-up of the
composite primary end point and its individual components (all-cause
mortality, myocardial infarction, stroke and acute renal failure), in a
sub-group of patients, intraoperative myocardial dysfunction assessed by
transesophageal echocardiography and the incidence of postoperative
neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC
neither showed any beneficial effect on the 1-year composite primary end
point (RIPC versus sham-RIPC 16.4% versus 16.9%) and its individual
components (all-cause mortality [3.4% versus 2.5%], myocardial infarction
[7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0%
versus 5.7%]) nor improved intraoperative myocardial dysfunction or
incidence of postoperative neurocognitive dysfunction 5 to 7 days (67
[47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%]
versus 18 [27.7%] patients), respectively. Conclusions--Similar to our
main study, RIPC had no effect on intraoperative myocardial dysfunction,
neurocognitive function and long-term outcome in cardiac surgery patients
undergoing propofol anesthesia.<br/>Copyright &#xa9; 2018 The Authors.

<55>
Accession Number
621544871
Author
Fisahn C.; Schmidt C.; Schroeder J.E.; Vialle E.; Lieberman I.H.; Dettori
J.R.; Schildhauer T.A.
Institution
(Fisahn, Schmidt) Swedish Neuroscience Institute, Swedish Medical Center,
Seattle, WA, United States
(Fisahn, Schildhauer) BG University Hospital Bergmannsheil, Ruhr
University Bochum, Bochum, Germany
(Schroeder) Hadassah Hebrew University Medical Center, Jerusalem, Israel
(Vialle) Cajuru Hospital, Catholic University of Parana, Curitiba, Brazil
(Lieberman) Texas Back Institute and Texas Health Plano Hospital, Plano,
TX, United States
(Dettori) Spectrum Research, Inc, Tacoma, WA, United States
Title
Blood Transfusion and Postoperative Infection in Spine Surgery: A
Systematic Review.
Source
Global Spine Journal. 8 (2) (pp 198-207), 2018. Date of Publication: 01
Apr 2018.
Publisher
SAGE Publications Ltd (E-mail: custserv@thieme.com)
Abstract
Study Design: Systematic review. Objectives: Allogeneic blood
transfusion-related immunomodulation may relatively suppress the immune
system, heightening the risk of infection following spine surgery. This
systematic review seeks to determine whether allogeneic blood transfusion
increases the risk of postoperative infection and whether there are any
factors that modify this association. Methods: PubMed, Cochrane Central
Register of Controlled Trials, and reference lists from included studies
were searched from inception to April 20, 2017 to identify studies
examining the risk of infection following allogeneic blood transfusion in
adult patients receiving surgery for degenerative spine disease. Results:
Eleven retrospective cohort or case-control studies, involving 8428
transfusion patients and 43 242 nontransfusion patients, were identified
as meeting the inclusion criteria. Regarding surgical site infection
(SSI), the results were mixed with roughly half reporting a significant
association. There was an association between allogeneic transfusion and
urinary tract infection (UTI) and any infection, but not respiratory tract
infection. There was no statistical modifying effect of lumbar versus
thoracic surgery on the association of allogeneic transfusion and SSI,
though subgroup analyses in 3 of 4 studies reported a statistical
association between transfusion and postoperative infections, including
SSI, UTI, and any infection within the lumbar spine. Conclusions: This
systematic review failed to find a consistent association between
allogeneic transfusion and postoperative infection in spine surgery
patients. However, these studies were all retrospective with a high or
moderately high risk of bias. To properly examine this association an
observational prospective study of sufficient power, estimated as 2400
patients, is required.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s)
2018.

<56>
Accession Number
2000600893
Author
Roullet S.; de Maistre E.; Ickx B.; Blais N.; Susen S.; Faraoni D.;
Garrigue D.; Bonhomme F.; Godier A.; Lasne D.
Institution
(Roullet) Inserm U 12-11, service anesthesie-reanimation 1, universite de
Bordeaux, CHU de Bordeaux, Bordeaux 33000, France
(de Maistre) Unite d'hemostase, centre hospitalier universitaire, Dijon
21079, France
(Ickx) Universite Libre de Bruxelles, Erasme University Hospital,
Department of Anesthesiology, Brussels, Belgium
(Blais) Hematologie et oncologie medicale, CHUM, Montreal, Canada
(Susen) Institut d'hematologie et transfusion, CHRU de Lille, Lille 59037,
France
(Faraoni) Department of Anaesthesia and Pain Medicine, The Hospital for
Sick Children, University of Toronto, Toronto, Canada
(Garrigue) Pole d'anesthesie-reanimation, CHRU de Lille, Lille 59037,
France
(Bonhomme) Service d'anesthesiologie, hopital universitaire de Geneve,
Geneva, Switzerland
(Godier) Service d'anesthesie-reanimation, Fondation Rothschild, Paris
75019, France
(Lasne) Laboratoire d'hematologie, hopital Necker, Paris 75015, France
Title
Position of the French Working Group on Perioperative Haemostasis (GIHP)
on viscoelastic tests: What role for which indication in bleeding
situations?.
Source
Anaesthesia Critical Care and Pain Medicine. (no pagination), 2018. Date
of Publication: 2018.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Purpose: Viscoelastic tests (VETs), thromboelastography (TEG)
and thromboelastometry (ROTEM) are global tests of coagulation
performed on whole blood. They evaluate the mechanical strength of a clot
as it builds and develops after coagulation itself. The time required to
obtain haemostasis results remains a major problem for clinicians dealing
with bleeding, although some teams have developed a rapid laboratory
response strategy. Indeed, the value of rapid point-of-care diagnostic
devices such as VETs has increased over the years. However, VETs are not
standardised and there are few recommendations from the learned societies
regarding their use. In 2014, the recommendations of the International
Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia.
The French Working Group on Perioperative haemostasis (GIHP) therefore
proposes to summarise knowledge on the clinical use of these techniques in
the setting of emergency and perioperative medicine. Methods: A review of
the literature. Principal findings: The role of the VETs seems established
in the management of severe trauma and in cardiac surgery, both adult and
paediatric. In other situations, their role remains to be defined: hepatic
transplantation, postpartum haemorrhage, and non-cardiac surgery. They
must be part of the global management of haemostasis based on algorithms
defined in each centre and for each population of patients. Their position
at the bedside or in the laboratory is a matter of discussion between
clinicians and biologists. Conclusion: VETs must be included in
algorithms. In consultation with the biology laboratory, these devices
should be situated according to the way each centre
functions.<br/>Copyright &#xa9; 2018 The Authors

