EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 89

Results Generated From:
Embase <1980 to 2018 Week 22>
Embase (updates since 2018-05-18)

<1>
Accession Number
619544490
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, United
Kingdom
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(MacLullich, Shenkin) Edinburgh Delirium Research Group, Geriatric
Medicine, University of Edinburgh, Edinburgh, United Kingdom
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (2) (pp
123-132), 2017. Date of Publication: 01 Apr 2017.
Publisher
Oxford University Press
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an increasingly
common intervention for patients with aortic stenosis deemed high risk for
major cardiac surgery, but identifying those who will benefit can be
challenging. Frailty reflects physiological reserve and may be a useful
prognostic marker in this population. We performed a systematic review and
meta-analysis of the association between frailty and outcomes after TAVI.
Methods and results Five databases were searched between January 2000 and
May 2015. From 2623 articles screened, 54 were assessed for eligibility.
Ten cohort studies (n = 4592) met the inclusion criteria of reporting a
measure of frailty with early (=30 days) or late (>30 days) mortality and
procedural complications following TAVI as defined by the Valve Academic
Research Consortium (VARC). Frailty was associated with increased early
mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P <
0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63,
95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even
higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P <
0.001). Frail individuals undergoing TAVI have a mortality rate of 34
deaths per 100 patient years, compared with 19 deaths per 100 patient
years in non-frail patients. There was limited reporting of VARC
procedural outcomes in relation to frailty, preventing meta-analysis.
Conclusion Frailty assessment in an already vulnerable TAVI population
identifies individuals at even greater risk of poor outcomes. Use of
objective frailty tools may inform patient selection, but this requires
further assessment in large prospective registries.<br/>Copyright &#xa9;
The Author 2016.

<2>
Accession Number
618872541
Author
Alfonso F.; Trillo R.; Moris C.
Institution
(Alfonso) Department of Cardiology, Hospital Universitario de la Princesa,
Instituto de Investigacion Sanitaria Princesa, Universidad Autonoma de
Madrid, IIS-IP, Diego de Leon 62, Madrid 28006, Spain
(Trillo) Department of Cardiology, Hospital Universitario de Santiago de
Compostela, La Coruna, Spain
(Moris) Department of Cardiology, Hospital Universitario Central de
Asturias, Oviedo, Spain
Title
Shifting transcatheter aortic valve implantation to low-risk patients: A
pilgrimage with no shortcuts.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
258-261), 2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press

<3>
Accession Number
618872391
Author
Singh K.; Bhalla A.S.; Qutub M.A.; Carson K.; Labinaz M.
Institution
(Singh) Department of Cardiology, Gold Coast University Hospital, 1
Hospital Blvd, Southport, QLD 4215, Australia
(Singh) Griffith University, 58 Parklands Drive, Gold Coast, QLD 4215,
Australia
(Singh, Carson) University of Adelaide, North Terrace, Adelaide, SA 5000,
Australia
(Bhalla) University of Sydney, Sydney, NSW 2006, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Labinaz) University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON
K1Y 4W7, Canada
Title
Systematic review and meta-analysis to compare outcomes between
intermediate- and high-risk patients undergoing transcatheter aortic valve
implantation.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
289-295), 2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press
Abstract
Aims Recent studies have reported non-inferior outcomes for transcatheter
aortic valve implantation (TAVI) compared with surgical aortic valve
replacement (SAVR) in intermediate-risk patients. However, a comparison of
outcomes among TAVI patients depending upon the surgical risk score has
not been performed in a large study. Our aim was to compare the outcomes
of TAVI in low-, intermediate-, and high-risk patients, to ascertain if
the morbidity and mortality is related to the patient's risk profile or
the procedure itself. Methods and results A thorough computer-based search
was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed
databases. We included original research studies reporting data on TAVI in
the low-, intermediate-, and high-risk groups. Patients in
intermediate-risk group were compared to the high-risk cohort for device
success, mortality, and complications. A total of 2414 patients in the
intermediate-risk group were compared with 1597 high-risk patients. On
meta-analysis, intermediate-risk group demonstrated similar device success
[odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90, I 2 = 0%, P
= 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34-0.86, I 2 = 49%,
P = 0.009). There was no difference in the incidence of stroke (OR 1.17,
95% CI 0.80-1.71, I 2 = 36%, P = 0.42) or permanent pacemaker implantation
between the two groups (OR 1.04, 95% CI 0.82-1.32, I 2 = 41%, P = 0.74).
Conclusion Transcatheter aortic valve implantation in intermediate-risk
patients carries a low mortality and high success. Incidence of pacemaker
and stroke remains high in the lower risk group. Published on behalf of
the European Society of Cardiology. All rights reserved.<br/>Copyright
&#xa9; The Author 2017.

<4>
Accession Number
619504651
Author
Andersson C.; Abdulla J.
Institution
(Andersson, Abdulla) Department of Internal Medicine, Glostrup Hospital,
University of Copenhagen, Nordre Ringvej 57, Glostrup 2600, Denmark
Title
Is the use of renin-angiotensin systeminhibitors in patients with aortic
valve stenosis safe and of prognostic benefit? A systematic review and
meta-analysis.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 3 (1) (pp 21-27),
2017. Date of Publication: 2017.
Publisher
Oxford University Press
Abstract
Aortic valve stenosis (AVS) is associated with significant morbidity and
mortality, especially in the presence of symptoms and echocardiographic
signs of left ventricular remodelling (i.e. increase in left ventricular
mass, left ventricular dilation, and systolic dysfunction). Renin-
angiotensin system inhibitors (RASi) attenuate cardiac remodelling in
various conditions, but the safety and efficacy of RASi in AVS is unsure.
We performed a systematic review and meta-analysis to address these
issues. We identified three smaller randomized clinical trials and five
observational studies eligible for inclusion (PubMed, EMBASE, and Cochrane
library search criteria: Aortic stenosis, aortic valve,
angiotensin-converting enzyme inhibitor in different combinations,
published in English at any time up to 1 April 2016). Our analyses
suggested that use of RASi was safe, with no observed increase in
mortality risk [576/3389 patients receiving RASi vs. 1118/4384 controls
died; relative risk 0.93 (95% confidence interval 0.78-1.11), P=0.44]. Use
of RASi was also observed to lower the risk of aortic valve replacement
(AVR) surgery [67/2913 patients with RASi vs. 154/3666 controls underwent
AVR; relative risk 0.68 (95% confidence interval 0.51-0.91), P=0.01]. In
current clinical practice (based on published literature; mainly
observational studies), use of RASi appears to be safe in patients with
AVS and may reduce the need for AVR, but the evidence is overall weak.
Large-scale randomized clinical trials are warranted to address whether
prescription of RASi to treatment-naive patients may prevent disease
progression, delay AVR surgery need, and lower the risk of
mortality.<br/>Copyright &#xa9; The Author 2016.

<5>
Accession Number
618389896
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 2017.
Publisher
Oxford University Press
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach.<br/>Copyright &#xa9; 2017 The Author.

<6>
Accession Number
622109408
Author
Liu Z.; Kidney E.; Bem D.; Bramley G.; Bayliss S.; De Belder M.A.; Cummins
C.; Duarte R.
Institution
(Liu) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Kidney, Bem, Bramley, Bayliss, Cummins) Institute of Applied Health
Research, University of Birmingham, Birmingham, United Kingdom
(De Belder) James Cook University Hospital, Middlesbrough, United Kingdom
(Duarte) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
Title
Transcatheter aortic valve implantation for aortic stenosis in high
surgical risk patients: A systematic review and meta-analysis.
Source
PLoS ONE. 13 (5) (no pagination), 2018. Article Number: e0196877. Date of
Publication: May 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Symptomatic aortic stenosis has a poor prognosis. Many
patients are considered inoperable or at high surgical risk for surgical
aortic valve replacement (SAVR), reflecting their age, comorbidities and
frailty. The clinical effectiveness and safety of TAVI have not been
reviewed systematically for these high levels of surgical risk. This
systematic review compares mortality and other important clinical outcomes
up to 5 years post treatment following TAVI or other treatment in these
risk groups. Methods A systematic review protocol was registered on the
PROSPERO database (CRD42016048396). The Cochrane Library, Centre for
Reviews and Dissemination Databases, MEDLINE, EMBASE, and ZETOC were
searched from January 2002 to August 2016. Clinical trials or matched
studies comparing TAVI with other treatments for AS in patients surgically
inoperable or operable at a high risk were included. Data extraction and
quality assessment were conducted by two reviewers. Data were pooled using
random-effects meta-analysis. The main outcomes were all-cause mortality,
efficacy and major complications. Results Three good quality randomised
controlled trials (RCTs) were included. Patients' mean age ranged from
83-85 years, around half were female and New York Heart Association (NYHA)
functional class III or IV ranged from 83.8% to 94.2% with frequent
comorbidities. In 358 surgically inoperable patients from one RCT, TAVI
was superior to medical therapy for all-cause mortality at 1 year (hazard
ratio (HR) 0.58, 95% confidence interval (CI) 0.36 -0.92), 2 years (HR
0.50, 95% CI 0.39-0.65), 3 years (HR 0.53, 95% CI 0.41to 0.68) and 5 years
(HR 0.50, 95% CI 0.39-0.65), and NYHA class III or IV at 2 years (TAVI
16.8% (16/ 95), medical therapy 57.5% (23/40), p<0.001), quality of life
and re-hospitalisation. TAVI had higher risks of major bleeding up to 1
year, of stroke up to 3 years (at one year 11.2% versus 5.5%, p = .06; HR
at 2 years 2.79, 95% CI 1.25-6.22; HR at 3 years 2.81; 95% CI 1.26-6.26)
and of major vascular complication at 3 years (HR 8.27, 95% CI
2.92-23.44). Using the GRADE tool, this evidence was considered to be of
moderate quality. In a meta-analysis including 1,494 high risk surgically
operable patients from two non-inferiority RCTs TAVI showed no significant
differences from SAVR in all-cause mortality at two years (HR 1.03, 95% CI
0.82-1.29) and up to 5 years (HR 0.83, 95% CI 0.83-1.12). There were no
statistically significant differences in major vascular complications and
myocardial infarction at any time point, discrepant results for major
bleeding on variable definitions and no differences in stroke rate at any
time point. Using the GRADE tool, this evidence was considered of low
quality. Conclusions Symptomatic aortic stenosis can be lethal without
intervention but surgical resection is contraindicated for some patients
and high risk for others. We found that all-cause mortality up to 5 years
of follow-up did not differ significantly between TAVI and SAVR in
patients surgically operable at a high risk, but favoured TAVI over
medical therapy in patients surgically inoperable. TAVI is a viable
life-extending treatment option in these surgical high risk
groups.<br/>Copyright &#xa9; 2018 Liu et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<7>
Accession Number
622127401
Author
Mariscalco G.; Maselli D.; Zanobini M.; Ahmed A.; Bruno V.D.; Benedetto
U.; Gherli R.; Gherli T.; Nicolini F.
Institution
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Maselli) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Italy
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Bruno, Benedetto) Heart Centre, Bristol University, Bristol, United
Kingdom
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, San
Camillo Hospital, Rome, Italy
(Gherli, Nicolini) Division of Cardiac Surgery, University of Parma,
Parma, Italy
Title
Aortic centres should represent the standard of care for acute aortic
syndrome.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 3-14), 2018.
Date of Publication: 01 Jun 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Existing evidence suggests that patients affected by acute
aortic syndromes (AAS) may benefit from treatment at dedicated specialized
aortic centres. The purpose of the present study was to perform a
meta-analysis to evaluate the impact aortic service configuration has in
clinical outcomes in AAS patients. Methods: The design was a quantitative
and qualitative review of observational studies. We searched
PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of
December 2017 to identify eligible articles. Areas of interest included
hospital and surgeon volume activity, presence of a multidisciplinary
thoracic aortic surgery program, and a dedicated on-call aortic team.
Participants were patients undergoing repair for AAS, and odds ratios
(ORs) with corresponding 95% confidence intervals (CIs) were adopted for
synthesizing hospital/30-day mortality. Results: A total of 79,131 adult
patients from a total of 30 studies were obtained. No randomized studies
were identified. Pooled unadjusted ORs showed that patients treated in
high-volume centres or by high-volume surgeons were associated with lower
mortality rates (OR 0.51; 95% CI 0.46-0.56, and OR 0.41, 95% CI 0.25-0.66,
respectively). Pooled adjusted estimates for both high-volume centres and
surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI
0.45-0.70, respectively). Patients treated in centres that introduced a
specific multidisciplinary aortic program and a dedicated on-call aortic
team also showed a significant reduction in mortality (OR 0.31; 95% CI
0.19-0.5, and OR 0.37; 95% CI 0.15-0.87, respectively). Conclusions: We
found that specialist aortic care improves outcomes and decreases
mortality in patients affected by AAS.<br/>Copyright &#xa9; 2018, &#xa9;
The European Society of Cardiology 2018.

<8>
Accession Number
622127391
Author
Molardi A.; Di Chicco M.V.; Carino D.; Goldoni M.; Ricci M.; Borrello B.;
Gripshi F.; Gherli T.; Nicolini F.
Institution
(Molardi, Borrello) Department of General and Specialized Surgery, Cardiac
Surgery Unit, University Hospital of Parma, Italy
(Di Chicco, Carino, Goldoni, Ricci, Gripshi, Gherli, Nicolini) Department
of Medicine and Surgery, University Medical School, University of Parma,
Italy
Title
The use of RemoweLL oxygenator-integrated device in the prevention of the
complications related to aortic valve surgery in the elderly patient:
Preliminary results.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 59-65), 2018.
Date of Publication: 01 Jun 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effects of fat microembolization due to cardiopulmonary
bypass are well known in cardiac surgery. Our aim is to evaluate the use
of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic
valve replacement in elderly patients (>70 years old) to rate its
biochemical and clinical effects. The RemoweLL device is an
oxygenator-integrated reservoir which combines two strategies for fat
emboli and leucocytes removal: filtration and supernatant elimination.
Methods: Forty-four elderly patients were enrolled and assigned randomly
to a Group A (standard device) and a Group B (RemoweLL). Biochemical
effects were evaluated by blood samples, which were tested for white blood
cells, neutrophils, protein SP-100 and interleukin 6 besides standard lab
tests. Our clinical endpoints were any type of neurological, cardiac,
respiratory, gastrointestinal or renal complications, and length of stay
in the intensive care unit. Statistical analysis was carried out with chi
square test for non-parametric data; t test and analysis of variance for
repeated measures were used for parametric data. Results: Group B showed
lower levels of white blood cells, neutrophils, interleukin 6 and protein
SP-100 immediately and 24 hours after the operation. Group B also showed a
lower amount of neurocognitive type II dysfunction even if the length of
stay in the ICU did not change. Conclusions: The RemoweLL system is safe
and effective in reducing inflammatory response to cardiopulmonary bypass
and it could be a useful tool in minimizing negative effects of
cardiopulmonary bypass; however, it does not seem to have any effect on
elderly patients' hospital stay.<br/>Copyright &#xa9; 2018, &#xa9; The
European Society of Cardiology 2018.

<9>
Accession Number
622046749
Author
Engel J.; Damen N.L.; van der Wulp I.; de Bruijne M.C.; Wagner C.
Institution
(Engel, van der Wulp, de Bruijne, Wagner) EMGO Institute for Health and
Care Research, Department of Public and Occupational Health, VU University
Medical Center, Amsterdam, Netherlands
(Damen, Wagner) NIVEL, Netherlands Institute for Health Services Research,
Utrecht, Netherlands
Title
Adherence to cardiac practice guidelines in the management of
non-ST-elevation acute coronary syndromes: A systematic literature review.
Source
Current Cardiology Reviews. 13 (1) (pp 3-27), 2017. Date of Publication:
2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: In the management of non-ST-elevation acute coronary syndrome
(NST-ACS) a gap between guideline-recommended care and actual practice has
been reported. A systematic overview of the actual extent of this gap, its
potential impact on patient-outcomes, and influential factors is lacking.
Objective: To examine the extent of guideline adherence, to study
associations with the occurrence of adverse cardiac events, and to
identify factors associated with guideline adherence. Method: Systematic
literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane
library were searched until March 2016. Further, a manual search was
performed using reference lists of included studies. Two reviewers
independently performed quality-assessment and data extraction of the
eligible studies. Results: Adherence rates varied widely within and
between 45 eligible studies, ranging from less than 5.0 % to more than
95.0 % for recommendations on acute and discharge pharmacological
treatment, 34.3 % - 93.0 % for risk stratification, and 16.0 % - 95.8 %
for performing coronary angiography. Seven studies indicated that higher
adherence rates were associated with lower mortality. Several
patient-related (e.g. age, gender, co-morbidities) and
organization-related (e.g. teaching hospital) factors influencing
adherence were identified. Conclusion: This review showed wide variation
in guideline adherence, with a substantial proportion of NST-ACS patients
possibly not receiving guideline-recommended care. Consequently, lower
adherence might be associated with a higher risk for poor prognosis.
Future research should further investigate the complex nature of guideline
adherence in NST-ACS, its impact on clinical care, and factors influencing
adherence. This knowledge is essential to optimize clinical management of
NST-ACS patients and could guide future quality improvement
initiatives.<br/>Copyright &#xa9; 2017 Bentham Science Publishers.

<10>
Accession Number
2000640576
Author
Reindl M.; Reinstadler S.J.; Tiller C.; Kofler M.; Theurl M.; Klier N.;
Fleischmann K.; Mayr A.; Henninger B.; Klug G.; Metzler B.
Institution
(Reindl, Reinstadler, Tiller, Theurl, Klier, Fleischmann, Klug, Metzler)
University Clinic of Internal Medicine III, Cardiology and Angiology,
Medical University of Innsbruck, Anichstrasse 35, Innsbruck A-6020,
Austria
(Kofler) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrasse 35, Innsbruck A-6020, Austria
(Mayr, Henninger) University Clinic of Radiology, Medical University of
Innsbruck, Anichstrasse 35, Innsbruck A-6020, Austria
Title
ACEF score adapted to ST-elevation myocardial infarction patients: The
ACEF-STEMI score.
Source
International Journal of Cardiology. 264 (pp 18-24), 2018. Date of
Publication: 1 August 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The age, creatinine and ejection fraction (ACEF) score has
originally been developed for risk stratification of patients undergoing
elective cardiac surgery. In patients with stable coronary artery disease
treated by percutaneous coronary intervention (PCI), the prognostic
accuracy of ACEF could be further improved by modifying the original
scoring system (called "modified ACEF" or "ACEF-MDRD"). We aimed to
specifically adapt the ACEF score for risk assessment of ST-elevation
myocardial infarction (STEMI) patients. Methods: In this observational
study, 390 STEMI patients undergoing primary PCI were included. Clinical
endpoint was the occurrence of major adverse cardiovascular events (MACE)
comprising all-cause mortality, non-fatal re-infarction, stroke and new
congestive heart failure. Results: Original ACEF (area under the curve
(AUC):0.63 [95%CI:0.53-0.73]; p = 0.01) and ACEF-MDRD score (AUC:0.62
[95%CI:0.53-0.72]; p = 0.01) significantly but weakly predicted MACE (n =
41, 11%). The addition of creatinine > 2 mg/dl (as suggested in original
ACEF, p = 0.32) or eGFR steps as proposed in ACEF-MDRD (p = 0.17) to
age/EF ratio were not associated with net reclassification improvements
(NRI), but DELTAeGRF (>10 ml/min/1.73 m² decrease within three
days after PCI) led to an NRI of 0.29 (95%CI:0.14-0.45; p < 0.001).
Replacement of cross-sectional renal assessment by DELTAeGRF and addition
of 3 clinical parameters (diabetes, anterior infarct location and
C-reactive protein), forming the new ACEF-STEMI score, led to a
significant improvement in MACE prediction (AUC:0.75 [95%CI:0.66-0.84]) as
compared to original ACEF or ACEF-MDRD (both p = 0.03). Conclusions: In
STEMI patients undergoing primary PCI, the novel ACEF-STEMI score provided
strong prognostic value and superior discriminative ability as compared to
the previously described original ACEF or ACEF-MDRD scores.<br/>Copyright
&#xa9; 2018 Elsevier B.V.

