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<1>
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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.

<2>
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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.

<3>
Accession Number
622903400
Author
Beloeil H.; Laviolle B.; Menard C.; Paugam-Burtz C.; Garot M.; Asehnoune
K.; Minville V.; Cuvillon P.; Oger S.; Nadaud J.; Lecoeur S.; Chanques G.;
Futier E.
Institution
(Beloeil) CHU Rennes, CIC, Universite de Rennes, Rennes, France
(Laviolle) Univ Rennes, Centre d'Investigation Clinique de Rennes, Service
de Pharmacologie Clinique, Rennes, France
(Menard) CHU de Rennes, Rennes, France
(Menard) INSERM, UMR, Universite Rennes, EFS Bretagne, Rennes, France
(Paugam-Burtz) Departement Anesthesie Reanimation, Hopitaux Universitaires
Paris Nord Val de Seine, Universite Paris Diderot, Clichy, France
(Garot) Centre Hospitalier Universitaire, Pole Anesthesie Reanimation,
Lille, France
(Asehnoune) Department of Anesthesiology and Critical Care Medicine,
Centre Hospitalier Universitaire, Nantes, France
(Minville) Departement d'Anesthesie et de Reanimation, Centre Hospitalier,
Universitaire de Toulouse, Toulouse, France
(Cuvillon) Service Anesthesie, Pole Anesthesie Reanimation Douleur
Urgence, Centre Hospitalier Universitaire Caremeau, Nimes, France
(Oger) Centre Hospitalier de Perigueux, Pole Bloc Anesthesie Chirurgie,
Perigueux, France
(Nadaud) Centre Hospitalier Metz Thionville, Pole Anesthesie Reanimation,
Metz, France
(Lecoeur) Centre Hospitalier Yves le Foll, Pole Anesthesie Reanimation,
Saint-Brieuc, France
(Chanques) Department of Anaesthesia and Critical Care Medicine,
University of Montpellier, Saint Eloi Hospital, Montpellier, France
(Futier) Departement de Medecine Perioperatoire, Universite Clermont
Auvergne, CNRS, Centre Hospitalier Universitaire, Clermont-Ferrand, France
Title
POFA trial study protocol: A multicentre, double-blind, randomised,
controlled clinical trial comparing opioid-free versus opioid anaesthesia
on postoperative opioid-related adverse events after major or intermediate
non-cardiac surgery.
Source
BMJ Open. 8 (6) (no pagination), 2018. Article Number: e020873. Date of
Publication: 01 Jun 2018.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Reducing opioid consumption during and after surgery has been
recommended for more than 10 years. Opioid-free anaesthesia (OFA) is a
multimodal anaesthesia associating hypnotics, NMDA antagonists, local
anaesthetics, anti-inflammatory drugs and alpha-2 agonists. Proofs of the
effect of OFA on reducing opioid-related adverse effects after major or
intermediate non-cardiac surgery are still scarce. We hypothesised that
the reduced opioid consumption allowed by OFA compared with standard of
care will be associated with a reduction of postoperative opioid-related
adverse events. Methods/analysis The POFA trial is a prospective,
randomised, parallel, single-blind, multicentre study of 400 patients
undergoing elective intermediate or major non-cardiac surgery. Patients
will be randomly allocated to receive either a standard anaesthesia
protocol or an OFA. The primary outcome measure is the occurrence of a
severe postoperative opioid-related adverse event within the first 48
hours after extubation defined as: Postoperative hypoxaemia or
postoperative ileus or postoperative cognitive dysfunction. In addition,
each component of the primary outcome measure will be analysed separately.
Data will be analysed on the intention-to-treat principle and a
per-protocol basis. Ethics and dissemination The POFA trial has been
approved by an independent ethics committee for all study centres.
Participant recruitment begins in November 2017. Results will be published
in international peer-reviewed medical journals. Trial registration number
NCT03316339; Pre-results.<br/>Copyright &#xa9; 2018 author(s).

<4>
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.

<5>
Accession Number
623037028
Author
Elkaryoni A.; Nanda N.C.; Baweja P.; Zamir H.; Arisha M.J.; Elgebaly A.;
Foxworth J.; Moormeier J.; Sharma R.
Institution
(Elkaryoni, Moormeier, Sharma) Department of Internal Medicine, University
of Missouri Kansas City, Kansas City, MO, United States
(Nanda, Arisha) Cardiovascular Disease Division, University of Alabama at
Birmingham, Birmingham, AL, United States
(Baweja) Cardiovascular Disease Division, University of Missouri Kansas
City, Kansas City, MO, United States
(Zamir) University of Missouri Kansas City, Kansas City, MO, United States
(Elgebaly) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Foxworth) University of Missouri Kansas City, Kansas CIty, MO, United
States
Title
Three-dimensional transesophageal echocardiography is an attractive
alternative to cardiac computed tomography for aortic annular sizing,
systematic review and meta-analysis.
Source
Journal of the American Society of Echocardiography. Conference: 29th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2018. United States. 31 (6) (pp B68), 2018. Date of Publication: June
2018.
Publisher
Mosby Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become an
established alternative to the surgical approach in high-risk patients
with severe inoperable aortic stenosis. Determination of the size of the
prosthesis is a crucial point of the procedure. As a result, accurate
cardiac imaging modalities are the cornerstone of successful outcomes from
TAVR. The evolution in the understanding of aortic root geometry has
significantly changed the prior assumption of the circular aortic annulus
and LVOT. Consequently, two-dimensional echocardiography became incapable
of defining the exact prosthesis size and paved the way for the
three-dimensional (3D) era. Currently, multi-detector computed tomography
(MDCT) with contrast angiography is the standard pre-TAVR imaging
technique. Observational studies have been conducted to correlate 3D
trans-esophageal echocardiography (TEE) annular sizing to MDCT annular
sizing. This pursuit of correlation stems from the targeted cohort with
multiple comorbidities and renal impairment in particular. Methods: We
performed a systematic review and meta-analysis to assess the correlation
and agreement between 3D TEE and MDCT annular sizing. A literature search
of EMBASE, PubMed, Cochrane Central Register of Controlled Trials
(CENTRAL), and Scopus was conducted using relevant keywords. We included
studies that compared the aortic annular sizing between 3D TEE and MDCT.
Two authors independently screened search results for eligibility. We used
the random-effect inverse-variance method to combine the mean differences
and limits of agreements, and generic inverse-variance method to combine
Pearson correlation coefficient. Heterogeneity was assessed by forest
plots and measured by I-square and Chi-square tests. P values less than
0.05 were considered significant. Results: Thirteen studies were included
in our analysis (N=1026 patients). There was strong linear correlation
between 3D TEE and MDCT measurements of aortic annulus area (r =0.84, p
<=0.001), mean perimeter (r =0. 0.85, p <=0.001), and mean diameter (r
=0.80, p <=0.001). Bland-Altman plots showed that 3D TEE mean values were
smaller than those of MDCT for the aortic annular area (mean difference
was-2.22mm2 with 95% limits of agreement-12.79 to 8.36). However, this
difference is insignificant to impact clinical decision making.
Conclusion: Measurements of the aortic annulus with 3D TEE were comparable
to those obtained by MDCT. Thus making 3D TEE an attractive alternative
for aortic annulus assessment before TAVR, with an added advantage of
reduced cost, radiation and contrast exposure.

<6>
Accession Number
623036970
Author
McConnaughey S.M.; Freeman R.V.; Sheehan F.H.
Institution
(McConnaughey, Freeman, Sheehan) University of Washington Hospitals,
Seattle, WA, United States
Title
Improving the efficiency of cardiac ultrasound training by integrating
scaffolding and deliberate practice.
Source
Journal of the American Society of Echocardiography. Conference: 29th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2018. United States. 31 (6) (pp B100), 2018. Date of Publication: June
2018.
Publisher
Mosby Inc.
Abstract
Background: As the use of focused cardiac ultrasound (FoCUS) spreads,
there is a growing need for efficient, effective training in this modality
across a variety of graduate and postgraduate medical education settings.
Methods: We created a simulator-based FoCUS curriculum using the
principles of instructional scaffolding and deliberate practice to help
guide the novice's learning efforts and moderate the cognitive load of
this complex learning task. The process of acquiring and interpreting
cardiac ultrasound images was broken into discrete steps, with focused
didactic information immediately followed by targeted simulator practice
for each module. Practice complexity increased through successive modules,
and learners ultimately applied their skills by completing unassisted
simulator cases that involved basic cardiac pathology. Immediate visual
and quantitative feedback was provided by the simulator during practice.
This scaffolded curriculum was then compared to a previously validated,
traditional didactic-before-practice curriculum in a randomized study of
cardiothoracic surgery residents and cardiac nurse practitioners. Both
curricula were simulator-based, entirely self-guided, and contained a
similar number of practice cases. Pre-and post-training tests assessed
technical skill in image acquisition using simulator scanning cases and
cognitive skill in image interpretation using multiple choice questions
(MCQ). Results: Twenty-four learners were included in this study: 11 in
the traditional curriculum group and 13 in the scaffolded curriculum
group. Compared to the traditional curriculum, the completion rate was
significantly higher for the scaffolded curriculum (92% vs 45% of
learners, p<=.00001), and the scaffolded curriculum decreased completion
time from 9.2 +/- 6.5 hrs (n=5) to 5.4 +/- 2.3 hrs (n=12, p=.08). Although
the low completion rate of the traditional curriculum precluded
statistical comparison of outcomes between groups, achievement of
cognitive and technical skills was comparable in both curricula (Table 1).
Conclusions: Compared to a didactic-before-practice approach, a curriculum
utilizing scaffolding and deliberate practice improves learning efficiency
and helps more novices achieve basic skills in FoCUS image acquisition and
interpretation (Table presented).

<7>
Accession Number
623036646
Author
Flueckiger P.; Gurung A.; Kaplan R.; Brogan A.; Arjoon R.; McNamara R.;
Lin B.; Sugeng L.
Institution
(Flueckiger, Kaplan, Brogan, Arjoon, McNamara, Lin, Sugeng) Yale School of
Medicine, New Haven, CT, United States
(Gurung) Siemens Healthineers, Malvern, PA, United States
Title
Automated protocols improve workflow in transesophageal echocardiography.
Source
Journal of the American Society of Echocardiography. Conference: 29th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2018. United States. 31 (6) (pp B95-B96), 2018. Date of Publication:
June 2018.
Publisher
Mosby Inc.
Abstract
Background: Intersocietal Accreditation Commission (IAC) mandates use of
specific and appropriate image acquisition for transesophageal
echocardiography (TEE) studies. We hypothesized that an automated TEE
imaging protocol improves study efficiency and workflow compared with a
manual protocol. Methods: Protocols for three TEE indications
(transcatheter aortic valve replacement (TAVR), mitral regurgitation (MR),
and atrial fibrillation (AFib)) at a large academic echocardiography lab
were used. Image acquisition was done twice for each TEE, once each using
a manual and automated method in random order. The same sonographer
assisted every acquisition with each operator (novice, <=3 years
experience, n=3; expert, >= 3 years experience, n=2). TEE exam duration
(defined by timestamp on first and last image) was acquired and number of
sonographer keystrokes for each method were counted. Keystrokes were
grouped into categories (Fig 1e). Multivariate analysis of variance was
performed for each variable. eSie Protocol on the Siemens SC2000 (Mountain
View, CA) was used for all TEE exams. Results: 22 patients, 14 males, ages
31-83 years, average BMI 28.8 kg/m2 (S.D.+/-6.3) were included in
analysis. 44 TEE image protocols were acquired (22 manual and 22 automated
comprised of 4 TAVR, 22 MR, and 18 AFib protocols). eSie TEE protocols
significantly reduced the TEE exam duration regardless of operator
experience level (Fig. 1A). The protocol performed secondly aft er
randomization was shorter regardless of protocol method; however, the
percentage decrease in duration of the second exam was significantly
greater when the automated protocol was done secondly (Fig 1B). The eSie
protocol required less number of sonographer keystrokes than manual
protocol, regardless of experience level (Fig. 1C) or the protocol order
(Fig 1D). Automated protocols required significantly fewer number of angle
corrections, gain adjustments, 2D optimizations, imaging plane navigations
and miscellaneous keystrokes. Image capture (representing total images
acquired) was similar between automated and manual protocols. (Fig. 1E)
Conclusion: Automated protocols improve TEE efficiency by reducing the
study duration and sonographer keystrokes regardless of TEE experience and
without a difference in total number of TEE images acquired.

<8>
Accession Number
623036192
Author
Konstanty-Kalandyk J.; Bartus K.; Piatek J.; Vuddanda V.; Lee R.; Kedziora
A.; Sadowski J.; Lakkireddy D.; Kapelak B.
Institution
(Vuddanda) Warren Alpert School of Medicine, Brown University, Miriam
Hospital, Harvard Medical School, Boston,Providence, United States
(Lee) Division of Cardiac Electrophysiology, Cardiovascular Research
Institute, Institute for Regenerative Medicine, University of California,
San Francisco, United States
(Lakkireddy) Cardiovascular Research Institute, University of Kansas,
Kansas City, United States
(Konstanty-Kalandyk, Bartus, Piatek, Kedziora, Sadowski, Kapelak)
Department of Cardiovascular Surgery and Transplantology, Jagiellonian
University, John Paul II Hospital, 80 Pradnicka St, Krakow 31-202, Poland
Title
Midterm outcomes of transmyocardial laser revascularization with
intramyocardial injection of adipose derived stromal cells for severe
refractory angina.
Source
Postepy w Kardiologii Interwencyjnej. 14 (2) (pp 176-182), 2018. Date of
Publication: 2018.
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Introduction: Refractory angina has limited effective therapeutic options
and often contributes to frequent hospitalizations, morbidity and impaired
quality of life. Aim: We sought to examine midterm results of a
bio-interventional therapy combining transmyocardial laser
revascularization (TMLR) and intramyocardial injection of adipose derived
stem cells (ADSC) in patients with refractory angina not amenable to
percutaneous or surgical revascularization. Material and methods: We
included 15 patients with severe refractory angina and anterior wall
ischemia who were ineligible for revascularization strategies. Adipose
tissue was harvested and purified, giving the stem cell concentrate. All
patients underwent left anterior thoracotomy and TMLR using a low-powered
holmium: yttrium-aluminum-garnet laser and intramyocardial injection of
ADSC using a combined delivery system. Results: No deaths or major adverse
cardiovascular or cerebrovascular events were observed in the 6-month
follow-up. Mean ejection fraction increased from 35% to 38%, and mean
Canadian Cardiovascular Society Angina Score decreased from 3.2 to 1.4,
with decreased necessity of nitrate usage. Seventy-three percent of
patients reported health improvement particularly regarding general health
and bodily pain. Improvement in endocardial movement, myocardial
thickening and stroke volume index (35.26 to 46.23 ml/m²) on
cardiac magnetic resonance imaging (MRI) was observed in 3 patients who
had repeat CMR imaging after 6 months. Conclusions: Our study suggested
that interventional therapy combining TMLR with intramyocardial
implantation of ADSC may reduce symptoms and improve quality of life in
patients with refractory angina. These early findings need further
validation in large scale randomized controlled trials.<br/>Copyright
&#xa9; 2018 Termedia Publishing House Ltd. All rights reserved.

<9>
Accession Number
622975188
Author
Singh T.P.; Skalina T.; Nour D.; Murali A.; Morrison S.; Moxon J.V.;
Golledge J.
Institution
(Singh, Skalina, Nour, Murali, Morrison, Moxon, Golledge) James Cook
University, Queensland Research Centre for Peripheral Vascular Disease,
College of Medicine and Dentistry, Townsville, QLD 4811, Australia
(Singh, Golledge) The Townsville Hospital, The Department of Vascular and
Endovascular Surgery, Townsville, QLD, Australia
Title
A meta-analysis of the efficacy of allopurinol in reducing the incidence
of myocardial infarction following coronary artery bypass grafting.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 143. Date of Publication: 11 Jul 2018.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The xanthine oxidase inhibitor allopurinol that is commonly
used to treat gout, has been suggested to have pleiotropic effects that
are likely to reduce the incidence of myocardial infarction (MI) in at
risk individuals. The aim of this meta-analysis was to assess the efficacy
of allopurinol treatment in reducing the incidence of MI. Method: MEDLINE,
Scopus, Web of Science, and Cochrane Library databases were searched for
randomised controlled trials examining the efficacy of allopurinol in
reducing the incidence of MI. The quality of study methodology was
assessed by two independent reviewers using the Cochrane Collaboration's
tool for assessing risk of bias. This meta-analysis was conducted using a
fixed-effects model, and heterogeneity was assessed with the I²
index. Results: One thousand one hundred twenty-three citations were
screened and only six studies satisfied the inclusion criterion. Published
between 1988 and 1995, all studies examined the cardioprotective efficacy
of allopurinol in the setting of coronary artery bypass graft (CABG). From
a total pooled sample size of 229, MI was reported in 2 (1.77%)
allopurinol and 14 (12.07%) control patients. A fixed-effects
meta-analysis (I² = 0%) identified a statistically significant
reduced incidence of myocardial infarction (RR 0.21, 95% CI: 0.06, 0.70, p
= 0.01) in patients allocated to allopurinol. However, in the
leave-one-out sensitivity analyses, the treatment effect became
non-significant with the removal of one of the studies. Conclusion: Based
on the limited evidence available, allopurinol appears to reduce the
incidence of perioperative MI following CABG. Further research is required
to confirm these findings.<br/>Copyright &#xa9; 2018 The Author(s).

<10>
Accession Number
623038486
Author
Helmy R.; Duerinckx N.; De Geest S.; Denhaerynck K.; Berben L.; Russell
C.L.; Van Cleemput J.; Crespo-Leiro M.G.; Dobbels F.; Cupples S.; De
Simone P.; Groenewoud A.; Kugler C.; Ohler L.; Poncelet A.J.; Sebbag L.;
Michel M.; Bernard A.; Doesch A.; Livi U.; Manfredini V.; Brossa-Loidi V.;
Segovia-Cubero J.; Almenar-Bonet L.; Saint-Gerons C.S.; Mohacsi P.;
Horvath E.; Riotto C.; Parry G.; Firouzi A.; Kozuszko S.; Haddad H.; Kaan
A.; Fisher G.; Miller T.; Flattery M.; Ludrosky K.; Albert N.; Coleman B.;
Trammell J.; St. Clair K.; Kao A.; Molina M.; Canales K.R.; de Almeida
S.S.; Cotait Ayoub A.; Barone F.; Harkess M.; Maddicks-Law J.
Institution
(Helmy, De Geest, Denhaerynck, Dobbels) Nursing Science, Department of
Public Health, Faculty of Medicine, University of Basel, Basel,
Switzerland
(Duerinckx, De Geest, Dobbels) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
(Duerinckx, Van Cleemput) Heart Transplant Program, University Hospitals
of Leuven, Leuven, Belgium
(Berben) University Hospital of Basel, University of Basel, Basel,
Switzerland
(Russell) School of Nursing and Health Studies, University of
Missouri-Kansas City, Kansas City, MO, United States
(Crespo-Leiro) Complexo Hospitalario Universitario A Coruna (CHUAC),
CIBERCV, INIBIC, Universidade da Coruna (UDC), La Coruna, Spain
Title
The international prevalence and variability of nonadherence to the
nonpharmacologic treatment regimen after heart transplantation: Findings
from the cross-sectional BRIGHT study.
Source
Clinical Transplantation. 32 (7) (no pagination), 2018. Article Number:
e13280. Date of Publication: July 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Heart transplant (HTx) recipients need to follow a complex
therapeutic regimen. We assessed the international prevalence and
variability in nonadherence to six nonpharmacologic treatment components
(physical activity, sun protection, diet, alcohol use, nonsmoking, and
outpatient follow-up visits). Methods: We used self-report data of 1397
adult HTx recipients from the 36-HTx-center, 11-country, 4-continent,
cross-sectional BRIGHT study (ClinicalTrials.gov ID: NCT01608477). The
nonadherence definitions used were as follows: Physical activity: <3
times/wk 20 minutes' vigorous activity, <5 times/wk 30 minutes' moderate
activity, or <5 times/wk a combination of either intensity; Sun
protection: not "always" applying any sun protection; Diet: not "often" or
"always" following recommended diet(s); Alcohol use: >1 alcoholic drink/d
(women) or >2 drinks/d (men); Smoking: current smokers or stopped <1 year
before; Follow-up visits: missing >=1 of the last 5 outpatient follow-up
visits. Overall prevalence figures were adjusted to avoid over- or
underrepresentation of countries. Between-country variability was assessed
within each treatment component via chi-square testing. Results: The
adjusted study-wide nonadherence prevalence figures were as follows: 47.8%
for physical activity (95% CI [45.2-50.5]), 39.9% for sun protection (95%
CI [37.3-42.5]), 38.2% for diet recommendations (95% CI [35.1-41.3]),
22.9% for alcohol consumption (95% CI [20.8-25.1]), 7.4% for smoking
cessation (95% CI [6.1-8.7]), and 5.7% for follow-up visits (95% CI
[4.6-6.9]). Significant variability was observed between countries in all
treatment components except follow-up visits. Conclusion: Nonadherence to
the post-HTx nonpharmacologic treatment regimen is prevalent and shows
significant variability internationally, suggesting a need for tailored
adherence-enhancing interventions.<br/>Copyright &#xa9; 2018 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd

<11>
Accession Number
623034687
Author
Kingeter A.J.; Raghunathan K.; Munson S.H.; Hayashida D.K.; Zhang X.;
Iyengar S.; Bunke M.; Shaw A.D.
Institution
(Kingeter) Department of Anesthesiology, Vanderbilt University Medical
Center, 1211 21st Avenue South MAB 422, Nashville, TN 37232-5614, United
States
(Raghunathan) Duke University Medical Center and Durham VA Medical Center,
Durham, NC, United States
(Munson, Hayashida, Zhang, Iyengar) Boston Strategic Partners, Inc.,
Boston, MA, United States
(Bunke) Grifols, Inc., Research Triangle Park, NC, United States
(Shaw) University of Alberta, Edmonton, AB, Canada
Title
Association between albumin administration and survival in cardiac
surgery: a retrospective cohort study.
Source
Canadian Journal of Anesthesia. (pp 1-10), 2018. Date of Publication: 13
Jul 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Albumin is widely used during and after on-pump cardiac surgery,
although it is unclear whether this therapy improves clinical outcomes.
Methods: This observational study utilized the Cerner Health Facts
database (a large HIPAA-compliant clinical-administrative database
maintained by Cerner Inc., USA) to identify a cohort of 6,188 adults that
underwent on-pump cardiac surgery for valve and/or coronary artery
procedures between January 2001 and March 2013. Of these, 1,095 patients
who received 5% albumin with crystalloid solutions and 1,095 patients who
received crystalloids alone on the day of or the day following cardiac
surgery were selected by propensity-score matching. The primary outcome
was all-cause in-hospital mortality. Three secondary outcomes analyzed
include acute kidney injury severity, major morbidity composite, and
all-cause 30-day readmissions. Results: In the propensity-score matched
cohort, receipt of perioperative 5% albumin was associated with decreased
risk of in-hospital mortality (odds ratio [OR], 0.5; 95% confidence
interval [CI], 0.3 to 0.9; P = 0.02) and lower all-cause 30-day
readmission rates (OR, 0.7; 98.3% CI, 0.5 to 0.9; P < 0.01). Albumin
therapy was not associated with differences in overall major morbidity
(OR, 0.9; 98.3% CI, 0.7 to 1.2; P = 0.39; composite) or acute kidney
injury severity (OR, 0.9; 98.3% CI, 0.6 to 1.4; P = 0.53) compared with
therapy with crystalloid solutions. Conclusions: In this large
retrospective study, use of 5% albumin solution was associated with
significantly decreased odds of in-hospital mortality and all-cause 30-day
readmission rate compared with administration of crystalloids alone in
adult patients undergoing on-pump cardiac surgery. These results warrant
further studies to examine fluid receipt, including 5% albumin, in
surgical populations via randomized-controlled trials.<br/>Copyright
&#xa9; 2018 Canadian Anesthesiologists' Society

<12>
Accession Number
619299961
Author
Panoulas V.F.; Francis D.P.; Ruparelia N.; Malik I.S.; Chukwuemeka A.; Sen
S.; Anderson J.; Nihoyannopoulos P.; Sutaria N.; Hannan E.L.; Samadashvili
Z.; D'Errigo P.; Schymik G.; Mehran R.; Chieffo A.; Latib A.; Presbitero
P.; Mehilli J.; Petronio A.S.; Morice M.-C.; Tamburino C.; Thyregod
H.G.H.; Leon M.; Colombo A.; Mikhail G.W.
Institution
(Panoulas, Francis, Malik, Sen, Nihoyannopoulos, Sutaria, Mikhail)
Cardiovascular Sciences, National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Panoulas, Ruparelia, Malik, Sen, Nihoyannopoulos, Mikhail) Cardiology
Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Chukwuemeka, Anderson) Cardiothoracic Department, Hammersmith Hospital,
Imperial College Healthcare NHS Trust, United States
(Hannan, Samadashvili) School of Public Health, University at Albany,
State University of New York, Albany, NY, United States
(D'Errigo) National Centre for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital
Karlsruhe, Academic Teaching Hospital of the University of Freiburg,
Freiburg, Germany
(Mehran) Interventional Cardiovascular Research and Clinical Trials, The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Chieffo, Latib, Colombo) Cardiology department, San Raffaele Scientific
Institute, Milan, Italy
(Presbitero) Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto
Clinico Humanitas, Milan, Italy
(Mehilli) Munich University Clinic, Ludwig-Maximilians University, Munich,
Germany
(Mehilli) Munich Heart Alliance at Deutsches Zentrum fur
Herz-Kreislauf-Forschung, Munich, Germany
(Petronio) Cardiothoracic and Vascular Department, University of Pisa,
Italy
(Morice) RAMSAY, Generale de Sante, ICPS, Institut Cardiovasculaire Paris
Sud, Massy, France
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Leon) Columbia University Medical Center, New York, United States
(Tamburino) ETNA Foundation, Catania, Italy
Title
Female-specific survival advantage from transcatheter aortic valve
implantation over surgical aortic valve replacement: Meta-analysis of the
gender subgroups of randomised controlled trials including 3758 patients.
Source
International Journal of Cardiology. 250 (pp 66-72), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis
(AS) is the first area of interventional cardiology where women are
treated as often as men. In this analysis of the gender specific results
of randomised controlled trials (RCTs) comparing TAVI with surgical aortic
valve replacement (SAVR) we aimed to determine whether gender affects the
survival comparison between TAVI and SAVR. We identified all RCTs
comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2 year
survival. Summary odds ratios (ORs) were obtained using a random-effects
model. Heterogeneity was assessed using the Q statistic and I².
Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052
men. Amongst females, TAVI recipients had a significantly lower mortality
than SAVR recipients, at 1 year (OR 0.68; 95%CI 0.50 to 0.94) and at 2
years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference
in mortality between TAVI and SAVR, at 1 year (OR 1.09; 95%CI 0.86 to
1.39) or 2 years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment
effect between genders was significant at both 1 year
(p<inf>interaction</inf> = 0.02) and 2 years (p<inf>interaction</inf> =
0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In
men, there is no difference in mortality between TAVI and
SAVR.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<13>
Accession Number
618322323
Author
Sabatine M.S.; Leiter L.A.; Wiviott S.D.; Giugliano R.P.; Deedwania P.; De
Ferrari G.M.; Murphy S.A.; Kuder J.F.; Gouni-Berthold I.; Lewis B.S.;
Handelsman Y.; Pineda A.L.; Honarpour N.; Keech A.C.; Sever P.S.; Pedersen
T.R.
Institution
(Sabatine, Wiviott, Giugliano, Murphy, Kuder) TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, United States
(Leiter) Li Ka Shing Knowledge Institute of St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Deedwania) UCSF Fresno, Fresno, CA, United States
(De Ferrari) Department of Molecular Medicine, University of Pavia, and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-IIT, Haifa, Israel
(Handelsman) Metabolic Institute of America, Tarzana, CA, United States
(Pineda, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Sydney, NSW, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Title
Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in
patients with and without diabetes and the effect of evolocumab on
glycaemia and risk of new-onset diabetes: a prespecified analysis of the
FOURIER randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 5 (12) (pp 941-950), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitor evolocumab reduced LDL cholesterol and cardiovascular events in
the FOURIER trial. In this prespecified analysis of FOURIER, we
investigated the efficacy and safety of evolocumab by diabetes status and
the effect of evolocumab on glycaemia and risk of developing diabetes.
Methods FOURIER was a randomised trial of evolocumab (140 mg every 2 weeks
or 420 mg once per month) versus placebo in 27 564 patients with
atherosclerotic disease who were on statin therapy, followed up for a
median of 2.2 years. In this prespecified analysis, we investigated the
effect of evolocumab on cardiovascular events by diabetes status at
baseline, defined on the basis of patient history, clinical events
committee review of medical records, or baseline HbA<inf>1c</inf> of 6.5%
(48 mmol/mol) or greater or fasting plasma glucose (FPG) of 7.0 mmol/L or
greater. The primary endpoint was a composite of cardiovascular death,
myocardial infarction, stroke, hospital admission for unstable angina, or
coronary revascularisation. The key secondary endpoint was a composite of
cardiovascular death, myocardial infarction, or stroke. We also assessed
the effect of evolocumab on glycaemia, and on the risk of new-onset
diabetes among patients without diabetes at baseline. HbA<inf>1c</inf> was
measured at baseline then every 24 weeks and FPG was measured at baseline,
week 12, week 24, and every 24 weeks thereafter, and potential cases of
new-onset diabetes were adjudicated centrally. In a post-hoc analysis, we
also investigated the effects on glycaemia and diabetes risk in patients
with prediabetes (HbA<inf>1c</inf> 5.7-6.4% [39-46 mmol/mol] or FPG
5.6-6.9 mmol/L) at baseline. FOURIER is registered with
ClinicalTrials.gov, number NCT01764633. Findings At study baseline, 11 031
patients (40%) had diabetes and 16 533 (60%) did not have diabetes (of
whom 10 344 had prediabetes and 6189 had normoglycaemia). Evolocumab
significantly reduced cardiovascular outcomes consistently in patients
with and without diabetes at baseline. For the primary composite endpoint,
the hazard ratios (HRs) were 0.83 (95% CI 0.75-0.93; p=0.0008) for
patients with diabetes and 0.87 (0.79-0.96; p=0.0052) for patients without
diabetes (p<inf>interaction</inf>=0.60). For the key secondary endpoint,
the HRs were 0.82 (0.72-0.93; p=0.0021) for those with diabetes and 0.78
(0.69-0.89; p=0.0002) for those without diabetes
(p<inf>interaction</inf>=0.65). Evolocumab did not increase the risk of
new-onset diabetes in patients without diabetes at baseline (HR 1.05,
0.94-1.17), including in those with prediabetes (HR 1.00, 0.89-1.13).
Levels of HbA<inf>1c</inf> and FPG were similar between the evolocumab and
placebo groups over time in patients with diabetes, prediabetes, or
normoglycaemia. Among patients with diabetes at baseline, the proportions
of patients with adverse events were 78.5% (4327 of 5513 patients) in the
evolocumab group and 78.3% (4307 of 5502 patients) in the placebo group;
among patients without diabetes at baseline, the proportions with adverse
events were 76.8% (6337 of 8256 patients) in the evolocumab group and
76.8% (6337 of 8254 patients) in the placebo group. Interpretation PCSK9
inhibition with evolocumab significantly reduced cardiovascular risk in
patients with and without diabetes. Evolocumab did not increase the risk
of new-onset diabetes, nor did it worsen glycaemia. These data suggest
evolocumab use in patients with atherosclerotic disease is efficacious and
safe in patients with and without diabetes. Funding Amgen.<br/>Copyright
&#xa9; 2017 Elsevier Ltd

<14>
Accession Number
619197476
Author
Ueki K.; Sasako T.; Okazaki Y.; Kato M.; Okahata S.; Katsuyama H.;
Haraguchi M.; Morita A.; Ohashi K.; Hara K.; Morise A.; Izumi K.; Ishizuka
N.; Ohashi Y.; Noda M.; Kadowaki T.; Haneda M.; Iwashima Y.; Suda T.;
Tamasawa N.; Daimon M.; Satoh J.; Takebe N.; Ishigaki Y.; Watanabe T.;
Satoh H.; Kasai K.; Aso Y.; Ishibashi S.; Katayama S.; Ishikawa S.-E.;
Kakei M.; Namai K.; Hashimoto N.; Suzuki Y.; Onishi S.; Yokote K.; Matsuda
M.; Masuzawa M.; Hayashi Y.; Saito S.; Ogihara N.; Ishihara H.; Tajima N.;
Utsunomiya K.; Itoh H.; Kawamori R.; Watada H.; Mori Y.; Shiba T.; Isogawa
A.; Sakura H.; Odawara M.; Tobe K.; Tsukamoto K.; Yamauchi T.; Teramoto
T.; Hirata Y.; Uchimura I.; Ogawa Y.; Yoshino G.; Hirose T.; Kajio H.;
Atsumi Y.; Shimada A.; Oikawa Y.; Araki A.; Ueki A.; Ohno A.; Kitaoka M.;
Fujita Y.; Moriya T.; Tojo T.; Shichiri M.; Suzuki D.; Toyoda M.; Hamano
K.; Komi R.; Terauchi Y.; Kuzuya N.; Yamada M.; Takamura T.; Imura M.;
Tanaka H.; Hayashi M.; Kato Y.; Itoh M.; Suzuki A.; Nakayama M.; Sano T.;
Nakashima E.; Sumida Y.; Yano Y.; Tanaka T.; Murata K.; Kashiwagi A.;
Maegawa H.; Kono S.; Inagaki N.; Kosugi K.; Yasuda T.; Yoshimasa Y.;
Kishimoto I.; Sato T.; Hosoi M.; Yamasaki T.; Matsuhisa M.; Shimomura I.;
Taniguchi A.; Kuroe A.; Kurose T.; Ohara T.; Sakaguchi K.; Namba M.; Kaku
K.; Fujiwara M.; Shimizu I.; Ono K.; Ebisui O.; Tanizawa Y.; Okada Y.;
Kodera T.; Sato N.; Ide M.; Yamada K.; Umeda F.; Natori S.; Eto T.; Mimura
K.; Hiramatsu S.; Inoue T.; Takei R.; Ogo A.; Eguchi K.; Kawasaki E.;
Koide Y.; Araki E.; Jinnouchi H.; Yamamoto H.; Motoyoshi M.; Hiyoshi T.;
Tanaka Y.; Momoki T.; Sato K.; Yoneyama A.; Ito K.; Sobajima H.; Ikegami
H.; Ikeda M.; Ikeda H.; Takahashi K.; Makino H.; Ueda Y.; Nakazato M.
Institution
(Ueki) Department of Molecular Diabetic Medicine, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Izumi) Department of Clinical Research Strategic Planning, Center for
Clinical Sciences, National Center for Global Health and Medicine, Tokyo,
Japan
(Ueki, Sasako, Okazaki, Haraguchi, Morita, Kadowaki) Department of
Diabetes and Metabolic Diseases, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan
(Sasako, Kadowaki) Translational Systems Biology and Medicine Initiative,
The University of Tokyo, Tokyo, Japan
(Kato) Health Management Center and Diagnostic Imaging Center, Toranomon
Hospital, Tokyo, Japan
(Okahata) Division of Diabetes and Metabolism, Toho University Ohashi
Medical Center, Tokyo, Japan
(Katsuyama) Department of Internal Medicine, National Center for Global
Health and Medicine, Kohnodai Hospital, Chiba, Japan
(Ohashi) Department of General Internal Medicine, National Cancer Center
Hospital, Tokyo, Japan
(Hara) Department of Endocrinology and Metabolism, Saitama Medical Center,
Jichi Medical University, Saitama, Japan
(Morise) Department of Internal Medicine, Tokyo Takanawa Hospital, Tokyo,
Japan
(Ishizuka) Clinical Research Center, The Cancer Institute Hospital,
Japanese Foundation for Cancer Research, Tokyo, Japan
(Ohashi) Department of Integrated Science and Engineering for Sustainable
Society, Chuo University, Tokyo, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Title
Effect of an intensified multifactorial intervention on cardiovascular
outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label,
randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 5 (12) (pp 951-964), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Limited evidence suggests that multifactorial interventions for
control of glucose, blood pressure, and lipids reduce macrovascular
complications and mortality in patients with type 2 diabetes. However,
safe and effective treatment targets for these risk factors have not been
determined for such interventions. Methods In this multicentre,
open-label, randomised, parallel-group trial, undertaken at 81 clinical
sites in Japan, we randomly assigned (1:1) patients with type 2 diabetes
aged 45-69 years with hypertension, dyslipidaemia, or both, and an
HbA<inf>1c</inf> of 6.9% (52.0 mmol/mol) or higher, to receive
conventional therapy for glucose, blood pressure, and lipid control
(targets: HbA<inf>1c</inf> <6.9% [52.0 mmol/mol], blood pressure <130/80
mm Hg, LDL cholesterol <120 mg/dL [or 100 mg/dL in patients with a history
of coronary artery disease]) or intensive therapy (HbA<inf>1c</inf> <6.2%
[44.3 mmol/mol], blood pressure <120/75 mm Hg, LDL cholesterol <80 mg/dL
[or 70 mg/dL in patients with a history of coronary artery disease]).
Randomisation was done using a computer-generated, dynamic balancing
method, stratified by sex, age, HbA<inf>1c</inf>, and history of
cardiovascular disease. Neither patients nor investigators were masked to
group assignment. The primary outcome was occurrence of any of a composite
of myocardial infarction, stroke, revascularisation (coronary artery
bypass surgery, percutaneous transluminal coronary angioplasty, carotid
endarterectomy, percutaneous transluminal cerebral angioplasty, and
carotid artery stenting), and all-cause mortality. The primary analysis
was done in the intention-to-treat population. This study is registered
with ClinicalTrials.gov, number NCT00300976. Findings Between June 16,
2006, and March 31, 2009, 2542 eligible patients were randomly assigned to
intensive therapy or conventional therapy (1271 in each group) and
followed up for a median of 8.5 years (IQR 7.3-9.0). Two patients in the
intensive therapy group were found to be ineligible after randomisation
and were excluded from the analyses. During the intervention period, mean
HbA<inf>1c</inf>, systolic blood pressure, diastolic blood pressure, and
LDL cholesterol concentrations were significantly lower in the intensive
therapy group than in the conventional therapy group (6.8% [51.0 mmol/mol]
vs 7.2% [55.2 mmol/mol]; 123 mm Hg vs 129 mm Hg; 71 mm Hg vs 74 mm Hg; and
85 mg/dL vs 104 mg/dL, respectively; all p<0.0001). The primary outcome
occurred in 109 patients in the intensive therapy group and in 133
patients in the conventional therapy group (hazard ratio [HR] 0.81, 95% CI
0.63-1.04; p=0.094). In a post-hoc breakdown of the composite outcome,
frequencies of all-cause mortality (HR 1.01, 95% CI 0.68-1.51; p=0.95) and
coronary events (myocardial infarction, coronary artery bypass surgery,
and percutaneous transluminal coronary angioplasty; HR 0.86, 0.58-1.27;
p=0.44) did not differ between groups, but cerebrovascular events (stroke,
carotid endarterectomy, percutaneous transluminal cerebral angioplasty,
and carotid artery stenting) were significantly less frequent in the
intensive therapy group (HR 0.42, 0.24-0.74; p=0.002). Apart from
non-severe hypoglycaemia (521 [41%] patients in the intensive therapy
group vs 283 [22%] in the conventional therapy group, p<0.0001) and oedema
(193 [15%] vs 129 [10%], p=0.0001), the frequencies of major adverse
events did not differ between groups. Interpretation Our results do not
fully support the efficacy of further intensified multifactorial
intervention compared with current standard care for the prevention of a
composite of coronary events, cerebrovascular events, and all-cause
mortality. Nevertheless, our findings suggest a potential benefit of an
intensified intervention for the prevention of cerebrovascular events in
patients with type 2 diabetes. Funding Ministry of Health, Labour and
Welfare of Japan, Asahi Kasei Pharma, Astellas Pharma, AstraZeneca, Bayer,
Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly,
GlaxoSmithKline, Kissei Pharmaceutical, Kowa Pharmaceutical, Mitsubishi
Tanabe Pharma, Mochida Pharmaceutical, MSD, Novartis Pharma, Novo Nordisk,
Ono Pharmaceutical, Pfizer, Sanwa Kagaku Kenkyusho, Shionogi, Sumitomo
Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda.<br/>Copyright
&#xa9; 2017 Elsevier Ltd

<15>
Accession Number
622996265
Author
Jarvela K.; Rantanen M.; Koobi T.; Huhtala H.; Sisto T.
Institution
(Koobi) Department of Clinical Physiology, Tampere University Hospital,
Tampere, Finland
(Huhtala) Faculty of Social Sciences, Tampere University, Tampere, Finland
(Jarvela, Rantanen, Sisto) Heart Centre Co. Tampere University Hospital,
PO Box 2000, Tampere FIN-33521, Finland
Title
Hypertonic saline-hydroxyethyl starch solution attenuates fluid
accumulation in cardiac surgery patients: A randomized controlled
double-blind trial.
Source
Anaesthesiology Intensive Therapy. 50 (2) (pp 122-127), 2018. Date of
Publication: 28 Jun 2018.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Significant fluid retention is common after cardiac surgery
with the use of cardiopulmonary bypass (CPB). The aim of the study was to
evaluate the effects of hypertonic saline-hydroxyethyl starch (HS-HES)
solution on fluid accumulation in patients undergoing coronary artery
bypass grafting surgery (CABG). Methods: Fifty adult male patients
undergoing coronary bypass surgery were enrolled in this interventional,
randomized, double-blinded study to compare HS-HES with saline solution.
The study fluid (250 mL) was given into the venous reservoir of the CPB
circuit at the time of aortic declamping. Results: Body mass change from
the baseline to the first postoperative morning was significantly less in
the HS-HES group compared with the control group (3.3 +/- 1.5 kg vs. 4.4
+/- 1.5 kg, P = 0.022). In the extracellular water (ECW) or ECW-balance,
there were no significant differences between the groups. The need for
fluids and diuretic medication did not differ between the groups during
the perioperative period. Conclusions: Our study shows that 250 mL of
HS-HES solution can reduce perioperative fluid accumulation to some degree
in patients undergoing CABG surgery with CPB.<br/>Copyright &#xa9; 2018
Via Medica. All rights reserved.

<16>
Accession Number
622987503
Author
Ahmad A.; Parvez Z.; Sanaullah O.
Institution
(Ahmad, Parvez, Sanaullah) Department of Cardiothoracic Surgery, Shaikh
Zayed Hospital, Lahore, Pakistan
Title
Outcome of off pump and on pump coronary artery bypass grafting in
patients with end stage renal disease.
Source
Medical Forum Monthly. 29 (6) (pp 25-29), 2018. Date of Publication: June
2018.
Publisher
Medical Forum Monthly (Gujjar Singh, Lahore 5460, Pakistan)
Abstract
Objective: To study the outcome of, off pump and on pump coronary artery
bypass grafting in terms of morbidity and mortality in patients with end
stage renal disease (ESRD). Study Design: Randomized controlled trial
study. Place and Duration of Study: This study was conducted at the
Department of Cardiothoracic Surgery, Shaikh Zayed Hospital, Lahore from
2014 to 2017. Materials and Methods: The study comprised 52 patients. We
divided these patients into two groups; Group:1 (on pump coronary artery
bypass grafting) and Group:2 (off pump coronary artery by pass grafting
[OPCAB]). We enrolled all patients with chronic kidney disease on
maintenance hemodialysis, those needed coronary artery bypass grafting.
Results: There was no significant demographic difference in both groups
preoperatively. Triple vessel coronary artery disease (CAD) was present in
28 (53.8%)patients; double vessel CAD was present in 18 (34.6%) patients
and sever left main CAD was present in 6 (11.5) patients. Peroperatively
3.5 and 3 number of grafts were used in-group:1 and group: 2 respectively.
Number of blood and blood products were used more in group:1 as compare to
group:2. The use of inotropic support and Intra aortic balloon pump (IABP)
was significantly higher in group:1. We found increased extubation time,
ICU stay and hospital stay in group:1 as compare to group:2. Early
postoperative mortality in group:1 and group:2 was 7.7% and 3.8%
respectively. Six months survival rate was equal in both groups.
Conclusion: Off pump coronary artery bypass grafting is encouraging
operative strategy in patients with End stage renal disease. In this
technique less number of blood and blood products are used and it has
lower morbidity, mortality and hospital stay.<br/>Copyright &#xa9; 2018
Medical Forum Monthly. All rights reserved.

<17>
Accession Number
621361839
Author
Zhang S.; Ding S.; Cai M.; Bai J.; Zhang M.; Huang Y.; Zheng J.
Institution
(Zhang, Cai, Zhang, Huang, Zheng) Pediatric Clinical Pharmacology
Laboratory, Shanghai Children's Medical Center, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
(Zhang, Bai, Zhang, Huang, Zheng) Department of Anesthesiology, Shanghai
Children's Medical Center, School of Medicine, Shanghai Jiao Tong
University, Shanghai, China
(Ding) Department of Anesthesiology, The People's Hospital of Gansu
Province, Lanzhou, China
Title
Impact of upper respiratory tract infections on perioperative outcomes of
children undergoing therapeutic cardiac catheterisation.
Source
Acta Anaesthesiologica Scandinavica. 62 (7) (pp 915-923), 2018. Date of
Publication: August 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Recent upper respiratory tract infection (URI) is associated
with increased incidence of perioperative complications in children
undergoing open heart surgery. As a result, surgery is often postponed.
However, the effect of recent URI on the incidence of perioperative
complications in children undergoing therapeutic cardiac catheterisation
is unknown. We investigated the perioperative outcomes of congenital heart
disease (CHD) children with recent URI who underwent elective therapeutic
catheterisation. Methods: We prospectively included children treated for
CHD. Before surgery, parents or legal guardians were interviewed to
complete a questionnaire on the child's demographics, history of asthma
and passive smoking, and URI symptoms. Recorded perioperative respiratory
adverse events (PRAEs) included laryngospasm, bronchospasm, breath
holding, oxygen desaturation, and severe cough. Information on
postoperative dysphoria, fever, copious sputum, and vomiting was obtained
by telephone 24 h after surgery. Results: Of 363 included children, 169
had recently (within 2 weeks) had a URI. The URI did not affect the
incidence of laryngospasm, bronchospasm, breath holding, fever, or
vomiting. The incidence of desaturation, severe cough, dysphoria, and
copious sputum were significantly increased. Independent risk factors for
PRAEs in children with a recent URI included age, passive smoking, and
presence of rhinorrhoea or moist cough. The lengths of stay in the
hospital and intensive care unit were not significantly different between
groups. Conclusion: Although recent URI increased the incidence of PRAEs
in children undergoing therapeutic cardiac catheterisation, most CHD
patients with recent URI can undergo elective therapeutic cardiac
catheterisation without serious adverse events or prolonged
hospitalisation.<br/>Copyright &#xa9; 2018 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<18>
Accession Number
621915628
Author
Hare G.M.T.; Han K.; Leshchyshyn Y.; Mistry N.; Kei T.; Dai S.Y.; Tsui
A.K.Y.; Pirani R.A.; Honavar J.; Patel R.P.; Yagnik S.; Welker S.L.; Tam
T.; Romaschin A.; Connelly P.W.; Beattie W.S.; Mazer C.D.
Institution
(Hare, Han, Leshchyshyn, Mistry, Kei, Dai, Tsui, Pirani, Yagnik, Mazer)
Department of Anesthesia, St. Michael's Hospital, University of Toronto,
30 Bond Street, Toronto, ON M5B 1W8, Canada
(Hare, Mazer) St. Michael's Hospital Center of Excellence for Patient
Blood Management, Toronto, ON, Canada
(Hare, Mazer) Department of Physiology, University of Toronto, 30 Bond
Street, Toronto, ON M5B 1W8, Canada
(Hare, Connelly, Mazer) Keenan Research Centre for Biomedical Research, Li
Ka Shing Knowledge Institute, Toronto, ON, Canada
(Honavar, Patel) Department of Pathology, Center for Free Radical Biology,
University of Alabama at Birmingham, Birmingham, AL, United States
(Welker, Tam) Department of Perfusion, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Romaschin, Connelly) Department of Laboratory Medicine and Pathobiology,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Connelly) Department of Medicine, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Beattie) Department of Anesthesia, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
Title
Potential biomarkers of tissue hypoxia during acute hemodilutional anemia
in cardiac surgery: A prospective study to assess tissue hypoxia as a
mechanism of organ injury.
Source
Canadian Journal of Anesthesia. 65 (8) (pp 901-913), 2018. Date of
Publication: 01 Aug 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hemodilutional anemia is associated with acute kidney injury
(AKI) and mortality in patients undergoing cardiac surgery by mechanisms
that may include tissue hypoxia. Our hypothesis was to assess if changes
in the potential hypoxic biomarkers, including methemoglobin and
erythropoietin, correlated with a decrease in hemoglobin (Hb)
concentration following hemodilution on cardiopulmonary bypass (CPB).
Methods: Arterial blood samples were taken from patients (n = 64)
undergoing heart surgery and CPB at baseline, during CPB, following CPB,
and in the intensive care unit (ICU). Potential hypoxic biomarkers were
measured, including methemoglobin, plasma Hb, and erythropoietin. Data
were analyzed by repeated measures one-way analysis of variance on ranks
and linear regression. Results: Hemoglobin levels decreased following CPB
and methemoglobin increased in the ICU (P < 0.001 for both). No
correlation was observed between the change in Hb and methemoglobin (P =
0.23). By contrast, reduced Hb on CPB correlated with increased lactate,
reduced pH, and increased erythropoietin levels following CPB (P <= 0.004
for all). Increased plasma Hb (P < 0.001) also correlated with plasma
erythropoietin levels (P < 0.001). Conclusion: These data support the
hypothesis that erythropoietin rather than methemoglobin is a potential
biomarker of anemia-induced tissue hypoxia. The observed relationships
between decreased Hb during CPB and the increase in lactate, reduced pH,
and increase in erythropoietin levels suggest that early changes in plasma
erythropoietin may be a pragmatic early biomarker of anemia-induced renal
hypoxia. Further study is required to determine if anemia-induced
increases in erythropoietin may predict AKI in patients undergoing cardiac
surgery. Trial registration: www.clinicaltrials.gov (NCT01883713).
Registered 21 June 2013.<br/>Copyright &#xa9; 2018, Canadian
Anesthesiologists' Society.

<19>
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).

<20>
Accession Number
622942127
Author
Petersen C.; Wetterslev J.; Meyhoff C.S.
Institution
(Petersen, Meyhoff) Department of Anaesthesia and Intensive Care,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
Title
Perioperative hyperoxia and post-operative cardiac complications in adults
undergoing non-cardiac surgery: Systematic review protocol.
Source
Acta Anaesthesiologica Scandinavica. 62 (7) (pp 1014-1019), 2018. Date of
Publication: August 2018.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Oxygen therapy is used liberally for all patients undergoing
anaesthesia. Recent studies have raised concerns that it may not be
without complications when arterial oxygen concentrations reach
supranormal concentrations (hyperoxia). Studies of oxygen therapy have
raised concerns that the risk of myocardial injury and infarction is
elevated in patients with hyperoxia due to vasoconstriction and formation
of reactive oxygen species. Due to lack of symptoms or silent ischaemia,
post-operative myocardial injury may be missed clinically. In some
studies, perioperative hyperoxia has been linked to increased long-term
mortality, but cardiac complications are sparsely evaluated. The aim of
this review is to summarize current evidence to assess the risk and
benefits of perioperative hyperoxia on post-operative cardiac
complications. Methods: This systematic review will include meta-analyses
and Trial Sequential Analyses. We will include randomized clinical trials
with patients undergoing non-cardiac surgery if the allocation separates
patients into a target of either higher (above 0.60) or lower (below 0.40)
inspired oxygen fraction. To minimize the risk of systematic error, we
will assess the risk of bias of the included trials using the Cochrane
Risk of Bias Tool. The overall quality of evidence for each outcome will
be assessed with the Grading of Recommendation, Assessment, Development
and Evaluation (GRADE). Discussion: This systematic review will provide
data on a severe, albeit rare, potential risk of oxygen therapy. We will
do a trial sequential analysis to assess the robustness of results as well
as help estimate the required patient size for future clinical
trials.<br/>Copyright &#xa9; 2018 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd

<21>
Accession Number
618173018
Author
Perrotti A.; Chenevier-Gobeaux C.; Ecarnot F.; Barrucand B.; Lassalle P.;
Dorigo E.; Chocron S.
Institution
(Perrotti, Barrucand, Dorigo, Chocron) Departments of Thoracic and
Cardiovascular Surgery, University Hospital Jean Minjoz, Boulevard
Fleming, Besancon FR-25000, France
(Ecarnot) Cardiology, EA3920, University Hospital Jean Minjoz, Besancon,
France
(Chenevier-Gobeaux) Department of Automated Biological Diagnosis, Hopitaux
Universitaires Paris Centre (HUPC), Assistance Publique des Hopitaux de
Paris (AP-HP), Paris, France
(Lassalle) Institut Pasteur de Lille, Center for Infection and Immunity of
Lille, Lille, France
Title
Relevance of Endothelial Cell-Specific Molecule 1 (Endocan) Plasma Levels
for Predicting Pulmonary Infection after Cardiac Surgery in Chronic Kidney
Disease Patients: The Endolung Pilot Study.
Source
CardioRenal Medicine. 8 (1) (pp 1-8), 2017. Date of Publication: 01 Dec
2017.
Publisher
S. Karger AG
Abstract
Objectives: This pilot study aimed to evaluate the relevance of endocan
plasma levels for predicting pulmonary infection after cardiac surgery in
patients with chronic kidney disease (CKD). Methods: Serum collected in a
previous prospective cohort study (from 166 patients with preoperative CKD
who underwent cardiac surgery) was used. Five patients with postoperative
pulmonary infection were compared with 15 randomly selected CKD patients
with an uneventful outcome. Blood samples were tested at 4 time points
(preoperatively and 6, 12, and 24 h after the end of surgery). Endocan,
procalcitonin, and C-reactive protein plasma levels were compared between
the two groups. Results: At 6 h, the patients with pulmonary infection had
significantly higher levels of endocan than the patients without pulmonary
infection (24.2 +/- 15.6 vs. 6.4 +/- 3.2 ng/mL; p = 0.03). A receiver
operating characteristic curve analysis showed 80% sensitivity and 100%
specificity for endocan to predict pulmonary infection (area under the
curve 0.84), with a cutoff value of 15.9 ng/mL. The time saved by
assessment of the endocan dosage compared to a clinical diagnosis of
pulmonary infection was 47 h. Conclusion: This pilot study showed that a
specific study to assess the link between endocan plasma levels and
pulmonary infection after cardiac surgery in CKD patients is of potential
utility.<br/>&#xa9; 2017 S. Karger AG, Basel. Copyright: All rights
reserved.

<22>
Accession Number
623021950
Author
Elhendy A.
Institution
(Elhendy) Marshfield Clinic, Marshfield, WI, United States
Title
Non-invasive evaluation of atherosclerotic coronary artery disease in
diabetic patients by current functional and anatomical imaging modalities.
Source
Atherosclerosis Supplements. Conference: 18th International Symposium on
Atherosclerosis, ISA 2018. Canada. 32 (pp 158-159), 2018. Date of
Publication: June 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Diabetes mellitus is a major risk factor for atherosclerotic
coronary artery disease and adverse cardiovascular outcome. Coronary
artery disease is often silent or may present with atypical symptoms due
to autonomic neuropathy and therefore, many patients with minimal or no
symptoms remain at high risk The aim of this review is to discuss the role
of cardiovascular imaging modalities in the diagnosis and risk
stratification of coronary artery disease in diabetic patients. Methods:
We reviewed current literature of original studies on diagnosis and risk
stratification of coronary artery disease in diabetic patients by stress
and anatomical non-invasive imaging. Results: In patients who are able to
exercise, a normal stress echocardio-gram identifies patients at low risk
The pattern of multi-vessel abnormality is associated with a dramatic
increase in cardiac events with approximately a third of these patients
developing cardiac death and non-fatal myocardial infarction within a few
years after the test. Myocardial contrast imaging during dobutamine stress
test is a promising tool and offers improved sensitivity at submaximal
heart rate and allows incremental risk assessment. Myocardial perfusion
imaging with radionuclide techniques is widely used and has a well
established diagnostic and prognostic value. However, even after a normal
study, diabetic patients remain at higher of cardiac events compared to
non diabetic patients with a normal imaging study The low risk warrantee
period after a normal imaging study is shorter in diabetic versus non
diabetic patients which necessitate closer follow up of high risk
patients. Coronary calcium scoring is useful in detecting early phase of
atherosclerosis and provides objective information to predict cardiac
events. CT angiography may serve as a gate keeper for invasive angiography
with a high sensitivity in patients with equivocal or non-feasible stress
test. Prognostic value is established, but information is largely
influenced by early revascularization. Limitations include artifacts,
irradiation and risk of contrast nephropathy. Conclusions: In patients
with diabetes mellitus, a comprehensive assessment of the advantages and
limitations of stress and functional imaging techniques can provide
guidance for risk stratification, implementation of aggressive preventive
therapy and selection of those who may benefit from coronary
revascularization.

<23>
Accession Number
623020863
Author
Pomeshkina S.; Pomeshkin E.; Barbarash O.
Institution
(Pomeshkina, Barbarash) Federal State Budgetary Institution Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian
Federation
(Pomeshkin) Kemerovo State Medical University, Kemerovo, Russian
Federation
Title
Exercise trainings and erectile dysfunction in patients after coronary
artery bypass grafting.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S32-S33), 2018. Date of Publication:
June 2018.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To assess the effects of physical training on erectile
dysfunction (ED) in patients undergoing coronary artery bypass grafting
(CABG). Methods: 129 patients with coronary artery disease and erectile
dysfunction aged 55.8 +/- 5.6 years referred to CABG were included in the
study. One month after CABG, all patients were randomized to two groups.
Group 1 patients were referred to supervised cycling training (phase 3
rehabilitation, SCT) in the rehabilitation center (n = 61), and Group 2
patients did not undergo any phase 3 rehabilitation program (n = 68). The
study groups were comparable in main clinical and demographic data.
Patients undergoing SCT have 3 sessions (at least 30 min) per week for 3
months. Control visits were at 1 month, 4 months and 1 year after CABG.
Erectile function was assessed using the "International Index of Erectile
Dysfunction" questionnaire. Nocturnal penile tumescence was assessed by
the NEVA System. Results: The comparative analysis aimed at evaluating
erectile function by the IIED reported that there were more patients with
improved erectile function in Group 1 undergoing phase 3 rehabilitation
program 4 months after CABG, compared to patients who did not receive
phase 3 rehabilitation program (24 (39%) vs. 6 (9%), p = 0.0001,
respectively). However, 1 year after CABG, the number of patients with
improved erectile function who underwent SCT remained the same, compared
to previous control visits, but the differences with patients who did not
receive any rehabilitation program became less pronounced (17 (28%) vs. 4
(6%), p = 0, 03, respectively). Four months after CABG, the number of
nocturnal penile tumescence (NTP) increased in the SCT group compared to
initial values (from 4.4 +/- 1.3 to 6.3 +/- 2.2, p= 0.02). But, 1 year
after CABG, there was a decrease in their number in comparison with the 4-
month data (5.0 +/- 1.9, p = 0.04), but their quantity was still higher in
comparison with the initial data (p = 0,04). 4 months after CABG, the
number of NTPs in patients without exercise trainings remained similar in
comparison with initial data (3.9 +/- 1.4 vs. 3.4 +/- 0.9). 1 year after
CABG, there was a tendency towards a decrease in the number of NTPs in
comparison with the values obtained 4 months after CABG (3.4 +/- 0.9 vs.
2.8 +/- 1.1, o = 0,06). In addition, 4 months and 1 year after CABG, the
number of NTPs in patients with SCT was significantly higher than in the
control group. But, 1 year after CABG, these differences between the
groups became less significant (p = 0.003 vs. p = 0.02, respectively).
Conclusion: The 3-month supervised cycling training allows optimizing
erectile function, assessed by the "International Index of Erectile
Function", and increasing the number of nocturnal penile tumescence. But,
the effects of exercise trainings are not long lasting suggesting the need
to improve phase 3 rehabilitation.

<24>
Accession Number
623020845
Author
Pomeshkina S.; Bezzubova V.; Barbarash O.
Institution
(Pomeshkina, Bezzubova, Barbarash) Federal State Budgetary Institution
Research Institute for Complex Issues of Cardiovascular Diseases,
Kemerovo, Russian Federation
Title
Impact of different exercise-based cardiac rehabilitation programs on
exercise adherence.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S32), 2018. Date of Publication: June
2018.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate the effectiveness of different outpatient
exercise-based cardiac rehabilitation programs on exercise adherence in
patients after coronary artery bypass grafting (CABG). Methods: 134
patients (the mean age 56.8 +/- 5.5 years) with coronary artery disease
who have undergone CABG were included in the study. 1 month after
completing phase 2 rehabilitation after CABG, all patients were randomized
into two groups, comparable in the main clinical and demographic data, to
undergo phase 3 rehabilitation program. Group 1 patients (n=62) were
referred to supervised cycling trainings (SCT) in the rehabilitation
center, whereas Group 2 patients (n=72) received home-based walking
training (HBWT). Patients in both groups have 3 sessions (at least 30 min)
per week for 3 months. Control visits were at 1 month, 4 months and 1 year
after CABG. All patients underwent echocardiography (ECHO-CG), bicycle
ergometry (BE) and the assessment of exercise adherence in all control
visits. Results: Importantly, 12 patients refused to sign written informed
consent, arguing about the lack of time to undergo exercise-based
rehabilitation, the presence of family problems, or having enough physical
load at home. During the follow-up, 10 patients were lost mostly in Group
1 undergoing SCT (p = 0.03). There were no significant differences found
in the number of patients undergoing phase 3 rehabilitation program 3
months after CABG. However, only 20% of patients in both study groups
visited 75 - 100% of all exercise training sessions. 20 (32%) patients
undergoing SCT and 20 (27%) patients undergoing HBWT visited only 50 - 74%
of exercise trainings, and 20 (32%) patients with SCT and 26 (36%) with
HBWT attended 25 - 49% of the exercise training sessions. Less than 25% of
the training sessions were attended by 11 (16%) patients with SCT and 10
(14%) patients with HBWT. 1 year after CABG, exercise adherence decreased
in Group 1 undergoing SCT, whereas in Group 2 undergoing HBWT it remained
similar to previous control visits (19% vs. 31%, p = 0.04, respectively).
Conclusion: Patients who have undergone CABG are not sufficiently adherent
to exercisebased cardiac rehabilitation programs, regardless of their type
(home-based rehabilitation or supervised one). Nevertheless, home-based
walking training has a beneficial advantage over supervised cycling
training at the rehabilitation center, reporting higher adherence to phase
3 rehabilitation program 3 month and 1 year after CABG.

<25>
Accession Number
623020655
Author
Ed De Kluiver E.P.
Institution
(Ed De Kluiver) Isala Clinics, Isala Heart Centre, Zwolle, Netherlands
Title
A EUropean study on effectiveness and sustainability of current CArdiac
REhabilitation programmes in the Elderly.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S102-S103), 2018. Date of Publication:
June 2018.
Publisher
SAGE Publications Inc.
Abstract
Background Cardiac rehabilitation (CR) is an evidence based intervention
to increase survival and quality of life. Yet studies consistently show
that elderly patients are less referred to CR, have less uptake and more
often drop out of CR programmes. Objective The aim of EU-CaRE is to map
the efficiency of current CR of the elderly in Europe, and to investigate
whether mCR is an effective alternative in terms of efficacy, adherence
and sustainability. Methods and results EU-CaRE includes patients aged 65
or older with ischemic heart disease or who have undergone heart valve
surgery. Patients participating in CR programmes in 8 regions of Europe
will be included. 238 patients declining regular CR will be included in
the RCT and randomised in two study arms: 1 Group receives a
telemonitoring guided programme while the control group receives only
usual care. (See flow chart in figure 1). The primary outcome (follow-up
12 months) is VO2peak and secondary outcomes include variables describing
CR uptake, adherence, efficacy and sustainability. Screening and enrolment
Preliminary screening and enrolment data are presented in table 1.
Conclusion The project will provide important information to improve CR in
the elderly. The EU-CaRE RCT is the first European multicentre study of
mCR as an alternative for elderly patients not attending usual CR. (Table
presented) (Figure presented).

<26>
Accession Number
623020500
Author
Straw S.; Baig W.; Gillott R.; Pirone F.; Sandoe J.
Institution
(Straw, Baig, Gillott, Pirone, Sandoe) Leeds Teaching Hospitals Trust,
United Kingdom
Title
Infective endocarditis and intravenous drug use: A descriptive study.
Source
Heart. Conference: British Cardiovascular Society Annual Conference, BCS
2018. United Kingdom. 104 (Supplement 6) (pp A65), 2018. Date of
Publication: June 2018.
Publisher
BMJ Publishing Group
Abstract
Background Intravenous drug use (IVDU) is a recognised predisposition for
the development of infective endocarditis (IE). There is controversy
regarding surgery for these patients because of relapse due to
non-compliance with medical therapy and recurrence due to ongoing IVDU.
This study aims to describe the outcomes in a large cohort of patients
referred to a single tertiary centre. Methods Between 01/01/06 and
31/12/16 consecutive patients referred to the endocarditis
multidisciplinary team were identified from our electronic database.
Patients were included if they were either Duke's confirmed or Duke's
possible and treated for IE and IVDU within 90 days. Affected valves and
microorganisms were recorded, as well as indications for, type and number
of operations. Outcomes were relapse (re-infection with same microorganism
within 1 year), recurrence (infection with different organism, or same
organism beyond 1 year), further surgical intervention and all-cause
mortality. Results In total, there were 105 episodes in 92 patients; 92
episodes were Duke's definite, and 13 Duke's possible. The incidence of IE
varied considerably year-on-year, but median age increased. Staphylococcus
aureus (59) was the most frequently observed pathogen, followed by
Streptococcus spp. (31), Enterococcus spp. (8), Staphylococcus.
epidermidis (2), Candida spp. (2), Pseudomonas aeruginosa (1) and
Corynebacterium diphtheriae (1). 7 episodes (6.67%) were culture negative.
Ninetyone episodes affected native values and 10, prosthetic valves. More
episodes affected left sided structures (78) than right (40) and the
mitral valve was most commonly implicated (42), followed by tricuspid
(38), aortic (36) and pulmonary (2). Pacemaker lead infection occurred in
one patient. Forty-eight (45.7%) episodes required surgery; bioprosthetic
valves for left sided disease were commonest with 17 aortic and 10 mitral
valves compared to 6 and 8 mechanical valves respectively. Intervention
for right sided disease was uncommon, with only 8 bioprosthetic tricuspid
valves and one abandoned attempt at pulmonary valve surgery. Only one
patient underwent further surgery following late recurrence with S.
epidermidis affecting a bioprosthetic mitral valve. Three (3.26%) patients
relapsed, 1 patient relapsed twice. 12 (13.0%) patients had recurrence,
one patient had two recurrences. All-cause mortality was 4.35% at 30 days,
26.4% at 1 year and 36.4% at 3 years. Unadjusted mortality was higher in
patients who underwent surgery, reflecting differences at baseline.
Implications Contrary to common perception, IE in IVDU patients affected
left sided structures more commonly than and right and surgery was
commonly indicated. The rate of relapse was low, but the recurrence rate
was high. All-cause mortality following an episode of IE is high, and so
surgery remains controversial, especially in patients who continue IVDU.

<27>
Accession Number
623020420
Author
Gaisin I.R.; Abbazova D.V.; Shilina L.V.; Vavilkina Z.V.; Smirnova E.S.
Institution
(Gaisin) Izhevsk State Medical Academy, Izhevsk, Russian Federation
(Abbazova, Shilina, Vavilkina, Smirnova) Clinical Diagnostic Centre of the
Udmurt Republic, Izhevsk, Russian Federation
Title
Magnesium orotate is a promising therapy for not closed atrial or
ventricular septal defect in pregnant patients.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S99), 2018. Date of Publication: June
2018.
Publisher
SAGE Publications Inc.
Abstract
Background: According to contemporary guidelines, women with unoperated
atrial or ventricular septal defect (ASD/VSD) have small increased risk of
maternal mortality or moderate increase in morbidity and follow-up every
trimester is recommended. Nevertheless, maternal cardiac complications
occur in 12% of completed pregnancies. Offspring complications, including
offspring mortality (4%), are more frequent than in the general
population. Magnesium orotate (MO) is a non-steroidal anabolic plus Mg2+
approved for pregnant patients. Purpose: To evaluate the safety and
efficacy of MO in pregnant women with not closed ASD/ AVD. Methods: We
studied 48 consecutive women with unoperated ASD (n=30) or AVD (n=18),
aged 28+/-7 years, who were referred to our regional
cardiology/cardiosurgery clinic before conception (n=20) or during the
first two months of pregnancy (n=28). Patients were randomized to control
group with conventional follow-up (n=24) and MO-group (n=24); in addition
to standard therapy (beta-blockers, diuretics, digoxin, if necessary),
they received magnesium orotate from 2nd trimester 1000 mg t.i.d. for 1
week, followed by 500 mg t.i.d. The primary endpoints were a major adverse
cardiovascular event (MACE), which included death, heart failure (HF),
thrombo-embolic event, pulmonary arterial hypertension (PAH), and
arrhythmia and pregnancy outcomes. Baseline and outcome data were analysed
and compared for control patients vs. MO-group. Results: At baseline,
there were no significant differences between control and MO-group. NYHA
functional class I had 20 (83.3%) and 19 (79.2%) patients, NYHA II had 4
(16.7%) and 5 (20.8%) patients, respectively (p>0.05). Atrial and/or
ventricular ectopic beats had 22 (91.7%) and 24 (100%) patients (p>0.05).
No maternal mortality and no thrombo-embolic event occurred in both
groups. In 11 control patients, at least one MACE occurred (45.8%): 7
worsened HF (29.2%), 2 had atrial flutter (8.3%), 1 had a ventricular
tachyarrhythmia (4.2%), and 1 patient developed PAH (4.2%). In MO-group,
no patient developed a MACE (p=0.008). MO reduced the HF occurrence during
pregnancy (p=0.0035). Improvements were noted in control-adjusted changes
in HF signs (-58.5%; p=0.0022) and in frequency of ectopic beats (-35.6%;
p=0.028). Perinatal mortality rate was 0 in the cohort, premature birth
occurred in 6 controls (25%) followed by being small for gestational age
(12.5%) vs. 0 in MO-group (p=0.035). MO had no maternal and offspring
adverse effects. Conclusions: Long-term magnesium orotate therapy for
pregnant patients with not closed ASD/AVD prevents MACEs, improves symptom
status, and contributes to successful obstetric and foetal outcomes. This
study provides the evidence that metabolically acting magnesium orotate
may be a new additional therapy for pregnant patients with unoperated
congenital heart disease.

<28>
Accession Number
623020208
Author
Adnan A.; Jadhav S.; Gondal M.; Harcombe A.
Institution
(Adnan, Jadhav, Gondal, Harcombe) Nottingham University Hospitals, United
Kingdom
Title
A comparative study of activated clotting time (ACT) achieved by weight
adjusted and fixed dose of unfractionated heparin during cardiac
catheterization procedures.
Source
Heart. Conference: British Cardiovascular Society Annual Conference, BCS
2018. United Kingdom. 104 (Supplement 6) (pp A57-A58), 2018. Date of
Publication: June 2018.
Publisher
BMJ Publishing Group
Abstract
Background The dose of unfractionated heparin (UFH) during cardiac
catheterisation procedures is still an area of debate. The ESC guideline
recommends using a weight adjusted dose where as the AHA guideline
recommends adjusting UFH dose according to target ACT. These
recommendations are based on older and mostly non randomised studies. A
recent metaanalysis of the randomised trials looking into optimum ACT
level during coronary intervention was inconclusive and recommended more
research in this area. Aim The aim of this study was to determine whether
there was any significant difference between ACT achieved with either
weight adjusted or fixed dose of UFH during cardiac catheterisation.
Methods Two operators used heparin at 70 IU/Kg in the weight adjusted arm
and 5000 IU in the fixed dose arm respectively for most of there cases
over a period of 13 months from December 2014 to December 2015. ACT was
measured at baseline and then at 2, 15 and then at 15 min intervals with
further dose of heparin given at the operator's discretion. The local
database was searched retrospectively and cases were included if baseline
and two of the 2, 15 and 30 min ACT were available. ACT values after
further dose of UFH were excluded. ACT values were compared between the
two groups. T test or Mann-Whitney u test was used for continues variables
and Chi square test was used for categorical variables. Result 93 cases in
the weight adjusted group and 166 cases in the fixed dose group met the
inclusion criteria. The baseline characteristics were similar as shown in
table 1. The weight adjusted group received more heparin (Mean difference
842 IU, 95% CI 633-1051, p<0.001). There were no difference in median ACTs
at 2 min (n=91/161; 237, IQR 215-267 vs 233, IQR 210-291; p=0.97) and 15
min (n=57/118; 218, IQR 198-247 vs 226, IQR 204-257; p=0.21) but at 30 min
post heparin, ACT for the fixed dose group was higher (n=14/75, 196, IQR
174-228 vs 225, 208-258; p=0.018). Figure 1 shows the trend of ACT over
time with peak ACT reached at 2 minuts in both groups. (Table Presented)
Conclusion This study shows that a fixed dose of 5000 IU of UFH archives
comparable or slightly higher ACT over a period of time compared to a
weight adjusted 70 IU/Kg dose while reducing the total dose of heparin
given to patient. (Figure Presented).

<29>
Accession Number
623020185
Author
Caio Teixeira Santos C.T.; Da Silva C.P.O.; Dos Anjos I.L.P.B.; Bandeira
L.L.B.; Macedo T.L.S.; Rebello D.M.; Queiroz A.C.R.; Aragao A.A.B.;
Vilagra M.M.; Vilagra S.M.B.V.; Rocha M.A.; Rosa R.B.R.; De Oliveira
M.G.F.; Freire D.O.; Aragao I.P.B.
Institution
(Caio Teixeira Santos, Da Silva, Dos Anjos, Bandeira, Macedo, Rebello,
Queiroz, Vilagra, Vilagra, Rocha, Rosa, De Oliveira, Freire, Aragao)
Universidade Severino Sombra - USS, Rio de Janeiro, Brazil
(Aragao) Universidade Estadual Do Rio de Janeiro, Rio de Janeiro, Brazil
Title
Myocardial revascularization surgery and percutaneous approach to left
coronary artery tron injury.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S118), 2018. Date of Publication: June
2018.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Cardiovascular atherosclerotic disease is the major cause of
morbidity and mortality in Brazil and in the world, with 36% of deaths in
adults between 50 and 64 years old and 42% in people older than 65 years.
Lesions of the left coronary artery (LLCA) tend to myocardial
revascularization surgery (MRS) as the main therapeutic alternative. As
percutaneous techniques evolved, the frequency of this method has
increased in medical practice, being also adopted as an option for
patients with prohibitive surgical risk. Objective: To analyze the
singularities between the intervention of LLCA by MRS and percutaneous
intervention (PI) according to the current trials. Materials and Methods:
A systematic review of the literature was carried out based on seven
articles, between 2007 and 2017, in the archives of sites such as Scielo,
Lilacs and PubMed. Results: The PRECOMBAT study randomized 600 patients
with lesions greater than 50% in the region to receive the two
interventions. It was observed that PI was not inferior to MRS, presenting
a composite rate of combined primary events of 8.7 and 6.7%, p = 0.001.
The composite events at 24 months had values of 12.2 and 8.1%, p = 0.12
for the respective groups and after that period, the occurrence of stroke,
AMI and death, with rates of 4.4 and 4.7%, p = 0.83 indicating little
difference. The combined analysis with the SYNTAX trial shows that the
incidence of cerebrovascular and cardiac events at the end of five years
was 23% in MRS and 28.3% in PI. PI was associated with a 67% reduction in
cardiac mortality and 60% in all causes in relation to surgery. The LEMANS
study with 52 patients with PI and 53 with MRS indicates, at 10 years of
follow-up, higher ejection fraction rates for PI - 54.9 +/- 8.3% and 49.8
+/- 10.3%. Mortality is 21.6 and 30.2%. The possibility of 14-year
survival was similar in both groups, with 74.2% and 67.5%, p = 0.34 and
the same was observed with event-free survival, with 34.7% vs. 22.1% p =
0.06. The frequency of infarcts and strokes, as well as the need for new
revascularizations did not have significant discrepancies, with values of
8.7% and 10.4%, p = 0.62; 4.3% and 6.3% p = 0.62 and 74.2% and 67.5%, p =
0.34. Concusions: Although MRS is more indicated for therapy, the cited
studies demonstrate the similarity in results with the percutaneous
approach. Patients with LLCA may have angioplasty as an effective and
viable route compared to long-term surgery, and therefore, it is valid in
the group.

<30>
Accession Number
623020050
Author
Caio Teixeira Santos C.T.; Da Silva C.P.O.; Dos Anjos I.L.P.B.; Bandeira
L.L.B.; Macedo T.L.S.; Rebello D.M.; Queiroz A.C.R.; Aragao A.A.B.;
Vilagra M.M.; Vilagra S.M.B.V.; Rocha M.A.; Aragao I.P.B.
Institution
(Caio Teixeira Santos, Da Silva, Dos Anjos, Bandeira, Macedo, Rebello,
Queiroz, Vilagra, Vilagra, Rocha, Aragao) Universidade Severino Sombra -
USS, Rio de Janeiro, Brazil
(Aragao) Universidade Estadual Do Rio de Janeiro, Rio de Janeiro, Brazil
Title
Changes in cardiovascular surgery from a religious concept.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2018.
Slovenia. 25 (2 Supplement 1) (pp S116-S117), 2018. Date of Publication:
June 2018.
Publisher
SAGE Publications Inc.
Abstract
Introduction: There are an estimated 8,220,105 Jehovah's Witnesses
worldwide, representing about 0.11% of the world's population. The refusal
of blood challenged a medicine with large studies of cardiovascular
surgery without blood transfusion, which is considered a determinant for a
development of techniques and tolerance towards ideologies. Objectives: To
demonstrate an influence of a religious conception in surgical practice,
as well as the opposite, and reaffirm the concept of patient autonomy
backed by the code of medical ethics. Materials and Methods: Systematic
review (PUBMED, EMBASE, SCIELO, LILACS) of the literature on an influence
of a religious conception on cardiovascular surgeries without blood
transfusion, minimally invasive and percutaneous interventions. Results:
Open heart surgery began in 1953 with the closure of interactive and
evolutionary communication to the present day, from transfusion to
minimally invasive methods and percutaneous interventions. A technique to
cool the patient to their oxygen needs during surgery - hypotensive
anesthesia - as well as a use of laser scalpel during the procedure. In
1977, a series of 202 serial and consecutive experiences of 542 Jehovah's
Witness patients ranging from 1 day to 89 years of age were reported.
Mortality in 30 days was 9.4%, and in 362 patients who temporarily
required cardiopulmonary bypass, was 10.7%, and in the valve replacement
(single or double), 13.5% among 126 patients. The incidence of haemorrhage
in the perioperative period was not higher, as complications were less
common in comparison to those who received. The literature demonstrates
that cardiovascular surgeries without blood transfusion are safe and that
has favorably impacted both religious conception and the general
population by reducing surgical time, decreasing a need for hemotherapy,
hospitalization and cost. Conclusions: The religious concept about the
procedure influenced positively in the perioperative process and vice
versa. Cardiovascular surgery progressively evolves to minimally invasive
methods until the percutaneous procedures, which provide a decrease in
morbidity and mortality.

<31>
Accession Number
622946700
Author
Jamshidi M.R.; Qatrehsamany F.; Golifarhood G.; Falakaflaki B.; Mehrad H.
Institution
(Jamshidi, Qatrehsamany) Department of Anesthesiology, Mousavy Hospital,
Zanjan University of Medical Sciences, Zanjan, Iran, Islamic Republic of
(Golifarhood) Department of Epidemiology, School of Public Health, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Falakaflaki) Department of Pediathric Medicine, Faculty of Medicine,
Zanjan University of Medical Sciences, Zanjan, Iran, Islamic Republic of
(Mehrad) Faculty of Medicine, Zanjan University of Medical Sciences,
Zanjan, Iran, Islamic Republic of
Title
Comparison of infusion and bolus injections of phenylephrine on
hemodynamic stability during cardiopulmonary bypass and their effects on
bicarbonate and lactate blood level.
Source
Eurasian Journal of Analytical Chemistry. 13 (3) (no pagination), 2018.
Article Number: em15. Date of Publication: 2018.
Publisher
Modestum LTD (E-mail: ejac@eurasianjournals.com)
Abstract
During open cardiac surgery that the heart should be suspended, for
preventing damage of other tissues and organs, vasopressors drugs have
been used for maintenance of blood pressure. The aim of this study was the
comparison of infusion and bolus injections of phenylephrine on
hemodynamic stability during cardiopulmonary bypass and their effects on
bicarbonate and lactate blood level. In this randomized double-blind
clinical trail, 88 patients who were candidate for on-pump coronary artery
bypass grafting, were considered and then divided into the infusion and
bolus groups. In the beginning and at the end of study, the blood pressure
and laboratorial variables was recorded and finally analyzed by SPSS
software. According to the obtained information, out of 88 examined
patients, 52.2% of them were received phenylephrine in bolus regimen while
47.8% were received phenylephrine in infusion regimen. The mean age of
patients in the bolus and infusion groups was 56.59 +/- 19.5 and 59.2 +/-
10.16 years, respectively. The results show that there were not
statistically significant differences in mean values of the MAP, PH, HCO3
and lactate between two groups. The results show that the infusion
injection of phenylephrine has no advantage than bolus injection on
hemodynamic stability during cardiac pulmonary bypass, and on the
bicarbonate and lactate blood level.<br/>Copyright &#xa9; Authors.

<32>
Accession Number
622994086
Author
McClure G.; Belley-Cote E.; Um K.; Gupta S.; Bouhout I.; Lortie H.;
Alradaddi H.; Alsagheir A.; McIntyre W.; Ouzounian M.; Chu M.; Parry D.;
El Hamamsy I.; Whitlock R.
Institution
(McClure, Belley-Cote, Um, Gupta, Bouhout, Lortie, Alradaddi, Alsagheir,
McIntyre, Ouzounian, Chu, Parry, El Hamamsy, Whitlock) OakvilleONCanada
Title
The ross procedure: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S85-S86), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: In young adult patients with aortic valve disease treated with
conventional aortic valve replacement (AVR), expected lifespan
post-operatively is decreased by up to 20 years. The Ross procedure
presents an alternative to conventional treatment that aims to provide a
durable valve substitute without the need for lifelong anticoagulation.
Recent evidence suggests the Ross procedure may restore life expectancy
equivalent to that of the age- and gender-matched general population.
However, concerns regarding increased perioperative risk and early
pulmonary valve re-intervention have limited its uptake. In this
systematic review and metaanalysis, we aimed to compare the Ross procedure
to conventional AVR with regards to mortality, reintervention, and adverse
valve-related events. METHODS: We searched MEDLINE, EMBASE, and Cochrane
CENTRAL from inception to February 2017 for observational studies (n>50)
or randomized controlled trials (RCTs) evaluating the Ross procedure
compared to any conventional AVR (including homograft, mechanical, and
biologic prostheses) in adult patients (+/-16 years of age). We performed
screening, full-text assessment, risk-ofbias evaluation and
data-collection independently and in duplicate. We evaluated risk-of-bias
for observational studies with the ROBINS-I tool and with the Cochrane
tool for RCTs, assessed quality of evidence with the GRADE framework and
pooled data using a random effects model. RESULTS: Twelve observational
cohort studies and two RCTs were identified (n=5456). Only two
observational studies were considered to be at low risk of bias. The Ross
procedure was associated with a decrease in mortality at latest follow-up
in both observational (mean follow-up = 3.6 years) and RCT (mean follow-up
= 10.4 months) data; respectively RR 0.50 (95%CI[0.31,0.80], I2=68%, very
low quality) and RR 0.51 (95%CI[0.06,4.64], I2=66%, low quality). We found
no significant difference in the risk for operated valve reintervention in
observational studies (RR 1.45, 95%CI[0.87,2.42], I2=55%, very low
quality] and RCTs (RR 0.86, 95%CI [0.07,11.46], I2=68%, low quality). In a
subgroup analysis stratifying based on conventional AVR comparator type
mortality benefit persisted when compared to mechanical valves alone and
reoperation results were consistent in all subgroups. CONCLUSION: Based on
very low quality observational evidence and limited RCT data, the Ross
procedure provides significant mortality benefit with no increased risk
for reoperation when compared to conventional AVR options. Although
high-quality randomized literature is required to validate these findings
before stronger recommendations can be made, the Ross procedure appears
safe for use in young adult patients and should be discussed with patients
at the time of operative planning and decision-making. (Figure Presented).

<33>
Accession Number
622994058
Author
AlTurki A.; Marafi M.; Alturki H.; Thanassoulis G.; Tardif J.; Huynh T.
Institution
(AlTurki, Marafi, Alturki, Thanassoulis, Tardif, Huynh) MontrealQCCanada
Title
The effect of proprotein convertase subtilisin/kexin type 9 antibodies on
mortality and cardiovascular outcomes: A meta-analysis of randomized
controlled trials.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S120),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) lowering is a
cornerstone in the prevention of coronary artery disease (CAD). Proprotein
convertase subtilisin/kexin type 9 (PCSK9) inhibition by monoclonal
antibodies has been shown to reduce LDL-C but its effect on cardiovascular
(CV) outcomes has not been fully described. The aim of this study is to
assess the impact of PCSK9 inhibition on mortality and CV outcomes by
pooling data from all available RCTs with any PCSK9 inhibitor. METHODS: We
conducted a comprehensive search of electronic databases, up to April 5th
2017, for all randomizedcontrolled trials (RCT) comparing PCSK9 inhibition
to placebo or ezetimibe in patients with hyperlipidemia receiving
maximally tolerated statin for primary or secondary prevention. We
included only studies reporting CV outcomes in adult humans. We used
random-effects meta-analyses to summarize the studies. RESULTS: We
retained 17 RCTs enrolling 65,895 patients. There were ten, five and two
studies evaluating the effects of alirocumab, evolocumab and bococizumab
respectively. The comparator arm was placebo in 12 studies and ezetimibe
in five studies. Nine studies were completed predominantly for secondary
prevention of CAD; four were for predominantly primary prevention and four
were in familial hypercholesterolemia populations. There was no important
difference of baseline characteristics between the two comparison arms.
The mean age of patients ranged from 50 to 64 years in the PCSK9 group
compared to 52 to 63 years in the placebo/ ezetimibe group (females 38%
and 37%). Baseline LDL-C ranged from 2.4 to 5.6 mmol/l in the PCSK9 group
and from 2.4 to 5.7 in the placebo/ezetimibe group. The mean follow-up
ranged from 6 to 26 months. PCSK9 inhibition was not significantly
associated with reduction in total mortality and CV mortality (odds ratio
(OR):0.95; 95% confidence intervals (CI):0.78-1.16; p:0.61) and (OR:1.00;
CI:0.86-1.17; p:0.98), respectively. Use of a PCSK9 inhibitor was
associated with reductions in myocardial infarction (OR:0.81;
CI:0.66-0.98; p:0.0296), stroke (OR:0.76; CI:0.65-0.90; p=0.0008) and
coronary revascularization (OR:0.79; CI:0.72-0.586; p < 0.0001).
CONCLUSION: The addition of a PCSK9 inhibitor to maximally tolerated
statin was associated with reductions in myocardial infarction, stroke and
coronary revascularization. There was no significant impact of PCSK9
inhibition on allcause or cardiovascular mortality in primary and
secondary prevention in patients with stable CAD. (Table Presented).

<34>
Accession Number
622992723
Author
Chahal D.; Sepehry A.; Wright A.; Toma M.
Institution
(Chahal, Sepehry, Wright, Toma) QuesnelBCCanada
Title
The impact of left ventricular assist device infections on post cardiac
transplant survival: Systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S159),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Left ventricular assist devices (LVADs) improve survival for
patients with end stage heart failure while they await transplantation.
LVADs may develop complications, such as infections. Development of
infection decreases survival while on LVAD support. The impact that LVAD
related infections have on outcomes after transplantation is less studied.
We sought to determine if infection while on LVAD support negatively
influences clinical outcomes after cardiac transplantation. METHODS: We
searched Medline (1946 to 2016), Embase (1974 to 2016), and Cochrane
Central Register of Controlled Trials (to 2016) for eligible full text
studies. We also hand searched study bibliographies. Eligible studies
included those that identified LVAD related infections during support and
reported on outcomes after cardiac transplantation. Reviewers determined
quality and collected baseline and outcomes data. Meta-analyses of
post-transplant survival were conducted utilizing a random effects model.
RESULTS: Electronic search identified 2373 records; 13 cohort studies were
selected for analysis (n=6631, 82% male, mean age 50 +/- 14 years). 3718
continuous flow LVADs and 1752 pulsatile LVADs were identified. Of these,
2586 (39 %) developed LVAD related infections. Patients with LVAD related
infections were younger (49.7 +/- 13.1 vs. 52.5 +/- 12.5, p = 0.02), had
higher mean BMIs (28.5 vs. 26.6, p < 0.01), and longer LVAD support times
(252 days vs. 221 days, p < 0.01). LVAD infection patients also seemed to
have lower incidence of ischemic etiology of heart failure (40% vs. 44%).
Meta-analysis of all studies demonstrated significantly increased
post-transplant mortality in those patients who had a documented LVAD
infection (HR 1.3, 95% CI 1.16 e 1.46, p < 0.001) (Fig 1). Sub-group
meta-analyses by continuous flow and pulsatile device type demonstrated
significant hazard ratios (1.47, 95% CI 1.22 e 1.76, p < 0.001 and 1.71,
95% CI 1.19 e 2.45, p=0.004, respectively). Meta-analyses by driveline or
bloodstream infection type did not display significance, likely due to
small sample size. Sub-group meta-analyses by study size where greater
than 100 patients were included also revealed a significant hazard ratio
(HR 1.35, 95% CI 1.18 e 1.54, p < 0.001). Post-hoc meta-regression
revealed significant impact of age, BMI, ischemic etiology and LVAD
duration on posttransplant survival. CONCLUSION: Our data suggests that
LVAD related infections result in a 30% increase in post cardiac
transplantation mortality. Patients who develop LVAD infections have
higher BMIs and longer LVAD support times. Interventions aimed at reducing
infection rates during LVAD support could improve outcomes both before and
after cardiac transplantation. (Table Presented).

<35>
Accession Number
616575738
Author
Sabri M.R.; Bigdelian H.; Hosseinzadeh M.; Ahmadi A.; Ghaderian M.; Shoja
M.
Institution
(Sabri, Hosseinzadeh, Ahmadi, Ghaderian, Shoja) Pediatric Department,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Bigdelian) Pediatric Cardiac Surgery Department, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Sabri, Bigdelian, Hosseinzadeh, Ahmadi, Ghaderian) Pediatric Cardiology
Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran,
Islamic Republic of
Title
Comparison of the therapeutic effects and side effects of tadalafil and
sildenafil after surgery in young infants with pulmonary arterial
hypertension due to systemic-to-pulmonary shunts.
Source
Cardiology in the Young. 27 (9) (pp 1686-1693), 2017. Date of Publication:
01 Nov 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Young children with CHD and large systemic-to-pulmonary shunts eventually
develop pulmonary hypertension. At present, phosphodiesterase type-5
inhibitors such as sildenafil have been used to control pulmonary pressure
before and after cardiac surgery. Recently, tadalafil has been utilised in
older children with similar efficacy, but it has been used to a lesser
extent in young infants. From April, 2015 to June, 2016, 42 patients aged
3-24 months with a large septal defect and pulmonary arterial hypertension
were randomly divided into two equal groups: one group received oral
sildenafil (1-3 mg/kg/day every 8 hours), whereas the other group received
oral tadalafil (1 mg/kg once a day) from 7-10 days before surgery to 3-4
weeks after surgery. During the first 48 hours after surgery, pulmonary
artery-to-aortic pressure ratio and recorded systolic pulmonary artery
pressures were not significantly different between the two groups
(p>0.05); moreover, there were no differences in paediatric ICU length of
stay, mechanical ventilation time, clinical findings of low cardiac output
state, and echocardiographic data between the two groups (p>0.05). Most of
the patients had no side effects, and only five patients had a minor with
no significant difference in both groups (p=0.371). Tadalafil can be
considered as an effective oral therapy for preoperative and postoperative
pulmonary hypertension in young infants. It can be administered at a
once-daily dose with an appropriate efficacy and safety profile as
sildenafil, and therefore it can be considered as an alternative to
sildenafil in young children.<br/>Copyright &#xa9; Cambridge University
Press 2017.

<36>
Accession Number
612920673
Author
Wang P.-L.; Zhang L.; Wang S.-L.; Yang Q.-N.; Gao Z.-Y.; Du J.-P.; Zhang
D.-W.; Fu C.-G.; Gu F.; Xu H.; Li L.-Z.; Wang C.-L.; Shi D.-Z.
Institution
(Wang, Zhang, Yang, Gao, Du, Zhang, Fu, Gu, Xu, Li, Wang, Shi) Institute
of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese
Medical Sciences, Beijing 100091, China
(Wang) Department of Gastroenterology, Guang'anmen Hospital, China Academy
of Chinese Medical Sciences, Beijing 100053, China
Title
Long-term follow-up of Chinese herbal medicines combined with conventional
treatment in patients with acute coronary syndrome after percutaneous
coronary intervention: A multicenter randomized controlled trial.
Source
Chinese Journal of Integrative Medicine. 23 (10) (pp 740-746), 2017. Date
of Publication: 01 Oct 2017.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To evaluate the prognosis effect of Chinese herbal medicines
(CHMs) for benefiting qi and activating blood circulation adjunctive to
conventional treatment in patients with acute coronary syndrome (ACS)
after percutaneous coronary intervention (PCI). Methods: A total of 702
patients with ACS who underwent PCI were enrolled and randomly assigned to
receive conventional treatment plus CHMs for benefiting qi and activating
blood circulation (treatment group, 351 cases) or conventional treatment
alone (control group, 351 cases) for 6 months. Six months later, all
patients received conventional treatment alone. Follow-ups were scheduled
at 6th, 12th, 18th, 24th month after enrollment in April 2008, and the
final follow-up visit was during September 2011 and November 2011. The
primary endpoint was the composite of cardiac death, nonfatal myocardial
infarction or revascularization (PCI or coronary artery bypass grafting);
and the secondary endpoint was the composite of re-admission for ACS,
congestive heart failure, nonfatal stroke or other thrombus events.
Results: A total of 621 (88.59%) patients completed 35.4+/-3.8 months
follow-up, while 80 (11.41%) patients withdrew from the trial (41 in the
treatment group and 39 in the control group). The incidence of primary
endpoint was 5.7% (20 patients) in the treatment group versus 10.86% (38
patients) in the control group [relative risk (RR): 0.53; 95% confidence
interval (CI): 0.30, 0.88; P=0.013; absolute risk reduction (ARR):-0.052,
95% CI: -0.06, 0.01]. The incidence of secondary endpoint was 5.98% (21
patients) in the treatment group versus 10.28% (36 patients) in control
group (RR: 0.58, 95% CI: 0.33, 0.97, P=0.037; ARR: -0.043, 95% CI: 0.06,
0.01). Most of the primary and secondary endpoints were occurred in 18
months (84.50% in the treatment group versus 78.10% in the control group).
Conclusion: CHMs for benefiting qi and activating blood circulation
adjunctive to conventional treatment improved clinical outcomes for
patients with ACS after PCI in long-term follow-up.<br/>Copyright &#xa9;
2015, Chinese Association of the Integration of Traditional and Western
Medicine and Springer-Verlag Berlin Heidelberg.

<37>
Accession Number
619619085
Author
Lehmann H.S.; Musk G.C.; Laurence M.; Hyndman T.H.; Tuke J.; Collins T.;
Gleerup K.B.; Johnson C.B.
Institution
(Lehmann, Musk, Laurence, Hyndman, Collins) College of Veterinary
Medicine, School of Veterinary and Life Sciences, Murdoch University,
Murdoch, Australia
(Tuke) School of Mathematics, University of Adelaide, Adelaide, Australia
(Gleerup) Department of Large Animal Sciences, University of Copenhagen,
Denmark
(Johnson) Institute of Veterinary, Animal and Biomedical Sciences, Massey
University, New Zealand
Title
Mitigation of electroencephalographic and cardiovascular responses to
castration in Bos indicus bulls following the administration of either
lidocaine or meloxicam.
Source
Veterinary Anaesthesia and Analgesia. 44 (6) (pp 1341-1352), 2017. Date of
Publication: November 2017.
Publisher
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia
Abstract
Objective To investigate the mitigating effects of administration of local
anaesthetic or systemic meloxicam on the electroencephalographic (EEG) and
cardiovascular responses during surgical castration of Bos indicus bull
calves. Study design Prospective, randomized, experimental study. Animals
Thirty-six 6-8 month-old Bos indicus bull calves, with a mean +/- standard
deviation weight of 237 +/- 19 kg. Methods Animals were allocated randomly
to three groups of 12 (group L, 260 mg of 2% lidocaine subcutaneously and
intratesticularly 5 minutes prior to castration; group M, 0.5 mg
kg^-1 of meloxicam subcutaneously 30 minutes prior to
castration; group C, no preoperative analgesia administered). Anaesthesia
was induced and maintained with halothane (0.9-1.1%) in oxygen.
Electroencephalogram, heart rate (HR) and mean blood pressure (MAP) were
recorded for 300 seconds prior to (baseline, B) and from the start of
surgery (first testicle removal, T1). HR and MAP were compared at 10
second intervals for 90 seconds from the start of T1. Median frequency
(F<inf>50</inf>), spectral edge frequency (F<inf>95</inf>) and total power
of the EEG (P<inf>tot</inf>) were analysed using area under the curve
comparing T1 to B. Results All EEG variables were significantly different
between B and T1 (p <= 0.0001). No differences in F<inf>50</inf> were
found between groups during T1 (p = 0.6491). F<inf>95</inf> and
P<inf>tot</inf> were significantly different between group L and groups C
and M during T1 (p = 0.0005 and 0.0163, respectively). There were
transient significant changes in HR and MAP in groups L and M compared to
group C during the 20-50 second periods. Conclusions The EEG changes
indicate nociceptive responses in all three groups during surgical
castration, greater in group L compared to groups C and M. Both analgesics
attenuated the peracute cardiovascular response. Lidocaine and meloxicam
administered prior to castration attenuated these responses in Bos indicus
bull calves. Clinical relevance These findings provide support for the
preoperative administration of lidocaine and potentially meloxicam for
castration in Bos indicus bull calves.<br/>Copyright &#xa9; 2017
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia

<38>
Accession Number
614148066
Author
Meersch M.; Schmidt C.; Hoffmeier A.; Van Aken H.; Wempe C.; Gerss J.;
Zarbock A.
Institution
(Meersch, Schmidt, Van Aken, Wempe, Zarbock) Department of Anesthesiology,
Intensive Care and Pain Medicine University, Hospital Munster,
Albert-Schweitzer-Campus 1, Building A1, Munster 48149, Germany
(Hoffmeier) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Title
Prevention of cardiac surgery-associated AKI by implementing the KDIGO
guidelines in high risk patients identified by biomarkers: the PrevAKI
randomized controlled trial.
Source
Intensive Care Medicine. 43 (11) (pp 1551-1561), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Care bundles are recommended in patients at high risk for acute
kidney injury (AKI), although they have not been proven to improve
outcomes. We sought to establish the efficacy of an implementation of the
Kidney Disease Improving Global Outcomes (KDIGO) guidelines to prevent
cardiac surgery-associated AKI in high risk patients defined by renal
biomarkers. Methods: In this single-center trial, we examined the effect
of a "KDIGO bundle" consisting of optimization of volume status and
hemodynamics, avoidance of nephrotoxic drugs, and preventing hyperglycemia
in high risk patients defined as urinary [TIMP-2].[IGFBP7] > 0.3
undergoing cardiac surgery. The primary endpoint was the rate of AKI
defined by KDIGO criteria within the first 72 h after surgery. Secondary
endpoints included AKI severity, need for dialysis, length of stay, and
major adverse kidney events (MAKE) at days 30, 60, and 90. Results: AKI
was significantly reduced with the intervention compared to controls [55.1
vs. 71.7%; ARR 16.6% (95 CI 5.5-27.9%); p = 0.004]. The implementation of
the bundle resulted in significantly improved hemodynamic parameters at
different time points (p < 0.05), less hyperglycemia (p < 0.001) and use
of ACEi/ARBs (p < 0.001) compared to controls. Rates of moderate to severe
AKI were also significantly reduced by the intervention compared to
controls. There were no significant effects on other secondary outcomes.
Conclusion: An implementation of the KDIGO guidelines compared with
standard care reduced the frequency and severity of AKI after cardiac
surgery in high risk patients. Adequately powered multicenter trials are
warranted to examine mortality and long-term renal outcomes.<br/>Copyright
&#xa9; 2017, The Author(s).

<39>
Accession Number
621585554
Author
Boreskie K.F.; Kehler D.S.; Costa E.C.; Cortez P.C.; Berkowitz I.; Hamm
N.C.; Moffatt T.L.; Stammers A.N.; Kimber D.E.; Hiebert B.M.; Kent D.E.;
Cornish D.E.; Blewett H.; Nguyen T.; Arora R.C.; Strachan S.M.; Semenchuk
B.N.; Hay J.L.; Cohn J.N.; Duhamel T.A.
Institution
(Boreskie, Kehler, Hamm, Moffatt, Stammers, Kimber, Kent, Cornish,
Strachan, Semenchuk, Hay, Duhamel) Faculty of Kinesiology and Recreation
Management, Health, Leisure and Human, Performance Research Institute,
University of Manitoba, Winnipeg, MB, Canada
(Boreskie, Kehler, Costa, Cortez, Berkowitz, Hamm, Moffatt, Stammers,
Kimber, Kent, Cornish, Arora, Hay, Duhamel) Institute of Cardiovascular
Sciences, St. Boniface Hospital, Albrechtsen Research Centre, Winnipeg,
MB, Canada
(Costa) Department of Physical Education, Federal University of Rio Grande
do Norte, Natal, Rio Grande do Norte, Brazil
(Cortez) Federal University of Para, Para, Brazil
(Hiebert) Department of Cardiac Sciences Program, Winnipeg Regional Health
Authority, Winnipeg, MB, Canada
(Blewett) Agriculture and Agri-Food Canada, Government of Canada,
Winnipeg, MB, Canada
(Blewett) Department of Human Nutritional Sciences, University of
Manitoba, Winnipeg, MB, Canada
(Nguyen) Section of Cardiology, University of Manitoba, Max Rady College
of Medicine, Winnipeg, MB, Canada
(Arora) Department of Surgery, University of Manitoba, Max Rady College of
Medicine, Winnipeg, MB, Canada
(Cohn) Rasmussen Center for Cardiovascular Disease Prevention, University
of Minnesota Medical School, Minneapolis, MB, United States
Title
BMJ open protocol for the HAPPY Hearts study: Cardiovascular screening for
the early detection of future adverse cardiovascular outcomes in
middle-aged and older women: A prospective, observational cohort study.
Source
BMJ Open. 7 (11) (no pagination), 2017. Article Number: e018249. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Efforts to identify individuals at a higher risk for adverse
cardiovascular outcomes focus on traditional risk factors, such as age,
sex, smoking status, blood pressure and and cholesterol; however, this
approach does not directly assess cardiovascular function and may
underestimate the risk of experiencing adverse cardiovascular outcomes in
women. This prospective, observational cohort study will examine the
ability of the Heart Attack Prevention Program for You (HAPPY) Hearts
screening protocol, a series of non-invasive procedures to identify
middle-aged and older women who are at an elevated risk for experiencing
an adverse cardiovascular event in the 5-year period after screening. The
predictive value of the HAPPY Hearts protocol will also be compared with
the Framingham Risk Score to determine the sensitivity for estimating risk
for an adverse cardiovascular outcome. Methods and analysis One thousand
women 55 years of age or older will be recruited to be screened by the
HAPPY Hearts protocol. This involves the cardiovascular assessment of
resting blood pressure, blood pressure response to 3 min of moderate
intensity exercise and large and small arterial elasticity. The
participants will be classifed into risk categories based on these
measures. The incidence of the following adverse cardiovascular outcomes
will be assessed in the 5-year period after screening in both groups:
ischaemic heart disease, acute myocardial infarction, stroke, percutaneous
coronary intervention, coronary bypass surgery, congestive heart failure
and new hypertension. Ethics and dissemination Information gathered in
this research will be published in peer-reviewed journals and presented in
a programme evaluation report to inform Manitoba Health and key
stakeholders about the outcomes of the study. The University of Manitoba
Health Research Ethics Board has approved the study protocol V.2.0, dated
29 September 2014 (H2014:224).<br/>Copyright &#xa9; Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2017.

<40>
Accession Number
614798887
Author
Vezzani A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.;
Gonzi G.; Nicolini F.; Gherli T.; Corradi F.
Institution
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Mura Della Cappuccine 14, Genoa 16128, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, AUSL of
Parma, Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
A randomized clinical trial of ultrasound-guided infra-clavicular
cannulation of the subclavian vein in cardiac surgical patients:
short-axis versus long-axis approach.
Source
Intensive Care Medicine. 43 (11) (pp 1594-1601), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The aim of this study was to compare the success rate and safety
of short-axis versus long-axis approaches to ultrasound-guided subclavian
vein cannulation. Methods: A total of 190 patients requiring central
venous cannulation following cardiac surgery were randomized to either
short-axis or long-axis ultrasound-guided cannulation of the subclavian
vein. Each cannulation was performed by anesthesiologists with at least 3
years' experience of ultrasound-guided central vein cannulation (>150
procedures/year, 50% short-axis and 50% long-axis). Success rate,
insertion time, number of needle redirections, number of separate skin or
vessel punctures, rate of mechanical complications, catheter
misplacements, and incidence of central line-associated bloodstream
infection were documented for each procedure. Results: The subclavian vein
was successfully cannulated in all 190 patients. The mean insertion time
was significantly shorter (p = 0.040) in the short-axis group (69 +/- 74
s) than in the long-axis group (98 +/- 103 s). The short-axis group was
also associated with a higher overall success rate (96 vs. 78%, p <
0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and
first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with
fewer needle redirections (0.39 +/- 0.88 vs. 0.88 +/- 1.15, p = 0.001),
skin punctures (1.12 +/- 0.38 vs. 1.28 +/- 0.54, p = 0.019), and
complications (3 vs. 13%, p = 0.028). Conclusions: The short-axis
procedure for ultrasound-guided subclavian cannulation offers advantages
over the long-axis approach in cardiac surgery patients.<br/>Copyright
&#xa9; 2017, Springer-Verlag Berlin Heidelberg and ESICM.

<41>
Accession Number
621953266
Author
Yoon J.W.; Chen R.E.; Kim E.J.; Akinduro O.O.; Kerezoudis P.; Han P.K.; Si
P.; Freeman W.D.; Diaz R.J.; Komotar R.J.; Pirris S.M.; Brown B.L.; Bydon
M.; Wang M.Y.; Wharen R.E.; Quinones-Hinojosa A.
Institution
(Yoon, Akinduro, Pirris, Brown, Wharen, Quinones-Hinojosa) Department of
Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
(Chen) Emory University School of Medicine, Atlanta, GA, United States
(Chen, Han, Si) Georgia Institute of Technology, Atlanta, GA, United
States
(Kim) Baylor College of Medicine, Houston, TX, United States
(Kerezoudis, Bydon) Department of Neurological Surgery, Mayo Clinic,
Rochester, MN, United States
(Freeman) Department of Neurology, Mayo Clinic, Jacksonville, FL, United
States
(Diaz) Department of Neurosurgery and Neurology, Montreal Neurological
Institute and Hospital, McGill University, Montreal, QC, Canada
(Komotar, Wang) Department of Neurological Surgery, University of Miami
Miller School of Medicine, University of Miami Hospital, University of
Miami Brain Tumor Initiative, Miami, FL, United States
(Pirris) St. Vincent's Spine and Brain Institute, Jacksonville, FL, United
States
Title
Augmented reality for the surgeon: Systematic review.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
14 (4) (no pagination), 2018. Article Number: e1914. Date of Publication:
August 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Introduction: Since the introduction of wearable head-up displays, there
has been much interest in the surgical community adapting this technology
into routine surgical practice. Methods: We used the keywords augmented
reality OR wearable device OR head-up display AND surgery using PubMed,
EBSCO, IEEE and SCOPUS databases. After exclusions, 74 published articles
that evaluated the utility of wearable head-up displays in surgical
settings were included in our review. Results: Across all studies, the
most common use of head-up displays was in cases of live streaming from
surgical microscopes, navigation, monitoring of vital signs, and display
of preoperative images. The most commonly used head-up display was Google
Glass. Head-up displays enhanced surgeons' operating experience; common
disadvantages include limited battery life, display size and discomfort.
Conclusions: Due to ergonomic issues with dual-screen devices, augmented
reality devices with the capacity to overlay images onto the surgical
field will be key features of next-generation surgical head-up
displays.<br/>Copyright &#xa9; 2018 John Wiley & Sons, Ltd.

<42>
Accession Number
622002880
Author
Altenberger J.; Polzl G.
Institution
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
(Polzl) Medical University Innsbruck, Department of Internal Medicine III,
Innsbruck, Austria
Title
Repetitive levosimendan for a LION's heart?.
Source
European Journal of Heart Failure. 20 (7) (pp 1137-1138), 2018. Date of
Publication: July 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)

<43>
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

<44>
Accession Number
622224524
Author
Saha T.; Naqvi S.Y.; Goldberg S.
Institution
(Saha, Naqvi, Goldberg) Pennsylvania Hospital, University of Pennsylvania,
800 Spruce Street, Philadelphia, PA 19107, United States
Title
Hybrid revascularization: A review.
Source
Cardiology (Switzerland). 140 (1) (pp 35-44), 2018. Date of Publication:
01 Jun 2018.
Publisher
S. Karger AG
Abstract
Hybrid coronary revascularization (HCR) combines surgical bypass with
percutaneous coronary intervention (PCI) performed either during the same
procedure or in a staged approach within 60 days. Coronary artery bypass
grafting using the left internal mammary artery (LIMA) has shown excellent
long-term patency with improved patient survival. It remains the gold
standard treatment for the majority of patients with multivessel coronary
artery disease. However, saphenous vein grafts have poor long-term
patency. Advances in stent technology have resulted in reduced rates of
thrombosis and restenosis, making PCI a viable alternative to coronary
surgery in selected patients. HCR is attractive as a less invasive method
of coronary revascularization which preserves the benefits of the LIMA
performed with less invasive surgical techniques with the efficacy of
newer generation stents.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.
All rights reserved.

<45>
Accession Number
622035440
Author
Karlson B.W.; Nicholls S.J.; Lundman P.; Barter P.J.; Palmer M.K.
Institution
(Karlson) AstraZeneca Gothenburg, Pepparedsleden 1, Molndal SE-43183,
Sweden
(Karlson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Lundman) Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
(Barter) University of New South Wales, Sydney, NSW, Australia
(Palmer) Manchester Metropolitan University, School of Healthcare Science,
Manchester, United Kingdom
Title
Modeling statin-induced reductions of cardiovascular events in primary
prevention: A VOYAGER meta-analysis.
Source
Cardiology (Switzerland). 140 (1) (pp 30-34), 2018. Date of Publication:
01 Jun 2018.
Publisher
S. Karger AG
Abstract
Objective: We used individual patient data from the VOYAGER database to
estimate cardiovascular (CV) risk reduction with commonly used
high-intensity statins. Methods: In patients with known atherosclerotic CV
disease (ASCVD) treated with high-intensity statin therapy (n = 6,735),
the predicted risk reduction was estimated using the Cholesterol Treatment
Trialists' Collaboration meta-analysis, which determined risk reduction
per 38.7 mg/dL statin-mediated reduction in low-density lipoprotein
cholesterol. Results: The greatest reductions in risk were seen in major
vascular events (estimated rate ratios ranged from 0.55 with rosuvastatin
[RSV] 40 mg to 0.60 with atorvastatin [ATV] 40 mg) and coronary heart
disease death (estimated rate ratios ranged from 0.58 with RSV 40 mg to
0.64 with ATV 40 mg). Conclusions: Our results show that, in individuals
without clinical ASCVD, statin therapy has the potential to reduce the
frequency of CV events.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel. All
rights reserved.

<46>
Accession Number
622925216
Author
Stegeman R.; Lamur K.D.; van den Hoogen A.; Breur J.M.P.J.; Groenendaal
F.; Jansen N.J.G.; Benders M.J.N.L.
Institution
(Stegeman, Lamur, van den Hoogen, Groenendaal, Benders) Department of
Neonatology, University Medical Center Utrecht, Utrecht University,
Wilhelmina Children's Hospital, Utrecht, Netherlands
(Stegeman, Lamur, Breur) Department of Pediatric Cardiology, University
Medical Center Utrecht, Utrecht University, Wilhelmina Children's
Hospital, Utrecht, Netherlands
(Stegeman, Lamur, Jansen) Department of Pediatric Intensive Care,
University Medical Center Utrecht, Utrecht University, Wilhelmina
Children's Hospital, Utrecht, Netherlands
Title
Neuroprotective drugs in infants with severe congenital heart disease: A
systematic review.
Source
Frontiers in Neurology. 9 (JUL) (no pagination), 2018. Article Number:
521. Date of Publication: 03 Jul 2018.
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Perinatal and perioperative brain injury is a fundamental
problem in infants with severe congenital heart disease undergoing
neonatal cardiac surgery with cardiopulmonary bypass. An impaired
neuromotor and neurocognitive development is encountered and associated
with a reduction in quality of life. New neuroprotective drugs during
surgery are described to reduce brain injury and improve
neurodevelopmental outcome. Therefore, our aim was to provide a systematic
review and best-evidence synthesis on the effects of neuroprotective drugs
on brain injury and neurodevelopmental outcome in congenital heart disease
infants requiring cardiac surgery with cardiopulmonary bypass. Methods: A
systematic search was performed in PubMed, Embase and the Cochrane Library
(PRISMA statement). Search terms were "infants," "congenital heart
disease," "cardiac surgery," "cardiopulmonary bypass," and
"neuroprotective drug." Data describing the effects on brain injury and
neurodevelopmental outcome were extracted. Study quality was assessed with
the Cochrane Risk of Bias Tool. Two reviewers independently screened
sources, extracted data and scored bias. Disagreements were resolved by
involving a third researcher. Results: The search identified 293 studies
of which 6 were included. In total 527 patients with various congenital
heart diseases participated with an average of 88 infants (13-318) per
study. Allopurinol, sodium nitroprusside, erythropoietin, ketamine,
dextromethorphan and phentolamine were administered around cardiac surgery
with cardiopulmonary bypass. Allopurinol showed less seizures, coma, death
and cardiac events in hypoplastic left heart syndrome (HLHS) infants (OR:
0.44; 95%-CI:0.21-0.91). Sodium nitroprusside resulted in lower post
cardiopulmonary bypass levels of S100beta in infants with transposition of
the great arteries after 24 (p < 0.01) and 48 (p = 0.04) h of treatment.
Erytropoietin, ketamine and dextromethorphan showed no neuroprotective
effects. Phentolamine led to higher S100beta-levels and cerebrovascular
resistance after rewarming and at the end of surgery (both p < 0.01). Risk
of bias varied between studies, including low (sodium nitroprusside,
phentolamine), moderate (ketamine, dextromethorphan), and high
(erytropoietin, allopurinol) quality. Conclusions: Allopurinol seems
promising for future trials in congenital heart disease infants to reduce
brain injury given the early neuroprotective effects in hypoplastic left
heart syndrome infants. Larger well-designed trials are needed to assess
the neuroprotective effects of sodium nitroprusside, erytropoietin,
ketamine and dextromethorphan. Future neuroprotective studies in
congenital heart disease infants should not only focus on the
perioperative period, however also on the perinatal period, since
significant brain injury already exists before surgery.<br/>Copyright
&#xa9; 2018 Stegeman, Lamur, van den Hoogen, Breur, Groenendaal, Jansen
and Benders.

<47>
Accession Number
622994059
Author
Leung A.; Williams M.; Korotkyi O.; Meleca N.; Fam N.
Institution
(Leung, Williams, Korotkyi, Meleca, Fam) TorontoONCanada
Title
Development and implementation of a bedside rounds checklist in a cardiac
ICU (CICU).
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S84-S85), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Best practice checklists have been regarded as a cognitive
tool to improve quality of care and interprofessional collaboration. This
project explores whether implementation of a bedside rounds checklist
improves assessment of important aspects of care in the cardiac intensive
care unit at St. Michael's Hospital, with a goal of improving patient
outcomes. METHODS AND RESULTS: A multidisciplinary team (physicians,
nurses, pharmacists, allied health) adapted a checklist from the
cardiovascular surgery ICU. Additional items and standardized definitions
were added to reflect the CICU specific needs. After the initial
electronic checklist was developed, data was prospectively collected over
three days including 19 patients to determine baseline performance.
Revisions were made to the tool based on the baseline data and experience
from the data collection. The revised tool was then trialed over a 12 week
period. Data was collected by the charge nurse on an electronic database
after the team's review of the checklist during daily bedside rounds.
After a review of the 12 week data required revisions were identified.
Multidisciplinary feedback was collected using a survey to qualitatively
describe the perceived value, usability, and integration of the checklist
during rounds. The checklist was completed for 556 of 669 patients (83%)
admitted to the CICU. Significant improvements were observed in multiple
checklist items, in particular documentation of code status (74% to 98%),
documentation and assessment of delirium (37% to 94%), and completion of
medication reconciliation (79% to 96%). Opportunities for improvement that
were identified include the need for a bowel regimen algorithm,
reassessment of best practice for NPO status prior to procedures, and need
for education on proper use and titration of sedatives. Multidisciplinary
feedback is currently being collected using a survey. CONCLUSION: With
multidisciplinary input, a checklist was developed using two PDSA cycles
thus far. The use of the checklist demonstrated an increase in several key
quality metrics and identified areas for future work. (Table Presented).

<48>
Accession Number
623004028
Author
Ong G.D.; Naim M.; Wang Q.; Manalo M.R.V.; Nguyen M.; Zhang X.
Institution
(Ong, Wang) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Naim) Cedars-Sinai Medical Ctr, Los Angeles, CA, United States
(Manalo, Nguyen) Cedars Sinai Medical Center, Los Angeles, CA, United
States
(Zhang) Cedars-Sinai Health System, Los Angeles, CA, United States
Title
Airfuge (high speed centrifugation)-does it really reduce background in
heart patients.
Source
Human Immunology. Conference: 43rd Annual Meeting of the American Society
for Histocompatibility and Immunogenetics. United States. 78 (Supplement
1) (pp 221), 2017. Date of Publication: September 2017.
Publisher
Elsevier Inc.
Abstract
Aim: The Luminex Single Antigen Assay is an integral part of the
transplant program to determine patient antibodies. It has an important
clinical impact on transplant outcomes. It is suggested that the Luminex
single antigen testing on heart transplant patients often has A high mean
fluorescent intensity (MFI) of the negative control bead (NC), which makes
antibody interpretation difficult. This study aims to determine if airfuge
is useful to reduce this background. Methods: HLA class I and class II
single antigen testing was performed on 20 serum samples from pre-or
post-heart transplant patients. All samples were tested in parallel with
and without airfuge. Out of 20 sam-ples, 10 samples were randomly selected
from our daily heart patient worklist. Another 10 samples exhibited A high
background in the original assay. The valid range for the negative control
bead cutoff was defined as 0-1000 in our laboratory. Results: MFI of NC in
single antigen testing on the randomly selected samples were all below
200. MFI of NC in one sample increased from 100 to 250 after airfuge. For
the group of samples that originally displayed high background, airfuge
treatment decreased MFI of NC 2 folds in only 7, out of 20, tests. Of
these 7 tests, NC in 5 tests that had MFI > 5000 without airfuge,
decreased to around 2000 after airfuge. However, NC beads in 4 tests
having MFI < 1000 increased dramatically after airfuge treatment, making
these tests invalid. Conclusions: High NC MFI was not observed in the
majority of testing on heart patients. Treatment of sera with airfuge in
heart patient samples before testing has A significant effect in
decreasing NC value only for some high background sera. It is not
effective in most patients' sera. It is unnecessary to pretreat sera with
airfuge for single antigen testing for heart transplant patients.

<49>
Accession Number
622993873
Author
Higgins J.; Bashir J.; Abel J.; Daniele P.; Lee M.; Humphries K.
Institution
(Higgins, Bashir, Abel, Daniele, Lee, Humphries) KitchenerONCanada
Title
Does dual-antiplatelet therapy decrease the risk of stroke following
coronary artery bypass grafting?.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S2-S3),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Stroke can be a devastating complication following coronary
artery bypass grafting (CABG). Recent trials suggest increased rates of
stroke in CABG vs percutaneous coronary intervention (PCI), even beyond
the first 30 days. There are suggestions that differences in medical
management between these 2 groups, including increased use of dual
antiplatelet therapy (DAPT) post-PCI, may contribute to differences in
mid-term rates of stroke. PURPOSE: To determine whether the use of DAPT
postoperatively, compared to ASA alone, decreases the risk of stroke after
discharge, following isolated CABG. METHODS: Prospectively maintained
provincial registry accessed to identify all residents, +/-20 years of
age, undergoing primary isolated CABG between April 2007-December 2012,
and discharged home on either (1)ASA or (2)ASA & clopidogrel (DAPT).
Baseline characteristics compared using Chisquare and Wilcoxon rank sum
tests. Fisher's exact test used to compare 30-day mortality and combined
30-day stroke/ death. Cumulative mortality and cumulative stroke/death
curves calculated up to 5 years. Five year cumulative event rates
estimated using Kaplan-Meier method. Cox proportional hazards model used
to determine unadjusted and adjusted hazard ratios for DAPT use on 5-year
stroke/death outcome. RESULTS: 8197 adults meeting inclusion criteria
underwent primary isolated CABG. Among this cohort, 12.9% were discharged
on DAPT. Prior myocardial infarction, prior cerebrovascular accident,
peripheral vascular disease, chronic obstructive pulmonary disease, and
prior PCI were all more common in patients discharged on DAPT (p < 0.05).
Within 30 days of discharge, 12 patients died, and 29 patients either had
a stroke or died. There were no significant differences between the 2
groups. Over the 5-year follow up, 319 patients died and 484 patients
either had a stroke or died. Again, there were no significant differences
in rates of death (log-rank p=0.81) or combined stroke/death (log-rank
p=0.48). At 5 years, rate of stroke/death was 7.3% (95% CI 6.7, 8.1) among
ASA group and 8.3% (95% CI 6.5, 10.5) among DAPT group. DAPT vs ASA was
not a significant predictor of 5-year stroke/death following isolated
CABG. Even after adjusting for 12 pre-operative and intra-operative
factors, DAPT vs ASA still was not a significant predictor of 5-year
stroke/death following isolated CABG. CONCLUSION: Following isolated CABG,
discharge on DAPT with ASA and clopidogrel does not decrease risk of
stroke or death, up to 5 years, compared to ASA alone. However, a
randomized trial is necessary to account for selection bias and provide
further information regarding which patients may benefit from DAPT.
(Figure Presented).

<50>
Accession Number
622993842
Author
Mazine A.; Verma S.; Tam D.; Puskas J.; Juni P.; Friedrich J.; Yanagawa B.
Institution
(Mazine, Verma, Tam, Puskas, Juni, Friedrich, Yanagawa) TorontoONCanada
Title
Impact of total arterial revascularization on long-term survival: A
systematic review and metaanalysis of 130,305 patients.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S2),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: This meta-analysis compares total arterial revascularization
(TAR) versus conventional coronary artery bypass and additionally to two
arterial grafts. METHODS: We searched MEDLINE and EMBASE Databases from
1996-to-2016 for studies comparing TAR versus non-TAR for multi-vessel
surgical revascularization. Data were extracted by 2 independent
investigators. Meta-analysis used random effects, which incorporates
heterogeneity. RESULTS: There were 4 smaller shorter follow-up randomized
controlled trials (RCTs), plus 15 matched/adjusted and 6 unmatched/
unadjusted larger longer follow-up observational studies that met
inclusion criteria (N = 130,305 patients; mean follow-up range: 1e15
years). There were no differences in perioperative stroke, myocardial
infarction or mortality. However, TAR was associated with lower long term
all-cause mortality in observational studies matched/adjusted for
confounders (incident rate ratio 0.85, 95% CI: 0.81e0.89, p b 0.0001; I2 =
0%) and unmatched/unadjusted (incident rate ratio 0.67, 95% CI: 0.59e0.76,
p b 0.0001; I2 = 67%) for TAR. Decreases in major cardiovascular outcomes
and revascularization did not achieve statistical significance. There were
greater sternal complications with TAR in the matched/ adjusted studies
(pooled risk ratio 1.21, 95% CI: 1.03e1.42, p = 0.02; I2 = 0%). When
compared to patients with two arterial grafts, TAR was still associated
with reduced long-term all-cause mortality (incident rate ratio 0.85, 95%
CI: 0.73e0.99, p = 0.04) with minimal heterogeneity (I2 = 5%). CONCLUSION:
Data from primarily observational studies suggest that TAR may improve
long-term survival compared with conventional coronary bypass by 15e20%
even when compared with two arterial grafts. Prospective randomized trials
of TAR with long-term follow-up are needed.

<51>
Accession Number
622993665
Author
Duteil J.; Senner W.
Institution
(Duteil, Senner) Interior Health Authority, Kelowna General Hospital,
Kelowna, BC, Canada
Title
Using lean management and team research to assess surgical site infections
in cardiac surgery.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S213),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
In 2016, clinical observations indicated rising cardiac surgical site
infections (SSI) at both saphenous and sternal sites. We confirmed this
observation using the cardiac surgery database. As a result, we
implemented a systematic review of our clinical practices. SSIs have been
shown to increase risk to patients' morbidity; including increased length
of stay, re-hospitalizations, and program costs. LEAN management steps
were implemented to increase staff awareness, identify areas for clinical
improvement and initiate necessary changes to lower SSI rates. We
simultaneously began three streams of team research: monthly data reports,
infection control statistical analysis and observational studies. Monthly
data reports and infection control analysis provided us with in-depth
knowledge of the types, causes and frequency of infections. The
observational research followed patients through the continuum of cardiac
surgery from the operating theater, cardiac surgery intensive care unit
and cardiac surgery in-patient unit. We examined a total of 1,610
procedures from April 2014 to December 2016 that indicated an overall SSI
rate of 2.8% (95% confidence interval, 2.0 aV'' 3.6). In addition, SSI
rates rose from 1.5% in 2015 to 3.4% in 2016, (p =0.04). The data
collected allowed us to implement changes in practice (including a back to
basics approach on wound care, review of hyperglycemia management,
continence care, and patient teaching) which aimed to improving patient
outcomes, lowering program costs and decreasing SSI to less than 1.5%.

<52>
Accession Number
622993420
Author
Drudi L.; Ades M.; Tat J.; MacKenzie K.; Afilalo J.; Gill H.
Institution
(Drudi, Ades, Tat, MacKenzie, Afilalo, Gill) MontrealQCCanada
Title
Preoperative exercise rehabilitation in cardiac and vascular
interventions.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S24-S25), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Exercise-based interventions have become part of the standard
of care in rehabilitation programs for cardiovascular risk reduction and
the promotion of a healthy lifestyle. The systematic review describes the
current state of knowledge of the effects of prehabilitation on
peri-operative clinical outcomes in patients undergoing cardiac and
vascular interventions. METHODS AND RESULTS: Studies were systematically
searched within 14 databases from inception to October 2016. Only studies
that assessed a pre-operative exercise program in adult patients
undergoing cardiac and vascular interventions with clinical or patient
centered end points were included in the review. Two independent reviewers
selected studies for inclusion, extracted data, and assessed quality using
Cochrane Collaboration's tool for RCTs1 and ROBINS-I tool for
nonrandomized studies. Nine studies met our inclusion criteria and were
stratified for qualitative analyses by cardiac (N=7) and vascular (N=2)
procedures. Among the studies evaluating prehabilitation in cardiac
interventions, there were 3 randomized controlled trials (RCTs) and 4
cohort studies. Six studies included patients undergoing surgical
procedures (coronary artery bypass grafting or valvular procedures) and 1
study included patients undergoing percutaneous coronary interventions.
Among the studies evaluating prehabilitation in vascular terventions, both
were RCTs. One study included patients undergoing aneurysm repair and 1
study included patients undergoing peripheral percutaneous interventions.
Prehabilitation was associated with decreased length of stay, reduced
post-operative complications, improved objective physical functioning, and
improved subjective quality of life measures in patients undergoing
cardiac procedures. Given the amount of heterogeneity that was present in
the designs, populations, and comparators among the included studies, we
were unable to statistically pool data across trials. CONCLUSION: Our
qualitative findings suggest that the prehabilitation may improve clinical
outcomes, physical performance, and health-related quality of life
measures in patients undergoing cardiac and vascular interventions;
however, the heterogeneity of the studies in terms of patient population
and outcomes limits how much we can generalize these findings.

<53>
Accession Number
622993409
Author
Lambert L.; Azzi L.; Desy F.; Potter B.; Racine N.; Beauchemin J.; Noiseux
N.; Asgar A.; Daneault B.; De Varennes B.; Dumont E.; Ibrahim R.; Lamarche
Y.; Martucci G.; Palisaitis D.; Piazza N.; Rodes-Cabau J.; Afilalo J.;
Carrier M.; De Guise M.; Bogaty P.
Institution
(Lambert, Azzi, Desy, Potter, Racine, Beauchemin, Noiseux, Asgar,
Daneault, De Varennes, Dumont, Ibrahim, Lamarche, Martucci, Palisaitis,
Piazza, Rodes-Cabau, Afilalo, Carrier, De Guise, Bogaty) MontrealQCCanada
Title
Transcatheter aortic valve implantation in Quebec: 4 years of
comprehensive evaluation and relation to quality indicators.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S141),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: INESSS (Institut national d'excellence en sante et en services
sociaux) has a ministerial mandate to aid decision-making pertaining to
use of transcatheter aortic valve implantation (TAVI) in Quebec. As part
of a comprehensive evaluation model, we have conducted systematic
literature reviews and collected 'real world' data since 2013. Provincial
quality standards have been formulated via an interactive, deliberative
process with clinical experts. Herein, we examine 4 years of TAVI in
Quebec in light of these provincial standards and the priority quality
indicators (QI) proposed by the Canadian Cardiovascular Society (CCS) in
2015. METHODS: Data were collected by our unit in collaboration with each
hospital's clinical team for all TAVI cases performed from April 1, 2013
to March 31, 2017 using standardized definitions. Data were entered into a
secure online portal, providing the clinical teams with real-time access.
RESULTS: Provincial annual TAVI volumes from 2013-14 to 2016-17 have
consistently increased: 294; 340; 360; 370. Over the 4 years, patient
characteristics have remained relatively constant (median age 83 years;
47% female). The Society of Thoracic Surgeons (STS) predicted risk of
operative mortality score was 6% (interquartile range, IQR: 4-9) in
2013-14 and 5% (IQR: 4-7) in 2016-17. Medical chart documentation of STS
score increased only slightly (50% in 2013-14 to 55% in 2016-17), but
varied widely across the 6 TAVI centers (3 - 86% in 2016-17). Heart Team
decision and wait times were measured only in the 2 most recent years.
Almost all (> 90%) patients had documentation of a Heart Team decision.
Delay from referral to decision was 60 days (IQR: 18-112) in 2015-16
versus 44 days (IQR: 15-99) in 2016-17. Median delay from decision to TAVI
procedure was 40 days (IQR: 12-82) in 2015-16 versus 42 days (IQR: 14-89)
in 2016-17. Over 4 years, in-hospital stroke rates remained stable (2.0%;
4.4%; 2.3%; 3.0%) while mortality at 30 days decreased (6.1%; 4.1%; 2.8%;
3.0%, p=0.03 test for trend). All of these results are very consistent
with QI measures reported at the national level in the CCS report for
2013-14. CONCLUSION: In Quebec, TAVI continues to be used in an elderly
patient population, but with improving processes of care and declining
adverse outcomes. Documentation of CCS priority QIs by clinical teams has
improved, permitting measurement of TAVI wait times. New Quebec quality
standards will ensure better documentation of the patient evaluation and
selection process for this evolving technology.

<54>
Accession Number
622992725
Author
Yanagawa B.; Elbatarny M.; Verma S.; Hill S.; Mazine A.; Puskas J.;
Friedrich J.
Institution
(Yanagawa, Elbatarny, Verma, Hill, Mazine, Puskas, Friedrich)
TorontoONCanada
Title
Surgical management of tricuspid valve infective endocarditis: A
systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S87-S88), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The incidence of tricuspid valve infective endocarditis (TVIE)
has been steadily increasing. The primary surgical strategies are TV
repair and replacement. This meta-analysis compares the early and late
outcomes of valve repair versus replacement for tricuspid valve infective
endocarditis (TVIE). METHODS AND RESULTS: We searched MEDLINE and EMBASE
databases until 2016 for studies comparing tricuspid valve repair and
replacement. Data were extracted by two independent investigators. The
main outcomes were mortality, recurrent IE and need for reoperation. There
were 13 unmatched retrospective observational studies with 836 patients
(median follow up 4.0 [inter-quartile range: 2.3-5.7] years). The most
common indication for surgery were septic pulmonary embolism, left-sided
IE, right heart failure and persistent bacteremia. The primary repair
strategies included vegetectomy with De Vega procedure, annuloplasty ring,
Kay procedure or pericardial leaflet patch. There were no differences in
peri-operative mortality between TV repair vs replacement (RR 0.62,
95%CI:0.26-1.46, p=0.3) despite a greater proportion of staphylococcal
endocarditis in the replacement group. Long-term outcomes of all-cause
mortality was not different (RR 0.61, 95% CI:0.22-1.72, p=0.4; FIGURE).
Valve repair was associated with lower recurrent IE (RR 0.17, 95%
CI:0.05-0.57, p=0.004) and need for reoperation (RR 0.26, 95%
CI:0.07-0.92, p=0.04) but a trend towards greater risk of moderate to
severe tricuspid regurgitation (RR 4.14, 95%CI: 0.80-21.34, p=0.09;
FIGURE). Furthermore, TV replacement is associated with need for permanent
pacemaker (RR 0.20, 95%CI: 0.11-0.35, p < 0.001). CONCLUSION: Tricuspid
valve repair and replacement offer similar midterm survival. However,
valve repair offers greater freedom from recurrent IE and reoperation as
well as need for permanent pacemaker and should be the preferred approach
for patients with TVIE. (Table Presented).

<55>
Accession Number
622993180
Author
Elsokkari I.; Parkash R.; Gray C.; Gardner M.; Abdel Wahab A.; Doucette
S.; Tang A.; Wells G.; Stevenson W.; Sapp J.
Institution
(Elsokkari, Parkash, Gray, Gardner, Abdel Wahab, Doucette, Tang, Wells,
Stevenson, Sapp) HalifaxNSCanada
Title
Does prior revascularization impact outcomes of patients with ischemic
cardiomyopathy and ventricular tachycardia results from VANISH clinical
trial.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S63-S64), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Coronary revascularization following myocardial infarction
(MI) is not always feasible. This could be due to late presentation of
infarction with non viable infarct related territory, small vessel disease
or if the patient is deemed to be at high risk for intervention. Patients
with ventricular tachycardia (VT) post MI are a higher risk group with
significant morbidity and mortality. OBJECTIVE: To examine the impact of
coronary revascularization on clinical outcomes in patients with ischemic
cardiomyopathy and VT. METHODS: The VANISH trial randomized 259 patients
with ischemic heart disease and scar-related VT to receive escalated
medical therapy or catheter ablation. Data on prior coronary
revascularization was available for all patients. Clinical outcomes were
compared according to baseline revascularization status. The primary
Outcome is a composite of time to death and appropriate ICD shock or VT
storm. Secondary Outcomes are elements of the primary outcome and
Ventricular arrhythmia; a composite of VT storm, Appropriate ICD shock,
Appropriate antitachycardia pacing (ATP), Sustained VT below detection or
Cardioversion for VT. RESULTS: 190 patients (73%) had prior coronary
revascularization. Patients in the revascularization group were older
(mean age 69.3 +/- 7.6 vs 66.7 +/- 9.2; P=0.04), males (97% vs 83%;
P=0.0003) and they had more renal insufficiency (22.6% vs 8.7%; P =0.01)
and they received more cardiac resynchronization therapy (23% vs 10%;
P=0.03) as compared with the non-revascularized patients. There was no
difference in baseline medication use. There was a trend towards less
hospitalizations in the revascularization group however this was not
statistically significant (64% vs 77%; P=0.07). There was no difference on
the individual outcomes of mortality, VT storm, ICD shocks, recurrent MI
or cardiac failure (table). There was no difference in the ventricular
arrhythmia composite secondary outcome (Fig). CONCLUSION: A history of
prior coronary revascularization was not significantly associated with
clinical outcomes for patients with ischemic scar-related VT. (Figure
Presented).

<56>
Accession Number
622993098
Author
McIntyre W.; Um K.; Lengyel A.; Healey J.; Whitlock R.; Belley-Cote E.
Institution
(McIntyre, Um, Lengyel, Healey, Whitlock, Belley-Cote) HamiltonONCanada
Title
Vasopressin versus catecholaminergic vasopressors in the treatment of
vasodilatory shock: A systematic review and meta-analysis of the impact on
atrial fibrillation, myocardial injury and mortality.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S129-S130), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Vasopressin is an endogenous hormone that is an alternative to
catecholamine vasopressors for patients with vasodilatory shock (e.g
sepsis, post-cardiac surgery vasoplegia). Blood pressure support with a
non-catecholaminergic vasopressor may reduce stimulation of adrenergic
receptors and decrease myocardial oxygen demand. These physiologic changes
may result in reductions in atrial fibrillation (AF), myocardial injury
(MI) and death. Our objective was to determine if the rates of AF, MI or
mortality are different in patients with vasodilatory shock who are
treated with vasopressin as compared to catecholaminergic vasopressors.
METHODS: We searched MEDLINE, EMBASE and CENTRAL (inception to January
2017). We included randomized controlled trials (RCTs) comparing
vasopressin (or its analogs) alone or in combination with
catecholaminergic vasopressors to catecholamines alone for patients with
vasodilatory shock. Two review authors abstracted data and assessed risk
of bias independently and in duplicate. We used a random-effects model to
combine quantitative data. Quality of evidence was rated using GRADE.
RESULTS: We identified 20 RCTs, including 5 different vasopressors in 4
different comparisons. AF was reported in 10 studies including 721
participants with 259 events. There was no difference in the relative risk
(RR) of AF between the two therapies. However, the point estimate did
favour vasopressin (RR 0.57 [95%CI 0.30-1.06]). Overall evidence quality
for AF was low (due to risk of bias and inconsistency). In a pre-defined
sensitivity analysis of studies at low risk of bias, AF was significantly
reduced with vasopressin (RR 0.77 [95%CI 0.67-0.88]). Eight studies
reported on MI, including 1626 participants with 57 events. There was no
difference in the rate of MI (RR 0.93 [95% CI 0.44 to 1.95]). Evidence for
this outcome was very low quality (due to risk of bias, indirectness and
imprecision). Mortality was reported as an outcome in 14 studies including
2472 participants with 931 events. Evidence was of moderate quality (due
to risk of bias) for a reduction in mortality with vasopressin (RR 0.92
[95%CI 0.84-1.00]). CONCLUSION: Administration of vasopressin to decrease
catecholamine requirements in patients with vasodilatory shock probably
leads to a decrease in the risk of AF. There is most likely a modest but
clinically relevant reduction in mortality in patients with vasodilatory
shock who receive vasopressin.

<57>
Accession Number
622993040
Author
Der Sarkissian S.; Sauve J.; Larose E.; Aceros H.; Mansour S.; Stevens L.;
Prieto I.; Basile F.; Roy D.; Noiseux N.
Institution
(Der Sarkissian, Sauve, Larose, Aceros, Mansour, Stevens, Prieto, Basile,
Roy, Noiseux) MontrealQCCanada
Title
Rna-seq data analysis identifies stem cell transcriptomic signatures
underpinning the therapeutic effectiveness of patient cells in the
IMPACT-CABG trial.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp S18),
2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Therapeutic benefits of cell therapy remain mitigated due to
factors including cell phenotypes and their poor survival and function in
pathologic heart. Whereas first generation of advances focused on cell
selection, delivery and a broad understanding of mechanisms involved in
therapy success, the next advances will come from decoding complex
biological pathways underpinning regenerative potential of cells from
different patients. IMPACT-CABG trial represents the first North American
phase II multicenter randomized study of intra-myocardial delivery of
autologous CD133+ cells in chronic cardiomyopathy patients undergoing
CABG. With banked stem cells from this trial, we have the opportunity to
correlate the patient's clinical outcome with cellular gene expression
profiles. Our goal is to identify genomic signatures responsible for
therapeutic effectiveness and identify pre-treatments from our drug
discovery platform that could activate cellular phenotypes replicating
those of patients responding to cell therapy. METHODS: In this exploratory
study, expression of 20,800 human genes (Ion AmpliSeq) are analyzed in
high-throughput format using CD133+ stem cells from 13 patients classified
as responders (+/-5% LVEF and/or +/-10% left ventricular volumes) vs
non-responders according to cardiac fMRI comparing pre- and 6-month
post-treatment changes. Differential expression and pathway analysis are
performed using computational tools including DESeq2, GAGE (Generally
Applicable GeneSet Enrichment for Pathways Analysis), PathView and R.
RESULTS: Pathway analyses show significant association in responders with
genes related to cytokine production, activity and receptor interaction,
cell adhesion molecules, regulation of kinase cascades (p < 0.05). Several
other comparisons were performed to characterize gene expression vs
patient demographics. The general pattern of activity was replicated in
human mesenchymal stem cells (hMSC) by short ex vivo pharmacological
conditioning with Celastrol, an HSP90 targeting compound. Celastrol
activates kinases PI3K/Akt and ERK1/2 within 5min, upregulates HSP70 and
HO-1 mRNAs (>30-fold) as well as VEGF in cells maintained in normoxic
(2.7-fold) or hypoxic condition (1.3-fold, p < 0.05). Celastrol improves
hMSC viability during hypoxic or oxidative challenges. Proteomic analysis
of culture conditioned-media shows upregulation (>2-fold) of over 100
proteins, including HSPs, growth factors, antioxidants, cytokines
indicating improved paracrine potential. CONCLUSION: IMPACT-CABG
responder's stem cells express gene sets associated with paracrine
potential, cell engraftment and survival that can be mimicked by an ex
vivo pharmacological pre-conditioning to improve stem cell therapeutic
potential. Information gathered will be used in IMPACTCABG II trial
involving a first of its kind precision pharmacooptimization strategy
(USPTO62/350,258 patent pending) to harness the full potential of cellular
cardiomyoplasty using CD133+ cells.

<58>
Accession Number
622992941
Author
McClure G.; Belley-Cote E.; Tong W.; Xie F.; Vincent J.; Lamy A.; Whitlock
R.
Institution
(McClure, Belley-Cote, Tong, Xie, Vincent, Lamy, Whitlock)
OakvilleONCanada
Title
Steroids in cardiac surgery (SIRS): Economics substudy.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Canada. 33 (10 Supplement 1) (pp
S93-S94), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The administration of perioperative steroids in cardiac
surgery has been shown in multiple recent randomized controlled trials to
provide no clinical benefit when compared to placebo. However, it has
repeatedly been shown to significantly influence both hospital and ICU
length of stay, and is an independent protective factor against all-site
infection. Consequently, the economic benefit from steroid administration
has remained an active question. We aimed to perform a cost effectiveness
analysis on the the SIRS trial to assess the cost-effectiveness of
perioperative steroid provision. METHODS: Steroids in Cardiac Surgery
(SIRS), was an international randomized controlled trial assessing
peri-operative methylprednisone administration during cardiac surgery
which enrolled 7507 patients in 80 centers and 18 countries. We calculated
total cost per patient for the control and treatment group during index
hospitalization and up to 30-day follow-up. This was compared to study
co-primary outcomes, death, and composite: death, MI, stroke, respiratory
failure and new renal failure, in a cost effectiveness approach. The
viewpoint of a third party payer was used in this trial. Events were
assessed using in-hospital data and data regarding adverse events
following hospital discharge were collected at independent follow-up
visits. The bias corrected and accelerated (BCa) method was used to obtain
confidence intervals for average costs sampling 1000 patients 1000 times
to achieve these estimates. RESULTS: Follow up was complete in 100% of
patients at 30 days, and no patients were excluded from analysis. The
average cost per patient in the intervention arm was $17,646 (95%CI
$15,940.50 - $19,350.91) and $17,650 (95%CI $16,095.18 - $19,204.05) in
the intervention arm. This difference was not seen to be significant
(p=0.21) and met our a-priori definition for cost neutrality. Overall cost
was contributed from 26.2% ward stay, 64.9% ICU stay, 3.2% infection
related expenses, 5.9% renal failure expenses and 1.4% additional adverse
event costs. Mean incremental cost effectiveness ratio's for each effect
outcome were calculated to be $554 saved per additional primary composite
event, -$773 per death avoided however cost-effect pair plots for each
showed broad overlapping of all quadrants. CONCLUSION: Methylprednisone at
the time of cardiac surgery when compared to placebo does not provide
significant reductions to overall cost, based on Canadian costing data,
and does not provide cost-effective change to clinical outcomes. This
further justifies the conclusion that steroids should not be considered
standard of care at the time of cardiac surgery. (Figure Presented).

<59>
Accession Number
622961049
Author
Heinrichs J.; Lodewyks C.; Neilson C.; Abou-Setta A.; Grocott H.P.
Institution
(Heinrichs, Grocott) Department of Anesthesia, Perioperative and Pain
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Grocott) Department of Surgery, Section of Cardiac Surgery,
University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Abou-Setta) Department of Community Health Sciences, University
of Manitoba, Winnipeg, MB, Canada
(Neilson, Abou-Setta) George & Fay Yee Center for Healthcare Innovation,
University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB,
Canada
(Neilson) Neil John Maclean Health Sciences Library, University of
Manitoba, Winnipeg, MB, Canada
(Grocott) University of Manitoba, St. Boniface Hospital, CR3008 - 369
Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Title
The impact of hyperoxia on outcomes after cardiac surgery: a systematic
review and narrative synthesis.
Source
Canadian Journal of Anesthesia. 65 (8) (pp 923-935), 2018. Date of
Publication: 01 Aug 2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Historically, cardiac surgery patients have often been managed
with supraphysiologic intraoperative oxygen levels to protect against the
risks of cellular hypoxia inherent in the un-physiologic nature of surgery
and cardiopulmonary bypass. This may result in excessive reactive oxygen
species generation and exacerbation of ischemia-reperfusion injury. In
this review, we synthesize all available data from randomized controlled
trials (RCTs) to investigate the impact that hyperoxia has on
postoperative organ dysfunction, length of stay, and mortality during
adult cardiac surgery. Source: We searched Medline, Embase, Scopus, and
Cochrane Central Register of Controlled Trials databases using a
high-sensitivity strategy for RCTs that compared oxygenation strategies
for adult cardiac surgery. Our primary outcome was postoperative organ
dysfunction defined by postoperative increases in myocardial enzymes,
acute kidney injury, and neurologic dysfunction. Secondary outcomes were
mortality, ventilator days, and length of stay in the hospital and
intensive care unit. Principal findings: We identified 12 RCTs that met
our inclusion criteria. Risk of bias was unclear to high in all but one
trial. Significant heterogeneity in timing of the treatment period and the
oxygenation levels targeted was evident and precluded meta-analysis. The
large majority of trials found no difference between hyperoxia and
normoxia for any outcome. Two trials reported reduced postoperative
myocardial enzymes and one trial reported reduced mechanical ventilation
time in the normoxia group. Conclusions: Hyperoxia had minimal impact on
organ dysfunction, length of stay, and mortality in adult cardiac surgery.
The current evidence base is small, heterogeneous, and at risk of bias.
Trial registration: International Prospective Register of Systematic
Reviews (PROSPERO) (CRD42017074712). Registered 17 August
2017.<br/>Copyright &#xa9; 2018, Canadian Anesthesiologists' Society.

<60>
Accession Number
2000945664
Author
Head S.J.; Milojevic M.; Daemen J.; Ahn J.-M.; Boersma E.; Christiansen
E.H.; Domanski M.J.; Farkouh M.E.; Flather M.; Fuster V.; Hlatky M.A.;
Holm N.R.; Hueb W.A.; Kamalesh M.; Kim Y.-H.; Makikallio T.; Mohr F.W.;
Papageorgiou G.; Park S.-J.; Rodriguez A.E.; Sabik J.F.; Stables R.H.;
Stone G.W.; Serruys P.W.; Kappetein A.P.
Institution
(Head, Milojevic, Papageorgiou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus Medical Center, Rotterdam, Netherlands
(Daemen, Boersma) Department of Cardiology, Erasmus Medical College,
Rotterdam, Netherlands
(Ahn, Kim, Park) Department of Cardiology, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Domanski, Farkouh, Fuster) Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, New York, United States
(Domanski, Farkouh) Division of Cardiology, Peter Munk Cardiac Centre and
Department of Medicine, Heart and Stroke Richard Lewar Centre, University
of Toronto, Toronto, Ontario, Canada
(Flather) Department of Medicine and Health Sciences, Norwich Medical
School University of East Anglia and Norfolk and Norwich University
Hospital, Norwich, United Kingdom
(Hlatky) Department of Health Research and Policy, Department of Medicine
(Cardiovascular Medicine), Stanford University School of Medicine,
Stanford, California, United States
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kamalesh) Department of Cardiology, Richard L. Roudebush Veterans Affairs
Medical Center, Indianapolis, Indiana, United States
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Mohr) Department of Cardiac Surgery, Herzzentrum Universitat Leipzig,
Leipzig, Germany
(Papageorgiou) Department of Biostatistics, Erasmus Medical Center,
Rotterdam, Netherlands
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, Ohio, United States
(Stables) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Stone) Department of Cardiology, Columbia University Medical Center and
Clinical Trials Center, the Cardiovascular Research Foundation, New York,
New York, United States
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
Title
Stroke Rates Following Surgical Versus Percutaneous Coronary
Revascularization.
Source
Journal of the American College of Cardiology. 72 (4) (pp 386-398), 2018.
Date of Publication: 24 July 2018.
Publisher
Elsevier USA
Abstract
Background: Coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) are used for coronary revascularization in
patients with multivessel and left main coronary artery disease. Stroke is
among the most feared complications of revascularization. Due to its
infrequency, studies with large numbers of patients are required to detect
differences in stroke rates between CABG and PCI. Objectives: This study
sought to compare rates of stroke after CABG and PCI and the impact of
procedural stroke on long-term mortality. Methods: We performed a
collaborative individual patient-data pooled analysis of 11 randomized
clinical trials comparing CABG with PCI using stents; ERACI II (Argentine
Randomized Study: Coronary Angioplasty With Stenting Versus Coronary
Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS
(Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine,
Angioplasty, or Surgery Study) (n = 408), SoS (Stent or Surgery) trial (n
= 988), SYNTAX (Synergy Between Percutaneous Coronary Intervention With
Taxus and Cardiac Surgery) trial (n = 1,800), PRECOMBAT (Bypass Surgery
Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left
Main Coronary Artery Disease) trial (n = 600), FREEDOM (Comparison of Two
Treatments for Multivessel Coronary Artery Disease in Individuals With
Diabetes) trial (n = 1,900), VA CARDS (Coronary Artery Revascularization
in Diabetes) (n = 198), BEST (Bypass Surgery Versus Everolimus-Eluting
Stent Implantation for Multivessel Coronary Artery Disease) (n = 880),
NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass
Grafting in Treatment of Unprotected Left Main Stenosis) trial (n =
1,184), and EXCEL (Evaluation of Xience Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial (n =
1,905). The 30-day and 5-year stroke rates were compared between CABG and
PCI using a random effects Cox proportional hazards model, stratified by
trial. The impact of stroke on 5-year mortality was explored. Results: The
analysis included 11,518 patients randomly assigned to PCI (n = 5,753) or
CABG (n = 5,765) with a mean follow-up of 3.8 +/- 1.4 years during which a
total of 293 strokes occurred. At 30 days, the rate of stroke was 0.4%
after PCI and 1.1% after CABG (hazard ratio [HR]: 0.33; 95% confidence
interval [CI]: 0.20 to 0.53; p < 0.001). At 5-year follow-up, stroke
remained significantly lower after PCI than after CABG (2.6% vs. 3.2%; HR:
0.77; 95% CI: 0.61 to 0.97; p = 0.027). Rates of stroke between 31 days
and 5 years were comparable: 2.2% after PCI versus 2.1% after CABG (HR:
1.05; 95% CI: 0.80 to 1.38; p = 0.72). No significant interactions between
treatment and baseline clinical or angiographic variables for the 5-year
rate of stroke were present, except for diabetic patients (PCI: 2.6% vs.
CABG: 4.9%) and nondiabetic patients (PCI: 2.6% vs. CABG: 2.4%) (p for
interaction = 0.004). Patients who experienced a stroke within 30 days of
the procedure had significantly higher 5-year mortality versus those
without a stroke, both after PCI (45.7% vs. 11.1%, p < 0.001) and CABG
(41.5% vs. 8.9%, p < 0.001). Conclusions: This individual patient-data
pooled analysis demonstrates that 5-year stroke rates are significantly
lower after PCI compared with CABG, driven by a reduced risk of stroke in
the 30-day post-procedural period but a similar risk of stroke between 31
days and 5 years. The greater risk of stroke after CABG compared with PCI
was confined to patients with multivessel disease and diabetes. Five-year
mortality was markedly higher for patients experiencing a stroke within 30
days after revascularization.<br/>Copyright &#xa9; 2018 American College
of Cardiology Foundation

<61>
Accession Number
2000946112
Author
Salim E.; Rezk M.
Institution
(Salim, Rezk) Department of Cardiothoracic Surgery, Faculty of Medicine,
Benha University, Egypt
(Salim) KSA, King Faisal Medical complex, Taif, Saudi Arabia
Title
Thoracoscopic versus subxiphoid pericardial window in patients with
end-stage renal disease.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Pericardial effusion is a common problem in patients with
end-stage renal disease (ESRD). There are many surgical approaches to
perform a pericardial window in those patients. This study compared the
safety and efficacy of VATS and subxiphoid approaches in performing a
pericardial window for pericardial effusion in patients with ESRD.
Methods: From February 2015 to March 2017, a prospective study included a
total number of 30 patients of ESRD who were prepared for pericardial
window. Patients were randomly divided into two groups: group A (15
patients who underwent VATS pericardial window), and group B (15 patients
who underwent subxiphoid pericardial window). Patients were followed-up
for 12 months postoperatively. Results: Both procedures were safe and
effective in the management of pericardial effusion. Preoperative data
showed no significant difference between both groups. In VATS group, there
were significant increased operative times (p-value = 0.031) but with a
significantly shorter length of hospital stay (p-value = 0.037) when
compared to the subxiphoid group. In both groups, no mortality was
recorded. Recurrent pericardial effusion was detected in 5 patients
(33.3%) in the subxiphoid group while it was detected in 1 patient (6.7%)
in VATS group (p-value = 0.169). VATS approach was the independent
predictor of freedom from recurrence (hazard ratio: 0.054; p-value =
0.020). Conclusions: VATS is a safe and effective procedure in the
management of pericardial effusion in patients with ESRD. VATS approach
decreased total length of hospital stay and decreased the incidence of
recurrence of pericardial effusion.<br/>Copyright &#xa9; 2018 The Egyptian
Society of Cardio-thoracic Surgery

<62>
Accession Number
2000943113
Author
Amin S.; Shawky H.A.E.F.; Rezk T.S.E.D.A.A.; Sharkawy I.M.S.E.D.E.;
Mohammed A.M.A.R.
Institution
(Amin, Shawky, Rezk, Sharkawy, Mohammed) Kasr EL EiNI-Cairo University
Cairo, Egypt
Title
The role of in-vivo optical spectroscopy in assessment of cerebral
perfusion in superior cavo-pulmonary shunt (Glenn).
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2018. Date of Publication: 2018.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Bidirectional Glenn shunt is a well-established procedure
performed as a part of the single ventricle palliation pathway. It may
also provide definitive palliation in certain other patients. However,
stroke and neurocognitive dysfunction are common after cardiac surgery
with rates of approximately 3-6% and 30-50%, respectively. This study
aimed to report and compare early post-operative neurological outcome
after on-pump and off pump using temporary cavoatrial shunt in
bidirectional Glenn shunt operation using a neurological monitor. Methods:
This prospective comparative non randomized controlled trial included 30
patients undergone Glenn shunt. The study was done at Kasr Alainy
Hospitals (Abul Reesh Specialized Pediatric Japanese Hospital) Cairo
University, Egypt in the period between October 2015 and October 2017.
Patients were divided into two matching and equally-numbered groups: Group
A contained 15 patients using cardiopulmonary bypass (CPB); while group B
contained 15 patients without using CPB. Cerebral oximetry was done using
INVOS. Results: As regards operative time it was shorter in group B (p =
0.003), post-operative fits in group A 2 patients (13%), in group B 3
patients (20%), the difference was statistically insignificant (p > 0.05).
There was a significant correlation between the area under the curve (AUC)
and neurological outcome (p = 0.01). Conclusions: We suggest that
pediatric INVOS system may help to reduce the high rate of brain
injuries.<br/>Copyright &#xa9; 2018

<63>
Accession Number
622992525
Author
Moreira R.I.; Abreu A.; Portugal G.; Oliveira L.; Oliveira M.; Rodrigues
I.; Cruz M.C.; Cunha P.S.; Santos V.; Clara H.S.; Carmo M.M.; Ferreira
R.C.
Institution
(Moreira, Abreu, Portugal, Oliveira, Rodrigues, Cruz, Cunha, Carmo,
Ferreira) Department of Cardiology, Hospital de Santa Marta, Centro
Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, Lisbon 1169-024,
Portugal
(Oliveira) Nuclear Medicine Department, Medical and Diagnosis Clinic
Quadrantes, Lisbon, Portugal
(Santos, Clara) CIPER, Human Kinetics Faculty, University of Lisbon,
Lisbon, Portugal
(Carmo) NOVA Medical School, New University of Lisbon, Lisbon, Portugal
Title
Prognostic effect and modulation of cardiac sympathetic function in heart
failure patients treated with cardiac resynchronization therapy.
Source
Journal of Nuclear Cardiology. (pp 1-8), 2018. Date of Publication: 10 Jul
2018.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Cardiac autonomic dysfunction as assessed by
¹²³I-metaiodobenzylguanidine (¹²³I-mIBG)
scintigraphy is associated with poor prognosis in heart failure (HF)
patients. Although cardiac resynchronization therapy (CRT) has emerged as
an effective therapy in improving outcomes on HF patients, its effect on
cardiac sympathetic nervous function is still not fully understood. We
aimed to study the value of pre-implantation ¹²³I-mIBG late
heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes
after CRT and to correlate modification in this parameter with CRT
response and functional improvement. Methods and Results: BETTER-HF
(Benefit of exercise training therapy and cardiac resynchronization in HF
patients) is a prospective randomized clinical trial including HF patients
submitted CRT (mean LVEF 24 +/- 8%, 74% NYHA class >= III) who underwent a
clinical, echocardiographic, and scintigraphic assessment before and 6
months after CRT. One-hundred and twenty-one patients were included.
Echocardiographic response was observed in 54% and composite outcome of
cardiac mortality, cardiac transplant or heart failure hospitalization in
24% of patients. Baseline late HMR was an independent predictor of CRT
response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and
outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up,
¹²³I-mIBG imaging showed positive changes in cardiac
sympathetic nerve activity only in responders to CRT (1.36 +/- 0.14 prior
vs. 1.42 +/- 0.16 after CRT, P .039). There was a significant correlation
between improvement in late HMR and improvement in peak oxygen consumption
(r 0.547, P < .001). Conclusion: In our study, baseline cardiac
denervation predicted response and clinical outcomes after CRT
implantation. Cardiac sympathetic function was improved only in patients
who responded to CRT and these positive changes were correlated with
improvement in functional capacity.<br/>Copyright &#xa9; 2018 American
Society of Nuclear Cardiology

<64>
Accession Number
622992072
Author
Opsomer M.; Dimitrova D.; Verspeelt J.; Purrington A.; Mehbob A.; Chavers
S.; Pai H.; Vanveggel S.; Luo D.; Brown K.; Moecklinghoff C.; Nettles
R.E.; Boven K.
Institution
(Opsomer, Verspeelt, Vanveggel) Janssen Research and Development, Beerse,
Belgium
(Dimitrova, Chavers, Luo, Boven) Janssen Research and Development, LLC,
Titusville, NJ, United States
(Purrington) Janssen Research and Development, LLC, Horsham, PA, United
States
(Mehbob) Janssen-Cilag Ltd, High Wycombe, United Kingdom
(Pai) Janssen Research and Development, LLC, Raritan, NJ, United States
(Brown, Nettles) Janssen Scientific Affairs, LLC, Titusville, NJ, United
States
(Moecklinghoff) Janssen EMEA, Neuss, Germany
Title
Evaluation of Cardiovascular Disease Risk in HIV-1-Infected Patients
Treated with Darunavir.
Source
Drugs in R and D. (pp 1-12), 2018. Date of Publication: 10 Jul 2018.
Publisher
Springer International Publishing
Abstract
Introduction: We evaluated cardiovascular disease (CVD) risk associated
with darunavir treatment and examined the demographic/clinical
characteristics of darunavir users based on data from Janssen-sponsored
clinical trials, post-marketing pharmacovigilance databases, and
administrative claims databases. Methods: First, selected CVD events
[myocardial infarction, stroke, sudden death, invasive cardiovascular
procedures (coronary artery angioplasty or bypass, or carotid
endarterectomy)] were analyzed in 19 Janssen-sponsored phase 2-4 studies
(incidence rates estimated from pooled data; 95% confidence intervals
derived from Poisson distribution). Second, analyses were conducted to
identify spontaneously reported CVD events in post-marketing
pharmacovigilance databases and evaluate disproportional reporting of CVD
events for darunavir (using Empirical Bayesian Geometric Mean scores).
Third, baseline demographic/clinical characteristics of human
immunodeficiency virus-1 (HIV-1)-infected patients in general and new
users of darunavir and atazanavir were explored using three US
administrative claims databases. Results: Among 19 Janssen-sponsored
clinical trials (treatment durations <= 6 years), the CVD event rate (95%
CI) per 1000 person-years (pooled population; n = 5713) was 6.15
(2.91-11.89), and was lower for patients who used once-daily
darunavir/ritonavir 800/100 mg [0.71 (0.16-3.05); n = 1326] versus
twice-daily darunavir/ritonavir 600/100 mg [9.21 (4.94-16.04); n = 3058].
Trend analysis of post-marketing pharmacovigilance data showed that
cumulative CVD event reporting rates for darunavir users (any dose)
generally declined over time. Spontaneously reported CVD events were not
disproportionately reported with darunavir versus other protease
inhibitors. Compared with the general HIV-1-infected population and
atazanavir users, higher proportions of darunavir users were male, older,
and had comorbidities associated with CVD risk based on results from US
administrative claims databases. Conclusions: This comprehensive review of
Janssen-sponsored clinical trial, post-marketing, and epidemiological data
does not suggest that CVD should be considered an important risk for users
of darunavir.<br/>Copyright &#xa9; 2018 The Author(s)

<65>
Accession Number
618470395
Author
Mylonas K.S.; Tzani A.; Metaxas P.; Schizas D.; Boikou V.; Economopoulos
K.P.
Institution
(Mylonas) Division of Pediatric Surgery, Massachusetts General Hospital,
Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA 02114,
United States
(Mylonas, Tzani, Metaxas, Schizas, Economopoulos) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Schizas) First Department of Surgery, Laiko General Hospital, National
and Kapodistrian University of Athens, Athens, Greece
(Boikou) Athens University of Economics and Business, Athens, Greece
(Economopoulos) Department of Surgery, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A
Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 38 (8) (pp 1527-1539), 2017. Date of Publication: 01
Dec 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The benefit of blood cardioplegia (BCP) compared to crystalloid
cardioplegia (CCP) is still debatable. Our aim was to systematically
review and synthesize all available evidence on the use of BCP and CCP to
assess if any modality provides superior outcomes in pediatric cardiac
surgery. A systematic literature search of the PubMed and Cochrane
databases was performed with respect to the PRISMA statement
(end-of-search date: January 30th, 2017). We extracted data on study
design, demographics, cardioplegia regimens, and perioperative outcomes as
well as relevant biochemical markers, namely cardiac troponin I (cTnI),
lactate, and ATP levels at baseline, after reperfusion and postoperatively
at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using
random and mixed effects models. Our systematic review includes 56 studies
reporting on a total of 7711 pediatric patients. A meta-analysis of the 10
eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was
also performed. There was no significant difference between the two groups
with regard to cTnI and Lac at any measured time point, ATP levels after
reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52
to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and
30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h
postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI
-2.07 to -1.18). Based on the available data, neither cardioplegia
modality seems to be superior in terms of clinical outcomes, ischemia
severity, and overall functional recovery.<br/>Copyright &#xa9; 2017,
Springer Science+Business Media, LLC.

<66>
Accession Number
617175060
Author
Spitzer S.G.; Andresen D.; Kuck K.-H.; Seidl K.; Eckardt L.; Ulbrich M.;
Brachmann J.; Gonska B.-D.; Hoffmann E.; Bauer A.; Hochadel M.; Senges J.
Institution
(Spitzer) Praxisklinik Herz und Gefase, Akademische Lehrpraxisklinik der
TU Dresden, Forststrase 3, Dresden 01099, Germany
(Spitzer) Brandenburgische Technische Universitat Cottbus-Senftenberg,
Senftenberg, Germany
(Andresen) Klinikum Am Urban, Berlin, Germany
(Kuck) Asklepios Klinik St Georg, Hamburg, Germany
(Seidl) Klinikum Ludwigshafen GGmbH, Ludwigshafen am Rhein, Germany
(Eckardt) University Hospital, Munster, Germany
(Ulbrich) Klinikum Groshadern, Munich, Germany
(Brachmann) Klinikum Coburg GmbH, Coburg, Germany
(Gonska) Vincentius Hospital, Karlsruhe, Germany
(Hoffmann) Klinikum Munchen Bogenhausen, Munich, Germany
(Bauer) Diakonie-Klinikum Schwabisch Hall GGmbH, Schwabisch Hall, Germany
(Hochadel, Senges) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
Title
Long-term outcomes after event-free cardioverter defibrillator
implantation: Comparison between patients discharged within 24 h and
routinely hospitalized patients in the German DEVICE registry.
Source
Europace. 19 (6) (pp 968-975), 2017. Date of Publication: 01 Jun 2017.
Publisher
Oxford University Press
Abstract
Aims To analyse the long-term safety of implantable cardioverter
defibrillators (ICDs) in patients discharged within 24 h or after 2- 5-day
hospitalization, respectively, after complication-free implantation, in
circumstances of actual care. Methods and results Patients in the
multicentre, nationwide German DEVICE registry were contacted 12-15 months
after their first ICD implantation or device replacement. Data were
collected on complications, potential arrhythmic events, syncope,
resuscitation, ablation procedures, cardiac events, hospitalizations,
heart failure status, change of medication, and quality of life. Of 2356
patients from 43 centres, 527 patients were discharged within 24 h and
1829 were hospitalized routinely for >24 h after complication-free
implantations. The disease profiles and rates of co-morbidities were
similar at baseline for both cohorts. During between 384 and 543 days of
follow-up, there were no significant differences between the groups in
terms of complications, hospitalizations, or quality of life. One-year
rates of death were 4.5% in patients discharged early compared with 7.2%
in hospitalized patients (hazard ratio 0.65; 95% confidence interval
0.42-1.02; P = 0.052). Rates of major adverse cardiovascular events or
defibrillator events were not higher in patients discharged after 24 h. In
both groups, a high rate of patients declared that they would opt for the
procedure again in the same situation. Conclusion Data from a large-scale
registry reflecting current day-to-day practice in Germany suggest that
most patients can be discharged safely within 24 h of successful ICD
implantation if there are no procedure-related events. Follow-up data up
to 1.5 years after implantation did not raise long-term safety
concerns.<br/>Copyright &#xa9; The Author 2016.

<67>
Accession Number
611844997
Author
Taksaudom N.; Cheewinmethasiri J.; Chittawatanarat K.; Nawarawong W.;
Ko-Iam W.; Sudthiviseschai P.
Institution
(Taksaudom, Chittawatanarat, Nawarawong, Ko-Iam) Department of Surgery,
Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
(Cheewinmethasiri) Cardiovascular and Thoracic Surgery Unit, Department of
Surgery, Lampang Hospital, Lampang, Thailand
(Sudthiviseschai) Department of Pharmacy, Maharaj Nakorn Chiang Mai
Hospital, Chiang Mai, Thailand
Title
Magnesium sulfate reduces incidence of atrial fibrillation after coronary
arterial bypass surgery: What is the proper dose? A randomized trial.
Source
Journal of the Medical Association of Thailand. 99 (7) (pp 794-802), 2016.
Date of Publication: July 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Atrial fibrillation (AF) is a common complication after
cardiac surgery and impacts length of hospital stay, greater utilization
of health care resources, and increases morbidity and mortality. Magnesium
sulfate (MgSO<inf>4</inf>) has been well documented in its effect of AF
reduction after cardiac surgery especially in coronary artery bypass
grafting (CABG) but the dosages are still not settled. Material and
Method: Eighty-eight elective CABG cases were randomized to receive a high
dose (10 gm) or low dose (5 gm) MgSO<inf>4</inf> and were blinded into
bottle 1 (n = 46) and bottle 2 (n = 42). Patients were closely observed
with continuous ECG monitoring in the first 24 hours then observed for
clinical symptoms until discharge. Results: The demographic data were
comparable except for a higher body weight in the high dose group
(60.21+/-11.32 kg vs. 65.85+/-12.2 kg, p = 0.03) and higher incidence of
diabetes in high dose group (52.4% vs. 28.3%, p = 0.02). Intraoperative
data were similar. No complications were related to MgSO<inf>4</inf>
except one patient in the high dose group that experienced flushing and
abdominal discomfort during administration. Immediate postoperative serum
magnesium was higher in the high dose group but rapidly returned to
similar level one day postoperatively. AF occurred in nine patients
(10.23%), four in the low dose and five in the high dose group and there
was no statistical significance (p = 0.62). Conclusion: Current data
suggested the safety and effectiveness of MgSO<inf>4</inf> for the
reduction of the incidence of AF during postoperative CABG surgery.
However, there was no statistical difference between the dosages of
MgSO<inf>4</inf> supplement. The 5-gm-MgSO<inf>4</inf> supplement was
effective in AF prevention and could avoid the adverse effect from high
dose MgSO<inf>4</inf> infusion. Clinical trials registration number:
TCTR20140122001.<br/>Copyright &#xa9; 2016, Medical Association of
Thailand. All rights reserved.

<68>
Accession Number
622921131
Author
Li X.; Cui X.; Zhang S.; Fu Z.
Institution
(Li, Fu) Shandong Provincial Hospital Affiliated to Shandong University,
Jinan 250021, China
(Li, Cui, Zhang) Department of Anesthesiology, Yantaishan Hospital, Yantai
264000, China
Title
Ameliorative effects of parecoxib in combination with ultrasound-guided
paravertebral block (UGPB) on stress and inflammatory responses following
thoracoscopic surgery.
Source
Tropical Journal of Pharmaceutical Research. 17 (6) (pp 1171-1175), 2018.
Date of Publication: June 2018.
Publisher
University of Benin (Benin City300001Nigeria)
Abstract
Purpose: To investigate the ameliorative effects of parecoxib combined
with ultrasound-guided paravertebral block (UGPB) on stress and
inflammatory responses after thoracoscopic surgery. Methods: Forty
thoracoscopic surgery patients were randomized into placebo (control) and
parecoxib groups. Parecoxib was administered pre-operation, 24 h and 48 h
after operation. Arterial blood was collected, and endotoxin (ET),
thromboxane A2 (TXA2), interleukin 6 (IL-6) and tumor necrosis factor
alpha (TNF-alpha) levels were measured. Opioid dosage, infusion volume,
blood loss, operation time, visual analogue scale (VAS) score at 24 h and
48 h, and hospitalization period were recorded. Results: No significant
differences were observed in age, sex, height, body weight, opioid dosage,
surgery time, blood loss, or infusion volume between groups. VAS scores in
the parecoxib group were significantly lower than the control group after
24 and 48 h. The hospitalization period of the parecoxib group was
significantly shorter than the control group. Plasma levels of ET, TXA2,
IL-6 and TNF-alpha in the parecoxib group were lower than the control
group after 24 h; however, there was no significant difference after 48 h.
Conclusion: Parecoxib, combined with UGPB, effectively relieves
thoracoscopic pain, stress, and inflammatory responses of patients after
thoracoscopic surgery. This treatment would improve the postoperative
quality of life of lung cancer patients.<br/>Copyright &#xa9;
Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin
City, 300001 Nigeria and 2018 Li X, Cui X, Zhang S, Fu Z.

<69>
Accession Number
620647616
Author
Shavit L.; Silberman S.; Tauber R.; Merin O.; Bitran D.; Fink D.
Institution
(Shavit) Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem,
Israel
(Silberman, Tauber, Merin, Bitran, Fink) Department of Cardiac Surgery,
Shaare Zedek Medical Center, Jerusalem, Israel
Title
Preoperative aldosterone receptor blockade and outcomes of cardiac surgery
in patients with chronic kidney disease.
Source
Clinical Nephrology. 89 (3) (pp 187-195), 2018. Date of Publication: 01
Mar 2018.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Background and aims: Recent clinical evidence demonstrates that chronic
low-dose mineralocorticoid receptor antagonists (MRA), when added to
optimal treatment, result in reductions in cardiovascular mortality.
However, continuation of MRAs before cardiac surgery in patients with CKD
has never been evaluated and its potential benefit or harm in this
specific clinical setting is largely unknown. Materials and methods: This
is an observational study that included adult CKD patients undergoing
cardiac surgery. Patients were divided into two groups according to
preoperative use of spironolactone (SPL). The studied outcomes were
postoperative acute kidney injury (AKI) requiring dialysis, mortality, and
major morbidities (cardiovascular, neurologic, and infectious). Results:
Data on 698 patients with preoperative CKD stage III and IV were analyzed:
99 received SPL preoperatively and 599 did not. At baseline, patients on
SPL had higher EuroScore and had more complicated surgery. No significant
differences in the incidence of postoperative AKI, myocardial infarction
(MI), cardiovascular accident (CVA), sepsis, and mortality were detected
between groups in both univariate and multivariate analyses. However,
incidence of postoperative low cardiac output state (p < 0.008) was
significantly higher in the SPL group. Propensity score matching analyses
yielded similar results. Conclusions: Although SPL is usually administered
to significantly sicker patients, its use is not associated with increased
major postoperative complications. However, the modulating effect of SPL
in this clinical study remains to be elucidated in a prospective
randomized trial.<br/>Copyright &#xa9; 2018 Dustri-Verlag Dr. K. Feistle.

<70>
Accession Number
622970862
Author
Iftikhar A.; Hines A.; Adial A.; Genin D.; Mann J.M.
Institution
(Iftikhar, Genin) Pulmonary and Critical care, New York Presbyterian
Queens, Flushing, NY, United States
(Hines) New York Presbyterian Queens, Flushing, NY, United States
(Adial) Pulmonary, NYPQ, Flushing, NY, United States
(Mann) Pulmonary and Critical Care, New York Presbyterian Queens, Bayside,
NY, United States
Title
Unusual presentation of pulmonary carcinoid: A case report and review of
literature.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Introduction: Bronchopulmonary carcinoid tumors represent approximately
25% of all carcinoid tumors and 1%-2% of all lung malignancies. Although
rare, carcinoid tumors are increasing in incidence, partly because of
better detection with imaging and endoscopy. Most commonly carcinoids
originate from the gastrointestinal tract (appendix, small intestine,
rectum), pancreas, and bronchopulmonary. Depending on the affected organ
and disease progression, there is a wide variability among symptoms. We
present a case of a patient found to have primary lung carcinoid with only
presenting symptom of one episode of mild hemoptysis. Case Presentation: A
62-year-old female with no past medical history presented to the Emergency
Department with chief complaint of hemoptysis. That morning she woke up
and had one mild episode of coughing productive of bloody sputum. The
patient had no other complaints or symptoms. Vital signs and basic
laboratory tests were within normal limits. Computed Tomography
Angiography (CTA) revealed a lobulated 3.7cm mass in the right lower lobe
(RLL) of lung suspicious for neoplasm and involving the RLL bronchus. The
patient was referred to pulmonology who performed a bronchoscopy which
revealed a nearly obstructing (greater than 90%) friable mass proximally
in the RLL. Surgical pathology and cytology revealed carcinoid tumor,
positive for TTF-1, synaptophysin, and chromogranin. At this point patient
was referred to cardiothoracic surgery. A Positron Emission Tomorgraphy
showed the mass but no other sign of metastasis. The patient underwent a
right thoracotomy with RLL sleeve resection along with mediastinal lymph
node dissection. The pathology report showing the tumor size of 2cm, no
lymph node (9 lymph nodes tested) or bone involvement (6th rib), along
with clear margins. Staged as pT1bN0. The patient has had no more known
symptoms including no reoccurrence of hemoptysis. A follow up CT lung is
scheduled 3 months from surgical resection. Discussion: Although rare,
primary bronchopulmonary carcinoid should remain in the differential
diagnosis in a patient presenting with hemoptysis. The most common
presentation is wheezing, cough, dyspnea and occasionally hemoptysis if
pulmonary involvement. About 25% of patients are asymptomatic and
diagnosed incidentally by endoscopy or imaging. This particular patient
had no family history of malignancy, nonsmoker, and no other risk factors.
Treatment for lung carcinoid is resection. Generally urine 5-
hydroxyindoleacetic acid (5-HIAA); and chromogranin A (CgA) along with
routine imaging are followed closely for the first 6-12 months post
resection. Chemotherapy and radiation have no therapeutic benefit. (Figure
Presented).

<71>
Accession Number
622970744
Author
Hallifax R.; Laskawiec M.; Rahman N.M.
Institution
(Hallifax, Laskawiec, Rahman) Oxford Centre for Respiratory Medicine,
University of Oxford, Oxford, United Kingdom
Title
Digital air flow measurement early in treatment course for spontaneous
pneumothorax predicting surgical referral.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Introduction Management of primary spontaneous pneumothorax (PSP) is not
optimally defined. Patients often require chest tube drainage with
inpatient stay of 4-6days, and are typically reviewed each day with chest
X-ray and assessment of on-going air leak by looking for bubbling through
the underwater seal. Between 7-21% of patients will have prolonged air
leak (PAL) and/or non-re-expansion of the lung at 7 days. At present,
there is no good way to predict this treatment failure. Digital suction
devices are routinely used post-cardiothoracic surgery and have been shown
to reduce drain duration. We hypothesize that air flow measured on Day 0,
1 and 2 can successfully predict which patients eventually require
surgical referral. Methods Interim analysis of data was conducted from
patients enrolled into the RAMPP trial (ISRCTN 79151659), a prospective
randomised trial comparing Pleural Vent (Rocket Medical) to standard care
(as per BTS guidelines). Air flow measurements were taken (over 10
minutes) using Thopaz+ digital suction device (Medela) each day until day
4, or until drain removal. Results 81 patients air leak data were
analysed: 74.1% (60/81) patients were male, mean age 30.0 years (SD, 7.9),
74.1% were current or ex-smokers, and 25.9% never smokers. Age, sex,
smoking history and size of initial pneumothorax were not significantly
different. However, median air flow measurements were significantly higher
in those patients eventually requiring surgery (compared to those
spontaneous resolving) on Day 1: 360 vs 10ml/min (p 0.015) and Day 2: 190
vs 10ml/min (p 0.03). Use of threshold value of 100ml/min (see Figure) and
150ml/min (not shown) were able to discriminate between those patients
meeting the pre-specified criteria of referral for surgery. If a patient's
air flow was >=100ml/min on Day 1, the odds of requiring surgical referral
were 5.1 greater (95%CI 1.34-19.95, p 0.008), than if <100ml/min. The
negative predictive value of air flow <100ml/min at Day 1 was 80.6% - i.e.
only 1 in 5 patients with <100ml/min will fail to resolve spontaneously.
Conclusion This study is the first to use sequential digitally measured
air flow measurements in patients with spontaneous pneumothorax,
demonstrating that air flow measurements early in treatment course can
predict future treatment failure. Further validation with larger dataset
is planned on completion of the RAMPP study. Figure: Median treatment
duration (days) by air flow threshold (100ml/min) by treatment day (DELTA
= difference in medians. p values calculated by Mann Whitney U test)
(Figure Presented).

<72>
Accession Number
622970672
Author
Phillips D.; Collins S.E.; Bryan T.L.; Wong E.Y.; McMurtry M.S.; Bhutani
M.; Stickland M.K.
Institution
(Phillips, Collins, Bryan, Wong, McMurtry, Bhutani, Stickland) University
of Alberta, Edmonton, AB, Canada
Title
Does the carotid chemoreceptor play a role in cardiopulmonary regulation
Dyspnea and Exercise Intolerance in COPD?.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
RATIONALE: COPD patients have an exaggerated ventilatory response to
exercise, contributing to exertional dyspnea and exercise intolerance,
however, the reasons are not well understood. We have recently
demonstrated enhanced activity and sensitivity of the carotid
chemoreceptor (CC) in COPD which may alter cardiopulmonary responses to
exercise, exertional dyspnea and exercise intolerance. Accordingly, we
sought to examine whether CC inhibition improves cardiovascular and
ventilatory responses, dyspnea and exercise tolerance in COPD. METHODS: In
a randomized double blind crossover study, six COPD patients (FEV1
predicted +/- SD: 82 +/- 19%) and fourteen healthy controls completed two
time to symptom limitation (TLIM) constant load exercise tests at 75% peak
power output with either intravenous saline or low-dose dopamine (2
mug/kg/min). Dopamine has been previously shown to inhibit the CC.
Ventilatory responses were evaluated using expired gas data and dyspnea
was evaluated using a modified Borg scale. Inspiratory capacity maneuvers
were performed to determine operating lung volumes. Cardiac output
(impedance cardiography), arterial O<inf>2</inf> saturation (pulse
oximetry) and haemoglobin concentration (venous blood sampling) were
collected to estimate oxygen delivery. Vascular conductance was calculated
as cardiac output/mean arterial pressure (MAP). RESULTS: At a standardized
exercise time (isotime) of 4 minutes and at TLIM, minute ventilation was
not different between saline and dopamine conditions in COPD (isotime 50.2
+/- 4.0 vs 49.3 +/- 4.3 L/min, p=0.35; TLIM 56.5 +/- 4.1 vs 60.0 +/- 4.5
L/min, p=0.30) or controls (isotime 72.6 +/- 7.0 vs 69.7 +/- 5.2 L/min,
p=0.24; TLIM 88.3 +/- 8.3 vs 88.0 +/- 7.8 L/min, p=0.92). Operating lung
volumes, exertional dyspnea and oxygen delivery were not different between
conditions within either group. Vascular conductance was increased with
dopamine, secondary to reduced MAP, in COPD (isotime 97.5 +/- 12.2 vs
108.3 +/- 11.5 ml/min/mmHg, p=0.04; TLIM 99.5 +/- 12.1 vs 115.8 +/- 15.6
ml/min/mmHg, p=0.04), while no change was observed in controls (isotime
109.0 +/- 6.5 vs 116.0 +/- 8.5 ml/min/mmHg, p=0.20; TLIM 121.0 +/- 9.2 vs
131.0 +/- 10.2 ml/min/mmHg, p=0.09). There was no change in time to
exhaustion in either group with dopamine (COPD 9.1 +/- 2.2 vs 10.8 +/- 3.2
min, p=0.63; Control 11.0 +/- 1.1 vs 12.4 +/- 1.2 min, p=0.14).
CONCLUSION: Preliminary data suggest that the CC plays a role in
cardiovascular regulation during exercise in COPD; however, ventilation,
dyspnea and exercise intolerance were unaffected by CC inhibition in COPD
patients.

<73>
Accession Number
622969465
Author
Chopra M.; Shamsid-Deen N.; GarciaOrr R.
Institution
(Chopra) Internal Medicine, University of Arizona, College of Medicine
Phoenix, Phoenix, AZ, United States
(Shamsid-Deen, GarciaOrr) Pulmonary and Critical Care Medicine, University
of Arizona, College of Medicine Phoenix, Phoenix, AZ, United States
Title
From meth to methylene blue: A unique case of vasopressor refractory
shock.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Introduction: Vasoplegic syndrome is a poorly understood disease state
which is best described as a loss of endothelial homeostasis and a
secondary drop in peripheral vascular resistance. This entity is seen in a
wide range of syndromes, including septic shock. Typically, in septic
shock, treatment is focused on restoration of tissue perfusion with the
goal directed fluid resuscitation, use of vasopressors, and if indicated
corticosteroids. However, in a selected population of patients, there is
refractory peripheral vasodilation despite maximal vasoconstrictor
therapy. We present a case of vasopressor refractory shock that responded
to the administration of methylene blue. Case Report: A 34-year-old male
with past medical history significant for splenectomy and methamphetamine
use presented with an eight-day history of progressively worsening diffuse
abdominal pain. In the ED the patient was noted to have septic shock with
an initial lactic acid of 10 mmol/L and respiratory distress. Physical
exam was significant for severe abdominal pain with palpation and
abdominal distention. The patient was admitted to the medical ICU where he
was noted to be in extremis requiring initiation of vasopressor therapy
and intubation. Bedside echocardiography revealed a large tricuspid valve
vegetation. CT angiography of the chest revealed the presence of multiple
bilateral septic emboli and wedge infarcts (Figure 1). Given the concern
for ischemic bowel emergent exploratory laparotomy was performed which was
negative for ischemic bowel. Post-operatively, he had worsening shock
requiring 3 vasopressors and stress dose corticosteroids. Methylene blue
was bolused at 2mg/kg and then continued at a rate of .5mg/kg/hr for 12
hours. Within an hour, the patient's vasopressor requirements were
decreased by more than half and his pH normalized. Discussion: There is no
consensus on the definition of refractory shock however, most studies
define it as the need to use vasopressin or a rate greater than 0.5
mcg/kg/min of norepinephrine. The data for methylene blue use in
vasoplegic refractory shock is controversial and is mostly extrapolated
from literature in cardiothoracic surgery patients. The pathophysiologic
basis behind the therapy is inhibition of nitric oxide synthase and
guanylate cyclase and therefore decreased second messengers of
vasodilation. Our comprehensive literature review found limited, but
supportive outcomes and limited number of associated side effects when
used at the doses described. This case highlights the use of methylene
blue as an effective therapy treating severe refractory shock and
emphasizes the need for more studies examining its effect on patient
mortality. (Figure Presented).

<74>
Accession Number
622969380
Author
Tariq U.; Khan R.; Jones T.W.; Nasser W.
Institution
(Tariq, Khan) Critical Care, Orlando Regional Medical Center, Orlando, FL,
United States
(Jones) Orlando Health, Orladno, FL, United States
(Nasser) Critical Care, Medicine/Pulmonary, Orlando, FL, United States
Title
Failure of standard acls protocol in refractory ventricular fibrillation
post cardiac bypass surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Case Report: Post CABG arrhythmias represent a major cause of morbidity in
patients. Incidence of supraventricular tachyarrhythmia is frequently
encountered however sustained ventricular arrhythmias are quite uncommon
after cardiac surgery with incidence of 0.41-1.4%. Epinephrine use can be
lethal when used as an adjunct to resuscitation of cardiac arrest.
Description: 64 year old Male patient with a past medical history of
hypertension, coronary vessel disease (right coronary artery stent) and
HIV (CD4 count of 359) was admitted to our institution for chest pain
evaluation. Cardiac angiography was performed, which was significant for
left ventricular ejection fraction of 60%, left main artery stenosis of
70% , left anterior descending artery stenosis of 70%, circumflex artery
stenosis of 70% and a patent stent in right coronary artery. Patient
underwent successful and uneventful 3-vessel CABG. 24 hours after his CABG
he was noted to have decreased blood pressure and sudden decline in his
mental status and immediately later was found to be in fine ventricular
fibrillation (VFIB). Standard ACLS protocol was initiated. He was in
refractory VFIB despite receiving amiodarone and attempted multiple
cardioversions Ultimately the ACLS was stopped after thirty minutes due to
unsuccessful outcome. Discussion: Refractory VFIB is rare after CABG.
Epinephrine can predispose patients to VFIB by causing electoral storm,
catecholamine surge and increasing myocardial oxygen demand due to beta
adrenergic effects. Beta blockage (BB) is often overlooked during ACLS. It
can block the deleterious effects of beta stimulation from exogenous
epinephrine given during ACLS and also the endogenous catecholamine surge
by the nervous system. We did not utilize BB during the ACLS procedure due
the fact the guidelines suggest to use epinephrine pulseless VFIB. To date
no randomized controlled human trial has evaluated early epinephrine
administration in VFIB arrest and more research needs to be conducted to
revise the current ACLS guidelines. We suggest the use of beta blockage
and limit the use of epinephrine in refractory VFIB.

<75>
Accession Number
622966925
Author
Victor N.; Hettenbaugh J.; Dickinson J.D.
Institution
(Victor) Pulm/CCM, Univ. of Nebraska Medical Center, Omaha, NE, United
States
(Hettenbaugh) Internal Medicine, Univ. of Nebraska Medical Center, Omaha,
NE, United States
(Dickinson) Pulmonary, Critical Care, Sleep, and Allergy, University of
Nebraska Medical Center, Omaha, NE, United States
Title
Repair with caution: Diffuse alveolar hemorrhage associated with mitral
valve repair.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Introduction: Diffuse alveolar hemorrhage (DAH) is a medical emergency
that has a wide spectrum of etiology ranging from capillaritis associated
with autoimmune diseases, infections, thromboembolism, anti-coagulants,
inhaled toxins, drugs etc. While DAH has been reported in mitral valvular
heart disease, systematic review of literature reveals the incidence of
DAH following mitral valve repair is unclear. We present a case of DAH in
a patient following elective mitral valve repairCase Report: 64 year-old
Caucasian female who recently underwent an elective mitral valve repair
(26mm Edwards annuloplasty ring for severe mitral regurgitation), severe
aortic stenosis s/p On-X-Mechanical aortic valve, single vessel coronary
artery bypass surgery (CABG)-right coronary artery (RCA) on Aspirin, post
operative right sub-segmental pulmonary emboli six weeks ago at an outside
hospital presented with hemoptysis and dyspnea for 3 days. Afebrile and
hemodynamically stable. Oxygen saturation 86% on room air. CT Angiogram
chest (Figure-1) revealed diffuse infiltrates suggestive of multifocal
pneumonia vs DAH with mild bilateral pleural effusions. No pulmonary
emboli noted. PT INR-1.8 and Hemoglobin 9.2 on admission. Bronchoalveolar
lavage (BAL)showed rising sequential bloody fluid on the third aliquot
from the right middle lobe and lingula consistent with DAH.
Anti-microbiological work up for infection was negative. Autoimmune
serologies for capillaritis were negative. ECHO showed mild-moderate
mitral stenosis, trace mitral regurgitation, pulmonary artery systolic
pressure (PASP) of 55-60 mmHg and left ventricular ejection fraction of
45%. No aortic regurgitation and gradient was 15 mmHg across the valve.
Aspirin and Warfarin held and supportive care provided. Hemoptysis
resolved and Hematocrit remained stable. She clinically improved and was
discharged to follow up with the heart failure team. Instructed to hold
Warfarin for 2 weeks before re-initiation of therapy. Discussion: Our
patient had no clinical/serological evidence of infection. Rheumatological
work up for capillaritis was negative. CTA did not show any evidence of
pulmonary emboli. Gram stain, cultures and viral panel on the BAL was
negative. No malignant cells noted. Given the temporal association of her
recent surgery, ECHO indicating mitral stenosis with high PASP, we suspect
her recent mitral valve repair in addition to being on blood thinners
could have provoked her DAH. Conclusion: While DAH has been associated
with acute and chronic mitral valve pathologies, it is seldom reported as
a complication following mitral valve repair. It is important to recognize
DAH as a potential complication post mitral valve repair especially in
patients on blood thinners for other co-existing conditions.

<76>
Accession Number
622966329
Author
Vento D.; Ferreira P.E.; Amaral L.A.; Ferreira A.C.; Rodrigues A.J.
Institution
(Vento, Ferreira, Amaral, Ferreira, Rodrigues) Surgery and Anatomy,
University of Sao Paulo, Ribeirao Preto, Brazil
Title
Effect of a respiratory muscle training protocol on nitrite and nitrate
levels in exhaled breath condensate.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
INTRODUCTION/RATIONALE Exhaled air from the lungs can provide relevant
information abou the concentration of many inflammatory biomarkers and
oxidative stress. The nitrate/nitrate
(NO^-<inf>2</inf>/NO^-<inf>3</inf>) determination in
exhaled breath condensate (EBC) has been used as a marker of airway
inflammation. Thus, since we were interested in investigating the levels
of NO^-<inf>2</inf>/NO^-<inf>3</inf> in EBC in cardiac
patients, we also conjecture to verify if respiratory muscle training in
these patients could influence levels of
NO^-<inf>2</inf>/NO^-<inf>3</inf> in exhaled. There
are experiments that suggest that physical exercise, even of low
intensity, may influence the inflammatory response of the airways. Thus,
the influence in levels could be benefical for elective surgery, if this
patients were admitted in the surgical center with lower levels of
mediators pulmonary inflammation. So, the aim of study was verify if
respiratory training program the influenced of
NO^-<inf>2</inf>/NO^-<inf>3</inf> levels in EBC.
METHODS: 21 patients volunteers of both sexes, older, with weakness of
inspiratory muscles and candidate operation of coronary artery bypass
and/or heart valve surgery admitted in the Clinical Hospital o the Medical
School of Ribeirao Preto of Sao Paulo University (FMRP/USP) were
randomized into 2 groups. In one group, 10 patients underwent a minimum of
9 days of inspiratory muscle training using an incentive spirometry
"Threshold IMT" (Respironics, Cedar Grove, NJ, USA) with progressive daily
increase of load (40, 60 and 80% of maximal inspiratory pressure)
according to patient tolerance. The other 11 patients received only
conventional physiotherapay without respiratory muscle training goal. We
compared spirometric values, maximal inspiratory pressure, maximal
expiratory pressure as well as the values of
NO^-<inf>2</inf>/NO^-<inf>3</inf> in EBC before and
after training in each group. RESULTS: It was observed that after the
training, in spirometry, only the peak expiratory flow (FEP) presented
significant alteration (p <0.02), there was no relevant alteration in the
respiratory muscle strength, the maximal inspiratory and expiratory
pressures did not change between the groups. There was a significant
reduction of NO^-<inf>2</inf>/NO^-<inf>3</inf> levels
in the EBC (p <0.05). CONCLUSION: The respiratory training protocol, even
in the very short term, influenced the concentration of nitrite / nitrate
mediators, which may suggest that the training may exert some influence on
the inflammation of the airway. Further larger sample studies are needed
to ascertain the benefit of mediator reduction with respiratory muscle
strength training.

<77>
Accession Number
622965733
Author
Haines K.J.; Beesley S.; Hopkins R.O.; McPeake J.; Quasim T.; Ritchie K.;
Iwashyna T.J.
Institution
(Haines) Physiotherapy, Western Health, Melbourne, Australia
(Beesley) Division of Pulmonary Medicine, Salt Lake City, UT, United
States
(Hopkins) Intermountain Medical Center, Murray, UT, United States
(McPeake) University of Glasgow, Glasgow, United Kingdom
(Quasim) Glasgow Royal Infirmary, Glasgow, United Kingdom
(Ritchie) Library Services, Western Health, Melbourne, Australia
(Iwashyna) Univ of Michigan, Ann Arbor, MI, United States
Title
Peer support in critical care: A systematic review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Rationale: Peer support has potential to ameliorate the burden of Post
Intensive Care Syndrome (PICS) through promoting resilience and enhanced
recovery. The aim of this systematic review was to identify and evaluate
the previously published outcomes of peer support interventions on patient
and family outcomes following critical illness and synthesise key elements
of model design and structure. Methods: A systematic search of MEDLINE,
CINAHL, PsychInfo and EMBASE was undertaken May 2017. Inclusion criteria
included: randomized, quasi-experimental or observational studies of 1)
patients (adult or paediatric) who had been admitted to the intensive care
unit and/or their family members and 2) had participated in a peer support
intervention. Case reports, reviews, editorials or descriptive commentary
publications were excluded. Two reviewers independently screened citations
for studies that investigated peer support interventions in critical care
cohorts. Data on outcomes of peer support and key elements of each model
were extracted into a standardised form. The Preferred Reporting Items for
Systematic Reviews guidelines were followed. PROSPERO ID: CRD42017070174.
Results: 2932 studies were screened and eight studies met criteria for
inclusion. These studies included a total of 192 family members and 92
patients including adults (with conditions: cardiac surgery, acute
myocardial infarction, trauma), paediatrics and neonates. Peer support
reduced psychological morbidity and improved social support and
self-efficacy in two studies; in both of these cases, peer support was
delivered via an individual peer-to-peer model. In the remaining studies
it was difficult to determine the outcomes of peer support as the
reporting and quality of studies was low. The most common peer support
model of the eight studies was an in-person, facilitated group for
families that occurred during the patients' ICU admission. Conclusions:
The evidence base for peer support in critical care is limited and no firm
recommendations could be made. In the small number of existing studies,
peer support appeared to reduce psychological morbidity and increase
social support. There is a need for well-designed and rigorously reported
research into this complex intervention.

<78>
Accession Number
622965651
Author
Corcoran J.P.; Psallidas I.; Gerry S.; Piccolo F.; Koegelenberg C.F.; Saba
T.; Daneshvar C.; Fairbairn I.; Heinink R.; West A.; Stanton A.E.; Holme
J.; Kastelik J.A.; Steer H.; Downer N.J.; Haris M.; Baker E.H.; Everett
C.F.; Pepperell J.; Bewick T.; Yarmus L.B.; Maldonado F.; Khan B.;
Hart-Thomas A.; Hands G.; Warwick G.; Munavvar M.; Guhan A.; Shahidi M.;
Pogson Z.E.; Dowson L.; Ward N.; Saba J.; Read C.; Bhatnagar R.; Hallifax
R.J.; Dobson M.; Shaw R.; Hedley E.L.; Sabia A.; Robinson B.; Collins
G.S.; Davies H.E.; Yu L.; Maskell N.A.; Miller R.F.; Rahman N.M.
Institution
(Corcoran, Dobson, Shaw, Hedley, Sabia, Robinson, Rahman) University of
Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom
(Psallidas, Hallifax) Oxford Centre for Respiratory Medicine, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Gerry, Collins) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Piccolo, Read) Pleural Medicine Unit, Sir Charles Gairdner Hospital,
Perth, Australia
(Koegelenberg) Division of Pulmonology, Department of Medicine,
Stellenbosch University, Cape Town, South Africa
(Saba, Saba) Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool,
United Kingdom
(Daneshvar, Ward) Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
(Fairbairn) Victoria Hospital, NHS Fife, United Kingdom
(Heinink) Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United
Kingdom
(West) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
(Stanton) Great Western Hospitals, NHS Foundation Trust, Swindon, United
Kingdom
(Holme) Manchester University, NHS Foundation Trust, Manchester, United
Kingdom
(Kastelik) Hull and East Yorkshire Hospitals NHS Trust, Hull, United
Kingdom
(Steer) Gloucestershire Hospitals, NHS Foundation Trust, Gloucester,
United Kingdom
(Downer) Sherwood Forest Hospitals, NHS Foundation Trust, Mansfield,
United Kingdom
(Haris) University Hospitals of North Midlands NHS Trust, Stoke-on-Trent,
United Kingdom
(Baker) Institute of Infection and Immunity, St George's, University of
London, London, United Kingdom
(Everett) York Teaching Hospital, NHS Foundation Trust, York, United
Kingdom
(Pepperell) Taunton and Somerset NHS Foundation Trust, Taunton, United
Kingdom
(Bewick) Derby Teaching Hospitals, NHS Foundation Trust, Derby, United
Kingdom
(Yarmus) Division of Pulmonary and Critical Care Medicine, Johns Hopkins
University, Baltimore, MD, United States
(Maldonado) Pulmonary and Critical Care Medicine, Vanderbilt University,
School of Medicine, Nashville, TN, United States
Title
Prospective validation of the rapid clinical risk prediction score in
patients with pleural infection: The pleural infection longitudinal
outcome study (PILOT).
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
RATIONALE Pleural infection is increasingly common and associated with
significant morbidity and mortality, with no current robust means of
predicting which patients will suffer poor clinical outcomes. A validated
risk score at baseline would allow high-risk patients to be identified
early, and directed towards more invasive management strategies aimed at
improving prognosis. METHODS The Pleural Infection Longitudinal Outcome
Study (PILOT) was a prospective observational cohort study, recruiting
adult patients with pleural infection from 29 centres in four countries,
with patients undergoing protocolised management based on widely accepted
national guidelines adapted for local practice. The study was powered to
validate a previously described clinical risk prediction score (RAPID),
derived and retrospectively validated using data from two large
multicentre randomised trials in pleural infection (MIST1 and MIST2). The
primary outcome was mortality associated with pleural infection at 3
months; secondary outcomes included mortality at 12 months, length of
hospital stay, need for thoracic surgical intervention, failure of initial
medical management (according to pre-defined criteria), and lung function
impairment at 3 months. Study follow-up was for 12 months. The study was
funded by the UK Medical Research Council, and registered with
ClinicalTrials.gov (ISRCTN 50236700). RESULTS 551 participants were
recruited between October 2013 and October 2016, and data were available
in 542 (98.4%) patients. 383/542 (70.7%) were male; mean age was 58 years
(SD 20). Overall mortality was 10% at 3 months (54/542) and 19% (101/542)
at 12 months. Mortality increased according to RAPID score overall (Figure
1a) and 3 month mortality was closely associated with RAPID category;
low-risk (RAPID score 0-2) 4/216 (1.9%, 95% CI 0.5 to 3.6), medium risk
(RAPID score 3-4) 22/233 (9.4%, 95% CI 5.7 to 13.2), and high-risk (RAPID
score 5- 7) 28/93 (30.1%, 95% CI 20.8 to 39.4) (Figure 1b). C-indexes
(AUROC) for the prediction score at 3 months and 12 months were 0.79 (95%
CI 0.73 to 0.85) and 0.77 (95% CI 0.72 to 0.82) respectively. CONCLUSIONS
RAPID is a robust prediction score for mortality in adult patients with
pleural infection, and should now be used to guide clinical care. Further
studies are now required to assess if targeting more interventional
treatment strategies in higher risk groups can reduce mortality.

<79>
Accession Number
622965347
Author
Kukrety S.P.; Parekh J.D.; Walters R.; Anantha Narayanan M.; Vivekanandan
R.
Institution
(Kukrety, Parekh, Walters, Vivekanandan) Internal Medicine, Creighton
University, School of Medicine, Omaha, NE, United States
(Anantha Narayanan) Cardiology, University of Minnesota, Minneapolis, MN,
United States
Title
Role of immunosuppressive regimen in post-transplant lymphoproliferative
disorders among thoracic organ transplant recipients.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a
devastating complication that occurs after solid organ transplant in the
setting of immunosuppression. Thoracic organ transplant recipients
generally require a higher level of immunosuppression and have a higher
incidence of PTLD as compared to other solid organ transplants. One of the
modifiable risk factors fot PTLD is the type of immunosuppressive therapy.
Methods: The United Network for Organ Sharing (UNOS) database was queried
to identify patients who were at least 18 years of age undergoing heart or
lung transplant. We evaluated the association between the incidence of
PTLD and age, gender, Body Mass Index (BMI) and immunosuppression.
Categorical variables are presented as frequency, denominator, and
incidence of PTLD. SASv. 9.4 was used for all statistical analyses.
Results: We retrospectively analysed 38,861 heart transplant recipients
and 21,857 lung transplant recipients within the UNOS Database. The
incidence of PTLD was higher in whites and patients < 55 years of age. The
gender and BMI of the recipient did not affect the incidence of PTLD.
Amongst heart transplant recipients, use of tacrolimus for maintenance
therapy was associated with a lower incidence of PTLD when compared to
other immunosuppressive agents. In lung transplant recipients, use of
ATGAM for induction was associated with increased incidence of PTLD; and
use of tacrolimus for maintenance therapy was associated with a lower
incidence of PTLD. Use of cyclosporine for maintenance therapy did not
affect the incidence of PTLD (Table 1). Conclusion: Incidence of PTLD is
higher among whites and patients < 55 years of age. Studies have
demonstrated an increased risk of PTLD with calcineurin inhibitor use [1],
with some studies showing an increased risk of PTLD with tacrolimus as
compared to cyclosporine alone [2]. In our study, we demonstrate decreased
incidence of PTLD with tacrolimus use when compared to other
immunosuppressive agents. Cyclosporine was not associated with an
increased incidence of PTLD. These findings suggest the need for
randomized control trials to assess the risk of PTLD with calcineurin
inhibitor use. (Table Presented) .

<80>
Accession Number
622964897
Author
Hogarth D.K.; Delage A.; Zgoda M.A.; Reed M.F.
Institution
(Hogarth) Pulmonary and Critical Care Medicine, Univ of Chicago, Chicago,
IL, United States
(Delage) Laval University, Quebec City, QC, Canada
(Zgoda) Carolinas Medical Center, Harrisburg, NC, United States
(Reed) Penn State Milton S. Hershey Med Ctr, Hershey, PA, United States
Title
Evaluation of the safety and effectiveness of the spiration valve system
for single lobe treatment of severe emphysema in patients with alpha-1
antitrypsin deficiency.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Rationale: Alpha-1 Antitrypsin Deficiency (AATD) is an inherited disorder
that raises the risk for lung disease and can often lead to emphysema.
Many of these patients have severe gas trapping and limited exercise due
to dyspnea. We report on the 6-month results of the AATD arm of the
EMPROVE study, a multicenter, prospective, randomized controlled trial
undertaken at 31 centers in US and Canada to assess the safety and
effectiveness of the Spiration Valve System (SVS) compared to standard
medical care in patients with severe emphysema. Methods: AATD patients
with severe airflow obstruction, hyperinflation, and severe dyspnea
without interlobar collateral ventilation were evaluated for enrollment in
a separate treatment arm of the EMPROVE trial. A total of 20 AATD subjects
already on optimal medical management were treated with SVS valves at 12
centers. Results: Target lobe selection, based on high resolution computed
tomography (HRCT) identified a lower lobe in 85% and an upper lobe in 15%
of patients. A mean of 4.4 valves per patient were used to isolate the
target lobe, with an average procedure time of 20 minutes. Through the
6-month primary study endpoint follow-up, there were statistical
improvements in FEV<inf>1</inf>, Target Lobe Volume (TLV) and disease
specific quality of life measures - St. George's Respiratory Questionnaire
(SGRQ), modified Medical Research Council dyspnea score (mMRC), and COPD
Assessment Test (CAT). Mean +/-SD Through 6-months, there was one death.
Six (30%) of the AATD group (including the patient who died) had
procedure/device related serious adverse events, consisting of acute COPD
exacerbations (10%), pneumonia (5%), and pneumothorax (15%), with early
onset pneumothorax resulting from acute reduction in lung volume due to
valve therapy being a recognized indicator of target lobe occlusion.
Conclusions: This AATD sub-study arm of the EMPROVE Trial showed that
implantation of the Spiration Valve System in patients with severe
emphysema provides statistical improvements in FEV<inf>1</inf>, target
lobe volume reduction and quality of life parameters, with a good safety
profile in this underserved patient population.

<81>
Accession Number
622964868
Author
Criner G.J.; Delage A.; Voelker K.G.
Institution
(Criner) Temple Univ Hosp, Philadelphia, PA, United States
(Delage) Laval University, Quebec, QC, Canada
(Voelker) Sarasota Memorial Hospital, Sarasota, FL, United States
Title
The emprove trial-a randomized, controlled multicenter clinical study to
evaluate the safety and effectiveness of the spiration valve system for
single lobe treatment of severe emphysema.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2018. United
States. 197 (MeetingAbstracts) (no pagination), 2018. Date of Publication:
2018.
Publisher
American Thoracic Society
Abstract
Rationale: Current treatments for chronic obstructive pulmonary disease
(COPD) fail to reverse the hyperinflation that impairs patients with a
predominant emphysematous phenotype. Minimally invasive bronchoscopically
placed endobronchial one-way valves have been developed to block airflow
to targeted hyperinflated, emphysematous lung lobes with the objective to
reduce endexpiratory lung volume and improve lung function, quality of
life and dyspnea. We report the 6- month primary endpoint results of the
EMPROVE study, a multicenter, prospective, randomized controlled trial
undertaken at 31 centers in US and Canada to assess the safety and
effectiveness of the Spiration Valve System (SVS) compared to standard
medical care in patients with severe emphysema. Methods: Patients with
severe airflow obstruction, hyperinflation, and severe dyspnea without
interlobar collateral ventilation were evaluated for enrollment. A total
of 172 subjects, were randomized in a 2:1 allocation ratio to either the
treatment group (SVS valves and medical management, N=113) or the control
group (medical management alone, N=59). Patients were unblinded to
treatment assignment. Results: Target lobe selection, based on high
resolution computed tomography (HRCT) identified an upper lobe in 70% and
a lower lobe in 30% of patients. SVS treatment to isolate the targeted
lobe resulted in a mean target lobe volume reduction of 974 ml (52.8%) at
6 months. At all-time points the primary endpoint, FEV<inf>1</inf>,
reached statistical and clinically meaningful differences between the
study groups as did secondary measures of hyperinflation, disease specific
quality of life, and dyspnea scores. Mean +/-SD; RV - residual volume, TLC
- Total Lung capacity, T - Treatment Group, C - Control Group SGRQ - St.
George's Respiratory Questionnaire, mMRC - Modified Medical Research
Council dyspnea score. Through 6-months, 11.9% of patients in the control
group had thoracic serious adverse events compared to 30.1% of the
treatment group. While pneumothorax rate (14.2%) was the main contributor,
early onset pneumothorax in the ipsilateral non-targeted lobe due to acute
volume reduction in the targeted lobe is a recognized adverse event with
significant targeted lobe volume reduction. Conclusions: The EMPROVE Trial
showed that bronchoscopic treatment of severe emphysema patients with the
Spiration Valve System provides statistical and clinically meaningful
improvements in FEV<inf>1</inf>, target lobe volume reduction and quality
of life parameters, with a good safety profile. Furthermore, this study
demonstrates that HRCT assessment is effective in choosing appropriate
patients and the target lobe for treatment.

<82>
Accession Number
622923198
Author
Guay J.; Ochroch E.A.; Kopp S.
Institution
(Guay) University of Sherbrooke, Department of Anesthesiology, Faculty of
Medicine, Sherbrooke, Quebec, Canada
(Guay) University of Quebec in Abitibi-Temiscamingue, Teaching and
Research Unit, Health Sciences, Rouyn-Noranda, QC, Canada
(Guay) Faculty of Medicine, Laval University, Department of Anesthesiology
and Critical Care, Quebec City, QC, Canada
(Ochroch) University of Pennsylvania, Department of Anesthesiology, 3400
Spruce Street, Philadelphia, PA 19104, United States
(Kopp) Mayo Clinic College of Medicine, Department of Anesthesiology and
Perioperative Medicine, 200 1st St SW, Rochester, MN 55901, United States
Title
Intraoperative use of low volume ventilation to decrease postoperative
mortality, mechanical ventilation, lengths of stay and lung injury in
adults without acute lung injury.
Source
Cochrane Database of Systematic Reviews. 2018 (7) (no pagination), 2018.
Article Number: CD011151. Date of Publication: 09 Jul 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Since the 2000s, there has been a trend towards decreasing
tidal volumes for positive pressure ventilation during surgery. This an
update of a review first published in 2015, trying to determine if lower
tidal volumes are beneficial or harmful for patients. Objectives: To
assess the benefit of intraoperative use of low tidal volume ventilation
(less than 10 mL/kg of predicted body weight) compared with high tidal
volumes (10 mL/kg or greater) to decrease postoperative complications in
adults without acute lung injury. Search methods: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL 2017, Issue 5), MEDLINE
(OvidSP) (from 1946 to 19 May 2017), Embase (OvidSP) (from 1974 to 19 May
2017) and six trial registries. We screened the reference lists of all
studies retained and of recent meta-analysis related to the topic during
data extraction. We also screened conference proceedings of
anaesthesiology societies, published in two major anaesthesiology
journals. The search was rerun 3 January 2018. Selection criteria: We
included all parallel randomized controlled trials (RCTs) that evaluated
the effect of low tidal volumes (defined as less than 10 mL/kg) on any of
our selected outcomes in adults undergoing any type of surgery. We did not
retain studies with participants requiring one-lung ventilation. Data
collection and analysis: Two authors independently assessed the quality of
the retained studies with the Cochrane 'Risk of bias' tool. We analysed
data with both fixed-effect (I² statistic less than 25%) or
random-effects (I² statistic greater than 25%) models based on
the degree of heterogeneity. When there was an effect, we calculated a
number needed to treat for an additional beneficial outcome (NNTB) using
the odds ratio. When there was no effect, we calculated the optimum
information size. Main results: We included seven new RCTs (536
participants) in the update. In total, we included 19 studies in the
review (776 participants in the low tidal volume group and 772 in the high
volume group). There are four studies awaiting classification and three
are ongoing. All included studies were at some risk of bias. Participants
were scheduled for abdominal surgery, heart surgery, pulmonary
thromboendarterectomy, spinal surgery and knee surgery. Low tidal volumes
used in the studies varied from 6 mL/kg to 8.1 mL/kg while high tidal
volumes varied from 10 mL/kg to 12 mL/kg. Based on 12 studies including
1207 participants, the effects of low volume ventilation on 0- to 30-day
mortality were uncertain (risk ratio (RR) 0.80, 95% confidence interval
(CI) 0.42 to 1.53; I² = 0%; low-quality evidence). Based on
seven studies including 778 participants, lower tidal volumes probably
reduced postoperative pneumonia (RR 0.45, 95% CI 0.25 to 0.82;
I² = 0%; moderate-quality evidence; NNTB 24, 95% CI 16 to 160),
and it probably reduced the need for non-invasive postoperative
ventilatory support based on three studies including 506 participants (RR
0.31, 95% CI 0.15 to 0.64; moderate-quality evidence; NNTB 13, 95% CI 11
to 24). Based on 11 studies including 957 participants, low tidal volumes
during surgery probably decreased the need for postoperative invasive
ventilatory support (RR 0.33, 95% CI 0.14 to 0.77; I² = 0%;
NNTB 39, 95% CI 30 to 166; moderate-quality evidence). Based on five
studies including 898 participants, there may be little or no difference
in the intensive care unit length of stay (standardized mean difference
(SMD) -0.06, 95% CI -0.22 to 0.10; I² = 33%; low-quality
evidence). Based on 14 studies including 1297 participants, low tidal
volumes may have reduced hospital length of stay by about 0.8 days (SMD
-0.15, 95% CI -0.29 to 0.00; I² = 27%; low-quality evidence).
Based on five studies including 708 participants, the effects of low
volume ventilation on barotrauma (pneumothorax) were uncertain (RR 1.77,
95% CI 0.52 to 5.99; I² = 0%; very low-quality evidence).
Authors' conclusions: We found moderate-quality evidence that low tidal
volumes (defined as less than 10 mL/kg) decreases pneumonia and the need
for postoperative ventilatory support (invasive and non-invasive). We
found no difference in the risk of barotrauma (pneumothorax), but the
number of participants included does not allow us to make definitive
statement on this. The four studies in 'Studies awaiting classification'
may alter the conclusions of the review once assessed.<br/>Copyright
&#xa9; 2018 The Cochrane Collaboration.

<83>
Accession Number
613978918
Author
El-Tahan M.R.
Institution
(El-Tahan) Anesthesiology Department, King Fahd Hospital of the University
of Dammam, Dammam, Saudi Arabia
Title
Role of Thoracic Epidural Analgesia for Thoracic Surgery and Its
Perioperative Effects.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1417-1426),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<84>
Accession Number
613851474
Author
Butler E.; Chin M.; Aneman A.
Institution
(Butler) Faculty of Medicine, University of New South Wales, Sydney,
Australia
(Chin, Aneman) Intensive Care Unit, Liverpool Hospital, Sydney, Australia
(Aneman) University of New South Wales, South Western Sydney Clinical
School, Sydney, Australia
(Aneman) Ingham Institute for Applied Medical Research, Sydney, Australia
Title
Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a
Systematic Review in Post-Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1407-1416),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<85>
Accession Number
614259143
Author
Howitt S.H.; Grant S.W.; Riding D.M.; Malagon I.; McCollum C.N.
Institution
(Howitt, Grant, Riding, McCollum) Academic Surgery Unit, Institute of
Cardiovascular Sciences, University of Manchester, University Hospital of
South Manchester, Manchester, United Kingdom
(Howitt, Malagon) Department of Cardiothoracic Anaesthesia and Critical
Care, University Hospital of South Manchester, Manchester, United Kingdom
(Grant) National Institute for Cardiovascular Outcomes Research,
University College London, Institute of Cardiovascular Science, London,
United Kingdom
Title
Risk Models That Use Postoperative Patient Monitoring Data to Predict
Outcomes in Adult Cardiac Surgery: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1865-1877),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders

<86>
Accession Number
613498993
Author
Diab M.; Bilkhu R.; Soppa G.; McGale N.; Hirani S.P.; Newman S.P.;
Jahangiri M.
Institution
(Diab, Bilkhu, Soppa, Jahangiri) Department of Cardiothoracic Surgery, St.
George's University of London, London, United Kingdom
(McGale, Hirani, Newman) Centre for Health Services Research, School of
Health Sciences, City University London, London, United Kingdom
Title
Quality of Life in Relation to Length of Intensive Care Unit Stay After
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (3) (pp 1080-1090),
2017. Date of Publication: June 2017.
Publisher
W.B. Saunders

<87>
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)

<88>
Accession Number
622748473
Author
Ejiri K.; Miyoshi T.; Kohno K.; Nakahama M.; Doi M.; Munemasa M.; Murakami
M.; Takaishi A.; Nakamura K.; Ito H.
Institution
(Ejiri, Miyoshi, Kohno, Nakamura, Ito) Department of Cardiovascular
Medicine, Okayama University Graduate School of Medicine, Density and
Pharmaceutical Sciences, Okayama, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Doi) Department of Cardiology, Kagawa Prefectural Central Hospital,
Kagawa, Japan
(Munemasa) Department of Cardiology, Okayama Medical Center, Okayama,
Japan
(Murakami) Department of Cardiology, Okayama Heart Clinic, Okayama, Japan
(Takaishi) Department of Cardiology, Mitoyo General Hospital, Kagawa,
Japan
Title
Protective effect of remote ischemic preconditioning on myocardial damage
after percutaneous coronary intervention in stable angina patients with
complex coronary lesions - Subanalysis of a randomized controlled trial.
Source
Circulation Journal. 82 (7) (pp 1788-1796), 2018. Date of Publication:
2018.
Publisher
Japanese Circulation Society
Abstract
Background: The effect of remote ischemic preconditioning (RIPC) on
periprocedural myocardial damage (pMD) in patients undergoing percutaneous
coronary intervention (PCI) is controversial. The aim of this study was to
investigate the effect of RIPC or intravenous nicorandil on pMD following
elective PCI in a subgroup of patients with complex coronary lesions from
a multicenter randomized controlled trial. Methods and Results: Patients
with stable angina who underwent elective PCI were assigned to 3 groups:
control, upper-limb RIPC or intravenous nicorandil. The major outcome was
pMD incidence following PCI, with pMD defined as an elevated level of
high-sensitivity cardiac troponin T or creatine kinase myocardial band at
12 or 24 h after PCI. A total of 171 patients with complex coronary
lesions (ACC-AHA coronary classification type B2 or C) were analyzed. The
incidence of pMD following PCI was significantly lower in the RIPC group
than in the control group (44.4% vs. 66.1%; P=0.023). The adjusted odds
ratio (95% confidence interval) for pMD in the RIPC vs. the controls was
0.41 (0.18-0.94). The incidence of pMD in the nicorandil group was not
significantly reduced compared with the control groups. Conclusions: This
substudy suggested that RIPC prior to PCI prevented pMD in patients with
complex coronary lesions. Further investigation in a multicenter
prospective study is needed to confirm these results.<br/>Copyright &#xa9;
2018, Japanese Circulation Society. All rights reserved.

<89>
Accession Number
622950773
Author
Ibrahim K.; Shah R.; Goli R.R.; Kickler T.S.; Clarke W.A.; Hasan R.K.;
Blumenthal R.S.; Thiemann D.R.; Resar J.R.; Schulman S.P.; Mcevoy J.W.
Institution
(Ibrahim, Hasan, Blumenthal, Thiemann, Resar, Schulman, Mcevoy) Division
of Cardiology, Johns Hopkins University School of Medicine, Baltimore,
Maryland, United States
(Shah, Goli) Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, Maryland, United States
(Kickler, Clarke) Department of Pathology, Johns Hopkins University School
of Medicine, Baltimore, Maryland, United States
(Blumenthal, Mcevoy) Ciccarone Center for the Prevention of Heart Disease,
Johns Hopkins University School of Medicine, Baltimore, Maryland, United
States
Title
Fentanyl Delays the Platelet Inhibition Effects of Oral Ticagrelor: Full
Report of the PACIFY Randomized Clinical Trial.
Source
Thrombosis and Haemostasis. (no pagination), 2018. Date of Publication: 04
Jul 2018.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Morphine delays oral P2Y <inf>12</inf> platelet inhibitor absorption and
is associated with adverse outcomes after myocardial infarction.
Consequently, many physicians and first responders are now considering
fentanyl as an alternative. We conducted a single-centre trial randomizing
cardiac patients undergoing coronary angiography to intravenous fentanyl
or not. All participants received local anaesthetic and intravenous
midazolam. Those requiring percutaneous coronary intervention (PCI) with
stenting received 180 mg oral ticagrelor intra-procedurally. The primary
outcome was area under the ticagrelor plasma concentration-time curve (AUC
<inf>0-24 hours</inf> ). The secondary outcomes were platelet function
assessed at 2 hours after loading, measured by P2Y <inf>12</inf> reaction
units (PRUs) and light transmission platelet aggregometry. Troponin-I was
measured post-PCI using a high-sensitivity troponin-I assay (hs-TnI). All
participants completed a survey of pain and anxiety. Of the 212
randomized, 70 patients required coronary stenting and were loaded with
ticagrelor. Two participants in the no-fentanyl arm crossed over to
receive fentanyl for pain. In as-treated analyses, ticagrelor
concentrations were higher in the no-fentanyl arm (AUC <inf>0-24
hours</inf> 70% larger, p = 0.03). Platelets were more inhibited by 2
hours in the no-fentanyl arm (71 vs. 113 by PRU, p = 0.03, and 25% vs. 41%
for adenosine diphosphate response by platelet aggregation, p < 0.01).
Mean hs-TnI was higher with fentanyl at 2 hours post-PCI (11.9 vs. 7.0
ng/L, p = 0.04) with a rate of enzymatic myocardial infarction of 11% for
fentanyl and 0% for no-fentanyl ( p = 0.08). No statistical differences in
self-reported pain or anxiety were found. In conclusion, fentanyl
administration can impair ticagrelor absorption and delay platelet
inhibition, resulting in mild excess of myocardial damage. This newly
described drug interaction should be recognized by physicians and suggests
that the interaction between opioids and oral P2Y <inf>12</inf> platelet
inhibitors is a drug class effect associated with all opioids. Clinical
Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02683707 (
NCT02683707). <br/>Copyright &#xa9; 2018, Georg Thieme Verlag KG. All
rights reserved.