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<1>
Accession Number
623151335
Author
Shiwani H.; Nagpal P.; Goyal A.; Blankstein R.; Villines T.C.; Cheezum
M.K.
Institution
(Shiwani) Dept. of Radiology, Leeds General Infirmary, Leeds, United
Kingdom
(Nagpal) Dept. of Radiology, University of Iowa, United States
(Goyal) Department of Internal Medicine, Westchester Medical Center,
Valhalla, NY, United States
(Blankstein) Departments of Medicine and Radiology, Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(Villines) Department of Medicine (Cardiology Service), Walter Reed
National Military Medical Center, Bethesda, MD, United States
(Cheezum) Department of Medicine (Cardiology Service), Fort Belvoir
Community Hospital, Ft. Belvoir, VA, United States
Title
Anomalous coronary artery injury in atrial septal defect closure: A
comprehensive review of the literature.
Source
Journal of Cardiovascular Computed Tomography. Conference: 2018 Winter
Meeting of the Society of Cardiovascular Computed Tomography. United
Kingdom. 12 (1 Supplement 1) (pp S76-S77), 2018. Date of Publication:
January - February 2018.
Publisher
Elsevier Inc.
Abstract
Introduction: The safety of atrial septal defect (ASD) and patent foramen
ovale (PFO) transcatheter device closure is not established in patients
with anomalous aortic origin of a coronary artery (AAOCA) from the
inappropriate sinus of Valsalva. Methods: We performed a comprehensive
search of Pubmed and EMBASE to identify patients with AAOCA undergoing
transcatheter device or surgical closure of an ASD or PFO. Results: Among
2727 abstracts, we identified 17 reports of 18 AAOCA patients (range: 4-64
years, 65% male) undergoing ASD or PFO closure (7 percutaneous, 11
surgical). In percutaneous attempts, 57% (n=4/7) of patients experienced
retroaortic AAOCA compression by a closure device along the
antero-superior rim of the left atrium. One patient undergoing surgical
ASD closure required emergent coronary artery bypass grafting for damage
to a high takeoff interarterial right coronary artery from aortic
cross-clamping. Three patients were referred for surgical closure with
elective AAOCA revascularization for high-risk anatomic findings, and 5
patients with pre-procedure cardiac CT (n=5/18, 28%) underwent surgical
closure with no reported complications. Conclusion: In addition to
characterizing AAOCA and septal defects, careful pre-procedural imaging in
patients undergoing ASD or PFO closure may help to avoid AAOCA injury.
(Figure Presented).

<2>
Accession Number
623151140
Author
Marwan M.; Feher M.; Schuhback A.; Hell M.; Ammon F.; Achenbach S.; Arnold
M.
Institution
(Marwan, Feher, Schuhback, Hell, Ammon, Achenbach, Arnold) Department of
Cardiology, University of Erlangen, Erlangen, Germany
Title
Prospective randomized comparison of systolic versus diastolic CT
acquisitions prior to transcatheter aortic valve implantation: A
prospective outcome analysis.
Source
Journal of Cardiovascular Computed Tomography. Conference: 2018 Winter
Meeting of the Society of Cardiovascular Computed Tomography. United
Kingdom. 12 (1 Supplement 1) (pp S29), 2018. Date of Publication: January
- February 2018.
Publisher
Elsevier Inc.
Abstract
Introduction: Currently, the use of systolic time interval for acquiring
CT data sets prior to TAVI procedures is recommended. We prospectively
compared the outcome of patients referred for TAVI according to the time
interval of CT acquisitions in a randomized fashion. Methods: A cohort of
166 consecutive patients referred for CT prior to TAVI procedure were
prospectively randomised to either systolic or diastolic ECG-triggered
acquisition. Diastolic acquisitions were acquired using high-pitch spiral
acquisition triggered at 60% of the peak R-wave to R-wave interval whereas
systolic acquisitions were triggered at 300 ms after the peak of the
R-wave using prospectively ECG-triggered sequential acquisition. The
degree of annular calcification was assessed based on a standardized
visual score (0-3). Primary endpoint was the prevalence of aortic
regurgitation >= 2 according to invasive aortography at the end of the
procedure. Secondary endpoints included need for post-dilatation, number
of post dilatations and aortic annular injury Results: 161 patients (mean
age 82+/-6 years, log. EuroScore 26+/-16%) were included. CT was
randomized to systole in 63 patients versus 58 patients in diastole. The
mean annular diameter as well as the mean annular area was not
significantly different in both groups (24.9 +/-2 mm and 482+/-94
mm² vs. 24.7+/- 3 mm and 495+/-94 mm² for diastole
and systole, respectively, p>0.1 for all). T he degree of aortic annular
calcification by visual assessment was comparable in both groups (Grade 0
in 21 vs. 40%, Grade 1 in 26 vs. 30%, grade 3 in 10 vs. 11% and grade 4 in
7 vs. 5%, for diastole vs. systole, respectively, p>0.5 for all). Moreover
the choice of balloon expandable prosthesis (Sapien 3 23, 26 and 29) as
well self-expanding prosthesis (Portico 25 and 27) were not significantly
different in both groups. The primary endpoint of aortic regurgitation >=
2 occurred in 12% of patients in the diastolic group vs. 17% in the
systolic group (p>0.5). Post dilatation of the aortic valve prosthesis was
performed in 55% of the patients in the diastolic group versus 49% of t he
patients in the systolic group (p=0.5) with the majority of patients
requiring a single post dilatation in both groups (53% and 47%,
respectively, p= n.s). Conclusions: In a prospective randomized setting,
ECG-triggered diastolic and systolic CT acquisitions for TAVI planning
show comparable procedural outcome.

<3>
Accession Number
623154684
Author
Tariq N.
Institution
(Tariq) Johns Hopkins Hospital, Columbia, MD, United States
Title
Post cardiac transplant headache and its treatment: A case report and
brief review of literature.
Source
Headache. Conference: 60th Annual Scientific Meeting American Headache
Society, AHS 2018. United States. 58 (Supplement 2) (pp 210-211), 2018.
Date of Publication: June 2018.
Publisher
Blackwell Publishing Inc.
Abstract
Background: The number of organ transplants in the U.S are on the rise.
Post organ transplant headache man-agement poses a significant challenge
because of the risks, potential immunosuppressant drug interactions and
side effects. Methods: We describe a case of a 46 years old male status
post cardiac transplant who developed first time migraine without aura
which fulfilled the ICHD-III criteria. Results: Patient never had
headaches prior to his cardiac transplant at age 41 secondary to dilated
cardiomyopathy of unknown cause. Two months later, he developed
intractable migraine without aura described as photo,-phono and
osmophobia, throbbing ipsilateral pain, facial flushing and nausea with
occasional vomiting which was occurring up to 15 days a month and lasting
up to 48 hours in duration. Cyclosporine and Tacroliumus levels were
repeatedly normal. MRI brain and lumbar puncture were normal. Both
medicines were withheld one at a time without relief. He established care
at a tertiary headache center at age 44. He was started on daily
cyclobenzaprine at bedtime and hydroxyzine, thorazine, toradol injection
were given as abortive treatment only. At 3 months follow up, his migraine
frequency had reduced to more than half i.e. 6 days per month. At 18
months follow up his headaches had decreased to once a month with no
reported side effects. Conclusion: We have described a case of de novo
migraine without aura in a cardiac transplant patient successfully treated
with abortives such as hydroxyzine, ketorolac injection, thorazine and
cyclobenzaprine at bed time for daily prophylaxis. Other case reports in
the literature have shown benefit with the use of propranolol, IV
valproate, amitripty-line, riboflavin and frovatriptan in liver and renal
transplant patients. This is an underserved topic and research is needed
to understand pathophysiology and identify safe treatment options for post
transplant headaches.

<4>
Accession Number
623151216
Author
Datta S.
Institution
(Datta) Datta Endoscopic Back Surgery and Pain Center, New York, NY 10016,
United States
Title
Outpatient thoracic endoscopic discectomy with or without foraminotomy -
Case series.
Source
Pain Physician. Conference: 19th Annual Meeting of the American Society of
Interventional Pain Physicians, ASIPP 2017. United States. 20 (4) (pp
E620), 2017. Date of Publication: 2017.
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: * Surgical management of thoracic disc herniations is a
challenge. * Due to poor outcomes with thoracic laminectomy,
posterolateral and lateral approaches have evolved. * All approaches have
high morbidity. Most approaches need hospitalization and extensive
post-operative rehabilitation. * With thecal sac adhesions, any approach
medially carries risk of thecal sac injury or dural sac tears. *
Additionally, thoracic disc herniations at T6 level carries risk of
'Watershed area' of tenous blood supply rending neurologic complications
common Case 1 Thoracic Endoscopic Discectomy T12-L1 without foraminotomy *
31 y/o white female with right sided thoracic pain after ski accident. *
MRI: T10-11 superiorly extruded component; T11-12 left sided disc
herniation; T12-L1 right sided disc herniations with adhesions to thecal
sac and mild flattening of cord. * Initial surgical option anterior
thoracic discectomy and fusion with thoracotomy. * Failed conservative
care, epidural injections, thoracic facet blocks and thoracic
radiofrequency ablation. * Thoracic discogram: concordant pain at T12-L1.
* Preoperative planning: Review of MRI and CT discogram and access
planning (Figure 3). * Endoscopic discectomy at T12-L1 via posterolateral
approach on right side. 18 G 10 inch needle into disc (Figure 4),
indigocarmine contrast into disc. * Guidewire inserted, needle removed, a
blunt dilator advanced under fluoroscopic control into posterolateral
disc. * Endoscope inserted through 9 mm sheath. * Surgical decompression
carried out with microforceps and radiofrequency ablation. * Complete
dissection carried out with good visualization of exiting nerve. Case 2:
Thoracic Endoscopic Discectomy T6-T7 with foraminotomy * 34 y/o female,
T6-7 disc herniation with failed conservative care and urinary urgency,
discogram positive concordant pain * 5 cm to right of midline incision,
serial dilatation to inferior aspect of the foramen posterior to the rib
and inferior aspect of the foramen and into the disc space. * Second
dilator passed, inner two stabilized. * First of three trephines used to
resect a portion of the superior articular process and initiate the
foraminotomy. Trephine removed and third dilator passed. * Cannula passed
over the four dilators and discectomy initiated. Bipolar radiofrequency
used to shrink disc. * Pulsating perioperative fat noted indicating
adequate decompression * Patient released home same day, no chest tube
needed, blood loss less than 150 ml (Figure Presented) (Figure Presented)
(Figure Presented) (Figure Presented) (Figure Presented) (Figure
Presented) (Figure Presented) Discussion: * Anatomic features increasing
complexity: Thoracic spine kyphotic, spinal cord runs close to posterior
elements. * Tethering of spinal cord by dentate ligaments limits mobilty
of spinal cord to drift away from anterior impingement. * The spinal cord
diameter to canal diameter ratio is higher in thoracic area compared to
lumbar and cervical area leaving less room for spinal cord in case of
stenosis. * Thoracic spinal cord vulnerable to ischemic injury ("watershed
zone") * Thoracic herniations frequently centrally located and calcify
more easily. * They may be adherent to and even erode over dural sac *
Anterior approaches: Conventional thoracotomy, mini-thoracotomy and
thoracoscopy allow excellent visualization and direct decompression,
however, pulmonary compromise is frequent. * Conventional posterior or
posterolateral approaches: Need dural retraction and more medial approach.
* All open approaches: need for hospitalization, possibility of
perioperative complications (bleeding) and insertion of chest tubes of
drains. Review of literature: * Natural history not well defined. Thus,
indications and optimal type of surgery controversial. 75% occur below T8
and commonest level is T11-12. * Approaches include laminectomy,
transpedicular (with or without endoscopy), mini-open transpedicular,
transfacet pedicle sparing approaches, costotransversectomy, transthoracic
transpleural approach * Recently reported(2011, Diverin et al): Minimal
invasive anterolateral Transthoracic Transpleural approach. 12 patients,
avg follow up 28 months, average hospital stay 5 days; VAS from 9 to 3
post-op. 1 patient had pleural effusion and 1 patient had intercostal
neuralgia. * Anand and Reagan (2002): Video assisted thoracoscopic
surgery-100 patients with minimal 2 year follow up: 21% complication rate;
15% pulmonary. * McAfee et al (1995): VATS anterior approach in 78
patients-intercostal neuralgia (8%) and atelactasis (6%) sufficient to
delay discharge. * Jho et al (1999): Endoscopic transpedicular thoracic
approach. * Thoracic Microendoscopic discectomy: medial approach-dural
tears * Transfacet pedicle sparing approach (Stillerman et al 1995) * Choi
et al (2010): Transforaminal Endoscopic Thoracic Discectomy: 14 patients;
foraminoplasty in all cases. Mean follow up of 60 months. * Other reported
complications: Hemothorax, chylothorax, paraplegia. Thoracic Endoscopic
Discectomy "Pearls": *Thoracic discogram absolutely essentially planning
level of surgery. *Review of MRI and CT discogram to identify ideal access
point. Identified a window between 5 and 9 cm from midline as ideal access
point *Case 1: Segmental blood vessel on intended area of access-therefore
initial access with guide wire performed very carefully. *Due to dural
adhesions, prudent to consider "inside out" decompression instead of a
direct access to disc with potential dural compromise. *Available Ellman
and Laser probe to address bleeding under direct vision. *Case 2:
Herniation higher up in spine, resection and enlargement of foramen
essential *Incision 5 cm from midline *Foraminotomy allowed access to more
medial disc herniation *BOTH CASES: No drains or chest tubes inserted,
outpatient procedure, no retraction of the spinal cord necessary. *Case
1-5 years follow up; Case 2 - 2 year follow up-no further surgery needed
Conclusion: * Thoracic discectomy endoscopic approach feasible in an
outpatient setting with proper planning. * Thoughtful planning necessary
for good outcomes. * Endoscopic approach to thoracic herniations can be
performed with or without foraminotomy *. Better access tools availability
and knowledge will lead to use of this approach more in the future. * Long
term follow up result great with neither cases needing fusion /
stabilization.

<5>
Accession Number
2000968232
Author
Jha N.; Jha A.K.; Chand Chauhan R.; Chauhan N.S.
Institution
(Jha, Chauhan) Department of Obstetrics and Gynecology, Pondicherry
Institute of Medical Sciences, Puducherry, India
(Jha) Department of Anesthesiology and Critical Care, Jawaharlal Institute
of Postgraduate Medical Education and Research, Puducherry, India
(Chand Chauhan) Department of Community and Family Medicine, All India
Institute of Medical Sciences, Bhubaneswar, India
Title
Maternal and Fetal Outcome After Cardiac Operations During Pregnancy: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (2) (pp 618-626), 2018. Date of
Publication: August 2018.
Publisher
Elsevier USA
Abstract
Background: In the past, cardiac surgical procedures during pregnancy have
been associated with a high risk of adverse maternal and fetal outcomes.
Therefore, this meta-analysis of more recent studies was done to assess
the fetomaternal risk after cardiac operations during pregnancy using
cardiopulmonary bypass. Methods: The MEDLINE, Embase, and Cochrane library
were searched to find studies from January 1, 1990, to July 31, 2016,
without language restriction. We selected studies that included at least 4
women to report fetomaternal outcomes after a cardiac operation using
cardiopulmonary bypass during pregnancy. Two authors independently
extracted data from the selected studies. The studies were assessed for
methodological qualities using the Newcastle-Ottawa Scale. The primary
outcomes included maternal death and any pregnancy loss. The secondary
outcomes were maternal complications and neonatal complications. Primary
analysis calculated absolute risks and 95% confidence intervals (CIs) for
pregnancy outcomes using the DerSimonian-Laird random effects model.
Heterogeneity was assessed by I² statistic and visual plot.
Results: Ten studies, including 154 women, were eligible for inclusion in
this study. The patients underwent cardiac operations during pregnancy
involving cardiopulmonary bypass. As calculated per 100 pregnancies, the
pooled unadjusted estimate of maternal mortality was 11.2 (95% CI, 6.8 to
17.8), pregnancy loss was 33.1 (95% CI, 25.1 to 41.2), maternal
complications were 8.8 (95% CI, 2.8 to 24.2), and neonatal complications
were 10.8 (95% CI, 4.2 to 25.2). The risks of preterm labor and cesarean
delivery were 28 per 100 pregnancies (95% CI, 15.6 to 45) and 33.8 per 100
pregnancies (95% CI, 19.1 to 52.4), respectively. Conclusions: The
fetomaternal mortality and morbidity after a cardiac operation during
pregnancy are higher than that reported in the earlier literature
(PROSPERO No. CRD42016047093).<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons

<6>
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Accession Number
623156245
Author
Vienne M.; Haas E.; Wipf T.; Grunebaum L.; Levy F.; Sattler L.; Minh T.H.;
Severac F.; Tacquard C.; Collange O.; Mertes P.-M.; Steib A.
Institution
(Vienne, Haas, Wipf, Levy, Tacquard, Collange, Mertes, Steib) Department
of Anesthesiology and Intensive Care, University Hospital, Nouvel Hopital
Civil, 1 Place de L'hopital, Strasbourg Cedex 67091, France
(Grunebaum, Sattler) Laboratory of Haemostasis, University Hospital,
Strasbourg, France
(Minh) Department of Cardiac Surgery, NHC, University Hospital,
Strasbourg, France
(Severac) Department of BioStatistics, Federation de Medecine
Translationelle, University Hospital, Strasbourg, France
Title
Adjusted calculation model of heparin management during cardiopulmonary
bypass in obese patients.
Source
European Journal of Anaesthesiology. 35 (8) (pp 613-620), 2018. Date of
Publication: 01 Aug 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Anticoagulation during cardiopulmonary bypass (CPB) is usually
adapted to total body weight (TBW). This may be inaccurate in obese
patients and lead to heparin overdose with a risk of bleeding. OBJECTIVES
To validate the efficacy and safety of an adjusted calculation model of
heparin dosing based on ideal body weight (IBW) rather than TBW in obese
CPB patients, with an expected target mean plasma heparin concentration of
4.5IUml -1 after onset of CPB in the experimental group. DESIGN Randomised
controlled study. SETTING University hospital. PATIENTS Sixty obese
patients (BMI>=30kgm -2) scheduled for CPB were included from January to
June 2016. INTERVENTIONS Patients received a bolus dose of unfractionated
heparin of either 300IUkg -1 of TBW or 340IUkg -1 of IBW before onset of
CPB. Additional adjusted boluses were injected to maintain an activated
clotting time (ACT) of at least 400s. MAIN OUTCOME MEASURES Plasma heparin
concentration and ACT were measured at different time points. Total
heparin doses and transfusion requirements were recorded. RESULTS The
target heparin concentration of 4.5IUml -1 was reached in the IBW group at
the onset of CPB and maintained at all time points during CPB. Heparin
concentrations were significantly higher in the TBW group after the bolus
(6.52+/-0.97 vs. 4.54+/-1.13IUml -1, P<0.001) and after cardioplegia
(5.10+/-1.03 vs. 4.31+/-1.00IUml -1, P=0.02). Total heparin doses were
significantly higher in the TBW group. Mean ACT was significantly lower in
the IBW group but remained over 400s during CPB. The correlation between
heparin and ACT was poor. Peri-operative bleeding and transfusion
requirements were comparable. No thrombotic event occurred in the CPB
circuit. CONCLUSION The current IBW-adjusted regimen of heparin
administration may be used efficiently in obese CPB patients, thereby
avoiding overdose which cannot be accurately assessed by ACT monitoring
alone. TRIAL REGISTRATION ClinicalTrials.gov identifier:
NCT02675647.<br/>Copyright &#xa9; 2018 European Society of
Anaesthesiology. All rights reserved.

<7>
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Accession Number
623156174
Author
Chong M.A.; Wang Y.; Berbenetz N.M.; McConachie I.
Institution
(Chong, Wang, McConachie) Department of Anesthesia and Perioperative
Medicine, Western University, University Hospital, London Health Sciences
Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
(Berbenetz) Department of Medicine, Western University, London, ON, Canada
Title
Does goal-directed haemodynamic and fluid therapy improve peri-operative
outcomes?.
Source
European Journal of Anaesthesiology. 35 (7) (pp 469-483), 2018. Date of
Publication: 01 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Much uncertainty exists as to whether peri-operative
goal-directed therapy is of benefit. OBJECTIVES To discover if
peri-operative goal-directed therapy decreases mortality and morbidity in
adult surgical patients. DESIGN An updated systematic review and random
effects meta-analysis of randomised controlled trials. DATA SOURCES
Medline, Embase and the Cochrane Library were searched up to 31 December
2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult
surgical patients allocated to receive goal-directed therapy or standard
care were eligible for inclusion. Trauma patients and parturients were
excluded. Goal-directed therapy was defined as fluid and/or vasopressor
therapy titrated to haemodynamic goals [e.g. cardiac output (CO)].
Outcomes included mortality, morbidity and hospital length of stay. Risk
of bias was assessed using Cochrane methodology. RESULTS Ninety-five
randomised trials (11659 patients) were included. Only four studies were
at low risk of bias. Modern goal-directed therapy reduced mortality
compared with standard care [odds ratio (OR) 0.66; 95% confidence interval
(CI) 0.50 to 0.87; number needed to treat=59; N = 52; I 2 =0.0%]. In
subgroup analysis, there was no mortality benefit for fluid-only
goal-directed therapy, cardiac surgery patients or nonelective surgery.
Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95%
CI, 0.51 to 0. 92; number needed to treat=38), acute kidney injury (OR 0.
73; 95% CI, 0.58 to 0.92; number needed to treat=29), wound infection (OR
0.48; 95% CI, 0.37 to 0.63; number needed to treat=19) and hospital length
of stay (days) (-0.90; 95% CI, -1.32 to -0.48; I 2 =81. 2%). No important
differences in outcomes were found for the pulmonary artery catheter
studies, after accounting for advances in the standard of care. CONCLUSION
Peri-operative modern goal-directed therapy reduces morbidity and
mortality. Importantly, the quality of evidence was low to very low (e.g.
Grading of Recommendations, Assessment, Development and Evaluation
scoring), and there was much clinical heterogeneity among the
goal-directed therapy devices and protocols. Additional well designed and
adequately powered trials on peri-operative goal-directed therapy are
necessary.<br/>Copyright &#xa9; 2018 European Society of Anaesthesiology.

<8>
Accession Number
623128217
Author
Kim W.H.; Hur M.; Park S.-K.; Jung D.E.; Kang P.; Yoo S.; Bahk J.-H.
Institution
(Kim, Hur, Park, Jung, Kang, Yoo, Bahk) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, Seoul, South Korea
Title
Pharmacological interventions for protecting renal function after cardiac
surgery: a Bayesian network meta-analysis of comparative effectiveness.
Source
Anaesthesia. 73 (8) (pp 1019-1031), 2018. Date of Publication: August
2018.
Publisher
Blackwell Publishing Ltd
Abstract
Many drugs have been investigated as potentially protective of renal
function after cardiac surgery. However, their comparative effectiveness
has not been established. We performed an arm-based hierarchical Bayesian
network meta-analysis including 95 randomised controlled trials with
28,833 participants, which allowed us to compare some agents not
previously compared directly. Renal outcomes, including: the incidence of
postoperative renal dysfunction and haemodialysis; serum creatinine level
at 24 hours postoperatively; all-cause mortality; and length of hospital
and ICU stay, were compared. Exploratory meta-regression was conducted for
potential effect modifiers. A random effects model was selected according
to the evaluation of model fit by deviance information criteria. Atrial
natriuretic peptide (odds ratio (95%CrI) 0.28 (0.17-0.48);
moderate-quality evidence), B-type natriuretic peptide, dexmedetomidine,
levosimendan and N-acetyl cysteine significantly decreased the rate of
postoperative renal dysfunction compared with placebo. Atrial natriuretic
peptide (OR (95%CrI) 0.24 (0.10-0.58); low-quality evidence), B-type
natriuretic peptide, and dexamethasone significantly decreased the need
for haemodialysis. Levosimendan significantly decreased mortality, OR
(95%CrI) 0.49 (0.27-0.91); low-quality evidence). The benefit of atrial
natriuretic peptide was still apparent when baseline renal function was
normal. None of the potential effect modifiers were significantly
correlated with our renal outcomes. Atrial natriuretic peptide was ranked
best regarding renal dysfunction, haemodialysis and length of hospital
stay. Levosimendan was ranked best regarding mortality and ICU stay.
However, our results should be interpreted cautiously given the
assumptions made about transitivity and consistency.<br/>Copyright &#xa9;
2018 The Association of Anaesthetists of Great Britain and Ireland

<9>
Accession Number
623126918
Author
Elsokkari I.; Parkash R.; Gray C.J.; Gardner M.J.; AbdelWahab A.M.;
Doucette S.; Tang A.S.; Wells G.A.; Stevenson W.G.; Sapp J.L.
Institution
(Elsokkari, Parkash, Gray, Gardner, AbdelWahab, Sapp) Queen Elizabeth II
Health Sciences Centre, Halifax, NS, Canada
(Doucette) Dalhousie University, Halifax, NS, Canada
(Tang) Western University, ON, Canada
(Wells) University of Ottawa Cardiovascular Methods Center, ON, Canada
(Stevenson) Brigham and Women's Hospital, Boston, MA, United States
Title
Effect of coronary revascularization on long-term clinical outcomes in
patients with ischemic cardiomyopathy and recurrent ventricular
arrhythmia.
Source
PACE - Pacing and Clinical Electrophysiology. 41 (7) (pp 775-779), 2018.
Date of Publication: July 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Patients with ventricular tachycardia (VT) postmyocardial
infarction (MI) are a higher risk group with significant morbidity and
mortality. We examined the impact of prior coronary revascularization on
clinical outcomes in patients with ischemic cardiomyopathy and VT.
Methods: The VANISH trial randomized 259 patients with prior MI and
antiarrhythmic drug-refractory VT to receive escalated medical therapy or
catheter ablation. Clinical outcomes were compared according to whether
patients have undergone prior revascularization procedures. The primary
outcome was a composite of death, appropriate implantable cardiac
defibrillator (ICD) shock, or VT storm. The secondary outcomes included
elements of the primary outcome, hospitalization, and any ventricular
arrhythmia. Results: 190 patients (73%) had prior coronary
revascularization. Revascularization group had more men (97% vs 83%; P =
0.0003) and patients in that group were older (mean age 69.3 +/- 7.6 vs
66.7 +/- 9.2; P = 0.04), had more renal insufficiency (22.6% vs 8.7%; P =
0.01), and were more likely to have an implanted cardiac resynchronization
device (23% vs 10%, P = 0.03) as compared with the nonrevascularized
patients. There were no significant differences in baseline medication
use. There was a trend toward fewer hospitalizations in the
revascularization group (64% vs 77%; P = 0.07); there were no differences
in the individual outcomes of mortality, VT storm, ICD shocks, recurrent
MI, or cardiac failure. Conclusions: In this cohort of patients with an
ischemic cause for VT, a history of prior coronary revascularization was
not associated with a reduction in ventricular arrhythmia or
mortality.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<10>
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Accession Number
623124757
Author
Wu T.; Liu J.; Wang Q.; Li P.; Shi G.
Institution
(Wu, Shi) Department of Perfusion, Tianjin Chest Hospital, Tianjin, China
(Liu, Wang) Department of Cardiac Surgery, Tianjin, China
(Li) Intensive Care Unit, Tianjin Chest Hospital, Tianjin, China
Title
Superior blood-saving effect and postoperative recovery of comprehensive
blood-saving strategy in infants undergoing open heart surgery under
cardiopulmonary bypass.
Source
Medicine (United States). 97 (27) (no pagination), 2018. Article Number:
e11248. Date of Publication: 01 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Optimization of blood-saving strategies during open heart
surgery in infants is still required. This study aimed to study a
comprehensive blood-saving strategy during cardiopulmonary bypass (CPB) on
postoperative recovery in low-weight infants undergoing open heart
surgery. Methods: This was a prospective study of 86 consecutive infants
(weighing <5kg) with acyanotic congenital heart disease treated at the
Tianjin Chest Hospital between March and December 2016, and randomized to
the control (traditional routine CPB) and comprehensive blood-saving
strategy groups. The primary endpoints were blood saving and clinical
prognosis. The secondary endpoints were safety and laboratory indicators,
prior to CPB (T1), after 30 minutes of CPB (T2), after modified
ultrafiltration (T3), and postoperative 12 (T4), 24 (T5), 48 (T6), and 72h
(T7). Results: The total priming volume and banked red blood cells in the
comprehensive strategy group were significantly lower than in the control
group (P=.009 and P=.04, respectively). In the comprehensive strategy
group, immediately after CPB, the amount of salvaged red blood cells
exceeded the priming red blood cells by 40+/-11mL. Postoperatively, the
comprehensive strategy group showed a significant decrease in the inotrope
score (P=.03), ventilation time (P=.03), intensive care unit stay (P=.04),
and hospital stay (P=.03) in comparison with the control group.
Conclusion: The comprehensive blood-saving strategies for CPB were
associated with less blood use and favorable postoperative recovery in
low-weight infants with congenital heart disease undergoing open heart
surgery.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<11>
Accession Number
623043923
Author
Purba A.K.; Setiawan D.; Bathoorn E.; Postma M.J.; Dik J.H.; Friedrich
A.W.
Institution
(Purba, Postma) Department of Health Sciences, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(Purba, Postma) Department of Pharmacology and Therapy, Faculty of
Medicine, Universitas Airlangga, Surabaya, Indonesia
(Purba, Bathoorn, Dik, Friedrich) Department of Medical Microbiology,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(Setiawan, Postma) Unit of PharmacoEpidemiology and Pharmacoeconomics
(PE2), Department of Pharmacy, University of Groningen, Groningen,
Netherlands
(Setiawan) Department of Pharmacology and Clinical Pharmacy, Faculty of
Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
(Postma) Department of Economics, Econometrics and Finance, Faculty of
Economics and Business, University of Groningen, Groningen, Netherlands
Title
Prevention of surgical site infections: A systematic review of cost
analyses in the use of prophylactic antibiotics.
Source
Frontiers in Pharmacology. 9 (JUL) (no pagination), 2018. Article Number:
776. Date of Publication: 18 Jul 2018.
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Introduction: The preoperative phase is an important period in which to
prevent surgical site infections (SSIs). Prophylactic antibiotic use helps
to reduce SSI rates, leading to reductions in hospitalization time and
cost. In clinical practice, besides effectiveness and safety, the
selection of prophylactic antibiotic agents should also consider the
evidence with regard to costs and microbiological results. This review
assessed the current research related to the use of antibiotics for SSI
prophylaxis from an economic perspective and the underlying epidemiology
of microbiological findings. Methods: A literature search was carried out
through PubMed and Embase databases from 1 January 2006 to 31 August 2017.
The relevant studies which reported the use of prophylactic antibiotics,
SSI rates, and costs were included for analysis. The causing pathogens for
SSIs were categorized by sites of the surgery. The quality of reporting on
each included study was assessed with the "Consensus on Health Economic
Criteria" (CHEC). Results: We identified 20 eligible full-text studies
that met our inclusion criteria, which were subsequently assessed, studies
had in a reporting quality scored on the CHEC list averaging 13.03
(8-18.5). Of the included studies, 14 were trial-based studies, and the
others were model-based studies. The SSI rates ranged from 0 to 71.1% with
costs amounting to US$480-22,130. Twenty-four bacteria were identified as
causative agents of SSIs. Gram negatives were the dominant causes of SSIs
especially in general surgery, neurosurgery, cardiothoracic surgery, and
obstetric cesarean sections. Conclusions: Varying results were reported in
the studies reviewed. Yet, information from both trial-based and
model-based costing studies could be considered in the clinical
implementation of proper and efficient use of prophylactic antibiotics to
prevent SSIs and antimicrobial resistance.<br/>Copyright &#xa9; 2018
Purba, Setiawan, Bathoorn, Postma, Dik and Friedrich.

<12>
Accession Number
618763459
Author
Dall'Ara G.; Marzocchi A.; Taglieri N.; Moretti C.; Rodino G.; Chiarabelli
M.; Bottoni P.; Marrozzini C.; Sabattini M.R.; Bacchi-Reggiani M.-L.;
Rapezzi C.; Saia F.
Institution
(Dall'Ara, Marzocchi, Taglieri, Moretti, Rodino, Chiarabelli, Bottoni,
Marrozzini, Sabattini, Bacchi-Reggiani, Rapezzi, Saia) Cardiology Unit,
Cardio-Thoraco-Vascular Department, University Hospital of Bologna,
Policlinico S. Orsola-Malpighi, Bologna, Italy
(Dall'Ara) Dottorato di ricerca XXXdegreeciclo, Scienze
Cardio-Nefro-Toraciche, University of Bologna, Bologna, Italy
Title
Randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing: The pacing versus no pacing (PNP) study.
Source
Journal of Interventional Cardiology. 31 (1) (pp 51-59), 2018. Date of
Publication: Februaryy 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background: BAV technique is poorly standardized. Methods: One
hundred consecutive patients were randomly assigned 1:1 between BAV
performed with or without RP. Exclusion criteria were an immediate
indication for surgical or transcatheter aortic valve replacement,
presentation in cardiogenic shock or pulmonary edema refractory to medical
stabilization. Results: There were 51 patients in the BAV group performed
with RP, 49 in the BAV group without RP (noRP). Procedural success (50%
hemodynamic gradient reduction) was achieved in 37.3% and 55.1%,
respectively (P = 0.16). Fewer people in the noRP group complained of poor
tolerance to the procedure (16% vs 41%). The primary efficacy endpoint, a
50% reduction in the mean echocardiographic trans-aortic gradient, was met
in 21/49 patients in the noRP group compared to 20/51 in the RP (42.9% vs
39.2%; P = 0.84). No significant difference between the groups was
observed in the primary safety endpoint, a 30-day composite of death,
myocardial infarction, stroke, acute aortic regurgitation, and BARC
bleeding >=3 (8.2% noRP vs 13.7%; P = 0.53). The noRP group required fewer
bailout temporary pacemakers (P = 0.048) and had a lower incidence of
moderate/severe renal function worsening (4.1% vs 17.6%; P = 0.052).
Conclusions: Rapid ventricular pacing did not influence BAV efficacy or
safety and tolerance was slightly worse.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<13>
Accession Number
619147414
Author
Putzu A.; Clivio S.; Belletti A.; Cassina T.
Institution
(Putzu, Clivio, Cassina) Department of Cardiovascular Anesthesia and
Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Title
Perioperative levosimendan in cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
International Journal of Cardiology. 251 (pp 22-31), 2018. Date of
Publication: 15 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background Several studies suggested beneficial effects of perioperative
levosimendan on postoperative outcome after cardiac surgery. However,
three large randomized controlled trials (RCTs) have been recently
published and presented neutral results. We performed a systematic review
with meta-analysis and trial sequential analysis (TSA) to assess benefits
and harms of perioperative levosimendan therapy in cardiac surgery.
Methods Electronic databases were searched up to September 2017 for RCTs
on preoperative levosimendan versus any type of control. The Cochrane
methodology was employed. We calculated odds ratio (OR) or Risk Ratio (OR)
and 95% confidence interval (CI) using fixed-effects meta-analyses and we
further performed TSA. Results We included data from 40 RCTs and 4246
patients. Pooled analysis of 5 low risk of bias trials (1910 patients)
showed no association between levosimendan and mortality (OR 0.86 [95% CI,
0.62, 1.18], p = 0.34, TSA inconclusive), acute kidney injury, need of
renal replacement therapy, myocardial infarction, ventricular arrhythmias,
and serious adverse events, but an association with higher incidence of
supraventricular arrhythmias (RR 1.11 [95% CI, 1.00, 1.24], p = 0.05, TSA
inconclusive) and hypotension (RR 1.15 [95% CI, 1.01, 1.30], p = 0.04, TSA
inconclusive). Analysis including all 40 trials found that levosimendan
was associated with lower postoperative mortality (OR 0.56 [95% CI, 0.44,
0.71], p < 0.00001, TSA conclusive), acute kidney injury, and renal
replacement therapy, and higher incidence of hypotension. Conclusions
There is not enough high-quality evidence to neither support nor
discourage the systematic use of levosimendan in cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<14>
Accession Number
614111733
Author
Silvestri L.; Weir W.I.; Gregori D.; Taylor N.; Zandstra D.F.; van Saene
J.J.M.; van Saene H.K.F.
Institution
(Silvestri) Department of Anaesthesia and Intensive Care, S. Giovanni di
Dio Hospital, Gorizia, Italy
(Silvestri, Taylor, van Saene, van Saene) Institute of Ageing and Chronic
Disease, University of Liverpool, Liverpool, UK, United States
(Weir) Department of Cardiothoracic Surgery, London Chest Hospital,
London, UK, United States
(Gregori) Department of Cardiological, Thoracic and Vascular Sciences,
Unit of Biostatistics Epidemiology and Public Health, University of
Padova, Padova, Italy
(Zandstra) University of Amsterdam, Amsterdam, Netherlands
Title
Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill
Patients: Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2236-2244),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives Oropharyngeal overgrowth of microorganisms in the critically
ill is a risk factor for lower respiratory tract infection and subsequent
invasion of the bloodstream. Oral chlorhexidine has been used to prevent
pneumonia, but its effect on bloodstream infection never has been assessed
in meta-analyses. The authors explored the effect of oral chlorhexidine on
the incidence of bloodstream infection, the causative microorganism, and
on all-cause mortality in critically ill patients. Design Systematic
review and meta-analysis of published studies. Setting Intensive care
unit. Participants The study comprised critically ill patients receiving
oral chlorhexidine (test group) and placebo or standard oral care (control
group). Interventions PubMed and the Cochrane Register of Controlled
Trials were searched. Odds ratios (ORs) were pooled using the
random-effects model. Measurements and Main Results Five studies including
1,655 patients (832 chlorhexidine and 823 control patients) were
identified. The majority of information was from studies at low or unclear
risk bias; 1 study was at high risk of bias. Bloodstream infection and
mortality were not reduced significantly by chlorhexidine (OR 0.74; 95%
confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53,
respectively). In the subgroup of surgical, mainly cardiac, patients,
chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97).
Chlorhexidine did not affect any microorganism significantly. Conclusion
In critically ill patients, oropharyngeal chlorhexidine did not reduce
bloodstream infection and mortality significantly and did not affect any
microorganism involved. The presence of a high risk of bias in 1 study and
unclear risk of bias in others may have affected the robustness of these
findings.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<15>
Accession Number
614929399
Author
Machan L.; Churilov L.; Hu R.; Peyton P.; Tan C.; Pillai P.; Ellard L.;
Harley I.; Story D.; Hayward P.; Matalanis G.; Roubos N.; Seevanayagam S.;
Weinberg L.
Institution
(Machan) University of Melbourne, Victoria, Australia
(Churilov) Florey Institute of Neuroscience and Mental Health, University
of Melbourne, Victoria, Australia
(Hu, Peyton, Tan, Pillai, Ellard, Harley) Department of Anesthesia, Austin
Hospital, Heidelberg, Victoria, Australia
(Story, Weinberg) Department of Anesthesia Perioperative and Pain
Medicine, University of Melbourne, Victoria, Australia
(Story, Weinberg) Department of Surgery and Centre for Anesthesia,
Perioperative and Pain Medicine, University of Melbourne, Victoria,
Australia
(Hayward, Matalanis, Roubos, Seevanayagam) Department of Cardiac Surgery,
Austin Hospital, Heidelberg, Victoria, Australia
Title
Apneic Oxygenation Versus Low-Tidal-Volume Ventilation in Anesthetized
Cardiac Surgical Patients: A Prospective, Single-Center, Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2000-2009),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives To compare the physiology of apneic oxygenation with
low-tidal-volume (VT) ventilation during harvesting of the left internal
mammary artery. Design Prospective, single-center, randomized trial.
Setting Single-center teaching hospital. Participants The study comprised
24 patients who underwent elective coronary artery bypass grafting
surgery. Interventions Apneic oxygenation (apneic group: 12 participants)
and low-VT ventilation (low-VT group: 12 participants) (2.5 mL/kg ideal
body weight) for 15 minutes during harvesting of the left internal mammary
artery. Measurement and Main Results The primary endpoint was an absolute
change in partial pressure of arterial carbon dioxide (PaCO<inf>2</inf>).
Secondary endpoints were changes in arterial pH, pulmonary artery
pressures (PAP), cardiac index, and pulmonary artery acceleration time and
ease of surgical access. The mean (standard deviation) absolute increase
in PaCO<inf>2</inf> was 31.8 mmHg (7.6) in the apneic group and 17.6 mmHg
(8.2) in the low-VT group (baseline-adjusted difference 14.2 mmHg [95%
confidence interval 21.0-7.3], p<0.001). The mean (standard deviation)
absolute decrease in pH was 0.15 (0.03) in the apneic group and 0.09
(0.03) in the low-VT group baseline-adjusted difference 0.06 [95%
confidence interval 0.03-0.09], p<0.001. Differences in the rate of change
over time between groups (time-by-treatment interaction) were observed for
PaCO<inf>2</inf> (p<0.001), pH (p<0.001), systolic PAP (p = 0.002),
diastolic PAP (p = 0.023), and mean PAP (p = 0.034). Both techniques
provided adequate ease of surgical access; however, apneic oxygenation was
preferred predominantly. Conclusions Apneic oxygenation caused a greater
degree of hypercarbia and respiratory acidemia compared with low-VT
ventilation. Neither technique had deleterious effects on PAP or cardiac
function. Both techniques provided adequate ease of surgical
access.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<16>
Accession Number
617604749
Author
Lips M.; Mraz M.; Klouckova J.; Kopecky P.; Dobias M.; Krizova J.; Lindner
J.; Diamant M.; Haluzik M.
Institution
(Lips, Kopecky, Dobias) Department of Anaesthesiology, Resuscitation and
Intensive Care, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Mraz, Haluzik) Department of Diabetes, Diabetes Centre, Institute for
Clinical and Experimental Medicine, Prague, Czech Republic
(Mraz, Klouckova, Haluzik) Institute of Medical Biochemistry and
Laboratory Diagnostics, First Faculty of Medicine, Charles University and
General University Hospital, Prague, Czech Republic
(Klouckova, Haluzik) Department of Experimental Diabetology, Centre for
Experimental Medicine, Institute for Clinical and Experimental Medicine,
Prague, Czech Republic
(Krizova) 3rd Department of Medicine - Department of Endocrinology and
Metabolism, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Lindner) 2nd Department of Surgery - Department of Cardiovascular
Surgery, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Diamant) VU University Medical Centre, Amsterdam, Netherlands
(Haluzik) Department of Obesitology, Institute of Endocrinology, Prague,
Czech Republic
Title
Effect of continuous exenatide infusion on cardiac function and
peri-operative glucose control in patients undergoing cardiac surgery: A
single-blind, randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 19 (12) (pp 1818-1822), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Ltd
Abstract
We performed a randomized controlled trial with the glucagon-like
peptide-1 (GLP-1) receptor agonist exenatide as add-on to standard
peri-operative insulin therapy in patients undergoing elective cardiac
surgery. The aims of the study were to intensify peri-operative glucose
control while minimizing the risk of hypoglycaemia and to evaluate the
suggested cardioprotective effects of GLP-1-based treatments. A total of
38 patients with decreased left ventricular systolic function (ejection
fraction <=50%) scheduled for elective coronary artery bypass grafting
(CABG) were randomized to receive either exenatide or placebo in a
continuous 72-hour intravenous (i.v.) infusion on top of standard
peri-operative insulin therapy. While no significant difference in
postoperative echocardiographic variables was found between the groups,
participants receiving exenatide showed improved peri-operative glucose
control as compared with the placebo group (average glycaemia 6.4 +/- 0.5
vs 7.3 +/- 0.8 mmol/L; P <.001; percentage of time in target range of
4.5-6.5 mmol/L 54.8% +/- 14.5% vs 38.6% +/- 14.4%; P =.001; percentage of
time above target range 39.7% +/- 13.9% vs 52.8% +/- 15.2%; P =.009)
without an increased risk of hypoglycaemia (glycaemia <3.3 mmol/L: 0.10
+/- 0.32 vs 0.21 +/- 0.42 episodes per participant; P =.586). Continuous
administration of i.v. exenatide in patients undergoing elective CABG
could provide a safe option for intensifying the peri-operative glucose
management of such patients.<br/>Copyright &#xa9; 2017 John Wiley & Sons
Ltd

<17>
Accession Number
618848092
Author
Pesonen E.; Keski-Nisula J.; Passov A.; Vahatalo R.; Puntila J.; Andersson
S.; Suominen P.K.
Institution
(Pesonen, Passov, Vahatalo) Division of Anaesthesiology, Department of
Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland
(Keski-Nisula, Vahatalo, Suominen) Department of Anaesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital, Finland
(Keski-Nisula, Suominen) Division of Anaesthesiology, Department of
Anaesthesiology, Intensive Care and Pain Medicine, Children's Hospital,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Puntila) Department of Paediatric Cardiac and Transplantation Surgery,
Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Andersson) Children's Hospital, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
Title
Heart-Type Fatty Acid Binding Protein and High-Dose Methylprednisolone in
Pediatric Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 1952-1956),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives Corticosteroids possess cardioprotection in experimental
cardiac ischemia/reperfusion. The authors hypothesized that if
cardioprotection of corticosteroids occured during pediatric cardiac
surgery, then methylprednisolone used in cardiopulmonary bypass prime
would reduce postoperative concentrations of heart-type fatty-acid-binding
protein, a cardiac biomarker. Design A double-blind, placebo-controlled,
randomized clinical trial. Setting Operating room and pediatric intensive
care unit of a university hospital. Participants Forty-five infants and
young children undergoing ventricular or atrioventricular septal defect
correction. Interventions The patients received one of the following: 30
mg/kg of methylprednisolone intravenously after anesthesia induction (n =
15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime
solution (n = 15), or placebo (n = 15). Measurements and Main Results
Plasma heart-type fatty-acid-binding protein (hFABP) was measured.
Preoperatively, hFABP did not differ among the study groups.
Methylprednisolone administered preoperatively and in the cardiopulmonary
bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033)
6 hours postoperatively. hFABP significantly correlated with concomitant
troponin T after protamine administration (R = 0.811, p < 0.001) and 6
hours postoperatively (R = 0.806, p < 0.001). Conclusions
Methylprednisolone in cardiopulmonary bypass prime solution administered
only a few minutes before cardiac ischemia confered cardioprotection of
the same magnitude as preoperative methylprednisolone as indicated by
hFABP concentrations. Rapid cardioprotective actions of corticosteroids in
pediatric heart surgery observed previously experimentally may have
occurred.<br/>Copyright &#xa9; 2017

<18>
Accession Number
618846988
Author
Turan A.; Karimi N.; Zimmerman N.M.; Mick S.L.; Sessler D.I.; Mamoun N.
Institution
(Turan, Karimi, Zimmerman, Sessler) Department of Outcomes Research,
Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
(Zimmerman) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Mick) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland,
OH, United States
(Mamoun) Departments of Cardiothoracic Anaesthesiology and Outcomes
Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
Title
Intravenous Acetaminophen Does Not Decrease Persistent Surgical Pain After
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2058-2064),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objective The authors investigated the hypothesis that perioperative
acetaminophen reduces incisional pain at 30 and 90 days. Design This was a
prospective, randomized, double-blind trial. Setting Tertiary-care
hospital (single center) cardiac surgery unit. Participants Patients
undergoing cardiac surgery via median sternotomy. Interventions Patients
were assigned randomly to intravenous (IV) acetaminophen or IV placebo.
Patients were given 4 doses of 1 g of IV acetaminophen or an equal volume
of saline placebo over 15 minutes every 6 hours for 24 hours starting in
the operating room after sternal closure. Measurements and Main Results
Study participants were assessed by phone for incisional pain severity 30
and 90 days after surgery. Those reporting any incisional pain were asked
to complete the Neuropathic Pain Questionnaire-Short Form and the modified
Brief Pain Inventory. Patients were compared on 30- and 90-day incisional
pain severity using separate multivariable linear regression models. IV
acetaminophen had no effect on 30- and 90-day incisional pain, with an
estimated difference in means (confidence interval) of 0.06 (-0.87 to
0.99) at 30 days (p = 0.88) and 0.07 (-0.71 to 0.86) at 90 days (p =
0.83). Low pain severity, neuropathic pain, and interference at both 30
and 90 days after surgery, regardless of treatment group, were observed.
Conclusions IV acetaminophen did not reduce the incidence or intensity of
incisional pain at 30 days and 90 days after surgery.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<19>
Accession Number
618025581
Author
Zhao B.-C.; Shen P.; Liu K.-X.
Institution
(Zhao, Liu) Department of Anesthesiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Shen) Department of Anesthesiology, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac
Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (6) (pp 2086-2092),
2017. Date of Publication: December 2017.
Publisher
W.B. Saunders
Abstract
Objectives To evaluate whether perioperative statins reduce the risk of
acute kidney injury (AKI) after cardiac surgery. Design Systematic review
and meta-analysis of randomized trials. Setting Perioperative management
in hospitals that perform cardiac surgery. Participants Adult patients
undergoing cardiac surgery. Interventions PubMed, EMBASE, and the Cochrane
Library databases were searched for randomized trials. Random-effects
meta-analyses were performed to compare the effects of statins versus
placebo/control. Trial sequential analysis was conducted to confirm the
results. Measurements and Main Results The primary outcome was incidence
of postoperative AKI. Eight trials enrolling 3,204 patients were included.
The statin arms and the control arms were comparable in incidence of
postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] =
0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI =
0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84
min, 95% CI = -55.53-105.20), intensive care unit length of stay (MD =
0.04 days, 95% CI = -3.13-3.20), hospital length of stay (MD = -0.08 days,
95% CI = -0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI =
0.93-15.14). Trial sequential analysis confirmed that it is unlikely that
perioperative statin therapy could achieve a 20% or more relative risk
reduction in AKI incidence. Conclusions Among patients undergoing cardiac
surgery, perioperative statin treatment did not reduce the risk of AKI.
Statin therapy should not be initiated to prevent AKI following cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<20>
Accession Number
619605925
Author
van der Werf H.W.; Schurer R.A.J.; Vonck T.E.; Poelman J.E.; Klungel A.A.;
Cernak V.; van den Heuvel A.F.M.; van der Harst P.
Institution
(van der Werf, Schurer, Vonck, Poelman, Klungel, van den Heuvel, van der
Harst) Department of Cardiology, University of Groningen, University
Medical Centre Groningen, Netherlands
(Cernak) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Netherlands
Title
Emergency transcatheter aortic valve implantation in patients with severe
aortic regurgitation and a left ventricle assist device: A case report and
systematic review.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (8) (pp 719-727),
2017. Date of Publication: 01 Dec 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Cardiogenic shock due to severe aortic regurgitation in
patients with left ventricle assist devices is a life threatening
condition. Here, we consider transcatheter aortic valve implantation as a
treatment option. Methods and results: A patient with a left ventricle
assist device was presented to us with cardiogenic shock due to severe
aortic regurgitation. We successfully implanted a transcatheter aortic
valve in emergency setting. The patient recovered and underwent cardiac
transplantation three months afterwards. We performed a systematic
literature review and identified 10 cases of patients with a left
ventricle assist device undergoing transcatheter aortic valve
implantation. In these cases, there was no procedural related mortality
reported. In four (40%) patients, transcatheter aortic valve implantation
resulted in significant paravalvular aortic regurgitation. In two of these
cases it was due to migration of the valve towards the left ventricle.
Conclusions: Our case report and review of literature suggests that
transcatheter aortic valve implantation is a feasible and lifesaving
treatment option for left ventricle assist device patients presenting with
severe aortic regurgitation.<br/>Copyright &#xa9; 2016, &#xa9; The
European Society of Cardiology 2016.

<21>
Accession Number
619605794
Author
Siller-Matula J.M.; Petre A.; Delle-Karth G.; Huber K.; Ay C.;
Lordkipanidze M.; De Caterina R.; Kolh P.; Mahla E.; Gersh B.J.
Institution
(Siller-Matula, Petre, Delle-Karth) Department of Cardiology, Medical
University of Vienna, Austria
(Huber) 3rd Medical Department of Cardiology and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Ay) Division of Haematology and Haemostaseology, Department of Medicine
I, Medical University of Vienna, Austria
(Lordkipanidze) Faculty of Pharmacy, University of Montreal; Research
Center, Montreal Heart Institute, Canada
(De Caterina) Institute of Cardiology, 'G d'Annunzio' University -
Chieti-Pescara, Chieti, Italy
(Kolh) Department of Cardiothoracic Surgery, University Hospital of Liege,
Belgium
(Mahla) Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Graz, Austria
(Gersh) Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic, College of Medicine Rochester, United States
Title
Impact of preoperative use of P2Y12 receptor inhibitors on clinical
outcomes in cardiac and non-cardiac surgery: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (8) (pp 753-770),
2017. Date of Publication: 01 Dec 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review systematically the evidence and perform a
meta-analysis of benefits and risks associated with use of
P2Y<inf>12</inf> receptor inhibitors in coronary artery bypass graft-,
non-cardiac- and device surgery. Data selection and analysis: We performed
a meta-analysis of published studies. Patients with preoperative use of
clopidogrel, ticagrelor or prasugrel (late discontinuation: <5 days before
surgery or no discontinuation) were compared with patients without
preoperative use of the respective drug (early discontinuation: 5 days
before surgery or no users of P2Y<inf>12</inf> receptor inhibitors).
Outcomes evaluated were re-operation for major bleeding, death, myocardial
infarction, combined major adverse cardiac events (MACEs) and major
haematoma. Using a random effect model, relative risks (RRs) and 95%
confidence intervals (CI) were calculated for each outcome. Results:
Fifty-four studies met the selection criteria and included 50,048
patients. Preoperative use of clopidogrel on top of aspirin in patients
undergoing coronary artery bypass graft was associated with a 2.5-fold
increased risk of re-operation for bleeding (95% CI: 1.92-3.25; p<0.001)
and a 1.47-fold increased risk of death (95% CI: 1.25-1.72; p<0.001), but
did not diminish the risk for myocardial infarction (RR: 0.96; 95% CI:
0.75-1.25; p=0.18) or MACE (RR: 1.16; 95% CI: 0.90--1.50; p=0.30). In
patients undergoing non-cardiac surgery, preoperative use of clopidogrel
increased the RR of re-operation for major bleeding by 2.05-fold (95% CI:
1.13-3.73; p=0.002) but did not reduce the RR for MACE or death.
Clopidogrel use during cardiac device implantation raised the RR for
procedure-related haematoma by 3.0-fold (95% CI: 1.30--6.94; p=0.001).
Whereas preoperative ticagrelor use did not increase the risk for
mortality (RR: 1.03; 95% CI: 0.49-2.14), preoperative prasugrel use tended
to increase the risk for death (RR: 5.06; 95% CI: 0.54-47.65). Conclusion:
Preoperative exposure to clopidogrel on top of aspirin did not reduce the
risk of MACE but was associated with increased risk of bleeding and
mortality.<br/>Copyright &#xa9; 2015, &#xa9; The European Society of
Cardiology 2015.

<22>
Accession Number
623038817
Author
Langstraat M.; Musters K.J.S.; Manintveld O.; Masetti M.; Potena L.
Institution
(Langstraat, Musters) School of Medicine, Erasmus MC, Rotterdam,
Netherlands
(Manintveld) Department of Cardiology, Thorax Center, Rotterdam,
Netherlands
(Masetti, Potena) Heart and Lung Transplant Program, Bologna University
Hospital, Bologna, Italy
Title
Coronary artery disease in heart transplantation: new concepts for an old
disease.
Source
Transplant International. 31 (8) (pp 787-827), 2018. Date of Publication:
August 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) remains one of the main long-term
complications after heart transplantation. We performed a systematic
review focused on articles published in the previous 6 years to reappraise
the novel evidences supporting risk factors, pathology, prevention, and
treatment of CAV. We identified a search string for a literature search on
PubMed. We excluded articles specifically focused on
diagnosis/biomarkers/imaging only or complications of other diseases. We
included 98 studies out of our search. Forty-eight articles describe risk
factors for CAV, 13 pathology, 24 prevention, and 13 treatment for CAV.
While confirming known concepts, we found supportive evidence that CAV
pathophysiology may vary according to the time post-transplant and the
prevalence of metabolic versus immune-mediated risk factors. Selective
revascularization of focal lesions in patients with CAV may result in some
clinical benefit, but CAV prevention, rather than treatment, by
controlling risk factors and by using targeted immunosuppressive therapies
is the most evidence-based approach to reduce disease
progression.<br/>Copyright &#xa9; 2018 Steunstichting ESOT

<23>
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).

<24>
Accession Number
2000956154
Author
Fernandes G.C.; Fernandes A.; Cardoso R.; Nasi G.; Rivera M.; Mitrani
R.D.; Goldberger J.J.
Institution
(Fernandes, Nasi, Rivera) Department of Internal Medicine, University of
Miami Miller School of Medicine, Miami, Florida, United States
(Fernandes) Centro de Ciencias Medicas, Universidade Federal da Paraiba,
Joao Pessoa, Brazil
(Cardoso) Division of Cardiology, Johns Hopkins University, Baltimore,
Maryland, United States
(Mitrani, Goldberger) Division of Cardiology, University of Miami Miller
School of Medicine, Miami, Florida, United States
Title
Ablation strategies for the management of symptomatic Brugada syndrome: A
systematic review.
Source
Heart Rhythm. 15 (8) (pp 1140-1147), 2018. Date of Publication: August
2018.
Publisher
Elsevier B.V.
Abstract
Background: Ablation approaches have been described for the management of
symptomatic ventricular arrhythmias in patients with Brugada syndrome, but
this treatment is still considered experimental. Objective: We aimed to
perform a systematic review of the current evidence on the use of catheter
ablation in Brugada syndrome. Methods: MEDLINE, Embase, and Scopus were
searched for articles describing the use of catheter ablation for
ventricular arrhythmia management in Brugada syndrome. Results: We
included 11 case series and 11 case reports including a total of 233
patients. Ablation strategies included epicardial mapping with substrate
modification (n = 180; 77.3%), endocardial-only mapping with substrate
modification (n = 17; 7.3%), ventricular fibrillation (VF)-triggering
premature ventricular complex ablation (n = 5; 2.1%), and mixed approaches
(n = 31; 13.3%). During a 2.5- to 78-month follow-up period, the success
rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%,
70.6%, and 80% with epicardial, endocardial, and triggering premature
ventricular complex ablation approaches, respectively. Among patients who
underwent both epicardial and endocardial mapping, there was no
identifiable endocardial substrate in 92.9% of cases. Elimination of type
1 Brugada-pattern electrocardiogram was attained in 98.3% and 34.8% of the
epicardial and endocardial ablation groups, respectively. VT/VF occurred
in 7 of 9 patients (77.8%) who had persistent or recurrent J-ST elevation
and in none of the 24 patients with complete resolution during follow-up.
Pharmacologic provocation augmented the abnormal area. Conclusion:
Epicardial substrate modification appears to be more effective than
endocardial-only approach in preventing VT/VF. Persistent or recurrent
J-ST elevation appears to represent a marker of failure of ablation.
Ablation seems to be an acceptable strategy for patients with Brugada
syndrome and VT/VF.<br/>Copyright &#xa9; 2018 Heart Rhythm Society

<25>
Accession Number
623030717
Author
McCreanor V.; Graves N.; Barnett A.G.; Parsonage W.; Merlo G.
Institution
(McCreanor, Graves, Barnett, Parsonage, Merlo) Institute of Health and
Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
4059, Australia
(McCreanor) Capital Markets Cooperative Research Centre, Sydney, NSW 2000,
Australia
(Parsonage) Royal Brisbane and Women's Hospital, Brisbane, QLD 4029,
Australia
Title
A systematic review and critical analysis of cost-effectiveness studies
for coronary artery disease treatment [version 2; referees: 2 approved].
Source
F1000Research. 7 (no pagination), 2018. Article Number: 77. Date of
Publication: 2018.
Publisher
F1000 Research Ltd (E-mail: info@f1000.com)
Abstract
Background: Cardiovascular disease remains the primary cause of death
among Australians, despite dramatic improvements in overall cardiovascular
health since the 1980s. Treating cardiovascular disease continues to place
a significant economic strain on the Australian health care system, with
direct healthcare costs exceeding those of any other disease. Coronary
artery disease accounts for nearly one third of these costs and spending
continues to rise. A range of treatments is available for coronary artery
disease yet evidence of cost-effectiveness is missing, particularly for
the Australian context. Cost-effectiveness evidence can signal waste and
inefficiency and so is essential for an efficient allocation of healthcare
resources. Methods: We used systematic review methods to search the
literature across several electronic databases for economic evaluations of
treatments for stable coronary artery disease. We critically appraised the
literature found in searches, both against the CHEERS statement for
quality reporting of economic evaluations and in terms of its usefulness
for policy and decision-makers. Results: We retrieved a total of 308
references, 229 once duplicates were removed. Of these, 26 were excluded
as they were not full papers (letters, editorials etc.), 55 were review
papers, 50 were not cost-effectiveness analyses and 93 related to a highly
specific patient sub-group or did not consider all treatment options. This
left five papers to be reviewed in full. Conclusions: The current
cost-effectiveness evidence does not support the increased use of PCI that
has been seen in Australia and internationally. Due to problems with
accessibility, clarity and relevance to policy and decision-makers, some
otherwise very scientifically rigorous analyses have failed to generate
any policy changes.<br/>Copyright &#xa9; 2018 McCreanor V et al.

<26>
Accession Number
619934429
Author
Smith L.E.; Smith D.K.; Blume J.D.; Linton M.F.; Billings F.T.
Institution
(Smith, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Smith, Blume) Department of Biostatistics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Linton, Billings) Department of Biostatistics and Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
Title
High-density lipoprotein cholesterol concentration and acute kidney injury
after cardiac surgery.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006975. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury (AKI) after cardiac surgery is associated
with increased short- and long-term mortality. Inflammation, oxidative
stress, and endothelial dysfunction and damage play important roles in the
development of AKI. Highdensity lipoproteins (HDLs) have anti-inflammatory
and antioxidant properties and improve endothelial function and repair.
Statins enhance HDL's anti-inflammatory and antioxidant capacities. We
hypothesized that a higher preoperative HDL cholesterol concentration is
associated with decreased AKI after cardiac surgery and that perioperative
statin exposure potentiates this association. Methods and Results--We
tested our hypothesis in 391 subjects from a randomized clinical trial of
perioperative atorvastatin to reduce AKI after cardiac surgery. A
2-component latent variable mixture model was used to assess the
association between preoperative HDL cholesterol concentration and
postoperative change in serum creatinine, adjusted for known AKI risk
factors and suspected confounders. Interaction terms were used to examine
the effects of preoperative statin use, preoperative statin dose, and
perioperative atorvastatin treatment on the association between
preoperative HDL and AKI. A higher preoperative HDL cholesterol
concentration was independently associated with a decreased postoperative
serum creatinine change (P=0.02). The association between a high HDL
concentration and an attenuated increase in serum creatinine was strongest
in long-term statinusing patients (P=0.008) and was further enhanced with
perioperative atorvastatin treatment (P=0.004) and increasing long-term
statin dose (P=0.003). Conclusions--A higher preoperative HDL cholesterol
concentration was associated with decreased AKI after cardiac surgery.
Preoperative and perioperative statin treatment enhanced this association,
demonstrating that pharmacological potentiation is possible during the
perioperative period.<br/>Copyright &#xa9; 2017 The Authors.

<27>
Accession Number
619934422
Author
Karatasakis A.; Danek B.A.; Karacsonyi J.; Rangan B.V.; Roesle M.K.;
Knickelbine T.; Miedema M.D.; Khalili H.; Ahmad Z.; Abdullah S.; Banerjee
S.; Brilakis E.S.
Institution
(Karatasakis, Danek, Karacsonyi, Rangan, Roesle, Khalili, Ahmad, Abdullah,
Banerjee, Brilakis) VA North Texas Health Care System, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Karatasakis, Danek) Rutgers New Jersey Medical School, Newark, NJ, United
States
(Knickelbine, Miedema, Brilakis) Minneapolis Heart Institute, Minneapolis,
MN, United States
Title
Effect of PCSK9 inhibitors on clinical outcomes in patients with
hypercholesterolemia: A meta-analysis of 35 randomized controlled trials.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006910. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--We sought to examine the efficacy and safety of 2 PCSK9
(proprotein convertase subtilisin/kexin type 9) inhibitors: alirocumab and
evolocumab. Methods and Results--We performed a systematic review and
meta-analysis of randomized controlled trials comparing treatment with and
without PCSK9 inhibitors; 35 randomized controlled trials comprising 45
539 patients (mean follow-up: 85.5 weeks) were included. Mean age was
61.0+/-2.8 years, and mean baseline low-density lipoprotein cholesterol
was 106+/-22 mg/dL. Compared with no PCSK9 inhibitor therapy, treatment
with a PCSK9 inhibitor was associated with a lower rate of myocardial
infarction (2.3% versus 3.6%; odds ratio [OR]: 0.72 [95% confidence
interval (CI), 0.64-0.81]; P < 0.001), stroke (1.0% versus 1.4%; OR: 0.80
[95% CI, 0.67-0.96]; P=0.02), and coronary revascularization (4.2% versus
5.8%; OR: 0.78 [95% CI, 0.71-0.86]; P < 0.001). Overall, no significant
change was observed in all-cause mortality (OR: 0.71 [95% CI, 0.47- 1.09];
P=0.12) or cardiovascular mortality (OR: 1.01 [95% CI, 0.85-1.19];
P=0.95). A significant association was observed between higher baseline
low-density lipoprotein cholesterol and benefit in all-cause mortality
(P=0.038). No significant change was observed in neurocognitive adverse
events (OR: 1.12 [95% CI, 0.88-1.42]; P=0.37), myalgia (OR: 0.95 [95% CI,
0.75-1.20]; P=0.65), new onset or worsening of preexisting diabetes
mellitus (OR: 1.05 [95% CI, 0.95-1.17]; P=0.32), and increase in levels of
creatine kinase (OR: 0.84 [95% CI, 0.70-1.01]; P=0.06) or alanine or
aspartate aminotransferase (OR: 0.96 [95% CI, 0.82- 1.12]; P=0.61).
Conclusions--Treatment with a PCSK9 inhibitor is well tolerated and
improves cardiovascular outcomes. Although no overall benefit was noted in
all-cause or cardiovascular mortality, such benefit may be achievable in
patients with higher baseline lowdensity lipoprotein
cholesterol.<br/>Copyright &#xa9; 2017 The Authors.

<28>
Accession Number
2000776132
Author
Danielsen S.O.; Moons P.; Sandven I.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Centre for Patient-centered Heart and Lung research,
Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo,
Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
(Solheim) Center for Clinical Heart Research and Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
Title
Thirty-day readmissions in surgical and transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 268 (pp 85-91), 2018. Date of
Publication: 1 October 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The 30-day all-cause readmission rate after surgical aortic
valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR)
vary substantially. We conducted a systematic review and meta-analysis to
examine the overall incidence, causes, and risk factors of 30-day
all-cause readmission rate after SAVR and TAVR. Methods: Eight medical
research databases were searched; Cochrane, Medline, Embase, UpToDate,
PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed
The Preferred Reporting Items for Systematic reviews and Meta-analysis
(PRISMA) for this study. Results: Thirty-three articles were included in
the systematic review, 32 of which were appropriate for the meta-analysis.
Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95%
CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart
failure, arrhythmia, infection, and respiratory problems were the most
frequent causes of all-cause readmission after SAVR and TAVR. Most
frequent reported prior risk factors for all-cause readmission following
TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary
disease, atrial fibrillation, kidney problems, and transapical
approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause
readmission were reported in the literature to date. Conclusion: In
conclusion, the overall proportion of 30-day all-cause readmission after
SAVR and TAVR are high. Interventions to prevent avoidable readmissions
ought to be developed and implemented.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<29>
Accession Number
2000878287
Author
Duan X.; Coburn M.; Rossaint R.; Sanders R.D.; Waesberghe J.V.; Kowark A.
Institution
(Duan) Department of Anaesthesiology, The Affiliated Hospital of Southwest
Medical University, LuZhou, China
(Duan, Coburn, Rossaint, Waesberghe, Kowark) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Sanders) Department of Anesthesiology, School of Medicine and Public
Health, University of Wisconsin, Madison, WI, United States
Title
Efficacy of perioperative dexmedetomidine on postoperative delirium:
systematic review and meta-analysis with trial sequential analysis of
randomised controlled trials.
Source
British Journal of Anaesthesia. 121 (2) (pp 384-397), 2018. Date of
Publication: August 2018.
Publisher
Elsevier Ltd
Abstract
Background: The influence of dexmedetomidine on postoperative delirium
(POD) in adult surgical patients remains controversial. We aimed to
analyse whether dexmedetomidine use could decrease POD incidence in this
population and its relation to timing of dexmedetomidine administration
and patient age. Methods: We used random-effects modelled meta-analysis,
trial sequential analysis, and followed Cochrane methodology with Grading
of Recommendations Assessment, Development, and Evaluation (GRADE). PubMed
and Cochrane library were searched up to July 2017 for randomised
controlled trials that analysed POD incidence of adult surgical patients
(age >=18 yr) after dexmedetomidine administration. Results: Eighteen
studies (comprising 3309 patients) were included. There was decreased risk
of POD with dexmedetomidine use for the entire adult surgical population
[odds ratio (OR) 0.35; 95% confidence interval (CI) 0.24-0.51)], with firm
evidence from trial sequential analysis. Pre-specified subgroup analyses
confirmed this result with firm evidence for cardiac and non-cardiac
surgical patients, (OR 0.41; 95% CI 0.26-0.63) and (OR 0.33; 95% CI
0.18-0.59), respectively. We also found firm evidence for reduction of POD
if dexmedetomidine is administered during the postoperative period (OR
0.30; 95% CI 0.21-0.44), in patients aged <65 yr (OR 0.19; 95% CI
0.10-0.36) or >=65 yr (OR 0.44; 95% CI 0.30-0.65). Evidence for
dexmedetomidine's influence on secondary outcomes (in-hospital mortality,
intensive care unit and hospital length of stay, bradycardia, and
hypotension) is thus far insufficient to draw conclusions. Conclusion:
Dexmedetomidine can reduce POD incidence for adult cardiac and non-cardiac
surgical patients. The optimal dose and timing of dexmedetomidine and
influence on other outcomes or particular patient populations with risk
factors warrants further studies. Clinical trial registration: PROSPERO:
CRD42017072380.<br/>Copyright &#xa9; 2018 British Journal of Anaesthesia

<30>
Accession Number
620544679
Author
Liu T.T.; Li L.; Wan L.; Zhang C.H.; Yao W.L.
Institution
(Liu, Wan, Zhang, Yao) Department of Anaesthesiology, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
(Li) Department of Physiology, Hubei University of Chinese Medicine,
Wuhan, China
Title
Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube
intubation in thoracic surgery: a systematic review and meta-analysis.
Source
Anaesthesia. 73 (8) (pp 997-1007), 2018. Date of Publication: August 2018.
Publisher
Blackwell Publishing Ltd
Abstract
Double-lumen intubation is more difficult than single-lumen tracheal
intubation. Videolaryngoscopes have many advantages in airway management.
However, the advantages of videolaryngoscopy for intubation with a
double-lumen tube remain controversial compared with traditional Macintosh
laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library
and the Web of Science for randomised controlled trials comparing
videolaryngoscopy with Macintosh laryngoscopy for double-lumen tube
intubation. We found that videolaryngoscopy provided a higher success rate
at first attempt for double-lumen tube intubation, with an odds ratio
(95%CI) of 2.77 (1.92-4.00) (12 studies, 1215 patients, moderate-quality
evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or
dental injuries during double-lumen tube intubation, odds ratio (95%CI)
0.36 (0.15-0.85) (11 studies, 1145 patients, low-quality evidence, p =
0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54
(0.36-0.81) (7 studies, 561 patients, moderate-quality evidence, p =
0.003), compared with Macintosh laryngoscopy. There were no significant
differences in intubation time, with a standardised mean difference
(95%CI) of -0.10 (-0.62 to 0.42) (14 studies, 1310 patients, very
low-quality evidence, p = 0.71); and the incidence of postoperative voice
change, odds ratio (95%CI) 0.53 (0.21-1.31) (7 studies, 535 patients,
low-quality evidence, p = 0.17). Videolaryngoscopy led to a higher
incidence of malpositioned double-lumen tube, with an odds ratio (95%CI)
of 2.23 (1.10-4.52) (six studies, 487 patients, moderate-quality evidence,
p = 0.03).<br/>Copyright &#xa9; 2018 The Association of Anaesthetists of
Great Britain and Ireland

<31>
Accession Number
2000733845
Author
Su L.-J.; Li Y.-M.; Kellum J.A.; Peng Z.-Y.
Institution
(Su, Li, Peng) Department of Critical Care Medicine, Zhongnan Hospital of
Wuhan University, Wuhan, Hubei Province, China
(Kellum, Peng) Center of Critical Care Nephrology, Department of Critical
Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
Title
Predictive value of cell cycle arrest biomarkers for cardiac
surgery-associated acute kidney injury: a meta-analysis.
Source
British Journal of Anaesthesia. 121 (2) (pp 350-357), 2018. Date of
Publication: August 2018.
Publisher
Elsevier Ltd
Abstract
Background: A biomarker test based on a combination of urine tissue
inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor
binding protein 7 (IGFBP7) has been used as a potential biomarker of acute
kidney injury (AKI). This meta-analysis aimed to evaluate the predictive
value of this biomarker for cardiac surgery-associated acute kidney injury
(CSA-AKI). Methods: We searched MEDLINE, PubMed, Cochrane, and EMBASE for
studies. We evaluated the methodological quality of each included study
using the Quality Assessment of Diagnostic Accuracy Studies 2 criteria.
Meta-DiSc and STATA were used for statistical analyses. Results: A total
of 10 studies (747 patients) were included in this meta-analysis. Pooled
sensitivity and specificity with corresponding 95% confidence intervals
(CI) were 0.77 (95% CI: 0.70-0.83, I²=40.7%) and 0.76 (95% CI:
0.72-0.79, I²=69.1%), respectively. Pooled positive likelihood
ratio (LR), negative LR, and diagnostic odds ratio were 3.26 (95% CI:
2.51-4.23, I²=50.7%), 0.32 (95% CI: 0.24-0.41,
I²=6.7%), and 10.08 (95% CI: 6.85-14.84, I²=6.7%),
respectively. The area under the curve estimated by summary receiver
operating characteristics was 0.83 [standard error (SE) 0.023] with a Q*
value of 0.759 (SE 0.021). There was no heterogeneity amongst the 10
studies from both threshold and non-threshold effects. Subgroup analysis
showed that the diagnostic value was related to the severity of AKI and
time measurement. Conclusions: Urinary [TIMP-2].[IGFBP7] is an effective
predictive test for cardiac surgery associated acute kidney injury with
good diagnostic accuracy within 24 h. Studies examining use of
biomarker-guided care bundles are indicated.<br/>Copyright &#xa9; 2018
British Journal of Anaesthesia

<32>
Accession Number
622055265
Author
Dedieu N.; Silva Vieira M.; Fenton M.; Wong J.; Botnar R.; Burch M.; Greil
G.; Hussain T.
Institution
(Dedieu, Fenton, Burch) Great Ormond Street Hospital for Children
Foundation Trust, London, United Kingdom
(Dedieu, Silva Vieira, Wong, Botnar, Greil, Hussain) King's College
London, The Rayne Institute, London, United Kingdom
(Greil, Hussain) UT Southwestern Medical Center, Children's Medical
Center, Dallas, TX, United States
Title
The importance of qualitative and quantitative regional wall motion
abnormality assessment at rest in pediatric coronary allograft
vasculopathy.
Source
Pediatric Transplantation. 22 (5) (no pagination), 2018. Article Number:
e13208. Date of Publication: August 2018.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
CAV remains one of the main limiting factors for survival in children
after heart transplantation. In this study, we explored the incremental
value of routine CMR for evaluation and detection of CAV using qualitative
and quantitative analysis of regional and global myocardial function and
strain. This was a prospective imaging biomarker validation trial.
Twenty-two patients (11 male), aged between 10 and 17 years (median 14
years) post-heart transplantation, were prospectively enrolled and
underwent CMR in addition to their biennial review workup with Echo,
angiography, and IVUS. Nine healthy control patients were enrolled to
undergo CMR alone. Echo was used to analyze WMAs and systolic function.
CMR images were analyzed qualitatively for RWMA and quantitatively for
volumetric analysis, S and SR. All results were compared to IVUS and
angiography assessments. Qualitatively, CMR detected RWMA corresponding to
angiographic disease in 3 patients that were not detected on Echo.
However, quantitative strain analysis suggested RWMA in an extra 9
patients. Detection of regional wall motion abnormality using quantitative
strain analysis was associated with a higher mean stenosis grade (P=.04)
and reduced graft survival (P=.04) compared to those with no quantitative
wall motion abnormality. Overall, only longitudinal stain was abnormal in
patients compared with controls, but there was no correlation between any
of the global indices of S or SR and IVUS measurements. CMR is more
sensitive than Echo for the visual detection of significant WMAs.
Quantitative CMR strain analysis at rest may give additional information
to discriminate those at greatest risk.<br/>Copyright &#xa9; 2018 John
Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<33>
Accession Number
622613765
Author
McQuillan C.; Gray A.; Kearney A.; Menown I.B.A.
Institution
(McQuillan, Gray, Kearney, Menown) Craigavon Cardiac Centre, Southern
Trust, Craigavon, United Kingdom
Title
Advances in Clinical Cardiology 2017: A Summary of Key Clinical Trials.
Source
Advances in Therapy. 35 (7) (pp 899-927), 2018. Date of Publication: 01
Jul 2018.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Numerous important cardiology clinical trials have been
published or presented at major international meetings during 2017. This
paper aims to summarize these trials and place them in clinical context.
Methods: The authors reviewed clinical trials presented at major
cardiology conferences during 2017 including the American College of
Cardiology, European Association for Percutaneous Cardiovascular
Interventions, European Society of Cardiology, European Association for
the Study of Diabetes, Transcatheter Cardiovascular Therapeutics, and the
American Heart Association. Selection criteria were trials with a broad
relevance to the cardiology community and those with potential to change
current practice. Results: A total of 75 key cardiology clinical trials
were identified for inclusion. New interventional and structural
cardiology data include left main bifurcation treatment strategy,
multivessel disease management in cardiogenic shock, drug-eluting balloons
for in-stent restenosis, instantaneous wave-free physiological assessment,
new-generation stents (COMBO, Orsiro), transcatheter aortic valve
implantation, and closure devices. New preventative cardiology data
include trials of liraglutide, empagliflozin, PCSK9 inhibitors (evolocumab
and bococizumab), inclisiran, and anacetrapib. Antiplatelet data include
the role of uninterrupted aspirin therapy during non-cardiac surgery and
dual antiplatelet therapy following coronary artery bypass grafting. New
data are also included from fields of heart failure (levosimendan,
spironolactone), atrial fibrillation (apixaban in DC cardioversion),
cardiac devices (closed loop stimulation pacing for neuromediated
syncope), and electrophysiology (catheter ablation for atrial
fibrillation). Conclusion: This paper presents a summary of key clinical
cardiology trials during the past year and should be of practical value to
both clinicians and cardiology researchers.<br/>Copyright &#xa9; 2018, The
Author(s).

<34>
Accession Number
2000662509
Author
Leone A.M.; Lassandro Pepe F.; Arioti M.; Crea F.
Institution
(Leone, Lassandro Pepe, Arioti, Crea) Department of Cardiovascular
Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Rome,
Italy
Title
Contrast Fractional Flow Reserve (cFFR): A pragmatic response to the call
for simplification of invasive functional assessment.
Source
International Journal of Cardiology. 268 (pp 45-50), 2018. Date of
Publication: 1 October 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Aim: To review the current approaches to simplify functional assessment of
coronary stenosis with particular regard for contrast Fractional Flow
Reserve (cFFR). Methods and results: Maximal hyperaemia to assess FFR is
perceived as time-consuming, costly, unpleasant for the patient and
associated with side effects. Resting indexes, like Pd/Pa and iFR, have
been proposed to circumvent the use of vasodilators as well as an approach
based on the administration of contrast medium to induce coronary
vasodilation, the cFFR. Contrast FFR can be obtained quickly, at very low
cost in the absence of substantial side effects. Among these alternative
indexes, cFFR shows the best correlation with FFR, reduces the use of
adenosine even more than a hybrid resting approach but has not yet been
tested in a randomized, controlled trial with clinical end-points.
Conclusion: cFFR represents a cheap, safe and effective alternative to
FFR, able to facilitate the dissemination of a functional approach to
myocardial revascularization.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<35>
Accession Number
621711072
Author
Mauri V.; Deuschl F.; Frohn T.; Schofer N.; Linder M.; Kuhn E.; Schaefer
A.; Rudolph V.; Madershahian N.; Conradi L.; Rudolph T.K.; Schafer U.
Institution
(Mauri, Frohn, Rudolph, Rudolph) Department of Cardiology, Heart Center,
University of Cologne, Kerpener Str. 62, Cologne 50937, Germany
(Deuschl, Schofer, Schafer) Department of General and Interventional
Cardiology, University Heart Center Hamburg, Martinistrase 52, Hamburg
20246, Germany
(Linder, Schaefer, Conradi) Department for Cardiovascular Surgery,
University Heart Center Hamburg, Hamburg, Germany
(Kuhn, Madershahian) Department of Cardiothoracic Surgery, Heart Center,
University of Cologne, Cologne, Germany
Title
Predictors of paravalvular regurgitation and permanent pacemaker
implantation after TAVR with a next-generation self-expanding device.
Source
Clinical Research in Cardiology. 107 (8) (pp 688-697), 2018. Date of
Publication: 01 Aug 2018.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: To identify predictors of paravalvular regurgitation (PVR) and
permanent pacemaker implantation (PPI) following TAVR with a
next-generation self-expanding device. Methods and results: Device landing
zone (DLZ) calcification, angiographic implantation depth, and baseline
and procedural characteristics were analyzed in 212 patients being treated
with the ACURATE neo aortic bioprosthesis. PVR was none/trace in 57.1% and
>= mild in 42.9% (37% mild, 6% moderate). DLZ calcification (705 (IQR
240-624) vs. 382 (IQR 240-624) mm³; P < 0.001) as well as
absolute calcium asymmetry (233 +/- 159 vs. 151 +/- 151 mm³; P
< 0.001) was significantly higher in patients with PVR >= mild. On
multivariate analysis, calcification of the aortic valve cusps (AVC) >
410.6 mm³ was independently associated with PVR >= mild. PPI
rate was 10.3% (n = 20). Patients with and without need for PPI had
similar total DLZ calcium volume (740 (IQR 378-920) vs. 536 (IQR 315-822)
mm³; P = 0.263), but exhibited different calcium distribution
patterns: LVOT calcium > 41.4 mm³ in the sector below the left
coronary cusp (LVOT<inf>LC</inf>) was associated with increased PPI risk
(26.9 vs. 7.7%; P = 0.008). Conclusions: The quantity of AVC calcium
predicts residual PVR. Multivariable analysis identified LVOT<inf>LC</inf>
calcium, pre-existing RBBB, and age > 82.7 years as independent predictors
of PPI. Based on these risk factors, a patient's individual PPI risk can
be stratified ranging from 3.8 to 100%.<br/>Copyright &#xa9; 2018,
Springer-Verlag GmbH Germany, part of Springer Nature.

<36>
[Use Link to view the full text]
Accession Number
623097761
Author
Koutsaki M.; Kallistratos M.; Soulioti E.; Poulimenos L.; Thomopoulos C.;
Mela A.; Batistaki C.; Chatziagelaki E.; Achimastos A.; Koutsaki S.;
Khashlok L.; Manolis A.J.
Institution
(Koutsaki, Kallistratos, Soulioti, Poulimenos, Mela, Batistaki, Koutsaki,
Khashlok, Manolis) Asklepeion General Hospital, Athens, Greece
(Thomopoulos) Elena Venizelou Hospital, Athens, Greece
(Chatziagelaki) Attikon University Hospital, Athens, Greece
(Achimastos) Ygeia Melathro, Athens, Greece
Title
Is it safe to withdraw combined antihypertensive treatment before
non-cardiac surgery in the very elderly ?.
Source
Journal of Hypertension. Conference: 28th Scientific Meeting of the
European Society of Hypertension, ESH 2018. Spain. 36 (Supplement 1) (pp
e151), 2018. Date of Publication: June 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Elevated systolic blood pressure (SBP)during pre-operative
evaluation is the main cause to postpone non-cardiac surgery. We
hypothesized that white-coat phenomenon might be exaggerated in
pre-operative visits. Design and method: During their perioperative visit,
we prospectively enrolled 22 very elderly hypertensive patients (aged 78
+/- 4) under chronic treatment with at least two antihypertensive agents.
The day of the surgery this treatment was not administered except
b-blockers according to guidelines. On-treatment office SBP, andBP
immediately before and after surgery were recorded, while all the
participants underwent ambulatory SBP measurement ranging from at least
four hourspreoperatively, intraoperatively, to 4 hours postoperatively. A
paired samples t-statistic was used for all comparisons after having
checked for linearity and outliers. Results: Pre-operative on-treatment
office SBP(142.2 +/- 18mmHg) was signifi-cantly higher compared to
inpatient SBP just before surgery (132.9 +/- 19mmHg, P = 0.037);
ambulatory SBP 4h-before surgery (130 +/- 17mmHg, P = 0.004); ambulatory
SBP during surgery (125.6 +/- 17mmHg, P < 0.001); ambulatory SBP 4h-after
surgery (126.6 +/- 25mmHg, P = 0.022), and mean ambulatory SBP (129.9 +/-
17mmHg, P = 0.004. In 17 patients (77.2%) pre-operative SBP was higher
than 140/90mmHg (158.3 +/- 16mmHg) despite ongoing treatment, and the
difference with SBP before operation was also significant (142.3+17mmHg, P
= 0.005). Conclusions: Office SBP during the usual pre-operative
evaluation was signifi-cantly higher compared to SBP before, during and
after surgery. A 24-hour withdrawal of any combined treatment was safe and
was accompanied by significant SBP decrease, and this finding may
stimulate randomized research in the field.

<37>
Accession Number
2000968229
Author
Zhou P.; Zhu P.; Xiao Z.; Lin X.; Xu R.; Zheng S.
Institution
(Zhou, Zhu, Xiao, Lin, Xu, Zheng) Department of Cardiovascular Surgery,
Nanfang Hospital, Southern Medical University, Guangzhou, China
Title
Meta-Analysis of Repeat Revascularization of Off-Pump and On-Pump Coronary
Artery Bypass Surgery.
Source
Annals of Thoracic Surgery. 106 (2) (pp 526-531), 2018. Date of
Publication: August 2018.
Publisher
Elsevier USA
Abstract
Background: There is an ongoing debate focusing on clinical outcomes after
off-pump coronary artery bypass graft surgery (OPCABG) and on-pump
coronary artery bypass graft surgery (ONCABG). The objective of the
present meta-analysis is to update and compare repeat revascularization
rates between OPCABG and ONCABG procedures. Methods: Data sources
including PubMed, EMBASE, Cochrane Library, and ISI Web of Knowledge were
searched between 1966 and October 2017. Studies considered for inclusion
should conform to the following criteria: prospective randomized clinical
trials comparing OPCABG and ONCABG. Outcome should include repeat
revascularization rate at the time of 1-month, 1-year, or 5-year
follow-up. Results: A literature search yielded 11 randomized controlled
trials, and a total of 11,246 patients were randomly allocated to OPCABG
or ONCABG procedures. Pooled analysis demonstrated a statistically
significant 53% increase in repeat revascularization rate at 1-year
follow-up with OPCABG relative to ONCABG in the fixed effects model (odds
ratio 1.53, 95% confidence interval: 1.17 to 2.00, p = 0.002), whereas
there was no significant difference in repeat revascularization rate at
5-year follow-up between OPCABG and ONCABG in the fixed effects model (OR
1.16, 95% confidence interval: 0.95 to 1.41, p = 0.14). In general,
exclusion of any single trial did not affect repeat revascularization rate
at 1-year and 5-year follow-up. There was no evidence of significant
publication bias. Conclusions: The result of our meta-analysis suggests
that compared with ONCABG, OPCABG increases repeat revascularization rate
at 1-year follow-up, but does not affect that of 5-year
follow-up.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<38>
Accession Number
623134952
Author
Ramesh C.; Nayak B.S.; Pai V.B.; Patil N.T.; George A.; George L.S.; Devi
E.S.
Title
Effect of Preoperative Education on Postoperative Outcomes Among Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 32 (6) (pp 518-529), 2017. Date of
Publication: 01 Dec 2017.
Abstract
FINDINGS: Meta-analysis showed that preoperative education reduced anxiety
scores (standardized mean difference = -0.96, 95% confidence interval:
-1.37, -0.54; P < .0001). However, there was no significant effect of
preoperative education on pain, depression, and length of hospital stay.
There is low-quality evidence, and reasons for downgrading are due to
study design limitations, inconsistency, and imprecision of effect
estimates.
CONCLUSIONS: The results show that preoperative education can effectively
decrease anxiety in patients undergoing cardiac surgery.
PURPOSE: The objective of this review was to assess the effect of
preoperative education on postoperative outcomes among patients undergoing
cardiac surgery.
DESIGN: Systematic review and meta-analysis.
METHODS: A comprehensive literature search was made on PubMed, CINAHL,
Ovid, ProQuest, ScienceDirect, Scopus, Web of Science, and the Cochrane
database between 1995 and 2015. Fourteen randomized controlled trials were
included. Data analysis was performed with RevMan software and created the
Supplementary Appendix using the GRADE approach.<br/>Copyright &#xa9; 2016
American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All
rights reserved.

<39>
Accession Number
623059082
Author
Lewis S.R.; Pritchard M.W.; Schofield-Robinson O.J.; Alderson P.; Smith
A.F.
Institution
(Lewis, Pritchard, Schofield-Robinson) Royal Lancaster Infirmary,
Lancaster Patient Safety Research Unit, Pointer Court 1, Ashton Road,
Lancaster LA1 4RP, United Kingdom
(Alderson) National Institute for Health and Care Excellence, Level 1A,
City Tower, Piccadilly Plaza, Manchester M1 4BD, United Kingdom
(Smith) Royal Lancaster Infirmary, Department of Anaesthesia, Ashton Road,
Lancaster, Lancashire LA1 4RP, United Kingdom
Title
Continuation versus discontinuation of antiplatelet therapy for bleeding
and ischaemic events in adults undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2018 (7) (no pagination), 2018.
Article Number: CD012584. Date of Publication: 18 Jul 2018.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Antiplatelet agents are recommended for people with myocardial
infarction and acute coronary syndromes, transient ischaemic attack or
stroke, and for those in whom coronary stents have been inserted. People
who take antiplatelet agents are at increased risk of adverse events when
undergoing non-cardiac surgery because of these indications. However,
taking antiplatelet therapy also introduces risk to the person undergoing
surgery because the likelihood of bleeding is increased. Discontinuing
antiplatelet therapy before surgery might reduce this risk but
subsequently it might make thrombotic problems, such as myocardial
infarction, more likely. Objectives: To compare the effects of
continuation versus discontinuation for at least five days of antiplatelet
therapy on the occurrence of bleeding and ischaemic events in adults
undergoing non-cardiac surgery under general, spinal or regional
anaesthesia. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL; 2018, Issue 1), MEDLINE (1946 to January
2018), and Embase (1974 to January 2018). We searched clinical trials
registers for ongoing studies, and conducted backward and forward citation
searching of relevant articles. Selection criteria: We included randomized
controlled trials of adults who were taking single or dual antiplatelet
therapy, for at least two weeks, and were scheduled for elective
non-cardiac surgery. Included participants had at least one cardiac risk
factor. We planned to include quasi-randomized studies. We excluded people
scheduled for minor surgeries under local anaesthetic or sedation in which
bleeding that required transfusion or additional surgery was unlikely. We
included studies which compared perioperative continuation of antiplatelet
therapy versus discontinuation of antiplatelet therapy or versus
substitution of antiplatelet therapy with a placebo for at least five days
before surgery. Data collection and analysis: Two review authors
independently assessed studies for inclusion, extracted data, assessed
risk of bias and synthesized findings. Our primary outcomes were:
all-cause mortality at longest follow-up (up to six months); all-cause
mortality (up to 30 days). Secondary outcomes included: blood loss
requiring transfusion of blood products; blood loss requiring further
surgical intervention; risk of ischaemic events. We used GRADE to assess
the quality of evidence for each outcome Main results: We included five
RCTs with 666 randomized adults. We identified three ongoing studies. All
study participants were scheduled for elective general surgery (including
abdominal, urological, orthopaedic and gynaecological surgery) under
general, spinal or regional anaesthesia. Studies compared continuation of
single or dual antiplatelet therapy (aspirin or clopidogrel) with
discontinuation of therapy for at least five days before surgery. Three
studies reported adequate methods of randomization, and two reported
methods to conceal allocation. Three studies were placebo-controlled
trials and were at low risk of performance bias, and three studies
reported adequate methods to blind outcome assessors to group allocation.
Attrition was limited in four studies and two studies had reported
prospective registration with clinical trial registers and were at low
risk of selective outcome reporting bias. We reported mortality at two
time points: the longest follow-up reported by study authors up to six
months, and time point reported by study authors up to 30 days. Five
studies reported mortality up to six months (of which four studies had a
longest follow-up at 30 days, and one study at 90 days) and we found that
either continuation or discontinuation of antiplatelet therapy may make
little or no difference to mortality up to six months (risk ratio (RR)
1.21, 95% confidence interval (CI) 0.34 to 4.27; 659 participants;
low-certainty evidence); the absolute effect is three more deaths per 1000
with continuation of antiplatelets (ranging from eight fewer to 40 more).
Combining the four studies with a longest follow-up at 30 days alone
showed the same effect estimate, and we found that either continuation or
discontinuation of antiplatelet therapy may make little or no difference
to mortality at 30 days after surgery (RR 1.21, 95% CI 0.34 to 4.27; 616
participants; low-certainty evidence); the absolute effect is three more
deaths per 1000 with continuation of antiplatelets (ranging from nine
fewer to 42 more). We found that either continuation or discontinuation of
antiplatelet therapy probably makes little or no difference in incidences
of blood loss requiring transfusion (RR 1.37, 95% CI 0.83 to 2.26; 368
participants; absolute effect of 42 more participants per 1000 requiring
transfusion in the continuation group, ranging from 19 fewer to 119 more;
four studies; moderate-certainty evidence); and may make little or no
difference in incidences of blood loss requiring additional surgery (RR
1.54, 95% CI 0.31 to 7.58; 368 participants; absolute effect of six more
participants per 1000 requiring additional surgery in the continuation
group, ranging from seven fewer to 71 more; four studies; low-certainty
evidence). We found that either continuation or discontinuation of
antiplatelet therapy may make little or no difference to incidences of
ischaemic events (to include peripheral ischaemia, cerebral infarction,
and myocardial infarction) within 30 days of surgery (RR 0.67, 95% CI 0.25
to 1.77; 616 participants; absolute effect of 17 fewer participants per
1000 with an ischaemic event in the continuation group, ranging from 39
fewer to 40 more; four studies; low-certainty evidence). We used the GRADE
approach to downgrade evidence for all outcomes owing to limited evidence
from few studies. We noted a wide confidence in effect estimates for
mortality at the end of follow-up and at 30 days, and for blood loss
requiring transfusion which suggested imprecision. We noted visual
differences in study results for ischaemic events which suggested
inconsistency. Authors' conclusions: We found low-certainty evidence that
either continuation or discontinuation of antiplatelet therapy before
non-cardiac surgery may make little or no difference to mortality,
bleeding requiring surgical intervention, or ischaemic events. We found
moderate-certainty evidence that either continuation or discontinuation of
antiplatelet therapy before non-cardiac surgery probably makes little or
no difference to bleeding requiring transfusion. Evidence was limited to
few studies with few participants, and with few events. The three ongoing
studies may alter the conclusions of the review once published and
assessed.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<40>
Accession Number
2000968654
Author
Subahi A.; Yassin A.S.; Adegbala O.; Akintoye E.; Abubakar H.; Elmoghrabi
A.; Ibrahim W.; Ajam M.; Pahuja M.; Weinberger J.J.; Levine D.; Afonso L.
Institution
(Subahi, Yassin, Akintoye, Abubakar, Elmoghrabi, Ibrahim, Ajam,
Weinberger, Levine) Department of Internal Medicine, Wayne State
University/Detroit Medical Center, Detroit, Michigan, United States
(Adegbala) Department of Internal Medicine, Englewood Hospital and Medical
Center, Seton Hall University-Hackensack Meridian School of Medicine,
Englewood, New Jersey, United States
(Pahuja, Afonso) Division of Cardiology, Department of Internal Medicine,
Wayne State University/Detroit Medical Center, Detroit, Michigan, United
States
Title
Comparison of Hospital Outcomes of Transcatheter Aortic Valve Implantation
With Versus Without Hypothyroidism.
Source
American Journal of Cardiology. (no pagination), 2018. Date of
Publication: 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Comparative outcomes of transcatheter aortic valve implantation (TAVI) in
patients with and without hypothyroidism were not previously reported.
This study aimed to appraise the clinical outcomes and impact of
hypothyroidism on patients who underwent TAVI. Patients with
hypothyroidism who underwent TAVI from 2011 to 2014 were identified in the
National Inpatient Sample database using the International Classification
of Diseases, ninth Revision, Clinical Modification. The primary outcome
was the effect of hypothyroidism on inpatient mortality. Secondary
outcomes were the impact of hypothyroidism on post-TAVI complications. We
also evaluated the length of hospital stay and the cost of
hospitalization. Propensity score-matched analysis was performed to
address potential confounding. The hypothyroid patients who underwent TAVI
had no significant increase in the risk of in-hospital mortality (odds
ratio 0.78; 95% confidence interval 0.51 to 1.21, p = 0.282), or most
postprocedural complications. However, hypothyroid patients were more
likely to develop hemorrhage requiring transfusion (odds ratio 1.36, 95%
confidence interval 1.05 to 1.76, p = 0.043). In conclusion, TAVI is a
feasible and relatively safe alternative with reasonable in-hospital
outcomes in patients with hypothyroidism and severe symptomatic aortic
stenosis. However, hypothyroid patients are more likely to require a blood
transfusion after TAVI. Additional randomized trials are needed to
evaluate TAVR outcomes in hypothyroid patients.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<41>
Accession Number
616940430
Author
Hengstenberg C.; Chandrasekhar J.; Sartori S.; Lefevre T.; Mikhail G.;
Meneveau N.; Tron C.; Jeger R.; Kupatt C.; Vogel B.; Farhan S.; Sorrentino
S.; Sharma M.; Snyder C.; Husser O.; Boekstegers P.; Hambrecht R.; Widder
J.; Hildick-Smith D.; De Carlo M.; Wijngaard P.; Deliargyris E.; Bernstein
D.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Hengstenberg) Division of Cardiology, DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Hengstenberg) Division of Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Chandrasekhar, Sartori, Vogel, Farhan, Sorrentino, Sharma, Snyder, Baber,
Mehran, Dangas) Division of Cardiology, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York, United States
(Lefevre) Division of Cardiology, Institut Hospitalier Jacques Cartier,
Ramsay Generale de Sante, Massy, France
(Mikhail) Division of Cardiology, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
(Meneveau) Division of Cardiology, CHU Jean Minjoz, Besancon, France
(Tron) Division of Cardiology, CHU de Rouen, Rouen, France
(Jeger) Department of Cardiology, University Hospital Basel, Switzerland
(Kupatt) Division of Cardiology, LMU Munich, Germany
(Husser) Division of Cardiology, Deutsches Herzzentrum Munchen, Germany
(Boekstegers) Division of Cardiology, Helios Heart Center, Siegburg,
Germany
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links der
Weser, Bremen, Germany
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Hildick-Smith) Division of Cardiology, Sussex Cardiac Centre-Brighton &
Sussex University Hospitals NHS Trust, Brighton, East Sussex, United
Kingdom
(De Carlo) Division of Cardiology, Azienda Ospedaliero-Universitaria
Pisana, Pisa, Italy
(Wijngaard, Anthopoulos) Division of Cardiology, The Medicines Company,
Zurich, Switzerland
(Deliargyris, Bernstein) Division of Cardiology, The Medicines Company,
Parsippany, NJ, United States
Title
Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical
outcomes following transcatheter aortic valve replacement: Results from
the BRAVO 3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 90 (6) (pp 1027-1037),
2017. Date of Publication: 15 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Prior studies have suggested that patients with atrial
fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR)
are at higher risk for adverse cardiovascular events. Whether procedural
bivalirudin compared with unfractionated heparin (UFH) has a beneficial
effect on early outcomes in these patients is unknown. We examined for the
effect of baseline or new-onset AF within 30 days of TAVR and explored for
the effect of bivalirudin versus UFH by AF status, on 30-day outcomes from
the BRAVO 3 trial. Methods: The BRAVO-3 trial multicenter randomized trial
included 802 patients undergoing transfemoral TAVR randomized to
bivalirudin or UFH. We compared AF and no-AF groups and examined for
30-day Bleeding Academic Research Consortium type >=3b bleeding, major
vascular complications and all ischemic endpoints. Adjusted outcomes were
analyzed using logistic regression methods. Results: Of the study
population, 41.4% (n = 332) patients had baseline or new-onset AF within
30 days of TAVR, whereas 58.6% (n = 470) had no AF. Patients with AF had
greater prevalence of renal dysfunction, lower left ventricular ejection
fraction, and higher euroSCORE I compared with their counterparts without
AF. Among AF and no-AF patients, there were no significant baseline
differences between bivalirudin and UFH groups. At 30 days the incidence
of death (6.0 vs. 4.5%, P = 0.324) and stroke (3.9 vs. 2.6%, P = 0.274)
was similar in AF vs. no-AF patients. However, new-onset AF (n = 38) was
associated with significantly greater crude risk of 30-day stroke compared
with no AF (HR 4.49, 95% CI 1.37-14.67). Regardless of AF status, there
were no differences in 30-day death (P-int = 0.652) or stroke (P-int =
0.066) by anticoagulation type. Conclusions: Prior or new-onset AF is
noted in more than one-third of patients undergoing transfemoral TAVR.
Despite greater baseline comorbidities than non-AF patients, AF was not
associated with significantly higher risk of adjusted 30-day outcomes. In
the BRAVO 3 trial, early outcomes were similar regardless of anticoagulant
strategy in each group.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<42>
Accession Number
617455253
Author
Linke A.; Chandrasekhar J.; Sartori S.; Lefevre T.; van Belle E.; Schaefer
U.; Tchetche D.; Sardella G.; Webb J.; Colombo A.; Windecker S.; Vogel B.;
Farhan S.; Sorrentino S.; Sharma M.; Snyder C.; Asgar A.; Dumonteil N.;
Tamburino C.; Hink U.; Violini R.; Stella P.; Bernstein D.; Deliargyris
E.; Hengstenberg C.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Linke) Department of Internal Medicine/Cardiology, University of Leipzig,
Heart Centre, Germany
(Chandrasekhar, Sartori, Vogel, Farhan, Sorrentino, Sharma, Snyder, Baber,
Mehran, Dangas) Division of Cardiology, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY,
United States
(Lefevre) Division of Cardiology, Institut Hospitalier Jacques Cartier,
Ramsay Generale de Sante, Massy, France
(van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital, and CHRU Lille, Lille, France
(Schaefer) Division of Cardiologyy, University Heart Center, Hamburg,
Germany
(Schaefer) Division of Cardiologyy, Asklepios Clinics St. Georg, Hamburg,
Germany
(Tchetche, Dumonteil) Division of Cardiologyy, Clinique Pasteur Toulouse,
France
(Sardella) Division of Cardiologyy, Policlinico Umberto I, Rome, Italy
(Webb) Division of Cardiologyy, St. Paul's Hospital, Vancouver, BC, Canada
(Colombo) Division of Cardiologyy, San Raffaele Hospital, Milan, Italy
(Windecker) Department of Cardiology, Bern University Hospital,
Switzerland
(Asgar) Division of Cardiology, Montreal Heart Institute, Montreal, Canada
(Tamburino) Division of Cardiology, University of Catania, Italy
(Hink) Cardiology Department, Johannes Gutenberg University Hospital,
Mainz, Germany
(Violini) Division of Cardiology, Azienda Ospedaliera San
Camillo-Forlanini di Roma, Italy
(Stella) Division of Cardiology, University Medical Center Utrecht,
Netherlands
(Bernstein, Deliargyris) Division of Cardiology, The Medicines Company,
Parsippany, NJ, United States
(Hengstenberg) Division of Cardiology, DZHK (German Centre for
Cardiovascular Research), partner site Munich Heart Alliance, Munich,
Germany
(Hengstenberg) Division of Cardiologyy, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Anthopoulos) Division of Cardiology, The Medicines Company, Zurich,
Switzerland
Title
Effect of valve design and anticoagulation strategy on 30-day clinical
outcomes in transcatheter aortic valve replacement: Results from the BRAVO
3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 90 (6) (pp 1016-1026),
2017. Date of Publication: 15 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Selection of valve type and procedural anticoagulant may
impact bleeding and vascular complications in transfemoral transcatheter
aortic valve replacement (TAVR). We sought to compare outcomes by valve
[balloon expandable (BE) or non-BE] and anticoagulant [bivalirudin vs.
unfractionated heparin (UFH)] type from the BRAVO-3 trial. Methods:
BRAVO-3 was a randomized multicenter trial including 500 BE-TAVR and 282
non-BE TAVR patients, randomized to bivalirudin versus UFH. Selection of
valve type was at the discretion of the operator but randomization was
stratified according to valve type. Total follow up was to 30 days. We
examined the incidence of Bleeding Academic Research Consortium type >=3b
bleeding, major vascular complications and all ischemic outcomes at
30-days. Outcomes were adjusted using logistic regression analysis.
Results: Of the trial cohort, 63.9% were treated with BE valves (n = 251
bivalirudin vs. n = 249 UFH) and 36.1% with non-BE valves (n = 140
bivalirudin vs. n = 142 UFH). Patients treated with non-BE valves were
older, with higher euroSCORE I. At 30 days, there were nonsignificant
differences between the two valve types for adjusted risk of all-cause
death (HR 2.07, 95% CI 0.91-4.70, P = 0.084) and major vascular
complications (HR 1.78, 95% CI 0.97-3.26, P = 0.062) with non-BE compared
with BE valves, but all other outcomes were similar. A significant
interaction was observed between valve and anticoagulant type, with lower
risk of major vascular complications with bivalirudin compared with UFH in
non-BE TAVR (P-interaction = 0.039). Conclusions: Majority of patients in
the BRAVO 3 trial received BE valves. At 30-days, adjusted risk of
clinical outcomes was similar with non-BE vs. BE valves. A significant
interaction was observed between valve type and procedural anticoagulant
for lower risk of major vascular complications with bivalirudin versus UFH
in non-BE TAVR.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<43>
Accession Number
613879052
Author
Joss J.D.; Hernan J.; Collier R.; Cardenas A.
Institution
(Joss, Collier) Good Samaritan Regional Medical Center, Corvallis, OR,
United States
(Hernan) CarePro Home Infusion and Ambulatory Care, Cedar Rapids, IA,
United States
(Cardenas) Harvard T. H. Chan School of Public Health, Boston, MA, United
States
Title
Perioperative supplementation of polyunsaturated omega-3 fatty acid for
the prevention of atrial fibrillation after cardiothoracic surgery.
Source
American Journal of Health-System Pharmacy. 74 (1) (pp e17-e23), 2017.
Date of Publication: 01 Jan 2017.
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. The effect of perioperative supplementation of polyunsaturated
omega-3 fatty acid (PUFA) on the frequency of atrial fibrillation (AF) in
patients without a history of AF was evaluated. Methods. A total of 561
patients were randomized to receive either 1 g of PUFA or placebo twice
daily. Treatment was started up to five days before surgery or within 24
hours after surgery, depending on when consent was received. Treatment was
continued until the patient's follow-up visit with the cardiologist up to
four weeks after surgery. The primary endpoint of the study was AF before
hospital discharge. Secondary endpoints included AF within one week after
surgery, AF within one month after surgery, length of hospital stay,
postoperative bleeding complications, and readmission within one month
after surgery. Results. No significant reduction in the risk of AF was
observed at hospital discharge (relative risk [RR], 0.98; p = 0.922) or at
three weeks after surgery (RR, 0.98; p = 0.844). After restricting the
analysis to treatmentadherent patients, the association remained
nonsignificant at hospital discharge (RR, 0.90; p = 0.374) and at three
weeks after surgery (RR, 0.90; p = 0.330). No significant differences were
observed between treatments for rates of readmission, death, and bleeding
complications or the length of hospital stay. Conclusion. Perioperative
supplementation with PUFA did not decrease the risk of AF in the immediate
postoperative period. PUFA also had no effect on the length of hospital
stay, postoperative bleeding complications, and readmissions within one
month after surgery.

<44>
Accession Number
622989595
Author
Abdelghani M.; Nassif M.; Blom N.A.; Van Mourik M.S.; Straver B.;
Koolbergen D.R.; Kluin J.; Tijssen J.G.; Mulder B.J.M.; Bouma B.J.; de
Winter R.J.
Institution
(Abdelghani, Nassif, Blom, Van Mourik, Tijssen, Mulder, Bouma, de Winter)
Department of Cardiology, Academic Medical Center, University of
Amsterdam, Netherlands
(Straver) Department of Pediatric Cardiology, Academic Medical Center,
University of Amsterdam, Netherlands
(Blom) Department of Pediatric Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(Koolbergen, Kluin) Department of Cardiothoracic Surgery, Academic Medical
Center, Amsterdam, Netherlands
(Mulder) Interuniversity Cardiology Institute of the Netherlands, Utrecht,
Netherlands
Title
Infective endocarditis after melody valve implantation in the pulmonary
position: A systematic review.
Source
Journal of the American Heart Association. 7 (13) (no pagination), 2018.
Article Number: e008163. Date of Publication: 01 Jul 2018.
Publisher
American Heart Association Inc.
Abstract
Background--Infective endocarditis (IE) after transcatheter pulmonary
valve implantation (TPVI) in dysfunctioning right ventricular outflow
tract conduits has evoked growing concerns. We aimed to investigate the
incidence and the natural history of IE after TPVI with the Melody valve
through a systematic review of published data. Methods and
Results--PubMed, EMBASE, and Web of Science databases were systematically
searched for articles published until March 2017, reporting on IE after
TPVI with the Melody valve. Nine studies (including 851 patients and 2060
patient-years of follow-up) were included in the analysis of the incidence
of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas
the annualized incidence rate ranged from 1.3% to 9.1% per patient-year.
The median (interquartile range) time from TPVI to the onset of IE was
18.0 (9.0-30.4) months (range, 1.0-72.0 months). The most common findings
were positive blood culture (93%), fever (89%), and new, significant,
and/or progressive right ventricular outflow tract obstruction (79%);
vegetations were detectable on echocardiography in only 34% of cases. Of
69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent
surgical and/or transcatheter reintervention. Death or reintervention was
more common in patients with new/ significant right ventricular outflow
tract obstruction (69% versus 33%; P=0.042) and in patients with
non-streptococcal IE (73% versus 30%; P=0.001). Conclusions--The incidence
of IE after implantation of a Melody valve is significant, at least over
the first 3 years after TPVI, and varies considerably between the studies.
Although surgical/percutaneous reintervention is a common consequence,
some patients can be managed medically, especially those with
streptococcal infection and no right ventricular outflow tract
obstruction.<br/>Copyright &#xa9; 2018 The Authors.

<45>
Accession Number
620743815
Author
Wand S.; Adam E.H.; Wetz A.J.; Meybohm P.; Kunze-Szikszay N.; Zacharowski
K.; Popov A.F.; Moritz A.; Moldenhauer L.; Kaiser J.; Bauer M.; Weber C.F.
Institution
(Wand, Wetz, Kunze-Szikszay, Moldenhauer, Bauer, Weber) Department of
Anesthesiology, University Medical Center Gottingen, Gottingen, Germany
(Adam, Meybohm, Zacharowski, Kaiser) Department of Anesthesia, Intensive
Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt
am Main, Germany
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Medical Center Gottingen, Gottingen, Germany
(Popov, Moritz) Department for Cardiothoracic and Vascular Surgery,
University Hospital Frankfurt, Frankfurt am Main, Germany
Title
The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac
Surgery: A Prospective Bicentric Study.
Source
Clinical and Applied Thrombosis/Hemostasis. (no pagination), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We aimed to identify the prevalence of acetylsalicylic acid (ASA)
nonresponse in patients after coronary artery bypass graft (CABG) surgery
and the possible consequences for the rate of major cardiovascular events.
This prospective, observational, bicentric cohort study was conducted in
two German University hospitals. A total of 400 patients (200 in each
study center) undergoing elective CABG surgery were enrolled after written
informed consent. Platelet function was analyzed on day 3 (d3) and day 5
(d5) postoperatively following stimulation with arachidonic acid
(ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest)
using multiple electrode aggregometry (Multiplate). Individuals with an
ASPItest >=40 AU.min were categorized as ASA nonresponders. A 1-year
follow-up recorded the combined end point of cardiovascular events,
hospital admissions, or deaths related to cardiovascular disease. The
prevalence of ASA nonresponse was 51.5% on d3, and it significantly
increased to 71.3% on d5 (P =.0049). The area under the aggregation curve
in the TRAPtest (P <.0001), the platelet count on d5 (P =.009), and the
cardiopulmonary bypass time (P =.01) were identified as independent
predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events
fulfilling criteria for the combined end point with no difference between
ASA responders and nonresponders. This study indicates a high incidence of
perioperative ASA nonresponse in patients following CABG. No effect on the
incidence of cardiovascular events was recorded in the 1-year follow-up.
Therefore, a randomized dosage adjustment trial should elucidate whether a
tailored ASA treatment after CABG surgery represents a useful
concept.<br/>Copyright &#xa9; 2017, The Author(s) 2017.

<46>
Accession Number
623088810
Author
Biancari F.; Anttila V.; Dell'Aquila A.M.; Airaksinen J.K.E.; Brascia D.
Institution
(Biancari, Brascia) Department of Surgery, University of Turku, Turku,
Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Biancari, Anttila, Airaksinen) Heart Center, Turku University Hospital
and University of Turku, Hameentie 11, 20521, Turku, PL 52, Finland
(Dell'Aquila) Department of Cardiac Surgery, University Hospital, Munster,
Germany
Title
Control angiography for perioperative myocardial Ischemia after coronary
surgery: meta-analysis.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 24), 2018. Date of
Publication: 27 Feb 2018.
Abstract
BACKGROUND: Perioperative myocardial ischemia (PMI) in patients undergoing
coronary artery bypass grafting (CABG) is associated with poor outcome.
The aim of this study was to pool the available data on the outcome after
control angiography and repeat revascularization in patients with
perioperative myocardial ischemia (PMI) after coronary artery bypass
grafting (CABG).
METHODS: A literature review was performed through PubMed, Scopus,
ScienceDirect and Google Scholar to identify studies published since 1990
evaluating the outcome of PMI after CABG.
RESULTS: Nine studies included 1104 patients with PMI after CABG and 1056
of them underwent control angiography early after CABG. Pooled early
mortality after reoperation for PMI without control angiography was 43.6%
(95%CI 29.7-57.6%) and 79.8% of them (95%CI 64.4-95.2%) had an acute graft
failure detected at reoperation. Among patients who underwent control
angiography for PMI, 31.7% had a negative finding at angiography (95%CI
25.6-37.8%) and 62.1% had an acute graft failure (95%CI 56.6-67.6%).
Repeat revascularization was performed after early control angiography in
46.3% of patients (95%CI 39.9-52.6%; 54.2% underwent repeat surgical
revascularization; 45.8% underwent percutaneous coronary intervention).
Pooled early mortality after control angiography with or without repeat
revascularization was 8.9% (95%CI 6.7-11.1%). Three studies reported on
early mortality rates which did not differ between repeat surgical
revascularization and PCI (11.7% vs. 9.2%, respectively; risk ratio 1.45,
95%CI 0.67-3.11). In these three series, early mortality after
conservative treatment was 5.9% (95%CI 3.6-8.2%).
CONCLUSIONS: Control angiography seems to be a valid life-saving strategy
to guide repeat revascularization in hemodynamically stable patients
suffering PMI after CABG.

<47>
Accession Number
623007075
Author
Yardley M.; Ueland T.; Aukrust P.; Michelsen A.; Bjorkelund E.; Gullestad
L.; Nytroen K.
Institution
(Yardley, Bjorkelund, Gullestad, Nytroen) Department of Cardiology, Oslo
University Hospital, Oslo, Norway
(Yardley, Ueland, Aukrust, Michelsen, Gullestad, Nytroen) Faculty of
Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
(Yardley) Norwegian Health Association, Oslo, Norway
(Ueland, Aukrust, Michelsen) Research Institute for Internal Medicine,
Oslo University Hospital, Oslo, Norway
(Ueland, Aukrust) K.G. Jebsen Inflammatory Research Center, University of
Oslo, Oslo, Norway
(Ueland, Aukrust) K.G. Jebsen Thrombosis and Expertise Center (TREC),
Arctic University of Norway, Tromso, Norway
(Aukrust) Section of Clinical Immunology and Infectious Disease, Oslo
Universitetssykehus, Oslo, Norway
(Gullestad) Center for Heart Failure Research, University of Oslo, Oslo,
Norway
Title
Immediate response in markers of inflammation and angiogenesis during
exercise: A randomised cross-over study in heart transplant recipients.
Source
Open Heart. 4 (2) (no pagination), 2017. Article Number: e000635. Date of
Publication: 01 Nov 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background The present study explored and compared the immediate responses
in markers of inflammation and angiogenesis in maintenance heart
transplant (HTx) recipients before, during and after sessions of
high-intensity interval training (HIT) versus moderate-intensity
continuous training (MICT). The study aimed to explain some of the trigger
mechanisms behind HIT in HTx recipients. Methods This cross-over study
included 14 HTx patients (mean+/-SD age: 53+/-13 years; time since HTx,
3+/-2 years). All participants underwent baseline blood samples and a
cardiopulmonary exercise test during their first visit. The next two
visits included one HIT session and one MICT session, in randomised order.
Blood samples were taken during and after each exercise session. Myokines
and inflammatory markers related to vascular inflammation, blood-platelet
activation and modulation of angiogenesis were analysed. Results The main
findings in this study were (1) exercise, regardless of intensity, induced
a significant immediate response in several vascular, angiogenetic and in
particular platelet-derived inflammatory mediators in HTx recipients. (2)
HIT showed trends to induce an increased response in von Willebrand
factor, vascular endothelial growth factor-1 and angiopoetin-2, and a
decreased response in growth differentiation factor-15, compared with
MICT. Conclusions This pattern and in particular the trend towards an
increased angiogenetic mediator response could contribute to the
beneficial effects of HIT in HTx recipients.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017.

<48>
Accession Number
615868858
Author
Singh K.; Carson K.; Rashid M.K.; Jayasinghe R.; AlQahtani A.; Dick A.;
Glover C.; Labinaz M.
Institution
(Singh, Carson, Jayasinghe) Griffith University, Brisbane, Qld, Australia
(Singh) Gold Coast University Hospital, Brisbane, Qld, Australia
(Rashid, AlQahtani, Dick, Glover, Labinaz) University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
Title
Transcatheter Aortic Valve Implantation in Intermediate Surgical Risk
Patients With Severe Aortic Stenosis: A Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. 27 (2) (pp 227-234), 2018. Date of
Publication: February 2018.
Publisher
Elsevier Ltd
Abstract
Background Recent data from randomised and observational studies have
reported non-inferior outcomes for transcatheter aortic valve implantation
(TAVI) compared to surgical aortic valve replacement (SAVR) in
intermediate-risk patients. We performed a systematic review to evaluate
the mortality of TAVI compared to SAVR in intermediate-risk patients.
Methods A comprehensive search of four major databases (Embase, Ovid
MEDLINE, PubMed, and Google Scholar) was performed from their inception to
29 April 2016. We included original research studies reporting data on
TAVI and SAVR in intermediate-risk patients. We compared the outcomes of
TAVI to SAVR. Results A total of 2,375 and 2,377 intermediate-risk
patients underwent TAVI and SAVR respectively. The 30-day all-cause (p =
0.07), 30-day cardiac (p = 0.53), and 12-month all-cause mortality (p =
0.34) was similar between the two groups. However, TAVI through
transfemoral access had a significantly lower mortality than SAVR (OR
0.58, p = 0.006). The incidence of >=moderate aortic incompetence (p <
0.00001) and pacemaker implantation (p < 0.0001) was higher in the TAVI
group. Conclusions In the intermediate-risk patients, the 30-day and
12-month mortality are similar between TAVI and SAVR. Increased operator
experience and improved device technology have led to a significant
reduction in mortality in intermediate-risk patients undergoing
TAVI.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<49>
Accession Number
618198288
Author
Khan S.U.; Rahman H.; Arshad A.; Khan M.U.; Lekkala M.; Yang T.; Mishra
A.; Kaluski E.
Institution
(Khan, Rahman, Lekkala, Yang, Mishra, Kaluski) Guthrie Health
System/Robert Packer Hospital, Sayre, PA, United States
(Arshad) Unity Hospital/Rochester Regional Health System, Rochester, NY,
United States
(Khan) West Virginia University School of Medicine, Morgantown, WV, United
States
(Kaluski) Rutgers Medical School, Newark, NY, United States
(Kaluski) Geisinger Commonwealth School of Medicine, Scranton, PA, United
States
Title
Percutaneous Coronary Intervention Versus Surgery in Left Main Stenosis-A
Meta-Analysis and Systematic Review of Randomised Controlled Trials.
Source
Heart Lung and Circulation. 27 (2) (pp 138-146), 2018. Date of
Publication: February 2018.
Publisher
Elsevier Ltd
Abstract
Objective To investigate the safety and efficacy of percutaneous coronary
interventions (PCI) versus coronary artery bypass graft (CABG) surgery for
left main coronary artery (LMCA) disease. Methods Six randomised
controlled trials (RCTs) were reviewed by searching PubMed/Medline, Embase
and the Cochrane Library. Estimates were pooled according to random
effects model. Binary outcomes were reported as risk ratio (RR) and
continuous outcomes were reported as mean difference (MD) with 95%
confidence interval (CI). Results 3794 patients were randomised into PCI
and CABG arms. Mean age of the total population was 64.7 years, 74.4% were
male and mean Logistic EURO score (LES) was 2.9. When compared with CABG,
patients treated with PCI had reduced risk of major adverse cardiovascular
events (MACE) at 30 days: (RR: 0.55; 95% CI, 0.41-0.75; p < 0.001;
I² = 0) but similar risk at 1 year (RR: 1.15; 95% CI,
0.92-1.45; p = 0.22; I² = 0). Five years MACE rates favoured
CABG (RR: 1.32; 95% CI, 1.13-1.53; p < 0.001; I² = 0) driven by
a higher rate of target vessel revascularisation (TVR) (RR: 1.71; 95%CI,
1.38-2.12; p < 0.001; I² = 0) and myocardial infarction (MI)
(RR: 1.97; 95%CI, 1.28-3.04; p < 0.001; I² = 22). Percutaneous
coronary intervention was comparatively a safer procedure with lower rates
of periprocedural adverse events including MI, stroke, bleeding events and
need for blood transfusions. Conclusion Percutaneous coronary intervention
reduced MACE at 30 days with comparable MACE at 1 year. However, CABG was
a more effective modality when considering mid- to long-term outcomes. PCI
is a safer procedure with regards to periprocedural adverse
events.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<50>
[Use Link to view the full text]
Accession Number
622577976
Author
Sessler D.I.; Meyhoff C.S.; Zimmerman N.M.; Mao G.; Leslie K.; Vasquez
S.M.; Balaji P.; Alvarez-Garcia J.; Cavalcanti A.B.; Parlow J.L.; Rahate
P.V.; Seeberger M.D.; Gossetti B.; Walker S.A.; Premchand R.K.; Dahl R.M.;
Duceppe E.; Rodseth R.; Botto F.; Devereaux P.J.
Institution
(Sessler, Zimmerman, Mao) Departments of Outcomes Research, Anesthesiology
Institute, Cleveland Clinic, 9500 Euclid Ave-P77, Cleveland, OH 44195,
United States
(Zimmerman, Mao) Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg
Hospital, United States
(Meyhoff, Dahl) Department of Anaesthesiology, Herlev Hospital, University
of Copenhagen, Copenhagen, Denmark
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Australia
(Vasquez) Department of Research, Grupo de Cardiologia Preventiva
Universidad Autonoma de Bucaramanga, Fundacion CardioInfantil Instituto de
Cardiologia, Bucaramanga, Colombia, Colombia
(Balaji) Anaesthetic Department, Hull and East Yorkshire Hospitals,
National Health Service Trust, Hull, East Yorkshire, United Kingdom
(Alvarez-Garcia) Department of Cardiology, Hospital de la Santa Creu i
Sant Pau, Universidad Autonoma de Barcelona, Barcelona, Spain
(Cavalcanti) Research Institute, Hospital Do Coracao, Sao Paulo, Brazil
(Parlow) Department of Anesthesia, Queen's University and Kingston General
Hospital, Kingston, Canada
(Rahate) Rahate Surgical Hospital, Nagpur, Maharashtra, India
(Seeberger) Department of Anesthesia and Intensive Care Medicine,
University Hospital Basel, University of Basel, Basel, Switzerland
(Gossetti) Department of Vascular Surgery, Sapienza University of Rome,
Rome, Italy
(Walker) Counties Manukau District Health, Aukland, New Zealand
(Premchand) Krishna Institute of Medical Sciences, Hyderbad, India
(Dahl) Department of Pediatrics, Hvidovre Hospital, Copenhagen, Denmark
(Rodseth) Department of Anaesthetics, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Botto) Hypertension and Vascular Aging Center, Hospital Universitario
Austral, Pilar, Argentina
(Devereaux) Departments of Health Research Methods, Evidence, and Impact
and Medicine, McMaster University, Hamilton, Canada
(Sessler, Duceppe, Devereaux) Population Health Research Institute,
Hamilton, Canada
Title
Period-dependent Associations between Hypotension during and for Four Days
after Noncardiac Surgery and a Composite of Myocardial Infarction and
Death: A Substudy of the POISE-2 Trial.
Source
Anesthesiology. 128 (2) (pp 317-327), 2018. Date of Publication: 01 Feb
2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The relative contributions of intraoperative and postoperative
hypotension to perioperative morbidity remain unclear. We determined the
association between hypotension and a composite of 30-day myocardial
infarction and death over three periods: (1) intraoperative, (2) remaining
day of surgery, and (3) during the initial four postoperative days.
Methods: This was a substudy of POISE-2, a 10,010-patient
factorial-randomized trial of aspirin and clonidine for prevention of
myocardial infarction. Clinically important hypotension was defined as
systolic blood pressure less than 90 mmHg requiring treatment. Minutes of
hypotension was the exposure variable intraoperatively and for the
remaining day of surgery, whereas hypotension status was treated as binary
variable for postoperative days 1 to 4. We estimated the average relative
effect of hypotension across components of the composite using a distinct
effect generalized estimating model, adjusting for hypotension during
earlier periods. Results: Among 9,765 patients, 42% experienced
hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30
days of surgery. Intraoperatively, the estimated average relative effect
across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12;
P < 0.001) per 10-min increase in hypotension duration. For the remaining
day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001)
per 10-min increase in hypotension duration. The average relative effect
odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with
hypotension during the subsequent four days of hospitalization.
Conclusions: Clinically important hypotension-A potentially modifiable
exposure-was significantly associated with a composite of myocardial
infarction and death during each of three perioperative periods, even
after adjustment for previous hypotension.<br/>Copyright &#xa9; 2018
Lippincott Williams and Wilkins. All rights reserved.

<51>
Accession Number
619329442
Author
Hu A.; Qiu Y.; Zhang P.; Hu B.; Yang Y.; Li S.; Zhao R.; Zhang Z.; Zhang
Y.; Zheng Z.; Qiu C.; Li F.; Gong X.
Institution
(Hu, Zhang, Zhang, Zheng) Shenzhen People's Hospital, Department of
Anesthesiology, Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Shenzhen Anesthesiology Engineering Center,
Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Jinan University, The Second Clinical Medical
College, Shenzhen 518001, China
(Qiu) West China Hospital, Sichuan University, Department of
Anesthesiology and Translational Neuroscience Center, Chengdu 610000,
China
(Zhang) Sichuan Academy of Medical Sciences and Sichuan Provincial
People's Hospital, Department of Anesthesiology, Chengdu 610072, China
(Hu) Affiliated Hospital of Guizhou Medical University, Department of
Anesthesiology, Guiyang 550004, China
(Yang) Henan Provincial People's Hospital of Zhengzhou University,
Department of Anesthesiology, Zhengzhou 450000, China
(Li) Taihe Hospital of Hubei University of Medicine, Department of
Anesthesiology, Shiyan, Hubei 442000, China
(Zhao) The Third Affiliated Hospital of Kunming Medical University,
Department of Anesthesiology, Kunming 650106, China
(Qiu, Li, Gong) The Second Clinical Medicine College, Jinan University,
Clinical Medical Research Center, Shenzhen 518001, China
Title
Comparison of the effect of high versus low mean arterial pressure levels
on clinical outcomes and complications in elderly patients during
non-cardiothoracic surgery under general anesthesia: Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 554. Date of
Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intraoperative blood pressure (BP) is a concern in daily
clinic anesthesia and contributes to the differences in clinical outcome.
We conducted a randomized controlled trial (RCT) to compare the effect of
high vs. low mean arterial pressure (MAP) levels on clinical outcomes and
complications in elderly patients under general anesthesia (GA). Methods:
In this multicenter, randomized, parallel-controlled, open-label,
assessor-blinded clinical trial, 322 patients aged more than 65years will
be randomized for a low-level MAP (60-70mmHg) or high-level MAP
(90-100mmHg) during non-cardiothoracic surgery under GA. The primary
outcome will be the incidence of postoperative delirium. The secondary
outcomes will include the delirium duration days, intraoperative urine
volume, intraoperative blood loss, specific postoperative complications,
and all-cause 28-day mortality. Discussion: Results of this trial will
help clarify whether BP management is beneficial for elderly patients
under GA and will make clear whether the effect of high-level MAP can
reduce the postoperative complication compared to low-level MAP. Trial
registration: ClinicalTrials.gov, NCT02857153. Registered on 15 July
2016.<br/>Copyright &#xa9; 2017 The Author(s).

<52>
Accession Number
615407118
Author
Ray Mohapatra C.K.; Mishra P.; Saxena P.; Raut C.; Khandekar J.; Ammannaya
G.K.; Seth H.S.; Shah V.; Singh J.
Institution
(Ray Mohapatra, Mishra, Raut, Khandekar, Ammannaya, Seth, Shah, Singh)
Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal
Medical College & Sion Hospital, Mumbai, India
(Saxena) Department of Cardiothoracic Surgery, The Townsville Hospital,
James Cook University, Australia
Title
Use of nitroglycerin and verapamil solution by organ bath technique in
preparation of left internal thoracic artery for coronary artery bypass
surgery.
Source
Indian Heart Journal. 69 (6) (pp 772-776), 2017. Date of Publication:
November 2017.
Publisher
Elsevier B.V.
Abstract
Background The aim of this prospective study was to compare the effect of
application of nitroglycerin and verapamil solution (GV) by organ bath
technique with other methods of applications and solutions on the free
blood flow of LITA. The technique was not described for in situ graft
before. Method The patients were randomly assigned to four groups: group I
(n_32, GV solution by organ bath technique), group II (n_30, papaverine
solution by organ bath technique), group III (n_29, topical GV solution)
or group IV (n_29, topical papaverine solution). In each patient, pedicled
LITA was harvested; thereafter applied with the randomized different
methods and solutions. The free flow from the distal end of the divided
LITA was measured for 15 s under controlled hemodynamic conditions after
harvesting (Flow 1). The flow of LITA was measured again just prior to
anastomosing the conduit (Flow 2). Result The mean blood flow in LITA was
56.2 +/- 5.0 ml/min before application of solutions. After application,
the mean blood flow in group I:102.3 +/- 7.0 ml/min, in group II: 92.7 +/-
3.4 ml/min, and in group III: 88.6 +/- 2.2 ml/min and in group IV: 81.4
+/- 2.1. Proportional increases in blood flow observed in group I (82.6%)
> group II (65.1%)?> group III (57.6) > group IV (44.8%) (p < 0.05).
Conclusions GV solution by organ bath technique is effective and superior
in comparison to use of papaverine using organ bath technique or topical
spray of GV or papaverine solution.<br/>Copyright &#xa9; 2017
Cardiological Society of India

<53>
Accession Number
621517543
Author
Gaudino M.; Alexander J.H.; Bakaeen F.G.; Ballman K.; Barili F.; Calafiore
A.M.; Davierwala P.; Goldman S.; Kappetein P.; Lorusso R.; Mylotte D.;
Pagano D.; Ruel M.; Schwann T.; Suma H.; Taggart D.P.; Tranbaugh R.F.;
Fremes S.
Institution
(Gaudino, Tranbaugh) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Alexander) Duke Clinical Research Institute, Duke Health, Durham, NC,
United States
(Bakaeen) Cleveland Clinic Foundation, Cleveland, OH, United States
(Ballman) Department of Biostatistics and Epidemiology, Weill Cornell
Medicine, New York, NY, United States
(Barili) Department of Cardiovascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
(Calafiore) Fondazione Giovanni Paolo II, Campobasso, Italy
(Davierwala) Herzzentrum Leipzig, Leipzig, Germany
(Goldman) Department of Medicine, University of Arizona, Tucson, AZ,
United States
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Lorusso) Maastricht University Medical Centre, Maastricht, Netherlands
(Mylotte) Galway University Hospitals, Galway, Ireland
(Pagano) University Hospital Birmingham, Birmingham, United Kingdom
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Schwann) The University of Toledo, Toledo, OH, United States
(Suma) Suma Heart Clinic, Tokyo, Japan
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Sunnybrook Health Science, University of Toronto, Toronto, ON,
Canada
Title
Randomized comparison of the clinical outcome of single versus multiple
arterial grafts: The ROMA trial-rationale and study protocol.
Source
European Journal of Cardio-thoracic Surgery. 52 (6) (pp 1031-1040), 2017.
Date of Publication: December 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The primary hypothesis of the ROMA trial is that in patients undergoing
primary isolated non-emergent coronary artery bypass grafting, the use of
2 or more arterial grafts compared with a single arterial graft (SAG) is
associated with a reduction in the composite outcome of death from any
cause, any stroke, post-discharge myocardial infarction and/or repeat
revascularization. The secondary hypothesis is that in these patients, the
use of 2 or more arterial grafts compared with a SAG is associated with
improved survival. The ROMA trial is a prospective, unblinded, randomized
event-driven multicentre trial comprising at least 4300 subjects. Patients
younger than 70 years with left main and/or multivessel disease will be
randomized to a SAG or multiple arterial grafts to the left coronary
system in a 1:1 fashion. Permuted block randomization stratified by the
centre and the type of second arterial graft will be used. The primary
outcome will be a composite of death from any cause, any stroke,
post-discharge myocardial infarction and/or repeat revascularization. The
secondary outcome will be all-cause mortality. The primary safety outcome
will be a composite of death from any cause, any stroke and any myocardial
infarction. In all patients, 1 internal thoracic artery will be
anastomosed to the left anterior descending coronary artery. For patients
randomized to the SAG group, saphenous vein grafts will be used for all
non-left anterior descending target vessels. For patients randomized to
the multiple arterial graft group, the main target vessel of the lateral
wall will be grafted with either a radial artery or a second internal
thoracic artery. Additional grafts for the multiple arterial graft group
can be saphenous veins or supplemental arterial conduits. To detect a 20%
relative reduction in the primary outcome, with 90% power at 5% alpha and
assuming a time-to-event analysis, the sample size must include 845 events
(and 3650 patients). To detect a 20% relative reduction in the secondary
outcome, with 80% power at 5% alpha, the sample size must include 631
events (and 3650 patients). To be conservative, the sample size will be
set at 4300 patients. The primary outcome will be tested according to the
intention-to-treat principle. The primary analysis will be a Cox
proportional hazards regression model, with the treatment arm included as
a covariate. If non-proportional hazards are observed, alternatives to Cox
proportional hazards regression will be explored.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<54>
Accession Number
620134765
Author
Xu Y.; Chen N.; Ma A.; Wang Z.; Zhang Y.; Liu C.; Liu L.
Institution
(Xu, Chen, Liu, Liu) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Xu, Chen, Liu, Liu) W. China Collab. Innovation Center for Early
Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan
University, Chengdu, Sichuan, China
(Ma, Wang, Zhang) West China School of Medicine, Sichuan University,
Chengdu, Sichuan, China
Title
Three-dimensional versus two-dimensional video-assisted thoracic surgery
for thoracic disease: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (6) (pp 862-871),
2017. Date of Publication: 01 Dec 2017.
Publisher
Oxford University Press
Abstract
OBJECTIVES It remains unclear whether 3D systems are manoeuvrable in
video-assisted thoracic surgery (VATS) for patients with thoracic
diseases. The objective of this systematic review and meta-analysis was to
evaluate the efficacy and safety of 3D VATS compared with 2D VATS. METHODS
A systemic research of the literature was performed using the PubMed,
Embase, the Cochrane library, China National Knowledge Infrastructure,
Wanfang and CQVIP databases through December 2016. Studies investigating
the efficacy and safety of 3D VATS compared with 2D VATS were eligible for
our meta-analysis. Odds ratios and mean differences or standard mean
differences with 95% confidence intervals (95% CI) as well as a P-value
were applied to compare continuous and dichotomous variables,
respectively. RESULTS Seven studies with 1080 patients (525 patients for
3D VATS and 555 patients for 2D VATS) were included. There were
significant differences in the 3D group with regard to shorter operation
times (standard mean difference = -0.66, 95% CI: -0.98 to - 0.34; P <
0.001), less blood loss (mean difference = -12.12, 95% CI: -19.07 to -
5.16; P < 0.001) and shorter postoperative drainage times (standard mean
difference = -0.53, 95% CI: -0.92 to - 0.14; P = 0.008) compared with the
2D group. However, no statistical difference was found for postoperative
hospital stay, total postoperative drainage volume, postoperative drainage
volume in 24 h, number of lymph nodes dissected and postoperative
complications. CONCLUSIONS The results of this systematic review and
meta-analysis suggest that 3D VATS might be an acceptable method for
treating thoracic diseases in the future.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<55>
Accession Number
619479166
Author
Nguyen L.S.; Merzoug M.; Estagnasie P.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Merzoug, Estagnasie, Brusset, Squara) CMC Ambroise Pare, Critical
Care Medicine Department, 25-27 Boulevard Victor Hugo, Neuilly-sur-Seine
92200, France
(Aubert, Waldmann, Grinda) CMC Ambroise Pare, Cardiac Surgery Department,
Neuilly-sur-Seine, France
(Law Koune, Gibert) CMC Ambroise Pare, Anesthesiology Department,
Neuilly-sur-Seine, France
Title
Low tidal volume mechanical ventilation against no ventilation during
cardiopulmonary bypass heart surgery (MECANO): Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 582. Date of
Publication: 02 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications are a leading cause of
morbidity and mortality after cardiac surgery. There are no
recommendations on mechanical ventilation associated with cardiopulmonary
bypass (CPB) during surgery and anesthesiologists perform either no
ventilation (noV) at all during CPB or maintain low tidal volume (LTV)
ventilation. Indirect evidence points towards better pulmonary outcomes
when LTV is performed but no large-scale prospective trial has yet been
published in cardiac surgery. Design: The MECANO trial is a single-center,
double-blind, randomized, controlled trial comparing two mechanical
ventilation strategies, noV and LTV, during cardiac surgery with CPB. In
total, 1500 patients are expected to be included, without any
restrictions. They will be randomized between noV and LTV on a 1:1 ratio.
The noV group will receive no ventilation during CPB. The LTV group will
receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive
end-expiratory pressure of 5 cmH2O. The primary endpoint will be a
composite of all-cause mortality, early respiratory failure defined as a
ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg
at 1 hour after arrival in the ICU, heavy oxygenation support (defined as
a patient requiring either non-invasive ventilation, mechanical
ventilation or high-flow oxygen) at 2 days after arrival in the ICU or
ventilator-acquired pneumonia defined by the Center of Disease Control.
Lung recruitment maneuvers will be performed in the noV and LTV groups at
the end of surgery and at arrival in ICU with an insufflation at +30 cmH20
for 5 seconds. Secondary endpoints are those composing the primary
endpoint with the addition of pneumothorax, CPB duration, quantity of
postoperative bleeding, red blood cell transfusions, revision surgery
requirements, length of stay in the ICU and in the hospital and total
hospitalization costs. Patients will be followed until hospital discharge.
Discussion: The MECANO trial is the first of its kind to compare in a
double-blind design, a no-ventilation to a low-tidal volume strategy for
mechanical ventilation during cardiac surgery with CPB, with a primary
composite outcome including death, respiratory failure and postoperative
pneumonia. Trial registration: ClinicalTrials.gov, NCT03098524. Registered
on 27 February 2017.<br/>Copyright &#xa9; 2017 The Author(s).

<56>
Accession Number
618786618
Author
Okuda M.; Go T.; Yokomise H.
Institution
(Okuda) Department of General Thoracic Surgery, Meiwa Hospital, 4-31,
Agenaruo-chou, Nishinomiya city, Hyogo, Japan
(Go, Yokomise) Department of General Thoracic, Breast and Endocrinological
Surgery, Faculty of Medicine, Kagawa University, 1750-1, Miki-cho,
Kita-gun, Kagawa, Japan
Title
Risk factor of bronchopleural fistula after general thoracic surgery:
review article.
Source
General Thoracic and Cardiovascular Surgery. 65 (12) (pp 679-685), 2017.
Date of Publication: 01 Dec 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: The aim of this article was to clarify recent risk factors for
the early bronchopleural fistula after anatomical lung resection. Methods:
Reports on early bronchopleural fistula after anatomical lung resection in
adults, including information on risk factors, published between 2006 and
2016 were reviewed and our institutional data were evaluated. The early
period was defined as within 30 days from surgery or as described early in
the manuscript. Results: A total of seven retrospective observational
articles were selected. Four articles investigated lobectomy and
pneumonectomy, while the other three articles investigated only
pneumonectomy. The surgical procedure, preoperative therapy, complications
after surgery, right side, patient age, past history, and tumor residuals
were mentioned as risk factors of bronchopleural fistula. Our data
concluded that neoadjuvant therapy and a right lower lobe location were
risk factors after a lobectomy, while a right side and complete
pneumonectomy were risk factors after a pneumonectomy. Conclusions:
Although recent studies have reached nearly the same conclusions as older
reports, continuous research of potential risk factor is needed as
therapeutic procedures continue to evolve.<br/>Copyright &#xa9; 2017, The
Japanese Association for Thoracic Surgery.

<57>
Accession Number
617716751
Author
Iliadis C.; Lee S.; Kuhr K.; Metze C.; Matzik A.-S.; Michels G.; Rudolph
V.; Baldus S.; Pfister R.
Institution
(Iliadis, Lee, Metze, Matzik, Michels, Rudolph, Baldus, Pfister)
Department III of Internal Medicine, Heart Center, University of Cologne,
Kerpener Str. 62, Cologne 50937, Germany
(Kuhr) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Title
Functional status and quality of life after transcatheter mitral valve
repair: a prospective cohort study and systematic review.
Source
Clinical Research in Cardiology. 106 (12) (pp 1005-1017), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Estimating the quantitative effect of transcatheter mitral
valve repair on functional parameters and quality of life is important for
individual treatment decision-making. Methods: We combined data from a
prospective monocentric cohort study (N = 215) with data from a systematic
literature review (PubMed search term "mitraclip", till 30.04.2016) on
patients undergoing MitraClip with at least mortality after discharge
reported as an outcome. Effects on functional parameters were reported as
range of mean change. Results: 36 observational studies and 1 randomized
controlled trial were identified. Due to substantial heterogeneity of
effect estimates (I²-heterogeneity >75%) and inadequate quality
of studies with a lack of comparison group in 97.4% and lack of an
independent assessment of outcomes in 86.8%, no pooled estimates were
calculated. All studies reported improvements of mean New York Heart
Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores
(4.4-9.2 for physical component score, 2.6-8.9 for mental component
score), 6-min walk distance [(6MWD) 2-336 m] and Minnesota Living with
Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with
improvements regarded as clinically relevant in 20 of 29 studies for NYHA
class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in
all of 8 studies for MLWHFQ. Conclusion: MitraClip therapy provides
improvements in physical capacity, physical and mental functioning and
disease-specific quality of life in the majority of patients. However,
more comparative and high-quality studies are required for understanding
the heterogeneity of results, which is crucial for optimal patient
selection.<br/>Copyright &#xa9; 2017, Springer-Verlag GmbH Germany.

<58>
Accession Number
617595638
Author
Hartman M.H.T.; Prins J.K.B.; Schurer R.A.J.; Lipsic E.; Lexis C.P.H.; van
der Horst-Schrivers A.N.A.; van Veldhuisen D.J.; van der Horst I.C.C.; van
der Harst P.
Institution
(Hartman, Prins, Schurer, Lipsic, Lexis, van Veldhuisen, van der Harst)
Department of Cardiology, University of Groningen, University Medical
Center Groningen, Hanzeplein 1, Groningen 9700 RB, Netherlands
(van der Horst-Schrivers) Department of Endocrinology and Metabolism,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(van der Horst) Department of Critical Care, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Title
Two-year follow-up of 4 months metformin treatment vs. placebo in
ST-elevation myocardial infarction: data from the GIPS-III RCT.
Source
Clinical Research in Cardiology. 106 (12) (pp 939-946), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objectives: Preclinical and clinical studies suggested cardioprotective
effects of metformin treatment. In the GIPS-III trial, 4 months of
metformin treatment did not improve left ventricular ejection fraction in
patients presenting with ST-elevation myocardial infarction (STEMI). Here,
we report the 2-year follow-up results. Methods: Between January 2011 and
May 2013, 379 STEMI patients without diabetes undergoing primary
percutaneous coronary intervention were randomized to a 4-month treatment
with metformin (500 mg twice daily) (N = 191) or placebo (N = 188) in the
University Medical Center Groningen. Two-year follow-up data was collected
to determine its effect on predefined secondary endpoints: the incidence
of major adverse cardiac events (MACE), its individual components,
all-cause mortality, and new-onset diabetes. Results: For all 379 patients
all-cause mortality data were available. For seven patients (2%) follow-up
data on MACE was limited, ranging from 129 to 577 days. All others
completed the 2-year follow-up visit. Incidence of MACE was 11 (5.8%) in
metformin and 6 (3.2%) in placebo treated patients [hazard ratio (HR)
1.84, confidence interval (CI) 0.68-4.97, P = 0.22]. Three patients died
in the metformin group and one in the placebo treatment group. Individual
components of MACE were also comparable between both groups. New-onset
diabetes mellitus was 34 (17.8%) in metformin and 32 (17.0%) in placebo
treated patients (odds ratio 1.15, CI 0.66-1.98, P = 0.84). After
multivariable adjustment the incidence of MACE was comparable between the
treatment groups (HR 1.02, CI 0.10-10.78, P = 0.99). Conclusions: Four
months metformin treatment initiated at the time of hospitalization in
STEMI patients without diabetes did not exert beneficial long-term
effects. Trial registration: clinicaltrials.gov Identifier:
NCT01217307.<br/>Copyright &#xa9; 2017, The Author(s).

<59>
Accession Number
616778832
Author
Rajesh G.N.; Thottian J.J.; Subramaniam G.; Desabandhu V.; Sajeev C.G.;
Krishnan M.N.
Institution
(Rajesh, Thottian, Desabandhu, Sajeev, Krishnan) Speciality Block,
Department of Cardiology, Government Medical College, Kozhikode, Kerala,
India
(Thottian) Westfort Group of Hospitals, Thrissur, Kerala, India
(Subramaniam) Department of Radiology, Government Medical College,
Kozhikode, Kerala, India
Title
Prevalence and prognostic significance of left ventricular myocardial late
gadolinium enhancement in severe aortic stenosis.
Source
Indian Heart Journal. 69 (6) (pp 742-750), 2017. Date of Publication:
November 2017.
Publisher
Elsevier B.V.
Abstract
Background Myocardial fibrosis occurs in aortic stenosis (AS) as part of
the hypertrophic response. It can be detected by LGE, which is associated
with an adverse prognosis in the form of increased mortality and
morbidity. Objectives To assess the prevalence of LGE patterns using
cardiac magnetic resonance (CMR) in severe AS patients and to study its
prognostic significance. Methods Patients enrolled into the study from
June 2012 to November 2014. All the patients underwent CMR and various
patterns of LGE studied. These patients if symptomatic were advised AVR
and others were managed conservatively. All patients were followed up and
watched for outcomes like mortality, heart failure/hospitalization for
cardiovascular cause, fall in left ventricular ejection fraction (LVEF)
>=20% and arrhythmia. Results A total of 109 patients (mean age-57.7 +/-
12.5yrs) underwent CMR with 63 males. These patients were followed up for
a mean of 13 months. Among 38 patients who underwent AVR, 6 died
(5-cardiovascular cause, 1-non cardiovascular). 71 patients were managed
conservatively out of which 18 died (17-cardiovascular cause, 1-non
cardiovascular cause). LGE patterns were seen in 46 patients (43%); mid
myocardial enhancement was seen in 31.1% of cases (33 patients). No LGE
pattern was seen in 57%(63 patients). Basal and mid regions were maximally
involved with mid myocardial enhancement in 66% & 68.3% respectively. LV
ejection fraction (p = 0.002), peak aortic systolic velocity (p = 0.01)
and peak aortic systolic gradient (p = 0.02) were the main predictors of
LGE. Main predictors of primary outcome were NYHA class [OR-
13.4(2.8-26.1), p <= 0.001], age- 62 +/- 9.6yrs(p = 0.001), EF
simpson-50.9 +/- 13%(p <= 0.001), LGE[OR 2.8 (1.27-6.47),p = 0.01], number
of segments involved [2.37 +/- 2.1,P <= 0.001] & CMR LV mass (151.73 +/-
32 gms, p = 0.007). LGE predicted heart failure/hospitalization for
cardiovascular cause [OR- 3.8(1.2-11.9), p = 0.01] and fall in LVEF [OR-
5.8(1.5-22.5), p = 0.005]. Patients with LGE had 2.87 times risk of
adverse outcomes and patients with more than 3 segment LGE involvement had
again increased chances for adverse outcomes. Conclusions LGE was detected
by CMR in 43% of patients with severe AS. It predicted recurrent heart
failure, hospitalization for cardiovascular cause and fall in LV ejection
fraction. Our study has laid a path to larger prospective studies with
long term follow up to assess the prognostic impact of CMR in patients
with severe AS.<br/>Copyright &#xa9; 2017

<60>
Accession Number
617902108
Author
Hong S.S.; Alison J.A.; Milross M.A.; Robledo K.; Dignan R.
Institution
(Hong) Physiotherapy Department, Liverpool Hospital, Elizabeth Street,
Liverpool, Sydney, NSW 2170, Australia
(Alison, Milross) Discipline of Physiotherapy, University of Sydney,
Sydney, Australia
(Alison) Department of Physiotherapy, Royal Prince Alfred Hospital,
Australia
(Dignan) Department of Cardiothoracic Surgery, Liverpool Hospital and
University of New South Wales, Sydney, Australia
(Robledo) NHMRC Clinical Trials Centre, University of Sydney, Sydney,
Australia
(Alison) Discipline of Physiotherapy, Faculty of Health Sciences, The
University of Sydney, 75 East Street, Lidcombe NSW 2141, Australia
(Dignan) Cardiothoracic Surgery Department, Liverpool Hospital, Elizabeth
Street, Liverpool NSW 2170, Australia
Title
Does continuous infusion of local anaesthesia improve pain control and
walking distance after coronary artery bypass graft surgery? A randomised
controlled trial.
Source
Physiotherapy (United Kingdom). 103 (4) (pp 407-413), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ltd
Abstract
Objectives To evaluate the effects of continuous infusion of ropivacaine
compared to sham infusion or usual care on pain scores before and after
physiotherapy treatment, distance walked and time to discharge from
physiotherapy, after coronary artery bypass graft (CABG) surgery. Design
Prospective, randomised, double blind controlled trial. Setting and
participants Seventy-five participants who underwent CABG surgery with
left internal mammary artery grafts were allocated, to the ropivacaine
group (n = 26), the sham group (n = 25), or usual care group (n = 24).
Participants in the ropivacaine group received 0.5% ropivacaine and
participants in the sham group received normal saline, both as continuous
infusions via two parasternally tunnelled catheters for 96 hours
continuously. The usual care group did not receive a device. All groups
had patient-controlled analgesia and/or oral analgesia. Results
Seventy-two participants completed the study. There was no significant
between-group differences in pain scores, distance walked on any post
operative day (POD) or number of participants discharged from
physiotherapy by POD 4. For the group as a whole there was a significant
linear decrease in pain score from mean (SD) 42 (24) mm on POD1 to 15 (16)
mm on POD4 (p < 0.001), (MD 27 mm, 95% CI 22 to 32) and walking distance
increased from 1 (5) m on POD1 to 183 (239) m on POD4 (p < 0.001) MD 181
m, 95% CI 126 to 236). Conclusion Infusion of ropivacaine post CABG
surgery was unable to reduce pain, increase distance walked or reduce time
to physiotherapy discharge compared to sham or usual care. Trial
registration number ACTRN12612001243808.<br/>Copyright &#xa9; 2017
Chartered Society of Physiotherapy

<61>
[Use Link to view the full text]
Accession Number
614962304
Author
Fernandez R.S.; Lee A.
Institution
(Fernandez) Centre for Evidence Based Initiatives in Health Care, Joanna
Briggs Institute Centre of Excellence, Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Sydney, Australia
(Lee) Wollongong Hospital, Wollongong, Australia
(Lee) School of Medicine, University of Wollongong, Wollongong, Australia
Title
Effects of methods used to achieve hemostasis on radial artery occlusion
following percutaneous coronary procedures: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (3) (pp
738-764), 2017. Date of Publication: 01 Mar 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Transradial access to percutaneous coronary procedures is
becoming the preferred access route, and it is being increasingly used for
emergent and elective procedures. However, radial artery occlusion (RAO)
continues to remain an adverse occurrence following sheath removal or in
the first 24 hours following sheath removal due to the smaller diameter of
the artery. Objectives The overall objective of this study was to
synthesize the best available research evidence related to the effects of
methods used to achieve hemostasis on RAO rates after percutaneous
coronary procedures. Inclusion criteria Types of participants The current
review considered trials that included adult patients (18 years and over)
who have had a coronary angiography or coronary re-vascularization
intervention via the radial artery. Types of intervention(s) The
interventions of interest were the use of various hemostatic methods
compared to traditional interventions to prevent RAO. Types of studies All
randomized and quasi-randomized controlled trials evaluating the effect of
various hemostatic methods on RAO rates after percutaneous coronary
procedures were included in the review. Outcomes The primary outcome of
interest was the incidence of RAO at the time of discharge and persistent
occlusion at the time of follow-up. Search strategy The search aimed to
find published and unpublished trials through electronic databases,
reference lists and key reports. An extensive search was undertaken for
the following databases - CINAHL, Embase, PubMed and the Cochrane Central
Register of Controlled Trials (CENTRAL). Databases were searched up to May
2016. The search for unpublished trials included Dissertation Abstracts
International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and
Theses and MedNar. Methodological quality Methodological quality was
assessed independently by two reviewers using the Joanna Briggs Institute
Meta- Analysis of Statistics Assessment and Review Instrument
(JBI-MAStARI) checklist. Disagreements that arose between the reviewers
were resolved through discussion. Data extraction Quantitative data were
extracted from papers included in the review by one reviewer using the
standardized data extraction tool from JBI-MAStARI. The data extracted
were checked by a second reviewer. Disagreements that arose between the
reviewerswere resolved through discussion. All resultswere subject to
double data entry in ReviewManager. Data synthesis Statistical pooling of
the data was not possible due to the heterogeneity of the trials;
therefore, the findings are presented in narrative form. However, figures
have been used to illustrate the results. Results A total of seven trials
were included in the review. One trial demonstrated a significant
reduction in RAO rates in patients who had a mean arterial pressure
(MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95%
confidence interval [CI] 0.02, 0.37). A statistically significant
reduction in the incidence of RAO was observed among patients who received
a biopolymer dressing (Chitosen) compared to those who received the TR
band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference
in the incidence of RAO was reported between those who received the TR
band and those who received either the elastic bandage (P1/40.08) or T
band (P1/40.76). Similarly, no statistically significant difference in
rates of RAO among patients was reported among those who had pro-coagulant
dressings compared to those who had short or long manual compression. One
trial that compared the TR band to a MAP-guided TR band demonstrated no
statistically significant difference in the time taken to obtain
hemostasis between the two groups (P1/40.61). A statistically significant
reduction in the time taken to obtain hemostasis was observed among
patients who received the hemostatic biopolymer dressing compared to the
TR band. No statistically significant difference in the incidence of
hematoma was identified among patients who received pneumatic compression
or traditional compression to achieve hemostasis. Conclusion There is
limited evidence to support the use of any single hemostatic method to
prevent RAO rates after percutaneous coronary procedures. Although used
extensively, there is evidence of no effect of the pneumatic compression
method using the TR band on the incidence of RAO at discharge or
follow-up, the time taken to obtain hemostasis and the incidence of
hematoma. The MAP-guided compression method and the Biopolymer dressing
(Chitosen) were superior to the TR band compression method, and patent
hemostasis was superior to hemoband in the prevention of RAO. However,
these results are based on single trials and should be interpreted with
caution. The evidence obtained from the review does not provide a concrete
base for the development of practice guidelines. Until more robust
evidence is available, practices will continue to be dictated by local
preferences and available resources.<br/>Copyright &#xa9; 2017 The Joanna
Briggs Institute.

<62>
[Use Link to view the full text]
Accession Number
620970795
Author
Pearce A.; Lockwood C.; Van Den Heuvel C.; Pearce J.
Institution
(Pearce, Lockwood, Pearce) Joanna Briggs Institute, Faculty of Health and
Medical Sciences, University of Adelaide, Adelaide, Australia
(Van Den Heuvel) School of Medical Sciences, Faculty of Health and Medical
Sciences, University of Adelaide, Adelaide, Australia
(Pearce) School of Nursing, Midwifery and Paramedicine, Australian
Catholic University, Canberra, Australia
Title
The use of therapeutic magnesium for neuroprotection during global
cerebral ischemia associated with cardiac arrest and cardiac surgery in
adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (1) (pp
86-118), 2017. Date of Publication: 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background: Global cerebral ischemia occurs due to reduced blood supply to
the brain. This is commonly caused by a cessation of myocardial activity
associated with cardiac arrest and cardiac surgery. Survival is not the
only important outcome because neurological dysfunction impacts on quality
of life, reducing independent living. Magnesium has been identified as a
potential neuroprotective agent; however, its role in this context is not
yet clear. Objectives: The objective of this review was to present the
best currently available evidence related to the neuroprotective effects
of magnesium during a period of global cerebral ischemia in adults with
cardiac arrest or cardiac surgery. Inclusion criteria Types of
participants: The current review considered adults aged over 18 years who
were at risk of global cerebral ischemia associated with cardiac arrest or
cardiac surgery. Studies of patients with existing neurological deficits
or under the age of 18 years were excluded from the review. Types of
intervention(s)/phenomena of interest: The intervention of interest was
magnesium administered in doses of at least of 2 g compared to placebo to
adult patients within 24 hours of cardiac arrest or cardiac surgery. Types
of studies: The current review considered experimental designs including
randomized controlled trials, non-randomized controlled trials and
quasi-experimental designs. Outcomes: The outcome of interest were
neurological recovery post-cardiac arrest or cardiac surgery, as measured
by objective scales, such as but not limited to, cerebral performance
category, brain stem reflexes, Glasgow Coma Score and independent living
or dependent living status. To enable assessment of the available data,
neuroprotection was examined by breaking down neurological outcomes into
three domains - functional neurological outcomes, neurophysiological
outcomes and neuropsychological outcomes. Search strategy: The search
strategy aimed to find both published and unpublished studies between
January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI)
three-step search strategy. Databases searched included PubMed, Embase,
CINAHL, Cochrane Central Register of Controlled Trials, Australian
Clinical Trials Register, Australian and New Zealand Clinical Trials
Register, Clinical Trials, European Clinical Trials Register and ISRCTN
Registry.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS INSTITUTE.

<63>
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.

<64>
Accession Number
2000945744
Author
Tuzcu E.M.; Kapadia S.R.; Vemulapalli S.; Carroll J.D.; Holmes D.R.; Mack
M.J.; Thourani V.H.; Grover F.L.; Brennan J.M.; Suri R.M.; Dai D.;
Svensson L.G.
Institution
(Tuzcu, Suri) Cleveland Clinic, Abu Dhabi, United Arab Emirates
(Kapadia, Svensson) Cleveland Clinic, Cleveland, Ohio, United States
(Vemulapalli, Brennan, Dai) Duke University Medical Center, Duke Clinical
Research Institute, Durham, North Carolina, United States
(Carroll) University of Colorado, Anschutz Medical Campus, School of
Medicine, Aurora, Colarado, United States
(Holmes) Mayo Clinic, Rochester, Minnesota, United States
(Mack) Baylor Scott and White Health, Plano, Texas, United States
(Thourani) Medstar Washington Hospital Center, Washington, DC, United
States
(Grover) Department of Surgery, School of Medicine, University of
Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
(Grover) Denver Department of Veterans Affairs Medical Center, Denver,
Colorado, United States
Title
Transcatheter Aortic Valve Replacement of Failed Surgically Implanted
Bioprostheses: The STS/ACC Registry.
Source
Journal of the American College of Cardiology. 72 (4) (pp 370-382), 2018.
Date of Publication: 24 July 2018.
Publisher
Elsevier USA
Abstract
Background: Valve-in-valve (ViV) transcatheter aortic valve replacement
(TAVR) has been shown to be feasible, yet the safety and efficacy in
relation to native valve (NV) TAVR are not known. Objectives: This study
sought to evaluate the safety and effectiveness of ViV TAVR for failed
surgical aortic valve replacement (SAVR) by comparing it with the
benchmark of NV TAVR. Methods: Patients who underwent ViV-TAVR (n = 1,150)
were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain
aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted Risk of
Mortality for reoperation) to patients undergoing NV-TAVR (n = 2,259).
Baseline characteristics, procedural data, and in-hospital outcomes were
obtained from the Transcatheter Valve Therapy Registry. The 30-day and
1-year outcomes were obtained from linked Medicare administrative claims
data. Results: Unadjusted analysis revealed lower 30-day mortality (2.9%
vs. 4.8%; p < 0.001), stroke (1.7% vs. 3.0%; p = 0.003), and heart failure
hospitalizations (2.4% vs. 4.6%; p < 0.001) in the ViV-TAVR compared with
NV-TAVR group. Adjusted analysis revealed lower 30-day mortality (hazard
ratio: 0.503; 95% confidence interval: 0.302 to 0.839; p = 0.008), lower
1-year mortality (hazard ratio: 0.653; 95% confidence interval: 0.505 to
0.844; p = 0.001), and hospitalization for heart failure (hazard ratio:
0.685; 95% confidence interval: 0.500 to 0.939; p = 0.019) in the ViV-TAVR
group. Patients in the ViV-TAVR group had higher post-TAVR mean gradient
(16 vs. 9 mm Hg; p < 0.001), but less moderate or severe aortic
regurgitation (3.5% vs. 6.6%; p < 0.001). Post-TAVR gradients were highest
in small SAVRs and stenotic SAVRs. Conclusions: Comparison with the
benchmark NV-TAVR shows ViV-TAVR to be a safe and effective procedure in
patients with failed SAVR who are at high risk for repeat
surgery.<br/>Copyright &#xa9; 2018 American College of Cardiology
Foundation

<65>
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.

<66>
Accession Number
622926655
Author
Wang M.; Zhang W.-B.; Song J.-L.; Luan Y.; Jin C.-Y.
Institution
(Wang, Zhang, Song, Luan, Jin) Department of Cardiology, Biomedical
Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine,
Zhejiang University, Hangzhou, Zhejiang, China
Title
Effect of breviscapine on recovery of viable myocardium and left
ventricular remodeling in chronic total occlusion patients after
revascularization: Rationale and design for a randomized controlled trial.
Source
Medical Science Monitor. 24 (pp 4602-4609), 2018. Date of Publication: 04
Jul 2018.
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: How to speed the recovery of viable myocardium in chronic
total occlusion (CTO) patients after revascularization is still an
unsolved problem. Breviscapine is widely used in cardiovascular diseases.
However, there has been no study focused on the effect of breviscapine on
viable myocardium recovery and left ventricular remodeling after CTO
revascularization. Material/Methods: We propose to recruit 78 consecutive
coronary artery disease (CAD) patients with CTO during a period of 12
months. They will be randomly assigned to receive either breviscapine (40
mg) or placebo in the following 12 months. Blood tests, electrocardiogram,
and Major Adverse Cardiac Events (MACE) will be collected at baseline and
the follow-up visits at 1, 3, 6, 9, and 12 months. Low-dose dobutamine MRI
will be applied for the assessment of viable myocardium, microcirculation
perfusion, and left ventricular remodeling, and the concentrations of
angiogenic cytokine, vascular endothelial growth factor (VEGF), and basic
fibroblast growth factor (bFGF) will be investigated at baseline and at
1-and 12-month follow-up. The recovery of viable myocardium after
revascularization in CTO patients was the primary endpoint. Improvement of
microcirculation perfusion, left ventricular remodeling, peripheral
concentrations of VEGF and bFGF as well as MACE will be the secondary
endpoints. Results: Breviscapine treatment obviously improve the recovery
of viable myocardium, myocardial microcirculation perfusion, and left
ventricular remodeling after revascularization in CTO patients, and reduce
the occurrence of MACE. We also will determine if breviscapine increases
the peripheral blood angiogenic cytokine concentrations of VEGF and bFGF.
Conclusions: This study will aim to demonstrate the effect of breviscapine
on the recovery of viable myocardium and left ventricular remodeling in
CTO patients after revascularization.<br/>Copyright &#xa9; Med Sci Monit,
2018.

<67>
Accession Number
617221471
Author
Desborough M.J.; Oakland K.; Brierley C.; Bennett S.; Doree C.; Trivella
M.; Hopewell S.; Stanworth S.J.; Estcourt L.J.
Institution
(Desborough, Oakland, Estcourt) NHS Blood and Transplant,
Haematology/Transfusion Medicine, Oxford, United Kingdom
(Brierley) John Radcliffe Hospital, Department of Haematology, Headley
Way, Oxford OX3 9DU, United Kingdom
(Bennett) University of Ottawa, Department of Surgery, 501 Smyth Road,
Ottawa, ON K1M 1R4, Canada
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Hopewell) University of Oxford, Oxford Clinical Trials Research Unit,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Title
Desmopressin use for minimising perioperative blood transfusion.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD001884. Date of Publication: 10 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Blood transfusion is administered during many types of
surgery, but its efficacy and safety are increasingly questioned.
Evaluation of the efficacy of agents, such as desmopressin (DDAVP;
1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood
loss is needed. Objectives: To examine the evidence for the efficacy of
DDAVP in reducing perioperative blood loss and the need for red cell
transfusion in people who do not have inherited bleeding disorders. Search
methods: We searched for randomised controlled trials (RCTs) in the
Cochrane Central Register of Controlled Trials (2017, issue 3) in the
Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the
Transfusion Evidence Library (from 1980), and ongoing trial databases (all
searches to 3 April 2017). Selection criteria: We included randomised
controlled trials comparing DDAVP to placebo or an active comparator (e.g.
tranexamic acid, aprotinin) before, during, or immediately after surgery
or after invasive procedures in adults or children. Data collection and
analysis: We used the standard methodological procedures expected by
Cochrane. Main results: We identified 65 completed trials (3874
participants) and four ongoing trials. Of the 65 completed trials, 39
focused on adult cardiac surgery, three on paediatric cardiac surgery, 12
on orthopaedic surgery, two on plastic surgery, and two on vascular
surgery; seven studies were conducted in surgery for other conditions.
These trials were conducted between 1986 and 2016, and 11 were funded by
pharmaceutical companies or by a party with a commercial interest in the
outcome of the trial. The GRADE quality of evidence was very low to
moderate across all outcomes. No trial reported quality of life. DDAVP
versus placebo or no treatment Trial results showed considerable
heterogeneity between surgical settings for total volume of red cells
transfused (low-quality evidence) and for total blood loss (very
low-quality evidence) due to large differences in baseline blood loss.
Consequently, these outcomes were not pooled and were reported in
subgroups. Compared with placebo, DDAVP may slightly decrease the total
volume of red cells transfused in adult cardiac surgery (mean difference
(MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14
trials, 957 participants), but may lead to little or no difference in
orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303
participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2
trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to
0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or
no difference in the total number of participants transfused with blood
(risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants)
(moderate-quality evidence). Whether DDAVP decreases total blood loss in
adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22
trials, 1358 participants), orthopaedic surgery (MD -285.76 mL, 95% CI
-514.99 mL to -56.53 mL; 5 trials, 241 participants), or vascular surgery
(MD -582.00 mL, 95% CI -1264.07 mL to 100.07 mL; 1 trial, 44 participants)
is uncertain because the quality of evidence is very low. DDAVP probably
leads to little or no difference in all-cause mortality (Peto odds ratio
(pOR) 1.09, 95% CI 0.51 to 2.34; 22 trials, 1631 participants) or in
thrombotic events (pOR 1.36, 95% CI, 0.85 to 2.16; 29 trials, 1984
participants) (both low-quality evidence). DDAVP versus placebo or no
treatment for people with platelet dysfunction Compared with placebo,
DDAVP may lead to a reduction in the total volume of red cells transfused
(MD -0.65 units, 95% CI -1.16 to -0.13 units; 6 trials, 388 participants)
(low-quality evidence) and in total blood loss (MD -253.93 mL, 95% CI
-408.01 mL to -99.85 mL; 7 trials, 422 participants) (low-quality
evidence). DDAVP probably leads to little or no difference in the total
number of participants receiving a red cell transfusion (RR 0.83, 95% CI
0.66 to 1.04; 5 trials, 258 participants) (moderate-quality evidence).
Whether DDAVP leads to a difference in all-cause mortality (pOR 0.72, 95%
CI 0.12 to 4.22; 7 trials; 422 participants) or in thrombotic events (pOR
1.58, 95% CI 0.60 to 4.17; 7 trials, 422 participants) is uncertain
because the quality of evidence is very low. DDAVP versus tranexamic acid
Compared with tranexamic acid, DDAVP may increase the volume of blood
transfused (MD 0.6 units, 95% CI 0.09 to 1.11 units; 1 trial, 40
participants) and total blood loss (MD 142.81 mL, 95% CI 79.78 mL to
205.84 mL; 2 trials, 115 participants) (both low-quality evidence).
Whether DDAVP increases or decreases the total number of participants
transfused with blood is uncertain because the quality of evidence is very
low (RR 2.42, 95% CI 1.04 to 5.64; 3 trials, 135 participants). No trial
reported all-cause mortality. Whether DDAVP leads to a difference in
thrombotic events is uncertain because the quality of evidence is very low
(pOR 2.92, 95% CI 0.32 to 26.83; 2 trials, 115 participants). DDAVP versus
aprotinin Compared with aprotinin, DDAVP probably increases the total
number of participants transfused with blood (RR 2.41, 95% CI 1.45 to
4.02; 1 trial, 99 participants) (moderate-quality evidence). No trials
reported volume of blood transfused or total blood loss and the single
trial that included mortality as an outcome reported no deaths. Whether
DDAVP leads to a difference in thrombotic events is uncertain because the
quality of evidence is very low (pOR 0.98, 95% CI 0.06 to 15.89; 2 trials,
152 participants). Authors' conclusions: Most of the evidence derived by
comparing DDAVP versus placebo was obtained in cardiac surgery, where
DDAVP was administered after cardiopulmonary bypass. In adults undergoing
cardiac surgery, the reduction in volume of red cells transfused and total
blood loss was small and was unlikely to be clinically important. It is
less clear whether DDAVP may be of benefit for children and for those
undergoing non-cardiac surgery. A key area for researchers is examining
the effects of DDAVP for people with platelet dysfunction. Few trials have
compared DDAVP versus tranexamic acid or aprotinin; consequently, we are
uncertain of the relative efficacy of these interventions.<br/>Copyright
&#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<68>
Accession Number
619392902
Author
Kato E.T.; Cannon C.P.; Blazing M.A.; Bohula E.; Guneri S.; White J.A.;
Murphy S.A.; Park J.-G.; Braunwald E.; Giugliano R.P.
Institution
(Kato) Kyoto University Hospital, Kyoto, Japan
(Cannon, Bohula, Murphy, Park, Braunwald, Giugliano) TIMI (Thrombolysis in
Myocardial Infarction) Study Group, Cardiovascular Division, Brigham and
Women's Hospital and Harvard Medical School, Boston, MA, United States
(Blazing, White) Duke Clinical Research Institute, Durham, NC, United
States
(Guneri) Dokuz Eylul University, Izmir, Turkey
Title
Efficacy and safety of adding ezetimibe to statin therapy among women and
men: Insight from IMPROVE-IT (improved reduction of outcomes: Vytorin
efficacy international trial).
Source
Journal of the American Heart Association. 6 (11) (no pagination), 2017.
Article Number: e006901. Date of Publication: 01 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy
International Trial) showed that adding the nonstatin ezetimibe to statin
therapy further reduced cardiovascular events in patients after an acute
coronary syndrome. In a prespecified analysis, we explore results
stratified by sex. Methods and Results--In IMPROVE-IT, patients with acute
coronary syndrome and low-density lipoprotein cholesterol of 50 to 125
mg/dL were randomized to placebo/simvastatin 40 mg or
ezetimibe/simvastatin 10/40 mg. They were followed up for a median of 6
years for the primary composite of cardiovascular death, myocardial
infarction, hospitalization for unstable angina, coronary
revascularization >=30 days, and stroke. Among 18 144 patients in
IMPROVE-IT, 4416 (24%) were women. At 12 months, the addition of ezetimibe
to simvastatin significantly reduced low-density lipoprotein cholesterol
from baseline compared with simvastatin monotherapy in men and women
equally (absolute reduction, 16.7 mg/dL in men and 16.4 mg/dL in women).
Women receiving ezetimibe/simvastatin had a 12% risk reduction over those
receiving placebo/simvastatin for the primary composite end point (hazard
ratio, 0.88; 95% confidence interval, 0.79-0.99) compared with a 5%
reduction for men (hazard ratio, 0.95; 95% confidence interval, 0.90-1.01;
P=0.26 for interaction). When the total number of primary events was
considered, women had an 18% reduction with the addition of ezetimibe
(relative risk, 95% confidence interval, 0.81; 0.71-0.94) and men had a 6%
reduction (relative risk, 0.94; 95% confidence interval, 0.87-1.02; P=0.08
for interaction). The addition of ezetimibe did not increase the rates of
safety events in either women or men. Conclusions--IMPROVE-IT demonstrated
that the benefit of adding ezetimibe to statin is present in both women
and men, with a good safety profile supporting the use of intensive,
combination, lipid-lowering therapy to optimize cardiovascular
outcomes.<br/>Copyright &#xa9; 2017 The Authors.

<69>
Accession Number
619934401
Author
Bang C.N.; Greve A.M.; Rossebo A.B.; Ray S.; Egstrup K.; Boman K.;
Nienaber C.; Okin P.M.; Devereux R.B.; Wachtell K.
Institution
(Bang) Department of Cardiology, Zealand University Hospital Roskilde,
Roskilde, Denmark
(Bang, Okin, Devereux, Wachtell) Department of Medicine, Weill Cornell
Medicine, New York, NY, United States
(Greve) Department of Clinical Biochemistry, Rigshospitalet, Copenhagen,
Denmark
(Rossebo) Department of Cardiology, Oslo University Hospital Ulleval,
Oslo, Norway
(Ray) Department of Cardiology, Manchester Academic Health Sciences
Centre, Manchester, United Kingdom
(Egstrup) Department of Cardiology, Odense University Hospital, Svendborg,
Denmark
(Boman) Institution of Public Health and Clinical Medicine, Medicine
Skelleftea, Umea University, Skelleftea, Sweden
(Nienaber) Department of Cardiology, University Hospital, Rostock, Germany
(Wachtell) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Title
Antihypertensive treatment with beta-blockade in patients with
asymptomatic aortic stenosis and association with cardiovascular events.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006709. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--Patients with aortic stenosis (AS) often have concomitant
hypertension. Antihypertensive treatment with a beta-blocker (Bbl) is
frequently avoided because of fear of depression of left ventricular
function. However, it remains unclear whether antihypertensive treatment
with a Bbl is associated with increased risk of cardiovascular events in
patients with asymptomatic mild to moderate AS. Methods and Results--We
did a post hoc analysis of 1873 asymptomatic patients with mild to
moderate AS and preserved left ventricular ejection fraction in the SEAS
(Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity-matched
Cox regression and competing risk analyses were used to assess risk ratios
for all-cause mortality, sudden cardiac death, and cardiovascular death. A
total of 932 (50%) patients received Bbl at baseline. During a median
follow-up of 4.3+/-0.9 years, 545 underwent aortic valve replacement, and
205 died; of those, 101 were cardiovascular deaths, including 40 sudden
cardiovascular deaths. In adjusted analyses, Bbl use was associated with
lower risk of all-cause mortality (hazard ratio 0.5, 95% confidence
interval 0.3-0.7, P < 0.001), cardiovascular death (hazard ratio 0.4, 95%
confidence interval 0.2-0.7, P < 0.001), and sudden cardiac death (hazard
ratio 0.2, 95% confidence interval 0.1-0.6, P=0.004). This was confirmed
in competing risk analyses (all P < 0.004). No interaction was detected
with AS severity (all P > 0.1). Conclusions--In post hoc analyses Bbl
therapy did not increase the risk of all-cause mortality, sudden cardiac
death, or cardiovascular death in patients with asymptomatic mild to
moderate AS. A prospective study may be warranted to determine if Bbl
therapy is in fact beneficial.<br/>Copyright &#xa9; 2017 The Authors.

<70>
Accession Number
623056651
Author
Karaca S.; Ucak H.A.; Coban A.A.; Uncu H.; Ozsoyler I.
Institution
(Karaca, Ucak, Coban, Uncu, Ozsoyler) Cardiovascular Surgery Clinic, Adana
City Training and Research Hospital, Adana, Turkey
Title
Use of del Nido Cardioplegia in minimally invasive cardiac surgery: Our
early clinical experience.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 4th Annual Minimally Invasive and Robotic
Cardiovascular Surgery Congress, MIRC 2018. Turkey. 13 (Supplement 2) (pp
S44), 2018. Date of Publication: June 2018.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Del Nido cardioplegia (DNC) has been popular in adult cardiac
surgery in recent years. Initial research in adults has shown that DNC has
a minimal effect on myocardial functions and improved myocardial recovery.
Our objective was to describe the efficacy of DNC as a primary myocardial
protection strategy in minimally invasive cardiac surgery. Methods: We
performed a retrospective review of all patients seen from November 2016
to April 2018 at the Adana City Training and Research Hospitals who
underwent minimally invasive aortic, mitral and atrial septal defect
closure surgery during which DNC was used. Results: During this period 15
patients underwent elective cardiac surgery with DNC. The mean age was
45.06 +/- 18.7 years, and 4 (26.6%) patients were women. Mitral valve
replacement was performed in 3 patients (20%); atrial septal defect
closure, in 6 patients (40%); and aortic valve replacement, in 6 patients
(40%). One patient required a second dose of DNC. The mean cross-clamp
time and bypass times were 86.3 +/- 25.4 and 134.5 +/- 34.8 minutes,
respectively. Atrial fibrillation occurred in 2 patients and returned to
sinus rhythm after defibrillation. After the cross-clamp was removed the
heart started to beat in a mean time of 115.2 +/- 77.8 seconds. There were
no deaths postoperatively, no reoperations for bleeding, and no renal
failure requiring dialysis. Conclusions: Our experience suggests that DNC
is cost-effective and safe in minimally invasive cardiac surgery. It
facilitates the ability to work in a limited area by reducing the number
of applications of cardioplegia. In high-risk patients, it has the
possible benefit of providing excellent myocardial recovery. Randomized
controlled studies are needed to evaluate its efficacy in minimally
invasive adult cardiac surgery.

<71>
Accession Number
623064138
Author
Alam S.R.; Stirrat C.; Spath N.; Zamvar V.; Pessotto R.; Dweck M.R.; Moore
C.; Semple S.; El-Medany A.; Manoharan D.; Mills N.L.; Shah A.; Mirsadraee
S.; Newby D.E.; Henriksen P.A.
Institution
(Alam, Stirrat, Spath, Dweck, Semple, Manoharan, Mills, Shah, Newby,
Henriksen) BHF Centre for Cardiovascular Science, University of Edinburgh,
The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
(Zamvar, Pessotto, Moore) Department of Cardiothoracic Surgery, Edinburgh
Heart Centre, Edinburgh, UK
(Semple, Mirsadraee) Clinical Research Imaging Centre, University of
Edinburgh, Edinburgh, UK
(El-Medany) NHS Lothian, Edinburgh, UK
Title
Myocardial inflammation, injury and infarction during on-pump coronary
artery bypass graft surgery.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 115), 2017. Date of
Publication: 16 Dec 2017.
Abstract
BACKGROUND: Myocardial inflammation and injury occur during coronary
artery bypass graft (CABG) surgery. We aimed to characterise these
processes during routine CABG surgery to inform the diagnosis of type 5
myocardial infarction.
METHODS: We assessed 87 patients with stable coronary artery disease who
underwent elective CABG surgery. Myocardial inflammation, injury and
infarction were assessed using plasma inflammatory biomarkers,
high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic
resonance imaging (CMR) using both late gadolinium enhancement (LGE) and
ultrasmall superparamagnetic particles of iron oxide (USPIO).
RESULTS: Systemic humoral inflammatory biomarkers (myeloperoxidase,
interleukin-6, interleukin-8 and c-reactive protein) increased in the
post-operative period with C-reactive protein concentrations plateauing by
48 h (median area under the curve (AUC) 7530 [interquartile range (IQR)
6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation
ranged from normal to those associated with type 1 myocardial infarction
(median 80.2 [IQR 67.4 to 104.8] /s). Plasma hs-cTnI concentrations rose
by >=50-fold from baseline and exceeded 10-fold the upper limit of normal
in all patients. Two distinct patterns of peak cTnI release were observed
at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n=18) of
patients although clinical peri-operative type 5 myocardial infarction was
diagnosed in only 9% (n=8). LGE was associated with the delayed 24-h peak
in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI
concentrations (r=0.33, p<0.01) but not systemic inflammation, myocardial
inflammation or bypass time.
CONCLUSION: Patients undergoing CABG surgery invariably have plasma
hs-cTnI concentrations >10-fold the 99th centile upper limit of normal
that is not attributable to inflammatory or ischemic injury alone.
Peri-operative type 5 myocardial infarction is often unrecognised and is
associated with a delayed 24-h peak in plasma hs-cTnI concentrations.

<72>
Accession Number
623066591
Author
Jayakar J.P.; Alter D.A.
Institution
(Jayakar) Department of Internal Medicine, University of Toronto, Toronto,
Ontario, Canada
(Alter) University Health Network - Toronto Rehabilitation Institute,
Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences
of Ontario, Toronto, Ontario, Canada
Title
Music for anxiety reduction in patients undergoing cardiac
catheterization: A systematic review and meta-analysis of randomized
controlled trials.
Source
Complementary therapies in clinical practice. 28 (pp 122-130), 2017. Date
of Publication: 01 Aug 2017.
Abstract
BACKGROUND: Medical diagnostic procedures, such as cardiac
catheterization, can cause significant patient anxiety. Patient anxiety
can have negative implications for compliance with healthcare visits,
medical tests, and treatments. Music interventions may have a role in
reducing anxiety related to cardiac catheterization procedures.
OBJECTIVE: To perform a comprehensive systematic review and meta-analysis
evaluating whether musical interventions reduce anxiety in patients
undergoing cardiac catheterization.
DATA SOURCES: MEDLINE, EMBASE, CENTRAL, AMED, and PsychINFO from inception
to May 2015. Reference lists of included articles were further hand
searched for additional eligible studies.
STUDY SELECTION: Randomized controlled trials evaluating the effectiveness
of music interventions for anxiety reduction in patients undergoing
cardiac catheterization.
DATA EXTRACTION AND SYNTHESIS: Data on trial design, baseline
characteristics and outcomes was extracted using a data extraction table.
Study quality and risk of bias were assessed using the JADAD scale.
MAIN OUTCOMES AND MEASURES: The main outcome was the effectiveness of
music interventions in reducing anxiety in this patient population.
Meta-analysis was pursued using data from studies that had used the
Spielberger state anxiety inventory (STAI-S) to measure anxiety reduction.
Other outcomes qualitatively reported include the use of anxiolytic
medications and effect on physiological parameters such as blood pressure
and heart rate.
RESULTS: A total of 15 studies were found to be eligible for inclusion (14
published trials and one conference abstract) in this review. Two-thirds
of these studies showed statistically significant reduction in measures of
patient anxiety or well-being with musical interventions. Meta-analysis
included six studies (n = 695) and showed statistically significant
reduction in mean STAI-S scores with music (-3.95 points; 95% confidence
-5.53 and -2.37; p value less than 0.005).
CONCLUSION AND RELEVANCE: In conclusion, music is a safe and easily
administered intervention that can be used for anxiety reduction among
patients undergoing cardiac catheterization. Further research is needed to
better evaluate the clinical implications associated with the anxiolytic
effects of music interventions during cardiac
catheterization.<br/>Copyright &#xa9; 2017 Elsevier Ltd. All rights
reserved.

<73>
Accession Number
623067052
Author
Bogachev-Prokophiev A.V.; Afanasyev A.V.; Zheleznev S.I.; Nazarov V.M.;
Sharifulin R.M.; Karaskov A.M.
Institution
(Bogachev-Prokophiev, Afanasyev, Zheleznev, Nazarov, Sharifulin, Karaskov)
Heart Valves Surgery Department, Meshalkin National Medical Research
Center Ministry of Health Russian Federation, 15 Rechkunovskaya street,
Novosibirsk, Russian Federation, 630055
Title
Mid-term results of mitral valve repair using flexible bands versus
complete rings in patients with degenerative mitral valve disease: a
prospective, randomized study.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 113), 2017. Date of
Publication: 13 Dec 2017.
Abstract
BACKGROUND: We aimed to compare the outcomes of mitral valve repair with
flexible band (FB) versus complete semirigid ring (SR) in degenerative
mitral valve disease patients.
METHODS: From September 2011 to 2014, 171 patients were randomized and
underwent successful mitral valve repair using a SR (n=85) or FB (n=86).
There were no significant between-group differences at baseline.
RESULTS: There were no early mortalities. The mean follow up was 24.7
months. The 2-year survival was 96.0+/-2.3% (95% confidence interval [CI],
88.6-98.7%) and 94.3+/-2.8% (95% CI, 85.5-97.9%) in the SR and FB groups,
respectively (p=0.899). The left ventricle remodeling was similar between
the groups. Higher transmitral peak (8.5 [3.9-17] vs. 6 [2.1-18] mmHg,
p<0.001), mean pressure gradients (3.7 [1.3-8] vs. 2.8 [0.6-6.8] mmHg,
p=0.001), and systolic pulmonary artery pressure (34.5 [20-68] vs. 29.5
[8-48] mmHg, p<0.001) was observed in the SR group. The 2-year freedom
from recurrence of significant mitral regurgitation was significantly
higher in the FB group than the SR group (p=0.002). Residual mitral
regurgitation was an independent prognostic factor of recurrence of mitral
regurgitation. The 3-year freedom from reoperation was significantly
higher in the FB group than the SR group (p=0.044).
CONCLUSION: Patients with degenerative mitral valve disease may benefit
from valve repair with FBs. Residual mitral regurgitation before discharge
is an independent risk factor of late insufficiency recurrence.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03278574 , retrospectively
registered on 06.09.2017.

<74>
Accession Number
623063041
Author
Rezaei-Nodehi M.; Bagheri-Nesami M.; Shorofi S.A.; Yazdani-Charati J.;
Ghafari R.
Institution
(Rezaei-Nodehi) Student Research Committee, School of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
(Bagheri-Nesami) Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran
(Shorofi) Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran; Flinders
University, Adelaide, Australia
(Yazdani-Charati) Health Sciences Research Center, Mazandaran University
of Medical Sciences, Sari, Iran
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran
Title
Effects of pleasant olfactory mental imagery on the arterial oxygenation
in patients with open heart surgery: A randomized controlled trial.
Source
Complementary therapies in clinical practice. 29 (pp 194-200), 2017. Date
of Publication: 01 Nov 2017.
Abstract
BACKGROUND AND PURPOSE: Arterial hypoxemia is one of the most common
respiratory complications following cardiac surgery. This study was
intended to examine the effects of pleasant olfactory mental imagery on
postoperative hypoxemia in patients undergoing open heart surgery.
MATERIALS AND METHODS: This is a randomized controlled clinical trial. The
sample consisted of 80 patients who were randomly assigned to either
practice olfactory mental imagery (experimental group) or receive routine
care (control group). A card with the image of roses was given to patients
and they were asked to look at the image, visualize the scent of roses in
the mind, and then sniff as much as possible, hold their breath for 2 s
and eventually exhale slowly through the nose. This procedure was
consecutively repeated five times. After a fifteen-minute break, patients
proceeded to practice olfactory mental imagery with other fruit images.
The experimental group executed the olfactory mental imagery for two hours
in the morning and two hours in the afternoon on postoperative days 1 and
2.
RESULTS: No statistically significant differences were observed between
the experimental and control groups regarding sociodemographic
characteristics, medical and surgical information. This study also
demonstrated that the mean Spao2 was significantly higher in the
experimental group (97.400 +/- 1.70) than the control group (96.465 +/-
1.70) (p = 0.015).
CONCLUSION: The results of this study suggest that olfactory mental
imagery can improve arterial oxygenation in patients with cardiac
surgery.<br/>Copyright &#xa9; 2017. Published by Elsevier Ltd.

<75>
Accession Number
2000954269
Author
Colomba C.; La Placa S.; Saporito L.; Corsello G.; Ciccia F.; Medaglia A.;
Romanin B.; Serra N.; Di Carlo P.; Cascio A.
Institution
(Colomba, La Placa, Saporito, Corsello, Medaglia, Romanin, Di Carlo,
Cascio) Department of Sciences for Health Promotion and Mother and Child
Care, University of Palermo, Palermo, Italy
(Ciccia) Biomedical Department of Internal and Specialist Medicine,
University of Palermo, Palermo, Italy
(Serra) Department of Pediatrics, School of Medicine, Federico II
University, Naples, Italy
Title
Intestinal Involvement in Kawasaki Disease.
Source
Journal of Pediatrics. (no pagination), 2018. Date of Publication: 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To describe a case of Kawasaki disease with intestinal
involvement and to analyze other published reports to define clinical
characteristics, diagnostic issues, and therapeutic approaches of
gastrointestinal involvement in Kawasaki disease. Study design: A
computerized search without language restriction was conducted using
PubMed and SCOPUS. An article was considered eligible for inclusion in the
systematic review if it reported data on patient(s) with intestinal
involvement in Kawasaki disease. Our case was also included in the
analysis. Results: Thirty-three articles reporting 48 cases of Kawasaki
disease with intestinal involvement were considered. Fever, abdominal
pain, and vomiting were the most frequent symptoms observed and typical
Kawasaki disease signs and symptoms appeared after intestinal complaints
in all cases. Plain radiographs, ultrasonography, and computed tomography
showed pseudo-obstruction as the most frequent sign of gastrointestinal
involvement; 25 patients underwent surgery. Cardiac involvement was
documented in 21 cases. All but three patients received medical treatment
with immunoglobulin intravenous or aspirin. The outcome was good in 28
patients; 7 patients showed persistence of coronary artery abnormalities;
1 patient developed cyanosis, and later, left hand and forefoot gangrene;
3 patients died. Conclusions: The diagnosis and treatment of Kawasaki
disease might be delayed if intestinal symptoms appear before the
characteristic clinical features of Kawasaki disease, thus, increasing the
risk of cardiac complications. Furthermore, patients may undergo
unnecessary invasive procedures. Pediatricians and pediatric surgeons,
therefore, should consider Kawasaki disease among diagnoses in children
with fever, abdominal symptoms, and radiologic findings of
pseudo-obstruction.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<76>
Accession Number
2000953232
Author
Kereiakes D.J.; Lepor N.E.; Gerber R.; Veronica Lee L.; Elassal J.;
Thompson D.; Michael Gibson C.
Institution
(Kereiakes) The Christ Hospital, Heart and Vascular Center/The Lindner
Research Center, Cincinnati, OH, United States
(Lepor) Cedars-Sinai Medical Center/Westside Medical Associates of Los
Angeles, Beverly Hills, CA, United States
(Gerber) Department of Cardiology, East Sussex Healthcare NHS Trust,
Hastings, United Kingdom
(Veronica Lee) Sanofi, Bridgewater, NJ, United States
(Elassal, Thompson) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United
States
(Michael Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United
States
Title
Efficacy and safety of alirocumab in patients with or without prior
coronary revascularization: Pooled analysis of eight ODYSSEY phase 3
trials.
Source
Atherosclerosis. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: Patients with atherosclerotic cardiovascular disease
(ASCVD) and prior revascularization are at high risk of further
cardiovascular events and may require additional lipid-lowering therapies
beyond maximally tolerated statin therapy. We assessed the efficacy and
safety of alirocumab, a proprotein convertase subtilisin/kexin type 9
(PCSK9) inhibitor, in patients with ASCVD, with or without prior coronary
revascularization (percutaneous coronary intervention [PCI] or coronary
artery bypass graft [CABG]). Methods: Data from eight controlled
(placebo/ezetimibe) phase 3 ODYSSEY trials were pooled and stratified by
trial design: alirocumab 150 mg or 75 mg with possible dose increase to
150 mg (75/150 mg) every 2 weeks (Q2W) versus placebo, and alirocumab
75/150 mg Q2W versus ezetimibe. Most patients received background
maximally tolerated statin therapy. Results: Among 4629 randomized
patients with hypercholesterolemia, 3382 had ASCVD including 2191 with
prior revascularization. Although baseline characteristics were comparable
between alirocumab and control groups, revascularized patients were more
likely to be male, have had prior myocardial infarction/stroke, have
higher lipoprotein (a) and PCSK9 levels, and were more often treated with
high-intensity statin therapy. Alirocumab significantly reduced
low-density lipoprotein cholesterol (LDL-C; primary endpoint; p < 0.0001),
lipoprotein (a), non-high-density lipoprotein cholesterol, and
apolipoprotein B levels from baseline to week 24 (vs. control), regardless
of stratified treatment group or revascularization status. On-treatment
LDL-C levels with alirocumab ranged from 45.6 to 64.8 mg/dL. Alirocumab
had a similar safety profile regardless of revascularization status, and
higher rates of injection-site reactions versus controls. Conclusions:
Alirocumab is generally well-tolerated and effective with a similar safety
profile in high-risk patients with or without prior revascularization
(PCI/CABG).<br/>Copyright &#xa9; 2018 The Authors

<77>
Accession Number
2000953084
Author
Goel P.K.; Menon A.; Mullasari A.S.; Valaparambil A.K.; Pinto B.;
Pahlajani D.; Hiremath M.S.; Gunasekaran S.; Trehan V.K.; Abhaichand R.K.
Institution
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGI), India
(Menon) Department of Cardiology, Lilavati Hospital & Research Centre,
India
(Mullasari) Department of Cardiology, Madras Medical Mission, India
(Valaparambil) Department of Cardiology, Sree Chitra Tirunal Institute,
India
(Pinto) Department of Cardiology, Holy Family Hospital, India
(Pahlajani) Department of Cardiology, Beach Candy Hospital, India
(Hiremath) Department of Cardiology, Ruby Hall Clinic, India
(Gunasekaran) Department of Cardiology, Apollo Hospital, India
(Trehan) Department of Cardiology, G.B. Pant Hospital (GIPMER), India
(Abhaichand) Department of Cardiology, G.K.N.M. Hospital, India
Title
Transradial access for coronary diagnostic and interventional procedures:
Consensus statement and recommendations for India: Advancing Complex
CoronariES Sciences through TransRADIAL intervention in India - ACCESS
RADIALTM: Clinical consensus recommendations.
Source
Indian Heart Journal. (no pagination), 2018. Date of Publication: 2018.
Publisher
Elsevier B.V.
Abstract
Radial access for cardiac catheterization and intervention in India has
been growing steadily over the last decade with favorable clinical
outcomes. However, its usage by interventional cardiologists varies
greatly among Indian operators and hospitals due to large geographic
disparities in health care delivery systems and practice patterns. It also
remains unclear whether the advantages, as well as limitations of
transradial (TR) intervention (as reported in the western literature), are
applicable to developing countries like India or not. An evidence-based
review involving various facets of radial procedure for cardiac
catheterization, including practical, patient-related and technical issues
was conducted by an expert committee that formed a part of Advancing
Complex CoronariES Sciences through TransRADIAL intervention (ACCESS
RADIALTM) Advisory Board. Emerging challenges in redefining TR management
based on evidence supporting practices were discussed to formulate these
final recommendations through consensus.<br/>Copyright &#xa9; 2018

<78>
Accession Number
623048379
Author
Khozhenko A.; Lamperti M.; Terracina S.; Bilotta F.
Institution
(Khozhenko, Lamperti) Department of General Anesthesiology, Cleveland
Clinic Abu Dhabi, Abu Dhabi, UAE
(Terracina, Bilotta) Department of Anesthesiology and Intensive Care
Medicine, University of Rome 'La Sapienza', Rome, Italy
Title
Can Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events
in Neurosurgical Patients? A Narrative Review of the Literature.
Source
Journal of Neurosurgical Anesthesiology. (no pagination), 2018. Date of
Publication: 11 Jul 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cerebral near-infrared spectroscopy (NIRS) is considered a valuable
noninvasive modality for cerebral oxygenation monitoring during
cardiovascular surgery and cardiac arrest. We assessed the capability of
cerebral NIRS to predict cerebral desaturation and the related
neurological outcomes in neurosurgical patients. A literature search in
different electronic medical databases was performed from inception to
January 2018. A total of 286 citations were found and finally 48 studies
were retrieved, only 7 of these were eligible and included for review. A
meta-analysis was not feasible because of high heterogeneity of patients'
groups, different NIRS techniques used in the studies and different
outcome criteria selected. The qualitative assessment showed controversial
data on the threshold value of cerebral near-infrared spectroscopy used
for detecting cerebral ischemia in neurosurgical patients. The evidence on
the selected studies is not strong enough, at the moment, to recommend
cerebral NIRS as a mandatory monitor to detect cerebral deoxygenation able
to predict the future neurological outcome in neurosurgical patients.
Further studies are needed to validate a threshold value for cerebral
ischemia and the relationship between NIRS-detected cerebral desaturation
and clinical outcome in the neurosurgical population.<br/>Copyright &#xa9;
2018 Wolters Kluwer Health, Inc. All rights reserved.

<79>
Accession Number
623048241
Author
van Groenendael R.; Kox M.; van Eijk L.T.; Pickkers P.
Institution
(van Groenendael, Kox, van Eijk, Pickkers) aDepartment of Intensive Care
Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
(van Groenendael, Kox, van Eijk, Pickkers) bRadboud Institute for
Molecular Life Sciences, Radboud Center for Infectious Diseases (RCI),
Nijmegen, the Netherlands
(van Groenendael, van Eijk) cDepartment of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, the
Netherlands
(van Groenendael, van Eijk) dRadboud institute of Molecular Life Sciences
(RIMLS), Nijmegen, the Netherlands
Title
Immunomodulatory and Kidney-Protective Effects of the Human Chorionic
Gonadotropin Derivate EA-230.
Source
Nephron. (pp 1-4), 2018. Date of Publication: 06 Jul 2018.
Publisher
S. Karger AG
Abstract
The systemic inflammatory response following infectious or non-infectious
insults is related to morbidity (including acute kidney injury) and
mortality. Pregnancy is associated with immunotolerance and an increased
glomerular filtration rate. EA-230, a linear tetrapeptide
(Alanine-Glutamine-Glycine-Valine), derived from the beta-chain of the
human chorionic gonadotropin hormone, has shown immunomodulatory and
renoprotective properties in several pre-clinical animal models of
systemic inflammation. Furthermore, an excellent safety profile of EA-230
was observed in phase 1 studies in humans, and the immunomodulatory
effects of EA-230 were recently demonstrated in a phase IIa study during
human experimental endotoxemia. A prospective double-blind
placebo-controlled randomized trial in 180 patients undergoing elective
CABG-surgery with or without valve surgery is currently conducted to
investigate the immunomodulatory and renoprotective properties of
EA-230.<br/>Copyright &#xa9; 2018 The Author(s) Published by S. Karger AG,
Basel