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<1>
Accession Number
2000822243
Author
Puskas J.D.; Yanagawa B.; Ely J.; Puskas J.; Gerdisch M.; Nichols D.;
Graeve A.; Fermin L.; Rhenman B.; Kapoor D.; Copeland J.; Quinn R.; Hughes
G.C.; Azar H.; McGrath M.; Wait M.; Kong B.; Martin T.; Douville E.C.;
Meyer S.; Jamieson W.R.E.; Ye J.; Landvater L.; Trotter T.; Armitage J.;
Askew J.; Accola K.; Levy P.; Duncan D.; Sethi G.; Razi A.; Hagberg R.;
Hamman B.; Swistel D.; Shoukfeh M.F.; Tutuska P.; Sai-Sudhakar C.B.;
Damiano R.; Pettersson G.; Campbell M.; Gregoric I.; Cameron D.; Blackwell
R.; Allen K.
Institution
(Puskas) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Gerdisch) Franciscan St. Francis Health, Indianapolis, Indiana, United
States
(Nichols, Graeve) Multicare Tacoma General, Tacoma, Washington, United
States
(Fermin, Rhenman, Kapoor) Southern Arizona Veterans Affairs Hospital,
Tucson, Arizona, United States
(Copeland) University of Arizona, Tucson, Arizona, United States
(Quinn) Maine Medical, Portland, Maine, United States
(Hughes) Duke University, Durham, North Carolina, United States
(Azar, McGrath) Sentara Norfolk General, Norfolk, Virginia, United States
(Wait) University of Texas Southwestern, Dallas, Texas, United States
(Kong) St. Joseph Mercy Hospital, Ann Arbor, Michigan, United States
(Martin) University of Florida, Gainesville, Florida, United States
(Douville) Providence Portland, Portland, Oregon, United States
(Meyer) University of Alberta, Edmonton, Alberta, Canada
(Ye) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Jamieson) Vancouver General Hospital, Vancouver, British Columbia, Canada
(Landvater) Carolina Cardiovascular, Raleigh, North Carolina, United
States
(Hagberg) Hartford Hospital, Hartford, Connecticut, United States
(Trotter) Oklahoma City VA, Oklahoma City, Oklahoma, United States
(Armitage, Askew) Mary Washington, Fredericksburg, Virginia, United States
(Accola) Florida Hospital, Orlando, Florida, United States
(Levy) New Mexico Heart Institute, Albuquerque, New Mexico, United States
(Duncan) Novant Health Forsyth Medical Center, Winston-Salem, North
Carolina, United States
(Yanagawa) St. Michael's Hospital, Toronto, Ontario, Canada
(Ely) On-X Life Technologies, Austin, Texas, United States
Title
Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic
Valve Replacement.
Source
Journal of the American College of Cardiology. 71 (24) (pp 2717-2726),
2018. Date of Publication: 19 June 2018.
Publisher
Elsevier USA
Abstract
Background: The burden oral anticoagulation is a limitation of mechanical
valve prostheses. Objectives: The aim of this study was to test whether
patients could be safely managed with dual-antiplatelet therapy (DAPT)
(aspirin 325 mg and clopidogrel 75 mg) or lower warfarin after On-X
mechanical aortic valve replacement (mAVR). Methods: PROACT (Prospective
Randomized On-X Anticoagulation Trial) (n = 576) is a multicenter (41
sites) noninferiority trial. From June 2006 through February 2014, 201
patients >=18 years of age without thromboembolic risk factors undergoing
mAVR were randomized to receive DAPT (n = 99) or standard warfarin plus
aspirin (n = 102) 3 months after mAVR (low-risk arm). From June 2006
through October 2009, 375 patients with 1 or more thromboembolic risk
factors were also randomized to lower intensity warfarin plus aspirin
(international normalized ratio 1.5 to 2.0; n = 185) or standard warfarin
plus aspirin (international normalized ratio 2.0 to 3.0; n = 190) 3 months
after mAVR (high-risk arm). Results: The low-risk arm was terminated for
excess cerebral thromboembolic events (3.12% per patient-year vs. 0.29%
per patient-year, p = 0.02) in the DAPT group at up to 8.8-year follow-up
(631.6 patient-years), with no differences in bleeding or all-cause
mortality. High-risk arm patients experienced significantly lower major
(1.59% per patient-year vs. 3.94% per patient-year, p = 0.002) and minor
(1.27% per patient-year vs. 3.49% per patient-year, p = 0.002) bleeding up
to 8.7-year follow-up (2,035.2 patient-years), with no differences in
thromboembolism (0.42% per patient-year vs. 0.09% per patient-year, p =
0.20) and all-cause mortality. Conclusions: DAPT was associated with
higher rates of thromboembolism and valve thrombosis compared with control
in the low-risk arm. International normalized ratios were safely
maintained at 1.5 to 2.0 in high-risk patients, without differences in
mortality or thromboembolic complications. (Randomized On-X
Anticoagulation Trial [PROACT]; NCT00291525)<br/>Copyright &#xa9; 2018

<2>
Accession Number
622517715
Author
Oldgren J.; Steg P.-G.; Hohnloser S.H.; Lip G.Y.; Ellis S.G.; Kimura T.;
Nordaby M.; Ten Berg J.M.; Bhatt D.L.; Cannon C.P.; Kleine E.
Institution
(Oldgren) Uppsala Clinical Rsch Cntr, Dept of Med Sciences, Uppsala Univ,
Uppsala, Sweden
(Steg) Dept of Cardiology, Hopital Bichat, Paris, France
(Hohnloser) Dept of Medicine, Div of Cardiology, Johann Wolfgang Goethe
Univ, Frankfurt, Germany
(Lip) Institute of Cardiovascular Sciences, Univ of Birmingham,
Birmingham, United Kingdom
(Ellis) Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United
States
(Kimura) Dept of Cardiovascular Medicine, Kyoto Univ, Kyoto, Japan
(Nordaby, Kleine) TA Cardiology Medicine, Boehringer Ingelheim GmbH,
Ingelheim, Germany
(Ten Berg) R and D Cardiology, St. Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Bhatt) Heart and Vascular Cntr, Brigham and Women's Hosp, Boston, MA,
United States
(Cannon) Cardiometabolic Trials, Baim Institute for Clinical Rsch, Boston,
MA, United States
Title
Subgroup analysis from the RE-DUAL PCI trial: Dual antithrombotic therapy
with dabigatran in patients with atrial fibrillation undergoing
percutaneous coronary intervention.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (pp e457),
2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the RE-DUAL PCI trial, we evaluated the safety and efficacy
of a dual antithrombotic therapy regimen using dabigatran and a P2Y12
platelet antagonist and we compared this with a triple therapy with
warfarin, aspirin and a P2Y12 platelet antagonist. In this abstract we
present major prespecified subgroups. Methods: The RE-DUAL PCI trial
(NCT02164864) was a phase IIIb, prospective, randomized trial that
enrolled 2725 patients at approximately 550 sites in 41 countries.
Patients were eligible if they had nonvalvular atrial fibrillation, and
had been successfully treated with percutaneous coronary intervention
(PCI) with a bare-metal or drug-eluting stent within the prior 120 hours.
Patients were either treatment-naive or receiving an oral anticoagulant
prior to PCI. The indication for PCI was either an acute coronary syndrome
or stable coronary artery disease. Exclusion criteria included patients
with bioprosthetic or mechanical heart valves, severe renal insufficiency,
or other major comorbidities. Patients were randomized to warfarin with
clopidogrel or ticagrelor, and aspirin for 1 to 3 months, or to dabigatran
110 mg or 150 mg twice daily -each with clopidogrel or ticagrelor. The
primary end point was the time to the first major or clinically relevant
nonmajor bleeding event through follow-up (a minimum of 6 months and a
maximum of 30 months). The study was designed to test for noninferiority
between each dabigatran dual therapy dose versus warfarin triple therapy.
The secondary thrombotic end point was death, myocardial infarction,
stroke, or unplanned revascularization, testing noninferiority between
both dabigatran doses combined and warfarin. The primary results were
published in the New England Journal of Medicine in 2017. We report here
outcomes in prespecified subgroups including acute coronary syndromes
(ACS) versus non-ACS, drug-eluting versus bare-metal stents, and also
concomitant P2Y12 platelet antagonist, i.e., ticagrelor versus
clopidogrel. Conclusions: The benefit of the dabigatran dual therapy
versus warfarin triple therapy in patients with atrial fibrillation who
had undergone PCI was consistent in subgroups of patients with ACS and
non-ACS, receiving drug-eluting and baremetal stents, and those treated
with ticagrelor or clopidogrel.

<3>
Accession Number
622517961
Author
Anonymous
Title
LBS-LBRS 2017 Abstracts.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (no
pagination), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
_oab The proceedings contain 40 papers. The topics discussed include:
efficacy and safety of dual acetylsalicylic acid plus ticagrelor or
ticagrelor alone antiplatelet strategy after coronary artery bypass
surgery at 12 months: randomized multicentre trial; a randomized
controlled trial of continued versus interrupted novel oral anti-coagulant
at the time of device surgery (BRUISE CONTROL-2); clinical benefit of
minimally-interrupted dabigatran versus uninterrupted warfarin for
catheter ablation of atrial fibrillation: a prospective randomized
multicenter trial; does high-intensity pitavastatin therapy further
improve clinical outcomes? the REAL-CAD study in 13,054 patients with
stable coronary artery disease; effects of anacetrapib on the incidence of
new-onset diabetes mellitus and on vascular events in people with
diabetes; evolocumab and outcomes in patients with peripheral artery
disease; time at blood pressure target and the risk of cardiovascular
diseases and mortality; and blood pressure measurement in the systolic
blood pressure intervention trial (SPRINT).

<4>
Accession Number
622517948
Author
Waldron N.H.; Cooter M.; Haney J.C.; Schroder J.N.; Milano C.A.; Piccini
J.P.; Mathew J.P.
Institution
(Waldron, Cooter, Mathew) Anesthesiology, Duke Univ Med Cntr, Durham, NC,
United States
(Haney, Schroder, Milano) Surgery, Duke Univ Med Cntr, Durham, NC, United
States
(Piccini) Medicine, Div of Cardiology, Duke Univ Med Cntr, Durham, NC,
United States
Title
Temporary neurotoxin treatment to prevent postoperative atrial
fibrillation.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (pp e462),
2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery,1 affecting 27%-40% of patients and
increasing risk for postoperative stroke, prolonged length of stay, and
mortality.2-4 Autonomic imbalance has been implicated in POAF,5-7 but few
prevention strategies target this imbalance. Epicardial botulinum toxin
injections have shown preliminary promise as a POAF prevention strategy in
a small randomized trial,8 but larger-scale evidence is lacking.
Therefore, we conducted a prospective double-blind randomized controlled
trial in order to determine if epicardial botulinum toxin injection is
safe and effective for the prevention of POAF after cardiac surgery.
Hypothesis: Epicardial fat pad injection of botulinum toxin reduces POAF
without increasing adverse events after cardiac surgery. Methods: Patients
undergoing coronary artery bypass grafting (CABG), valve surgery, or CABG
+ valve surgery who were able to provide informed consent were eligible.
Patients were randomized 1:1 to injection of botulinum toxin (250 units)
or normal saline (5mL) in 5 epicardial fat pads, with providers and
research staff blinded to treatment assignment. All patients underwent
continuous ECG monitoring until discharge. The primary endpoint was time
to POAF. Secondary endpoints included AF burden, length of stay, and
adverse events. Target sample size is 130 patients, which will provide 80%
power to detect a 40% relative risk reduction over the course of the study
(alpha=0.05). The primary endpoint will be compared with Cox proportional
hazards models using the intention to treat. Results: Trial recruitment is
complete, with 130/130 patients having completed in-hospital follow-up.
Analysis is ongoing, with results available for presentation at the annual
AHA meeting. For all randomized patients, we have collected data on
incidence, time to POAF, POAF burden, length of stay, and adverse events.
Conclusions: Data analysis from this double-blind randomized controlled
trial is ongoing. This trial will determine if epicardial fat pad
botulinum toxin injection is a safe and effective means of successfully
reducing the risk of POAF, a common and costly complication of cardiac
surgery.

<5>
Accession Number
622517451
Author
Kimura T.; Inoue T.; Taguchi I.; Iwata H.; Iimuro S.; Hiro T.; Nakagawa
Y.; Ozaki Y.; Ohashi Y.; Daida H.; Shimokawa H.; Nagai R.
Institution
(Kimura) Cardiovascular Medicine, Kyoto Univ, Graduate Sch of Medicine,
Kyoto, Japan
(Inoue) Dept of Cardiovascular Medicine, Dokkyo Med Univ, Mibu, Japan
(Taguchi) Dept of Cardiology, Dokkyo Med Univ Koshigaya Hosp, Saitama,
Japan
(Iwata) Cardiovascular Medicine, Juntendo Univ, Tokyo, Japan
(Iimuro) Teikyo Academic Rsch Cntr (TARC), Teikyo Univ, Tokyo, Japan
(Hiro) Dept of Medicine, Nihon Univ., Sch of Medicine, Kyoto, Japan
(Nakagawa) Cardiology, Tenri Hosp, Nara, Japan
(Ozaki) Cardiology, Fujita Health Univ Hosp, Toyoake, Japan
(Ohashi) Integrated Science and Technology for Sustainable Society, Chuo
Univ, Tokyo, Japan
(Daida) Cardiovascular Medicine, Juntendo Univ, Graduate Sch of Medicine,
Tokyo, Japan
(Shimokawa) Dept of Cardiovascular Medicine, Tohoku Univ, Graduate Sch of
Medicine, Sendai, Japan
(Nagai) NA, Jichi Med Univ, Tochigi, Japan
Title
Does high-intensity pitavastatin therapy further improve clinical
outcomes? the REAL-CAD study in 13,054 patients with stable coronary
artery disease.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (pp
e450-e451), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Current guidelines call for high-intensity statin therapy in
patients with coronary artery disease (CAD) based on several previous
"more or less statins" trials. However, no clear evidence regarding "more
or less statins" has been established in Asian population. Hypothesis: We
hypothesized that more intensive statin therapy would further improve
clinical outcomes even for Japanese patients in whom cardiovascular event
risk is lower than Western patients. Methods: A prospective, multicenter,
open-label, randomized controlled trial (Randomized Evaluation of
Aggressive or moderate Lipid lowering therapy with pitavastatin in
Coronary Artery Disease [REAL-CAD]) was conducted in patients with stable
CAD in Japan. Patients who achieved low-density lipoprotein cholesterol
(LDL-C) < 120 mg/dL during a 4-week run-in period (pitavastatin 1 mg/day)
were randomized 1:1 to high-dose (pitavastatin 4 mg/ day) or low-dose
(pitavastatin 1 mg/day) statin therapy. The primary endpoint is a
composite of cardiovascular death, non-fatal myocardial infarction,
nonfatal ischemic stroke, and unstable angina requiring emergency
hospitalization. Results: We randomized 13,054 patients from 733 Japanese
institutions to high-dose (N=6,526) or low-dose treatment (N=6,528).
Baseline demographics were age: 68 years, body mass index: 24.6, male:
83%, hypertension: 76%, diabetes: 40%, history of myocardial infarction:
51%, and previous coronary revascularization: 90%. Despite a high
incidence of concomitant hypertension, blood pressure was well controlled
(127.6+/-16.2/73.0+/-10.8 mmHg). In diabetic patients, mean HbA1c level
was also well controlled at 6.47+/-0.93%. Mean baseline LDL-C, HDL-C, and
TG were 87.9+/-19.0 mg/dL, 50.7+/-12.6 mg/dL and 144.7+/-89.6 mg/dL,
respectively. Six months after randomization, mean LDL-C was 73.8+/-20.3
mg/dL in the high-dose group and 89.4+/-21.4 mg/dL in the lowdose group.
Interpretation: The REAL-CAD study, one of the largest and firstin-Asia
randomized trials comparing high-dose and low-dose statin therapy, offers
pivotal evidence for the role of high-intensity statin therapy in
secondary CAD prevention. The final 5-year outcomes will be presented at
the meeting.

<6>
Accession Number
622517379
Author
Zhu Y.; Xu Z.; Cheng Z.; Mei J.; Chen X.; Wang X.; Zhao Q.
Institution
(Zhu, Zhao) Dept of Cardiac Surgery, Ruijin Hosp, Shanghai Jiaotong Univ,
Shanghai, China
(Xu) Dept of Cardiac Surgery, Changhai Hosp of Shanghai, Shanghai, China
(Cheng) Dept of Cardiac Surgery, Henan Provincial People's Hosp,
Zhengzhou, China
(Mei) Dept of Cardiac Surgery, Xinhua Hosp, Shanghai Jiaotong Univ,
Shanghai, China
(Chen) Dept of Cardiac Surgery, Nanjing First Hosp, Nanjing, China
(Wang) Dept of Cardiac Surgery, Jiangsu Province Hosp, Nanjing, China
Title
Efficacy and safety of dual acetylsalicylic acid plus ticagrelor or
ticagrelor alone antiplatelet strategy after coronary artery bypass
surgery at 12 months: Randomized multicentre trial.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (pp
e449-e450), 2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Ticagrelor has been shown to reduce mortality in patients
who underwent coronary artery bypass grafting (CABG), but its effect on
graft patency is still uncertain. We hypothesized that ticagrelor would
improve saphenous vein graft(SVG)patency after CABG at 12 months with or
without acetylsalicylic acid (ASA). Methods: We performed a prospective,
randomized, open-label, multicentre trial (NCT 02201771). 500 patients
from 6 sites undergoing isolated CABG were randomized to start
antiplatelet therapy with 1 of 3 regimens within 24 hours post-CABG to
continue for 12 months: ASA 100 mg QD (A group, n=166); ASA 100 mg QD plus
ticagrelor 90 mg BID (A+T group, n=168) or ticagrelor 90 mg BID (T group,
n=166). Graft patency was assessed by multislice computed tomographic
angiography (MSCTA) or coronary angiography (CAG). Patients were followed
for MACE (CV death, myocardial infarction, stroke) and bleeding. The
primary endpoint was the patency rate of SVG at 12 months and was analysed
on an intent-to-treat (ITT) basis. SVGs from dropouts were treated as
non-patency. Results: At 12 months, 93.4%(467/500) patients with 93.8%
(1369/1460) SVGs were assessed for primary endpoint. The patency
(Fitzgibbon Class A) rate of SVG at 12 months was 76.5% (371/485) in the A
group, 88.7% (432/487) in the A+T group, and 82.8% (404/488) in the T
group. The difference of patency rate for A+T vs A was 12.2% (95% CI
5.2-19.2%, p=0.0006), and for T vs A was 6.3% (95% CI -1.1-13.7%,
p=0.0962). The results of the Non-occlusion (Fitzgibbon Class A + Class B)
rate were similar. There were a few MACE in each group (9 in A group, 3 in
A+T group and 4 in T group). Only 5 major bleedings (all CABG -related
bleeding plus Non-CABGrelated major bleeding) were observed (2 in T group
and 3 in A+T group). These results are summarized in Table 1. Conclusions:
Compared with ASA monotherapy, ASA plus ticagrelor significantly improves
SVG patency after CABG at 12 months with no clinical concerns for major
bleeding. (Table Presented).

<7>
Accession Number
622517364
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Thorpe K.E.; Shehata N.
Institution
(Mazer) Anesthesia, St Michaels Hosp, Univ of Toronto, Toronto, Canada
(Whitlock) Dept of Clinical Epidemiology and Biostatistics, Population
Health Rsch Institute, McMaster Univ, Hamilton, Canada
(Fergusson) Depts of Medicine, Surgery, Sch of Epidemiology, Public Health
and Preventive Medicine, Univ of Ottawa, Ottawa, Canada
(Thorpe) Biostatistics, St. Michael's Hosp, Univ of Toronto, Toronto,
Canada
(Shehata) Depts of Medicine, Mount Sinai Hosp, Univ of Toronto, Toronto,
Canada
Title
TRiCS III - An international multicenter randomized trial of transfusion
requirements in cardiac surgery.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
and Resuscitation Science Symposium 2017. United States. 136 (pp e449),
2017. Date of Publication: December 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There is a critical need to determine the appropriate
threshold for red cell transfusion in patients undergoing cardiac surgery
since perioperative anemia and allogeneic red blood cell transfusions are
both independent predictors of morbidity and mortality. In addition, there
is considerable inter-physician and inter-hospital variability in
transfusion practice. While restrictive transfusion strategies have been
shown to reduce transfusion, their clinical effectiveness and safety in
cardiac surgery are not known. Methods: TRICS III is a multicenter
randomized controlled trial to evaluate the non-inferiority of a
restrictive transfusion strategy compared to a liberal transfusion
strategy in cardiac surgery patients with a preoperative European System
for Cardiac Operative Risk Evaluation (additive EuroSCORE I) of >=6
(NCT02042898). Patients were randomized to a "restrictive" strategy
(transfusion if hemoglobin <7.5 g/dL intraoperatively and postoperatively)
or a "liberal" strategy (transfusion if hemoglobin <9.5 g/dL in the
operating room or ICU, and <8.5 g/dL on the ward). The primary outcome is
a composite of in hospital death, myocardial infarction, stroke or new
renal failure requiring dialysis. Secondary outcomes include duration of
hospital stay and mechanical ventilation; and individual perioperative
adverse events including myocardial infarction, stroke, delirium,
infection, acute kidney injury, gut infarction, prolonged low cardiac
output state and blood product transfusion. Results: 5035 patients were
randomized at 74 sites in 19 countries from January 2014 to March 2017.
The overall mean age was 72+/-10 years, 65% were male, and the EuroSCORE
was 8+/-2. The overall mean cardiopulmonary bypass time was 120+/-58
minutes and aortic crossclamp time was 88+/-44 minutes. Conclusions: TRICS
III is the largest multicenter international transfusion study completed
to date in cardiac surgery. The results of this trial presented at the AHA
meeting will provide high quality generalizable data to guide transfusion
practice for cardiac surgery worldwide.

<8>
Accession Number
622518909
Author
Banik A.; Schwarzer R.; Knoll N.; Czekierda K.; Luszczynska A.
Institution
(Banik, Czekierda, Luszczynska) Psychology Department in Wroclaw, SWPS
University of Social Sciences and Humanities, Poland
(Schwarzer, Knoll) Department of Education and Psychology, Freie
Universitat Berlin, Germany
(Luszczynska) Trauma, Health, and Hazards Center, University of Colorado,
Colorado Springs, United States
Title
Self-efficacy and quality of life among people with cardiovascular
diseases: A meta-analysis.
Source
Rehabilitation Psychology. 63 (2) (pp 295-312), 2018. Date of Publication:
May 2018.
Publisher
American Psychological Association Inc. (E-mail: journals@apa.org)
Abstract
Purpose/Objective: Self-efficacy forms key modifiable personal resources
influencing illness management, rehabilitation participation, and their
outcomes such as perceived health-related quality of life (HRQOL) among
people with a cardiovascular disease (CVD). Yet, an overarching research
synthesis of the selfefficacy- HRQOL association in the CVD context is
missing. This systematic review and meta-analysis of research on the
self-efficacy-HRQOL relationship among people with CVD investigates
whether the strength of associations depends on conceptualizations of
self-efficacy and HRQOL (general vs. specific), presence of cardiovascular
surgery, the type of CVD diagnosis, and patients' age (up to 60 vs. older
than 60). Research Method/Design: We searched the following databases:
PsycINFO, PsycARTICLES, Academic Search Complete, Health Source:
Nursing/Academic Edition, and MEDLINE. This search resulted in 17 original
studies (k = 18 samples) included in the meta-analysis. Results: Findings
suggested that stronger self-efficacy was associated with better HRQOL (r
= .37; 95% CI [.29, .44]). Moderator analyses indicated stronger
associations when HRQOL was measured in a general way (compared to
CVD-specific) and when selfefficacy was measured in a general or
exercise-specific way (as opposed to CVD symptom-specific).
Self-efficacy-HRQOL associations were similar in strength across age
groups, regardless of presence of cardiovascular surgery, and among
patients diagnosed with different forms of CVD. Conclusions/ Implications:
General and exercise-specific self-efficacy are moderately related with
HRQOL among people with CVD after surgery or during rehabilitation.
Results need to be interpreted with caution due to heterogeneity of
original research and the dominance of cross-sectional
designs.<br/>Copyright &#xa9; 2018 American Psychological Association.

<9>
Accession Number
604760831
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Nugara F.; Yu L.-M.;
Flather M.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Altman, Yu) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Altman, Yu) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Botnar Research Centre, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Headington, Oxford, United Kingdom
(Lees, Nugara, Flather) Clinical Trials and Evaluation Unit, Royal
Brompton and Harefield NHS Trust, London, United Kingdom
(Lees, Flather) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
Title
Effects of on-pump and off-pump surgery in the arterial revascularization
trial.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 1059-1065), 2015.
Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The Arterial Revascularization Trial (ART) is a randomized
comparison of bilateral internal mammary artery (BIMA) versus single
internal mammary artery (SIMA) grafting in coronary artery bypass graft
(CABG) surgery and is one of the largest randomized trials of surgery ever
conducted. ART is also one of the largest studies of contemporary CABG
with a high proportion of off-pump surgeries (41%). The objective of this
post hoc analysis was to evaluate the surgical process and 1-year outcomes
for surgery performed on-pump compared with off-pump. METHODS: ART
randomized 3102 patients with multivessel coronary artery disease (CAD) to
SIMA or BIMA grafts to determine if BIMA grafts have an additional
survival advantage at 10 years. The 1-year interim analysis showed an
overall very low mortality and major morbidity rate irrespective of
whether the procedure was with an SIMA or BIMA. The surgical process and
1-year outcomes were analysed according to whether surgery was performed
on-pump or off-pump. RESULTS: Baseline variables were not statistically
significantly different between on- and off-pump surgery within each
treatment group after taking account of the effects of clustering by
individual surgeons. At both 30 days and 1 year, there was a low incidence
of death (1.2%, 2.3%), stroke (1.1%, 1.7%), myocardial infarction (MI)
(1.4%, 1.9%), repeat revascularization (0.5%, 1.5%) and wound
reconstruction (1.2%). A similar average number of grafts were performed
with on- and off-pump surgery (median = 3), but the duration of surgery
was 20-30 min and ventilation time ~2 h shorter with off-pump surgery.
Blood loss and platelet transfusions were lower in the off-pump group,
with no difference in the need for balloon pump or renal support. Sternal
wound reconstruction was similar with off-pump surgery in the SIMA group
(0.5 vs 0.6%) and lower with off-pump surgery in the BIMA group (1.4 vs
2.2%). Repeat revascularization was marginally higher in off-pump patients
at 30 days (0.8 vs 0.3%) and at 1 year (1.7 vs 1.3%). CONCLUSIONS: The
outcomes of contemporary CABG are excellent with low mortality, stroke,
myocardial infarction and need for wound reconstruction and repeat
revascularization whether performed on-pump or off-pump. CLINICAL TRIAL
REGISTRATION: Controlled-trials.com (ISRCTN46552265).<br/>Copyright &#xa9;
The Author 2014. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<10>
Accession Number
604760745
Author
Cheng X.; Tong J.; Hu Q.; Chen S.; Yin Y.; Liu Z.
Institution
(Cheng, Tong, Chen, Yin, Liu) Department of Cardiology, The Second
Affiliated Hospital, The Second Clinical Institute, Chongqing Medical
University, Chongqing, China
(Tong) Department of Respirology, The Second Affiliated Hospital, The
Second Clinical Institute, Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, The Third People's Hospital of
Chongqing, Chongqing, China
(Chen) Shanghai First People's Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
Title
Meta-analysis of the effects of preoperative renin-angiotensin system
inhibitor therapy on major adverse cardiac events in patients undergoing
cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 958-966), 2015.
Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The purpose of this meta-analysis was to assess the role of preoperative
renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac
events (MACE) in patients undergoing cardiac surgery. The Medline,
Cochrane Library and Embase databases were searched for clinical studies
published up to May 2014. Studies that evaluated the effects of
preoperative RASI therapy in cardiac surgery were included. Odds ratio
(OR) estimates were generated under a random-effects model. After a
literature search in the major databases, 18 studies were identified
[three randomized prospective clinical trials (RCTs) and 15 observational
trials] that reported outcomes of 54 528 cardiac surgery patients with (n
= 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy.
Pool analysis indicated that preoperative RASI therapy was not associated
with a significant reduction of early all-cause mortality [OR: 1.01; 95%
confidence interval (CI) 0.88-1.15, P = 0.93; I² = 25%],
myocardial infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I²
= 16%), or stroke (OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I² =
38%). Meta-regression analysis confirmed that there was a strong negative
correlation between the percentage of diabetics and early all-cause
mortality (P = 0.03). Furthermore, preoperative RASI therapy significantly
reduced mortality in studies containing a high proportion of diabetic
patients (OR: 0.84; 95% CI 0.71-0.99, P = 0.04; I² = 0%). In
conclusion, our meta-analysis indicated that although preoperative RASI
therapy was not associated with a lower risk of MACE in cardiac surgery
patients, it might provide benefits for diabetic patients.<br/>Copyright
&#xa9; The Author 2014. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
620594411
Author
Colella T.J.F.; King-Shier K.
Institution
(Colella) University Health Network/Toronto Rehab Cardiovascular
Prevention & Rehabilitation Program, Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto, Toronto, ON, Canada
(King-Shier) Faculty of Nursing, Department of Community Health Sciences,
University of Calgary, AB, Canada
Title
The effect of a peer support intervention on early recovery outcomes in
men recovering from coronary bypass surgery: A randomized controlled
trial.
Source
European Journal of Cardiovascular Nursing. 17 (5) (pp 408-417), 2018.
Date of Publication: 01 Jun 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background and aim: Examine the effect of a professionally-guided
telephone peer support intervention on recovery outcomes including
depression, perceived social support, and health services utilization
after coronary artery bypass graft surgery (CABG). Methods: A randomized
controlled trial was conducted with post-coronary artery bypass graft
surgery men (N=185) who were randomized before hospital discharge. The
intervention arm received telephone-based peer support through weekly
telephone calls from a peer volunteer over six weeks, initiated within 3-4
days of discharge. Results: Although a significant difference was detected
in pre-intervention depression scores at discharge, there were no
differences between groups in changes in depression scores at six weeks
(p=0.08), 12 weeks (0.49) or over time (p=0.51); and no significant
differences in perceived social support scores over time (p=0.94). At 12
weeks, the intervention group had significantly lower incidence of health
services utilization (family physician (p=0.02) and emergency room
(p=0.04)). Conclusions: Healthcare providers need to continue to
investigate novel interventions to enhance social support and reduce
depression in cardiac patients.<br/>Copyright &#xa9; 2017, &#xa9; The
European Society of Cardiology 2017.

<12>
Accession Number
622281712
Author
Tufano A.; Galderisi M.; Esposito L.; Trimarco V.; Sorriento D.; Gerusalem
G.; Picardi M.; Lancellotti P.; Pane F.
Institution
(Tufano, Picardi, Pane) Department of Clinical Medicine and Surgery,
Regional Reference Centre for Coagulation Disorders, Federico II
University Hospital, Via S. Pansini, 5, Naples 80131, Italy
(Galderisi, Esposito, Sorriento) Dipartimento di Scienze Biomediche
Avanzate, Universita Federico II, Napoli, Italy
(Trimarco) Dipartimento di Neuroscienze e Scienze Riproduttive Ed
Odontostomatologiche, Universita Federico II, Napoli, Italy
(Gerusalem) Department of Medical Oncology, CHU Sart Tilman Liege, Liege
University, Liege, Belgium
(Lancellotti) University of Liege Hospital, GIGA Cardiovascular Sciences,
Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liege,
Belgium
(Lancellotti) Gruppo Villa Maria Care and Research, Anthea, Hospital,
Bari, Italy
Title
Anticancer Drug-Related Nonvalvular Atrial Fibrillation: Challenges in
Management and Antithrombotic Strategies.
Source
Seminars in Thrombosis and Hemostasis. 44 (4) (pp 388-396), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Cancer patients may experience nonvalvular atrial fibrillation (AF) as a
manifestation of cardiotoxicity. AF may be a direct effect of a neoplasm
or, more often, appear as a postsurgical complication, especially after
thoracic surgery. AF may also develop as a consequence of anticancer
therapy (chemotherapy or radiotherapy), a condition probably
underestimated. Cancer patients with AF require a multidisciplinary
approach involving oncologists/hematologists, cardiologists, and
coagulation experts. An echocardiogram should be performed to detect
possible abnormalities of left ventricular systolic and diastolic
function, as well as left atrial dilation and the existence of valvular
heart disease, to determine pretest probability of sinus rhythm
restoration, and identify the best treatment. The choice of antiarrhythmic
treatment in cancer patients may be difficult because scanty information
is available on the interactions between anticancer agents and
antiarrhythmic drugs. A careful evaluation of the antithrombotic strategy
with the best efficacy/safety ratio is always needed. The use of vitamin K
antagonists (VKAs) may be problematic because of the unpredictable
therapeutic response and high bleeding risk in patients with active cancer
who are undergoing chemotherapy and who may experience thrombocytopenia
and changes in renal or hepatic function. Low molecular weight heparins
(in particular for short and intermediate periods) and non-VKA oral
anticoagulants (NOACs) should be preferred. However, the possible
pharmacological interactions of NOACs with both anticancer and
antiarrhythmic drugs should be considered. Based on all these
considerations, antiarrhythmic and anticoagulant therapy for AF should be
tailored individually for each patient.<br/>&#xa9; Copyright 2018 by
Thieme Medical Publishers, Inc.

<13>
Accession Number
2000825445
Author
Rahate P.V.; Chaudhry N.K.; Iglesias P.P.; Eikelboom J.W.; Connolly S.J.;
Devereaux P.J.; Duceppe E.; Bangdiwala S.I.; Connolly S.; Eikelboom J.;
Guyatt G.; Kearon C.; Pettit S.; Pogue J.; Rodseth R.; Sessler D.I.;
Vincent J.; Yusuf S.; Di Diodato S.; Gasic Z.; Mastrangelo L.J.; Molnar
S.H.; Swanson J.L.; Tosh M.L.; Wells J.R.; Botto F.; Diaz R.; Chow C.K.;
Berwanger O.; Gonzales B.; Tandon V.; Villar J.C.; Vasquez S.; Jansky P.;
Dusek R.; Meyhoff C.S.; Coriat P.; Hoeft A.; Wittmann M.; Yonga G.; Xavier
D.; Rao M.; Mathur N.; Franzosi M.G.; Seletti E.; Malaga G.;
Tumanan-Mendoza B.A.; Tagle M.P.A.; Szczeklik W.; Biccard B.M.;
Alonso-Coello P.; Popova E.; Shields M.; Le Manach Y.; Moayyedi P.; van
Zanten S.; Fleischmann E.; Garg A.; Karaye K.; McFalls E.; Sigamani A.;
Belley-Cote E.; Biedron G.; Borges F.; Frosi Stella S.; Haarmark Nielsen
C.; Leong D.P.; Spence J.; Tran A.; Wawrzycka-Adamczyk K.; Yang S.S.; Yung
T.; Wyse D.G.; Cheng D.; Johnstone D.E.; Wells G.A.; Joseph P.; Patel A.;
Gregus K.; Lawrence K.; Doharris L.; Conen D.; Cheung J.; Douketis J.;
Wright D.; Wikkerink S.; Dechert W.; Panju M.; Azzam K.; Rapanos T.; Van
Helder T.; Shroff A.; Hare J.; Kidane B.; Nguyen T.; Leydier L.; Bayaraa
V.; Parlow J.; DuMerton D.A.; Thakrar A.; Shelley J.; Deligne B.; Carling
R.D.; Mrkobrada M.; Dresser G.K.; Jacka M.J.; Hornstein D.; Winkelaar
G.B.; Haider Z.H.; Lanjewar P.P.; Varughese V.; Calton R.; Ahuja H.;
George P.; Sharma A.; Bhatt K.S.; Mangukiya D.O.; Nandaniya K.V.; Parekh
V.V.; Pillai A.B.; Menon V.P.; Desai S.C.; Sidhu R.S.; Gupta S.K.; George
R.K.; Gurunath T.R.; Drummond L.W.; Torborg A.M.; Kusel B.S.; Naidoo P.;
Naidoo D.P.; Rajah C.; Farina Z.; von Rahden R.P.; Gumede S.; Chishala C.;
Coetzee E.; Dyer R.A.; Diedericks J.; Bielanski P.; Kaczmarek B.;
Studzinska D.; Zaniewski M.; Libura M.J.; Zacharias-Nalichowski T.M.; Sega
A.A.S.; Salwa J.; Kozka M.; Gorka J.; Wludarczyk A.; Nowak-Kozka I.;
Grudzien P.S.; Gucwa J.W.; Slowiaczek M.P.; Dobosz P.P.D.; Gogenur I.;
Eriksen J.R.; Borup T.; Kirkegaard T.; Isbye D.; Sonne A.; Rasmussen L.S.;
Troensegaard H.; Duus C.L.; Halle B.M.; Gundel O.N.; Bernholm K.F.;
Martinsen K.R.; Pedersen S.; Itenov T.S.; Camio E.; Vazquez C.; Matarin
S.; Cano E.; Alvarez-Garcia J.; India I.; Gonzalez-Osuna A.; Vives M.;
Rossello E.; Serrano A.B.; Turiel M.; Drago L.; Colombo C.; Marra F.; Mos
L.; Arteni F.; Lembo R.; Ortalda A.; Passarani S.; Mokini Z.; Figueiredo
E.L.; Werner G.F.; Petriz J.L.; Maia L.N.; Bergo R.R.; Precoma D.B.;
Saraiva J.F.K.; Vilamajo O.G.; Allegrini E.; Benzadon M.; Parody M.L.;
Duronto E.A.; Ingaramo A.C.; Parra G.A.; Novoa D.; Miller S.A.; Thomas S.;
Karlapudi S.P.; Bourji M.H.; Banerjee S.; Gupta A.; Opole I.O.; Fischer
M.; Mendoza V.L.; Reyes E.B.; Pierson R.J.; Shields M.O.; Piriou V.;
Zacharowski K.; Rotta-Rotta A.; Paper M.; Srinathan S.K.; Erb J.; Magloire
P.; Neary J.; Rahate P.; Chaudhry N.; Mayosi B.; de Nadal M.; Paniagua
Iglesias P.; Sharma M.; Rao-Melacini P.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391 (10137) (pp 2325-2334), 2018. Date of Publication: 9 - 15
June 2018.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. Methods: In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. Findings: Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). Interpretation: Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. Funding: Boehringer
Ingelheim and Canadian Institutes of Health Research.<br/>Copyright &#xa9;
2018 Elsevier Ltd

<14>
Accession Number
622501256
Author
Pavasini R.; Ruggerini S.; Grapsa J.; Biscaglia S.; Tumscitz C.; Serenelli
M.; Boriani G.; Squeri A.; Campo G.
Institution
(Pavasini, Biscaglia, Tumscitz, Serenelli, Campo) Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
(Ruggerini, Boriani) Division of Cardiology, Department of Diagnostics,
University of Modena and Reggio Emilia, Policlinico d Modena, Italy
(Grapsa) Heart and Vascular Institute, Cleaveland Clinic, Cleaveland,
United States
(Squeri) Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research,
Cotignola, Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, E.S.: Health
Science Foundation, Cotignola, Italy
Title
Role of the tricuspid regurgitation after mitraclip and transcatheter
aortic valve implantation: A systematic review and meta-Analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (6) (pp 654-659), 2018.
Date of Publication: 01 Jun 2018.
Publisher
Oxford University Press
Abstract
Aims Treatment of tricuspid regurgitation (TR) is common after surgery for
mitral and/or aortic valves. The prognostic role of moderate to severe TR
in patients undergoing mitraclip or transcatheter aortic valve
implantation (TAVI) is not well-defined. Thus, the aim of this article is
to perform a systematic review and meta-Analysis of articles valuing the
prognostic role of TR for patients undergoing mitraclip and TAVI. Methods
and results Articles were searched in Pubmed, Cochrane Library, Google
Scholar and Biomed Central in September 2016. Inclusion criteria:
observational or randomized clinical trials with data on the prognostic
role of TR in patients undergoing mitraclip or TAVI. Primary outcome was
all-cause mortality expressed as hazard ratio (HR). Six articles fulfilled
inclusion criteria, three were on mitraclip and three on TAVI. A total of
2329 patients were analysed (mean age was 78.38 (3.09), 63% male): 1328
treated with TAVI and 1001 with mitraclip. The HR for all-cause mortality
of moderate to severe TR was 2.0 (95% CI 1.57-2.55, I 2 = 0%). Data were
confirmed also after subgroup analysis for mitraclip vs. TAVI. None of the
factor considered in meta-regression analyses was affecting the primary
outcome. Conclusions The current meta-Analysis suggests that the presence
of moderate to severe TR in patients undergoing mitraclip or TAVI might be
a major determinant of all-cause mortality. New studies are needed to
confirm it and to plan possible intervention in order to reduce its
impact.<br/>Copyright &#xa9; The Author 2017.

<15>
Accession Number
622483740
Author
Neugarten J.; Golestaneh L.; Kolhe N.V.
Institution
(Neugarten, Golestaneh) Department of Medicine, Nephrology Division,
Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210
St, Bronx, NY 10467, United States
(Kolhe) Department of Renal Medicine, Royal Derby Hospital, Uttoxeter
Road, Derby DE22 3NE, United Kingdom
Title
Sex differences in acute kidney injury requiring dialysis.
Source
BMC Nephrology. 19 (1) (no pagination), 2018. Article Number: 131. Date of
Publication: 08 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Female sex has been included as a risk factor in models
developed to predict the risk of acute kidney injury (AKI) associated with
cardiac surgery, aminoglycoside nephrotoxicity and contrast-induced
nephropathy. The commentary acompanying the Kidney Disease Improving
Global Outcomes Clinical Practice Guideline for Acute Kidney Injury
concludes that female sex is a shared susceptibility factor for acute
kidney injury based on observations that female sex is associated with the
development of hospital-acquired acute kidney injury. In contrast, female
sex is reno-protective in animal models. In this context, we sought to
examine the role of sex in hospital-associated acute kidney injury in
greater detail. Methods: We utilized the Hospital Episode Statistics
database to calculate the sex-stratified incidence of AKI requiring renal
replacement therapy (AKI-D) among 194,157,726 hospital discharges reported
for the years 1998-2013. In addition, we conducted a systematic review of
the English literature to evaluate dialysis practices among men versus
women with AKI. Results: Hospitalized men were more likely to develop
AKI-D than hospitalized women (OR 2.19 (2.15, 2.22) p < 0.0001). We found
no evidence in the published literature that dialysis practices differ
between men and women with AKI. Conclusions: Based on a population of
hospitalized patients which is more than 3 times larger than all
previously published cohorts reporting sex-stratified AKI data combined,
we conclude that male sex is associated with an increased incidence of
hospital-associated AKI-D. Our study is among the first reports to
highlight the protective role of female gender in AKI.<br/>Copyright
&#xa9; 2018 The Author(s).

<16>
Accession Number
617472324
Author
Elgendy H.; Helmy H.A.R.
Institution
(Elgendy) HAMAD Medical Corporation, Doha, Qatar
(Elgendy) Anesthesia Dept., Assiut University Hospitals, Egypt
(Helmy) Cardiology Dept., Assiut University Hospitals, Egypt
Title
Intrathecal morphine improves hemodynamic parameters and analgesia in
patients undergoing aortic valve replacement surgery: A prospective,
double-blind, randomized trial.
Source
Pain Physician. 20 (5) (pp 405-412), 2017. Date of Publication: 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Intrathecal morphine (ITM) has been used in hopes of providing
good postoperative analgesia in cardiac surgery. Little is known about its
use in isolated aortic valve replacement surgery. Objectives: To evaluate
the effects of 7 mu/kg ITM administration in aortic valve replacement in
regards to hemodynamics, pain score, and postoperative complications when
compared to general anesthesia alone. Study Design: A randomized,
double-blind trial. Setting: Academic medical center. Methods: Forty-four
patients, who underwent aortic valve replacement, were randomly assigned
to receive ITM, before the induction of general anesthesia (ITM group, n =
22) or no intrathecal injection i.e., general anesthesia alone (control
group, n = 22). Induction of anesthesia was done with fentanyl, propofol,
and isoflurane. Pain scores, determined by visual analog scale (VAS), were
recorded immediately after extubation, at the first, sixth, twelfth,
eighteenth, and twenty-fourth hour after extubation. Hemodynamics, heart
rate, mean arterial pressure, central venous pressure, pulmonary capillary
wedge pressure, and cardiac index were recorded intra-operatively and up
to 24 hours post-operatively. Results: VAS scores were lower in the ITM
group at each measured time than control group (P < 0.01). The cumulative
fentanyl consumption during the first 24 hours after extubation was
significantly reduced by 35% in the ITM group (951 micro&#32;g/first 24
hours) as compared to the control group (1463.6 micro&#32;g/first 24
hours), (P < 0.001). The mean time to first request for rescue analgesia
was significantly prolonged in the ITM group (20.11 +/- 4.24 hours, P <
0.001) compared with the control group (0.60 +/- 0.44 hours). The mean
tramadol consumption dose was significantly reduced in the ITM group
(279.33 +/- 61.35 mg), compared with the control group (895 +/- 106.42
mg), (P < 0.001). Hemodynamic parameters exhibited a significant decrease
in HR and MAP in the ITM group, but no significant difference was found in
regards to CVP, PCWP, and CI. Glyceryl trinitrate consumption in the first
24 hours was significantly reduced by 43% in the ITM group (28.3 mg/first
24 hours) when compared to the control group (145.5 mg/first 24 hours), (P
< 0.001). Extubation time (4.5 +/- 7.5 vs. 5.3 +/- 1.0 hours, P < 0.05)
and intensive care unit length of stay (3.7 +/- 1.0 vs. 5.6 +/- 1.6 days,
P < 0.01) were shorter in the ITM group. Limitations: Small sample size.
Conclusions: In valvular heart disease patients undergoing aortic
replacement surgery, ITM is a good adjunct to general anesthesia as a safe
and effective analgesic alternative. It provides better hemodynamic
control, earlier tracheal extubation, and shorter ICU stay.<br/>Copyright
&#xa9; 2017, American Society of Interventional Pain Physicians. All
rights reserved.

<17>
Accession Number
618450149
Author
Eljezi V.; Biboulet C.; Boby H.; Schoeffler P.; Pereira B.; Duale C.
Institution
(Eljezi, Biboulet, Boby, Schoeffler, Pereira, Duale) CHU Clermont-Ferrand,
Clermont-Ferrand, France
Title
The dose-dependent effects of ketoprofen on dynamic pain after open heart
surgery.
Source
Pain Physician. 20 (6) (pp 509-520), 2017. Date of Publication:
September-October 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce
postoperative pain, in both static (i.e., at rest) and dynamic contexts
(e.g., during coughing or mobilization), and reduced doses could improve
their efficacy/tolerance balance. Objectives: To test this hypothesis of
efficacy after open heart surgery, in which NSAIDs are poorly used,
particularly for safety concerns. Study Design: Randomized, double-blind
trial. Setting: Single-center, French university hospital. Methods:
Patients. One hundred patients at low risk of postoperative complications
undergoing scheduled open heart surgery (97 analyzed). Intervention. We
tested intravenous ketoprofen, at a dose of 0.5 mg/kg-1 every 6 hours
during the 48 hours following the end of sedation, after surgery. This
standard protocol was compared to a similar one in which half doses were
administered, to one with quarter doses, as well as to a placebo group.
Analgesia was supplemented by acetaminophen plus self- and
nurse-administered intravenous morphine. Measurement. The primary outcome
was the intensity of dynamic pain, assessed over 48 hours on an 11-point
numerical rating scale (NRS). Results: Only the full-dose ketoprofen group
showed reduced dynamic and static postoperative pain vs. placebo (P <
0.00001 for both). The evolution of dynamic pain suggested a delayed and
therefore non-significant effect with the low doses. Ketoprofen did not
affect either the postoperative morphine consumption or the tolerance
outcomes, such as the volumes of chest tube drainage and the renal
function. Limitations: This pilot trial was undersized to test major
tolerance outcomes. Conclusions: Although we failed to demonstrate any
analgesic effects with low doses of ketoprofen, we confirmed the good
efficacy/tolerance balance with this propionic NSAID of intermediate
COX<inf>2</inf>-selectivity. Lower doses of NSAIDs, potentiated by a
loading dose, should be tested in the future.<br/>Copyright &#xa9; 2017,
American Society of Interventional Pain Physicians. All rights reserved.

<18>
Accession Number
614094611
Author
Shiomi H.; Morimoto T.; Kitaguchi S.; Nakagawa Y.; Ishii K.; Haruna Y.;
Takamisawa I.; Motooka M.; Nakao K.; Matsuda S.; Mimoto S.; Aoyama Y.;
Takeda T.; Murata K.; Akao M.; Inada T.; Eizawa H.; Hyakuna E.; Awano K.;
Shirotani M.; Furukawa Y.; Kadota K.; Miyauchi K.; Tanaka M.; Noguchi Y.;
Daida H.; Ikari Y.; Hirayama H.; Sumiyoshi T.; Kimura T.; Kimura K.; Hibi
K.; Kataoka K.; Miyazaki S.; Yasuda S.; Ishii M.; Momona E.; Nakamura S.;
Takizawa A.; Nanasato M.
Institution
(Shiomi, Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Kitaguchi, Haruna) Division of Cardiology, Hirakata Kohsai Hospital,
Hirakata, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Nara, Japan
(Ishii) Division of Cardiology, Kansai Electric Power Hospital, Osaka,
Japan
(Takamisawa, Sumiyoshi) Department of Cardiology, Sakakibara Heart
Institute, Japan Research Promotion Society for Cardiovascular Diseases,
Tokyo, Japan
(Motooka) Division of Cardiology, Shizuoka General Hospital, Shizuoka,
Japan
(Nakao, Yasuda) Department of Cardiovascular Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Matsuda, Eizawa) Division of Cardiology, Nishikobe Medical Center, Kobe,
Japan
(Mimoto, Nakamura) Department of Cardiology, New Tokyo Hospital, Tokyo,
Japan
(Aoyama, Hirayama) Department of Cardiology, Nagoya Second Red Cross
Hospital, Nagoya, Japan
(Takeda) Division of Cardiology, Koto Memorial Hospital, Higashioumi,
Japan
(Murata) Department of Cardiology, Shizuoka City Shizuoka Hospital,
Shizuoka, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada, Tanaka) Cardiovascular Center Osaka Red Cross Hospital, Osaka,
Japan
(Hyakuna) Department of Cardiology, Saiseikai Shimonoseki General
Hospital, Yamaguchi, Japan
(Awano) Department of Cardiology, Kitaharima Medical Center, Hyogo, Japan
(Shirotani) Department of Cardiology, Kindai University Nara Hospital,
Nara, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Miyauchi, Daida) Department of Cardiovascular Medicine, Juntendo
University, Graduate School of Medicine, Tokyo, Japan
(Noguchi) Department of Cardiology, Tsukuba Medical Center Hospital,
Tsukuba, Japan
(Miyazaki) Division of Cardiology, Kindai University, Osaka, Japan
(Kimura) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Ikari) Department of Cardiology, Tokai University, Kanagawa, Japan
Title
The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary
Angiography After Percutaneous Coronary Intervention Trial.
Source
JACC: Cardiovascular Interventions. 10 (2) (pp 109-117), 2017. Date of
Publication: 23 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to evaluate long-term clinical
impact of routine follow-up coronary angiography (FUCAG) after
percutaneous coronary intervention (PCI) in daily clinical practice in
Japan. Background The long-term clinical impact of routine FUCAG after PCI
in real-world clinical practice has not been evaluated adequately. Methods
In this prospective, multicenter, open-label, randomized trial, patients
who underwent successful PCI were randomly assigned to routine
angiographic follow-up (AF) group, in which patients were to receive FUCAG
at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The
primary endpoint was defined as a composite of death, myocardial
infarction, stroke, emergency hospitalization for acute coronary syndrome,
or hospitalization for heart failure over a minimum of 1.5 years
follow-up. Results Between May 2010 and July 2014, 700 patients were
enrolled in the trial among 22 participating centers and were randomly
assigned to the AF group (n = 349) or the CF group (n = 351). During a
median of 4.6 years of follow-up (interquartile range [IQR]: 3.1 to 5.2
years), the cumulative 5-year incidence of the primary endpoint was 22.4%
in the AF group and 24.7% in the CF group (hazard ratio: 0.94; 95%
confidence interval: 0.67 to 1.31; p = 0.70). Any coronary
revascularization within the first year was more frequently performed in
AF group than in CF group (12.8% vs. 3.8%; log-rank p < 0.001), although
the difference between the 2 groups attenuated over time with a similar
cumulative 5-year incidence (19.6% vs. 18.1%; log-rank p = 0.92).
Conclusions No clinical benefits were observed for routine FUCAG after PCI
and early coronary revascularization rates were increased within routine
FUCAG strategy in the current trial. (Randomized Evaluation of Routine
Follow-up Coronary Angiography After Percutaneous Coronary Intervention
Trial [ReACT]; NCT01123291)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<19>
[Use Link to view the full text]
Accession Number
53136951
Author
Adie S.; Ma D.; Harris I.A.; Naylor J.M.; Craig J.C.
Institution
(Adie, Ma, Harris, Naylor) Orthopaedic Department, Liverpool Hospital,
South Western Sydney Clinical School, University of New South Wales,
Locked Bag 7103, Liverpool BC, NSW 1871, Australia
(Adie, Harris, Naylor) Whitlam Orthopaedic Research Centre, Ingham
Institute for Applied Medical Research, Liverpool, NSW, Australia
(Craig) School of Public Health, University of Sydney, Sydney, NSW,
Australia
(Craig) Centre for Kidney Research, Children's Hospital at Westmead,
Sydney, Australia
Title
Quality of conduct and reporting of meta-analyses of surgical
interventions.
Source
Annals of Surgery. 261 (4) (pp 685-694), 2015. Date of Publication: April
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Meta-analyses are useful tools for summarizing surgical
evidence as they aim to encompassmultiple sources of information on a
particular research question, but they may be prone to methodological and
reporting biases. We evaluated the conduct and reporting of meta-analyses
of surgical interventions. Methods and Findings: We performed a systematic
review of 150 metaanalyses of randomized trials of surgical interventions
published between January 2010 and June 2011. A comprehensive search
strategy was executed using MEDLINE, EMBASE, and the Cochrane Database of
Systematic Reviews. Data were independently extracted by 2 authors using
the PRISMA statement (preferred reporting items for systematic reviews and
meta-analyses, a standardized quality of reporting guideline) and AMSTAR
(a tool for methodological quality). Descriptive statistics were used for
individual items, and as a measure of overall compliance, PRISMA and
AMSTAR scores were calculated as the sum of adequately reported domains. A
median of 8 trials (interquartile range = 8) was included in each
meta-analysis. One third of all meta-analyses had an author with a
background in epidemiology and/or statistics. Forty-four percent were
published in PRISMA-endorsing journals with a median impact factor of 3.5.
There was moderate compliance with PRISMA, with an average of 71% of items
reported, but poorer compliance with AMSTAR, with 48% of items adequately
described, on average. Conclusions: Substantial gaps in the conduct and
reporting of meta-analyses within the surgical literature exist, mainly in
the specification of aims and/or objectives, the use of preplanned
protocols, and the evaluation of potential bias at the review (rather than
trial) level. Editorial insistence on using reporting guidelines would
improve this situation.<br/>Copyright &#xa9; 2015 Wolters Kluwer Health,
Inc. All rights reserved.

<20>
[Use Link to view the full text]
Accession Number
622304261
Author
Pina I.L.; Zheng Q.; She L.; Szwed H.; Lang I.M.; Farsky P.S.;
Castelvecchio S.; Biernat J.; Paraforos A.; Kosevic D.; Favaloro L.E.;
Nicolau J.C.; Varadarajan P.; Velazquez E.J.; Pai R.G.; Cyrille N.; Lee
K.L.; Desvigne-Nickens P.
Institution
(Pina, Zheng, Cyrille) Albert Einstein College of Medicine, Montefore
Medical Center, New York, NY, United States
(She) Duke Clinical Research Institute, United States
(Lee) Department of Biostatistics and Bioinformatics, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(Szwed) National Institute of Cardiology, Warsaw, Poland
(Lang) Medical University of Vienna, Austria
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Castelvecchio) Istituti di Ricovero e Cura A Carattere Scientifco
Policlinico San Donato, Milan, Italy
(Biernat) Medical University of Silesia, Katowice, Poland
(Paraforos) Department of Surgery-Cardiac, University of Trier, Germany
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Varadarajan, Pai) Department of Medicine/Cardiology, University of
California, Riverside School of Medicine, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
Title
Sex difference in patients with ischemic heart failure undergoing surgical
revascularization results from the STICH trial (surgical treatment for
ischemic heart failure).
Source
Circulation. 137 (8) (pp 771-780), 2018. Date of Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Female sex is conventionally considered a risk factor for
coronary artery bypass grafting (CABG) and has been included as a poor
prognostic factor in multiple cardiac operative risk evaluation scores. We
aimed to investigate the association of sex and the long-term beneft of
CABG in patients with ischemic left ventricular dysfunction enrolled in
the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure
Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women
and 1064 [88%] men) with coronary artery disease and left ventricular
ejection fraction =35% to CABG+medical therapy (MED) versus MED alone.
Long-term (10-year) outcomes with each treatment were compared according
to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years;
P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001).
Women had more coronary artery disease risk factors (diabetes mellitus,
55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia,
70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower
rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women
had higher New York Heart Association class (class III/IV, 66.2% versus
57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas
City Cardiomyopathy Questionnaire overall summary scores (51 versus 63;
all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus
65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86;
P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard
ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly
lower in women compared with men. With randomization to CABG+MED versus
MED treatment, there was no signifcant interaction between sex and
treatment group in all-cause mortality, cardiovascular mortality, or the
composite of all-cause mortality or cardiovascular hospitalization (all
P>0.05). In addition, surgical deaths were not statistically different
(1.5% versus 5.1%; P=0.187) between sexes among patients randomized to
CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated
with the effect of CABG+MED versus MED on all-cause mortality,
cardiovascular mortality, the composite of death or cardiovascular
hospitalization, or surgical deaths in patients with ischemic left
ventricular dysfunction. Thus, sex should not influence treatment
decisions about CABG in these patients.<br/>Copyright &#xa9; 2017 American
Heart Association, Inc.

<21>
Accession Number
2000821714
Author
Zellweger M.; Abdelnour-Berchtold E.; Krueger T.; Ris H.-B.; Perentes
J.Y.; Gonzalez M.
Institution
(Zellweger, Abdelnour-Berchtold, Krueger, Ris, Perentes, Gonzalez)
Division of Thoracic Surgery, Centre Hospitalier Vaudois (CHUV), Lausanne,
Switzerland
Title
Surgical treatment of pulmonary metastasis in colorectal cancer patients:
Current practice and results.
Source
Critical Reviews in Oncology/Hematology. 127 (pp 105-116), 2018. Date of
Publication: July 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed
at a local stage in only 40% of cases. Lung metastases (LM) appear in
5-15% of patients and, left untreated, carry a very poor prognosis. Some
CRC patients may benefit from a potentially curative LM resection, but
success and benefit are difficult to predict. We discuss prognostic
factors of survival after lung metastasectomy in CRC patients under
several scenarios (with/ without prior liver metastases; repetitive
pulmonary resections). We reviewed all studies (2005-2015) about pulmonary
metastases surgical management with curative intent in CRC patients, with
a minimum threshold on the number of patients reported (without prior
liver metastases: n >= 100; with prior resection of liver metastases: n >=
50; repetitive thoracic surgery: n >= 30). The picture of the prognostic
factors of survival is nuanced: surgical management demonstrates clear
successes and steady progress, yet there is no single success criterion;
stratification of patients and selection bias impact the conclusions.
Surgical management of liver and lung metastases may prolong life or cure
CRC patients, provided the lesions are fully resected and patients
carefully selected. Repeat lung metastasectomy is a safe approach to treat
patients in selected cases. In conclusion, there is no standard for
surgical management in CRC patients with pulmonary metastases. Patients
with isolated unilateral lung metastasis with normal CEA level and no
lymph node involvement benefit the most from surgery. Most series report
good results in highly selected patients, but instances of long-term
disease-free survival remain exceptional.<br/>Copyright &#xa9; 2018
Elsevier B.V.

<22>
Accession Number
618567714
Author
Dastan F.; Talasaz A.H.; Mojtahedzadeh M.; Karimi A.; Salehiomran A.; Bina
P.; Jalali A.
Institution
(Dastan) School of Pharmacy, ShahidBeheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Mojtahedzadeh) School of Pharmacy, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Karimi, Salehiomran, Bina, Jalali) Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Randomized Trial of Carnitine for the Prevention of Perioperative Atrial
Fibrillation.
Source
Seminars in Thoracic and Cardiovascular Surgery. 30 (1) (pp 7-13), 2018.
Date of Publication: Spring 2018.
Publisher
W.B. Saunders
Abstract
Atrial fibrillation (AF) is one of the most common complications in
patients who undergo coronary artery bypass graft surgery (CABG). The aim
of this study was to evaluate the effect of L-carnitine administration on
postoperative AF and the levels of C-reactive protein (CRP) following
CABG. The effects of L-carnitine on the incidence of acute kidney injury
after CABG were also assessed. One hundred thirty-four patients undergoing
elective CABG, without a history of AF or previous L-carnitine treatment,
were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or
a control group. CRP levels, as a biomarker of inflammation, were assessed
in all the patients before surgery as baseline levels and 48 hours
postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney
biomarker, was also measured in the patients before surgery and 2 hours
thereafter. The incidence of AF was 13.4% in our population. The incidence
of AF was decreased in the L-carnitine group (7.5% in the L-carnitine
group vs 19.4% in the control group; P = 0.043) and the postoperative CRP
level (8.79 +/- 6.9 in the L-carnitine group, and 10.83 +/- 5.7 in the
control group; P = 0.021). The postoperative neutrophil
gelatinase-associated lipocalin concentration demonstrated no significant
rise after surgery compared with the preoperative concentration (72.54 +/-
20.30 in the L-carnitine group vs 67.68 +/- 22.71 in the placebo group; P
= 0.19). Our study showed that L-carnitine administration before CABG
might inhibit and reduce the incidence of AF after CABG. It seems that a
rise in the CRP level, as an inflammation marker, may be associated with
the incidence of AF. Inflammation as measured by CRP was also reduced in
the carnitine group, compared with the control group.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<23>
Accession Number
610941185
Author
Carubelli V.; Lombardi C.; Lazzarini V.; Bonadei I.; Castrini A.I.; Gorga
E.; Richards A.M.; Metra M.
Institution
(Carubelli, Lombardi, Lazzarini, Bonadei, Castrini, Gorga, Metra) Division
of Cardiology, Department of Medical and Surgical Specialties,
Radiological Sciences, and Public Health, University and Civil Hospital of
Brescia, Spedali Civili di Brescia, P.zza Spedali Civili 1, Brescia 25123,
Italy
(Richards) Cardiovascular Research Institute, National University of
Singapore, Singapore, Singapore
Title
N-terminal pro-B-type natriuretic peptide-guided therapy in patients
hospitalized for acute heart failure.
Source
Journal of Cardiovascular Medicine. 17 (11) (pp 828-839), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background In patients with acute heart failure, high levels of
N-terminal-pro-brain natriuretic peptide (NT-proBNP) at discharge are
associated with worse outcomes. We hypothesized that NT-proBNP-guided
therapy may improve prognosis. Methods and results Two hundred and
seventy-one consecutive patients, admitted for acute heart failure, were
prospectively randomized to NT-proBNP-guided therapy or control group. The
NT-proBNP-guided therapy group underwent medical treatment intensification
when predischarge NT-proBNP was at least 3000 pg/ml. The primary endpoint
was cardiovascular death or cardiovascular rehospitalization at day 182.
The secondary endpoints were all-cause death, cardiovascular death,
cardiovascular rehospitalization, heart failure rehospitalization, and
cardiovascular death or heart failure rehospitalization at day 182.
Treatment intensification in the NT-proBNP-guided therapy group regarded
mainly diuretics. The NT-proBNP strategy was not associated with a
significant reduction of the primary endpoint [43% intervention vs. 39%
controls, hazard ratio 1.22 (0.84, 1.76), PU0.305] and of any secondary
endpoint. The change of NT-proBNP from predischarge to discharge was
associated with the risk of cardiovascular death or cardiovascular
rehospitalization through day 182, even after multivariable adjustment.
Conclusion NT-proBNP-guided therapy resulted mainly in an increase of
diuretics in acute setting and compared with clinical evaluation alone did
not improve prognosis. However, the reduction of NT-proBNP at discharge
was an independent predictor of outcomes.<br/>Copyright &#xa9; 2016
Italian Federation of Cardiology. All rights reserved.

<24>
Accession Number
2000707429
Author
Halbach M.; Abraham W.T.; Butter C.; Ducharme A.; Klug D.; Little W.C.;
Reuter H.; Schafer J.E.; Senni M.; Swarup V.; Wachter R.; Weaver F.A.;
Wilks S.J.; Zile M.R.; Muller-Ehmsen J.
Institution
(Halbach, Reuter) Department of Internal Medicine III, University Hospital
of Cologne, Cologne, Germany
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau - Medical
School Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Klug) Department of Cardiology A, University Hospital, Lille, France
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, MS, United States
(Schafer) Department of Statistics, NAMSA, Inc., Minneapolis, MN, United
States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
AZ, United States
(Wachter) Clinic and Policlinic for Cardiology, University Hospital
Leipzig, Leipzig, Germany
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
United States
(Wilks) Department of Research, CVRx, Inc., Minneapolis, MN, United States
(Zile) Medical University of South Carolina, Charleston, SC, United States
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, SC, United States
Title
Baroreflex activation therapy for the treatment of heart failure with
reduced ejection fraction in patients with and without coronary artery
disease.
Source
International Journal of Cardiology. 266 (pp 187-192), 2018. Date of
Publication: 1 September 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: In a randomized trial, baroreflex activation therapy (BAT)
improved exercise capacity, quality of life and NT-proBNP in patients with
heart failure with reduced ejection fraction (HFrEF). In view of different
mechanisms underlying HFrEF, we performed a post-hoc subgroup analysis of
efficacy and safety of BAT in patients with and without coronary artery
disease (CAD). Methods and results: Patients with left ventricular
ejection fraction <35% and NYHA Class III were randomized 1:1 to
guideline-directed medical and device therapy alone or plus BAT. Patients
with a history of CAD, prior myocardial infarction or coronary artery
bypass graft were assigned to the CAD group with all others assigned to
the no-CAD group. Of 71 BAT treated patients, 52 had CAD and 19 had no
CAD. In the control group, 49 of 69 patients had CAD and 20 had no CAD.
The system- or procedure-related major adverse neurological or
cardiovascular event rate was 3.8% in the CAD group vs. 0% in the no-CAD
group (p = 1.0). In the whole cohort, NYHA Class, Minnesota Living with
Heart Failure score, 6-minute hall walk distance and NTproBNP were
improved in BAT treated patients compared with controls. Statistical
analyses revealed no interaction between the presence of CAD and effect of
BAT (all p > 0.05). Conclusion: No major differences were found in BAT
efficacy or safety between patients with and without CAD, indicating that
BAT improves exercise capacity, quality of life and NTproBNP in patients
with ischemic and non-ischemic cardiomyopathy. ClinicalTrials.gov
identifier NCT01471860 and NCT01720160.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<25>
Accession Number
622379895
Author
Gaudino M.; Benedetto U.; Fremes S.; Biondi-Zoccai G.; Sedrakyan A.;
Puskas J.D.; Angelini G.D.; Buxton B.; Frati G.; Hare D.L.; Hayward P.;
Nasso G.; Moat N.; Peric M.; Yoo K.J.; Speziale G.; Girardi L.N.; Taggart
D.P.
Institution
(Gaudino, Girardi) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, 525 E. 68th St., New York, NY 10065, United States
(Sedrakyan) Department of Healthcare Policy and Research, Weill Cornell
Medicine, New York, NY, United States
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Benedetto, Angelini) Bristol Heart Institute, Bristol, United Kingdom
(Moat) Royal Brompton and Harefield Trust, London, United Kingdom
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, Toronto, Canada
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai, Frati) Department of Angiocardioneurology, IRCCS Neuromed,
Pozzilli, Italy
(Nasso, Speziale) Anthea Hospital, Bari, Italy
(Buxton, Hare) University of Melbourne, Australia
(Hayward) Austin Hospital, Melbourne, VIC, Australia
(Peric) Dedinje Cardiovascular Institute, Belgrade University, School of
Medicine, Belgrade, Serbia
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
Title
Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery.
Source
New England Journal of Medicine. 378 (22) (pp 2069-2077), 2018. Date of
Publication: 31 May 2018.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The use of radial-artery grafts for coronary-artery bypass
grafting (CABG) may result in better postoperative outcomes than the use
of saphenous-vein grafts. However, randomized, controlled trials comparing
radial-artery grafts and saphenous-vein grafts have been individually
underpowered to detect differences in clinical outcomes. We performed a
patient-level combined analysis of randomized, controlled trials to
compare radial-artery grafts and saphenous-vein grafts for CABG. METHODS
Six trials were identified. The primary outcome was a composite of death,
myocardial infarction, or repeat revascularization. The secondary outcome
was graft patency on follow-up angiography. Mixed-effects Cox regression
models were used to estimate the treatment effect on the outcomes. RESULTS
A total of 1036 patients were included in the analysis (534 patients with
radialartery grafts and 502 patients with saphenous-vein grafts). After a
mean (+/-SD) follow-up time of 60+/-30 months, the incidence of adverse
cardiac events was significantly lower in association with radial-artery
grafts than with saphenousvein grafts (hazard ratio, 0.67; 95% confidence
interval [CI], 0.49 to 0.90; P = 0.01). At follow-up angiography (mean
follow-up, 50+/-30 months), the use of radial-artery grafts was also
associated with a significantly lower risk of occlusion (hazard ratio,
0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of
saphenous-vein grafts, the use of radial-artery grafts was associated with
a nominally lower incidence of myocardial infarction (hazard ratio, 0.72;
95% CI, 0.53 to 0.99; P = 0.04) and a lower incidence of repeat
revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but
not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI,
0.59 to 1.41; P = 0.68). CONCLUSIONS As compared with the use of
saphenous-vein grafts, the use of radial-artery grafts for CABG resulted
in a lower rate of adverse cardiac events and a higher rate of patency at
5 years of follow-up. (Funded by Weill Cornell Medicine and
others.).<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<26>
Accession Number
622488494
Author
Martinez Peralta S.; Dominguez-Diez J.; Sierra-Gomez A.; Alvarez-Alvarez
M.; Murillo-Hernandez A.; Lopez-Agudelo O.; Calabria-Gallego M.D.;
Marquez-Batalla S.; Vera-Monge V.; Lopez-Mesonero L.
Institution
(Martinez Peralta, Dominguez-Diez, Sierra-Gomez, Alvarez-Alvarez,
Murillo-Hernandez, Lopez-Agudelo, Calabria-Gallego, Vera-Monge,
Lopez-Mesonero) Complejo Asistencial Unviersitario de Salamanca,
Neurology, Salamanca, Spain
(Marquez-Batalla) Complejo Asistencial Unviersitario de Salamanca,
Radiology, Salamanca, Spain
Title
Early left atrial appendage closure after subaracnoid hemorrhage.
Source
European Stroke Journal. Conference: 4th European Stroke Organisation
Conference, ESOC 2018. Sweden. 3 (1 Supplement 1) (pp 586), 2018. Date of
Publication: May 2018.
Publisher
SAGE Publications Ltd
Abstract
Background and Aims: Oral anticoagulants are the treatment of choice for
ischemic stroke prevention in patients with non-valvular atrial
fibrillation but there is an increased risk of bleeding associated to the
use of these drugs. In patients with previous intracranial hemorrhage,
oral anticoagulation therapy triples this risk of bleeding and left atrial
appendage closure has been shown as a good alternative. Method: We report
a case of early left appendage closure after acute subaracnoid hemorrhage
due to oral anticoagulation. Results: An eighty-year-old woman presented
to the emergency room complaning of intense cephalea that started three
days before with associated dizziness and nausea; it was persistent
despite analgesic therapy. In physical examination only postural tremor
was seen and CT images showed an hyperdense material taking up left
frontal convexity sulcus, suggesting subaracnoid hemorrhage. Given the
high atherothrombotic and cardioembolic risks (history of bilateral
carotid stenosis with repeated ischemic strokes, ischemic hearat disease
with coronary revascularization and permanent atrial fibrillation), left
atrial appendage closure was performed in 24 hours, and antithrombotic
therapy was prescribed. Conclusion: Patients with acute bleeding and
atrial fibrilation suppose a clinical setting of controversial treatment,
without conclusive data in randomized studies about the optimum time for
reintroduction of anticoagulation. Left atrial apprendage closure could
reduce the embolic risk during the early post-hemorrhage period, and would
allow a safer use of antithrombotic therapy in patients with both
cardioembolic and atherothrombotic risk.

<27>
Accession Number
622389214
Author
Reddi D.; Fung M.; Mofeez A.
Institution
(Reddi, Mofeez) University College London Hospital, United Kingdom
(Fung) Royal Free Hospital, United Kingdom
Title
An audit of chronic pain after breast cancer surgery with perioperative
thoracic paravertebral block.
Source
British Journal of Pain. Conference: 51st Annual Scientific Meeting of the
British Pain Society, BPS 2018. United Kingdom. 12 (2 Supplement 1) (pp
37), 2018. Date of Publication: May 2018.
Publisher
SAGE Publications Ltd
Abstract
Background Chronic pain after surgery is increasingly recognized as a
cause of post-operative morbidity. Rates of chronic pain after breast
surgery have been estimated at 20-30%, with severe pain affecting 5-10%
(Kehlet 2010). A Cochrane review suggested that thoracic paravertebral
block (TPVB) reduces persistent pain after surgery compared to
conventional analgesia, with a number needed to treat of 5 (Andreae 2012).
Aims The aim of our retrospective audit was to quantify rates of chronic
pain after breast surgery in patients receiving TPVB, and to assess for
the presence of neuropathic pain. Methods Women who had undergone breast
cancer surgery with TPVB at least 3 months ago were identified from a
single centre database of patients between 23/10/2014 and 25/02/2016.
Patients were excluded if they were unable to speak English due to the
follow up being carried out by telephone. Written records were accessed
where details from the database were unclear. Patients were telephoned and
pain was assessed using the Brief Pain Inventory and self-report Leeds
Assessment of Neuropathic Symptoms and Signs (S-LANSS). If patients could
not be contacted on the initial phone call then 2 further attempts were
made. Patients with post-operative complications such as infection were
also excluded. results Thirty-seven women eligible for inclusion were
identified and 25 were contacted. Eleven women could not be contacted by
telephone. One patient did not speak English and was excluded. Seven
patients reported ongoing discomfort related to surgery. Using the BPI,
the worst pain ranged from 0-8/10, the least pain 0-5/10 and average pain
ranged from 0-8/10 over the last 24 hours. Some patients had not had pain
in the last 24 hours. One patient was using analgesia specifically for the
post-surgical pain and reported 40% pain relief. Two patients reported
interference with activity, mood, walking, relationships or enjoyment of
life. Pain affected work in 3 cases and in 3 cases pain affected sleep. On
further questioning using the S-LANSS in patients reporting persistent
pain 5 of 7 patients had a score consistent with a neuropathic pain. The
mean duration of follow up was 241 days, range 105-407 days. conclusion
Our findings demonstrate chronic pain in 7/25 (28%) of patients undergoing
breast cancer surgery with TPVB, although it was only moderate or severe
in 2 patients and mild in the other 5 patients. Of the women with chronic
pain 5/7 (83%) experienced pain with a S-LANSS score suggestive of
neuropathic pain (12/20). Chronic pain after breast cancer surgery has
been reported as being predominantly neuropathic in nature and our
findings are consistent with this. This audit was a small retrospective
study. Further work should focus on a randomized controlled trial,
comparing TPVB against standard multimodal analgesia.

<28>
[Use Link to view the full text]
Accession Number
622491250
Author
Nguyen J.; Nacpil N.
Institution
(Nguyen, Nacpil) School of Nurse Anesthesia, Texas Christian University,
Fort Worth, United States
(Nguyen, Nacpil) Center for Translational Research, Joanna Briggs
Institute Center of Excellence, United Kingdom
Title
Effectiveness of dexmedetomidine versus propofol on extubation times,
length of stay and mortality rates in adult cardiac surgery patients: A
systematic review and meta-analysis.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (5) (pp
1220-1239), 2018. Date of Publication: 01 May 2018.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Objective: To determine the effects of dexmedetomidine versus propofol on
extubation time, intensive care unit (ICU) length of stay, total hospital
length of stay and in-hospital mortality rates in cardiac surgery
patients. Introduction: Recovery from cardiovascular surgery involves
weaning from mechanical ventilation. Mechanical ventilation decreases the
work of breathing for patients by inhaling oxygen and exhaling carbon
dioxide via a ventilator or breathing machine. Prolonged mechanical
ventilation is associated with complications, such as pneumonia and lung
injury, and increases the risk of morbidity and mortality. Major risk
factors that contribute to lung injury are due to high tidal volumes and
barotrauma. Cardiac surgery patients remain on the ventilator
postoperatively due to the high dose opioid-based anesthesia and the
initial vulnerable hemodynamic state. An important component of
postoperative management following cardiac surgery is the use of sedation
to reduce the stress response, facilitate assisted ventilation, and
provide anxiolysis. Propofol and dexmedetomidine are two common sedative
agents with differing pharmacological profiles used to provide comfort and
minimize hemodynamic disturbances during this recovery phase. Choice of
drug may have an impact on length of mechanical ventilation, length of
stay and mortality. Inclusion criteria: Participants included were >=18
years, of any gender or ethnicity, undergoing valvular surgery, coronary
artery bypass graft (CABG) surgery, or valvular surgery and CABG. Studies
were excluded if participants received both dexmedetomidine and propofol
concurrently as a primary sedative. Interventions were propofol compared
to dexmedetomidine as continuous infusions for sedation after cardiac
surgery. All variations of dosages and duration of both sedative agents
were included. Outcomes of interest were: total time (hours) of mechanical
ventilation after cardiac surgery, specifically from end of surgery to
extubation; total length of stay (LOS) in the ICU (hours) following
cardiac surgery, specifically from ICU admission to transfer to medical
ward; total hospital LOS (hours) following cardiac surgery, from date of
admission to date of discharge; and in-hospital mortality rates, from date
of admission to date of discharge. Randomized controlled trials (RCTs),
controlled trials, and prospective and retrospective cohort studies were
considered for inclusion. Methods: A search was conducted in MEDLINE via
PubMed, Embase, Trip Database, ProQuest Nursing and Allied Health Source
Database, Web of Science, ProQuest Dissertations and Theses Global, and
MedNar to locate both published and unpublished studies between January 1,
1999 and November 23, 2017. Two reviewers assessed the methodological
quality using standardized critical appraisal instruments from the Joanna
Briggs Institute System for the Unified Management, Assessment and Review
of Information (JBI SUMARI). Quantitative data were extracted using the
standardized data extraction tool from JBI SUMARI. Data were pooled using
Comprehensive Meta-Analysis Software Version 3 (Biostat, NJ, USA). Mean
differences (95% confidence interval [CI]) and effect size estimates were
calculated for continuous outcomes. Meta-analysis using a random-effects
model was performed for length of mechanical ventilation, ICU LOS, and
hospital LOS. Results have been presented in narrative form when findings
could not be pooled using meta-analysis. Standard GRADE (Grading of
Recommendations, Assessment, Development, and Evaluation) evidence
assessment of outcomes has been reported. Results: A total of four studies
were included in the review. Meta-analysis of three cohort studies
revealed dexmedetomidine to be superior to propofol with an average
reduction of 4.18 hours (95% CI-6.69 to-1.67, p = 0.001) on the extubation
times, an average 9.89 hour (95% CI-18.6 to-1.19, p = 0.03) reduction in
ICU LOS, and an average 37.9 hour (95% CI,-60.41 to-15.46, p = 0.00)
reduction in overall hospital LOS. A RCT was excluded from pooling for
meta-analysis, but its results were congruent with meta-analysis results.
There was lack of sufficient data to perform meta-analysis on in-hospital
mortality rates. Conclusions: In postoperative cardiac surgery patients,
dexmedetomidine is associated with a shorter time to extubation, shorter
ICU LOS, and shorter hospital LOS in postoperative cardiac surgery
patients compared to propofol. The quality of evidence for these findings
however is low and no recommendations can be made to change current
practice. There was insufficient evidence to determine significant
differences in-hospital mortality rates. Sedation protocols still need to
be formulated. There are significant gaps in the literature. Areas of
further research include additional well-designed and appropriately
powered RCTs with wide inclusion criteria to reflect this surgical
population; quantitative, transparent, and standardized sedation, weaning,
and extubation protocols; precise and standardized methods and
measurements for interventions and outcomes, and short-and long-term
morbidity and mortality follow-up.<br/>Copyright &#xa9; 2018 THE JOANNA
BRIGGS INSTITUTE.

<29>
[Use Link to view the full text]
Accession Number
622491123
Author
Leigh V.; Tufanaru C.; Elliott R.
Institution
(Leigh) Joanna Briggs Institute, Faculty of Health and Medical Sciences,
University of Adelaide, Adelaide, Australia
(Leigh, Tufanaru) Cardiothoracic Unit, Malcolm Fisher Intensive Care Unit,
Royal North Shore Hospital, Sydney, Australia
(Elliott) Malcolm Fisher Intensive Care Unit, Royal North Shore Hospital,
Sydney, Australia
(Elliott) Nursing and Midwifery Directorate, Northern Sydney Local Health
District, Sydney, Australia
(Elliott) Faculty of Health, University of Technology Sydney, Sydney,
Australia
Title
Effectiveness and harms of pharmacological interventions in the treatment
of delirium in adults in intensive care units post cardiac surgery: A
systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (5) (pp
1117-1125), 2018. Date of Publication: 01 May 2018.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The review objective is to synthesize the best
available evidence on the effectiveness and harms of pharmacological
interventions in the treatment of delirium in adults in intensive care
units (ICU) after cardiac surgery. The specific review question is: What
is the effectiveness and what are the harms of pharmacological
interventions in relation to the duration and severity of delirium
episodes, length of stay in ICU, length of stay in hospital, functional
capacity and quality of life and mortality for critically ill adult
patients treated in intensive care after cardiac surgery?<br/>Copyright
&#xa9; 2018 THE JOANNA BRIGGS INSTITUTE.

<30>
Accession Number
622489096
Author
Van Rosendael P.J.; Delgado V.; Bax J.J.
Institution
(Van Rosendael, Delgado, Bax) Department of Cardiology, Leiden University
Medical Center, Albinusdreef 2, Leiden 2333 ZA, Netherlands
Title
Pacemaker implantation rate after transcatheter aortic valve implantation
with early and new-generation devices: A systematic review.
Source
European Heart Journal. 39 (21) (pp 2003-2013), 2018. Date of Publication:
01 Jun 2018.
Publisher
Oxford University Press
Abstract
Aims The incidence of new-onset conduction abnormalities requiring
permanent pacemaker implantation (PPI) after transcatheter aortic valve
implantation (TAVI) with new-generation prostheses remains debated. This
systematic review analyses the incidence of PPI after TAVI with
new-generation devices and evaluates the electrical, anatomical, and
procedural factors associated with PPI. In addition, the incidence of PPI
after TAVI with early generation prostheses was reviewed for comparison.
Methods and results According to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses checklist, this systematic review
screened original articles published between October 2010 and October
2017, reporting on the incidence of PPI after implantation of early and
new-generation TAVI prostheses. Of the 1406 original articles identified
in the first search for new-generation TAVI devices, 348 articles were
examined for full text, and finally, 40 studies (n = 17 139) were
included. The incidence of a PPI after the use of a new-generation TAVI
prosthesis ranged between 2.3% and 36.1%. For balloon-expandable
prostheses, the PPI rate remained low when using an early generation
SAPIEN device (ranging between 2.3% and 28.2%), and with the
new-generation SAPIEN 3 device, the PPI rate was between 4.0% and 24.0%.
For self-expandable prostheses, the PPI rates were higher with the early
generation CoreValve device (16.3-37.7%), and despite a reduction in PPI
rates with the new Evolut R, the rates remained relatively higher
(14.7-26.7%). When dividing the studies according to the highest (>26.0%)
and the lowest (<12.1%) quintile of PPI rate, patients within the highest
quintile were more frequently women when compared with the lowest quintile
group (50.9% vs. 46.3%, P < 0.001). Pre-existent conduction abnormalities
(electrical factor), calcification of the left ventricular outflow tract
(anatomical factor), and balloon valvuloplasty and depth of implantation
(procedural factors) were associated with increased risk of PPI.
Conclusion The rate of PPI after TAVI with new-generation devices is
highly variable. Specific recommendations for implantation of each
prosthesis, taking into consideration the presence of pre-existent
conduction abnormalities and anatomical factors, may be needed to reduce
the risk of PPI.<br/>Copyright &#xa9; The European Society of Cardiology
2017. All rights reserved.

<31>
Accession Number
622485032
Author
Zhou X.; Hu C.; Xu Z.; Liu P.; Zhang Y.; Sun L.; Wang Y.; Gao X.
Institution
(Zhou, Xu, Liu, Zhang, Wang) Department of Intensive Care Unit, Ningbo No.
2 Hospital, Ningbo, Zhejiang 315000, China
(Hu) Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
(Sun) Department of Geriatrics, Ningbo No. 2 Hospital, Ningbo, China
(Gao) Department of Cardiology, Hangzhou First People's Hospital,
Hangzhou, China
Title
Effect of levosimendan on clinical outcomes in adult patients undergoing
cardiac surgery: A meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 1016-1026),
2018. Date of Publication: 01 Jun 2018.
Publisher
Oxford University Press
Abstract
It is currently unknown whether levosimendan can improve clinical outcomes
in patients undergoing cardiac surgery. This meta-analysis aimed to assess
the effect of levosimendan on mortality and the duration of intensive care
unit (ICU) and hospital stay in adult patients undergoing cardiac surgery.
A comprehensive search for eligible articles was conducted in PubMed, OVID
and Cochrane databases of clinical trials and the Web of Science from
database inception to August 2017. Stata/SE 11.0 was used to calculate the
pooled odds ratio for postoperative mortality and the pooled standardized
mean difference (SMD) for the duration of ICU stay and hospital stay. A
total of 30 randomized controlled trials were included in the final
analysis; the pooled results indicated that perioperative administration
of levosimendan was associated with a reduction in postoperative mortality
[5.8% vs 8.5%; odds ratio 0.66, 95% confidence interval 0.50-0.86, P =
0.002; I 2 = 17.1%; 25 trials; 3239 patients] and length of ICU stay (SMD
-0.32, 95% CI -0.58 to 0.06, P = 0.017; I 2 = 88.0%; 23 trials; 2536
patients) compared with the control group but not in length of hospital
stay (SMD -0.41, 95% CI -0.89 to 0.07, P = 0.094; I 2 = 95.9%; 18 trials;
2047 patients). A subanalysis was conducted for trials published after
2015, and it suggested that levosimendan could not reduce the
postoperative mortality (odds ratio = 0.91, 95% CI 0.63-1.31, P = 0.626; I
2 = 0.9%), length of ICU stay (SMD -0.03, 95% CI -0.32 to 0.27, P = 0.850;
I 2 = 81.2%) or length of hospital stay (SMD 0.06, 95%CI -0.43 to 0.54, P
= 0.821; I 2 = 91.3%). To summarize, the evidence from studies published
in the last 3 years indicated that perioperative administration of
levosimendan was not associated with better clinical outcomes in adult
patients undergoing cardiac surgery.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<32>
Accession Number
622485027
Author
Amin S.; Werner R.S.; Madsen P.L.; Krasopoulos G.; Taggart D.P.
Institution
(Amin, Krasopoulos, Taggart) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Amin, Krasopoulos, Taggart) Department of Cardiovascular Surgery, Oxford
University Hospitals Trust, University of Oxford, John Radcliffe Hospital,
Headley Way, Headington, Oxford OX3 9DU, United Kingdom
(Werner) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Madsen) Department of Cardiology, Copenhagen University Hospital, Herlev,
Denmark
Title
Influence of external stenting on venous graft flow parameters in coronary
artery bypass grafting: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 926-931),
2018. Date of Publication: 01 Jun 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES Long-term patency of saphenous vein grafts (SVGs) remains a
concern after coronary artery bypass grafting. Interventions to overcome
this problem include monitoring intraoperative flow profile and, more
recently, external stenting of SVGs. It is not known to what extent
external stenting changes the perioperative flow characteristics of SVGs.
The aim of this study was to assess whether the presence of an external
stent affects perioperative graft flow parameters as evaluated by transit
time flowmetry. METHODS Thirty-five patients were included from 1 centre
participating in a multicentre, randomized clinical trial of external
stenting of SVGs. Patients were eligible if scheduled for on-pump
multivessel coronary artery bypass grafting including planned SVGs to both
the right and the left coronary territories. Each patient received
external stenting of a single SVG randomly allocated intraoperatively to
either coronary territory. The primary end-points were mean graft flow,
pulsatility index, percentage of diastolic filling and percentage of
backward flow in stented versus non-stented SVGs. RESULTS External
stenting was performed in 17 SVGs supplying the left territory (20
non-stented SVGs for control) and in 18 SVGs supplying the right territory
(18 non-stented SVGs for control). No significant difference was found in
flow parameters between stented and non-stented SVGs in the overall group
or between pre-defined groups of SVGs supplying the right and left
territories, respectively. CONCLUSIONS External stenting of SVGs do not
affect intraoperative flow parameters significantly. CLINICAL TRIAL
REGISTRATION clinicaltrials.gov identifier: NCT02511834.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<33>
Accession Number
622495957
Author
Li C.; Wang H.; Liu N.; Jia M.; Zhang H.; Xi X.; Hou X.
Institution
(Li, Wang, Liu, Jia, Hou) Center for Cardiac Intensive Care, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
(Zhang) Department of Cardiovascular Surgery, National Center for
Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
(Xi) Intensive Care Unit, Fuxing Hospital, Capital Medical University,
Beijing, China
Title
Early negative fluid balance is associated with lower mortality after
cardiovascular surgery.
Source
Perfusion (United Kingdom). (no pagination), 2018. Date of Publication: 01
Jun 2018.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Early fluid expansion could prevent postoperative organ
hypoperfusion. However, excessive fluid resuscitation adversely influences
multiple organ systems. This retrospective, observational study aimed to
investigate the relationship between early negative fluid balance and
postoperative mortality in critically ill adult patients following
cardiovascular surgery. Methods: In total, 567 critically ill patients who
had undergone cardiovascular surgery and whose intensive care unit length
of stay (LOS) was more than 24 hours were enrolled. The baseline
characteristics, daily fluid balance and cumulative fluid balance were
obtained. Patients were followed until discharge or day 28. Multivariate
logistic regressions adjusted by propensity score were used to analyze the
relationship between early negative fluid balance and postoperative
mortality. Results: Overall, postoperative mortality was 6.2% (35/567).
Acute Physiology and Chronic Health Evaluation II on admission (odd ratios
[OR] 1.110), acute kidney injury stage (OR 1.639) and renal replacement
therapy received (OR 3.922) were the independent risk factors of
postoperative mortality, whereas negative daily fluid balance at day 2 (OR
0.411) was the protective factor. Patients with a negative daily fluid
balance at day 2 had lower postoperative mortality (3.4% vs. 12.2% in the
positive fluid balance group), lower acute kidney injury (AKI) stage, were
less likely to receive renal replacement therapy (RRT) and experienced
shorter hospital LOS compared with those with a daily positive fluid
balance. Conclusion: This retrospective, observational study indicates
that early negative fluid balance is associated with lower postoperative
mortality in critically ill patients following cardiovascular surgery.
Further prospective, randomized trials are needed to prove the benefits
from the restrictive fluid management strategy.<br/>Copyright &#xa9; 2018,
The Author(s) 2018.

<34>
Accession Number
622474694
Author
Lau A.; Lowlaavar N.; Cooke E.M.; West N.; German A.; Morse D.J.; Gorges
M.; Merchant R.N.
Institution
(Lau, Lowlaavar, Cooke, West, Gorges, Merchant) Department of
Anesthesiology, Pharmacology, & Therapeutics, University of British
Columbia, Vancouver, BC, Canada
(German) Graduate School of Medicine, University of Wollongong,
Wollongong, Australia
(Morse) 3M Infection Prevention Division, 3M Corporation, St. Paul, MN,
United States
(Gorges) Research Institute, BC Children's Hospital, Vancouver, BC, Canada
(Merchant) Department of Anesthesia and Perioperative Medicine, Royal
Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
Title
Effect of preoperative warming on intraoperative hypothermia: a
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. (pp 1-12), 2018. Date of Publication: 05
Jun 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The purpose of this study was to evaluate the effects of
preoperative forced-air warming on intraoperative hypothermia. Methods: In
this randomized-controlled trial, adult patients scheduled for elective,
non-cardiac surgery under general anesthesia were stratified by scheduled
surgical duration (< 2.5 hr or >= 2.5 hr) and then randomized to a
pre-warming group using a BairPawsTM forced-air warming system for at
least 30 min preoperatively or to a control group with warmed blankets on
request. All patients were warmed intraoperatively via convective
forced-air warming blankets. Perioperative temperature was measured using
the SpotOnTM temperature system consisting of a single-use disposable
sensor applied to the participant's forehead. The primary outcome was the
magnitude of intraoperative hypothermia calculated as the area under the
time-temperature curve for core temperatures < 36degreeC between induction
of general anesthesia and leaving the operating room. Secondary outcomes
included surgical site infections, packed red blood cell requirements, and
24 hr postoperative opioid consumption. Results: Two hundred participants
were analyzed (101 control; 99 pre-warmed). Pre-warmed participants had a
lower median [interquartile range] magnitude of hypothermia than controls
(0.00 [0.00-0.12] degreeC.hr^-1vs 0.05 [0.00-0.36]
degreeC.hr^-1, respectively; median difference,
-0.01degreeC.hr^-1; 95% confidence interval, -0.04 to
0.00degreeC.hr^-1; P = 0.005). There were no between-group
differences in the secondary outcomes. Conclusion: A minimum of 30 min of
preoperative forced-air convective warming decreased the overall
intraoperative hypothermic exposure. While redistribution hypothermia
still occurs despite pre- and intraoperative forced-air warming, their
combined application results in greater preservation of intraoperative
normothermia compared with intraoperative forced-air warming alone. Trial
registration: www.clinicaltrials.gov(NCT02177903). Registered 25 June
2014.<br/>Copyright &#xa9; 2018 Canadian Anesthesiologists' Society

<35>
Accession Number
606579913
Author
Amanda Dew M.; Rosenberger E.M.; Myaskovsky L.; DiMartini A.F.; DeVito
Dabbs A.J.; Posluszny D.M.; Steel J.; Switzer G.E.; Shellmer D.A.;
Greenhouse J.B.
Institution
(Amanda Dew, DiMartini) University of Pittsburgh School of Medicine and
Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
(Amanda Dew) Department of Psychology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Biostatistics, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew, Rosenberger) Clinical and Translational Science Institute,
University of Pittsburgh, Pittsburgh, PA, United States
(Rosenberger, Myaskovsky, Posluszny, Switzer) Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Myaskovsky, Switzer) Center for Health Equity Research and Promotion,
Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA,
United States
(DiMartini, Steel, Shellmer) Department of Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(DeVito Dabbs) Department of Acute and Tertiary Care, University of
Pittsburgh School of Nursing, Pittsburgh, PA, United States
(Greenhouse) Department of Statistics, Carnegie Mellon University,
Pittsburgh, PA, United States
Title
Depression and anxiety as risk factors for morbidity and mortality after
organ transplantation: A systematic review and meta-analysis.
Source
Transplantation. 100 (5) (pp 988-1003), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. Depression and anxiety are common mental health problems in
transplant populations. There is mixed evidence concerning whether they
increase morbidity and mortality risks after transplantation. If such
associations exist, additional risk reduction strategiesmay be
needed.Methods. Four bibliographic databases were searched from1981
through September 2014 for studies prospectively examining whether
depression or anxiety (determined with diagnostic evaluations or
standardized symptomscales) affected risk for posttransplant mortality,
graft loss, acute graft rejection, chronic rejection, cancer, infection,
and rehospitalization. Results. Twenty-seven studies (10 heart, total n =
1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas,
n = 80; 1 mixed recipient sample, n = 205) were identified. In each,
depression and/or anxiety were typically measured before or early after
transplantation. Follow-up for outcomes was a median of 5.8 years (range,
0.50-18.0). Depression increased the relative risk (RR) of mortality by
65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies).
Meta-regression indicated that risk was stronger in studies that did (vs
did not) control for potential confounders (P = .032). Risk was unaffected
by type of transplant or other study characteristics. Depression increased
death-censored graft loss risk (RR, 1.65; 95% CI, 1.21- 2.26, 3 studies).
Depression was not associated with other morbidities (each morbidity was
assessed in 1-4 studies). Anxiety did not significantly increase mortality
risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed
in single studies). Conclusions. Depression increases risk for
posttransplant mortality. Few studies considered morbidities; the
depression-graft loss association suggests that linkages with morbidities
deserve greater attention. Depression screening and treatment may be
warranted, although whether these activities would reduce posttransplant
mortality requires study.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<36>
[Use Link to view the full text]
Accession Number
606627138
Author
Ziegler T.R.; May A.K.; Hebbar G.; Easley K.A.; Griffith D.P.; Dave N.;
Collier B.R.; Cotsonis G.A.; Hao L.; Leong T.; Manatunga A.K.; Rosenberg
E.S.; Jones D.P.; Martin G.S.; Jensen G.L.; Sax H.C.; Kudsk K.A.; Galloway
J.R.; Blumberg H.M.; Evans M.E.; Wischmeyer P.E.
Institution
(Ziegler, Hebbar, Hao) Division of Endocrinology, Metabolism and Lipids,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Ziegler, Galloway) Center for Clinical and Molecular Nutrition, Emory
University, School of Medicine, Atlanta, GA, United States
(Ziegler, Hebbar, Griffith, Dave, Galloway) Emory University Hospital,
Nutrition and Metabolic Support Service, Atlanta Clinical and
Translational Science Institute, 1364 Clifton Rd, Atlanta, GA 30322,
United States
(May, Collier) Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Easley, Cotsonis, Leong, Manatunga) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Collier) Department of Surgery, Virginia Technical Institute Carilion,
School of Medicine, Roanoke, VA, United States
(Rosenberg) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Jones) Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Martin) Department of Nutritional Sciences, Pennsylvania State
University, University Park, PA, United States
(Jensen, Blumberg) Department of Surgery, Miriam Hospital, Providence, RI,
United States
(Sax) Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA,
United States
(Sax) Department of Surgery, University of Wisconsin, Schools of Medicine
and Public Health, Madison, WI, United States
(Kudsk) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States
(Galloway) Division of Infectious Diseases, Department of Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Evans) Hubert Department of Global Health Rollins, School of Public
Health, Emory University, Atlanta, GA, United States
(Wischmeyer) National Institutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases, Bethesda, MD, United States
(Wischmeyer) Department of Anesthesiology, University of Colorado, School
of Medicine, Aurora, CO, United States
Title
Efficacy and safety of glutamine-supplemented parenteral nutrition in
surgical ICU patients: An American mul ticenter rand omized controlled
trial.
Source
Annals of Surgery. 263 (4) (pp 646-655), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To determine whether glutamine (GLN)-supplemented parenteral
nutrition (PN) improves clinical outcomes in surgical intensive care unit
(SICU) patients. Summary Background Data: GLN requirements may increase
with critical illness. GLN-supplemented PN may improve clinical outcomes
in SICU patients. Methods: A parallel-group, multicenter, double-blind,
randomized, controlled clinical trial in 150 adults after
gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care.
Patients were without significant renal or hepatic failure or shock at
entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids
(AAs) and energy at 1.3x estimated basal energy expenditure]. Controls (n
= 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75)
received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally
replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN
weaned as indicated. Hospital mortality and infections were primary
endpoints. Results: Baseline characteristics, days on study PN and daily
macronutrient intakes via PN and EN, were similar between groups. There
were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the
STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to
9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN
group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream
infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and
STD-PN groups, respectively (P = 0.73). Other clinical outcomes and
adverse events were similar. Conclusions: PN supplemented with GLN
dipeptide was safe, but did not alter clinical outcomes among SICU
patients.<br/>Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights
reserved.

<37>
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Accession Number
606901254
Author
Bode L.G.M.; Rijen M.M.L.V.; Wertheim H.F.L.; Vandenbroucke-Grauls
C.M.J.E.; Troelstra A.; Voss A.; Verbrugh H.A.; Vos M.C.; Kluytmans
J.A.J.W.
Institution
(Bode, Wertheim, Verbrugh, Vos) Erasmus University, Department of Medical
Microbiology and Infectious Diseases, Rotterdam, Netherlands
(Rijen, Kluytmans) Amphia Hospital, Laboratory for Microbiology and
Infection Control, Breda, Netherlands
(Vandenbroucke-Grauls, Kluytmans) VU Medical Center, Department of Medical
Microbiology and Infection Control, Amsterdam, Netherlands
(Troelstra) University Medical Center, Department of Medical Microbiology,
Utrecht, Netherlands
(Voss) Can-Canisius Wilhelmina Hospital, Department of Medical
Microbiology and Infectious Diseases, Nijmegen, Netherlands
(Bode) Department of Medical Microbiology, Heidelberglaan 100, Utrecht
3584, Netherlands
Title
Long-term mortality after rapid screening and decolonization of
staphylococcus aureus carriers : Observational follow-up study of a
randomized, placebo-controlled trial.
Source
Annals of Surgery. 263 (3) (pp 511-515), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To identify patients who benefit most from Staphylococcus aureus screening
and decolonization treatment upon admission. Background: S. aureus
carriers are at increased risk of developing surgicalsite infections with
S. aureus. Previously, we demonstrated in a randomized, placebo-controlled
trial (RCT) that these infections can largely be prevented by detection of
carriage and decolonization treatment upon admission. In this study, we
analyzed 1-and 3-year mortality rates in both treatment arms of the RCT to
identify patient groups that should be targeted when implementing the
screen-and-treat strategy. Methods: Three years after enrolment in the
RCT, mortality dates of all surgical patients were checked. One-and 3-year
mortality rates were calculated for all patients and for various
subgroups. Results: After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%)
patients had died in the mupirocin/chlorhexidine and placebo groups,
respectively. No significant differences in mortality rates were observed
between the treatment groups or the subgroups according to type of
surgery. In the subgroup of patients with clean procedures (382
cardiothoracic, 167 orthopedic, 61 vascular, and 56 other),
mupirocin/chlorhexidine reduced 1-year mortality: 11 of 365 (3.0%) died in
the mupirocin/chlorhexidine versus 21 of 301 (7.0%) in the placebo group
[hazard ratio=0.38 (95% CI: 0.18-0.81)]. Conclusions: Detection and
decolonization of S. aureus carriage not only prevents S. aureus
surgical-site infections but also reduces 1-year mortality in surgical
patients undergoing clean procedures. Such patients with a high risk of
developing S. aureus infections should therefore be the primary target
when implementing the screen-and-treat strategy in clinical
practice.<br/>Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<38>
[Use Link to view the full text]
Accession Number
605233268
Author
Zhu F.; Gomersall C.D.; Ng S.K.; Underwood M.J.; Lee A.
Institution
(Zhu, Gomersall, Ng, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing
Street, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong
Title
A randomized controlled trial of adaptive support ventilation mode to wean
patients after fast-track cardiac valvular surgery.
Source
Anesthesiology. 122 (4) (pp 832-840), 2015. Date of Publication: 20 Apr
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Adaptive support ventilation can speed weaning after coronary
artery surgery compared with protocolized weaning using other modes. There
are no data to support this mode of weaning after cardiac valvular
surgery. Furthermore, control group weaning times have been long,
suggesting that the results may reflect control group protocols that delay
weaning rather than a real advantage of adaptive support ventilation.
Methods: Randomized (computer-generated sequence and sealed opaque
envelopes), parallel-arm, unblinded trial of adaptive support ventilation
versus physician-directed weaning after adult fast-track cardiac valvular
surgery. The primary outcome was duration of mechanical ventilation.
Patients aged 18 to 80 yr without significant renal, liver, or lung
disease or severe impairment of left ventricular function undergoing
uncomplicated elective valve surgery were eligible. Care was standardized,
except postoperative ventilation. In the adaptive support ventilation
group, target minute ventilation and inspired oxygen concentration were
adjusted according to blood gases. A spontaneous breathing trial was
carried out when the total inspiratory pressure of 15 cm H<inf>2</inf>O or
less with positive end-expiratory pressure of 5 cm H<inf>2</inf>O. In the
control group, the duty physician made all ventilatory decisions. Results:
Median duration of ventilation was statistically significantly shorter (P
= 0.013) in the adaptive support ventilation group (205 [141 to 295] min,
n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual
ventilator changes and alarms were less common in the adaptive support
ventilation group, and arterial blood gas estimations were more common.
Conclusion: Adaptive support ventilation reduces ventilation time by more
than 2 h in patients who have undergone fast-track cardiac valvular
surgery while reducing the number of manual ventilator changes and
alarms.<br/>Copyright &#xa9; 2015 The American Society of
Anesthesiologists, Inc.

<39>
[Use Link to view the full text]
Accession Number
605293568
Author
Afilalo J.; Grapsa J.; Nihoyannopoulos P.; Beaudoin J.; Gibbs J.S.R.;
Channick R.N.; Langleben D.; Rudski L.G.; Hua L.; Handschumacher M.D.;
Picard M.H.; Levine R.A.
Institution
(Afilalo, Langleben, Rudski) Division of Cardiology, Jewish General
Hospital, McGill University, 3755 Cote Ste Catherine, Montreal, QC H3T
1E2, Canada
(Grapsa, Nihoyannopoulos) Cardiac Ultrasound Laboratory, Division of
Cardiology, Hammersmith Hospital, Imperial College, Healthcare NHS Trust,
London, United Kingdom
(Gibbs) National Pulmonary Hypertension Service, Division of Cardiology,
Hammersmith Hospital, Imperial College, Healthcare NHS Trust, London,
United Kingdom
(Channick) Pulmonary Hypertension and Thromboendarterectomy Program,
Division of Pulmonary and Critical Care Medicine, Massachusetts General
Hospital, Harvard University, Boston, United States
(Afilalo, Beaudoin, Hua, Handschumacher, Picard, Levine) Cardiac
Ultrasound Laboratory, Division of Cardiology, Massachusetts General
Hospital, Harvard University, Boston, United States
Title
Leaflet Area as a Determinant of Tricuspid Regurgitation Severity in
Patients with Pulmonary Hypertension.
Source
Circulation: Cardiovascular Imaging. 8 (5) (no pagination), 2015. Article
Number: e002714. Date of Publication: 21 May 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Tricuspid regurgitation (TR) is a risk factor for mortality
in pulmonary hypertension (PH). TR severity varies among patients with
comparable degrees of PH and right ventricular remodeling. The
contribution of leaflet adaptation to the pathophysiology of TR has yet to
be examined. We hypothesized that tricuspid leaflet area (TLA) is
increased in PH, and that the adequacy of this increase relative to right
ventricular remodeling determines TR severity. Methods and Results - A
prospective cohort of 255 patients with PH from pre and postcapillary
pathogeneses was assembled from 2 centers. Patients underwent a
3-dimensional echocardiogram focused on the tricuspid apparatus. TLA was
measured with the Omni 4D software package. Compared with normal controls,
patients with PH had a 2-fold increase in right ventricular volumes, 62%
increase in annular area, and 49% increase in TLA. Those with severe TR
demonstrated inadequate increase in TLA relative to the closure area, such
that the ratio of TLA:closure area <1.78 was highly predictive of severe
TR (odds ratio, 68.7; 95% confidence interval, 16.2-292.7). The median
vena contracta width was 8.5 mm in the group with small TLA and large
closure area as opposed to 4.8 mm in the group with large TLA and large
closure area. Conclusions - TLA plays a significant role in determining
which patients with PH develop severe functional TR. The ratio of
TLA:closure area, reflecting the balance between leaflet adaptation versus
annular dilation and tethering forces, is an indicator of TR severity that
may identify which patients stand to benefit from leaflet augmentation
during tricuspid valve repair.<br/>Copyright &#xa9; &#xa9; 2015 American
Heart Association, Inc.

<40>
Accession Number
605293529
Author
Clavel M.-A.; Mantovani F.; Malouf J.; Michelena H.I.; Vatury O.; Jain
M.S.; Mankad S.V.; Suri R.M.; Enriquez-Sarano M.
Institution
(Clavel, Mantovani, Malouf, Michelena, Vatury, Jain, Mankad, Suri,
Enriquez-Sarano) Division of Cardiovascular Diseases and Internal
Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
Title
Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease.
Source
Circulation: Cardiovascular Imaging. 8 (5) (no pagination), 2015. Article
Number: e002989. Date of Publication: 21 May 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Fibro-elastic deficiency (FED) and diffuse myxomatous
degeneration (DMD) are phenotypes of degenerative mitral valve disease
defined morphologically. Whether physiological differences in annular and
valvular dynamics exist between these phenotypes remains unknown. Methods
and Results - We performed triple quantitation of cardiac remodeling and
of mitral regurgitation severity and of annular and valvular dimensions by
real-time 3-dimensional-transesophageal-echocardiography. Forty-nine
patients with degenerative mitral valve disease classified as FED (n=31)
and DMD (n=18) by surgical observation showed no difference in age
(65+/-10 versus 59+/-13; P=0.5), body surface area (2.0+/-0.2 versus
2.0+/-0.2 m 2; P=0.5), left ventricular and atrial dimensions (all
P>0.55), and mitral regurgitation regurgitant orifice (P=0.62). On
average, annular dimensions were larger in DMD versus FED, but height was
similar resulting in lower saddle shape. Dynamically, annular DMD versus
FED display poorer contraction and saddle-shape accentuation in early
systole and abnormal enlargement, particularly intercommissural, in
late-systole (all P<0.05). Valvular dynamics showed stable valvular area
in systole in FED versus considerable systolic increased area in DMD
(P<0.001). Prolapse height and volume increased little throughout systole
in FED versus marked increase in DMD (P<0.001). Conclusions - Our novel
observations show that FED and DMD, although both labeled myxomatous,
display considerable physiological phenotypic differences. In DMD, the
annular increased size and profoundly abnormal dynamics demonstrate
DMD-specific annular degeneration compared with the enlarged but
relatively normal FED annulus. DMD does not incur more severe mitral
regurgitation, despite larger prolapse and valve redundancy, underscoring
potential compensatory role of tissue redundancy of DMD (or aggravating
role of tissue paucity of FED) on mitral regurgitation
severity.<br/>Copyright &#xa9; &#xa9; 2015 American Heart Association,
Inc.

<41>
Accession Number
605280253
Author
Alfonso F.; Perez-Vizcayno M.J.; Cardenas A.; Garcia Del Blanco B.;
Garcia-Touchard A.; Lopez-Minguez J.R.; Benedicto A.; Masotti M.; Zueco
J.; Iniguez A.; Velazquez M.; Moreno R.; Mainar V.; Dominguez A.; Pomar
F.; Melgares R.; Rivero F.; Jimenez-Quevedo P.; Gonzalo N.; Fernandez C.;
Macaya C.
Institution
(Alfonso, Benedicto, Rivero) Hospital Universitario de la Princesa,
Departamento de Cardiologia, Diego de Leon 62, Madrid 28006, Spain
(Perez-Vizcayno, Cardenas, Jimenez-Quevedo, Gonzalo, Fernandez, Macaya)
Hospital Universitario Clinico San Carlos, Madrid, Spain
(Garcia Del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina, Badajoz, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Iniguez) Hospital Universitario de Meixoeiro, Vigo, Spain
(Velazquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Moreno) Hospital Universitario la Paz, Madrid, Spain
(Mainar) Hospital Universitario de Alicante, Alicante, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Pomar) Hospital Universitario General de Valencia, Valencia, Spain
(Melgares) Hospital Universitario Virgen de Las Nieves, E-Granada, Spain
Title
A Prospective Randomized Trial of Drug-Eluting Balloons Versus
Everolimus-Eluting Stents in Patients with In-Stent Restenosis of
Drug-Eluting Stents the RIBS IV Randomized Clinical Trial.
Source
Journal of the American College of Cardiology. 66 (1) (pp 23-33), 2015.
Date of Publication: 07 Jul 2015.
Publisher
Elsevier USA
Abstract
Background Treatment of patients with drug-eluting stent (DES) in-stent
restenosis (ISR) remains a major challenge. Objectives This study
evaluated the comparative efficacy of drug-eluting balloons (DEB) and
everolimus-eluting stents (EES) in patients presenting with DES-ISR.
Methods The study design of this multicenter randomized clinical trial
assumed superiority of EES for the primary endpoint, in-segment minimal
lumen diameter at the 6- to 9-month angiographic follow-up. Results A
total of 309 patients with DES-ISR from 23 Spanish university hospitals
were randomly allocated to DEB (n = 154) or EES (n = 155). At late
angiography (median 247 days; 90% of eligible patients), patients in the
EES arm had a significantly larger minimal lumen diameter (2.03 +/- 0.7 mm
vs. 1.80 +/- 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI:
00.7 to 0.38), net lumen gain (1.28 +/- 0.7 mm vs. 1.01 +/- 0.7 mm; p <
0.01), and lower percent diameter stenosis (23 +/- 22% vs. 30 +/- 22%; p <
0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with
patients in the DEB arm. Consistent results were observed in the in-lesion
analysis. At the 1-year clinical follow-up (100% of patients), the main
clinical outcome measure (composite of cardiac death, myocardial
infarction, and target vessel revascularization) was significantly reduced
in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to
0.98), mainly driven by a lower need for target vessel revascularization
(8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES
provided superior long-term clinical and angiographic results compared
with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting
Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940)<br/>Copyright
&#xa9; 2015 American College of Cardiology Foundation.

<42>
Accession Number
605293585
Author
Hernesniemi J.A.; Vanni V.; Hakala T.
Institution
(Hernesniemi, Vanni, Hakala) Departments of Internal Medicine and Surgery,
North Karelia Central Hospital, Joensuu, Finland
Title
The prevalence of abdominal aortic aneurysm is consistently high among
patients with coronary artery disease.
Source
Journal of Vascular Surgery. 62 (1) (pp 232-240), 2015. Article Number:
7941. Date of Publication: 01 Jul 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Emerging evidence suggests high prevalence of abdominal aortic
aneurysm (AAA) among patients with coronary disease. Accurate
characterization of the association between coronary disease and AAA and
of the actual prevalence of AAA among patients with angiography-verified
coronary artery disease (CAD) is needed to evaluate the possible benefits
of systematic screening for AAA. Methods We searched for studies that
reported the association between AAA and CAD or coronary heart disease
(CHD; wider phenotype definition) in the general population (randomized
controlled trials, prospective population cohorts) and those that reported
the prevalence of AAA among patients with angiography-verified CAD through
PubMed, Embase, and reference lists for the period between 1980 and 2014.
Random-effects models were applied because of the high heterogeneity
between included studies. Results Among the general population, 23 studies
reported the association between CHD and the occurrence of subclinical AAA
(positive ultrasound screening; meta-analyzed odds ratio of 2.38 with 95%
confidence interval [CI] of 1.78-3.19; P = 4.1 x 10^-9).
According to four prospective studies, CHD is a strong predictor of future
AAA events (fatal and nonfatal; meta-analyzed hazard ratio of 3.49 with
95% CI of 2.56-4.76; P = 2.4 x 10^-15). Altogether, 10 studies
reported the prevalence of AAA among patients with angiography-verified
CAD or undergoing coronary artery bypass grafting. Among men,
meta-analyzed prevalence was 9.5% (95% CI, 7.6%-11.7%). Among men
undergoing coronary artery bypass grafting or with three-vessel disease,
the prevalence was 11.4% (95% CI, 9.1%-13.9%). Among women, the prevalence
was low (0.35%). Conclusions The risk of subclinical AAA and future AAA
events is high among patients with coronary disease. Screening for AAA
among CAD patients by cardiologists would be easy and inexpensive, with
possible benefits to survival and risk evaluation.<br/>Copyright &#xa9;
2015 Society for Vascular Surgery.

<43>
[Use Link to view the full text]
Accession Number
605252581
Author
Jerath A.; Beattie S.W.; Chandy T.; Karski J.; Djaiani G.; Rao V.; Yau T.;
Wasowicz M.
Institution
(Jerath, Beattie, Karski, Djaiani, Wasowicz) Department Anesthesia and
Pain Management, Toronto General Hospital, 200 Elizabeth St, Toronto, ON
M5G 2C4, Canada
(Chandy) Department Anesthesia and Pain Management, Christian Medical
College, Vellore, India
(Rao, Yau) Divison of Cardiac Surgery, Toronto General Hospital, Toronto,
ON, Canada
Title
Volatile-based short-term sedation in cardiac surgical patients: A
prospective randomized controlled trial.
Source
Critical Care Medicine. 43 (5) (pp 1062-1069), 2015. Date of Publication:
20 May 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To evaluate the differences in extubation times in a group of
cardiac surgical patients who were anesthetized and sedated with either IV
propofol or inhaled volatile anesthetic agents. Design: This was a
prospective randomized controlled trial performed between September 2009
and August 2011. Setting: Cardiovascular ICU within a tertiary referral
university-affiliated teaching hospital. Patients: One hundred forty-one
patients undergoing coronary artery bypass graft surgery with normal or
mildly reduced left ventricular systolic function. Intervention:
Participants were randomly assigned to receive anesthesia and
postoperative sedation using IV propofol (n = 74) or inhaled volatile
(isoflurane or sevoflurane) anesthetic agent (n = 67). Measurements and
Main Results: Patients sedated using inhaled volatile agent displayed
faster readiness to extubation time at 135 minutes (95-200 min) compared
with those receiving IV propofol at 215 minutes (150-280 min) (p < 0.001).
Extubation times were faster within the volatile group at 182 minutes
(140-255 min) in comparison with propofol group at 291 minutes (210-420
min) (p < 0.001). The volatile group showed a higher prevalence of
vasodilatation with hypotension and higher cardiac outputs necessitating
greater use of vasoconstrictors. There was no difference in postoperative
pain scores, opioid consumption, sedation score, ICU or hospital length of
stay, or patient mortality. Conclusions: Inhaled volatile anesthesia and
sedation facilitates faster extubation times in comparison with IV
propofol for patient undergoing coronary artery bypass graft
surgery.<br/>Copyright &#xa9; 2015 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc.

<44>
Accession Number
605295218
Author
Chatterjee S.; Herrmann H.C.; Wilensky R.L.; Hirshfeld J.; McCormick D.;
Frankel D.S.; Yeh R.W.; Armstrong E.J.; Kumbhani D.J.; Giri J.
Institution
(Chatterjee) Division of Cardiology, St Lukes-Roosevelt Hospital Center of
the Mount Sinai Health System, New York, NY, United States
(Herrmann, Wilensky, Hirshfeld, McCormick, Frankel, Giri) Cardiovascular
Medicine Division, University of Pennsylvania, Perelman School of
Medicine, 3400 Spruce St, Philadelphia, PA 19104, United States
(Yeh) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(Armstrong) Division of Cardiology, University of Colorado, Denver, United
States
(Kumbhani) Division of Cardiology, University of Texas-Southwestern
Medical School, Dallas, United States
Title
Safety and procedural success of left atrial appendage exclusion with the
lariat device: A systematic review of published reports and analytic
review of the FDAMAUDE database.
Source
JAMA Internal Medicine. 175 (7) (pp 1104-1109), 2015. Date of Publication:
01 Jul 2015.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The Lariat device has received US Food and Drug Administration
(FDA) 510(k) clearance for soft-tissue approximation and is being widely
used off-label for left atrial appendage (LAA) exclusion. A comprehensive
analysis of safety and effectiveness has not been reported. OBJECTIVES To
perform a systematic review of published literature to assess safety and
procedural success, defined as successful closure of the LAA during the
index procedure, of the Lariat device.We performed a formal analytic
review of the FDAMAUDE (Manufacturer and User Facility Device Experience)
database to compile adverse event reports from real-world practice with
the Lariat. DATA SOURCES For the systematic review, PubMed, EMBASE,
CINAHL, and the Cochrane Library were searched from January 2007 through
August 2014 to identify all studies reporting use of the Lariat device in
3 or more patients. The FDA MAUDE database was queried for adverse events
reports related to Lariat use. DATA EXTRACTIONS AND SYNTHESIS Datawere
abstracted in duplicate by 2 physician reviewers. Events from published
literature were pooled using a generic inverse variance weighting with a
random effects model. Cumulative and individual adverse events were also
reported using the FDAMAUDE data set. MAIN OUTCOMES AND MEASURES
Procedural adverse events and procedural success. RESULTS In the
systematic review, 5 reports of Lariat device use in 309 participants were
identified. Specific complications weighted for inverse of variance of
individual studies were urgent need for cardiac surgery (2.3%; 7 of 309
procedures) and death (0.3%; 1 of 309 procedures). Procedural success was
90.3%(279 of 309 procedures). In the FDAMAUDE database, there were 35
unique reports of adverse events with use of the Lariat device. Among
these, we identified 5 adverse event reports that noted pericardial
effusion and death and an additional 23 reported urgent cardiac surgery
without mention of death. CONCLUSIONS AND RELEVANCE This review of
published reports and case reports identified risks of adverse events with
off-label use of the Lariat device for LAA exclusion. Formal, controlled
investigations into the safety and efficacy of the device for this
indication are warranted.

<45>
Accession Number
605281373
Author
Ardehali A.; Esmailian F.; Deng M.; Soltesz E.; Hsich E.; Naka Y.; Mancini
D.; Camacho M.; Zucker M.; Leprince P.; Padera R.; Kobashigawa J.
Institution
(Ardehali, Deng) UCLA Medical Center, Division of Cardiac Surgery, Los
Angeles, CA 90049, United States
(Esmailian, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
(Soltesz, Hsich) Cleveland Clinic Foundation, Cleveland, OH, United States
(Naka, Mancini) Columbia University Medical Center, New York, NY, United
States
(Camacho, Zucker) St Barnabas Heart Center, Newark Beth Israel Medical
Center, Newark, NJ, United States
(Leprince) Hopital de la Pitie-Salpetriere, Paris, France
(Padera) Brigham and Women's Hospital, Boston, MA, United States
Title
Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED
II): A prospective, open-label, multicentre, randomised non-inferiority
trial.
Source
The Lancet. 385 (9987) (pp 2577-2584), 2015. Date of Publication: 27 Jun
2015.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The Organ Care System is the only clinical platform for ex-vivo
perfusion of human donor hearts. The system preserves the donor heart in a
warm beating state during transport from the donor hospital to the
recipient hospital. We aimed to assess the clinical outcomes of the Organ
Care System compared with standard cold storage of human donor hearts for
transplantation. Methods We did this prospective, open-label, multicentre,
randomised non-inferiority trial at ten heart-transplant centres in the
USA and Europe. Eligible heart-transplant candidates (aged >18 years) were
randomly assigned (1:1) to receive donor hearts preserved with either the
Organ Care System or standard cold storage. Participants, investigators,
and medical staff were not masked to group assignment. The primary
endpoint was 30 day patient and graft survival, with a 10% non-inferiority
margin. We did analyses in the intention-to-treat, as-treated, and
per-protocol populations. This trial is registered with
ClinicalTrials.gov, number NCT00855712. Findings Between June 29, 2010,
and Sept 16, 2013, we randomly assigned 130 patients to the Organ Care
System group (n=67) or the standard cold storage group (n=63). 30 day
patient and graft survival rates were 94% (n=63) in the Organ Care System
group and 97% (n=61) in the standard cold storage group (difference 2.8%,
one-sided 95% upper confidence bound 8.8; p=0.45). Eight (13%) patients in
the Organ Care System group and nine (14%) patients in the standard cold
storage group had cardiac-related serious adverse events. Interpretation
Heart transplantation using donor hearts adequately preserved with the
Organ Care System or with standard cold storage yield similar short-term
clinical outcomes. The metabolic assessment capability of the Organ Care
System needs further study. Funding TransMedics.<br/>Copyright &#xa9; 2015
Elsevier Ltd.

<46>
[Use Link to view the full text]
Accession Number
605268707
Author
Helmerhorst H.J.F.; Roos-Blom M.-J.; Van Westerloo D.J.; De Jonge E.
Institution
(Helmerhorst, Van Westerloo, De Jonge) Department of Intensive Care
Medicine, Leiden University Medical Center, Leiden, Netherlands
(Helmerhorst) Laboratory of Experimental Intensive Care and
Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
(Roos-Blom) Department of Medical Informatics, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Association between arterial hyperoxia and outcome in subsets of critical
illness: A systematic review, meta-analysis, and meta-regression of cohort
studies.
Source
Critical Care Medicine. 43 (7) (pp 1508-1519), 2015. Date of Publication:
21 Jul 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Oxygen is vital during critical illness, but hyperoxia may harm
patients. Our aim was to systematically evaluate the methodology and
findings of cohort studies investigating the effects of hyperoxia in
critically ill adults. Data Source: A meta-analysis and meta-regression
analysis of cohort studies published between 2008 and 2015 was conducted.
Electronic databases of MEDLINE, EMBASE, and Web of Science were
systematically searched for the keywords hyperoxia and mortality or
outcome. Study Selection: Publications assessing the effect of arterial
hyperoxia on outcome in critically ill adults (>= 18 yr) admitted to
critical care units were eligible. We excluded studies in patients with
chronic obstructive pulmonary disease, extracorporeal life support or
hyperbaric oxygen therapy, and animal studies. Due to a lack of data, no
studies dedicated to patients with acute lung injury, sepsis, shock, or
multiple trauma could be included. Data Extraction: Studies were included
independent of admission diagnosis and definition of hyperoxia. The
primary outcome measure was in-hospital mortality, and results were
stratified for relevant subgroups (cardiac arrest, traumatic brain injury,
stroke, post-cardiac surgery, and any mechanical ventilation). The effects
of arterial oxygenation on functional outcome, long-term mortality, and
discharge variables were studied as secondary outcomes. Data Synthesis:
Twenty-four studies were included of which five studies were only for a
subset of the analyses. Nineteen studies were pooled for meta-analyses and
showed that arterial hyperoxia during admission increases hospital
mortality: adjusted odds ratio, 1.21 (95% CI, 1.08-1.37) (p = 0.001).
Functional outcome measures were diverse and generally showed a more
favorable outcome for normoxia. Conclusions: In various subsets of
critically ill patients, arterial hyperoxia was associated with poor
hospital outcome. Considering the substantial heterogeneity of included
studies and the lack of a clinical definition, more evidence is needed to
provide optimal oxygen targets to critical care physicians.<br/>Copyright
&#xa9; 2015 by the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc.

<47>
[Use Link to view the full text]
Accession Number
605264575
Author
Murphy G.S.; Szokol J.W.; Avram M.J.; Greenberg S.B.; Marymont J.H.; Shear
T.; Parikh K.N.; Patel S.S.; Gupta D.K.
Institution
(Murphy, Szokol, Greenberg, Marymont, Shear, Parikh, Patel) Department of
Anesthesiology, North-Shore University HealthSystem, Pritzker School of
Medicine, University of Chicago, 2650 Ridge Ave., Chicago, IL 60201,
United States
(Avram, Gupta) Department of Anesthesiology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Title
Intraoperative Methadone for the Prevention of Postoperative Pain: A
Randomized, Double-blinded Clinical Trial in Cardiac Surgical Patients.
Source
Anesthesiology. 122 (5) (pp 1112-1122), 2015. Date of Publication: 20 May
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The intensity of pain after cardiac surgery is often
underestimated, and inadequate pain control may be associated with poorer
quality of recovery. The aim of this investigation was to examine the
effect of intraoperative methadone on postoperative analgesic
requirements, pain scores, patient satisfaction, and clinical recovery.
Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass
(n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12
mug/kg) intraoperatively. Postoperative analgesic requirements were
recorded. Patients were assessed for pain at rest and with coughing 15 min
and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were
also evaluated for level of sedation, nausea, vomiting, itching,
hypoventilation, and hypoxia at these times. Results: Postoperative
morphine requirements during the first 24 h were reduced from a median of
10 mg in the fentanyl group to 6 mg in the methadone group (median
difference [99% CI],-4 [-8 to-2] mg; P < 0.001). Reductions in pain scores
with coughing were observed during the first 24 h after extubation; the
level of pain with coughing at 12 h was reduced from a median of 6 in the
fentanyl group to 4 in the methadone group (-2 [-3 to-1]; P < 0.001).
Improvements in patient-perceived quality of pain management were
described in the methadone group. The incidence of opioid-related adverse
events was not increased in patients administered methadone. Conclusions:
Intraoperative methadone administration resulted in reduced postoperative
morphine requirements, improved pain scores, and enhanced
patient-perceived quality of pain management.<br/>Copyright &#xa9; 2015,
the American Society of Anesthesiologists, Inc. Wolters Kluwer Health,
Inc. All Rights Reserved.

<48>
[Use Link to view the full text]
Accession Number
605252306
Author
Saager L.; Duncan A.E.; Yared J.-P.; Hesler B.D.; You J.; Deogaonkar A.;
Sessler D.I.; Kurz A.
Institution
(Saager, Duncan, Yared, Hesler, You, Sessler, Kurz) Department of Outcomes
Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195,
United States
(Duncan, Yared) Department of Cardiothoracic Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
(You) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Deogaonkar) Department of Regional Practice Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Kurz) Department of General Anesthesiology, Cleveland Clinic, Cleveland,
OH, United States
Title
Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia
Increases Delirium after Cardiac Surgery.
Source
Anesthesiology. 122 (6) (pp 1214-1223), 2015. Date of Publication: 20 Jun
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Postoperative delirium is common in patients recovering from
cardiac surgery. Tight glucose control has been shown to reduce mortality
and morbidity. Therefore, the authors sought to determine the effect of
tight intraoperative glucose control using a
hyperinsulinemic-normoglycemic clamp approach on postoperative delirium in
patients undergoing cardiac surgery. Methods: The authors enrolled 198
adult patients having cardiac surgery in this randomized, double-blind,
single-center trial. Patients were randomly assigned to either tight
intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp
(target blood glucose, 80 to 110 mg/dl) or standard therapy (conventional
insulin administration with blood glucose target, <150 mg/dl). Delirium
was assessed using a comprehensive delirium battery. The authors
considered patients to have experienced postoperative delirium when
Confusion Assessment Method testing was positive at any assessment. A
positive Confusion Assessment Method was defined by the presence of
features 1 (acute onset and fluctuating course) and 2 (inattention) and
either 3 (disorganized thinking) or 4 (altered consciousness). Results:
Patients randomized to tight glucose control were more likely to be
diagnosed as being delirious than those assigned to routine glucose
control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to
3.37; P = 0.03), after adjusting for preoperative usage of calcium channel
blocker and American Society of Anesthesiologist physical status. Delirium
severity, among patients with delirium, was comparable with each glucose
management strategy. Conclusion: Intraoperative
hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac
surgery, but not its severity.<br/>Copyright &#xa9; 2015, the American
Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights
Reserved.

<49>
[Use Link to view the full text]
Accession Number
605251575
Author
Mahler S.A.; Riley R.F.; Hiestand B.C.; Russell G.B.; Hoekstra J.W.;
Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.; Elliott S.B.;
Herrington D.M.; Burke G.L.; Miller C.D.
Institution
(Mahler, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Elliott,
Miller) Department of Emergency Medicine, Wake Forest School of Medicine,
Medical Center Boulevard, Winston-Salem, NC 27157, United States
(Riley, Herrington) Division of Cardiology, Department of Internal
Medicine, United States
(Russell) Department of Biostatistical Sciences, United States
(Burke) Division of Public Health Sciences, Public Health Sciences, Wake
Forest School of Medicine, Winston-Salem, NC, United States
Title
The HEART Pathway Randomized Trial: Identifying Emergency Department
Patients with Acute Chest Pain for Early Discharge.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (2) (pp 195-203),
2015. Date of Publication: 21 Mar 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The HEART Pathway is a decision aid designed to identify emergency
department patients with acute chest pain for early discharge. No
randomized trials have compared the HEART Pathway with usual care. Methods
and Results-Adult emergency department patients with symptoms related to
acute coronary syndrome without ST-elevation on ECG (n=282) were
randomized to the HEART Pathway or usual care. In the HEART Pathway arm,
emergency department providers used the HEART score, a validated decision
aid, and troponin measures at 0 and 3 hours to identify patients for early
discharge. Usual care was based on American College of Cardiology/American
Heart Association guidelines. The primary outcome, objective cardiac
testing (stress testing or angiography), and secondary outcomes, index
length of stay, early discharge, and major adverse cardiac events (death,
myocardial infarction, or coronary revascularization), were assessed at 30
days by phone interview and record review. Participants had a mean age of
53 years, 16% had previous myocardial infarction, and 6% (95% confidence
interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of
randomization. Compared with usual care, use of the HEART Pathway
decreased objective cardiac testing at 30 days by 12.1% (68.8% versus
56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours;
P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%;
P<0.001). No patients identified for early discharge had major adverse
cardiac events within 30 days. Conclusions-The HEART Pathway reduces
objective cardiac testing during 30 days, shortens length of stay, and
increases early discharges. These important efficiency gains occurred
without any patients identified for early discharge suffering MACE at 30
days.<br/>Copyright &#xa9; 2015 American Heart Association, Inc.

<50>
Accession Number
621589228
Author
Gupta S.; Belley-Cote E.P.; Sarkaria A.; Pandey A.; Spence J.; McClure G.;
Panchal P.; Jaffer I.H.; An K.; Eikelboom J.; Whitlock R.P.
Institution
(Gupta, Jaffer, Whitlock) Department of Surgery, McMaster University,
Hamilton, ON, Canada
(Gupta, Belley-Cote, Spence, McClure, Whitlock) Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Eikelboom, Whitlock) Perioperative and Surgery Program,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Sarkaria) Department of Medicine, School of Medicine, Queen's University,
Kingston, ON, Canada
(Pandey, Jaffer) Experimental Thrombosis and Atherosclerosis Program,
Thrombosis and Atherosclerosis Research Institute, Hamilton Health
Sciences, Hamilton, ON, Canada
(Pandey, Panchal) Department of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(McClure, An) Michael DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
237 Barton Street East, Hamilton, ON L8L 2X2, Canada
Title
International Normalized Ratio Targets for Left-Sided Mechanical Valve
Replacement.
Source
Thrombosis and Haemostasis. 118 (5) (pp 906-913), 2018. Article Number:
170712. Date of Publication: 01 May 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Guidelines recommend higher international normalized ratio
(INR) targets for patients with mechanical valves believed to be at higher
risk for thromboembolism. Higher INR targets are associated with increased
bleeding risk. We performed a systematic review and meta-analysis
assessing effects of lower and higher INR targets on thromboembolic and
bleeding risk in patients with mechanical heart valves. Methods We
searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled
trials (RCTs) evaluating lower versus higher INR targets for adults with
bileaflet mechanical valves. We performed title and abstract screening,
full-text review, risk of bias evaluation and data collection
independently and in duplicate. We pooled data using a random effects
model and used the Grading of Recommendations Assessment, Development and
Evaluation framework to evaluate overall quality of evidence. Results We
identified six RCTs (n = 5,497). Lower INR targets were associated with
significantly less bleeding--22% versus 40% (relative risk [RR]: 0.54, 95%
confidence interval [CI]: 0.31, 0.93, p = 0.03, very low quality). There
was no difference in thromboembolism--2% in both groups (RR: 1.28, 95% CI:
0.88, 1.85, p = 0.20, very low quality) or mortality--5.5% with lower INR
targets versus 8.5% (RR: 1.00, 95% CI: 0.82, 1.21, p = 0.47, moderate
quality). Conclusion In patients with mechanical valves, higher INR
targets are not supported by current evidence, which is of very low
quality. In fact, our systematic review suggests that lower INR targets
offer significantly lower bleeding risks with no significant difference in
thromboembolic risk.<br/>Copyright &#xa9; 2018 Schattauer.

<51>
Accession Number
2000611624
Author
Jennings D.L.; Lange N.; Shullo M.; Latif F.; Restaino S.; Topkara V.K.;
Takeda K.; Takayama H.; Naka Y.; Farr M.; Colombo P.; Baker W.L.
Institution
(Jennings, Lange) Department of Pharmacy, Columbia University Medical
Center, New York, NY, United States
(Shullo) WVU Medicine, West Virginia Health System, Morgantown, WV, United
States
(Latif, Restaino, Topkara, Farr, Colombo) Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Takeda, Takayama, Naka) Division of Cardiovascular Surgery, Department of
Surgery, Columbia University Medical Center, New York, NY, United States
(Baker) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
International Journal of Cardiology. 265 (pp 71-76), 2018. Date of
Publication: 15 August 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Data evaluating mTOR inhibitor use heart transplant (HT)
patients comes from relatively small studies and controversy exists
regarding their specific role. We performed a meta-analysis of randomized
trials to evaluate the efficacy and safety of mTOR inhibitors in HT
patients. Methods: We performed a systematic literature search of Medline
and Embase through July 2017 identifying studies evaluating mTOR
inhibitors in HT patients reporting effects on coronary allograft
vasculopathy (CAV), renal function, acute cellular rejection (ACR),
cytomegalovirus (CMV) infection, and discontinuation due to adverse drug
events (ADE). Data were pooled using a random-effects model producing a
mean difference (MD; for continuous data) or odds ratio (OR; for
dichotomous data) and 95% confidence interval (CI). Results: 14 trials
reported at least one outcome of interest. Change in mean maximal intimal
thickness was significantly reduced with mTOR (-0.04 [-0.07 to -0.02])
compared to calcineurin inhibitor/mycophenolate mofetil (CNI/MMF). Rates
of CMV infection were also significantly reduced (0.26; [0.2 to 0.32])
with mTOR regimens compared to CNI/MMF therapy. ACR was more frequent with
CNI-sparing regimens 6.46 [1.55 to 26.95]). eGFR was significantly
improved with CNI-sparing therapies (mean difference 12.09 mL/min [2.43 to
21.74]), but was similar between CNI/mTOR versus CNI/MMF regimens (p >
0.05). Rates of discontinuation due to ADE were higher in mTOR-containing
regimens (OR 2.15 [1.28 to 3.60], p = 0.01), while mortality rates were
similar (OR 0.91 [0.61 to 1.37], p = 0.62). Conclusions: mTOR-containing
regimens can attenuate CAV and CMV risk in HT recipients. A mTOR/MMF
combination preserves renal function but increases the risk of
ACR.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<52>
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. 122 (1) (pp 141-148), 2018. Date of
Publication: 1 July 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.

<53>
Accession Number
622470290
Author
Kosmidou I.; Redfors B.; Chen S.; Kappetein A.P.; Serruys P.W.; Gersh
B.J.; Puskas J.D.; Kandzari D.A.; Taggart D.P.; Morice M.-C.; Buszman
P.E.; Bochenek A.; Schampaert E.; Page P.; Sabik J.; Thomas M.; Ben-Yehuda
O.; Stone G.W.
Institution
(Kosmidou, Redfors, Chen, Kappetein, Serruys, Gersh, Puskas, Kandzari,
Taggart, Morice, Buszman, Bochenek, Schampaert, Page, Sabik, Thomas,
Ben-Yehuda, Stone) St Francis Hospital and Cardiovascular Research
Foundation, New York, NY, Cardiovascular Research Foundation, New York,
NY, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands, Imperial College of
Science, Technology and Medicine, London, United Kingdom, Mayo Clinic,
Cardiovascular Div, Rochester, MN, Icahn School of Medicine at Mount
Sinai, New York, NY, Piedmont Heart Institute, Atlanta, GA, Ramsay
Generale deSante, Hopital Prive Jacques Cartier, Massy, France, Medical
University of Silesia, Katowice, Poland, Cardiovascular Research
Foundation, Katowice, Poland, Hopital du Sacre-Coeur de Montreal, Quebec,
QC, Canada, Universite De Montreal, Hopital Du Sacre-Coeur De Montreal,
Montreal, QC, Canada, Department of Surgery, UH Cleveland Medical Cente,
Cleveland, OH
Title
Timing, incidence, and prognostic impact of atrial fibrillation after
percutaneous or surgical revascularization for left main disease: Analysis
from the excel trial.
Source
Heart Rhythm. Conference: 39th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2018. United States. 15 (5 Supplement 1) (pp
S36), 2018. Date of Publication: May 2018.
Publisher
Elsevier B.V.
Abstract
Background: There is limited data on the frequency and prognostic impact
of atrial fbrillation or futter (AF) following percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for left
main coronary artery disease (LMCAD). Objective: The study sought to
determine the frequency and impact of AF on cardiovascular outcomes in
patients with LMCAD treated with PCI or CABG. Methods: In the EXCEL trial,
1905 patients with LMCAD and low or intermediate SYNTAX scores were
randomized to PCI with everolimus-eluting stents versus CABG. We analyzed
the incidence and timing of AF following PCI or CABG and its multivariable
time-adjusted association with death, cardiovascular death, stroke and the
composite endpoint of death, stroke or myocardial infarction (MI) at 3
years. Results: 1,812 patients without AF at baseline were included in the
analysis. A total of 229 episodes of AF [31 (13.5%) in the PCI arm and 198
(86.5%) in the CABG arm, P<0.0001] during 3-year follow-up; 166 (72.2%) AF
episodes were perioperative (POAF, occurring intraoperatively or during
the index hospitalization) and 63 (27.8%) occurred post-discharge. By 3
years AF had occurred in 26 PCI and 198 CABG patients (2.9% vs. 20.3%
respectively, P<0.0001); multiple episodes during follow-up occurred in 17
patients (9.4%) with AF. Greater age and reduced left ventricular ejection
fraction (LVEF) were major predictors of AF; POAF and greater age were
major predictors of post-discharge AF. By multivariable analysis, AF was
an independent predictor of 3-year death (HR 3.66, 95% CI 2.03-6.60,
P<0.0001), stroke (HR 7.90, 95% CI 2.96-21.12, P<0.0001) and the composite
of death, stroke or MI (HR 3.72, 95% CI 1.86-7.45, P=0.0009). Both POAF
and post-discharge AF were independent predictors of 3-year death, stroke
and the composite endpoint of death, stroke or MI. Conclusion: The
peri-procedural and 3-year incidence of AF is signifcantly greater after
CABG compared to PCI for LMCAD, and is strongly associated with increased
mortality, stroke and composite adverse outcomes. Heightened surveillance,
prophylaxis and treatment of AF may improve cardiovascular outcomes in
this high-risk patient population.

<54>
Accession Number
622461661
Author
Ibrahim M.; Patel M.
Institution
(Ibrahim, Patel) University of Florida Health Jacksonville, Jacksonville,
FL, United States
Title
Use of preoperative thoracic epidural and the prevention of chronic pain
in patients undergoing open thoracotomy.
Source
Pain Medicine (United States). Conference: 60th Annual Meeting of the
American Association of Physicists in Medicine, AAPM 2018. United States.
19 (4) (pp 837-838), 2018. Date of Publication: April 2018.
Publisher
Oxford University Press
Abstract
Introduction: Regional anesthesia has been used in the pre-operative
period with the intention to reduce acute post-operative pain after
surgical interventions. This is a literature review to determine if the
use of preoperative thoracic epidural placement affects the development of
chronic pain in patients undergoing open thoracotomy. Methods: The review
was performed by searching PubMed for studies utilizing pre-operative
epidurals compared to post-operative epidural utilization, cryotherapy of
intercostal nerves, or intravenous patient controlled analgesia in
patients undergoing open thoracotomy. Studies were analyzed and graded in
terms of quality of data based on the Agency for Healthcare Research and
Quality (AHRQ) and given a respective grade of High, Moderate, Low or
Insufficient. Results: There were four randomized control studies and one
meta-analysis that fit the criteria. Three studies provided a high-grade
level of evidence and two provided a moderate grade level of evidence. All
of the high-grade studies and one of the moderate grade studies concluded
that pre-operative placement and utilization of thoracic epidurals
significantly reduced the incidence of chronic pain in patients who
underwent open thoracotomy. One of the moderate grade studies concluded no
difference between preoperative and post-operative utilization of thoracic
epidurals and the development of chronic pain in open thoracotomy
patients. Conclusions: Pre-operative initiation of thoracic epidurals
prior to surgical incision in patients undergoing open thoracotomies seems
to prevent the development of chronic pain when compared to patients who
were provided post-operative thoracic epidurals, cryoablation of
intercostal nerves, or postoperative intravenous patient controlled
analgesia.

<55>
Accession Number
622469582
Author
Thomas G.R.; Mariano Z.; Aves T.; Mangat I.; Dorian P.; Angaran P.
Institution
(Thomas, Mariano, Aves, Mangat, Dorian, Angaran) University of Toronto,
Toronto, ON, Canada, St. Michael's Hospital, Toronto, ON, Canada
Title
Safete: Stroke and atrial fibrillation evaluation of therapy
electronically.
Source
Heart Rhythm. Conference: 39th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2018. United States. 15 (5 Supplement 1) (pp
S564), 2018. Date of Publication: May 2018.
Publisher
Elsevier B.V.
Abstract
Background: Oral anticoagulants (OACs) decrease stroke rates in atrial
fbrillation (AF) by 70%, but large outpatient registry studies have not
demonstrated a signifcant improvement in actual OAC use over the past
decade The pattern of OAC use in teaching hospitals is poorly understood
and relies on data from administrative coding. Objective: We assessed the
rate of OAC use for AF at our institution using an automated method for
data extraction directly from the electronic medical record (EMR).
Secondly, we aimed to gain perspective on why some patients, who met
guideline indications, were not on an OAC. Methods: This is a
retrospective study of 3,915 inpatients at an academic hospital (January
2010-December 2014) with at least one 12-lead ECG showing AF. We excluded
patients with the following characteristics: i) <65 years old, ii)
prosthetic valves, iii) death during admission, iv) absence of discharge
summary, and vi) intensive care unit admission at the time of ECG. Patient
data was electronically extracted from the Cerner Soarian and GE Muse
databases A sample of 133 patients, randomly selected and equally
distributed over the study period, was manually reviewed to validate the
accuracy of the automated data extraction and to subsequently investigate
reasons for not anticoagulating patients. Results: On average, 50.9+/-2.3%
of patients were discharged on a systemic anticoagulant from 2010-2014.
This was corroborated by the manual review that showed a mean OAC rate of
56.0% The remaining patients were on ASA alone (33.1%) or no stroke
prevention therapy (16.0%) The most common reasons for not prescribing an
OAC included: i) most responsible physicians not recognizing AF on ECG,
ii) neglecting stroke prevention in AF management, and iii) deferring OAC
decisions to primary care providers. OAC rates were lowest among patients
admitted to surgical services (21.7%) and highest on cardiology (64.4%)
and neurology (69.2%). Conclusion: Anticoagulation rates in inpatients
with AF remain suboptimal. Our approach allowed for an automated,
feasible, and accurate review of a large population over a period of time.

<56>
Accession Number
622467437
Author
Gaudino M.; Bakaeen F.; Benedetto U.; Rahouma M.; Di Franco A.; Tam D.Y.;
Iannaccone M.; Schwann T.A.; Habib R.; Ruel M.; Puskas J.D.; Sabik J.;
Girardi L.N.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, United Kingdom
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, ON, Canada
(Iannaccone) Citta della Scienza e della Salute, Department of Cardiology,
University of Turin, Torino, Italy
(Schwann) University of Toledo Medical Center, Toledo, OH, United States
(Habib) The Society of Thoracic Surgeons Research Center, Chicago, IL,
United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Taggart) University of Oxford, United Kingdom
Title
Use rate and outcome in bilateral internal thoracic artery grafting:
Insights From a systematic review and meta-analysis.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e009361. Date of Publication: 01 Jun 2018.
Publisher
American Heart Association Inc.
Abstract
Background--This meta-analysis was designed to assess whether center
experience affects the short- and long-term results and the relative
benefits of bilateral internal thoracic artery grafting (BITA) for
coronary artery bypass grafting. Methods and Results--MEDLINE and EMBASE
were searched to identify all articles reporting the outcome of BITA in
patients undergoing coronary artery bypass grafting. The BITA center
experience was gauged according to the percentage use of BITA in the
institutional overall coronary artery bypass grafting population (%BITA).
The primary outcome was long-term all-cause mortality. Secondary outcomes
were operative mortality, perioperative myocardial infarction,
perioperative stroke, deep sternal wound infections (DSWIs), and major
postoperative adverse event. The rates of the primary and secondary
outcomes were calculated after adjusting for %BITA. Primary and secondary
outcomes were also compared between the BITA and the single internal
thoracic artery arms in the adjusted studies. Meta-regression was used to
evaluate the effect of %BITA on the primary and secondary outcomes.
Thirty-four studies (27 894 patients undergoing BITA) were included. In
the pooled analysis, the incidence rate for long-term mortality was 2.83%
(95% confidence interval, 2.21%-3.61%). %BITA was significantly and
inversely associated with long-term mortality and the rate of DSWI. In the
pairwise comparison, %BITA was significantly and inversely associated with
the risk of longterm mortality and DSWI in the group undergoing BITA.
Conclusions--BITA series with higher %BITA report significantly lower
long-term mortality and DSWI rate as well as higher longterm survival
advantage and lower relative risk of DSWI in their BITA cohort. These
findings suggest that a specific volume-outcome relationship exists for
BITA grafting.<br/>Copyright &#xa9; 2018 The Authors.

<57>
Accession Number
622467398
Author
Natsuaki M.; Morimoto T.; Yamaji K.; Watanabe H.; Yoshikawa Y.; Shiomi H.;
Nakagawa Y.; Furukawa Y.; Kadota K.; Ando K.; Akasaka T.; Hanaoka K.I.;
Kozuma K.; Tanabe K.; Morino Y.; Muramatsu T.; Kimura T.; Matsuda M.;
Mitsuoka H.; Fujiwara H.; Takatsu Y.; Taniguchi R.; Nohara R.; Murakami
T.; Takeda T.; Nobuyoshi M.; Iwabuchi M.; Tatami R.; Shirotani M.; Kita
T.; Ehara N.; Kato H.; Eizawa H.; Ishii K.; Tanaka M.; Lee J.-D.; Nakano
A.; Takizawa A.; Horie M.; Takahashi M.; Tei C.; Hamasaki S.; Kambara H.;
Doi O.; Kaburagi S.; Mitsudo K.; Miki S.; Mizoguchi T.; Ogawa H.; Sugiyama
S.; Hattori R.; Araki M.; Urasawa K.; Koshida R.; Hirokami M.; Yamashita
T.; Nagashima M.; Nozaki Y.; Igarashi K.; Furuya J.; Yoshimachi F.;
Nakamura A.; Fukui S.; Itoh T.; Inoue N.; Takizawa K.; Katahira Y.; Nakano
T.; Kato A.; Yamamoto Y.; Tada T.; Takeishi Y.; Nakazato K.; Kijima M.;
Ujiie Y.; Komatsu N.; Ishida G.; Ota Y.; Honda A.; Muto M.; Ishikawa T.;
Komatsu T.; Shimizu M.; Uehara Y.; Ogawa T.; Ogawa K.; Daida H.; Miyauchi
K.; Sumiyoshi T.; Asano R.; Yamasaki M.; Yajima J.; Funada R.; Taniwaki
M.; Ogawa M.; Miyazawa A.; Suzuki N.; Mori F.; Sumiyoshi M.; Okazaki S.;
Tejima T.; Tanabe Y.; Ishimori H.; Kato K.; Yumoto K.; Kimura K.; Tojo T.;
Shimohama T.; Namura M.; Horita Y.; Mizuno S.; Misawa K.; Onodera T.;
Takeuchi R.; Okada H.; Kobayashi M.; Takayama Y.; Suzuki T.; Kimura M.;
Ito T.; Takashima H.; Asano H.; Hirayama H.; Nanasato M.; Tatematsu Y.;
Umeda H.; Aoyama T.; Ozaki Y.; Naruse H.; Miyahara M.; Hoshino K.;
Tanigawa T.; Nishikawa H.; Suzuki H.; Kawamura M.; Yamamoto T.; Abe M.;
Fujita H.; Itoh A.; Osawa K.; Take S.; Koyama S.; Yoshiyama M.; Nishimura
S.; Inada T.; Hayashi F.; Nonogi H.; Tada E.; Yasuga Y.; Mitsusada N.;
Sakanoue Y.; Kataoka K.; Kinoshita M.; Shite J.; Hariki H.; Uematsu M.;
Kondo H.; Uemura S.; Ishigami K.; Furuse Y.; Shirota K.; Mimura A.;
Yamamoto K.; Takinami H.; Tanaka H.; Okura H.; Neishi Y.; Ito H.; Hata Y.;
Ishihara M.; Dai K.; Haruta S.; Takebayashi H.; Toyofuku M.; Kawai K.;
Seki S.; Sonoda S.; Muraoka Y.; Ueno T.; Kanaya S.; Shirai S.; Iwasaki Y.;
Nakao K.; Matsumura T.; Nakata S.; Kuriyama N.; Nakashima H.; Iriki Y.;
Kato N.; Hotta D.; Yamaki M.; Miura D.; Aida Y.; Konta A.; Nakajima S.;
Fusazaki T.; Takii T.; Fujii T.; Nakamura S.; Kurita N.; Takamisawa I.;
Tanaka S.; Murata N.; Nakajima Y.; Tanaka N.; Hagiwara N.; Yamaguchi J.;
Inoue K.; Ohta H.; Namiki A.; Ogata N.; Torii S.; Hibi K.; Uzui H.; Mukawa
H.; Shibata Y.; Terada K.; Suwa S.; Moriwaki H.; Sakamoto H.; Tarutani Y.;
Sato T.; Tetsuya A.; Ajioka M.; Murase Y.; Sakamoto Y.; Hayashi K.; Kamiya
H.; Amano T.; Yoshida T.; Uetani T.; Sawai T.; Yamanaka T.; Heigen H.;
Kato M.; Akao M.; Nanto S.; Kumada M.; Tachibana K.; Okayama K.; Fujii K.;
Naruko T.; Yunoki K.; Kato Y.; Hasegawa T.; Iguchi T.; Yasuda S.; Shinke
T.; Inoue T.; Konishi A.; Awata M.; Ishihara T.; Masutani M.; Tamura T.;
Kawase Y.; Ino Y.; Kitabata H.; Hirohata A.; Hirose E.; Habara S.; Nakama
Y.; Goto K.; Shiode N.; Otsuka M.; Sakuragi S.; Saito T.; Otsuka Y.;
Mitsutake Y.; Chibana H.; Ishizaki M.; Miyamoto S.; Fujimoto K.; Tsurugi
T.; Yamaguchi H.; Takaoka J.; Atsuchi N.; Kataoka T.; Kusumoto K.
Institution
(Natsuaki) Department of Cardiovascular Medicine, Saga University, Saga,
Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Yamaji, Ando) Division of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Watanabe, Yoshikawa, Shiomi, Kimura) Department of Cardiovascular
Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Hanaoka) Division of Cardiology, Hanaokaseishu Memorial Cardiovascular
Clinic, Sapporo, Japan
(Kozuma) Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Division of Cardiology, Iwate Medical University Hospital,
Morioka, Japan
(Muramatsu) Division of Cardiology, Tokyo Hospital, Tokyo, Japan
(Kimura) Kyoto University Hospital, Japan
(Matsuda, Mitsuoka) Kishiwada City Hospital, Japan
(Nakagawa, Kondo, Uemura, Ishigami, Tamura) Tenri Hospital, Japan
(Fujiwara, Takatsu, Taniguchi) Hyogo Prefectural Amagasaki Hospital, Japan
(Nohara) Kitano Hospital, Japan
(Murakami, Takeda) Koto Memorial Hospital, Japan
(Nobuyoshi, Iwabuchi, Shirai) Kokura Memorial Hospital, Japan
(Tatami) Maizuru Kyosai Hospital, Japan
(Shirotani) Nara Hospital, Kinki University Faculty of Medicine, Japan
(Furukawa, Kita, Ehara, Kinoshita) Kobe City Medical Center General
Hospital, Japan
(Kato, Eizawa) Nishi-Kobe Medical Center, Japan
(Ishii, Kataoka) Kansai Denryoku Hospital, Japan
(Tanaka, Inada, Hayashi, Nonogi, Tada) Osaka Red Cross Hospital, Japan
(Lee, Nakano, Mizuno, Misawa, Uzui) University of Fukui Hospital, Japan
(Takizawa, Onodera, Takeuchi) Shizuoka City Shizuoka Hospital, Japan
(Takahashi) Hamamatsu Rosai Hospital, Japan
(Natsuaki, Watanabe, Shiomi, Kimura, Horie, Takashima, Yamamoto, Heigen)
Shiga University of Medical Science Hospital, Japan
(Tamura) Japanese Red Cross Wakayama Medical Center, Japan
(Takahashi) Shimabara Hospital, Japan
(Tei, Hamasaki) Kagoshima University Medica and Dental Hospital, Japan
(Kambara, Doi, Kaburagi, Moriwaki, Sakamoto) Shizuoka General Hospital,
Japan
(Kadota, Mitsudo, Tanaka, Habara) Kurashiki Central Hospital, Japan
(Miki, Mizoguchi, Kato) Mitsubishi Kyoto Hospital, Japan
(Ogawa, Sugiyama) Kumamoto University Hospital, Japan
(Hattori, Aoyama, Araki) Shimada Municipal Hospital, Japan
(Suwa) Juntendo University Shizuoka Hospital, Japan
(Urasawa, Koshida) Caress Sappro Tokeidai Memorial Hospital, Japan
(Ishii, Hirokami, Kato, Hotta, Yamaki) Teine Keijinkai Hospital, Japan
(Yamashita, Nagashima) Cardio-vascular Center Hokkaido Ohno Hospital,
Japan
(Nozaki) Caress Sappro Hokko Memorial Hospital, Japan
(Igarashi, Furuya) Hokkaido Social Insurance Hospital, Japan
(Yoshimachi, Sakamoto, Miura, Aida, Konta) Aomori Prefectural Central
Hospital, Japan
(Nakamura, Fukui, Nakajima) Iwate Prefectural Central Hospital, Japan
(Itoh, Fusazaki) Iwate Medical University Hospital, Japan
(Inoue, Takizawa) Sendai Kosuei Hospital, Japan
(Katahira, Nakano) Tohoku Kousei Nenkin Hospital, Japan
(Kato, Takii) Sendai Open Hospital, Japan
(Yamamoto, Tada) Iwaki Kyoritsu General Hospital, Japan
(Takeishi, Nakazato) Fukushima Medical University Hospital, Japan
(Kijima, Ujiie) Hoshi General Hospital, Japan
(Komatsu, Ishida) Ohta Nishinouchi Hospital, Japan
(Ota, Honda) Saiseikai Kurihashi Hospital, Japan
(Muto, Ishikawa, Komatsu, Fujii) Saitama Cardiovascular and Respiratory
Center, Japan
(Komatsu, Shimizu, Uehara) Dokkyo Medical University Koshigaya Hospital,
Japan
(Ogawa, Ogawa, Nakamura, Kurita) New Tokyo Hospital, Japan
(Daida, Miyauchi) Juntendo University Hospital, Japan
(Sumiyoshi, Asano, Takamisawa) Sakakibara Memorial Hospital, Japan
(Yamasaki) NTT Medical Center Tokyo, Japan
(Yajima, Funada, Tanaka, Murata) The Cardiovascular Institute Hospital,
Japan
(Tanabe, Taniwaki, Nakajima) Mitsui Memorial Hospital, Japan
(Ogawa, Murata, Tanaka) Tokyo Medical University Hospital, Japan
(Kozuma, Miyazawa, Suzuki) Teikyo University Hospital, Japan
(Mori, Hagiwara, Yamaguchi) Tokyo Women's Medical University Hospital,
Japan
(Sumiyoshi, Okazaki, Inoue) Juntendo University Nerima Hospital, Japan
(Tejima, Tanabe, Ohta) Itabashi Chuo Medical Center, Japan
(Muramatsu, Ishimori) Saiseikai Yokohama-city Eastern Hospital, Japan
(Namiki) Kanto Rosai Hospital, Japan
(Kato, Yumoto) Yokohama Rosai Hospital, Japan
(Morino, Ogata, Torii) Tokai University Hospital, Japan
(Kimura, Hibi, Hibi) Yokohama City University Medical Center, Japan
(Tojo, Shimohama) Kitasato University Hospital, Japan
(Namura, Horita) Kanazawa Cardiovascular Hospital, Japan
(Mizuno, Misawa) Fukui Cardiovascular Center, Japan
(Mukawa, Shibata, Terada) Ogaki Municipal Hospital, Japan
(Tarutani) Okamura Memorial Hospital, Japan
(Okada) Seirei Hamamatsu General Hospital, Japan
(Kobayashi, Takayama, Suzuki, Kimura, Sato) Hamamatsu Medical Center,
Japan
(Ito, Takashima, Tetsuya) Aichi Medical University Hospital, Japan
(Asano, Hirayama, Nanasato, Tatematsu, Ajioka, Murase, Sakamoto) Tosei
General Hospital, Japan
(Umeda, Aoyama, Hayashi) Toyota Memorial Hospital, Japan
(Ozaki, Naruse) Fujita Health University Hospital, Japan
(Hirayama, Tatematsu, Miyahara, Kamiya) Japanese Red Cross Nagoya Daini
Hospital, Japan
(Amano, Yoshida, Uetani) Chubu Rosai Hospital, Japan
(Hoshino) Nagai Hospital, Japan
(Tanigawa, Sawai) Mie University Hospital, Japan
(Nishikawa, Suzuki, Kawamura) Mie Heart Center, Japan
(Kawamura, Yamanaka) Japan Community Health Care Organization Yokkaichi
Hazu Medical Center, Japan
(Abe, Akao) National Hospital Organization Kyoto Medical Center, Japan
(Fujita) Kyoto Second Red Cross Hospital, Japan
(Nanto, Kumada, Tachibana, Okayama) Osaka University Hospital, Japan
(Fujii, Fujii) Sakurabashi Watanabe Hospital, Japan
(Itoh, Osawa, Naruko, Yunoki) Osaka City General Hospital, Japan
(Take, Koyama, Kato) Osaka Saiseikai Noe Hospital, Japan
(Yoshiyama, Nishimura, Hasegawa, Iguchi) Osaka City University Hospital,
Japan
(Sakamoto, Yasuda) National Cerebral and Cardiovascular Center Hospital,
Japan
(Yasuga, Mitsusada) Sumitomo Hospital, Japan
(Sakanoue) Higashisumiyoshi Morimoto Hospital, Japan
(Kataoka) Bell Land General Hospital, Japan
(Shite, Hariki, Shinke, Inoue, Konishi) Kobe University Hospital, Japan
(Uematsu, Awata, Ishihara) Kansai Rosai Hospital, Japan
(Masutani, Ishihara, Masutani) Hyogo College of Medicine Hospital, Japan
(Tamura, Toyofuku, Sakamoto, Kawase) Japanese Red Cross Society Wakayama
Medical Center, Japan
(Akasaka, Ino, Kitabata) Wakayama Medical University Hospital, Japan
(Kato, Furuse) Tottori University Hospital, Japan
(Shirota, Mimura) Matsue Red Cross Hospital, Japan
(Yamamoto, Takinami, Hirohata, Hirose) The Sakakibara Heart Institute of
Okayama, Japan
(Okura, Neishi, Ito, Hata) Kawasaki Medical School Hospital, Japan
(Ishihara, Dai, Nakama) Hiroshima City Hospital, Japan
(Haruta, Takebayashi, Goto) Fukuyama Cardiovascular Hospital, Japan
(Toyofuku, Shiode, Otsuka) Tsuchiya General Hospital, Japan
(Sakuragi) Iwakuni Clinical Center, Japan
(Kawai, Seki) Chikamori Hospital, Japan
(Sonoda, Muraoka) University of Occupational and Environmental Health
Japan, Japan
(Saito, Otsuka) Fukuoka Wajiro Hospital, Japan
(Ueno, Kanaya, Mitsutake, Chibana) Kurume University Hospital, Japan
(Iwasaki, Ishizaki) Kouseikai Hospital, Japan
(Nakao, Miyamoto) Saiseikai Kumamoto Hospital, Japan
(Fujimoto) National Hospital Organization Kumamoto Medical Center, Japan
(Matsumura, Nakata, Tsurugi) Kumamoto Rousai Hospital, Japan
(Shibata, Kuriyama) Miyazaki Medical Association Hospital, Japan
(Nakashima, Iriki, Yamaguchi, Takaoka, Atsuchi) Tenyokai Central Hospital,
Japan
(Nakashima, Kataoka, Kusumoto) National Hospital Organization Kagoshima
Medical Center, Japan
Title
Prediction of thrombotic and bleeding events after percutaneous coronary
intervention: CREDO-Kyoto thrombotic and bleeding risk scores.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e008708. Date of Publication: 01 Jun 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Prediction of thrombotic and bleeding risk is important to
optimize antithrombotic therapy after percutaneous coronary intervention.
Methods and Results--We developed the prediction rules for thrombotic and
bleeding events separately in Japanese patients. Derivation and validation
cohorts consisted of 4778 patients from CREDO-Kyoto (Coronary
Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2
and 4669 patients from RESET (Randomized Evaluation of Sirolimus-Eluting
Versus Everolimus-Eluting Stent Trial) and NEXT (Nobori Biolimus-Eluting
Versus Xience/Promus Everolimus-Eluting Stent Trial). Primary thrombotic
and bleeding events were a composite of myocardial infarction, definite or
probable stent thrombosis or ischemic stroke, and GUSTO (Global
Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded
Coronary Arteries) moderate or severe bleeding. The prediction rule for
thrombosis assigned 2 points for severe chronic kidney disease, atrial
fibrillation, peripheral vascular disease, and anemia and 1 point for age
>=75 years, heart failure, diabetes mellitus, and chronic total occlusion.
The prediction rule for bleeding assigned 2 points for thrombocytopenia,
severe chronic kidney disease, peripheral vascular disease, and heart
failure and 1 point for prior myocardial infarction, malignancy, and
atrial fibrillation. In derivation and validation cohorts, area under the
curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66,
respectively, for bleeding. In the validation cohort, a high thrombosis
risk score (>=4, n=682) was associated with higher 3-year incidence of
thrombotic events than a score that was intermediate (2-3, n=1178) or low
(0-1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P < 0.0001). A high
bleeding risk score (>=3, n=666) was associated with higher incidence of
bleeding than scores that were intermediate (1-2, n=1802) or low (0,
n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P < 0.0001). Among 682
patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk,
whereas 401 (58.8%) had high bleeding risk with very high incidence of
bleeding (11.6%). Conclusions--CREDO-Kyoto thrombotic and bleeding risk
scores demonstrated modest accuracy in stratifying thrombotic and bleeding
risks; however, a large proportion of patients at high thrombotic risk
also had high bleeding risk.<br/>Copyright &#xa9; 2018 The Authors.

<58>
Accession Number
622467047
Author
Kim H.J.; Oh Y.N.; Ju M.H.; Kim J.B.; Jung S.-H.; Chung C.H.; Lee J.W.;
Choo S.J.
Institution
(Kim, Oh, Ju, Kim, Jung, Chung, Lee, Choo) Department of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, South Korea
Title
On-pump beating heart versus conventional coronary artery bypass grafting:
Comparative study on early and long-term clinical outcomes.
Source
Journal of Thoracic Disease. 10 (5) (pp 2656-2665), 2018. Date of
Publication: 01 May 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: We reviewed our experience with on-pump beating (OPB) heart
coronary artery bypass grafting (CABG) to evaluate the impacts of
obviating aortic cross-clamping and cardioplegic arrest on clinical
outcomes compared with conventional CABG (C-CABG). Methods: Between 2006
and 2012, elective isolated cardiopulmonary bypass (CPB)-assisted CABG was
consecutively performed in 645 patients (mean patient age 63.3+/-9.1
years, 471 women) with 254 (39.4%) undergoing OPB-CABG and 391 (60.6%)
undergoing C-CABG. The early and long-term clinical outcomes were compared
between the two groups after adjusting for risk profiles through
propensity score (PS) analyses. Results: The OPB-CABG group presented
significant morbidities more frequently than the C-CABG group, including
severe chronic kidney disease (CKD) (P=0.026), severe chest pain (P <
0.001), and poor left ventricular function (P < 0.001). Early mortality
occurred in 6 (2.4%) and 2 (0.5%) patients in the OPB- and C-CABG group,
respectively (P=0.087). The number of distal anastomosis was comparable
between the two groups (3.0+/-0.9 vs. 3.0+/-1.0, P=0.816). After PS
matching, the incidence of major complications such as stroke (P > 0.99)
and new-onset dialysis (P=0.109) was comparable. During a median follow-up
of 81.0 months (quartiles 1-3, 66.6-95.0 months), 118 patients died and
the PS-matched models showed no significant between-group differences in
the risk of overall death [hazard ratio (HR), 1.19; 95% confidence
interval (CI), 0.72-1.95; P=0.507] and major adverse cardiac events (MACE)
(HR, 1.49; 95% CI, 0.67-3.31; P=0.328). Conclusions: The OPB strategy may
be as safe and effective as the conventional strategy during CABG among
patients with similar risk profiles. A prospective randomized trial is
warranted to better ascertain the beneficial impact of OPB-CABG as both a
viable and a durable alternative strategy to C-CABG.<br/>Copyright &#xa9;
Journal of Thoracic Disease.

<59>
Accession Number
622459795
Author
Chen P.; Wu X.; Wang Z.; Li Z.; Tian X.; Wang J.; Yan T.
Institution
(Chen) Department of Intensive Care, First People's Hospital of Shangqiu,
Shangqiu, China
(Wu, Wang, Tian, Wang, Yan) Department of Urology, Henan Provincial
People's Hospital, Zhengzhou, China
(Li) Department of Ultrasound, Zhengzhou Central Hospital, Zhengzhou,
China
Title
Effects of levosimendan on mortality in patients undergoing cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (6) (pp 322-329), 2018. Date of
Publication: June 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Purpose: We sought to determine the impact of levosimendan on mortality
following cardiac surgery based on large-scale randomized controlled
trials (RCTs). Methods: We searched PubMed, Web of Science, Cochrane
databases, and ClinicalTrials.gov for RCTs published up to December 2017,
on levosimendan for patients undergoing cardiac surgery. Results: A total
of 25 RCTs enrolling 2960 patients met the inclusion criteria; data from
15 placebo-controlled randomized trials were included for meta-analysis.
Pooled analysis showed that the all-cause mortality rate was 6.4% (71 of
1106) in the levosimendan group and 8.4% (93 of 1108) in the placebo group
(odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55-1.04; P =
0.09). There were no significant differences between the two groups in the
rates of myocardial infarction (OR: 0.91; 95% CI, 0.68-1.21; P = 0.52),
serious adverse events (OR: 0.84; 95% CI, 0.66-1.07; P = 0.17),
hypotension (OR: 1.69; 95% CI, 0.94-3.03; P = 0.08), and low cardiac
output syndrome (OR: 0.47; 95% CI, 0.22-1.02; P = 0.05). Conclusion:
Levosimendan did not result in a reduction in mortality in adult cardiac
surgery patients. Well designed, adequately powered, multicenter trials
are necessary to determine the role of levosimendan in adult cardiac
surgery.<br/>Copyright &#xa9; 2018 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals Inc.

<60>
Accession Number
619235004
Author
Hirata Y.; Hirahara N.; Murakami A.; Motomura N.; Miyata H.; Takamoto S.
Institution
(Hirata, Hirahara, Murakami, Motomura, Miyata, Takamoto) Japan
Cardiovascular Surgery Database, 2-26-9 Hongo, Bunkyo-ku, Tokyo 113-0033,
Japan
(Hirata) Department of Cardiac Surgery, The University of Tokyo School of
Medicine, Tokyo, Japan
(Hirahara, Miyata) Department of Health Policy and Management, Keio
University, Tokyo, Japan
(Murakami) Kanazawa Cardiovascular Hospital, Kanazawa, Japan
(Motomura) Department of Cardiovascular Surgery, Toho University Sakura
Medical Center, Tokyo, Japan
(Takamoto) Mitsui Memorial Hospital, Tokyo, Japan
Title
Current status of cardiovascular surgery in Japan 2013 and 2014: A report
based on the Japan Cardiovascular Surgery Database. 2: Congenital heart
surgery.
Source
General Thoracic and Cardiovascular Surgery. 66 (1) (pp 4-7), 2018. Date
of Publication: 01 Jan 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: We analyzed the mortality and morbidity of congenital heart
surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD).
Methods: Data regarding congenital heart surgery performed between January
2013 and December 2014 were obtained from JCVSD. The 20 most frequent
procedures were selected and the mortality rates and major morbidities
were analyzed. Results: The mortality rates of atrial septal defect repair
and ventricular septal defect repair were less than 1%, and the mortality
rates of tetralogy of Fallot repair, complete atrioventricular septal
defect repair, bidirectional Glenn, and total cavopulmonary connection
were less than 2%. The mortality rates of the Norwood procedure and total
anomalous pulmonary venous connection repair were more than 10%. The rates
of unplanned reoperation, pacemaker implantation, chylothorax, deep
sternal infection, phrenic nerve injury, and neurological deficit were
shown for each procedure. Conclusion: Using JCVSD, the national data for
congenital heart surgery, including postoperative complications, were
analyzed. Further improvements of the database and feedback for clinical
practice are required.<br/>Copyright &#xa9; 2017, The Japanese Association
for Thoracic Surgery.

<61>
Accession Number
617848745
Author
Narendra Kumar K.; Singh N.G.; P.S. N.; Patil T.A.; Manjunath N.
Institution
(Narendra Kumar, Singh, P.S., Manjunath) Department of Cardiac
Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Jayanagar, Bangalore, India
(Patil) Department of Cardiac Anaesthesiology, Fortis Hospital, Bangalore,
India
Title
Transesophageal Echocardiographic Assessment of Pulmonary
Artery-to-Ascending Aorta Ratio for the Detection of Pulmonary
Hypertension in Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1702-1706),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The objective of the study was to investigate if the main
pulmonary artery (mPA)-to-ascending aorta (AscAo), (mPA:AscAo) ratio could
serve as a screening tool in identifying pulmonary artery hypertension
(PAH). Design A prospective observational study. Setting Tertiary care
center, university hospital. Participants Fifty-four adult patients
undergoing off-pump coronary artery bypass grafting surgery (OPCAB).
Interventions mPA and AscAo transverse diameters were measured by
transesophageal echocardiography (TEE) and the mean pulmonary arterial
pressures (mPAP) were recorded simultaneously using a pulmonary artery
catheter. Measurements and Main Results mPA:AscAo ratio demonstrated
significant linear correlation with mPAP measured by pulmonary artery
catheterization (ie, r = 0.61, confidence interval [CI] = 0.5352-0.6736, p
< 0.0001). Receiver operating characteristic curves were performed to
evaluate sensitivity and specificity of mPA:AscAo ratio >=1 for diagnosing
PAH (mPAP >=25 mmHg). Area under the curve for mPA:AscAo ratio was 0.91
(95% CI, 0.869-0.936, p < 0.0001), with a sensitivity of 84.27%,
specificity of 83.92%, positive-predictive value of 87.6% and
negative-predictive value of 81.1% for a mPAP >=25 mmHg. Conclusions The
ratio of mPA:AscAo is a simple, reliable, and reproducible method that can
be obtained through TEE, which guides the clinician to screen patients
with PAH.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<62>
Accession Number
617592053
Author
Reddy S.K.; Bailey M.J.; Beasley R.W.; Bellomo R.; Mackle D.M.; Psirides
A.J.; Young P.J.
Institution
(Reddy, Beasley, Mackle, Young) Medical Research Institute of New Zealand,
Wellington, New Zealand
(Bailey, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University, Melbourne, VIC, Australia
(Bellomo) Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
(Psirides, Young) Intensive Care Unit, Wellington Regional Hospital,
Wellington, New Zealand
Title
Effect of 0.9% Saline or Plasma-Lyte 148 as Crystalloid Fluid Therapy in
the Intensive Care Unit on Blood Product Use and Postoperative Bleeding
After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1630-1638),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of Plasma-Lyte 148 (PL-148) compared with
0.9% saline (saline) on blood product use and postoperative bleeding in
patients admitted to the intensive care unit (ICU) following cardiac
surgery. Design A post hoc subgroup analysis conducted within a
multicenter, double-blind, cluster-randomized, double-crossover study
(study 1) and a prospective, single-center nested-cohort study (study 2).
Setting Tertiary-care hospitals. Participants Adults admitted to the ICU
after cardiac surgery requiring crystalloid fluid therapy as part of the
0.9% saline vs. PL-148 for ICU fluid therapy (SPLIT) trial. Interventions
Blinded saline or PL-148 for 4 alternating 7-week blocks. Measurements and
Main Results 954 patients were included in study 1; 475 patients received
PL-148, and 479 received saline. 128 of 475 patients (26.9%) in the PL-148
group received blood or a blood product compared with 94 of 479 patients
(19.6%) in the saline group (OR [95% confidence interval], 1.51
[1.11-2.05]; p = 0.008). In study 2, 131 patients were allocated to PL-148
and 120 patients were allocated to saline. There were no differences
between groups in chest drain output from the time of arrival in the ICU
until 12 hours postoperatively (geometric mean, 566 mL for the PL-148
group v 547 mL in the saline group; p = 0.60). Conclusions The findings
did not support the hypothesis that using PL-148 for fluid therapy in ICU
following cardiac surgery reduces transfusion requirements compared to
saline. The significantly increased proportion of patients receiving blood
or blood product with allocation to PL-148 compared to saline was
unexpected and requires verification through further
research.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<63>
Accession Number
617070931
Author
Mahmoud K.; Ammar A.; Kasemy Z.
Institution
(Mahmoud, Ammar, Kasemy) Minoufiya Faculty of Medicine, Minoufiya
University, Shebin Elkoam, Egypt
Title
Comparison Between Pressure-Regulated Volume-Controlled and
Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures,
and Immune Modulation During Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1760-1766),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objectives To compare 2 different ventilatory strategies:
pressure-regulated volume-controlled (PRVC) versus volume-controlled
ventilation during thoracotomy. Design Prospective randomized study.
Setting University hospital. Participants The study comprised 70 adult
patients undergoing thoracic surgery. Interventions Evaluation of
oxygenation parameters, airway pressures, and immune modulation.
Measurements and Main Results The primary outcome was arterial oxygen
tension/fraction of inspired oxygen
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>) ratio, whereas secondary
outcomes included arterial and central venous blood gases, deadspace
volume/tidal volume ratio, peak inspiratory pressure, mean inspiratory
pressure, and plateau inspiratory pressure obtained at the following 4
time points: 20 minutes after total lung ventilation (T<inf>0</inf>), 20
minutes after 1-lung ventilation (T<inf>1</inf>), 20 minutes after return
to total lung ventilation (T<inf>2</inf>), and at the end of surgery
(T<inf>3</inf>). Furthermore, alveolar and plasma levels of interleukin-8
and tumor necrosis factor-alpha and changes in alveolar albumin levels and
cell numbers were measured at the same time points. Oxygenation parameters
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> and PaO<inf>2</inf>) were
significantly better in the PRVC group
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at T<inf>1</inf> was 176
v 146 in the PRVC and volume-controlled groups, respectively, with a p
value of 0.004). Deadspace volume/tidal volume ratio and inspiratory
airway pressures were significantly lower in the PRVC group. Furthermore,
all inflammatory parameters (alveolar and plasma interleukins, alveolar
albumin levels, and cell numbers) were significantly lower in the PRVC
group. Conclusions The PRVC mode during 1-lung ventilation in thoracic
surgery caused a favorable effect on oxygenation parameters, respiratory
mechanics, and immune modulation during thoracic surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<64>
Accession Number
615119276
Author
Ryhammer P.K.; Tang M.; Hoffmann-Petersen J.; Leonaviciute D.; Greisen J.;
Storebjerg Gissel M.; Jakobsen C.-J.
Institution
(Ryhammer, Greisen, Storebjerg Gissel, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus,
Denmark, United Kingdom
(Tang) Department of Cardiothoracic Surgery, Aarhus University Hospital,
Aarhus, Denmark, United Kingdom
(Hoffmann-Petersen) Department of Anaesthesiology and Intensive Care,
Odense University Hospital, Odense, Denmark, United Kingdom
(Leonaviciute) Department of Thoracic Anaesthesiology and Intensive Care,
Aalborg University Hospital, Aalborg, Denmark, United Kingdom
Title
Colloids in Cardiac Surgery-Friend or Foe?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1639-1648),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The right choice of fluid replacement still is a matter of
debate. Recently, two large-scale studies on the use of hydroxyethyl
starches (HES) in the intensive care setting have been published, which
have caused a huge shift in the daily practice of volume therapy. These
results have been applied to patients outside intensive care. The aim of
this study was to evaluate the impact this change has had on the outcomes
in a large population of cardiac surgery patients, with a focus on the
type of colloid infusion. Design A prospective, registered, observational
study, using propensity score matching. Setting Cohort study from 3
university hospitals using a common registry. Participants The study
comprised 17,742 patients who were referred for cardiac surgery from 2007
to 2014. Interventions Patients were divided in groups according to
perioperative fluid replacement with either crystalloids or colloids. The
colloid group was further divided into HES or human albumin (HA). Analyses
were based on the following 3 subsections: HES versus crystalloids, HA
versus crystalloids, and HES versus HA, with use of propensity score
matching or direct matching of cases. Primary outcome parameters were
30-day and 6-month mortality, new postoperative renal replacement therapy,
and new cardiac ischemic events. Measurements and Main Results The groups
were fully comparable in individual analyses. The use of HES had no impact
on new dialysis and 30-day mortality. A Cox proportional regression
analysis showed that HES had no impact on 6-month mortality and new
postoperative ischemic events. When comparing HA with crystalloid use, a
significantly increased risk in crude analysis was demonstrated on all
outcome parameters; and when comparing HA with HES, a significantly higher
risk was observed in HA patients in mortality parameters and new
postoperative, but after adjustment, only the risk of new postoperative
dialysis persisted. Conclusion This study underlined the difficulties in
establishing hardcore outcome data, even in large cohort studies. The
findings seemed to diminish the magnitude of risk when using HES in
cardiac surgery patients and seriously questioned the choice of HA when a
plasma expander is needed.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<65>
Accession Number
614831487
Author
Mahmoud A.N.; Elgendy I.Y.; Mentias A.; Saad M.; Ibrahim W.; Mojadidi
M.K.; Nairooz R.; Eshtehardi P.; David Anderson R.; Samady H.
Institution
(Mahmoud, Elgendy, Mojadidi, David Anderson) Division of Cardiovascular
Medicine, University of Florida, Gainesville, FL, United States
(Mentias) Division of Cardiovascular Medicine, University of Iowa, Iowa
City, IA, United States
(Saad, Nairooz) Division of Cardiovascular Medicine, University of
Arkansas, Little Rock, AR, United States
(Ibrahim) Department of Medicine, Wayne State University, Detroit, MI,
United States
(Eshtehardi, Samady) Division of Cardiovascular Medicine, Emory University
School of Medicine, Atlanta, GA, United States
Title
Percutaneous coronary intervention or coronary artery bypass grafting for
unprotected left main coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 90 (4) (pp 541-552),
2017. Date of Publication: 01 Oct 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Recent trials comparing PCI with CABG for unprotected left
main disease yielded discrepant evidence. Objectives: To perform an
updated meta-analysis of randomized trials comparing percutaneous coronary
intervention (PCI) with coronary artery bypass grafting (CABG) in patients
with unprotected left main coronary artery disease. Methods: Randomized
trials comparing PCI versus CABG for patients with unprotected left main
coronary artery disease were included. Summary estimates risk ratios (RRs)
were performed with a DerSimonian and Laird model at short-term,
intermediate and long-term follow-up periods (i.e., 30-days, 1-year, and
>1-year). Outcomes evaluated were major adverse cardiac and
cerebrovascular events (MACCE), all-cause mortality, myocardial
infarction, stroke, revascularization and stent thrombosis or symptomatic
graft occlusion. Results: Six trials with 4,700 patients and a mean SYNTAX
score of 23 were included. At short-term follow-up, the risk of MACCE was
lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39-0.76) driven by
the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46-0.99), and
stroke (RR 0.38, 95% CI 0.16-0.90). The risk of MACCE was similar at the
intermediate follow-up (RR 1.21, 95% CI 0.97-1.51). At long-term
follow-up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI
1.01-1.41), due to a higher risk of revascularization (RR 1.62, 95% CI
1.34-1.94), while the risk of all-cause mortality, myocardial infarction,
and stroke were similar. Conclusions: In patients with unprotected left
main coronary disease and low to intermediate SYNTAX score, PCI might be
an acceptable alternative to CABG. &#xa9; 2017 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<66>
Accession Number
617323653
Author
Esteves W.A.M.; Lodi-Junqueira L.; Soares J.R.; Sant'Anna Athayde G.R.;
Goebel G.A.; Carvalho L.A.; Zeng X.; Hung J.; Tan T.C.; Nunes M.C.P.
Institution
(Esteves, Soares, Sant'Anna Athayde, Nunes) Post-Graduate Program in
Infectious Diseases and Tropical Medicine, School of Medicine,
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
(Esteves, Lodi-Junqueira, Soares, Sant'Anna Athayde, Goebel, Carvalho,
Nunes) School of Medicine and Hospital das Clinicas, Universidade Federal
de Minas Gerais, Belo Horizonte, MG, Brazil
(Zeng, Hung, Tan) Cardiac Ultrasound Lab, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Impact of percutaneous mitral valvuloplasty on left ventricular function
in patients with mitral stenosis assessed by 3D echocardiography.
Source
International Journal of Cardiology. 248 (pp 280-285), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The status of intrinsic left ventricular (LV) contractility in
patients with isolated rheumatic mitral stenosis (MS) has been debated.
The acute changes in loading conditions after percutaneous mitral
valvuloplasty (PMV) may affect LV performance. We aimed to examine the
acute effects of PMV on LV function and identify factors associated with
LV ejection fraction (LVEF) changes, and determinants of long-term events
following the procedure. Methods One hundred and forty-two patients who
underwent PMV for symptomatic rheumatic MS (valve area of 0.99 +/- 0.3
cm²) were prospectively enrolled. LV volumes and LVEF were
measured by three-dimensional (3D) echocardiography. Long-term outcome was
a composite endpoint of death, mitral valve (MV) replacement, repeat PMV,
new onset of atrial fibrillation, and stroke. Results The mean age was
42.3 +/- 12.1 years, and 125 patients were women (88%). After PMV, LVEF
increased significantly (51.4 vs 56.5%, p < 0.001), primary due to a
significant increase in LV end-diastolic volume (65.8 mL vs 67.9 mL, p =
0.002), and resultant increase in the stroke volume (33.9 mL vs 39.6 mL, p
< 0.001). Changes in cardiac index and systolic pulmonary artery pressure
were associated with LVEF changes after PMV. During a mean follow-up
period of 30.8 months, 28 adverse clinical events were observed.
Postprocedural mitral regurgitation, MV area, and mean gradient were
independent predictors of composite endpoints. Conclusions In patients
with rheumatic MS, PMV resulted in a significant improvement in LV
end-diastolic volume, stroke volume and consequently increased in LVEF.
Changes in cardiac index and systolic pulmonary artery pressure were
associated with LVEF changes after PMV. The predictors of long-term
adverse events following PMV were post-procedural variables, including
mitral regurgitation, valve area, and mean gradient.<br/>Copyright &#xa9;
2017 Elsevier B.V.

<67>
Accession Number
615402298
Author
Maddali M.M.; Arora N.R.; Chatterjee N.
Institution
(Maddali, Arora) Department of Cardiac Anesthesia, National Heart Center
Royal Hospital, Muscat, Oman
(Chatterjee) Department of Anesthesia, Khoula Hospital, Muscat, Oman
Title
Ultrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary
Vein Cannulation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1707-1712),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The primary objective was to compare the frequency of
first-attempt successful axillary vein cannulation by the Seldinger
technique using out-of-plane ultrasound guidance versus in-plane imaging.
Between the two ultrasound imaging planes, this study also compared the
number of attempts that were necessary for the cannulation of the left
axillary vein along with the number of needle redirections that had to be
done for final cannulation of the vein. Incidence of complications and the
number of times the procedure was abandoned also were compared between the
two imaging planes. Design Prospective, randomized, interventional study.
Setting Tertiary care cardiac center. Participants Cardiac surgical
patients. Interventions Left axillary vein cannulation under ultrasound
guidance by Seldinger technique. Measurements and Main Results The left
axillary vein was accessed under ultrasound guidance in 86 consecutive
adult cardiac surgical patients. They were randomized to out-of-plane
(Group I, n = 43) and in-plane (Group II, n = 43) groups. In group I, the
number of first-attempt cannulations was very high (p < 0.01). The number
of attempts to access the vein was significantly lower in this group (p <
0.05). The duration for completion of the procedure was also less in group
I with out-of-plane ultrasound guidance (p < 0.01). The number of needle
redirections and the incidence of complications (arterial puncture,
pneumothorax hematoma formation) were similar between the groups. There
was no difference in the number of times the procedure was abandoned
between the two groups. With an assumption that the first 10 patients in
each group would suffice for overcoming the learning curve, the above
aspects were analyzed further in each group. The first-attempt cannulation
success continued to be significantly higher in the out-of-plane group.
Conclusions Out-of-plane ultrasound imaging during axillary vein
cannulation increased the chance of first-attempt successful cannulation.
Axillary vein cannulation under out-of-plane ultrasound imaging also
appeared to be quicker and was preferable in terms of the fewer number of
attempts that were necessary for a successful vein
cannulation.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<68>
Accession Number
617972770
Author
Fabbro M.; Winkler A.M.; Levy J.H.
Institution
(Fabbro) Miller School of Medicine, University of Miami, Miami, FL, United
States
(Winkler) Instrumentation Laboratory, Bedford, MA, United States
(Levy) Duke University Hospital, Duke University, Durham, NC, United
States
Title
Technology: Is There Sufficient Evidence to Change Practice in
Point-of-Care Management of Coagulopathy?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1849-1856),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Currently, hemostasis is one of the most widely researched topics in
perioperative medicine. As investigators learn more about the complexity
of coagulation, developing tests with the ability to rapidly monitor
coagulation and guide targeted therapy is the key to optimizing hemostasis
management. There is mounting evidence that algorithmic transfusion using
point-of-care (POC) testing can reduce red cell and platelet transfusions
and major bleeding after cardiac surgery. Integrating these tests during
cardiac surgery and trauma management is especially important because
these groups use the most blood products within a health system and the
risks of transfusion are well documented. Currently, numerous POC tests
are available for evaluating hemostasis. The purpose of this review is to
provide a comprehensive evaluation of the current evidence surrounding the
most common POC testing devices in practice for managing
coagulation.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<69>
Accession Number
616204732
Author
Sanfilippo F.; Johnson C.; Bellavia D.; Morsolini M.; Romano G.;
Santonocito C.; Centineo L.; Pastore F.; Pilato M.; Arcadipane A.
Institution
(Sanfilippo, Santonocito, Centineo, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Johnson) Department of Anesthesiology, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Bellavia, Romano) Cardiology Unit, Department for the Treatment and Study
of Cardiothoracic Diseases and Cardiothoracic Transplantation,
IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta
Specializzazione), Palermo, Italy
(Morsolini, Pilato) Cardiac Surgery and Heart Transplantation Unit,
Department for the Treatment and Study of Cardiothoracic Diseases and
Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
Title
Mitral Regurgitation Grading in the Operating Room: A Systematic Review
and Meta-analysis Comparing Preoperative and Intraoperative Assessments
During Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1681-1691),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective To assess differences in mitral regurgitation (MR) grade between
the preoperative and the intraoperative evaluations. Design Systematic
review and meta-analysis of 6 observational studies found from MEDLINE and
EMBASE. Setting Cardiac surgery. Participants One hundred thirty-seven
patients. Intervention Comparison between the preoperative MR assessment
and the intraoperative evaluation conducted under general anesthesia (GA),
with or without "hemodynamic matching" (HM) (artificial increase of
afterload). Measurements and Main Results The primary outcome was the
difference between the preoperative and intraoperative MR grade under
"GA-only" or "after-HM." Secondary analyses addressed differences
according to effective regurgitant orifice area (EROA), regurgitant volume
(RVol), color-jet area, and vena contracta width. Risk of MR
underestimation was found under "GA-only" (SMD: 0.55; 95% confidence
interval [CI], 0.31-0.79, p < 0.00001), but not "after-HM" (SMD: -0.16;
95% CI, -0.46 to 0.13, p = 0.27). Under "GA-only", EROA had a trend toward
underestimation (p = 0.07), RVol was reliable (p = 0.17), while reliance
on color-jet area and vena contracta width incur risk of underestimation
(both p = 0.003). After HM, EROA accurately reflected preoperative MR (p =
0.68) while RVol had a trend toward overestimation (p = 0.05). The overall
reported incidence of misdiagnoses was slightly more common under
"GA-only" (mean 48%, 39% underestimation, 9% overestimation; range:
32%-57%) than "after-HM" (mean 41%, 12% underestimation, 29%
overestimation; range: 33%-50%). Only the minority of misdiagnoses were
clinically relevant: underestimation was around 10% (both approaches), but
18% had clinically significant overestimation "after-HM" as compared with
3% under GA-only. Conclusions Intraoperative assessment under "GA-only"
significantly underestimated MR. A more accurate intraoperative evaluation
can be obtained with afterload manipulation, although HM strategy carries
high risk of clinically significant overestimation.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<70>
Accession Number
618015127
Author
El Tahan M.R.; Pasin L.; Marczin N.; Landoni G.
Institution
(El Tahan) Anesthesiology Department, University of Dammam, Al Khubar,
Saudi Arabia
(El Tahan) Cardiothoracic Anaesthesia and Surgical Intensive Care,
Mansoura University, Mansoura City, Egypt
(Pasin) Department of Anesthesia and Intensive Care, Sant'Antonio
Hospital, Padova, Italy
(Marczin) The Royal Brompton and Harefield NHS Foundation Trust, London,
United Kingdom
(Marczin) Section of Anaesthesia, Pain Medicine, and Intensive Care,
Imperial College London, London, United Kingdom
(Marczin) Semmelweis University, Budapest, Hungary
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milano, Italy
Title
Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis
of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1767-1773),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objectives The link between ventilation strategies and perioperative
outcomes remains one of the fundamental paradigms of thoracic anaesthesia.
During one-lung ventilation (OLV), one lung is excluded from gas exchange
and ventilation is directed at the dependent lung. The authors
hypothesised that the use of low tidal volumes (V<inf>T</inf>) during OLV
provides adequate gas exchange and improves postoperative outcome. Design
Meta-analysis of randomized clinical trials. Setting Thoracic surgery.
Participants Patients undergoing OLV. Interventions None. Measurements and
Main Results The authors performed a meta-analysis of all randomized
trials on low versus high V<inf>T</inf> during OLV in patients undergoing
thoracic surgery. Outcomes of the study were gas exchange and airway
pressures during and after OLV, postoperative pulmonary complications
(PPCs), and hospital stay (HLOS). Fourteen randomized trials were
selected, but only a few of them contained one outcome of interest. Low
V<inf>T</inf> was associated with lower arterial oxygen tension, lower
airway pressures, and higher arterial carbon dioxide tension at specific
time points during OLV. Low V<inf>T</inf> was associated with preserved
gas exchange after OLV, lower incidence of pulmonary infiltrations, and
acute respiratory distress syndrome. Incidences of PPCs and HLOS were
similar. Conclusions The use of low V<inf>T</inf> reduces airway pressure
but worsens gas exchange during OLV. Preservation of postoperative
oxygenation and reduction in infiltrates suggest a lung-protective
modality with no demonstrable impact on PPCs and HLOS.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<71>
Accession Number
615604231
Author
Kamran S.; Conti F.; Pomey M.-P.; Baron G.; Calmus Y.; Vidal-Trecan G.
Institution
(Kamran, Vidal-Trecan) Public Health Ward: Quality and Risk Management,
Paris left University Hospitals, Assistance Publique - Hopitaux de Paris,
Paris, France
(Kamran) Doctoral School of Public Health (EDSP), Paris, France
(Conti, Calmus) Centre de Transplantation Hepatique, Pitie Salpetriere
Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
(Pomey) Department of Health Administration, Institut de Recherche en
Sante Publique, Universite de Montreal, Montreal, QC, Canada
(Baron, Vidal-Trecan) UMR 1153 Epidemiology and Statistics Sorbonne Paris
Cite left (CRESS), METHODS Team, INSERM, Paris, France
(Baron) Centre d'Epidemiologie Clinique, Hopital Hotel Dieu, Assistance
Publique des Hopitaux de Paris, Paris, France
(Vidal-Trecan) Department of Public Health, Medical School, Paris
Descartes University, Paris, France
Title
Patients' preferences in transplantation from marginal donors: results of
a discrete choice experiment.
Source
Transplant International. 30 (6) (pp 589-602), 2017. Date of Publication:
June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
To increase the donor pool, the strategy of transplantation from
"marginal" donors was developed though patients' preferences about these
donors were insufficiently known. The preferences of patients registered
on the waiting list or already transplanted in eight transplant teams
covering four main organs (i.e., kidney, liver, heart, and lung) were
evaluated using the discrete choice experiment method. In each left during
2 days, patients were interviewed on four scenarios. Of 178 eligible
patients, 167 were interviewed; 40% accepted marginal graft in their own
situation and 89% at least in one of the scenarios. Imagining urgent
situations or rare profiles with difficult access to transplantation,
respectively, 86% and 71% accepted these grafts. Most (76%) preferred to
be informed about these grafts and 43% preferred to be involved in
decision. The emergency [OR = 1.24; 95% CI: (1.06-1.45)] and the
hazardousness [OR = 0.88; 95% CI: (0.78-0.99)] of the transplantation were
factors independently associated with marginal graft acceptance. Most
patients preferred to be informed and to be involved in the decision.
Marginal grafts could be more accepted by patients in critical medical
situations or perceiving their situation as critical. Physicians'
practices in transplantation should be reconsidered taking into account
individual preferences. This study was performed in a single country and
thus reflects the cultural bias and practice thereof.<br/>Copyright &#xa9;
2017 Steunstichting ESOT

<72>
Accession Number
622339568
Author
Al Kindi H.; Samaan A.; Hosny H.
Institution
(Al Kindi, Samaan, Hosny) Aswan Heart Centre, Aswan, Egypt
(Al Kindi) Sultan Qaboos University Hospital, Muscat, Oman
(Samaan) Cairo University, Cairo, Egypt
Title
NOBLE and EXCEL: The debate for excellence in dealing with left main
stenosis.
Source
Global Cardiology Science and Practice. 2018 (1) (no pagination), 2018.
Article Number: 3. Date of Publication: 2018.
Publisher
Bloomsbury Qatar Foundation Journals (E-mail: info@QScience.com)
Abstract
Left main coronary artery (LMCA) disease is associated with increased
morbidity and mortality. Coronary artery bypass grafting surgery (CABG)
has always been the standard revascularization strategy for this group of
patients. However, with the recent developments in stents design and
medical therapy over the past decade, several trials have been designed to
evaluate the safety and efficacy of percutaneous coronary intervention
(PCI) as an alternative to CABG surgery in patients with LMCA disease.
Recently, the results of two major trials, EXCEL and NOBLE, comparing CABG
versus PCI in this patient population have been released. In fact, the
results of both trials might appear contradictory at first glance. While
the EXCEL trial showed that PCI was non-inferior to CABG surgery, the
NOBLE trial suggested that CABG surgery is a better option. In the
following review, we will discuss some of the similarities and contrasts
between these two trials and conclude with lessons to be learned to our
daily practice.<br/>Copyright &#xa9; 2018 The Author(s), licensee Magdi
Yacoub Institute.

<73>
[Use Link to view the full text]
Accession Number
622386754
Author
Akbulut S.
Institution
(Akbulut) Department of Surgery and Liver Transplant Institute, Inonu
University Faculty of Medicine, Turgut Ozal Medical Center, Elazig Yolu
15. Km, 44280, Malatya 44280, Turkey
Title
Parietal complication of the hydatid disease comprehensive literature
review.
Source
Medicine (United States). 97 (21) (no pagination), 2018. Article Number:
e10671. Date of Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The aim of the study was to provide an overview of the medical
literature on parietal complications of hydatid disease (HD). Methods: A
literature search was conducted on PubMed, Medline, Google Scholar, and
Google databases in accordance with the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines, using keywords to
identify articles related to parietal complications of HD in the thoracic
and abdominal cavities. The following keywords were used: HD, hydatid
cyst, cystic echinococcosis, alveolar echinococcosis, abdominal HD,
thoracic HD, parietal complication, cutaneous fistulization,
cystocutaneous fistulization, cutaneous involvement, external rupture,
external fistulization, subcutaneous involvement, and subcutaneous
abscess. The language of publication, journal, or country was not included
as limitation criteria, and publications dated before August 1, 2016, were
considered. Articles or abstracts containing adequate information, such as
age, sex, cyst size, cyst location, clinical presentation, fistula opening
location, and management were included in the study, whereas articles with
insufficient clinical and demographic data were excluded. Results: The
literature review included 52 articles involving 55 patients with parietal
complications of HD. Thirty-two articles were written in English, 15 in
French, 2 in Spanish, 1 in Italian, 1 in German and 1 in Russian. All 55
patients (women, 30; men, 23; unknown, 2) involved in the study were aged
7 to 93 (mean +/- standard deviation, 54.5 +/- 20.2) years. A total of 24
patients had cysto-cutaneous fistula (Echinococcus granulosus), 12 had
subcutaneous rupture, 10 had cutaneous fistula (E multilocularis), 3 had
cystosubcutaneous abscess, 3 had cysto-cutaneo-bronchial fistula, 2 had
cysto-cutaneo-bronchio-biliary fistula, and 1 had cutaneo-bronchial
fistula. E granulosus were detected in 43 and E multilocularis in 12
patients through clinical, radiological, or histopathological
examinations. Conclusion: Parietal complications such as cysto-cutaneous
fistulization are a rare complication of HD. Complicated HD should be
considered in the differential diagnosis of patients presenting with
cutaneous involvement, especially in HD endemic regions. Abbreviations: CT
= computed tomography, HD = hydatid disease, MRI = magnetic resonance
imaging, SD = standard deviation, US = ultrasonography.<br/>Copyright
&#xa9; &#xa9; 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

<74>
Accession Number
622383195
Author
De Vecchis R.; Ariano C.; Giasi A.; Cioppa C.
Institution
(De Vecchis, Ariano, Giasi, Cioppa) Unit of Cardiology, Presidio Sanitario
Intermedio Elena D'Aosta, ASL Napoli 1 Centro, Via P. Gaurico 21, Naples
80125, Italy
Title
Antiarrhythmic effects of ranolazine used both alone for prevention of
atrial fibrillation and as an add-on to intravenous amiodarone for its
pharmacological cardioversion: A meta-Analysis.
Source
Minerva Cardioangiologica. 66 (3) (pp 349-359), 2018. Date of Publication:
June 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Recent evidence from relatively small randomized controlled
trials would seem to support a useful role of ranolazine for the
prevention and treatment of atrial fibrillation (AF). The present study is
aimed at providing information about the possible beneficial
anti-Arrhythmic properties of ranolazine. In particular, the meta-Analysis
carried out in this study focuses on the application of ranolazine to
prophylaxis and treatment of atrial fibrillation. EVIDENCE ACQUISITION:
Both methods randomized controlled trials (RCTs) and non-randomized
observational studies concerning the effects of ranolazine on AF were
included in the meta-Analysis. In each of the considered studies, a
comparison was made between a group of patients taking ranolazine and a
second group treated instead with another antiarrhythmic therapy, or
assigned to placebo. Efficacy outcomes were the risk of new-onset AF, the
probability of conversion to sinus rhythm of patients with recent
occurrence (>=48 h) of AF and the time to conversion to sinus rhythm.
Safety endpoints were death, adverse events, QTc prolongation and
hypotension. EVIDENCE SYNTHESIS: Ten studies (8 RCTs and 2 nonrandomized
observational studies) were gathered on the whole. Ranolazine was
effective in preventing the occurrence of AF when compared to controls
(RR=0.60; 95% CI: 0.43-0.83; P=0.002). Subgroup analysis showed a more
pronounced preventive effect of ranolazine against AF in the postoperative
setting of coronary artery bypass grafting (CABG) surgery (RR=0.39; 95%
CI: 0.18-0.83; P=0.02) when compared to non-postoperative AF (RR=0.76; 95%
CI: 0.63-0.92; P=0.04). Ranolazine enhanced the chances of successful
cardioversion when added to intravenous amiodarone compared to amiodarone
alone (RR 1.18; 95% CI: 1.05-1.33; P=0.004) and significantly decreased
the time to cardioversion (SMD=-10.35 h; 95% CI:-18.13 hours to-2.57
hours; P<0.001). Overall risks of death, adverse events, and QTc
prolongation were shown to be similar in the comparison between patients
treated with ranolazine and controls. CONCLUSIONS: Ranolazine given orally
at appropriate doses showed the property to significantly quicken the
conversion of AF to sinus rhythm when combined with the IV amiodarone,
compared to IV amiodarone alone. Furthermore, in patients in sinus rhythm,
ranolazine proved to reduce the frequency of new onset AF as well as of
its recurrences, especially in patients undergone CABG surgery, known to
be at high risk of developing postoperative AF. In addition, ranolazine
use seems to be safe and associated with relatively few adverse
events.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<75>
Accession Number
618878399
Author
Reindl M.; Reinstadler S.J.; Feistritzer H.-J.; Theurl M.; Basic D.;
Eigler C.; Holzknecht M.; Mair J.; Mayr A.; Klug G.; Metzler B.
Institution
(Reindl, Reinstadler, Feistritzer, Theurl, Basic, Eigler, Holzknecht,
Mair, Klug, Metzler) University Clinic of Internal Medicine III,
Cardiology and Angiology, Medical University of Innsbruck, Austria
(Mayr) University Clinic of Radiology, Medical University of Innsbruck,
Austria
Title
Relation of low-density lipoprotein cholesterol with microvascular injury
and clinical outcome in revascularized ST-elevation myocardial infarction.
Source
Journal of the American Heart Association. 6 (10) (no pagination), 2017.
Article Number: e006957. Date of Publication: 01 Oct 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Microvascular injury (MVI) after primary percutaneous coronary
intervention for ST-elevation myocardial infarction (STEMI) is a major
determinant of adverse clinical outcome. Experimental data indicate an
impact of hypercholesterolemia on MVI; however, there is a lack of
clinical studies confirming this relation. We aimed to investigate the
association of cholesterol concentrations on admission with MVI visualized
by cardiac magnetic resonance imaging and clinical outcome in STEMI
patients treated by primary percutaneous coronary intervention. Methods
and Results--In this prospective, observational study, we included 235
consecutive revascularized STEMI patients. Cholesterol (total cholesterol,
low-density lipoprotein [LDL], and high-density lipoprotein cholesterol)
and triglyceride concentrations were determined at presentation. Cardiac
magnetic resonance scans were performed 2 (2-4) days after infarction to
assess infarct characteristics, including MVI. Clinical end point was the
occurrence of major adverse cardiac events (MACE) comprising allcause
mortality, nonfatal reinfarction, and new congestive heart failure.
Patients with MVI (n=129; 55%) showed higher levels of total cholesterol
(204 [172-226] versus 185 [168-212] mg/dL; P=0.01) and LDL cholesterol
(142 [113-166] versus 118 [103-149] mg/dL; P=0.001), whereas high-density
lipoprotein cholesterol and triglycerides did not differ significantly. In
multivariable analysis, including all significant clinical and cardiac
magnetic resonance determinants of MVI, LDL concentration emerged as an
independent predictor of MVI (odds ratio, 1.02 [95% confidence interval,
1.01-1.02]; P=0.002). Furthermore, increased LDL cholesterol (>150 mg/dL)
significantly predicted the occurrence of major adverse cardiac events
(hazard ratio, 3.09 [95% confidence interval, 1.22-7.87]; P=0.01).
Conclusions--In STEMI patients undergoing primary percutaneous coronary
intervention, baseline LDL cholesterol concentrations were independently
associated with MVI, revealing a clinically relevant link between LDL
metabolism and MVI in acute STEMI.<br/>Copyright &#xa9; 2017 The Authors.

<76>
Accession Number
622439528
Author
Gani H.; Hoxha B.; Janko A.; Dredha H.; Beqiri V.; Domi R.; Karamitro G.
Institution
(Gani, Hoxha, Janko, Dredha, Beqiri, Domi, Karamitro) UHC Mother Teresa,
Dept. of Surgery, Tirana, Albania
Title
Comparison of crystalloid preloading versus intramuscular ephedrine 25 mg,
on MAP during the first 30 minutes after performing spinal anaesthesia in
patients undergoing transurethral resection of prostate (TURP).
Source
European Urology, Supplements. Conference: 12th South Eastern European
Meeting, SEEM 2016. Bosnia and Herzegovina. 15 (10) (pp e1312), 2016. Date
of Publication: December 2016.
Publisher
Elsevier B.V.
Abstract
INTRODUCTION & OBJECTIVES: Spinal anaesthesia is quick, cost-efficient,
safe, and is the technique of choice in transurethral resection of
prostate (TURP). The major complication of spinal technique is risk of
hypotension. Both crystalloid preloading and intramuscular ephedrine are
used in clinical practice for preventing arterial hypotension secondary to
spinal anesthesia. The aim of this study was to investigate whether any of
these interventions may be more effective in protecting from significant
decreases in Mean Arterial Pressure (MAP) during the first 30 minutes
after performing spinal anaesthesia for transurethral resection of
prostate (TURP). We compared the effects of crystalloid preloading versus
intramuscular (i/m) ephedrine 25 mg, 30 min before spinal anaesthaesia
administration on mean arterial blood pressure during the first 30 minutes
after performing spinal anaesthesia in patients undergoing transurethral
resection of prostate (TURP). MATERIAL & METHODS: In a prospective,
controlled, randomized, double-blind clinical. The participants of this
study were 60 patients, male ASA I-III. The time of this study was January
2016-June 2016. The age of patients was 55-80 years old. Patients were
randomized in two groups. G1 (GC. crystalloid group) thirty patients who
received the crystalloid 500ml, G2 group (G.E. ephedrine group) thirty
patients who received the ephedrine 25 mg i/m 30 min before spinal
anaesthaesia administration. Blood pressure was monitored every 2 min for
first 30 min and every 5 min after 30 min, in both groups. All patients
underwent spinal anaesthesia. Level L2-L3, or L3-L4. With needle G26 with
sol Bupivacaine 0.5%-3ml (15mg). Standard monitoring was used. During
operation, heart rate and arterial oxygen saturation percentage were
measured by pulse oxymetery equipment and their blood pressure by a
non-invasive sphygnomanometer. A p-value <=0.05 was considered
statistically significant. RESULTS: There were no significant differences
between the two groups in age (p = 0.6) and weight (p = 0.6) chronic
alcohol consumption,(P=0.6) history of hypertension,(p=0.8) body mass
index, (p=0.8) sensory block height,(p=0.6) of patients. MAP significantly
decreased from baseline in the G1 crystalloid group (from 110 +/-15 mm Hg
to 50+/-12mm Hg), (p = 0.005), while in the G2 G.E. ephedrine group no
decrease statistically significant in the blood pressure was noticed from
the basal one. [from 110 +/-15 mm Hg to 80 +/-12 mm /Hg (p = 0.5)]. The G1
crystalloid group had a lower MAP than G2 ephedrine group statistically
significant between of them [p = 0.001]. CONCLUSIONS: We concluded that
using i/m ephedrine 25mg, 30 min before spinal anaesthaesia is more
effective than preloading with crystalloid to prevents hypotension during
the first 30 minutes after performing spinal anaesthesia in patients
undergoing transurethral resection of prostate (TURP). [p = 0.001].

<77>
Accession Number
622436681
Author
Van Wijk S.W.; Driessen M.M.; Meijboom F.J.; Doevendans P.A.; Schoof P.H.;
Breur H.M.; Takken T.
Institution
(Van Wijk, Meijboom, Breur) Department of Paediatric Cardiology,
Wilhelmina Children's Hospital, University Medical Centre Utrecht,
Lundlaan 6, Utrecht 3584 EA, Netherlands
(Driessen, Meijboom, Doevendans) Department of Cardiology, University
Medical Centre Utrecht, Netherlands
(Doevendans) ICIN-Netherlands Heart Institute, Utrecht, Netherlands
(Schoof) Paediatric Cardiothoracic Surgery, Wilhelmina Children's
Hospital, University Medical Centre Utrecht, Netherlands
(Takken) Paediatric Clinical Exercise Physiology, Wilhelmina Children's
Hospital, University Medical Centre Utrecht, Netherlands
Title
Left ventricular function and exercise capacity after arterial switch
operation for transposition of the great arteries: A systematic review and
meta-Analysis.
Source
Cardiology in the Young. 28 (7) (pp 895-902), 2018. Date of Publication:
01 Jul 2018.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The arterial switch operation for transposition of the great
arteries was initially believed to be an anatomical correction. Recent
evidence shows reduced exercise capacity and left ventricular function in
varying degrees in the long term after an arterial switch
operation.Objective To perform a meta-Analysis on long-Term exercise
capacity and left ventricular ejection fraction after an arterial switch
operation.Methods A literature search was performed to cover all studies
on patients who had undergone a minimum of 6 years of follow-up that
reported either left ventricular ejection fraction, peak oxygen uptake,
peak workload, and/or peak heart rate. A meta-Analysis was performed if
more than three studies reported the outcome of interest.Results A total
of 21 studies reported on the outcomes of interest. Oxygen uptake was
consistently lower in patients who had undergone an arterial switch
operation compared with healthy controls, with a pooled average peak
oxygen uptake of 87.5+/-2.9% of predicted. The peak heart rate was also
lower compared with that of controls, at 92+/-2% of predicted. Peak
workload was significantly reduced in two studies. Pooled left ventricular
ejection fraction was normal at 60.7+/-7.2%.Conclusion Exercise capacity
is reduced and left ventricular ejection fraction is preserved in the long
term after an arterial switch operation for transposition of the great
arteries.<br/>Copyright &#xa9; Cambridge University Press 2018.

<78>
Accession Number
2000823087
Author
Chang H.W.; Hwang H.Y.; Seo J.-W.; Kim K.-B.
Institution
(Chang) Department of Thoracic and Cardiovascular Surgery, Sejong General
Hospital, Bucheon-si, Gyeonggi-do, South Korea
(Hwang, Kim) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Seo) Department of Pathology, Seoul National University Hospital, Seoul
National University College of Medicine, Seoul, South Korea
Title
Lower versus upper leg saphenous vein composite grafts based on the left
internal thoracic artery: A randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The "lower versus upper leg saphenous vein (SV) composite
graft based on the left internal thoracic artery (ITA) for coronary artery
bypass grafting" trial was designed to compare the histologic,
immunohistochemical, and angiographic findings of lower versus upper leg
SV composite grafts. Methods: Twenty-six patients with multivessel
coronary artery disease were prospectively randomized to undergo
revascularization using a lower leg (n = 13) or upper leg (n = 13) SV
composite graft based on the in situ left ITA. The SV was harvested with a
"no-touch" technique, and 2 excess segments were removed from the distal
and proximal portions of each SV conduit. Another proximal segment was
removed from the reversed SV composite graft, which had been dilated by
the native ITA pressure. Hematoxylin and eosin staining,
immunohistochemistry, and early and 1-year postoperative angiographic
results were compared. Results: The histologic study showed that the
proximal and dilated proximal SV conduit lumen diameters were smaller in
the lower leg group than in the upper leg group (proximal, 623 +/- 143 mum
vs 858 +/- 266 mum; P =.008; dilated proximal, 1138 +/- 419 mum vs 1477
+/- 353 mum; P =.047). However, there were no differences in the lumen
diameters of the distal SV segments in terms of immunohistochemical
comparisons, diameters, patency rates, or filling frame counts of the SV
conduits on early and 1-year postoperative angiograms between the 2
groups. Conclusions: Although the proximal segment luminal diameters were
smaller in the lower leg SV, there were no differences in the
immunohistochemical results or patency rates on early and 1-year
postoperative angiograms between the lower and upper leg "no-touch" SV
conduits.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery