EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 87

Results Generated From:
Embase <1980 to 2018 Week 23>
Embase (updates since 2018-05-25)

<1>
Accession Number
613300045
Author
Vives M.; Callejas R.; Duque P.; Echarri G.; Wijeysundera D.N.; Hernandez
A.; Sabate A.; Bes-Rastrollo M.; Monedero P.
Institution
(Vives) Anaesthesia and Intensive Care, Hospital Universitari Bellvitge,
Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona
08907, Spain
(Callejas, Duque, Echarri, Monedero) Anesthesiology and Critical Care,
Clinica Universidad de Navarra, Avenida Pio 12, 36, Pamplona 31008, Spain
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Wijeysundera) Department of Anesthesia and Institute of Health Policy
Management and Evaluation, University of Toronto, Toronto, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
(Hernandez) Department of Anesthesiology and Critical Care, University
Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23
9LT, United Kingdom
(Sabate) Department of Anesthesiology and Critical Care, Bellvitge
University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907,
Spain
(Bes-Rastrollo) Department Preventive Medicine and Public Health,
University of Navarra, Av. Pio XII, 36, Pamplona 31008, Spain
(Bes-Rastrollo) CIBERobn, Instituto de Salud Carlos III, Spain
(Bes-Rastrollo) IDISNA, Navarra's Health Research Institute, Spain
Title
Modern hydroxyethyl starch and acute kidney injury after cardiac surgery:
A prospective multicentre cohort.
Source
British Journal of Anaesthesia. 117 (4) (pp 458-463), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press
Abstract
Background Recent trials have shown hydroxyethyl starch (HES) solutions
increase the risk of acute kidney injury (AKI) in critically ill patients.
It is uncertain whether these adverse effects also affect surgical
patients. We sought to determine the renal safety of modern tetrastarch
(6% HES 130/0.4) use in cardiac surgical patients. Methods In this
multicentre prospective cohort study, 1058 consecutive patients who
underwent cardiac surgery from 15th September 2012 to 15th December 2012
were recruited in 23 Spanish hospitals. Results We identified 350 patients
(33%) administered 6% HES 130/0.4 intraoperatively and postoperatively,
and 377 (36%) experienced postoperative AKI (AKI Network criteria).
In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES
group had higher Euroscore and more comorbidities including unstable
angina, preoperative cardiogenic shock, preoperative intra-aortic balloon
pump use, peripheral arterial disease, and pulmonary hypertension. The
non-HES group received more intraoperative vasopressors and had longer
cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES
130/0.4 use was not associated with significantly increased risks of AKI
(adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were
confirmed by propensity score-matched pairs analyses. Conclusions The
intraoperative and postoperative use of modern hydroxyethyl starch 6% HES
130/0.4 was not associated with increased risks of AKI and dialysis after
cardiac surgery in our multicentre cohort.<br/>Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.

<2>
Accession Number
622110038
Author
Krievins D.; Kramer A.; Savlovskis J.; Oszkinis G.; Debus E.S.; Oberhuber
A.; Zarins C.K.
Institution
(Krievins) Department of Vascular Surgery, Pauls Stradins Clinical
University Hospital, University of Latvia, Riga, Latvia
(Kramer) Department of Vascular and Endovascular Surgery, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Savlovskis) Department of Invasive Radiology, Pauls Stradins Clinical
University Hospital, University of Latvia, Riga, Latvia
(Oszkinis) Department of General and Vascular Surgery, Poznan University
of Medical Sciences, Poznan, Poland
(Debus) Department for Vascular Medicine, Vascular Surgery, Angiology, and
Endovascular Therapy, University Heart Center Hamburg, University Hospital
Hamburg-Eppendorf, Hamburg, Germany
(Oberhuber) Department of Vascular and Endovascular Surgery, University
Hospital Dusseldorf, Germany
(Zarins) Department of Surgery, Stanford University Medical Center,
Stanford, CA, United States
Title
Initial Clinical Experience Using the Low-Profile Altura Endograft System
With Double D-Shaped Proximal Stents for Endovascular Aneurysm Repair.
Source
Journal of Endovascular Therapy. 25 (3) (pp 379-386), 2018. Date of
Publication: 01 Jun 2018.
Publisher
SAGE Publications Inc. (E-mail: setac@allenpress.com)
Abstract
Purpose: To report the initial clinical results of endovascular aneurysm
repair (EVAR) using the low-profile (14-F) Altura Endograft System, which
features a double "D-shaped" stent design with suprarenal fixation and
modular iliac components that are deployed from distal to proximal.
Methods: From 2011 to 2015, 90 patients (mean age 72.8+/-8.3 years; 79
men) with abdominal aortic aneurysm (AAA; mean diameter 53.8+/-5.7 mm)
were treated at 10 clinical sites in 2 prospective, controlled clinical
studies using the Altura endograft. Outcomes evaluated included mortality,
major adverse events (MAEs: all-cause death, stroke, paraplegia,
myocardial infarction, respiratory failure, bowel ischemia, and blood loss
>=1000 mL), and clinical success (freedom from procedure-related death,
type I/III endoleak, migration, thrombosis, and reintervention). Results:
Endografts were successfully implanted in 89 (99%) patients; the single
failure was due to delivery system malfunction before insertion in the
early-generation device. One (1%) patient died and 4 patients underwent
reinterventions (1 type I endoleak, 2 iliac limb stenoses, and 1 endograft
occlusion) within the first 30 days. During a median follow-up of 12.5
months (range 11.5-50.9), there were no aneurysm ruptures, surgical
conversions, or AAA-related deaths. The cumulative MAE rates were 3%
(3/89) at 6 months and 7% (6/89) at 1 year. Two patients underwent coil
embolization of type II endoleaks at 6.5 months and 2.2 years,
respectively. Clinical success was 94% (84/89) at 30 days, 98% (85/87) at
6 months, and 99% (82/83) at 1 year. Conclusion: Early results suggest
that properly selected AAA patients can be safely treated using the Altura
Endograft System with favorable midterm outcome. Thus, further clinical
investigation is warranted to evaluate the role of this device in the
treatment of AAA.<br/>Copyright &#xa9; 2018, &#xa9; The Author(s) 2018.

<3>
Accession Number
2000787779
Author
Sharifi M.; Mousavi S.R.; Rafiei M.
Institution
(Sharifi) Cardiovascular Surgery, Department of Cardiovascular Surgery,
Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran,
Islamic Republic of
(Mousavi) Vascular Surgery, Department of Vascular Surgery, Faculty of
Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Rafiei) Biostatistics, Department of Biostatistics and Epidemiology,
Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran,
Islamic Republic of
Title
Our modified technique of combined antegrade-vein graft cardioplegia
infusion versus conventional antegrade method in coronary artery bypass
grafting. A randomized clinical trial.
Source
International Journal of Surgery. 55 (pp 53-59), 2018. Date of
Publication: July 2018.
Publisher
Elsevier Ltd
Abstract
Background: To determine the efficacy of antegrade cardioplegia
supplemented with venous graft perfusion in patients scheduled for
coronary artery bypass grafting (CABG). Methods: 223 consecutive patients
scheduled for isolated CABG were randomized to receive either continuous
crystalloid cardioplegia via vein grafts on completion of each distal
anastomosis plus intermittent blood cardioplegia through aortic root
(group 1, n = 110) or antegrade blood cardioplegia alone (group 2, n =
113). Two groups were similar in terms of preoperative patients' and
procedural characteristics. The primary end-points were low output
syndrome (LOS) variables. Results: The inotrope and intra-aortic balloon
pump demand during weaning were significantly higher in the control group
(31.8% vs. 20%, p = 0.043 and 7.9% vs. 1.8%, p = 0.034 respectively).
Postoperative level of potassium and arterial base excess (BE), stood in
the normal range in both groups, despite significant inter-group
differences. Peak serum level of myocardial injury biomarkers (CK, CK-MB,
and cTnI) at 12 h following operation, though markedly greater in the
group 2, did not reach the cut-off point of myocardial necrosis.
Postoperative arrhythmia was more commonly encountered in the control
group (p = 0.045). The duration of ventilation and hospital stay were
considerably longer in the group 2. In a subgroup with LVEF<30%, the
length of ICU stay was more prolonged in the control group, as well (p =
0.0145). The significant differences among groups regarding LOS parameters
were more remarkable in the two high-risk subgroups (LVEF<30%, left main
coronary stenosis). Conclusions: Given the better postoperative cardiac
performance, we recommend this method to all CABG candidates, particularly
in higher-risk patients.<br/>Copyright &#xa9; 2018 IJS Publishing Group
Ltd

<4>
Accession Number
622328067
Author
Hsiao W.L.; Wang T.J.
Institution
(Hsiao, Wang) National Taiwan University, Nursing, Taipei, Taiwan
(Republic of China)
Title
Testing efficacy of a pulmonary rehabilitation program for post lung
cancer resection surgery.
Source
Supportive Care in Cancer. Conference: 2018 Joint Meeting of the
Multinational Association of Supportive Care in Cancer, MASCC and the
International Society of Oral Oncology, ISOO 2018. Austria. 26 (2
Supplement 1) (pp S283), 2018. Date of Publication: 2018.
Publisher
Springer Verlag
Abstract
Introduction Pulmonary rehabilitation enhancing lung expansion and
ventilation may help to improve oxygenation and reduce postoperative lung
complications in patients with lung resection for removing lung cancer.
Objectives The purpose of this study is to test the effects of an early
rehabilitation intervention on oxygenation, postoperative complications,
and recovery from lung cancer surgery. Methods An experimental design.
Ninety patients for lung cancer surgeries was recruited from thoracic
surgery units of a medical center. Patients were randomly assigned to the
intervention or the control group. The intervention includes a 5-day
preoperative home-based rehabilitation and a 5-day postoperative
in-hospital rehabilitation. The main components of the rehabilitation were
aerobic and strength exercises as well as breathing training by using an
incentive spirometry. Results The GEE showed a significant group by time
interaction effect on SpO2/FiO2 ratio. As for the parameter estimates,
from postoperative day 1 to day 4, the S/F ratio improvement in the
intervention group was 74.49 (Wald X² = 46.42, p<0.001) more
than in the control group. Result of Chi-square test showed that the
number of postoperative lung complications in the intervention group (n
=1) was significantly less (X² = 8.39, p = 0.004) than it in
the control group. Result of the duration of chest tube drainage in the
intervention group (2.00+/-1.00 days) was significantly shorter (t =-
2.32, p = 0.022) than it in the control group (2.56+/-1.25 days).
Conclusions Pulmonary rehabilitation designed to enhance lung expansion
and ventilation may help to reduce postoperative lung complications and
promote patients' recovery from lung cancer surgery.

<5>
Accession Number
622327096
Author
Rashid H.; Amiruddin A.; Ihdayhid A.R.; McCormick L.; Nerlekar N.; Nasis
A.; Cameron J.; Gooley R.; Brown A.
Institution
(Rashid, Amiruddin, Ihdayhid, McCormick, Nerlekar, Nasis, Cameron, Gooley,
Brown) Monash Health and Monash University, Melbourne, VIC, Australia
Title
Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic
aortic valve detected by multidetector computed tomography is associated
with adverse cerebrovascular events: A meta-analysis of observational
studies.
Source
Journal of the American College of Cardiology. Conference: 23rd
Cardiovascular Summit, TCTAP 2018. South Korea. 71 (16 Supplement 1) (pp
S43-S44), 2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
BACKGROUND Leaflet thrombosis (LT) is becoming increasingly recognized
following transcatheter and surgical aortic bioprosthetic valve (ABV)
replacement and can be identified by multidetector computed tomography
(MDCT). MDCT-defined LT features such as hypo-attenuated leaflet
thickening (HALT) and reduced leaflet motion (RELM) has recently been
described. It is unclear if MDCT-defined LT is associated with adverse
cerebrovascular outcomes. METHODS Electronic databases (Pubmed, EMBASE,
and MEDLINE) were searched for studies that performed mandatory MDCT
imaging of patients following ABV. Inclusion criteria were 1) mandated
MDCT on all patients in the registry, 2) reported clinical outcomes
between LT and non-LT and 3) fully published status. Primary end point was
the incidence of a cerebrovascular event, defined as the composite of
stroke or transient ischaemic attack (TIA). Secondary end point included
major adverse cerebrovascular events (MACCE) and its subcomponents
(stroke, TIA, death, and myocardial infarction). RESULTS Primary End Point
Six studies met inclusion criteria with a weighted prevalence of
MDCT-defined LT of 13.1% (Figure 1). Cerebrovascular events were
significantly increased in patients with LT (odds ratio [OR] 3.38, 95% CI
1.78-6.41, I2=0%, p<0.01) (Figure 2A). A pre-specified sensitivity
analysis stratifying outcomes by type of LT demonstrated reduced leaflet
motion (RELM) was related to higher rates of cerebrovascular events (OR
3.41, 95%CI 1.67 - 6.96, I2=0%, p<0.01) when compared to hypo-attenuated
leaflet thickening (HALT) (OR 3.23, 95%CI 0.75-13.95, I2=0%, p=0.12) (p
for interaction=0.95) (Figure 2B). Secondary End Point The risk of MACCE
was increased in patients with LT (OR 2.10, 95% CI 1.21-3.64, p< 0.01).
This was primarily driven by increased TIA events in patients with LT (OR
5.86, 95%CI 2.05-16.75, p<0.01) (Figure 3). There were no differences in
the incidence of stroke (OR 2.43, 95%CI 1.00-5.94, p=0.05), death (OR
0.92, 95%CI 0.42-2.03, p=0.84) or myocardial infarction (OR 1.72, 95%CI
0.34-9.78, p=0.54) between groups. (Figure Presented) CONCLUSION
MDCT-defined LT following transcatheter and surgical ABV replacement is
associated with a significantly increased risk of adverse cerebrovascular
events. (Figure Presented).

<6>
Accession Number
622327084
Author
Testa L.; Latib A.; Colombo A.; Bedogni F.
Institution
(Testa, Bedogni) IRCCS Policlinico San Donato, Italy
(Latib) San Raffaele Scientific Institute, Italy
(Colombo) EMO GVM Centro Cuore Columbus, San Raffaele Hospital, Italy
Title
Cerebral protection during transcatheter aortic valve implantation: An
updated systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 23rd
Cardiovascular Summit, TCTAP 2018. South Korea. 71 (16 Supplement 1) (pp
S62-S63), 2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
BACKGROUND In the last decade, transcatheter aortic valve implantation
(TAVI) triggered a paradigm shift in the treatment of patients with severe
symptomatic aortic stenosis. Nonetheless, along with groundbreaking
efficacy results, data concerning the risk of cerebrovascular
complications have been consistently reported in studies using either
diffusion-weighted magnetic resonance imaging (DWMRI) or high-intensity
transient signals as assessed by transcranial Doppler. As conceivable,
embolic protection devices (EPDs) have been ideated and introduced with
the aim of reducing suchan inherent risk but they have been tested in
relatively small populations, providing inconclusive results. We thus
aimed at summarizing, by means of a meta-analytic approach, the available
evidence concerning the safety and efficacy profile of current EPDs in the
setting of TAVI. METHODS EMBASE, PubMed, Web of Science Core Collection,
and the Cochrane Library were searched up to May 2017. The search terms
used were transcatheter aortic valve implantation ORTAVI OR transcatheter
aortic valve replacement OR TAVR AND embolic protection device. No
language restriction was applied. Abstracts and unpublished studies
presented in conferences were excluded. Single-arm studies that evaluated
the feasibility of performing TAVI with EPD were also excluded. We
included studies that evaluated 1 or more of the following outcomes: EPD
delivery success, stroke, death, new-silent ischemic lesions as assessed
by DW-MRI, neuro-cognitive function as assessed by Mini-Mental State
Examination, Montreal Cognitive Assessment, Center for Epidemiological
Studies Depression Scale, or National Institutes of Health Stroke Scale.
End points were calculated at 30 days and in accordance with Valve
Academic Research Consortium-2 definition. RESULTS Seven studies have been
included, totaling 725 patients [15-21]. Five studies were randomized
controlled trials [17-21], the remaining two were registries [15, 16]. The
mean age was 81.7 years, and 50.2% were female. Atrial fibrillation was
present at baseline in 30.6% of the patients. A previous stroke was
diagnosed in 94 patients (12.9%). See the Tables for more details. The EPD
delivery success rate was reported in all studies and was achieved in
94.5% of patients, ranging from 64% to 100%. All-cause mortality occurred
in 1.9% of the patients treated with the use of an EPD; 2.8% in patients
without. The incidence of stroke was 4.8% in patients treated with the use
of EPD and 6% in patients without the use of EPD. Clinical Outcomes: The
use of EPD was not associated with significant differences in terms of
30-day mortality [OR 0.57 (0.19, 1.66), p=0.3] or stroke [OR 0.67
(0.35-1.29), p=0.23], without significant differences between RCTs and
registries. No differences were detected according to the study design.
DW-MRI assessment: The overall incidence of new lesions was 88%: 86% in
patients with the use of EPD and 91% in patients without EPD. The total
volume of lesions was 88 to 466 mm3 in patients with EPD and 168 to 800
mm3 in patients without EPD. The meta-analysis showed no differences in
terms of the number of new lesions: [standardized mean difference-0.19;
(-0.71 to 0.34); p=0.49]. On the other hand, the use of EPD was associated
with a significantly smaller 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]. In
registry studies, the use of EPD seemed detrimental with respect to the
number of new lesions. The analysis according to the type of valve showed
that the beneficial effect of the EPD is mainly driven by the benefit in
patients treated with a self-expanding valve. CONCLUSION The use of EPD is
not associated with a reduced rate of stroke, mortality and new ischemic
cerebral lesions. The use of EPD during TAVI is associated with smaller
volume of ischemic lesions and smaller total volume of ischemic lesions.

<7>
Accession Number
622326783
Author
Pasciolly M.R.J.; Mathur A.; Seth A.
Institution
(Pasciolly) Al Ihsan General Hospital West Java Province, Indonesia
(Mathur, Seth) Fortis Escorts Heart Institute, India
Title
Outcome of carotid artery stenting in patient with combined carotid and
coronary artery disease.
Source
Journal of the American College of Cardiology. Conference: 23rd
Cardiovascular Summit, TCTAP 2018. South Korea. 71 (16 Supplement 1) (pp
S29-S30), 2018. Date of Publication: April 2018.
Publisher
Elsevier USA
Abstract
BACKGROUND Myocardial infarction (MI) remains the most common cause of
mortality in the world, while stroke is the second leading cause of death
and most common cause of disability. Atherosclerosis is a diffuse process
that affects multiple vascular beds. Severe carotid, vertebral or
subclavian stenosis is found in 16.6% of patients with triple vessel
coronary artery disease (CAD), whereas multi-vessel coronary disease and
significant carotid stenosis coexists in 2.8-22% of patients undergoing
coronary artery bypass grafting (CABG). With an increase in elderly
patients incidence of concomitant carotid and coronary artery disease will
continue to increase. Concomitant severe coronary and carotid artery
disease increase the risk of death, stroke, or myocardial infarction. The
management of concurrent severe carotid and coronary artery disease is
still controversial. Trials like Sapphire, EVA, Space, ICSS, CREST, and
Sharp showed non-inferiority of carotid artery stenting (CAS) with respect
to carotid endarterectomy (CEA). But still debate is on which strategy is
better. Carotid artery stenting (CAS) using cerebral protection devices is
rapidly evolving as an alternative to carotid endarterectomy, mainly for
patients with severe carotid artery stenosis who are at high surgical
risk, such as patients with coronary artery disease. We planned to study
whether carotid artery stenting is safe and effective in patients with
co-existing coronary artery disease. OBJECTIVE Carotid artery stenting has
been accepted as a potential alternative to carotid endarterectomy
inpatients with significant carotid artery stenosis. The objective of this
study was to evaluate the feasibility, safety and short-term outcome of
Carotid artery stenting in patients with coexisting symptomatic coronary
artery disease. (Table Presented) METHODS Medical records of patients who
underwent CAS at Fortis Escorts Heart Institute and Research Center, since
January 2015 were reviewed. We also maintained a prospective registry of
all patients undergoing CAS at our hospital. Patients with CAS were
selected for study if they satisfied following inclusion criteria: 1)
Combined carotid and coronary artery disease; 2) Patients at high risk of
CEA and having indication for CAS, (restenosis after CEA, contralateral
carotid artery occlusion or laryngeal nerve palsy, bilateral carotid
artery stenosis, previous radiation therapy or surgery on the neck, neck
immobility, tracheostomy or tracheostoma, severe intracranial lesion,
lesion inaccessible by surgery, advanced CAD example acute coronary
syndrome, three vessels disease or left main disease, heart failure,
severe aortic stenosis, left ventricular ejection < 30%, renal failure,
planned CABG or valve replacement, chronic obstructive pulmonary disease,
cardiac and pulmonary disease, planned peripheral vascular surgery,
myocardial infarction within 6 weeks of the procedure, age older than 80
years) 4) Adults>18 years 5) Carotid angiography showed carotid stenosis >
50% if symptomatic and >70% if asymptomatic. Exclusion criteria 1) Stroke
/ TIA / Amaurosis fugax within the past 14 days 2) Severely disabled as a
result of stroke or dementia 3) Complete occlusion of carotid artery 4)
Severe calcification, tortuosity of carotid artery 5) Intracranial tumor
or cerebral venous malformation. The degree of stenosis was measured with
duplex ultrasound scanning and arch aortography, according to the North
American Asymptomatic Carotid Endarterectomy Trial (NASCET) method.
Statististical analysis was done using Mann Whitney test. All patients
were seen by neurologist within 24 hrs after CAS, after 1 week and after
30 days. Patients were instructed to inform the coordinator (research
nurse) or general practitioner if any symptoms possibly related to an
ischemic event occurred after hospital discharge. Medical and nursing
records were reviewed to determine nature and time of complications in the
hospital and 30 days after CAS. RESULTS 44 (77.2%) patients were male. The
mean age of patients was 65 +/- 8 years. 40 (71.9%) patients were
neurologically asymptomatic. Symptomatic patient had predominant symptoms
of chest pain, dyspnea, syncope/presyncope, dizziness, blurring of vision,
paresis/paralysis. 47.4% patients had unilateral and 52.5% patients had
bilateral carotid artery disease. Amongst all patients 59.6% had TVD,
17.5% had DVD, 14% had SVD & 8.8% patients had non-critical CAD. Among
them 38.6% patients underwent PCI, 33.3% patients underwent surgery, 17.5%
patients underwent both PCI and surgery and 10.6% patients were managed
medically. Only 1 patient died after the procedure. Complications after
CAS was seen in 10 patients: 1 patient had a stroke, 1 had shock, 6
patients had acute renal failure, 1 patient had infection and 1 patient
had arrhythmia (Table2). One patient died. After discharge from the
hospital, we followed all patients. Of all patients 4 had a myocardial
infarction, 1 patient had stroke (infarct) and 3 patients had worsening
renal failure (Table3). There was no significant difference between
in-hospital complication and complication at one month after CAS.
CONCLUSION Limitation. This is small registry with retrospective date to
analyse. No randomized trial comparing different treatment strategies for
concomitant carotid and coronary artery disease management has been
conducted till date so thus far reported series are prone to selection/
reporting bias. In addition to the established surgical treatment
(CEACABG, sequential/simultaneous), hybrid revascularization (CAS-CABG) is
emerging as a viable therapeutic option. Larger, preferably multicenter,
studies are required before this can become widely applied. We showed that
for CAS EPD should be used to reduce complications. No significant
difference between complications during hospitalization and within 30 days
of CAS was seen. Severe combined carotid and coronary artery disease can
be managed safely by hybrid approach. (Table Presented).

<8>
Accession Number
622329443
Author
Patel K.M.; Vaghaiwalla Z.M.; Denoux P.
Institution
(Patel, Vaghaiwalla, Denoux) Florida State University College of Medicine,
Tallahassee, FL, United States
(Patel, Vaghaiwalla, Denoux) Tallahassee Memorial Hospital, Tallahassee,
FL, United States
Title
Atypical cause of typical chest pain.
Source
Journal of General Internal Medicine. Conference: 41st Annual Meeting of
the Society of General Internal Medicine, SGIM 2018. United States. 33 (2
Supplement 1) (pp 472), 2018. Date of Publication: 2018.
Publisher
Springer New York LLC
Abstract
Learning Objective #1: Understand similarities of physical exam with
sternoclavicular abscess and cardiac chest pain. CASE: A 47-year-old male
with no past medical history presented with substernal chest pain for one
day that radiated down his left arm and up the left side of his neck.
Exertion and movement made the pain worse, while rest and nitroglycerin
helped alleviate pain. He denied trauma, recreational drug use, heavy
lifting, fevers or chills. Vital signsonpresentation were BP 215/119, RR
24, HR 95 and temperature 98.5F, oxygen saturation 99%. On physical exam,
patient was muscularly built, in mild distress, without lesions on chest
wall, with normal rate and regular rhythm, without murmurs. Initial lab
work showed elevated CPK, otherwise unremarkable. EKG showed inverted
T-waves in the lateral leads without a previous EKG for comparison. He
underwent a nuclear perfusion stress test which revealed anterolateral
attenuation. Hypertension was controlled on two medications, however his
chest pain persisted. Due to EKG abnormalities and MPI results, cardiology
recommended cardiac catheterization. Cardiac catheterization showed
minimal left anterior descending artery luminal irregularities with normal
ejection fraction. His chest pain remained unchanged, WBC became elevated
and he became febrile with temperature of 102.6F. Blood cultures were
negative. Empiric antibiotics were initiated. MRI chest performed showed
an abnormal signal in the superior mediastinum extending in an extra
mediastinal location in the subclavicular soft tissue extending laterally
deep in the pectoralis muscle resembling a sternoclavicular abscess.
Cardiovascular surgery drained the septic joint with subsequent repair of
pectoralis flap by plastic surgery. IMPACT: This case of a
sternoclavicular abscess (SCA) depicted features of typical chest pain.
Structural abnormalities and inflammation from infections such as SCA are
important to recognize as a differential for chest pain that has been
ruled out for cardiac origin, as untreated SCA can lead to fatal
complications. DISCUSSION: Upon review of literature, septic arthritis has
an incidence of 2 out of 10 cases per 100,000 in the general population
and 1% found in the sternoclavicular joint. This case illustrates common
features of typical cardiac chest pain that was noncardiac in etiology.
Clinical features of sternoclavicular septic arthritis vary, however, it
most commonly presents with insidious onset of chest pain localized to the
sternoclavicular joint, worse with shoulder movement, limiting range of
motion, with accompanying fever. In most cases, infection is usually long
standing and at presentation more easily discernable. This case was
uncommon, in that the patient had no gross lesions or palpable
abnormalities. The best imaging modalities to determine the extent of the
condition are CT or MRI, as these modalities can depict joint destruction,
abscess, and periarticular inflammation.

<9>
Accession Number
622323907
Author
Skobel E.C.; Dreher M.; Knackstedt C.
Institution
(Skobel) Clinic Rosenquelle, Clinic for Cardiac and Pulmonary,
Rehabilitation, Aachen, Germany
(Dreher) Department of Cardiology, Pneumology, Angiology and Intensive
Care Medicine, University Hospital Aachen, Aachen, Germany
(Knackstedt) Maastricht University Medical Centre, Maastricht, Netherlands
Title
Effect of cardiac training therapy on minute ventilation/carbon dioxide
production slope and exercise parameters in patients with severe chronic
heart failure in short-time rehabilitation.
Source
Research in Cardiovascular Medicine. 6 (4) (pp 20-23), 2017. Date of
Publication: October-December 2017.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Aim: Treatment for patients with severe chronic heart failure (CHF) (NYHA
III, ejection fraction (EF) <30%) consists of medical or cardiac device
theraphy, or heart transplantation. Cardiac exercise traning (CET) has
also been shown to be effective and safe. Even though exercise therapy
improves quality of life and exercise capacity, is not commonly used. The
determination of the VE/VCO<inf>2</inf> slope >34 during exercise have
been shown to be useful for mortability risk stratification in CHF. This
analysis investigated the effects of 3 weeks' cardiac rehabilitation (CR)
on exercise parameters and VE/VCO2 slope in CHF patients. Materials and
Methods: Data from 35 patients with CHF (age 68 +/- 11 years, 3 female, EF
29 +/- 7%, maximum oxygen uptake (VO<inf>2</inf> max) 10.8 +/- 2.7
mL/min/kg, NYHA class III, all ischemic heart disease) on optimal
medication who underwent CR including aerobic endurance training theraphy
combined with low dose local muscle strength for 3 weeks were evaluated
retrospectively using 6 -min walking test, echocardiography and exercise
testing. Results: All patients showed improvement in NYHA class,
improvement in 6-min walking distance (285 +/- 113 m to 431 +/- 120 m, P <
0.0001), increasing VO<inf>2</inf> max (10.8 to 12.9 +/- 3.2 mL/kg, P <
0.0001) and reduced VE/VCO<inf>2</inf> -slope (44.8 +/- 9 to 37.1 +/- 6, P
< 0.0001). These was no significant effect on EF (29 +/- 8% to 32 +/-
11%). Conclusion: CET for 3 weeks in severe CHF is associated with reduced
VE/VCO2-slope and improved exercise capacity. Longer and randomized
studies are needed to evaluate the role of VE/VCO<inf>2</inf> -slope in
mortality risk stratification during training in CHF.<br/>Copyright &#xa9;
2018 Research in Cardiovascular Medicine.

<10>
Accession Number
622321968
Author
Nalluri N.; Atti V.; Munir A.B.; Karam B.; Patel N.J.; Kumar V.; Vemula
P.; Edla S.; Asti D.; Paturu A.; Gayam S.; Spagnola J.; Barsoum E.;
Maniatis G.A.; Tamburrino F.; Kandov R.; Lafferty J.; Kliger C.
Institution
(Nalluri, Munir, Karam, Spagnola, Barsoum, Maniatis, Tamburrino, Kandov,
Lafferty) Department of Cardiology, Staten Island University
HospitalNorthwell Health, Staten IslandNew York City, New York
(Atti) Department of Internal MedicineMichigan State UniversitySparrow
HospitalEast Lansing, Michigan
(Patel) Department of CardiologyUniversity of MiamiJackson Memorial
HospitalMiami, Florida
(Kumar) Department of CardiologyMount Sinai St. Luke's Roosevelt
HospitalNew York City, New York
(Vemula) Department of Internal MedicineSparrow Health SystemLansing,
Michigan
(Edla) Department of CardiologySt. John Hospital and Medical
CenterDetroit, Michigan
(Asti, Kliger) Department of Interventional CardiologyLenox Hill Hospital,
Northwell Health, ManhattanNew York City, New York
(Paturu) Department of Internal MedicineNRI Medical CollegeGunturIndia
(Gayam) Department of Internal MedicineKVG Medical CollegeSullia,
KarnatakaIndia
Title
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) versus
redo-Surgical aortic valve replacement (redo-SAVR): A systematic review
and meta-analysis.
Source
Journal of Interventional Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bioprosthetic (BP) valves have been increasingly used for
aortic valve replacement over the last decade. Due to their limited
durability, patients presenting with failed BP valves are rising. Valve in
Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an
alternative to the gold standard redo-Surgical Aortic Valve Replacement
(redo-SAVR). However, the utility of ViV-TAVI is poorly understood.
Methods: A systematic electronic search of the scientific literature was
done in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov.
Only studies which compared the safety and efficacy of ViV-TAVI and
redo-SAVR head to head in failed BP valves were included. Results: Six
observational studies were eligible and included 594 patients, of whom 255
underwent ViV- TAVI and 339 underwent redo-SAVR. There was no significant
difference between ViV-TAVI and redo- SAVR for procedural, 30 day and 1
year mortality rates. ViV-TAVI was associated with lower risk of permanent
pacemaker implantation (PPI) (OR: 0.43, CI: 0.21-0.89; P=0.02) and a trend
toward increased risk of paravalvular leak (PVL) (OR: 5.45, CI:
0.94-31.58; P=0.06). There was no significant difference for stroke, major
bleeding, vascular complications and postprocedural aortic valvular
gradients more than 20mm-hg. Conclusion: Our results reiterate the safety
and feasibility of ViV-TAVI for failed aortic BP valves in patients deemed
to be at high risk for surgery. VIV-TAVI was associated with lower risk of
permanent pacemaker implantation with a trend toward increased risk of
paravalvular leak.<br/>Copyright &#xa9; 2018, Wiley Periodicals, Inc.

<11>
Accession Number
616913400
Author
Katijjahbe M.A.; Denehy L.; Granger C.L.; Royse A.; Royse C.; Bates R.;
Logie S.; Clarke S.; El-Ansary D.
Institution
(Katijjahbe, Denehy, Granger, El-Ansary) Melbourne School of Health
Sciences, The University of Melbourne, Department of Physiotherapy,
Parkville, VIC 3053, Australia
(Katijjahbe) Hospital Cancelor Tuaku Mukhriz, Pusat Perubatan University
Kebangsaan Malaysia, Department of Physiotherapy, Kuala Lumpur 56000,
Malaysia
(Granger, Bates) The Royal Melbourne Hospital, Department of
Physiotherapy, Parkville, VIC 3050, Australia
(Royse, Royse) University of Melbourne, Department of Surgery, Parkville,
VIC 3010, Australia
(Royse, Royse) Royal Melbourne Hospital, Department of Surgery, Parkville,
VIC 3050, Australia
(Logie) Melbourne Private Hospital, Physiotherapy Department, Parkville,
VIC 3052, Australia
(Clarke) School of Mathematics and Statistics, The University of
Melbourne, Statistical Consulting Centre, Parkville, VIC 3010, Australia
Title
The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) - standard
restrictive versus an intervention of modified sternal precautions
following cardiac surgery via median sternotomy: Study protocol for a
randomised controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 290. Date of
Publication: 23 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The routine implementation of sternal precautions to prevent
sternal complications that restrict the use of the upper limbs is
currently worldwide practice following a median sternotomy. However,
evidence is limited and drawn primarily from cadaver studies and
orthopaedic research. Sternal precautions may delay recovery, prolong
hospital discharge and be overly restrictive. Recent research has shown
that upper limb exercise reduces post-operative sternal pain and results
in minimal micromotion between the sternal edges as measured by
ultrasound. The aims of this study are to evaluate the effects of modified
sternal precautions on physical function, pain, recovery and
health-related quality of life after cardiac surgery. Methods/design: This
study is a phase II, double-blind, randomised controlled trial with
concealed allocation, blinding of patients and assessors, and
intention-to-treat analysis. Patients (n = 72) will be recruited following
cardiac surgery via a median sternotomy. Sample size calculations were
based on the minimal important difference (two points) for the primary
outcome: Short Physical Performance Battery. Thirty-six participants are
required per group to counter dropout (20%). All participants will be
randomised to receive either standard or modified sternal precautions. The
intervention group will receive guidelines encouraging the safe use of the
upper limbs. Secondary outcomes are upper limb function, pain,
kinesiophobia and health-related quality of life. Descriptive statistics
will be used to summarise data. The primary hypothesis will be examined by
repeated-measures analysis of variance to evaluate the changes from
baseline to 4 weeks post-operatively in the intervention arm compared with
the usual-care arm. In all tests to be conducted, a p value <0.05
(two-tailed) will be considered statistically significant, and confidence
intervals will be reported. Discussion: The Sternal Management Accelerated
Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial
powered and designed to investigate whether the effects of modifying
sternal precautions to include the safe use of the upper limbs and trunk
impact patients' physical function and recovery following cardiac surgery
via median sternotomy. Trial registration: Australian and New Zealand
Clinical Trials Registry identifier: ACTRN12615000968572. Registered on 16
September 2015 (prospectively registered).<br/>Copyright &#xa9; 2017 The
Author(s).

<12>
Accession Number
618731093
Author
Lockwood G.G.; Cabreros L.; Banach D.; Punjabi P.P.
Institution
(Lockwood, Cabreros, Banach) Centre for Perioperative Medicine and
Critical Care Research, Imperial College Healthcare NHS Trust, Department
of Anaesthesia, Hammersmith Hospital, London W12 0HS, United Kingdom
(Punjabi) Department of Cardiothoracic Surgery, Imperial College
Healthcare NHS Trust, London, United Kingdom
Title
Continuous bilateral thoracic paravertebral blockade for analgesia after
cardiac surgery: A randomised, controlled trial.
Source
Perfusion (United Kingdom). 32 (7) (pp 591-597), 2017. Date of
Publication: 01 Oct 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Continuous bilateral thoracic paravertebral blockade has been
used for analgesia after cardiac surgery, but its efficacy has never been
formally tested. Method: Fifty adult patients were enrolled in a
double-blind, randomised, controlled study of continuous bilateral
thoracic paravertebral infusion of 0.5% lidocaine (1
mg.kg^-1.hr^-1) for analgesia after coronary surgery.
Control patients received a subcutaneous infusion of lidocaine at the same
rate through catheters inserted at the same locations as the study group.
The primary outcome was morphine consumption at 48 hours using
patient-controlled analgesia (PCA). Secondary outcomes included pain,
respiratory function, nausea and vomiting. Serum lidocaine concentrations
were measured on the first two post-operative days. Results: There was no
difference in morphine consumption or in any other outcome measure between
the groups. Serum lidocaine concentrations increased during the study,
with a maximum of 5.9 mg.l^-1. There were no adverse events as a
consequence of the study. Conclusion: Bilateral paravertebral infusion of
lidocaine confers no advantage over systemic lidocaine infusion after
cardiac surgery. Clinical trial registration: ISRCTN13424423
(https://www.isrctn.com)<br/>Copyright &#xa9; The Author(s) 2017.

<13>
Accession Number
622228015
Author
Ellis A.G.; Trikalinos T.A.; Wessler B.S.; Wong J.B.; Dahabreh I.J.
Institution
(Ellis, Trikalinos, Dahabreh) Center for Evidence Synthesis in Health,
School of Public Health, Brown University, 121 South Main Street,
Providence, RI 02912, United States
(Ellis, Trikalinos, Dahabreh) Department of Health Services, Policy and
Practice, Brown University, Providence, RI, United States
(Wessler) Predictive Analytics and Comparative Effectiveness Center, Tufts
Medical Center, Boston, MA, United States
(Wong) Department of Cardiology, Tufts Medical Center, Boston, MA, United
States
(Wong) Division of Clinical Decision Making, Department of Medicine, Tufts
Medical Center, Boston, MA, United States
(Dahabreh) Department of Epidemiology, School of Public Health, Brown
University, Providence, RI, United States
Title
Propensity Score-Based Methods in Comparative Effectiveness Research on
Coronary Artery Disease.
Source
American Journal of Epidemiology. 187 (5) (pp 1064-1078), 2018. Date of
Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
This review examines the conduct and reporting of observational studies
using propensity score-based methods to compare coronary artery bypass
grafting (CABG), percutaneous coronary intervention (PCI), or medical
therapy for patients with coronary artery disease. A systematic selection
process identified 48 studies: 20 addressing CABG versus PCI; 21
addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG
versus medical therapy; 1 addressing PCI versusmedical therapy; and 1
addressing drug-eluting stents versus balloon angioplasty.Of 32 studies
reporting information on variable selection, 7 relied exclusively on
statistical criteria for the association of covariates with treatment, and
5 used such criteria to determine whether product or nonlinear terms
should be included in the propensity score model. Twenty-five (52%)
studies reported assessing covariate balance using the estimated
propensity score, but only 1 described modifications to the propensity
score model based on this assessment. The over 400 variables used in the
48 propensity scoremodels were classified into 12 categories and 60
subcategories; only 17 subcategories were represented in at least half of
the propensity score models. Overall, reporting of propensity score-based
methods in observational studies comparing CABG, PCI, and medical therapy
was incomplete; when adequately described, the methods used were often
inconsistent with current methodological standards.<br/>Copyright &#xa9;
2018 The Author(s).

<14>
[Use Link to view the full text]
Accession Number
622261069
Author
Lauten A.; Figulla H.R.; Unbehaun A.; Fam N.; Schofer J.; Doenst T.;
Hausleiter J.; Franz M.; Jung C.; Dreger H.; Leistner D.; Alushi B.;
Stundl A.; Landmesser U.; Falk V.; Stangl K.; Laule M.
Institution
(Lauten, Dreger, Leistner, Alushi, Landmesser, Falk, Stangl, Laule)
Charite - Universitatsmedizin Berlin, Charite Campus Mitte and Campus
Benjamin Franklin, Berlin, Germany
(Lauten, Unbehaun, Dreger, Leistner, Alushi, Landmesser, Falk, Stangl,
Laule) Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK), Berlin,
Germany
(Figulla, Doenst, Franz) Friedrich-Schiller-Universitaet Jena, Germany
(Stundl) Department of Medicine II, Heart Center Bonn, University Hospital
Bonn, Germany
(Unbehaun, Falk) German Heart Center Berlin, St. Michaels Hospital,
Toronto, Canada
(Fam) Division of Cardiology, St. Michaels Hospital, Toronto, Canada
(Schofer) Albertinen Heart Center, Hamburg, Germany
(Hausleiter) Medizinische Klinik und Poliklinik i,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Jung) Medical Faculty, Division of Cardiology, Pulmonology and Vascular
Medicine, University Dusseldorf, Germany
(Landmesser) Berlin Institute of Health, Germany
Title
Interventional Treatment of Severe Tricuspid Regurgitation.
Source
Circulation: Cardiovascular Interventions. 11 (2) (no pagination), 2018.
Article Number: e006061. Date of Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Transcatheter caval valve implantation is under evaluation as
a treatment option for inoperable patients with severe tricuspid
regurgitation (TR). The procedure involves the catheter-based implantation
of bioprosthetic valves in the inferior vena cava and superior vena cava
to treat symptoms associated with TR. This study is the first to evaluate
the feasibility, safety, and efficacy of this interventional concept.
Methods and Results - Twenty-five patients (mean age, 73.9+/-7.6 years;
women, 52.0%) with severe symptomatic TR despite optimal medical treatment
deemed unsuitable for surgery were treated with caval valve implantation
under a compassionate clinical use program. Technical feasibility defined
as procedural success, hemodynamic effect defined as venous pressure
reduction, and safety defined as periprocedural adverse events were
evaluated, with clinical follow-up at discharge and up to 12 months. The
functional impact was evaluated by assessment of New York Heart
Association class at the time of hospital discharge. The total number of
valves implanted in the caval position was 31. Patients were treated with
single (inferior vena cava-only; n=19; 76.0%) or bicaval valve
implantation (inferior vena cava+superior vena cava; n=6; 24.0%). Either
balloon-expandable valves (Sapien XT/3: n=18; 72.0%) or self-expandable
valves (TricValve: n=6; 24.0%; Directflow: n=1; 4.0%) were used.
Procedural success was achieved in 96% (n=24). Early and late valve
migration requiring surgical intervention occurred in 1 patient each.
Thirty-day and in-hospital mortality were 8% (2 of 25) and 16% (4 of 25).
Causes of in-hospital mortality included respiratory (n=1) or multiple
organ failure (n=3) and were not linked to the procedure. Mean overall
survival in the study cohort was 316+/-453 days (14-1540 days).
Conclusions - Caval valve implantation for the treatment of severe TR and
advanced right ventricular failure is associated with a high procedural
success rate and seems safe and feasible in an excessive-risk cohort. The
study demonstrates hemodynamic efficacy with consistent elimination of
TR-associated venous backflow and initial clinical improvement. These
results encourage further trials to determine which patients benefit most
from this interventional approach.<br/>Copyright &#xa9; 2018 American
Heart Association, Inc.

<15>
[Use Link to view the full text]
Accession Number
622261043
Author
Mariscalco G.; Rosato S.; Serraino G.F.; Maselli D.; Dalen M.; Airaksinen
J.K.E.; Reichart D.; Zanobini M.; Onorati F.; De Feo M.; Gherli R.;
Santarpino G.; Rubino A.S.; Gatti G.; Nicolini F.; Santini F.; Perrotti
A.; Bruno V.D.; Ruggieri V.G.; Biancari F.
Institution
(Mariscalco, Serraino) Department of Cardiovascular Sciences, University
of Leicester, Glenfield Hospital, Clinical Science Wing, Leicester LE39QP,
United Kingdom
(Rosato) National Center for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
(Serraino) Cardiac Surgery Unit, Magna Graecia University of Catanzaro,
Italy
(Maselli) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Dalen) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Karolinska University Hospital, Stockholm, Sweden
(Dalen) Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Airaksinen, Biancari) Heart Center, Turku University Hospital, University
of Turku, Finland
(Biancari) Department of Surgery, University of Turku, Finland
(Reichart) Hamburg University Heart Center, Germany
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Italy
(De Feo) Division of Cardiac Surgery, Department of Cardiothoracic
Sciences, Second University of Naples, Italy
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, S.
Camillo-Forlanini Hospital, Rome, Italy
(Santarpino) Citta di Lecce Hospital, GVM Care and Research, Italy
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Rubino) Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara,
Italy
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Nicolini) Division of Cardiac Surgery, University of Parma, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Italy
(Perrotti) Department of Thoracic and Cardiovascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Bruno) Heart Centre, Bristol University, United Kingdom
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Biancari) Department of Surgery, Oulu University Hospital, Finland
Title
Prior Percutaneous Coronary Intervention and Mortality in Patients
Undergoing Surgical Myocardial Revascularization.
Source
Circulation: Cardiovascular Interventions. 11 (2) (no pagination), 2018.
Article Number: e005650. Date of Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The clinical impact of prior percutaneous coronary
intervention (PCI) in patients requiring coronary artery bypass grafting
(CABG) remains unsettled. We sought to determine whether prior PCI is
associated with adverse outcome after CABG. Methods and Results - Data
from the prospective E-CABG (European Multicenter Study on Coronary Artery
Bypass Grafting) conducted between January 2015 and March 2016 at 16
European centres were analyzed using propensity weighted methodology to
adjust for confounding. A parallel systematic review/meta-analysis
(MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was
accomplished. Of a total of 3641 adult patients included in the E-CABG
study, 685 (19%) patients had a history of PCI. At multivariable level,
prior PCI was not associated with an increased hospital mortality in both
unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence
interval, 0.29-1.38; P=0.33 and odds ratio, 0.90; 95% confidence interval,
0.39-2.08; P=0.81, respectively). Subgroup analyses confirmed that prior
PCI had no impact on hospital mortality and morbidity, including
reexploration for bleeding, blood transfusion, hospital resource use, and
neurological, renal, and cardiac complications. The systematic review
provided a total of 71 366 individuals and showed a trend toward higher
in-hospital/30-day mortality (adjusted odds ratio, 1.30; 95% confidence
interval, 0.99-1.70; I 2 =43.1%) in patients with prior PCI. Conclusions -
Our prospective multicenter study showed that prior PCI was not associated
with an increased risk of mortality or other adverse outcomes in patients
undergoing CABG. In light of a trend toward increased mortality observed
in the meta-analysis, further studies are needed to ascertain the
prognostic impact of prior PCI in the outcome after CABG.<br/>Copyright
&#xa9; 2018 American Heart Association, Inc.

<16>
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. 5 (2) (pp 151-156), 2018. Date
of Publication: 10 April 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

<17>
Accession Number
2000766040
Author
Neupane S.; Singh H.; Lammer J.; Othman H.; Yamasaki H.; Rosman H.S.;
Bossone E.; Mehta R.H.; Eggebrecht H.
Institution
(Neupane, Othman, Yamasaki, Rosman) Division of Cardiology, Department of
Internal Medicine, St John Hospital and Medical Center, Detroit, Michigan,
United States
(Singh) Division of Cardiology, Mercy-Health St Vincent Medical Center,
Toledo, Ohio, United States
(Lammer, Eggebrecht) Division of Cardiology, Cardioangiological Center
Bethanien (CCB), Frankfurt, Germany
(Bossone) Cardiology Division, "Cava de' Tirreni and Amalfi Coast"
Hospital, University of Salerno, Fisciano, Italy
(Mehta) Division of Cardiology, Department of Medicine, Duke University
Medical Center, Durham, North Carolina, United States
Title
Meta-Analysis of Transcatheter Valve-in-Valve Implantation Versus Redo
Aortic Valve Surgery for Bioprosthetic Aortic Valve Dysfunction.
Source
American Journal of Cardiology. 121 (12) (pp 1593-1600), 2018. Date of
Publication: 15 June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter valve-in-valve implantation (ViV-TAVI) has evolved as an
alternative to redo surgical valve replacement (redo-SAVR) for high-risk
patients with aortic bioprosthetic valve (BPV) dysfunction. The
differences in procedural success and outcomes in a large number of
patients who underwent ViV-TAVI compared with redo-SAVR for aortic BPV
dysfunction are not known. We conducted a meta-analysis of the previously
reported studies to determine outcomes after ViV-TAVI and redo-SAVR.
PubMed, MEDLINE, and Google Scholar databases were searched for studies
that reported comparative outcomes of patients who underwent either
ViV-TAVI or redo-SAVR. Four observational studies met the inclusion
criteria, with a total of 489 patients, 227 of whom underwent ViV-TAVI and
262 underwent redo-SAVR. Thirty-day mortality was similar in 2 groups (5%
vs 4%; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.44 to
2.62) despite the higher operative risk in the ViV-TAVI cohort as
evidenced by significantly higher EuroSCORE I or II. There were similar
rates of stroke (2% vs 2%; OR = 1.00, 95% CI = 0.28 to 3.59), myocardial
infarction (2% vs 1%; OR = 1.08, 95% CI = 0.27 to 4.33), and acute kidney
injury requiring dialysis (7% vs 10%; OR = 0.80, 95% CI = 0.36 to 0.1.77)
between 2 groups but a lower rate of permanent pacemaker implantation in
the ViV-TAVI group (9% vs 15%; OR = 0.44, 95% CI = 0.24 to 0.81). This
meta-analysis of nonrandomized studies with modest number of patients
suggested that ViV-TAVI had similar 30-day survival compared with
redo-SAVR for aortic BPV dysfunction.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<18>
Accession Number
622310043
Author
Singh T.; O'Horo J.; Sakusic A.; Kashyap R.; Petersen R.; Rabinstein A.
Institution
(Singh, O'Horo, Kashyap, Petersen, Rabinstein) Mayo Clinic, Rochester, MN,
United States
(Sakusic) Internal Medicine, Tuzla University, Tuzla, Bosnia and
Herzegovina
Title
Potentially modifiable risk factors for long-term cognitive impairment
after critical illness-a systematic review.
Source
Neurology. Conference: 70th Annual Meeting of the American Academy of
Neurology, AAN 2018. United States. 90 (15 Supplement 1) (no pagination),
2018. Date of Publication: April 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: We sought to summarize the current scientific knowledge
regarding potentially modifiable risk factors during ICU treatment that
may play a significant role in the development of long-term cognitive
impairment. Background: Long-term cognitive impairment is common in
survivors of critical illness. Little is known about the etiology of this
serious complication. Design/Methods: The search strategy included Ovid
MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central and DARE, Scopus and Web
of Science. Searches were restricted to adult subjects. Inclusion required
follow-up cognitive evaluation at least two months after ICU discharge.
Studies assessing patients with cardiac arrest, traumatic brain injury and
cardiac surgery were excluded. Results: The search strategy resulted in
3,180 studies. Of these, 28 studies met our inclusion criteria and were
analyzed. Delirium and duration of delirium were associated with long term
cognitive impairment after ICU admission in 6 of 9 studies where this
factor was analyzed. Weaker and more inconsistent associations have been
reported with hypoglycemia, hyperglycemia, fluctuations in serum glucose,
and inhospital acute stress symptoms. Instead, most of the studies did not
find significant associations between long term cognitive impairment and
mechanical ventilation, use of sedative, vasopressors, or analgesic
medications, enteral feeding, hypoxia, ECMO, systolic blood pressure,
pulse rate or length of ICU stay. Conclusions: Prolonged delirium may be a
risk factor for long-term cognitive impairment after critical illness,
though this association has not been entirely consistent across studies.
Other potentially preventable factors have not been shown to have strong
or consistent associations with long term cognitive dysfunction in
survivors of critical illness.

<19>
Accession Number
622306158
Author
Faritus Z.; Sadeghi A.; Ziaiifard M.; Moghaddam M.Y.; Tabaei A.S.;
Gorjipour F.
Institution
(Faritus, Sadeghi, Ziaiifard, Tabaei, Gorjipour) Rajaei Cardiovascular
Medical And Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Moghaddam) Department of Anesthesiology, School of Medicine, Sabzevar
University of Medical Sciences, Sabzevar, Iran, Islamic Republic of
Title
Hemodynamic stability and analgesic effects of intravenous dexmedetomidine
premedication in adult patients undergoing coronary artery bypass graft
surgery.
Source
Research in Cardiovascular Medicine. 7 (2) (pp 87-91), 2018. Date of
Publication: April-June 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Sternotomy for coronary artery bypass surgery operation is
associated with neuropathic pain, hypertension, tachycardia, agitation,
and several other complications. In severe cases, the neuropathic pain may
result in arrhythmia which is an important concern in cardiopulmonary
bypass surgeries. Premedication for reducing the risk of hemodynamic
instability, neuropathic pain, and other adverse associated consequences
is very important. Objectives: We Scrutinized the effects of
dexmedetomidine intravenous infusions on hemodynamic parameters and
postsurgical pain in coronary artery bypass patients. Patients and
Methods: A total of 60 coronary artery bypass surgery patients were
recruited and were randomly allocated into two groups. 31 patients
received placebo, and 29 received 1 micro&#32;g/kg of dexmedetomidine 10
min before anesthesia and then 0.4 micro&#32;g/kg/h of dexmedetomidine
until the end of the operation. Heart rate, blood pressure, and
postsurgical pain score according to the numerical rating scale were
measured and recorded after recovery from anesthesia. Results: Blood
pressure significantly decreased after bolus administration of
dexmedetomidine which remained lower at the end of screening in most of
the times. No remarkable adverse effects were observed, and its
consumption was associated with significant reduction in the postsurgical
pain scores as measured in 2, 4, and 6 h after surgery as well as the time
of extubation. Conclusions: Infusion with 1 mug/kg of dexmedetomidine 10
min before anesthesia and 0.4 mug/kg/h of dexmedetomidine from the time of
sternum closure until the extubation time appears to be effective for the
maintenance of hemodynamics in coronary artery bypass surgery without
remarkable adverse outcomes.<br/>Copyright &#xa9; 2018 Research in
Cardiovascular Medicine.

<20>
Accession Number
622306154
Author
Soroush A.; Komasi S.; Heydarpour B.; Ezzati P.; Saeidi M.
Institution
(Soroush, Komasi, Heydarpour, Ezzati) Cardiac Rehabilitation Center, Imam
Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran,
Islamic Republic of
(Saeidi) Heart Research Center, Imam Ali Hospital, Kermanshah University
of Medical Sciences, Kermanshah, Iran, Islamic Republic of
Title
The effectiveness of psychosexual education program on psychological
dimensions of sexual function and its quality in cardiac rehabilitation
patients.
Source
Research in Cardiovascular Medicine. 7 (2) (pp 82-86), 2018. Date of
Publication: April-June 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Objectives: The study aimed to assess the efficacy of a psychosexual
education program (PSEP) on the psychological dimensions of sexual
function and its quality in cardiac rehabilitation (CR) patients. Methods:
In this randomized clinical trial, 43 male patients undergoing coronary
artery bypass graft were selected randomly and then divided into case (n =
23) or control groups (n = 20). The research instruments consist of
multidimensional sexual questionnaire and Sexual Quality of Life
Questionnaire. Levin's PSEP (two 1-hour sessions) is presented as an
intervention program. Data were analyzed through multivariate analysis of
covariance to control the baseline scores. Results: Approximately 84% of
patients (cases: 87% and controls: 80%) completed the final assessment.
The results indicated that PSEP is significantly effective in the
enhancement of sexual assertiveness (P = 0.034) and reduction of fear
about intercourse (P = 0.007). There were no significant differences
between two groups in other variables (P > 0.05). Conclusion: The results
of the study indicated that PSEP is effective in the promotion of sexual
assertiveness and fear of intercourse among CR patients. As the resumption
of sexual function is one of the most important components in the
psychosocial improvement of patients, it seems that this intervention
should be included as a priority among educational programs in Iranian
CRs.<br/>Copyright &#xa9; 2018 Research in Cardiovascular Medicine.

<21>
Accession Number
622306126
Author
Hasandokht T.; Salari A.; Pour S.S.; Tirani H.D.; Shad B.; Rajabi E.
Institution
(Hasandokht, Salari, Tirani, Shad, Rajabi) Cardiovascular Disease Research
Center, Department of Cardiology, Heshmat Hospital, School of Medicine,
Guilan University of Medical Science, Rasht, Iran, Islamic Republic of
(Hasandokht, Pour) Department of Community Medicine, School of Medicine,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Title
Does opium have benefit for coronary artery disease? A systematic review.
Source
Research in Cardiovascular Medicine. 7 (2) (pp 51-58), 2018. Date of
Publication: April-June 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Opium is a plant with euphoria effect. People from some parts of the world
traditionally use opium for cardioprotective effects. We did a systematic
review to assess the effect of opium on coronary artery disease (CAD). A
systematic database search was conducted in PubMed, Web of Science, Google
Scholar, Cochrane library, Scopus, and SID from their onset up to June
2016. The quality of the studies was assessed with a standardized scoring
system. Articles assessing the effect of opium consumption as orally or
smoked were included in this review. Outcome was defined as age on CAD
disease, risk of CAD, and morbidity from CAD. Poor methodological studies,
animal studies, and studies on cardiovascular risk factors or serum
markers were excluded from the review. Three case-control, three cohort,
and eight cross-sectional studies were included in this systematic review.
The age at the occurrence of myocardial infarction, coronary bypass
surgery, and percutaneous intervention in opium users was significantly
lower than that of nonusers. Odds ratio of opium consumption for CAD
ranged from 1.3 to 3.8 in different studies. Hazard ratio of opium
consumption for ischemic heart disease was 1.90 (1.57-2.29) with
modification by sex, ethnicity, education level, marital status,
residential place, and cigarette smoking. We concluded, in spite of the
traditional belief, that the current evidence did not support the
protective effect of opium on CAD. Future well-designed studies concerning
probable confounders in Iran and other similar parts of world are
required.<br/>Copyright &#xa9; 2018 Research in Cardiovascular Medicine.

<22>
Accession Number
2000791907
Author
Ackland G.L.; Abbott T.E.F.; Pearse R.M.; Karmali S.N.; Minto G.; King A.;
Pollak C.; Williams C.; Patrick A.; West C.; Vickers E.; Green R.; Clark
M.; Ackland G.; Whittle J.; Paredes L.G.; Stephens R.C.M.; Jones A.; Otto
J.; Lach A.; del Arroyo A.G.; Toner A.; Williams A.; Owen T.; Pradhu P.;
Hull D.; Montague L.
Institution
(Ackland, Abbott, Pearse, Karmali) Translational Medicine and
Therapeutics, William Harvey Research Institute, Barts and The London
Medical School, Queen Mary University of London, London EC1M, United
Kingdom
(Whittle) Department of Anaesthesia, University College London Hospitals
NHS Trust, London, United Kingdom
(Minto) Directorate of Anaesthesia, Derriford Hospital, Plymouth, United
Kingdom
(Minto) Plymouth University, Peninsula Schools of Medicine and Dentistry,
Plymouth, United Kingdom
(Minto, King, Pollak, Williams, Patrick, West) Derriford Hospital,
Plymouth Hospitals NHS Trust and Peninsula Schools of Medicine and
Dentistry, Plymouth University, United Kingdom
(Vickers, Green, Clark) Royal Bournemouth Hospital, United Kingdom
(Ackland, Whittle, Paredes, Stephens, Jones, Otto, Lach, del Arroyo,
Toner) University College London Hospitals NHS Trust, United Kingdom
(Williams, Owen) Royal Preston Hospital, Lancashire Teaching Hospitals NHS
Foundation Trust, United Kingdom
(Pradhu, Hull, Montague) Royal Surrey County Hospital, United Kingdom
Title
Arterial pulse pressure and postoperative morbidity in high-risk surgical
patients.
Source
British Journal of Anaesthesia. 120 (1) (pp 94-100), 2018. Date of
Publication: January 2018.
Publisher
Elsevier Ltd
Abstract
Background: Systemic arterial pulse pressure (systolic minus diastolic
pressure) <=53 mm Hg in patients with cardiac failure is correlated with
reduced stroke volume and is independently associated with accelerated
morbidity and mortality. Given that deconditioned surgical and heart
failure patients share similar cardiopulmonary physiology, we examined
whether lower pulse pressure is associated with excess morbidity after
major surgery. Methods: This was a prospective observational cohort study
of patients deemed by their preoperative assessors to be at higher risk of
postoperative morbidity. Preoperative pulse pressure was calculated before
cardiopulmonary exercise testing. The primary outcome was any morbidity
(PostOperative Morbidity Survey) occurring within 5 days of surgery,
stratified by pulse pressure threshold <=53 mm Hg. The relationship
between pulse pressure, postoperative morbidity, and oxygen pulse (a
robust surrogate for left ventricular stroke volume) was examined using
logistic regression analysis (accounting for age, sex, BMI,
cardiometabolic co-morbidity, and operation type). Results: The primary
outcome occurred in 578/660 (87.6%) patients, but postoperative morbidity
was more common in 243/ 660 patients with preoperative pulse pressure <=53
mm Hg{odds ratio (OR): 2.24 [95% confidence interval (CI): 1.29-3.38];
P<0.001). Pulse pressure <=53 mm Hg [OR:1.23 (95% CI: 1.03-1.46); P=0.02]
and type of surgery were independently associated with all-cause
postoperative morbidity (multivariate analysis). Oxygen pulse <90% of
population-predicted normal values was associated with pulse pressure <=
53 mm Hg [OR: 1.93 (95% CI: 1.32-2.84); P=0.007]. Conclusions: In
deconditioned surgical patients, lower preoperative systemic arterial
pulse pressure is associated with excess morbidity. These data are
strikingly similar to meta-analyses identifying low pulse pressure as an
independent risk factor for adverse outcomes in cardiac failure. Low
preoperative pulse pressure is a readily available measure, indicating
that detailed physiological assessment may be warranted. Clinical trial
registration: ISRCT registry, ISRCTN88456378.<br/>Copyright &#xa9; 2017

<23>
Accession Number
2000793241
Author
Wozniak M.J.; Sullo N.; Qureshi S.; Dott W.; Cardigan R.; Wiltshire M.;
Morris T.; Nath M.; Bittar N.; Bhudia S.K.; Kumar T.; Goodall A.H.; Murphy
G.J.
Institution
(Wozniak, Sullo, Qureshi, Dott, Nath, Kumar, Goodall, Murphy) Department
of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research
Unit, University of Leicester, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
(Cardigan, Wiltshire) National Health Service Blood and Transplant,
Cambridge CB2 0PT, United Kingdom
(Morris) Leicester Clinical Trials Unit, Leicester Diabetes Centre,
Leicester General Hospital, Leicester LE5 4PW, United Kingdom
(Bittar) Blackpool Victoria Hospital NHS Trust, Blackpool, Lancashire FY3
8NR, United Kingdom
(Bhudia) University Hospitals Coventry and Warwickshire NHS Trust,
Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
Title
Randomized trial of red cell washing for the prevention of
transfusion-associated organ injury in cardiac surgery.
Source
British Journal of Anaesthesia. 118 (5) (pp 689-698), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
Background: Experimental studies suggest that mechanical cell washing to
remove pro-inflammatory components that accumulate in the supernatant of
stored donor red blood cells (RBCs) might reduce inflammation and organ
injury in transfused patients. Methods: Cardiac surgery patients at
increased risk of large-volume RBC transfusion were eligible. Participants
were randomized to receive either mechanically washed allogenic RBCs or
standard care RBCs. The primary outcome was serum interleukin-8 measured
at baseline and at four postsurgery time points. A mechanism substudy
evaluated the effects of washing on stored RBCs in vitro and on markers of
platelet, leucocyte, and endothelial activation in trial subjects.
Results: Sixty adult cardiac surgery patients at three UK cardiac centres
were enrolled between September 2013 and March 2015. Subjects received a
median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of
21 (SD 5.2) days, within 48 h of surgery. Mechanical washing reduced
concentrations of RBC-derived microvesicles but increased cell-free
haemoglobin concentrations in RBC supernatant relative to standard care
RBC supernatant. There was no difference between groups with respect to
perioperative serum interleukin-8 values [adjusted mean difference 0.239
(95% confidence intervals -0.231, 0.709), P=0.318] or concentrations of
plasma RBC microvesicles, platelet and leucocyte activation, plasma
cell-free haemoglobin, endothelial activation, or biomarkers of heart,
lung, or kidney injury. Conclusions: These results do not support a
hypothesis that allogenic red blood cell washing has clinical benefits in
cardiac surgery. Clinical trial registration: ISRCTN
27076315.<br/>Copyright &#xa9; 2017 The Author(s)

<24>
Accession Number
2000791819
Author
Vlot E.A.; Rigter S.; Noordzij P.G.
Institution
(Vlot, Rigter, Noordzij) NieuwegeinNetherlands
Title
Optimal patient blood management in cardiac surgery using viscoelastic
point-of-care testing: Response to: Routine use of viscoelastic blood
tests for diagnosis and treatment of coagulopathic bleeding in cardiac
surgery: updated systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 119 (3) (pp 544-545), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Ltd

<25>
Accession Number
2000791818
Author
Kozek S.; Schoechl H.; Gratz J.
Institution
(Kozek) Department of Anaesthesia and Intensive Care, Evangelical Hospital
Vienna and Sigmund Freud Private University Vienna, Austria
(Schoechl) Department of Anaesthesiology and Intensive Care, AUVA Trauma
Hospital Salzburg, Austria
(Gratz) Department of Anaesthesiology, General Intensive Care and Pain
Control, Vienna Medical University, Vienna, Austria
Title
Response to: Routine use of viscoelastic blood tests for diagnosis and
treatment of coagulopathic bleeding in cardiac surgery: updated systematic
review and meta-analysis.
Source
British Journal of Anaesthesia. 119 (3) (pp 543-544), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Ltd

<26>
Accession Number
2000793724
Author
Bianchi P.; Cotza M.; Beccaris C.; Silvetti S.; Isgro G.; Pome G.;
Giamberti A.; Ranucci M.
Institution
(Bianchi, Cotza, Beccaris, Isgro, Ranucci) Department of Cardiothoracic,
Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Via
Morandi 30, 20097 San Donato Milanese, Milan, Italy
(Silvetti) Department of Cardiac Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pome, Giamberti) Department of Congenital Heart Surgery, IRCCS
Policlinico San Donato, Milan, Italy
Title
Early or late fresh frozen plasma administration in newborns and small
infants undergoing cardiac surgery: the APPEAR randomized trial.
Source
British Journal of Anaesthesia. 118 (5) (pp 788-796), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
Background: In newborns and small infants undergoing cardiac surgery with
cardiopulmonary bypass (CPB) and blood priming, it is unclear whether
there is reduced blood loss if fresh frozen plasma (FFP) is added to the
CPB priming volume. This single-centre, randomized trial tested the
hypothesis that the administration of FFP after CPB (late FFP group) is
superior to FFP priming (early FFP group) in terms of postoperative
bleeding and overall red blood cell (RBC) transfusion. Methods:
Seventy-three infants weighing <10 kg were randomly allocated to receive
FFP to supplement RBCs in the CPB priming solution (n=36) or immediately
after CPB (n=37). The primary endpoint was a difference in postoperative
blood loss; secondary endpoints included the amount of RBCs and FFP
transfused through the first 48 postoperative hours. Results: All patients
were included in the analysis. Patients in the late FFP arm had greater
postoperative mean blood loss than patients in the early FFP arm [33.1 (SD
20.6) vs 24.1 (12.9) ml kg^-1; P=0.028], but no differences in
transfusions were found. The subgroup of cyanotic heart disease patients
had comparable results, but with greater use of RBCs in the late FFP
group. Conclusions: In infants undergoing cardiac surgery, FFP in the
priming solution appears slightly superior to late administration in terms
of postoperative bleeding. Clinical trial registration:
www.ClinicalTrials.gov, NCT02738190.<br/>Copyright &#xa9; 2017 The
Author(s)

<27>
Accession Number
2000792419
Author
Spence J.; Belley-Cote E.; Ma H.K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.J.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti) Department of Anaesthesia
and Critical Care, McMaster University, Population Health Research
Institute, Hamilton, ON, Canada
(Spence, Devereaux, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine (Cardiology), McMaster University,
Population Health Research Institute, Hamilton, ON, Canada
(Hussain) Department of Surgery, Division of Cardiac Surgery, McGill
University, Montreal, PQ, Canada
(Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
Population Health Research Institute, Hamilton, ON, Canada
(Devereaux) Department of Medicine, Division of Cardiology, Population
Health Research Institute, Hamilton, ON, Canada
(Spence, Belley-Cote, Hussain, Devereaux, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
Title
Efficacy and safety of inhaled anaesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: a
systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 118 (5) (pp 658-669), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
The aim was to evaluate the efficacy and safety of volatile anaesthetic
for postoperative sedation in adult cardiac surgery patients through a
systematic review and meta-analysis. We retrieved randomized controlled
trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials
registries, conference proceedings, and reference lists of included
articles. Independent reviewers extracted data, including patient
characteristics, type of intraoperative anaesthesia, inhaled anaesthetic
used, comparator sedation, and outcomes of interest, using pre-piloted
forms. We assessed risk of bias using the Cochrane Tool and evaluated the
strength of the evidence using the GRADE approach. Eight studies enrolling
610 patients were included. Seven had a high and one a low risk of bias.
The times to extubation after intensive care unit (ICU) admission and
sedation discontinuation were, respectively, 76 [95% confidence interval
(CI) -150 to - 2, I²=79%] and 74 min (95% CI - 126 to - 23,
I²=96%) less in patients who were sedated using volatile
anaesthetic. There was no difference in ICU or hospital length of stay.
Patients who received volatile anaesthetic sedation had troponin
concentrations that were 0.71 ng ml^-1 (95% CI 0.23-1.2) lower
than control patients. Reporting on other outcomes was varied and not
suitable for meta-analysis. Volatile anaesthetic sedation may be
associated with a shorter time to extubation after cardiac surgery but no
change in ICU or hospital length of stay. It is associated with a
significantly lower postoperative troponin concentration, but the impact
of this on adverse cardiovascular outcomes is uncertain. Blinded
randomized trials using intention-to-treat analysis are required. PROSPERO
registry number: 2016:CRD42016033874. Available from
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016033874.<b
r/>Copyright &#xa9; 2017 The Author(s)

<28>
Accession Number
2000792299
Author
Benstoem C.; Goetzenich A.; Stoppe C.
Institution
(Benstoem, Goetzenich, Stoppe) AachenGermany
Title
The role of propofol for remote ischaemic preconditioning in the setting
of cardiac surgery - a Cochrane systematic review⁺.
Source
British Journal of Anaesthesia. 119 (6) (pp 1234-1235), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ltd

<29>
Accession Number
2000794102
Author
Parke R.L.
Institution
(Parke) AucklandNew Zealand
Title
A randomized feasibility study to assess a novel strategy to rationalize
fluid in patients after cardiac surgery.
Source
British Journal of Anaesthesia. 117 (1) (pp 141), 2016. Date of
Publication: July 2016.
Publisher
Elsevier Ltd

<30>
Accession Number
2000793966
Author
Hastings S.; Myles P.S.; McIlroy D.R.
Institution
(Hastings, Myles, McIlroy) MelbourneAustralia
Title
Aspirin and coronary artery surgery: an updated meta-analysis.
Source
British Journal of Anaesthesia. 116 (5) (pp 716-717), 2016. Date of
Publication: May 2016.
Publisher
Elsevier Ltd

<31>
Accession Number
622047939
Author
Vogkou C.T.; Vlachogiannis N.I.; Palaiodimos L.; Kousoulis A.A.
Institution
(Vogkou, Vlachogiannis, Palaiodimos, Kousoulis) AthensGreece
(Vogkou, Vlachogiannis) School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Palaiodimos) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Kousoulis) Faculty of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, London, United Kingdom
Title
The causative agents in infective endocarditis: A systematic review
comprising 33,214 cases.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 35 (8)
(pp 1227-1245), 2016. Date of Publication: 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Infective endocarditis (IE) incidence remains high with considerable
fatality rates; guidelines for prophylaxis against IE are currently under
review in some settings which highlights the importance of maintaining
up-to-date epidemiological estimates about the most common microbial
causes. The objective of this systematic review, following PRISMA
guidelines, was to identify the most common microbial causes of IE in
recent years. Medline was searched from January 1, 2003 to March 31, 2013
for all articles containing the term "in-fective endocarditis". All
relevant studies reporting diagnostic results were included. Special
patient subpopula-tions were assessed separately. A total of 105 studies
were included, from 36 countries, with available data on a total of 33,214
cases. Staphylococcus aureus was found to be the most common
microorganism, being the most frequent in 54.3 % of studies (N = 57) (and
in 55.4 % of studies using Duke's criteria for diagnosis [ N = 51]. Vi r i
dans gr oup st r ept ococci (VGS), coagulase-negative staphylococci
(CoNS), Enterococcus spp and Streptococcus bovis were among the most
common causes. S. aureus was the most common pathogen in almost all
population subgroups; however, this was not the case in patients with
implantable devices, prosthetic valves, or immunocompromised non-HIV, as
well as in the sub-group from Asia, emphasizing that a global
one-size-fits-all approach to the management of suspected IE is not
appropriate. This review provides an evidence-based map of the most common
causative agents of IE, highlighting S. aureus as the leading cause in the
21st century. The changing epidemiology of IE in some patient sub-groups
in the last decade and the very high number of microbiologically
undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and
diagnostic strategies.<br/>Copyright &#xa9; Springer-Verlag Berlin
Heidelberg 2016.

<32>
Accession Number
2000802013
Author
Gaynor J.W.; Nicolson S.C.; Spray D.M.; Burnham N.B.; Chittams J.L.;
Sammarco T.; Walsh K.W.; Spray T.L.; Licht D.J.
Institution
(Gaynor, Spray, Burnham, Walsh, Spray) Division of Cardiothoracic Surgery,
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United
States
(Nicolson) Department of Anesthesia and Critical Care Medicine, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(Chittams, Sammarco) Biostatistics Consulting Unit, Office of Nursing
Research, University of Pennsylvania School of Nursing, Philadelphia,
Pennsylvania, United States
(Licht) Department of Pediatrics, Division of Neurology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Title
Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in
Neonates.
Source
Annals of Thoracic Surgery. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier USA
Abstract
Background: Remote ischemic preconditioning (RIPC) is a mechanism to
protect tissues from injury during ischemia and reperfusion. We
investigated the neuroprotective effects of RIPC in neonates undergoing
cardiac surgery. Methods: The outcome was white matter injury (WMI),
assessed by the change in volume of WMI from preoperative to postoperative
brain magnetic resonance imaging (MRI). Patients were randomized to RIPC
or SHAM. RIPC was induced prior to cardiopulmonary bypass by four 5-minute
cycles of blood pressure cuff inflation to produce ischemia of the lower
extremity. For patients randomized to SHAM, the cuff was positioned, but
not inflated. Results: The study included 67 patients, with 33 randomized
to RIPC and 34 randomized to SHAM. Preoperative and postoperative MRIs
were available in 50 patients, including 26 of the 33 RIPC patients and 24
of the 34 SHAM patients. There were no differences in baseline and
operative characteristics for either the overall study group or the group
with evaluable MRIs. WMI was identified in 28% of the patients
preoperatively and in 62% postoperatively. There was no difference in the
prevalence of WMI by treatment group (p > 0.5). RIPC patients had an
average change in WMI of 600 mL³, and SHAM subjects had an
average WMI change of 107 mL³. There was no significant
difference in the mean value of WMI change between patients who received
RIPC and those who received SHAM treatments (p = 0.178). Conclusions: In
this randomized, blinded clinical trial, there was no evidence that use of
RIPC provides neuroprotection in neonates undergoing repair of congenital
heart defects with cardiopulmonary bypass.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<33>
Accession Number
2000795963
Author
Heredia-Rodriguez M.; Alvarez-Fuente E.; Bustamante-Munguira J.;
Poves-Alvarez R.; Fierro I.; Gomez-Sanchez E.; Gomez-Pesquera E.;
Lorenzo-Lopez M.; Eiros J.M.; Alvarez F.J.; Tamayo E.
Institution
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez) Department of Anaesthesiology, Hospital
Clinico Universitario, Valladolid, Spain
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez, Tamayo) BioCritic, Group for Biomedical
Research in Critical Care Medicine, Valladolid, Spain
(Bustamante-Munguira) Department of Cardiovascular Surgery, Hospital
Universitario de La Princesa, Madrid, Spain
(Fierro) Department of Health Sciences, European University Miguel de
Cervantes, Valladolid, Spain
(Alvarez, Tamayo) Department of Pharmacology, University of Valladolid,
Valladolid, Spain
(Eiros) Department of Microbiology, Hospital Rio Hortega, Valladolid,
Spain
Title
Impact of an ultraviolet air sterilizer on cardiac surgery patients, a
randomized clinical trial.
Source
Medicina Clinica. (no pagination), 2018. Date of Publication: 2018.
Publisher
Ediciones Doyma, S.L.
Abstract
Background: Numerous studies have evaluated the use of ultraviolet-C
devices for terminal disinfection in hospitals, however, to date there is
little information about the device's final impact on patients. We
investigated the effect of an ultraviolet air sterilizer (UVAS) on the
clinical outcomes of cardiac surgery patients. Materials and methods: This
random, prospective and non-interventional study included 1097 adult
patients undergoing elective cardiac surgery: 522 stayed in an ICU room
with UVAS (Medixair) and 575 patients ICU room without UVAS and
were used as a control. The primary outcome measure was to evaluate the
effect of a UVAS on the overall prevalence of nosocomial infections in
postoperative cardiac patients in ICUs. Results: No significant
differences in ventilator-associated pneumonia (4.6% vs. 5.0%, p = 0.77)
and total infection (14.0% vs. 15.5%, p = 0.45) rates were detected in
patients with and without the UVAS. The length of stay in the intensive
care unit and at the hospital was similar in both groups, UVAS (4.6 (8.2)
days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and 19.2 (18.6)
days). The 30-day in-hospital mortality rate was 5.3%, no significant
differences between groups were observed (p = 0.053). Conclusion: Novel
ultraviolet-C technology has not been shown to significantly reduce
nosocomial infections or mortality rates in cardiac surgery
patients.<br/>Copyright &#xa9; 2018 Elsevier Espana, S.L.U.

<34>
Accession Number
622314105
Author
Pistolesi V.; Regolisti G.; Morabito S.; Gandolfini I.; Corrado S.; Piotti
G.; Fiaccadori E.
Institution
(Pistolesi, Morabito) Hemodialysis Unit, Policlinico Umberto I, "Sapienza"
University, Viale del Policlinico, 155, Rome 00161, Italy
(Regolisti, Gandolfini, Corrado, Piotti, Fiaccadori) Acute and Chronic
Renal Failure Unit, Parma University Medical School, Parma, Italy
Title
Contrast medium induced acute kidney injury: a narrative review.
Source
Journal of Nephrology. (pp 1-16), 2018. Date of Publication: 25 May 2018.
Publisher
Springer International Publishing (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background and aims: Contrast-induced acute kidney injury (CI-AKI) is the
third leading cause of hospital-acquired acute kidney injury. It is more
commonly observed following intra-arterial administration of iodinated
contrast media (CM) for cardiac procedures in patients with pre-existing
chronic kidney disease (CKD), and is associated with increased short- and
long-term morbidity and mortality. This review investigates the key
current evidence on CI-AKI definition, epidemiology and pathogenesis, as a
basis for recommending preventive measures that can be implemented in
clinical practice. Methods: An extensive literature search was performed
to identify the relevant studies describing the epidemiology,
pathogenesis, outcome and prevention of CI-AKI. Results and conclusion:
Pre-existing CKD, intra-arterial administration and CM volume are the most
important risk factors for CI-AKI. Since risk factors for CI-AKI are well
defined, and the timing of renal insult is known, patients should be
carefully stratified before the administration of CM, in order to reduce
the negative impact of modifiable risk factors on renal function. The
intravenous administration of moderate amounts of isotonic saline solution
or bicarbonate solution still represents the principal intervention with
documented and acceptable effectiveness for CI-AKI prevention. More data
are needed on aggressive volume expansion strategies along with diuretics,
targeting forced diuresis with high urinary output. The role of
antioxidant agents remains controversial, and only moderate evidence
exists in favour of N-acetylcysteine. Statins could contribute to reducing
the incidence of CI-AKI, although their mechanism of action is not fully
ascertained. No robust data demonstrate a reduction of CI-AKI incidence by
peri-procedural hemodialysis/hemofiltration; renal replacement therapies
may carry instead unnecessary risks. Remote ischemic preconditioning might
represent a simple, non-invasive and cost effective preventive measure for
CI-AKI prevention, but few data are currently available about its clinical
application in patients at high risk of CI-AKI.<br/>Copyright &#xa9; 2018
Italian Society of Nephrology

<35>
[Use Link to view the full text]
Accession Number
621749966
Author
Mousavi Malek N.; Zakerimoghadam M.; Esmaeili M.; Kazemnejad A.
Institution
(Mousavi Malek, Zakerimoghadam) School of Nursing and Midwifery, Tehran
University of Medical Sciences, Nosrat St Tohid Sq, Tehran, Iran, Islamic
Republic of
(Esmaeili) School of Nursing and Midwifery, Nursing and Midwifery Care
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Kazemnejad) Department of Biostatics, Tarbiat Modares University, Tehran,
Iran, Islamic Republic of
Title
Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep before
Coronary Artery Bypass Grafting.
Source
Critical Care Nursing Quarterly. 41 (2) (pp 161-169), 2018. Date of
Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study to examine the effects of supportive-educational
nurse-led intervention on the patients' anxiety and sleep before the
coronary artery bypass grafting. The current clinical trial recruited 160
patients (N = 160) waiting for the coronary artery bypass grafting by
random block sampling and divided them into two 80-people experimental and
control groups. Spielberger's State Anxiety Inventory was completed on the
first day. The Groningen's Sleep Quality Index was also completed by the
patients on the day of surgery. Data were analyzed in SPSS software
version 16, using descriptive and inferential statistics tests. The mean
anxiety score in the experimental group decreased to 48.39, whereas in the
control group, the mean anxiety score saw a rise after the intervention
(61.09). The comparison of the mean quality of sleep the night before the
surgery for both groups showed that sleep in the control group compared
with sleep in the experimental group had a lower quality, and
statistically, it was significant (P <.001). Results showed that
nonpharmacological and supportive interventions can reduce patients'
anxiety and sleep disturbance before the coronary artery bypass grafting.
According to the results, nonpharmacological therapies should be placed at
the top of nurses' tasks.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health,
Inc. All rights reserved.

<36>
Accession Number
618499671
Author
Body R.; Boachie C.; McConnachie A.; Carley S.; Van Den Berg P.; Lecky
F.E.
Institution
(Body) Cardiovascular Sciences, University of Manchester, Manchester,
United Kingdom
(Body, Carley) Emergency Department, Central Manchester University
Hospitals Foundation NHS Trust, Manchester, United Kingdom
(Boachie, McConnachie) Robertson Centre for Biostatistics, Institute of
Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
(Carley) Healthcare Sciences, Manchester Metropolitan University,
Manchester, United Kingdom
(Van Den Berg) School of Medicine, Maastricht University, Maastricht,
Netherlands
(Lecky) Emergency Department, Salford Royal Infirmary, Manchester, United
Kingdom
Title
Feasibility of the Manchester Acute Coronary Syndromes (MACS) decision
rule to safely reduce unnecessary hospital admissions: A pilot randomised
controlled trial.
Source
Emergency Medicine Journal. 34 (9) (pp 586-592), 2017. Date of
Publication: September 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Observational studies suggest that the Manchester Acute
Coronary Syndromes (MACS) decision rule can effectively rule out' and rule
in' acute coronary syndromes (ACS) following a single blood test. In a
pilot randomised controlled trial, we aimed to determine whether a large
trial is feasible. Methods Patients presenting to two EDs with suspected
cardiac chest pain were randomised to receive care guided by the MACS
decision rule (intervention group) or standard care (controls). The
primary efficacy outcome was a successful discharge from the ED, defined
as a decision to discharge within 4 hours of arrival providing that the
patient did not have a missed acute myocardial infarction (AMI) or develop
a major adverse cardiac event (MACE: death, AMI or coronary
revascularisation) within 30 days. Feasibility outcomes included
recruitment and attrition rates. Results In total, 138 patients were
included between October 2013 and October 2014, of whom 131 (95%) were
randomised (66 to intervention and 65 controls). Nine (7%) patients had
prevalent AMI and six (5%) had incident MACE within 30 days. All 131
patients completed 30-day follow-up and were included in the final
analysis with no missing data for the primary analyses. Compared with
standard care, a significantly greater proportion of patients whose care
was guided by the MACS rule were successfully discharged within 4 hours
(26% vs 8%, adjusted OR 5.45, 95% CI 1.73 to 17.11, p=0.004). No patients
in either group who were discharged within 4 hours had a diagnosis of AMI
or incident MACE within 30 days (0.0%, 95% CI 0% to 20.0% in the
intervention group). Conclusions In this pilot trial, use of the MACS rule
led to a significant increase in safe discharges from the ED but a larger,
fully powered trial remains necessary. Our findings seem to support the
feasibility of that trial. Trial registration number ISRCTN 86818215.
Research Ethics Committee reference 13/NW/0081. UKCRN registration ID
14334.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All rights reserved.

<37>
Accession Number
618222734
Author
Serraino G.F.; Murphy G.J.
Institution
(Serraino, Murphy) Department of Cardiovascular Sciences, NIHR Leicester
Biomedical Research Unit in Cardiovascular Medicine, University of
Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester,
United Kingdom
Title
Effects of cerebral near-infrared spectroscopy on the outcome of patients
undergoing cardiac surgery: A systematic review of randomised trials.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016613. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Goal-directed optimisation of cerebral oxygenation using
near-infrared spectroscopy (NIRS) during cardiopulmonary bypass is widely
used. We tested the hypotheses that the use of NIRS cerebral oximetry
results in reductions in cerebral injury (neurocognitive function, serum
biomarkers), injury to other organs including the heart and brain,
transfusion rates, mortality and resource use. Design Systematic review
and meta-analysis. Setting Tertiary cardiac surgery centres in North
America, Europe and Asia. Participants A search of Cochrane Central
Register of Controlled Trials, ClinicalTrials.gov, Medline, Embase, and
the Cumulative Index to Nursing and Allied Health Literature Plus from
inception to November 2016 identified 10 randomised trials, enrolling a
total of 1466 patients, all in adult cardiac surgery. Interventions
NIRS-based algorithms designed to optimise cerebral oxygenation versus
standard care (non-NIRS-based) protocols in cardiac surgery patients
during cardiopulmonary bypass. Outcome measures Mortality, organ injury
affecting the brain, heart and kidneys, red cell transfusion and resource
use. Results Two of the 10 trials identified in the literature search were
considered at low risk of bias. Random-effects meta-analysis demonstrated
similar mortality (risk ratio (RR) 0.76, 95% CI 0.30 to 1.96), major
morbidity including stroke (RR 1. 08, 95% CI 0.40 to 2.91), red cell
transfusion and resource use in NIRS-treated patients and controls, with
little or no heterogeneity. Grades of Recommendation, Assessment,
Development and Evaluation of the quality of the evidence was low or very
low for all of the outcomes assessed. Conclusions The results of this
systematic review did not support the hypotheses that cerebral NIRS-based
algorithms have clinical benefits in cardiac surgery. Trial registration
number PROSPERO CRD42015027696.<br/>Copyright &#xa9; Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<38>
Accession Number
618433429
Author
Zorrilla-Vaca A.; Nunez-Patino R.A.; Torres V.; Salazar-Gomez Y.
Institution
(Zorrilla-Vaca) Faculty of Health, Universidad Del Valle, School of
Medicine, Hospital Universitario Del Valle, Cali, Colombia
(Zorrilla-Vaca) Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins Hospital, Baltimore, MD, United States
(Nunez-Patino) Faculty of Health Sciences, Pontificia Universidad
Javeriana, Cali, Colombia
(Torres, Salazar-Gomez) Faculty of Health, Universidad Libre, Cali,
Colombia
Title
The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of
Cardiac Surgery: A Meta-Analysis.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
7073401. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To evaluate the impact of volatile anesthetic choice on
clinically relevant outcomes of patients undergoing cardiac surgery.
Methods. Major databases were systematically searched for randomized
controlled trials (RCTs) comparing volatile anesthetics (isoflurane versus
sevoflurane) in cardiac surgery. Study-level characteristics,
intraoperative events, and postoperative outcomes were extracted from the
articles. Results. Sixteen RCTs involving 961 patients were included in
this meta-analysis. There were no significant differences between both
anesthetics in terms of intensive care unit length of stay (SMD -0.07, 95%
CI -0.38 to 0.24, P=0.66), hospital length of stay (SMD 0.06, 95% CI -0.33
to 0.45, P=0.76), time to extubation (SMD 0.29, 95% CI -0.08 to 0.65,
P=0.12), S100beta (at the end of surgery: SMD 0.08, 95% CI -0.33 to 0.49,
P=0.71; 24 hours after surgery: SMD 0.21, 95% CI -0.23 to 0.65, P=0.34),
or troponin (at the end of surgery: SMD -1.13, 95% CI -2.39 to 0.13,
P=0.08; 24 hours after surgery: SMD 0.74, 95% CI -0.15 to 1.62, P=0.10).
CK-MB was shown to be significantly increased when using isoflurane
instead of sevoflurane (SMD 2.16, 95% CI 0.57 to 3.74, P=0.008).
Conclusions. The volatile anesthetic choice has no significant impact on
postoperative outcomes of patients undergoing cardiac
surgery.<br/>Copyright &#xa9; 2017 Andres Zorrilla-Vaca et al.

<39>
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.

<40>
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.

<41>
Accession Number
622178514
Author
Tian B.; Song C.; Li H.; Zhang W.; Chen Q.; Chen S.; Fu Y.; Hu X.; You B.;
Li T.; Hu B.; Hou S.
Institution
(Tian, Song, Li, Zhang, Chen, Chen, Fu, Hu, You, Li, Hu, Hou) Department
of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical
University, Beijing 100020, China
Title
The significance of perioperative coagulation and fibrinolysis related
parameters after lung surgery for predicting venous thromboembolism: A
prospective, single center study.
Source
Journal of Thoracic Disease. 10 (4) (pp 2223-2230), 2018. Date of
Publication: 01 Apr 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: The high incidence of venous thromboembolism (VTE) has been
perceived in post thoracic surgery patients. However, the significance of
perioperative coagulation and fibrinolysis related parameters after lung
surgery for VTE predicting is not clear. To investigate that, we conducted
a prospective single center study. Methods: A total of 111 patients
undergoing lung surgery were enrolled in this study, included 52 primary
lung cancer patients and 59 benign lung disease patients from July 2016 to
March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation
and fibrinolysis related parameters were tested, including antithrombin
(AT), fibrinogen degradation product (FDP), prothrombin time (PT),
prothrombin time activity (PA), prothrombin time ratio (PR), international
normalized ratio (INR), activated partial thromboplastin time (APTT),
plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler
ultrasonography was performed before and after surgery for deep venous
thrombosis (DVT) confirmation. Patients with new postoperative DVT,
unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (=9)
were received further computer tomography pulmonary angiography (CTPA) for
pulmonary embolism (PE). We used the area under
receiver-operating-characteristic (ROC) curve to discriminate patients
between those who developed VTE and those who did not. Single factor
analysis was utilized to define risk factors associated with VTE. Results:
The overall incidence of VTE was 16.2% (18/111). The incidence of VTE in
primary lung cancer patients was 23.1% (12/52), much higher than that in
benign lung diseases 10.2% (6/59), but did not reach statistical
significance (P=0.066). Among 18 VTE patients, 83.3% was DVT, 16.7% was
DVT + PE and 72.2% was muscular veins of the calf thrombosis. D-Dimer was
much higher in VTE group than that in non-VTE group preoperatively and at
postoperative days 1, 3 (0.64+/-0.24 vs. 0.33+/-0.06, P=0.007; 3.14+/-0.75
vs. 1.51+/-0.09, P=0.005, and 1.88+/-0.53 vs. 0.76+/-0.05, P=0.001,
respectively). And the ROC curve areas of preoperative and postoperative
days 1, 3 of D-Dimer were 0.70, 0.71 and 0.74, respectively. And FDP was
much higher in VTE group than that in non-VTE group at postoperative day 3
(6.78+/-1.43 vs. 3.79+/-0.15, P=0.004). But AT, PT, PA, PR, INR, APTT, FBG
and TT there were no significantly difference. Conclusions: The overall
incidence of VTE after lung surgery was 16.2%. The patients with
preoperative high D-Dimer should receive VTE prophylaxis.<br/>Copyright
&#xa9; Journal of Thoracic Disease.

<42>
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

<43>
Accession Number
622242883
Author
Arslan Y.; Kudsioglu T.; Yapici N.; Aykac Z.
Institution
(Arslan) Universitesi Tip Faktlltesi, Afyon 03200, Turkey
(Kudsioglu, Yapici) Siyami Ersek Gftgus Kalp Ve Damar Cerrahisi Merkezi,
Hastanesi, Turkey
(Aykac) Marmara Universitesi Tip Faktlltesi, Turkey
Title
Administration of paracetamol, diclofenac sodium, and tramadol for
postoperative analgesia after coronary artery bypass surgery.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 24 (1) (pp
23-28), 2018. Date of Publication: March 2018.
Publisher
Turkish Anaesthesiology and Intensive Care Society (Yildiz Posta Caddesi,
Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul 34349, Turkey)
Abstract
Objective: In this study we aimed to compare the effects of paracetamol,
diclofenac sodium, and tramadol administration on postoperative pain
during postoperative period of the patients who underwent coronary artery
bypass grafting (CABG). Material and Method: After acquirement of the
approval of ethics committee and informed consent of the patients, 200
patients with normal renal and liver functions and an ejection fraction
value of 40 % who would undergo CABG were included in the study. The
patients were randomly divided into four groups: Group I (n=50)
paracetamol group (IV); Group II (n=50) diclofenac sodium (IM) group;
Group III (n~50) tramadol (IV) group, and Group IV (n=50) placebo group.
Group IV patients were given only 2 pgikglh of fentanyl. Hemodynamic
values and biochemical parameters were recorded. Postoperative pain was
assessed using Visual Analog Scale (VAS). Residts: In the placebo group,
PaC02 levels were higher, mean arterial pressure was higher and
extubati-on time was longer than the other groups. There was no
statistically significant difference between the three analgesia groups.
Conclusion: Based on our study results, analgesic effect of IV paracetamol
appears to be similar to diclofenac and tramadol.<br/>Copyright &#xa9;
2018 Turkish Anaesthesiology and Intensive Care Society. All rights
reserved.

<44>
Accession Number
2000533314
Author
Sohn S.H.; Jang M.-J.; Hwang H.Y.; Kim K.H.
Institution
(Sohn, Hwang, Kim) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Title
Rapid deployment or sutureless versus conventional bioprosthetic aortic
valve replacement: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (6) (pp 2402-2412.e5),
2018. Date of Publication: June 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: This meta-analysis was conducted to compare the early and
follow-up outcomes of aortic valve replacement using rapid deployment or
sutureless (RD) valves (RDAVR group) with aortic valve replacement using
conventional bioprostheses (CAVR group). Methods: A literature search of 5
online databases was conducted. The primary outcomes were postoperative
complications and the secondary outcomes included the aortic cross-clamp
(ACC) and cardiopulmonary bypass (CPB) times and early mortality and
all-cause mortality during follow-up. Results: Twenty-one articles (RDAVR
group = 1297 patients; CAVR group = 1488 patients) were selected. The
pooled analyses showed that the ACC and CPB times were significantly
shorter in the RDAVR group than in the CAVR group (mean difference,
-26.34; 95% confidence interval [CI], -31.86 to -20.82 and mean
difference, -25.33; 95% CI, -30.79 to -19.87, respectively). The pooled
risk ratios (RRs) of any paravalvular leak and permanent pacemaker (PPM)
insertion were significantly higher in the RDAVR group than in the CAVR
group (RR, 2.32; 95% CI, 1.53-3.51 and RR, 2.08; 95% CI, 1.49-2.90,
respectively). The pooled analysis showed that the risk of a paravalvular
leak grade >=2 in the RDAVR group did not significantly differ between the
RDAVR and CAVR groups (RR, 2.05; 95% CI, 0.71-5.93). The risk of PPM
insertion remained significant when only studies reporting adjusted
outcomes were pooled. The risks of other postoperative complications,
early mortality, and all-cause mortality during follow-up were not
significantly different between the RDAVR and CAVR groups. Conclusions:
RDAVR is associated with significantly shorter ACC and CPB times than
CAVR, although this difference did not translate into improved
postoperative outcomes, early mortality, and all-cause mortality during
follow-up. Care might be needed when implanting RD valves because they are
associated with a higher incidence of PPM insertion, regardless of the RD
valve type.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<45>
Accession Number
622142159
Author
Barten M.J.; Zuckermann A.
Institution
(Barten) University Heart Center, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
(Zuckermann) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
Title
BK virus: A cause for concern in thoracic transplantation?.
Source
Annals of Transplantation. 23 (pp 310-321), 2018. Date of Publication: 11
May 2018.
Publisher
International Scientific Information, Inc. (E-mail:
office@isl-science.com)
Abstract
Human BK polyomavirus (BKV) infection is poorly documented in heart and
lung transplant patients. BK viruria and viremia have been estimated to
affect 19% and 5% of heart transplant recipients, respectively. Data are
limited, especially for lung transplantation, but the proportion of
patients progressing from BK viruria to viremia or BKV-related nephropathy
(BKVN) appears lower than in kidney transplantation. Nevertheless, a
number of cases of BKVN have been reported in heart and lung transplant
patients, typically with late diagnosis and generally poor outcomes. Risk
factors for BKV infection or BKVN in this setting are unclear but may
include cytomegalovirus infection and anti-rejection treatment. The
relative infrequency of BKVN or other BK-related complications means that
routine BKV surveillance in thoracic transplantation is not warranted, but
a diagnostic workup for BKV infection may be justified for progressive
renal dysfunction with no readily-identifiable cause; after anti-rejection
therapy; and for renal dysfunction in patients with cytomegalovirus
infection or hypogammaglobulinemia. Treatment strategies in heart or lung
transplant recipients rely on protocols developed in kidney
transplantation, with reductions in immunosuppression tailored to match
the higher risk status of thoracic transplant patients.<br/>Copyright
&#xa9; 2018, Ann Transplant.

<46>
Accession Number
614748523
Author
Nagaraja V.; Mamas M.; Mahmoudi M.; Rogers C.; Curzen N.
Institution
(Nagaraja) Department of Cardiology, Prince of Wales Hospital, Sydney,
NSW, Australia
(Mamas) Keele Cardiovascular Research Group, University of Keele, Royal
Stoke University Hospital, University Hospitals of North Midlands,
Stoke-on-Trent, United Kingdom
(Mahmoudi, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Rogers) HeartFlow, Redwood City, CA, United States
(Curzen) University Hospital Southampton NHS Foundation Trust, United
Kingdom
Title
Change in angiogram-derived management strategy of patients with chest
pain when some FFR data are available: How consistent is the effect?.
Source
Cardiovascular Revascularization Medicine. 18 (5) (pp 320-327), 2017. Date
of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The assessment of patients presenting with angina using
invasive angiography alone is imperfect. By contrast, fractional flow
reserve (FFR) allows for assessment of lesion-specific ischemia, which is
predictive of clinical outcome. A series of studies has demonstrated that
the availability of FFR data at the time of diagnostic angiography leads
to significant differences in the management of those patients.
Hypothesis: The objective of this paper is to assess the consistency in
the difference in management resulting from an FFR-directed versus and
angiogram-directed strategy in appropriate observational and randomized
trials. Methods A methodical search was made using MEDLINE, Current
Contents Connect, Google Scholar, EMBASE, Cochrane library, PubMed,
Science Direct, and Web of Science. Results Eight studies were identified
using the eligibility criteria. A total of 2468 patients were recommended
to have optimal medical therapy (OMT) alone after initial angiographic
assessment but, after FFR results were available, a total of 716 (29.0%)
were referred for revascularization (PCI 626 patients [25.36%]; CABG 90
patients [3.64%]). Similarly, 3766 patients were originally committed to
PCI after initial angiography: of these 1454 patients (38.61%) were
reconsidered to be suitable for OMT alone and 71 individuals (1.8%) were
deemed suitable for CABG after FFR data were available. Further, of 366
patients referred for CABG based on angiographic data, the availability of
FFR data changed the final decision to OMT alone in 65 patients (17.76%)
and PCI in 51 patients (13.9%). Overall, the angiogram-derived management
was changed in 22%-48% of these study populations when FFR data were
available. Conclusions Some use of FFR during coronary angiography alters
the angiogram-directed management in a remarkably consistent manner. These
data suggest that routine use of FFR at the diagnostic angiogram would
improve patient care.<br/>Copyright &#xa9; 2017

<47>
Accession Number
620784697
Author
Mayr N.P.; Wiesner G.; van der Starre P.; Hapfelmeier A.; Goppel G.; Kasel
A.M.; Hengstenberg C.; Husser O.; Schunkert H.; Tassani-Prell P.
Institution
(Mayr, Wiesner, Tassani-Prell) Institut fur Anasthesiologie, Deutsches
Herzzentrum Munchen des Freistaates Bayern, Technische Universitat
Munchen, Lazarettstr. 36, Munich 80636, Germany
(van der Starre) Department of Anesthesiology and Perioperative Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Hapfelmeier) Institut fur Medizinische Statistik und Epidemiologie,
Klinikum Rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Goppel) Klinik fur Herz- und Gefaschirurgie, Deutsches Herzzentrum
Munchen des Freistaates Bayern, Technische Universitat Munchen, Munich,
Germany
(Kasel, Hengstenberg, Husser, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen des Freistaates
Bayern, Technische Universitat Munchen, Munich, Germany
(Hengstenberg, Schunkert) DZHK, Partner Site Munich Heart Alliance,
Munich, Germany
Title
Dexmedetomidine versus propofol-opioid for sedation in transcatheter
aortic valve implantation patients: a retrospective analysis of
periprocedural gas exchange and hemodynamic support.
Source
Canadian Journal of Anesthesia. 65 (6) (pp 647-657), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Different sedation regimens have been described for use during
transfemoral transcatheter aortic valve implantation (tf-TAVI) for
treatment in patients with severe aortic stenosis. The purpose of this
study was to compare dexmedetomidine (DEX) with a combination of
propofol-opioid (PO) with respect to periprocedural gas exchange and
hemodynamic support. Methods: Data from a cohort of patients sedated with
either DEX or PO for tf-TAVI were retrospectively analyzed from a
prospectively maintained TAVI registry. Operative risk was determined from
comorbidities and risk scores. Periprocedural partial pressure of carbon
dioxide (P<inf>a</inf>CO<inf>2</inf>) was chosen as the primary endpoint.
Other differences in gas exchange, need for catecholamine therapy, the
frequency of conversion to general anesthesia, and need for sedative
"rescue therapy" (in DEX patients) were secondary endpoints. Inverse
probability of treatment weighting (IPTW) was used for analysis to
minimize any selection bias. Results: Of the 297 patients (140 PO, 157
DEX) included, the median [interquartile range] periprocedural
P<inf>a</inf>CO<inf>2</inf> values of DEX patients were significantly
lower than in PO patients (40 [36-45] mmHg vs 44 [40-49] mmHg,
respectively; median difference -4 mmHg; 95% confidence interval, -5 to -3
mmHg; P < 0.001). Hypercapnia (P<inf>a</inf>CO<inf>2</inf> > 45 mmHg) was
significantly less frequent in DEX patients compared with the PO group
(25% vs 42%, respectively; P = 0.005). Vasopressor support was more
frequent in the PO group compared with DEX (68% vs 25%, respectively; P <
0.001). Conversion to general anesthesia was not different between groups
(9%, PO vs 3%, DEX; P = 0.051). Additional sedatives/opioids were required
in 25 (16%) of the DEX patients. Conclusions: In sedated TAVI patients,
DEX was associated with lower P<inf>a</inf>CO<inf>2</inf> values and
reduced requirements for vasopressor support, making it a promising
alternative to PO for sedation during TAVI. Trial registration:
www.ClinicalTrials.gov (NCT01390675). Registered 11 July
2011.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists' Society.

<48>
Accession Number
622280890
Author
Vondrak K.; Parisi F.; Dhawan A.; Grenda R.; Webb N.; Marks S.; Debray D.;
Holt R.; Lachaux A.; Kelly D.; Kazeem G.; Undre N.
Institution
(Vondrak) University Hospital Motol, Prague, Czech Republic
(Parisi) Osp Pediatrico Bambino Gesu, Rome, Italy
(Dhawan) King's College Hospital, London, United Kingdom
(Grenda) Children's Memorial Health Institute, Warsaw, Poland
(Webb) Manchester University Foundation Trust, Manchester, United Kingdom
(Marks) Great Ormond Street Hospital for Children NHS Foundation Trust,
London, United Kingdom
(Debray) APHP-Hopital Universitaire Necker, Paris, France
(Holt) Alder Hey Children's Hospital, Liverpool, United Kingdom
(Lachaux) Universite Lyon 1 et Hospices Civils de Lyon, Lyon, France
(Kelly) Birmingham Children's Hospital, Birmingham, United Kingdom
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
Title
Efficacy and safety of immediate-and prolonged-release tacrolimus in de
novo pediatric transplantation: Randomized study.
Source
American Journal of Transplantation. Conference: 2018 American Transplant
Congress, ATC 2018. United States. 18 (Supplement 4) (pp 731), 2018. Date
of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
This study assessed long-term efficacy/safety of prolonged-release
tacrolimus (PR-T) vs immediate-release tacrolimus (IR-T) in de novo
pediatric transplant pts. Phase II, parallel-group, multicenter,
open-label study in de novo kidney, liver or heart allograft recipients
aged <16 years. Pts randomized (1:1) to receive once-daily PR-T or
twice-daily IR-T (initial daily dose 0.075mg/kg in heart, 0.3mg/kg in
liver/kidney recipients). Target tacrolimus trough level 5-15ng/mL from
Day 22. Pts followedup to Year 1 post randomization. Pts remained on
immunosuppressive regimen they were receiving on entry. Efficacy
endpoints: Biopsy-confi rmed acute rejection (BCAR), pt/graft survival,
efficacy failure. Adverse events (AEs) were recorded. Overall, 44 pts (20
PR-T; 24 IR-T; mean +/-standard deviation [SD] age 10.6+/-3.1 yrs)
received study drug. Baseline characteristics were similar between
treatment groups. Mean+/-SD tacrolimus daily dose was 0.3+/-0.1mg/kg
initially and 0.2+/-0.1mg/kg at Year 1 with both PR-T and IR-T; at Year 1,
tacrolimus trough levels were 6.6+/-2.2 and 5.4+/-1.6ng/mL, respectively;
BCAR in 1 and 4 pts, respectively. No graft losses/deaths. Efficacy
failure occurred in 8 pts (1 PR-T; 7 IR-T). AEs were experienced by most
pts, were mild/moderate in 73.8%, and led to study discontinuation in 1 pt
(IR-T) (Table). No new safety signals reported. These data support
long-term use of PR-T-based immunosuppression in de novo pediatric solid
organ allograft recipients.

<49>
Accession Number
622280884
Author
Burckart G.; Cavaille-Coll M.; Duong A.; Hothem L.; Albrecht R.
Institution
(Burckart) Office of Clinical Pharmacology, CDER, US Food and Drug
Administration, Silver Spring, MD, United States
(Cavaille-Coll, Albrecht) Division of Transplant and Opthalmology
Products, Office of New Drugs, US Food and Drug Administration, Silver
Spring, MD, United States
(Duong) Tauro University, New York, NY, United States
(Hothem) University of North Carolina, Chapel Hill, NC, United States
Title
A review of pediatric drug development programs and FDA labeling for
immunosuppressive drugs in organ transplant patients.
Source
American Journal of Transplantation. Conference: 2018 American Transplant
Congress, ATC 2018. United States. 18 (Supplement 4) (pp 714), 2018. Date
of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
The development of drugs for organ transplantation spanned the time before
and after pediatric regulatory requirements under the Best Pharmaceuticals
for Children Act (BPCA) and the Pediatric Research Equity Act. Therefore
pediatric labeling for these drugs may be inconsistent. The objective of
this review was to (a) document present FDA labeling for transplant agents
in relation to pediatric indications and the Physician Labeling Rule
requirements, and (b) to assess published organ transplant pediatric
studies for their ability to contribute to pediatric labeling. Methods:
For objective (a), transplant drugs were identified in current or previous
clinical use were identified, and the FDA labels were examined as found on
Labels@ FDA for pediatric content and Physician Labeling Rule (PLR)
format. For objective (b), Medline was searched for all articles
containing "pediatric" and "transplant" for each drug. Study data was
collected for each of the publications reviewed. Results: The FDA labels
for 12 immunosuppressive drugs were examined. Five out of the 12 labels
are in PLR format, and 7 labels (58%) contained at least one pediatric
indication for the drug in organ transplantation. For those products not
labeled for pediatric use, between 8 and 249 (median of 46) published
articles were identified with the "pediatric" and "transplant" search for
each drug. Tacrolimus had 731 pediatric publications, but is not directly
approved in pediatric renal or cardiac transplantation. Discussion: The
current BPCA initiative for labeling off-patent off-label drugs for
pediatric use has not included any drugs for organ transplantation. Given
the considerable published information on most of the drugs either without
a pediatric indication or limited indications, the BPCA program should
consider the inclusion of the transplant medications for FDA labeling and
a PLR update.

<50>
Accession Number
622279503
Author
Barten M.J.; Hirt S.W.; Garbade J.; Bara C.; Doesch A.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Junge M.; Schulz U.
Institution
(Barten, Hirt, Garbade, Bara, Doesch, Knosalla, Grinninger, Stypmann,
Schulz) Mandela Study Group, Germany
(Sieder, Junge) Novartis, Pharma, Germany
Title
Superior renal function with cni-free everolimus over standard cni-based
regimen: 18 months data from the randomized, multi-center mandela trial in
de novo heart transplant recipients.
Source
American Journal of Transplantation. Conference: 2018 American Transplant
Congress, ATC 2018. United States. 18 (Supplement 4) (pp 476-477), 2018.
Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: The MANDELA study (NCT00862979) was designed to assess the
benefit on renal function of either CNI-free or CNI-minimized EVR-based
regimen after early conversion of de novo heart transplant recipients
(HTxR). Methods: MANDELA is a multi-center, randomized, controlled,
open-label, 12 month study. In total 232 de novo HTxR were enrolled 3
months post Tx, of whom 162 could be randomized (1:1) to receive either
EVR (C0-h 5-10ng/mL) with reduced CNI (TAC C0-h 3-8ng/mL or CsA C0-h
50-150ng/mL) and steroids (<=0.3mg/kg) or EVR (C0-h 5-10ng/mL) with
mycophenolic acid (EC-MPS max. 2880mg/day or MMF max. 3g/day) and steroids
(<=0.3mg/kg). The primary objective was assessment of eGFR (MDRD) 12
months after randomization for superiority in CNI-free over CNI-reduced
everolimus group. Key secondary objectives included efficacy (composite of
BPAR ISHLT 1990 grade >=3A / ISHLT 2004 grade >=2R, graft loss /
re-transplant, death or loss to follow-up) and assessment of safety
profiles including infections. Results: Primary endpoint for superior
renal function in CNI-free EVR arm was met with high significance with a
difference of +11.2 ml/min in favor of CNI-free EVR arm vs CNI-reduced
group (p<0.0001) [cGFR (ml/min) MDRD; LS-mean ANCOVA with LOCF] (Fig.1:
course of mean+/-SD cGFR; MDRD). Per protocol analysis showed a difference
of +19.0 ml/min in favor of CNI-free EVR arm (p<0.0001) [cGFR (ml/min)
from MDRD formula; LS-mean from ANCOVA model]. Rate of MACE and BPAR was
in line with international standards and the safety profile according to
the patient population and drugs investigated herein. Data from full
analysis will be available for presentation at ATC2018 meeting.
Conclusion: The MANDELA study showed that improved renal function can be
achieved by early conversion to an everolimus-based CNI-free regimen in
HTxR without compromising safety and efficacy.

<51>
Accession Number
622273110
Author
Ovcinnikova O.; Marshall M.; Bagnati F.; Hoffmanns P.; Taveau C.; Nayroles
G.
Institution
(Ovcinnikova) Mapi, London, United Kingdom
(Marshall, Taveau) Mapi, Paris, France
(Bagnati, Hoffmanns, Nayroles) Ipsen Pharma SAS, Boulogne-Billancourt,
France
Title
Epidemiology of carcinoid heart disease (CHD) in patients (pts) with
carcinoid syndrome (CS): A systematic literature review.
Source
Neuroendocrinology. Conference: 14th Annual ENETS Conference for the
Diagnosis and Treatment of Neuroendocrine Tumor Disease. Spain. 105
(Supplement 1) (pp 50), 2017. Date of Publication: October 2017.
Publisher
S. Karger AG
Abstract
Introduction: CHD develops in the context of CS due to the exposure of
high levels of vasoactive substances, such as serotonin. Aim(s): This
review reports CHD among CS pts epidemiology outcomes. Materials and
methods: A systematic literature search was performed in PubMed, Embase,
Cochrane Library and ClinicalTrials.gov. Study type, patient
characteristics and epidemiological outcomes were collected. Results:
Reported prevalence of CHD in CS varied from 16 to 28% but rises at 40-85%
in cohorts of CS pts referred for echocardiography because of suspected
CHD. CHD is an independent negative prognostic factor for CS pts survival.
In pts with small intestine NETs, 5 year overall survival is 37% for pts
with CHD and 71% for non-CHD pts. CHD pts had higher mortality and
morbidity vs non-CHD pts. Perioperative valvular surgery mortality remains
consistently at 15-20%. When pts survived, acceptable outcomes and better
functional status were achieved. Long-term survival of CHD pts undergoing
valve replacement is determined by tumour progression. Conclusion: It is
likely that 15-30% of CS pts develop CHD rather than the 20-70% usual
estimate. Over the past decades, progress in the management of CS and CHD
has increased pts' survival. However, the understanding of CHD
epidemiology and trends remains limited due to small numbers of pts. A
registry for CS with harmonized CHD data could facilitate further
research. Industry sponsored.

<52>
Accession Number
622291410
Author
Sebio Garcia R.; Yanez-Brage M.I.; Gimenez Moolhuyzen E.; Salorio Riobo
M.; Lista Paz A.; Borro Mate J.M.
Institution
(Sebio Garcia, Yanez-Brage, Lista Paz) 1 Physiotherapy Department,
University of A Coruna, A Coruna, Spain
(Gimenez Moolhuyzen, Borro Mate) 2 Thoracic Department, University
Hospital of A Coruna, A Coruna, Spain
(Salorio Riobo) 3 DC Fisioterapia Ares, A Coruna, Spain
Title
Preoperative exercise training prevents functional decline after lung
resection surgery: a randomized, single-blind controlled trial.
Source
Clinical rehabilitation. 31 (8) (pp 1057-1067), 2017. Date of Publication:
01 Aug 2017.
Abstract
OBJECTIVES: To investigate the effects of a preoperative pulmonary
rehabilitation programme in patients with lung cancer undergoing
video-assisted thoracic surgery.
DESIGN: Randomized, single-blind controlled trial.
SETTING: Teaching hospital.
SUBJECTS: Patients with suspected or confirmed lung cancer undergoing
video-assisted thoracic surgery.
INTERVENTION: Participants were randomized to either a prehabilitation
group or a control group. Participants in the prehabilitation group
underwent a combination of moderate endurance and resistance training plus
breathing exercises three to five times per week.
MAIN MEASURES: The primary outcome of the study was exercise capacity.
Secondary outcomes were muscle strength (Senior Fitness Test),
health-related quality of life (Short-Form 36) and the postoperative
outcomes. Patients were evaluated at baseline (before randomization),
presurgery (only the prehabilitation group), after surgery and three
months post-operatively.
RESULTS: A total of 40 patients were randomized and 22 finished the study
(10 in the prehabilitation group and 12 in the control group). Three
patients were lost to follow-up at three months. After the training, there
was a statistically significant improvement in exercise tolerance
(+397seconds, p=0.0001), the physical summary component of the SF-36 (+4.4
points, p=0.008) and muscle strength ( p<0.01). There were no significant
differences between groups after surgery. However, three months
postoperatively, significant differences were found in the mean change of
exercise capacity ( p=0.005), physical summary component ( p=0.001) and
upper and lower body strength ( p=0.045 and p=0.002).
CONCLUSIONS: A pulmonary rehabilitation programme before video-assisted
thoracic surgery seems to improve patients' preoperative condition and may
prevent functional decline after surgery. Clinical Registration Number:
NCT01963923 (Registration date 10/10/2013).

<53>
[Use Link to view the full text]
Accession Number
622291267
Author
Guimaraes-Pereira L.; Reis P.; Abelha F.; Azevedo L.F.; Castro-Lopes J.M.
Institution
(Guimaraes-Pereira) aDepartment of Anesthesiology, Centro Hospitalar de
Sao Joao, Porto, PortugalDepartments of bHealth Information and Decision
Sciences (CIDES) andcSurgery, Faculty of Medicine, University of Porto,
Porto, PortugaldCINTESIS-Centre for Health Technology and Services
Research, University of Porto, Porto, PortugaleNational Observatory of
Pain-NOPain (OBSERVDOR), Faculty of Medicine, University of Porto, Porto,
PortugalfDepartment of Experimental Biology, Faculty of Medicine,
University of Porto, Porto, PortugalgIBMC-Institute for Molecular and Cell
Biology, University of Porto, Porto, Portugal
Title
Persistent postoperative pain after cardiac surgery: a systematic review
with meta-analysis regarding incidence and pain intensity.
Source
Pain. 158 (10) (pp 1869-1885), 2017. Date of Publication: 01 Oct 2017.
Abstract
Persistent postoperative pain (PPP) has been described as a complication
of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by
conducting a systematic review of the literature regarding its incidence,
intensity, location, and the presence of neuropathic pain, according to
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The review comprised 3 phases: a methodological assessment of 6 different
databases identifying potential articles and screening for inclusion
criteria by 2 independent reviewers; data extraction; and study quality
assessment. Meta-analysis was used to estimate the pooled incidence rates
using a random effects model. We have identified 442 potentially relevant
studies through database searching. A total of 23 studies (involving
11,057 patients) met our inclusion criteria. Persistent postoperative pain
affects 37% patients in the first 6 months after CS, and it remains
present more than 2 years after CS in 17%. The reported incidence of PPP
during the first 6 months after CS increased in recent years. Globally,
approximately half of the patients with PPPCS reported moderate to severe
pain. Chest is the main location of PPPCS followed by the leg; neuropathic
pain is present in the majority of the patients. This is the first
systematic review and meta-analysis to provide estimates regarding
incidence and intensity of PPPCS, which elucidates its relevance. There is
an urgent need for adequate treatment and follow-up in patients with
PPPCS.

<54>
Accession Number
622271742
Author
Dong L.; Kang Y.-K.; An X.-G.
Institution
(Dong, Kang, An) Heart Center & Beijing Key Laboratory of Hypertension,
Beijing Chaoyang Hospital, Capital Medical University, Beijng, China
Title
Short-term and mid-term clinical outcomes following hybrid coronary
revascularization versus off-pump coronary artery bypass: A meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (4) (pp 321-330), 2018. Date of
Publication: April 2018.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Off-pump coronary artery bypass grafting (OPCAB) is one of the
standard treatments for coronary artery disease (CAD) while hybrid
coronary revascularization (HCR) represents an evolving revascularization
strategy. However, the difference in outcomes between them remains
unclear. Objective: We performed a meta-analysis to compare the short-term
and mid-term outcomes of HCR versus OPCAB for the treatment of multivessel
or left main CAD. Methods: We searched the PubMed, EMBASE, Web of Science
and Cochrane databases to identify related studies and a routine
meta-analysis was conducted. Results: Nine studies with 6121 patients were
included in the analysis. There was no significant difference in
short-term major adverse cardiac and cerebrovascular event (MACCE) rate
(RR: 0.55, 95% CI: 0.30-1.03, p = 0.06) or mortality (RR: 0.51, 95% CI:
0.17-1.48, p = 0.22). HCR required less ventilator time (SMD: -0.36, 95%
CI: -0.55- -0.16, p < 0.001), ICU stay (SMD: -0.35, 95% CI: -0.58 - -0.13,
p < 0.01), hospital stay (SMD: -0.29, 95% CI: -0.50- -0.07, p < 0.05) and
blood transfusion rate (RR: 0.57, 95% CI: 0.49-0.67, p < 0.001), but
needed more operation time (SMD: 1.29, 95% CI: 0.54-2.05, p < 0.001) and
hospitalization costs (SMD: 1.06, 95% CI: 0.45-1.66, p < 0.001). The HCR
group had lower mid-term MACCE rate (RR: 0.49, 95% CI: 0.26-0.92, p <
0.05) but higher rate in mid-term target vessel revascularization (TVR,
RR: 2.20, 95% CI: 1.32-3.67, p < 0.01). Conclusions: HCR had similar
short-term mortality and morbidity comparing to OPCAB. HCR decreased the
ventilator time, ICU stay, hospital stay, blood transfusion rate and
increased operation time and hospitalization costs. HCR has a lower
mid-term MACCE rate while OPCAB shows better in mid-term
TVR.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de Cardiologia. All
rights reserved.

<55>
Accession Number
2000791088
Author
Bohula E.A.; Scirica B.M.; Fanola C.; Inzucchi S.E.; Keech A.; McGuire
D.K.; Smith S.R.; Abrahamsen T.; Francis B.H.; Miao W.; Perdomo C.A.;
Satlin A.; Wiviott S.D.; Sabatine M.S.
Institution
(Bohula, Scirica, Fanola, Abrahamsen, Wiviott, Sabatine) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Inzucchi) Yale University School of Medicine, New Haven, CT, United
States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(McGuire) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Smith) Translational Research Institute for Metabolism and Diabetes,
Florida Hospital, Orlando, FL, United States
(Francis, Miao, Perdomo, Satlin) Eisai, Inc., Woodcliff Lake, NJ, United
States
Title
Design and rationale for the Cardiovascular and Metabolic Effects of
Lorcaserin in Overweight and Obese Patients-Thrombolysis in Myocardial
Infarction 61 (CAMELLIA-TIMI 61) trial.
Source
American Heart Journal. 202 (pp 39-48), 2018. Date of Publication: August
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Lorcaserin, a selective serotonin 2C receptor agonist, is an
effective pharmacologic weight-loss therapy that improves several
cardiovascular risk factors. The long-term clinical cardiovascular and
metabolic safety and efficacy in patients with elevated cardiovascular
risk are unknown. Research design and methods: CAMELLIA-TIMI 61
(NCT02019264) is a randomized, double-blind, placebo-controlled,
multinational clinical trial designed to evaluate the safety and efficacy
of lorcaserin with regard to major adverse cardiovascular events and
progression to diabetes in overweight or obese patients at high
cardiovascular risk. Overweight or obese patients either with established
cardiovascular disease or with diabetes and at least 1 other
cardiovascular risk factor were randomized in a 1:1 ratio to lorcaserin 10
mg twice daily or matching placebo. The primary safety objective is to
assess for noninferiority of lorcaserin for the composite end point of
cardiovascular death, myocardial infarction, or stroke (major adverse
cardiovascular event [MACE]) (with noninferiority defined as the upper
bound of a 1-sided 97.5% CI excluding a hazard ratio of 1.4) compared with
placebo assessed at an interim analysis with 460 adjudicated events. The
efficacy objectives, assessed at study completion, will evaluate the
superiority of lorcaserin for the primary composite end point of
cardiovascular death, myocardial infarction, stroke, hospitalization for
unstable angina, heart failure, or any coronary revascularization (MACE+)
and the key secondary end point of conversion to diabetes. Recruitment
began in January 2014 and was completed in November 2015 resulting in a
total population of 12,000 patients. The trial is planned to continue
until at least 1,401 adjudicated MACE+ events are accrued and the median
treatment duration exceeds 2.5 years. Conclusion: CAMELLIA-TIMI 61 is
investigating the safety and efficacy of lorcaserin for MACEs and
conversion to diabetes in overweight or obese patients with established
cardiovascular disease or multiple cardiovascular risk
factors.<br/>Copyright &#xa9; 2018

<56>
Accession Number
2000782780
Author
Arbel Y.; Ko D.T.; Yan A.T.; Cantor W.J.; Bagai A.; Koh M.; Eberg M.; Tan
M.; Fitchett D.; Borgundvaag B.; Ducas J.; Heffernan M.; Morrison L.J.;
Langer A.; Dzavik V.; Mehta S.R.; Goodman S.G.
Institution
(Arbel) Department of Cardiology, Tel Aviv Medical Center, Sackler School
of Medicine, Tel Aviv University, Tel Aviv, Israel
(Ko) Schulich Heart Centre, Division of Cardiology, Sunnybrook Health
Sciences Centre, University of Toronto, Ontario, Canada
(Ko, Koh, Eberg) Institute for Clinical Evaluative Sciences (ICES),
Toronto, Ontario, Canada
(Yan, Bagai, Fitchett, Goodman) St Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Cantor) Department of Cardiology, Southlake Regional Health Centre,
University of Toronto, Ontario, Canada
(Borgundvaag) Schwartz/Reisman Emergency Medicine Institute at Mount Sinai
Hospital, University of Toronto, Toronto, Ontario, Canada
(Ducas) St Boniface General Hospital, University of Manitoba, Winnipeg,
Manitoba, Canada
(Heffernan) Halton Healthcare Services, Oakville Hospital, Oakville,
Ontario, Canada
(Morrison) Robert and Dorothy Pitts Chair of Acute Care and Emergency
Medicine, Keenan Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Tan, Langer, Goodman) Canadian Heart Research Centre, Toronto, Ontario,
Canada
(Dzavik) University Health Network and Mount Sinai Hospital, University of
Toronto, Toronto, Ontario, Canada
(Mehta) Population Health Research Institute, Hamilton General Hospital,
Hamilton, Ontario, Canada
Title
Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After
Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction
(TRANSFER-AMI).
Source
Canadian Journal of Cardiology. 34 (6) (pp 736-743), 2018. Date of
Publication: June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The Trial of Routine Angioplasty and Stenting after
Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction
(TRANSFER-AMI) demonstrated superiority of routine early coronary
angiography (and percutaneous coronary intervention [PCI]) compared with
standard therapy in fibrinolytic-treated patients with ST-segment
elevation myocardial infarction (STEMI) at 30 days. The aim of the current
study was to evaluate the long-term (>7 year) effects of an early invasive
strategy. Methods: We linked the study cohort and administrative datasets
to assess long-term follow-up status including repeat procedures,
hospitalizations, and major adverse cardiovascular events (MACE).
Kaplan-Meier and Cox regression analysis were used to evaluate the
relationship between randomized treatment and long-term adverse outcomes.
Results: A total of 881 patients had long-term follow-up and were included
in our study. After a mean follow-up of 7.8 years, there were no
significant differences in death, myocardial infarction (MI), unstable
angina, stroke, transient ischemic attack (TIA), or heart failure
admissions (hazard ratio [HR] 0.91; 95% confidence interval [CI]
0.73-1.13]; P = 0.41) between those randomized to an early invasive vs
standard treatment strategy. Following the index hospitalization, there
were no significant difference in the rates of coronary revascularization
between the early invasive and the standard therapy groups (81 [19.3%] vs
76 [17.9%]; P = 0.61). Conclusions: Despite the short-term benefit and
safety of an early invasive strategy in patients with STEMI receiving
fibrinolysis, no statistically significant differences in MACE were
observed over 7.8 years.<br/>Copyright &#xa9; 2018 Canadian Cardiovascular
Society

<57>
Accession Number
622276075
Author
Deferrari G.; Bonanni A.; Bruschi M.; Alicino C.; Signori A.
Institution
(Deferrari, Bonanni) Department of Cardionephrology, Istituto Clinico di
Alta Specialita (ICLAS) Rapallo (GE), Italy
(Deferrari) Department of Internal Medicine (Di.MI), University of Genoa,
Genoa, Italy
(Bonanni, Bruschi) Division of Nephrology, Dialysis and Transplantation
and Laboratory on Pathophysiology of Uremia, IRCCS Istituto Giannina
Gaslini, Genoa, Italy
(Alicino, Signori) Department of Health Science (Di.S.Sal), University of
Genoa, Genoa, Italy
Title
Remote ischaemic preconditioning for renal and cardiac protection in adult
patients undergoing cardiac surgery with cardiopulmonary bypass:
Systematic review and meta-analysis of randomized controlled trials.
Source
Nephrology Dialysis Transplantation. 33 (5) (pp 813-824), 2018. Date of
Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
Background. The main aim of this systematic review was to assess whether
remote ischaemic preconditioning (RIPC) protects kidneys and the heart in
cardiac surgery with cardiopulmonary bypass (CPB) and to investigate a
possible role of anaesthetic agents. Methods. Randomized clinical trials
(RCTs) on the effects of RIPC through limb ischaemia in adult patients
undergoing cardiac surgery with CPB were searched (1965-October 2016) in
PubMed, Cochrane Library and article reference lists. A random effects
model on standardized mean difference 0.97)]. In the volatile anaesthetic
group, RIPC significantly reduced AKI incidence [OR 0.57 (95% CI
0.41-0.79)] and marginally reduced ICU stay. Conversely, except for MIBs,
RIPC had fewer non-significant effects under propofol with or without
volatile anaesthetics. Conclusions. RIPC did not consistently reduce
morbidity and mortality in adults undergoing cardiac surgery with CPB. In
the subgroup on volatile anaesthetics only, RIPC markedly and
significantly reduced the incidence of AKI and composite endpoint as well
asmyocardial injury.<br/>Copyright &#xa9; The Author 2017.

<58>
Accession Number
2000790595
Author
Wee I.J.Y.; Syn N.; Choong A.M.T.L.
Institution
(Wee, Syn, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Title
Transcaval approach for endovascular aortic interventions: A systematic
review.
Source
Journal of Cardiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
The caval-aortic path is a novel access route for endovascular aortic
interventions in aortic interventions, particularly for patients
unsuitable for traditional access routes including femoral, subclavian,
transapical, and aortic. A systematic review was conducted as per the
PRISMA guidelines utilizing three electronic databases: Medline, Embase,
and Cochrane database. There were 10 studies identified, including 7
retrospective studies, 1 prospective cohort study, and 2 case reports.
Data on 209 patients (mean age 79.5 +/- 5.1 years; 51.2% male) were
abstracted including preoperative work-up, technical procedure details,
and outcomes. The overall technical success rate for all procedures is
96.2%, with a 4.3% mortality rate and a mean follow up of 17.9 +/- 19.8
months. Individually in the various interventions, the technical success
rate of transcaval endoleak repair and transcatheter aortic valve
implantation (TAVI) was 94.4% and 97.5% respectively, with a low 30-day
mortality rate of 7.6% in the TAVI intervention. There is encouraging
evidence regarding the rates of mortality and complications in the
transcaval approach for endovascular aortic interventions. It presents a
feasible alternative for a judiciously select group of patients who are
not suitable for other access routes.<br/>Copyright &#xa9; 2018 Japanese
College of Cardiology

<59>
Accession Number
618046831
Author
Huang S.-C.; Wong M.-K.; Lin P.-J.; Tsai F.-C.; Chu J.-J.; Wu M.-Y.; Fu
T.-C.; Wang J.-S.
Institution
(Huang, Wong) Department of Physical Medicine and Rehabilitation, Chang
Gung Memorial Hospital, Linkuo, Taiwan (Republic of China)
(Lin, Tsai, Chu, Wu) Division of Thoracic and Cardiovascular Surgery,
Chang Gung Memorial Hospital, Linkuo, Taiwan (Republic of China)
(Fu) Department of Physical Medicine and Rehabilitation, Chang Gung
Memorial Hospital, Keelung, Taiwan (Republic of China)
(Wang) Healthy Aging Research Center, Graduate Institute of Rehabilitation
Science, Medical College, Chang Gung University, Tao-Yuan, Taiwan
(Republic of China)
(Wang) Heart Failure Center, Department of Physical Medicine and
Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan (Republic of
China)
Title
Short-term intensive training attenuates the exercise-induced interaction
of mono-1/2 cells and platelets after coronary bypass in cardiac patients.
Source
Thrombosis and Haemostasis. 117 (9) (pp 1761-1771), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: iaorl@iaorl.org)
Abstract
The interaction between platelets and monocytes plays a critical role in
the pathogenesis and progression of cardiovascular diseases. This study
investigated how short-term intensive training (SIT) influences monocyte
subset characteristics and exercise-induced monocyte and platelet
aggregates (MPAs) following elective coronary bypass (CABG) in cardiac
patients. Forty-nine patients hospitalised for CABG were randomised into
SIT (N=26) and conventional training (CT, N=23) groups. The SIT subjects
underwent supervised aerobic training at 80~120 % of the ventilatory
anaerobic threshold based on sub-maxi-mal exercise tests performed 7 days
post-CABG for 20 sessions with two sessions/day and 30 min/session, which
were completed within four weeks after surgery. The CT subjects performed
light-intensity conditioning exercise for <=4 sessions. Resting and
maximal exercise-mediated monocyte characteristics and MPA were determined
before and following intervention. The SIT group had a larger improvement
in ventilation efficiency and anaerobic threshold than the CT group; the
SIT group exhibited larger reductions in blood monocyte subtypes 1 and 2
(Mono1 and 2) counts at rest than the CT group; the SIT group but not the
CT group exhibited attenuated formation of Mono1/pla-telet
hetero-aggregation (MPA1) and CD42b expression on Mono1/2 caused by
strenuous exercise; and plasma levels of macrophage inflammatory
protein-1beta and soluble P-selectin showed similar trends as Mono1/2 and
MPA1, respectively. In conclusion, SIT modestly improved aerobic capacity
in patients following CABG. Moreover, SIT simultaneously ameliorated the
CD42b expression of Mono1/2 cells and maximal exercise-induced MPA1, which
may reduce the risk of inflammatory thrombosis.<br/>Copyright &#xa9;
Schattauer 2017.

<60>
Accession Number
617739121
Author
Nassr A.A.; Shazly S.A.; Morris S.A.; Ayres N.; Espinoza J.; Erfani H.;
Olutoye O.A.; Sexson S.K.; Olutoye O.O.; Fraser C.D.; Belfort M.A.;
Shamshirsaz A.A.
Institution
(Nassr, Espinoza, Erfani, Belfort, Shamshirsaz) Department of Obstetrics
and Gynecology, Baylor College of Medicine and Texas Children's Fetal
Center, Houston, TX, United States
(Nassr) Women's Health Hospital, Assiut University, Assiut, Egypt
(Shazly) Department of Obstetrics and Gynecology, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Morris, Ayres, Sexson) Division of Pediatric Cardiology, Baylor College
of Medicine and Texas Children's Fetal Center, Houston, TX, United States
(Olutoye) Division of Pediatric Anesthesia, Baylor College of Medicine and
Texas Children's Fetal Center, Houston, TX, United States
(Olutoye) Division of Pediatric Surgery, Baylor College of Medicine and
Texas Children's Fetal Center, Houston, TX, United States
(Fraser) Division of Congenital Heart Surgery, Baylor College of Medicine
and Texas Children's Heart Center, Houston, TX, United States
Title
Prenatal management of fetal intrapericardial teratoma: a systematic
review.
Source
Prenatal Diagnosis. 37 (9) (pp 849-863), 2017. Date of Publication:
September 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Objectives: The purpose of this systematic review is to provide a
comprehensive overview on the clinical course, perinatal outcome, and
effectiveness of prenatal management options for pericardial teratoma.
Methods: A comprehensive search including Ovid MEDLINE, Ovid EMBASE, and
Scopus was conducted from inception to September 2016. All studies that
reported the prenatal course of pericardial teratoma in singleton or twin
gestations were considered eligible. Standardized forms were used for data
abstraction by two independent reviewers. Results: Out of 217 screened
abstracts, 59 studies reporting 67 fetuses with pericardial teratoma were
included. Twenty-three singleton fetuses and 3 fetuses in twin gestations
underwent prenatal treatment, and 20 (76.9%) of them were hydropic at the
time of intervention. Of those, 15/20 (75%) had a favorable outcome. In
the non-intervention group (n = 41), 26 (63.4%) developed hydrops, and out
of those, 8 (30.8%) had a favorable outcome. Conclusion: Prenatal fluid
drainage and other prenatal techniques have been utilized in the treatment
of intrapericardial teratoma. While most fetuses tolerated
pericardiocentesis, the neonatal benefit of this procedure is still
uncertain, and outcomes of other interventions had variable success.
Prenatal intervention for pericardial teratoma may be an option in
specialized units but, given the maternal and fetal risks, needs careful
consideration. &#xa9; 2017 John Wiley & Sons, Ltd.<br/>Copyright &#xa9;
2017 John Wiley & Sons, Ltd.

<61>
Accession Number
618424535
Author
Giuliano S.; Guastalegname M.; Russo A.; Falcone M.; Ravasio V.; Rizzi M.;
Bassetti M.; Viale P.; Pasticci M.B.; Durante-Mangoni E.; Venditti M.
Institution
(Giuliano, Guastalegname, Russo, Falcone, Venditti) Department of Public
Health and Infectious Diseases, Policlinico Umberto I 'Sapienza'
University of Rome, Rome, Italy
(Ravasio, Rizzi) Infectious Diseases Unit, ASST Papa Giovanni XXIII,
Bergamo, Italy
(Bassetti) Infectious Diseases Division, Santa Maria Misericordia
University Hospital, Udine, Italy
(Viale) Infectious Diseases Unit, Department of Medical and Surgical
Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
(Pasticci) Infectious Disease Unit, University of Perugia, Perugia, Italy
(Durante-Mangoni) Department of Clinical and Experimental Medicine,
Universita della Campania 'Luigi Vanvitelli', AORN dei Colli-Ospedale
Monaldi, Naples, Italy
Title
Candida endocarditis: systematic literature review from 1997 to 2014 and
analysis of 29 cases from the Italian Study of Endocarditis.
Source
Expert Review of Anti-Infective Therapy. 15 (9) (pp 807-818), 2017. Date
of Publication: 02 Sep 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Candida Endocarditis (CE) is a deadly disease. It is of
paramount importance to assess risk factors for acquisition of both
Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate
clinical features and treatment strategies with the outcome of the
disease. Areas covered: We searched the literature using the Pubmed
database. Cases of CE from the Italian Study on Endocarditis (SEI) were
also included. Overall, 140 cases of CE were analyzed. Patients with a
history of abdominal surgery and antibiotic exposure had higher
probability of developing NVE than PVE. In the PVE group, time to onset of
CE was significantly lower for biological prosthesis compared to
mechanical prosthesis. In the whole population, greater age and longer
time to diagnosis were associated with increased likelihood of death.
Patients with effective anti-biofilm treatment, patients who underwent
cardiac surgery and patients who were administered chronic suppressive
antifungal treatment showed increased survival. For PVE, moderate active
anti-biofilm and highly active anti-biofilm treatment were associated with
lower mortality. Expert commentary: Both NVE and PVE could be considered
biofilm-related diseases, pathogenetically characterized by Candida
intestinal translocation and initial transient candidemia. Cardiac
surgery, EAB treatment and chronic suppressive therapy might be crucial in
increasing patient survival.<br/>Copyright &#xa9; 2017 Informa UK Limited,
trading as Taylor & Francis Group.

<62>
[Use Link to view the full text]
Accession Number
620314329
Author
Thomaidou E.; Argiriadou H.; Vretzakis G.; Megari K.; Taskos N.;
Chatzigeorgiou G.; Anastasiadis K.
Institution
(Thomaidou, Argiriadou) Department of Anesthesia and Intensive Care,
Aristotle University of Thessaloniki, AHEPA University Hospital, 1st
Kyriakidi str, Thessaloniki 546 36, Greece
(Vretzakis) Department of Anesthesia, University of Thessaly, Larisa,
Greece
(Megari) Laboratory of Cognitive Neuroscience, School of Psychology,
Thessaloniki, Greece
(Taskos) 1st Neurology Department, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Chatzigeorgiou) Neurology Department, University of Thessaly, Larisa,
Greece
(Anastasiadis) Cardiothoracic Department, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Title
Perioperative Use of Erythromycin Reduces Cognitive Decline after Coronary
Artery Bypass Grafting Surgery: A Pilot Study.
Source
Clinical Neuropharmacology. 40 (5) (pp 195-200), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Adverse neurologic outcome can be a debilitating complication
after cardiac surgery. The aim of this study was to investigate the
potential neuroprotective action of erythromycin, a well known antibiotic
agent, regarding postoperative cognitive decline in patients undergoing
cardiac surgery. Methods Forty patients scheduled for elective coronary
artery bypass grafting surgery were prospectively randomly assigned in 2
groups: the erythromycin group (n = 19) who received erythromycin at a
dose of 25 mg/kg before and after surgery and the control group (n = 21)
who did not receive it. All patients were monitored with near-infrared
spectroscopy during the operation. Interleukin (IL) 1 and IL-6 as
inflammatory markers and tau protein as a marker of brain injury were
measured before and after surgery. Neurocognitive assessment was performed
before surgery, on the day of discharge, and at 3 months postoperatively.
Results Both groups were comparable in terms of demographic and clinical
data. Patients who took erythromycin presented with significantly better
cognitive performance before discharge and 3 months after surgery. No
significant differences between the 2 groups referring to IL-1 and IL-6
values were detected. Tau serum values were lower in the erythromycin
group after surgery. Conclusions Erythromycin administration attenuates
cerebral damage and postoperative cognitive decline after coronary artery
bypass grafting surgery. Trial registration The study was retrospectively
registered at ClinicalTrials.gov (NCT01274754). Study start day: November
2008.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<63>
Accession Number
618265750
Author
Simon G.I.; Craswell A.; Thom O.; Fung Y.L.
Institution
(Simon, Fung) School of Health and Sports Sciences, University of the
Sunshine Coast, Sunshine Coast, QLD, Australia
(Craswell) School of Nursing, Midwifery, and Paramedicine, University of
the Sunshine Coast, Sunshine Coast, QLD, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Sunshine Coast, QLD, Australia
Title
Outcomes of restrictive versus liberal transfusion strategies in older
adults from nine randomised controlled trials: a systematic review and
meta-analysis.
Source
The Lancet Haematology. 4 (10) (pp e465-e474), 2017. Date of Publication:
October 2017.
Publisher
Elsevier Ltd
Abstract
Background Guidelines for patient blood management recommend restrictive
transfusion practice for most adult patients. These guidelines are
supported by evidence from randomised controlled trials (RCTs); however,
one of the patient groups not explicitly examined in these studies is the
geriatric population. We examined RCTs relevant to transfusion outcomes in
older patients. Our aim was to determine whether special guidelines are
warranted for geriatric patients, recognising the different
pathophysiological characteristics of this group. Methods For this
systematic review and meta-analysis, we searched PubMed, Scopus, and the
Cochrane Library databases from their inception to May 5, 2017, for
evidence relating to transfusion outcomes in adults aged 65 years and
older. This criterion was widened to include RCTs where a substantial
proportion of the study population was older than 65 years. We also
included study populations of all clinical settings, and did not limit the
search by date, language, or study type. For articles not in English, only
available translations of the abstracts were reviewed. Studies were
excluded if they did not specify age. Observational studies and duplicate
patient and outcome data from studies that generated multiple publications
were also excluded. We screened bibliographies of retrieved articles for
additional publications. We analysed data extracted from published RCTs
comparing restrictive and liberal transfusion strategies in older adults.
We generated fixed effects risk ratios (RR) for pooled study data using
the Mantel-Haenszel method. Primary outcomes were 30-day and 90-day
mortality events for patients enrolled in restrictive and liberal
transfusion study groups. We included intention-to-treat outcome data in
the meta-analysis when available, otherwise we used per-protocol outcome
data. Findings 686 articles were identified by the search, and a further
37 by the snowball approach. Of these articles, 13 eligible papers
described findings from nine RCTs (five trials investigating orthopaedic
surgery, three cardiac surgery, and one oncology surgery; including 5780
patients). The risk of 30-day mortality was higher in older patients who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (risk ratio [RR] 1.36, 95% CI 1.05-1.74;
p=0.017). The risk of 90-day mortality was also higher in those who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (RR 1.45, 95% CI 1.05-1.98; p=0.022).
Interpretation Liberal transfusion strategies might produce better
outcomes in geriatric patients than restrictive transfusion strategies.
This outcome contradicts current restrictive transfusion approaches.
Population ageing will challenge resources globally, and this finding has
implications for blood supply and demand, and optimal care of older
adults. Further research is needed to formulate evidence-based transfusion
practice across clinical specialties specific to the geriatric population,
and to examine resource effects. Funding Australia's National Blood
Authority.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<64>
Accession Number
617056265
Author
Bai A.D.; Agarwal A.; Steinberg M.; Showler A.; Burry L.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Agarwal) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, 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
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Clinical predictors and clinical prediction rules to estimate initial
patient risk for infective endocarditis in Staphylococcus aureus
bacteraemia: a systematic review and meta-analysis.
Source
Clinical Microbiology and Infection. 23 (12) (pp 900-906), 2017. Date of
Publication: December 2017.
Publisher
Elsevier B.V.
Abstract
Objectives We conducted a meta-analysis to summarize diagnostic properties
of risk factors and clinical prediction rules for diagnosing infective
endocarditis (IE) in Staphylococcus aureus bacteraemia (SAB). Methods We
searched MEDLINE, Embase, and the Cochrane Database from inception to 6
January 2016 to identify studies evaluating risk factors and clinical
prediction rules for IE in SAB patients. Pooled estimates of diagnostic
properties for main risk factors were calculated using a bivariate random
effects model. Results Of 962 articles identified, 30 studies were
included. These involved 16 538 SAB patients including 1572 IE cases. Risk
factors with positive likelihood ratio (PLR) greater than 5 included
embolic events (PLR 12.7, 95% CI 9.2-17.7), pacemakers (PLR 9.7, 95% CI
3.7-21.2), history of previous IE (PLR 8.2, 95% CI 3.1-22.0), prosthetic
valves (PLR 5.7, 95% CI 3.2-9.5), and intravenous drug use (PLR 5.2, 95%
CI 3.8-6.9). The only clinical factor with negative likelihood ratio (NLR)
less than 0.5 was documented clearance of bacteraemia within 72 hours (NLR
range 0.32-0.35). Of the nine published clinical prediction rules for
ruling out IE, five had an NLR below 0.1. Conclusions SAB patients with
high-risk features (embolic events, pacemakers, prosthetic valves,
previous IE, or intravenous drug use) should undergo a trans-esophageal
echocardiography (TEE) for IE. Clinical prediction rules show promise in
safely ruling out endocarditis, but require validation in future
studies.<br/>Copyright &#xa9; 2017 European Society of Clinical
Microbiology and Infectious Diseases

<65>
Accession Number
615548519
Author
Sardar P.; Kundu A.; Chatterjee S.; Feldman D.N.; Owan T.; Kakouros N.;
Nairooz R.; Pape L.A.; Feldman T.; Dawn Abbott J.; Elmariah S.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu, Kakouros, Pape) Department of Medicine, University of
Massachusetts Medical School, Worcester, MA, United States
(Chatterjee) Division of Cardiology, Temple University School of Medicine,
Philadelphia, PA, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, NY, United States
(Nairooz) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Feldman) Department of Medicine, Division of Cardiology, Evanston
Hospital, Evanston, IL, United States
(Dawn Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, RI, United States
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
Title
Transcatheter versus surgical aortic valve replacement in
intermediate-risk patients: Evidence from a meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (3) (pp 504-515),
2017. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a meta-analysis to evaluate the efficacy and
safety of transcatheter aortic valve replacement (TAVR) in comparison to
surgical aortic valve replacement (SAVR) in intermediate-risk patients.
Background: TAVR is an established treatment option in high-risk patients
with severe aortic valve stenosis (AS). There are fewer data regarding
efficacy of TAVR in intermediate-risk patients. Methods: Databases were
searched through April 30, 2016 for studies that compared TAVR with SAVR
for the treatment of intermediate-risk patients with severe AS. We
calculated summary risk ratios (RRs) and 95% confidence intervals (CIs)
with the random-effects model. Results: The analysis included 4,601
patients from 7 studies (2 randomized and 5 observational). There was no
significant difference in all-cause mortality between the two groups after
mean follow-up of 1.15 years [14.7% with TAVR vs 15.4% with SAVR; RR 0.93;
95% CI 0.77-1.12]. TAVR resulted in lower rates of acute kidney injury
[number needed to treat (NNT) = 26], major bleeding (NNT = 4), and
atrial-fibrillation (NNT = 6), but higher rates of major vascular
complications [number needed to harm (NNH)= 18], and moderate/severe
aortic regurgitation (NNH = 13). The rate of permanent-pacemaker
implantation was significantly higher with TAVR in observational studies
(RR 2.31; 95% CI 1.22-2.81), but not in RCTs (RR 1.21; 95% CI 0.93-1.56).
No significant difference in the rate of stroke or myocardial infarction
was observed. Conclusions: Our analysis of mid-term results showed that
TAVR has similar clinical efficacy to SAVR in intermediate-risk patients
with severe AS, and can be a suitable alternative to surgical valve
replacement. &#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<66>
Accession Number
618049129
Author
Jeong H.S.; Hong S.J.; Cho S.-A.; Kim J.-H.; Cho J.Y.; Lee S.H.; Joo H.J.;
Park J.H.; Yu C.W.; Lim D.-S.
Institution
(Jeong, Hong, Cho, Kim, Cho, Lee, Joo, Park, Yu, Lim) Department of
Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul,
South Korea
Title
Comparison of Ticagrelor Versus Prasugrel for Inflammation, Vascular
Function, and Circulating Endothelial Progenitor Cells in Diabetic
Patients With Non-ST-Segment Elevation Acute Coronary Syndrome Requiring
Coronary Stenting: A Prospective, Randomized, Crossover Trial.
Source
JACC: Cardiovascular Interventions. 10 (16) (pp 1646-1658), 2017. Date of
Publication: 28 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study compared adenosine-associated pleiotropic effects of
the 2 P2Y<inf>12</inf> receptor antagonists on vascular function, systemic
inflammation, and circulating endothelial progenitor cells (EPCs).
Background Both ticagrelor and prasugrel have potent antiplatelet effects.
However, only ticagrelor inhibits cellular uptake of adenosine. Methods
Using a randomized, crossover design with 10-week follow-up ticagrelor or
prasugrel was administered to type 2 diabetic patients with non-ST-segment
elevation acute coronary syndrome requiring stent implantation. A total of
62 patients underwent randomization in a 1:1 ratio to receive ticagrelor
or prasugrel for 5 weeks followed by a direct cross over to the
alternative treatment for 5 additional weeks. Brachial artery
flow-mediated dilation, inflammatory markers, and number of circulating
EPCs were compared. Results Improvement in brachial artery flow-mediated
dilation was greater in the ticagrelor group (0.15 +/- 0.19 mm vs. -0.03
+/- 0.18 mm; p < 0.001). Moreover, ticagrelor compared with prasugrel
decreased interleukin 6 (-0.58 +/- 0.43 pg/ml vs. -0.05 +/- 0.24 pg/ml; p
< 0.001), tumor necrosis factor alpha (-5.62 +/- 4.40 pg/ml vs. -0.42 +/-
2.64 pg/ml; p < 0.001), and increased adiponectin (2.31 +/- 2.00 mug/ml
vs. 0.08 +/- 1.50 mug/ml; p < 0.001) during 10-week follow-up. Other
inflammatory cytokines like high-sensitivity C-reactive protein and
soluble vascular cell adhesion molecule-1 were decreased in both groups.
Ticagrelor compared with prasugrel significantly increased absolute
numbers of circulating EPCs CD34+/KDR+ (42.5 +/- 37.8 per mul vs. -28.2
+/- 23.7 per mul; p < 0.001), CD34+/CD117+ (51.9 +/- 77.2 per mul vs.
-66.3 +/- 45.2 per mul; p < 0.001), and CD34+/CD133+ (55.2 +/- 69.2 per
mul vs. -28.0 +/- 34.1 per mul; p < 0.001). Conclusions Compared with
prasugrel, ticagrelor significantly decreased inflammatory cytokines such
as interleukin 6 and tumor necrosis factor alpha and increased circulating
EPCs, contributing to improved arterial endothelial function in diabetic
non-ST-segment elevation acute coronary syndrome patients. Thus, data
support that pleiotropic effects of ticagrelor beyond its potent
antiplatelet effects could contribute to additional clinical benefits.
(Comparison of Ticagrelor vs. Prasugrel on Inflammation, Arterial
Stiffness, Endothelial Function, and Circulating Endothelial Progenitor
Cells in Diabetic Patients With Non-ST Elevation Acute Coronary Syndrome
[NSTE-ACS] Requiring Coronary Stenting; NCT02487732)<br/>Copyright &#xa9;
2017 American College of Cardiology Foundation

<67>
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.

<68>
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.

<69>
Accession Number
621462679
Author
Wang Y.; Zhu S.; Du R.; Zhou J.; Chen Y.; Zhang Q.
Institution
(Wang, Du, Zhou, Chen, Zhang) Department of Cardiology, Sichuan
University, West China Hospital, Chengdu, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Statin initiation and renal outcomes following isolated coronary artery
bypass grafting: A meta-Analysis.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 282-290), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The effects of preoperative statin therapy (PST) on renal
outcomes in patients with isolated coronary artery bypass grafting (CABG)
are in controversial. This study aimed to assess the effects of
preoperative statin use on postoperative renal outcomes in patients
undergoing isolated CABG. EVIDENCE ACQUISITION: PubMed, EMBASE, and
Cochrane Library were searched for studies published up to February 2017.
Pooled odds ratio (OR) and its corresponding 95% confidence interval (95%
CI) were calculated. Outcomes evaluated were occurrence of postoperative
acute kidney injury (AKI)/failure, requirement of any postoperative renal
replacement therapy (RRT) and change in serum creatinine (Scr) levels. We
used random-effects model and calculated pooled effect estimate of outcome
between statin and non-statin use groups. EVIDENCE SYNTHESIS: Eighteen
studies consisting of 32,747 patients following CABG were included. PST
was associated with a significant protective effect for perioperative
renal dysfunction (OR 0.89; 95% CI: 0.82-0.97; P=0.01) and postoperative
requirement for RRT (OR 0.54; 95% CI: 0.41-0.72; P=0.001) in patients
undergoing CABG surgery. However, there were no effects of preoperative
statin therapy on the risk of postoperative AKI and serum creatinine
concentration. In the subgroup of patients after on-pump CABG surgery, PST
significantly reduced the perioperative renal dysfunction and requirement
for RRT (OR 0.69; 95% CI: 0.53-0.89; P=0.005, OR 0.51; 95% CI: 0.30-0.87;
P=0.014, respectively). CONCLUSIONS: In patients undergoing isolated CABG,
PST might be associated with lower risk of postoperative renal dysfunction
and the requirement for RRT. However, PST may not reduce the risk of AKI.
Future large well-designed randomized controlled trials are needed on this
topic.<br/>Copyright &#xa9; 2018 Edizioni Minerva Medica.

<70>
Accession Number
621462666
Author
Laguna G.; Di Stefa No S.; Maroto L.; Fulquet E.; Echevarria J.R.; Revilla
A.; Uruena N.; Sevilla T.; Arnold R.; Ramos B.; Gutierrez H.; Serrador A.;
San Roman J.A.
Institution
(Laguna, Di Stefa No, Fulquet, Echevarria) Department of Cardiac Surgery,
Clinic University Hospital of Valladolid, Avenue Ramon y Cajal, Valladolid
47003, Spain
(Maroto) Department of Cardiac Surgery, MediClin Herzzentrum Coswig,
Coswig (Anhalt), Germany
(Revilla, Uruena, Sevilla, Arnold, Ramos, Gutierrez, Serrador, San Roman)
Department of Cardiology, Clinic University Hospital of Valladolid,
Valladolid, Spain
Title
Effect of direct intramyocardial autologous stem cell grafting in the
sub-Acute phase after myocardial infarction.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 259-267), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: To assess the efficacy and safety of intramyocardial
autologous bone marrow mononuclear stem cells (BMMNC) grafting combined
with coronary artery bypass grafting (CABG) on ventricular remodeling and
global and regional wall motion after acute transmural myocardial
infarction (AMI). METHODS: Randomized controlled trial including 20
patients with non-revascularized transmural AMI, left ventricular ejection
fraction (LVEF) lower than 50% and surgical indication for CABG. The stem
cell group was treated with BMMNC grafting by direct intramyocardial
injection between the 10th and 15th days after AMI (subacute phase)
combined with CABG under cardiopulmonary bypass; the control group was
only treated with CABG. Magnetic resonance imaging with gadolinium and
stress echocardiography were performed presurgery and 9 months
postsurgery. RESULTS: Seventeen patients completed the follow-up. The
baseline characteristics of both groups were homogeneous. No significant
differences were found in the increase in LVEF (control: 6.99+/-4.60,
cells: 7.47+/-6.61, P=0.876) or in the decrease in global (control:
0.28+/-0.39, cells: 0.22+/-0.28, P=0.759) or regional (control:
0.52+/-0.38, cells: 0.74+/-0.60, P=0.415) wall motion indices between the
control and stem cell groups of AMI patients. No differences were found in
the recovered non-viable segments (control: 1.29+/-1.11, cells:
2.50+/-1.41, P=0.091) or in the decrease in end-diastolic (control:
14.05+/-19.72, cells: 18.40+/-29.89, P=0.725) or end-systolic (control:
15.42+/-13.93, cells: 23.06+/-25.03, P=0.442) volumes. No complications
from stem cell grafting were observed. CONCLUSIONS: The results from our
study reported herein suggest that intramyocardial BMMNC administration
during CABG in patients with AMI causes no medium-To long-Term improvement
in ventricular remodeling.<br/>Copyright &#xa9; 2018 Edizioni Minerva
Medica.

<71>
Accession Number
621462662
Author
Mostafa E.A.; El Midany A.A.; Taha A.S.; El-Aasy S.R.; Doghish A.A.; Helmy
A.; Mansour S.A.; Khorshid R.; Ashor H.E.; Elnahas Y.; Saffan M.
Institution
(Mostafa, El Midany, Taha, El-Aasy, Doghish, Helmy, Mansour, Khorshid,
Ashor, Elnahas) Department of Cardiovascular and Thoracic Surgery, Faculty
of Medicine, Ain-Shams University Hospital, Ramses, Abbassia, Cairo 11588,
Egypt
(Saffan) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, Banha University, Banha, Egypt
Title
On-X versus St Jude medical mechanical prosthesis in mitral position: Are
we moving forward in design technology?.
Source
Journal of Cardiovascular Surgery. 59 (2) (pp 252-258), 2018. Date of
Publication: April 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Continuous effort is still provided in designing optimal
artificial heart valves with better hemodynamic function and reduced
thromboembolic potential. The question is do we have moved forward toward
this goal or not. METHODS: A prospective, randomized comparative study was
done on 360 patients scheduled for elective mitral valve replacement.
Patients were grouped into an On-X group (N.=180), who received On-X
mechanical valve, and a SJM group (N.=180), who received St Jude
mechanical valve. Echocardiographic and clinical assessments were
performed for all patients at 6 and 12 months follow-up period. RESULTS:
Rheumatic heart disease was the most common cause of valve affection
(94.2%). Early mortality was 6.4%. The mean follow-up time was 3.11+/-2.44
years. No structural or non-structural valvular dysfunction and no
thromboembolism cases were encountered. Late valve thrombosis
was1.9%/patient-year in On-X group and 2.1%/patient-year in SJM group. The
mean EOA was higher in On-X group (2.0+/-0.3 cm2) than in SJM group
(1.9+/-0.2 cm2), (P>=0.05). The mean EOAI was higher in On-X group
(1.1+/-0.1 cm2/m2) than in SJM group (1.0+/-0.1 cm2/m2), (P=0.034),
especially significant in small valve size (25 mm) where it was 1.09+/-021
cm2/m2 in On-X group and 0.93+/-0.12 cm2/m2 in SJM group (P=0.02).
CONCLUSIONS: On-X and St Jude prosthetic valves have a comparable
hemodynamic performance in mitral position. However, On-X prosthesis might
have a forward step on the way of design technology that may allow better
function in terms of EOA and EOAI especially in smaller valve
size.<br/>Copyright &#xa9; 2018 Edizioni Minerva Medica.

<72>
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

<73>
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

<74>
Accession Number
618736209
Author
Kano S.; Yamamoto M.; Shimura T.; Kagase A.; Tsuzuki M.; Kodama A.; Koyama
Y.; Kobayashi T.; Shibata K.; Tada N.; Naganuma T.; Araki M.; Yamanaka F.;
Shirai S.; Mizutani K.; Tabata M.; Ueno H.; Takagi K.; Higashimori A.;
Otsuka T.; Watanabe Y.; Hayashida K.
Institution
(Kano, Yamamoto, Otsuka) Department of Cardiology, Toyohashi Heart Canter,
2 1-1 Gobudori, Oyamachyo, Toyohashi, Aichi 441-8530, Japan
(Shimura, Higashimori) Department of Cardiology, Toyohashi Heart Canter,
Japan
(Kagase) Department of Cardiology, Sendai Kosei Hospital, Japan
(Tsuzuki) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Kodama, Takagi) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Japan
(Koyama, Watanabe) Department of Cardiology, Syonan Kamakura General
Hospital, Japan
(Kobayashi, Hayashida) Department of Cardiology, Kokura Memorial Hospital,
Japan
(Shibata) Department of Cardiology, Osaka City General Hospital, Japan
(Tada) Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa
Medical Center, Chiba, Japan
(Naganuma) Department of Cardiology, Toyama University Hospital, Japan
(Araki) Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
(Yamanaka) Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka,
Japan
(Shirai) Department of Hygiene and Public Health, Nippon Medical School,
Tokyo, Japan
(Mizutani) Center for Clinical Research, Nippon Medical School Hospital,
Tokyo, Japan
(Tabata) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Ueno) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Gait speed can predict advanced clinical outcomes in patients who undergo
transcatheter aortic valve replacement insights from a Japanese
multicenter registry.
Source
Circulation: Cardiovascular Interventions. 10 (9) (no pagination), 2017.
Article Number: e005088. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Gait speed reflects an important factor of frailty and is
associated with an increased risk of late mortality in patients with
cardiac disease. This study sought to assess the prognostic value of gait
speed in elderly patients who underwent transcatheter aortic valve
replacement. Methods and Results-We investigated the 5-m or 15-feet gait
speed (m/sec) in 1256 patients who underwent transcatheter aortic valve
implantation using data from the OCEAN-TAVI Japanese multicenter registry
(Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve
Implantation). Baseline characteristics, procedural outcomes, and
all-cause mortality were compared among groups defined by differential
gait speed classification: model 1, normal (0.83 m/sec; n=563; 44.8%),
slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (0.83 m/sec; n=205; 16.3%),
unable to walk (n=48; 3.8%); and model 2, classification and regression
tree survival model indicating the threshold of gait speed as 0.385 m/sec
(0.385 m/sec; n=1080 versus =0.385 m/sec; n=117). The cumulative 1-year
mortality rate showed significant differences in the classical gait speed
groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P0.001) and
survival classification and regression tree group in model 2 (7.7% versus
21.9%; P0.001). The slowest walkers and those unable to walk demonstrated
independent associations with increased midterm mortality after adjustment
for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence
interval, 1.03-3.26, 2.22-8.72; P=0.039, 0.001, respectively). Gait speed
0.385 m/sec determined by classification and regression tree also
independently associated with worse prognosis (hazard ratio, 2.40; 95%
confidence interval, 1.75-5.88; P=0.001). Conclusions-Gait speed using
both traditional and specific classification is useful as a potential
marker for predicting vulnerable patients associated with adverse clinical
outcomes after transcatheter aortic valve replacement..<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

<75>
Accession Number
618452031
Author
Schwarz K.; Singh S.; Parasuraman S.K.; Rudd A.; Shepstone L.; Feelisch
M.; Minnion M.; Ahmad S.; Madhani M.; Horowitz J.; Dawson D.K.; Frenneaux
M.P.
Institution
(Schwarz, Singh, Parasuraman, Rudd, Dawson) School of Medicine and
Dentistry, University of Aberdeen, Aberdeen, United Kingdom
(Schwarz) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom
(Parasuraman, Shepstone, Frenneaux) Norwich Medical School, University of
East Anglia, Norwich, United Kingdom
(Feelisch, Minnion) University of Southampton, Southampton, United Kingdom
(Ahmad) Aston Medical Research Institute, Aston University, Birmingham,
United Kingdom
(Horowitz) Basil Hetzel Institute, University of Adelaide, Adelaide,
Australia
(Madhani) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
Title
Inorganic nitrate in angina study: A randomized double-blind
placebo-controlled trial.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e006478. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--In this double-blind randomized placebo-controlled crossover
trial, we investigated whether oral sodium nitrate, when added to existing
background medication, reduces exertional ischemia in patients with
angina. Methods and Results--Seventy patients with stable angina, positive
electrocardiogram treadmill test, and either angiographic or functional
test evidence of significant ischemic heart disease were randomized to
receive oral treatment with either placebo or sodium nitrate (600 mg; 7
mmol) for 7 to 10 days, followed by a 2-week washout period before
crossing over to the other treatment (n=34 placebo-nitrate, n=36
nitrate-placebo). At baseline and at the end of each treatment, patients
underwent modified Bruce electrocardiogram treadmill test, modified
Seattle Questionnaire, and subgroups were investigated with dobutamine
stress, echocardiogram, and blood tests. The primary outcome was time to 1
mm ST depression on electrocardiogram treadmill test. Compared with
placebo, inorganic nitrate treatment tended to increase the primary
outcome exercise time to 1 mm ST segment depression (645.6 [603.1, 688.0]
seconds versus 661.2 [6183, 704.0] seconds, P=0.10) and significantly
increased total exercise time (744.4 [702.4, 786.4] seconds versus 760.9
[719.5, 802.2] seconds, P=0.04; mean [95% confidence interval]). Nitrate
treatment robustly increased plasma nitrate (18.3 [15.2, 21.5] versus
297.6 [218.4, 376.8] mumol/L, P < 0.0001) and almost doubled circulating
nitrite concentrations (346 [285, 405] versus 552 [398, 706] nmol/L,
P=0.003; placebo versus nitrate treatment). Other secondary outcomes were
not significantly altered by the intervention. Patients on antacid
medication appeared to benefit less from nitrate supplementation.
Conclusions--Sodium nitrate treatment may confer a modest exercise
capacity benefit in patients with chronic angina who are taking other
background medication.<br/>Copyright &#xa9; 2017 The Authors.

<76>
Accession Number
618451983
Author
Khan A.A.; Chung M.J.; Novak E.; Brown D.L.
Institution
(Khan) Department of Internal Medicine, Washington University School of
Medicine, St. Louis, MO, United States
(Chung, Novak, Brown) Cardiovascular Division, Washington University
School of Medicine, St. Louis, MO, United States
Title
Increased hazard of myocardial infarction with insulin-provision therapy
in actively smoking patients with diabetes mellitus and stable ischemic
heart disease: The BARI 2D (Bypass Angioplasty Revascularization
Investigation 2 Diabetes) trial.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e005946. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--In the BARI 2D (Bypass Angioplasty Revascularization
Investigation 2 Diabetes) trial, randomization of diabetic patients with
stable ischemic heart disease to insulin provision (IP) therapy, as
opposed to insulin sensitization (IS) therapy, resulted in biochemical
evidence of impaired fibrinolysis but no increase in adverse clinical
outcomes. We hypothesized that the prothrombotic effect of IP therapy in
combination with the hypercoagulable state induced by active smoking would
result in an increased risk of myocardial infarction (MI). Methods and
Results--We analyzed BARI 2D patients who were active smokers randomized
to IP or IS therapy. The primary end point was fatal or nonfatal MI. PAI-1
(plasminogen activator inhibitor 1) activity was analyzed at 1, 3, and 5
years. Of 295 active smokers, MI occurred in 15.4% randomized to IP and in
6.8% randomized to IS over the 5.3 years (P=0.023). IP therapy was
associated with a 3.2-fold increase in the hazard of MI compared with IS
therapy (hazard ratio: 3.23; 95% confidence interval, 1.43- 7.28;
P=0.005). Baseline PAI-1 activity (19.0 versus 17.5 Au/mL, P=0.70) was
similar in actively smoking patients randomized to IP or IS therapy.
However, IP therapy resulted in significantly increased PAI-1 activity at
1 year (23.0 versus 16.0 Au/mL, P=0.001), 3 years (24.0 versus 18.0 Au/mL,
P=0.049), and 5 years (29.0 versus 15.0 Au/mL, P=0.004) compared with IS
therapy. Conclusions--Among diabetic patients with stable ischemic heart
disease who were actively smoking, IP therapy was independently associated
with a significantly increased hazard of MI. This finding may be explained
by higher PAI-1 activity in active smokers treated with IP
therapy.<br/>Copyright &#xa9; 2017 The Authors.

<77>
Accession Number
621588365
Author
Mukaida H.; Matsushita S.; Inotani T.; Nakamura A.; Amano A.
Institution
(Mukaida, Matsushita, Amano) Department of Cardiovascular Surgery, Faculty
of Medicine, Juntendo University, Tokyo, Japan
(Mukaida, Inotani) Department of Clinical Engineering, Juntendo University
Hospital, Tokyo, Japan
(Nakamura) Department of Clinical Engineering, Faculty of Health Sciences,
Kyorin University, Tokyo, Japan
Title
Continuous renal replacement therapy with a polymethyl methacrylate
membrane hemofilter suppresses inflammation in patients after open-heart
surgery with cardiopulmonary bypass.
Source
Journal of Artificial Organs. 21 (2) (pp 188-195), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Cardiopulmonary bypass (CPB) induces a complex inflammatory response
involving an increase in inflammatory cytokines, called postperfusion
syndrome. Previous studies demonstrated that adsorption of the serum
cytokines can reduce acute inflammation and improve clinical outcomes. In
this study, patients were placed on continuous renal replacement therapy
(CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter
immediately after the start of an open-heart surgery with CPB and
throughout the postoperative course to prevent postperfusion syndrome. The
aim of this study was to assess whether continuous CRRT using a PMMA
filter (PMMA-CRRT) could affect cytokine expression and improve
perioperative outcomes. We designed a randomized controlled trial, which
included 19 consecutive adult patients on maintenance dialysis and 7
consecutive adult patients who were not on maintenance dialysis (NHD
group). Patients on maintenance dialysis were randomly divided into two
groups: Ten patients who received CRRT with a polysulfone membrane
hemofilter (PS group) and nine patients who received CRRT with a PMMA
membrane (PMMA group). Blood samples were collected from the radial or
brachial artery at five different time points. Comparisons between the PS,
PMMA, and NHD groups revealed a significant main effect of time on changes
in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p <
0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery
were significantly lower in the PMMA group than in the PS group, while
other cytokines measured in this study were not significantly different.
In addition, clinical outcomes were not significantly different between
the groups. The continuous use of PMMA-CRRT throughout the perioperative
period suppressed serum IL-6 and IL-8 concentrations, although there were
no differences in clinical outcomes.<br/>Copyright &#xa9; 2018, The
Japanese Society for Artificial Organs.

<78>
Accession Number
622245992
Author
Stephan F.; Berard L.; Rezaiguia-Delclaux S.; Amaru P.
Institution
(Stephan) Service de Reanimation adulte, Hopital Marie Lannelongue, Le
Plessis Robinson, France. f.stephan@ccml.fr
(Berard) APHP, GH HUEP, Hopital St Antoine, Plateforme de recherche
Clinique de l'Est Parisien (URC-Est-CRC-Est), Paris, France
(Rezaiguia-Delclaux, Amaru) Service de Reanimation adulte, Hopital Marie
Lannelongue, Le Plessis Robinson, France
Title
High-Flow Nasal Cannula Therapy Versus Intermittent Noninvasive
Ventilation in Obese Subjects After Cardiothoracic Surgery.
Source
Respiratory care. 62 (9) (pp 1193-1202), 2017. Date of Publication: 01 Sep
2017.
Abstract
BACKGROUND: Obese patients are considered at risk of respiratory failure
after cardiothoracic surgery. High-flow nasal cannula has demonstrated its
non-inferiority after cardiothoracic surgery compared to noninvasive
ventilation (NIV), which is the recommended treatment in obese patients.
We hypothesized that NIV was superior to high-flow nasal cannula for
preventing or resolving acute respiratory failure after cardiothoracic
surgery in this population.
METHODS: We performed a post hoc analysis of a randomized, controlled
trial. Obese subjects were randomly assigned to receive NIV for at least 4
h/d (inspiratory pressure, 8 cm H2O; expiratory pressure, 4 cm H2O; FIO2 ,
0.5) or high-flow nasal cannula delivered continuously (flow, 50 L/min,
FIO2 0.5).
RESULTS: Treatment failure (defined as re-intubation, switch to the other
treatment, or premature discontinuation) occurred in 21 of 136 (15.4%, 95%
CI 9.8-22.6%) subjects with NIV compared to 18 of 135 (13.3%, 95% CI
8.1-20.3%) subjects with high-flow nasal cannula (P = .62). No significant
differences were found for dyspnea and comfort scores. Skin breakdown was
significantly more common with NIV after 24 h (9.2%, 95% CI 5.0-16.0 vs
1.6%, 95% CI 1.0-6.0; P = .01). No significant differences were found for
ICU mortality (5.9% for subjects with NIV vs 2.2% for subjects with
high-flow nasal cannula, P = .22) or for any of the other secondary
outcomes.
CONCLUSIONS: Among obese cardiothoracic surgery subjects with or without
respiratory failure, the use of continuous high-flow nasal cannula
compared to intermittent NIV (8/4 cm H2O) did not result in a worse rate
of treatment failure. Because high-flow nasal cannula presents some
advantages, it may be used instead of NIV in obese patients after
cardiothoracic surgery.<br/>Copyright &#xa9; 2017 by Daedalus Enterprises.

<79>
Accession Number
622247456
Author
Liu Y.; Bian W.; Liu P.; Zang X.; Gu X.; Chen W.
Institution
(Liu, Bian, Liu, Zang, Gu, Chen) Department of Intensive Care Unit,
Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Title
Dexmedetomidine improves the outcomes in paediatric cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 852-858),
2018. Date of Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES Dexmedetomidine has been shown to decrease cardiac
complications in adults undergoing cardiac surgery. Results from clinical
trials of dexmedetomidine on outcomes following paediatric cardiac surgery
are controversial. METHODS We searched EMBASE, PubMed and Cochrane CENTRAL
databases for randomized controlled trials comparing the effect of
dexmedetomidine versus placebo or other anaesthetic drugs in paediatric
patients undergoing cardiac surgery. The primary outcome was the duration
of mechanical ventilation. The secondary outcomes were intensive care unit
stay, hospital length of stay (LOS), incidence of junctional ectopic
tachycardia and postoperative deaths. RESULTS Nine trials with a total of
837 patients were selected. Compared with controls, dexmedetomidine
significantly reduced the postoperative duration of mechanical ventilation
[in hours; n = 837; weighted mean difference-2.20, 95% confidence interval
(CI)-3.51 to-0.90; P = 0.001; I 2 = 97%], intensive care unit LOS (in
days; n = 737; weighted mean difference-0.47, 95% CI-0.90 to-0.03; P =
0.03; I 2 = 97%) and hospital LOS (in days; n = 291; weighted mean
difference-1.80, 95% CI-3.36 to-0.25; P = 0.02; I 2 = 96%).
Dexmedetomidine also significantly reduced the incidence of postoperative
junctional ectopic tachycardia (21/292 vs 50/263; risk ratio 0.40, 95% CI
0.25-0.64; P = 0.0001; I 2 = 0.0%), but there was no difference between
groups in postoperative deaths (4/182 vs 6/153; odds ratio 0.54, 95% CI
0.15-1.93; P = 0.34; I 2 = 0.0%). CONCLUSIONS Perioperative administration
of dexmedetomidine to paediatric patients undergoing cardiac surgery may
shorten the duration of mechanical ventilation, LOS in the intensive care
unit and in the hospital and reduce the incidence of junctional ectopic
tachycardia. More high-quality randomized controlled trials are encouraged
to verify the beneficial effect of dexmedetomidine before its clinical
application in paediatric patients undergoing surgery for congenital heart
disease.<br/>Copyright &#xa9; 2018 The Author.

<80>
Accession Number
622247434
Author
Dalen M.; Da Silva C.O.; Sartipy U.; Winter R.; Franco-Cereceda A.;
Barimani J.; Back M.; Svenarud P.
Institution
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Cardiac Surgery,
Karolinska University Hospital, Stockholm 17176, Sweden
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Da Silva, Winter, Barimani, Back) Department of Cardiology, Karolinska
University Hospital, Stockholm, Sweden
(Back) Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Title
Comparison of right ventricular function after ministernotomy and full
sternotomy aortic valve replacement: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 790-797),
2018. Date of Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac
surgery, possibly because of the opening of the pericardium. In minimally
invasive aortic valve replacement, the pericardium is only partially
incised. METHODS A randomized trial compared RV function after
ministernotomy versus full sternotomy in 40 adults undergoing aortic valve
replacement at the Karolinska University Hospital. Primary outcomes were
tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler
velocity, RV fractional area change and basal and mid-RV transversal
diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4,
the tricuspid annular plane systolic excursion had decreased in both
groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P <
0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was
higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler
RV velocity decreased significantly in patients who underwent sternotomy
[10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease
significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10
(9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in
both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001;
sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not
change on postoperative Day 4 in both groups. The differences between the
2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis
function was reduced after both ministernotomy and full sternotomy aortic
valve replacement, but the reduction was more pronounced in the full
sternotomy group. Global RV function was equally impaired in both groups
postoperatively. Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier:
NCT01972555.<br/>Copyright &#xa9; 2018 The Author.

<81>
Accession Number
2000776232
Author
Al Halabi S.; Newman J.; Farkouh M.E.; Fortuin D.; Leya F.; Sweeney J.;
Darki A.; Lopez J.; Steen L.; Lewis B.; Webb J.; Leon M.B.; Mathew V.
Institution
(Al Halabi, Newman, Leya, Darki, Lopez, Steen, Lewis, Mathew) Division of
Cardiology, Loyola University Medical Center, Maywood, Illinois, United
States
(Farkouh) Division of Cardiology, University of Toronto, Toronto, Ontario,
Canada
(Fortuin, Sweeney) Department of Cardiovascular Medicine, Mayo Clinic,
Phoenix, Arizona, United States
(Webb) Division of Cardiology, University of British Columbia, Vancouver,
British Columbia, Canada
(Leon) Division of Cardiology, Columbia University Medical Center, New
York, New York, United States
Title
Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy
Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Current guidelines recommend dual-antiplatelet therapy (DAPT) after
transcatheter aortic valve implantation (TAVI), although some studies
suggest mono-antiplatelet therapy is equally efficacious with an improved
safety profile. We performed a meta-analysis of studies comparing DAPT
with mono-antiplatelet therapy after TAVI. Study quality and heterogeneity
were assessed using Jadad score, Newcastle-Ottawa Scale, and Cochran's Q
statistics. Mantel-Haenszel odds ratios (ORs) were calculated using fixed
effect models as the primary analysis. Eight studies including 2,439
patients met the inclusion criteria. At 30 days, DAPT was associated with
an increased risk of all-cause mortality (OR 2.06, 95% confidence interval
[CI] 1.34 to 3.18, p = 0.001), major or life-threatening bleeding (OR
2.04, 95% CI 1.60 to 2.59, p <0.001), and major vascular complications (OR
2.15, 95% CI 1.51 to 3.06, p <0.001). There was no difference in the rate
of the combined end point of stroke or transient ischemic attack, or
myocardial infarction. Outcome data up to 6 months were available in 5
studies; all-cause mortality and stroke were similar between groups,
although major or life-threatening bleeding was more frequent with DAPT.
In conclusion, in patients undergoing TAVI, DAPT is associated with
increased risk at 30 days of all-cause mortality, major or
life-threatening bleeding, and major vascular complications without a
decrease in ischemic complications; at 6 months, the excess bleeding risk
persisted. These data suggest a safety concern with DAPT and justify
further investigation of the optimal antiplatelet therapy regimen after
TAVI.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<82>
Accession Number
2000774397
Author
Ranucci M.; Johnson I.; Willcox T.; Baker R.A.; Boer C.; Baumann A.;
Justison G.A.; de Somer F.; Exton P.; Agarwal S.; Parke R.; Newland R.F.;
Haumann R.G.; Buchwald D.; Weitzel N.; Venkateswaran R.; Pistuddi V.
Institution
(Ranucci, Pistuddi) Department of Cardiothoracic and Vascular Anesthesia
and Intensive Care Unit, Istituto di Ricovero e Cura a Carattere
Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy
(Johnson, Agarwal) Department of Perfusion, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Johnson, Agarwal) Department of Anesthesia, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Willcox, Parke) Green Lane Cardiothoracic Unit and Cardiothoracic and
Vascular Intensive Care, Auckland City Hospital, Auckland, New Zealand
(Willcox, Parke) Department of Anaesthesiology, Faculty of Medical and
Health Sciences, University of Auckland, Auckland, New Zealand
(Baker, Newland) Cardiac Research and Perfusion, Cardiac and Thoracic
Surgical Unit, Flinders Medical Centre and Flinders University, Adelaide,
South Australia, Australia
(Boer, Haumann) Department of Anesthesiology, Institute for Cardiovascular
Research, VU University Medical Center, Amsterdam, Netherlands
(Boer, Haumann) Department of Cardiothoracic Surgery, Institute for
Cardiovascular Research, VU University Medical Center, Amsterdam,
Netherlands
(Baumann, Buchwald) Department of Anaesthesiology, Intensive Care,
Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil,
Ruhr University, Bochum, Germany
(Baumann, Buchwald) Department of Cardiac and Thoracic Surgery, BG
University Hospital Bergmannsheil, Ruhr University, Bochum, Germany
(Justison, Weitzel) Department of Perfusion, University of Colorado
Denver, Aurora, Colo, United States
(Justison, Weitzel) Department of Anesthesiology, University of Colorado
Denver, Aurora, Colo, United States
(de Somer) Heart Centre, University Hospital Ghent, Ghent, Belgium
(Exton, Venkateswaran) Department of Cardiothoracic Surgery, University
Hospital of South Manchester National Health Service Foundation Trust,
Manchester, United Kingdom
Title
Goal-directed perfusion to reduce acute kidney injury: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a goal-directed perfusion (GDP) strategy
aimed at maintaining oxygen delivery (DO<inf>2</inf>) at >=280
mL.min^-1.m^-2 reduces the incidence of acute kidney
injury (AKI). Methods: This multicenter randomized trial enrolled a total
of 350 patients undergoing cardiac surgery in 9 institutions. Patients
were randomized to receive either GDP or conventional perfusion. A total
of 326 patients completed the study and were analyzed. Patients in the
treatment arm were treated with a GDP strategy during cardiopulmonary
bypass (CPB) aimed to maintain DO<inf>2</inf> at >=280
mL.min^-1.m^-2. The perfusion strategy for patients in
the control arm was factored on body surface area and temperature. The
primary endpoint was the rate of AKI. Secondary endpoints were intensive
care unit length of stay, major morbidity, red blood cell transfusions,
and operative mortality. Results: Acute Kidney Injury Network (AKIN) stage
1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95%
confidence interval [CI], 0.25-0.83; P =.01). AKIN stage 2-3 did not
differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P =.528).
There were no significant differences in secondary outcomes. In a
prespecified analysis of patients with a CPB time between 1 and 3 hours,
the differences in favor of the treatment arm were more pronounced, with
an RR for AKI of 0.49 (95% CI, 0.27-0.89; P =.017). Conclusions: A GDP
strategy is effective in reducing AKIN stage 1 AKI. Further studies are
needed to define perfusion interventions that may reduce more severe
levels of renal injury (AKIN stage 2 or 3).<br/>Copyright &#xa9; 2018 The
American Association for Thoracic Surgery

<83>
Accession Number
620560783
Author
Germanoska B.; Coady M.; Ng S.; Fermanis G.; Miller M.
Institution
(Germanoska, Coady, Ng, Fermanis) St George Hospital, Kogarah, Australia
(Miller) Ambulance Service of New South Wales, Rozelle, Australia
Title
The reliability of carotid ultrasound in determining the return of
pulsatile flow: A pilot study.
Source
Ultrasound. 26 (2) (pp 118-126), 2018. Date of Publication: 01 May 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Manual palpation of pulses is unreliable in detecting pulsatile flow in
human participants, complicating the assessment of return of spontaneous
circulation after cardiac arrest. Ultrasound may offer an alternative.
This study's objective was to investigate whether return of pulsatile flow
in humans can be reliably assessed by common carotid artery ultrasound. We
conducted a single-blinded randomised study of common carotid artery
ultrasound using 20 cardiopulmonary bypass patients to model the return of
pulsatile flow. Synchronised time-stamped videos of radial artery invasive
blood pressure and 10 two-dimensional or 10 colour Doppler ultrasounds
were recorded. Three independent reviewers recorded the timestamp where
they considered pulsatile flow was first visible on ultrasound. Ultrasound
times were compared to the onset of arterial line pulsatile flow and
reliability assessed by intraclass correlation coefficient. The median
difference between radial artery and ultrasound flow time (interquartile
range (range)) was 24 seconds (5-40 (0-93)) for two-dimensional and 5
seconds (2-17 (-28 to 188)) for colour Doppler. The intraclass correlation
coefficient for two-dimensional ultrasound was 0.86 (95%CI 0.63-0.96) and
0.32 (95%CI -0.01 to 0.71) for colour Doppler. The median (interquartile
range (range)) mean arterial pressure where ultrasound flow occurred for
two-dimensional ultrasound was 62 mmHg (49-74 (33-82)) and 56 mmHg (52-73
(43-83)) for colour Doppler. In our pilot study, two-dimensional
ultrasound was reliable in detecting the return of pulsatile flow. Colour
Doppler detected pulsatile flow earlier and at lower mean arterial
pressure but was not reliable, although a larger study is needed to
determine colour Doppler's utility.<br/>Copyright &#xa9; 2018, &#xa9; The
British Medical Ultrasound Society 2018.

<84>
Accession Number
622228591
Author
Straiton N.; Jin K.; Bhindi R.; Gallagher R.
Institution
(Straiton, Jin, Gallagher) Sydney Nursing School, University of Sydney,
Sydney, NSW, Australia
(Straiton, Bhindi) Department of Cardiology, Royal North Shore Hospital,
Sydney, NSW, Australia
(Bhindi) The University of Sydney, Sydney, NSW, Australia
Title
Functional capacity and health-related quality of life outcomes post
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Age and Ageing. 47 (3) (pp 478-482), 2018. Date of Publication: 01 May
2018.
Publisher
Oxford University Press
Abstract
Background: transcatheter aortic valve replacement (TAVR) provides
prognostic benefit for high surgical-risk patients with severe aortic
stenosis (AS), yet the impact to patient outcomes is far less understood.
Method: we performed a systematic review and meta-analysis to evaluate
functional capacity and health-related quality of life (HRQoL) outcomes
for patients up to 12 months post TAVR. A total of 20 eligible
publications, comprising randomised-controlled trials, observational
studies and a registry study were identified from electronic databases,
including MEDLINE, EMBASE, Cochrane Library and others (inception to
February 2017). Results: the total sample was 2,775 with a mean age of
81.8 +/- 2.1 years, more than half (52%) were female and high surgical
risk 9.6 +/- 4.3% mean STS (Society of Thoracic Surgeons risk model). Post
TAVR, patients had significant improvement in functional capacity of > 40
m in the 6-minute walk test (6MWT) (95% confidence interval (CI)
9.69-73.28) and a clinically meaningful increase in ability to perform
daily physical-based tasks (Duke Activity Status Index (DASI), mean
difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved
consistently following TAVR regardless of measure used. Significant
increases occurred in the physical component summary scores (PCS) of the
short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12)
points). Conclusion: functional capacity and HRQoL improved substantially
following TAVR, despite evolving patient selection criteria, thus TAVR
continues to provide a directly beneficial option for severe AS
patients.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the British Geriatrics Society. All rights
reserved.

<85>
Accession Number
622222736
Author
Glaser N.; Jackson V.; Franco-Cereceda A.; Sartipy U.
Institution
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Glaser) Department of Cardiology, Stockholm South General Hospital,
Stockholm, Sweden
(Jackson, Franco-Cereceda, Sartipy) Department of Heart and Vascular
Theme, Karolinska University Hospital, Stockholm, Sweden
Title
Survival after Aortic Valve Replacement with Bovine or Porcine Valve
Prostheses: A Systematic Review and Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2018. Date of
Publication: 17 May 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Bovine and porcine bioprostheses are commonly used for surgical
aortic valve replacement. It is unknown if the long-term survival differs
between the two valve types. We performed a systematic review and
meta-analysis to compare survival in patients who underwent aortic valve
replacement and received a bovine or a porcine prosthesis. Methods We
performed a systematic search of Medline, Embase, Web of Science, and the
Cochrane Library. Cohort studies that compared survival between patients
who underwent aortic valve replacement and received either a bovine or a
porcine bioprosthesis and that reported overall long-term survival with
hazard ratio (HR) and 95% confidence interval (CI) were included. Two
authors independently reviewed articles considered for inclusion,
extracted the information from each study, and performed the quality
assessment. We performed a meta-analysis using a random effects model to
calculate the pooled HR (95% CI) for all-cause mortality. We did
sensitivity analyses to assess the robustness of our findings. Results
Seven studies published between 2010 and 2015 were included, and the
combined study population was 49,190 patients. Of these, 32,235 (66%)
received a bovine, and 16,955 (34%) received a porcine bioprosthesis.
There was no significant difference in all-cause mortality between
patients who received a bovine compared with a porcine bioprosthesis
(pooled HR 1.00, 95% CI: 0.92-1.09). Heterogeneity between studies was
moderate (55.8%, p = 0.04). Conclusions This systematic review and
meta-analysis suggest no difference in survival between patients who
received a bovine versus a porcine bioprosthesis after aortic valve
replacement. Our study provides valuable evidence for the continuing use
of both bovine and porcine bioprosthetic valves for surgical aortic valve
replacement. <br/>Copyright &#xa9; 2018, Georg Thieme Verlag KG. All
rights reserved.

<86>
Accession Number
622222162
Author
Doenst T.; Kirov H.; Moschovas A.; Gonzalez-Lopez D.; Safarov R.; Diab M.;
Bargenda S.; Faerber G.
Institution
(Doenst, Kirov, Moschovas, Gonzalez-Lopez, Safarov, Diab, Bargenda,
Faerber) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Title
Cardiac surgery 2017 reviewed.
Source
Clinical Research in Cardiology. (pp 1-16), 2018. Date of Publication: 17
May 2018.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2017, more than 21,000 published references can be found in
PubMed when entering the search term "cardiac surgery". This review
focusses on conventional cardiac surgery, considering the new
interventional techniques only if they were directly compared to classic
techniques but also entails aspects of perioperative intensive care
management. The publications last year provided a plethora of new and
interesting information that helped to quantify classic surgical treatment
effects and provided new guidelines for the management of structural heart
disease, which made comparisons to interventional techniques easier. The
field of coronary bypass surgery was primarily filled with confirmatory
evidence for the beneficial role of coronary artery bypass grafting for
complex coronary disease and equal outcomes for percutaneous coronary
intervention for less complex disease including main stem lesions. For
aortic valve treatment, the new guidelines provide an equal recommendation
for surgical and transcatheter aortic valve replacement for high and
intermediate risk giving specific check lists to individualize
decision-making by the heart team. For low-risk aortic stenosis, surgical
valve replacement remains the primary indication. For the mitral valve,
the importance of surgical experience of the individual surgeon on short-
and long-term outcome was presented and the prognostic impact of mitral
repair for primary mitral regurgitation was emphasized. In addition, there
were many relevant and interesting other contributions from the purely
operative arena in the fields of tricuspid disease as well as terminal
heart failure (i.e., transplantation and ventricular assist devices).
While this article attempts to summarize the most pertinent publications,
it does not have the expectation of being complete and cannot be free of
individual interpretation. As in recent years, it provides a condensed
summary that is intended to give the reader "solid ground" for up-to-date
decision-making in cardiac surgery.<br/>Copyright &#xa9; 2018
Springer-Verlag GmbH Germany, part of Springer Nature

<87>
Accession Number
622221591
Author
Verma S.; Mazer C.D.; Fitchett D.; Inzucchi S.E.; Pfarr E.; George J.T.;
Zinman B.
Institution
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fitchett) Division of Cardiology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Inzucchi) Section of Endocrinology, Yale University School of Medicine,
New Haven, CT, United States
(Pfarr) Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
(George) Boehringer Ingelheim International GmbH, Ingelheim, Germany
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
Title
Empagliflozin reduces cardiovascular events, mortality and renal events in
participants with type 2 diabetes after coronary artery bypass graft
surgery: subanalysis of the EMPA-REG OUTCOME randomised trial.
Source
Diabetologia. (pp 1-12), 2018. Date of Publication: 19 May 2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Aims/hypothesis: After coronary artery bypass graft (CABG) surgery in
individuals with type 2 diabetes, there remains a considerable residual
cardiovascular risk. In the EMPA-REG OUTCOME trial in participants with
type 2 diabetes and established cardiovascular disease, empagliflozin
reduced the risk of cardiovascular death by 38%, all-cause mortality by
32%, hospitalisation for heart failure by 35% and incident or worsening
nephropathy by 39% vs placebo when given in addition to standard of care.
The aim of this post hoc analysis of the EMPA-REG OUTCOME trial was to
determine the effects of the sodium glucose cotransporter 2 inhibitor
empagliflozin on cardiovascular events and mortality in participants with
type 2 diabetes and a self-reported history of CABG surgery. Methods: The
EMPA-REG OUTCOME trial was a randomised, double-blind, placebo-controlled
trial. Participants with type 2 diabetes and established cardiovascular
disease were randomised 1:1:1 to receive placebo, empagliflozin 10 mg or
empagliflozin 25 mg, once daily, in addition to standard of care. In
subgroups by self-reported history of CABG (yes/no) at baseline, we
assessed: cardiovascular death; all-cause mortality; hospitalisation for
heart failure; and incident or worsening nephropathy (progression to
macroalbuminuria, doubling of serum creatinine, initiation of renal
replacement therapy or death due to renal disease). Differences in risk
between empagliflozin and placebo were assessed using a Cox proportional
hazards model. Results: At baseline, 25% (1175/4687) of participants who
received empagliflozin and 24% (563/2333) of participants who received
placebo had a history of CABG surgery. In participants with a history of
CABG surgery, HRs (95% CI) with empagliflozin vs placebo were 0.52 (0.32,
0.84) for cardiovascular mortality, 0.57 (0.39, 0.83) for all-cause
mortality, 0.50 (0.32, 0.77) for hospitalisation for heart failure and
0.65 (0.50, 0.84) for incident or worsening nephropathy. Results were
consistent between participants with and without a history of CABG surgery
(p > 0.05 for treatment by subgroup interactions).
Conclusions/interpretation: In participants with type 2 diabetes and a
self-reported history of CABG surgery, treatment with empagliflozin was
associated with profound reductions in cardiovascular and all-cause
mortality, hospitalisation for heart failure, and incident or worsening
nephropathy. These data have important implications for the secondary
prevention of cardiovascular events after CABG in individuals with type 2
diabetes. Trial registration:: ClinicalTrials.govNCT01131676<br/>Copyright
&#xa9; 2018 The Author(s)