<11>
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. 105 (6) (pp 1771-1777), 2018. Date of
Publication: June 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

<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, 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. 105 (6) (pp 1745-1753), 2018. Date of
Publication: June 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
620272450
Author
Albert C.; Albert A.; Kube J.; Bellomo R.; Wettersten N.; Kuppe H.;
Westphal S.; Haase M.; Haase-Fielitz A.
Institution
(Albert, Albert, Haase) Medical Faculty Otto-von-Guericke University,
Magdeburg, Germany
(Albert, Albert, Haase) Diaverum Deutschland, Potsdam, Germany
(Kube) Clinic of Nephrology and Hypertension, Diabetes and Endocrinology,
Otto-von-Guericke University, Magdeburg, Germany
(Kube) Department of Intensive Care, German Heart Center Leipzig,
University Clinic, Leipzig, Germany
(Bellomo) Department of Intensive Care, The Austin Hospital, Melbourne,
Australia
(Wettersten) Division of Cardiovascular Medicine, University of
California, San Diego, La Jolla, Calif, United States
(Kuppe) Department of Anesthesiology, The German Heart Center, Berlin,
Germany
(Westphal) Institute of Laboratory Medicine, Hospital Dessau, Dessau,
Germany
(Haase-Fielitz) Brandenburg Medical School (MHB) and Heart Center
Brandenburg, Department of Cardiology, Bernau, Germany
(Haase-Fielitz) Institute of Social Medicine and Health Economics,
Otto-von-Guericke University, Magdeburg, Germany
Title
Urinary biomarkers may provide prognostic information for subclinical
acute kidney injury after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (6) (pp
2441-2452.e13), 2018. Date of Publication: June 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: This study aimed to determine the biomarker-specific outcome
patterns and short-and long-term prognosis of cardiac surgery-asoociated
acute kidney injury (AKI) identified by standard criteria and/or urinary
kidney biomarkers. Methods: Patients enrolled (N = 200), originated a
German multicenter study (NCT00672334). Standard risk injury, failure,
loss, and end-stage renal disease classification (RIFLE) criteria
(including serum creatinine and urine output) and urinary kidney biomarker
test result (neutrophil gelatinase-associated lipocalin, midkine,
interleukin 6, and proteinuria) were used for diagnosis of postoperative
AKI. Primary end point was acute renal replacement therapy or in-hospital
mortality. Long-term end points among others included 5-year mortality.
Patients with single-biomarker-positive subclinical AKI (RIFLE negative)
were identified. We controlled for systemic inflammation using C-reactive
protein test. Results: Urinary biomarkers (neutrophil
gelatinase-associated lipocalin, midkine, and interleukin 6) were
identified as independent predictors of the primary end point. Neutrophil
gelatinase-associated lipocalin, midkine, or interleukin 6 positivity or
de novo/worsening proteinuria identified 21.1%, 16.9%, 30.5%, and 48.0%
more cases, respectively, with likely subclinical AKI (biomarker
positive/RIFLE negative) additionally to cases with RIFLE positivity
alone. Patients with likely subclinical AKI (neutrophil
gelatinase-associated lipocalin or interleukin 6 positive) had increased
risk of primary end point (adjusted hazard ratio, 7.18; 95% confidence
interval, 1.52-33.93 [P =.013] and hazard ratio, 6.27; 95% confidence
interval, 1.12-35.21 [P =.037]), respectively. Compared with
biomarker-negative/RIFLE-positive patients, neutrophil
gelatinase-associated lipocalin positive/RIFLE-positive or
midkine-positive/RIFLE-positive patients had increased risk of primary end
point (odds ratio, 9.6; 95% confidence interval, 1.4-67.3 [P =.033] and
odds ratio, 14.7; 95% confidence interval, 2.0-109.2 [P =.011],
respectively). Three percent to 11% of patients appear to be influenced by
single-biomarker-positive subclinical AKI. During follow-up, kidney
biomarker-defined short-term outcomes appeared to translate into long-term
outcomes. Conclusions: Urinary kidney biomarkers identified RIFLE-negative
patients with high-risk subclinical AKI as well as a higher risk subgroup
of patients among RIFLE-AKI-positive patients. These findings support the
concept that urinary biomarkers define subclinical AKI and higher risk
subpopulations with worse long-term prognosis among standard patients with
AKI.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<14>
Accession Number
2000644715
Author
Kalra R.; Vohra R.; Negi M.; Aggarwal N.; Aggarwal M.; Joshi R.
Institution
(Kalra, Vohra, Negi, Joshi, Aggarwal, Aggarwal, Joshi) Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi 110060, India
Title
Feasibility of initiating early enteral nutrition after congenital heart
surgery in neonates and infants.
Source
Clinical Nutrition ESPEN. 25 (pp 100-102), 2018. Date of Publication: June
2018.
Publisher
Elsevier Ltd
Abstract
Objective: To assess the feasibility of initiating enteral nutrition
support with first 24 h of congenital heart repairs in neonates and
Infants and its impact on outcomes following surgery. Design: It is a
prospective randomized control single blind study. Setting: It is a single
centre prospective study carried out in a tertiary care centre at
Pediatric cardiac intensive care unit. Patients: All patients with the
cyanotic congenital heart disease with increase pulmonary blood flow,
weighing less than 5 kg and undergoing congenital heart repair during the
study period were included in the study. Patients with single ventricle
status, those undergoing palliative procedures (PA band), open chest,
requiring ECMO before leaving operating room, having any other
contraindication for starting enteral feeding or those who refuse for
consent were excluded from study. Interventions: The patients were
randomized into two groups. Group 1 received trophic feeds (10-20
ml/kg/day) starting 4-6 h after surgery while feeds children in group 2
were kept NPO and received feeds after 48 h after surgery. Measurements
and main results: 15 children enrolled in both the groups. Both
pre-operative and intraoperative variables were comparable in both the
groups. There was no complication (vomiting, diarrhea, NEC, bowel
necrosis) noted in the children who received feeds after surgery. Mean
duration of mechanical ventilation in the feeds group was 58.2 +/- 4.71 h,
which was less then significantly less than those in the NPO group (P
value 0.05). Similarly, duration of ICU stay was only 179.04 +/- 41.28 h
in feeds group as compared to 228.72 +/- 85.44 h in the NPO group.
Conclusions: Neonates and Infants tolerate feeds immediately following
congenital heart repairs. Moreover, feeds appear to decrease duration of
mechanical ventilation and duration of ICU stay.<br/>Copyright &#xa9; 2018
European Society for Clinical Nutrition and Metabolism

<15>
Accession Number
622213736
Author
Fernandez-Avila D.G.; Munoz-Velandia O.M.; Garcia A.; Toro E.; Sanchez
P.M.
Institution
(Fernandez-Avila, Munoz-Velandia, Garcia, Toro, Sanchez) Pontificia
Universidad Javeriana, Hospital Universitario San Ignacio, Bogota,
Colombia
Title
Therapeutic impact of statins on the lipid profile and cardiovascular risk
in patients with systemic lupus erythematosus: Systematic review of the
literature and meta-analysis.
Source
Journal of Clinical Rheumatology. Conference: 20th Pan-American League of
Associations of Rheumatology Congress, PANLAR 2018. Argentina. 24 (3
Supplement 1) (pp S54), 2018. Date of Publication: April 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To evaluate through a systematic review the impact of the use
of statins in patients with SLE. Material and Methods: A literature search
was conducted from 1990 to August 2016 in the following databases: Embase
MEDLINE, Cochrane, Scielo, Clinical evidence, Dynamed, Cochrane Clinical
Trials Registry, LILACS). The intervention was defined as the use of
statins (atorvastatin, rosuvastatin, pravastatin or simvastatin) for
either primary or secondary prevention. As a control group, use of placebo
or another statin was accepted. The outcomes of interest were: death from
any cause, death from cardiovascular causes, acute myocardial infarction,
cerebrovascular accident, myocardial revascularization, modification of
lipid fractions, CRP levels and the presence of adverse or side effects.
The studies were selected from the analysis of titles and abstracts done
by 2 reviewers; the differences were resolved by a third evaluator. The
quality of the clinical trials was assessed according to the "Scottish
Intercollegiate Guidelines Network (SIGN)" checklist. For the summary and
meta-analysis of the information, the Review Manager 5.3 software was
used. Results: A total of 38 studies were identified, of which 32 were
excluded (26 corresponded to duplicates, 4 included children and 2 did not
report any outcomes of interest). 6 studies with a total of 412 patients
were included in the final analysis, and all corresponded to randomized
clinical trials. Five studies evaluated the impact of statins against
placebo on the lipid profile. The mean in total cholesterol reduction was
31.2 mg/dL (95% CI: -41.9 -20.5 I2 60%), this finding being consistent in
all studies. The mean low-density cholesterol (LDL-C) reduction o 31.4
mg/dL (95% CI: -43 -19.9 I2 30%). With regards to high density cholesterol
(HDL-C) levels, three studies evaluated this finding a non-clinically
significant increase. Findings did not have significant heterogeneity.
Five studies evaluated the impact of statins on CRP levels, evidencing
statistical but not clinically significant decrease of 0.78 mg/dl (95% CI
-1.43 -0.13 I2: 98%). Conclusion: The use of statins in patients with SLE
has a direct impact on the decrease in total cholesterol and LDL-C. No
evidence was found on the reduction of cardiovascular outcomes in this
population during pharmacological treatment with statins. There is
insufficient information to analyze the effect of statins use in
decreasing cardiovascular events and mortality.

<16>
Accession Number
622127116
Author
Punjasawadwong Y.; Chau-in W.; Laopaiboon M.; Punjasawadwong S.; Pin-on P.
Institution
(Punjasawadwong) Chiang Mai University, Department of Anesthesiology,
Faculty of Medicine, Chiang Mai 50200, Thailand
(Chau-in) Faculty of Medicine, Khon Kaen University, Department of
Anesthesiology, 19-32 Chuabchuen Road, Khon Kaen, Thailand
(Laopaiboon) Khon Kaen University, Department of Epidemiology and
Biostatistics, Faculty of Public Health, 123 Mitraparb Road, Amphur Muang,
Khon Kaen 40002, Thailand
(Punjasawadwong, Pin-on) Faculty of Medicine, Chiang Mai University,
Department of Anesthesiology, Chiang Mai 50200, Thailand
Title
Processed electroencephalogram and evoked potential techniques for
amelioration of postoperative delirium and cognitive dysfunction following
non-cardiac and non-neurosurgical procedures in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (5) (no pagination), 2018.
Article Number: CD011283. Date of Publication: 15 May 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative delirium (POD) and postoperative cognitive
dysfunction (POCD) may complicate a patient's postoperative recovery in
several ways. Monitoring of processed electroencephalogram (EEG) or evoked
potential (EP) indices may prevent or minimize POD and POCD, probably
through optimization of anaesthetic doses. Objectives: To assess whether
the use of processed EEG or auditory evoked potential (AEP) indices
(bispectral index (BIS), narcotrend index, cerebral state index, state
entropy and response entropy, patient state index, index of consciousness,
A-line autoregressive index, and auditory evoked potentials (AEP index))
as guides to anaesthetic delivery can reduce the risk of POD and POCD in
non-cardiac surgical or non-neurosurgical adult patients undergoing
general anaesthesia compared with standard practice where only clinical
signs are used. Search methods: We searched CENTRAL, MEDLINE, Embase and
clinical trial registry databases up to 28 March 2017. We updated this
search in February 2018, but these results have not been incorporated in
the review. Selection criteria: We included randomized or quasi-randomized
controlled trials comparing any method of processed EEG or evoked
potential techniques (entropy, BIS, AEP etc.) against a control group
where clinical signs were used to guide doses of anaesthetics in adults
aged 18 years or over undergoing general anaesthesia for non-cardiac or
non-neurosurgical elective operations. Data collection and analysis: We
used the standard methodological procedures expected by Cochrane. Our
primary outcomes were: occurrence of POD; and occurrence of POCD.
Secondary outcomes included: all-cause mortality; any postoperative
complications; and postoperative length of stay. We used GRADE to assess
the quality of evidence for each outcome. Main results: We included six
randomized controlled trials (RCTs) with 2929 participants comparing
processed EEG or EP indices-guided anaesthesia with clinical signs-guided
anaesthesia. There are five ongoing studies and one study awaiting
classification. Anaesthesia administration guided by the indices from a
processed EEG (bispectral index) probably reduces the risk of POD within
seven days after surgery with risk ratio (RR) of 0.71 (95% CI 0.59 to
0.85; number needed to treat for an additional beneficial outcome (NNTB)
of 17, 95% CI 11 to 34; 2197 participants; 3 RCTs; moderate quality of
evidence). Three trials also showed the lower rate of POCD at 12 weeks
after surgery (RR 0.71, 95% CI 0.53 to 0.96; NNTB 38, 95% CI 21 to 289;
2051 participants; moderate-quality evidence), but it is uncertain whether
processed EEG indices reduce POCD at one week (RR 0.84, 95% CI 0.69 to
1.02; 3 trials; 1989 participants; moderate-quality evidence), and at 52
weeks (RR 0.30, 95% CI 0.05 to 1.80; 1 trial; 59 participants; very low
quality of evidence). There may be little or no effect on all-cause
mortality (RR 1.01, 95% CI 0.62 to 1.64; 1 trial; 1155 participants;
low-quality evidence). One trial suggested a lower risk of any
postoperative complications with processed EEG (RR 0.51, 95% CI 0.37 to
0.71; 902 participants, moderate-quality evidence). There may be little or
no effect on reduced postoperative length of stay (mean difference -0.2
days, 95% CI -2.02 to 1.62; 1155 participants; low-quality evidence).
Authors' conclusions: There is moderate-quality evidence that optimized
anaesthesia guided by processed EEG indices could reduce the risk of
postoperative delirium in patients aged 60 years or over undergoing
non-cardiac surgical and non-neurosurgical procedures. We found
moderate-quality evidence that postoperative cognitive dysfunction at
three months could be reduced in these patients. The effect on POCD at one
week and over one year after surgery is uncertain. There are no data
available for patients under 60 years. Further blinded randomized
controlled trials are needed to elucidate strategies for the amelioration
of postoperative delirium and postoperative cognitive dysfunction, and
their consequences such as dementia (including Alzheimer's disease (AD))
in both non-elderly (below 60 years) and elderly (60 years or over) adult
patients. The one study awaiting classification and five ongoing studies
may alter the conclusions of the review once assessed.<br/>Copyright
&#xa9; 2018 The Cochrane Collaboration.

<17>
Accession Number
2000778981
Author
Martino E.A.; Baiardo Redaelli M.; Sardo S.; Lembo R.; Giordano V.F.;
Winterton D.; Ruggeri L.; Hajjar L.A.; Zangrillo A.; Landoni G.
Institution
(Martino, Baiardo Redaelli, Lembo, Giordano, Winterton, Ruggeri,
Zangrillo, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Sardo) Department of Medical Sciences "M. Aresu, " University of
Cagliari, Cagliari, Italy
(Hajjar) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of
135 Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: Corticosteroids have important effects on intermediate outcomes
in critically ill patients, but their effect on survival is unknown. The
objective of this meta-analysis was to analyze the effect on mortality of
corticosteroids in critical and perioperative settings. Design: A
meta-analysis of randomized trials. Setting: PubMed, Embase, BioMed
Central, Google Scholar, and the Cochrane Central Register of Controlled
Trials were searched to February 1, 2018, for randomized trials comparing
corticosteroids with placebo or standard care. Participants: Critically
ill or surgical adult patients. Interventions: Corticosteroids compared
with placebo or standard care. Measurements and Main Results: A total of
44,553 patients from 135 studies were included. Overall, mortality in the
corticosteroid group and in the control group were similar (16% v 16%; p =
0.9). Subanalyses identified a beneficial effect of corticosteroids on
survival in patients with respiratory system diseases (9% v 13%; p <
0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental
effect on survival in patients with traumatic brain injury (22% v 19%; p <
0.001). No differences in mortality were found in patients with cardiac
diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8%
v 3.2% p = 0.14), and when treatment duration or patient age were
considered. Conclusions: This meta-analysis documents the safety of
corticosteroids in the overall critically ill population with the notable
exception of brain injury patients, a setting where the authors confirmed
their detrimental effect on survival. A possible beneficial effect of
corticosteroids on survival was found among patients with respiratory
diseases and in patients with bacterial meningitis.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<18>
Accession Number
2000776132
Author
Danielsen S.O.; Moons P.; Sandven I.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Centre for Patient-centered Heart and Lung research,
Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo,
Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
(Solheim) Center for Clinical Heart Research and Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
Title
Thirty-day readmissions in surgical and transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The 30-day all-cause readmission rate after surgical aortic
valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR)
vary substantially. We conducted a systematic review and meta-analysis to
examine the overall incidence, causes, and risk factors of 30-day
all-cause readmission rate after SAVR and TAVR. Methods: Eight medical
research databases were searched; Cochrane, Medline, Embase, UpToDate,
PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed
The Preferred Reporting Items for Systematic reviews and Meta-analysis
(PRISMA) for this study. Results: Thirty-three articles were included in
the systematic review, 32 of which were appropriate for the meta-analysis.
Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95%
CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart
failure, arrhythmia, infection, and respiratory problems were the most
frequent causes of all-cause readmission after SAVR and TAVR. Most
frequent reported prior risk factors for all-cause readmission following
TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary
disease, atrial fibrillation, kidney problems, and transapical
approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause
readmission were reported in the literature to date. Conclusion: In
conclusion, the overall proportion of 30-day all-cause readmission after
SAVR and TAVR are high. Interventions to prevent avoidable readmissions
ought to be developed and implemented.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<19>
Accession Number
2000773716
Author
Wu F.; Wu Y.; Tao W.; Zhao H.; Shen D.
Institution
(Wu, Wu, Tao) School of Nursing, Capital Medical University, Beijing,
China
(Zhao) Heart Center, Beijing Chao-yang Hospital Affiliated to Capital
Medical University, Beijing, China
(Shen) Heart Center, Beijing Jian-gong Hospital, Beijing, China
Title
Preoperative P-wave duration as a predictor of atrial fibrillation after
coronary artery bypass grafting: A prospective cohort study with
meta-analysis.
Source
International Journal of Nursing Sciences. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Chinese Nursing Association (E-mail: mahongying@hotmail.com)
Abstract
Objectives: Reported prediction rules for postoperative atrial
fibrillation (AF) have suffered from inconsistent results and controversy
surrounding the predictive value of a preoperative P-wave duration
(PreOPWD). This study examined PreOPWD as a predictor for AF after
coronary artery bypass grafting (CABG). Methods:
Two-hundred-and-ninety-nine patients with sinus rhythm before off-pump
CABG were recruited into the study. Patients' demographic and clinical
data were evaluated prospectively. Patients were continuously monitored
for the first seven postoperative days. Multiple logistic regression was
used to determine significant predictors of AF. Findings were then
combined with similar studies and a meta-analysis was performed. Results:
Postoperative AF was observed in 33.1% of 299 patients. Patients with AF
were older, had a prolonged PreOPWD, higher incidences of hypertension,
aortic regurgitation, and mitral regurgitation. A cut-off point of
PreOPWD>=105 ms achieved a specificity of 74%, and a sensitivity of 65%
for predictive of AF. Multivariate analysis showed that PreOPWD>=105 ms
(odds ratio [OR] 4.63, 95% confidence intervals [CI] 2.66 to 8.03, P <
0.001), age>=60 years (OR 2.72, 95% CI 1.51 to 4.90, P < 0.01) and
hypertension (OR 2.10, 95% CI 1.08 to 4.07, P < 0.05) independently
predicted postoperative AF. A meta-analysis of this data combined with
those of ten other studies showed that PreOPWD was greater in patients
with POAF, with a weighted mean difference of 3.95 ms (95% CI 1.97 to
5.92, P < 0.001). Conclusion: This study confirmed, among other predictive
characteristics, that PreOPWD is a powerful independent predictor of
POAF.<br/>Copyright &#xa9; 2018 Chinese Nursing Association

<20>
Accession Number
2000758454
Author
Makki N.; Shreenivas S.; Kereiakes D.; Lilly S.
Institution
(Makki, Lilly) Department of Cardiology, Ohio State University Wexner
Medical Center, Columbus, OH 43210, United States
(Shreenivas, Kereiakes) Department Cardiology, The Christ Hospital,
Cincinnati, OH 45219, United States
Title
A meta-analysis of reduced leaflet motion for surgical and transcatheter
aortic valves: Relationship to cerebrovascular events and valve
degeneration.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Reduced leaflet motion (RLM) of transcatheter aortic valves
(TAV) is observed in up to 4% of cases with similar frequency in surgical
valves, with an overall incidence that differs based on prosthesis type
and size. This phenomenon likely represents subclinical leaflet
thrombosis. Herein we sought to analyze the existing reported literature
to assess whether or not RLM is associated with subsequent valve
degeneration or cerebrovascular events. Methods and results: We searched
PubMed, and EMBASE (2008-2017) to identify relevant studies. Studies with
<1-year follow-up, studies not evaluating RLM, and/or clinical outcomes
were excluded. Our co-primary endpoints were the incidence of
cerebrovascular events (stroke and/or transient ischemic attack-TIA) or
structural valvular degeneration defined as moderate or greater
regurgitation and/or a mean gradient >=20 mm Hg. The literature search
yielded 30 potential studies. Of these, six observational studies with a
total population of 1704 patients met our selection criteria. RLM was
associated with an increased risk of stroke or TIA (adjusted OR 2.60, 95%
CI 1.56 to 4.34, p = 0.004). At one year, RLM was associated with an
increased risk of structural valve degeneration (adjusted OR 2.51, 95% CI
1.47 to 4.30, p = 0.006). The association between RLM and clinical
endpoints remained even after limiting analysis to transcatheter aortic
valve replacement (TAVR) patients only. Conclusions: In patients with bio
prosthetic aortic valve, presence of RLM is associated with increased risk
of stroke or TIA as well as structural valvular degeneration. These
findings support ongoing surveillance efforts and evaluation of
pharmacotherapies to address RLM in effort to minimize subsequent clinical
events.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<21>
Accession Number
620412984
Author
Risom S.S.
Institution
(Risom) University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen
2100, Denmark
(Risom) Institute of Nursing, Metropolitan University College, Copenhagen,
Denmark
Title
Cardiac rehabilitation in real life.
Source
International Journal of Cardiology. 255 (pp 154-155), 2018. Date of
Publication: 15 Mar 2018.
Publisher
Elsevier Ireland Ltd

<22>
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.

<23>
Accession Number
617759020
Author
Kehler D.S.; Stammers A.N.; Tangri N.; Hiebert B.; Fransoo R.; Schultz
A.S.H.; Macdonald K.; Giacomontonio N.; Hassan A.; Legare J.-F.; Arora
R.C.; Duhamel T.A.
Institution
(Kehler, Stammers, Duhamel) Health, Leisure and Human Performance Research
Institute, Faculty of Kinesiology and Recreation Management, University of
Manitoba, Winnipeg, MB, Canada
(Kehler, Stammers, Duhamel) Institute of Cardiovascular Sciences, St.
Boniface Hospital Research Centre, Winnipeg, Canada
(Tangri) Seven Oaks Hospital Research Centre, Winnipeg, Canada
(Hiebert, Arora) Department of Surgery, University of Manitoba and Cardiac
Sciences Program, Winnipeg, Canada
(Fransoo) Department of Community Health Sciences and Manitoba Centre for
Health Policy, University of Manitoba, Winnipeg, Canada
(Schultz) College of Nursing, Faculty of Heath Sciences, University of
Manitoba, Winnipeg, Canada
(Macdonald) Seven Oaks Hospital Library, Winnipeg, Canada
(Giacomontonio) Division of Cardiology, Department of Medicine, Dalhousie
University, Halifax, Canada
(Hassan) Department of Cardiac Surgery, New Brunswick Heart Centre, Saint
John Regional Hospital, Saint John, MB, Canada
(Legare) Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, Canada
Title
Systematic review of preoperative physical activity and its impact on
postcardiac surgical outcomes.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e015712. Date of
Publication: 01 Aug 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The objective of this systematic review was to study the impact
of preoperative physical activity levels on adult cardiac surgical
patients' postoperative: (1) major adverse cardiac and cerebrovascular
events (MACCEs), (2) adverse events within 30 days, (3) hospital length of
stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5)
activities of daily living (ADLs), (6) quality of life, (7) cardiac
rehabilitation attendance and (8) physical activity behaviour. Methods A
systematic search of MEDLINE, Embase, AgeLine and Cochrane library for
cohort studies was conducted. Results Eleven studies (n=5733 patients) met
the inclusion criteria. Only self-reported physical activity tools were
used. Few studies used multivariate analyses to compare active versus
inactive patients prior to surgery. When comparing patients who were
active versus inactive preoperatively, there were mixed findings for
MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that
adjusted for confounding variables, five studies found a protective,
independent association between physical activity and MACCE (n=1), 30-day
postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies
found no protective association for 30-day postoperative events (n=1) and
postoperative ADLs (n=1). No studies investigated if activity status
before surgery impacted quality of life or cardiac rehabilitation
attendance postoperatively. Three studies found that active patients prior
to surgery were more likely to be inactive postoperatively. Conclusion Due
to the mixed findings, the literature does not presently support that
self-reported preoperative physical activity behaviour is associated with
postoperative cardiac surgical outcomes. Future studies should objectively
measure physical activity, clearly define outcomes and adjust for
clinically relevant variables. Registration Trial registration number
NCT02219815. PROSPERO number CRD42015023606.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<24>
Accession Number
616631334
Author
Bignami E.; Guarnieri M.; Saglietti F.; Maglioni E.M.; Scolletta S.;
Romagnoli S.; De Paulis S.; Paternoster G.; Trumello C.; Meroni R.;
Scognamiglio A.; Budillon A.M.; Pota V.; Zangrillo A.; Alfieri O.
Institution
(Bignami, Guarnieri, Saglietti, Meroni, Zangrillo) IRCCS San Raffaele
Scientific Institute, Department of Anaesthesia and Intensive Care, Via
Olgettina 60, Milan 20132, Italy
(Maglioni, Scolletta) Intensive Care and Medical Biotechnologies
University of Siena, Department of Anaesthesia, Siena, Italy
(Romagnoli) Azienda Ospedaliera Universitaria Careggi, Department of
Anaesthesiology and Intensive Care, Florence, Italy
(De Paulis) Catholic University of the Sacred Heart, Department of
Cardiovascular Sciences, Rome 00168, Italy
(Pota) Pineta Grande Private Hospital, Department of Anesthesia and
Intensive Care, Castelvolturno 80122, Italy
(Trumello) IRCCS San Raffaele Scientific Institute, Department of Cardiac
Surgery, Milan, Italy
(Budillon, Alfieri) Parma University Hospital, Department of Cardiac
Surgery, Parma, Italy
(Paternoster) Azienda Ospedaliera S. Carlo, Department of Cardiovascular
Anaesthesia and Intensive Care, Potenza, Italy
(Scognamiglio) University of Naples Federico II, Section of Anesthesia and
Intensive Care, Department of Neurosciences, Reproductive and
Odontostomatological Sciences, Via Pansini 16, Naples, Italy
Title
Different strategies for mechanical VENTilation during CardioPulmonary
Bypass (CPBVENT 2014): Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 264. Date of
Publication: 07 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There is no consensus on which lung-protective strategies
should be used in cardiac surgery patients. Sparse and small randomized
clinical and animal trials suggest that maintaining mechanical ventilation
during cardiopulmonary bypass is protective on the lungs. Unfortunately,
such evidence is weak as it comes from surrogate and minor clinical
endpoints mainly limited to elective coronary surgery. According to the
available data in the academic literature, an unquestionable standardized
strategy of lung protection during cardiopulmonary bypass cannot be
recommended. The purpose of the CPBVENT study is to investigate the
effectiveness of different strategies of mechanical ventilation during
cardiopulmonary bypass on postoperative pulmonary function and
complications. Methods/design: The CPBVENT study is a single-blind,
multicenter, randomized controlled trial. We are going to enroll 870
patients undergoing elective cardiac surgery with planned use of
cardiopulmonary bypass. Patients will be randomized into three groups: (1)
no mechanical ventilation during cardiopulmonary bypass, (2) continuous
positive airway pressure of 5 cmH<inf>2</inf>O during cardiopulmonary
bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2-3
ml/Kg of ideal body weight and positive end-expiratory pressure of 3-5
cmH<inf>2</inf>O during cardiopulmonary bypass. The primary endpoint will
be the incidence of a PaO<inf>2</inf>/FiO<inf>2</inf> ratio <200 until the
time of discharge from the intensive care unit. The secondary endpoints
will be the incidence of postoperative pulmonary complications and 30-day
mortality. Patients will be followed-up for 12 months after the date of
randomization. Discussion: The CPBVENT trial will establish whether, and
how, different ventilator strategies during cardiopulmonary bypass will
have an impact on postoperative pulmonary complications and outcomes of
patients undergoing cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02090205. Registered on 8 March
2014.<br/>Copyright &#xa9; 2017 The Author(s).

<25>
Accession Number
618478264
Author
Khan H.; Uzzaman M.; Benedetto U.; Butt S.; Raja S.G.
Institution
(Khan, Raja) Department of Cardiac Surgery, Harefield Hospital, London,
United Kingdom
(Uzzaman) Department of Cardiac Surgery, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Butt) Department of Cardiac Surgery, Kings College Hospital, London,
United Kingdom
Title
On- or off-pump coronary artery bypass grafting for octogenarians: A
meta-analysis of comparative studies involving 27,623 patients.
Source
International Journal of Surgery. 47 (pp 42-51), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Objective Coronary artery bypass grafting (CABG) is being increasingly
offered to octogenarians. Both on- and off-pump CABG are reported as
effective surgical revascularization strategies for octogenarians by
single institution studies. However, the issue of superiority of one
strategy over the other for octogenarians remains unresolved due to
limited sample size of these studies. A meta-analysis of studies comparing
outcomes of on- and off-pump CABG in octogenarians was undertaken to
address the issue. Methods A literature search was conducted from 1966
through September 2016 using MEDLINE, EMBASE, Scopus and Web of Science to
identify relevant articles. Primary outcomes of interest included
in-hospital mortality and stroke. Secondary outcomes of interest were
atrial fibrillation, acute renal failure, reoperation for bleeding, deep
sternal wound infection, myocardial infarction, intensive therapy unit
(ITU) stay and hospital stay. The random effects model was used to
calculate the outcomes of both binary and continuous data to control any
heterogeneity between the studies. Heterogeneity amongst the trials was
determined by means of the Cochran Q value and quantified using the
I² inconsistency test. All p-values were 2-sided and a 5% level
was considered significant. Results Sixteen retrospective studies (18,685
on-pump patients and 8938 off-pump patients) were included in the
systematic review. In-hospital mortality (pooled OR = 0.64, 95% CI = 0.44
to 0.93; p = 0.02), stroke rate (pooled OR = 0.61, 95% CI = 0.48 to 0.76;
p < 0.001) and length of hospital stay (pooled WMD = +0.29, 95% CI = +0.02
to +0.56; p = 0.04) were significantly lower in the off-pump patients.
Atrial fibrillation (p = 0.36), acute renal failure (p = 0.47),
reoperation for bleeding (p = 0.99), deep sternal wound infection (p =
0.59), myocardial infarction (p = 0.93), and length of ITU stay (p = 0.27)
were comparable. Conclusion Off-pump compared to on-pump CABG offers
surgical myocardial revascularization to octogenarians with lower
in-hospital mortality, stroke rate and length of hospital stay with
similar incidence of other adverse outcomes. Preferentially offering
off-pump CABG to octogenarians could translate into reduced economic
burden on the healthcare providers.<br/>Copyright &#xa9; 2017 IJS
Publishing Group Ltd

<26>
Accession Number
619398361
Author
Fiorentino M.; Castellano G.; Kellum J.A.
Institution
(Fiorentino, Kellum) Department of Critical Care Medicine, Center for
Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and
Systems Modeling of Acute Illness) Center, University of Pittsburgh School
of Medicine, Pittsburgh, United States
(Fiorentino, Castellano) Department of Emergency and Organ
Transplantation, Nephrology, Dialysis and Transplantation Unit, University
of Bari, Bari, Italy
Title
Differences in acute kidney injury ascertainment for clinical and
preclinical studies.
Source
Nephrology Dialysis Transplantation. 32 (11) (pp 1789-1805), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Oxford University Press
Abstract
Background Acute kidney injury (AKI) is a common clinical condition
directly associated with adverse outcomes. Several AKI biomarkers have
been discovered, but their use in clinical and preclinical studies has not
been well examined. This study aims to investigate the differences between
clinical and preclinical studies on AKI biomarkers. Methods We performed a
systematic review of clinical and preclinical interventional studies that
considered AKI biomarkers in enrollment criteria and/or outcome assessment
and described the main differences according to their setting, the
inclusion of biomarkers in the definition of AKI and the use of biomarkers
as primary or secondary end points. Results In the 151 included studies
(76 clinical, 75 preclinical), clinical studies have prevalently focused
on cardiac surgery (38.1%) and contrast-associated AKI (17.1%), while the
majority of preclinical studies have focused on ether ischemia-reperfusion
injury or drug-induced AKI (42.6% each). A total of 57.8% of clinical
studies defined AKI using the standard criteria and only 19.7% of these
studies used AKI biomarkers in the definition of renal injury. Conversely,
the majority of preclinical studies defined AKI according to the increase
in serum creatinine and blood urea nitrogen, and 32% included biomarkers
in that definition. The percentage of both clinical and preclinical
studies with biomarkers as a primary end point has not significantly
increased in the last 10 years; however, preclinical studies are more
likely to use AKI biomarkers as a primary end point compared with clinical
studies [odds ratio 2.31 (95% confidence interval 1.17-4.59); P=0.016].
Conclusion Differences between clinical and preclinical studies are
evident and may affect the translation of preclinical findings in the
clinical setting.<br/>Copyright &#xa9; The Author 2017. Published by
Oxford University Press on behalf of ERA-EDTA. All rights reserved.

<27>
Accession Number
620069745
Author
Hosny H.; Ibrahim M.; El-Siory W.; Abdel-Monem A.
Institution
(Hosny, Ibrahim, El-Siory, Abdel-Monem) Department of Anesthesia and
Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt
(Hosny) Department of Cardiothoracic Anaesthesia, Harefield Hospital,
London, United Kingdom
Title
Comparative Study Between Conventional Fasting Versus Overnight Infusion
of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients
Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (3) (pp 1248-1253),
2018. Date of Publication: June 2018.
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative insulin resistance represents a major component
of postoperative metabolic disorder. The authors compared the effects of
preoperative infusion of lipid emulsion or carbohydrate to conventional
preoperative fasting on postoperative insulin and free fatty acid (FFA)
levels. Design: A prospective randomized double-blinded study. Settings:
Tertiary university hospital. Participants: Sixty-three patients
undergoing coronary artery bypass grafting. Intervention: Participants
were randomized into 3 equal groups. Group G received 500 mL of glucose
10% (50 g glucose). Group L received 100 mL of 2% lipid emulsion (soybean
30%, medium chain triglycerides (TG) 30%, olive oil 25%, fish oil 15%, and
20 mg vitamin E). Group C fasted overnight except for clear fluids allowed
until 4 hours preoperatively. Serum insulin at the start of infusion
(T<inf>1</inf>), 1-hour preinduction (T<inf>2</inf>), on admission to the
intensive care unit (T<inf>3</inf>), after 24 hours of admission
(T<inf>4</inf>), and after 48 hours of admission (T<inf>5</inf>), and FFA
at T<inf>1</inf> and T<inf>2</inf> were measured. Serum very-low-density
lipoprotein (VLDL), serum TG, and blood sugar were all measured
(T<inf>1</inf>-T<inf>4</inf>). Bypass time, ischemic time, need for
inotropic support, and length of intensive care unit stay also were
measured. Measurements and Main Results: At the end of infusion FFAs were
significantly lower in the L group (1.1 +/- 0.76 mg/dL) compared with G
(1.64 +/- 0.85 mg/dL) and C groups (1.48 +/- 0.76 mg/dL). Insulin levels
were significantly lower in the L group compared with levels in the G and
C groups at T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf>. Also, TG,
VLDL, and random blood sugar levels decreased significantly at
T<inf>2</inf>, T<inf>3</inf>, and T<inf>4</inf> in the L group compared
with the other 2 groups and compared with baseline value within the same
group. Conclusion: Preoperative lipid infusion lowered postoperative FFA,
insulin, TG, VLDL, and random blood sugar in obese patients undergoing
coronary artery bypass grafting surgeries.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<28>
Accession Number
619469955
Author
Li H.-F.; Wu Y.; Wang M.; Grunkemeier G.L.
Institution
(Li, Wu, Wang, Grunkemeier) Medical Data Research Center, Providence
Health and Service, Portland, Oregon, United States
Title
A Stopping Guideline for Pulmonary Heart Valve Premarket Approval Studies.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 81-84), 2018.
Date of Publication: Spring 2018.
Publisher
W.B. Saunders

<29>
[Use Link to view the full text]
Accession Number
622140427
Author
Wright E.J.; Grund B.; Robertson K.R.; Cysique L.; Brew B.J.; Collins
G.L.; Poehlman-Roediger M.; Vjecha M.J.; Penalva De Oliveira A.C.;
Standridge B.; Carey C.; Avihingsanon A.; Florence E.; Lundgren J.D.;
Arenas-Pinto A.; Mueller N.J.; Winston A.; Nsubuga M.S.; Lal L.; Price
R.W.
Institution
(Wright) Department of Infectious Diseases Alfred Health, Monash
University, Burnet Institute, Peter Doherty Institute for Infection and
Immunity, Melbourne, VIC, Australia
(Grund) School of Statistics, University of Minnesota, Minneapolis, MN,
United States
(Robertson) Department of Neurology, University of North Carolina, NC,
United States
(Cysique) Neurosciences Research Australia, St. Vincent's Hospital Sydney,
Applied Medical Research Centre, Australia
(Brew) Neurosciences Program, Peter Duncan Neurosciences Unit, St
Vincent's Centre for Applied Medical Research, University of New South
Wales, Sydney, Australia
(Collins, Poehlman-Roediger) Division of Biostatistics, School of Public
Health, University of Minnesota, Minneapolis, MN, United States
(Vjecha) Institute for Clinical Research, Inc, Washington, DC, United
States
(Penalva De Oliveira) Instituto Emilio Ribas, Sao Paulo, Brazil
(Standridge) Veterans Affairs Medical Center, Washington, DC, United
States
(Carey) Kirby Institute, University of New South Wales, Sydney, Australia
(Avihingsanon) HIV-NAT Thai Red Cross AIDS Research Centre and Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand
(Florence) Department of Clinical Sciences, Institute of Tropical
Medicine, Antwerp, Belgium
(Lundgren) CHIP, Department of Infectious Diseases, Rigshospitalet,
University of Copenhagen, Denmark
(Arenas-Pinto) MRC Clinical Trials Unit at UCL, Institute of Clinical
Trials and Methodology, University College London, London, United Kingdom
(Mueller) Division of Infectious Diseases and Hospital Epidemiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland
(Winston) Division of Infectious Diseases, Department of Medicine,
Imperial College London, London, United Kingdom
(Nsubuga) People in Need Agency (PINA), Uganda
(Lal) Burnet Institute, Melbourne, Australia
(Price) Department of Neurology, University of California San Francisco,
San Francisco, CA, United States
Title
No neurocognitive advantage for immediate antiretroviral treatment in
adults with greater than 500 CD4⁺ T-cell counts.
Source
AIDS. 32 (8) (pp 985-997), 2018. Date of Publication: 15 May 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: To compare the effect of immediate versus deferred
antiretroviral treatment (ART) on neuropsychological test performance in
treatment-naive HIV-positive adults with more than 500 CD4 + cells/mul.
Design: Randomized trial. Methods: The START parent study randomized
participants to commence immediate versus deferred ART until CD4 + less
than 350 cells/mul. The START Neurology substudy used eight
neuropsychological tests, at baseline, months 4, 8, 12 and annually, to
compare groups for changes in test performance. Test results were
internally standardized to z-scores. The primary outcome was the average
of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline
were compared by intent-to-treat using longitudinal mixed models. Changes
from baseline to specific time points were compared using ANCOVA models.
Results: The 592 participants had a median age of 34 years; median
baseline CD4 + count was 629 cells/mul; the mean follow-up was 3.4 years.
ART was used for 94 and 32% of accrued person-years in the immediate and
deferred groups, respectively. There was no difference between the
immediate and deferred ART groups in QNPZ-8 change through follow-up
[-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However,
QNPZ-8 scores increased in both arms during the first year, by 0.22 and
0.24, respectively (P < 0.001 for increase from baseline). Conclusion: We
observed substantial improvement in neurocognitive test performance during
the first year in both study arms, underlining the importance of using a
control group in studies assessing neurocognitive performance over time.
Immediate ART neither benefitted nor harmed neurocognitive performance in
individuals with CD4 + cell counts above 500 cells/mul.<br/>Copyright
&#xa9; 2018 Wolters Kluwer Health, Inc. All rights reserved.

<30>
Accession Number
621978576
Author
Breivik H.; Norum H.; Fenger-Eriksen C.; Alahuhta S.; Vigfusson G.; Thomas
O.; Lagerkranser M.
Institution
(Breivik) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Pain Management and Research, Oslo 0424, Norway
(Breivik) University of Oslo, Faculty of Medicine, Oslo, Norway
(Norum) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Anaesthesiology, Oslo, Norway
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Aarhus, Denmark
(Alahuhta) Department of Anaesthesiology, MRC Oulu, University of Oulu,
Oulu University Hospital, Oulu, Finland
(Vigfusson) Department of Anaesthesia and Intensive Care, University
Hospital Landspitalinn, Reykjavik, Iceland
(Thomas) Institute of Clinical Sciences, University of Lund, Department of
Paediatric Anaesthesiology and Intensive Care, SUS Lund University
Hospital, Lund, Sweden
(Lagerkranser) Section for Anaesthesiology and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institute,
Stockholm, Sweden
Title
Reducing risk of spinal haematoma from spinal and epidural pain
procedures.
Source
Scandinavian Journal of Pain. 18 (2) (pp 129-150), 2018. Date of
Publication: 25 Apr 2018.
Publisher
Walter de Gruyter GmbH
Abstract
Central neuraxial blocks (CNB: epidural, spinal and their combinations)
and other spinal pain procedures can cause serious harm to the spinal cord
in patients on antihaemostatic drugs or who have other risk-factors for
bleeding in the spinal canal. The purpose of this narrative review is to
provide a practise advisory on how to reduce risk of spinal cord injury
from spinal haematoma (SH) during CNBs and other spinal pain procedures.
Scandinavian guidelines from 2010 are part of the background for this
practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS
and EMBASE for new and relevant randomised controlled trials (RCT),
case-reports and original articles concerning benefits of neuraxial
blocks, risks of SH due to anti-haemostatic drugs, patient-related risk
factors, especially renal impairment with delayed excretion of
antihaemostatic drugs, and specific risk factors related to the neuraxial
pain procedures. Epidural and spinal analgesic techniques, as well as
their combination provide superior analgesia and reduce the risk of
postoperative and obstetric morbidity and mortality. Spinal pain procedure
can be highly effective for cancer patients, less so for chronic
non-cancer patients. We did not identify any RCT with SH as outcome. We
evaluated risks and recommend precautions for SH when patients are treated
with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients'
comorbidities may increase risks, and when procedure-specific risk factors
are present. Inserting and withdrawing epidural catheters appear to have
similar risks for initiating a SH. Invasive neuraxial pain procedures,
e.g. spinal cord stimulation, have higher risks of bleeding than
traditional neuraxial blocks. We recommend robust monitoring routines and
treatment protocol to ensure early diagnosis and effective treatment of SH
should this rare but potentially serious complication occur. When
neuraxial analgesia is considered for a patient on anti-haemostatic
medication, with patient-related, or procedure-related risk factors, the
balance of benefits against risks of bleeding is decisive; when CNB are
offered exclusively to patients who will have a reduction of postoperative
morbidity and mortality, then a higher risk of bleeding may be accepted.
Robust routines should ensure appropriate discontinuation of
anti-haemostatic drugs and early detection and treatment of SH. There is
an on-going development of drugs for prevention of thromboembolic events
following surgery and childbirth. The present practise advisory provides
up-to-date knowledge and experts' experiences so that patients who will
greatly benefit from neuraxial pain procedures and have increased risk of
bleeding can safely benefit from these procedures. There are always
individual factors for the clinician to evaluate and consider.
Increasingly it is necessary for the anaesthesia and analgesia provider to
collaborate with specialists in haemostasis. Surgeons and obstetricians
must be equally well prepared to collaborate for the best outcome for
their patients suffering from acute or chronic pain. Optimal pain
management is a prerequisite for enhanced recovery after surgery, but
there is a multitude of additional concerns, such as early mobilisation,
early oral feeding and ileus prevention that surgeons and anaesthesia
providers need to optimise for the best outcome and least risk of
complications.<br/>Copyright &#xa9; 2018 2018 Harald Breivik et al.,
published by De Gruyter, Berlin/Boston.

<31>
Accession Number
2000556010
Author
Ozaki S.; Kawase I.; Yamashita H.; Uchida S.; Takatoh M.; Kiyohara N.
Institution
(Ozaki, Kawase, Yamashita, Uchida, Takatoh, Kiyohara) Department of
Cardiovascular Surgery, Toho University Ohashi Medical Center, Tokyo,
Japan
Title
Midterm outcomes after aortic valve neocuspidization with
glutaraldehyde-treated autologous pericardium.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (6) (pp 2379-2387),
2018. Date of Publication: June 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: We had previously reported the short-term results of the aortic
valve neocuspidization (AVNeo) procedure. We have now evaluated the
midterm results with the longest follow-up of 118 months. Methods: From
April 2007 through December 2015, 850 patients were treated with AVNeo
using autologous pericardium. Medical records of these patients were
retrospectively reviewed. The procedure was on the basis of independent
tricuspid replacement using autologous pericardium. The distances between
the commissures were measured with an original sizing device, the
pericardial cusp was trimmed using an original template, and then sutured
to the annulus. Results: There were 534 patients with aortic stenosis, 254
with aortic regurgitation, 61 with aortic stenoregurgitation, 19 with
infective endocarditis, and 5 with a previous aortic valve procedure.
Besides 596 patients with tricuspid aortic valve, 224 patients had
bicuspid valve, 28 had unicuspid valve, and 2 had quadricuspid valve.
There were 444 male and 406 female patients. The median age was 71 (range,
13-90) years old. Preoperative echocardiography revealed a peak pressure
gradient average of 68.9 +/- 36.3 mm Hg with aortic stenosis. Surgical
annular diameter was 20.9 +/- 3.3 mm. There was no conversion to a
prosthetic valve replacement. There were 16 in-hospital mortalities.
Postoperative echocardiography revealed a peak pressure gradient average
of 19.5 +/- 10.3 mm Hg 1 week after surgery and 15.2 +/- 6.3 mm Hg 8 years
after surgery. Fifteen patients needed reoperation (13 infective
endocarditis, 1 break of thread, and 1 tear of cusp case). The mean
follow-up period was 53.7 +/- 28.2 months. Actuarial freedom from death,
cumulative incidence of reoperation, and that of recurrent moderate aortic
regurgitation or greater was 85.9%, 4.2%, and 7.3%, respectively, with the
longest follow-up of 118 months. Conclusions: The midterm outcomes of
AVNeo using autologous pericardium were satisfactory in 850 patients with
various aortic valve diseases. However, further randomized, multicenter
prospective studies are needed to confirm the results of the current
study.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<32>
Accession Number
2000613103
Author
Lauricella L.L.; Costa P.B.; Salati M.; Pego-Fernandes P.M.; Terra R.M.
Institution
(Lauricella, Costa, Pego-Fernandes, Terra) Thoracic Surgery Division,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Lauricella, Terra) Instituto do Cancer do Estado de Sao Paulo, Hospital
das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao
Paulo, Brazil
(Pego-Fernandes) Thoracic Surgery Division, Instituto do Coracao, Hospital
da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao
Paulo, Brazil
(Salati) University of Ancona, School of Medicine, Ancona, Italy
Title
Measurement of the Inter-Rater Reliability Rate Is Mandatory for Improving
the Quality of a Medical Database: Experience with the Paulista Lung
Cancer Registry.
Source
Journal of the American College of Surgeons. 226 (6) (pp 1128-1136), 2018.
Date of Publication: June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Database quality measurement should be considered a mandatory
step to ensure an adequate level of confidence in data used for research
and quality improvement. Several metrics have been described in the
literature, but no standardized approach has been established. We aimed to
describe a methodological approach applied to measure the quality and
inter-rater reliability of a regional multicentric thoracic surgical
database (Paulista Lung Cancer Registry). Study Design: Data from the
first 3 years of the Paulista Lung Cancer Registry underwent an audit
process with 3 metrics: completeness, consistency, and inter-rater
reliability. The first 2 methods were applied to the whole data set, and
the last method was calculated using 100 cases randomized for direct
auditing. Inter-rater reliability was evaluated using percentage of
agreement between the data collector and auditor and through calculation
of Cohen's kappa and intraclass correlation. Results: The overall
completeness per section ranged from 0.88 to 1.00, and the overall
consistency was 0.96. Inter-rater reliability showed many variables with
high disagreement (>10%). For numerical variables, intraclass correlation
was a better metric than inter-rater reliability. Cohen's kappa showed
that most variables had moderate to substantial agreement. Conclusions:
The methodological approach applied to the Paulista Lung Cancer Registry
showed that completeness and consistency metrics did not sufficiently
reflect the real quality status of a database. The inter-rater reliability
associated with kappa and intraclass correlation was a better quality
metric than completeness and consistency metrics because it could
determine the reliability of specific variables used in research or
benchmark reports. This report can be a paradigm for future studies of
data quality measurement.<br/>Copyright &#xa9; 2018 American College of
Surgeons

<33>
Accession Number
622198159
Author
Herry Y.
Institution
(Herry) Diponegoro University, Department of Cardiology and Vascular
Medicine, Semarang, Indonesia
Title
Statin inhibits synthesis of type i collagen in patients with rheumatic
heart disease.
Source
Cardiovascular Research. Conference: 5th Congress of the ESC Council on
Basic Cardiovascular Science: Frontiers in CardioVascular Biology 2018.
Austria. 114 (Supplement 1) (pp S83), 2018. Date of Publication: April
2018.
Publisher
Oxford University Press
Abstract
Background: Rheumatic heart disease (RHD) remains a health burden in
developing countries with lack of pharmacological agents to slow this
disease process. Increasing of collagen synthesis plays an important role
in the progression of fibrosis, thickening and calcification of cardiac
valves in patients with RHD. Statins have been known to have anti-fibrotic
and anti-inflammatory effect; however their effect on on the synthesis of
type I collagen, primary collagen component of human cardiac valves, has
not been elucidated. Purpose: To evaluate the effect of simvastatin on the
synthesis of type I collagen in patients with RHD Methods: This
experimental randomized pretest-posttest control group study was performed
in 31 RHD patients confirmed by echocardiographic finding. Patients with
age > 75 years old, unstable hemodynamic, previous percutaneus or valvular
heart surgery, renal failure, and previous statins treatment were
excluded. Treatment and control groups received a standard medical therapy
with (16 patients) and without (15 patients) simvastatin 40 mg/day for 4
weeks, respectively. Carboxy-terminal propeptide of type I procollagen
(PICP) is used as a marker of type I collagen synthesis. PICP blood serum
was taken from peripheral vein blood and measured by ELISA method prior
and after 4 weeks treatment. Results: There were no significant
differences in clinical and echocardiographic baseline paramaters between
treatment and control groups. Most of cardiac valve abnormality was mitral
stenosis concomitant with atrial fibrillation. Prior serum level of PICP
were similar between treatment and control groups (7096269 versus 6716242
ng/mL, p=0.699). A significantly lower of PICP serum level was found in
statin treated group than untreated patients (5836236 versus 8796316
ng/mL, p=0.008). There were minor side effect reported, including mild
myalgia and nausea in two (2) patients treated with statin. Conclusion:
Simvastatin may reduce synthesis of type I collagen in patients with RHD
which could represent potential pharmacological agents to slow the disease
process.

<34>
Accession Number
622205584
Author
Benedetto U.; Altman D.G.; Gerry S.; Gray A.; Lees B.; Flather M.; Taggart
D.P.
Institution
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, UK
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of
Oxford, Oxford, UK
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Headington, Oxford, UK
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, UK
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Norwich, UK
Title
Impact of dual antiplatelet therapy after coronary artery bypass surgery
on 1-year outcomes in the Arterial Revascularization Trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 52 (3) (pp 456-461),
2017. Date of Publication: 01 Sep 2017.
Abstract
OBJECTIVES: There is still little evidence to boldport routine dual
antiplatelet therapy (DAPT) with P2Y12 antagonists following coronary
artery bypass grafting (CABG). The Arterial Revascularization Trial (ART)
was designed to compare 10-year survival after bilateral versus single
internal thoracic artery grafting. We aimed to get insights into the
effect of DAPT (with clopidogrel) following CABG on 1-year outcomes by
performing a post hoc ART analysis.
METHODS: Among patients enrolled in the ART (n=3102), 609 (21%) and 2308
(79%) were discharged on DAPT or aspirin alone, respectively. The primary
end-point was the incidence of major adverse cerebrovascular and cardiac
events (MACCE) at 1 year including cardiac death, myocardial infarction,
cerebrovascular accident and reintervention; safety end-point was bleeding
requiring hospitalization. Propensity score (PS) matching was used to
create comparable groups.
RESULTS: Among 609PS-matched pairs, MACCE occurred in 34 (5.6%) and 34
(5.6%) in the DAPT and aspirin alone groups, respectively, with no
significant difference between the 2 groups [hazard ratio (HR) 0.97, 95%
confidence interval (CI) 0.59-1.59; P=0.90]. Only 188 (31%) subjects
completed 1 year of DAPT, and in this subgroup, MACCE rate was 5.8% (HR
1.11, 95% CI 0.53-2.30; P=0.78). In the overall sample, bleeding rate was
higher in DAPT group (2.3% vs 1.1%; P=0.02), although this difference was
no longer significant after matching (2.3% vs 1.8%; P=0.54).
CONCLUSIONS: Based on these findings, when compared with aspirin alone,
DAPT with clopidogrel prescribed at discharge was not associated with a
significant reduction of adverse cardiac and cerebrovascular events at 1
year following 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.

<35>
Accession Number
622205281
Author
Milojevic M.; Head S.J.; Mack M.J.; Mohr F.W.; Morice M.-C.; Dawkins K.D.;
Holmes D.R.; Serruys P.W.; Kappetein A.P.
Institution
(Milojevic, Head, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mack) Department of Cardiovascular Surgery, Heart Hospital Baylor Plano,
Baylor Healthcare System, Plano, TX, USA
(Mohr) Department of Cardiovascular Surgery, Herzzentrum Universitat
Leipzig, Leipzig, Germany
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Massy, France
(Dawkins) Boston Scientific Corporation, Natick, MA, USA
(Holmes) Division of Cardiovascular Disease and Internal Medicine, Mayo
Clinic, Rochester, MN, USA
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Title
Influence of practice patterns on outcome among countries enrolled in the
SYNTAX trial: 5-year results between percutaneous coronary intervention
and coronary artery bypass grafting.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 52 (3) (pp 445-453),
2017. Date of Publication: 01 Sep 2017.
Abstract
OBJECTIVES: To examine differences among participating countries in
baseline characteristics, clinical practice, medication strategies and
outcomes of patients randomized to coronary artery bypass grafting and
percutaneous coronary intervention in the SYNTAX trial.
METHODS: In SYNTAX, centres in 18 different countries enrolled 1800
patients, of which 8 countries enrolled >=80 patients, what was projected
to be a large enough sample size to be included in the analysis. Baseline
characteristics, practice patterns and clinical outcomes were compared
between the USA (n=245), the UK (n=267), Italy (n=197), France (n=208),
Germany (n=179), Netherlands (n=148), Belgium (n=91) and Hungary (n=83).
The remaining patients from other participating countries were pooled
together (n=382).
RESULTS: Five-year results demonstrated significantly different outcomes
between countries. After adjustment, percutaneous coronary intervention
patients in France had lower rates of major adverse cardiac and
cerebrovascular events [hazard ratio (HR)=0.60, 95% confidence interval
(CI) 0.37-0.98], while the incidence of repeat revascularization was
higher in Hungary (HR=1.89, 95% CI 1.14-3.42). Coronary artery bypass
grafting showed the lowest rate of repeat revascularization in the UK
(HR=0.32, 95% CI 0.12-0.85). There were numerous differences in the risk
profile of patients between participating countries, as well as marked
differences in surgical practice across countries in the use of blood
cardioplegia (range 3.1-89.0%; P<0.001), bilateral internal mammary artery
usage (range 7.8-68.2%; P<0.001) and off-pump procedures (range 3.9-44.4%;
P<0.001). Variation was also found for percutaneous coronary intervention
in the number of implanted stents (range 4.0+/-2.3 to 6.1+/-2.6; P<0.001)
as well as for the entire stents length (range 69.0+/-45.1 to
124.1+/-60.9; P<0.001). Remarkable differences were observed in the
prescription of post-coronary artery bypass grafting medication in terms
of acetylsalicylic acid (range 79.6-95.0%; P=0.004), thienopyridine
(6.8-31.1%; P<0.001) and statins (41.3-89.1%; P<0.001).
CONCLUSIONS: Patient characteristics and clinical patterns are
significantly different between countries, resulting in significantly
different 5-year outcomes. This article presents specific data that can
further improve outcomes in each country.
Clinical Trials Registry: NCT00114972.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<36>
Accession Number
622199966
Author
Pinheiro V.F.; da Costa J.M.; Cascudo M.M.; Pinheiro EdeO.; Fernandes
M.A.; de Araujo I.B.
Institution
(Pinheiro) Departamento de Enfermagem, Universidade Federal do Rio Grande
do Norte, Natal, RN, Brazil
(da Costa, Cascudo, Pinheiro) Hospital Promater, Natal, RN, Brazil
(Fernandes) Departamento de Odontologia, Universidade Federal do Rio
Grande do Norte, Natal, RN, Brazil
(de Araujo) Departamento de Farmacia, Universidade Federal do Rio Grande
do Norte, Natal, RN, Brazil
Title
Analgesic efficacy of lidocaine and multimodal analgesia for chest tube
removal: A randomized trial study.
Source
Revista latino-americana de enfermagem. 23 (6) (pp 1000-1006), 2015. Date
of Publication: 01 Nov 2015.
Abstract
OBJECTIVE: To assess the analgesic efficacy of subcutaneous lidocaine and
multimodal analgesia for chest tube removal following heart surgery.
METHODS: Sixty volunteers were randomly allocated in two groups; 30
participants in the experimental group were given 1% subcutaneous
lidocaine, and 30 controls were given a multimodal analgesia regime
comprising systemic anti-inflammatory agents and opioids. The intensity
and quality of pain and trait and state anxiety were assessed. The
association between independent variables and final outcome was assessed
by means of the Chi-squared test with Yates' correction and Fisher's exact
test.
RESULTS: The groups did not exhibit significant difference with respect to
the intensity of pain upon chest tube removal (p= 0.47). The most frequent
descriptors of pain reported by the participants were pressing, sharp,
pricking, burning and unbearable.
CONCLUSION: The present study suggests that the analgesic effect of the
subcutaneous administration of 1% lidocaine combined with multimodal
analgesia is most efficacious.

<37>
Accession Number
621562750
Author
Ney J.; Hoffmann K.; Meybohm P.; Goetzenich A.; Kraemer S.; Benstom C.;
Weber N.C.; Bickenbach J.; Rossaint R.; Marx G.; Zacharowski K.; Bernhagen
J.; Stoppe C.
Institution
(Ney, Rossaint) Department of Anesthesiology, Medical Faculty, RWTH Aachen
University, Aachen 52074, Germany
(Ney, Hoffmann, Benstom, Bickenbach, Marx, Stoppe) Department of Intensive
Care Medicine, Medical Faculty, RWTH Aachen University, Aachen 52074,
Germany
(Meybohm, Zacharowski) Departments of Anesthesiology, Intensive Care
Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt 60590,
Germany
(Goetzenich, Kraemer) Department of Thoracic, Cardiac and Vascular
Surgery, Medical Faculty, RWTH Aachen University, Aachen 52074, Germany
(Weber) Department of Anesthesiology, Laboratory of Experimental Intensive
Care and Anesthesiology, L.E.I.C.A, Amsterdam 1105 AZ, Netherlands
(Bernhagen) Vascular Biology, Institute for Stroke and Dementia Research,
Ludwig-Maximilians-University of Munich Hospital, Munich 80539, Germany
Title
Remote ischemic preconditioning does not affect the release of humoral
factors in propofol-anesthetized cardiac surgery patients: A secondary
analysis of the RIPHeart study.
Source
International Journal of Molecular Sciences. 19 (4) (no pagination), 2018.
Article Number: 1094. Date of Publication: 05 Apr 2018.
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
In contrast to several smaller studies, which demonstrate that remote
ischemic preconditioning (RIPC) reduces myocardial injury in patients that
undergo cardiovascular surgery, the RIPHeart study failed to demonstrate
beneficial effects of troponin release and clinical outcome in
propofol-anesthetized cardiac surgery patients. Therefore, we addressed
the potential biochemical mechanisms triggered by RIPC. This is a
predefined prospective sub-analysis of the randomized and controlled
RIPHeart study in cardiac surgery patients (n = 40) that was recently
published. Blood samples were drawn from patients prior to surgery, after
RIPC of four cycles of 5 min arm ischemia/5 min reperfusion (n = 19) and
the sham (n = 21) procedure, after connection to cardiopulmonary bypass
(CPB), at the end of surgery, 24 h postoperatively, and 48 h
postoperatively for the measurement of troponin T, macrophage migration
inhibitory factor (MIF), stromal cell-derived factor 1 (CXCL12), IL-6,
CXCL8, and IL-10. After RIPC, right atrial tissue samples were taken for
the measurement of extracellular-signal regulated kinase (ERK1/2), protein
kinase B (AKT), Glycogen synthase kinase 3 (GSK-3beta), protein kinase C
(PKC"), and MIF content. RIPC did not significantly reduce the troponin
release when compared with the sham procedure. MIF serum levels
intraoperatively increased, peaking at intensive care unit (ICU) admission
(with an increase of 48.04%, p = 0.164 in RIPC; and 69.64%, p = 0.023 over
the baseline in the sham procedure), and decreased back to the baseline 24
h after surgery, with no differences between the groups. In the right
atrial tissue, MIF content decreased after RIPC (1.040 +/- 1.032 Arbitrary
units [au] in RIPC vs. 2.028 +/- 1.631 [au] in the sham procedure, p <
0.05). CXCL12 serum levels increased significantly over the baseline at
the end of surgery, with no differences between the groups. ERK1/2, AKT,
GSK-3beta, and PKC<inf>epsilon</inf> phosphorylation in the right atrial
samples were no different between the groups. No difference was found in
IL-6, CXCL8, and IL10 serum levels between the groups. In this cohort of
cardiac surgerypatients that received propofol anesthesia, we could not
show a release of potential mediators of signaling, nor an effect on the
inflammatory response, nor an activation of well-established protein
kinases after RIPC. Based on these data, we cannot exclude that
confounding factors, such as propofol, may have interfered with
RIPC.<br/>Copyright &#xa9; 2018 by the authors. Licensee MDPI, Basel,
Switzerland.

<38>
Accession Number
621544871
Author
Fisahn C.; Schmidt C.; Schroeder J.E.; Vialle E.; Lieberman I.H.; Dettori
J.R.; Schildhauer T.A.
Institution
(Fisahn, Schmidt) Swedish Neuroscience Institute, Swedish Medical Center,
Seattle, WA, United States
(Fisahn, Schildhauer) BG University Hospital Bergmannsheil, Ruhr
University Bochum, Bochum, Germany
(Schroeder) Hadassah Hebrew University Medical Center, Jerusalem, Israel
(Vialle) Cajuru Hospital, Catholic University of Parana, Curitiba, Brazil
(Lieberman) Texas Back Institute and Texas Health Plano Hospital, Plano,
TX, United States
(Dettori) Spectrum Research, Inc, Tacoma, WA, United States
Title
Blood Transfusion and Postoperative Infection in Spine Surgery: A
Systematic Review.
Source
Global Spine Journal. 8 (2) (pp 198-207), 2018. Date of Publication: 01
Apr 2018.
Publisher
SAGE Publications Ltd (E-mail: custserv@thieme.com)
Abstract
Study Design: Systematic review. Objectives: Allogeneic blood
transfusion-related immunomodulation may relatively suppress the immune
system, heightening the risk of infection following spine surgery. This
systematic review seeks to determine whether allogeneic blood transfusion
increases the risk of postoperative infection and whether there are any
factors that modify this association. Methods: PubMed, Cochrane Central
Register of Controlled Trials, and reference lists from included studies
were searched from inception to April 20, 2017 to identify studies
examining the risk of infection following allogeneic blood transfusion in
adult patients receiving surgery for degenerative spine disease. Results:
Eleven retrospective cohort or case-control studies, involving 8428
transfusion patients and 43 242 nontransfusion patients, were identified
as meeting the inclusion criteria. Regarding surgical site infection
(SSI), the results were mixed with roughly half reporting a significant
association. There was an association between allogeneic transfusion and
urinary tract infection (UTI) and any infection, but not respiratory tract
infection. There was no statistical modifying effect of lumbar versus
thoracic surgery on the association of allogeneic transfusion and SSI,
though subgroup analyses in 3 of 4 studies reported a statistical
association between transfusion and postoperative infections, including
SSI, UTI, and any infection within the lumbar spine. Conclusions: This
systematic review failed to find a consistent association between
allogeneic transfusion and postoperative infection in spine surgery
patients. However, these studies were all retrospective with a high or
moderately high risk of bias. To properly examine this association an
observational prospective study of sufficient power, estimated as 2400
patients, is required.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s)
2018.

<39>
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.

<40>
Accession Number
2000552881
Author
Cui L.; Han Y.; Zhang S.; Liu X.; Zhang J.
Institution
(Cui, Zhang) Department of Vascular and Thyroid Surgery, The First
Hospital of China Medical University, Shenyang, China
(Han, Liu) Department of General Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Zhang) Department of Endovascular Surgery, The First Hospital of
Zhengzhou University, Zhengzhou, China
Title
Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery
Stenosis: A Meta-Analysis of Randomised Controlled Trials.
Source
European Journal of Vascular and Endovascular Surgery. 55 (5) (pp
614-624), 2018. Date of Publication: May 2018.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: A meta-analysis of recently published randomised
controlled trials (RCTs) was performed to evaluate the safety of carotid
artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic
carotid stenosis with average risk. Methods: The MEDLINE, Embase, and
Cochrane Library databases were systematically searched for RCTs that
compared CAS with CEA for asymptomatic carotid stenosis. These
publications reported clinical outcomes after revascularisation in
patients with asymptomatic carotid stenosis during their primary
intervention. Trials published in English were searched for on 31 May
2017. End points (composite of ipsilateral stroke, any stroke, major
stroke, minor stroke, myocardial infarction [MI], and death during the
post-procedural period) were extracted from the publications by two
reviewers. The pooled odds ratios (ORs) and 95% confidence intervals (CIs)
were calculated for peri-operative outcomes following CAS and CEA using a
fixed effects model. Results: Five studies involving 3901 patients (1585
with CEA; 2316 with CAS) were included in the meta-analysis. The risk of
any stroke during the peri-procedural period was significantly lower in
patients who underwent CEA than CAS (OR 0.53; 95% CI 0.29-0.96). The
difference between CAS and CEA in the rate of stroke could be driven by
minor stroke (OR 0.50; 95% CI 0.25-1.00). The risk of death, major stroke,
ipsilateral stroke, and MI were not significantly different between the
two interventions (peri-procedural death: OR 1.49 [95% CI 0.26-8.68];
peri-procedural major stroke: OR 0.69 [95% CI 0.20-2.35]; peri-procedural
ipsilateral stroke: OR 0.63 [95% CI 0.27-1.47]; peri-procedural MI: OR
1.75 [95% CI 0.84-3.65]). No robust conclusion could be drawn regarding
mid to long-term complications because of the heterogeneity of the
reported data. The different outcomes precluded any further analysis being
conducted. Conclusion: Among patients with asymptomatic carotid stenosis,
stenting has a significantly higher rate of any peri-procedural stroke and
peri-procedural minor stroke than CEA, and similar risk of peri-procedural
major stroke, peri-procedural ipsilateral stroke, or MI.<br/>Copyright
&#xa9; 2018 European Society for Vascular Surgery

<41>
Accession Number
621948971
Author
Franchini M.; Mengoli C.; Cruciani M.; Marietta M.; Marano G.; Vaglio S.;
Pupella S.; Veropalumbo E.; Masiello F.; Liumbruno G.M.
Institution
(Franchini, Mengoli, Marano, Vaglio, Pupella, Veropalumbo, Masiello,
Liumbruno) Italian National Blood Centre, National Institute of Health,
Rome, Italy
(Franchini) Department of Haematology and Transfusion Medicine, Carlo Poma
Hospital, Strada Lago Paiolo 1, Mantua 46100, Italy
(Cruciani) Infection Control Committee, AULSS9 Scaligera, Verona, Italy
(Marietta) Department of Oncology, Hematology and Respiratory Diseases,
University Hospital, Modena, Italy
(Vaglio) Department of Clinical and Molecular Medicine, La Sapienza
University of Rome, Rome, Italy
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 235-243), 2018. Date of Publication: 2018.
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background: Thrombelastography (TEG) and rotational thromboelastometry
(ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the
elastic properties of clotting blood. The aim of this systematic review
and meta-analysis was to evaluate the usefulness of these tests in
bleeding patients outside the cardiac surgical setting. Materials and
methods: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We
also searched clinical trial registries for ongoing and unpublished
studies, and checked reference lists to identify additional studies.
Results: We found 4 randomised controlled trials (RCTs) that met our
inclusion criteria with a total of 229 participants. The sample size was
small (from 28 to 111 patients) and the follow-up periods very
heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials
reporting on mortality (199 participants) do not show any effect of the
use of TEG on mortality as compared to standard monitoring (based on the
average treatment effect from a fixed-effects model): Risk Ratio (RR)
0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA
does not reduce the need for red blood cells (mean difference -0.64; 95%
CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI:
-3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI:
-2.02 to 0.19) transfusion. The evidence on mortality and other outcomes
was uncertain (very low-certainty evidence, down-graded due to risk of
biases, imprecision, and inconsistency). Conclusions: Overall, the
certainty of the evidence provided by the trials was too low for us to be
certain of the benefits and harms of viscoelastic haemostatic assay in
non-cardiac surgical settings. More, larger, and better-designed RCTs
should be carried out in this area.<br/>Copyright &#xa9; SIMTI Servizi
Srl.

<42>
Accession Number
621948966
Author
De Cristofaro R.
Institution
(De Cristofaro) Institute of Internal Medicine and Geriatrics, Haemostasis
and Thrombosis Centre, Fondazione Policlinico Universitario Agostino
Gemelli, Area of Haematological Sciences, Catholic University of the
Sacred Heart, School of Medicine, Largo Francesco Vito 1, Rome 00168,
Italy
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 224-226), 2018. Date of Publication: 2018.
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)

<43>
Accession Number
620560845
Author
El-Baz N.; Ondusova D.; Studencan M.; Rosenberger J.; Reijneveld S.A.; van
Dijk J.P.; Middel B.
Institution
(El-Baz) University of Groningen, University Medical Center Groningen,
Department of Epidemiology, Groningen, Netherlands
(El-Baz) Alexandria University, Faculty of Nursing, Department of
Emergency and Critical Care Nursing, Alexandria, Egypt
(El-Baz, Reijneveld, van Dijk, Middel) University of Groningen, University
Medical Center Groningen, Department of Community & Occupational Medicine,
Netherlands
(Ondusova) East Slovakian Institute for Cardiac and Vascular Diseases,
Kosice, Slovakia
(Studencan) Cardiocentre of Teaching Hospital of J.A. Reiman, Presov,
Slovakia
(Rosenberger, van Dijk) Pavol Jozef Safarik University, Faculty of
Medicine, Graduate School Kosice Institute for Society and Health, Kosice,
Slovakia
Title
Differences between Slovak and Dutch patients scheduled for coronary
artery bypass graft surgery regarding clinical and psychosocial predictors
of physical and mental health-related quality of life.
Source
European Journal of Cardiovascular Nursing. 17 (4) (pp 324-335), 2018.
Date of Publication: 01 Apr 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Differences in health-related quality of life in coronary
artery disease patients and associated factors between patients of central
and western European descent are rarely investigated. We aim to test
differences between Dutch and Slovak health-related quality of life,
whether nationality predicted health-related quality of life and if
standardised beta weights of health-related quality of life determinants
differ across countries. Design: An observational multicentre study at
university cardiac centres in the Netherlands and Slovakia. Methods: In
226 coronary artery disease patients, health-related quality of life was
measured by the Short Form Health Survey 36, anxiety and depression were
measured using the Hospital Anxiety and Depression Scale, and type D
personality was assessed with the 14-item Type D Scale. Multivariate
analysis was used to explore the effect of patient characteristics on the
physical and mental component summaries. Estimates of each predictor's
beta value of the physical and mental component summaries in the Slovak
and Dutch patient sample were separately calculated using the Cummings
criterion for comparison of two independent betas. Results: Stronger
predictors of physical health-related quality of life in Slovak patients
were educational level, current smoking, poor functional status, history
of diabetes and amount of social support. In Dutch patients, only more
symptoms of depression was a stronger predictor (P<0.05). Regarding Slovak
mental health-related quality of life, stronger predictors were
educational level, current smoking and amount of social support. Female
gender, history of myocardial infarction and more symptoms of depression
were stronger predictors in Dutch patients (P<0.05). Conclusion: Descent
and differences between both populations in determinants of health-related
quality of life should be considered while planning care, follow-up,
health education and rehabilitation.<br/>Copyright &#xa9; 2017, &#xa9; The
European Society of Cardiology 2017.

<44>
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.

<45>
Accession Number
621864972
Author
Natori Y.; Alghamdi A.; Tazari M.; Miller V.; Husain S.; Komatsu T.;
Griffiths P.; Ljungman P.; Orchanian-Cheff A.; Kumar D.; Humar A.
Institution
(Natori, Alghamdi, Tazari, Husain, Kumar, Humar) Multi-Organ Transplant
Program, University Health Network, 585 University Ave, 11-PMB-175,
Toronto, ON M5G 2N2, Canada
(Alghamdi) King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
(Miller) Forum for Collaborative Research, University of California,
Berkeley, United States
(Komatsu) Division of Antiviral Products, Center for Drug Evaluation and
Research, Food and Drug Administration, Silver Spring, MD, United States
(Griffiths) Institute for Immunity and Transplantation, University College
London, Medical School, United Kingdom
(Ljungman) Division of Hematology, Department of Medicine Huddigne,
Karolinksa Institutet, Stockholm, Sweden
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, ON, Canada
Title
Use of Viral load as a surrogate marker in clinical studies of
cytomegalovirus in solid organ transplantation: A systematic review and
meta-analysis.
Source
Clinical Infectious Diseases. 66 (4) (pp 617-631), 2018. Date of
Publication: 15 Feb 2018.
Publisher
Oxford University Press
Abstract
Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint
for clinical trials in organ transplant recipients. Viral load may be a
more relevant endpoint due to low frequency of disease. We performed a
meta-analysis and systematic review of the literature. We found several
lines of evidence to support the validity of viral load as an appropriate
surrogate end-point, including the following: (1) viral loads in CMV
disease are significantly greater than in asymptomatic viremia (odds
ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral
replication are strongly associated with progression to disease; (3)
pooled incidence of CMV viremia and disease is significantly lower during
prophylaxis compared with the full patient follow-up period (viremia
incidence: 3.2% vs 34.3%; P <.001) (disease incidence: 1.1% vs 13.0%; P
<.001); (4) treatment of viremia prevented disease; and (5) viral load
decline correlated with symptom resolution. Based on the analysis, we
conclude that CMV load is an appropriate surrogate endpoint for CMV trials
in organ transplant recipients.<br/>Copyright &#xa9; The Author(s) 2017.

<46>
Accession Number
620676580
Author
Chu R.; Yu D.; Chu J.; Lin M.; Yu H.
Institution
(Chu, Yu, Chu, Yu) Department of Interventional Radiology, Wendeng
Osteopathy Hospital, Weihai, China
(Lin) Department of Radiology, Wendeng Osteopathy Hospital, Weihai, China
Title
Prognostic efficacy of circulating asymmetric dimethylarginine in patients
with peripheral arterial disease: A meta-analysis of prospective cohort
studies.
Source
Vascular. 26 (3) (pp 322-330), 2018. Date of Publication: 01 Jun 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Asymmetric dimethylarginine is suggested to be a marker of
poor prognosis in patients with atherosclerosis. However, the predictive
role of circulating asymmetric dimethylarginine for clinical outcome in
patients with peripheral arterial disease has not been determined. Aims:
To quantitatively assess the predictive value of circulating asymmetric
dimethylarginine for clinical outcome in patients with peripheral arterial
disease in a meta-analysis of prospective cohort studies. Methods:
Relevant studies were identified by systematically searching of PubMed and
Embase databases. A random-effect model was used to synthesize the
results. Sensitivity analyses by omitting one study at a time were
performed to evaluate the robustness of the results. Results: Six studies
with 2535 peripheral arterial disease patients were included. Patients
with higher circulating asymmetric dimethylarginine at baseline were
associated with higher risk of all-cause mortality (adjusted hazard ratio:
1.63, 95% confidence interval: 1.28-2.06, I² = 16%), and major
adverse cardiovascular events (adjusted hazard ratio: 2.01, 95% confidence
interval: 1.08-3.73, I² = 78%) as compared with those with
lower circulating asymmetric dimethylarginine at baseline. Specifically,
every increment of 0.1 micro&#32;mol/l of asymmetric dimethylarginine was
associated with 18% (adjusted hazard ratio: 1.18, 95% confidence interval:
1.06-1.31) increased risk for all-cause mortality and 14% (adjusted hazard
ratio: 1.14, 95% confidence interval: 1.04-1.25) increased risk for major
adverse cardiovascular disease. Sensitivity analyses by omitting one study
at a time did not significantly change the results. Conclusion: Higher
circulating asymmetric dimethylarginine at baseline may be associated with
higher incidence of cardiovascular events and mortality in patients with
peripheral arterial disease.<br/>Copyright &#xa9; 2017, &#xa9; The
Author(s) 2017.

<47>
Accession Number
622178592
Author
Testa L.; Latib A.; Casenghi M.; Gorla R.; Colombo A.; Bedogni F.
Institution
(Testa, Casenghi, Gorla, Bedogni) Department of Cardiology, IRCCS Pol. S.
Donato, S. Donato Milanese, Milan, Italy
(Latib, Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, EMO-GVM Centro Cuore Columbus, Milan, Italy
Title
Cerebral protection during transcatheter aortic valve implantation: An
updated systematic review and meta-analysis.
Source
Journal of the American Heart Association. 7 (10) (no pagination), 2018.
Article Number: e008463. Date of Publication: 15 May 2018.
Publisher
American Heart Association Inc.
Abstract
Background--The use of embolic protection devices (EPD) may theoretically
reduce the occurrence of cerebral embolic lesions during transcatheter
aortic valve implantation. Available evidence from single studies is
inconclusive. The aim of the present metaanalysis was to assess the safety
and efficacy profile of current EPD. Methods and Results--Major medical
databases were searched up to December 2017 for studies that evaluated
patients undergoing transcatheter aortic valve implantation with or
without EPD. End points of interest were 30-day mortality, 30-day stroke,
the total number of new lesions, the ischemic volume per lesion, and the
total volume of lesions. Eight studies involving 1285 patients were
included. The EPD delivery success rate was reported in all studies and
was achieved in 94.5% of patients. The use of EPD was not associated with
significant differences in terms of 30-day mortality (odds ratio 0.43
[0.18-1.05], P=0.3) but it was associated with a lower rate of 30-day
stroke (odds ratio 0.55 [0.31-0.98], P=0.04). No differences were detected
with respect to the number of new lesions (standardized mean difference
-0.19 [-0.71 to 0.34], P=0.49). The use of EPD was associated with a
significantly smaller ischemic volume per lesion (standardized mean
difference, -0.52 [-0.85 to -0.20], P=0.002) and smaller total volume of
lesions (standardized mean difference, -0.23 [-0.42 to -0.03], P=0.02).
Conclusions--The use of EPD is not associated with a reduced rate of
mortality and new ischemic cerebral lesions. The use of EPD during
transcatheter aortic valve implantation seems to be associated with a
lower 30-day stroke rate, although this result is driven by a single
nonrandomized study. The use of EPD is associated with a smaller volume of
ischemic lesions, and smaller total volume of ischemic
lesions.<br/>Copyright &#xa9; 2018 The Authors.

<48>
Accession Number
622178534
Author
Alai G.-H.; Deng H.-Y.; Li G.; Luo J.; Liu L.-X.; Lin Y.-D.
Institution
(Alai, Deng, Li, Luo, Liu, Lin) Department of Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu 610041, China
(Deng) Lung Cancer Center, West China Hospital, Sichuan University,
Chengdu 610041, China
Title
The influence of heparin on coagulation function of patients undergoing
video-assisted major thoracic surgery.
Source
Journal of Thoracic Disease. 10 (4) (pp 2288-2294), 2018. Date of
Publication: 01 Apr 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Venous thromboembolism (VTE) remains a common complication
after major thoracic surgery, especially resection of lung or esophagus
cancer. This trial aims to explore the influence of preoperative usage of
heparin on coagulation function of patients treated with video-assisted
major thoracic surgery. Methods: This prospective randomized control trial
collected 91 patients who are diagnosed with lung or esophagus cancer
intending to accept video-assisted neoplasm resection from June 2016 to
May 2017 in West China Hospital, Sichuan University. After admission to
hospital, the patients received heparin sodium (unfractionated heparin)
5,000 U twice a day before operation. The change of blood platelet count
(PLT), prothrombin time (PT), activated partial thromboplastin time
(APTT), thrombin time (TT), fibrinogen (FIB), international normalized
ratio (INR) was collected and analyzed at the points of admission to
hospital and post-operation. Results: The mean value of all coagulation
parameters (PLT, PT, APTT, TT, INR, FIB) were in normal range both before
and after operation. Postoperative PLT and FIB were not significantly
different from preoperative PLT and FIB respectively (P > 0.05).
Preoperative PT, APTT, and INR increased significantly compared to
pre-operation respectively (P < 0.05). Postoperative TT significantly
decreased when compared to preoperative TT (P < 0.05). Preoperative and
postoperative abnormal rate of PT or APTT or TT or INR (number of abnormal
cases/all cases) was not different significantly respectively (P > 0.05).
Postoperative mean drainage was 240 mL/d, mean time of hospital stay was
7.50 days, drainage tube was maintained for 4.22 days on average.
Conclusions: All patients underwent video-assisted major thoracic surgery
with preoperative use of heparin, there were significant differences in
coagulation function after operation. However, mean values of all
coagulation parameters stayed normal range clinically. In a word, the
method showed no influence on coagulation function
clinically.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<49>
Accession Number
622171559
Author
Batog P.; Rencz F.; Pentek M.; Gulacsi L.; Filipiak K.J.; Rupel V.P.;
Simon J.; Brodszky V.; Baji P.; Zavada J.; Petrova G.; Rotar A.; Golicki
D.
Institution
(Batog) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, Warsaw, Poland
(Rencz, Pentek, Gulacsi, Brodszky, Baji) Corvinus University of Budapest,
Department of Health Economics, Budapest, Hungary
(Rencz) Hungarian Academy of Sciences, Premium Postdoctoral Research
Programme, Budapest, Hungary
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Rupel) Institute for Economic Research, Ljubljana, Slovenia
(Simon) Department of Health Economics, Centre for Public Health, Medical
University of Vienna, Vienna, Austria
(Zavada) Institute of Rheumatology, Prague, Czech Republic
(Petrova) Department of Social Pharmacy and Pharmacoeconomics, Faculty of
Pharmacy, Medical University, Sofia, Bulgaria
(Rotar) Department of Social Medicine, University of Amsterdam, Amsterdam,
Netherlands
(Golicki) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, ul. Banacha 1B, Warszawa 02-097, Poland
Title
EQ-5D studies in cardiovascular diseases in eight Central and Eastern
European countries: A systematic review of the literature.
Source
Kardiologia Polska. 76 (5) (pp 860-870), 2018. Date of Publication: 11 May
2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: The measurement of health-related quality of life (HRQoL) by
validated generic instruments, such as EQ-5D, has become an increasingly
important tool for the assessment of health care in a wide range of
diagnoses. Aim: We aimed to systematically review EQ-5D literature on
cardiovascular diseases in eight Central and Eastern European (CEE)
countries. Methods: A structured literature search was conducted in
MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and
the EuroQol website up to November 2016. Original cardiovascular-related
studies that reported EQ-5D results were included. Results: Of the 36
papers, 17 reported EQ-5D index scores. Most studies were performed in
Poland (n = 24, 67%). The most common diagnosis regarding the number of
publications and population size was ischaemic heart disease (n = 13, N =
6394), followed by atrial fibrillation (n = 4, N = 1052). The average
EQ-5D index scores ranged from 0.61 to 0.88 and from 0.66 to 0.95 for
patients before and after cardiac procedure/surgery, respectively
(including angioplasty, coronary artery bypass grafting, ablation,
surgical correction of septal defects, transcatheter aortic valve
implantation [TAVI]). In all studies baseline scores were lower than the
repeated assessments after the procedure, with the most substantial
improvement of 0.24 in high-risk elderly patients after TAVI. Studies
which did not assess invasive treatment reported mean EQ-5D index scores
ranging from 0.18 to 0.80. Conclusions: The number of
cardiovascular-related studies reporting HRQoL using EQ-5D has
consistently increased in CEE countries over the past decade and is
outstanding compared with other clinical fields. The EQ-5D index and EQ
VAS scores varied based on the disease severity, patient characteristics,
and treatment protocol.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<50>
Accession Number
621798531
Author
Moazen-Zadeh E.; Abbasi S.H.; Safi-Aghdam H.; Shahmansouri N.;
Arjmandi-Beglar A.; Hajhosseinn Talasaz A.; Salehiomran A.; Forghani S.;
Akhondzadeh S.
Institution
(Moazen-Zadeh, Safi-Aghdam, Akhondzadeh) Psychiatric Research Center,
Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South
Kargar Street, Tehran 13337, Iran, Islamic Republic of
(Abbasi, Shahmansouri, Arjmandi-Beglar, Hajhosseinn Talasaz, Salehiomran)
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Forghani) Razi Vaccine and Serum Research Institute, Karaj, Iran, Islamic
Republic of
Title
Effects of Saffron on Cognition, Anxiety, and Depression in Patients
Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind
Placebo-Controlled Trial.
Source
Journal of Alternative and Complementary Medicine. 24 (4) (pp 361-368),
2018. Date of Publication: April 2018.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Objectives: Cognitive decline, depression, and anxiety are among the major
concerns in patients undergoing coronary artery bypass grafting (CABG).
Crocus sativus L. (saffron) seems to be a promising candidate for
treatment of these conditions. Design: In this 12-week, randomized,
double-blind, placebo-controlled clinical trial, men and women with
on-pump CABG, who had Wechsler Memory Scale (WMS) score >70 and age <70
years, received either saffron capsules (15 mg/twice daily) or placebo.
Patients were excluded if they had history of treatment with saffron or
acetylcholinesterase inhibitors, comorbid neuropsychiatric disorders,
serious medical conditions other than cardiovascular diseases, and
hypersensitivity to herbal compounds. The primary outcome was defined as
the difference in mean total score changes for WMS-Revised from the
baseline to week 12 between the saffron and placebo groups. Secondary
outcomes included difference in mean score changes from baseline to
endpoint between the two treatment groups for Mini Mental Status
Examination and subscales of Hospital Anxiety and Depression Scale
(www.irct.ir; IRCT201408071556N63). Results: No significant difference was
detected in primary or secondary outcomes between the saffron and placebo
groups. Also, no significant time x treatment interaction effect was found
for any of the scales. Conclusions: The results of this trial do not
support the hypothesis of potential benefits of saffron in treatment of
CABG-related neuropsychiatric conditions.<br/>&#xa9; Copyright 2018, Mary
Ann Liebert, Inc. 2018.

<51>
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.

<52>
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.

<53>
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.

<54>
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.

<55>
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.

<56>
[Use Link to view the full text]
Accession Number
621738909
Author
Pitre L.; Garbee D.; Tipton J.; Schiavo J.; Pitt A.
Institution
(Pitre, Garbee, Tipton, Schiavo, Pitt) Louisiana Ctr. for Prom. of Optimal
Health Outcomes: A Joanna Briggs Institute Center of Excellence,
Switzerland
Title
Effects of preoperative intrathecal morphine on postoperative intravenous
morphine dosage: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (4) (pp
867-870), 2018. Date of Publication: 01 Apr 2018.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The purpose of this systematic review is to
describe the effect of preoperative intrathecal morphine (ITM) on
postoperative intravenous (IV) morphine dosage during the first
postoperative day. This systematic review will compare the postoperative
IV morphine dosage of patients receiving ITM plus morphine morphine-based
patient-controlled analgesia (PCA), to patients receiving PCA morphine
without ITM. This will establish the magnitude of the postoperative
morphine sparing effect of ITM. This review aims to answer the following
specific question: In adult abdominal and thoracic surgery patients
undergoing general anesthesia (GA), what is the effect of ITM plus PCA
morphine, compared to PCA morphine alone, on total IV morphine dosage (in
milligrams) during the first 24 hours after surgery?<br/>Copyright &#xa9;
2018 THE JOANNA BRIGGS INSTITUTE.

<57>
Accession Number
621304862
Author
Cavallari I.; Cannon C.P.; Braunwald E.; Goodrich E.L.; Im K.A.; Lukas
M.A.; O'Donoghue M.L.
Institution
(Cavallari, Cannon, Braunwald, Goodrich, Im, O'Donoghue) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
United States
(Cavallari) Department of Cardiovascular Science, Campus Bio-Medico
University of Rome, Italy
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, United States
Title
Metabolic syndrome and the risk of adverse cardiovascular events after an
acute coronary syndrome.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 830-838), 2018. Date
of Publication: 01 May 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The incremental prognostic value of assessing the metabolic
syndrome has been disputed. Little is known regarding its prognostic value
in patients after an acute coronary syndrome. Design and methods: The
presence of metabolic syndrome (2005 International Diabetes Federation)
was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30
days of acute coronary syndrome (median follow-up 2.5 years). The primary
endpoint was major coronary events (coronary heart disease death,
myocardial infarction or urgent coronary revascularization). Results: At
baseline, 61.6% (n = 7537) of patients met the definition of metabolic
syndrome, 34.7% (n = 4247) had diabetes and 29.3% had both (n = 3584). The
presence of metabolic syndrome was associated with increased risk of major
coronary events (adjusted hazard ratio (adjHR) 1.29, p < 0.0001) and
recurrent myocardial infarction (adjHR 1.30, p < 0.0001). Of the
individual components of the definition, only diabetes (adjHR 1.48, p <
0.0001) or impaired fasting glucose (adjHR 1.21, p = 0.002) and
hypertension (adjHR 1.46, p < 0.0001) were associated with the risk of
major coronary events. In patients without diabetes, metabolic syndrome
was numerically but not significantly associated with the risk of major
coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a strong
independent predictor of major coronary events in the absence of metabolic
syndrome (adjHR 1.57, p < 0.0001). The presence of both diabetes and
metabolic syndrome identified patients at highest risk of adverse outcomes
but the incremental value of metabolic syndrome was not significant
relative to diabetes alone (adjHR 1.07, p = 0.54). Conclusions: After
acute coronary syndrome, diabetes is a strong and independent predictor of
adverse outcomes. Assessment of the metabolic syndrome provides only
marginal incremental value once the presence or absence of diabetes is
established.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of
Cardiology 2018.

<58>
Accession Number
619342048
Author
Czerwinska-Jelonkiewicz K.; Witkowski A.; Dabrowski M.; Piotrowski W.;
Hryniewiecki T.; Stepinska J.
Institution
(Czerwinska-Jelonkiewicz, Stepinska) Intensive Cardiac Therapy Department,
Institute of Cardiology, Warsaw, Poland
(Witkowski, Dabrowski) Department of Cardiology and Interventional
Angiology, Institute of Cardiology, Warsaw, Poland
(Piotrowski) Department of Epidemiology, Institute of Cardiology, Warsaw,
Poland
(Hryniewiecki) Department of Acquired Valvular Heart Disease, Institute of
Cardiology, Warsaw, Poland
Title
The role of platelet reactivity assessment in dual antiplatelet
prophylaxis after transcatheter aortic valve implantation.
Source
Archives of Cardiovascular Diseases. 111 (4) (pp 233-245), 2018. Date of
Publication: April 2018.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Dual antiplatelet therapy (DAPT) is recommended prophylaxis
after transcatheter aortic valve implantation (TAVI). The usefulness of
platelet reactivity (PLTR) tests in predicting the safety of
periprocedural DAPT in the TAVI population is unknown. Aim: To analyze the
value of aspirin/clopidogrel PLTR testing in predicting the risk of
in-hospital TAVI-related bleeding. Methods: PLTR, expressed as
P2Y<inf>12</inf>/aspirin reaction units (PRU/ARU), was performed using
optical aggregometry with the VerifyNow device, in the 24 h
before and on the sixth day after TAVI. Follow-up was by telephone.
Bleeding was defined according to VARC-2, and comprised in-hospital, major
and life-threatening events. Results: Overall, 100 patients undergoing
TAVI were included; 30 (30%) had bleeding. Clopidogrel PLTR before TAVI
(area under the curve [AUC] 0.686, 95% confidence interval [CI]
0.542-0.808; P = 0.02) and after TAVI (AUC 0.970, 95% CI 0.904-0.995; P <
0.001) correlated with bleeding, with PRU cut-off values of <=204 and
<=124 as bleeding predictors, respectively. A significant periprocedural
decrease in clopidogrel PLTR was noted, with a PRU drop of >78 as bleeding
predictor (AUC 0.851, 95% CI 0.725-0.935; P < 0.001). Only postprocedural
aspirin PLTR was associated with bleeding (AUC 0.697, 95% CI 0.585-0.794;
P = 0.008). Follow-up (359 +/- 73 days after TAVI) included 85 patients
(85%) (after exclusion for in-hospital death [n = 4] and lack of contact
[n = 11]). Major bleeding was noted in four patients (4.7%), all on
combined prophylaxis. Conclusions: TAVI-related bleeding occurs mainly
during the procedure or in the early postprocedural period. Testing of
periprocedural clopidogrel PLTR, but not aspirin PLTR, seems useful
because of its predictive value for TAVI-related bleeding. PLTR testing
suggests that premedication with clopidogrel, enhanced response to
clopidogrel early after TAVI and significant periprocedural drop in
clopidogrel PLTR might increase the risk of TAVI-related
bleeding.<br/>Copyright &#xa9; 2017 Elsevier Masson SAS

<59>
Accession Number
622107434
Author
Lowry J.E.; Fichtlscherer S.; Witte K.K.
Institution
(Lowry, Witte) Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Fichtlscherer) Department of Internal Medicine, Division of Cardiology,
University Hospital Frankfurt, Frankfurt am Main, Germany
Title
Therapeutic options for functional mitral regurgitation in chronic heart
failure.
Source
Expert Review of Medical Devices. 15 (5) (pp 357-365), 2018. Date of
Publication: 04 May 2018.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Mitral regurgitation is a common finding in patients with
chronic heart failure and is associated with a progressive worsening of
symptoms, reduced survival and increased cost of care. However, the use of
mitral valve surgery for these patients remains controversial and has not
been shown to improve survival. Consequently, research has been
increasingly directed towards the nonsurgical management of this important
co-morbidity of heart failure. Areas covered: The present review will
describe the relevance of mitral regurgitation in people with chronic
heart failure, the current options for percutaneous treatment and the
evidence base for each of these. Expert commentary: Although at present
there are few solid data to guide heart teams in deciding what degree of
mitral regurgitation to treat, in which patients, and with what, this
situation is likely to change over the next two years with the release of
the first large randomised trials of percutaneous
interventions.<br/>Copyright &#xa9; 2018 Informa UK Limited, trading as
Taylor & Francis Group.

<60>
Accession Number
615985103
Author
Bai A.D.; Steinberg M.; Showler A.; Burry L.; Bhatia R.S.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Bhatia) Women's College Hospital Institute for Health Systems Solutions
and Virtual Care, Toronto, Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Diagnostic Accuracy of Transthoracic Echocardiography for Infective
Endocarditis Findings Using Transesophageal Echocardiography as the
Reference Standard: A Meta-Analysis.
Source
Journal of the American Society of Echocardiography. 30 (7) (pp
639-646.e8), 2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Echocardiography is important for the diagnosis of infective
endocarditis (IE), for which transesophageal echocardiography (TEE) is
superior to transthoracic echocardiography (TTE). Methods A systematic
review and meta-analysis of observational studies was performed with the
objective of evaluating diagnostic properties of TTE, with transesophageal
findings of IE as the reference standard in patients with suspected IE.
Results The literature search yielded 377 unique articles, of which 16 met
the inclusion criteria. The 16 studies included 2,807 patients, of whom
793 (28%) had vegetations on TEE. For detecting vegetations, harmonic TTE
had sensitivity of 61% (95% CI, 45%-75%) and specificity of 94% (95% CI,
85%-98%) with a negative likelihood ratio (NLR) of 0.42 (95% CI,
0.26-0.61). NLR for harmonic TTE can be improved by including only
patients without prosthetic valves (NLR = 0.36; 95% CI, 0.22-0.55) or by
having strict criteria for conclusively negative results on TTE (NLR =
0.17; 95% CI, 0.10-0.28). In the setting of patients without prosthetic
valves, harmonic TTE had likelihood ratios of 0.14 (95% CI, 0.09-0.23) for
a conclusively negative result, 0.66 (95% CI, 0.53-0.81) for an
indeterminate result, and 14.60 (95% CI, 3.37-70.40) for a positive
result. Conclusions Modern harmonic TTE still has the potential to miss
many vegetations detected on TEE. When limited to patients without
prosthetic valves, a conclusively negative TTE under optimal view greatly
decreases likelihood of IE. All other transthoracic results are not useful
for ruling out IE, and subsequent TEE is almost always
required.<br/>Copyright &#xa9; 2017 American Society of Echocardiography

<61>
Accession Number
622146291
Author
Latham S.; Bob-Manuel T.; Sharma A.; Ibebuogu U.
Institution
(Latham, Bob-Manuel, Sharma) UTHSC, United States
(Ibebuogu) UTHSC, Cardiology, United States
Title
Outcomes after percutaneous occlusion device in patients who develop
severe aortic insufficiency following left ventricular assist device
implantation-a systematic review.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S188), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Aortic insufficiency(AI) is a common side effect of continuous
flow left ventricular assist devices (LVAD). In severe AI, patients
develop symptomatic heart failure which is refractory to conservative
management. The treatment of choice in the past has been open heart
surgery with either aortic valve replacement (AVR) or surgical closure of
the valve. Unfortunately, in the aging population many patients are not
candidates for these procedures due to multiple comorbidities. We present
the most detailed review to date on the off label use of transcutaneous
occluder devices such as the Amplatzer Septal Occluder Devices in LVAD
patients with severe AI too high risk to undergo conventional surgery
Methods: A systematic database search via PubMed, EMBASE, and Cochrane was
done using keywords LVAD, AI, Occluder, Amplatzer from dates ranging from
inception to May 2017. Case Reports, Case Studies, and original articles
were identified Results: A total of nine publications describing 22
patients with AI after LVAD were identified. Mean age was 58.6+/-13.33.
73% were males. 52% (n=11) had ischemic cardiomyopathy. LVAD implantation
to Severe AI was 12+/-11.5 months. Amplatzer Cribiform Septal Occluder was
used in 80% while Ampletzer PI Muscular VSD Occluder was used in 20% of
patients. Device success was achieved initially in all 22 patients (100%)
however in 3 patients (13.6%), the device migrated several days later,
none of which resulted in immediate death. There was 42% (n=20) in
hospital mortality, while 38% (n=20) were discharged home with device in
place. In reports where survival data was recorded, 30 day survival post
discharge was 85% (n=7). 6-month survival was 85% (n=7). 81% (n=21) had no
post procedural AI, while 19% (n=21) had trace AI Conclusion: In patients
with prohibitively high surgical risk, Percutaneous occluder devices are
an acceptable alternative to open aortic valve replacement (AVR). Our
results show improvement of symptoms as well as good short term survival.
However larger studies are needed to look at long term survival data and
validate our results.

<62>
Accession Number
622146280
Author
Kiani J.; Bob-Manuel T.; Heckle M.; Marella H.; Khouzam R.; Ibebuogu U.;
Jenkins J.S.
Institution
(Kiani, Jenkins) Ochsner Heart and Vascular Clinic, United States
(Bob-Manuel, Marella, Khouzam, Ibebuogu) University of Tennessee, Health
Science Center, Memphis, TN, United States
(Heckle) University of Tennessee, Health Sciences Center, United States
Title
Outcomes following combined transcatheter aortic valve replacement and
mitraclip in high-surgical-risk patients with severe aortic stenosis and
significant mitral regurgitation, a Systematic Review.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S187-S188), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: In patients with high surgical risk, transcatheter aortic
valve replacement (TAVR) and percutaneous mitral valve replacement (PMVR)
using the MitraClip have emerged as novel treatments for aortic stenosis
and mitral regurgitation respectively. The aim of this study is to review
published data on the safety and efficacy of combined TAVR/PMVR treatment
in patients who have high surgical risk. Methods: Studies including case
reports and case series published between 2012 and 2017 were identified
using SCOPUS, EMBASE and MEDLINE. Data was analyzed using SPSS version 23
(SPSS Inc., Chicago, Illinois). The primary outcome of interest was 30-day
all-cause mortality. Pooled estimates were calculated using a
random-effects meta-analysis. Results: A total number of 11 publications
describing 60 patients who underwent both TAVR and PMVR were identified.
Mean age was 79.3+/-6.5 years; 33% were female; Mean Society of Thoracic
Surgeons score was 14.4+/-11.27%. All included patients had severe
symptomatic aortic stenosis and 80% had moderate to severe Mitral
regurgitation (MR), Mean LVEF was 39.8+/-12.6. The preferred access site
was Transfemoral (83%), 66% received Self-Expandable valves while 34%
received Balloon-Expandable valves. Median time of Mitra- Clip placement
after TAVR was 76 days (IQR 29-180). Device success for the PMVR, defined
as achieving MR<=grade 2, was 90%. There was no reported valve
embolization or major procedural bleeding. Thirtyone patients (77.5%) were
in NYHA class II or less post procedure. After a median follow up of 7
months IQR (3-11), one patient suffered a stroke within 30-days. 30-day
all-cause mortality was 7.7%, while 1- year all-cause mortality was 38.5%
(95% confidence interval [CI]: 23.4% to 55.4%). Conclusion: Combined
transcatheter treatment of patients with AS and MR is technically feasible
as a staged procedure, with high procedural success, symptom reduction and
a low 30-day mortality.

<63>
Accession Number
622146252
Author
Flores E.A.; Todd R.M.
Institution
(Flores, Todd) Georgia Heart Specialists, United States
Title
Use of the distal radial artery (DRA) in the anatomical snuffbox as a
default access in the cardiac catheterization laboratory.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S218), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Radial artery (RA) access has limitations, including
uncomfortable position, depth of the RA, risk of bleeding, risk of
occlusion, and arm immobility post access. The DRA runs superficial in the
anatomical snuffbox, making it more accessible, and it lies immediately
above the wrist bones, facilitating the hemostasis and allowing free
movement of the wrist post procedure. We evaluated the potential benefits
and limitations of changing routine practice from RA to DRA access.
Methods: For 7 months, consecutive patients undergoing cardiovascular
procedures at a community hospital were considered for DRA access. All
patients had the DRA punctured under ultrasound (US) and received heparin
and intraarterial vasodilators. Patent hemostasis of the DRA was achieved
using the PreludeSync device. No arm board was used, and patients were
allowed to move their hands post procedure. Patients had a follow up
outpatient Duplex US of the DRA & RA. Results: DRA access was used in 113
of 163 patients (63 y, 76% m) undergoing predominantly cardiac procedures.
The most common cause of access failure was the inability to advance the
needle wire into the DRA, which significantly improved with the expected
learning curve; there were no complications related to the access site
attempt. The average door-to-balloon time in DRA STEMI patients was 46
min. No bleeding complications occurred, and no patient required arm
immobilization. RA occlusion was 2% and occurred with artery lumen
diameter/sheath outer size (A/S) ratio <0.7. There was no difference
between the RA and DRA lumen diameter (LD) in the overall group (t50.15,
p=0.88), but females had smaller LD than males (2.1 mm vs. 2.5 mm, t5
-2.57, p<0.02). Wrist pain lasting >24 h occurred in 3.5%; no patient
experienced disabling symptoms. Conclusion: DRA access is safe and
effective for patients undergoing cardiovascular procedures. The absence
of bleeding complications may be an advantage over RA. Routine use of US
to measure the DRA LD before puncture and choosing a sheath size that
allows a higher A/S ratio may prove beneficial in preventing DRA and RA
occlusion, especially in women. Wrist pain is uncommon. Randomized studies
comparing RA with DRA access are needed to confirm the optimal arm entry
site.

<64>
Accession Number
622146247
Author
Khalil C.; Mosleh W.; Megaly M.; Iskander M.H.; Iskander F.H.; Ibrahim A.;
Shah T.; Ekladios C.; Iyer V.
Institution
(Khalil, Mosleh, Ibrahim, Shah, Ekladios, Iyer) University at Buffalo,
State University of New York, United States
(Megaly) Abbott Northwestern Hospital, Minneapolis Heart Institute, United
States
(Iskander, Iskander) John H Stroger Jr Hospital of Cook County, United
States
Title
Mono-versus dual-antiplatelet therapy after transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S186), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Dual antiplatelet therapy (DAPT) is routinely prescribed after
transcatheter aortic valve replacement (TAVR) despite the lack of
sufficient data demonstrating its superiority over mono-antiplatelet
therapy (MAPT). Given the availability of new studies with longer
follow-up durations, we aim to investigate the benefits of DAPT versus
MAPT and at different follow-up time points. Methods: A systematic search
was conducted for studies investigating DAPT vs MAPT in patients after
TAVR. The primary outcome studied used was net adverse clinical events
(NACE) at longest reported follow-up, defined as a composite end-point of
all-cause mortality, major stroke, spontaneous myocardial infarction (MI),
and combined life threatening and major bleeding. Secondary endpoints of
all-cause mortality, major stroke, spontaneous MI, and combined life
threatening and major bleeding were also studied individually. We
performed a subgroup analysis according to follow-up duration post-TAVR
(<=30 days, between 3 to 6 months, and >=1 year). Results: Twelve studies
with 9,650 patients were eligible for inclusion. In the pooled analysis,
MAPT compared to DAPT showed reduced NACE (OR 0.68 [0.47, 0.98], p=0.04),
and combined major and lifethreatening bleeding (0.53 [0.34, 0.85],
p=0.008), but higher all-cause mortality (OR 1.17 [1.03, 1.33], P=0.02).
No differences were seen with other secondary outcomes. Subgroup analysis
according to studies' follow-up duration post-TAVR showed that the reduced
NACE in the MAPT group compared to DAPT is only statistically significant
in studies with <=30 day follow-up (0.60 [0.45, 0.81], p<0.001). Similarly
MAPT had lower all-cause mortality compared to DAPT in studies with <=30
day follow-up (OR 0.54 [0.33, 0.88], p=0.01). Whereas all else was equal
between the MAPT and DAPT groups in the 3-6 month and the <=1 year follow
up studies. Conclusion: Our study demonstrates reduced harm in using MAPT
over DAPT in post-TAVR patients. This benefit is most pronounced in the
first 30 days post-TAVR when MAPT has a lower risk of major or life
threatening bleeding and all-cause mortality. If a decision is made to
proceed with DAPT regimen, it would be more preferable to start it after
the initial critical 30-day period.

<65>
Accession Number
622146225
Author
Kanmanthareddy A.; Anugula D.; Tandra A.; Balan P.; Dhoble A.; Charitakis
K.; Johnson N.; Arain S.; Madjid M.; Anderson H.V.; Smalling R.
Institution
(Kanmanthareddy, Balan, Dhoble, Charitakis, Johnson, Arain, Madjid,
Anderson, Smalling) University of Texas at Houston, United States
(Anugula, Tandra) Creighton University, School of Medicine, United States
Title
Embolic protection device for stroke prevention in patients undergoing
transcatheter aortic valve replacement-a systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S184-S185), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Embolic events to the brain during transcatheter aortic valve
replacement (TAVR) can result in increased morbidity and mortality.
Embolic protection devices (EPD) can significantly mitigate this risk.
Methods: Electronic search of PubMed, EBSCO and Google Scholar databases
was performed for relevant articles. Outcomes of all-cause mortality,
stroke, presence of new ischemic lesions on the MRI, number of new
ischemic lesions, and total lesion volume on the MRI were extracted from
the included studies. Meta-analysis was performed using STATA 13 software.
Risk ratio (RR) and weighted mean difference (WMD) with their respective
95% confidence intervals (CI) were computed using fixed or random effects
model based on the heterogeneity (I2 test). Results: A total of 5
randomized trials and 3 observational studies were included with a total
of 709 patients had EPD during TAVR and 576 patients did not have any EPD
during the TAVR. The risk of clinical stroke was significantly lower in
the patients receiving EPD (RR 0.55, 95% CI 0.33 - 0.93). The risk of
mortality was also significantly lower in patients having EPD device
during TAVR (RR 0.44, 95% CI 0.19 - 1.00). The number of new stroke
lesions (WMD -0.75, 95% CI -1.40, -0.09, p<0.001) and stroke volume (WMD
-77.04, 95% CI -135, -19.09, p<0.001) as evaluated by MRI were also
significantly lower in the group of patients receiving EPD. Conclusion:
The use of EPD during TAVR is associated with significantly lower risk of
clinical stroke, mortality, stroke lesions and stroke lesion volume. EPD
should therefore be considered for patients undergoing TAVR to mitigate
stroke risk. (Table presented).

<66>
Accession Number
622146146
Author
Adhikari B.K.; Li B.; Wang S.; Liu Q.
Institution
(Adhikari, Li, Wang, Liu) First Hospital, Jilin University, China
Title
Procedural outcomes using rotational atherectomy for percutaneous
intervention of coronary chronic total occlusion: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S59-S60), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The success rate of percutaneous intervention for coronary
chronic total occlusion (CCTO) is highly dependent on lesion complexity,
operator experience and availability of adjunctive modalities. Several
modalities have been developed to assist in crossing the lesion with
guidewire, sometimes crossing the lesion with balloon or dilate the lesion
by balloon inflation. Among these modalities, rotational atherectomy (RA)
works by pulverizing rigid calcified plaque, thus modifying lesion and
reducing plaque burden. Commonly indicated for densely calcified lesions,
RA has also shown effective modality in managing chronic total occlusions.
We here discuss the procedural outcomes of RA on managing CCTO PCI.
Methods: Using search items, "rotational atherectomy", "rotablator",
"chronic total occlusion", "coronary chronic total occlusion", "plaque
debulking", we searched Pubmed, Sciencedirect, Web of Science, Cochraine
Library and CNKI. Both randomized and observational studies related to
study of rotational atherectomy on CCTO PCI were included. The case
reports, abstracts, review articles, editorial comments, protocols, animal
studies were excluded. We identified 4 original research articles,
clinical outcomes of the patients were extracted to analyse using RevMan
5.3 software. Results: Technical success, defined as residual stenosis<30%
with antegrade TIMI grade 3 flow, was higher in RA group, but was not
statistically significant, odd ratio [OR] (0.85 [95% confidence interval
0.50- 1.44]; p>0.05). Peri-procedural complications included death,
myocardial infarction, urgent revascularization, urgent CABG, cardiac
tamponade requiring pericardiocentesis, contrast induced renal injury,
which were significantly higher in conventional group as compared with RA
group during percuantous management of CTO, odd ratio [OR] (1.96 [95%
confidence interval 1.23-3.14]; p<0.05). Conclusion: Rotational
atherectomy can be an important adjunctive modality for percutaneous
management of CCTO. Though it has similar technical success with
conventional management, it significantly reduces peri-procedural
complications, hence improves procedural outcomes.

<67>
Accession Number
622146105
Author
Siddamsetti S.; Vij A.; Yandrapalli S.; Balasubramanian S.; Kodumuri V.
Institution
(Siddamsetti, Vij, Balasubramanian, Kodumuri) John H Stroger Jr Hospital
of Cook County, United States
(Yandrapalli) Westchester Medical Center, New York Medical College,
Valhalla, NY, United States
Title
Dual antiplatelet therapy versus aspirin alone after transcatheter aortic
valve replacement: An updated meta-analysis of randomized controlled
trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S212), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The 2014 ACC/AHA valvular heart disease guidelines give a
Class IIb recommendation for aspirin and clopidogrel (DAPT) for six months
after Transcatheter aortic valve replacement (TAVR) (level of evidence C).
This regimen is based on the protocol used in the first randomized control
trial (RCT) of TAVR (PARTNER). Recent small-scale studies have questioned
the benefit of clopidogrel in patients getting TAVR, where predominant
complications are related to bleeding. We performed a meta-analysis of all
the RCT's comparing the efficacy and safety of aspirin to DAPT in patients
undergoing TAVR. Methods: Three RCT's involving 421 patients were
identified based on search of PubMed, Medline and Scopus databases.
Individual outcomes of all-cause mortality, myocardial infarction (MI),
ischemic stroke and major bleeding were analyzed. Heterogeneity of the
studies was analyzed by Cochran's Q statistics. Mantel- Haenszel model was
used to calculate the odds ratio (OR) for outcomes. Results: There was no
significant difference in all-cause mortality [odds ratio (OR); 1.17, 95%
confidence interval (CI); 0.53 - 2.60, p=0.70], ischemic stroke [OR; 0.81,
95% CI; 0.23, 2.84, p=0.74), cardiovascular mortality or MI between the
two treatment arms. Major bleeding rates [OR; 3.36, 95% CI; 1.44, 7.82,
p=0.005) were significantly higher in DAPT arm compared to aspirin only.
Conclusion: In patients undergoing TAVR, DAPT increases the risk of major
bleeding compared to aspirin alone. There was no difference in
thromboembolic events or mortality. Further large scale RCT's are required
to evaluate the optimal antithrombotic therapy after TAVR.

<68>
Accession Number
622146058
Author
Gerhardt L.
Institution
(Gerhardt) Morgan Stanley Children's Hospital of New York, Presbyterian
Columbia University, United States
Title
Maximizing laboratory testing on minimum blood volume for heart transplant
patients.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S151), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: In post heart transplantation, a pediatric patient is required
to come to the cardiac catheterization lab for a tissue biopsy on a
routinue schedule to rule out rejection of the newly transplanted organ.
During this visit, there are some important laboratory tests that are
needed for medical surveillance. Many of these patients are also
participating in clinical trials which require additional blood specimens
to be drawn at the time of biopsy, increasing the volume required at one
time. Although there was a large volume of blood being drawn for each
patient, some of the tests were cancelled due to an insufficient amount of
blood collected. Methods: We identified the different tubes that were
needed for each specific blood test and analyzed the volume of blood
required for the laboratory to run each of the blood tests ordered. An
inquiry was done to look into combining some of the tests that used the
same color tubes to reduce the number of tubes and the volume required.
The review of current literature shows that blood volume limits should be
between 1% and 5% of total blood volume (TBV) on a single draw (or over 24
hours). (Howie, 2010). Many of the pediatric hospitals throughout the
United States are utilizing 2.5% of TBV as their safe practice guidelines.
Results: We maximized the number of tests by consolidating blood tests
into compatible specimen tubes; decreasing the total number of tubes
required. We were able to eliminate 2 full specimen tubes by combining a
total of 10 tests thus reducing the total volume of pediatric blood loss.
The catheterization lab nurses follow the guideline for the maximum
allowable blood volume based on the patient's weight and place the exact
volume in each tube. Conclusion: This performance improvement project
increased clinical efficiency by preventing insufficient collection errors
and proving to be cost effective practice. Since the implementation of the
color coded chart, we noted fewer instances of cancelled labs due to
insufficent volume.

<69>
Accession Number
622146033
Author
Darmoch F.; Al-Khadra Y.; Pacha H.M.; Soud M.; Kabach A.; Idris A.;
Alrifai A.; Fanari Z.; Alraies M.C.
Institution
(Darmoch, Al-Khadra, Soud) Cleveland Clinic Foundation, United States
(Pacha) Med- Star Heart and Vascular Institute, MedStar Washington
Hospital Center, United States
(Kabach) Creighton University Cardiac Center, United States
(Idris) University of Central Florida, North Florida Regional Medical
Center, United States
(Alrifai) University of Miami, Miller School of Medicine Regional Campus,
United States
(Fanari) Heartland Cardiology, University of Kansas, School of Medicine,
United States
Title
The outcome of transcatheter aortic valve replacement in patients with low
gradient versus high gradient severe aortic stenosis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S178-S179), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The outcome of patients undergoing transcatheter aortic valve
replacement (TAVR) for severe aortic valve stenosis (AS) and preserved
ejection fraction (EF) with low gradient (LG) is not wellestablished.
Thus, we sought to compare the outcome of TAVR in patients with LG vs high
gradient (HG) AS patients undergoing TAVR. Methods: We conducted
literature search using PubMed, Medline and Cochrane Central Registry from
January 2000 through December 2017 for all randomized controlled trials
(RCT) which compared the outcome of TAVR in AS patients with normal EF and
LG (<40 mmHg) to those with HG (>=40 mmHg). Data was pooled for the
primary outcome using the random-effects model as pooled Rate Ratio (RR).
The primary outcome was 30-day and 1-year mortality including
cardiovascular causes. Results: Out of 68 studies, five met the inclusion
criteria. Total of 15,012 patients (mean age 81 year, 51.4% men). 4,988
patients had LG while 10,024 had HG severe AS. LG group had 77.5% coronary
artery disease (CAD), Hypertension(HTN) 82.4%, Diabetes (DM) 37%,
cerebrovascular accident(CVA) 18.7% and average aortic valve area (AVA) of
0.7 cm compared with HG group CAD 87.4%, HTN 71.6%, DM 33%, CVA 16.4%, and
AVA of 0.6 cm. A random effects model combining the results of the
included studies demonstrated no statistical significance in the 30-day
(RR 1.11; 95% CI: 0.97-1.28, p=0.12, I²= 0%) or 1-year
mortality (RR 1.02; 95% CI: 0.88-1.17, p=0.81, I²= 60%) between
LG group and HG group. Conclusion: Outcome of patients with severe AS and
preserved EF with LG is not different compared with those with HG at
30-day and 1-year follow up. These findings suggest that aortic valve area
can reliably estimate severity of AS regardless of gradient across the
aortic valve. 30 days&1-year mortality.

<70>
Accession Number
622145986
Author
Rafeedheen R.; Oman Z.; Abo-Salem E.; Helmy T.; Nasir A.; Forsberg M.
Institution
(Rafeedheen, Oman, Abo-Salem, Helmy, Nasir, Forsberg) Saint Louis
University, United States
Title
Graft markers for angiography in post-bypass patients category:
Miscellaneous.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S120), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: About 10% of the patients who are referred for coronary
angiograms have had prior coronary artery bypass grafting (CABG).
Angiography of the vein grafts can be challenging, particularly when the
graft anatomy is not available. Graft markers can facilitate
identification of vein graft origin, and decrease radiation and contrast
volume. However, there is paucity of data comparing angiography of
coronary vein grafts with and without graft markers. Methods: We performed
a retrospective study in all post-CABG patients who underwent angiography
at John Cochrane Veterans Affair Medical Center between 2009 and 2017.
Patients who underwent intervention were excluded. Baseline
characteristics, contrast volume and fluoroscopy time were compared in
patients with and without vein graft markers. Results: We identified 300
subjects who underwent diagnostic angiograms involving vein grafts; 121
had vein graft markers compared to 179 cases without graft markers. Access
was predominantly femoral and 98% were males. There was no significant
difference between the two groups in regard to baseline characteristics
(Table 1). The median number of vein grafts in both groups was 2.
Fluoroscopy time and contrast volume were significantly higher among cases
without graft markers (Table 1). Conclusion: During angiography in
post-CABG patients, presence of graft markers is associated with reduced
contrast use and shorter fluoroscopy times.

<71>
Accession Number
622145976
Author
Darmoch F.; Alrifai A.; Al-Khadra Y.; Soud M.; Pacha H.M.; Kabach A.;
Idris A.; Alraies M.C.; Fanari Z.
Institution
(Darmoch) Cleveland Clinic Foundation, United States
(Alrifai) University of Miami, Miller School of Medicine Regional Campus,
United States
(Al-Khadra) Cleveland Clinic Foundations, United States
(Soud, Pacha) MedStar Heart and Vascular Institute, MedStar Washington
Hospital Center, United States
(Kabach) Creighton University, School of Medicine, United States
(Idris) University of Central Florida, North Florida Regional Medical
Center, United States
(Alraies) Aultman Hospital, United States
(Fanari) Heartland Cardiology, University of Kansas, School of Medicine,
United States
Title
The impact of transcatheter aortic valve replacement on short and long
term outcomes in high gradient versus paradoxical low flow severe aortic
stenosis a meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S177), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The ACC/AHA Guidelines recognized symptomatic paradoxical low
flow low gradient as with preserved ejection fraction (mean gradient MG
<40 mmHg and stroke volume index<35, ejection fraction>50) severe aortic
Stenosis (AS) as a separate entity called D3 AS. The impact of
transcatheter aortic valve replacement (TAVR) on D3 AS in comparison to
that of symptomatic high gradient (HG) (>=40 mm Hg) Severe AS (designated
as D1 AS by guidelines) is not well established. Available studies
reported variable results. The aim of this meta-analysis is to compare the
outcome of TAVR in these 2 distinctive groups. Methods: We performed a
meta-analysis from randomized clinical trials (RCTs) that compared D1 AS
vs. D3 AS patients. Data was pooled for the primary outcome measure using
the random-effects model as pooled Rate Ratio (RR). The primary outcomes
were 30-day and 1-year mortality. Results: Our analysis included 4,834
patients from 6 RCTs (mean age 85 years in D1 group vs 85 years in D3,
3,743 in the D1 group and 706 in D3. Patient with D1 had a 24% lower
30-days mortality (RR 0.38-1.42; 95% CI) and 37% lower 1-year mortality
(RR 0.42-0.86; 95% CI) when compared to D3. Conclusion: Patients with D1
AS undergoing TAVR has lower 30-day and 1-year when compared to D3AS.

<72>
Accession Number
622145822
Author
Haddad T.M.; Kabach A.; Tandon T.; Patel A.; Smer A.; White M.; Del Core
M.; Azzouz M.
Institution
(Haddad, Kabach, Tandon, Patel, Smer, White, Del Core) Creighton
University, School of Medicine, United States
(Azzouz) University of Alabama - Birmingham, United States
Title
The impact of obstructive sleep apnea on atrial fibrillation after
coronary artery bypass graft surgery: A meta-analysis category:
Miscellaneous.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S115), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The development of post-operative atrial fibrillation (POAF)
is common in patients undergoing cardiac surgery. However, only a few
studies have evaluated the independent correlation between obstructive
sleep apnea (OSA) and the incidence of POAF in patients undergoing
coronary artery bypass graft (CABG) surgery. We therefore systematically
reviewed published literature to analyze this correlation. Methods:
PubMed, Cochrane Library, and Web of Science databases were searched for
studies evaluating the correlation between OSA and POAF in patients
undergoing CABG. OSA was diagnosed by polysomnography (PSG) or validated
questionnaire. Primary endpoint was POAF defined as a new incidence of
atrial fibrillation post-CABG. The analysis was done with the DerSimonian
and Laird random effect model. Results: Seven observational studies met
the criteria for inclusion with a total of 1120 patients (OSA group: 495
patients; non-OSA group: 625 patients) for the final analysis. Six of the
studies were prospective cohort analyses and one was retrospective study.
Mean age was 62.3 years old, and 71.8% were male. Patients with OSA had a
significantly higher risk of atrial fibrillation as compared to patients
who did not have OSA (OR: 2.31; 95% CI: 1.41-3.79, P=0.0009) (Figure 1A).
Subanalysis of the six prospective cohort studies did not show a
significant difference in the results (OR: 1.96; 95% CI: 1.26-3.05;
P=0.003) (Figure 1B). Conclusion: Our analysis shows that OSA is
associated with higher incidence of POAF in patients undergoing CABG.
Identification and treatment of OSA prior to surgery may reduce incidence
of POAF.

<73>
Accession Number
622145763
Author
Joshi U.; Ranka S.; Siddamsetti S.; Vij A.; Kodumuri V.
Institution
(Joshi, Ranka, Siddamsetti, Vij, Kodumuri) John H Stroger Jr Hospital of
Cook County, United States
Title
Comparison of off pump versus on pump coronary artery bypass grafting:
Meta-analysis of randomized controlled trials category: Miscellaneous.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S112-S113), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Off pump CABG is known to decrease stroke events as compared
to on pump CABG but there is no difference with respect to other clinical
outcomes. Recent long term data from randomized controlled trials (RCTs)
showed conflicting evidence. We conducted a meta-analysis of randomized
trials to compare off pump versus on pump CABG at 30 days and 5 year
follow up. Methods: PubMed, Medline, Embase, and Cochrane databases were
analyzed for all RCTs comparing off pump versus on pump CABG from 2000 to
2017. 33 RCTs with 19157 patients were identified with 30 days (early) and
3 RCTs were identified for 5 years (late) outcomes of myocardial
infarction, stroke and all-cause death. Results: At 30 days, there were
lower rates of myocardial infarction {Odds Ratio (OR) 0.84, 95% Confidence
Interval (CI) 0.71-0.99, P=0.04} and stroke {OR 0.78, CI 0.62-0.98,
P=0.03} with off pump CABG; however, there was no significant differences
in all cause death between the two groups {OR 0.88, CI 0.72-1.07, P=0.21}.
At 5 years, there was no significant difference for rate of stroke {OR
0.81, CI 0.57- 1.15, P=0.25} and MI {OR 1.19, CI 0.79-1.79, P=0.40};
however, allcause death was in favor of on pump CABG {OR 1.17, CI
1.02-1.33, P=0.03}. Conclusion: There are early benefits of off pump CABG
in terms of AMI and stroke, however long-term benefits are still unclear;
there are only three RCTs that evaluated long term outcomes. We recommend
further RCTs to better evaluate the outcomes with off pump versus on pump
CABG long term.

<74>
Accession Number
622145754
Author
Alrifai A.; Darmoch F.; Al-khadra Y.; Soud M.; Pacha H.M.; Kabach A.;
Idris A.; Alraies M.C.; Fanari Z.
Institution
(Alrifai) University Of Miami, JFK Medical Center Palm Beach Regional
Consortium, United States
(Darmoch, Al-khadra) Cleveland Clinic Foundation, United States
(Soud, Pacha) MedStar Heart and Vascular Institute, MedStar Washington
Hospital Center, United States
(Kabach) CHI health Creighton University Medical Canter, United States
(Idris) University of Central Florida, North Florida Regional Medical
Center, United States
(Alraies) Aultman Hospital, United States
(Fanari) Heartland Cardiology, University of Kansas, School of Medicine,
United States
Title
Transcatheter aortic valve replacement outcomes in patients with low flow
low gradient severe aortic stenosis and reduced ejection fraction: A
meta-analysis of randomized controlled trails.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S170), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The ACC/AHA guidelines recognized symptomatic low flow low
gradient as with reduced ejection fraction (mean gradient MG <40 mmHg and
stroke volume index<35, ejection fraction<50%) severe aortic stenosis (AS)
as a separate entity called D2 AS. The impact of transcatheter aortic
valve replacement (TAVR) on D2 AS in comparison to that of symptomatic
high gradient (HG) (>=40 mm Hg) Severe AS (designated as D1 AS by
guidelines) is not well established. Available studies reported variable
results. The aim of this metaanalysis is to compare the outcome of TAVR in
these 2 distinctive groups. Methods: We performed a meta-analysis from
randomized clinical trials (RCTs) that compared TAVR outcomes in D1 AS vs
D2 patients. Data was pooled for the primary outcome measure using the
random-effects model as pooled Rate Ratio (RR). The primary outcomes were
30-day, and 1-year mortality. Results: Our analysis included 4,449
patients from 6 RCTs (mean age 85 years in D1 vs 84 years in D2), 3,743
patients had D1 and 706 had D2. Patients with D1 AS had a 49% lower
30-days mortality (RR 0.26- 0.97; 95% CI) and 55% lower 1-year mortality
(RR 0.31 - 0.65; 95% CI) when compared to D2. Conclusion: Patients with D1
severe AS who underwent TAVR had better 30-day and 1-year mortality when
compared to D2.

<75>
Accession Number
622145745
Author
Alrifai A.; Soud M.; Kabach A.; Masrani A.; Jobanputra Y.; Al-khadra Y.;
Darmoch F.; Baibars M.; Pacha H.M.; Idris A.; Fanari Z.; Alraies M.C.
Institution
(Alrifai, Masrani) University Of Miami, JFK Medical Center Palm Beach
Regional Consortium, United States
(Soud, Jobanputra) MedStar Heart and Vascular Institute, MedStar
Washington Hospital Center, United States
(Kabach, Al-khadra) Creighton University Cardiac Center, United States
(Darmoch) Barnes Jewish Hospital, Washington University, School of
Medicine, United States
(Baibars) Cleveland Clinic Foundation, United States
(Pacha) Johns Hopkins Medicine, Howard County General Hospital, United
States
(Idris) University of Central Florida, North Florida Regional Medical
Center, United States
(Fanari) Heartland Cardiology, University of Kansas, School of Medicine,
United States
(Alraies) Aultman Hospital, United States
Title
Dual antiplatelet therapy compared with single antiplatelet therapy after
transaortic valve replacement: Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S142-S143), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: ACC/AHA recommends empirical therapy with dual antiplatelet
(DAPT) regimen of ASA and P2Y12 inhibitor for six months after TAVR. This
is based on expert consensus rather than strong evidence. Giving the lack
of consensus on treatment strategy for ischemic events prevention
following TAVR, we performed meta-analysis of studies comparing aspirin
based mono-antiplatelet therapy (MAPT) with DAPT in TAVR patients.
Methods: We included only randomized clinical trials (RCTs) and
prospective studies that tested DAPT vs. MAPT for all cause mortality and
major bleeding. The primary efficacy outcomes were 30 days mortality and
stroke. The primary safety outcomes were major bleeding and major vascular
complications. Secondary safety outcomes included minor bleeding and minor
vascular complications. Results: The meta-analysis included 603 patients
with 301 receiving MAPT and 302 receiving DAPT. The use of MAPT was
associated with similar mortality (MAPT 5.9% vs. the DAPT 6.6%; RR=
0.92;595% CI 0.49 to 1.71; P= 0.68) or in major strokes (1.3% vs. 1.3%; RR
1.04; 95% CI 0.27 to 4.04; P=0.81). MAPT was associated with significantly
less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI 0.20 to 0.70;
P<0.01. However there was no difference in major vascular complication
(4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to 1.18; P=0.17), minor bleeding
(4.2% vs. 3.6%; RR 1.16; 95% CI 0.43 to 3.10; P= 0.85) or minor vascular
complication (4.2% vs. 7.3%; RR 0.58; 95% CI 0.25 to 1.34; P=0.14).
Conclusion: The use of MAPT post TAVR is associated with lower risk of
major bleeding comparing to DAPT with no significant difference in
mortality, stroke or vascular complications. (Figure presented).

<76>
Accession Number
622145589
Author
Pourdjabbar A.; Sab S.; Serruys P.W.; Collet C.; Ben-Yehuda O.; Hueb W.;
Patel M.; Reeves R.R.; Ang L.; Mahmud E.
Institution
(Pourdjabbar, Sab, Patel, Reeves, Ang, Mahmud) UCSD Medical Center,
Cardiology, United States
(Serruys) Imperial College London, United Kingdom
(Collet) University of Amsterdam, Netherlands
(Ben-Yehuda) CRF, United States
(Hueb) InCor - Instituto do Coracao - HC/FMUSP, Brazil
Title
Comparison of stenting versus bypass surgery in patients with multivessel
disease who achieved complete revascularizatoin: A meta-analysis.
Category: Left Main & Multi-Vessel Intervention.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S107), 2018. Date of
Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Clinical data suggest that coronary artery bypass graft (CABG)
surgical revascularization is superior to percutaneous revascularization
in patients with multivessel coronary artery disease (MVD). These findings
might be due to the higher prevalence of complete revascularization (CR)
achieved with CABG. With advances in interventional tools and techniques,
CR is increasingly possible with percutaneous coronary intervention (PCI).
However, it remains unclear whether clinical outcomes differ with the two
revascularization strategies in patients with MVD when CR is achieved.
Methods: A systematic review and meta-analysis was performed using studies
involving patients with MVD undergoing revascularization with either PCI
or CABG and where clinical data were reported or provided in those who
achieved CR. Data were obtained and pooled from ARTSI, ARTS-II, MASS-II,
SYNTAX, Bangalore et al. The primary clinical end points included, death,
myocardial infarction (MI), stroke and repeat revascularization Results:
Outcome data were available from 6347 patients with MVD who achieved
complete revascularization (32+/-6 PCI and 3081 CABG) Table. Among those
who achieved CR, No difference was observed in terms of mortality (odds
ratio [OR]: 0.924, 95% confidence interval [CI] 0.758-1.126; p=0.43) or MI
(OR 1.27, 95% CI 0.996-1.622; p=0.163). PCI was associated lower risk of
stroke (OR 0.611, 95% CI 0.426- 0.876; p=0.007) and increased repeat
revascularization (OR 1.835, 95% CI 1.5+/-5-2.152; p=0.0001). Conclusion:
For patients with MVD achieving complete revascularization, PCI was
associated with similar risk of mortality and MI, lower risk of stroke,
but an increased incidence of repeat revascularization as compared to
those undergoing surgical revascularization. Therefore in patients with
MVD, percutaneous revascularization should be considered if CR can be
achieved.

<77>
Accession Number
622145576
Author
Hesterberg K.; Lathem S.; Jagadish P.; Almaddah N.; Shah R.
Institution
(Hesterberg, Lathem, Jagadish, Almaddah) University of Tennessee, Health
Science Center, Memphis, TN, United States
(Shah) University of Tennessee, Health Sciences Center and Memphis VA
Medical Center, United States
Title
Aspirin alone versus dual antiplatelet therapy following coronary artery
bypass surgery: Comprehensive pairwise and network meta-analyses of
randomized controlled trials category: Left main & multi-vessel
intervention.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 91 (Supplement 2) (pp S106-S107), 2018. Date
of Publication: April 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Aspirin (ASA) therapy is class 1 indication following CABG to
prevent graft occlusion. Several small-sized trials suggest that dual
antiplatelet therapy (DAPT) including ASA plus a p2y12 inhibitor could be
more effective than ASA alone. However, the findings of individual trials
have been scrutinized for small sample size and lack of statistical power.
In addition, it is unclear whether some p2y12 inhibitors are more
effective than others. Therefore, we performed standard pairwise
meta-analyses and a Bayesian network meta-analysis with the largest sample
to date by including trails from recent months. Methods: In pairwise
analyses, the pooled risk difference (RD) was estimated using a random
model. For the network meta-analysis, we converted events rate to
events/per 10,000 patient-days because followup duration varied across
trials. Results: Data from nine trials including 1677 patients were
analyzed. Compared to ASA alone, DAPT decreased the absolute risk for
graft occlusion by 7.4% (RD=-0.074; 95% CI, -0.132 to -0.017, p=0.011) and
for MACE by 3.8% (Figure B). It was also associated with a numerically
higher risk of major bleeding, but without statistical significance
(Figure C). Results of the network meta-analysis was consistent with those
from pairwise analyses (Figure D). In addition, the rate of graft
occlusion was not different between ASA+clopidogrel and ASA+ticagrelor
(Figure D). Conclusion: Following CABG, DAPT seems to be more effective at
preventing graft occlusion compared to ASA alone. Clopidogrel- and
ticagrelor-based DAPT seem to be equally effective for this indication.

<78>
Accession Number
2000755235
Author
Marasco S.F.; Fuller L.; Zimmet A.; McGiffin D.; Seitz M.; Ch'ng S.;
Gangahanumaiah S.; Bailey M.
Institution
(Marasco, Zimmet, McGiffin, Seitz, Ch'ng, Gangahanumaiah) CJOB
Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Marasco, McGiffin) Department of Surgery, The Alfred Hospital, Monash
University, Melbourne, Victoria, Australia
(Fuller) Physiotherapy Department, The Alfred Hospital, Melbourne,
Victoria, Australia
(Bailey) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, Victoria, Australia
Title
Prospective, randomized, controlled trial of polymer cable ties versus
standard wire closure of midline sternotomy.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Midline sternotomy remains the most common access incision for
cardiac operations. Traditionally, the sternum is closed with stainless
steel wires. Wires are well known to stretch and break, however, leading
to pain, nonunion, and potential deep sternal wound infection. We
hypothesized that biocompatible plastic cable ties would achieve a more
rigid sternal fixation, reducing postoperative pain and analgesia
requirements. Methods: A prospective, randomized study compared the ZIPFIX
(De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with
standard stainless steel wires (n = 60). Primary outcomes were pain and
analgesia requirements in the early postoperative period. Secondary
outcome was sternal movement, as assessed by ultrasound at the
postoperative follow-up visit. Results: Groups were well matched in
demographic and operative variables. There were no significant differences
between groups in postoperative pain, analgesia, or early ventilatory
requirements. Patients in the ZIPFIX group had significantly more movement
in the sternum and manubrium on ultrasound at 4 weeks. Conclusions: ZIPFIX
sternal cable ties provide reliable closure but no demonstrable benefit in
this study in pain or analgesic requirements relative to standard wire
closure after median sternotomy.<br/>Copyright &#xa9; 2018

<79>
Accession Number
621915915
Author
Lewis K.M.; Ikeme S.; Olubunmi T.; Kuntze C.E.
Institution
(Lewis, Ikeme, Kuntze) Global Medical Affairs, Baxter Healthcare
Corporation, Deerfield, IL, United States
(Olubunmi) Global Medical Affairs, Magni Consulting Group, Woodland Hills,
CA, United States
Title
Clinical effectiveness and versatility of a sealing hemostatic patch
(HEMOPATCH) in multiple surgical specialties.
Source
Expert Review of Medical Devices. 15 (5) (pp 367-376), 2018. Date of
Publication: 04 May 2018.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Intraoperative surgical sealants and hemostatic agents have
been shown to reduce postoperative complications, transfusions, and
hospital resource utilization. Despite availability of these agents, the
incidence and burden of bleeding remains high and surgeons' requirements
for hemostatic control continue to evolve. A burgeoning class of
hemostatic agents are hemostatic patches, which offer package-to-patient
readiness and direct application. In addition, hemostatic patches may
provide tissue sealing capabilities. Areas covered: This review focuses on
the clinical effectiveness, versatility, and surgical efficiency of
HEMOPATCH as a surgical sealant and hemostatic agent in various surgical
specialties including: cardiac, digestive (hepatic, gastrointestinal,
pancreatic), urological, neurological, and endocrine. Expert commentary:
Among hemostatic patches, HEMOPATCH is a valuable tool to stop bleeding
without adverse events across various surgical specialties. Clinical
evidence demonstrates the safety, clinical effectiveness, and versatility
of HEMOPATCH as a unique surgical adjunct in patients undergoing complex
and routine surgical procedures. Larger randomized-controlled clinical
studies, or clinical registries, will continue to be used to evaluate its
performance and versatility, particularly for sealing tissues and closing
the dura. In the current field of surgical sealing and hemostasis,
however, HEMOPATCH represents the next step in improving patient
outcomes.<br/>Copyright &#xa9; 2018 Informa UK Limited, trading as Taylor
& Francis Group.

<80>
Accession Number
621966741
Author
Bermejo J.; Yotti R.; Garcia-Orta R.; Sanchez-Fernandez P.L.; Castano M.;
Segovia-Cubero J.; Escribano-Subias P.; San Roman J.A.; Borras X.;
Alonso-Gomez A.; Botas J.; Crespo-Leiro M.G.; Velasco S.; Bayes-Genis A.;
Lopez A.; Munoz-Aguilera R.; De Teresa E.; Gonzalez-Juanatey J.R.;
Evangelista A.; Mombiela T.; Gonzalez-Mansilla A.; Elizaga J.;
Martin-Moreiras J.; Gonzalez-Santos J.M.; Moreno-Escobar E.;
Fernandez-Aviles F.
Institution
(Bermejo, Yotti, Mombiela, Gonzalez-Mansilla, Elizaga, Fernandez-Aviles)
Department of Cardiology, Hospital General Universitario Gregorio Maranon,
Instituto de Investigacion Sanitaria Gregorio Maranon, Facultad de
Medicina, Universidad Complutense de Madrid, Dr Esquerdo 46, Madrid 28007,
Spain
(Garcia-Orta) Hospital Virgen de Las Nieves, Granada, Spain
(Sanchez-Fernandez, Martin-Moreiras, Gonzalez-Santos) Hospital Clinico
Universitario de Salamanca, CIBERCV Salamanca, Spain
(Castano) Hospital Universitario de Leon, Leon, Spain
(Segovia-Cubero) Hospital Puerta de Hierro Majadahonda and CIBERCV,
Majadahonda, Spain
(Escribano-Subias) Hospital 12 de Octubre and CIBERCV, Madrid, Spain
(San Roman) Hospital Clinico de Valladolid and CIBERCV, Valladolid, Spain
(Borras) Hospital Santa Creu i San Pau and CIBERCV, Barcelona, Spain
(Alonso-Gomez) Hospital Universitario de Araba-Txagorritxu, Vitoria, Spain
(Botas) Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain
(Crespo-Leiro) Complejo Hospitalario Universitario de A Coruna and
CIBERCV, A Coruna, Spain
(Velasco) Hospital de Galdakao-Usansolo, Usansolo, Spain
(Bayes-Genis) Hospital Universitari Germans Trias i Pujol and CIBERCV,
Badalona, Spain
(Lopez) Hospital Universitario Reina Sofia, Cordoba, Spain
(Munoz-Aguilera) Hospital Infanta Leonor, Madrid, Spain
(De Teresa) Hospital Virgen de la Victoria and CIBERCV, Malaga, Spain
(Gonzalez-Juanatey) Hospital Clinico de Santiago de Compostela and
CIBERCV, Santiago de Compostela, Spain
(Evangelista) Hospital Universitario de la Vall d'Hebron and CIBERCV,
Barcelona, Spain
(Moreno-Escobar) Hospital Universitario San Cecilio, Granada, Spain
Title
Sildenafil for improving outcomes in patients with corrected valvular
heart disease and persistent pulmonary hypertension: A multicenter,
double-blind, randomized clinical trial.
Source
European Heart Journal. 39 (15) (pp 1255-1264), 2018. Date of Publication:
14 Apr 2018.
Publisher
Oxford University Press
Abstract
Aims We aimed to determine whether treatment with sildenafil improves
outcomes of patients with persistent pulmonary hypertension (PH) after
correction of valvular heart disease (VHD). Methods and results The
sildenafil for improving outcomes after valvular correction (SIOVAC) study
was a multricentric, randomized, parallel, and placebo-controlled trial
that enrolled stable adults with mean pulmonary artery pressure > 30mmHg
who had undergone a successful valve replacement or repair procedure at
least 1 year before inclusion. We assigned 200 patients to receive
sildenafil (40mg three times daily, n= 104) or placebo (n= 96) for
6months. The primary endpoint was the composite clinical score combining
death, hospital admission for heart failure (HF), change in functional
class, and patient global self-assessment. Only 27 patients receiving
sildenafil improved their composite clinical score, as compared with 44
patients receiving placebo; in contrast 33 patients in the sildenafil
group worsened their composite score, as compared with 14 in the placebo
group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P<0.001].
The Kaplan-Meier estimates for survival without admission due to HF were
0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard
ratio 2.0, 95% CI= 1.0-4.0; log-rank P= 0.044). Changes in 6-min walk test
distance, natriuretic peptides, and Doppler-derived systolic pulmonary
pressure were similar in both groups. Conclusion Treatment with sildenafil
in patients with persistent PH after successfully corrected VHD is
associated to worse clinical outcomes than placebo. Off-label usage of
sildenafil for treating this source of left heart disease PH should be
avoided.<br/>Copyright &#xa9; The Author 2017.

<81>
Accession Number
621918721
Author
Breau R.H.; Lavallee L.T.; Cnossen S.; Witiuk K.; Cagiannos I.; Momoli F.;
Bryson G.; Kanji S.; Morash C.; Turgeon A.; Zarychanski R.; Mallick R.;
Knoll G.; Fergusson D.A.
Institution
(Breau, Lavallee, Cnossen, Witiuk, Momoli, Bryson, Kanji, Mallick,
Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Breau, Lavallee, Cagiannos, Morash, Knoll) Division of Urology,
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
(Bryson) University of Ottawa and Ottawa Hospital, Department of
Anesthesiology and Pain Medicine, Ottawa, ON, Canada
(Turgeon) CHU de Quebec, Universite Laval, Quebec City, QC, Canada
(Zarychanski) University of Manitoba, Department of Internal Medicine,
Section of Medical Oncology and Haematology, Winnipeg, MB, Canada
Title
Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical
Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized
Controlled Trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 261. Date of
Publication: 02 May 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Radical cystectomy for bladder cancer is associated with a
high risk of needing red blood cell transfusion. Tranexamic acid reduces
blood loss during cardiac and orthopedic surgery, but no study has yet
evaluated tranexamic acid use during cystectomy. Methods: A randomized,
double-blind (surgeon-, anesthesiologist-, patient-,
data-monitor-blinded), placebo-controlled trial of tranexamic acid during
cystectomy was initiated in June 2013. Prior to incision, the intervention
arm participants receive a 10 mg/kg loading dose of intravenously
administered tranexamic acid, followed by a 5 mg/kg/h maintenance
infusion. In the control arm, the patient receives an identical volume of
normal saline that is indistinguishable from the intervention. The primary
outcome is any blood transfusion from the start of surgery up to 30 days
post operative. There are no strict criteria to mandate the transfusion of
blood products. The decision to transfuse is entirely at the discretion of
the treating physicians who are blinded to patient allocation. Physicians
are allowed to utilize all resources to make transfusion decisions,
including serum hemoglobin concentration and vital signs. To date, 147
patients of a planned 354 have been randomized to the study. Discussion:
This protocol reviews pertinent data relating to blood transfusion during
radical cystectomy, highlighting the need to identify methods for reducing
blood loss and preventing transfusion in patients receiving radical
cystectomy. It explains the clinical rationale for using tranexamic acid
to reduce blood loss during cystectomy, and outlines the study methods of
our ongoing randomized controlled trial.<br/>Copyright &#xa9; 2018 The
Author(s).

<82>
Accession Number
618556258
Author
Reddy G.; Wang Z.; Nishimura R.A.; Greason K.L.; Yoon S.-H.; Makkar R.R.;
Holmes D.R.
Institution
(Reddy, Wang, Nishimura, Greason, Holmes) Department of Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, United States
(Yoon, Makkar) Department of Cardiovascular Diseases, Cedars Sinai Medical
Center, Los Angeles, CA, United States
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Systematic review and meta analyses of observational studies.
Source
Catheterization and Cardiovascular Interventions. 91 (5) (pp 975-983),
2018. Date of Publication: 01 Apr 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to perform a systematic review and
meta-analyses of observational studies of transcatheter aortic valve
replacement (TAVR) for bicuspid aortic valve stenosis (BcAV). Background:
TAVR for BcAV stenosis has been associated with an increased incidence of
paravalvular leaks, valve malposition, pacemaker placement and all-cause
mortality. The conclusions drawn have been limited by small sample sizes.
The use of TAVR for BcAV stenosis remains controversial. Methods: We
searched multiple databases from the inception of the databases through
September 30, 2016 for studies of TAVR for BcAV stenosis. We included all
observational studies with more than one patient and at least 1 month of
outcomes. Results: We analyzed 13 observational studies with 758 patients.
Meta analyses showed device success rate of 95% [95% confidence interval
(CI) 90.2% to 98.5%] and an early safety event in 16.9% [95% CI 12.2% to
22%]. At 30 days, moderate to severe paravalvular leak was seen in 12.2%
[95% CI 3.1% to 24.8%] and new pacemaker implantation in 17.9% [95% CI
14.2% to 22%]. All-cause mortality was 3.7% [95% CI 2.1% to 5.6%], which
should be viewed in the context of an STS PROM of 5.0%. Conclusions: This
analysis suggests that TAVR for BcAV is not associated with excess
mortality. The incidence of paravalvular leaks and pacemaker implant is
increased compared to tricuspid aortic valve cohorts undergoing TAVR, and
operators should weigh these potential complications against the clinical
benefit provided by TAVR for BcAV patients at high risk for surgical valve
replacement.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<83>
Accession Number
619944647
Author
Oriol I.; Sabe N.; Tebe C.; Veroux M.; Boin I.F.S.F.; Carratala J.
Institution
(Oriol, Sabe, Carratala) Infectious Disease Department, Hospital
Universitari de Bellvitge - IDIBELL, Spanish Network for Research in
Infectious Diseases (REIPI), and Clinical Science Department, Faculty of
Medicine, University of Barcelona, Barcelona, Spain
(Tebe) Statistical Assessment Service at Bellvitge Biomedical Research
Institute (IDIBELL) and Department of Basic Sciences, Universitat Rovira I
Virgili, Spain
(Veroux) Organ Transplant Unit, Department of Medical and Surgical
Sciences and Advanced Technologies, Gf. Ingrassia University of Catania,
Catania, Italy
(Boin) Unit of Liver Transplantation, State University of Campinas, Sao
Paulo, Brazil
Title
Clinical impact of culture-positive preservation fluid on solid organ
transplantation: A systematic review and meta-analysis.
Source
Transplantation Reviews. 32 (2) (pp 85-91), 2018. Date of Publication:
April 2018.
Publisher
W.B. Saunders
Abstract
Contamination of the preservation fluid (PF) used for donated organs is a
potential source of post-transplant infection. However, the information on
this issue is scarce. We therefore conducted a systematic review and
meta-analysis to assess the incidence of culture-positive PF and its
impact on solid organ transplant (SOT) recipients. Seventeen studies were
identified and included. The overall incidence of culture-positive PF was
37% (95% CI: 27% to 49%), and the incidence of PF-related infections among
SOT recipients with PF cultures that grew pathogenic microorganisms was
10% (95% CI: 7% to 15%). There were differences in the rates of infections
due to pathogenic microorganisms between SOT recipients who received
pre-emptive treatment and those who did not, but without statistical
significance. The mortality rate among SOT recipients with PF-related
infection was 35% (95% CI: 21% to 53%). In conclusion, although
contamination of the PF of donated organs is frequent, the incidence of
PF-related infection is relatively low. A closely clinical and
microbiologic monitoring of the SOT recipient in case of culture-positive
PF, regardless of the type of microorganism isolated might be do in order
to establish a prompt diagnosis of PF-related infection.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<84>
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.

<85>
Accession Number
622069197
Author
Tchetche D.
Institution
(Tchetche) Groupe Cardiovasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
Title
The revolution of transcatheter aortic valve implantation.
Source
Journal of Cardiovascular Surgery. 59 (3) (pp 368-369), 2018. Date of
Publication: June 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)

<86>
Accession Number
618484830
Author
Lemoine S.; Zhu L.; Gerard J.-L.; Hanouz J.-L.
Institution
(Lemoine, Zhu, Gerard, Hanouz) Department of Anaesthesiology and Intensive
Care, Universite Caen-Normandie, Centre Hospitalier Universitaire de Caen,
Caen 14033, France
(Hanouz) EA 4650, Universite Caen-Normandie, Centre Hospitalier
Universitaire de Caen, Caen 14033, France
Title
Sevoflurane-induced cardioprotection in coronary artery bypass graft
surgery: Randomised trial with clinical and ex-vivo endpoints.
Source
Anaesthesia Critical Care and Pain Medicine. 37 (3) (pp 217-223), 2018.
Date of Publication: June 2018.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Myocardial ischaemia reperfusion injury following cardiac
surgery with cardiopulmonary bypass (CPB) increases postoperative
mortality. Setting techniques to protect the heart during this critical
period therefore represents a considerable challenge. Method: A randomised
controlled study in Caen University Hospital Centre, investigated whether
the clinical cardio protective effects of administration sevoflurane
before cardiopulmonary bypass during coronary artery bypass graft surgery
(CABG) could translate into protected atrial trabeculae contractility
against hypoxia-reoxygenation in vitro. Patients undergoing elective
on-pump CABG surgery were allocated to receive either sevoflurane (n = 24)
or no halogenated volatile anaesthetic (n = 21). Main outcome measures:
the relationship between sevoflurane exposure before CPB and the incidence
of major adverse cardiac events, with primary endpoint: the postoperative
troponin I peak level, and secondary endpoints: the inotropic support, and
the duration of stay in intensive unit and in-hospital stay were chosen as
study endpoints. The right atrial was collected at the beginning of bypass
surgery for the in vitro experimentation. Isometrically contracting
isolated human right atrial trabeculae obtained from the two groups were
exposed to 30-min hypoxia followed by 60-min reoxygenation. Results: The
patients receiving sevoflurane prior to aortic clamping significantly
exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64]
ng.mL^-1 in Control; P = 0.03) and required a reduced inotropic
drug support (P < 0.001). Isolated trabeculae from patients receiving
sevoflurane enhanced the recovery of force after reoxygenation compared to
the Control group (79 +/- 5% vs. 53 +/- 8% of baseline in Control; P <
0.001). Conclusions: Administration of sevoflurane before CPB induced
cardioprotection in patients undergoing CABG and preconditioned human
myocardium against hypoxia-reoxygenation in vitro.<br/>Copyright &#xa9;
2018 Societe francaise d'anesthesie et de reanimation (Sfar)

<87>
Accession Number
2000753024
Author
Yasuda S.; Kaikita K.; Ogawa H.; Akao M.; Ako J.; Matoba T.; Nakamura M.;
Miyauchi K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.
Institution
(Yasuda) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka
565-8565, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto
860-8556, Japan
(Ogawa) National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555,
Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University School of
Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
30-1 Ohyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
(Matsui) Department of Community, Family, and General Medicine, Kumamoto
University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Title
Atrial fibrillation and ischemic events with rivaroxaban in patients with
stable coronary artery disease (AFIRE): Protocol for a multicenter,
prospective, randomized, open-label, parallel group study.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: In atrial fibrillation (AF) patients with coronary artery
disease (CAD), anticoagulants are commonly used in combination with
antiplatelet drugs. However, dual therapy can increase the risk of
bleeding, and the potential therapeutic benefits must be weighed against
this. Therefore, it is recommended that dual therapy is only used for a
limited time, and that monotherapy with anticoagulants should start from 1
year after percutaneous coronary intervention (PCI). However, there is a
lack of evidence on the use of monotherapy, in particular with direct oral
anticoagulants, in this group of patients. Methods: The AFIRE Study is a
multicenter, prospective, randomized, open-label, parallel group study
conducted in patients aged >=20 years with non-valvular AF (NVAF) and CAD.
Patients who have undergone PCI or coronary artery bypass graft at least 1
year prior to enrollment, or those without significant coronary lesions
requiring PCI (>=50% stenosis), will be included. Approximately 2200
participants will be randomized to receive either rivaroxaban monotherapy
or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or
prasugrel). The primary efficacy endpoints are the composite of
cardiovascular events (stroke, non-central nervous system embolism,
myocardial infarction, and unstable angina pectoris requiring
revascularizations) and all-cause mortality. The primary safety endpoint
is major bleeding as defined by the International Society on Thrombosis
and Haemostasis criteria. Conclusions: This study will be the first to
assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients
with stable CAD.<br/>Copyright &#xa9; 2017

<88>
Accession Number
2000741576
Author
Dunser M.W.; Bouvet O.; Knotzer H.; Arulkumaran N.; Hajjar L.A.; Ulmer H.;
Hasibeder W.R.
Institution
(Dunser) Department of Anesthesiology and Intensive Care Medicine, Kepler
University Hospital and Johannes Kepler University Linz, Linz, Austria
(Bouvet) Amomed Pharma GmbH, Vienna, Austria
(Knotzer) Department of Anesthesiology and Critical Care Medicine II,
Klinikum Wels, Wels, Austria
(Arulkumaran) Department of Critical Care, University College of London
Hospital, London, United Kingdom
(Hajjar) Department of Cardiopneumology, InCor, University of Sao Paulo,
Sao Paulo, Brazil
(Ulmer) Institute of Medical Statistics, Informatics and Health Economics,
Innsbruck Medical University, Innsbruck, Austria
(Hasibeder) Department of Anesthesiology and Critical Care Medicine,
Krankenhaus St. Vinzenz in Zams, Zams, Austria
Title
Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: To summarize the results of randomized controlled trials on the
use of vasopressin as a vasopressor agent in cardiac surgery. Design:
Meta-analysis. Participants: Six-hundred-twenty-five adult patients
undergoing elective or emergency cardiac surgery. Interventions: Arginine
vasopressin infusion (n = 313) or control/standard therapy (n = 312).
Measurements and Main Results: The rates of perioperative complications
and postoperative mortality were used as primary and secondary endpoints,
respectively. Fixed and/or random effects models were used to compare
pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio
(OR) of perioperative complications (OR, 0.33; 95% confidence interval
[CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest
trial showed an unchanged reduction in perioperative complications (OR,
0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative
complication separately, vasopressin reduced the pooled OR of vasodilatory
shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial
fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of
postoperative death was not different between patients treated with
arginine vasopressin and those receiving standard therapy or placebo (OR,
0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary
endpoint suggested a relevant publication bias. All included trials
suffered from a high risk of bias. Conclusion: Our meta-analysis suggests
that arginine vasopressin may reduce the rate of perioperative
complications in patients undergoing elective or emergency cardiac
surgery. No difference in postoperative mortality was observed. An
adequately powered multicenter trial is required for reliable estimation
of the effects of arginine vasopressin on perioperative complication rates
and mortality in cardiac surgical patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<89>
Accession Number
2000737452
Author
Lazkani M.; Singh N.; Howe C.; Patel N.; Colon M.J.; Tasset M.; Amabile
O.; Morris M.; Fang H.K.; Pershad A.
Institution
(Lazkani, Patel, Colon, Tasset, Amabile, Morris, Fang, Pershad) University
of Arizona, Banner University Medical Center - Phoenix, United States
(Singh, Howe) University of Arizona, Banner University Medical Center,
Tuscon, United States
Title
An updated meta-analysis of TAVR in patients at intermediate risk for
SAVR.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved for use in patients with severe aortic stenosis at intermediate,
high and extreme surgical risk. This meta-analysis was performed to assess
the safety and efficacy of TAVR compared to surgical aortic valve
replacement (SAVR) in intermediate risk patients. Methods: We searched
PubMed, EMBASE, Web of science, and the Cochrane Central Register of
Controlled Trials databases for studies comparing TAVR versus SAVR in
patients at intermediate surgical risk, with a mean Society of Thoracic
Surgeon score of 3-8% or a mean logistic European risk score of 10-20%.
The primary endpoint was to assess the efficacy of TAVR compared to SAVR,
defined as all-cause and cardiovascular mortality at 30-days, 1-year, and
>=2 years of follow-up. Secondary endpoints were the safety profile,
comprising of cerebrovascular events, myocardial infarctions, permanent
pacemaker placement, new onset atrial fibrillation, aortic regurgitation,
vascular complications, major bleeding and acute kidney injury. Results:
This is the largest and most contemporary meta-analysis of 5647
intermediate risk patients in eleven studies published to date. There were
no statistically significant differences in all-cause and cardiac
mortality at 30 days, 1- year and >2-years of follow up. Acute kidney
injury and atrial fibrillation occurred more frequently in patients
treated with SAVR and permanent pacemaker implantation and aortic
insufficiency were more frequent in patients treated with TAVR.
Conclusion: This meta-analysis suggests that for intermediate risk
patients with severe aortic stenosis, TAVR has similar efficacy as SAVR
but with a different adverse event profile.<br/>Copyright &#xa9; 2018
Elsevier Inc.