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<1>
Accession Number
621390420
Author
Tufail S.A.; Ahmad N.; Akhter N.
Institution
(Tufail) Department of Anaesthesiology and Intensive Care, Shri Maharaja
Hari Singh Hospital, Srinagar, Jammu and Kashmir, India
(Ahmad) Department of Gastroenterology, Sheri Kashmir Institute of Medical
Sciences, Srinagar, Jammu and Kashmir, India
(Akhter) Department of Gynaecology and Obstetrics, Lala Ded Hospital,
Srinagar, Jammu and Kashmir, India
Title
Comparative analysis of dexmedetomidine and propofol based sedation
regimens on anaesthetic requirements in cardiac surgery with on-pump
cardiopulmonary bypass.
Source
Journal of Clinical and Diagnostic Research. 12 (3) (pp UC05-UC08), 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: Dexmedetomidine is a selective alpha<inf>2</inf>-agonist
that has been successfully used as an anaesthetic adjuvant in cardiac
surgery. Aim: To evaluate the effect of dexmedetomidine on intraoperative
requirements of isoflurane and opioids for maintenance of anaesthesia
during On-pump cardiac surgery and compare the anaesthesia sparing effect
with that of propofol. Materials and Methods: This was a randomised,
double blind observational study. Morphine consumption and minimum
alveolar concentration of isoflurane was compared among 60 patients
planned for elective open heart surgeries who were randomised to receive
either dexmedetomidine (1 mug/kg bolus over 10 minutes followed by
infusion of 0.2 to 0.6 mug/kg/hour) or propofol (0.25-1 mg/kg/hour)
throughout the intraoperative period till skin closure. The drug infusions
were titrated to target Bispectral Index (BIS) score of 40-60. BIS scores
and minimum alveolar concentration of isoflurane were recorded at
predetermined intervals during surgery. Total dose of morphine used was
also recorded. Statistical analysis was carried out using analysis of
variance, Chi-square test, Student's t-test and Mann-Whitney U test.
Results: BIS scores were significantly lower in dexmedetomidine group
(p<0.05). Total dose of morphine and minimum alveolar concentration of
isoflurane were significantly lower in dexmedetomidine group (p<0.05).
Conclusion: From the results we concluded that intraoperatively
administered dexmedetomidine during On-pump cardiac surgery has specific
analgesic properties and decreases intraoperative anaesthetic requirement.
Thus, dexmedetomidine has significant opioid and anaesthetic sparing
property.<br/>Copyright &#xa9; 2018, Journal of Clinical and Diagnostic
Research. All rights reserved.

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

<3>
Accession Number
615879106
Author
Ferraris A.; Jacquet-Lagreze M.; Fellahi J.-L.
Institution
(Ferraris, Jacquet-Lagreze, Fellahi) Service d'Anesthesie-Reanimation,
Hopital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de
Lyon, 59 Boulevard Pinel, Lyon Cedex 69394, France
(Fellahi) Inserm U 1060, Universite Claude Bernard Lyon 1, Lyon, France
Title
Four-wavelength near-infrared peripheral oximetry in cardiac surgery
patients: a comparison between EQUANOX and O3.
Source
Journal of Clinical Monitoring and Computing. 32 (2) (pp 253-259), 2018.
Date of Publication: 01 Apr 2018.
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Near-infrared spectroscopy (NIRS) is a continuous and noninvasive
technology that measures regional tissue oxygen saturation
(rSO<inf>2</inf>). A new 4-wavelength generation of NIRS monitors is now
available. We aimed to compare peripheral somatic rSO<inf>2</inf> values
given by the 4-wavelength EQUANOXTM 7600 device (Nonin Medical Inc.,
Plymouth, Mn) and O3TM device (Masimo Corporation, Irvine, CA). Twenty
adult patients scheduled for conventional elective cardiac surgery with
cardiopulmonary bypass over a 4-month period were included after local
Ethics Committee approval. For each patient, 2 NIRS sensors (EQUANOX and
O3) were placed over the medial part of the forearm. Thirteen couples of
measurements were performed at predefined intraoperative time points. We
compared 260 couples of absolute intraoperative rSO<inf>2</inf> values. No
significant difference was found between both monitors: EQUANOX median
rSO<inf>2</inf> 60% (95% CI 57-62) versus O3 median rSO<inf>2</inf> 62%
(95% CI 61-64), P = 0.103. Bias was 4.0% and limits of agreement were
+/-26.3%. Significant correlations were evidenced between EQUANOX and O3
rSO<inf>2</inf> absolute values: rho = 0.758 (95% CI 0.701-0.806), P
OpenSPiltSPi 0.0001, and rSO<inf>2</inf> percent maximum difference versus
baseline: rho = 0.582 (95% CI 0.188-0.815), P = 0.007. While absolute
values of rSO<inf>2</inf> given by both devices were equivalent and well
correlated, the clinical agreement is probably not acceptable, meaning
that EQUANOX and O3 are not interchangeable in routine
practice.<br/>Copyright &#xa9; 2017, Springer Science+Business Media
Dordrecht.

<4>
Accession Number
619240305
Author
Sulzenko J.; Pieniazek P.
Institution
(Sulzenko) Cardiocenter, Third Faculty of Medicine, Charles University in
Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
(Pieniazek) Department of Interventional Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
Title
The cardiovascular risk of patients with carotid artery stenosis.
Source
Cor et Vasa. 60 (1) (pp e42-e48), 2018. Date of Publication: February
2018.
Publisher
Elsevier Science B.V.
Abstract
It is commonly accepted that a relationship exists between coronary and
carotid arterial disease, given that the prevalence of coronary artery
disease (CAD) in patients with carotid stenosis is as high as 77%,
depending on the population studied. Elevated cardiovascular (CV) risks
are apparent in patients with either asymptomatic or symptomatic carotid
stenosis. Patients with asymptomatic carotid stenosis are at about a
three-fold higher risk of CV death/myocardial infarction compared with a
matched population without carotid stenosis, and this risk may be even
higher among patients with symptomatic carotid stenosis. Thus,
antiplatelet and lipid-lowering therapies are indicated not only to
prevent stroke, but also especially to lower elevated CV risks. Carotid
revascularization has become well established in patients with symptomatic
carotid stenosis, which is associated with significant absolute risk
reductions in terms of recurrent stroke, but remains controversial for
patients with significant but asymptomatic carotid stenosis. Carotid
revascularization in those with asymptomatic carotid stenosis seems to
principally benefit patients with specific clinical/imaging features
indicating a high risk of stroke. Screening and treatment of asymptomatic
CAD can be beneficial for patients with recently symptomatic carotid
stenosis and especially for those for whom surgical or endovascular
carotid revascularization is planned. Because evidence of the benefits
afforded by prophylactic revascularization of asymptomatic carotid artery
stenosis in all CABG candidates (in terms of reducing perioperative
stroke) is lacking, it may be reasonable to restrict prophylactic carotid
revascularization to patients at the highest risk of postoperative stroke,
thus those with severe bilateral lesions or a history of prior
stroke/transient ischemic event.<br/>Copyright &#xa9; 2017 The Czech
Society of Cardiology

<5>
Accession Number
621112482
Author
Acosta J.; Penela D.; Andreu D.; Cabrera M.; Carlosena A.; Vassanelli F.;
Alarcon F.; Soto-Iglesias D.; Korshunov V.; Borras R.; Linhart M.;
Martinez M.; Fernandez-Armenta J.; Mont L.; Berruezo A.
Institution
(Acosta, Penela, Andreu, Cabrera, Carlosena, Vassanelli, Alarcon,
Soto-Iglesias, Korshunov, Borras, Linhart, Martinez, Fernandez-Armenta,
Mont, Berruezo) Arrhythmia Section, Cardiology Department, Thorax
Institute, Hospital Clinic and IDIBAPS, Institut d'Investigacio Agusti Pi
i Sunyer, Barcelona, Catalonia, Spain
Title
Multielectrode vs. point-by-point mapping for ventricular tachycardia
substrate ablation: A randomized study.
Source
Europace. 20 (3) (pp 512-519), 2018. Date of Publication: 01 Mar 2018.
Publisher
Oxford University Press
Abstract
Aims Ventricular tachycardia (VT) substrate ablation is based on detailed
electroanatomical maps (EAM). This study analyses whether high-density
multielectrode mapping (MEM) is superior to conventional point-by-point
mapping (PPM) in guiding VT substrate ablation procedures. Methods and
results This was a randomized controlled study (NCT02083016). Twenty
consecutive ischemic patients undergoing VT substrate ablation were
randomized to either group A [n = 10; substrate mapping performed first by
PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or
group B [n = 10; substrate mapping performed first by MEM and second by
PPM ablation guided by MEM]. Ablation was performed according to the
scardechanneling technique. Late potential (LP) pairs were defined as a
Navistar-LP and a PentaRay-LP located within a three-dimensional distance
of <= 3 mm. Data obtained from EAM, procedure time, radiofrequency time,
and postablation VT inducibility were compared between groups. Larger
bipolar scar areas were obtained with MEM (55.7+/-31.7 vs. 50.5+/-26.6
cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7+/-7.9
minutes) and PPM (25+/-9.2 minutes); P = 0.222. No differences were
observed in the number of LPs identified within the scar by MEM vs. PPM
(73+/-50 vs. 76+/-52 LPs per patient, respectively; P = 0.965). A total of
1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was
significantly lower (0.58+/-0.4 vs. 1.64+/-1.1; P = 0.01) and
radiofrequency time was shorter [median (interquartile range) 12 (7-20)
vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT
inducibility after procedure. Conclusion MEM with PentaRay catheter
provided better discrimination of LPs due to a lower sensitivity for
far-field signals. Ablation guided by MEM was associated with a shorter
radiofrequency time.<br/>Copyright &#xa9; The Author 2017.

<6>
Accession Number
621405522
Author
Rahimi M.; Eshraqi S.; Nooralishahi B.
Institution
(Rahimi) Department of Anesthesiology, Imam Khomeini Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eshraqi) Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Nooralishahi) Department of Anesthesiology, Children's Medical Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Comparing the efficacy of 6% hydroxyethyl starch 130/0.4 and human albumin
for intravenous fluid replacement in pediatric open-heart surgery.
Source
Iranian Heart Journal. 19 (1) (pp 37-43), 2018. Date of Publication: 2018.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Providing and maintaining normovolemic condition during major
surgeries is a major challenge, especially in children. In this respect,
third-generation hydroxyethyl starches seem to be more cost-effective than
human albumin. However, the efficacy of 6% hydroxyethyl starch (HES)
130/0.4 compared to other alternatives such as human albumin 5% remains
uncertain in children. The present study aimed to assess the efficacy and
safety of replacing human albumin 5% with 6% HES 130/0.4 for volume
replacement therapy in children undergoing selective open cardiac surgery.
Method: This randomized double-blinded clinical trial was performed on 59
children aged less than 2 years and ASA I-III who were candidated for
selective open-heart surgery and referred to a children medical center in
2014. The patients were randomly assigned via the block randomization
method to the case group (n = 30) receiving a solution of 6% HES 130/0.4
and the control group (n = 29) receiving 5% human albumin. There were no
between-group differences in hemodynamic parameters-including pulse rate,
systolic and diastolic blood pressures, and mean blood pressure-at the
time points of before anesthesia induction, before and after pump
insertion, and 24 hours after surgery. Results: Comparisons of the
laboratory indices indicated no differences between the 2 groups at the
different time points. The volume of packed cell and colloid fluids
infused in the case and control group was also similar. Conclusions:
Compared to human albumin 5%, 6% HES 130/0.4 is a safe alternative to
fluid supply during cardiac surgery among children.<br/>Copyright &#xa9;
2018, Iranian Heart Association. All rights reserved.

<7>
Accession Number
617329801
Author
Aksut B.; Starling R.; Kapadia S.
Institution
(Aksut, Starling, Kapadia) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
Title
Stable coronary artery disease and left ventricular dysfunction: The role
of revascularization.
Source
Catheterization and Cardiovascular Interventions. 90 (5) (pp 777-783),
2017. Date of Publication: 01 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The aim of this review is to present existing evidence of
revascularization in patients with stable coronary artery disease (CAD)
and left ventricular (LV) dysfunction. A literature review was performed
for trials studying revascularization, via CABG or PCI, in patients with
CAD and LV dysfunction. Pivotal, high-quality trials have investigated
revascularization with CABG in stable CAD and LV dysfunction. CASS
demonstrated improved 10-year survival in the surgical group compared to
medically treated patients. While 56-month follow-up of the STICH trial
found no statistically significant difference between CABG and medical
therapy in patients with stable CAD and LV dysfunction, the long-term
follow-up at 10 years (STICHES) demonstrated that CABG did significantly
decrease death from any cause and all secondary outcomes. However, these
pivotal trials have focused solely on surgical revascularization.
Comparable studies regarding outcomes after contemporary PCI methods in
this particular subset of patients are severely lacking. More recent
studies have included very small numbers of patients with reduced EF. In
conclusion, given advances in surgical and non-invasive fields, studies
investigating long-term effects of PCI versus CABG, including combined
hybrid revascularization techniques are warranted. This review sets the
stage for a high-quality randomized, controlled trial comparing
revascularization with PCI versus CABG in patients with stable CAD and LV
dysfunction.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<8>
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

<9>
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

<10>
Accession Number
621500826
Author
Scheiber D.; Zweck E.; Jelenik T.; Horn P.; Boeken U.; Saeed D.; Kelm M.;
Roden M.; Szendrodi J.; Westenfeld R.
Institution
(Scheiber, Zweck, Jelenik, Horn, Boeken, Saeed, Kelm, Roden, Szendrodi,
Westenfeld) Heinrich-Heine University, Dusseldorf, Germany
Title
Myocardial mitochondrial ROS production is reduced in the left ventricle
of mechanically unloaded hearts.
Source
Journal of Cardiovascular Translational Research. Conference: 2nd Annual
Acute Cardiac Unloading and Recovery Symposium, A-CURE 2017. Spain. 11 (1)
(pp 64), 2018. Date of Publication: February 2018.
Publisher
Springer New York LLC
Abstract
Background: Increased ventricular filling pressure and volume overload are
hallmarks of advanced heart failure (HF). Previous studies have linked
pressure and volume overload with alterations in myocardial substrate
utilization and mitochondrial energy production in HF. It is well
established that mitochondrial production of reactive oxygen species is
increased in HF leading to oxidative stress. Mechanical ventricular
unloading has been shown to induce protective reverse remodeling in
myocardial tissues; however, little is known about the impact of
ventricular unloading on myocardial mitochondrial energy metabolism. In
this study, we compare mitochondrial reactive oxygen species (ROS)
production and respiration in human hearts that were mechanically
supported prior to explantation for heart transplantation (HTX) to
unsupported hearts. Hypothesis: We hypothesize that (1) chronic left
ventricular unloading reduces myocardial mitochondrial ROS production, and
(2) improves myocardial mitochondrial oxidative capacity in patients
suffering from advanced HF. Methods: We prospectively evaluated 11
patients undergoing HTX between October 2016 and May 2017 in this
single-center trial. Myocardial tissue specimens were harvested from
macroscopically scar-free areas of the left ventricle during heart
explantation. Mitochondrial hydrogen peroxide emission was analyzed
fluoroscopically in an Oxygraph-2k (OROBOROS INSTRUMENTS, Austria).
Mitochondrial oxidative capacity on citrate cycle-derived substrates and
fatty acids was analyzed by high-resolution respirometry. Results: Eight
patients had left ventricular assist device (LVAD) implantation prior to
heart transplantation (LVAD-HTX, age 58.9 years; BMI 27.12.7; six ischemic
heart disease and two dilated heart disease (DCM)), and three patients did
not receive mechanical circulatory support prior to transplantation (HTX,
49.11 years; BMI 26.57.1; 3*DCM). Myocardial mitochondrial reactive oxygen
species (ROS) production was significantly decreased in the LVAD-HTX group
compared to the HTX group (1.40 1 vs 0.90 1 pmol/(s*mg); p < 0.0001).
There were no differences in either maximal oxidative capacity on fatty
acids or citrate cycle-derived substrates, or on uncoupled respiration or
mitochondrial coupling efficiency between the groups. Conclusions: These
data suggest that ventricular unloading decreases myocardial mitochondrial
ROS production in the setting of HF, whereas mitochondrial respiration
remains unaffected. This mechanism may reveal a new target of ventricular
unloading-dependent cardioprotection.

<11>
Accession Number
621485263
Author
Stammers A.H.; Miller R.; Francis S.G.; Fuzesi L.; Nostro A.; Tesdahl E.
Institution
(Stammers, Tesdahl) SpecialtyCare, Nashville, Tennessee
(Miller) Chester County Hospital, West Chester, Pennsylvania
(Francis) Spring Valley Hospital, Las Vegas, Nevada
(Fuzesi) Mohawk Valley Health System, Utica, New York
(Nostro) Pocono Medical Center, East Stroudsburg, Pennsylvania
Title
Goal-Directed Perfusion Methodology for Determining Oxygenator Performance
during Clinical Cardiopulmonary Bypass.
Source
The journal of extra-corporeal technology. 49 (2) (pp 81-92), 2017. Date
of Publication: 01 Jun 2017.
Abstract
New generation oxygenators incorporate arterial line filtration either
sequential to, or directly in, the gas exchange module. This unique design
may affect gas exchange performance by altering the operational
characteristics of the device. The present study was designed to evaluate
three oxygenators in a clinical setting using a goal-directed perfusion
algorithm during cardiopulmonary bypass (CPB). After institutional review
board approval, 60 adult patients undergoing cardiac surgery for acquired
heart disease were matched for disease state and body size into three
groups based on oxygenator type: Terumo SX18TM (n = 20), Terumo FX15TM (n
= 20), and LivaNova Inspire6FTM 6 Dual (n = 20). An external arterial line
filter was used with the FX15, whereas the SX18 and Inspire6F had
integrated arterial filters. All perfusion, anesthetic and postoperative
care management was standardized using institutional goal-directed patient
management processes. Data were collected and stored according to quality
improvement guidelines. There were no differences in demographics or type
of surgical procedure performed among groups. The Inspire6F patients
required lower fraction of inspired oxygen values as compared to the SX18
(67.9% +/- 6.2% vs. 75.4% +/- 6.5%, p < .005) and FX15 (79.1% +/- 8.4%, p
< .0001) groups. Arterial oxygen content and oxygen delivery were slightly
higher in the FX15 group as compared to SX18 (13.1 +/- 1.4 mL O2/dL vs.
12.4 +/- 1.1 mL O2/dL, 611.1 +/- 150.4 mL O2 vs. 528.2 +/- 102.3 mL O2, p
< .05). The FX15 patients had significantly higher CPB hematocrits
compared to SX18 patients (30.3% +/- 3.9% vs. 27.7% +/- 2.6%, p < .05),
but were not different when compared to the Inspire6F group (28.8% +/-
3.5%, p < .50). There were no differences in intraoperative transfusion
rates, but a higher percent of patients received postoperative
transfusions in the SX18 group as compared to either FX15 or Inspire6F
groups (p < .039). There were no differences in postoperative morbidity or
complications in any group. In conclusion, the use of the SX18 was
comparable to newer generation oxygenators in regard to gas exchange
performance and the degree of hemodilution.

<12>
Accession Number
621499410
Author
Wu Q.; Wang T.; Chen S.; Zhou Q.; Li H.; Hu N.; Feng Y.; Dong N.; Yao S.;
Xia Z.
Institution
(Wu, Wang, Chen, Zhou, Hu, Feng, Yao) Department of Anaesthesiology,
Institute of Anaesthesiology and Critical Care Medicine, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
1277 Jiefang Avenue, Wuhan 430022, China
(Li, Xia) State Key Laboratory of Pharmaceutical Biotechnology, University
of Hong Kong, 21 Sassoon Road, Hong Kong, Hong Kong
(Li, Xia) Department of Anaesthesiology, University of Hong Kong, 102
Pokfulam Road, Hong Kong, Hong Kong
(Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, 1277
Jiefang Avenue, Wuhan 430022, China
Title
Cardiac protective effects of remote ischaemic preconditioning in children
undergoing tetralogy of fallot repair surgery: A randomized controlled
trial.
Source
European Heart Journal. 39 (12) (pp 1028-1037), 2018. Date of Publication:
21 Mar 2018.
Publisher
Oxford University Press
Abstract
Aims Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia
in distant tissues protects the heart against myocardial
ischaemia-reperfusion injury (IRI) in children undergoing open-heart
surgery, although its effectiveness in adults with comorbidities is
controversial. The effectiveness and mechanism of RIPC with respect to
myocardial IRI in children with tetralogy of Fallot (ToF), a severe
cyanotic congenital cardiac disease, undergoing open heart surgery are
unclear. We hypothesized that RIPC can confer cardioprotection in children
undergoing ToF repair surgery. Methods and results Overall, 112 ToF
children undergoing radical open cardiac surgery using cardiopulmonary
bypass (CPB) were randomized to either a RIPC group (n = 55) or a control
group (n = 57). The RIPC protocol consisted of three cycles of 5-min lower
limb occlusion and 5-min reperfusion using a cuff-inflator. Serum
inflammatory cytokines and cardiac injury markers were measured before
surgery and after CPB. Right ventricle outflow tract (RVOT) tissues were
collected during the surgery to assess hypoxia-inducible factor
(Hif)-1alpha and other signalling proteins. Cardiac mitochondrial injury
was assessed by electron microscopy. The primary results showed that the
length of stay in the intensive care unit (ICU) was longer in the control
group than in the RIPC group (52.30 +/- 13.43 h vs. 47.55 +/- 10.34 h,
respectively, P = 0.039). Patients in the control group needed longer
post-operative ventilation time compared to the RIPC group (35.02 +/- 6.56
h vs. 31.96 +/- 6.60 h, respectively, P = 0.016). The levels of
post-operative serum troponin-T at 12 and 18 h, CK-MB at 24 h, as well as
the serum h-FABP levels at 6 h, after CPB were significantly lower, which
was coincident with significantly higher protein expression of cardiac
Hif-1alpha, p-Akt, p-STAT3, p-STAT5, and p-eNOS and less vacuolization of
mitochondria in the RIPC group compared to the control group. Conclusion
In ToF children undergoing open heart surgery, RIPC attenuates myocardial
IRI and improves the short-term prognosis.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<13>
Accession Number
2000613103
Author
Lauricella L.L.; Costa P.B.; Salati M.; Pego-Fernandes P.M.; Terra R.M.
Institution
(Lauricella, Costa, Pego-Fernandes, Terra) Thoracic Surgery Division,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Lauricella, Terra) Instituto do Cancer do Estado de Sao Paulo, Hospital
das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao
Paulo, Brazil
(Pego-Fernandes) Thoracic Surgery Division, Instituto do Coracao, Hospital
da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao
Paulo, Brazil
(Salati) University of Ancona, School of Medicine, Ancona, Italy
Title
Measurement of the Inter-Rater Reliability Rate Is Mandatory for Improving
the Quality of a Medical Database: Experience with the Paulista Lung
Cancer Registry.
Source
Journal of the American College of Surgeons. (no pagination), 2018. Date
of Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Database quality measurement should be considered a mandatory
step to ensure an adequate level of confidence in data used for research
and quality improvement. Several metrics have been described in the
literature, but no standardized approach has been established. We aimed to
describe a methodological approach applied to measure the quality and
inter-rater reliability of a regional multicentric thoracic surgical
database (Paulista Lung Cancer Registry). Study Design: Data from the
first 3 years of the Paulista Lung Cancer Registry underwent an audit
process with 3 metrics: completeness, consistency, and inter-rater
reliability. The first 2 methods were applied to the whole data set, and
the last method was calculated using 100 cases randomized for direct
auditing. Inter-rater reliability was evaluated using percentage of
agreement between the data collector and auditor and through calculation
of Cohen's kappa and intraclass correlation. Results: The overall
completeness per section ranged from 0.88 to 1.00, and the overall
consistency was 0.96. Inter-rater reliability showed many variables with
high disagreement (>10%). For numerical variables, intraclass correlation
was a better metric than inter-rater reliability. Cohen's kappa showed
that most variables had moderate to substantial agreement. Conclusions:
The methodological approach applied to the Paulista Lung Cancer Registry
showed that completeness and consistency metrics did not sufficiently
reflect the real quality status of a database. The inter-rater reliability
associated with kappa and intraclass correlation was a better quality
metric than completeness and consistency metrics because it could
determine the reliability of specific variables used in research or
benchmark reports. This report can be a paradigm for future studies of
data quality measurement.<br/>Copyright &#xa9; 2018 American College of
Surgeons

<14>
Accession Number
2000602256
Author
Mina G.S.; Watti H.; Soliman D.; Shewale A.; Atkins J.; Reddy P.; Dominic
P.
Institution
(Mina, Watti, Reddy, Dominic) Department of Cardiology, LSUHSC-Shreveport,
1501 Kings Hwy, Shreveport, LA 71103, United States
(Soliman) LSUHSC-Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, United
States
(Shewale) Division of Pharmaceutical Evaluation & Policy, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Atkins) Department of Medicine, LSUHSC-Shreveport, 1501 Kings Hwy,
Shreveport, LA 71103, United States
Title
Long term outcomes of new generation drug eluting stents versus coronary
artery bypass grafting for multivessel and/or left main coronary artery
disease. A Bayesian network meta-analysis of randomized controlled trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Most data guiding revascularization of multivessel disease
(MVD) and/or left main disease (LMD) favor coronary artery bypass grafting
(CABG) over percutaneous coronary intervention (PCI). However, those data
are based on trials comparing CABG to bare metal stents (BMS) or old
generation drug eluting stents (OG-DES). Hence, it is essential to
outcomes of CABG to those of new generation drug eluting stents (NG-DES).
Methods: We searched PUBMED and Cochrane database for trials evaluating
revascularization of MVD and/or LMD with CABG and/or PCI. A Bayesian
network meta-analysis was performed to calculate odds ratios (OR) and 95%
credible intervals (CrI). Primary outcome was major adverse cardiovascular
events (MACE) at 3-5 years. Secondary outcomes were mortality,
cerebrovascular accidents (CVA), myocardial infarction (MI) and repeat
revascularization. Results: We included 10 trials with a total of 9287
patients. CABG was associated with lower MACE when compared to BMS or
OG-DES. However, MACE was not significantly different between CABG and
NG-DES (OR 0.79, CrI 0.45-1.40). Moreover, there were no significant
differences between CABG and NG-DES in mortality (OR 0.78, CrI 0.45-1.37),
CVA (OR 0.93 CrI 0.35-2.2) or MI (OR 0.6, CrI 0.17-2.0). On the other
hand, CABG was associated with lower repeat revascularization (OR 0.55,
CrI 0.36-0.84). Conclusions: Our study suggests that NG-DES is an
acceptable alternative to CABG in patients with MVD and/or LMD. However,
repeat revascularization remains to be lower with CABG than with
PCI.<br/>Copyright &#xa9; 2018

<15>
Accession Number
2000598963
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Faculty of Medicine, Minoufiya
University, Minoufiya, Egypt
Title
A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before
Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To assess the feasibility, safety, and potential useful effect
of adenosine as a postconditioning agent in patients undergoing coronary
artery bypass grafting surgeries. Design: Prospective randomized
controlled study. Setting: University hospital. Participants: The study
comprised 60 patients scheduled for coronary artery bypass grafting
surgery. Interventions: Adenosine (postconditioning group) or placebo
(control group). Adenosine infusion (150 micro&#32;g/kg/min) for 10
minutes via a cardioplegia needle into the aortic root was started 10
minutes before aortic cross-clamp removal. Measurements and Main Results:
Compared with the control group, ejection fraction, fractional shortening,
cardiac index (2.9 +/- 0.3 v 2.2 +/- 0.3 L/min/m², p = 0.032 at
60 min postbypass) and diastolic function indices were significantly
better in the postconditioning group at most time points in the postbypass
period. Cardiac troponin I and creatine kinase-MB release and the
inotropic score were significantly lower in the postconditioning group at
most time points in the postoperative period. The need for intra-aortic
balloon and epicardial pacing were comparable in both groups, whereas
incidence of arrhythmia, duration of postoperative mechanical ventilation,
and intensive care unit and total hospital stays were significantly lower
in the postconditioning group. Conclusions: Adenosine postconditioning
provided cardiac protection as evidenced by a favorable outcome on
systolic and diastolic function indices, less cardiac troponin I and
creatine kinase-MB release, lower incidence of arrhythmia, lower inotropic
score, and shorter duration of postoperative mechanical ventilation and
intensive care unit stay.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<16>
Accession Number
2000597707
Author
Fitzsimons S.; Evans J.; Parameshwar J.; Pettit S.J.
Institution
(Fitzsimons, Evans, Parameshwar, Pettit) Transplant Unit, Papworth
Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom
(Fitzsimons, Evans, Parameshwar, Pettit) Department of Public Health and
Primary Care, University of Cambridge, Cambridge, United Kingdom
Title
Utility of troponin assays for exclusion of acute cellular rejection after
heart transplantation: A systematic review.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier USA
Abstract
Background: Acute cellular rejection (ACR) is a common complication in the
first year after heart transplantation (HT). Routine surveillance for ACR
is undertaken by endomyocardial biopsy (EMB). Measurement of cardiac
troponins (cTn) in serum is an established diagnostic test of cardiac
myocyte injury. This systematic review aimed to determine whether cTn
measurement could be used to diagnose or exclude ACR. Methods: PubMed,
Google Scholar and the JHLT archive were searched for studies reporting
the result of a cTn assay and a paired surveillance EMB. Significant ACR
was defined as International Society for Heart and Lung Transplantataion
(ISHLT) Grade >=3a/>=2R. Considerable heterogeneity between studies
precluded quantitative meta-analysis. Individual study sensitivity and
specificity data were examined and used to construct a pooled hierarchical
summary receiver-operator characteristic (ROC) curve. Results: Twelve
studies including 993 patients and 3,803 EMBs, of which 3,729 were paired
with cTn levels, had adequate data available for inclusion. The overall
rate of significant ACR was 12%. There was wide variation in diagnostic
performance. cTn assays demonstrated sensitivity of 8% to 100% and
specificity of 13% to 88% for detection of ACR. The positive predictive
value (PPV) was low but the negative predictive value (NPV) was relatively
high (79% to 100%). High-sensitivity cTn assays had greater sensitivity
and NPV than conventional cTn assays for detection of ACR (sensitivity:
82% to 100% vs 8% to 77%; NPV: 97% to 100% vs 81% to 95%, respectively).
Conclusions: cTn assays do not have sufficient specificity to diagnose ACR
in place of EMB. However, hs-cTn assays may have sufficient sensitivity
and negative predictive value to exclude ACR and limit the need for
surveillance EMB. Further research is required to assess this
strategy.<br/>Copyright &#xa9; 2018 International Society for the Heart
and Lung Transplantation

<17>
Accession Number
2000541708
Author
Mohananey D.; Sankaramangalam K.; Kumar A.; Jobanputra Y.; Villablanca P.;
Krishnaswamy A.; Mick S.; Svensson L.G.; Tuzcu E.M.; Kapadia S.R.
Institution
(Mohananey, Sankaramangalam, Jobanputra, Krishnaswamy, Kapadia) Department
of Cardiovascular Medicine, Cleveland Clinic, OH, United States
(Kumar) Department of Cardiovascular Medicine, Emory University, GA,
United States
(Villablanca) Division of Cardiology, New York University, NY, United
States
(Mick, Svensson) Department of Cardiothoracic surgery, Cleveland Clinic,
OH, United States
(Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Title
Safety and efficacy of cerebral protection devices in transcatheter aortic
valve replacement: A clinical end-points meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Stroke after transcatheter aortic valve replacement (TAVR)
occurs with an incidence of 4-11% and is a particularly devastating
adverse event associated with the procedure. Several cerebral protection
devices (CPD) have been developed to prevent cerebrovascular events during
TAVR. While most studies have shown CPD to be associated with decreased
number and volume of lesions on diffusion weighted magnetic resonance
imaging, the clinical benefit of these devices remains uncertain. Methods:
We aimed to use meta-analysis techniques to study the clinical safety and
efficacy of these CPD in prospective randomized and non-randomized
studies. Data was summarized as Mantel-Haenszel relative risk (RR) and 95%
confidence intervals (CI). We used the Higgins' I² statistic to
evaluate heterogeneity. Results: We found no evidence of difference
between patients with and without CPD [RR 0.70 (95% CI 0.40-1.21)] for the
primary composite outcome of stroke and mortality at 30 days. The two
groups were also comparable in peri-procedural strokes [RR 0.53 (95% CI
0.27-1.07)], stroke at 30 days [RR 0.69(95% CI 0.38-1.26)], mortality [RR
0.59 (95% CI 0.22-1.59) at 30 days, AKI [RR 0.68(95% CI 0.28-1.62)], major
bleeding [RR 0.56 (95% CI 0.26-1.18)], life threating bleeding [0.54 (95%
CI 0.19-1.53)] and major vascular complications [RR 0.80 (95% CI
0.52-1.24)]. The risk of strokes within the first week of TAVR was
significantly lower in the CPD group [0.56(95% CI 0.33-0.96)]. Conclusion:
CPD are associated with a decreased incidence of strokes within 1 week of
follow-up without showing any evidence of increased risk of other
peri-procedural adverse events.<br/>Copyright &#xa9; 2018

