EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2000613974
Author
Young J.; Geraci T.; Milman S.; Maslow A.; Jones R.N.; Ng T.
Institution
(Young, Geraci, Milman, Ng) Department of Surgery, The Warren Alpert
Medical School of Brown University, Providence, RI, United States
(Maslow) Department of Anesthesiology, The Warren Alpert Medical School of
Brown University, Providence, RI, United States
(Jones) Department of Psychiatry and Human Behavior, The Warren Alpert
Medical School of Brown University, Providence, RI, United States
Title
Risk factors for reinsertion of urinary catheter after early removal in
thoracic surgical patients.
Source
Journal of Thoracic and Cardiovascular Surgery. 156 (1) (pp 430-435),
2018. Date of Publication: July 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To reduce the incidence of urinary tract infection, Surgical
Care Improvement Project 9 mandates the removal of urinary catheters
within 48 hours postoperatively. In patients with thoracic epidural
anesthesia, we sought to determine the rate of catheter reinsertion, the
complications of reinsertion, and the factors associated with reinsertion.
Methods: We conducted a prospective observational study of consecutive
patients undergoing major pulmonary or esophageal resection with thoracic
epidural analgesia over a 2-year period. As per Surgical Care Improvement
Project 9, all urinary catheters were removed within 48 hours
postoperatively. Excluded were patients with chronic indwelling catheter,
patients with urostomy, and patients requiring continued strict urine
output monitoring. Multivariable logistic regression analysis was used to
identify independent risk factors for urinary catheter reinsertion.
Results: Thirteen patients met exclusion criteria. Of the 275 patients
evaluated, 60 (21.8%) required reinsertion of urinary catheter. There was
no difference in the urinary tract infection rate between patients
requiring reinsertion (1/60 [1.7%]) versus patients not requiring
reinsertion (1/215 [0.5%], P =.389). Urethral trauma during reinsertion
was seen in 1 of 60 patients (1.7%). After reinsertion, discharge with
urinary catheter was required in 4 of 60 patients (6.7%). Multivariable
logistic regression analysis found esophagectomy, lower body mass index,
and benign prostatic hypertrophy to be independent risk factors associated
with catheter reinsertion after early removal in the presence of thoracic
epidural analgesia. Conclusions: When applying Surgical Care Improvement
Project 9 to patients undergoing thoracic procedures with thoracic
epidural analgesia, consideration to delayed removal of urinary catheter
may be warranted in patients with multiple risk factors for
reinsertion.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<2>
Accession Number
2000859892
Author
Jun Yan Wee I.; Mohamed I.H.; Patel A.; Choong A.M.T.L.
Institution
(Jun Yan Wee, Mohamed, Patel, Choong) SingVaSC, Singapore Vascular
Surgical Collaborative, Singapore
(Jun Yan Wee) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Mohamed) Renal Transplantation and Vascular Access Surgery, Royal London
Hospital, London, United Kingdom
(Patel) Stem Cell Transplantation and Cellular Therapy Unit, The
Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool,
Liverpool, United Kingdom
(Patel) Institute of Translational Medicine and School of Medicine,
University of Liverpool, Liverpool, United Kingdom
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Title
A systematic review and meta-analysis of one-stage versus two-stage
brachiobasilic arteriovenous fistula creation.
Source
Journal of Vascular Surgery. 68 (1) (pp 285-297), 2018. Date of
Publication: July 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Long-term patency of arteriovenous fistulas (AVFs) is critical
for hemodialysis vascular access. We compared the efficacy of a one-stage
vs two-stage approach to brachiobasilic AVF creation by primarily
investigating primary and secondary patency rates. We hypothesize that the
two-stage is superior to the one-stage procedure in terms of efficacy and
safety. Methods: This review was performed as per the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis guidelines. Searches were
performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database. Risk
of bias and quality assessment scores were both performed based on
previously validated tool. Results: The systematic search revealed a total
of 242 publications for possible inclusion. On the basis of title and
abstract review, two randomized controlled trials and nine case-cohort
series fit our inclusion criteria. There were no statistically significant
differences in failure rates (pooled risk ratio [RR], 1.10; 95% confidence
interval [CI], 0.79-1.55; P =.25), 1-year primary patency rates (RR, 1.31;
95% CI, 0.83-2.06; P =.24), 1-year secondary patency rates (RR, 0.97; 95%
CI, 0.54-1.77) and 2-year secondary patency rates (RR, 1.19; 95% CI,
0.54-2.63; P =.67) between both groups. However, the two-stage procedure
had significantly improved 2-year primary patency rates (RR, 2.50; 95% CI,
1.66-3.74; P <.00001). There were no differences in steal syndrome,
hematoma, infection, pseudoaneuryms, or stenosis, although there was a
trend toward an increased incidence of postoperative thrombosis (RR, 1.81;
95% CI, 0.95-3.45; P =.07) in one-stage procedures. Conclusions: With
improved 2-year primary patency rates and the absence of significant
differences in complications, this study suggests potential benefit of a
two-stage over a one-stage procedure for brachiobasilic AVF creation.
However, rather than being a definitive answer, our results merely
highlight the continuing need for an adequately powered, well-designed,
randomized controlled trial to interrogate this question
further.<br/>Copyright &#xa9; 2018 Society for Vascular Surgery

<3>
Accession Number
622640220
Author
Zusterzeel R.; Mishra N.K.; Beydoun H.; Laschinger J.; Wu C.; Dong L.M.;
Marinac-Dabic D.; Strauss D.G.; Canos D.A.
Institution
(Zusterzeel, Mishra, Beydoun, Laschinger, Wu, Dong, Marinac-Dabic,
Strauss, Canos) U.S. Food and Drug Administration, 10903 New Hampshire
Avenue 64-2014, Silver Spring, MD 20993, United States
Title
Sex-Specific Outcomes after Transcatheter Aortic Valve Replacement: FDA
Patient-Level Meta-Analysis of Premarket Clinical Trials.
Source
Journal of Women's Health. 27 (6) (pp 808-814), 2018. Date of Publication:
June 2018.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a less
invasive alternative approach to surgery. Individual randomized clinical
trials evaluating the safety and efficacy of TAVR were mostly underpowered
for conducting separate analyses for women and men. We pooled data from
premarket TAVR clinical trials comparing short (30 days)- and long-term
(~2 years) outcomes by sex. Methods: Patient-level data from the TAVR arms
of six clinical trials were pooled (2515 patients). Random-effects models
for time-to-event outcomes (odds ratios [ORs] for 30-day outcomes and
hazard ratios [HRs] for complete follow-up for mortality, ischemic stroke,
kidney injury, major bleeding, myocardial infarction, and device
migration) and dichotomous outcomes (ORs for reintervention,
rehospitalization, and pacemaker implantation) were then fit to directly
compare outcomes between women and men. Results: Overall, the pattern of
individual comorbidities was more severe in men. There was no difference
in mortality risk at 30 days (female-to-male OR = 1.00 [0.69-1.46]);
however, at follow-up completion (~2 years post-TAVR), women had a 24%
lower mortality risk than men (HR = 0.76 [95% CI: 0.65-0.89]). Women also
had a 30% lower risk of kidney injury at 30 days (OR = 0.70 [0.49-0.98]),
which increased to 33% over the complete follow-up period (HR = 0.67
[0.51-0.87]). Major bleeding was more common in women compared to men at
both 30 days (OR = 1.44 [1.19-1.76]) and long-term follow-up (HR = 1.22
[1.04-1.43]). For dichotomous outcomes, women had a 68% lower risk for
reinterventions (OR = 0.32 [0.18-0.58]). We did not observe any difference
in the risk of ischemic stroke, myocardial infarction, device migration,
rehospitalizations, or pacemaker implantations between sexes. Conclusions:
This patient-level data meta-analysis of six premarket clinical trials
found that women who received TAVR had fewer comorbidities at baseline.
Acute outcomes (30 day) with respect to mortality were similar. Women were
observed to have a lower risk of kidney injury, but higher risk of major
bleeding compared to men receiving TAVR at 30 days. At complete follow-up,
statistically significant advantages for women emerged in improved
survival and lower reintervention risk. No differences in ischemic stroke,
pacemaker implantation, or rehospitalization were observed. That women are
healthier at baseline and develop fewer postprocedural complications than
men may explain their higher survival.<br/>&#xa9; Copyright 2018, Mary Ann
Liebert, Inc. 2018.

<4>
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).

<5>
Accession Number
620852204
Author
Kubo T.; Shinke T.; Okamura T.; Hibi K.; Nakazawa G.; Morino Y.; Shite J.;
Ino Y.; Kitabata H.; Shimokawa T.; Akasaka T.
Institution
(Kubo, Ino, Kitabata, Akasaka) Department of Cardiovascular Medicine,
Wakayama Medical University, Wakayama, Japan
(Shinke) Department of Internal Medicine, Division of Cardiovascular
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
(Okamura) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Nakazawa) Division of Cardiology, Tokai University School of Medicine,
Isehara, Japan
(Morino) Division of Cardiology, Iwate Medical University, Morioka, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Ino, Kitabata) Department of Cardiovascular Imaging and Dynamics,
Wakayama Medical University, Wakayama, Japan
(Shimokawa) Clinical Research Center, Wakayama Medical University,
Wakayama, Japan
Title
Comparison between Optical COherence tomography guidance and Angiography
guidance in percutaneous coronary intervention (COCOA): Study protocol for
a randomized controlled trial.
Source
Journal of Cardiology. 72 (2) (pp 170-175), 2018. Date of Publication:
August 2018.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Optical coherence tomography (OCT) is increasingly used as an
adjunct to coronary angiography for guiding percutaneous coronary
intervention (PCI). The current consensus on PCI is that the large final
stent area offers the best chance of a good late clinical outcome. Since
OCT provides more accurate information about the coronary artery and
implanted stents, OCT-guided stent implantation is expected to achieve
greater stent expansion than angiography guidance alone. Therefore, we
designed the COCOA (Comparison between Optical COherence tomography
guidance and Angiography guidance in percutaneous coronary intervention)
study to evaluate whether OCT-guided stent implantation would result in a
minimum stent area greater than that achieved with angiography guidance
alone. Methods and design: The COCOA study is a large-scale, multicenter,
single country (Japan), prospective randomized controlled, open-label,
parallel group, superiority study comparing OCT-guided PCI with
angiography-guided PCI. The eligible patients (n = 550) are randomly
allocated in a 1:1 ratio to receive either OCT-guided PCI or
angiography-guided PCI. PCI is performed using the everolimus-eluting
stent in accordance with certain criteria of OCT or angiography for
optimal stent implantation. Following the stent optimization guided by OCT
or angiography alone, OCT is performed in both groups. The primary
endpoint is minimum stent area at post-PCI with allocated imaging
guidance. Conclusion: When completed, the COCOA study will contribute to
define the clinical value of the OCT guidance in PCI.<br/>Copyright &#xa9;
2018 Japanese College of Cardiology

<6>
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

<7>
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.

<8>
Accession Number
2000715329
Author
Dew M.A.; DiMartini A.F.; Dobbels F.; Grady K.L.; Jowsey-Gregoire S.G.;
Kaan A.; Kendall K.; Young Q.-R.; Abbey S.E.; Butt Z.; Crone C.C.; De
Geest S.; Doligalski C.T.; Kugler C.; McDonald L.; Ohler L.; Painter L.;
Petty M.G.; Robson D.; Schloglhofer T.; Schneekloth T.D.; Singer J.P.;
Smith P.J.; Spaderna H.; Teuteberg J.J.; Yusen R.D.; Zimbrean P.C.
Institution
(Dew, DiMartini) University of Pittsburgh School of Medicine and Medical
Center, Pittsburgh, Pennsylvania, United States
(Dobbels, De Geest) Katholieke Universiteit Leuven, Leuven, Belgium
(Grady, Butt) Northwestern University Feinberg School of Medicine,
Chicago, Illinois, United States
(Jowsey-Gregoire, Schneekloth) Mayo Clinic, Rochester, Minnesota, United
States
(Kaan, Young) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Kendall) Cleveland Clinic, Cleveland, Ohio, United States
(Abbey) University of Toronto and University Health Network, Toronto,
Ontario, Canada
(Crone) INOVA Hospitals, Fairfax, Virginia, United States
(De Geest) University of Basel, Basel, Switzerland
(Doligalski) Tampa General Hospital, Tampa, Florida, United States
(Kugler) University of Freiburg, Freiburg, Germany
(McDonald) University of North Carolina, Chapel Hill, North Carolina,
United States
(Ohler) George Washington University, Washington, DC, United States
(Painter) Auckland City Hospital, Auckland, New Zealand
(Petty) University of Minnesota, Minneapolis, Minnesota, United States
(Robson) St. Vincent's Hospital, Sydney, New South Wales, Australia
(Schloglhofer) Medical University of Vienna, Vienna, Austria
(Singer) University of California at San Francisco, San Francisco,
California, United States
(Smith) Duke University, Durham, North Carolina, United States
(Spaderna) Trier University, Trier, Germany
(Teuteberg) Stanford University, Stanford, California, United States
(Yusen) Washington University, St. Louis, Missouri, United States
(Zimbrean) Yale University, New Haven, Connecticut, United States
(Doligalski) University of North Carolina, Chapel Hill, NC, United States
(Ohler) New York University Medical Center, New York, NY, United States
Title
The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial
evaluation of adult cardiothoracic transplant candidates and candidates
for long-term mechanical circulatory support.
Source
Journal of Heart and Lung Transplantation. 37 (7) (pp 803-823), 2018. Date
of Publication: July 2018.
Publisher
Elsevier USA
Abstract
The psychosocial evaluation is well-recognized as an important component
of the multifaceted assessment process to determine candidacy for heart
transplantation, lung transplantation, and long-term mechanical
circulatory support (MCS). However, there is no consensus-based set of
recommendations for either the full range of psychosocial domains to be
assessed during the evaluation, or the set of processes and procedures to
be used to conduct the evaluation, report its findings, and monitor
patients' receipt of and response to interventions for any problems
identified. This document provides recommendations on both evaluation
content and process. It represents a collaborative effort of the
International Society for Heart and Lung Transplantation (ISHLT) and the
Academy of Psychosomatic Medicine, American Society of Transplantation,
International Consortium of Circulatory Assist Clinicians, and Society for
Transplant Social Workers. The Nursing, Health Science and Allied Health
Council of the ISHLT organized a Writing Committee composed of
international experts representing the ISHLT and the collaborating
societies. This Committee synthesized expert opinion and conducted a
comprehensive literature review to support the psychosocial evaluation
content and process recommendations that were developed. The
recommendations are intended to dovetail with current ISHLT guidelines and
consensus statements for the selection of candidates for cardiothoracic
transplantation and MCS implantation. Moreover, the recommendations are
designed to promote consistency across programs in the performance of the
psychosocial evaluation by proposing a core set of content domains and
processes that can be expanded as needed to meet programs' unique needs
and goals.<br/>Copyright &#xa9; 2018 International Society for Heart and
Lung Transplantation