<57>
Accession Number
619467904
Author
Xu J.; Yang X.; Hu X.; Chen X.; Zhang J.; Wang Y.
Institution
(Xu, Yang, Hu, Zhang, Wang) Department of Anesthesiology, Huashan
Hospital, Fudan University, Shanghai, China
(Chen) Department of Cardiothorcic Surgery, Huashan Hospital, Fudan
University, Shanghai, China
Title
Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without
Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 318-324),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: Thoracic paravertebral block (TPVB) is reported to have
advantages in postoperative pain management in unilateral thoracic
surgeries. Previous studies have demonstrated that dexmedetomidine could
be used as an adjuvant to local anesthetics, with the aim of prolonging
the duration of neural blockade. However, little is known about whether
such a combination could improve the quality of postoperative analgesia
compared with local anesthetic only when TPVB is used for patients
undergoing video-assisted thoracoscopic surgery (VATS). Design: A
prospective, randomized, controlled study. Setting: Single-center
university hospital. Participants: The study included 60 patients
undergoing VATS under general anesthesia. Interventions: The patients were
allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL
only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 mug/kg of
dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided
using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8-of
the surgical side; 5 mL of solution were injected at each point.
Postoperatively, the intravenous nonsteroidal anti-inflammatory drug
flurbiprofen was used as part of multimodal analgesia. Measurements and
Main Results: Pain scores at rest and during coughing were evaluated by a
blinded observer in the postanesthesia care unit postoperatively at 1, 2,
4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory
blockade, postoperative requirements for rescue analgesia, adverse events,
and patient satisfaction also were recorded. There was a significant
reduction in postoperative pain scores at rest starting from the
postoperative 8th hour until the 48th hour and during coughing starting at
the postoperative 4th hour until the 48th hour in the group RD compared
with those in group R (p = 0.043). The dermatomal levels of sensory
blockade were comparable in the 2 groups. Patient satisfaction after
surgery was significantly higher in the group RD than in group R (p <
0.001). Total consumption of the intravenous rescue analgesic morphine and
adverse events were not significantly different between the 2 groups.
Conclusions: Compared with ropivacaine only, the addition of
dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in
patients undergoing VATS prolonged the duration of postoperative analgesia
and improved patient satisfaction without serious side effects when
combined with postoperative intravenous nonsteroidal anti-inflammatory
drug administration.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<58>
Accession Number
618847531
Author
El-Tahan M.R.; Khidr A.M.; Gaarour I.S.; Alshadwi S.A.; Alghamdi T.M.;
Al'ghamdi A.
Institution
(El-Tahan, Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamdi) Anesthesiology
Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University
(formerly University of Dammam), Dammam, Saudi Arabia
Title
A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in
Humans by Users With Mixed Experience: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 277-286),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To test the hypothesis that laryngoscopy using the Airtraq
(Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu
A/S, Ballerup, Denmark) would result in a shorter time for successful
double-lumen endobronchial tube (DLT) intubation by users with mixed
experience than the time required using the Macintosh or GlideScope
(Verathon Inc., Bothell, WA) laryngoscopes. Design: A randomized,
prospective, blind study. Setting: A single university hospital.
Participants: The study comprised 133 patients undergoing elective
thoracic surgery. Interventions: Patients were randomly allocated into the
following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34),
Airtraq (n = 35), or KVL (n = 32). Measurements and Main Results: The
following data were recorded: time required for achieving successful DLT
intubation; glottis visualization; optimization maneuvers; first-pass
success rate; intubation difficulty; failure to intubate, defined as an
attempt taking >150 seconds to perform or if peripheral oxygen saturation
<92% was noted; and postoperative sore throat and hoarseness were
recorded. Compared with GlideScope, the Airtraq resulted in shorter times
for achieving successful DLT intubation (median times: 21 s [95%
confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval
46.2-89.1 s], respectively; p = 0.021); a lower score for difficult
intubations (p = 0.023); and fewer optimization maneuvers. The 4
laryngoscopes were associated with comparable glottis visualization;
first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p =
0.522); incidence of oropharyngeal trauma; postoperative sore throat; and
hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures
using the Airtraq due to the inability to advance the DLT through the
glottis opening. The experience of the anesthesiologists in using the 4
devices had a statistically significant negative correlation with the time
to confirmation of endobronchial intubation (Spearman r -0.392; p <
0.001). Conclusion: When used by operators with mixed experience, the
channeled Airtraq required less time for DLT intubation and was easier to
use than the GlideScope, although failures did occur with the Airtraq,
whereas they did not occur with the other systems.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<59>
Accession Number
619209390
Author
Teng Y.; Ou M.; Yu H.
Institution
(Teng, Ou, Yu) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Feasibility of the Use of Transesophageal Echocardiography as a Surface
Probe for Puncturing and Catheterization of the Internal Jugular Vein: A
Randomized Controlled Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 363-369),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare the transesophageal echocardiography (TEE) probe as
a surface probe with the vascular probe for guiding internal jugular vein
(IJV) catheterization. Design: Prospective, randomized, controlled pilot
study. Setting: University hospital. Participants: One hundred cardiac
surgery patients, including 50 adult and 50 pediatric patients.
Interventions: Patients in the TEE probe group received right IJV
catheterization using the TEE probe, while the vascular probe group used
the vascular probe for catheterization. Measurements and Main Results: The
puncture time, first-attempt success rate, quality of the imaging with
needle tip positioning, wire positioning, and catheter positioning were
recorded. The incidence of complication or any adverse event also was
observed. Adult patients: In the vascular probe group, the success rate
for first attempt IJV catheterization was 24/25 (96%), while in the TEE
probe group, the success rate for first attempt IJV catheterization was
25/25 (100%). There was no statistical difference in the puncture time,
image quality, needle tip positioning, wire positioning, and catheter
positioning between groups (p > 0.05). Pediatric patients: The success
rate for first-attempt IJV catheterization was 100% in both groups, and
there were no statistical differences in the puncture time, image quality,
and positioning between the 2 groups (p > 0.05). No complications or
adverse events were observed in either group. Conclusion: The TEE probe,
used as a surface probe, can be used to guide IJV puncturing and
catheterization in cardiac surgery patients with favorable feasibility and
safety.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<60>
Accession Number
619216352
Author
Chang J.-E.; Kim H.; Min S.-W.; Lee J.-M.; Ryu J.-H.; Yoon S.; Hwang J.-Y.
Institution
(Chang, Kim, Min, Lee, Hwang) Department of Anesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University Bundang Hospital, Gyeonggi-go, South Korea
(Yoon) Department ofDepartment of Anesthesiology & Pain Medicine, Seoul
National University Hospital, Seoul, South Korea
Title
A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and
GlideScope for Double-Lumen Endobronchial Intubation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 290-296),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare GlideScope and lighted stylet for double-lumen
endobronchial tube (DLT) intubation in terms of intubation time, success
rate of first attempt at intubation, difficulty in DLT advancement toward
the glottis, and postoperative sore throat and hoarseness. Design: A
prospective, randomized study. Setting: Medical center governed by a
university hostpial. Participants: Sixty-two adult patients undergoing
thoracic surgery using DLT intubation. Intervention: After the induction
of anesthesia, DLT intubation was performed using GlideScope (n = 32) or
lighted stylet (n = 32). Measurements and Main Results: Number of
intubation attempts, difficulty of DLT advancement toward the glottis,
time taken for DLT intubation, and the incidence and severity of
postoperative sore throat and hoarseness at 1 and 24 hours after surgery
were evaluated. Time taken for DLT intubation was shorter in the lighted
stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53]
s, median [interquartile range], respectively; p < 0.001). DLT advancement
toward the glottis was easier in the lighted stylet group than in the
GlideScope group (p = 0.016). The success rate of DLT intubation in the
first attempt (96.9% v 90.6% for lighted stylet and GlideScope,
respectively), and the incidence and severity of postoperative sore throat
and hoarseness were not different between the two groups. Conclusions: The
use of lighted stylet allowed easier advancement of the DLT toward the
glottis in the oropharyngeal space and reduced time for achieving DLT
intubation compared with GlideScope.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<61>
Accession Number
619159136
Author
Landoni G.; Lomivorotov V.; Silvietti S.; Nigro Neto C.; Pisano A.; Alvaro
G.; Hajjar L.A.; Paternoster G.; Riha H.; Monaco F.; Szekely A.; Lembo R.;
Aslan N.A.; Affronti G.; Likhvantsev V.; Amarelli C.; Fominskiy E.;
Baiardo Redaelli M.; Putzu A.; Baiocchi M.; Ma J.; Bono G.; Camarda V.;
Covello R.D.; Di Tomasso N.; Labonia M.; Leggieri C.; Lobreglio R.; Monti
G.; Mura P.; Scandroglio A.M.; Pasero D.; Turi S.; Roasio A.; Votta C.D.;
Saporito E.; Riefolo C.; Sartini C.; Brazzi L.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Silvietti, Monaco, Lembo, Affronti, Baiardo Redaelli, Camarda,
Di Tomasso, Leggieri, Monti, Scandroglio, Turi, Votta, Riefolo, Sartini,
Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesiology and Intensive Care,
Siberian Biomedical Research Center of the Ministry of Health,
Novosibirsk, Russian Federation
(Nigro Neto) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Pisano) Division of Cardiac Anesthesia and Intensive Care, Azienda
Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
(Alvaro, Bono, Labonia, Saporito) Department of Anesthesia and Intensive
Care, Policlinico Universitario Mater Domini, Catanzaro, Italy
(Hajjar) Surgical Intensive Care, Department of Cardiopneumology, InCor,
University of Sao Paulo., Sao Paulo, Brazil
(Paternoster) Department of Cardiovascular Anaesthesia and Intensive Care,
Ospedale San Carlo, Potenza, Italy
(Riha) Cardiothoracic Anaesthesiology and Intensive Care, Department of
Anaesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Szekely) Department of Anesthesia and Intensive Care, Semmelweis Egyetem,
Budapest, Hungary
(Aslan) Medipol Mega University Hospital, Department of Anesthesiology and
Intensive Care, Istanbul, Turkey
(Likhvantsev) Department of Anesthesia and Intensive Care, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Amarelli) Department of Cardiovascular Surgery and Transplants, Monaldi
Hospital, Azienda dei Colli, Naples, Italy
(Putzu) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
(Baiocchi) Department of Anesthesia and Intensive Care, S. Orsola-Malpighi
University Hospital, Bologna, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Covello) Anesthesia and Intensive Care Unit, Busto Arsizio Hospital, ASST
Valle Olona, Varese, Italy
(Lobreglio, Pasero, Brazzi) Department of Anesthesia and Intensive Care,
A.O.U. Citta della Salute e della Scienza, Turin, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU Cagliari, Department of Medical Sciences "M. Aresu,
Cagliari, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Bellomo) School of Medicine, The University of Melbourne, Parkville,
Melbourne, Australia
(Brazzi) Department of Surgical Sciences, University of Turin, Italy
Title
Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac
Surgery: An Updated Consensus Process.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 225-235),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: A careful choice of perioperative care strategies is pivotal to
improve survival in cardiac surgery. However, there is no general
agreement or particular attention to which nonsurgical interventions can
reduce mortality in this setting. The authors sought to address this issue
with a consensus-based approach. Design: A systematic review of the
literature followed by a consensus-based voting process. Setting: A
web-based international consensus conference. Participants: More than 400
physicians from 52 countries participated in this web-based consensus
conference. Interventions: The authors identified all studies published in
peer-reviewed journals that reported on interventions with a statistically
significant effect on mortality in the setting of cardiac surgery through
a systematic Medline/PubMed search and contacts with experts. These
studies were discussed during a consensus meeting and those considered
eligible for inclusion in this study were voted on by clinicians
worldwide. Measurements and Main Results: Eleven interventions finally
were selected: 10 were shown to reduce mortality (aspirin, glycemic
control, high-volume surgeons, prophylactic intra-aortic balloon pump,
levosimendan, leuko-depleted red blood cells transfusion, noninvasive
ventilation, tranexamic acid, vacuum-assisted closure, and volatile
agents), whereas 1 (aprotinin) increased mortality. A significant
difference in the percentages of agreement among different countries and a
variable gap between agreement and clinical practice were found for most
of the interventions. Conclusions: This updated consensus process
identified 11 nonsurgical interventions with possible survival
implications for patients undergoing cardiac surgery. This list of
interventions may help cardiac anesthesiologists and intensivists
worldwide in their daily clinical practice and can contribute to direct
future research in the field.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<62>
Accession Number
619146700
Author
Laine A.; Niemi T.; Schramko A.
Institution
(Laine, Niemi, Schramko) Division of Anesthesiology, Department of
Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki,
Helsinki University Hospital, Helsinki, Finland
Title
Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in
Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 131-139),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: Anemia is common after cardiac surgery and, according to some
suggestive evidence, may be associated with increased bleeding, other
morbidity, and mortality. However, transfusion of red blood cells (RBC)
may cause adverse effects and increase cost. The authors hypothesized that
the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding
more than the higher Hb threshold (Hb 100 g/L). Design: Prospective
randomized trial. Type of Hospital: University Hospital of Helsinki,
Finland. Participants: Eighty patients with written informed consent,
scheduled for elective open-heart surgery were randomized in 2 groups.
Interventions: Two study groups had RBC transfusion threshold of either Hb
80 g/L or 100 g/L. These triggers were followed for a 24-hour period
postoperatively. A medical follow-up was carried out for 7 days after
surgery. Measurements and Main Results: Rotational thromboelastometry
(ROTEM) and conventional laboratory tests were performed to evaluate
coagulation. There was no significant difference in bleeding or ROTEM
parameters between the groups. Complication rate and Hb concentration
after 7-day follow-up were not different between the groups, but Group 100
g/L had received twice the amount of RBC transfusions. Conclusion: Hb
threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable
to 100 g/L in terms of bleeding and possibly short-term
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<63>
Accession Number
618954521
Author
Cardoso R.; Knijnik L.; Bhonsale A.; Miller J.; Nasi G.; Rivera M.; Blumer
V.; Calkins H.
Institution
(Cardoso, Bhonsale, Miller, Calkins) Division of Cardiology, Department of
Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United
States
(Knijnik, Nasi, Rivera, Blumer) Division of Cardiology, Department of
Medicine, University of Miami-Jackson Memorial Hospital, Miami, Florida,
United States
Title
An updated meta-analysis of novel oral anticoagulants versus vitamin K
antagonists for uninterrupted anticoagulation in atrial fibrillation
catheter ablation.
Source
Heart Rhythm. 15 (1) (pp 107-115), 2018. Date of Publication: January
2018.
Publisher
Elsevier B.V.
Abstract
Background: Catheter ablation is recommended as a first- or second-line
rhythm control therapy for selected patients with atrial fibrillation
(AF). There is a wide variability in the periprocedural management of oral
anticoagulation in patients undergoing AF ablation. Objective: We aimed to
perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs
vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients
undergoing AF ablation. Methods: Databases and conference abstracts were
searched. Studies were excluded if oral anticoagulants were held at any
periprocedural period. The primary outcomes were stroke or transient
ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962
patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%)
and not different between groups (odds ratio [OR] 0.66; 95% confidence
interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events
was also not significantly different between NOACs (8%) and VKAs (9.6%)
(OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in
the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50;
95% CI 0.30-0.84; P <.01). This finding was confirmed in a subgroup
analysis of randomized and cohort studies with matched controls (OR 0.45;
95% CI 0.24-0.83; P =.01). There was no significant difference in the
outcomes of individual NOACs and VKAs, although these analyses may have
been underpowered to detect minor differences in such rare outcomes.
Conclusion: In patients undergoing AF ablation, uninterrupted
periprocedural NOACs are associated with a low incidence of stroke or TIA
and a significant reduction in major bleeding as compared with
uninterrupted VKAs.<br/>Copyright &#xa9; 2017 Heart Rhythm Society

<64>
Accession Number
618947562
Author
Faraji R.; Behjati-Ardakani M.; Moshtaghioun S.M.; Kalantar S.M.;
Namayandeh S.M.; Soltani M.; Emami M.; Zandi H.; Firoozabadi A.D.;
Kazeminasab M.; Ahmadi N.; Sarebanhassanabadi M.
Institution
(Faraji, Behjati-Ardakani, Namayandeh, Soltani, Emami, Firoozabadi,
Ahmadi, Sarebanhassanabadi) Yazd Cardiovascular Research Center, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Moshtaghioun) Department of Biology, Faculty of Science, Yazd University,
Yazd, Iran, Islamic Republic of
(Kalantar) Medical Genetic Research and Clinical Centre for Infertility,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Zandi) Department of Microbiology, Faculty of Medicine, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Kazeminasab) Student Research Committee, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Title
The diagnosis of microorganism involved in infective endocarditis (IE) by
polymerase chain reaction (PCR) and real-time PCR: A systematic review.
Source
Kaohsiung Journal of Medical Sciences. 34 (2) (pp 71-78), 2018. Date of
Publication: February 2018.
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by
sequencing may be identified as the etiology of infective endocarditis
(IE) from surgically removed valve tissue; therefore, we reviewed the
value of molecular testing in identifying organisms' DNA in the studies
conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect,
Cochrane, PubMed, and Medline electronic databases without any time
limitations up to December 2016 for English studies reporting
microorganisms involved in infective endocarditis microbiology using PCR
and real-time PCR. Most studies were prospective. Eleven out of 12 studies
used valve tissue samples and blood cultures while only 1 study used whole
blood. Also, 10 studies used the molecular method of PCR while 2 studies
used real-time PCR. Most studies used 16S rDNA gene as the target gene.
The bacteria were identified as the most common microorganisms involved in
infective endocarditis. Streptococcus spp. and Staphylococcus spp. were,
by far, the most predominant bacteria detected. In all studies, PCR and
real-time PCR identified more pathogens than blood and tissue cultures;
moreover, the sensitivity and specificity of PCR and real-time PCR were
more than cultures in most of the studies. The highest sensitivity and
specificity were 96% and 100%, respectively. The gram positive bacteria
were the most frequent cause of infective endocarditis. The molecular
methods enjoy a greater sensitivity compared to the conventional blood
culture methods; yet, they are applicable only to the valve tissue of the
patients undergoing cardiac valve surgery.<br/>Copyright &#xa9; 2017