<18>
Accession Number
2000461878
Author
Sai C.; Li J.; Ruiyan M.; Yingbin X.
Institution
(Sai, Li, Ruiyan, Yingbin) Department of Cardiovascular Surgery, Xinqiao
Hospital, Third Military Medical University, Chongqing, China
Title
Atorvastatin prevents postoperative atrial fibrillation in patients
undergoing cardiac surgery.
Source
Hellenic Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Hellenic Cardiological Society
Abstract
Background: Observational studies have suggested that statins might reduce
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery. However, a number of retrospective studies have shown equivocal
results. We aimed to evaluate whether different statins can reduce the
risk for AF at different doses. Methods: We searched PubMed, EMBASE, and
the Cochrane Database for all published randomized controlled trials
(RCTs) that examined the effects of statin therapy on AF up to June 2016.
A random-effects model was used when there was substantial heterogeneity.
Results: Eighteen published studies that included 4003 statin-naive
patients (2009 receiving satins and 1994 receiving regime) with sinus
rhythm before cardiac surgeries were identified for inclusion in the
analysis. Thirteen studies investigated the prevention of AF by
atorvastatin, two studies investigated the prevention of AF by
rosuvastatin, two studies investigated the prevention of AF by
simvastatin, and one study investigated the prevention of AF by
pravastatin. The remaining two studies compared the effects of different
doses of atorvastatin on the prevention of AF in patients undergoing
coronary artery bypass grafting (CABG). Overall, statin therapy was
associated with a significant decrease in the risk for AF (relative risk
[RR]: 0.57, 95% confidence interval [CI]: 0.45-0.73, P = 0.000). However,
subgroup analyses showed that only atorvastatin reduced the risk for
new-onset AF in patients after cardiac surgery (RR: 0.53, 95% CI:
0.41-0.69, P = 0.000). Patients undergoing CABG possibly received more
benefits from statin therapy (RR: 0.52, 95% CI: 0.39-0.68).Statin therapy
in a moderate dose may be optimal (RR: 0.42, 95% CI: 0.28-0.64).
Conclusions: This meta-analysis suggests that statin therapy has an
overall protective effect against postoperative AF, among which
atorvastatin in a moderate dose was significantly associated with a
decreased risk for new-onset AF in patients after CABG. Moreover,
simvastatin may also exert a significant protective effect against the AF
recurrences in patients undergoing cardiac surgeries; hence, further
prospective studies are warranted.<br/>Copyright &#xa9; 2018 Hellenic
Society of Cardiology

<19>
Accession Number
618785012
Author
de Barros Araujo Junior R.; Gonzaga I.C.A.; Fernandes G.A.; Lima A.C.G.;
Cortelazzi P.S.T.; de Oliveira R.A.; Nicolau R.A.
Institution
(de Barros Araujo Junior) Department of Cardiac Surgery, Santa Maria
Hospital, University of Piaui State (UESPI), Rua Olavo Bilac 2335,
Teresina, Piaui 64001-280, Brazil
(Gonzaga, Fernandes, Lima, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Avenida Shishima Hifumi, 2911, Sao Jose dos Campos, Sao Paulo
12244-000, Brazil
(Gonzaga, Fernandes, de Oliveira) Uninovafapi College, Rua Vitorino
Orthigues Fernandes 6123, Teresina, Piaui 64003-505, Brazil
(Lima) University of Piaui State (UESPI), Rua Olavo Bilac 2335, Teresina,
Piaui 64001-280, Brazil
(Cortelazzi) Department of Cardiac Surgery, Sao Paulo Hospital, Rua
Lindolfo Monteiro, 1551, Bairro de Fatima, Teresina, PI 64049-440, Brazil
(de Oliveira) Department of Health Sciences, University of Piaui State
(UESPI), Rua Olavo Bilac 2335, Teresina, Piaui 64001-280, Brazil
Title
Low-intensity LED therapy (lambda 640 +/- 20 nm) on saphenectomy healing
in patients who underwent coronary artery bypass graft: a randomized,
double-blind study.
Source
Lasers in Medical Science. 33 (1) (pp 103-109), 2018. Date of Publication:
01 Jan 2018.
Publisher
Springer London
Abstract
Myocardial revascularization surgery (CABG) is the most appropriate
treatment for coronary artery disease. Currently, the great challenge is
to reduce postoperative complications, such as wound infections,
dehiscence, pain, and patients' quality of life. The saphenectomy is the
target of complications in 10% of cases, which can cause greater
morbidity, time, and cost of hospitalization. Studies show that
low-intensity laser or light-emitted diode (LED) therapy promotes positive
biomodulation of the tissue repair process, culminating in a lower
incidence of dehiscence, pain reduction, and improvement in quality of
life. The objective of the present study was to evaluate clinically the
saphenous tissue repair after LED therapy. Forty subjects of both genders
who underwent CABG with extracorporeal circulation were randomly divided
into two groups: the placebo (PG) and experimental (EG). The experimental
group underwent low-intensity LED therapy (lambda 640 +/- 20 nm, 6
J/cm²) on saphenectomy. The tissue repair was analyzed by
digital photogrammetry on the first and fifth postoperative day. The
border closure was blindly evaluated by three researchers. The hematoma
and hyperemia area was quantitatively analyzed using ImageJ&#xa9;
software. The results showed that in the experimental group, there were
less bleeding points and no dehiscence in saphenectomy, as compared to the
placebo group. There was also a smaller area of hematoma and hyperemia in
the experimental group (p < 0.0009). These data lead to the conclusion
that the type of phototherapy protocol employed can assist in tissue
repair.<br/>Copyright &#xa9; 2017, Springer-Verlag London Ltd.

<20>
[Use Link to view the full text]
Accession Number
621342986
Author
Yoo J.Y.; Park S.Y.; Kim J.Y.; Kim M.; Haam S.J.; Kim D.H.
Institution
(Yoo, Park, Kim, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon
16499, South Korea
(Haam) Department of Cardiovascular and Thoracic Surgery, Ajou University
School of Medicine, Suwon, South Korea
Title
Comparison of the McGrath videolaryngoscope and the Macintosh laryngoscope
for double lumen endobronchial tube intubation in patients with manual
in-line stabilization: A randomized controlled trial.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e0081. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Double lumen endobronchial tube (DLT) intubation is commonly
used for one-lung ventilation in thoracic surgery. However, because of its
large size and shape, it is difficult to perform intubation compared with
a single lumen tube. The aim of this randomized controlled trial was to
determine whether the McGrath videolaryngoscope has any advantage over the
direct Macintosh laryngoscope for DLT intubation in patients with a
simulated difficult airway. Methods: Forty-four patients (19-60 years of
age); scheduled to undergo general anesthesia with one-lung ventilation
were assigned to 1 of 2 groups: DLT intubation with the McGrath
videolaryngoscope (ML group [n = 22]); or conventional Macintosh
laryngoscope (DL group [n = 22]). After manual in-line stabilization was
applied as a way of simulating a difficult airway, the time required for
intubation and the quality of glottic view were evaluated. Results: The
time to successful intubation was not different between the 2 groups (ML
group, 45 s [interquartile range, 38-52 s] versus DL group, 54 s [45-59
s]; P = .089). The McGrath videolaryngoscope, however, provided a
significantly better glottic view. Modified Cormack and Lehane grade was
better (P < .001), and the percentage of glottis opening score was higher
in the ML group (P < .001). Overall intubation difficulty scale score was
lower in the ML group (1 [0-2]) versus the DL group (3 [2-4]) (P < .001).
Conclusion: The McGrath videolaryngoscope improved glottic view and
resulted in lower overall intubation difficulty scale score in patients
with in-line stabilization.<br/>Copyright &#xa9; 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<21>
[Use Link to view the full text]
Accession Number
621342930
Author
Liu Q.; Wu H.; Wang J.; Li X.-M.
Institution
(Liu) Qingdao University, Qingdao, China
(Wu, Li) Department of Anesthesiology, Linyi City People's Hospital, Linyi
276000, China
(Wang) Department of Anesthesiology, Shandong Lunan Ophthalmologic
Hospital, Linyi, China
Title
Effects of Shenmai injection on the values of CO, SV, and EF in patients
undergoing off-pump coronary artery bypass graft: A randomized, clinical
trial.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e0085. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: To explore the effects of Shenmai (SM) injection on the values
of cardiac output (CO), stroke volume (SV), and the ejection fraction (EF)
in patients treated with off-pump coronary artery bypass graft (OPCABG).
Methods: Forty patients undergoing OPCABG were randomly divided into SM
group (n = 20) and the 5% glucose (G) group (n = 20). The control liquids
were injected from the beginning of the operation to the start of coronary
artery bypass graft (CABG). The values of CO, SV, and EF before induction
(t<inf>1</inf>), at the beginning of operation (t<inf>2</inf>), 30 minutes
after the start of operation (t<inf>3</inf>), at the beginning of coronary
artery bypass graft (t<inf>4</inf>), at the end of coronary artery bypass
graft (CABG) (t<inf>5</inf>), and at the end of operation (t<inf>6</inf>)
were recorded. Results: The values of CO, SV, and EF in the patients of SM
group at t<inf>3</inf> to t<inf>6</inf> were found to be significantly
higher than those at t<inf>1</inf> (P < .05). The values of CO, SV, and EF
in the patients of G group were found to be increased at t<inf>5</inf> and
t<inf>6</inf> (P < .05). At t<inf>3</inf> and t<inf>4</inf>, the values of
CO, SV, and EF in SM group were significantly higher than those in the G
group (P < .05). Conclusion: In patients with OPCABG, the infusion of SM
injection can effectively increase the values of CO, SV, and EF and
increase the safety of anesthesia management.<br/>Copyright &#xa9; 2018
the Author(s). Published by Wolters Kluwer Health, Inc.

<22>
Accession Number
616999765
Author
Sun Y.; Liu X.; Chen Z.; Fan J.; Jiang J.; He Y.; Zhu Q.; Hu P.; Wang L.;
Xu Q.; Lin X.; Wang J.
Institution
(Sun, Liu, Fan, Jiang, He, Zhu, Hu, Wang, Xu, Lin, Wang) Department of
Cardiology, Second Affiliated Hospital, Zhejiang University School of
Medicine, Hangzhou, China
(Chen) Department of Clinical Epidemiology and Biostatistics, Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wang) Zhejiang University School of Medicine, Hangzhou, China
Title
Meta-analysis of Predictors of Early Severe Bleeding in Patients Who
Underwent Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 120 (4) (pp 655-661), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Severe bleeding (SB) in patients who underwent transcatheter aortic valve
implantation (TAVI) could be fatal. Although multiple independent
predictors of bleeding post-TAVI have been identified, the definitions of
bleeding and predictors vary across studies. This study aimed to provide
summary effect estimates for predictors of SB within 30 days post-TAVI. A
systematic review of studies that reported the incidence of bleeding
post-TAVI with raw data for predictors of interest was performed. Data on
characteristics of study, patient, and procedure were extracted. Crude
risk ratios (RRs) and 95% confidence intervals were calculated using
random-effect model. Fifteen predictors on 65,209 patients from 47 studies
were analyzed. The median rate of SB was 11% across studies. Seven factors
(3 patient related and 4 procedure related) were recognized as predictors
of early SB post-TAVI. Age >=90 years (RR 1.17; p = 0.008), female (RR
1.13; p = 0.01), and sheath diameter >19 Fr (RR 1.19; p = 0.04) were weak
predictors. Chronic kidney disease (RR 1.94; p <0.001) and transapical
(TA) (RR 1.82; p <0.001) were moderate predictors that were almost
associated with twofold risk. Vascular complication (RR 2.97; p <0.001)
and circulatory support (RR 3.39; p <0.001) were strong predictors that
were nearly associated with threefold risk. In conclusion, age, gender,
chronic kidney disease, TA, sheath diameter, vascular complication, and
circulatory support were all predictors of early SB post-TAVI in this
meta-analysis, which provided possible guidance for prevention and
management of SB related to TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<23>
Accession Number
616738390
Author
Wong S.G.; Maida E.; Harvey D.; Wagner N.; Sonnadara R.; Amin N.
Institution
(Wong, Wagner, Sonnadara, Amin) Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Maida, Harvey) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Wagner, Sonnadara) Department of Psychology, Neuroscience and Behaviour,
McMaster University, Hamilton, ON, Canada
Title
Evaluation of a physiatrist-directed prehabilitation intervention in frail
patients with colorectal cancer: A randomised pilot study protocol.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e015565. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Prehabilitation interventions have shown efficacy in the
orthopaedic and cardiothoracic surgical populations, but there has been
limited evidence for general surgical patients. We present the protocol
for a pilot trial of a novel prehabilitation intervention, consisting of a
physiatrist-directed preoperative assessment and treatment programme.
Methods and analysis: This is a single-centre pilot randomised controlled
trial investigating physiatrist-directed prehabilitation for a 4 to 6-week
preoperative period. We will block randomise 40-50 participants awaiting
surgery for colorectal cancer to prehabilitation versus control.
Participants in the prehabilitation arm will undergo assessment by a
physiatrist and enrol in a supervised exercise programme. The control
group will not undergo any prehabilitation interventions in the
preoperative period. Our primary outcome is feasibility, measured by
examining recruitment, refusal, retention and adherence rates as well as
participant satisfaction and feedback. Secondary outcomes include physical
fitness, functional ability, health-related quality of life, postoperative
complications, mortality, readmissions, length of stay, prehabilitation
interventions performed and exercise complications. Ethics and
dissemination: This study has been approved by the Hamilton Integrated
Research Ethics Board (HIREB reference number 2015-0090-GRA). The results
of this pilot study will be used to design a full-scale study and
published in peer-reviewed journals.<br/>Copyright &#xa9; 2017 Article
author(s).

<24>
Accession Number
618295121
Author
Tariq M.I.; Khan A.A.; Khalid Z.; Farheen H.; Siddiqi F.A.; Amjad I.
Institution
(Tariq, Amjad) Riphah College of Rehabilitation Sciences, Islamabad,
Pakistan
(Khan) BARM Bahria Hospital, Rawalpindi, Pakistan
(Khalid, Farheen) Railway Hospital, Rawalpindi, Pakistan
(Siddiqi) Foundation University Institute of Rehabilitation Sciences,
Foundation University, Islamabad, Pakistan
Title
Effect of early <= 3 Mets (Metabolic Equivalent of Tasks) of physical
activity on patient's outcome after cardiac surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (8) (pp
490-494), 2017. Date of Publication: 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To determine the effect of <= 3 Mets (Metabolic Equivalent of
Tasks) of physical activity on zero postoperative days for improving
hemodynamic and respiratory parameters of patients after cardiac
surgeries. Study Design: Randomized control trial. Place and Duration of
Study: BARMWT Hospital, Rawalpindi, from March to August 2015.
Methodology: A randomized controlled trial was conducted on 174 CABG and
valvular heart disease patients undergoing cardiac surgical procedures.
After selection of sample via non-probability purposive sampling, they
were randomly allocated into interventional group (n=87) and control group
(n=87). Treatment protocol for experimental group was <=3 Mets of physical
activity, i.e. chest physiotherapy, sitting over edge of bed, standing and
sitting on chair at bedside, on zero postoperative day but the control
group was treated with conventional treatment on first postoperative day.
Pre- and post-treatment assessment was done in control and interventional
groups on both zero and first postoperative days. Data was analyzed on
SPSS version 21. Results: The patients' mean age was 51.86 +/-13.76 years.
Male to female ratio was 132:42. Statistically significant differences in
respiratory rate and SpO<inf>2</inf> (p=0.000 and 0.000, respectively)
were found between both groups. Among ABG's, PCO<inf>2</inf> and pH showed
significant differences with p values of 0.039 and < 0.001, respectively.
No significant differences were observed between both groups regarding
electrolytes (Na+, K+, Cl-, p-values of 0.361, 0.575 and 0.120
respectively) and creatinine (p=0.783). Marked improvement in oxygen
saturation, dyspnea and a fall in systolic BP was seen in interventional
group. There was also observed to be a reduction in the length of ICU stay
among interventional group patients as frequency with percentage of total
stay was compared to control group. Conclusion: Early physical activity
(<=3 METS) post-cardiac surgeries prevent respiratory complications
through improvement in dyspnea, respiratory rate, and oxygen saturation.

<25>
Accession Number
615612401
Author
Carter B.W.; Erasmus J.J.; Truong M.T.; Shepard J.-A.O.; Hofstetter W.;
Clarke R.; Munden R.F.; Steele J.R.
Institution
(Carter, Erasmus, Truong) Department of Diagnostic Radiology, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Shepard) Department of Radiology, Massachusetts General Hospital, Boston,
Massachusetts, United States
(Hofstetter) Department of Thoracic and Cardiovascular Surgery, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Clarke) Emory Healthcare, Atlanta, Georgia
(Munden) Department of Radiology, Wake Forest School of Medicine,
Winston-Salem, North Carolina, United States
(Steele) Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, Texas, United States
Title
Quality and Value of Subspecialty Reinterpretation of Thoracic CT Scans of
Patients Referred to a Tertiary Cancer Center.
Source
Journal of the American College of Radiology. 14 (8) (pp 1109-1118), 2017.
Date of Publication: August 2017.
Publisher
Elsevier B.V.
Abstract
Introduction Patients referred to tertiary cancer centers often present
with imaging studies performed and interpreted at other health care
institutions. Although reinterpretation of imaging performed at another
health care institution can reduce repeat imaging, unnecessary radiation
dose, and cost, the benefit is uncertain. The purpose of this study is to
evaluate the quality of initial imaging studies of patients seeking a
second opinion at a tertiary cancer center, to compare the accuracy of
initial interpretations to reinterpretations performed by subspecialty
trained radiologists at a tertiary oncologic center, and to determine the
potential impact on patient management. Methods An institutional review
board-approved retrospective, single-institution database review was
performed in 120 new patients presenting to the thoracic surgery clinics
at our institution from 2010 through 2013, with initial chest CTs
performed at another institution. Two thoracic radiologists blinded to the
interpretation independently assessed the quality and performed a
reinterpretation of 52 CTs. Fisher's exact tests were used to compare the
frequency with which clinically important staging parameters appeared in
the reinterpretations and initial reports. Discrepancies between the
reinterpretations and initial interpretations were adjudicated
independently by two thoracic radiologists at different tertiary cancer
institutions to determine which interpretations were more accurate. The
impact of discrepancies on clinical management was evaluated based on
National Comprehensive Cancer Network guidelines. Results Of the 52 CTs,
32 (62%) were of inadequate image quality for staging. In 17 of 52 (33%),
discrepancies were identified between reinterpretations and initial
interpretations. For discrepancies, the reinterpretation was judged to be
more accurate for staging than the initial interpretation. In nine of
these patients, staging parameters were omitted in the initial
interpretations that precluded adequate staging. In the remaining eight
patients, six were upstaged, one was downstaged, and one was unchanged by
the reinterpretation. Conclusions Imaging studies from outside
institutions are of variable image quality and often not adequate for
appropriate staging of thoracic malignancies. Reinterpretation can
decrease repeat imaging and associated technical costs. Additionally, the
accuracy of staging is improved by reinterpretation of CTs by subspecialty
trained radiologists and can significantly impact clinical
management.<br/>Copyright &#xa9; 2017 American College of Radiology

<26>
Accession Number
615546686
Author
Guzzetta N.A.; Williams G.D.
Institution
(Guzzetta) Department of Anesthesiology, Emory University School of
Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
(Williams) Department of Anesthesiology, Stanford University School of
Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, United States
Title
Current use of factor concentrates in pediatric cardiac anesthesia.
Source
Paediatric Anaesthesia. 27 (7) (pp 678-687), 2017. Date of Publication:
July 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Excessive bleeding following pediatric cardiopulmonary bypass is
associated with increased morbidity and mortality, both from the effects
of hemorrhage and the therapies employed to achieve hemostasis. Neonates
and infants are especially at risk because their coagulation systems are
immature, surgeries are often complex, and cardiopulmonary bypass
technologies are inappropriately matched to patient size and physiology.
Consequently, these young children receive substantial amounts of
adult-derived blood products to restore adequate hemostasis. Adult and
pediatric data demonstrate associations between blood product transfusions
and adverse patient outcomes. Thus, efforts to limit bleeding after
pediatric cardiopulmonary bypass and minimize allogeneic blood product
exposure are warranted. The off-label use of factor concentrates, such as
fibrinogen concentrate, recombinant activated factor VII, and prothrombin
complex concentrates, is increasing as these hemostatic agents appear to
offer several advantages over conventional blood products. However,
recognizing that these agents have the potential for both benefit and
harm, well-designed studies are needed to enhance our knowledge and to
determine the optimal use of these agents. In this review, our primary
objective was to examine the evidence regarding the use of factor
concentrates to treat bleeding after pediatric CPB and identify where
further research is required. PubMed, MEDLINE/OVID, The Cochrane Library
and the Cochrane Central Register of Controlled Trials (CENTRAL) were
systematically searched to identify existing studies.<br/>Copyright &#xa9;
2017 John Wiley & Sons Ltd

<27>
Accession Number
615654699
Author
Paikin J.S.; Hirsh J.; Ginsberg J.S.; Weitz J.I.; Chan N.C.; Whitlock
R.P.; Pare G.; Eikelboom J.W.
Institution
(Paikin, Whitlock, Eikelboom) Hamilton General Hospital, McMaster
University, Hamilton, ON, Canada
(Paikin, Hirsh, Ginsberg, Weitz, Pare, Eikelboom) Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Hirsh, Chan, Whitlock, Pare, Eikelboom) Population Health Research
Institute, McMaster University, Hamilton, ON, Canada
(Ginsberg, Weitz) Thrombosis and Atherosclerosis Research Institute,
McMaster University, Hamilton, ON, Canada
Title
Once versus twice daily aspirin after coronary bypass surgery: a
randomized trial.
Source
Journal of Thrombosis and Haemostasis. 15 (5) (pp 889-896), 2017. Date of
Publication: May 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Essentials Coronary artery bypass graft (CABG) failure is associated with
myocardial infarction and death. We tested whether more frequent dosing
improves aspirin (ASA) response following CABG surgery. Twice-daily
compared with once-daily dosing reduces ASA hyporesponsiveness after CABG
surgery. The efficacy of twice-daily ASA needs to be tested in a trial
powered for clinical outcomes. Summary: Background Acetyl-salicylic acid
(ASA) hyporesponsiveness occurs transiently after coronary artery bypass
graft (CABG) surgery and may compromise the effectiveness of ASA in
reducing thrombotic graft failure. A reduced response to ASA 81 mg
once-daily after CABG surgery is overcome by four times daily ASA dosing.
Objectives To determine whether ASA 325 mg once-daily or 162 mg
twice-daily overcomes a reduced response to ASA 81 mg once-daily after
CABG surgery. Methods Adults undergoing CABG surgery were randomized to
ASA 81 mg once-daily, 325 mg once-daily or 162 mg twice-daily. The primary
outcome was median serum thromboxane B<inf>2</inf> (TXB<inf>2</inf>) level
on postoperative day 4. We pooled the results with those of our earlier
study to obtain better estimates of the effect of ASA 325 mg once-daily or
in divided doses over 24 h. Results We randomized 68 patients undergoing
CABG surgery. On postoperative day 4, patients randomized to receive ASA
81 mg once-daily had a median day 4 TXB<inf>2</inf> level of 4.2 ng
mL^-1 (Q1, Q3: 1.5, 7.5 ng mL^-1), which was higher
than in those randomized to ASA 162 mg twice-daily (1.1 ng
mL^-1; Q1, Q3: 0.7, 2.7 ng mL^-1) and similar to those
randomized to ASA 325 mg once-daily (1.9 ng mL^-1; Q1, Q3: 0.9,
4.7 ng mL^-1). Pooled data showed that the median
TXB<inf>2</inf> level on day 4 in groups receiving ASA 162 mg twice-daily
or 81 mg four times daily was 1.1 ng mL^-1 compared with 2.2 ng
mL^-1 in those receiving ASA 325 mg once-daily. Conclusions
Multiple daily dosing of ASA is more effective than ASA 81 mg once-daily
or 325 mg once-daily at suppressing serum TXB<inf>2</inf> formation after
CABG surgery. A twice-daily treatment regimen needs to be tested in a
clinical outcome study.<br/>Copyright &#xa9; 2017 International Society on
Thrombosis and Haemostasis

<28>
Accession Number
616713766
Author
Itoh H.; Kurihara I.; Miyashita K.; Tanaka M.
Institution
(Itoh, Kurihara, Miyashita, Tanaka) Division of Endocrinology Metabolism,
and Nephrology, Department of Internal Medicine, School of Medicine, Keio
University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
Title
Clinical significance of cardiometabolic memory: A systematic review of
randomized controlled trials.
Source
Hypertension Research. 40 (6) (pp 526-534), 2017. Date of Publication: 01
Jun 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom. E-mail: office@jpnsh.org)
Abstract
Cardiometabolic memory has been proposed based on clinical evidence to
explain how, even after the cessation of a clinical trial, the superiority
of one treatment over the outcome persists. To understand the
cardiometabolic memory phenomenon, we performed a systematic review of
randomized controlled trials (RCTs) using PubMed in August 2016. The
search terms randomized controlled trial', post-trial follow-up' and
diabetes, hypertension or dyslipidemia' were used, and articles published
after the year 2000 were searched. We judged the memory phenomenon to be
positive when the cardiovascular outcome at the end of the post-trial
follow-up period in the intervention group was significantly superior even
though the favorable control of a risk factor (blood glucose, blood
pressure or lipid level) during the trial period was lost after the
cessation of the intervention. Among 907 articles retrieved in the initial
screening, 21 articles were judged as describing a positive memory
phenomenon. Eight, six and seven of the articles concerned diabetes,
hypertension and dyslipidemia, respectively. Transient intensive glucose
lowering rather easily induced memory for the suppression of diabetic
microangiopathies, while memory for the suppression of macroangiopathies
tended to be first evident in the post-trial follow-up period. Transient
intensive blood pressure lowering was generally effective in the formation
of memory for the suppression of cardiovascular events and had an
especially strong impact on risk reduction of chronic heart failure.
Transient intensive LDL cholesterol lowering clearly had a long-term
beneficial effect on risk reduction of cardiovascular events. Our
systematic review revealed the clinical relevance of cardiometabolic
memory.<br/>Copyright &#xa9; 2017 The Japanese Society of Hypertension All
rights reserved.

<29>
Accession Number
616402038
Author
van Osch D.; Nathoe H.M.; Jacob K.A.; Doevendans P.A.; van Dijk D.; Suyker
W.J.; Dieleman J.M.
Institution
(van Osch, Nathoe, Doevendans) Department of Cardiology, University
Medical Center Utrecht, Utrecht, Netherlands
(Jacob, Suyker) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(van Dijk, Dieleman) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
Title
Determinants of the postpericardiotomy syndrome: a systematic review.
Source
European Journal of Clinical Investigation. 47 (6) (pp 456-467), 2017.
Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Postpericardiotomy syndrome (PPS) is a common complication
following cardiac surgery; however, the exact pathogenesis remains
uncertain. Identifying risk factors of PPS might help to better understand
the syndrome. The aim of this study was to provide an overview of existing
literature around determinants of PPS in adult cardiac surgery patients.
Material and methods: Two independent investigators performed a systematic
search in MEDLINE, EMBASE and the Cochrane Central Register. The search
aimed to identify studies published between January 1950 and December
2015, in which determinants of PPS were reported. Results: A total of 19
studies met the selection criteria. In these studies, 14 different
definitions of PPS were used. The median incidence of PPS was 16%. After
quality assessment, seven studies were considered eligible for this
review. Lower preoperative interleukin-8 levels and higher postoperative
complement conversion products were associated with a higher risk of PPS.
Among other clinical factors, a lower age, transfusion of red blood cells
and lower preoperative platelet and haemoglobin levels were associated
with a higher risk of PPS. Colchicine use decreased the risk of PPS.
Conclusion: We found that both the inflammatory response and perioperative
bleeding and coagulation may play a role in the development of PPS,
suggesting a multifactorial aetiology of the syndrome. Due to a lack of a
uniform definition of PPS in the past, study comparability was poor across
the studies.<br/>Copyright &#xa9; 2017 Stichting European Society for
Clinical Investigation Journal Foundation

<30>
Accession Number
616333991
Author
da Costa M.A.C.; Lirani W.; Wippich A.C.; Lopes L.; de souza Tolentino E.;
Zampar B.; Schafranski M.D.
Institution
(da Costa, Lirani, Wippich, Lopes, de souza Tolentino, Zampar,
Schafranski) Universidade Estadual de Ponta Grossa, Ponta Grossa, PR,
Brazil
Title
Comparison of two central venous pressure control strategies to prevent
atrial fibrillation after coronary artery bypass grafting.
Source
Arquivos Brasileiros de Cardiologia. 108 (4) (pp 297-303), 2017. Date of
Publication: 2017.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Atrial fibrillation (AF) takes place in 10-40% of patients
undergoing coronary artery bypass grafting (CABG), and increases
cardiovascular mortality. Enlargement of atrial chambers is associated
with increased AF incidence, so patients with higher central venous
pressure (CVP) are expected to have larger atrial distension, which
increases AF incidence. Objective: To compare post-CABG AF incidence,
following two CVP control strategies. Methods: Interventional, randomized,
controlled clinical study. The sample comprised 140 patients undergoing
CABG between 2011 and 2015. They were randomized into two groups, G15 and
G20, with CVP maintained <= 15 cmH<inf>2</inf>O and <= 20
cmH<inf>2</inf>O, respectively. Results: 70 patients were included in each
group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with
absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7
(p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital
length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of
grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use
(G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p
= 0.04) and hospital length of stay (p = 0.001) were significantly higher
in patients who developed AF in both groups. Conclusion: Keeping CVP low
in the first 72 post-CABG hours reduces the relative risk of AF, and may
be useful to prevent AF after CABG.<br/>Copyright &#xa9; 2017, Arquivos
Brasileiros de Cardiologia. All rights reserved.

