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<1>
Accession Number
622355870
Author
Tabaie A.S.; Azarfarin R.; Baharestani B.; Mali S.; Tabaei S.S.
Institution
(Tabaie, Baharestani) Department of Cardiac Surgery, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Azarfarin) Echocardioghraphy Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Mali) Department of Cardiac Surgery, Shahid Sadoughi University of
Medical Science, Yazd, Iran, Islamic Republic of
(Tabaei) Department of Internal Medicine, Shahid Beheshti Medical
University, Tehran, Iran, Islamic Republic of
Title
The effect of negative pressure applied on chest tubes in the amount of
pleural effusions in postcoronary artery bypass grafting patients.
Source
Research in Cardiovascular Medicine. 7 (1) (pp 10-14), 2018. Date of
Publication: January-March 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Application of negative pressure on chest tubes is one of the
most common methods for management of chest tubes drainage after
cardio-thoracic surgeries. However, the effect of this measure on
long-term outcome of these patients and especially on postoperative
pleural effusions is not thoroughly evaluated. For this reason, we
designed a clinical randomized trial for the evaluation of the effect of
negative pressure application on early and late pleural effusions after
coronary artery bypass grafting (CABG) operations. Methods: A total of 440
patients entered in this study and divided into two groups: 220 patients,
their chest tubes managed by application of -10--20 cmH<inf>2</inf>O
negative pressure (negative pressure drainage group) and those who managed
conventionally by simple under-water seal method (control group, n = 220).
Evaluation for pleural effusion performed by signs and symptoms and chest
X-rays at 3^rd and 7^th postoperative days and for
those became symptomatic after 30^th day of operation. Results:
The occurrence of moderate and massive effusions at 3^rd and
7^th days after operation was the same in both groups. The most
striking difference was in patients' required pleural tap or chest tube
insertion, late after surgery due to pleural effusion. This was
significantly more common in patients in control group (P < 0.001).
Conclusion: Negative pressure application on chest tubes after CABG
surgery is a safe and effective method for decreasing the occurrence of
late pleural effusion.<br/>Copyright &#xa9; 2018 Research in
Cardiovascular Medicine.

<2>
Accession Number
622355868
Author
Tarbiat M.; Farhanchi A.; Davoudi M.; Farhadian M.
Institution
(Tarbiat, Farhanchi, Davoudi) Department of Anesthesiology, Clinical
Research Development Unit of Farshchian Hospital, School of Medicine,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Farhadian) Department of Biostatistics, Modeling of Noncommunicable
Diseases Research Center, School of Public Health, Hamadan University of
Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Supraclavicular versus infraclavicular subclavian vein catheterization in
coronary artery bypass graft surgery.
Source
Research in Cardiovascular Medicine. 7 (1) (pp 5-9), 2018. Date of
Publication: January-March 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Percutaneous central vein catheterization is one of the most
invasive procedures commonly performed by anesthesiologists during cardiac
surgery. Objectives: The aim of this study was to investigate the
complications of supraclavicular (SC) versus infraclavicular (IC)
approaches for subclavian vein catheterization during coronary artery
bypass graft surgery. Materials and Methods: Between October 2014 and June
2015, this prospective, randomized clinical trial was performed in 280
patients. The patients were randomly cannulated by SC or IC approach. The
success and complication rates were compared for the two approaches. The
outcome of this study was analyzed using SPSS software and through
Chi-square test. Results: In the first attempt of catheterization, the
success rate in SC (78.6%) group was lower than IC (94.3%) group (P =
0.0001). The overall success rate in two attempts were 136 (97.1%) in the
IC approach and 132 (94.3%) in the SC approach (P = 0.238). In 12 (4.3%)
patients, subclavian catheterizations were failed after two attempts in
both approaches. In 28 (10%) patients, hematoma at puncture site occurred,
1 (0.7%) in IC approach, and 27 (19.3%) in SC approach (P = 0.0001). The
differences in other complications on two approaches were statistically
insignificant. Conclusions: Compared with the SC approach, the IC approach
resulted in fewer hematomas at puncture sites. The incidence of overall
cannulation failure and other complications were similar on both
approaches.<br/>Copyright &#xa9; 2018 Research in Cardiovascular Medicine.

<3>
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Accession Number
622083325
Author
Maggiolini S.; De Carlini C.C.; Imazio M.
Institution
(Maggiolini, De Carlini) Cardiology Division, Cardiovascular Department,
San L. Mandic Hospital, Largo Mandic 1, Merate 23807, Italy
(Imazio) Cardiology, Cardiovascular and Thoracic Department, AOU
Cittadella Salute e della Scienza di Torino, Torino, Italy
Title
Evolution of the pericardiocentesis technique.
Source
Journal of Cardiovascular Medicine. 19 (6) (pp 267-273), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Pericardiocentesis is a valuable technique for the diagnosis and treatment
of patients with pericardial effusion and cardiac tamponade, although it
may be associated with potentially serious complications. Through the
years, many different imaging approaches have been described to reduce the
complication rate of the procedure. This systematic review provides a
focused overview of the different techniques developed in recent years to
reduce the procedural complications and to increase the related success
rate.<br/>Copyright &#xa9; 2018 Italian Federation of Cardiology. All
rights reserved.

<4>
[Use Link to view the full text]
Accession Number
622304918
Author
Martinez S.; Alexander S.
Institution
(Martinez, Alexander) Texas Christian University, Ctr. for Evidence-based
Practice and Research: A Collaborating Center of the Joanna Briggs
Institute, Fort Worth, TX, United States
Title
The effect of low-dose ketamine via patient-controlled analgesic pump on
morphine consumption in the postoperative period in thoracotomies: A
systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (8) (pp
34-42), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The objective of this systematic review is to
determine if adding low-dose ketamine to a morphine patient-controlled
analgesic pump will have an impact on the total consumption of morphine
during the first 72 hours postoperative in patients over the age of 15
undergoing surgery involving thoracotomy. In addition, secondary outcomes
assessing the impact on pain, nausea and vomiting will be evaluated for
any alteration with ketamine co-administration.<br/>Copyright &#xa9; 2016
Joanna Briggs Institute.

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

<6>
Accession Number
622047569
Author
Harris J.; Teuteberg J.; Shullo M.
Institution
(Harris) Department of Pharmacy, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Teuteberg) Falk Cardiovascular Research Center, Stanford University
School of Medicine, Stanford, CA, United States
(Shullo) J.W. Ruby Memorial Hospital, Morgantown, WV, United States
Title
Optimal low-density lipoprotein concentration for cardiac allograft
vasculopathy prevention.
Source
Clinical Transplantation. 32 (5) (no pagination), 2018. Article Number:
e13248. Date of Publication: May 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) is a major risk factor influencing
graft loss and patient survival following orthotopic heart transplant.
Allograft vasculopathy is a multifactorial process, which includes both
immunologic and non-immunologic mechanisms. Given the non-immunological
risk factors for vasculopathy, particularly hyperlipidemia, it is
intuitive that reducing a patient's LDL would help attenuate the disease
process. Multiple studies have shown benefits with the use of statin
therapy. However, current heart transplant guidelines do not give a
specific recommendation as to what LDL goal should be achieved in this
patient population. This study is a retrospective cohort analysis designed
to determine the relative risk of developing cardiac allograft
vasculopathy with respect to different LDL goals. Median LDL level of <100
mg/dL was shown to significantly reduce the risk of developing cardiac
allograft vasculopathy. Twelve of 37 patients with an LDL >=100 mg/dL
(32.4%) developed CAV vs 25 of 157 patients (15.9%) with an LDL <100 mg/dL
(P =.021). Furthermore, a delay in to time to cardiac allograft
vasculopathy was seen when a median LDL concentration of <100 mg/dL was
achieved. This benefit was not extended when a goal concentration of <70
mg/dL was targeted.<br/>Copyright &#xa9; 2018 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<7>
Accession Number
2000819956
Author
Lodge F.; Khatun R.; Lord R.; John A.; Fraser A.G.; Yousef Z.
Institution
(Lodge, Khatun) Cardiology Department, University Hospital of Wales,
Cardiff, United Kingdom
(Lord) Cardiff School of Sport, Cardiff Metropolitan University, Cardiff,
United Kingdom
(John) Consultant in Trauma and Orthopaedics, University Hospital of
Wales, Cardiff, United Kingdom
(Fraser) Emeritus Professor of Cardiology, Cardiff University, Cardiff,
United Kingdom
(Yousef) Consultant Cardiologist, University Hospital of Wales, Cardiff,
United Kingdom
Title
Prevalence of subclinical cardiac abnormalities in patients with
metal-on-metal hip replacements.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Metal-on-metal (MOM) hip prostheses have a higher failure rate
than conventional prostheses and leaching of cobalt and chromium has been
linked to cardiomyopathy. We screened MOM subjects to evaluate if cobalt
and chromium are related to subclinical cardiac dysfunction. Methods: A
single centre, non-randomised, observational study using echocardiography
in 95 patients who had undergone MOM hip prostheses, and 15 age matched
controls with non-MOM hip replacement. Serial plasma cobalt and chromium
levels were recorded, and data compared by tertiles of cobalt exposure.
Results: Indexed left ventricular (LV) end-diastolic and end-systolic
volumes (EDVi and ESVi) increased with tertile of cobalt (omnibus p =
0.003 for EDVi and ESVi), as did indexed left atrial (LA) volumes (p =
0.003). MOM subjects had 25% larger EDVi than controls, 32% larger ESVi
(40 ml vs. 32 ml, and 15 ml vs. 11 ml, p = 0.003 for both) and 28% larger
indexed LA (23 ml vs. 18 ml, p = 0.002). There were no differences in LV
systolic or diastolic function, including ejection fraction, tissue
velocity and mitral E/e'. Estimated glomerular filtration rate was 18%
lower in the highest tertile compared with the lowest (p = 0.01) and
correlated inversely with LA volume (r = -0.36, p < 0.001) and LV EDV (r =
-0.24, p = 0.02). Conclusions: No correlations between sensitive measures
of systolic or diastolic cardiac function or serum cobalt/chromium levels
were observed in this study. However, there was a relationship between
increasing left ventricular and left atrial volumes and declining renal
function with high cobalt levels which requires further evaluation in MOM
patients.<br/>Copyright &#xa9; 2017

<8>
Accession Number
2000624198
Author
Marso S.P.; Nauck M.A.; Monk Fries T.; Rasmussen S.; Treppendahl M.B.;
Buse J.B.
Institution
(Marso) HCA Midwest Health Heart & Vascular Institute, Kansas City,
Missouri, United States
(Nauck) Diabetes Center Bochum-Hattingen, St. Josef Hospital,
Ruhr-University Bochum, Bochum, Germany
(Monk Fries, Rasmussen, Treppendahl) Novo Nordisk A/S, Soborg, Denmark
(Buse) Department of Medicine, University of North Carolina School of
Medicine, Chapel Hill, North Carolina, United States
Title
Myocardial Infarction Subtypes in Patients With Type 2 Diabetes Mellitus
and the Effect of Liraglutide Therapy (from the LEADER Trial).
Source
American Journal of Cardiology. 121 (12) (pp 1467-1470), 2018. Date of
Publication: 15 June 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Diabetes mellitus (DM) is a known risk factor for myocardial infarction
(MI); however, data regarding MI subtypes in people with diabetes are
limited. In the Liraglutide Effect and Action in Diabetes: Evaluation of
Cardiovascular Outcome Results (LEADER) trial (n = 9,340), liraglutide
significantly reduced the risk of major adverse cardiovascular (CV) events
(composite of CV death, nonfatal MI, or nonfatal stroke) versus placebo in
patients with type 2 DM and high CV risk. Liraglutide also reduced risk of
first MI (292 events with liraglutide vs 339 with placebo). This post hoc
analysis characterized MIs (first and recurrent) occurring in LEADER, by
treatment arm and regarding incidence, outcome, subtype, and troponin
levels. A total of 780 MIs (first and recurrent) were reported, with fewer
in the liraglutide-treatment group than in the placebo-treatment group
(359 vs 421, p = 0.022). Numerically fewer MIs were associated with CV
death with liraglutide than with placebo (17 vs 28 fatal MIs, p = 0.28).
Symptomatic MIs in both arms were mainly non-ST-segment elevation MI
(555/641) and spontaneous MI (518/641). Numerically greater proportions of
symptomatic MIs were associated with troponin levels <=5x or <=10x the
upper reference limit with liraglutide versus placebo (p = 0.16 and p =
0.42, respectively). At baseline, more liraglutide-treated patients than
placebo-treated patients with MI during the trial had a history of
coronary artery bypass graft (p = 0.008), and fewer had peripheral
arterial disease in the lower extremities (p = 0.005) and >50% stenosis of
the coronary artery, the carotid artery, or other arteries (p = 0.044). In
conclusion, this analysis showed that liraglutide reduces the incidence of
MIs in patients with type 2 DM at high CV risk and may impact the clinical
outcomes of MI.<br/>Copyright &#xa9; 2018 The Author(s)

<9>
Accession Number
2000800778
Author
Jakobsen L.; Christiansen E.H.; Maeng M.; Kristensen S.D.; Botker H.E.;
Terkelsen C.J.; Madsen M.; Raungaard B.; Jensen S.E.; Christensen M.K.;
Hansen H.S.; Jensen L.O.
Institution
(Jakobsen, Christiansen, Maeng, Kristensen, Botker, Terkelsen) Department
of Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Raungaard, Jensen, Christensen) Department of Cardiology, Aalborg
University Hospital, Aalborg, Denmark
(Hansen, Jensen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
Title
Randomized clinical comparison of the dual-therapy CD34 antibody-covered
sirolimus-eluting Combo stent with the sirolimus-eluting Orsiro stent in
patients treated with percutaneous coronary intervention: Rationale and
study design of the Scandinavian Organization for Randomized Trials with
Clinical Outcome (SORT OUT) X trial.
Source
American Heart Journal. 202 (pp 49-53), 2018. Date of Publication: August
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The Combo stent (OrbusNeich, Hoevelaken, the Netherlands)
combining an abluminal, bioabsorbable polymer eluting sirolimus with a
luminal CD34+ antibody to capture endothelial progenitor cells has been
developed to further improve safety and efficacy of coronary
interventions. We have designed a large-scale registry-based randomized
clinical trial to compare the Combo stent to the Orsiro stent (Biotronik,
Bulach, Switzerland) in patients undergoing percutaneous coronary
intervention. Methods: The SORT OUT X study will randomly assign 3,140
patients to treatment with Combo or Orsiro stents at 3 sites in Western
Denmark. Patients are eligible if they are >=18 years old, have chronic
stable coronary artery disease or acute coronary syndromes, and have >=1
coronary lesion with >50% diameter stenosis requiring treatment with a
drug-eluting stent. The primary end point target lesion failure is a
composite of cardiac death, myocardial infarction (not related to other
than index lesion), or target lesion revascularization within 12 months.
Clinically driven event detection will be derived from validated Danish
registries. An event rate of 4.2% is assumed in each stent group. With a
sample size of 1,570 patients in each treatment arm, a 2-group
large-sample normal approximation test of proportions with a 1-sided 5%
significance level will have 90% power to detect noninferiority of the
Combo stent compared with the Orsiro stent with a predetermined
noninferiority margin of 2.1%. Conclusion: The SORT OUT X trial will
determine whether the dual-therapy Combo stent is noninferior to the
Orsiro stent with respect to clinically driven events (ClinicalTrials.gov
NCT03216733).<br/>Copyright &#xa9; 2018 Elsevier Inc.

<10>
Accession Number
622219722
Author
Saccocci M.; Taramasso M.; Maisano F.
Institution
(Saccocci, Taramasso, Maisano) Heart Center University Hospital of Zurich,
Department of Cardiac Surgery - UniversitatsSpital Zurich, Ramistrasse
100, Zurich 8091, Switzerland
Title
Mitral Valve Interventions in Structural Heart Disease.
Source
Current Cardiology Reports. 20 (6) (no pagination), 2018. Article Number:
49. Date of Publication: 01 Jun 2018.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of review: Analyze the current state of the art and the future
perspectives of mitral interventions in clinical setting. Recent Findings:
A systematic and critical review of the new mitral percutaneous therapies
and imaging technologies is the basis to adopt the right treatment for
each patient according to specific valve dysfunction and clinical
presentation, waiting for definitive guidelines. While surgical mitral
repair will remain the gold standard for low-risk healthy patients with
degenerative mitral regurgitation (DMR), transcatheter mitral valve repair
is becoming first line therapy in high risk patients with functional
mitral regurgitation (FMR). The introduction of transcatheter mitral valve
replacement will expand indications for advanced DMR and FMR in inoperable
patients. Summary: The introduction of transcatheter mitral interventions
is changing the mitral therapy scenario. Mitral interventionalists might
evolve into hybrid professional figures able to offer a tailored approach
for each patient, including surgical and percutaneous approaches,
depending on the anatomo-functional status of the valve, to clinical
conditions, and to the timing of the intervention.<br/>Copyright &#xa9;
2018, Springer Science+Business Media, LLC, part of Springer Nature.

<11>
Accession Number
622338679
Author
Park K.W.; Rhee T.-M.; Kang H.-J.; Koo B.-K.; Gwon H.-C.; Yoon J.-H.; Lim
D.-S.; Chae I.-H.; Han K.-R.; Ahn T.; Jeong M.-H.; Jeon D.-W.; Jang Y.-S.;
Kim H.-S.
Institution
(Park, Rhee, Kang, Koo, Kim) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
(Gwon) Sung-Kyun-Kwan University Samsung Medical Center, Seoul, South
Korea
(Yoon) Yonsei University Wonju Severance Hospital, Wonju, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Chae) Seoul National University Bundang Hospital, Seongnam, South Korea
(Han) Kangdong Sacred Heart Hospital, Seoul, South Korea
(Ahn) Gachon University Gil Medical Center, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Jeon) NHIC Ilsan Hospital, Ilsan, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
Title
Randomized prospective comparison of everolimus-eluting vs.
Sirolimus-eluting stents in patients undergoing percutaneous coronary
intervention - 3-year clinical outcomes of the EXCELLENT randomized trial.
Source
Circulation Journal. 82 (6) (pp 1566-1574), 2018. Date of Publication:
2018.
Publisher
Japanese Circulation Society
Abstract
Background: Everolimus-eluting stents (EES) have equivalent short-term
angiographic and clinical outcomes to sirolimus-eluting stents (SES), but
EES may be superior to SES with regard to long-term clinical safety. We
report the 3-year clinical outcomes of EES and SES from the prospective
EXCELLENT Randomized Trial (NCT00698607). Methods and Results: We randomly
assigned 1,443 patients undergoing percutaneous coronary intervention 3:1
to receive EES and SES, respectively. We investigated endpoints including
target lesion failure (TLF) and individual clinical outcomes including
stent thrombosis (ST) at 3 years. For EES and SES, the TLF rate was 4.82%
and 4.12% (risk ratio [RR], 1.16, 95% CI: 0.65-2.06, P=0.62),
respectively. Results were similar in other efficacy endpoints including
target lesion revascularization. For safety endpoints, rate of all-cause
death was significantly lower for EES (1.67%) than SES (3.57%; RR, 0.46;
95% CI: 0.23-0.94, P=0.03), while the incidence of cardiac death or
myocardial infarction was numerically lower in EES. On 1-year landmark
analysis, rates of all-cause death and major adverse cardiovascular events
were significantly lower for EES than SES. Definite or probable ST was
numerically 3-fold higher for SES (1.37%) compared with EES (0.46%).
Conclusions: EES and SES had similar efficacy with regard to 3-year
outcomes in the EXCELLENT trial, while delayed safety events all trended
to favor EES.<br/>Copyright &#xa9; 2018, Japanese Circulation Society. All
rights reserved.

<12>
Accession Number
622305664
Author
Jacobs M.S.; Tieleman R.G.
Institution
(Jacobs) Department of Clinical Pharmacy and Toxicology, Martini Hospital,
Groningen, Netherlands
(Jacobs) Groningen Research Institute of Pharmacy, Unit of
PharmacoTherapy, Epidemiology & Economics (PTEE), University of Groningen,
Groningen, Netherlands
(Tieleman) Department of Cardiology, Martini Hospital, Groningen,
Netherlands
(Tieleman) Department of Cardiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Title
Optimal antithrombotic treatment of patients with atrial fibrillation
undergoing percutaneous coronary intervention: triple therapy is too
much!.
Source
Netherlands Heart Journal. 26 (6) (pp 334-340), 2018. Date of Publication:
01 Jun 2018.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Patients with atrial fibrillation who undergo a coronary intervention are
eligible for both anticoagulation and (dual) antiplatelet therapy
((D)APT). An optimal balance has to be found to reduce the thromboembolic
risk (i.e. stroke, systemic embolism and myocardial infarction) and to
minimise the increased risk of bleeding with concomitant use of an
anticoagulant and (D)APT. Owing to a lack of evidence, the guideline
recommendations are predominantly based on expert opinion. Current
evidence indicates that the combination of a non-vitamin K oral
anticoagulant (NOAC) and clopidogrel is safer than vitamin-K oral
antagonists plus DAPT, which increases the risk of bleeding, without clear
advantages in regard to efficacy. Concerning whether (N)OACs should be
combined with single APT rather than DAPT, the findings of the WOEST,
PIONEER AF-PCI and RE-DUAL PCI trials seem to favour a combination with
clopidogrel only, thus omitting aspirin. Choosing the optimal treatment
strategies for individual patients on NOACs and (D)APT will remain a
challenge for clinicians, though triple therapy seems to be the less
favourable option owing to the increased risk of bleeding.<br/>Copyright
&#xa9; 2018, The Author(s).

<13>
Accession Number
622279321
Author
Wang B.; He X.; Gong Y.; Cheng B.
Institution
(Wang, Gong, Cheng) Department of Anesthesiology, Critical Care and Pain
Medicine, Second Affiliated Hospital, Yuying Children's Hospital of
Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
(He) School of Ophthalmology and Optometry and Eye Hospital, Wenzhou
Medical University, Wenzhou, Zhejiang 325000, China
Title
Levosimendan in Patients with Left Ventricular Dysfunction Undergoing
Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
7563083. Date of Publication: 2018.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Recent studies suggest that levosimendan does not provide
mortality benefit in patients with low cardiac output syndrome undergoing
cardiac surgery. These results conflict with previous findings. The aim of
the current study is to assess whether levosimendan reduces postoperative
mortality in patients with impaired left ventricular function (mean EF <=
40%) undergoing cardiac surgery. Methods. We conducted a comprehensive
search of PubMed, EMBASE, and Cochrane Library Database through November
20, 2017. Inclusion criteria were random allocation to treatment with at
least one group receiving levosimendan and another group receiving placebo
or other treatments and cardiac surgery patients with a left ventricular
ejection fraction of 40% or less. The primary endpoint was postoperative
mortality. Secondary outcomes were cardiac index, pulmonary capillary
wedge pressure (PCWP), length of intensive care unit (ICU) stay,
postoperative atrial fibrillation, and postoperative renal replacement
therapy. We performed trial sequential analysis (TSA) to evaluate the
reliability of the primary endpoint. Results. Data from 2,152 patients in
15 randomized clinical trials were analyzed. Pooled results demonstrated a
reduction in postoperative mortality in the levosimendan group [RR = 0.53,
95% CI (0.38-0.73), I2=0]. However, the result of TSA showed that the
conclusion may be a false positive. Secondary outcomes demonstrated that
PCWP, postoperative renal replacement therapy, and length of ICU stay were
significantly reduced. Cardiac index was greater in the levosimendan
group. No difference was found in the rate of postoperative atrial
fibrillation. Conclusions. Levosimendan reduces the rate of death and
other adverse outcomes in patients with low ejection fraction who were
undergoing cardiac surgery, but results remain inconclusive. More
large-volume randomized clinical trials (RCTs) are
warranted.<br/>Copyright &#xa9; 2018 Benji Wang et al.

<14>
Accession Number
615346947
Author
Enezate T.H.; Kumar A.; Fadel M.A.; Patel M.; Al Dadah A.; Omran J.
Institution
(Enezate, Kumar, Omran) University of Missouri-Columbia School of
Medicine, Columbia, MO, United States
(Fadel) University of Oklahoma Health Science Center, Oklahoma City, OK,
United States
(Patel) University of California-San Diego Health Systems, San Diego, CA,
United States
(Al Dadah) Prairie Heart Institute, SpringField, IL, United States
Title
Transcatheter versus surgical aortic valve replacement in patients with
non-high surgical risk severe aortic stenosis: A systematic review.
Source
Cardiovascular Revascularization Medicine. 18 (5 Supplement 1) (pp
S40-S48), 2017. Date of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Transcatether aortic valve replacement (TAVR) has emerged as an
acceptable alternative to surgical aortic valve replacement (SAVR) in
patients with high-risk surgical profile. In this analysis, we compare
both approaches in non-high surgical risk severe aortic stenosis. Methods
Only studies comparing SAVR and TAVR and enrolling patients with
low-intermediate risk were included from January 2000 through May 2016.
Primary endpoints were assessed at 1 and 12 months including: mortality,
cerebrovascular accident (CVA) and myocardial infarction (MI). Secondary
endpoints at 1 month included: bleeding, acute kidney injury, new
permanent pacemaker implantation and vascular access site complications.
Results A total of 5223 patients from 8 studies were included (4
prospective and 4 retrospective). There were no significant differences
between TAVR and SAVR at one month in terms of mortality (risk ratio RR
0.91, 95% CI: 0.68 to 1.20), or CVA (RR 0.91, 95% CI 0.68 to 1.21).
However, MI was lower in the TAVR group (RR 0.58, 95% CI 0.34 to 0.99). At
12 months, there was no significant difference between strategies in terms
of mortality (RR 0.98, 95% CI 0.84-1.13), CVA (RR1.07, 95% CI 0.85-1.33)
or MI (RR 0.78, 95% CI 0.53-1.15). With regard to secondary outcomes, TAVR
was associated with lower rates of bleeding (RR 0.44, 95% CI 0.22-0.88)
and acute kidney injury (RR 0.54, 95% CI 0.31-0.93) but higher need for
new permanent pacemaker implantation (RR 2.99, 95% CI 1.51-5.94) and high
rate of vascular access site complications (RR 9.08, 95% CI 2.03-40.66).
Conclusion In severe AS patients with non-high surgical risk, TAVR has
lower risk of MI at one month, but both TAVR and SAVR yielded similar
outcomes at one month in terms of mortality and CVA and at 12 months in
terms of mortality, CVA and MI. In regard to secondary outcomes at one
month, TAVR has lower rates of bleeding and acute kidney injury, and
higher rates of need for new permanent pacemakers and high rate of
vascular access site complications.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<15>
Accession Number
619714357
Author
Schulman-Marcus J.; Lin F.Y.; Gransar H.; Berman D.; Callister T.; DeLago
A.; Hadamitzky M.; Hausleiter J.; Al-Mallah M.; Budoff M.; Kaufmann P.;
Achenbach S.; Raff G.; Chinnaiyan K.; Cademartiri F.; Maffei E.; Villines
T.; Kim Y.-J.; Leipsic J.; Feuchtner G.; Rubinshtein R.; Pontone G.;
Andreini D.; Marques H.; Chang H.-J.; Chow B.J.W.; Cury R.C.; Dunning A.;
Shaw L.; Min J.K.
Institution
(Schulman-Marcus) Division of Cardiology, Albany Medical College, Albany,
NY, United States
(Lin, Min) Dalio Institute of Cardiovascular Imaging, Weill Cornell
Medical College, New York Presbyterian Hospital, New York, NY, United
States
(Gransar, Berman) Department of Imaging, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Callister) Tennessee Heart and Vascular Institute, Hendersonville, TN,
United States
(DeLago) Capital Cardiology Ass., Albany, NY, United States
(Hadamitzky, Hausleiter) Division of Cardiology, Deutsches Herzzentrum
Munchen, Munich, Germany
(Al-Mallah) King Saud Bin Abdul Aziz University for Health Sciences, King
Abdullah International Medical Research Center, King Abdul Aziz Cardiac
Center, Ministry of National Guard Health Affairs, Saudi Arabia
(Budoff) Department of Medicine, Harbor UCLA Medical Center, Los Angeles,
CA, United States
(Kaufmann) University Hospital, Zurich, Switzerland
(Achenbach) Department of Medicine, University of Erlangen, Erlangen,
Germany
(Raff) William Beaumont Hospital, Royal Oaks, MI, United States
(Chinnaiyan, Cademartiri, Maffei) Cardiovascular Imaging Unit, Giovanni
XXIII Hospital, Monastier, Treviso, Italy
(Villines) Department of Medicine, Walter Reed Medical Center, Washington,
DC, United States
(Kim) Seoul National University Hospital, Seoul, South Korea
(Leipsic) Department of Medicine and Radiology, University of British
Columbia, Vancouver, BC, Canada
(Feuchtner) Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
(Rubinshtein) Department of Cardiology, Lady Davis Carmel Medical Center,
Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel
(Pontone, Andreini) Department of Clinical Sciences and Community Health,
University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Marques) Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
(Chang) Division of Cardiology, Severance Cardiovascular Hospital, Seoul,
South Korea
(Chow) Department of Medicine and Radiology, University of Ottawa, ON,
Canada
(Cury) Baptist Cardiac and Vascular Institute, Miami, FL, United States
(Dunning) Duke Clinical Research Institute, Durham, NC, United States
(Shaw) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
Title
Coronary revascularization vs. medical therapy following coronary-computed
tomographic angiography in patients with low-, intermediateand high-risk
coronary artery disease: Results from the CONFIRM long-term registry.
Source
European Heart Journal Cardiovascular Imaging. 18 (8) (pp 841-848), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To identify the effect of early revascularization on 5-year survival
in patients with CAD diagnosed by coronarycomputed tomographic angiography
(CCTA). Methods and results We examined 5544 stable patients with
suspected CAD undergoing CCTA who were followed a median of 5.5 years in a
large international registry. Patients were categorized as having low-,
intermediate-, or high-risk CAD based on CCTA findings. Two treatment
groups were defined: early revascularization within 90 days of CCTA (n =
1171) and medical therapy (n = 4373). To account for the non-randomized
referral to revascularization, we developed a propensity score by logistic
regression. This score was incorporated into Cox proportional hazard
models to calculate the effect of revascularization on all-cause
mortality. Death occurred in 363 (6.6%) patients and was more frequent in
medical therapy. In multivariable models, when compared with medical
therapy, the mortality benefit of revascularization varied significantly
over time and by CAD risk (P for interaction 0.04). In high-risk CAD,
revascularization was significantly associated with lower mortality at 1
year (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.11-0.47) and
5 years (HR 0.31, 95% CI 0.18-0.54). For intermediate-risk CAD,
revascularization was associated with reduced mortality at 1 year (HR
0.45, 95% CI 0.22-0.93) but not 5 years (HR 0.63, 95% CI 0.33-1.20). For
low-risk CAD, there was no survival benefit at either time point.
Conclusions Early revascularization was associated with reduced 1-year
mortality in intermediate-and high-risk CAD detected by CCTA, but this
association only persisted for 5-year mortality in high-risk
CAD.<br/>Copyright &#xa9; 2017 The Author.

<16>
Accession Number
622413105
Author
Iscan S.; Eygi B.; Besir Y.; Yurekli I.; Cakir H.; Yilik L.; Gokalp O.;
Gurbuz A.
Institution
(Iscan, Eygi, Besir, Yurekli, Cakir, Yilik, Gokalp, Gurbuz) Department of
Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training and
Research Hospital, Izmir, Turkey
Title
Inflammation, atrial fibrillation and cardiac surgery: Current medical and
invasive approaches for the treatment of atrial fibrillation.
Source
Current Pharmaceutical Design. 24 (3) (pp 310-322), 2018. Date of
Publication: 2018.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in
clinical practice especially after cardiac surgery. It is associated with
increased morbidity and mortality for the patients. The pathogenesis of AF
is not exactly understood yet, but there is growing data about the
relationship between AF and inflammation. Cardiac surgery itself is a big
source for inflammation. It causes major surgical trauma,
ischemia/reperfusion injury, hypothermia, low arterial pressure, and the
equipment of cardiopulmonary bypass makes a large foreign surface thus it
activates inflammatory response. There is a large number of data about the
treatment options of AF and there are also strategies, which are related
to reduction of inflammatory activation during cardiopulmonary bypass. In
order to review the relationship between cardiac surgery, inflammation, AF
and treatment strategies in patients with AF, we conducted a search
through Pubmed for articles in English using the keywords: "atrial
fibrillation, cardiac surgery, inflammation, medical therapy, surgical
therapy, ablation therapy" from January 2012 to present. We also searched
separately for each alternative treatment modality on Pubmed. To identify
further articles, we also looked into related citations in review articles
and commentaries. We searched thoroughly the guidelines published by the
European Society of Cardiology (2016), and the American Heart
Association/American College of Cardiology/ Heart Rhythm Surgery (2014).
Many studies concluded that inflammation contributes in the occurrence of
AF. Inflammatory markers, such as CRP, interleukins and complements have
high sensitivity and specificity for prediction of AF whether the patient
having cardiac surgery or not. Betablockers, diltiazem and amiodarone are
the most commonly used drugs for rate control in AF following surgery.
Although there are some new therapeutic approaches to reduce postoperative
inflammatory activation, such as the use of vitamins, fatty acids,
statins, or technical improvements to cardiopulmonary bypass unit like
miniaturized bypass circuits, heparin coating of the circuits, leukocyte
filters, or various surgical approaches like off-pump coronary bypass
surgery, we still need more effective strategies to reduce both
postoperative inflammation and postoperative AF risk after cardiac
surgery. Today we use more advanced invasive and surgical treatment
strategies for AF although we need far more advanced technics to reduce
perioperative inflammatory activation, which actually causes
AF.<br/>Copyright &#xa9; 2018 Bentham Science Publishers.

<17>
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. (no pagination), 2018. Date of Publication:
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

<18>
Accession Number
618426306
Author
Yousif A.; Addison D.; Lakkis N.; Rosengart T.; Virani S.S.; Birnbaum Y.;
Alam M.
Institution
(Yousif) Department of Medicine, Section of Cardiology, University of
Oklahoma School of Medicine, Oklahoma City, OK, United States
(Addison) Department of Medicine, Section of Cardiology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Addison) Department of Internal Medicine, Division of Cardiology,
Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston,
MA 02114, United States
(Lakkis, Virani, Birnbaum, Alam) Department of Medicine, Section of
Cardiology, Baylor College of Medicine, Houston, TX, United States
(Rosengart) Department of Surgery, Section of Cardiothoracic Surgery,
Baylor College of Medicine, Houston, TX, United States
(Virani) Center Health Services Research and Development, Michael E.
DeBakey Veterans Affairs Medical Center, Houston, TX, United States
Title
Use of cardiopulmonary pump support during coronary artery bypass grafting
in the high-risk: a meta-analysis.
Source
Irish Journal of Medical Science. 187 (2) (pp 369-377), 2018. Date of
Publication: 01 May 2018.
Publisher
Springer London
Abstract
Background: Data from randomized trials evaluating the efficacy of on-
versus off-pump coronary artery bypass grafting remain inconclusive,
particularly in high-risk populations. Aims: The aim of this study is to
compare the outcomes associated with on- versus off-pump coronary artery
bypass grafting among high-risk patients. Methods: We performed a
meta-analysis of randomized control trials comparing on- versus off-pump
coronary artery bypass grafting, focusing on high-risk populations.
Studies focusing on "high-risk" features: European System of Cardiac
Operative Risk Evaluation (EuroSCORE) >= 5, age > 70 years, preexisting
renal insufficiency, history of stroke(s), and the presence of left
ventricular dysfunction were included. MEDLINE, Scopus, and Embase were
searched for all publications between January 1, 2000 and August 1, 2016,
using the following terms: on-pump, off-pump, coronary artery bypass,
high-risk, left ventricular dysfunction, elderly, aged, and renal
insufficiency. Endpoints included cardiovascular and all-cause mortality,
non-fatal myocardial infarction, stroke, need for revascularization, renal
failure, and length of hospital stay. Results: Nine studies incorporating
11,374 patients with a mean age of 70 years were selected. There was no
statistical difference in cardiovascular mortality, all-cause mortality,
non-fatal myocardial infarction, and renal failure between the two groups.
There was a decrease in further revascularization at 1 year with on-pump
(OR 0.67 (0.50-0.89)). However, there was an increase in length of
hospital stay by 2.24 days (p = 0.03) among the on-pump group with no
difference in stroke (OR 1.34 (1.00-1.80)). Conclusions: On-pump is
associated with a decreased risk of additional revascularization by 1
year. However, this appears to be a cost of longer
hospitalization.<br/>Copyright &#xa9; 2017, Royal Academy of Medicine in
Ireland.

<19>
Accession Number
619909843
Author
Head S.J.; Celik M.; Kappetein A.P.
Institution
(Head, Celik, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Dr Molewaterplein 40, Rotterdam 3015GE,
Netherlands
Title
Mechanical versus bioprosthetic aortic valve replacement.
Source
European Heart Journal. 38 (28) (pp 2183-2191), 2017. Date of Publication:
21 Jul 2017.
Publisher
Oxford University Press
Abstract
Mechanical valves used for aortic valve replacement (AVR) continue to be
associated with bleeding risks because of anticoagulation therapy, while
bioprosthetic valves are at risk of structural valve deterioration
requiring reoperation. This risk/benefit ratio of mechanical and
bioprosthetic valves has led American and European guidelines on valvular
heart disease to be consistent in recommending the use of mechanical
prostheses in patients younger than 60 years of age. Despite these
recommendations, the use of bioprosthetic valves has significantly
increased over the last decades in all age groups. A systematic review of
manuscripts applying propensity-matching or multivariable analysis to
compare the usage of mechanical vs. bioprosthetic valves found either
similar outcomes between the two types of valves or favourable outcomes
with mechanical prostheses, particularly in younger patients. The
risk/benefit ratio and choice of valves will be impacted by developments
in valve designs, anticoagulation therapy, reducing the required
international normalized ratio, and transcatheter and minimally invasive
procedures. However, there is currently no evidence to support lowering
the age threshold for implanting a bioprosthesis. Physicians in the Heart
Team and patients should be cautious in pursuing more bioprosthetic valve
use until its benefit is clearly proven in middle-Aged
patients.<br/>Copyright &#xa9; The Author 2017.

<20>
Accession Number
618107572
Author
Mahajan V.; Samra T.; Puri G.D.
Institution
(Mahajan, Samra, Puri) Department of Anesthesia, Post Graduate Institute
of Medical Education and Research, Sector 12, Chandigarh 160012, India
Title
Anaesthetic depth control using closed loop anaesthesia delivery system
vs. target controlled infusion in patients with moderate to severe left
ventricular systolic dysfunction.
Source
Journal of Clinical Anesthesia. 42 (pp 106-113), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives To compare the efficacy of anaesthetic depth control using
Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled
Infusion (TCI) in patients with moderate to severe left ventricular
dysfunction (LVSD). Design Randomized control trial. Patients Forty ASA
III/IV adult patients with moderate to severe LVSD scheduled for open
heart surgery. Interventions Propofol was administered using CLADS or TCI
for maintaining BIS of 50. Induction and maintenance doses were controlled
automatically in CLADS. Dixon's up and down method was used to estimate
the plasma concentration needed for induction in TCI. Measurement
Percentage of total anaesthesia time ("valid CLADS time") for which BIS
remained within +/- 10 of target (BIS = 50). Main results BIS remained
within +/- 10 of the target for a significantly longer duration of time in
CLADS group (p = 0.001). Performance parameters like Median Performance
Error (MDPE), p = 0.024; Median Absolute Performance Error (MDAPE), p =
0.0212; and global score p = 0.017 were significantly better in CLADS
group. Total propofol consumption was significantly less in CLADS group (p
= 0.014). Mean value (95% CI) of EC<inf>50</inf> and EC<inf>95</inf> for
target plasma propofol concentration for induction was 1.62 (1.45-1.79)
mug ml^{- 1} and 1.87 (1.73-2.96) mug ml^{- 1}
respectively using probit analysis. Conclusions Closed loop delivery of
propofol using CLADS performed significantly better than TCI in this
subset of patients. Clinical trials registration no.
www.ClinicalTrials.gov-NCT02645994<br/>Copyright &#xa9; 2017 Elsevier Inc.

<21>
Accession Number
614570177
Author
Xiong B.; Nie D.; Cao Y.; Zou Y.; Yao Y.; Qian J.; Rong S.; Huang J.
Institution
(Xiong, Cao, Zou, Yao, Qian, Rong, Huang) Department of Cardiology, The
Second Affiliated Hospital of Chongqing Medical University, Chongqing
400010, China
(Nie) Department of Gastroenterology, The First Affiliated Hospital of
Chengdu Medical College, Chengdu, Sichuan 610500, China
Title
Preoperative Statin Treatment for the Prevention of Acute Kidney Injury in
Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomised
Controlled Trials.
Source
Heart Lung and Circulation. 26 (11) (pp 1200-1207), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Background The effect of preoperative statin treatment (PST) on the risk
of postoperative acute kidney injury (AKI) after cardiac surgery remains
controversial. We performed a meta-analysis of randomised controlled
trials (RCT) to investigate whether PST could improve the renal outcomes
in patients undergoing cardiac surgery. Methods We conducted a
comprehensive search on PubMed, Embase and Cochrane Central Register of
Controlled Trials. Randomised controlled trials which reported incidence
of AKI and renal replacement treatment (RRT), mean change of serum
creatine (SCr) and C-reactive protein (CRP), length of stay in intensive
care unit (LOS-ICU) and hospital (LOS-HOS) were included. Results A total
of nine RCTs, covering 3,201 patients were included. Based on the results
of our meta-analysis, PST could not reduce the incidence of AKI (risk
ratio (RR) 1.12, 95% confidence interval (CI) 0.97 to 1.29, p = 0.37), and
RRT (RR 1.13, 95% CI 0.45 to 2.85, p = 0.80). Furthermore, SCr was not
likely to be improved by PST (weighted mean difference (WMD) 0.03, 95% CI
0.00 to 0.06, p = 0.055). However, the level of CRP (WMD -5.93, 95% CI
11.71 to 0.15, p = 0.044) in patients treated with PST was significantly
lower than that of patients administered with placebo. In addition, no
significant difference was observed in LOS-ICU and LOS-HOS between PST and
control groups. Conclusion Our meta-analysis suggests that PST cannot
provide any benefit for improving renal complications and clinical
outcomes, but may slightly reduce postoperative inflammation in patients
undergoing cardiac surgery. In the future, more powerful RCTs will be
needed to confirm these findings.<br/>Copyright &#xa9; 2017 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<22>
Accession Number
618501264
Author
Kwong J.S.W.; Li S.; Gu W.-J.; Chen H.; Zhang C.; Zeng X.-T.; Yu C.-M.
Institution
(Kwong) Department of Health Policy, National Center for Child Health and
Development, Tokyo, Japan
(Li) Department of Endocrinology and Metabolism, West China Hospital,
Sichuan University, Chengdu, China
(Gu) Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical
College of Nanjing University, Nanjing, China
(Chen) Second Clinical College, Nanjing University of Chinese Medicine,
Nanjing, China
(Zhang) Center for Evidence-Based Medicine and Clinical Research, Taihe
Hospital, Hubei University of Medicine, Shiyan, China
(Zeng) Center for Evidence-Based and Translational Medicine, Zhongnan
Hospital of Wuhan University, Wuhan, China
(Zeng) Department of Urology, Zhongnan Hospital of Wuhan University,
Wuhan, China
(Yu) Chiu Hin Kwong Heart Centre, Hong Kong Baptist Hospital, Kowloon,
Hong Kong
Title
Efficacy and safety of instantaneous wave-free ratio in patients
undergoing coronary revascularisation: Protocol for a systematic review.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e017868. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Effective selection of coronary lesions for revascularisation
is pivotal in the management of symptoms and adverse outcomes in patients
with coronary artery disease. Recently, instantaneous a wave-free' ratio
(iFR) has been proposed as a new diagnostic index for assessing the
severity of coronary stenoses without the need of pharmacological
vasodilation. Evidence of the effectiveness of iFR-guided
revascularisation is emerging and a systematic review is warranted.
Methods and analysis This is a protocol for a systematic review of
randomised controlled trials and controlled observational studies.
Electronic sources including MEDLINE via Ovid, Embase, Cochrane databases
and ClinicalTrials.gov will be searched for potentially eligible studies
investigating the effects of iFR-guided strategy in patients undergoing
coronary revascularisation. Studies will be selected against transparent
eligibility criteria and data will be extracted using a prestandardised
data collection form by two independent authors. Risk of bias in included
studies and overall quality of evidence will be assessed using validated
methodological tools. Meta-analysis will be performed using the Review
Manager software. Our systematic review will be performed according to the
guidance from the Cochrane Handbook for Systematic Reviews of
Interventions and the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. Ethics and dissemination Ethics approval
is not required. Results of the systematic review will be disseminated as
conference proceedings and peer-reviewed journal publication. Trial
registration number This protocol is registered in the International
Prospective Register of Systematic Reviews (PROSPERO), registration number
CRD42017065460.<br/>Copyright &#xa9; Article author(s) 2017. All rights
reserved.

<23>
Accession Number
618728981
Author
Chen F.; Duan G.; Wu Z.; Zuo Z.; Li H.
Institution
(Chen, Duan, Wu, Li) Department of Anesthesiology, Xinqiao Hospital, Third
Military Medical University, Chongqing, China
(Zuo) Department of Anesthesiology, University of Virginia,
Charlottesville, VA, United States
Title
Comparison of the cerebroprotective effect of inhalation anaesthesia and
total intravenous anaesthesia in patients undergoing cardiac surgery with
cardiopulmonary bypass: A systematic review and meta-Analysis.
Source
BMJ Open. 7 (10) (no pagination), 2017. Article Number: e014629. Date of
Publication: 01 Oct 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Neurological dysfunction remains a devastating postoperative
complication in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB), and previous studies have shown that inhalation anaesthesia
and total intravenous anaesthesia (TIVA) may produce different degrees of
cerebral protection in these patients. Therefore, we conducted a
systematic literature review and meta-Analysis to compare the
neuroprotective effects of inhalation anaesthesia and TIVA. Design
Searching in PubMed, EMBASE, Science Direct/Elsevier, China National
Knowledge Infrastructure and Cochrane Library up to August 2016, we
selected related randomised controlled trials for this meta-Analysis.
Results A total of 1485 studies were identified. After eliminating
duplicate articles and screening titles and abstracts, 445 studies were
potentially eligible. After applying exclusion criteria (full texts
reported as abstracts, review article, no control case, lack of outcome
data and so on), 13 studies were selected for review. Our results
demonstrated that the primary outcome related to S100B level in the
inhalation anaesthesia group was significantly lower than in the TIVA
group after CPB and 24 hours postoperatively (weighted mean difference
(WMD); 95% CI (CI): a 0.41(-0.81 to-0.01), a 0.32 (a 0.59 to a 0.05),
respectively). Among secondary outcome variables, mini-mental state
examination scores of the inhalation anaesthesia group were significantly
higher than those of the TIVA group 24 hours after operation (WMD (95%
CI): 1.87 (0.82 to 2.92)), but no significant difference was found in
arteriovenous oxygen content difference, cerebral oxygen extraction ratio
and jugular bulb venous oxygen saturation, which were assessed at cooling
and rewarming during CPB. Conclusion This study demonstrates that
anaesthesia with volatile agents appears to provide better cerebral
protection than TIVA for patients undergoing cardiac surgery with CPB,
suggesting that inhalation anaesthesia may be more suitable for patients
undergoing cardiac surgery.<br/>Copyright &#xa9; 2017 BMJ Publishing
Group. All rights reserved.

<24>
Accession Number
617384012
Author
Tamura T.; Yatabe T.; Yokoyama M.
Institution
(Tamura, Yatabe, Yokoyama) Department of Anesthesiology and Intensive Care
Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi
783-8505, Japan
Title
Prevention of atrial fibrillation after cardiac surgery using low-dose
landiolol: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 42 (pp 1-6), 2017. Date of Publication:
November 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Atrial fibrillation (AF) is associated with mortality
after cardiac surgery. Several studies have reported that landiolol might
help to prevent postoperative AF. The objective of this study was to
investigate whether low-dose landiolol is useful in terms of balance of
benefit and risk. Design We conducted a meta-analysis after systematically
searching the PubMed, the Cochrane library and the ICHUSHI to identify
randomized, controlled trials investigating the preventive effect of
landiolol on incidence of AF after cardiac surgery. Patients Six
randomized trial with 571 patients were included. Measurements The primary
outcome was incidence of AF after surgery, while secondary outcomes were
mortality and complications. Main results Incidence of AF within 1 week
after surgery was significantly lower in the landiolol group than in the
control group (odds ratio, 0.27; 95% confidence interval, 0.18-0.42; p <
0.001). Three of the 6 studies reported data regarding in-hospital
mortality and complications, showing no significant differences between
groups (0.7 vs 3.0%; OR, 0.45; 95% CI, 0.07-2.74; p = 0.39; and 4.5 vs
9.7%; OR, 0.45; 95% CI, 0.16-1.23; p = 0.12, respectively). Conclusions
Our systematic review revealed that low-dose landiolol might help to
prevent AF after cardiac surgery and further large trials are needed to
evaluate safety because mortality and morbidity rate were very low in
included studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<25>
Accession Number
618473534
Author
Ehret C.; Rossaint R.; Foldenauer A.C.; Stoppe C.; Stevanovic A.; Dohms
K.; Hein M.; Schalte G.
Institution
(Ehret, Rossaint, Stoppe, Stevanovic, Dohms, Hein, Schalte) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Foldenauer) Department of Medical Statistics, University Hospital RWTH
Aachen, Aachen, Germany
Title
Is local anaesthesia a favourable approach for transcatheter aortic valve
implantation? A systematic review and meta-analysis comparing local and
general anaesthesia.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016321. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives We conducted a systematic review and meta-analysis to identify
the potential favourable effects of local anaesthesia plus sedation (LAS)
compared with general anaesthesia (GA) in transcatheter aortic valve
implantation (TAVI). Methods Electronic databases (PubMed/Medline, Embase,
Cochrane Central Register of Controlled Trials) and the reference lists of
eligible publications were screened for randomised controlled trials
(RCTs) and observational studies published between 1 January 2006 and 26
June 2016 that compare LAS to GA in an adult study population undergoing
TAVI. We conducted study quality assessments using the Cochrane risk of
bias tool and structured the review according to PRISMA. A meta-analysis
calculating the pooled risk ratios (RRs) and mean differences (MDs) with
95% confidence intervals (CIs) under the assumption of a random-effects
model was performed. Statistical heterogeneity was evaluated using the I
statistic and Cochran's Q-test. Results After database screening, one RCT
and 19 observational studies were included in the review. We found no
differences between LAS and GA in terms of 30-day mortality, in-hospital
mortality and other endpoints that addressed safety and complication
rates. LAS was associated with a shorter ICU and hospital stay and with
lower rates of catecholamine administration and red blood cell
transfusion. New pacemaker implantations occurred more frequently under
LAS. The overall conversion rate from LAS to GA was 6.2%. Conclusion For
TAVI, both LAS and GA are feasible and safe. LAS may have some benefits
such as increased haemodynamic stability and shorter hospital and ICU
stays, but it does not impact 30-day mortality. Since there is a paucity
of randomised trial data and the findings are mainly based on
observational study data, this review should be considered as a
hypothesis-generating article for subsequent RCTs that are required to
confirm the potential favourable effects we detected for LAS. Registration
number CRD42016048398 (PROSPERO).<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<26>
Accession Number
2000770869
Author
Ridker P.M.; MacFadyen J.G.; Glynn R.J.; Koenig W.; Libby P.; Everett
B.M.; Lefkowitz M.; Thuren T.; Cornel J.H.
Institution
(Ridker, MacFadyen, Glynn, Everett) Center for Cardiovascular Disease
Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Ridker, Libby, Everett) Cardiovascular Division, Brigham and Women's
Hospital, Harvard Medical School, Boston, Massachusetts, United States
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
DZHK (German Centre for Cardiovascular Research), partner site Munich
Heart Alliance, Munich, Germany
(Koenig) University of Ulm Medical Center, Department of Internal Medicine
II-Cardiology, Ulm, Germany
(Lefkowitz, Thuren) Novartis Pharmaceutical Corporation, East Hanover, New
Jersey, United States
(Lefkowitz, Thuren) Novartis Pharmaceutical Corporation, Basel,
Switzerland
(Cornel) Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
Title
Inhibition of Interleukin-1beta by Canakinumab and Cardiovascular Outcomes
in Patients With Chronic Kidney Disease.
Source
Journal of the American College of Cardiology. 71 (21) (pp 2405-2414),
2018. Date of Publication: 29 May 2018.
Publisher
Elsevier USA
Abstract
Background: Inflammation contributes to chronic kidney disease (CKD), in
part mediated through activation of interleukin (IL)-1beta by the NLRP3
inflammasome within the kidney. This process also likely contributes to
the accelerated atherosclerosis associated with nephropathy. Objectives:
The authors hypothesized that canakinumab, a human monoclonal antibody
targeting IL-1beta, might reduce cardiovascular event rates and improve
renal function among post-myocardial infarction patients with CKD.
Methods: Stable post-myocardial infarction patients with high-sensitivity
C-reactive protein (hsCRP) >= 2mg/l were randomly allocated to placebo or
to 1 of 3 doses of canakinumab (50, 150, or 300 mg) given subcutaneously
once every 3 months. Participants were followed for incident myocardial
infarction, stroke, hospitalization for unstable angina requiring urgent
revascularization, cardiovascular death, or death from any cause over a
median follow-up period of 3.7 years (maximum 5 years). All patients
additionally had serial monitoring of estimated glomerular filtration rate
(eGFR), creatinine, the urine albumin to creatinine ratio (uACR), and were
monitored for adverse renal and urinary events. Results: Of 10,061
participants, 1,875 (18.6%) had baseline eGFR <60 ml/min/1.73
m². These moderate CKD patients had higher incidence rates for
major adverse vascular events compared with those with eGFR >=60
ml/min/1.73 m² (6.92 vs. 4.13 per 100 person-years; p <
0.0001). Random allocation to canakinumab reduced the risk of major
adverse cardiovascular events among those with CKD (hazard ratio: 0.82;
95% confidence interval: 0.68 to 1.00; p = 0.05) with the largest
cardiovascular benefits accruing among those who achieved on-treatment
hsCRP levels below 2 mg/l measured after taking the first dose (hazard
ratio: 0.68; 95% confidence interval: 0.53 to 0.86; p = 0.0015).
Comparable effects were observed among those with baseline albuminuria or
diabetes. Canakinumab had neither clinically meaningful benefits nor
substantive harms with respect to serial measures of eGFR, creatinine, the
uACR, or reported adverse renal events during trial follow-up.
Conclusions: IL-1beta inhibition with canakinumab reduces major adverse
cardiovascular event rates among high-risk atherosclerosis patients with
CKD, particularly among those with a robust anti-inflammatory response to
initial treatment. These cardiovascular benefits accrued with no adverse
clinical renal events. (Canakinumab Anti-inflammatory Thrombosis Outcomes
Study [CANTOS]; NCT01327846)<br/>Copyright &#xa9; 2018 American College of
Cardiology Foundation

<27>
Accession Number
622228591
Author
Straiton N.; Jin K.; Bhindi R.; Gallagher R.
Institution
(Straiton, Jin, Gallagher) Sydney Nursing School, University of Sydney,
Sydney, NSW, Australia
(Straiton, Bhindi) Department of Cardiology, Royal North Shore Hospital,
Sydney, NSW, Australia
(Bhindi) The University of Sydney, Sydney, NSW, Australia
Title
Functional capacity and health-related quality of life outcomes post
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Age and Ageing. 47 (3) (pp 478-482), 2018. Date of Publication: 01 May
2018.
Publisher
Oxford University Press
Abstract
Background: transcatheter aortic valve replacement (TAVR) provides
prognostic benefit for high surgical-risk patients with severe aortic
stenosis (AS), yet the impact to patient outcomes is far less understood.
Method: we performed a systematic review and meta-analysis to evaluate
functional capacity and health-related quality of life (HRQoL) outcomes
for patients up to 12 months post TAVR. A total of 20 eligible
publications, comprising randomised-controlled trials, observational
studies and a registry study were identified from electronic databases,
including MEDLINE, EMBASE, Cochrane Library and others (inception to
February 2017). Results: the total sample was 2,775 with a mean age of
81.8 +/- 2.1 years, more than half (52%) were female and high surgical
risk 9.6 +/- 4.3% mean STS (Society of Thoracic Surgeons risk model). Post
TAVR, patients had significant improvement in functional capacity of > 40
m in the 6-minute walk test (6MWT) (95% confidence interval (CI)
9.69-73.28) and a clinically meaningful increase in ability to perform
daily physical-based tasks (Duke Activity Status Index (DASI), mean
difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved
consistently following TAVR regardless of measure used. Significant
increases occurred in the physical component summary scores (PCS) of the
short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12)
points). Conclusion: functional capacity and HRQoL improved substantially
following TAVR, despite evolving patient selection criteria, thus TAVR
continues to provide a directly beneficial option for severe AS
patients.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the British Geriatrics Society. All rights
reserved.

<28>
Accession Number
618484830
Author
Lemoine S.; Zhu L.; Gerard J.-L.; Hanouz J.-L.
Institution
(Lemoine, Zhu, Gerard, Hanouz) Department of Anaesthesiology and Intensive
Care, Universite Caen-Normandie, Centre Hospitalier Universitaire de Caen,
Caen 14033, France
(Hanouz) EA 4650, Universite Caen-Normandie, Centre Hospitalier
Universitaire de Caen, Caen 14033, France
Title
Sevoflurane-induced cardioprotection in coronary artery bypass graft
surgery: Randomised trial with clinical and ex-vivo endpoints.
Source
Anaesthesia Critical Care and Pain Medicine. 37 (3) (pp 217-223), 2018.
Date of Publication: June 2018.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Myocardial ischaemia reperfusion injury following cardiac
surgery with cardiopulmonary bypass (CPB) increases postoperative
mortality. Setting techniques to protect the heart during this critical
period therefore represents a considerable challenge. Method: A randomised
controlled study in Caen University Hospital Centre, investigated whether
the clinical cardio protective effects of administration sevoflurane
before cardiopulmonary bypass during coronary artery bypass graft surgery
(CABG) could translate into protected atrial trabeculae contractility
against hypoxia-reoxygenation in vitro. Patients undergoing elective
on-pump CABG surgery were allocated to receive either sevoflurane (n = 24)
or no halogenated volatile anaesthetic (n = 21). Main outcome measures:
the relationship between sevoflurane exposure before CPB and the incidence
of major adverse cardiac events, with primary endpoint: the postoperative
troponin I peak level, and secondary endpoints: the inotropic support, and
the duration of stay in intensive unit and in-hospital stay were chosen as
study endpoints. The right atrial was collected at the beginning of bypass
surgery for the in vitro experimentation. Isometrically contracting
isolated human right atrial trabeculae obtained from the two groups were
exposed to 30-min hypoxia followed by 60-min reoxygenation. Results: The
patients receiving sevoflurane prior to aortic clamping significantly
exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64]
ng.mL^-1 in Control; P = 0.03) and required a reduced inotropic
drug support (P < 0.001). Isolated trabeculae from patients receiving
sevoflurane enhanced the recovery of force after reoxygenation compared to
the Control group (79 +/- 5% vs. 53 +/- 8% of baseline in Control; P <
0.001). Conclusions: Administration of sevoflurane before CPB induced
cardioprotection in patients undergoing CABG and preconditioned human
myocardium against hypoxia-reoxygenation in vitro.<br/>Copyright &#xa9;
2018 Societe francaise d'anesthesie et de reanimation (Sfar)

<29>
Accession Number
622339513
Author
Wamboldt R.; Bisleri G.; Glover B.; Haseeb S.; Tse G.; Liu T.; Baranchuk
A.
Institution
(Wamboldt, Glover, Haseeb, Baranchuk) Division of Cardiology, Kingston
Health Science Center, Queen's University, Kingston, Canada
(Bisleri) Division of Cardiovascular Surgery, Kingston Health Science
Center, Queen's University, Kingston, Canada
(Tse) Department of Medicine, Chinese University of Hong Kong, Hong Kong
(Liu) Department of Cardiology, Tianjin Institute of Cardiology Second
Hospital of Tianjin Medical University, Tianjin, China
Title
Primary prevention of post-pericardiotomy syndrome using corticosteroids:
a systematic review.
Source
Expert Review of Cardiovascular Therapy. 16 (6) (pp 405-412), 2018. Date
of Publication: 03 Jun 2018.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Post-pericardiotomy syndrome is a well-recognized
inflammatory phenomenon that commonly occurs in patients following cardiac
surgery. Due to the increased morbidity and resource utilization
associated with this condition, research has recently focused on ways of
preventing its prevention this condition; primarily using colchicine,
NSAIDs and corticosteroids. Areas covered: This systematic review
summarizes the three clinical studies that have used corticosteroids for
PPS primary prevention in the perioperative period. Due to the
heterogeneity amongst these three studies in terms of population (both
pediatric and adult patients), surgical procedure, administration regimen
and results (only 1/3 studies reporting a positive effect), the
effectiveness of corticosteroids remains unproven. Expert commentary:
Corticosteroids have shown to be useful in the treatment of PPS but have
thus far have shown mixed results as a primary prevention method. Research
on patients taking corticosteroids pre-operatively have shown a
significant reduction in the risk of developing PPS. Further research is
required to determine if corticosteroids are helpful in preventing PPS in
patient undergoing cardiac surgery, before any recommendations regarding
their use in cardiovascular surgery can be made.<br/>Copyright &#xa9; 2018
Informa UK Limited, trading as Taylor & Francis Group.

<30>
Accession Number
622276075
Author
Deferrari G.; Bonanni A.; Bruschi M.; Alicino C.; Signori A.
Institution
(Deferrari, Bonanni) Department of Cardionephrology, Istituto Clinico di
Alta Specialita (ICLAS) Rapallo (GE), Italy
(Deferrari) Department of Internal Medicine (Di.MI), University of Genoa,
Genoa, Italy
(Bonanni, Bruschi) Division of Nephrology, Dialysis and Transplantation
and Laboratory on Pathophysiology of Uremia, IRCCS Istituto Giannina
Gaslini, Genoa, Italy
(Alicino, Signori) Department of Health Science (Di.S.Sal), University of
Genoa, Genoa, Italy
Title
Remote ischaemic preconditioning for renal and cardiac protection in adult
patients undergoing cardiac surgery with cardiopulmonary bypass:
Systematic review and meta-analysis of randomized controlled trials.
Source
Nephrology Dialysis Transplantation. 33 (5) (pp 813-824), 2018. Date of
Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
Background. The main aim of this systematic review was to assess whether
remote ischaemic preconditioning (RIPC) protects kidneys and the heart in
cardiac surgery with cardiopulmonary bypass (CPB) and to investigate a
possible role of anaesthetic agents. Methods. Randomized clinical trials
(RCTs) on the effects of RIPC through limb ischaemia in adult patients
undergoing cardiac surgery with CPB were searched (1965-October 2016) in
PubMed, Cochrane Library and article reference lists. A random effects
model on standardized mean difference 0.97)]. In the volatile anaesthetic
group, RIPC significantly reduced AKI incidence [OR 0.57 (95% CI
0.41-0.79)] and marginally reduced ICU stay. Conversely, except for MIBs,
RIPC had fewer non-significant effects under propofol with or without
volatile anaesthetics. Conclusions. RIPC did not consistently reduce
morbidity and mortality in adults undergoing cardiac surgery with CPB. In
the subgroup on volatile anaesthetics only, RIPC markedly and
significantly reduced the incidence of AKI and composite endpoint as well
asmyocardial injury.<br/>Copyright &#xa9; The Author 2017.

<31>
Accession Number
2000793241
Author
Wozniak M.J.; Sullo N.; Qureshi S.; Dott W.; Cardigan R.; Wiltshire M.;
Morris T.; Nath M.; Bittar N.; Bhudia S.K.; Kumar T.; Goodall A.H.; Murphy
G.J.
Institution
(Wozniak, Sullo, Qureshi, Dott, Nath, Kumar, Goodall, Murphy) Department
of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research
Unit, University of Leicester, Glenfield Hospital, Leicester LE3 9QP,
United Kingdom
(Cardigan, Wiltshire) National Health Service Blood and Transplant,
Cambridge CB2 0PT, United Kingdom
(Morris) Leicester Clinical Trials Unit, Leicester Diabetes Centre,
Leicester General Hospital, Leicester LE5 4PW, United Kingdom
(Bittar) Blackpool Victoria Hospital NHS Trust, Blackpool, Lancashire FY3
8NR, United Kingdom
(Bhudia) University Hospitals Coventry and Warwickshire NHS Trust,
Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
Title
Randomized trial of red cell washing for the prevention of
transfusion-associated organ injury in cardiac surgery.
Source
British Journal of Anaesthesia. 118 (5) (pp 689-698), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
Background: Experimental studies suggest that mechanical cell washing to
remove pro-inflammatory components that accumulate in the supernatant of
stored donor red blood cells (RBCs) might reduce inflammation and organ
injury in transfused patients. Methods: Cardiac surgery patients at
increased risk of large-volume RBC transfusion were eligible. Participants
were randomized to receive either mechanically washed allogenic RBCs or
standard care RBCs. The primary outcome was serum interleukin-8 measured
at baseline and at four postsurgery time points. A mechanism substudy
evaluated the effects of washing on stored RBCs in vitro and on markers of
platelet, leucocyte, and endothelial activation in trial subjects.
Results: Sixty adult cardiac surgery patients at three UK cardiac centres
were enrolled between September 2013 and March 2015. Subjects received a
median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of
21 (SD 5.2) days, within 48 h of surgery. Mechanical washing reduced
concentrations of RBC-derived microvesicles but increased cell-free
haemoglobin concentrations in RBC supernatant relative to standard care
RBC supernatant. There was no difference between groups with respect to
perioperative serum interleukin-8 values [adjusted mean difference 0.239
(95% confidence intervals -0.231, 0.709), P=0.318] or concentrations of
plasma RBC microvesicles, platelet and leucocyte activation, plasma
cell-free haemoglobin, endothelial activation, or biomarkers of heart,
lung, or kidney injury. Conclusions: These results do not support a
hypothesis that allogenic red blood cell washing has clinical benefits in
cardiac surgery. Clinical trial registration: ISRCTN
27076315.<br/>Copyright &#xa9; 2017 The Author(s)

<32>
Accession Number
2000792419
Author
Spence J.; Belley-Cote E.; Ma H.K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.J.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti) Department of Anaesthesia
and Critical Care, McMaster University, Population Health Research
Institute, Hamilton, ON, Canada
(Spence, Devereaux, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine (Cardiology), McMaster University,
Population Health Research Institute, Hamilton, ON, Canada
(Hussain) Department of Surgery, Division of Cardiac Surgery, McGill
University, Montreal, PQ, Canada
(Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
Population Health Research Institute, Hamilton, ON, Canada
(Devereaux) Department of Medicine, Division of Cardiology, Population
Health Research Institute, Hamilton, ON, Canada
(Spence, Belley-Cote, Hussain, Devereaux, Whitlock) Population Health
Research Institute, Hamilton, ON, Canada
Title
Efficacy and safety of inhaled anaesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: a
systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 118 (5) (pp 658-669), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
The aim was to evaluate the efficacy and safety of volatile anaesthetic
for postoperative sedation in adult cardiac surgery patients through a
systematic review and meta-analysis. We retrieved randomized controlled
trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials
registries, conference proceedings, and reference lists of included
articles. Independent reviewers extracted data, including patient
characteristics, type of intraoperative anaesthesia, inhaled anaesthetic
used, comparator sedation, and outcomes of interest, using pre-piloted
forms. We assessed risk of bias using the Cochrane Tool and evaluated the
strength of the evidence using the GRADE approach. Eight studies enrolling
610 patients were included. Seven had a high and one a low risk of bias.
The times to extubation after intensive care unit (ICU) admission and
sedation discontinuation were, respectively, 76 [95% confidence interval
(CI) -150 to - 2, I²=79%] and 74 min (95% CI - 126 to - 23,
I²=96%) less in patients who were sedated using volatile
anaesthetic. There was no difference in ICU or hospital length of stay.
Patients who received volatile anaesthetic sedation had troponin
concentrations that were 0.71 ng ml^-1 (95% CI 0.23-1.2) lower
than control patients. Reporting on other outcomes was varied and not
suitable for meta-analysis. Volatile anaesthetic sedation may be
associated with a shorter time to extubation after cardiac surgery but no
change in ICU or hospital length of stay. It is associated with a
significantly lower postoperative troponin concentration, but the impact
of this on adverse cardiovascular outcomes is uncertain. Blinded
randomized trials using intention-to-treat analysis are required. PROSPERO
registry number: 2016:CRD42016033874. Available from
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016033874.<b
r/>Copyright &#xa9; 2017 The Author(s)

<33>
Accession Number
2000792299
Author
Benstoem C.; Goetzenich A.; Stoppe C.
Institution
(Benstoem, Goetzenich, Stoppe) AachenGermany
Title
The role of propofol for remote ischaemic preconditioning in the setting
of cardiac surgery - a Cochrane systematic review⁺.
Source
British Journal of Anaesthesia. 119 (6) (pp 1234-1235), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ltd

<34>
Accession Number
2000793724
Author
Bianchi P.; Cotza M.; Beccaris C.; Silvetti S.; Isgro G.; Pome G.;
Giamberti A.; Ranucci M.
Institution
(Bianchi, Cotza, Beccaris, Isgro, Ranucci) Department of Cardiothoracic,
Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Via
Morandi 30, 20097 San Donato Milanese, Milan, Italy
(Silvetti) Department of Cardiac Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Pome, Giamberti) Department of Congenital Heart Surgery, IRCCS
Policlinico San Donato, Milan, Italy
Title
Early or late fresh frozen plasma administration in newborns and small
infants undergoing cardiac surgery: the APPEAR randomized trial.
Source
British Journal of Anaesthesia. 118 (5) (pp 788-796), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
Background: In newborns and small infants undergoing cardiac surgery with
cardiopulmonary bypass (CPB) and blood priming, it is unclear whether
there is reduced blood loss if fresh frozen plasma (FFP) is added to the
CPB priming volume. This single-centre, randomized trial tested the
hypothesis that the administration of FFP after CPB (late FFP group) is
superior to FFP priming (early FFP group) in terms of postoperative
bleeding and overall red blood cell (RBC) transfusion. Methods:
Seventy-three infants weighing <10 kg were randomly allocated to receive
FFP to supplement RBCs in the CPB priming solution (n=36) or immediately
after CPB (n=37). The primary endpoint was a difference in postoperative
blood loss; secondary endpoints included the amount of RBCs and FFP
transfused through the first 48 postoperative hours. Results: All patients
were included in the analysis. Patients in the late FFP arm had greater
postoperative mean blood loss than patients in the early FFP arm [33.1 (SD
20.6) vs 24.1 (12.9) ml kg^-1; P=0.028], but no differences in
transfusions were found. The subgroup of cyanotic heart disease patients
had comparable results, but with greater use of RBCs in the late FFP
group. Conclusions: In infants undergoing cardiac surgery, FFP in the
priming solution appears slightly superior to late administration in terms
of postoperative bleeding. Clinical trial registration:
www.ClinicalTrials.gov, NCT02738190.<br/>Copyright &#xa9; 2017 The
Author(s)

<35>
Accession Number
615245057
Author
Mauthner O.; Claes V.; Deschodt M.; Jha S.R.; Engberg S.; Macdonald P.S.;
Newton P.J.; De Geest S.
Institution
(Mauthner, Claes, Deschodt, De Geest) Institute of Nursing Science,
Faculty of Medicine, University of Basel, Switzerland
(Claes, Deschodt, De Geest) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, Belgium
(Jha, Macdonald) Heart Transplant Program, St Vincent's Hospital, Sydney,
Australia
(Jha, Newton) Centre for Cardiovascular and Chronic Care, Faculty Health,
University of Technology Sydney, Australia
(Engberg) School of Nursing, University of Pittsburgh, United States
(Macdonald) Victor Chang Cardiac Research Institute, Sydney, NSW,
Australia
Title
Handle with care: A systematic review on frailty in cardiac care and its
usefulness in heart transplantation.
Source
Transplantation Reviews. 31 (3) (pp 218-224), 2017. Date of Publication:
July 2017.
Publisher
W.B. Saunders
Abstract
Background There is growing consensus that frailty, a state of
vulnerability and a decline in functioning across multiple physiological
body systems, is a valuable criterion to guide clinicians' risk prediction
for poor outcomes in adult transplant candidates. In its 2016 listing
criteria for heart transplantation the International Society for Heart
Lung Transplantation recommends frailty assessment. We aimed to summarize
the usefulness of frailty assessment in heart transplant candidates or
recipients reported throughout the literature. Methods We performed a
systematic literature search in PubMed to identify papers reporting on
frailty in transplantation, chronic heart failure, and ventricualr assist
device implantation published over the last 10 years in English.
Additionally, a hand search was conducted, including manually searching
the reference lists and a citation search of relevant papers. Results
Eleven primary research articles were included in this systematic review.
Frailty is a risk factor for morbidity, hospitalization, and mortality in
patients with advanced heart failure and individuals being considered for
ventricualr assist device implantation. Of the patients being considered
for transplantation, 33% are frail. The Frailty Phenotype by Fried is a
particularly useful tool to quickly identify higher risk patients for
adverse outcomes. Conclusion A lack of standardization and limited
evidence on frailty in transplantation limit its use as a definitive
listing criterion. Future research efforts should focus on systematic
integration of frailty measures in transplant practice.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<36>
Accession Number
2000795289
Author
Amour J.; Garnier M.; Szymezak J.; Le Manach Y.; Helley D.; Bertil S.;
Ouattara A.; Riou B.; Gaussem P.
Institution
(Amour, Garnier, Szymezak, Le Manach, Helley, Bertil, Ouattara, Riou,
Gaussem) Universite Pierre et Marie Curie, Assistance Publique-Hopitaux de
Paris (APHP), Department of Anaesthesiology and Critical Care, UMRS
INSERM, IHU ICAN, CHU Pitie-Salpetriere, Paris, 1166, France; Assistance
Publique-Hopitaux de Paris (APHP), Department of Biological Hematology,
Hopital Europeen Georges Pompidou, Inserm UMR-S1140, Faculte de Pharmacie,
Descartes University, Sorbonne Paris Cite Paris, France; Departments of
Anaesthesia and Clinical Epidemiology and Biostatistics, Michael DeGroote
School of Medicine, Faculty of Health Sciences, McMaster University,
Canada; Department of Anaesthesiology and Critical Care, Groupe
Hospitalier Sud, Pessac, Bordeaux; Universite Pierre et Marie Curie,
Assistance Publique-Hopitaux de Paris (APHP), Department of Emergency
Medicine and Surgery, UMRS INSERM 1166, IHU ICAN, CHU Pitie-Salpetriere,
Assistance Publique-Hopitaux de Paris (APHP), Paris, France
Title
Prospective observational study of the effect of dual antiplatelet therapy
with tranexamic acid treatment on platelet function and bleeding after
cardiac surgery.
Source
British Journal of Anaesthesia. 117 (6) (pp 749-757), 2016. Date of
Publication: December 2016.
Publisher
Elsevier Ltd
Abstract
Background: The bleeding impact of dual antiplatelet therapy (DAPT),
aspirin and clopidogrel, maintained until coronary artery bypass graft
surgery (CABG), is still a matter of debate. The lack of preoperative
antiplatelet activity measurement and heterogeneity of antifibrinolytic
protocols in prior studies make the conclusions questionable. The aim of
this prospective study was to determine, after preoperative antiplatelet
activity measurement, if the maintenance of DAPT until CABG increases
bleeding in patients treated with tranexamic acid (TA). Methods: This
observational study included 150 consecutive patients, 89 treated with
aspirin and 61 treated with DAPT, undergoing a first-time planned on-pump
CABG with TA treatment. Antiplatelet activity was measured with platelet
aggregation tests and quantification of VASP phosphorylation.
Postoperative bleeding at 24 h was recorded and propensity score analysis
was performed. Results: Based on VASP assay, 54% of patients showed high
on-clopidogrel platelet activity inhibition. Postoperative bleeding at 24
h increased by 22% in the DAPT group, compared with the aspirin group (680
[95% CI: 360-1670] vs 558 [95%CI: 267-1270] ml, P < 0.01), consistent with
increased blood transfusion (21% vs 7%, P = 0.01); a higher incidence of
mediastinitis did not reach statistical significance (15% vs 4%, P =
0.05). Bleeding correlated with the extent of clopidogrel antiplatelet
effect, with the best correlation for the VASP assay. Conclusions:
Maintenance of DAPT until the day of CABG in patients treated with TA,
increased postoperative bleeding at 24 h in parallel with preoperative
antiplatelet activity induced by clopidogrel.<br/>Copyright &#xa9; 2016
The Author(s)

<37>
Accession Number
2000518728
Author
Cassao B.D.; Herbella F.A.M.; Schlottmann F.; Patti M.G.
Institution
(Cassao, Herbella) Department of Surgery, Escola Paulista de Medicina,
Federal University of Sao Paulo, Sao Paulo, Brazil
(Schlottmann, Patti) Department of Medicine and Surgery, University of
North Carolina, Chapel Hill, North Carolina, United States
Title
Retracted articles in surgery journals. What are surgeons doing wrong?.
Source
Surgery (United States). 163 (6) (pp 1201-1206), 2018. Date of
Publication: June 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Retraction of previously published scientific articles is an
important mechanism to preserve the integrity of scientific work. This
study analyzed retractions of previously published articles from surgery
journals. Methods: We searched for retracted articles in the 100 surgery
journals with the highest SJR2 indicator grades. Results: We found 130
retracted articles in 49 journals (49%). Five or more retracted articles
were published in 8 journals (8%). The mean time between publication and
retraction was 26 months (range 1 to 158 months). The United States,
China, Germany, Japan, and the United Kingdom accounted for more than 3
out of 4 of the retracted articles. The greatest number of retractions
came from manuscripts about orthopedics and traumatology, general surgery,
anesthesiology, cardiothoracic surgery, and plastic surgery. Nonsurgeons
were responsible for 16% of retractions in these surgery journals. The
main reasons for retraction were duplicate publication (42%), plagiarism
(16%), absence of proven integrity of the study (14%), incorrect data
(13%), data published without authorization (12%), violation of research
ethics (11%), documented fraud (11%), request of an author(s) (5%), and
unknown (3%). In 25% of the retracted articles, other publications by the
same authors also had been retracted. Conclusion: Retraction of published
articles does not occur frequently in surgery journals. Some form of
scientific misconduct was present in the majority of retractions,
especially duplication of publication and plagiarism. Retractions of
previously published articles were most frequent from countries with the
greatest number of publications; some authors showed
recidivism.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<38>
Accession Number
622387516
Author
Yao X.; Gersh B.J.; Holmes D.R.; Melduni R.M.; Johnsrud D.O.;
Sangaralingham L.R.; Shah N.D.; Noseworthy P.A.
Institution
(Yao, Sangaralingham, Shah, Noseworthy) Robert D. and Patricia E. Kern
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester,
MN, United States
(Yao, Shah) Division of Health Care Policy and Research, Department of
Health Sciences Research, Mayo Clinic, Rochester, MN, United States
(Gersh, Holmes, Melduni, Noseworthy) Department of Cardiovascular
Medicine, Mayo Clinic, Rochester, MN, United States
(Johnsrud) Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Shah) OptumLabs, Cambridge, MA, United States
Title
Association of surgical left atrial appendage occlusion with subsequent
stroke and mortality among patients undergoing cardiac surgery.
Source
JAMA - Journal of the American Medical Association. 319 (20) (pp
2116-2126), 2018. Date of Publication: 22 May 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Surgical occlusion of the left atrial appendage (LAAO) may be
performed during concurrent cardiac surgery. However, few data exist on
the association of LAAO with long-term risk of stroke, and some evidence
suggests that this procedure may be associated with subsequent development
of atrial fibrillation (AF). OBJECTIVE To evaluate the association of
surgical LAAO performed during cardiac surgery with risk of stroke,
mortality, and development of subsequent AF. DESIGN, SETTING, AND
PARTICIPANTS Retrospective cohort study using a large US administrative
database that contains data from adult patients (18 years) with private
insurance or Medicare Advantage who underwent coronary artery bypass graft
(CABG) or valve surgery between January 1, 2009, and March 30, 2017, with
final follow-up on March 31, 2017. One-to-one propensity score matching
was used to balance patients on 76 dimensions to compare those with vs
without LAAO, stratified by history of prior AF at the time of surgery.
EXPOSURES Surgical LAAO vs no surgical LAAO during cardiac surgery. MAIN
OUTCOMES AND MEASURES The primary outcomes were stroke (ie, ischemic
stroke or systemic embolism) and all-cause mortality. The secondary
outcomes were postoperative AF (AF within 30 days after surgery among
patients without prior AF) and long-term AF-related health utilization
(event rates of outpatient visits and hospitalizations). RESULTS Among 75
782 patients who underwent cardiac surgery (mean age, 66.0 [SD, 11.2]
years; 2 2091 [29.2%] women, 25 721 [33.9%] with preexisting AF), 4374
(5.8%) underwent concurrent LAAO, and mean follow-up was 2.1 (SD, 1.9)
years. In the 8590 propensity score-matched patients, LAAO was associated
with a reduced risk of stroke (1.14 vs 1.59 events per 100 person-years;
hazard ratio [HR], 0.73 [95% CI, 0.56-0.96]; P = .03) and mortality (3.01
vs 4.30 events per 100 person-years; HR, 0.71 [95% CI, 0.60-0.84]; P <
.001). LAAO was associated with higher rates of AF-related outpatient
visits (11.96 vs 10.26 events per person-year; absolute difference, 1.70
[95% CI, 1.60-1.80] events per person-year; rate ratio, 1.17 [95% CI,
1.10-1.24]; P < .001) and hospitalizations (0.36 vs 0.32 event per
person-year; absolute difference, 0.04 [95% CI, 0.02-0.06] event per
person-year; rate ratio, 1.13 [95% CI, 1.05-1.21]; P = .002). In patients
with prior AF (6438/8590 [74.9%]) with vs without LAAO, risk of stroke was
1.11 vs 1.71 events per 100 person-years (HR, 0.68 [95% CI, 0.50-0.92]; P
= .01) and risk of mortality was 3.22 vs 4.93 events per 100 person-years
(HR, 0.67 [95% CI, 0.56-0.80]; P < .001), respectively. In patients
without prior AF (2152/8590 [25.1%]) with vs without LAAO, risk of stroke
was 1.23 vs 1.26 events per 100 person-years (HR, 0.95 [95% CI,
0.54-1.68]), risk of mortality was 2.30 vs 2.49 events per 100
person-years (HR, 0.92 [95% CI, 0.61-1.37]), and risk of postoperative AF
was 27.7% vs 20.2% events per 100 person-years (HR, 1.46 [95% CI,
1.22-1.73]; P < .001). The interaction term between prior AF and LAAO was
not significant (P = .29 for stroke and P = .16 for mortality).
CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery,
concurrent surgical LAAO, compared with no surgical LAAO, was associated
with reduced risk of subsequent stroke and all-cause mortality. Further
research, including from randomized clinical trials, is needed to more
definitively determine the role of surgical LAAO.<br/>Copyright &#xa9;
2018 American Medical Association. All rights reserved.

<39>
Accession Number
622383195
Author
De Vecchis R.; Ariano C.; Giasi A.; Cioppa C.
Institution
(De Vecchis, Ariano, Giasi, Cioppa) Unit of Cardiology, Presidio Sanitario
Intermedio Elena D'Aosta, ASL Napoli 1 Centro, Via P. Gaurico 21, Naples
80125, Italy
Title
Antiarrhythmic effects of ranolazine used both alone for prevention of
atrial fibrillation and as an add-on to intravenous amiodarone for its
pharmacological cardioversion: A meta-Analysis.
Source
Minerva Cardioangiologica. 66 (3) (pp 349-359), 2018. Date of Publication:
June 2018.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Recent evidence from relatively small randomized controlled
trials would seem to support a useful role of ranolazine for the
prevention and treatment of atrial fibrillation (AF). The present study is
aimed at providing information about the possible beneficial
anti-Arrhythmic properties of ranolazine. In particular, the meta-Analysis
carried out in this study focuses on the application of ranolazine to
prophylaxis and treatment of atrial fibrillation. EVIDENCE ACQUISITION:
Both methods randomized controlled trials (RCTs) and non-randomized
observational studies concerning the effects of ranolazine on AF were
included in the meta-Analysis. In each of the considered studies, a
comparison was made between a group of patients taking ranolazine and a
second group treated instead with another antiarrhythmic therapy, or
assigned to placebo. Efficacy outcomes were the risk of new-onset AF, the
probability of conversion to sinus rhythm of patients with recent
occurrence (>=48 h) of AF and the time to conversion to sinus rhythm.
Safety endpoints were death, adverse events, QTc prolongation and
hypotension. EVIDENCE SYNTHESIS: Ten studies (8 RCTs and 2 nonrandomized
observational studies) were gathered on the whole. Ranolazine was
effective in preventing the occurrence of AF when compared to controls
(RR=0.60; 95% CI: 0.43-0.83; P=0.002). Subgroup analysis showed a more
pronounced preventive effect of ranolazine against AF in the postoperative
setting of coronary artery bypass grafting (CABG) surgery (RR=0.39; 95%
CI: 0.18-0.83; P=0.02) when compared to non-postoperative AF (RR=0.76; 95%
CI: 0.63-0.92; P=0.04). Ranolazine enhanced the chances of successful
cardioversion when added to intravenous amiodarone compared to amiodarone
alone (RR 1.18; 95% CI: 1.05-1.33; P=0.004) and significantly decreased
the time to cardioversion (SMD=-10.35 h; 95% CI:-18.13 hours to-2.57
hours; P<0.001). Overall risks of death, adverse events, and QTc
prolongation were shown to be similar in the comparison between patients
treated with ranolazine and controls. CONCLUSIONS: Ranolazine given orally
at appropriate doses showed the property to significantly quicken the
conversion of AF to sinus rhythm when combined with the IV amiodarone,
compared to IV amiodarone alone. Furthermore, in patients in sinus rhythm,
ranolazine proved to reduce the frequency of new onset AF as well as of
its recurrences, especially in patients undergone CABG surgery, known to
be at high risk of developing postoperative AF. In addition, ranolazine
use seems to be safe and associated with relatively few adverse
events.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<40>
Accession Number
622304547
Author
Magliano C.A.S.; Monteiro A.L.; Tura B.R.; Oliveira C.S.R.; Rebelo A.R.O.;
Pereira C.C.A.
Institution
(Magliano, Tura, Oliveira, Rebelo) HTA Department, National Institute of
Cardiology, Rio de Janeiro, Brazil
(Monteiro) Department of Pharmacy Systems, Outcomes and Policy, College of
Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
(Pereira) The National School of Public Health Sergio Arouca ENSP/Fiocruz,
Rio de Janeiro, Brazil
Title
Patient and physician preferences for attributes of coronary
revascularization.
Source
Patient Preference and Adherence. 12 (pp 757-764), 2018. Date of
Publication: 08 May 2018.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Patients with a diagnosis of coronary artery disease (CAD) may
face important decisions regarding treatment options, with the "right
choice" depending on the relative weights of risks and benefits. Studies
performed as discrete choice experiments are used to estimate these
weights, and attribute selection is an essential step in the design of
these studies. Attributes not included in the design cannot be analyzed.
In this study, we aimed to elicit, rank, and rate attributes that may be
considered important to patients and physicians who must choose between
angioplasty and surgery for coronary revascularization. Methods: The
elicitation process involved performing a systematic review to search for
attributes cited in declared preference studies in addition to
face-to-face interviews with cardiologists and experts. The interviews
were audio-recorded in digital format, and the collected data were
transcribed and searched to identify new attributes. The criterion used to
finish the data collection process was sampling saturation. Results: A
systematic review resulted in the selection of the following 14
attributes: atrial fibrillation, heart failure, incision scar, length of
stay, long-term survival, myocardial infarction, periprocedural death,
postoperative infection, postprocedural angina, pseudoaneurysm, renal
failure, repeat coronary artery bypass grafting, repeat percutaneous
coronary intervention, and stroke. The interviews added no new attributes.
After rating, we identified significant differences in the values that
patients and cardiologists placed on renal insufficiency (p<0.001),
periprocedural death (p<0.001), and long-term survival (p<.001).
Conclusion: Decisions regarding the best treatment option for patients
with CAD should be made based on differences in risk and the patient's
preference regarding the most relevant endpoints. We elicited, ranked, and
rated 14 attributes related to CAD treatment options. This list of
attributes may help researchers who seek to perform future preference
studies of CAD treatment options.<br/>Copyright &#xa9; 2018 Magliano et
al.

<41>
[Use Link to view the full text]
Accession Number
622304261
Author
Pina I.L.; Zheng Q.; She L.; Szwed H.; Lang I.M.; Farsky P.S.;
Castelvecchio S.; Biernat J.; Paraforos A.; Kosevic D.; Favaloro L.E.;
Nicolau J.C.; Varadarajan P.; Velazquez E.J.; Pai R.G.; Cyrille N.; Lee
K.L.; Desvigne-Nickens P.
Institution
(Pina, Zheng, Cyrille) Albert Einstein College of Medicine, Montefore
Medical Center, New York, NY, United States
(She) Duke Clinical Research Institute, United States
(Lee) Department of Biostatistics and Bioinformatics, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(Szwed) National Institute of Cardiology, Warsaw, Poland
(Lang) Medical University of Vienna, Austria
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Castelvecchio) Istituti di Ricovero e Cura A Carattere Scientifco
Policlinico San Donato, Milan, Italy
(Biernat) Medical University of Silesia, Katowice, Poland
(Paraforos) Department of Surgery-Cardiac, University of Trier, Germany
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Varadarajan, Pai) Department of Medicine/Cardiology, University of
California, Riverside School of Medicine, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
Title
Sex difference in patients with ischemic heart failure undergoing surgical
revascularization results from the STICH trial (surgical treatment for
ischemic heart failure).
Source
Circulation. 137 (8) (pp 771-780), 2018. Date of Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Female sex is conventionally considered a risk factor for
coronary artery bypass grafting (CABG) and has been included as a poor
prognostic factor in multiple cardiac operative risk evaluation scores. We
aimed to investigate the association of sex and the long-term beneft of
CABG in patients with ischemic left ventricular dysfunction enrolled in
the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure
Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women
and 1064 [88%] men) with coronary artery disease and left ventricular
ejection fraction =35% to CABG+medical therapy (MED) versus MED alone.
Long-term (10-year) outcomes with each treatment were compared according
to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years;
P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001).
Women had more coronary artery disease risk factors (diabetes mellitus,
55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia,
70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower
rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women
had higher New York Heart Association class (class III/IV, 66.2% versus
57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas
City Cardiomyopathy Questionnaire overall summary scores (51 versus 63;
all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus
65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86;
P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard
ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly
lower in women compared with men. With randomization to CABG+MED versus
MED treatment, there was no signifcant interaction between sex and
treatment group in all-cause mortality, cardiovascular mortality, or the
composite of all-cause mortality or cardiovascular hospitalization (all
P>0.05). In addition, surgical deaths were not statistically different
(1.5% versus 5.1%; P=0.187) between sexes among patients randomized to
CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated
with the effect of CABG+MED versus MED on all-cause mortality,
cardiovascular mortality, the composite of death or cardiovascular
hospitalization, or surgical deaths in patients with ischemic left
ventricular dysfunction. Thus, sex should not influence treatment
decisions about CABG in these patients.<br/>Copyright &#xa9; 2017 American
Heart Association, Inc.

<42>
Accession Number
2000813985
Author
Maes F.; Stabile E.; Ussia G.P.; Tamburino C.; Pucciarelli A.; Masson
J.-B.; Marsal J.R.; Barbanti M.; Cote M.; Rodes-Cabau J.
Institution
(Maes, Cote, Rodes-Cabau) Department of Cardiology, Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Stabile) Department of Advanced Biomedical Sciences, University "Federico
II", Napoli, Italy
(Ussia) Department of Cardiology, Tor Vergata University of Rome, Rome,
Italy
(Tamburino, Barbanti) Department of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Pucciarelli) Department of Cardiology, Clinica Montevergine, Mercogliano,
Italy
(Masson) Department of Cardiology, Centre Hospitalier Universitaire de
Montreal, Montreal, Quebec, Canada
(Marsal) Epidemiology Unit of the Cardiology Department and CIBER de
Epidemiologia y Salud Publica (CIBERESP), Vall d'Hebron University
Hospital, Barcelona, Spain
Title
Meta-Analysis Comparing Single Versus Dual Antiplatelet Therapy Following
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To compare dual antiplatelet therapy (DAPT) versus single antiplatelet
therapy (SAPT) as antithrombotic treatment after transcatheter aortic
valve implantation (TAVI) for the prevention of ischemic events, vascular
and bleeding events, and death. Data from the 3 randomized trials
comparing DAPT versus SAPT post-TAVI were pooled and analyzed in a
patient-level meta-analysis. The primary end point was the occurrence of
death, major or life-threatening bleedings, and major vascular
complications at 30-day follow-up. Events were adjudicated according to
the Valve Academic Research Consortium 2 definitions. A total of 421
patients randomized to DAPT (210 patients) or SAPT (211 patients)
post-TAVI were analyzed. There were no differences between groups in
baseline clinical and procedural characteristics. The occurrence of the
30-day combined primary end point was higher in the DAPT group (17.6% vs
10.9%, odds ratio 1.73, 95% confidence interval 1.00 to 2.98, p = 0.050),
with an increased rate of major or life-threatening bleeding events in the
DAPT group (11.4% vs 5.2%, odds ratio 2.24, 95% confidence interval 1.12
to 4.46, p = 0.022). There were no differences between DAPT and SAPT
groups in the incidence of death (5.2% vs 3.8%, p = 0.477), global
ischemic events (3.8% vs 3.8%, p = 0.999), or stroke (2.4% vs 2.4%, p =
0.996). DAPT (vs SAPT) was associated with a higher rate of major adverse
events after TAVI, mainly driven by an increased risk of major or
life-threatening bleeding complications along with a lack of beneficial
effect on ischemic events. These results do not support the current
recommendation of DAPT as antithrombotic therapy after TAVI.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<43>
Accession Number
611545503
Author
Polymeropoulos E.; Bagos P.; Papadimitriou M.; Rizos I.; Patsouris E.;
Toumpoulis I.
Institution
(Polymeropoulos) Cardiology Department Red Cross Hospital, Athens, Greece
(Bagos) Department of Computer Science and Biomedical Informatics,
University of Thessaly, Lamia, Greece
(Papadimitriou) Internal Medicine Department, Laiko Hospital, Athens,
Greece
(Rizos) Cardiology Department, Attiko Hospital, Athens, Greece
(Patsouris) Department of Pathology, Medical School of the National
University of Athens, Greece
(Toumpoulis) Cardiac Surgery Department, Attiko Hospital, Athens, Greece
Title
Vitamin C for the prevention of postoperative atrial fibrillation after
cardiac surgery: A meta-analysis.
Source
Advanced Pharmaceutical Bulletin. 6 (2) (pp 243-250), 2016. Date of
Publication: 2016.
Publisher
Tabriz University of Medical Sciences (Daneshgah St, Tabriz 5166614713,
Iran, Islamic Republic of. E-mail: joddd@tbzmed.ac.ir)
Abstract
Purpose: Several studies have investigated the administration of vitamin C
(vitC) for the prevention of postoperative atrial fibrillation (AF) after
cardiac surgery. However, their findings were inconsistent. The purpose of
this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for
the prevention of postoperative AF in cardiac surgery. Methods: A
systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library,
and clinical trial registries, was performed. 9 studies, published from
August 2001 to May 2015, were included, with a total of 1,037 patients.
Patients were randomized to receive vitC, or placebo. Results: Cardiac
surgery patients who received vitC as prophylaxis, had a significantly
lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340
- 0.673, P < 10^-4). No significant heterogeneity was detected
across the analyzed studies (I²=21.7%), and no publication bias
or other small study-related bias was found. Conclusion: Our findings
suggest that VitC is effective as prophylaxis for the prevention of
postoperative AF. The administration of vitC may be considered in all
patients undergoing cardiac surgery.<br/>Copyright &#xa9; 2016 The
Authors.

<44>
Accession Number
372123679
Author
Samadikhah J.; Golzari S.E.J.; Sabermarouf B.; karimzadeh I.; Tizro P.;
Khanli H.M.; Ghabili K.
Institution
(Samadikhah, karimzadeh, Tizro, Khanli) Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Golzari) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Golzari) Students' Research Committee, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Sabermarouf) Neurosciences Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Ghabili) Physical Medicine and Rehabilitation Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
Efficacy of combination therapy of statin and vitamin C in comparison with
statin in the prevention of post-CABG atrial fibrillation.
Source
Advanced Pharmaceutical Bulletin. 4 (1) (pp 97-100), 2014. Date of
Publication: March 2014.
Publisher
Tabriz University of Medical Sciences (Daneshgah St, Tabriz 5166614713,
Iran, Islamic Republic of. E-mail: joddd@tbzmed.ac.ir)
Abstract
Purpose: Atrial fibrillation (AF) is the most frequent arrhythmia that
follows coronary artery bypass graft (CABG). Patients developing
postoperative AF (POAF) have significantly higher mortality rates. The
consistent prophylactic effectiveness of statins and vitamin C are
well-accepted; however, no evaluation on combined therapy has been
performed. We aimed at assessing the efficacy of combination therapy with
statin and vitamin C in comparison with statin alone in the prevention of
post CABG-AF. Methods: In a randomized double blind clinical trial, 120
candidates of CABG were recruited in Tabriz Madani Educational Center in a
15-month period of time. Patients were randomized into two groups of 60
receiving oral atorvastatin (40mg) plus oral vitamin C (2g/d operation day
and 1g/d for five consequent days) for intervention group and oral
atorvastatin (40mg) for control group. Occurrence of post CABG AF was
compared between the two groups. Results: There were 60 patients, 43 males
and 17 females with a mean age of 61.0+/-11.5 (29-78) years, in the
intervention group and sixty patients, 39 males and 21 females with a mean
age of 60.5+/-11.3 (39-81) years, in the control group. The post CABG AF
occurred in 6 cases (10%) in the interventional group and 15 patients
(25%) in the controls (P=0.03, odds ratio=0.33, 95% confidence interval
0.12-0.93). Conclusion: Based on our findings, combination prophylaxis
against post CABG AF with oral atorvastatin plus vitamin C is
significantly more effective than single oral atorvastatin. &#xa9; 2014 by
Tabriz University of Medical Sciences.

<45>
Accession Number
2000773716
Author
Wu F.; Wu Y.; Tao W.; Zhao H.; Shen D.
Institution
(Wu, Wu, Tao) School of Nursing, Capital Medical University, Beijing,
China
(Zhao) Heart Center, Beijing Chao-yang Hospital Affiliated to Capital
Medical University, Beijing, China
(Shen) Heart Center, Beijing Jian-gong Hospital, Beijing, China
Title
Preoperative P-wave duration as a predictor of atrial fibrillation after
coronary artery bypass grafting: A prospective cohort study with
meta-analysis.
Source
International Journal of Nursing Sciences. 5 (2) (pp 151-156), 2018. Date
of Publication: 10 April 2018.
Publisher
Chinese Nursing Association (E-mail: mahongying@hotmail.com)
Abstract
Objectives: Reported prediction rules for postoperative atrial
fibrillation (AF) have suffered from inconsistent results and controversy
surrounding the predictive value of a preoperative P-wave duration
(PreOPWD). This study examined PreOPWD as a predictor for AF after
coronary artery bypass grafting (CABG). Methods:
Two-hundred-and-ninety-nine patients with sinus rhythm before off-pump
CABG were recruited into the study. Patients' demographic and clinical
data were evaluated prospectively. Patients were continuously monitored
for the first seven postoperative days. Multiple logistic regression was
used to determine significant predictors of AF. Findings were then
combined with similar studies and a meta-analysis was performed. Results:
Postoperative AF was observed in 33.1% of 299 patients. Patients with AF
were older, had a prolonged PreOPWD, higher incidences of hypertension,
aortic regurgitation, and mitral regurgitation. A cut-off point of
PreOPWD>=105 ms achieved a specificity of 74%, and a sensitivity of 65%
for predictive of AF. Multivariate analysis showed that PreOPWD>=105 ms
(odds ratio [OR] 4.63, 95% confidence intervals [CI] 2.66 to 8.03, P <
0.001), age>=60 years (OR 2.72, 95% CI 1.51 to 4.90, P < 0.01) and
hypertension (OR 2.10, 95% CI 1.08 to 4.07, P < 0.05) independently
predicted postoperative AF. A meta-analysis of this data combined with
those of ten other studies showed that PreOPWD was greater in patients
with POAF, with a weighted mean difference of 3.95 ms (95% CI 1.97 to
5.92, P < 0.001). Conclusion: This study confirmed, among other predictive
characteristics, that PreOPWD is a powerful independent predictor of
POAF.<br/>Copyright &#xa9; 2018 Chinese Nursing Association

<46>
Accession Number
613085809
Author
Aguade-Bruix S.; Romero-Farina G.; Candell-Riera J.; Pizzi M.N.;
Garcia-Dorado D.
Institution
(Aguade-Bruix) Department of Nuclear Medicine, Hospital Universitari Vall
d'Hebron, Institut de Recerca (VHIR), Universitat Autonoma de Barcelona,
Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain
(Romero-Farina, Candell-Riera, Pizzi, Garcia-Dorado) Cardiology
Department, Hospital Universitari Vall d'Hebron, Institut de Recerca
(VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
Title
Mechanical dyssynchrony according to validated cut-off values using gated
SPECT myocardial perfusion imaging.
Source
Journal of Nuclear Cardiology. 25 (3) (pp 999-1008), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The aim of this study was to establish different degrees of
mechanical dyssynchrony according to validated cut-off (CO) values of
myocardial perfusion gated SPECT phase analysis parameters (SD, standard
deviation; B, bandwidth; S, skewness; K, kurtosis). Methods: Using Emory
Cardiac ToolboxTM, we prospectively analyzed 408 patients (mean age 64.1
years, 26.7% female), divided into a control group of 150 normal subjects
and a validation group of 258 patients (left bundle branch block: 17.8%,
right bundle branch block: 8.9%. atrial fibrillation: 16.3%, coronary
revascularization: 30%, dilated cardiomyopathy: 7.4%. valvulopathies:
2.7%, ischemic test: 45.3%) with ischemic and non-ischemic cardiac
diseases, by means of phase analysis. Results: Agreement of CO values (SD
> 18.4degree; B > 51degree; S <= 3.2; K <= 9.3) used to discriminate
between normal subjects and patients was strong (c-statistic 0.9; 95% CI
0.98-0.99). Four degrees of dyssynchrony were found according to the
number of abnormal phase parameters. All patients with mechanical and
electrical criteria for cardiac resynchronization therapy (CCRT) (n: 82)
had Grade 2 to 4 (two to four abnormal phase parameters). Agreement of CO
values (SD > 40.2degree; B > 132degree; S <= 2.3; K <= 4.6) used to
discriminate between patients with and without CCRT was strong
(c-statistic 0.8; 95% CI 0.79-0.87) but 12% of patients with CCRT did not
have any of these abnormal phase parameters. Conclusions: The
discriminatory capacity of gated SPECT phase analysis parameters between
normal subjects and patients, and between patients with and without CCRT,
is very good, making it possible to define different degrees of mechanical
dyssynchrony.<br/>Copyright &#xa9; 2016, American Society of Nuclear
Cardiology.

<47>
Accession Number
622306126
Author
Hasandokht T.; Salari A.; Pour S.S.; Tirani H.D.; Shad B.; Rajabi E.
Institution
(Hasandokht, Salari, Tirani, Shad, Rajabi) Cardiovascular Disease Research
Center, Department of Cardiology, Heshmat Hospital, School of Medicine,
Guilan University of Medical Science, Rasht, Iran, Islamic Republic of
(Hasandokht, Pour) Department of Community Medicine, School of Medicine,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Title
Does opium have benefit for coronary artery disease? A systematic review.
Source
Research in Cardiovascular Medicine. 7 (2) (pp 51-58), 2018. Date of
Publication: April-June 2018.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Opium is a plant with euphoria effect. People from some parts of the world
traditionally use opium for cardioprotective effects. We did a systematic
review to assess the effect of opium on coronary artery disease (CAD). A
systematic database search was conducted in PubMed, Web of Science, Google
Scholar, Cochrane library, Scopus, and SID from their onset up to June
2016. The quality of the studies was assessed with a standardized scoring
system. Articles assessing the effect of opium consumption as orally or
smoked were included in this review. Outcome was defined as age on CAD
disease, risk of CAD, and morbidity from CAD. Poor methodological studies,
animal studies, and studies on cardiovascular risk factors or serum
markers were excluded from the review. Three case-control, three cohort,
and eight cross-sectional studies were included in this systematic review.
The age at the occurrence of myocardial infarction, coronary bypass
surgery, and percutaneous intervention in opium users was significantly
lower than that of nonusers. Odds ratio of opium consumption for CAD
ranged from 1.3 to 3.8 in different studies. Hazard ratio of opium
consumption for ischemic heart disease was 1.90 (1.57-2.29) with
modification by sex, ethnicity, education level, marital status,
residential place, and cigarette smoking. We concluded, in spite of the
traditional belief, that the current evidence did not support the
protective effect of opium on CAD. Future well-designed studies concerning
probable confounders in Iran and other similar parts of world are
required.<br/>Copyright &#xa9; 2018 Research in Cardiovascular Medicine.

<48>
Accession Number
622047939
Author
Vogkou C.T.; Vlachogiannis N.I.; Palaiodimos L.; Kousoulis A.A.
Institution
(Vogkou, Vlachogiannis, Palaiodimos, Kousoulis) AthensGreece
(Vogkou, Vlachogiannis) School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Palaiodimos) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Kousoulis) Faculty of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, London, United Kingdom
Title
The causative agents in infective endocarditis: A systematic review
comprising 33,214 cases.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 35 (8)
(pp 1227-1245), 2016. Date of Publication: 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Infective endocarditis (IE) incidence remains high with considerable
fatality rates; guidelines for prophylaxis against IE are currently under
review in some settings which highlights the importance of maintaining
up-to-date epidemiological estimates about the most common microbial
causes. The objective of this systematic review, following PRISMA
guidelines, was to identify the most common microbial causes of IE in
recent years. Medline was searched from January 1, 2003 to March 31, 2013
for all articles containing the term "in-fective endocarditis". All
relevant studies reporting diagnostic results were included. Special
patient subpopula-tions were assessed separately. A total of 105 studies
were included, from 36 countries, with available data on a total of 33,214
cases. Staphylococcus aureus was found to be the most common
microorganism, being the most frequent in 54.3 % of studies (N = 57) (and
in 55.4 % of studies using Duke's criteria for diagnosis [ N = 51]. Vi r i
dans gr oup st r ept ococci (VGS), coagulase-negative staphylococci
(CoNS), Enterococcus spp and Streptococcus bovis were among the most
common causes. S. aureus was the most common pathogen in almost all
population subgroups; however, this was not the case in patients with
implantable devices, prosthetic valves, or immunocompromised non-HIV, as
well as in the sub-group from Asia, emphasizing that a global
one-size-fits-all approach to the management of suspected IE is not
appropriate. This review provides an evidence-based map of the most common
causative agents of IE, highlighting S. aureus as the leading cause in the
21st century. The changing epidemiology of IE in some patient sub-groups
in the last decade and the very high number of microbiologically
undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and
diagnostic strategies.<br/>Copyright &#xa9; Springer-Verlag Berlin
Heidelberg 2016.

<49>
Accession Number
622361493
Author
Zhang L.; Zheng M.; Mao Z.
Institution
(Zhang, Zheng, Mao) Department of General Surgery, Rui Jin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
Title
The application of supine position in ercp: Is it as safe and effective as
prone position?.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: 16th
World Congress of Endoscopic Surgery. United States. 32 (1 Supplement 1)
(pp S159), 2018. Date of Publication: 2018.
Publisher
Springer New York LLC
Abstract
Objective: To investigate if ERCP (endoscopic retrograde
cholangiopancreatography) conducted with patient in supine position is as
safe and effective as in traditional prone position. Methods: 52
consecutive patients who were undergoing ERCP in our center were
randomized to be operated in either prone or supine position. Demographic
and clinical characteristics of the 52 study patients were recorded.
Difficulty of cannulation of the ampulla of Vater was assessed with the
Freeman Score. Total procedure time, intra-operative vital signs (Heart
rate, oxygen desaturation and mean artery pressure), patient tolerance
were also recorded and compared. Results: There was no statistically
difference for the Freeman score and procedure time between the two
groups. Vital signs were compared in the two groups respectively on the
basis of 4 steps during the procedure: enter of endoscope; canulation;
sphincterotomy and nasobiliary drainage, no significant difference were
found between the two groups during each step, while heart rate and MAP
during enter of endoscope in both supine (p=0.01; p=0.001) and prone group
(p=0.027; p= 0.021) increased significantly compared to base line level.
Conclusion: We believe that ERCP could be performed with the patient in
the supine position since it is as safe and effective as that in prone
position.

<50>
Accession Number
622357667
Author
Pratama E.A.; Nurwulan S.
Institution
(Pratama, Nurwulan) Puskesmas Kecamatan Makasar, Jakarta, Indonesia
Title
Facial cold stimuli to treat supraventricular tachycardia at makasar
subdistrict primary health Care, Jakarta, Indonesia: A case report.
Source
European Heart Journal, Supplement. Conference: 27th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2018. Indonesia. 20
(Supplement D) (pp D39-D40), 2018. Date of Publication: April 2018.
Publisher
Oxford University Press
Abstract
Introduction: Supraventricular tachycardia (SVT) is a common cardiac
arrhythmia in the emergency setting with prevalence in the general
population is 2.25 per 1.000 persons and a two-fold risk in female. Vagal
manoeuvres are used as a first-line treatment to terminate SVT. Facial
cold stimuli is another type of vagal manoeuvres that increasing vagal
tone and results bradycardia response. Objective: This is a preliminary
study to prove of concept that facial cold stimuli is effective to treat
SVT in primary health care of remote areas. Case Illustration: A
46-year-old woman came to the emergency department with complaints of
palpitation and chest discomfort in 1.5 hours. History of congestive heart
disease confirmed. At the admission, blood pressure was 130/70 mmHg, heart
rate 150 beats/min with regular rhytm, body weight 75 kg, and no cardiac
murmur. Electrocardiography revealed SVT with 157 beats/min (Figure 1).
There was no response to carotid massage. Then, we performed ice cube
application on her face and SVT converted to sinus rhytm with 105
beats/min, without hypotension and loss of consiousness. At the first
minute, sinus rhytm followed with PVC for a few cycle (Figure 2) and the
PVC slowly diminished after 15 minute and completely become sinus rhytm
(Figure 3). The patient reffered to the hospital for the further
investigations. aortocoronary bypass is one of the treatment option to
salvage the infarcting myocardium. Our patient was successfully treated
with intracoronary catheter aspiration and stent implantation to restore
coronary flow and later underwent open heart surgery to remove the myxoma.
Conclusion: STEMI caused by left atrial myxoma was successfully treated by
intra-coronary aspiration and stent implantation. It is should be
considered to perform echocardiography prior coronary intervention.
Discussion: Facial cold stimuli creates physiological response similar to
diving reflex (DR). DR can be considered as peripheral a sub-form of the
trigeminocardiac reflex (TCR). In American Heart Association 2015
guidelines, applying an ice-cold wet towel to the face or doing facial
immersion in water at 10degreeC has proved effective for terminating
tachycardia. However, Smith et al, in his metaanalysis, there is no
stand-ardize method for DR. In this case, we applied an ice cube around
cheek and palpe-bra without giving any pressure on eyeball for 10s and the
SVT succesfully terminated. Conclusion: Facial cold stimuli is easy,
effective, and non-invasive treatment for terminating SVT. A further
research about this procedure is needed so it can be used as a standard
procedure in primary health care.

<51>
Accession Number
622167084
Author
Mannes K.; Hertzberg S.; Vecellio E.; Chiew A.
Institution
(Mannes) Prince of Wales Clinical School, University of NSW, Australia
(Hertzberg, Chiew) Department of Emergency Medicine, Prince of Wales
Hospital, Australia
(Vecellio) NSW Health Pathology, Prince of Wales Hospital, Australia
Title
Undetectable high-sensitivity troponin T in the Emergency Department.
Source
EMA - Emergency Medicine Australasia. Conference: 34th Australasian
College of Emergency Medicine Annual Scientific Meeting. Australia. 30
(Supplement 1) (pp 3), 2018. Date of Publication: April 2018.
Publisher
Blackwell Publishing
Abstract
Background: Chest pain guidelines recommend serial troponin testing using
a high-sensitivity troponin T (hscTnT) assay, combined with clinical
findings.1 Evidence suggests an initial presentation hs-cTnT<3 ng/L (>3 h
after symptom onset) could be used as an effective cutoff for earlier
rule-out in the Emergency Department (ED) without need for serial
testing.2 Objectives: To investigate whether patients with undetectable
hs-cTnT (<3 ng/L) develop a subsequent troponin rise on serial testing.
Secondary outcomes were acute coronary syndrome, cardiac interventions and
death. Method: Retrospective chart review of patients who had an initial
hs-cTnT < 3 ng/L and a serial hs-cTnT measured, presenting to tertiary
adult hospital ED (over 3 years). Results: 33457 hs-cTnT tests were
ordered, 9.5% (n = 3177) had an initial hs-cTnT<3 ng/L. Of these, 27% (n =
867) had serial testing of which 696 (80%) were <3 ng/L (taken >=2 h from
presentation). A further 169 (19%) serial hs-cTnT = 3-14 ng/L. Three
(0.3%) had a subsequent hs-cTnT > 14 ng/L, of which two had a STEMI, both
presented <3 h after symptom onset and had ECG changes. The other's serial
hs-cTnT = 20 ng/L and was subsequently discharged. 295 (34%) were
admitted, 85 had a coronary angiogram of which 32 had mildsevere coronary
artery disease and 4 had stenting or cardiac surgery. No deaths were
recorded. Conclusion: We found those patients with an initial hscTnT < 3
ng/L, <1% had a serial hs-cTnT above normal. The two with a STEMI
presented within 3 h of chest pain and had ECG changes. This is consistent
with results of a systematic review that found a single baseline hs-cTnT <
3 ng/L could be used to rule out AMI. However a small percentage of
patients presenting within 3 h of symptom onset, may be missed.

<52>
Accession Number
2000811503
Author
Viszlayova D.; Brozman M.; Langova K.; Herzig R.; Skoloudik D.
Institution
(Viszlayova, Brozman) Department of Neurology, Faculty Hospital Nitra and
Constantine Philosopher University, Nitra, Slovakia
(Viszlayova) Department of Neurology, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Viszlayova) Department of Neurology, Charles University Faculty of
Medicine, Hradec Kralove, Czech Republic
(Langova, Skoloudik) Centre for Research and Science, Faculty of Health
Sciences, Palacky University, Olomouc, Czech Republic
(Langova) Department of Biophysics, Faculty of Medicine and Dentistry,
Palacky University, Olomouc, Czech Republic
(Herzig) Department of Neurology, Comprehensive Stroke Center, Charles
University Faculty of Medicine and University Hospital Hradec Kralove,
Hradec Kralove, Czech Republic
SONOREDUCE Trial Group, Department of Clinical Psychology, Faculty
Hospital Nitra, Nitra, Slovakia
Title
Sonolysis in risk reduction of symptomatic and silent brain infarctions
during coronary stenting (SONOREDUCE): Randomized, controlled trial.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Silent brain infarcts can be detected on magnetic resonance
imaging (MRI) in ~22% of patients after coronary angioplasty and stenting
(CS). The effect of periprocedural sonolysis on the risk of new brain
infarcts during CS was examined. Methods: Patients undergoing elective CS
were allocated randomly to a bilateral sonolysis group (70 patients, 58
men; mean age, 59.9 years) or a control group (74 patients, 45 men; mean
age, 65.5 years). Neurologic examination, cognitive function tests, and
brain MRI were performed prior to intervention and at 24 h after CS.
Neurologic examination and cognitive function tests were repeated at 30
days after CS. Results: No significant differences were observed in the
number of patients with new infarcts (25.7 vs. 18.9%, P = 0.423), the
number of lesions (1.3 +/- 1.0 vs. 2.9 +/- 5.3, P = 0.493), lesion volume
(0.16 +/- 0.34 vs. 0.28 +/- 0.60 mL, P = 0.143), and the number of
patients with new ischemic lesions in the insonated MCA territories
(18.6vs. 17.6%, P = 0.958) between the sonolysis group and the control
group. There were no cases of stroke, transient ischemic attack,
myocardial infarction, or death in the two groups. Intracranial bleeding
was reported only in 1 patient in the control group (0 vs. 1.4%, P =
0.888). Clock-drawing test scores at 30 days were significantly higher in
the sonolysis group than in the control group (median 3.0 vs. 2.5, P =
0.031). Conclusions: Sonolysis does not reduce the risk of new brain
infarcts after CS. The effect of sonolysis on number and volume of
ischemic lesions and cognitive function should be assessed in further
studies.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<53>
Accession Number
622037763
Author
Sharples L.; Everett C.; Singh J.; Mills C.; Spyt T.; Abu-Omar Y.; Fynn
S.; Thorpe B.; Stoneman V.; Goddard H.; Fox-Rushby J.; Nashef S.
Institution
(Sharples) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Everett, Thorpe) Leeds Institute of Clinical Trials Research, University
of Leeds, Leeds, United Kingdom
(Singh) Health Economics Research Group (HERG), Brunel University London,
London, United Kingdom
(Mills, Stoneman, Goddard) Papworth Trials Unit Collaboration, Papworth
Hospital, Cambridge, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Abu-Omar, Fynn, Nashef) Department of Cardiology and Department of
Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Title
Amaze: A double-blind, multicentre randomised controlled trial to
investigate the clinical effectiveness and cost-effectiveness of adding an
ablation device-based maze procedure as an adjunct to routine cardiac
surgery for patients with pre-existing atrial fibrillation.
Source
Health Technology Assessment. 22 (19) (no pagination), 2018. Date of
Publication: April 2018.
Publisher
NIHR Journals Library (NETSCCAlpha HouseUniversity of Southampton, Science
Park, Southampton SO167NS, United Kingdom)
Abstract
Background: Atrial fibrillation (AF) can be treated using a maze procedure
during planned cardiac surgery, but the effect on clinical patient
outcomes, and the cost-effectiveness compared with surgery alone, are
uncertain. Objectives: To determine whether or not the maze procedure is
safe, improves clinical and patient outcomes and is cost-effective for the
NHS in patients with AF. Design: Multicentre, Phase III, pragmatic,
double-blind, parallel-arm randomised controlled trial. Patients were
randomised on a 1: 1 basis using random permuted blocks, stratified for
surgeon and planned procedure. Setting: Eleven acute NHS specialist
cardiac surgical centres. Participants: Patients aged >= 18 years,
scheduled for elective or in-house urgent cardiac surgery, with a
documented history (> 3 months) of AF. Interventions: Routine cardiac
surgery with or without an adjunct maze procedure administered by an AF
ablation device. Main outcome measures: The primary outcomes were return
to sinus rhythm (SR) at 12 months and quality-adjusted life-years (QALYs)
over 2 years after randomisation. Secondary outcomes included return to SR
at 2 years, overall and stroke-free survival, drug use, quality of life
(QoL), cost-effectiveness and safety. Results: Between 25 February 2009
and 6 March 2014, 352 patients were randomised to the control (n = 176) or
experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12
months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091].
The mean difference (95% CI) in QALYs at 2 years between the two trial
arms (maze/control) was -0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR
for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients
requiring anticoagulant drug use was significantly lower in the maze arm
from 6 months after the procedure. There were no significant differences
between the two arms in operative or overall survival, stroke-free
survival, need for cardioversion or permanent pacemaker implants, New York
Heart Association Functional Classification (for heart failure), EuroQol-5
Dimensions, three-level version score and Short Form questionnaire-36
items score at any time point. Sixty per cent of patients in each trial
arm had a serious adverse event (p = 1.000); most events were mild, but 71
patients (42.5%) in the maze arm and 84 patients (45.5%) in the control
arm had moderately severe events; 31 patients (18.6%) in the maze arm and
38 patients (20.5%) in the control arm had severe events. The mean
additional cost of the maze procedure was 3533 (95% CI 1321 to 5746); the
mean difference in QALYs was -0.022 (95% CI -0.1231 to 0.0791). The maze
procedure was not cost-effective at 30,000 per QALY over 2 years in any
analysis. In a small substudy, the active left atrial ejection fraction
was smaller than that of the control patients (mean difference of -8.03,
95% CI -12.43 to -3.62), but within the predefined clinically equivalent
range. Limitations: Low recruitment, early release of trial summaries and
intermittent resource-use collection may have introduced bias and
imprecise estimates. Conclusions: Ablation can be practised safely in
routine NHS cardiac surgical settings and increases return to SR rates,
but not survival or QoL up to 2 years after surgery. Lower anticoagulant
drug use and recovery of left atrial function support anticoagulant drug
withdrawal provided that good atrial function is confirmed.<br/>Copyright
&#xa9; Queen's Printer and Controller of HMSO 2018.

<54>
Accession Number
622265424
Author
Ahmad Y.; Howard J.P.; Arnold A.; Shin M.S.; Cook C.; Petraco R.; Demir
O.; Williams L.; Iglesias J.F.; Sutaria N.; Malik I.; Davies J.; Mayet J.;
Francis D.; Sen S.
Institution
(Ahmad, Howard, Arnold, Shin, Cook, Petraco, Demir, Williams, Iglesias,
Sutaria, Malik, Davies, Mayet, Francis, Sen) National Heart and Lung
Institute, Hammersmith Hospital, Imperial College London W12 0HS, United
Kingdom
Title
Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: A
meta-analysis of randomized controlled trials.
Source
European Heart Journal. 39 (18) (pp 1638-1649), 2018. Date of Publication:
07 May 2018.
Publisher
Oxford University Press
Abstract
Aims The efficacy of patent foramen ovale (PFO) closure for cryptogenic
stroke has been controversial. We undertook a meta-analysis of randomized
controlled trials (RCTs) comparing device closure with medical therapy to
prevent recurrent stroke for patients with PFO. Methods and results We
systematically identified all RCTs comparing device closure to medical
therapy for cryptogenic stroke in patients with PFO. The primary efficacy
endpoint was recurrent stroke, analysed on an intention-to-treat basis.
The primary safety endpoint was new onset atrial fibrillation (AF). Five
studies (3440 patients) were included. In all, 1829 patients were
randomized to device closure and 1611 to medical therapy. Across all
patients, PFO closure was superior to medical therapy for prevention of
stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI)
0.13-0.82; P = 0.018, I 2 = 73.4%]. The risk of AF was significantly
increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00,
P<0.001, heterogeneity I 2 = 27.5%)]. In patients with large shunts, PFO
closure was associated with a significant reduction in stroke (HR 0.33,
95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in
stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P =
0.712). There was no effect from the presence or absence of an atrial
septal aneurysm on outcomes (P = 0.994). Conclusion In selected patients
with cryptogenic stroke, PFO closure is superior to medical therapy for
the prevention of further stroke: this is particularly true for patients
with moderate-to-large shunts. Guidelines should be updated to reflect
this.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<55>
Accession Number
621588365
Author
Mukaida H.; Matsushita S.; Inotani T.; Nakamura A.; Amano A.
Institution
(Mukaida, Matsushita, Amano) Department of Cardiovascular Surgery, Faculty
of Medicine, Juntendo University, Tokyo, Japan
(Mukaida, Inotani) Department of Clinical Engineering, Juntendo University
Hospital, Tokyo, Japan
(Nakamura) Department of Clinical Engineering, Faculty of Health Sciences,
Kyorin University, Tokyo, Japan
Title
Continuous renal replacement therapy with a polymethyl methacrylate
membrane hemofilter suppresses inflammation in patients after open-heart
surgery with cardiopulmonary bypass.
Source
Journal of Artificial Organs. 21 (2) (pp 188-195), 2018. Date of
Publication: 01 Jun 2018.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Cardiopulmonary bypass (CPB) induces a complex inflammatory response
involving an increase in inflammatory cytokines, called postperfusion
syndrome. Previous studies demonstrated that adsorption of the serum
cytokines can reduce acute inflammation and improve clinical outcomes. In
this study, patients were placed on continuous renal replacement therapy
(CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter
immediately after the start of an open-heart surgery with CPB and
throughout the postoperative course to prevent postperfusion syndrome. The
aim of this study was to assess whether continuous CRRT using a PMMA
filter (PMMA-CRRT) could affect cytokine expression and improve
perioperative outcomes. We designed a randomized controlled trial, which
included 19 consecutive adult patients on maintenance dialysis and 7
consecutive adult patients who were not on maintenance dialysis (NHD
group). Patients on maintenance dialysis were randomly divided into two
groups: Ten patients who received CRRT with a polysulfone membrane
hemofilter (PS group) and nine patients who received CRRT with a PMMA
membrane (PMMA group). Blood samples were collected from the radial or
brachial artery at five different time points. Comparisons between the PS,
PMMA, and NHD groups revealed a significant main effect of time on changes
in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p <
0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery
were significantly lower in the PMMA group than in the PS group, while
other cytokines measured in this study were not significantly different.
In addition, clinical outcomes were not significantly different between
the groups. The continuous use of PMMA-CRRT throughout the perioperative
period suppressed serum IL-6 and IL-8 concentrations, although there were
no differences in clinical outcomes.<br/>Copyright &#xa9; 2018, The
Japanese Society for Artificial Organs.

<56>
Accession Number
622247456
Author
Liu Y.; Bian W.; Liu P.; Zang X.; Gu X.; Chen W.
Institution
(Liu, Bian, Liu, Zang, Gu, Chen) Department of Intensive Care Unit,
Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Title
Dexmedetomidine improves the outcomes in paediatric cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 852-858),
2018. Date of Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES Dexmedetomidine has been shown to decrease cardiac
complications in adults undergoing cardiac surgery. Results from clinical
trials of dexmedetomidine on outcomes following paediatric cardiac surgery
are controversial. METHODS We searched EMBASE, PubMed and Cochrane CENTRAL
databases for randomized controlled trials comparing the effect of
dexmedetomidine versus placebo or other anaesthetic drugs in paediatric
patients undergoing cardiac surgery. The primary outcome was the duration
of mechanical ventilation. The secondary outcomes were intensive care unit
stay, hospital length of stay (LOS), incidence of junctional ectopic
tachycardia and postoperative deaths. RESULTS Nine trials with a total of
837 patients were selected. Compared with controls, dexmedetomidine
significantly reduced the postoperative duration of mechanical ventilation
[in hours; n = 837; weighted mean difference-2.20, 95% confidence interval
(CI)-3.51 to-0.90; P = 0.001; I 2 = 97%], intensive care unit LOS (in
days; n = 737; weighted mean difference-0.47, 95% CI-0.90 to-0.03; P =
0.03; I 2 = 97%) and hospital LOS (in days; n = 291; weighted mean
difference-1.80, 95% CI-3.36 to-0.25; P = 0.02; I 2 = 96%).
Dexmedetomidine also significantly reduced the incidence of postoperative
junctional ectopic tachycardia (21/292 vs 50/263; risk ratio 0.40, 95% CI
0.25-0.64; P = 0.0001; I 2 = 0.0%), but there was no difference between
groups in postoperative deaths (4/182 vs 6/153; odds ratio 0.54, 95% CI
0.15-1.93; P = 0.34; I 2 = 0.0%). CONCLUSIONS Perioperative administration
of dexmedetomidine to paediatric patients undergoing cardiac surgery may
shorten the duration of mechanical ventilation, LOS in the intensive care
unit and in the hospital and reduce the incidence of junctional ectopic
tachycardia. More high-quality randomized controlled trials are encouraged
to verify the beneficial effect of dexmedetomidine before its clinical
application in paediatric patients undergoing surgery for congenital heart
disease.<br/>Copyright &#xa9; 2018 The Author.

<57>
Accession Number
622247434
Author
Dalen M.; Da Silva C.O.; Sartipy U.; Winter R.; Franco-Cereceda A.;
Barimani J.; Back M.; Svenarud P.
Institution
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Cardiac Surgery,
Karolinska University Hospital, Stockholm 17176, Sweden
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Da Silva, Winter, Barimani, Back) Department of Cardiology, Karolinska
University Hospital, Stockholm, Sweden
(Back) Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Title
Comparison of right ventricular function after ministernotomy and full
sternotomy aortic valve replacement: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 790-797),
2018. Date of Publication: 01 May 2018.
Publisher
Oxford University Press
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac
surgery, possibly because of the opening of the pericardium. In minimally
invasive aortic valve replacement, the pericardium is only partially
incised. METHODS A randomized trial compared RV function after
ministernotomy versus full sternotomy in 40 adults undergoing aortic valve
replacement at the Karolinska University Hospital. Primary outcomes were
tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler
velocity, RV fractional area change and basal and mid-RV transversal
diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4,
the tricuspid annular plane systolic excursion had decreased in both
groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P <
0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was
higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler
RV velocity decreased significantly in patients who underwent sternotomy
[10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease
significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10
(9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in
both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001;
sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not
change on postoperative Day 4 in both groups. The differences between the
2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis
function was reduced after both ministernotomy and full sternotomy aortic
valve replacement, but the reduction was more pronounced in the full
sternotomy group. Global RV function was equally impaired in both groups
postoperatively. Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier:
NCT01972555.<br/>Copyright &#xa9; 2018 The Author.

<58>
Accession Number
2000791088
Author
Bohula E.A.; Scirica B.M.; Fanola C.; Inzucchi S.E.; Keech A.; McGuire
D.K.; Smith S.R.; Abrahamsen T.; Francis B.H.; Miao W.; Perdomo C.A.;
Satlin A.; Wiviott S.D.; Sabatine M.S.
Institution
(Bohula, Scirica, Fanola, Abrahamsen, Wiviott, Sabatine) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Inzucchi) Yale University School of Medicine, New Haven, CT, United
States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(McGuire) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Smith) Translational Research Institute for Metabolism and Diabetes,
Florida Hospital, Orlando, FL, United States
(Francis, Miao, Perdomo, Satlin) Eisai, Inc., Woodcliff Lake, NJ, United
States
Title
Design and rationale for the Cardiovascular and Metabolic Effects of
Lorcaserin in Overweight and Obese Patients-Thrombolysis in Myocardial
Infarction 61 (CAMELLIA-TIMI 61) trial.
Source
American Heart Journal. 202 (pp 39-48), 2018. Date of Publication: August
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Lorcaserin, a selective serotonin 2C receptor agonist, is an
effective pharmacologic weight-loss therapy that improves several
cardiovascular risk factors. The long-term clinical cardiovascular and
metabolic safety and efficacy in patients with elevated cardiovascular
risk are unknown. Research design and methods: CAMELLIA-TIMI 61
(NCT02019264) is a randomized, double-blind, placebo-controlled,
multinational clinical trial designed to evaluate the safety and efficacy
of lorcaserin with regard to major adverse cardiovascular events and
progression to diabetes in overweight or obese patients at high
cardiovascular risk. Overweight or obese patients either with established
cardiovascular disease or with diabetes and at least 1 other
cardiovascular risk factor were randomized in a 1:1 ratio to lorcaserin 10
mg twice daily or matching placebo. The primary safety objective is to
assess for noninferiority of lorcaserin for the composite end point of
cardiovascular death, myocardial infarction, or stroke (major adverse
cardiovascular event [MACE]) (with noninferiority defined as the upper
bound of a 1-sided 97.5% CI excluding a hazard ratio of 1.4) compared with
placebo assessed at an interim analysis with 460 adjudicated events. The
efficacy objectives, assessed at study completion, will evaluate the
superiority of lorcaserin for the primary composite end point of
cardiovascular death, myocardial infarction, stroke, hospitalization for
unstable angina, heart failure, or any coronary revascularization (MACE+)
and the key secondary end point of conversion to diabetes. Recruitment
began in January 2014 and was completed in November 2015 resulting in a
total population of 12,000 patients. The trial is planned to continue
until at least 1,401 adjudicated MACE+ events are accrued and the median
treatment duration exceeds 2.5 years. Conclusion: CAMELLIA-TIMI 61 is
investigating the safety and efficacy of lorcaserin for MACEs and
conversion to diabetes in overweight or obese patients with established
cardiovascular disease or multiple cardiovascular risk
factors.<br/>Copyright &#xa9; 2018

<59>
Accession Number
622271742
Author
Dong L.; Kang Y.-K.; An X.-G.
Institution
(Dong, Kang, An) Heart Center & Beijing Key Laboratory of Hypertension,
Beijing Chaoyang Hospital, Capital Medical University, Beijng, China
Title
Short-term and mid-term clinical outcomes following hybrid coronary
revascularization versus off-pump coronary artery bypass: A meta-analysis.
Source
Arquivos Brasileiros de Cardiologia. 110 (4) (pp 321-330), 2018. Date of
Publication: April 2018.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Off-pump coronary artery bypass grafting (OPCAB) is one of the
standard treatments for coronary artery disease (CAD) while hybrid
coronary revascularization (HCR) represents an evolving revascularization
strategy. However, the difference in outcomes between them remains
unclear. Objective: We performed a meta-analysis to compare the short-term
and mid-term outcomes of HCR versus OPCAB for the treatment of multivessel
or left main CAD. Methods: We searched the PubMed, EMBASE, Web of Science
and Cochrane databases to identify related studies and a routine
meta-analysis was conducted. Results: Nine studies with 6121 patients were
included in the analysis. There was no significant difference in
short-term major adverse cardiac and cerebrovascular event (MACCE) rate
(RR: 0.55, 95% CI: 0.30-1.03, p = 0.06) or mortality (RR: 0.51, 95% CI:
0.17-1.48, p = 0.22). HCR required less ventilator time (SMD: -0.36, 95%
CI: -0.55- -0.16, p < 0.001), ICU stay (SMD: -0.35, 95% CI: -0.58 - -0.13,
p < 0.01), hospital stay (SMD: -0.29, 95% CI: -0.50- -0.07, p < 0.05) and
blood transfusion rate (RR: 0.57, 95% CI: 0.49-0.67, p < 0.001), but
needed more operation time (SMD: 1.29, 95% CI: 0.54-2.05, p < 0.001) and
hospitalization costs (SMD: 1.06, 95% CI: 0.45-1.66, p < 0.001). The HCR
group had lower mid-term MACCE rate (RR: 0.49, 95% CI: 0.26-0.92, p <
0.05) but higher rate in mid-term target vessel revascularization (TVR,
RR: 2.20, 95% CI: 1.32-3.67, p < 0.01). Conclusions: HCR had similar
short-term mortality and morbidity comparing to OPCAB. HCR decreased the
ventilator time, ICU stay, hospital stay, blood transfusion rate and
increased operation time and hospitalization costs. HCR has a lower
mid-term MACCE rate while OPCAB shows better in mid-term
TVR.<br/>Copyright &#xa9; 2018, Arquivos Brasileiros de Cardiologia. All
rights reserved.

<60>
Accession Number
621958366
Author
Mu J.-W.; Gao S.-G.; Xue Q.; Mao Y.-S.; Wang D.-L.; Zhao J.; Gao Y.-S.;
Huang J.-F.; He J.
Institution
(Mu, Gao, Xue, Mao, Wang, Zhao, Gao, Huang, He) Department of Thoracic
Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing 100021, China
Title
A propensity matched comparison of effects between video assisted
thoracoscopic single-port, two-port and three-port pulmonary resection on
lung cancer.
Source
Journal of Thoracic Disease. 8 (7) (pp 1469-1476), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: To summarize our experiences of single-port, two-port vs.
three-port VATS pulmonary resection for lung cancer patients. Methods:
Data of consecutive 1,553 patients who underwent video assisted
thoracoscopic surgery (VATS) pulmonary resection for lung cancer in the
Department of Thoracic Surgery of Cancer Hospital of Chinese Academy of
Medical Sciences and Peking Union Medical College between November 2014
and January 2016 were prospectively collected and analyzed. A
propensity-matched analysis was used to compare the short-term outcomes of
lung cancer patients who received VATS single-port, two-port and
three-port pulmonary resection. Results: There were 716 males and 837
females. The mean age was 58.90 years (range, 25-82 years) and the
conversion rate was 2.7% (42/1,553) in this cohort. After propensity score
matching, there were 207 patients in single-port and two-port group, and
680 patients in three-port group. Propensity-matched analysis demonstrated
that there were no significant differences in duration of operation (129
vs. 131 min, P=0.689), intra-operative blood loss (63 vs. 70 mL, P=0.175),
number of dissected lymph nodes (12 vs. 13, P=0.074), total hospital
expense ($9,928 vs. $9,956, P=0.884) and cost of operation ($536 vs. $535,
P=0.879) between VATS single-port, two-port and conventional three-port
pulmonary resection groups. There was no significant difference in the
complication rate between two groups (5.3% vs. 4.7%, P=0.220). However,
compared with three-port group, patients who underwent single port and
two-port experienced shorter postoperative length of stay (6.24 vs. 5.61
d, P=0.033), shorter duration of chest tube (4.92 vs. 4.25 d, P=0.008),
and decreased volume of drainage (926 vs. 791 d, P=0.003). Conclusions:
The short term outcomes between VATS single-port, two-port and
conventional threeport groups for the surgical treatment of lung cancer
were comparable. However, compared with three-port VATS pulmonary
resection, single-port and two-port were associated with shorter
postoperative length of stay, shorter duration of chest tube, and
decreased volume of drainage.<br/>Copyright &#xa9; Journal of Thoracic
Disease.

<61>
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. (no pagination), 2018. Date of Publication: 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: -0.24days, 95% CI: -0.45 to -0.03, P=0.023), hospital length
of stay (weighted mean difference: -0.95days, 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.