<65>
Accession Number
618945432
Author
Heir J.S.; Guo S.-L.; Purugganan R.; Jackson T.A.; Sekhon A.K.; Mirza K.;
Lasala J.; Feng L.; Cata J.P.
Institution
(Heir, Purugganan, Jackson, Sekhon, Mirza, Lasala, Cata) Department of
Anesthesiology and Perioperative Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Guo) Department of Anesthesiology, Cathay General Hospital, Taipei,
Taiwan (Republic of China)
(Guo) Department of Anesthesiology, Tri-Service General Hospital and
National Defense Medical Center, Taipei, Taiwan (Republic of China)
(Feng) Department of Biostatistics, The University of Texas MD Anderson
Cancer Center, Houston, TX, United States
Title
A Randomized Controlled Study of the Use of Video Double-Lumen
Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 267-274),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use
(1) during verification of initial placement and (2) for reconfirmation of
correct placement following repositioning, when either a double-lumen tube
(DLT) or video double-lumen tube (VDLT) was used for lung isolation during
thoracic surgery. Design: A randomized controlled study. Setting:
Single-center university teaching hospital. Participants: The study
comprised 80 patients who were 18 years or older requiring lung isolation
for surgery. Interventions: After institutional review board approval,
patients were randomized prior to surgery to either DLT or VDLT usage.
Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET
View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video
laryngoscopy then verified correct tube position through the view provided
with either VDLT external monitor or FOB. Measurements and Main Results:
Data collected included: sex, body mass index, successful intubation and
endobronchial placement, intubation time, confirmation time of tube
position, FOB use, quality of view, dislodgement of tube, and ability to
forewarn dislodgement of endobronchial cuff and complications. FOB use for
verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100%
[42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7%
[1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning
(VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during
surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to
forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8%
[2/42], p = 0.078). Conclusion: This study demonstrated a reduction of
86.8% in FOB use, which was a similar reduction found in other published
studies.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<66>
Accession Number
617532618
Author
Hernandez J.M.; Urso S.; Tena M.A.; Sadaba R.; Portela F.
Institution
(Hernandez) Servicio de Cardiologia, Hospital San Roque, Maspalomas, Spain
(Urso, Tena, Sadaba, Portela) Servicio de Cirugia Cardiaca, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
Title
Percutaneous left appendage closure: A systematic review of safety and
efficacy events.
Source
Cirugia Cardiovascular. 25 (1) (pp 17-23), 2018. Date of Publication:
January 2018.
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: The aim of the present study is to
systematically review the success rate of percutaneous left atrial
appendage closure, its efficacy and safety, and the incidence of
peri-device leakage. Methods: A bibliographic search was performed using
the Google Scholar, MEDLINE, EMBASE and Cochrane databases, restricting
this search in English and collecting articles published until 2016. Our
analysis was limited to those studies that met the following inclusion
criteria: 1) studies with a prospective unicenter, prospective multicenter
and retrospective multicentre design. 2) Studies that had a sample size >=
80 patients. Results: Data from the two clinical trials (PROTECT-AF and
PREVAIL) suggest that percutaneous exclusion of the left atrial appendage
provides a similar long-term rate of cerebrovascular embolic events and
mortality compared to warfarin therapy. In the PROTECT AF study, an
incidence of peri-device leak of 39% is documented. The remaining studies,
which analyze patients with contraindications to anticoagulation and
without a control group, report a significant rate of severe complications
related to the procedure (up to 13,7%), the most frequent cause being
pericardial effusion and/or cardiac tamponade. Conclusions: Percutaneous
closure of the left atrial appendage is associated with a significant
incidence of severe periprocedural complications and peri-device
leak.<br/>Copyright &#xa9; 2017 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<67>
Accession Number
611367894
Author
Coelho-Filho O.R.; Shah R.; Lavagnoli C.F.R.; Barros J.C.; Neilan T.G.;
Murthy V.L.; de Oliveira P.P.M.; Souza J.R.M.; de Oliveira Severino
E.S.B.; de Souza Vilarinho K.A.; da Mota Silveira Filho L.; Garcia J.;
Semigran M.J.; Coelho O.R.; Jerosch-Herold M.; Petrucci O.
Institution
(Coelho-Filho, Lavagnoli, Barros, de Oliveira, Souza, de Oliveira
Severino, de Souza Vilarinho, da Mota Silveira Filho, Coelho, Petrucci)
Faculty of Medical Science, State University of Campinas (UNICAMP),
Campinas, Sao Paulo, Brazil
(Shah) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Neilan, Garcia, Semigran) Massaschussetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Murthy) Cardiovascular Medicine Division, Department of Medicine,
University of Michigan, Ann Arbor, MI, United States
(Murthy) Nuclear Medicine Division, Department of Radiology, University of
Michigan, Ann Arbor, MI, United States
(Jerosch-Herold) Noninvasive Cardiovascular Imaging Program,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Jerosch-Herold) Department of Radiology, Brigham and Women's Hospital,
Boston, MA, United States
(Petrucci) Division of Cardiothoracic Surgery, Section of Pediatric
Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO,
United States
(Coelho-Filho) Discipline of Cardiology, Department of Internal Medicine,
Hospital das Clinicas, State University of Campinas, UNICAMP, Rua Vital
Brasil, 251-Cidade Universitaria "Zeferino Vaz", Campinas-SP, Sao Paulo
CEP 13083-888, Brazil
(Coelho-Filho) Fundacao Centro Medico de Campinas, Campinas, Sao Paulo,
Brazil
Title
Myocardial tissue remodeling after orthotopic heart transplantation: a
pilot cardiac magnetic resonance study.
Source
International Journal of Cardiovascular Imaging. 34 (1) (pp 15-24), 2018.
Date of Publication: 01 Jan 2018.
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
After orthotopic heart transplantation (OHT), the allograft undergoes
characteristic alterations in myocardial structure, including hypertrophy,
increased ventricular stiffness, ischemia, and inflammation, all of which
may decrease overall graft survival. Methods to quantify these phenotypes
may clarify the pathophysiology of progressive graft dysfunction post-OHT.
We performed cardiac magnetic resonance (CMR) with T1 mapping in 26 OHT
recipients (mean age 47 +/- 7 years, 30 % female, median follow-up
post-OHT 6 months) and 30 age-matched healthy volunteers (mean age 50.5
+/- 15 years; LVEF 63.5 +/- 7 %). OHT recipients had a normal left
ventricular ejection fraction (LVEF 65.3 +/- 11 %) with higher LV mass
relative to age-matched healthy volunteers (114 +/- 27 vs. 85.8 +/- 18 g;
p < 0.001). There was no late gadolinium enhancement in either group. Both
myocardial extracellular volume fraction (ECV) and intracellular lifetime
of water (tau<inf>ic</inf>), a measure of cardiomyocyte hypertrophy, were
higher in patients post-OHT (ECV: 0.39 +/- 0.06 vs. 0.28 +/- 0.03, p <
0.0001; tau<inf>ic</inf>: 0.12 +/- 0.08 vs. 0.08 +/- 0.03, p < 0.001). ECV
was associated with LV mass (r = 0.74, p < 0.001). In follow-up, OHT
recipients with normal biopsies by pathology (ISHLT grade 0R) in the first
year post-OHT exhibited a lower ECV relative to patients with any
rejection >=2R (0.35 +/- 0.02 for 0R vs. 0.45 +/- 0, p < 0.001). Higher
ECV but not LVEF was significantly associated with a reduced
rejection-free survival. After OHT, markers of tissue remodeling by CMR
(ECV and tau<inf>ic</inf>) are elevated and associated with myocardial
hypertrophy. Interstitial myocardial remodeling (by ECV) is associated
with cellular rejection. Further research on the impact of graft
preservation and early immunosuppression on tissue-level remodeling of the
allograft is necessary to delineate the clinical implications of these
findings.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
Dordrecht.

<68>
Accession Number
619924382
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.;
Kent B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.;
Mazer C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario,
Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, Ontario, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, The
Ottawa Hospital, General Campus, Centre for Practice-Changing Research,
Ottawa, Ontario, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, Ontario, Canada
(MacAdams) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, University of Melbourne, Toronto, Ontario, Canada
(Grocott) Departments of Anesthesia & Perioperative Medicine and Surgery,
University of Manitoba, St. Boniface General Hospital, Winnipeg, Manitoba,
Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, Quebec, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
(Royse, Royse) Department of Surgery, The University of Melbourne, The
Royal Melbourne Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, Ontario, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
Quebec, Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, Ontario, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN, United States
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Royse) Department of Cardiothoracic Anaesthesia, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 121-129),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity. Design: Transfusion Requirements in
Cardiac Surgery (TRICS) III was a multicenter, international, open-label
randomized controlled trial of two commonly used transfusion strategies in
patients having cardiac surgery using a noninferiority trial design
(ClinicalTrials.gov number, NCT02042898). Setting: Eligible patients were
randomized prior to surgery in a 1:1 ratio. Participants: Potential
participants were 18 years or older undergoing planned cardiac surgery
using cardiopulmonary bypass (CPB) with a preoperative European System for
Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more.
Interventions: Five thousand patients; those allocated to a restrictive
transfusion group received a red blood cell (RBC) transfusion if the
hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively
and/or postoperatively. Patients allocated to a liberal transfusion
strategy received RBC transfusion if the Hb was less than 9.5 g/dL
intraoperatively or postoperatively in the intensive care unit or less
than 8.5 g/dL on the ward. Measurements and Main Results: The primary
outcome was a composite of all-cause mortality, myocardial infarction,
stroke, or new onset renal dysfunction requiring dialysis at hospital
discharge or day 28, whichever comes first. The primary outcome was
analyzed as a per-protocol analysis. The trial monitored adherence closely
as adherence to the transfusion triggers is important in ensuring that
measured outcomes reflect the transfusion strategy. Conclusion: By
randomizing prior to surgery, the TRICS III trial captured the most acute
reduction in hemoglobin during cardiopulmonary bypass.<br/>Copyright
&#xa9; 2018

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

<70>
Accession Number
618981393
Author
Wilczynski M.; Wybraniec M.T.; Sanak M.; Goral J.; Mizia-Stec K.
Institution
(Wilczynski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
(Wybraniec, Mizia-Stec) First Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland
(Sanak) II Department of Internal Medicine, Division of Molecular Biology
and Clinical Genetics, Jagiellonian University Medical College, Krakow,
Poland
(Goral) Department of Laboratory Medicine, Public Hospital No 7 in
Katowice, Upper Silesia Medical Center, Katowice, Poland
Title
Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary
Artery Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (1) (pp 178-186),
2018. Date of Publication: February 2018.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of the study was to evaluate the impact of
intravenous metamizole on platelet inhibition by aspirin in patients with
coronary artery disease early after on-pump coronary artery bypass
grafting (CABG). Design: Prospective, single-blind, randomized trial.
Setting: Tertiary referal hospital. Participants: The study comprised 43
patients with multivessel coronary artery disease undergoing CABG.
Interventions: Patients were randomized to postoperative intravenous
metamizole +/- opioids (study group; n = 23) or opioids alone (control
group; n = 20). Aspirin was withheld at least 7 days before the surgery
and reinitiated (300 mg) immediately after the procedure prior to
metamizole use, and continued daily thereafter (150 mg). Platelet function
was evaluated using multielectrode impedance aggregometry (acid-induced
platelet activation [ASPI] and collagen-induced platelet activation [COL]
test), P-selectin expression and urinary 11-dehydro-thromboxane
B<inf>2</inf> (11-DTXB<inf>2</inf>) level at baseline, postoperative day
(POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was
defined as ASPI test >400 AU*min. Measurements and Main Results: In all
study participants, postoperative ASPI test value moderately decreased
(1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB<inf>2</inf> level
increased (923.4 v 4367.3 pg/mg, p < 0.001), and P-selectin expression and
COL test value remained stable postprocedure. The decreases of ASPI (p =
0.146) and COL test (p = 0.642), and P-selectin expression (p = 0.318) did
not differ between both groups. Patients in the control group had higher
postoperative increase of urinary 11-DTXB<inf>2</inf> level (p = 0.001).
The prevalence of RPR was high and comparable between study and control
groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p = 0.21).
Multivariate analysis revealed that metamizole use did not predict the
fluctuations of ASPI and COL test values and P-selectin expression, yet it
independently predicted postoperative change of 11-DTXB<inf>2</inf> level
(b = -0.518, p = 0.001). Conclusions: Intravenous metamizole preceded by a
loading dose of aspirin did not modify platelet response to aspirin in the
postoperative period after CABG.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<71>
Accession Number
619009547
Author
Soliman R.; Hussien M.
Institution
(Soliman) Departments of Cardiac Anesthesia, Madinah Cardiac Center,
Almadinah Almonwarah, Saudi Arabia
(Soliman) Department of Anesthesia, Cairo University, Giza, Egypt
(Hussien) Cardiac Surgery, Madinah Cardiac Center, Almadinah Almonwarah,
Saudi Arabia
Title
Comparison of the renoprotective effect of dexmedetomidine and dopamine in
high-risk renal patients undergoing cardiac surgery: A double-blind
randomized study.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 408-415), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The purpose of the current study was to compare the
renoprotective effects of continuous infusion of dexmedetomidine and
dopamine in high-risk renal patients undergoing cardiac surgery. Design: A
double-blind randomized study. Setting: Cardiac Centers. Patients: One
hundred and fifty patients with baseline serum creatinine level >=1.4
mg/dl were scheduled for cardiac surgery with cardiopulmonary bypass.
Intervention: The patients were classified into two groups (each = 75):
Group Dex - the patients received a continuous infusion of dexmedetomidine
0.4 mug/kg/h without loading dose during the procedure and the first 24
postoperative hours and Group Dopa - the patients received a continuous
infusion of dopamine 3 mug/kg/min during the procedure and the first 24
postoperative hours. Measurements: The monitors included serum creatinine,
creatinine clearance, blood urea nitrogen, and urine output. Main Results:
The creatinine levels and blood urea nitrogen decreased at days 1, 2, 3,
4, and 5 in Dex group and increased in patients of Dopa group (P < 0.05).
The creatinine clearance increased at days 1, 2, 3, 4, and 5 in Dex group
and decreased in patients of Dopa group (P < 0.05). The amount of urine
output was too much higher in the Dex group than the Dopa group (P <
0.05). Conclusions: The continuous infusion of dexmedetomidine during
cardiac surgery has a renoprotective effect and decreased the
deterioration in the renal function in high-risk renal patients compared
to the continuous infusion of dopamine.<br/>Copyright &#xa9; 2017 Annals
of Cardiac Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<72>
Accession Number
616132945
Author
Pagnesi M.; Montalto C.; Mangieri A.; Agricola E.; Puri R.; Chiarito M.;
Ancona M.B.; Regazzoli D.; Testa L.; De Bonis M.; Moat N.E.; Rodes-Cabau
J.; Colombo A.; Latib A.
Institution
(Pagnesi, Montalto, Mangieri, Ancona, Regazzoli, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Agricola) Echocardiography Laboratory, San Raffaele Scientific Institute,
Milan, Italy
(Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Laval University,
Quebec City, Canada
(Chiarito) Division of Clinical and Interventional Cardiology, Humanitas
Research Hospital, Milan, Italy
(Testa) Department of Cardiology, IRCCS Policlinico San Donato, Milan,
Italy
(De Bonis) Department of Cardiovascular and Thoracic Surgery, San Raffaele
Scientific Institute, Milan, Italy
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
London, United Kingdom
(Colombo) Vita-Salute San Raffaele University, Milan, Italy
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Tricuspid annuloplasty versus a conservative approach in patients with
functional tricuspid regurgitation undergoing left-sided heart valve
surgery: A study-level meta-analysis.
Source
International Journal of Cardiology. 240 (pp 138-144), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Tricuspid valve (TV) repair at the time of left-sided valve
surgery is indicated in patients with either severe functional tricuspid
regurgitation (TR) or mild-to-moderate TR with coexistent tricuspid
annular dilation or right heart failure. We assessed the benefits of a
concomitant TV repair strategy during left-sided surgical valve
interventions, focusing on mortality and echocardiographic TR-related
outcomes. Methods A meta-analysis was performed of studies reporting
outcomes of patients who underwent left-sided (mitral and/or aortic) valve
surgery with or without concomitant TV repair. Primary endpoints were
all-cause and cardiac-related mortality; secondary endpoints were the
presence of more-than-moderate TR, TR progression, and TR severity grade.
All endpoints were evaluated at the longest available follow-up. Results
Fifteen studies were included for a total of 2840 patients. TV repair at
the time of left-sided valve surgery was associated with a significantly
lower risk of cardiac-related mortality (odds ratio [OR] 0.38; 95%
confidence interval [CI]: 0.25-0.58; p < 0.001), with a trend towards a
lower risk of all-cause mortality (OR 0.57; 95% CI: 0.32-1.05; p = 0.07)
at a mean weighted follow-up of 6 years. The presence of
more-than-moderate TR (OR 0.19; 95% CI: 0.12-0.30; p < 0.001), TR
progression (OR 0.03; 95% CI: 0.01-0.05; p < 0.001), and TR grade
(standardized mean difference - 1.11; 95% CI: - 1.57 to - 0.65; p < 0.001)
were significantly lower in the TV repair group at a mean weighted
follow-up of 4.7 years. Conclusions A concomitant TV repair strategy
during left-sided valve surgery is associated with a reduction in
cardiac-related mortality and improved echocardiographic TR outcomes at
follow-up.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<73>
Accession Number
615431818
Author
Kwok C.S.; Bagur R.; Rashid M.; Lavi R.; Cibelli M.; de Belder M.A.; Moat
N.; Hildick-Smith D.; Ludman P.; Mamas M.A.
Institution
(Kwok, Bagur, Rashid, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Bagur) Division of Cardiology, London Health Sciences Centre, Department
of Medicine, Western University, London, Ontario, Canada
(Bagur) Department of Epidemiology and Biostatistics, Western University,
London, Ontario, Canada
(Lavi) Department of Anesthesia and Perioperative Medicine, London Health
Sciences Centre, Western University, London, Ontario, Canada
(Cibelli, Moat) Royal Brompton Hospital, London, United Kingdom
(de Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton & Sussex University
Hospitals, Brighton, United Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
Title
Aortic stenosis and non-cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 240 (pp 145-153), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Aortic stenosis (AS) poses a perioperative management dilemma
to physicians looking after patients who require non-cardiac surgery. The
objective of this review is to investigate mortality and adverse
cardiovascular events in patients with and without AS who underwent
non-cardiac surgery. Methods We searched MEDLINE and EMBASE for studies
that evaluated mortality and adverse cardiovascular events in patients
with and without AS who underwent non-cardiac surgery. Pooled risk ratios
for mortality and adverse outcomes (myocardial infarction, stroke, heart
failure, death) were calculated using the dichotomous analysis method and
subgroup analysis was performed considering the effect of severity of AS
and symptoms. Results We identified 9 relevant studies with 29,327
participants. Among studies of severe AS, there was no significant
difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P = 0.16) associated
with non-cardiac surgery, but there was a significant increase in the
composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P = 0.003). When the
analysis involved any other degree of AS, eight studies were included and
the pooled results showed a significant increase in composite adverse
outcome (RR: 1.64, 95%CI:1.23-2.19; P < 0.001) and myocardial infarction
(RR: 1.90, 95%CI:1.54-2.34; P < 0.001). When patients with asymptomatic AS
were considered, the pooled results of four studies suggested an increased
risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P = 0.002)
but not mortality, myocardial infarction, heart failure or stroke.
Conclusions Patients with AS undergoing non-cardiac surgery have not been
shown to be at increased risk of mortality, but have significantly higher
rates of adverse cardiovascular events compared to patients without
AS.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<74>
Accession Number
609203018
Author
Karthikesalingam A.; Holt P.J.; Thompson M.M.; Bak A.A.A.; Pattynama P.M.;
Van Voorthuisen A.E.; Grobbee D.E.; Hunink M.G.; Van Engelshoven J.M.;
Jacobs M.J.H.M.; De Mol B.A.J.M.; Van Bockel J.H.; Reekers J.; Tielbeek
X.; Boekema N.; Heuveling L.M.; Sikking I.; Cuypers P.W.M.; De Bruin J.L.;
Baas A.F.; Prinssen M.; Buth J.; Tielbeek A.V.; Blankensteijn J.D.; Balm
R.; Reekers J.A.; Van Sambeek M.R.H.M.; Pattynama P.; Verhoeven E.L.G.;
Prins T.; Van Der Ham A.C.; Van Der Velden J.J.I.M.; Van Sterkenburg
S.M.M.; Ten Haken G.B.; Bruijninckx C.M.A.; Van Overhagen H.; Tutein
Nolthenius R.P.; Hendriksz T.R.; Teijink J.A.W.; Odink H.F.; De Smet
A.A.E.A.; Vroegindeweij D.; Van Loenhout R.M.M.; Rutten M.J.; Hamming
J.F.; Lampmann L.E.H.; Bender M.H.M.; Pasmans H.; Vahl A.C.; De Vries C.;
MacKaay A.J.C.; Van Dortmont L.M.C.; Van Der Vliet A.J.; Schultze Kool
L.J.; Boomsma J.H.B.; Van H.R.; De Mol Van Otterloo J.C.A.; De Rooij
T.P.W.; Smits T.M.; Yilmaz E.N.; Wisselink W.; Van Den Berg F.G.; Visser
M.J.T.; Van Der Linden E.; Schurink G.W.H.; De Haan M.; Smeets H.J.;
Stabel P.; Van Elst F.; Poniewierski J.; Vermassen F.E.G.
Institution
(De Bruin, Blankensteijn) Division of Vascular Surgery, Department of
Surgery, VU University Medical Center, Amsterdam, Netherlands
(De Bruin, Karthikesalingam, Holt, Thompson) Division of Vascular Surgery,
St George's Vascular Institute, St George's Healthcare NHS Trust, St James
Wing, Blackshaw Rd, London SW17 0QT, United Kingdom
(Prinssen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Title
Predicting reinterventions after open and endovascular aneurysm repair
using the St George's Vascular Institute score.
Source
Journal of Vascular Surgery. 63 (6) (pp 1428-1433e1), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Identifying patients at risk for aneurysm rupture and sac
expansion after open and endovascular abdominal aortic aneurysm (AAA)
repair (EVAR) may help to attenuate this risk by intensifying follow-up
and early detection of problems. The goal of this study was to validate
the St George's Vascular Institute (SGVI) score to identify patients at
risk for a secondary intervention after elective aneurysm repair. Methods
A post hoc on-treatment analysis of a randomized trial comparing open AAA
repair and EVAR was performed. In this multicenter trial, 351 patients
were randomly assigned to undergo open AAA repair or EVAR. Information on
survival and reinterventions was available for all patients at 5 years
postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair
was completed in 173 patients and EVAR in 171, based on an on-treatment
analysis. Because 17 patients had incomplete anatomic data, 327 patients
(157 open repair and 170 EVAR) were available for analysis. During 6 years
of follow-up, 78 patients underwent at least one reintervention. The SGVI
score, which is calculated from preoperative AAA morphology using aneurysm
and iliac diameter, predictively dichotomized patients into groups at
high-risk or low-risk for a secondary intervention. The observed freedom
from reintervention was compared between groups at predicted high-risk and
predicted low-risk. Results The 20 patients in the high-risk group were
indeed at higher risk for a secondary intervention compared with the 307
patients predicted to be at low risk (hazard ratio [HR], 3.82; 95%
confidence interval [CI], 2.05-7.11; P <.001). Discrimination between
high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI,
1.93-8.51; P <.001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P
=.033). Conclusions The SGVI score appears to be a useful tool to predict
reintervention risk in patients after open repair and EVAR.<br/>Copyright
&#xa9; 2016 Society for Vascular Surgery.

