EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
622019247
Author
Huber C.; Thanh T.; May-Slater S.; Ballotta J.; Turakhia M.
Institution
(Huber, Thanh, May-Slater) Precision Health Economics, 11100 Santa Monica
Blvd., Suite 500, Los Angeles, CA 90025, United States
(Ballotta) Cardiva Medical,Inc., 11100 Santa Monica Blvd., Suite 500, Los
Angeles, CA 90025, United States
(Turakhia) Stanford University, Precision Health Economics, 11100 Santa
Monica Blvd., Suite 500, Los Angeles, CA 90025, United States
Title
A review of the impact of vascular closure devices and patient preferences
in cardiac ablation.
Source
Journal of Cardiovascular Electrophysiology. Conference: 23rd Annual
International Atrial Fibrillation Symposium. United States. 29 (4) (pp
676-677), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction Objectives:Although catheter ablation for atrial fibrillation
has matured in terms of procedural duration, safety, efficacy, and
medication management, perioperative care surrounding atrial fibrillation
ablation has not changed significantly. One such example is process
measures related to procedure recovery, such as early ambulation. We
sought to understand the patient recovery experience, impact of faster
recovery times, and associated costs of vascular closure device (VCD) use
through a literature review. Methods: In accordance with the PICOT
framework guidelines, we performed a systematic review using five
databases (PubMed, Google Scholar, Cochrane Reviews, EconLit, Ebsco) of
VCD-related literature published between 2007 and 2017. Eligible
literature included peerreviewed, original, clinical studies detailing
patient reported outcomes, recovery time metrics, costs, and resource
utilization associated with vascular closure device use in diagnostic and
interventional procedures as well as relevant commentary articles and
reviews. References of articles retrieved were searched for additional
citations. We excluded any articles > 10 years to capture current data
related to patient-reported outcomes and costs of improvements in catheter
ablation technology. Results: We identified 76 relevant articles and
extracted data from 50 articles. The literature demonstrated that VCD use
for arterial access reduces time to hemostasis, time to ambulation, and
time to discharge as compared to manual compression (MC). Themost commonly
measured PROs relate to pain, inconvenience, and overall satisfaction, and
there is strong evidence on the burden of MC and patient preferences for
earlier ambulation and discharge. Few studies examined these issues in the
venous setting. For arterial VCD, per-patient institutional costs for
cardiac diagnostic procedures were nearly $1,000 less with use of VCDs,
compared toMC. However, we found no studies looking at economic outcomes
for VCDfor venous closure or for use in cardiac ablation. Conclusions:
Earlier ambulation and discharge could influence patientreported outcomes.
For complex ablation, VCDs could have a role in reducing recovery burden
for both patients and hospitals by enabling faster time to hemostasis and
time to ambulation, which could improve patient satisfaction and reduce
treatment costs. (Figure Presented).

<2>
Accession Number
2000630351
Author
Collet J.-P.; Berti S.; Cequier A.; Van Belle E.; Lefevre T.; Leprince P.;
Neumann F.-J.; Vicaut E.; Montalescot G.
Institution
(Collet, Montalescot) Sorbonne Universite, ACTION Study Group, INSERM
UMR_S 1166, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Berti) Fondazione Toscana G. Monasterio, Ospedale del Cuore G.
Pasquinucci, Massa, Italy
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Van Belle) Department of Cardiology Centre, Hospitalier Universitaire
(CHU), Lille, France
(Lefevre) Hopital prive Jacques Cartier, Institut cardiovasculaire Paris
Sud, Massy, France
(Leprince) Sorbonne Universite (UPMC), INSERM UMR_S 1166, Chrirugie
Cardiaque, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Neumann) Herz-Zentrum Bad Krozingen, Germany
(Vicaut) ACTION Study Group, Unite de Recherche Clinique, Hopital
Lariboisiere, APHP, Paris, France
Title
Oral anti-Xa anticoagulation after trans-aortic valve implantation for
aortic stenosis: The randomized ATLANTIS trial.
Source
American Heart Journal. 200 (pp 44-50), 2018. Date of Publication: June
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Antithrombotic treatment regimen following transcatheter
aortic valve replacement (TAVR) is not evidence-based. Apixaban, a
non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA
and superior to aspirin to prevent cardioembolic stroke in non-valvular
atrial fibrillation. It may have the potential to reduce TAVR-related
thrombotic complications including subclinical valve thrombosis along with
a better safety than the standard of care. Design: ATLANTIS is a
multicenter, randomized, phase IIIb, prospective, open-label, superiority
study comparing standard of care (SOC Group) versus an apixaban-based
strategy (Anti-Xa Group) after successful TAVR (ClinicalTrials.gov NCT
02664649). Randomization is stratified according to the need for chronic
anticoagulation therapy for a reason other than the TAVR procedure. In the
experimental arm, patients receive 5 mg bid of apixaban or a reduced dose
of 2.5 mg bid according to the drug label or when apixaban is combined
with antiplatelet therapy. In the control arm, patients receive VKA
therapy if there is an indication for oral anticoagulation or antiplatelet
therapy alone (single or dual) or the combination of both if needed. The
primary study end point is the composite of all-cause death, TIA/stroke,
myocardial infarction, symptomatic valve thrombosis, pulmonary embolism,
deep venous thrombosis, systemic embolism, life-threatening, disabling or
major bleeding, according to the Valve Academic Research Consortium
definitions. Conclusions: ATLANTIS tests the superiority of an
apixaban-based strategy versus the recommended standard of care strategy
to reduce the risk of post-TAVR thromboembolic and bleeding complications
in an all comer population.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<3>
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Accession Number
608646250
Author
Petite S.E.; Bishop B.M.; Mauro V.F.
Institution
(Petite, Bishop, Mauro) University of Toledo College of Pharmacy, 3000
Arlington Avenue, MS# 1013, Toledo, OH 43614, United States
Title
Role of the funny current inhibitor ivabradine in cardiac pharmacotherapy:
A systematic review.
Source
American Journal of Therapeutics. 25 (2) (pp e247-e266), 2018. Date of
Publication: March-April 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The pharmacology, pharmacokinetics, efficacy and safety of ivabradine are
reviewed. Ivabradine is an oral medication that directly and selectively
inhibits the hyperpolarization-activated cyclicnucleotide gated funny (If)
current in the sinoatrial node resulting in heart rate reduction. It has a
plasma elimination half-life of 6 hours and is administered twice daily.
Ivabradine is extensively metabolized by cytochrome P450 3A4, and its
metabolism is affected by inducers and inhibitors of the 3A4 enzyme.
Studies in patients with heart failure indicate that ivabradine improves
surrogate markers such as exercise tolerance. The results of (1) phase III
trial demonstrated ivabradine significantly reduced heart failure
hospitalizations but had no effect on mortality. Ivabradine has been
extensively evaluated for coronary artery disease wherein (2) large trials
was shown to have no mortality benefit. Ivabradine has been associated
with improved symptoms in stable chronic angina pectoris. Ivabradine has
been evaluated for other cardiovascular conditions including tachycardias
of various natures, arrhythmia prevention postcardiac surgery, in acute
coronary syndrome, and for heart rate control during coronary computed
tomography angiogram. The most common adverse events reported in clinical
trials were bradycardia, new-onset atrial fibrillation, and phosphenes.
Ivabradine, a novel cardiac medication, has been studied in numerous
cardiac conditions. It is only currently approved in the United States to
reduce hospitalizations for systolic heart failure. The role of this
medication in other conditions has not been fully
elucidated.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<4>
Accession Number
621862076
Author
Kindler H.L.; Ismaila N.; Armato S.G.; Bueno R.; Hesdorffer M.; Jahan T.;
Jones C.M.; Miettinen M.; Pass H.; Rimner A.; Rusch V.; Sterman D.; Thomas
A.; Hassan R.
Institution
(Kindler, Armato) University of Chicago, Chicago, IL, United States
(Ismaila) American Society of Clinical Oncology, Alexandria, VA, United
States
(Hesdorffer) Mesothelioma Applied Research Foundation, Alexandria, VA,
United States
(Bueno) Harvard Medical School, Boston, MA, United States
(Jahan) University of California San Francisco, San Francisco, CA, United
States
(Jones) Baptist Cancer Center Physicians Foundation, Memphis, TN, United
States
(Miettinen, Thomas, Hassan) Center for Cancer Research, National Cancer
Institute, Bethesda, MD, United States
(Pass, Sterman) New York University Langone Medical Center, New York, NY,
United States
(Rimner, Rusch) Memorial Sloan Kettering Cancer Center, New York, NY,
United States
Title
Treatment of malignant pleural mesothelioma: American society of clinical
oncology clinical practice guideline.
Source
Journal of Clinical Oncology. 36 (13) (pp 1343-1373), 2018. Date of
Publication: 01 May 2018.
Publisher
American Society of Clinical Oncology (E-mail: jcoservice@asco.org)
Abstract
Purpose To provide evidence-based recommendations to practicing physicians
and others on the management of malignant pleural mesothelioma. Methods
ASCO convened an Expert Panel of medical oncology, thoracic surgery,
radiation oncology, pulmonary, pathology, imaging, and advocacy experts to
conduct a literature search, which included systematic reviews,
meta-analyses, randomized controlled trials, and prospective and
retrospective comparative observational studies published from 1990
through 2017. Outcomes of interest included survival, disease-free or
recurrence-free survival, and quality of life. Expert Panel members used
available evidence and informal consensus to develop evidence-based
guideline recommendations. Results The literature search identified 222
relevant studies to inform the evidence base for this guideline.
Recommendations Evidence-based recommendations were developed for
diagnosis, staging, chemotherapy, surgical cytoreduction, radiation
therapy, and multimodality therapy in patients with malignant pleural
mesothelioma.<br/>Copyright &#xa9; 2018 American Society of Clinical
Oncology. All rights reserved.

<5>
Accession Number
618426306
Author
Yousif A.; Addison D.; Lakkis N.; Rosengart T.; Virani S.S.; Birnbaum Y.;
Alam M.
Institution
(Yousif) Department of Medicine, Section of Cardiology, University of
Oklahoma School of Medicine, Oklahoma City, OK, United States
(Addison) Department of Medicine, Section of Cardiology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Addison) Department of Internal Medicine, Division of Cardiology,
Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston,
MA 02114, United States
(Lakkis, Virani, Birnbaum, Alam) Department of Medicine, Section of
Cardiology, Baylor College of Medicine, Houston, TX, United States
(Rosengart) Department of Surgery, Section of Cardiothoracic Surgery,
Baylor College of Medicine, Houston, TX, United States
(Virani) Center Health Services Research and Development, Michael E.
DeBakey Veterans Affairs Medical Center, Houston, TX, United States
Title
Use of cardiopulmonary pump support during coronary artery bypass grafting
in the high-risk: a meta-analysis.
Source
Irish Journal of Medical Science. 187 (2) (pp 369-377), 2018. Date of
Publication: 01 May 2018.
Publisher
Springer London
Abstract
Background: Data from randomized trials evaluating the efficacy of on-
versus off-pump coronary artery bypass grafting remain inconclusive,
particularly in high-risk populations. Aims: The aim of this study is to
compare the outcomes associated with on- versus off-pump coronary artery
bypass grafting among high-risk patients. Methods: We performed a
meta-analysis of randomized control trials comparing on- versus off-pump
coronary artery bypass grafting, focusing on high-risk populations.
Studies focusing on "high-risk" features: European System of Cardiac
Operative Risk Evaluation (EuroSCORE) >= 5, age > 70 years, preexisting
renal insufficiency, history of stroke(s), and the presence of left
ventricular dysfunction were included. MEDLINE, Scopus, and Embase were
searched for all publications between January 1, 2000 and August 1, 2016,
using the following terms: on-pump, off-pump, coronary artery bypass,
high-risk, left ventricular dysfunction, elderly, aged, and renal
insufficiency. Endpoints included cardiovascular and all-cause mortality,
non-fatal myocardial infarction, stroke, need for revascularization, renal
failure, and length of hospital stay. Results: Nine studies incorporating
11,374 patients with a mean age of 70 years were selected. There was no
statistical difference in cardiovascular mortality, all-cause mortality,
non-fatal myocardial infarction, and renal failure between the two groups.
There was a decrease in further revascularization at 1 year with on-pump
(OR 0.67 (0.50-0.89)). However, there was an increase in length of
hospital stay by 2.24 days (p = 0.03) among the on-pump group with no
difference in stroke (OR 1.34 (1.00-1.80)). Conclusions: On-pump is
associated with a decreased risk of additional revascularization by 1
year. However, this appears to be a cost of longer
hospitalization.<br/>Copyright &#xa9; 2017, Royal Academy of Medicine in
Ireland.

<6>
Accession Number
621998682
Author
Ilic N.; Ilic D.; Juricic J.; Krnic D.; Frleta Ilic N.; Simundza I.;
Orsulic D.
Institution
(Ilic, Ilic, Juricic, Krnic, Simundza, Orsulic) University Hospital Center
Split-KBC Split, Split, Croatia
(Frleta Ilic) Policlinic Cito, Split, Croatia
Title
Intubated versus non-intubated general anesthesia for minimally invasive
videoassisted thoracic surgery (VATS) in octogenarians.
Source
Journal of Thoracic Oncology. Conference: 8th European Lung Cancer
Congress, ELCC 2018. Switzerland. 13 (4 Supplement 1) (pp S53), 2018. Date
of Publication: April 2018.
Publisher
Elsevier Inc.
Abstract
Background: In recent years, non-intubated videoassisted thoracic surgey
has gained popularity worldwide, especially in elderly lung patients. The
main goal of this surgical practice is to achieve an overall improvement
of patient management and outcome thanks to the avoidance of side-effects
related to general anesthesia (GA) and single-lung ventilation. In this
study we tried to compare a non-intubated general anesthetic technique
with an intubated general anesthetic technique for VATS. Methods: Sixty
patients aged 80 and more scheduled for VATS lung surgery, were allocated
randomly into two groups with 30 patients each. The first group received
standard general anesthesia with double lumen tube. The second group
underwent a non-intubated anesthetic technique. Heart rate, mean arterial
pressure, end-tidal CO2 and the visual analog pain score (VAS)
measurements were recorded during the surgery and 24 hours after the
surgery. Both groups received ultrasound guided paravertebral block before
surgery with single injection of 20 ml of 0.25% levobupivacaine. VATS lung
biopsy, sublobar or lobar resection were equally distributed in both
groups of patients. Results: Time for anesthetic procedurewas shorter in
the non-intubated group. VATS lobecotomy was performed in the usual manner
in all patients without any intraoperative complications. VAS scores in
the first 24 hours werecomparable. We found significantlly shorter
recovery times, reduced oxygen requirement, and shorter hospital stays in
the non-intubated group. There were no significant differences in
intraoperative blood loss, the operation time or postoperative
complications between the non-intubated group and the intubated group of
patients. Conclusions: In this study, our experience has shown that
non-intubated VATS is a safe and feasible surgery for elderly lung cancer
patients with certain advantages for the patients undergoing VATS. Our
results indicate that we can achieve day surgery for selected patients.
Further clinical studies should be carried out in order to improve
surgical outcomes in elderly LC patients.

<7>
Accession Number
621997768
Author
Singh N.; Dornadula I.; Ramezani A.; Sheth S.; De Mesa C.
Title
Psychological preparation for neuromodulation: A systematic review.
Source
Neuromodulation. Conference: 21st Annual Meeting of the North American
Neuromodulation Society. United States. 21 (3) (pp e72), 2018. Date of
Publication: April 2018.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Surgical outcomes are improved when the psychological
preparation is implemented. Beltrutti et al. (2004) have identified the
need for psychological preparation for patients undergoing neuromodulation
in improving surgical outcomes. However, evidence for creating a
psychological preparation framework does not exist for spinal cord
stimulation (SCS). Extrapolated from the surgical literature, outcomes
affected by psychological preparation include a decrease in pain and
anxiety as well as shortened hospital stay, decreased post-operative pain
medication use, and increased patient satisfaction. This systematic review
sought to analyze the current literature on use of psychological
modalities in improving outcomes for patients undergoing surgery as a
proxy for preparation of neuromodulation patients. Methods: A systemic
review of the surgical literature was done using PubMed, Science Direct,
PsycINFO, and Google Scholar by two reviewers. A total of 520 recent
English-language studies on adults were screened and 36 studies met the
following inclusion criteria: behavioral interventions used preoperatively
to improve post-operative outcomes for spine and non-spine surgery
candidates and psychosocial factors in predicting post-surgical outcomes.
Results: Fourteen spine (cervical and lumbar) surgery articles were
identified while 22 articles were non- spine surgery such as gastric
bypass, heart surgery, and prostatectomy or noted as simply "elective
surgery". No studies specifically addressing the psychological preparation
of patients for SCS were identified. Of these studies, 8 were reviews, 5
were meta-analyses, 8 were prospective, and 15 were randomized-controlled
trials. Studies on preoperative interventions (11 studies) showed that
there are many interventions, including relaxation, pain coping and stress
management, that improved postoperative outcomes such as less pain
disability, decreased analgesic use, and decreased hospital length of
stay. Seven out of eight studies showed that pre-procedural information
can decrease depression and/or anxiety and help manage patient
expectations and possibly improve satisfaction. Individuals with
pre-operative depression and anxiety had poorer outcomes with less pain
relief and symptoms of depression and anxiety post operatively (8
studies). In 3 studies of smoking and alcohol cessation preoperatively,
patients had decreased complications and improved outcomes
postoperatively. Additionally, those with anxiety (1 study) benefitted
from preoperative interventions to lower anxiety. Conclusion:
Pre-operative cognitive behavior therapies such as relaxation techniques,
pain coping strategies, and anxiety and stress management and mitigation
of risk factors seemed to show positive effects for relevant psychological
and medical outcomes in patients undergoing a variety of surgeries
including spinal surgery, which may be helpful as a framework for
neuromodulation.

<8>
Accession Number
621938310
Author
Bao F.; Zhang C.; Yang Y.; He Z.; Wang L.; Hu J.
Institution
(Bao, Zhang, Yang, He, Wang, Hu) Department of Thoracic Surgery, First
Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
Title
Comparison of robotic and video-assisted thoracic surgery for lung cancer:
A propensity-matched analysis.
Source
Journal of Thoracic Disease. 8 (7) (pp 1798-1803), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Reports of comparison between robotic and thoracoscopic
surgery for lung cancer are limited, we aimed to compare the perioperative
outcomes of robotic and thoracoscopic anatomic pulmonary resection for
lung cancer. Methods: A total of 184 patients with lung cancer underwent
anatomic pulmonary resection by robotics or thoracoscopy. A
propensity-matched analysis with incorporated preoperative variables was
used to compare the perioperative outcomes between the two procedures.
Results: Overall, 71 patients underwent robotic pulmonary resection,
including 64 lobectomies and 7 segmentectomies, while 113 patients
underwent thoracoscopic lobectomy and segmentectomy. Propensity match
produced 69 pairs. The mean length of postoperative stay (7.6+/-4.6 vs.
6.4+/-2.6 d, P=0.078), chest tube duration (5.3+/-3.7 vs. 4.4+/-1.7 d,
P=0.056), number of lymph nodes retrieved (17.9+/-6.9 vs. 17.4+/-7.0,
P=0.660), stations of lymph nodes resected (7.4+/-1.6 vs. 7.6+/-1.7,
P=0.563), operative blood loss (53.9+/-29.3 vs. 50.3+/-37.9 mL, P=0.531),
morbidity rates (42.0% vs. 30.4%, P=0.157) were similar between the
robotics and thoracoscopy. However, robotics was associated with higher
cost ($12,067+/-1,610 vs. $8,328+/-1,004, P < 0.001), and longer operative
time (136+/-40 vs. 111+/-28 min, P < 0.001). Conclusions: Robotics seems
to have higher hospital costs and longer operative time, without superior
advantages in morbidity rates and oncologic efficiency. Further
prospective randomized clinical trials were needed to validate both of its
short- and long-term oncologic efficiency.<br/>Copyright &#xa9; Journal of
Thoracic Disease.

<9>
Accession Number
2000717740
Author
Kokkinidis D.G.; Papanastasiou C.A.; Jonnalagadda A.K.; Oikonomou E.K.;
Theochari C.A.; Palaiodimos L.; Karvounis H.I.; Armstrong E.J.; Faillace
R.T.; Giannakoulas G.
Institution
(Kokkinidis, Palaiodimos, Faillace) Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Kokkinidis, Armstrong) Division of Cardiology, Denver VA Medical Center
and University of Colorado, Denver, United States
(Papanastasiou, Karvounis, Giannakoulas) 1st Cardiology Department, AHEPA
University Hospital, Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Jonnalagadda) Division of Cardiology, Medstar, Washington Hospital
Center, DC, United States
(Oikonomou, Theochari) Cardiology Working Group, Society of Junior
Doctors, Athens, Greece
Title
The predictive value of baseline pulmonary hypertension in early and long
term cardiac and all-cause mortality after transcatheter aortic valve
implantation for patients with severe aortic valve stenosis: A systematic
review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a safe and
effective alternative to surgical aortic valve replacement (SAVR) for the
treatment of severe aortic valve stenosis (AS). The impact of concomitant
baseline elevated pulmonary artery pressures on outcomes after TAVI has
not been established, since different studies used different definitions
of pulmonary hypertension (PH). Objective: To determine the association of
PH with early and late cardiac and all-cause mortality after TAVI.
Methods: We performed a meta-analysis of studies comparing patients with
elevated pulmonary artery pressures (defined as pulmonary hypertension or
not) versus patients without elevated pulmonary artery pressures
undergoing TAVI. We first performed stratified analyses based on the
different PH cut-off values utilized by the included studies and
subsequently pooled the studies irrespective of their cut-off values. We
used a random effects model for the meta-analysis and assessed
heterogeneity with I-square. Separate meta-analyses were performed for
studies reporting outcomes as hazards ratios (HRs) and relative risks
(RRs). Subgroup analyses were performed for studies published before and
after 2013. Meta-regression analysis in order to assess the effect of
chronic obstructive pulmonary disease and mitral regurgitation were
performed. Results: In total 22 studies were included in this systematic
review. Among studies presenting results as HR, PH was associated with
increased late cardiac mortality (HR: 1.8. 95% CI: 1.3-2.3) and late
all-cause mortality (HR: 1.56; 95% CI: 1.1-2). The PH cut-off value that
was most likely to be associated with worst outcomes among the different
endpoints was pulmonary artery systolic pressure of 60 mm Hg (HR: 1.8; 95%
CI: 1.3-2.3; I² = 0, for late cardiac mortality and HR: 1.52;
95% CI: 1-2.1; I² = 85% for late all-cause mortality).
Conclusion: This systematic review and meta-analysis emphasizes the
importance of baseline PH in predicting mortality outcomes after TAVI.
Additional studies are needed to clarify the association between elevated
baseline pulmonary artery pressures and outcomes after TAVI.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<10>
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.

<11>
Accession Number
617515495
Author
Arruda A.P.N.; Ayala A.P.; Lopes L.C.; Bergamaschi C.C.; Guimaraes C.;
Grossi M.D.; Righesso L.A.R.; Agarwal A.; Dib R.E.
Institution
(Arruda) Department of Surgery and Orthopedics, Botucatu Medical School,
UNESP - Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Ayala) Instruction and Faculty Liaison Librarian, Gerstein Science
Information Centre, University of Toronto Libraries, University of
Toronto, Toronto, ON, Canada
(Lopes, Bergamaschi, Guimaraes, Grossi) Ciencias Biologicas e da Saude,
University of Sorocaba, Sorocaba, Sao Paulo, Brazil
(Lopes) Faculdade de Ciencias Farmaceuticas, Universidade Estadual
Paulista, Araraquara, Sao Paulo, Brazil
(Righesso) Department of Oral and Maxillofacial Surgery, University
Medical Center Mainz, Mainz, Renania, Germany
(Agarwal) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Agarwal) School of Medicine, University of Toronto, Toronto, ON, Canada
(Dib) Department of Anesthesiology, Botucatu Medical School, UNESP -
Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Dib) Institute of Urology, McMaster University, St. Joseph's Healthcare,
Hamilton, ON, Canada
(Dib) Department of Biosciences and Oral Diagnosis, Institute of Science
and Technology, UNESP - Universidade Estadual Paulista, Sao Jose Dos
Campos, Sao Paulo, Brazil
Title
Herbal medications for surgical patients: A systematic review protocol.
Source
BMJ Open. 7 (7) (no pagination), 2017. Article Number: e014290. Date of
Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative nausea and vomiting (PONV) affect approximately
80% of surgical patients and is associated with increased length of
hospital stay and systemic costs. Preoperative and postoperative pain,
anxiety and depression are also commonly reported. Recent evidence
regarding their safety and effectiveness has not been synthesised. The aim
of this systematic review is to evaluate the efficacy and safety of herbal
medications for the treatment and prevention of anxiety, depression, pain
and PONV in patients undergoing laparoscopic, obstetrical/gynaecological
and cardiovascular surgical procedures. Methods and analysis The following
electronic databases will be searched up to 1 October 2016 without
language or publication status restrictions: CENTRAL, MEDLINE, EMBASE,
CINAHL, Web of Science and LILACS. Randomised clinical trials enrolling
adult surgical patients undergoing laparoscopic,
obstetrical/gynaecological and cardiovascular surgeries and managed with
herbal medication versus a control group (placebo, no intervention or
active control) prophylactically or therapeutically will be considered
eligible. Outcomes of interest will include the following: anxiety,
depression, pain, nausea and vomiting. A team of reviewers will complete
title and abstract screening and full-text screening for identified hits
independently and in duplicate. Data extraction, risk of bias assessments
and evaluation of the overall quality of evidence for each relevant
outcome reported will be conducted independently and in duplicate using
the Grading of Recommendations Assessment Development and Evaluation
classification system. Dichotomous data will be summarised as risk ratios;
continuous data will be summarised as standard average differences with
95% CIs. Ethics and dissemination This is one of the first efforts to
systematically summarise existing evidence evaluating the use of herbal
medications in laparoscopic, obstetrical/gynaecological and cardiovascular
surgical patients. The findings of this review will be disseminated
through peer-reviewed publications and conference presentations.
Systematic review registration PROSPERO CRD42016042838.<br/>Copyright
&#xa9; 2017 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article). All rights reserved.

<12>
Accession Number
618043763
Author
van't Hof A.; Giannini F.; ten Berg J.; Tolsma R.; Clemmensen P.;
Bernstein D.; Coste P.; Goldstein P.; Zeymer U.; Hamm C.; Deliargyris E.;
Steg P.G.
Institution
(van't Hof, Giannini) Isala Hospital, Netherlands
(ten Berg) St Antonius Hospital, Netherlands
(Tolsma) EMS RAV IJsselland, Netherlands
(Clemmensen) The Heart Centre, Copenhagen University Hospital, Denmark
(Bernstein, Deliargyris) The Medicines Company, United States
(Coste) Centre Hospitalier Universitaire Bordeaux, Universite de Bordeaux,
France
(Goldstein) Centre Hospitalier Regional Universitaire de Lille, France
(Zeymer) Klinikum Ludwigshafen, Germany
(Hamm) Kerckhoff Heart and Thoraxcenter, Germany
(Steg) Universite Paris-Diderot, France
Title
ST-segment resolution with bivalirudin versus heparin and routine
glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment
elevation myocardial infarction patients transported for primary
percutaneous coronary intervention: The EUROMAX ST-segment resolution
substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (5) (pp 404-411),
2017. Date of Publication: 01 Aug 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Myocardial reperfusion after primary percutaneous coronary
intervention (PCI) can be assessed by the extent of post-procedural
ST-segment resolution. The European Ambulance Acute Coronary Syndrome
Angiography (EUROMAX) trial compared pre-hospital bivalirudin and
pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors
(GPIs) in primary PCI. This nested substudy was performed in centres
routinely using pre-hospital GPI in order to compare the impact of
randomized treatments on ST-resolution after primary PCI. Methods:
Residual cumulative ST-segment deviation on the single one hour
post-procedure electrocardiogram (ECG) was assessed by an independent core
laboratory and was the primary endpoint. It was calculated that 762
evaluable patients were needed to show non-inferiority (85% power, alpha
2.5%) between randomized treatments. Results: A total of 871 participated
with electrocardiographic data available in 824 patients (95%). Residual
ST-segment deviation one hour after PCI was 3.8+/-4.9 mm versus 3.9+/-5.2
mm for bivalirudin and heparin+GPI, respectively (p=0.0019 for
non-inferiority). Overall, there were no differences between randomized
treatments in any measures of ST-segment resolution either before or after
the index procedure. Conclusions: Pre-hospital treatment with bivalirudin
is non-inferior to pre-hospital heparin + GPI with regard to residual
ST-segment deviation or ST-segment resolution, reflecting comparable
myocardial reperfusion with the two strategies.<br/>Copyright &#xa9; The
European Society of Cardiology 2015.

<13>
Accession Number
616479978
Author
Anand V.; Bates A.; Featherstone R.; Murthy S.
Institution
(Anand, Featherstone) University of Alberta, Edmonton, Canada
(Bates) University of Pennsylvania, Philadelphia, United States
(Murthy) University of British Columbia, 4500 Oak Street, Vancouver,
Canada
Title
Perioperative antibiotics in pediatric cardiac surgery: Protocol for a
systematic review.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 107. Date
of Publication: 30 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative infections in pediatric cardiac surgery are an
ongoing clinical challenge, with rates between 1 and 20%. Perioperative
antibiotics remain the standard for prevention of surgical-site
infections, but the type of antibiotic and duration of administration
remain poorly defined. Current levels of practice variation through
informal surveys are very high. Rates of antibiotic-resistant organisms
are increasing steadily around the world. Methods/design: We will identify
all controlled observational studies and randomized controlled trials
examining prophylactic antibiotic use in pediatric cardiac surgery. Data
sources will include MEDLINE, EMBASE, CENTRAL, and proceedings from recent
relevant scientific meetings. For each included study, we will conduct
duplicate independent data extraction, risk of bias assessment, and
evaluation of quality of evidence using the GRADE approach. Discussion: We
will report the results of this review in agreement with the PRISMA
statement and disseminate our findings at relevant critical care and
cardiology conferences and through publication in peer-reviewed journals.
We will use this systematic review to inform clinical guidelines, which
will be disseminated in a separate stand-alone publication. Study
registration number: PROSPERO CRD42016052978C<br/>Copyright &#xa9; 2017
The Author(s).

<14>
Accession Number
615794674
Author
Borji R.; Ahmadi S.H.; Barkhordari K.; Meysami A.P.; Karimi A.A.;
Mortazavi S.H.; Dadlani P.; Ayatollah Zadeh Esfahani F.; Khatami S.M.R.
Institution
(Borji) Internal Medicine Department, Imam Khomeini Hospital, Iran,
Islamic Republic of
(Meysami) Community and Preventive Medicine Department, Medical Faculty,
Iran, Islamic Republic of
(Ahmadi, Barkhordari, Karimi, Mortazavi, Dadlani, Ayatollah Zadeh
Esfahani) Tehran Heart Center, Iran, Islamic Republic of
(Khatami) Nephrology Research Center, Tehran University of Medical
Sciences, PO Box 1419733141, Tehran, Iran, Islamic Republic of
Title
Effect of Prophylactic Dialysis on Morbidity and Mortality in
Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A
Pilot Study.
Source
Nephron. 136 (3) (pp 226-232), 2017. Date of Publication: 01 Jul 2017.
Publisher
S. Karger AG
Abstract
Background/Aims: Coronary artery bypass grafting (CABG) is associated with
an increased risk of morbidity and mortality in patients with pre-existing
renal dysfunction. Numerous measures have been implemented to overcome
this problem; however, no improvement in outcomes has been achieved. This
study was aimed at investigating the effects of prophylactic dialysis on
mortality and morbidity in these patients. Methods: This
randomized-controlled clinical trial enrolled 88 non-dialysis-dependent
patients with chronic kidney disease awaiting CABG surgery. Thirty-nine
randomly selected patients received dialysis 3 times prior to surgery, and
49 patients formed the control group. Kaplan-Meier analysis and Cox
proportional-hazards models were used to identify factors associated with
survival. Results: There was no significant difference in the development
of morbidities between the groups (p = 0.413). A significant difference
was evident in the average survival time (p = 0.037). Cox
proportional-hazards models determined that the hazard ratio of death
after surgery was 10.854-fold greater in non-dialysis patients than in
patients who received dialysis (hazard ratio = 2). Conclusion:
Prophylactic dialysis prior to CABG decreases mortality, but does not
affect morbidity, in patients with renal insufficiency.<br/>Copyright
&#xa9; 2017 S. Karger AG, Basel.

<15>
Accession Number
617475673
Author
Barnwal N.K.; Umbarkar S.R.; Sarkar M.; Dias R.
Institution
(Barnwal, Umbarkar, Sarkar) Department of Cardiac Anesthesiology, Seth GS
Medical College and KEM Hospital, 2/7, Stone Building, B. J. Marg,
Byculla, Mumbai, Maharashtra 400 011, India
(Dias) Department of Pediatric Anesthesiology, Seth GS Medical College and
KEM Hospital, Mumbai, Maharashtra, India
Title
Randomized comparative study of intravenous infusion of three different
fixed doses of milrinone in pediatric patients with pulmonary hypertension
undergoing open heart surgery.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 318-322), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Pulmonary hypertension secondary to congenital heart disease
is a common problem in pediatric patients presenting for open heart
surgery. Milrinone has been shown to reduce pulmonary vascular resistance
and pulmonary artery pressure in pediatric patients and neonates
postcardiac surgery. We aimed to evaluate the postoperative outcome in
such patients with three different fixed maintenance doses of milrinone.
Methodology: Patients were randomized into three groups. All patients
received fixed bolus dose of milrinone 50 mug/kg on pump during rewarming.
Following this, patients in low-dose group received infusion of milrinone
at the rate of 0.375 mug/kg/min, medium-dose group received 0.5
mug/kg/min, and high-dose group received 0.75 mug/kg/min over 24 h. Heart
rate, mean arterial pressure (MAP), mean airway pressure (MaP),
oxygenation index (OI), and central venous pressure (CVP) were compared at
baseline and 24 h postoperatively. Dose of inotropic requirement, duration
of ventilatory support and Intensive Care Unit (ICU) stay were noted.
Results: MAP, MaP, OI, and CVP were comparable in all three groups
postoperatively. All patients in the low-dose group required low inotropic
support while 70% of patients in the high-dose group needed high inotropic
support to manage episodes of hypotension (P = 0.000). Duration of
ventilatory support and ICU stay in all three groups was comparable (P =
0.412, P = 0.165). Conclusion: Low-dose infusions while having a clinical
impact were more beneficial in avoiding adverse events and decreasing
inotropic requirement without affecting duration of ventilatory support
and duration of ICU stay.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<16>
Accession Number
617475668
Author
Soliman R.; Mofeed M.; Momenah T.
Institution
(Soliman) Department of Cardiac Anesthesia, Prince Sultan Cardiac Centre,
Riyadh, Saudi Arabia
(Soliman) Department of Anesthesia, Faculty of Medicine, Cairo University,
Egypt
(Mofeed) Department of Cardiology, Madinah Cardiac Center, Al Madinah Al
Monourah, Saudi Arabia
(Mofeed) Department of Pediatric Cardiology, Sohag University, Egypt
(Momenah) Department of Pediatric Cardiology, Prince Sultan Cardiac
Centre, Riyadh, Saudi Arabia
Title
Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing
Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized
Study.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 313-317), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The study was done to compare propofol and ketofol for sedation
of pediatric patients scheduled for elective pulmonary valve implantation
in a catheterization laboratory. Design: This was a double-blind
randomized study. Setting: This study was conducted in Prince Sultan
Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60
pediatric patients with pulmonary regurge undergoing pulmonary valve
implantation. Intervention: The study included sixty patients, classified
into two groups (n = 30). Group A: Propofol was administered as a bolus
dose (1-2 mg/kg) and then a continuous infusion of 50-100 mug/kg/min
titrated as needed. Group B: Ketofol was administered 1-2 mg/kg and then
infusion of 20-60 mug/kg/min. The medication was prepared by the nursing
staff and given to anesthetist blindly. Measurements: The monitors
included heart rate, mean arterial blood pressure, respiratory rate,
temperature, SPO<inf>2</inf>and PaCO<inf>2</inf>, Michigan Sedation Score,
fentanyl dose, antiemetic medications, and Aldrete score. Main Results:
The comparison of heart rate, mean arterial pressure, respiratory rate,
temperature, SPO<inf>2</inf>and PaCO<inf>2</inf>, Michigan Sedation Score,
and Aldrete score were insignificant (P > 0.05). The total fentanyl
increased in Group A more than Group B (P = 0.045). The required
antiemetic drugs increased in Group A patients more than Group B (P =
0.020). The durations of full recovery and in the postanesthesia care unit
were longer in Group A than Group B (P = 0.013, P < 0.001, respectively).
Conclusion: The use of propofol and ketofol is safe and effective for
sedation of pediatric patients undergoing pulmonary valve implantation in
a catheterization laboratory. However, ketofol has many advantages more
than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery
time, decreased incidence of nausea and vomiting and leads to rapid
discharge of patients from the postanesthesia care unit.<br/>Copyright
&#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<17>
Accession Number
617475655
Author
Kanchi M.; Manjunath R.; Massen J.; Vincent L.; Belani K.
Institution
(Kanchi) Department of Anesthesia and Intensive Care, Narayana Hrudayalaya
Hospital, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bengaluru,
Karnataka, India
(Manjunath) Department of Anesthesia, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Massen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Vincent) Department of Nephrology, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Belani) Department of Anesthesiology, Medicine and Pediatrics, University
of Minnesota, Minneapolis, MN, United States
Title
Neutrophil gelatinase-associated lipocalin as a biomarker for predicting
acute kidney injury during off-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 297-302), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Acute kidney injury (AKI) following cardiac surgery is a major
complication resulting in increased morbidity, mortality, and economic
burden. In this study, we assessed the usefulness of estimating serum
neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in
predicting AKI in patients with stable chronic kidney disease (CKD) and
undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients
and Methods: We prospectively studied sixty nondialysis-dependent CKD
patients with estimated glomerular filtration rate <60 ml/min/1.73
m² who required elective OP-CABG. Patients were randomized into
two groups, Group D received dopamine infusion at 2 mug/kg/min following
anesthesia induction till the end of the surgery and Group P did not
receive any intervention. Serum creatinine, NGAL, brain natriuretic
peptide, and troponin-I were estimated at specified intervals before,
during, and after surgery. The results of the study patients were also
compared to a simultaneous matched cohort control of thirty patients
(Group A) without renal dysfunction who underwent OP-CABG. Results: No
patient required renal replacement therapy, and no mortality was observed
during perioperative and hospitalization period. Six patients from control
group (n = 30), ten patients from placebo group (n = 30), and 12 patients
from dopamine group (n = 30) developed stage 1 AKI. However, we did not
observe any stage 2 and stage 3 AKI among all the groups. There was a
significant increase in serum NGAL levels at the end of surgery and 24 h
postoperatively in placebo and dopamine groups as compared to the control.
Conclusion: The measurement of NGAL appears to predict the occurrence of
AKI after OP-CAB surgery. However, large multicentric studies may be
required to confirm the findings of this study.<br/>Copyright &#xa9; 2017
Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<18>
Accession Number
618042607
Author
Nemeth E.; Vig K.; Racz K.; Koritsanszky K.B.; Ronkay K.I.; Hamvas F.P.;
Borbely C.; Eory A.; Merkely B.; Gal J.
Institution
(Nemeth, Racz, Koritsanszky, Ronkay, Hamvas, Gal) Semmelweis University,
Department of Anaesthesia and Intensive Therapy, P.O.B. 2, Budapest
H-1428, Hungary
(Vig, Merkely) Semmelweis University, Heart and Vascular Centre, P.O.B. 2,
Budapest H-1428, Hungary
(Borbely) National Institute of Neuroscience, Amerikai Street 57, Budapest
H-1145, Hungary
(Eory) Semmelweis University, Department of Family Medicine, P.O.B. 2,
Budapest H-1428, Hungary
Title
Influence of the postoperative inflammatory response on cognitive decline
in elderly patients undergoing on-pump cardiac surgery: A controlled,
prospective observational study.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 113.
Date of Publication: 29 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The role of non-infective inflammatory response (IR) in the
aetiology of postoperative cognitive dysfunction (POCD) is still
controversial. The aim of this controlled, prospective observational study
was to assess the possible relationship between the grade of IR, defined
by procalcitonin (PCT) changes, and development of POCD related to cardiac
surgery. Methods: Forty-two patients, who were >= 60 years of age and
scheduled for elective cardiac surgery, were separated into the low
inflammatory (LIR) and high inflammatory (HIR) response groups based on
their PCT levels measured on the first postoperative day. A matched
normative control group of 32 subjects was recruited from primary care
practice. The PCT and C-reactive protein (CRP) levels were monitored daily
during the first five postoperative days. The cognitive function and mood
state were preoperatively tested with a set of five neurocognitive tests
and two mood inventories and at the seventh postoperative day. The
Reliable Change Index modified for practice (RCIp) using data from
normative controls was applied to determine the significant decline in
test performance. Results: The LIR (n = 20) and HIR (n = 22) groups
differed significantly in the PCT (p < 0.001) but not in the CRP time
courses. The incidence of POCD at the first postoperative week was 35.7%
in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of
neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively,
p > 0.05). Additionally, there was no difference in the mood states,
anxiety levels and perioperative parameters known to influence the
development of POCD. Conclusions: In this study, the magnitude of the
non-infective inflammatory response generated by on-pump cardiac surgery
did not influence the development of POCD in the early postoperative
period in elderly patients.<br/>Copyright &#xa9; 2017 The Author(s).

<19>
Accession Number
616633961
Author
Giannini C.; De Carlo M.; Tamburino C.; Ettori F.; Latib A.M.; Bedogni F.;
Bruschi G.; Presbitero P.; Poli A.; Fabbiocchi F.; Violini R.; Trani C.;
Giudice P.; Barbanti M.; Adamo M.; Colombo P.; Benincasa S.; Agnifili M.;
Petronio A.S.
Institution
(Giannini, De Carlo, Petronio) Azienda Ospedaliero-Universitaria Pisana,
Pisa, Italy
(Tamburino, Barbanti) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Ettori, Adamo) Ospedali Civili, Brescia, Italy
(Latib, Benincasa) Scientific Institute S. Raffaele, Milan, Italy
(Bedogni, Agnifili) Policlinico San Donato, San Donato, Italy
(Bruschi, Colombo) "De Gasperis" Cardio Center ASST Niguarda Metropolitan
Hospital, Milan, Italy
(Presbitero) Clinical Institute Humanitas, Rozzano, Milan, Italy
(Poli) Ospedale Civile, Legnano, Italy
(Fabbiocchi) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Violini) San Camillo Forlanini Hospital, Rome, Italy
(Trani) Institute of Cardiology, Catholic University of Sacred Heart,
Rome, Italy
(Giudice) Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno,
Italy
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Evolut R versus CoreValve system: A case-matched
comparison.
Source
International Journal of Cardiology. 243 (pp 126-131), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite promising results following transcatheter aortic valve
implantation (TAVI), several relevant challenges still remain. To overcome
these issues, new generation devices have been developed. The purpose of
the present study was to determine whether TAVI with the new
self-expanding repositionable Evolut R offers potential benefits compared
to the preceding CoreValve, using propensity matching. Methods Between
June 2007 and November 2015, 2148 consecutive patients undergoing TAVI
either CoreValve (n = 1846) or Evolut R (n = 302) were prospectively
included in the Italian TAVI ClinicalService project. For the purpose of
our analysis 211 patients treated with the Evolut R were matched to 211
patients treated with the CoreValve. An independent core laboratory
reviewed all angiographic procedural data and an independent clinical
events committee adjudicated all events. Results Patients treated with
Evolut R experienced higher 1-year overall survival (log rank test p =
0.045) and a significantly lower incidence of major vascular access
complications, bleeding events and acute kidney injury compared to
patients treated with the CoreValve. Recapture manoeuvres to optimize
valve deployment were performed 44 times, allowing a less implantation
depth for the Evolut R. As a consequence, the rate of more than mild
paravalvular leak and new permanent pacemaker was lower in patients
receiving the Evolut R. Conclusion In this matched comparison of high
surgical risk patients undergoing TAVI, the use of Evolut R was associated
with a significant survival benefit at 1 year compared with the CoreValve.
This was driven by lower incidence of periprocedural complications and
higher rates of correct anatomic positioning.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<20>
Accession Number
616180586
Author
Elmaraezy A.; Ebraheem Morra M.; Tarek Mohammed A.; Al-Habaa A.; Elgebaly
A.; Abdelmotaleb Ghazy A.; Khalil A.M.; Tien Huy N.; Hirayama K.
Institution
(Elmaraezy, Ebraheem Morra, Tarek Mohammed, Elgebaly) Faculty of Medicine,
Al-Azhar University, Cairo 11884, Egypt
(Elmaraezy) Online Research Club, Nagasaki University, Nagasaki, Japan
(Al-Habaa) Department of Cardiology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Abdelmotaleb Ghazy) Department of Cadiology, Shebin El-Kom Teaching
Hospital, Menofia 31515, Egypt
(Khalil) Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
(Tien Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Tien Huy) Department of Clinical Product Development, Institute of
Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate
School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto,
Nagasaki 852-8523, Japan
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, and Graduate School of
Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki
852-8523, Japan
Title
Risk of cataract among interventional cardiologists and catheterization
lab staff: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 1-9), 2017.
Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a systematic review and meta-analysis to assess
the risk of developing a radiation-induced cataract in interventional
cardiologists (ICs). Background: ICs are forced to radiation exposure
during cardiac catheterization procedures. Since the eye lens is one of
the most radiosensitive organs in the body, ICs are highly susceptible to
develop a radiation-induced cataract. Method: We performed a systematic
literature search of nine electronic databases to retrieve studies that
report cataract among interventional cardiologists. Records were screened
for eligibility and data were extracted and analyzed using review manager
(RevMan) for windows. Results: Eight studies involving 2559 subjects
(exposed ICs = 1224) were included. Posterior lens opacity was
significantly higher in ICs relative to the control group (RR= 3.21, 95%
CI [2.14, 4.83], P < 0.00001). In contrast, there was no significant
difference between both groups in cortical lens opacity (RR= 0.69, 95% CI
[0.46, 1.06], P = 0.09) and nuclear opacity (RR= 0.85, 95% CI [0.71,
1.02], P = 0.08). Conclusion: Interventional cardiologists are at high
risk of developing radiation-induced cataract; therefore, protective
measures with high safety rates should be implied. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<21>
Accession Number
615667177
Author
Gerkens S.; Van Brabandt H.; Desomer A.; Leonard C.; Neyt M.
Institution
(Gerkens, Van Brabandt, Desomer, Leonard, Neyt) Belgian Health Care
Knowledge Centre (KCE), Belgium
Title
Cardiovascular screening of young athletes: A review of economic
evaluations.
Source
International Journal of Technology Assessment in Health Care. 33 (1) (pp
76-83), 2017. Date of Publication: 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objectives: Some experts have promoted preparticipative cardiovascular
screening programs for young athletes and have claimed that such programs
were cost-effective without performing a critical analysis of studies
supporting this statement. In this systematic review, a critical
assessment of economic evaluations on these programs is performed to
determine if they really provide value for money. Methods: A systematic
review of economic evaluations was performed on December 24, 2014. Web
sites of health technology assessment agencies, the Cochrane database of
systematic review, the National Health Service Economic Evaluation
Database of the Cochrane Library, EMBASE, Medline, Psychinfo, and EconLit
were searched to retrieve (reviews of) economic evaluations. No language
or time restrictions were imposed and predefined selection criteria were
used. Selected studies were critically assessed applying a structured data
extraction sheet. Results: Five relevant economic evaluations were
critically assessed. Results of these studies were mixed. However, those
in favor of screening made (methodological) incorrect choices, of which
the most important one was not taking into account a no-screening
alternative as comparator. Compared with no screening, other strategies
(history and physical examination or history and physical examination plus
electrocardiogram) were not considered cost-effective. Conclusions:
Results of primary economic evaluations should not be blindly copied
without critical assessment. Economic evaluations in this field lack the
support of robust evidence. Negative consequences of screening (false
positive findings, overtreatment) should also be taken into account and
may cause more harm than good. A mass screening of young athletes for
cardiovascular diseases does not provide value for money and should be
discouraged.<br/>Copyright &#xa9; Cambridge University Press 2017.

<22>
Accession Number
616895258
Author
Nguyen A.V.; Thanh L.V.; Kamel M.G.; Abdelrahman S.A.M.; EL-Mekawy M.;
Mokhtar M.A.; Ali A.A.; Hoang N.N.N.; Vuong N.L.; Abd-Elhay F.A.-E.; Omer
O.A.; Mohamed A.A.; Hirayama K.; Huy N.T.
Institution
(Nguyen, Hoang) Pham Ngoc Thach University of Medicine, Ho Chi Minh City
70000, Vietnam
(Thanh, Vuong) University of Medicine and Pharmacy, Ho Chi Minh City
70000, Vietnam
(Kamel, Ali, Mohamed) Faculty of Medicine, Minia University, Minia 61519,
Egypt
(Abdelrahman, Abd-Elhay) Faculty of Medicine, Alexandria University,
Beheira 22762, Egypt
(EL-Mekawy) Faculty of Medicine, Cairo University, Cairo 13719, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Omer) Faculty of Medicine, Gezira University, 20, Wad Madani, Sudan
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, Graduate School of Biomedical
Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), Leading Graduate School Program, Graduate School of
Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki
852-8523, Japan
Title
Optimal percutaneous coronary intervention in patients with ST-elevation
myocardial infarction and multivessel disease: An updated, large-scale
systematic review and meta-analysis.
Source
International Journal of Cardiology. 244 (pp 67-76), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Our study aimed to compare three different percutaneous
coronary intervention (PCI) approaches: culprit-only (COR) and complete
(CR) revascularization - categorizing into immediate (ICR) or staged
(SCR). Methods We searched 13 databases for randomized controlled trials.
Articles were included if they compared at least two strategies. To have
more studies in each analysis, an adjusted analysis was performed using
person-years to incorporate follow-up durations and obtain pooled rate
ratios (RR), with their corresponding 95% confidence interval. Results
Thirteen trials were included with a population of 2830 patients. COR
significantly increased major adverse cardiac event (MACE) (adjusted RR
1.67, 95% CI: 1.27-2.19) and repeat revascularization (2.12, 1.67-2.69),
which was driven by repeat PCI, without any difference in all-cause
mortality and myocardial infarction (MI) compared to CR. When categorizing
CR into SCR and ICR, the trend repeated with COR increased MACE (1.99,
1.53-2.6 for ICR), cardiovascular mortality (2.06, 1.07-3.96 for ICR), MI
for ICR (1.72, 1.04-2.86), repeat revascularization and repeat PCI for
both ICR and SCR. Non-cardiovascular mortality, stroke, nephropathy,
re-hospitalization, stent thrombosis and bleeding were similar among all
approaches. Conclusions In MVD-STEMI patients, CR is better than COR in
terms of MACE, cardiovascular mortality, repeat revascularization with no
difference in safety outcomes. There was a trend towards to a reduction of
cardiovascular mortality and MI in ICR compared to SCR when each matched
with COR; even though there is no statistically significant difference
between ICR and SCR when compared together.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<23>
Accession Number
617279769
Author
Krzysztof S.; Wojciech P.; Zbigniew S.; Mariusz K.; Remigiusz T.; Damian
P.; Magdalena S.; Marta T.; Lech A.; Alina B.
Institution
(Krzysztof, Magdalena, Marta, Alina) Department of Clinical
Neuropsychology, Nicolaus Copernicus University, Collegium Medicum,
Bydgoszcz, Poland
(Wojciech, Mariusz, Remigiusz, Damian, Lech) Department of Cardiac
Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz,
Poland
(Zbigniew) Department of Radiology, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz, Poland
Title
CArbon dioxide surgical field flooding and aortic NO-touch off-pump
coronary artery bypass grafting to reduce Neurological injuries after
surgical coronary revascularisation (CANON): Protocol for a randomised,
controlled, investigator and patient blinded single-centre superiority
trial with three parallel arms.
Source
BMJ Open. 7 (7) (no pagination), 2017. Article Number: e016785. Date of
Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Neurological injuries remain a major concern following
coronary artery bypass grafting (CABG) that offsets survival benefit of
CABG over percutaneous coronary interventions. Among numerous efforts to
combat this issue is the development of off-pump CABG (OPCABG) that
obviates the need for extracorporeal circulation and is associated with
improved neurological outcomes. The objective of this study is to examine
whether the neuroprotective effect of OPCABG can be further pronounced by
the use of two state-of-the-art operating techniques. Methods and analysis
In this randomised, controlled, investigator and patient blinded
single-centre superiority trial with three parallel arms, a total of 360
patients will be recruited. They will be allocated in a 1:1:1 ratio to two
treatment arms and one control arm. Treatment arms undergoing either
aortic no-touch OPCABG or OPCABG with partial clamp applying carbon
dioxide surgical field flooding will be compared against control arm
undergoing OPCABG with partial clamp. The primary endpoint will be the
appearance of new lesions on control brain MRI 3 days after surgery.
Secondary endpoints will include the prevalence of new focal neurological
deficits in the first 7 days after surgery, the occurrence of
postoperative cognitive dysfunction at either 1 week or 3 months after
surgery and the incidence of delirium in the first 7 days after surgery.
Data will be analysed on intention-to-treat principles and a per protocol
basis. Ethics and dissemination Ethical approval has been granted for this
study. Results will be disseminated through peer-reviewed
media.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
617686215
Author
Dadkhah S.; Almuwaqqat Z.; Sulaiman S.; Husein H.; Nguyen Q.; Ali S.;
Taskesen T.
Institution
(Dadkhah, Husein, Nguyen, Ali, Taskesen) Galvin Heart Center, Presence St
Francis Hospital, 333 Ridge Avenue, Evanston, IL 60202, United States
(Almuwaqqat) Department of Medicine, Emory School of Medicine, Atlanta,
GA, United States
(Sulaiman) Department of Medicine, Medical College of Wisconsin,
Milwaukee, WI, United States
Title
Sensitive Troponin i and Stress Testing in the Emergency Department for
the Early Management of Chest Pain Using 2-Hour Protocol.
Source
Critical Pathways in Cardiology. 16 (3) (pp 89-92), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Despite improvements in identifying high-risk patients with
non-ST segment ACS (acute coronary syndrome), low risk patients presenting
with atypical chest pain and non-diagnostic Electrocardiogram (ECG)
continued to undergo unnecessary admissions and testing. Since 1992, our
chest pain protocol included using 4-hour serial biomarkers from ED
admission in combination with stress testing to evaluate these patients.
Our study aimed at determining whether a new accelerated diagnostic
protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission
to the ED followed by stress testing is safe and effective in emergency
settings, allowing for appropriate triage, earlier discharge and reducing
costs. Methods: We conducted a single center randomized trial at Presence
St. Francis Hospital Chest pain center in Evanston, Illinois enrolling
sixty-four consecutive patients with atypical chest pain and
non-diagnostic ECG, participants were randomized to accelerated 2 hrs
protocol or our pre-existing 4-hrs protocol. Sixty patients completed the
protocol and were randomized to either a 2-hour (29 patients) or 4-hour
protocol using both I-STAT and PATHFAST cTnI (31 Patients). Troponin I was
evaluated at 0 and at 2 hours from ED presentation with and additional
draw for patients in the 4-hour rule out-group. Patients with normal
serial biomarkers were then evaluated with stress testing and qualified
for earlier discharge if the stress test was negative, while those with a
positive biomarker at any time were admitted. Thirty-six patients had
exercise treadmill stress test and 24 patients had either nuclear or Echo
stress test. Results: Fifty-three patients had a normal stress test and
were discharged home. One patient in the 4-hour group with normal serial
troponins developed ventricular tachycardia/fibrillation during the
recovery period of a regular stress test. Six patients had a positive
PATHFAST cTnI and a normal I-STAT cTnI at 2-hours. Two out of these six
patients evaluated by coronary angiography. One patient had severe
tortuous coronaries but no significant obstructive lesion and one had a
severe CAD who needed Coronary artery bypass grafting (CABG). Three of the
six patients had a normal stress test and one patient decided to leave
without further testing. None of the patients with a normal stress test
had a major cardiac event or adverse cardiac outcome at six-month follow
up. Conclusion: This study demonstrates that the 2 hours accelerated
protocol using high sensitivity Troponin assay at 0 and 2 hours with
comprehensive clinical evaluation and ECG followed by stress testing might
be successful in identifying low-risk patient population who may benefit
from early discharge from ED reducing associated costs and length of
stay.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<25>
Accession Number
616484508
Author
Janssen P.W.A.; Mol E.A.; Geene S.M.C.; Barbato E.; ten Berg J.M.
Institution
(Janssen, Mol, Geene, ten Berg) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(Janssen, Mol, Geene, ten Berg) St. Antonius Center for Platelet Function
Research, St. Antonius Hospital, Nieuwegein, Netherlands
(Mol) Department of Cardiology, Laboratory of Experimental Cardiology,
University Medical Center Utrecht, Netherlands
(Barbato) Cardiovascular Research Center Aalst OLV Hospital, Aalst,
Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
Title
Does percutaneous coronary stent implantation increase platelet
reactivity?.
Source
Blood Reviews. 31 (5) (pp 271-275), 2017. Date of Publication: September
2017.
Publisher
Churchill Livingstone
Abstract
High platelet reactivity (PR) values on treatment with clopidogrel are
associated with an increased rate of thrombotic events after a
percutaneous coronary intervention (PCI). However, we do not know the
optimal timing of the performance of the PR measurements. Platelets might
be activated during a PCI, which means that the timing of PR measurements,
before or after PCI, could influence the outcome. In turn, this could lead
to misinterpretation of the patient's response to antiplatelet therapy and
a less accurate prediction of the patient's risk of thrombotic events
during follow-up. We aimed to evaluate the effect of stent implantation on
PR in patients with and without acute coronary syndromes who undergo PCI
to assess the optimal timing of PR measurements. A systematic literature
search was performed and the results are summarized in this
review.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<26>
Accession Number
617924585
Author
Moscarelli M.; Athanasiou T.; Speziale G.; Punjabi P.P.; Malietzis G.;
Lancellotti P.; Fattouch K.
Institution
(Moscarelli) NHLI, Imperial College London, London, United Kingdom
(Moscarelli, Speziale) GVM Care and Research, Anthea Hospital, Via Camillo
Rosalba 35/37, Bari, Italy
(Athanasiou, Punjabi, Malietzis) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
(Lancellotti) Department of Cardiology, GIGA Cardiovascular Sciences,
University of Liege Hospital, Liege, Belgium
(Lancellotti, Fattouch) GVM Care and Research Group, Maria Eleonora,
Palermo, Italy
Title
The value of adding sub-valvular procedures for chronic ischemic mitral
regurgitation surgery: A meta-analysis.
Source
Perfusion (United Kingdom). 32 (6) (pp 436-445), 2017. Date of
Publication: 01 Sep 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The most performed repair technique for the treatment of
chronic ischemic mitral regurgitation in patients referred for bypass
grafting remains restricted annuloplasty. However, it is associated with a
high rate of failure, especially if severe tenting exists. Objectives: To
understand if adjunctive sub-valvular mitral procedures may provide better
repair performance. Methods: A systematic literature review identified six
studies of which five fulfilled the criteria for meta-analysis. Outcomes
for a total of 404 patients (214 had adjunctive sub-valvular procedures
and 190 restricted annuloplasty) were meta-analyzed using random effects
modeling. Heterogeneity and subgroup sensitivity analysis were assessed.
Primary endpoints were: late recurrence of moderate mitral regurgitation,
left ventricle remodeling and coaptation depth at follow-up. Secondary
endpoints were: early mortality, mid-term survival and operative outcomes.
Results: Sub-valvular procedure technique was associated with a
significantly lower late recurrence of mitral regurgitation (Odds ratio
(OR) 0.34, 95% Confidence Interval (CI) [0.18, 0.65], p=0.0009), smaller
left ventricle end-systolic diameter (Weighted Mean Difference (WMD)
-4.06, 95% CI [-6.10, -2.03], p=0.0001) and reduced coaptation depth (WMD
-2.36, 95% CI [-5.01, -0.71], p=0.009). These findings were consistent,
even in studies that included patients at high risk for repair failure
(coaptation depth >10 mm and tenting area >2.5 cm²). A low
degree of heterogeneity was observed. There was no difference in terms of
early mortality and mid-term survival; sub-valvular technique was
associated with prolonged cardiopulmonary and cross-clamp time.
Conclusions: Adding sub-valvular procedures when repairing ischemic
chronic mitral valve regurgitation may be associated with better
durability, even in the case of the presence of predictors for late
failure. Perspective: Surgical sub-valvular adjunctive procedures have to
be considered in the case of the presence of echocardiographic predictors
for late failure.<br/>Copyright &#xa9; The Author(s) 2017.

<27>
Accession Number
616133199
Author
Jahangirifard A.; Razavi M.R.; Ahmadi Z.H.; Forozeshfard M.
Institution
(Jahangirifard) Cardiac Anesthesiology, Tracheal Diseases Research Center,
NRITLD, Shaheed Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Razavi) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Ahmadi) Department of Surgery, Masih Daneshvari Hospital, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Forozeshfard) Cancer Research Center and Department of Anesthesiology,
Semnan University of Medical Sciences, Semnan, Iran, Islamic Republic of
Title
Effect of Desmopressin on the Amount of Bleeding and Transfusion
Requirements in Patients Undergoing Heart Transplant Surgery.
Source
Basic and Clinical Pharmacology and Toxicology. 121 (3) (pp 175-180),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
One of the most common risks after a heart transplant is bleeding. In this
study, the effect of desmopressin administration on the amount of bleeding
and transfusion requirements after heart transplant surgery was
investigated. In a double-blind clinical trial, 48 patients who were
candidates for heart transplant surgery were randomly assigned to two
groups. In the intervention group, patients received desmopressin of 0.3
mug/kg, 30 min. before surgery. Patients in the control group received
normal saline at the same amount and time. Homeostasis was evaluated using
activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after
surgery, and also, chest tube drainage, blood products transfusion
requirements during the first day in both groups. No significant
differences were found between the groups in terms of ACT, PT, PTT and PLT
at all times. Transfusion of packed red blood cells and the mean drainages
of chest tube during the first 24 hr after surgery were significantly
lower in the desmopressin group compared to the saline group. Desmopressin
may reduce post-operative bleeding in patients undergoing heart transplant
surgery. Further studies are required to confirm the potential effect of
desmopressin on establishing haemostasis after heart
transplantation.<br/>Copyright &#xa9; 2017 Nordic Association for the
Publication of BCPT (former Nordic Pharmacological Society)

<28>
Accession Number
621625870
Author
Costa K.M.; Saxena A.K.
Institution
(Costa, Saxena) Department of Pediatric Surgery, Chelsea Children's
Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial
College London, London, United Kingdom
(Costa, Saxena) Ribeirao Preto Medical School, University of Sao Paulo,
Ribeirao Preto, Brazil
Title
Surgical chylothorax in neonates: management and outcomes.
Source
World Journal of Pediatrics. 14 (2) (pp 110-115), 2018. Date of
Publication: 01 Apr 2018.
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Postoperative chylothorax occurs due to trauma to lymphatic
vessels and can occur after any thoracic procedure. This study reviewed
recent literature to evaluate the management and outcomes of surgical
chylothorax in neonates. Methods: PubMed database was searched for
articles in English, Portuguese and Spanish from 2000 to 2016. Data were
collected for surgery, chylothorax management, complications, mortality
and length of hospital stay (LOS). Results: Twenty studies offered 107
neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac
malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH +
extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT)
was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in
one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three
patients (2.8%) did not require any treatment. Octreotide and somatostatin
were used as second or third line treatment in 25 neonates (23.4%), and 15
neonates (14%) underwent 17 surgeries, including thoracic duct ligation
(TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL +
pleurodesis (n = 2), and TDL + placement of hemostat (n = 1).
Complications due to the chylothorax were reported in 27 neonates (25.2%):
hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4),
hypoalbuminemia with cutaneous flushing as colateral effect of
somatostatin (n = 1), loose stool after somatostatin use (n = 1),
pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and
hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4
days (30-93.1 days). Conclusions: Conservative management is appropriate
as initial treatment for neonatal postsurgical chylothorax. Octreotide and
somatostatin are safe in neonates and surgical approach should be
considered in prolonged leaks.<br/>Copyright &#xa9; 2018, Children's
Hospital, Zhejiang University School of Medicine.

<29>
Accession Number
621740386
Author
Shehada S.-E.; Elhmidi Y.; Ozturk O.; Kasel M.; Frangieh A.H.; Mourad F.;
Benedik J.; El Bahi J.; El Gabry M.; Thielmann M.; Jakob H.; Wendt D.
Institution
(Shehada, Mourad, Benedik, El Bahi, El Gabry, Thielmann, Jakob, Wendt)
Department of Thoracic and Cardiovascular Surgery, West-German Heart and
Vascular Center Essen, University of Duisburg-Essen, Duisburg, Germany
(Elhmidi) Department of Cardiovascular Surgery, German Heart Center
Munich, Technical University Munich, Munich, Germany
(Ozturk) Department of Cardiovascular Surgery, Klinikum Bogenhausen,
Munich, Germany
(Kasel, Frangieh) Department of Cardiology, German Heart Center Munich,
Technical University Munich, Munich, Germany
Title
Transcatheter versus surgical aortic valve replacement after previous
cardiac surgery: A systematic review and meta-Analysis.
Source
Cardiology Research and Practice. 2018 (no pagination), 2018. Article
Number: 4615043. Date of Publication: 2018.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aim. Aortic valve replacement (AVR) in patients with prior cardiac surgery
might be challenging. Transcatheter aortic valve replacement (TAVR) offers
a promising alternative in such patients. We therefore aimed at comparing
the outcomes of patients with aortic valve diseases undergoing TAVR versus
those undergoing surgical AVR (SAVR) after previous cardiac surgery.
Methods and Results. MEDLINE, EMBASE, and the Cochrane Central Register
were searched. Seven relevant studies were identified, published between
01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac
surgery (97.6 prior CABG): 49.2 underwent TAVR, whereas 50.8 underwent
SAVR. Incidence of stroke (3.8 versus 7.9, p=0.04) and major bleeding (8.3
versus 15.3, p=0.04) was significantly lower in the TAVR group. Incidence
of mild/severe paravalvular leakage (14.4/10.9 versus 0, p<0.0001) and
pacemaker implantation (11.3 versus 3.9, p=0.01) was significantly higher
in the TAVR group. There were no significant differences in the incidence
of acute kidney injury (9.7 versus 8.7, p=0.99), major adverse
cardiovascular events (8.7 versus 12.3, p=0.21), 30-day mortality (5.1
versus 5.5, p=0.7), or 1-year mortality (11.6 versus 11.8, p=0.97) between
the TAVR and SAVR group. Conclusions. TAVR as a redo procedure offers a
safe alternative for patients presenting with aortic valve diseases after
previous cardiac surgery especially those with prior CABG.<br/>Copyright
&#xa9; 2018 Sharaf-Eldin Shehada et al.

<30>
Accession Number
621761102
Author
Gandhi H.; Sarvaia A.; Malhotra A.; Acharya H.; Shah K.; Rajavat J.
Institution
(Gandhi, Sarvaia, Rajavat) Department of Cardiac Anesthesia, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat 380 016,
India
(Malhotra) Department of Cardio Vascular and Thoracic Surgery, U N Mehta
Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
(Acharya, Shah) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
Title
Effects of glargine insulin on glycemic control in patients with diabetes
mellitus type II undergoing off-pump coronary artery bypass graft.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 167-172), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The prevalence of diabetes mellitus in patients requiring
coronary artery bypass grafting (CABG) is noticeably high (20%-30%). These
patients have inferior perioperative outcome, reduced long-term survival,
and high risk of recurrent episodes of angina. To improve perioperative
outcome surgical unit defined satisfactory glycemic control is desired
during this period. Hence, the aim of our study is to compare the efficacy
of glargine insulin combination with continuous human insulin infusion for
perioperative glycemic control in patients with diabetes undergoing CABG.
Materials and Methods: Fifty Patients, who were posted for off-pump CABG
with diabetes mellitus type II, were randomized in two group, Group I
normal saline + human insulin infusion during the perioperative period,
Group II (glargine group): Glargine + human insulin infusion during
perioperative period. Results: During surgery and in the postoperative
period, random blood sugar and human insulin requirement are significantly
higher in control group than glargine group. Other infection, step-up
antibiotics, intensive care unit (ICU) stay, and hospital stay were
significantly higher in control groups in postoperative period.
Conclusion: Our study results suggest that glargine effectively manages
blood glucose level with significantly greater control over postoperative
morbidity.<br/>Copyright &#xa9; 2018 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<31>
Accession Number
621761084
Author
Soliman R.; Ragheb A.
Institution
(Soliman) Department of Anesthesia, Cairo University, Egypt
(Soliman, Ragheb) Prince Sultan Cardiac Centre, Riyadh, Al-Hassa, Saudi
Arabia
(Ragheb) National Heart Institute, Cairo, Egypt
Title
Assessment of the effect of two regimens of milrinone infusion in
pediatric patients undergoing fontan procedure: A randomized study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 134-140), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to compare the effect of two different
regimens of milrinone on hemodynamics and oxygen saturation in pediatric
patients undergoing Fontan procedure. Design: This was a randomized study.
Setting: Cardiac centers. Patients: This study included 116 patients
undergoing Fontan procedure. Material and Methods: Group E: Milrinone was
started as infusion 0.5 mug/kg/min without a loading dose at the beginning
of cardiopulmonary bypass (CPB) followed by infusion 0.5-0.75 mug/kg/min
in the pediatric cardiac surgical intensive care unit (PSICU). Group L:
Milrinone was started as a loading dose 50 mug/kg over 10 min before
weaning from CPB followed by infusion 0.5-0.75 mug/kg/min in the PSICU.
Measurements: Heart rate, mean arterial blood pressure, central venous
pressure, transpulmonary pressure, cardiac index, pharmacological support,
lactate level, urine output, oxygen saturation, ICU, and hospital length
of stay. Main Results: There were no changes in the heart rate and mean
arterial blood pressure (P > 0.05). The increase in the postoperative
central venous pressure, transpulmonary pressure and lactate level was
lower in Group E than Group L (P < 0.05). The increase in the
postoperative cardiac index, oxygen saturation, and urine output was
higher in Group E than Group L (P < 0.05). The requirement for
pharmacological support was lower in the Group E (P < 0.05). The ICU and
hospital length of stay were shorter in the Group E than Group L (P <
0.05). Conclusion: Early use of milrinone during Fontan procedure
facilitated the weaning from CPB, decreased the elevation in the central
venous pressure, transpulmonary gradient pressure, and the requirement for
pharmacological support. Furthermore, it increased the cardiac index and
arterial oxygen saturation.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<32>
Accession Number
621761074
Author
Desai P.M.; Sarkar M.S.; Umbarkar S.R.
Institution
(Desai, Sarkar, Umbarkar) Department of Anesthesiology, Seth GS Medical
College and KEM Hospital, A703, Noopur Apartments, PG Rood, Malad West,
Mumbai, Maharashtra 400 064, India
Title
Prophylactic preoperative levosimendan for off-pump coronary artery bypass
grafting in patients with left ventricular dysfunction: Single-centered
randomized prospective study.
Source
Annals of Cardiac Anaesthesia. 21 (2) (pp 123-128), 2018. Date of
Publication: April-June 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Off-pump coronary artery bypass surgery (OPCAB) is often
complicated by hemodynamic instability, especially in patients with prior
left ventricular (LV) dysfunction and appropriate choice of inotrope plays
a vital role in perioperative management of these patients. Aim and
Objective: To study hemodynamic effects and immediate outcome of
prophylactic infusion of levosimendan in patients with the LV dysfunction
undergoing OPCAB surgery and whether this strategy helps in successful
conduct of OPCAB surgery. Materials and Methods: After Institutional
Ethics Committee approval, 60 patients posted for elective OPCAB surgery
were randomly divided into two groups (n = 30 each). Patients with the LV
ejection fraction <30% were included. Study group was started on injection
levosimendan (@ 0.1 mug/kg/min) in the previous night before surgery and
continued for 24 h including intraoperative period. Hemodynamic monitoring
included heart rate, invasive blood pressure, cardiac index (CI),
pulmonary capillary wedge pressure (PCWP), pulse oximetry, and arterial
blood gases with serum lactates at as T0 (baseline), T1 (15 min after
obtuse marginal and/or PDA anastomoses), T2 (at end of surgery), T3 (6 h
after surgery in Intensive Care Unit [ICU]), T4 (12 h after surgery), and
T5 (24 h after surgery in ICU). Vasopressor was added to maintain mean
arterial pressure >60 mmHg. Chi-square/Fisher's exact/Mid P exact test and
Student's t-tests were applied for categorical and continuous data.
Results: CI was greater and PCWP reduced significantly in Group L during
intraoperative and early postoperative period. Serum lactate concentration
was lower in patients pretreated with levosimendan. Incidence of
postoperative atrial fibrillation (POAF) (36.6 vs. 6.6%; P = 0.01), low
cardiac output syndrome (LCOS) (30% vs. 6%; P = 0.02), and acute kidney
injury (23.3% vs. 6.7%; P = 0.04) was less in Group L. Three patients
(10%) in control group required conversion to cardiopulmonary bypass (CPB)
as compared to none in the study group. There was no difference regarding
ICU or hospital stay and mortality in both groups. Conclusion:
Preoperative levosimendan helps in successful conduct of OPCAB and reduces
the incidence of LCOS, POAF, conversion to CPB, and requirement of
intra-aortic balloon pump.<br/>Copyright &#xa9; 2018 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<33>
Accession Number
616480051
Author
Lie I.; Danielsen S.O.; Tonnessen T.; Solheim S.; Leegaard M.; Sandvik L.;
Wisloff T.; Vangen J.; Rosstad T.H.; Moons P.
Institution
(Lie, Danielsen) Oslo University Hospital, Centre for Patient-centered
Heart and Lung research, Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Building 63, Ulleval, Pb 4956,
Oslo, Nydalen 0424, Norway
(Danielsen) University of Oslo, Institute of Clinical Medicine, Faculty of
Medicine, Oslo, Norway
(Danielsen, Moons) KU Leuven - University of Leuven, KU Leuven Department
of Public Health and Primary Care, Leuven, Belgium
(Tonnessen, Vangen, Rosstad) Oslo University Hospital, Department of
Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases,
Ulleval, Oslo, Norway
(Solheim) Oslo University Hospital, Department of Cardiology, Division of
Medicine, Ulleval, Oslo, Norway
(Leegaard) Oslo and Akershus University College of Applied Sciences,
Department of Nursing and Health Promotion, Faculty of Health Sciences,
Oslo, Norway
(Sandvik) Oslo University Hospital, Oslo Centre for Biostatistics and
Epidemiology (OCBE), Oslo, Norway
(Wisloff) Norwegian Institute of Public Health, Department of Infectious
Disease Epidemiology and Modelling, Oslo, Norway
(Wisloff) University of Oslo, Department of Health Management and Health
Economics, Oslo, Norway
(Moons) University of Gothenburg, Institute of Health and Care Sciences,
Gothenburg, Sweden
Title
Determining the impact of 24/7 phone support on hospital readmissions
after aortic valve replacement surgery (the AVRre study): Study protocol
for a randomised controlled trial.
Source
Trials. 18 (Supplement 2) (no pagination), 2017. Article Number: 246. Date
of Publication: 30 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients undergoing surgical aortic valve replacement (sAVR)
have high rates of 30-day readmissions. They also report a low
health-related quality of life (HRQOL) and elevated anxiety and
depression. The aim of the AVRre study is to determine the efficacy and
cost of a 24/7 phone-support intervention in reducing post-discharge
readmissions after sAVR. The nature of the support is to help patients
better understand and self-manage non-urgent symptoms at home.
Methods/design: AVRre is a prospective, randomised controlled study
comprising 30 days of continuous phone-support intervention and then
intermittent follow-up for the first 12 months. Phone call data from and
to patients are evaluated qualitatively; thus, the study has a
mixed-method design. Two hundred and eighty-six patients, aged >18 years,
scheduled for a sAVR - singly or in combination with another procedure -
are recruited from locations in southeast Norway. Patients are randomly
assigned to the intervention group, who are purposively phone-called
individually 2 and 9 days after discharge and offered on-demand 24/7
(around-the-clock) telephone support for 30 days post-discharge. The
primary outcome variable is the number of 30-day hospital readmissions.
Secondary outcomes are anxiety and depression symptoms, as measured by the
Hospital Anxiety and Depression Scale, HRQOL and quality-adjusted life
years, measured by the EuroQol (EQ-5D). Intervention and hospital
readmission (diagnosis-related groups (DRGs)/length of stay) for the first
year after initial discharge from hospital are used for a cost-utility
analysis. Standard parametric and non-parametric tests are used for
evaluations over time. Analysis of covariance is used to control for
possible differences at baseline. Narratives from phone calls are
transcribed verbatim and analysed using systematic text condensation.
Discussion: A complex 'around-the-clock' intervention within a university
hospital-based setting could be an effective strategy to reduce the high
readmission rates to hospital after sAVR. Furthermore, the AVRre 24/7
phone-support manual can be adapted to other high-risk surgery populations
with high readmission rates. Trial registration: ClinicalTrials.gov,
NCT02522663. Registered on 11 August 2015.<br/>Copyright &#xa9; 2017 The
Author(s).

<34>
Accession Number
613474456
Author
Ohlow M.-A.; Farah A.; Richter S.; El-Garhy M.; von Korn H.; Lauer B.
Institution
(Ohlow, Richter, El-Garhy, Lauer) Department of Cardiology, Zentralklinik,
Bad Berka, Germany
(Farah) Department of Cardiology, Knappschaftskrankenhaus, Dortmund,
Germany
(von Korn) Medizinische Klinik, I, Hetzelstift, Neustadt, Weinstrasse,
Germany
Title
Comparative Case-Control analysis of a dedicated self-expanding Biolimus
A9-eluting Bifurcation stent versus provisional or mandatory side branch
intervention strategies in the treatment of coronary bifurcation lesions.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 39-47), 2017.
Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In a number of coronary bifurcation lesions, both the main
vessel and the side branch (SB) need stent coverage. Objectives: To
analyze the procedural performance and the impact on radiation times (RT)
and contrast medium consumption (CMC) of the AxxessTM stent system
(Biosensors, Switzerland) treating de novo bifurcation lesions (DBL).
Methods: One hundred and ten consecutive prospectively enrolled cases
(Axxess Group) and 110 age, sex, and lesion location matched controls
undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB
intervention were analyzed. Results: Although more pre-dilatation was
performed in the Axxess Group (92.7% vs. 46.4% [Group A] vs. 24.1% [Group
B]), and more stents were used (2.4 vs. 1.2 vs. 1.05), RT and CMC were
significantly lower in the Axxess Group [7.9 min/129 ml vs. 14.2 min/209
ml vs. 7.8 min/152 ml; P < 0.001]. Final Thrombolysis In Myocardial
Infarction three flow in both branches was significantly more frequent in
the Axxess Group (98.2% vs. 94.6% vs. 88.9%; P = 0.02), and
post-interventional troponin T elevations were the lowest in the Axxess
Group. Eighty one percent of the Axxess-stents could be implanted without
technical difficulties. Difficult implantations procedures were mainly
related to coronary anatomy. There was no safety concerns (cardiac death,
stent-thrombosis) compared to controls. Cumulative 6-months MACE rates
were 11% versus 23% versus 25%. TLR rates at 6-months were 5%, 18%, and
15%, respectively. Conclusions: Axxess bifurcation stent system procedures
were associated with significantly less RT and CMC compared to
conventional DBL therapy strategies. Difficult coronary anatomy may hinder
successful implantation and a learning curve has to be considered. &#xa9;
2016 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals,
Inc.

<35>
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.

<36>
Accession Number
613126793
Author
Baptista R.
Institution
(Baptista) Membro do Corpo Redatorial da Revista Portuguesa de
Cardiologia, Portugal
Title
Comment on "Blood-Pressure and Cholesterol Lowering in Persons without
Cardiovascular Disease".
Source
Revista Portuguesa de Cardiologia. 35 (9) (pp 511-513), 2016. Date of
Publication: September 2016.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)

<37>
Accession Number
621766577
Author
Scarfe A.J.; Schuhmann-Hingel S.; Duncan J.K.; Ma N.; Atukorale Y.N.;
Cameron A.L.
Institution
(Scarfe, Duncan, Ma, Atukorale, Cameron) Australian Safety and Efficacy
Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal
Australasian College of Surgeons, Adelaide, SA, Australia
(Schuhmann-Hingel) KAGes - Styrian Hospitals Holding, Graz, Australia
Title
Continuous paravertebral block for post-cardiothoracic surgery analgesia:
A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1010-1018), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A continuous paravertebral block is used when pain relief is required
beyond the duration of a single-injection paravertebral block. Surgical
procedures requiring an incision into the pleural cavity are some of the
most painful procedures postoperatively and, if not managed appropriately,
can lead to chronic pain. The current gold standard for
post-cardiothoracic surgery pain management is epidural analgesia, which
has contraindications, a failure rate of up to 12% and risk of
complications such as epidural abscess and spinal haematoma. This
systematic review and meta-analysis aimed to investigate the use of a
continuous paravertebral block for post-cardiothoracic surgery analgesia.
Randomized controlled trials evaluating the continuous paravertebral block
against epidural analgesia, wound infiltration, placebo or standard care
(intravenous opioids) for post-cardiothoracic surgery analgesia were
considered for inclusion in the systematic review. PubMed, EMBASE, The
Cochrane Library and the University of York Centre for Reviews and
Dissemination databases were searched from inception to 15 September 2014.
Risk of bias and generalizability were assessed using a modified Downs and
Black checklist. A meta-analysis was conducted on suitable studies
comparing the continuous paravertebral nerve block with epidural
anaesthesia, with fixed-effects models being used to pool the effects.
Twenty-three randomized controlled trials with 1120 participants were
included. The continuous paravertebral block was associated with a
significant improvement in incidence of nausea and vomiting (odds ratio =
0.29, 95% confidence interval = [0.16, 0.56]), hypotension (odds ratio =
0.16, 95% confidence interval = [0.06, 0.41]) and urinary retention (odds
ratio = 0.22, 95% confidence interval = [0.09, 0.52]) compared with the
epidural block. No statistically significant difference in pain relief was
reported. The continuous paravertebral block has equivalent analgesic
effects to epidural analgesia, wound infiltration and standard care, but
is associated with a lower incidence of nausea and vomiting, hypotension
and urinary retention than epidural analgesia.<br/>Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<38>
Accession Number
621989852
Author
Arora S.; Ramm C.J.; Misenheimer J.A.; Vavalle J.P.
Institution
(Arora) Division of Cardiology, University of North Carolina at Chapel
Hill, North Carolina, USA. Electronic correspondence: saror@email.unc.edu
(Ramm, Misenheimer, Vavalle) Division of Cardiology, University of North
Carolina at Chapel Hill, North Carolina, USA
(Misenheimer) Since submission Dr Misenheimer has moved to Medical College
of Georgia at Augusta University, Augusta, Georgia, USA
Title
TAVR in Intermediate-Risk Patients: A Review of the PARTNER 2 Trial and
its Future Implications.
Source
The Journal of heart valve disease. 25 (6) (pp 653-656), 2016. Date of
Publication: 01 Nov 2016.
Abstract
BACKGROUND: Following publication of the results of the PARTNER trial, the
American College of Cardiology/American Heart Association recognized the
success of transcatheter aortic valve replacement (TAVR) by incorporating
it as a feasible option in high-surgical risk patients, and recommending
it as the standard of care for patients at prohibitive risk of surgery.
Although this was recognized as a major success in the field of
percutaneous valve replacement, surgical aortic valve replacement (SAVR)
continued to be realized as the procedure of choice for low and
intermediate surgical risk patients. Meanwhile, observational studies -
predominantly from Europe - showed encouraging results for TAVR in
lower-risk populations. With a lack of any large randomized controlled
clinical trial, however, the advantages of TAVR continued to be limited to
only a minority of patients with severe, symptomatic aortic stenosis.
METHODS: Between December 2011 and November 2013, the PARTNER 2
investigators enrolled a total of 2,032 intermediate-risk patients with
severe symptomatic aortic stenosis at 57 centers in the United States and
Canada. Patients were randomized 1:1 to undergo either TAVR or SAVR. The
primary end point was death and neurological events after two years.
RESULTS: The study results showed similar rates for death and neurological
events in the TAVR and SAVR groups. The TAVR group was found to have a
larger valve area and a lower incidence of acute kidney injury, bleeding
events, and atrial fibrillation. Conversely, the SAVR group experienced
fewer vascular complications and lower rates of paravalvular
regurgitation.
CONCLUSIONS: The results of the PARTNER 2 trial are reviewed, and its
implications for the future discussed.

<39>
Accession Number
621990052
Author
Andalib A.; Chetrit M.; Eberg M.; Filion K.B.; Theriault-Lauzier P.; Lange
R.; Buithieu J.; Martucci G.; Eisenberg M.; Bolling S.F.; Piazza N.
Institution
(Andalib, Chetrit, Theriault-Lauzier, Buithieu, Martucci, Piazza)
Department of Cardiology, McGill University Health Centre, Montreal,
Quebec, Canada
(Eberg, Filion, Eisenberg) Centre for Clinical Epidemiology, Lady Davis
Institute, Jewish General Hospital, Montreal, Quebec, Canada
(Lange) Department of Cardiac Surgery, German Heart Center, Munich,
Germany
(Bolling) Department of Cardiac Surgery, University of Michigan Health
System, Ann Arbor, Michigan, USA
(Piazza) Department of Cardiac Surgery, German Heart Center, Munich,
Germany. Electronic correspondence:
Title
A Systematic Review and Meta-Analysis of Outcomes Following Mitral Valve
Surgery in Patients with Significant Functional Mitral Regurgitation and
Left Ventricular Dysfunction.
Source
The Journal of heart valve disease. 25 (6) (pp 696-707), 2016. Date of
Publication: 01 Nov 2016.
Abstract
BACKGROUND AND AIM OF THE STUDY: The surgical correction of functional
mitral regurgitation (MR) remains challenging and controversial. The study
aim was to systematically review the outcomes of surgical mitral valve
repair (MVRpr) and mitral valve replacement (MVR) in patients with
significant functional MR and left ventricular (LV) dysfunction.
METHODS: A meta-analysis was performed of published data acquired from
patients with moderate to severe functional MR and LV ejection fraction
(LVEF) <40% who underwent surgical MVRpr or MVR. The data were
meta-analyzed across studies using Bayesian hierarchical models when
feasible.
RESULTS: The search yielded 36 observational studies. The pooled
proportion of operative mortality following MVRpr was 5% (33 studies;
2,231 patients; 95% credible interval (CrI) 4-7%), while that following
MVR was 10% (10 studies; 389 patients; 95% CrI 5-18%). For patients
undergoing MVRpr, pooled proportions of postoperative cerebrovascular
accidents and renal failure were 2% (11 studies; 750 patients; 95% CrI
1-3%) and 9% (11 studies; 756 patients; 95% CrI 5-16%), respectively. The
five-year actuarial survival rates following MVRpr across 12 studies
ranged from 47% to 78% (median 66%).
CONCLUSIONS: In selected patients with significant functional MR and LV
dysfunction, surgical MVRpr and MVR can be performed with acceptable
intermediate operative mortality risks.

<40>
Accession Number
621966741
Author
Bermejo J.; Yotti R.; Garcia-Orta R.; Sanchez-Fernandez P.L.; Castano M.;
Segovia-Cubero J.; Escribano-Subias P.; San Roman J.A.; Borras X.;
Alonso-Gomez A.; Botas J.; Crespo-Leiro M.G.; Velasco S.; Bayes-Genis A.;
Lopez A.; Munoz-Aguilera R.; De Teresa E.; Gonzalez-Juanatey J.R.;
Evangelista A.; Mombiela T.; Gonzalez-Mansilla A.; Elizaga J.;
Martin-Moreiras J.; Gonzalez-Santos J.M.; Moreno-Escobar E.;
Fernandez-Aviles F.
Institution
(Bermejo, Yotti, Mombiela, Gonzalez-Mansilla, Elizaga, Fernandez-Aviles)
Department of Cardiology, Hospital General Universitario Gregorio Maranon,
Instituto de Investigacion Sanitaria Gregorio Maranon, Facultad de
Medicina, Universidad Complutense de Madrid, Dr Esquerdo 46, Madrid 28007,
Spain
(Garcia-Orta) Hospital Virgen de Las Nieves, Granada, Spain
(Sanchez-Fernandez, Martin-Moreiras, Gonzalez-Santos) Hospital Clinico
Universitario de Salamanca, CIBERCV Salamanca, Spain
(Castano) Hospital Universitario de Leon, Leon, Spain
(Segovia-Cubero) Hospital Puerta de Hierro Majadahonda and CIBERCV,
Majadahonda, Spain
(Escribano-Subias) Hospital 12 de Octubre and CIBERCV, Madrid, Spain
(San Roman) Hospital Clinico de Valladolid and CIBERCV, Valladolid, Spain
(Borras) Hospital Santa Creu i San Pau and CIBERCV, Barcelona, Spain
(Alonso-Gomez) Hospital Universitario de Araba-Txagorritxu, Vitoria, Spain
(Botas) Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain
(Crespo-Leiro) Complejo Hospitalario Universitario de A Coruna and
CIBERCV, A Coruna, Spain
(Velasco) Hospital de Galdakao-Usansolo, Usansolo, Spain
(Bayes-Genis) Hospital Universitari Germans Trias i Pujol and CIBERCV,
Badalona, Spain
(Lopez) Hospital Universitario Reina Sofia, Cordoba, Spain
(Munoz-Aguilera) Hospital Infanta Leonor, Madrid, Spain
(De Teresa) Hospital Virgen de la Victoria and CIBERCV, Malaga, Spain
(Gonzalez-Juanatey) Hospital Clinico de Santiago de Compostela and
CIBERCV, Santiago de Compostela, Spain
(Evangelista) Hospital Universitario de la Vall d'Hebron and CIBERCV,
Barcelona, Spain
(Moreno-Escobar) Hospital Universitario San Cecilio, Granada, Spain
Title
Sildenafil for improving outcomes in patients with corrected valvular
heart disease and persistent pulmonary hypertension: A multicenter,
double-blind, randomized clinical trial.
Source
European Heart Journal. 39 (15) (pp 1255-1264), 2018. Date of Publication:
14 Apr 2018.
Publisher
Oxford University Press
Abstract
Aims We aimed to determine whether treatment with sildenafil improves
outcomes of patients with persistent pulmonary hypertension (PH) after
correction of valvular heart disease (VHD). Methods and results The
sildenafil for improving outcomes after valvular correction (SIOVAC) study
was a multricentric, randomized, parallel, and placebo-controlled trial
that enrolled stable adults with mean pulmonary artery pressure > 30mmHg
who had undergone a successful valve replacement or repair procedure at
least 1 year before inclusion. We assigned 200 patients to receive
sildenafil (40mg three times daily, n= 104) or placebo (n= 96) for
6months. The primary endpoint was the composite clinical score combining
death, hospital admission for heart failure (HF), change in functional
class, and patient global self-assessment. Only 27 patients receiving
sildenafil improved their composite clinical score, as compared with 44
patients receiving placebo; in contrast 33 patients in the sildenafil
group worsened their composite score, as compared with 14 in the placebo
group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P<0.001].
The Kaplan-Meier estimates for survival without admission due to HF were
0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard
ratio 2.0, 95% CI= 1.0-4.0; log-rank P= 0.044). Changes in 6-min walk test
distance, natriuretic peptides, and Doppler-derived systolic pulmonary
pressure were similar in both groups. Conclusion Treatment with sildenafil
in patients with persistent PH after successfully corrected VHD is
associated to worse clinical outcomes than placebo. Off-label usage of
sildenafil for treating this source of left heart disease PH should be
avoided.<br/>Copyright &#xa9; The Author 2017.

<41>
Accession Number
621966727
Author
Grigioni F.; Clavel M.-A.; Vanoverschelde J.-L.; Tribouilloy C.; Pizarro
R.; Huebner M.; Avierinos J.-F.; Barbieri A.; Suri R.; Pasquet A.;
Rusinaru D.; Gargiulo G.D.; Oberti P.; Thdron A.; Bursi F.; Michelena H.;
Lazam S.; Szymanski C.; Nkomo V.T.; Schumacher M.; Bacchi-Reggiani L.;
Enriquez-Sarano M.
Institution
(Grigioni, Gargiulo, Bacchi-Reggiani) Department of Experimental,
Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University
of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
(Clavel, Michelena, Nkomo, Enriquez-Sarano) Mayo Clinic, Division of
Cardiovascular Disease, Mayo Medical School, 200 First St. SW, Rochester,
MN 55905, United States
(Vanoverschelde, Pasquet, Lazam) Cardiovascular Department, University
Catholic of Louvain, Avenue Hippocrates 10, Bruxelles 1200, Belgium
(Tribouilloy, Rusinaru, Szymanski) University of Amiens, Cardiology, CHU
Amiens-Picardie - SITE SUD, Amiens Cedex 1 80054, France
(Pizarro, Oberti) Department of Cardiology, Hospital Italiano de Buenos
Aires, Juan D. Peron 4190, Buenos Aires, Argentina
(Huebner) Michigan State University, Department of Statistics and
Probability, 619 Red Cedar Rd C413, East Lansing, MI 48824, United States
(Avierinos, Thdron) University of Marseille, La Timone Hospital, Service
de Cardiologie B, Boulevard Jean Moulin, Marseille 13005, France
(Barbieri, Bursi) Department of Diagnostic Medicine, Clinical and Health
Public, University of Modena, Via del Pozzo 71, Modena 41124, Italy
(Suri) Cleveland Clinic, Department of Executive Administration, Al Maryah
Island, Abu Dhabi, United Arab Emirates
(Schumacher) Institute for Medical Biometry and Statistics, Medical
Center-University of Freiburg, Stefan-Meier-Str. 26, Freiburg 79104,
Germany
Title
The MIDA Mortality Risk Score: Development and external validation of a
prognostic model for early and late death in degenerative mitral
regurgitation.
Source
European Heart Journal. 39 (15) (pp 1281-1291), 2018. Date of Publication:
14 Apr 2018.
Publisher
Oxford University Press
Abstract
Aims In degenerative mitral regurgitation (DMR), lack of mortality scores
predicting death favours misperception of individual patients' risk and
inappropriate decision-making. Methods and results The Mitral
Regurgitation International Database (MIDA) registries include 3666
patients (age 66 +/- 14 years; 70% males; follow-up 7.8 +/- 5.0 years)
with pure, isolated, DMR consecutively diagnosed by echocardiography at
tertiary (European/North/South-American) centres. The MIDA Score was
derived from the MIDA-Flail-Registry (2472 patients with DMR and flail
leaflet-Derivation Cohort) by weighting all guideline-provided prognostic
markers, and externally validated in the MIDA-BNP-Registry (1194 patients
with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score
ranged from 0 to 12 depending on accumulating risk factors. In predicting
total mortality post-diagnosis, the MIDA Score showed excellent
concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c
= 0.81). In the whole MIDA population (n = 3666 patients), 1-year
mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical
management and 1, 7, and 14% after surgery, respectively (P < 0.001).
Five-year survival with Scores 0, 7-8, and 11-12 was 98 +/- 1, 57 +/- 4,
and 21 +/- 10% under medical management and 99 +/- 1, 82 +/- 2, and 57 +/-
9% after surgery (P < 0.001). In models including all guideline-provided
prognostic markers and the EuroScoreII, the MIDA Score provided
incremental prognostic information (P < 0.002). Conclusion The MIDA Score
may represent an innovative tool for DMR management, being able to
position a given patient within a continuous spectrum of short- and
long-term mortality risk, either under medical or surgical management.
This innovative prognostic indicator may provide a specific framework for
future clinical trials aiming to compare new technologies for DMR
treatment in homogeneous risk categories of patients.<br/>Copyright &#xa9;
The Author 2017.

<42>
Accession Number
621918721
Author
Breau R.H.; Lavallee L.T.; Cnossen S.; Witiuk K.; Cagiannos I.; Momoli F.;
Bryson G.; Kanji S.; Morash C.; Turgeon A.; Zarychanski R.; Mallick R.;
Knoll G.; Fergusson D.A.
Institution
(Breau, Lavallee, Cnossen, Witiuk, Momoli, Bryson, Kanji, Mallick,
Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Breau, Lavallee, Cagiannos, Morash, Knoll) Division of Urology,
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
(Bryson) University of Ottawa and Ottawa Hospital, Department of
Anesthesiology and Pain Medicine, Ottawa, ON, Canada
(Turgeon) CHU de Quebec, Universite Laval, Quebec City, QC, Canada
(Zarychanski) University of Manitoba, Department of Internal Medicine,
Section of Medical Oncology and Haematology, Winnipeg, MB, Canada
Title
Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical
Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized
Controlled Trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 261. Date of
Publication: 02 May 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Radical cystectomy for bladder cancer is associated with a
high risk of needing red blood cell transfusion. Tranexamic acid reduces
blood loss during cardiac and orthopedic surgery, but no study has yet
evaluated tranexamic acid use during cystectomy. Methods: A randomized,
double-blind (surgeon-, anesthesiologist-, patient-,
data-monitor-blinded), placebo-controlled trial of tranexamic acid during
cystectomy was initiated in June 2013. Prior to incision, the intervention
arm participants receive a 10 mg/kg loading dose of intravenously
administered tranexamic acid, followed by a 5 mg/kg/h maintenance
infusion. In the control arm, the patient receives an identical volume of
normal saline that is indistinguishable from the intervention. The primary
outcome is any blood transfusion from the start of surgery up to 30 days
post operative. There are no strict criteria to mandate the transfusion of
blood products. The decision to transfuse is entirely at the discretion of
the treating physicians who are blinded to patient allocation. Physicians
are allowed to utilize all resources to make transfusion decisions,
including serum hemoglobin concentration and vital signs. To date, 147
patients of a planned 354 have been randomized to the study. Discussion:
This protocol reviews pertinent data relating to blood transfusion during
radical cystectomy, highlighting the need to identify methods for reducing
blood loss and preventing transfusion in patients receiving radical
cystectomy. It explains the clinical rationale for using tranexamic acid
to reduce blood loss during cystectomy, and outlines the study methods of
our ongoing randomized controlled trial.<br/>Copyright &#xa9; 2018 The
Author(s).

<43>
Accession Number
621977881
Author
Ahmad F.M.; Ali R.; Gul A.M.
Institution
(Ahmad) Biochemistry Department, Frontier Medical College, Abbottabad,
Pakistan
(Ali) Biochemistry Department, Institute of Basic Medical Sciences (IBMS),
Khyber Medical University, Peshawar, Pakistan
(Gul) Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
Title
Effect of percutaneous transvenous mitral commissurotomy on brain
natriuretic peptide in mitral stenosis in tertiary care hospitals of
Peshawar.
Source
Journal of the Pakistan Medical Association. 68 (5) (pp 780-782), 2018.
Date of Publication: May 2018.
Publisher
Pakistan Medical Association
Abstract
The current study was planned to determine the effect of percutaneous
transvenous mitral commissurotomy (PTMC) on brain natriuretic peptide
(BNP) levels in mitral stenosis patients. It was conducted at the
Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, and
Rehman Medical Institute Laboratory, Peshawar, Pakistan, from December
2013 to June 2014. Of the 100 patients, 63(63%) were females. The
patients' age ranged from 14 to 58 years. Patients diagnosed with isolated
mitral valve stenosis or with grade 1 or with grade 2 mitral regurgitation
were randomly selected. BNP values before and after 24 hours of PTMC were
calculated. The statistical analysis of the echocardiographic variables
and BNP levels showed an increase in mitral valve area, drop in pulmonary
artery systolic pressure, left atrium diameter and reduction in BNP levels
(p<0,05 each) after PTMC that provides a concrete evidence for a
successful PTMC procedure.<br/>Copyright &#xa9; 2018, Pakistan Medical
Association. All rights reserved.

<44>
Accession Number
2000715329
Author
Dew M.A.; DiMartini A.F.; Dobbels F.; Grady K.L.; Jowsey-Gregoire S.G.;
Kaan A.; Kendall K.; Young Q.-R.; Abbey S.E.; Butt Z.; Crone C.C.; De
Geest S.; Doligalski C.T.; Kugler C.; McDonald L.; Ohler L.; Painter L.;
Petty M.G.; Robson D.; Schloglhofer T.; Schneekloth T.D.; Singer J.P.;
Smith P.J.; Spaderna H.; Teuteberg J.J.; Yusen R.D.; Zimbrean P.C.
Institution
(Dew, DiMartini) University of Pittsburgh School of Medicine and Medical
Center, Pittsburgh, Pennsylvania, United States
(Dobbels, De Geest) Katholieke Universiteit Leuven, Leuven, Belgium
(Grady, Butt) Northwestern University Feinberg School of Medicine,
Chicago, Illinois, United States
(Jowsey-Gregoire, Schneekloth) Mayo Clinic, Rochester, Minnesota, United
States
(Kaan, Young) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Kendall) Cleveland Clinic, Cleveland, Ohio, United States
(Abbey) University of Toronto and University Health Network, Toronto,
Ontario, Canada
(Crone) INOVA Hospitals, Fairfax, Virginia, United States
(De Geest) University of Basel, Basel, Switzerland
(Doligalski) Tampa General Hospital, Tampa, Florida, United States
(Kugler) University of Freiburg, Freiburg, Germany
(McDonald) University of North Carolina, Chapel Hill, North Carolina,
United States
(Ohler) George Washington University, Washington, DC, United States
(Painter) Auckland City Hospital, Auckland, New Zealand
(Petty) University of Minnesota, Minneapolis, Minnesota, United States
(Robson) St. Vincent's Hospital, Sydney, New South Wales, Australia
(Schloglhofer) Medical University of Vienna, Vienna, Austria
(Singer) University of California at San Francisco, San Francisco,
California, United States
(Smith) Duke University, Durham, North Carolina, United States
(Spaderna) Trier University, Trier, Germany
(Teuteberg) Stanford University, Stanford, California, United States
(Yusen) Washington University, St. Louis, Missouri, United States
(Zimbrean) Yale University, New Haven, Connecticut, United States
(Doligalski) University of North Carolina, Chapel Hill, NC, United States
(Ohler) New York University Medical Center, New York, NY, United States
Title
The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial
evaluation of adult cardiothoracic transplant candidates and candidates
for long-term mechanical circulatory support.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier USA
Abstract
The psychosocial evaluation is well-recognized as an important component
of the multifaceted assessment process to determine candidacy for heart
transplantation, lung transplantation, and long-term mechanical
circulatory support (MCS). However, there is no consensus-based set of
recommendations for either the full range of psychosocial domains to be
assessed during the evaluation, or the set of processes and procedures to
be used to conduct the evaluation, report its findings, and monitor
patients' receipt of and response to interventions for any problems
identified. This document provides recommendations on both evaluation
content and process. It represents a collaborative effort of the
International Society for Heart and Lung Transplantation (ISHLT) and the
Academy of Psychosomatic Medicine, American Society of Transplantation,
International Consortium of Circulatory Assist Clinicians, and Society for
Transplant Social Workers. The Nursing, Health Science and Allied Health
Council of the ISHLT organized a Writing Committee composed of
international experts representing the ISHLT and the collaborating
societies. This Committee synthesized expert opinion and conducted a
comprehensive literature review to support the psychosocial evaluation
content and process recommendations that were developed. The
recommendations are intended to dovetail with current ISHLT guidelines and
consensus statements for the selection of candidates for cardiothoracic
transplantation and MCS implantation. Moreover, the recommendations are
designed to promote consistency across programs in the performance of the
psychosocial evaluation by proposing a core set of content domains and
processes that can be expanded as needed to meet programs' unique needs
and goals.<br/>Copyright &#xa9; 2018 International Society for Heart and
Lung Transplantation

<45>
Accession Number
2000715217
Author
Belda J.; Ferrando C.; Garutti I.
Institution
(Belda, Ferrando) Hospital Clinico de Valencia, Valencia, Spain
(Ferrando) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos
III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
Title
The Effects of an Open-Lung Approach During One-Lung Ventilation on
Postoperative Pulmonary Complications and Driving Pressure: A Descriptive,
Multicenter National Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgical procedures are associated with an increased
risk of postoperative pulmonary complications (PPCs), which seem to be
related directly to intraoperative driving pressure. The authors conducted
this study to describe the incidence of PPCs in patients in whom an
individualized open-lung approach was applied during one-lung ventilation.
Design: This was a prospective, multicenter, national descriptive study.
Setting: Thoracic surgery patients undergoing one-lung ventilation.
Participants: Eligible participants were included consecutively from
October 1, 2016, to September 30, 2017. A total of 690 patients were
included. Interventions: An individualized open-lung approach that
consisted of an alveolar recruitment maneuver followed by a positive
end-expiratory pressure adjusted to best respiratory system compliance was
performed in all patients. Measurements and Main Results: Preoperative and
intraoperative data were recorded; the primary outcome was a description
of the incidence of PPCs in these patients during the first 7
postoperative days. The patients were mainly male, and half of them had a
high risk of PPCs (ARISCAT score exceeding 44). Eleven percent of
participants developed a PPC within the first postoperative week. The mean
open lung positive end-expiratory pressure was 8 +/- 3 cmH<inf>2</inf>O.
When compared with pre-open lung approach values, the open-lung approach
significantly decreased the driving pressure (14 +/- 4 cmH<inf>2</inf>O v
11 +/- 3 cmH<inf>2</inf>O; p < 0.001) and increased dynamic compliance (30
+/- 10 mL/cmH<inf>2</inf>O v 43 +/-15 mL/cmH<inf>2</inf>O; p < 0.001).
Conclusions: The low incidence of PPCs in patients who underwent an
open-lung approach during one-lung ventilation compared with that reported
for other thoracic surgery series and the decrease in the driving pressure
in these patients justify an additional randomized controlled trial to
compare the open-lung approach with the standard protective strategy of
low tidal volume and low positive end-expiratory pressure.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<46>
Accession Number
2000708855
Author
Nair A.G.; Oladunjoye O.O.; Trenor C.C.; LaRonde M.; van den Bosch S.J.;
Sleeper L.A.; VanderPluym C.; Emani S.M.; Kheir J.N.
Institution
(Nair, LaRonde, van den Bosch, Sleeper, VanderPluym, Kheir) Department of
Cardiology, Boston Children's Hospital, Boston, Mass, United States
(Oladunjoye, Emani) Department of Cardiovascular Surgery, Boston
Children's Hospital, Boston, Mass, United States
(Trenor) Division of Hematology/Oncology, Boston Children's Hospital,
Boston, Mass, United States
(Nair, Trenor, Sleeper, VanderPluym, Kheir) Department of Pediatrics,
Harvard Medical School, Boston, Mass, United States
(Emani) Department of Surgery, Harvard Medical School, Boston, Mass,
United States
Title
An anticoagulation protocol for use after congenital cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients undergoing surgery for congenital heart disease are
at high risk for bleeding as well as thrombosis in the postoperative
period. The objective of the study was to describe the design and effects
of implementing a standardized unfractionated heparin anticoagulation
protocol for children after congenital heart surgery. Methods: We created
a tiered guideline for the postoperative management of bleeding and
thrombosis. In patients treated with unfractionated heparin, anti-factor
Xa activity level as well as activated partial thromboplastin time were
used for dose titration. Clinical outcomes, including bleeding and
thrombosis events, were prospectively collected for 5 months before and
after protocol implementation and adjudicated as either minor, clinically
relevant nonmajor, or major. Results: Among 792 surgical patients followed
during the study period, a total of 203 patients (87 preimplementation,
116 postimplementation) were treated with therapeutic unfractionated
heparin over a total of 1481 patient days. Of these, 28% were neonates and
35% were infants (29 days to 1 year), with a trend toward fewer neonates
and lower Risk Adjustment for Congenital Heart Surgery (RACHS) scores
after protocol implementation. Among 1321 time-matched pairs, activated
partial thromboplastin time and antifactor Xa activity levels were poorly
correlated (r² = 0.33). Clinically relevant bleeding events,
which required increased medical care, including blood transfusion,
decreased after protocol implementation (4.14 vs 1.62 bleeding events per
100 patient-days; risk ratio, 0.39 [0.20-0.75]; P =.005), even after
correcting for differences in age and RACHS scores (P =.006). This finding
was primarily found after RACHS category 1 to 3 procedures (risk ratio,
0.27 [0.10-0.73]; P =.0099) and in noninfants (risk ratio, 0.25
[0.09-0.65]; P =.005). There were no significant differences in the
incidences of major bleeding (P =.88) or any thrombosis (P =.55).
Conclusions: The use of a standardized anticoagulation protocol is
feasible and might reduce the incidence of bleeding and thrombosis events
in postcardiotomy patients.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<47>
Accession Number
2000707429
Author
Halbach M.; Abraham W.T.; Butter C.; Ducharme A.; Klug D.; Little W.C.;
Reuter H.; Schafer J.E.; Senni M.; Swarup V.; Wachter R.; Weaver F.A.;
Wilks S.J.; Zile M.R.; Muller-Ehmsen J.
Institution
(Halbach, Reuter) Department of Internal Medicine III, University Hospital
of Cologne, Cologne, Germany
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau - Medical
School Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Klug) Department of Cardiology A, University Hospital, Lille, France
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, MS, United States
(Schafer) Department of Statistics, NAMSA, Inc., Minneapolis, MN, United
States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
AZ, United States
(Wachter) Clinic and Policlinic for Cardiology, University Hospital
Leipzig, Leipzig, Germany
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Wilks) Department of Research, CVRx, Inc., Minneapolis, MN, United States
(Zile) Medical University of South Carolina, Charleston, SC, United States
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, SC, United States
Title
Baroreflex activation therapy for the treatment of heart failure with
reduced ejection fraction in patients with and without coronary artery
disease.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: In a randomized trial, baroreflex activation therapy (BAT)
improved exercise capacity, quality of life and NT-proBNP in patients with
heart failure with reduced ejection fraction (HFrEF). In view of different
mechanisms underlying HFrEF, we performed a post-hoc subgroup analysis of
efficacy and safety of BAT in patients with and without coronary artery
disease (CAD). Methods and results: Patients with left ventricular
ejection fraction <35% and NYHA Class III were randomized 1:1 to
guideline-directed medical and device therapy alone or plus BAT. Patients
with a history of CAD, prior myocardial infarction or coronary artery
bypass graft were assigned to the CAD group with all others assigned to
the no-CAD group. Of 71 BAT treated patients, 52 had CAD and 19 had no
CAD. In the control group, 49 of 69 patients had CAD and 20 had no CAD.
The system- or procedure-related major adverse neurological or
cardiovascular event rate was 3.8% in the CAD group vs. 0% in the no-CAD
group (p = 1.0). In the whole cohort, NYHA Class, Minnesota Living with
Heart Failure score, 6-minute hall walk distance and NTproBNP were
improved in BAT treated patients compared with controls. Statistical
analyses revealed no interaction between the presence of CAD and effect of
BAT (all p > 0.05). Conclusion: No major differences were found in BAT
efficacy or safety between patients with and without CAD, indicating that
BAT improves exercise capacity, quality of life and NTproBNP in patients
with ischemic and non-ischemic cardiomyopathy. ClinicalTrials.gov
identifier: NCT01471860 and NCT01720160.<br/>Copyright &#xa9; 2018

<48>
Accession Number
2000706372
Author
Elagizi A.; Lavie C.J.; Marshall K.; DiNicolantonio J.J.; O'Keefe J.H.;
Milani R.V.
Institution
(Elagizi) Department of Internal Medicine, Leonard J Chabert Medical
Center, Houma, LA, United States
(Lavie, Milani) Department of Cardiovascular Diseases, John Ochsner Heart
and Vascular Institute, Ochsner Clinical School, the University of
Queensland School of Medicine, New Orleans, LA, United States
(Marshall) Director Global Lipid Science and Advocacy for DSM Nutritional
Products, Columbia, MD, United States
(DiNicolantonio, O'Keefe) Mid America Heart Institute at Saint Luke's
Hospital, Kansas City, MO, United States
Title
Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health: A
Comprehensive Review.
Source
Progress in Cardiovascular Diseases. (no pagination), 2018. Date of
Publication: 2018.
Publisher
W.B. Saunders
Abstract
The potential cardiovascular (CV) disease (CVD) benefits of Omega-3
Polyunsaturated Fatty Acids (OM3) have been intensely studied and debated
for decades. Initial trials were performed in patients with low use of
maximal medical therapy for CVD, and reported significant mortality
benefits with the use of 1 g/day OM3 intervention following myocardial
infarction (MI). More recent studies, including cohorts of patients
receiving modern guideline directed medical therapy for CVD, have often
not shown similar benefits with OM3 use. We conducted a literature review
using PubMed, professional society guidelines, specific journal databases
including New England Journal of Medicine and Journal of the American
College of Cardiology from January 1, 2007 to December 31, 2017.
References from selected articles were also reviewed, as well as key
articles outside of the selected time-frame for their important findings
or historical perspectives. Currently, there are no Class I
recommendations from the American Heart Association (AHA) for the use of
OM3, however, considering the safety of this therapy and beneficial
findings of some modern studies (including patients with current maximal
medical therapy for CVD), the AHA has recently expanded their list of
Class II recommendations, in which treatment with OM3 for CVD benefit is
reasonable. This review discusses the current state of the evidence,
summarizes current professional recommendations, and provides
recommendations for future research.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<49>
Accession Number
2000705146
Author
Sardo S.; Osawa E.A.; Finco G.; Gomes Galas F.R.B.; de Almeida J.P.;
Cutuli S.L.; Frassanito C.; Landoni G.; Hajjar L.A.
Institution
(Sardo, Finco) Department of Medical Sciences and Public Health,
University of Cagliari, Monserrato, Italy
(Osawa) Intensive Care Unit, Instituto do Cancer, Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
(Gomes Galas, de Almeida, Hajjar) Heart Institute, University of Sao
Paulo, Sao Paulo, Brazil
(Cutuli) Department of Anesthesiology and Intensive Care, Universita
Cattolica del Sacro Cuore, Rome, Italy
(Frassanito, Landoni) IRCCS San Raffaele Scientific Institute, Milan,
Italy
(Landoni) Vita-Salute San Raffaele University of Milan, Milan, Italy
Title
Nitric Oxide in Cardiac Surgery: A Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objectives: To investigate the efficacy and safety of perioperative
administration of nitric oxide in cardiac surgery. Design: Meta-analysis
of randomized controlled trials (RCTs). Participants: Cardiac surgery
patients. Interventions: A search of Cochrane Central Register of
Controlled Trials (CENTRAL), Embase, and MEDLINE for RCTs that compared
nitric oxide with placebo or other comparators. Measurements and Main
Results: The primary outcome was intensive care unit (ICU) stay, and
secondary outcomes were mortality, duration of mechanical ventilation, and
reduction of mean pulmonary artery pressure. The study included 18 RCTs
comprising 958 patients. The authors calculated the pooled odds ratio (OR)
and the mean difference (MD) with random-effects model. Quantitative
synthesis of data demonstrated a clinically negligible reduction in the
length of ICU stay (MD -0.38 days, confidence interval CI [-0.65 to
-0.11]; p = 0.005) and mechanical ventilation duration (MD -4.81 hours, CI
[-7.79 to -1.83]; p = 0.002) compared with all control interventions with
no benefit on mortality. Conclusions: Perioperative delivery of inhaled
nitric oxide resulted to be of no or minimal benefit in patients with
pulmonary hypertension undergoing cardiac surgery. Large, randomized
trials are needed to further assess its effect on major clinical outcomes
and its cost-effectiveness.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<50>
Accession Number
621726140
Author
Gialama F.; Prezerakos P.; Apostolopoulos V.; Maniadakis N.
Institution
(Gialama, Maniadakis) Department of Health Services Management, National
School of Public Health, 196 Alexandras Avenue, Athens 115 21, Greece
(Prezerakos) Department of Nursing Studies, University of Peloponnese,
Efstathiou and Stamatikis Valioti and Plateon, Sparti 23100, Greece
(Apostolopoulos) Administration, Athens Medical Group, Filadelfeos and
Kefalariou 1, Square Kefalariou, Kifisia, Athens 14562, Greece
Title
Systematic review of the cost-effectiveness of transcatheter interventions
for valvular heart disease.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 4 (2) (pp
81-90), 2018. Date of Publication: 01 Apr 2018.
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve implantation (TAVI) and transcatheter mitral
valve repair (TMVR) are increasingly used for managing patients with
valvular heart disease to whom surgery presents a high-risk. As these are
costly procedures, a systematic review of studies concerned with their
economic assessment was undertaken. The search was performed in PubMed and
the Cochrane Library and followed recommended methodological steps.
Studies were screened and their data were retrieved and were synthesized
using a narrative approach. Twenty-four, good to high quality, evaluations
were identified, representing different viewpoints, modelling techniques
and willingness-topay thresholds. Studies show that in high-risk patients
with symptomatic aortic stenosis, TAVI may be cost-effective compared with
medical management (MM) across many health care settings. In contrast,
studies of TAVI compared with surgical aortic valve replacement (SAVR)
yield conflicting and inconclusive results. The limited data available
show that TMVR may also be cost-effective relative to MM in mitral valve
disease. Existing evidence indicates that transcatheter techniques may be
cost-effective options, relative to MM, in high-risk patients with
valvular disease. Nonetheless, more research is needed to establish their
economic value further, to investigate the drives of cost-effectiveness,
and to evaluate surgical with transcatheter techniques in aortic valvular
disease.<br/>Copyright &#xa9; 2018 The Author(s). Published on behalf of
the European Society of Cardiology. All rights reserved.

<51>
Accession Number
2000595311
Author
Mazine A.; Verma S.; Yanagawa B.
Institution
(Mazine, Verma, Yanagawa) Division of Cardiac Surgery, Department of
Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
Title
Mitral valve repair with resection versus neochordae: A call for
high-quality evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (2) (pp 601-602),
2018. Date of Publication: February 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<52>
Accession Number
2000567409
Author
Dvirnik N.; Belley-Cote E.P.; Hanif H.; Devereaux P.J.; Lamy A.; Dieleman
J.M.; Vincent J.; Whitlock R.P.
Institution
(Dvirnik, Belley-Cote, Devereaux, Lamy, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario,
Canada
(Dvirnik, Hanif, Lamy, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada
(Devereaux, Lamy, Vincent, Whitlock) Population Health Research Institute,
Hamilton, Ontario, Canada
(Dieleman) Division of Anaesthesiology, Intensive Care, and Emergency
Medicine, University Medical Center Utrecht, Netherlands
(Dieleman) Department of Anaesthesia and Perioperative Medicine, Monash
University, Melbourne, Australia
Title
Steroids in cardiac surgery: a systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 120 (4) (pp 657-667), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory
reaction that may contribute to postoperative complications. Preventing
this reaction with steroids may improve outcomes. We performed a
systematic review to evaluate the impact of prophylactic steroids on
clinical outcomes in patients undergoing on-pump cardiac surgery. Methods:
We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised
controlled trials (RCTs) comparing perioperative corticosteroid
administration with a control group in adults undergoing CPB. Outcomes of
interest included mortality, myocardial infarction, and new onset atrial
fibrillation. We assessed the quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation approach. Results:
Fifty-six RCTs published between 1977 and 2015 were included in this
meta-analysis. Mortality was not significantly different between groups
[3.0% (215/7258 patients) in the steroid group and 3.5% (252/7202
patients) in the placebo group; relative risk (RR), 0.85; 95% confidence
interval (CI), 0.71-1.01; P=0.07; I² = 0%]. Myocardial injury
was more frequent in the steroid group [8.0% (560/6989 patients), compared
with 6.9% (476/6929 patients); RR, 1.17, 95% CI, 1.04-1.31; P=0.008;
I²=0%]. New onset atrial fibrillation was lower in the steroid
group [25.7% (1792/6984 patients) compared with 28.3% (1969/6964
patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005, I²=43%]; this
beneficial effect was limited to small trials (P for interaction
<0.00001). Conclusions: After randomising 16 013 patients, steroid
administration at the time of cardiac surgery had an unclear impact on
mortality, increased the risk of myocardial injury, and the impact on
atrial fibrillation should be viewed with caution given that large trials
showed no effect.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<53>
Accession Number
2000537654
Author
Lee C.; Lee C.H.; Lee G.; Lee M.; Hwang J.
Institution
(Lee, Lee, Lee) Department of Anesthesiology and Pain Medicine, Wonkwang
University School of Medicine, Iksang, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Konkuk University
School of Medicine, South Korea
(Hwang) Department of Orthopaedic Surgery, Hallym University Kangnam
Sacred Heart Hospital, Seoul, South Korea
Title
The effect of the timing and dose of dexmedetomidine on postoperative
delirium in elderly patients after laparoscopic major non-cardiac surgery:
A double blind randomized controlled study.
Source
Journal of Clinical Anesthesia. 47 (pp 27-32), 2018. Date of Publication:
June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: There were few clinical data dosing and timing regimen
for preventing postoperative delirium. The present study aimed to
investigate the effect of the timing and dose of dexmedetomidine on
postoperative delirium in elderly patients after laparoscopic major
non-cardiac surgery. Patients and interventions: A total of 354 patients
>65 years of age undergoing laparoscopic major non-cardiac surgery under
general anesthesia received a dexmedetomidine 1 mug/kg bolus followed by
0.2-0.7 mug/kg/h infusion from induction of anesthesia to the end of
surgery [group D1]); a dexmedetomidine (1 mug/kg bolus [group D2]); or
saline (group S) 15 min before the end of surgery. Measurements: The
incidence and duration of delirium for 5 days after surgery and the
cytokine (tumor necrosis factor-alpha TNFalpha interleukin [IL]-1 beta
IL-2, IL-6, IL-8, and IL-10) and cortisol levels were measured 1 h and 24
h after surgery. Main results: Group D1 reduced incidence and duration of
delirium and group D2 decreased its duration in patients with delirium
compared to group S. IL-6 levels were significantly lower at 1 h and 24 h
after surgery in group D1 than in group S, and lower at 24 h after surgery
than in group D2. IL-6 levels in group D2 were significantly lower only at
1 h after surgery than in group S. However, IL-6 levels in delirious
patients in group D2 were significantly lower at 1 h and 24 h after
surgery than those in group S. Cortisol levels 1 h after surgery were
significantly lower in groups D1 and D2 than in group S. Conclusions: The
dose and timing of dexmedetomidine appeared to be important in preventing
delirium. The reduced incidence and duration of delirium by
dexmedetomidine was associated with reduced levels of IL-6 24 h after
surgery.<br/>Copyright &#xa9; 2018

<54>
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

<55>
Accession Number
621886449
Author
Qin X.; Li F.; Yu C.
Institution
(Qin, Li) Department of Anesthesiology, Fifth Affiliated Hospital,
Xinjiang Medical University, Urumqi City, Xinjiang Uygur Autonomous
Region, China
(Yu) Department of Anesthesiology, Third Affiliated Hospital (Tumor
Hospital), Xinjiang Medical University, Urumqi City, Xinjiang Uygur
Autonomous Region 830000, China
Title
Myocardial protection of dexmedetomidine in patients undergoing cardiac
valve replacement under cardiopulmonary bypass.
Source
International Journal of Clinical and Experimental Medicine. 11 (4) (pp
4101-4107), 2018. Article Number: IJCEM0074582. Date of Publication: 30
Apr 2018.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To clarify myocardial protection of metodetomidine during
anesthesia induction for cardiac valve replacement (CVR) under
cardiopulmonary bypass (CPB). Methods: From January 2016 to January 2017,
a total of 76 patients undergoing CVR under CPB in our hospital were
recruited in this study and randomly assigned to receive dexmedetomidine
for anesthesia before CVR (observation group, n=41) or equivalent amounts
of normal saline (control group, n=35). The two groups of patients were
compared in the myocardial injury markers, and operative parameters at
different time points (before anesthesia induction (T1), 30 min after
aortic unclamping (T2), immediately after operation (T3), 6 h after
operation (T4) and 24 h after operation (T5)), and the hemodynamic
parameters and oxidative stress parameters at diverse time intervals (T1,
after intubation (T6), immediately after sternotomy (T7), before CPB (T8),
and 10 min after CPB (T9)). Results: The serum creatine kinase (CK),
creatine kinase isoenzyme (CK-MB), and cardiac troponin I (cTnI) levels
were increased more remarkably at T2, T3, T4, and T5 than at T1 in both
groups (P<0.05); the serum cTnI level at T3 (P=0.034), the serum CK
(P=0.041, P=0.045), CK-MB (P=0.047, P=0.039), and cTnI (P=0.031, P=0.038)
levels at T4, and T5 in the observation group were considerably lower than
those in the control group. The heart rates (HR) at T6, T7, and T9 in the
control group and the HR at T9 in the observation group were increased
more remarkably than those at T1 in the same group (all P<0.001). The mean
arterial pressure (MAP) values in the observation group rose more
strikingly than those in the control group (all P<0.001). In the
observation group, the serum superoxide dismutase (SOD) levels at T2, T3,
T4, and T5 rose more remarkably than that at T1 (all P<0.001). In both
groups, the serum malondialdehyde (MDA) levels rose more substantially at
T2, T3, T4, and T5 than those at T1 (all P<0.001); the serum MDA levels at
T2, T3, T4, and T5 in the observation group were remarkably lower than
those in the control group (all P<0.001). Conclusion: Dexmedetomidine
helps relieve oxidative stress and maintain hemodynamic stability during
CPB; hence it has certain effect of myocardial protection.<br/>Copyright
&#xa9; 2018, E-Century Publishing Corporation. All rights reserved.

<56>
Accession Number
621948971
Author
Franchini M.; Mengoli C.; Cruciani M.; Marietta M.; Marano G.; Vaglio S.;
Pupella S.; Veropalumbo E.; Masiello F.; Liumbruno G.M.
Institution
(Franchini, Mengoli, Marano, Vaglio, Pupella, Veropalumbo, Masiello,
Liumbruno) Italian National Blood Centre, National Institute of Health,
Rome, Italy
(Franchini) Department of Haematology and Transfusion Medicine, Carlo Poma
Hospital, Strada Lago Paiolo 1, Mantua 46100, Italy
(Cruciani) Infection Control Committee, AULSS9 Scaligera, Verona, Italy
(Marietta) Department of Oncology, Hematology and Respiratory Diseases,
University Hospital, Modena, Italy
(Vaglio) Department of Clinical and Molecular Medicine, La Sapienza
University of Rome, Rome, Italy
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 235-243), 2018. Date of Publication: 2018.
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background: Thrombelastography (TEG) and rotational thromboelastometry
(ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the
elastic properties of clotting blood. The aim of this systematic review
and meta-analysis was to evaluate the usefulness of these tests in
bleeding patients outside the cardiac surgical setting. Materials and
methods: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We
also searched clinical trial registries for ongoing and unpublished
studies, and checked reference lists to identify additional studies.
Results: We found 4 randomised controlled trials (RCTs) that met our
inclusion criteria with a total of 229 participants. The sample size was
small (from 28 to 111 patients) and the follow-up periods very
heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials
reporting on mortality (199 participants) do not show any effect of the
use of TEG on mortality as compared to standard monitoring (based on the
average treatment effect from a fixed-effects model): Risk Ratio (RR)
0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA
does not reduce the need for red blood cells (mean difference -0.64; 95%
CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI:
-3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI:
-2.02 to 0.19) transfusion. The evidence on mortality and other outcomes
was uncertain (very low-certainty evidence, down-graded due to risk of
biases, imprecision, and inconsistency). Conclusions: Overall, the
certainty of the evidence provided by the trials was too low for us to be
certain of the benefits and harms of viscoelastic haemostatic assay in
non-cardiac surgical settings. More, larger, and better-designed RCTs
should be carried out in this area.<br/>Copyright &#xa9; SIMTI Servizi
Srl.

<57>
Accession Number
621948966
Author
De Cristofaro R.
Institution
(De Cristofaro) Institute of Internal Medicine and Geriatrics, Haemostasis
and Thrombosis Centre, Fondazione Policlinico Universitario Agostino
Gemelli, Area of Haematological Sciences, Catholic University of the
Sacred Heart, School of Medicine, Largo Francesco Vito 1, Rome 00168,
Italy
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 224-226), 2018. Date of Publication: 2018.
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)

<58>
Accession Number
621948822
Author
Bignami E.; Castella A.; Pota V.; Saglietti F.; Scognamiglio A.; Trumello
C.; Pace M.C.; Allegri M.
Institution
(Bignami, Castella, Saglietti) Department of Anesthesia and Intensive
Care, San Raffaele Scientific Institute for Research and Care, Via
Olgettina 60, Milan 20132, Italy
(Pota, Pace) Department of Woman, Child, General, and Specialty Surgery,
L. Vanvitelli University of Campania, Naples, Italy
(Scognamiglio) Section of Anesthesia and Intensive Care, Department of
Neurosciences, Reproductive, and Odontostomatological Sciences, Federico
II University of Naples, Naples, Italy
(Trumello) Department of Cardiac Surgery, San Raffaele Scientific
Institute for Research and Care, Milan, Italy
(Allegri) Anesthesia, Intensive Care and Pain Therapy Unit, Division of
Surgical Sciences, Department of Medicine and Surgery, University of
Parma, Parma, Italy
(Allegri) Study in Multidisciplinary Pain Research (SIMPAR) Group, Pavia,
Italy
Title
Perioperative pain management in cardiac surgery: A systematic review.
Source
Minerva Anestesiologica. 84 (4) (pp 488-503), 2018. Date of Publication:
April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Every year, more than 1.5 million patients, who undergo
cardiac surgery worldwide, are exposed to a series of factors that can
trigger acute postoperative pain associated with hemodynamic instability,
respiratory complications, and psychological disorders. Through an
evaluation of literature data about postoperative pain in cardiac surgery
we define unmet needs and potential objectives for future research on this
often-underestimated problem. METHODS: Following PRISMA Guidelines, a
systematic literature search was carried out by two independent
researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the
key words: (perioperative OR postoperative) analgesia AND "cardiac
surgery." Papers concerning children, or published prior to 2000, were
considered ineligible, as well as abstracts, animal studies, and studies
written in languages other than English. RESULTS: Fifty-four papers were
selected and subsequently divided into two main categories: systemic
analgesic drugs and regional anesthesia techniques. CONCLUSIONS: Over the
past 17 years, opioids are still the most extensively used therapy,
whereas we found only few trials investigating other drugs (e.g.
paracetamol). Regional anesthesia techniques, especially thoracic epidural
analgesia and intrathecal morphine administration, can effectively treat
pain, but have not yet showed any significant impact on major clinical
outcomes, with several concerns related to their potential complications.
To date multimodal analgesia with implementation of regional analgesia
seems to be the best choice. In the future, better-designed studies should
consider other drugs stratifying groups according to comorbidities and
risk factors, as well as using standardized units of
measurement.<br/>Copyright &#xa9; 2017 Edizioni Minerva Medica.

<59>
Accession Number
621948808
Author
Sperna Weiland N.H.; De Wever J.W.; Van Duivenvoorde Y.; Boer C.; Mitrev
L.; Muntazar M.; Patel K.; Hollmann M.W.; Preckel B.
Institution
(Sperna Weiland, Hollmann, Preckel) Department of Anesthesiology, Academic
Medical Center (AMC) Amsterdam, University of Amsterdam, P.O. Box 22660,
Amsterdam 1100 DD, Netherlands
(De Wever, Van Duivenvoorde, Boer) Department of Anesthesiology, Free
University Medical Center, Amsterdam, Netherlands
(Mitrev, Muntazar, Patel) Department of Anesthesiology, Cooper University
Hospital, Cooper Medical School of Rowan University, Camden, NJ, United
States
Title
Agreement between ^ccNexfin CO-trek cardiac output and
intermittent cold-bolus pulmonary thermodilution in a prospective
multicenter study.
Source
Minerva Anestesiologica. 84 (4) (pp 473-480), 2018. Date of Publication:
April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: The ccNexfin System uses the CO-trek algorithm to analyze a
non-invasively obtained arterial pressure waveform and calculate cardiac
output (NEXCO). It remains matter of debate whether NEXCO can replace
invasive, pulmonary artery catheter-derived, cold-bolus pulmonary
thermodilution cardiac output measurement (PACCO). This study aimed at
testing NEXCO-PACCO agreement in a large sample size, multicenter study.
We hypothesized that agreement between NEXCO and PACCO would be
demonstrated by a mean accuracy (bias) <0.6 L/min with a percentage error
<30%. METHODS: Patients undergoing cardiac surgery in three academic
hospitals clinically requiring pulmonary artery catheterization were
included. Exclusion criteria were aortic, pulmonary and tricuspid (valve)
abnormalities, non-sinus rhythm and insufficient perfusion of the digits
such as in Raynaud's disease. After induction of anesthesia, cardiac
output was measured with four cold bolus thermodilution measurements and
four averaged 30-second ccNexfin measurements randomized through the
respiratory cycle to obtain one measurement pair. Mean accuracy and
precision of ccNexfin were expressed as bias (mean of all NEXCO-PACCO
differences) and limits of agreement (LOA) (1.96*SD of bias). Percentage
error was calculated as [LOA / (NEXCO-PACCO average)]. RESULTS: Fifty-five
patients were enrolled in the study, 51 completed the protocol. Median
PACCO was 3.7 (IQR: 3.2 to 4.6) L/min and median NEXCO was 3.8 (IQR: 3.1
to 4.7) L/min. NEXCO-PACCO bias was 0.1 (LOA: -1.4 to +1.6) L/min with a
37% percentage error. CONCLUSIONS: In this study, cardiac output
measurement with ccNexfin failed to meet the predefined criteria for
agreement with cold-bolus pulmonary artery thermodilution.<br/>Copyright
&#xa9; 2017 Edizioni Minerva Medica.

<60>
Accession Number
617520718
Author
Buckert D.; Witzel S.; Cieslik M.; Tibi R.; Rottbauer W.; Bernhardt P.
Institution
(Buckert, Witzel, Cieslik, Tibi, Rottbauer) University of Ulm, Department
of Internal Medicine II, Albert-Einstein-Allee 23, Ulm 89081, Germany
(Bernhardt) Heart Clinic Ulm, Ulm, Germany
Title
Magnetic resonance Adenosine perfusion imaging as Gatekeeper of invasive
coronary intervention (MAGnet): Study protocol for a randomized controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 358. Date of
Publication: 28 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Current guidelines for the diagnosis and management of
patients with stable coronary artery disease (CAD) recommend functional
stress testing for risk stratification prior to revascularization
procedures. Cardiac magnetic resonance imaging (CMR) is a modality of
choice for stress testing because of its capability to detect myocardial
ischemia sensitively and specifically. Nevertheless, evidence from
randomized trials evaluating a CMR-based management of stable CAD patients
in comparison to a more common angiography-based approach still is
limited. Methods/design: Patients presenting themselves with symptoms
indicating a stable CAD and a class I or IIa indication for diagnostic
coronary angiography are prospectively screened and enrolled in the study.
All subjects receive a basic cardiological work-up and guideline-directed
medical therapy. A 1:1 randomization in two groups is being performed.
Patients in group 1 undergo diagnostic coronary angiography and subsequent
revascularization according to current guidelines. Subjects in group 2
undergo adenosine stress CMR and in case of myocardial ischemia are sent
to coronary angiography. Follow-up is planned for 3 years. During this
time, the number of primary endpoints (defined as cardiac death and
non-fatal myocardial infarction) and unplanned invasive procedures will be
documented. Furthermore, symptom burden and quality of life will be
assessed by use of the Seattle Angina Questionnaire. Sample size is
calculated to prove non-inferiority of the CMR-based approach. Discussion:
In case this study is able to accomplish its aim to prove non-inferiority
of the CMR-based management in patients with stable CAD; the importance of
this emerging modality may further increase. Trial registration:
ClinicalTrials.gov, identifier: NCT02580851. Registered on 14 October
2015. Unique Protocol ID: 237/11.<br/>Copyright &#xa9; 2017 The Author(s).

<61>
Accession Number
616541696
Author
Jacobsohn E.; Grocott H.P.; Lee Y.H.; Waszynski C.M.; Waberski W.; Apakama
G.P.; Aquino K.G.; Arya V.K.; Avidan M.S.; Abdallah A.B.; Dicks R.S.;
Downey R.J.; Emmert D.A.; Escallier K.E.; Fritz B.A.; Fardous H.; Funk
D.J.; Gipson K.E.; Girardi L.N.; Grocott H.; Gruber A.T.; Hudetz J.A.;
Inouye S.K.; Ivascu N.S.; Jayant A.; Kashani H.H.; Kavosh M.S.; Kunkler
B.S.; Lee Y.; Lenze E.J.; Mashour G.A.; Maybrier H.R.; McKinney A.S.;
McKinnon S.L.; Mickle A.M.; Monterola M.; Muench M.R.; Murphy M.R.; Noh
G.-J.; Pagel P.S.; Pryor K.O.; Rogers E.M.; Redko M.; Schmitt E.M.;
Sivanesan L.; Steinkamp M.L.; Tellor B.; Thomas S.; Upadhyayula R.T.;
Veselis R.A.; Vlisides P.E.; Waszynski C.; Yulico H.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
United States
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, United States
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, United States
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, United States
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, United States
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, United States
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT,
United States
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, United States
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife,
Boston, MA, United States
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: an international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. 390 (10091) (pp 267-275), 2017. Date of Publication: 15 Jul
2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding National Institutes of Health and
Cancer Center Support.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<62>
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.

<63>
[Use Link to view the full text]
Accession Number
621798694
Author
Bajraktari G.; Jashari H.; Ibrahimi P.; Alfonso F.; Jashari F.; Ndrepepa
G.; Elezic S.; Heneina M.Y.
Institution
(Bajraktari, Jashari, Ibrahimi, Jashari, Elezic, Heneina) Department of
Public Health and Clinical Medicine, Umea University, Umea, Sweden
(Bajraktari, Jashari, Ibrahimi) Clinic of Cardiology, University Clinical
Centre of Kosova, Serbia
(Bajraktari, Jashari) Department of Internal Medicine, Medical Faculty,
University of Prishtina, Prishtina, Kosovo, Serbia
(Alfonso) Cardiac Department, La Princesa University Hospital, Institute
of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain
(Ndrepepa) Department of Adult Cardiology, German Heart Centre Munich,
Technical University of Munich, Munich, Germany
(Heneina) St George University, London, United Kingdom
Title
Complete revascularization for patients with ST-segment elevation
myocardial infarction and multivessel coronary artery disease: A
meta-analysis of randomized trials.
Source
Coronary Artery Disease. 29 (3) (pp 204-215), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Introduction Despite the recent findings in randomized clinical trials
(RCTs) with limited sample sizes and the updates in clinical guidelines,
the current available data for the complete revascularization (CR) in
hemodynamically stable patients with ST-segment elevation myocardial
infarction (STEMI) at the time of primary percutaneous coronary
intervention (PCI) are still contradictory. Aim The aim of this
meta-analysis of the existing RCTs was to assess the efficacy of the CR
versus revascularization of infarct-related artery (IRA) only during
primary PCI in patients with STEMI and multivessel disease (MVD). Patients
and methods We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar,
Cochrane Central Register of Controlled Trials (CENTRAL), and
ClinicalTrials. gov databases aiming to find RCTs for patients with STEMI
and MVD which compared CR with IRA-only. Random effect risk ratios (RRs)
were calculated for efficacy and safety outcomes. Results Ten RCTs with
3291 patients were included. The median follow-up duration was 17.5
months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001),
cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat
revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared
with IRA-only strategies. However, there was no significant difference in
the risk of all-cause mortality, recurrent nonfatal myocardial infarction,
stroke, major bleeding events, and contrast-induced nephropathy.
Conclusion For patients with STEMI and MVD undergoing primary PCI, the
current evidence suggests that the risk of major adverse cardiac events,
repeat revascularization, and cardiac death is reduced by CR. However, the
risk for all-cause mortality and PCI-related complications is not
different from the isolated culprit lesion-only treatment. Although these
findings support the cardiac mortality and safety benefit of CR in stable
STEMI, further large trials are required to provide better guidance for
optimum management of such patients.<br/>Copyright &#xa9; 2018 Wolters
Kluwer Health, Inc.

<64>
[Use Link to view the full text]
Accession Number
621798692
Author
Gatto L.; Di Landro A.; Romagnoli E.; Marco V.; Russo C.; Pawlowski T.;
Versaci F.; Limbruno U.; Castriota F.; Di Vito L.; Trivisonno A.; Prati F.
Institution
(Gatto, Romagnoli, Prati) Interventional Cardiology, San Giovanni
Addolorata Hospital, Via dell'Amba Aradam, 8, Rome 00184, Italy
(Gatto, Di Landro, Romagnoli, Marco, Russo, Di Vito, Prati) Centro per la
Lotta Contro L'Infarto, CLI Foundation, Rome, Italy
(Versaci) S. Maria Goretti Hospital, Latina, Italy
(Limbruno) Misericordia Hospital, Grosseto, Italy
(Castriota) Maria Cecilia Hospital, GVM Care and Research, Ettore
Sansavini Health Science Foundation, Cotignola, Italy
(Trivisonno) Ospedale A. Cardarelli, Campobasso, Italy
(Pawlowski) Central Clinical Hospital, Ministry of Interior, Warsaw,
Poland
Title
A comparison of intracoronary treatment strategies for thrombus burden
removal during primary percutaneous coronary intervention: A COCTAIL II
substudy.
Source
Coronary Artery Disease. 29 (3) (pp 186-193), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Manual thrombus aspiration and local drug delivery of abciximab
have been proposed as a strategy to reduce thrombus burden during
percutaneous coronary intervention in patients with ST elevation
myocardial infarction; however, the effectiveness of these approaches, is
uncertain. In this COCTAIL II substudy, we compared the effect of these
strategies on prestenting and poststenting thrombus burden assessed by
optical coherence tomography. Patients and methods COCTAIL II trial
enrolled patients with ST elevation myocardial infarction randomized to
intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by
the guide catheter) abciximab bolus with or without aspiration
thrombectomy (AT). The following parameters were used to quantify
atherothrombotic burden: thrombus volume (TVol), maximum thrombus area
(TA), and thrombus burden (TB). Primary endpoint was the comparison of
prestenting TVol after the use of local drug delivery (group IL+IL
abciximab plus AT) versus nonlocal drug delivery (group IC abciximab plus
AT+IC). Results The final population consisted of 59 patients undergoing
both prestenting and poststenting optical coherence tomography assessment.
The amount of thrombus was not significantly different in the groups with
local drug delivery of abciximab versus nonlocal drug delivery in both
prestenting (TVol: 18.87+/- 26.70 vs. 19.02 +/-18.45; TB: 26.73 +/-12.8
vs. 25.18 +/-13.25; and maximum TA: 59.25 +/- 18.84 vs. 53.34 +/- 19.30)
and poststenting (TVol: 8.46+/- 9.15 vs. 8.05 +/- 6.81; TB: 6.68 +/-3.54
vs. 6.24+/- 3.66; and maximum TA: 15.47 +/-7.61 vs. 16.52 +/-11.55)
evaluations. A good correlation between thrombus measurements after
thrombus removal techniques and intrastent thrombus was observed.
Conclusion Either local drug delivery of abciximab or manual thrombus
aspiration showed comparable results in terms of prestenting and
poststenting thrombus burden removal.<br/>Copyright &#xa9; 2018 Wolters
Kluwer Health, Inc.

<65>
Accession Number
619096217
Author
Zittermann A.; Ernst J.B.; Prokop S.; Fuchs U.; Dreier J.; Kuhn J.; Knabbe
C.; Birschmann I.; Schulz U.; Berthold H.K.; Pilz S.; Gouni-Berthold I.;
Gummert J.F.; Dittrich M.; Borgermann J.
Institution
(Zittermann, Ernst, Prokop, Fuchs, Schulz, Gummert, Borgermann) Clinic for
Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr
University Bochum, Georgstrase 11, Bad Oeynhausen 32545, Germany
(Dreier, Kuhn, Knabbe, Birschmann) Institute for Laboratory and
Transfusion Medicine, Heart and Diabetes Center NRW, Ruhr University
Bochum, Georgstrase 11, Bad Oeynhausen 32545, Germany
(Berthold) Department of Internal Medicine and Geriatrics, Evangelical
Hospital of the Bethel Foundation, Schildescher Strase 99, Bielefeld
33611, Germany
(Pilz) Division of Endocrinology and Diabetology, Department of Internal
Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz 8036,
Austria
(Gouni-Berthold) Center of Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Kerpener Strase 62, Cologne 50937,
Germany
(Dittrich) Department of Bioinformatics, Institute of Human Genetics,
Biocenter, University of Wuerzburg, Am Hubland/Biozentrum, Wuerzburg
97074, Germany
Title
Effect of Vitamin D on all-causemortality in heart failure (EVITA): A
3-year randomized clinical trial with 4000 IU Vitamin D daily.
Source
European Heart Journal. 38 (29) (pp 2279-2286), 2017. Date of Publication:
01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Circulating 25-hydroxyVitamin D (25OHD) levels <75 nmol/L are
associated with a nonlinear increase in mortality risk. Such 25OHD levels
are common in heart failure (HF). We therefore examined whether oral
Vitamin D supplementation reduces mortality in patients with advanced HF.
Methods and results Four hundred HF patients with 25OHD levels <75 nmol/L
were randomized to receive 4000 IU Vitamin D daily or matching placebo for
3 years. Primary endpoint was all-cause mortality. Key secondary outcome
measures included hospitalization, resuscitation, mechanical circulatory
support (MCS) implant, high urgent listing for heart transplantation,
heart transplantation, and hypercalcaemia. Initial 25OHD levels were on
average <40 nmol/L, remained around 40 nmol/L in patients assigned to
placebo and plateaued around 100 nmol/L in patients assigned to Vitamin D.
Mortality was not different in patients receiving Vitamin D (19.6%; n =
39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 [95%
confidence interval (CI): 0.69-1.71; P = 0.726]. The need for MCS implant
was however greater in patients assigned to Vitamin D (15.4%, n = 28) vs.
placebo [9.0%, n = 15; HR: 1.96 (95% CI: 1.04-3.66); P = 0.031]. Other
secondary clinical endpoints were similar between groups. The incidence of
hypercalcaemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving
Vitamin D or placebo (P = 0.192). Conclusion A daily Vitamin D dose of
4000 IU did not reduce mortality in patients with advanced HF but was
associated with a greater need for MCS implants. Data indicate caution
regarding long-term supplementation with moderately high Vitamin D doses.
Trial Registration Information clinicaltrials.gov Idenitfier:
NCT01326650.<br/>Copyright &#xa9; The Author 2016.

<66>
Accession Number
619096188
Author
Hagiwara N.; Kawada-Watanabe E.; Koyanagi R.; Arashi H.; Yamaguchi J.;
Nakao K.; Tobaru T.; Tanaka H.; Oka T.; Endoh Y.; Saito K.; Uchida T.;
Matsui K.; Ogawa H.
Institution
(Hagiwara, Kawada-Watanabe, Koyanagi, Arashi, Yamaguchi, Ogawa) Department
of Cardiology, Heart Institute of Japan, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku, Tokyo 162-8666, Japan
(Nakao) Division of Cardiology, Cardiovascular Center, Saisei-Kai Kumamoto
Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto-shi, Kumamoto 861-4193, Japan
(Tobaru) Department of Cardiology, Sakakibara Heart Institute, 3-16-1
Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan
(Tanaka) Division of Cardiology, Tokyo Metropolitan Tama Medical Center,
2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan
(Oka) Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12
Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka 430-8558, Japan
(Endoh) Department of Cardiology, Saisei-Kai Kurihashi Hospital, 714-6
Kouemon, Kuki-shi, Saitama 349-1105, Japan
(Saito) Department of Cardiology, Nishiarai Heart Center, 1-12-8,
Nishiarai-honcho, Adachi-Ku, Tokyo 123-0845, Japan
(Uchida) Department of Cardiology, Cardiovascular Center of Sendai, 1-6-12
Izumichuo, Izumi-ku, Sendai-shi, Miyagi 981-3133, Japan
(Matsui) Department of General and Community Medicine, Kumamoto University
Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Title
Low-density lipoprotein cholesterol targeting with pitavastatin 1
ezetimibe for patients with acute coronary syndrome and dyslipidaemia: The
HIJ-PROPER study, a prospective, open-label, randomized trial.
Source
European Heart Journal. 38 (29) (pp 2264-2275), 2017. Date of Publication:
01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To elucidate the effects of intensive LDL-C lowering treatment with a
standard dose of statin and ezetimibe in patients with dyslipidaemia and
high risk of coronary events, targeting LDL-C less than 70 mg/dL (1.8
mmol/L), compared with standard LDL-C lowering lipid monotherapy targeting
less than 100 mg/dL (2.6 mmol/L). Methods and results The HIJ-PROPER study
is a prospective, randomized, open-label trial to assess whether intensive
LDL-C lowering with standard-dose pitavastatin plus ezetimibe reduces
cardiovascular events more than standard LDL-C lowering with pitavastatin
monotherapy in patients with acute coronary syndrome (ACS) and
dyslipidaemia. Patients were randomized to intensive lowering (target
LDL-C < 70 mg/dL [1.8mmol/L]; pitavastatin plus ezetimibe) or standard
lowering (target LDL-C 90 mg/dL to 100 mg/dL [2.3-2.6mmol/L]; pitavastatin
monotherapy). The primary endpoint was a composite of all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischaemiadriven revascularization. Between January 2010 and April 2013,
1734 patients were enroled at 19 hospitals in Japan. Patients were
followed for at least 36months. Median follow-up was 3.86 years. Mean
follow-up LDL-C was 65.1 mg/dL (1.68mmol/L) for pitavastatin plus
ezetimibe and 84.6 mg/dL (2.19mmol/L) for pitavastatin monotherapy. LDL-C
lowering with statin plus ezetimibe did not reduce primary endpoint
occurrence in comparison with standard statin monotherapy (283/864, 32.8%
vs. 316/857, 36.9%; HR 0.89, 95% CI 0.76-1.04, P = 0.152). In, ACS
patients with higher cholesterol absorption, represented by elevated
pre-treatment sitosterol, was associated with significantly lower
incidence of the primary endpoint in the statin plus ezetimibe group (HR
0.71, 95% CI 0.56-0.91).<br/>Copyright &#xa9; The Author 2016.

<67>
Accession Number
618551751
Author
Chatterjee A.; Bajaj N.S.; McMahon W.S.; Cribbs M.G.; White J.S.;
Mukherjee A.; Law M.A.
Institution
(Chatterjee, Bajaj, Cribbs) Division of Cardiovascular Diseases,
University of Alabama at Birmingham, AL, United States
(McMahon, Cribbs, Law) Department of Pediatric Cardiology, University of
Alabama at Birmingham, AL, United States
(White) Department of Internal Medicine, University of Alabama at
Birmingham, AL, United States
(Mukherjee) School of Public Health, University of Alabama at Birmingham,
AL, United States
Title
Transcatheter pulmonary valve implantation: A comprehensive systematic
review and meta-analyses of observational studies.
Source
Journal of the American Heart Association. 6 (8) (no pagination), 2017.
Article Number: e006432. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Transcatheter pulmonary valve implantation is approved for the
treatment of dysfunctional right ventricle to pulmonary artery conduits.
However, the literature is limited because of a small patient population,
and it does not reflect changing procedural practice patterns over the
last decade. Methods and Results--A comprehensive search of Medline and
Scopus databases from inception through August 31, 2016 was conducted
using predefined criteria. We included studies reporting transcatheter
pulmonary valve implantation in at least 5 patients with a follow-up
duration of 6 months or more. In 19 eligible studies, 1044 patients
underwent transcatheter pulmonary valve implantation with a pooled
follow-up of 2271 person-years. Procedural success rate was 96.2% (95%
confidence intervals [CI], 94.6-97.4) with a conduit rupture rate of 4.1%
(95% CI, 2.5-6.8) and coronary complication rate of 1.3% (95% CI,
0.7-2.3). Incidence of reintervention was 4.4 per 100 person-years overall
(95% CI, 3.0-5.9) with a marked reduction in studies reporting >=75%
prestenting (2.9 per 100 person-years [95% CI, 1.5-4.3] versus 6.5/100
person-years [95% CI, 4.6-8.5]; P < 0.01). Pooled endocarditis rate was
1.4 per 100 person-years (95% CI, 0.9-2.0). Conclusions--Our study
provides favorable updated estimates of procedural and follow-up outcomes
after transcatheter pulmonary valve implantation. Widespread adoption of
prestenting has improved longer-term outcomes in these
patients.<br/>Copyright &#xa9; 2017 The Authors and Medtronic.

<68>
Accession Number
614135995
Author
Cho J.S.; Soh S.; Shim J.-K.; Kang S.; Choi H.; Kwak Y.-L.
Institution
(Cho, Soh, Shim, Choi, Kwak) Yonsei Cardiovascular Hospital, Yonsei
University College of Medicine, Department of Anesthesiology and Pain
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Shim, Kwak) Yonsei University College of Medicine, Anesthesia and Pain
Research Institute, Seoul, South Korea
(Kang) National Health Insurance Corporation Ilsan Hospital, Department of
Anesthesiology and Pain Medicine, Gyeonggi-do, South Korea
Title
Effect of perioperative sodium bicarbonate administration on renal
function following cardiac surgery for infective endocarditis: A
randomized, placebo-controlled trial.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 3. Date of
Publication: 05 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients with infective endocarditis (IE) have an elevated
risk of renal dysfunction because of extensive systemic inflammation and
use of nephrotoxic antibiotics. In this randomized, placebo-controlled
trial, we investigated whether perioperative sodium bicarbonate
administration could attenuate postoperative renal dysfunction in patients
with IE undergoing cardiac surgery. Methods: Seventy patients randomly
received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium
bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h
commencing with anesthetic induction, followed by a 0.15 mmol/kg/h
infusion for 23 h. The primary outcome was peak serum creatinine (SCr)
level during the first 48 h postoperatively. The incidence of acute kidney
injury, SCr level, estimated glomerular filtration rate, and major
morbidity endpoints were assessed postoperatively. Results: The peak SCr
during the first 48 h postoperatively (bicarbonate vs. control: 1.01
(0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the
incidence of acute kidney injury (bicarbonate vs. control: 29% vs. 23%, P
= 0.584) were similar in both groups. The postoperative increase in SCr
above baseline was greater in the bicarbonate group than in the control
group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00,
0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl
vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017). Conclusions: Perioperative sodium
bicarbonate administration had no favorable impact on postoperative renal
function and outcomes in patients with IE undergoing cardiac surgery.
Instead, it was associated with possibly harmful renal effects,
illustrated by a greater increase in SCr postoperatively, compared to
control. Trial registration: ClinicalTrials.gov, NCT01920126. Registered
on 31 July 2013.<br/>Copyright &#xa9; 2017 The Author(s).

<69>
Accession Number
613880897
Author
Sundermann S.H.; Czesla M.; Kempfert J.; Walther T.; Nataf P.; Raanani E.;
Jacobs S.; Alfieri O.; Maisano F.; Falk V.
Institution
(Sundermann, Kempfert, Jacobs, Falk) Department of Cardiothoracic and
Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,
Berlin 13353, Germany
(Sundermann, Jacobs, Falk) DZHK (German Centre for Cardiovascular
Research), Partner Site Berlin, Berlin, Germany
(Czesla) Klinikum Passau, Department of Cardiac Surgery. Innstrasse 76,
Passau 94032, Germany
(Walther) Department of Cardiac Surgery, Kerckhoff-Klinik, Benekestr. 2-8,
Bad Nauheim 61231, Germany
(Nataf) Department of Cardiac Surgery, Assistance Publique-Hopitaux de
Paris, Bichat Hospital, Paris, France
(Raanani) Department of Cardiac Surgery, Sheba Medical Center,
Tel-Hashomer, Israel
(Alfieri) Department of Cardiovascular Surgery, San Raffaele Hospital,
Milan, Italy
(Maisano) University Hospital of Zurich, Heart Center, Zurich, Switzerland
(Falk) Charite, Universitatsmedizin Berlin, Berlin, Germany
Title
Results of mitral valve repair with an adjustable annuloplasty ring 2
years after implantation.
Source
Heart and Vessels. 32 (7) (pp 843-849), 2017. Date of Publication: 01 Jul
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Abstract: We aimed to investigate the safety and medium-term durability of
an adjustable mitral annuloplasty ring in patients undergoing surgery for
mitral valve regurgitation. Forty-five patients requiring mitral valve
repair were enrolled into this prospective, multicentre study between May
2012 and May 2013 in six hospitals in Europe and Israel. Study endpoints
evaluated the performance and safety of the device assessed using
inter-individual comparisons. Implantation was performed through a
sternotomy in ten patients and mini-thoracotomy in 35 patients. The ring
was adjusted after declamping and weaning from cardio-pulmonary bypass
under echocardiographic guidance if the coaptation surface was not
optimal, or in cases of residual mitral regurgitation. Follow-up was
performed up to 2 years post-procedure. Mean age was 61 +/- 12 years. Ring
adjustment was performed in 71% of patients to optimise the results of
mitral valve repair. Following the procedure, 11/45 patients (24%) who had
had mild residual mitral regurgitation had no mitral regurgitation
following ring adjustment. Two patients with severe mitral regurgitation
post-procedure had mild regurgitation following ring adjustment.
Coaptation length increased significantly after adjustment. One patient
died before hospital discharge due to complications unrelated to the
adjustable ring. One patient had to undergo re-operation at 39 days
post-procedure due to endocarditis. At 2 years of follow-up, 78% of
patients had no residual mitral regurgitation and 22% had mild residual
mitral regurgitation. Adjustable mitral annuloplasty ring implantation was
safe in all patients. Mitral valve repair with the adjustable ring was
durable in all patients who reached 2 years follow-up. Clinical Trial
Registration: NCT01617720.<br/>Copyright &#xa9; 2016, Springer Japan.

<70>
[Use Link to view the full text]
Accession Number
615137499
Author
Morris N.P.; Body R.
Institution
(Morris, Body) University of Manchester and Central Manchester NHS
Foundation Trust, Manchester Royal Infirmary Emergency Department, Oxford
Road, Manchester M13 9WL, United Kingdom
Title
The de Winter ECG pattern: Morphology and accuracy for diagnosing acute
coronary occlusion: Systematic review.
Source
European Journal of Emergency Medicine. 24 (4) (pp 236-242), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The De Winter ECG pattern has been reported to indicate acute left
anterior descending coronary artery occlusion and is often considered to
be an 'ST elevation myocardial infarction (STEMI) equivalent'. We aimed to
investigate the morphology of the 'De Winter ECG pattern' and evaluate the
test characteristics of the De Winter pattern for the diagnosis of acute
coronary occlusion. We identified papers through the Medline, EMBASE and
COCHRANE databases and screened for bias using QUADAS-2. First,
measurements were recorded from every ECG reported in the literature and
aggregated. Second, diagnostic accuracy data from eligible cohort studies
were extracted. The primary outcome was defined as at least 70%
angiographic stenosis of a major epicardial vessel. Thirteen papers
reported data relevant to question 1 and three papers reported data
relevant to question 2. All ECGs showed maximal up-sloping ST depression
in lead V3 with a median amplitude of 0.3 mV (interquartile range: 0.2-4
mV). T-wave height peaked in lead V3 with a median amplitude 0.9 mV
(interquartile range: 0.8-1.1 mV). The De Winter pattern had positive
predictive values of 95.2% (95% confidence interval: 76.2-99.9%), 100%
(69.2-100.0%) and 100% (51.7-100%) in the three respective diagnostic
studies. There is limited evidence that the De Winter ECG pattern is a
'STEMI equivalent'. The available data suggest that the pattern has high
positive predictive value for acute occlusion. Further research is
required to evaluate specificity and to determine whether rapid
revascularization improves mortality.<br/>Copyright &#xa9; 2017 Wolters
Kluwer Health, Inc. All rights reserved.

<71>
Accession Number
620554491
Author
Leonard J.R.; Abouarab A.A.; Tam D.Y.; Girardi L.N.; Gaudino M.F.L.;
Fremes S.E.
Institution
(Leonard, Abouarab, Girardi, Gaudino) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON,
Canada
Title
The radial artery: Results and technical considerations.
Source
Journal of Cardiac Surgery. 33 (5) (pp 213-218), 2018. Date of
Publication: May 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The radial artery (RA) is a frequently used conduit for
coronary artery bypass graft (CABG). We review the results of the use of
the RA in CABG patients and discuss the unique technical considerations
when using this conduit. Methods: A literature search was performed in
PubMed through December 2017 on the comparative efficacy of the RA to
other conduits and technical considerations for the use of the RA in CABG
surgery. Results: When compared to the saphenous vein graft, the RA proved
to be superior in graft patency in multiple randomized clinical trials.
The RA was associated with better clinical outcomes in observational
studies. The debate over the second best arterial conduit remains
unresolved between the RA and the right internal thoracic artery.
Preoperative evaluation of the patient's coronary anatomy and the quality
of the RA is imperative to achieve the best clinical outcome with RA
grafting. Conclusion: With careful preoperative planning and attention to
technical details, the RA is an excellent choice as the second conduit for
CABG surgery.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<72>
Accession Number
621936949
Author
Bundhun P.K.; Pursun M.; Teeluck A.R.; Bhurtu A.; Soogund M.Z.; Huang
W.-Q.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, the First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi,
530027, P. R. China
(Pursun, Teeluck, Bhurtu, Soogund) Guangxi Medical University, Nanning,
Guangxi, 530027, P. R. China
Title
Adverse Cardiovascular Outcomes associated with Coronary Artery Bypass
Surgery and Percutaneous Coronary Intervention with Everolimus Eluting
Stents: A Meta-Analysis.
Source
Scientific reports. 6 (pp 35869), 2016. Date of Publication: 24 Oct 2016.
Abstract
This study aimed to compare the mid-term adverse cardiovascular outcomes
associated with Coronary Artery Bypass Surgery (CABG) and Percutaneous
Coronary Intervention (PCI) with Everolimus Eluting Stents (EES).
Electronic databases were searched for studies comparing the mid-term (>1
year) adverse cardiovascular outcomes between CABG and PCI with EES. Odd
Ratios (OR) with 95% Confidence Intervals (CIs) were calculated and the
pooled analyses were performed with RevMan 5.3 software. A total number of
5207 patients were involved in this analysis. No significant difference
was observed in mortality between CABG and EES with OR: 0.90, 95% CI:
0.73-1.10; P=0.30. Moreover, CABG was associated with a high stroke rate,
with OR: 0.73, 95% CI: 0.45-1.17; P=0.19, without any statistical
significant. CABG was associated with significantly lower Major Adverse
Cardiac Events and Myocardial Infarction with OR: 1.46, 95% CI: 1.05-2.04;
P=0.03 and OR: 1.46, 95% CI: 1.01-2.12; P=0.05 respectively whereas PCI
was associated with a significantly higher repeated revascularization with
OR: 2.21; 95% CI: 1.76-2.77; P=0.00001. In conclusion, significant
differences were noted in several subgroups analyzing the mid-term
cardiovascular outcomes between CABG and EES.

<73>
Accession Number
621937879
Author
Harrison S.; Stiles B.; Altorki N.
Institution
(Harrison, Stiles, Altorki) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United
States
(Harrison) Department of Cardiothoracic Surgery, New York-Presbyterian
Brooklyn Methodist Hospital, New York, NY, United States
Title
What is the role of wedge resection for T1a lung cancer?.
Source
Journal of Thoracic Disease. 10 (Supplement10) (pp S1157-S1162), 2018.
Date of Publication: 01 Apr 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Since 1995, lobar resection became the standard of care for medically fit
patients with early stage lung cancer. This was based on the results of a
single randomized trial comparing lobectomy and sublobar resection (SLR)
in stage I lung cancer conducted by the lung cancer study group between
1982 and 1988. The conclusions of the study included a statistically
significant tripling in loco-regional recurrence (LR) after limited
resection but no difference between the two arms of the trial in systemic
recurrence. Although both overall survival and cancer specific survival
favored lobectomy, neither achieved statistical significance. Regardless,
this landmark trial established lobectomy as the preferred oncological
resection for early stage lung cancer. The practice of thoracic surgery
has evolved significantly since the study period of the Lung Cancer Study
Group, and this has led some surgeons to question its relevance to
contemporary practice. The increased detection of smaller more precisely
staged tumors combined with the rising segment of the population that is
elderly with limited cardiopulmonary reserve has renewed interest in
sub-lobar resection including wedge resection as either a definitive
therapeutic strategy or as a compromise approach in patients with poor
performance status. The interest in wedge resections is also to some
extent further fueled by the emergence and increased utilization of
competing technologies of local control such as stereotactic radiation or
percutaneous and trans-bronchial ablative techniques. Although the results
of the LCSG still cast a long shadow over the soundness of wedge resection
as a cancer operation, much literature has been published in the
subsequent years on this topic. We present in this review an overview of
the conflicting data and offer our perspective on the role of wedge
resection in early stage lung cancer.<br/>Copyright &#xa9;Journal of
Thoracic Disease.

<74>
Accession Number
621927750
Author
Zhao Q.; Zhu Y.; Xu Z.; Cheng Z.; Mei J.; Chen X.; Wang X.
Institution
(Zhao, Zhu) Ruijin Hospital Shanghai Jiao Tong University, School of
Medicine, Department of Cardiovascular Surgery, Shanghai 200025, China
(Xu) Changhai Hospital of Shanghai, Shanghai, China
(Cheng) Henan Provincial People's Hospital, Zhengzhou, China
(Mei) Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine,
Shanghai, China
(Chen) Nanjing First Hospital, Nanjing, China
(Wang) Jiangsu Province Hospital, Nanjing, China
Title
Effect of ticagrelor plus aspirin, ticagrelor alone, OR aspirin alone on
saphenous vein graft patency 1 year after coronary artery bypass grafting:
A Randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 319 (16) (pp
1677-1686), 2018. Date of Publication: 24 Apr 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The effect of ticagrelor with or without aspirin on saphenous
vein graft patency in patients undergoing coronary artery bypass grafting
(CABG) is unknown. OBJECTIVE: To compare the effect of ticagrelor +
aspirin or ticagrelor alone vs aspirin alone on saphenous vein graft
patency 1 year after CABG. DESIGN, SETTING, AND PARTICIPANTS: Randomized,
multicenter, open-label, clinical trial among 6 tertiary hospitals in
China. Eligible patients were aged 18 to 80 years with indications for
elective CABG. Patients requiring urgent revascularization, concomitant
cardiac surgery, dual antiplatelet or vitamin K antagonist therapy
post-CABG, and who were at risk of serious bleeding were excluded. From
July 2014 until November 2015, 1256 patients were identified and 500 were
enrolled. Follow-up was completed in January 2017. INTERVENTIONS: Patients
were randomized (1:1:1) to start ticagrelor (90 mg twice daily) + aspirin
(100 mg once daily) (n = 168), ticagrelor (90 mg twice daily) (n = 166),
or aspirin (100 mg once daily) (n = 166) within 24 hours post-CABG.
Neither patients nor treating physicians were blinded to allocation. MAIN
OUTCOMESAND MEASURES: Primaryoutcome was saphenous vein graft patency1year
after CABG (FitzGibbon grade A) adjudicated independently by a committee
blinded to allocation. Saphenous vein graft patency was assessed by
multislice computed tomographic angiography or coronary angiography.
RESULTS: Among 500 randomized patients (mean age, 63.6 years; women, 91
[18.2%]), 461 (92.2%) completed the trial. Saphenous vein graft patency
rates 1 year post-CABG were 88.7% (432 of 487 vein grafts) with ticagrelor
+ aspirin; 82.8% (404 of 488 vein grafts) with ticagrelor alone; and 76.5%
(371 of 485 vein grafts) with aspirin alone. The difference between
ticagrelor + aspirin vs aspirin alone was statistically significant (12.2%
[95% CI, 5.2% to 19.2%]; P <.001), whereas the difference between
ticagrelor alone vs aspirin alone was not statistically significant (6.3%
[95% CI, -1.1% to 13.7%]; P =.10). Five major bleeding episodes occurred
during 1 year of follow-up (3 with ticagrelor + aspirin; 2 with ticagrelor
alone). CONCLUSIONS AND RELEVANCE: Among patients undergoing elective CABG
with saphenous vein grafting, ticagrelor + aspirin significantly increased
graft patency after 1 year vs aspirin alone; there was no significant
difference between ticagrelor alone and aspirin alone. Further research
with more patients is needed to assess comparative bleeding
risks.<br/>Copyright &#xa9; 2018 American Medical Association. All rights
reserved.

<75>
Accession Number
621865285
Author
Anastasiadis K.; Antonitsis P.; Kostarellou G.; Kleontas A.; Deliopoulos
A.; Grosomanidis V.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Kostarellou, Kleontas, Deliopoulos,
Grosomanidis, Argiriadou) Cardiothoracic Department, AHEPA University
Hospital, Thessaloniki, Greece
Title
Minimally invasive extracorporeal circulation improves quality of life
after coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1196-1203), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The effect on postoperative health-related quality of life
(HRQoL) after coronary artery bypass grafting (CABG) surgery with
conventional cardiopulmonary bypass (cCPB) and off-pump surgery has been
investigated extensively; however, there are no studies focusing on HRQoL
after surgery with minimally invasive extracorporeal circulation (MiECC).
Therefore, we sought to prospectively investigate the effect of MiECC on
postoperative HRQoL when compared with cCPB in patients undergoing CABG
over a short-term (3-month) follow-up period. METHODS: Sixty patients
scheduled for elective CABG surgery were randomly assigned into two
groups: those who had surgery on MiECC system (n = 30) and those who
underwent CABG using cCPB (n = 30). Quality-of-life assessment was
performed preoperatively (baseline- T0), at first postoperative month (T1)
and at 3-month follow-up (T3). The RAND SF-36 scale was used for data
collection, which included both sociodemographic and clinical
characteristics of patients. The primary outcome of the study was
quantitative measurement of postoperative HRQoL at 3-month follow-up.
RESULTS: Both groups were balanced in terms of demographic, socio-economic
and operative characteristics. At 3-month follow-up, mean SF-36 component
and summary scores in each group were higher in absolute values than the
respective mean baseline scores, apart from role-physical score in
patients operated with cCPB. Patients operated on MiECC showed uniformly
significantly higher values in all individual and summary domains, whereas
patients operated on cCPB showed significant improvement in 6/8 individual
domains. Patients operated on MiECC showed a more pronounced increase in
SF-36 individual domain scores from the first to the third postoperative
month when compared with cCPB, which was statistically significant
regarding physical functioning (P = 0.001), role-physical (P < 0.001),
vitality (P = 0.01) and role-emotional (P = 0.004). This resulted in a
significant improvement in physical (P = 0.002) and mental (P = 0.01)
summary scores. CONCLUSIONS: The current study proves that MiECC
significantly improves HRQoL after coronary surgery compared with cCPB.
This finding, combined with results from large-scale studies showing
superior clinical outcomes from its use, enhances the role of MiECC as a
dominant technique in coronary revascularization surgery.<br/>Copyright
&#xa9; The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<76>
Accession Number
621863445
Author
Kimenai D.M.; Gerritse B.M.; Lucas C.; Rosseel P.M.; Bentala M.; Hattum
P.; van der Meer N.J.M.; Scohy T.V.
Institution
(Kimenai) Department of Extracorporeal Circulation, Amphia Hospital,
Breda, Netherlands
(Gerritse, Hattum, van der Meer, Scohy) Department of Anesthesiology,
Amphia Hospital, Breda, Netherlands
(Lucas) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Academic Medical University Centre of Amsterdam,
Amsterdam, Netherlands
(Rosseel) Department of Cardiothoracic Surgery, Amphia Hospital, Breda,
Netherlands
(Bentala) Department of Clinical Pharmacology, Amphia Hospital, Breda,
Netherlands
Title
Effectiveness of pericardial lavage with or without tranexamic acid in
cardiac surgery patients receiving intravenous tranexamic acid: A
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1124-1131), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Pericardial lavage with saline, with or without tranexamic
acid (TA), is still not evidence-based within current clinical practice as
a part of a blood conservation strategy in cardiac surgery patients
receiving intravenous TA administration. The objective was to determine
whether intravenous TA combined with pericardial lavage with saline, with
or without TA, reduces blood loss by 25% after cardiac surgery measured in
the first 12 h postoperatively. METHODS: In this single-centre, randomized
controlled, multiple-armed, parallel study, individual patients were
randomly assigned to receive either topical administration of 2 g TA
diluted in 200 ml of saline (TA group), 200 ml of saline (placebo group)
or no topical administration at all (control group). Eligible participants
were all adults aged 18 or older and scheduled for elective cardiac
surgery on cardiopulmonary bypass. All patients received 2 g TA
intravenously before sternal incision and 2 g TA after cardiopulmonary
bypass. The main outcome measure was the 12-h postoperative blood loss.
RESULTS: In total, 739 individuals were analysed according to
intention-to-treat analyses (TA group, n = 245 patients; placebo group, n
= 249 patients; control group, n = 245 patients). There was no difference
in the median 12-h postoperative blood loss between the three groups [TA
group, 290 (IQR 190-430) ml; placebo group, 290 (IQR 210-440) ml; control
group, 300 (IQR 190-450) ml, P = 0.759]. CONCLUSIONS: Pericardial lavage,
with or without TA, does not result in a statistically significant
difference in the 12-h postoperative blood loss in cardiac surgery
patients receiving intravenous TA administration. Pericardial lavage with
saline, with or without TA, should not be a part of a blood conservation
strategy.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.