<31>
Accession Number
616890841
Author
Mendirichaga R.; Singh V.; Blumer V.; Rivera M.; Rodriguez A.P.; Cohen
M.G.; O'Neill W.W.; Elmariah S.
Institution
(Mendirichaga, Blumer, Rivera, Rodriguez, Cohen) Cardiovascular Division,
University of Miami Miller School of Medicine, Miami, Florida, United
States
(Singh, Elmariah) Structural Heart Diseases, Cardiology Division,
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(O'Neill) Structural Heart Diseases, Cardiology Division, Henry Ford
Hospital, Detroit, Michigan, United States
Title
Transcatheter Mitral Valve Repair With MitraClip for Symptomatic
Functional Mitral Valve Regurgitation.
Source
American Journal of Cardiology. 120 (4) (pp 708-715), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has
proved to be safe and effective for high-risk surgical patients with
severe symptomatic degenerative mitral regurgitation. There is paucity of
data regarding its use in functional mitral regurgitation (FMR). The
objective of this study was to evaluate the use of MitraClip in patients
with symptomatic moderate or severe FMR and a high surgical risk. Medical
libraries were systematically searched for studies assessing the use of
MitraClip for patients with symptomatic moderate or severe FMR and a high
surgical risk. Studies reporting safety and efficacy outcomes at 12 months
were included in the analysis. A total of 12 studies including 1,695
patients (age 73 [interquartile range [IQR] 70.5 to 74], 69.8% men, left
ventricular ejection fraction 32.5% [IQR 29.5 to 36], New York Heart
Association class II to IV) who underwent TMVr with MitraClip were
included in the analysis. Acute procedural success was 89% (IQR 85.5 to
92). Ischemic cardiomyopathy was the most common cause of left ventricular
dysfunction. Over 2/3 of patients had known coronary artery disease, 35% a
previous myocardial infarction, and 38.5% had a previous cardiac surgery.
Survival to hospital discharge was 98% (IQR 97 to 100) and 30-day survival
97% (IQR 96 to 98). Overall survival at 12 months was 82% (IQR 77 to 87).
Mitral valve re-intervention at 12 months was infrequent (3%; IQR 2 to
6.5). In conclusion, our pooled analysis suggests that TMVr with MitraClip
is feasible, safe, and carries a low rate of mitral valve re-intervention
at 12 months in patients with symptomatic moderate or severe FMR and a
high surgical risk.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<32>
Accession Number
611216505
Author
Chan M.; Ridley L.; Dunn D.J.; Tian D.H.; Liou K.; Ozdirik J.; Cheruvu C.;
Cao C.
Institution
(Chan, Ridley) Department of Radiology, Concord Repatriation and General
Hospital, Sydney, Australia
(Dunn) The University of Sydney, Sydney, Australia
(Tian, Liou, Ozdirik, Cao) The Collaborative Research Group, Macquarie
University, Sydney, Australia
(Cheruvu) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
Title
A systematic review and meta-analysis of multidetector computed tomography
in the assessment of coronary artery bypass grafts.
Source
International Journal of Cardiology. 221 (pp 898-905), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose The present meta-analysis aimed to compare the diagnostic accuracy
of more recent computed tomography coronary angiography (CTCA) with
invasive coronary angiography (ICA) in the assessment of graft patency
after coronary artery bypass graft surgery (CABG). Material and methods A
systematic review was performed using nine electronic databases from their
dates of inception to July 2015. Predefined inclusion criteria included
studies reporting on comparative outcomes using >= 64 slice multidetector
computed tomography (MDCT) and ICA. The primary endpoints included graft
occlusion and significant graft stenosis >= 50%. Secondary analyses
included the comparison of arterial versus venous graft conduits, and the
use of different MDCT techniques. Results Thirty-one studies were
identified according to selection criteria, involving 1975 patients with
5364 assessed grafts. Combined assessment of stenosis and occlusion for
all grafts demonstrated a sensitivity of 96.1% [95% confidence interval
(CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA
assessment of venous grafts demonstrated higher sensitivity compared to
arterial grafts, when testing for both occlusion and stenosis (97.6% vs
89.2%, p = 0.004). Conclusion Results of this study demonstrated that CTCA
had a relatively high pooled sensitivity, specificity and negative
predictive value compared to ICA. However, patient baseline
characteristics varied between studies, and the results should be
interpreted with caution. Nonetheless, our results indicate that CTCA
should be recognized as an accurate and non-invasive investigation for
graft patency in symptomatic patients after CABG.<br/>Copyright &#xa9;
2016 Elsevier Ireland Ltd

<33>
Accession Number
608882726
Author
Ortega-Deballon I.; Hornby L.; Shemie S.D.; Bhanji F.; Guadagno E.
Institution
(Ortega-Deballon) Canadian National Transplant Research Program, Canada
(Ortega-Deballon) Research Institute McGill University Health Centre,
Montreal, Canada
(Ortega-Deballon) Centre de Prelevement d'Organes, Laboratoire de
Simulation, Hopital du Sacre-Coeur, Montreal, Canada
(Ortega-Deballon) Faculty of Medicine and Health Sciences, Universidad de
Alcala de Henares, Madrid, Spain
(Ortega-Deballon) Helicopter Emergency Medical Service (SUMMA 112),
Madrid, Spain
(Hornby) DePPaRT Study, Pediatric Critical Care, Children's Hospital of
Eastern Ontario Research Institute, Ottawa, Canada
(Hornby, Shemie) Deceased Donation, Canadian Blood Services, Ottawa,
Canada
(Shemie, Bhanji) Division of Critical Care, Montreal Children's Hospital,
McGill University Health Centre, Montreal, Canada
(Shemie, Bhanji) McGill University, Montreal, Canada
(Bhanji) Royal College of Physicians and Surgeons of Canada, Canada
(Guadagno) Medical Library, McConnell Resource Centre, McGill University
Health Centre, Montreal, Canada
Title
Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest
in adults: A systematic review of international practices and outcomes.
Source
Resuscitation. 101 (pp 12-20), 2016. Date of Publication: April 01, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aim: Extracorporeal resuscitation during cardiopulmonary resuscitation
(ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated
circulation until the return of spontaneous circulation (ROSC). The
purpose of this systematic review is to address the defining elements and
outcomes (quality survival and organ donation) of currently active
protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of
cardiac origin in adult patients. The results may inform policy and
practices for ECPR and help clarify the corrresponding intersection with
deceased organ donation. Methods: We searched Medline, Embase, Cochrane
and seven other electronic databases from 2005 to 2015, with no language
restrictions. Internal validity and the quality of the studies reporting
outcomes and guidelines were assessed. The review was included in the
international prospective register of systematic reviews (Prospero,
CRD42014015259). Results: One guideline and 20 outcome studies were
analyzed. Half of the studies were prospective observational studies
assessed to be of fair to good methodological quality. The remainder were
retrospective cohorts, case series, and case studies. Ages ranged from 16
to 75 years and initial shockable cardiac rhythms, witnessed events, and a
reversible primary cause of cardiac arrest were considered favorable
prognostic factors. CPR duration and time to hospital cannulation varied
considerably. Coronary revascularization, hemodynamic interventions and
targeted temperature management neuroprotection were variable. A total of
833 patients receiving this ECPR approach had an overall reported survival
rate of 22%, including 13% with good neurological recovery. Additionally,
88 potential and 17 actual deceased organ donors were identified among the
non-survivor population in 8 out of 20 included studies. Study
heterogeneity precluded a meta-analysis preventing any meaningful
comparison between protocols, interventions and outcomes. Conclusions:
ECPR is feasible for refractory OHCA of cardiac origin in adult patients.
It may enable neurologically good survival in selected patients, who
practically have no other alternative in order to save their lives with
quality of life, and contribute to organ donation in those who die. Large,
prospective studies are required to clarify patient selection, modifiable
outcome variables, risk-benefit and cost-effectiveness.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd.

<34>
Accession Number
613138844
Author
Orchard T.J.; Backlund J.-Y.C.; Costacou T.; Cleary P.; Lopes-Virella M.;
Levy A.P.; Lachin J.M.
Institution
(Orchard, Costacou) Graduate School of Public Health, University of
Pittsburgh, Pittsburgh, PA, United States
(Backlund, Cleary, Lachin) The Biostatistics Center, The George Washington
University, Rockville, MD, United States
(Lopes-Virella) Medical University of South Carolina, Charleston, SC,
United States
(Levy) Israel Institute of Technology, Haifa, Israel
Title
Haptoglobin 2-2 genotype and the risk of coronary artery disease in the
Diabetes Control and Complications Trial/Epidemiology of Diabetes
Interventions and Complications study (DCCT/EDIC).
Source
Journal of Diabetes and its Complications. 30 (8) (pp 1577-1584), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aims/hypothesis Haptoglobin(Hp) 2-2 genotype has been shown to increase
coronary artery disease (CAD) risk in numerous type 2 diabetes studies but
in only one type 1 diabetes cohort. We assessed the association of Hp2-2
with incident CAD over 26 years of follow-up in 1303 Caucasian
participants of the Diabetes Control and Complications Trial/Epidemiology
of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods
DCCT randomized volunteers with type 1 diabetes to intensive versus
conventional therapy within two cohorts: 'primary prevention' with 1-5
years diabetes duration and 'secondary intervention' with 1-15 years
diabetes duration and early retinopathy, with or without albuminuria, but
no advanced complications. CAD was defined as myocardial infarction (MI)
or death judged to be from CAD, silent MI, angina, coronary
revascularization, or congestive heart failure due to CAD. Results In the
entire DCCTcohort, Hp2-2 was not significantly associated with incident
CAD or MI. However, in pre-specified exploratory subgroup analyses, an
increased MI risk was suggested in the secondary cohort for those with
Hp2-2. Conclusions/interpretation The analysis does not statistically
confirm an overall association between Hp 2-2 and incident CAD, however,
some suggestions of associations were observed in secondary
analyses.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<35>
Accession Number
611350788
Author
Ski C.F.; Jelinek M.; Jackson A.C.; Murphy B.M.; Thompson D.R.
Institution
(Ski, Jelinek, Thompson) Centre for the Heart and Mind, Mary MacKillop
Institute for Health Research, Australian Catholic University, 215 Spring
Street, Melbourne, VIC 3000, Australia
(Ski, Thompson) Department of Psychiatry, University of Melbourne,
Melbourne, Australia
(Jelinek) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Jackson, Murphy) Heart Research Centre, Melbourne, Australia
(Murphy) Department of Psychology, University of Melbourne, Melbourne,
Australia
Title
Psychosocial interventions for patients with coronary heart disease and
depression: A systematic review and meta-analysis.
Source
European Journal of Cardiovascular Nursing. 15 (5) (pp 305-316), 2016.
Date of Publication: 01 Aug 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Depression is common in patients with coronary heart
disease, and together these conditions significantly affect health
outcomes. Impaired social support is also considered an important
predictor of coronary heart disease prognosis and, as there is a complex
interplay between social isolation and depression, interventions to
address both may be required. This review aimed to assess the
effectiveness of psychosocial interventions addressing both depression and
social support for people with coronary heart disease and depression.
Methods: PRISMA guidelines were used to search major health databases to
identify randomised controlled trials that evaluated psychosocial
interventions compared with usual care in patients with coronary heart
disease and depression; the primary outcome was depressive symptoms and
secondary outcomes were mortality (all-cause and cardiac), myocardial
infarction, revascularisation, anxiety, social support and quality of
life. Data, when suitable, were pooled using a random-effects
meta-analysis model. Results: Five studies (n=1358 participants) were
eligible and included. The psychosocial intervention group had
significantly lower levels of depressive symptoms (standardised mean
difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03;
P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to
0.30; P=0.01) but no differences were found for mortality (all-cause and
cardiac), myocardial infarction, revascularisation, anxiety or quality of
life. Conclusions: Psychosocial interventions for patients with coronary
heart disease and depression result in modest reductions in depressive
symptoms and improvements in social support. However, caution is warranted
in view of the small number of studies included in the review and
potential heterogeneity in outcomes and in differences in
treatment.<br/>Copyright &#xa9; European Society of Cardiology.

<36>
[Use Link to view the full text]
Accession Number
617003416
Author
Wakeam E.; Acuna S.A.; Keshavjee S.
Institution
(Wakeam, Keshavjee) Division of Thoracic Surgery, Toronto General
Hospital, University Health Network, Department of Surgery, University of
Toronto, 200 Elizabeth St, 9N-946, Toronto, ON M5G 2C4, Canada
(Acuna) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Canada
Title
Chest Wall Resection for Recurrent Breast Cancer in the Modern Era.
Source
Annals of Surgery. 267 (4) (pp 646-655), 2018. Date of Publication: 01 Apr
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To review the literature on chest wall resection for recurrent
breast cancer and evaluate overall survival (OS) and quality-of-life (QOL)
outcomes. Background: Full-thickness chest wall resection for recurrent
breast cancer is controversial, as historically these recurrences have
been thought of as a harbinger of systemic disease. Methods: A systematic
search in MEDLINE, EMBASE, and Cochrane CENTRAL identified 48 eligible
studies, all retrospective, accounting for 1305 patients. The review is
reported following Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Primary end points were patient-centered QOL
outcomes and OS; secondary outcomes included disease-free survival (DFS)
and 30-day morbidity. Risk of bias was assessed using the Methodological
Index for Non-Randomized Studies instrument and the Oxford Centre for
Evidence-Based Medicine's levels of evidence tool. Random-effects
meta-analysis was used to create pooled estimates. Meta-regressions and
sensitivity analyses were used to explore study heterogeneity by age, year
of publication, risk of bias, and surgical intent (curative vs
palliative). Results: Studies consistently reported excellent OS and DFS
in properly selected patients. Pooled estimates for 5-year OS in all
studies and those from the past 15 years were 40.8% [95% confidence
interval (CI) 35.2-46.7) and 43.1% (95% CI 35.8-50.7), whereas pooled
5-year DFS was 27.1% (95% CI 16.6-41.0). Eight studies reported excellent
outcomes related to QOL. Mortality was consistently low (<1%) and 30-day
pooled morbidity was 20.2% (95% CI 15.3%-26.3%). Study quality varied, and
risk of selection bias in included studies was high. Conclusions:
Full-thickness chest wall resection can be performed with excellent
survival and low morbidity. Few studies report on QOL; prospective studies
should focus on patient-centered outcomes in this
population.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<37>
Accession Number
621364753
Author
Naseri M.H.; Madani H.; Tafti S.H.A.; Farahani M.M.; Saleh D.K.;
Hosseinnejad H.; Hosseini S.; Hekmat S.; Ahmadi Z.H.; Dehghani M.; Saadat
A.; Mardpour S.; Hosseini S.E.; Esmaeilzadeh M.; Sadeghian H.; Bahoush G.;
Bassi A.; Amin A.; Fazeli R.; Sharafi Y.; Arab L.; Movahhed M.; Davaran
S.; Ramezanzadeh N.; Kouhkan A.; Hezavehei A.; Namiri M.; Kashfi F.;
Akhlaghi A.; Sotoodehnejadnematalahi F.; Dizaji A.V.; Gourabi H.; Syedi
N.; Shahverdi A.; Baharvand H.; Aghdami N.
Institution
(Naseri) Department of Surgery, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Madani, Mardpour, Hosseini, Fazeli, Arab, Kouhkan, Namiri,
Sotoodehnejadnematalahi, Shahverdi, Baharvand, Aghdami) Department of
Regenerative Medicine, Cell Science Research Center, Royan Institute for
Stem Cell Biology and Technology, ACECR, Tehran, Iran, Islamic Republic of
(Tafti, Sadeghian, Davaran, Ramezanzadeh) Research Department, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Farahani) Department of Echocardiography, Baqiyatallah Hospital, Tehran,
Iran, Islamic Republic of
(Saleh) Department of Cardiology, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Hosseinnejad, Dehghani) Department of Cardiac Surgery, Lavasani Hospital,
Social Security Organization, Tehran, Iran, Islamic Republic of
(Hosseini) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hekmat, Movahhed) Department of Nuclear Medicine, Hasheminejad Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ahmadi) Transplantation Research Center, Masih Daneshvari Hospital,
Shaheed Beheshti University of Medical Science, Darabad, Niavaran, Tehran,
Iran, Islamic Republic of
(Saadat, Sharafi) Department of Internal Medicine, Baqiyatallah Hospital,
Tehran, Iran, Islamic Republic of
(Hosseini) School of Nursing and Midwifery, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Esmaeilzadeh) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bahoush) Department of Pediatrics, Ali Asghar Pediatric Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bassi) Department of Hematology and Oncology, Firoozgar Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Amin) Department of Heart Failure and Transplantation, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hezavehei) Department of Internal Medicine, Lavasani Hospital, Social
Security Organization, Tehran, Iran, Islamic Republic of
(Kashfi, Akhlaghi) Department of Epidemiology and Reproductive Health,
Reproductive Epidemiology Research Center, Royan Institute for
Reproductive Biomedicine, Tehran, Iran, Islamic Republic of
(Dizaji) Department of Reproductive Imaging, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran, Islamic Republic of
(Gourabi) Department of Genetics, Reproductive Biomedicine Research
Center, ACECR, Tehran, Iran, Islamic Republic of
(Syedi) School of Pharmacy and Medical Sciences, Sansom Institute for
Health Research, University of South Australia, SA, Australia
Title
COMPARE CPM-RMI Trial: Intramyocardial transplantation of autologous bone
marrow-derived CD133+ Cells and MNCs during CABG in patients with recent
MI: A Phase II/III, multicenter, placebo-controlled, randomized,
double-blind clinical trial.
Source
Cell Journal. 20 (2) (pp 267-277), 2018. Date of Publication: Summer 2018.
Publisher
Royan Institute (ACECR) (E-mail: info@royaninstitute.org)
Abstract
Objective: The regenerative potential of bone marrow-derived mononuclear
cells (MNCs) and CD133+ stem cells in the heart varies in terms of their
pro-angiogenic effects. This phase II/III, multicenter and double-blind
trial is designed to compare the functional effects of intramyocardial
autologous transplantation of both cell types and placebo in patients with
recent myocardial infarction (RMI) post-coronary artery bypass graft.
Materials and Methods: This was a phase II/III, randomized, double-blind,
placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent
myocardial infarction) conducted in accordance with the Declaration of
Helsinki that assessed the safety and efficacy of CD133 and MNCs compared
to placebo in patients with RMI. We randomly assigned 77 eligible RMI
patients selected from 5 hospitals to receive CD133+ cells, MNC, or a
placebo. Patients underwent gated single photon emission computed
tomography assessments at 6 and 18 months post-intramyocardial
transplantation. We tested the normally distributed efficacy outcomes with
a mixed analysis of variance model that used the entire data set of
baseline and between-group comparisons as well as within subject (time)
and groupxtime interaction terms. Results: There were no related serious
adverse events reported. The intramyocardial transplantation of both cell
types increased left ventricular ejection fraction by 9% [95% confidence
intervals (CI): 2.14% to 15.78%, P=0.01] and improved decreased systolic
wall thickening by -3.7 (95% CI: -7.07 to -0.42, P=0.03). The CD133 group
showed significantly decreased non-viable segments by 75% (P=0.001)
compared to the placebo and 60% (P=0.01) compared to the MNC group. We
observed this improvement at both the 6- and 18-month time points.
Conclusion: Intramyocardial injections of CD133+ cells or MNCs appeared to
be safe and efficient with superiority of CD133+ cells for patients with
RMI. Although the sample size precluded a definitive statement about
clinical outcomes, these results have provided the basis for larger
studies to confirm definitive evidence about the efficacy of these cell
types (Registration Number: NCT01167751).<br/>Copyright &#xa9; 2018 Royan
Institute (ACECR). All Rights Reserved.

<38>
Accession Number
620795999
Author
Ibrahim N.E.; Januzzi J.L.
Institution
(Ibrahim, Januzzi) Cardiology Division, Massachusetts General Hospital, 55
Fruit Street, GRB-800, Boston, MA 02114, United States
(Ibrahim, Januzzi) Harvard Medical School, Boston, MA, United States
(Januzzi) Baim Institute for Clinical Research, Boston, MA, United States
Title
The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) Study.
Source
Current Heart Failure Reports. 15 (2) (pp 37-43), 2018. Date of
Publication: 01 Apr 2018.
Publisher
Current Science Inc. (E-mail: info@current-reports.com)
Abstract
Purpose of Review: Biomarker-guided management of patients with chronic
heart failure with reduced ejection fraction (HFrEF) remains
controversial. Recent Findings: Biomarkers have established roles for
diagnosis and prognostication in HF. Pilot data suggested that use of
natriuretic peptides might be helpful to guide HF care. The recent Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided
by NT-proBNP to be more effective than usual care in improving the primary
endpoint of HF hospitalization or cardiovascular mortality amongst
patients with chronic HFrEF. Patients in GUIDE-IT received similar care
and had similar NT-proBNP lowering regardless of treatment allocation.
Summary: Though biomarkers retain important standing for diagnosis and
prognosis in HF, the GUIDE-IT trial results suggest carefully managed
patients may not benefit from a biomarker-guided strategy. Future studies
focusing this intervention on patients treated in a more real-world
setting are needed.<br/>Copyright &#xa9; 2018, Springer Science+Business
Media, LLC, part of Springer Nature.

<39>
Accession Number
620559155
Author
Poh C.L.; d'Udekem Y.
Institution
(Poh, d'Udekem) Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Vic, Australia
(Poh, d'Udekem) Department of Paediatrics, University of Melbourne,
Melbourne, Vic, Australia
(Poh, d'Udekem) Heart Research, The Murdoch Childrens Research Institute,
Melbourne, Vic, Australia
Title
Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and
Predictors of Late Death.
Source
Heart Lung and Circulation. 27 (5) (pp 552-559), 2018. Date of
Publication: May 2018.
Publisher
Elsevier Ltd
Abstract
Aim: We now know that 20-40% of patients with a single ventricle will
develop heart failure after the second decade post-Fontan surgery.
However, we remain unable to risk-stratify the cohort to identify patients
at highest risk of late failure and death. We conducted a systematic
review of all reported late outcomes for patients with a Fontan
circulation to identify predictors of late death. Methods: We searched
MEDLINE, Embase and PubMed with subject terms ("single ventricle"
"Hypoplastic left heart syndrome" "congenital heart defects" or "Fontan
procedure") AND ("heart failure" "post-operative complications" "death"
"cause of death" "transplantation" or "follow-up studies") for relevant
studies between January 1990 and December 2015. Variables identified as
significant predictors of late death on multivariate analysis were
collated for meta-analysis. Survival data was extrapolated from
Kaplan-Meier survival curves to generate a distribution-free summary
survival curve. Results: Thirty-four relevant publications were
identified, with a total of 7536 patients included in the analysis. Mean
follow-up duration was 114 months (range 24-269 months). There were 688
(11%) late deaths. Predominant causes of death were late Fontan failure
(34%), sudden death (19%) and perioperative death (16%). Estimated mean
survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93-96),
91% (95%CI 89-93) and 82% (95%CI 77-85). Significant predictors of late
death include prolonged pleural effusions post Fontan surgery (HR1.18,
95%CI 1.09-1.29, p < 0.001), protein losing enteropathy (HR2.19, 95%CI
1.69-2.84, p < 0.001), increased ventricular end diastolic volume (HR1.03
per 10 ml/BSA increase, 95%CI 1.02-1.05, p < 0.001) and having a permanent
pacemaker (HR12.63, 95%CI 6.17-25.86, p < 0.001). Conclusions: Over 80% of
patients who survive Fontan surgery will be alive at 20 years. Developing
late sequelae including protein losing enteropathy, ventricular
dysfunction or requiring a pacemaker predict a higher risk of late
death.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<40>
Accession Number
619144063
Author
Varenne O.; Cook S.; Sideris G.; Kedev S.; Cuisset T.; Carrie D.; Hovasse
T.; Garot P.; El Mahmoud R.; Spaulding C.; Helft G.; Diaz Fernandez J.F.;
Brugaletta S.; Pinar-Bermudez E.; Mauri Ferre J.; Commeau P.; Teiger E.;
Bogaerts K.; Sabate M.; Morice M.-C.; Sinnaeve P.R.
Institution
(Varenne) Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris,
France
(Varenne) Cardiology Department, Universite' Paris Descartes, Sorbonne
Paris-Cite', Paris, France
(Cook) Cardiology Department, University and Hospital Fribourg, Fribourg,
Switzerland
(Sideris) Service de Cardiologie-Institut national de la sante' et de la
recherche me'dicale U942, Hopital Lariboisiere, Assistance Publique -
Hopitaux de Paris, Universite' Paris Diderot, Paris, France
(Kedev) Cardiology Department, University St Cyril and Methodius, Skopje,
Macedonia
(Cuisset) De'partement de Cardiologie, Centre hospitalier universitaire
Timone, Marseille, France
(Carrie') Service de Cardiologie, Centre hospitalier universitaire
Toulouse Rangueil, Universite' Paul Sabatier, Toulouse, France
(Hovasse, Garot) Institut Cardiovasculaire Paris-Sud, Ramsay Ge'ne'rale de
Sante', Massy and Quincy, France
(El Mahmoud) Hopital Ambroise Pare' Assistance Publique-Hopitaux de Paris,
Universite' Versailles-Saint Quentin en Yvelines, Versailles, France
(Spaulding) Service de Cardiologie, Hopital Europe'en Georges Pompidou,
Assistance Publique-Hopitaux de Paris, Paris Descartes University and
Sudden Death Expert Center, Institut national de la sante' et de la
recherche me'dicale U990, Paris, France
(Helft) Institut de Cardiologie, Hopital Pitie'-Salpe'triere, Assistance
Publique-Hopitaux de Paris, Universite' Pierre et Marie Curie et Institut
hospitalo-universitaire, Institute of Cardiometabolism and Nutrition,
Hopital Pitie'-Salpe'triere, Paris, France
(Diaz Fernandez) Juan Ramo'n Jime'nez University Hospital, Huelva, Spain
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Pinar-Bermudez) Hospital Universitario Virgen de la Arrixaca, Murcia,
Spain
(Mauri Ferre) Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Commeau) De'partement de Cardiologie Interventionnelle, Polyclinique Les
Fleurs, Ollioules, France
(Teiger) Service de Cardiologie, Hopital Henri Mondor Assistance
Publique-Hopitaux de Paris, Universite' Paris Est Cre'teil, Cre'teil,
France
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), Department of Public Health and Primary Care,
Katholieke Universiteit Leuven, Leuven, Belgium
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
(Sabate) Interventional Cardiology Unit, Cardiovascular Institute,
Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer,
Barcelona, Spain
(Morice) Cardiovascular European Research Center, Massy, France
(Sinnaeve) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
Title
Drug-eluting stents in elderly patients with coronary artery disease
(SENIOR): A randomised single-blind trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Elderly patients regularly receive bare-metal stents (BMS)
instead of drug-eluting stents (DES) to shorten the duration of double
antiplatelet therapy (DAPT). The aim of this study was to compare outcomes
between these two types of stents with a short duration of DAPT in such
patients. Methods: In this randomised single-blind trial, we recruited
patients from 44 centres in nine countries. Patients were eligible if they
were aged 75 years or older; had stable angina, silent ischaemia, or an
acute coronary syndrome; and had at least one coronary artery with a
stenosis of at least 70% (>=50% for the left main stem) deemed eligible
for percutaneous coronary intervention (PCI). Exclusion criteria were
indication for myocardial revascularisation by coronary artery bypass
grafting; inability to tolerate, obtain, or comply with DAPT; requirement
for additional surgery; non-cardiac comorbidities with a life expectancy
of less than 1 year; previous haemorrhagic stroke; allergy to aspirin or
P2Y<inf>12</inf> inhibitors; contraindication to P2Y<inf>12</inf>
inhibitors; and silent ischaemia of less than 10% of the left myocardium
with a fractional flow reserve of 0.80 or higher. After the intended
duration of DAPT was recorded (1 month for patients with stable
presentation and 6 months for those with unstable presentation), patients
were randomly allocated (1:1) by a central computer system (blocking used
with randomly selected block sizes [two, four, eight, or 16]; stratified
by site and antiplatelet agent) to either a DES or similar BMS in a
single-blind fashion (ie, patients were masked), but those assessing
outcomes were masked. The primary outcome was to compare major adverse
cardiac and cerebrovascular events (ie, a composite of all-cause
mortality, myocardial infarction, stroke, or ischaemia-driven target
lesion revascularisation) between groups at 1 year in the
intention-to-treat population, assessed at 30 days, 180 days, and 1 year.
This trial is registered with ClinicalTrials.gov, number NCT02099617.
Findings: Between May 21, 2014, and April 16, 2016, we randomly assigned
1200 patients (596 [50%] to the DES group and 604 [50%] to the BMS group).
The primary endpoint occurred in 68 (12%) patients in the DES group and 98
(16%) in the BMS group (relative risk [RR] 0.71 [95% CI 0.52-0.94];
p=0.02). Bleeding complications (26 [5%] in the DES group vs 29 [5%] in
the BMS group; RR 0.90 [0.51-1.54]; p=0.68) and stent thrombosis (three
[1%] vs eight [1%]; RR 0.38 [0.00-1.48]; p=0.13) at 1 year were infrequent
in both groups. Interpretation: Among elderly patients who have PCI, a DES
and a short duration of DAPT are better than BMS and a similar duration of
DAPT with respect to the occurrence of all-cause mortality, myocardial
infarction, stroke, and ischaemia-driven target lesion revascularisation.
A strategy of combination of a DES to reduce the risk of subsequent repeat
revascularisations with a short BMS-like DAPT regimen to reduce the risk
of bleeding event is an attractive option for elderly patients who have
PCI. Funding: Boston Scientific.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<41>
Accession Number
621477058
Author
Foster S.J.; Cooper M.N.; Oosterhof S.; Borland M.L.
Institution
(Foster, Oosterhof, Borland) Paediatric Emergency Department, Princess
Margaret Hospital for Children, Perth, WA, Australia
(Cooper) Telethon Kids Institute, University of Western Australia, Perth,
Australia
(Borland) Divisions of Paediatrics and Emergency Medicine, School of
Medicine, University of Western Australia, Perth, Australia
Title
The preview trial-a prospective, randomised, double-blind, placebo
controlled trial assessing oral prednisolone in pre-school aged children
with viral associated wheeze.
Source
Archives of Disease in Childhood. Conference: Royal College of Paediatrics
and Child Health Annual Conference, RCPCH 2018. United Kingdom. 103
(Supplement 1) (pp A133-A134), 2018. Date of Publication: March 2018.
Publisher
BMJ Publishing Group
Abstract
Background Pre-school aged children experience frequent episodes of wheeze
that follow a different clinical course to provide assessment, operative
intervention and postoperative care to a paediatric cohort. Results Twelve
operations were undertaken for ten patients (table 1) with a median age of
3.4 years (IQR [2.3-5.8]) and weight 11.9 kg (IQR [9.1-14.5]). For those
requiring cardio-pulmonary bypass (CPB), median time was 107 min (IQR
[92-150]) and cross-clamp (XC) time 73 min (IQR [49.2-98.5]). [Table
Presented] Fast-track extubation was performed in 70% with no
reintuba-tions. Post-operative morbidity was low and only patient 2
returned to theatre for additional procedures: delayed sternal closure and
subsequent re-exploration. Case 3 was complicated by Junctional Ectopic
Tachycardia, which resolved with medical management. The team performed
the institution's first redo surgery and neonatal operation. The local
cardiac surgeon led his first paediatric VSD closure and Tetralogy of
Fallot repair. All patients were extubated and discharged, or eligible for
ICU discharge prior to conclusion of the mission. Visiting PICU staff were
resident 24 hours a day. The local ICU team were supported by twice daily
PICU rounds, multi-disciplinary meetings and bedside teaching for nurses
and trainees. The visiting Cardiologist undertook outpatient
consultations, intra-and post-operative echocardiography and ECHO
teaching. A morning lecture series delivered education to local trainees
on topics including cardiac output, inotropes, heart failure and the
surgical management of congenital heart disease. Conclusions Healing
Little Hearts provides cardiac surgical and critical care in developing
countries. Short, well-planned missions can deliver quality care to a high
turnover of patients with safe, early extubation and minimal morbidity,
despite lim-ited resources. Future missions will provide ongoing training
and support the development of a safe, independent program capable of
handling carefully selected paediatric congenital cardiac surgeries.