<75>
Accession Number
617329777
Author
Brugaletta S.; Gomez-Lara J.; Caballero J.; Ortega-Paz L.; Teruel L.;
Jimenez Fernandez M.; Romaguera R.; Alcalde Martinez V.; Nato M.; Molina
Navarro E.; Gomez-Hospital J.-A.; Correa Vilches C.; Joyera M.; Cequier
A.; Sabate M.
Institution
(Brugaletta, Ortega-Paz, Sabate) Cardiovascular Institute, Hospital
Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
(Gomez-Lara, Teruel, Romaguera, Nato, Gomez-Hospital, Cequier) Heart
Disease Institute, Bellvitge Universitari Hospital, Universitari of
Barcelona, IDIBELL, Barcelona, Spain
(Caballero, Jimenez Fernandez, Alcalde Martinez, Molina Navarro, Correa
Vilches) Hospitales Universitarios San Cecilio y Virgen de las Nieves,
Granada, Spain
(Joyera) Hospital Clinic, Barcelona, Spain
Title
TIcaGrEloR and Absorb bioresorbable vascular scaffold implantation for
recovery of vascular function after successful chronic total occlusion
recanalization (TIGER-BVS trial): Rationale and study design.
Source
Catheterization and Cardiovascular Interventions. 91 (1) (pp 1-6), 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 explore the role of ticagrelor versus clopidogrel in
coronary blood flow normalization immediately after chronic coronary total
occlusion (CTO) recanalization. Background: Coronary vascular function of
a CTO immediately after recanalization is demonstrated to be poor.
Methods: The TIGER BVS is a prospective, double-randomized, open-label,
two parallel-group controlled clinical trial to evaluate efficacy of
ticagrelor versus clopidogrel in improving vascular function of coronary
segment distal to CTO immediately after CTO recanalization. A total of 50
patients who receive CTO PCI will be randomized 1:1 to receive ticagrelor
versus clopidogrel at least 3 days before the procedure. Immediately after
CTO recanalization with Absorb BVS implantation, a specific study of
vascular function under adenosine infusion will be performed. Patients
will be therefore randomized 1:1 to receive angiographic follow-up with
vascular function and optical coherence tomography analyses at 1- or
3-year follow-up. This study is registered on ClinicalTrials.gov with
number NCT02211066. Conclusions: The TIGER BVS trial will provide the
first randomized comparison between ticagrelor versus clopidogrel in
recovering vascular function in CTO patients. It will also provide
important data on vascular restoration therapy of Absorb BVS in this
scenario.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<76>
Accession Number
605909981
Author
Mashaqi B.; Ismail I.; Siemeni T.T.; Ruemke S.; Fleissner F.; Zhang R.;
Wiegmann B.; Filitz J.; Gottlieb J.; Haverich A.
Institution
(Mashaqi, Ismail, Siemeni, Ruemke, Fleissner, Zhang, Wiegmann, Haverich)
Department of Thoracic, Transplant and Cardiovascular Surgery, Hannover
Medical School, Carl-Neuberg-Str.1, Hannover 30625, Germany
(Filitz) Department of Anesthesiology and Intensive Care, Hannover Medical
School, Hannover, Germany
(Gottlieb) Department of Respiratory Medicine, Hannover Medical School,
Hannover, Germany
Title
Local Anesthetics delivered through Pleural Drainages improve Pain and
Lung Function after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 66 (2) (pp 198-202), 2018. Date of
Publication: 01 Mar 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective Pleural tubes after coronary artery bypass graft (CABG) surgery
usually cause pain resulting interalia in an impact of postoperative
breathing. Therefore, the influence of intrapleural lidocaine application
through special double-lumen chest tubes with respect to pain relief and
lung function was investigated and compared with placebo. Methods In this
study, 40 patients who underwent CABG got intrapleural injection either
with 2% lidocaine (n = 20) or placebo (0.9% saline solution) (n = 20) on
the first 2 days after surgery. Pain was measured by pain intensity
numeric rating scale (NRS) (0 = no pain; 10 = the most intense pain) and
lung function by portable spirometer. Results On the first postoperative
day (POD1), mean pain reduction was NRS 1.9 for the lidocaine group with
an improvement of the forced expiratory volume in 1 second (FEV1) of 0.51
L. Similar results were shown on the second postoperative day (POD2) with
a decreased pain level of mean NRS 1.65 and an FEV1 improvement of 0.26 L.
In comparison, results of the placebo group showed no significant pain
reduction, neither on the POD1 (NRS 0.35; p = 0.429) nor on the POD2 (NRS
0.55; p = 0.159). Also, there was no significant influence of FEV1 after
placebo on the POD1 (FEV1 = 0.048 L; p = 0.70) or on the POD2 (FEV1 =
0.0135 L; p = 0.925). Conclusion Intrapleural application of lidocaine is
a safe and feasible method to reduce drainage-related pain and improving
lung function after CABG.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG
Stuttgart, New York.

<77>
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.

<78>
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.

<79>
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.

<80>
Accession Number
621102968
Author
Obeid S.; Yousif N.; Schelldorfer A.; Shahin M.; Raber L.; Gencer B.; Mach
F.; Roffi M.; Matter C.M.; Windecker S.; Luscher T.F.
Institution
(Luscher) Royal Brompton and Harefield Hospital, Imperial College, London
SW3 6NP, United Kingdom
(Obeid, Yousif, Schelldorfer, Shahin, Raber, Gencer, Mach, Roffi, Matter,
Windecker) Department of Cardiology, University Heart Center, University
Hospital Zurich, Switzerland
Title
Short-Term Outcome after Left Main Interventions in Patients Presenting
with Acute Coronary Syndrome.
Source
Journal of Invasive Cardiology. 30 (3) (pp 98-104), 2018. Date of
Publication: March 2018.
Publisher
HMP Communications
Abstract
OBJECTIVE: To assess the efficacy and safety of coronary left main (LM)
disease interventions in patients with acute coronary syndromes (ACS) as
compared to those without LM coronary artery disease. METHODS: A total of
2899 patients with ACS, enrolled in the prospective Swiss Program
University Medicine ACS (SPUM-ACS) cohort, were included. The primary
endpoints of independently adjudicated major adverse cardiovascular and
cerebrovascular event (MACCE) and net adverse clinical event (NACE) were
determined at 30-day follow-up. RESULTS: Seventy-one (2.0%) of the 2899
ACS patients had significant LM disease. At 30-day follow-up, the primary
outcomes of MACCE and NACE occurred in 140 patients (4.8%) and 272
patients (9.4%), respectively. Compared to those without LM disease,
patients in the LM group were significantly older (P<.001), had a higher
incidence of hypertension (P<.001) and diabetes (P<=.013), and more often
had a history of coronary artery bypass graft (CABG) surgery (P<.001).
Analyses on non-matched populations showed a nearly significant trend
toward a higher incidence of MACCE (P<=.06) and NACE (P<=.10) in patients
with LM disease compared to those without LM disease. This trend, however,
disappeared after matching the populations for all significant confounding
variables on a 3:1 basis. This subanalysis showed MACCE rates of 10.0% in
the LM group and 7.3% in the non-LM group (P<=.61). Notably, the matched
patients with LM disease treated with percutaneous coronary intervention
had a lower NACE incidence when compared to those undergoing urgent CABG
surgery (P<.01). CONCLUSIONS: In ACS patients with LM disease,
revascularization with PCI is feasible and safe, with short-term outcomes
comparable to ACS patients without significant LM disease.<br/>Copyright
&#xa9; 2018 HMP Communications. All rights reserved.

