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<1>
Accession Number
617681232
Author
Gastelurrutia P.; Galvez-Monton C.; Camara M.L.; Bustamante-Munguira J.;
Garcia-Pavia P.; Avanzas P.; Alberto San Roman J.; Pascual-Figal D.;
Teresa E.D.; Crespo-Leiro M.G.; Manito N.; Nunez J.; Fernandez-Aviles F.;
Caballero A.; Teis A.; Lupon J.; Brugada R.; Martin C.; Silva J.;
Revilla-Orodea A.; Canovas S.J.; Melero J.M.; Cuenca-Castillo J.J.;
Gonzalez-Pinto A.; Bayes-Genis A.
Institution
(Gastelurrutia, Galvez-Monton, Bayes-Genis) ICREC Research Program,
Fundacio Institut dInvestigacio en Ciencies de la Salut Germans Trias i
Pujol (IGTP), Badalona, Spain
(Gastelurrutia, Galvez-Monton, Bustamante-Munguira, Garcia-Pavia, Alberto
San Roman, Pascual-Figal, Teresa, Crespo-Leiro, Nunez, Fernandez-Aviles,
Lupon, Brugada, Revilla-Orodea, Melero, Cuenca-Castillo, Bayes-Genis)
CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
(Camara, Bustamante-Munguira, Caballero, Teis, Lupon, Bayes-Genis)
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Bustamante-Munguira, Brugada) Hospital Universitari de Girona Josep
Trueta, Girona, Spain
(Garcia-Pavia, Martin) Hospital Universitario Puerta del Hierro, Madrid,
Spain
(Avanzas, Silva) Hospital Universitario Central de Asturias, Oviedo, Spain
(Alberto San Roman, Revilla-Orodea) Hospital Clinico Universitario,
Valladolid ICICORELAB, Valladolid, Spain
(Pascual-Figal, Canovas) Hospital Clinico Universitario Virgen de la
Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
(Teresa, Melero) Hospital Clinico Universitario Virgen de la Victoria de
Malaga, IDIMA, Malaga, Spain
(Crespo-Leiro, Cuenca-Castillo) Complejo Hospitalario Universitario A
Coruna (CHUAC), A Coruna, Spain
(Manito) Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat,
Spain
(Nunez) Hospital Clinic de Valencia, Valencia, Spain
(Fernandez-Aviles, Gonzalez-Pinto) Hospital General Universitario Gregorio
Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid,
Spain
(Lupon, Bayes-Genis) Department of Medicine, Universitat Autonoma de
Barcelona, Barcelona, Spain
Title
Rationale and design of a multicentre, prospective, randomised, controlled
clinical trial to evaluate the efficacy of the adipose graft transposition
procedure in patients with a myocardial scar: The AGTP II trial.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e017187. Date of
Publication: 01 Aug 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Cardiac adipose tissue is a source of progenitor cells with
regenerative capacity. Studies in rodents demonstrated that the
intramyocardial delivery of cells derived from this tissue improves
cardiac function after myocardial infarction (MI). We developed a new
reparative approach for damaged myocardium that integrates the
regenerative properties of cardiac adipose tissue with tissue engineering.
In the adipose graft transposition procedure (AGTP), we dissect a
vascularised flap of autologous pericardial adipose tissue and position it
over the myocardial scarred area. Following encouraging results in acute
and chronic MI porcine models, we performed the clinical trial
(NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic
MI undergoing coronary artery bypass graft. The good safety profile and
trends in efficacy warranted a larger trial. Study design The AGTP II
trial (NCT02798276) is an investigator initiated, prospective, randomised,
controlled, multicentre study to assess the efficacy of the AGTP in 108
patients with non-revascularisable MI. Patients will be assigned to
standard clinical practice or the AGTP. The primary endpoint is change in
necrotic mass ratio by gadolinium enhancement at 91 and 365 days.
Secondary endpoints include improvement in regional contractibility by MRI
at 91 and 365 days; changes in functional MRI parameters (left ventricular
ejection fraction, left and right ventricular geometric remodelling) at 91
and 365 days; levels of N-terminal prohormone of brain natriuretic peptide
(NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour
Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or
re-hospitalisation at 365 days; and cardiovascular death or
re-hospitalisation at 365 days. Ethics and dissemination The institutional
review board approved the trial which will comply with the Declaration of
Helsinki. All patients will provide informed consent. It may offer a
novel, effective and technically simple technique for patients with no
other therapeutic options. The results will be submitted to indexed
medical journals and national and international meetings.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<2>
Accession Number
618536171
Author
Blaudszun G.; Butchart A.; Klein A.A.
Institution
(Blaudszun, Butchart, Klein) Department of Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Title
Blood conservation in cardiac surgery.
Source
Transfusion Medicine. 28 (2) (pp 168-180), 2018. Date of Publication:
April 2018.
Publisher
Blackwell Publishing Ltd
Abstract
This article aims at reviewing the currently available evidence about
blood conservation strategies in cardiac surgery. Pre-operative anaemia
and perioperative allogeneic blood transfusions are associated with worse
outcomes after surgery. In addition, transfusions are a scarce and costly
resource. As cardiac surgery accounts for a significant proportion of all
blood products transfused, efforts should be made to decrease the risk of
perioperative transfusion. Pre-operative strategies focus on the detection
and treatment of anaemia. The management of haematological abnormalities,
most frequently functional iron deficiency, is a matter for debate.
However, iron supplementation therapy is increasingly commonly
administered. Intra-operatively, antifibrinolytics should be routinely
used, whereas the cardiopulmonary bypass strategy should be adapted to
minimise haemodilution secondary to circuit priming. There is less
evidence to recommend minimally invasive surgery. Cell salvage and
point-of-care tests should also be a part of the routine care.
Post-operatively, any unnecessary iatrogenic blood loss should be
avoided.<br/>Copyright &#xa9; 2017 British Blood Transfusion Society

<3>
Accession Number
619290615
Author
Biancari F.; Perrotti A.; Dalen M.; Guerrieri M.; Fiore A.; Reichart D.;
Dell'Aquila A.M.; Gatti G.; Ala-Kokko T.; Kinnunen E.-M.; Tauriainen T.;
Chocron S.; Airaksinen J.K.E.; Ruggieri V.G.; Brascia D.
Institution
(Biancari, Kinnunen, Tauriainen, Airaksinen, Brascia) Heart Center, Turku
University Hospital and Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Guerrieri) Department of Surgery, University of Oulu, Oulu,
Finland
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Reichart) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila) Department of Cardiothoracic Surgery, University Hospital
Muenster, Muenster, Germany
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Ala-Kokko) Department of Anesthesiology, Division of Intensive Care
Medicine, Oulu University Hospital, Medical Research Center Oulu, Oulu
University, Oulu, Finland
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
Title
Meta-Analysis of the Outcome After Postcardiotomy Venoarterial
Extracorporeal Membrane Oxygenation in Adult Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1175-1182),
2018. Date of Publication: June 2018.
Publisher
W.B. Saunders
Abstract
Objective: This study was planned to pool existing data on outcome and to
evaluate the efficacy of postcardiotomy venoarterial extracorporeal
membrane oxygenation (VA-ECMO) in adult patients. Design: Systematic
review of the literature and meta-analysis. Setting: Multi-institutional
study. Participants: Adult patients with acute heart failure immediately
after cardiac surgery. Interventions: VA-ECMO after cardiac surgery.
Studies evaluating only heart transplant patients were excluded from this
analysis. Measurements and Main Results: A literature search was performed
to identify studies published since 2000. Thirty-one studies reported on
2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO.
The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1%
(95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%,
major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal
wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%.
The pooled mean number of transfused red blood cell units was 17.7 (95% CI
13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI
10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years,
p = 0.015) and their blood lactate level before starting VA-ECMO was lower
(mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year
survival rate was 30.9% (95% CI 24.3-37.5). Conclusions: Pooled data
showed that VA-ECMO may salvage one-third of patients unresponsive to any
other resuscitative treatment after adult cardiac surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<4>
Accession Number
620609218
Author
Struck R.; Wittmann M.; Muller S.; Meybohm P.; Muller A.; Bagci S.
Institution
(Struck, Wittmann, Muller) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Muller) Department of Anesthesiology and Intensive Care and Emergency
Medicine and Pain Therapy Kemperhof Koblenz, Gemeinschaftsklinikum
Mittelrhein, Koblenz, Germany
(Meybohm) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Muller, Bagci) Neonatology and Pediatric Intensive Care, Children's
Hospital, University of Bonn, Bonn, Germany
Title
Effect of Remote Ischemic Preconditioning on Intestinal
Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A
Randomized Controlled Pilot Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1243-1247),
2018. Date of Publication: June 2018.
Publisher
W.B. Saunders
Abstract
Objective: Cardiopulmonary bypass (CPB) surgery commonly threatens the
heart and remote organs with ischemia-reperfusion injury. Transient
episodes of ischemia to nonvital tissue, known as remote ischemic
preconditioning (RIPC), is thought to help local and remote vital organs
to withstand subsequent ischemic insults. Design: Prospective, randomized,
double-blinded control trial. Setting: Tertiary referral academic teaching
hospital. Participants: Thirty patients undergoing elective CPB surgery
Intervention: RIPC was achieved via three 5-minute cycles of upper limb
ischemia using a blood pressure cuff or control (sham cuff). Measurements
and Main Results: Primary outcome was the occurrence of intestinal injury,
as measured by an increase in intestinal fatty acid binding protein
(I-FABP). Secondary outcomes included incidence of gastrointestinal
complications and duration of intensive care unit (ICU) stay. RIPC did not
affect serum IFABP levels at the end of surgery and on the first
postoperative day (p = 0.697 and p = 0.461, respectively). For all
patients, mean I-FABP levels significantly increased at the end of surgery
and decreased to under baseline levels on the first postoperative day
(from a mean [+/- standard deviation] baseline value of 764 +/- 492 pg/mL
to 2,002 +/- 974 pg/mL and decreased to 568 +/- 319 pg/mL, p < 0.001). All
patients remained clinically absent of gastrointestinal complications
until hospital discharge. Duration of ICU stay was not correlated with
I-FABP levels at the end of surgery. Neither duration of CPB nor duration
of aortic clamping significantly correlated with postoperative I-FABP
levels. Conclusions: These findings suggest that RIPC does not affect
intestinal injury in patients undergoing CPB surgery. In patients
undergoing cardiac surgery, intestinal injury appears to be moderate and
transient without any clinical relevant complication.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<5>
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Accession Number
621749966
Author
Mousavi Malek N.; Zakerimoghadam M.; Esmaeili M.; Kazemnejad A.
Institution
(Mousavi Malek, Zakerimoghadam) School of Nursing and Midwifery, Tehran
University of Medical Sciences, Nosrat St Tohid Sq, Tehran, Iran, Islamic
Republic of
(Esmaeili) School of Nursing and Midwifery, Nursing and Midwifery Care
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Kazemnejad) Department of Biostatics, Tarbiat Modares University, Tehran,
Iran, Islamic Republic of
Title
Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep before
Coronary Artery Bypass Grafting.
Source
Critical Care Nursing Quarterly. 41 (2) (pp 161-169), 2018. Date of
Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study to examine the effects of supportive-educational
nurse-led intervention on the patients' anxiety and sleep before the
coronary artery bypass grafting. The current clinical trial recruited 160
patients (N = 160) waiting for the coronary artery bypass grafting by
random block sampling and divided them into two 80-people experimental and
control groups. Spielberger's State Anxiety Inventory was completed on the
first day. The Groningen's Sleep Quality Index was also completed by the
patients on the day of surgery. Data were analyzed in SPSS software
version 16, using descriptive and inferential statistics tests. The mean
anxiety score in the experimental group decreased to 48.39, whereas in the
control group, the mean anxiety score saw a rise after the intervention
(61.09). The comparison of the mean quality of sleep the night before the
surgery for both groups showed that sleep in the control group compared
with sleep in the experimental group had a lower quality, and
statistically, it was significant (P <.001). Results showed that
nonpharmacological and supportive interventions can reduce patients'
anxiety and sleep disturbance before the coronary artery bypass grafting.
According to the results, nonpharmacological therapies should be placed at
the top of nurses' tasks.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health,
Inc. All rights reserved.

<6>
Accession Number
620739796
Author
Fayad A.; Shillcutt S.; Meineri M.; Ruddy T.D.; Ansari M.T.
Institution
(Fayad) University of Ottawa, Ottawa, ON, Canada
(Shillcutt) University of Nebraska Medical Center, Omaha, NE, United
States
(Meineri) University of Toronto, Toronto, ON, Canada
(Ruddy) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Ansari) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
Title
Comparative Effectiveness and Harms of Intraoperative Transesophageal
Echocardiography in Noncardiac Surgery: A Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 22 (2) (pp 122-136),
2018. Date of Publication: 01 Jun 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Intraoperative use of transesophageal echocardiography (TEE) has become
commonplace in high-risk noncardiac surgeries but the balance of benefits
and harms remains unclear. This systematic review investigated the
comparative effectiveness and harms of intraoperative TEE in noncardiac
surgery. We searched Ovid MEDLINE, PubMed, EMBASE, and the Cochrane
Library from 1946 to March 2017. Two reviewers independently screened the
literature for eligibility. Studies were assessed for the risk of
selection bias, confounding, measurement bias, and reporting bias. Three
comparative and 13 noncomparative studies were included. Intraoperative
TEE was employed in a total of 1912 of 3837 patients. Studies had
important design limitations. Data were not amenable to quantitative
synthesis due to clinical and methodological diversity. Reported incidence
of TEE complications ranged from 0% to 1.7% in patients undergoing various
procedures (5 studies, 540 patients). No serious adverse events were
observed for mixed surgeries (2 studies, 197 patients). Changes in
surgical or medical management attributable to the use of TEE were noted
in 17% to 81% of patients (7 studies, 558 patients). The only randomized
trial of intraoperative TEE was grossly underpowered to detect meaningful
differences in 30-day postoperative outcomes. There is lack of
high-quality evidence of effectiveness and harms of intraoperative TEE in
the management of non-cardiac surgeries. Evidence, however, indicates
timely evaluation of cardiac function and structure, and hemodynamics.
Future studies should be comparative evaluating confounder-adjusted impact
on both intraoperative and 30-day postoperative clinical
outcomes.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<7>
Accession Number
2000744045
Author
Shaefi S.; Mittel A.; Loberman D.; Ramakrishna H.
Institution
(Shaefi) Divisions of Cardiac Anesthesia and Critical Care, Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Mittel) Cardiothoracic Anesthesiology, New York-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Loberman) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Loberman) Department of Surgery, Harvard Medical School, Boston, MA,
United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology,
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in
Arizona, Phoenix, AZ, United States
Title
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic
Review and Analysis of Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Surgical coronary artery bypass grafting (CABG) is the standard of care
for revascularization of left main or three-vessel coronary artery
disease. The off-pump coronary artery bypass graft (OPCAB) procedure
avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve
long-term outcomes by reducing the rates of perioperative myocardial
injury, stroke, neurocognitive impairment, and cardiac-related mortality.
Several high-quality clinical trials have been conducted since OPCAB
became popular in the 1990s and have demonstrated no benefit of OPCAB over
traditional CABG with respect to these outcomes despite favorable
short-term reductions in transfusion requirements and other postoperative
complications. Ultimately, OPCAB is associated with less effective
myocardial revascularization and does not entirely prevent complications
traditionally associated with cardiopulmonary bypass. This article reviews
major high-quality trials of OPCAB versus traditional CABG with respect to
both short- and long-term clinical outcomes.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<8>
Accession Number
2000741432
Author
Mei B.; Yang S.; Yue Y.; Hou J.; Wang K.; Chen G.; Liang M.; Wu Z.
Institution
(Mei, Yue, Hou, Wang, Chen, Liang, Wu) Department of Cardiac Surgery,
First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
(Yang) Department of Cardiosurgery Intensive Care Unit, First Affiliated
Hospital of Sun Yat-Sen University, Guangzhou, China
(Mei, Yang, Yue, Hou, Wang, Chen, Liang, Wu) Key Laboratory on Assisted
Circulation, Ministry of Health, Guangzhou, China
Title
Acute adrenal cortex injury during cardiopulmonary bypass in a canine
model.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Cardiopulmonary bypass (CPB) might induce systemic inflammatory
responses that cause acute injuries to multiple organs. However, no direct
evidence exists to determine whether CPB leads to adrenal cortex injury or
to describe its underlying mechanism. Methods: Twelve healthy adult
beagles were randomly assigned into control and CPB groups. After
cannulation, mild hypothermia CPB was performed in the CPB group but not
in the control group. The serum concentrations of various cytokines,
cortisol, and aldosterone were assessed. Adrenal cortex injuries were
evaluated using standard histological methods. Steroidogenic enzymes and
the nucleotide-binding oligomerization domain-like receptor containing
pyrin domain 3 (NLRP3) inflammasome pathway were detected using
quantitative polymerase chain reaction and Western blot analysis. Results:
During CPB, serum interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor
alpha cortisol, and aldosterone levels were significantly higher in the
CPB group. The pathologic study revealed higher injury scores (3.6 +/- 0.6
vs 0.7 +/- 0.7) and significantly more severe edema, inflammatory cell
infiltration (lymphocytes and neutrophils), and apoptosis in the CPB
group. The electron microscopic examination showed swollen mitochondria,
ruptured mitochondrial cristae, reduced lipid droplets, and increased
secondary lysosomes in the CPB group. The mRNA expression levels of NLRP3
and the protein levels of 17alpha-hydroxylase and IL-1beta in adrenal
tissue were significantly upregulated in the CPB group. Conclusions: CPB
induces significant systemic and local inflammation in the adrenal cortex
and results in cytological architectural and ultrastructural alterations
in adrenocorticocytes. In addition, the NLRP3 inflammasome pathway might
promote adrenal gland injury during CPB and might represent a novel
potential therapeutic target.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<9>
Accession Number
2000733845
Author
Su L.-J.; Li Y.-M.; Kellum J.A.; Peng Z.-Y.
Institution
(Su, Li, Peng) Department of Critical Care Medicine, Zhongnan Hospital of
Wuhan University, Wuhan, Hubei Province, China
(Kellum, Peng) Center of Critical Care Nephrology, Department of Critical
Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
Title
Predictive value of cell cycle arrest biomarkers for cardiac
surgery-associated acute kidney injury: a meta-analysis.
Source
British Journal of Anaesthesia. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Background: A biomarker test based on a combination of urine tissue
inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor
binding protein 7 (IGFBP7) has been used as a potential biomarker of acute
kidney injury (AKI). Our meta-analysis aimed to evaluate the predictive
value of this biomarker for cardiac surgery-associated acute kidney injury
(CSA-AKI). We searched MEDLINE, PubMed, Cochrane, and EMBASE for studies.
Methods: We evaluated the methodological quality of each included study
using the Quality Assessment of Diagnostic Accuracy Studies 2 criteria.
Meta-DiSc and STATA were used for all statistical analyses. Results: A
total of 10 studies (747 patients) were included in this meta-analysis.
Pooled sensitivity and specificity with corresponding 95% confidence
intervals (CI) were 0.77 (95% CI: 0.70-0.83, I²=40.7%) and 0.76
(95% CI: 0.72-0.79, I²=69.1%), respectively. Pooled positive
likelihood ratio (LR), negative LR, and diagnostic odds ratio were 3.26
(95% CI: 2.51-4.23, I²=50.7%), 0.32 (95% CI: 0.24-0.41,
I²=6.7%), and 10.08 (95% CI: 6.85-14.84, I²=6.7%),
respectively. The area under the curve estimated by summary receiver
operating characteristics was 0.83 [standard error (SE) 0.023] with a Q*
value of 0.759 (SE 0.021). There was no heterogeneity amongst the 10
studies from both threshold and non-threshold effects. Subgroup analysis
showed that the diagnostic value was related to the severity of AKI and
time measurement. Conclusions: This study shows that urinary
[TIMP-2].[IGFBP7] is an effective predictive test for cardiac surgery
associated acute kidney injury with good diagnostic accuracy within 24 h.
Studies examining use of biomarker-guided care bundles are
indicated.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<10>
Accession Number
2000731249
Author
Grieshaber P.; Heim N.; Herzberg M.; Niemann B.; Roth P.; Boening A.
Institution
(Grieshaber, Heim, Herzberg, Niemann, Roth, Boening) Department of Adult
and Pediatric Cardiovascular Surgery, University Hospital Giessen,
Giessen, Germany
Title
Active Chest Tube Clearance After Cardiac Surgery Is Associated With
Reduced Reexploration Rates.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Background: Ineffective evacuation of intrathoracic fluid after cardiac
surgery (retained blood syndrome [RBS]) might increase postoperative
complications, morbidity, and mortality. Active tube clearance (ATC)
technology using an intraluminal clearing apparatus aims at increasing
chest tube drainage efficiency. This study evaluated whether ATC reduces
RBS in an all-comers collective undergoing scheduled cardiac surgery with
cardiopulmonary bypass and full or partial median sternotomy. Methods: In
this nonrandomized prospective trial, 581 consecutive patients undergoing
scheduled cardiac surgery with median sternotomy between January 2016 and
December 2016 were assigned to receive conventional chest tubes (control
group) or a combination of conventional tubes and as many as two ATC
devices (ATC group), depending on their operation date. Postoperative
occurrence of RBS (one or more of the following: reexploration for
bleeding or tamponade, pericardial drainage procedure, pleural drainage
procedure) and other endpoints were compared. Propensity score matching
was applied. Results: In 222 ATC patients and 222 matched control
patients, RBS occurrence did not differ between the groups (ATC 16%,
control 22%; p = 0.15). However, reexploration rate for bleeding or
tamponade was significantly reduced in the ATC group compared with the
control group (4.1% versus 9.1%, respectively; p = 0.015). The mortality
of RBS patients (21%) was higher compared with patients without RBS (3.9%,
p < 0.001). Among the RBS components, only reexploration (odds ratio 16,
95% confidence interval: 5.8 to 43, p < 0.001) was relevant for inhospital
mortality (ATC 6.8%, control 7.7%; p = 0.71). Conclusions: Active tube
clearance is associated with reduced reexploration rates in an all-comers
collective undergoing cardiac surgery. Reexploration is the only RBS
component relevant for mortality. The ATC effect does not translate into
improved overall survival.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons

<11>
Accession Number
2000731187
Author
Nogueira S.S.; Felizardo A.A.; Caldas I.S.; Goncalves R.V.; Novaes R.D.
Institution
(Nogueira, Felizardo, Caldas, Novaes) Institute of Biomedical Sciences,
Federal University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Caldas) Department of Pathology and Parasitology, Federal University of
Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Nogueira, Felizardo, Novaes) Department of Structural Biology, Federal
University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Goncalves) Department of Animal Biology, Federal University of Vicosa,
Vicosa, Minas Gerais 36570-000, Brazil
Title
Challenges of immunosuppressive and antitrypanosomal drug therapy after
heart transplantation in patients with chronic Chagas disease: A
systematic review of clinical recommendations.
Source
Transplantation Reviews. (no pagination), 2018. Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Background: Although contraindicated for decades, heart transplantation
(HT) has finally become a feasible therapeutic option for the treatment of
Chagasic patients with end-stage heart failure. Part of the success in
achieving acceptable survival rates after HT is due to the enhancement of
the pharmacological management of allograft rejection and reactivation of
Trypanosoma cruzi infection. Methods: By using the framework of a
systematic review, we investigated if Chagasic patients who have undergone
a HT are treated with similar immunosuppressive and antitrypanosomal
regimens in endemic and non-endemic countries and exhibits similar T.
cruzi reactivation, allograft rejection and survival rates. From a
structured search in PubMed/Medline, Scopus, and Web of Sciences
databases, 30 clinical studies were reviewed. Results and conclusion:
Although immunosuppressive regimens are variable in endemic and
non-endemic countries, the current evidence supports the administration of
lower doses of corticosteroids, adjusted cyclosporine levels (100-150
ng/mL) 3 months after HT, and azathioprine rather than mycophenolate
mofetil to reduce the risk of T. cruzi reactivation and rejection
episodes. Antitrypanosomal therapy exclusively based on benznidazole,
nifurtimox, and allopurinol was consistent in endemic and non-endemic
countries, achieving effective results in the control of infection
reactivation. The evidence that supports prophylactic antitrypanosomal
therapy or administration of allopurinol alone is limited. By highlighting
the main sources of research bias, we hope that our critical analysis can
help to expedite clinical research and to reduce methodological bias,
thereby improving the quality of evidence in new research
initiatives.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<12>
Accession Number
2000730032
Author
O'Neil M.P.; Alie R.; Guo L.R.; Myers M.-L.; Murkin J.M.; Ellis C.G.
Institution
(Guo, Myers) Department of Surgery, Division of Cardiac Surgery, London
Health Sciences Centre, London, Ontario, Canada
(O'Neil, Alie) Department of Clinical Perfusion Services, Division of
Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
(Murkin) Department of Anesthesiology and Perioperative Medicine, Schulich
School of Medicine and Dentistry, University of Western Ontario, London,
Ontario, Canada
(O'Neil, Ellis) Department of Medical Biophysics, Schulich School of
Medicine and Dentistry, University of Western Ontario, London, Ontario,
Canada
Title
Microvascular Responsiveness to Pulsatile and Nonpulsatile Flow During
Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Background: Pulsatile perfusion may offer microcirculatory advantages over
conventional nonpulsatile perfusion during cardiopulmonary bypass (CPB).
Here, we present direct visual evidence of microvascular perfusion and
vasoreactivity between perfusion modalities. Methods: A prospective,
randomized cohort study of 20 high-risk cardiac surgical patients
undergoing pulsatile (n = 10) or nonpulsatile (n = 10) flow during CPB was
conducted. Changes in sublingual mucosal microcirculation were assessed
with orthogonal polarization spectral imaging along with near-infrared
spectroscopic indices of thenar muscle tissue oxygen saturation
(StO<inf>2</inf>) and its recovery during a vascular occlusion test at the
following time points: baseline (T<inf>0</inf>), 30 minutes on CPB
(T<inf>1</inf>), 90 minutes on CPB (T<inf>2</inf>), 1 hour after CPB
(T<inf>3</inf>), and 24 hours after CPB (T<inf>4</inf>). Results: On the
basis of our scoring scale, a shift in microcirculatory blood flow
occurred over time. The pulsatile group maintained normal perfusion
characteristics, whereas the nonpulsatile group exhibited deterioration in
perfusion during CPB (T<inf>2</inf>: 74.0% +/- 5.6% versus 57.6% +/- 5.0%)
and after CPB (T<inf>3</inf>: 76.2% +/- 2.7% versus 58.9% +/- 5.2%,
T<inf>4</inf>: 85.7% +/- 2.6% versus 69.8% +/- 5.9%). Concurrently, no
important differences were found between groups in baseline
StO<inf>2</inf> and consumption slope at all time points. Reperfusion
slope was substantially different between groups 24 hours after CPB
(T<inf>4</inf>: 6.1% +/- 0.6% versus 3.7% +/- 0.5%), indicating improved
microvascular responsiveness in the pulsatile group versus the
nonpulsatile group. Conclusions: Pulsatility generated by the roller pump
during CPB improves microcirculatory blood flow and tissue oxygen
saturation compared with nonpulsatile flow in high-risk cardiac surgical
patients, which may reflect attenuation of the systemic inflammatory
response and ischemia-reperfusion injury.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<13>
Accession Number
2000644989
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Zembala
M.; Gasior M.; Zembala M.O.
Institution
(Tajstra, Hawranek, Gierlotka, Gasior) 3rd Chair and Department of
Cardiology, SMDZ in Zabrze, Silesian Center for Heart Diseases, Medical
University of Silesia, Katowice, Poland
(Hrapkowicz, Filipiak, Zembala, Zembala) Department of Cardiac, Vascular
and Endovascular Surgery and Transplantology, Silesian Center for Heart
Diseases, Medical University of Silesia, Zabrze, Poland
Title
Hybrid Coronary Revascularization in Selected Patients With Multivessel
Disease: 5-Year Clinical Outcomes of the Prospective Randomized Pilot
Study.
Source
JACC: Cardiovascular Interventions. 11 (9) (pp 847-852), 2018. Date of
Publication: 14 May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aimed to investigate the 5-year clinical follow-up
of the HYBRID (Hybrid Revascularization for Multivessel Coronary Artery
Disease) trial. Background: The HYBRID trial, the only randomized study
involving thorough analysis of outcome after the 2 procedures, suggested
that hybrid coronary revascularization (HCR) is feasible in selected
patients with multivessel coronary disease referred for conventional
coronary artery bypass grafting (CABG). There are currently no long-term
outcome data from randomized trials in this setting. Methods: A total of
200 patients with multivessel coronary disease referred for conventional
surgical revascularization were randomly assigned to undergo HCR or CABG.
The primary endpoint was the occurrence of all-cause mortality at 5 years.
Results: Nine patients (4 in HCR and 5 in CABG group) were lost to the
5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG group)
formed the basis of this study. The groups were well balanced in terms of
pre-procedural characteristics. All-cause mortality at 5-year follow-up
was similar in the 2 groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69).
The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat
revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p =
0.35), and major adverse cardiac and cerebrovascular events (45.2% vs.
53.4%; p = 0.39) were also similar in the 2 groups. Conclusions: HCR has
similar 5-year all-cause mortality when compared with conventional
coronary bypass grafting (Safety and Efficacy Study of Hybrid
Revascularization in Multivessel Coronary Artery Disease;
NCT01035567)<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<14>
Accession Number
621928180
Author
Navarese E.P.; Robinson J.G.; Kowalewski M.; Kolodziejczak M.; Andreotti
F.; Bliden K.; Tantry U.; Kubica J.; Raggi P.; Gurbel P.A.
Institution
(Navarese, Bliden, Tantry, Gurbel) Interventional Cardiology and
Cardiovascular Medicine Research, Inova Center for Thrombosis Research and
Drug Development, Inova Heart and Vascular Institute, Falls Church, VA,
United States
(Navarese, Kowalewski, Kolodziejczak, Andreotti, Gurbel) Systematic
Investigation and Research on Interventions and Outcomes (SIRIO), MEDICINE
Cardiovascular Research Network, United States
(Navarese, Kolodziejczak, Kubica) Cardiovascular Institute, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Poland
(Robinson) Prevention Intervention Center, Department of Epidemiology and
Medicine, University of Iowa, S455 CPHB, 145 N Riverside Dr, Iowa City, IA
52242, United States
(Kowalewski) Department of Cardiac Surgery, Cardiovascular Institute, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Andreotti) Institute of Cardiology, Catholic University, Medical School,
Rome, Italy
(Raggi) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Title
Association between baseline LDL-C level and total and cardiovascular
mortality after LDL-C lowering a systematic review and meta-analysis.
Source
JAMA - Journal of the American Medical Association. 319 (15) (pp
1566-1579), 2018. Date of Publication: 17 Apr 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Effects on specific fatal and nonfatal end points appear to
vary for low-density lipoprotein cholesterol (LDL-C)-lowering drug trials.
OBJECTIVE: To evaluate whether baseline LDL-C level is associated with
total and cardiovascular mortality risk reductions. DATA SOURCESAND STUDY
SELECTION: Electronic databases (Cochrane, MEDLINE, EMBASE, TCTMD,
ClinicalTrials.gov, major congress proceedings) were searched through
February 2, 2018, to identify randomized clinical trials of statins,
ezetimibe, and PCSK9-inhibiting monoclonal antibodies. DATA EXTRACTION AND
SYNTHESIS: Two investigators abstracted data and appraised risks of bias.
Intervention groups were categorized as "more intensive" (more potent
pharmacologic intervention) or "less intensive" (less potent, placebo, or
control group). MAIN OUTCOMES AND MEASURES: The coprimary end points were
total mortality and cardiovascular mortality. Random-effects
meta-regression and meta-analyses evaluated associations between baseline
LDL-C level and reductions in mortality end points and secondary end
points including major adverse cardiac events (MACE). RESULTS: In 34
trials, 136 299 patients received more intensive and 133 989 received less
intensive LDL-C lowering. All-cause mortality was lower for more vs less
intensive therapy (7.08% vs 7.70%; rate ratio [RR], 0.92 [95% CI, 0.88 to
0.96]), but varied by baseline LDL-C level. Meta-regression showed more
intensive LDL-C lowering was associated with greater reductions in
all-cause mortality with higher baseline LDL-C levels (change in RRs per
40-mg/dL increase in baseline LDL-C, 0.91 [95% CI, 0.86 to 0.96]; P =.001;
absolute risk difference [ARD], -1.05 incident cases per 1000 person-years
[95% CI, -1.59 to -0.51]), but only when baseline LDL-C levels were 100
mg/dL or greater (P <.001 for interaction) in a meta-analysis.
Cardiovascular mortality was lower for more vs less intensive therapy
(3.48% vs 4.07%; RR, 0.84 [95% CI, 0.79 to 0.89]) but varied by baseline
LDL-C level. Meta-regression showed more intensive LDL-C lowering was
associated with a greater reduction in cardiovascular mortality with
higher baseline LDL-C levels (change in RRs per 40-mg/dL increase in
baseline LDL-C, 0.86 [95% CI, 0.80 to 0.94]; P <.001; ARD, -1.0 incident
cases per 1000 person-years [95% CI, -1.51 to -0.45]), but only when
baseline LDL-C levels were 100 mg/dL or greater (P <.001 for interaction)
in a meta-analysis. Trials with baseline LDL-C levels of 160 mg/dL or
greater had the greatest reduction in all-cause mortality (RR, 0.72 [95%
CI, 0.62 to 0.84]; P <.001; 4.3 fewer deaths per 1000 person-years) in a
meta-analysis. More intensive LDL-C lowering was also associated with
progressively greater risk reductions with higher baseline LDL-C level for
myocardial infarction, revascularization, and MACE. CONCLUSIONS AND
RELEVANCE: In these meta-analyses and meta-regressions, more intensive
compared with less intensive LDL-C lowering was associated with a greater
reduction in risk of total and cardiovascular mortality in trials of
patients with higher baseline LDL-C levels. This association was not
present when baseline LDL-C level was less than 100 mg/dL, suggesting that
the greatest benefit from LDL-C-lowering therapy may occur for patients
with higher baseline LDL-C levels.<br/>Copyright &#xa9; 2018 American
Medical Association. All rights reserved.

<15>
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.

<16>
[Use Link to view the full text]
Accession Number
621681840
Author
Phan K.; Luc J.G.Y.; Xu J.; Maltais S.; Stulak J.M.; Yan T.D.;
Tchantchaleishvili V.
Institution
(Phan, Xu, Tchantchaleishvili) Faculty of Medicine, University of Sydney,
Sydney, Australia
(Phan, Yan) Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Luc) Department of Surgery, Faculty of Medicine and Dentistry, University
of Alberta, Edmonton, AB, Canada
(Maltais, Stulak) Department of Cardiovascular Surgery, Mayo Clinic and
Foundation, Rochester, MN, United States
(Yan) Department of Cardiothoracic Surgery, University of Sydney, Royal
Prince Alfred Hospital, Sydney, Australia
(Tchantchaleishvili) Department of Surgery, Division of Cardiac Surgery,
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
14642, United States
(Tchantchaleishvili) Department of Surgery, Division of Cardiothoracic
Surgery, Thomas Jefferson University, Philadelphia, PA, United States
Title
Utilization and outcomes of temporary mechanical circulatory support for
graft dysfunction after heart transplantation.
Source
ASAIO Journal. 63 (6) (pp 695-703), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Graft dysfunction is the main cause of early mortality after heart
transplantation. In cases of severe graft dysfunction, temporary
mechanical circulatory support (TMCS) may be necessary. The aim of this
systematic review was to examine the utilization and outcomes of TMCS in
patients with graft dysfunction after heart transplantation. Electronic
search was performed to identify all studies in the English literature
assessing the use of TMCS for graft dysfunction. All identified articles
were systematically assessed for inclusion and exclusion criteria. Of the
5,462 studies identified, 41 studies were included. Among the 11,555
patients undergoing heart transplantation, 695 (6.0%) required TMCS with
patients most often supported using venoarterial extracorporeal membrane
oxygenation (79.4%) followed by right ventricular assist devices (11.1%),
biventricular assist devices (BiVADs) (7.5%), and left ventricular assist
devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be
supported longer (p = 0.003), have a higher death by cardiac event (p =
0.013) and retransplantation rate (p = 0.015). In contrast, patients
supported with BiVAD and LVAD were more likely to be weaned off support (p
= 0.020). Overall, no significant difference was found in pooled 30 day
survival (p = 0.31), survival to discharge (p = 0.19), and overall
survival (p = 0.51) between the subgroups. Temporary mechanical
circulatory support is an effective modality to support patients with
graft dysfunction after heart transplantation. Further studies are needed
to establish the optimal threshold and strategy for TMCS and to augment
cardiac recovery and long-term survival.<br/>&#xa9; Copyright 2017 by the
ASAIO.

<17>
Accession Number
2000648523
Author
Tarantini G.; D'Amico G.; Brener S.J.; Tellaroli P.; Basile M.; Schiavo
A.; Mojoli M.; Fraccaro C.; Marchese A.; Musumeci G.; Stone G.W.
Institution
(Tarantini, D'Amico, Schiavo, Mojoli, Fraccaro) Cardiology Unit,
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
Medical School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, New York, New York, United States
(Tellaroli) Epidemiology and Public Health Unit, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy
(Basile, Marchese) Anthea Hospital, GVM Care & Research, Cardiology Unit,
Bari, Italy
(Musumeci) Papa Giovanni XXIII Hospital, Bergamo, Italy
(Stone) Columbia University Medical Center, New York Presbyterian
Hospital, the Cardiovascular Research Foundation, New York, New York,
United States
Title
Survival After Varying Revascularization Strategies in Patients With
ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery
Disease: A Pairwise and Network Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 9 (17) (pp 1765-1776), 2016. Date of
Publication: 12 September 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors conducted a systematic pairwise and network
meta-analysis to assess optimal treatment strategies in patients with
ST-segment elevation myocardial infarction (STEMI) and multivessel
coronary artery disease (MV-CAD) undergoing primary percutaneous coronary
intervention (PCI). Background: Patients with STEMI and MV-CAD have a
worse prognosis than those with single-vessel CAD. The optimal
revascularization strategy for these patients is uncertain. Methods:
Studies of revascularization strategies for MV-CAD in STEMI patients
undergoing primary PCI published between 2001 and 2015 were identified
using an electronic search. Pairwise and network meta-analyses were
performed for 3 PCI strategies in prospective and retrospective studies:
1) infarct-related artery (IRA)-only PCI; 2) single procedure MV-PCI; and
3) staged MV-PCI. Information on study design, inclusion and exclusion
criteria, and clinical outcomes was extracted. The outcomes of interest
were short-term and long-term mortality. Results: Thirty-two studies (13
prospective and 19 retrospective) with 54,148 patients (IRA-only PCI [n =
42,112], single procedure MV-PCI [n = 8,138], and staged MV-PCI [n =
3,898]) were included in the analysis. Pairwise meta-analyses showed that
staged MV-PCI was associated with lower short-term and long-term mortality
compared with both IRA-only PCI and single stage MV-PCI, whereas IRA-only
PCI was associated with lower mortality compared with single stage MV-PCI.
Staged MV-PCI was also associated consistently with improved survival in
network analyses. Conclusions: The present systematic review and
meta-analysis supports the hypothesis that in patients with MV-CAD
presenting with STEMI undergoing primary PCI, a staged multivessel
revascularization strategy may improve early and late
survival.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<18>
Accession Number
621796319
Author
Panigrahi D.; Roychowdhury S.; Guhabiswas R.; Rupert E.; Das M.; Narayan
P.
Institution
(Panigrahi, Roychowdhury, Guhabiswas, Rupert) Department of Cardiac
Anesthesia, NH Rabindranath Tagore International Institute of Cardiac
Sciences, Kolkata, India
(Das, Narayan) Department of Cardiac Surgery, NH Rabindranath Tagore
International Institute of Cardiac Sciences, Kolkata, India
Title
Myocardial protection following del Nido cardioplegia in pediatric cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 26 (4) (pp 267-272), 2018. Date
of Publication: 01 May 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: This study was designed to compare myocardial protection with
del Nido cardioplegia and conventional blood cardioplegia in children
undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery
categories 1 and 2. Methods: Sixty patients were randomized into 2 groups
receiving del Nido cardioplegia solution or conventional blood
cardioplegia. Myocardial injury was assessed using biochemical markers
(troponin I and creatine kinase-MB). Vasoactive-inotropic scores were
calculated to compare inotropic requirements. Results: Demographic
characteristics, cardiopulmonary bypass time, and aortic crossclamp time
were comparable in the 2 groups. Time-related changes in troponin I and
creatine kinase-MB were similar in both groups. Statistically significant
differences were seen in total cardioplegia volume requirement (p <
0.0001), number of cardioplegia doses given (p < 0.0001), packed red cell
volume usage during cardiopulmonary bypass (p < 0.02), and time taken to
restore spontaneous regular rhythm (p < 0.0001). Vasoactive-inotropic
scores on transfer to the intensive care unit (p < 0.040) and at 24 h (p <
0.030) were significantly lower in the del Nido group. Duration of
mechanical ventilation, intensive care unit stay, and hospital stay were
comparable in the 2 groups. Conclusions: Our results show that del Nido
cardioplegia solution is as safe as conventional blood cardioplegia.
Moreover, it provides the benefits of reduced dose requirement, lower
consumption of allogenic blood on cardiopulmonary bypass, quicker
resumption of spontaneous regular cardiac rhythm, and less inotropic
support requirement on transfer to the intensive care unit and at 24 h,
compared to conventional blood cardioplegia.<br/>Copyright &#xa9; 2018,
&#xa9; The Author(s) 2018.

<19>
Accession Number
621375589
Author
Pressler A.; Forschner L.; Hummel J.; Haller B.; Christle J.W.; Halle M.
Institution
(Pressler, Forschner, Hummel, Christle, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Technische Universitat Munchen,
Germany
(Haller) Institute for Medical Statistics and Epidemiology, Technische
Universitat Munchen, Germany
(Christle) Department of Medicine, Stanford University, United States
(Halle) DZHK (German Center for Cardiovascular Research), partner site
Munich Heart Alliance, Germany
Title
Long-term effect of exercise training in patients after transcatheter
aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot
study.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 794-801), 2018. Date
of Publication: 01 May 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Increased exercise capacity favourably influences clinical
outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI
randomised pilot trial, eight weeks of endurance and resistance training
(training group, TG) shortly after transcatheter aortic valve implantation
resulted in significantly improved exercise capacity, muscular strength
and quality of life compared to usual care (UC). However, the long-term
clinical benefits of such an intervention are unknown. Design: A
randomised controlled trial. Methods: SPORT:TAVI participants underwent
reassessment of trial endpoints 24 +/- 6 months after baseline: maximal
oxygen uptake (VO<inf>2</inf>peak) and anaerobic threshold
(VO<inf>2</inf>AT) were assessed with cardiopulmonary exercise testing,
muscular strength with one-repetition maximum testing, quality of life
with the Kansas City cardiomyopathy and medical outcomes study 12-item
short-form health survey questionnaires, and prosthetic aortic valve
function with echocardiography. Results: Of 27 original participants (TG
13; UC 14; age 81 +/- 6 years), more patients had died during follow-up in
UC (n = 5) than in TG (n = 2; P = 0.165); three further patients (TG 1; UC
2) were unavailable for other reasons. In the remaining patients (TG 10;
UC 7), a significant between-group difference in favour of TG was observed
for change in VO<inf>2</inf>AT from baseline (2.7 ml/min/kg (95%
confidence interval 0.8-4.6); P = 0.008), but not for change in
VO<inf>2</inf>peak (2.1 ml/min/kg (-1.1-5.4); P = 0.178). Changes in
muscular strength and quality of life did not differ between groups over
time. Overall, prosthetic valve function remained intact in both groups.
Conclusions: Eight weeks of exercise training shortly after transcatheter
aortic valve implantation resulted in preserved long-term improvements in
VO<inf>2</inf>AT, but not VO<inf>2</inf>peak, muscular strength or quality
of life compared to usual care. The findings emphasise the importance of
ongoing exercise interventions following transcatheter aortic valve
implantation to maintain initial improvements long term. Clinical Trial
Registration (original trial): Clinicaltrials.gov
NCT01935297.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of
Cardiology 2018.

<20>
Accession Number
618808988
Author
Coverdale N.S.; Hamilton A.; Petsikas D.; McClure R.S.; Malik P.; Milne
B.; Saha T.; Zelt D.; Brown P.; Payne D.M.
Institution
(Coverdale, Hamilton, Petsikas, Zelt, Brown, Payne) Department of Surgery,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
(McClure) Department of Surgery, Libin Cardiovascular Institute of
Alberta, Foothills Medical Center, University of Calgary, Calgary,
Alberta, Canada
(Malik) Department of Medicine, Queen's University and Kingston General
Hospital, Kingston, Ontario, Canada
(Milne, Saha) Department of Anesthesiology and Perioperative Medicine,
Queen's University and Kingston General Hospital, Kingston, Ontario,
Canada
Title
Remote Ischemic Preconditioning in High-risk Cardiovascular Surgery
Patients: A Randomized-controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 26-33), 2018.
Date of Publication: Spring 2018.
Publisher
W.B. Saunders
Abstract
Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic
injury after cardiovascular surgery. However, it is unclear whether RIPC
has a positive impact on clinical outcomes. We performed a blinded,
randomized controlled trial to determine if RIPC resulted in fewer adverse
clinical outcomes after cardiac or vascular surgery. The intervention
consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated
with 5 minutes of rest. A sham intervention was performed on the control
group. Patients were recruited who were undergoing (1) high-risk cardiac
or vascular surgery or (2) cardiac or vascular surgery and were at high
risk of ischemic complications. The primary end point was a composite
outcome of mortality, myocardial infarction, stroke, renal failure,
respiratory failure, and low cardiac output syndrome, and the secondary
end points included the individual outcome parameters that made up this
score, as well as troponin-I values. A total of 436 patients were
randomized and analysis was performed on 215 patients in the control group
and on 213 patients in the RIPC group. There were no differences in the
composite outcome between the 2 groups (RIPC: 67 [32%] and control: 72
[34%], relative risk [0.94 {0.72-1.24}]) or in any of the individual
components that made up the composite outcome. Additionally, we did not
observe any differences between the groups in troponin-I values, the
length of intensive care unit stay, or the total hospital stay. RIPC did
not have a beneficial effect on clinical outcomes in patients who had
cardiovascular surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<21>
Accession Number
620719044
Author
Weinberg L.; Chiam E.; Hooper J.; Liskaser F.; Hawkins A.K.; Massie D.;
Ellis A.; Tan C.O.; Story D.; Bellomo R.
Institution
(Weinberg, Hooper, Liskaser, Hawkins, Tan) Department of Anesthesia,
Austin Health, Heidelberg, VIC, Australia
(Weinberg, Chiam) Department of Surgery, The University of Melbourne,
Austin Health, VIC, Australia
(Massie, Ellis) Department of Clinical Pharmacology & Therapeutics, Austin
Hospital, Heidelberg, VIC, Australia
(Story) Anesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, The University of Melbourne, VIC,
Australia
Title
Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump
prime: a prospective double-blind randomized trial.
Source
Perfusion (United Kingdom). 33 (4) (pp 310-319), 2018. Date of
Publication: 01 May 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The mechanisms of acid-base changes during cardiopulmonary
bypass (CPB) remain unclear. We tested the hypothesis that, when used as
CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution
(HS) have differential mechanisms of action in their contribution to
acid-base changes. Methods: We performed a prospective, double-blind,
randomized trial in adult patients undergoing elective cardiac surgery
with CPB. Participants received a CPB prime solution of 2000 mL, with
either PL or HS. The primary endpoint was the standard base excess (SBE)
value measured at 60 minutes after full CPB flows (SBE60min). Secondary
outcomes included changes in SBE, pH, chloride, sodium, lactate,
gluconate, acetate, strong ion difference and strong ion gap at two
(T2min), five (T5min), ten (T10min), thirty (T30min) and sixty (T60min)
minutes on CPB. The primary outcome was measured using a two-tailed
Welch's t-test. Repeated measures ANOVA was used to test for differences
between time points. Results: Twenty-five participants were randomized to
PL and 25 to HS. Baseline characteristics, EURO and APACHE scores,
biochemistry, hematology and volumes of cardioplegia were similar. Mean
(SD) SBE at T60min was -1.3 (1.4) in the PL group and -0.1 (2.7) in the HS
group; p=0.55. No significant differences in SBE between the groups was
observed during the first 60 minutes (p=0.48). During CPB, there was
hyperacetatemia and hypergluconatemia in the PL group and hyperlactatemia
and hyperchloremia in the HS group. No significant difference between the
groups in plasma bicarbonate levels and total weak acid levels were found.
Complications and intensive care unit and hospital length of stays were
similar. Conclusions: During CPB, PL and HS did not cause a significant
metabolic acidosis. There was hyperacetatemia and hypergluconatemia with
PL and hyperchloremia and hyperlactatemia with HS. These physiochemical
effects appear clinically innocuous.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<22>
Accession Number
622094643
Author
Fukuchi T.
Institution
(Fukuchi) Division of General Medicine, Jichi Medical University, Saitama
Medical Center, Japan
Title
Comparative assessment of guidelines for individuals with a risk of
infective endocarditis.
Source
International Journal of Antimicrobial Agents. Conference: 30th
International Congress of Chemotherapy and Infection, ICC 2017. Taiwan
(Republic of China). 50 (Supplement 2) (pp S261), 2017. Date of
Publication: November 2017.
Publisher
Elsevier B.V.
Abstract
Background: Infective endocarditis is a severe disease with high morbidity
and mortality rates. Health care providers worldwide should consider means
to prevent this disease; however, guidelines related this topic differ
among industrialized countries. The author makes close examination of
these guidelines. Methods: The guidelines of the United Kingdom's National
Institute for Health and Care Excellence (NICE) are the most notable, but
do not contain prescription recommendations for prophylactic antibiotics,
while the European Society of Cardiology (ESC) recommends antibiotics for
only the highest-risk individuals, and only during dental procedures. The
American Heart Association (AHA) recommends antibiotics for the
highest-risk individuals during dental, urological, gastroenterological,
dermatological, and other invasive procedures. In contrast, the Japanese
Society of Cardiology recommends antibiotics for a broader range of
individuals including those with lower risk such as during procedures for
almost all congenital and valvular heart diseases. In addition, the
recommendation in the NICE guideline has been changed slightly because an
English population-based study revealed higher incidence of endocarditis
after the introduction of an aggressive new guideline in 2008. One reason
for the many differences among guidelines might be that no randomized
control trial has been conducted on the prophylactic effect of antibiotics
for individual at risk of endocarditis; therefore, guideline formulating
committees do not do not have access to concrete evidence. In terms of
causative pathogens of endocarditis, staphylococcal endocarditis, which is
unpreventable by oral amoxicilline, has increased worldwide. Findings from
studies in East Asia, including Japan, showthat up to one third of
endocarditis cases are caused by Streptococcus spp. Moreover, as states in
all major guidelines, oral hygiene is more important than dental
procedures for preventing Streptococcus infection. Results: A historical
cohort study reveals indirect evidence for prevention of endocarditis with
amoxicilline, which indicates that the UK guidelines might be
insufficient. The Japanese guidelines implemented standard practices
driven more by the local political climate than scientific evidence. On
the basis of current evidence, neither the AHA nor the ESC guidelines can
be considered superior to the other. Conclusion: Primary care physicians
and dentists should consider prophylaxis against endocarditis during
dental procedures as recommended AHA or ESC.

<23>
Accession Number
622107568
Author
Bion V.; Lowe A.S.W.; Puthucheary Z.; Montgomery H.
Institution
(Bion, Montgomery) Intensive Care Unit, Whittington Hospital, London,
United Kingdom
(Lowe) Neurology Department, Homerton University Hospital, London, United
Kingdom
(Puthucheary) Royal Brompton Hospital, Adult Intensive Care Unit, London,
United Kingdom
(Puthucheary, Montgomery) University College London, Centre for Sports,
Exercise and Health; Institute for Sport Exercise and Health, London,
United Kingdom
Title
Reducing sound and light exposure to improve sleep on the adult intensive
care unit: An inclusive narrative review.
Source
Journal of the Intensive Care Society. 19 (2) (pp 138-146), 2018. Date of
Publication: 01 May 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: Sleep disturbance is common in intensive care units. It is
associated with detrimental psychological impacts and has potential to
worsen outcome. Irregular exposure to sound and light may disrupt
circadian rhythm and cause frequent arousals from sleep. We sought to
review the efficacy of environmental interventions to reduce sound and
light exposure with the aim of improving patient sleep on adult intensive
care units. Methods: We searched both PubMed (1966-30 May 2017) and Embase
(1974-30 May 2017) for all relevant human (adult) studies and
meta-analyses published in English using search terms ((intensive care OR
critical care), AND (sleep OR sleep disorders), AND (light OR noise OR
sound)). Bibliographies were explored. Articles were included if reporting
change in patient sleep in response to an intervention to reduce
disruptive intensive care unit sound /light exposure. Results: Fifteen
studies were identified. Nine assessed mechanical interventions, four of
which used polysomnography to assess sleep. Five studies looked at
environmental measures to facilitate sleep and a further two (one already
included as assessing a mechanical intervention) studied the use of sound
to promote sleep. Most studies found a positive impact of the intervention
on sleep. However, few studies used objective sleep assessments, sample
sizes were small, methodologies sometimes imperfect and analysis limited.
Data are substantially derived from specialist (neurosurgical,
post-operative, cardiothoracic and cardiological) centres. Patients were
often at the 'less sick' end of the spectrum in a variety of settings
(open ward beds or side rooms). Conclusions: Simple measures to reduce
intensive care unit patient sound/light exposure appear effective.
However, larger and more inclusive high-quality studies are required in
order to identify the measures most effective in different patient groups
and any impacts on outcome.<br/>Copyright &#xa9; 2017, &#xa9; The
Intensive Care Society 2017.

<24>
Accession Number
618326864
Author
Ganesan V.; Ponnusamy S.S.; Sundaramurthy R.
Institution
(Ganesan, Ponnusamy, Sundaramurthy) Velammal Medical College Hospital and
Research Institute, Microbiology and Interventional Cardiology, Velammal
Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, India
Title
Fungal endocarditis in paediatrics: A review of 192 cases (1971-2016).
Source
Cardiology in the Young. 27 (8) (pp 1481-1487), 2017. Date of Publication:
01 Oct 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The aims of this article were to review the published
literature on fungal endocarditis in children and to discuss the aetiology
and diagnosis, with emphasis on non-invasive methods and various treatment
regimes. Methods We systematically reviewed published cases and case
series of fungal endocarditis in children. We searched the literature,
including PubMed and individual references for publications of original
articles, single cases, or case series of paediatric fungal endocarditis,
with the following keywords: fungal endocarditis, neonates, infants,
child, and cardiac vegetation. Results There have been 192 documented
cases of fungal endocarditis in paediatrics. The highest number of cases
was reported in infants (93/192, 48%) including 60 in neonates. Of the
neonatal cases, 57 were premature with a median gestational age of 27
weeks and median birth weight of 860 g. Overall, 120 yeast - fungus that
grows as a single cell - infections and 43 mould - fungus that grows in
multicellular filaments, hyphae - infections were reported. With
increasing age, there was an increased infection rate with moulds. All the
yeast infections were detected by blood culture. In cases with mould
infection, diagnosis was mainly established by culture or histology of
emboli or infected valves after invasive surgical procedures. There have
been a few recent cases of successful early diagnosis by non-invasive
methods such as blood polymerase chain reaction (PCR) for moulds. The
overall mortality for paediatric fungal endocarditis was 56.25%. The most
important cause of death was cardiac complications due to heart failure.
Among the various treatment regimens used, none of them was significantly
associated with better outcome. Conclusions Non-invasive methods such as
PCR tests can be used to improve the chances of detecting and identifying
the aetiological agent in a timely manner. Delays in the diagnosis of
these infections may result in high mortality and morbidity. No
significant difference was noted between combined surgical and medical
therapy over exclusively combined medical therapy.<br/>Copyright &#xa9;
Cambridge University Press 2017.

<25>
Accession Number
617558114
Author
Barbanti M.; Buccheri S.; Rodes-Cabau J.; Gulino S.; Genereux P.; Pilato
G.; Dvir D.; Picci A.; Costa G.; Tamburino C.; Leon M.B.; Webb J.G.
Institution
(Barbanti, Buccheri, Gulino, Pilato, Picci, Costa, Tamburino) Division of
Cardiology, Ferrarotto Hospital, University of Catania, Italy
(Rodes-Cabau) Division of Cardiology, Quebec Heart & Lung Institute,
Quebec City, Quebec, Canada
(Genereux) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
Universite de Montreal, Montreal, Quebec, Canada
(Dvir, Webb) Division of Cardiology, St. Paul's Hospital, University of
British Columbia, Vancouver, British Columbia, Canada
(Leon) Division of Cardiology, Columbia University Medical Center/New
York-Presbyterian Hospital, New York, United States
Title
Transcatheter aortic valve replacement with new-generation devices: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 245 (pp 83-89), 2017. Date of
Publication: 15 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective The aim of this study was to conduct a weighted meta-analysis to
determine the rates of acute (<= 30 days) major outcomes after (TAVR) with
second-generation devices. Methods A comprehensive search of multiple
electronic databases from January 2011 to May 2017 was conducted using
predefined criteria. New-generation TAVR devices were defined as any
device which received CE mark approval or is still under evaluation for CE
marking after CoreValve and SAPIEN XT prostheses. Results A total of 37
studies including 10,822 patients met inclusion criteria and were included
in the analysis. Devices investigated in the studies were the following:
SAPIEN 3 (n = 5423, 45.9%), Lotus Valve (n = 3007, %), Portico (n = 130,
1.1%), JenaValve (n = 345, 2.9%), Symetis Acurate (n = 1314, 11,1%), and
Evolut R (n = 1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day
death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%),
respectively; Any stroke and major/disabling stroke occurred at a pooled
estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to
1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to
5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%);
pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild
aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). Conclusions
Second-generation TAVR devices are associated with very low mortality and
major complications rates at 30-day, and improved prosthesis performance
with < 2% of patients having more than mild post-procedural aortic
regurgitation. On the other hand, the need for pacemaker implantation
seems to remain an unresolved issue, and warrants further
investigation.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<26>
Accession Number
615736083
Author
Chavush M.A.; Yagar S.; Erturk A.; Ozgok A.
Institution
(Chavush, Yagar, Erturk, Ozgok) Turkiye Yuksek Ihtisas Training and
Research Hospital, Ankara, Turkey
Title
Preliminary investigation of preoperative pregabalin and total intravenous
anesthesia doses: a randomized controlled trial.
Source
Journal of Clinical Anesthesia. 41 (pp 137-140), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective To determine the efficacy of 2 different doses (150-300
mg) of preoperative pregabalin on propofol and remifentanil doses for
total intravenous anesthesia in laparoscopic cholecystectomy. Design
Prospective, randomized, placebo-controlled, double-blinded study. Setting
Training and research hospital. Patients Forty-eight adult, American
Society of Anesthesiologists physical status 1 and 2 patients.
Interventions Patients were randomly assigned to 3 groups to receive
orally 1 hour before surgery, a placebo group (group 1), pregabalin 150 mg
(group 2), or pregabalin 300 mg (group 3). Measurements In the operating
room, heart rate, systolic and diastolic blood pressures, SpO<inf>2</inf>,
bispectral index, and body temperature were recorded just before
anesthesia induction; 1 and 5 minutes after induction; and at minutes 10,
15, 20, 25, 30, 35, and 40 of the surgery. Required propofol and
remifentanil doses to obtain bispectral index value less than 60 were also
recorded. Main Results The remifentanil doses used in the pregabalin
groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15,
20, 25, and 30 were statistically significantly lower in comparison to the
placebo group. Conclusion The observations provide preliminary evidence
that preoperative pregabalin may decrease anesthetic agent requirement in
total intravenous anesthesia patients.<br/>Copyright &#xa9; 2016 Elsevier
Inc.

<27>
Accession Number
618049564
Author
Phillips B.; Turco L.; Mirzaie M.; Fernandez C.
Institution
(Phillips, Mirzaie, Fernandez) Department of Surgery, Creighton University
School of Medicine, Omaha, NE, United States
(Phillips) Department of Clinical Science and Translational Research,
Creighton University School of Medicine, Omaha, NE, United States
(Turco) Department of Surgery, University of Kansas Medical Center, Kansas
City, KS, United States
Title
Trauma pneumonectomy: A narrative review.
Source
International Journal of Surgery. 46 (pp 71-74), 2017. Date of
Publication: October 2017.
Publisher
Elsevier Ltd
Abstract
Purpose Thoracic injuries are common in both blunt and penetrating trauma.
Most thoracic injuries are managed non-operatively, approximately 7-20%
undergo thoracotomy. Of the injuries requiring thoracotomy, 1-6%
ultimately require pulmonary resection. Wedge resection and lobectomies
are well-studied in the literature; however, there is a paucity regarding
reports on total pneumonectomy in the setting of trauma. Our objectives
were to summarize the evidence supporting the role of trauma pneumonectomy
(TP) in the current era and reiterate that despite the associated
morbidity and mortality TP is justified in selective cases. Methods A
review of the world's literature was conducted following standard
guidelines. Inclusion criteria included those studies reviewing blunt and
penetrating trauma to the lungs in adults (age greater than 15 year) that
reported mortality rates and outcome measures. Results The PubMed search
yielded 713 studies. Of these, 14 studies included pertinent information
on TP. Studies included in this review were published from 1985 to 2017
and involved patient data that was collected from 1972 to 2014. Mortality
ranged from 50% to 100% (median 63%; mean 68%). Conclusion In the setting
of severe thoracic trauma, pulmonary resection may be necessary. Less
aggressive techniques are options in a stable patient; however, in the
setting of ongoing hemorrhage, TP should be considered and expediently
conducted. The role of damage control thoracic surgery and related
techniques is vitally important in these patients to improve the
significant mortality of trauma pneumonectomy.<br/>Copyright &#xa9; 2017
IJS Publishing Group Ltd

<28>
[Use Link to view the full text]
Accession Number
619000838
Author
Kiaii B.B.; Swinamer S.A.; Fox S.A.; Stitt L.; Quantz M.A.; Novick R.J.
Institution
(Kiaii, Swinamer, Fox, Stitt, Quantz) Departments of Surgery, Western
University, 339 Windermere Rd, London, ON N0M 1C0, Canada
(Novick) Department of Surgery, University of Calgary, Calgary, AL, Canada
Title
A Prospective Randomized Study of Endoscopic Versus Conventional
Harvesting of the Radial Artery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (4) (pp 231-238), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective The aims of the study were to determine whether endoscopic
harvesting of the radial artery (RA) reduces morbidity due to pain,
infection, and disability with improvement in satisfaction and cosmesis
compared to the conventional technique and (2) to compare the 6-month
angiographic patency of the RA harvested conventionally and
endoscopically. Methods In a prospective randomized study, 119 patients
undergoing coronary artery bypass grafting using the RA were randomized to
have RA harvested either conventionally (n = 59) or endoscopically (n =
60). Results Radial artery harvest time (open wound time) was
significantly reduced in the endoscopic group (36.5 +/- 9.4 vs 57.7 +/-
9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%)
in the endoscopic group compared with six patients (10.2%), P = 0.061, in
the conventional group. Although this was not statistically significant,
clinically this was relevant in terms of reduction in postoperative
morbidity. Postoperative pain in the arm incision was significantly lower
in the endoscopic group at postoperative day 2 (P < 0.001) and at
discharge (P < 0.001) and similar to the conventional open group at 6
weeks' follow-up (P = 0.103). Overall patient satisfaction and cosmesis
were significantly better in the endoscopic group at postoperative day 2
(P < 0.001), at discharge (P < 0.001), and at 6 weeks' follow-up (P <
0.001). There was no difference in the arm disability postoperatively (P =
0.505) between the two groups. Six-month angiographic assessment of 23
patients (12 endoscopic and 11 open) revealed no difference in the patency
rate (10/12 in endoscopic and 9/11 in open group). Conclusions Endoscopic
RA harvesting reduced the incidence of postoperative wound infection and
wound pain and improved patient satisfaction and cosmesis compared with
conventional harvesting technique. There was no difference in the 6-month
angiographic patency of the RA harvested conventionally and
endoscopically.<br/>Copyright &#xa9; 2017 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<29>
[Use Link to view the full text]
Accession Number
611807732
Author
Meybohm P.; Choorapoikayil S.; Wessels A.; Herrmann E.; Zacharowski K.;
Spahn D.R.
Institution
(Meybohm, Choorapoikayil, Wessels, Zacharowski) Department of
Anesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Germany
(Herrmann) Institute for Anesthesiology, University and University
Hospital Zurich, Zurich, Switzerland
(Spahn) Institute of Biostatistics and Mathematical Modelling, Goethe
University Frankfurt, Germany
Title
Washed cell salvage in surgical patients: A review and meta-analysis of
prospective randomized trials under PRISMA.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4490. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cell salvage is commonly used as part of a blood conservation
strategy. However concerns among clinicians exist about the efficacy of
transfusion of washed cell salvage. Methods: We performed a meta-analysis
of randomized controlled trials in which patients, scheduled for all types
of surgery, were randomized to washed cell salvage or to a control group
with no cell salvage. Data were independently extracted, risk ratio (RR),
and weighted mean differences (WMD) with 95% confidence intervals (CIs)
were calculated. Data were pooled using a random effects model. The
primary endpoint was the number of patients exposed to allogeneic red
blood cell (RBC) transfusion. Results: Out of 1140 search results, a total
of 47 trials were included. Overall, the use of washed cell salvage
reduced the rate of exposure to allogeneic RBC transfusion by a relative
39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average
saving of 0.20 units of allogeneic RBC per patient (weighted mean
differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk
of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced
length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11;
P < 0.001), but did not significantly affect risk of mortality (RR = 0.92;
95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be
observed in the number of patients exposed to re-operation, plasma,
platelets, or rate of myocardial infarction and stroke. Conclusions:
Washed cell salvage is efficacious in reducing the need for allogeneic RBC
transfusion and risk of infection in surgery.<br/>Copyright &#xa9; 2016
the Author(s). Published by Wolters Kluwer Health, Inc. All rights
reserved.

<30>
Accession Number
621806878
Author
Wang J.-J.; Chi N.-H.; Huang T.-M.; Connolly R.; Chen L.W.; Chueh S.-C.J.;
Kan W.-C.; Lai C.-C.; Wu V.-C.; Fang J.-T.; Chu T.-S.; Wu K.-D.
Institution
(Wang) Chi Mei Medical Center, Division of Nephrology, Department of
Internal Medicine, Liouying, Tainan, Taiwan (Republic of China)
(Wang, Huang, Wu, Chu, Wu) NSARF group (National Taiwan University
Hospital Study Group of ARF), Taipei, Taiwan (Republic of China)
(Chi, Chen) National Taiwan University Hospital, Department of Surgery,
Taipei, Taiwan (Republic of China)
(Huang, Wu, Chu, Wu) National Taiwan University Hospital, Division of
Nephrology, Department of Internal Medicine, Taipei, Taiwan (Republic of
China)
(Connolly) Dublin City University, School of Biotechnology, Glasnevin,
Dublin 9, Ireland
(Chueh) Cleveland Clinic Lerner College of Medicine, Glickman Urological
and Kidney Institute, Cleveland Clinic, Cleveland, United States
(Kan) Chi-Mei Medical Center, Division of Nephrology, Department of
Internal Medicine, Tainan, Taiwan (Republic of China)
(Lai) Chi Mei Medical Center, Department of Intensive Care Medicine,
Liouying, Tainan, Taiwan (Republic of China)
(Fang) Chang Gung University College of Medicine, Taoyuan, Taiwan
(Republic of China)
(Fang) Chang Gung Memorial Hospital, Kidney Research Center, Department of
Nephrology, Taoyuan City, Taiwan (Republic of China)
Title
Urinary biomarkers predict advanced acute kidney injury after
cardiovascular surgery.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 108. Date of
Publication: 26 Apr 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) after cardiovascular surgery is a
serious complication. Little is known about the ability of novel
biomarkers in combination with clinical risk scores for prediction of
advanced AKI. Methods: In this prospectively conducted multicenter study,
urine samples were collected from 149 adults at 0, 3, 6, 12 and 24 h after
cardiovascular surgery. We measured urinary hemojuvelin (uHJV), kidney
injury molecule-1 (uKIM-1), neutrophil gelatinase-associated lipocalin
(uNGAL), alpha-glutathione S-transferase (ualpha-GST) and pi-glutathione
S-transferase (upi-GST). The primary outcome was advanced AKI, under the
definition of Kidney Disease: Improving Global Outcomes (KDIGO) stage 2, 3
and composite outcomes were KDIGO stage 2, 3 or 90-day mortality after
hospital discharge. Results: Patients with advanced AKI had significantly
higher levels of uHJV and uKIM-1 at 3, 6 and 12 h after surgery. When
normalized by urinary creatinine level, uKIM-1 in combination with uHJV at
3 h post-surgery had a high predictive ability for advanced AKI and
composite outcome (AUC=0.898 and 0.905, respectively). The combination of
this biomarker panel (normalized uKIM-1, uHJV at 3 h post-operation) and
Liano's score was superior in predicting advanced AKI (AUC=0.931,
category-free net reclassification improvement of 1.149, and p< 0.001).
Conclusions: When added to Liano's score, normalized uHJV and uKIM-1
levels at 3 h after cardiovascular surgery enhanced the identification of
patients at higher risk of progression to advanced AKI and composite
outcomes.<br/>Copyright &#xa9; 2018 The Author(s).

<31>
[Use Link to view the full text]
Accession Number
619000848
Author
Fok M.; Bashir M.; Harky A.; Sladden D.; Dimartino M.; Elsyed H.; Howard
C.; Knipe M.; Shackcloth M.J.
Institution
(Fok, Elsyed, Howard, Knipe) Thoracic Aortic Aneurysm Service, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Bashir, Harky, Sladden, Dimartino) Cardiothoracic Surgery, Barts Heart
Centre, St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom
(Shackcloth) General Thoracic and Oesophageal Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
Title
Video-Assisted Thoracoscopic Versus Robotic-Assisted Thoracoscopic
Thymectomy.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (4) (pp 259-264), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Minimally invasive thoracic surgical procedures, performed with
or without the assistance of a robot, have gained popularity over the last
decade. They have increasingly become the choice of intervention for a
number of thoracic surgical operations. Minimally invasive surgery
decreases postoperative pain, hospital stay and leads to a faster recovery
in comparison with conventional open methods. Minimally invasive
techniques to perform a thymectomy include video-assisted thoracoscopic
surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS). In this
study, we aim to systematically review and interrogate the literature on
minimally invasive thymectomy and draw a meta-analysis on the outcomes
between the two approaches. Methods An extensive electronic health
database search was performed on all articles published from inception to
May 2015 for studies describing outcomes in VATS and RATS thymectomy.
Results A total of 350 patients were included in this study, for which 182
and 168 patients underwent RATS and VATS thymectomy, respectively. There
were no recorded in-hospital deaths for either procedure. There was no
statistical difference in conversion to open, length of hospital stay, or
postoperative pneumonia. Operational times for RATS thymectomy were
longer. Conclusions The VATS and RATS thymectomy offer good and safe
operative and perioperative outcomes. There is little difference between
the two groups. However, there is poor evidence basis for the long-term
outcomes in minimally invasive procedures for thymectomy. It is imperative
that future studies evaluate oncological outcomes both short and long term
as well as those related to safety.<br/>Copyright &#xa9; 2017 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<32>
Accession Number
610849441
Author
Piccioni F.; Bernasconi F.; Tramontano G.T.A.; Langer M.
Institution
(Piccioni, Langer) Department of Anesthesia, Intensive Care and Palliative
Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1,
Milan 20133, Italy
(Bernasconi, Tramontano) School of Anesthesia and Intensive Care,
University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
(Langer) Department of Pathophysiology and Transplantation, University of
Milan, Via Festa del Perdono 7, Milan 20122, Italy
Title
A systematic review of pulse pressure variation and stroke volume
variation to predict fluid responsiveness during cardiac and thoracic
surgery.
Source
Journal of Clinical Monitoring and Computing. 31 (4) (pp 677-684), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Springer Netherlands
Abstract
This systematic review aims to summarize the published data on the
reliability of pulse pressure variation (PPV) and stroke volume variation
(SVV) to predict fluid responsiveness in an open-chest setting during
cardio-thoracic surgery. The analysis included studies reporting receiver
operating characteristics or correlation coefficients between PPV/SVV and
change in any hemodynamic variables after a fluid challenge test in
open-chest conditions. The literature search included seven studies.
Increase in cardiac index and stroke volume index after a fluid challenge
were the most adopted end-point variables. PPV and SVV showed similar area
under the receiver operating characteristic curve values but high
heterogeneity among studies. Cardiac and thoracic studies did not differ
between PPV/SVV pooled area under the receiver operating characteristic
curve. Studies exploring correlation between dynamic indices and end-point
variable increase after fluid challenge showed conflicting results. The
great heterogeneity between studies was due to small sample size and
differences among protocol designs (different monitor devices, mechanical
ventilation settings, fluid challenge methodologies, surgical incisions,
and end-point variables). PPV and SVV seem to be inaccurate in predicting
fluid responsiveness in an open-chest setting during cardio-thoracic
surgery. Given the high heterogeneity of published data, more studies are
needed to define the role of PPV/SVV in this context.<br/>Copyright &#xa9;
2016, Springer Science+Business Media Dordrecht.

<33>
Accession Number
618551653
Author
Hahalis G.; Aznaouridis K.; Tsigkas G.; Davlouros P.; Xanthopoulou I.;
Koutsogiannis N.; Koniari I.; Leopoulou M.; Costerousse O.; Tousoulis D.;
Bertrand O.F.
Institution
(Hahalis, Tsigkas, Davlouros, Xanthopoulou, Koutsogiannis, Koniari,
Leopoulou) Patras University Hospital Rio, Rio, Patras, Greece
(Aznaouridis, Tousoulis) Hippokration Hospital, Athens Medical School,
Athens, Greece
(Aznaouridis) Castle Hill Hospital, Cottingham, United Kingdom
(Costerousse, Bertrand) Quebec Heart-Lung Institute, Quebec, Canada
Title
Radial artery and ulnar artery occlusions following coronary procedures
and the impact of anticoagulation: ARTEMIS (radial and ulnar artery
occlusion meta-analysis) systematic review and meta-analysis.
Source
Journal of the American Heart Association. 6 (8) (no pagination), 2017.
Article Number: e005430. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Incidence of radial artery occclusions (RAO) and ulnar artery
occclusions (UAO) in coronary procedures, factors predisposing to forearm
arteries occlusion, and the benefit of anticoaggulation vary significantly
in existing literature. We sought to determine the incidence of RAO/UAO
and the impact of anticoagulation intensity. Methods and
Results--Meta-analysis of 112 studies assessing RAO and/or UAO (N=46 631)
were included. Overall, there was no difference between crude RAO and UAO
rates (5.2%; 95% confidence interval [CI], 4.4-6.0 versus 4.0%; 95% CI,
2.8-5.8; P=0.171). The early occlusion rate (in-hospital or within 7 days
after procedure) was higher than the late occlusion rate. The detection
rate of occlusion was higher with vascular ultrasonography compared with
clinical evaluation only. Low-dose heparin was associated with a
significantly higher RAO rate compared with high-dose heparin (7.2%; 95%
CI, 5.5-9.4 versus 4.3%; 95% CI, 3.5-5.3; Q=8.81; P=0.003). Early
occlusions in low-dose heparin cohorts mounted at 8.0% (95% CI, 6.1-10.6).
The RAO rate was higher after diagnostic angiographies compared with
coronary interventions, presumably attributed to the higher intensity of
anticoagulation in the latter group. Hemostatic techniques (patent versus
nonpatent hemostasis), geography (US versus non-US cohorts) and sheath
size did not impact on vessel patency. Conclusions--RAO and UAO occur with
similar frequency and in the order of 7% to 8% when evaluated early by
vascular ultrasonography following coronary procedures. More-intensive
anticoagulation is protective. Late recanalization occurs in a substantial
minority of patients.<br/>Copyright &#xa9; 2017 The Authors and Medtronic.

<34>
Accession Number
609598447
Author
Gupta P.; Robertson M.J.; Rettiganti M.; Seib P.M.; Wernovsky G.;
Markovitz B.P.; Simsic J.; Tobias J.D.
Institution
(Gupta) Division of Pediatric Critical Care, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Gupta, Robertson, Seib) Division of Pediatric Cardiology, Arkansas
Children's Hospital, University of Arkansas for Medical Sciences, 1
Children's Way, Slot 512-3, Little Rock, AR, United States
(Rettiganti) Biostatistics Section, Department of Pediatrics, University
of Arkansas for Medical Sciences, Little Rock, AR, United States
(Wernovsky) Department of Pediatric Cardiology, Miami Children's Hospital,
Miami, FL, United States
(Markovitz) Department of Anesthesiology and Critical Care Medicine,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Simsic) Division of Pediatric Cardiology, Department of Pediatrics,
Nationwide Children's Hospital, The Ohio State University, Columbus, OH,
United States
(Tobias) Department of Anesthesiology and Pain Medicine, Nationwide
Children's Hospital, The Ohio State University, Columbus, OH, United
States
Title
Impact of Timing of ECMO Initiation on Outcomes After Pediatric Heart
Surgery: A Multi-Institutional Analysis.
Source
Pediatric Cardiology. 37 (5) (pp 971-978), 2016. Date of Publication: 01
Jun 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Little is known about the relationship of timing of extracorporeal
membrane oxygenation (ECMO) initiation on patient outcomes after pediatric
heart surgery. We hypothesized that increasing timing of ECMO initiation
after heart surgery will be associated with worsening study outcomes.
Patients aged <=18 years receiving ECMO after pediatric cardiac surgery at
a Pediatric Health Information System-participating hospital (2004-2013)
were included. Outcomes evaluated included in-hospital mortality,
composite poor outcome, prolonged length of ECMO, prolonged length of
mechanical ventilation, prolonged length of ICU stay, and prolonged length
of hospital stay. Multivariable logistic regression models were fitted to
study the probability of study outcomes as a function of timing from
cardiac surgery to ECMO initiation. A total of 2908 patients from 42
hospitals qualified for inclusion. The median timing of ECMO initiation
after cardiac surgery was 0 days (IQR 0-1 day; range 0-294 days). After
adjusting for patient and center characteristics, increasing duration of
time from surgery to ECMO initiation was not associated with higher
mortality or worsening composite poor outcome. However, increasing
duration of time from surgery to ECMO initiation was associated with
prolonged length of ECMO, prolonged length of ventilation, prolonged
length of ICU stay, and prolonged length of hospital stay. Although this
relationship was statistically significant, the odds for prolonged length
of ECMO, prolonged length of ventilation, prolonged length of ICU stay,
and prolonged length of hospital stay increased by only 1-3 % for every
1-day increase in ECMO that may be clinically insignificant. We did not
demonstrate any relationship between timing of ECMO initiation and
mortality among the patients of varying age groups, and patients
undergoing cardiac surgery of varying complexity. We concluded that
increasing duration of time from surgery to ECMO initiation is not
associated with worsening mortality. Our results suggest that ECMO is
initiated at the appropriate time when dictated by clinical situation
among patients of all age groups, and among patients undergoing heart
operations of varying complexity.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<35>
Accession Number
618567714
Author
Dastan F.; Talasaz A.H.; Mojtahedzadeh M.; Karimi A.; Salehiomran A.; Bina
P.; Jalali A.
Institution
(Dastan) School of Pharmacy, ShahidBeheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Mojtahedzadeh) School of Pharmacy, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Karimi, Salehiomran, Bina, Jalali) Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Randomized Trial of Carnitine for the Prevention of Perioperative Atrial
Fibrillation.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 7-13), 2018.
Date of Publication: Spring 2018.
Publisher
W.B. Saunders
Abstract
Atrial fibrillation (AF) is one of the most common complications in
patients who undergo coronary artery bypass graft surgery (CABG). The aim
of this study was to evaluate the effect of L-carnitine administration on
postoperative AF and the levels of C-reactive protein (CRP) following
CABG. The effects of L-carnitine on the incidence of acute kidney injury
after CABG were also assessed. One hundred thirty-four patients undergoing
elective CABG, without a history of AF or previous L-carnitine treatment,
were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or
a control group. CRP levels, as a biomarker of inflammation, were assessed
in all the patients before surgery as baseline levels and 48 hours
postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney
biomarker, was also measured in the patients before surgery and 2 hours
thereafter. The incidence of AF was 13.4% in our population. The incidence
of AF was decreased in the L-carnitine group (7.5% in the L-carnitine
group vs 19.4% in the control group; P = 0.043) and the postoperative CRP
level (8.79 +/- 6.9 in the L-carnitine group, and 10.83 +/- 5.7 in the
control group; P = 0.021). The postoperative neutrophil
gelatinase-associated lipocalin concentration demonstrated no significant
rise after surgery compared with the preoperative concentration (72.54 +/-
20.30 in the L-carnitine group vs 67.68 +/- 22.71 in the placebo group; P
= 0.19). Our study showed that L-carnitine administration before CABG
might inhibit and reduce the incidence of AF after CABG. It seems that a
rise in the CRP level, as an inflammation marker, may be associated with
the incidence of AF. Inflammation as measured by CRP was also reduced in
the carnitine group, compared with the control group.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<36>
Accession Number
622069291
Author
Atashi A.; Verburg I.W.; Karim H.; Miri M.; Abuhanna A.; De JoNge E.; De
Keizer N.F.; Eslami S.
Institution
(Atashi) E-Health Department, Virtual school, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Atashi) Department of Medical Informatics, Breast Cancer research Center,
Motamed Cancer Institute, ACECR, Tehran, Iran, Islamic Republic of
(Verburg, Abuhanna, De Keizer, Eslami) Academic Medical Center, Department
of Medical Informatics, Amsterdam Public Health Research Institute,
Amsterdam, Netherlands
(Karim) Department of Health Information Management, Faculty of Allied
Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Miri) Department of Anesthesiology and Critical Care, Emam Hossein
Hospital, Shahid Beheshti Medical University, Tehran, Iran, Islamic
Republic of
(De JoNge) Department of Intensive Care, Leiden University Medical Center,
Leiden, Netherlands
(Eslami) Pharmaceutical Research Center, School of Pharmacy, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Eslami) Department of Medical Informatics, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Models to predict length of stay in the intensive Care unit after coronary
artery bypass grafting: A systematic review.
Source
Journal of Cardiovascular Surgery. 59 (3) (pp 471-482), 2018. Date of
Publication: June 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
iNTroduCTioN: intensive Care units (iCu) length of stay (los) prediction
models are used to compare different institutions and surgeons on their
performance, and is useful as an efficiency indicator for quality control.
There is little consensus about which prediction methods are most suitable
to predict (iCu) length of stay. The aim of this study is to
systematically review models for predicting iCu los after coronary artery
bypass grafting and to assess the reporting and methodological quality of
these models to apply them for benchmarking. EVIDENCE ACQUISITION: A
general search was conducted in Medline and Embase up to 31-12-2016. Three
authors classified the papers for inclusion by reading their title,
abstract and full text. all original papers describing development and/or
validation of a prediction model for los in the iCu after CaBg surgery
were included. We used a checklist developed for critical appraisal and
data extraction for systematic reviews of prediction modeling and extended
it on handling specific patients subgroups. We also defined other items
and scores to assess the methodological and reporting quality of the
models. EVIDENCE SYNTHESIS: Of 5181 uniquely identified articles, fifteen
studies were included of which twelve on development of new models and
three on validation of existing models. all studies used linear or
logistic regression as method for model development, and reported various
performance measures based on the difference between predicted and
observed iCu los. Most used a prospective (46.6%) or retrospective study
design (40%). We found heterogeneity in patient inclusion/exclusion
criteria; sample size; reported accuracy rates; and methods of candidate
predictor selection. Most (60%) studies have not mentioned the handling of
missing values and none compared the model outcome measure of survivors
with non-survivors. for model development and validation studies
respectively, the maximum reporting (methodological) scores were 66/78 and
62/62 (14/22 and 12/22). CoNClusioNs: There are relatively few models for
predicting iCu length of stay after CaBg. several aspects of
methodological and reporting quality of studies in this field should be
improved. There is a need for standardizing outcome and risk factor
definitions in order to develop/ validate a multi-institutional and
international risk scoring system.<br/>Copyright &#xa9; 2018 Edizioni
Minerva Medica.

<37>
Accession Number
622095665
Author
Warner M.A.; Welsby I.J.; Norris P.J.; Silliman C.C.; Armour S.; Wittwer
E.D.; Santrach P.J.; Meade L.A.; Liedl L.M.; Nieuwenkamp C.M.; Douthit B.;
van Buskirk C.M.; Schulte P.J.; Carter R.E.; Kor D.J.
Institution
(Warner) Division of Critical Care, Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
(Welsby, Douthit) Department of Anesthesiology, Duke University Medical
Center, Raleigh, North Carolina, USA
(Norris) Blood Systems Research Institute,University of California, San
Francisco, California, USA
(Silliman) Bonfils Blood Center, University of Colorado Denver, Denver,
Colorado, USA
(Armour, Wittwer, Meade, Liedl, Kor) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
(Santrach, Nieuwenkamp) Department of Laboratory Medicine and Pathology,
Mayo Clinic, Rochester, Minnesota, USA
(Liedl, Schulte, Carter) Department of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, Minnesota, USA
(van Buskirk) Laboratory Medicine and Pathology, Mayo Clinic, Rochester,
MN
Title
Point-of-care washing of allogeneic red blood cells for the prevention of
transfusion-related respiratory complications (WAR-PRC): a protocol for a
multicenter randomised clinical trial in patients undergoing cardiac
surgery.
Source
BMJ open. 7 (8) (pp e016398), 2017. Date of Publication: 18 Aug 2017.
Abstract
INTRODUCTION: The transfusion-related respiratory complications,
transfusion-related acute lung injury (TRALI) and transfusion-associated
circulatory overload (TACO), are leading causes of transfusion-related
morbidity and mortality. At present, there are no effective preventive
strategies with red blood cell (RBC) transfusion. Although mechanisms
remain incompletely defined, soluble biological response modifiers (BRMs)
within the RBC storage solution may play an important role. Point-of-care
(POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating
their impact on post-transfusion respiratory complications.
METHODS AND ANALYSIS: This is a multicenter randomised clinical trial of
standard allogeneic versus washed allogeneic RBC transfusion for adult
patients undergoing cardiac surgery testing the hypothesis that POC RBC
washing is feasible, safe, and efficacious and will reduce recipient
immune and physiologic responses associated with transfusion-related
respiratory complications. Relevant clinical outcomes will also be
assessed. This investigation will enrol 170 patients at two hospitals in
the USA. Simon's two-stage design will be used to assess the feasibility
of POC RBC washing. The primary safety outcomes will be assessed using
Wilcoxon Rank-Sum tests for continuous variables and Pearson chi-square
test for categorical variables. Standard mixed modelling practices will be
employed to test for changes in biomarkers of lung injury following
transfusion. Linear regression will assess relationships between
randomised group and post-transfusion physiologic measures.
ETHICS AND DISSEMINATION: Safety oversight will be conducted under the
direction of an independent Data and Safety Monitoring Board (DSMB).
Approval of the protocol was obtained by the DSMB as well as the
institutional review boards at each institution prior to enrolling the
first study participant. This study aims to provide important information
regarding the feasibility of POC washing of allogeneic RBCs and its
potential impact on ameliorating post-transfusion respiratory
complications. Additionally, it will inform the feasibility and scientific
merit of pursuing a more definitive phase II/III clinical trial.
REGISTRATION: ClinicalTrials.gov registration number is NCT02094118
(Pre-results).<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2017. All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<38>
Accession Number
622069287
Author
Um K.J.; McClure G.R.; Belley-Cote E.P.; Gupta S.; Bouhout I.; Lortie H.;
Alraddadi H.; Alsagheir A.; Bossard M.; McIntyre W.F.; Lengyel A.;
Eikelboom J.W.; Ouzounian M.; Chu M.W.; Parry D.; Elhamamsy I.; Whitlock
R.P.
Institution
(Um, McClure) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Belley-Cote, Gupta, Alsagheir, McIntyre, Whitlock) Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
ON, Canada
(Belley-Cote, McIntyre, Eikelboom) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Bossard, McIntyre, Eikelboom, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
(Gupta, Alraddadi, Alsagheir, Parry, Whitlock) Division of Cardiac
Surgery, McMaster University, Hamilton, ON, Canada
(Bouhout, Elhamamsy) Division of Cardiac Surgery, Montreal Heart
Institute, University of Montreal, Montreal, QC, Canada
(Lortie) Department of Medicine, University of Sherbrooke, Sherbrooke, QC,
Canada
(Bossard, Ouzounian) Division of Cardiac Surgery, Peter Munk Cardiac
Center, University of Toronto, Toronto, ON, Canada
(Lengyel) McMaster University, Undergraduate Faculty of Health Sciences,
Hamilton, ON, Canada
(Chu) Division of Cardiac Surgery, Western University, London, ON, Canada
Title
Hemodynamic outcomes of the ross procedure versus other aortic valve
replacement: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Surgery. 59 (3) (pp 462-470), 2018. Date of
Publication: June 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
inTroduCTion: life expectancy in young adults undergoing mechanical or
bioprosthetic aortic valve replacement (avr) may be reduced by up to 20
years compared to age matched controls. The ross procedure is a durable,
anticoagulation-sparing alternative. We performed a systematic review and
meta-analysis to compare the valve hemodynamics of the ross procedure
versus other avr. evidenCe aCQuisiTion: We searched Cochrane CenTral,
Medline and eMBase from inception to february 2017 for randomized
controlled trials (RCTs) and observational studies (n>=10 Ross).
Independently and in duplicate, we performed title and abstract screening,
full-text eligibility assessment, and data collection. We evaluated the
risk of bias with the Cochrane and ClariTy tools, and the quality of
evidence with the grade framework. EVIDENCE SYNTHESIS: We identified 2
RCTs and 13 observational studies that met eligibility criteria (N.=1412).
In observational studies, the ross procedure was associated with a lower
mean aortic gradient at discharge (Md -9 mmhg, 95% Ci: -13 to -5,
P<0.0001, i²=97%) and latest follow-up (Md -5 mmhg, 95% Ci: -7
to -3, P<0.0001, i²=92%). There was no significant difference
in the incidence of severe aortic regurgitation at latest follow-up (RR
1.3, 95% CI: 0.3 to 5.8, P=0.70, I²=30%). In RCTs, the Ross
procedure was associated with a lower mean gradient at latest follow-up
(MD -15 mmHg, 95% CI: -32 to 2, P=0.08, I²=99%). The mean
pulmonic gradient for the Ross procedure was 18.0 mmhg (95% Ci: 16 to 20,
P<0.0001) at latest follow-up. The evidence for all outcomes from
observational studies was deemed to be of very low quality, while the
evidence from rCTs was downgraded for imprecision and moderately serious
risk of bias. ConClusions: Compared to conventional avr, the ross
procedure was associated with better aortic valve hemodynamics. future
studies should evaluate the impact of the ross procedure on exercise
capacity and quality of life.<br/>Copyright &#xa9; 2018 Edizioni Minerva
Medica.

<39>
Accession Number
622087351
Author
Benowitz N.L.; Pipe A.; West R.; Hays J.T.; Tonstad S.; McRae T.; Lawrence
D.; St Aubin L.; Anthenelli R.M.
Institution
(Benowitz) Department of Medicine, University of California, PO Box 1220,
San Francisco, CA 94143, United States
(Benowitz) Department of Bioengineering and Therapeutic Sciences,
University of California, San Francisco, United States
(Pipe) Division of Prevention and Rehabilitation, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(West) Health Behaviour Research Centre, Department of Epidemiology and
Public Health, University College, London, United Kingdom
(Hays) Nicotine Dependence Center and General Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Tonstad) Department of Preventive Cardiology, Oslo University Hospital,
Oslo, Norway
(McRae, Lawrence, St Aubin) Global Product Development, Pfizer, New York,
NY, United States
(Anthenelli) Department of Psychiatry, University of California, San
Diego, United States
Title
Cardiovascular safety of varenicline, bupropion, and nicotine patch in
smokers a randomized clinical trial.
Source
JAMA Internal Medicine. 178 (5) (pp 622-631), 2018. Date of Publication:
May 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies,
but concerns have been raised regarding the cardiovascular safety of such
medications. OBJECTIVE To compare the relative cardiovascular safety risk
of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A
double-blind, randomized, triple-dummy, placeboand active-controlled trial
(Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES])
and its nontreatment extension trial was conducted at 140 multinational
centers. Smokers, with or without established psychiatric diagnoses, who
received at least 1 dose of study medication (n = 8058), as well as a
subset of those who completed 12 weeks of treatment plus 12 weeks of
follow up and agreed to be followed up for an additional 28 weeks (n =
4595), were included. INTERVENTIONS Varenicline, 1mg twice daily;
bupropion hydrochloride, 150mg twice daily; and nicotine replacement
therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The
primary end pointwas the time to development of a major adverse
cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial
infarction, or nonfatal stroke) during treatment; secondary end points
were the occurrence of MACE and other pertinent cardiovascular events
(MACE+: MACE or new-onset or worsening peripheral vascular disease
requiring intervention, coronary revascularization, or hospitalization for
unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male
(mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events
during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and
did not differ significantly by treatment. No significant treatment
differences were observed in time to cardiovascular events, blood
pressure, or heart rate. There was no significant difference in time to
onset ofMACE for either varenicline or bupropion treatment vs placebo
(varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard
ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that
the use of smoking cessation pharmacotherapies increased the risk of
serious cardiovascular adverse events during or after treatment was
observed. The findings of EAGLES and its extension trial provide further
evidence that smoking cessation medications do not increase the risk of
serious cardiovascular events in the general population of
smokers.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<40>
[Use Link to view the full text]
Accession Number
622083325
Author
Maggiolini S.; De Carlini C.C.; Imazio M.
Institution
(Maggiolini, De Carlini) Cardiology Division, Cardiovascular Department,
San L. Mandic Hospital, Largo Mandic 1, Merate 23807, Italy
(Imazio) Cardiology, Cardiovascular and Thoracic Department, AOU
Cittadella Salute e della Scienza di Torino, Torino, Italy
Title
Evolution of the pericardiocentesis technique.
Source
Journal of Cardiovascular Medicine. 19 (6) (pp 267-273), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Pericardiocentesis is a valuable technique for the diagnosis and treatment
of patients with pericardial effusion and cardiac tamponade, although it
may be associated with potentially serious complications. Through the
years, many different imaging approaches have been described to reduce the
complication rate of the procedure. This systematic review provides a
focused overview of the different techniques developed in recent years to
reduce the procedural complications and to increase the related success
rate.<br/>Copyright &#xa9; 2018 Italian Federation of Cardiology. All
rights reserved.

<41>
Accession Number
622088151
Author
Asmarats L.; Rodriguez-Gabella T.; Chamandi C.; Bernier M.; Beaudoin J.;
O'Connor K.; Dumont E.; Dagenais F.; Paradis J.-M.; Rodes-Cabau J.
Institution
(Asmarats, Rodriguez-Gabella, Chamandi, Bernier, Beaudoin, O'Connor,
Dumont, Dagenais, Paradis, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval UniversityQuebec City, QuebecCanada
Title
Infective endocarditis following transcatheter edge-to-edge mitral valve
repair: A systematic review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2018.
Date of Publication: 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the clinical characteristics, management, and
outcomes of patients diagnosed with infective endocarditis (IE) after
edge-to-edge mitral valve repair with the MitraClip device. Background:
Transcatheter edge-to-edge mitral valve repair has emerged as an
alternative to surgery in high-risk patients. However, few data exist on
IE following transcatheter mitral procedures. Methods: Four electronic
databases (PubMed, Google Scholar, Embase, and Cochrane Library) were
searched for original published studies on IE after edge-to-edge
transcatheter mitral valve repair from 2003 to 2017. Results: A total of
10 publications describing 12 patients with definitive IE (median age 76
years, 55% men) were found. The mean logistic EuroSCORE/EuroSCORE II were
41% and 45%, respectively. The IE episode occurred early (within 12 months
post-procedure) in nine patients (75%; within the first month in five
patients). Staphylococcus aureus was the most frequent (60%) causal
microorganism, and severe mitral regurgitation was present in all cases
but one. Surgical mitral valve replacement (SMVR) was performed in most
(67%) patients, and the mortality associated with the IE episode was high
(42%). Conclusions: IE following transcatheter edge-to-edge mitral valve
repair is a rare but life-threatening complication, usually necessitating
SMVR despite the high-risk profile of the patients. These results
highlight the importance of adequate preventive measures and a prompt
diagnosis and treatment of this serious complication.<br/>Copyright &#xa9;
2018 Wiley Periodicals, Inc.

<42>
Accession Number
622077222
Author
Kadomatsu Y.; Mori S.; Ueno H.; Uchiyama M.; Wakai K.
Institution
(Kadomatsu) Department of Thoracic Surgery, Nagoya University Graduate
School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
(Mori, Ueno, Uchiyama) Department of Thoracic Surgery, Japanese Red Cross
Nagoya Daiichi Hospital, Mitishita-cho 3-35, Nakamura-ku, Nagoya 453-8511,
Japan
(Kadomatsu, Wakai) Department of Preventive Medicine, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550,
Japan
Title
Comparison of the analgesic effects of modified continuous intercostal
block and paravertebral block under surgeon's direct vision after
video-assisted thoracic surgery: a randomized clinical trial.
Source
General Thoracic and Cardiovascular Surgery. (pp 1-7), 2018. Date of
Publication: 08 May 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: Clinical evidence comparing paravertebral (PVB) and continuous
intercostal nerve (ICB) blocks for pain management post video-assisted
thoracic surgery (VATS) is limited. This study confirms the analgesic
effect of ICB using two catheters is not inferior to that of PVB under
direct vision. Methods: Fifty patients who underwent VATS lobectomy from
July 2015 to March 2016 were prospectively recruited and randomly assigned
to PVB and ICB groups. Postoperative pain was assessed using the visual
analog scale (VAS). VAS score at rest at 24 h was the primary endpoint.
Data on time required for catheter insertion, adverse effects, and
frequency of additional analgesics as secondary endpoints were also
collected. Noninferiority was assessed by adding a VAS margin of 15 mm to
the PVB group. Results: No significant differences were observed between
the VAS scores of the two groups except at 48 h after surgery, with a
margin noted for the PVB group. No significant differences were detected
in the frequency of additional analgesics and occurrence of adverse
effects. Conclusions: Our results could not clearly establish
noninferiority of ICB to PVB. Improvements in ICB may be necessary for it
to be used as an alternative method to PVB.<br/>Copyright &#xa9; 2018 The
Japanese Association for Thoracic Surgery

<43>
[Use Link to view the full text]
Accession Number
619007127
Author
Salzmann S.; Euteneuer F.; Laferton J.A.C.; Auer C.J.; Shedden-Mora M.C.;
Schedlowski M.; Moosdorf R.; Rief W.
Institution
(Salzmann, Euteneuer, Laferton, Auer, Rief) Department of Clinical
Psychology and Psychotherapy, Philipps University of Marburg,
Gutenbergstrase 18, Marburg 35032, Germany
(Laferton) Philipps University of Marburg, Germany
(Shedden-Mora) Department of Clinical Psychology and Psychotherapy,
Psychologische Hochschule Berlin, Germany
(Schedlowski) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Germany
(Moosdorf) Institute of Medical Psychology and Behavioral Immunobiology,
University Clinic Essen, Essen, Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Philipps University of Marburg, Germany
Title
Effects of Preoperative Psychological Interventions on Catecholamine and
Cortisol Levels after Surgery in Coronary Artery Bypass Graft Patients:
The Randomized Controlled PSY-HEART Trial.
Source
Psychosomatic Medicine. 79 (7) (pp 806-814), 2017. Date of Publication: 01
Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective The aim of the study was to examine whether preoperative
psychological interventions targeting patients' expectations are capable
of influencing the biological stress response after coronary artery bypass
graft (CABG) surgery and could thus improve recovery after heart surgery.
Methods Randomized controlled trial with assessments 10 days before
surgery, after psychological intervention (day of hospital admission, but
before surgery), postoperative (6-8 days later), and at follow-up (6
months after surgery). Eligible patients (N = 124) scheduled for elective
on-pump CABG or CABG with valve replacement surgery were approached before
hospital admission. Standard medical care (SMC) was compared with two
additional preoperative psychological interventions: (a) an expectation
manipulation intervention to optimize patients' expectations about course
and outcomes or (b) supportive therapy, containing the same amount of
therapeutic attention, but without specifically focusing on expectations.
Postoperative plasma adrenaline, noradrenaline, and cortisol levels were a
secondary outcome of our study (primary outcome patients' disability 6
months after surgery and other secondary patient-reported or clinical
outcomes were reported elsewhere). Results Expectation manipulation
intervention (3.68 ln pg/mL, 95% confidence interval = 3.38-3.98, p =.015)
and supportive therapy (3.70 ln pg/mL, 95% confidence interval =
3.38-4.01, p =.026) led to significantly lower postoperative adrenaline
levels compared with SMC (4.26 ln pg/mL, 95% confidence interval =
3.99-4.53) only. There were no treatment effects of the preoperative
intervention for noradrenaline (p =.90) or cortisol (p =.30). Higher
postoperative adrenaline levels predicted disability 6 months after
surgery (r =.258, p =.018). Conclusions In addition to SMC, preoperative
psychological interventions seem to buffer psychobiological stress
responses and could thus facilitate recovery from CABG surgery. Patients'
postoperative stress responses could be an important factor for explaining
trajectories of long-term outcomes. Clinical Trial Registration
www.clinicaltrials.gov (NCT01407055).<br/>Copyright &#xa9; Lippincott
Williams & Wilkins.

<44>
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.

<45>
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.

<46>
Accession Number
2000702468
Author
Cheng H.; Clymer J.W.; Po-Han Chen B.; Sadeghirad PhD B.; Ferko N.C.;
Cameron C.G.; Hinoul P.
Institution
(Cheng, Clymer, Po-Han Chen, Hinoul) Ethicon Inc, Cincinnati, Ohio, United
States
(Sadeghirad PhD, Ferko, Cameron) Cornerstone Research Group, Burlington,
Ontario, Canada
Title
Prolonged operative duration is associated with complications: a
systematic review and meta-analysis.
Source
Journal of Surgical Research. 229 (pp 134-144), 2018. Date of Publication:
September 2018.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: The aim of this study was to systematically synthesize the
large volume of literature reporting on the association between operative
duration and complications across various surgical specialties and
procedure types. Methods: An electronic search of PubMed, Cochrane Central
Register of Controlled Trials, and Cochrane Database of Systematic Reviews
from January 2005 to January 2015 was conducted. Sixty-six observational
studies met the inclusion criteria. Results: Pooled analyses showed that
the likelihood of complications increased significantly with prolonged
operative duration, approximately doubling with operative time thresholds
exceeding 2 or more hours. Meta-analyses also demonstrated a 14% increase
in the likelihood of complications for every 30 min of additional
operating time. Conclusions: Prolonged operative time is associated with
an increase in the risk of complications. Given the adverse consequences
of complications, decreased operative times should be a universal goal for
surgeons, hospitals, and policy-makers. Future study is recommended on the
evaluation of interventions targeted to reducing operating
time.<br/>Copyright &#xa9; 2018 The Authors

<47>
Accession Number
614895150
Author
Kransdorf E.P.; Kittleson M.M.; Patel J.K.; Pando M.J.; Steidley D.E.;
Kobashigawa J.A.
Institution
(Kransdorf, Kittleson, Patel, Kobashigawa) Cedars-Sinai Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, California, United States
(Pando) Division of Laboratory Medicine and Pathology, Mayo Clinic
Arizona, Phoenix, Arizona, United States
(Steidley) Division of Cardiovascular Diseases, Mayo Clinic Arizona,
Phoenix, Arizona, United States
Title
Calculated panel-reactive antibody predicts outcomes on the heart
transplant waiting list.
Source
Journal of Heart and Lung Transplantation. 36 (7) (pp 787-796), 2017. Date
of Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Sensitized heart transplant candidates spend more time and have
higher mortality on the waiting list. Although the calculated
panel-reactive antibody (CPRA) value is used to assign allocation priority
to kidney transplant candidates in the United States, the relationship
between CPRA and outcomes on the heart transplant waiting list is unknown.
Methods A data set of patients listed for heart transplant with
unacceptable human leukocyte antigens (HLA) entered was obtained from the
United Network for Organ Sharing. The study cohort was composed of 3,855
adult candidates listed for heart transplant between 2006 and 2013 with
active waiting time. The cohort was divided into 5 groups by increasing
CPRA. Outcomes were assessed using competing risks and sub-hazard
regression analyses. Results In each group of successively higher CPRA,
the percentage of candidates who received a transplant decreased, whereas
the percentage of those who were still waiting for a transplant increased,
as did the percentage of those removed from the waiting list or had died.
The group of candidates with a CPRA >80% displayed a markedly decreased
incidence of transplantation (hazard ratio 0.37) and an increased risk of
removal from the waiting list or death (hazard ratio 2.18) as compared to
those with CPRA of <=10%. Conclusions Sensitized heart transplant
candidates are at high risk of adverse outcomes on the heart transplant
waiting list. Clinicians should strive to minimize the CPRA by maximizing
specificity in the selection of HLA antigens to exclude. The optimal
clinical approach for candidates with high CPRA requires further
study.<br/>Copyright &#xa9; 2017 International Society for the Heart and
Lung Transplantation

<48>
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.

<49>
Accession Number
622060634
Author
Viszlayova D.; Skoloudik D.; Brozman M.; Herzig R.; Langova K.; Patrovic
L.; Kurray P.; Kiralova S.
Institution
(Viszlayova, Brozman) Faculty Hospital Nitra, Department of Neurology,
Nitra, Slovakia
(Skoloudik) Palacky University Olomouc, Centre for Research and Science,
Faculty of Health Sciences, Olomouc, Czech Republic
(Herzig) Comprehensive Stroke Center, Charles University Faculty of
Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech
Republic
(Langova) Faculty of Medicine and Dentistry-Palacky University Olomouc,
Department of Biophysics, Olomouc, Czech Republic
(Patrovic) Jessenius Nitra A.s.-Diagnostic Centre, Department of
Radiology, Nitra, Slovakia
(Kurray) Kardiocentrum Nitra, Department of Interventional Cardiology,
Nitra, Slovakia
(Kiralova) Faculty Hospital Nitra, Department of Clinical Psychology,
Nitra, Slovakia
Title
Sonolysis in risk reduction of symptomatic and silent brain infarctions
during coronary stenting (SONOREDUCE): A randomized controlled trial.
Source
European Journal of Neurology. Conference: 23rd Meeting of the European
Society of Neurosonology and Cerebral Hemodynamics, ESNCH 2018. Czech
Republic. 25 (Supplement 1) (pp 30), 2018. Date of Publication: April
2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Silent brain ischemic lesions can be detected on magnetic
resonance imaging (MRI) in as many as 22% of patients after coronary
angioplasty and stenting (CS). The effect of periprocedural sonolysis on
the risk of new brain ischemic lesions during CS was examined. Material
and Methods: Patients undergoing elective CS were allocated randomly to a
bilateral sonolysis group (70 patients, 58 men; mean age, 59.9 years),
which underwent sonolysis of both middle cerebral arteries (MCAs) during
CS, or a control group (74 patients, 45 men; mean age, 65.5 years).
Neurologic examination, cognitive function tests, and brain MRI were
performed prior to intervention and at 24 h and 30 days after CS.
Neurologic examination and cognitive function tests were repeated at 30
days after CS. Results: No significant differences were observed in the
number of patients with new ischemic lesions (25.7 vs. 18.9%, P = 0.423),
the number of lesions (1.3 +/- 1.0 vs. 2.9 +/- 5.3, P = 0.493), lesion
volume (0.16 +/- 0.34 vs. 0.28 +/- 0.60 ml, P = 0.143), and the number of
patients with new ischemic lesions in the insonated MCA territories (18.6
vs. 17.6%, P = 0.958) between the sonolysis group and the control group.
There were no cases of stroke, transient ischemic attack, myocardial
infarction, or death in the two groups. Intracranial bleeding was not
reported in the sonolysis group, whereas there was one occurrence in the
control group (0 vs. 1.4%, P = 0.888). Clock-drawing test scores at 30
days were significantly higher in the sonolysis group than in the control
group (median 3.0 vs. 2.5, P = 0.031). Conclusions: Sonolysis does not
reduce the risk of new brain ischemic lesion after CS. The effect of
sonolysis on the number and volume of ischemic lesions and cognitive
function should be assessed in further studies.

<50>
Accession Number
621979297
Author
Fischer K.; Yamaji K.; Luescher S.; Ueki Y.; Jung B.; Von Tengg-Kobligk
H.; Windecker S.; Friedrich M.G.; Eberle B.; Guensch D.P.
Institution
(Fischer, Luescher, Eberle, Guensch) Department of Anaesthesiology and
Pain Medicine, Bern University Hospital, Inselspital, University of Bern,
Bern 3010, Switzerland
(Fischer, Friedrich) Research Institute, McGill University Health Centre,
Montreal, QC, Canada
(Fischer, Jung, Von Tengg-Kobligk, Guensch) Institute for Diagnostic,
Interventional and Paediatric Radiology, Bern University Hospital,
Inselspital, University of Bern, Bern, Switzerland
(Yamaji, Ueki, Windecker) Department of Cardiology, Bern University
Hospital, Inselspital, University of Bern, Bern, Switzerland
(Friedrich) Department of Cardiology, Heidelberg University Hospital,
Heidelberg, Germany
Title
Feasibility of cardiovascular magnetic resonance to detect oxygenation
deficits in patients with multi-vessel coronary artery disease triggered
by breathing maneuvers.
Source
Journal of Cardiovascular Magnetic Resonance. 20 (1) (no pagination),
2018. Article Number: 31. Date of Publication: 07 May 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Hyperventilation with a subsequent breath-hold has been
successfully used as a non-pharmacological vasoactive stimulus to induce
changes in myocardial oxygenation. The purpose of this pilot study was to
assess if this maneuver is feasible in patients with multi-vessel coronary
artery disease (CAD), and if it is effective at detecting coronary artery
stenosis > 50% determined by quantitative coronary angiography (QCA).
Methods: Twenty-six patients with coronary artery stenosis (QCA > 50%
diameter stenosis) underwent a contrast-free cardiovascular magnetic
resonance (CMR) exam in the time interval between their primary coronary
angiography and a subsequent percutaneous coronary intervention (PCI, n =
24) or coronary artery bypass (CABG, n = 2) revascularization procedure.
The CMR exam involved standard function imaging, myocardial strain
analysis, T2 mapping, native T1 mapping and oxygenation-sensitive CMR
(OS-CMR) imaging. During OS-CMR, participants performed a paced
hyperventilation for 60s followed by a breath-hold to induce a vasoactive
stimulus. Ten healthy subjects underwent the CMR protocol as the control
group. Results: All CAD patients completed the breathing maneuvers with an
average breath-hold duration of 48 +/- 23 s following hyperventilation and
without any complications or adverse effects. In comparison to healthy
subjects, CAD patients had a significantly attenuated global myocardial
oxygenation response to both hyperventilation (- 9.6 +/- 6.8% vs. -3.1 +/-
6.5%, p = 0.012) and apnea (11.3 +/- 6.1% vs. 2.1 +/- 4.4%, p < 0.001).
The breath-hold maneuver unmasked regional oxygenation differences in
territories subtended by a stenotic coronary artery in comparison to
remote territory within the same patient (0.5 +/- 3.8 vs. 3.8 +/- 5.3%, p
= 0.011). Conclusion: Breathing maneuvers in conjunction with OS-CMR are
clinically feasible in CAD patients. Furthermore, OS-CMR demonstrates
myocardial oxygenation abnormalities in regional myocardium related to CAD
without the use of pharmacologic vasodilators or contrast agents. A larger
trial appears warranted for a better understanding of its diagnostic
utility. Trial registration: Clinical Trials Identifier: NCT02233634,
registered 8 September 2014.<br/>Copyright &#xa9; 2018 The Author(s).

<51>
[Use Link to view the full text]
Accession Number
622058778
Author
Marcuschamer I.A.; Abelow A.; Kornowski R.
Institution
(Marcuschamer, Abelow, Kornowski) Department of Cardiology, Rabin Medical
Center, Beilinson Hospital, 39 Jabotinsky, Petach Tikva 49100, Israel
Title
The evolving role of percutaneous ventricular assist devices in high-risk
cardiac patients.
Source
Coronary Artery Disease. 29 (4) (pp 344-353), 2018. Date of Publication:
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
The Impella is a mechanical circulatory support device that supports
ventricular function. Since 2008, when the first Impella device received
Food and Drug Administration clearance, its use has become increasingly
prevalent. A variety of Impella devices are available, and are
differentiated by size, power, and insertion techniques. These versions of
the Impella have been used in a multitude of clinical scenarios, both
emergent and elective, including high-risk coronary interventions, acute
myocardial infarction complicated by cardiogenic shock, decompensated left
and right heart failure, high-risk ventricular tachycardia ablations, and
aortic valvuloplasty. However, the available evidence supporting its use
is less than robust, primarily consisting of case reports and registries,
with a limited number of randomized-controlled trials comparing the
Impella with the intra-aortic balloon pump. Although these trials show
that the Impella provides better hemodynamic support compared with the
intra-aortic balloon pump, they failed to show a survival benefit for the
Impella. This finding may have a number of explanations, foremost the
inherent difficulty of selecting appropriate patients for trials that are
conducted in extreme clinical settings. In this study, we discuss the
mechanism of the Impella and the different types of Impella devices
available, and review the medical literature for evidence of its efficacy
in treating cardiac patients. Although the Impella has become ubiquitous
in certain markets, such as in the USA, it has yet to be a part of the
standard of care for patients in Israel.<br/>Copyright &#xa9; 2018 Wolters
Kluwer Health, Inc.

<52>
Accession Number
622055265
Author
Dedieu N.; Silva Vieira M.; Fenton M.; Wong J.; Botnar R.; Burch M.; Greil
G.; Hussain T.
Institution
(Dedieu, Fenton, Burch) Great Ormond Street Hospital for Children
Foundation Trust London UK
(Dedieu, Silva Vieira, Wong, Botnar, Greil, Hussain) King's College London
The Rayne Institute London UK
(Greil, Hussain) UT Southwestern Medical Center Children's Medical Center
Dallas TX USA
Title
The importance of qualitative and quantitative regional wall motion
abnormality assessment at rest in pediatric coronary allograft
vasculopathy.
Source
Pediatric Transplantation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
CAV remains one of the main limiting factors for survival in children
after heart transplantation. In this study, we explored the incremental
value of routine CMR for evaluation and detection of CAV using qualitative
and quantitative analysis of regional and global myocardial function and
strain. This was a prospective imaging biomarker validation trial.
Twenty-two patients (11 male), aged between 10 and 17 years (median 14
years) post-heart transplantation, were prospectively enrolled and
underwent CMR in addition to their biennial review workup with Echo,
angiography, and IVUS. Nine healthy control patients were enrolled to
undergo CMR alone. Echo was used to analyze WMAs and systolic function.
CMR images were analyzed qualitatively for RWMA and quantitatively for
volumetric analysis, S and SR. All results were compared to IVUS and
angiography assessments. Qualitatively, CMR detected RWMA corresponding to
angiographic disease in 3 patients that were not detected on Echo.
However, quantitative strain analysis suggested RWMA in an extra 9
patients. Detection of regional wall motion abnormality using quantitative
strain analysis was associated with a higher mean stenosis grade (P=.04)
and reduced graft survival (P=.04) compared to those with no quantitative
wall motion abnormality. Overall, only longitudinal stain was abnormal in
patients compared with controls, but there was no correlation between any
of the global indices of S or SR and IVUS measurements. CMR is more
sensitive than Echo for the visual detection of significant WMAs.
Quantitative CMR strain analysis at rest may give additional information
to discriminate those at greatest risk.<br/>Copyright &#xa9; 2018 John
Wiley & Sons A/S.

<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>
[Use Link to view the full text]
Accession Number
618128930
Author
Cerrato E.; Barbero U.; D'Ascenzo F.; Taha S.; Biondi-Zoccai G.; Omede P.;
Bianco M.; Echavarria-Pinto M.; Escaned J.; Gaita F.; Varbella F.
Institution
(Cerrato, Varbella) Interventional Cardiology, San Luigi Gonzaga
University Hospital, Orbassano and Rivoli Infermi Hospital, Italy
(Barbero, D'Ascenzo, Taha, Omede, Gaita) Division of Cardiology, Citta
della Salute e della Scienza, University of Turin, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina and Department of
AngioCardioNeurology, IRCCS, Neuromed, Pozzilli, Italy
(Bianco) Division of Cardiology, San Luigi Gonzaga University Hospital,
Orbassano, Turin, Italy
(Echavarria-Pinto) Department of Cardiology, Hospital General ISSSTE,
Queretaro, Mexico
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
Title
What is the optimal treatment for symptomatic patients with isolated
coronary myocardial bridge? A systematic review and pooled analysis.
Source
Journal of Cardiovascular Medicine. 18 (10) (pp 758-770), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Myocardial bridging is a common coronary anomaly, with few
severe adverse events but a relevant symptom burden. Myocardial bridging
treatment, however, remains uncertain because of the lack of randomized
trials. Material MEDLINE/PubMed was systematically screened for studies
reporting on isolated myocardial bridging diagnosed at coronary
angiography or with coronary computed tomography in patients admitted for
suspected angina or with an acute coronary syndrome. Baseline, treatment
and outcome data were appraised and pooled according to treatment (medical
therapy, bypass surgery/myotomy or stenting). Results A total of 899
patients in 18 studies were included with a low prevalence of traditional
risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5).
After a median of 31.0 months (interquartile range 12.4-37.1), major
cardiovascular events (composite of death, myocardial infarction or target
vessel revascularization) occurred in only 3.4% of the study patients and
78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed
conservatively and free of symptoms. When an invasive strategy was
planned, freedom from angina was higher in patients treated with surgery
[84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7%
(38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high
incidence of major cardiovascular events related to target vessel
revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed
that patients treated with beta-blockers or with a history of hypertension
were more likely to remain free from angina (B -0.6, P=0.013; B -0.66,
P=0.006). Conclusion Patients with symptomatic isolated myocardial
bridging generally have a good long-term prognosis. Pharmacological
treatment alone, especially with beta-blockers, is able to improve angina
in most cases. Surgical treatment appears to be more effective than
stenting in nonresponders.<br/>Copyright &#xa9; 2017 Italian Federation of
Cardiology. All rights reserved.

<55>
Accession Number
618053455
Author
Agarwal N.; Jain A.; Garg J.; Mojadidi M.K.; Mahmoud A.N.; Patel N.K.;
Agrawal S.; Gupta T.; Bhatia N.; Anderson R.D.
Institution
(Agarwal, Jain, Mojadidi, Mahmoud, Anderson) Department of Medicine,
University of Florida, Gainesville, FL, United States
(Garg) Department of Medicine, Lehigh Valley Health Network, Allentown,
PA, United States
(Patel) Department of Medicine, Virginia Commonwealth University Health
System, Richmond, VA, United States
(Agrawal) Department of Medicine, St. Lukes University Health Network,
Bethlehem, PA, United States
(Gupta) Department of Medicine, Montefiore Medical Centre, Albert Einstein
College of Medicine, Bronx, NY, United States
(Bhatia) Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
Staged versus index procedure complete revascularization in ST-elevation
myocardial infarction: A meta-analysis.
Source
Journal of Interventional Cardiology. 30 (5) (pp 397-404), 2017. Date of
Publication: October 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Complete revascularization of patients with ST-elevation
myocardial infarction and multivessel coronary artery disease reduces
adverse events compared to infarct-related artery only revascularization.
Whether complete revascularization should be done as multivessel
intervention during index procedure or as a staged procedure remains
controversial. Method: We performed a meta-analysis of randomized
controlled trials comparing outcomes of multivessel intervention in
patients with ST-elevation myocardial infarction and multivessel coronary
artery disease as staged procedure versus at the time of index procedure.
Composite of death or myocardial infarction was the primary outcome.
Mantel-Haenszel risk ratios were calculated using random effect model.
Results: Six randomized studies with a total of 1126 patients met our
selection criteria. At a mean follow-up of 13 months, composite of
myocardial infarction or death (7.2% vs 11.7%, RR: 1.66, 95%CI: 1.09-2.52,
P = 0.02), all cause mortality (RR: 2.55, 95%CI: 1.42-4.58, P < 0.01),
cardiovascular mortality (RR: 2.8, 95%CI: 1.33-5.86, P = 0.01), and
short-term (<30 days) mortality (RR: 3.54, 95%CI: 1.51-8.29, P < 0.01)
occurred less often in staged versus index procedure multivessel
revascularization. There was no difference in major adverse cardiac events
(RR: 1.14, 95%CI: 0.88-1.49, P = 0.33), repeat myocardial infarction (RR:
1.14, 95%CI: 0.68-1.92, P = 0.61), and repeat revascularization (RR: 0.92,
95%CI: 0.66-1.28, P = 0.62). Conclusion: In patients with ST-elevation
myocardial infarction and multivessel coronary artery disease, a strategy
of complete revascularization as a staged procedure compared to index
procedure revascularization results in reduced mortality without an
increase in repeat myocardial infarction or need for repeat
revascularization.<br/>Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<56>
Accession Number
617753769
Author
Templeton T.W.; Morris B.N.; Goenaga-Diaz E.J.; Forest D.J.; Hadley R.;
Moore B.A.; Bryan Y.F.; Royster R.L.
Institution
(Templeton, Morris, Goenaga-Diaz, Forest, Hadley, Moore, Bryan, Royster)
Department of Anesthesiology, Wake Forest School of Medicine,
Winston-Salem, NC, United States
Title
A Prospective Comparison of Intraluminal and Extraluminal Placement of the
9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1335-1340),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objective To compare the standard intraluminal approach with the placement
of the 9-French Arndt endobronchial blocker with an extraluminal approach
by measuring the time to positioning and other relevant intraoperative and
postoperative parameters. Design A prospective, randomized, controlled
trial. Setting University hospital. Participants The study comprised 41
patients (20 intraluminal, 21 extraluminal) undergoing thoracic surgery.
Intervention: Placement of a 9-French Arndt bronchial blocker either
intraluminally or extraluminally. Comparisons between the 2 groups
included the following: (1) time for initial placement, (2) quality of
isolation at 1-hour intervals during one-lung ventilation, (3) number of
repositionings during one-lung ventilation, and (4) presence or absence of
a sore throat on postoperative days 1 and 2 and, if present, its severity.
Measurements and Main Results Median time to placement (min:sec) in the
extraluminal group was statistically faster at 2:42 compared with 6:24 in
the intraluminal group (p < 0.05). Overall quality of isolation was
similar between groups, even though a significant number of blockers in
both groups required repositioning (extraluminal 47%, intraluminal 40%, p
> 0.05), and 1 blocker ultimately had to be replaced intraoperatively. No
differences in the incidence or severity of sore throat postoperatively
were observed. Conclusions A statistically significant reduction in time
to placement using the extraluminal approach without any differences in
the rate of postoperative sore throat was observed. Whether placed
intraluminally or extraluminally, a significant percentage of Arndt
endobronchial blockers required at least one intraoperative
repositioning.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<57>
Accession Number
617753766
Author
Chan M.J.; Chung T.; Glassford N.J.; Bellomo R.
Institution
(Chan, Chung, Glassford, Bellomo) Department of Intensive Care, Austin
Hospital, Heidelberg, Australia
(Chan, Glassford, Bellomo) The Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventative Medicine, Monash
University Alfred Hospital, Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Title
Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1155-1165),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives To identify the normal baseline preoperative range of cerebral
tissue oxygen saturation (SctO<inf>2</inf>) derived using near-infrared
spectroscopy (NIRS) and the efficacy of perioperative interventions
designed to modulate SctO<inf>2</inf> in cardiac surgical patients. Design
Systematic review and meta-analysis of relevant randomized controlled
trials (RCTs) extracted from the Medline, Embase, and Cochrane Central
Register of Controlled Trials databases. Setting Hospitals performing
cardiac surgery. Participants The study comprised 953 participants from 11
RCTs. Interventions Interventions included the following: (1)
SctO<inf>2</inf> monitoring protocol compared with no monitoring; (2) use
of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB
compared with hypothermic CPB; (4) glyceryl trinitrate during surgery
compared with placebo; (5) midazolam during induction of anesthesia
compared with propofol; (6) sevoflurane anesthesia compared with total
intravenous anesthesia; (7) sevoflurane anesthesia compared with
propofol-based anesthesia; and (8) norepinephrine during CPB compared with
phenylephrine. Measurements and Main Results Eleven RCTs with 953
participants measured baseline preoperative SctO<inf>2</inf> using NIRS.
The pooled mean baseline SctO<inf>2</inf> was 66.4% (95% CI 65.0-67.7),
generating a reference range of 51.0% to 81.8%. Four interventions (1, 3,
4, and 6 described in the Interventions section above) increased
intraoperative SctO<inf>2</inf> across the majority of reported time
points. Postoperative follow-up of SctO<inf>2</inf> occurred in only 1
study, and postoperative cognitive assessment correlating SctO<inf>2</inf>
with cognitive function was applied in only 4 studies using variable
methodology. Conclusions The authors have established that reference
values for baseline NIRS-derived SctO<inf>2</inf> in cardiac surgery
patients are varied and have identified interventions that modulate
SctO<inf>2</inf>. This information opens the door to standardized research
and interventional studies in this field.<br/>Copyright &#xa9; 2017

<58>
Accession Number
621775974
Author
Siontis G.C.M.; Mavridis D.; Greenwood J.P.; Coles B.; Nikolakopoulou A.;
Juni P.; Salanti G.; Windecker S.
Institution
(Siontis, Windecker) Department of Cardiology, Bern University Hospital,
Inselspital, Bern, Switzerland
(Mavridis) Department of Primary Education, University of Ioannina,
Ioannina, Greece
(Greenwood) Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Coles) Cancer Research Wales Library, Velindre National Health Trust,
Cardiff, United Kingdom
(Nikolakopoulou, Salanti) Institute of Social and Preventive Medicine,
University of Bern, Bern, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, Canada
Title
Outcomes of non-invasive diagnostic modalities for the detection of
coronary artery disease: Network meta-analysis of diagnostic randomised
controlled trials.
Source
BMJ (Online). 360 (no pagination), 2018. Article Number: k504. Date of
Publication: 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate differences in downstream testing, coronary
revascularisation, and clinical outcomes following non-invasive diagnostic
modalities used to detect coronary artery disease. Design Systematic
review and network meta-analysis. Data sources Medline, Medline in
process, Embase, Cochrane Library for clinical trials, PubMed, Web of
Science, SCOPUS, WHO International Clinical Trials Registry Platform, and
Clinicaltrials.gov. Eligibility criteria for selecting studies Diagnostic
randomised controlled trials comparing non-invasive diagnostic modalities
in patients presenting with symptoms suggestive of low risk acute coronary
syndrome or stable coronary artery disease. Data synthesis A random
effects network meta-analysis synthesised available evidence from trials
evaluating the effect of non-invasive diagnostic modalities on downstream
testing and patient oriented outcomes in patients with suspected coronary
artery disease. Modalities included exercise electrocardiograms, stress
echocardiography, single photon emission computed tomography-myocardial
perfusion imaging, real time myocardial contrast echocardiography,
coronary computed tomographic angiography, and cardiovascular magnetic
resonance. Unpublished outcome data were obtained from 11 trials. Results
18 trials of patients with low risk acute coronary syndrome (n=11 329) and
12 trials of those with suspected stable coronary artery disease (n=22
062) were included. Among patients with low risk acute coronary syndrome,
stress echocardiography, cardiovascular magnetic resonance, and exercise
electrocardiograms resulted in fewer invasive referrals for coronary
angiography than coronary computed tomographic angiography (odds ratio
0.28 (95% confidence interval 0.14 to 0.57), 0.32 (0.15 to 0.71), and 0.53
(0.28 to 1.00), respectively). There was no effect on the subsequent risk
of myocardial infarction, but estimates were imprecise. Heterogeneity and
inconsistency were low. In patients with suspected stable coronary artery
disease, an initial diagnostic strategy of stress echocardiography or
single photon emission computed tomography-myocardial perfusion imaging
resulted in fewer downstream tests than coronary computed tomographic
angiography (0.24 (0.08 to 0.74) and 0.57 (0.37 to 0.87), respectively).
However, exercise electrocardiograms yielded the highest downstream
testing rate. Estimates for death and myocardial infarction were imprecise
without clear discrimination between strategies. Conclusions For patients
with low risk acute coronary syndrome, an initial diagnostic strategy of
stress echocardiography or cardiovascular magnetic resonance is associated
with fewer referrals for invasive coronary angiography and
revascularisation procedures than non-invasive anatomical testing, without
apparent impact on the future risk of myocardial infarction. For suspected
stable coronary artery disease, there was no clear discrimination between
diagnostic strategies regarding the subsequent need for invasive coronary
angiography, and differences in the risk of myocardial infarction cannot
be ruled out. Systematic review registration PROSPERO registry no
CRD42016049442.<br/>Copyright &#xa9; 2018 Published by the BMJ Publishing
Group Limited. For permission to use (where not already granted under a
licence) please go to.

<59>
Accession Number
621773546
Author
Wang M.-L.; Wang Y.-P.; Hung M.-H.; Hsu H.-H.; Chen J.-S.; Yang F.-S.;
Cheng Y.-J.
Institution
(Wang, Wang, Hung, Yang, Cheng) Department of Anesthesiology, National
Taiwan University Hospital, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Wang, Hung) Graduate Institute of Clinical Medicine, National Taiwan
University College of Medicine, Taipei, Taiwan (Republic of China)
(Hsu, Chen) Department of Surgery, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
(Chen) Department of Traumatology, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
Title
Is fibre-optic bronchoscopy necessary to confirm the position of
rigid-angled endobronchial blockers before thoracic surgery? A randomized
controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 53 (1) (pp 241-246), 2018.
Date of Publication: January 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To determine the success rate of blind insertion and the
usefulness of fibre-optic bronchoscopy for directing rigid-angled
endobronchial blockers (EBs) to the correct side and achieving
satisfactory surgical fields. METHODS: A randomized trial was designed to
determine the extent to which the Coopdech Endobronchial Blocker Tube
(Daiken Medical Co., Ltd) could successfully be placed through either
auscultation (n = 57) or fibre-optic bronchoscopy (n = 55) in patients
scheduled for thoracic surgery. The placement time was recorded and
quality of the thoracoscopic operation field was determined by the
thoracic surgeon. Anaesthesiologists with varying thoracic experience
levels were enrolled. RESULTS: The success rates of insertion through
auscultation were 100% (32 of 32) for the right side and 88% (22 of 25)
for the left side. Placement through auscultation was faster than that
through bronchoscopy (mean 89.6 vs 141.1 s, P = 0.008) in the right-sided
procedure but non-significant in the left-sided procedure (mean 138.5 vs
130 s, P = 0.795). Surgical grading of the operation field was not
significantly different between both techniques (P = 0.502). Experienced
anaesthesiologists took less time to position EBs (mean 91.0 vs 138.0 s, P
= 0.015). Surgical grading was comparable between specialists and
residents (P = 0.058). CONCLUSIONS: Once an EB was correctly inserted and
confirmed through auscultation, the corresponding surgical satisfaction
was comparable to that through bronchoscopy. In the majority of cases,
bronchoscopy is unnecessary for correct and efficient EB positioning.
However, bronchoscopy is still mandatory in left-sided EB insertion and in
patients with deviated tracheobronchial anatomy.<br/>Copyright &#xa9; The
Author 2017.

<60>
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.

<61>
Accession Number
621948449
Author
Meng L.; Gruenbaum S.E.; Dai F.; Wang T.
Institution
(Meng, Gruenbaum) Division of Neuro Anesthesia, Department of
Anesthesiology, Yale University School of Medicine, 333 Cedar Street, New
Haven, CT 06520, United States
(Dai) Department of Biostatistics, Yale University School of Public
Health, Yale Center for Analytical Sciences, New Haven, CT, United States
(Wang) Department of Anesthesiology, Xuanwu Hospital, Capital Medical
University, Beijing, China
Title
Physiology, intervention, and outcome: Three critical questions about
cerebral tissue oxygen saturation monitoring.
Source
Minerva Anestesiologica. 84 (5) (pp 599-614), 2018. Date of Publication:
May 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
The balance between cerebral tissue oxygen consumption and supply can be
continuously assessed by cerebral tissue oxygen saturation
(SctO<inf>2</inf>) monitor. A construct consisting of three sequential
questions, targeting the physiology monitored, the intervention
implemented, and the outcomes affected, is proposed to critically appraise
this monitor. The impact of the SctO<inf>2</inf>-guided care on patient
outcome was examined through a systematic literature search and
meta-analysis. We concluded that the physiology monitored by
SctO<inf>2</inf> is robust and dynamic, fragile (prone to derangement),
and adversely consequential when deranged. The inter-individual
variability of SctO<inf>2</inf> measurement advocates for an intervention
threshold based on a relative, not absolute, change. The intra-individual
variability has multiple determinants which is the foundation of
intervention. A variety of therapeutic options are available; however,
none are 100% efficacious in treating cerebral dys-oxygenation. The
therapeutic efficacy likely depends on both an appropriate differential
diagnosis and the functional status of the regulatory mechanisms of
cerebral blood flow. Meta-analysis based on five randomized controlled
trials suggested a reduced incidence of early postoperative cognitive
decline after major surgeries (RR= 0.53; 95% CI: 0.33-0.87; I2 =82%;
P=0.01). However, its effects on other neurocognitive outcomes remain
unclear. These results need to be interpreted with caution due to the high
risks of bias. Quality RCTs based on improved intervention protocols and
standardized outcome assessment are warranted in the future.<br/>Copyright
&#xa9; 2018 Edizioni Minerva Medica.

<62>
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.

<63>
Accession Number
621861287
Author
Gao L.; Qin Q.; Chen S.-L.; Chen H.; Wang L.-F.; Jin Z.-N.; Li H.; Zhang
J.; Wang J.-A.; Zheng Y.; Fu G.-S.; Chen Y.-D.
Institution
(Gao, Chen) Department of Cardiology, Chinese PLA General Hospital,
Beijing, China
(Qin) Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
(Chen) Department of Cardiology, Nanjing First Hospital, Nanjing, China
(Chen) Department of Cardiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Wang) Department of Cardiology, Beijing Chao-yang Hospital, Capital
Medical University, Beijing, China
(Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Li) Department of Cardiology, Daqing Oilfield General Hospital, Daqing,
China
(Zhang) Department of Cardiology, Cangzhou Central Hospital, Cangzhou,
China
(Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University, School of Medicine, Hangzhou, China
(Zheng) Department of Cardiology, First Hospital of Jilin University,
Changchun, China
(Fu) Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang
University, School of Medicine, Hangzhou, China
Title
Comparison of the safety and efficacy of two types of drug-eluting
balloons (RESTORE DEB and SeQuent Please) in the treatment of
coronary in-stent restenosis: Study protocol for a randomized controlled
trial (RESTORE ISR China).
Source
Journal of Geriatric Cardiology. 15 (2) (pp 117-122), 2018. Date of
Publication: 2018.
Publisher
Science Press

<64>
Accession Number
618044503
Author
Giugliano R.P.; Pedersen T.R.; Park J.-G.; De Ferrari G.M.; Gaciong Z.A.;
Ceska R.; Toth K.; Gouni-Berthold I.; Lopez-Miranda J.; Schiele F.; Mach
F.; Ott B.R.; Kanevsky E.; Pineda A.L.; Somaratne R.; Wasserman S.M.;
Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Giugliano, Park, Kanevsky, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United
States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(De Ferrari) Department of Molecular Medicine, University of Pavia and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, The Medical University of Warsaw, Warsaw, Poland
(Ceska) Center of Preventive Cardiology, 3rd Department Internal Medicine,
University General Hospital and 1st Medical Faculty, Prague, Czech
Republic
(Toth) 1st Department of Medicine, University of Pecs, Pecs, Hungary
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lopez-Miranda) Lipids and Atherosclerosis Unit, Maimonides Biomedical
Research Institute of Cordoba, Reina Sofia University Hospital, University
of Cordoba, CIBEROBN, Cordoba, Spain
(Schiele) University Hospital Center Besancon, Besancon, France
(Mach) Hopital Cantonal, Hopitaux Universitaires de Geneva, Geneva,
Switzerland
(Ott) Rhode Island Hospital, Department of Neurology, Alpert Medical
School of Brown University, Providence, RI, United States
(Pineda, Somaratne, Wasserman) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
Clinical efficacy and safety of achieving very low LDL-cholesterol
concentrations with the PCSK9 inhibitor evolocumab: a prespecified
secondary analysis of the FOURIER trial.
Source
The Lancet. 390 (10106) (pp 1962-1971), 2017. Date of Publication: 28
October - 3 November 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: LDL cholesterol is a well established risk factor for
atherosclerotic cardiovascular disease. How much one should or safely can
lower this risk factor remains debated. We aimed to explore the
relationship between progressively lower LDL-cholesterol concentrations
achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial
of evolocumab, a monoclonal antibody to proprotein convertase
subtilisin-kexin type 9 (PCSK9). Methods: In this prespecified secondary
analysis of 25 982 patients from the randomised FOURIER trial, the
relationship between achieved LDL-cholesterol concentration at 4 weeks and
subsequent cardiovascular outcomes (primary endpoint was the composite of
cardiovascular death, myocardial infarction, stroke, coronary
revascularisation, or unstable angina; key secondary endpoint was the
composite of cardiovascular death, myocardial infarction, or stroke) and
ten prespecified safety events of interest was examined over a median of
2.2 years of follow-up. We used multivariable modelling to adjust for
baseline factors associated with achieved LDL cholesterol. This trial is
registered with ClinicalTrials.gov, number NCT01764633. Findings: Between
Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a
treatment in the FOURIER study. 1025 (4%) patients did not have an LDL
cholesterol measured at 4 weeks and 557 (2%) had already had a primary
endpoint event or one of the ten prespecified safety events before the
week-4 visit. From the remaining 25 982 patients (94% of those randomly
assigned) 13 013 were assigned evolocumab and 12 969 were assigned
placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol
concentrations of less than 0.5 mmol/L, 8003 (31%) patients achieved
concentrations between 0.5 and less than 1.3 mmol/L, 3444 (13%) patients
achieved concentrations between 1.3 and less than 1.8 mmol/L, 7471 (29%)
patients achieved concentrations between 1.8 to less than 2.6 mmol/L, and
4395 (17%) patients achieved concentrations of 2.6 mmol/L or higher. There
was a highly significant monotonic relationship between low
LDL-cholesterol concentrations and lower risk of the primary and secondary
efficacy composite endpoints extending to the bottom first percentile
(LDL-cholesterol concentrations of less than 0.2 mmol/L; p=0.0012 for the
primary endpoint, p=0.0001 for the secondary endpoint). Conversely, no
significant association was observed between achieved LDL cholesterol and
safety outcomes, either for all serious adverse events or any of the other
nine prespecified safety events. Interpretation: There was a monotonic
relationship between achieved LDL cholesterol and major cardiovascular
outcomes down to LDL-cholesterol concentrations of less than 0.2 mmol/L.
Conversely, there were no safety concerns with very low LDL-cholesterol
concentrations over a median of 2.2 years. These data support further
LDL-cholesterol lowering in patients with cardiovascular disease to well
below current recommendations. Funding: Amgen.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<65>
Accession Number
614202057
Author
Chatterjee S.; Kundu A.; Mukherjee D.; Sardar P.; Mehran R.; Bashir R.;
Giri J.; Abbott J.D.
Institution
(Chatterjee) Division of Cardiology, St. Luke's-Roosevelt Hospital Center
of the Mount Sinai Health System, New York, NY, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Mukherjee) Division of Cardiology, Texas Tech University Health Sciences
Center, El Paso, TX, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, UT, United States
(Mehran) Director of Interventional Research, Icahn School of Medicine,
Mount Sinai Health System, New York, NY, United States
(Bashir) Division of Cardiology, Temple University School of Medicine,
Philadelphia, PA, United States
(Giri) Penn Cardiovascular Outcomes, Quality & Evaluative Research Center,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
(Abbott) Warren Alpert School of Medicine and Brown University, Rhode
Island Hospital, Providence, RI, United States
Title
Risk of contrast-induced acute kidney injury in ST-elevation myocardial
infarction patients undergoing multi-vessel intervention-meta-analysis of
randomized trials and risk prediction modeling study using observational
data.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 205-212),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Ascertaining risk of contrast induced acute kidney injury
(CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients
undergoing multi-vessel percutaneous coronary intervention (MV-PCI).
Background: Complete revascularization may improve outcomes in STEMI
patients with multi-vessel disease. However, a practice of MV-PCI may be
associated with a higher risk of CI-AKI. We aimed to evaluate the risk of
CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a
validated risk score. Methods: We searched PubMed, Cochrane Library,
EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through
August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI
and infarct-related artery (IRA) only PCI during index hospitalization. A
random effects model was used to estimate the risk ratio (RR) and
respective 95% confidence intervals (CI). We queried the Nationwide
Inpatient Sample (NIS) to assess the ability of the Mehran risk score to
accurately predict the incidence of CI-AKI in patients undergoing MV-PCI.
Results: Four randomized studies (N = 1,602) were included in the final
analysis. The risk of CI-AKI was low and no difference was observed with
MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57;
P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI
for STEMI patients in the NIS. The Mehran risk score accurately
discriminated 78% of the patients who developed CI-AKI in this cohort
(c-statistic of 0.78, P = 0.002). Conclusions: MV-PCI in STEMI is not
associated with a higher risk of CI-AKI and the Mehran risk score can
identify patients at higher risk for this complication. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<66>
Accession Number
614202053
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Han M.;
Park S.-W.; Serruys P.W.; Park S.-J.
Institution
(Chang) Seoul St. Mary's Hospital, The Catholic University of Korea,
Seoul, South Korea
(Lee, Ahn, Park, Park) Heart Institute, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center, Rotterdam,
Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Netherlands
(Han) Division of Biostatistics, University of Ulsan, Asan Medical Center,
Seoul, South Korea
(Serruys) Imperial College of London, International Center for Circulatory
Health, London, United Kingdom
Title
Predictors of long-term outcomes after bypass grafting versus drug-eluting
stent implantation for left main or multivessel coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 177-185),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: We assessed predictors of long-term outcomes after coronary
artery bypass grafting (CABG) versus those after percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) in 3,230 patients with
left main or multivessel coronary artery disease (CAD). Methods and
Results: Data were pooled from the BEST, PRECOMBAT, and SYNTAX trials.
Age, chronic kidney disease, chronic obstructive lung disease, left
ventricular dysfunction, and peripheral arterial disease (PAD) were common
predictors of all-cause mortality. Diabetes mellitus, previous myocardial
infarction (MI), and SYNTAX score were independent predictors of all-cause
mortality in the PCI group, but not in the CABG group. In the CABG group,
age was the only risk factor for MI; left ventricular dysfunction,
hypertension, and PAD were risk factors for stroke. On the other hand, in
the PCI group, incomplete revascularization and previous MI were risk
factors for MI; age and previous stroke for stroke. In addition, chronic
kidney disease significantly correlated with a composite outcome of death,
MI, or stroke in the CABG group, and incomplete revascularization and
previous MI in the PCI group. Conclusions: Simple clinical variables and
SYNTAX score differentially predict long-term outcomes after CABG versus
those after PCI with DES for left main or multivessel CAD. Those
predictors might help to guide the choice of revascularization strategy.
&#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<67>
Accession Number
614103034
Author
Molstrom S.; Nielsen T.H.; Andersen C.; Nordstrom C.H.; Toft P.
Institution
(Molstrom, Toft) Department of Anesthesiology and Intensive Care, Odense
University Hospital, Odense, Denmark
(Nielsen, Nordstrom) Department of Neurosurgery, Odense University
Hospital, Odense, Denmark
(Andersen) Department of Anesthesiology and Intensive Care, Thorax
Anesthesiology Unit VITA, Odense University Hospital, Odense, Denmark
Title
Bedside Monitoring of Cerebral Energy State During Cardiac Surgery-A Novel
Approach Utilizing Intravenous Microdialysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1166-1173),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study investigated whether the lactate-to-pyruvate (LP)
ratio obtained by microdialysis (MD) of the cerebral venous outflow
reflected a derangement of global cerebral energy state during
cardiopulmonary bypass (CPB). Design Interventional, prospective,
randomized study. Setting Single-center, university teaching hospital.
Participants The study included 10 patients undergoing primary, elective
coronary artery bypass grafting. Interventions Patients were randomized
blindly to low mean arterial pressure (MAP) (40-60 mmHg; n = 5) or high
MAP (60-80 mmHg; n = 5) during CPB. The MD catheters were positioned in a
retrograde direction into the jugular bulb, and a reference catheter was
inserted into the brachial artery. The correlations among LP ratio, MAP,
data obtained from bifrontal near-infrared spectroscopy (NIRS), and
postoperative neurologic outcome measures were assessed. Measurements and
Main Results The correlated difference between pooled LP ratio (low and
high MAP) of the jugular venous and the arterial blood was significant
(LP<inf>arterial</inf> 17 [15-20] v LP<inf>venous</inf> 26 [23-27]; p =
0.0001). No cerebral desaturations (decrease in rSO<inf>2</inf>>20% from
baseline) were observed in either group during CPB. In each group, 50% of
the patients showed significant cognitive decline (mini-mental state
examination, 3 points) 2 days after surgery. Conclusion The LP ratio of
cerebral venous blood increased significantly during CPB, indicating
compromised cerebral oxidative metabolism. Conventional monitoring of
rSO<inf>2</inf> by NIRS did not show a corresponding decrease in cerebral
oxygenation. As the patients exhibited decreased cognitive functions after
CPB, increases in jugular venous LP ratio may be a sensitive indicator of
impending cerebral damage.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<68>
Accession Number
613973933
Author
Borde D.P.; Futane S.S.; Asegaonkar B.; Apsingekar P.; Khade S.; Khodve
B.; Puranik M.; George A.; Joshi S.
Institution
(Borde, Futane, Asegaonkar, Apsingekar, Khade, Khodve) Ozone Anesthesia
Group, Aurangabad, Maharashtra, India
(Puranik) Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
(George) Fortis Hospitals, Bengaluru, Karnataka, India
(Joshi) Nayati Super-Speciality Hospital, Mathura, Uttar Pradesh, India
Title
Effect of Perioperative Pregabalin on Postoperative Quality of Recovery in
Patients Undergoing Off-Pump Coronary Artery Bypass Grafting (OPCABG): A
Prospective, Randomized, Double-Blind Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1241-1245),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives Use of pregabalin is increasing in cardiac surgical patients.
However, studies using comprehensive scoring systems are lacking on the
drug's impact on postoperative recovery. The authors tested the hypothesis
that perioperative oral pregabalin improves the postoperative quality of
recovery as assessed using the Quality of Recovery (QoR-40) questionnaire
in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Design This was a randomized, double-blind, placebo-controlled study.
Settings Tertiary-care hospital. Participants Patients undergoing OPCABG.
Interventions Patients were assigned randomly to the following 2 groups:
the pregabalin group (those who received pregabalin, 150 mg capsule
orally, 1 hour before surgery and 2 days postoperatively [75 mg twice a
day] starting after extubation; n = 37); and the control group (those who
received 2 similar-looking multivitamin capsules at similar times; n =
34). The QoR-40 scores were noted preoperatively and 24 hours after
extubation. Measurements and Main Results Both groups were comparable in
terms of preoperative patient characteristics and baseline QoR-40 scores.
Global scores were significantly improved in the pregabalin group compared
with the control group in the postoperative period (177+/-9 v 170+/-9; p =
0.002). QoR-40 values in the dimensions of emotional state (p = 0.005),
physical comfort (p = 0.04), and pain (p = 0.02) were improved in the
pregabalin group. Conclusions Perioperative pregabalin improved
postoperative quality of recovery as assessed using the QoR-40
questionnaire in patients undergoing OPCABG. Perioperative pregabalin
offered advantages beyond better pain control, such as improved physical
comfort and better emotional state; therefore, the drug's use in the
perioperative period is recommended.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<69>
Accession Number
621585554
Author
Boreskie K.F.; Kehler D.S.; Costa E.C.; Cortez P.C.; Berkowitz I.; Hamm
N.C.; Moffatt T.L.; Stammers A.N.; Kimber D.E.; Hiebert B.M.; Kent D.E.;
Cornish D.E.; Blewett H.; Nguyen T.; Arora R.C.; Strachan S.M.; Semenchuk
B.N.; Hay J.L.; Cohn J.N.; Duhamel T.A.
Institution
(Boreskie, Kehler, Hamm, Moffatt, Stammers, Kimber, Kent, Cornish,
Strachan, Semenchuk, Hay, Duhamel) Faculty of Kinesiology and Recreation
Management, Health, Leisure and Human, Performance Research Institute,
University of Manitoba, Winnipeg, MB, Canada
(Boreskie, Kehler, Costa, Cortez, Berkowitz, Hamm, Moffatt, Stammers,
Kimber, Kent, Cornish, Arora, Hay, Duhamel) Institute of Cardiovascular
Sciences, St. Boniface Hospital, Albrechtsen Research Centre, Winnipeg,
MB, Canada
(Costa) Department of Physical Education, Federal University of Rio Grande
do Norte, Natal, Rio Grande do Norte, Brazil
(Cortez) Federal University of Para, Para, Brazil
(Hiebert) Department of Cardiac Sciences Program, Winnipeg Regional Health
Authority, Winnipeg, MB, Canada
(Blewett) Agriculture and Agri-Food Canada, Government of Canada,
Winnipeg, MB, Canada
(Blewett) Department of Human Nutritional Sciences, University of
Manitoba, Winnipeg, MB, Canada
(Nguyen) Section of Cardiology, University of Manitoba, Max Rady College
of Medicine, Winnipeg, MB, Canada
(Arora) Department of Surgery, University of Manitoba, Max Rady College of
Medicine, Winnipeg, MB, Canada
(Cohn) Rasmussen Center for Cardiovascular Disease Prevention, University
of Minnesota Medical School, Minneapolis, MB, United States
Title
BMJ open protocol for the HAPPY Hearts study: Cardiovascular screening for
the early detection of future adverse cardiovascular outcomes in
middle-aged and older women: A prospective, observational cohort study.
Source
BMJ Open. 7 (11) (no pagination), 2017. Article Number: e018249. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Efforts to identify individuals at a higher risk for adverse
cardiovascular outcomes focus on traditional risk factors, such as age,
sex, smoking status, blood pressure and and cholesterol; however, this
approach does not directly assess cardiovascular function and may
underestimate the risk of experiencing adverse cardiovascular outcomes in
women. This prospective, observational cohort study will examine the
ability of the Heart Attack Prevention Program for You (HAPPY) Hearts
screening protocol, a series of non-invasive procedures to identify
middle-aged and older women who are at an elevated risk for experiencing
an adverse cardiovascular event in the 5-year period after screening. The
predictive value of the HAPPY Hearts protocol will also be compared with
the Framingham Risk Score to determine the sensitivity for estimating risk
for an adverse cardiovascular outcome. Methods and analysis One thousand
women 55 years of age or older will be recruited to be screened by the
HAPPY Hearts protocol. This involves the cardiovascular assessment of
resting blood pressure, blood pressure response to 3 min of moderate
intensity exercise and large and small arterial elasticity. The
participants will be classifed into risk categories based on these
measures. The incidence of the following adverse cardiovascular outcomes
will be assessed in the 5-year period after screening in both groups:
ischaemic heart disease, acute myocardial infarction, stroke, percutaneous
coronary intervention, coronary bypass surgery, congestive heart failure
and new hypertension. Ethics and dissemination Information gathered in
this research will be published in peer-reviewed journals and presented in
a programme evaluation report to inform Manitoba Health and key
stakeholders about the outcomes of the study. The University of Manitoba
Health Research Ethics Board has approved the study protocol V.2.0, dated
29 September 2014 (H2014:224).<br/>Copyright &#xa9; Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2017.

<70>
Accession Number
613739469
Author
Magalhaes M.A.; Minha S.; Lhermusier T.; Pendyala L.; Escarcega R.O.;
Baker N.C.; Torguson R.; Satler L.F.; Pichard A.; Waksman R.
Institution
(Magalhaes, Minha, Lhermusier, Pendyala, Escarcega, Baker, Torguson,
Satler, Pichard, Waksman) Department of Internal Medicine, MedStar
Washington Hospital Center, Washington, DC, United States
(Magalhaes, Minha, Lhermusier, Pendyala, Escarcega, Baker, Torguson,
Satler, Pichard, Waksman) Division of Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Magalhaes) Department of Cardiology/Division of Interventional
Cardiology, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
Title
Does direct stenting with drug-eluting stents improve outcome? A
meta-analysis of 10,900 patients.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 213-222),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of this study is to summarize the outcomes of patients
undergoing direct stenting (DS) with drug-eluting stents (DES) compared to
those who underwent balloon predilatation. Background: DS has been
associated with improved outcomes in the bare-metal stent era. Although DS
with DES implantation has been increasingly adopted in clinical practice,
its safety and effectiveness remain controversial. Methods: The search
criteria identified 546 studies in the Medline/PubMed, Cochrane, and
EMBASE databases from 2001 to July 2014. From these, seven studies
totaling 10,900 patients were selected. Summarized estimates [odds ratio
(OR) and 95% confidence intervals] were obtained using a random-effects
model. The primary outcomes were a composite of major adverse cardiac
events (MACE), including all-cause death, myocardial infarction (MI), and
repeat revascularization. The secondary outcomes included a composite of
death and MI and the rates of target lesion revascularization (TLR).
Results: Overall, 4101 (38%) and 6799 (62%) patients underwent DS with DES
and balloon pre-dilatation, respectively. DS with DES reduced the
likelihood of MACE (OR: 0.81 [0.71-0.93]). Additionally, DS with DES was
associated with reduced rates of death/MI (OR: 0.76 [0.62-0.92]), and TLR
(OR: 0.66 [0.44-0.98]). Conclusions: DS with DES is safe and may be
associated with better outcomes in selected patients. &#xa9; 2016 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<71>
Accession Number
621870186
Author
Renew J.R.
Institution
(Renew) Department of Anesthesiology and Perioperative Medicine, Mayo
Clinic, Jacksonville, FL 32224, United States
Title
Perioperative management of hyperlipidemia medications.
Source
Current Clinical Pharmacology. 12 (3) (pp 152-156), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Coronary artery disease is a common comorbidity encountered
during the perioperative period. Whether patients are scheduled for
cardiac or noncardiac surgery, this cardiovascular disease must be
addressed in the preoperative period to decrease the accompanying risks
and potential postoperative problems. Lipid-lowering medications are often
used to treat hyperlipidemia, a risk factor for the development of
atherosclerosis and coronary artery disease. Objective: To discuss the
medications most commonly used to treat hyperlipidemia and to describe
strategies for handling these treatment regimens in the perioperative
period. Method: An online search of studies and review articles was
conducted through PubMed and Medline that addressed pharmacology and
perioperative management of hyperlipidemia medications. Results: Statins
are the most commonly prescribed lipid-lowering agents, with benefits that
extend beyond correcting lipid levels. However, statins can have
clinically significant adverse effects that may necessitate the use of
other lipid-lowering medications with different mechanisms of action.
Alternative medications such as nicotinic acid and omega-3 fatty acids
should be withheld in the preoperative period because these agents have
been associated with hypotension and increased bleeding. Conclusion:
Clinicians must be familiar with the various lipid-lowering agents because
it is very likely they will encounter such medications during preoperative
visits.<br/>Copyright &#xa9; 2017 Bentham Science Publishers.

<72>
Accession Number
617923267
Author
Rogers C.A.; Capoun R.; Scott L.J.; Taylor J.; Jain A.; Angelini G.D.;
Narayan P.; Suleiman M.-S.; Sarkar K.; Ascione R.
Institution
(Rogers, Scott, Taylor) Clinical Trials and Evaluation Unit, School of
Clinical Sciences, University of Bristol, Bristol, United Kingdom
(Capoun, Angelini, Suleiman, Ascione) Bristol Heart Institute, School of
Clinical Sciences, University of Bristol, Bristol, United Kingdom
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Narayan, Sarkar) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
Title
Shortening cardioplegic arrest time in patients undergoing combined
coronary and valve surgery: Results from a multicentre randomized
controlled trial: The SCAT trial.
Source
European Journal of Cardio-thoracic Surgery. 52 (2) (pp 288-296), 2017.
Article Number: ezx087. Date of Publication: 01 Aug 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Combined coronary artery bypass grafting and valve surgery
requires a prolonged period of cardioplegic arrest (CA) predisposing to
myocardial injury and postoperative cardiac-specific complications. The
aim of this trial was to reduce the CA time in patients undergoing
combined coronary artery bypass grafting and valve surgery and assess if
this was associated with less myocardial injury and related
complications.METHODS: Participants were randomized to (i) coronary artery
bypass grafting performed on the beating heart with cardiopulmonary bypass
support followed by CA for the valve procedure (hybrid) or (ii) both
procedures under CA (conventional). To assess complications related to
myocardial injury, we used the composite of death, myocardial infarction,
arrhythmia, need for pacing or inotropes for >12 h. To assess myocardial
injury, we used serial plasma troponin T and markers of metabolic stress
in myocardial biopsies.RESULTS: Hundred and sixty patients (80 hybrid and
80 conventional) were randomized. Mean age was 66.5 years and 74% were
male. Valve procedures included aortic (61.8%) and mitral (33.1%) alone or
in combination (5.1%). CA time was 16% lower in the hybrid group [median
98 vs 89 min, geometric mean ratio (GMR) 0.84, 95% confidence interval
(CI) 0.77-0.93, P = 0.0004]. Complications related to myocardial injury
occurred in 131/160 patients (64/80 conventional, 67/80 hybrid), odds
ratio 1.24, 95% CI 0.54-2.86, P = 0.61. Release of troponin T was similar
between groups (GMR 1.04, 95% CI 0.87-1.24, P = 0.68). Adenosine
monophosphate was 28% lower in the hybrid group (GMR 0.72, 95% CI
0.51-1.02, P = 0.056).CONCLUSIONS: The hybrid procedure reduced the CA
time but myocardial injury outcomes were not superior to conventional
approach.TRIAL REGISTRATION: ISRCTN65770930.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<73>
Accession Number
617923195
Author
Head S.J.; da Costa B.R.; Beumer B.; Stefanini G.G.; Alfonso F.;
Clemmensen P.; Collet J.-P.; Cremer J.; Falk V.; Filippatos G.; Hamm C.;
Kappetein A.P.; Kastrati A.; Knuuti J.; Kolh P.; Landmesser U.; Laufer G.;
Neumann F.-J.; Richter D.J.; Schauerte P.; Taggart D.P.; Torracca L.;
Valgimigli M.; Wijns W.; Witkowski A.; Windecker S.; Juni P.; Sousa-Uva M.
Institution
(Head, Beumer, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano-Milan, Italy
(Alfonso) Department of Cardiology, Hospital Universitario de La Princesa,
Madrid, Spain
(Clemmensen) Department of Medicine, Nykoebing F Hospital, University of
Southern Denmark, Odense, Denmark
(Collet) ACTION Study Group, Universite Pierre et Marie Curie (UPMC-Paris
06), Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP), Paris,
France
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, Klinik fur
Herz-Thorax-Gefasschirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
(Filippatos) Heart Failure Unit, Department of Cardiology, Athens
University Hospital Attikon, Athens, Greece
(Hamm) Department of Cardiology, Kerckhoff Heart and Thoraxenter, Bad
Nauheim, Germany
(Kastrati) Department of Adult Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Knuuti) Turku PET Centre, University of Turku, Turku University Hospital,
Turku, Finland
(Kolh) Department of Cardiovascular Surgery, University Hospital of Liege,
Liege, Belgium
(Landmesser) Department of Cardiology, Charite Berlin-University Medicine,
Campus Benjamin Franklin and Berlin Institute of Health (BIH), Berlin,
Germany
(Laufer) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Neumann) Division of Cardiology and Angiology II, University Heart Center
Freiburg - Bad Krozingen, Bad Krozingen, Germany
(Richter) Second Cardiac Department, Euroclinic Hospital, Athens, Greece
(Schauerte) Department of Cardiology, University Hospital Aachen RWTH,
Aachen, Germany
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Torracca) Cardio Center, Humanitas Research Hospital, Rozzano-Milan,
Italy
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Wijns) Cardiovascular Research Center, OLV Hospital Aalst, Aalst, Belgium
(Witkowski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Sousa-Uva) Department of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon,
Portugal
Title
Adverse events while awaiting myocardial revascularization: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 52 (2) (pp 206-217), 2017.
Article Number: ezx115. Date of Publication: 01 Aug 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of the current study was to estimate adverse event
rates while awaiting myocardial revascularization and review criteria for
prioritizing patients. METHODS: A PubMed search was performed on 19
January 2015, to identify English-language, original, observational
studies reporting adverse events while awaiting coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI). Rates of
death, nonfatal myocardial infarction (MI) and emergency revascularization
were calculated as occurrence rates per 1000 patient-weeks and pooled
using random-effects models. RESULTS: The search yielded 1323 articles, of
which 22 were included with 66 410 patients and 607 675 patient-weeks on
the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1
[95% confidence interval 0.9-1.3] for death, 1.0 [0.6-1.6] for non-fatal
MI and 1.8 [0.8-4.1] for emergency revascularization. Subgroup analyses
demonstrated consistent outcomes, and sensitivity analyses demonstrated
comparable event rates with low heterogeneity. Higher urgency of
revascularization was based primarily on angiographic complexity, angina
severity, left ventricular dysfunction and symptoms on stress testing, and
such patients with a semi-urgent status had a higher risk of death than
patients awaiting elective revascularization (risk ratio at least 2.8).
Individual studies identified angina severity and left ventricular
dysfunction as most important predictors of death when awaiting CABG.
Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1
[95% confidence interval 0.0-0.4] for death, 0.4 [0.1-1.2] for non-fatal
MI and 0.7 [0.4-1.4] for emergency revascularization but were based on
only a few old studies. CONCLUSIONS: Rates of death, non-fatal MI and
emergency revascularization when awaiting myocardial revascularization are
infrequent but higher in specific patients. Countries that not yet have
treatment recommendations related to waiting times should consider
introducing a maximum to limit adverse events, particularly when awaiting
CABG.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<74>
Accession Number
614328029
Author
Kalkman D.N.; Woudstra P.; Lu H.; Menown I.B.A.; den Heijer P.;
Suryapranata H.; Iniguez A.; Arkenbout K.E.; van't Hof A.W.J.; Muller P.;
Erglis A.; Tijssen J.G.; Beijk M.A.M.; de Winter R.J.
Institution
(Kalkman, Woudstra, Lu, Tijssen, Beijk, de Winter) Academic Medical Center
- University of Amsterdam, Amsterdam, Netherlands
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(den Heijer) Amphia Hospital Breda, Breda, Netherlands
(Suryapranata) Radboud University Medical Center, Nijmegen, Netherlands
(Iniguez) Hospital Alvaro Cunqueiro - Complejo Hospitalario Universitario,
Vigo, Spain
(Arkenbout) Tergooi Ziekenhuis, Blaricum, Netherlands
(van't Hof) Isala Klinieken, Zwolle, Netherlands
(Muller) Institut National de Cardiochirurgie et de Cardiologie
Interventionnelle, Luxembourg
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
Title
Evaluation of clinical outcomes after COMBO stent treatment in patients
presenting with acute coronary syndrome.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp E31-E37),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Patients presenting with acute coronary syndrome (ACS) are at
increased risk of complications after percutaneous coronary intervention
with stent placement compared to patients with stable angina (SA) treated
in an elective setting. The novel pro-healing COMBO stent is a
bio-engineered drug eluting stent designed to promote vessel healing.
Therefore, the stent may reduce this difference in clinical outcomes
between elective and ACS-patients and prevent late stent thrombosis.
Methods and Results: The European, prospective, multicenter, 1000
all-comers patient REMEDEE registry evaluates clinical outcomes after
COMBO stent placement in ACS- and elective patients. The primary endpoint
at 12 months is target lesion failure (TLF), a composite of cardiac death,
target-vessel myocardial infarction and target lesion revascularization. A
total of 49.9% (n = 498) of patients presented with acute coronary
syndrome. TLF was 7.1% in ACS patients, definite and probable stent
thrombosis was observed in 0.5% of ACS patients and in all within 9 days
post stenting. We found no significant difference in TLF between ACS and
non-ACS patients and a low overall rate of TLF. Conclusions: The COMBO
stent is a safe and efficient device for patients presenting with ACS. Low
ST rate and only early stent thrombosis were observed. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<75>
Accession Number
622022405
Author
Ashok A.; Soman A.
Institution
(Ashok) Nitte Institute of Physiotherapy, Nitte University, Mangalore,
Karnataka, India
(Soman) College of Applied Medical Sciences, Department of Health
Rehabilitation Sciences, Shaqra University, Saudi Arabia
Title
Efficacy of music therapy on hospital induced anxiety and health related
quality of life in coronary artery bypass graft patients: Study protocol
for a randomized controlled trial.
Source
International Journal of Pharma and Bio Sciences. 9 (2) (pp B68-B72),
2018. Date of Publication: 01 Apr 2018.
Publisher
International Journal of Pharma and Bio Sciences (E-mail:
prasmol@rediffmail.com)
Abstract
Coronary artery bypass grafting (CABG) is a common surgery which
enablesnew arteries to provide blood to the heart by makingthem bypass the
obstructions in the patient's coronary arteries. Anxiety is increased in
CABG patients compared to any other surgeries as it is associated with the
functioning of vital organs. Music therapy is one of the adjunct therapies
which have an effect on patient's anxiety. This study is to prove the
effect of music therapy on hospital induced anxiety and health related
quality of life in patients after CABG. In this assessor blinded
randomized controlled trial (RCT) the efficacy of music therapy on
post-operative anxiety and quality of life in CABG patients will be
tested. The intervention group of 60 participants, aged between 30-80
years, will be selected to receive music therapy along with cardiac
rehabilitation. The control group will receive cardiac rehabilitation
alone twice a day. The primary outcome measures areHospital Anxiety and
Depression score and secondary outcome measures are SF- 36 and 6-minute
walk distance. The primary outcomes will be measured by trained
physiotherapist on preoperative day and post-operative days 2 & 7.
Secondary outcomes will be measured on preoperative day and post-operative
day 7. According to current knowledge this is the first outcome assessor
blinded RCT on the efficacy of music therapy on hospital induced anxiety
and health related quality of life in CABG patients and strictly follows
consort guidelines (2010) with minimal confounding factors.<br/>Copyright
&#xa9; 2009-2013 IJPBS, India.

<76>
Accession Number
622037763
Author
Sharples L.; Everett C.; Singh J.; Mills C.; Spyt T.; Abu-Omar Y.; Fynn
S.; Thorpe B.; Stoneman V.; Goddard H.; Fox-Rushby J.; Nashef S.
Institution
(Sharples) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Everett, Thorpe) Leeds Institute of Clinical Trials Research, University
of Leeds, Leeds, United Kingdom
(Singh) Health Economics Research Group (HERG), Brunel University London,
London, United Kingdom
(Mills, Stoneman, Goddard) Papworth Trials Unit Collaboration, Papworth
Hospital, Cambridge, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Abu-Omar, Fynn, Nashef) Department of Cardiology and Department of
Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Title
Amaze: A double-blind, multicentre randomised controlled trial to
investigate the clinical effectiveness and cost-effectiveness of adding an
ablation device-based maze procedure as an adjunct to routine cardiac
surgery for patients with pre-existing atrial fibrillation.
Source
Health Technology Assessment. 22 (19) (no pagination), 2018. Date of
Publication: April 2018.
Publisher
NIHR Journals Library (NETSCCAlpha HouseUniversity of Southampton, Science
Park, Southampton SO167NS, United Kingdom)
Abstract
Background: Atrial fibrillation (AF) can be treated using a maze procedure
during planned cardiac surgery, but the effect on clinical patient
outcomes, and the cost-effectiveness compared with surgery alone, are
uncertain. Objectives: To determine whether or not the maze procedure is
safe, improves clinical and patient outcomes and is cost-effective for the
NHS in patients with AF. Design: Multicentre, Phase III, pragmatic,
double-blind, parallel-arm randomised controlled trial. Patients were
randomised on a 1: 1 basis using random permuted blocks, stratified for
surgeon and planned procedure. Setting: Eleven acute NHS specialist
cardiac surgical centres. Participants: Patients aged >= 18 years,
scheduled for elective or in-house urgent cardiac surgery, with a
documented history (> 3 months) of AF. Interventions: Routine cardiac
surgery with or without an adjunct maze procedure administered by an AF
ablation device. Main outcome measures: The primary outcomes were return
to sinus rhythm (SR) at 12 months and quality-adjusted life-years (QALYs)
over 2 years after randomisation. Secondary outcomes included return to SR
at 2 years, overall and stroke-free survival, drug use, quality of life
(QoL), cost-effectiveness and safety. Results: Between 25 February 2009
and 6 March 2014, 352 patients were randomised to the control (n = 176) or
experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12
months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091].
The mean difference (95% CI) in QALYs at 2 years between the two trial
arms (maze/control) was -0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR
for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients
requiring anticoagulant drug use was significantly lower in the maze arm
from 6 months after the procedure. There were no significant differences
between the two arms in operative or overall survival, stroke-free
survival, need for cardioversion or permanent pacemaker implants, New York
Heart Association Functional Classification (for heart failure), EuroQol-5
Dimensions, three-level version score and Short Form questionnaire-36
items score at any time point. Sixty per cent of patients in each trial
arm had a serious adverse event (p = 1.000); most events were mild, but 71
patients (42.5%) in the maze arm and 84 patients (45.5%) in the control
arm had moderately severe events; 31 patients (18.6%) in the maze arm and
38 patients (20.5%) in the control arm had severe events. The mean
additional cost of the maze procedure was 3533 (95% CI 1321 to 5746); the
mean difference in QALYs was -0.022 (95% CI -0.1231 to 0.0791). The maze
procedure was not cost-effective at 30,000 per QALY over 2 years in any
analysis. In a small substudy, the active left atrial ejection fraction
was smaller than that of the control patients (mean difference of -8.03,
95% CI -12.43 to -3.62), but within the predefined clinically equivalent
range. Limitations: Low recruitment, early release of trial summaries and
intermittent resource-use collection may have introduced bias and
imprecise estimates. Conclusions: Ablation can be practised safely in
routine NHS cardiac surgical settings and increases return to SR rates,
but not survival or QoL up to 2 years after surgery. Lower anticoagulant
drug use and recovery of left atrial function support anticoagulant drug
withdrawal provided that good atrial function is confirmed.<br/>Copyright
&#xa9; Queen's Printer and Controller of HMSO 2018.

<77>
Accession Number
622013116
Author
Wang K.; Zhang H.; Jia B.
Institution
(Wang, Zhang, Jia) Department of Cardiovascular Surgery, Children's
Hospital of Fudan University, Cardiovascular Center, 399 Wanyuan Road,
Minhang District, Shanghai 201102, China
Title
Current surgical strategies and techniques of aortic valve diseases in
children.
Source
Translational Pediatrics. 7 (2) (pp 83-90), 2018. Date of Publication: 01
Apr 2018.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
While the long-term outcome of surgical aortic valvotomy (SAV) appears to
be better than that of balloon aortic valvuloplasty (BAV) as the primary
procedure of aortic valve stenosis, the surgical strategies and techniques
of treating aortic valve disease in children in other situations remain
controversial. Valve repair should be first considered while replacement
is still unavoidable in some cases, and new repair techniques developed by
innovative surgeons are gradually becoming adopted. Some complex repair
procedures such as cusp extension, leaflet replacement/reconstruction have
provided satisfactory outcomes. The Ozaki technique replaces aortic valve
leaflets with glutaraldehyde-treated autologous pericardium instead of
replacing the valve entirely. Special instruments have been developed to
make the Ozaki technique more reproducible and standardized. Neonates and
infants undergoing aortic valve replacement (AVR) are a high-risk group,
where repair should be the primary consideration rather than replacement.
Several systematic reviews reveal that all currently available aortic
valve substitutes such as pulmonary autograft, mechanical prosthesis,
homograft and bioprosthesis are associated with suboptimal results in
children, but pulmonary autograft appeared to be superior with high
freedom from reintervention and better hemodynamic performance. The
strategy for treatment of aortic valve disease should be specifically
analyzed based on the brief of being beneficial for
children.<br/>Copyright &#xa9; Translational Pediatrics. All rights
reserved.

<78>
Accession Number
621951634
Author
Del Trigo M.; Munoz-Garcia A.J.; Latib A.; Auffret V.; Wijeysundera H.C.;
Nombela-Franco L.; Gutierrez E.; Cheema A.N.; Serra V.; Amat-Santos I.J.;
Kefer J.; Benitez L.M.; Leclercq F.; Mangieri A.; Le Breton H.;
Jimenez-Quevedo P.; Garcia Del Blanco B.; Dager A.; Abdul-Jawad Altisent
O.; Puri R.; Pibarot P.; Rodes-Cabau J.
Institution
(Del Trigo, Abdul-Jawad Altisent, Puri, Pibarot, Rodes-Cabau) Quebec Heart
and Lung Institute, Laval University, Quebec City, QC G1V 4GS, Canada
(Munoz-Garcia) Department of Cardiology, Hospital Universitario Virgen de
la Victoria, Malaga, Spain
(Latib, Mangieri) Department of Interventional Cardiology, San Raffaele
Hospital, Milan, Italy
(Auffret, Le Breton) Service de Cardiologie et Maladies Vasculaires,
Pontchaillou University Hospital, Rennes, France
(Wijeysundera) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Nombela-Franco, Jimenez-Quevedo) Department of Interventional Cardiology,
Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid,
Spain
(Gutierrez) Department of Interventional Cardiology, Instituto de
Investigacion Sanitaria Gregorio Maranon, Madrid, Spain
(Cheema) Department of Interventional Cardiology, St Michael's Hospital,
Toronto, ON, Canada
(Serra, Garcia Del Blanco) Department of Interventional Cardiology,
Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Amat-Santos) Cardiology Department, Hospital Clinico Univeritario de
Valladolid, Valladolid, Spain
(Kefer) Cardiology Department, Cliniques Universitaires Saint-Luc,
Brussels, Belgium
(Benitez, Dager) Cardiology Department, Clinica de Occidente de Cali,
Valle del Cauca, Colombia
(Leclercq) Departement de Cardiologie et Maladies Vasculaires, Arnaud
DeVilleneuve University Hospital, Montpellier, France
Title
Impact of anticoagulation therapy on valve haemodynamic deterioration
following transcatheter aortic valve replacement.
Source
Heart. 104 (10) (pp 814-820), 2018. Date of Publication: 01 May 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the changes in transvalvular gradients and the
incidence of valve haemodynamic deterioration (VHD) following
transcatheter aortic valve replacement (TAVR), according to use of
anticoagulation therapy. Methods and results This multicentre study
included 2466 patients (46% men; mean age 81+/-7 years) who underwent TAVR
with echocardiography performed at 12-month follow-up. Anticoagulation
therapy was used in 707 patients (28.7%) following TAVR (AC group). A
total of 663 patients received vitamin K antagonists, and 44 patients
received direct oral anticoagulants. A propensity score matching analysis
was performed to adjust for intergroup (AC vs non-AC post-TAVR)
differences. A total of 622 patients per group were included in the
propensity-matched analysis. VHD was defined as a >=10 mm Hg increase in
the mean transprosthetic gradient at follow-up (vs hospital discharge).
The mean clinical follow-up was 29+/-18 months. The mean transvalvular
gradient significantly increased at follow-up in the non-AC group within
the global cohort (P=0.003), whereas it remained stable over time in the
AC group (P=0.323). The incidence of VHD was significantly lower in the AC
group (0.6%) compared with the non-AC group (3.7%, P<0.001), and these
significant differences remained within the propensity-matched populations
(0.6% vs 3.9% in the AC and non-AC groups, respectively, P<0.001). The
occurrence of VHD did not associate with an increased risk of all-cause
death (P=0.468), cardiovascular death (P=0.539) or stroke (P=0.170) at
follow-up. Conclusions The lack of anticoagulation therapy post-TAVR was
associated with significant increments in transvalvular gradients and a
greater risk of VHD. VHD was subclinical in most cases and did not
associate with major adverse clinical events. Future randomised trials are
needed to determine if systematic anticoagulation therapy post-TAVR would
reduce the incidence of VHD.<br/>Copyright &#xa9; Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2018. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<79>
Accession Number
622047569
Author
Harris J.; Teuteberg J.; Shullo M.
Institution
(Harris) Department of Pharmacy Hospital of the University of Pennsylvania
Philadelphia, PA USA
(Teuteberg) Falk Cardiovascular Research Center Stanford University School
of Medicine Stanford, CA USA
(Shullo) J.W. Ruby Memorial Hospital Morgantown, WV USA
Title
Optimal low-density lipoprotein concentration for cardiac allograft
vasculopathy prevention.
Source
Clinical Transplantation. (no pagination), 2018. Date of Publication:
2018.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) is a major risk factor influencing
graft loss and patient survival following orthotopic heart transplant.
Allograft vasculopathy is a multifactorial process, which includes both
immunologic and non-immunologic mechanisms. Given the non-immunological
risk factors for vasculopathy, particularly hyperlipidemia, it is
intuitive that reducing a patient's LDL would help attenuate the disease
process. Multiple studies have shown benefits with the use of statin
therapy. However, current heart transplant guidelines do not give a
specific recommendation as to what LDL goal should be achieved in this
patient population. This study is a retrospective cohort analysis designed
to determine the relative risk of developing cardiac allograft
vasculopathy with respect to different LDL goals. Median LDL level of <100
mg/dL was shown to significantly reduce the risk of developing cardiac
allograft vasculopathy. Twelve of 37 patients with an LDL >=100 mg/dL
(32.4%) developed CAV vs 25 of 157 patients (15.9%) with an LDL <100 mg/dL
(P = .021). Furthermore, a delay in to time to cardiac allograft
vasculopathy was seen when a median LDL concentration of <100 mg/dL was
achieved. This benefit was not extended when a goal concentration of <70
mg/dL was targeted.<br/>Copyright &#xa9; 2018 John Wiley & Sons A/S.