<42>
Accession Number
621478750
Author
Bugeja S.; Yim I.; Tamimi A.; Roberts N.; Mundy A.
Institution
(Bugeja, Mundy) University College London Hospitals, NHS Foundation Trust,
Reconstructive Urology Unit, London, United Kingdom
(Yim) University College London Hospitals, NHS Foundation Trust, Heart
Hospital, London, United Kingdom
(Tamimi) University College London Hospitals, NHS Foundation Trust, The
Heart Hospital, Dept. of Radiology, London, United Kingdom
(Roberts) University College London Hospitals, NHS Foundation Trust, The
Heart Hospital, New Barts Heart Centre, London, United Kingdom
Title
Use of a new urethral catheterisation device (UCD) to reduce the risks of
urethral trauma due to urethral catheterisation.
Source
European Urology, Supplements. Conference: 33rd Annual European
Association of Urology Congress, EAU 2018. Denmark. 17 (2) (pp e1765),
2018. Date of Publication: March 2018.
Publisher
Elsevier B.V.
Abstract
Introduction & Objectives: The UCDTM has been developed by UrethrotecTM to
facilitate urethral catheterisation after a failed initial attempt and to
prevent urethral trauma which commonly occurs when this happens. The UCDTM
consists of an integrated hydrophilic nitinol guide wire into a 16F
Silicone 3-way Foley catheter as a single 'ready-to-use' medical device
for difficult urethral catheterisation particularly in clinical
environments where no specialist equipment or expertise is available,
avoiding more dangerous alternatives such as suprapubic catheter (SPC)
insertion. This study evaluates the efficacy and safety of this new UCDTM
in men undergoing cardiac-surgery. Materials & Methods: 150 consecutive
men undergoing urethral catheterisation prior to cardiac-surgery were
evaluated retrospectively and 74 prospectively to determine the incidence
of urethral trauma due to urethral catheterisation and the need for SPC
insertion. 100 patients were then studied prospectively to trial the new
UCDTM to see whether it reduced the incidence of difficult urethral
catheterisation and adverse events. All patients in the three groups had
comparable demographic data. Results: 4 of 150 (2.7%) patients required a
SPC for traumatic/unsuccessful catheterisation with a standard urethral
catheter. No other adverse events were recorded. 7 of 74 (9.5%) patients
studied prospectively after counselling and consenting had an adverse
event: 5(6.8%) had urethral/ perineal pain and urethral bleeding and 2
(2.7%) required SPC. All of the 100 patients undergoing urethral
catheterisation using the UCDTM were catheterised successfully and none
reported any complications. Conclusions: Urethral catheterisation has a
significant risk of trauma, particularly in elderly men with a larger
prostate. The Urethrotech UCDTM reduces the risk of trauma in difficult
urethral catheterisation, particularly in high-risk patients, such as
fully heparinised cardiac-surgery patients. A nurse-led service is
empowered with this simple and safe device which has now been approved by
National Institute for Clinical Excellence (NICE) in the UK as a second
line option after failed a failed initial attempt at standard
catheterisation. The UCD is suitable for use in any clinical environment,
primary or secondary, with the potential of reducing unnecessary Accident
and Emergency attendance and hospitalisation.

<43>
Accession Number
621478561
Author
Warren H.; Fernando A.; Austin C.; Thomas K.; Chowdhury S.; O'Brien T.
Institution
(Warren, Fernando, Thomas, O'Brien) Guy's and St Thomas' NHS Foundation
Trust, Dept. of Urology, London, United Kingdom
(Austin) Guy's and St Thomas' NHS Foundation Trust, Dept. of Cardiac
Surgery, London, United Kingdom
(Chowdhury) Guy's and St Thomas' NHS Foundation Trust, Dept. of Oncology,
London, United Kingdom
Title
Simultaneous cardiac and renal surgery for renal and retroperitoneal
tumours invading the right atrium and peri-diaphragmatic inferior vena
cava: Oncological outcome and long-term survival.
Source
European Urology, Supplements. Conference: 33rd Annual European
Association of Urology Congress, EAU 2018. Denmark. 17 (2) (pp e607-e608),
2018. Date of Publication: March 2018.
Publisher
Elsevier B.V.
Abstract
Introduction & Objectives: Simultaneous cardiac and renal surgery for
tumours invading the inferior vena cava up to the right atrium is feasible
but high risk. Given the risk and changing landscape of systemic therapy
in renal cell cancer (RCC) it is important to know contemporary
oncological and long-term outcomes. Materials & Methods: Retrospective
cohort study of patients referred for simultaneous cardiac and renal
surgery for renal and retroperitoneal tumours. Cases identified from a
prospective database from initiation of the service in December 2007 to
September 2017. Perioperative data and oncological follow-up were
extracted from electronic patient records. For patients lost to follow up,
survival data was obtained from general practitioners. We used
Kaplan-Meier curves to estimate overall survival and disease-free
survival. Results: 54 cases identified, 47 (87%) of whom underwent
surgery. Mean age at operation was 63 years (range 17-95). Neves-Zincke
classification of IVC thrombus: 62% level 4 (intra-atrial), 34% level 3
(hepatic veins), 4% stages 1&2. 12/47 (26%) had radiological evidence of
metastasis at presentation. 3/47 patients (6%) died in the peri-operative
period and were excluded from further analysis. Histology confirmed 33
clear cell RCCs, six papillary cell RCCs and five non-renal cell tumours.
Overall median post-operative survival was 995 days (interquartile range
455 - upper quartile not reached). Of the 12 who underwent cytoreductive
surgery median post-operative survival was 490 days compared to 1057 days
for those undergoing surgery with apparent curative intent. Disease free
survival was 315 days (interquartile range 180 - 1181) in those treated
with curative intent. The details of oncological treatment were available
for 29/39 of operated RCC cases. 23/29 (79%) had progressive disease, with
12 cases receiving first-line pazopanib, five sunitinib, two declined
systemic therapy, two were not fit for systemic therapy, one entered a
clinical trial and one remained on active surveillance. 2/11 RCC cases for
whom 5-year follow up data was available remained disease-free.
Conclusions: A median survival of >2.5 years post surgery coupled with the
relief of circulatory symptoms appears to justify this type of surgery in
patients with renal and retroperitoneal tumours invading the heart.

<44>
Accession Number
621449552
Author
Feldheiser A.; Hunsicker O.; Kaufner L.; Kohler J.; Sieglitz H.; Casans
Frances R.; Wernecke K.-D.; Sehouli J.; Spies C.
Institution
(Feldheiser, Hunsicker, Kaufner, Kohler, Sieglitz, Spies) Department of
Anesthesiology and Intensive Care Medicine, Campus Charite Mitte and
Campus Virchow-Klinikum, Charite-University Medicine Berlin, Berlin,
Alemania
(Casans Frances) Servicio de Anestesiologia y Reanimacion, Hospital
Clinico Universitario Lozano Blesa, Zaragoza, Espana
(Wernecke) Charite-University Medicine Berlin and SOSTANA GmbH Berlin,
Berlin, Alemania
(Sehouli) Department of Gynaecology, European Competence Center for
Ovarian Cancer, Charite-Universitaetsmedizin Berlin, Campus
Virchow-Klinikum, Berlin, Alemania
Title
Dynamic muscle O2 saturation response is impaired during major non-cardiac
surgery despite goal-directed haemodynamic therapy.
Source
Revista espanola de anestesiologia y reanimacion. 63 (3) (pp 149-158),
2016. Date of Publication: 01 Mar 2016.
Abstract
BACKGROUND: Near-infrared spectroscopy combined with a vascular occlusion
test (VOT) could indicate an impairment of microvascular reactivity (MVR)
in septic patients by detecting changes in dynamic variables of muscle O2
saturation (StO2). However, in the perioperative context the consequences
of surgical trauma on dynamic variables of muscle StO2 as indicators of
MVR are still unknown.
METHODS: This study is a sub-analysis of a randomised controlled trial in
patients with metastatic primary ovarian cancer undergoing debulking
surgery, during which a goal-directed haemodynamic algorithm was applied
using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy
was used to assess dynamic variables arising from changes in muscle StO2.
RESULTS: At the beginning of surgery, values of desaturation and recovery
slope were comparable to values obtained in healthy volunteers. During the
course of surgery, both desaturation and recovery slope showed a gradual
decrease. Concomitantly, the study population underwent a transition to a
surgically induced systemic inflammatory response state shown by a gradual
increase in norepinephrine administration, heart rate, and Interleukin-6,
with a peak immediately after the end of surgery. Higher rates of
norepinephrine and a higher heart rate were related to a faster decline in
StO2 during vascular occlusion.
CONCLUSIONS: Using near-infrared spectroscopy combined with a VOT during
surgery showed a gradual deterioration of MVR in patients treated with
optimal haemodynamic care. The deterioration of MVR was accompanied by the
transition to a surgically induced systemic inflammatory response
state.<br/>Copyright &#xa9; 2015 Sociedad Espanola de Anestesiologia,
Reanimacion y Terapeutica del Dolor. Publicado por Elsevier Espana, S.L.U.
All rights reserved.

<45>
Accession Number
621400301
Author
Peeters F.E.C.M.; Van Mourik M.J.W.; Meex S.J.R.; Bucerius J.; Schalla
S.M.; Gerretsen S.C.; Mihl C.; Dweck M.R.; Schurgers L.J.; Wildberger
J.E.; Crijns H.J.G.M.; Kietselaer B.L.J.H.
Institution
(Peeters, Van Mourik, Crijns, Kietselaer) Department of Cardiology,
Maastricht University Medical Center+, CARIM, P. Debyelaan 25, Maastricht
6229 HX, Netherlands
(Meex) Department of Clinical Chemistry, Maastricht University Medical
Center+, P. Debyelaan 25, Maastricht 6229 HX, Netherlands
(Bucerius, Gerretsen, Mihl, Wildberger) Department of Radiology & Nuclear
Medicine, Maastricht University Medical Center+, CARIM, P. Debyelaan 25,
Maastricht 6229 HX, Netherlands
(Bucerius) Department of Nuclear Medicine, University Hospital RWTH
Aachen, Pauwelsstrase 30, Aachen 52074, Germany
(Schalla) Departments of Cardiology and Radiology, Maastricht University
Medical Center+, CARIM, P. Debyelaan 25, Maastricht 6229 HX, Netherlands
(Dweck) Centre for Cardiovascular Science, University of Edinburgh, 47
Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
(Schurgers) Department of Biochemistry, Maastricht University, CARIM, P.O.
Box 616, Maastricht 6200 MD, Netherlands
(Kietselaer) Department of Cardiology, Zuyderland Medisch Centrum
Heerlen/Sittard, Henri Dunantstraat 5, Heerlen 6419 PC, Netherlands
Title
Bicuspid aortic valve stenosis and the effect of vitamin K2 on
calcification using ¹⁸F-sodium fluoride positron emission
tomography/magnetic resonance: The BASIK2 rationale and trial design.
Source
Nutrients. 10 (4) (no pagination), 2018. Article Number: 386. Date of
Publication: April 2018.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
BASIK2 is a prospective, double-blind, randomized placebo-controlled trial
investigating the effect of vitamin K2 (menaquinone-7;MK7) on imaging
measurements of calcification in the bicuspid aortic valve (BAV) and
calcific aortic valve stenosis (CAVS). BAV is associated with early
development of CAVS. Pathophysiologic mechanisms are incompletely defined,
and the only treatment available is valve replacement upon progression to
severe symptomatic stenosis. Matrix Gla protein (MGP) inactivity is
suggested to be involved in progression. Being a vitamin K dependent
protein, supplementation with MK7 is a pharmacological option for
activating MGP and intervening in the progression of CAVS. Forty-four
subjects with BAV and mild-moderate CAVS will be included in the study,
and baseline ¹⁸F-sodiumfluoride (¹⁸F-NaF) positron
emission tomography (PET)/magnetic resonance (MR) and computed tomography
(CT) assessments will be performed. Thereafter, subjects will be
randomized (1:1) to MK7 (360 mcg/day) or placebo. During an 18-month
follow-up period, subjects will visit the hospital every 6 months,
undergoing a second ¹⁸F-NaF PET/MR after 6 months and CT after
6 and 18 months. The primary endpoint is the change in PET/MR
¹⁸F-NaF uptake (6 months minus baseline) compared to this delta
change in the placebo arm. The main secondary endpoints are changes in
calcium score (CT), progression of the left ventricularremodeling response
and CAVS severity (echocardiography). We will also examine the association
between early calcification activity (PET) and later changes in calcium
score (CT).<br/>Copyright &#xa9; 2018 by the authors. Licensee MDPI,
Basel, Switzerland.

<46>
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.

<47>
Accession Number
2000609395
Author
Khoynezhad A.; DelaRosa J.; Moon M.R.; Brinkman W.T.; Thompson R.B.; Desai
N.D.; Malaisrie S.C.; Girardi L.N.; Bavaria J.E.; Reece T.B.
Institution
(Khoynezhad) Department of Cardiovascular Surgery, MemorialCare Health
System, Long Beach, California, United States
(DelaRosa) Cardiothoracic Surgery, Portneuf Medical Center, Pocatello,
Idaho, United States
(Moon) Department of Cardiothoracic Surgery, Washington University, St.
Louis, Missouri, United States
(Brinkman) Department of Cardiothoracic Surgery, Baylor Scott & White,
Plano, Texas, United States
(Thompson) Department of Cardiothoracic Surgery, Bryan Heart, Lincoln,
Nebraska, United States
(Desai, Bavaria) Division of Cardiovascular Surgery, Department of
Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United
States
(Malaisrie) Division of Cardiac Surgery, Department of Surgery,
Northwestern University, Chicago, Illinois, United States
(Girardi) Department of Cardiothoracic Surgery, Cornell University, New
York, New York, United States
(Reece) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado Hospital, Aurora, Colorado, United States
Title
Facilitating Hemostasis After Proximal Aortic Surgery: Results of The
PROTECT Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Background: This study intended to evaluate the safety and hemostatic
efficacy of a novel vascular sealant (Tridyne; Neomend, Inc, Irvine, CA)
compared with an accepted adjunctive hemostatic agent applied to aortotomy
and sutures lines in cardiovascular operations. Methods: Patients
undergoing aortic valve replacement, ascending aortic replacement, or
aortic root replacement were randomly assigned 2:1 to Tridyne (n = 107) or
Gelfoam Plus (Baxter Healthcare Corp, Hayward, CA) (n = 51). These groups
were similar with regard to age, sex, race, medical history, duration of
bypass and cross-clamping, and number of suture lines treated. Suture
lines were treated after confirmation of some leakage but before formal
removal of the clamp. Results: The median bleeding time was significantly
lower for Tridyne versus Gelfoam Plus (0 versus 10.0 minutes, p < 0.0001).
Immediate hemostasis was achieved in 59.4% of the Tridyne group versus
16.0% of Gelfoam Plus group (p < 0.0001). A significantly greater
proportion of patients in the Tridyne group achieved successful hemostasis
at the aortic suture line than patients in the Gelfoam Plus group (85.7%
versus 40.0%, p < 0.0001). The Clinical Events Committee adjudicated 7
patients with possible device-related serious adverse events: 3 patients
(2.9%) in the Tridyne group and 4 patients (8.2%) in the Gelfoam Plus
group (p = 0.2097). Conclusions: Tridyne was safe and effective when used
as an adjunct to conventional hemostasis to treat high-pressure vessels in
patients who receive anticoagulation agents, in reducing time to
hemostasis, and in promoting both immediate and persistent
hemostasis.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<48>
Accession Number
621493019
Author
Eckersley M.J.; Sepehripour A.H.; Casula R.; Punjabi P.; Athanasiou T.
Institution
(Eckersley, Sepehripour, Casula, Punjabi, Athanasiou) Department of
Surgery and Cancer, Imperial College London, London, UK
Title
Do selective serotonin reuptake inhibitors increase the risk of bleeding
or mortality following coronary artery bypass graft surgery? A
meta-analysis of observational studies.
Source
Perfusion (United Kingdom). (no pagination), 2018. Date of Publication: 01
Mar 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Depressive illness has a high prevalence in patients
undergoing coronary artery bypass graft surgery (CABG). The first line
treatment for depression are selective serotonin reuptake inhibitors
(SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal
membrane and uptake by platelets, inhibiting subsequent serotonin-mediated
platelet activation. This presents a theoretically increased risk of
bleeding and subsequent postoperative mortality. This review aims to
investigate the effects of SSRIs on postoperative bleeding, defined as the
need for transfusions and re-operation for bleeding, as well as 30-day
mortality in patients undergoing CABG. Method: Four hundred and
thirty-seven papers were screened with seven meeting the full inclusion
criteria. Results: Meta-analysis demonstrated that SSRI use increased the
risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence
interval (CI): 1.06-1.26), but resulted in no difference in the rate of
re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no
effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh
frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the
mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion: This review
demonstrates that SSRIs are largely safe in cardiac surgery as no increase
in mortality was observed. However, there is a significantly raised chance
of red blood cell transfusion. The heterogeneous nature of the current
evidence base highlights the need for further research into SSRIs and
whether any effect on patient outcomes in cardiac surgery
occurs.<br/>Copyright &#xa9; 2018, The Author(s) 2018.

<49>
Accession Number
620922554
Author
Williams C.; Hine T.
Institution
(Williams) Queensland Conservatorium Research Centre, Griffith University,
South Brisbane, QLD, Australia
(Hine) Menzies Health Institute Queensland, Australia
(Hine) School of Applied Psychology, Griffith University, Mt Gravatt, QLD,
Australia
Title
An investigation into the use of recorded music as a surgical
intervention: A systematic, critical review of methodologies used in
recent adult controlled trials.
Source
Complementary Therapies in Medicine. 37 (pp 110-126), 2018. Date of
Publication: April 2018.
Publisher
Churchill Livingstone
Abstract
Context: While music is being increasingly used as a surgical
intervention, the types of music used and the reasons underlying their
selection remain inconsistent. Empirical research into the efficacy of
such musical interventions is therefore problematic. Objective: To provide
clear guidelines for musical selection and employment in surgical
interventions, created through a synthesis of the literature. The aim is
to examine how music is implemented in surgical situations, and to provide
guidance for the selection and composition of music for future
interventions. Methods: English language quantitative surgical
intervention studies from Science Direct, ProQuest, and Sage Journals
Online, all published within the last 10 years and featuring recorded
music, were systematically reviewed. Variables investigated included: the
time the intervention was performed, the intervention length, the outcomes
targeted, music description (general and specific), theoretical frameworks
underlying the selection of the music, whether or not a musical expert was
involved, participant music history, and the participants' feedback on the
chosen music. Results: Several aspects contribute to the lack of
scientific rigour regarding music selection in this field, including the
lack of a theoretical framework or frameworks, no involvement of musical
experts, failure to list the music tracks used, and the use of vague and
subjective terms in general music descriptions. Patients are frequently
allowed to select music (risking both choosing music that has an adverse
effect and making study replication difficult), and patient music history
and listening habits are rarely considered. Crucially, five primary
theoretical frameworks underlying the effectiveness of music arose in the
literature (distraction, relaxation, emotional shift, entrainment, and
endogenous analgesia), however music was rarely selected to enhance any of
these mechanisms. Conclusions: Further research needs to be conducted to
ensure that music is selected according to a theoretical framework and
more rigorous and replicable methodology. Music interventions can be made
more effective at improving psychological states and reducing
physiological arousal by selecting music conducive to specific mechanisms,
and also by considering at what point during the surgical experience the
music would be most effective. Greater involvement of music experts in
interventions would help to ensure that the most appropriate music was
chosen, and that it is clearly and precisely described.<br/>Copyright
&#xa9; 2018

<50>
Accession Number
2000570319
Author
Kanwar A.; Thaden J.J.; Nkomo V.T.
Institution
(Kanwar) Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA,
United States
(Kanwar) Mayo Clinic College of Medicine and Science, Rochester, MN,
United States
(Thaden, Nkomo) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Title
Management of Patients With Aortic Valve Stenosis.
Source
Mayo Clinic Proceedings. 93 (4) (pp 488-508), 2018. Date of Publication:
April 2018.
Publisher
Elsevier Ltd
Abstract
With increased life expectancy and aging of the population, aortic
stenosis is now one of the most common valvular heart diseases. Early
recognition and management of aortic stenosis are of paramount importance
because untreated symptomatic severe disease is universally fatal. The
advent of transcather aortic valve replacement technologies provides
exciting avenues of care to patients with this disease in whom traditional
surgical procedures could not be performed or were associated with high
risk. This review for clinicians offers an overview of aortic stenosis and
updated information on the current status of various treatment strategies.
An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was
performed from conception July 1, 2016, through November 30, 2017, using
the terms aortic stenosis, aortic valve replacement, transcatheter aortic
valve replacement (TAVR), transcatheter aortic valve insertion (TAVI),
surgical aortic valve replacement, aortic stenosis flow-gradient patterns,
low-flow aortic valve stenosis, natural history, stress testing,
pathophysiology, bicuspid aortic valve, and congenital aortic valve
disease.<br/>Copyright &#xa9; 2018 Mayo Foundation for Medical Education
and Research

<51>
Accession Number
621391592
Author
Kishimoto Y.; Nakamura Y.; Harada S.; Onohara T.; Kishimoto S.; Kurashiki
T.; Fujiwara Y.; Nishimura M.
Institution
(Kishimoto, Nakamura, Harada, Onohara, Kishimoto, Kurashiki, Fujiwara,
Nishimura) Department of Cardiovascular Surgery, Tottori University
Faculty of Medicine, Yonago, Japan
Title
Can tolvaptan protect renal function in the early postoperative period of
cardiac surgery?: - Results of a single-center randomized controlled study
-.
Source
Circulation Journal. 82 (4) (pp 999-1007), 2018. Date of Publication:
2018.
Publisher
Japanese Circulation Society
Abstract
Background: Oral administration of tolvaptan, a vasopressin V<inf>2</inf>
receptor antagonist, significantly reduces deterioration of renal
function, which has recently been highlighted as an exacerbating factor
for adverse events in patients with acute heart failure. In the present
study we tested the hypothesis that concomitant administration of
tolvaptan with a conventional diuretic is beneficial for perioperative
body fluid management in patients who have undergone cardiac surgery.
Methods and Results: In all, 280 patients who underwent cardiac surgery
were prospectively randomized to concomitant treatment with tolvaptan and
a conventional diuretic (tolvaptan group; 147 patients) or treatment with
a conventional diuretic alone (control group; 133 patients). Groups were
compared in terms of the time required to restore preoperative body weight
and the incidence of worsening renal function (WRF), defined as an
increase in the serum creatinine level >=0.3 mg/dL. The time required to
restore preoperative body weight was significantly shorter in the
tolvaptan than control group (mean [+/-SD] 3.97+/-1.95 vs. 5.02+/-2.83
days, respectively; P<0.001). The incidence of WRF was significantly lower
in the tolvaptan than control group (n=11 [7.5%] vs. n=25 [18.8%],
respectively; P=0.011). Conclusions: Administration of tolvaptan with
conventional diuretics in the early postoperative period after cardiac
surgery could be beneficial in maintaining urine output without affecting
renal function and may thus help avoid WRF.<br/>Copyright &#xa9; 2018,
Japanese Circulation Society. All rights reserved.

<52>
Accession Number
621224479
Author
Rosenstock J.; Perkovic V.; Alexander J.H.; Cooper M.E.; Marx N.; Pencina
M.J.; Toto R.D.; Wanner C.; Zinman B.; Baanstra D.; Pfarr E.; Mattheus M.;
Broedl U.C.; Woerle H.-J.; George J.T.; von Eynatten M.; McGuire D.K.
Institution
(Rosenstock) Dallas Diabetes Research Center at Medical City, 7777 Forest
Lane, Suite C-685, Dallas, TX 75230, United States
(Perkovic) University of New South Wales, The George Institute for Global
Health, Faculty of Medicine, Sydney, NSW, Australia
(Alexander, Pencina) Duke Clinical Research Institute, Duke Health,
Durham, NC, United States
(Cooper) Monash University, Head of Diabetes, Melbourne, VIC, Australia
(Marx) RWTH Aachen University, Department of Internal Medicine I,
University Hospital Aachen, Aachen, Germany
(Toto) University of Texas Southwestern Medical Center, Dallas, TX, United
States
(Wanner) Wurzburg Univ Clinic, Dept of Medicine, Wurzburg, Germany
(Zinman) Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute,
Toronto, Canada
(Zinman) University of Toronto, Toronto, Canada
(Baanstra) Boehringer Ingelheim bv, Alkmaar, Netherlands
(Pfarr, Mattheus, Broedl, George, von Eynatten) Boehringer Ingelheim
Pharma GmbH and Co. KG, Ingelheim, Germany
(Woerle) Ulm University, Ulm, Germany
(McGuire) University of Texas Southwestern Medical Center, Division of
Cardiology, Department of Internal Medicine, Dallas, TX, United States
Title
Rationale, design, and baseline characteristics of the CArdiovascular
safety and Renal Microvascular outcomE study with LINAgliptin
(CARMELINA): A randomized, double-blind, placebo-controlled
clinical trial in patients with type 2 diabetes and high cardio-renal
risk.
Source
Cardiovascular Diabetology. 17 (1) (no pagination), 2018. Article Number:
39. Date of Publication: 14 Mar 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiovascular (CV) outcome trials in type 2 diabetes (T2D)
have underrepresented patients with chronic kidney disease (CKD), leading
to uncertainty regarding their kidney efficacy and safety. The
CARMELINA trial aims to evaluate the effects of linagliptin, a
DPP-4 inhibitor, on both CV and kidney outcomes in a study population
enriched for cardio-renal risk. Methods: CARMELINA is a
randomized, double-blind, placebo-controlled clinical trial conducted in
27 countries in T2D patients at high risk of CV and/or kidney events.
Participants with evidence of CKD with or without CV disease and HbA1c
6.5-10.0% (48-86 mmol/mol) were randomized 1:1 to receive linagliptin once
daily or matching placebo, added to standard of care adjusted according to
local guidelines. The primary outcome is time to first occurrence of CV
death, non-fatal myocardial infarction, or non-fatal stroke. The key
secondary outcome is a composite of time to first sustained occurrence of
end-stage kidney disease, >= 40% decrease in estimated glomerular
filtration rate (eGFR) from baseline, or renal death. CV and kidney events
are prospectively adjudicated by independent, blinded clinical event
committees. CARMELINA was designed to continue until at least
611 participants had confirmed primary outcome events. Assuming a hazard
ratio of 1.0, this provides 90% power to demonstrate non-inferiority of
linagliptin versus placebo within the pre-specified non-inferiority margin
of 1.3 at a one-sided alpha-level of 2.5%. If non-inferiority of
linagliptin for the primary outcome is demonstrated, then its superiority
for both the primary outcome and the key secondary outcome will be
investigated with a sequentially rejective multiple test procedure.
Results: Between July 2013 and August 2016, 6980 patients were randomized
and took >= 1 dose of study drug (40.6, 33.1, 16.9, and 9.4% from Europe,
South America, North America, and Asia, respectively). At baseline, mean
+/- SD age was 65.8 +/- 9.1 years, HbA1c 7.9 +/- 1.0%, BMI 31.3 +/- 5.3
kg/m², and eGFR 55 +/- 25 mL/min/1.73 m². A total of
5148 patients (73.8%) had prevalent kidney disease (defined as eGFR < 60
mL/min/1.73 m² or macroalbuminuria [albumin-to-creatinine ratio
> 300 mg/g]) and 3990 patients (57.2%) had established CV disease with
increased albuminuria; these characteristics were not mutually exclusive.
Microalbuminuria (n = 2896 [41.5%]) and macroalbuminuria (n = 2691
[38.6%]) were common. Conclusions: CARMELINA will add important
information regarding the CV and kidney disease clinical profile of
linagliptin by including an understudied, vulnerable cohort of patients
with T2D at highest cardio-renal risk.<br/>Copyright &#xa9; 2018 The
Author(s).

<53>
Accession Number
621182080
Author
Blessberger H.; Kammler J.; Domanovits H.; Schlager O.; Wildner B.; Azar
D.; Schillinger M.; Wiesbauer F.; Steinwender C.
Institution
(Blessberger, Kammler, Steinwender) Kepler University Hospital, Medical
Faculty of the Johannes Kepler University Linz, Department of Cardiology,
Krankenhausstrase 9, Med Campus III, Linz 4020, Austria
(Domanovits) Vienna General Hospital, Medical University of Vienna,
Department of Emergency Medicine, Wahringer Gurtel 18-20, Vienna 1090,
Austria
(Schlager, Schillinger) Vienna General Hospital, Medical University of
Vienna, Department of Internal Medicine II, Division of Angiology,
Wahringer Gurtel 18-20, Vienna 1090, Austria
(Wildner) University Library of the Medical University of Vienna,
Information Retrieval Office, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Azar) Landesklinikum Thermenregion Baden, Department of General Surgery,
Wimmergasse 19, Baden 2500, Austria
(Wiesbauer) Division of Cardiology, Vienna General Hospital, Medical
University of Vienna, Department of Internal Medicine II, Wahringerstrasse
18-20, Vienna 1090, Austria
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
Cochrane Database of Systematic Reviews. 2018 (3) (no pagination), 2018.
Article Number: CD004476. Date of Publication: 13 Mar 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Randomized controlled trials have yielded conflicting results
regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue. Objectives:
The objective of this review was to systematically analyse the effects of
perioperatively administered beta-blockers for prevention of
surgery-related mortality and morbidity in patients undergoing any type of
surgery while under general anaesthesia. Search methods: We identified
trials by searching the following databases from the date of their
inception until June 2013: MEDLINE, Embase , the Cochrane Central Register
of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative
Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File,
Science Citation Index Expanded, Life Sciences Collection, Global Health
and PASCAL. In addition, we searched online resources to identify grey
literature. Selection criteria: We included randomized controlled trials
if participants were randomly assigned to a beta-blocker group or a
control group (standard care or placebo). Surgery (any type) had to be
performed with all or at least a significant proportion of participants
under general anaesthesia. Data collection and analysis: Two review
authors independently extracted data from all studies. In cases of
disagreement, we reassessed the respective studies to reach consensus. We
computed summary estimates in the absence of significant clinical
heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and
mean differences (MDs) were used for continuous outcomes. We performed
subgroup analyses for various potential effect modifiers. Main results: We
included 88 randomized controlled trials with 19,161 participants. Six
studies (7%) met the highest methodological quality criteria (studies with
overall low risk of bias: adequate sequence generation, adequate
allocation concealment, double/triple-blinded design with a placebo group,
intention-to-treat analysis), whereas in the remaining trials, some form
of bias was present or could not be definitively excluded (studies with
overall unclear or high risk of bias). Outcomes were evaluated separately
for cardiac and non-cardiac surgery. CARDIAC SURGERY (53 trials) We found
no clear evidence of an effect of beta-blockers on the following outcomes.
* All-cause mortality: RR 0.73, 95% CI 0.35 to 1.52, 3783 participants,
moderate quality evidence. * Acute myocardial infarction (AMI): RR 1.04,
95% CI 0.71 to 1.51, 3553 participants, moderate quality evidence. *
Myocardial ischaemia: RR 0.51, 95% CI 0.25 to 1.05, 166 participants, low
quality evidence. * Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02,
1400 participants, low quality evidence. * Hypotension: RR 1.54, 95% CI
0.67 to 3.51, 558 participants, low quality evidence. * Bradycardia: RR
1.61, 95% CI 0.97 to 2.66, 660 participants, low quality evidence. *
Congestive heart failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants,
low quality evidence. Beta-blockers significantly reduced the occurrence
of the following endpoints. * Ventricular arrhythmias: RR 0.37, 95% CI
0.24 to 0.58, number needed to treat for an additional beneficial outcome
(NNTB) 29, 2292 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB five,
6420 participants, high quality evidence. * On average, beta-blockers
reduced length of hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450
participants, low quality evidence). NON-CARDIAC SURGERY (35 trials)
Beta-blockers significantly increased the occurrence of the following
adverse events. * All-cause mortality: RR 1.25, 95% CI 1.00 to 1.57,
11,413 participants, low quality of evidence, number needed to treat for
an additional harmful outcome (NNTH) 167. * Hypotension: RR 1.50, 95% CI
1.38 to 1.64, NNTH 16, 10,947 participants, high quality evidence. *
Bradycardia: RR 2.23, 95% CI 1.48 to 3.36, NNTH 21, 11,033 participants,
moderate quality evidence. We found a potential increase in the occurrence
of the following outcomes with the use of beta-blockers. * Cerebrovascular
events: RR 1.59, 95% CI 0.93 to 2.71, 9150 participants, low quality
evidence. Whereas no clear evidence of an effect was found when all
studies were analysed, restricting the meta-analysis to low risk of bias
studies revealed a significant increase in cerebrovascular events with the
use of beta-blockers: RR 2.09, 95% CI 1.14 to 3.82, NNTH 265, 8648
participants. Beta-blockers significantly reduced the occurrence of the
following endpoints. * AMI: RR 0.73, 95% CI 0.61 to 0.87, NNTB 76, 10,958
participants, high quality evidence. * Myocardial ischaemia: RR 0.51, 95%
CI 0.34 to 0.77, NNTB nine, 978 participants, moderate quality evidence. *
Supraventricular arrhythmias: RR 0.73, 95% CI 0.57 to 0.94, NNTB 112, 8744
participants, high quality evidence. We found no clear evidence of an
effect of beta-blockers on the following outcomes. * Ventricular
arrhythmias: RR 0.68, 95% CI 0.31 to 1.49, 476 participants, moderate
quality evidence. * Congestive heart failure: RR 1.18, 95% CI 0.94 to
1.48, 9173 participants, moderate quality evidence. * Length of hospital
stay: mean difference -0.45 days, 95% CI -1.75 to 0.84, 551 participants,
low quality evidence. Authors' conclusions: According to our findings,
perioperative application of beta-blockers still plays a pivotal role in
cardiac surgery, as they can substantially reduce the high burden of
supraventricular and ventricular arrhythmias in the aftermath of surgery.
Their influence on mortality, AMI, stroke, congestive heart failure,
hypotension and bradycardia in this setting remains unclear. In
non-cardiac surgery, evidence shows an association of beta-blockers with
increased all-cause mortality. Data from low risk of bias trials further
suggests an increase in stroke rate with the use of beta-blockers. As the
quality of evidence is still low to moderate, more evidence is needed
before a definitive conclusion can be drawn. The substantial reduction in
supraventricular arrhythmias and AMI in this setting seems to be offset by
the potential increase in mortality and stroke.<br/>Copyright &#xa9; 2018
The Cochrane Collaboration.

<54>
Accession Number
2000561784
Author
Brignardello-Petersen R.; Johnston B.C.; Jadad A.R.; Tomlinson G.
Institution
(Brignardello-Petersen) Department of Health Research Methods, Evidence,
and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S
4L8, Canada
(Brignardello-Petersen) Evidence-Based Dentistry Unit, Faculty of
Dentistry, University of Chile, Sergio, Livingstone 943, Independencia,
Santiago, Chile
(Johnston, Jadad, Tomlinson) Institute of Health Policy, Management and
Evaluation, University of Toronto, 155 College Street, Toronto, Ontario
M5T 3M6, Canada
(Johnston) Child Health Evaluative Sciences, Hospital for Sick Children
Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay
Street, Rm 11.9859 West, Toronto, Ontario M5G 0A4, Canada
(Johnston) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
(Jadad) Institute for Global Health Equity and Innovation, Dalla Lana
School of Public Health, University of Toronto, 155 College Street,
Toronto, Ontario M5T 3M6, Canada
(Jadad) Centre for global eHealth Innovation, R Fraser Elliot Building,
190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
(Tomlinson) Department of Medicine, University Health Network and Mt Sinai
Hospital, Toronto, Eaton North, 10th floor, room 235, 200 Elizabeth
Street, Toronto, Ontario M5G 2C4, Canada
Title
Using decision thresholds for ranking treatments in network meta-analysis
results in more informative rankings.
Source
Journal of Clinical Epidemiology. 98 (pp 62-69), 2018. Date of
Publication: June 2018.
Publisher
Elsevier USA
Abstract
Objectives: To evaluate how the rank probabilities obtained from network
meta-analysis (NMA) change with the use of increasingly stringent criteria
for the relative effect comparing two treatments which ranks one treatment
better than the other. Study Design and Setting: Systematic survey and
reanalysis of published data. We included all systematic reviews (SRs)
with NMA from the field of cardiovascular medicine that had trial-level
data available, published in Medline up to February 2015. We reran all the
NMAs and determined the probabilities of each treatment being the best.
For the best treatment, we examined the effect on these probabilities of
varying, what we call the decision threshold, the relative effect required
to declare two treatments different. Results: We included 14 SRs, having a
median of 20 randomized trials and 9 treatments. The best treatments had
probabilities of being best that ranged from 38% to 85.3%. The effect of
changing the decision thresholds on the probability of a treatment being
best varied substantially across reviews, with relatively little decrease
(~20 percentage points) in some settings but a decline to near 0% in
others. Conclusion: Rank probabilities can be fragile to increases in the
decision threshold used to claim that one treatment is more effective than
another. Including these thresholds into the calculation of rankings may
aid their interpretation and use in clinical practice.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<55>
Accession Number
621344135
Author
Perrier-Melo R.J.; Figueira F.A.M.S.; Guimaraes G.V.; Costa M.C.
Institution
(Perrier-Melo, Costa) Universidade de Pernambuco (UPE), Recife, PE, Brazil
(Figueira) Instituto de Medicina Integral Professor Fernando Figueira,
Recife, PE, Brazil
(Guimaraes) Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Title
High-intensity interval training in heart transplant recipients: A
systematic review with meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (2) (pp 188-194), 2018. Date of
Publication: February 2018.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Heart transplantation (HTx) is considered an efficient and gold-standard
procedure for patients with end-stage heart failure. After surgery,
patients have lower aerobic power (VO<inf>2</inf> max) and compensatory
hemodynamic responses. The aim of the present study was to assess through
a systematic review with meta-analysis whether high-intensity interval
training (HIIT) can provide benefits for those parameters. This is a
systematic review with meta-analysis, which searched the databases and
data portals PubMed, Web of Science, Scopus, Science Direct and Wiley
until December 2016 (pairs). The following terms and descriptors were
used: "heart recipient" OR "heart transplant recipient" OR "heart
transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS
and Mesh were: "heart transplantation'' OR "cardiac transplantation". The
words used in combination (AND) were: "exercise training" OR "interval
training" OR "high intensity interval training" OR "high intensity
training" OR "anaerobic training" OR "intermittent training" OR "sprint
training". The initial search identified 1064 studies. Then, only those
studies assessing the influence of HIIT on the post-HTx period were added,
resulting in three studies analyzed. The significance level adopted was
0.05. Heart transplant recipients showed significant improvement in
VO<inf>2</inf>peak, heart rate and peak blood pressure in 8 to 12 weeks of
intervention.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de
Cardiologia. All rights reserved.

<56>
[Use Link to view the full text]
Accession Number
621343004
Author
Liu S.; Li Z.; Liu Z.; Hu Z.; Zheng G.
Institution
(Liu, Li, Liu, Hu, Zheng) Department of Anesthesiology, Henan Provincial
People's Hospital, Henan University, Zhengzhou, Henan 450003, China
Title
Blood transfusion and risk of atrial fibrillation after coronary artery
bypass graft surgery: A meta-analysis of cohort studies.
Source
Medicine (United States). 97 (10) (no pagination), 2018. Article Number:
e9700. Date of Publication: 01 Mar 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study was to systematically evaluate the effect of blood
transfusion (BT) on postoperative atrial fibrillation (AF) in adult
patients who had undergone coronary artery bypass grafting (CABG) surgery.
PubMed, Embase, and Cochrane Library databases from inception to January
2017 were searched. Cohort studies were searched that evaluated the
association between BT and the risk of postoperative AF in adult patients
who had undergone CABG surgery. Study quality was assessed by using the
Newcastle-Ottawa scale (NOS). A meta-analysis was performed with the
random-effect model. Eight cohort studies involving 7401 AF cases and
31,069 participants were identified and included in our data analysis. The
pooled odds ratio of postoperative AF in patients with BT was 1.45 (95%
confidence interval, 1.26-1.67), with significant heterogeneity (P <
.0001, I² = 79%). Excluding one study that had an off-pump CABG
did not significantly impact this result (odds ratio, 1.36; 95% confidence
interval, 1.23-1.50; n = 7). To examine the stability of the primary
results, we performed subgroup analyses. The association between BT and
the risk of postoperative AF was similar, as determined in the stratified
analyses conducted according to study design, type of surgery, and
country. The findings of the present meta-analysis demonstrated a
statistically significant increase in postoperative AF risk among adult
patients with BT. Further prospective large-scale studies are needed to
establish causality and to elucidate the underlying
mechanisms.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<57>
Accession Number
620280126
Author
Tkachuk S.; Collins K.; Ensom M.H.H.
Institution
(Tkachuk, Collins, Ensom) Faculty of Pharmaceutical Sciences, The
University of British Columbia, Vancouver, Canada
(Tkachuk, Collins, Ensom) Children's and Women's Health Centre of British
Columbia, Vancouver, Canada
Title
The Relationship Between Vancomycin Trough Concentrations and AUC/MIC
Ratios in Pediatric Patients: A Qualitative Systematic Review.
Source
Pediatric Drugs. 20 (2) (pp 153-164), 2018. Date of Publication: 01 Apr
2018.
Publisher
Springer International Publishing
Abstract
Background: In adults, the area under the concentration-time curve (AUC)
divided by the minimum inhibitory concentration (MIC) is associated with
better clinical and bacteriological response to vancomycin in patients
with methicillin-resistant Staphylococcus aureus who achieve target
AUC/MIC >= 400. This target is often extrapolated to pediatric patients
despite the lack of similar evidence. The impracticalities of calculating
the AUC in practice means vancomycin trough concentrations are used to
predict the AUC/MIC. Objective: This review aimed to determine the
relationship between vancomycin trough concentrations and AUC/MIC in
pediatric patients. Methods: We searched the MEDLINE and Embase databases,
the Cochrane Database of Systematic Reviews, and the Cochrane Central
Register of Controlled Trials using the medical subject heading (MeSH)
terms vancomycin and AUC and pediatric* or paediatric*. Articles were
included if they were published in English and reported a relationship
between vancomycin trough concentrations and AUC/MIC. Results: Of 122
articles retrieved, 11 met the inclusion criteria. One trial reported a
relationship between vancomycin trough concentrations, AUC/MIC, and
clinical outcomes but was likely underpowered. Five studies found troughs
6-10 mg/l were sufficient to attain an AUC/MIC > 400 in most general
hospitalized pediatric patients. One study in patients undergoing
cardiothoracic surgery found a trough of 18.4 mg/l achieved an AUC/MIC >
400. Two oncology studies reported troughs >= 15 mg/l likely attained an
AUC/MIC >= 400. In critical care patients: one study found a trough of 9
mg/l did not attain the AUC/MIC target; another found 7 mg/l corresponded
to an AUC/MIC of 400. Conclusions: Potential vancomycin targets varied
based on the population studied but, for general hospitalized pediatric
patients, troughs of 6-10 mg/l are likely sufficient to achieve AUC/MIC >=
400. For MIC >= 2 mg/l, higher troughs are likely necessary to achieve an
AUC/MIC >= 400. More research is needed to determine the relationships
between vancomycin trough concentrations, AUC/MIC, and clinical
outcomes.<br/>Copyright &#xa9; 2018, Springer International Publishing AG,
part of Springer Nature.

<58>
Accession Number
620258769
Author
Song L.; Li J.; Guan C.; Jing Q.; Lu S.; Yang L.; Xu K.; Yang Y.; Xu B.;
Han Y.
Institution
(Song, Yang) Department of Cardiology, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Li, Jing, Xu, Han) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Guan, Xu) Catheterization Laboratory, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Lu) Department of Cardiology, Affiliated Anzhen Hospital of Capital
Medical University, Beijing, China
(Yang) Department of Cardiology, Kunming General Hospital of Chengdu
Military Region, Kunming, China
Title
Randomized comparison of novel biodegradable polymer and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year
Outcomes of the I-LOVE-IT 2 Trial.
Source
Catheterization and Cardiovascular Interventions. 91 (Supplement 1) (pp
608-616), 2018. Date of Publication: 15 Feb 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to compare the long-term outcomes of the novel
biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES)
versus the durable polymer sirolimus-eluting stent (DP-SES) in the
I-LOVE-IT2 trial. Backgrounds: Comparisons of the long-term safety and
efficiency of the BP-DES versus the DP-DES are limited. Methods: A total
of 2,737 patients eligible for coronary stenting were randomized to the
BP-SES or DP-SES group at a 2:1 ratio. The primary endpoint of target
lesion failure (TLF) was defined as a composite of cardiac death, target
vessel myocardial infarction (MI), or clinically indicated target lesion
revascularization. Results: A three-year clinical follow-up period was
available for 2,663 (97.3%) patients. There were no significant
differences in TLF (8.9% vs. 8.6%, P = 0.81), patient-oriented composite
endpoint (PoCE) (15.2% vs.14.5%, P = 0.63), or individual components
between the BP-SES and DP-SES. Definite/probable stent thrombosis (ST) was
low and similar at 3 years (0.8% vs. 1.0%, P = 0.64). Landmark analysis of
1-3 years showed that the TLF (2.7% vs. 2.6%, P = 0.81), PoCE (6.2% vs.
5.1%, P = 0.28), and definite/probable ST (0.4% vs. 0.4%, P = 1.00) were
comparable between the 2 arms. Conclusions: In this prospective randomized
trial, the BP-SES showed similar clinical results versus the DP-SES in
terms of safety and efficacy outcomes over a 3-year follow-up
period.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<59>
Accession Number
618786136
Author
Nicholls S.J.; Ray K.K.; Johansson J.O.; Gordon A.; Sweeney M.; Halliday
C.; Kulikowski E.; Wong N.; Kim S.W.; Schwartz G.G.
Institution
(Nicholls, Kim) South Australian Health and Medical Research Institute,
University of Adelaide, PO Box 11060, Adelaide, SA 5001, Australia
(Ray) School of Public Health, Imperial College London, London, United
Kingdom
(Johansson, Gordon, Sweeney, Halliday, Kulikowski, Wong) Resverlogix
Corporation, Denver, CO, United States
(Schwartz) University of Colorado School of Medicine, Denver, CO, United
States
Title
Selective BET Protein Inhibition with Apabetalone and Cardiovascular
Events: A Pooled Analysis of Trials in Patients with Coronary Artery
Disease.
Source
American Journal of Cardiovascular Drugs. 18 (2) (pp 109-115), 2018. Date
of Publication: 01 Apr 2018.
Publisher
Springer International Publishing
Abstract
Background: Inhibition of bromodomain and extra-terminal (BET) proteins
can modulate lipoprotein and inflammatory factors that mediate
atherosclerosis. The impact of the BET inhibitor, apabetalone, on
cardiovascular events is unknown. Objective: Our objective was to
investigate the impact of apabetalone on cardiovascular event rates in a
pooled analysis of clinical studies in patients with established coronary
artery disease. Methods: We conducted a pooled analysis of patients (n =
798) with coronary artery disease who participated in clinical trials
(ASSERT, ASSURE, SUSTAIN) that evaluated the impact of 3-6 months of
treatment with apabetalone on lipid parameters and coronary
atherosclerosis. The incidence of major adverse cardiovascular events
(death, myocardial infarction, coronary revascularization, hospitalization
for cardiovascular causes) in the treatment groups was evaluated. Results:
At baseline, patients treated with apabetalone were more likely to be
Caucasian, have a history of dyslipidemia, and be undertreated with
s-blocker and anti-platelet agents. Treatment with apabetalone produced
the following dose-dependent changes compared with placebo: increases in
apolipoprotein A-I (apoA-I) of up to 6.7% (P < 0.001), increases in
high-density lipoprotein cholesterol (HDL-C) of up to 6.5% (P < 0.001),
increases in large HDL particles of up to 23.3% (P < 0.001), and decreases
in high-sensitivity C-reactive protein (hsCRP) of - 21.1% (P = 0.04).
Apabetalone treatment did not affect atherogenic lipoproteins compared
with placebo. Patients treated with apabetalone experienced fewer major
adverse cardiovascular events than those treated with placebo (5.9 vs.
10.4%; P = 0.02), a finding that was more prominent in patients with
diabetes (5.4 vs. 12.7%; P = 0.02), with baseline HDL-C < 39 mg/dl (5.5
vs. 12.8%; P = 0.01), or with elevated hsCRP levels (5.4 vs. 14.2%; P =
0.02). Conclusion: Pooled analysis of short-term studies demonstrated
fewer cardiovascular events among patients treated with the BET protein
inhibitor, apabetalone, than among those treated with placebo. BET protein
inhibition warrants further investigation as a novel approach to
cardiovascular risk reduction.<br/>Copyright &#xa9; 2017, Springer
International Publishing AG.

<60>
Accession Number
614145828
Author
Dunning J.; Levine A.; Ley J.; Strang T.; Lizotte D.E.; Lamarche Y.;
Bartley T.; Zellinger M.; Katz N.; Arora R.C.; Dembitsky W.; Cheng A.M.;
Lonchyna V.A.; Haft J.; Deakin C.D.; Mitchell J.D.; Firestone S.; Bakaeen
F.G.
Institution
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
(Levine) Department of Cardiothoracic Surgery, North Staffordshire
Hospital, Stoke-on-Trent, United Kingdom
(Ley) Department of Cardiac Surgery, California Pacific Medical Center,
San Francisco, California, United States
(Strang) Department of Cardiothoracic Anaesthesia, Wythenshawe Hospital,
United Kingdom
(Lizotte) Department of Cardiovascular and Thoracic Surgery, University of
Louisville, Louisville, Kentucky, United States
(Lamarche) Department of Surgery, Montreal Heart Institute and Critical
Care Program, Hopital du Sacre Coeur de Montreal, Universite de Montreal,
Montreal, Canada
(Bartley) Department of Cardiothoracic Surgery, Birmingham, United Kingdom
(Zellinger) Cardiac Surgery, Emory University Hospital, Atlanta, Georgia
(Katz) Division of Cardiac Surgery, Johns Hopkins University, Baltimore,
Maryland, United States
(Arora) Department of Surgery, Cardiac Sciences Program, St. Boniface
Hospital, Winnipeg, Manitoba, Canada
(Dembitsky) Department of Cardiac Surgery, Sharp Medical Centre, San
Diego, California, United States
(Cheng) University of Washington Medical Center, Seattle, Washington,
United States
(Lonchyna) Section of Cardiac and Thoracic Surgery, University of Chicago
School of Medicine, Chicago, Illinois, United States
(Haft) Department of Cardiac Surgery, University of Michigan, Ann Arbor,
Michigan, United States
(Deakin) Department of Cardiac Surgery and NIHR Southampton Respiratory
Biomedical Research Unit, University Hospital Southampton, Hampshire,
United Kingdom
(Mitchell) Department of Thoracic Surgery, University of Colorado
Hospital, Aurora, Colorado, United States
(Firestone) The Society of Thoracic Surgeons, Chicago, Illinois, United
States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, The Cleveland
Clinic, Cleveland, Ohio, United States
Title
The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of
Patients Who Arrest After Cardiac Surgery.
Source
Annals of Thoracic Surgery. 103 (3) (pp 1005-1020), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Executive Summary The Society of Thoracic Surgeons Task Force on
Resuscitation After Cardiac Surgery provides this professional society
perspective on resuscitation in patients who arrest after cardiac surgery.
This document was created using a multimodal methodology for evidence
generation and includes information from existing guidelines, from the
International Liaison Committee on Resuscitation, from our own structured
literature reviews on issues particular to cardiac surgery, and from an
international survey on resuscitation hosted by CTSNet. In gathering
evidence for this consensus paper, searches were conducted using the
MEDLINE keywords "cardiac surgery," "resuscitation," "guideline,"
"thoracic surgery," "cardiac arrest," and "cardiac massage." Weight was
given to clinical studies in humans, although some case studies, mannequin
simulations of potential protocols, and animal models were also
considered. Consensus was reached using a modified Delphi method
consisting of two rounds of voting until 75% agreement on appropriate
wording and strength of the opinions was reached. The Society of Thoracic
Surgeons Workforce on Critical Care was enlisted in this process to
provide a wider variety of experiences and backgrounds in an effort to
reinforce the opinions provided. We start with the premise that external
massage is ineffective for an arrest due to tamponade or hypovolemia
(bleeding), and therefore these subsets of patients will receive
inadequate cerebral perfusion during cardiac arrest in the absence of
resternotomy. Because these two situations are common causes for an arrest
after cardiac surgery, the inability to provide effective external
cardiopulmonary resuscitation highlights the importance of early emergency
resternotomy within 5 minutes. In addition, because internal massage is
more effective than external massage, it should be used preferentially if
other quickly reversible causes are not found. We present a protocol for
the cardiac arrest situation that includes the following recommendations:
(1) successful treatment of a patient who arrests after cardiac surgery is
a multidisciplinary activity with at least six key roles that should be
allocated and rehearsed as a team on a regular basis; (2) patients who
arrest with ventricular fibrillation should immediately receive three
sequential attempts at defibrillation before external cardiac massage, and
if this fails, emergency resternotomy should be performed; (3) patients
with asystole or extreme bradycardia should undergo an attempt to pace if
wires are available before external cardiac massage, then optionally
external pacing followed by emergency resternotomy; and (4) pulseless
electrical activity should receive prompt resternotomy after quickly
reversible causes are excluded. Finally, we recommend that full doses of
epinephrine should not be routinely given owing to the danger of extreme
hypertension if a reversible cause is rapidly resolved. Protocols are
given for excluding reversible airway and breathing complications, for
left ventricular assist device emergencies, for the nonsternotomy patient,
and for safe emergency resternotomy. We believe that all cardiac units
should have accredited policies and protocols in place to specifically
address the resuscitation of patients who arrest after cardiac
surgery.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<61>
[Use Link to view the full text]
Accession Number
614735343
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent)
Direction Prelevement Greffe Organes-Tissus, Saint-Denis La Plaine 93212,
France
(Leprince) Service de Chirurgie Cardio-vasculaire, Hopital de la Pitie
Salpetriere, Paris, France
(Porcher) Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Paris U1153, France
Title
Prediction of waitlist mortality in adult heart transplant candidates: The
candidate risk score.
Source
Transplantation. 101 (9) (pp 2175-2182), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The cardiac allocation system in France is currently based on urgency and
geography.Medical urgency is defined by therapies without considering
objective patient mortality risk factors. This study aimed to develop a
waitlist mortality risk score from commonly available candidate variables.
Methods. The study included all patients, aged 16 years or older,
registered on the national registry CRISTAL for first single-organ heart
transplantation between January 2010 and December 2014. This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables at listing with 1-year waitlist
death or delisting for worsening medical condition was assessed within the
derivation cohort. The predictors were used to generate a candidate risk
score (CRS). Validation of the CRS was performed in the validation cohort.
Concordance probability estimation (CPE) was used to evaluate the
discriminative capacity of the models. Results. During the study period,
2333 patients were newly listed. The derivation (n =1 555) and the
validation cohorts (n = 778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate, and total bilirubin level were included in a simplified model and
incorporated into the score. The Concordance probability estimation of the
CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort.
The correlation between observed and expected 1-year waitlist mortality in
the validation cohort was 0.87. Conclusions. The candidate risk score
provides an accurate objective prediction of waitlist mortality. It is
currently being used to develop a modified cardiac allocation system in
France.<br/>Copyright &#xa9; 2017 Wolters Kluwer.

<62>
Accession Number
614485541
Author
Chang Y.-S.; Wang J.-X.; Chang D.-W.
Institution
(Chang) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, China
(Wang) Department of Surgery, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Chang) Faculty of Mathematics and Information Science, Shaanxi Normal
University, Xi'an, China
Title
Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main
Coronary Stenosis.
Source
Annals of Thoracic Surgery. 104 (2) (pp 630-637), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study assessed the short-, medium-, and long-term outcomes
of coronary artery bypass grafting vs stenting for patients with
unprotected left main coronary artery disease through a meta-analysis of
randomized controlled trials. Methods PubMed, Embase, Scopus, Web of
Science, Cochrane Library, and major conference proceedings databases were
systematically searched for randomized controlled trials of coronary
artery bypass grafting compared with stents in unprotected left main
coronary artery disease. End points assessed were all-cause death,
myocardial infarction, major adverse cardiac and cerebrovascular events,
target vessel revascularization, and cerebral stroke. A meta-analysis was
conducted according to predefined clinical end points. Results All-cause
death and stroke were similar between stenting and coronary artery bypass
grafting at 1 year and at follow-up beyond 1 year. The incidence of
myocardial infarction was similar between stenting and coronary artery
bypass grafting at each separate time point. The incidence of repeat
revascularization was similar between the two groups at 30 days but was
higher for stenting at 1 year and beyond. There was a trend toward fewer
major adverse cardiac and cerebrovascular events after stenting compared
with coronary artery bypass grafting at 30 days, but this difference was
no longer significant at 1 year and reversed at follow-up beyond 1 year.
Conclusions The early advantages of stenting over coronary artery bypass
grafting have been shown to progressively shift to coronary artery bypass
grafting over time. Further larger sample randomized controlled trials are
warranted to confirm the results.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<63>
Accession Number
613709874
Author
Peek J.; Vos C.G.; Unlu C.; van de Pavoordt H.D.W.M.; van den Akker P.J.;
de Vries J.-P.P.M.
Institution
(Peek, van de Pavoordt, de Vries) Department of Vascular Surgery, St
Antonius Hospital, Nieuwegein, Netherlands
(Vos, Unlu, van den Akker) Department of Vascular Surgery, Noordwest
Ziekenhuisgroep, Alkmaar, Netherlands
Title
Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic
Review and Meta-Analysis.
Source
Annals of Vascular Surgery. 40 (pp 303-326), 2017. Date of Publication:
April 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Many publications report outcomes of surgical treatment for
thoracic outlet syndrome (TOS); however, high-quality reviews and
meta-analyses are lacking. This systematic review and meta-analysis
summarizes and compares the outcomes and major complications of the
surgical procedures for the 3 types of TOS: arterial, venous, and
neurogenic. Methods MEDLINE, EMBASE, and CINAHL databases, and the
Cochrane Database of Systematic Reviews were searched for papers published
between January 1980 and February 2015, using the keywords thoracic outlet
syndrome, and treatment and surgical. Articles were eligible for inclusion
if the following criteria were met: studies describing outcomes of surgery
for TOS, published in English, human studies, and available full-text. The
exclusion criteria were case-series and case reports (n < 5), reviews,
abstracts, and studies of endoscopic-assisted or robotic
endoscopic-assisted transaxillary first rib resection. Results A total of
12 papers met our inclusion criteria and were finally included in this
systematic review. All included articles showed improvement of complaints
after surgical treatment. In our meta-analysis, improvement to Derkash's
classification category excellent/good was achieved in 90% of the arterial
and venous TOS groups. Preoperative and postoperative Disabilities of the
Arm, Shoulder, and Hand scores show improvement of 28.3 points after
operative treatment of neurogenic TOS. Conclusions In conclusion, surgical
treatment of TOS seems to be beneficial in most patients and is relatively
safe. The largest challenge remains the diagnosis of TOS, especially
neurogenic TOS, because standardized diagnostic criteria are lacking.
Future studies should focus on the diagnostic work-up of
TOS.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<64>
Accession Number
614312762
Author
Arora S.; Strassle P.D.; Ramm C.J.; Rhodes J.A.; Vaidya S.R.; Caranasos
T.G.; Vavalle J.P.
Institution
(Arora, Ramm, Caranasos, Vavalle) Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Strassle) Division of Epidemiology, University of North Carolina, Chapel
Hill, NC, United States
(Rhodes) Campbell University School of Osteopathic Medicine, Buies Creek,
NC, United States
(Vaidya) Department of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC, United States
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early
Outcomes.
Source
Heart Lung and Circulation. 26 (8) (pp 840-845), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background The results from the PARTNER 2 trial showed the feasibility of
transcatheter aortic valve replacement (TAVR) in intermediate surgical
risk patients. Although low risk clinical trials will take time to
conclude, some data has emerged comparing TAVR with surgical aortic valve
replacement (SAVR) in lower risk patients. Methods A Medline search was
conducted using standard methodology to search for studies reporting
results comparing TAVR and SAVR. Studies were included if the overall mean
Society of Thoracic Surgeons Score was less than 4% (or equivalent
Euroscore). A meta-analysis comparing the 30-day risk of clinical outcomes
between TAVR and SAVR in the lower surgical risk population was conducted.
Results A total of four studies, including one clinical trial and three
propensity-matched cohort studies met the inclusion criteria. Compared to
SAVR, TAVR had a lower risk of 30-day mortality (RR 0.67, 95% CI 0.41,
1.10), stroke (RR 0.60, 95% CI 0.30, 1.22), bleeding complications (RR
0.51, 95% CI 0.40, 0.67) and acute kidney injury (RR 0.66, 95% CI 0.47,
0.94). However, a higher risk of vascular complications (RR 11.72, 95% CI
3.75, 36.64), moderate or severe paravalvular leak (RR 5.04, 95% CI 3.01,
8.43), and permanent pacemaker implantations (RR 4.62, 95% CI 2.63, 8.12)
was noted for TAVR. Conclusion Among lower risk patients, TAVR and SAVR
appear to be comparable in short term outcomes. Additional high quality
studies among patients classified as low risk are needed to further
explore the feasibility of TAVR in all surgical risk
patients.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<65>
Accession Number
610067530
Author
Loladze G.; Kuehnel R.U.; Claus T.; Hartrumpf M.; Kuepper F.; Pohl M.;
Albes J.M.
Institution
(Loladze, Kuehnel, Claus, Hartrumpf, Kuepper, Albes) Department of
Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
(Pohl) Institute of Medical Physics and Biophysics, University Hospital
Charite, Berlin, Germany
Title
Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a
Randomized Prospective Study.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 332-337), 2017. Article
Number: 154307oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Sternal instability after coronary artery bypass grafting
(CABG) is a serious complication. Obese patients are at high risk for
sternal instability after CABG. This study was conducted to assess the
positive impact of double-wire sternal closure on sternal instability.
Methods A total of 200 obese patients with a body mass index >= 30
kg/m² undergoing isolated CABG with left internal mammary
artery (LIMA) graft were randomly assigned to sternal closure either by
eight single wires (n = 100) or by a combination of four double wires and
four single wires. Results There was a total of 21 cases with sternal
instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases
(16%) in the single-wire group (p = 0.019). Logistic regression analysis
showed sternal closure via double wires as an independent protection
factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006)
and postoperative delirium (OR: 3.5; p = 0.033) turned out to be
independent risk factors for the development of sternal instability.
Conclusion Double-wire sternal closure significantly reduces postoperative
sternal instability in obese patients undergoing isolated CABG with LIMA
graft.<br/>Copyright &#xa9; Georg Thieme Verlag KGStuttgart . New York.