<81>
Accession Number
615095875
Author
Singh V.; Yadav P.K.; Eng M.H.; Macedo F.Y.; Silva G.V.; Mendirichaga R.;
Badiye A.P.; Sakhuja R.; Elmariah S.; Inglessis I.; Alfonso C.E.;
Schreiber T.L.; Cohen M.; Palacios I.; O'Neill W.W.
Institution
(Singh, Sakhuja, Elmariah, Inglessis, Palacios) Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Yadav) Penn State Milton S. Hershey Medical Center, Hershey, PA, United
States
(Eng, O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Macedo, Silva) Baylor College of Medicine, Houston, TX, United States
(Silva) Texas Heart Institute, Houston, TX, United States
(Mendirichaga, Badiye, Alfonso, Cohen) University of Miami Miller School
of Medicine, Miami, FL, United States
(Schreiber) Detroit Medical Center and Wayne State University, Detroit,
MI, United States
Title
Outcomes of hemodynamic support with Impella in very high-risk patients
undergoing balloon aortic valvuloplasty: Results from the Global cVAD
Registry.
Source
International Journal of Cardiology. 240 (pp 120-125), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Reports on the role of hemodynamic support devices in patients
with severe aortic stenosis (AS) and left ventricular (LV) dysfunction
undergoing balloon aortic valvuloplasty (BAV) are limited. Methods
Patients were identified from the cVAD registry, an ongoing multicenter
voluntary registry at selected sites in North America that have used
Impella in > 10 patients. Results A total of 116 patients with AS who
underwent BAV with Impella support were identified. Mean age was 80.41 +/-
9.03 years and most patients were male. Mean STS score was 18.77% +/-
18.32, LVEF was 27.14% +/- 16.07, and 42% underwent concomitant PCI. In
most cases Impella was placed electively prior to BAV, whereas 26.7% were
placed as an emergency. The two groups had similar baseline
characteristics except for higher prevalence of CAD and lower LVEF in the
elective group, and higher STS score in the emergency group. Elective
strategy was associated higher 1-year survival compared to emergency
placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when
BAV was used as a bridge to definitive therapy as opposed to palliative
treatment (90% vs. 28%, p < 0.001). On multivariate analysis, STS score
and aim of BAV (bridge to definitive therapy vs. palliative indication)
were independent predictors of mortality. Conclusion In this large cohort
of patients with AS and severe LV dysfunction undergoing BAV, our results
demonstrates feasibility and promising long-term outcomes using elective
Impella support with the intention to bridge to a definitive
therapy.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<82>
Accession Number
615175939
Author
Hahn J.-Y.; Choi S.-H.; Jeong J.-O.; Song Y.B.; Choi J.-H.; Park Y.H.;
Chun W.J.; Oh J.H.; Cho D.K.; Lim S.-H.; Choi Y.J.; Im E.-S.; Won K.-H.;
Lee S.Y.; Kim S.-W.; Gwon H.-C.
Institution
(Hahn, Choi, Song, Choi, Gwon) Division of Cardiology, Department of
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Jeong) Chungnam National University Hospital, Daejeon, South Korea
(Park, Chun, Oh) Samsung Changwon Hospital, Sungkyunkwan University School
of Medicine, Changwon, South Korea
(Cho) Hanmaeum Hospital, Jeju, South Korea
(Lim) Dankook University Hospital, Cheonan, South Korea
(Choi) Eulji Medical Center, Eulji University, Daejeon, South Korea
(Im) Dongsuwon General Hospital, Suwon, South Korea
(Won) Seoul Medical Center, Seoul, South Korea
(Lee) Inje University Ilsan Paik Hospital, Goyang, South Korea
(Kim) Chung-Ang University Hospital, Seoul, South Korea
Title
Conservative versus aggressive treatment strategy with angiographic
guidance alone in patients with intermediate coronary lesions: The
SMART-CASE randomized, non-inferiority trial.
Source
International Journal of Cardiology. 240 (pp 114-119), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Although coronary angiography is still the technique most
widely used to guide percutaneous coronary intervention (PCI), the
appropriate angiographic indication of revascularization for intermediate
coronary lesions remains controversial. The aim of this study was to
compare conservative versus aggressive strategies with angiographic
guidance alone in patients with intermediate coronary lesions. Methods and
results A total of 899 patients with intermediate coronary lesions between
50% and 70% diameter stenosis by quantitative coronary analysis were
randomly assigned to the conservative group (n = 449) or the aggressive
group (n = 450). For intermediate lesions, PCI was performed using
everolimus-eluting stents in the aggressive group, but was deferred in the
conservative group. The primary end point was a composite of all-cause
death, myocardial infarction, or any revascularization at 1 year. The
number of treated lesions per patient was 0.8 +/- 0.9 in the conservative
group and 1.7 +/- 0.9 in the aggressive group (p < 0.001). The cumulative
rate of the primary endpoint was 7.3% in the conservative group and 6.8%
in the aggressive group (the upper limit of the one-sided 95% confidence
interval [CI], 3.4%; p = 0.006 for non-inferiority with a predefined
non-inferiority margin of 5.0%). The risk of death or myocardial
infarction (hazard ratio [HR] 0.50; 95% CI, 0.19-1.33; p = 0.17) and
revascularization (HR 1.42; 95% CI, 0.80-2.52; p = 0.23) was not
significantly different between the 2 groups. Conclusions Conservative
revascularization was non-inferior to aggressive revascularization for
intermediate coronary lesions. Revascularization of intermediate lesions
can be safely deferred in patients undergoing PCI with angiographic
guidance alone. Clinical trial registration: URL:
http://ClinicalTrials.gov. Unique identifier: NCT00743899.<br/>Copyright
&#xa9; 2017

<83>
Accession Number
621538988
Author
Kotronias R.A.; Kwok C.S.; George S.; Capodanno D.; Ludman P.F.; Townend
J.N.; Doshi S.N.; Khogali S.S.; Genereux P.; Herrmann H.C.; Mamas M.A.;
Bagur R.
Institution
(Kotronias, Kwok, George, Mamas, Bagur) Keele Cardiovascular Research
Group, Institute for Applied Clinical Science and Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, University of
Keele, Stoke-on-Trent, United Kingdom
(Kotronias) Oxford University Clinical Academic Graduate School, Oxford
University, Oxford, United Kingdom
(Kwok, George, Mamas) The Heart Centre, Royal Stoke Hospital, University
Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom
(Capodanno) Cardio-Thoracic-Vascular Department, Ferrarotto Hospital
University of Catania, Italy
(Ludman, Townend, Doshi) Department of Cardiology, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
(Khogali) The Heart and Lung Centre, New Cross Hospital, Wolverhampton,
United Kingdom
(Genereux) Cardiovascular Research Foundation, New York, NY
(Genereux) Columbia University Medical Center/New York-Presbyterian
Hospital, New York, NY
(Genereux) Morristown Medical Center, Morristown, NJ
(Herrmann) Cardiology Division, Department of Medicine, Perelman School of
Medicine of the University of Pennsylvania, Philadelphia, PA
(Bagur) Division of Cardiology, Department of Medicine, London Health
Sciences Centre, London, Ontario, Canada
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, Western University, London, Ontario, Canada
Title
Transcatheter Aortic Valve Implantation With or Without Percutaneous
Coronary Artery Revascularization Strategy: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. 6 (6) (no pagination), 2017.
Date of Publication: 27 Jun 2017.
Abstract
METHODS AND RESULTS: We conducted a search of Medline and Embase to
identify studies evaluating patients who underwent transcatheter aortic
valve implantation with or without percutaneous coronary intervention.
Random-effects meta-analyses with the inverse variance method were used to
estimate the rate and risk of adverse outcomes. Nine studies involving
3858 participants were included in the meta-analysis. Patients who
underwent revascularization with percutaneous coronary intervention had a
higher rate of major vascular complications (odd ratio [OR]: 1.86; 95%
confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality
(OR: 1.42; 95% CI, 1.08-1.87; P=0.01). There were no differences in effect
estimates for 30-day cardiovascular mortality (OR: 1.03; 95% CI,
0.35-2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14-5.28), acute
kidney injury (OR: 0.89; 95% CI, 0.42-1.88), stroke (OR: 1.07; 95% CI,
0.38-2.97), or 1-year mortality (OR: 1.05; 95% CI, 0.71-1.56). The timing
of percutaneous coronary intervention (same setting versus a priori) did
not negatively influence outcomes.
CONCLUSIONS: Our analysis suggests that revascularization before
transcatheter aortic valve implantation confers no clinical advantage with
respect to several patient-important clinical outcomes and may be
associated with an increased risk of major vascular complications and
30-day mortality. In the absence of definitive evidence, careful
evaluation of patients on an individual basis is of paramount importance
to identify patients who might benefit from elective revascularization.
BACKGROUND: Recent recommendations suggest that in patients with severe
aortic stenosis undergoing transcatheter aortic valve implantation and
coexistent significant coronary artery disease, the latter should be
treated before the index procedure; however, the evidence basis for such
an approach remains limited. We performed a systematic review and
meta-analysis to study the clinical outcomes of patients with coronary
artery disease who did or did not undergo revascularization prior to
transcatheter aortic valve implantation.<br/>Copyright &#xa9; 2017 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<84>
Accession Number
621531363
Author
Anonymous
Title
Erratum to: Deep hypothermic circulatory arrest or tepid regional cerebral
perfusion: Impact on haemodynamics and myocardial integrity in a
randomized experimental trial (Interactive CardioVascular and Thoracic
Surgery (2018) 26 (667-672) DOI: 10.1093/icvts/ivx393).
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 715), 2018.
Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
The acknowledgement section in this article has been removed by error at
proof stage. The missing section is reproduced below and is now included
in the final printed version of the above article. The editorial office
apologise for this unfortunate occurrence. ACKNOWLEDGEMENT This study was
performed in fulfillment of the requirement for obtaining the degree Dr.
med.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<85>
Accession Number
621531340
Author
Deng H.-Y.; Qin C.-L.; Qiu X.-M.; Zhou Q.
Institution
(Deng, Qin, Qiu, Zhou) Lung Cancer Center, West China Hospital, Sichuan
University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Does high body mass index have any impact on survival of patients
undergoing oesophagectomy for oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 693-695),
2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does high body mass index
(BMI) have any impact on survival of patients undergoing oesophagectomy
for oesophageal cancer?' A total of 232 papers were found using the
reported search, of which 8 papers represented the best evidence to answer
the clinical question, which included 1 meta-analysis and 7 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. One meta-analysis and 4 cohort studies provided the
evidence that high BMI was significantly correlated with a better survival
of oesophageal cancer patients undergoing oesophagectomy, while the other
3 cohort studies found that high BMI had no impact on the survival of
those patients. We conclude that patients with high BMI may have a better
prognosis than those with normal BMI undergoing oesophagectomy for
oesophageal cancer.<br/>Copyright &#xa9; The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<86>
Accession Number
621531250
Author
Zhao Y.; Peng H.; Li X.; Qin Y.; Cao F.; Peng D.; Liu J.
Institution
(Zhao, Peng, Cao, Peng) Department of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Li, Qin, Liu) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Anzhen Road, Chaoyang District, Beijing 100029, China
Title
Dual antiplatelet therapy after coronary artery bypass surgery: Is there
an increase in bleeding risk? A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 573-582),
2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES: There is increasing evidence that dual antiplatelet therapy
(DAPT) when compared with single antiplatelet therapy may improve venous
graft patency after coronary artery bypass graft. However, it is not yet
known whether postoperative administration of DAPT may increase the
potential risk of bleeding, especially in the early postoperative period.
METHODS: We searched studies on PubMed, Embase, Web of Science and the
Cochrane Central Register of Controlled Trials. Relative risk (RR) was
pooled with 95% confidence intervals (CIs) for dichotomous data. Prior
subgroup analyses were performed to look for potential heterogeneity.
RESULTS: Thirteen studies involving 23 591 participants were included. Our
meta-analysis showed that DAPT does not increase the risk of major
bleeding (randomized controlled trials group: RR = 1.28, 95% CI 0.951.71;
cohort studies group: RR = 0.99, 95% CI 0.661.51) and minor bleeding
(randomized controlled trials group: RR = 1.15, 95% CI 0.731.81; cohort
studies group: RR = 0.84, 95% CI 0.371.93) when compared with single
antiplatelet therapy. Meanwhile, DAPT does not increase the incidence of
major bleeding events during hospitalization (randomized controlled trials
group: RR = 1.27, 95% CI 0.911.78; cohort studies group: RR = 0.50, 95% CI
0.122.09). Sensitivity analyses showed that our results are stable, and
there was no evidence of publication bias. CONCLUSIONS: DAPT does not
increase the risk of major bleeding and minor bleeding when compared with
single antiplatelet therapy. Postoperative administration of DAPT is
considered to be safe in patients after coronary artery bypass graft, even
in the early postoperative period.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<87>
Accession Number
2000588272
Author
Goecke T.; Theodoridis K.; Tudorache I.; Ciubotaru A.; Cebotari S.; Ramm
R.; Hoffler K.; Sarikouch S.; Vasquez Rivera A.; Haverich A.; Wolkers
W.F.; Hilfiker A.
Institution
(Goecke, Theodoridis, Tudorache, Ciubotaru, Cebotari, Hoffler, Sarikouch,
Haverich) Department of Cardiac-, Thoracic-, Transplantation and Vascular
Surgery, Hannover Medical School, Hannover, Germany
(Goecke, Theodoridis, Tudorache, Cebotari, Ramm, Haverich, Hilfiker)
Leibniz Research Laboratories for Biotechnology and Artificial Organs
(LEBAO), Hannover Medical School, Hannover, Germany
(Vasquez Rivera, Wolkers) Institute of Multiphase Processes, Leibniz
Universitat Hannover, Hannover, Germany
Title
In vivo performance of freeze-dried decellularized pulmonary heart valve
allo- and xenografts orthotopically implanted into juvenile sheep.
Source
Acta Biomaterialia. 68 (pp 41-52), 2018. Date of Publication: 1 March
2018.
Publisher
Acta Materialia Inc (E-mail: actachair@actamaterialia.org)
Abstract
The decellularization of biological tissues decreases immunogenicity,
allows repopulation with cells, and may lead to improved long-term
performance after implantation. Freeze drying these tissues would ensure
off-the-shelf availability, save storage costs, and facilitates easy
transport. This study evaluates the in vivo performance of freeze-dried
decellularized heart valves in juvenile sheep. TritonX-100 and sodium
dodecylsulfate decellularized ovine and porcine pulmonary valves (PV) were
freeze-dried in a lyoprotectant sucrose solution. After rehydration for 24
h, valves were implanted into the PV position in sheep as allografts
(fdOPV) and xenografts (fdPPV), while fresh dezellularized ovine grafts
(frOPV) were implanted as controls. Functional assessment was performed by
transesophageal echocardiography at implantation and at explantation six
months later. Explanted grafts were analysed histologically to assess the
matrix, and immunofluorescence stains were used to identify the
repopulating cells. Although the graft diameters and orifice areas
increased, good function was maintained, except for one insufficient,
strongly deteriorated frOPV. Cells which were positive for either
endothelial or interstitial markers were found in all grafts. In fdPPV,
immune-reactive cells were also found. Our findings suggest that
freeze-drying does not alter the early hemodynamic performance and
repopulation potential of decellularized grafts in vivo, even in the
challenging xenogeneic situation. Despite evidence of an immunological
reaction for the xenogenic valves, good early functionalities were
achieved. Statement of Significance: Decellularized allogeneic heart
valves show excellent results as evident from large animal experiments and
clinical trials. However, a long-term storing method is needed for an
optimal use of this limited resource in the clinical setting, where an
optimized matching of graft and recipient is requested. As demonstrated in
this study, freeze-dried and freshly decellularized grafts reveal equally
good results after implantation in the juvenile sheep concerning function
and repopulation with recipients' cells. Thus, freeze-drying arises as a
promising method to extend the shelf-life of valvular grafts compared to
those stored in antibiotic-solution as currently practised.<br/>Copyright
&#xa9; 2017 Acta Materialia Inc.

<88>
Accession Number
619266041
Author
Lopez F.J.G.; Ruiz-Tovar M.; Almazan-Isla J.; Alcalde-Cabero E.; Calero
M.; de Pedro-Cuesta J.
Institution
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, de Pedro-Cuesta)
National Epidemiology Centre, Carlos III Institute of Health, Madrid,
Spain
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, Calero, de Pedro-Cuesta)
Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED),
Madrid, Spain
(Calero) Carlos III Institute of Health, Madrid, Spain
(Calero) Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia
Foundation Alzheimer Centre, Madrid, Spain
Title
Risk of transmission of sporadic Creutzfeldt-Jakob disease by surgical
procedures: Systematic reviews and quality of evidence.
Source
Eurosurveillance. 22 (43) (no pagination), 2017. Date of Publication: 26
Oct 2017.
Publisher
European Centre for Disease Prevention and Control (ECDC) (ECDC, Stockholm
171 83, Sweden)
Abstract
Background: Sporadic Creutzfeldt-Jakob disease (sCJD) is potentially
transmissible to humans. Objective: This study aimed to summarise and rate
the quality of the evidence of the association between surgery and sCJD.
Design and methods: Firstly, we conducted systematic reviews and
meta-analyses of case-control studies with major surgical procedures as
exposures under study. To assess quality of evidence, we used the Grading
of Recommendations, Assessment, Development and Evaluations (GRADE)
approach. Secondly, we conducted a systematic review of sCJD case reports
after sharing neurosurgical instruments. Results: Thirteen case-control
studies met the inclusion criteria for the systematic review of
case-control studies. sCJD was positively associated with heart surgery,
heart and vascular surgery and eye surgery, negatively associated with
tonsillectomy and appendectomy, and not associated with neurosurgery or
unspecified major surgery. The overall quality of evidence was rated as
very low. A single case-control study with a low risk of bias found a
strong association between surgery conducted more than 20 years before
disease onset and sCJD. Seven cases were described as potentially
transmitted by reused neurosurgical instruments. Conclusion: The
association between surgery and sCJD remains uncertain. Measures currently
recommended for preventing sCJD transmission should be strongly
maintained. Future studies should focus on the potential association
between sCJD and surgery undergone a long time previously.<br/>Copyright
&#xa9; The Authors, 2017.

<89>
Accession Number
616777963
Author
Brainard J.; Scott B.K.; Sullivan B.L.; Fernandez-Bustamante A.; Piccoli
J.R.; Gebbink M.G.; Bartels K.
Institution
(Brainard, Scott, Sullivan, Fernandez-Bustamante, Bartels) Department of
Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th
Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045,
United States
(Piccoli, Gebbink) Department of Respiratory Care, University of Colorado
Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, United
States
Title
Heated humidified high-flow nasal cannula oxygen after thoracic surgery -
A randomized prospective clinical pilot trial.
Source
Journal of Critical Care. 40 (pp 225-228), 2017. Date of Publication: 01
Aug 2017.
Publisher
W.B. Saunders
Abstract
Background Thoracic surgery patients are at high-risk for adverse
pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen
(HHFNC O<inf>2</inf>) may decrease such events. We hypothesized that
patients randomized to prophylactic HHFNC O<inf>2</inf> would develop
fewer pulmonary complications compared to conventional O<inf>2</inf>
therapy. Methods and patients Fifty-one patients were randomized to HHFNC
O<inf>2</inf> vs. conventional O<inf>2</inf>. The primary outcome was a
composite of postoperative pulmonary complications. Secondary outcomes
included oxygenation and length of stay. Continuous variables were
compared with t-test or Mann-Whitney-U test, categorical variables with
Fisher's Exact test. Results There were no differences in postoperative
pulmonary complications based on intention to treat [two in HHFNC
O<inf>2</inf> (n = 25), two in control (n = 26), p = 0.680], and after
exclusion of patients who discontinued HHFNC O<inf>2</inf> early [one in
HHFNC O<inf>2</inf> (n = 18), two in control (n = 26), p = 0.638].
Discomfort from HHFNC O<inf>2</inf> occurred in 11/25 (44%); 7/25 (28%)
discontinued treatment. Conclusions Pulmonary complications were rare
after thoracic surgery. Although HHFNC O<inf>2</inf> did not convey
significant benefits, these results need to be interpreted with caution,
as our study was likely underpowered to detect a reduction in pulmonary
complications. High rates of patient-reported discomfort with HHFNC
O<inf>2</inf> need to be considered in clinical practice and future
trials.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<90>
Accession Number
616606442
Author
Joannidis M.; Druml W.; Forni L.G.; Groeneveld A.B.J.; Honore P.M.; Hoste
E.; Ostermann M.; Schetz M.
Institution
(Joannidis) Division of Intensive Care and Emergency Medicine, Department
of Internal Medicine, Medical University Innsbruck, Anichstasse 35,
Innsbruck 6020, Austria
(Druml) Department of Internal Medicine III, University Hospital Vienna,
Vienna, Austria
(Forni) Department of Clinical and Experimental Medicine, Faculty of
Health and Medical Sciences, University of Surrey and Surrey Perioperative
Anaesthesia and Critical Care Collaborative Research Group (SPACeR),
Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust,
Egerton Road, Guildford GU2 7XX, United Kingdom
(Honore) Department of Intensive Care, Universitair Ziekenhuis Brussel,
Vrije Universiteit Brussel (VUB), Brussels, Belgium
(Hoste) Department of Intensive Care Medicine, Ghent University Hospital,
Ghent University, De Pintelaan 185, Ghent 9000, Belgium
(Ostermann) Department of Critical Care and Nephrology, Guy's and St
Thomas' Hospital, London, United Kingdom
(Oudemans-van Straaten) Department of Adult Intensive Care, VU University
Medical Centre, De Boelelaan 1118, Amsterdam 1081 HZ, Netherlands
(Schetz) Clinical Department and Laboratory of Intensive Care Medicine,
Division of Cellular and Molecular Medicine, KU Leuven University, Leuven,
Belgium
Title
Prevention of acute kidney injury and protection of renal function in the
intensive care unit: update 2017: Expert opinion of the Working Group on
Prevention, AKI section, European Society of Intensive Care Medicine.
Source
Intensive Care Medicine. 43 (6) (pp 730-749), 2017. Date of Publication:
01 Jun 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: Acute kidney injury (AKI) in the intensive care unit is
associated with significant mortality and morbidity. Objectives: To
determine and update previous recommendations for the prevention of AKI,
specifically the role of fluids, diuretics, inotropes,
vasopressors/vasodilators, hormonal and nutritional interventions,
sedatives, statins, remote ischaemic preconditioning and care bundles.
Method: A systematic search of the literature was performed for studies
published between 1966 and March 2017 using these potential protective
strategies in adult patients at risk of AKI. The following clinical
conditions were considered: major surgery, critical illness, sepsis,
shock, exposure to potentially nephrotoxic drugs and radiocontrast.
Clinical endpoints included incidence or grade of AKI, the need for renal
replacement therapy and mortality. Studies were graded according to the
international GRADE system. Results: We formulated 12 recommendations, 13
suggestions and seven best practice statements. The few strong
recommendations with high-level evidence are mostly against the
intervention in question (starches, low-dose dopamine, statins in cardiac
surgery). Strong recommendations with lower-level evidence include
controlled fluid resuscitation with crystalloids, avoiding fluid overload,
titration of norepinephrine to a target MAP of 65-70 mmHg (unless chronic
hypertension) and not using diuretics or levosimendan for kidney
protection solely. Conclusion: The results of recent randomised controlled
trials have allowed the formulation of new recommendations and/or increase
the strength of previous recommendations. On the other hand, in many
domains the available evidence remains insufficient, resulting from the
limited quality of the clinical trials and the poor reporting of kidney
outcomes.<br/>Copyright &#xa9; 2017, The Author(s).

<91>
Accession Number
619544418
Author
Ariyaratne T.V.; Yap C.-H.; Ademi Z.; Rosenfeldt F.; Duffy S.J.; Billah
B.; Reid C.M.
Institution
(Ariyaratne, Yap, Ademi, Duffy, Billah, Reid) Centre of Cardiovascular
Research and Education in Therapeutics, Department of Epidemiology and
Preventive Medicine (DEPM), Monash University, 99 Commercial Rd,
Melbourne, VIC 3004, Australia
(Yap) Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
(Ademi) Institute of Pharmaceutical Medicine (ECPM), University of Basel,
Basel, Switzerland
(Rosenfeldt) Cardiac Surgical Research Unit, Department of Cardiothoracic
Surgery, Alfred Hospital, Melbourne, VIC, Australia
(Duffy) Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
Title
A systematic review of cost-effectiveness of percutaneous coronary
intervention vs. surgery for the treatment of multivessel coronary artery
disease in the drug-eluting stent era.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (4) (pp
261-270), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press
Abstract
Aims The suitability of percutaneous coronary intervention (PCI), compared
with coronary artery bypass grafting (CABG), for patients with complex
multivessel coronary artery disease (MVCAD) remains a contentious topic.
While the body of evidence regarding the clinical effectiveness of these
revascularization strategies is growing, there is limited evidence
concerning their long-term cost-effectiveness. We aim to critically
appraise the body of literature investigating the cost-effectiveness of
CABG compared with PCI using stents, and to assess the quality of the
economic evidence available. Methods and results A systematic review was
performed across six electronic databases; Medline, Embase, the NHS
Economic Evaluation Database, the Database of Abstracts of Reviews of
Effects, the health technology assessment database, and the Cochrane
Library. All studies comparing economic attractiveness of CABG vs. PCI
using bare-metal stents (BMS) or drug-eluting stents (DES) in balanced
groups of patients were considered. Sixteen studies were included. These
comprised studies of conventional CABG vs. BMS (n 1/4 8), or DES (n 1/4
4); off-pump CABG vs. BMS (n 1/4 2), or DES (n 1/4 1); and minimally
invasive direct CABG vs. BMS (n 1/4 2). The majority adopted a healthcare
payer perspective (n 1/4 14). The incremental cost-effectiveness ratios
(ICERs) reported across studies varied widely according to perspective and
time horizon. Favourable lifetime ICERs were reported for CABG in three
trials. For patients with left main coronary artery disease, however, DES
was reported as the dominant (more effective and cost-saving) strategy in
one study. Conclusion Overall, CABG rather than PCI was the favoured
cost-effective treatment for complex MVCAD in the long term. While the
evidence base for the cost-effectiveness of DES compared with CABG is
growing, there is a need for more evaluations adopting a societal
perspective, and time horizons of a lifetime or 10 or more
years.<br/>Copyright &#xa9; The Author 2016.

<92>
Accession Number
619544359
Author
Gandapur Y.; Kianoush S.; Kelli H.M.; Misra S.; Urrea B.; Blaha M.J.;
Graham G.; Marvel F.A.; Martin S.S.
Institution
(Gandapur) Department of Internal Medicine, Good Samaritan/Union Memorial
Hospital, 201 East University Parkway, Baltimore, MD 21218, United States
(Kianoush, Misra, Urrea, Blaha, Marvel, Martin) Ciccarone Center for the
Prevention of Heart Disease, Division of Cardiology, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Kelli) Emory Clinical Cardiovascular Research Institute, Emory University
School of Medicine, Atlanta, GA, United States
(Graham) Aetna Foundation, Hartford, CT, United States
(Graham) University of Connecticut School of Medicine, Farmington, CT,
United States
Title
The role of mHealth for improving medication adherence in patients with
cardiovascular disease: A systematic review.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (4) (pp
237-244), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality
worldwide, and a key barrier to improved outcomes is medication
non-adherence. The aim of this study is to review the role of mobile
health (mHealth) tools for improving medication adherence in patients with
cardiovascular disease. We performed a systematic search for randomized
controlled trials that primarily investigated mHealth tools for improving
adherence to cardiovascular disease medications in patients with
hypertension, coronary artery disease, heart failure, peripheral arterial
disease, and stroke. We extracted and reviewed data on the types of
mHealth tools used, preferences of patients and healthcare providers, the
effect of the mHealth interventions on medication adherence, and the
limitations of trials. We identified 10 completed trials matching our
selection criteria, mostly with,100 participants, and ranging in duration
from 1 to 18 months. mHealth tools included text messages,
Bluetooth-enabled electronic pill boxes, online messaging platforms, and
interactive voice calls. Patients and healthcare providers generally
preferred mHealth to other interventions. All 10 studies reported that
mHealth interventions improved medication adherence, though the magnitude
of benefit was not consistently large and in one study was not greater
than a telehealth comparator. Limitations of trials included small sample
sizes, short duration of follow-up, self-reported outcomes, and
insufficient assessment of unintended harms and financial implications.
Current evidence suggests that mHealth tools can improve medication
adherence in patients with cardiovascular diseases. However, high-quality
clinical trials of sufficient size and duration are needed to move the
field forward and justify use in routine care.<br/>Copyright &#xa9; The
Author 2016.

<93>
Accession Number
621400230
Author
Onk D.; Ozcelik F.; Onk O.A.; Gunay M.; Ayazoglu T.A.; Unver E.
Institution
(Onk) Department of Anesthesiology, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Ozcelik) Department of Medical Biochemistry, Sultan Abdulhamid Han
Training Hospital, University of Health Sciences, Istanbul, Turkey
(Onk) Department of Cardiovascular Surgery, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Gunay) Department of Biochemistry, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
(Ayazoglu) Department of Anesthesiology, Goztepe Training and Research
Hospital, Istanbul, Turkey
(Unver) Department of Chest Diseases, Faculty of Medicine, Erzincan
University, Erzincan, Turkey
Title
Assessment of renal and hepatic tissue-protective effects of
n-acetylcysteine via ammonia metabolism: A prospective randomized study.
Source
Medical Science Monitor. 24 (pp 1540-1546), 2018. Article Number: 908172.
Date of Publication: 15 Mar 2018.
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: The present study sought to assess the renal and liver
protective effect of N-acetylcysteine through NH3 and urea metabolism in
patients with chronic obstructive pulmonary disease who were scheduled for
coronary artery bypass grafting surgery. Material/Methods: Patients with
chronic obstructive pulmonary disease (COPD) who were scheduled for
coronary artery bypass grafting were divided into 2 groups so as to
receive (Group 1, n=35) or not receive (Group 2, n=35) 900 mg/day of
n-acetylcysteine for 7 days before the operation starting from their
admission to the service by a pulmon-ologist with the purpose of treating
COPD until the day of surgery. Both groups were subjected to the same
anesthesia protocol. Blood samples were taken preoperatively, within the
first 15^th minute following cessation of the cardiopulmonary
bypass, at postoperative 24^th hour, and at postoperative
48^th hour. Blood tests included ammonia (NH3), lactate, blood
urea nitrogen, creatinine, aspartate transaminase (AST), alanine
transaminase (ALT), alkaline phosphatase (ALP), troponin I (Tn I), and
creatinine kinase-muscle brain (CKMB). Results: There was a significant
difference between the groups' NH3 and lactate levels after
cardiopulmonary bypass, postoperative 24^th hour, and
postoperative 48^th hour (respectively, NH3: 39.0+/-8.8 vs.
55.4+/-19.6 and 40.1+/-8.4 vs. 53.2+/-20.2 mcg/dl, lactate: 1.7+/-0.9 vs.
2.1+/-1.2 and 1.2+/-0.5 vs. 1.8+/-1.4 mmol/L; p<0.01). Creatinine and BUN
levels in Group 2 were found to be significantly higher at the
postoperative 48^th hour compared to the levels of Group 1
(P<0.05). Conclusions: N-acetylcysteine pretreatment appears to improve
renal and hepatic functions through regulation of ammonia and nitrogen
metabolism and reduction of lactate in patients with chronic obstructive
pulmonary disease who undergo coronary artery bypass grafting surgery. We
found that N-acetylcysteine improved kidney and/or liver
functions.<br/>Copyright &#xa9; Med Sci Monit.

<94>
Accession Number
619180949
Author
Jungmann F.; Emrich T.; Mildenberger P.; Emrich A.L.; Duber C.; Kreitner
K.F.
Institution
(Jungmann, Emrich, Mildenberger, Duber, Kreitner) Department of Diagnostic
and Interventional Radiology, University Medical Center, Johannes
Gutenberg University Mainz, Germany
(Emrich) Department of Cardiothoracic and Vascular Surgery, University
Medical Center, Johannes Gutenberg University Mainz, Germany
(Jungmann) Radiologie, Johannes Gutenberg-Universitat Mainz, Klinik und
Poliklinik fur Diagnostische und Interventionelle Radiologie -Str
Langenbeckstr. 1, Mainz 55131, Germany
Title
Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery
Bypass Grafts - Update 2017.
Source
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden
Verfahren. 190 (3) (pp 237-249), 2018. Date of Publication: 01 Mar 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
BackgroundCoronary artery bypass grafting (CABG) is still an important
therapeutic approach in the treatment especially of advanced coronary
artery disease. In this study, we elucidate the current role of
multidetector computed tomography angiography (MD-CTA) in imaging patients
after CABG surgery. MethodThis study is based on recent reports in the
literature (2007-2016) on imaging of CABG using 64-slice MD-CT scanners
and beyond. We included 13 reports that compared ECG-gated MD-CTA with
conventional invasive coronary angiography (ICA) as the reference standard
for the assessment of graft patency and for the detection of >50%
stenoses. These studies had to provide absolute values for true-positive,
true-negative, false-positive and false-negative results or at least allow
calculation of these numbers. In total, 1002 patients with 2521 bypass
grafts were the basis for this review. Results and ConclusionThe
sensitivity and specificity for the assessment of graft patency or the
detection of >50% graft stenosis were 97.2% and 97.5%, respectively. The
negative and positive predictive values were 93.6% and 99%, respectively.
By using prospective ECG-gating and an increasing pitch factor, the
radiation dose exposure declined to 2.4mSv in the latest reports.
ECG-gated MD-CTA provides a fast and reliable, noninvasive method for
assessing patients after CABG. The most substantial benefit of the newest
CT scanner generations is a remarkable reduction of radiation dose
exposure while maintaining a still excellent diagnostic accuracy during
recent years. Key Points MD-CTA using 64-slice MDCT scanners and beyond is
a reliable, noninvasive method for evaluating CABGs. Technical advances
such as prospective ECG-gating, iterative reconstruction algorithms and
high-pitch scanning lead to a remarkable drop-down in radiation dose
exposures as low as 2.4mSv. Despite significant dose reductions, MD-CTA
could maintain a high diagnostic accuracy in evaluating CABGs in recent
years. Citation Format Jungmann F, Emrich T, Mildenberger P etal.
Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery
Bypass Grafts - Update 2017. Fortschr Rontgenstr 2018; 190:
237-249.<br/>Copyright &#xa9; Georg Thieme Verlag KG, Stuttgart.New York.

<95>
Accession Number
619490713
Author
Choi D.-H.; Chmura S.A.; Ramachandran V.; Dionis-Petersen K.Y.; Kobayashi
Y.; Nishi T.; Luikart H.; Dimbil S.; Kobashigawa J.; Khush K.; Lewis D.B.;
Fearon W.F.
Institution
(Choi, Kobayashi, Nishi, Luikart, Khush, Fearon) Division of
Cardiovascular Medicine, Stanford University Medical Center, Stanford,
California, United States
(Choi) Department of Internal Medicine, Chosun University School of
Medicine, Gwangju, South Korea
(Chmura, Ramachandran, Dionis-Petersen, Lewis) Division of Allergy,
Immunology, and Rheumatology, Department of Pediatrics, Stanford
University School of Medicine, Stanford, California, United States
(Dimbil, Kobashigawa) Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
Title
The ratio of circulating regulatory cluster of differentiation 4 T cells
to endothelial progenitor cells predicts clinically significant acute
rejection after heart transplantation.
Source
Journal of Heart and Lung Transplantation. 37 (4) (pp 496-502), 2018. Date
of Publication: April 2018.
Publisher
Elsevier USA
Abstract
Background: The aim of this study was to determine the value of the ratio
of the percentage of circulating regulatory cluster of differentiation 4 T
cells (%Tregs) to the percentage of endothelial progenitor cells (%EPCs;
Treg/EPC ratio) for predicting clinically significant acute rejection.
Methods: Peripheral blood %Tregs and %EPCs were quantified in 91 cardiac
transplant recipients using flow cytometry at a mean of 42 +/- 13 days
after transplant. The primary end point was clinically significant acute
rejection, defined as an event that led to an acute augmentation of
immunosuppression in conjunction with an International Society for Heart
and Lung Transplantation grade >= 2R in a right ventricular endomyocardial
biopsy specimen or non-cellular rejection (specimen-negative rejection)
with hemodynamic compromise (decrease in left ventricular ejection
fraction by > 25%). Results: Significant rejection occurred in 27
recipients (29.7%) during a median of 49.4 months (interquartile range,
37.0-62.0 months). The mean %Tregs and %EPCs were not significantly
different between those with and without an episode of significant
rejection, but the mean Treg/EPC ratio was significantly lower in
recipients with significant rejection (44.9 vs 106.7, p = 0.001). Receiver
operating characteristic curve analysis showed an area under the curve
value for significant rejection for a Treg/EPC ratio of 0.712. The best
cutoff value of the Treg/EPC ratio that distinguished between those with
or without significant rejection was <= 18 by receiver operating
characteristic curve analysis. Kaplan-Meier analysis revealed that
patients with a Treg/EPC ratio of <= 18 had a significantly higher rate of
rejection than those with a Treg/EPC ratio > 18 (61.5% vs 16.9%, log-rank
p < 0.0001). A low Treg/EPC ratio was an independent predictor of
significant rejection. Conclusions: A low Treg/EPC ratio measured soon
after heart transplantation is an independent predictor of acute
rejection. The Treg/EPC ratio has potential as an early biomarker after
heart transplantation for predicting acute rejection.<br/>Copyright &#xa9;
2018

<96>
[Use Link to view the full text]
Accession Number
620970795
Author
Pearce A.; Lockwood C.; Van Den Heuvel C.; Pearce J.
Institution
(Pearce, Lockwood, Pearce) Joanna Briggs Institute, Faculty of Health and
Medical Sciences, University of Adelaide, Adelaide, Australia
(Van Den Heuvel) School of Medical Sciences, Faculty of Health and Medical
Sciences, University of Adelaide, Adelaide, Australia
(Pearce) School of Nursing, Midwifery and Paramedicine, Australian
Catholic University, Canberra, Australia
Title
The use of therapeutic magnesium for neuroprotection during global
cerebral ischemia associated with cardiac arrest and cardiac surgery in
adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (1) (pp
86-118), 2017. Date of Publication: 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background: Global cerebral ischemia occurs due to reduced blood supply to
the brain. This is commonly caused by a cessation of myocardial activity
associated with cardiac arrest and cardiac surgery. Survival is not the
only important outcome because neurological dysfunction impacts on quality
of life, reducing independent living. Magnesium has been identified as a
potential neuroprotective agent; however, its role in this context is not
yet clear. Objectives: The objective of this review was to present the
best currently available evidence related to the neuroprotective effects
of magnesium during a period of global cerebral ischemia in adults with
cardiac arrest or cardiac surgery. Inclusion criteria Types of
participants: The current review considered adults aged over 18 years who
were at risk of global cerebral ischemia associated with cardiac arrest or
cardiac surgery. Studies of patients with existing neurological deficits
or under the age of 18 years were excluded from the review. Types of
intervention(s)/phenomena of interest: The intervention of interest was
magnesium administered in doses of at least of 2 g compared to placebo to
adult patients within 24 hours of cardiac arrest or cardiac surgery. Types
of studies: The current review considered experimental designs including
randomized controlled trials, non-randomized controlled trials and
quasi-experimental designs. Outcomes: The outcome of interest were
neurological recovery post-cardiac arrest or cardiac surgery, as measured
by objective scales, such as but not limited to, cerebral performance
category, brain stem reflexes, Glasgow Coma Score and independent living
or dependent living status. To enable assessment of the available data,
neuroprotection was examined by breaking down neurological outcomes into
three domains - functional neurological outcomes, neurophysiological
outcomes and neuropsychological outcomes. Search strategy: The search
strategy aimed to find both published and unpublished studies between
January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI)
three-step search strategy. Databases searched included PubMed, Embase,
CINAHL, Cochrane Central Register of Controlled Trials, Australian
Clinical Trials Register, Australian and New Zealand Clinical Trials
Register, Clinical Trials, European Clinical Trials Register and ISRCTN
Registry.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS INSTITUTE.

<97>
Accession Number
615007132
Author
McIlroy D.; Murphy D.; Kasza J.; Bhatia D.; Wutzlhofer L.; Marasco S.
Institution
(McIlroy, Bhatia, Wutzlhofer) Department of Anaesthesia and Perioperative
Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004,
Australia
(McIlroy, Marasco) Monash University, Commercial Road, Melbourne, VIC
3004, Australia
(Murphy) Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
(Kasza) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Marasco) Department of Surgery, Alfred Hospital, Melbourne, VIC,
Australia
Title
Effects of restricting perioperative use of intravenous chloride on kidney
injury in patients undergoing cardiac surgery: the LICRA pragmatic
controlled clinical trial.
Source
Intensive Care Medicine. 43 (6) (pp 795-806), 2017. Date of Publication:
01 Jun 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The administration of chloride-rich intravenous (IV) fluid and
hyperchloraemia have been associated with perioperative renal injury. The
aim of this study was to determine whether a comprehensive perioperative
protocol for the administration of chloride-limited IV fluid would reduce
perioperative renal injury in adults undergoing cardiac surgery. Methods:
From February 2014 through to December 2015, all adult patients undergoing
cardiac surgery within a single academic medical center received IV fluid
according to the study protocol. The perioperative protocol governed all
fluid administration from commencement of anesthesia through to discharge
from the intensive care unit and varied over four sequential periods, each
lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting
of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a
chloride-limited strategy, consisting of a buffered salt solution and 20%
albumin, was used. Co-primary outcomes were peak delta serum creatinine
(S<inf>Cr</inf>) within 5 days after the operation and KDIGO-defined stage
2 or stage 3 acute kidney injury (AKI) within 5 days after the operation.
Results: We enrolled and analysed data from 1136 patients, with 569
patients assigned to a chloride-rich fluid strategy and 567 to a
chloride-limited one. Compared with a chloride-limited strategy and
adjusted for prespecified covariates, there was no association between a
chloride-rich perioperative fluid strategy and either peak S<inf>Cr</inf>,
transformed to satisfy the assumptions of multivariable linear regression
[regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08);
p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI
0.65-1.47; p = 0.90]. Conclusions: A perioperative fluid strategy to
restrict IV chloride administration was not associated with an altered
incidence of AKI or other metrics of renal injury in adult patients
undergoing cardiac surgery. Trial Registration: Clinicaltrials.gov
Identifier: NCT02020538.<br/>Copyright &#xa9; 2017, Springer-Verlag Berlin
Heidelberg and ESICM.

<98>
Accession Number
621462679
Author
Wang Y.; Zhu S.; Du R.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Du, Zhou, Chen, Zhang) Department of Cardiology, Sichuan
University, West China Hospital, Chengdu, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Statin initiation and renal outcomes following isolated coronary artery
bypass grafting: A meta-Analysis.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 282-290), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The effects of preoperative statin therapy (PST) on renal
outcomes in patients with isolated coronary artery bypass grafting (CABG)
are in controversial. This study aimed to assess the effects of
preoperative statin use on postoperative renal outcomes in patients
undergoing isolated CABG. EVIDENCE ACQUISITION: PubMed, EMBASE, and
Cochrane Library were searched for studies published up to February 2017.
Pooled odds ratio (OR) and its corresponding 95% confidence interval (95%
CI) were calculated. Outcomes evaluated were occurrence of postoperative
acute kidney injury (AKI)/failure, requirement of any postoperative renal
replacement therapy (RRT) and change in serum creatinine (Scr) levels. We
used random-effects model and calculated pooled effect estimate of outcome
between statin and non-statin use groups. EVIDENCE SYNTHESIS: Eighteen
studies consisting of 32,747 patients following CABG were included. PST
was associated with a significant protective effect for perioperative
renal dysfunction (OR 0.89; 95% CI: 0.82-0.97; P=0.01) and postoperative
requirement for RRT (OR 0.54; 95% CI: 0.41-0.72; P=0.001) in patients
undergoing CABG surgery. However, there were no effects of preoperative
statin therapy on the risk of postoperative AKI and serum creatinine
concentration. In the subgroup of patients after on-pump CABG surgery, PST
significantly reduced the perioperative renal dysfunction and requirement
for RRT (OR 0.69; 95% CI: 0.53-0.89; P=0.005, OR 0.51; 95% CI: 0.30-0.87;
P=0.014, respectively). CONCLUSIONS: In patients undergoing isolated CABG,
PST might be associated with lower risk of postoperative renal dysfunction
and the requirement for RRT. However, PST may not reduce the risk of AKI.
Future large well-designed randomized controlled trials are needed on this
topic.<br/>Copyright &#xa9; 2018 Edizioni Minerva Medica.

<99>
Accession Number
621462666
Author
Laguna G.; Di Stefa No S.; Maroto L.; Fulquet E.; Echevarria J.R.; Revilla
A.; Uruena N.; Sevilla T.; Arnold R.; Ramos B.; Gutierrez H.; Serrador A.;
San Roman J.A.
Institution
(Laguna, Di Stefa No, Fulquet, Echevarria) Department of Cardiac Surgery,
Clinic University Hospital of Valladolid, Avenue Ramon y Cajal, Valladolid
47003, Spain
(Maroto) Department of Cardiac Surgery, MediClin Herzzentrum Coswig,
Coswig (Anhalt), Germany
(Revilla, Uruena, Sevilla, Arnold, Ramos, Gutierrez, Serrador, San Roman)
Department of Cardiology, Clinic University Hospital of Valladolid,
Valladolid, Spain
Title
Effect of direct intramyocardial autologous stem cell grafting in the
sub-Acute phase after myocardial infarction.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 259-267), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: To assess the efficacy and safety of intramyocardial
autologous bone marrow mononuclear stem cells (BMMNC) grafting combined
with coronary artery bypass grafting (CABG) on ventricular remodeling and
global and regional wall motion after acute transmural myocardial
infarction (AMI). METHODS: Randomized controlled trial including 20
patients with non-revascularized transmural AMI, left ventricular ejection
fraction (LVEF) lower than 50% and surgical indication for CABG. The stem
cell group was treated with BMMNC grafting by direct intramyocardial
injection between the 10th and 15th days after AMI (subacute phase)
combined with CABG under cardiopulmonary bypass; the control group was
only treated with CABG. Magnetic resonance imaging with gadolinium and
stress echocardiography were performed presurgery and 9 months
postsurgery. RESULTS: Seventeen patients completed the follow-up. The
baseline characteristics of both groups were homogeneous. No significant
differences were found in the increase in LVEF (control: 6.99+/-4.60,
cells: 7.47+/-6.61, P=0.876) or in the decrease in global (control:
0.28+/-0.39, cells: 0.22+/-0.28, P=0.759) or regional (control:
0.52+/-0.38, cells: 0.74+/-0.60, P=0.415) wall motion indices between the
control and stem cell groups of AMI patients. No differences were found in
the recovered non-viable segments (control: 1.29+/-1.11, cells:
2.50+/-1.41, P=0.091) or in the decrease in end-diastolic (control:
14.05+/-19.72, cells: 18.40+/-29.89, P=0.725) or end-systolic (control:
15.42+/-13.93, cells: 23.06+/-25.03, P=0.442) volumes. No complications
from stem cell grafting were observed. CONCLUSIONS: The results from our
study reported herein suggest that intramyocardial BMMNC administration
during CABG in patients with AMI causes no medium-To long-Term improvement
in ventricular remodeling.<br/>Copyright &#xa9; 2018 Edizioni Minerva
Medica.

<100>
Accession Number
621462662
Author
Mostafa E.A.; El Midany A.A.; Taha A.S.; El-Aasy S.R.; Doghish A.A.; Helmy
A.; Mansour S.A.; Khorshid R.; Ashor H.E.; Elnahas Y.; Saffan M.
Institution
(Mostafa, El Midany, Taha, El-Aasy, Doghish, Helmy, Mansour, Khorshid,
Ashor, Elnahas) Department of Cardiovascular and Thoracic Surgery, Faculty
of Medicine, Ain-Shams University Hospital, Ramses, Abbassia, Cairo 11588,
Egypt
(Saffan) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, Banha University, Banha, Egypt
Title
On-X versus St Jude medical mechanical prosthesis in mitral position: Are
we moving forward in design technology?.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 252-258), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Continuous effort is still provided in designing optimal
artificial heart valves with better hemodynamic function and reduced
thromboembolic potential. The question is do we have moved forward toward
this goal or not. METHODS: A prospective, randomized comparative study was
done on 360 patients scheduled for elective mitral valve replacement.
Patients were grouped into an On-X group (N.=180), who received On-X
mechanical valve, and a SJM group (N.=180), who received St Jude
mechanical valve. Echocardiographic and clinical assessments were
performed for all patients at 6 and 12 months follow-up period. RESULTS:
Rheumatic heart disease was the most common cause of valve affection
(94.2%). Early mortality was 6.4%. The mean follow-up time was 3.11+/-2.44
years. No structural or non-structural valvular dysfunction and no
thromboembolism cases were encountered. Late valve thrombosis
was1.9%/patient-year in On-X group and 2.1%/patient-year in SJM group. The
mean EOA was higher in On-X group (2.0+/-0.3 cm2) than in SJM group
(1.9+/-0.2 cm2), (P>=0.05). The mean EOAI was higher in On-X group
(1.1+/-0.1 cm2/m2) than in SJM group (1.0+/-0.1 cm2/m2), (P=0.034),
especially significant in small valve size (25 mm) where it was 1.09+/-021
cm2/m2 in On-X group and 0.93+/-0.12 cm2/m2 in SJM group (P=0.02).
CONCLUSIONS: On-X and St Jude prosthetic valves have a comparable
hemodynamic performance in mitral position. However, On-X prosthesis might
have a forward step on the way of design technology that may allow better
function in terms of EOA and EOAI especially in smaller valve
size.<br/>Copyright &#xa9; 2018 Edizioni Minerva Medica.

<101>
Accession Number
621416207
Author
Eraballi A.; Raghuram N.; Ramarao N.H.; Pradhan B.; Rao P.V.
Institution
(Eraballi, Raghuram, Ramarao, Pradhan) Division of Yoga and Life Sciences,
Swami Vivekananda Yoga Anusandhana Smasthana, Bangalore, Karnataka, India
(Rao) Department of Cardiology, Narayana Hrudayalaya Institute of Cardiac
Sciences, Bangalore, Karnataka, India
Title
Yoga based lifestyle program in improving quality of life after coronary
artery bypass graft surgery: A randomised controlled trial.
Source
Journal of Clinical and Diagnostic Research. 12 (3) (pp YC05-YC09), 2018.
Date of Publication: 01 Mar 2018.
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar,GT
Karnal Road, Delhi 110007, India)
Abstract
Introduction: The Quality of Life (QOL) after Coronary Artery Bypass
Grafting (CABG) is an important contributor to morbidity and mortality.
Addition of Yoga Based Lifestyle Program (YLSP) to conventional cardiac
rehabilitation has found useful and effective in improving ejection
fraction and reducing risk factor profiles. Aim: The aim of the present
study was to evaluate the effect of add-on YLSP to conventional post-CABG
rehabilitation and to compare the changes of QOL. Materials and Methods: A
total of 300 patients posted for elective CABG at Narayana Hrudayalaya
Super Specialty Hospital, Bengaluru, India were randomised into two groups
(150 each) i.e., Conventional Lifestyle Program (CLSP) and YLSP. Data on
CLSP (95) and YLSP (102) was available for analysis at one year follow up.
The YLSP Group practiced integrated yoga module including Yama, Niyama,
Anasa, Pranayama and Meditation as an add-on to conventional lifestyle
advice. Assessments were done before and one year after CABG on World
Health Organization Quality of Life- Brief form questionnaire (WHOQOLBREF)
with four domains viz., 'Physical Health', 'Mental Health', 'Social
relationships' and 'Environmental health'. As the data was not normally
distributed, the non-parametric tests viz., Mann-Whitney Test and Wilcoxon
signed ranks test for between group and within group comparisons were
applied. Results: In YLSP group, significant (p<0.001; Wilcoxon's test)
improvements were found within group after one year in all domains of
WHOQOL-BREF, while there was significant improvement (p<0.05; Wilcoxon's
test) only in the Social health domain, in the control (CLSP) group. There
was significant differences between groups (p<0.05; Mann-Whitney test) in
all domains with better improvement in the YLSP Group. Conclusion:
Addition of integrated yoga program to conventional post-CABG
rehabilitation leads to better improvement in all domains of quality of
life after coronary artery bypass surgery.<br/>Copyright &#xa9; 2018,
Journal of Clinical and Diagnostic Research. All rights reserved.

<102>
Accession Number
621522924
Author
Gunay S.; Eser I.; Ozbey M.; Agar M.; Koruk I.; Kurkcuoglu I.C.
Institution
(Gunay) Department of Thoracic Surgery, Harran University Faculty of
Medicine, Sanliurfa, Turkey
Title
Evaluation of two different respiratory physiotherapy methods after
thoracoscopy with regard to arterial blood gas, respiratory function test,
number of days until discharge, cost analysis, comfort and pain control.
Source
Nigerian journal of clinical practice. 19 (3) (pp 353-358), 2016. Date of
Publication: 01 May 2016.
Abstract
CONCLUSIONS: Based on the outcome of this study, respiratory physiotherapy
methods carried out by a respiratory physiotherapist are more effective in
acute cardiothoracic conditions after thoracotomy compared to IS by
patients.
RESULTS: There were no statistical difference in first and last values of
pH and PCO2and also there were no difference between groups (P > 0.05).
Forced expiratory volume one second (FEV1) values are statistically
increased compared to basal levels in both groups and mean difference in
FEV1values was statistically increased in physiotherapist group compared
to spirometry group (P < 0.001). Forced vital capacity (FVC), PO2and SaO2
values are statistically increased compared to basal levels in both groups
but mean difference in FVC values was not statistically different between
groups (P > 0.05). Cost analysis was not statistically different, mean
hospitalization day and mean pain score were statistically decreased in
physiotherapist group.
INTRODUCTION: Although the methods used in thoracic surgery have been
developing rapidly over the last five decades, postoperative pulmonary
complications are seen in this field more than in other surgical branches.
We aimed at comparing the acute effects of incentive spirometry (IS) and
breathing retraining exercises by a respiratory physiotherapist or
experienced physiotherapist.
METHODS: Patients were randomized into two groups as spirometry and
physiotherapist. Combined respiratory exercises were implemented through
IS inspirometry group and by a physiotherapist in physiotherapist group.
Blood gas, respiratory function tests, survey results of the Burford pain
thermometer, discharge days, and cost analyses of both groups were
examined just before the beginning of physiotherapy and on the 3rd day of
therapy.

<103>
Accession Number
621523279
Author
Ni Z.; Chao Y.; Xue X.
Institution
(Ni) Children's Hospital of Soochow University, Suzhou, China
(Chao) Department of Nursing, Mackay Medical College, New Taipei City,
Taiwan
(Xue) School of Nursing, Soochow University, Suzhou, China
annie8888@yeah.net
Title
An empowerment health education program for children undergoing surgery
for congenital heart diseases.
Source
Journal of child health care : for professionals working with children in
the hospital and community. 20 (3) (pp 354-364), 2016. Date of
Publication: 01 Sep 2016.
Abstract
Since the surgery for congenital heart disease (CHD) is considered highly
risky, appropriate postoperative care is crucial. After the surgery,
children are often discharged with unhealed wounds, incomplete recovery,
and continuing pain. Health education programs based on empowerment
education model can assist clients to develop skills in self-management.
This study aimed to evaluate the effectiveness of an empowerment health
education program for improving caregiving knowledge, caring behaviors,
and self-efficacy of parents caring for children after corrective surgery
for CHD. This prospective clinical trial enrolled pediatric patients
undergoing surgical correction for CHD. Patients were divided into two
groups: the control group (n = 42), which received the standard education
program, and the intervention group (n = 44), which participated in the
empowerment theory-based education program. We collected data on left
ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2);
New York Heart Association classification of the patients; and the
parents' caregiving knowledge, caring behaviors, and self-efficacy before
surgery and one month and three months after surgery. At one month and
three months after surgery, the intervention group scored higher than the
control group in caregiving knowledge, caring behavior, and self-efficacy.
By the third month after surgery, the intervention group had significantly
higher values of LVEF and SpO2 than the control group. <br/>Copyright
&#xa9; The Author(s) 2015.