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<1>
Accession Number
621079995
Author
Gottlieb M.; Long B.; Koyfman A.
Institution
(Gottlieb) Department of Emergency Medicine, Rush University Medical
Center, Chicago, Illinois, United States
(Long) Department of Emergency Medicine, San Antonio Military Medical
Center, Fort Sam Houston, Texas, United States
(Koyfman) Department of Emergency Medicine, The University of Texas
Southwestern Medical Center, Dallas, Texas, United States
Title
Evaluation and Management of Aortic Stenosis for the Emergency Clinician:
An Evidence-Based Review of the Literature.
Source
Journal of Emergency Medicine. 55 (1) (pp 34-41), 2018. Date of
Publication: July 2018.
Publisher
Elsevier USA
Abstract
Introduction: Aortic stenosis is a common condition among older adults
that can be associated with dangerous outcomes, due to both the disease
itself and its influence on other conditions. Objective: This review
provides an evidence-based summary of the current emergency department
(ED) evaluation and management of aortic stenosis. Discussion: Aortic
stenosis refers to significant narrowing of the aortic valve and can be
caused by calcific disease, congenital causes, or rheumatic valvular
disease. Symptoms of advanced disease include angina, dyspnea, and
syncope. Patients with these symptoms have a much higher mortality rate
than asymptomatic patients. Initial evaluation should include an
electrocardiogram, complete blood count, basic metabolic profile,
coagulation studies, troponin, brain natriuretic peptide, type and screen,
and a chest radiograph. Transthoracic echocardiogram is the test of
choice, but point-of-care ultrasound has been found to have good accuracy
when a formal echocardiogram is not feasible. Initial management should
begin with restoring preload and ensuring a normal heart rate, as both
bradycardia and tachycardia can lead to clinical decompensation. For
patients with high blood pressure and heart failure symptoms, nitrate
agents may be reasonable, but hypotension should be avoided. Dobutamine
can increase inotropy. For hypotensive patients, vasopressors should be
used at the lowest effective dose. The treatment of choice is valve
replacement, but extracorporeal membrane oxygenation and percutaneous
balloon dilatation of the aortic valve have been described as temporizing
measures. Conclusion: Aortic stenosis is an important condition that can
lead to dangerous outcomes and requires prompt recognition and
disease-specific management in the ED.<br/>Copyright &#xa9; 2018

<2>
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.

<3>
Accession Number
2000795810
Author
Baron S.J.; Thourani V.H.; Kodali S.; Arnold S.V.; Wang K.; Magnuson E.A.;
Pichard A.D.; Babaliaros V.; George I.; Miller D.C.; Tuzcu E.M.; Greason
K.; Herrmann H.C.; Smith C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron, Thourani, Kodali, Arnold, Wang, Magnuson, Pichard, Babaliaros,
George, Miller, Tuzcu, Greason, Herrmann, Smith, Leon, Cohen) Saint Luke's
Mid America Heart Institute, Kansas City, Missouri, United States
Title
Effect of SAPIEN 3 Transcatheter Valve Implantation on Health Status in
Patients With Severe Aortic Stenosis at Intermediate Surgical Risk:
Results From the PARTNER S3i Trial.
Source
JACC: Cardiovascular Interventions. 11 (12) (pp 1188-1198), 2018. Date of
Publication: 25 June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate whether transcatheter
aortic valve replacement (TAVR) with the SAPIEN 3 valve (S3-TAVR) results
in improved quality of life (QoL) compared with previous-generation TAVR
devices or surgical aortic valve replacement (SAVR). Background: In
patients with severe aortic stenosis at intermediate surgical risk, TAVR
using the SAPIEN XT valve (XT-TAVR) results in similar QoL compared with
SAVR. Compared with SAPIEN XT, the SAPIEN 3 valve offers a lower delivery
profile and modifications to reduce paravalvular regurgitation. Methods:
Between February and December 2014, 1,078 patients at intermediate
surgical risk with severe aortic stenosis were treated with S3-TAVR in the
PARTNER S3i (Placement of Aortic Transcatheter Valve) trial. QoL was
assessed at baseline, 1 month, and 1 year using the Kansas City
Cardiomyopathy Questionnaire, Medical Outcomes Study Short Form-36, and
EQ-5D. QoL outcomes of S3-TAVR patients were compared with those in the
SAVR and XT-TAVR arms of the PARTNER 2A trial using propensity score
stratification to adjust for differences between the treatment groups.
Results: Over 1 year, S3-TAVR was associated with substantial improvements
in QoL compared with baseline. At 1 month, S3-TAVR was associated with
better QoL than either SAVR or XT-TAVR (adjusted differences in Kansas
City Cardiomyopathy Questionnaire overall summary score 15.6 and 3.7
points, respectively; p < 0.001). At 1 year, the differences in QoL
between S3-TAVR and both SAVR and XT-TAVR were reduced but remained
statistically significant (adjusted differences 2.0 and 2.2 points,
respectively; p < 0.05). Similar results were seen for generic QoL
outcomes. Conclusions: Among patients at intermediate surgical risk with
severe aortic stenosis, S3-TAVR resulted in improved QoL at both 1 month
and 1 year compared with both XT-TAVR and SAVR.<br/>Copyright &#xa9; 2018
American College of Cardiology Foundation

<4>
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

<5>
Accession Number
622527284
Author
Mirmohammadsadeghi A.; Mirmohammadsadeghi M.; Kheiri M.
Institution
(Mirmohammadsadeghi, Mirmohammadsadeghi) Department of Cardiovascular
Surgery, Chamran Hospital, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Kheiri) Department of Cardilogy, Islamic Azad University Najafabad
Branch, Isfahan, Iran, Islamic Republic of
Title
Does topical tranexamic acid reduce postcoronary artery bypass graft
bleeding?.
Source
Journal of Research in Medical Sciences. 23 (1) (no pagination), 2018.
Article Number: 6. Date of Publication: January 2018.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Postoperative bleeding is a common problem in cardiac surgery.
We tried to evaluate the effect of topical tranexamic acid (TA) on
reducing postoperative bleeding of patients undergoing on-pump coronary
artery bypass graft (CABG) surgery. Materials and Methods: One hundred and
twenty-six isolated primary CABG patients were included in this clinical
trial. They were divided blindly into two groups; Group 1, patients
receiving 1 g TA diluted in 100 ml normal saline poured into mediastinal
cavity before closing the chest and Group 2, patients receiving 100 ml
normal saline at the end of operation. First 24 and 48 h chest tube
drainage, hemoglobin decrease and packed RBC transfusion needs were
compared. Results: Both groups were the same in baseline characteristics
including gender, age, body mass index, ejection fraction, clamp time,
bypass time, and operation length. During the first 24 h postoperatively,
mean chest tube drainage in intervention group was 567 ml compared to 564
ml in control group (P = 0.89). Mean total chest tube drainage was 780 ml
in intervention group and 715 ml in control group (P = 0.27). There was no
significant difference in both mean hemoglobin decrease (P = 0.26) and
packed RBC transfusion (P = 0.7). Topical application of 1 g TA diluted in
100 ml normal saline does not reduce postoperative bleeding of isolated
on-pump CABG surgery. Conclusion: We do not recommend topical usage of 1 g
TA diluted in 100 ml normal saline for decreasing blood loss in on-pump
CABG patients.<br/>Copyright &#xa9; 2018 Journal of Research in Medical
Sciences.

<6>
Accession Number
622441087
Author
Gongora C.A.; Bavishi C.; Uretsky S.; Argulian E.
Institution
(Gongora, Bavishi, Argulian) Mount Sinai Heart, Mount Sinai St Luke's
Hospital, Icahn School of Medicine, Division of Cardiology, New York
10019, United States
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, Morristown, NJ, United States
Title
Acute chest pain evaluation using coronary computed tomography angiography
compared with standard of care: A meta-analysis of randomised clinical
trials.
Source
Heart. 104 (3) (pp 215-221), 2018. Date of Publication: 01 Feb 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Coronary CT angiography (CCTA) has certain advantages compared
with stress testing including greater accuracy in identifying obstructive
coronary disease. The aim of the study was to perform a systematical
review and meta-analysis comparing CCTA with other standard-of-care (SOC)
approaches in evaluation of patients with acute chest pain. Methods
Electronic databases were systematically searched to identify randomised
clinical trials of patients with acute chest pain comparing CCTA with SOC
approaches. We examined the following end points: mortality, major adverse
cardiac events (MACE), myocardial infarction (MI), invasive coronary
angiography (ICA) and revascularisation. Pooled risk ratios (RR) and their
95% CIs were calculated using random-effects models. Results Ten trials
with 6285 patients were included. The trials used different definitions
and implementation for SOC but all used physiologic testing. The clinical
follow-up ranged from 1 to 19 months. There were no significant
differences in all-cause mortality (RR 0.48, 95% CI 0.17 to 1.36, p=0.17),
MI (RR 0.82, 95% CI 0.49 to 1.39, p=0.47) or MACE (RR 0.98, 95% CI 0.67 to
1.43, p=0.92) between the groups. However, significantly higher rates of
ICA (RR 1.32, 95% CI 1.07 to 1.63, p=0.01) and revascularisation (RR 1.77,
95% CI 1.35 to 2.31, p<0.0001) were observed in the CCTA arm. Conclusions
Compared with other SOC approaches use of CCTA is associated with similar
major adverse cardiac events but higher rates of revascularisation in
patients with acute chest pain.<br/>Copyright &#xa9; 2018 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<7>
Accession Number
622441081
Author
Adamson P.D.; Hunter A.; Williams M.C.; Shah A.S.V.; McAllister D.A.;
Pawade T.A.; Dweck M.R.; Mills N.L.; Berry C.; Boon N.A.; Clark E.;
Flather M.; Forbes J.; McLean S.; Roditi G.; Van Beek E.J.R.; Timmis A.D.;
Newby D.E.
Institution
(Adamson, Hunter, Williams, Shah, Pawade, Dweck, Mills, Boon, Clark, Van
Beek, Newby) BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh EH16 4SB, United Kingdom
(Williams, Van Beek) Edinburgh Imaging, Queens Medical Research Institute,
University of Edinburgh, Edinburgh, United Kingdom
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Berry, Roditi) Institute of Clinical Sciences, University of Glasgow,
Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Title
Diagnostic and prognostic benefits of computed tomography coronary
angiography using the 2016 National Institute for Health and Care
Excellence guidance within a randomised trial.
Source
Heart. 104 (3) (pp 207-214), 2018. Date of Publication: 01 Feb 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To evaluate the diagnostic and prognostic benefits of CT
coronary angiography (CTCA) using the 2016 National Institute for Health
and Care Excellence (NICE) guidelines for the assessment of suspected
stable angina. Methods Post hoc analysis of the Scottish COmputed
Tomography of the HEART (SCOT-HEART) trial of 4146 participants with
suspected angina randomised to CTCA. Patients were dichotomised into NICE
guideline-defined possible angina and non-anginal presentations. Primary
(diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and
prognostic endpoint comprised fatal and non-fatal myocardial infarction
(MI). Results In 3770 eligible participants, CTCA increased diagnostic
certainty more in those with possible angina (relative risk (RR) 2.22 (95%
CI 1.91 to 2.60), p<0.001) than those with non-anginal symptoms (RR 1.30
(1.11 to 1.53), p=0.002; p interaction <0.001). In the possible angina
cohort, CTCA did not change rates of invasive angiography (p=0.481) but
markedly reduced rates of normal coronary angiography (HR 0.32 (0.19 to
0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography
increased (HR 1.82 (1.13 to 2.92), p=0.014) without reducing rates of
normal coronary angiography (HR 0.78 (0.30 to 2.05), p=0.622). At 3.2
years of follow-up, fatal or non-fatal MI was reduced in patients with
possible angina (3.2% to 1.9%%; HR 0.58 (0.34 to 0.99), p=0.045) but not
in those with non-anginal symptoms (HR 0.65 (0.25 to 1.69), p=0.379).
Conclusions NICE-guided patient selection maximises the benefits of CTCA
on diagnostic certainty, use of invasive coronary angiography and
reductions in fatal and non-fatal myocardial infarction. Patients with
non-anginal chest pain derive minimal benefit from CTCA and increase the
rates of invasive investigation. Trial registration number
ClinicalTrials.gov: NCT01149590;post results.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<8>
Accession Number
622615859
Author
Shao Q.; Korantzopoulos P.; Letsas K.P.; Tse G.; Hong J.; Li G.; Liu T.
Institution
(Shao, Li, Liu) Department of Cardiology, Tianjin Institute of Cardiology,
Second Hospital of Tianjin Medical University, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular disease, Tianjin, China
(Korantzopoulos) First Department of Cardiology, University Hospital of
Ioannina, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, "Evangelismos" General Hospital of Athens, Athens,
Greece
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong
(Hong) Department of Internal Medicine, Shanghai First People's Hospital,
Shanghai Jiao Tong University, Shanghai, China
Title
Red blood cell distribution width as a predictor of atrial fibrillation.
Source
Journal of Clinical Laboratory Analysis. 32 (5) (no pagination), 2018.
Article Number: e22378. Date of Publication: June 2018.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Current evidence suggests that a higher red blood cell
distribution width (RDW) may be associated with increased risk of atrial
fibrillation (AF) development. Given that some controversial results have
been published, we conducted a systematic review of the current literature
along with a comprehensive meta-analysis to evaluate the association
between RDW and AF development. Methods: We performed a systematic search
of the literature using electronic databases (PubMed, Ovid, Embase, and
Web of Science) to identify studies reporting on the association between
RDW and AF development published until June 2016. We used both fix-effects
and random-effects models to calculate the overall effect estimate. An
I² > 50% indicates at least moderate statistical heterogeneity.
A sensitivity analysis and subgroup analysis were performed to find the
origin of heterogeneity. Results: A total of 12 studies involving 2721
participants were included in this meta-analysis. The standardized mean
difference in the RDW levels between patients with and those without AF
development was 0.66 units (P <.05; 95% confidence interval 0.44-0.88). A
significant heterogeneity between the individual studies was observed (P
<.05; I² = 80.4%). A significant association between the
baseline RDW levels and AF occurrence or recurrence following cardiac
procedure or surgery was evident (SMD: 0.61; 95% confidence interval
0.33-0.88; P <.05) with significant heterogeneity across the studies
(I² = 80.7%; P <.01). Conclusions: Our comprehensive
meta-analysis suggests that higher levels of RDW are associated with an
increased risk of AF in different populations.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<9>
Accession Number
2000859042
Author
Gouriet F.; Chaudet H.; Gautret P.; Pellegrin L.; de Santi V.P.; Savini
H.; Texier G.; Raoult D.; Fournier P.-E.
Institution
(Gouriet, Raoult) UMR MEPHI, France
(Chaudet, Gautret, Pellegrin, de Santi, Savini, Texier, Fournier) UMR
VITROME, Aix-Marseille Universite, IRD, Service de Sante des Armees,
Assistance Publique-Hopitaux de Marseille, Institut
Hospitalo-Universitaire Mediterranee-Infection, France
(Pellegrin, de Santi, Texier) Forces Centre for Epidemiology and Public
Health, French Forces Health Services, France
(Savini) Military Teaching Hospital Laveran, Department of Infectious
Diseases and Tropical Medicine, French Forces Health Services, Marseille,
France
Title
Endocarditis in the Mediterranean Basin.
Source
New Microbes and New Infections. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Infective endocarditis is a severe disease with high mortality. Despite a
global trend towards an increase in staphylococcal aetiologies, in older
patients and a decrease in viridans streptococci, we have observed in
recent studies great epidemiologic disparities between countries. In order
to evaluate these differences among Mediterranean countries, we performed
a PubMed search of infective endocarditis case series for each country.
Data were available for 13 of the 18 Mediterranean countries. Despite
great differences in diagnostic strategies, we could classify countries
into three groups. In northern countries, patients are older (>50 years
old), have a high rate of prosthetic valves or cardiac electronic
implantable devices and the main causative agent is Staphylococcus aureus.
In southern countries, patients are younger (<40 years old), rheumatic
heart disease remains a major risk factor (45-93%), viridans streptococci
are the main pathogens, zoonotic and arthropod-borne agents are frequent
and blood culture-negative endocarditis remains highly prevalent. Eastern
Mediterranean countries exhibit an intermediate situation: patients are 45
to 60 years old, the incidence of rheumatic heart disease ranges from 8%
to 66%, viridans streptococci play a predominant role and zoonotic and
arthropod-borne diseases, in particular brucellosis, are identified in up
to 12% of cases.<br/>Copyright &#xa9; 2018 The Author(s)

<10>
Accession Number
2000856302
Author
Hahn R.T.; Leipsic J.; Douglas P.S.; Jaber W.A.; Weissman N.J.; Pibarot
P.; Blanke P.; Oh J.K.
Institution
(Hahn) Columbia University Medical Center/New York-Presbyterian Hospital,
New York, New York, United States
(Leipsic, Blanke) University of British Columbia and St. Paul's Hospital,
Vancouver, Canada
(Douglas) Division of Cardiovascular Medicine, Duke University Medical
Center, and Duke Clinical Research Institute, Durham, North Carolina,
United States
(Jaber) Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec/Quebec Heart & Lung Institute, Department of Medicine, Laval
University, Quebec, Canada
(Oh) Mayo Clinic, Rochester, Minnesota, United States
Title
Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve
Function.
Source
JACC: Cardiovascular Imaging. (no pagination), 2018. Date of Publication:
2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aims to establish parameters for identifying normal
function for each of the 3 iterations of balloon-expandable valves and 2
iterations of self-expanding valves. Background: Expected transthoracic
echocardiographic Doppler-derived hemodynamic data for transcatheter
aortic valves inform pre-implant decision-making and post-implanted
monitoring of longitudinal valve function. Methods: We collected the
Echocardiography Core Lab measured mean gradients and effective orifice
area (EOA) from discharge or 30-day echocardiograms from randomized
trials; the PARTNER (Placement of Aortic Transcatheter Valves) trials for
the balloon-expandable valves and the Medtronic CoreValve US Pivotal trial
and Medtronic CoreValve Evolut R United States IDE Clinical Study for the
self-expanding valves. Results: For all SAPIEN (Edwards Lifesciences,
Irvine, California) valve sizes, mean EOA = 1.70 +/- 0.49 cm²
with mean gradient of 9.36 +/- 4.13 mm Hg. For all SAPIEN XT valve sizes,
mean EOA = 1.67 +/- 0.46 cm² with mean gradient of 9.52 +/-
3.64 mm Hg. For all SAPIEN 3 valve sizes, the mean EOA = 1.66 +/- 0.38
cm² with mean gradient of 11.18 +/- 4.35 mm Hg. For all
CoreValve valve sizes, the mean EOA = 1.88 +/- 0.56 cm² with
mean gradient of 8.85 +/- 4.14 mm Hg. For all Evolut R valve sizes, the
mean EOA = 2.01 +/- 0.65 cm² with mean gradient of 7.52 +/-
3.19 mm Hg. The SAPIEN 3 post-implant EOA was progressively larger for
each quintile of baseline annular area by computed tomography (p < 0.001).
Similarly, for the Evolut R valve, post-implantation EOA was significantly
larger for each quintile of baseline annular perimeter (p < 0.001).
Conclusions: Tables of expected mean transcatheter aortic valve
hemodynamics by valve type and size are essential in evaluating the
function of these transcatheter prosthetic valves. Tables of expected EOA
by the native annular anatomy may be useful for pre-implantation decision
making. Criteria for defining structural valve dysfunction are
proposed.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<11>
Accession Number
2000848811
Author
Mancini G.B.J.; Boden W.E.; Brooks M.M.; Vlachos H.; Chaitman B.R.; Frye
R.; Bittner V.; Hartigan P.M.; Dagenais G.R.
Institution
(Mancini) University of British Columbia, Vancouver, British Columbia,
Canada
(Boden) Clinical Trials Network and Massachusetts Veterans Epidemiology,
Research, and Informatics Center (MAVERIC), Veterans Affairs New England
Healthcare System, Boston, MA, United States
(Brooks, Vlachos) University of Pittsburgh, Graduate School of Public
Health, Pittsburgh, PA, United States
(Chaitman) St. Louis University School of Medicine, St. Louis, Missouri,
United States
(Frye) Mayo Clinic, Rochester, MN, United States
(Bittner) University of Alabama at Birmingham, Birmingham, AL, United
States
(Hartigan) West Haven Veterans Administration Coordinating Center, West
Haven, CT, United States
(Dagenais) Quebec Heart and Lung University Institute, Quebec City,
Quebec, Canada
Title
Impact of treatment strategies on outcomes in patients with stable
coronary artery disease and type 2 diabetes mellitus according to
presenting angina severity: A pooled analysis of three federally-funded
randomized trials.
Source
Atherosclerosis. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: The impact of treatment strategies on outcomes in
patients with stable coronary artery disease (CAD) and type 2 diabetes
mellitus (T2DM) according to presenting angina has not been rigorously
assessed. Methods: We performed a patient-level pooled-analysis (n = 5027)
of patients with stable CAD and T2DM randomized to optimal medical therapy
[OMT], percutaneous coronary intervention [PCI] + OMT, or coronary artery
bypass grafting [CABG] + OMT. Endpoints were death/myocardial infarction
(MI)/stroke, post-randomization revascularization (both over 5 years), and
angina control at 1 year. Results: Increasing severity of baseline angina
was associated with higher rates of death/MI/stroke (p = 0.009) and
increased need for post-randomization revascularization (p = 0.001); after
multivariable adjustment, only association with post-randomization
revascularization remained significant. Baseline angina severity did not
influence the superiority of CABG + OMT to reduce the rate of
death/MI/stroke and post-randomization revascularization compared to other
strategies. CABG + OMT was superior for angina control at 1 year compared
to both PCI + OMT and OMT alone but only in patients with >= Class II
severity at baseline. Comparisons between PCI + OMT and OMT were neutral
except that PCI + OMT was superior to OMT for reducing the rate of
post-randomization revascularization irrespective of presenting angina
severity. Conclusions: Presenting angina severity did not influence the
superiority of CABG + OMT with respect to 5-year rates of death/MI/stroke
and need for post-randomization revascularization. Presenting angina
severity minimally influenced relative benefits for angina control at 1
year.<br/>Copyright &#xa9; 2018 The Authors

<12>
Accession Number
2000822273
Author
Eskandr A.M.; Metwally A.A.; Abu Elkassem M.S.; Sadik S.A.; Elmiligy A.E.;
Mourad M.; Hussein L.
Institution
(Eskandr, Metwally, Abu Elkassem, Sadik, Elmiligy) Anesthesia, ICU, and
Pain Therapy, Faculty of Medicine, Menoufiya University, Shibin El-koom,
Egypt
(Mourad, Hussein) Cardiothoracic Anesthesia and ICU, National Heart
Institute, Cairo, Egypt
Title
Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management
of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of dobutamine and nitroglycerin to
milrinone in young patients with severe pulmonary hypertension undergoing
mitral valve replacement. Design: A prospective randomized,
double-blinded, controlled study. Setting: Single university hospital.
Participants: Forty patients had systolic pulmonary arterial pressure >=60
mmHg and were scheduled for elective mitral valve replacement. The
patients were divided randomly into 2 equal groups according to the drugs
given during the study. Interventions: The patients in group I received 5
to 20 micro&#32;g/kg/min of dobutamine and 0.5 to 3 micro&#32;g/kg/min of
nitroglycerin, and patients in group II received a loading dose of
milrinone, 50 micro&#32;g/kg over 10 minutes, followed by a maintenance
dose of 0.25 to 0.75 micro&#32;g/kg/min. Measurements and Main Results:
The primary outcome was the effects of interventional drugs on mean
pulmonary artery pressure. The secondary outcomes were the effects of
interventional drugs on systemic and pulmonary hemodynamic parameters
measured from induction of anesthesia until the first 12 hours in the
intensive care unit stay. There was a more significant decrease in mean
pulmonary artery pressure, pulmonary capillary wedge pressure, and central
venous pressure in group II than group I at all time points after
cardiopulmonary bypass. There were more significant increases in heart
rate, mean arterial pressure, cardiac output, and mixed venous oxygen
tension in group I than group II, which became more obvious in time. In
both groups, there was a significant decrease in systemic vascular
resistance and pulmonary vascular resistance at all times. Conclusion:
Milrinone provides adequate cardiac performance, causing a greater
reduction in pulmonary artery pressure and pulmonary capillary wedge
pressure.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<13>
Accession Number
622613765
Author
McQuillan C.; Gray A.; Kearney A.; Menown I.B.A.
Institution
(McQuillan, Gray, Kearney, Menown) Craigavon Cardiac Centre, Southern
Trust, Craigavon, Northern Ireland, United Kingdom
Title
Advances in Clinical Cardiology 2017: A Summary of Key Clinical Trials.
Source
Advances in Therapy. (pp 1-29), 2018. Date of Publication: 14 Jun 2018.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Numerous important cardiology clinical trials have been
published or presented at major international meetings during 2017. This
paper aims to summarize these trials and place them in clinical context.
Methods: The authors reviewed clinical trials presented at major
cardiology conferences during 2017 including the American College of
Cardiology, European Association for Percutaneous Cardiovascular
Interventions, European Society of Cardiology, European Association for
the Study of Diabetes, Transcatheter Cardiovascular Therapeutics, and the
American Heart Association. Selection criteria were trials with a broad
relevance to the cardiology community and those with potential to change
current practice. Results: A total of 75 key cardiology clinical trials
were identified for inclusion. New interventional and structural
cardiology data include left main bifurcation treatment strategy,
multivessel disease management in cardiogenic shock, drug-eluting balloons
for in-stent restenosis, instantaneous wave-free physiological assessment,
new-generation stents (COMBO, Orsiro), transcatheter aortic valve
implantation, and closure devices. New preventative cardiology data
include trials of liraglutide, empagliflozin, PCSK9 inhibitors (evolocumab
and bococizumab), inclisiran, and anacetrapib. Antiplatelet data include
the role of uninterrupted aspirin therapy during non-cardiac surgery and
dual antiplatelet therapy following coronary artery bypass grafting. New
data are also included from fields of heart failure (levosimendan,
spironolactone), atrial fibrillation (apixaban in DC cardioversion),
cardiac devices (closed loop stimulation pacing for neuromediated
syncope), and electrophysiology (catheter ablation for atrial
fibrillation). Conclusion: This paper presents a summary of key clinical
cardiology trials during the past year and should be of practical value to
both clinicians and cardiology researchers.<br/>Copyright &#xa9; 2018 The
Author(s)

<14>
Accession Number
622613183
Author
Felix R.C.M.; Gouvea C.M.; Reis C.C.W.; Dos Santos Miranda J.S.; Schtruk
L.B.C.E.; Colafranceschi A.S.; Mesquita C.T.
Institution
(Felix, Mesquita) Federal Fluminense University, Av. Marques do Parana,
303 - Centro, Niteroi, RJ 24033-900, Brazil
(Gouvea, Reis, Dos Santos Miranda, Schtruk, Colafranceschi) National
Institute of Cardiology, Rio de Janeiro, Brazil
Title
18F-fluorodeoxyglucose use after cardiac transplant: A comparative study
of suppression of physiological myocardial uptake.
Source
Journal of Nuclear Cardiology. (pp 1-9), 2018. Date of Publication: 14 Jun
2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: 18F-fluorodeoxyglucose (FDG) has been useful in the evaluation
of myocardial inflammatory processes. However, it is challenging to
identify them due to physiological 18F-FDG uptake. There are no
publications demonstrating the application of FDG in post-transplant
rejection in humans yet. The aim of this study is to determine the
feasibility of suppression of myocardial FDG uptake in post-transplant
patients, comparing three different protocols of preparation. Methods: Ten
patients after heart transplantation were imaged by FDG associated with
three endomyocardial biopsies (EMB), scheduled in the first year after the
procedure. Before each imaging, patients were randomized to one of three
preparations: (1) hyperlipidic-hypoglycemic diet; (2) fasting longer than
12 hours; and (3) fasting associated with intravenous heparin. All
patients would undergo the three methods. FDG images were analyzed using
visual analysis scores and relative radiotracer cardiac uptake (RRCU).
Results: The suppression rate of radiotracer activity ranged from 55% to
62%. Visual analysis showed that preparation 3 presented less efficacy in
the suppression compared to the others. However, RRCU did not show
difference between the preparations. Conclusions: Suppression of
physiological myocardial FDG uptake after cardiac transplantation is
feasible. The usefulness of heparin in the suppression is
unclear.<br/>Copyright &#xa9; 2018 American Society of Nuclear Cardiology

<15>
Accession Number
622530321
Author
Zolfaghari M.; Mirhosseini S.J.; Baghbeheshti M.; Bauer B.A.
Institution
(Zolfaghari, Baghbeheshti) Student Research Committee, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Bauer) Complementary and Integrative Medicine, Division General Internal
Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United
States
Title
The effect of classic chest physiotherapy on postoperative pain scores and
hospital stay in patients undergoing off-pump coronary artery bypass graft
surgery: A randomized clinical trial.
Source
Galen Medical Journal. 7 (1) (no pagination), 2018. Article Number: e838.
Date of Publication: 2018.
Publisher
Shiraz University of Medical Sciences (E-mail: info@gmj.ir)
Abstract
Background: Background: Chest physiotherapy (CPT) is a care that increases
the mobilization of several structures from both muscle and subcutaneous
tissue. We planned to investigate the effect of classic CPT on pain,
fatigue, satisfaction, and hospital length of stay (LOS) in patients
undergoing off-pump coronary artery bypass graft (CABG). Materials and
Methods: This study was a randomized controlled trial that conducted on 50
patients undergoing elective off-pump CABG. The patients have been
randomly divided into two groups; in the group A (n=25) patients received
physiotherapy at a single session of classic CPT, 4 times during 2nd to
5th days for 15 minutes in every session, in the group B (n=25) patients
had not protocol of this exercise therapy (control). Results:The average
age of all participants was 62.08 +/-9.08 years. Of the 50 patients, 33
(66%) was male. Classic CPT significantly decreased pain (P=0.04),
hospital LOS (P=0.010) and could increase in patients' satisfaction (P <
0.001). However, it had no considerable effect on fatigue (P=0.725).
Conclusion: According to our findings, classic CPT could improve
postoperative care after off-pump CABG surgery.<br/>Copyright &#xa9; 2018,
Galen Medical Journal.

<16>
Accession Number
622526446
Author
DeStephan C.M.; Schneider D.J.
Institution
(DeStephan, Schneider) Department of Medicine, Cardiovascular Research
Institute, University of Vermont, 308 S. Park Drive, Colchester, VT 05446,
United States
Title
Antiplatelet therapy for patients undergoing coronary artery bypass
surgery.
Source
Kardiologia Polska. 76 (6) (pp 945-952), 2018. Date of Publication: 11 Jun
2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Considerable variation in the use and duration of antiplatelet medications
during the perioperative and postoperative care of patients undergoing
coronary artery bypass grafting (CABG) reflects the limited number of
studies focused directly on these patients as well as the variation in the
results reported. In this review we highlight the incidence and mechanisms
of graft closure as well as the evidence in support of antiplatelet
therapy that is balanced by the impact of antiplatelet therapy on the risk
of bleeding to provide recommendations for the use of this therapy in
patients undergoing CABG. Low-dose acetylsalicylic acid (ASA; <= 160 mg
daily) reduces the incidence of perioperative myocardial infarction, acute
renal injury, and mortality without increasing the risk of bleeding and so
is recommended both before and after CABG. The use of dual antiplatelet
therapy with ASA plus a P2Y12 antagonist adds a greater risk of bleeding.
While additional studies are required, we can make the following
recommendations: Because of increased bleeding and mortality when patients
are treated with clopidogrel preoperatively, CABG should be delayed for
five days. Because of increased bleeding when patients are treated with
ticagrelor preoperatively, CABG should be delayed for three days. Because
of increased bleeding when patients are treated with prasugrel
preoperatively, CABG should be delayed for seven days. For patients who
had a coronary stent placed preoperatively or had an acute coronary
syndrome preoperatively, resumption of therapy with their P2Y12 antagonist
postoperatively for 12 months reduces the subsequent incidence of
cardiovascular events.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<17>
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.

<18>
Accession Number
622518976
Author
Ling H.; Andrews E.; Ombengi D.; Li F.
Institution
(Ling) Department of Pharmacy Practice, School of Pharmacy, Georgia
Campus- Philadelphia College of Osteopathic Medicine, Suwanee, GA, United
States
(Andrews) Department of Pharmacy Practice, School of Pharmacy, Hampton
University, Hampton, VA, United States
(Ombengi) Department of Clinical Sciences, Medical College of Wisconsin
Pharmacy School, Milwaukee, WI, United States
(Li) Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
Title
Extended duration dual antiplatelet therapy after percutaneous coronary
intervention in patients with peripheral arterial disease: A
meta-analysis.
Source
Cardiology Research. 9 (3) (pp 137-143), 2018. Date of Publication: 01 Jun
2018.
Publisher
Elmer Press (E-mail: production@elmerpress.com)
Abstract
Background: Patients with peripheral arterial disease (PAD) undergoing
percutaneous coronary intervention (PCI) are at elevated risk of ischemic
and bleeding events. However, the optimal duration of dual antiplatelet
therapy (DAPT) after PCI in patients with PAD remains unclear. Methods: A
systematic literature search was performed through June 2017 using PubMed,
EMBASE and Cochrane databases with the following key terms: "dual
antiplatelet therapy", "P2Y12 inhibitor", "myocardial infarction",
"percutaneous coronary intervention", "stent", "peripheral arterial
disease", and "ankle-brachial index". The analysis was restricted to
randomized trials published in English in patients with PAD receiving
extended DAPT ( > 12-month) after PCI. Overall analysis was performed
using Review Manager 5.3 with the Mantel-Haenszel method. Results: Two
randomized controlled trials involving 895 patients were included in this
review. Compared to the placebo group, there was no statistical
significance in the occurrence of major adverse cardiovascular and
cerebrovascular events (MACCE) in patients receiving extended DAPT (odds
ratio (OR) 0.76, 95% confidence interval (CI) 0.37 - 1.57; P = 0.46). The
results were associated with substantial heterogeneity (I² =
71%, P = 0.07). Extended DAPT was not significantly associated with
increased moderate/severe bleeding events (OR 1.63, 95% CI 0.84 - 3.18; P
= 0.15; I² = 0%, P = 0.59). The extended DAPT was associated
with 82% relative risk reduction in the events of definite/probably stent
thrombosis. Conclusions: Among patients with PAD, extended DAPT after PCI
resulted in a non-significant difference in ischemic and bleeding events
compared to placebo, respectively. The routine use of extended DAPT in
this cohort should be carefully evaluated.<br/>Copyright &#xa9; The
authors.

<19>
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.

<20>
Accession Number
622499275
Author
Glineur D.; Hendrikx M.; Krievins D.; Stradins P.; Voss B.; Waldow T.;
Haenen L.; Oberhoffer M.; Ritchie C.M.
Institution
(Glineur) Saint Luc Cliniques Universitaires, Brussels, Belgium
(Hendrikx) Faculty of Medicine and Life Sciences, Jessa Hospital, Hasselt
University, Hasselt, Belgium
(Krievins, Stradins) Pauls Stradins Clinical University Hospital, Riga,
Latvia
(Voss) German Heart Center Munich, Department of Cardiovascular Surgery,
Technische Universitat Munchen, Munich, Germany
(Waldow) Heart Center Dresden GmbH, University Hospital Dresden, Dresden,
Germany
(Haenen) Imelda Hospital, Bonheiden, Belgium
(Oberhoffer) Asklepios Klinik St. Georg, Herzchirurgische Abteilung,
Hamburg, Germany
(Ritchie) Covidien, Medical Affairs, Bedford, MA, United States
Title
A randomized, controlled trial of verisetTM hemostatic patch in halting
cardiovascular bleeding.
Source
Medical Devices: Evidence and Research. 11 (pp 65-75), 2018. Date of
Publication: 08 Mar 2018.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background: Obtaining hemostasis during cardiovascular procedures can be a
challenge, particularly around areas with a complex geometry or that are
difficult to access. While several topical hemostats are currently on the
market, most have caveats that limit their use in certain clinical
scenarios such as pulsatile arterial bleeding. The aim of this study was
to assess the effectiveness and safety of VerisetTM hemostatic patch in
treating cardiovascular bleeding. Methods: Patients (N=90) scheduled for
cardiac or vascular surgery at 12 European institutions were randomized
1:1 to treatment with either VerisetTM hemostatic patch (investigational
device) or TachoSil (control). After application of the hemostat,
according to manufacturer instructions for use, time to hemostasis was
monitored. Follow-up occurred up to 90 days post-surgery. Results: Median
time to hemostasis was 1.5 min with VerisetTM hemostatic patch, compared
to 3.0 min with TachoSil (p<0.0001). Serious adverse events within 30 days
post-surgery were experienced by 12/44 (27.3%) patients treated with
VerisetTM hemostatic patch and 10/45 (22.2%) in the TachoSil group
(p=0.6295). None of these adverse events were device-related, and no
reoperations for bleeding were required within 5 days post-surgery in
either treatment group. Conclusion: This study reinforces the difference
in minimum recommended application time between VerisetTM hemostatic patch
and TachoSil (30 s versus 3 min respectively). When compared directly at 3
min, VerisetTM displayed no significant difference, showing similar
hemostasis and safety profiles on the cardiovascular bleeding sites
included in this study.<br/>Copyright &#xa9; 2018 Glineur et al.

<21>
Accession Number
615771861
Author
Ak A.; Porokhovnikov I.; Kuethe F.; Schulze P.C.; Noutsias M.; Schlattmann
P.
Institution
(Ak, Porokhovnikov, Schlattmann) Institute of Medical Statistics,
Informatics and Documentation (IMSID), Friedrich-Schiller University and
University Hospital Jena, Bachstrase 18, Jena 07743, Germany
(Kuethe, Schulze, Noutsias) Department of Internal Medicine I, Division of
Cardiology, Pneumology, Angiology and Intensive Medical Care, University
Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
Title
Transcatheter vs. surgical aortic valve replacement and medical treatment:
Systematic review and meta-analysis of randomized and non-randomized
trials.
Source
Herz. 43 (4) (pp 325-337), 2018. Date of Publication: 01 Jun 2018.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
the procedure of choice for patients with severe aortic stenosis (AS) and
high perioperative risk. We performed a meta-analysis to compare the
mortality related to TAVR with medical therapy (MT) and surgical aortic
valve replacement (SAVR). Methods: A systematic literature search was
conducted by two independent investigators from the database inception to
30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated
and graphically displayed in forest plots. We used I² for
heterogeneity (meta-regression) and Egger's regression test of asymmetry
(funnel plots). Results: We included 24 studies (n = 19 observational
studies; n = 5 randomized controlled trials), with a total of 7356
patients in this meta-analysis. Mean age had a substantial negative impact
on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90).
Compared with MT, TAVR showed a statistically significant benefit for
all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR
and SAVR were associated with better outcomes compared with MT. TAVR
showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95%
CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed
no significant difference (OR = 1.09; 95% CI: 1.01-1.17). Conclusion: In
AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore,
MT is not the preferred treatment option for AS. Furthermore, our data
show that TAVR is associated with lower mortality at 12 months compared
with SAVR. Further studies are warranted to compare the long-term outcome
of TAVR versus SAVR beyond a 2-year follow-up period.<br/>Copyright &#xa9;
2017, Springer Medizin Verlag GmbH.

<22>
Accession Number
616133266
Author
Schmidt T.; Pargger H.; Seeberger E.; Eckhart F.; von Felten S.; Haberthur
C.
Institution
(Schmidt, Eckhart, Haberthur) Department for Anesthesia, Intensive Care
Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne,
Switzerland
(Pargger, Seeberger) Department of Anesthesiology, Operative Intensive
Care, Preclinical Emergency Medicine and Pain Management, University
Hospital Basel, Switzerland
(von Felten) Department of Clinical Research, Clinical Trial Unit,
University Hospital Basel, Switzerland
(Haberthur) Department of Anesthesiology and Intensive Care Medicine,
Hirslanden Clinic, Zurich, Switzerland
Title
Effect of high-dose sodium selenite in cardiac surgery patients: A
randomized controlled bi-center trial.
Source
Clinical Nutrition. 37 (4) (pp 1172-1180), 2018. Date of Publication:
August 2018.
Publisher
Churchill Livingstone
Abstract
Background & aims: Cardiac surgery is accompanied by oxidative stress and
systemic inflammatory response, which may be associated with organ
dysfunction and increased mortality. Selenium and selenoenzymes are
important constituents of anti-oxidative defense. We hypothesized that
high-dose sodium selenite supplementation can attenuate the postoperative
inflammation and might, therefore, improve clinical outcome. Methods:
Randomized, placebo-controlled, double-blinded, bi-center study on 411
adult patients undergoing elective cardiac surgery. Patients received an
intravenous bolus of 4000 mug selenium (in the form of sodium selenite) or
placebo after induction of anesthesia and 1000 mug/d selenium or placebo
during their intensive care unit (ICU) stay. Primary outcome measure was
the Sequential Organ Failure Assessment (SOFA) score on the second
postoperative day. Secondary endpoints included the change in
perioperative selenium levels, change of inflammatory and cardiac markers,
use of vasoactive medication, incidence of acute kidney injury, ICU and
hospital length of stay, and mortality. Results: The perioperative
administration of high-dose sodium selenite prevented the postoperative
drop of blood and serum selenium levels, reduced the number of patients
depending on postoperative vasoactive support but failed to reduce the
postoperative SOFA score and its related organ-specific scores compared to
placebo. Except for an increase of postoperative procalcitonin and
bilirubin levels in the sodium selenite group, other inflammatory markers,
organ function variables and clinical endpoints remained unchanged.
Conclusions: The perioperative administration of high-dose sodium selenite
in cardiac surgery patients prevented the postoperative fall of blood
selenium levels and reduced the need for postoperative vasoactive support
by a yet unknown mechanism. Trial registration: Registered under
ClinicalTrials.gov Identifier no. NCT01141556.<br/>Copyright &#xa9; 2017
Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

<23>
Accession Number
2000753024
Author
Yasuda S.; Kaikita K.; Ogawa H.; Akao M.; Ako J.; Matoba T.; Nakamura M.;
Miyauchi K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.
Institution
(Yasuda) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka
565-8565, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto
860-8556, Japan
(Ogawa) National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555,
Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University School of
Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
30-1 Ohyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
(Matsui) Department of Community, Family, and General Medicine, Kumamoto
University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Title
Atrial fibrillation and ischemic events with rivaroxaban in patients with
stable coronary artery disease (AFIRE): Protocol for a multicenter,
prospective, randomized, open-label, parallel group study.
Source
International Journal of Cardiology. 265 (pp 108-112), 2018. Date of
Publication: 15 August 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: In atrial fibrillation (AF) patients with coronary artery
disease (CAD), anticoagulants are commonly used in combination with
antiplatelet drugs. However, dual therapy can increase the risk of
bleeding, and the potential therapeutic benefits must be weighed against
this. Therefore, it is recommended that dual therapy is only used for a
limited time, and that monotherapy with anticoagulants should start from 1
year after percutaneous coronary intervention (PCI). However, there is a
lack of evidence on the use of monotherapy, in particular with direct oral
anticoagulants, in this group of patients. Methods: The AFIRE Study is a
multicenter, prospective, randomized, open-label, parallel group study
conducted in patients aged >=20 years with non-valvular AF (NVAF) and CAD.
Patients who have undergone PCI or coronary artery bypass graft at least 1
year prior to enrollment, or those without significant coronary lesions
requiring PCI (>=50% stenosis), will be included. Approximately 2200
participants will be randomized to receive either rivaroxaban monotherapy
or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or
prasugrel). The primary efficacy endpoints are the composite of
cardiovascular events (stroke, non-central nervous system embolism,
myocardial infarction, and unstable angina pectoris requiring
revascularizations) and all-cause mortality. The primary safety endpoint
is major bleeding as defined by the International Society on Thrombosis
and Haemostasis criteria. Conclusions: This study will be the first to
assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients
with stable CAD.<br/>Copyright &#xa9; 2018

<24>
Accession Number
622606570
Author
Zeraati A.A.; Amini S.; Mortazi H.; Zeraati T.; Zeraati D.
Institution
(Zeraati) Student Research Committee, Islamic Azad University of Mashhad,
Mashhad, Iran, Islamic Republic of
(Amini) Anesthesia, Mashhad University of Medical Science, Mashhad, Iran,
Islamic Republic of
(Mortazi) Internal Medicine, Mashhad University of Medical Science,
Mashhad, Iran, Islamic Republic of
(Zeraati) Student Research Committee, Mashhad University of Medical
Science, Mashhad, Iran, Islamic Republic of
(Zeraati) Internal Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
Title
The effect of selenium on prevention of acute kidney injury after on-pump
cardiac surgery.
Source
Nephrology Dialysis Transplantation. Conference: 55th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2018. Denmark. 33 (Supplement 1) (pp i423-i424),
2018. Date of Publication: May 2018.
Publisher
Oxford University Press
Abstract
INTRODUCTION AND AIMS: Cardiac surgery-associated acute kidney injury
(CSAAKI) is a frequent complication among patients who suffer from heart
diseases. To our knowledge,AKI affects the outcome of cardiac surgeries.
Also, Selenium has important influences on renal function. Therefore, the
present study was performed to investigate the effect of Selenium on the
prevention of CSA-AKI. METHODS: In a randomized double-blind
placebo-controlled trial, 120 patients consisting of 46 males and 74
females with the mean age of 52.8+/-16.7 years, whom had undergone
elective on-pump cardiac surgery. Patients were divided into two groups of
60 patients each: Selenium (case) group and placebo group. The case group
received two doses of 500 mg Selenium orally,14 and 2 hours before
surgery. The control group received only the standard care. The following
tests were performed daily:arterial boold
gasometry,creatinine,BUN,Albumin,electrolytes and lactate. The RIFLE and
AKIN criteria were used to diagnose AKI RESULTS: There was not any
significant difference in the mean score of European System for Cardiac
Operative Risk Evaluation(EuroSCORE) between Se and placebo
groups(1.3860.7 Vs. 1.3060.6, respectively; P=0.15).Based on the
RIFLEcriteria,AKI was demonstrated to occur in 11(17.9%) patients from Se
group and 13(21.4%) patients from placebo group(P=0.73),with the highest
rate of AKI reported on the third and fourth post-operative days in both
groups. Furthermore, there was not any significant differences in the
frequency of the patients were in the risk, injury,and failure stages,
between groups, respectively (P=0.64).Also, according to the AKIN
criteria, 28.8% and 35.7% patients in Se and placebo group developed AKI
and were only in the first stage (P=0.55).The mean length of stay in ICU
was 2.5361.07 days, and only one case of ICU mortality occurred
CONCLUSIONS: The results of the present study showed that 500 microgram of
oral Se was safe with no side effects, but did not support the superiority
of this treatment as an anti-inflammatory agent in on-pump CABG surgery.
We hope that the present findings underlie new studies in the future.

<25>
Accession Number
622605556
Author
Dalili N.
Institution
(Dalili) Nephrology, Shahid Beheshti University of Medical Science,
Tehran, Iran, Islamic Republic of
Title
Effects of oral pentoxifylline on reducing acute kidney injury
inflammation and oxidative stress after cardiac surgery.
Source
Nephrology Dialysis Transplantation. Conference: 55th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2018. Denmark. 33 (Supplement 1) (pp i49), 2018.
Date of Publication: May 2018.
Publisher
Oxford University Press
Abstract
Introduction and Aims: AKI is acommon and serious post operative
complication and may occur in up to 50% of all patients undergoing cardiac
surgery and is associated with 8% mortality rate compared with 0.9% in
non-affected patients and remains a major factor for post surgery adverse
outcomes. Early interventions to prevent postoperative AKI can help
decreasing morbidity and mortality in these patients. Using
cardiopulmonary bypass during cardiac surgery triggers systemic
inflammatory response and recruits pro-inflammatory cytokines such as
tumor necrosis factor, inter-leukin-10 and IL-6 accompanying with
production of free oxygen radicals which provokes oxidative stress in the
milieu of ischemic reperfusion injury. Pentoxifylline as a non-specific
phosphodiesterase inhibitor, can suppress the production of some factors
of inflammatory response and oxidative stress, probably prevent post
surgery AKI with these mechanisms. We examined the effects of
pentoxifylline on preventing the development of AKI and reducing
inflammatory and oxidative stress responses in patients undergoing
elective coronary artery bypass graft surgery (CABG). Methods: We
performed a double blind randomized multicenter clinical trial, enrolling
100 consecutive patients undergoing elective CABG. Patients randomly and
within concealment method divided into two groups, one to receive oral
pentxifylline 400 mg every 8 hours from three days before surgery and the
other group received placebo. All the intubation, surgery and weaning
protocols were the same. Serum interleu-kin levels (IL-6, IL-10)
C-reactive protein, total leukocyte count, erythrocyte sedimentation rate,
serum albumin, plasma malondialdehyde, reduced glutathione level and
thiobarbituric reactive substances as a marker of lipid peroxidation and
urinary excretion of 15-F2-isoprostane and urine NGAL level measured
before starting intervention 6, 24 and 72 hours after surgery. RIFLE
criteria for AKI and timely clearance of creatinine measured before
starting intervention and 6 and 24 and 72 hours after induction of
anesthesia. Results: Both groups did not differ significantly in
demographic and baseline characteristics. 43 patients developed AKI 72
hours after surgery; 12 of them were in the intervention group and 31 in
the control group (p= 0.003). Postoperative leukocyte count was also
higher in the untreated placebo than in the pentoxifylline-treated
patients. Starting from normal values at base line, CRP and IL-6 levels
increased in both groups showing no significantly differences but higher
results of blood IL-10 were seen in placebo-treated patients 72 hours post
surgery.(46 6 8.1 versus 15.6 6 4.9, p <0.005). Pentoxifylline group also
showed higher clinical although not statistical significant (p = 0.1)
reduction of lipid peroxidation marker (thiobarbituric reactive
sub-stances). Pentoxifylline-treated patients showed 12.4% reduction in
plasma malondialdehyde and 3% increase in blood reduced glutathione level.
Conclusions: This study reveals improvements in inflammatory markers, and
oxi-dative stress by pentoxifylline, thus preventing some complications in
patients undergoing cardiac surgery. We demonstrated pre-operative use of
oral pentoxifylline can improve renal function and reduces post cardiac
surgery AKI without causing hemody-namic instability in this population.
Overall, we recommend future studies with larger sample size and longer
follow up periods to determine the different aspects of administrating
prophylactic pentoxifylline.

<26>
Accession Number
622605325
Author
See E.; Jayasinghe K.; Glassford N.; Bailey M.; Johnson D.; Polkinghorne
K.; Toussaint N.; Bellomo R.
Institution
(See, Glassford, Bellomo) Intensive Care, Austin Health, Melbourne,
Australia
(Jayasinghe, Polkinghorne) Nephrology, Monash Health, Melbourne, Australia
(Bailey) Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
(Johnson) Nephrology, Princess Alexandra Hospital, Brisbane, Australia
(Toussaint) Nephrology, Royal Melbourne Hospital, Melbourne, Australia
(See) School of Medicine, University of Melbourne, Melbourne, Australia
Title
Long term sequelae of acute kidney injury: A systematic review and
meta-analysisof cohort studies using consensus definitions of exposure.
Source
Nephrology Dialysis Transplantation. Conference: 55th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2018. Denmark. 33 (Supplement 1) (pp i114), 2018.
Date of Publication: May 2018.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Robust estimatesof the long-term outcomesof acute
kidney injury are needed to inform clinical practice and guide optimal
allocation of healthcare resources. This systematic review and
meta-analysis aimed to quantify the association between acute kidney
injury and chronic kidney disease, end stage kidney disease, and death,
using consensus definitions of exposure. Methods: Systematic searches were
performed through EMBASE, MEDLINE, and grey literature sources to identify
cohort studies reporting an association between acute kidney injury and at
least one of the outcomes of interest. All studies in adults published
after 2004, using standardised definitions for acute kidney injury (Risk,
Injury, Failure, Loss, and End-stage kidney disease; Acute Kidney Injury
Network; or Kidney Disease Improving Global Outcomes), which included a
non-acute kidney injury control arm, and followed patients for at least 1
year were considered eligible. A modified Newcastle-Ottawa Scale was used
to assess risk of bias, random effects meta-analysis was performed to
estimate the pooled risk, and meta-regression was completed to identify
potential sources of heterogeneity. Results: The search retrieved 3435
unique citations, of which 30 cohort studies (comprising 1,012,627
participants) were eligible for inclusion. The most frequent sources of
bias related to inadequate follow up and variable adjustment for potential
confounders. Compared to those without acute kidney injury, individuals
with acute kidney injury were at significantly increased risk of chronic
kidney disease (6 studies; 15,925 participants; hazard ratio [HR] 3.71,
95% CI 2.35-5.86; I² 93.1% p<0.001), end stage kidney disease
(5 studies; 45,365 participants; HR 4.18, 95% CI 1.93-9.08; I²
88.8% p<0.001), and death (16 studies; 913,682 participants; HR 1.54, 95%
CI 1.40-1.71; I² 85.6% p<0.001). The risk of death increased
with greater acute kidney injury severity, and was highest in intensive
care and cardiac surgery settings. Conclusions: These findings establish
the poor long-term outcomes of acute kidney injury, and support the
development of targeted strategies to manage individuals at greatest
future risk. A feasible, sustainable, and efficacious model of chronic
care for survivors of acute kidney injury is needed.

<27>
Accession Number
622605094
Author
Krackhardt F.; Waliszewski M.; Kherad B.; Barth C.; Marcelli D.
Institution
(Waliszewski) Medical Scientific Affairs, Aesculap, B. Braun, Melsungen,
Germany
(Barth, Marcelli) Medical Scientific Affairs, B. Braun Avitum, Melsungen,
Germany
(Krackhardt, Kherad) Internal Medicine and Cardiology, Charite
Universitatsmedizin, Berlin, Germany
Title
Nine-month clinical outcomes in dialysis patients following polymer-free
sirolimus-eluting stent implantations.
Source
Nephrology Dialysis Transplantation. Conference: 55th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2018. Denmark. 33 (Supplement 1) (pp i224-i225),
2018. Date of Publication: May 2018.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Inthe treatment ofacutecoronary syndrome (ACS) or
stable coronary disease, drug-eluting stents are the standard of care.
Unfortunately, patients with chronic kidney disease who are affected by
high morbidity from cardiovascular diseases are frequently excluded from
coronary artery disease trials. The aim of this study was to study the
safety and efficacy of polymer-free sirolimus-eluting stents (PF-SES) in
dialyzed patients. Methods: A previously published unselected large-scale,
international, single-armed, multicenter, 'all comers' observational study
(ClinicalTrials.gov Identifier NCT02629575) was used for this subgroup
analysis to study the clinical outcomes in patients with normal renal
function (NRF), with chronic renal insufficiency (CRI) and dialysis
dependent (DD) patients. The 9-month target lesion revascularization (TLR)
rate was the primary endpoint whereas the 9-month major adverse cardiac
events (MACE) and procedural success rates were part of the secondary
endpoints. [Figure Presented] Results: The primary endpoint TLR at 9
months was not significantly different between NRF, CRI and DD patients
(2.2% vs. 4.3% vs. 2.2%, p=0.969). As compared to patients with NRF, the
9-month MACE rate in the CRI group was significantly higher (10.3% vs.
3.9%, p=0.001) whereas the 9-month MACE rate in the DD group was only
numerically higher (3.9% vs. 6.7, p=0.348), However, the accumulated stent
thrombosis (ST) rates were significantly higher in the DD group (4.4%) as
compared to the NRF (0.6%) and the CRI groups (0.9%, p<0.001).Table:
Clinical outcomes up to 9 months of follow-up (MACE: major adverse cardiac
events, TLR: target lesion revascularization; MI: myocardial infarction;
PCI: percutaneous intervention; CABG: coronary artery bypass graft).
Conclusions: Percutaneous coronary interventions with a polymer free,
ultra-thin strut sirolimus-eluting stent are safe and effective in
dialysis patients. The TLR rate in dialyzed patients is not higher as
compared to patients who are not dialyzed. Randomized controlled trials or
propensity score matched cohorts would be highly desirable to confirm this
result.

<28>
Accession Number
622519495
Author
Zeilmaker-Roest G.A.; van Rosmalen J.; van Dijk M.; Koomen E.; Jansen
N.J.G.; Kneyber M.C.J.; Maebe S.; van den Berghe G.; Vlasselaers D.;
Bogers A.J.J.C.; Tibboel D.; Wildschut E.D.
Institution
(Zeilmaker-Roest, van Dijk, Tibboel, Wildschut) Erasmus MC-Sophia
Children's Hospital, Department of Pediatric Intensive Care, Rotterdam,
Netherlands
(Zeilmaker-Roest, Bogers) Department of Cardiothoracic Surgery, Erasmus
MC, Rotterdam, Netherlands
(van Rosmalen) Department of Biostatistics, Erasmus MC, Rotterdam,
Netherlands
(Koomen, Jansen) Wilhelmina Children's Hospital, University Medical Center
Utrecht, Department of Pediatric Intensive Care, Utrecht, Netherlands
(Kneyber) Beatrix Children's Hospital, University Medical Center
Groningen, Department of Pediatrics, division of Pediatric Critical Care
Medicine, Groningen, Netherlands
(Maebe, van den Berghe, Vlasselaers) UZ Leuven, Department of Intensive
Care Medicine, Leuven, Belgium
Title
Intravenous morphine versus intravenous paracetamol after cardiac surgery
in neonates and infants: A study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 318. Date of
Publication: 13 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Morphine is worldwide the analgesic of first choice after
cardiac surgery in children. Morphine has unwanted hemodynamic and
respiratory side effects. Therefore, post-cardiac surgery patients may
potentially benefit from a non-opioid drug for pain relief. A previous
study has shown that intravenous (IV) paracetamol is effective and
opioid-sparing in children after major non-cardiac surgery. The aim of the
study is to test the hypothesis that intermittent IV paracetamol
administration in children after cardiac surgery will result in a
reduction of at least 30% of the cumulative morphine requirement. Methods:
This is a prospective, multi-center, randomized controlled trial at four
level-3 pediatric intensive care units (ICUs) in the Netherlands and
Belgium. Children who are 0-36months old will be randomly assigned to
receive either intermittent IV paracetamol or continuous IV morphine up to
48h post-operatively. Morphine will be available as rescue medication for
both groups. Validated pain and sedation assessment tools will be used to
monitor patients. The sample size (n=208, 104 per arm) was calculated in
order to detect a 30% reduction in morphine dose; two-sided significance
level was 5% and power was 95%. Discussion: This study will focus on the
reduction, or replacement, of morphine by IV paracetamol in children
(0-36months old) after cardiac surgery. The results of this study will
form the basis of a new pain management algorithm and will be implemented
at the participating ICUs, resulting in an evidence-based guideline on
post-operative pain after cardiac surgery in infants who are 0-36months
old.<br/>Copyright &#xa9; 2018 The Author(s).

<29>
Accession Number
2000850445
Author
Kok L.; Hillegers M.H.; Veldhuijzen D.S.; Boks M.P.; Dieleman J.M.; van
Dijk D.; Joels M.; Vinkers C.H.
Institution
(Kok, Veldhuijzen, Dieleman, van Dijk) Department of Anesthesiology and
Intensive Care, Brain Center Rudolf Magnus, University Medical Center
Utrecht, Utrecht, Netherlands
(Hillegers, Boks, Vinkers) Department of Psychiatry, Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht, Netherlands
(Veldhuijzen) Leiden Institute for Brain and Cognition, Institute of
Psychology, Health, Medical and Neuropsychology Unit, Leiden University,
Leiden, Netherlands
(Kok, Joels) Department of Translational Neuroscience, Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht, Netherlands
(Joels) University of Groningen, Groningen, Netherlands
Title
Genetic variation in the glucocorticoid receptor and psychopathology after
dexamethasone administration in cardiac surgery patients.
Source
Journal of Psychiatric Research. 103 (pp 167-172), 2018. Date of
Publication: August 2018.
Publisher
Elsevier Ltd
Abstract
The glucocorticoid receptor (GR) agonist dexamethasone is frequently used
for its anti-inflammatory properties. We recently showed that a single
high-dose of dexamethasone had long-lasting protective effects on the
development of psychopathology after cardiac surgery and postoperative
intensive care unit stay. In this study, we investigated whether common
genetic variation in the hypothalamic-pituitary-adrenal (HPA)-axis would
influence the susceptibility for PTSD and depression after dexamethasone
administration. Participants (n = 996) of the Dexamethasone for Cardiac
Surgery (DECS) randomized clinical trial were followed after receiving a
single high intraoperative dose of dexamethasone (1 mg/kg), a GR agonist,
or placebo. PTSD and depressive symptoms were assessed up to four years
after cardiac surgery. We focused primarily on five common single
nucleotide polymorphisms (SNPs) in the glucocorticoid receptor (GR).
Secondarily, we comprehensively assessed common genetic variation in the
FK506 binding protein (FKBP5) and the mineralocorticoid receptor (MR). The
protective effects of dexamethasone on postoperative PTSD symptoms were
dependent on the GR polymorphisms rs41423247 (p =.009), rs10052957 (p
=.003), and rs6189 (p =.002), but not on rs6195 (p =.025) or rs6198, (p
=.026) after Bonferroni correction. No genotype-dependent effects were
found for postoperative depressive symptoms. Also, no associations of
FKBP5 and MR polymorphisms were found on PTSD and depression outcomes.
Protective effects of dexamethasone on PTSD symptoms after cardiac surgery
and ICU stay seem to depend on common genetic variation in its target
receptor, the GR. These effects indicate that pre-operative genetic
screening could potentially help in stratifying patients for their
vulnerability for developing PTSD symptoms after surgery.<br/>Copyright
&#xa9; 2018

<30>
Accession Number
622516238
Author
Karmali K.N.; Davies P.; Taylor F.; Beswick A.; Martin N.; Ebrahim S.
Institution
(Karmali) Northwestern University Feinberg School of Medicine, Departments
of Preventive Medicine and Medicine (Cardiology), 680 N. Lake Shore Drive,
Suite 1400, Chicago, IL 60611, United States
(Davies) University of Bristol, School of Social and Community Medicine,
Canynge Hall, Bristol BS8 2PS, United Kingdom
(Taylor, Martin, Ebrahim) London School of Hygiene and Tropical Medicine,
Department of Non-communicable Disease Epidemiology, Keppel Street, London
WC1E 7HT, United Kingdom
(Beswick) University of Bristol, Musculoskeletal Research Unit, Avon
Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom
Title
Promoting patient uptake and adherence in cardiac rehabilitation.
Source
Cochrane Database of Systematic Reviews. 2014 (6) (no pagination), 2014.
Article Number: CD007131. Date of Publication: 25 Jun 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiac rehabilitation is an important component of recovery
from coronary events but uptake and adherence to such programs are below
recommended levels. In 2010, our Cochrane review identified some evidence
that interventions to increase uptake of cardiac rehabilitation can be
effective but there was insufficient evidence to provide recommendations
on intervention to increase adherence. In this review, we update the
previously published Cochrane review. Objectives: To determine the
effects, both harms and benefits, of interventions to increase patient
uptake of, or adherence to, cardiac rehabilitation. Search methods: We
performed an updated search in January 2013 to identify studies published
after publication of the previous systematic review. We searched the
Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 12, 2012),
MEDLINE (Ovid), EMBASE (Ovid), CINAHL EBSCO, Conference Proceedings
Citation Index - Science (CPCI-S) on Web of Science (Thomson Reuters), and
National Health Service (NHS) Centre for Reviews and Dissemination (CRD)
databases (Health Technology Assessment (HTA) and Database of Abstracts of
Reviews of Effects (DARE)) on The Cochrane Library (Issue 4, 2012). We
also checked reference lists of identified systematic reviews and
randomised controlled trials (RCTs) for additional studies. We applied no
language restrictions. Selection criteria: Adults with myocardial
infarction, coronary artery bypass graft, percutaneous transluminal
coronary angioplasty, heart failure, angina, or coronary heart disease
eligible for cardiac rehabilitation and RCTs or quasi-randomized trials of
interventions to increase uptake or adherence to cardiac rehabilitation or
any of its component parts. We only included studies reporting a primary
outcome. Data collection and analysis: At least three authors
independently screened titles and abstracts of all identified references
for eligibility and obtained full papers of potentially relevant trials.
At least two authors checked the selection. Three authors assessed
included studies for risk of bias. Main results: The updated search
identified seven new studies (880 participants) of interventions to
improve uptake of cardiac rehabilitation and one new study (260
participants) of interventions to increase adherence. When added to the
previous version of this review, we included 18 studies (2505
participants), 10 studies (1338 participants) of interventions to improve
uptake of cardiac rehabilitation and eight studies (1167 participants) of
interventions to increase adherence. We assessed the majority of studies
as having high or unclear risk of bias. Meta-analysis was not possible due
to multiple sources of heterogeneity. Eight of 10 studies demonstrated
increased uptake of cardiac rehabilitation. Successful interventions to
improve uptake of cardiac rehabilitation included: structured nurse- or
therapist-led contacts, early appointments after discharge, motivational
letters, gender-specific programs, and intermediate phase programs for
older patients. Three of eight studies demonstrated improvement in
adherence to cardiac rehabilitation. Successful interventions included:
self monitoring of activity, action planning, and tailored counselling by
cardiac rehabilitation staff. Data were limited on mortality and morbidity
but did not demonstrate a difference in cardiovascular events or mortality
except for one study that noted an increased rate of revascularization in
the intervention group. None of the studies found a difference in
health-related quality of life and there was no evidence of adverse
events. No studies reported on costs or healthcare utilization. Authors'
conclusions: We found only weak evidence to suggest that interventions to
increase the uptake of cardiac rehabilitation are effective. Practice
recommendations for increasing adherence to cardiac rehabilitation cannot
be made. Interventions targeting patient-identified barriers may increase
the likelihood of success. Further high-quality research is still
needed.<br/>Copyright &#xa9; 2014 The Cochrane Collaboration.

<31>
Accession Number
622515349
Author
Hartley L.; Igbinedion E.; Holmes J.; Flowers N.; Thorogood M.; Clarke A.;
Stranges S.; Hooper L.; Rees K.
Institution
(Hartley, Igbinedion, Flowers, Clarke, Stranges, Rees) Warwick Medical
School, University of Warwick, Division of Health Sciences, Coventry,
Warwickshire CV4 7AL, United Kingdom
(Holmes) University of Warwick, Warwick Medical School, Coventry, United
Kingdom
(Thorogood) Division of Health Sciences, Public Health and Epidemiology,
Warwick Medical School, University of Warwick, Gibbet Hill, Coventry CV4
7AL, United Kingdom
(Hooper) University of East Anglia, Norwich Medical School, Norwich
Research Park, Norwich NR4 7TJ, United Kingdom
Title
Increased consumption of fruit and vegetables for the primary prevention
of cardiovascular diseases.
Source
Cochrane Database of Systematic Reviews. 2013 (6) (no pagination), 2013.
Article Number: CD009874. Date of Publication: 04 Jun 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: There is increasing evidence that high consumption of fruit
and vegetables is beneficial for cardiovascular disease (CVD) prevention.
Objectives: The primary objective is to determine the effectiveness of i)
advice to increase fruit and vegetable consumption ii) the provision of
fruit and vegetables to increase consumption, for the primary prevention
of CVD. Search methods: We searched the following electronic databases:
The Cochrane Library (2012, issue 9-CENTRAL, HTA, DARE, NEED), MEDLINE
(1946 to week 3 September 2012); EMBASE (1980 to 2012 week 39) and the
Conference Proceedings Citation Index - Science on ISI Web of Science (5
October 2012). We searched trial registers, screened reference lists and
contacted authors for additional information where necessary. No language
restrictions were applied. Selection criteria: Randomised controlled
trials with at least three months follow-up (follow-up was considered to
be the time elapsed since the start of the intervention) involving healthy
adults or those at high risk of CVD. Trials investigated either advice to
increase fruit and vegetable intake (via any source or modality) or the
provision of fruit and vegetables to increase intake. The comparison group
was no intervention or minimal intervention. Outcomes of interest were CVD
clinical events (mortality (CVD and all-cause), myocardial infarction
(MI), coronary artery bypass grafting (CABG) or percutaneous transluminal
coronary angioplasty (PTCA), angiographically-defined angina pectoris,
stroke, carotid endarterectomy, peripheral arterial disease (PAD)) and
major CVD risk factors (blood pressure, blood lipids, type 2 diabetes).
Trials involving multifactorial lifestyle interventions (including
different dietary patterns, exercise) or where the focus was weight loss
were excluded to avoid confounding. Data collection and analysis: Two
review authors independently selected trials for inclusion, extracted data
and assessed the risk of bias. Trials of provision of fruit and vegetables
were analysed separately from trials of dietary advice. Main results: We
identified 10 trials with a total of 1730 participants randomised, and one
ongoing trial. Six trials investigated the provision of fruit and
vegetables, and four trials examined advice to increase fruit and
vegetable consumption.The ongoing trial is examining the provision of an
avocado-rich diet.The number and type of intervention components for
provision, and the dietary advice provided differed between trials. None
of the trials reported clinical events as they were all relatively short
term. There was no strong evidence for effects of individual trials of
provision of fruit and vegetables on cardiovascular risk factors, but
trials were heterogeneous and short term. Furthermore, five of the six
trials only provided one fruit or vegetable. Dietary advice showed some
favourable effects on blood pressure (systolic blood pressure (SBP): mean
difference (MD) -3.0 mmHg (95% confidence interval (CI) -4.92 to -1.09),
diastolic blood pressure (DBP): MD -0.90 mmHg (95% CI -2.03 to 0.24)) and
low-density lipoprotein (LDL) cholesterol but analyses were based on only
two trials. Three of the 10 included trials examined adverse effects,
which included increased bowel movements, bad breath and body odour.
Authors' conclusions: There are very few studies to date examining
provision of, or advice to increase the consumption of, fruit and
vegetables in the absence of additional dietary interventions or other
lifestyle interventions for the primary prevention of CVD. The limited
evidence suggests advice to increase fruit and vegetables as a single
intervention has favourable effects on CVD risk factors but more trials
are needed to confirm this.<br/>Copyright &#xa9; 2013 The Cochrane
Collaboration.

<32>
Accession Number
620799646
Author
Marmelo F.; Rocha V.; Goncalves D.
Institution
(Marmelo, Rocha, Goncalves) Department of Surgery and Physiology of the
Faculty of Medicine of Porto, Porto, Portugal
(Rocha) Sao Martinho Hospital, Valongo, Portugal
(Goncalves) Ave Valley Superior School of Health, Famalicao, Portugal
Title
The impact of prehabilitation on post-surgical complications in patients
undergoing non-urgent cardiovascular surgical intervention: Systematic
review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (4) (pp 404-417), 2018. Date
of Publication: 01 Mar 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Cardiac surgery is an aggressive procedure, inducing a great
level of stress and disturbance to the homeostasis of the organism and
underlying several postoperative complications. Surgical prehabilitation
comprises pre-operative physical conditioning designed to improve the
physiological and functional capacities of the individual, prepare the
organism for surgical stress and reduce the risk of postoperative
morbidity. Aim: This systematic review and meta-analysis is aimed at
evaluating the ability of prehabilitation to prevent post-surgical
complications in cardiac patients. Methods: We selected studies conducted
among patients who were waiting for non-urgent cardiac surgical
procedures, where a comparison between prehabilitation and standard
treatment was made. A total of 3650 possible studies were researched, of
which eight were selected for inclusion. Results: A reduction in the
number of complications in the groups submitted to prehabilitation (odds
ratio = 0.41; 95% confidence interval (CI): 0.28-0.62; p < 0.001;
I²= 0%) was observed, as well as a significant increase in
maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95%
CI: 0.35-0.96; p < 0.001; I²= 58%), a non-significant decrease
in the length of stay (SMD = -0.56; 95% CI: -1.13, 0.01; p = 0.05;
I²= 93%), a non-significant increase in the distance walked by
the intervention group in the six-minute walk test (SMD = 0.89; 95% CI
-0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time
(SMD = -0.03; 95% CI: -0.22, 0.16; p = 0.75; I²= 0%).
Conclusion: Prehabilitation reduces the number of post-surgical
complications and increases maximal inspiratory pressure; a reduction in
the length of stay and an improvement of functional capacities are also
probable.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of
Cardiology 2018.

<33>
Accession Number
621364753
Author
Naseri M.H.; Madani H.; Tafti S.H.A.; Farahani M.M.; Saleh D.K.;
Hosseinnejad H.; Hosseini S.; Hekmat S.; Ahmadi Z.H.; Dehghani M.; Saadat
A.; Mardpour S.; Hosseini S.E.; Esmaeilzadeh M.; Sadeghian H.; Bahoush G.;
Bassi A.; Amin A.; Fazeli R.; Sharafi Y.; Arab L.; Movahhed M.; Davaran
S.; Ramezanzadeh N.; Kouhkan A.; Hezavehei A.; Namiri M.; Kashfi F.;
Akhlaghi A.; Sotoodehnejadnematalahi F.; Dizaji A.V.; Gourabi H.; Syedi
N.; Shahverdi A.; Baharvand H.; Aghdami N.
Institution
(Naseri) Department of Surgery, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Madani, Mardpour, Hosseini, Fazeli, Arab, Kouhkan, Namiri,
Sotoodehnejadnematalahi, Shahverdi, Baharvand, Aghdami) Department of
Regenerative Medicine, Cell Science Research Center, Royan Institute for
Stem Cell Biology and Technology, ACECR, Tehran, Iran, Islamic Republic of
(Tafti, Sadeghian, Davaran, Ramezanzadeh) Research Department, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Farahani) Department of Echocardiography, Baqiyatallah Hospital, Tehran,
Iran, Islamic Republic of
(Saleh) Department of Cardiology, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Hosseinnejad, Dehghani) Department of Cardiac Surgery, Lavasani Hospital,
Social Security Organization, Tehran, Iran, Islamic Republic of
(Hosseini) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hekmat, Movahhed) Department of Nuclear Medicine, Hasheminejad Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ahmadi) Transplantation Research Center, Masih Daneshvari Hospital,
Shaheed Beheshti University of Medical Science, Darabad, Niavaran, Tehran,
Iran, Islamic Republic of
(Saadat, Sharafi) Department of Internal Medicine, Baqiyatallah Hospital,
Tehran, Iran, Islamic Republic of
(Hosseini) School of Nursing and Midwifery, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Esmaeilzadeh) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bahoush) Department of Pediatrics, Ali Asghar Pediatric Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bassi) Department of Hematology and Oncology, Firoozgar Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Amin) Department of Heart Failure and Transplantation, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hezavehei) Department of Internal Medicine, Lavasani Hospital, Social
Security Organization, Tehran, Iran, Islamic Republic of
(Kashfi, Akhlaghi) Department of Epidemiology and Reproductive Health,
Reproductive Epidemiology Research Center, Royan Institute for
Reproductive Biomedicine, Tehran, Iran, Islamic Republic of
(Dizaji) Department of Reproductive Imaging, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran, Islamic Republic of
(Gourabi) Department of Genetics, Reproductive Biomedicine Research
Center, ACECR, Tehran, Iran, Islamic Republic of
(Syedi) School of Pharmacy and Medical Sciences, Sansom Institute for
Health Research, University of South Australia, SA, Australia
Title
COMPARE CPM-RMI Trial: Intramyocardial transplantation of autologous bone
marrow-derived CD133+ Cells and MNCs during CABG in patients with recent
MI: A Phase II/III, multicenter, placebo-controlled, randomized,
double-blind clinical trial.
Source
Cell Journal. 20 (2) (pp 267-277), 2018. Date of Publication: Summer 2018.
Publisher
Royan Institute (ACECR) (E-mail: info@royaninstitute.org)
Abstract
Objective: The regenerative potential of bone marrow-derived mononuclear
cells (MNCs) and CD133+ stem cells in the heart varies in terms of their
pro-angiogenic effects. This phase II/III, multicenter and double-blind
trial is designed to compare the functional effects of intramyocardial
autologous transplantation of both cell types and placebo in patients with
recent myocardial infarction (RMI) post-coronary artery bypass graft.
Materials and Methods: This was a phase II/III, randomized, double-blind,
placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent
myocardial infarction) conducted in accordance with the Declaration of
Helsinki that assessed the safety and efficacy of CD133 and MNCs compared
to placebo in patients with RMI. We randomly assigned 77 eligible RMI
patients selected from 5 hospitals to receive CD133+ cells, MNC, or a
placebo. Patients underwent gated single photon emission computed
tomography assessments at 6 and 18 months post-intramyocardial
transplantation. We tested the normally distributed efficacy outcomes with
a mixed analysis of variance model that used the entire data set of
baseline and between-group comparisons as well as within subject (time)
and groupxtime interaction terms. Results: There were no related serious
adverse events reported. The intramyocardial transplantation of both cell
types increased left ventricular ejection fraction by 9% [95% confidence
intervals (CI): 2.14% to 15.78%, P=0.01] and improved decreased systolic
wall thickening by -3.7 (95% CI: -7.07 to -0.42, P=0.03). The CD133 group
showed significantly decreased non-viable segments by 75% (P=0.001)
compared to the placebo and 60% (P=0.01) compared to the MNC group. We
observed this improvement at both the 6- and 18-month time points.
Conclusion: Intramyocardial injections of CD133+ cells or MNCs appeared to
be safe and efficient with superiority of CD133+ cells for patients with
RMI. Although the sample size precluded a definitive statement about
clinical outcomes, these results have provided the basis for larger
studies to confirm definitive evidence about the efficacy of these cell
types (Registration Number: NCT01167751).<br/>Copyright &#xa9; 2018 Royan
Institute (ACECR). All Rights Reserved.

<34>
Accession Number
622436734
Author
Fleck D.A.; Marino B.S.; Costello J.M.; Ravishankar C.; Torowicz D.; Alden
C.; Van'T Hof K.; Medoff-Cooper B.
Institution
(Fleck) School of Nursing, University of Pennsylvania, Claire M Fagin
Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, United States
(Fleck, Ravishankar, Torowicz, Medoff-Cooper) Cardiac Center, Children's
Hospital of Philadelphia, Philadelphia, PA, United States
(Marino, Costello, Alden, Van'T Hof) Ann and Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
Title
The REACH protocol: An innovative strategy for home management of infants
with complex CHD.
Source
Cardiology in the Young. 28 (7) (pp 961-967), 2018. Date of Publication:
01 Jul 2018.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Approximately 32,000 infants are born with CHDs each year in the United
States of America. Of every 1000 live births, 2.3 require surgical or
transcatheter intervention in the first year of life. There are few more
stressful times for parents than when their neonate receives a diagnosis
of complex CHD requiring surgery. The stress of caring for these infants
is often unrelenting and may last for weeks, months, and often years,
placing parents at risk for developing post-Traumatic stress disorder, as
well as a drastic decrease in quality of life. Anxiety often peaks in the
days and weeks after discharge from the hospital as families no longer
have immediate access to nursing and medical staff. The purpose of this
paper is to describe the methods of a randomised controlled trial that was
designed to determine whether REACH would favourably affect parental and
infant outcomes by decreasing parental stress, improve parental quality of
life, increase infant stability, and decrease resource utilisation in
infants with complex CHD.<br/>Copyright &#xa9; Cambridge University Press
2018.

<35>
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.

<36>
Accession Number
2000705864
Author
Milasinovic D.; Milosevic A.; Vasiljevic-Pokrajcic Z.; Marinkovic J.;
Vukcevic V.; Stefanovic B.; Asanin M.; Stankovic S.; Ivanovic B.;
Stankovic G.
Institution
(Milasinovic, Milosevic, Vukcevic, Stefanovic, Asanin, Ivanovic,
Stankovic) Department of Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
(Milosevic, Stefanovic, Asanin) Emergency Department, Department of
Cardiology, Clinical Center of Serbia, Belgrade, Serbia
(Vasiljevic-Pokrajcic, Marinkovic, Vukcevic, Stefanovic, Asanin, Ivanovic,
Stankovic) Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(Marinkovic) Institute for Medical Statistics and Informatics, Belgrade,
Serbia
(Stankovic) Center for Medical Biochemistry, Clinical Center of Serbia,
Belgrade, Serbia
Title
Three-Year Impact of Immediate Invasive Strategy in Patients With
Non-ST-Segment Elevation Myocardial Infarction (from the RIDDLE-NSTEMI
Study).
Source
American Journal of Cardiology. 122 (1) (pp 54-60), 2018. Date of
Publication: 1 July 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Previous studies compared clinical outcomes of early versus delayed
invasive strategy in patients with non-ST-elevation acute coronary
syndrome up to 1-year follow-up, but long-term data remain scarce. Our aim
was to evaluate the long-term effects of immediate invasive intervention
in patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI).
The Randomized Study of Immediate Versus Delayed Invasive Intervention in
Patients With Non-ST-Segment Elevation Myocardial Infarction
(RIDDLE-NSTEMI) was a randomized, investigator-initiated, parallel-group
trial that assigned 323 patients with NSTEMI (1:1) to either immediate
(median time to intervention 1.4 hours) or delayed invasive strategy (61.0
hours). The primary end point was the composite of death or new myocardial
infarction (MI). At 3 years, immediate invasive intervention was
associated with a lower rate of death or new MI, compared with a delayed
invasive strategy (12.3% vs 22.5%, hazard ratio 0.50, 95% confidence
interval 0.29 to 0.87, p = 0.014). The observed benefit of immediate
intervention was mainly driven by an increased early reinfarction risk in
delayed strategy, with similar new MI rates beyond 30 days (4.4% in the
immediate and 5.6% in the delayed group, p = 0.61). Three-year mortality
was 9.3% in the immediate invasive strategy, and 10.0% in the delayed
strategy (p = 0.83). High baseline Global Registry of Acute Coronary
Events score (>140) was associated with a significant increase in
long-term mortality, regardless of the timing of invasive intervention. In
conclusion, whereas immediate invasive intervention significantly reduced
the early risk of new MI, the timing of invasive intervention appears to
have no significant impact on clinical outcomes beyond 30 days, which seem
to mostly be related to the baseline clinical risk profile.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<37>
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.

<38>
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.

<39>
Accession Number
2000599946
Author
Liao S.-F.; Chen P.-J.; Chaou C.-H.; Lee C.-H.
Institution
(Liao, Chen, Chaou) Department of Emergency Medicine, Chang Gung Memorial
Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
(Chaou) Chang-Gung Medical Education Research Center, Taiwan
(Lee) Department of Emergency Medicine, Chang Gung Memorial Hospital and
Chang Gung University College of Medicine, Keelung, Taiwan
Title
Top-cited publications on point-of-care ultrasound: The evolution of
research trends.
Source
American Journal of Emergency Medicine. (no pagination), 2018. Date of
Publication: 2018.
Publisher
W.B. Saunders
Abstract
Study objectives: Point-of-care ultrasound (POCUS) has been a rapidly
growing and broadly used modality in recent decades. The purpose of this
study was to determine how POCUS is incorporated into clinical medicine by
analyzing trends of use in the published literature. Methods:
POCUS-related publications were retrieved from the Web of Science (WoS)
database. The search results were ranked according to the number of times
an article was cited during three time frames and average annual number of
citations. Of the top 100 most cited publications in the four rankings,
information regarding the publication journal, publication year, first
author's nationality, field of POCUS application, and number of times the
article was cited was recorded for trend analysis. Results: A total of
7860 POCUS-related publications were retrieved, and publications related
to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited
publications from the four ranking groups were included in this study.
Trauma was the leading application field in which POCUS was studied prior
to 2001. After 2004, thorax, cardiovascular, and procedure-guidance were
the leading fields in POCUS research. >79% (118/148) of the top-cited
publications were conducted by authors in the United States, Italy, and
France. The majority of publications were published in critical care
medicine and emergency medicine journals. Conclusions: In recent years,
publications relating to POCUS have increased. POCUS-related research has
mainly been performed in thorax, cardiovascular, and procedure-guidance
ultrasonography fields, replacing trauma as the major field in which POCUS
was previously studied.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<40>
Accession Number
2000604759
Author
Oesterle A.; Weber B.; Tung R.; Choudhry N.K.; Singh J.P.; Upadhyay G.A.
Institution
(Oesterle, Weber, Tung, Upadhyay) Center for Arrhythmia Care, The
University of Chicago, Ill, United States
(Choudhry) Department of Medicine, Brigham and Women's Hospital, Boston,
Mass, United States
(Singh) Massachusetts General Hospital Heart Center, Boston, United States
Title
Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A
Meta-analysis.
Source
American Journal of Medicine. 131 (7) (pp 795-804.e5), 2018. Date of
Publication: July 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Although postoperative atrial fibrillation is common after
noncardiac surgery, there is a paucity of data regarding prophylaxis. We
sought to determine whether pharmacologic prophylaxis reduces the
incidence of postoperative atrial fibrillation after noncardiac surgery.
Methods: We performed an electronic search of Ovid MEDLINE, the Cochrane
central register of controlled trials database, and SCOPUS from inception
to September 7, 2016 and included prospective randomized studies in which
patients in sinus rhythm underwent noncardiac surgery and examined the
incidence of postoperative atrial fibrillation as well as secondary safety
outcomes. Results: Twenty-one studies including 11,608 patients were
included. Types of surgery included vascular surgery (3465 patients),
thoracic surgery (2757 patients), general surgery (2292 patients),
orthopedic surgery (1756 patients), and other surgery (1338 patients).
Beta-blockers (relative risk [RR] 0.32; 95% confidence interval [CI],
0.11-0.87), amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and statins (RR
0.43; 95% CI, 0.27 to 0.68) reduced postoperative atrial fibrillation
compared with placebo or active controls. Calcium channel blockers (RR
0.55; 95% CI, 0.30 to 1.01), digoxin (RR 1.62; 95% CI, 0.95 to 2.76), and
magnesium (RR 0.73; 95% CI, 0.23 to 2.33) had no statistically significant
effect on postoperative atrial fibrillation incidence. The incidence of
adverse events was comparable across agents, except for increased
mortality (RR 1.33; 95% CI, 1.03 to 1.37) and bradycardia (RR 2.74; 95%
CI, 2.19 to 3.43) in patients receiving beta-blockers. Conclusions:
Pharmacologic prophylaxis with amiodarone, beta-blockers, or statins
reduces the incidence of postoperative atrial fibrillation after
noncardiac surgery. Amiodarone and statins have a relatively low overall
risk of short-term adverse events.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<41>
Accession Number
622559093
Author
Kilicaslan B.; Kanbak M.; Tokur M.; Kara E.; Akca B.; Yilbas A.;
Celebioglu B.
Institution
(Kilicaslan, Kanbak, Tokur, Kara, Akca, Yilbas, Celebioglu) Hacettepe
University, Department of Anaesthesiology and Reanimation, Ankara, Turkey
Title
Changes in microcirculatory perfusion using acute normovolemic
hemodilution (ANH) with HES (130/0,4) during cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S43-S44), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Cardiac surgery remains a major consumer of blood
components. ANH provides fresh autologous blood units for later
retransfusion after control of surgical bleeding. The real efficacy of ANH
in reducing allogeneic blood transfusions is discussed controversially in
the literature. Thus, the present investigation was performed to effects
of ANH with HES (130/0.4) on microcirculation in cardiac surgery. Method:
Patients scheduled to undergo CABG entered the study protocol and were
randomly allocated to one of two groups:ANH (n:11) or standard care
management(n:11). In the ANH group, 500 ml whole-blood was withdrawn from
the patients and 500 ml colloid was given to the patients. SDF imaging
technique was used to evaluate the sublingual microcirculation.
Haemodynamic variables (HR, MAP, CVP, CO, PCWP), laboratory parameters
(Htc, lactate and K+) and microcirculatory variables (Total vascular
density-TVD (mm. mm-2), microvascular flow index-MFI (AU), perfused vessel
density-PVD (mm.mm-2), proportion of perfused vessels-PPV (%) of vessels
were obtained after induction (before ANH), before CPB (after ANH), during
CPB, at the end of the operation and at 24 hours postoperatively. These
images have been analysed by using AVA (Automated Vascular Analysis)
software. Results: In the two groups; CVP, CO, PCWP, and CI values did not
differ significantly between the groups. The greatest alterations at the
microcirculatory level occurred on the small vessels during CPB. In the
ANH group, small vessels of TVD (from 12.9+/-2.6 to 11.0+/-2.6, 14.7%),
PVD (from 13.6+/-2.5 to 10.6+/-3.0, 22%), PPV (from 90.5+/-5.6% to
85.1+/-12.7%, 5.97%)(P<0.05) and MFI (from 2.25+/-0.29 to 2.0+/-1.0,
7.69%) (P<0.05) were decreased. In the Control group, small vessels of TVD
(from 12.9+/-1.83 to 11.0+/-2.3, 14.7%), PVD (from 13.3+/-1.8 to
10.6+/-2.2, 20.3%) were decreased but PPV (from 94.5+/-4.7% to 96+/-6.2%,
1.69%) and MFI (from 2.39+/-0.33 to 3.0+/-00, 17.99%) were increased
(P<0.05). These changes were returned to initial values 24 hours
postoperatively. Conclusion: We observed that ANH with HES had no negative
effects on hemodynamics and microcirculatory parameters. Therefore this
technique can find a place in cardiac surgery .

<42>
Accession Number
622559061
Author
Anwar S.; Shaw M.; Baxter S.
Institution
(Anwar) Barts Heart Centre, Department of Perioperative Medicine, London,
United Kingdom
(Shaw, Baxter) St. Thomas' Hospital, London, United Kingdom
Title
Outcomes following minimally invasive cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S41-S42), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Survival outcomes are improving following elective cardiac
surgery. Quality of recovery and the cost of treatment are increasingly
important in the delivery of this complex intervention. Recent innovations
have included minimising the size of surgical incision to potentially
improve pain and recovery times. Only one study in the literature has
studied the health economics of minimal access aortic valve replacement
(AVR) revealing potential cost savings(1). Methods: In the POMICS study
(Pain Outcomes following Minimally Invasive Cardiac Surgery), with
institutional review board approval we are prospectively collecting data
on recovery profiles following isolated AVR through the following
incisions: Standard midline sternotomy (STERN) Mini sternotomy (MINI)
Right anterior thoracotomy (RAT) We report an interim analysis of the
first 100 patients from the POMICS study. Logistic and regression
analysis, as appropriate for the data, was performed using SPSS 24 (IBM
Corporation). Results: The likelihood of developing clinically meaningful
postoperative pain -a score of at least four on a numerical rating scale
of zero to ten - at 24 hours following surgery, both at rest (Odds ratio
OR=1.11 for MINI and 1.56 for RAT) and at maximum cough (OR=1.14 and
1.89), are non significant, when compared with the STERN incision.
Morphine equivalent consumption of opioids is also similar across the
three groups (133mg, 142, 158mg respectively) with non-significant
differences in doses when comparing STERN with MINI (95% Confidence
Interval (CI) = -19 to 38) and STERN with RAT (95%CI=-11 to 62mg).
Extubation times are similar (490, 460 and 464 minutes for STERN, MINI and
RAT respectively, all non-significant at the p=0.05 level.) Length of stay
on the Cardiac Intensive Care Unit (CICU) varied between groups with MINI
incision reducing time by 19 hours (95%CI =4-34 hours, p=0.013) and RAT
incision by 18.5 hours (95%CI= 2-37 hours, p=0.05) from a mean time of 51
hours for STERN. Overall median length of stay in hospital in hospital was
similar at 7, 7 and 7.5 days respectively. Discussion: Our study confirms
the previous work around the potential for cost saving with the use of
minimally invasive surgical incisions for isolated AVR. The potential to
discharge patients earlier from the cardiac CICU may improve flow of
patients throughout the institution and improve patient experience. While
not randomised, this observational study suggests that recovery profiles
and pain outcomes following MICS are similar to standard incision. There
are however potential resource utilisation implications from this study
and the health economics of minimally invasive surgery need to be explored
further.

<43>
Accession Number
622559057
Author
El Tahan M.; Khidr A.; Gaarour I.; Alshadwi S.; Alghamdi T.; Al'ghamd A.
Institution
(El Tahan, Khidr, Gaarour, Alshadwi, Alghamdi, Al'ghamd) King Fahd
Hospital, University of Dammam, Department of Anaesthesiology, Al Khobar,
Dammam, Saudi Arabia
Title
A comparison of three videolaryngoscopes for double-lumen tubes intubation
in humans by users with mixed experience. A randomized controlled study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S4-S5), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: A recent manikin study demonstrated that the Airtraq and
non-channelled King VisionTM videolaryngoscopes (VL) took longer times for
double-lumen tube (DLT) intubation than the Macintosh by less experienced
providers. [1] We hypothesized that the use of the King VisionTM and
Airtraq VLs by users with mixed experience might reduce the time to DLT
intubation in patients undergoing thoracic surgery. Methods: One
hundred-thirty-three patients scheduled for elective thoracic surgery
using the DLT for one-lung ventilation were assigned randomly to place the
DLT using the Macintosh (n=32), GlideScope (n=34), Airtraq (n=35) or King
VisionTM (n=32). Time to DLT intubation, first-pass success rate,
percentage of glottic opening score, intubation difficulty using a Likert
scale, optimisation manoeuvers, failure to intubation, defined as an
attempt taking longer than 150 s. or if peripheral oxygen saturation
decreased <92%, and postoperative sore throat and hoarseness of voice,
were recorded. Results: Compared with the GlideScope, the Macintosh,
Airtraq, and KVL took shorter times to DLT intubation (median times:
GlideScope111.5 s. [95% confidence interval (CI) 89.3 s. to 136.6 s.];
Macintosh 64 s. [95% CI 59.3 s. to 76.6 s.]; Airtraq 67 s. [95% CI 49.5 s.
to 86.2 s.]; KVL 91 s. [95% CI 39.2 to 80.4], P=0.004) and had comparable
firstpass success rate (100%, 100%, 94.4%, and 100%, respectively,
P=0.522), glottis view, and postoperative sore throat and hoarseness of
voice. Compared with the GlideScope, the Airtraq and KVL required less
frequent optimising manoeuvres (Po 0.001). The Airtraq was easier to use
than the GlideScope [1.1 7 1.53 vs. 2.4 7 1.60; P=0.023] and associated
with two failures due to the inability to advance the DLT through the
glottis opening because the blade was placed too deep in the airway and
not midline. Duration of DLT intubation had a significant negative
correlation with the prior experience of using the device tested (r
=-0.392, P=0.001). Discussion: The channeled Airtraq required less time
for DLT intubation and was easier to use than the GlideScope when used by
users with mixed experience. (Figuer Presented).

<44>
Accession Number
622559035
Author
Holmgaard F.; Vedel A.G.; Rasmussen L.S.; Langkilde A.; Nilsson J.C.; Ravn
H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) Department of Cardiothoracic
Anaesthesiology, Heart Centre,Rigshospitalet, University of Copenhagen,
Copenhagen O, Denmark
(Rasmussen) Department of Anaesthesia, Centre of Head and
Orthopaedics,Rigshospitalet, University of Copenhagen, Copenhagen O,
Denmark
(Langkilde) Department of Radiology, Diagnostic Centre,Rigshospitalet,
University of Copenhagen, Copenhagen O, Denmark
Title
Near infrared spectroscopy at two levels of mean arterial pressure during
cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S3), 2017. Date of Publication: April 2017.
Publisher
W.B. Saunders
Abstract
Introduction: Cerebral injury is a common complication after cardiac
surgery where postoperative cognitive dysfunction (POCD) can occur, and
new cerebral infarcts can be detected using diffusion-weighted magnetic
resonance imaging (DWI) in up to 50% of patients. Near InfraRed
Spectroscopy (NIRS) is used increasingly during cardiac surgery to monitor
regional cerebral oxygen saturation (rSO<inf>2</inf>), but so far, the use
of NIRS has not been demonstrated to result in prevention of postoperative
neurological injury. The Perfusion Pressure Cerebral Infarct (PPCI)
trial(1) sought to assess whether the incidence of new cerebral infarcts
and postoperative cognitive dysfunction were influenced by mean arterial
pressure (MAP) level during cardiopulmonary bypass (CPB). Blinded NIRS
monitoring was used throughout the PPCI trial. The aim of the present
substudy of the PPCI trial was to: 1. Compare rSO<inf>2</inf> levels
between patients randomised to two distinct MAP levels during CPB. 2.
Evaluate changes in rSO<inf>2</inf> in patients with and without new
cerebral infarcts on DWI. 3. Evaluate changes in rSO<inf>2</inf> in
patients with and without POCD. Method: In the PPCI trial 197 patients
were included from July 2014 until January 2016 and follow-up finished in
April 2016. Patients were 18 years or older and underwent CABG and/or
valve replacement surgery. Patients with a history of neurological disease
and patients where DWI was contraindicated were excluded. Patients were
randomised to either a MAP at 40-50 mmHg or 70-80 mmHg during CPB. A
Covidien/Medtronic Invos Somatic/Cerebral 5100c NIRS monitor was used
throughout the trial. Data collection was done with a frequency of
approximately 0.2Hz and time points for initiation and weaning of CPB were
clearly marked on each patient record. The NIRS monitor was blinded and
all alarms were muted prior to recording, and management of patients was
based on conventional haemodynamic and respiratory monitoring. DWI was
conducted the day before surgery (baseline) and day 3 to 6. Cognitive
dysfunction was evaluated at baseline, discharge and at 3 months. Results:
Patient inclusion in the PPCI trial has been completed and data analysis
is currently undertaken. For this reason, the results of the present
substudy are not available before deadline for abstract submission, but
will be presented at the EACTA meeting. Discussion: Discussion of the
results will be carried out as part of the EACTA meeting presentation.

<45>
Accession Number
622558999
Author
Glass A.; McCall P.; Arthur A.; Kinsella J.; Shelley B.
Institution
(Glass, McCall, Shelley) Golden Jubilee National Hospital, Department of
Anaesthesia, Clydebank, United Kingdom
(Glass, McCall, Arthur, Kinsella, Shelley) University of Glasgow,
Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow,
United Kingdom
Title
Non-invasive indices of right ventricular afterload following lung
resection.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S73-S74), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Surgical resection of lung cancer offers the best chance of
cure but is associated with post-operative dyspnoea and decrease in
functional capacity. This decrease in functional capacity is poorly
related to the change in lung function and may be influenced by
post-operative cardiac dysfunction. Our group has shown that right
ventricular (RV) ejection fraction falls following lung resection and we
hypothesise that this change results, at least in part, from an increase
in RV afterload. Previous studies have not demonstrated a consistent
increase in pulmonary vascular resistance following resection although
this measure overlooks changes in the pulsatile components of afterload.
Pulmonary artery (PA) distensibility and PA acceleration time (PAAT) are
non-invasive indices of afterload which assess the pulsatile components of
afterload and may offer insight into RV loading conditions following lung
resection. Distensibility is a measure of pulmonary artery stiffness and
is related to compliance whereas PAAT is associated wave reflections; both
decrease in conditions of increased afterload. Methods: With ethics
approval, velocity encoded cardiac MRI of the main, right and left PA's
was performed; pre-op, on postop day two (POD2) and two months on 27
patients undergoing lung resection by thoracotomy. Randomised and
anonymised images were dual reported for PAAT and distensibility. PAAT is
the time to peak flow (ms) and distensibility was calculated as (max-min
PA area)/min PA area. Comparisons were made using independent samples or
paired t-tests. Results: The distribution of cardiac output was higher
through the PA on the operative side than the non-operative side pre-op
(p=0.03) but higher in non-operative vessel on POD2 (p<0.01) and at two
months (p<0.01). Operative vessel distensibility fell from pre-op on POD2
(p=0.02) and at two months (p=0.04); non-operative and main PA
distensibility were unchanged throughout (p>0.14). Distensibility was
lower in the operative than non-operative vessels only at two months
(p=0.01). PAAT decreased in all vessels from pre-op to POD2 (p<0.01 for
all). Main and operative PAAT remained decreased from pre-op at two months
(p=0.02 and po0.01) whilst non-operative PAAT returned to baseline
(p=0.22) (Figure 1). PAAT was shorter in the operative than non-operative
vessels on POD2 (p<0.01) and at two months (p=0.02). Discussion: The
changes in distensibility and PAAT imply the RV is subject to increased
afterload following lung resection. By two months the non-operative vessel
appears to have adapted to the increased cardiac output showing no change
in distensibility or PAAT whilst the operative vessel has decreased
distensibility and PAAT despite receiving a lower cardiac output. This
operative vessel afterload is reflected in the main PA as decreased PAAT.
Further work is needed to investigate if the described changes in
afterload worsen on exercise and contributes to the post-operative
decrease in functional capacity. (Figure presented) .

<46>
Accession Number
622559237
Author
Maghsoudi B.; Rastegarian A.; Khosravi M.; Azemati Khademi S.; Tabatabaie
H.; Aflaki K.K.; Ghasemzadeh B.
Institution
(Maghsoudi, Khosravi, Azemati Khademi, Tabatabaie, Aflaki, Ghasemzadeh)
Shiraz University of Medical Sciences, Department of Anesthesia and
Intensive Care, Shiraz, Iran, Islamic Republic of
(Rastegarian) Jahrom university of Medical Sciences, Department of
Anaesthesia, Jahrom, Iran, Islamic Republic of
Title
Oral levothyroxine in the management of sick euthyroid syndrome after
child open heart surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S55-S56), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Thyroid hormone has long been known to exert profound
effects on the cardiovascular system. Cardiopulmonary bypass (CPB) in
children is associated with a marked decline in thyroid hormone levels
consistent with the phenomenon referred to as sick euthyroid syndrome. Iv
and Po Triiodothyronine is not available in many countries. The purpose of
the present study was to determine if oral levothyroxine could reduce the
length of stay in ICU in infants and children undergoing open heart
surgery using CPB. Method: In a randomised, placebo-controlled, double
blind clinical trial 40 children less than 5 year of age candidate of open
heart surgery, were divided to two groups of 20 each; oral levothyoxine
(T) and placebo (P). I group T oral levothyroxine given by nasogastric
tube (3 microg/kg) starting on induction of anaesthesia and then every 24
hours for 5 days. We evaluated the length of stay in the intensive care
unit (ICU), time to extubation, length of hospital stay and the mean
inotrope use in the first 24h in the ICU, total T3 (TT3), free T3(FT3),
total T4(TT4), free T4(FT4) and TSH levels during 5 days after surgery.
Results: Demography of surgery and anaesthetic data were comparable
between the two groups. All the data were numerically and clinically
different between the two groups, but statistically most were not
significant (possibly due to sample size). TSH at fifth day, TT3, TT4,
FT3, FT4 during the whole study period were all significantly different
between the two groups. The need for dopamine was less (p<0.05) in the
control group. The time to extubation, ICU stay and hospital stay were
clinically less in the control group, but was not significantly different.
Discussion: Oral Levothyroxin could have a clinically significant impact
in the postoperative course of children undergoing open heart surgery as
paediatric intensivist and nurses imply. We need larger sample size to
show how significant is this therapy. Comparing time to extubation and
length in ICU and Hospital Stay between two groups Case and Control, All
Data are presented in Hours.

<47>
Accession Number
622559224
Author
Tewari P.; Agarwal S.; Majumdar G.
Institution
(Tewari, Agarwal, Majumdar) Sanjay Gandhi Postgraduate Institute of
Medical Sciences (SGPGIMS), Department of Anaesthesiology, Lucknow, Uttar
Pradesh, India
Title
Levosimendon after mitral valve replacement supports right ventricular
function better in mitral stenosis patients with moderate to severe
pulmonary hypertension.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S17-S18), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Development of pulmonary arterial hypertension (PAH) in
patients having rheumatic mitral stenosis (MS) results in right
ventricular hypertrophy and dysfunction that affects postoperative
outcome. Conventional vasodilators though improve right ventricular
function but also result in an increase in heart rate and contribute in
development of AF. Levosimendan has been used in the care of heart-failure
patients for the positive inotropic effect by binding to cardiac troponin
C and sensitising cardiac myofilaments to calcium without increase in
oxygen consumption[1]. Pleiotropic effects include activation of adenosine
triphosphate-sensitive sarcolemmal K+ channels of smooth muscle cells
(linked to vasodilation) and activation of adenosine
triphosphate-sensitive K+ channels in cardiovascular mitochondria
(involved in a cardioprotective effect). We postulated that Levosimendon
can be a better vasodilator in supporting RV function in patients that
develop moderate to severe PAH due to severe MS Methods: 50 patients with
normal LV size and contractility with moderate to severe PAH (MPA P >25
and beyond at rest) but without AF were randomised to conventional
management with dobutamine and noradrenaline combination(Gr.1) or addition
of levosimendon as a bolus in pump followed by infusion (Gr.2) during and
after coming off bypass after mitral valve replacement. The levosimendon
infusion was continued for 48 hours. The RV function was evaluated by
TAPSE, FAC, MPI of RV, PRVSP,S' pulmonary flow Acceleration time (PAt) by
TEE post induction prebypass, after closure of chest and 24 hours in ICU
by TTE Results: Complete data of 25 patients of in Gr.1 and 24 in Gr. 2
was analysed using SPSS ver 21 using appropriate test (significant
p<0.05). Demographically both the groups were similar. There was
significant improvement in the echo RV parameters of TAPSE, FAC and S'
velocity and PAt in Gr. 2. 11 patients developed AF in postoperative
period in Gr.1 as compared to 4 in Gr.2. The 24 hours urine output was
significantly more in Gr.2. Patients in Gr. 2, warmed up earlier and
needed significantly more pacing as compared to Gr.1. There were no deaths
and they were extubated within 10-12 hours and after the completion of
study they were placed on oral sildenafil. Discussion: Levosimendon exerts
a vasodilatory effect on vascular smooth muscle cells, by inducing
adenosine triphosphate-dependent potassium channel opening, primarily in
the pulmonary arterial vasculature. It results in improved RV-PA coupling
in experimental acute RV failure more than dobutamine. In this study these
effects have been shown, clinically, with improvements in RV function and
reduction in PAH after mitral valve replacement, including reduction in AF
with better outcome.

<48>
Accession Number
622559192
Author
Vedel A.G.; Holmgaard F.; Rasmussen L.; Langkilde A.; Paulson O.B.; Olsen
P.S.; Lange T.; Ravn H.B.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Rasmussen, Langkilde, Paulson, Olsen, Ravn, Nilsson)
Copenhagen University Hospital, Rigshospitalet, Department of
Cardiothoracic Anaesthesiology, Copenhagen, Denmark
(Lange) Univesity of Copenhagen, Section of Biostatistics, Copenhagen,
Denmark
Title
The influence of mean arterial pressure during cardiopulmonary bypass on
cerebral complications.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S14), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Stroke and postoperative cognitive dysfunction are common
complications after cardiac surgery. Furthermore, silent strokes detected
by diffusion-weighted magnetic resonance imaging (DWI) have been reported
in up to 50% of cardiac surgery patients. The majority of these lesions
seems to be caused by emboli, but other mechanisms may induce
hypoperfusion and consequently lead to tissue ischaemia. A few randomised
controlled trials have previously investigated the influence of mean
arterial pressure (MAP) during cardiopulmonary bypass (CPB) on cardiac and
neurological endpoints with diverging results. The aim of the Perfusion
Pressure Cerebral Infarct (PPCI) trial was to assess the effects of two
distinct levels of MAP during CPB on the development of perioperative
cerebral injury in cardiac surgery patients(1). Methods: We randomised 197
(99 vs. 98) patients in a singlecentre, patient- and investigator blinded
trial. Before undergoing coronary artery bypass grafting and/or left heart
valve surgery, patients were stratified by age and surgical procedure and
randomised 1:1 to CPB with either increased MAP (70-80 mmHg) or 'usual
MAP' (departmental practice) (40-50 mmHg). CPB pump flow was fixed at 2.4
l/min/m2 body surface area plus 10-20 % in both groups and MAP was
increased to the target level by phenylephrine and a titrated infusion of
norepinephrine to a maximum of 0.4 mug/kg/min, if necessary. The primary
endpoint was total volume of new cerebral infarcts (ml) (change from
baseline DWI scan to one conducted day 3-6). Secondary endpoints included
the total number of new ischaemic infarcts and postoperative cognitive
dysfunction at discharge and after 3 months. Results: The results reported
below are blinded. Final, unblinded results will be presented at EACTA
Annual Congress 2017. Mean MAP was 66.8 mmHg (SD 4.9) in one group and
44.7 mmHg (SD 4.9) in the other. Mean age was 67 years (SD 11), 57% of the
procedures were coronary artery bypass graftings and 43% were left heart
valve procedures. We found no significant difference in volume of new
cerebral infarcts between the two groups (median 0.03 mL (IQR 0-0.12) vs.
0.03 mL (IQR 0-0.14); P= 0.48). The total numbers of new cerebral infarcts
were comparable between groups (median 1 (IQR 0-2); P=0.53), as was the
incidences of cognitive dysfunction after 1 week and 3 months. Discussion:
In cardiac surgery patients, the volume of new cerebral infarcts was
comparable in patients randomised to a low vs. high mean arterial pressure
during CPB. Moreover, there was no statistically significant difference in
the incidence of postoperative cognitive dysfunction between groups.

<49>
Accession Number
622559172
Author
Fenger A.-S.; Vedel A.G.; Rasmussen S.R.; Nilsson J.C.; Ravn H.B.
Institution
(Fenger, Vedel, Rasmussen, Nilsson, Ravn) University Hospital -
Rigshospitalet, Department of Cardiothoracic Anaesthesiology, Copenhagen,
Denmark
Title
Effects of mean arterial pressure on haematocrit during cardiopulmonary
bypass-a substudy of the PPCI-trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S12-S13), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Induction of general anaesthesia is known to cause an
increase in plasma volume resulting in decrease in haematocrit. Recently,
a randomised study showed preservation of haematocrit if mean arterial
pressure (MAP) was maintained at baseline level by means of
vasoconstrictors (1). Haemodilution is even more pronounced during
cardiopulmonary bypass (CPB) and a low haematocrit is associated with
ischaemic complications. The purpose of this substudy of the Perfusion
Pressure Cerebral Infarct (PPCI) trial (2) was to investigate whether a
higher MAP resulted in a higher level of haematocrit during CPB. Method:
The PPCI trial randomised 197 (97 versus 98) patients undergoing coronary
artery bypass grafting and/or heart valve surgery, in a 1:1 allocation
ratio, to either a high MAP (70-80 mmHg) or low MAP (departmental
practice) (40- 50 mmHg) during CPB. The CPB pump flow was fixed at 2.4
l/min/m2 plus 10-20 % in both groups. Bolus phenylephrine to a maximum of
2 mg and a titrated infusion of noradrenaline up to 0.4 mug/kg/min was
given to obtain target MAP, if necessary. The endpoint of this substudy
was the relative change in haematocrit from initiation until the end of
CPB defined as first and last haematocrit measured during CPB at full
flow, respectively. Secondary outcomes were intraoperative urine output
and fluid balance. Patients who required red blood cell (RBC) transfusions
during their primary surgery were excluded from the analysis. Results:
Median MAP during CPB was 45 (IQR 42-47) mmHg and 68 (IQR 64-70) mmHg in
the low and high MAP group, respectively. Complete data were available for
171 patients. Baseline haematocrit levels were comparable in the two
groups, but the high MAP group maintained a higher haematocrit level
during CPB with a relative change of +8 % versus -3 % in the low MAP group
(P<0.001) (Figure 1A). The median urine output was significantly higher in
the high MAP group (700 (IQR 400-1100) mL) compared to the low MAP group
(500 (IQR (310-800) mL), (P = 0.01) (Figure 1B). Amounts of fluid
administered during the first 24 hours were comparable between groups, as
were haematocrit levels and fluid balance on the morning after surgery.
Discussion: This PPCI trial substudy showed preservation of haematocrit
and a higher urine output in the group randomised to a high MAP during
surgery. (Figuer Presented).

<50>
Accession Number
622559171
Author
Lomivorotov V.V.; Perovskiy P.; Fominskiy E.; Ponomarev D.; Shmyrev V.;
Kornilov I.; Lomivorotov V.N.; Karaskov A.
Institution
(Lomivorotov, Perovskiy, Fominskiy, Ponomarev, Shmyrev, Kornilov,
Lomivorotov, Karaskov) Research Institute of Circulation Pathology,
Department of Anaesthesiology and Intensive Care, Novosibirsk, Russian
Federation
Title
Cerebral oximetry in reducing postoperative morbidity in high-risk cardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S48-S49), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Numerous studies have shown that the magnitude and duration
of cerebral oxygen (rSO2) desaturation is associated with early
postoperative neuropsychological dysfunction and prolonged stay after
cardiac surgery. We hypothesized that the use of predefined protocol of
interventions [1] for correcting rSO2 desaturation (<60%) during high-risk
cardiac surgery under cardiopulmonary bypass would reduce the overall
incidence of postoperative complications. Methods: 120 patients were
randomized before surgery to one of two groups, control (CG) or
intervention (IG) with cerebral oximetry monitoring using FORE-SIGHT
oximeter (CAS Medical Systems Inc., USA). High-risk surgery was defined as
a presence of at least one of the following: the age greater than or equal
to 75 years on the day of screening; left ventricle ejection fraction less
than 35%; use of a preoperative intraaortic balloon pump; combined valve
and coronary artery surgery or multiple valve surgery in patients who have
congestive heart failure, or renal insufficiency (creatinine clearance <
60 ml/min). In the IG, predefined protocol of interventions for correcting
rSO2 desaturation during cardiac surgery was used. In the CG the screen of
cerebral oximeter was closed with the paper and the alarms of low rSO2
were turned off. The primary outcome was the incidence of postoperative
complications (composite outcome). Patients were followed-up for 30 days
after surgery by the phone. Comparative analysis of qualitative data was
performed with Fisher exact test. For all statistical criteria, the type-I
error was considered equal to 0.05. All of the statistical analyses were
executed using the Rx64 2.15.0 statistical programming language (R
Development Core Team, 2012). Results: Groups were comparable in
preoperative demographic characteristics. The average baseline rSO2 was
not different between the groups. Cerebral desaturations occurred in 52
(86.7%) of the 60 patients in IG and 41 (68.3%) of the 60 patients in CG
patients (P = 0.02). Although cerebral desaturation was successfully
corrected in 47 of 52 patients (90.4%), mean cerebral desaturation load
did not differ between the groups. There was no difference in composite
outcome (68 events in IG vs 70 events in CG, p=0.82) and duration of
hospitalization between the groups. Discussion: In our study, application
of a predefined algorithm to correct a decrease in cerebral oxygenation
failed to reduce cerebral desaturation load and the overall incidence of
postoperative complications in high-risk cardiac surgery. Future studies
are needed to determine the effects of desaturation reversal on clinical
outcome in different populations of cardiac surgery patients.

<51>
Accession Number
622559126
Author
Jensen P.B.; Dalgaard C.; Gissel M.S.; Jakobsen C-.J.
Institution
(Jensen, Gissel, Jakobsen) Odense University Hospital, Odense, Denmark
(Jensen) Aalborg University Hospital, Aalborg, Denmark
(Dalgaard) Aarhus University Hospital, Department of Anaesthesiology and
Intensive Care, Aarhus N, Denmark
Title
The preconditioning properties of Sevoflurane seems not to be superior to
TIVA-a cohort study of 17,771 patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S82-S83), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Although several meta-analyses suggest beneficial effects of volatile
inhalation agents (VIA) compared to total intravenous anaesthesia (TIVA)
results are conflicting. Theoretically, experimentally and clinically
propofol reduces oxidative stress and may thus protect against
ischemia-reperfusion injury. The aim of this study was to evaluate whether
the cardio protective effects of VIA is superior to TIVA, taking the
patient preoperative cardiac state into consideration. Methods: A study of
17,771 eligible procedures prospectively registered in the detailed West
Denmark Heart Registry (WDHR) from 2007-15. All patients received TIVA or
VIA. Patients in TIVA group received propofol 40-80 mug/kg/min. Induction
in VIA patients were Midazolam or propofol and maintenance Sevoflurane
1.5-2.5%, continued during cardiopulmonary bypass. All patients received
sufentanil 3-5 mug/kg or less often fentanyl 10-25 mug/kg for pain control
and rocuronium/cisatracurium before endotracheal intubation. Perioperative
treatment was at the discretion of the attending anaesthesiologist and
surgeon. Patients received routine monitoring including ECG, radial and
for the majority pulmonary artery catheters, pulse oximetry, capnography
and temperature monitoring. Most patients were additionally monitored with
perioperative transesophageal echocardiography. Patient characteristics
and procedures were described primarily by EuroSCORE. The short-term
outcomes were 30-days mortality and postoperative incidence of in-hospital
myocardial infarction (MI), CKMB level, stroke and new dialysis. Long-term
outcomes were long time in ICU, new ischaemic event (coronary angiography,
percutaneous coronary intervention or re-do coronary artery bypass
grafting) together with mortality within 6-months after the procedure. All
outcome measures were in accordance with the pre-specified classifications
used in the WDHR. Propensity score matching was used to reduce the risk of
confounding bias and non-random factors. Each TIVA patient was matched
with a VIA patient with the nearest propensity score within a caliper
range +/- 0.025. We matched 6,800 (87.2%) of 7,796 TIVA patients. Results:
In crude analysis, TIVA was superior to VIA regarding 30-days mortality,
in hospital MI and more than 72 hours in ICU. The effect on 6-month
mortality was borderline. All outcomes, also in subgroups were
nonsignificant after adjustments. Discussion: In this large cohort study
of cardiac surgery patients from three university hospitals, we could not
demonstrate differences between volatile anaesthesia and TIVA in
postoperative outcomes. (Table presented) .

<52>
Accession Number
622559104
Author
Ulugol H.; Gunes I.; Tosun M.; Karduz G.; Vardar K.; Kilercik M.; Okten
M.; Aksu U.; Toraman F.
Institution
(Ulugol, Tosun, Toraman) Acibadem University, School of Medicine,
Department of Anaesthesiology and Reanimation, Istanbul, Turkey
(Kilercik) Erciyes University Faculty of Medicine, Department of
Anaesthesiology and Reanimation, Kayseri, Turkey
(Okten) Acibadem University, School of Medicine, Department of Clinical
Biochemistry, Istanbul, Turkey
(Karduz, Vardar, Aksu) Acibadem University, School of Medicine, Department
of Cardiovascular Surgery, Istanbul, Turkey
(Gunes) Istanbul University, Science Faculty, Deparrtment of Biology,
Istanbul, Turkey
Title
The effects of Alprazolam and melatonin used in premedication on oxidative
stress, glycocalyx integrity and postoperative neuro-congnitivity
disorders.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S44), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Oxidative stress in open heart surgery can disrupt
microvascular control and impairs tissue perfusion and leads to organ
damage. We aimed to investigate the effects of melatonin as an anxiolytic
drug, which has high antioxidant activity and radical scavenging
properties, on oxidative stress status and postoperative neuro-cognitive
dysfunction. Methods: In this prospective randomized controlled study
approved by the Acibadem University ethics committee, 42 patients who
underwent elective cardiovascular surgery were included and were divided
into two groups: Patients given alprazolam (0.5 mg) 22 hours prior to
surgery, Group-A (n: 21) and patients given melatonin (3 mg p.o.) At 22
and 4 hours prior to surgery (total 6 mg), Group M (n: 21). Midazolam
(0.06mg / kg i.m.) was administered to both groups 30 minutes before the
surgery. To assess the oxidative stress status of patients undergoing
standard anesthesia protocol blood samples were collected at (T0)
pre-induction, (T1) intensive care admission and (T2) postoperative 24
hours and measured ischemia modified albumin (IMA), advanced oxide protein
products (AOPP), total thiol (T-SH), free haemoglobin (fHb) and sialic
acid (SA). In addition, a Mini-Mental State Examination (MMSE) test was
performed to evaluate the preop and postoperative neuro-cognitive status
of the patients. Results: The total T-SH level reflecting the potentiation
of the endogenous defense response to the oxidative stress was found to be
significantly higher in the melatonin group at the T1 time point than at
the baseline level and the alprazolam group (p<0.05). Looking at oxidative
stress, the free hemoglobin level was lower in the melatonin group than
the alprazolam group in T1 (p<0.05) and higher sialic acid in melatonin
group (p <0.05). In other variables, no significant difference was found
between the groups at the measurement time points. Discussion: In terms of
T-SH, endogenous defense response against oxidative stress was found to be
superior with melatonin administration, but in terms of sialic acid,
endothelial damage was still present. We believe that melatonin should be
used in higher doses to be able to detect the injury preventive effect.

<53>
Accession Number
622559323
Author
Okuyama K.; Ariffn S.A.; Nomura M.
Institution
(Okuyama, Nomura) Tokyo Women's Medical University, Department of
Anaesthesiology, Tokyo, Japan
(Ariffn) National Heart Institute of Malaysia, Kuala Lumpur, Malaysia
Title
Can foreign trainees be distractive in terms of communication during
cardiac surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S70), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: We sometimes experience misunderstandings/ miscommunication
due to a different background or a language barrier in our life. Our
hypothesis was that there were more communication errors in actual
surgical settings where there were foreign doctors who had a different
cultural and linguistic background. The aim of this study was to explore
and quantify the effect dissimilar languages and cultures could have in
the operating theatre, especially in cardiac surgery which requires
effective communication to achieve excellent surgical performance.
Methods: Fifty elective conventional coronary artery bypass grafting
(CABG) cases were randomly selected, and observed following obtaining
written consent forms from the patient. All communication-related events
from administration of heparin to chest closure, where all team members
were present in the operating theatre, were documented. These events were
then examined by the researchers whether it matched our definition of
'communication error'. With those which had been addressed as a
communication error, the number of total communication error in theatres
with foreign trainees was statistically compared to those without. The
surgery time was also statistically analysed. Results: In 38 cases (76%),
there was at least one foreign doctor in the theatres (mode = 1, minimum
0, maximum 3), and in 12 cases (24%), there was only local staff. None of
the foreign doctors, in our sample, had English as their first language.
In 43 cases (86%) in this study, English was spoken throughout or
predominantly in the surgical procedure, and in 7 cases which were all
local-language speakers, the local language only was spoken. There was not
a significant difference in the number of communication errors between
theatres with foreign doctor(s) and those without (p > 0.05) by
Mann-Whitney test. Surgery time was also not statistically different
between these two groups (p > 0.05, mean: 211.1 vs. 181.3 mins).
Discussion: Our study found that foreign trainees who had different
cultural backgrounds did not have a negative impact on communication
during CABG against our hypothesis. In the institute where the study was
conducted there were no required English language qualifications, and we
often do experience language barriers. It implies that understanding
surgical procedure and flow may cover language barriers in terms of
communication during cardiac surgery.

<54>
Accession Number
622559298
Author
Kolbintsev S.; Dimova O.; Zjuljaeva T.; Javorovskiy A.
Institution
(Kolbintsev, Javorovskiy) I. M. Sechenov First Moscow State Medical
University, Department of Anaesthesiology, Moscow, Russian Federation
(Dimova, Zjuljaeva) National Research Surgical Center B. V. Petrovski,
Moscow, Russian Federation
Title
Role of local hyperfibrinolysis in the postoperative blood loss after
open-heart surgery with cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S65), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Cardiopulmonary bypass can activate hyperfibrinolysis. In
spite of pharmacological intervention and detailed surgical hemostasis,
post-bypass bleeding remains the problem. Local hyperfibrinolysis can be
one of the reasons of nonsurgical bleeding after open-heart surgery with
CPB. Methods: This blind randomised clinical trial recruited two groups of
patients (TXA 1 - 32 patients, TXA 2 - 28 patients) undergoing coronary
artery bypass graft surgery or valve replacement surgery with CPB. In 1
group TXA has been administered at a dose of 15 mg/kg tranexamic acid
after induction of anesthesia and 1mg/kg during all operation. As well
there was local application of 1g TXA in the cavity of the pericardium in
group 2. Criteria for evaluation: interoperative blood loss(ml),
postoperative blood loss(ml), tempo of chest tube drainage on 2, 4, 6, 16
hours, thromboelastometry (ROTEM) after protamine. Results: Intraoperative
blood loss consisted in TXA 1 - 870 ml, TXA 2 - 910 ml. There is no
difference between the groups. Tempo of chest tube drainage on 2 hour was
40 ml/h in TXA 1, 25 ml/h in TXA 2, on 4 hour - 20 ml/h and 15 ml/h, on 6
hour - 17,5 ml/h and 10 ml/h, on 16 hour - 8 ml/h and 8 ml/h. There is not
a difference between the groups. Patients in the TXA 2 group had a
significantly lower postoperative blood loss (180 ml) than the TXA 1 group
(265 ml) (P<0,05). There is no difference between results of
thromboelastometry in group TXA 1 and TXA 2. LY 30 was 100% in two groups.
Conclusions: Postoperative blood loss was significantly lower in the TXA
group 2 then the TXA group1, however there is no difference between
results of thromboelastometry in both groups. Consequently, there is a
possibility of local hyperfibrinolysis in group TXA 1.

<55>
Accession Number
622559281
Author
Ulugol H.; Tosun M.; Okten M.; Vardar K.; Karduz G.; Kilercik M.; Aksu U.;
Senturk M.; Alhan C.; Toraman F.
Institution
(Ulugol, Tosun, Toraman) Acibadem University, School of Medicine,
Department of Anaesthesiology and Reanimation, Istanbul, Turkey
(Kilercik) Acibadem University, School of Medicine, Department of Clinical
Biochemistry, Istanbul, Turkey
(Okten, Alhan) Acibadem University, School of Medicine, Cardiovascular
Surgery Department, Istanbul, Turkey
(Vardar, Karduz, Aksu) Istanbul University, Faculty of Science, Department
of Biology, Istanbul, Turkey
(Senturk) Istanbul University, School of Medicine, Department of
Anaesthesiology and Reanimation, Istanbul, Turkey
Title
Elimination of hydroxyethyl starch (HES) when used as colloid priming in
cardivascular surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S25-S26), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Synthetic colloid fluids (Hydroxyl ethyl starch (HES)) are
widely used especially in non-cardiac surgery due to their plasma
expanding properties. In cardiac surgery, colloids (HES) may be preferred
to reduce interstitial oedema caused by increased permeability during
extracorporeal circulation (ECC). It is known that HES is primarily
cleared by plasma amylase activity. However, there is insufficient
information about the elimination of HES when organ dysfunction is present
due to non-pulsatile flow. In this study, we aimed to evaluate the
elimination process of HES used as priming solution. Method: In this
prospective randomized study approved by Acibadem University ethics
committee, patients who underwent elective cardiovascular surgery without
any systemic disease other than hypertension and who used HES as a priming
solution in ECC were included. Patients who underwent emergency surgery
and who used HES during and after surgery except priming were excluded
from the study. All patients underwent standard anesthesia and CPB
management protocol. Blood and urine samples were collected at 7 time
points: Before induction (T0), intensive care admission (T1), 2nd hour
(T2), 4th hour (T3), 6th hour (T4), 12th hour (T5), 24th hour (T6) post
operatively. HES levels both in plasma and urine were determined as well
as standard biochemical measurements. Results: The maximum plasma HES
concentration during ICU admission reached the baseline level at post-6th
hour (0.039+/-0.004 g/100 mL, p>0.05) (Figure-1). There was no correlation
between blood and urinary HES levels at any time (p>0.05). Discussion: As
the non-HES polysaccharides in plasma might also interfere with the
measurements, the baseline plasma HES level was not found to be zero
(1,2). The plasma level of the HES used as a prime solution reached the
baseline level at 6 hours of post operation. There is no significant
relationship between urine concentration of HES in a small amount and the
plasma concentration of HES. Further studies are needed to investigate the
way in which the breakdown products of HES were eliminated. (Figuer
Presented).

<56>
Accession Number
622559277
Author
Toptan F.; Savluk O.F.; Guzelmeric F.; Yaltirik R.; Erkilinc A.; Gurcu E.;
Guler C.; Kocak T.
Institution
(Toptan, Savluk, Guzelmeric, Yaltirik, Erkilinc, Gurcu, Guler, Kocak)
Kartal Kosuyolu High Education and Training Hospital, Department of
Anaesthesiology and Reanimation, Istanbul, Turkey
Title
The effect of n-acetylcysteine on respiratory function in the aortic
surgery with antegrade cerebral perfusion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S25), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Cardiopulmonary by-pass and antegrade cerebral perfusion
have important advantages during aortic surgery. However it has
bronchopulmonary, cardiovascular and other multisystem side effects caused
by peroperative hypothermia and non-physiological components like
ischaemic process, laminar flow circulation, blood contact with foreign
surfaces during antegrade cerebral perfusion. In this study we aimed to
study the use of NACs protective effect of respiratory functions
prophylactic in elective ascending aortic surgery patients with antegrade
cerebral perfusion. Method: Between 40-80 years old ASA I- III patients 25
consecutively had elective aortic surgery with planned anterograde
cerebral perfusion were included in this study. The patients were
separated into two groups: study group (NAC +, n=13) and control group
(NAC -, n=12). After induction, a loading dose of 50mg/kg was given to
Group NAC +, and the same dose of saline was given to Group NAC - for 30
minutes maximum. Preoperative and postoperative 72 hour respiratory
function tests were performed to all patients in the sitting and upright
position. Results: 72 hours postoperatively, the PaO2 of the study group
were significantly higher statistically than the control group (p=0.001)
72 hours postoperatively, the PaO2 measurements in the study group were
lower than the control group although not statistically significant
(p=0.067). Postoperative FEV1 and FVC measurements showed statistically
difference between the groups. (p=0.005 and p=0.006 respectively.)
Discussion: The effect of NAC application to the neutrophil's oxidative
response during the cardiopulmonary by-pass was firstly evaluated by
Anderson et. al. in 1995. 24 patients included in that study and 12
patients got a bolus of 100 mg/kg followed by 20 mg/kg infused NAC during
the by-pass. In NAC (+) patients neutrophil respond was statistically
significantly lower. This finding predicted that NAC has a role of a free
oxygen radical scavenger in open heart surgery (1). In this prospective,
randomised, placebo controlled clinical original study we found that the
use of NAC in antegrade cerebral perfusion applied to elective aortic
surgery cases increases the oxygenation and prevents respiratory effects
of aortic surgery and speeds up the healing process of the lungs. (Table
Presented).

<57>
Accession Number
622559265
Author
Molstrom S.; Andersen C.; Halfeld Nielsen T.; Nordstrom C.-H.; Toft P.
Institution
(Molstrom, Andersen, Toft) Department of Anesthesiology and Intensive
Care, Odense University Hospital, Odense, Denmark
(Halfeld Nielsen, Nordstrom) Department of Neurosurgery, Odense University
Hospital, Odense, Denmark
Title
Bedside monitoring of cerebral energy state during cardiac surgery-a novel
approach utilizing intravenous microdialysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S22), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Brain damage remains an important complication of cardiac
surgery1. During neurocritical care cerebral energy state is routinely
evaluated from the lactate to pyruvate (LP) ratio obtained by
intracerebral microdialysis (MD). In an experimental study we have
recently shown that a global decrease in cerebral oxygenation due to a
pronounced decrease in MAP is reflected in an increased LP ratio of the
draining venous blood2. This study investigates whether the LP ratio
obtained by MD of the cerebral venous outflow reflects a derangement of
global cerebral energy state during cardio-pulmonary bypass (CPB). Method:
Ten patients undergoing primary, elective coronary artery bypass grafting,
were blindly randomised to low MAP (40 to 60 mmHg, n = 5) or high MAP (60
to 80 mmHg, n = 5) during CPB. MD catheters were positioned in a
retrograde direction into the jugular bulb and a reference catheter was
inserted into the brachial artery. Association between biochemical MD
variables, MAP, data obtained from simultaneous bi-frontal near infrared
spectroscopy (NIRS), and postoperative neurological outcome measures
(MMSE) were assessed. Results: During CPB the mean LP ratio obtained from
microdialysis of the internal jugular vein increased significantly by 160
% (low MAP) and 130 % (high MAP). The correlated difference between pooled
LP ratio (low and high MAP) of the jugular venous and the arterial blood
was significant (LPartery 17 [15-20] vs. LPbulb 26 [23-27]; p = 0.0001).
No cerebral desaturations (decrease in rSO2 > 20 % from baseline) were
observed in either group utilising NIRS. In both groups 50 % of the
patients showed significant cognitive decline (MMSE 3 points) two days
after surgery. Discussion: It is technically simple and feasible to place
a microdialysis catheter in the jugular bulb and monitor biochemical
variables related to energy metabolism bedside. The LP ratio of cerebral
venous blood increased significantly during CPB indicating compromised
cerebral oxidative metabolism and was correlated to the decrease in MAP.
The increase in the jugular bulb LP ratio was significantly higher than
the increase in LP ratio of the arterial blood. There was no significant
difference between low and high MAP groups regarding their venous outflow
LP ratio during CPB but low MAP patients had tendency to higher LP ratios.
Conventional monitoring of rSO2 by NIRS did not show a corresponding
decrease in cerebral oxygenation. As the patients exhibited decreased
cognitive functions after CPB increase in jugular venous LP ratio may be a
sensitive indicator of impending cerebral damage.

<58>
Accession Number
622559255
Author
Makhija N.; Ladha S.; Chauhan S.; Talwar S.
Institution
(Makhija, Ladha, Chauhan, Talwar) All India Institute of Medical Sciences,
Department of Cardiac Anaesthesia, New Delhi, India
Title
Celite based viscometer sonoclot analysis in infants with D-transposition
of great arteries undergoing arterial switch operation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Germany. 31 (Supplement 1) (pp S20-S21), 2017. Date of Publication: April
2017.
Publisher
W.B. Saunders
Abstract
Introduction: The present study was undertaken in infants with dextro-
Transposition of the great arteries (d-TGA) undergoing an arterial switch
operation (ASO). The primary objective of the study was to evaluate the
baseline and post cardiopulmonary bypass (CPB) coagulation profiles
employing Sonoclot technique. A secondary objective of the study was to
evaluate the efficacy of epsilon- aminocaproic acid (EACA) in preventing
peri-operative blood loss. Methods: A prospective, randomised, study was
carried out in a tertiary care set up on thirty five patients undergoing
ASO for d-TGA. The study group patients received EACA, in a dosage of 100
mg/kg after induction of anaesthesia, upon initiation of CPB and after
protamine, while the Control group patients received normal saline.
Sonoclot analysis was done after induction of anaesthesia (T0) and 15 min
after the administration of the third dose of EACA (T1). The quantitative
measurements included the activated clotting time (SonACT), the clot rate
(CR), the platelet function (PF) and DR15 (Diminishing rate of clot
strength at 15 min postmaximal clot strength). Results: The SonACT was
prolonged in both groups at T0 (163.41 +/- 16.72 and 171.72 +/-12.22,
p=0.1). The CR (15.47 +/- 9.02 and 13.83 +/- 9.27,p=0.601) and the PF
(0.91 +/- 0.57 and 0.85 +/- 0.45,p=0.748) were at the lower limit of
normal values in both groups. Preoperative PF(T0) was deranged in 74.2%
and preoperative CR in 51.43% of the total patients which increased to
62.8% in the post CPB period (T1). There was no significant difference in
ACT, CR and PF at T1 between the two groups (p > 0.05). DR 15 increased
significantly after CPB in the control group while no significant change
occurred in the study group.(53.06 +/- 3.45 vs 29.76 +/- 2.58, p<0.01).
Intra-group comparison between pre-CPB (T0) and post-CPB(T1) in both the
groups showed statistically significant decrease in platelet function at
T1 . PF also had significant positive correlation with preoperative oxygen
saturation (r=0.346,p=0.042). Cumulative mean blood loss, total packed red
blood cells, and fresh frozen plasma requirements were significantly less
in study group (p<0.01). Discussion: There was a high incidence of
preoperative abnormalities in the Sonoclot measured CR and PF in infants
with d-TGA undergoing ASO. Preoperative ACT was prolonged in all subjects
at baseline and the clot rate and platelet function was at the lower limit
of reference values,1 suggesting the impairment of the entire coagulation
process in patients with TGA. After CPB, there was a significant decline
in the PF. EACA was found to be effective in reducing postoperative blood
loss and transfusion requirements.

<59>
[Use Link to view the full text]
Accession Number
622577987
Author
Yoshikawa Y.; Shiomi H.; Watanabe H.; Natsuaki M.; Kondo H.; Tamura T.;
Nakagawa Y.; Morimoto T.; Kimura T.
Institution
(Yoshikawa, Shiomi, Watanabe, Kimura) Department of Cardiovascular
Medicine, Kyoto University Graduate School of Medicine, 54
Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
(Natsuaki) Department of Cardiovascular Medicine, Saga University, Japan
(Kondo, Tamura, Nakagawa) Department of Cardiology, Tenri Hospital, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
Title
Validating Utility of Dual Antiplatelet Therapy Score in a Large Pooled
Cohort from 3 Japanese Percutaneous Coronary Intervention Studies.
Source
Circulation. 137 (6) (pp 551-562), 2018. Date of Publication: 06 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The dual antiplatelet therapy (DAPT) score was developed to
estimate ischemic and bleeding risks from the DAPT study. However, few
studies validated its utility externally. We sought to validate the
utility of the DAPT score in the Japanese population. Methods: In a pooled
cohort of 3 studies conducted in Japan (the CREDO-Kyoto [Coronary
Revascularization Demonstrating Outcome Study in Kyoto] Registry Cohort-2,
RESET [Randomized Evaluation of Sirolimus-Eluting Versus
Everolimus-Eluting Stent Trial], and NEXT [NOBORI Biolimus-Eluting Versus
XIENCE/PROMUS Everolimus-Eluting Stent Trial]), we compared risks for
ischemic and bleeding events from 13 to 36 months after percutaneous
coronary intervention among patients with a DAPT score >=2 (high DS) and a
DAPT score <2 (low DS). Results: Among 12 223 patients receiving
drug-eluting stents who were free from ischemic or bleeding events at 13
months after percutaneous coronary intervention, 3944 patients had high DS
and 8279 had low DS. The cumulative incidence of primary ischemic end
point (myocardial infarction/stent thrombosis) was significantly higher in
high DS than in low DS (1.5% versus 0.9%, P=0.002), whereas the cumulative
incidence of primary bleeding end point (GUSTO moderate/severe) tended to
be lower in high DS than in low DS (2.1% versus 2.7%, P=0.07). The
cumulative incidences of cardiac death, myocardial infarction, and stent
thrombosis were also significantly higher in high DS than in low DS (2.0%
versus 1.4%, P=0.03; 1.5% versus 0.8%, P=0.002; 0.7% versus 0.3%, P<0.001,
respectively), whereas the cumulative incidences of noncardiac death and
GUSTO severe bleeding were significantly lower in high DS than in low DS
(2.4% versus 3.9%, P<0.001; 1.0% versus 1.6%, P=0.03, respectively).
Conclusions: In the current population, the DAPT score successfully
stratified ischemic and bleeding risks, although the ischemic event rate
was remarkably low even in high DS. Further studies would be warranted to
evaluate the utility of prolonged DAPT guided by the DAPT
score.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<60>
Accession Number
622577863
Author
Liu C.-Y.; Du J.-Z.; Rao C.-F.; Zhang H.; Liu H.-N.; Zhao Y.; Yang L.-M.;
Li X.; Li J.; Wang J.; Wang H.-S.; Liu Z.-G.; Cheng Z.-Y.; Zheng Z.
Institution
(Liu, Du, Rao, Zhang, Liu, Zhao, Li, Zheng) National Clinical Research
Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College, 167
Beilishi Road, Beijing 100073, China
(Rao, Zhang, Liu, Yang, Li, Zheng) Department of Cardiovascular Surgery,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing 100073,
China
(Wang) Department of Thoracic and Cardiovascular Surgery, First Affiliated
Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
(Wang) Department of Cardiovascular Surgery, General Hospital of Shenyang
Military Region, Shenyang, Liaoning 110016, China
(Liu) Department of Cardiovascular Surgery, TEDA International
Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of
Medical Science, Tianjin 300457, China
(Cheng) Department of Cardiovascular Surgery, Henan Provincial People's
Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan
450003, China
Title
Quality Measurement and Improvement Study of Surgical Coronary
Revascularization: Medication Adherence (MISSION-2).
Source
Chinese Medical Journal. 131 (12) (pp 1480-1489), 2018. Date of
Publication: 20 Jun 2018.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Secondary preventive therapies play a key role in the
prevention of adverse outcomes after coronary artery bypass grafting
(CABG). However, medication adherence after CABG is often poor, and
conventional interventions for improving adherence have limited success.
With increasing penetration of smartphones, health-related smartphone
applications might provide an opportunity to improve adherence. Carefully
designed trials are needed to provide reliable evidence for the use of
these applications in patients after CABG. Methods: The Measurement and
Improvement Studies of Surgical Coronary Revascularization: Medication
Adherence (MISSION-2) study is a multicenter randomized controlled trial,
aiming to randomize 1000 CABG patients to the intervention or control
groups in a 1:1 ratio. We developed the multifaceted, patient-centered,
smartphone-based Heart Health Application to encourage medication
adherence in the intervention group through a health self-management
program initiated during hospital admission for CABG. The application
integrated daily scheduled reminders to take the discharge medications,
cardiac educational materials, a dynamic dashboard to review
cardiovascular risk factors and secondary prevention targets, and weekly
questionnaires with interactive feedback. The primary outcome was
secondary preventive medication adherence measured by the Chinese version
of the 8-item Morisky Medication Adherence Scale at 6 months after
randomization. Secondary outcomes included all-cause death, cardiovascular
rehospitalization, and a composite of death, myocardial infarction,
stroke, and repeat revascularization. Discussion: Findings will not only
provide evidence regarding the feasibility and effectiveness of the
described intervention for improving adherence to CABG secondary
preventive therapies but also explore a model for outpatient health
self-management that could be translated to various chronic diseases and
widely disseminated across resource-limited settings. Trial Registration:
https://clinicaltrials.gov (NCT02432469).<br/>Copyright &#xa9; 2018
Chinese Medical Journal. Produced by Wolters Kluwer Medknow.

<61>
Accession Number
622577721
Author
Bonaca M.P.; Nault P.; Giugliano R.P.; Keech A.C.; Pineda A.L.; Kanevsky
E.; Kuder J.; Murphy S.A.; Jukema J.W.; Lewis B.S.; Tokgozoglu L.;
Somaratne R.; Sever P.S.; Pedersen T.R.; Sabatine M.S.
Institution
(Bonaca, Giugliano, Kanevsky, Kuder, Murphy, Sabatine) Thrombolysis in
Myocardial Infarction Study Group, Brigham and Women's Hospital Heart and
Vascular Center, 75 Francis St, Boston, MA 02115, United States
(Nault) McGill University, Montreal, Division of Vascular and Endovascular
Surgery, Centre Integre de la Sante et des Services Sociaux de
l'Outaouais, Gatineau, Canada
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Australia
(Pineda, Somaratne) Amgen, Thousand Oaks, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Lewis) Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport
School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Tokgozoglu) Department of Cardiology, Hacettepe University, Ankara,
Turkey
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Norway
Title
Low-Density Lipoprotein Cholesterol Lowering with Evolocumab and Outcomes
in Patients with Peripheral Artery Disease: Insights from the FOURIER
Trial (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in
Subjects with Elevated Risk).
Source
Circulation. 137 (4) (pp 338-350), 2018. Date of Publication: 23 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The PCSK9 (proprotein convertase subtilisin/kexin type 9)
inhibitor evolocumab reduced low-density lipoprotein cholesterol and
cardiovascular events in the FOURIER trial (Further Cardiovascular
Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk).
We investigated the efficacy and safety of evolocumab in patients with
peripheral artery disease (PAD) as well as the effect on major adverse
limb events. Methods: FOURIER was a randomized trial of evolocumab versus
placebo in 27 564 patients with atherosclerotic disease on statin therapy
followed for a median of 2.2 years. Patients were identified as having PAD
at baseline if they had intermittent claudication and an ankle brachial
index of <0.85, or if they had a prior peripheral vascular procedure. The
primary end point was a composite of cardiovascular death, myocardial
infarction, stroke, hospital admission for unstable angina, or coronary
revascularization. The key secondary end point was a composite of
cardiovascular death, myocardial infarction, or stroke. An additional
outcome of interest was major adverse limb events defined as acute limb
ischemia, major amputation, or urgent peripheral revascularization for
ischemia. Results: Three thousand six hundred forty-two patients (13.2%)
had PAD (1505 with no prior myocardial infarction or stroke). Evolocumab
significantly reduced the primary end point consistently in patients with
PAD (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.66-0.94;
P=0.0098) and without PAD (HR 0.86; 95% CI, 0.80-0.93; P=0.0003;
Pinteraction=0.40). For the key secondary end point, the HRs were 0.73
(0.59-0.91; P=0.0040) for those with PAD and 0.81 (0.73-0.90; P<0.0001)
for those without PAD (Pinteraction=0.41). Because of their higher risk,
patients with PAD had larger absolute risk reductions for the primary end
point (3.5% with PAD, 1.6% without PAD) and the key secondary end point
(3.5% with PAD, 1.4% without PAD). Evolocumab reduced the risk of major
adverse limb events in all patients (HR, 0.58; 95% CI, 0.38-0.88;
P=0.0093) with consistent effects in those with and without known PAD.
There was a consistent relationship between lower achieved low-density
lipoprotein cholesterol and lower risk of limb events (P=0.026 for the
beta coefficient) that extended down to <10 mg/dL. Conclusions: Patients
with PAD are at high risk of cardiovascular events, and PCSK9 inhibition
with evolocumab significantly reduced that risk with large absolute risk
reductions.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<62>
[Use Link to view the full text]
Accession Number
622570819
Author
Azarbaijani Y.; O'Callaghan K.; Sanders W.E.; Wu C.; Laschinger J.;
Marinac-Dabic D.; Strauss D.G.; Canos D.A.; Zusterzeel R.
Institution
(Azarbaijani, O'Callaghan, Sanders, Wu, Laschinger, Marinac-Dabic,
Strauss, Canos, Zusterzeel) US Food and Drug Administration, 10903 New
Hampshire Ave, Silver Spring, MD 20993-0002, United States
Title
Sex-Specific Outcomes after Transcatheter Aortic Valve Replacement: A
Review of the Literature.
Source
Cardiology in Review. 26 (2) (pp 73-81), 2018. Date of Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective
therapy for aortic valve replacement in patients ineligible for or at high
risk for surgery. However, outcomes after TAVR based on an individual's
sex remain to be fully elucidated. We searched PUBMED and EMBASE using the
keywords: "transcatheter aortic valve replacement," "transcatheter aortic
valve implantation," "sex differences," "gender," "sex characteristics"
and collected information on baseline features, procedural
characteristics, and postprocedural outcomes in women. Inclusion/exclusion
resulted in 23 publications. Women had less preexisting comorbidities than
men. Most studies reported better survival in women (range of hazard ratio
[95% CI] = 0.27 [0.09-0.84] to 0.91 [0.75-1.10]). At 30 days, women also
had more vascular complications (6-20% vs 2-14%) and higher bleeding rates
(10-44% vs 8-25%). Stroke rates were similar at 30 days (women, 1-7%; men,
1-5%). This literature review showed better survival in women than men
after TAVR. However, women had more vascular complications and bleeding;
stroke rates were similar. These findings may partly be explained by fewer
baseline comorbidities in women. These results should be interpreted with
caution as most measures only include unadjusted
percentages.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<63>
Accession Number
622425319
Author
Yang H.-T.; Xiu W.-J.; Zheng Y.-Y.; Ma Y.-T.; Xie X.
Institution
(Yang, Xiu, Zheng, Ma, Xie) Heart Center, First Affiliated Hospital,
Xinjiang Medical University, No. 137 Liyushan Road, Urumqi, Xinjiang
830011, China
Title
Effects of erythropoietin on the clinical outcomes of patients with acute
ST segment elevation myocardial infarction after percutaneous coronary
intervention: A meta-analysis.
Source
International Journal of Clinical Pharmacology and Therapeutics. 56 (6)
(pp 277-279), 2018. Date of Publication: 2018.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Aims: To investigate the effects of erythropoietin (EPO) on the clinical
outcomes of patients with acute ST segment elevation myocardial infarction
(STEMI) after percutaneous coronary intervention (PCI). Material and
methods: We collected randomized controlled studies conducted before April
15, 2017, and performed a metaanalysis using RevMan5.3 software. Results:
Compared with the conventional revascularization group, mortality (RR =
0.79; 95% Cl, 0.42 - 1.50; p = 0.47), stroke events (RR = 2.63; 95% Cl,
0.70 - 9.85; p = 0.15), recurrent myocardial infarction (RR = 0.99; 95%
Cl, 0.44 - 2.20; p = 0.98), and other clinical endpoints were not
significantly different in the EPO group. However, subgroup analysis
showed a marginally significant difference between the high-dose EPO group
and the control group (MD = 1.29; 95% CI, 0.02 - 2.56; p = 0.05) in
ejection fraction. Conclusion: The administration of EPO has no effects on
the clinical outcomes of patients with acute STEMI after PCI, whilst a
high dose of EPO may increase patients' ejection fraction.<br/>Copyright
&#xa9; 2018 Dustri-Verlag Dr. K. Feistle.

<64>
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.

<65>
Accession Number
622545454
Author
Kleinbongard P.; Gedik N.; Frey U.; Zandi A.; Thielmann M.; Jakob H.;
Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Frey, Zandi, Thielmann, Jakob, Peters, Kamler,
Heusch) University of Essen Medical School, Essen, Germany
Title
Improvement of mitochondrial function in human atrial tissue by remote
ischemic conditioning.
Source
FASEB Journal. Conference: Experimental Biology 2018, EB. United States.
32 (1 Supplement 1) (no pagination), 2018. Date of Publication: April
2018.
Publisher
FASEB
Abstract
Introduction Remote ischemic preconditioning (RIPC), repeated cycles of
brief limb ischemia/reperfusion, attenuates postoperative troponin release
in patients undergoing surgical coronary revascularization and improves
clinical outcome in some, but not all studies. Mitochondria are the
end-effectors of cardioprotection by local ischemic conditioning maneuvers
in experimental studies. Here, we now analyzed mitochondrial function in
response to RIPC in human atrial tissue. Methods Patients undergoing
elective surgical coronary revascularization under isoflurane anesthesia
were randomized to RIPC by 3+/- 5 min/5 min upper arm blood pressure cuff
inflation/deflation or placebo (n=30/30), and their right atrial
appendages were harvested prior to ischemic cardioplegic arrest.
Cardioprotection was reflected by a 14% decrease with RIPC vs. placebo in
the area under the curve of serum troponin I/T concentrations over 72 h
after surgery. Mitochondria were isolated from the atrial tissue
(n=10/10). Mitochondrial function, i.e. mitochondrial respiration,
adenosine triphosphate (ATP) production, reactive oxygen species (ROS)
production and calcium retention capacity (CRC) to estimate mitochondrial
permeability transition pore (mPTP) opening, was measured at physiological
temperature of 37degreeC. Data are given as mean+/-SEM. Results Associated
with the observed cardioprotection in patients, mitochondrial function was
improved by RIPC. Basal respiration was not different between RIPC and
placebo. ADP-stimulated complex I respiration was significantly greater
with RIPC than with placebo. Mitochondrial complex IV respiration and
maximal oxygen uptake of uncoupled mitochondria were not different between
RIPC and placebo, reflecting an equal loading of viable mitochondria
(Figure 1A). The mitochondrial ATP production (Figure 1B) was greater
whereas mitochondrial ROS production (Figure 1C) was less with RIPC than
with placebo. CRC of mitochondria (Figure 1D) was improved with RIPC in
comparison to placebo, with and without cyclosporine A. Conclusion In
human myocardium, mitochondria are an intracellular target of protection
by RIPC.

<66>
Accession Number
605972767
Author
Smelt J.; Corredor C.; Edsell M.; Fletcher N.; Jahangiri M.; Sharma V.
Institution
(Smelt) Department of Cardiothoracic Surgery, St George's Hospital,
London, United Kingdom
(Corredor) Cardiothoracic Anesthesia, St George's Hospital, London, United
Kingdom
(Edsell) Cardiothoracic Anesthesia, St George's Hospital, London, United
Kingdom
(Fletcher) Cardiothoracic Anesthesia, St George's Hospital, London, United
Kingdom
(Jahangiri) Department of Cardiothoracic Surgery, St George's Hospital,
London, United Kingdom. Electronic address:
(Sharma) Cardiothoracic Anesthesia, St George's Hospital, London, United
Kingdom
Title
Simulation-based learning of transesophageal echocardiography in
cardiothoracic surgical trainees: A prospective, randomized study.
Source
The Journal of thoracic and cardiovascular surgery. 150 (1) (pp 22-25),
2015. Date of Publication: 01 Jul 2015.
Abstract
METHODS: A total of 25 cardiac surgical trainees with no formal
transesophageal echocardiography learning experience were randomly
assigned by computer to a study group receiving simulation-based
transesophageal echocardiography teaching via the Heartworks (Inventive
Medical, London, UK) simulator (n = 12) or a control group receiving
transesophageal echocardiography teaching during elective cardiac surgery
(n = 13). Each subject undertook a video-based test composed of 20
multiple choice questions on standard transesophageal echocardiography
views before and after teaching.
RESULTS: There was no significant difference in the pretest scores between
the 2 groups (P = .89). After transesophageal echocardiography teaching,
subjects within each group demonstrated a statistically significant
improvement in transesophageal echocardiography knowledge. Although the
subjects within the simulation group outperformed their counterparts in
the operating room teaching group in the post-test scores, this difference
was not significant (P = .14).
CONCLUSIONS: Despite the familiarity with transesophageal echocardiography
images during surgery, subjects in the simulation group performed at least
as well as those in the operating room group. Surgical trainees will
benefit from formal transesophageal echocardiography teaching incorporated
into their training via either learning method.
OBJECTIVES: The Intercollegiate Surgical Curriculum now recommends that
cardiac surgical trainees should be able to understand and interpret
transesophageal echocardiography images. However, cardiac surgical
trainees receive limited formal transesophageal echocardiography training.
The objective of this study was to assess the impact of simulation-based
teaching versus more traditional operating room teaching on
transesophageal echocardiography knowledge in cardiac surgical
trainees.<br/>Copyright &#xa9; 2015 The American Association for Thoracic
Surgery. Published by Elsevier Inc. All rights reserved.

<67>
Accession Number
606184226
Author
Widimsky P.; Motovska Z.; Bolognese L.; Dudek D.; Hamm C.; Tanguay J.-F.;
Ten Berg J.; Brown E.; LeNarz L.; Miller D.L.; Montalescot G.
Institution
(Widimsky) Cardiocenter, Third Faculty of Medicine, Charles University
Prague, Prague, Czech Republic
(Motovska) Cardiocenter, Third Faculty of Medicine, Charles University
Prague, Prague, Czech Republic
(Bolognese) Cardiovascular and Neurological Department Azienda
Ospedaliera, Arezzo, Italy
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
University Hospital, Krakow, Poland
(Hamm) Kerckhoff Heart and Thoraxcenter, Bad Nauheim and Medical Clinic I,
University of Giessen Germany, Bad Nauheim, Germany
(Tanguay) MD Interventional Cardiology and Research Program, Universite de
Montreal, Montreal, Quebec, Canada
(Ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Brown) Eli Lilly and Company, Lilly Corporate Center, Indianapolis,
Indiana, USA
(LeNarz) Eli Lilly and Company, Lilly Corporate Center, Indianapolis,
Indiana, USA
(Miller) Eli Lilly and Company, Lilly Corporate Center, Indianapolis,
Indiana, USA
(Montalescot) Institut de Cardiologie, Centre Hospitalier Universitaire
Pitie-Salpetriere (ACTION Study Group, AP-HP, Universite Paris 6), Paris,
France
Title
Predictors of bleeding in patients with acute coronary syndromes treated
with prasugrel.
Source
Heart (British Cardiac Society). 101 (15) (pp 1219-1224), 2015. Date of
Publication: 01 Aug 2015.
Abstract
BACKGROUND: When considering antiplatelet therapy for acute coronary
syndrome (ACS), it is essential to balance benefits (less
thrombotic/ischaemic events) versus bleeding risks related to intense
platelet inhibition via antagonism of P2Y12 receptors. This analysis aimed
to identify predictors of bleeding events among A Comparison of Prasugrel
at the Time of PCI or as Pretreatment at the Time of Diagnosis in Patients
with NSTEACS (ACCOAST) study population.
METHODS AND RESULTS: The ACCOAST study randomised 4033 patients with
non-ST-segment elevation myocardial infarction (NSTEMI) to (A) a 30 mg
prasugrel loading dose (LD) followed by coronary angiography with an
additional 30 mg prasugrel at the time of percutaneous coronary
intervention (PCI) or (B) a placebo LD followed by a 60 mg prasugrel at
the time of PCI. Patients received standard of care, including use of
aspirin. Independent predictors of Thrombolysis in Myocardial Infarction
(TIMI) major bleeding not related to coronary artery bypass grafting
(CABG) within 7 days were assessed using stepwise Cox proportional model
for time to first occurrence of the event. Non-CABG-related TIMI major or
minor bleeding was similarly analysed. Non-CABG-related TIMI major
bleeding occurred in 36 (0.9%) patients, and TIMI major or minor bleeding
occurred in 81 (2.0%) patients. Independent predictors for TIMI major
bleeding alone were pretreatment with prasugrel LD (HR 3.02; 95% CI 1.42
to 6.43), femoral access (HR 2.45; 95% CI 1.11 to 5.38), female sex (HR
2.57; 95% CI 1.32 to 5.00), placement of >1 stent (HR 2.50; 95% CI 1.26 to
4.95) and age (HR 1.05; 95% CI 1.02 to 1.09). Pretreatment with prasugrel
LD (HR 3.05; 95% CI 1.84 to 5.07), femoral access (HR 3.06; 95% CI 1.74 to
5.38), female sex (HR 2.62; 95% CI 1.67 to 4.12), performed PCI (HR 2.21;
95% CI 1.23 to 3.99), therapy with glycoprotein IIb/IIIa inhibitors (HR
1.88; 95% CI 1.06 to 3.33) and age (increased bleed per year of age HR
1.04; 95% CI 1.02 to 1.06) were independent predictors of TIMI major or
minor bleeding through 7 days.
CONCLUSIONS: Pretreatment, age, gender and procedural variables predicted
bleeding risk in patients with NSTEMI.
CLINICAL REGISTRATION NO: NCT01015287.<br/>Copyright Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.

<68>
Accession Number
610979427
Author
Puskas J.D.; Martin J.; Cheng D.C.; Benussi S.; Bonatti J.O.; Diegeler A.;
Ferdinand F.D.; Kieser T.M.; Lamy A.; Mack M.J.; Patel N.C.; Ruel M.;
Sabik J.F.; Yanagawa B.; Zamvar V.
Institution
(Puskas, Martin, Cheng, Benussi, Bonatti, Diegeler, Ferdinand, Kieser,
Lamy, Mack, Patel, Ruel, Sabik, Yanagawa, Zamvar) From the *Department of
Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai, New York,
NY USA; +Centre for Medical Evidence, Decision Integrity, Clinical Impact
(MEDICI), Department of Anesthesia & Perioperative Medicine, and
Department of Epidemiology & Biostatistics, Western University, London,
Ontario, Canada; ++Division of Cardiovascular Surgery, University Hospital
Zurich, Zurich, Switzerland; Heart and Vascular Institute, Cleveland
Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Herz-Und Gefasse Klinik
Bad Neustadt, University of Leipzig, Bad Neustadt, Germany; PDivision of
Cardiovascular and Thoracic Surgery, Lankenau Medical Center, Wynnewood,
PA USA; #Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB Canada; **Division of Cardiac Surgery and Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
Ontario, Canada; ++Baylor Health System, Heart Hospital Baylor Plano,
Dallas, TX USA; ++++Department of Cardiothoracic Surgery, Lenox Hill, New
York, NY USA; University of Ottawa Heart Institute, Ottawa, Ontario,
Canada; Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA; and
PPRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
ISMICS Consensus Conference and Statements of Randomized Controlled Trials
of Off-Pump Versus Conventional Coronary Artery Bypass Surgery.
Source
Innovations (Philadelphia, Pa.). 10 (4) (pp 219-229), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: At this consensus conference, we developed evidence-informed
consensus statements and recommendations on the practice of off-pump
coronary artery bypass graft (OPCAB) by systematically reviewing and
performing meta-analysis of the randomized controlled trials (RCTs)
comparing OPCAB and conventional coronary artery bypass (CCAB).
METHODS: All RCTs of OPCAB versus CCAB through April 2013 were screened,
and 102 relevant RCTs (19,101 patients) were included in a systematic
review and meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs
of 9550 low-risk patients) in accordance with the Cochrane Collaboration
and PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) methodology. Consensus statements for the risks and
benefits of OPCAB surgery in mortality, morbidity, and resource use were
developed based on best available evidence.
RESULTS: Compared to CCAB, it is reasonable to perform OPCAB to reduce
risks of stroke [class IIa, level of evidence (LOE) A], renal
dysfunction/failure (class IIa, LOE A), blood transfusion (class I, LOE
A), respiratory failure (class I, LOE A), atrial fibrillation (class I,
LOE A), wound infection (class I, LOE A), ventilation time, and ICU and
hospital length of stay (class I, LOE A). However, OPCAB may be associated
with a reduced number of grafts performed (class I, LOE A) and with
diminished graft patency (class IIa, LOE A, with increased coronary
reintervention at 1 year and beyond (class IIa, LOE A), as well as
increased mortality at a median follow-up of 5 years (class IIb, LOE A).
CONCLUSIONS: OPCAB compared with CCAB may improve outcomes in the
short-term (stroke, renal dysfunction, blood transfusion, respiratory
failure, atrial fibrillation, wound infection, ventilation time, and
length of stay). However, over the longer-term, OPCAB may be associated
with reduced graft patency, and increased risk of cardiac re-intervention
and death.

<69>
Accession Number
610979309
Author
Watanabe G.; Yamaguchi S.; Tomita S.; Nishida Y.
Institution
(Watanabe, Yamaguchi, Tomita, Nishida) From the Department of General and
Cardiothoracic Surgery, Kanazawa University Graduate School of Medical
Science, Kanazawa, Japan
Title
Fasudil Is an Effective Graft Vasodilator for Gastroepiploic Artery in
Coronary Artery Bypass Grafting.
Source
Innovations (Philadelphia, Pa.). 10 (4) (pp 268-272), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: The gastroepiploic artery (GEA) has been used as an alternative
arterial in situ graft for coronary artery bypass grafting (CABG).
However, because of the large individual differences and the spastic
nature of the GEA, caution has to be exercised during harvesting. We
evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a
vasodilator for right GEA (RGEA) graft after harvesting, compared with the
conventional agents papaverine and verapamil-nitroglycerin.
METHODS: Between June 2009 and January 2013, 30 patients with ischemic
heart disease who underwent isolated CABG using RGEA graft were randomly
assigned to fasudil (n = 10), papaverine (n = 10), or
verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine
(1.0 mmol/L) mixed with heparinized blood, or verapamil-nitroglycerin (30
mumol/L each) was injected intraluminally into the RGEA graft after
harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and
histopathology of RGEA were evaluated.
RESULTS: Intraluminal injection of fasudil increased GFF significantly (P
< 0.001) and markedly from 41.5 +/- 31.5 mL/min at baseline to 149.3 +/-
46.7 mL/min after injection. Papaverine increased GFF (P < 0.001) from
40.0 +/- 35.8 to 64.9 +/- 33.7 mL/min, and verapamil-nitroglycerin also
increased GFF (P < 0.001) from 38.8 +/- 32.1 to 79.0 +/- 35.2 mL/min. The
GFF was significantly higher (P = 0.001) in the fasudil group than in the
other two groups. Histopathologically, fasudil treatment markedly
increased the diameter of RGEA graft, while maintaining integrity of the
multiple elastic lamellae. Blood pressure did not change significantly
after drug injection in all groups.
CONCLUSIONS: Fasudil is more potent than papaverine or
verapamil-nitroglycerin in increasing GFF of RGEA graft for CABG.

<70>
[Use Link to view the full text]
Accession Number
604995599
Author
Zhu F.; Gomersall C.D.; Ng S.K.; Underwood M.J.; Lee A.
Institution
(Zhu, Gomersall, Ng, Underwood, Lee) From the Department of Anaesthesia
and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
(F.Z., C.D.G., S.K.N., A.L.); and Division of Cardiothoracic Surgery,
Department of Surgery, The Chinese University of Hong Kong, Hong Kong,
China (M.J.U.)
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: 01 Apr
2015.
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 H2O or less with
positive end-expiratory pressure of 5 cm H2O. 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.

<71>
Accession Number
604693273
Author
Marui A.; Kimura T.; Nishiwaki N.; Mitsudo K.; Komiya T.; Hanyu M.; Shiomi
H.; Tanaka S.; Sakata R.
Institution
(Marui) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan; Department of Cardiovascular Surgery,
Nara Hospital Kinki University School of Medicine, Ikoma, Japan.
Electronic address: marui@kuhp.kyoto-u.ac.jp
(Kimura) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Nishiwaki) Department of Cardiovascular Surgery, Nara Hospital Kinki
University School of Medicine, Ikoma, Japan
(Mitsudo) Department of Cardiovascular Medicine, Kurashiki Central
Hospital, Kurashiki, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Japan
(Hanyu) Department of Cardiovascular Surgery, Kokura Memorial Hospital,
Kitakyushu, Japan
(Shiomi) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Tanaka) Department of Pharmacoepidemiology, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Sakata) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan
Title
Five-year outcomes of percutaneous versus surgical coronary
revascularization in patients with diabetes mellitus (from the CREDO-Kyoto
PCI/CABG Registry Cohort-2).
Source
The American journal of cardiology. 115 (8) (pp 1063-1072), 2015. Date of
Publication: 15 Apr 2015.
Abstract
We investigated the impact of diabetes mellitus on long-term outcomes of
percutaneous coronary intervention (PCI) in the drug-eluting stent era
versus coronary artery bypass grafting (CABG) in a real-world population
with advanced coronary disease. We identified 3,982 patients with 3-vessel
and/or left main disease of 15,939 patients with first coronary
revascularization enrolled in the Coronary Revascularization Demonstrating
Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without
diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with
diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year
incidence of all-cause death after PCI was significantly higher than after
CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01,
and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders,
the excess mortality risk of PCI relative to CABG was no longer
significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to
1.54; p = 0.29) in patients without diabetes, whereas it remained
significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with
diabetes. The excess adjusted risks of PCI relative to CABG for cardiac
death, myocardial infarction (MI), and any coronary revascularization were
significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p =
0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to
4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to
2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95%
CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between
diabetic status and the effect of PCI relative to CABG for all-cause
death, cardiac death, MI, and any revascularization. In conclusion, in
both patients without and with diabetes with 3-vessel and/or left main
disease, CABG compared with PCI was associated with better 5-year outcomes
in terms of cardiac death, MI, and any coronary revascularization. There
was no difference in the direction and magnitude of treatment effect of
CABG relative to PCI regardless of diabetic status.<br/>Copyright &#xa9;
2015 Elsevier Inc. All rights reserved.

<72>
Accession Number
605671425
Author
Phan K.; Ha H.; Phan S.; Misfeld M.; Di Eusanio M.; Yan T.D.
Institution
(Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia; Westmead Clinical School, Sydney Medical School, The
University of Sydney, Sydney, Australia; St Vincent's Clinical School, The
University of New South Wales, Sydney, Australia
(Ha) St Vincent's Clinical School, The University of New South Wales,
Sydney, Australia
(Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Misfeld) University of Leipzig, Heart Center, Leipzig, Germany
(Di Eusanio) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia; Cardiovascular Surgery Department,
Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
(Yan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, University of Sydney, Sydney, Australia. Electronic
address: tristanyan@annalscts.com
Title
Early hemodynamic performance of the third generation St Jude Trifecta
aortic prosthesis: A systematic review and meta-analysis.
Source
The Journal of thoracic and cardiovascular surgery. 149 (6) (pp
1567-1575), 2015. Date of Publication: 01 Jun 2015.
Abstract
OBJECTIVE: The Trifecta aortic prosthesis is a latest-generation
trileaflet stented pericardial valve designed for supra-annular placement
in the aortic position. Robust clinical evidence and long-term follow-up
data for this new prosthesis are lacking; a systematic review was
conducted to assess current evidence.
METHODS: A comprehensive search from 6 electronic databases was performed,
with time period parameters dating from database inception to January
2014. Results utilizing Trifecta prosthesis for aortic valve replacement
(AVR) were identified.
RESULTS: A total of 13 studies with 2549 patients undergoing AVR with this
prosthesis were included in this review. The mean proportion of patients
with aortic stenosis was 82.4%, with a mean gradient of 47.4 mm Hg, and a
pooled effective orifice area (EOA) of 0.74 cm(2). Valve sizes of 21 mm
and 23 mm were implanted in 71.3% of patients. The pooled rates of 30-day
mortality, cerebrovascular accidents, and acute kidney injuries were 2.7%,
1.9%, and 2.6%, respectively. After implantation, the pooled mean gradient
decreased to 9.2 mm Hg, whereas discharge EOA increased to 1.8 cm(2),
compared with preoperative parameters. Among included studies with
significant heterogeneity detected, most patients had satisfactory
patient-prosthesis mismatch, with 2.7% having severe mismatch.
CONCLUSIONS: The present systematic review demonstrated that short-term
AVR with this prosthesis provided excellent early safety and hemodynamic
outcomes with acceptable mean gradients and EOA. Long-term follow-up and
randomized controlled trials are warranted to confirm the early
results.<br/>Copyright &#xa9; 2015 The American Association for Thoracic
Surgery. Published by Elsevier Inc. All rights reserved.

<73>
Accession Number
611470742
Author
Hassell M.E.; Hildick-Smith D.; Durand E.; Kikkert W.J.; Wiegerinck E.M.;
Stabile E.; Ussia G.P.; Sharma S.; Baan J.; Eltchaninoff H.; Rubino P.;
Barbanti M.; Tamburino C.; Poliacikova P.; Blanchard D.; Piek J.J.; Delewi
R.
Institution
(Hassell) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
(Hildick-Smith) Department of Cardiology, Brighton and Sussex University
Hospitals, Sussex, UK
(Durand) Department of Cardiology, University hospital of Rouen, Hospital
Charles Nicolle, Rouen, France
(Kikkert) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
(Wiegerinck) Department of Cardiology, Academic Medical Center, University
of Amsterdam, Amsterdam, The Netherlands
(Stabile) Department of Advanced Biomedical Sciences, University of Napoli
"Federico II", Napoli, Italy
(Ussia) Cardiologia Interventistica Strutturale Policlinico Tor Vergata,
Universita degli Studi di Roma Tor Vergata, Roma, Italy
(Sharma) Department of Cardiology, Brighton and Sussex University
Hospitals, Sussex, UK
(Baan) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
(Eltchaninoff) Department of Cardiology, University hospital of Rouen,
Hospital Charles Nicolle, Rouen, France
(Rubino) Laboratory of Invasive Cardiology, Clinica Montevergine,
Mercogliano, Italy
(Barbanti) Department of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Tamburino) Department of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Poliacikova) Department of Cardiology, Brighton and Sussex University
Hospitals, Sussex, UK
(Blanchard) Department of Cardiology, University Paris descartes, AP-HP;
European Georges Pompidou Hospital, Paris, France
(Piek) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
(Delewi) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
Title
Antiplatelet therapy following transcatheter aortic valve implantation.
Source
Heart (British Cardiac Society). 101 (14) (pp 1118-1125), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: There is limited evidence to support decision making on
antiplatelet therapy following transcatheter aortic valve implantation
(TAVI). Our aim was to assess the efficacy and safety of aspirin-only
(ASA) versus dual antiplatelet therapy (DAPT) following TAVI.
METHODS: We performed a systematic review and pooled analysis of
individual patient data from 672 participants comparing single versus DAPT
following TAVI. Primary endpoint was defined as the composite of net
adverse clinical and cerebral events (NACE) at 1 month, including
all-cause mortality, acute coronary syndrome (ACS), stroke,
life-threatening and major bleeding.
RESULTS: At 30 days a NACE rate of 13% was observed in the ASA-only and in
15% of the DAPT group (OR 0.83, 95% CI 0.48 to 1.43, p=0.50). A tendency
towards less life-threatening and major bleeding was observed in patients
treated with ASA (OR 0.56, 95% CI 0.28 to 1.11, p=0.09). Also, ASA was not
associated with an increased all-cause mortality (OR 0.91, 95% CI 0.36 to
2.27, p=0.83), ACS (OR 0.5, 95% CI 0.05 to 5.51, p=0.57) or stroke (OR
1.21; 95% CI 0.36 to 4.03, p=0.75).
CONCLUSIONS: No difference in 30-day NACE rate was observed between
ASA-only or DAPT following TAVI. Moreover, a trend towards less
life-threatening and major bleeding was observed in favour of ASA.
Consequently the additive value of clopidogrel warrants further
investigation.<br/>Copyright Published by the BMJ Publishing Group
Limited. For permission to use (where not already granted under a licence)
please go to http://group.bmj.com/group/rights-licensing/permissions.

<74>
[Use Link to view the full text]
Accession Number
601989242
Author
Hess C.N.; Lopes R.D.; Gibson C.M.; Hager R.; Wojdyla D.M.; Englum B.R.;
Mack M.J.; Califf R.M.; Kouchoukos N.T.; Peterson E.D.; Alexander J.H.
Institution
(Hess) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Lopes) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Gibson) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Hager) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Wojdyla) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Englum) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Mack) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Califf) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Kouchoukos) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Peterson) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Alexander) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.). john.h.alexander@duke.edu
Title
Saphenous vein graft failure after coronary artery bypass surgery:
insights from PREVENT IV.
Source
Circulation. 130 (17) (pp 1445-1451), 2014. Date of Publication: 21 Oct
2014.
Abstract
BACKGROUND: Coronary artery bypass grafting success is limited by vein
graft failure (VGF). Understanding the factors associated with VGF may
improve patient outcomes.
METHODS AND RESULTS: We examined 1828 participants in the Project of Ex
Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial
undergoing protocol-mandated follow-up angiography 12 to 18 months
post-coronary artery bypass grafting or earlier clinically driven
angiography. Outcomes included patient- and graft-level angiographic VGF
(>=75% stenosis or occlusion). Variables were selected by using Fast False
Selection Rate methodology. We examined relationships between variables
and VGF in patient- and graft-level models by using logistic regression
without and with generalized estimating equations. At 12 to 18 months
post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had
VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and
clinical characteristics were similar between patients with and without
VGF, although VGF patients had longer surgical times, worse target artery
quality, longer graft length, and they more frequently underwent
endoscopic vein harvesting. After multivariable adjustment, longer
surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence
interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95%
confidence interval, 1.16-1.71), poor target artery quality (odds ratio,
1.43; 95% confidence interval, 1.11-1.84), and postoperative use of
clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval,
1.07-1.69) were associated with patient-level VGF. The predicted
likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%.
CONCLUSIONS: VGF is common and associated with patient and surgical
factors. These findings may help identify patients with risk factors for
VGF and inform the development of interventions to reduce VGF.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00042081.<br/>Copyright &#xa9; 2014 American Heart
Association, Inc.

<75>
Accession Number
604774459
Author
Brunsting L.A.; Snyder A.B.; Espinal E.A.; Srivastava S.P.
Institution
(Brunsting, Snyder, Espinal, Srivastava) From the *Division of
Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham,
AL USA; +St. Joseph's Hospital, Atlanta, GA USA; ++Akron City Hospital,
Akron, OH USA; and The International Centre for Robotic Surgery, New
Delhi, India
Title
Robotically assisted, completely endoscopic transmyocardial
revascularization is feasible.
Source
Innovations (Philadelphia, Pa.). 9 (5) (pp 379-382), 2014. Date of
Publication: 01 Sep 2014.
Abstract
OBJECTIVE: The purpose of this study was to assess the feasibility of an
endoscopic, optical-fiber-based, laser delivery system (LDS) developed to
perform sole-therapy transmyocardial revascularization (TMR) in a totally
endoscopic, robotically assisted operation.
METHODS: Forty-two patients were enrolled in a multicenter, prospective,
single-arm clinical trial conducted at four US centers between 2005 and
2007. Transmyocardial revascularization was performed completely
endoscopically with robotic assistance, introducing the Holmium:Yttrium
aluminum garnet (YAG) LDS via a 5-mm port. Completion of the operation
endoscopically defined procedural success. Clinical data were recorded
before, during, and at least 30 days after the procedure.
RESULTS: All patients had Canadian Cardiovascular Score angina class IV at
baseline. The mean ejection fraction was 49% (range [R], 28-71), the mean
age was 59.1 years (R, 36-80), 71% (30/42) were men, 86% (36/42) underwent
previous coronary artery bypass grafting surgery, and 76% (32/42)
underwent prior coronary stenting. Procedural success was accomplished in
93% (39/42). For the procedural successes, the mean number of TMR channels
was 32 (R, 16-50), the median operative time was 88 minutes (R, 48-250
minutes), and the median length of stay postoperatively was 2.5 days (R,
1-10). There was no operative or 30-day mortality, and no patient received
any transfusion. At 30 days, freedom from major adverse cardiac events was
95% (two patients had transient congestive heart failure). At the median
6-month follow-up (single-center data, n = 12), the mean (SD) Canadian
Cardiovascular Score angina score was 1.3 (0.05) (P < 0.001 vs baseline).
CONCLUSIONS: Robotically assisted TMR can be performed using an
endoscopic, optical-fiber-based LDS, with high procedural success,
avoidance of early adverse clinical events, and potential for successful
angina relief.

<76>
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.

<77>
Accession Number
622465249
Author
Li H.; Lin X.; Ma X.; Tao J.; Zou R.; Yang S.; Liu H.; Hua P.
Institution
(Li, Liu) Department of Cardiovascular Surgery, Quanzhou First Hospital,
Fujian Medical University, Quanzhou 362000, China
(Lin, Tao, Zou, Hua) Department of Cardiovascular Surgery, Sun Yat-sen
Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Ma) Guangzhou Women and Children's Medical Center, Guangzhou 510623,
China
(Yang) Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University,
Guangzhou 510120, China
(Yang) Guangdong Province Key Laboratory of Brain Function and Disease,
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080,
China
Title
Biatrial versus Isolated Left Atrial Ablation in Atrial Fibrillation: A
Systematic Review and Meta-Analysis.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
3651212. Date of Publication: 2018.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objective. The outcomes of biatrial ablation (BA) and isolated left atrial
ablation (LA) in atrial fibrillation remain inconclusive. In this
meta-analysis, we assess the currently available evidence to compare
outcomes between BA and LA. Methods. Electronic searches were performed
from database inception to December 2016, and relevant studies were
accessed. Odds ratios and weight mean differences with 95% confidence
intervals are reported. Twenty-one studies comprising 3609 patients were
included in the present meta-analysis. Results. The prevalence of sinus
rhythm in the BA cohort was similar to that in the LA cohort at discharge,
at 12 months, and after more than 1 year of follow-up. However, at 6
months, the prevalence of sinus rhythm was higher in the BA cohort than in
the LA cohort. The rate of permanent pacemaker implantation was higher in
the BA cohort than in the LA cohort. However, 30-day and late mortality
and neurological events were similar between the BA and LA groups.
Conclusion. There was no significant difference in the rate of restored
sinus rhythm, the risk of death, and cerebrovascular events between BA and
LA, but BA had a higher rate of permanent pacemaker
implantation.<br/>Copyright &#xa9; 2018 Hongmu Li et al.

<78>
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.

<79>
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.

<80>
Accession Number
2000828202
Author
Carlisle E.M.; Shinkunas L.A.; Kaldjian L.C.
Institution
(Carlisle) Department of Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, United States
(Shinkunas, Kaldjian) Program in Bioethics and Humanities, University of
Iowa Carver College of Medicine, Iowa City, Iowa, United States
Title
Do surgeons and patients/parents value shared decision-making in pediatric
surgery? A systematic review.
Source
Journal of Surgical Research. 231 (pp 49-53), 2018. Date of Publication:
November 2018.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Shared decision-making (SDM) is touted as the preferred
approach to clinical counseling. However, few data exist regarding whether
patients prefer SDM over surgeon-guided discussions for complex surgical
decision-making. Even fewer data exist regarding surgeon preferences. Such
issues may be especially pronounced in pediatric surgery given the complex
decision-making triad between patients/parents and surgeons. The objective
of this systematic review was to evaluate patient/parent and surgeon
attitudes toward SDM in pediatric surgery. Methods: A systematic review of
English language articles in Medline, EMBASE, and Cochrane databases was
performed. Inclusion and exclusion criteria were predefined. Text
screening and data abstraction were performed by two investigators.
Results: Seven thousand five hundred eighty-four articles were screened.
Title/abstract review excluded 7544 articles, and full-text review
excluded four articles. Thirty-six articles were identified as addressing
patient/parent or surgeon preferences toward SDM in pediatric surgery.
Subspecialties included Otolaryngology (33%), General Surgery (30%),
Plastics (14%), Cardiac (11%), Urology (8%), Neurosurgery (6%),
Orthopedics (6%), and Gynecology (3%). Most studies (94%) evaluated
elective/nonurgent procedures. The majority (97%) concentrated on
patient/parent preferences, whereas only 22% addressed surgeon
preferences. Eleven percent of studies found that surgeons favored SDM,
and 73% demonstrated that patients/parents favored SDM. Conclusions:
Despite recommendations that SDM is the preferred approach to clinical
counseling, our systematic literature review shows that few studies
evaluate patient/parent and surgeon attitudes toward SDM in pediatric
surgery. Of these studies, very few focus on complex, urgent/emergent
decision-making. Further research is needed to understand whether
patients/parents, as well as surgeons, may prefer a more surgeon-guided
approach to decision-making, especially when surgery is complex or taking
place in urgent/emergent settings.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<81>
[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.

<82>
[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.

<83>
Accession Number
622483854
Author
Groleau C.; Morin S.N.; Vautour L.; Amar-Zifkin A.; Bessissow A.
Institution
(Groleau) McGill University, Hematology Residency Program, Montreal,
Canada
(Morin, Bessissow) McGill University Health Centre, Department of
Medicine, Division of General Internal Medicine, Montreal, Canada
(Vautour) McGill University Health Centre, Department of Medicine,
Division of Endocrinology, Montreal, Canada
(Amar-Zifkin) McGill University Health Centre, Medical library, Montreal,
Canada
Title
Perioperative corticosteroid administration: A systematic review and
descriptive analysis.
Source
Perioperative Medicine. 7 (1) (no pagination), 2018. Article Number: 10.
Date of Publication: 08 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative administration of corticosteroid is common and
variable. Guidelines for perioperative corticosteroid administration
before non-cardiac non-transplant surgery in patients with current or
previous corticosteroid use to reduce the risk of adrenal insufficiency
are lacking. Perioperative use of corticosteroid may be associated with
serious adverse events, namely hyperglycemia, infection, and poor wound
healing. Objective: To determine whether perioperative administration of
corticosteroids, compared to placebo or no intervention, reduces the
incidence of adrenal insufficiency in adult patients undergoing
non-cardiac surgery who were or are exposed to corticosteroids. Methods:
We searched MEDLINE via Ovid and PubMed, EMBASE via Ovid, and the Cochrane
Central Register of Controlled Trials, all from 1995 to January 2017.
Selection criteria: We included randomized controlled trials (RCTs),
cohort studies, case-studies, and systematic reviews involving adults
undergoing non-cardiac non-transplant surgery and reporting the incidence
of postoperative adrenal insufficiency. Data collection and analysis: Two
authors independently assessed studies' quality and extracted data. A
descriptive and bias assessment analysis was performed. Results: Two RCTs
(total of 37 patients), five cohort studies (total of 462 patients), and
four systematic reviews were included. Neither RCT showed a significant
difference in the outcome. This result was like that of the five cohort
studies. The quality of the evidence was low. Conclusion: The current use
of perioperative corticosteroid supplementation to prevent adrenal
insufficiency is not supported by evidence. Given the significant studies'
limitations, it is not possible to conclude that perioperative
administration of corticosteroids, compared to placebo, reduces the
incidence of adrenal insufficiency.<br/>Copyright &#xa9; 2018 The
Author(s).

<84>
Accession Number
622524792
Author
Goicoechea M.; de Vinuesa S.G.; Quiroga B.; Verde E.; Bernis C.; Morales
E.; Fernandez-Juarez G.; de Sequera P.; Verdalles U.; Delgado R.; Torres
A.; Arroyo D.; Abad S.; Ortiz A.; Luno J.
Institution
(Goicoechea, de Vinuesa, Verde, Verdalles, Abad, Luno) Nephrology
Department, Hospital General Universitario Gregorio Maranon, C/ Dr
Esquerdo 46, Madrid 28007, Spain
(Goicoechea, de Vinuesa, Verde, Morales, Fernandez-Juarez, Verdalles,
Abad, Ortiz, Luno) Spanish Kidney Research Network (REDINREN), Madrid,
Spain
(Quiroga, Bernis) Nephrology Department, Hospital Universitario La
Princesa, Madrid, Spain
(Morales) Nephrology Department, Hospital Universitario Doce de Octubre,
Madrid, Spain
(Fernandez-Juarez) Nephrology Department, Hospital Universitario Fundacion
Alcorcon, Madrid, Spain
(de Sequera) Nephrology Department, Hospital Universitario Infanta Leonor,
Madrid, Spain
(Delgado) Nephrology Department, Clinica Ruber, Madrid, Spain
(Torres) Nephrology Department, Hospital Universitario La Paz, Madrid,
Spain
(Arroyo) Nephrology Department, Hospital Universitario Severo Ochoa,
Madrid, Spain
(Ortiz) Nephrology Department, IIS-Fundacion Jimenez Diaz UAM, Madrid,
Spain
Title
Aspirin for Primary Prevention of Cardiovascular Disease and Renal Disease
Progression in Chronic Kidney Disease Patients: a Multicenter Randomized
Clinical Trial (AASER Study).
Source
Cardiovascular Drugs and Therapy. (pp 1-9), 2018. Date of Publication: 08
Jun 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Patients with chronic kidney disease (CKD) are at high risk
for developing cardiovascular events. However, limited evidence is
available regarding the use of aspirin in CKD patients to decrease
cardiovascular risk and to slow renal disease progression. Study Design:
Prospective, multicenter, open-label randomized controlled trial. Setting
and Participants: One hundred eleven patients with estimated glomerular
filtration rate (eGFR) 15-60 ml/min/1.73 m² without previous
cardiovascular events. Intervention: Aspirin treatment (100 mg/day) (n =
50) or usual therapy (n = 61). Mean follow-up time was 64.8 +/- 16.4
months. Outcomes: The primary endpoint was composed of cardiovascular
death, acute coronary syndrome (nonfatal MI, coronary revascularization,
or unstable angina pectoris), cerebrovascular disease, heart failure, or
nonfatal peripheral arterial disease. Secondary endpoints were fatal and
nonfatal coronary events, renal events (defined as doubling of serum
creatinine, >= 50% decrease in eGFR, or renal replacement therapy), and
bleeding episodes. Results: During follow-up, 17 and 5 participants
suffered from a primary endpoint in the control and aspirin groups,
respectively. Aspirin did not significantly reduce primary composite
endpoint (HR, 0.396 (0.146-1.076), p = 0.069. Eight patients suffered from
a fatal or nonfatal coronary event in the control group compared to no
patients in the aspirin group. Aspirin significantly reduced the risk of
coronary events (log-rank, 5.997; p = 0.014). Seventeen patients in the
control group reached the renal outcome in comparison with 3 patients in
the aspirin group. Aspirin treatment decreased renal disease progression
in a model adjusted for age, baseline kidney function, and diabetes
mellitus (HR, 0.272; 95% CI, 0.077-0.955; p = 0.043) but did not when
adjusted for albuminuria. No differences were found in minor bleeding
episodes between groups and no major bleeding was registered. Limitations:
Small sample size and open-label trial. Conclusions: Long-term treatment
with low-dose aspirin did not reduce the composite primary endpoint;
however, there were reductions in secondary endpoints with fewer coronary
events and renal outcomes. ClinicalTrials.govIdentifier:
NCT01709994.<br/>Copyright &#xa9; 2018 Springer Science+Business Media,
LLC, part of Springer Nature