<66>
Accession Number
613353885
Author
Jha A.K.; Malik V.; Gharde P.; Chauhan S.; Kiran U.; Hote M.P.
Institution
(Jha, Malik, Gharde, Chauhan, Kiran, Hote) All India Institute of Medical
Sciences, New Delhi, India
Title
Echocardiographic Predictors of Immediate Postoperative Outcomes in
Patients With Severe Left Ventricular Systolic Dysfunction Undergoing
On-Pump Coronary Artery Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 184-190),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives The postoperative course following on-pump coronary artery
bypass grafting (CABG) in patients with severe left ventricular (LV)
systolic dysfunction is often unpredictable. Therefore, the aim of this
study was to identify predictors of poor postoperative outcome in this
subset of patients. Design Prospective observational study Setting Single
university hospital Participants Forty patients with severe LV systolic
dysfunction undergoing isolated on-pump CABG Interventions None
Measurements and Main Results Comprehensive transesophageal
echocardiographic examination was performed to obtain the indices of
systolic and diastolic LV function after induction of anesthesia. A poor
postoperative outcome was defined as patient death or vasoactive inotropic
score>=20 for at least 6 hours and/or requiring intra-aortic balloon
counterpulsation and/or mechanical ventilation for>=24 hours. Poor
postoperative outcome was observed in 40% (16/40) of patients. Patients
with poor postoperative outcomes had a significantly higher systolic
dyssynchrony index, septal-lateral delay with a significantly lower global
longitudinal strain and isovolumic acceleration, end-diastolic volume,
end-systolic volume, and lateral and medial mitral annulus systolic
velocity. In a binary logistic regression model, global longitudinal
strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p =
0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p =
0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48;
p = 0.000) were found to be predictors of poor postoperative outcome.
Conclusion Global longitudinal strain, systolic dyssynchrony index, and
septal-lateral delay were reliable and accurate predictors of adverse
outcomes in patients with severe LV systolic dysfunction undergoing
on-pump CABG.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<67>
Accession Number
612901782
Author
Narula J.; Kiran U.; Malhotra Kapoor P.; Choudhury M.; Rajashekar P.;
Kumar Chowdhary U.
Institution
(Narula, Kiran, Malhotra Kapoor, Choudhury) Departments of Cardiac
Anesthesiology and, Cardio and Neurosciences Centre, All India Institute
of Medical Sciences, New Delhi, India
(Rajashekar, Kumar Chowdhary) Cardio-Thoracic and Vascular Surgery, Cardio
and Neurosciences Centre, All India Institute of Medical Sciences, New
Delhi, India
Title
Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using
Electrical Cardiometry During Autologous Blood Harvest.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 84-89),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of autologous blood harvest (ABH)-induced
volume shifts using electrical cardiometry (EC) in patients with pulmonary
artery hypertension secondary to left heart disease. Design Prospective,
randomized, controlled trial. Setting A tertiary care hospital.
Participants The study comprised 50 patients scheduled to undergo heart
valve replacement. Interventions Patients were divided randomly into 2
experimental groups that were distinguished by whether ABH was performed.
Blood volume extracted in the test group was replaced simultaneously with
1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany).
Hemodynamic, respiratory, and EC-derived parameters were recorded at
predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes
post-ABH]). Measurements and Main Results Withdrawal of 15% of blood
volume in the ABH group caused significant reductions in thoracic fluid
content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23%
[-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]);
airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to
-8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear
regression analysis showed good correlation between the percentage change
in TFC after ABH and the percentage of change in right atrial pressure,
stroke volume variation, autologous blood extracted, peak and mean airway
pressures, and oxygen index. Conclusions In addition to its proven role in
blood conservation, therapeutic benefits derived from ABH include
decongestion of volume-loaded patients, decrease in TFC, and improved gas
exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during
ABH and helps in the execution of an early patient-specific, goal-directed
therapy, allowing for its safe implementation in patients with pulmonary
hypertension secondary to left heart disease.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<68>
[Use Link to view the full text]
Accession Number
615369281
Author
Sible A.M.; Nawarskas J.J.
Institution
(Sible, Nawarskas) College of Pharmacy, University of New Mexico, 2502
Marble NE, Albuquerque, NM 87131, United States
Title
Cangrelor: A New Route for P2Y12 Inhibition.
Source
Cardiology in Review. 25 (3) (pp 133-139), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Antiplatelet therapy with a P2Y 12 inhibitor is a key component of
treatment for patients with acute coronary syndromes undergoing
percutaneous coronary intervention. Before the development of cangrelor
(Kengreal, The Medicines Company, Parsippany, NJ), only oral P2Y 12
inhibitors were available. Cangrelor is a reversible P2Y 12 inhibitor that
is administered as an intravenous infusion, and its quick onset and offset
make it an appealing option for antiplatelet therapy, particularly for
patients who are unable to take oral medications. Although cangrelor
struggled to show benefit in early trials, the positive results of the
CHAMPION PHOENIX trial led to its approval for use as an adjunct to
percutaneous coronary intervention to reduce the risk of periprocedural
myocardial infarction, repeat coronary revascularization, and stent
thrombosis in patients who have not been treated with another P2Y 12
inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.
Cangrelor has also been evaluated as an option for bridging therapy in
patients who must discontinue their oral P2Y 12 inhibitor before coronary
artery bypass grafting. This review of cangrelor will discuss its
mechanism of action, its pharmacodynamics and pharmacokinetics, the
clinical trial experience, and its potential place in
therapy.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<69>
Accession Number
613487706
Author
Kavrut Ozturk N.; Kavakli A.S.
Institution
(Kavrut Ozturk, Kavakli) Department of Anesthesiology and Reanimation,
Antalya Education and Research Hospital, Antalya, Turkey
Title
Use of McGrath MAC Videolaryngoscope to Assist Transesophageal
Echocardiography Probe Insertion in Intubated Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 191-196),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Transesophageal echocardiography (TEE) probe insertion with the
conventional blind insertion technique may be difficult in anesthetized
and intubated patients. The use of a videolaryngoscope may facilitate the
insertion of the TEE probe. The aim of this study was to compare the
conventional technique with the use of the McGrath MAC videolaryngoscope
for TEE probe insertion in terms of success rate, duration of insertion,
and complications in patients undergoing cardiovascular surgery. Design A
prospective, randomized study. Setting Training and research hospital.
Participants Eighty-six adult patients undergoing cardiovascular surgery
were included. Interventions Eighty-six adult patients were randomized
into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope
group (n = 43). Success rates, duration of insertion, complications, and
hemodynamic changes during insertion were recorded. Measurements and Main
Results The success rate of TEE probe insertion at the first attempt was
higher in the McGrath videolaryngoscope group (90.5%) than in the
conventional group (43.9%) (p = 0.012). The mean duration for successful
insertion of the TEE probe at the first attempt was longer in the McGrath
videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for
successful insertion of the TEE probe was similar in both groups.
Pharyngeal injuries were observed more frequently in the conventional
group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe
tip in the conventional group was higher than in the McGrath group (21.9%
v 4.8%). There were no statistical differences between the 2 groups in
systolic blood pressure, mean arterial pressure, diastolic blood pressure,
and heart rate before and after TEE insertion. Conclusions The use of the
McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery
patients increases the success rate and reduces pharyngeal injuries
compared to the conventional technique. The use of the McGrath MAC
videolaryngoscope for TEE insertion causes similar hemodynamic changes as
in the conventional blind insertion technique.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<70>
Accession Number
614922993
Author
Kosova E.C.; Bonaca M.P.; Dellborg M.; He P.; Morais J.; Oude Ophuis T.;
Scirica B.M.; Tendera M.; Theroux P.; Braunwald E.; Morrow D.A.
Institution
(Kosova) Department of Medicine, Brigham and Women's Hospital, Boston,
United States
(Bonaca, He, Scirica, Braunwald, Morrow) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, United States
(Dellborg) Sahlgrenska Academy, University of Gothenburg and Sahlgrenska
University Hospital, Gothenburg, Sweden
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Oude Ophuis) Canisius-Willhelmina Hospital, Nijmegen, Netherlands
(Tendera) Third Division of Cardiology, Medical University of Silesia,
Katowice, Poland
(Theroux) Montreal Heart Institute, University of Montreal, Canada
Title
Vorapaxar in patients with coronary artery bypass grafting: Findings from
the TRA 2degreeP-TIMI 50 trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (2) (pp 164-172),
2017. Date of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Vorapaxar is a first-in-class protease-activated receptor-1
antagonist indicated for the reduction of cardiovascular death, myocardial
infarction, and stroke in stable patients with prior atherothrombosis, who
have not had a prior stroke or transient ischemic attack. The aims of this
study were to investigate: 1) the role of vorapaxar in patients with
severe coronary artery disease treated previously with coronary artery
bypass grafting (CABG); and 2) safety in patients undergoing CABG while
receiving vorapaxar. Methods: TRA 2degreeP-TIMI 50 was a randomized,
double-blinded, placebo-controlled trial of vorapaxar in 26,449 stable
patients with prior atherothrombosis followed for a median of 30 months.
We 1) investigated the efficacy of vorapaxar among patients with a history
of CABG prior to randomization (n=2942); and 2) assessed the safety among
367 patients who underwent a new CABG during the trial. Results: Patients
with a prior CABG were at higher risk for cardiovascular death, myocardial
infarction, or stroke at three years compared with patients without a
prior CABG (13.7% vs. 7.8%, p<0.001). Among patients with a prior CABG,
vorapaxar significantly reduced the risk of cardiovascular death,
myocardial infarction, or stroke (11.9% vs. 15.6%, hazard ratio 0.71, 95%
confidence interval 0.58-0.88, p=0.001; number-needed-to-treat = 27). In
patients undergoing CABG while receiving vorapaxar, the rate of
Thrombolysis in Myocardial Infarction CABG major bleeding was 6.3% vs.
4.1% with placebo (hazard ratio 1.53, 95% confidence interval 0.58-4.01,
p=0.39). Conclusions: In patients with a prior CABG, vorapaxar
significantly reduced the risk of recurrent major cardiovascular events.
In patients undergoing CABG while receiving vorapaxar, bleeding risk
appeared similar to that seen in the overall trial
population.<br/>Copyright &#xa9; 2016, &#xa9; The European Society of
Cardiology 2016.

<71>
Accession Number
614921778
Author
Rusch D.; Koch T.; Seel F.; Eberhart L.
Institution
(Rusch, Koch, Seel, Eberhart) Department of Anesthesia and Intensive Care,
University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany
Title
Vapocoolant Spray Versus Lidocaine Infiltration for Radial Artery
Cannulation: A Prospective, Randomized, Controlled Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 77-83),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Local infiltration with lidocaine is a frequently used measure
to prevent pain during arterial cannulation. Its administration is
associated with pain. Vapocoolants like ethyl chloride or alkanes also
affect rapid-onset anesthesia. However, their administration causes less
discomfort compared with administration of lidocaine. The effectiveness of
vapocoolants in mitigating discomfort associated with arterial cannulation
never has been studied. The authors therefore compared vapocoolant with
lidocaine for reducing discomfort caused by arterial cannulation. Design
Prospective, randomized, controlled study. Setting University hospital,
single center. Participants One hundred sixty adult patients requiring
arterial cannulation before induction of general anesthesia for cardiac
surgery or carotid endarterectomy. Interventions Patients received either
lidocaine infiltration or vapocoolant spray prior to arterial cannulation.
Overall discomfort resulting from the whole procedure (applying
local/topical anesthesia followed by arterial puncture) was rated on a 0
to 10 numerical rating scale. Puncture failure rate and time required for
the intervention also were recorded. Measurements and Main Results One
hundred forty-three patients were included in the per-protocol analysis.
Mean pain scores in the vapocoolant group were 3.4 (+/-1.58) compared with
4.5 (+/-2.29) in the lidocaine group (difference 1.1+/-0.33; p = 0.032;
Mann-Whitney U-test). The higher puncture failure rate in the lidocaine
group (n = 11 v 4) was not significant (p = 0.06; Fisher's exact test).
The time required for the intervention was longer in the lidocaine group
(138+/-44 s v 128+/-44 s; p = 0.019; Mann-Whitney U-test). Conclusions
Vapocoolant spray is an alternative to lidocaine infiltration to mitigate
discomfort associated with arterial cannulation.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<72>
Accession Number
614921777
Author
Bulte C.S.E.; Boer C.; Hartemink K.J.; Kamp O.; Heymans M.W.; Loer S.A.;
de Marchi S.F.; Vogel R.; Bouwman R.A.
Institution
(Bulte, Boer, Loer, Bouwman) Department of Anesthesiology, VU University
Medical Center, 1007 MB, Amsterdam, Netherlands
(Hartemink) Department of Surgery, VU University Medical Center, 1007 MB,
Amsterdam, Netherlands
(Kamp) Department of Cardiology, VU University Medical Center, 1007 MB,
Amsterdam, Netherlands
(Heymans) Epidemiology and Biostatistics, VU University Medical Center,
1007 MB, Amsterdam, Netherlands
(de Marchi) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Vogel) Department of Cardiology, Burgerspital Solothurn, Solothurn,
Switzerland
Title
Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy
Induced by Thoracic Epidural Anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 134-141),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of acute cardiac sympathectomy by
thoracic epidural anesthesia on myocardial blood flow and microvascular
function. Design A prospective observational study. Setting The study was
conducted in a tertiary teaching hospital. Participants Ten patients with
a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery.
Interventions Myocardial contrast echocardiography was used to study
myocardial blood flow and microvascular responsiveness at rest, during
adenosine-induced hyperemia, and after sympathetic stimulation by the cold
pressor test. Repeated measurements were performed without and with
thoracic epidural anesthesia. Measurements and Main Results An increased
myocardial blood volume was observed with thoracic epidural anesthesia
compared to baseline (from 0.08+/-0.02 to 0.10+/-0.03 mL/mL; p = 0.02). No
difference existed in resting myocardial blood flow between baseline
conditions and epidural anesthesia (0.85+/-0.24 v 1.03+/-0.27 mL/min/g,
respectively). Hyperemia during thoracic epidural anesthesia increased
myocardial blood flow to 4.31+/-1.07 mL/min/g (p = 0.0008 v baseline) and
blood volume to 0.17+/-0.04 mL/mL (p = 0.005 baseline). After sympathetic
stimulation, no difference in myocardial blood flow parameters was
observed Conclusions Acute cardiac sympathectomy by thoracic epidural
anesthesia increased the blood volume in the myocardial capillary system.
Also, thoracic epidural anesthesia increased hyperemic myocardial blood
flow, indicating augmented endothelial-independent vasodilator capacity of
the myocardium.<br/>Copyright &#xa9; 2017

<73>
Accession Number
614529437
Author
Ip W.T.K.; Chandramouli C.; Smith J.A.; McLennan P.L.; Pepe S.; Delbridge
L.M.D.
Institution
(Ip, Chandramouli, Delbridge) Cardiac Phenomics Laboratory, Department of
Physiology, University of Melbourne, Melbourne, Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Monash
University, Melbourne, Vic, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Vic, Australia
(McLennan) Graduate School of Medicine, Centre for Human Applied
Physiology, University of Wollongong, Sydney, NSW, Australia
(Pepe) Murdoch Children's Research Institute, Department of Paediatrics,
University of Melbourne, Royal Children's Hospital, Melbourne, Vic,
Australia
Title
A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying
According to Lipid Membrane Incorporation in Cardiac Surgical Patients.
Source
Heart Lung and Circulation. 26 (8) (pp 846-855), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Epidemiological studies and randomised clinical trials (RCTs)
report disparate findings in relation to omega-3 polyunsaturated fatty
acids (n-3 PUFA) benefit for cardiac patients. With RCTs interpretation is
potentially confounded by background n-3 PUFA intake. The goal of this
pilot, small cohort, pre-surgical supplementation study was to evaluate
postoperative atrial fibrillation (AF) and cardiac molecular expression
profiles employing two data analysis approaches - by treatment
randomisation and by stratification using measured n-3 PUFA. Methods
Patients (n = 20) received 3 g/day of fish or placebo oil (FO vs PO) in a
double blind randomised protocol prior to elective coronary artery graft
and valve surgery. Groups were matched for age, gender, and mean treatment
duration (~20 days). Resected atrial myocardium was sampled for assay of
viability metabolic markers, and blood obtained for erythrocyte membrane
lipid measurement. Results There was substantial overlap of cell membrane
n-3 PUFA content across PO and FO groups, and no group treatment effects
on AF incidence or myocardial molecular marker levels were detected. In
contrast, data stratification using membrane n-3 PUFA content (at 8% total
membrane lipid) achieved significant separation of patients (by n-6:n-3
PUFA ratio), a significant differential cardiac expression of the marker
peroxisomal proliferator-activated receptor, but no difference in AF
incidence. Conclusions This small n-3 PUFA case study demonstrates that
the same cohort may yield differing findings when evaluated using
randomisation or stratification approaches based on direct molecular
measures in cell membranes.<br/>Copyright &#xa9; 2017 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<74>
Accession Number
606883944
Author
Zhang J.; Xu R.W.; Fan X.; Ye Z.; Liu P.
Institution
(Zhang, Xu, Fan, Ye, Liu) Department of Cardiovascular Surgery,
China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029,
China
Title
A Systematic Review of Early Results Following Synchronous or Staged
Carotid Artery Stenting and Coronary Artery Bypass Grafting.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 302-310), 2017. Article
Number: 154228oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The optimal management of patients with concomitant coronary
artery disease (CAD) and severe carotid artery stenosis remains a
controversy. We performed a systematic review of studies comparing early
outcomes of synchronous or staged carotid artery stenting (CAS) and
coronary artery bypass grafting (CABG) in the treatment of patients with
concomitant CAD and severe carotid artery stenosis. Methods Multiple
databases were systematically searched to identify studies of synchronous
or staged CAS and CABG in the treatment of concomitant severe carotid and
coronary artery disease published from 2005 to 2015. The quality of
studies was assessed using the MINORS scale. The demographic data, risk
factors, 30-day outcomes, and antiplatelet strategy were extracted.
Results 23 studies were identified with a total of 873 and 459 patients in
the staged and synchronous group, respectively. The observed overall
death/stroke/MI rate was 8.5% (95% CI: 7.6-9.4%) in staged group and 4.8%
(95% CI: 3.8-5.8%) in synchronous group. It seems that the synchronous
group has better 30-day outcomes, but these data could not be compared
statistically. Conclusion Our systematic review suggests either
synchronous or staged CAS and CABG can be chosen for the treatment of
concomitant carotid and coronary artery disease. It seems that the
synchronous approach is relatively convenient and the antiplatelet
strategy is relatively definite. For these patients, hybrid
revascularization by synchronous CAS and CABG might be a feasible and
promising therapeutic strategy. Our conclusions and the quality of the
existing data suggest that a randomized controlled trial is needed to
define the best treatment for patients with concomitant carotid and
coronary artery disease.<br/>Copyright &#xa9; Georg Thieme Verlag
KGStuttgart . New York.

<75>
Accession Number
608748329
Author
Sharma G.; Anantha Krishnan R.; Bohra V.; Ramakrishnan S.; Naik N.; Seth
S.; Juneja R.; Kalaivani M.; Bahl V.K.
Institution
(Sharma, Naik, Seth, Juneja) Department of Cardiology, All India Institute
of Medical Sciences, New Delhi 110029, India
(Anantha Krishnan, Bohra) Senior Resident, Department of Cardiology, All
India Institute of Medical Sciences, New Delhi 110029, India
(Ramakrishnan) Additional Professor, Department of Cardiology, All India
Institute of Medical Sciences, New Delhi 110029, India
(Kalaivani) Scientist-II, Department of Biostatistics, All India Institute
of Medical Sciences, New Delhi 110029, India
(Bahl) Professor & Head, Department of Cardiology, All India Institute of
Medical Sciences, New Delhi 110029, India
Title
Evaluation of early direct current cardioversion for maintenance of sinus
rhythm in rheumatic atrial fibrillation following successful balloon
mitral valvotomy.
Source
Indian Heart Journal. 68 (4) (pp 486-492), 2016. Date of Publication: July
- August 2016.
Publisher
Elsevier B.V.
Abstract
Background: Patients with rheumatic mitral stenosis (MS) and atrial
fibrillation (AF) are at risk for thromboembolism and restoration of sinus
rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral
valvotomy (PBMV) improves hemodynamics, but may not be enough to restore
SR. Methods: Prospective randomized study aimed at evaluating efficacy of
early direct current cardioversion (DCCV) following successful PBMV in
patients with long-standing AF. Group 1 (n = 20) had patients of rheumatic
MS with AF who underwent successful PBMV. Group 2 (n = 15) patients were
DC cardioverted and administered oral Amiodarone for 6 weeks. Primary
endpoint was maintenance of SR after 6 months. Secondary endpoints were
functional capacity, number of embolic episodes, adverse drug effects, and
all-cause mortality. Results: In Group 2, all patients underwent
successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group
1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to
AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p = 0.001), with
relative risk of 7.1 (1.95, 25.9, 95% CI, p = 0.001) for patients to be in
AF who underwent only successful PBMV, i.e. Group 1. There was significant
improvement in quality of life (SF36) score in Group 2 (p = 0.001), with
no deaths, stroke, or adverse drug effects in either group. Conclusion: In
patients with rheumatic MS and AF, early DCCV and a short-duration oral
Amiodarone, following successful PBMV, may be a reasonable strategy to
attain long-term SR.<br/>Copyright &#xa9; 2016

<76>
Accession Number
610630784
Author
Landenhed M.; Cunha-Goncalves D.; Al-Rashidi F.; Pierre L.; Hoglund P.;
Koul B.
Institution
(Landenhed, Cunha-Goncalves, Al-Rashidi, Pierre, Koul) Department of
Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University
Hospital, Lund University, Lund SE-221 85, Sweden
(Hoglund) Clinical Research and Competence Center, Skane University
Hospital, Lund University, Lund, Sweden
Title
Pulmonary collapse alone provides effective de-airing in cardiac surgery:
A prospective randomized study.
Source
Perfusion (United Kingdom). 31 (4) (pp 320-326), 2015. Date of
Publication: 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objectives: We previously described and showed that the method for cardiac
de-airing involving: (1) bilateral, induced pulmonary collapse by opening
both pleurae and disconnecting the ventilator before cardioplegic arrest
and (2) gradual pulmonary perfusion and ventilation after cardioplegic
arrest is superior to conventional de-airing methods, including carbon
dioxide insufflation of the open mediastinum. This study investigated
whether one or both components of this method are responsible for the
effective de-airing of the heart. Methods: Twenty patients scheduled for
open, left heart surgery were randomized to two de-airing techniques: (1)
open pleurae, collapsed lungs and conventional pulmonary perfusion and
ventilation; and (2) intact pleurae, expanded lungs and gradual pulmonary
perfusion and ventilation. Results: The number of cerebral microemboli
measured by transcranial Doppler sonography was lower in patients with
open pleurae 9 (6-36) vs 65 (36-210), p=0.004. Residual intra-cardiac air
grade I or higher as monitored by transesophageal echocardiography 4-6
minutes after weaning from cardiopulmonary bypass was seen in few patients
with open pleurae 0 (0%) vs 7 (70%), p=0.002. Conclusions: Bilateral,
induced pulmonary collapse alone is the key factor for quick and effective
de-airing of the heart. Gradual pulmonary perfusion and ventilation, on
the other hand, appears to be less important.<br/>Copyright &#xa9; 2015
SAGE Publications.

<77>
Accession Number
620002863
Author
Ruzicic D.; Dobric M.; Vukovic M.; Hrncic D.; Dordevic S.; Ruzicic M.;
Aleksandric S.; Dordevic-Dikic A.; Beleslin B.
Institution
(Ruzicic, Vukovic, Ruzicic) General Hospital Valjevo, Department of
Cardiology and Invasive Cardiology, Street Sindeliceva 62, Valjevo 14000,
Serbia
(Dobric, Aleksandric, Dordevic-Dikic, Beleslin) Cardiology Clinic,
Clinical Center of Serbia, Faculty of Medicine, University of Belgrade,
Street Pasterova 2, Belgrade 11000, Serbia
(Hrncic) Institute of Medical Physiology "Richard Burian", Faculty of
Medicine, University of Belgrade, Street Visegradska 26, Belgrade 11000,
Serbia
(Dordevic) General Hospital Valjevo, Department of Radiology, Street
Sindeliceva 62, Valjevo 14000, Serbia
Title
The correlation of SYNTAX score by coronary angiography with breast
arterial calcification by digital mammography.
Source
Clinical Radiology. 73 (5) (pp 454-459), 2018. Date of Publication: May
2018.
Publisher
W.B. Saunders Ltd
Abstract
Aim: To evaluate the hypothesis that breast arterial calcification (BAC)
may predict coronary artery disease (CAD) severity. Materials and methods:
The study comprised 102 women >45 years (mean age 62+/-8 years) referred
for digital mammography after coronary angiography. BAC was assessed using
the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy
between percutaneous coronary intervention with TAXus and cardiac surgery
trial) score. Results: In comparison to the low SYNTAX score group (<=22)
patients with a intermediate-to-high SYNTAX score (>22) were older
(p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes
(p=0.021), and a history of smoking (p=0.048). They also had a
statistically higher level of fasting blood glucose (p<0.001), glycated
haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen
(p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the
group with a SYNTAX score <=22 (p=0.005). BAC was significantly higher in
patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC
(odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7,
p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001)
and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent
predictive factors for patients with intermediate-to-high SYNTAX score.
Conclusions: In women >45 years, there was a significant correlation
between the severity of CAD as evaluated by the SYNTAX score and BAC as
evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen
may be used as an additional diagnostic tool to predict the presence and
severity of CAD.<br/>Copyright &#xa9; 2017 The Royal College of
Radiologists

<78>
Accession Number
619956880
Author
White K.; Macfarlane H.; Hoffmann B.; Sirvas-Brown H.; Hines K.; Rolley
J.X.; Graham S.
Institution
(White) MonashHeart, Clayton, Vic, Australia
(Macfarlane) Frankston Hospital, Frankston, Vic, Australia
(Hoffmann) Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
(Sirvas-Brown) St John of God Subiaco Hospital, Subiaco, WA, Australia
(Hines) Calvary Wakefield Hospital, Adelaide, SA, Australia
(Rolley) University of Canberra, Bruce, ACT, Australia
(Graham) Middlemore Hospital, Auckland, New Zealand
Title
Consensus Statement of Standards for Interventional Cardiovascular Nursing
Practice.
Source
Heart Lung and Circulation. 27 (5) (pp 535-551), 2018. Date of
Publication: May 2018.
Publisher
Elsevier Ltd
Abstract
Interventional cardiovascular nursing is a critical care nursing specialty
providing complex nursing interventions to patients prone to clinical
deterioration, through the combined risks of the pathophysiology of their
illness and undergoing technically complex interventional cardiovascular
procedures. No guidelines were identified worldwide to assist health care
providers and educational institutions in workforce development and
education guidelines to minimise patients' risk of adverse events. The
Interventional Nurses Council (INC) developed a definition and scope of
practice for interventional cardiac nursing (ICN's) in 2013. The INC
executive committee established a working party of seven representatives
from Australia and New Zealand. Selection was based on expertise in
interventional cardiovascular nursing and experience providing education
and mentoring in the clinical and postgraduate environment. A literature
search of the electronic databases Science Direct, Cumulative Index to
Nursing and Allied Health Literature (CINAHL), Medline and Health Source
was performed, using the search terms: clinical deterioration, ST
elevation myocardial infarction, vital signs, primary percutaneous
coronary intervention, PCI, AMI, STEMI, acute coronary syndrome,
peri-procedural care, unstable angina, PCI complications, structural heart
disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology
studies, vascular access, procedural sedation. Articles were limited to
the cardiac catheterisation laboratory and relevance to nursing based
outcomes. Reference lists were examined to identify relevant articles
missed in the initial search. The literature was compared with national
competency standards, quality and safety documents and the INC definition
and scope of practice. Consensus of common themes, a taxonomy of education
and seven competency domains were achieved via frequent teleconferences
and two face-to-face meetings. The working party finalised the standards
on 14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm
Council, CSANZ Quality Standards Committee and the Australian College of
Critical Care Nurses (ACCCN). The resulting document provides clinical
practice and education standards for interventional cardiac nursing
practice.<br/>Copyright &#xa9; 2017

<79>
Accession Number
618265935
Author
Bhavnani S.P.; Bhavnani S.; Adams D.; Sengupta P.P.; Ryan T.; Narula J.;
Thomas J.; Lang R.; Pellikka P.; Choudhary V.; Iyer V.R.; Dash P.K.;
Barooah B.; Sola S.; Varyani R.; Lingan A.; Murugan V.; Kini P.;
Venkateshvaran A.; Srinivas N.; Barooah A.C.; Subbarao G.V.R.; Shivakumar
C.; Subramaniyan M.; Sengupta S.P.; Bansal M.; Rahaman A.; Patil V.N.;
Kumar N.R.; Gahlot M.Y.; Damani I.M.; Gulati R.; Joshi S.S.; Dubey S.;
Krupa J.; Irfan S.; Vidhyakar R.B.; Bidarkar N.; Shantesh B.K.; Chavan
S.S.; Chandramohan R.; Kumar V.; Tirkey S.; Prasad G.; Lakshmana S.S.;
Malkar R.M.; Manjunath V.; Kumar Reddy K.; Ramesha L.G.; Kumbhalkar S.;
Thadlani J.A.; Basha T.M.N.; Hafeez S.A.; Leelavathi V.; Mathews R.;
Daubert M.; Cleve J.; Burdulis E.; Fauss N.; Lammertin G.; Patel B.;
Petrovets E.; Shah D.; Thurmond K.; Tomberlin D.; Umamaheswar H.; Kadakia
A.
Institution
(Bhavnani) Scripps Clinic and Research Foundation, San Diego, California,
United States
(Sola, Venkateshvaran, Dash) Sri Sathya Sai Institute of Higher Medical
Sciences, Whitefield, Bangalore, India
(Adams) Duke University School of Medicine, Durham, North Carolina, United
States
(Sengupta) West Virginia University Heart and Vascular Institute at West
Virginia University School of Medicine, Morgantown, West Virginia, United
States
Title
A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics.
Source
JACC: Cardiovascular Imaging. 11 (4) (pp 546-557), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to determine whether mobile health (mHealth)
device assessments used as clinical decision support tools at the
point-of-care can reduce the time to treatment and improve long-term
outcomes among patients with rheumatic and structural heart diseases
(SHD). Background: Newly developed smartphone-connected mHealth devices
represent promising methods to diagnose common diseases in
resource-limited areas; however, the impact of technology-based care on
long-term outcomes has not been rigorously evaluated. Methods: A total of
253 patients with SHD were randomized to an initial diagnostic assessment
with wireless devices in mHealth clinics (n = 139) or to standard-care (n
= 114) in India. mHealth clinics were equipped with point-of-care devices
including pocket-echocardiography, smartphone-connected-electrocardiogram
blood pressure and oxygen measurements, activity monitoring, and portable
brain natriuretic peptide laboratory testing. All individuals underwent
comprehensive transthoracic echocardiography to assess the severity of
SHD. The primary endpoint was the time to referral for therapy with
percutaneous valvuloplasty or surgical valve replacement. Secondary
endpoints included the probability of a cardiovascular hospitalization
and/or death over 1 year. Results: An initial mHealth assessment was
associated with a shorter time to referral for valvuloplasty and/or valve
replacement (83 +/- 79 days vs. 180 +/- 101 days; p <0.001) and was
associated with an increased probability for valvuloplasty/valve
replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio:
1.54; 95% CI: 0.96 to 2.47; p = 0.07). Patients randomized to mHealth were
associated with a lower risk of a hospitalization and/or death on
follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83;
p = 0.013). Conclusions: An initial mHealth diagnostic strategy was
associated with a shorter time to definitive therapy among patients with
SHD in a resource-limited area and was associated with improved outcomes.
(A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics;
NCT02881398)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<80>
Accession Number
621461719
Author
Brillant-Marquis F.; Sauve J.A.; Laplante P.; Thebault P.; Chasse M.;
Carrier F.M.; Lapointe R.; Cailhier J.F.
Institution
(Brillant-Marquis, Sauve, Laplante, Thebault, Chasse, Carrier, Lapointe,
Cailhier) CRCHUM, CHUM, Universite de Montreal, Montreal, Canada
Title
Deciphering the immunomodulatory consequences of crystalloids.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Our aim is to evaluate the impact of crystalloid fluids on
immune cells. Intensive care unit (ICU) patients' inflammatory status can
switch from an early pro-inflammatory to a late anti-inflammatory phase,
which favors infections. They can receive different crystalloids, either
Normal Saline (NS), Ringer's Lactate (RL) or Plasma-Lyte (PL). High
chloride concentration present in NS has been associated with various
complications [1], whereas high doses of NaCl have inflammatory effects on
immune cells [2]. However, the immune consequences of crystalloids in
humans are ill-defined. Methods: Using our comprehensive immunemonitoring
platform, we assessed the immunological phenotype of peripheral blood
mononuclear cells (PBMC) in humans. 11 healthy subjects received a liter
of NS, RL and PL. Blood samples were taken before and 6h later. PBMC
phenotypes were assessed by flow cytometry and cytokine concentrations
were measured by a multiplex assay. 9 off-pump cardiac surgery patients
were also randomized to receive either NS, RL or PL during surgery and
their stay in the ICU. Blood samples were drawn at various time-points.
All leucocytes were analyzed in a similar fashion. We are still
recruiting. Results: Study of healthy subject's PBMC suggested that RL
reduced classical monocytes, whereas NS increased lymphocyte activation
and IL-17 and MIP-1b levels. In cardiac surgery patients, our preliminary
results suggested that RL and PL reduced classical monocytes and increased
non-classical monocytes compared to NS. Neutrophils were also affected
differently by crystalloids, where NS seemed to activate them more.
Conclusions: Our results suggest that crystalloids have different immune
consequences. A better understanding of their immune modulation will lead
to personalization of their use according to the inflammatory status of
patients to restore their immune homeostasis.

<81>
Accession Number
621461712
Author
Shehabi Y.; Smith J.; McIlroy D.; Green M.; Wienberg L.; Kadiman S.;
Bailey M.; Endre Z.
Institution
(Shehabi, Smith, Green, Bailey) School of Clinical Sciences, Monash
University, Melbourne, Australia
(McIlroy) Alfred Hospital, Melbourne, Australia
(Wienberg) Austin Hospital, Melbourne, Australia
(Kadiman) National Heart Institute, Kuala Lumpur, Malaysia
(Endre) Prince of Wales Hospital, Sydney, Australia
Title
Peri-operative dexmedetomidine in high risk cardiac surgery - Multicentre
randomized double blind placebo controlled pilot trial.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: We hypothesized that perioperative dexmedetomidine (Dex) is
safe and effective in patients undergoing high risk cardiac surgery. The
primary purpose was to assess the feasibility, safety and efficacy of Dex
compared to placebo. We compared vasopressors, inotropes, pacing and
cardiac complications for safety and severe acute kidney injury (AKI),
dialysis and death (Major Adverse Kidney Events MAKE) for efficacy.
Methods: Adults patients undergoing cardiac surgery [combined (valve +
Coronary bypass) or complex] or with preoperative glomerular filtration
rate (eGFR) < 60 mls/min/1.73m2 were included. Salvage or transplant
surgery, dialysis, eGFR < 15 mls/min/1.73m2 and those on extracorporeal
support were excluded. Dex (0.7 ug/kg/hr) was started at induction of
anaesthesia and continued up to 24 hours after surgery. Equivalent volume
of saline was given to control group. Standard intra and post-operative
care was provided. Results: We randomized 44 patients in the Dex group and
44 in the placebo (Pgp). The mean(SD) age 70.1(11.3) and eGFR 59.6(20.4)
in all patients. No significant differences at baseline. in the Dex, 38.7%
underwent complex surgery vs 19.7% pts in the Pgp. The mean(SD) bypass
time and aortic clamp was comparable 140(62) and 106(49) min. The
vasopressor requirements, pacing or cardiac complications at the end of
bypass or in the first 24 hours after surgery were comparable. More
patients in the Dex received inodilators 22.8% vs 13.6% in Pgp. MAKE
occurred in 15.9% of Dex vs 11.4% in the Pgp. Dialysis requirements and
28-day mortality in the Dex group was 6.8% vs 11.4%and of 2.3% vs 9.1% in
the Pgp respectively. Severe AKI occurred in 15.9% of Dex vs 11.4% Pgp.
The ICU and hospital length of stay and postoperative ventilation time
were comparable. Conclusions: The use of perioperative Dex in high risk
cardiac surgery is safe and well tolerated in the context of a double
blind multicentre study. A Definitive trial is needed to investigate the
role of Dex in high risk cardiac surgery.

<82>
Accession Number
621461485
Author
Guarracino F.; Bouchet S.; Heringlake M.; Pollesello P.
Institution
(Guarracino) Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
(Bouchet) University Hospital, Ghent, Ghent, Belgium
(Heringlake) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany
(Pollesello) Orion Pharma RandD, Espoo, Finland
Title
Perioperative use of levosimendan: Harmful or beneficious?.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Levosimendan is a calcium sensitizer and KATP-channel opener
exerting sustained hemodynamic and symptomatic effects. In the past
fifteen years, levosimendan has been used in clinical practice also to
stabilize at-risk patients undergoing cardiac surgery. Recently, the three
randomized, placebo-controlled, multicenter studies LICORN [1], CHEETAH
[2] and LEVO-CTS [3] have been testing the peri-operative use of
levosimendan in patients with compromised cardiac ventricular function.
Over 40 smaller trials conducted in the past [4] suggested beneficial
outcomes with levosimendan in peri-operative settings. In contrast, the
latest three studies were neutral or inconclusive. We aim to understand
the reasons for such dissimilarity. Methods: We re-analyzed the results of
the latest trials in the light of the previous literature to find
sub-settings in which levosimendan can be demonstrated harmful or
beneficious. Results: None of the three latest studies raised any safety
concern, which is consistent with the findings of the previous smaller
studies. In LEVO-CTS, mortality was significantly lower in the
levosimendan arm than in the placebo arm in the subgroup of isolated CABG
patients (Fig. 1) [3]. The trend towards both hemodynamic and long term
mortality benefits is maintained in recent meta-analyses [5, 6] including
the three larger recent studies. Conclusions: Despite the fact that the
null hypothesis could not be ruled out in the recent trials, we conclude
that levosimendan can still be viewed as a safe and effective inodilator
in cardiac surgery. Statistically significant mortality benefits seem to
be limited to sub-groups, such as the isolated CABG procedures, and/or the
low EF patients. (Figure presented).

<83>
Accession Number
621461387
Author
Ilic M.K.; Svagusa M.D.; Leko I.; Slunjski K.; Kozul I.; Nikles L.
Institution
(Ilic) Clinical Hospital Sveti Duh, Faculty of Medicine JJ Strossmayer
University Osijek, Zagreb, Croatia
(Svagusa, Leko, Slunjski, Kozul, Nikles) Clinical Hospital Sveti Duh,
Anesthesiology and ICU, Zagreb, Croatia
Title
Restrictive inter operative volume coupled with lung ultrasound in
prevention of post operative cardiogenic pulmonary edema development at
cardiac patients who undergone non cardiac surgical procedure-pilot study.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Aim of this prospective randomized pilot study was to
investigate influence of intra operative restrictive volume approach and
post operative lung ultrasound (LUS)on prevention and early detection of
postoperative interstitial syndrome development Methods: 42 cardiac
patients who underwent non cardiac surgical procedure were randomly
assigned for: group A-liberal volume approach or for group B-combination
of restrictive intra operative volume approach and small dose of
norepinephrine. All patients post operatively received <=1.5 ml/kg/h
fluids, mostly crystalloids. LUS was performed before surgical procedure
and 24 hours after their admission in ICU together with arterial blood
gases measurements. The ultrasound characteristic of interstitial syndrome
was development of B profile Results: Before surgery all patients had A
profile. Twenty for hours later in A group significantly higher number of
patients 16/22 (72.7%) vs 3/22(13.6%) in B group, had B profile
(p<0.05).At the same time there were no significant difference between the
groups in amount of patients with PaO2/FiO2 ratio <= 270 (3 patients with
positive B lines from A group vs 0 patients from group B).(p>0.05)
Conclusions: Intra operative fluid restriction is efficient in prevention
of post operative cardiogenic pulmonary edema development. LUS is a simple
non invasive method for early detection of interstitial syndrome even
before development of signs of respiratory deterioration.

<84>
Accession Number
621461295
Author
Santana G.; Hajjar L.; Camara L.; Piccioni M.; Galas L.; Galas F.
Institution
(Santana, Hajjar, Camara, Piccioni, Galas, Galas) Heart Institution, Sao
Paulo, Brazil
Title
The effect of intravenous desmopressin in coagulation profile of patients
undergoing valve surgery: A randomized clinical study.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Desmopressin (DDAVP) is a vasopressin analogue which
improves platelet function. Its general use as a haemostatic agent is
still controversial. The aim of study was to evaluate the effect of
prophylactic desmopressin in blood coagulation in patients undergoing
heart valve surgery. Methods: Prospective, randomized, double-blind
clinical trial performed at the Heart Institute of the University of Sao
Paulo. A total of 108 adult patients undergoing heart valve surgery were
enrolled from February 2015 to November 2016. Immediately after
cardiopulmonary bypass weaning and heparin reversal, patients were
randomized in ratio 1:1 to intervention group: DDAVP (0.3 mug/kg) or
control group. Blood samples were drawn at three different times, at
baseline (T0), 2 hours (T1) and 24 hours (T2) after study medication.
Blood coagulation and perioperative bleeding were analysed using
laboratorial tests and thromboelastometry, chest tube drainage and
requirement of allogenic transfusion within 48 hours. Results: A total of
54 patients were allocated to intervention and 54 to control group. Blood
levels of factor VIII at T2 (236.5 +/- 62.9 vs. 232.3 +/- 66.7, P=0.015)
and prothrombin time [14.1 (12.9 - 15.2) vs. 13.4 (12.1 - 14.5), P=0.007]
were significantly higher in desmopressin group. Standard coagulation
tests, as well as viscoelastic and platelet aggregation tests, were
similar between groups. There was no difference in postoperative drainage
and blood transfusion [10% (21.3) vs. 15%, P=0.526] between desmopressin
and control group. Conclusions: Prophylactic use of desmopressin in heart
valve surgery does not influence coagulation and thromboelastometric
parameters.

<85>
Accession Number
621461281
Author
Lima L.; Hajjar L.; Camara L.; Ferreira F.; Galas L.; Sundin M.; Jardim
J.; Galas F.
Institution
(Lima, Hajjar, Camara, Ferreira, Galas, Sundin, Jardim, Galas) Heart
Institution, Sao Paulo, Brazil
Title
Prophylactic fibrinogen concentrate reduces postoperative bleeding in
pediatric cardiac surgery: A randomized clinical trial.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Bleeding is a common complication during and after pediatric
cardiac surgery, with acquired hypofibrinogenemia being the most
associated disorder. This trial evaluated whether the use of prophylactic
fibrinogen concentrate reduces bleeding and the requirement of allogeneic
blood transfusion after pediatric cardiac surgery. Methods: A clinical
randomized study with children undergoing cardiac surgery. Inclusion
criteria: Cardiac surgery with cardiopulmonary bypass, age under 28 days
or RACHS 1 >= 3 or reoperation with age under 10 years and FIBTEM-A10 less
than 15 mm at thromboelastometry. Patients were randomized 1:1 to
treatment group [fibrinogen concentrate according to the formula (15 - A10
(mm) x body weight(Kg)/140)] or control group (saline 0.9%). Outcomes were
postoperative bleeding and the number of transfused units. Results: In
these preliminary results, 30 patients were analyzed; 14 (46.7%) patients
were allocated in the fibrinogen concentrate group and 16 (53.3%) patients
in the control group. Fibrinogen concentrate patients had lower total
blood drainage volume compared to the control group (125 vs. 244 ml, p=
0.042). There was no difference between groups regarding intraoperative
and postoperative blood transfusion. Fibrinogen levels analyzed by FIBTEM
were similar between the groups at the end of CPB (6 vs. 7 mm, p= 0.292).
Patients receiving fibrinogen concentrate had a significant increase in
fibrinogen levels after infusion of the study solution (10 vs. 8 mm, p=
0.059, 204 vs. 160 mg/dL, p= 0.009). Conclusions: These preliminary
findings suggest that prophylactic use of fibrinogen concentrate reduced
postoperative bleeding in children undergoing cardiac surgery. There was
no significant difference in the need of blood transfusion between groups.

<86>
Accession Number
621461269
Author
Scharlaeken I.; Flechet M.; Vlasselaers D.; Desmet L.; Van Den Berghe G.;
Guiza F.; Meyfroidt G.
Institution
(Scharlaeken, Vlasselaers, Desmet, Van Den Berghe, Meyfroidt) University
Hospitals Leuven, Leuven, Belgium
(Flechet, Guiza) KU Leuven, Leuven, Belgium
Title
A clinical prediction model for severe AKI after pediatric cardiac
surgery.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Acute kidney injury (AKI) is very prevalent after cardiac
surgery in children, and associated with poor outcomes [1]. The present
study is a preplanned sub-analysis of a prospective blinded observational
study on the clinical value of the Foresight nearinfrared spectroscopy
(NIRS) monitor [2]. The purpose of this subanalysis was to develop a
clinical prediction model for severe AKI (sAKI) in the first week of PICU
stay. Methods: sAKI was defined as serum creatinine (SCr) >/= 2 times the
baseline, or urine output < 0.5 ml/kg/h for >/= 12h. Predictive models
were built using multivariable logistic regression. Data collected during
surgery, upon PICU admission, as well as monitoring and lab data until 6h
before sAKI onset, were used as predictors. Relevant predictors with a
univariate association with sAKI, were included in the models. Accuracy of
the models was tested using bootstraps, by AUROC and decision curves.
Results: 177 children were enrolled, admitted to the PICU of the Leuven
University Hospitals after cardiac surgery, between October 2012 and
November 2015. 5 patients were excluded. 70 children (40.7%) developed
sAKI in the first week of PICU stay. A multivariate model with 5 admission
parameters (maximum lactate during surgery, duration of CPB, baseline sCr,
RACHS1 and PIM2 scores), and 4 postoperative measurements (average heart
rate, average blood pressure, hemoglobin, lactate), was most predictive
for sAKI (Fig. 1). Conclusions: The risk of sAKI in children after
congenital cardiac surgery could be predicted with high accuracy. Future
models will also include medication data. These models will be compared
against and combined with NIRS oximetry data to investigate the
independent and added predictive value of the Foresight monitor. (Figure
presented).

<87>
Accession Number
621461196
Author
Nielsen N.D.; Zeng F.; Gerbasi M.E.; Oster G.; Grossman A.; Shapiro N.I.
Institution
(Nielsen) Tulane School of Medicine, New Orleans, LA, United States
(Zeng) LaJolla Pharmaceutical Company, San Diego, CA, United States
(Gerbasi, Oster, Grossman) Policy Analysis Inc, Brookline, MA, United
States
(Shapiro) Beth Israel Deaconess Medical Center, Boston, MA, United States
Title
Treatment and outcomes of vasodilatory shock in an academic medical
center.
Source
Critical Care. Conference: 38th International Symposium on Intensive Care
and Emergency Medicine, ISICEM 2018. Belgium. 22 (Supplement 1) (no
pagination), 2018. Date of Publication: 2018.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Consensus clinical guidelines recommend maintaining mean
arterial pressure (MAP) >=65 mmHg for vasodilatory shock (VS) patients.
This study uses the Medical Information Mart for Intensive Care
(MIMIC-III) database to examine treatment and outcomes in patients with
severe VS in a real-world setting. Methods: We identified patients in the
MIMIC-III database which contains information for 61, 532 admissions to
intensive care units (ICU) at Beth Israel Deaconess Medical Center (BIDMC)
in Boston, Massachusetts between 2001 and 2012. Inclusion criteria: 1)
aged >=18 years, 2) treated with vasopressors for >=6 hours. Exclusion
criteria: cardiac surgery, vasoplegia, cardiogenic shock, intra-aortic
balloon pump, extracorporeal membrane oxygenation, large amount of blood
transfusion, cardiac tamponade or pulmonary embolism. The primary outcome
was mortality. Results: There were 5, 922 ICU admissions. Among these
patients, those who consistently maintained MAP above 65 mmHg (n=167, 3%),
60 mmHg (n=418, 7%), and 55 mmHg (n=949, 16%) while in ICU had lower
mortality rates than patients with one or more MAP excursions below these
thresholds (n=5755, n=5504, and n=4973, respectively): 11% vs 31% for MAP
<65 (p<0.0001); 10% vs 32% for MAP <60 (p<0.0001); and 10% vs 34% for MAP
<55 (p<0.0001). When assessing the exposure of hypotension for >=2
continuous hours, ICU mortality rates were 31% for 65 threshold (n=4741),
34% for 60 threshold (n=3498), and 41% for 55 threshold (n=2090). ICU
mortality rates were 41%, 52% and 66% for patients with MAP below 65
(n=1686), 60 (n=746), and 55 (n=354), respectively, for >=8 continuous
hours. Conclusions: Most patients did not have MAP control based on
current clinical guidelines, and not achieving the recommended target MAP
was associated with worse outcomes. However, since association does not
imply causation, trials aimed at more aggressively achieving a MAP >=65
are warranted, and quality of care initiatives aimed at improving MAP
control for patients with VS may be helpful.

<88>
Accession Number
621462457
Author
Heald A.H.; Malipatil N.S.; Gibson J.M.; Moreno G.Y.C.; Livingston M.;
Rutter M.K.; Donn R.P.; Hackett G.; Mumdzic E.; Jones T.H.
Institution
(Heald, Malipatil, Gibson, Donn) School of Medicine and Manchester
Academic Health Sciences Centre, University of Manchester, Manchester,
United Kingdom
(Heald, Malipatil, Gibson) Department of Diabetes and Endocrinology,
Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
(Moreno) Department of Obesity, Medicine School of Instituto Politecnico
Nacional, Mexico City, Mexico
(Livingston) Department of Blood Sciences, Walsall Manor Hospital,
Walsall, United Kingdom
(Rutter) Faculty of Biology, Medicine and Health, University of
Manchester, Manchester, United Kingdom
(Rutter) Manchester Academic Health Science Centre, Manchester University
NHS Foundation Trust, Manchester, United Kingdom
(Mumdzic, Jones) Department of Oncology and Metabolism, University of
Sheffield, Sheffield, United Kingdom
(Hackett) Department of Sexual Medicine, Heartlands Hospital, Birmingham,
United Kingdom
Title
Male hypogonadism: 15-year prospective outcome in 550 men with Type 2
diabetes.
Source
Diabetic Medicine. Conference: 2018 Diabetes UK Professional Conference.
United Kingdom. 35 (Supplement 1) (pp 202), 2018. Date of Publication:
March 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Hypogonadism is more prevalent in men with Type 2 diabetes
(25% to 40%) than in men without diabetes. Hypog onadism has been
associated with poorer glycaemic outcomes and increased cardiovascular
morbidity/mortality. We report a 15-year follow-up study to evaluate the
influence of baseline testosterone level on diabetes outcomes. Research
design and methods: A cohort of 550 men (mean age 59.7 years) with Type 2
diabetes underwent baseline total testosterone (TT) measurement by tandem
mass spectrometry. SHBG was measured and free testosterone calculated
(FT). Patients were followed up between 2002 and 2017. Mean follow-up
period was 12 +/- 4 (mean +/- SD) years using the Salford (UK) Integrated
Health Records system. Results: Mean TT was 13.7 +/- 5.8 nmol/l and mean
FT was 245.7 +/- 88.0 pmol/l. Mean TT for hypogonadal men (TT <10n-mol/l)
was 7.6 +/- 2.0 nmol/l (n = 154) and 142 men had a FT <190pmol/l. During
the 15-year duration follow-up, 42% died, 22% of men experienced a
myocardial infarction, 18% experienced a stroke, 11% developed angina and
15% underwent coronary revascularisation. A lower TT was associated with a
higher body mass index at follow-up (adjusted beta coefficient-0.28 [95%
CI-0.35,-0.18], p < 0.001). The mortality rate was higher in patients with
lower TT compared to normal baseline TT (4.9% vs 2.1% per year, p <
0.001). In Cox regression, the hazard ratio (HR) for higher mortality
associated with low TT was 1.8 (95% CI [1.4, 2.4], p < 0.001) and for
incident myocardial infarction was 1.50 (0.97 to 2.32). Conclusion: Low
testosterone levels are associated with a higher all-cause mortality in
diabetes men. Hypogonadal men with diabetes should be considered as very
high risk for cardiovascular events/death and for testosterone
replacement.

<89>
Accession Number
621440554
Author
Gkegkes I.D.; Minis E.E.; Iavazzo C.
Institution
(Gkegkes, Minis) First Department of Surgery, General Hospital of Attica
KAT, Athens, Greece
(Iavazzo) Gynecological Oncology Department, Northampton General Hospital,
Northampton, United Kingdom
Title
Oxycodone/naloxone in postoperative pain management of surgical patients.
Source
Journal of Opioid Management. 14 (1) (pp 52-60), 2018. Date of
Publication: January-February 2018.
Publisher
Weston Medical Publishing (E-mail: jom@pnpco.com)
Abstract
Background: The role of analgesia is crucial in the management of
postoperative pain. Different combinations of oral analgesics have been
proposed in the past. The oxycodone/naloxone (OXN) combination is a recent
addition and is being used by different surgical specialties. The aim of
our study was to clarify the possible role, advantages, and disadvantages
of OXN in the pain management of surgical patients. Method: The authors
retrieved the included studies after performing a systematic search in
PubMed and Scopus. Results: Ten studies (six randomized controlled trials,
three retrospective studies, and a prospective study) were eligible for
inclusion in this review. In total, 1,996 patients were included. Six
studies reported on orthopedic procedures while four studies referred to
colorectal, gynecologic, cardiac, and thoracic surgery procedures,
respectively. The analgesic effect of OXN was evaluated in nine out of 10
studies, where OXN showed superiority only in two out of nine studies.
Postoperative bowel function was evaluated in seven out of 10 studies.
Patients treated with OXN did not show any significant differences in
bowel function when compared to control groups. No superiority was found
regarding the possible adverse events. Conclusion: Analgesia is crucial to
postoperative recovery. Pain control can be achieved a combination of
different analgesics, including OXN. This oral analgesic combination can
have the potential to minimize side effects, such as opioidinduced
constipation and optimize the recovery period.<br/>Copyright &#xa9; 2017
Journal of Opioid Management, All Rights Reserved.

<90>
Accession Number
621432925
Author
Zhang Q.-Y.; Jin H.-F.; Chen S.; Chen Q.-H.; Tang C.-S.; Du J.-B.; Huang
Y.-Q.
Institution
(Zhang, Jin, Chen, Du, Huang) Department of Pediatrics, Peking University,
First Hospital, Xi-An Men Street No 1, Xicheng District, Beijing 100034,
China
(Chen) Division of Biological Sciences, University of California, San
Diego, San Diego, CA 92093, United States
(Tang) Small Gaseous Molecules and Cardiovascular Disease Section, Key
Laboratory of Molecular Cardiology, Ministry of Education, Beijing 100191,
China
(Tang) Department of Physiology and Pathophysiology, Health Sciences
Center, Peking University, Beijing 100191, China
Title
Hydrogen Sulfide Regulating Myocardial Structure and Function by Targeting
Cardiomyocyte Autophagy.
Source
Chinese Medical Journal. 131 (7) (pp 839-844), 2018. Date of Publication:
05 Apr 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Hydrogen sulfide (H<inf>2</inf>S), a gaseous signal molecule,
plays a crucial role in many pathophysiologic processes in the
cardiovascular system. Autophagy has been shown to participate in the
occurrence of many cardiac diseases. Increasing evidences indicated that
H<inf>2</inf>S regulates myocardial structure and function in association
with the altered autophagy and plays a 'switcher' role in the autophagy of
myocardial diseases. The aim of this review was to summarize these
insights and provide the experimental evidence that H<inf>2</inf>S targets
cardiomyocyte autophagy to regulate cardiovascular function. Data Sources:
This review was based on data in articles published in the PubMed
databases up to October 30, 2017, with the following keywords: 'hydrogen
sulfide,' 'autophagy,' and 'cardiovascular diseases.' Study Selection:
Original articles and critical reviews on H<inf>2</inf>S and autophagy
were selected for this review. Results: When autophagy plays an adaptive
role in the pathogenesis of diseases, H<inf>2</inf>S restores autophagy;
otherwise, when autophagy plays a detrimental role, H<inf>2</inf>S
downregulates autophagy to exert a cardioprotective function. For example,
H<inf>2</inf>S has beneficial effects by regulating autophagy in
myocardial ischemia/reperfusion and plays a protective role by inhibiting
autophagy during the operation of cardioplegia and cardiopulmonary bypass.
H<inf>2</inf>S postpones cardiac aging associated with the upregulation of
autophagy but improves the left ventricular function of smoking rats by
lowering autophagy. Conclusions: H<inf>2</inf>S exerts cardiovascular
protection by regulating autophagy. Cardiovascular autophagy would likely
become a potential target of H<inf>2</inf>S therapy for cardiovascular
diseases.<br/>Copyright &#xa9; 1998 Medknow Publications. All Rights
Reserved.

<91>
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.

<92>
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.

<93>
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.

<94>
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.

<95>
Accession Number
2000611624
Author
Jennings D.L.; Lange N.; Shullo M.; Latif F.; Restaino S.; Topkara V.K.;
Takeda K.; Takayama H.; Naka Y.; Farr M.; Colombo P.; Baker W.L.
Institution
(Jennings, Lange) Department of Pharmacy, Columbia University Medical
Center, New York, NY, United States
(Shullo) WVU Medicine, West Virginia Health System, Morgantown, WV, United
States
(Latif, Restaino, Topkara, Farr, Colombo) Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Takeda, Takayama, Naka) Division of Cardiovascular Surgery, Department of
Surgery, Columbia University Medical Center, New York, NY, United States
(Baker) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Data evaluating mTOR inhibitor use heart transplant (HT)
patients comes from relatively small studies and controversy exists
regarding their specific role. We performed a meta-analysis of randomized
trials to evaluate the efficacy and safety of mTOR inhibitors in HT
patients. Methods: We performed a systematic literature search of Medline
and Embase through July 2017 identifying studies evaluating mTOR
inhibitors in HT patients reporting effects on coronary allograft
vasculopathy (CAV), renal function, acute cellular rejection (ACR),
cytomegalovirus (CMV) infection, and discontinuation due to adverse drug
events (ADE). Data were pooled using a random-effects model producing a
mean difference (MD; for continuous data) or odds ratio (OR; for
dichotomous data) and 95% confidence interval (CI). Results: 14 trials
reported at least one outcome of interest. Change in mean maximal intimal
thickness was significantly reduced with mTOR (-0.04 [-0.07 to -0.02])
compared to calcineurin inhibitor/mycophenolate mofetil (CNI/MMF). Rates
of CMV infection were also significantly reduced (0.26; [0.2 to 0.32])
with mTOR regimens compared to CNI/MMF therapy. ACR was more frequent with
CNI-sparing regimens 6.46 [1.55 to 26.95]). eGFR was significantly
improved with CNI-sparing therapies (mean difference 12.09 mL/min [2.43 to
21.74]), but was similar between CNI/mTOR versus CNI/MMF regimens (p >
0.05). Rates of discontinuation due to ADE were higher in mTOR-containing
regimens (OR 2.15 [1.28 to 3.60], p = 0.01), while mortality rates were
similar (OR 0.91 [0.61 to 1.37], p = 0.62). Conclusions: mTOR-containing
regimens can attenuate CAV and CMV risk in HT recipients. A mTOR/MMF
combination preserves renal function but increases the risk of
ACR.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<96>
Accession Number
2000599946
Author
Liao S.-F.; Chen P.-J.; Chaou C.-H.; Lee C.-H.
Institution
(Liao, Chen, Chaou) Department of Emergency Medicine, Chang Gung Memorial
Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
(Republic of China)
(Chaou) Chang-Gung Medical Education Research Center, Taiwan (Republic of
China)
(Lee) Department of Emergency Medicine, Chang Gung Memorial Hospital and
Chang Gung University College of Medicine, Keelung, Taiwan (Republic of
China)
Title
Top-cited publications on point-of-care ultrasound: The evolution of
research trends.
Source
American Journal of Emergency Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
W.B. Saunders
Abstract
Study objectives: Point-of-care ultrasound (POCUS) has been a rapidly
growing and broadly used modality in recent decades. The purpose of this
study was to determine how POCUS is incorporated into clinical medicine by
analyzing trends of use in the published literature. Methods:
POCUS-related publications were retrieved from the Web of Science (WoS)
database. The search results were ranked according to the number of times
an article was cited during three time frames and average annual number of
citations. Of the top 100 most cited publications in the four rankings,
information regarding the publication journal, publication year, first
author's nationality, field of POCUS application, and number of times the
article was cited was recorded for trend analysis. Results: A total of
7860 POCUS-related publications were retrieved, and publications related
to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited
publications from the four ranking groups were included in this study.
Trauma was the leading application field in which POCUS was studied prior
to 2001. After 2004, thorax, cardiovascular, and procedure-guidance were
the leading fields in POCUS research. >79% (118/148) of the top-cited
publications were conducted by authors in the United States, Italy, and
France. The majority of publications were published in critical care
medicine and emergency medicine journals. Conclusions: In recent years,
publications relating to POCUS have increased. POCUS-related research has
mainly been performed in thorax, cardiovascular, and procedure-guidance
ultrasonography fields, replacing trauma as the major field in which POCUS
was previously studied.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<97>
Accession Number
613898453
Author
Ilic I.; Stankovic I.; Ilisic B.; Cerovic M.; Aleksic A.; Nikolajevic I.;
Kafedzic S.; Cuellas Ramon C.; Sokolov M.; El Setecha M.; Putnikovic B.;
Neskovic A.N.
Institution
(Ilic, Stankovic, Ilisic, Cerovic, Aleksic, Nikolajevic, Kafedzic,
Putnikovic, Neskovic) Department of Cardiology, Clinical Hospital Centre
Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(Cuellas Ramon) Cardiology, Hospital de Leon, Leon, Spain
(Sokolov) Cardiology, Ukrainian Institute of Cardiology, Kiev, Ukraine
(El Setecha) Cardiology, Om El-kora Cardiac Center, Gharbia, Egypt
Title
Favorable outcomes in octogenarians treated with bioresorbable polymer
drug-eluting stent.
Source
Geriatrics and Gerontology International. 16 (12) (pp 1246-1253), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Blackwell Publishing
Abstract
Aim: As a result of a higher prevalence of comorbidities, elderly adults
are often underrepresented in clinical trials, and more often experience
complications during percutaneous coronary intervention. Our aim was to
evaluate clinical outcomes of patients older than 80 years, compared with
their younger counterparts, when bioresorbable polymer biolimus A9
drug-eluting stent is used for their treatment. Methods: The prospective,
observational e-Nobori registry was created to validate the safety and
efficacy of bioresorbable polymer drug-eluting stent in unselected
patients. The primary end-point of the study was freedom from target
lesion failure defined as a composite of cardiac death, target
vessel-related myocardial infarction and clinically-driven target lesion
revascularization at 1 year. Results: There were 781 (7.8%) octogenarians,
they were less frequently male (62% vs 77%; P < 0.0001) and more often
presented as acute coronary syndrome (44% vs 39%; P = 0.0182). The index
percutaneous coronary intervention success was lower in the elderly
patients (98% vs 99%; P = 0.0398). One-year follow up was completed for
97% of the elderly patients and 99% of the younger patients. The
difference in target lesion failure (3.33% vs 2.83%; log-rank P = 0.0114)
was mainly driven by increased mortality in octogenarians (3.73% vs 1.47%;
P < 0.0001). Elderly patients had more bleeding and vascular complications
(2.67% vs 1.05%; P = 0.0001). Conclusions: Despite advanced age, multiple
comorbidities and complexity of treated lesions, clinical outcomes are
favorable in octogenarians treated by bioresorbable polymer biolimus A9
drug-eluting stent. Geriatr Gerontol Int 2016; 16:
1246-1253.<br/>Copyright &#xa9; 2015 Japan Geriatrics Society

<98>
Accession Number
621417954
Author
Carek S.M.; Durkin T.J.; Dillon M.C.; Burke F.W.; Arnaoutakis G.J.;
Silvestri P.; Nicolette G.; Clugston J.R.; Edenfield K.M.
Institution
(Carek, Durkin, Dillon, Burke, Arnaoutakis, Silvestri, Nicolette,
Clugston, Edenfield) Department of Community Health and Family Medicine,
University of Florida, Gainesville, FL, United States
Title
The root of the problem.
Source
Clinical Journal of Sport Medicine. Conference: 27th Annual Meeting of
American Medical Society for Sports Medicine, AMSSM 2018. United States.
28 (2) (pp e19), 2018. Date of Publication: March 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
History: A 19-year-old, healthy African American male presented for his
pre-participation evaluation prior to the start of football season. He
denied any personal history of cardiovascular disease or family history of
sudden cardiac death or connective tissue disease. As a part of his
initial screening, an electrocardiogram (ECG) and transthoracic
echocardiogram were obtained. His ECG demonstrated sinus bradycardia with
early repolarization and was considered normal for an athlete. His
echocardiogram demonstrated normal left ventricular size and function.
However, a significantly dilated aortic root diameter of 4.67 cm at the
sinuses of Valsalva was identified in the setting of a tricuspid aortic
valve without evidence of insufficiency. He was withheld from exertional
activities as further evaluation was pending. Physical Exam: Blood
pressure 132/84, Pule 64 bpm, Height 74.5 in, Weight 221.6 lbs, BMI 28
kg/m2, Total Arm Span 80 in, Arm Span-to-Height Ratio: 1.07. His
cardiovascular exam did not demonstrate a murmur, rub or gallop. No
further Marfanoid features were noted. Differential Diagnosis: 1. Marfan
Syndrome 2. Loeys-Dietz Syndrome 3. Ehlers-Danlos Syndrome 4. Familial
Thoracic Aortic Aneurysm 5. Isolated Dilation of the Aorta at the sinuses
of Valsalva Test Results: CT angiogram of the chest and abdomen
demonstrated an aortic annulus of approximately 3.3 cm, with an aortic
root diameter at the sinuses of Valsalva of 4.5 cm. The remainder of the
ascending aorta, aortic arch and descending aorta demonstrated normal
caliber and diameter. A gated CT angiogram of the aorta, obtained at an
outside facility, confirmed a dilated aortic root of 4.53 4.53 4.5 cm.
Exercise stress testing was electrocardiographically negative for
exercise-induced ischemic changes or conduction disturbances and was
negative for chest pain. His aortic root size, relative to an age and
BSA-adjusted expected size of approximately 3.4 cm, represents a Z-score
of approximately 3.9. Final Diagnosis: Isolated Dilation of the Aorta at
the sinuses of Valsalva. Discussion: Intense physical exertion is
associated with hemodynamic changes that increase aortic wall tension and
may increase aortic dimensions. In the setting of connective tissue
disease or a weakened aortic wall, this could result in a catastrophic
aortic rupture or dissection. Although mild aortic enlargement may be a
normal adaptation to intense training, large increases in aortic size are
unusual in athletes and when present are more consistent with an
underlying aortopathy. There is a paucity of data examining the long-term
outcome of athletes with unexplained aortic dilatation. Some studies
suggest a small increase in average size amongst athletes as compared to
non-athletic controls is normal. However, significant aortic enlargement
(Aortic diameter .4.0 cm or a Z-score .2) is rare and likely cannot be
attributed to sport-specific training and remodeling. Current
recommendations do not comment on the participation status of an athlete
with an enlarged aorta in this range with a tricuspid aortic valve and no
clear genetic diagnosis for connective tissue disease. Conservative
management would preclude this athlete from highly static and highly
dynamic exercises or competition involving bodily collisions. Outcome:
Evaluation is ongoing by multiple experts in sports cardiology and
cardiothoracic surgery. There is currently no definitive etiology. His
history and physical are not consistent with Marfan's, but genetic testing
for connective tissue diseases commonly associated with aortopathies is
pending. Follow-up: He has been allowed to train at moderate intensities
aerobically and light intensities with weight lifting as long as he
remains asymptomatic. Further decisions regarding his eligibility for
participation in more demanding activities such as football will be made
after genetic test results are available.

<99>
Accession Number
621421110
Author
Bautista Aguilar L.; Salmoral Chamizo A.; Gomez Gracia I.; Jimenez Gasco
R.; Font Ugalde P.; Lopez Medina E.C.; Ladehesa Pineda M.L.; Perez Sanchez
L.; Escudero Contreras A.; Collantes Estevez E.
Institution
(Bautista Aguilar, Salmoral Chamizo, Gomez Gracia, Jimenez Gasco, Font
Ugalde, Lopez Medina, Ladehesa Pineda, Perez Sanchez, Escudero Contreras,
Collantes Estevez) Rheumatology, Reina Sofia University Hospital/IMIBIC,
University of Cordoba, Cordoba, Spain
Title
Left ventricular ejection fraction and bone mineral density after cardiac
transplantation.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology, EULAR 2017. Spain. 76 (Supplement 2) (pp 700), 2017. Date of
Publication: June 2017.
Publisher
BMJ Publishing Group
Abstract
Background: Left ventricular ejectionfraction (LVEF) has
beendirectlyassociatedwith BMD in patientswithheartfailure. Nevertheless,
no study has linked yet the left ventricular ejection fraction to bone
mineral density and fragility fractures in cardiac transplantation.
Objectives: The main aim of this study was to evaluate the possible
relationship between LVEF and BMD in heart transplantation and the
association of LVEF with 25 OH vitamin D, paratohormone (PTH) and markers
of bone remodeling in patients with heart transplantation (osteocalcin,
telopeptide C terminal (CTX). Methods: Seventy nine patients (66 male)
were included in this cross-sectional study with a mean age of
55,75+/-14,81 years, body mass index (BMI) values of 26,95+/-5,35
kg/m² and an average post-transplantation period of 8,46+/-8,71
years. Transthoracic doppler echocardiography measuring LVEF (%) was
calculated for each of patients, as well as bone mass study that included:
bone mineral density scans of lumbar spine and hip, spine radiography,
biomarkers of bone metabolism (calcium, phosphorus,
osteocalcin,CTX,Parathyroid hormone and vitamin D). The association of
LVEF with BMD and biomarkers of bone remodeling was determined by
performing multiple linear regression analysis adjusted for variables
directly related to BMD (age, sex, BMI, post-transplantation period and
pharmacological treatment (daily corticoids dose, immunosuppressive
treatment). Results: A total of 79 patients were included in this present
study. BMD in osteoporotic range was found in 31.2% of patients (17.7% in
spine,16.52% in femoral neck and 13% in hip). Vitamin D deficiency
(<=20ng/d) was detected in 68.4% of patients. Vertebral fracture was found
in 30.4% and a 2.6% hip fracture. Bivariate analysis showed that the group
of patients with FEVI <=65% had a higher proportion of femoral neck
osteoporosis (p=0.04), higher proportion of osteoporosis in total hip
(p=0.03) and higher percentage of vertebral fractures (p=0.04) compared
with group with LVEF>65%. The multiple linear regression analysis
indicated that LVEF was independently associated with osteoporosis in
spine (B = -5.225, p=0.011), femoral neck osteoporosis (B = -5.411,
p=0.015) and vertebral fractures (B = -5.433, p=0.002). In addition, LVEF
was associated with osteocalcin levels (B = -0.105, p=0.002). Conclusions:
These results suggest that post-transplantation LVEF may have an influence
on bone remodeling. However, further studies are neededin order to
consider LVEF as a risk factor for osteoporosis and fractures due to
fragility after heart transplantation.

<100>
Accession Number
621328138
Author
Takayoshi M.; Wada K.; Terada Y.; Matsuda S.; Nakagita K.; Oita A.; Takada
M.; Shionoiri A.; Sunami H.; Nakajima S.; Kuroda K.; Sato T.; Seguchi O.;
Yanase M.; Fukushima N.
Institution
(Takayoshi, Wada, Terada, Matsuda, Nakagita, Oita) Department of Pharmacy,
National Cerebral and Cardiovascular Center, Suita, Japan
(Wada, Nakagita, Takada) Division of Cardiovascular Drugs and Therapy,
Kindai University Graduate School of Pharmacy, Higashi-Osaka, Japan
(Shionoiri, Sunami, Nakajima, Kuroda, Sato, Seguchi, Yanase, Fukushima)
Department of Transplant Medicine, National Cerebral and Cardiovascular
Center, Suita, Osaka, Japan
Title
Use of rifabutin to treat tuberculosis in a cardiac transplant recipient:
A case report.
Source
International Journal of Clinical Pharmacology and Therapeutics. 56 (4)
(pp 184-188), 2018. Date of Publication: 2018.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Objective: Tuberculosis is an important concern following organ
transplantation. Unfortunately, several antituberculosis drugs interact
with immunosuppres-sants. This report describes our experience with
rifabutin (RBT) in the treatment of acute tuberculosis in a cardiac
transplant recipient. Case: A 61-year-old cardiac transplant recipient
developed tuberculosis meningitis during treatment of miliary
tuberculosis. RBT was given for 27 days concomitantly with cyclosporine
(CsA). CsA concentrations at 0 hour (C<inf>0</inf>) decreased within 3
days of starting RBT. The serum concentration-curve from 0 to 12 hours
(AUC<inf>0-12h</inf>)/dose 7 days after starting RBT therapy decreased by
28%, compared to the values before RBT therapy. The apparent clearance at
both 7 and 21 days after starting RBT therapy was 1.4 times higher than
before RBT therapy. Conclusion: RBT has fewer drug-drug interactions than
rifampin and should be preferentially used for the treatment of
tuberculosis in transplant patients treated with CsA. Close monitoring of
CsA blood concentration during RBT therapy minimized the risk of under- or
over-immunosuppression in a cardiac transplant patient.<br/>Copyright
&#xa9;2018 Dustri-Verlag Dr. K. Feistle

<101>
Accession Number
621384471
Author
Wang X.; Yao L.; Ge L.; Li L.; Liang F.; Zhou Q.; Chen Y.; Wang Y.; Yang
K.
Institution
(Wang, Ge, Chen, Yang) Evidence Based Medicine Centre, School of Basic
Medical Sciences, Lanzhou University, Lanzhou, China
(Wang, Ge, Chen, Yang) Key Laboratory of Evidence Based Medicine and
Knowledge Translation of Gansu Province, Lanzhou, China
(Wang, Ge, Chen, Yang) Chinese GRADE Centre, Lanzhou University, Lanzhou,
China
(Yao) Clinical Research and Evidence Based Medicine Institute, People's
Hospital of Gansu Province, Lanzhou, Gansu, China
(Li) Xiangya Hospital of Central South University, Lanzhou, China
(Liang, Zhou) First Hospital of Lanzhou University, Lanzhou, China
(Wang) Gansu University of Chinese Medicine, Lanzhou, China
Title
Pharmacological interventions for preventing post-operative atrial
fibrillation in patients undergoing cardiac surgery: A network
metaanalysis protocol.
Source
BMJ Open. 7 (12) (no pagination), 2017. Article Number: e018544. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative atrial fibrillation (POAF) is the most common
complication following cardiac surgery, and randomised clinical trials
(RCTs) and systematic reviews have been conducted to compare and evaluate
different pharmacological interventions for preventing POAF. This study
aimed to explore the effect of different pharmacological interventions for
prophylaxis against POAF after cardiac surgery using network meta-analysis
(NMA). Methods and analysis A systematic search will be performed in
PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic
reviews, metaanalyses or NMA of different pharmacological interventions
for POAF. We will evaluate the risk of bias of the included RCTs according
to the Cochrane Handbook V.5.1.0, and use GRADE to assess the quality of
evidence. Standard pairwise meta-analysis, trial sequential analysis and
Bayesian network metaanalysis will be used to compare the efficacy of
different pharmacological interventions. Ethics and dissemination Ethics
approval and patient consent are not required as this study is a
meta-analysis based on published studies. The results of this NMA and
trial sequential analysis will be submitted to a peerreviewed journal for
publication.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2017. All rights
reserved.

<102>
Accession Number
621398868
Author
Da Silva M.P.; Chahal J.K.; Fischer A.; Da Costa F.A.; Martins A.P.;
Antoniou S.
Institution
(Da Silva, Martins) Faculty of Pharmacy, University of Lisbon, Lisbon,
Portugal
(Chahal, Fischer, Antoniou) Pharmacy, Barts Health NHS Trust, London,
United Kingdom
(Da Costa) CiiEM, ISCEM, Lisbon, Portugal
Title
Anticoagulation management for post-operative atrial fibrillation after
cardiac surgery.
Source
International Journal of Clinical Pharmacy. Conference: 46th ESCP
Symposium on Clinical Pharmacy. Germany. 40 (1) (pp 220), 2018. Date of
Publication: 2018.
Publisher
Springer Netherlands
Abstract
Background and Objective: Oral anticoagulation is essential following
post-operative atrial fibrillation (POAF). Although warfarin is commonly
used, it's efficacy is dependent on time in therapeutic range (TTR) [65%.
Direct oral anticoagulants (DOACs) are an alternative option, however the
optimal time to initiate post-opera-tively is unknown, due to exclusion of
'recent surgery' within phase 3 clinical trials. Design: To identify the
number of patients that revert back to sinus rhythm (SR) 6 weeks following
POAF following cardiac surgery and assess which class provides optimal
stroke prevention for this period. A retrospective study was conducted at
large tertiary centre analysing patients that developed POAF after
cardiothoracic surgery from January 2016 to January 2017 reviewing both
patient and surgical data. Results: Sixty-four patients had developed
POAF, of which 39 (60.9%) and 25 (39.1%) were prescribed warfarin and DOAC
respectively. 13 (33.3%) patients had a confirmed TTR\65%, reflecting poor
anticoagulant control with warfarin. DOACs were initiated on an average of
8.36 +/- 3.74 days post-operatively. 21 (53.8%) patients in the warfarin
group and 11 (44%) patients in the DOAC group were confirmed to be in
sinus rhythm 6 weeks after discharge. Among these patients, 37.5% stopped
the anticoagulation when in SR. Conclusion: A TTR\65% for warfarin shows
that acute optimal anticoagulation management is difficult to achieve,
especially for the short term patients that revert back into SR. DOACs may
possibly be a more effective alternative, initiating 8 days post
operatively. However further studies need to be conducted to ensure
optimal dose of each DOACs in the acute post-operative phase.

<103>
Accession Number
621403861
Author
Karkouti K.
Institution
(Karkouti) Department of Anesthesia, Toronto General Hospital, Toronto,
ON, Canada
Title
Protocol for a phase 3, non-inferiority, randomized comparison of a new
fibrinogen concentrate vs. cryoprecipitate for treating acquired
hypofibrinogenemia in bleeding cardiac surgical patients: The FIBRES
study.
Source
Hamostaseologie. Conference: 62nd Annual Meeting of the Society of
Thrombosis and Haemostasis Research, GTH 2018. Austria. 38 (Supplement 1)
(pp A70), 2018. Date of Publication: 2018.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Coagulopathic bleeding is a serious complication of cardiac
surgery involving cardiopulmonary bypass (CPB), often requiring massive
transfusion with allogeneic blood products (ABPs). Acquired
hypofibrinogenemia (plasma fibrinogen <1.5-2.0g/L) is a primary causative
factor. Randomized trials evaluating fibrinogen supplementation are needed
in this setting. Methods: FIBrinogen REplenishment in Surgery (FIBRES) is
a multi-center, randomized (1:1), active-control, single-blinded trial in
adult cardiac surgical patients experiencing clinically significant
bleeding due to acquired hypofibrinogenemia (NCT03037424). The primary
objective is to determine if efficacy of fibrinogen concentrate
(Octafibrin/Fibryga, Octapharma) is non-inferior to cryoprecipitate.
Patients will receive 4g fibrinogen concentrate or 10 units
cryoprecipitate (dose-equivalent to 4g) whenever fibrinogen
supplementation is ordered within 24 hours after CPB; all randomized
patients will receive fibrinogen supplementation as clinically indicated.
The primary outcome is total ABPs administered within 24 hours. Secondary
outcomes include: major bleeding; fibrinogen levels; adverse events (AEs)
and serious AEs within 28 days. Need for patient consent is waived, and
the study will include 1,200 patients; assuming 20% non-inferiority margin
and ~10% drop-out after randomization 550 patients/group provides >90%
power. Interim analysis will include 600 patients. The pragmatic design
and algorithm align with standard practice, aiding adherence and clinical
relevance. Figure 1. Study Design. Results: Completion late 2018; results
early 2019. Conclusion: This is the largest randomized comparison of
fibrinogen concentrate and cryoprecipitate in this setting.
Non-inferiority of the new, highly purified fibrinogen concentrate would
support its use in acquired hypofibrinogenemia. The results are likely to
improve care for cardiac surgical patients experiencing significant
bleeding, an under-studied, high-risk population.

<104>
Accession Number
621398350
Author
Yang G.-Z.; Xue F.-S.; Liu Y.-Y.
Institution
(Yang, Xue, Liu) Plastic Surgery Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Department of Anesthesiology,
33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144, China
Title
Use of a meta-analysis to assess the preventive effect of dexmedetomidine
on cardiac surgery-associated acute kidney injury.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 85. Date of
Publication: 27 Mar 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)

<105>
Accession Number
621364210
Author
Kundu A.; Sardar P.; O'Day K.; Chatterjee S.; Owan T.; Dawn Abbott J.
Institution
(Kundu) Department of Cardiovascular Medicine, University of Massachusetts
Medical School, Worcester, MA, United States
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah
Health Science Center, 30 North 1900 East, Room 4A100 SOM, Salt Lake City,
UT 84132, United States
(O'Day) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Chatterjee) Department of Cardiology, Saint Francis Hospital, Teaching
Affiliate, University of Connecticut School of Medicine, Hartford, CT,
United States
(Dawn Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, RI, United States
Title
SYNTAX Score and Outcomes of Coronary Revascularization in Diabetic
Patients.
Source
Current Cardiology Reports. 20 (5) (no pagination), 2018. Article Number:
28. Date of Publication: 01 May 2018.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: This review describes the dynamic relationship between
diabetes mellitus (DM) and coronary artery disease (CAD) with respect to
different revascularization strategies and how angiographic tools such as
the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score can
supplement clinical decision-making. Recent Findings: The SYNTAX score
characterizes the anatomical extent of CAD in terms of the number of
lesions, functional importance, and complexity. Studies not limited to
patients with DM suggest that percutaneous coronary intervention (PCI) is
a reasonable alternative to coronary artery bypass grafting (CABG) in
patients with low-medium SYNTAX scores, while patients with high SYNTAX
scores should be revascularized with CABG if operable. Similar findings
were also observed for diabetes patients with multivessel disease in
retrospective pooled analysis. The SYNTAX II score combines anatomical and
clinical risk to improve upon the decision regarding the optimal
revascularization strategy. The SYNTAX II score can be applied to patients
with DM. Summary: The SYNTAX scores provide guidance to clinicians faced
with determining the optimal revascularization strategy in patients with
DM and advanced CAD. Using a heart team approach, the information can be
considered along with other factors that influence PCI or CABG
risk.<br/>Copyright &#xa9; 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<106>
Accession Number
2000579594
Author
Martin Gutierrez E.; Castano Ruiz M.; Gualis Cardona J.A.; Martinez
Comendador J.M.; Otero Saiz J.; Maiorano P.
Institution
(Martin Gutierrez, Castano Ruiz, Gualis Cardona, Martinez Comendador,
Otero Saiz, Maiorano) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, Leon, Spain
Title
Double antiplatelet therapy after coronary surgery: A review of
literature.
Source
Cirugia Cardiovascular. 23 (1) (pp 31-37), 2016. Date of Publication:
January - February 2016.
Publisher
Elsevier Doyma
Abstract
Introduction: Extensive and early use of acetyl-salicylic acid (ASA) is
widely accepted in the post-operative period after coronary artery bypass
grafting surgery (CABG), however, its combination in double antiplatelet
therapy (DAT) is still controversial. DAT may improve coronary graft
patency due to a lower vulnerability against constitutive and/or transient
antiplatelet therapy resistance, and due to potential pleiotropic effects
against intimal hyperplasia. Nevertheless, dosage and duration of the
treatment are not completely established. Methods: Systematic
bibliographic review in Medline combining 3 clusters of key words and
stepwise selection of articles obtained. Results: Out of a total of 56
preliminary studies found, 19 were chosen for analysis, of which 7 were
randomised controlled trials, 2 meta-analyses, 1 literature review, 3
clinical guidelines, and 6 non-randomised studies. All of them were
individually analysed and classified as favourable or not to DAT.
Conclusions: There is not enough evidence to warrant extensive use of DAT
after CABG. However, DAT could show a benefit in certain clinical
scenarios, such as CABG after prior coronary acute syndrome, extensive use
of venous grafts, or CABG off-pump. The benefits shown in studies
favourable to DAT on the improvement of coronary graft patency in the
short-midterm did not lead to differences in the incidence of major
cardiovascular events. Neither of the groups showed differences in terms
of safety related to haemorrhagic events, nor in the immediate
postoperative or follow-up period<br/>Copyright &#xa9; 2015 Sociedad
Espanola de Cirugia Toracica-Cardiovascular

<107>
Accession Number
621401491
Author
Gibson C.M.; Hankey G.J.; Nafee T.; Welsh R.C.
Institution
(Gibson, Nafee) Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Massachusetts, United
States
(Hankey) Medical School, Faculty of Health and Medical Sciences, The
University of Western Australia, Perth, Western Australia, Australia
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
Title
Beyond Stroke Prevention in Atrial Fibrillation: Exploring Further Unmet
Needs with Rivaroxaban.
Source
Thrombosis and Haemostasis. (no pagination), 2018. Date of Publication: 22
Mar 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
With improved life expectancy and the aging population, the global burden
of atrial fibrillation (AF) continues to increase, and with AF comes an
estimated fivefold increased risk of ischaemic stroke. Prophylactic
anticoagulant therapy is more effective in reducing the risk of ischaemic
stroke in AF patients than acetylsalicylic acid or dual-antiplatelet
therapy combining ASA with clopidogrel. Non-vitamin K antagonist oral
anticoagulants are the standard of care for stroke prevention in patients
with non-valvular AF. The optimal anticoagulant strategy to prevent
thromboembolism in AF patients who are undergoing percutaneous coronary
intervention and stenting, those who have undergone successful
transcatheter aortic valve replacement and those with embolic stroke of
undetermined source are areas of ongoing research. This article provides
an update on three randomized controlled trials of rivaroxaban, a direct,
oral factor Xa inhibitor, that are complete or are ongoing, in these unmet
areas of stroke prevention: oPen-label, randomized, controlled,
multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a
dose-adjusted oral vitamin K antagonist treatment strategy in patients
with Atrial Fibrillation who undergo Percutaneous Coronary Intervention
(PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor
Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of
Undetermined Source (NAVIGATE ESUS) trial and the Global study comparing a
rivAroxaban-based antithrombotic strategy to an antipLatelet-based
strategy after transcatheter aortIc vaLve rEplacement to Optimize clinical
outcomes (GALILEO) trial. The data from these studies are anticipated to
help address continuing challenges for a range of patients at risk of
stroke.<br/>Copyright &#xa9; 2018, Schattauer. All rights reserved.

<108>
Accession Number
621401316
Author
Reents W.; Zacher M.; Boergermann J.; Kappert U.; Hilker M.; Farber G.;
Albert M.; Holzhey D.; Conradi L.; Riess F.C.; Veeckman P.; Strauch J.T.;
Diegeler A.; Boning A.
Institution
(Reents, Zacher, Veeckman, Strauch, Diegeler, Boning) Herzchirurgie, Herz-
und Gefasklinik Bad Neustadt, Bad Neustadt, Germany
(Boergermann) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Bad Oeynhausen, NRW, Germany
(Kappert) Herzzentrum Dresden, Dresden, Germany
(Hilker) Herz-, Thorax- und herznahe Gefaschirurgie, Regensburg, Germany
(Farber) Department of Cardiac and Thoracic Surgery, University of Jena,
Jena, Germany
(Albert) Herzchirurgie, Robert-Bosch-Krankenhaus GmbH, Stuttgart,
Baden-Wurttemberg, Germany
(Holzhey) Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Riess) Department of Cardiac Surgery, Albertinenkrankenhaus, Hamburg,
Germany
(Veeckman) HELIOS Klinik fur Herzchirurgie Karlsruhe, Karlsruhe,
Baden-Wurttemberg, Germany
(Strauch) Department of Cardiothoracic Surgery, Ruhr-University Bochum,
Bochum, Germany
(Boning) Department of Cardiovascular Surgery, University Hospital
Giessen, Giessen, Germany
Title
Off-Pump Coronary Artery Bypass Grafting and Stroke-Exploratory Analysis
of the GOPCABE Trial and Methodological Considerations.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2018. Date of
Publication: 22 Mar 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Coronary artery bypass grafting (CABG) without cardiopulmonary
bypass (off-pump CABG) may reduce severe adverse events including stroke.
Methods In the German Off-Pump Coronary Artery Bypass Grafting in Elderly
patients trial, the rate of major adverse cardiovascular events was
compared in 2,394 elderly (>= 75 years) patients undergoing CABG with
(on-pump) or without (off-pump) cardiopulmonary bypass. This exploratory
post-hoc analysis investigated the impact of surgical aortic manipulation
on the rate of stroke. Results There was no significant difference in the
rate of stroke within 30 days after surgery between both groups (off-pump:
2.2%; on-pump: 2.7%; odds ratio [OR]: 0.83 [0.5-1.38]; p = 0.47). Within
the off-pump group, different degrees of aortic manipulation did not lead
to significant different stroke rates (tangential clamping: 2.3%; OR 0.86
[0.46-1.60]; clampless device: 1.8%; OR 0.67 [0.26-1.75]; no aortic
manipulation: 2.4%; OR 0.88 [0.37-2.14]). An aggregate analysis including
more than 10,000 patients out of the four recent major trials also yielded
comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%;
on-pump: 1.7%; OR 0.87 [0.64-1.20]). Conclusion Within recent prospective
randomized multicenter trials off-pump CABG did not result in lower stroke
rates. The possible intrinsic benefit of off-pump CABG may be offset by
the complexity of the operative therapy as well as the multiple
pathomechanisms involved in perioperative stroke. <br/>Copyright &#xa9;
2018, Georg Thieme Verlag KG. All rights reserved.

<109>
Accession Number
621398121
Author
Chan B.; Butler E.; Frost S.A.; Chuan A.; Aneman A.
Institution
(Chan, Butler) Faculty of Medicine University of New South Wales Sydney,
NSW Australia
(Frost, Aneman) Intensive Care Unit Liverpool Hospital Liverpool, NSW
Australia
(Frost, Chuan, Aneman) Ingham Institute for Applied Medical Research
Sydney, NSW Australia
(Frost, Chuan, Aneman) South Western Sydney Clinical School University of
New South Wales Sydney, NSW Australia
(Frost) Centre for Applied Nursing Research Western Sydney University
Sydney, NSW Australia
(Chuan) Department of Anaesthesia Liverpool Hospital Liverpool, NSW
Australia
Title
Cerebrovascular autoregulation monitoring and patient-centred outcomes
after cardiac surgery: A systematic review.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Impaired cerebrovascular autoregulation (CVAR) is observed in
up to 20% of cardiac surgical patients. This systematic review aims to
evaluate the association between impaired CVAR, measured by current
monitoring techniques, and patient-centred outcomes in adults following
cardiac surgery. Methods: MEDLINE, EMBASE, PubMed, MEDLINE In-Process and
Cochrane Library were systematically searched through 8 December 2017.
Studies were included if they assessed associations between CVAR and
patient-centred outcomes in the adult cardiac surgical population. The
primary outcome of this systematic review was mortality. Secondary
outcomes were stroke, delirium and acute kidney injury. Risk of bias was
systematically assessed, and the GRADE methodology was used to evaluate
the quality of evidence across outcomes. Results: Eleven observational
studies and no randomised controlled trials met the inclusion criteria.
Due to methodological heterogeneity, meta-analysis was not possible. There
was a high risk of bias within individual studies and low quality of
evidence across outcomes. Of the included studies, one assessed mortality,
five assessed stroke, four assessed delirium, and three assessed acute
kidney injury. No reliable conclusions can be drawn from the one study
assessing mortality. Interpretation of studies investigating CVAR and
stroke, delirium and acute kidney injury was complicated by the lack of
standardisation of monitoring techniques as well as varying definitions of
impaired CVAR. Conclusions: There is a paucity of high quality evidence
for CVAR monitoring and its associations with outcome measures in
post-cardiac surgical patients, highlighting the need for future
studies.<br/>Copyright &#xa9; 2018 The Acta Anaesthesiologica Scandinavica
Foundation.

<110>
Accession Number
2000604759
Author
Oesterle A.; Weber B.; Tung R.; Choudhry N.K.; Singh J.P.; Upadhyay G.A.
Institution
(Oesterle, Weber, Tung, Upadhyay) Center for Arrhythmia Care, The
University of Chicago, Ill, United States
(Choudhry) Department of Medicine, Brigham and Women's Hospital, Boston,
Mass, United States
(Singh) Massachusetts General Hospital Heart Center, Boston, United States
Title
Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A
Meta-analysis.
Source
American Journal of Medicine. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Although postoperative atrial fibrillation is common after
noncardiac surgery, there is a paucity of data regarding prophylaxis. We
sought to determine whether pharmacologic prophylaxis reduces the
incidence of postoperative atrial fibrillation after noncardiac surgery.
Methods: We performed an electronic search of Ovid MEDLINE, the Cochrane
central register of controlled trials database, and SCOPUS from inception
to September 7, 2016 and included prospective randomized studies in which
patients in sinus rhythm underwent noncardiac surgery and examined the
incidence of postoperative atrial fibrillation as well as secondary safety
outcomes. Results: Twenty-one studies including 11,608 patients were
included. Types of surgery included vascular surgery (3465 patients),
thoracic surgery (2757 patients), general surgery (2292 patients),
orthopedic surgery (1756 patients), and other surgery (1338 patients).
Beta-blockers (relative risk [RR] 0.32; 95% confidence interval [CI],
0.11-0.87), amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and statins (RR
0.43; 95% CI, 0.27 to 0.68) reduced postoperative atrial fibrillation
compared with placebo or active controls. Calcium channel blockers (RR
0.55; 95% CI, 0.30 to 1.01), digoxin (RR 1.62; 95% CI, 0.95 to 2.76), and
magnesium (RR 0.73; 95% CI, 0.23 to 2.33) had no statistically significant
effect on postoperative atrial fibrillation incidence. The incidence of
adverse events was comparable across agents, except for increased
mortality (RR 1.33; 95% CI, 1.03 to 1.37) and bradycardia (RR 2.74; 95%
CI, 2.19 to 3.43) in patients receiving beta-blockers. Conclusions:
Pharmacologic prophylaxis with amiodarone, beta-blockers, or statins
reduces the incidence of postoperative atrial fibrillation after
noncardiac surgery. Amiodarone and statins have a relatively low overall
risk of short-term adverse events.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<111>
Accession Number
2000570896
Author
Elbadawi A.; Elgendy I.Y.; Saad M.; Megaly M.; Mentias A.; Abuzaid A.S.;
Shahin H.I.; Goswamy V.; Abowali H.; London B.
Institution
(Elbadawi, Goswamy) Department of Internal Medicine, Rochester General
Hospital, Rochester, New York, United States
(Elbadawi, Abowali) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, Florida, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arkansas, United States
(Megaly) Division of Cardiovascular Medicine, Hennepin County Medical
Center/Minneapolis Heart Institute, Abbot Northwestern Hospital,
Minneapolis, Minnesota, United States
(Mentias, London) Department of Cardiovascular Medicine, University of
Iowa, Iowa City, Iowa, United States
(Abuzaid) Sidney Kimmel Medical College at Thomas Jefferson
University/Christiana Care Health System, Newark, Delaware, United States
(Shahin) Department of Pharmaceutics and Pharmaceutical Technology,
Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future
University in Egypt, Cairo, Egypt
Title
Meta-Analysis of Trials on Prophylactic Use of Levosimendan in Patients
Undergoing Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Background: The role of prophylactic levosimendan in patients undergoing
cardiac surgery is controversial. Methods: We performed a computerized
search of Medline, Embase, and Cochrane databases through September 2017
for randomized trials evaluating the prophylactic use of levosimendan in
patients undergoing cardiac surgery (ie, patients without low cardiac
output syndrome). The main study outcome was mortality at 30 days.
Results: The final analysis included 16 randomized trials with total of
2,273 patients. There was no statistically significant difference in
mortality at 30 days between levosimendan and control groups (relative
risk 0.68, 95% confidence interval [CI]: 0.45 to 1.03). Subgroup analysis
showed no statistically significant difference in mortality at 30 days for
patients with reduced left ventricular ejection fraction compared with
patients having preserved left ventricular ejection fraction (p for
interaction = 0.12). Further analysis suggested that levosimendan might be
associated with improved mortality at 30 days when compared with
active-control but not when compared with placebo (p for interaction =
0.01). The levosimendan group had a significant reduction in acute kidney
injury (relative risk 0.59, 95% CI: 0.38 to 0.92), intensive care unit
stay (standardized mean difference = -0.21, 95% CI: -0.29 to -0.13), and
ventilation time (standardized mean difference = -0.43, 95% CI: -0.61 to
-0.25), whereas it had higher rates of atrial fibrillation (relative risk
1.11, 95% CI: 1.00 to 1.24). No statistically significant differences were
observed between groups in mortality beyond 30 days, postoperative
dialysis, or myocardial infarction. Conclusions: Prophylactic use of
levosimendan does not appear to reduce the mortality at 30 days or beyond
30 days in patients undergoing cardiac surgery. This lack of benefit was
noted irrespective of the LVEF.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons