EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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Accession Number
622871276
Author
Yates B.C.; Vazquez Hernandez M.L.; Rowland S.A.; Bainter D.E.; Schulz P.;
Hanson C.K.
Institution
(Yates, Rowland) College of Nursing, University of Nebraska Medical Center
(UNMC), Omaha, NE 68198, United States
(Vazquez Hernandez) CHI Health Creighton University Medical Center Bergan
Mercy, Omaha, NE, United States
(Bainter) Cardiopulmonary Rehabilitation, Nebraska Methodist Health
System, Omaha, United States
(Schulz) College of Nursing, UNMC, Lincoln, United States
(Hanson) College of Allied Health Professions, UNMC, Omaha, United States
Title
A Qualitative Study of Experiences of Participants in Cardiac
Rehabilitation.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 38 (4) (pp
E6-E9), 2018. Date of Publication: 01 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Maintenance of lifestyle changes after cardiac rehabilitation
(CR) is suboptimal. In addition, partners of cardiac patients are invited
to participate in CR educational sessions and implicitly expected to
assist patients with their lifestyle changes. The purpose of this study
was to qualitatively examine patient and partner perceptions of phase 2 CR
3 mo after completion of the program. Methods: A purposive sample of 11
couples (patients post-heart surgery and their spouses) was interviewed
following completion of CR. Semistructured, in-person interviews were
conducted with patients and spouses separately. Data were analyzed using
line-by-line coding to identify themes. Results: Themes were identified in
relation to program elements of CR. Exercise themes were as follows: (1)
benefitted from exercise and (2) felt held back. Education themes were as
follows: (1) received basic education and (2) needed more personalized
information. CR environment themes were as follows: (1) developed
confidence; (2) made social comparisons; and (3) helped to have partner
there. Conclusion: Overall, participant perceptions of exercise,
education, and the CR environment were very positive. Nevertheless, there
is a need to improve educational efforts within CR to rely less on
"canned" presentations and more on participants developing their own
self-management methods to maintain a healthy lifestyle after
CR.<br/>Copyright &#xa9; 2018 Lippincott Williams and Wilkins. All rights
reserved.

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

<3>
Accession Number
622901049
Author
Campelo-Parada F.; Carrie D.; Bartorelli A.L.; Namiki A.; Hovasse T.;
Kimura T.; Serra-Penaranda A.; Varenne O.; Lalmand J.; Kadota K.; Ikari
Y.; Tobaru T.; Fujii K.; Nakamura S.; Saito S.; Wijns W.
Institution
(Campelo-Parada, Bartorelli) Hopital Rangueil, CHU Toulouse, 1 Avenue Jean
Poulhes, Toulouse 31059, France
(Carrie) Centro Cardiologico Monzino, University of Milan, Italy
(Namiki) Kanto Rosai Hospital, Japan
(Hovasse) Hopital Prive Jacques Cartier (ICPS), Massy, France
(Kimura) Kyoto University Graduate School of Medicine, Japan
(Serra-Penaranda) Hospital de la Santa Creu i Sant Pau, Spain
(Varenne) Hopital Cochin, Paris, France
(Lalmand) CHU Charleroi, Belgium
(Kadota) Kurashiki Central Hospital, Japan
(Ikari) Tokai University Hospital, Japan
(Tobaru) Sakakibara Heart Institute, Japan
(Fujii) Sakurabashi Watanabe Hospital, Japan
(Nakamura) Kyoto Katsura Hospital, Japan
(Saito) Shonan Kamakura General Hospital, Japan
(Wijns) Cardiovascular Research Center, OLV Hospital, Aalst, Belgium
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway, Ireland
Title
Radial Versus Femoral Approach for Percutaneous Coronary Intervention:
MACE Outcomes at Long-Term Follow-up.
Source
Journal of Invasive Cardiology. 30 (7) (pp 262-268), 2018. Date of
Publication: July 2018.
Publisher
HMP Communications
Abstract
Objective: To compare the main outcomes of radial versus femoral access at
long-term follow-up. Background: Little is known about the long-term major
cardiovascular events and bleeding complications of patients undergoing
percutaneous coronary intervention (PCI) with radial vs femoral approach.
Methods: A total of 1107 patients from the CENTURY II trial were included.
To minimize baseline differences between radial and femoral groups, we
applied propensity-score matching for this comparison. Results: In this
multicenter study, the radial approach was used in 73.4% of patients.
After propensity-score matching, baseline and procedural characteristics
were comparable between both groups. Procedural success was high and
similar in radial and femoral approaches (98.2% vs 97.5%; P=.47) while
radial access was associated with a shorter hospital stay (1.69 +/- 1.92
days vs 2.08 +/- 1.98 days; P<.01). The short-term bleeding and vascular
complication rates were significantly lower in the radial group (1.7% vs
6.2% [P<.001 in-hospital] and 2.7% vs 9.6% [P<.001 at 1-month follow-up]).
At 3-year follow-up, radial access was associated with lower rates of
all-cause mortality (3.9 vs 6.9%; P=.04) and cardiovascular death (2.1 vs
4.9%; P=.02). The composite of all-cause mortality, myocardial infarction,
and revascularization showed no differences between groups (18.2 vs 21.1%;
P=.29). Conclusions: Compared to the femoral approach, the radial approach
is associated with significantly lower long-term all-cause mortality rate
as well as lower in-hospital and short-term bleeding rates. These results
suggest additional long-term benefits of radial access for PCI, but should
be interpreted within the context of the current study and further
verified in future studies.<br/>Copyright &#xa9; 2018 HMP Communications.
All rights reserved.

<4>
Accession Number
622221591
Author
Verma S.; Mazer C.D.; Fitchett D.; Inzucchi S.E.; Pfarr E.; George J.T.;
Zinman B.
Institution
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fitchett) Division of Cardiology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Inzucchi) Section of Endocrinology, Yale University School of Medicine,
New Haven, CT, United States
(Pfarr) Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
(George) Boehringer Ingelheim International GmbH, Ingelheim, Germany
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
Title
Empagliflozin reduces cardiovascular events, mortality and renal events in
participants with type 2 diabetes after coronary artery bypass graft
surgery: subanalysis of the EMPA-REG OUTCOME randomised trial.
Source
Diabetologia. 61 (8) (pp 1712-1723), 2018. Date of Publication: 01 Aug
2018.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Aims/hypothesis: After coronary artery bypass graft (CABG) surgery in
individuals with type 2 diabetes, there remains a considerable residual
cardiovascular risk. In the EMPA-REG OUTCOME trial in participants with
type 2 diabetes and established cardiovascular disease, empagliflozin
reduced the risk of cardiovascular death by 38%, all-cause mortality by
32%, hospitalisation for heart failure by 35% and incident or worsening
nephropathy by 39% vs placebo when given in addition to standard of care.
The aim of this post hoc analysis of the EMPA-REG OUTCOME trial was to
determine the effects of the sodium glucose cotransporter 2 inhibitor
empagliflozin on cardiovascular events and mortality in participants with
type 2 diabetes and a self-reported history of CABG surgery. Methods: The
EMPA-REG OUTCOME trial was a randomised, double-blind, placebo-controlled
trial. Participants with type 2 diabetes and established cardiovascular
disease were randomised 1:1:1 to receive placebo, empagliflozin 10 mg or
empagliflozin 25 mg, once daily, in addition to standard of care. In
subgroups by self-reported history of CABG (yes/no) at baseline, we
assessed: cardiovascular death; all-cause mortality; hospitalisation for
heart failure; and incident or worsening nephropathy (progression to
macroalbuminuria, doubling of serum creatinine, initiation of renal
replacement therapy or death due to renal disease). Differences in risk
between empagliflozin and placebo were assessed using a Cox proportional
hazards model. Results: At baseline, 25% (1175/4687) of participants who
received empagliflozin and 24% (563/2333) of participants who received
placebo had a history of CABG surgery. In participants with a history of
CABG surgery, HRs (95% CI) with empagliflozin vs placebo were 0.52 (0.32,
0.84) for cardiovascular mortality, 0.57 (0.39, 0.83) for all-cause
mortality, 0.50 (0.32, 0.77) for hospitalisation for heart failure and
0.65 (0.50, 0.84) for incident or worsening nephropathy. Results were
consistent between participants with and without a history of CABG surgery
(p > 0.05 for treatment by subgroup interactions).
Conclusions/interpretation: In participants with type 2 diabetes and a
self-reported history of CABG surgery, treatment with empagliflozin was
associated with profound reductions in cardiovascular and all-cause
mortality, hospitalisation for heart failure, and incident or worsening
nephropathy. These data have important implications for the secondary
prevention of cardiovascular events after CABG in individuals with type 2
diabetes. Trial registration:: ClinicalTrials.gov
NCT01131676.<br/>Copyright &#xa9; 2018, The Author(s).

<5>
Accession Number
622934098
Author
Lodha R.; Kabra S.K.
Institution
(Lodha, Kabra) Department of Pediatrics, India Institute of Medical
Sciences, New Delhi 110029, India
Title
NIV in developing countries: Is it feasible?".
Source
Pediatric Pulmonology. Conference: 17th International Congress of
Pediatric Pulmonology, CIPP 2018. Spain. 53 (Supplement 1) (pp S32-S34),
2018. Date of Publication: June 2018.
Publisher
John Wiley and Sons Inc.
Abstract
Introduction: Mechanical ventilation is the one of the major therapies in
pediatric intensive care units. It is usually delivered through an
endotracheal tube and occasionally tracheostomy tube; this "invasive"
ventilation is associated with complications including mechanical
obstruction and infections, along with airway complications. It also
requires infrastructure including equipments, training, and meticulous
nursing care. Over past few years, non-invasive ventilation is getting
more popular across the ICUs as well as for long-term ventilatory support
at home (1). Non-invasive ventilation (NIV) consists of ventilator support
without endotracheal intubation. It provides support with an interface.
Based on the interface being used, NIV may be delivered by using nasal
prongs, nasal or face mask or a helmet (2). High flow nasal cannula (HFNC)
oxygen therapy is one of most commonly used form of NIV in all infants and
children. It improves gas exchange by multiple mechanisms including:
better tolerance by patients as it allows patients to clear airways by
active participation, prevents drying of airways as it provides heated
humidified air, provides high FiO² up to 100% as body parts act
as a reservoir, minimizes dead space due to high flow of oxygen and it
provides positive airway pressure. It decreases claustrophobic sensation.
HNFC is being used as an alternative to mechanical ventilation in neonatal
respiratory distress syndrome and apnea, impending respiratory failure in
children and adolescents, during weaning (post extubation respiratory
distress), post surgical care, and in patients where intubation is
avoided. Equipment for providing HFNC consists of different sizes of nasal
cannulae, blender, humidifier and inline oxygen analyzer. The equipment is
relatively less expensive and can be used easily after training
residents/nursing staff. The important part of training includes not only
about providing respiratory support but to identify failure of improvement
and need for intubation without delay (3). By using a nasal or face mask
as interface may be able to provide continuous positive airway pressure
(CPAP) or bi-level positive airway pressure (BiPAP). CPAP improves
ventilation, and decreases work of breathing. However, it may increase the
possibility of aspiration. BiPAP resembles the pressure support mode used
in conventional ventilation. It permits setting of inspiratory and
expiratory positive pressure. This mode may help in ventilation of
neuromuscular illnesses, obesity hypoventilation syndrome and acute
respiratory failure. Indications for NIV NIV is indicated in acute
respiratory failure caused by asthma, acute bronchiolitis or pneumonia. It
is indicated in children with obstructive sleep apnea, congenital central
hypoventilation, chronic respiratory failure in conditions such as cystic
fibrosis and in children having poor systolic ventricular function after
cardiac surgery (4). NIV is not suitable for infants and children with
severe hemodynamic instability, high risk of aspiration, or need for high
positive end expiratory pressure (PEEP). NIV should be avoided in children
with recent cardiorespiratory arrest, shock, multi-organ dysfunction, and
severe neurological dysfunction (5). Feasibility of NIV in developing
countries We will discuss feasibility of NIV in developing countries under
the following headings: indications, infrastructure (equipment, trained
manpower), advantages and risks. Indications NIV is commonly used
successfully in children with acute respiratory failure due to pneumonia,
bronchiolitis, etc. These conditions are common in developing countries
and are the major cause of mortality in under-five year olds. There is a
high burden of severe disease requiring hospitalization and a sizeable
number would need respiratory support. In addition, children with other
conditions that are common in developing countries such as severe dengue,
malaria, may also need respiratory support. The recent guidelines for
pediatric acute respiratory distress syndrome (PARDS) also recommend the
use of NIV for mild PARDS (6). Use of NIV reduces complications due to
intubation; thus we may conclude that there are sufficient indications for
NIV in developing countries. Infrastructure (equipment and trained
manpower) Equipment for HFNC, CPAP and BiPAP are relatively less expensive
and available or can be made available in pediatric intensive care
units/pediatric wards. A properly fitting interface in the form of nasal
or face mask may be a problem. Indigenously-made CPAP equipment and bubble
CPAP have been used successfully in Indian ICUs. Kinikar et al. (7) used
an indigenously-assembled Nasal Bubble CPAP (NB-CPAP) in 60 children
(median age 18 months) with acute hypoxemic respiratory failure during the
H1N1 pandemic. The equipment provided an expiratory positive airway
pressure of 5 cm water and delivered FiO<inf>2</inf> of about 70%. All
patients tolerated CPAP and none required endotracheal intubation. Anitha
et al. (8) used a modified system of Mapleson D or F circuits and face
mask as interface. They treated 214 children with CPAP through a flow
inflating device successfully in 89.7% of cases. The most successful
outcome was observed in infants with acute bronchiolitis. Children with
pneumonia required longer duration of CPAP. CPAP failed in 10.3% of cases
and reasons for failure were: children <1 year and pneumonia with septic
shock (8). A recently published systematic review has evaluated the
effects of NIV for acute respiratory failure (ARF) in low- and low-middle
income countries (9). The authors included 10 pediatric studies with 1099
subjects. The primary diagnoses in the pediatric studies were pneumonia,
malaria, and dengue shock syndrome. The median age was 9.0 months (IQR
2.6-27.6) and 34.2% were female. The most common modes used were
ventilator CPAP and Bubble CPAP. In these children, the pooled risks for
mortality were 9.5% (95%CI 4.6- 14.5), NIV failure 10.5% (4.6-16.5), and
for endotracheal intubation 5.3% (0.8-9.7). The authors attributed a lower
pooled intubation rate relative to NIV failure rate to the following
reasons: patients with NIV failure receiving a trial of high flow oxygen
prior to intubation, transfer of patients who failed NIV to another
facility, and death while on NIV (9). Training of health care personnel is
equally important for successful outcome of NIV in intensive care. Health
care personnel are relatively better trained in conventional ventilation
and they need training in early identification of failure of NIV. Training
should be feasible. Advantages The major advantage of NIV includes
avoidance of intubation. Intubation may be associated with increased risk
of ventilatorassociated infections, specifically ventilator-associated
pneumonia (VAP). The rate of VAP is between 20 and 30% in developing
countries. Use of NIV is expected to reduce the incidence of VAP (10).
Risks NIV may be associated with a false sense of security and may delay
intubation. A proper training of health care personnel may reduce this
risk. As mentioned above, the meta-analysis suggests a risk of NIV failure
in about 10% (9). In this study, in 5 pediatric studies, the pooled risk
of facial skin sores was 2.4% (95%CI 0.8-3.9) and that of pneumothorax was
1.9% (0.1-3.9). We conclude that NIV is feasible in developing countries
and may be associated with major advantages.

<6>
Accession Number
622935321
Author
Azeem T.M.A.; Yosif N.E.; Alansary A.M.; Esmat I.M.; Mohamed A.K.
Institution
(Azeem) Intensive Care Specialist at Intensive Care Department of Dar El
Fouad Hospital, Ain-shams University, Cairo, Egypt
(Yosif, Alansary, Esmat, Mohamed) Department of Anesthesia and Intensive
Care, Ain-shams University, 29-Ahmed Fuad St., Saint Fatima Square,
Heliopolis, Cairo, Egypt
Title
Dexmedetomidine vs morphine and midazolam in the prevention and treatment
of delirium after adult cardiac surgery; A randomized, double-blinded
clinical trial.
Source
Saudi Journal of Anaesthesia. 12 (2) (pp 190-197), 2018. Date of
Publication: April-June 2018.
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: The aim of this clinical study was to evaluate the efficacy of
neurobehavioral, hemodynamics and sedative characteristics of
dexmedetomidine compared with morphine and midazolam-based regimen after
cardiac surgery at equivalent levels of sedation and analgesia in
improving clinically relevant outcomes such as delirium. Methods: Sixty
patients were randomly allocated into one of two equal groups: group A =
30 patients received dexmedetomidine infusion (0.4-0.7 mug/kg/h) and Group
B = 30 patients received morphine in a dose of 10-50 mug/kg/h as an
analgesic with midazolam in a dose of 0.05 mg/kg up to 0.2 mg/kg as a
sedative repeated as needed. Titration of the study medication infusions
was conducted to maintain light sedation (Richmond agitation-sedation
scale) (-2 to +1). Primary outcome was the prevalence of delirium measured
daily through confusion assessment method for intensive care. Results:
Group A was associated with shorter length of mechanical ventilation,
significant shorter duration of intensive care unit (ICU) stay (P =
0.038), and lower risk of delirium following cardiac surgery compared to
Group B. Group A showed statistically significant decrease in heart rate
values 4 h after ICU admission (P = 0.015) without significant
bradycardia. Group A had lower fentanyl consumption following cardiac
surgery compared to Group B. Conclusion: Dexmedetomidine significantly
reduced the length of stay in ICU in adult cardiac surgery with no
significant reduction in the incidence of postoperative delirium compared
to morphine and midazolam.<br/>Copyright &#xa9; 2018 Saudi Journal of
Anesthesia <br/> Published by Wolters Kluwer -Medknow.

<7>
Accession Number
622933097
Author
Van Driest S.L.; Jooste E.H.; Shi Y.; Choi L.; Darghosian L.; Hill K.D.;
Smith A.H.; Kannankeril P.J.; Roden D.M.; Ware L.B.
Institution
(Van Driest, Smith, Kannankeril) Department of Pediatrics, Vanderbilt
University School of Medicine, 2200 Children's Way, 8232 Doctor's Office
Tower, Nashville, TN 37232, United States
(Van Driest, Darghosian, Roden, Ware) Department of Medicine, Vanderbilt
University School of Medicine, Nashville, TN, United States
(Jooste, Hill) Department of Pediatrics, Duke University School of
Medicine, Durham, NC, United States
(Shi, Choi) Department of Biostatistics, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Darghosian) Cardiovascular Perfusion Technology Program, Vanderbilt
University Medical Center, Nashville, TN, United States
(Roden) Department of Biomedical Informatics, Vanderbilt University School
of Medicine, Nashville, TN, United States
(Roden) Department of Pharmacology, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Ware) Department of Pathology, Microbiology, and Immunology, Vanderbilt
University School of Medicine, Nashville, TN, United States
Title
Association between early postoperative acetaminophen exposure and acute
kidney injury in pediatric patients undergoing cardiac surgery.
Source
JAMA Pediatrics. 172 (7) (pp 655-663), 2018. Date of Publication: July
2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Acute kidney injury (AKI) is a common and serious complication
for pediatric cardiac surgery patients associated with increased
morbidity, mortality, and length of stay. Current strategies focus on risk
reduction and early identification because there are no known preventive
or therapeutic agents. Cardiac surgery and cardiopulmonary bypass lyse
erythrocytes, releasing free hemoglobin and contributing to oxidative
injury. Acetaminophen may prevent AKI by reducing the oxidation state of
free hemoglobin. Objective: To test the hypothesis that early
postoperative acetaminophen exposure is associated with reduced risk of
AKI in pediatric patients undergoing cardiac surgery. Design, Setting, and
Participants: In this retrospective cohort study, the settingwas 2
tertiary referral children's hospitals. The primary and validation cohorts
included children older than 28 days admitted for cardiac surgery between
July 1, 2008, and June 1, 2016. Exclusion criteria were postoperative
extracorporeal membrane oxygenation and inadequate serum creatinine
measurements to determine AKI status. Exposures: Acetaminophen exposure in
the first 48 postoperative hours. Main Outcomes and Measures: Acute kidney
injury based on Kidney Disease: Improving Global Outcomes serum creatinine
criteria (increase by >=0.3mg/dL from baseline or at least 1.5-fold more
than the baseline [to convert to micromoles per liter, multiply by 88.4])
in the first postoperative week. Results: The primary cohort (n = 666) had
a median age of 6.5 (interquartile range [IQR], 3.9-44.7) months, and 341
(51.2%) had AKI. In unadjusted analyses, those with AKI had lower median
acetaminophen doses than those without AKI (47 [IQR, 16-88] vs 78 [IQR,
43-104] mg/kg, P < .001). In logistic regression analysis adjusting for
age, cardiopulmonary bypass time, red blood cell distribution width,
postoperative hypotension, nephrotoxin exposure, and Risk Adjustment for
Congenital Heart Surgery score, acetaminophen exposure was protective
against postoperative AKI (odds ratio, 0.86 [95%CI, 0.82-0.90] per each
additional 10mg/kg). Findings were replicated in the validation cohort (n
= 333), who had a median age of 14.1 (IQR, 3.9-158.2) months, and 162
(48.6%) had AKI. Acetaminophen doses were 60 (95%CI, 40-87)mg/kg in those
with AKI vs 70 (95%CI, 45-94)mg/kg in those without AKI (P = .03), with an
adjusted odds ratio of 0.91 (95%CI, 0.84-0.99) for each additional
10mg/kg. Conclusions and Relevance: These results indicate that early
postoperative acetaminophen exposure may be associated with a lower rate
of AKI in pediatric patients who undergo cardiac surgery. Further analysis
to validate these findings, potentially through a prospective, randomized
trial, may establish acetaminophen as a preventive agent for
AKI.<br/>Copyright &#xa9; 2018 American Medical Association. All rights
reserved.

<8>
Accession Number
622931550
Author
Holmgaard F.; Vedel A.G.; Ravn H.B.; Nilsson J.C.; Rasmussen L.S.
Institution
(Holmgaard, Vedel, Ravn, Nilsson) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Rasmussen) Department of Anesthesia, Centre of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Title
Impact of mean arterial pressure on sublingual microcirculation during
cardiopulmonary bypass-Secondary outcome from a randomized clinical trial.
Source
Microcirculation. 25 (5) (no pagination), 2018. Article Number: e12459.
Date of Publication: July 2018.
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Objective: In this substudy of a randomized, clinical trial, we explored
the sublingual microcirculation during cardiac surgery at 2 different
levels of blood pressure. We hypothesized that a higher map during CPB
would cause higher MFI. Methods: Thirty-six cardiac surgery patients
undergoing CABG were included and randomized to either low (40-50 mm Hg)
or high (70-80 mm Hg) MAP during CPB. SDF video images were recorded from
the sublingual mucosa. Recordings were analyzed in a blinded fashion to
quantify microcirculatory variables. Results: MAP during CPB in the low
target group was 45.0 mm Hg (SD: 5.3) vs 67.2 mm Hg (SD: 8.9) in the high
target group. We found no significant difference between the 2 groups in
MFI during CPB evaluated for AV: 2.91 vs 2.90 (P =.82). For sm AV (<20
mum), the corresponding values were 2.87 and 2.85 in the low and high
target groups, respectively (P =.82). Conclusions: We found no significant
difference in sublingual microcirculatory flow expressed as MFI according
to 2 different levels of MAP during CPB.<br/>Copyright &#xa9; 2018 John
Wiley & Sons Ltd

<9>
Accession Number
622870113
Author
Lee S.H.; Shim J.-K.; Soh S.; Song J.W.; Chang B.C.; Lee S.; Kwak Y.-L.
Institution
(Lee, Chang, Lee) Yonsei University Health System, Department of Thoracic
and Cardiovascular Surgery, Severance Cardiovascular Hospital, College of
Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Soh, Song, Kwak) Yonsei University Health System, Department of
Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute,
Yonsei, South Korea
Title
The effect of perioperative intravenously administered iron isomaltoside
1000 (Monofer) on transfusion requirements for patients undergoing complex
valvular heart surgery: Study protocol for a randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 350. Date of
Publication: 04 Jul 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Anemia is a frequent complication after cardiac surgery
especially following reoperation due to previous prosthetic valve failure
or multiple valve surgery (including combined coronary artery bypass
grafting). This trial explores whether intravenously administered iron
isomaltoside 1000 (Monofer) results in better clinical outcomes in
patients undergoing complex heart valve surgery who are expected to
receive transfusion. Methods/design: In this prospective, single-center,
double-blinded, randomized controlled trial, 214 patients undergoing
reoperation or multiple valve surgery are randomly allocated to either the
iron isomaltoside 1000 (IVFe) or the control group from August 2016 to
August 2018. The IVFe group receives iron isomaltoside 1000 mg (maximum
dose 20 mg/kg) intravenously 3 days before and after the surgery. The
control group receives an equivalent volume of normal saline. The primary
endpoint is transfusion requirement (more than 1 unit of packed
erythrocytes) for postoperative care until discharge and secondary
endpoint are major complications, such as delayed ventilator therapy,
acute kidney injury, and mortality. Reticulocyte count, plasma hepcidin,
iron profiles (serum iron, serum ferritin, total iron-binding capacity,
transferrin, transferrin saturation), coagulation profiles, urinary
analysis, and chemical profiles are measured for three preoperative
baseline-data days and just before surgery, except for hepcidin. After
surgery, daily routine basic laboratory tests are measured just before
discharge and reticulocyte count, iron profiles, and hepcidin are
repeatedly checked for three postoperative days. Discussions: From our
study, we can clarify the following points: the first is the perioperative
IVFe effect on the demand for transfusion, and clinical outcomes in
reoperation or complex valve surgery and the second is the role of
hepcidin in the effect of IVFe on the hemoglobin level
increase.<br/>Copyright &#xa9; 2018 The Author(s).

<10>
Accession Number
622792032
Author
Srivastava V.K.; Singh D.; Agrawal S.; Khan S.; Gupta A.; Miree R.D.
Institution
(Srivastava, Khan, Gupta) Department of Anesthesia, Apollo Hospitals,
Bilaspur, Chhattisgarh, India
(Singh, Miree) Department of Gastroenterology, Apollo Hospitals, Bilaspur,
Chhattisgarh, India
(Agrawal) Department of Anesthesia, Himalayan Institute of Medical
Sciences, Dehradoon, Uttarakhand, India
Title
Comparative evaluation of propofol fentanyl, propofol-midazolam and
propofol-dexmedetomidine on haemodynamic and postoperative recovery for
endoscopic retrograde cholangiopancreatography.
Source
Journal of Clinical and Diagnostic Research. 12 (7) (pp UC01-UC05), 2018.
Date of Publication: July 2018.
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar,GT
Karnal Road, Delhi 110007, India)
Abstract
Introduction: Adequate patient sedation is mandatory for Endoscopic
Retrograde Cholangiopancreatography (ERCP). Recent studies indicate that
propofol and combination of midazolam or fentanyl or dexmedetomidine is
superior to propofol alone in terms of haemodynamic stability, sedation
efficacy and recovery parameter. Aim: The present study compared the
efficacy of propofol-fentanyl, propofol-midazolam and
propofol-dexmedetomidine on haemodynamic and postoperative recovery in
ERCP patients. Materials and Methods: A total of 105 patients were
randomly assigned to three groups. Group I received fentanyl 1 mcg/ kg
over 10 min, followed by propofol loading dose 1-2 mg/kg before procedure
and maintenance 1-5 mg/kg/h throughout the procedure. Group II received
midazolam 0.04 mg/kg over 10 minute, followed by the same dose of propofol
and group III received dexmedetomidine 1 mcg/kg over 10 minute, followed
by the same dose of propofol throughout the procedure. Heart rate, blood
pressure and oxygen saturation were recorded at preoperative, after study
drug, after induction, during procedure and after 5 minute of end of the
procedure. Time to achieve Modified Aldrete Score of 9-10, endoscopist's
satisfaction and patients's satisfaction (according to Visual Analog Scale
0-100 mm) were also recorded. Patient characteristic data were analysed
with one-way analysis of variance (ANOVA) and Chi-square test.
Haemodynamic parameters were compared with ANOVA. Satisfaction score was
analysed by the Kruskal-Wallis test. Results: Demographic data of all the
groups were comparable. In group III, there was no significant increase in
heart rate and blood pressure values during the procedure (p>0.05), while
in group I and II there was a significant change in heart rate and blood
pressure at various intervals. Endoscopist's satisfaction was
significantly more in group I and group III compared to group II (p<0.05),
but patients's satisfaction was similar among the groups (p>0.05).
Conclusion: Dexmedetomidine-propofol and fentanyl-propofol combination are
more effective than midazolam-propofol for maintaining the haemodynamic
stability during ERCP. Dexmedetomidine is most appropriate adjuvant
because it reduces the pain level and the amount of propofol to be
administered to the greatest extent and is not different from other agents
in terms of satisfaction score and side effects.<br/>Copyright &#xa9;
2018, Journal of Clinical and Diagnostic Research. All rights reserved.

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

<12>
Accession Number
622859329
Author
Harky A.; Hof A.; Garner M.; Froghi S.; Bashir M.
Institution
(Harky, Garner, Bashir) Department of Cardiac Surgery, Barts Heart Centre,
St. Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Hof) Department of Cardiovascular Surgery, Heinrich-Heine-University,
Medical Faculty, Dusseldrof, Germany
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, London, United Kingdom
Title
Mitral valve repair or replacement in native valve endocarditis?
Systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (7) (pp 364-371), 2018. Date of
Publication: July 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The objective of this study is to review the morbidity and
mortality associated with mitral valve repair versus replacement in
infective endocarditis patients. Methods: A comprehensive search was
undertaken among the four major databases (PubMed, Embase, Scopus, and
Ovid) to identify all available data comparing mitral valve repair or
replacement in infective endocarditis. Databases were evaluated and
assessed to March 2017. Data were analyzed using meta-analytical
techniques including odds ratio and mean weighted difference. Results: A
total of 8978 patients were analyzed in a total of 14 articles. The
average age of the cohort was 53 years. Results revealed a shorter CPB
time in the mitral valve (MV) repair compared to replacement group (P =
0.05). Postoperative outcomes (30 days/in hospital events) such as
bleeding (P = 0.0047) and recurrence of infective endocarditis (IE) (P =
0.004) were significantly lower in the MV repair group. Beyond 30 days,
recurrence of IE was higher in the MV replacement than the repair group (P
< 0.0001). Additionally, there were significantly less reoperations in the
repair group (P = 0.0021). The MV repair group had significantly better
survival at 1 and 5 years postop (P < 0.0001, P < 0.0001). Conclusion:
This meta-analysis shows that mitral valve repair has good clinical
outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve
repair should be attempted in those patients in whom sufficient valve
tissue is present for reconstruction after all infectious tissue has been
resected.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<13>
Accession Number
622859320
Author
Salmasi M.Y.; Harky A.; Chowdhury M.F.; Abdelnour A.; Benjafield A.; Suker
F.; Hubbard S.; Vohra H.A.
Institution
(Salmasi, Chowdhury) Department of Cardiothoracic Surgery, University
Hospitals of Leicester, Leicester, United Kingdom
(Harky) Department of Cardiac Surgery, St Bartholemew's Hospital, London,
United Kingdom
(Abdelnour) Department of Cardiac Surgery, Royal Hospitals, Belfast,
United Kingdom
(Benjafield) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
(Suker) Department of Medical Sciences, University of Nottingham,
Nottingham, United Kingdom
(Hubbard) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Vohra) Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United
Kingdom
Title
Should the mitral valve be repaired for moderate ischemic mitral
regurgitation at the time of revascularization surgery?.
Source
Journal of Cardiac Surgery. 33 (7) (pp 374-384), 2018. Date of
Publication: July 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Ischemic mitral regurgitation (IMR) is associated with
increased mortality and recurrent congestive heart failure following
coronary artery bypass graft (CABG) surgery. While mitral surgery should
be undertaken for severe MR during CABG, the treatment of moderate IMR
remains controversial. We conducted a meta-analysis to determine the
outcomes of CABG alone and combine with mitral valve repair (MVr) in
moderate IMR. Methods: A literature search was conducted by Pubmed, Ovid,
and Embase, which included 643 articles. Eleven studies (seven
observational studies and four randomized controlled trials) with a total
of 1406 patients were included (CABG alone = 864 and CABG plus MVr = 542).
Results: There was no difference in operative mortality (odds ratio 1.56,
95% confidence interval [CI] 0.92-2.71) or long-term survival at 1 or 5
years (hazard ratio 0.98, 95%CI 0.71-1.35, P = 0.49) between the two
groups, and little evidence of heterogeneity was found in the studies
(I² = 0.0, P = 0.562). There was significantly greater
improvement in MR grade (weighted mean difference [WMD] -1.15, 95%CI -1.67
to -0.064, P = < 0.001) and left ventricular systolic diameter (WMD -3.02,
95%CI -4.85 to -1.18, P = 0.001) following CABG and MVr compared to CABG
alone. No difference in postoperative functional class or ejection
fraction was found. Conclusions: Our results show that in the presence of
moderate IMR, adding MVr to revascularization reduces MR grade on
follow-up echocardiography and promotes ventricular remodeling, with no
improvement in long-term survival or functional class.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<14>
Accession Number
622736154
Author
Zhong M.; Tang B.; Zhao Q.; Cheng J.; Jin Q.; Fu S.
Institution
(Zhong, Tang, Zhao, Cheng, Jin, Fu) Department of Cardiology, Jinhua
Municipal General Hospital, Jinhua, Zhejiang, China
Title
Should kissing balloon inflation after main vessel stenting be routine in
the one-stent approach? A systematic review and meta-analysis of
randomized trials.
Source
PLoS ONE. 13 (6) (no pagination), 2018. Article Number: e0197580. Date of
Publication: June 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The KBI (kissing balloon inflation) technique is considered the default
strategy for the two-stent approach in real world practice. Studies
comparing KBI and No-KBI in patients undergoing the one-stent approach
have reported conflicting results. The meta-analysis was performed to
compare the clinical outcomes of the KBI strategy and the No-KBI strategy
for coronary bifurcation lesions in the one-stent approach. Five
randomized studies were included, and a total of 1264 patients were
involved in the meta-analysis. The primary outcome was cardiac death. The
secondary end points were stent thrombosis, MI (myocardial infarction),
target lesion revascularization (TLR), target vessel revascularization
(TVR), and main vessel and side branch restenosis. Compared with the
No-KBI strategy, the KBI strategy was associated with a significant
reduction in side branch restenosis (OR: 0.44, 95% CI: 0.30-0.64,
p<0.001). A high risk of main vessel restenosis was found in the KBI group
(OR: 2.96, 95% CI: 1.74-5.01, p<0.001). There were no significant
differences in rates of cardiac death (OR: 1.89, 95% CI: 0.60-5.95, p =
0.28), stent thrombosis (OR: 0.98, 95% CI: 0.19-4.94, p = 0.98), MI (OR:
0.68, 95% CI: 0.33-1.44, p = 0.30), TLR (OR 1.14, 95% CI 0.68-1.90, p =
0.62), or TVR (OR 1.27, 95% CI 0.75-2.16, p = 0.38). Compared with the
No-KBI strategy, the KBI strategy reduced the incidence of side branch
restenosis and increased the risk of main branch restenosis in the
one-stent approach. However, the clinical outcomes were similar between
the KBI and No-KBI groups.<br/>Copyright &#xa9; 2018 Zhong et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<15>
Accession Number
2000546852
Author
Joseph C.; Garrubba M.; Smith J.A.; Melder A.
Institution
(Joseph, Garrubba, Smith, Melder) Monash Health, Melbourne, Vic, Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Vic, Australia
Title
Does the Use of a Pulmonary Artery Catheter Make a Difference During or
After Cardiac Surgery?.
Source
Heart Lung and Circulation. 27 (8) (pp 952-960), 2018. Date of
Publication: August 2018.
Publisher
Elsevier Ltd
Abstract
Pulmonary artery catheters (PACs) were introduced in 1970. Since then,
their use has steadily increased. However, there have been questions
raised regarding their efficacy for multiple clinical scenarios. The
purpose of this systematic review was to determine the safety and
effectiveness of routine use of PACs post cardiac surgery on mortality,
complications, days in intensive care unit, days in hospital, and costs in
patients undergoing cardiac surgery, or patients who end up in an
intensive care unit. Methods: Medline, All EBM, EMBASE and Cumulative
Index to Nursing and Allied Health Literature (CINAHL) databases were
searched using predetermined search terms. Google, British Medical Journal
(BMJ) Best Practice, and the National Institute for Clinical Excellence
(NICE) were also searched. All searches were from 2012 to current to
update a previous review from 2013. Studies were included if they involved
adult cardiac surgery patients, or intensive care unit (ICU) patients
requiring haemodynamic monitoring. All other surgical patients were
excluded. Results: Six articles were included in this review. Of the six
articles, five were randomised or observational studies, and one was an
expert recommendation. For all cardiac surgery patients and patients
having coronary artery bypass grafting, there was no difference in
mortality. There was an increase in mortality in high-risk cardiac surgery
patients, who had a PAC. For patients following coronary artery bypass
grafting, there was no difference in ICU length of stay (LOS) but for
patients following cardiac surgery total length of hospital stay >30 days
was greater in patients with a PAC. For patients following coronary artery
bypass grafting, in-hospital costs for the entire hospitalisation were
higher in patients with a PAC and, there was no difference in
complications between PAC and a central venous catheter use. Overall, PACs
were not a predictor of worse outcomes. Conclusion: This review revealed
that PAC use was associated with a poorer outcome in a small subset of
cardiac surgical patients but in the majority of patients PAC use made no
difference to outcome. Further studies are required to confirm the true
safety and efficacy of PAC use in cardiac surgery.<br/>Copyright &#xa9;
2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<16>
Accession Number
2000926704
Author
Milano C.A.; Rogers J.G.; Tatooles A.J.; Bhat G.; Slaughter M.S.; Birks
E.J.; Mokadam N.A.; Mahr C.; Miller J.S.; Markham D.W.; Jeevanandam V.;
Uriel N.; Aaronson K.D.; Vassiliades T.A.; Pagani F.D.
Institution
(Milano, Rogers) Departments of Surgery and Medicine, Duke University
School of Medicine, Durham, North Carolina, United States
(Tatooles, Bhat) Center for Heart Transplant and Assist Devices, Advocate
Christ Medical Center, Oak Lawn, Illinois, United States
(Slaughter, Birks) Cardiovascular and Thoracic Surgery and Department of
Cardiovascular Medicine, University of Louisville, Louisville, Kentucky,
United States
(Mokadam, Mahr) Divisions of Cardiothoracic Surgery and Cardiology,
University of Washington, Seattle, Washington, United States
(Miller, Markham) Departments of Cardiac Surgery and Medicine, St.
Joseph's Hospital of Atlanta, Atlanta, Georgia
(Jeevanandam, Uriel) Heart and Vascular Center, University of Chicago
Medicine, Chicago, Illinois, United States
(Aaronson, Pagani) Divisions of Cardiovascular Medicine and Cardiothoracic
Surgery, University of Michigan, Ann Arbor, Michigan, United States
(Vassiliades) Department of Clinical and Medical Affairs, Medtronic
(formerly HeartWare), Framingham, Massachusetts, United States
Title
HVAD: The ENDURANCE Supplemental Trial.
Source
JACC: Heart Failure. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to prospectively evaluate the impact
of blood pressure management on stroke rates in patients receiving the
HeartWare HVAD System. Background: The ENDURANCE trial demonstrated
noninferiority of the HeartWare HVAD System versus control (HeartMate II)
in patients with advanced heart failure ineligible for heart
transplantation. However, stroke was more common in HVAD subjects. Post
hoc analyses demonstrated increased mean arterial blood pressure as a
significant independent risk factor for stroke. Methods: The ENDURANCE
Supplemental Trial was a prospective, multicenter evaluation of 465
patients with advanced heart failure ineligible for transplantation,
randomized 2:1 to HVAD (n = 308) or control (n = 157). The primary
endpoint was the 12-month incidence of transient ischemic attack or stroke
with residual deficit 24 weeks post-event. Secondary endpoints included
the composite of freedom from death, disabling stroke, and need for device
replacement or urgent transplantation, as well as comparisons of stroke or
transient ischemic attack rates in HVAD cohorts in ENDURANCE Supplemental
and ENDURANCE. Results: The enhanced blood pressure protocol significantly
reduced mean arterial blood pressure. The primary endpoint was not
achieved (14.7% with HVAD vs. 12.1% with control, noninferiority [margin
6%] p = 0.14). However, the secondary composite endpoint demonstrated
superiority of HVAD (76.1%) versus control (66.9%) (p = 0.04). The
incidence of stroke in HVAD subjects was reduced 24.2% in ENDURANCE
Supplemental compared with ENDURANCE (p = 0.10), and hemorrhagic
cerebrovascular accident was reduced by 50.5% (p = 0.02). Conclusions: The
ENDURANCE Supplemental Trial failed to demonstrate noninferiority of HVAD
versus control regarding the pre-specified primary endpoint. However, the
trial confirmed that BP management is associated with reduced stroke rates
in HVAD subjects. HVAD subjects, relative to control subjects, more
commonly achieved the composite endpoint (freedom from death, disabling
stroke, and device replacement or urgent transplantation). (A Clinical
Trial to Evaluate the HeartWareTM Ventricular Assist System [ENDURANCE
SUPPLEMENTAL TRIAL] [DT2]; NCT01966458)<br/>Copyright &#xa9; 2018 The
Authors

<17>
Accession Number
616608978
Author
Yang S.; Song L.; Zhao L.; Dong P.; Lai L.; Wang H.
Institution
(Yang, Song, Dong, Lai, Wang) Department of Cardiology, The First
Affiliated Hospital and College of Clinical Medicine of Henan University
of Science and Technology, Luoyang 471003, China
(Zhao) Department of Pain, The First Affiliated Hospital and College of
Clinical Medicine of Henan University of Science and Technology, Luoyang
471003, China
Title
Predictive value of cystatin C in people with suspected or established
coronary artery disease: A meta-analysis.
Source
Atherosclerosis. 263 (pp 60-67), 2017. Date of Publication: August 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims Circulating cystatin C has been recognized as an
independent predictor of cardiovascular and all-cause mortality in the
general population. We aimed to evaluate the prognostic value of baseline
circulating cystatin C levels in people with suspected or established
coronary artery disease (CAD) by conducting a meta-analysis. Methods We
searched Pubmed and Embase databases up to October 2016 for prospective
observational studies investigating the predictive value of elevated
circulating cystatin C levels in people with suspected or established CAD.
Adverse vascular outcomes included all-cause mortality, cardiovascular
mortality, or total adverse vascular events consisting of death,
myocardial infarction, revascularization, stroke, and heart failure.
Results Ten studies involving participants with known or suspected CAD
were included in this meta-analysis. When comparing the highest with the
lowest cystatin C levels, the pooled hazard ratio (HR) was 2.27 (95%
confidence interval [CI] 1.86-2.78) for all-cause mortality, 2.24 (95% CI
1.69-2.97) for cardiovascular mortality, and 1.87 (95% CI 1.57-2.24) for
total adverse vascular events, respectively. Subgroup analysis results
showed that this association was not influenced by follow-up duration,
region, or CAD type. Conclusions Elevated circulating cystatin C is
independently associated with adverse vascular outcomes in people with
suspected or established CAD in terms of all-cause mortality,
cardiovascular mortality, and total adverse vascular events. This
increased risk is probably independent of creatinine/estimated glomerular
filtration rate.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<18>
Accession Number
622826738
Author
Verma A.; Ha A.C.T.; Rutka J.T.; Verma S.
Institution
(Ha) Department of Medicine, University of Toronto, Toronto, ON, Canada
(Verma, Rutka, Verma) Department of Surgery, University of Toronto, 30
Bond St, Toronto, ON M5B 1W8, Canada
Title
What surgeons should know about non-Vitamin K oral anticoagulants a
review.
Source
JAMA Surgery. 153 (6) (pp 577-585), 2018. Date of Publication: June 2018.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Non-vitamin K oral anticoagulants (NOACs) are increasingly
prescribed for patients to treat or prevent arterial or venous
thromboembolism. The following 4 NOAC agents are approved by the US Food
and Drug Administration for clinical use: dabigatran etexilate, apixaban,
edoxaban tosylate, and rivaroxaban. A good understanding of these agents'
pharmacologic properties is important for surgeons given their marked
differences compared with warfarin sodium. This review highlights key
practical issues surrounding the use of NOACs in the perioperative
setting. OBSERVATIONS The PubMed and Cochrane Library databases were
searched for English-language studies from May 1, 2009, until May 1, 2017,
for randomized clinical trials, meta-analyses, systematic reviews,
observational studies, and clinical guidelines. From a systematic review
of the published literature that included 70 articles and 166 404
patients, this study identified 5 key practical issues surrounding the use
of NOACs in the perioperative setting. These include patient populations
for which NOAC use is indicated and contraindicated, the timing of NOAC
treatment cessation before invasive interventions, management of
NOAC-treated patients requiring urgent interventions, the need for
"bridging," and the timing of NOAC treatment's reinitiation after invasive
interventions. Important findings are as follows: NOAC agents are not
recommended for patients with mechanical heart valves or advanced kidney
disease (creatinine clearance, <15 mL/min); minimal to no anticoagulant
effect remains when therapy with a NOAC is withheld for 48 to 72 hours
before surgery in the context of normal kidney function; a reversal agent
is clinically available for dabigatran, while reversal agents for
apixaban, edoxaban, and rivaroxaban are under regulatory review; and
laboratory testing of the anticoagulant effects of NOACs are not routinely
available. There is a paucity of high-quality data on the optimal timing
of NOAC cessation and resumption in the perioperative period, particularly
for patients who undergo procedures with high bleeding risk. CONCLUSIONS
AND RELEVANCE The anticoagulant effect of NOAC agents is predictable but
not readily measurable in routine clinical practice. A number of
uncertainties remain surrounding the use of these agents in the
perioperative setting. Ongoing prospective studies and randomized clinical
trials will provide greater clarity on these management issues in the near
future.<br/>Copyright &#xa9; 2018 American Medical Association. All rights
reserved.

<19>
Accession Number
622127116
Author
Punjasawadwong Y.; Chau-in W.; Laopaiboon M.; Punjasawadwong S.; Pin-on P.
Institution
(Punjasawadwong) Chiang Mai University, Department of Anesthesiology,
Faculty of Medicine, Chiang Mai 50200, Thailand
(Chau-in) Faculty of Medicine, Khon Kaen University, Department of
Anesthesiology, 19-32 Chuabchuen Road, Khon Kaen, Thailand
(Laopaiboon) Khon Kaen University, Department of Epidemiology and
Biostatistics, Faculty of Public Health, 123 Mitraparb Road, Amphur Muang,
Khon Kaen 40002, Thailand
(Punjasawadwong, Pin-on) Faculty of Medicine, Chiang Mai University,
Department of Anesthesiology, Chiang Mai 50200, Thailand
Title
Processed electroencephalogram and evoked potential techniques for
amelioration of postoperative delirium and cognitive dysfunction following
non-cardiac and non-neurosurgical procedures in adults.
Source
Cochrane Database of Systematic Reviews. 2018 (5) (no pagination), 2018.
Article Number: CD011283. Date of Publication: 15 May 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Postoperative delirium (POD) and postoperative cognitive
dysfunction (POCD) may complicate a patient's postoperative recovery in
several ways. Monitoring of processed electroencephalogram (EEG) or evoked
potential (EP) indices may prevent or minimize POD and POCD, probably
through optimization of anaesthetic doses. Objectives: To assess whether
the use of processed EEG or auditory evoked potential (AEP) indices
(bispectral index (BIS), narcotrend index, cerebral state index, state
entropy and response entropy, patient state index, index of consciousness,
A-line autoregressive index, and auditory evoked potentials (AEP index))
as guides to anaesthetic delivery can reduce the risk of POD and POCD in
non-cardiac surgical or non-neurosurgical adult patients undergoing
general anaesthesia compared with standard practice where only clinical
signs are used. Search methods: We searched CENTRAL, MEDLINE, Embase and
clinical trial registry databases up to 28 March 2017. We updated this
search in February 2018, but these results have not been incorporated in
the review. Selection criteria: We included randomized or quasi-randomized
controlled trials comparing any method of processed EEG or evoked
potential techniques (entropy, BIS, AEP etc.) against a control group
where clinical signs were used to guide doses of anaesthetics in adults
aged 18 years or over undergoing general anaesthesia for non-cardiac or
non-neurosurgical elective operations. Data collection and analysis: We
used the standard methodological procedures expected by Cochrane. Our
primary outcomes were: occurrence of POD; and occurrence of POCD.
Secondary outcomes included: all-cause mortality; any postoperative
complications; and postoperative length of stay. We used GRADE to assess
the quality of evidence for each outcome. Main results: We included six
randomized controlled trials (RCTs) with 2929 participants comparing
processed EEG or EP indices-guided anaesthesia with clinical signs-guided
anaesthesia. There are five ongoing studies and one study awaiting
classification. Anaesthesia administration guided by the indices from a
processed EEG (bispectral index) probably reduces the risk of POD within
seven days after surgery with risk ratio (RR) of 0.71 (95% CI 0.59 to
0.85; number needed to treat for an additional beneficial outcome (NNTB)
of 17, 95% CI 11 to 34; 2197 participants; 3 RCTs; moderate quality of
evidence). Three trials also showed the lower rate of POCD at 12 weeks
after surgery (RR 0.71, 95% CI 0.53 to 0.96; NNTB 38, 95% CI 21 to 289;
2051 participants; moderate-quality evidence), but it is uncertain whether
processed EEG indices reduce POCD at one week (RR 0.84, 95% CI 0.69 to
1.02; 3 trials; 1989 participants; moderate-quality evidence), and at 52
weeks (RR 0.30, 95% CI 0.05 to 1.80; 1 trial; 59 participants; very low
quality of evidence). There may be little or no effect on all-cause
mortality (RR 1.01, 95% CI 0.62 to 1.64; 1 trial; 1155 participants;
low-quality evidence). One trial suggested a lower risk of any
postoperative complications with processed EEG (RR 0.51, 95% CI 0.37 to
0.71; 902 participants, moderate-quality evidence). There may be little or
no effect on reduced postoperative length of stay (mean difference -0.2
days, 95% CI -2.02 to 1.62; 1155 participants; low-quality evidence).
Authors' conclusions: There is moderate-quality evidence that optimized
anaesthesia guided by processed EEG indices could reduce the risk of
postoperative delirium in patients aged 60 years or over undergoing
non-cardiac surgical and non-neurosurgical procedures. We found
moderate-quality evidence that postoperative cognitive dysfunction at
three months could be reduced in these patients. The effect on POCD at one
week and over one year after surgery is uncertain. There are no data
available for patients under 60 years. Further blinded randomized
controlled trials are needed to elucidate strategies for the amelioration
of postoperative delirium and postoperative cognitive dysfunction, and
their consequences such as dementia (including Alzheimer's disease (AD))
in both non-elderly (below 60 years) and elderly (60 years or over) adult
patients. The one study awaiting classification and five ongoing studies
may alter the conclusions of the review once assessed.<br/>Copyright
&#xa9; 2018 The Cochrane Collaboration.

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

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

<22>
Accession Number
622801072
Author
Chatellier G.; Mas J.-L.; Turc G.; Domigo V.; Guiraud V.; Touze E.; Calvet
D.; Varenne O.; Menacer S.; Sroussi M.; Nana A.; Cabanes L.; Guillon B.;
Schunck A.; Herisson F.; De Gaalon S.; Sevin M.; Langlard J.-M.; Piriou
N.; Jaafar P.; Massardier E.; d'Here B.; Stepowski D.; Bauer F.; Hosseini
H.; Teiger E.; Duval A.-M.; Lim P.; Mechtouff L.; Nighoghossian N.; Derex
L.; Cho T.; Rossi R.; Rioufol G.; Derumeaux G.; Thibaut H.; Barthelet M.;
Thivolet S.; Arquizan C.; Mourand I.; Sportouch C.; Cade S.; Cransac F.;
Giroud M.; Bejot Y.; Eicher J.-C.; L'Huillier I.; Vuillier F.; Moulin T.;
Meneveau N.; Chopard R.; Descotes-Genon V.; Detante O.; Garambois K.;
Bertrand B.; Saunier C.; Mazighi M.; Juliard E.J.-M.; Brochet E.; Guidoux
C.; Meseguer D.; Cabrejo L.; Lavallee P.; Amarenco P.; Messika-Zeitoun;
Lepage L.; Bugnicourt J.-M.; Canaple S.; Lamy C.; Godefroy O.; Leborgne
L.; Guillaumont M.-P.; Trojette F.; Malaquin D.; Vaduva C.; Couvreur G.;
Golfier V.; Plurien F.; Taldir G.; Lucas C.; Cordonnier C.; Henon H.;
Dumont F.; Dequatre-Ponchelle N.; Leys D.; Godart F.; Richardson M.; Polge
A.-S.; Montaigne D.; Coisne A.; Sibon I.; Rouanet F.; Renou P.; Thambo
J.-B.; Reant P.; Laffite S.; Roudaut R.; Garnier P.; Comtet C.; Delsart
D.; Ferrier A.; Bourgois N.; Clavelou P.; Rouhart F.; Timsit S.; Le Cadet
E.; Tirel A.; Mocquard Y.; Guerin P.; Jobic Y.; Le Ven F.; Pouliquen
M.-C.; Milandre L.; Robinet-Borgomano E.; Laksiri N.; Rey C.; Fraisse A.;
Habib G.; Chalvignac V.; Thuny F.; Sablot D.; Runavot G.; Piot C.; Targosz
F.; Chopat P.; Sultan P.; Lacour C.; Richard S.; Ducrocq X.; Marcon F.;
Selton-Suty M.C.; Huttin O.; Bruandet M.; Zuber M.; Tamazyan R.; Antakly
Y.; Garcon P.; Serfaty J.; Favrole P.; Dubois-Rande J.-L.; Hammoudi N.;
Pinel J.-F.; Schleich J.-M.; Donal E.; Lelong B.; Chabanne C.; Viader F.;
Apoil M.; Cogez J.; Labombarda F.; Saloux E.; Reiner P.; Buffon F.; Baudet
M.; Logeart D.; Lefebvre C.; Bataille M.; Godard F.; Biausque F.; Lefetz
Y.; Clement-Dupont M.; Weimar C.; Zegarac V.; Schmitz T.; Plicht B.;
Eissmann M.; Mahabadi A.; Obadia M.; Aubry P.; Iglesias Benyounes N.;
Macian F.; Lusson J.-R.; Darodes N.; Tanguy B.; Mohty D.; Vuillemet F.;
Onea R.; Greciano S.; Roth O.; Neau J.-P.; Quillet L.; Christiaens L.;
Saudeau D.; Patat F.; Singer O.; Fichtlscherer S.; Pico F.; Juliard J.-M.;
Charbonnel C.
Institution
(Turc, Calvet, Mas) Department of Neurology, Hopital Sainte-Anne, Paris,
France
(Turc, Calvet, Sroussi, Chatellier, Mas) Universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Turc, Calvet, Mas) INSERM U894, Paris, France
(Turc, Calvet, Mas) DHU Neurovasc, Paris, France
(Guerin) Department of Cardiology, INSERM UMR 915, Institut du Thorax,
Nantes, France
(Guerin) Institut du Thorax, Centre Hospitalier Universitaire de Nantes,
Nantes, France
(Sroussi) Department of Cardiology, Cochin Hospital, India
(Chatellier) Epidemiology and Clinical Research Unit, Georges Pompidou
European Hospital, France
(Chatellier) APHP, Paris, France
(Chatellier) INSERM CIC 1418, Paris, France
(Mas, Turc, Domigo, Guiraud, Touze, Calvet, Lamy, Teiger, Juliard,
Dubois-Rande, Aubry, Varenne, Menacer, Sroussi, Nana, Cabanes) Hopital
Sainte-Anne, Paris, France
(Guillon, Schunck, Herisson, De Gaalon, Sevin, Guerin, Langlard, Piriou,
Jaafar) Hopital Laennec, Nantes, France
(Massardier, Juliard, Aubry, d'Here, Stepowski, Bauer) CHU Rouen, France
(Hosseini, Dubois-Rande, Teiger, Duval, Lim) Hopital Henri Mondor,
Creteil, France
(Mechtouff, Nighoghossian, Derex, Cho, Rossi, Rioufol, Derumeaux, Thibaut,
Barthelet, Thivolet) CHU Pierre Wertheimer, Lyon, France
(Arquizan, Mourand, Piot, Sportouch, Cade, Cransac) Hopital Gui de
Chauliac, Montpellier, France
(Giroud, Bejot, Eicher, Eicher, L'Huillier) CHU Dijon, France
(Vuillier, Moulin, Meneveau, Chopard, Descotes-Genon) CHU Jean Minjoz,
Besancon, France
(Detante, Garambois, Bertrand, Saunier) CHU Grenoble-Alpes, France
(Mazighi, Guidoux, Juliard, Aubry, Brochet, Guidoux, Meseguer, Cabrejo,
Lavallee, Amarenco, Messika-Zeitoun, Lepage) Hopital Bichat, Paris, France
(Bugnicourt, Canaple, Lamy, Godefroy, Rey, Leborgne, Guillaumont,
Trojette, Malaquin) CHU Nord, Amiens, France
(Vaduva, Couvreur, Golfier, Schleich, Plurien, Taldir) Hopital Yves Le
Foll, St-Brieuc, France
(Lucas, Cordonnier, Henon, Dumont, Dequatre-Ponchelle, Leys, Godart, Rey,
Richardson, Polge, Montaigne, Coisne) CHU Salengro, Lille, France
(Sibon, Rouanet, Renou, Thambo, Reant, Laffite, Roudaut) CHU Bordeaux,
France
(Garnier, Lusson, Comtet, Delsart) Hopital Nord, St-Etienne, France
(Ferrier, Bourgois, Clavelou, Lusson, Lusson) CHU Montpied,
Clermont-Ferrand, France
(Rouhart, Timsit, Le Cadet, Tirel, Mocquard, Guerin, Jobic, Le Ven,
Pouliquen) CHU La Cavale Blanche, Brest, France
(Milandre, Robinet-Borgomano, Laksiri, Rey, Fraisse, Habib, Chalvignac,
Thuny) CHU La Timone, Marseille, France
(Sablot, Runavot, Piot, Targosz, Chopat, Sultan) CH Perpignan, France
(Lacour, Richard, Ducrocq, Marcon, Selton-Suty, Huttin) CHU Nancy, France
(Bruandet, Zuber, Tamazyan, Juliard, Aubry, Antakly, Garcon, Serfaty)
Hopital Saint-Joseph, Paris, France
(Favrole, Dubois-Rande, Hammoudi) Hopital Tenon, Paris, France
(Pinel, Schleich, Donal, Lelong, Chabanne) Hopital Pontchaillou, Rennes,
France
(Viader, Apoil, Cogez, Juliard, Labombarda, Saloux) CHU Caen, France
(Reiner, Buffon, Juliard, Baudet, Logeart) Hopital Lariboisiere, Paris,
France
(Lefebvre, Bataille, Godard, Biausque, Lefetz, Clement-Dupont) CH Lens,
France
(Weimar, Zegarac, Schmitz, Plicht, Eissmann, Mahabadi) Essen University
Hospital, Essen, Germany
(Obadia, Juliard, Aubry, Iglesias Benyounes) Fondation Hopital Rothschild,
Paris, France
(Macian, Lusson, Darodes, Tanguy, Mohty) CHU Limoges, France
(Vuillemet, Onea, Greciano, Roth) Hopitaux Civils de Colmar, France
(Neau, Quillet, Christiaens) CHU Poitiers et CHRU Tours, France
(Saudeau, Patat) CHU Bretonneau, Tours, France
(Singer, Fichtlscherer) Goethe University Hospital, Frankfurt, Germany
(Pico, Juliard, Charbonnel) CH Mignot, Versailles, France
Title
Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke
with patent foramen ovale: Systematic review of randomized trials,
sequential meta-analysis, and new insights from the CLOSE study.
Source
Journal of the American Heart Association. 7 (12) (no pagination), 2018.
Article Number: e008356. Date of Publication: 01 Jun 2018.
Publisher
American Heart Association Inc.
Abstract
Background--We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) comparing patent foramen ovale (PFO)
closure, anticoagulation, and antiplatelet therapy to prevent stroke
recurrence in patients with PFO-associated cryptogenic stroke. Methods and
Results--We searched Medline, Cochrane Library, and EMBASE through March
2018. The primary outcome was stroke recurrence. Pooled incidences, hazard
ratios, and risk ratios (RRs) were calculated in random-effects
meta-analyses. PFO closure was associated with a lower risk of recurrent
stroke compared with antithrombotic therapy (antiplatelet therapy or
anticoagulation: 3560 patients from 6 RCTs; RR=0.36, 95% CI: 0.17-0.79;
I²=59%). The effect of PFO closure on stroke recurrence was
larger in patients with atrial septal aneurysm or large shunt (RR=0.27,
95% CI, 0.11-0.70; I²=42%) compared with patients without these
anatomical features (RR=0.80, 95% CI, 0.43-1.47; I²=12%). Major
complications occurred in 2.40% (95% CI, 1.03-4.25; I²=77%) of
procedures. New-onset atrial fibrillation was more frequent in patients
randomized to PFO closure versus antithrombotic therapy (RR=4.33, 95% CI,
2.37-7.89; I²=14%). One RCT compared PFO closure versus
anticoagulation (353 patients; hazard ratio=0.14, 95% CI, 0.00-1.45) and 2
RCTs compared PFO closure versus antiplatelet therapy (1137 patients;
hazard ratio=0.18, 95% CI, 0.05-0.63; I²=12%). Three RCTs
compared anticoagulation versus antiplatelet therapy, with none showing a
significant difference. Conclusions--PFO closure is superior to
antithrombotic therapy to prevent stroke recurrence after cryptogenic
stroke. The annual absolute risk reduction of stroke was low, but it has
to be tempered by a substantial time at risk (at least 5 years) in young
and middle-aged patients. PFO closure was associated with an increased
risk of atrial fibrillation.<br/>Copyright &#xa9; 2018 The Authors.

<23>
[Use Link to view the full text]
Accession Number
620568177
Author
Chaikriangkrai K.; Jhun H.Y.; Shantha G.P.S.; Abdulhak A.B.; Tandon R.;
Alqasrawi M.; Klappa A.; Pancholy S.; Deshmukh A.; Bhama J.; Sigurdsson G.
Institution
(Chaikriangkrai, Shantha, Abdulhak, Tandon, Alqasrawi, Klappa, Bhama,
Sigurdsson) Heart and Vascular Center, University of Iowa Hospitals and
Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Jhun) Department of Medicine, University of Kansas Medical Center, Kansas
City, KS, United States
(Pancholy) Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Deshmukh) Mayo Clinic, Rochester, MN, United States
Title
Diagnostic Accuracy of Coronary Computed Tomography before Aortic Valve
Replacement: Systematic Review and Meta-Analysis.
Source
Journal of Thoracic Imaging. 33 (4) (pp 207-216), 2018. Date of
Publication: 01 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: In aortic stenosis patients referred for surgical and
transcatheter aortic valve replacement (AVR), the evidence of diagnostic
accuracy of coronary computed tomography angiography (CCTA) has been
limited. The objective of this study was to investigate the diagnostic
accuracy of CCTA for significant coronary artery disease (CAD) in patients
referred for AVR using invasive coronary angiography (ICA) as the gold
standard. Materials and Methods: We searched databases for all diagnostic
studies of CCTA in patients referred for AVR, which reported diagnostic
testing characteristics on patient-based analysis required to pool summary
sensitivity, specificity, positive-likelihood ratio, and
negative-likelihood ratio. Significant CAD in both CCTA and ICA was
defined by >50% stenosis in any coronary artery, coronary stent, or bypass
graft. Results: Thirteen studies evaluated 1498 patients (mean age, 74 y;
47% men; 76% transcatheter AVR). The pooled prevalence of significant
stenosis determined by ICA was 43%. Hierarchical summary
receiver-operating characteristic analysis demonstrated a summary area
under curve of 0.96. The pooled sensitivity, specificity, and
positive-likelihood and negative-likelihood ratios of CCTA in identifying
significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06,
respectively. In subgroup analysis, the diagnostic profiles of CCTA were
comparable between surgical and transcatheter AVR. Conclusions: Despite
the higher prevalence of significant CAD in patients with aortic stenosis
than with other valvular heart diseases, our meta-analysis has shown that
CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for
ICA. Our study illustrates a need for further study of the potential role
of CCTA in preoperative planning for AVR.<br/>Copyright &#xa9; 2018
Wolters Kluwer Health, Inc. All rights reserved.

<24>
Accession Number
622850902
Author
Vagvolgyi A.; Rozgonyi Z.; Kerti M.; Agathou G.; Vadasz P.; Varga J.
Institution
(Vagvolgyi, Vadasz) Department of Thoracic Surgery, National Koranyi
Institute for Pulmonology, Budapest, Hungary
(Rozgonyi) Department of Anaesthesiology and Intensive Care, National
Koranyi Institute for Pulmonology, Budapest, Hungary
(Kerti, Agathou, Varga) Department of Pulmonary Rehabilitation, National
Koranyi Institute for Pulmonology, Budapest, Hungary
Title
Effectiveness of pulmonary rehabilitation and correlations in between
functional parameters, extent of thoracic surgery and severity of
post-operative complications: Randomized clinical trial.
Source
Journal of Thoracic Disease. 10 (6) (pp 3519-3531), 2018. Date of
Publication: 01 Jun 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Pulmonary rehabilitation can be effective in perioperative
condition. Our aim was to examine whether the changes of functional
markers are significant and search connections between these values and
the severity of postoperative complications. Methods: A total of 238
chronic obstructive pulmonary disease (COPD) patients underwent
perioperative pulmonary rehabilitation with thoracic surgery. Health
status and the following parameters were examined: lung function
(FEV<inf>1</inf>, FVC), chest kinematics [chest wall expansion (CWE)],
6-minute walking test (6MWT), breath holding time (BHT), grip strength
(GS) and exercise capacity. Patients were separated into three groups: 72
patients had preoperative rehabilitation only (PRE group), 80 had only
postoperative rehabilitation (POS group), and 86 patients underwent pre-
and postoperative rehabilitation as well (PPO group). Postoperative
complications were classed as "severe" and "not severe". We evaluated the
changes in functional parameters. Significance was recognized at P < 0.05.
Connections in between variables and severity of complications were
analyzed. Results: Pulmonary rehabilitation resulted significant changes
of all examined parameters in all three groups. The direction of changes
were favourable, so all of the changes can be considered to be improvement
[PRE: CWE: 4.2+/-2.3 vs. 5.8+/-2.2 cm; FEV<inf>1</inf>: 63.2+/-15.6 vs.
70.1+/-16.6 %pred; 6-minute walking distance (6MWD): 392.9+/-93.5 vs.
443.2+/-86.6 m; FVC: 83.1+/-15.9 vs. 90.9+/-15.6 %pred; POS: CWE:
2.9+/-1.4 vs. 5.0+/-2.0 cm; FEV<inf>1</inf>: 56.4+/-15.6 vs. 64.6+/-16.0
%pred; 6MWD: 354.7+/-90.7 vs. 437.0+/-96.0 m; FVC: 66.2+/-18.7 vs.
76.1+/-17.7 %pred; PPO: preoperatively: CWE: 4.0+/-2.1 vs. 5.6+/-2.6 cm;
FEV<inf>1</inf>: 58.2+/-15.1 vs. 67.0+/-14.6 %pred; 6MWD: 378.3+/-90.5 vs.
441.3+/-86.4 m; FVC: 82.4+/-16.7 vs. 93.3+/-16.7 %pred; postoperatively:
CWE: 2.7+/-1.5 vs. 4.4+/-2.2 cm; FEV<inf>1</inf>: 47.4+/-13.0 vs.
53.4+/-14.7 %pred; 6MWD: 341.4+/-115.9 vs. 403.3+/-98.4 m; FVC:
63.6+/-16.9 vs. 72.6+/-18.6 %pred; P < 0.05]. BHT, GS, dyspnoea and health
status were also improved significantly. By discriminant analysis 5 of the
variables proved to have discriminative value: kilometers travelled via
cycle ergometer at the onset of the preoperative rehabilitation, gender,
FEV<inf>1</inf> after preoperative rehabilitation, extent of the operation
and 6MWD before preoperative rehabilitation. These 5 parameters can
predict severe complications correctly in 72.5% of all cases. Conclusions:
Pulmonary rehabilitation can reduce the functional depletion caused by the
thoracic surgical operation. Identification of more predictive factors of
severe complications can help making preoperative risk stratification more
precisely.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<25>
Accession Number
622850255
Author
Solo K.; Lavi S.; Choudhury T.; Martin J.; Nevis I.F.; Kwok C.S.;
Kotronias R.A.; Nishina N.; Sponga S.; Ayan D.; Mamas M.A.; Bagur R.
Institution
(Solo, Martin, Bagur) Department of Epidemiology and Biostatistics,
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
(Lavi, Choudhury, Ayan, Bagur) London Health Sciences Centre, London, ON,
Canada
(Martin) Department of Anesthesia and Perioperative Medicine, Centre for
Medical Evidence, Decision Integrity and Clinical Impact (MEDICI),
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
(Nevis) Health Quality Ontario, Toronto, ON, Canada
(Kwok, Mamas, Bagur) Keele Cardiovascular Research Group, Institute for
Applied Clinical Science and Centre for Prognosis Research, Institute of
Primary Care and Health Sciences, University of Keele, Stoke-on-Trent,
United Kingdom
(Kotronias) Oxford University Clinical Academic Graduate School, Oxford
University, Oxford, United Kingdom
(Nishina) Faculty of International Communication, Gunma Prefectural
Women's University, Tamamura, Gunma, Japan
(Sponga) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
Title
Pre-operative use of aspirin in patients undergoing coronary artery bypass
grafting: A systematic review and updated metaanalysis.
Source
Journal of Thoracic Disease. 10 (6) (pp 3444-3459), 2018. Date of
Publication: 01 Jun 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Aspirin therapy improves saphenous vein graft (SVG) patency in
patients undergoing coronary artery bypass graft (CABG), however, its use
in the pre-operative period remains controversial. Therefore, we conducted
a systematic review and meta-analysis of randomized-controlled trials
(RCTs) to update the evidence about risk and benefits of pre-operative
aspirin therapy in patients undergoing CABG. Methods: Electronic databases
(Medline, Embase, PubMed, Cochrane Library, and Scopus) were searched to
identify RCTs evaluating the effect of aspirin versus placebo/control
before CABG. Two investigators independently and in duplicate screened
citations and extracted data and rated the risk of bias. The strength of
evidence was appraised using the Grading of Recommendation Assessment,
Development, and Evaluation (GRADE) approach. Meta-analysis was performed
using a random-effects model. The main outcomes of interest were 30-day
mortality, peri-operative myocardial infarction (MI), chest tube drainage
and SVG occlusion. Results: A total of 13 RCTs involving 4,377
participants (2,266/2,111 pre-operative aspirin/control) met the inclusion
criteria. Pre-operative aspirin reduced the risk of SVG occlusion [risk
ratio (RR): 0.69, 95% confidence interval (CI): 0.49-0.97, P=0.03,
I²=16%], but no differences in mortality (RR: 1.41, 95% Cl:
0.73-2.74, I²=0%) and MI (RR: 0.84, 95% CI: 0.69-1.03,
I²=0%) were found. However, pre-operative aspirin increased
chest tube drainage (MD: 100.40 mL, 95% CI: 24.32-176.47 mL, P=0.01,
I²=84%) and surgical reexploration (RR: 1.52, 95% CI:
1.02-2.27, P=0.04, I²=8%), with no significant difference in
RBC transfusion (RR: 1.06, 95% CI: 0.90-1.25, I²=35%).
Conclusions: Based on trials where the rated body of evidence was of low
to very-low quality, preoperative aspirin improves SVG patency but
increases chest tube drainage and need for surgical
reexploration.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<26>
Accession Number
622848955
Author
Li S.; Zhu R.; Li D.; Li N.; Zhu X.
Institution
(Li, Zhu, Li, Li, Zhu) Department of Radiation Oncology, Nanfang Hospital,
Southern Medical University, Guangzhou 510515, China
Title
Prognostic factors of oligometastatic non-small cell lung cancer: A
meta-analysis.
Source
Journal of Thoracic Disease. 10 (6) (pp 3701-3713), 2018. Date of
Publication: 01 Jun 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: The prognostic factors of oligometastatic non-small cell lung
cancer (NSCLC) are uncertain. We performed a meta-analysis to assess the
prognostic factors of oligometastatic NSCLC patients who are most likely
to achieve long-term survival. Methods: We searched PubMed, EMBASE, the
Cochrane to identify eligible articles and performed the meta-analysis of
all randomized controlled trials (RCTs) and retrospective comparative
studies revealing the prognostic factors of oligometastatic NSCLC. The
primary endpoint of interest was overall survival (OS). Results: We
analyzed data from twenty-four eligible studies, including data from 1,935
patients with oligometastatic NSCLC. In the univariate analysis, we found
no significant difference in OS of prognostic factors including age
[hazard ratios (HRs) 1.02, 95% CI: 0.80-1.31, P=0.86], smoking status (HR
1.08, 95% CI: 0.80-1.46, P=0.62), type of metastases (HR 1.61, 95% CI:
0.86-3.03, P=0.14), but significantly positive prognoses containing female
(HR 1.21, 95% CI: 1.02-1.45, P=0.03), (y)pN0 stage (HR 1.82, 95% CI:
1.40-2.36, P < 0.00001), adenocarcinoma (HR 1.44, 95% CI: 1.10-1.88,
P=0.008). In the multivariate analysis, patients with (y)pN0 stage had an
obvious survival benefit compared with (y)pN1 (HR 1.63, 95% CI: 1.27-2.10,
P=0.001), but no significant survival in contrast with (y)pN2 (HR 2.01,
95% CI: 0.80-5.03, P=0.14). In subgroup analyses, neither thoracic stage
(HR 2.06, 95% CI: 1.52-2.78, P=0.55), (y)pT-stage of primary lung cancer
(HR 1.38, 95% CI: 0.86-2.21, P=0.14) nor tumorous histology (HR 2.99, 95%
CI: 2.10-4.28, P=0.91) and oligometastatic number (HR 1.25, 95% CI:
0.97-1.62, P=0.98) were significantly different in OS. However, patients
with aggressive thoracic treatment (ATT) had improved survival (HR 0.56,
95% CI: 0.37-0.83, P=0.001), and notably, different strategies of ATT
received by oligometastatic NSCLC patients might significantly influence
survival (HR 0.54, 95% CI: 0.36-0.82, P < 0.00001). Conclusions: Overall,
factors including age, smoking status, type of metastasis were not
associated with long-term survival of oligometastatic NSCLC patients.
However, our finding suggests that aggressive therapies in the primary
lung cancer, as well as female, (y)pT-stage, absence of nodal diseases,
adenocarcinoma histology have been clarified as positive prognosis.
Further studies of prospective study for these patients are
warranted.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<27>
Accession Number
622901135
Author
Anonymous
Title
Abstracts from the 16th National Congress of the Italian Society of
Cardiovascular Prevention, SIPREC 2018.
Source
High Blood Pressure and Cardiovascular Prevention. Conference: 16th
National Congress of the Italian Society of Cardiovascular Prevention,
SIPREC 2018. Italy. 25 (2) (no pagination), 2018. Date of Publication:
2018.
Publisher
Springer International Publishing
Abstract
The proceedings contain 30 papers. The topics discussed include: is
antihypertensive therapy with thiazides diuretics in post-menopausal women
a risk factor for ruinous spinal osteoporosis? a case-control study;
phosphodiesterase-5 inhibition in outpatients with chronic heart failure
with reduced left ventricular ejection fraction yields improvements in
clinical and functional outcomes: a meta-analysis; the effects exerted by
ranolazine for both prevention and pharmacological cardioversion of atrial
fibrillation: a meta-analysis; usefulness of aliskiren supplementation for
treatment of heart failure: a meta-analysis; acute ischemic stroke: the
role of transcranial ultrasound. case reports; mini mental state exam for
evaluating cognitive function in patients with CHF treated with
sacubitril/valsartan compared with controls taking conventional therapy: a
retrospective cohort study; impact of new recommendations for management
of high blood pressure in overweight/obese youth; seasonal changes and
vitamin D deficiency in recent cardiac surgical patients; exercise
prescription in breast cancer survivors: one-year of an unsupervised
program; the new horizons of sport medicine; effects of different statin
types and dosages on diastolic blood pressure levels: retrospective
analysis of 24-hour ambulatory blood pressure database; and prognostic
role of left ventricular dysfunction in patients with coronary artery
disease after a cardiac rehabilitation program.

<28>
Accession Number
622899761
Author
Smith Z.L.; Elsner J.A.; Patel R.S.; Kodali D.; Hollander T.; Mullady D.;
Lang G.; Das K.K.; Mark Hovis R.; Ifune C.; Kushnir V.
Institution
(Smith, Elsner, Patel, Kodali, Hollander, Mullady, Lang, Das, Mark Hovis,
Ifune, Kushnir) Washington University, School of Medicine, Cleveland, OH,
United States
Title
A randomized-controlled trial evaluating the use of general endotracheal
anesthesia compared with monitored anesthesia care without an endotracheal
tube and the incidence of sedation-relatedadverse events during ERCP in
high-risk patients.
Source
Gastrointestinal Endoscopy. Conference: Digestive Diease Week, DDW 2018
ASGE. United States. 87 (6 Supplement 1) (pp AB134-AB135), 2018. Date of
Publication: June 2018.
Publisher
Mosby Inc.
Abstract
Introduction: ERCP is a complex procedure which is often performed in
patients at high risk for sedation-related adverse events (SRAE). There is
currently no standard of care with regard to mode of anesthesia and airway
management during ERCP. The aim of this study was to compare the safety of
general endotracheal anesthesia (GEA) vs propofol-based monitored
anesthesia care (MAC) in patients at high risk for SRAE undergoing ERCP.
Method: Consecutive patients with a high risk for SRAE undergoing ERCP at
a single center were invited to participate in this randomizedcontrolled
trial (NCT02850887) comparing GEA and MAC. Inclusion criteria were:
STOP-BANG score of 3, abdominal ascites, BMI 35, chronic lung disease, ASA
class >3, Mallampati class 4 airway, moderate to heavy alcohol use.
Exclusion criteria were preceding EUS, emergent ERCP, tracheostomy,
unstable airway, gastric outlet obstruction and altered foregut anatomy.
The primary end point was composite incidence of SRAE: [hypoxia (SpO2 <
90%) requiring airway maneuvers (nasal airway, oral airway, chin lift, jaw
thrust or bag max ventilation)], hypotension requiring vasopressors,
sedation-related procedure interruption, cardiac arrhythmia and
respiratory failure. Secondary outcomes included procedure duration,
cannulation success, in-room time and immediate complications. Results:
Two hundred patients (mean age 61.1+/-13.6 years, 36.5% female) were
randomly assigned to GEA (n=101) and MAC (n=99). Univariate analyses of
patient demographic and baseline variables are outlined in Table 1. Aside
from higher STOP-BANG scores in the GEA group, the cohorts were well
matched. Composite SRAE were significantly more in the MAC group compared
with GEA (51% vs 9.1%, p<0.001). This was primarily driven by the frequent
need for airway maneuvers in the MAC group (Table 2). Additionally, ERCP
was interrupted in 10.1% of patients in the MAC group in order to convert
to GEA due to respiratory instability refractory to AM (n=8) or
significant retained gastric contents (n=2). There were no statistically
significant differences in cannulation, in-room, procedure or fluoroscopy
times between the two groups (Table 2). All patients undergoing GEA were
successfully extubated in the procedure room at completion of ERCP and
Aldrete scores in recovery did not differ between the two groups. There
were no immediate adverse events. Conclusion: In patients at high risk for
SRAE undergoing ERCP, GEA is associated with a significantly lower
incidence of SRAE, without impacting procedure duration, success rate,
recovery time, or in-room procedure time. Additionally, use of MAC in this
high-risk cohort resulted in the need for procedure interruption and
conversion to GEA 10.1% of cases. These data suggest that GEA should be
utilized for ERCP in patients at high risk for sedation-related adverse
events.

<29>
[Use Link to view the full text]
Accession Number
622901361
Author
Yanagawa B.; Mazine A.; Tam D.Y.; Juni P.; Bhatt D.L.; Spindel S.; Puskas
J.D.; Verma S.; Friedrich J.O.
Institution
(Yanagawa, Mazine, Tam, Verma) Division of Cardiac Surgery, St Michael's
Hospital, University of Toronto, Division of Cardiac Surgery, 30 Bond
Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada
(Juni) Applied Health Research Centre, St Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Juni, Friedrich) Li Ka Shing Knowledge Institute, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Spindel, Puskas) Department of Cardiothoracic Surgery, Mount Sinai
Hospital, New York, NY, United States
(Friedrich) Department of Critical Care and Medicine, St Michael's
Hospital, University of Toronto, Toronto, ON, Canada
Title
Homograft Versus Conventional Prosthesis for Surgical Management of Aortic
Valve Infective Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 163-170), 2018. Date of Publication: 01 May 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Surgical management of aortic valve infective endocarditis (IE)
with cryopreserved homograft has been associated with lower risk of
recurrent IE, but there is equipoise with regard to the optimal
prosthesis. This systematic review and meta-analysis were performed to
compare outcomes between homograft and conventional prosthesis for aortic
valve IE. Methods We searched MEDLINE database to September 2017 for
studies comparing homograft versus conventional prosthesis. The main
outcomes were all-cause mortality, recurrent IE, and reoperation. Results
There were 18 included comparative observational studies with 2232
patients (median follow up = 5 [interquartile range: 2-7] years, 30%
prosthetic valve endocarditis); four studies were adjusted for baseline
differences. There were no differences in perioperative mortality or
stroke despite a greater proportion of staphylococcal endocarditis,
abscess, and root replacements but less multivalve involvement in the
homograft group. Long-term outcomes of all-cause mortality [incidence rate
ratio (IRR) = 1.03, 95% confidence interval (CI) = 0.81-1.31, P = 0.83,
for unmatched, and IRR = 0.82, 95% CI = 0.36-1.84, P = 0.63, for matched
studies], recurrent endocarditis (IRR = 1.01, 95% CI = 0.53-1.93, P =
0.96, for unmatched, and IRR = 1.04, 95% CI = 0.49-2.19, P = 0.92, for
matched studies), and reoperation (IRR = 1.60, 95% CI = 0.80-3.21, P =
0.18, for unmatched, and IRR = 3.17, 95% CI = 0.52-19.44, P = 0.21, for
matched studies) were not different comparing homograft versus
conventional prosthesis. There was a significantly increased need for
reoperation with homograft versus mechanical prosthetic valves, but this
comparison was based on limited data. Conclusions Homografts and
conventional prostheses offer similar survival and freedom from recurrent
endocarditis and reoperation for aortic valve IE. Homografts may be
associated with greater risk of reoperation compared with mechanical
valves.<br/>Copyright &#xa9; 2018 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<30>
[Use Link to view the full text]
Accession Number
622901359
Author
Siordia J.A.; Loera J.M.; Scanlon M.; Evans J.; Knight P.A.
Institution
(Siordia, Loera, Scanlon, Evans, Knight) Department of Cardiac Surgery,
University of Rochester Medical Center, 7796 Victor Mendon Rd, Victor,
Rochester, NY 14564, United States
Title
Three-Year Survival Comparison between Transcatheter and Surgical Aortic
Valve Replacement for Intermediate- and Low-Risk Patients.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 13 (3) (pp 153-162), 2018. Date of Publication: 01 May 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Transcatheter aortic valve implantation is a suitable therapeutic
intervention for patients deemed inoperable or high risk for surgical
aortic valve replacement. Current investigations question whether it is a
suitable alternative to surgery for intermediate- and low-risk patients.
The following meta-analysis presents a comparison between transcatheter
versus surgical aortic valve replacement in patients that are intermediate
and low risk for surgery. Articles were collected via an electronic search
using Google Scholar and PubMed. Articles of interest included studies
comparing the survival of intermediate- and low-risk patients undergoing
transcatheter aortic valve implantation to those undergoing surgical
aortic valve replacement. Primary end points included 1-, 2-, and 3-year
survival. Secondary end points included postintervention thromboembolic
events, stroke, transient ischemic attacks, major vascular complications,
permanent pacemaker implantation, life-threatening bleeding, acute kidney
injury, atrial fibrillation, and moderate-to-severe aortic regurgitation.
Six studies met the criteria for the meta-analysis. One- and two-year
survival comparisons showed no difference between the two interventions.
Surgical aortic valve replacement, however, presented with favorable
3-year survival compared with the transcatheter approach. Transcatheter
aortic valve implantation had more major vascular complications, permanent
pacemaker implantation, and moderate-to-severe aortic regurgitation rates
compared with surgery. Surgical aortic valve replacement presented more
life-threatening bleeding, acute kidney injury, and atrial fibrillation
compared with a transcatheter approach. There was no statistical
difference between the two approaches in terms of thromboembolic events,
strokes, or transient ischemic attack rates. Surgical aortic valve
replacement presents favorable 3-year survival rates compared with
transcatheter aortic valve implantation.<br/>Copyright &#xa9; 2018 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<31>
Accession Number
622796284
Author
Andresen B.; Dohlen G.; Diep L.M.; Lindberg H.; Fosse E.; Andersen M.H.
Institution
(Andresen, Fosse) Intervention Centre, Oslo University Hospital, Oslo,
Norway
(Andresen, Lindberg) Department of Cardiothoracic Surgery, Oslo University
Hospital, Oslo, Norway
(Andresen, Lindberg, Fosse) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Dohlen) Department of Pediatric Cardiology, Oslo University Hospital,
Oslo, Norway
(Diep) Oslo Centre for Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Andersen) Department of Transplantation Medicine, Oslo University
Hospital, Oslo, Norway
(Andersen) Department of Transplant Medicine, Oslo University Hospital,
Oslo, Norway
(Andersen) Institute of Health and Society, Faculty of Medicine,
University of Oslo, Oslo, Norway
Title
Psychosocial and clinical outcomes of percutaneous versus surgical
pulmonary valve implantation.
Source
Open Heart. 5 (1) (no pagination), 2018. Article Number: e000758. Date of
Publication: 01 Jun 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective This prospective non-randomised study was performed to compare
the psychosocial function and clinical outcomes following surgical and
percutaneous implantation of a pulmonary valve at 3 months and 1 year
after treatment. Methods All patients were consecutively admitted for
treatment by either method from June 2011 to October 2014. The data of 20
patients treated with the percutaneous technique and 14 patients treated
with open heart surgery were compared. Psychosocial function was measured
by the Achenbach System of Empirically Based Assessment (ASEBA). We used
linear mixed-effect models to investigate group changes between the
psychosocial function and clinical data of 34 patients with congenital
pulmonary valve disease. Results A significant difference in favour of the
percutaneous pulmonary valve implantation group was observed regarding the
ASEBA scores, specifically in the Thought problems subscale at 1 year
(p=0.015), Attention problems subscale at 3 months (p=0.016) and 1 year
(p=0.007) after treatment. After adjustment for the right ventricle to
pulmonary artery pressure gradient at 3 months, a significant change in
the Attention problems subscale (p=0.038) was noted in the percutaneous
group. The New York Heart Association functional score significantly
improved in both groups. The measured right ventricle to pulmonary artery
pressure gradient was reduced significantly in both groups at 1 year.
Conclusions Both methods led to significant clinical improvement. Thought
and attention problems such as intrusive behaviour significantly decreased
only in patients who underwent the percutaneous procedure. Complications
as reintervention, bleeding and arrhythmia were only observed in the open
surgery group.<br/>Copyright &#xa9; 2018 Article author(s) (or their
employer(s) unless otherwise stated in the text of the article). All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<32>
Accession Number
2000922101
Author
Yu W.; Wang B.; Zhan B.; Li Q.; Li Y.; Zhu Z.; Yan Z.
Institution
(Yu, Wang, Li, Li, Zhu, Yan) The Center for Hypertension and Metabolic
Diseases, Department of Hypertension and Endocrinology, Daping Hospital,
Third Military Medical University, Chongqing Institute of Hypertension,
Chongqing 400042, China
(Yu, Zhan) The Thirteenth People's Hospital of Chongqing, The Chongqing
Geriatric Hospital, Chongqing 400053, China
(Wang) Department of Nephrology, Chinese PLA General Hospital, Chinese PLA
Institute of Nephrology, Beijing Key Laboratory of Kidney Disease,
National Clinical Research Center for Kidney Diseases, Fuxing Road 28,
Beijing 100853, China
Title
Statin therapy improved long-term prognosis in patients with major
non-cardiac vascular surgeries: a systematic review and meta-analysis.
Source
Vascular Pharmacology. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To investigate whether statin intervention will improve the
long-term prognosis of patients undergoing major non-cardiac vascular
surgeries. Methods: Major database searches for clinical trials enrolling
patients undergoing major non-cardiac vascular surgeries, including lower
limb revascularization, carotid artery surgeries, arteriovenous fistula,
and aortic surgeries, were performed. Subgroup analyses, stratified by
surgical types or study types, were employed to obtain statistical results
regarding survival, patency rates, amputation, and cardiovascular and
stroke events. Odds ratio (ORs) and 95% confidence intervals (CIs) were
calculated by Review Manager 5.3. Sensitivity analysis, publication bias
and meta-regression were conducted by Stata 14.0. Results: In total, 34
observational studies, 8 prospective cohort studies and 4 randomized
controlled clinical trials (RCTs) were enrolled in the present analysis.
It was demonstrated that statin usage improved all-cause mortality in
lower limb, carotid, aortic and mixed types of vascular surgery subgroups
compared with those in which statins were not used. Additionally, the
employment of statins efficiently enhanced the primary and secondary
patency rates and significantly decreased the amputation rates in the
lower limb revascularization subgroup. Furthermore, for other
complications, statin intervention decreased cardiovascular events in
mixed types of vascular surgeries and stroke incidence in the carotid
surgery subgroup. No significant publication bias was observed. The
meta-regression results showed that the morbidity of cardiovascular
disease or the use of aspirin might affect the overall estimates in
several subgroups. Conclusions: This meta-analysis demonstrated that
statin therapy was associated with improved survival rates and patency
rates and with reduced cardiovascular or stroke morbidities in patients
who underwent non-cardiac vascular surgeries.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<33>
Accession Number
622178514
Author
Tian B.; Song C.; Li H.; Zhang W.; Chen Q.; Chen S.; Fu Y.; Hu X.; You B.;
Li T.; Hu B.; Hou S.
Institution
(Tian, Song, Li, Zhang, Chen, Chen, Fu, Hu, You, Li, Hu, Hou) Department
of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical
University, Beijing 100020, China
Title
The significance of perioperative coagulation and fibrinolysis related
parameters after lung surgery for predicting venous thromboembolism: A
prospective, single center study.
Source
Journal of Thoracic Disease. 10 (4) (pp 2223-2230), 2018. Date of
Publication: 01 Apr 2018.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: The high incidence of venous thromboembolism (VTE) has been
perceived in post thoracic surgery patients. However, the significance of
perioperative coagulation and fibrinolysis related parameters after lung
surgery for VTE predicting is not clear. To investigate that, we conducted
a prospective single center study. Methods: A total of 111 patients
undergoing lung surgery were enrolled in this study, included 52 primary
lung cancer patients and 59 benign lung disease patients from July 2016 to
March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation
and fibrinolysis related parameters were tested, including antithrombin
(AT), fibrinogen degradation product (FDP), prothrombin time (PT),
prothrombin time activity (PA), prothrombin time ratio (PR), international
normalized ratio (INR), activated partial thromboplastin time (APTT),
plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler
ultrasonography was performed before and after surgery for deep venous
thrombosis (DVT) confirmation. Patients with new postoperative DVT,
unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (=9)
were received further computer tomography pulmonary angiography (CTPA) for
pulmonary embolism (PE). We used the area under
receiver-operating-characteristic (ROC) curve to discriminate patients
between those who developed VTE and those who did not. Single factor
analysis was utilized to define risk factors associated with VTE. Results:
The overall incidence of VTE was 16.2% (18/111). The incidence of VTE in
primary lung cancer patients was 23.1% (12/52), much higher than that in
benign lung diseases 10.2% (6/59), but did not reach statistical
significance (P=0.066). Among 18 VTE patients, 83.3% was DVT, 16.7% was
DVT + PE and 72.2% was muscular veins of the calf thrombosis. D-Dimer was
much higher in VTE group than that in non-VTE group preoperatively and at
postoperative days 1, 3 (0.64+/-0.24 vs. 0.33+/-0.06, P=0.007; 3.14+/-0.75
vs. 1.51+/-0.09, P=0.005, and 1.88+/-0.53 vs. 0.76+/-0.05, P=0.001,
respectively). And the ROC curve areas of preoperative and postoperative
days 1, 3 of D-Dimer were 0.70, 0.71 and 0.74, respectively. And FDP was
much higher in VTE group than that in non-VTE group at postoperative day 3
(6.78+/-1.43 vs. 3.79+/-0.15, P=0.004). But AT, PT, PA, PR, INR, APTT, FBG
and TT there were no significantly difference. Conclusions: The overall
incidence of VTE after lung surgery was 16.2%. The patients with
preoperative high D-Dimer should receive VTE prophylaxis.<br/>Copyright
&#xa9; Journal of Thoracic Disease.

<34>
Accession Number
620908706
Author
Ling X.; Zhou H.; Ni Y.; Wu C.; Zhang C.; Zhu Z.
Institution
(Ling) Outpatient Nursing Department, Second Affiliated Hospital of
Jiaxing University, Jiaxing City, Zhejiang Province, China
(Zhou, Ni, Wu, Zhang, Zhu) Department of Anesthesiology, Second Affiliated
Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
Title
Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A
meta-analysis of randomized controlled trials.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0193303. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiac surgery patients often experience several types of
tachyarrhythmias after admission to the intensive care unit (ICU), which
increases mortality and morbidity. Dexmedetomidine (DEX) is a popular
medicine used for sedation in the ICU, and its other pharmacological
characteristics are gradually being uncovered. Purpose To determine
whether DEX has an antiarrhythmic effect after cardiac surgery. Methods
The three primary databases MEDLINE, Embase (OVID SP) and the Cochrane
Central Register of Controlled Trials (CENTRAL) were searched, and all
English-language and randomized control-designed clinical publications
comparing DEX to control medicines for sedation after elective cardiac
surgery were included. Two colleagues independently extracted the data and
performed other quality assessments. A subgroup analysis was performed
according to the different medicines used and whether cardiopulmonary
bypass (CPB) was applied. All tachyarrhythmias that occurred in the atria
and ventricles were analyzed. Results A total of 1295 patients in 9
studies met the selection criteria among 2587 studies that were screened.
After quantitative synthesis, our results revealed that the DEX group was
associated with a lower incidence of ventricular arrhythmia (VA, OR 0.24,
95% CI 0.09-0.64, I² = 0%, P = 0.005) than the control group.
Subgroup analysis did not reveal a significant difference between the DEX
and propofol subgroups (OR 0.13, 95% CI 0.03-0.56, I² = 0%, P =
0.007). Additionally, no difference in the incidence of atrial
fibrillation (AF) was observed regardless of the different control
medicines (OR 0.82, 95% CI 0.60-1.10, I² = 25%, P = 0.19) or
whether CPB was applied. Conclusions This meta-analysis revealed that DEX
has an antiarrhythmic effect that decreases the incidence of VA compared
to other drugs used for sedation following cardiac surgery. DEX May not
have an effect on AF, but cautious interpretation should be exercised due
to high heterogeneity.<br/>Copyright &#xa9; 2018 Ling et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<35>
Accession Number
620085906
Author
Chaikof E.L.; Dalman R.L.; Eskandari M.K.; Jackson B.M.; Lee W.A.; Mansour
M.A.; Mastracci T.M.; Mell M.; Murad M.H.; Nguyen L.L.; Oderich G.S.;
Patel M.S.; Schermerhorn M.L.; Starnes B.W.
Institution
(Chaikof, Patel, Schermerhorn) Department of Surgery, Beth Israel
Deaconess Medical Center, Boston, Mass, United States
(Dalman, Mell) Department of Surgery, Stanford University, Palo Alto,
Calif, United States
(Eskandari) Department of Surgery, Northwestern University, Chicago, Ill,
United States
(Jackson) Department of Surgery, University of Pennsylvania, Philadelphia,
Pa, United States
(Lee) Christine E. Lynn Heart & Vascular Institute, Boca Raton Regional
Hospital, Boca Raton, Fla, United States
(Mansour) Department of Surgery, Spectrum Health Medical Group, Grand
Rapids, Mich, United States
(Mastracci) The Royal Free Hospital, London, United Kingdom
(Murad) Evidence-based Practice Center, Mayo Clinic, Rochester, Minn,
United States
(Nguyen) Department of Surgery, Brigham and Women's Hospital, Boston,
Mass, United States
(Oderich) Department of Surgery, Mayo Clinic, Rochester, Minn, United
States
(Patel) Department of Surgery, Massachusetts General Hospital, Boston,
Mass, United States
(Starnes) Department of Surgery, University of Washington, Seattle, Wash,
United States
Title
The Society for Vascular Surgery practice guidelines on the care of
patients with an abdominal aortic aneurysm.
Source
Journal of Vascular Surgery. 67 (1) (pp 2-77.e2), 2018. Date of
Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Decision-making related to the care of patients with an
abdominal aortic aneurysm (AAA) is complex. Aneurysms present with varying
risks of rupture, and patient-specific factors influence anticipated life
expectancy, operative risk, and need to intervene. Careful attention to
the choice of operative strategy along with optimal treatment of medical
comorbidities is critical to achieving excellent outcomes. Moreover,
appropriate postoperative surveillance is necessary to minimize subsequent
aneurysm-related death or morbidity. Methods The committee made specific
practice recommendations using the Grading of Recommendations Assessment,
Development, and Evaluation system. Three systematic reviews were
conducted to support this guideline. Two focused on evaluating the best
modalities and optimal frequency for surveillance after endovascular
aneurysm repair (EVAR). A third focused on identifying the best available
evidence on the diagnosis and management of AAA. Specific areas of focus
included (1) general approach to the patient, (2) treatment of the patient
with an AAA, (3) anesthetic considerations and perioperative management,
(4) postoperative and long-term management, and (5) cost and economic
considerations. Results Along with providing guidance regarding the
management of patients throughout the continuum of care, we have revised a
number of prior recommendations and addressed a number of new areas of
significance. New guidelines are provided for the surveillance of patients
with an AAA, including recommended surveillance imaging at 12-month
intervals for patients with an AAA of 4.0 to 4.9 cm in diameter. We
recommend endovascular repair as the preferred method of treatment for
ruptured aneurysms. Incorporating knowledge gained through the Vascular
Quality Initiative and other regional quality collaboratives, we suggest
that the Vascular Quality Initiative mortality risk score be used for
mutual decision-making with patients considering aneurysm repair. We also
suggest that elective EVAR be limited to hospitals with a documented
mortality and conversion rate to open surgical repair of 2% or less and
that perform at least 10 EVAR cases each year. We also suggest that
elective open aneurysm repair be limited to hospitals with a documented
mortality of 5% or less and that perform at least 10 open aortic
operations of any type each year. To encourage the development of
effective systems of care that would lead to improved outcomes for those
patients undergoing emergent repair, we suggest a door-to-intervention
time of <90 minutes, based on a framework of 30-30-30 minutes, for the
management of the patient with a ruptured aneurysm. We recommend treatment
of type I and III endoleaks as well as of type II endoleaks with aneurysm
expansion but recommend continued surveillance of type II endoleaks not
associated with aneurysm expansion. Whereas antibiotic prophylaxis is
recommended for patients with an aortic prosthesis before any dental
procedure involving the manipulation of the gingival or periapical region
of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not
recommended before respiratory tract procedures, gastrointestinal or
genitourinary procedures, and dermatologic or musculoskeletal procedures
unless the potential for infection exists or the patient is
immunocompromised. Increased utilization of color duplex ultrasound is
suggested for postoperative surveillance after EVAR in the absence of
endoleak or aneurysm expansion. Conclusions Important new recommendations
are provided for the care of patients with an AAA, including suggestions
to improve mutual decision-making between the treating physician and the
patients and their families as well as a number of new strategies to
enhance perioperative outcomes for patients undergoing elective and
emergent repair. Areas of uncertainty are highlighted that would benefit
from further investigation in addition to existing limitations in
diagnostic tests, pharmacologic agents, intraoperative tools, and
devices.<br/>Copyright &#xa9; 2017 Society for Vascular Surgery

<36>
Accession Number
618469322
Author
Spinthakis N.; Farag M.; Gorog D.A.; Prasad A.; Mahmood H.; Gue Y.;
Wellsted D.; Nabhan A.; Srinivasan M.
Institution
(Spinthakis, Farag, Gorog, Mahmood, Gue, Srinivasan) Department of
Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United
Kingdom
(Spinthakis, Farag, Gorog, Wellsted) Postgraduate Medical School,
University of Hertfordshire, United Kingdom
(Gorog) National Heart & Lung Institute, Imperial College, London, United
Kingdom
(Prasad) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Nabhan) Cochrane Advisory Group, Postgraduate Medical School, Ain Shams
University, Cairo, Egypt
Title
Percutaneous coronary intervention with drug-eluting stent versus coronary
artery bypass grafting: A meta-analysis of patients with left main
coronary artery disease.
Source
International Journal of Cardiology. 249 (pp 101-106), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The relative efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES), in comparison to
coronary artery bypass grafting (CABG) for left main coronary artery
disease (LMCAD) remains controversial. Methods We performed a
meta-analysis of randomised studies comparing patients with LMCAD treated
with PCI with DES versus those treated with CABG, with respect to clinical
outcomes at 1, 3 and 5 years. A secondary meta-analysis was performed
according to low (< 32), or high (>= 33) SYNTAX score. Results Five
studies comprising 4595 patients were included. There was no significant
difference in all-cause death at all time points or when stratified with
respect to SYNTAX score. The need for repeat revascularization was
significantly higher with PCI at all time-points, and regardless of SYNTAX
score. There was significant association between need for repeat
revascularization with PCI and diabetics (p = 0.04). At 5 years, non-fatal
MI was higher with PCI owing to increased non-procedural events (OR 3.00;
CI 1.45-6.21; p = 0.003). CABG showed higher rate of stroke at 1 year (OR
0.21; CI 0.07-0.63; p = 0.005). There was no difference in non-fatal MI or
stroke at other time points, nor according to SYNTAX score. Conclusions
PCI with DES or CABG are equivalent strategies for LMCAD up to 5 years
with respect to death, regardless of SYNTAX score. PCI increases the rate
of non-procedural MI at 5 years. CABG avoids the need for repeat
revascularization, especially in diabetics, but this benefit is offset by
higher rate of stroke in the first year of follow up.<br/>Copyright &#xa9;
2017

<37>
Accession Number
617329801
Author
Aksut B.; Starling R.; Kapadia S.
Institution
(Aksut, Starling, Kapadia) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
Title
Stable coronary artery disease and left ventricular dysfunction: The role
of revascularization.
Source
Catheterization and Cardiovascular Interventions. 90 (5) (pp 777-783),
2017. Date of Publication: 01 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The aim of this review is to present existing evidence of
revascularization in patients with stable coronary artery disease (CAD)
and left ventricular (LV) dysfunction. A literature review was performed
for trials studying revascularization, via CABG or PCI, in patients with
CAD and LV dysfunction. Pivotal, high-quality trials have investigated
revascularization with CABG in stable CAD and LV dysfunction. CASS
demonstrated improved 10-year survival in the surgical group compared to
medically treated patients. While 56-month follow-up of the STICH trial
found no statistically significant difference between CABG and medical
therapy in patients with stable CAD and LV dysfunction, the long-term
follow-up at 10 years (STICHES) demonstrated that CABG did significantly
decrease death from any cause and all secondary outcomes. However, these
pivotal trials have focused solely on surgical revascularization.
Comparable studies regarding outcomes after contemporary PCI methods in
this particular subset of patients are severely lacking. More recent
studies have included very small numbers of patients with reduced EF. In
conclusion, given advances in surgical and non-invasive fields, studies
investigating long-term effects of PCI versus CABG, including combined
hybrid revascularization techniques are warranted. This review sets the
stage for a high-quality randomized, controlled trial comparing
revascularization with PCI versus CABG in patients with stable CAD and LV
dysfunction.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<38>
Accession Number
618216921
Author
Fors A.; Swedberg K.; Ulin K.; Wolf A.; Ekman I.
Institution
(Fors, Ulin, Wolf, Ekman) Institute of Health and Care Sciences,
Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden, Box 457,
Gothenburg 405 30, Sweden
(Fors, Swedberg, Ulin, Wolf, Ekman) Centre for Person-Centred Care (GPCC),
University of Gothenburg, Gothenburg, Sweden
(Fors) Narhalsan Research and Development Primary Health Care, Region
Vastra Gotaland, Sweden
(Swedberg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
Title
Effects of person-centred care after an event of acute coronary syndrome:
Two-year follow-up of a randomised controlled trial.
Source
International Journal of Cardiology. 249 (pp 42-47), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aim To assess the long-term effect of person-centred care (PCC) in
patients with acute coronary syndrome (ACS). Method Patients with ACS were
randomly assigned to treatment as usual (control group) or an added PCC
intervention for six months. The primary endpoint was a composite score of
changes in general self-efficacy >= five units, return to work or to a
prior activity level and re-hospitalisation or death. Results The
composite score improved in the PCC intervention group (n = 94) at a
two-year follow-up compared with the control group (n = 105) (18.1%, n =
17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183)
the improvement was significant in favour of the PCC intervention (n = 78)
compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P =
0.039). This effect was driven by the finding that more patients in the
PCC group improved their general self-efficacy score >= 5 units (32.2%, n
= 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was
significantly higher in the PCC intervention group without post-secondary
education (n = 33) in comparison with corresponding patients in the
control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024).
Conclusion Implementation of PCC results in sustained improvements in
health outcome in patients with ACS. PCC can be incorporated into
conventional cardiac prevention programmes to improve equity in uptake and
patient health outcomes. Trial registration Swedish registry,
Researchweb.org, ID NR 65791.<br/>Copyright &#xa9; 2017 The Authors

<39>
Accession Number
618215074
Author
Song Y.; Song J.W.; Lee S.; Jun J.-H.; Kwak Y.-L.; Shim J.-K.
Institution
(Song, Song, Kwak, Shim) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
South Korea
(Song, Song, Jun, Kwak, Shim) Anesthesia and Pain Research Institute,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Yonsei University
College of Medicine, Seoul, South Korea
Title
Effects of remote ischemic preconditioning in patients with concentric
myocardial hypertrophy: A randomized, controlled trial with molecular
insights.
Source
International Journal of Cardiology. 249 (pp 36-41), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Efficacy of remote ischemic preconditioning (RIPC) for
cardioprotection in cardiac surgery is controversial. We aimed to evaluate
the clinical and molecular effects of RIPC on the concentrically
hypertrophied myocardium. Methods Seventy-two aortic stenosis patients
receiving aortic valve replacement (AVR) under sevoflurane anesthesia were
randomly allocated to RIPC (3 cycles of 5-min inflation [300 mm Hg] and
deflation on the left arm) or control (deflated cuff placement) group. The
primary endpoints were 24-h area under the curve (AUC) for serum creatine
kinase (CK)-MB and troponin (Tn)-T levels. The secondary endpoints were
myocardial activation of cell signaling pathways, including reperfusion
injury salvage kinases (RISK), signal transducer and activator of
transcription (STAT), nitric oxide synthase (NOS), and apoptosis related
molecules, obtained from right atrial tissue before and after
cardiopulmonary bypass (CPB). Results There were no intergroup differences
in 24-h AUCs of CK-MB and Tn-T. Phosphorylations of RISK pathway molecules
were not enhanced by RIPC before and after CPB. Phosphorylation of STAT5
was significantly lower in the RIPC group before and after CPB.
Phosphorylations of STAT3 and endothelial NOS were not enhanced by RIPC
before and after CPB. Expression level of cleaved caspases-3/caspase-3 was
significantly higher in the RIPC group before CPB. Conclusions RIPC did
not provide clinical benefits or activate protective signaling in patients
with concentric left ventricular hypertrophy undergoing AVR.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<40>
Accession Number
618637096
Author
Roy A.K.; Chevalier B.; Lefevre T.; Louvard Y.; Segurado R.; Sawaya F.;
Spaziano M.; Neylon A.; Serruys P.W.; Dawkins K.D.; Kappetein A.P.; Mohr
F.-W.; Colombo A.; Feldman T.; Morice M.-C.
Institution
(Roy, Chevalier, Lefevre, Louvard, Sawaya, Spaziano, Neylon, Morice)
Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital
Prive Jacques Cartier, 6 Avenue du Noyer Lambert, Massy 91300, France
(Segurado) CSTAR Biostatistics, University College Dublin, Dublin, Ireland
(Serruys) Thoraxcenter, Rotterdam, Netherlands
(Dawkins) Boston Scientific Corporation, Marlborough, MA, United States
(Kappetein) Erasmus MC, Rotterdam, Netherlands
(Mohr) Heart Center Leipzig, University of Leipzig, Leipzig, Germany
(Colombo) EMO GVM Centro Cuore Columbus/San Raffaele Hospital, Milan,
Italy
(Feldman) Evanston Hospital, Evanston, IL, United States
Title
Does geographical variability influence five-year MACCE rates in the
multicentre SYNTAX revascularisation trial?.
Source
EuroIntervention. 13 (7) (pp 828-834), 2017. Date of Publication:
September 2017.
Publisher
EuroPCR
Abstract
Aims: The use of multiple geographical sites for randomised cardiovascular
trials may lead to important heterogeneity in treatment effects. This
study aimed to determine whether treatment effects from different
geographical recruitment regions impacted significantly on five-year MACCE
rates in the SYNTAX trial. Methods and results: Five-year SYNTAX results
(n=1,800) were analysed for geographical variability by site and country
for the effect of treatment (CABG vs. PCI) on MACCE rates. Fixed, random,
and linear mixed models were used to test clinical covariate effects, such
as diabetes, lesion characteristics, and procedural factors. Comparing
five-year MACCE rates, the pooled odds ratio (OR) between study sites was
0.58 (95% CI: 0.47-0.71), and countries 0.59 (95% CI: 0.45-0.73). By
homogeneity testing, no individual site (X2=93.8, p=0.051) or country
differences (X2=25.7, p=0.080) were observed. For random effects models,
the intraclass correlation was minimal (ICC site=5.1%, ICC country=1.5%,
p<0.001), indicating minimal geographical heterogeneity, with a hazard
ratio of 0.70 (95% CI: 0.59-0.83). Baseline risk (smoking, diabetes, PAD)
did not influence regional five-year MACCE outcomes (ICC 1.3%-5.2%), nor
did revascularisation of the left main vs. three-vessel disease (p=0.241),
across site or country subgroups. For CABG patients, the number of
arterial (p=0.49) or venous (p=0.38) conduits used also made no
difference. Conclusions: Geographic variability has no significant
treatment effect on MACCE rates at five years. These findings highlight
the generalisability of the five-year outcomes of the SYNTAX
study.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All rights
reserved.

<41>
Accession Number
619678797
Author
Fairley J.L.; Zhang L.; Glassford N.J.; Bellomo R.
Institution
(Fairley) Alfred Hospital, Prahran, VIC 3004, Australia
(Fairley) School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
(Zhang, Glassford, Bellomo) Department of Intensive Care, Austin Hospital,
145 Studley Rd, Heidelberg, Melbourne, VIC 3084, Australia
(Zhang) Department of Nephrology, West China Hospital of Sichuan
University, Chengdu, Sichuan, China
(Glassford, Bellomo) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
Title
Magnesium status and magnesium therapy in cardiac surgery: A systematic
review and meta-analysis focusing on arrhythmia prevention.
Source
Journal of Critical Care. 42 (pp 69-77), 2017. Date of Publication:
December 2017.
Publisher
W.B. Saunders
Abstract
Purpose To investigate magnesium as prophylaxis or treatment of
postoperative arrhythmias in cardiac surgery (CS) patients. To assess
impact on biochemical and patient-centered outcomes. Materials and methods
We searched MEDLINE, CENTRAL and EMBASE electronic databases from 1975 to
October 2015 using terms related to magnesium and CS. English-Language
RCTs were included involving adults undergoing CS with parenterally
administered magnesium to treat or prevent arrhythmias, compared to
control or standard antiarrythmics. We extracted incidence of
postoperative arrhythmias, termination following magnesium administration
and secondary outcomes (including mortality, length of stay, hemodynamic
parameters, biochemistry). Results Thirty-five studies were included, with
significant methodological heterogeneity. Atrial fibrillation (AF) was
most commonly reported, followed by ventricular, supraventricular and
overall arrhythmia frequency. Magnesium appeared to reduce AF (RR 0.69,
95% confidence interval (95%CI) 0.56-0.86, p = 0.002), particularly
postoperatively (RR 0.51, 95%CI 0.34-0.77, p = 0.003) for longer than 24
h. Maximal benefit was seen with bolus doses up to 60 mmol. Magnesium
appeared to reduce ventricular arrhythmias (RR = 0.46, 95%CI 0.24-0.89, p
= 0.004), with a trend to reduced overall arrhythmias (RR = 0.80, 95%CI
0.57-1.12, p = 0.191). We found no mortality effect or significant
increase in adverse events. Conclusions Magnesium administration post-CS
appears to reduce AF without significant adverse events. There is limited
evidence to support magnesium administration for prevention of other
arrhythmias.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<42>
Accession Number
618863964
Author
Kassimis G.; Bourantas C.V.; Tushar R.; de Maria G.L.; Davlouros P.;
Hahalis G.; Alexopoulos D.; Banning A.P.
Institution
(Kassimis, Tushar) Cardiology Department, Gloucestershire Hospitals NHS
Foundation Trust, Cheltenham General Hospital, Cheltenham, United Kingdom
(Bourantas) Institute of Cardiovascular Sciences, University College of
London, London, United Kingdom
(Bourantas) Department of Cardiology, Barts Health NHS Trust, London,
United Kingdom
(de Maria, Banning) Oxford Heart Center, John Radcliffe Hospital, Oxford,
United Kingdom
(Davlouros, Hahalis) Cardiology Department, University Hospital of Patras,
Rion, Greece
(Alexopoulos) Cardiology Department, Attikon University Hospital, Athens,
Greece
Title
Percutaneous coronary intervention vs. cardiac surgery in diabetic
patients. Where are we now and where should we be going?.
Source
Hellenic Journal of Cardiology. 58 (3) (pp 178-189), 2017. Date of
Publication: May 2017.
Publisher
Hellenic Cardiological Society
Abstract
Patients with diabetes mellitus are at increased risk of developing
coronary artery disease (CAD) and have an increased incidence of recurrent
events following revascularization. Choosing the most appropriate strategy
to revascularize these high-risk patients is crucial for improving the
clinical outcomes. Several studies, randomized trials and meta-analyses
have compared short- and long-term outcomes following coronary artery
bypass grafting (CABG) and percutaneous coronary intervention (PCI) in
diabetic patients suffering from CAD. The aim of this article is to review
the currently available evidence on the role of PCI and CABG in the
management of diabetic patients with CAD.<br/>Copyright &#xa9; 2017
Hellenic Society of Cardiology

<43>
Accession Number
617683187
Author
Asakura M.; Kim J.; Asanuma H.; Hamasaki T.; Tsukahara K.; Higashino Y.;
Ishikawa T.; Nakama Y.; Koba S.; Maruyama Y.; Tsujimoto M.; Himeno H.;
Ohkusa T.; Fujino S.; Shimizu M.; Endo T.; Yoda S.; Muroya T.; Murohara
T.; Ohte N.; Suzuki H.; Kohno T.; Fukui K.; Shiono T.; Takase H.; Uzui H.;
Nagai Y.; Hashimoto Y.; Ikeda S.; Mizuno S.; Tamita K.; Fujita M.; Satake
K.; Kinoshita Y.; Nunohiro T.; Sakagami S.; Higaki J.; Morii I.; Sawada
R.; Hiasa Y.; Shigemasa T.; Nakahama M.; Sata M.; Doi O.; Ueda T.; Yamada
T.; Yamanouchi T.; Yamaguchi H.; Morita Y.; Hayashi H.; Kitakaze M.
Institution
(Asakura, Kim, Kitakaze) Department of Clinical Medicine and Development,
National Cerebral and Cardiovascular Center Suita, Osaka 565-8565, Japan
(Asakura, Kitakaze) Department of Cardiovascular Medicine, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Asanuma) Department of Cell Biology, National Cerebral and Cardiovascular
Center, Osaka, Japan
(Asanuma) Cardiovascular Science and Technology, Kyoto Prefectural
University of Medicine, Kyoto, Japan
(Hamasaki) Department of Biomedical Statistics, Osaka University Graduate
School of Medicine, Suita, Japan
(Hamasaki) Department of Data Science, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Tsukahara) Division of Cardiology, Yokohama City University Medical
Center, Kanagawa, Japan
(Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
Hyogo, Japan
(Ishikawa) Department of Cardiology, Saitama Prefecture Cardiovascular and
Respiratory Center, Saitama, Japan
(Nakama) Department of Cardiology, Hiroshima City Hospital, Hiroshima,
Japan
(Koba) Division of Cardiology, Department of Medicine, Showa University
Hospital, Tokyo, Japan
(Maruyama) Department of Cardiology, Iwatsuki-minami Hospital, Saitama,
Japan
(Tsujimoto) Department of Cardiology, Cardiovascular Center, Veritas
Hospital, Hyogo, Japan
(Himeno) Division of Cardiology, Fujisawa City Hospital, Kanagawa, Japan
(Ohkusa) Department of Cardiology, Hokko Memorial Hospital, Hokkaido,
Japan
(Fujino) Department of Cardiology, Fukui Prefectural Hospital, Fukui,
Japan
(Shimizu) Department of Cardiology, International Goodwill Hospital,
Kanagawa, Japan
(Endo) Department of Cardiology, Saiseikai Yokohama City Southern
Hospital, Kanagawa, Japan
(Yoda) Division of Cardiology, Department of Internal Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Muroya) Department of Cardiology, National Hospital Organization Ureshino
Medical Center, Saga, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Japan
(Ohte) Department of Cardio-Renal Medicine and Hypertension, Nagoya City
University Graduate School of Medical Sciences, Aichi, Japan
(Suzuki) Division of Cardiology, Showa University Fujigaoka Hospital,
Kanagawa, Japan
(Kohno) Department of Cardiology, Tokyo Rinkai Hospital, Tokyo, Japan
(Kohno) Department of Cardiology, Kasukabe Municipal Hospital, Saitama,
Japan
(Fukui) Division of Cardiology, Kanagawa Cardiovascular Respiratory
Center, Kanagawa, Japan
(Shiono) Department of Cardiology, Kitasato University Medical Center,
Saitama, Japan
(Takase) Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan
(Uzui) Department of Cardiology, Fukui University Hospital, Fukui, Japan
(Nagai) Department of Cardiology, Rinku General Medical Center, Osaka,
Japan
(Hashimoto) Department of Cardiology, Kameda Medical Center, Chiba, Japan
(Ikeda) Division of Cardiology, Uwajima City Hospital, Ehime, Japan
(Mizuno) Department of Cardiology, Fukui Cardiovascular Center, Fukui,
Japan
(Tamita) Department of Cardiology, Nishinomiya Watanabe Cardiovascular
Center, Hyogo, Japan
(Fujita) Department of Cardiovascular Division, Kansai Rosai Hospital,
Hyogo, Japan
(Satake) Department of Cardiology, Fukui General Clinic, Fukui, Japan
(Kinoshita) Kinoshita Clinic, Hiroshima, Japan
(Nunohiro) Department of Cardiology, Nagasaki Municipal Hospital,
Nagasaki, Japan
(Nunohiro) Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
(Sakagami) Department of Cardiology, National Hospital Organization
Kanazawa Medical Center, Ishikawa, Japan
(Higaki) Department of Integrated Medicine and Informatics, Ehime
University Graduate School of Medicine, Ehime, Japan
(Morii) Department of Cardiology, Hokusetsu General Hospital, Osaka, Japan
(Sawada) Department of Cardiology, Hadano Red Cross Hospital, Kanagawa,
Japan
(Hiasa) Department of Cardiology, Tokushima Red Cross Hospital, Tokushima,
Japan
(Shigemasa) Department of Cardiovascular Medicine, International
University of Health and Welfare Atami Hospital, Shizuoka, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Sata) Department of Cardiovascular Medicine, University of Tokushima,
Tokushima, Japan
(Doi) Department of Cardiology, Shizuoka Prefectural General Hospital,
Shizuoka, Japan
(Ueda) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Tokyo, Japan
(Yamada) Division of Cardiology, Osaka General Medical Center, Osaka,
Japan
(Yamanouchi) Department of Cardiology, Department of Internal Medicine,
Hitachi, Ltd. Hitachinaka General Hospital, Ibaraki, Japan
(Yamaguchi) Yamaguchi Clinic, Fukushima, Japan
(Morita) Department of Cardiology, National Hospital Organization
Sagamihara Hospital, Kanagawa, Japan
(Hayashi) Department of Internal Medicine, Hoetsu Hospital, Tokurshima,
Japan
Title
Does Treatment of Impaired Glucose Tolerance Improve Cardiovascular
Outcomes in Patients with Previous Myocardial Infarction?.
Source
Cardiovascular Drugs and Therapy. 31 (4) (pp 401-411), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We evaluated the effects of an alpha-glucosidase inhibitor,
voglibose, on cardiovascular events in patients with a previous myocardial
infarction (MI) and impaired glucose tolerance (IGT). Methods: This
prospective, randomized, open, blinded-endpoint study was conducted in 112
hospitals and clinics in Japan in 3000 subjects with both previous MI and
IGT receiving voglibose (0.6 mg/day, n = 424) or no drugs (n = 435) for 2
years. The Data and Safety Monitoring Board (DSMB) recommended
discontinuation of the study in June 2012 after an interim analysis when
the outcomes of 859 subjects were obtained. The primary endpoint was
cardiovascular events including cardiovascular death, nonfatal MI,
nonfatal unstable angina, nonfatal stroke, and percutaneous coronary
intervention/coronary artery bypass graft. Secondary endpoints included
individual components of the primary endpoint in addition to all-cause
mortality and hospitalization due to heart failure. Results: The age,
ratio of males, and HbA<inf>1</inf>C were 65 vs. 65 years, 86 vs. 87%, and
5.6 vs. 5.5% in the groups with and without voglibose, respectively.
Voglibose improved IGT; however, Kaplan-Meier analysis showed no
significant between-group difference with respect to cardiovascular events
[12.5% with voglibose vs. 10.1% without voglibose for the primary endpoint
(95% confidence interval, 0.82-1.86)]; there were no significant
differences in secondary endpoints. Conclusion: Although voglibose
effectively treated IGT, no additional benefits for cardiovascular events
in patients with previous MI and IGT were observed. Voglibose may not be a
contributing therapy to the secondary prevention in patients with MI and
IGT. Trial Registration: Clinicaltrials.gov number:
NCT00212017.<br/>Copyright &#xa9; 2017, Springer Science+Business Media,
LLC.

<44>
Accession Number
619152530
Author
Antonic M.
Institution
(Antonic) Department of Cardiac Surgery, University Medical Centre
Maribor, Ljubljanska ulica 5, Maribor SI-2000, Slovenia
Title
Effect of ascorbic acid on postoperative acute kidney injury in coronary
artery bypass graft patients: A pilot study.
Source
Heart Surgery Forum. 20 (5) (pp E214-E218), 2017. Date of Publication:
October 2017.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Even minor postoperative reductions in renal function
influence the outcome of cardiac surgery. The mechanisms of postoperative
renal injury in cardiac surgery are multifactorial and include
ischemia-reperfusion injury. The study investigates the effect of the
antioxidant ascorbic acid on the postoperative acute kidney injury after
elective CABG surgery. Methods: A prospective randomized single-center
trial was conducted in on-pump coronary artery bypass patients. The
patients in the ascorbic acid group received 2 grams of ascorbic acid 24
hours and 2 hours preoperatively and 1 gram twice daily five days after
the surgery. Postoperatively, the subjects were monitored for renal
dysfunction and other complications. Results: 100 patients were included,
with 50 patients in each study group. The groups were well matched for
baseline demographics, preoperative medications, comorbidities, and had
similar intraoperative characteristics. The incidence of postoperative
acute kidney injury in the ascorbic acid group was 16% and 14% in the
control group (P = .779). The groups also did not differ in peak
postoperative serum creatinine (83 [33] mumol/L versus 83 [39] mumol/L; P
= .434), the lowest postoperative creatinine clearance (96.40 +/- 35.78
mL/min versus 90.89 +/- 36.18 mL/min; P = .766), and time from surgery to
the onset of peak postoperative serum creatinine (1.64 +/- 1.34 days
versus 1.92 +/- 1.54 days; P = .393). There was no dialysis required in
any patient. Conclusion: The results of this study did not demonstrate a
significant protective effect of ascorbic acid on the incidence of
postoperative acute renal injury in elective onpump CABG
patients.<br/>Copyright &#xa9; 2017 Forum Multimedia Publishing, LLC.

<45>
Accession Number
619085266
Author
Ding M.; Gao Y.-D.; Zeng X.-T.; Guo Y.; Yang J.
Institution
(Ding, Gao, Yang) Zhongnan Hospital of Wuhan University, Department of
Respiratory Medicine, Donghu Road 169, Wuhan 430071, China
(Zeng, Guo) Center for Evidence-based and Translational Medicine, Zhongnan
Hospital of Wuhan University, Donghu Road 169, Wuhan 430071, China
Title
Endobronchial one-way valves for treatment of persistent air leaks: A
systematic review.
Source
Respiratory Research. 18 (1) (no pagination), 2017. Article Number: 186.
Date of Publication: 06 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Persistent air leak (PAL) is associated with significant morbidity and
mortality, prolonged hospitalization and increased health-care costs. It
can arise from a number of conditions, including pneumothorax, necrotizing
infection, trauma, malignancies, procedural interventions and
complications after thoracic surgery. Numerous therapeutic options,
including noninvasive and invasive techniques, are available to treat
PALs. Recently, endobronchial one-way valves have been used to treat PAL.
We conducted a systematic review based on studies retrieved from PubMed,
EMbase and Cochrane library. We also did a hand-search in the
bibliographies of relevant articles for additional studies. 34 case
reports and 10 case series comprising 208 patients were included in our
review. Only 4 patients were children, most of the patients were males.
The most common underlying disease was COPD, emphysema and cancer. The
most remarkable cause was pneumothorax. The upper lobes were the most
frequent locations of air leaks. Complete resolution was gained within
less than 24 h in majority of patients. Complications were migration or
expectoration of valves, moderate oxygen desaturation and infection of
related lung. No death related to endobronchial one-way valves
implantation has been found. The use of endobronchial one-way valve adds
to the armamentarium for non-invasive treatments of challenging PAL,
especially those with difficulties of anesthesia, poor condition and high
morbidity. Nevertheless, prospective randomized control trials with large
sample should be needed to further evaluate the effects and safety of
endobronchial one-way valve implantation in the treatment of
PAL.<br/>Copyright &#xa9; 2017 The Author(s).

<46>
Accession Number
618314681
Author
Lennerz C.; Barman M.; Tantawy M.; Sopher M.; Whittaker P.
Institution
(Lennerz) Deutsches Herzzentrum Munchen, Klinik fur Herz- und
Kreislauferkrankungen, Abteilung fur Elektrophysiologie, Faculty of
Medicine, Technische Universitat Munchen, Munich, Germany
(Barman) Cardiology Department, Al Ahli Hospital, Doha, Qatar
(Tantawy) Memorial Souad Kafafi University Hospital, Cardiology
Department, Misr University for Science and Technology of October City 6,
Egypt
(Sopher) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Whittaker) Cardiovascular Research Institute, Department of Emergency
Medicine, Wayne State University School of Medicine, Detroit, United
States
(Lennerz, Barman, Tantawy, Sopher, Whittaker) Department of Social Policy,
The London School of Economics and Political Science, London, United
Kingdom
Title
Colchicine for primary prevention of atrial fibrillation after open-heart
surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 249 (pp 127-137), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Atrial fibrillation occurs frequently after open-heart surgery.
It is associated with increased morbidity and mortality, longer hospital
stays, and increased healthcare costs. Prophylactic administration of
colchicine may mitigate post-operative atrial fibrillation (POAF). Methods
We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify
randomized controlled trials (RCTs) that; (1) compared prophylactic use of
colchicine to placebo, or usual care, in patients with sinus rhythm who
underwent elective open-heart surgery and (2) reported POAF-incidence. We
excluded trials focused on incidence of atrial fibrillation after
percutaneous interventions or colchicine treatment of diagnosed
pericarditis or post-pericardiotomy-syndrome. A random-effects model was
used to pool data for POAF-incidence as the primary outcome and for
drug-related adverse effects, major adverse events (death and stroke), and
hospital length-of-stay as secondary outcomes. Results We included five
RCTs (1412 patients). Colchicine treatment reduced POAF-events by 30%
versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95%
confidence interval (CI) 0.57 to 0.84, p = 0.0002). Adverse drug-related
effects, especially gastrointestinal intolerance, increased with
colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p < 0.0001).
However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95%
CI 0.48 to 1.95, p = 0.92). Length-of-stay decreased by 1.2 days with
colchicine (95% CI -1.89 to - 0.44, p = 0.002). Conclusion Colchicine
demonstrated superior efficacy versus usual care for prevention of atrial
fibrillation after cardiac surgery. Moreover, colchicine treatment was
associated with shorter hospital stays. These benefits outweigh increased
risk of adverse drug-related effects; although further work is needed to
minimize gastrointestinal effects.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<47>
Accession Number
619051548
Author
Zhang R.; Gupta D.; Albert S.G.
Institution
(Zhang) Department of Internal Medicine, Saint Louis University School of
Medicine, United States
(Gupta, Albert) Division of Endocrinology, Saint Louis University School
of Medicine, United States
Title
Pheochromocytoma as a reversible cause of cardiomyopathy: Analysis and
review of the literature.
Source
International Journal of Cardiology. 249 (pp 319-323), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Context Pheochromocytoma and paraganglioma are rare neuroendocrine tumors
which overproduce catecholamines and arise from the adrenal gland or
extra-adrenal chromaffin cells of the sympathetic and parasympathetic
ganglia (1). Excessive catecholamine-induced stimulation of cardiac
myocytes leads to damage which manifests in several forms ranging from
Takotsubo to dilated cardiomyopathy. Diagnosis of pheochromocytoma-related
cardiomyopathies is often delayed due to the atypical presentation
associated with many cases. Objective Limited data exists on the
presentation and outcomes of the various forms of pheochromocytoma-induced
cardiomyopathies. We performed a literature review to assess the
association of pheochromocytoma and cardiomyopathy to aide in further
understanding this clinical entity. Design 163 cases from 150 articles
published between 1991 and November 2016 were included from a PubMed
search. Results There were 163 occurrences of pheochromocytoma and
cardiomyopathy (63 dilated cardiomyopathy, 38 Takotsubo cardiomyopathy, 30
inverted Takotsubo cardiomyopathy, 10 HOCM, 8 myocarditis, and 14
unspecified cardiomyopathy). Many patients lacked classic signs or
symptoms of pheochromocytoma with hypertension as a presenting symptom in
65% and the triad of headache, palpitations, and diaphoresis only in 4%.
Resection of the pheochromocytoma led to improvement of the cardiomyopathy
in 96% while lack of resection was associated with death or cardiac
transplantation in 44%. Conclusion Pheochromocytoma should be considered
in the evaluation of non-ischemic, non-valvular cardiomyopathy even in the
absence of symptoms of catecholamine excess. Our study highlights the
importance of early suspicion and diagnosis of pheochromocytoma in cases
of idiopathic heart failure as early resection may prevent progression to
irreversible myocardial remodeling and death.<br/>Copyright &#xa9; 2017
Elsevier Ireland Ltd

<48>
Accession Number
619051523
Author
Hansen R.; Frydland M.; Moller-Helgestad O.K.; Lindholm M.G.; Jensen L.O.;
Holmvang L.; Ravn H.B.; Kjaergaard J.; Hassager C.; Moller J.E.
Institution
(Hansen, Moller-Helgestad, Jensen, Holmvang, Moller) Department of
Cardiology, Odense University Hospital, Sdr Boulevard 29, Odense C
DK-5000, Denmark
(Frydland, Lindholm, Ravn, Kjaergaard, Hassager) The Heart Center,
Copenhagen University Hospital Rigshospitalet, Blegdamsvej, Copenhagen
DK-2100, Denmark
Title
Association between QRS duration on prehospital ECG and mortality in
patients with suspected STEMI.
Source
International Journal of Cardiology. 249 (pp 55-60), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background QRS duration has previously shown association with mortality in
patients with acute myocardial infarction treated with thrombolytics, less
is known in patients with suspected ST segment elevation myocardial
infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus,
the objective was to investigate the prognostic effect of QRS duration on
prehospital ECG and presence of classic left and right bundle branch block
(LBBB/RBBB) for all-cause mortality in patients with suspected STEMI.
Method In total 2105 consecutive patients (mean age 64 +/- 13 years, 72%
men) with suspected STEMI were prospectively included. QRS duration was
registered from automated QRS measurement on prehospital ECG and patients
were divided according to quartiles of QRS duration (< 89 ms, 89-98 ms,
99-111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality.
Predictors of all-cause mortality were assessed using Cox proportional
hazards analysis. Results Among all patients median QRS duration was 98 ms
(IQR 88-112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB
in 88 patients (4.2%), 80% were treated with percutaneous coronary
intervention and the final diagnosis was STEMI in 1777 patients (84%).
Thirty-day mortality was 7.6% in patients with suspected STEMI. In
multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95%
confidence interval (CI): 1.71-5.57, p = 0.0002), LBBB - morphology (HR
3.0; 95% CI: 1.38-6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95-6.95, p
< 0.0001) were associated with 30 day all-cause mortality. Conclusion In
patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on
prehospital ECG are associated with increased risk of death.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<49>
Accession Number
619305019
Author
Della Corte A.; Bancone C.; Spadafora A.; Borrelli M.; Galdieri N.;
Quintiliano S.N.; Bifulco O.; de Feo M.
Institution
(Della Corte, Bancone, Spadafora, Borrelli, Galdieri, Quintiliano,
Bifulco, de Feo) Department of Cardiothoracic Sciences, Second University
of Naples, Unit of Cardiac Surgery of the Monaldi Hospital, Naples, Italy
Title
Postoperative bleeding in coronary artery bypass patients on double
antiplatelet therapy: Predictive value of preoperative aggregometry.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 901-908), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We tested the possible value of routine aggregometry testing
for bleeding prediction following coronary artery bypass grafting in
patients who received preoperative double antiplatelet therapy. METHODS:
In 226 patients undergoing on-pump isolated coronary artery bypass
grafting, aggregometry [adenosine diphosphate (ADP) test and ASPI test]
was always prospectively performed by Multiplate analyser immediately
before surgery. We assessed the differences in postoperative bleeding
according to the type of double antiplatelet therapy [acetylsalicylic acid
plus clopidogrel (ASA+C), or plus ticagrelor (ASA+T)], duration of
clopidogrel/ticagrelor withdrawal (0-3 days or >= 4 days) and results of
aggregometry tests. Multivariable predictors of blood losses were sought
by linear regressions (drainage amount at 6, 12 and 24 postoperative
hours) and logistic regression (increased bleeding: 75th percentile of
blood losses at 6 h, i.e. >450 ml). RESULTS: Overall, postoperative blood
losses did not significantly differ between treatment groups (median at 6
h: ASA + C = 335 ml, ASA + T = 300 ml, P = 0.21). With longer withdrawal
interval, higher rates of patients with normal ADP-related platelet
function were observed in both groups (ASA + C: P = 0.04; ASA + T: P =
0.006) but only in the ASA + T group were blood losses significantly
smaller at all 3 time points. Bleeders (>450 ml at 6 h) were significantly
less frequent among patients with ADP test showing recovered platelet
function (ASA + T: P = 0.002; ASA + C: P = 0.053). The correlation between
ADP test result and blood losses amount was stronger in the ASA + T group
(e.g. at 6 h: r = -0.6; P < 0.001). In multivariable analyses, the ADP
test result independently predicted postoperative bleeding in the ASA + T
group and the ASPI test in the ASA + C group. CONCLUSIONS: Aggregometry
can help in predicting postoperative bleeding in double antiplatelet
therapy patients undergoing coronary artery bypass grafting.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<50>
Accession Number
619305011
Author
Schiller W.; Barnewold L.; Kazmaier T.; Beckmann A.; Masseli F.; Welz A.;
Szecsenyi J.; Heller G.
Institution
(Schiller, Masseli, Welz) Department of Cardiac Surgery, University of
Bonn, Bonn, Germany
(Barnewold, Kazmaier, Szecsenyi) AQUA-Institut fur angewandte
Qualitatsforderung, Forschung im Gesundheitswesen GmbH, Gottingen, Germany
(Beckmann) Department of Cardiac and Vascular Surgery, Heart Center
Duisburg, Duisburg, Germany
(Heller) IQTIG-Institut fur Qualitatssicherung, Transparenz im
Gesundheitswesen, Berlin, Germany
Title
The German aortic valve score II.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 881-887), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The German Aortic Valve Score (GAVS) was developed for
national quality assurance regarding the in-hospital mortality rate of
patients following isolated aortic valve replacement. The goal of this
work was the recalibration of the GAVS in the context of increased numbers
of transcatheter aortic valve implantations. METHODS: In 2011 and 2012, 36
183 cases were documented who had either surgical aortic valve replacement
or transcatheter aortic valve implantation (45%). All cases were randomly
assigned to the study or to the validation group. All items of the data
set were checked for significance by developing a multiregression risk
model using iterative backward elimination. Calibration was ascertained
using the Hosmer-Lemeshow method. To define the quality of discrimination,
the area under the receiver operating characteristic curve (C-statistic)
was calculated. RESULTS: The randomized study cohort comprised 18 054
patients. After modelling with multiple regression algorithms, 18 of the
initial 28 risk factors entered the risk model. When applied to the
validation group, the newly developed GAVS II showed good calibration with
a P-value of 0.411 in the Hosmer-Lemeshow test and good discrimination
with a C-statistic of 0.741. CONCLUSIONS: The GAVS II is a new risk model
that is applicable to cohorts having surgical aortic valve replacement or
transcatheter aortic valve implantation procedures.<br/>Copyright &#xa9;
The Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<51>
Accession Number
619304993
Author
Sa M.P.B.O.; Soares A.F.; Miranda R.G.A.; Araujo M.L.; Menezes A.M.;
Vasconcelos Silva F.P.; Lima R.C.
Institution
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) Division
of Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco
(PROCAPE), Recife, Brazil
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) University
of Pernambuco (UPE), Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences, Biological Sciences Instituite (FCM/ICB),
Recife, Brazil
Title
Stopping versus continuing acetylsalicylic acid before coronary artery
bypass surgery: A systematic review and meta-analysis of 14 randomized
controlled trials with 4499 patients.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 838-847), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This study aimed to evaluate the efficacy and safety of continuing versus
stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients
undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE,
CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov,
Scientific Electronic Library Online (SciELO), Literatura Latino Americana
em Ciencias da Saude (LILACS), Google Scholar and reference lists of
relevant articles were searched for randomized controlled trials that
reported efficacy outcomes ofmyocardial infarction and mortality, and
safety outcomes of blood loss, packed red blood cell transfusion and
surgical re-exploration were compared between groups. Fourteen studies
fulfilled our eligibility criteria and included a total of 4499 patients
(2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled
analysis, continuing aspirin therapy did not reduce the risk of myocardial
infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P
= 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P =
0.323). Preoperative ASA increased postoperative chest tube drainage (mean
difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell
transfusion (mean difference 142ml, 95% CI 55-228; P = 0.001) but did not
increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI
0.910-1.905; P = 0.145). This meta-analysis found no statistically
significant difference regarding the risk of operative mortality and
myocardial infarction between the 'continuing ASA' and 'stopping ASA'
strategies. On the other hand, the mean volume of blood loss and packed
red blood cell transfusion was higher in the 'continuing ASA' group, but
this finding did not translate into higher risk of reoperation for
bleeding.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<52>
Accession Number
619265543
Author
Rajapakse S.; Weeratunga P.; Rodrigo C.; de Silva N.L.; Fernando S.D.
Institution
(Rajapakse, Weeratunga, de Silva) University Medical Unit, National
Hospital Colombo, Colombo, Sri Lanka
(Rajapakse, Weeratunga, Rodrigo) Faculty of Medicine, Department of
Clinical Medicine, University of Colombo, Colombo, Sri Lanka
(Rodrigo) Department of Pathology, School of Medical Sciences, University
of New South Wales, Sydney, Australia
(de Silva) Faculty of Medicine, Department of Medicine, General Sir John
Kotelawala Defence University, Rathmalana, Sri Lanka
(Fernando) Faculty of Medicine, Department of Parasitology, University of
Colombo, Colombo, Sri Lanka
Title
Prophylaxis of human toxoplasmosis: a systematic review.
Source
Pathogens and Global Health. 111 (7) (pp 333-342), 2017. Date of
Publication: 03 Oct 2017.
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Toxoplasmosis is an infection caused by the intracellular protozoan
parasite Toxoplasma gondii, and is associated with clinically significant
infection in immunocompromised individuals. Vertical transmission during
pregnancy can manifest as congenital toxoplasmosis in the neonate, and can
have serious consequences. This review aims to describe the modalities for
prophylaxis of toxoplasmosis in susceptible populations, and focuses on
the following: (1) prophylaxis of congenital toxoplasmosis; (2)
prophylaxis of toxoplasmosis in patients with HIV/AIDS; and (3)
prophylaxis of toxoplasmosis in transplant recipients.<br/>Copyright
&#xa9; 2017 Informa UK Limited, trading as Taylor & Francis Group.

<53>
Accession Number
614101023
Author
Micha G.; Tzimas P.; Zalonis J.; Kotsis K.; Papadopoulos G.; Arnaoutoglou
E.
Institution
(Micha, Tzimas, Papadopoulos, Arnaoutoglou) Department of Anesthesiology
and Postoperative Intensive Care Unit, Medical School, University of
Ioannina, 10 Kanari Street 17235, Greece
(Zalonis) Department of Neuropsychology, National and Kapodistrian
University of Athens, Medical School, Greece
(Kotsis) Department of Child and Adolescent Psychiatry, Thriasi Elefsina,
General Hospital, Greece
Title
Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction
in the elderly. A randomized controlled trial.
Source
Acta Anaesthesiologica Belgica. 67 (3) (pp 129-137), 2016. Date of
Publication: 2016.
Publisher
ARSMB-KVBMG (Avenue W. Churchill-laan 11/30, Brussels B-1180, Belgium.
E-mail: aob.edit@skynet.be)
Abstract
Background: Postoperative cognitive dysfunction is a topic of special
importance in the geriatric surgical population which primarily resolves
within the short term postoperative period, but it can become a long term
disorder with significant impact on patient's quality of life. This study
was designed to compare the short and long term postoperative cognitive
function after propofol and sevoflurane anaesthesia in the elderly and to
evaluate the role of the inflammatory process. Methods:: Patients, aged
60-74, scheduled for a non-cardiac operation of more than two-hour
duration were enrolled in this prospective randomized controlled trial and
allocated into two groups in order to receive propofol or sevoflurane
anaesthesia. Postoperative early cognitive function was assessed by means
of the Mini Mental State Examination test (MMSE) 48 hours postoperatively.
Late cognitive function was evaluated by means of 10 psychometric tests, 9
months postoperatively. The role of inflammation was estimated by the
incidence of SIRS and the levels of the inflammatory markers. Results::
Statistical significant decrease was observed in the postoperative MMSE
values in the sevoflurane group. Nine months postoperatively, there was a
decline in test performance in the same group and an increase in
postoperative values of inflammatory markers in both groups, which turned
non-significant in their between comparison (except CRP). Conclusion:
According to the neuropsychological test evaluation of cognition, there is
a negative influence of sevoflurane anaesthesia on the early and late
postoperative state. As far as the inflammatory markers are concerned,
they don't relate to the patient's cognitive status.<br/>Copyright &#xa9;
Acta Anaesthesiologica Belgica, 2016.

<54>
Accession Number
622745297
Author
Salaminia S.; Sayehmiri F.; Angha P.; Sayehmiri K.; Motedayen M.
Institution
(Salaminia) Yasuj University of Medical Science, Department of Cardiac
Surgery, Yasuj, Iran, Islamic Republic of
(Sayehmiri) Shahid Beheshti University of Medical Sciences, Proteomics
Research Center, Tehran, Iran, Islamic Republic of
(Angha) Yasuj University of Medical Sciences, Social Determinants of
Health Research Center, Yasuj, Iran, Islamic Republic of
(Sayehmiri) Ilam University of Medical Sciences, Department of Social
Medicine, School of Medicine, Ilam, Iran, Islamic Republic of
(Motedayen) Zanjan University of Medical Sciences, Department of
Cardiology, Faculty of Medicine, Zanjan, Iran, Islamic Republic of
Title
Evaluating the effect of magnesium supplementation and cardiac arrhythmias
after acute coronary syndrome: A systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 129. Date of Publication: 28 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial and ventricular cardiac arrhythmias are one of the most
common early complications after cardiac surgery and these serve as a
major cause of mortality and morbidity after cardiac revascularization. We
want to evaluate the effect of magnesium sulfate administration on the
incidence of cardiac arrhythmias after cardiac revascularization by doing
this systematic review and meta-analysis. Methods: The search performed in
several databases (SID, Magiran, IranDoc, IranMedex, MedLib, PubMed,
EmBase, Web of Science, Scopus, the Cochrane Library and Google Scholar)
for published Randomized controlled trials before December 2017 that have
reported the association between Magnesium consumption and the incidence
of cardiac arrhythmias. This relationship measured using odds ratios (ORs)
with a confidence interval of 95% (CIs). Funnel plots and Egger test used
to examine publication bias. STATA (version 11.1) used for all analyses.
Results: Twenty-two studies selected as eligible for this research and
included in the final analysis. The total rate of ventricular arrhythmia
was lower in the group receiving magnesium sulfate than placebo (11.88%
versus 24.24%). The same trend obtained for the total incidence of
supraventricular arrhythmia (10.36% in the magnesium versus 23.91% in the
placebo group). In general the present meta-analysis showed that magnesium
could decrease ventricular and supraventricular arrhythmias compared with
placebo (OR = 0.32, 95% CI 0.16-0.49; p < 0.001 and OR = 0.42, 95% CI
0.22-0.65; p < 0.001, respectively). Subgroup analysis showed that the
effect of magnesium on the incidence of cardiac arrhythmias was not
affected by clinical settings and dosage of magnesium. Meta-regression
analysis also showed that there was no significant association between the
reduction of ventricular arrhythmias and sample size. Conclusion: The
results of this meta-analysis study suggest that magnesium sulfate can be
used safely and effectively and is a cost-effective way in the prevention
of many of ventricular and supraventricular arrhythmias.<br/>Copyright
&#xa9; 2018 The Author(s).

<55>
[Use Link to view the full text]
Accession Number
615007272
Author
Soh S.; Shim J.-K.; Ha Y.; Kim Y.-S.; Lee H.; Kwak Y.-L.
Institution
(Soh, Shim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institut, Yonsei University College of
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Severance
Cardiovascular Hospital, United States
(Ha) Departments of and Neurosurgery, United States
(Kim) Internal Medicine, United States
(Lee) Anesthesiology and Pain Medicine, United States
(Ha) Spine and Spinal Cord Institute, Yonsei University College of
Medicine, Seoul, South Korea
Title
Ventilation with High or Low Tidal Volume with PEEP Does Not Influence
Lung Function after Spinal Surgery in Prone Position: A Randomized
Controlled Trial.
Source
Journal of Neurosurgical Anesthesiology. 30 (3) (pp 237-245), 2018. Date
of Publication: 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Spinal surgery in the prone position is accompanied by
increased intrathoracic pressure and decreased respiratory compliance.
This study investigated whether intraoperative lung protective mechanical
ventilation improved lung function evaluated with pulmonary function tests
in patients at risk of postoperative pulmonary complications (PPCs) after
major spinal surgery in the prone position. Methods: Seventy-eight
patients at potential risk of PPCs were randomly assigned to the
protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H 2 O
positive end-expiratory pressure with recruitment maneuvers) or the
conventional group (10 mL/kg predicted body weight, no positive
end-expiratory pressure). The primary efficacy variables were assessed by
pulmonary function tests, performed before surgery, and 3 and 5 days
afterward. Results: Postoperative forced vital capacity (2.17+/-0.1 L vs.
1.91+/-0.1 L, P=0.213) and forced expiratory volume in 1 second
(1.73+/-0.08 L vs. 1.59+/-0.08 L, P=0.603) at postoperative day (POD) 3 in
the protective and conventional groups, respectively, were similar. Trends
of a postoperative decrease in forced vital capacity (P=0.586) and forced
expiratory volume in 1 second (P=0.855) were similar between the groups.
Perioperative blood-gas analysis variables were comparable between the
groups. Patients in the protective and conventional groups showed similar
rates of clinically significant PPCs (8% vs. 10%, P>0.999). Conclusions:
In patients at potential risk of developing PPCs undergoing major spinal
surgery, we did not find evidence indicating any difference between the
lung protective and conventional ventilation in postoperative pulmonary
function and oxygenation.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc. All rights reserved.

<56>
Accession Number
2000859892
Author
Jun Yan Wee I.; Mohamed I.H.; Patel A.; Choong A.M.T.L.
Institution
(Jun Yan Wee, Mohamed, Patel, Choong) SingVaSC, Singapore Vascular
Surgical Collaborative, Singapore
(Jun Yan Wee) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Mohamed) Renal Transplantation and Vascular Access Surgery, Royal London
Hospital, London, United Kingdom
(Patel) Stem Cell Transplantation and Cellular Therapy Unit, The
Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool,
Liverpool, United Kingdom
(Patel) Institute of Translational Medicine and School of Medicine,
University of Liverpool, Liverpool, United Kingdom
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Title
A systematic review and meta-analysis of one-stage versus two-stage
brachiobasilic arteriovenous fistula creation.
Source
Journal of Vascular Surgery. 68 (1) (pp 285-297), 2018. Date of
Publication: July 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Long-term patency of arteriovenous fistulas (AVFs) is critical
for hemodialysis vascular access. We compared the efficacy of a one-stage
vs two-stage approach to brachiobasilic AVF creation by primarily
investigating primary and secondary patency rates. We hypothesize that the
two-stage is superior to the one-stage procedure in terms of efficacy and
safety. Methods: This review was performed as per the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis guidelines. Searches were
performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database. Risk
of bias and quality assessment scores were both performed based on
previously validated tool. Results: The systematic search revealed a total
of 242 publications for possible inclusion. On the basis of title and
abstract review, two randomized controlled trials and nine case-cohort
series fit our inclusion criteria. There were no statistically significant
differences in failure rates (pooled risk ratio [RR], 1.10; 95% confidence
interval [CI], 0.79-1.55; P =.25), 1-year primary patency rates (RR, 1.31;
95% CI, 0.83-2.06; P =.24), 1-year secondary patency rates (RR, 0.97; 95%
CI, 0.54-1.77) and 2-year secondary patency rates (RR, 1.19; 95% CI,
0.54-2.63; P =.67) between both groups. However, the two-stage procedure
had significantly improved 2-year primary patency rates (RR, 2.50; 95% CI,
1.66-3.74; P <.00001). There were no differences in steal syndrome,
hematoma, infection, pseudoaneuryms, or stenosis, although there was a
trend toward an increased incidence of postoperative thrombosis (RR, 1.81;
95% CI, 0.95-3.45; P =.07) in one-stage procedures. Conclusions: With
improved 2-year primary patency rates and the absence of significant
differences in complications, this study suggests potential benefit of a
two-stage over a one-stage procedure for brachiobasilic AVF creation.
However, rather than being a definitive answer, our results merely
highlight the continuing need for an adequately powered, well-designed,
randomized controlled trial to interrogate this question
further.<br/>Copyright &#xa9; 2018 Society for Vascular Surgery

<57>
Accession Number
2000920365
Author
Orange S.T.; Northgraves M.J.; Marshall P.; Madden L.A.; Vince R.V.
Institution
(Orange, Northgraves, Marshall, Vince) Sport, Health and Exercise Science,
School of Life Sciences, University of Hull, Hull, United Kingdom
(Northgraves) Department of Health Sciences, University of York, York,
United Kingdom
(Madden) Centre of Biomedical Research, School of Life Sciences,
University of Hull, Hull, United Kingdom
Title
Exercise prehabilitation in elective intra-cavity surgery: A role within
the ERAS pathway? A narrative review.
Source
International Journal of Surgery. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ltd
Abstract
The Enhanced Recovery after Surgery (ERAS) model integrates several
elements of perioperative care into a standardised clinical pathway for
surgical patients. ERAS programmes aim to reduce the rate of
complications, improve surgical recovery, and limit postoperative length
of hospital stay (LOHS). One area of growing interest that is not
currently included within ERAS protocols is the use of exercise
prehabilitation (PREHAB) interventions. PREHAB refers to the systematic
process of improving functional capacity of the patient to withstand the
upcoming physiological stress of surgery. A number of recent systematic
reviews have examined the role of PREHAB prior to elective intra-cavity
surgery. However, the results have been conflicting and a definitive
conclusion has not been obtained. Furthermore, a summary of the research
area focussing exclusively on the therapeutic potential of exercise prior
to intra-cavity surgery is yet to be undertaken. Clarification is required
to better inform perioperative care and advance the research field.
Therefore, this "review of reviews" provides a critical overview of
currently available evidence on the effect of exercise PREHAB in patients
undergoing i) coronary artery bypass graft surgery (CABG), ii) lung
resection surgery, and iii) gastrointestinal and colorectal surgery. We
discuss the findings of systematic reviews and meta-analyses and
supplement these with recently published clinical trials. This article
summarises the research findings and identifies pertinent gaps in the
research area that warrant further investigation. Finally, studies are
conceptually synthesised to discuss the feasibility of PREHAB in clinical
practice and its potential role within the ERAS pathway.<br/>Copyright
&#xa9; 2018 IJS Publishing Group Ltd

<58>
Accession Number
2000919966
Author
Patti G.; Pecen L.; Lucerna M.; Huber K.; Rohla M.; Renda G.;
Siller-Matula J.; Schnabel R.B.; Cemin R.; Kirchhof P.; De Caterina R.
Institution
(Patti) Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Italy
(Pecen) Medical Faculty Pilsen of Charles University, Czech Republic
(Lucerna) Daiichi Sankyo Europe, Munich, Germany
(Huber, Rohla) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria
(Huber, Rohla) Sigmund Freud University, Medical School, Vienna, Austria
(Renda, De Caterina) G. d'Annunzio University, Chieti, Italy
(Siller-Matula) Department of Cardiology, Medical University of Vienna,
Austria
(Siller-Matula) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poland
(Schnabel) University Heart Center Hamburg, Clinic for General and
Interventional Cardiology, Hamburg, Germany
(Schnabel) DZHK (German Center for Cardiovascular Research), partner site
Hamburg/Kiel/Luebeck, Germany
(Cemin) Department of Cardiology, San Maurizio Regional Hospital of
Bolzano, Italy
(Kirchhof) Institute of Cardiovascular Sciences, University of Birmingham
and SWBH and UHB NHS Trust, Birmingham, United Kingdom
(De Caterina) Fondazione G. Monasterio, Pisa, Italy
Title
Outcomes of anticoagulated patients with atrial fibrillation treated with
or without antiplatelet therapy - A pooled analysis from the PREFER in AF
and PREFER in AF PROLONGATON registries.
Source
International Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Evidence on whether antiPLT added to OACs is of advantage in
atrial fibrillation (AF) patients with concomitant stable coronary artery
disease (CAD) is limited. We evaluated clinical outcomes with oral
anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC
in patients with AF and stable CAD. Methods: Data on 1058 AF patients on
OACs and history (>1 year) of myocardial infarction or coronary stenting
were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION
registries. We primarily compared the 1-year incidence of a net composite
endpoint (primary endpoint), including acute coronary syndrome and major
bleeding, with or without antiPLT. Results: The incidence of the primary
net composite endpoint was significantly higher in patients receiving OACs
+ antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100
patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the
components of the primary endpoint, the greatest relative difference was
found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and
especially life-threatening or non-gastrointestinal bleeding. The net
clinical outcome with OACs + antiPLT was poorer irrespective of the type
of CAD (previous infarction or coronary stenting), the type of stent (bare
metal or drug-eluting) or the type of OAC (vitamin K antagonist or
non-vitamin K antagonist OAC). Conclusions: Among patients with AF and
stable CAD >1-year after the index event, the addition of antiPLT to OAC
does not apparently provide added protection against coronary events, but
increases major bleeding. OAC monotherapy should thus be considered the
antithrombotic therapy of choice for such patients.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<59>
Accession Number
2000917472
Author
Banerjee K.; Kandregula K.; Sankaramangalam K.; Anumandla A.; Kumar A.;
Parikh P.; Kerrigan J.; Khubber S.; Krishnaswamy A.; Mick S.; White J.;
Svensson L.; Kapadia S.
Institution
(Banerjee, Sankaramangalam, Kerrigan, Krishnaswamy, Mick, White, Svensson,
Kapadia) Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Kandregula) Department of Internal Medicine, Drexel University,
Philadelphia, Pennsylvania, United States
(Anumandla, Parikh, Khubber) Department of Internal Medicine, Cleveland
Clinic, Cleveland, Ohio, United States
(Kumar) Department of Cardiology, Emory University, Atlanta, Georgia,
United States
Title
Meta-analysis of the Impact of Avoiding Balloon Predilation in
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
Balloon predilation (BPD) has been an integral part of transcatheter
aortic valve implantation (TAVI) since inception. We sought to investigate
the effect of avoiding BPD on outcomes of TAVI across different valve
types. Articles were included if outcomes of TAVI without BPD were
reported. Pooled meta-analysis used a random effects model and reported
odds ratios (ORs). Twenty-one studies with 10,752 patients were pooled for
analysis. Age and gender were well matched between NoBPD and BPD groups.
There was no difference in mortality, stroke, bleeding, and acute kidney
injury. NoBPD showed lower pacemaker rates (OR 0.84, 95% confidence
interval [CI] 0.72 to 0.97), vascular complications (OR 0.77, 95% CI 0.62
to 0.95), and early safety at 30days (OR 0.81, 95% CI 0.66 to 0.99). For
balloon-expandable valves, lower rates of aortic regurgitation (OR 0.73,
95% CI 0.53 to 0.99) and early safety (OR 0.68, 95% CI 0.55 to 0.85) were
seen. Self-expanding valves showed lower pacemaker (OR 0.80, 95% CI 0.66
to 0.97) and vascular complications (OR 0.70, 95% CI 0.50 to 0.99), with a
trend toward higher postdilation (OR 1.51, 95% CI 0.85 to 2.67). TAVI
without BPD is safe and effective. NoBPD is associated with fewer vascular
complications, less aortic regurgitation, and fewer pacemaker requirements
and composite early safety end points.<br/>Copyright &#xa9; 2018

<60>
Accession Number
2000896646
Author
Martin Gutierrez E.; Martinez Comendador J.M.; Gualis Cardona J.; Maiorano
P.; Castillo Pardo L.; Cuellas Ramon C.; Fernandez Vazquez F.; Castano
Ruiz M.
Institution
(Martin Gutierrez, Martinez Comendador, Gualis Cardona, Maiorano, Castillo
Pardo, Castano Ruiz) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, CAULE, Leon, Spain
(Cuellas Ramon, Fernandez Vazquez) Servicio de Cardiologia, Hospital
Universitario de Leon, CAULE, Leon, Spain
Title
Transcatheter aortic valve implantation versus aortic valve replacement in
intermediate surgical risk patients. Review of literature and
meta-analysis.
Source
Cirugia Cardiovascular. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Doyma
Abstract
Introduccion y objetivos: El implante valvular aortico transcateter (TAVI)
ha mostrado resultados excelentes, constituyendo una alternativa
terapeutica a la sustitucion valvular aortica para pacientes de riesgo
quirurgico alto o excesivo. Sin embargo, no existe un claro consenso sobre
los beneficios del TAVI en pacientes con riesgo quirurgico intermedio.
Realizamos una revision sistematica de la literatura y el consiguiente
metaanalisis considerando resultados periprocedimiento y en el seguimiento
maximo disponible. Metodos: Se realizo una busqueda bibliografica
combinando 3 grupos de palabras clave: <<TAVR/TAVI/transcatheter aortic
valve implantation/transcatheter aortic valve replacement>> AND
<<intermediate risk>> AND <<aortic valve replacement/AVR/surgery>>. Fueron
considerados los trabajos publicados en los ultimos 6 anos. Resultados:
Fueron seleccionados 21 trabajos: 4 estudios prospectivos aleatorizados y
17 estudios observacionales, 13 de ellos ajustados por analisis de
propensiones. No existieron diferencias significativas en la mortalidad
(RR = 1; IC95%: 0,99-1,02) o incidencia de accidente cerebrovascular (RR =
0,96; IC95%: 0,77-1,20) en el seguimiento maximo (1-3 anos). La lesion
vascular (accidente cerebrovascular) grave fue significativamente mayor en
el grupo TAVI (RR = 4,39; IC95%: 2,17-8,91), asi como la necesidad de
implante de marcapasos permanente (RR = 2,96; IC95%: 2-4,36) y la
incidencia de fuga paravalvular significativa (>= 2+; RR = 6,83; IC95%:
4,64-10,05). Tanto la incidencia de fibrilacion auricular (RR = 0,39;
IC95%: 0,25-0,61) como de fallo renal (RR = 0,45; IC95%: 0,28-0,72) fueron
superiores en el grupo quirurgico. Conclusiones: Tras comparar TAVI frente
a la sustitucion valvular aortica en pacientes con riesgo quirurgico
intermedio mediante metaanalisis, no se han identificado diferencias
significativas en terminos de mortalidad o accidente cerebrovascular a lo
largo del seguimiento. Sin embargo, el diferente perfil de complicaciones
de cada una de las tecnicas deberia guiar la seleccion de pacientes
realizada por el Heart-Team para reducir la morbilidad posprocedimiento.
Introduction and objectives: Transcatheter aortic valve implantation
(TAVI) has shown excellent results, and is a therapeutic alternative to
aortic valve replacement for high or excessive surgical risk patients.
However, there is no clear consensus about the benefits of TAVI for
patients with intermediate surgical risk. A systematic review of
literature and subsequent meta-analysis was carried out considering
outcomes after the procedure and during the maximum available follow-up.
Methods: A systematic review of literature was performed, combining three
clusters of Keywords: "TAVR/TAVI/transcatheter aortic valve
implantation/transcatheter aortic valve replacement "AND "intermediate
risk" AND "aortic valve replacement/AVR/surgery". Studies published in the
last 6 years were considered for analysis. Results: A total of 21 studies
were included in the analysis, of which 4 were randomised controlled
trials and 17 were observation studies, with 13 of them being
propensity-score adjusted. No differences were found in terms of mortality
(RR = 1.00, 95% CI: 0.99-1.02) or incidence of cerebrovascular accident
(RR = 0.96, 95% CI: 0.77-1.20) during the maximum follow-up (1-3 years). A
major vascular lesion (cerebrovascular accident) (RR = 4.39, 95% CI:
2.17-8.91), need of permanent pacemaker implantation (RR = 2.96, 95% CI:
2.00-4.36), and residual significant paravalvular leak (>= 2+; RR = 6.83,
95% CI: 4.64-10.05) were significantly higher in TAVI group. The incidence
of atrial fibrillation (RR = 0.39, 95% CI: 0.25-0.61) and kidney failure
(RR = 0,45, 95% CI: 0.28-0.72) were higher in the surgical group.
Conclusions: After comparing TAVI and aortic valve replacement in patients
with intermediate surgical risk using meta-analysis, no significatant
differences were identified in terms of mortality or cerebrovascular
accident during follow-up. However, the different profile of complications
of each technique should guide patient selection by the Heart-Team in
order to reduce post-procedural morbidity.

<61>
Accession Number
2000776173
Author
Busu T.; Alqahtani F.; Badhwar V.; Cook C.C.; Rihal C.S.; Alkhouli M.
Institution
(Busu, Alqahtani, Alkhouli) Division of Cardiology, West Virginia School
of Medicine, Morgantown, West Virginia, United States
(Badhwar, Cook) Department of Cardiothoracic Surgery, West Virginia School
of Medicine, Morgantown, West Virginia, United States
(Rihal) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
Title
Meta-analysis Comparing Transcatheter and Surgical Treatments of
Paravalvular Leaks.
Source
American Journal of Cardiology. 122 (2) (pp 302-309), 2018. Date of
Publication: 15 July 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Percutaneous paravalvular leak (PVL) closure has emerged as a feasible
alternative to redo valve surgery. However, comparative data on
percutaneous and surgical treatment of PVL are scarce. We performed a
systematic review and a meta-analysis of studies on percutaneous and
surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible
studies were analyzed. Primary end points were technical success, 30-day
mortality, stroke, and length of stay. Secondary end points were 1-year
mortality, readmission for heart failure, reoperation, and symptomatic
improvement at follow-up. A total of 2,373 patients were included, of whom
1,511 (63.7%) underwent percutaneous closure. Technical success was higher
with surgery (96.7% vs 72.1%, odds ratio [OR] 9.7, p <0.001) but at the
cost of higher 30-day mortality (8.6% vs 6.8%, OR 1.90, p <0.001), a trend
toward higher stroke (3.3% vs 1.4%, OR 1.94, p = 0.069), and longer
hospitalizations. However, surgery was associated with similar 1-year
mortality (17.3% vs 17.2%, OR 1.07, p = 0.67), reoperation (9.1% vs 9.9%,
OR 0.72, p = 0.1), readmission for heart failure (13.3% vs 26.4%, OR 0.51,
p = 0.29), and improvement in New York Heart Association classification
(67.4% vs 56%, OR 1.37, p = 0.74), compared with percutaneous closure. A
sensitivity analysis including comparative studies only yielded similar
results. Surgical treatment of PVL achieves higher technical success rates
but is associated with higher early morbidity and mortality compared with
percutaneous closure. Nevertheless, mortality rates and clinical efficacy
parameters were similar at midterm with both procedures. Further studies
are warranted to identify the ideal management approach to patients with
symptomatic PVL.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<62>
Accession Number
620683046
Author
Gygax E.; Kaeser H.-U.; Stalder M.; Gahl B.; Rieben R.; Carrel T.; Erdoes
G.
Institution
(Gygax, Kaeser, Stalder, Carrel) Department of Cardiovascular Surgery,
Inselspital, University Hospital Bern, University of Bern, Bern,
Switzerland
(Gahl) Clinical Trials Unit, Inselspital, University Hospital Bern,
University of Bern, Bern, Switzerland
(Rieben) Department for Biomedical Research, Inselspital, University
Hospital Bern, University of Bern, Bern, Switzerland
(Erdoes) Department of Anesthesiology and Pain Therapy, Inselspital,
University Hospital Bern, University of Bern, Bern, Switzerland
Title
Type II Minimal-Invasive Extracorporeal Circuit for Aortic Valve
Replacement: A Randomized Controlled Trial.
Source
Artificial Organs. 42 (6) (pp 620-629), 2018. Date of Publication: June
2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Extracorporeal circulation triggers systemic inflammatory response and
coagulation disorders which may lead to unfavorable clinical outcome. A
type II minimally-invasive extracorporeal circuit (MiECC) is a closed
system with markedly reduced artificial surface as compared to
conventional extracorporeal circuits (CECC). The aim of this study was to
investigate and compare inflammatory responses, complement activation and
selected clinical end-points in isolated surgical aortic valve replacement
(SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients
were prospectively randomized to MiECC or CECC perfusion regimen.
Complement activation (sC5b-9), inflammation (IL-6, TNF-alpha,
sCD40-ligand) and activation of the coagulation system (D-dimer,
TAT-complex) were determined before operation, at 2 hours and 24 hours
after surgery. Clinical end-points included perfusion time, transfusion of
allogeneic blood products, postoperative bleeding, sepsis, new onset of
atrial fibrillation, stroke and in-hospital mortality. Patient
characteristics and baseline plasma markers were similar in both groups.
Levels for sC5b-9, TNF-alpha, sCD40 ligand, TAT-complex and D-dimers were
not significantly different between MiECC and CECC at 2 hours and 24 hours
after surgery. The IL-6 plasma concentration was lower in the CECC group
at 24 hours (P = 0.026, vs. MiECC). Comparisons of the baseline level to
values at 2 hours and 24 hours, adjusted for the type of oxygenator and
hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours (P =
0.013), but no difference at 24 hours (P=0.990). Compared with CECC, MiECC
patients had a shorter perfusion time (P = 0.037) and less transfusion
requirements (P = 0.04). In this selected cohort of SAVR patients, the
type II MiECC was not inferior to CECC in terms of inflammatory response
and complement activation. Thus, MiECC might be an alternative perfusion
strategy to conventional.<br/>Copyright &#xa9; 2018 International Center
for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

<63>
Accession Number
622684681
Author
Silvetti S.; Aloisio T.; Cazzaniga A.; Ranucci M.
Institution
(Silvetti, Aloisio, Cazzaniga, Ranucci) IRCCS Policlinico San Donato,
Department of Cardiovascular Anesthesia and Intensive Care, Via Morandi
30, San Donato Milanese, Milan 20097, Italy
Title
Jugular vs femoral vein for central venous catheterization in pediatric
cardiac surgery (PRECiSE): Study protocol for a randomized controlled
trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 329. Date of
Publication: 25 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placement of central venous catheters (CVCs) is essential and
routine practice in the management of children with congenital heart
disease. The purpose of the present protocol is to evaluate the risk for
infectious complications in terms of catheter colonization, catheter
line-associated bloodstream infections, and catheter-related bloodstream
infections (CRBSIs), and the mechanical complications from different
central venous access sites in infants and newborns undergoing cardiac
surgery. Methods: One hundred sixty patients under 1 year of age and
scheduled for cardiac surgery will be included in this randomized
controlled trial (RCT); patients will be randomly allocated to the jugular
or femoral vein arms. CVC insertion will be performed by one of three
selected expert operators. Discussion: The choice of the insertion site
for central venous catheterization can influence the incidence and type of
infectious complications in adults but this is not unanimously evidenced
in the pediatric setting. The experimental hypothesis of this RCT is that
the jugular insertion site is less likely to induce catheter colonization
and CRBSI than the femoral site.<br/>Copyright &#xa9; 2018 The Author(s).

<64>
Accession Number
622653312
Author
Shankar P.; Mueller A.; Packiasabapathy S.; Gasangwa D.; Patxot M.; O'Gara
B.; Shaefi S.; Marcantonio E.R.; Subramaniam B.
Institution
(Shankar, Mueller, Packiasabapathy, Gasangwa, Patxot, O'Gara, Shaefi,
Subramaniam) Beth Israel Deaconess Medical Center, Center for Anesthesia
Research Excellence (CARE), Department of Anesthesia, Critical Care and
Pain Medicine, One Deaconess Road, CC-650, Boston, MA 02215, United States
(Mueller, O'Gara, Shaefi, Marcantonio, Subramaniam) Harvard Medical
School, 25 Shattuck Street, Boston, MA 02215, United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of General Medicine and Primary Care, 330 Brookline
Avenue, Boston, MA 02215, United States
Title
Dexmedetomidine and intravenous acetaminophen for the prevention of
postoperative delirium following cardiac surgery (DEXACET trial): Protocol
for a prospective randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 326. Date of
Publication: 22 Jun 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative delirium is common in elderly cardiac surgery
patients. It is multifactorial and is influenced by the patient's baseline
status and the nature of the medical and surgical interventions that the
patient receives. Some of these factors are potentially modifiable,
including postoperative sedation and analgesia protocols. This study has
been designed to evaluate the effectiveness of postoperative intravenous
acetaminophen in conjunction with either dexmedetomidine or propofol in
decreasing the incidence of delirium. Methods: This is a prospective,
randomized, placebo-controlled, double-blinded, factorial trial that
includes patients who are at least 60 years old and who are undergoing
cardiac surgeries involving cardiopulmonary bypass, including coronary
artery bypass graft (CABG) and combined CABG/valve surgeries. Patients are
randomly assigned to receive one of four postoperative analgesic-sedation
regimens: (1) acetaminophen and dexmedetomidine, (2) acetaminophen and
propofol, (3) dexmedetomidine and placebo, or (4) propofol and placebo.
The primary outcome, incidence of delirium, will be assessed with the
Confusion Assessment Method (CAM or CAM-ICU). The secondary outcome,
postoperative cognitive decline, will be assessed with the Montreal
Cognitive Assessment. Additional secondary outcomes, including duration of
delirium, postoperative analgesic requirement, length of stay, and
incidence of adverse events, will also be reported. Data will be analyzed
in 120 randomly assigned patients who received at least one dose of the
study medication(s) on a modified intention-to-treat basis. Discussion:
This study has been approved by the institutional review board at Beth
Israel Deaconess Medical Center, and the trial is currently recruiting.
This study will systematically examine the implications of modification in
postoperative sedative/analgesic protocols after cardiac surgery,
specifically for short- and long-term cognitive outcomes. Any positive
outcomes from this study could direct simple yet effective practice
changes aimed to reduce morbidity. Trial registration: ClinicalTrials.gov
Identifier: NCT02546765 , registered January 13, 2015.<br/>Copyright
&#xa9; 2018 The Author(s).

<65>
Accession Number
621329537
Author
Paling F.P.; Olsen K.; Ohneberg K.; Wolkewitz M.; Fowler V.G.; DiNubile
M.J.; Jafri H.S.; Sifakis F.; Bonten M.J.M.; Harbarth S.J.; Kluytmans
J.A.J.W.
Institution
(Paling, Olsen, Bonten, Kluytmans) Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
(Ohneberg, Wolkewitz) Institute for Medical Biometry and Statistics,
University Medical Center Freiburg, Freiburg, Germany
(Fowler) Division of Infectious Diseases, Duke University Medical Center,
Durham, NC, United States
(DiNubile) Merck & Company Incorporation, Kenilworth, NJ, United States
(Jafri) MedImmune, Gaithersburg, MD, United States
(Sifakis) AstraZeneca Pharmaceuticals LP, Gaithersburg, MD, United States
(Bonten) Department of Medical Microbiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Harbarth) Geneva University Hospitals and Medical School, Geneva,
Switzerland
(Kluytmans) Amphia Hospital, Breda, Netherlands
Title
Risk prediction for Staphylococcus aureus surgical site infection
following cardiothoracic surgery; A secondary analysis of the V710-P003
trial.
Source
PLoS ONE. 13 (3) (no pagination), 2018. Article Number: e0193445. Date of
Publication: March 2018.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Identifying patients undergoing cardiothoracic surgery at high
risk of Staphylococcus aureus surgical site infection (SSI) is a
prerequisite for implementing effective preventive interventions. The
objective of this study was to develop a risk prediction model for S.
aureus SSI or bacteremia after cardiothoracic surgery based on
pre-operative variables. Materials/Methods Data from the Merck Phase
IIb/III S. aureus vaccine (V710-P003) clinical trial were analyzed. In
this randomized placebo-controlled trial, the effect of preoperative
vaccination against S. aureus was investigated in patients undergoing
cardiothoracic surgery. The primary outcome was deep/superficial S. aureus
SSI or S. aureus bacteremia through day 90 after surgery. Performance,
calibration, and discrimination of the final model were assessed. Results
Overall 164 out of 7,647 included patients (2.1%) developed S. aureus
infection (149 SSI, 15 bacteremia, 28 both). Independent risk factors for
developing the primary outcome were pre-operative colonization with S.
aureus (OR 3.08, 95% confidence interval [CI] 2.23-4.22), diabetes
mellitus (OR 1.87, 95% CI 1.34-2.60), BMI (OR 1.02 per kg/m²,
95% CI 0.99-1.05), and CABG (OR 2.67, 95% CI 1.91-3.78). Although
vaccination had a significant (albeit modest) protective effect, it was
omitted from the model because its addition did not significantly change
the coefficients of the final model and V710-vaccine development has been
discontinued due to insufficient efficacy. The final prediction model had
moderate discriminative accuracy (AUC-value, 0.72). Conclusion
Pre-operative S. aureus colonization status, diabetes mellitus, BMI, and
type of surgical procedure moderately predicted the risk of S. aureus SSI
and/or bacteremia among patients undergoing cardiothoracic
surgery.<br/>Copyright &#xa9; 2018 Paling et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<66>
[Use Link to view the full text]
Accession Number
620308238
Author
Krishnamoorthy B.; Critchley W.R.; Nair J.; Malagon I.; Carey J.; Barnard
J.B.; Waterworth P.D.; Venkateswaran R.V.; Fildes J.E.; Caress A.L.; Yonan
N.
Institution
(Krishnamoorthy, Malagon, Carey, Barnard, Waterworth, Venkateswaran,
Yonan) Department of Cardiothoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester M23 9LT, United Kingdom
(Krishnamoorthy) Faculty of Health and Social Care, Edge Hill University,
Ormskirk, Lancashire, United Kingdom
(Critchley, Nair, Fildes) Manchester Collaborative Centre for Inflammation
Research, Faculty of Medical and Human Sciences, University of Manchester,
Manchester, United Kingdom
(Caress) School of Nursing and Midwifery, University of Manchester,
Manchester, United Kingdom
Title
Randomized Study Comparing the Effect of Carbon Dioxide Insufflation on
Veins Using 2 Types of Endoscopic and Open Vein Harvesting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (5) (pp 320-328), 2017. Date of Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The aim of the study was to assess whether the use of carbon
dioxide insufflation has any impact on integrity of long saphenous vein
comparing 2 types of endoscopic vein harvesting and traditional open vein
harvesting. Methods: A total of 301 patients were prospectively randomized
into 3 groups. Group 1 control arm of open vein harvesting (n = 101),
group 2 closed tunnel (carbon dioxide) endoscopic vein harvesting (n =
100) and Group 3 open tunnel (carbon dioxide) endoscopic vein harvesting
(open tunnel endoscopic vein harvesting) (n = 100). Each group was
assessed to determine the systemic level of partial arterial carbon
dioxide, end-tidal carbon dioxide, and pH. Three blood samples were
obtained at baseline, 10 minutes after start of endoscopic vein
harvesting, and 10 minutes after the vein was retrieved. Vein samples were
taken immediately after vein harvesting without further surgical handling
to measure the histological level of endothelial damage. A modified
validated endothelial scoring system was used to compare the extent of
endothelial stretching and detachment. Results: The level of end-tidal
carbon dioxide was maintained in the open tunnel endoscopic vein
harvesting and open vein harvesting groups but increased significantly in
the closed tunnel endoscopic vein harvesting group (P = 0.451, P = 0.385,
and P < 0.001). Interestingly, partial arterial carbon dioxide also did
not differ over time in the open tunnel endoscopic vein harvesting group
(P = 0.241), whereas partial arterial carbon dioxide reduced significantly
over time in the open vein harvesting group (P = 0.001). A profound
increase in partial arterial carbon dioxide was observed in the closed
tunnel endoscopic vein harvesting group (P < 0.001). Consistent with these
patterns, only the closed tunnel endoscopic vein harvesting group
demonstrated a sudden drop in pH over time (P < 0.001), whereas pH
remained stable for both open tunnel endoscopic vein harvesting and open
vein harvesting groups (P = 0.105 and P = 0.869, respectively).
Endothelial integrity was better preserved in the open vein harvesting
group compared with open tunnel endoscopic vein harvesting or closed
tunnel endoscopic vein harvesting groups (P = 0.012) and was not affected
by changes in carbon dioxide or low pH. Significantly greater stretching
of the endothelium was observed in the open tunnel endoscopic open tunnel
endoscopic vein harvesting group compared with the other groups (P =
0.003). Conclusions: This study demonstrated that the different vein
harvesting techniques impact on endothelial integrity; however, this does
not seem to be related to the increase in systemic absorption of carbon
dioxide or to the pressurized endoscopic tunnel. The open tunnel
endoscopic harvesting technique vein had more endothelial stretching
compared with the closed tunnel endoscopic technique; this may be due to
manual dissection of the vein. Further research is required to evaluate
the long-term clinical outcome of these vein grafts.<br/>&#xa9; Copyright
2017 by the International Society for Minimally Invasive Cardiothoracic
Surgery.

<67>
[Use Link to view the full text]
Accession Number
620308203
Author
Ferdinand F.D.; MacDonald J.K.; Balkhy H.H.; Bisleri G.; Hwang H.Y.;
Northrup P.; Trimlett R.H.J.; Wei L.; Kiaii B.B.
Institution
(Ferdinand, Northrup) Division of Cardiothoracic Surgery, Albany Medical
College, 563 New Scotland Ave, MC 8656, Albany, NY 12208, United States
(MacDonald) Department of Medicine, University of Western Ontario, London,
ON, Canada
(Balkhy) Section of Cardiac and Thoracic Surgery, University of Chicago
Medicine and Biological Sciences, Chicago, IL, United States
(Bisleri) Division of Cardiac Surgery, Kingston General Hospital,
Kingston, ON, Canada
(Hwang) Division of Cardiac Surgery, Seoul National University Hospital,
Seoul, South Korea
(Trimlett) Department of Surgery, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Wei) Division of Cardiovascular Surgery, Zhongshan Hospital of Fudan
University, Shanghai, China
(Kiaii) Division of Cardiac Surgery, University Campus, Western
University, London, ON, Canada
Title
Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An
ISMICS Systematic Review and Consensus Conference Statements.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (5) (pp 301-319), 2017. Date of Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The purpose of this consensus conference was to develop and
update evidence-informed consensus statements and recommendations on
harvesting saphenous vein and radial artery via an open as compared with
endoscopic technique by systematically reviewing and performing a
meta-analysis of randomized and nonrandomized clinical trials. Methods:
All randomized controlled trials and nonrandomized controlled trials
included in the first the International Society for Minimally Invasive
Cardiothoracic Surgery Consensus Conference and Statements,^1,2
in 2005 up to November 30, 2015, were included in a systematic review and
meta-analysis. Based on the resultant, 76 studies (23 randomized
controlled trials and 53 nonrandomized controlled trials) on 281,459
patients analyzed, consensus statements, and recommendations were
generated comparing the risks and benefits of endoscopic versus open
conduit harvesting for patients undergoing coronary artery bypass
grafting. Results: Compared with open vein harvest, it is reasonable to
perform endoscopic vein harvest of saphenous vein to reduce wound-related
complications, postoperative length of stay, and outpatient wound
management resources and to increase patient satisfaction (class I, level
A). Based on the quality of the conduit and major adverse cardiac events
as well as 6-month angiographic patency, endoscopic vein harvest was
noninferior to open harvest. It is reasonable to perform endoscopic radial
artery harvest to reduce wound-related complication and to increase
patient satisfaction (class I, level B-R and B-NR, respectively) with
reduction in major adverse cardiac events and noninferior patency rate at
1 and 3 to 5 years (class III, level B-R). Conclusions: Based on the
consensus statements, the consensus panel recommends (class I, level B)
that endoscopic saphenous vein and radial artery harvesting should be the
standard of care for patients who require these conduits for coronary
revascularization.<br/>&#xa9; Copyright 2017 by the International Society
for Minimally Invasive Cardiothoracic Surgery.

<68>
Accession Number
622684275
Author
Stephan F.; Berard L.; Rezaiguia-Delclaux S.; Amaru P.
Institution
(Stephan, Rezaiguia-Delclaux, Amaru) Service de Reanimation adulte,
Hopital Marie Lannelongue, Le Plessis Robinson, France
(Berard) APHP, GH HUEP, Hopital St An-toine, Plateforme de recherche
Clinique de l'Est Parisien (URC-Est-CRC-Est), Paris, France
Title
High-flow nasal cannula therapy versus intermittent noninvasive
ventilation in obese subjects after cardiothoracic surgery.
Source
Respiratory Care. 62 (9) (pp 1193-1202), 2017. Date of Publication: 2017.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Obese patients are considered at risk of respiratory failure
after cardiothoracic surgery. High-flow nasal cannula has demonstrated its
non-inferiority after cardiothoracic surgery compared to noninvasive
ventilation (NIV), which is the recommended treatment in obese patients.
We hypothesized that NIV was superior to high-flow nasal cannula for
preventing or resolving acute respiratory failure after cardiothoracic
surgery in this population. METHODS: We performed a post hoc analysis of a
randomized, controlled trial. Obese subjects were randomly assigned to
receive NIV for at least 4 h/d (inspiratory pressure, 8 cm H<inf>2</inf>O;
expiratory pressure, 4 cm H<inf>2</inf>O; F<inf>IO2</inf>, 0.5) or
high-flow nasal cannula delivered continuously (flow, 50. L/min,
F<inf>IO2</inf> 0.5). RESULTS: Treatment failure (defined as
re-intubation, switch to the other treatment, or premature
discontinuation) occurred in 21 of 136 (15.4%, 95% CI 9.8-22.6%) subjects
with NIV compared to 18 of 135 (13.3%, 95% CI 8.1-20.3%) subjects with
high-flow nasal cannula (P =.62). No significant differences were found
for dyspnea and comfort scores. Skin breakdown was significantly more
common with NIV after 24 h (9.2%, 95% CI 5.0-16.0 vs 1.6%, 95% CI 1.0-6.0;
P =.01). No significant differences were found for ICU mortality (5.9% for
subjects with NIV vs 2.2% for subjects with high-flow nasal cannula, P
=.22) or for any of the other secondary outcomes. CONCLUSIONS: Among obese
cardiothoracic surgery subjects with or without respiratory failure, the
use of continuous high-flow nasal cannula compared to intermittent NIV
(8/4 cm H<inf>2</inf>O) did not result in a worse rate of treatment
failure. Because high-flow nasal cannula presents some advantages, it may
be used instead of NIV in obese patients after cardiothoracic
surgery.<br/>Copyright &#xa9; 2017 Daedalus Enterprises.

<69>
Accession Number
619208648
Author
Wang J.; Li K.; Li H.; Zhu W.; Sun H.; Lu C.
Institution
(Wang, Li, Li, Zhu, Sun, Lu) Qindao University Medical College Affiliated
Yantai Yuhuangding Hospital, Yantai, Shandong, China
Title
Comparison of anticoagulation regimens for pregnant women with prosthetic
heart valves: A meta-analysis of prospective studies.
Source
Cardiovascular Therapeutics. 35 (6) (no pagination), 2017. Article Number:
e12292. Date of Publication: December 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Introduction: Pregnancy is associated with a hypercoagulable state, which
makes pregnant women with prosthetic heart valves at high risk of
thromboembolism. The proper anticoagulation regimen should take both the
maternal protection and the fetal outcomes into consideration. However, no
consensus on the present anticoagulation regimen for those women has been
reached yet, especially in the first trimester of pregnancy. Aims: The
present meta-analysis is conducted to compare anticoagulation efficiency
and feto-maternal complications of heparin and warfarin in the first
trimester. Results: Databases of MEDLINE, EMBASE, and the Cochrane Library
were systematically searched (all from their inception to October 2016)
for cohort studies reporting the outcome of anticoagulation in pregnant
women with mechanical heart valves. Seven relevant prospective studies
were identified for inclusion in the present meta-analysis. The forest
plots indicated that warfarin was more effective in prevention valve
thrombosis in the first trimester than heparin (OR: 14.58; 95% confidence
interval [CI]: 3.94-53.94; P <.0001; I² = 0%). The spontaneous
abortion between the two regimens was not statistically different (OR:
1.42; 95% CI: 0.80-2.49; P =.23; I² = 20%), which indicated
that heparin could not provide better protection to the fetus in the early
stage of pregnancy than warfarin. The incidence of warfarin embryopathy
was low, and it only occurred in a twin among all the included cases.
Conclusions: The present meta-analysis indicated that warfarin can provide
better protection for the mother and the teratogenic effects may be
overestimated. Heparin does not ensure better fetal outcomes as it is
associated with severe adverse maternal outcomes, including
mortality.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<70>
Accession Number
615411557
Author
Auffret V.; Regueiro A.; Campelo-Parada F.; del Trigo M.; Chiche O.;
Chamandi C.; Puri R.; Rodes-Cabau J.
Institution
(Auffret, Regueiro, Campelo-Parada, del Trigo, Chiche, Chamandi, Puri,
Rodes-Cabau) Quebec Heart and Lung Institute, Laval UniversityQuebec City,
Quebec Canada
(Auffret) Signal and Image Processing LaboratoryRennes 1 UniversityRennes
France
Title
Feasibility, safety, and efficacy of transcatheter aortic valve
replacement without balloon predilation: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the feasibility, safety, and efficacy of direct
transcatheter aortic valve replacement (TAVR), that is, TAVR without
balloon predilation (BPD), by performing a systematic review and
meta-analysis of available evidence. Background: Avoiding BPD during TAVR
was shown to be feasible in previous studies but the risks and benefits of
this technique are unknown owing to the limited number of patients
included in these studies. Methods: We performed a systematic search for
studies comparing direct TAVR vs TAVR performed with BPD. Crude risk
ratios (RRs) or mean differences and 95% confidence intervals (CI) for
each endpoint were calculated using random effects models. Results: Twenty
studies including 3586 patients (1606 undergoing direct TAVR) were
selected for the analysis. Mean device success with direct TAVR was 88%
with <5% of bail-out techniques. There were no differences between direct
and BPD-TAVR in short-term (in-hospital or 30-day) mortality (RR: 1.06;
95% CI: 0.78-1.43) or cerebrovascular events (RR: 0.92; 95% CI:
0.58-1.46). Direct TAVR associated with reduced moderate or severe
paravalvular leak post-TAVR (RR: 0.59; 95% CI: 0.36-0.98) but not with a
reduced risk of permanent pacemaker implantation (RR: 0.85, 95% CI:
0.71-1.02). A slight increase in postdilation was observed in direct
transfemoral-TAVR recipients (RR: 1.2; 95% CI: 1.00-1.44). Conclusion:
Direct TAVR is feasible and safe. However, given the unadjusted nature of
our results, uncertainties remain regarding the independent effect of
direct TAVR on outcomes post-TAVR. Randomized studies are warranted to
determine the potential benefits of direct TAVR.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<71>
Accession Number
622822579
Author
Mills Brandy W.; Gest T.R.
Institution
(Mills Brandy, Gest) Texas Tech University Health Sciences Center, El Paso
Paul L. Foster School of Medicine, El Paso, TX 79905, United States
Title
Persistent double dorsal aorta: A systematic review of the literature.
Source
Clinical Anatomy. Conference: 34th Annual Scientific Meeting of the
American Association of Clinical Anatomists, AACA 2017. United States. 30
(8) (pp 1135), 2017. Date of Publication: October 2017.
Publisher
John Wiley and Sons Inc.
Abstract
INTRODUCTION. Our discovery of a case of persistent double dorsal aorta
prompted us to systematically review the literature of all previously
reported cases of this anomaly. For our case, we present a completely
separated double dorsal aorta, with the right accessory aorta arising from
the abdominal aorta and ascending through the aortic hiatus to supply
posterior intercostal arteries to the ninth-third spaces bilaterally.
RESOURCES. We utilized data from the 10 previously reported cases of
persistent double dorsal aorta as well as our recently discovered case to
create a systematic review of all known cases of this anomaly. In addition
to our case report and systematic review, we investigated the literature
focusing on formation of the dorsal aorta in the embryo in order to
postulate potential mechanisms for formation of this anomaly. Finally, to
provide a visual representation of normal anatomy for comparison to the
case of double dorsal aorta we discovered, the descending aorta of a body
donor featuring an anatomically normal arrangement was thoroughly
dissected and photographed. DESCRIPTION. Two variants of persistent double
dorsal aorta have been reported in the literature. The first type is
characterized by a double-lumen descending aorta with a central dividing
septum, and the second features complete separation of the two dorsal
aortae. The completely separated variant shows further heterogeneity in
the origins of the posterior intercostal arteries and the iliac arteries,
and the majority of the reported cases also demonstrate additional
anatomical anomalies. SIGNIFICANCE. Understanding the pathogenesis and
prevalence of vascular malformations is important in neonatal medicine,
vascular and thoracic surgery, and diagnostic and interventional
radiology.