<9>
Accession Number
622631915
Author
Weinstein E.J.; Levene J.L.; Cohen M.S.; Andreae D.A.; Chao J.Y.; Johnson
M.; Hall C.B.; Andreae M.H.
Institution
(Weinstein, Levene) Albert Einstein College of Medicine of Yeshiva
University, 1300 Morris Park Ave, Bronx, NY 10461, United States
(Cohen, Chao) Montefiore Medical Center, Albert Einstein College of
Medicine, Department of Anesthesiology, 111 E 210 Street, Bronx, NY
#N4-005, United States
(Andreae) Milton S Hershey Medical Center, Department of Allergy/
Immunology, 500 University Dr, Hershey, PA 17033, United States
(Johnson) Teachers College, Columbia University, Human Development, New
York, NY 10027, United States
(Hall) Albert Einstein College of Medicine, Division of Biostatistics,
Department of Epidemiology and Population Health, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Andreae) Milton S Hershey Medical Centre, Department of Anesthesiology
and Perioperative Medicine, 500 University Drive, H187, Hershey, PA 17033,
United States
Title
Local anaesthetics and regional anaesthesia versus conventional analgesia
for preventing persistent postoperative pain in adults and children.
Source
Cochrane Database of Systematic Reviews. 2018 (6) (no pagination), 2018.
Article Number: CD007105. Date of Publication: 20 Jun 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Regional anaesthesia may reduce the rate of persistent
postoperative pain (PPP), a frequent and debilitating condition. This
review was originally published in 2012 and updated in 2017. Objectives:
To compare local anaesthetics and regional anaesthesia versus conventional
analgesia for the prevention of PPP beyond three months in adults and
children undergoing elective surgery. Search methods: We searched CENTRAL,
MEDLINE, and Embase to December 2016 without any language restriction. We
used a combination of free text search and controlled vocabulary search.
We limited results to randomized controlled trials (RCTs). We updated this
search in December 2017, but these results have not yet been incorporated
in the review. We conducted a handsearch in reference lists of included
studies, review articles and conference abstracts. We searched the
PROSPERO systematic review registry for related systematic reviews.
Selection criteria: We included RCTs comparing local or regional
anaesthesia versus conventional analgesia with a pain outcome beyond three
months after elective, non-orthopaedic surgery. Data collection and
analysis: At least two review authors independently assessed trial quality
and extracted data and adverse events. We contacted study authors for
additional information. We presented outcomes as pooled odds ratios (OR)
with 95% confidence intervals (95% CI), based on random-effects models
(inverse variance method). We analysed studies separately by surgical
intervention, but pooled outcomes reported at different follow-up
intervals. We compared our results to Bayesian and classical (frequentist)
models. We investigated heterogeneity. We assessed the quality of evidence
with GRADE. Main results: In this updated review, we identified 40 new
RCTs and seven ongoing studies. In total, we included 63 RCTs in the
review, but we were only able to synthesize data on regional anaesthesia
for the prevention of PPP beyond three months after surgery from 39
studies, enrolling a total of 3027 participants in our inclusive analysis.
Evidence synthesis of seven RCTs favoured epidural anaesthesia for
thoracotomy, suggesting the odds of having PPP three to 18 months
following an epidural for thoracotomy were 0.52 compared to not having an
epidural (OR 0.52 (95% CI 0.32 to 0.84, 499 participants, moderate-quality
evidence). Simlarly, evidence synthesis of 18 RCTs favoured regional
anaesthesia for the prevention of persistent pain three to 12 months after
breast cancer surgery with an OR of 0.43 (95% CI 0.28 to 0.68, 1297
participants, low-quality evidence). Pooling data at three to 8 months
after surgery from four RCTs favoured regional anaesthesia after caesarean
section with an OR of 0.46, (95% CI 0.28 to 0.78; 551 participants,
moderate-quality evidence). Evidence synthesis of three RCTs investigating
continuous infusion with local anaesthetic for the prevention of PPP three
to 55 months after iliac crest bone graft harvesting (ICBG) was
inconclusive (OR 0.20, 95% CI 0.04 to 1.09; 123 participants, low-quality
evidence). However, evidence synthesis of two RCTs also favoured the
infusion of intravenous local anaesthetics for the prevention of PPP three
to six months after breast cancer surgery with an OR of 0.24 (95% CI 0.08
to 0.69, 97 participants, moderate-quality evidence). We did not
synthesize evidence for the surgical subgroups of limb amputation, hernia
repair, cardiac surgery and laparotomy. We could not pool evidence for
adverse effects because the included studies did not examine them
systematically, and reported them sparsely. Clinical heterogeneity,
attrition and sparse outcome data hampered evidence synthesis. High risk
of bias from missing data and lack of blinding across a number of included
studies reduced our confidence in the findings. Thus results must be
interpreted with caution. Authors' conclusions: We conclude that there is
moderate-quality evidence that regional anaesthesia may reduce the risk of
developing PPP after three to 18 months after thoracotomy and three to 12
months after caesarean section. There is low-quality evidence that
regional anaesthesia may reduce the risk of developing PPP three to 12
months after breast cancer surgery. There is moderate evidence that
intravenous infusion of local anaesthetics may reduce the risk of
developing PPP three to six months after breast cancer surgery. Our
conclusions are considerably weakened by the small size and number of
studies, by performance bias, null bias, attrition and missing data.
Larger, high-quality studies, including children, are needed. We caution
that except for breast surgery, our evidence synthesis is based on only a
few small studies. On a cautionary note, we cannot extend our conclusions
to other surgical interventions or regional anaesthesia techniques, for
example we cannot conclude that paravertebral block reduces the risk of
PPP after thoracotomy. There are seven ongoing studies and 12 studies
awaiting classification that may change the conclusions of the current
review once they are published and incorporated.<br/>Copyright &#xa9; 2018
The Cochrane Collaboration.

<10>
Accession Number
2000882198
Author
Miura M.C.; Ribeiro de Carvalho C.R.; Yamada da Silveira L.T.; de Moraes
Regenga M.; Petri Damiani L.; Fu C.
Institution
(Miura, de Moraes Regenga) Hospital do Coracao, Sao Paulo-SP, Brazil
(Miura) Department of Physiotherapy, Communication Science & Disorders,
Occupational Therapy, Medical School of the University of Sao Paulo, Sao
Paulo, Brazil
(Miura, Yamada da Silveira, Fu) Cardio-Pulmonary Department-Respiratory
ICU, Pulmonary Division, Heart Institute, Hospital das Clinicas da FMUSP,
University of Sao Paulo, Sao Paulo, Brazil
(Ribeiro de Carvalho) University Hospital, Universidade de Sao Paulo, Sao
Paulo, Brazil
(Petri Damiani) HCor Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
Title
The effects of recruitment maneuver during noninvasive ventilation after
coronary bypass grafting: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Pulmonary impairment is a common complication after coronary
artery bypass graft procedure and may be prevented or treated by
noninvasive ventilation. Recruitment maneuvers include sustained airway
pressure with high levels of positive end-expiratory pressure in patients
with hypoxemia, favoring homogeneous pulmonary ventilation and
oxygenation. This study aimed to evaluate whether noninvasive ventilation
with recruitment maneuver could safely improve oxygenation in patients
with atelectasis and hypoxemia who underwent a coronary artery bypass
grafting procedure. Methods: Thirty-four patients admitted to our
intensive care unit undergoing mechanical ventilation after surgery, with
ratio of arterial oxygen partial pressure to fraction of inspired oxygen <
300 and radiologic atelectasis score >=2, were included. The control group
consisted of 16 randomized patients and the recruitment group consisted of
18 patients. After extubation, noninvasive ventilation was applied for 30
minutes 3 times a day with positive end-expiratory pressure of 8 cm
H<inf>2</inf>O. The recruitment group received recruitment maneuver with
positive end-expiratory pressure of 15 cm H<inf>2</inf>O and 20 cm
H<inf>2</inf>O for 2 minutes each during noninvasive ventilation. We
analyzed the arterial oxygen partial pressure in room air, radiologic
atelectasis score, hemodynamic stability, and adverse events from
extubation until discharge. Results: Arterial oxygen partial pressure
increased 12.6% +/- 6.8% in the control group and 23.3% +/- 8.5% in the
recruitment group (P < .001). The radiologic atelectasis score was
completely improved for 94.4% of the recruitment group with no adverse
events, whereas 87.5% of the control group presented some atelectasis (P <
.001). Conclusions: Noninvasive ventilation with recruitment maneuvers is
safe, improves oxygenation, and reduces atelectasis in patients undergoing
coronary artery bypass.<br/>Copyright &#xa9; 2018 The American Association
for Thoracic Surgery

<11>
Accession Number
2000824091
Author
Collis R.A.; Rahman M.S.; Watkinson O.; Guttmann O.P.; O'Mahony C.;
Elliott P.M.
Institution
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Institute of
Cardiovascular Science, University College London, Gower Street, London
WC1E 6BT, United Kingdom
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Barts Heart Centre, St
Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
(Rahman) Institute of Statistical Research and Training (ISRT), University
of Dhaka, Dhaka, Bangladesh
Title
Outcomes following the surgical management of left ventricular outflow
tract obstruction; A systematic review and meta-analysis.
Source
International Journal of Cardiology. 265 (pp 62-70), 2018. Date of
Publication: 15 August 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Left ventricular outflow tract obstruction (LVOTO) causes
exertional symptoms in two thirds of patients with hypertrophic
cardiomyopathy (HCM). Consensus guidelines recommend surgical intervention
in patients with drug refractory symptoms. The primary aim of this study
was to perform a systematic review and meta-analysis to determine
morbidity and mortality after surgery. Methods: Study Selection: Studies
reporting outcomes following surgical intervention for symptomatic LVOTO
in HCM. Data Extraction: Articles from searching two scientific databases
(PubMed and Web of Science) were reviewed and data were extracted by two
investigators. Meta-analysis of data was performed with heterogeneity
assessed using I² statistic. Results: 85 studies were included
in the systematic review and 35 studies in the meta-analysis. Contemporary
early (<30 days) and late (>30 days) mortality following septal myectomy
were 1.4% (CI 0.8, 2.4) I² 9.0%, p = 0.36 and 0.7% (CI 0.3,
1.2) I² 70.7%, p < 0.05 respectively. Sixty-eight studies (80%)
reported perioperative complications. The contemporary rate of a
perioperative ventricular septal defect was 1.4% (0.8, 2.3) I²
0%, p < 0.05. Late morbidities including atrial fibrillation, stroke,
heart failure and transplant were reported in fewer than 22% of studies
and few studies compared mortality and clinical outcomes using different
surgical approaches to LVOTO. The incidence rate (IR) of reintervention
with a further surgical procedure was 0.3% (CI 0.2, 0.4) I²
52.5%, p < 0.05. Conclusions: Contemporary surgical management of LVOTO is
associated with low operative mortality rates but further studies are
needed to investigate the impact of surgical therapy on non-fatal early
and late complications.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<12>
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

<13>
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).

<14>
Accession Number
622467437
Author
Gaudino M.; Bakaeen F.; Benedetto U.; Rahouma M.; Di Franco A.; Tam D.Y.;
Iannaccone M.; Schwann T.A.; Habib R.; Ruel M.; Puskas J.D.; Sabik J.;
Girardi L.N.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, United Kingdom
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, ON, Canada
(Iannaccone) Citta della Scienza e della Salute, Department of Cardiology,
University of Turin, Torino, Italy
(Schwann) University of Toledo Medical Center, Toledo, OH, United States
(Habib) The Society of Thoracic Surgeons Research Center, Chicago, IL,
United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Taggart) University of Oxford, United Kingdom
Title
Use rate and outcome in bilateral internal thoracic artery grafting:
Insights From a systematic review and meta-analysis.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e009361. Date of Publication: 01 Jun 2018.
Publisher
American Heart Association Inc.
Abstract
Background--This meta-analysis was designed to assess whether center
experience affects the short- and long-term results and the relative
benefits of bilateral internal thoracic artery grafting (BITA) for
coronary artery bypass grafting. Methods and Results--MEDLINE and EMBASE
were searched to identify all articles reporting the outcome of BITA in
patients undergoing coronary artery bypass grafting. The BITA center
experience was gauged according to the percentage use of BITA in the
institutional overall coronary artery bypass grafting population (%BITA).
The primary outcome was long-term all-cause mortality. Secondary outcomes
were operative mortality, perioperative myocardial infarction,
perioperative stroke, deep sternal wound infections (DSWIs), and major
postoperative adverse event. The rates of the primary and secondary
outcomes were calculated after adjusting for %BITA. Primary and secondary
outcomes were also compared between the BITA and the single internal
thoracic artery arms in the adjusted studies. Meta-regression was used to
evaluate the effect of %BITA on the primary and secondary outcomes.
Thirty-four studies (27 894 patients undergoing BITA) were included. In
the pooled analysis, the incidence rate for long-term mortality was 2.83%
(95% confidence interval, 2.21%-3.61%). %BITA was significantly and
inversely associated with long-term mortality and the rate of DSWI. In the
pairwise comparison, %BITA was significantly and inversely associated with
the risk of longterm mortality and DSWI in the group undergoing BITA.
Conclusions--BITA series with higher %BITA report significantly lower
long-term mortality and DSWI rate as well as higher longterm survival
advantage and lower relative risk of DSWI in their BITA cohort. These
findings suggest that a specific volume-outcome relationship exists for
BITA grafting.<br/>Copyright &#xa9; 2018 The Authors.

<15>
Accession Number
622467410
Author
Ford T.J.; McCartney P.; Corcoran D.; Collison D.; Hennigan B.; McEntegart
M.; Hildick-Smith D.; Oldroyd K.G.; Berry C.
Institution
(Ford, McCartney, Corcoran, Collison, Hennigan, McEntegart, Oldroyd,
Berry) West of Scotland Heart and Lung Centre, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Ford, McCartney, Corcoran, Collison, Hennigan, McEntegart, Oldroyd,
Berry) British Heart Foundation Glasgow Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
United Kingdom
(Ford) University of New South Wales, Sydney, Australia
(Hildick-Smith) Division of Cardiology, Royal Sussex County Hospital,
Brighton, United Kingdom
Title
Single- versus 2-stent strategies for coronary bifurcation lesions: A
systematic review and meta-analysis of randomized trials with long-term
follow-up.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e008730. Date of Publication: 01 Jun 2018.
Publisher
American Heart Association Inc.
Abstract
Background--The majority of coronary bifurcation lesions are treated with
a provisional single-stent strategy rather than an upfront 2-stent
strategy. This approach is supported by multiple randomized controlled
clinical trials with short- to medium-term follow-up; however, long-term
follow-up data is evolving from many data sets. Methods and
Results--Meta-analysis of randomized controlled trials evaluating
long-term outcomes (>=1 year) according to treatment strategy for coronary
bifurcation lesions. Nine randomized controlled trials with 3265 patients
reported long-term clinical outcomes at mean weighted follow-up of
3.1+/-1.8 years. Provisional single stenting was associated with lower
all-cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence
interval, 0.48-1.00; P=0.049; I²=0). There was no difference in
major adverse cardiac events (15.8% versus 15.4%; P=0.79), myocardial
infarction (4.8% versus 5.5%; P=0.51), target lesion revascularization
(9.3% versus 7.6%; P=0.19), or stent thrombosis (1.8% versus 1.6%; P=0.28)
between the groups. Prespecified sensitivity analysis of long-term
mortality at a mean of 4.7 years of follow-up showed that the provisional
single-stent strategy was associated with reduced all-cause mortality
(3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42-0.97;
P=0.036; I²=0). Conclusions--Coronary bifurcation percutaneous
coronary intervention using a provisional single-stent strategy is
associated with a reduction in all-cause mortality at long-term
follow-up.<br/>Copyright &#xa9; 2018 The Authors.

<16>
Accession Number
622467924
Author
Pozdnyakov Y.M.; Uskov V.L.; Gon-charenko I.I.; Prasolova T.P.; Guseva
V.G.; Shinkar A.S.; Samsonova S.M.; Vikhrova I.V.; Kuz'kina S.A.; Mitina
L.V.; Timofeeva I.V.; Archakova T.M.; Kovaleva N.Y.; Romanova E.A.; Tivon
Y.V.; Antonova Y.N.; Kurganova O.B.; Davydova N.N.; Klyuchantseva O.V.;
Popovskaya Y.V.; Kharitonova E.I.; Kuzmina T.N.; Buzmakova K.V.; Kaplenko
L.I.; Pospelova N.V.; Stepanova A.Y.; Kol-basheva N.A.; Krasnova G.M.;
Pal'vin-skaya A.Y.; Toloknova V.A.; Bikmullina R.F.; Gainullina A.A.;
Kedrina E.V.; Mikhailova S.A.; Nabiullina T.A.; Nizamova A.F.; Uskova
A.A.; Yushkova A.E.; Andreeva O.V.; Fedotova G.V.; Besser-geneva O.L.;
Gavrilyuk D.D.; Ehalo N.V.; Zlo-bina M.V.; Zhemartseva E.Y.; Markushina
I.A.; Pavlovets V.P.; Sobolenko A.A.; Apanovich I.E.; Kireeva N.V.;
Maksimova I.V.; Butz T.V.; Pavlova I.A.; Bachurina S.N.; Orlyachenko S.V.;
Zaitseva T.V.; Beznogova V.F.; Litsis N.N.; Novozhenina A.Y.; Abramyan
L.L.; Adamyan M.M.; Askerko S.N.; Bolmosov A.N.; Vasilieva I.N.; Volodova
S.I.; Grishko P.V.; Zherebetskaya E.S.; Zemlyanaya N.S.; Klysh-nikova
L.N.; Kononchik E.I.; Kuznetsova N.A.; Kuz'minova I.A.; Marmurova I.V.;
Mikhailova R.Y.; Mordovina I.P.; Nazarkina O.V.; Per-epechko A.P.;
Pivovarova N.G.; Potapova T.P.; Prokofiev D.A.; Proniushkina N.E.;
Savelieva E.V.; A Semovskikh N.; Timonenkova L.D.; Fomin V.V.; Furman
O.A.; Tsutsieva R.M.; Chibrikina M.V.; Shoshina I.N.; Yashchenko P.;
Bocharova T.I.; Demya-nenko O.L.; Zhukova L.B.; Melnikov A.Y.; Mer-kulieva
I.A.; Tyasina E.I.; Pakholkova N.S.; Rogozina S.V.; Chugunova I.V.;
Brazhnik M.L.; Guseva Y.V.; Anisimova A.N.; Kuzeyina S.S.; Kulakhmetova
R.G.; Petrova I.S.; Ignatyeva I.A.; Morozova T.A.; Ryb-nikova N.V.;
Gritsenko I.I.; Kondratskaya O.V.; Shishkin A.V.; Gogleva N.N.; Kulipanova
V.M.; Mitrofanova S.V.; Parada E.V.; Svistunova S.Y.; Sergeeva T.M.;
Kryukova V.V.; Suprun T.N.; Fedorova E.M.; Shnor O.F.; Mitroshina T.N.;
Shemetova T.S.; Val'kevich L.P.; Varnikova S.N.; Ivanova E.A.; Shlykova
O.N.; Guryanova I.R.; Zheltova V.L.; Bulygina E.D.; Gorskaya E.V.; Kosenko
L.V.; Musaeva F.K.; Fedorchenko M.Y.; Harish V.I.; Serbarinova O.M.;
Yatsenya Y.A.; Golubev M.N.; Kopaev D.E.; Miludina L.A.; Polischuk L.V.;
Shilintseva O.A.; Krylova L.M.; Vasilik M.V.; Zotov D.D.; Kalishevich
N.B.; Kachmazova L.I.; Kontorikova S.G.; Mamoshko T.A.; Osnovin S.A.;
Timosh-enko (Schmalz) I.O.; Kashina A.N.; Kiryanova O.G.; Kotova L.E.;
Kuvshinova L.E.; Ulyanova I.M.; Shevelo O.F.; Kir-eeva I.B.; Korohova
L.V.; Lisunova T.I.; Medvedeva E.V.; Matvienko T.E.; Shovgaryan S.L.;
Nebolsina T.F.; Mikusheva M.A.; Misharin N.N.; Kutaliya T.O.; Chernova
V.N.; Yanina Y.A.; Permyakova O.V.; Skurikhina N.N.; Goldinova L.M.;
Pri-khodko T.N.; Myshyakova A.G.; Akhmerova E.Z.; Zaitseva K.V.; Ozerchuk
A.A.; Polyakova I.M.; Rodionova; Safiullina I.D.; Arsentieva I.N.; Volkova
O.O.; Kondrina I.N.; Kharlova T.E.; Grigorieva T.L.; Kurtmulaeva K.V.;
Rogozina O.M.
Institution
(Pozdnyakov) Moscow Regional Cardiology Centre, Zhukovsky, Russian
Federation
Title
Clinical Acceptability Of Trimetazidine Modified-Release 80 mg Once Daily
Versus Trimetazidine Modified-Release 35 mg Twice Daily In Stable Angina
Pectoris.
Source
Cardiology and Therapy. 7 (1) (pp 61-70), 2018. Date of Publication: 01
Jun 2018.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Trimetazidine (TMZ) is an anti-ischemic metabolic agent that
has been shown to be efficacious in angina treatment, both in monotherapy
and in combination. A new formulation of TMZ modified-release (MR) 80 mg
was developed, which is to be taken once daily (od), instead of twice
daily (bid) for the currently available TMZ MR 35 mg, with the aim of
simplifying the medication regimen. Methods: The present study was an
international, multicenter, randomized, double-blind, parallel-group phase
III study with a 12-week treatment period. The safety of TMZ MR 80 mg once
daily was assessed compared to TMZ MR 35 mg twice daily, in patients
previously treated successfully by the latter. Emergent adverse events
(EAEs), biological parameters, vital signs, 12-lead resting ECG
(electrocardiogram) and Canadian Cardiovascular Society (CCS)
classification were recorded. Results: One-hundred and sixty-five patients
previously diagnosed with stable angina pectoris on treatment were
randomized to receive either TMZ MR 80 mg od or TMZ MR 35 mg bid. In the
TMZ MR 80 mg group, fewer patients had >= 1 EAE (17.1 vs. 22.9% in the TMZ
MR 35 mg group). Serious EAEs were reported by three patients in each
group. No EAE required dose modification, withdrawal, or temporary
interruption of study treatments. Vital signs, 12-lead ECG, and laboratory
parameters did not change. No worsening in CCS classes was observed with
either treatment. Conclusions: TMZ MR 80 mg od and TMZ MR 35 mg bid have
similar safety profiles. This new once-daily formulation could improve
patient compliance with therapy, thereby enhancing clinical benefit. Trial
Registration: ISRCTN registry, ISRCTN 84362208. Funding: Institut de
Recherches Internationales Servier and Servier, Moscow, Russian
Federation. Plain Language Summary: Plain language summary available for
this article.<br/>Copyright &#xa9; 2018, The Author(s).

<17>
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.

<18>
Accession Number
619411693
Author
Tamisier R.; Fabre F.; O'Donoghue F.; Levy P.; Payen J.-F.; Pepin J.-L.
Institution
(Tamisier, O'Donoghue, Levy, Pepin) Laboratoire HP2, Inserm 1042,
Universitee Grenoble Alpes, Grenoble F-38042, France
(Tamisier, Levy, Pepin) Laboratoire EFCR et Sommeil, Pole Thorax et
Vaisseaux, Grenoble Alpes University Hospital, Grenoble 38043, France
(Fabre, Payen) Pole Anesthesie-reanimation - Hopital Michallon, Grenoble
Alpes University Hospital, Grenoble F-38000, France
(O'Donoghue) Institute for Breathing and Sleep, Austin Health, Heidelberg,
Victoria 3084, Australia
(O'Donoghue) The University of Melbourne, Parkville, Victoria 3010,
Australia
(Payen) Grenoble Institut des Neurosciences, Univ. Grenoble Alpes,
Grenoble F-38000, France
(Payen) INSERM, U1216, Grenoble F-38000, France
Title
Anesthesia and sleep apnea.
Source
Sleep Medicine Reviews. 40 (pp 79-92), 2018. Date of Publication: August
2018.
Publisher
W.B. Saunders Ltd
Abstract
Due to its low rate of diagnosis, in the general population over half of
those experiencing obstructive sleep apnea (OSA) are unaware that they
have the condition. However, any acute medical event may exacerbate OSA
and could have serious health consequences. In this context the management
of the perioperative period, from anesthesia through the surgery itself
and into the postoperative period, is more problematic for patients with
sleep disordered breathing than for others. There is prolific literature
in this area although large randomized trials are few due to the high
sample size needed and possible ethical difficulties of withholding OSA
treatment in the perioperative period. In 2014 the American Society of
Anesthesiologists published an updated set of recommendations to guide OSA
management during the perioperative period. In this present review we
provide an overview of the different issues that practitioners face with
regard to OSA, from the initial consultation with the anesthesiologist to
the extended post-operative period. There is considerable evidence that
OSA patients are at high risk of perioperative complications, though the
inherent risks from OSA per se and its comorbidities remain difficult to
discern. Nevertheless, appropriate screening and management allow
clinicians to minimize OSA associated risk.<br/>Copyright &#xa9; 2017
Elsevier Ltd

<19>
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.

<20>
Accession Number
622516405
Author
Katsura M.; Kuriyama A.; Takeshima T.; Fukuhara S.; Furukawa T.A.
Institution
(Katsura, Takeshima, Fukuhara) Kyoto University Graduate School of
Medicine and Public Health, Department of Healthcare Epidemiology,
Konoe-cho, Yoshida, Kyoto, Sakyo-ku 606-8501, Japan
(Katsura) Okinawa Prefectural Hokubu Hospital, Department of Surgery,
Okinawa, Japan
(Kuriyama) Kurashiki Central Hospital, Department of General Medicine,
1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
(Furukawa) Kyoto University Graduate School of Medicine / School of Public
Health, Department of Health Promotion and Human Behavior, Yoshida
Konoe-cho, Kyoto, Sakyo-ku 601-8501, Japan
Title
Preoperative inspiratory muscle training for postoperative pulmonary
complications in adult patients undergoing cardiac and major abdominal
surgery.
Source
Cochrane Database of Systematic Reviews. 2013 (2) (no pagination), 2013.
Article Number: CD010356. Date of Publication: 28 Feb 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: Our primary objective is to compare the effectiveness of
preoperative IMT and usual preoperative care on PPCs in adult patients
undergoing cardiac or major abdominal surgery. We will look at the
all-cause mortality and adverse events. Our secondary objective is to
investigate the effects of preoperative IMT on postoperative pulmonary
functions, duration of hospital stay, and postoperative complications of
other types. We will also evaluate the total drop-out, quality of life,
and cost-effectiveness of preoperative IMT.<br/>Copyright &#xa9; 2013 The
Cochrane Collaboration.

<21>
Accession Number
2000815595
Author
Tam D.Y.; Nedadur R.; Yu M.; Yanagawa B.; Fremes S.E.; Friedrich J.O.
Institution
(Tam, Nedadur, Fremes) Division of Cardiac Surgery, Department of Surgery,
Sunnybrook Health Sciences Center, University of Toronto, Toronto,
Ontario, Canada
(Tam, Fremes) Institute of Health Policy, Management, and Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Yu) Division of Plastic Surgery, Department of Surgery, University of
Toronto, Toronto, Ontario, Canada
(Yanagawa) Division of Cardiac Surgery, Department of Surgery, St.
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Friedrich) Critical Care and Medicine Departments, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Friedrich) Department of Medicine and Interdepartmental Division of
Critical Care, University of Toronto, Toronto, Ontario, Canada
Title
Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac
Surgery: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (1) (pp 298-304), 2018. Date of
Publication: July 2018.
Publisher
Elsevier USA
Abstract
Background: Traditionally, wire cerclage has been used to reapproximate
the sternum after sternotomy. Recent evidence suggests that rigid plate
fixation for sternal closure may reduce the risk of sternal complications.
Methods: The Medline and Embase databases were searched from inception to
February 2017 for studies that compared rigid plate fixation with wire
cerclage for cardiac surgery patients undergoing sternotomy. Random
effects meta-analysis compared rates of sternal complications (primary
outcome, defined as deep or superficial sternal wound infection, or
sternal instability), early mortality, and length of stay (secondary
outcomes). Results: Three randomized controlled trials (n = 427) and five
unadjusted observational studies (n = 1,025) met inclusion criteria. There
was no significant difference in sternal complications with rigid plate
fixation at a median of 6 months' follow-up (incidence rate ratio 0.51,
95% confidence interval [CI]: 0.20 to 1.29, p = 0.15) overall, but a
decrease when including only patients at high risk for sternal
complications (incidence rate ratio 0.23, 95% CI: 0.06 to 0.89, p = 0.03;
two observational studies). Perioperative mortality was reduced favoring
rigid plate fixation (relative risk 0.40, 95% CI: 0.28 to 0.97, p = 0.04;
four observational studies and one randomized controlled trial). Length of
stay was similar overall (mean difference -0.77 days, 95% CI: -1.65 to
+0.12, p = 0.09), but significantly reduced with rigid plate fixation in
the observational studies (mean difference -1.34 days, 95% CI: -2.05 to
-0.63, p = 0.0002). Conclusions: This meta-analysis, driven by the results
of unmatched observational studies, suggests that rigid plate fixation may
lead to reduced sternal complications in patients at high risk for such
events, improved perioperative survival, and decreased hospital length of
stay. More randomized controlled trials are required to confirm the
potential benefits of rigid plate fixation for primary sternotomy
closure.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<22>
Accession Number
2000802013
Author
Gaynor J.W.; Nicolson S.C.; Spray D.M.; Burnham N.B.; Chittams J.L.;
Sammarco T.; Walsh K.W.; Spray T.L.; Licht D.J.
Institution
(Gaynor, Spray, Burnham, Walsh, Spray) Division of Cardiothoracic Surgery,
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United
States
(Nicolson) Department of Anesthesia and Critical Care Medicine, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(Licht) Department of Pediatrics, Division of Neurology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(Chittams, Sammarco) Biostatistics Consulting Unit, Office of Nursing
Research, University of Pennsylvania School of Nursing, Philadelphia,
Pennsylvania, United States
Title
Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in
Neonates.
Source
Annals of Thoracic Surgery. 106 (1) (pp 151-155), 2018. Date of
Publication: July 2018.
Publisher
Elsevier USA
Abstract
Background: Remote ischemic preconditioning (RIPC) is a mechanism to
protect tissues from injury during ischemia and reperfusion. We
investigated the neuroprotective effects of RIPC in neonates undergoing
cardiac surgery. Methods: The outcome was white matter injury (WMI),
assessed by the change in volume of WMI from preoperative to postoperative
brain magnetic resonance imaging (MRI). Patients were randomized to RIPC
or SHAM. RIPC was induced prior to cardiopulmonary bypass by four 5-minute
cycles of blood pressure cuff inflation to produce ischemia of the lower
extremity. For patients randomized to SHAM, the cuff was positioned, but
not inflated. Results: The study included 67 patients, with 33 randomized
to RIPC and 34 randomized to SHAM. Preoperative and postoperative MRIs
were available in 50 patients, including 26 of the 33 RIPC patients and 24
of the 34 SHAM patients. There were no differences in baseline and
operative characteristics for either the overall study group or the group
with evaluable MRIs. WMI was identified in 28% of the patients
preoperatively and in 62% postoperatively. There was no difference in the
prevalence of WMI by treatment group (p > 0.5). RIPC patients had an
average change in WMI of 600 mL³, and SHAM subjects had an
average WMI change of 107 mL³. There was no significant
difference in the mean value of WMI change between patients who received
RIPC and those who received SHAM treatments (p = 0.178). Conclusions: In
this randomized, blinded clinical trial, there was no evidence that use of
RIPC provides neuroprotection in neonates undergoing repair of congenital
heart defects with cardiopulmonary bypass.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<23>
Accession Number
2000731187
Author
Nogueira S.S.; Felizardo A.A.; Caldas I.S.; Goncalves R.V.; Novaes R.D.
Institution
(Nogueira, Felizardo, Caldas, Novaes) Institute of Biomedical Sciences,
Federal University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Caldas) Department of Pathology and Parasitology, Federal University of
Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Nogueira, Felizardo, Novaes) Department of Structural Biology, Federal
University of Alfenas, Alfenas, Minas Gerais 37130-001, Brazil
(Goncalves) Department of Animal Biology, Federal University of Vicosa,
Vicosa, Minas Gerais 36570-000, Brazil
Title
Challenges of immunosuppressive and antitrypanosomal drug therapy after
heart transplantation in patients with chronic Chagas disease: A
systematic review of clinical recommendations.
Source
Transplantation Reviews. 32 (3) (pp 157-167), 2018. Date of Publication:
July 2018.
Publisher
W.B. Saunders
Abstract
Background: Although contraindicated for decades, heart transplantation
(HT) has finally become a feasible therapeutic option for the treatment of
Chagasic patients with end-stage heart failure. Part of the success in
achieving acceptable survival rates after HT is due to the enhancement of
the pharmacological management of allograft rejection and reactivation of
Trypanosoma cruzi infection. Methods: By using the framework of a
systematic review, we investigated if Chagasic patients who have undergone
a HT are treated with similar immunosuppressive and antitrypanosomal
regimens in endemic and non-endemic countries and exhibits similar T.
cruzi reactivation, allograft rejection and survival rates. From a
structured search in PubMed/Medline, Scopus, and Web of Sciences
databases, 30 clinical studies were reviewed. Results and conclusion:
Although immunosuppressive regimens are variable in endemic and
non-endemic countries, the current evidence supports the administration of
lower doses of corticosteroids, adjusted cyclosporine levels (100-150
ng/mL) 3 months after HT, and azathioprine rather than mycophenolate
mofetil to reduce the risk of T. cruzi reactivation and rejection
episodes. Antitrypanosomal therapy exclusively based on benznidazole,
nifurtimox, and allopurinol was consistent in endemic and non-endemic
countries, achieving effective results in the control of infection
reactivation. The evidence that supports prophylactic antitrypanosomal
therapy or administration of allopurinol alone is limited. By highlighting
the main sources of research bias, we hope that our critical analysis can
help to expedite clinical research and to reduce methodological bias,
thereby improving the quality of evidence in new research
initiatives.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<24>
Accession Number
621756065
Author
D'Journo X.B.; Falcoz P.-E.; Alifano M.; Le Rochais J.-P.; D'Annoville T.;
Massard G.; Regnard J.F.; Icard P.; Marty-Ane C.; Trousse D.; Doddoli C.;
Orsini B.; Edouard S.; Million M.; Lesavre N.; Loundou A.; Baumstarck K.;
Peyron F.; Honore S.; Dizier S.; Charvet A.; Leone M.; Raoult D.; Papazian
L.; Thomas P.A.
Institution
(D'Journo, Trousse, Doddoli, Orsini, Thomas) Service de Chirurgie
Thoracique, Chemin des Bourrely, Hopital Nord, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille cedex 20 13915,
France
(Falcoz, Massard) Service de Chirurgie Thoracique, Nouvel Hopital Civil,
Strasbourg University, Strasbourg, France
(Alifano, Regnard) Service de Chirurgie Thoracique, Hopital Cochin,
Assistance Publique Hopitaux de Paris, Paris Descartes University, Paris,
France
(Le Rochais, Icard) Service de Chirurgie Thoracique, Hopital de la cote de
Nacre, Caen University, Caen, France
(D'Annoville, Marty-Ane) Service de Chirurgie Thoracique, Hopital Arnaud
de Villeneuve, Montpellier University, Montpellier, France
(D'Journo, Doddoli, Edouard, Million, Leone, Raoult, Thomas) Unite de
Recherche sur les Maladies Infectieuses et Tropicales Emergentes
(URMITE),UM63, CNRS 7278, IRD 198 INSERM U1095, Institut
Hospitalo-Universitaire Mediterranee Infection, Marseille Aix-Marseille
Univ., Marseille, France
(Lesavre, Leone) Centre d'Investigation Clinique, Hopital Nord, Assistance
Publique Hopitaux de Marseille, Aix-Marseille University, Marseille,
France
(Loundou, Baumstarck) Unite d'aide methodologique, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Peyron, Honore) Service Clinique de Pharmacologie, Assistance Publique
Hopitaux de Marseille, Aix-Marseille University, Marseille, France
(Dizier, Charvet, Leone) Service d'Anesthesie-Reanimation, Hopital Nord,
Assistance Publique Hopitaux de Marseille, Aix-Marseille University,
Marseille, France
(Papazian) Reanimation des Detresses Respiratoires et Infections Severes,
Hopital Nord, Assistance Publique Hopitaux de Marseille, Aix-Marseille
University, Marseille, France
Title
Oropharyngeal and nasopharyngeal decontamination with chlorhexidine
gluconate in lung cancer surgery: a randomized clinical trial.
Source
Intensive Care Medicine. 44 (5) (pp 578-587), 2018. Date of Publication:
01 May 2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Respiratory complications are the leading causes of morbidity and
mortality after lung cancer surgery. We hypothesized that oropharyngeal
and nasopharyngeal decontamination with chlorhexidine gluconate (CHG)
would be an effective method to reduce these complications as reported in
cardiac surgery. Methods: In this multicenter parallel-group randomized
double-blind placebo-controlled trial, we enrolled consecutive adults
scheduled for anatomical pulmonary resection for lung cancer.
Perioperative decontamination consisted in oropharyngeal rinse solution
(0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary
outcome measure was the proportion of patients requiring postoperative
invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome
measures included occurrence of respiratory and non-respiratory
healthcare-associated infections (HAIs) and outcomes within 90 days.
Results: Between July 2012 and April 2015, 474 patients were randomized.
Of them, 24 had their surgical procedure cancelled or withdrew consent.
The remaining 450 patients were included in a modified intention-to-treat
analysis: 226 were allocated to CHG and 224 to the placebo. Proportions of
patients requiring postoperative MV were not significantly different [CHG
14.2%; placebo 15.2%; relative risks (RRs) 0.93; 95% confidence interval
(CI) 0.59-1.45; P = 0.76]. Neither of the proportions of patients with
respiratory HAIs were different (CHG 13.7%; placebo 12.9%; RRs 1.06; 95%
CI 0.66-1.69; P = 0.81). The CHG group had significantly decreased
incidence of bacteremia, surgical-site infection and overall
Staphylococcus aureus infections. However, there were no significant
between-group differences for hospital stay length, change in tracheal
microbiota, postoperative antibiotic utilization and outcomes by day 90.
Conclusions: CHG decontamination decreased neither MV requirements nor
respiratory infections after lung cancer surgery. Additionally, CHG did
not change tracheal microbiota or postoperative antibiotic utilization.
Trial Registration: This study is registered on ClinicalTrials.gov, number
NCT01613365.<br/>Copyright &#xa9; 2018, Springer-Verlag GmbH Germany, part
of Springer Nature and ESICM.

<25>
Accession Number
622347418
Author
Shi R.; Li Z.-H.; Chen D.; Wu Q.-C.; Zhou X.-L.; Tie H.-T.
Institution
(Shi, Chen, Wu, Tie) Department of Cardiothoracic Surgery, the First
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Shi, Zhou) Department of Cardiology, the First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Li) Department of Metabolism and Endocrinology, Shanghai East Hospital,
Tongji University School of Medicine, Shanghai, China
Title
Sole and combined vitamin C supplementation can prevent postoperative
atrial fibrillation after cardiac surgery: A systematic review and
meta-analysis of randomized controlled trials.
Source
Clinical Cardiology. 41 (6) (pp 871-878), 2018. Date of Publication: June
2018.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
We undertook a systematic review and meta-analysis to evaluate the effect
of vitamin C supplementation (vitamin C solely or as adjunct to other
therapy) on prevention of postoperative atrial fibrillation (POAF) in
patients after cardiac surgery. PubMed, Embase, Web of Science, and
Cochrane Library were systematically searched to identify randomized
controlled trials assessing the effect of vitamin C supplementation in
adult patients undergoing cardiac surgery, and the meta-analysis was
performed with a random-effects model. Thirteen trials involving 1956
patients were included. Pooling estimate showed a significantly reduced
incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]:
0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63
to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI:
0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup
and sensitivity analyses, and trial sequential analysis also confirmed
that the evidence was sufficient and conclusive. Additionally, vitamin C
could significantly decrease intensive care unit length of stay (weighted
mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital
length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to
-0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to
0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy
can prevent POAF in patients undergoing cardiac surgery and should be
recommended for patients receiving cardiac surgery for prevention of
POAF.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<26>
Accession Number
622663959
Author
Lee S.; Binte Said N.; Ho R.; Singh G.; Tang S.; Sanjeeva R.; Moshi G.; Ng
B.; Tan L.
Institution
(Lee, Ho, Moshi, Tan) Department of Laboratory Medicine, Singapore
(Binte Said) Department of Oncology Nursing, Singapore
(Singh) Department of Orthopaedic Surgery, Singapore
(Tang) Department of Surgery, Singapore
(Sanjeeva, Ng) Department of Anaesthesia, National University Hospital,
Singapore, Singapore
Title
Multifaceted patient blood management measures reduce red cell transfusion
in surgery.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 303), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Patient Blood Management (PBM) is a multidisciplinary,
evidence-based approach to optimizing the care of patients who might need
a blood transfusion. National recommendations were instituted in the last
several years, which all hospitals were encouraged to adopt. Aims: This
study aims to examine the impact of PBM implementation on red cell (RBC)
transfusion rates in surgeries performed in a tertiary hospital. Methods:
Perioperative RBC transfusions rates (number of cases transfused/total
number of cases x 100%) occurring between 3 days pre-operation to 3 days
post-operation for six surgeries, coronary artery bypass grafting (CABG),
total knee arthroplasty (TKA), total hip arthroplasty (THA), nephrectomy,
colectomy and hys-terectomy, were studied. Baseline transfusion rates
before intensive implementation of PBM were measured in June 2016.
Post-implementation transfusion rates were measured in a randomly selected
two-month period in 2017. PBM planning phase occurred from 2014 and 2015,
and these measures were intensively implemented from July 2016 onwards:
(1) early pre-operative screening for anemia, (2) rapid access
pre-operative anemia management clinic, (3) use of tranexamic acid when
indicated, (4) use of Intraoperative Cell Salvage for high blood loss
surgeries, (5) introducing reminders of evidence-based transfusion
guidelines into the electronic ordering system at the time of RBC
ordering, (6) hospital-wide audit of appropriateness of RBC transfusions.
Extensive engagement with surgeons and anaesthetists occurred through
talks and meetings to raise awareness of PBM. To measure the take up rate
of PBM, two indicators were recorded: (i) proportion of patients whose
pre-operative anemia was managed, (ii) mean pre-transfusion hemoglobin of
post-operative transfusions as a surrogate of adoption of evidence-based
transfusion thresh-olds. Results: The number of surgeries in the
baseline/post-implementation periods were 33/40 CABG, 26/48 TKA, 12/11
THA, 4/9 nephrectomies, 7/11 colectomies, 27/50 hysterectomies.
Transfusion rates for CABG and THA were significantly lower
post-implementation compared to baseline (CABG: 57.5 vs 87.9%, 95% CI of
difference 9.74-47.36, P = 0.005; THA: 18.2 vs 66.7%, 95% CI of difference
8.08-71.97, P = 0.022). TKA, nephrectomies and hysterectomies all showed
trends towards lower transfusion rates post-implementation compared to
baseline, i.e. 2.1 vs 11.5%, 11.1 vs 25.0%, 6.0 vs 14.8%. Transfusion rate
for colectomies increased from 14.3% to 36.4%, but sample size was small.
All surgeries combined, the proportion whose preoperative anemia was
managed increased from baseline 6.1% to 50.0% post-imple-mentation (95% CI
of difference 24.48-58.73, P < 0.0001) and mean pre-transfusion hemoglobin
decreased from baseline 8.4 g/dl to 7.8 g/dl post-implementation (95% CI
of difference-0.59 +/- 0.21, P = 0.0061). For CABG, these differences
remained significant: proportion whose pre-operative anemia was managed
increased (0% vs 35.7%; P = 0.015), while mean pre-transfusion hemoglobin
decreased (8.4 g/dl vs 7.7 g/dl; P = 0.003) and mean number of RBC units
transfused per transfused patient decreased (4.3 vs 3.3).
Summary/Conclusions: Implementation of multifaceted PBM is able to reduce
transfusion rates across different types of surgery. Proportion of
pre-operative anemia managed increased and mean pre-transfusion hemoglobin
decreased, reflecting adoption of PBM measures. The next phase would focus
on ensuring as many patients as possible are managed accordingly, and to
study outcomes such as infection rates and resource utilization.

<27>
Accession Number
622663899
Author
Gilchrist P.; Coopersmith A.; Li M.; Woroniak V.; Ditto B.
Institution
(Gilchrist) Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Coopersmith, Li, Woroniak, Ditto) Psychology, McGill University,
Montreal, Canada
Title
Standing enhances vasovagal symptoms elicited by stimuli associated with
blood but not other emotional stressors.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 144), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Various stimuli (orthostatic stress, blood-related stimuli,
fear, haemorrhage, etc.) are capable of triggering a vasovagal response
(VVR). It remains unclear to what extent these represent identical or just
similar physiological reactions. Aims: This study examined the specificity
of VVR in response to stimuli involving Blood/Injury when compared to
other emotional stimuli, and built upon the idea of 'simulated' blood loss
by hypothesizing that VVR are based on the prevention of excessive blood
loss and thus triggered by stimuli that suggest as well as produce actual
loss. As a result, the effects of certain emotional, blood-related
stressors should interact with certain postural stressors. Methods: 48
healthy young adults completed a questionnaire assessing medical fears
(Medical Fears Survey-MFS-SF; Olatunji et al., 2012) and watched five
5-min-ute stimulus videos with different emotional content. All
participants watched the Neutral video followed by 4 subsequent videos
presented in counter-balanced orders: a Blood/Injury video depicting an
open heart surgery, and three additional videos (Medical, Chase/Fear, and
Loss/Sadness). Participants were randomly assigned to watch the videos
either standing or sitting in an arm-chair. Vasovagal symptoms, blood
pressure (BP), and heart rate (HR) were assessed during each video.
Results: The primary analyses were 2 Posture (sitting/standing) x 4 Video
(Loss/Chase/Medical/Blood-Injury) x Medical Fear (treated as a continuous
measure) repeated-measure general linear models (GLMs) with sex and a
Neutral video value as covariates. As predicted, there was a significant
Posture x Video interaction, F(3, 129) = 3.53, P = 0.040,
T)²<inf>p</inf>= 0.076, due to a specific enhancement of
symptoms during the Blood/Injury video by standing. This effect was
moderated by fearfulness leading to a significant Posture x Video X
Medical Fear interaction, F(3, 129) = 5.30, P = 0.010,
g²<inf>p</inf>= 0.11. Standing significantly increased symptoms
experienced by more fearful participants during Blood/Injury but not other
videos. This pattern was corroborated by SBP and HR with significant
Posture x Film interaction effects, F(3, 117) = 2.84, P = 0.048,
g²<inf>p</inf>= 0.068, and F(3, 117) = 4.20, P = 0.011,
g²<inf>p</inf>= 0.097, respectively. As expected, this was due
to notable decreases among those who watched the surgery film while
standing. Summary/Conclusions: Blood-related fears play a key role in
eliciting VVR and orthostatic stress enhances this effect. These findings
provide support for the theory that VVR may have developed as a means to
facilitate the survival of animals who were injured and experiencing
significant blood loss. Clinical implications include the management or
reduction of blood-related stimuli for blood donors.

<28>
Accession Number
622663888
Author
Ng M.S.; Hay K.; Middelburg R.; Suen J.; Tung J.; Fraser J.
Institution
(Ng, Suen, Fraser) Critical Care Research Group, Faculty of Medicine,
University of Queensland, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Australia
(Hay) QIMR Berghofer Medical Research Institute, Brisbane, Australia
(Middelburg) Centre for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
Title
Fresh frozen plasma storage duration associated with small increased
in-hopsital mortality risk.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 301), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Storage-induced changes in fresh frozen plasma (FFP) have been
posited to lead to decreased transfusion efficacy and safety. To date, the
effects of FFP storage duration on mortality has only been investigated in
one study of cardiac surgery patients (Van Straten, J Thorac Cardiovasc
Surg, 2011). Aims: This study aimed to determine the relationship between
FFP storage duration and in-hospital mortality. Methods: Secondary
analyses were conducted on patient level data previously collected for an
individual meta-analysis studying the effects of packed red blood cell
storage duration. Studies reporting FFP storage duration were included in
the analysis. Two-stage meta-analyses were performed to derive pooled
effect estimates of FFP storage duration on mortality. Patient-level mixed
effects logistic regression models were also fitted. Models were adjusted
for age, gender and volume of FFP transfused. Results: The FFP storage
duration analysis included 3625 patients across 4 studies, conducted in
orthopaedic surgery, acute medicine, intensive care and cardiac surgery
patients. Each additional month of FFP storage was associated with a small
enhanced risk of in-hospital mortality (OR 1.05, 95% CI 1.01-1.08, P =
0.01). Effect estimates from the patient-level mixed effects model were
consistent, but did not remain significant at the 5% level (OR 1.03, 95%
CI 1.00-1.06; P = 0.09). Summary/Conclusions: This study updates existing
information on the clinical FFP storage duration effects by including a
wide range of patient subtypes. There was an increased risk of in-hospital
mortality with longer storage of FFPs. Before considering FFP shelf life
alterations, further investigation is warranted to address potential
confounding factors such as patient subgroup, country and recruitment
year. Acknowledgements: Australian governments fund the Australian Red
Cross Blood Service for the provision of blood, blood products and
services to the Australian community. This project was partially funded by
The Prince Charles Hospital Foundation.

<29>
Accession Number
622663716
Author
Simon G.; Craswell A.; Thom O.; Fung L.
Institution
(Simon, Fung) School of Sport and Health Sciences, Australia
(Craswell) School of Nursing, Midwifery and Paramedicine, USC Australia,
Sippy Downs, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Birtinya, Australia
Title
Questioning the benefit of restrictive transfusion practice in older
adults.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 17), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: In recent years, randomised controlled trials (RCTs) have
published findings comparing patient outcomes associated with liberal
versus restrictive transfusion strategies. RCT evidence has challenged
some assumptions generated by earlier observational studies. Guidelines
based on RCTs promote restrictive transfusion practice, except for
specific patient groups where there is insufficient evidence to make
recommendations. Most adult studies enrol patients across a broad age
range, with very few studies focussed on patients aged 65 years and above.
Patients aged 65 years and above are the highest consumers of red cells.
Aims: To examine evidence regarding restrictive and liberal transfusion
strategies in older adults; and to examine pathophysiological changes
associated with ageing that may impact tolerance of anaemia and
transfusion outcomes. Methods: The Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. We
first identified RCTs that focussed on transfusion evidence in adults aged
65 years and above. As only three RCTs met this condition, inclusion
criteria were widened to incorporate additional studies that had a mean
patient age of at least 64 years. The identified RCTs comparing liberal
versus restrictive transfusion strategies were subjected to meta-analysis.
Literature related to the pathophysiology of aging was examined for
factors that impact circulation and oxygen transport. Results: A total of
nine RCTs, with mean patient ages ranging from 64 to 87 years, were
included. Meta-analysis of evidence from the RCTs supported liberal
transfusion strategies for older adults with respect to mortality and
cardiac outcomes. Infection risk and hospital length of stay were
equivocal between restrictive and liberal transfusion strategies. After
publication of these findings, the Transfusion Requirements in Cardiac
Surgery (TRICS III) study report, including analysis of older patient
sub-groups, was released. It found that a restrictive strategy in
moderate-to-high risk patients was non-inferior to a liberal strategy,
including in older sub-groups of patients. Differences in Hb thresholds
were noted between the studies. In our meta-analysis, liberal Hb
thresholds for the RCTs restricted to patients aged 65 and above ranged
from 100 to 113! g/l. TRICS III, however, applied lower liberal thresholds
of 85 g/l for non-ICU and 90 g/l for ICU patients. Pathophysiological
changes of ageing occur at cellular and systemic levels, negatively
impacting the rate of oxygen delivery relative to haemoglobin level.
Summary/Conclusions: Recent RCTs have provided valuable new information
and challenged some observational study evidence regarding associations
between blood transfusion, infections and length of stay. However,
findings from RCT and meta-ana-lysis regarding transfusion outcomes in
older adults are conflicted. Differences in RCT Hb triggers complicate
interpretation, and consequently the inference of the terms 'liberal' and
'restrictive' transfusion. This paper will critically analyse differences
in study approaches and outcomes, with the intent of highlighting
challenges that need to be considered and addressed. Age-related
pathophysiological changes may explain differences in outcome associated
with the various Hb triggers used in RCTs. Avenues for further research
will be discussed, particularly in the context of informing PBM guideline
development for older adults, the largest cohort of blood recipients.

<30>
Accession Number
622663572
Author
Khalaf Adeli E.
Institution
(Khalaf Adeli) Blood Transfusion Research Center, High Institute for
Research and Education in Transfusion Medicine, Tehran, Iran, Tehran,
Iran, Islamic Republic of
Title
Impact of pre-operative supplemental of fibrinogen concentrate on bleeding
and transfusion requirements in cardiac surgery.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 296), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiopulmonary bypass (CPB) induces a multifactorial
coagulopathy due to an extensive consumption of coagulation factors
especially fibrinogen. There are contradictory reports about effects of
preoperative supplemental fibrinogen in patients without
hypofibrinogenemia. Aims: The aim of this study was to investigate the
effect of pre-operative supplemental of fibrinogen concentrate on bleeding
and transfusion requirements in car-diac surgery. Methods: Totally 78
patients scheduled elective CABG or valvular surgery, were included in a
clinical trial study between March 2017 and November 2017. Patients were
randomly assigned to the fibrinogen and control groups. In the fibrinogen
group patients received 2 grams of fibrinogen dissolved in 50 mL of normal
saline over a 15 min period 30 min after induction of anesthesia. In the
control group the patients were received the same volume of normal saline
during the same period of time. Post-operative bleeding was recorded as
the overall mediastinal drainage or other drain in surgical site during 24
H after surgery. Amount of transfused packed red blood cells, fresh frozen
plasma, and platelets during first post-surgery day were also documented.
Results: The mean volume of bleeding was significantly lower in fibrinogen
group compared with control group (168 +/- 12 ml vs 344 +/- 37 ml) (P =
0.001). Furthermore, the mean volume of FFP and platelet concentrate which
used in fibrinogen group was significantly lower in fibrinogen group
compared with control group (P < 0.05). However, we didn't found any
significant differences in RBC consumption between groups
Summary/Conclusions: Preoperative supplementation with fibrinogen results
in reduction in postoperative blood loss and transfusion requirements
during cardiac surgery.

<31>
Accession Number
622663544
Author
Reade M.C.
Institution
(Reade) Faculty of Medicine, University of Queensland, Brisbane, Australia
(Reade) Joint Health Command, Australian Defence Force, Canberra,
Australia
Title
Frozen platelets: Current practice, evidence, evidence gaps and clinical
research programs underway.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 48), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Platelets are essential for haemostasis. Liquid-stored platelets have a
shorter shelf life (5 days) than other blood components (42 days for red
cells and 12 months for fresh frozen plasma), so outer metropolitan
hospitals, rural hospitals and deployed military hospitals usually cannot
justify maintaining platelet units on-site, as this would inevitably waste
a resource in high demand elsewhere. In response, the Netherlands Military
Blood Bank built on earlier US Navy research to refine a process to freeze
(using dimethylsulfoxide as a cryopreservative), store (for up to 2 years)
and reconstitute (in plasma) platelets for use in military operations.
Experience with 1,143! cry-opreserved platelet units transfused into 349
patients in Afghanistan suggests they were both safe and effective in
treating active bleeding (Noorman et al., 2016), although no comparisons
with liquid-stored platelets or whole blood were made. There are also
several instances in civilian practice in which the ability to transfuse
platelets has been judged to outweigh any unquantified risk associated
with the cry-opreserved product, including in Poland, the Czech Republic,
France and the United States. However, while extensive preclinical
assessments and one phase I human study of cryopreserved platelets have
been performed, to date there has only been one clinical trial involving
bleeding patients published. This US Navy-sponsored study (Khuri et al.,
1999) randomised 73 patients to cryopreserved or liquid-stored platelets
for treatment of bleeding after cardiac surgery. No adverse effects were
observed in the 24 patients who received cryopreserved platelets. Blood
loss with cryopreserved platelets was significantly less, despite lower
post-transfusion platelet increments and a tendency towards decreased
platelet survival. While uniformly encouraging, this evidence base is
insufficient to justify regulatory approval. Several international trial
groups are seeking to address this deficiency, including the Czech
military and the US Department of Defense/Dartmouth University. In 2015
the Australian Red Cross Blood Service and the Australian Defence Force
commenced a clinical trial program, the Cryopreserved vs. Liquid Platelet
trial (CLIP), designed to evaluate the effectiveness, safety and
cost-effectiveness of cryopreserved platelets in comparison to
liquid-stored platelets. The Australian pilot trial ceased enrolment in
December 2017, with a New Zealand variant of the protocol due to run
through 2018. In the Australian pilot, 121 high-risk cardiac surgical
patients were ran-domised, of whom 42 were transfused platelets. Study
groups were well-balanced at baseline. There were no adverse events
attributed to platelet transfusion. Medical complications that might have
been related to cryopreserved platelet transfusion, but which are also
common after high-risk cardiac surgery, such as fever, infection, acute
respiratory distress syndrome, and deep venous thrombosis, were present in
similar proportions in the two trial groups. There were non-statistically
significant trends to superiority in several bleeding-related outcomes,
including blood loss, requirement for red cell transfusion, and need to
return to the operating theatre for bleeding. The results justify
progression to a definitive phase III trial, CLIP-II.

<32>
Accession Number
622663066
Author
Yates J.; Perelman I.; Khair S.; Taylor J.; Lampron J.; Tinmouth A.;
Saidenberg E.
Institution
(Yates, Lampron, Tinmouth, Saidenberg) Ottawa Hospital, Canada
(Perelman, Khair, Taylor) University of Ottawa, Canada
(Perelman, Tinmouth, Saidenberg) Ottawa Hospital Research Institute,
Ottawa, Canada
Title
Exclusion criteria and adverse events in peri-operative cardiac surgery
tranexamic acid trials: A systematic review and meta-analysis.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 323), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac surgeries are often associated with substantial blood
loss, putting patients at increased risk for blood transfusions. The use
of tranexamic acid (TXA), an anti-fibrinolytic agent, as a blood
conservation strategy has gained popularity in many surgical specialties,
and it has been shown to be both an effective and safe therapy. However,
TXA remains underutilized, largely due to fear of potential thromboembolic
events, which are of concern in cardiac surgery. Another possible
contributing factor to the under-use of TXA is the lack of evidence-based
guidelines outlining which patient groups should not receive TXA due to
risks outweighing the benefits. Aims: We conducted a systematic review to
determine which patients were excluded from clinical trials of TXA in
cardiac surgery to help determine if there are patient groups in whom the
risk of TXA therapy cannot be estimated. As a secondary objective, we
assessed the safety of systemic TXA. We hope the findings of this review
will enable the development of evidence-informed exclusion criteria for
TXA use in patients undergoing cardiac surgeries. Methods: The databases
Medline, EMBASE, and the Cochrane Central Register of Controlled Trials
were searched from inception until September 2017. Eligible studies were
randomized controlled trials (RCTs) administering systemic TXA
peri-operatively to patients undergoing any cardiac surgery. Comparator
groups of placebo, no intervention, or an active comparator were accepted.
Our primary outcome was a description of the exclusion criteria for each
RCT, and as a secondary endpoint we assessed the rate of adverse events
associated with TXA use. A descriptive synthesis was performed to
synthesize study characteristics and analyze the exclusion criteria. TXA
safety was assessed with meta-analysis using a random effects model.
Results: 70 eligible RCTs were included in this systematic review. A
variety of cardiac surgeries were included, the most common one being
coronary artery bypass graft surgery (45.7% of studies). The two most
common reasons for excluding patients from TXA trials in cardiac surgery
were major hepatic, renal, or cardiac comorbidities (75.7% of studies),
and the use of medications affecting coagulation (55.7% of studies). Other
patient groups frequently excluded from these trials were those with
coagulopathy (41.4% of studies), known allergy to TXA (3!5.7%), an
abnormal coagulation profile (32.9% of studies), a previous history of
arterial or venous thromboembolic events (27.1% of studies), and anemia
(20.0% of studies). Meta-analysis showed that systemic TXA did not
increase the risk of adverse events compared to placebo or no intervention
(RR = 0.97, 95% CI: 0.88, 1.07). Summary/Conclusions: Systemic TXA is safe
to use peri-operatively in cardiac surgery, and evidence-based guidelines
for its use in surgery can be developed for many patient populations.
Regarding the patient groups commonly excluded from TXA trials in cardiac
surgery, some of the exclusions may not be warranted based on current
evidence. However, due to frequent exclusion from RCTs, there may be
limited efficacy and safety data on TXA in these populations, and further
research on TXA in these patient groups may be warranted.

<33>
Accession Number
622663051
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Canada
(Perelman, Khair, Dermer, Fergusson) University of Ottawa, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, Canada
Title
The epidemiology of multiple blood component transfusion: A systematic
review.
Source
Vox Sanguinis. Conference: 35th International Congress of the
International Society of Blood Transfusion, ISBT 2018. Canada. 113
(Supplement 1) (pp 304), 2018. Date of Publication: June 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Patient care and blood product allocation within the hospital
can be optimized by better understanding the prevalence of patients that
receive co-transfusions of multiple blood products (multi-transfusions),
as well as the characteristics and outcomes of these multi-transfusion
recipients. However, there is a lack of literature describing the
epidemiology of multi-transfusion, as most studies concentrate on a
particular blood product and its utilization. Aims: The purpose of this
systematic review was to describe the prevalence of multi-transfusion, and
as a secondary objective, to determine any patient characteristics and
outcomes associated with multi-transfusion. Methods: The databases
Medline, EMBASE, and the Cochrane Library of Systematic Reviews were
searched. Observational cohort and cross-sectional studies of adult or
pediatric hospital patients that reported on multi-transfusion incidence
or prevalence, or on patient characteristics and outcomes associated with
multi-transfusion, were included. A descriptive synthesis of studies was
performed. Results: A total of 37 studies were identified and included, of
which 34 (92%) reported on multi-transfusion prevalence. It was found that
multi-transfusion prevalence varied greatly by patient population and by
the specific combination of blood products given in the multi-transfusion,
but changed little over time. Multi-transfused patients included those
with burns, cardiac surgery, liver transplant, cancer, infectious
diseases, trauma, patients requiring massive blood transfusions, and ICU
patients. Five studies found associations between multi-transfusion and
adverse health outcomes for cardiac surgery and liver transplant patients;
however, these findings are likely confounded by indication. The overall
quality of evidence was very low, given a fair-to-poor individual study
quality, inconsistent multi-transfu-sion estimates, and significant
confounding by indication. Summary/Conclusions: A knowledge of
multi-transfusion trends and of multi-transfusion recipients is needed to
help improve patient care and patient blood man-agement. Physician
awareness of the risks and benefits of multi-transfusion can help optimize
transfusion decision-making, leading to appropriate transfusion practice
and avoidance of unnecessary transfusions. Our research showed that in
certain patient groups, as many as 99% of patients are multi-transfused.
Yet, little is really known about these patients. Further research is
needed in several areas to gain a better understanding of the epidemiology
of multi-transfusion, including more studies on multi-transfusion in
hematologic cancer patients, and studies looking for patient
characteristics that can better predict the need for multi-transfusion.

<34>
Accession Number
622651978
Author
Jamal Uddin J.
Institution
(Jamal Uddin) Ibrahim Cardiac Hospital, Research Institute, Dhaka,
Bangladesh
Title
The effect of home-based cardiac rehabilitation following coronary artery
bypass graft surgery in a low income country: A controlled trial.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
379-380), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Background: CVD is the leading cause of mortality and morbidity in Lower
and low to middle income countries, including Bangladesh. To date no
controlled trials of cardiac rehabilitation (CR) have been conducted in
low or low to middle income countries (LLMICs). Methods: A
quasi-randomised controlled trial comparing home-based CR plus usual care
(CR group) to usual care alone (UC group) for patients following coronary
artery bypass graft (CABG) surgery. CR consisted of an initial CR class,
an educational booklet with details of a home-based exercise programme,
and monthly telephone calls from a CR team member over a 12-month period.
The outcomes of maximal oxygen uptake (VO2max), coronary risk factors,
health-related quality of life, and mental health status were collected at
baseline between at 3 and 6 months follow-up. Differences in outcomes
between groups were compared in patients with complete outcome data.
Results: A total of 142 participants participated in the trial 71 patients
in each group. At 12-months follow-up, 61 (86%) patients in the CR group
and 40 (56%) in the UC group provided complete outcome data. VO2maxwas
higher in CR compared to UC group (mean difference: 7 ml/kg/min, 95% CI: 2
to 11, P = 0.005). In addition, greater improvements in health-related
quality of life, and coronary heart disease (CHD) risk factors were seen
for CR group compared to UC group. Conclusions: In the context of a
low-income country, the addition of a home-based CR programme supported by
telephone calls following CABG surgery has been shown to provide important
patient benefits compared to usual care alone. (Table presented) .

<35>
Accession Number
622651830
Author
Vera Marinho V.; Milner J.; Alves P.; Domingues C.; Ferreira F.; Antonio
N.; Elvas L.; Goncalves F.; Pego M.
Institution
(Vera Marinho, Milner, Alves, Domingues, Ferreira, Antonio, Elvas,
Goncalves, Pego) University Hospitals of Coimbra, Cardiology, Coimbra,
Portugal
Title
Effectiveness of cardiac resynchronization therapy in heart failure
patients with valvular heart disease: Comparison with patients with
dilated cardiomyopathy.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
449-450), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Heart failure (HF) may occur in the presence of a wide range
of underlying heart diseases, including valvular heart disease (VHD). In
the majority of randomized clinical trials that validated the clinical use
of cardiac resynchronization therapy (CRT), the presence of a clinically
significant valvular heart disease were exclusion criteria. The aim of
this study was to analyze the effectiveness of CRT in patients with VHD in
comparison with dilated cardiomyopathy patients. Methods: Retrospective
single-centre study that included all patients submitted to CRT therapy
between January 2006 and December 2015. For the aims of current analysis,
the following groups were considered: 1) patients with valvular heart
disease (evidence of clinically significant primary valvular disease or
previous valve replacement or repair; 2) patients with dilated
cardiomyopathy (presence of a typical pattern of this heart disease,
without ischaemic or organic VHD). The response to CRT was evaluated
comparing the baseline with 6 month follow-up echo data. In long term
follow-up we evaluated all-cause mortality, transplantation rate and
admissions for HF. Results: A total of 431 patients submitted to
resynchronization therapy in our centre were included. Of these, 199
patients (46%) had dilated cardiomyopathy and 26(6.0%) had valvular heart
disease. Age did not differ between groups [65 (+11) vs 69 (+9) years, p =
0.253)]. There were no differences between the distribution of Diabetes
Mellitus (29% vs 24%, p = 0.574), hypertension (51% vs 42%, p = 0.531),
dyslipidemia (62% vs 75%, p = 0.331) and chronic kidney disease (29%vs53%,
p = 0.07). The distribution of LBBB (82% vs 89%, p = 0.402), and basal LV
end diastolic volume [219(104) vs 210(110), p = 0.867] was similar between
groups. At 6 months echo, there was a trend to a more positive response to
CRT in group of patients with dilated cardiomyopathy (55% vs 49%, p =
0.06). Interestingly, group 1 patients were more frequently super
responders (29 vs 6.3%, p = 0.04). The mean follow up was 42(+33) months.
Mortality (18% vs 35%, p = 0.04) was significantly lower in dilated
cardiomyopathy. Both groups did not differ in transplantation rate (6.1 vs
3.8, p = 0.538) and admissions for acute HF (29% vs 35%, p = 0.33). The
survival curves for all-cause mortality obtained by Kaplan-Meier analysis
are shown in Figure 1 and revealed a worse prognosis of patients with VHD
(Log-rank test, p = 0,037). In multivariate logistic regression analysis,
the presence of Diabetes Mellitus [4.0 (1.1-16), p = 0.04] and the VHD
etiology [6.1(1.1-33), p = 0.03] significantly increased the risk, while
responsiveness to CRT proved to have a significant protective role in the
whole patient population [0.13(0.03-0.4), p = 0.02]. Conclusions: No
randomized controlled trial has specifically evaluated the effects of CRT
in patients affected by a VHD, but on the basis of 'real world' clinical
practice, CRT appears more effective in dilated cardiomyopathy than VHD.

<36>
Accession Number
622651772
Author
Basuoni A.; El-Naggar W.A.E.L.; Mahdy M.; Al-Kaffas S.
Institution
(Basuoni, El-Naggar, Mahdy, Al-Kaffas) Cairo University Hospitals,
Cardiology, Cairo, Egypt
Title
Effect of intra-coronary (IC) Tirofiban following aspiration thrombectomy
on infarct size, in patients with large anterior ST-segment elevation
myocardial infarction (STEMI) undergoing primary PCI.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
485), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Thrombus embolization during percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
is common and results in sub-optimal myocardial perfusion and increased
infarct size. Two strategies were proposed to reduce distal embolization
and improve outcomes after primary PCI are bolus intra-coronary (IC)
Tirofiban and manual Aspiration Thrombectomy. Objective: To evaluate
effect of Intra-coronary delivery of bolus Tirofiban following Aspiration
Thrombectomy on reduction of infarct size using cardiac magnetic resonance
imaging (cMRI) in patients with large anterior STEMI undergoing primary
PCI. Methods: A Prospective single-blind randomized controlled trial was
conducted between August, 2014 and November, 2015. 50 patients with large
anterior STEMI were screened at 2 sites in one country (Egypt). Aspiration
Thrombectomy was performed in all patients using a 6 F aspiration
catheter. Patients were randomized to IC Tirofiban (Study group) and no IC
Tirofiban (control group). To ensure high intra-thrombus drug
concentrations, a 25 mcg/kg bolus of Tirofiban was administered locally at
the site of the infarct lesion via the aspiration catheter after flushing
of the aspiration catheter well. Primary end point was infarct Size at 30
Days measured by cMRI. Secondary end point was myocardial blush grade at
the end of the PCI procedure. Major Adverse Cardiac and Cerebrovascular
events (MACCE) at 30 days defined as re-infarction, stroke, severe heart
failure and death. Results: Evaluable MRI results at 30 days were present
in only 40 of 50 patients (80%), with the most common reasons for missing
data being patient re-infarction prior to 30 days and inability to
tolerate the procedure. Patients randomized to IC Tirofiban compared with
no IC Tirofiban had a significant reduction at 30 days infarct size
(median, 15451 mm3 - IQR, 17404 mm3 - n = 20) vs (median, 43828 mm3 - IQR,
49599 mm3 - n = 20) P value= 0.002. myocardial blush grade results at the
end of the PCI where present in 50 patients, randomized to IC Tirofiban
compared with no IC Tirofiban had no significant difference (P value=
0.67). There is no significant difference in MACCE at 30 days between
patients received bolus IC Tirofiban and patients who did not receive (P
value= 0.723). Conclusions: In patients with large anterior STEMI
presenting early after symptom onset and undergoing primary PCI, infarct
size at 30 days was significantly reduced by bolus IC Tirofiban delivered
to the infarct lesion site following manual Aspiration Thrombectomy. There
is no significant difference in MACCE at 30 days between patients received
bolus IC Tirofiban and patients who did not receive.

<37>
Accession Number
622651713
Author
Vlasova E.; Gazizova V.; Dzybinskaya E.; Kheymets G.; Akchurin R.
Institution
(Vlasova, Gazizova, Dzybinskaya, Kheymets, Akchurin) National Medical
Research Center Of Cardiology, Ministry Of Healthcare Of The Russian
Federati, Cardiac Surgery, Moscow, Russian Federation
Title
Preoperative levosimendan improves outcomes of coronary artery bypass
grafting in patients with poor left ventricular function: Cardiologist's
opinion.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
321), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Background: We suggested that in patients with coronary heart disease
(CHD) and low left ventricle ejection fraction (LVEF) scheduled for
coronary artery bypass grafting (CABG), levosimendan (L) when administered
preoperatively would effect the outcomes of operation and early
postoperative period. Purpose: to determine the benefit of preoperative
levosimendan administration in patients with low LVEF underwent CABG.
Methods: The design of investigation was non-randomised study with
retrospective control 46 patients with multivessel coronary disease and
LVEF = 35%, subjected to on-pump CABG in 2014-2017 were included. All pts
received standart therapy for congestive heart failure (ACE-inhibitor,
s-blocker, spironolactone, diuretic, statin, aspirin) and were not taken
to surgery until maximal possible compensation. 17 pts (mean age 64+/-5
years, 82.7% male), received L, administered by a cardiologist, as
infusion of 12.5mg for 24 h, without a bolus, 2 days before surgery (group
L). 29 pts (mean age 60+/-6 years, 82.3% male) made up the retrospective
control group (group C). Results: One patient in the group C but none in
the group L died within 30 days of surgery. Need for inotropic support in
preperfusion period was 12% in group L and 48% in group C, p = 0,023.
Failure to wean developed in 12% vs 48% in groups L and C resp., p =
0,023. In group L the incidence of preperfusion atrial fibrillation and
re-cardiopulmonary bypass (CPB) were lower. Doses of dopmin, epinephrine
and norepinephrine at the end of the operation were lower in group L. CPB
duration, tracheal intubation time, length of inotropic support, length of
Intensive Care Unit stay and postoperative length of stay were shorter in
group L. Those differences did not reach statistical significance probably
due to the small number of pts in the group L. Conclusion: In CHD-patients
with low LVEF a preoperative levosimendan definitely shows
cardioprotective effects that could provide better results of CABG and
benefits in the postoperative period.

<38>
Accession Number
622651683
Author
Volha Sujayeva V.
Institution
(Volha Sujayeva) Republican Scientific and Practical Centre of Cardiology,
Minsk, Belarus
Title
The influence of personalized program of physical trainings on tolerance
to physical loading, aerobic physical capacity and character of myocardial
vascularization in patients with terminal heart fail.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
270), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Purpose: to develop personalized program of cardiac rehabilitation of
patients with terminal heart failure before and after heart
transplantation based on pathophysiological mechanisms of tolerance to
physical loading decreasing and to estimate its efficiency. Methods: 32
patients with terminal heart failure before heart transplantation (age
46.4+/-12.1 y.o.) and 81 pts after heart transplantation (age 45.2+/-12.1
y.o.). We defined both tolerance to physical loading (TPL) and aerobic
physical capacity in condition of Spiro Bicycle Ergometry Test (spiroBET)
before heart transplantation (I test), in 6 and 12 month after heart
transplantation (II and III test, correspondingly). In the same times we
also performed echocardiography (EcoCG) and endomyocardial biopsy (EMB) to
study both myocardial rejection and character of myocardial
vascularization. Results: Before heart transplantation al pts had low TPL
- 62.9+/-4.4 Wt (33.9+/-2.3% of age-appropriate level). Patients were
randomized in to 2 Groups: Group 1 received individual controlled bicycle
physical trainings, pts in Group 2 didn't have bicycle physical trainings.
Type of the training load depended on individual character of blood
circulatory system reaction on spiroBET. The main principle of the
training loading selection - taking into the account individual level of
power when anaerobic threshold was reached. In Group 1 we established more
pronounced improvement of TPL than in Group 2. TPL in Group 1 increased
from 62.9+/-4.4 Et - at I test to 118.8+/-23.9 Wt - at III test (p <
0.05), in Group 2 - to 87.5+/-17.7Wt, p < 0.05. We estimated aerobic
physical capacity according to maximal oxygen uptake (VO2max) level. It
was 19.9+/-4.0 ml/kg/min in Group 1 and only 15.4+/-6.2 ml/kg/min - in
Group 2 at III test (p < 0.05). In Group 1 we also revealed more
pronounced than in Group 2 improvement of systolic and diastolic function
of a left ventricle according to EcoCG within 12 months after heart
transplantation (p < 0.05). The average number of vessels on 10 fields of
vision haven't changed significantly during all period of study: it was
69.5+/-17.4 in Group 1 and 68.0+/-13.3 - in Group 2 at the I test,
63,7+/-12.4 and 70.8+/-15.6 - at II, and 65.2+/-3.3, 77.9+/-7.0 - at III
test, correspondingly (>0,05). The sum of vessels on 10 fields of vision
also haven't changed: it was 694.6+/-173.8 and 679.7+/-132.5 - in Group 1
and 2 at the I test, 637.4+/-123.8 and 708.3+/-155.9 - at the II test,
588,8+/-117.2 and 779.0 - at III test, accordingly (>0,05). Thus, the
cardiac rehabilitation improves TPL and aerobic physical capacity without
significant influence on character of microvasculature in patients with
heart failure after heart transplantation.

<39>
Accession Number
622651555
Author
Christian Roth C.; Schneider M.; Dalos D.; Gangl C.; Berger R.
Institution
(Christian Roth, Schneider, Dalos, Gangl, Berger) Medical University of
Vienna, Department of Internal Medicine II, Division of Cardiology,
Vienna, Austria
Title
Coronary artery bypass surgery versus percutaneous coronary intervention
in patients with ischemic cardiomyopathy. Long term outcome depends on
severity of heart failure.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
571), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Registries and a meta-analysis suggested a similar survival benefit
from percutaneous coronary intervention (PCI) compared to coronary artery
bypass graft surgery (CABG) over medical therapy alone for treatment of
ischemic cardiomyopathy. The severity of heart failure may impact the
long-term results of these different revascularisation strategies. Methods
and Results: Patients with moderate to severe left ventricular systolic
dysfunction and multivessel disease who underwent either PCI with
drug-eluting stents (DES) or CABG were selected from the catheter
laboratory database of the Medical University of Vienna. The primary
outcome was long-term all-cause death. Among 398 patients (340 PCI, 58
CABG) the mode of revascularisation did not contribute to the prediction
of death (univariate analysis - p = 0.336; Kaplan-Meier analysis - p =
0,442 during a median observation period of 1,495 (819/2,458) days),
whereas NT-proBNP was the strongest predictor of long-term all-cause
death. In patients with advanced heart failure (NTproBNP > median
3042pg/ml, n = 199) themode of revascularisation was an independent
predictor of death. In the Kaplan-Meier analysis patients with CABG had a
better long-term survival compared to patients with PCI (p = 0.035).
Conclusions: Among patients with ischemic cardiomyopathy, PCI with DES had
comparable long-term survival compared with CABG. However, patients with
advanced heart failure may benefit from CABG compared to PCI.

<40>
Accession Number
622651152
Author
Bortsova M.A.; Sitnikova M.U.; Demchenko E.A.; Lelyavina T.A.; Babich
O.A.; Galenko V.L.; Fedotov P.A.
Institution
(Bortsova, Sitnikova, Lelyavina, Galenko, Fedotov) Federal Almazov
North-West Medical Research Centre, Heart Failure, Saint-Petersburg,
Russian Federation
(Demchenko, Babich) Federal Almazov North-West Medical Research Centre,
Saint-Petersburg, Russian Federation
Title
Efficiency and safety of physical rehabilitation in patients with chronic
heart failure III-IV class NYHA candidates for heart transplantation.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
86), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Purpose: To asses the efficiency of physical rehabilitation in patients
with chronic heart failure (CHF) III-IV class NYHA candidates for heart
transplantation (HT). Methods: In pilot study were included 51 men,
candidates for heart transplantation, aged 20-65 years old, LVEF = 30%
Simpson, ischemic etiology or dilated cardiomyopathy, stabilizated in NYHA
class III-IV CHF during = 2 weeks, BP = 90/60 mm Hg, HR = 100 beats per
minute, treated with standart therapy of CHF. Patients with sustained
ventricular tachycardia, myocardial infarction (MI) and pulmonary embolism
(PE) during the previous 3 months, unstable angina pectoris during 1 month
and stroke for 6 months were not included. Safety of physical
rehabilitation program (PRP) was monitored with continuous
cardiomonitoring during training in the presence of a cardiologist and a
physiotherapist. Patients were randomized into 2 groups: 1-st -
participating in PRP (n = 26), 2-nd (control) - standard therapy of CHF (n
= 25). The duration of follow-up was 6 months. Results: Both groups were
comparable in age, background cardiac and concomitant pathology. In both
groups, patients received standard CHF therapy: in 1-st group and in 2-nd
group: ACEI/ARA - 24 and 23 patients, s-blockers - 23 and 21 patients,
aldosterone antagonists - 24 and 16 patients, loop diuretics - 26 and 25
patients , thiazides - 8 and 4 patients, amiodarone - 14 and 10 patients,
respectively. In both groups, a comparable number of patients finish the
study: In 1-st group - 18 patients, early completion of 8 patients: 2
deaths, 6 - HT. In 2-nd group - 16 patients, early completion of 7
patients: 3 deaths, 4 - HT. In both groups, there were no statistically
significant differences in the number of deaths. In both groups up to 6-th
month, there was a comparable number of patients who switched to II NYHA
class : 6 in group 1 and 5 in group 2. In the 1-st group there were not
observed life-threatening ventricular arrhythmia during exercising and
within 3 hours after. After 6 months in 1-st group PE was not established
while in 2-nd group were observed 4 cases, without statistical
significance. In group 1, there was a statistically significant decrease
in the number of the lower respiratory tract infections (LRTI): bronchitis
+ pneumonia compared to the 2-nd group: 5 and 18 patients, respectively (p
= 0.001). Conclusions: 1. Participation in an individually designed PRP
does not increase mortality and the number of life-threatening ventricular
arrhythmias in patients with stabilization of CHF in III-IV NYHA class. 2.
Participation in an individually designed PRP does not cause progression
of CHF in patients with stabilization of CHF in III-IV NYHA class. 3.
Patients participating in an individually PRP have a lower number of LRTI
compared with the control group.

<41>
Accession Number
622650973
Author
Galati G.; Di Lenarda A.; Margonato A.
Institution
(Galati, Margonato) San Raffaele Hospital and Scientific Institute
(IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and
Vascular Department, Milan, Italy
(Di Lenarda) Cardiovascular Center A.S.S. 1 of Trieste, Cardiovascular
Department, Trieste, Italy
Title
Clinical-pathological profiles responsible for advanced heart failure,
heart transplantation, left ventricular assist device implantation and
death for heart failure in Hypertrophic cardiomyopathy.
Source
European Journal of Heart Failure. Conference: Heart Failure 2018 and the
5th World Congress on Acute Heart Failure. Austria. 20 (Supplement 1) (pp
493), 2018. Date of Publication: May 2018.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Over the last 50 years, advanced heart failure (AdvHF) in
hypertrophic cardiomyopathy (HCM) was overlooked. Neither large case
series nor clinical trials on this topic have been reported. The main
clinical-pathological profiles responsible for AdvHF in HCM are: 1)
End-stage HCM (ES-HCM) defined by an ejection fraction (EF) = 50%; 2)
Left-Ventricular outflow obstruction despite optimal pharmacological and
not pharmacological therapy (Refractory HOCM); 3) Nonobstructive HCM with
preserved EF (HNOCMpEF). Purpose: Based on a systematic revision of all
published manuscripts on this topic, this study describes the prevalence
of the three main HCM phenotypes responsible for AdvHF, heart
transplantation (HTx), left-ventricular assist device (LVAD) implantation
and death for heart failure (HF) despite the contemporary management of
HCM. Methods: The study screened 120 manuscripts in MEDLINE and EMBASE on
HCM cases of AdvHF and HTx published since 2000 until December 2017, in
adult patients ( = 18 years old). The authors identified 8 manuscripts
eligible for the analysis, 4 of whom where excluded for incomplete
information before HTx. 205 patients with AdvHF due to HCM, despite
optimal therapy, were included in the main analysis. AdvHF was defined by
severe NYHA symptoms (class III and IV), because in all the manuscripts
this definition was used. Minimum reported follow-up was 6.1 years.
Results: Table 1 shows the prevalence of phenotypes responsible for
AdvHF/HTx/LVAD implantation/HF-Death. Of 205 HCM patients, 119 (58%)
underwent HTx, LVAD implantation or died for HF. Conclusion: AdvHF in HCM
has a poor prognosis. With the current management of HOCM only a very
little percentage of these patient experiences AdvHF. Less than 1/3 of
HNOCMpEF patients had AdvHF due to restrictive physiology and less than
1/4 of these patients had a poor prognosis. Nowadays, ES-HCM represents
the main cause of AdvHF inHCMand the major determinant for poor outcome.
Although it has been managed with HTx or LVAD implantation, a significant
percentage (78.5%) died for HF. This reflect poor attention and portrays
an unmet need for ES-HCM patients. These findings reinforce the emphasis
on long-term surveillance of HCM patient in order to timely identify
patients at risk of ES evolution and early start the standard HF
therapeutic (pharmacological and non-pharmacological) armamentarium (Table
Presented).

<42>
Accession Number
622640991
Author
Liu L.; Huang J.; Zhang X.; Tang X.
Institution
(Liu, Zhang, Tang) Department of Cardiology, First Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Huang) Department of Cardiology, Chongqing Emergency Medical Center,
Chongqing, China
Title
Efficacy and safety of triple therapy versus dual antiplatelet therapy in
patients with atrial fibrillation undergoing coronary stenting: A
meta-analysis.
Source
PLoS ONE. 13 (6) (no pagination), 2018. Article Number: e0199232. Date of
Publication: June 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The optimal antithrombotic therapy for atrial fibrillation (AF)
patients undergoing coronary stenting is unknown. The present
meta-analysis sought to investigate the efficacy and safety of triple
therapy (TT; warfarin, clopidogrel and aspirin) vs dual antiplatelet
therapy (DAPT; clopidogrel plus aspirin) in those patients. Methods PubMed
and Cochrane Library were searched for studies enrolling AF patients
undergoing coronary stenting on TT and DAPT up to September 2016, and
fourteen studies were included. Efficacy outcomes included ischemic
stroke, stent thrombosis, major adverse cardiovascular event (MACE),
all-cause mortality and myocardial infarction (MI); safety outcome was
major bleeding. We conducted meta-analysis and used odds ratio (OR) with
95% confidence intervals (CI) to compare TT and DAPT. Meta-regression,
sensitivity and subgroup analysis were taken to investigate the source of
heterogeneity in the outcome of major bleeding. Results 14 eligible
observational studies with 11,697 subjects were identified. Compared with
DAPT, TT had decreased the risk of ischemic stroke [OR = 0.74, 95% CI
(0.59, 0.93), P = 0.009] and stent thrombosis [OR = 0.40, 95% CI (0.18,
0.93), P = 0.033]. While, there was an increased risk of major bleeding
[OR = 1.55, 95% CI (1.16, 2.09), P = 0.004] associated with TT. The risk
of MACE, all-cause mortality and MI had no significant statistical
difference between TT and DAPT. Furthermore, the results of univariate and
multivariate meta-regression analysis implicated that there were no
obvious correlations between certain baseline characteristics (age,
gender, race, hypertension, study design) and risk of major bleeding. Also
of major bleeding, the findings of sensitivity analysis were generally
robust, and a prespecified subgroup analysis of race demonstrated that the
source of heterogeneity might attribute to Asian studies mostly.
Conclusions TT reduced the risk of ischemic stroke and stent thrombosis
with an acceptable major bleeding risk compared with DAPT, and TT was
considered as a valid alternative in AF patients undergoing coronary
stenting. Further prospective randomized trials are needed to ensure the
reliability of these data and find the optimal therapeutic strategy in
this setting of patients.<br/>Copyright &#xa9; 2018 Liu et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<43>
Accession Number
2000878287
Author
Duan X.; Coburn M.; Rossaint R.; Sanders R.D.; Waesberghe J.V.; Kowark A.
Institution
(Duan) Department of Anaesthesiology, The Affiliated Hospital of Southwest
Medical University, LuZhou, China
(Duan, Coburn, Rossaint, Waesberghe, Kowark) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Sanders) Department of Anesthesiology, School of Medicine and Public
Health, University of Wisconsin, Madison, WI, United States
Title
Efficacy of perioperative dexmedetomidine on postoperative delirium:
systematic review and meta-analysis with trial sequential analysis of
randomised controlled trials.
Source
British Journal of Anaesthesia. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Background: Dexmedetomidine's influence on postoperative delirium (POD) in
adult surgical patients remains controversial. We aimed to analyse whether
dexmedetomidine could decrease POD incidence in this population and to
address the dependency on dexmedetomidine administration timing and
patients' age. Methods: We used random-effects modelled meta-analysis,
trial sequential analysis, and followed Cochrane methodology with Grading
of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed
and Cochrane library were searched up to July 2017 for randomised
controlled trials that analysed POD incidence of adult surgical patients
(age >=18 yr) after dexmedetomidine administration. Results: Eighteen
studies (comprising 3309 patients) were included and showed decreased risk
of POD with dexmedetomidine for entire adult surgical population [odds
ratio (OR) 0.35; 95% confidence interval (CI) 0.24-0.51)], with firm
evidence from trial sequential analysis. Pre-specified subgroup analyses
confirmed this result with firm evidence for cardiac and non-cardiac
surgical patients, (OR 0.41; 95% CI 0.26-0.63) and (OR 0.33; 95% CI
0.18-0.59), respectively. We also revealed firm evidence for a reduction
of POD, if dexmedetomidine is administered during postoperative period (OR
0.30; 95% CI 0.21-0.44), in patients aged <65 yr (OR 0.19; 95% CI
0.10-0.36) or >=65 yr (OR 0.44; 95% CI 0.30-0.65). Evidence for
dexmedetomidine's influence on secondary outcomes (in-hospital mortality,
intensive care unit- and hospital length of stay, bradycardia, and
hypotension) is thus far insufficient to draw any conclusion. Conclusion:
Dexmedetomidine may reduce POD incidence for adult cardiac and non-cardiac
surgical patients. The optimal dose and timing of dexmedetomidine and
influence on other outcomes or particular patient populations with risk
factors warrants further studies. Clinical trial registration: PROSPERO:
CRD42017072380.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<44>
Accession Number
2000877776
Author
Villanueva C.; Talwar A.; Doyle M.
Institution
(Villanueva, Talwar) Cardiothoracic Surgery Unit, Royal North Shore
Hospital, Sydney, Australia
(Villanueva) Conjoint Lecturer University of New South Wales, Sydney,
Australia
(Doyle) Cardiothoracic Surgery Unit, St George Hospital, Sydney, Australia
Title
Improving informed consent in cardiac surgery by enhancing preoperative
education.
Source
Patient Education and Counseling. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To investigate the effect of enhancing preoperative education
in improving recall and understanding of a surgical procedure and its
application to the informed consent process in cardiac surgery. Methods:
Four electronic database searches were performed from January 2000 to
August 2017. A total of 282 articles were identified from which 22
prospective studies assessing an intervention were selected according to
predefined selection criteria. Results: Most articles that used additional
written information and all that used multimedia presentations to enhance
informed consent showed that their intervention improved risk recall and
patient's understanding of the procedure. A single randomised controlled
trial in cardiac surgery showed that audiotaped consultations improved
patient's knowledge of the operation. Conclusions: Patient recall and
understanding of pre-operative information can significantly improve with
a variety of educational tools. Procedure-specific forms with or without
illustrations as well as interactive multimedia interventions enhance
patient recall and understanding of information. In cardiac surgery
patients, interventions need to meet patients' preferences, be repetitive
on crucial points and consider the nature of the procedure.<br/>Copyright
&#xa9; 2018 Elsevier B.V.

<45>
Accession Number
2000873413
Author
Moskowitz E.E.; Garabedian L.; Harden K.; Perkins-Pride E.; Asfaw M.;
Preslaski C.; Liasia K.N.; Lawless R.; Burlew C.C.; Pieracci F.
Institution
(Moskowitz, Garabedian, Harden, Perkins-Pride, Asfaw, Preslaski, Liasia,
Lawless, Burlew, Pieracci) Denver Health Medical Center, University of
Colorado School of Medicine, United States
Title
A double-blind, randomized controlled trial of gabapentin vs. placebo for
acute pain management in critically ill patients with rib fractures.
Source
Injury. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Ltd
Abstract
Introduction: Achieving adequate pain control for rib fractures remains
challenging; prescription of alternatives to narcotics is imperative to
curtail the current opioid epidemic. Although gabapentin has shown promise
following elective thoracic procedures, its efficacy in patients with rib
fractures remains unstudied. We hypothesized that gabapentin, as compared
to placebo, would both improve acute pain control and decrease narcotic
use among critically ill patients with rib fractures. Materials and
Methods: Adult patients admitted to the trauma surgery service from
November 2016 - November 2017 at an urban, Level I trauma center with one
or more rib fractures were randomized to either gabapentin 300 mg thrice
daily or placebo for one month following their injury. Daily numeric pain
scores, opioid consumption, oxygen requirement, respiratory rate, and
incentive spirometry recordings during the index admission, as well as and
one-month quality of life survey data were abstracted. Results: Forty
patients were randomized. The groups were well matched with respect to
age, gender, prior narcotic use, tobacco use, and prior respiratory
disease. Although the median RibScore did not differ between groups, the
gabapentin group had a higher median number of ribs fractured as compared
to the placebo group (7 vs. 5, respectively). Degree of pulmonary
contusion and injury severity score were similar between groups. Use of
loco-regional anesthetic modalities did not differ between groups. Daily
numeric pain scores, opioid consumption, oxygen requirement, respiratory
rate, and incentive spirometry recordings were similar between both
groups. No benefit was observed when adding gabapentin to a multi-modal
analgesic regimen for rib fractures. There were no instances of pneumonia,
respiratory failure, or mortality in either group. Hospital and intensive
care unit length of stay were similar between groups. Both overall and
chest-specific quality of life was equivalent between groups at one month
follow-up. Conclusions: In this group of critically ill patients with rib
fractures, gabapentin did not improve acute outcomes for up to one month
of treatment.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<46>
Accession Number
622656967
Author
Kallistratos M.S.; Poulimenos L.E.; Giannitsi S.; Tsinivizov P.; Manolis
A.J.
Institution
(Kallistratos, Poulimenos, Giannitsi, Tsinivizov, Manolis) Cardiology
Department, Asklepieion General Hospital, Athens, Greece
Title
Trimetazidine in the Prevention of Tissue Ischemic Conditions.
Source
Angiology. (no pagination), 2018. Date of Publication: 2018.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Trimetazidine (TMZ) is a metabolic agent with significant anti-ischemic
properties. By inhibiting the terminal enzyme in the beta-oxidation
pathway, it shifts the energy substrate metabolism, enhancing glucose
metabolism. Thus, it maintains the required energy production with less
oxygen consumption, an effect necessary in cases of myocardi.
Trimetazidine was recently reaccredited as add-on therapy for symptomatic
treatment in patients with stable angina, not adequately controlled or
intolerant to first-line therapy. Trimetazidine was included in the
European Society of Cardioloy 2013 guidelines for the management of stable
coronary artery disease. Although TMZ has been used in cardiology for >40
years, only a few studies have assessed its effects in patients with acute
ischemic conditions. This review summarizes the current literature
regarding the addition of TMZ in patients with acute ischemic conditions
(acute myocardial infarction, ST-segment elevation myocardial infarction,
non-ST-segment elevation myocardial infarction, percutaneous coronary
intervention, and coronary artery bypass grafting). There is growing
evidence from recent studies that the addition of TMZ in patients with
such conditions is beneficial in terms of myocardial damage and major
cardiac events as well as decreasing reperfusion injury and
contrast-induced nephropathy.<br/>Copyright &#xa9; 2018, The Author(s)
2018.

<47>
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.

<48>
Accession Number
622578241
Author
Elguindy M.; Stables R.; Nicholas Z.; Kemp I.; Curzen N.
Institution
(Elguindy, Stables, Kemp) Institute of Cardiovascular Medicine and
Science, London, United Kingdom
(Elguindy, Stables, Kemp) Liverpool Heart and Chest Hospital NHS
Foundation Trust, United Kingdom
(Nicholas, Curzen) Wessex Cardiothoracic Centre, University Hospital
Southampton NHS Foundation Trust, Department of Cardiology, E Level N
Wing, Tremona Rd, Southampton SO16 6YD, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, United Kingdom
Title
Design and Rationale of the RIPCORD 2 Trial (Does Routine Pressure Wire
Assessment Influence Management Strategy at Coronary Angiography for
Diagnosis of Chest Pain?): A Randomized Controlled Trial to Compare
Routine Pressure Wire Assessment with Conventional Angiography in the
Management of Patients with Coronary Artery Disease.
Source
Circulation: Cardiovascular Quality and Outcomes. 11 (2) (no pagination),
2018. Article Number: e004191. Date of Publication: 01 Feb 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Investigation of anginal chest pain has traditionally involved
either assessment of the coronary anatomy by angiography or noninvasive
testing for reversible ischemia. Invasive pressure wire assessment at the
time of angiography offers information on both anatomy and physiology.
Fractional flow reserve-guided percutaneous coronary intervention is
associated with lower resource utilization and improved clinical outcome
compared with angiographic guidance alone. However, the value of routine
fractional flow reserve of all major coronary vessels at the time of
diagnostic angiography has not been established in a randomized trial
despite persuasive observational data. A change in practice to routine
fractional flow reserve assessment of all major vessels during diagnostic
angiography would require evidence not just of clinical benefit but also
of cost effectiveness. This randomized trial aims to test that strategy.
Methods and Results: RIPCORD 2 (Does Routine Pressure Wire Assessment
Influence Management Strategy at Coronary Angiography for Diagnosis of
Chest Pain?) is an 1100 patient prospective, multicenter, randomized
trial. Participants are randomized, after initial coronary angiography,
and in equal proportion, to assessment and management according to (1)
conventional angiography only or (2) additional routine pressure wire
assessment in all epicardial vessels of sufficient size to be amenable to
revascularization. The primary economic outcome measure will be a
comparison of healthcare costs at 1 year. The primary quality-of-life
outcome measure analysis will compare patient-reported quality-of-life
scores at 1 year. Secondary outcome measures include clinical events at 1
year, management strategy (optimal medical therapy with or without
revascularization), and angina status at 1 year according to Canadian
Cardiovascular Society angina grade. Conclusions: The aim of the RIPCORD 2
trial is to assess whether a strategy of routine fractional flow
reserve-guided assessment and management of all major coronary arteries
will be associated with more effective resource utilization, improved
quality of life, and better clinical outcome, compared with angiographic
guidance alone.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<49>
Accession Number
622577976
Author
Sessler D.I.; Meyhoff C.S.; Zimmerman N.M.; Mao G.; Leslie K.; Vasquez
S.M.; Balaji P.; Alvarez-Garcia J.; Cavalcanti A.B.; Parlow J.L.; Rahate
P.V.; Seeberger M.D.; Gossetti B.; Walker S.A.; Premchand R.K.; Dahl R.M.;
Duceppe E.; Rodseth R.; Botto F.; Devereaux P.J.
Institution
(Sessler, Zimmerman, Mao) Departments of Outcomes Research, Anesthesiology
Institute, Cleveland Clinic, 9500 Euclid Ave-P77, Cleveland, OH 44195,
United States
(Zimmerman, Mao) Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg
Hospital, United States
(Meyhoff, Dahl) Department of Anaesthesiology, Herlev Hospital, University
of Copenhagen, Copenhagen, Denmark
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Australia
(Vasquez) Department of Research, Grupo de Cardiologia Preventiva
Universidad Autonoma de Bucaramanga, Fundacion CardioInfantil Instituto de
Cardiologia, Bucaramanga, Colombia, Colombia
(Balaji) Anaesthetic Department, Hull and East Yorkshire Hospitals,
National Health Service Trust, Hull, East Yorkshire, United Kingdom
(Alvarez-Garcia) Department of Cardiology, Hospital de la Santa Creu i
Sant Pau, Universidad Autonoma de Barcelona, Barcelona, Spain
(Cavalcanti) Research Institute, Hospital Do Coracao, Sao Paulo, Brazil
(Parlow) Department of Anesthesia, Queen's University and Kingston General
Hospital, Kingston, Canada
(Rahate) Rahate Surgical Hospital, Nagpur, Maharashtra, India
(Seeberger) Department of Anesthesia and Intensive Care Medicine,
University Hospital Basel, University of Basel, Basel, Switzerland
(Gossetti) Department of Vascular Surgery, Sapienza University of Rome,
Rome, Italy
(Walker) Counties Manukau District Health, Aukland, New Zealand
(Premchand) Krishna Institute of Medical Sciences, Hyderbad, India
(Dahl) Department of Pediatrics, Hvidovre Hospital, Copenhagen, Denmark
(Rodseth) Department of Anaesthetics, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Botto) Hypertension and Vascular Aging Center, Hospital Universitario
Austral, Pilar, Argentina
(Devereaux) Departments of Health Research Methods, Evidence, and Impact
and Medicine, McMaster University, Hamilton, Canada
(Sessler, Duceppe, Devereaux) Population Health Research Institute,
Hamilton, Canada
Title
Period-dependent Associations between Hypotension during and for Four Days
after Noncardiac Surgery and a Composite of Myocardial Infarction and
Death: A Substudy of the POISE-2 Trial.
Source
Anesthesiology. 128 (2) (pp 317-327), 2018. Date of Publication: 01 Feb
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The relative contributions of intraoperative and postoperative
hypotension to perioperative morbidity remain unclear. We determined the
association between hypotension and a composite of 30-day myocardial
infarction and death over three periods: (1) intraoperative, (2) remaining
day of surgery, and (3) during the initial four postoperative days.
Methods: This was a substudy of POISE-2, a 10,010-patient
factorial-randomized trial of aspirin and clonidine for prevention of
myocardial infarction. Clinically important hypotension was defined as
systolic blood pressure less than 90 mmHg requiring treatment. Minutes of
hypotension was the exposure variable intraoperatively and for the
remaining day of surgery, whereas hypotension status was treated as binary
variable for postoperative days 1 to 4. We estimated the average relative
effect of hypotension across components of the composite using a distinct
effect generalized estimating model, adjusting for hypotension during
earlier periods. Results: Among 9,765 patients, 42% experienced
hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30
days of surgery. Intraoperatively, the estimated average relative effect
across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12;
P < 0.001) per 10-min increase in hypotension duration. For the remaining
day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001)
per 10-min increase in hypotension duration. The average relative effect
odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with
hypotension during the subsequent four days of hospitalization.
Conclusions: Clinically important hypotension-A potentially modifiable
exposure-was significantly associated with a composite of myocardial
infarction and death during each of three perioperative periods, even
after adjustment for previous hypotension.<br/>Copyright &#xa9; 2018
Lippincott Williams and Wilkins. All rights reserved.

<50>
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.

<51>
Accession Number
622577731
Author
Fearon W.F.; Nishi T.; De Bruyne B.; Boothroyd D.B.; Barbato E.; Tonino
P.; Juni P.; Pijls N.H.J.; Hlatky M.A.
Institution
(Fearon, Nishi, Hlatky) Division of Cardiovascular Medicine, Stanford
Cardiovascular Institute, Stanford University School of Medicine, 300
Pasteur Dr, H2103, Stanford, CA 94305-5218, United States
(Boothroyd) Quantitative Sciences Unit, United States
(Hlatky) Department of Health Research and Policy, United States
(De Bruyne, Barbato) Stanford University School of Medicine, Stanford
Cardiovascular Institute, CA. Cardiovascular Center Aalst, Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Tonino, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, ON, Canada
Title
Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided
Percutaneous Coronary Intervention in Patients with Stable Coronary Artery
Disease.
Source
Circulation. 137 (5) (pp 480-487), 2018. Date of Publication: 30 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Previous studies found that percutaneous coronary intervention
(PCI) does not improve outcome compared with medical therapy (MT) in
patients with stable coronary artery disease, but PCI was guided by
angiography alone. FAME 2 trial (Fractional Flow Reserve Versus
Angiography for Multivessel Evaluation) compared PCI guided by fractional
flow reserve with best MT in patients with stable coronary artery disease
to assess clinical outcomes and cost-effectiveness. Methods: A total of
888 patients with stable single-vessel or multivessel coronary artery
disease with reduced fractional flow reserve were randomly assigned to PCI
plus MT (n=447) or MT alone (n=441). Major adverse cardiac events included
death, myocardial infarction, and urgent revascularization. Costs were
calculated on the basis of resource use and Medicare reimbursement rates.
Changes in quality-adjusted life-years were assessed with utilities
determined by the European Quality of Life-5 Dimensions health survey at
baseline and over follow-up. Results: Major adverse cardiac events at 3
years were significantly lower in the PCI group compared with the MT group
(10.1% versus 22.0%; P<0.001), primarily as a result of a lower rate of
urgent revascularization (4.3% versus 17.2%; P<0.001). Death and
myocardial infarction were numerically lower in the PCI group (8.3% versus
10.4%; P=0.28). Angina was significantly less severe in the PCI group at
all follow-up points to 3 years. Mean initial costs were higher in the PCI
group ($9944 versus $4440; P<0.001) but by 3 years were similar between
the 2 groups ($16 792 versus $16 737; P=0.94). The incremental
cost-effectiveness ratio for PCI compared with MT was $17 300 per
quality-adjusted life-year at 2 years and $1600 per quality-adjusted
life-year at 3 years. The above findings were robust in sensitivity
analyses. ConclusionS: PCI of lesions with reduced fractional flow reserve
improves long-term outcome and is economically attractive compared with MT
alone in patients with stable coronary artery disease. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01132495.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<52>
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.

<53>
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

<54>
Accession Number
622627671
Author
Winter M.-P.; Zbiral M.; Kietaibl A.; Sulzgruber P.; Kastner J.; Rosenhek
R.; Binder T.; Lang I.; Goliasch G.
Institution
(Winter, Zbiral, Kietaibl, Sulzgruber, Kastner, Rosenhek, Binder, Lang,
Goliasch) Department of Internal Medicine II, Division of Cardiology,
Medical University Vienna, Vienna, Austria
Title
Normal values for doppler Echocardiographic Assessment of prosthetic valve
function after TAVR-A systematic review and meta-analysis.
Source
Wiener Klinische Wochenschrift. Conference: Osterreichische Kardiologische
Gesellschaft Jahrestagung, OKG 2018. Austria. 130 (2 Supplement 1) (pp
S69), 2018. Date of Publication: June 2018.
Publisher
Springer-Verlag Wien
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
an attractive, minimally invasive alternative to surgical AVR in patients
at high and intermediate surgical risk. Particularities specific to TAVR
and a rapidly growing number of available prosthesis make post-procedural
assessment of valve function challenging. Aim of the present analysis was
to collect and pool all available data cin the literature regarding normal
doppler values for transcatheter prosthetic heart valves and to provide a
comprehensive overview. Methods: A PRISMA checklist-guided systematic
review and meta-analysis of prospective observational studies or national
and device specific registries or randomized clinical trials was
conducted. Studies were identified by searching PUBMED, SCOPUS, Cochrane
Central Register of Controlled Trials and LILACs from 01/2000 to 03/2017.
Results: Out of 240 abstracts, 155 studies (entailing a total of 27,159
patients) reported echocardiographic parameters. 55 studies in 7778
patients for the CoreValve, SAPIEN valve: 35 studies with 4942 patients,
SAPIEN XT: 32 studies with 3557, SAPIEN III:12 studies with 6231 patients,
Direct Flow Medical Transcatheter valve: 12 studies with 816 patients,
LOTUSTM Valve: 8 studies with 984 patients, EvolutTM R valve:4 studies
with 872 patients, JenaValveTM: 4 studies with 206 patients, ACURATE
TATM:10 studies with 1161 patients, ACURATE neoTM valve: 5 studies with
273 patients, PorticoTM valve: 4 studies with 191 patients for the and the
EngagerTM valve:4 studies with 148 patients. The pooled means and standard
deviations for all available TAVR prosthesis were classified according to
implanted valve size and time since implantation. We observed a mild
increase in the different doppler indices from the discharge to the long
term follow up (Fig. 1). However the changes were minor reassuring the
stable haemodynamic performance of the different TAVR prosthesis. Second
and third generation successors of the available TAVR prosthesis tended to
show superior hemodynamic characteristics as compared to the first
generation devices. We found no significant difference in mean
transprosthetic gradient between the Edwards Sapien and the Sapien XT
(9.85 +/- 4.19 mmHg, vs. 9.94 +/- 4.7 mmHg, p = 0.40). Interestingly the
analysis revealed a significant higher mean gradient of the Edwards Sapien
III valve as compared to the Edwards Sapien (10.45 +/- 4.91 vs. 9.85 +/-
4.19 mmHg. P < 0.001) and the Edwards Sapien XT (10.45 +/- 4.91 vs. 9.94
+/- 4.7 mmHg, p < 0.001). In contrast to this, the newer Medtronic
EvolutTM R showed significant lower mean gradients at baseline as compared
to the Medtronic CoreValve (7.41 +/- 4.7 vs. 8.53 +/- 4.7, p < 0.001).
Conclusions: The present study firstly describes a pooled analysis of
normal values for all available TAVR prosthesis to empower physicians with
a reliable tool to perform follow-up echocardiographic assessment in TAVR
patients and to safely identify patients with prostheses dysfunction.

<55>
Accession Number
622627666
Author
Podesser B.; Chalupsky L.; Dietl W.; Nagel F.; Dunkel E.; Hofer C.;
Trescher K.; Holzinger C.
Institution
(Podesser, Chalupsky, Dietl, Nagel, Dunkel, Hofer, Trescher, Holzinger)
Center for Biomedical Research, Medical University Vienna, Vienna, Austria
Cardiovascular Surgery, Landesklinikum St. Polten, St. Polten, Austria
Title
Early and mid-term results of new rapid deployment and sutureless valves
for aortic valve replacement.
Source
Wiener Klinische Wochenschrift. Conference: Osterreichische Kardiologische
Gesellschaft Jahrestagung, OKG 2018. Austria. 130 (2 Supplement 1) (pp
S139-S140), 2018. Date of Publication: June 2018.
Publisher
Springer-Verlag Wien
Abstract
Background: As a result of a continuously ageing population the prevalence
of age-related cardiac diseases is steadily increasing. This is certainly
also true for degenerative calcified aortic valve stenosis. Surgical
aortic valve replacement (AVR) is still the standard treatment for
symptomatic calcified aortic valve stenosis. As surgical procedures in
elderly multimorbid patients are related to a significantly increased
perioperative risk, a lot of efforts have been made to find alternative
methods of treatment such as transcatheter aortic valve interventions
(TAVI). Recently, "rapid deployment valves" (Intuity and Intuity Elite,
Edwards Life Science) and "sutureless valves" (Perceval Liva Nova)" have
been introduced to reduce duration of surgery, cardiopulmonary bypass time
and aortic cross clamp time. It was the aim of this monocentric,
retrospective registry to evaluate the intraoperative, early postoperative
and midterm outcome of this new technology. Methods: Between the 20th of
September 2012 and the 31st of December 2015, 132 patients with AVR using
Edwards Intuity/Intuity Elite (n = 97) or Liva Nova Perceval (n = 35) were
included in this study. Besides demographic data, operative mortality,
hemodynamic performance and the duration of surgery, cardiopulmonary
bypass time (CBP) and aortic cross-clamp time (ACC) have been monitored.
Subsequently, 30d mortality as well as 12 and 50 months postoperative
follow-up was analyzed. All data were entered into the institutional
database (Cardiac 2, S2 Engineering, Wels, Austria) and statistically
analyzed using IBM SPSS Statistics 24. Data are presented as mean+/-SD. A
p-value of <0.05 was considered to be statistically significant. Results:
Mean age was 75 +/- 7 years (55% male). Out of the total cohort, 76
patients (58%) received isolated AVR, 49 patients (37%) had a combined
operation of AVR and coronary bypass surgery and 7 patients (5%) had
additional procedures. There was no difference in preoperative demographic
data and NYHA staging. According to the preoperative -score, 76 patients
(60%) were considered to be "high risk". In total, 48 patients (36%) were
operated minimal-invasively using upper-hemisternotomy. Average operation
time of the entire cohort was 157 +/- 50 min, average CBP time was 90 +/-
32 min, and average ACC time was 68 +/- 24 min. For minimal invasive AVR,
average operation time was 127 +/- 28 min, average CBP time was 70 +/- 19
min and average ACC time was 55 +/- 15 min. Four patients needed
reoperation due to paravalvular leak (n = 2, 1.5%) or instable valve
position (n = 2; 1.5%), 6 patients (5%) needed perioperative pace makers.
The postoperative Pmax returned to physiological values in 90% of
patients, Vmax in 84% and both remained stable over the first year of
follow up. Overall 30d mortality was 5% (n = 7). At one year follow-up 112
patients (85%) were alive, 12 patients died for cardiac reasons, 8
patients for non-cardiac. After 50 months culmulative survival was 76%
(Fig. 1). Conclusions: The new devices are safe and can easily be used
also for minimal-invasive access. Therefore they are a valuable
alternative for the treatment of symptomatic aortic valve stenosis in
elderly and multimorbid patients. Randomised controlled trials should be
performed with a longer observation period to determine ultimate
superiority to standard valve procedures.

<56>
Accession Number
622627579
Author
Beitelstein T.; Campean R.; Winkler W.-B.; Derntl M.; Stollberger C.;
Weidinger F.
Institution
(Beitelstein, Campean, Winkler, Derntl, Stollberger, Weidinger) 2nd
Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria
Title
Prognostic relevance of the SYNTAX Score in patients with coronary
multivessel disease: A one-year follow-up study.
Source
Wiener Klinische Wochenschrift. Conference: Osterreichische Kardiologische
Gesellschaft Jahrestagung, OKG 2018. Austria. 130 (2 Supplement 1) (pp
S120), 2018. Date of Publication: June 2018.
Publisher
Springer-Verlag Wien
Abstract
Background: Therapeutic decisions for patients with coronary multivessel
disease (CMVD) have been controversially discussed in the past. The
complex atherosclerotic involvement of the coronary vessels renders it
difficult to decide between percutaneous coronary intervention (PCI),
coronary artery bypass grafting (CABG) and conservative treatment. In
2005, the SYNTAX Score was developed, which quantifies the severity of
coronary heart disease and should serve as a decision-making tool for the
appropriate revascularization therapy. Although recommended by ESC
guidelines, the SYNTAX score is not routinely applied in clinical
practice. Methods: In this retrospective unicentric analysis, subsequent
patients with CMVD were included and angiograms were scored
retrospectively according to the SYNTAX score algorithm. The following
major adverse cardiac and cerebrovascular events (MACCE) were defined:
death, acute coronary syndrome, acute PCI, acute CABG and stroke. The
prognostic relevance of the SYNTAX score was examined within a 1-year
follow-up as well as its potential as a decision-making tool between PCI,
CABG and conservative treatment. Results: One-hundred-three patients (22
females, average age 68 years) were included. A SYNTAX score 0-22 was
found in 29 patients (28%), 32-32 in 29 (28%) and >32 in 45 (44%). CABG
was performed in 36 patients (35%), PCI in 43 (42%) and conservative
treatment in 24 (23%). During one year of follow-up, MACCE occurred in 21
patients (death n = 9, acute coronary syndrome n = 10, stroke n = 2, acute
revascularization n = 9). Patients with a lower SYNTAX score tended to
have less MACCE than with a higher score (MACCE rate: 17% score 0-22 vs.
24% score 23-32 vs. 20% score >= 33; p = 0.806, mortality: 0% score 0-22
vs. 14% score 23-32 vs. 11% score >=33; p = 0.143). Patients receiving a
CABG had a higher SYNTAX score than the other groups (CABG 36 +/- 10.1 vs.
PCI 28 +/- 11.6 vs. conservative treatment 29 +/- 12.5; p = 0.005).
Patients receiving PCI did not differ in outcome from the other groups
(MACCE rate: PCI 9% vs. CABG 28% vs. conservative treatment 29%; p =
0.064, mortality: PCI 5% vs. CABG 14% vs. conservative treatment 8%; p =
0.331). Conclusions: The use of the SYNTAX Score for patients with CMVD
might be relevant for the prognosis and decision-making in clinical
practice. There is a need to investigate the prognostic value of the
SYNTAX Score, regardless of the method of treatment, in large randomized
trials. The use of the SYNTAX score in interventional cardiology practice
should be further supported.

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Accession Number
622634397
Author
Kleina P.; Klop I.D.G.; Kloppenburg G.L.; van Putte B.P.
Institution
(Kleina, Klop, Kloppenburg, van Putte) Department of Cardiothoracic
Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
(van Putte) Department of Cardiothoracic Surgery, AMC Heart Centre,
Academic Medical Center, Amsterdam, Netherlands
Title
Planning for minimally invasive aortic valve replacement: Key steps for
patient assessment.
Source
European Journal of Cardio-thoracic Surgery. 53 (Supplement 2) (pp
ii3-ii8), 2018. Date of Publication: 01 May 2018.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Minimally invasive aortic valve replacement (MIAVR) has proved to be a
safe approach for the treatment of aortic valve stenosis and/or
insufficiency and is associated with a number of additional benefits for
patients. This includes reduced blood loss, reduced transfusion
requirements, reduced length of hospital stay and improved aesthetic
appearance. As all types of minimally invasive surgery rely on optimizing
exposure within a more limited field of view, a thorough preoperative
assessment of patients is important to identify and address potential
exposure problems. MIAVR through an upper hemisternotomy is considered
feasible in almost every patient, but various clinical conditions or
anatomical variations can complicate the procedure and may impact on the
postoperative outcome. MIAVR through an anterior right thoracotomy
requires suitable anatomy, and this should be evaluated preoperatively
through a computed tomography or magnetic resonance imaging scan. In this
review, we aimed to present an overview of the current literature and to
reflect on our personal experiences with MIAVR techniques. This should
provide an aid-especially to surgeons wanting to start or have little
experience with MIAVR-for a structured preoperative patient assessment and
planning to increase the chance of a safe procedure with a good
outcome.<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.